Articles de revues : « Electronic Health Record (EHR) systems »

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Seymour, Tom, Dean Frantsvog et Tod Graeber. « Electronic Health Records (EHR) ». American Journal of Health Sciences (AJHS) 3, n^o 3 (13 juillet 2012) : 201–10. http://dx.doi.org/10.19030/ajhs.v3i3.7139.

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Electronic Health Records are electronic versions of patients’ healthcare records. An electronic health record gathers, creates, and stores the health record electronically. The electronic health record has been slow to be adopted by healthcare providers. The federal government has recently passed legislation requiring the use of electronic records or face monetary penalties. The electronic health record will improve clinical documentation, quality, healthcare utilization tracking, billing and coding, and make health records portable. The core components of an electronic health record include administrative functions, computerized physician order entry, lab systems, radiology systems, pharmacy systems, and clinical documentation. HL7 is the standard communication protocol technology that an electronic health record utilizes. Implementation of software, hardware, and IT networks are important for a successful electronic health record project. The benefits of an electronic health record include a gain in healthcare efficiencies, large gains in quality and safety, and lower healthcare costs for consumers. Electronic health record challenges include costly software packages, system security, patient confidentiality, and unknown future government regulations. Future technologies for electronic health records include bar coding, radio-frequency identification, and speech recognition.

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Mehmood, Hamid, Muhammad Aslam, Sadia Aslam, Ammara Waqar, Athar Khan, Yasir Hassan, Faryal Murtaza Cheema, Hassan Mujtaba et Noor-e. Maham. « ELECTRONIC HEALTH RECORD SYSTEMS ; ». Professional Medical Journal 24, n^o 01 (18 janvier 2017) : 182–87. http://dx.doi.org/10.29309/tpmj/2017.24.01.401.

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Introduction: e-Health is a combination of medical informatics, public health,business and information technology. Health information technology has increased theproductivity by reengineering of health care but it requires new measurement tools to monitorthe impact of it .e-health is not only for the development of technologies but also it includesproper planning, thinking, broad thinking to improve healthcare services with the help ofinformation and communication technology. Objectives: 1) To assess the perceptions ofphysicians towards the use, effectiveness and efficiency of EHR 2) To identify the differencesbetween electronic and paper based records 3) To evaluate the usage of Electronic HealthRecords.4) To analyze satisfaction and challenges face by the physicians using EHR. ResearchDesign: This is an Exploratory and Descriptive Research. In this study hybrid research methodis used which includes qualitative and quantitative research methods. Sampling technique:For this study, a purposive sample of 43 physicians was selected. The sample size was 60but 17 responses were incomplete so they were excluded and the final sample size was 43.Data was collected from two different hospitals of Pakistan which include the physicians fromShaukat Khanum Memorial Cancer Hospital and Research Centre, and Indus Hospital. Of the43 participants, 51% were from Indus Hospital and 49% were from Shaukat Khanum MemorialCancer Hospital and Research Centre. Instrument: A structured questionnaire was used tocollect data and it was collected by email responses and direct interview. EHR Questionnaire:A questionnaire was used in the study. The EHR Questionnaire has comprised of 24 items. Thisquestionnaire was developed by Msukwa. B.K.Martin.1 Data Analysis: Data analysis was doneby Statistical Package for Social Sciences (SPSS) and Microsoft Excel. Procedure: The sampleconsisted of physicians from Shaukat Khanum Memorial Cancer Hospital and Research Centre,and Indus Hospital from Karachi. EHR is a new technology and hospitals are moving towardsit, some are under process and very few like the above mentioned hospitals are using it. Thequestionnaire was not complicated. It was a structured questionnaire with easy questions withmultiple options to fill in. Respondents were also acknowledged for their cooperation andparticipation in the study. Conclusion: EHR should be used effectively, proper training is neededto ensure that physicians are able to operate the system and can have maximum benefits fromthe technology by utilizing all its applications. The government should encourage adoption ofElectronic Health l Records in Pakistan by developing a public-private partnership. The studyfocused also on EHR effectiveness by checking the working of EHR its quick and satisfactoryresults its accuracy, adequacy, timeliness, user- friendliness, availability and reliability.

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King, Jason, Ben Smith et Laurie Williams. « Audit Mechanisms in Electronic Health Record Systems ». International Journal of Computational Models and Algorithms in Medicine 3, n^o 2 (avril 2012) : 23–42. http://dx.doi.org/10.4018/jcmam.2012040102.

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Inadequate audit mechanisms may result in undetected misuse of data in software-intensive systems. In the healthcare domain, electronic health record (EHR) systems should log the creating, reading, updating, or deleting of privacy-critical protected health information. The objective of this paper is to assess electronic health record audit mechanisms to determine the current degree of auditing for non-repudiation and to assess whether general audit guidelines adequately address non-repudiation. The authors analyzed the audit mechanisms of two open source EHR systems, OpenEMR and Tolven eCHR, and one proprietary EHR system. The authors base the qualitative assessment on a set of 16 general auditable events and 58 black-box test cases for specific auditable events. The authors find that OpenEMR satisfies 62.5% of the general criteria and passes 63.8% of the black-box test cases. Tolven eCHR and the proprietary EHR system each satisfy less than 19% of the general criteria and pass less than 11% of the black-box test cases.

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Nøhr, C. « Evaluation of Electronic Health Record Systems ». Yearbook of Medical Informatics 15, n^o 01 (août 2006) : 107–13. http://dx.doi.org/10.1055/s-0038-1638481.

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SummaryThe objective of this article is to present an overview of the various considerations to be made prior to evaluating electronic health record (EHR) systems.From the methodological literature, a number of themes for decisions are presented and related to the contemporary EHR situation. Special attention is paid to a number of important methodological themes.Definitive checklists for evaluation of EHR systems can not be recommended, but seven key steps are listed to guide the design of evaluation projects.It is concluded that the issues presented are not completely exhausted and the seven key steps might have to include iterative loops because of interdependencies between some of the steps.

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Kalra, D. « Electronic Health Record Standards ». Yearbook of Medical Informatics 15, n^o 01 (août 2006) : 136–44. http://dx.doi.org/10.1055/s-0038-1638463.

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SummaryThis paper seeks to provide an overview of the initiatives that are proceeding internationally to develop standards for the exchange of electronic health record (EHR) information between EHR systems.The paper reviews the clinical and ethico-legal requirements and research background on the representation and communication of EHR data, which primarily originates from Europe through a series of EU funded Health Telematics projects over the past thirteen years. The major concepts that underpin the information models and knowledge models are summarised. These provide the requirements and the best evidential basis from which HER communications standards should be developed.The main focus of EHR communications standardisation is presently occurring at a European level, through the Committee for European Normalisation (CEN). The major constructs of the CEN 13606 model are outlined. Complementary activity is taking place in ISO and in HL7, and some of these efforts are also summarised.There is a strong prospect that a generic EHR interoperability standard can be agreed at a European (and hopefully international) level. Parts of the challenge of EHR interoperability cannot yet be standardised, because good solutions to the preservation of clinical meaning across heterogeneous systems remain to be explored. Further research and empirical projects are therefore also needed.

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Galli, Brian J. « Ethics of Electronic Health Record Systems ». International Journal of Information Systems and Social Change 9, n^o 3 (juillet 2018) : 53–69. http://dx.doi.org/10.4018/ijissc.2018070104.

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This article describes how healthcare and IT are combatting the ethical implications of electronic health records (EHRs) in order to make them adopted by over 90% of small practices. There is a lack of trust in EHRs and uneasiness about what they will accomplish. Furthermore, security concerns have become more prevalent as a result of increased hacker activity. The objective of this article is to analyze these ethical issues in an effort to eliminate them as a hinderance to EHR implementation. As of now, 98% of all hospitals use EHRs. Between 2009 and 2015, the government allocated money and resources for incentive programs to get EHRs into every healthcare providers' office. During this time period, over $800 million dollars facilitated EHR implementation. Using this as a tool EHRs negative perception can be revitalized and combated with the meaningful use program. This article will highlight the ethical implications of EHRs and suggest ways in which to avoid them to make EHRs available in every healthcare provider.

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Stead, W. W., J. C. Denny, D. Giuse, N. M. Lorenzi, S. H. Brown, K. B. Johnson et S. T. Rosenbloom. « Generating Clinical Notes for Electronic Health Record Systems ». Applied Clinical Informatics 01, n^o 03 (2010) : 232–43. http://dx.doi.org/10.4338/aci-2010-03-ra-0019.

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SummaryClinical notes summarize interactions that occur between patients and healthcare providers. With adoption of electronic health record (EHR) and computer-based documentation (CBD) systems, there is a growing emphasis on structuring clinical notes to support reusing data for subsequent tasks. However, clinical documentation remains one of the most challenging areas for EHR system development and adoption. The current manuscript describes the Vanderbilt experience with implementing clinical documentation with an EHR system. Based on their experience rolling out an EHR system that supports multiple methods for clinical documentation, the authors recommend that documentation method selection be made on the basis of clinical workflow, note content standards and usability considerations, rather than on a theoretical need for structured data.

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Katamanin, Olivia, et Alex M. Glazer MD. « Dermatologists' Perceptions and Use of Electronic Health Record Systems ». SKIN The Journal of Cutaneous Medicine 4, n^o 5 (29 août 2020) : 404–7. http://dx.doi.org/10.25251/skin.4.5.2.

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Introduction: Electronic Health Records (EHR) have been adopted and integrated into medical practices over the past 20 years. Many positive and negative implications have been described by physicians using EHR. This study aims to US dermatologists' perceptions and use of EHR within their clinical practice. Methods: A validated survey was administered to US dermatologists at a national educational conference to assess use and perceptions of EHR. Results Seventy-two percent (291/400) of those sampled completed greater than 90% survey and were included in outcome analysis. Eighty-six percent of the participants were currently using or had used EHR. Most dermatologists felt that EHR negatively impacted their workflow efficiency and face-to-face time with patients. A portion of dermatologists thought that EHR improved their documentation. Limitations: Selection bias may have led those with strong beliefs with EHR more likely to complete the entire survey. Conclusion: Despite widespread adoption, most dermatologists have a negative impression of EHR and felt that it interfered with their ability to effectively see patients. Interventions to improve EHR should focus on improving workflow efficiency and maximizing the amount of time dermatologists can spend with patients.

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Khedr, Dr Ayman E., et Fahad Kamal Alsheref. « A Proposed Electronic Health Record Content Structure Based on Clinical Organizations Survey ». INTERNATIONAL JOURNAL OF COMPUTERS & ; TECHNOLOGY 15, n^o 13 (22 octobre 2014) : 5233–46. http://dx.doi.org/10.24297/ijct.v15i13.5283.

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Computer systems and communication technologies made a strong and influential presence in the different fields of medicine. The cornerstone of a functional medical information system is the Electronic Health Records (EHR) management system. Several electronic health records systems were implemented in different states with different clinical data structures that prevent data exchange between systems even in the same state. This leads to the important barrier in implementing EHR system which is the lack of standards of EHR clinical data structure. In this paper we made a survey on several in international and Egyptian medical organization for implementing electronic health record systems for finding the best electronic health record clinical data structure that contains all patientâ€™s medical data. We proposed an electronic health record system with a standard clinical data structure based on the international and Egyptian medical organization survey and with avoiding the limitations in the other electronic health record that exists in the survey.

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Flores Zuniga, Alejandro Enrique, Khin Than Win et Willy Susilo. « Functionalities of free and open electronic health record systems ». International Journal of Technology Assessment in Health Care 26, n^o 4 (octobre 2010) : 382–89. http://dx.doi.org/10.1017/s0266462310001121.

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Objectives: The aim of this study was to examine open-source electronic health record (EHR) software to determine their level of functionalities according to the International Organization for Standardization (ISO) standards.Methods: ISO standards were used as a guideline to determine and describe the reference architecture and functionalities of a standard electronic health record system as well the environmental context for which the software has been built. Twelve open-source EHR systems were selected and evaluated according to two-dimensional criteria based on ISO/TS 18308:2004 functional requirements and ISO/TR 20514:2005 context of the EHR system.Results: Open EHR software programs mostly fulfill structural, procedural, evolutional, and medicolegal requirements at the minimal and full functionality levels. Communication, privacy, and security requirements are accomplished in less than 23 percent of the cases, mainly at minimal functional level. Ethical, cultural, and consumer requirements still need to be fulfilled by free and open-source EHR applications.Conclusions: Most analyzed systems had several functional limitations. Nevertheless, especially for clinicians and decision makers in developing countries, open-source EHR systems are an option. The limited functionalities are likely to become requirements for further releases of open-source EHR systems.

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Blijleven, Vincent, Florian Hoxha et Monique Jaspers. « Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework : Scoping Review ». Journal of Medical Internet Research 24, n^o 3 (15 mars 2022) : e33046. http://dx.doi.org/10.2196/33046.

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Background Electronic health record (EHR) system users devise workarounds to cope with mismatches between workflows designed in the EHR and preferred workflows in practice. Although workarounds appear beneficial at first sight, they frequently jeopardize patient safety, the quality of care, and the efficiency of care. Objective This review aims to aid in identifying, analyzing, and resolving EHR workarounds; the Sociotechnical EHR Workaround Analysis (SEWA) framework was published in 2019. Although the framework was based on a large case study, the framework still required theoretical validation, refinement, and enrichment. Methods A scoping literature review was performed on studies related to EHR workarounds published between 2010 and 2021 in the MEDLINE, Embase, CINAHL, Cochrane, or IEEE databases. A total of 737 studies were retrieved, of which 62 (8.4%) were included in the final analysis. Using an analytic framework, the included studies were investigated to uncover the rationales that EHR users have for workarounds, attributes characterizing workarounds, possible scopes, and types of perceived impacts of workarounds. Results The SEWA framework was theoretically validated and extended based on the scoping review. Extensive support for the pre-existing rationales, attributes, possible scopes, and types of impact was found in the included studies. Moreover, 7 new rationales, 4 new attributes, and 3 new types of impact were incorporated. Similarly, the descriptions of multiple pre-existing rationales for workarounds were refined to describe each rationale more accurately. Conclusions SEWA is now grounded in the existing body of peer-reviewed empirical evidence on EHR workarounds and, as such, provides a theoretically validated and more complete synthesis of EHR workaround rationales, attributes, possible scopes, and types of impact. The revised SEWA framework can aid researchers and practitioners in a wider range of health care settings to identify, analyze, and resolve workarounds. This will improve user-centered EHR design and redesign, ultimately leading to improved patient safety, quality of care, and efficiency of care.

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Bloom, Benjamin Michael, Jason Pott, Stephen Thomas, David Ramon Gaunt et Thomas C. Hughes. « Usability of electronic health record systems in UK EDs ». Emergency Medicine Journal 38, n^o 6 (3 mars 2021) : 410–15. http://dx.doi.org/10.1136/emermed-2020-210401.

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BackgroundThe large volume of patients, rapid staff turnover and high work pressure mean that the usability of all systems within the ED is important. The transition to electronic health records (EHRs) has brought many benefits to emergency care but imposes a significant burden on staff to enter data. Poor usability has a direct consequence and opportunity cost in staff time and resources that could otherwise be employed in patient care. This research measures the usability of EHR systems in UK EDs using a validated assessment tool.MethodsThis was a survey completed by members and fellows of the Royal College of Emergency Medicine conducted during summer 2019. The primary outcome was the System Usability Scale Score, which ranges from 0 (worst) to 100 (best). Scores were compared with an internationally recognised measure of acceptable usability of 68. Results were analysed by EHR system, country, healthcare organisation and physician grade. Only EHR systems with at least 20 responses were analysed.ResultsThere were 1663 responses from a total population of 8794 (19%) representing 192 healthcare organisations (mainly UK NHS), and 25 EHR systems. Fifteen EHR systems had at least 20 responses and were included in the analysis. No EHR system achieved a median usability score that met the industry standard of acceptable usability.The median usability score was 53 (IQR 35–68). Individual EHR systems’ scores ranged from 35 (IQR 26–53) to 65 (IQR 44–80).ConclusionIn this survey, no UK ED EHR system met the internationally validated standard of acceptable usability for information technology.

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Berry, D., et J. Bisbal. « An Analysis Framework for Electronic Health Record Systems ». Methods of Information in Medicine 50, n^o 02 (2011) : 180–89. http://dx.doi.org/10.3414/me09-01-0002.

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Summary Background: The timely provision of complete and up-to-date patient data to clinicians has for decades been one of the most pressing objectives to be fulfilled by information technology in the healthcare domain. The so-called electronic health record (EHR), which provides a unified view of all relevant clinical data, has received much attention in this context from both research and industry. This situation has given rise to a large number of research projects and commercial products that aim to address this challenge. Different projects and initiatives have attempted to address this challenge from various points of view, which are not easily comparable. Objectives: This paper aims to clarify the challenges, concepts, and approaches involved, which is essential in order to consistently compare existing solutions and objectively assess progress in the field. Methods: This is achieved by two different means. Firstly, the paper will identify the most significant issues that differentiate the points of view and intended scope of existing approaches. As a result, a framework for analysis of EHR systems will be produced. Secondly, the most representative EHR-related projects and initiatives will be described and compared within the context of this framework. Results: The main result of the present paper is an analysis framework for EHR systems. This is intended as an initial step towards an attempt to structure research on this field, clearly lacking sound principles to evaluate and compare results, and ultimately focusing its efforts and being able to objectively evaluate scientific progress. Conclusions: Evaluation and comparison of results in medical informatics, and specifically EHR systems, must address technical and nontechnical aspects. It is challenging to condensate in a single framework all potential views of such a field, and any chosen approach is bound to have its limitations. That being said, any well structured comparison approach, such as the framework presented here, is better than no comparison framework at all, as has been the current situation to date. This paper has presented the first attempt known to the authors to define such a framework.

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Ross, M. K., Wei Wei et L. Ohno-Machado. « “Big Data” and the Electronic Health Record ». Yearbook of Medical Informatics 23, n^o 01 (août 2014) : 97–104. http://dx.doi.org/10.15265/iy-2014-0003.

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Summary Objectives: Implementation of Electronic Health Record (EHR) systems continues to expand. The massive number of patient encounters results in high amounts of stored data. Transforming clinical data into knowledge to improve patient care has been the goal of biomedical informatics professionals for many decades, and this work is now increasingly recognized outside our field. In reviewing the literature for the past three years, we focus on “big data” in the context of EHR systems and we report on some examples of how secondary use of data has been put into practice. Methods: We searched PubMed database for articles from January 1, 2011 to November 1, 2013. We initiated the search with keywords related to “big data” and EHR. We identified relevant articles and additional keywords from the retrieved articles were added. Based on the new keywords, more articles were retrieved and we manually narrowed down the set utilizing predefined inclusion and exclusion criteria. Results: Our final review includes articles categorized into the themes of data mining (pharmacovigilance, phenotyping, natural language processing), data application and integration (clinical decision support, personal monitoring, social media), and privacy and security. Conclusion: The increasing adoption of EHR systems worldwide makes it possible to capture large amounts of clinical data. There is an increasing number of articles addressing the theme of “big data”, and the concepts associated with these articles vary. The next step is to transform healthcare big data into actionable knowledge.

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Al-Rayes, Saja A., Arwa Alumran et Weam AlFayez. « The Adoption of the Electronic Health Record by Physicians ». Methods of Information in Medicine 58, n^o 02/03 (septembre 2019) : 063–70. http://dx.doi.org/10.1055/s-0039-1695006.

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Abstract Background Health information technology, especially the electronic health record (EHR) systems, improves health care quality and patient safety. Objectives This study's objectives are as follows: first, to explore the adoption of EHR systems among physicians in Saudi Arabia (with King Fahd Military Medical Complex as the location of the pilot study), and second, to identify the factors that influence these physicians' adoption of such systems. Methods This cross-sectional quantitative study is based on a paper survey that was administered to a sample of 213 physicians. The theoretical model is a version of the Technology Acceptance Model (TAM) that features the following additional variables: resistance to change, training, and social influence. Results The sample includes 133 (62%) physicians who used EHRs and 80 (38%) who did not. The main findings show that users and nonusers of the EHR system differ significantly for several factors such as perceived usefulness, perceived ease of use, social influence, and resistance to change. In addition, age, work experience, and medical specialty are significantly associated with physicians' use of the EHR system. Conclusion To increase EHR systems' adoption rate, the following elements should be improved: the systems' design, the social environments, and the physicians' awareness of the systems' benefits. This is the first study to produce a valid and reliable instrument for measuring the factors that influences physicians' use of the EHR system at a Saudi hospital in the Eastern Province. Further studies are needed to measure how these factors influence physicians' use of EHRs in other settings.

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Pfaff, Mark S., Amanda Anganes, Ozgur Eris, Aileen Prior, Merry Ward et Jonathan Nebeker. « Cognitive Usability Evaluation of Electronic Health Record Systems (CUE-E) ». Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 8, n^o 1 (septembre 2019) : 13–17. http://dx.doi.org/10.1177/2327857919081003.

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This project’s purpose was to develop cognitively-focused usability evaluation methods for electronic health records (EHRs). This research involved developing a conceptual framework for evaluating EHR usability in terms of clinical cognition and operationalizing the framework in the form of two novel EHR usability evaluation methods. The two evaluation methods - one observational and one lab-based - are described in a suite of protocol materials and recommendations for EHR evaluation and design. This resulting body of work is referred to as CUE-E: Cognitive Usability Evaluation - EHR. This paper describes the process behind the development of the CUE-E evaluation methods, summarizes the use of both, and discusses directions for future work. The two CUE-E evaluation methods are currently ready for pilot applications to assess their reliability and validity and identify opportunities for further improvement.

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Skinner, A., J. Windle et L. Grabenbauer. « Electronic Health Record Adoption – Maybe It’s not about the Money ». Applied Clinical Informatics 02, n^o 04 (2011) : 460–71. http://dx.doi.org/10.4338/aci-2011-05-ra-0033.

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SummaryObjective: The slow adoption of electronic health record (EHR) systems has been linked to physician resistance to change and the expense of EHR adoption. This qualitative study was conducted to evaluate benefits, and clarify limitations of two mature, robust, comprehensive EHR Systems by tech-savvy physicians where resistance and expense are not at issue.Methods: Two EHR systems were examined – the paperless VistA / Computerized Patient Record System used at the Veterans‘ Administration, and the General Electric Centricity Enterprise system used at an academic medical center. A series of interviews was conducted with 20 EHR-savvy multi-institutional internal medicine (IM) faculty and house staff. Grounded theory was used to analyze the transcribed data and build themes. The relevance and importance of themes were constructed by examining their frequency, convergence, and intensity.Results: Despite eliminating resistance to both adoption and technology as drivers of acceptance, these two robust EHR’s are still viewed as having an adverse impact on two aspects of patient care, physician workflow and team communication. Both EHR’s had perceived strengths but also significant limitations and neither were able to satisfactorily address all of the physicians’ needs.Conclusion: Difficulties related to physician acceptance reflect real concerns about EHR impact on patient care. Physicians are optimistic about the future benefits of EHR systems, but are frustrated with the non-intuitive interfaces and cumbersome data searches of existing EHRs.

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Lavariega, Juan C., Roberto Garza, Lorena G. Gómez, Victor J. Lara-Diaz et Manuel J. Silva-Cavazos. « EEMI - An Electronic Health Record for Pediatricians ». International Journal of Healthcare Information Systems and Informatics 11, n^o 3 (juillet 2016) : 57–69. http://dx.doi.org/10.4018/ijhisi.2016070104.

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The use of paper health records and handwritten prescriptions are prone to preset errors of misunderstanding instructions or interpretations that derive in affecting patients' health. Electronic Health Records (EHR) systems are useful tools that among other functions can assists physicians' tasks such as finding recommended medicines, their contraindications, and dosage for a given diagnosis, filling prescriptions and support data sharing with other systems. This paper presents EEMI, a Children EHR focused on assisting pediatricians in their daily office practice. EEMI functionality keeps the relationships among diagnosis, treatment, and medications. EEMI also calculates dosages and automatically creates prescriptions which can be personalized by the physician. The system also validates patient allergies. This paper also presents the current use of EHRs in Mexico, the Mexican Norm (NOM-024-SSA3-2010), standards for the development of electronic medical records and its relationships with other standards for data exchange and data representation in the health area.

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Shahriar, Hossain, Hisham M. Haddad et Maryam Farhadi. « Assessing HIPAA Compliance of Open Source Electronic Health Record Applications ». International Journal of Information Security and Privacy 15, n^o 2 (avril 2021) : 181–95. http://dx.doi.org/10.4018/ijisp.2021040109.

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Electronic health record (EHR) applications are digital versions of paper-based patient health information. EHR applications are increasingly being adopted in many countries. They have resulted in improved quality in healthcare, convenient access to histories of patient medication and clinic visits, easier follow up of patient treatment plans, and precise medical decision-making process. The goal of this paper is to identify HIPAA technical requirements, evaluate two open source EHR applications (OpenEMR and OpenClinic) for security vulnerabilities using two open-source scanner tools (RIPS and PHP VulnHunter), and map the identified vulnerabilities to HIPAA technical requirements.

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Bourgeois, Stacy, et Ulku Yaylacicegi. « Electronic Health Records ». International Journal of Healthcare Information Systems and Informatics 5, n^o 3 (juillet 2010) : 1–13. http://dx.doi.org/10.4018/jhisi.2010070101.

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Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. This study investigates how EHR use, as implemented and utilized, impacts patient safety and quality performance. Data in this paper include nonfederal acute care hospitals in the state of Texas, and the data sources include the American Hospital Association, the Dallas Fort Worth Hospital Council, and the American Hospital Directory. The authors use partial least squares modeling to assess the relationship between hospital EHR use, patient safety, and quality of care. Patient safety is measured using 11 indicators as identified by the Agency for Healthcare Research and Quality (AHRQ) and quality performance is measured by 11 mortality indicators as related to 2 constructs, that is, conditions and surgical procedures. Results identify positive significant relationships between EHR use, patient safety, and quality of care with respect to procedures. The authors conclude that there is sufficient evidence of the relationship between hospital EHR use and patient safety, and that sufficient evidence exists for the support of EHR use with hospital surgical procedures.

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Alsadi, Mohammad, Ali Saleh, Malek Khalil et Islam Oweidat. « Readiness-Based Implementation of Electronic Health Records ». Creative Nursing 28, n^o 1 (1 février 2022) : 42–47. http://dx.doi.org/10.1891/cn-2021-0024.

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Electronic health record (EHR) implementation is expanding worldwide to achieve the benefits of that technology, but it is reported in the literature as a “disruptive” change to the work environment in which all health-care workers need to be ready for the change, to enhance adoption and harvest the benefits. Jordan has rolled out a national EHR system. This study explored EHR implementation readiness, levels of realizing the benefits of EHR, and adoption among Jordanian nurses, using a self-report questionnaire at nine governmental hospitals in Jordan. A total of 462 registered nurses participated in the study. Results showed that nurses have moderate levels of readiness for EHR implementation, but higher levels of EHR benefits realization and adoption. All health-care workers’ readiness for EHR implementation must be assessed regularly before, during, and after EHR implementation. Readiness-based roll-out can be used as a strategy in implementing EHR systems. Introducing a large-scale change management program is recommended to assess readiness, guide roll-out plans, enhance EHR implementation readiness, improve benefits realization, and increase EHR adoption levels, to help move health-care systems into the digital era.

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Shashi, Dr Manish. « Leveraging Blockchain-Based Electronic Health Record Systems in Healthcare 4.0 ». International Journal of Innovative Technology and Exploring Engineering 12, n^o 1 (30 décembre 2022) : 1–5. http://dx.doi.org/10.35940/ijitee.a9359.1212122.

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Digitalization has become a crucial part of healthcare 4.0 by transforming systems such as electronic health records (EHR), electronic medical records (EMR), and electronic personal medical records (ePHR). Healthcare 4.0 is derived from industry 4.0 and aims to enhance collaboration, virtualization, coherence, and convergence, which helps transform modern healthcare into more personalized and predictive. Healthcare 4.0 also aims to develop digital enablers which will support coordination among various stakeholders and seamless information flow in the patient journey towards wellbeing. These systems enhance patient care through the timely sharing of patient data across different providers globally. Timely sharing helps, but it also makes the electronic system vulnerable to alteration and breaches. In healthcare, blockchain application is widely used in various areas, such as health information exchange, pharmaceutical counterfeit, clinical trials, health supply chain management, patient data management, insurance claims, and product recall in case of adverse events. This research paper aims to identify how blockchain technology can help enhance the privacy and security of electronic health record systems. This paper discusses various blockchain-based systems, which provide a more efficient and secure option than client-server architecture-based traditional EHR systems.

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Grimsmo, A., A. Faxvaag et V. Heimly. « Diffusion of Electronic Health Records and electronic communication in Norway ». Applied Clinical Informatics 02, n^o 03 (2011) : 355–64. http://dx.doi.org/10.4338/aci-2011-01-ie-0008.

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SummaryObjective: To assess the diffusion of Electronic Health Record (EHR) systems over time in Norwegian health care.Methods: This study was based on a retrospective cross-sectional questionnaire survey. Questionnaires for three groups of responders were based on two validated questionnaires from prior studies, which were further customized through workshops. The questionnaires were sent to a random sample of 180 municipalities and 150 general practices in all 26 hospitals in Norway.Results: The diffusion curves for EHR systems from 1980 to 2008 were established and analyzed. The most striking finding was the length of time from the availability of the first adequate EHR systems until full coverage was achieved in general practice and in hospitals. Diffusion of EHRs into nursing homes and maternal and child health centers started ten years later, and the diffusion for these centers has also been slow. In general practice the diffusion seems to follow the classical s-curve of diffusion. Costs and the increasing complexity of EHR systems were regarded by respondents as the most important challenges and concerns for the future. Resistance among health personnel was seen only as a small problem.Conclusion: National strategic processes account for the slow diffusion and complexity of EHR systems in the health sector.

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Panigrahi, Amrutanshu, Ajit Kumar Nayak et Rourab Paul. « HealthCare EHR ». International Journal of Information Systems and Supply Chain Management 15, n^o 3 (juillet 2022) : 1–15. http://dx.doi.org/10.4018/ijisscm.290017.

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Blockchain technology is currently playing a significant role in providing a secure and effective means to share information in a variety of domains, including the financial sector, supply chain management (SCM) in various domains, IoT, and the field of health care systems (HCS). The HCS application's interoperability and security allow patients and vendors to communicate information seamlessly. The absence of such traits reveals the patient's difficulties in gaining access to his or her own health status. As a result, incorporating blockchain technology will eliminate this disadvantage, allowing the HCS to become more effective and efficient. These potential benefits provide a foundation for blockchain technology to be used in various aspects of HCS, such as maintain the patient electronic health record (EHR) and electronic medical records (EMR) for various medical devices, billing, and telemedicine systems, and so on.

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Holzer, K., et W. Gall. « Utilizing IHE-based Electronic Health Record Systems for Secondary Use ». Methods of Information in Medicine 50, n^o 04 (2011) : 319–25. http://dx.doi.org/10.3414/me10-01-0060.

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SummaryObjectives: Due to the increasing adoption of Electronic Health Records (EHRs) for primary use, the number of electronic documents stored in such systems will soar in the near future. In order to benefit from this development in secondary fields such as medical research, it is important to define requirements for the secondary use of EHR data. Furthermore, analyses of the extent to which an IHE (Integrating the Healthcare Enterprise)-based architecture would fulfill these requirements could provide further information on upcoming obstacles for the secondary use of EHRs.Methods: A catalog of eight core requirements for secondary use of EHR data was deduced from the published literature, the risk analysis of the IHE profile MPQ (Multi-Patient Queries) and the analysis of relevant questions. The IHE-based architecture for cross-domain, patient-centered document sharing was extended to a cross-patient architecture.Results: We propose an IHE-based architecture for cross-patient and cross-domain secondary use of EHR data. Evaluation of this architecture concerning the eight core requirements revealed positive fulfillment of six and the partial fulfillment of two requirements.Conclusions: Although not regarded as a primary goal in modern electronic healthcare, the re-use of existing electronic medical documents in EHRs for research and other fields of secondary application holds enormous potential for the future. Further research in this respect is necessary.

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Giordanengo, Alain, Meghan Bradway, Rune Pedersen, Astrid Grøttland, Gunnar Hartvigsen et Eirik Årsand. « Integrating data from apps, wearables and personal Electronic Health Record (pEHR) systems with clinicians’ Electronic Health Records (EHR) systems ». International Journal of Integrated Care 16, n^o 5 (9 novembre 2016) : 16. http://dx.doi.org/10.5334/ijic.2565.

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Butler, Jorie M., Bryan Gibson, Lacey Lewis, Gayle Reiber, Heidi Kramer, Rand Rupper, Jennifer Herout, Brenna Long, David Massaro et Jonathan Nebeker. « Patient-centered care and the electronic health record : exploring functionality and gaps ». JAMIA Open 3, n^o 3 (1 octobre 2020) : 360–68. http://dx.doi.org/10.1093/jamiaopen/ooaa044.

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Abstract Objective Healthcare systems have adopted electronic health records (EHRs) to support clinical care. Providing patient-centered care (PCC) is a goal of many healthcare systems. In this study, we sought to explore how existing EHR systems support PCC; defined as understanding the patient as a whole person, building relational connections between the clinician and patient, and supporting patients in health self-management. Materials and Methods We assessed availability of EHR functions consistent with providing PCC including patient goals and preferences, integrated care plans, and contextual and patient-generated data. We surveyed and then interviewed technical representatives and expert clinical users of 6 leading EHR systems. Questions focused on the availability of specific data and functions related to PCC (for technical representatives) and the clinical usefulness of PCC functions (for clinicians) in their EHR. Results Technical representatives (n = 6) reported that patient communication preferences, personalized indications for medications, and end of life preferences were functions implemented across 6 systems. Clinician users (n = 10) reported moderate usefulness of PCC functions (medians of 2–4 on a 5-pointy -35t scale), suggesting the potential for improvement across systems. Interviews revealed that clinicians do not have a shared conception of PCC. In many cases, data needed to deliver PCC was available in the EHR only in unstructured form. Data systems and functionality to support PCC are under development in these EHRs. Discussion and Conclusion There are current gaps in PCC functionality in EHRs and opportunities to support the practice of PCC through EHR redesign.

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Alfiansyah, Gamasiano, Andar Sifa’il Fajeri, Maya Weka Santi et Selvia Juwita Swari. « Evaluasi Kepuasan Pengguna Electronic Health Record (EHR) Menggunakan Metode EUCS (End User Computing Satisfaction) di Unit Rekam Medis Pusat RSUPN Dr. Cipto Mangunkusumo ». Jurnal Penelitian Kesehatan "SUARA FORIKES" (Journal of Health Research "Forikes Voice") 11, n^o 3 (3 avril 2020) : 258. http://dx.doi.org/10.33846/sf11307.

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RSUPN Dr. Cipto Mangunkusumo is one of the hospitals whose services have used Electronic Health Record (EHR). The implementation of EHR is frequent loading and errors during service and lacking for several menus. The research purpose was to evaluate user satisfaction related to reporting on the Electronic Health Record (EHR) in the central medical records unit Dr. RSUPN. Cipto Mangunkusumo. This research was quantitative descriptive with population of all Electronic Health Record users in the central medical record unit, with 50 sample of respondents. The sampling technique was conducted by sistematic random sampling. Data was analyzed through scoring and presented in table form. The results showed that the dimension of accuracy was 73.28%, format was 71.6%, ease of use was 69.2%, content was 69.2 %, and timelines was 65.66%. These dimension scores indicated good criteria or the user was satisfied with the current Electronic Health Record (EHR) condition, but it requires the development of information systems by adding and adjusting modules contained in the EHR so that user satisfaction continues to increase. Keywords: evaluation; electronic health record (HER); end user computing satisfaction (EUCS) ABSTRAK Rumah Sakit Umum Pusat Nasional (RSUPN) Dr. Cipto Mangunkusumo merupakan salah satu rumah sakit yang pelayanannya sudah menggunakan SIMRS yang disebut Electronic Health Record (EHR). Penggunaan EHR sering loading dan error pada saat pelayanan dan ada beberapa menu yang masih kurang. Tujuan penelitian ini adalah untuk mengevaluasi kepuasan pengguna terkait pelaporan pada Electronic Health Record (EHR) di unit rekam medis pusat RSUPN Dr. Cipto Mangunkusumo. Penelitian ini adalah kuantitatif deskriptif dengan populasi seluruh pengguna Electronic Health Record di unit rekam medis pusat, dan sampel berjumlah 50 responden. Teknik pengambilan sampel dilakukan dengan sistematic random sampling. Analisa data dilakukan melalui skoring dan disajika ndalam bentuk tabel. Hasil penelitian menunjukkan bahwa dimensi keakuratan memiliki nilai tertinggi, yaitu 73,28%, tampilan 71,6%, kemudahan pengguna 69,2%, isi 69,2%, dan waktu 65,66%. Skor dalam dimensi tersebut termasuk dalam kriteria baik atau pengguna puas terhadap konsisi Electronic Health Record (EHR) saat ini, namun masih diperlukan pengembangan sistem informasi serta menambahkan dan menyesuaikan modul yang ada di dalam EHR sehingga kepuasan pengguna terus meningkat. Kata kunci: evaluasi; electronic health record (HER); end user computing satisfaction (EUCS)

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Holmes, John H., James Beinlich, Mary R. Boland, Kathryn H. Bowles, Yong Chen, Tessa S. Cook, George Demiris et al. « Why Is the Electronic Health Record So Challenging for Research and Clinical Care ? » Methods of Information in Medicine 60, n^o 01/02 (mai 2021) : 032–48. http://dx.doi.org/10.1055/s-0041-1731784.

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Abstract Background The electronic health record (EHR) has become increasingly ubiquitous. At the same time, health professionals have been turning to this resource for access to data that is needed for the delivery of health care and for clinical research. There is little doubt that the EHR has made both of these functions easier than earlier days when we relied on paper-based clinical records. Coupled with modern database and data warehouse systems, high-speed networks, and the ability to share clinical data with others are large number of challenges that arguably limit the optimal use of the EHR Objectives Our goal was to provide an exhaustive reference for those who use the EHR in clinical and research contexts, but also for health information systems professionals as they design, implement, and maintain EHR systems. Methods This study includes a panel of 24 biomedical informatics researchers, information technology professionals, and clinicians, all of whom have extensive experience in design, implementation, and maintenance of EHR systems, or in using the EHR as clinicians or researchers. All members of the panel are affiliated with Penn Medicine at the University of Pennsylvania and have experience with a variety of different EHR platforms and systems and how they have evolved over time. Results Each of the authors has shared their knowledge and experience in using the EHR in a suite of 20 short essays, each representing a specific challenge and classified according to a functional hierarchy of interlocking facets such as usability and usefulness, data quality, standards, governance, data integration, clinical care, and clinical research. Conclusion We provide here a set of perspectives on the challenges posed by the EHR to clinical and research users.

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Friebe, Michael P., Joseph R. LeGrand, Bryan E. Shepherd, Elizabeth A. Breeden et Scott D. Nelson. « Reducing Inappropriate Outpatient Medication Prescribing in Older Adults across Electronic Health Record Systems ». Applied Clinical Informatics 11, n^o 05 (octobre 2020) : 865–72. http://dx.doi.org/10.1055/s-0040-1721398.

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Abstract Background The American Geriatrics Society recommends against the use of certain potentially inappropriate medications (PIMs) in older adults. Prescribing of these medications correlates with higher rates of hospital readmissions, morbidity, and mortality. Vanderbilt University Medical Center previously deployed clinical decision support (CDS) to decrease PIM prescribing rates, but recently transitioned to a new electronic health record (EHR). Objective The goal of this study was to evaluate PIM prescribing rates for older adults before and after migration to the new EHR system. Methods We reviewed prescribing rates of PIMs in adults 65 years and older, normalized per 100 total prescriptions from the legacy and new EHR systems between July 1, 2014 and December 31, 2019. The PIM prescribing rates before and after EHR migration during November 2017 were compared using a U-chart and Poisson regression model. Secondary analysis descriptively evaluated the frequency of prescriber acceptance rates in the new EHR. Results Prescribing rates of PIMs decreased 5.2% (13.5 per 100 prescriptions to 12.8 per 100 prescriptions; p < 0.0001) corresponding to the implementation of alternatives CDS in the legacy EHR. After migration of the alternative CDS from the legacy to the new EHR system, PIM prescribing rates dropped an additional 18.8% (10.4 per 100 prescriptions; p < 0.0001). Acceptance rates of the alternative recommendations for PIMs was low overall at 11.1%. Conclusion The prescribing rate of PIMs in adults aged 65 years and older was successfully decreased with the implementation of prescribing CDS. This decrease was not only maintained but strengthened by the transition to a new EHR system.

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Vállez, Noelia, Gloria Bueno, Óscar Déniz, María del Milagro Fernández, Carlos Pastor, Miguel Ángel Rienda, Pablo Esteve et María Arias. « CADe System Integrated within the Electronic Health Record ». BioMed Research International 2013 (2013) : 1–14. http://dx.doi.org/10.1155/2013/219407.

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The latest technological advances and information support systems for clinics and hospitals produce a wide range of possibilities in the storage and retrieval of an ever-growing amount of clinical information as well as in detection and diagnosis. In this work, an Electronic Health Record (EHR) combined with a Computer Aided Detection (CADe) system for breast cancer diagnosis has been implemented. Our objective is to provide to radiologists a comprehensive working environment that facilitates the integration, the image visualization, and the use of aided tools within the EHR. For this reason, a development methodology based on hardware and software system features in addition to system requirements must be present during the whole development process. This will lead to a complete environment for displaying, editing, and reporting results not only for the patient information but also for their medical images in standardised formats such as DICOM and DICOM-SR. As a result, we obtain a CADe system which helps in detecting breast cancer using mammograms and is completely integrated into an EHR.

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Fraser, R., J. McClay, N. Woelfl, C. B. Thompson, J. Cambell, J. Windle et L. Grabenbauer. « Adoption of Electronic Health Records ». Applied Clinical Informatics 02, n^o 02 (2011) : 165–76. http://dx.doi.org/10.4338/aci-2011-01-ra-0003.

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SummaryObjective: Less than 20% of hospitals in the US have an electronic health record (EHR). In this qualitative study, we examine the perspectives of both academic and private physicians and administrators as stakeholders, and their alignment, to explore their perspectives on the use of technology in the clinical environment.Methods: Focus groups were conducted with 74 participants who were asked a series of open-ended questions. Grounded theory was used to analyze the transcribed data and build convergent themes. The relevance and importance of themes was constructed by examining frequency, convergence, and intensity. A model was proposed that represents the interactions between themes. Results: Six major themes emerged, which include the impact of EHR systems on workflow, patient care, communication, research/outcomes/billing, education/learning, and institutional culture. Academic and private physicians were confident of the future benefits of EHR systems, yet cautious about the current implementations of EHR, and its impact on interactions with other members of the healthcare team and with patients, and the amount of time necessary to use EHR’s. Private physicians differed on education and were uneasy about the steep learning curve necessary for use of new systems. In contrast to physicians, university and hospital administrators are optimistic, and value the availability of data for use in reporting.Conclusion: The results of our study indicate that both private and academic physicians concur on the need for features that maintain and enhance the relationship with the patient and the healthcare team. Resistance to adoption is related to insufficient functionality and its potential negative impact on patient care. Integration of data collection into clinical workflows must consider the unexpected costs of data acquisition.

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Rostamzadeh, Neda, Sheikh S. Abdullah et Kamran Sedig. « Visual Analytics for Electronic Health Records : A Review ». Informatics 8, n^o 1 (23 février 2021) : 12. http://dx.doi.org/10.3390/informatics8010012.

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The increasing use of electronic health record (EHR)-based systems has led to the generation of clinical data at an unprecedented rate, which produces an untapped resource for healthcare experts to improve the quality of care. Despite the growing demand for adopting EHRs, the large amount of clinical data has made some analytical and cognitive processes more challenging. The emergence of a type of computational system called visual analytics has the potential to handle information overload challenges in EHRs by integrating analytics techniques with interactive visualizations. In recent years, several EHR-based visual analytics systems have been developed to fulfill healthcare experts’ computational and cognitive demands. In this paper, we conduct a systematic literature review to present the research papers that describe the design of EHR-based visual analytics systems and provide a brief overview of 22 systems that met the selection criteria. We identify and explain the key dimensions of the EHR-based visual analytics design space, including visual analytics tasks, analytics, visualizations, and interactions. We evaluate the systems using the selected dimensions and identify the gaps and areas with little prior work.

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Septiani, Riza, et Tiara Mairani. « THE EVALUATION OF ELECTRONIC HEALTH RECORD ADOPTION AMONG HEALTH PROFESSIONALS IN HOSPITAL SETTING ». Jukema (Jurnal Kesehatan Masyarakat Aceh) 7, n^o 1 (1 juillet 2021) : 69–75. http://dx.doi.org/10.37598/jukema.v7i1.1068.

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Background: Electronic Health Record (EHR) utilization has been improved nowadays and it is believed that the adoption of Information Technology (IT) that has been implemented in various setting may also accelerate qualified implementation in health care setting. This study aimed to evaluate EHR utilization in various settings by systemic literature review. Methods: systemic literature research was conducted with keywords “(evaluat* model OR evaluat* framework) AND (health professional* OR health staff*) AND (electronic health record OR EHR) AND (us* OR engagement OR implementation OR adoption) AND hospital”. Result: 833 literatures found at the beginning of literature search, after apply limitations, remove duplicates and exclude of irrelevant literatures, finally total 7 articles were included in the review. Conclusion: there are benefits and drawbacks of EHR utilization among health professional in different healthcare settings in some countries that included in this review. Some health professionals had positive experience of using EHR that its use can improve clinicians’ involvement, better clinicians’ representation and decrease workload. Meanwhile, others had different views that EHR use are ineffectiveness due to inability of the systems to meet users’ need, poor integration with existing workflows, poor IT skills among users and limited resources and training of EHR. Recommendation: Therefore, it is important to improve better design of EHR system with customized functionalities so it could improve the implementation and adoption of EHR by health professionals as end user.

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Oster, A., G. H. Yeh, J. Magno, H. M. Paek et L. Au. « Utilizing an Electronic Health Record System to Improve Vaccination Coverage in Children ». Applied Clinical Informatics 01, n^o 03 (2010) : 221–31. http://dx.doi.org/10.4338/aci-2009-12-cr-0028.

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Summary Background: Electronic Health Records (EHR) are widely believed to improve quality of care and effectiveness of service delivery. Use of EHR to improve childhood immunization rates has not been fully explored in an ambulatory setting. Objective: To describe a pediatric practice’s use of Electronic Health Records (EHR) in improving childhood immunization. Methods: A multi-faceted EHR-based quality improvement initiative used electronic templates with pre-loaded immunization records, automatic diagnosis coding, and EHR alerts of missing or delayed vaccinations. An electronic patient tracking system was created to identify patients with missing vaccines. Barcode scanning technology was introduced to aid speed and accuracy of documentation of administered vaccines. Electronic reporting to a local health department immunization registry facilitated ordering of vaccines. Results: Immunization completion rates captured in monthly patient reports showed a rise in the percentage of children receiving the recommended series of vaccination (65% to 76%) (p<0.000). Bar-code technology reduced the time of immunization documentation (86 seconds to 26 seconds) (p<0.000). Use of barcode scanning showed increased accuracy of documentation of vaccine lot numbers (from 95% to 100%) (p<0.000). Conclusion: EHR-based quality improvement interventions were successfully implemented at a community health center. EHR systems have versatility in their ability to track patients in need of vaccines, identify patients who are delayed, facilitate ordering and coding of multiple vaccines and promote interdisciplinary communication among personnel involved in the vaccination process. EHR systems can be used to improve childhood vaccination rates.

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Pereira, Anne, Michael Kim, Marcus Seywerd, Brooke Nesbitt et Michael Pitt. « Collaborating for Competency—A Model for Single Electronic Health Record Onboarding for Medical Students Rotating among Separate Health Systems ». Applied Clinical Informatics 09, n^o 01 (janvier 2018) : 199–204. http://dx.doi.org/10.1055/s-0038-1635096.

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Background Use of the electronic health record (EHR) is widespread in academic medical centers, and hands-on EHR experience in medical school is essential for new residents to be able to meaningfully contribute to patient care. As system-specific EHR training is not portable across institutions—even when the same EHR platform is used—students rotating across health systems are often required to spend time away from clinical training to complete each system's, often duplicative, EHR training regardless of their competency within the EHR. Methods We aimed to create a single competency-based Epic onboarding process that would be portable across all the institutions in which our medical students complete clinical rotations. In collaboration with six health systems, we created online EHR training modules using a systematic approach to curriculum development and created an assessment within the Epic practice environment. Results All six collaborating health systems accepted successful completion of the developed assessment in lieu of standard site-specific medical student EHR training. In the pilot year, 443 students (94%) completed the modules and assessment prior to their clinical training and successfully entered clinical rotations without time consuming, often repetitive onsite training, decreasing the cumulative time as student might be expected to engage in Epic onboarding as much as 20-fold. Conclusion Medical schools with multisystem training sites with a single type of EHR can adopt this approach to minimize training burden for their learners and to allow them more time in the clinical setting with optimized access to the EHR.

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Khan, S., M. Millery, A. Campbell, J. Merrill, S. Shih, R. Kukafka et P. Messeri. « An Information Systems Model of the Determinants of Electronic Health Record Use ». Applied Clinical Informatics 04, n^o 02 (2013) : 185–200. http://dx.doi.org/10.4338/aci-2013-01-ra-0005.

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SummaryObjectives: The prominence given to universal implementation of electronic health record (EHR) systems in U.S. health care reform, underscores the importance of devising reliable measures of factors that predict medical care providers’ use of EHRs. This paper presents an easily administered provider survey instrument that includes measures corresponding to core dimensions of DeLone and McClean’s (D & M) model of information system success.Methods: Study data came from self-administered surveys completed by 460 primary care providers, who had recently begun using an EHR.Results: Based upon assessment of psychometric properties of survey items, a revised D&M causal model was formulated that included four measures of the determinants of EHR use (system quality, IT support, ease of use, user satisfaction) and five indicators of provider beliefs about the impact on an individual’s clinical practice. A structural equation model was estimated that demonstrated a high level of inter-correlation between the four scales measuring determinants of EHR use. All four variables had positive association with each of the five individual impact measures. Consistent with our revised D&M model, the association of system quality and IT support with the individual impact measures was entirely mediated by ease of use and user satisfaction.Conclusions: Survey research provides important insights into provider experiences with EHR. Additional studies are in progress to investigate how the variables constructed for this study are related to direct measures of EHR use.Citation: Messeri P, Khan S, Millery M, Campbell A, Merrill J, Shih S, Kukafka R. An information systems model of the determinants of electronic health record use. Appl Clin Inf 2013; 4: 185–200http://dx.doi.org/10.4338/ACI-2013-01-RA-0005

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Andellini, Martina, Francesco Faggiano, Francesca Sabusco, Pietro Derrico et Matteo Ritrovato. « VP147 Implementing Electronic Health Record In A Children's Hospital ». International Journal of Technology Assessment in Health Care 33, S1 (2017) : 216–17. http://dx.doi.org/10.1017/s0266462317003919.

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INTRODUCTION:Since the adoption of electronic health record (EHR) systems, which contain large volumes of aggregated longitudinal clinical data, promises a number of substantial benefits including better care, improved safety issues and decreased healthcare costs (1). It is also associated with significant costs and large technical and organizational impacts, therefore it is important to conduct comprehensive evaluations of healthcare delivery outcomes. The purpose of the study is to gather evidence on safety and overall effectiveness of EHR implementation in Bambino Gesù Children's Hospital (OPBG).METHODS:Decision-oriented HTA (DoHTA) method (2) was applied to assess the technology on clinical, technical, organizational, economic, legal, ethical and safety domains. It's a new implementation of the European Network for Health Technology Assessment (EUnetHTA) CoreModel integrated with the Analytic Hierarchy Process. It allows defining an evaluation structure represented by a hierarchical decision tree filled by indicators of technology's performances, each of which was given a weight proportional to the impact that this criterion provides to achieve the purpose of the decision problem; finally, the alternatives’ ranking was defined.RESULTS:The multidisciplinary assessment took into consideration all of the aspects and recommendations about the benefits and disadvantages of EHR (3). The synthesis of scientific evidence integrated with results of the specific context analysis, resulted in the definition of components of the decisional hierarchy structure. In particular, EHR seems to offer many benefits in terms of safety and clinical effectiveness such as improved continuity and quality of care, and increased accessibility of the data. The implementation of EHR resulted in important organizational outcome such as EHR configuration, learning curve and training. For these reasons, the usability was the main technical characteristics of the technology taken into account. Finally, legal aspects on privacy and security of data, covered a key role in the assessment.CONCLUSIONS:A thorough evaluation of the EHR before its implementation has permitted hospital's decision makers to choose knowingly.

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Pantuvo, Jerry S., Raouf Naguib et N. Wickramasinghe. « Towards Implementing a Nationwide Electronic Health Record System in Nigeria ». International Journal of Healthcare Delivery Reform Initiatives 3, n^o 1 (janvier 2011) : 39–55. http://dx.doi.org/10.4018/jhdri.2011010104.

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The World Health Organization identified inadequate Health Information Systems as a challenge in Nigeria. Many developed countries have either implemented or are in the process of implementing an Integrated Electronic Health Record (EHR) system because of its potential benefits. Pilot projects in many developing countries like Kenya, Malawi, Peru, and Haiti are demonstrating the viability of EHR in resource constrained areas. This study shows that the health system in Nigeria is pluralistic and complex with Federal, State and Local Governments, Health Related Agencies, Non-Governmental Organizations, private healthcare providers, patients, and researchers as the major stakeholders. The drivers for adoption of a nationwide EHR include the need to report data; improve patient safety, improve work place efficiency; comply with government reforms aimed at reducing the cost and increasing access to health services. Corruption, poor coordination among stakeholders, and lack of constant supply of electricity are some of the barriers to a successful implementation of a nationwide EHR. Factors considered critical to a successful implementation of a nationwide EHR include enforceable legislation, a trained and motivated workforce, and significant and sustainable funding.

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Adams, Katharine, Jessica Howe, Allan Fong, Joseph Puthumana, Kathryn Kellogg, Michael Gaunt et Raj Ratwani. « An Analysis of Patient Safety Incident Reports Associated with Electronic Health Record Interoperability ». Applied Clinical Informatics 08, n^o 02 (avril 2017) : 593–602. http://dx.doi.org/10.4338/aci-2017-01-ra-0014.

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SummaryBackground: With the widespread use of electronic health records (EHRs) for many clinical tasks, interoperability with other health information technology (health IT) is critical for the effective delivery of care. While it is generally recognized that poor interoperability negatively impacts patient care, little is known about the specific patient safety implications. Understanding the patient safety implications will help prioritize interoperability efforts around architectures and standards.Objectives: Our objectives were to (1) identify patient safety incident reports that reflect EHR interoperability challenges with other health IT, and (2) perform a detailed analysis of these reports to understand the health IT systems involved, the clinical care processes impacted, whether the incident occurred within or between provider organizations, and the reported severity of the patient safety events.Methods: From a database of 1.735 million patient safety event (PSE) reports spanning multiple provider organizations, 2625 reports that were indicated as being health IT related by the event reporter were reviewed to identify EHR interoperability related reports. Through a rigorous coding process 209 EHR interoperability related events were identified and coded.Results: The majority of EHR interoperability PSE reports involved interfacing with pharmacy systems (i.e. medication related), followed by laboratory, and radiology. Most of the interoperability challenges in these clinical areas were associated with the EHR receiving information from other health IT systems as opposed to the EHR sending information to other systems. The majority of EHR interoperability challenges were within a provider organization and while many of the safety events reached the patient, only a few resulted in patient harm.Conclusions: Interoperability efforts should prioritize systems in pharmacy, laboratory, and radiology. Providers should recognize the need to improve EHRs interfacing with other health IT systems within their own organization.Citation: Adams KT, Howe JL, Fong A, Puthumana JS, Kellogg KM, Gaunt M, Ratwani RM. An analysis of patient safety incident reports associated with electronic health record interoperability. Appl Clin Inform 2017; 8: 593–602 https://doi.org/10.4338/ACI-2017-01-RA-0014

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Lindenberg, Julie A. « Benchmarking : Extracting Clinical Measures and Practice Performance From the Electronic Health Record ». Clinical Scholars Review 2, n^o 1 (avril 2009) : 23–26. http://dx.doi.org/10.1891/1939-2095.2.1.23.

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Adoption of electronic health record (EHR) systems can lead to health care savings, reduction in medical errors, and improvement in health. The intersection of health information technology (HIT) and health care quality is a result of the following two developments: the quality improvement movement and the maturation of HIT. The potential safety benefits of EHR systems focus largely on alerts, reminders, and other components of ambulatory computerized provider order entry. EHR systems are integral throughout the disease management process. Using HIT for near-term chronic disease management programs has the benefits of identifying people with a potential or active chronic disease, targeting services based on their level of risk, and monitoring their risk. The purposes of benchmarking and survey reports are to provide a quantifiable measure of performance and to quantify gaps between your practice and best practices.

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Cromer, Sara J., Victoria Chen, Christopher Han, William Marshall, Shekina Emongo, Evelyn Greaux, Tim Majarian, Jose C. Florez, Josep Mercader et Miriam S. Udler. « Algorithmic identification of atypical diabetes in electronic health record (EHR) systems ». PLOS ONE 17, n^o 12 (12 décembre 2022) : e0278759. http://dx.doi.org/10.1371/journal.pone.0278759.

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Aims Understanding atypical forms of diabetes (AD) may advance precision medicine, but methods to identify such patients are needed. We propose an electronic health record (EHR)-based algorithmic approach to identify patients who may have AD, specifically those with insulin-sufficient, non-metabolic diabetes, in order to improve feasibility of identifying these patients through detailed chart review. Methods Patients with likely T2D were selected using a validated machine-learning (ML) algorithm applied to EHR data. “Typical” T2D cases were removed by excluding individuals with obesity, evidence of dyslipidemia, antibody-positive diabetes, or cystic fibrosis. To filter out likely type 1 diabetes (T1D) cases, we applied six additional “branch algorithms,” relying on various clinical characteristics, which resulted in six overlapping cohorts. Diabetes type was classified by manual chart review as atypical, not atypical, or indeterminate due to missing information. Results Of 114,975 biobank participants, the algorithms collectively identified 119 (0.1%) potential AD cases, of which 16 (0.014%) were confirmed after expert review. The branch algorithm that excluded T1D based on outpatient insulin use had the highest percentage yield of AD (13 of 27; 48.2% yield). Together, the 16 AD cases had significantly lower BMI and higher HDL than either unselected T1D or T2D cases identified by ML algorithms (P<0.05). Compared to the ML T1D group, the AD group had a significantly higher T2D polygenic score (P<0.01) and lower hemoglobin A1c (P<0.01). Conclusion Our EHR-based algorithms followed by manual chart review identified collectively 16 individuals with AD, representing 0.22% of biobank enrollees with T2D. With a maximum yield of 48% cases after manual chart review, our algorithms have the potential to drastically improve efficiency of AD identification. Recognizing patients with AD may inform on the heterogeneity of T2D and facilitate enrollment in studies like the Rare and Atypical Diabetes Network (RADIANT).

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Vest, Joshua R., Mark Aaron Unruh, Seth Freedman et Kosali Simon. « Health systems’ use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions ». Journal of the American Medical Informatics Association 26, n^o 10 (26 juillet 2019) : 989–98. http://dx.doi.org/10.1093/jamia/ocz116.

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Abstract Objective Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. Materials and Methods The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor. Results Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant. Conclusion Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.

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Barron, Sandra, et Sumanjit Manhas. « Electronic health record (EHR) projects in Canada : participation options for Canadian health librarians ». Journal of the Canadian Health Libraries Association / Journal de l'Association des bibliothèques de la santé du Canada 32, n^o 3 (22 juillet 2014) : 137. http://dx.doi.org/10.5596/c11-044.

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Research question: What are the major issues in the implementation of electronic health record (EHR) systems in Canada and what competencies can Canadian health librarians bring to their participation in these projects? Data sources: Health informatics and library science databases were searched for EHR literature. Grey literature was located at Canada Health Infoway's website, on provincial and federal government websites, and by searching online news websites. Study selection: The data sources were searched for journal articles, reviews, newspaper articles, government publications, interviews, grey literature, dissertations, editorials, and discussions. Data extraction: Data were extracted from the data sources using search strategies and keywords outlined in Appendix A. Due to the scope and focus of this paper, search terms were selected to emphasize a Canadian context; in particular, a British Columbian perspective in regards to EHR implementation. Results: This paper draws on a body of evidence to discuss EHR implementation issues and health librarian involvement in Canada. There is a growing body of research in the American biomedical literature about health librarian participation in EHR implementation but little in the Canadian health literature. Conclusion: This is the first paper of its kind that proposes new roles for Canadian health librarians in EHR implementation. Health librarians’ expertise in organizing and retrieving information makes them ideally suited for providing evidence-based medicine or consumer health information embedded directly in EHRs. Further research is needed to demonstrate the value of health librarians on EHR project teams.

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Pivovarov, Rimma, et Noémie Elhadad. « Automated methods for the summarization of electronic health records ». Journal of the American Medical Informatics Association 22, n^o 5 (15 avril 2015) : 938–47. http://dx.doi.org/10.1093/jamia/ocv032.

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Abstract Objectives This review examines work on automated summarization of electronic health record (EHR) data and in particular, individual patient record summarization. We organize the published research and highlight methodological challenges in the area of EHR summarization implementation. Target audience The target audience for this review includes researchers, designers, and informaticians who are concerned about the problem of information overload in the clinical setting as well as both users and developers of clinical summarization systems. Scope Automated summarization has been a long-studied subject in the fields of natural language processing and human–computer interaction, but the translation of summarization and visualization methods to the complexity of the clinical workflow is slow moving. We assess work in aggregating and visualizing patient information with a particular focus on methods for detecting and removing redundancy, describing temporality, determining salience, accounting for missing data, and taking advantage of encoded clinical knowledge. We identify and discuss open challenges critical to the implementation and use of robust EHR summarization systems.

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Saleem, Jason J., et Jennifer Herout. « Transitioning from one Electronic Health Record (EHR) to Another : A Narrative Literature Review ». Proceedings of the Human Factors and Ergonomics Society Annual Meeting 62, n^o 1 (septembre 2018) : 489–93. http://dx.doi.org/10.1177/1541931218621112.

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This paper reports the results of a literature review of health care organizations that have transitioned from one electronic health record (EHR) to another. Ten different EHR to EHR transitions are documented in the academic literature. In eight of the 10 transitions, the health care organization transitioned to Epic, a commercial EHR which is dominating the market for large and medium hospitals and health care systems. The focus of the articles reviewed falls into two main categories: (1) data migration from the old to new EHR and (2) implementation of the new EHR as it relates to patient safety, provider satisfaction, and other measures pre-and post-transition. Several conclusions and recommendations are derived from this review of the literature, which may be informative for healthcare organizations preparing to replace an existing EHR. These recommendations are likely broadly relevant to EHR to EHR transitions, regardless of the new EHR vendor.

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Tevaarwerk, Amye J., Kari B. Wisinski, Kevin A. Buhr, Ucheanna O. Njiaju, May Tun, Sarah Donohue, Navnit Sekhon, Thomas Yen, Douglas A. Wiegmann et Mary E. Sesto. « Leveraging Electronic Health Record Systems to Create and Provide Electronic Cancer Survivorship Care Plans : A Pilot Study ». Journal of Oncology Practice 10, n^o 3 (mai 2014) : e150-e159. http://dx.doi.org/10.1200/jop.2013.001115.

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Rapid care plan creation and delivery within an EHR is possible. Further research is required to explore the barriers to automating importation into plans as well as the impact of EHR-integrated plans.

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Saleem, Jason J., Meredith Price, Jacob M. Read, Ki-Hwan Bae, Monica Gentili, Jonathan A. Becker et Michael Eli Pendleton. « Provider Burnout as it relates to the Electronic Health Record and Clinical Workflow ». Proceedings of the Human Factors and Ergonomics Society Annual Meeting 64, n^o 1 (décembre 2020) : 598–602. http://dx.doi.org/10.1177/1071181320641135.

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Provider burnout has reached epidemic levels, especially with primary care-oriented specialties such as Family Medicine. Guided by a sociotechnical systems perspective, we investigated contributing burnout factors that relate to the electronic health record (EHR) and clinical workflow in an academic healthcare institution. We conducted semi-structured interviews with 10 family medicine and geriatrics providers and administered EHR usability and workflow integration surveys. Findings are organized around recurrent, overarching themes: (1) Clinic Workflow, (2) Documentation, (3) EHR Workflow and Usability, (4) Patient Complexity, (5) Staffing, and (6) Technical Issues. The most consistent finding across all provider interviews was poor EHR usability as a contributing factor to burnout; especially the number of clicks needed to complete EHR tasks. This finding is supported by low usability and workflow integration survey ratings. Using a sociotechnical systems framework, we demonstrate social, technological, and environmental contributors to burnout and discuss potential interventions to mitigate these contributing factors.

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Pylypchuk, Yuriy, Chad D. Meyerhoefer, William Encinosa et Talisha Searcy. « The role of electronic health record developers in hospital patient sharing ». Journal of the American Medical Informatics Association 29, n^o 3 (6 décembre 2021) : 435–42. http://dx.doi.org/10.1093/jamia/ocab263.

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Abstract Objective To determine whether hospital adoption of a new electronic health record (EHR) developer increases patient sharing with hospitals using the same developer. Materials and Methods We extracted data on patients shared with other hospitals for 3076 US nonfederal acute care hospitals from the 2011 to 2016 Centers for Medicare & Medicaid Services Physician Shared Patient Patterns database. We calculated the ratio of patients shared with hospitals outside of the focal hospital’s network that use the same EHR developer as the focal hospital, and estimated difference-in-differences models to compare same-developer patient sharing among hospitals that switched to a new developer with those that did not switch developer. Results Switching to a new EHR developer increased the ratio of patients shared with other hospitals having the same EHR developer by 4.1–19.3%, depending on model specification. The magnitude of this effect varied by EHR developer and was increasing in developer market share. Discussion Consolidation in the EHR industry has led to higher patient sharing among hospitals with the same EHR developer. Contributing factors could include the growth of developer-based health information exchanges, customizable referral management systems, and provider preferences for easy and reliable data exchange. However, hospital transfers that are significantly influenced by EHR developer could lead to poor patient-provider matches. Conclusion Hospitals’ choice of EHR developer impacts the flow of patients across hospitals, which could have both desirable and undesirable effects on patient care. Future research should investigate whether health outcomes decline with greater same-developer patient sharing.

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Rodriguez, Patricia J., Zachary J. Ward, Michael W. Long, S. Bryn Austin et Davene R. Wright. « Applied Methods for Estimating Transition Probabilities from Electronic Health Record Data ». Medical Decision Making 41, n^o 2 (février 2021) : 143–52. http://dx.doi.org/10.1177/0272989x20985752.

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Background Electronic health record (EHR) data contain longitudinal patient information and standardized diagnostic codes. EHR data may be useful for estimating transition probabilities for state-transition models, but no guidelines exist on appropriate methods. We applied 3 potential methods to estimate transition probabilities from EHR data, using pediatric eating disorders (EDs) as a case study. Methods We obtained EHR data from PEDsnet, which includes 8 US children’s hospitals. Data included inpatient, outpatient, and emergency department visits for all patients with an ED. We mapped diagnoses to 3 ED health states: anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorder. We estimated 1-y transition probabilities for males and females using 3 approaches: simple first-last proportions, a multistate Markov (MSM) model, and independent survival models. Results Transition probability estimates varied widely between approaches. The first-last proportion approach estimated higher probabilities of remaining in the same health state, while the MSM and independent survival approaches estimated higher probabilities of transitioning to a different health state. All estimates differed substantially from published literature. Limitations As a source of health state information, EHR data are incomplete and sometimes inaccurate. EHR data were especially challenging for EDs, limiting the estimation and interpretation of transition probabilities. Conclusions The 3 approaches produced very different transition probability estimates. Estimates varied considerably from published literature and were rescaled and calibrated for use in a microsimulation model. Estimation of transition probabilities from EHR data may be more promising for diseases that are well documented in the EHR. Furthermore, clinicians and health systems should work to improve documentation of ED in the EHR. Further research is needed on methods for using EHR data to inform transition probabilities.

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