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Perumal, Palani. « Business model and strategy analysis for radiologists to use electronic health records (EHR) ». Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/76928.
Texte intégralRésumé :
Thesis (S.M. in Engineering and Management)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2012.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 90-94).
Radiology is a medical specialty that employs imaging to diagnose and treat disease. It has long been an advance user of technology to capture, store, share, and use images electronically. In 2009, President Obama signed into law a measure, the HITECH Act (part of the stimulus package), that incentivizes healthcare providers to use electronic health records (EHR) in care delivery to improve quality, efficiency, safety, and reduce cost. The meaningful use (MU) program's Stage 1 requirements (part of HITECH Act) did not include imaging requirements, leading to confusion among radiologists and other specialties with regard to what MU offers to and requires of them. This thesis attempts to clarify the contribution radiology can make to MU by understanding radiology as a system, including its surrounding issues and its drivers, using Stage 1 MU requirements, data from qualitative research, and results from analysis. It answers the following question: Should Radiologists be considered part of the care team, leveraging EHR for meaningful use and hence eligible for incentive payments? It does so via the following methods: a) Discussing in detail current issues surrounding radiology systems from quality, safety, efficiency, and cost perspectives; b) Discussing MU in the context of radiology and reviewing what is missing in it for radiologists; c) Providing deeper systems analysis of current behaviors and why they have this form at this time; and d) Explaining how MU objectives can help to overcome many current issues and ultimately help to improve health outcomes. Specific changes to MU criteria to achieve these benefits are recommended. This thesis employs systems concepts and tools including system architecture and system dynamics for research and analysis to understand the system and derive hypotheses. A system dynamics model is used to analyze current drivers in imaging and to clarify the impact MU can have on these drivers. Thesis conclusions are supported by the analysis performed using the model as well as information gathered through industry interviews, online articles, academic and industry journals, and blogs.
by Palani Perumal.
S.M.in Engineering and Management
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Adams, Sharon L. « Nurses Knowledge, Skills, and Attitude Toward Electronic Health Records (EHR) ». ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/875.
Texte intégralRésumé :
Information technology (IT) has been rapidly integrated into the healthcare industry, including nursing, and has the ability to reduce errors, cut cost, and enhance patient care. However, approximately 45% of the current nurse workforce lacks adequate training in computer skills, which may hinder the adoption of health-related IT in the workplace. Characteristics of Rogers's diffusion of innovation (relative advantage, compatibility, complexity, trialability, and observability) guided this project. This project was conducted to address the problem of IT adoption on a local level and was designed to assess whether simulation training on a generic electronic health record (EHR) system would improve the knowledge, skill, and attitude of nurses with little or no experience with EHR. A convenience sample of nurses (n = 13) unfamiliar with EHR was obtained by posting flyers in long-term care or home health agencies. The nurses completed the P.A.T.C.H. assessment scale v. 3 (2011) before and after participating in the one-time simulation training on EHR. Scores on the P.A.T.C.H. were calculated according to the established scoring system and revealed a positive increase nurses' attitude and self-efficacy toward the EHR system. Posttest scores yielded an increase ranging from 0.5 to 5 points from pretest scores, with an average pretest score of 54.23 on a scale of 0-100. The results of this project are consistent with the literature and current research and illustrate the importance of addressing the need for interactive training. This project contributes to social change in practice by enhancing the awareness of EHR in nurses who are new users of IT and promoting the adoption of technology in healthcare.
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Ngunyu, Daniel Kanyi. « Strategies for Applying Electronic Health Records to Achieve Cost Saving Benefits ». ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5236.
Texte intégralRésumé :
The American Recovery and Reinvestment Act (ARRA) of 2009 authorized the distribution of about $30 billion incentive funds to accelerate electronic health record (EHR) applications to improve the quality of care, safety, privacy, care coordination, and patients' involvement in healthcare. EHR use has the potential of saving $731 in costs for hospitals per patient admission; however, most hospitals are not applying EHR to reach the level at which cost savings are possible. The purpose of this single case study was to explore strategies that IT leaders in hospitals can use to apply EHR to achieve the cost saving benefits. The participants were IT leaders and EHR super users at a large hospital in Texas with successful experience in applying EHR. Information systems success model formed the conceptual framework for the study. I conducted face-to-face interviews and analyzed organizational documents. I used qualitative textual data analysis method to identify themes. Five themes emerged from this study, which are ensuring information quality, ensuring system quality, assuring service quality, promoting usability, and maximizing net benefits of the EHR system. The findings of this study included four strategies to apply EHR; these strategies include engaging training staff, documenting accurately and in a timely manner, protecting patient data, and enforcing organizational best practice policies to maximize reimbursement and cost savings. The findings of this study could contribute to positive social change for the communities because EHR successful application includes lower cost for hospitals that may lead to the provision of affordable care to more low-income patients.
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Najaftorkaman, Mohammadreza. « Facilitators and Barriers to User Adoption of Electronic Health Record Systems ». Thesis, Griffith University, 2016. http://hdl.handle.net/10072/368008.
Texte intégralRésumé :
Information Technology (IT) applications have brought massive changes in healthcare and health providers have shifted from paper-based systems to computerized ones. The electronic medical record (EMR) and personal health record (PHR) are good examples of the application of IT in healthcare settings. Despite the enormous benefits of the available applications in healthcare, the adoption of EMR in primary care has been identified at 38.4 percent in the U.S., in Denmark, almost 62 percent of doctors use EMR, while only 55 percent of Australian physicians apply EMR systems (Sicotte et al. 2016; Venkatesh et al. 2011). Furthermore, with regard to the PHR system, the Australian government’s development of a national PHR system (personally controlled electronic health record (PCEHR) system) in 2010 was a part of their national e-health strategy to overcome common challenges such as medication errors, fragmented sources of health information, repetition of tests, an increase in chronic illness, workforce resource constraints, and individuals’ changing expectations of technology. The Australian government expected that 500,000 users would register at the first release of the national PHR system; however, only 400,000 users have signed up to this system and of those, many registered but their records remain empty.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of information and Communication Technology
Science, Environment, Engineering and Technology
Full Text
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Nanouris, Elizabeth. « The ethical and legal complications surrounding the implementation of a pan-Canadian electronic health record (EHR) system ». Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=104728.
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Canada lags behind other countries in the development of electronic health records. If Canada develops a pan-Canadian electronic health record (EHR) system, the quality of patient care can improve. A review of the literature lists potential benefits of EHRs such as improvements in medical research, a reduction in emergency room and diagnostic test wait times. Such a system will make medical records readily available to health care providers which will help them make informed critical decisions. Regardless of the benefits of such a system, there are legal and ethical implications hindering its development and implementation. The federal and provincial governments are at odds as to who is in charge of health care. Canadians need to be consulted on its implementation, and their concerns regarding privacy legislation addressed. Canada Health Infoway has undergone initiatives to create an interoperable EHR system in Canada with audit trails, smart card technology, etc. The benefits of such a system are seen in an analysis of Alberta that has created its own provincial EHR system. Case studies of both Alberta and the United Kingdom's EHR systems should be used as a foundation to begin developing Canada's national system. If Canada addresses the concerns surrounding the implementation of a national EHR system through policies with sanctions to deal with the ethical implications of such a system (informed consent, unlawful access, etc), then studies have shown that Canadians will support a pan-Canadian EHR system initiative. Before addressing ethical dilemmas, the governments must assume responsibility of who will develop and maintain this system.Le Canada accuse un retard important par rapport à d'autres pays dans le développement de dossiers de santé électroniques. Si le Canada développe un système de dossier de santé électronique pancanadien (DSE), la qualité des soins patients peut s'améliorer. Une revue de la littérature décrit les avantages potentiels des DSEs tels que des améliorations de la recherche médicale, une réduction au niveau des temps d'attente en salle d'urgence et des tests diagnostiques. Un tel système facilitera la disponibilité des dossiers médicaux pour les fournisseurs de soins médicaux et les aideront à prendre des décisions critiques éclairées. Indépendamment des avantages d'un tel système, des implications sur le point de vue légal et éthique empêchent son développement et sa mise en œuvre. Les gouvernements fédéraux et provinciaux sont en désaccord quant à qui la responsabilité des soins médicaux incombe. Les Canadiens doivent être consultés sur la mise en œuvre de ce système et leurs préoccupations quant à la législation sur la vie privée doivent être adressées. Inforoute Santé du Canada a entrepris des démarches afin de créer un système de DSEs interopérable au Canada avec des protocoles d'audit, la technologie de carte à puce, etc. Une analyse de l'Alberta, qui a créé son propre système de DSE provincial, a permis de voir les bénéfices d'un tel système. Les études de cas portant sur les systèmes de DSEs de l'Alberta et du Royaume-Uni devraient être utilisées comme fondement afin de débuter le développement d'un système national au Canada. Les études ont démontré que les Canadiens supporteront l'initiative d'un système de DSE pancanadien si le Canada adresse les préoccupations entourant la mise en œuvre de ce système national par des mesures avec sanction afin de répondre aux implications éthiques que ce dernier pose (le consentement éclairé, l'accès illégal, etc.). Avant d'adresser les dilemmes éthiques que pose ce système, les gouvernements doivent assumer la responsabilité de décider qui développera et maintiendra ce système.
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Davids, Kaashiefah. « The role of electronic healthcare systems (EHS) for patient recordkeeping in the Western Cape ». University of Western Cape, 2019. http://hdl.handle.net/11394/7829.
Texte intégralRésumé :
Magister Commercii - MComInformation and communication technologies (ICT) have changed the way healthcare processes are being documented. This results in better quality and ethical vigilance to ensure a more accurate form of data recordkeeping (Stevenson, Nilsson, Petersson & Johansson, 2010). Health care in South Africa, is facing major issues relating to patient care, such as delays in patients receiving medical care. According to the national Department of Health, the improvement of public healthcare facilities is crucial (McIntyre & Ataguba, 2017). Information and communication technology (ICT) has the ability to significantly alter the status of healthcare services in the Western Cape, which can be achieved through the role of an electronic healthcare record (EHR).
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Huang, Jiawei. « The Road to a Nationwide Electronic Health Record System : Data Interoperability and Regulatory Landscape ». Scholarship @ Claremont, 2019. https://scholarship.claremont.edu/cmc_theses/2224.
Texte intégralRésumé :
This paper seeks to break down how a large scale Electronic Health Records system could improve quality of care and reduce monetary waste in the healthcare system. The paper further explores issues regarding regulations to data exchange and data interoperability. Due to the massive size of healthcare data, the exponential increase in the speed of data generation through innovative technologies, and the complexity of healthcare data types, the widespread of a large-scale EHR system has hit barriers. Much of the data available is unstructured or contained within a singular healthcare provider’s systems. To fully utilize all the data available, methods for making data interoperable and regulations for data exchange to protect and support patients must be made. Through angles addressing data exchange and interoperability, we seek to break down the constraints and issues that EHR systems still face and gain an understanding of the regulatory landscape.
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Bozan, Karoly. « Essays on Electronic Health Records (EHR) Process Framework and Design-Theoretic Model in a Multi-Stakeholder Context ». Kent State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=kent1416865146.
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Tyler, Lamonte Bryant. « Exploring the Implementation of Cloud Security to Minimize Electronic Health Records Cyberattacks ». ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5281.
Texte intégralRésumé :
Health care leaders lack the strategies to implement cloud security for electronic medical records to prevent a breach of patient data. The purpose of this qualitative case study was to explore strategies senior information technology leaders in the healthcare industry use to implement cloud security to minimize electronic health record cyberattacks. The theory supporting this study was routine activities theory. Routine activities theory is a theory of criminal events that can be applied to technology. The study's population consisted of senior information technology leaders from a medical facility in a large northeastern city. Data collection included semistructured interviews, phone interviews, and analysis of organizational documents. The use of member checking and methodological triangulation increased the validity of this study's findings among all participants. There were 5 major themes that emerged from the study (a) requirement of coordination with the electronic health record vendor and the private cloud vendor, (b) protection of the organization, (c) requirements based on government and organizational regulations, (d) access management, (e) a focus on continuous improvement. The results of this study may create awareness of the necessity to secure electronic health records in the cloud to minimize cyberattacks. Cloud security is essential because of its social impact on the ability to protect confidential data and information. The results of this study will further serve as a foundation for positive social change by increasing awareness in support of the implementation of electronic health record cloud security.
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Hopes, Scott L. « Healthcare IT in Skilled Nursing and Post-Acute Care Facilities : Reducing Hospital Admissions and Re-Admissions, Improving Reimbursement and Improving Clinical Operations ». Scholar Commons, 2017. https://scholarcommons.usf.edu/etd/7409.
Texte intégralRésumé :
Health information technology (HIT), which includes electronic health record (EHR) systems and clinical data analytics, has become a major component of all health care delivery and care management. The adoption of HIT by physicians, hospitals, post-acute care organizations, pharmacies and other health care providers has been accepted as a necessary (and recently, a government required) step toward improved quality, care coordination and reduced costs: “Better coordination of care provides a path to improving communication, improving quality of care, and reducing unnecessary emergency room use and hospital readmissions. LTPAC providers play a critical role in achieving these goals” (HealthIT.gov, 2013).
Though some of the impacts of evolving HIT and EHRs have been studied in acute care hospitals and physician office settings, a dearth of information exists about the deployment and effectiveness of HIT and EHRs in long-term and post-acute care facilities, places where they are becoming more essential. This dissertation examines how and to what extent health information technology and electronic health record implementation and use affects certain measurable outcomes in long term and post-acute care facilities. Monthly data were obtained for the period beginning January 1, 2016 through June 30, 2017, a total of 18 months. The level of EHR adoption was found to positively impact hospital readmission rates, employee engagement, complaint deficiencies, failed revisit surveys, staff overtime (partial EHR), staff turnover rate (full EHR) and United States Centers for Medicare and Medicaid Services (CMS) Five Star Quality score. The level of EHR adoption was found to negatively impact CMS Five Star Total score, staff retention rate (full EHR) and staff overtime (full EHR group higher than partial EHR).
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Ingabire, Paula. « Convergence of eco-system technologies : potential for hybrid electronic health record (EHR) systems combining distributed ledgers and the Internet of Medical Things towards delivering value-based Healthcare ». Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/118548.
Texte intégralRésumé :
Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, System Design and Management Program, 2018.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 64-66).
The Healthcare industry, just like any industry, is constantly racing to stay abreast with pace of technological innovations, especially at such a time where the industry is experiencing a strain on the global healthcare infrastructure. Specifically, the evolution of record management systems in the healthcare system has taken a slow and gradual transformation with each stage of transformation carrying over certain aspects and functions of previous stages. A survey of record management practices reveals that record management begun with paper-based records that have since partially been replaced with centralized Electronic Health Records (EHR). With the advent of Electronic Health Records enabled by distributed ledgers, we continue to see the inclusion of traditional paper-based functions beyond centralized EHR functions. Electronic data sharing in the healthcare ecosystem is constrained by interoperability challenges with different providers choosing to implement systems that respond to increasing their productivity. Prioritizing a patient-focused strategy during implementation of EHRs forces providers to implement systems that are more interoperable. A system engineering approach was adopted to guide the development and valuation of candidate architectures from Stakeholder analysis to concept generation and enumeration. Nine (9) key design decisions were selected with their combinations yielding 512 feasible hybrid architectures. In this paper, we proposed a hybrid EHR solution combining distributed ledger technologies and Internet of Medical Things, which contributes towards providing value-based healthcare. Leveraging properties of distributed ledgers and IoMT, the hybrid solution interconnects various data sources for health records to provide real-time record creation and monitoring whilst enabling data sharing and management in a secure manner.
by Paula Ingabire.
S.M. in Engineering and Management
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Brancazio, Maria Leigh. « Physician EMR Documentation Preference and Voice Recognition Acceptance in an Ambulatory Academic Health System ». The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1339441679.
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Kvastad, Johan. « ICT Security of an Electronic Health Record System : an Empirical Investigation : An in depth investigation of ICT security in a modern healthcare system ». Thesis, KTH, Skolan för datavetenskap och kommunikation (CSC), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-194121.
Texte intégralRésumé :
An empirical investigation of the security flaws and features of an in-use modern electronic health record system is performed. The investigation was carried out using dynamic analysis, manual testing and interviews with developers. The results indicate that in-use electronic health record systems suffer from serious authentication flaws, arising from the interaction of many different proprietary systems. The authentication problems are so severe that gaining access to any user’s computer on the hospital intranet would compromise a large database of patient medical records, including radiological data regarding the patients. Common web vulnerabilities were also present, such as injections and incorrectly configured HTTP security headers. These vulnerabilities were heavily mitigated by the use of libraries for constructing web interfaces.En empirisk undersökning av säkerheten inom ett modernt elektroniskt patientjournal-system har utförts. Undersökningen genomfördes med hjälp av dynamisk analys, manuell testning och intervjuer med utvecklarna. Resultatet indikerar att system för elektroniska patientjournaler har stora brister inom autentisering, vilka uppstår p.g.a. att flera olika kommersiella system måste samarbeta. Problemen är så allvarliga att med tillgång till en enda dator på intranätet kan en stor databas med patientdata äventyras, inklusive radiologisk data gällande patienterna. Vanliga websårbarheter fanns också, så som injektioner av skript och inkorrekt konfigurerade HTTP säkerhetsheaders. Dessa sårbarheter mitigerades starkt genom användandet av bibliotek för webinterface.
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Neuhaus, Christian, Andreas Polze et Mohammad M. R. Chowdhuryy. « Survey on healthcare IT systems : standards, regulations and security ». Universität Potsdam, 2011. http://opus.kobv.de/ubp/volltexte/2011/5146/.
Texte intégralRésumé :
IT systems for healthcare are a complex and exciting field. One the one hand, there is a vast number of improvements and work alleviations that computers can bring to everyday healthcare. Some ways of treatment, diagnoses and organisational tasks were even made possible by computer usage in the first place. On the other hand, there are many factors that encumber computer usage and make development of IT systems for healthcare a challenging, sometimes even frustrating task. These factors are not solely technology-related, but just as well social or economical conditions. This report describes some of the idiosyncrasies of IT systems in the healthcare domain, with a special focus on legal regulations, standards and security.IT Systeme für Medizin und Gesundheitswesen sind ein komplexes und spannendes Feld. Auf der einen Seite stehen eine Vielzahl an Verbesserungen und Arbeitserleichterungen, die Computer zum medizinischen Alltag beitragen können. Einige Behandlungen, Diagnoseverfahren und organisatorische Aufgaben wurden durch Computer überhaupt erst möglich. Auf der anderen Seite gibt es eine Vielzahl an Fakturen, die Computerbenutzung im Gesundheitswesen erschweren und ihre Entwicklung zu einer herausfordernden, sogar frustrierenden Aufgabe machen können. Diese Faktoren sind nicht ausschließlich technischer Natur, sondern auch auf soziale und ökonomische Gegebenheiten zurückzuführen. Dieser Report beschreibt einige Besondenderheiten von IT Systemen im Gesundheitswesen, mit speziellem Fokus auf gesetzliche Rahmenbedingungen, Standards und Sicherheit.
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Tokosi, Temitope Oluwaseyi. « Electronic patient record (EPR) system in South Africa : information, storage, retrieval and share amongst clinicians ». University of the Western cape, 2016. http://hdl.handle.net/11394/5414.
Texte intégralRésumé :
Philosophiae Doctor - PhDA phenomenological philosophy underlies this research study which attempts to understand clinicians’ perception and understanding of an electronic patient record (EPR) system currently operational at a hospital in the Western Cape Province in South Africa (SA). Healthcare is a human right, thus patient records contain critical data and mostly paper-based in many SA hospitals. Clinicians are the EPR primary users and their attitude in its use is important for its success. This study explores, identifies and determines clinicians’ cognitive attributes towards EPR with a technology use framework developed. An initial quantitative approach was applied but unsuccessful due to low sample size. A pilot study was then conducted using 11 respondents. Purposive sampling was first initiated then snowball introduced later to improve the sample size qualitatively. Interviews were administered to 15 clinicians and tape recorded. Narrative content analysis was used as the preferred analysis technique because of the advantage of gaining direct information from study participants, unobtrusive and a nonreactive way to study the phenomenon of interest. Research findings tested 12 propositions and found high impact relationships between attitude (ATT) and each listed theme namely: perceived usefulness (PU), perceived ease of use (PEOU), complexity (COM), facilitating condition (FC), use behaviour (USE). Use behaviour had high impact relationships with storage (STO) and retrieval (RET). There were moderate impact relationships between PU and USE; PEOU and PU; RA and ATT; job fit (JF) and ATT; USE and share (SHA). The implication here is that any EPR system to be implemented should be tested using this framework to ascertain its usefulness and fit with a hospital's objectives and users expectations. By so doing, anticipated problems can be mitigated against and resolved before implementation. The study contributes to the information system (IS) body of knowledge through the technology use framework. The framework is for adoption by hospital management and its use by clinicians where EPR is operational. Traditional IS frameworks can be adopted for hospitals about to implement EPR because of the relevance of the "intent to use" theme.
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Nicholas, Marcia M. « Successful Strategies for Implementing EMR Systems in Hospitals ». ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5386.
Texte intégralRésumé :
Some hospital leaders are ineffective in implementing the electronic medical record (EMR) systems in the hospitals. The purpose of this multiple case study was to explore strategies hospital leaders use to successfully implement EMR systems. The target population consisted of hospital leaders and healthcare professionals from two hospitals who have successfully implemented EMR systems. The conceptual framework of this research study was Kotter's 8-stage process for leading change, building on the model of an effective change management method. Data were collected from 5 interviewed participants and company documents related to strategies regarding the EMR system implementation. The results of reviewing open-ended interview questions and archived documents were analyzed using codes and themes to facilitate triangulation. Three primary themes were developed from the coded data: (a) strategies hospital leaders use to implement the EMR system, (b) strategies hospital leaders use to achieve quality and best practice, and (c) strategies hospital leaders use to manage change and resistance to change. Results revealed 4 steps for successful implementation: (1) creating a vision, (2) communicating the vision, (3) establishing strong leadership, and (4) consolidating gains. Utilizing the successful strategies hospital leaders use to implement the EMR systems could produce quality patient care, efficiencies in hospital operations, and reduced organizational operation cost. The findings could effect positive social change through delivery of quality health and patient care that results in community cost benefits and healthier patient lifestyles.
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TÖCKSBERG, EMMA, et ERIK ÖHLÉN. « Clinical decision support systemsin the Swedish health care system : Mapping and analysing existing needs ». Thesis, KTH, Hållbarhet och industriell dynamik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-147793.
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Purpose:The thesis will shed light on the overall need of CDSSs in the Swedish health care system, and it will also present a specific efficiency problem that could be solved by implementing a CDSS. The need for a CDSS is where an implementation would improve patient outcome, by delivering the right care at the right time, and where the CDSS could reduce the cost of the delivered care. A better understanding of the current need could help eliminate the existing empirical gap and ultimately lead to better and more efficient health care in Sweden. The research question was formulated as: Where within Swedish health care can a need for increased efficiency be met through the implementation of a realistic CDSS system? Design and methodology: The thesis is a case study where qualitative data, collected through a literature review and interviews, was used to answer the research question. The methodology used was tailored to the unique setting of the research and in accordance to the purpose of the study. The method was divided into five phases. (1) Finding an area of focus, such as a specific diagnosis, within the health care system where the need for a CDSS system is deemed high. (2) Mapping the care chain of the identified area of interest. (3) Developing hypotheses concerning where in the care chain challenges could be solved using a clinical decision support system. (4) Confirming or rejecting the proposed hypotheses through interviews with relevant experts. (5) Presenting the specific efficiency problem that could be solved using a CDSS and a presentation of the design of said CDSS. Findings: The efficiency problem that could be solved using a CDSS was identified to be within the area of heart failure treatment. There were a multitude of areas of improvement found along the care chain and a number of them could be solved by developing and using specific CDSSs. A CDSS that could help physicians, within the primary care system, to identify patients that could benefit from being assessed by cardiology specialist was proposed as the most beneficial CDSS system. The proposed CDSS would be both beneficial and realistically implementable.Syftet med uppsatsen är att belysa det övergripande behovet av kliniska beslutsstödssystem inom den svenska vården och slutligen finna det mest trängande behovet. En bättre förståelse för detta behov kan hjälpa att minska det existerande empiriska gapet och slutligen leda till en bättre och mer effektiv vård i Sverige. Forskarfrågan formulerades som uppdraget att finna ett behov för ökad effektivitet inom svensk sjukvård, som kan lösas genom implementering av ett realistiskt kliniskt beslutsstöd. Design och metodologi: Uppsatsen är en casestudie där kvalitativ data, samlad genom en litteraturstudie samt intervjuer, användes för att besvara forskningsfrågan. Metodologin som brukades var anpassad efter den unika naturen för forskningen, samt i enighet med syftet av studien. Metoden delades in i fem faser. (1) Finna ett fokusområde, exempelvis en specifik diagnos, där behovet av ett kliniskt beslutsstöd bedömdes högt. (2) Kartlägga vårdkedjan för den identifierade diagnosen. (3) Utveckla hypoteser angående var inom vårdkedjan som utmaningar skulle kunna lösas med ett kliniskt beslutsstöd. (4) Bekräfta eller förkasta ypoteserna genom intervjuer med relevanta experter. (5) Presentera problemet med det mest trängande behovet efter ett kliniskt beslutsstöd och hur ett sådans skulle utformas. Fynd: Effektivitetsproblemet som kunde lösas bäst via ett kliniskt beslutsstöd identifierades att vara inom området hjärtsviktsbehandling. Det fanns flertalet områden med utvecklingspotential som urskiljdes ur vårdkedjan för hjärtsviktspatienter, och vissa av dessa utmaningar kunde lösas genom utveckling och implementering av specifika kliniska beslutsstöd. Det kliniska beslutsstöd som skulle lösa det mest trängande behovet inom vården idag föreslås vara ett system som hjälper läkare inom vårdcentralerna att identifiera patienter som skulle gagnas av en remiss till en kardiolog. Det föreslagna kliniska beslutsstödet skulle vara både fördelaktigt för vårdpersonal samt patienter samt är realistiskt implementerbart.
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Bazile, Emmanuel Patrick. « Electronic Medical Records (EMR) : An Empirical Testing of Factors Contributing to Healthcare Professionals’ Resistance to Use EMR Systems ». NSUWorks, 2016. http://nsuworks.nova.edu/gscis_etd/964.
Texte intégralRésumé :
The benefits of using electronic medical records (EMRs) have been well documented; however, despite numerous financial benefits and cost reductions being offered by the federal government, some healthcare professionals have been reluctant to implement EMR systems. In fact, prior research provides evidence of failed EMR implementations due to resistance on the part of physicians, nurses, and clinical administrators. In 2010, only 25% of office-based physicians have basic EMR systems and only 10% have fully functional systems. One of the hindrances believed to be responsible for the slow implementation rates of EMR systems is resistance from healthcare professionals not truly convinced that the system could be of substantive use to them.
This study used quantitative methods to measure the relationships between six constructs, namely computer self-efficacy (CSE), perceived complexity (PC), attitude toward EMR (ATE), peer pressure (PP), anxiety (AXY), and resistance to use of technology (RES), are predominantly found in the literature with mixed results. Moreover, they may play a significant role in exposing the source of resistance that exists amongst American healthcare professionals when using Electronic Medical Records (EMR) Systems. This study also measured four covariates: age, role in healthcare, years in healthcare, gender, and years of computer use. This study used Structural Equation Modeling (SEM) and an analysis of covariance (ANCOVA) to address the research hypotheses proposed. The survey instrument was based on existing construct measures that have been previously validated in literature, however, not in a single model. Thus, construct validity and reliability was done with the help of subject matter experts (SMEs) using the Delphi method. Moreover, a pilot study of 20 participants was conducted before the full data collection was done, where some minor adjustments to the instrument were made. The analysis consisted of SEM using the R software and programming language.
A Web-based survey instrument consisting of 45 items was used to assess the six constructs and demographics data. The data was collected from healthcare professionals across the United States. After data cleaning, 258 responses were found to be viable for further analysis. Resistance to EMR Systems amongst healthcare professionals was examined through the utilization of a quantitative methodology and a cross-sectional research measuring the self-report survey responses of medical professionals. The analysis found that the overall R2 after the SEM was performed, the model had an overall R2 of 0.78, which indicated that 78% variability in RES could be accounted by CSE, PC, ATE, PP, and AXY. The SEM analysis of AXY and RES illustrated a path that was highly significant (β= 0.87, p < .001), while the other constructs impact on RES were not significant. No covariates, besides years of computer use, were found to show any significance differences.
This research study has numerous implications for practice and research. The identification of significant predictors of resistance can assist healthcare administrators and EMR system vendors to develop ways to improve the design of the system. This study results also help identify other aspects of EMR system implementation and use that will reduce resistance by healthcare professionals. From a research perspective, the identification of specific attitudinal, demographic, professional, or knowledge-related predictors of reference through the SEM and ANCOVA could provide future researchers with an indication of where to focus additional research attention in order to obtain more precise knowledge about the roots of physician resistance to using EMR systems.
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Nordlander, Henrik, et Olof Mjöberg. « Användbarhet hos journalsystem : En fallstudie om upplevd användbarhet hos Cosmic på Akademiska Sjukhuset ». Thesis, Uppsala universitet, Institutionen för informatik och media, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-376641.
Texte intégralRésumé :
Det har i Sverige gjorts stora åtaganden om att vara världsledande inom digitalisering av vården. Ett av de verktyg som möjliggör för vårdpersonalen att uppnå dessa åtaganden är de digitala journalsystem som idag används. I detta arbete genomför vi en fallstudie i syfte att undersöka hur användarna av det största digitala journalsystemet Cambio Cosmic upplever användbarheten hos systemet samt vilka förändringar och åtgärder som kan öka användbarheten. Datan i studien har insamlats med hjälp av fem intervjuer, tre läkare och två sjuksköterskor vid Akademiska sjukhuset som sedan analyserats utifrån modellen Quality in Use Integrated Measurement(QUIM) om användbarhet. En modell som används för att mäta användbarhet hos ett informationssystem. Resultatet av studien tyder på att Cosmic är användbart, men användbarheten är bristande vad gäller tillgänglighet av information och möjligheter att överblicka relevanta patientdata är undermålig. Studien visar att datorvana inte nödvändigtvis är synonymt med enkelhet att lära sig använda Cosmic, men att datorvana möjliggör en mer intuitiv navigering. Datorvana räcker däremot inte för att användaren ska bemästra Cosmic. Vi identifierar därför behovet av en introduktionsutbildning och regelbunden fortbildning inom systemet. Sett till hur användare söker kunskap om, och lösningar på, problem som kan uppstå i arbetet, försöker de ofta skapa egna lösningar än de Cosmic förser dem med. Vi identifierar i studien att en större delaktighet av användarna i vidareutvecklingen av systemet krävs för att nå bättre användbarhet. Vidare finner vi även att det bör implementeras utbredd funktionalitet och rutiner för återkoppling mellan användarna och ansvariga av systemet. Delaktigheten och återkopplingen ses som nära sammankopplade i resultatet. Återkoppling kan vara en del av, eller i helhet utgöra den delaktighet användarna efterfrågar och studien visar vara nödvändig. Det är dessa faktorer som studien sammanfattningsvis visar vara avgörande för att genom digitala journalsystem göra vården mer effektiv.
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Sattar, Abdus. « Create a Medical information Extraction tool applied on Electronic Patient Record systems mainly for Retrospective Research ». Thesis, KTH, Skolan för informations- och kommunikationsteknik (ICT), 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-121527.
Texte intégralRésumé :
This paper deals with medical data extraction from electronic patient record (EPR) system. Most of the medical data are stored in patient record systems, and data that are much valuable for medical research. If a researcher wants to extract medical information today, it has to be done manually because the data are stored in unstructured textual format in a system created by hospital staff. There is no way of extracting data in structure way. This paper is going to introduce an information extraction application for EPR system that allows the researcher to set up a study with inclusion and parameters for extraction for retrospective surveys in a webuser-interface environment. Inclusion is what the researcher would like to study (a defined category or criteria) and parameters specify the characteristics of inclusion the criteria. Result of this application provides an extracted clinical data that is used for retrospective surveys, downloadable to an MS-Excel file.
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Lusk, David Michael. « An Evaluative Study of User Satisfaction and Documentation Compliance : Using an Electronic Medical Record in an Emergency Department ». The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1280237643.
Texte intégral
22
Cesene, Daniel Fredrick. « The Completeness of the Electronic Medical Record with the Implementation of Speech Recognition Technology ». Youngstown State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ysu1401735616.
Texte intégral
23
Okoro, Chris U. « Perspectives of Primary Care Physicians on Adopting Electronic Medical Records in the Atlanta, Georgia Area ». ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5923.
Texte intégralRésumé :
Slow adoption of electronic medical records (EMR) by primary care physicians in medical office practices has not facilitated the EMR adoption process. The problem is the slow pace of EMR adoption by primary care physicians in the Atlanta, Georgia area has become a public health concern. Research regarding the lived experiences of these physicians with EMR implementation and utilization may identify reasons for the slow adoption. The purpose of this phenomenological study was to explore the lived experiences of primary care physicians, who practice in the Atlanta area, regarding their perception, successes, barriers, and urgency of adoption of EMR in their healthcare practice. Lewin's change management model of health services served as the framework for the study. Data was collected during face-to-face interviews with 19 primary care physicians at Grady's Ponce de Leon Clinic and Grady's East Point Clinic in Atlanta, Georgia. Participants were physicians or residents and not those in authority to make decisions about the EMR at the two clinics. NVivo 10 and automatic coding was used for data analysis to develop themes from the interviews. The findings revealed that the adoption of EMR has enabled primary care physicians to spend more time with their patients, but the barriers such as a lack of interoperability and lack of training, has fostered a feeling of disinterestedness towards EMR adoption. This study supports positive social change that EMR adoption aids in improving patient safety and outcome.
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Schultze, Jakob. « Digital transformation : How does physician’s work become affected by the use of digital health technologies ? » Thesis, Mittuniversitetet, Institutionen för data- och systemvetenskap, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-41260.
Texte intégralRésumé :
Digital transformation is evolving, and it is driving at the helm of the digital evolution. The amount of information accessible to us has revolutionized the way we gather information. Mobile technology and the immediate and ubiquitous access to information has changed how we engage with services including healthcare. Digital technology and digital transformation have afforded people the ability to self-manage in different ways than face-to-face and paper-based methods through different technologies. This study focuses on exploring the use of the most commonly used digital health technologies in the healthcare sector and how it affects physicians’ daily routine practice. The study presents findings from a qualitative methodology involving semi-structured, personal interviews with physicians from Sweden and a physician from Spain. The interviews capture what physicians feel towards digital transformation, digital health technologies and how it affects their work. In a field where a lack of information regarding how physicians work is affected by digital health technologies, this study reveals a general aspect of how reality looks for physicians. A new way of conducting medicine and the changed role of the physician is presented along with the societal implications for physicians and the healthcare sector. The findings demonstrate that physicians’ role, work and the digital transformation in healthcare on a societal level are important in shaping the future for the healthcare industry and the role of the physician in this future.Den digitala transformationen växer och den drivs vid rodret för den digitala utvecklingen. Mängden information som är tillgänglig för oss har revolutionerat hur vi samlar in information. Mobila tekniker och den omedelbara och allmänt förekommande tillgången till information har förändrat hur vi tillhandahåller oss tjänster inklusive inom vården. Digital teknik och digital transformation har gett människor möjlighet att kontrollera sig själv och sin egen hälsa på olika sätt än ansikte mot ansikte och pappersbaserade metoder genom olika tekniker. Denna studie fokuserar på att utforska användningen av de vanligaste digitala hälsoteknologierna inom hälso- och sjukvårdssektorn och hur det påverkar läkarnas dagliga rutin. Studien presenterar resultat från en kvalitativ metod som involverar semistrukturerade, personliga intervjuer med läkare från Sverige och en läkare från Spanien. Intervjuerna fångar vad läkare tycker om digital transformation, digital hälsoteknik och hur det påverkar deras arbete. I ett fält där brist på information om hur läkare arbetar påverkas av digital hälsoteknik avslöjar denna studie en allmän aspekt av hur verkligheten ser ut för läkare. Ett nytt sätt att bedriva medicin och läkarens förändrade roll presenteras tillsammans med de samhälleliga konsekvenserna för läkare och vårdsektorn. Resultaten visar att läkarnas roll, arbete och den digitala transformationen inom hälso- och sjukvården på samhällsnivå är viktiga för att utforma framtiden för vårdindustrin och läkarens roll i framtiden.
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Barry, Sacha (Sacha M. ). « Critical factors for successful electronic health record (EHR) implementation ». Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/104546.
Texte intégralRésumé :
Thesis: S.M. in Management Studies, Massachusetts Institute of Technology, Sloan School of Management, 2016.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 68-75).
Since the 1970s, the healthcare industry has been moving from paper-based documents towards computer information systems in an effort to increase timely access to quality information, with the ultimate objective of wide dissemination and adoption of Electronic Health Records (EHRs). EHRs are electronic collections of patient health information that are recorded by physicians, nurses and patients themselves, before being approved by physicians and shared across diverse settings. EHR implementation can improve care quality and efficiency and physician productivity and reduce healthcare costs. However, implementation often proves to be difficult. This paper reviews several common issues associated with EHR adoption including negative impacts on quality of care, physicians' productivity, patients' safety and organizations' financials from high maintenance and implementation costs. It then summarizes critical success factors found in the literature. It eventually examines two cases studies of Enterprise Resource Planning (ERP) implementation in the automotive and food and beverage industries and leverages ERP implementation best practices to develop a practical framework for successful HER adoption. Hopefully, it will be useful for future EHR adoption projects in the U.S. and other regions of the world.
by Sacha Barry.
S.M. in Management Studies
26
Huang, Qian, et Qin Yin. « Study on Electronic Health Record and its Implementation ». Thesis, Högskolan Kristianstad, Sektionen för hälsa och samhälle, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-9464.
Texte intégralRésumé :
This degree project deals with electronic health record (EHR). The report is divided into two main sections; literature study on electronic health record and an EHR system implementation. In the literature study section, EHR background, development history and service condition are introduced. The paper focuses on the sharing of medical information in different users, data safety and privacy. The adjunctions of computer science, technologies are used to solve the medical informatics’ problems. In the implementation section, based on the study of the current EHR systems, the design and implement of a shared EHR system are presented, which can be accessed by different doctors and patients. Access control function and cryptography protections are included in this system. The system test and evaluation are also given.
27
Kilic, Ozgur. « Achieving Electronic Healthcare Record (ehr) Interoperability Across Healthcare Information Systems ». Phd thesis, METU, 2008. http://etd.lib.metu.edu.tr/upload/12609665/index.pdf.
Texte intégralRésumé :
Providing an interoperability infrastructure for Electronic Healthcare Records (EHRs) is on the agenda of many national and regional eHealth initiatives. Two important integration profiles have been specified for this purpose: the "IHE Cross-enterprise Document Sharing (XDS)"
and the "
IHE Cross Community Access (XCA)"
. XDS describes how to share EHRs in a community of healthcare enterprises and XCA describes how EHRs are shared across communities. However, currently no solution addresses some of the important challenges of cross community exchange environments. The first challenge is scalability. If every community joining the network needs to connect to every other community, this solution will not scale. Furthermore, each community may use a different coding vocabulary for the same metadata attribute in which case the target community cannot interpret the query involving such an attribute. Another important challenge is that each community has a different patient identifier domain. Querying for the patient identifiers in another community using patient demographic data may create patient privacy concerns. Yet another challenge in cross community EHR access is the EHR interoperability since the communities may be using different EHR content standards.
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Drill, Valerie Gerene. « A Multisite Hospital's Transition to an Interoperable Electronic Health Records System ». ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3293.
Texte intégralRésumé :
The health care industry is transforming into an industry that requires health information technology, yet many health care organizations are reluctant to implement new technology. The purpose of this case study was to explore strategies that led to a successful transition from an older electronic health record (EHR) system to a compliant EHR system at a multisite hospital system (MHS). The study included face-to-face and phone interviews with 12 managers who worked on the transition of an MHS's EHR system in the Pacific Northwest region of the United States. The technology acceptance model was used to frame the study. Audio recordings with these managers were transcribed and analyzed along with interview notes and publicly available documents to identify themes regarding strategies used by managers to successfully upgrade to a compliant EHR system at an MHS. Three major themes emerged: hybrid implementation strategy, training strategy, and social pressure strategy. Results may be used to facilitate the adoption of information technology systems in any industry. Results may directly benefit other MHSs by facilitating successful EHR system transitions. Implications for social change include improved care coordination, reductions in duplicated medical procedures, and more timely and relevant tests for patients through the full use of EHRs.
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Johnson, Robyn. « Predicting clinicians’ intentions towards the electronic health record (EHR) : an extended UTAUT model ». Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/75255.
Texte intégralRésumé :
The Electronic Health Record (EHR) has the potential to promote understanding or awareness of healthcare knowledge among patients and healthcare providers to facilitate collaboration between various key stakeholders to improve the quality of healthcare. The technology is also expected to provide global health communities with benefits, from improved health outcomes, reduced medical errors, and a reduction in healthcare expenditure. These benefits will not be realised unless the key stakeholders and consumers of the technology are willing to accept, adopt, and use the EHR. The purpose of this study is to identify crucial factors influencing clinicians’ adoption of the EHR in South Africa’s healthcare system by expanding the Unified Theory of Acceptance and Use of Technology (UTAUT) model to include the additional constructs Resistance to Change and Attitude Towards Organisational Change. A cross-sectional online questionnaire was used to gather data from 168 clinicians employed at various private and public healthcare facilities across South Africa. Performance expectancy and facilitating conditions were found to have a statistically significant positive impact on clinicians’ behavioural intention, whereas effort expectancy and social influence had no similar result. Resistance to change had a statistically significant negative influence on behavioural intention, and a negative attitude towards organisational change positively influenced resistance to change. The findings of this study can be used by government bodies, the private sector and technology vendors to better understand clinicians’ perceptions of the EHR in order to guide policy and effect implementation strategies accordingly.Mini Dissertation (MBA)--University of Pretoria, 2020.
Gordon Institute of Business Science (GIBS)
MBA
Unrestricted
30
Mejia, Susan. « Strategies Rural Hospital Leaders Use to Implement Electronic Health Record ». ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5225.
Texte intégralRésumé :
The Centers for Medicare and Medicaid Services issued over 144,000 payments totaling $7.1 billion to medical facilities that have adopted and successfully demonstrated meaningful use of certified electronic health record (EHR). Hospital organizations can increase cost savings by using the electronic components of EHRs to improve medical coding and reduce medical errors and transcription costs. Despite the incentives, some rural health care facilities are failing to progress. The purpose of this multiple case study was to explore the strategies rural hospital leaders used to implement an EHR. The target population consisted of rural hospital leaders who were involved in the successful implementation of an EHR in South Texas. The conceptual framework chosen for this study was the sociotechnical systems theory. Data were collected through telephone interviews using open-ended semistructured interviews with 5 participants from 4 rural hospitals who were involved in the EHR implementation. Data analysis occurred using Yin's 5-step process which includes compiling, disassembling, reassembling, interpreting, and concluding. Data analysis included collecting information from government websites, company documents, and open-ended information to develop recurring themes. Several themes emerged including ongoing training, provider buy-in, constant communication, use of super users, and workflow maintenance. The findings could influence social change by making the delivery of health care more efficient and improving quality, safety, and access to health care services for patients.
31
Abdulrazak, Kadhim Duaa. « Improving Electronic Health Records for Non-Swedish Speaking Refugees : A Qualitative Case Study ». Thesis, Linnéuniversitetet, Institutionen för informatik (IK), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-71811.
Texte intégralRésumé :
Abstract Information and communication technology is used in healthcare in Sweden to improve health quality. Electronic Health Records are one of the technologies in healthcare which can increase a patient’s involvement in his/her healthcare and decision-making related to it. The patient can discuss the treatments, analyses and medical information stored in Electronic Health Records. The aim in this study is to investigate how the Electronics Health Records can be improved to motivate refugees in Sweden who cannot speak Swedish. This research is a qualitative interpretive case study. The methods used in this study are observation and interviews. Thematic analysis was used for data analysis. The findings show that refugees don’t receive information or instructions about how to use electronic health records properly. The language is the biggest hurdle to use electronic health records for refugee patients without knowing Swedish language. The findings further show that the electronic health records can be improved by adding sound or translated medical information in the diagnosis part of the electronic health record. This research might contribute to the healthcare process of any country in the world which has refugees and they use electronic health records.
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Kruse, Clemens. « An Analysis of the External Environmental and Internal Organizational Factors Associated With Adoption of the Electronic Health Record ». VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/3006.
Texte intégralRésumé :
Despite a Presidential Order in 2004 that launched national incentives for the use of health information technology, specifically the Electronic Health Record (EHR), adoption of the EHR has been slow. This study attempts to quantify factors associated with adoption of the EHR and Computerized Provider Order Entry (CPOE) by combining multiple organizational theories and empirical studies. The study is conducted in two phases. The primary phase of this study identifies and evaluates the effects of external environmental and internal organizational factors on healthcare organizations to adopt the EHR. From secondary data, twelve IVs (df=19) are chosen based on existing models and literature. Logistic regression is used to determine the association between the environmental factors and EHR adoption. The secondary phase of this study examines the adoption of five variations of CPOE using the same IVs from phase one. This EHR component of CPOE is chosen due to its promotion as a solution to help cross the quality chasm (IOM, 2001). Secondary data are analyzed and logistic regression is used to quantify the association between the factors of EHR adoption and CPOE adoption. Eleven of the twelve IVs are significant between the two phases (p<.1). This study uses data from 2009 because the HITECH Act was passed that year and significant government incentives were offered for those health care organizations (HCOs) that meet the qualifications of meaningful use. This study serves as a baseline for future studies, extends the work of other empirical studies, and fills a gap in the literature concerning factors associated with the adoption of the EHR and specific dimensions of CPOE. The Kruse Theory developed is strongly based in literature and reflects complexity commensurate with the health care industry.
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Sundvall, Erik. « Scalability and Semantic Sustainability in Electronic Health Record Systems ». Doctoral thesis, Linköpings universitet, Medicinsk informatik, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-87702.
Texte intégralRésumé :
This work is a small contribution to the greater goal of making software systems used in healthcare more useful and sustainable. To come closer to that goal, health record data will need to be more computable and easier to exchange between systems. Interoperability refers to getting systems to work together and semantics concerns the study of meanings. If Semantic interoperability is achieved then information entered in one information system is usable in other systems and reusable for many purposes. Scalability refers to the extent to which a system can gracefully grow by adding more resources. Sustainability refers more to how to best use available limited resources. Both aspects are important. The main focus and aim of the thesis is to increase knowledge about how to support scalability and semantic sustainability. It reports explorations of how to apply aspects of the above to Electronic Health Record (EHR) systems, associated infrastructure, data structures, terminology systems, user interfaces and their mutual boundaries. Using terminology systems is one way to improve computability and comparability of data. Modern complex ontologies and terminology systems can contain hundreds of thousands of concepts that can have many kinds of relationships to multiple other concepts. This makes visualization challenging. Many visualization approaches designed to show the local neighbourhood of a single concept node do not scale well to larger sets of nodes. The interactive TermViz approach described in this thesis, is designed to aid users to navigate and comprehend the context of several nodes simultaneously. Two applications are presented where TermViz aids management of the boundary between EHR data structures and the terminology system SNOMED CT. The amount of available time from people skilled in health informatics is limited. Adequate methods and tools are required to develop, maintain and reuse health-IT solutions in a sustainable way. Multiple levels of modelling including a fixed reference model and another layer of flexible reusable ‘archetypes’ for domain specific data structures, is an approach with that aim used in openEHR and the ISO 13606 standard. This approach, including learning, implementing and managing it, is explored from different angles in this thesis. An architecture applying Representational State Transfer (REST) to archetype-based EHR systems, in order to address scalability, is presented. Combined with archetyping this architecture also aims at enabling a sustainable way of continuously evolving multi-vendor EHR solutions. An experimental open source implementation of it, aimed for learning and prototyping, is also presented. Manually changing database structures used for storage every time new versions of archetypes and associated data structures are needed is likely not a sustainable activity. Thus storage systems that can handle change with minimal manual interventions are desirable. Initial explorations of performance and scalability in such systems are also reported Graphical user interfaces focused on EHR navigation, time-perspectives and highlighting of EHR content are also presented – illustrating what can be done with computable health record data and the presented approaches. Desirable aspects of semantic sustainability have been discussed, including: sustainable use of limited resources (such as available time of skilled people), and reduction of unnecessary risks. A semantic sustainability perspective should be inspired and informed by research in complex systems theory, and should also include striving to be highly aware of when and where technical debt is being built up. Semantic sustainability is a shared responsibility. The combined results presented contribute to increasing knowledge about ways to support scalability and semantic sustainability in the context of electronic health record systems. Supporting tools, architectures and approaches are additional contributions.Syftet med denna avhandling är ytterst att göra informationssystem som används i hälso- och sjukvård, särskilt patientjournaler, mer användbara och lättarbetade. Om systemen vore lättare att utveckla och underhålla skulle fler resurser kunna läggas på att tillföra nya och mer användarvänliga funktioner. Om journalsystem och datorprogram kan ”begripa” vad olika saker i journalen är och betyder så kan de vara till större hjälp, t.ex. genom att visa bättre patientöversikter och bidra med beslutsstöd. En del i att göra journalinnehållet begripligt och hanterbart för datorer är att använda sig av terminologisystem som t.ex. ICD-10 och SNOMED CT. En annan viktig del är datastrukturerna där man stoppar in text, mätvärden, koderna från terminologisystem etc. De flesta journalsystem har någon sorts mallar som datastrukturer. Projektet openEHR har tagit fram ett sätt att dela specifikationer av datastrukturer mellan olika journalsystem så att man lättare kan dela och återanvända dem och den journaldata som matats in i dem. Dessa specifikationer kallas ”arketyper” och arketyp-metoden beskrivs även i standarden ISO 13606. Om två olika journalsystem använder samma datastruktur, t.ex. med hjälp av samma arketyper, så kan de utväxla patientdata mellan varandra (de uppnår s.k. semantisk interoperabilitet). Begreppet ”Semantic sustainability” definieras i avhandlingen som ett förhållningssätt som är bredare än semantisk interoperabilitet. Det syftar till att möjliggöra långsiktigt hållbar utveckling av semantik (betydelse) i journalsystem och genom att hantera risker och resurser förståndigt. Förhållningssättet baserar sig på forskning och erfarenheter från systemutveckling och hantering av komplexa system och är avsett att stödja beslutsfattare, och de som utvecklar och underhåller journalsystem, relaterade system och strukturer. För att datorsystem ska kunna växa vid ökad användning ,utan att hamna i återvändsgränder avseende prestanda, så bör vissa designprinciper för skalbarhet följas. Avhandlingen presenterar en systemarkitektur baserad på sådana principer och på arketyp-metoden. Denna arkitektur gör det möjligt att bygga system med delsystem från flera olika leverantörer. Skalbarheten i några lagringslösningar redovisas också. Slutligen redovisas prototyper av gränssnitt för patientöversikter och journalläsning.
34
Riddley, Priscilla. « Strategies for Developing and Implementing Information Technology Systems for EHRs ». ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5120.
Texte intégralRésumé :
Some hospital leaders lack the technical expertise to implement electronic health records (EHRs) even though the healthcare industry has a government mandate. The purpose of this single case study was to explore strategies healthcare executives use to develop and implement information technology systems for processing EHRs. The target population consisted of healthcare leaders and managers successful in implementing EHR systems in a healthcare organization. Lewin's 3-step change theory was used as the conceptual framework for this study with data collected from observations (5), semistructured interviews (5), and organizational documents. Descriptive coding was used to identify 3 themes that emerged from observations, document analysis, recording and analyzing the interview transcripts of research participants. The themes included communication and management plan for EHR implementation, information technology EHR vendor selection, and EHR implementation technical support strategy. The findings benefit both the patients and clinicians with the potential to improve healthcare service delivery utilizing electronic technology for documenting physician visits. Study results may assist healthcare providers with identifying implementation strategies successful for EHR adoption and assisting with speeding the process. The research findings may contribute to social change through increasing patient access to treatment along with community engagement in using EHRs by information sharing to reduce healthcare cost.
35
McIntire, Anne. « The Nursing Handover : The Role Of The Electronic Health Record In Facilitating The Transfer Of Care ». The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1479565854775435.
Texte intégral
36
Reid, Jr Marvin Leon. « Adoption of Electronic Health Record Systems Within Primary Care Practices ». ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2228.
Texte intégralRésumé :
Primary care physicians (PCPPs) have been slow to implement electronic health records (EHRs), even though there is a U.S. federal requirement to implement EHRs. The purpose of this phenomenological study was to determine why PCPPs have been slow to adopt electronic health record (EHR) systems despite the potential to increase efficiency and quality of health care. The complex adaptive systems theory (CAS) served as the conceptual framework for this study. Twenty-six PCPPs were interviewed from primary care practices (PCPs) based in southwestern Ohio. The data were collected through a semistructured interview format and analyzed using a modified van Kaam method. Several themes emerged as barriers to EHR implementation, including staff training on the new EHR system, the decrease in productivity experienced by primary care practice (PCP) staff adapting to the new EHR system, and system usability and technical support after adoption. The findings may contribute to the body of knowledge regarding EHR system implementation and assist healthcare providers who are slow to adopt EHRs. Additionally, findings could contribute to social change by reducing healthcare costs, increasing patient access to care, and improving the efficacy of patient diagnosis and treatment.
37
Borek, Jarrod. « Managerial Strategies for Maximizing Benefits From Electronic Health Record Systems ». ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4959.
Texte intégralRésumé :
In 2009, the U.S. government allocated $27 billion to health care agencies for electronic health records (EHRs) implementation. The increased use of EHR systems is expected to drive down health care costs and increase profits. To meet this anticipated return on investment (ROI), hospital managers need to be able to successfully design, deploy, and manage EHR systems. The purpose of this single case study was to explore organizational management strategies that hospital managers can use to ensure their investments in EHRs meet targeted ROIs and work efficiency goals. The conceptual framework for this study was based on the technology acceptance model. Primary data were collected from a criterion sample of 6 hospital managers with direct experience designing and implementing successful EHRs in a small hospital in the Northeastern United States. Secondary data were collected using public financial records available on the Internet. After cataloging and grouping the raw data, 4 emergent themes were identified: (a) training, (b) the role of organizational management strategies, (c) technological barriers, and (d) ongoing support and maintenance. Findings may contribute to social change through an increase in the quality of patient care and making health care records more accessible to doctors in isolated areas.
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Weston, Daniel Joseph II. « Improving Estimates for Electronic Health Record Take up in Ohio : A Small Area Estimation Technique ». The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1325266402.
Texte intégral
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Moner, Cano David. « Archetype development and governance methodologies for the electronic health record ». Doctoral thesis, Universitat Politècnica de València, 2021. http://hdl.handle.net/10251/164916.
Texte intégralRésumé :
[ES] La interoperabilidad semántica de la información sanitaria es un requisito imprescindible para la sostenibilidad de la atención sanitaria, y es fundamental para afrontar los nuevos retos sanitarios de un mundo globalizado. Esta tesis aporta nuevas metodologías para abordar algunos de los aspectos fundamentales de la interoperabilidad semántica, específicamente aquellos relacionados con la definición y gobernanza de modelos de información clínica expresados en forma de arquetipo.
Las aportaciones de la tesis son:
- Estudio de las metodologías de modelado existentes de componentes de interoperabilidad semántica que influirán en la definición de una metodología de modelado de arquetipos.
- Análisis comparativo de los sistemas e iniciativas existentes para la gobernanza de modelos de información clínica.
- Una propuesta de Metodología de Modelado de Arquetipos unificada que formalice las fases de desarrollo del arquetipo, los participantes requeridos y las buenas prácticas a seguir.
- Identificación y definición de principios y características de gobernanza de arquetipos.
- Diseño y desarrollo de herramientas que brinden soporte al modelado y la gobernanza de arquetipos.
Las aportaciones de esta tesis se han puesto en práctica en múltiples proyectos y experiencias de desarrollo. Estas experiencias varían desde un proyecto local dentro de una sola organización que requirió la reutilización de datos clínicos basados en principios de interoperabilidad semántica, hasta el desarrollo de proyectos de historia clínica electrónica de alcance nacional.[CA] La interoperabilitat semàntica de la informació sanitària és un requisit imprescindible per a la sostenibilitat de l'atenció sanitària, i és fonamental per a afrontar els nous reptes sanitaris d'un món globalitzat. Aquesta tesi aporta noves metodologies per a abordar alguns dels aspectes fonamentals de la interoperabilitat semàntica, específicament aquells relacionats amb la definició i govern de models d'informació clínica expressats en forma d'arquetip. Les aportacions de la tesi són: - Estudi de les metodologies de modelatge existents de components d'interoperabilitat semàntica que influiran en la definició d'una metodologia de modelatge d'arquetips. - Anàlisi comparativa dels sistemes i iniciatives existents per al govern de models d'informació clínica. - Una proposta de Metodologia de Modelatge d'Arquetips unificada que formalitza les fases de desenvolupament de l'arquetip, els participants requerits i les bones pràctiques a seguir. - Identificació i definició de principis i característiques de govern d'arquetips. - Disseny i desenvolupament d'eines que brinden suport al modelatge i al govern d'arquetips. Les aportacions d'aquesta tesi s'han posat en pràctica en múltiples projectes i experiències de desenvolupament. Aquestes experiències varien des d'un projecte local dins d'una sola organització que va requerir la reutilització de dades clíniques basades en principis d'interoperabilitat semàntica, fins al desenvolupament de projectes d'història clínica electrònica d'abast nacional.
[EN] Semantic interoperability of health information is an essential requirement for the sustainability of healthcare, and it is essential to face the new health challenges of a globalized world. This thesis provides new methodologies to tackle some of the fundamental aspects of semantic interoperability, specifically those aspects related to the definition and governance of clinical information models expressed in the form of archetypes. The contributions of the thesis are: - Study of existing modeling methodologies of semantic interoperability components that will influence in the definition of an archetype modeling methodology. - Comparative analysis of existing clinical information model governance systems and initiatives. - A proposal of a unified Archetype Modeling Methodology that formalizes the phases of archetype development, the required participants, and the good practices to be followed. - Identification and definition of archetype governance principles and characteristics. - Design and development of tools that provide support to archetype modeling and governance. The contributions of this thesis have been put into practice in multiple projects and development experiences. These experiences vary from a local project inside a single organization that required a reuse on clinical data based on semantic interoperability principles, to the development of national electronic health record projects.
This thesis was partially funded by the Ministerio de Economía y Competitividad, ayudas para contratos para la formación de doctores en empresas “Doctorados Industriales”, grant DI-14-06564 and by the Agencia Valenciana de la Innovación, ayudas del Programa de Promoción del Talento – Doctorados empresariales (INNODOCTO), grant INNTA3/2020/12.
Moner Cano, D. (2021). Archetype development and governance methodologies for the electronic health record [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/164916
TESIS
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Eguale, Tewodros. « Novel use of electronic health record (EHR) to estimate the prevalence of off-label prescribing, determinants and its association with adverse drug events (ADE) ». Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=119344.
Texte intégralRésumé :
Background Adverse drug events (ADE) are leading cause of death. Current pharmacosurveillance methods rely on passive reporting to monitor drug safety, but this is slow and many ADEs are unreported. Moreover, physicians regularly prescribe drugs for indications for which they were never tested (off-label use), despite some highly-publicized associations with ADEs. We urgently need timely pharmacosurveillance methods to monitor drug safety and effectiveness for on- and off-label uses. Electronic health records (EHR) may help fill this void if they document the reasons for drug prescription (treatment indications) and discontinuation (e.g. adverse drug event, ineffectiveness). Objectives 1) To determine the accuracy of an EHR system in documenting orders for drug discontinuation and dose changes of prescription drugs. 2) To determine the sensitivity and positive predictive value of using an EHR to document treatment indications at the time of prescribing. 3) To evaluate the prevalence of off-label prescribing and its drug, patient and physician determinants in primary care. 4) To determine the association between off-label use and ADEs. Methods I conducted four studies using the Medical Office of the XXI century (MOXXI) EHR system, developed by the McGill clinical and health informatics research group. First, I conducted a validation study to assess the sensitivity, specificity, positive and negative predictive value of the MOXXI EHR system in documenting prescription drug discontinuation and dose-change orders by comparing with information from physician-facilitated chart review. Second, I assessed the sensitivity and the positive predictive value of MOXXI EHR in documenting treatment indications. Third, I estimated the prevalence of off-label prescribing and assessed the strength of scientific evidence for off-label use. Moreover, the drug, patient and physician determinants of off-label prescribing were assessed. Fourth, I assessed the association between off-label use and ADE using incident drug prescriptions, treatment indications and ADE data collected using an EHR. Results Manuscript 1 The sensitivity of the EHR in identifying physician-initiated drug discontinuations and dose-changes was 67.0% (95% CI: 54.1, 77.7), the specificity was 99.7% (95% CI: 99.5, 99.9), and the positive predictive value was 97.3% (95% CI: 95.6, 98.7). Manuscript 2 The sensitivity of the EHR treatment indication was 98.5% (95% CI; 96.5%, 99.5%) and the PPV of the system in identifying the treatment indication was 97.0% (95% CI; 94.2%, 98.6%). Manuscript 3 The prevalence of off-label use was 11.0% of 253,347 prescriptions written to 50,823 patients. 79.0% of off-label prescriptions lacked strong scientific evidence. Off-label use was highest for CNS drugs (26.3%), including anticonvulsants (67%), antipsychotics (44%), and antidepressants (33%). Higher risk of off-label use was demonstrated in drugs with 1-2 approved indications, older drugs, in women and in physicians with less evidence-based orientation. Manuscript 4 Off-label use and off-label use without strong scientific evidence had higher risk of ADE compared to on-label use [HR, 1.43 (95% CI, 1.29, 1.59) and HR, 1.53 (95% CI, 1.37, 1.72), respectively]. Younger patients, women, and patients who received ≥8 drugs or anti-infective drugs had increased ADE risk. Conclusion I have shown for the first time that an EHR system can accurately document physician-identified treatment indications and adverse drug events and other treatment outcomes. The treatment indication data could measure prevalence of off-label use. In addition, the treatment indication data, combined with drug treatment outcome data, could create a novel pharmacosurveillance tool. Moreover, I demonstrated that off-label prescribing is an independent determinant of ADEs. Future EHRs should incorporate treatment indication and treatment outcome features to monitor the safety and effectiveness of on- and off-label uses of drugs.Contexte Les effets indésirables des médicaments (EIM) sont une cause importante de mortalité. Les méthodes actuelles de pharmacovigilance sous-estiment l'incidence des EIM et sont inefficientes. De plus, les médecins prescrivent souvent des médicaments pour des indications pour lesquelles ils n'ont pas été approuvés (usage non indiqué), une pratique associée à des EIM hautement médiatisés. Il y a donc un urgent besoin de développer de nouvelles méthodes de pharmacovigilance. À cette fin, les dossiers de santé électroniques (DSE) pourraient être utiles, notamment si l'indication de traitement et la raison justifiant l'arrêt d'un médicament y sont documentées.Objectifs1) Déterminer l'exactitude d'un DSE à documenter les arrêts de traitement médicamenteux; 2) Déterminer la sensibilité et la valeur prédictive positive d'un DSE à documenter les indications de traitement; 3) Évaluer la prévalence des prescriptions non indiquées en soins primaires et les déterminants y étant associées. 4) Déterminer l'association entre l'utilisation non indiquée des médicaments et les EIM. Méthodes Pour atteindre ces objectifs de recherche, j'ai réalisé quatre études en utilisant le DSE Medical Office of the XXI century (MOXXI). Premièrement, j'ai mené une étude de validation afin d'évaluer la sensibilité, la spécificité et les valeurs prédictives positive (VPP) et négative (VPN) du DSE MOXXI à documenter les ordonnance d'arrêt de traitement. Deuxièmement, j'ai mené une étude de validation afin d'évaluer la sensibilité et la VPP de MOXXI à documenter les indications de traitement. Troisièmement, j'ai estimé la prévalence de l'usage non indiqué des médicaments en soins primaires, ainsi que la robustesse des données supportant ce type d'usage. Quatrièmement, j'ai utilisé MOXXI afin d'évaluer l'association entre l'usage non indiqué des médicaments et les EIM. Résultats Manuscrit 1 La sensibilité de MOXXI à identifier des arrêts de traitements est de 67,0% (IC à 95%: 54,1 - 77,7), la spécificité est de 99,7% (IC 95%: 99,5, 99,9), la VPP est de 97,3% (IC à 95%: 95,6 - 98,7). Manuscrit 2 La sensibilité de l'indication de traitement documentée dans MOXXI était de 98,5% (IC à 95%; 96,5% - 99,5%) et sa VPP était de 97,0% (IC à 95%, 94,2% - 98,6%). Manuscrit 3 La prévalence de l'usage non indiqué des médicaments est de 11,0% parmi 253 347 prescriptions reçues par 50 823 patients. On estime que 79,0% des prescriptions non indiquées ne sont pas justifiées empiriquement. L'usage non indiqué des médicaments est le plus élevé pour les médicaments du système nerveux central (26,3%), dont les anticonvulsivants (66,6%), les antipsychotiques (43,8%) et les antidépresseurs (33,4%). Des taux élevés d'usages non indiqués des médicaments ont été démontrés pour les médicaments n'ayant que 1 ou 2 indications approuvées, les médicaments plus anciens, chez les femmes et pour les médecins plus empiristes. Manuscrit 4 Le taux d'EIM associé à un usage non indiqué des médicaments (19.8/10 000 personnes-mois) est plus élevé que celui pour les usages indiqués (12,5 pour 10.000 personnes-mois) [HR : 1,43; IC à 95% : 1,29 - 1,59)]. Les usages non indiqués, non justifiés empiriquement, ont un taux encore plus élevé d'EIM (21,8 pour 10.000 personnes-mois) par rapport aux usages indiqués [HR : 1,53; IC à 95% : 1,37 - 1,72]). Les patients plus jeunes, les femmes et les patients ayant reçu ≥8 médicaments ou des agents anti-infectieux ont un risque accru d'EIM. Conclusion Un DSE peut documenter avec précision les indications de traitement, les EIM et d'autres résultats de traitement. Les données relatives à l'indication de traitement pourraient être combinées à celles relatives aux résultats cliniques afin de créer un nouvel outil de pharmacosurveillance. L'usage non indiqué des médicaments est un déterminant indépendant des EIM. Les DSE devront intégrer les indications et les résultats de traitements afin de faciliter l'évaluation de la sécurité et de l'efficacité des médicaments.
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Huffaker, Luke Gregor, et Luke Gregor Huffaker. « Assessment of School Nurse-Provider Communication of Changes in Student Condition ». Diss., The University of Arizona, 2018. http://hdl.handle.net/10150/626690.
Texte intégralRésumé :
The landscape of the United States public school system was greatly improved upon with the
creation of The Individuals with Disabilities Education Act of 2004 (IDEA 2004). This act established a standard that allowed all school aged children living with chronic illnesses to integrate into public school systems. This mandate currently impacts over 12 million children living with chronic illness including and not limited to asthma, seizure disorders, developmental delay, cystic fibrosis, traumatic brain injuries, anxiety and cancer. IDEA 2004 extended healthcare into public school systems and as a result, increased the average acuity of students that school nurses (SNs) care for. It is estimated that 15% of school-aged children miss 11 or more school days per year because of illness or injury demonstrating evidence of increased student acuity and a need to provide more appropriate care for these students in order to increase their time spent in the academic setting. Adequate SN and primary care provider (PCP) communication is essential to reduce absenteeism for this population and to ensure that students are safe during their time spent away from home and healthcare clinics. From this quality improvement project, more is understood pertaining to the communication patterns between SNs and PCPs and recommendations are provided in order to increase effective SN and PCP communication.
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Chang, Jaime. « Medication concepts, records, and lists in electronic medical record systems ». Thesis, Massachusetts Institute of Technology, 2006. http://hdl.handle.net/1721.1/35551.
Texte intégralRésumé :
Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2006.Includes bibliographical references.
A well-designed implementation of medication concepts, records, and lists in an electronic medical record (EMR) system allows it to successfully perform many functions vital for the provision of quality health care. A controlled medication terminology provides the foundation for decision support services, such as duplication checking, allergy checking, and drug-drug interaction alerts. Clever modeling of medication records makes it easy to provide a history of any medication the patient is on and to generate the patient's medication list for any arbitrary point in time. Medication lists that distinguish between description and prescription and that are exportable in a standard format can play an essential role in medication reconciliation and contribute to the reduction of medication errors. At present, there is no general agreement on how to best implement medication concepts, records, and lists. The underlying implementation in an EMR often reflects the needs, culture, and history of both the developers and the local users. survey of a sample of medication terminologies (COSTAR Directory, the MDD, NDDF Plus, and RxNorm) and EMR implementations of medication records (OnCall, LMR, and the Benedum EMR) reveals the advantages and disadvantages of each. There is no medication system that would fit perfectly in every single context, but some features should strongly be considered in the development of any new system.
(cont.) A survey of a sample of medication terminologies (COSTAR Directory, the MDD, NDDF Plus, and RxNorm) and EMR implementations of medication records (OnCall, LMR, and the Benedum EMR) reveals the advantages and disadvantages of each. There is no medication system that would fit perfectly in every single context, but some features should strongly be considered in the development of any new system.
by Jaime Chang.
S.M.
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Almutiry, Omar Saud. « Data quality assessment instrument for electronic health record systems in Saudi Arabia ». Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/419029/.
Texte intégralRésumé :
The provision of high quality data is of considerable importance to both business and government; poor data may lead to poor decisions, so quality plays a crucial role. With the proliferation of electronic data collection by businesses and governments, there has arisen a pressing need to assure this quality. This has been recognized by both the private and public sectors, and many initiatives such as the Data Quality Initiative Framework by the Welsh government, passed in 2004, and the Data Quality Act by the United States government, passed in 2002, have been launched to improve it in those countries. At the same time, healthcare is a domain in which the timely provision of accurate, current and complete patient data is one of the most important objectives. Instigation of a so-called Electronic Health Record (EHR), defined as a repository of patient data in digital form that is stored and exchanged securely and is accessible by different levels of authorized users, has been attracting the attention of both research and industry. EHRs allow information regarding a patient’s health to be distributed among heterogeneous information systems. This evolution has added a layer of complexity in data quality, making data quality assurance a challenging issue, as the key barriers to optimal use of EHR data are the increasing quantity of data and their poor quality. Many data quality frameworks have been developed to measure the quality of data in information systems. However, there is no consensus on a rigorously defined set of data quality dimensions. Existing dimensions are usually based on literature reviews, industrial experiences or intuitive understanding and do not take into consideration the nature of e-healthcare systems. Moreover, definitions of these dimensions vary from one data quality framework to another. The aim of this research is to develop a data quality framework consisting of health-relevant dimensions, and data quality measures that help health organisations to enhance the quality of their data. The study provides both subjective and objective measures for assessing the quality of data. An 11-dimensional data quality framework has been developed and confirmed by EHR stakeholders and a group of experts and data consumers. With each dimension, several associated measures have been developed to help an organisation to measure the quality of the data populating their EHR systems. Some issues linked with the measures associated with security-related dimensions have arisen during the confirmation stage. Therefore, these issues were further discussed and reviewed with security experts in order to revise the proposed framework and its measures. Subsequently, a case study was conducted in a large hospital to examine the practicality of the proposed instrument. The instrument was used to help hospitals to assess their data. After that, the usefulness and practicality of the instrument were examined through an evaluation questionnaire distributed to quality assessment team members. Follow-up interviews with senior managers were carried out to discuss the output of the assessment and its practicality. The contribution of this research is the development of a proper data quality framework for EHRs in the context of Saudi Arabia which resulted in 11 health-relevant data quality dimensions. An instrument was also introduced to represent all developed and confirmed measures that assess data population in EHRs.
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Erdil, Nadiye Özlem. « Systems analysis of electronic health record adoption in the U.S. healthcare system ». Diss., Online access via UMI:, 2009.
Trouver le texte intégralRésumé :
Thesis (Ph. D.)--State University of New York at Binghamton, Thomas J. Watson School of Engineering and Applied Science, Department of Systems Science and Industrial Engineering, 2009.Includes bibliographical references.
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Tannan, Ritu. « Acceptance and Usage of Electronic Health Record Systems in Small Medical Practices ». ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1028.
Texte intégralRésumé :
One of the objectives of the U.S. government has been the development of a nationwide health information infrastructure, including adoption and use of an electronic health records (EHR) system. However, a 2008 survey conducted by the National Center for Health Statistics indicated a 41.5% usage of the EHR system by physicians in office-based practices. The purpose of this study was to explore opinions and beliefs on the barriers to the diffusion of an ERH system using Q-methodology. Specifically, the research questions examined the subjectivity in the patterns of perspectives at the preadoption stage of the nonusers and at the postadoption stage of the users of an EHR system to facilitate effective diffusion. Data were collected by self-referred rank ordering of opinions on such barriers and facilitators. The results suggested that the postadoption barriers of time, change in work processes, and organizational factors were critical. Although the time barrier was common, barriers of organizational culture and change in work processes differed among typologies of perspectives at the postadoption stage. Preadoption barriers of finance, organizational culture, time, technology, and autonomy were critical. The typologies of perspectives diverged on critical barriers at the preadoptive stage. A customized solution of an in-house system and training is recommended for perspectives dealing with technical and organizational concerns and a web-based system for perspectives concerned with barriers of finance, technology, and organization. The social impact of tailoring solutions to personal viewpoints would result in the increased sharing of quality medical information for meaningful decision making.
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Miller, Shaunette. « Strategies Hospital Leaders Use in Implementing Electronic Medical Record Systems ». ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3311.
Texte intégralRésumé :
Some hospital leaders lacked strategies for implementing electronic medical record (EMR) systems. The purpose of this case study was to explore successful strategies that hospital leaders used in implementing EMR systems. The target population consisted of hospital leaders who succeeded in implementing EMR systems in a single healthcare organization located in the Los Angeles, California region. The conceptual framework used was Kotter's (1996) eight-step process for leading change, and data were collected from face-to-face recorded interviews with 5 participants and from company documents related to EMR design and development. Data were analyzed through methodological triangulation of data types, and exploring codes exhibiting high frequencies to identify principal themes and subthemes. The data coding revealed three primary themes. The first theme related to strategies addressing training, technology, and catalyzing team effort. The second theme related to strategies focusing on employees' concerns, and the third theme related to strategies for designing, developing, and disseminating workflow. The findings affirmed the conceptual framework of Kotter (1996) inasmuch as they showed that participating hospital leaders used one or more steps in Kotter's eight-stage process of creating, implementing, and sustaining significant change. The findings could effect social change by improving the quality of healthcare services provided to patients, which can subsequently benefit patients' families and communities through reducing the costs of healthcare.
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Lozano, Rubí Raimundo. « A metamodel for clinical data integration. Basis for a new EHR model driven by ontologies ». Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/399855.
Texte intégralRésumé :
Durante las últimas décadas se ha extendido la implantación de sistemas de información en las organizaciones sanitarias, proporcionando un adecuado soporte a los principales procesos de las mismas. Sin embargo, a pesar de los avances producidos durante los últimos años en las tecnologías de la información y la comunicación, los sistemas actuales no son capaces de proporcionar un verdadero soporte a los profesionales sanitarios en su práctica diaria y sus actividades de investigación. Como consecuencia de la variedad de organizaciones sanitarias existentes y la heterogeneidad de los sistemas de información en uso, los sistemas actuales de Historia Clínica Electrónica no son capaces de mostrar a los profesionales sanitarios una visión conceptualmente consolidada del estado de salud de los pacientes. Los datos clínicos de los pacientes se encuentran fragmentados tanto entre diferentes sistemas de información como dentro de los mismos, de modo que los profesionales deben interpretar las relaciones entre los mismos así como inferir relaciones ausentes. En este escenario, la interoperabilidad semántica es considerada por la comunidad científica como un factor esencial para que los sistemas de HCE constituyan una ayuda para mejorar la calidad y seguridad de la atención a los pacientes, la salud pública, la investigación clínica y la gestión sanitaria.
En esta tesis proponemos OntoEHR, una arquitectura conceptual para un nuevo sistema de HCE semánticamente interoperable, enfocado sobre el proceso clínico y dirigido por ontologías. Tanto los elementos conceptuales como estructurales del sistema son definidos explícitamente mediante ontologías OWL, conforme a un metamodelo declarativo que dirige el sistema. Los datos clínicos procedentes de diferentes fuentes son almacenados e integrados en un repositorio clínico, conforme con la norma CEN/ISO 13606, que es capaz de comunicar los datos clínicos mediante extractos CEN/ISO 13606. Por último, proponemos un modelo de Historia Clínica Orientada por Problemas, basada en la norma CEN/ISO 13940, para representar los datos clínicos de los pacientes, asegurando una continuidad asistencial segura y eficiente.
Esta tesis no propone ningún sistema de HCE específico y completo, sino las bases para construir tales sistemas.The deployment of information systems in healthcare facilities has become widespread in recent decades and the main processes at Healthcare facilities are generally well supported. However, in spite of great advances in information and communication technologies domain during last years, current systems fail to provide true support to healthcare professionals in their daily practice and research activities. As a consequence of the variety of organizations providing healthcare and the heterogeneity of information systems used, current Electronic Health Record systems are not capable to show to healthcare professionals a conceptually consolidated view of the patients’ health state. Patient’s health data are fragmented inside information systems and over different information systems, and the professional should interpret and infer lacking relationships among them. In this scenario, semantic interoperability is pointed out by scientific community as an essential factor in achieving benefits from EHR systems to improve the quality and safety of patient care, public health, clinical research, and health service management. In this thesis we propose OntoEHR, a conceptual architecture for a new semantically interoperable EHR system, focused on the clinical process and driven by ontologies. Conceptual and structural elements of the system are explicitly defined in OWL ontologies, conforming a declarative metamodel that drive all the system. Clinical data coming from different sources are stored and integrated in a clinical repository conforming to CEN/ISO 13606 standard, which is able to communicate clinical data using CEN/ISO 13606 extracts. Lastly, we propose a Problem Oriented Medical Record model, founded on CEN/ISO 13940 standard, to represents patients’ clinical data, assuring a safe and efficient continuity of care. This thesis do not propose a specific and complete EHR system, but the foundation to build such systems.
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Win, Khin Than. « The application of the FMEA risk assessment technique to electronic health record systems ». Access electronically, 2005. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20050822.093730/index.html.
Texte intégral
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San, Jose Rhoda Lynn Atienza. « Educating Nurses on Workflow Changes from Electronic Health Record Adoption ». ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3321.
Texte intégralRésumé :
Workflow issues related to adoption of the electronic health record (EHR) has led to unsafe workarounds, decreased productivity, inefficient clinical documentation and slow rates of EHR adoption. The problem addressed in this quality improvement project was nurses' lack of knowledge about workflow changes due to EHR adoption. The purpose of this project was to identify changes in workflow and to develop an educational module to communicate the changes. This project was guided by both the ADDIE model (analysis, design, development, implementation, and evaluation) and the diffusion of innovations theory. Five stages were involved: process mapping, cognitive walkthrough, eLearning module development, pilot study, and evaluation. The process maps and cognitive walkthrough revealed significant workflow changes particularly in clinical practice guidelines, emergency department treatment plan, and the interdisciplinary care plan. The eLearning module was developed to describe workflow changes using gamification, scenario-based learning, and EHR simulation. The 14-item course evaluation included a 6-point Likert scale and closed- and open-ended questions. A purposive sample of nurses (N = 30) from the emergency department and inpatient care areas were invited to complete the eLearning module and course evaluation. Data were collected until saturation was achieved (n = 15). Descriptive statistics revealed the participants' positive learning experience. This quality improvement project is expected to contribute to positive social change by facilitating the effective use of the new EHR which can improve the quality of patient care, promote patient safety, reduce healthcare costs, and improve patient outcomes.
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Weagraff, Joseph B. « Health Care Leaders' Experiences of Electronic Medical Record Adoption and Use ». ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3216.
Texte intégralRésumé :
Adoption of electronic medical record (EMR) technology systems of meaningful use has been slow despite the mandate by the U.S. government. The purpose of this single case study was to explore strategies used by health care leaders to implement EMR technology systems of meaningful use to take advantage of federal incentive payments. Diffusion of innovation theory provided the conceptual framework for the study. Semistructured interviews were conducted with 6 health care leaders from a military installation in the Southeast United States. Data were analyzed using software, coding, and inductive analyses. The 3 prominent themes were patient, provider, and champion. Alerts from an EMR technology system can increase providers' awareness and improve patient safety. Providers' involvement in every phase of an EMR system's implementation can improve the adoption rate. Champions play a critical role in successful adoption and implementation of EMR systems. Results of this study may assist health care leaders in implementing EMR systems to take advantage of federal incentive payments. Implications for positive social change include enhanced delivery of safe, high-quality health care.