No description available.

Over 700,000 adverse drug events (ADEs) result in emergency hospital visits annually, and many of these ADEs are preventable through the use of health information technology in hospitals. However, only 12.6% of U.S. hospitals have developed the capacity to adopt closed-loop electronic medical records (EMR). Organizational complexity may be a major factor influencing hospitals' adoption of closed-loop EMR. This quantitative study explored how organizational complexity influenced hospitals' adoption of closed-loop EMR. Diffusion of innovation theory was the foundation for this study. Logistic regression was used to establish possible relationships between organizational complexity and hospitals' adoption of EMR for closed-loop medication therapy management. Secondary data from Health Information and Management Systems Society were examined to explore the relationship between organization complexity and hospitals' adoption of EMR for closed-loop medication therapy. The research questions explored whether vendor selection strategy, structural complexity, and management structure influence hospitals' adoption of EMR for closed-loop medication therapy management. The results indicated that all three variables, vendor selection strategy, structural complexity, and management structure, are statistically significant predictors of hospitals' adoption of EMR for closed-loop medication therapy management. Results from this study may promote positive social change by enhancing hospitals' adoption of EMR for closed-loop medication therapy management, which may therefore help improve the quality, efficiency, and safety of health care delivery in U.S. hospitals.

No description available.

臺灣電子病歷內容基本格式 (Taiwan Electronic Medical Record Template, TMT)是參考國際相關標準之後，專為臺灣本土需求而設計的電子病歷標準。為了進一步評估TMT的實用性與實施上可能遭遇到的問題，衛生署於民國96年推動了「建構以病人為中心之電子病歷跨院資訊交換環境案」，目前已完成參與該專案各醫院的實地測試工作。 在檢視專案執行的結果後，我們發現TMT資訊系統有三項主要的缺點：一、TMT病歷標準不易閱讀，難以撰寫從醫院醫療資訊系統彙總TMT所需資料的指令集；二、製作TMT系統所須的設定檔程序過於繁複，不但時間攏長而且容易出錯；三、線上實際產生個別病患的TMT資料的時間過長，執行效能有待提昇。有鑑於此，我們設計並實作了一套適用於TMT標準的電子病歷文件產生工具，我們重新設計了規格文件檔及輔助設定檔，並提供了Schema Processor自動化工具產生這些檔案；同時，我們也改進了病歷資料彙總程序，搭配高便利性的設定檔，病歷文件產生工具在執行效能上了有明顯的改善。 在詳細、完整的規格文件檔協助下，資訊人員能更快的了解病歷標準架構及撰寫病歷資料查詢語法，以利產出正確的電子病歷文件；透過自動化工具的輔助，簡化了設定檔的製作程序，改善了耗時且容易出錯的缺點；相較於目前的TMT系統，我們的工具執行效能提昇了80%以上，產出電子病歷文件的時間只要原來的五分之一。 / The Taiwan Electronic Medical Record Template (TMT) proposed by Taiwan Association for Medical Informatics (TAMI) aims to provide a suite of standard forms that will become the common basis for developing electronic medical record (EMR) systems in Taiwan. It is specified in the XML standard for facilitating data interchange. In order to further assess the usefulness of TMT, in 2007 the Department of Health lauched the project "Building of an Information Exchange Environment for Cross-Hospital Digital Medical Record" to put the TMT to a filed test. There are in total eleven hospitals in the project and they all successfully implemented a significant subset of TMT using their hospital information systems (HIS). / However, towards the end of the project, we have identified three major shortcomings of the content aggregator for TMT provided by the TAMI: First, as the TMT Schema is rather complex, it is very difficult for hospital IT staff to prepare the required query instructions to retrieve the data stored in the HIS database. Although there is a XML data mapping tool provided to simplify the mapping process, we found that it did not ease the mapping task as the TAMI staff had expected. Second, the configuration files for preparing a patient’s EMR are too complicated, making the implementation process not only long time but also error-prone. Third, the time required to produce a single sheet of TMT is much longer than planned. There is an urgent need to improve the performance of the content aggregator. / Therefore, we propose to re-engineer the content aggregator of TMT for retrieving the required data from the HIS database. Specifically, we redesigned the specification document files and configuration files, and provided a Schema Processor tool to generate these files in a semi-automatically manner. As a result, the IT staff of hospitals can more quickly understand the structure of TMT Schema and prepare the query instructions effectively. Finally, with the powerful configuration files, our TMT document generator runs much faster than the existing one. According to our experimental results, it enhances the performance of generating a TMT sheet more than 80 percent.

Thesis (M.Com. (Information Systems))--University of the Witwatersrand, Faculty of Commerce, Law and Management, School of Economic and Business Sciences, 2014. / Successful implementation of electronic medical record systems (EMRs) can result in many benefits. However, the adoption and use of EMRs by health workers is often problematic. Understanding the perceptions and attitudes of health workers towards the use of these systems is therefore important. This study has contributed by examining (a) perceptions of health workers towards the characteristics of EMR systems, (b) perceptions of the impacts of EMR use on healthcare delivery and other workplace outcomes (i.e. individual work performance and job satisfaction), (c) their intentions to continue using EMRs. The DeLone and McLean Information System Success model and the Information Systems Continuance model were used to underpin the study and to hypothesize inter-relationships amongst these perceptions and attitudes. The empirical context of the study was Tygerberg Hospital in Cape Town, South Africa. A survey was carried out and 142 responses were obtained from the nurses at the hospital. Results showed that system characteristics, namely, system quality, information quality and service quality were significant predictors of user satisfaction, which in turn was found to be a significant predictor of EMR use. Satisfaction together with perceptions of individual impacts and healthcare impacts was found to lead to continuance intention. Users reported statistically significantly higher levels of job satisfaction than non-users. Healthcare impact perceptions was positively associated with job satisfaction. Based on the results of the study, it is recommended that decision makers, policy makers and EMR vendors pay close attention to the service quality and the system quality of EMRs as these are the key determinants of user satisfaction. It is also recommended that managers ensure that all healthcare workers be given access to and encouraged to use EMRs to perform their work related task as EMR users have been shown to have higher levels of job satisfaction than non-users.

Electronic medical records (EMRs) or electronic health records have been in use for years in hospitals around the world as a time-saving system for patient record keeping. Despite its widespread use, some physicians disagree with the assertion that EMRs save time. The purpose of this study was to explore whether any time saved with the use of the EMR system was actually devoted by doctors to patient-care and thereby to improved patient-care efficiency. The conceptual support for this study was predicated employing the task-technology fit theory. Task-technology theorists argue that information technology is likely to have a positive impact in individual performance and production timeliness if its capabilities match the task that the user must perform. The research questions addressed the use of an EMR system as a time-saving device, its impact on the quality of patient-care, and how it has influenced patients' access to healthcare in Nigeria. In this research, a comparative qualitative case study was conducted involving 2 hospitals in Nigeria, one using EMRs and another using paper-based manual entry. A purposeful sample of 12 patients and 12 physicians from each hospital was interviewed. Data were compiled and organized using Nvivo 10 software for content analysis. Categories and recurring themes were identified from the data. The findings revealed that reduced patients' registration processing time gave EMR-using doctors more time with their patients, resulting in better patient care. These experiences were in stark contrast to the experiences of doctors who used paper-based manual entry. This study supports positive social change by informing decision makers that time saved by implementing EMR keeping may encourage doctors to spend more time with their patients, thus improving the general quality of healthcare in Nigeria.

Health information technology (HIT), which includes electronic health record (EHR) systems and clinical data analytics, has become a major component of all health care delivery and care management. The adoption of HIT by physicians, hospitals, post-acute care organizations, pharmacies and other health care providers has been accepted as a necessary (and recently, a government required) step toward improved quality, care coordination and reduced costs: “Better coordination of care provides a path to improving communication, improving quality of care, and reducing unnecessary emergency room use and hospital readmissions. LTPAC providers play a critical role in achieving these goals” (HealthIT.gov, 2013). Though some of the impacts of evolving HIT and EHRs have been studied in acute care hospitals and physician office settings, a dearth of information exists about the deployment and effectiveness of HIT and EHRs in long-term and post-acute care facilities, places where they are becoming more essential. This dissertation examines how and to what extent health information technology and electronic health record implementation and use affects certain measurable outcomes in long term and post-acute care facilities. Monthly data were obtained for the period beginning January 1, 2016 through June 30, 2017, a total of 18 months. The level of EHR adoption was found to positively impact hospital readmission rates, employee engagement, complaint deficiencies, failed revisit surveys, staff overtime (partial EHR), staff turnover rate (full EHR) and United States Centers for Medicare and Medicaid Services (CMS) Five Star Quality score. The level of EHR adoption was found to negatively impact CMS Five Star Total score, staff retention rate (full EHR) and staff overtime (full EHR group higher than partial EHR).

L'ús de materials híbrids ha estat demostrat que és una aposta important en moltes àrees de la ciència i particularment, dels processos de separació. En aquest treball s'ha utilitzat el carbó activat per obtenir membranes compostes. Les membranes de naturalesa carbonosa ofereixen el potencial de combinar la senzilla utilització dels polímers amb les bones propietats de separació dels tamisos moleculars carbonosos. Tanmateix, la incorporació del carbó activat respon a una segona motivació corresponent al seu ús com a suport per obtenir reactors de membrana enzimàtics (EMR). D'aquesta manera s'aconsegueix obtenir en un únic procés una operació de separació i una de reacció, fet que es coneix com intensificació de processos, i que respon a una de les principals tendències de la recerca actual. En la primera etapa del treball es van sintetitzar membranes polimèriques de polisulfona mitjançant el mètode de precipitació per immersió, i en primer terme, es va estudiar l'efecte de la concentració de polímer, i el tipus de solvent a utilitzar. Determinades aquestes condicions, es va realitzar un estudi més profund considerant la variació de la composició del bany de coagulació. La caracterització va incloure la microscòpia electrònica d'escombratge (SEM), la microscòpia de força atòmica, la tècnica experimental de rebuig de sòlids i l'angle de contacte. També es van caracteritzar les membranes mecànicament. Els resultats van demostrar que amb la variació de la concentració del bany de coagulació s'obtenen membranes amb morfologies molt diferents, aptes per processos de micro i ultrafiltració, les quals ofereixen un rang de tall d'entre 25 i 700 kDa (mesurat amb dextrans). El mètode de SEM és un dels més versàtils ja que permet caracteritzar morfològicament tota la superfície de la membrana, de manera relativament ràpida i senzilla i sobretot podent-la examinar globalment. Tanmateix, els resultats són qualitatius, i en aquest treball es va desenvolupar una eina informàtica (IFME®) que permet obtenir resultats quantitatius, ràpids i sistemàtics. Relatiu al mètode experimental, cal destacar que el rendiment de les membranes es veu decisivament afectat pel disseny del mòdul: un mal disseny pot implicar un inadequat flux sobre la mateixa i l'aparició de fenòmens com l'embrutiment o la polarització que implica una sensible reducció del flux de permeat i una modificació del tall de la membrana. És per això, que es van considerar diversos mòduls, i per cada un d'ells es va realitzar un estudi de la dinàmica de fluid (CFD) per tal d'estudiar-ne el seu comportament i optimitzar-lo en els casos necessaris.La segona etapa va consistir en l'obtenció i caracterització de membranes compostes mitjançant l'ús de carbó activat (mateixos mètodes). Se'n van obtenir de dos tipus: les formades per una i dues capes. En les primeres, el carbó es va addicionar juntament amb el polímer i el solvent, de manera que quedava una mescla homogènia a partir de la qual s'obtenia la membrana. En les de dues, el carbó es va addicionar a la part superior del film un cop estava format, però abans d'obtenir la membrana. Els resultats van mostrar que l'addició de carbó activat no modificava les propietats morfològiques de les membranes, i conseqüentment, la seva capacitat de separació, malgrat les funcionalitzava.En la darrera etapa es van desenvolupar dos tipus d'EMRs. Un primer utilitzant enzim sòlid que es va immobilitzar entre dues capes de membrana (sense enllaç químic), i un segon que va incloure un complex enzimàtic líquid enllaçat químicament al carbó activat de dues maneres: directament a ell i mitjançant l'ús d'un ió metàl·lic, Cu(II), (tècnica IMAC). D'aquest darrer tipus, se'n van obtenir dos configuracions: d'una capa, on el complex es va addicionar juntament amb el polímer i el solvent obtenint una mescla homogènia de tots els components, i de dues capes, addicionant el complex damunt el film polimèric, però abans d'introduir-lo al bany de coagulació i obtenir la membrana. Totes les membranes enzimàtiques obtingudes van mostrar una adequada immobilització de l'enzim i una bona reactivitat i per tant, es va aconseguir un bon equilibri entre la velocitat de reacció i la de separació. Els reactors monocapa obtinguts amb l'enzim líquid són els que van oferir un rendiment global millor, ja que permeten l'obtenció d'aquells components més desitjats, mantenen inalterada la capacitat de separació de la membrana, són vàlids també per processos difusius i són sistemes molt compactes. / The utilization of hydride materials has been demonstrated to be an important approach in many fields of science, and particularly, in separation processes. In this work, activated carbon was used to obtain composite membranes. They offer the potential of combine the simple utilization of polymers with the functional properties of carbon materials. Nevertheless, the incorporation of the activated carbon responds also to a second objective: the production of enzymatic membrane reactors by taking advantage of its adsorption capability. Therefore it is possible to obtain a single unit which carries out two processes: separation and reaction. This is process intensification, which is one of the main research trends. In the first stage, polysulfone membranes were synthesized by immersion precipitation. Firstly, the effect of its concentration in the polymeric mixture was studied. Secondly, the type of solvent was also investigated. When the best conditions of these variables were encountered, the effect of the composition of the coagulation bath was deeply studied. The characterization included methods as the scanning electron microscopy (SEM), the force atomic microscopy, the experimental related to solid exclusion and the contact angle. Membranes were also mechanical characterized by strain-stress tests. Results demonstrated that with the variation of the coagulation bath it is possible to obtain a wide range of membrane morphologies with a cut-off range from 25 to 700 kDa (measured with dextrans). The SEM is one of the most versatile method because allows to characterize morphologically almost all the membrane surface, in a quick and simple way. But the results obtained are qualitative, and in this work, a software (IFME®) was developed to obtain quantitative results, quickly and systematically. Related to the experimental, the global performance of membranes depends also on the module design: a wrong design could imply a non-adequate flux flow over the membrane, which facilitates the phenomena of fouling and polarization that reduces the permeate flow. For this reason, several modules were considered, used and also simulated with computational fluid dynamics, and in those necessary cases, were also optimized. The second stage consisted on the synthesis and characterization of composite membranes by adding activated carbon (same techniques). Two types of composite membranes were obtained. A single-layered one, which the activated carbon was added to the polymeric solution at the beginning of the process and, therefore, a homogeneous film and membrane were obtained, and a two-layered one. The activated carbon was added over the surface of the film obtained before immersing it in the coagulation bath, and therefore, producing the membrane. Results showed that the addition of the carbon did not modify the morphology of the membranes and therefore, their separation capability, but it added functionality to the membrane.The last stage of the work consisted on the synthesis of two types of EMR. The first one contained a solid enzyme which was immobilized between two membrane layers (without chemical bind). The second one contained an enzymatic liquid complex with was bounded directly to the activated carbon and by using an ion metal (IMAC technique). Related to this second type of enzyme, two different EMR configurations were obtained: a single-layered one (adding the complex to the polymeric mixture) and two-layered one (adding the complex over the obtained film before producing the membrane). All the configurations demonstrated a successfully immobilization of the enzyme and also proper reactivity results (a good equilibrium between the kinetics of the reaction and the membrane flux was achieved). The monolayer enzymatic membrane reactor was the one which showed best overall results, since the desired reaction products could be obtained, the separation capability of the membrane was not altered, the system is also valid for diffusive processes and the system is very compact.

Electronic medical records (EMR) and computerized provider order entry (CPOE) are recognized as a means to improve quality of care and patient safety. This research examines factors that contribute to clinician acceptance of an EMR implemented in a pediatric hospital system and applies this knowledge to improve implementation methods to ensure they foster acceptance. A framework for User-Centered Implementation (UCI) was developed based on previous EMR and CPOE, technology acceptance, user-centered design, and change management research. The UCI framework identifies tools from change management and user-centered design and links them to the systems development lifecycle stage(s) at which they can be applied to achieve improved user acceptance. Next, a study examined clinician EMR acceptance in a pediatric hospital system at various points during their EMR implementation which employed a UCI-based methodology. Surveys before and after implementation of each phase examined physician, nurse, and other staff perceptions about the systems usefulness (performance expectancy (PE)) and ease of use (effort expectancy (EE)). Results indicate users had positive perceptions of system ease of use (EE) after implementation. Post-implementation PE ratings were neutral or positive for most users. Pre- and post-implementation regression models indicate the factors that influence PE change over time. Compatibility with clinician work practices was important both before and after implementation. Before implementation, users who perceived a greater need for the system and felt their needs were represented during design had higher expectations of system usefulness. After implementation, system characteristics including how well it supports clinical decision making and how easy it is to use influenced PE. Support provided by super users positively influenced both PE and EE after implementation. Based on these findings, guidelines for using UCI to improve clinician acceptance of EMR are presented. Designing EMR systems that are usable within the clinical work context enables clinicians to focus on the patient, rather than the system. Accomplishing this in practice is difficult given the complexity of EMRs and the dynamic clinical processes they support. This studys results indicate the UCI framework can be effectively applied to EMR implementations to improve the usability, utility, and, consequently, acceptance of these systems.

The timely communication and access to a complete history of lab results is at the heart of patient diagnosis, monitoring, and treatment planning. When lab results are effectively shared, in a manner conducive to family physician processes and systems, the business and clinical processes are improved, with possible value to the care of the patient. Current lab result sharing occurs through disparate and often proprietary one-to-one connections, often non-electronically, making integration of results difficult. There is broad value in coordinating efforts and consolidating processes across organizations, through electronic health record solutions. Referencing the published literature, this paper evaluates the local context of Waterloo-Wellington counties in southwestern Ontario, stakeholders, and processes, and describes the applicable standards and existing solutions. Recommendations are made for how to progress towards interoperable lab result sharing with family physicians.