Academic literature on the topic 'Electronic records Australia Management Computer programs'

THE SITUATION DESCRIBED by Stevens1 in the foregoing article is similar to that navigated by thousands of individuals in hospitals around Australia each day. Stevens has been able to identify gaps in communication, processes and timely availability of pertinent information which potentially put her health at risk. There is little doubt that her call for ?legible and enduring record systems accessible by appropriate people? (page 400) would be supported by most of the general community. Health information management is hugely complex, with large numbers of concepts and high rates of clinical knowledge change. Electronic health records (EHRs) are definitely not simple concepts that are solved by storing information in a relational database for use in a single organisational silo, but require the capture of the full breadth of health information in a manner that can be easily stored, retrieved in varying contexts, and searched. Then there is the additional and unique requirement of sharing this same information with a range of health care providers with differing foci, requirements, technical tools and term-sets. When you add in some of the other more lateral requirements such as medico-legal accountability, pooling data for public health research, and privacy, consent and authorisation for sharing sensitive health information, it becomes increasingly evident that health data management has no real equivalent in other industries. In order for shareable electronic health records to become ubiquitous, there are numerous building blocks that need to be in place ? appropriate levels of funding, legislative changes, consensus on a range of standards, stakeholder engagement, implementation of massive change management programs and so on, as outlined by Grain.2 Australia?s solution is the HealthConnect program ? a joint Commonwealth and state government initiative ? which is gradually identifying the required pieces, and laying them out in a systematic way to solve the e-health system puzzle.

Summary Background: Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited. Objectives: The present paper aims at the description and comparison of the current major quality certification approaches to EHRs. Methods: A literature analysis was carried out in order to identify the relevant publications with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar) were used to collect relevant sources. The documents that were obtained were analyzed using techniques of qualitative content analysis. Results: The analysis discusses and compares the quality approaches of CCHIT, EuroRec, IHE, openEHR, and EN13606. These approaches differ with regard to their focus, support of service-oriented EHRs, process of (re-)certification and testing, number of systems certified and tested, supporting organizations, and regional relevance. Discussion: The analyzed approaches show differences with regard to their structure and processes. System vendors can exploit these approaches in order to improve and certify their information systems. Health care organizations can use these approaches to support selection processes or to assess the quality of their own information systems. Citation: Hoerbst A, Ammenwerth E. Quality and certification of electronic health records – An overview of current approaches from the US and Europe. Appl Clin Inf 2010; 1: 149–164 http://dx.doi.org/10.4338/ACI-2010-02-R-0009

In modern conditions, the traditional manual manner of working with documents in business is replaced gradually by the most rational methods of conducting digital office using a personal computer. Nowadays in the software market there is a wide enough choice of various programs for personnel records management at the company. However, the best properly choice often has difficulties connected with the juridical status of the real consumer of the software, the purpose of its activities, computer literacy of workers and the current experience of using a particular software package. The relevance of the problem is due to the fact that the state character of the work and the specific legal framework of the state institution differ significantly from the one of doing business by commercial (private) enterprises, on which are mainly focused the majority of the human resources software applications. The situation of the issue of electronic personnel records management in state institutions was analyzed on the pat-tern of experience with personnel documentation established in the State Committee on Price Policy of the Republic of Sakha (Yakutia). The main aspects of the paperless office work was studied, covering a variety of procedures and routine works with documents, as well as the software itself for dealing with documents of the personnel database of the institution. The article presents the results of studying indicators of electronic document administration and comparative analysis of options for professional personnel management programs. It was noted that at the moment the level of electronic personnel records management in the state institution does not yet fully meet the requirements of modern digital personnel documents management. It was concluded that the destination of further improving the activity of the state institution and raising work on personnel records administration and HR management to a higher level could be solved only if the digital document system for personnel records and accounting will be applied with an operatively updated package of legislative and regulatory framework.

Abstract Background Digital availability of patient data is continuously improving with the increasing implementation of electronic patient records in physician practices. The emergence of digital health data defines new fields of application for data analytics applications, which in turn offer extensive options of using data. Common areas of data analytics applications include decision support, administration, and fraud detection. Risk scores play an important role in compiling algorithms that underlay tools for decision support. Objectives This study aims to identify the current state of risk score integration and integration capability in electronic patient records for cardiovascular disease and diabetes in German primary care practices. Methods We developed an evaluation framework to determine the current state of risk score integration and future integration options for four cardiovascular disease risk scores (arriba, Pooled Cohort Equations, QRISK3, and Systematic Coronary Risk Evaluation) and two diabetes risk scores (Finnish Diabetes Risk Score and German Diabetes Risk Score). We then used this framework to evaluate the integration of risk scores in common practice software solutions by examining the software and inquiring the respective software contact person. Results Our evaluation showed that the most widely integrated risk score is arriba, as recommended by German medical guidelines. Every software version in our sample provided either an interface to arriba or the option to implement one. Our assessment of integration capability revealed a more nuanced picture. Results on data availability were mixed. Each score contains at least one variable, which requires laboratory diagnostics. Our analysis of data standardization showed that only one score documented all variables in a standardized way. Conclusion Our assessment revealed that the current state of risk score integration in physician practice software is rather low. Integration capability currently faces some obstacles. Future research should develop a comprehensive framework that considers the reasonable integration of risk scores into practice workflows, disease prevention programs, and the awareness of physicians and patients.

Assessment of a child’s weight status is the first step in the management of childhood overweight and obesity. We reviewed routine assessment programs to inform early and routine identification of childhood overweight and obesity to address this global health issue. Twelve electronic databases were searched (Scopus, Web of Science, Wiley, ScienceDirect, PsycINFO, PsycARTICLES, PsycEXTRA, CINAHL, Primary Search, MEDLINE, ERIC, Academic Search Elite) for universal programs for weight status assessment of children aged 4–12 in Organization for Economic Co-operation and Development – countries, which included more than one assessment and parents receiving feedback. Of 1638 papers found via database searches, and 18 additional records identified through other sources, 26 were included. Reference to five countries’ programs for weight status assessment was found in the results: Australia, Sweden, the Netherlands, the United Kingdom and the United States. All of these programs were implemented in a school setting. Lack of services, stakeholder collaboration, parental awareness and engagement and government funding need to be improved for this health check to be undertaken as a part of an ongoing program. This review is about the implementation of similar programs. Early identification of risk for overweight and obesity allows families that require help to connect with available health services.

Abstract Background Electronic health record (EHR) alert fatigue, while widely recognized as a concern nationally, lacks a corresponding comprehensive mitigation plan. Objectives The goal of this manuscript is to provide practical guidance to clinical informaticists and other health care leaders who are considering creating a program to manage EHR alerts. Methods This manuscript synthesizes several approaches and recommendations for better alert management derived from four U.S. health care institutions that presented their experiences and recommendations at the American Medical Informatics Association 2019 Clinical Informatics Conference in Atlanta, Georgia, United States. The assembled health care institution leaders represent academic, pediatric, community, and specialized care domains. We describe governance and management, structural concepts and components, and human–computer interactions with alerts, and make recommendations regarding these domains based on our experience supplemented with literature review. This paper focuses on alerts that impact bedside clinicians. Results The manuscript addresses the range of considerations relevant to alert management including a summary of the background literature about alerts, alert governance, alert metrics, starting an alert management program, approaches to evaluating alerts prior to deployment, and optimization of existing alerts. The manuscript includes examples of alert optimization successes at two of the represented institutions. In addition, we review limitations on the ability to evaluate alerts in the current state and identify opportunities for further scholarship. Conclusion Ultimately, alert management programs must strive to meet common goals of improving patient care, while at the same time decreasing the alert burden on clinicians. In so doing, organizations have an opportunity to promote the wellness of patients, clinicians, and EHRs themselves.

Summary Objective: To discuss the possible contribution of electronic patient records in closing the loop among clinical practice, research and education. Results and conclusions: Applying Information and Communication Technology (ICT) to a given medical domain is not merely adding a new technique. When introduced into an environment, ICT will initially often emulate or resemble the already existing processes. When workers and researchers in that domain begin to appreciate the potential of ICT, this initial stage is followed by more fundamental changes in that domain that take advantage of the potential of ICT. To understand the scope of the potential changes enabled by electronic records, three principle changes need to be understood. First, data recorded in computer memories can be readily retrieved and re-used for a variety of purposes. Second, once data are available in computer memories, the data can be transported easily. Third, as physicians (and patients) are using computers to record medical data, the same electronic record can be used to introduce other computer programs that interact with the user. New usage of data, however, generates additional requirements. Thus the experience in developing decision support systems and analyzing observational databases feeds back into the requirements for electronic medical records.Each patient-physician encounter, each investigation, each laboratory test, and each treatment in medical practice constitutes, in principle, an experiment. Ideally, we learn from each experiment. Electronic medical records will facilitate research that relies on data recorded in routine medical practice. The potential and challenge, however, of Medical Informatics lies in its ability to close the loop among clinical practice, research, and education.

AbstractAntibiotic stewardship (ABS) denotes structured and continuous measures to improve the quality of prescribing anti-infectives. The aim is to achieve optimal treatment results and to minimize undesirable effects, especially the emergence of antibiotic resistance. This review summarizes the most important ABS principles based on recently published studies with implications for the management of community-acquired pneumonia. Local guidelines, education and training and “prospective audit and feedback” are established strategies to improve the management of patients with community-acquired pneumonia. However, the implementation of ABS programs requires trained personnel and may be impeded by limited structural and time resources. Hence, electronic health records and computer-based interventions are useful support for ABS programs and offer potential to facilitate ABS in inpatient and outpatient care. PCR-based rapid diagnostic tests, PCT-guided algorithms and penicillin allergy testing are suitable procedures to supplement ABS programs.

Abstract Background Health Informatics (HI) is an interdisciplinary field, integrating health sciences, computer science, information science, and cognitive science to assist health information management, analysis, and utilization. As the HI field is broad, it is impossible that a student will be able to master all the diverse HI topics. Thus, it is important to train the HI students based on the offering of the various HI programs and needs of the current market. This project will study the U.S. HI programs, training materials, HI job market, the skillset required by the employers, competencies taught in HI programs, and comparisons between them. Methods We collected the training information for the 238 U.S. universities that offered MS, PhD, or postbaccalaureate certificate programs in HI or related professions. Next, we explored the HI job market by randomly checking 200 jobs and their required skillsets and domain knowledge. Then, we compared these skillsets with those offered by the HI programs and identified the gaps and overlaps for program enhancements. Results Among the 238 U.S. universities, 94 universities offer HI programs: 92 universities with MS (Master of Science), 43 with doctoral, 42 with both MS and doctoral, and 54 with certificate programs. The most offered HI courses are related to practicum, data analytics, research, and ethics. For the HI job postings, the three most technical skillsets required in HI job posting are data analysis, database management, and knowledge of electronic health records. However, only 58% of HI programs offer courses in database management and analytics. Compared with American Medical Informatics Association's recommended 10 fundamental domains, the HI curriculum generally lacks training in socio-technical systems, social-behavioral aspects of health, and interprofessional collaborative practice. Conclusion There are gaps between the industry expectations of HI and the training received in HI programs. Advance level technical courses are needed in HI programs to meet industry expectations.

Abstract:We recently have shown that a computer system, known as HyperCritic, can successfully audit general practitioners’ treatment of hypertension by analyzing computer-based patient records. HyperCritic reviews the electronic medical records and offers unsolicited advice. To determine which unsolicited advice might be perceived as inappropriate, builders of programs such as HyperCritic need insight into providers’ responses to computer-generated critique of their patient care. Twenty medical charts, describing in total 243 visits of patients with hypertension, were audited by 8 human reviewers and by the critiquing-system HyperCritic. A panel of 14 general practitioners subsequently judged the relevance of those critiques on a five-point scale ranging from relevant critique to erroneous or harmful critique. The panel judged reviewers’ comments to be either relevant or somewhat relevant in 61 to 68% of cases, and either erroneous or possibly erroneous in 15 to 18%; the panel judged HyperCritic’s comments to be either relevant or somewhat relevant in 65% of cases, and either erroneous or possibly erroneous in 16%. Comparison of individual members of the panel showed large differences; for example, the portion of HyperCritic’s comments judged relevant ranged from 0 to 82%. We conclude that, from the perspective of general practitioners, critiques generated by the critiquing system HyperCritic are perceived equally beneficial as critiques generated by human reviewers. Different general practitioners, however, judge the critiques differently. Before auditing systems based on computer-based patient records that are acceptable to practitioners can be introduced, additional studies are needed to evaluate the reasons a physician may have for judging critiques to be irrelevant, and to evaluate the effect of critiques on physician behavior.

This study investigated the use and management of electronic mail (email) in Zimbabwe’s central government. Employing a mixed method research approach, the study used a pluralist ontological paradigm and a pragmatic epistemological paradigm within the convergent mixed methods research design. Quantitative responses from questionnaires were corroborated by qualitative findings from semi-structured interviews, personal observation and document reviews. The study was restricted to Zimbabwe’s central government, focusing on head offices of 22 government ministries situated in Zimbabwe’s capital city of Harare. The population of the study was 670. The Corona Virus Disease 2019 (COVID-19) lockdown imposed in Zimbabwe as from 30 March 2020 negatively affected data collection as some targeted respondents could not be accessed as the researcher had initially planned, leading to an overall response rate of 37.3%. Nonetheless, 12 out of 22 government ministries participated in the study. Quantitative data were analysed using Microsoft Excel 2010® and descriptive statistics while qualitative data were analysed thematically using Atlas.ti®. The study conformed to ethical standards of research as espoused in the University of South Africa’s ethical review guidelines. The study revealed that due to the adoption of electronic government and the inherent relative advantages of email, among other factors, there was increase in use of email as an official record in Zimbabwe’s central government. Nonetheless, management of email was still in its nascent stages and was largely poorly articulated. Poor email classification, filing, appraisal, security, preservation and disposal were largely traceable to deficiencies in legal, policy and procedural frameworks as well as skills and information and communication technology infrastructural challenges. These in turn triggered email retrieval, access, preservation and authenticity challenges. This study was a first local research to address both the use and management of email in a single study and one which proposed a framework for the effective use and management of email where a call was made to match increase in use of email with increase in professional management of the same. The proposed framework may go a long way in influencing proper and professional use and management of email in Zimbabwe’s central government and similar organisations.
Information Science
D. Phil. (Information Science)

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.