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Forsyth, Rowena Public Health & Community Medicine Faculty of Medicine UNSW. "Tricky technology, troubled tribes: a video ethnographic study of the impact of information technology on health care professionals??? practices and relationships." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/30175.
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Whilst technology use has always been a part of the practice of health care delivery, more recently, information technology has been applied to aspects of clinical work concerned with documentation. This thesis presents an analysis of the ways that two professional groups, one clinical and one ancillary, at a single hospital cooperatively engage in a work practice that has recently been computerised. It investigates the way that a clinical group???s approach to and actual use of the system creates problems for the ancillary group. It understands these problems to arise from the contrasting ways that the groups position their use of documentation technology in their local definitions of professional status. The data on which analysis of these practices is based includes 16 hours of video recordings of the work practices of the two groups as they engage with the technology in their local work settings as well as video recordings of a reflexive viewing session conducted with participants from the ancillary group. Also included in the analysis are observational field notes, interviews and documentary analysis. The analysis aimed to produce a set of themes grounded in the specifics of the data, and drew on TLSTranscription?? software for the management and classification of video data. This thesis seeks to contribute to three research fields: health informatics, sociology of professions and social science research methodology. In terms of health informatics, this thesis argues for the necessity for health care information technology design to understand and incorporate the work practices of all professional groups who will be involved in using the technology system or whose work will be affected by its introduction. In terms of the sociology of professions, this thesis finds doctors and scientists to belong to two distinct occupational communities that each utilise documentation technology to different extents in their displays of professional competence. Thirdly, in terms of social science research methodology, this thesis speculates about the possibility for viewing the engagement of the groups with the research process as indicative of their reactions to future sources of outside perturbance to their work.
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Masiza, Melissa. "Factors affecting the adoption and meaningful use of electronic medical records in general practices." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1018561.
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Patients typically enter the healthcare systems at the primary care level from where they are further referred to specialists or hospitals as necessary. In the private healthcare system, primary care is provided by a general practitioner (GP). A GP will refer a patient to a specialist for treatment when necessary, while the GP remains the main healthcare provider. The provision of care is, thus, fragmented which results in continuity of care becoming a challenge. Furthermore, the majority of healthcare providers continue to use paper-based systems to capture and store patient medical data. However, capturing and storing patient medical data via electronic methods, such as Electronic Medical Records (EMRs), has been found to improve continuity of care. Despite this benefit, research reveals that smaller practices are slow to adopt electronic methods of record keeping. Hence this explorative research attempts to identify factors that affect the lack of adoption and meaningful use of EMRs in general practices. Four general practices are surveyed through patient and staff questionnaires, as well as GP interviews. Socio-Technical Systems (STS) theory is used as a theoretical lens to formulate the resulting factors. The findings of the research indicate specific factors that relate to either the social, environmental or technical sub-systems of the socio-technical system, or an overlap between these sub-systems. It is significant to note that within these sub-systems, the social sub-system plays a key role. This is due to various reasons revealed by this research. Furthermore, multiple perceptions emerged from the GP and patient participants during the analysis of the findings. These perceptions may have an influence on the adoption and potential meaningful use of an EMR in a general practice. Additionally, the socio-technical factors identified from this research highlight the challenges related to encouraging the adoption and meaningful use of EMRs. These challenges are introduced by the complexities represented by these factors. Nevertheless, addressing the factors will contribute towards improving the rate of adoption and meaningful use of EMRs in small practices.
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Vu, Manh Tuan. "Literature review implementation of electronic medical records what factors are driving it? /." Thesis, Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42997896.
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Tse, Pui-yin Fiona, and 謝佩妍. "Systematic review : the return on investment of EHR implementation and associated key factors leading to positive return-on-investment." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193818.
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Background: Implementations of national electronic health record (EHR) were currently underway worldwide as a core objective of eHealth strategies. It was widely believed that implementation of EHR might lead to considerable financial savings. This paper aimed to conduct a systematic review to assess return-on-investment (ROI) of HER implementation and to identify areas with greatest potential to positive ROI for ongoing deliberation on continuous development of EHR.
Methodology: An inclusive string was developed to search English paper published between January 2003 and June 2013. This paper only included studies meet the following criteria 1) Primary study; 2) Involve a computerized system with electronic health record; and 3) include some form of economic evaluation. Critical appraisal was undertaken and articles with higher quality were selected. Hard ROI and soft ROI defined for EHR implementation were adopted as outcome metrics to examine both tangible and intangible return of EHR implementation.
Results: A total of 18 articles were examined for data extraction and synthesis. Most of the available evidences came from pre-post evaluation or cross-sectional analysis without uniform standards for reporting. Findings of 56% of the articles indicated that there is cost saving after EHR implementation while 17% of the articles indicated loss in totalrevenue. The remaining articles concluded that there is no association between cost reduction and EHR implementation. Among the defined hard ROI, most studies mentioned the positive effect in resource reduction. Some authors argued that the resource was reallocated to other initiatives and resulted in negligible cost saving. According to the selected literatures, evidences showed that EHR was able to achieve defined soft ROI, especially for improving caring process, but the overall outcome was subject to individual practice. Authors of 12 out of 18 articles have identified the factor leading to positive return and provided recommendation toward successful EHR implementation. Other than implying helpful EHR functions and promoting practice change, additional incentive on quality improvement and performance benchmarking should be considered. The organizations and EHR systems studied in the articles examined were vastly different; it would be desirable if a controlled study adopting EHR with uniform standards can be performed to evaluate the ROI of different clinical settings.
Conclusions: The benefits of EHR are not guaranteed, it requires change of practice and substantial efforts. Healthcare industries have to equip themselves for implementing the new technology and to exploit the usage for better clinical outcome.published_or_final_version
Public Health
Master
Master of Public Health
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Herbst, Abraham J. "The use of evaluation in the design and development of interactive medical record systems." Master's thesis, University of Cape Town, 1988. http://hdl.handle.net/11427/27210.
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An explorative study was done to develop an evaluation methodology. This method can be applied during the development of interactive medical record systems in order to provide information which can be used to improve user interaction with the system. Th e evaluation methodology consists of a number of interactive sessions with potential users of the interactive medical record system. During the first two sessions the subjects are trained to use the system. During the third and last session the subjects are videotaped while they are doing a set of benchmark tasks on the system under evaluation. The video recordings are analysed to obtain performance data. This performance data consists of task timings and a list of problems experienced (errors made) by the subjects. The systems evaluated during the study were a problem-oriented manual medical record and an interactive computerized medical record. The computerized record system was specifically developed for this study. The design and subsequent improvements to this system are documented in the study.
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Chava, Nalini. "Administrative reporting for a hospital document scanning system." Virtual Press, 1996. http://liblink.bsu.edu/uhtbin/catkey/1014839.
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This thesis will examine the manual hospital document retrieval system and electronic document scanning system. From this examination, requirements will be listed for the Administrative Reporting for the Hospital Document Scanning System which will provide better service and reliability than the previous systems. To assure that the requirements can be met, this will be developed into a working system which is named as the Administrative Reporting for the Hospital Document Scanning System(ARHDSS).Department of Computer Science
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Mxoli, Ncedisa Avuya Mercia. "Guidelines for secure cloud-based personal health records." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/14134.
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Traditionally, health records have been stored in paper folders at the physician’s consulting rooms – or at the patient’s home. Some people stored the health records of their family members, so as to keep a running history of all the medical procedures they went through, and what medications they were given by different physicians at different stages of their lives. Technology has introduced better and safer ways of storing these records, namely, through the use of Personal Health Records (PHRs). With time, different types of PHRs have emerged, i.e. local, remote server-based, and hybrid PHRs. Web-based PHRs fall under the remote server-based PHRs; and recently, a new market in storing PHRs has emerged. Cloud computing has become a trend in storing PHRs in a more accessible and efficient manner. Despite its many benefits, cloud computing has many privacy and security concerns. As a result, the adoption rate of cloud services is not yet very high. A qualitative and exploratory research design approach was followed in this study, in order to reach the objective of proposing guidelines that could assist PHR providers in selecting a secure Cloud Service Provider (CSP) to store their customers’ health data. The research methods that were used include a literature review, systematic literature review, qualitative content analysis, reasoning, argumentation and elite interviews. A systematic literature review and qualitative content analysis were conducted to examine those risks in the cloud environment that could have a negative impact on the secure storing of PHRs. PHRs must satisfy certain dimensions, in order for them to be meaningful for use. While these were highlighted in the research, it also emerged that certain risks affect the PHR dimensions directly, thus threatening the meaningfulness and usability of cloud-based PHRs. The literature review revealed that specific control measures can be adopted to mitigate the identified risks. These control measures form part of the material used in this study to identify the guidelines for secure cloud-based PHRs. The guidelines were formulated through the use of reasoning and argumentation. After the guidelines were formulated, elite interviews were conducted, in order to validate and finalize the main research output: i.e. guidelines. The results of this study may alert PHR providers to the risks that exist in the cloud environment; so that they can make informed decisions when choosing a CSP for storing their customers’ health data.
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Wong, Sze-nga, and 王絲雅. "The impact of electronic health record on diabetes management : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193850.
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Objectives: To investigate the impact of electronic health record (EHR) on diabetes management through examination of the effectiveness of implementation of EHR and to improve the quality of care and the cost-effectiveness on the use of EHR.
Methods: Three databases, PubMed, Ovid Medline and Google Scholar, were searched with specific combination keywords including electronic medical record and electronic health record, and diabetes. Quality appraisal and extraction of data were conducted on literature that met with the inclusion criteria.
Results: 10 literature studies, a total of 204,251 participants with diabetes, were included in this study. All subjects, with similar demographic and clinical characteristics, were from clinic and primary care setting with the use of EHR. Different outcome measures were compared and to evaluate the effectiveness of EHR on quality of care and cost-effectiveness.
Discussion: The impact of EHR on effectiveness of diabetes management, potential factors of barrier for adoption and the limitation for implementation of EHR were discussed. These suggested that further research is needed to have stronger evidence to widespread the use of EHR in Hong Kong as a future direction on public health issue.
Conclusion: In this systematic review, EHR showed potential benefit in improving the quality of care and reduce the health care expenditure for long term running. Patient safety and efficiency are yet to be covered in the studies. Further research is needed on the acceptability and applicability of the use of EHR in Hong Kong.published_or_final_version
Public Health
Master
Master of Public Health
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Song, Lihong. "Medical concept embedding with ontological representations." HKBU Institutional Repository, 2019. https://repository.hkbu.edu.hk/etd_oa/703.
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Learning representations of medical concepts from the Electronic Health Records (EHRs) has been shown effective for predictive analytics in healthcare. The learned representations are expected to preserve the semantic meanings of different medical concepts, which can be treated as features and thus benefit a variety of applications. Medical ontologies have also been explored to be integrated with the EHR data to further enhance the accuracy of various prediction tasks in healthcare. Most of the existing works assume that medical concepts under the same ontological category should share similar representations, which however does not always hold. In particular, the categorizations in the categorical medical ontologies were established with various factors being considered. Medical concepts even under the same ontological category may not follow similar occurrence patterns in the EHR data, leading to contradicting objectives for the representation learning. In addition, these existing works merely utilize the categorical ontologies. Actually, it has been noticed that ontologies containing multiple types of relations are also available. However, studies rarely make use of the diverse types of medical ontologies. In this thesis research, we propose three novel representation learning models for integrating the EHR data and medical ontologies for predictive analytics. To improve the interpretability and alleviate the conflicting objective issue between the EHR data and medical ontologies, we propose techniques to learn medical concepts embeddings with multiple ontological representations. To reduce the reliance on labeled data, we treat the co-occurrence statistics of clinical events as additional training signals, which help us learn good representations even with few labeled data. To leverage the various domain knowledge, we also consider multiple medical ontologies (CCS, ATC and SNOMED-CT) and propose corresponding attention mechanisms so as to take the best advantage of the medical ontologies with better interpretability. Our proposed models can achieve the final medical concept representations which align better with the EHR data. We conduct extensive experiments, and our empirical results prove the effectiveness of the proposed methods. Keywords: Bio/Medicine, Healthcare-AI, Electronic Health Record, Representation Learning, Machine Learning Applications
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Bickram-Shrestha, Ravi. "The patient information folder : an approach to the Electronic Patient Record." Thesis, Imperial College London, 1999. http://hdl.handle.net/10044/1/7473.
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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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Cucciniello, Maria. "Investigation of the use of ICT in the modernization of the health care sector : a comparative analysis." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/8733.
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This Ph.D. project started from a broad analysis aiming at investigating the key issues in the development of Information and Communication Technologies (ICT) in the health care sector, with the aim of making an in depth investigation to evaluate the effects of Electronic Medical Record (EMR) implementation on the organizations adopting them. Furthermore the study examined two study settings which have adopted the same EMR system produced by the same provider. This comparative study aims, in particular, to analyse how EMR systems are adopted by different health organizations focusing on the antecedents of the EMR project, on the implementation processes used and on the impacts produced. Diffusion theory, through the lens of socio-technical approach, represents the theoretical framework of the analysis. The research results are based on policy evaluation and case studies. The two hospitals selected for the case study analysis are the Regional Hospital of Local Health Authority in Aosta, Italy and the Royal Infirmary of Edinburgh, Scotland. In conducting the data collection several strategies have been used: documentary analysis, interviews and observations have been carried out. This work provides an overview of the key issues arising over e-health policy development through a comparative analysis of the UK and Italy and provides an insight into how EMR systems are adopted, implemented and evaluated within acute care organizations. The thesis is a comparative international research about the development of e-health and the use of ICT in health care sector. This approach makes a both a theoretical and methodological contribution. By focusing, in particular, on EMR systems, it offers to practitioners and policy makers a better basis of analysing ICT usage and its impacts on health care service delivery.
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Van, der Westhuizen Eldridge Welner. "A framework for personal health records in online social networking." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1012382.
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Since the early 20th century, the view has developed that high quality health care can be delivered only when all the pertinent data about the health of a patient is available to the clinician. Various types of health records have emerged to serve the needs of healthcare providers and more recently, patients or consumers. These health records include, but are not limited to, Personal Health Records, Electronic Heath Records, Electronic Medical Records and Payer-Based Health Records. Payer-Based Health Records emerged to serve the needs of medical aids or health care plans. Electronic Medical Records and Electronic Health Records were targeted at the healthcare provider market, whereas a gap developed in the patient market. Personal Health Records were developed to address the patient market, but adoption was slow at first. The success of online social networking reignited the flame that Personal Health Records needed and online consumer-based Personal Health Records were developed. Despite all the various types of health records, there still seems to be a lack of meaningful use of personal health records in modern society. The purpose of this dissertation is to propose a framework for Personal Health Records in online social networking, to address the issue of a lack of a central, accessible repository for health records. In order for a Personal Health Record to serve this need it has to be of meaningful use. The capability of a PHR to be of meaningful use is core to this research. In order to determine whether a Personal Health Record is of meaningful use, a tool is developed to evaluate Personal Health Records. This evaluation tool takes into account all the attributes that a Personal Health Record which is of meaningful use should comprise of. Suitable ratings are allocated to enable measuring of each attribute. A model is compiled to facilitate the selection of six Personal Health Records to be evaluated. One of these six Personal Health Records acts as a pilot site to test the evaluation tool in order to determine the tool’s utility and effect improvements. The other five Personal Health Records are then evaluated to measure their adherence to the attributes of meaningful use. These findings, together with a literature study on the various types of health records and the evaluation tool, inform the building blocks used to present the framework. It is hoped that the framework for Personal Health Records in online social networking proposed in this research, may be of benefit to provide clear guidance for the achievement of a central or integrated, accessible repository for health records through the meaningful use of Personal Health Records.
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Harmse, Magda Susanna. "Physicians' perspectives on personal health records: a descriptive study." Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/6876.
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A Personal Health Record (PHR) is an electronic record of a patient’s health-related information that is managed by the patient. The patient can give access to other parties, such as healthcare providers and family members, as they see fit. These parties can use the information in emergency situations, in order to help improve the patient’s healthcare. PHRs have an important role to play in ensuring that a patient’s complete health history is available to his healthcare providers at the point of care. This is especially true in South Africa, where the majority of healthcare organizations still rely on paper-based methods of record-keeping. Research indicates that physicians play an important role in encouraging the adoption of PHRs amongst patients. Whilst various studies have focused on the perceptions of South African citizens towards PHRs, to date no research has focused on the perceptions of South African physicians. Considering the importance of physicians in encouraging the adoption of PHRs, the problem being addressed by this research project thus relates to the lack of information relating to the perceptions of South African physicians of PHRs. Physicians with private practices at private hospitals in Port Elizabeth, South Africa were surveyed in order to determine their perceptions towards PHRs. Results indicate perceptions regarding benefits to the physician and the patient, as well as concerns to the physician and the patient. The levels of trust in various potential PHR providers and the potential uses of a PHR for the physician were also explored. The results of the survey were compared with the results of relevant international literature in order to describe the perceptions of physicians towards PHRs.
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Sze, Hang-chi Candice, and 施行芝. "An evaluation of the Hospital Authority public private interface: electronic patient record (PPI-ePR)sharing." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B39724591.
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Chipfumbu, Colletor Tendeukai. "Engendering the meaningful use of electronic medical records: a South African perspective." Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/18420.
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Theoretically, the use of Electronic Medical Records (EMRs) holds promise of numerous benefits in healthcare provision, including improvement in continuity of care, quality of care and safety. However, in practice, there is evidence that the adoption of electronic medical records has been slow and where adopted, often lacks meaningful use. Thus there is a clear dichotomy between the ambitions for EMR use and the reality of EMR implementation. In the USA, a legislative approach was taken to turn around the situation. Other countries such as Canada and European countries have followed suit (in their own way) to address the adoption and meaningful use of electronic medical records. The South African e-Health strategy and the National Health Normative Standards Framework for Interoperability in eHealth in South Africa documents both recommend the adoption of EMRs. Much work has been done to establish a baseline for standards to ensure interoperability and data portability of healthcare applications and data. However, even with the increased focus on e-Health, South Africa remains excessively reliant on paper-based medical records. Where health information technologies have been adopted, there is lack of coordination between and within provinces, leading to a multitude of systems and vendors. Thus there is a lack of systematic adoption and meaningful use of EMRs in South Africa. The main objective of this research is to develop the components required to engender meaningful use of electronic medical records in the South African healthcare context. The main contributors are identified as EMR certification and consistent, proper use of certified EMRs. Literature review, a Delphi study and logical argumentation are used to develop the relevant components for the South African healthcare context. The benefits of EMRs can only be realized through systematic adoption and meaningful use of EMRs, thus this research contributes to providing a road map for engendering the meaningful use of EMRs with the ultimate aim of improving healthcare in the South African healthcare landscape.
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Williams, Patricia A. "An investigation into information security in general medical practice." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/274.
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Increased demand by governments and patients for better healthcare communication has seen a growth in adoption of electronic medical records, with general practice as the cornerstone of this distributed environment. In this progressively more electronic state, general practice is charged with the responsibility to ensure confidentiality and privacy of patient infonnation. However, evidence suggests that protection of patient information is poorly handled in general practice. The deficiency in awareness of vulnerability and risk, together with the lack of appropriate controls and knowledge, leaves medical practice insecure and potentially vulnerable to information security breaches.
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Ling, Meng-Chun. "Senior health care system." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2785.
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Senior Health Care System (SHCS) is created for users to enter participants' conditions and store information in a central database. When users are ready for quarterly assessments the system generates a simple summary that can be reviewed, modified, and saved as part of the summary assessments, which are required by Federal and California law.
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Bantom, Simlindile Abongile. "Accessibility to patients’ own health information: a case in rural Eastern Cape, South Africa." Thesis, Cape Peninsula University of Technology, 2016. http://hdl.handle.net/20.500.11838/2411.
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Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016.Access to healthcare is regarded as a basic and essential human right. It is widely known that ICT solutions have potential to improve access to healthcare, reduce healthcare cost, reduce medical errors, and bridge the digital divide between rural and urban healthcare centres. The access to personal healthcare records is, however, an astounding challenge for both patients and healthcare professionals alike, particularly within resource-restricted environments (such as rural communities). Most rural healthcare institutions have limited or non-existent access to electronic patient healthcare records. This study explored the accessibility of personal healthcare records by patients and healthcare professionals within a rural community hospital in the Eastern Cape Province of South Africa. The case study was conducted at the St. Barnabas Hospital with the support and permission from the Faculty of Informatics and Design, Cape Peninsula University of Technology and the Eastern Cape Department of Health. Semi-structured interviews, observations, and interactive co-design sessions and focus groups served as the main data collection methods used to determine the accessibility of personal healthcare records by the relevant stakeholders. The data was qualitatively interpreted using thematic analysis. The study highlighted the various challenges experienced by healthcare professionals and patients, including time-consuming manual processes, lack of infrastructure, illegible hand-written records, missing records and illiteracy. A number of recommendations for improved access to personal healthcare records are discussed. The significance of the study articulates the imperative need for seamless and secure access to personal healthcare records, not only within rural areas but within all communities.
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Mashima, Daisuke. "Safeguarding health data with enhanced accountability and patient awareness." Diss., Georgia Institute of Technology, 2012. http://hdl.handle.net/1853/45775.
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Several factors are driving the transition from paper-based health records to electronic health record systems. In the United States, the adoption rate of electronic health record systems significantly increased after "Meaningful Use" incentive program was started in 2009. While increased use of electronic health record systems could improve the efficiency and quality of healthcare services, it can also lead to a number of security and privacy issues, such as identity theft and healthcare fraud. Such incidents could have negative impact on trustworthiness of electronic health record technology itself and thereby could limit its benefits.
In this dissertation, we tackle three challenges that we believe are important to improve the security and privacy in electronic health record systems. Our approach is based on an analysis of real-world incidents, namely theft and misuse of patient identity, unauthorized usage and update of electronic health records, and threats from insiders in healthcare organizations. Our contributions include design and development of a user-centric monitoring agent system that works on behalf of a patient (i.e., an end user) and securely monitors usage of the patient's identity credentials as well as access to her electronic health records. Such a monitoring agent can enhance patient's awareness and control and improve accountability for health records even in a distributed, multi-domain environment, which is typical in an e-healthcare setting. This will reduce the risk and loss caused by misuse of stolen data. In addition to the solution from a patient's perspective, we also propose a secure system architecture that can be used in healthcare organizations to enable robust auditing and management over client devices. This helps us further enhance patients' confidence in secure use of their health data.
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Mostert-Phipps, Nicolette. "Health information technologies for improved continuity of care: a South African perspective." Thesis, Nelson Mandela Metropolitan University, 2011. http://hdl.handle.net/10948/1619.
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The fragmented nature of modern health care provision makes it increasingly difficult to achieve continuity of care. This is equally true in the context of the South African healthcare landscape. This results in a strong emphasis on the informational dimension of continuity of care which highlights the importance of the continuity of medical records. Paper-based methods of record keeping are inadequate to support informational continuity of care which leads to an increased interest in electronic methods of record keeping through the adoption of various Health Information Technologies (HITs). This research project investigates the role that various HITs such as Personal Health Records (PHRs), Electronic Medical Records (EMRs), and Health Information Exchanges (HIEs) can play in improving informational continuity of care resulting in the development of a standards-based technological model for the South African healthcare sector. This technological model employs appropriate HITs to address the problem of informational continuity of care in the South African healthcare landscape The benefits that are possible through the adoption of the proposed technological model can only be realized if the proposed HITs are used in a meaningful manner once adopted and implemented. The Delphi method is employed to identify factors that need to be addressed to encourage the adoption and meaningful use of such HITs in the South African healthcare landscape. Lastly, guidelines are formulated to encourage the adoption and meaningful use of HITs in the South African healthcare landscape to improve the continuity of care. The guidelines address both the technological requirements on a high level, as well as the factors that need to be addressed to encourage the adoption and meaningful use of the technological components suggested. These guidelines will play a significant role in raising awareness of the factors that need to be addressed to create an environment conducive to the adoption and meaningful use of appropriate HITs in order to improve the continuity of care in the South African healthcare landscape.
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Sukhija, Ruchi. "Document imaging application." CSUSB ScholarWorks, 2007. https://scholarworks.lib.csusb.edu/etd-project/3217.
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The purpose of this project was to develop a document imaging application. By scanning the documents into an electronic repository, medical staff will be able to more easily store and locate these records. To make the application user friendly and facilitate staff access to patient medical records, the application is wed-based and uses the Oracle Application Server to implement a multitiered model.
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Ogundaini, Oluwamayowa Oaikhena. "Adoption and use of electronic healthcare information systems to support clinical care in public hospitals of the Western Cape, South Africa." Thesis, Cape Peninsula University of Technology, 2016. http://hdl.handle.net/20.500.11838/2417.
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Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016.In the Western Cape, South Africa, despite the prospective benefits that e-Health information systems (e-Health IS) offer to support the healthcare sector; there are limitations in terms of usability, functionality and peculiar socio-technical factors. Thus, healthcare professionals do not make the most use of the implemented e-Health IS. Unfortunately, explanations remain tentative and unclear, yet non-usage of the e-Health IS defeats the objectives of its adoption, in the sense that the plan to improve and deliver quality healthcare service in the public sector may not be achieved as envisaged. The aim of the study was to acquire explanations to the causes of the limitations regarding the adoption and, particularly, the use (or non-use) of e-Health IS by clinical staff in the public healthcare institutions in South Africa. The choice of research approach was informed by the research problem, objectives, and the main research question. By the reasons of the subjective and socio-technical nature of the phenomenon, a deductive approach was adopted for this investigation. The nominalist ontology and interpretivist epistemology positions were taken by the researcher as a lens to conduct this research; which informed a qualitative methodology for this investigation. The purposive sampling technique was used to identify the appropriate participants from different hospital levels consisting of Hospital Administrative staff, and Clinical staff (Clinicians and Nurses) of relative experiences in their clinical units. Subsequently, the Unified Theory of Acceptance and Use of Technology (UTAUT) and content analysis technique were used to contextualize, simplify, and analysis the text data transcripts. The findings indicate that healthcare professionals have a high level of awareness and acceptance to use implemented e-Health IS. There are positive perceptions on the expected outcomes, that e-Health IS would improve processes and enhance healthcare services delivery in the public healthcare sector. Also, findings indicate that social influence plays a vital role especially on the willingness of individuals (or groups); as the clinical staff are influenced by their colleagues despite the facilitating conditions provided by the hospital management. Further, findings indicate that it is somewhat problematic to maintain balance in running a parallel paper-electronic system in the hospital environment. Hence, the core factors that influence successful adoption and use of e-Health IS include; willingness of an individual (or group) to accept and use a technology, the performance expectancy, social influence among professionals in the healthcare scenery and adequate facilitating conditions. In summary, it is recommended that there should be an extensive engagement inclusive of all respective stakeholders involved in the adoption processes. This would ensure that e-Health IS are designed to meet both practical organizational and clinical needs (and expectations) with respect to the hospital contexts.
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Van, der Watt Cecil Clifford. "Design considerations of a semantic metadata repository in home-based healthcare." Thesis, Cape Peninsula University of Technology, 2011. http://hdl.handle.net/20.500.11838/2300.
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Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2011.The research was conducted as part of a socio-tech initiative undertaken at the Cape Peninsula University of Technology. The socio-tech initiative overall focus was on addressing issues faced by rural and under-resourced communities in South Africa, specifically looking at Home-Based Healthcare (HBHC) primarily in the Western Cape. As research into the HBHC context in rural and under-resourced communities continued numerous issues around data and data-elements came to light. These data issues were especially prevalent in relation to the various paper forms being used by the HBHC initiatives that attempt to deliver care in these communities. The communities have the tendency to suffer from poor access to formal healthcare services and healthcare facilities. The data issues were primarily in terms of how data was defines and used within the HBHC initiatives. Within the HBHC initiatives that cater for rural and under-resourced communities there was a clear prevalence of paper-based systems, and a very low penetration of IT-based solution. Because similar and related data-elements are used throughout the paper forms and within different context these data-elements are inconsistently used and presented. The paper forms further obfuscate these inconsistencies as the paper forms regularly change due to internal and external factors. When these paper forms are changed date elements are added or removed without the changes to the underlying ontologies being considered.
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Harvey, Brett D. "A code of practice for practitioners in private healthcare: a privacy perspective." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/521.
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Whereas there are various initiatives to standardize the storage, processing and use of electronic patient information in the South African health sector, the sector is fragmented through the adoption of various approaches on national, provincial and district levels. Divergent IT systems are used in the public and private health sectors (“Recommendations of the Committee on …” 2003). Furthermore, general practitioners in some parts of the country still use paper as a primary means of documentation and storage. Nonetheless, the use of computerized systems is increasing, even in the most remote rural areas. This leads to the exposure of patient information to various threats that are perpetuated through the use of information technology. Irrespective of the level of technology adoption by practitioners in private healthcare practice, the security and privacy of patient information remains of critical importance. The disclosure of patient information whether intentional or not, can have dire consequences for a patient. In general, the requirements pertaining to the privacy of patient information are controlled and enforced through the adoption of legislation by the governing body of a country. Compared with developed nations, South Africa has limited legislation to help enforce privacy in the health sector. Conversely, Australia, New Zealand and Canada have some of the most advanced legislative frameworks when it comes to the privacy of patient information. In this dissertation, the Australian, New Zealand, Canadian and South African health sectors and the legislation they have in place to ensure the privacy of health information, will be investigated. Additionally, codes of practice and guidelines on privacy of patient information for GPs, in the afore-mentioned countries, will be investigated to form an idea as to what is needed in creating and formulating a new code of practice for the South African GP, as well as a pragmatic tool (checklist) to check adherence to privacy requirements.
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Kelman, Christopher William, and christopher kelman@cmis csiro au. "Monitoring Health Care Using National Administrative Data Collections." The Australian National University. National Centre for Epidemiology and Population Health, 2001. http://thesis.anu.edu.au./public/adt-ANU20020620.151547.
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With the inevitable adoption of information technology into all areas of human pursuit, the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation.
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Evaluation of health services has become increasingly important to provide indicators of the benefits, risks and cost-effectiveness of treatments. However, if administrative data are to be used for this purpose, several questions must first be addressed: Are the current data collections accessible? What outcome measures can be derived from these data? Can privacy issues be managed? Could the quality of the data be improved? Is the existing infrastructure adequate to supply data for evaluation purposes? Could the existing system provide a basis for the development of an integrated health information system?
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The aims of the project were:
· To examine the potential for using administrative data to generate outcome measures and surveillance indicators.
· To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework.
· To compare the Australian health-service data system with the current international state-of-the-art.
· To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity.
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The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. The potential to evaluate outcomes was investigated using all national health-service information currently available in electronic form. Record linkage techniques were used to combine and augment the existing data collections. Australias national health databases are to varying degrees, amenable to such linkage and cover doctor visits, pharmaceuticals, hospital admissions and deaths. The study focused on medical devices as an illustrative case but the results are applicable to the routine assessment of all medical and surgical interventions.
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For the Australian Medical Devices study, the records of 5,316 patients who had medical device implants in 1993-94 were selected from the archives of a major private health insurer. Five groups of medical implants were studied: heart valves, pacemakers, hips, vascular grafts and intra-optic lenses. Outcomes for these patients, including death, re-operation and health service utilisation, were compared and analysed.
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A comparison study was performed using data from the Manitoba Health database in Winnipeg, Canada. Manitoba provides a very similar demographic group to that found in Australia and is an example of a prototype integrated-health-information system. One of the principal advantages for research is that personally identified data about medical and hospital services are collected for all patients. Selection bias is eliminated because individual consent is not required for this type of research and all selected patients could be included in the study.
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The two studies revealed many barriers to the use of administrative data for health outcomes research. Service event data for the Australian cohort could be collected but only after long delays and hospital morbidity data were not available for the entire cohort. In contrast to the situation in Australia, the Manitoba data were both accessible and complete, but were lacking in detail in some areas.
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Analysis of the collected data demonstrated that without the addition of clinical data only general indications of trends could be deduced. However, with minimal supplementary clinical data, it was possible to examine differences in performance between brands of medical devices thus indicating one of the uses for this type of data collection.
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In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). The need for the establishment of a systemic quality management system for health care is discussed.
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The study shows that linked administrative data can provide information about health outcomes which is not readily available from other sources. If expanded and integrated, the system that is currently used to collect and manage administrative data, could provide the basis for a national health information system. This system would provide many benefits for health care. Benefits would include the monitoring, surveillance and cost-effectiveness analysis of new and existing treatments involving medical devices, drugs and surgical procedures. An integrated health information system could thus provide for both clinical and administrative needs, while in addition providing data for research.
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Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures.
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Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.
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Lee, Koon-hung, and 勵冠雄. "Communicating patients' medical information by online electronic health record system: physicians anddentists' perception." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31971933.
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Ho, Lai-ming, and 何禮明. "Evaluation of the development and impact of clinical information systems." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B31236984.
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Roboji, Zukiswa. "Factors influencing reports on anti-retroviral therapy sites at Amathole health district." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1020607.
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The study sought to investigate the factors influencing the contents of antiretroviral therapy (ART) reports in the Amathole Health District of the Eastern Cape Province. A qualitative and quantitative study was conducted to assess the challenges that inhibit this phenomenon. Structurally, the population consists of Amahlati and Nkonkobe sub-districts. Operational managers, information officers, professional nurses, data capturers, and administration clerks were randomly selected from sixteen facilities. Data collection was done on semi-structured interviews, questionnaires; observations were done using the probability sampling method, and the findings were analysed according to the same technique. The study revealed that the District Health Information System (DHIS) is the universal data management and reporting system which all healthcare and ART facilities are using to manage ART. However, regardless of all these universal arrangements such as the use of the DHIS to aid in reporting, the contents of ART reports from various facilities have not been uniform due to various factors. There is a lack of a reliable network to link DHIS computers across facilities. The shift from paper-based to electronic data management has caused the difficulties in the collating and management of ART data since some facilities are manual paper- based while others are automated using the modern DHIS. Lack of daily capturing and validation is a major challenge across the ART facilities. Further, there are Non-Governmental Organisations(NGOs) such as AFRICARE and the IYDSA that have signed a memorandum of understanding (MOU) with the district to provide a budgetary support for staff training in data management of ART reports in the district. While the NGOs keep on assisting the ART facilities with data management, there is a lack of skills transfer. The district could not account on follow-up of ART patients from one facility to another. This is increasing the number of defaulting in ART patients, thus there is no accurate figures on retention of patients in ART Programme. The officials from ART sites tend to use their own transport to carry data from facilities to the district offices and this resulted in late submission of reports. The study thus recommends that, inter alia, data management and trainings should be done to improve data quality in reporting, a reliable computer network be installed, backed-up and maintained for data and report management in the all healthcare facilities. All the ART sites should adopt and use the automated data management system for universality and eliminating the faults of manual paper data management and reporting. This would ensure that the contents of ART reports are uniform and a true reflection of the situation on the ground towards universal access to ART and healthcare in the Amathole Health District, and South Africa at large.
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Ward, Gary Ray. "Training the trainer: A manual for Kaiser Permanente educators who teach employees to use computer systems." CSUSB ScholarWorks, 1991. https://scholarworks.lib.csusb.edu/etd-project/758.
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Maxwell, Karen Elizabeth. "Designing the Plane While Flying It: A Case Study on Nursing Faculty Development during Academic Electronic Health Records Integration in a Small Liberal Arts College." PDXScholar, 2014. https://pdxscholar.library.pdx.edu/open_access_etds/1930.
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The expectation of graduating nurses today is to be knowledgeable and responsive to rapidly changing technology in the health care environment. Although federal mandates, Institute of Medicine (IOM) recommendations, and nursing program accreditation initiatives are pushing an "informatics" healthcare agenda by promoting the implementation of electronic health record (EHR) systems by 2014 in all healthcare facilities, very few US nursing schools provide students with access and training in, EHR systems. In addition, nursing faculty may not have a clear understanding of healthcare informatics; the use of information and technology to communicate, manage knowledge, mitigate error, and support decision-making. Nursing education must address faculty issues related to this innovative paradigm in order to keep pace and participate as co-creators of relevant informatics technology curriculum that prepares graduates for real life workforce.
Understanding the challenges, concerns, and successes in implementing informatics may help nurse educators as they develop curriculum and teach in this environment. This case study explores and describes, with nursing faculty of a small liberal arts college, faculty knowledge, skills, and attitudes (KSAs) as they participate in an action research framed curriculum development program for informatics academic EHR (AEHR) integration. The research question:What is the experience of nursing educators and nursing faculty members involved in the integration of an AEHR project framed in the Learning by Developing model at a small liberal arts college school of nursing?
Significant insights as participants in the study influenced nurse educators' ideas regarding collaborative curricular design, meaningful assignments, and the importance of feedback.
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Pacheco, Edson José. "MorphoMap: mapeamento automático de narrativas clínicas para uma terminologia médica." Universidade Tecnológica Federal do Paraná, 2009. http://repositorio.utfpr.edu.br/jspui/handle/1/124.
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A documentação clínica requer a representação de situações complexas como pareceres clínicos, imagens e resultados de exames, planos de tratamento, dentre outras. Entre os profissionais da área de saúde, a linguagem natural é o meio principal de documentação. Neste tipo de linguagem, caracterizada por uma elevada flexibilidade sintática e léxica, é comum a prevalência de ambigüidades em sentenças e termos. O objetivo do presente trabalho consiste em mapear informações codificadas em narrativas clínicas para uma ontologia de domínio (SNOMED CT). Para sua consecução, aplicaram-se ferramentas processamento de linguagem natural (PLN), assim como adotaram-se heurísticas para o mapeamento de textos para ontologias. Para o desenvolvimento da pesquisa, uma amostra de sumários de alta foi obtida junto ao Hospital das Clínicas de Porto Alegre, RS, Brasil. Parte dos sumários foi manualmente anotada, com a aplicação da estratégia de Active Learning, visando a preparação de um corpus para o treinamento de ferramentas de PLN. Paralelamente, foram desenvolvidos algoritmos para o pré-processamento dos textos ‘sujos’ (com grande quantidade de erros, acrônimos, abreviações, etc). Com a identificação das frases nominais, resultado do processamento das ferramentas de PLN, diversas heurísticas (identificação de acrônimos, correção ortográfica, supressão de valores numéricos e distância conceitual) para o mapeamento para a SNOMED CT foram aplicadas. A versão atual da SNOMED CT não está disponível em português, demandando o uso de ferramentas para processamento multi-lingual. Para tanto, o pesquisa atual é parte da iniciativa do projeto MorphoSaurus, por meio do qual desenvolve-se e disponibiliza-se um thesaurus multi-língue (português, alemão, inglês, espanhol, sueco, francês), bem como componentes de software que permitem o processamento inter-lingual. Para realização da pesquisa, 80% da base de sumários foi analisada e manualmente anotada, resultando em um corpus de domínio (textos médicos e em português) que permitiu a especialização do software OpenNLP (baseado no modelo estatístico para o PLN e selecionado após a avaliação de outras soluções disponíveis). A precisão do etiquetador atingiu 93.67%. O thesaurus multi-língue do MorphoSaurus foi estendido, reestruturado e avaliado (automaticamente com a comparação por meio de textos comparáveis – ‘traduções de um mesmo texto para diferentes idiomas’) e sofreu intervenções objetivando a correção de imperfeições existentes, resultando na melhoria da cobertura lingüística, no caso do português, em 2%; e 50% para o caso do espanhol, medidas obtidas por meio do levantamento das curvas de precisão e revocação para a base do OHSUMED. Por fim, a codificação de informações de narrativas clínicas para uma ontologia de domínio é uma área de elevado interesse científico e clínico, visto que grande parte dos dados produzidos quando do atendimento médico é armazenado em texto livre e não em campos estruturados. Para o alcance deste fim, adotou-se a SNOMED CT. A viabilidade da metodologia de mapeamento foi demonstrada com a avaliação dos resultados do mapeamento automático contra um padrão ouro, manualmente desenvolvido, indicando precisão de 83,9%.Clinical documentation requires the representation of fine-grained descriptions of patients' history, evolution, and treatment. These descriptions are materialized in findings reports, medical orders, as well as in evolution and discharge summaries. In most clinical environments natural language is the main carrier of documentation. Written clinical jargon is commonly characterized by idiosyncratic terminology, a high frequency of highly context-dependent ambiguous expressions (especially acronyms and abbreviations). Violations of spelling and grammar rules are common. The purpose of this work is to map free text from clinical narratives to a domain ontology (SNOMED CT). To this end, natural language processing (NLP) tools will be combined with a heuristic of semantic mapping. The study uses discharge summaries from the Hospital das Clínicas de Porto Alegre, RS, Brazil. Parts of these texts are used for creating a training corpus, using manual annotation supported by active learning technology, used for the training of NLP tools that are used for the identification of parts of speech, the cleansing of "dirty" text passages. Thus it was possible to obtain relatively well-formed and unambiguous noun phrases, heuristics was implemented to semantic mapping between these noun phrases (in Portuguese) and the terms describing the SNOMED CT concepts (English and Spanish) uses the technology of morphosemantic indexing, using a multilingual subword thesaurus, provided by the MorphoSaurus system, the resolution of acronyms, and the identification of named entities (e.g. numbers). In this study, 80 per cent of the summaries are analyzed and manually annotated, resulting in a domain corpus that supports the specialization of the OpenNLP system, mainly following the paradigm of statistical natural language processing (the accuracy of the tagger obtained was 93.67%). Simultaneously, several techniques have been used for validating and improving the subword thesaurus. To this end, the semantic representations of comparable test corpora from the medical domain in English, Spanish, and Portuguese were compared with regard to the relative frequency of semantic identifiers, improving the corpus coverage (2% to Portuguese, and 50% to Spanish). The result was used as an input by a team of lexicon curators, which continuously fix errors and fill gaps in the trilingual thesaurus underlying the MorphoSaurus system. The progress of this work could be objectified using OHSUMED, a standard medical information retrieval benchmark. The mapping of text-encoded clinical information to a domain ontology constitutes an area of high scientific and practical interest due to the need for the analysis of structured data, whereas the clinical information is routinely recorded in a largely unstructured way. In this work the ontology used was SNOMED CT. The evaluation of mapping methodology indicates accuracy of 83.9%.
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Castilla, André Coutinho. "Instrumento de investigação clínico-epidemiológica em Cardiologia fundamentado no processamento de linguagem natural." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-16022009-165641/.
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O registro eletrônico do paciente (REP) está sendo gradativamente implantado no meio médico hospitalar. Grande parte das informações essenciais do REP está armazenada na forma de texto narrativo livre, dificultando operações de procura, análise e comparação de dados. O processamento de linguagem natural (PLN) refere-se a um conjunto de técnicas computacionais, cujo objetivo é a análise de texto através de conhecimentos léxicos, gramaticais e semânticos. O presente projeto propõe a criação de uma ferramenta computacional de investigação clínicoepidemiológica aplicada a textos narrativos médicos. Como metodologia propomos a utilização do processador de linguagem natural especializado em medicina MEDLEE desenvolvido para textos em Inglês. Para que seu uso seja possível textos médicos em Português são traduzidos ao Inglês automaticamente. A tradução automatizada (TA) é realizada utilizando o aplicativo baseado em regras SYSTRAN especialmente configurado para processar textos médicos através da incorporação de terminologias especializadas. O resultado desta seqüência de TA e PLN são informações conceituais que serão investigadas à procura de achados clínicos pré-definidos, atrvés de inferência lógica sobre uma ontologia. O objetivo experimental desta tese foi conduzir um estudo de recuperação de informações em um conjunto de 12.869 relatórios de radiografias torácicas à procura de vinte e dois achados clínicos e radiológicas. A sensibilidade e especificidade médias obtidas em comparação com referência formada pela opinião de três médicos radiologistas foram de 0,91 e 0,99 respectivamente. Os resultados obtidos indicam a viabilidade da procura de achados clínicos em relatórios de radiografias torácicas através desta metodologia de acoplamento da TA e PLN. Conseqüentemente em trabalhos futuros poderá ser ampliado o número de achados investigados, estendida a metodologia para textos de outras modalidades, bem como de outros idiomasThe Electronic Medical Record (EMR) is gradually replacing paper storage on clinical care settings. Most of essential information contained on EMR is stored as free narrative text, imposing several difficulties on automated data extraction and retrieval. Natural language processing (NLP) refers to computational linguistics tools, whose main objective is text analysis using lexical, grammatical and semantic knowledge. This project describes the creation of a computational tool for clinical and epidemiologic queries on narrative medical texts. The proposed methodology uses the specialized natural language processor MEDLEE developed for English language. To use this processor on Portuguese medical texts chest x-ray reports were Machine Translated into English. The machine translation (MT) was performed by SYSTRAN software, a rule based system customized with a specialized lexicon developed for this project. The result of serial coupling of MT an NLP is tagged text which needs further investigation for extracting clinical findings, whish was done by logical inference upon an ontolgy. The experimental objective of this thesis project was to investigate twenty-two clinical and radiological findings on 12.869 chest x-rays reports. Estimated sensitivity and specificity were 0.91 and 0.99 respectively. The gold standard reference was formed by the opinion of three radiologists. The obtained results indicate the viability of extracting clinical findings from chest x-ray reports using the proposed methodology through coupling MT and NLP. Consequently on future works the number of investigated conditions could be expanded. It is also possible to use this methodology on other medical texts, and on texts of other languages
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Etien-Gnoan, N'Da Brigitte. "L'encadrement juridique de la gestion électronique des données médicales." Thesis, Lille 2, 2014. http://www.theses.fr/2014LIL20022/document.
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La gestion électronique des données médicales consiste autant dans le simple traitement automatisé des données personnelles que dans le partage et l'échange de données relatives à la santé. Son encadrement juridique est assuré, à la fois, par les règles communes au traitement automatisé de toutes les données personnelles et par celles spécifiques au traitement des données médicales. Cette gestion, même si elle constitue une source d'économie, engendre des problèmes de protection de la vie privée auxquels le gouvernement français tente de faire face en créant l'un des meilleurs cadres juridiques au monde, en la matière. Mais, de grands chantiers comme celui du dossier médical personnel attendent toujours d'être réalisés et le droit de la santé se voit devancer et entraîner par les progrès technologiques. Le développement de la télésanté bouleverse les relations au sein du colloque singulier entre le soignant et le soigné. L'extension des droits des patients, le partage de responsabilité, l'augmentation du nombre d'intervenants, le secret médical partagé constituent de nouveaux enjeux avec lesquels il faut, désormais compter. Une autre question cruciale est celle posée par le manque d'harmonisation des législations augmentant les risques en cas de partage transfrontalier de données médicalesThe electronic management of medical data is as much in the simple automated processing of personal data in the sharing and exchange of health data . Its legal framework is provided both by the common rules to the automated processing of all personal data and those specific to the processing of medical data . This management , even if it is a source of economy, creates protection issues of privacy which the French government tries to cope by creating one of the best legal framework in the world in this field. However , major projects such as the personal health record still waiting to be made and the right to health is seen ahead and lead by technological advances . The development of e-health disrupts relationships within one dialogue between the caregiver and the patient . The extension of the rights of patients , sharing responsibility , increasing the number of players , the shared medical confidentiality pose new challenges with which we must now count. Another crucial question is posed by the lack of harmonization of legislation increasing the risks in cross-border sharing of medical
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Wandner, Hendrik. "Computergestützte Dokumentation von Patienten mit Lippen-Kiefer-Gaumenspalten." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 1997. http://dx.doi.org/10.18452/14424.
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Es wurde eine Datenbankmanagementsystem-Anwendung zur Dokumentation von Patienten mit Lippen-Kiefer-Gaumenspalten entwickelt. Ziel des Computerprogramms ist, anhand großer Patientenzahlen weitere statistisch abgesicherte Daten zur Heredität, anderen ätiologischen Faktoren, Epidemiologie und Therapiebewertung zu gewinnen. Besonderes Augenmerk wurde auf Angaben zu möglichen ursächlichen Faktoren der Spaltentstehung gelegt. Möglicherweise ergeben sich doch einmal durchgreifende präventive Maßnahmen bei Risikoschwangerschaften. Die Auswertung großer Patientenkollektive (seit 1948 etwa 3000 Spaltpatienten an der Charité) im objektiven Vergleich mit anderen Behandlungszentren kann zur Therapieoptimierung beitragen. Zur Analyse werden die funktionellen und aesthetischen Behandlungsresultate in Abhängigkeit vom Therapieverfahren eingeschätzt. Die Gesamtbehandlung erstreckt sich über 20 Jahre. Eine endgültige Ergebnisbeurteilung kann erst nach dieser Zeit erfolgen. Es muß von einer großen Variationsbreite der Behandlungsmodelle ausgegangen werden. Diese müssen an großen Patientenkollektiven statistisch in ihrem Erfolg abgesichert werden. Das Projekt steht im Konsens mit den Empfehlungen des interdisziplinären Arbeitskreises Dokumentation der Arbeitsgemeinschaft Lippen-Kiefer-Gaumenspalten der Deutschen Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie. Die Anwendung wurde auf Basis eines relationalen Datenbankmanagementsystems entwickelt. Das Programm zeichnet sich durch einfache Bedienbarkeit und schnelle Datenerfassung aus. Es ist als detaillierte Erfassung konzipiert. Verschiedenartige Eingabeerleichterungen wurden eingearbeitet. Die Datenerfassung ist weitgehend standardisiert und skaliert. Voraussetzung für diese Eigenschaften, die in ihrer Gesamtheit einen Fortschritt im Vergleich zu vorgenannten anderen Systemen darstellen, war die rasante Entwicklung der Hard- und Softwaretechnik. Nunmehr ist es problemlos möglich, die Datenfülle zu bewältigen. Schon für den einzelnen Patienten besteht durch die vielen beteiligten Fachgebiete, diverse Behandlungsmaßnahmen und wiederholte Kontrolluntersuchungen ein beachtlicher Dokumentationsbedarf. Bei den für die statistische Auswertung nötigen hohen Patientenzahlen resultieren tausende Datensätze. Der erreichte Stand ist nicht endgültig. Das Programm kann ständig weiterentwickelt und angepaßt werden. Bezugnehmend auf andere Systeme soll der interdisziplinäre Charakter noch einmal betont werden. Dafür spricht unter anderem die Netzwerkkompatibilität. Im Wechselspiel mit der Kieferorthopädie, der Hals-Nasen-Ohrenheilkunde, Pädiatrie, Logopädie sowie der konservierenden Zahnheilkunde ergibt sich eine gegenseitige Beeinflussung. Das fand Berücksichtigung bereits im anamnestischen Bereich, setzt sich bei der Diagnose und Befunddokumentation fort. Auch die Menügestaltung ist darauf abgestimmt. Die Wechselwirkung der beteiligten Fachgebiete zu optimieren, ist das Ziel der Auswertung großer Patientenkollektive. Dazu sind ausgezeichnete Voraussetzungen geschaffen worden. Größte Patientenkollektive können nach beliebigen Kriterien und deren Verknüpfung in beeindruckender Schnelligkeit ausgewertet werden. Die Anwendung moderner Erfassungssysteme und insbesondere die Archivierung und Bearbeitung visueller Befunde besitzt nicht nur wissenschaftlichen Wert in ihrer Auswertung oder der Therapieplanung, sondern kann im Praxisbetrieb motivierende Wirkung auf den Patienten haben. Er fühlt sich optimal mit modernsten Mitteln betreut, was die Compliance erhöhen kann. Die eingehende Beschäftigung mit seinen Befunden beziehungsweise mit den Eltern bezüglich der Krankengeschichte vermittelt dem Einzelnen, daß sein Schicksal nicht nur für ihn wichtig ist, sondern sich in die Gesamtheit der Bemühungen einordnet, die Prävention und Therapie der Spaltbildungen zu verbessern.The efforts in the past to improve the treatment of patients suffering from cleft lip and palate as well as to better understand the etiology of clefts have shown that a large number of cases with very large amount of data will normally have to be assessed considering the natural variation of the cleft lip and palate and the true effects to be apparent clinically and statistically. With the help of computer supported databases it is possible to keep comprehensive records about anamnestic information and results of clinical examination before and after all types of treatment including the assessment of the standard of outcome. If necessary the future treatment approaches can be altered. Therefore a computer supported database system using the latest features of object orientated relational database management systems was developed. The efforts of the German Society Of Maxillofacial Surgery to standardize the clinical records and treatment evaluations were considered. The introduced system features network compatibility, high performance query tools and can be managed by average computer users. Running it on actual customary hardware the processing speed considering the very large amount of data to be collected from thousands of patients with often more than 18 years of treatment is excellent. The introduced system contributes to the general approach to improve the treatment outcome and to better understand the etiology of cleft lip and palate.
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Hruby, Gregory William. "Toward a Generalized Model of Biomedical Query Mediation to Improve Electronic Health Record Data Retrieval." Thesis, 2016. https://doi.org/10.7916/D8R49QZW.
Full textAbstract:
The electronic health record (EHR) is an invaluable resource for medical knowledge discovery. EHR data interrogation requires significant medical and technical knowledge. To access EHR data, medical researchers often rely on query analysts to translate their EHR information needs into EHR database queries. The conversation between the medical researcher and the query analyst is an information needs negotiation; I have named this process biomedical query mediation (BQM). There exists no BQM standard to guide medical researchers and query analysts to effectively bridge the communication gap between these medical and technical experts. The current practice of BQM likely varies among query analysts. This variation may contribute to the delivery of EHR data sets with varying degrees of accuracy. For example, a query analyst may return an EHR dataset that misrepresents the medical researcher’s information need or another query analyst may return a different EHR dataset to the medical researcher for the same information need. The process used to formulate the medical researcher’s information need and translate that need into an executable EHR database query may have severe downstream consequences affecting the reliability and quality of EHR datasets for medical research. This dissertation contributes early understandings of the BQM process and thereby improves the transparency and highlights the complexity of BQM by completing five studies: 1) survey the literature from other information intensive scientific disciplines to identify knowledge and methods potentially useful for BQM, 2) perform a review of existing tools and forms for assisting researchers in BQM, 3) perform a content analysis of the BQM process, 4) conduct a cognitive task analysis to detail a generalized workflow, and 5) develop an enriched concept schema to capture comprehensive EHR data needs. This dissertation employs extensive qualitative methods using grounded theory, expert interviews, and cognitive task analysis to produce a deep understanding of BQM. Additionally, I contribute a promising concept class schema to represent medical researchers’ EHR data needs to help standardize the BQM process.
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Weiskopf, Nicole Gray. "Enabling the Reuse of Electronic Health Record Data through Data Quality Assessment and Transparency." Thesis, 2015. https://doi.org/10.7916/D8RF5SS2.
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With the increasing adoption of health information technology and the growth in the resulting electronic repositories of clinical data, the secondary use of electronic health record data has become one of the most promising approaches to enabling and speeding clinical research. Unfortunately, electronic health record data are known to suffer from significant data quality problems. Awareness of the problem of electronic health record data quality is growing, but methods for measuring data quality remain ad hoc. Clinical researchers must handle this complicated problem without systematic or validated methods. The lack of appropriate or trustworthy electronic health record data quality assessment methodology limits the validity of research performed with electronic health record data.
This dissertation documents the development of a data quality assessment framework and guideline for clinical researchers engaged in the secondary use of electronic health record data for retrospective research. Through a systematic literature review and interviews with key stakeholders, we identified core constructs of data quality, as well as priorities for future approaches to electronic health record data quality assessment. We used a data-driven approach to demonstrate that data quality is task-dependent, indicating that appropriate data quality measures must be selected, applied, and interpreted within the context of a specific study. On the basis of these results, we developed and evaluated a dynamic guideline for data quality measures in order to help researchers choose data quality measures and methods appropriately within the context of reusing electronic health record data for research.
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LU, HSIN-WEN, and 呂欣汶. "Implementation of a Big Data Accessing and Processing Platform for Medical Records in Cloud." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/03661519546201696329.
Full textAbstract:
碩士東海大學
資訊工程學系
102
Big Data analysis has become a key factor of being innovative and competitive. Along with population growth worldwide and the trend aging of population in developed countries, the rate of the national medical care usage has been increasing. Due to the fact that individual medical data are usually scattered in different institutions and their data formats are varied, to integrate those data that continue increasing is challenging. In order to have scalable load capacity for these data platforms, we must build them in good platform architecture. Some issues must be considered in order to use the cloud computing to quickly integrate big medical data into database for easy analyzing, searching, and filtering big data to obtain valuable information. In this paper we build a cloud storage platform with HBase for storing and analyzing big data of medical records and improve the performance of importing data into database. The data of medical records are stored in HBase database platform for big data storage. It also can compute through Hadoop MapReduce for HBase database to do distributed computing or cloud computing to process medical records, and to provide functions, including keyword search, data filtering, and basic statistics. We use Put with the single-threaded method and the CompleteBulkload method to import data. From the experimental results we find that when the file size is less than 300MB we can use the Put with single-threaded method and when the file size is larger than 300MB we can use the CompleteBulkload method to improve the performance of data import into database. This work provides a web interface that allows users to search data, filter out meaningful information through the web, and analyze and convert data in suitable forms that will be helpful for medical staff and institutions.
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Baptista, Diogo Veiga Amorim Santos. "Structured and unstructured data integration with electronic medical records." Master's thesis, 2019. http://hdl.handle.net/10071/20470.
Full textAbstract:
In recent years there has been a great population and technological evolution all over the world. At the same time, more areas beyond technology and information technology have also developed, namely medicine, which has led to an increase in average life expectancy which in turn, leads to a greater need for healthcare.
In order to provide the best possible treatments and healthcare services, nowadays the hospitals store large amounts of data regarding patients and diseases (in the form of electronic medical records) or the logistics of some departments in their storage systems. Therefore, computer science techniques such as data mining and natural language processing have been used to extract knowledge and value from these information-rich sources in order not only to develop, for example, new models for disease prediction, as well as improving existing processes in healthcare centres and hospitals. This data storage can be done in one of three ways: structured, unstructured or semi-structured.
In this paper, the author tested the integration of structured and unstructured data from two different departments of the same Portuguese hospital, in order to extract knowledge and improve hospital processes. Aiming to reduce the value loss of loading data that is not used in the healthcare providers systems.Nos últimos anos tem-se assistido a uma grande evolução populacional e tecnológica por todo o mundo. Paralelamente, mais áreas para além da tecnologia e informática têm-se também desenvolvido, nomeadamente a área da medicina, o que tem permitido um aumento na esperança média de vida que por sua vez leva a uma maior necessidade de cuidados de saúde. Com o intuito de fornecer os melhores serviços de saúde possíveis, nos dias que hoje os hospitais guardam nos seus sistemas informáticos grandes quantidades de dados relativamente aos pacientes e doenças (sobre a forma de registos médicos eletrónicos) ou relativos à logística de alguns departamentos dos hospitais, etc. Por conseguinte, a estes dados têm vindo a ser utilizadas técnicas da área das ciências da computação como o data mining e o processamento da língua natural para extrair conhecimento e valor dessas fontes ricas em informação com o intuito não só de desenvolver, por exemplo, novos modelos de predição de doenças, como também de melhorar processos já existentes em centros de saúde e hospitais. Este armazenamento de dados pode ser feito em uma de três formas: de forma estruturada, não estruturada ou semi-estruturada. Neste trabalho o autor testou a integração de dados estruturados e não estruturados de dois departamentos diferentes do mesmo hospital português, com o intuito de extrair conhecimento e melhorar os processos do hospital. Com o intuito de reduzir a perda do armazenamento de dados que não são utilizados.
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Salmasian, Hojjat. "Identifying and reducing inappropriate use of medications using Electronic Health Records." Thesis, 2015. https://doi.org/10.7916/D8XD10X1.
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Inappropriate use of medications (IUM) is a global problem that can lead to unnecessary harm to the patients and unnecessary costs across the health care system. Identifying and reducing IUM has been a long-lasting challenge and currently, no systematic and automated solution exists to address it. IUM can be manually identified by experts using medication appropriateness criteria (MAC).
In this research I first conducted a review of approaches used to identify IUM and reduce IUM. Next, I developed a conceptual model for representing the MAC, and then developed a tool and a workflow for translating the MAC into structured form. Because indications are an important component of the MAC, I conducted a critical appraisal of existing knowledge sources that can be used to that end, namely the medication-indication knowledge-bases. Finally, I demonstrated how these structured MAC can be used to identify patients who are potentially subject to IUM and evaluated the accuracy of this approach.
This research identifies the knowledge gaps and technological challenges in identifying and reducing IUM and addresses some of these gaps through the creation of a representation for MAC, a repository of structured MAC, and a set of tools that can assist in evaluating the impact of interventions aimed to reduce IUM or assess its downstream effects. This research also discusses the limitations of existing methods for executing computable decision support rules and proposes solutions needed to enhance these methods so they can support implementation of the MAC.
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Wu, Peng. "Machine Learning Methods for Personalized Medicine Using Electronic Health Records." Thesis, 2019. https://doi.org/10.7916/d8-wn9q-mp94.
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The theme of this dissertation focuses on methods for estimating personalized treatment using machine learning algorithms leveraging information from electronic health records (EHRs). Current guidelines for medical decision making largely rely on data from randomized controlled trials (RCTs) studying average treatment effects. However, RCTs are usually conducted under specific inclusion/exclusion criteria, they may be inadequate to make individualized treatment decisions in real-world settings. Large-scale EHR provides opportunities to fulfill the goals of personalized medicine and learn individualized treatment rules (ITRs) depending on patient-specific characteristics from real-world patient data. On the other hand, since patients' electronic health records (EHRs) document treatment prescriptions in the real world, transferring information in EHRs to RCTs, if done appropriately, could potentially improve the performance of ITRs, in terms of precision and generalizability. Furthermore, EHR data domain usually consists text notes or similar structures, thus topic modeling techniques can be adapted to engineer features.
In the first part of this work, we address challenges with EHRs and propose a machine learning approach based on matching techniques (referred as M-learning) to estimate optimal ITRs from EHRs. This new learning method performs matching method instead of inverse probability weighting as commonly used in many existing methods for estimating ITRs to more accurately assess individuals' treatment responses to alternative treatments and alleviate confounding. Matching-based value functions are proposed to compare matched pairs under a unified framework, where various types of outcomes for measuring treatment response (including continuous, ordinal, and discrete outcomes) can easily be accommodated. We establish the Fisher consistency and convergence rate of M-learning. Through extensive simulation studies, we show that M-learning outperforms existing methods when propensity scores are misspecified or when unmeasured confounders are present in certain scenarios. In the end of this part, we apply M-learning to estimate optimal personalized second-line treatments for type 2 diabetes patients to achieve better glycemic control or reduce major complications using EHRs from New York Presbyterian Hospital (NYPH).
In the second part, we propose a new domain adaptation method to learn ITRs in by incorporating information from EHRs. Unless assuming no unmeasured confounding in EHRs, we cannot directly learn the optimal ITR from the combined EHR and RCT data. Instead, we first pre-train “super" features from EHRs that summarize physicians' treatment decisions and patients' observed benefits in the real world, which are likely to be informative of the optimal ITRs. We then augment the feature space of the RCT and learn the optimal ITRs stratifying by these features using RCT patients only. We adopt Q-learning and a modified matched-learning algorithm for estimation. We present theoretical justifications and conduct simulation studies to demonstrate the performance of our proposed method. Finally, we apply our method to transfer information learned from EHRs of type 2 diabetes (T2D) patients to improve learning individualized insulin therapies from an RCT.
In the last part of this work, we report M-learning proposed in the first part to learn ITRs using interpretable features extracted from EHR documentation of medications and ICD diagnoses codes. We use a latent Dirichlet allocation (LDA) model to extract latent topics and weights as features for learning ITRs. Our method achieves confounding reduction in observational studies through matching treated and untreated individuals and improves treatment optimization by augmenting feature space with clinically meaningful LDA-based features. We apply the method to extract LDA-based features in EHR data collected at NYPH clinical data warehouse in studying optimal second-line treatment for T2D patients. We use cross validation to show that ITRs outperforms uniform treatment strategies (i.e., assigning insulin or another class of oral organic compounds to all individuals), and including topic modeling features leads to more reduction of post-treatment complications.
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Pivovarov, Rimma. "Electronic Health Record Summarization over Heterogeneous and Irregularly Sampled Clinical Data." Thesis, 2015. https://doi.org/10.7916/D89W0F6V.
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The increasing adoption of electronic health records (EHRs) has led to an unprecedented amount of patient health information stored in an electronic format. The ability to comb through this information is imperative, both for patient care and computational modeling. Creating a system to minimize unnecessary EHR data, automatically distill longitudinal patient information, and highlight salient parts of a patient’s record is currently an unmet need. However, summarization of EHR data is not a trivial task, as there exist many challenges with reasoning over this data. EHR data elements are most often obtained at irregular intervals as patients are more likely to receive medical care when they are ill, than when they are healthy. The presence of narrative documentation adds another layer of complexity as the notes are riddled with over-sampled text, often caused by the frequent copy-and-pasting during the documentation process.
This dissertation synthesizes a set of challenges for automated EHR summarization identified in the literature and presents an array of methods for dealing with some of these challenges. We used hybrid data-driven and knowledge-based approaches to examine abundant redundancy in clinical narrative text, a data-driven approach to identify and mitigate biases in laboratory testing patterns with implications for using clinical data for research, and a probabilistic modeling approach to automatically summarize patient records and learn computational models of disease with heterogeneous data types. The dissertation also demonstrates two applications of the developed methods to important clinical questions: the questions of laboratory test overutilization and cohort selection from EHR data.
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Anthopolos, Rebecca. "Bayesian Modeling of Latent Heterogeneity in Complex Survey Data and Electronic Health Records." Thesis, 2019. https://doi.org/10.7916/d8-px1j-7442.
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In population health, the study of unobserved, or latent, heterogeneity in longitudinal data may help inform public health interventions. Growth mixture modeling is a flexible tool for modeling latent heterogeneity in longitudinal data. However, the application of growth mixture models to certain data types, namely, complex survey data and electronic health records, is underdeveloped. For valid statistical inferences in complex survey data, features of the sample design must be incorporated into statistical analysis. In electronic health records, the application of growth mixture modeling is challenged by high levels of missing values. In this dissertation, I have three goals: First, I propose a Bayesian growth mixture model for complex survey data in which I directly incorporate features of the complex sample design. Second, I extend a Bayesian growth mixture model of multiple longitudinal health outcomes collected in electronic health records to a shared parameter model that can account for dierent missing data assumptions. Third, I develop open-source software packages in R for each method that can be used for model tting, selection, and checking.
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Phalane, Modiegi Rebecca. "A conceptualized model for the acceptance of E-health in South African hospitals." 2015. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1001604.
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M. Tech. Business Information SystemsThe acceptance of E-health in South African Hospitals and other developing countries is slow and confusing. Healthcare professionals must be fully engaged in the E-health decision making since they are the main users of E-health systems. It is important to note that using E-health to support the daily work of healthcare professionals can improve healthcare provision and so improve citizens' health. However, investing in affordable E-health applications that can help in realising the benefits of technology and minimizing health costs is not easy. Literature shows that much as there are several studies that have been conducted in respect of technology acceptance, adoption and use, little attention has been given to E-health acceptance in South Africa. Therefore, this study sought to design a model for E-health acceptance for South African hospitals.
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Levy-Fix, Gal. "Patient Record Summarization Through Joint Phenotype Learning and Interactive Visualization." Thesis, 2020. https://doi.org/10.7916/d8-hba0-nx88.
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Complex patient are becoming more and more of a challenge to the health care system given the amount of care they require and the amount of documentation needed to keep track of their state of health and treatment. Record keeping using the EHR makes this easier but mounting amounts of patient data also means that clinicians are faced with information overload. Information overload has been shown to have deleterious effects on care, with increased safety concerns due to missed information. Patient record summarization has been a promising mitigator for information overload. Subsequently, a lot of research has been dedicated to record summarization since the introduction of EHRs. In this dissertation we examine whether unsupervised inference methods can derive patient problem-oriented summaries, that are robust to different patients. By grounding our experiments with HIV patients we leverage the data of a group of patients that are similar in that they share one common disease (HIV) but also exhibit complex histories of diverse comorbidities. Using a user-centered, iterative design process, we design an interactive, longitudinal patient record summarization tool, that leverages automated inferences about the patient's problems. We find that unsupervised, joint learning of problems using correlated topic models, adapted to handle the multiple data types (structured and unstructured) of the EHR, is successful in identifying the salient problems of complex patients. Utilizing interactive visualization that exposes inference results to users enables them to make sense of a patient's problems over time and to answer questions about a patient more accurately and faster than using the EHR alone.
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Bassett, Cameron. "Cloud computing and innovation: its viability, benefits, challenges and records management capabilities." Diss., 2015. http://hdl.handle.net/10500/20149.
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This research investigated the potential benefits, risks and challenges, innovation properties and viability of cloud computing for records management on an Australian organisation within the mining software development sector. This research involved the use of a case study results analysis as well as a literature analysis. The literature analysis identified the ten potential benefits of cloud computing, as well as the ten risks and challenges associated with cloud computing. It further identified aspects, which needed to be addressed when adopting cloud computing in order to promote innovation within an organisation.
The case study analysis was compared against a literature review of ten potential benefits of cloud computing, as well as the ten risks and challenges associated with cloud computing. This was done in order to determine cloud computing’s viability for records management for Company X (The company in the case study). Cloud computing was found to be viable for Company X. However, there were certain aspects, which need to be discussed and clarified with the cloud service provider beforehand in order to mitigate possible risks and compliance issues. It is also recommended that a cloud service provider who complies with international standards, such as ISO 15489, be selected. The viability of cloud computing for organisations similar to Company X (mining software development) followed a related path. These organisations need to ensure that the service provider is compliant with laws in their local jurisdiction, such as Electronic Transactions Act 1999 (Australia, 2011:14-15), as well as laws where their data (in the cloud) may be hosted. The benefits, risks and challenges of records management and cloud computing are applicable to these similar organisations. However, mitigation of these risks needs to be discussed with a cloud service provider beforehand.
From an innovation perspective, cloud computing is able to promote innovation within an organisation, if certain antecedents are dealt with. Furthermore, if cloud computing is successfully adopted then it should promote innovation within organisations.Information Science
M. Inf.
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Wang, Chenkun. "Flexible models of time-varying exposures." Thesis, 2015. http://hdl.handle.net/1805/7938.
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Indiana University-Purdue University Indianapolis (IUPUI)With the availability of electronic medical records, medication dispensing data offers an unprecedented opportunity for researchers to explore complex relationships among longterm medication use, disease progression and potential side-effects in large patient populations. However, these data also pose challenges to existing statistical models because both medication exposure status and its intensity vary over time. This dissertation focused on flexible models to investigate the association between time-varying exposures and different types of outcomes. First, a penalized functional regression model was developed to estimate the effect of time-varying exposures on multivariate longitudinal outcomes. Second, for survival outcomes, a regression spline based model was proposed in the Cox proportional hazards (PH) framework to compare disease risk among different types of time-varying exposures. Finally, a penalized spline based Cox PH model with functional interaction terms was developed to estimate interaction effect between multiple medication classes. Data from a primary care patient cohort are used to illustrate the proposed approaches in determining the association between antidepressant use and various outcomes.
NIH grants, R01 AG019181 and P30 AG10133.
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Jiang, Silis Y. "A Team-Based Approach to Studying Complex Healthcare Processes." Thesis, 2017. https://doi.org/10.7916/D8MP5FRN.
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Communication is a critical aspect of clinical work. In 2010, the Joint Commission (JC) found that gaps in communication were among leading factors contributing to medical errors. Healthcare processes, such as patient discharge, depend on interdisciplinary communication to be successful. Electronic health records (EHRs) have the potential to facilitate communication and information sharing between interdisciplinary care team members; however, challenges remain in designing tools for team-based care and questions remain in understanding how EHRs impact interdisciplinary team communication. This dissertation focuses on understanding how EHRs can be designed to support communication and information sharing within interdisciplinary patient care teams. The first aim of the dissertation investigated how EHRs impact interdisciplinary clinical teams’ communication, shared mental models, and information sharing activities. The results showed that implementing new EHR tools appeared to have little impact on communication and shared mental models, but new information sharing activities mediated by EHR developed. These changes and lack thereof suggest that new EHR tools will be specifically needed to facilitate interdisciplinary team information sharing activities. The second aim of the dissertation investigates the information sharing activities and information needs of interdisciplinary team members during patient discharge. The results showed that the information clinicians sought out during discharge depended on the roles that person played as well as the progress of the discharge process. Future EHR tools should be aware of how patient care teams are progressing through the patient discharge process in order to provide information contextualized to their current tasks. In conclusion, interdisciplinary team communication and information sharing remain poorly supported by current EHRs and new tools designed specifically for interdisciplinary teams should provide information based on the completion of team activities.
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Mikhno, Arthur. "Non-invasive and cost-effective quantification of Positron Emission Tomography data." Thesis, 2015. https://doi.org/10.7916/D8222SQ1.
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Molecular imaging of the human body is beginning to revolutionize drug development, drug delivery targeting, prognostics and diagnostics, and patient screening for clinical trials. The primary clinical tool of molecular imaging is Positron Emission Tomography (PET), which uses radioactively tagged probes (radioligands) for the in vivo quantification of blood flow, metabolism, protein distribution, gene expression and drug target occupancy. While many radioligands are used in human research, only a few have been adopted for clinical use. A major obstacle to translating these tools from bench-to-bedside is that PET images acquired using complex radioligands can not be properly interpreted or quantified without arterial blood sampling during the scan. Arterial blood sampling is an invasive, risky, costly, time consuming and uncomfortable procedure that deters subjects' participation and requires highly specialized medical staff presence and laboratories to run blood analysis. Many approaches have been developed over the years to reduce the number of blood samples for certain classes of radioligands, yet the ultimate goal of zero blood samples has remained illusive. In this dissertation we break this proverbial blood barrier and present for the first time a non-invasive PET quantification framework. To accomplish this, we introduce novel image processing, modeling, and tomographic reconstruction tools.
First, we developed dedicated pharmacokinetic modeling, machine learning and optimization framework based on the fusion of Electronic Health Records (EHR) data with dynamic PET brain imaging information. EHR data is used to infer individualized metabolism and clearance rates of the radioligand from the body. This is combined with simultaneous estimation on multiple distinct regions of the PET image. A substantial part of this effort involved curating, and then mining, an extensive database of PET, EHR and arterial blood sampling data.
Second, we outline a new tomographic reconstruction and resolution modeling approach that takes into account the scanner point spread function in order to improve the resolution of existing PET data-sets. This technique allows visualization and quantification of structures smaller than previously possible. Recovery of signal from blood vessels and integration with the non-invasive framework is demonstrated. We also show general applicability of this technique for visualization and signal recovery from the raphe, a sub-resolution cluster of nuclei in the brain that were previously not detectible with standard techniques.
Our framework can be generalizable to all classes of radioligands, independent of their kinetics and distribution within body. Work presented in this thesis will allow the PET scientific and clinical community to advance towards the ultimate goal of making PET cost-effective and to enable new clinical use cases.
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Beauchemin, Melissa Parsons. "Supporting Clinical Decision Making in Cancer Care Delivery." Thesis, 2019. https://doi.org/10.7916/d8-70wy-w603.
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Background: Cancer treatment and management require complicated clinical decision making to provide the highest quality of care for an individual patient. This is facilitated in part with ever-increasing availability of medications and treatments but hindered due to barriers such as access to care, cost of medications, clinician knowledge, and patient preferences or clinical factors. Although guidelines for cancer treatment and many symptoms have been developed to inform clinical practice, implementation of these guidelines into practice is often delayed or does not occur. Informatics-based approaches, such as clinical decision support, may be an effective tool to improve guideline implementation by delivering patient-specific and evidence-based knowledge to the clinician at the point of care to allow shared decision making with a patient and their family. The large amount of data in the electronic health record can be utilized to develop, evaluate, and implement automated approaches; however, the quality of the data must first be examined and evaluated.
Methods: This dissertation addresses gaps the literature about clinical decision making for cancer care delivery. Specifically, following an introduction and review of the literature for relevant topics to this dissertation, the researcher presents three studies. In Study One, the researcher explores the use of clinical decision support in cancer therapeutic decision making by conducting a systematic review of the literature. In Study Two, the researcher conducts a quantitative study to describe the rate of guideline concordant care provided for prevention of acute chemotherapy-induced nausea and vomiting (CINV) and to identify predictors of receiving guideline concordant care. In Study Three, the researcher conducts a mixed-methods study to evaluate the completeness, concordance, and heterogeneity of clinician documentation of CINV. The final chapter of this dissertation is comprised of key findings of each study, the strengths and limitations, clinical and research implications, and future research.
Results: In Study One, the systematic review, the researcher identified ten studies that prospectively studied clinical decision support systems or tools in a cancer setting to guide therapeutic decision making. There was variability in these studies, including study design, outcomes measured, and results. There was a trend toward benefit, both in process and patient-specific outcomes. Importantly, few studies were integrated into the electronic health record.
In Study Two, of 180 patients age 26 years or less, 36% received guideline concordant care as defined by pediatric or adult guidelines, as appropriate. Factors associated with receiving guideline concordant care included receiving a cisplatin-based regimen, being treated in adult oncology compared to pediatric oncology, and solid tumor diagnosis.
In Study Three, of the 127 patient records reviewed for the documentation of chemotherapy-induced nausea and vomiting, 75% had prescriber assessment documented and 58% had nursing assessment documented. Of those who had documented assessments by both prescriber and nurse, 72% were in agreement of the presence/absence of chemotherapy-induced nausea and vomiting. After mapping the concept through the United Medical Language System and developing a post-coordinated expression to identify chemotherapy-induced nausea and vomiting in the text, 85% of prescriber documentation and 100% of nurse documentation could be correctly categorized as present/absent. Further descriptors of the symptoms, such as severity or temporality, however, were infrequently reported.
Conclusion: In summary, this dissertation provides new knowledge about decision making in cancer care delivery. Specifically, in Study One the researcher describes that clinical decision support, one potential implementation strategy to improve guideline concordant care, is understudied or under published but a promising potential intervention. In Study Two, I identified factors that were associated with receipt of guideline concordant care for CINV, and these should be further explored to develop interventions. Finally, in Study Three, I report on the limitations of the data quality of CINV documentation in the electronic health record. Future work should focus on validating these results on a multi-institutional level.