Dissertations / Theses: 'Electronic personal health record'

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Baron, Karen. "Incorporating Personal Health Records into the Disease Management of Rural Heart Failure Patients." NSUWorks, 2012. http://nsuworks.nova.edu/gscis_etd/85.

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Personal Health Records (PHRs) allow patients to access and in some cases manage their own health records. Their potential benefits include access to health information, enhanced asynchronous communication between patients and clinicians, and convenience of online appointment scheduling and prescription refills. Potential barriers to PHR use include lack of computer and internet access, poor computer or health literacy, security concerns, and provider disengagement. PHRs may help those living in rural areas and those with chronic conditions such as heart failure, monitor and manage their disease, communicate with their health care team and adhere to clinical recommendations. To provide some much needed actual research, a descriptive mixed methods study of the usability, usefulness, and disease management potential of PHRs for rural heart failure patients was conducted. Fifteen participants were enrolled. Usability issues fell into three categories: screen layout; applying consistent, standard formatting; and providing concise, clear instructions. Participants used PHR features that were more convenient than other methods or that had some additional benefit to them. There was no difference between rural and urban participants. A heart failure nurse promoted recording daily heart failure symptoms in the PHR. Most participants did so at least once, but many found it cumbersome. Reasons for recording included the comfort of having clinical staff monitor the data. Participants who were stable did not find recording as useful as did those who were newly diagnosed or unstable. Participants used asynchronous communication to send messages to the heart failure nurse that they would not otherwise have communicated. The study expands the knowledge of PHR use by addressing useful functionality and disease management tools among rural patients with heart failure. The patients were able to complete tasks they found useful. The increased communication and disease management tools were useful to some.

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Cunningham, Scott. "My diabetes my way : an electronic personal health record for NHS Scotland." Thesis, University of Dundee, 2014. https://discovery.dundee.ac.uk/en/studentTheses/24b55130-8e8a-4316-8681-b9f4d8513631.

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Background: Diabetes prevalence in Scotland is increasing at ~4.6% annually; 247,278 (4.7%) in 2011. My Diabetes My Way (MDMW) is the NHS Scotland information portal, containing validated educational materials for people with diabetes and their carers. Internet-based interventions have potential to enhance self-management and shift power towards the patient, with electronic personal health records (PHRs) identified as an ideal method of delivery. In December 2010, a new service was launched in MDMW, allowing patients across Scotland access to their shared electronic record. The following thesis aims to identify and quantify the benefits of a diabetes-focused electronic personal health record within NHS Scotland. Methods: A diabetes-focused, population-based PHR was developed based on data sourced from primary, secondary and tertiary care via the national diabetes system, Scottish Care Information - Diabetes Collaboration (SCI-DC). The system includes key diagnostic information; demography; laboratory tests; lifestyle factors, foot and eye screening results; prescribed medication and clinical correspondence. Changes are tracked by patients over time using history graphs and tables, data items link to detailed descriptions explaining why they are collected, what they are used for and what normal values are, while tailored information links refer individuals to facts related to their condition. A series of quasi-experimental studies have been designed to assess the intervention using subjectivist, mixed-methods approaches incorporating multivariate analysis and grounded theory. These studies assess patient expectations and experiences of records access, system usage and uptake and provide preliminary analysis on the impact on clinical process outcomes. Survey questionnaires were used to capture qualitative data, while quantitative data were obtained from system audit trails and from the analysis of clinical process outcomes before and after the intervention. Results: By the end of the second year, 2601 individuals registered to access their data (61% male; 30.4% with type 1 diabetes); 1297 completed the enrolment process and 625 accessed the system (most logins=346; total logins=5158; average=8.3/patient; median=3). Audit trails show 59599 page views (95/patient), laboratory test results proving the most popular (11818 accesses;19/patient). The most utilised history graph was HbA1c (2866 accesses;4.6/patient). Users are younger, more recently diagnosed and have a heavy bias towards type 1 diabetes when compared to the background population. They are also likely to be a more highly motivated ‘early adopting’ cohort. Further analysis was performed to compare pre- and post-intervention clinical outcomes after the system had been active for nearly two and a half years. Results of statistical significance were not forthcoming due to limited data availability, however there are grounds for encouragement. Creatinine tests in particular improved following 1 year of use, with type 1 females in particular faring better than those in patient other groups. For other clinical tests such as HbA1c, triglycerides, weight and body mass index improvements were shown in mean and/or median values.96% of users believe the system is usable. Users also stated that it useful to monitor diabetes control (93%), improve knowledge (89%) and enhance motivation (89%). Findings show that newly diagnosed patients may be more likely to learn more about their new condition, leading to more productive consultations with the clinical team (98%). In the pre-project analysis, 26% of registrants expressed concerns about the security of personal information online, although those who actually went on to use it reported 100% satisfaction that their data were safe. Engagement remains high. In the final month of year two, 44.6% of users logged in to the system. 55.3% of users had logged in within the previous 3 months, 78.9% within the previous 6 months and 91.4% within the previous year. Some legacy PHRs have failed due to lack of uptake and deficiencies in usability, so as new systems progress, it is essential not to repeat the mistakes of the past. Feedback: "It is great to be able to view all of my results so that I can be more in charge of my diabetes".Conclusion: The MDMW PHR is now a useful additional component for the self-management of diabetes in Scotland. Although there are other patient access systems available internationally, this system is unique in offering access to an entire national population, providing access to information collected from all diabetes-related sources. Despite its development for the NHS Scotland environment, it has the potential to connect to any electronic medical record. This local and domain-specific knowledge has much wider applicability as outlined in the recommendations detailed, particularly around health service and voluntary sector ownership, patient involvement, administrative processes, research activities and communication. The current project will reach 5000 patients by the end of 2013.

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Gartrell, Kyungsook. "Factors Associated with Electronic Personal Health Record Use among Registered Nurses for Their Own Health Management." Thesis, University of Maryland, Baltimore, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3636110.

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Background: Electronic personal health records (ePHRs) are consumer-centric tools that enable consumers to securely access, manage and share their health information with health care providers. Although the potential for ePHRs to improve healthcare is significant, there is no available evidence on health care professionals' use of ePHRs for their own health management. Nurses have a tremendous opportunity to assist and educate patients in ePHRs. Research has shown that ePHR adoption among patients were influenced by perceived usefulness and ease of use using the technology acceptance model (TAM). This study expanded the TAM adding perceived data privacy security protections and health promoting role models for the ePHR acceptance model.

Purpose: This study examined (1) characteristics associated with ePHR use by nurses: health, technology experience, and attitudes about privacy of electronic health information, (2) psychometric properties of the measures in the research model, (3) association of ePHR acceptance constructs: perceived usefulness, ease of use, data privacy and security protections, and health promoting role model with ePHR use, and (4) moderating effects of nurses characteristics: age, chronic illness and/or medication use, providers use of electronic personal health record (EHR) on the relationships between ePHR acceptance constructs and ePHR use.

Methods: Registered nurses working in hospitals and members of the nursing informatics community (NIC) completed an anonymous online survey in the Fall of 2013 (n=847). Differences between groups were examined using t-tests and χ² tests. The associations between nurses' characteristics and ePHR use were examined via multiple logistic regression models that also held constant possible confounding covariates and interaction terms.

Results: Less than half (41%) of the hospital nurses were ePHR users. The odds of ePHR use was significantly greater among those with chronic medical conditions/medication use (OR=1.64, 95% CI=1.06-2.53) and those whose health care providers used EHRs (OR=3.62, 95% CI=2.45-5.36) controlling for age, marital status, current positions and specialty area. ePHR use was more common among NIC nurses (72%). The odds of ePHR use was also increased among NIC nurses with providers that used EHRs (OR=5.99, 95% CI=1.40-25.61), but users were 70% less concerned about privacy of health information online than nonusers (OR=0.32, 95% CI=0.14-0.70) controlling for ethnicity, race and practice regions. The majority of both ePHR users and nonusers would grant access to their primary care providers. However, fewer ePHR users in both nursing groups granted permission to designated family members or friends, other care providers who care for them, or pharmacists to view ePHRs than nonusers who answered hypothetically. Sufficient reliability for usefulness, ease of use, and privacy and security protections, and health promoting role model scales were found (all Cronbach alphas>0.70). Three constructs contributed significantly to ePHR use after adjusting nursing group, age, chronic illness and medication use, and health care providers use of EHR (usefulness, OR=0.87, 95% CI=0.85-0.89; data privacy and security protection, OR=1.04, 95% CI=1.01-1.07; and health promoting role model, OR=1.07, 95% CI=1.04-1.11). Significant interactions existed between perceived data privacy and security protections and providers EHR use, and between perceived health promoting role model and age on ePHR use (p<0.05).

Conclusion: The study findings suggest practical insights for nurses. With the experience of using ePHRs, nurses can leverage use of ePHRs for patient education on chronic illness and medication management. Nurses in NIC can also play an important role in practical ePHR design to enhance functionality and security in ePHR with their specialties in nursing informatics.

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Abd-Alrazaq, Alaa Ali Eid. "Factors affecting patients' use of electronic personal health records." Thesis, University of Leeds, 2018. http://etheses.whiterose.ac.uk/21951/.

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England has recently introduced a nationwide electronic personal health record (ePHR) called Patient Online. Although ePHRs are widely available, adoption rates of ePHRs are usually low. Understanding the factors affecting patients’ use of ePHRs is considered important to increase adoption rates and improve the implementation success of ePHRs. Therefore, the current study aims to examine the factors that affect patients’ adoption of ePHRs in England. A systematic review was conducted to identify factors that affect patients’ adoption of ePHRs. Then, the most common theories and models relevant to technology adoption and human behaviour were reviewed to select an appropriate theory and use it as a theoretical lens for examining the factors in the current study. The Unified Theory of Acceptance and Use of Technology (UTAUT) was selected and tailored to the context of ePHRs by including the most influential factors identified by the systematic review. A cross-sectional survey of 624 patients in four general practices in West Yorkshire was carried out to empirically examine the proposed model via structural equation modelling. The results showed that performance expectancy, effort expectancy, and perceived privacy and security were significant predictors of behavioural intention. The relationship between social influence and behavioural intention was not statistically significant. Both facilitating conditions and behavioural intention affected use behaviour. Performance expectancy was also a significant mediator of the effect of both effort expectancy and perceived privacy and security on behavioural intention. Eleven relationships were moderated by age, sex, income, education, ethnicity, and internet access. The proposed model accounted for 76% and 48% of the variance in behavioural intention and use behaviour, respectively. The current study makes a significant contribution by adapting and validating a theoretical model (UTAUT) in a new context (ePHRs). Further, this study contributes to practices by providing several implications for developers, marketers, and GP practices.

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Logue, Melanie D. "Validating and Testing A Model to Predict Adoption of Electronic Personal Health Record Systems in the Self-Management of Chronic Illness in the Older Adult." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/204269.

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Problem statement: As a result of the aging population, the number of people living with chronic disease has increased to almost 50% (CDC, 2004). Two of the main goals in treating patients with chronic diseases are to provide seamless care from setting to setting and prevent disability in the older adult. Many have proposed the use of electronic personal health record systems (PHRs) in the self-management process, but adoption remains low. The purpose of this research was to validate and test an explanatory model of the barriers and facilitators to older adults' adoption of personal health records for self-managing chronic illnesses. The long range goal of the research is to use the explanatory model to develop interventions that will maximize the facilitators and minimize the barriers to adoption. Methods: A preliminary attempt to capture the essential barriers and facilitators that predict adoption of PHRs among older adults with chronic illness was synthesized from the literature. In Phase One of the study, the model was integrated from existing literature and validated using a Delphi method. In Phase Two of the study, the model was pilot tested and refined for future investigations. Findings: The results of this study validated the Personal Health Records Adoption Model (PHRAM) and a preliminary instrument that measured barriers and facilitators to the adoption of PHRs in older adults who are self managing chronic illness. Additional findings indicate that while seniors are seeking options to manage their health and have expressed an interest in using Internet-based PHRs, they may require assistance to gain access to PHRs. Implications: The potential for PHRs to increase patient autonomy and reduce for disability and the resulting negative health consequences needs further investigation as we move into the next era of healthcare delivery. The results of this study provided the foundation for continued theoretically-based research in this area.

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Carneiro, Carla Margarida da Silva. "Voluntary electronic patient record state of the art." Master's thesis, Universidade da Beira Interior, 2012. http://hdl.handle.net/10400.6/1191.

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Introduction: With an ongoing economic crisis, Portugal and many other countries are looking into ways to increase efficiencies in all sectors. With almost 10% of the Gross Domestic Product (GDP) spent in Healthcare, there is a need to improve the use of resources. A Voluntary Electronic Patient Record (VEPR) is an online record of health and healthcare related data provided by the patient himself, available to him, and his authorized health care providers and relatives, in a ubiquitous way anywhere/everywhere. According to some authors through VEPRs, every health institution could have an easier access to a summary of the patient’s most important health data if needed and authorized. Just like Portugal, Australia, for example, is currently preparing a health care reform and the implementation of a Personally Controlled Electronic Health Record (PCEHR) system is also being studied. Surveys to general practitioners and consumers of eHealth are being conducted in order to evaluate the quality and sustainability of Australia’s health care and to develop change and adoption strategies for the PCEHR system. VEPRs can be provided by private companies, hospitals and health organizations or health departments of governments themselves. In Portugal there is at least one VEPR free of charge provided by a private company. This has raised issues of security of data and risks, and has not been approved by the data protection agency, possibly due to considerations on its massive use as well as the ethical issues of linking it to national health data from the NHS. In addition to this private VEPR, Portugal also provides some health online services: eAgenda and eRNU (“Registo Nacional de Utentes”) since 2009. Currently, eAgenda allows patients to schedule for doctor´s appointments and to ask for prescriptions renewal. The online health service, eRNU, allows users to check their general practitioner, the health institution in which they are registered, the health services it provides and its opening schedule. VEPR can be efficient, allowing better sharing of information between health care providers through the online availability of health information. It can be convenient; provide easy access to timely and accurate information no matter where the patient is or when he needs it. It is empowering as it enables the patient to be more active and involved with his own health care. To ensure the privacy of the patient’s health information, a security program is required to allow only the appropriately authorized individuals to access the VEPR and to save the record’s data in case of a technical breakdown occurs. On the other hand, although everyone can have a VEPR, this is normally restricted to younger, more info-included citizens as access to the internet is not universal and there is a natural difficulty in older generations to use IT and Internet. This, however, can be mitigated and will only have a tendency to dissipate in future. Aims: 1. To assess the state of the art about VEPR; 2. To assess the state of the art about VEPR in Portugal; 3. To assess users expectancies towards VEPR in Portugal; 4. To help developing and set in motion a VEPR adjusted to Portuguese population’s health challenges. Methodology: This is a transversal study with a qualitative and quantitative approach. To elaborate this paper, a literature review was made in order to identify sources of information about VEPR and current state of the art on this field. It was established a cooperation with the Portuguese Ministry of Health as it was the only way to indirect and directly collect data about the portuguese VEPR, eAgenda and eRNU. A questionnaire composed of 14 questions, made anonymous, was created using Lime SurveyTM, named “Inquérito para utilizadores dos serviços eAgenda e eRNU”, permission obtained and it was then sent to eAgenda and eRNU users through their e-mail addresses. Data was processed using Microsoft Office Excel 97-2003 and statistically analyzed resorting to Epi Info 7. Because the last question was an open question, the related data was processed manually. Results: Currently, eAgenda and eRNU serve about 4% of the portuguese population. The typical user is female, married, completed high school, has children and age median 38, 5 years old. Own and household appointments scheduling were the more frequently selected as the most useful functionalities as well as those that most contributed to improvement on health care delivery. Waiting time reduction was the most frequent selected advantage of eAgenda and eRNU. Conclusions: It is to be concluded that eAgenda and eRNU are well suited for the portuguese population as only 3,28% of the inquired users pointed eAgenda and eRNU services has not having any advantage. More studies are still required to understand the patterns of use and to promote the online services so that more people, not only 4% of the overall portuguese population, may take advantage of their benefits.

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Richards, Rhonda J. "A Study of the Intent to Fully Utilize Electronic Personal Health Records in the Context of Privacy and Trust." Thesis, University of North Texas, 2012. https://digital.library.unt.edu/ark:/67531/metadc115145/.

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Government initiatives called for electronic health records for each individual healthcare consumer by 2014. the purpose of the initiatives is to provide for the common exchange of clinical information between healthcare consumers, healthcare providers, third-party payers and public healthcare officials.This exchange of healthcare information will impact the healthcare industry and enable more effective and efficient application of healthcare so that there may be a decrease in medical errors, increase in access to quality of care tools, and enhancement of decision making abilities by healthcare consumers, healthcare providers and government health agencies. an electronic personal health record (ePHR) created, managed and accessed by healthcare consumers may be the answer to fulfilling the national initiative. However, since healthcare consumers potentially are in control of their own ePHR, the healthcare consumer’s concern for privacy may be a barrier for the effective implementation of a nationwide network of ePHR. a technology acceptance model, an information boundary theory model and a trust model were integrated to analyze usage intentions of healthcare consumers of ePHR. Results indicate that healthcare consumers feel there is a perceived usefulness of ePHR; however they may not see ePHR as easy to use. Results also indicate that the perceived usefulness of utilizing ePHR does not overcome the low perceived ease of use to the extent that healthcare consumers intend to utilize ePHR. in addition, healthcare consumers may not understand the different components of usage: access, management, sharing and facilitating third-party ePHR. Also, demographics, computer self-efficacy, personal innovativeness, healthcare need and healthcare literacy impact a healthcare consumer’s privacy concerns and trusting intentions in the context of ePHR and intent to utilize ePHR. Finally, this research indicates that healthcare consumers may need a better understanding of the Health Insurance and Portability and Accountability Act of 1996 (HIPAA) regulations of ePHR as well as a better understanding of the impact HIPAA has on websites that may facilitate ePHR.

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Ansved, Linn, and Karin Eklann. "Exploring ways to convey medical information during digital triage : A combined user research and machine learning approach." Thesis, Uppsala universitet, Avdelningen för visuell information och interaktion, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-386420.

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The aim of this project was to investigate what information is critical to convey to nurses when performing digital triage. In addition, the project aimed to investigate how such information could be visualized. This was done through a combined user research and machine learning approach, which enabled for a more nuanced and thorough investigation compared to only making use of one of the two fields. There is sparse research investigating how digital triaging can be improved and made more efficient. Therefore, this study has contributed with new and relevant insights. Three machine learning algorithms were implemented to predict the right level of care for a patient. Out of these three, the random forest classifier proved to have the best performance with an accuracy of 69.46%, also having the shortest execution time. Evaluating the random forest classifier, the most important features were stated to be the duration and progress of the symptoms, allergies to medicine, chronic diseases and the patient's own estimation of his/her health. These factors could all be confirmed by the user research approach, indicating that the results from the approaches were aligned. The results from the user research approach also showed that the patients' own description of their symptoms was of great importance. These findings served as a basis for a number of visualization decisions, aiming to make the triage process as accurate and efficient as possible.

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Braga, Renata Dutra. "Registro eletrônico em saúde: proposta de um modelo de informação para uso na atenção primária com vistas à interoperabilidade." Universidade Federal de Goiás, 2014. http://repositorio.bc.ufg.br/tede/handle/tede/3870.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
There are various health information systems in use in the country, which serve different purposes, but are not interoperable. To ensure interoperability in the development of a model that serves different health professions was held this research, which aimed to define a conceptual model for the registration of health information in primary care. Methods: This action research with analytical approach was held in conjunction with a panel of experts to represent the health professions recognized by the National Health Council (CNS), which through discussion meetings identified and systematized essential information needed to evaluate the overall health of individual, in the context of multidisciplinary primary care demands generating a preliminary model. This model was validated by Delphi method and a consensus model was proposed. Results: The conceptual model to health information registration obtained goes beyond the demands of administration, since its focus is the individual - source of all the information that generates health demands. The central structure of the information registry model comprised four groups of information, which were called pillars: Data Gathering, Diagnosis, Care Plan and Evaluation. Each of these pillars presented subgroups important to the different professions, whose complexity limit of detail of information stood on the complexity of primary health care. Conclusion: This study represents a joint effort to establish an architecture of essential information for creating an electronic record in interoperable and necessary to meet the individual's health in primary care.
Há vários sistemas de informação em saúde em uso no país, que servem a propósitos distintos, contudo não são interoperáveis. Para assegurar a interoperabilidade na elaboração de um modelo que atende diferentes profissões de saúde realizou-se esta pesquisa, cujo objetivo foi definir um modelo conceitual para o registro da informação em saúde na atenção primária. Métodos: Esta pesquisa-ação, com abordagem analítica, foi realizada em conjunto com um painel de profissionais que, por meio de reuniões de discussão identificou e sistematizou informações essenciais para a avaliação da saúde geral do indivíduo, no contexto das demandas multiprofissionais da atenção primária, gerando um modelo preliminar. Esse modelo foi validado pelo método Delphi e um modelo consensual foi proposto. Resultados: O modelo conceitual de registro da informação em saúde obtido extrapola as demandas da gestão administrativa, visto que o seu foco foi o indivíduo – fonte de todas as informações que geram as demandas em saúde. A estrutura central do modelo compreendeu quatro grupos de informações, denominados de pilares: Coleta de Dados, Diagnóstico, Plano de Cuidados e Avaliação. Cada um desses pilares apresentaram subgrupos importantes para as diferentes profissões, cujo limite de complexidade e detalhamento da informação situou-se na atenção primária em saúde. Conclusão: Este estudo representa um esforço conjunto para o estabelecimento de uma arquitetura de informações essenciais para a criação de um registro eletrônico em saúde interoperável e necessárias para o atendimento do indivíduo na atenção primária.

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Tilman, Laora. "L’utilisation des technologies de l’information et de la communication à l’hôpital face au droit." Thesis, Lille 2, 2017. http://www.theses.fr/2017LIL20008/document.

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L’utilisation des TIC à l’hôpital prend une place de plus en plus importante et son développement ne cesse de croître. Le cadre juridique applicable se révèle cependant complexe à appréhender, composé à la fois de textes de droit commun et de textes plus spécifiques, le tout formant un ensemble pas toujours cohérent. Pour accompagner au mieux l’utilisation des TIC à l’hôpital, le législateur doit trouver le juste équilibre entre cadre propice pour le développement de ces pratiques, protection des droits fondamentaux et sécurisation des pratiques. Or, à l’heure actuelle, le cadre juridique applicable à l’utilisation des TIC à l’hôpital ne permet pas d’assurer cet équilibre délicat. Les pouvoirs publics ont donc un rôle stratégique à jouer dans la sécurisation de l’utilisation des TIC à l’hôpital. Une impulsion nationale doit être donnée en la matière, afin d’assurer la cohérence des projets développés, au travers d’une gouvernance forte. Le cadre juridique doit, quant à lui, être rénové afin d’accompagner l’innovation dans le numérique en santé et assurer la sécurité juridique nécessaire à la bonne utilisation des TIC. Dans ce contexte, les hôpitaux ont un rôle essentiel à jouer afin de sécuriser leurs pratiques
The use of ICT has become increasingly important in hospitals. However, the legal framework structuring its use is very complex to grasp. Indeed, it is made up of general laws as well as specific ones and makes this framework sometimes unconsistent. To provide an optimal legal framework for the ICT to expand safely, the legislator needs to strike the right balance between protecting fundamental rights and securing practices. As the current legal framework does not provide this delicate balance, public authorities have a strategic role to play to ensure a secure use of ICT within hospitals. To guarantee the development of consistent projects, a strong governance has to set up a national leadership. The legal framework needs to be rehabilitated to support digital innovation in Healthcare and to ensure a legal protection required for an appropriate use of ICT. Hospitals have then a key role to play in securing their practices

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Maiorano, Picone Pasquale Carlo. "Applicazioni Android per accesso a personal health record." Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2013. http://amslaurea.unibo.it/5761/.

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Tourille, Julien. "Extracting Clinical Event Timelines : Temporal Information Extraction and Coreference Resolution in Electronic Health Records." Thesis, Université Paris-Saclay (ComUE), 2018. http://www.theses.fr/2018SACLS603/document.

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Les dossiers patients électroniques contiennent des informations importantes pour la santé publique. La majeure partie de ces informations est contenue dans des documents rédigés en langue naturelle. Bien que le texte texte soit pertinent pour décrire des concepts médicaux complexes, il est difficile d'utiliser cette source de données pour l'aide à la décision, la recherche clinique ou l'analyse statistique.Parmi toutes les informations cliniques intéressantes présentes dans ces dossiers, la chronologie médicale du patient est l'une des plus importantes. Être capable d'extraire automatiquement cette chronologie permettrait d'acquérir une meilleure connaissance de certains phénomènes cliniques tels que la progression des maladies et les effets à long-terme des médicaments. De plus, cela permettrait d'améliorer la qualité des systèmes de question--réponse et de prédiction de résultats cliniques. Par ailleurs, accéder aux chronologiesmédicales est nécessaire pour évaluer la qualité du parcours de soins en le comparant aux recommandations officielles et pour mettre en lumière les étapes de ce parcours auxquelles une attention particulière doit être portée.Dans notre thèse, nous nous concentrons sur la création de ces chronologies médicales en abordant deux questions connexes en traitement automatique des langues: l'extraction d'informations temporelles et la résolution de la coréférence dans des documents cliniques.Concernant l'extraction d'informations temporelles, nous présentons une approche générique pour l'extraction de relations temporelles basée sur des traits catégoriels. Cette approche peut être appliquée sur des documents écrits en anglais ou en français. Puis, nous décrivons une approche neuronale pour l'extraction d'informations temporelles qui inclut des traits catégoriels.La deuxième partie de notre thèse porte sur la résolution de la coréférence. Nous décrivons une approche neuronale pour la résolution de la coréférence dans les documents cliniques. Nous menons une étude empirique visant à mesurer l'effet de différents composants neuronaux, tels que les mécanismes d'attention ou les représentations au niveau des caractères, sur la performance de notre approche
Important information for public health is contained within Electronic Health Records (EHRs). The vast majority of clinical data available in these records takes the form of narratives written in natural language. Although free text is convenient to describe complex medical concepts, it is difficult to use for medical decision support, clinical research or statistical analysis.Among all the clinical aspects that are of interest in these records, the patient timeline is one of the most important. Being able to retrieve clinical timelines would allow for a better understanding of some clinical phenomena such as disease progression and longitudinal effects of medications. It would also allow to improve medical question answering and clinical outcome prediction systems. Accessing the clinical timeline is needed to evaluate the quality of the healthcare pathway by comparing it to clinical guidelines, and to highlight the steps of the pathway where specific care should be provided.In this thesis, we focus on building such timelines by addressing two related natural language processing topics which are temporal information extraction and clinical event coreference resolution.Our main contributions include a generic feature-based approach for temporal relation extraction that can be applied to documents written in English and in French. We devise a neural based approach for temporal information extraction which includes categorical features.We present a neural entity-based approach for coreference resolution in clinical narratives. We perform an empirical study to evaluate how categorical features and neural network components such as attention mechanisms and token character-level representations influence the performance of our coreference resolution approach

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Postaci, Senan. "An Advanced Personal Health Record Platform For Patient Empowerment." Master's thesis, METU, 2012. http://etd.lib.metu.edu.tr/upload/12614583/index.pdf.

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In recent years, many Personal Health Record (PHR) systems have been developed to retrieve patients&rsquo
Electonic Health Records (EHRs) from external sources. However, current PHRs can provide access to only a small number of EHR systems, since there are many dierent interfaces, data formats and medical terminologies among dierent systems. When this is the case, all these diversity yields high integration costs. Development of such systems is dicult and expensive because of the reasons such as accessing to evidence based medical information, utilization of social networks to share information, incorporation of available medical knowledge models, etc. Due to the technical diversity of external information systems, a developer of a PHR system faces a dicult integration process when he wants to integrate a new source or service. Integration of medical devices is also important and necessary in a PHR system. However, most of the medical device vendors use proprietary formats and protocols for communicating their devices with external systems
again, causing high integration eorts and costs. In this thesis, these problems and challenges are addressed by providing an on-line personal iv healthcare management platform, i.e. eSaglikKaydim which is built on top of a highly modular architecture and provides services based on worldwide standards. In this way, eSaglikKaydim platform can be integrated with any external health information service and medical device so that it maximizes the data variety retrieved from all kinds of external health data sources. The work presented in this thesis is part of the OSAmI project supported by European ITEA and funded by the TU¨
BI

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Huang, Qian, and Qin Yin. "Study on Electronic Health Record and its Implementation." Thesis, Högskolan Kristianstad, Sektionen för hälsa och samhälle, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-9464.

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This degree project deals with electronic health record (EHR). The report is divided into two main sections; literature study on electronic health record and an EHR system implementation. In the literature study section, EHR background, development history and service condition are introduced. The paper focuses on the sharing of medical information in different users, data safety and privacy. The adjunctions of computer science, technologies are used to solve the medical informatics’ problems. In the implementation section, based on the study of the current EHR systems, the design and implement of a shared EHR system are presented, which can be accessed by different doctors and patients. Access control function and cryptography protections are included in this system. The system test and evaluation are also given.

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Xin, Zhang. "Distributed Electronic Health Record System based on Middleware." Thesis, Mittuniversitetet, Institutionen för informationsteknologi och medier, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-18947.

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With the fast development of information technology, traditional healthcare is evolving to a more digital and electronic stage. Electronic HealthRecord (EHR) is residents’ basic information and health care relatedinformation conforming to standard. It can not only provide usefulinformation to medical workers, but also exchange resources with otherinformation systems. But with the growing complexity of electronichealth record data sources, it becomes a big challenge to set up a structurewhich allows different types of data sharing and exchanging inmulti-platform applications. It’s even more important to find out amethod to support great amount of users from different applicationplatform to sharing and exchanging data at the same time.In this paper, we proposed a distributed electronic health record systembased on middleware to address the problem. Both permanent and realtimedata should pass through the middleware provided by the system,and will be transformed into standard format for storage. Multi-threadand distributed server group design will let the system be more flexibleand scalable, and will be able to provide service to users concurrently.The system creates a standard data format for data transferring andstorage. All raw data collected from different kinds of sensor system willbe formatted with application programming interface (API) or softwaredevelopment kit (SDK) system provided before upload to the system.Encryption methods are also implemented to ensure data security andprivacy protection.

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Simpson, Johnnie Lee Jr. "Examining differences in electronic health record adoption and motivations." Thesis, Capella University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3637298.

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My dissertation research aims to provide greater knowledge about the healthcare industry and federal budgets, within the education and infrastructure. The view point of the financials spent in the United States on healthcare is supported by the economic reports and facts dealing with the studies that the current cost is unstainable. It is also likely that rates of EHR adoption increased after the healthcare legislation associated with the administration of President Barack Obama.

Together, these two pieces of legislation represent a challenge for healthcare providers in the United States, as such providers will have not only to adopt EHR if they have not done so already, but they must also prepare for a torrent of new patients who typically have not had medical care—especially those eligible for Medicaid benefits.

One problem raised by the new healthcare legislation, according to Frenkel (2010), is that it unknown how the adoption of EHR will affect smaller healthcare providers financially and in terms of service, especially those that accept Medicaid reimbursement. Most EHR literature addresses circumstances before the passage of the ARRA of 2009 and the PPACA. While there are reliable figures for nationwide EHR adoption, Frenkel (2010) argued that some key questions remain unanswered:

1. Are Medicaid providers more advanced in EHR adoption than non-Medicaid providers?

2. What are the main obstacles to, and incentives for, adopting EHR in the new era of American healthcare?

3. Are obstacles and incentives different from those in the past before the new healthcare legislation, or are they similar to previous obstacles and incentives?

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Avillach, Paul. "Du système d'information clinique au système d'information épidémiologique : apport de l'intéropérabilité sémantique." Thesis, Aix-Marseille 2, 2011. http://www.theses.fr/2011AIX20697.

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Les informations médicales recueillies dans le cadre du soin doivent être utilisables pour répondre à d’autres objectifs plus collectifs. Dans ce contexte de réutilisation des données d’un système d’information clinique pour de la recherche en épidémiologie, l’objectif de ce travail est d’étudier l’apport de l'intéropérabilité sémantique à travers un certain nombre de situations concrêtes que nous avons rencontrées et étudiées et qui illustrent la nature des problèmes de cohérence sémantiques liés au traitement des données médicales et de santé.La coexistence, à un moment donné, de plusieurs référentiels sémantiques ne doit pas être considéré comme un obstacle à l'interopérabilité. Des outils génériques peuvent être conçus et développés pour passer de façon transparente d'un composant à un autre avec aussi peu de perte d’information que possible. L’Unified Medical Language System (UMLS) est un de ses outils d’intégration sémantique. Son usage dans le cadre de ces travaux montre le caractère général de cette méthode et son potentiel pour résoudre cette classe de problèmes d’intéropérabilité sémantique.La richesse de chacune des terminologies permet, lorsqu’elles sont associées dans un même référentiel sémantique pivot, d’enrichir l’ensemble des terminologies prises individuellement pour une meilleur représentation des connaissances.L’interopérabilité sémantique améliore la disponibilité et la qualité des données réutilisables pour des recherches en santé publique. Elle permet d’enrichir les données existantes. Elle fournit les moyens d'accéder à de nouvelles sources de données, agrégées de manière valide, permettant des analyses comparatives ou des analyses plus riches
Medical information collected during clinical care must be re-used to address other more collective goals. In this context of re-using data from a clinical information system for epidemiological research, the objective of this work is to study the contribution of semantic interoperability across a number of practical situations we have met and discussed which illustrate the nature of semantic consistency problems associated with processing of medical data.Coexistence at a given time, of several semantic repositories should not be considered as an obstacle to interoperability. Generic tools can be designed and developed to move seamlessly from one component to another with as little loss of information as possible. The Unified Medical Language System (UMLS) is one of the semantic integration tools. Its use in this work shows the generality of this method and its potential for solving this class of semantic interoperability problems.The richness of each of the terminology can, when combined into a single pivot semantic repository, enrich the set of terminologies individually for a better representation of knowledge.Semantic interoperability improves the availability and quality of reusable data for public health research. It also enriches existing data. It provides access to new sources of data, aggregated in a valid manner, allowing benchmarking or richer analysis

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ZHENG, YAO. "Privacy-Preserving Personal Health Record System Using Attribute-Based Encryption." Digital WPI, 2011. https://digitalcommons.wpi.edu/etd-theses/902.

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"Personal health record (PHR) service is an emerging model for health information exchange. It allows patients to create, manage, control and share their health information with other users as well as healthcare providers. In reality, a PHR service is likely to be hosted by third-party cloud service providers in order to enhance its interoperability. However, there have been serious privacy concerns about outsourcing PHR data to cloud servers, not only because cloud providers are generally not covered entities under HIPAA, but also due to an increasing number of cloud data breach incidents happened in recent years. In this thesis, we propose a privacy-preserving PHR system using attribute-based encryption (ABE). In this system, patients can encrypt their PHRs and store them on semi-trusted cloud servers such that servers do not have access to sensitive PHR contexts. Meanwhile patients maintain full control over access to their PHR files, by assigning fine-grained, attribute-based access privileges to selected data users, while different users can have access to different parts of their PHR. Our system also provides extra features such as populating PHR from professional electronic health record (EHR) using ABE. In order to evaluate our proposal, we create a Linux library that implement primitive of key-policy attribute-based encryption (KP-ABE) algorithms. We also build a PHR application based on Indivo PCHR system that allow doctors to encrypt and submit their prescription and diagnostic note to PHR servers using KP-ABE. We evaluate the performance efficiency of different ABE schemes as well as the data query time of Indivo PCHR system when PHR data are encrypted under ABE scheme."

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Sundvall, Erik. "Scalability and Semantic Sustainability in Electronic Health Record Systems." Doctoral thesis, Linköpings universitet, Medicinsk informatik, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-87702.

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This work is a small contribution to the greater goal of making software systems used in healthcare more useful and sustainable. To come closer to that goal, health record data will need to be more computable and easier to exchange between systems. Interoperability refers to getting systems to work together and semantics concerns the study of meanings. If Semantic interoperability is achieved then information entered in one information system is usable in other systems and reusable for many purposes. Scalability refers to the extent to which a system can gracefully grow by adding more resources. Sustainability refers more to how to best use available limited resources. Both aspects are important. The main focus and aim of the thesis is to increase knowledge about how to support scalability and semantic sustainability. It reports explorations of how to apply aspects of the above to Electronic Health Record (EHR) systems, associated infrastructure, data structures, terminology systems, user interfaces and their mutual boundaries. Using terminology systems is one way to improve computability and comparability of data. Modern complex ontologies and terminology systems can contain hundreds of thousands of concepts that can have many kinds of relationships to multiple other concepts. This makes visualization challenging. Many visualization approaches designed to show the local neighbourhood of a single concept node do not scale well to larger sets of nodes. The interactive TermViz approach described in this thesis, is designed to aid users to navigate and comprehend the context of several nodes simultaneously. Two applications are presented where TermViz aids management of the boundary between EHR data structures and the terminology system SNOMED CT. The amount of available time from people skilled in health informatics is limited. Adequate methods and tools are required to develop, maintain and reuse health-IT solutions in a sustainable way. Multiple levels of modelling including a fixed reference model and another layer of flexible reusable ‘archetypes’ for domain specific data structures, is an approach with that aim used in openEHR and the ISO 13606 standard. This approach, including learning, implementing and managing it, is explored from different angles in this thesis. An architecture applying Representational State Transfer (REST) to archetype-based EHR systems, in order to address scalability, is presented. Combined with archetyping this architecture also aims at enabling a sustainable way of continuously evolving multi-vendor EHR solutions. An experimental open source implementation of it, aimed for learning and prototyping, is also presented. Manually changing database structures used for storage every time new versions of archetypes and associated data structures are needed is likely not a sustainable activity. Thus storage systems that can handle change with minimal manual interventions are desirable. Initial explorations of performance and scalability in such systems are also reported Graphical user interfaces focused on EHR navigation, time-perspectives and highlighting of EHR content are also presented – illustrating what can be done with computable health record data and the presented approaches. Desirable aspects of semantic sustainability have been discussed, including: sustainable use of limited resources (such as available time of skilled people), and reduction of unnecessary risks. A semantic sustainability perspective should be inspired and informed by research in complex systems theory, and should also include striving to be highly aware of when and where technical debt is being built up. Semantic sustainability is a shared responsibility. The combined results presented contribute to increasing knowledge about ways to support scalability and semantic sustainability in the context of electronic health record systems. Supporting tools, architectures and approaches are additional contributions.
Syftet med denna avhandling är ytterst att göra informationssystem som används i hälso- och sjukvård, särskilt patientjournaler, mer användbara och lättarbetade. Om systemen vore lättare att utveckla och underhålla skulle fler resurser kunna läggas på att tillföra nya och mer användarvänliga funktioner. Om journalsystem och datorprogram kan ”begripa” vad olika saker i journalen är och betyder så kan de vara till större hjälp, t.ex. genom att visa bättre patientöversikter och bidra med beslutsstöd. En del i att göra journalinnehållet begripligt och hanterbart för datorer är att använda sig av terminologisystem som t.ex. ICD-10 och SNOMED CT. En annan viktig del är datastrukturerna där man stoppar in text, mätvärden, koderna från terminologisystem etc. De flesta journalsystem har någon sorts mallar som datastrukturer. Projektet openEHR har tagit fram ett sätt att dela specifikationer av datastrukturer mellan olika journalsystem så att man lättare kan dela och återanvända dem och den journaldata som matats in i dem. Dessa specifikationer kallas ”arketyper” och arketyp-metoden beskrivs även i standarden ISO 13606. Om två olika journalsystem använder samma datastruktur, t.ex. med hjälp av samma arketyper, så kan de utväxla patientdata mellan varandra (de uppnår s.k. semantisk interoperabilitet). Begreppet ”Semantic sustainability” definieras i avhandlingen som ett förhållningssätt som är bredare än semantisk interoperabilitet. Det syftar till att möjliggöra långsiktigt hållbar utveckling av semantik (betydelse) i journalsystem och genom att hantera risker och resurser förståndigt. Förhållningssättet baserar sig på forskning och erfarenheter från systemutveckling och hantering av komplexa system och är avsett att stödja beslutsfattare, och de som utvecklar och underhåller journalsystem, relaterade system och strukturer. För att datorsystem ska kunna växa vid ökad användning ,utan att hamna i återvändsgränder avseende prestanda, så bör vissa designprinciper för skalbarhet följas. Avhandlingen presenterar en systemarkitektur baserad på sådana principer och på arketyp-metoden. Denna arkitektur gör det möjligt att bygga system med delsystem från flera olika leverantörer. Skalbarheten i några lagringslösningar redovisas också. Slutligen redovisas prototyper av gränssnitt för patientöversikter och journalläsning.

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Barry, Sacha (Sacha M. ). "Critical factors for successful electronic health record (EHR) implementation." Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/104546.

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Thesis: S.M. in Management Studies, Massachusetts Institute of Technology, Sloan School of Management, 2016.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 68-75).
Since the 1970s, the healthcare industry has been moving from paper-based documents towards computer information systems in an effort to increase timely access to quality information, with the ultimate objective of wide dissemination and adoption of Electronic Health Records (EHRs). EHRs are electronic collections of patient health information that are recorded by physicians, nurses and patients themselves, before being approved by physicians and shared across diverse settings. EHR implementation can improve care quality and efficiency and physician productivity and reduce healthcare costs. However, implementation often proves to be difficult. This paper reviews several common issues associated with EHR adoption including negative impacts on quality of care, physicians' productivity, patients' safety and organizations' financials from high maintenance and implementation costs. It then summarizes critical success factors found in the literature. It eventually examines two cases studies of Enterprise Resource Planning (ERP) implementation in the automotive and food and beverage industries and leverages ERP implementation best practices to develop a practical framework for successful HER adoption. Hopefully, it will be useful for future EHR adoption projects in the U.S. and other regions of the world.
by Sacha Barry.
S.M. in Management Studies

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Barnawi, Abdullah. "Risk management of electronic health record system in hospitals." Thesis, De Montfort University, 2013. http://hdl.handle.net/2086/10411.

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This thesis investigates the use of electronic medical record (EMR) systems and risk management in hospitals. It provides a critical analysis of recognized EMR systems and potential failures and discusses six traditional risk management techniques including brain storming, cause, effect analysis, failure mode effective analysis (FMEA), fault tree analysis (FTA), and Binary Decision Diagram (BDD) in addition, to one of the most recent systematic risk management techniques, Systems Theoretic Accident Model Process (STAMP). The traditional techniques are not as well suited to managing risks and preventing failures in modern information systems with complex software that involves human and machine interaction. The thesis introduces the implementation of common traditional risk management technique such as BDD and FTA which is mostly used in nuclear plants, transportation and medical devices backed by a hypothetical example to help and explain the process of the FTA usage. Most traditional techniques rely on a direct cause-and-effect chain and have no clear formal guidance. The systematic technique introduced and used in this study, is known as Systems Theoretic Accident Model Process (STAMP). It is one of the recent systematic techniques developed and used in many sectors including aerospace. This study applied the STAMP technique to the EMR system failure at King Khalid General Hospital (KKGH) in Riyadh. One of the reasons for selecting the STAMP technique is that it is based on system theory and established the risk factors that lead to system failure. It also provides guidance for managing and controlling risk factors. This thesis discusses the implementation of STAMP, supported by examples, to explain how the technique conducted. System failures occur unexpectedly and have the potential to affect health services; they can compromise patient health and sometimes lead to death. The aims of this study are to explore The Kingdom of Saudi Arabia healthcare usage of EMRs and risk factors that leads to system failure and demonstrate the benefit of STAMP for RM in EMR system, define gaps and provide suggestion based on international best practice The study was conducted in three phases. The first phase explored EMR system usage and failures. The second phase implemented the STAMP risk management technique at one hospital of our 8 surveyed hospitals, the King Khalid General Hospital’s (KKGH), to identify and manage risks. In the third phase, the study modified the STAMP technique and reapplied it. The modified technique STAMP Checklist (STAMPC) was compared with the original STAMP technique. We found that STAMPC is much more usable and subjectively beneficial for the hospital that uses a hybrid system. Data extracted using the modified technique provided more useful information to improve EMR system safety, and prevent potential failures. This study addresses the challenges of how effectively RM techniques used to reduce the potential risk of EMR system failures in hospitals. It improves the efficiency of the STAMP risk management technique by proposing a new (STAMPC) technique. There are 3 important implications for both RM and EMRs practice: first, the study suggests that RM and EMRs are integral parts of the management decision-making process; second, they are necessary to improve human health and safety; and, third, RM may minimise the possibility of system failure.

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Wissel, Benjamin D. "Generalizability of Electronic Health Record-Based Machine Learning Models." University of Cincinnati / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1627659161796896.

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Velte, Linda Maria. "Electronic health record repository based on the openEHR standard." Master's thesis, Universidade de Aveiro, 2011. http://hdl.handle.net/10773/7479.

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Mestrado em Engenharia de Computadores e Telemática
An Electronic Health Record (EHR) aggregates all relevant medical information regarding a single patient, allowing a patient centric storage approach. This way the complete medical history of a patient is stored together in one record, making it possible to save time and work by allowing the sharing of information between health care institutions. To make this sharing possible there has to be agreed on the format in which the information is saved. There are many standards to de ne the way health information is stored, exchanged and retrieved. One of this standards is the Open Electronic Health Record (OpenEHR). The goal of this thesis is to create a repository which allows to store and manage patient records which follow the OpenEHR standard. The result of the implementation consists in three software parts, being them a Extensible Markup Language (XML) repository to store health information, a set of services allowing to manage and query the information stored and a web interface to demonstrate the implemented functionalities.
Um registo electrónico de saúde agrega toda a informação médica relevante de um paciente, permitindo uma filosofia de armazenamento orientada ao mesmo. Desta forma todo o historial médico do paciente encontra-se armazenado num único registo, permitindo a optimização de custos e tempo gasto nas diferentes tarefas, através de partilha de informação entre diferentes instituições médicas. Para possibilitar esta partilha é necessário definir um formato comum em que a informação é armazenada. Para tal foram definidas diversas normas que ditam as regras de armazenamento, troca e recuperação de informação médica. Uma destas normas é o Open Electronic Health Record (OpenEHR). O objectivo desta dissertação e criar um reposit orio que permite o armazenamento de registos médicos que sigam a norma OpenEHR. A implementação dá origem a três componentes de software, sendo eles uma base de dados Extensible Markup Language (XML) para armazenamento de registos médicos, um conjunto de serviços para gestão e pesquisa da informação armazenada e uma interface web para demonstração das funcionalidades implementadas.

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Malta, André Filipe Domingues. "Open-source electronic health record system for neglected diseases." Master's thesis, Universidade de Aveiro, 2016. http://hdl.handle.net/10773/18342.

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Mestrado em Engenharia de Computadores e Telemática
Low-resource countries are primarily the ones afected by tropical diseases where environmental factors play a major role. Means for controlling these diseases are often lacking in these countries in part due to their poor support of Health Information Technology. Nowadays, with the advances of standards and software in the health-field, several open-source electronic health record systems (EHR) exist which can assist facilities to capture of information, aiding to research and better health-care of neglected diseases in these countries. In this work, we performed a systematic review of several of such solutions to select the most appropriate candidate to satisfy the requirements of a testbed in a low-resource country - Gondar in Ethiopia. The implementation was conducted with a strong focus on adapting the existing paper-based workflow of the institution to the proposed system, to assure that all the information generated in this center can be captured in a digital way. As a final result, a working prototype was deployed and some conclusions are obtained from all this process.
Países sub-desenvolvidos são os principalmente afectados por um conjunto de doenças tropicais onde factores ambientais desempenham uma contribuição maior na sua origem. No geral estes países não dispõem de métodos para controlar estas doenças eficazmente, em parte devido à fraca implementação de Tecnologias da Informação em Saúde. Atualmente, com o avanço em standards e software na área da saúde, existem diversos sistemas opensource de registos clínicos que podem auxiliar centros de cuidados médicos na captura de informação útil à melhoria dos serviços prestados e há investigação de doenças negligenciadas. Nesta dissertação efectuámos uma revisão sistemática de tais soluções de maneira a escolher um candidato apropriado aos requisitos de uma cama de teste de um país sub-desenvolvido - Gondar, Etiópia. A implementação foi conduzida com ênfase à adaptação do fluxo de trabalho baseado em papel da instituição para o sistema proposto, assegurando que toda a informação gerada pelo centro pode ser capturada de forma digital. Como resultado final, um protótipo foi criado e algumas conclusões obtidas de todo este processo.

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Foster, Christopher A. "Electronic Health Record Implementation Strategies for Decreasing Healthcare Costs." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6426.

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Some managers of primary care provider (PCP) facilities lack the strategies to implement electronic health records (EHRs), which could decrease healthcare costs and enhance the efficiency and quality of healthcare that patients receive. The purpose of this single-case study was to explore the strategies PCP managers used to implement EHRs to decrease healthcare costs. The population consisted of 5 primary care managers with responsibility for the administration, oversight, and direct working knowledge of EHRs in Central Florida. The conceptual framework was the technology acceptance model. Data were collected from semistructured face-to-face interviews and the review of company documents, including training logs, activity records, and cost information. Methodological triangulation was used to validate the creditability and interpretation of the data in transcribing themes. Three themes emerged from the analysis of study data: implementation of EHRs, costs of implementing EHRs, and perceived usefulness of EHRs. Participants indicated that the implementation of EHRs depended on motivation, financial cost, and the usefulness of EHRs relating to training that reflected user-friendliness. The implications of this study for social change include the potential to lower the cost and improve the efficiency of healthcare for patients. The use of EHR systems could enhance the quality of care delivered to patients through improved accessibility, elimination of duplicative tests, and retrieval of accurate patient information. The use of EHRs can lead to a comprehensive preventative healthcare system resulting in a healthier environment.

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Moner, Cano David. "Archetype development and governance methodologies for the electronic health record." Doctoral thesis, Universitat Politècnica de València, 2021. http://hdl.handle.net/10251/164916.

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[ES] La interoperabilidad semántica de la información sanitaria es un requisito imprescindible para la sostenibilidad de la atención sanitaria, y es fundamental para afrontar los nuevos retos sanitarios de un mundo globalizado. Esta tesis aporta nuevas metodologías para abordar algunos de los aspectos fundamentales de la interoperabilidad semántica, específicamente aquellos relacionados con la definición y gobernanza de modelos de información clínica expresados en forma de arquetipo. Las aportaciones de la tesis son: - Estudio de las metodologías de modelado existentes de componentes de interoperabilidad semántica que influirán en la definición de una metodología de modelado de arquetipos. - Análisis comparativo de los sistemas e iniciativas existentes para la gobernanza de modelos de información clínica. - Una propuesta de Metodología de Modelado de Arquetipos unificada que formalice las fases de desarrollo del arquetipo, los participantes requeridos y las buenas prácticas a seguir. - Identificación y definición de principios y características de gobernanza de arquetipos. - Diseño y desarrollo de herramientas que brinden soporte al modelado y la gobernanza de arquetipos. Las aportaciones de esta tesis se han puesto en práctica en múltiples proyectos y experiencias de desarrollo. Estas experiencias varían desde un proyecto local dentro de una sola organización que requirió la reutilización de datos clínicos basados en principios de interoperabilidad semántica, hasta el desarrollo de proyectos de historia clínica electrónica de alcance nacional.
[CA] La interoperabilitat semàntica de la informació sanitària és un requisit imprescindible per a la sostenibilitat de l'atenció sanitària, i és fonamental per a afrontar els nous reptes sanitaris d'un món globalitzat. Aquesta tesi aporta noves metodologies per a abordar alguns dels aspectes fonamentals de la interoperabilitat semàntica, específicament aquells relacionats amb la definició i govern de models d'informació clínica expressats en forma d'arquetip. Les aportacions de la tesi són: - Estudi de les metodologies de modelatge existents de components d'interoperabilitat semàntica que influiran en la definició d'una metodologia de modelatge d'arquetips. - Anàlisi comparativa dels sistemes i iniciatives existents per al govern de models d'informació clínica. - Una proposta de Metodologia de Modelatge d'Arquetips unificada que formalitza les fases de desenvolupament de l'arquetip, els participants requerits i les bones pràctiques a seguir. - Identificació i definició de principis i característiques de govern d'arquetips. - Disseny i desenvolupament d'eines que brinden suport al modelatge i al govern d'arquetips. Les aportacions d'aquesta tesi s'han posat en pràctica en múltiples projectes i experiències de desenvolupament. Aquestes experiències varien des d'un projecte local dins d'una sola organització que va requerir la reutilització de dades clíniques basades en principis d'interoperabilitat semàntica, fins al desenvolupament de projectes d'història clínica electrònica d'abast nacional.
[EN] Semantic interoperability of health information is an essential requirement for the sustainability of healthcare, and it is essential to face the new health challenges of a globalized world. This thesis provides new methodologies to tackle some of the fundamental aspects of semantic interoperability, specifically those aspects related to the definition and governance of clinical information models expressed in the form of archetypes. The contributions of the thesis are: - Study of existing modeling methodologies of semantic interoperability components that will influence in the definition of an archetype modeling methodology. - Comparative analysis of existing clinical information model governance systems and initiatives. - A proposal of a unified Archetype Modeling Methodology that formalizes the phases of archetype development, the required participants, and the good practices to be followed. - Identification and definition of archetype governance principles and characteristics. - Design and development of tools that provide support to archetype modeling and governance. The contributions of this thesis have been put into practice in multiple projects and development experiences. These experiences vary from a local project inside a single organization that required a reuse on clinical data based on semantic interoperability principles, to the development of national electronic health record projects.
This thesis was partially funded by the Ministerio de Economía y Competitividad, ayudas para contratos para la formación de doctores en empresas “Doctorados Industriales”, grant DI-14-06564 and by the Agencia Valenciana de la Innovación, ayudas del Programa de Promoción del Talento – Doctorados empresariales (INNODOCTO), grant INNTA3/2020/12.
Moner Cano, D. (2021). Archetype development and governance methodologies for the electronic health record [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/164916
TESIS

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Mejia, Susan. "Strategies Rural Hospital Leaders Use to Implement Electronic Health Record." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5225.

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The Centers for Medicare and Medicaid Services issued over 144,000 payments totaling $7.1 billion to medical facilities that have adopted and successfully demonstrated meaningful use of certified electronic health record (EHR). Hospital organizations can increase cost savings by using the electronic components of EHRs to improve medical coding and reduce medical errors and transcription costs. Despite the incentives, some rural health care facilities are failing to progress. The purpose of this multiple case study was to explore the strategies rural hospital leaders used to implement an EHR. The target population consisted of rural hospital leaders who were involved in the successful implementation of an EHR in South Texas. The conceptual framework chosen for this study was the sociotechnical systems theory. Data were collected through telephone interviews using open-ended semistructured interviews with 5 participants from 4 rural hospitals who were involved in the EHR implementation. Data analysis occurred using Yin's 5-step process which includes compiling, disassembling, reassembling, interpreting, and concluding. Data analysis included collecting information from government websites, company documents, and open-ended information to develop recurring themes. Several themes emerged including ongoing training, provider buy-in, constant communication, use of super users, and workflow maintenance. The findings could influence social change by making the delivery of health care more efficient and improving quality, safety, and access to health care services for patients.

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Reid, Jr Marvin Leon. "Adoption of Electronic Health Record Systems Within Primary Care Practices." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2228.

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Primary care physicians (PCPPs) have been slow to implement electronic health records (EHRs), even though there is a U.S. federal requirement to implement EHRs. The purpose of this phenomenological study was to determine why PCPPs have been slow to adopt electronic health record (EHR) systems despite the potential to increase efficiency and quality of health care. The complex adaptive systems theory (CAS) served as the conceptual framework for this study. Twenty-six PCPPs were interviewed from primary care practices (PCPs) based in southwestern Ohio. The data were collected through a semistructured interview format and analyzed using a modified van Kaam method. Several themes emerged as barriers to EHR implementation, including staff training on the new EHR system, the decrease in productivity experienced by primary care practice (PCP) staff adapting to the new EHR system, and system usability and technical support after adoption. The findings may contribute to the body of knowledge regarding EHR system implementation and assist healthcare providers who are slow to adopt EHRs. Additionally, findings could contribute to social change by reducing healthcare costs, increasing patient access to care, and improving the efficacy of patient diagnosis and treatment.

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San, Jose Rhoda Lynn Atienza. "Educating Nurses on Workflow Changes from Electronic Health Record Adoption." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3321.

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Workflow issues related to adoption of the electronic health record (EHR) has led to unsafe workarounds, decreased productivity, inefficient clinical documentation and slow rates of EHR adoption. The problem addressed in this quality improvement project was nurses' lack of knowledge about workflow changes due to EHR adoption. The purpose of this project was to identify changes in workflow and to develop an educational module to communicate the changes. This project was guided by both the ADDIE model (analysis, design, development, implementation, and evaluation) and the diffusion of innovations theory. Five stages were involved: process mapping, cognitive walkthrough, eLearning module development, pilot study, and evaluation. The process maps and cognitive walkthrough revealed significant workflow changes particularly in clinical practice guidelines, emergency department treatment plan, and the interdisciplinary care plan. The eLearning module was developed to describe workflow changes using gamification, scenario-based learning, and EHR simulation. The 14-item course evaluation included a 6-point Likert scale and closed- and open-ended questions. A purposive sample of nurses (N = 30) from the emergency department and inpatient care areas were invited to complete the eLearning module and course evaluation. Data were collected until saturation was achieved (n = 15). Descriptive statistics revealed the participants' positive learning experience. This quality improvement project is expected to contribute to positive social change by facilitating the effective use of the new EHR which can improve the quality of patient care, promote patient safety, reduce healthcare costs, and improve patient outcomes.

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Borek, Jarrod. "Managerial Strategies for Maximizing Benefits From Electronic Health Record Systems." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4959.

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In 2009, the U.S. government allocated $27 billion to health care agencies for electronic health records (EHRs) implementation. The increased use of EHR systems is expected to drive down health care costs and increase profits. To meet this anticipated return on investment (ROI), hospital managers need to be able to successfully design, deploy, and manage EHR systems. The purpose of this single case study was to explore organizational management strategies that hospital managers can use to ensure their investments in EHRs meet targeted ROIs and work efficiency goals. The conceptual framework for this study was based on the technology acceptance model. Primary data were collected from a criterion sample of 6 hospital managers with direct experience designing and implementing successful EHRs in a small hospital in the Northeastern United States. Secondary data were collected using public financial records available on the Internet. After cataloging and grouping the raw data, 4 emergent themes were identified: (a) training, (b) the role of organizational management strategies, (c) technological barriers, and (d) ongoing support and maintenance. Findings may contribute to social change through an increase in the quality of patient care and making health care records more accessible to doctors in isolated areas.

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Eyoh, Unyime. "Polypharmacy, the Electronic Medical Record, and Adverse Drug Events." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2535.

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Polypharmacy, a concurrent chronic use of multiple prescribed and over-the-counter medications by the same individual, is one of the clinical problems facing primary care providers. Polypharmacy creates the potential for adverse drug-related events, especially in the elderly. The advent of electronic medical records (EMR) may help identify and respond to these potential adverse events. The purpose of this project was to investigate the relationship between the total number of medication taken by elderly, 65 years and older, and the severity of drug-drug and drug-disease interactions triggered by the EMR system. The study used a retrospective chart review of the EMRs. Three independent variables (age, gender, and number of medications) and 4 dependent variables (major drug-drug, moderate drug-drug, major drug-drug, and moderate drug-drug interactions) were analyzed among a sample of 247 individuals, ranging in age from 65 to 98 years. The total number of medications used among this sample ranged from 2 to 27 medications, with 177 (71.7%) patients using 2 to 9 medications, and 70 (28.3%) using 10 or more medications. Correlational analysis showed a positive relationship between number of medication and major drug-drug, moderate drug-drug, major drug-disease, and moderate drug-disease interactions (r = 0.240, p = 0.0001; r = .596, p = 0.0001; r = 464, p =0.0001; r = 669, p = 0.0001, respectively). However, there was no significant relationship between age and major and moderate drug-drug and drug disease interactions. The results of this study contribute to positive social change by increasing primary care providers' understanding of the EMR as a tool to improve the identification and management of patients with polypharmacy.

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Dewart, Courtney McAlear. "Evaluating Risk Factors for Antimicrobial Resistance Using Electronic Health Record Data." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1555234514305512.

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Delespierre, Tiba. "Du dossier résident informatisé à la recherche en santé publique : Application des méthodes de surveillance en temps réel à des données médico-sociales de la personne âgée et exploration de données de cohorte pour la santé publique." Thesis, Université Paris-Saclay (ComUE), 2018. http://www.theses.fr/2018SACLV030/document.

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La France connaît un vieillissement de sa population sans précédent. La part des séniors s’accroît et notre société se doit de repenser son organisation pour tenir compte de ce changement et mieux connaître cette population.De nombreuses cohortes de personnes âgées existent déjà à travers le monde dont quatre en France et, bien que la part de cette population vivant dans des structures d’hébergement collectif (EHPAD, cliniques de soins de suite) augmente, la connaissance de ces seniors reste lacunaire.Aujourd’hui les groupes privés de maisons de retraite et d’établissements sanitaires comme Korian ou Orpéa s’équipent de grandes bases de données relationnelles permettant d’avoir de l’information en temps réel sur leurs patients/résidents. Depuis 2010 les dossiers de tous les résidents Korian sont dématérialisés et accessibles par requêtes. Ils comprennent à la fois des données médico-sociales structurées décrivant les résidents et leurs traitements et pathologies, mais aussi des données textuelles explicitant leur prise en charge au quotidien et saisies par le personnel soignant.Au fil du temps et alors que le dossier résident informatisé (DRI) avait surtout été conçu comme une application de gestion de base de données, il est apparu comme une nécessité d’exploiter cette mine d’informations et de construire un outil d’aide à la décision destiné à améliorer l’efficacité des soins. L’Institut du Bien Vieillir IBV devenu entretemps la Fondation Korian pour le Bien Vieillir a alors choisi, dans le cadre d’un partenariat Public/Privé de financer un travail de recherche destiné à mieux comprendre le potentiel informatif de ces données, d’évaluer leur fiabilité et leur capacité à apporter des réponses en santé publique. Ce travail de recherche et plus particulièrement cette thèse a alors été pensée en plusieurs étapes.- D’abord l’analyse de contenu du data warehouse DRI, l’objectif étant de construire une base de données recherche, avec un versant social et un autre de santé. Ce fut le sujet du premier article.- Ensuite, par extraction directe des informations socio-démographiques des résidents dès leur entrée, de leurs hospitalisations et décès puis, par un processus itératif d’extractions d’informations textuelles de la table des transmissions et l’utilisation de la méthode Delphi, nous avons généré vingt-quatre syndromes, ajouté les hospitalisations et les décès et construit une base de données syndromique, la Base du Bien Vieillir (BBV) . Ce système d’informations d’un nouveau type a permis la constitution d’une cohorte de santé publique à partir de la population des résidents de la BBV et l’organisation d’un suivi longitudinal syndromique de celle-ci. La BBV a également été évaluée scientifiquement dans un cadre de surveillance et de recherche en santé publique au travers d’une analyse de l’existant : contenu, périodicité, qualité des données. La cohorte construite a ainsi permis la constitution d’un outil de surveillance. Cet échantillon de population a été suivi en temps réel au moyen des fréquences quotidiennes d’apparitions des 26 syndromes des résidents. La méthodologie d’évaluation était celle des systèmes de surveillance sanitaire proposée par le CDC d’Atlanta et a été utilisée pour les syndromes grippaux et les gastro entérites aiguës. Ce fut l’objet du second article.- Enfin la construction d’un nouvel outil de santé publique : la distribution de chacun des syndromes dans le temps (dates de transmissions) et l’espace (les EHPAD de transmissions) a ouvert le champ de la recherche à de nouvelles méthodes d’exploration des données et permis d’étudier plusieurs problématiques liées à la personne âgée : chutes répétées, cancer, vaccinations et fin de vie
French population is rapidly aging. Senior citizens ratio is increasing and our society needs to rethink its organization, taking into account this change, better knowing this fast growing population group.Even if numerous cohorts of elderly people already exist worldly with four in France and, even as they live in growing numbers in nursing homes and out-patient treatment clinics, knowledge of this population segment is still missing.Today several health and medico-social structures groups as Korian and Orpéa invest in big relational data bases enabling them to get real-time information about their patients/residents. Since 2010 all Korian residents’ files are dematerialized and accessible by requests. They contain at the same time, structured medico-social data describing the residents as well as their treatments and pathologies, but also free-textual data detailing their daily care by the medical staff.Through time and as the computerized resident file (DRI) was mainly conceived as a data base management application, it appeared essential to mine these data and build a decision-making tool intended to improve the care efficiency. The Ageing Well Institute becoming meanwhile the Korian Ageing Well Foundation chose then, working in a private/public partnership, to finance a research work intented to better understand these datas’ informative potential, to assess their reliability and response to public health threats. This research work and this thesis were then designed in several steps:- First, a content analysis of the data warehouse DRI, the objective being to build a research data base, with a social side and a health side. This was the first paper subject.- Then, by direct extraction of the residents’ socio-demographic information at nursing home (NH) entry, adding hospitalizations and deaths, and finally, by an iterative textual extraction process of the transmissions data and by using the Delphi method, we created twenty-four syndromes, added hospitalizations and deaths and built a syndromic data base, the Ageing Well data base. This information system of a new kind, allowed the constitution of a public health cohort for elderly people from the BBV residents’population and its syndromic longitudinal follow-up. The BBV was also scientifically assessed for surveillance and public health research through present situation analysis: content, periodicity and data quality. This cohort then gave us the opportunity to build a surveillance tool and follow the residents’ population in real-time by watching their 26 daily frequency syndromic distributions. The methodology for that assessment, Atlanta CDCs’ health surveillance systems method, was used for flu and acute gastro enteritis syndroms and was the second paper subject.- Finally, the building of a new public health tool: each syndrom’s distribution through time (transmissions dates) and space (transmissions NH ids) opened the research field to new data exploration methods. I used these to study different health problems afflicting senior citizens: frequent falls, cancer, vaccinations and the end of life

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Kantanka, Nana Sarfo. "Personal health record as a backbone for primary healthcare in developing countries." Thesis, Norwegian University of Science and Technology, Department of Computer and Information Science, 2007. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-9630.

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Increasingly, the ability to improve the efficiency, safety and quality of care is being recognized across the primary health sector. Increased focus on "seamless delivery of care", particularly for those with complex care needs, has highlighted the requirement for improved information exchange between health service providers. Personal Health records (PHR) as a transmission of personal health information can be powerful tools for linking the fragmented information that exists between services and allow providers immediate access to essential clinical information. This research is to make known how personal health records (PHR) can be of a greater support or possible as a backbone for continual of service for primary health care. The acquisition of knowledge by this research is about how personal health records can contribute to the planning of efficient patients information which in the long run helps in acquiring the rightful treatment and which also results in the benefit of primary health organization members in the whole. The results illustrate the conceptions of the need to in cooperate and encourage the use of personal health records which in the long effect can serve as a backbone for the existing primary healthcare.

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Nguyen, Quynh. "The views and expectations of young healthy adults about using an online personal health record." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=104516.

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BACKGROUND: Personal health records (PHRs) are tools that allow individuals to access, share and manage their health information online. PHRs have received considerable interest and investment in recent years, because they are thought to have the potential to promote patient self-management and greater involvement in their own care. Despite apparent public interest and a proliferation of available options, adoption rates remain low. There is a gap in our understanding as to why people are choosing to use or not use PHRs, and what different populations of users might want from such a tool. In particular, young adults could be a potential group to target with preventative strategies using a PHR, since technology is much more integrated in their everyday life.OBJECTIVE: This qualitative descriptive study therefore aimed to explore the views and expectations of young healthy adults about using an online personal health record. METHODS: Four focus groups were conducted with a total of 29 participants (18-34 years old) from a community setting in Montreal, Canada. Interviews were transcribed and analyzed with inductive thematic analysis. RESULTS: With respect to how young adults viewed PHRs, three broad themes were identified: perceived advantages to using a PHR; future PHR users; and concerns about PHRs. In terms of what they themselves expected from using a PHR, different themes were elaborated: characteristics of an “ideal” PHR; using the PHR for preventative health; taking more control over their health; and making the PHR worthwhile. A conceptual framework of factors influencing expectations of PHR use in this population is proposed.CONCLUSION: The findings suggest that what young adults perceive as benefits of a PHR may not be the same things that motivate them to actually use a PHR. The results emphasize the fact that more research is needed to understand the expectations and anticipated use of different populations in designing a patient-centered tool. The proposed framework can be used as a basis and tested in future research on PHR adoption.
CONTEXTE: Les dossiers de santé personnels (DSP) sont des outils qui permettent aux individus d'accéder, de partager et de gérer l'information sur leur santé en ligne. Ils ont obtenu beaucoup d'intérêt et des investissements considérables ces dernières années puisqu'on considère que les DSP ont le potentiel de promouvoir une plus grande implication des patients dans la gestion de leurs propres soins. Malgré l'intérêt public apparent et une prolifération des options, les taux d'adoption des DSP restent faibles. Notre compréhension des raisons pour lesquelles les gens choisissent d'utiliser ou non les DSP et de ce que les différentes populations d'utilisateurs pourraient vouloir d'un tel outil est limitée. En particulier, les jeunes adultes pourraient être un bon groupe à cibler en ce qui concerne les possibilités de prévention avec un DSP puisque la technologie est beaucoup plus intégrée dans leur vie quotidienne.OBJECTIF: Cette étude qualitative descriptive vise donc à explorer les points de vue et les attentes des jeunes adultes en bonne santé à propos de l'utilisation d'un dossier de santé personnel. METHODES: Quatre tables rondes ont été menées avec un total de 29 participants (18-34 ans) dans un milieu communautaire de Montréal, au Canada. Les entrevues ont été transcrites et ensuite analysées avec la méthode d'analyse thématique inductive. RÉSULTATS: En ce qui concerne ce que les jeunes adultes pensent à propos des DSP, trois grands thèmes ont été identifiés: les avantages perçus, les futurs utilisateurs et les préoccupations au sujet des DSP. En terme de ce qu'eux-mêmes attendaient d'un DSP, différents thèmes ont été élaborés: les caractéristiques d'un DSP «idéal»; la contribution des DSP à la santé préventive en prenant plus de contrôle sur leur santé, et l'aspect pratique des DSP. Un cadre conceptuel des facteurs ayant une influence sur les attentes des participants à propos des DSP est proposé. CONCLUSION: Les résultats suggèrent que ce que les jeunes adultes perçoivent comme avantages d'un DSP ne sont pas les mêmes choses qui les motivent à se servir d'une PHR. Cela souligne l'importance de comprendre l'utilisation prévue et les attentes des populations d'utilisateurs spécifiques dans la conception d'un outil centré sur le patient. Le cadre proposé peut constituer une base pour de plus amples recherches sur l'adoption des DSP.

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Fernández, Alexis Martínez. "Authorization schema for electronic health-care records : For Uganda." Thesis, KTH, Kommunikationssystem, CoS, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-101165.

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This master’s thesis project began at the Karolinska University Hospital. This thesis discusses how to design an authorization schema focused on ensuring each patient’s data privacy within a hospital information system. It begins with an overview of the current problem, followed by a review of related work. The overall project’s goal is to create and evaluate an authorization schema that can ensure each patient’s data confidentiality. Authorization has currently become a very important aspect in information systems, to the point of being a necessity when implementing a complete system for managing access control in certain complex environments. This requirement lead to the approach that this master thesis takes for effectively reasoning about authorization requests in situations where a great number of parameters could affect the access control assessment. This study is part of the ICT4MPOWER project developed in Sweden by both public and private organizations with the objective of improving health-care aid in Uganda through the use of information and communication technologies. More concretely, this work defines an authorization schema that can cope with the increasing needs of sophisticated access control methods where a complex environment exists and policies require certain flexibility.
Detta examensarbete projektet startade vid Karolinska Universitetssjukhuset. Denna avhandling diskuterar hur man designar ett tillstånd schema fokuserat på att säkerställa varje patients dataskydd inom ett sjukhus informationssystem. Det börjar med en översikt över det aktuella problemet, följt av en genomgång av arbete. Projektets övergripande mål är att skapa och utvärdera ett tillstånd schema som kan garantera varje patient data sekretess. Bemyndigande har för närvarande blivit en mycket viktig aspekt i informationssystem, till den grad att vara nödvändigt att genomföra komplett system för hantering av åtkomstkontroll i vissa komplexa miljöer. Detta är i själva verket den strategi som detta examensarbete tar för att effektivt resonemang om en ansökan om godkännande i situationer där ett stort antal parametrar kan påverka i åtkomstkontroll bedömningen. Denna studie är en del av ICT4MPOWER projektet utvecklades i Sverige av både offentliga och privata organisationer i syfte att förbättra stödet sjukvård i Uganda med användning av informations-och kommunikationsteknik.<p> Mer konkret definierar detta arbete ett tillstånd schema som kan hantera de ökande behoven av sofistikerade metoder för åtkomstkontroll där en komplex miljö finns och politik kräver en viss flexibilitet.

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Poon, Wai-yin, and 潘慧賢. "Review of the implementation of electronic health record in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B50257456.

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eHR is one of the main development area in healthcare sector to ensure a high quality and effective healthcare service in Hong Kong is provided. However, the present development of eHR in Hong Kong is mainly focused on public sectors healthcare providers – the hospitals and clinics under HA and DH. Most of the private hospitals and clinics are still using paper based health records. Although some of them may have implemented their own eHR systems, there is no interconnection among other healthcare providers. In this dissertation, the eHR system development in Hong Kong for both public and private sectors will be reviewed, to figure out the development of eHR and various clinical management systems, as well as the problems facing by the healthcare workers and patients. Also, HKSAR government shows supportive to the eHR development both in the governance and financial aspects. To facilitate the coordination of developing her sharing system among different healthcare providers, an eHR Office has been setup under Food and Health Bureau for this purpose. The eHR office will monitor the progress of the eHR development process. As HA has a well-developed world-known Clinical Management System (CMS), which handles patient records in electronic forms in public hospitals daily. HA acts as one major advisor in her implementation for HKSAR. Data privacy and data security issues are the major concerns of healthcare workers and patients. The Personal Data Protection Ordinance (PDPO) provides protection on the data privacy in legal aspect. However, no legislation on data privacy has been specified for eHR currently. Meanwhile, various physical security protections have been adopted in the implementation of eHR in technology side, which provided a certain level of data security to the system. Chinese Medicine has been developed rapidly recently, it is expected the Chinese Medicine would become one of the core service area in healthcare sector in Hong Kong, sharing the healthcare service with the Western Medicine. However, there is no integration between Chinese Medicine and Western Medicine in current her sharing system development. eHR development involves huge investment, to evaluate the feasibility of developing the eHR system, a scientific tool is recommended, a Cost and Benefit Analysis is hence conducted for the eHR in Hong Kong, to compare the effectiveness of eHR with the traditional paper-based health records in the healthcare setting. As recommended from the CBA, the eHR system will be developed with the consideration on the system flexibility and the adaptability from all the healthcare providers. On the other hand, the implementation of the her system will be a long and complex process and will require the contribution and participation from all parties.
published_or_final_version
Politics and Public Administration
Master
Master of Public Administration

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Aldajani, Mouhamad. "Electronic patient record security policy in Saudi Arabia National Health Service." Thesis, De Montfort University, 2012. http://hdl.handle.net/2086/6016.

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Saudi Arabia is in the process of implementing Electronic Patient Records (EPR) throughout its National Health services. One of the key challenges during the adoption process is the security of EPR. This thesis investigates the current state of EPR security in Saudi Arabia’s National Health Services (SA NHS) both from a policy perspective and with regard to its implementation in SA NHS’s information systems. To facilitate the analysis of EPR security, an EPR model has been developed that captures the information that is stored as part of the electronic record system in conjunction with stated security requirements. This model is used in the analysis of policy consistency and to validate operational reality against stated policies at various levels within the SA NHS. The model is based on a comprehensive literature survey and structured interviews which established the current state of practice with respect to EPRs in a representative Saudi Arabian hospital. The key contribution of this research is the development and evaluation of a structured and model-based analysis approach to EPR security at the early adoption stage in SA, based on types of information present in EPRs and the needs of the users of EPRs. The key findings show that the SA EPR adoption process is currently proceeding without serious consideration for security policy to protect EPR and a lack of awareness amongst hospital staff.

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Fareed, Naleef. "Hospital Electronic Health Record Adoption and its Influence on Postoperative Sepsis." VCU Scholars Compass, 2013. https://scholarscompass.vcu.edu/etd/3003.

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Electronic Health Record (EHR) systems could make healthcare delivery safer by providing benefits such as timely access to accurate and complete patient information, advances in diagnosis and coordination of care, and enhancements for monitoring patient vitals. This study explored the nature of EHR adoption in U.S. hospitals and their patient safety performance in relation to one hospital acquired condition: postoperative sepsis – a condition that complicates hospitalizations, increases lengths of stay, and leads to higher mortality rates. Administrative data from several sources were utilized in order to obtain comprehensive information about the patient, organizational, and market characteristics of hospitals, their EHR adoption patterns, and the occurrence of postoperative sepsis among their patients. The study sample consisted of 404 general, short-term, acute care, non-federal, and urban hospitals based in six states, which provided longitudinal data from 2005 to 2009. Hospital EHR and the EHR’s sophistication level were measured by the presence of eight clinical applications. Econometric techniques were used to test six hypotheses that were derived from macro-organizational theories and frameworks. After controlling for potential confounders, the study’s key findings suggested that hospitals had a significant increase in the probability of having EHR as the percent of other hospitals having the most sophisticated EHR (i.e., EHRS3) in the market increased. Conversely, hospitals had a significant decrease in the probability of having EHR when the percent of Medicaid patients increased within a hospital or when the hospital belonged to centralized or moderately centralized systems. Also, the study findings suggested that EHR was associated with a higher rate of postoperative sepsis. Specifically, the intermediate EHR sophistication level (i.e., EHRS2) and the most sophisticated EHR level (i.e., EHRS3) were associated with a significantly higher rate of postoperative sepsis when compared to hospitals that did not have such EHR sophistication. The study results, however, did not support the hypotheses that higher degrees of fit between hospitals’ EHR sophistication level and specific structural dimensions were associated with greater reductions in postoperative sepsis outcomes vis-à-vis hospitals that did not have these types of fit.

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Weagraff, Joseph B. "Health Care Leaders' Experiences of Electronic Medical Record Adoption and Use." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3216.

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Adoption of electronic medical record (EMR) technology systems of meaningful use has been slow despite the mandate by the U.S. government. The purpose of this single case study was to explore strategies used by health care leaders to implement EMR technology systems of meaningful use to take advantage of federal incentive payments. Diffusion of innovation theory provided the conceptual framework for the study. Semistructured interviews were conducted with 6 health care leaders from a military installation in the Southeast United States. Data were analyzed using software, coding, and inductive analyses. The 3 prominent themes were patient, provider, and champion. Alerts from an EMR technology system can increase providers' awareness and improve patient safety. Providers' involvement in every phase of an EMR system's implementation can improve the adoption rate. Champions play a critical role in successful adoption and implementation of EMR systems. Results of this study may assist health care leaders in implementing EMR systems to take advantage of federal incentive payments. Implications for positive social change include enhanced delivery of safe, high-quality health care.

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Sesay, Nanah Sheriff. "Development of an Electronic Health Record Educational Project for Staff Nurses." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1214.

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Abstract The use for electronic health records (EHRs) by 2015 is being mandated through incentive payments for health care providers. Evidence-based literature has shown that almost half of the hospitals in the Unites States have not adopted EHRs, and many nurses have not been educated to effectively use them. In order to enhance and sustain EHR adoption by hospitals, nurses need to be educated on EHRs' usability. The purpose of this project was to develop an evidence-based EHR educational project for nurses on how to enter nursing assessments, document patients' medical data, and communicate effectively with patients and health care providers. The development of this educational project was guided by Ajzen's theory of planned behavior. An advisory committee of 5 members determined the effectiveness and usefulness of the project. The advisory committee was comprised of the director of nursing, the director of information technology, a nurse manager, a nursing informatics specialist, and a staff nurse. Findings from the advisory committee indicated the project was in alignment with the objectives for meaningful use of EHR adoption by hospitals, conformed to the quality standards established by the agency for which this project was developed, and provided educational materials that were helpful in enhancing staff nurses understanding of EHR usability. In addition, feedback from the nurses who reviewed the educational project indicated that they were concerned about frequent upgrades and customization that were being made in Epic and the project was useful in enhancing staff nurses understanding of Epic usability. This project has the potential of increasing staff nurses' efficiency in using the Epic EHR system.

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Kiihamäki, S.-P. (Simo-Pekka). "A latent class approach:characterizing the willingness to share personal health information in Finland." Master's thesis, University of Oulu, 2019. http://jultika.oulu.fi/Record/nbnfioulu-201908232813.

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Abstract. BACKGROUND: With the fast advances in technology, the aging populations, and the climate change, the amount of data in our hands has become enormous, and the ways of handling it has become better. There has been large amount of privacy concerns as well due to the fast-growing data that are spread everywhere. This study focuses on health data to find out whether personal characteristics can be associated with the willingness to consent it for secondary purposes. METHODS: A sample data (n=2338) concerning the Finnish populations attitudes towards secondary uses of health data was acquired and analyzed. The questionnaire included 14 questions regarding the willingness to consent data for different purposes. The dimensionality of this issue was reduced with a latent class analysis, and the information was condensed into one latent variable with 5 classes. After that a latent class regression was performed to find out whether the willingness could be explained with the help of other background information. RESULTS: A statistically significant association between the willingness to consent health data and the following characteristics; Gender, Age, Education, Perception of health, Number of visits to health or social care, and Financial situation. Political orientation had a high value of estimate, but no significance. CONCLUSIONS: Secondary uses of health data can achieve improvements in public health and welfare and health equality. Therefore, it is important that we make sure that the privacy concerns of using and sharing health data are taken care of. Methods for increasing the citizens willingness to consent their health data could be done through education and by building mutual trust between the health care system and the patients.

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Jing, Xia. "Constructing a bio-health knowledge base for access via a standardised electronic health record prototype." Thesis, University of Salford, 2009. http://usir.salford.ac.uk/26738/.

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Aim and Objectives: To explore the feasibility of accessing biological information and associated health information through a standards-based electronic health record. The objectives include constructing: a condition specific knowledge base prototype; an EHR system prototype based on a standard record architecture; and an interface that connects the two. Method: An ontology was constructed to organise biological and health information in a formal and structured way. Cystic fibrosis was selected as an exemplar condition and the Continuity of Care Record was selected for an EHR prototype application. The sequence variations information and health information in the knowledge base are presented through the EHR prototype's interface and the results are evaluated. Results: A substantive knowledge base prototype of cystic fibrosis was constructed. The content includes: the most common genetic mutations related to cystic fibrosis; time-oriented descriptions of cystic fibrosis; Cochrane conclusions; and gene therapy for cystic fibrosis. The content is organised on both time and problem oriented axes. It was found to be possible to present bio-health information that was case-specific through the EHR prototype interface. Conclusion: Sequence variations information and associated health information can be made accessible through a standards-based electronic health record prototype. Complex knowledge can be accessed, to some extent automatically, thereby providing a starting point for integrating formal and structured biological information within health record systems which can be deployed in clinical settings.

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Fylan, F., L. Caveney, A. Cartwright, and Beth Fylan. "Making it work for me: beliefs about making a personal health record relevant and useable." 2018. http://hdl.handle.net/10454/16382.

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Yes
Background: A Personal Health Record (PHR) is an electronic record that individuals use to manage and share their health information, e.g. data from their medical records and data collected by apps. However, engagement with their record can be low if people do not find it beneficial to their health, wellbeing or interactions with health and other services. We have explored the beliefs potential users have about a PHR, how it could be made personally relevant, and barriers to its use. Methods: A qualitative design comprising eight focus groups, each with 6–8 participants. Groups included adults with long-term health conditions, young people, physically active adults, data experts, and members of the voluntary sector. Each group lasted 60–90 min, was audio recorded and transcribed verbatim. We analysed the data using thematic analysis to address the question “What are people’s beliefs about making a Personal Health Record have relevance and impact?” Results: We found four themes. Making it work for me is about how to encourage individuals to actively engage with their PHR. I control my information is about individuals deciding what to share and who to share it with. My concerns is about individuals’ concerns about information security and if and how their information will be acted upon. Potential impact shows the potential benefits of a PHR such as increasing self-efficacy, uptake of health-protective behaviours, and professionals taking a more holistic approach to providing care and facilitating behaviour change. Conclusions: Our research shows the functionality that a PHR requires in order for people to engage with it. Interactive functions and integration with lifestyle and health apps are particularly important. A PHR could increase the effectiveness of behaviour change apps by specifying evidence-based behaviour change techniques that apps should incorporate. A PHR has the potential to increase health-protective behaviours and facilitate a more person-driven health and social care system. It could support patients to take responsibility for self-managing their health and treatment regimens, as well as helping patients to play a more active role when care transfers across boundaries of responsibility.
Leeds Informatics Board

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Amarante, Fábio André da Silva. "Extracting medical information from personal child health records." Master's thesis, 2018. https://repositorio-aberto.up.pt/handle/10216/111181.

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Amarante, Fábio André da Silva. "Extracting medical information from personal child health records." Dissertação, 2018. https://repositorio-aberto.up.pt/handle/10216/111181.

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Guarin, Desmond Medina. "The Effect of Stakeholders’ Background on Perceptions of Usability and Usefulness on Personal Health Records." Thesis, 2013. http://hdl.handle.net/1828/5117.

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Despite rapid advances in technology, there is currently a complex, and somewhat disjointed approach to the way health information is collected, stored, and organized for both healthcare consumers and professionals. Incompatible electronic medical records from various healthcare providers add to the complexity of a system tasked with delivering a patient’s relevant medical information in a timely manner to the appropriate point of care. Personal health records (PHR) grew out of the efforts to produce an integrated electronic record to manage the multifaceted aspects of healthcare required by both healthcare consumers and professionals. PHRs are a transformative technology with the potential to alter patient-provider relationships in a way that produces a more efficient and cost effective healthcare system as a result of better patient outcomes. PHRs can potentially include a wide variety of users ranging from the lay public to clinical professionals. As such, it is important to identify potential user groups and their corresponding health information needs in order to design PHRs that maximize accessibility, usability, and clinical relevance. This study focused on laypeople who represented a wide age-range of individuals, evenly split in gender, with an above average level of computer literacy. Most of the participants had not used an electronic PHR prior to this study. However, after a hands-on session with PHR software, most participants found it to be easy to use, accompanied with the functionality they expected from such a system. Most participants were satisfied that an electronic PHR would meet their health information needs and would recommend the use of PHRs to family and friends. Anyone in the general public is a potential PHR user. However, this study found that individuals with chronic conditions and those with complex health needs had the most to gain from using a PHR as an integral part of their healthcare routine. This study also demonstrated that an individual’s health condition has a stronger influence on their perceptions about the usefulness of PHRs than does their demographic background (age, education, computer literacy). Finally, this study established that PHRs are considered by participants of the study to be useful tools in meeting their health information needs.
Graduate
0723
0769
0984
dguarin@uvic.ca

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Eastway, Julia Sara. "Adult patients’ experiences of using electronic personal health records for self-management of chronic non-communicable disease: a qualitative systematic review." Thesis, 2020. http://hdl.handle.net/2440/126623.

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Objective: The objective of the systematic review was to identify and synthesise the best available evidence on adult patients’ experiences of using electronic personal health records (e-PHRs) for chronic non-communicable disease self-management. Introduction: Self-management is a key component of chronic non-communicable disease management. One of the strategies to support self-management in patients with chronic non-communicable disease is the use of e-PHRs. Electronic personal health records offer patients the opportunity to actively engage with their own health management, promote continuity of care and collaboration through disease tracking, and provide patients and providers with an ongoing connection. For e-PHRs to be adopted and their benefits for chronic non-communicable disease management maximised, they should align with patients’ values and preferences. Methods: The systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence, with meta-aggregation as the method of synthesis. The review included qualitative studies that explored the experiences of adult patients (aged 18 years and over) with a chronic non-communicable disease who had used e-PHRs for the self-management of their condition. Published studies were retrieved following searches conducted in CINAHL, PubMed, PsycINFO, Embase and Scopus. Grey literature was also considered. Critical appraisal and data extraction were conducted using the appropriate JBI tools. Studies were included, regardless of their methodological quality. Extracted data were aggregated and analysed to produce a set of synthesised findings that were used to develop evidence-informed recommendations for the use of e-PHRs in chronic non-communicable disease self-management. Results: Fifteen studies that considered adult patients’ (n= 412) experiences of using e-PHRs for chronic non-communicable disease self-management were included in the review. A total of 113 findings were extracted and aggregated into 17 categories from which four synthesised findings were developed: 1) Electronic personal health records can strengthen patient-practitioner relationships and support personcentred care when both patients and practitioners engage in productive and transparent communication built on mutual trust; 2) The versatility of e-PHR functions can support self-management of various chronic diseases; 3) Adoption of e-PHRs is dependent on individual patient characteristics, and may be compromised if patients’ expectations remain unmet, there were unintended consequences that hinder use, and patients believe e-PHRs are unnecessary for their care needs; and 4) Tailoring e-PHRs to the design preferences, training and education needs of patients with chronic disease through developer-user collaboration may facilitate optimal use of e-PHR. Conclusions: Electronic personal health records are an emerging technology that have the potential to empower patients and facilitate shared decision-making with their health practitioners. The findings of this review suggest that to facilitate adoption of e-PHRs, patients should be proactive in raising and discussing their concerns with healthcare practitioner (HCPs). Additionally, HCPs should learn appropriate ways of communicating with their patients in order to build trust, maintain transparency, and offer reassurance for effective patient and provider encounters. Awareness of the various functions of e- PHRs that are the most useful for the management of a specific chronic disease will assist patients and their providers in making informed decisions regarding which functions best fit their needs and requirements. Adoption of e-PHR may be optimised when the patient’s individual characteristics or concerns around their specific chronic disease needs are understood. The findings of this review also suggest that patients require tailored training and education programs which are focused on the technical and non-technical aspects of e-PHR use in chronic disease management. Creating avenues where health information technology developers can engage with patients and obtain their input in relation to the design or modification of e-PHRs can yield useful information that can increase e-PHR adoption. Further studies exploring the experiences of e-PHR use for other prevalent chronic conditions such as obesity, asthma and kidney disease may provide valuable contributions for the enhanced use of e-PHR for selfmanagement. Future studies should also aim to adhere to well established and robust qualitative methodologies, which is a significant issue identified in the current review. Furthermore, to assist future qualitative evidence synthesis and strengthen findings for subsequent systematic reviews, future research should focus on advancing efforts to create a standardised e-PHR taxonomy.
Thesis (MClinSc.) -- University of Adelaide, The Joanna Briggs Institute, 2020

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Clark, Wayne Voisey. "Diffusion of personal health information : self-determining and empowering practices for Manitoba Inuit." 2012. http://hdl.handle.net/10170/522.

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This paper describes Inuit cultural considerations when defining and communicating electronic health concepts and personal health information services to urban Inuit audiences. Applying a two-eyed seeing model to build on and describe contextual meanings for Western and Inuit versions of health information and information communication technologies is critical to sustained relevance of electronic health information. Overarching concerns include reclaiming Inuit ownership and vision; sustainability; and; authority and capacity. It is within an electronic health space that Inuit can attain self-determination for the management of their own personal health data and develop a set of culturally safe and empowering practices for communicating ownership and cultural relevancy of health and health information in an evolving health care system.

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Pedrosa, Tiago. "Electronic health records for mobile citizens: a secure and collaborative architecture." Doctoral thesis, 2013. http://hdl.handle.net/10198/9014.

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Since their early adoption Electronic Health Records (EHR) have been evolving to cope with increasing requirements from institutions, professionals and, more recently, from patients. Citizens became more involved demanding successively more control over their records and an active role on their content. Mobility brought also new requirements, data become scattered over heterogeneous systems and formats, with increasing di culties on data sharing between distinct providers. To cope with these challenges several solutions appeared, mostly based on service level agreements between entities, regions and countries. They usually required de ning complex federated scenarios and left the patient outside the process. More recent approaches, such as personal health records (PHR), enable patient control although raises clinical integrity doubts to other actors, such as physicians. Also, information security risk increase as data travels outside controlled networks and systems. To overcome this, new solutions are needed to facilitate trustable collaboration between the diverse actors and systems. In this thesis we present a solution that enables a secure and open collaboration between all healthcare actors. It is based on a service-oriented architecture that deals with the clinical data using a closed envelope concept. The architecture was modeled with minimal functionality and privileges bearing in mind strong protection of data during transmission, processing and storing. The access control is made through patient policies and authentication uses electronic identi cation cards or similar certi cates, enabling auto-enrollment. All the components require mutual authentication and uses cyphering mechanisms to assure privacy. We also present a threat model to verify, through our solution, if possible threats were mitigated or if further re nement is needed. The proposed solution solves the problem of patient mobility and data dispersion, and empowers citizens to manage and collaborate in their personal healthcare information. It also permits open and secure collaboration, enabling the patient to have richer and up to date records that can foster new ways to generate and use clinical or complementary information.
Durante as últimas décadas, os registos de saúde electrónicos (EHR) têm evoluído para se adaptar a novos requisitos. O cidadão tem-se envolvido cada vez mais na prestação dos cuidados médicos, sendo mais pró activo e desejando potenciar a utilização do seu registo. A mobilidade do cidadão trouxe mais desafios, a existência de dados dispersos, heterogeneidade de sistemas e formatos e grande dificuldade de partilha e comunicação entre os prestadores de serviços. Para responder a estes requisitos, diversas soluções apareceram, maioritariamente baseadas em acordos entre instituições, regiões e países. Estas abordagens são usualmente assentes em cenários federativos muito complexos e fora do controlo do paciente. Abordagens mais recentes, como os registos pessoais de saúde (PHR), permitem o controlo do paciente, mas levantam dúvidas da integridade clinica da informação aos profissionais clínicos. Neste cenário os dados saem de redes e sistemas controlados, aumentando o risco de segurança da informação. Assim sendo, são necessárias novas soluções que permitam uma colaboração confiável entre os diversos actores e sistemas. Esta tese apresenta uma solução que permite a colaboração aberta e segura entre todos os actores envolvidos nos cuidados de saúde. Baseia-se numa arquitectura orientada ao serviço, que lida com a informação clínica usando o conceito de envelope fechado. Foi modelada recorrendo aos princípios de funcionalidade e privilégios mínimos, com o propósito de fornecer protecção dos dados durante a transmissão, processamento e armazenamento. O controlo de acesso é estabelecido por políticas definidas pelo paciente. Cartões de identificação electrónicos, ou certificados similares são utilizados para a autenticação, permitindo uma inscrição automática. Todos os componentes requerem autenticação mútua e fazem uso de algoritmos de cifragem para garantir a privacidade dos dados. Apresenta-se também um modelo de ameaça para a arquitectura, por forma a analisar se as ameaças possíveis foram mitigadas ou se são necessários mais refinamentos. A solução proposta resolve o problema da mobilidade do paciente e a dispersão de dados, capacitando o cidadão a gerir e a colaborar na criação e manutenção da sua informação de saúde. A arquitectura permite uma colaboração aberta e segura, possibilitando que o paciente tenha registos mais ricos, actualizados e permitindo o surgimento de novas formas de criar e usar informação clínica ou complementar.
Programa PROTEC, bolsa SFRH/BD/49765/2009

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Dissertations / Theses on the topic 'Electronic personal health record'

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