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.

>Magister Scientiae - MSc / With the development of information and network technologies, Electronic Health Records (EHRs) management system has gained wide spread application in managing medical records. One of the major challenges of EHRs is the independent nature of medical institutions. This non-collaborative nature puts a significant barrier between patients, doctors, medical researchers and medical data. Moreover, unlike the unique and strong anti-tampering nature of traditional paper-based records, electronic health records stored in centralization database are vulnerable to risks from network attacks, forgery and tampering. In view of the data sharing difficulties and information security problems commonly found in existing EHRs, this dissertation designs and develops a credible Blockchain-based electronic health records (CB-EHRs) management system.

Masters of Science / With the development of information and network technologies, Electronic Health Records (EHRs) management system has gained wide spread application in managing medical records. One of the major challenges of EHRs is the independent nature of medical institutions. This non-collaborative nature puts a significant barrier between patients, doctors, medical researchers and medical data. Moreover, unlike the unique and strong anti-tampering nature of traditional paper-based records, electronic health records stored in centralization database are vulnerable to risks from network attacks, forgery and tampering. In view of the data sharing difficulties and information security problems commonly found in existing EHRs, this dissertation designs and develops a credible Blockchain-based electronic health records (CB-EHRs) management system. To improve security, the proposed system combines digital signature (using MD5 and RSA) with Role-Based Access Control (RBAC). The advantages of these are strong anti-tampering, high stability, high security, low cost, and easy implementation. To test the efficacy of the system, implementation was done using Java web programming technology. Tests were carried out to determine the efficiency of the Delegated Byzantine Fault Tolerance (dBFT) consensus algorithm, functionality of the RBAC mechanism and the various system modules. Results obtained show that the system can manage and share EHRs safely and effectively. The expectation of the author is that the output of this research would foster the development and adaptation of EHRs management system.

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

Táto práca sa zaoberá významom a možnosťami rekuperácie tepla výfukových plynov, ktoré pomáhajú pri štarte urýchliť zahrievanie motora a tým znižovať emisie. Teoretická časť pojednáva o emisiach a v snahe znížiť ich o predošlých konštrukčných riešeniach v priebehu rokov. Praktická časť je venovaná vytvorení modelov s implementovanými systémami rekuperácie tepelnej energie a ich dopad na teplotu chladiacej kvapaliny a oleja ako aj na celkovú spotrebu vozidla.

This study explored the phenomenon of electronic medical records systems in Zimbabwean primary healthcare institutions. The goal of the study was to investigate the lack of adoption of electronic medical records systems by primary healthcare institutions in developing countries using an interpretative case study approach focusing on the Zimbabwean context. Despite the positive benefits that are associated with EMRs, developing countries have been reluctant in implementing this technology within their primary healthcare institutions. A number of studies have been conducted on EMR systems but only a few have investigated the reasons for the limited use of EMR technology in developing countries particularly within the Zimbabwean context. This study primarily adopted a case study approach and was qualitative in nature. The study made use of in-depth interviews to obtain its data, and purposive sampling method was used to identify participants for the study. The study made use of a sample size of fourteen respondents who were identified based on their knowledge and could assist explore this particular topic relevant to the research. The targeted population for this research were key staff members privy to patients’ medical records management within the primary healthcare facilities. The data collected was analysed using thematic analysis soon after the transcription process. The results of the study show that EMRs technology in Zimbabwe has been implemented on a limited scale within its public hospitals. The technology is being used mostly in HIV/AIDS management or in particular departments. The study reveals that although healthcare institutions in Zimbabwe have adopted EMRs technology, most of the information is still being archived on the paper based system. The findings of the study show that Zimbabwe hasn’t adopted EMRs due to challenges such as lack of proper infrastructures, resistance in the use of EMRs, remoteness, shortages in skilled labour and concerns of confidentiality and privacy. Furthermore, the study shows that though the application of the EMR system is limited in Zimbabwean hospitals, the study found that its benefits have been noticeable. EMR technology has made it easy to access information, averted redundant expenditure and has made time improvements. However, the study revealed that EMR systems come with their own shortcomings such as lack of access to patient documents due to network faults and the need for familiarity with computer systems.

As Information Communication Technologies (ICTs) are growing, there have been ceaseless efforts to develop a National Health Information Infrastructure (NHII). One of the challenges in constructing a NHII is concerned with the management of Electronic Health Records (EHRs). In particular, exchanging EHRs is an important factor in establishing interoperability within a NHII, and the reusability of the functionality for exchanging EHRs is one of major solutions to construct an NHII. In this study, we obtain several component models, and conduct empirical studies to validate the component models in terms of component reusability. Using HL7 CDA (Health Level 7 Clinical Document Architecture) as an EHR standard, we implemented three prototypes of the EHR Exchanger based on JavaBeans, the exogenous connectors and the mediator connector respectively. As shown in the experiment results, the reuse approach using a mediator connector leads to better component reusability in terms of external dependency, total coupling between objects (CBO), additional lines of codes (LOC), and performance. Thus, we believe that the reuse approach using a mediator connector yields many benefits in terms of component reusability for the EHR Exchanger implementation.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelinesare used to guide clinical practices for treating Chronic Obstructive Pulmonary Disease (COPD). GOLD focuses heavily on stable COPD patients, limiting its use fornon-stable COPD patients such as those with severe, acute exacerbations of COPD (AECOPD) that require hospitalization. Although AECOPD can be heterogeneous, it can lead to deterioration of health and early death. Electronic health records (EHRs) can be used to analyze patient data for understanding disease progression and generating guideline evidence for AECOPD patients. However, because of its structure and representation, retrieving, analyzing, and properly interpreting EHR data can be challenging, and existing tools do not provide granular analytic capabil-ities for this data.<div><br></div><div>This dissertation presents, develops, and implements a novel approach that systematically captures the effect of interventions during patient medical encounters, and hence may support evidence generation for clinical guidelines in a systematic and principled way. A conceptual framework that structures components, such as data storage, aggregation, extraction, and visualization, to support EHR data analytics for granular analysis is introduced. We develop a software framework in Python based on these components to create longitudinal representations of raw medical data extracted from the Medical Information Mart for Intensive Care (MIMIC-III) clinical database. The software framework consists of two tools: Patient Aggregated Care Events (PACE), a novel tool for constructing and visualizing entire medical histories of both individual patients and patient cohorts, and Mark SIM, a Markov Chain Monte Carlo modeling and simulation tool for predicting clinical outcomes through probabilistic analysis that captures granular temporal aspects of aggregated, clinicaldata.<br></div><div><br></div><div>We assess the efficacy of antibiotic treatment and the optimal time of initiationfor in-hospitalized AECOPD patients as an application to probabilistic modeling. We identify 697 AECOPD patients of which 26.0% were administered antibiotics. Our model simulations show a 50% decrease in mortality rate as the number of patients administered antibiotics increase, and an estimated 5.5% mortality rate when antibiotics are initially administrated after 48 hours vs 1.8% when antibiotics are initially administrated between 24 and 48 hours. Our findings suggest that there may be amortality benefit in initiation of antibiotics early in patients with acute respiratory failure in ICU patients with severe AECOPD.<br></div><div><br></div><div>Thus, we show that it is feasible to enhance representation of EHRs to aggregate patients’ entire medical histories with temporal trends and support complex clinical questions to drive clinical guidelines for COPD.<br></div>

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.

This diploma thesis deals with the design and optimization of the control valve for EHRS exchanger. The first part of the thesis contains a research describing the historical development of internal combustion engines, their impact on the environment and especially the possible ways of waste heat recovery. The second part focuses on the design of the control valve and experimental measurement to verify its functionality. The final part contains an analysis of pressure losses of the designed valve to improve its construction disadvantages.