The management process of chronic diseases is longitudinal in nature. Patient records in electronic format provide information at the point of care and support decision-making processes. In our research, we analyzed the clinical pragmatics of Chronic Disease Management (CDM) and formulated a knowledge model to develop Ontology-based EMR. Our research involved knowledge abstraction, knowledge modeling, and ontology engineering. We applied the Knowledge Management approach to knowledge sources including medical literature, the Chronic Care Model (CCM), CPR Ontology and HL-7 RIM. We studied CDM in detail to abstract conceptual knowledge involved in the process of CDM. The abstracted knowledge was modeled into a formal model called CD-EMR Model. We adapted Methontology and developed an OWL-based ontology from the CD-EMR Model. We evaluated the ontology by instantiating longitudinal clinical cases of chronic diseases. CD-EMR ontology allows (a) computerization of longitudinal patient records, (b) semantic interoperability, and (c) reasoning for clinical decision support.

The objective of the thesis was to evaluate the quality of diabetes care in the Canadian Forces by determining the extent to which physicians adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines. In addition, the effect of patient age, sex, rank and size of base on quality of care was assessed and the accuracy of a diagnosis of diabetes in an extract of the electronic medical record (EMR) was evaluated. Fourteen bases within the Canadian Forces were selected for investigation, representing roughly half of the Canadian Forces population. Cases of diabetes were ascertained based on laboratory criteria following a chart review. Twenty-one CDA guideline recommendations were considered. The Canadian Forces demonstrated greater than 75% adherence with each of 9 recommendations, 50-75% adherence with each of 7 recommendations and less than 50% adherence with each of 5 recommendations. The overall adherence with all applicable recommendations per patient was 60.3% (SE 0.66). Age, sex, rank and size of base were not important factors influencing guideline adherence. The sensitivity of a diabetes diagnosis in an extract of the EMR was 84.5%, the specificity was 99.8%, the positive predictive value was 85.1% and the negative predictive value was 99.8%. This is similar to the performance of provincial and national diabetes registries. The quality of diabetes care in the Canadian Forces compared favourably with that of the civilian population within Canada and internationally. The creation of a diabetes registry is expected to lead to further improvements in diabetes care.

付記する学位プログラム名: デザイン学大学院連携プログラム / 京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第22097号 / 情博第707号 / 新制||情||121(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 黒田 知宏, 教授 吉川 正俊, 教授 矢守 克也 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

A 15-facility healthcare organization utilized organizational change management techniques to aid with the adoption of a clinical information system to accomplish desired cultural transformation. The aim of this article was to provide a description of team member and physician attitudes toward change during conversion to a new clinical information system of electronic documentation. The tool developed and utilized was a change readiness survey to assess randomly selected team member and physician perceived readiness for the transition to an electronic documentation system. This article reviewed the rationale for using organizational change management techniques to facilitate adoption of a new clinical information system and discussed development of a change readiness survey tool. It explored the findings from the first 3 years of the survey.

Frontline RNs knowledgeable in the strategic objectives of their organization made a difference in the selection of an electronic medical record business partner for a large, complex healthcare system. Their impact was significant because of the chief nurse executive's personal articulation of the organization's strategic goals and of her investment in their education. These factors provided the frontline RNs with a foundational base of knowledge about a variety of electronic medical record systems. The preparation and exposure enabled the frontline RNs to make a valuable contribution to the selection of an electronic medical record business partner. The RNs were a major force in affecting philosophical change from the organization's original pursuit of "best-of-breed" interfaced systems to a fully integrated, "best-of-class" vendor business partner. The learning experiences of the frontline RNs are explored to answer the following question: Why must frontline RNs play a key role in this process?

As the digitisation of healthcare progresses, there are still problems in terms of usability. With the goal of exploring solutions to these, an email inspired design for an electronic health record system was implemented using modern web technologies. The implementation was then evaluated in a series of usability tests conducted with five orthopaedic surgeons. Participants were asked to perform small tasks on a mocked data set, and the sessions were concluded with debriefing interviews. The focus was on the areas that are new in this design. The results suggest that the general design works, and no critical flaws were identified at this stage. Most of the issues that were found are likely to be solved with more training and experience, but there is still room for improvement. Participants had positive reactions overall, and plenty of feedback was collected regarding areas of improvement and feature suggestions. Due to the limitations of the test, the findings mostly relate to the intuitiveness of the design. To draw stronger conclusions regarding the viability of the design in a real environment, further testing with more data, realistic test tasks and more prerequisite training is necessary. / Digitiseringen inom sjukvården ökar, men det finns fortfarande problem när det kommer till användbarheten av de digitala system som finns på marknaden. Med målet att utforska lösningar på dessa problem implementerades i detta arbete en e-post-inspirerad gränssnittsdesign för ett digitalt journalsystem med hjälp av moderna webb-teknologier. Implementationen utvärderades genom användartester där fem ortopediska kirurger deltog. Deltagarna ombads använda gränssnittet för att utföra små testuppgifter med påhittad patientdata, och sessionerna avslutades med intervjufrågor. Fokuset var på de delar som är nya i den här designen jämfört med redan existerande system. Resultatet visar att det generella upplägget fungerar, och inga kritiska brister upptäcktes i detta stadie. De flesta av problemen som uppdagades kan troligen lösas genom att användarna ges möjlighet till mer träning och får mer erfarenhet, men det finns fortfarande förbättringutrymme. Deltagarna hade positiva reaktioner i allmänhet, och många förslag kring förbättringsområden och önskemål kring utökad funktionalitet samlades upp. På grund av användartestets begränsningar belyser resultaten i detta test mest vilka delar av gränssnittet som är intuitiva eller ej, medan det som är mer intressant för den här typen av dagligen använda system egentligen är huruvida de är effektiva att använda i det dagliga arbetet. För att kunna dra säkrare slutsatser kring om den här designen skulle fungera i riktiga arbetssituationer behövs mer testning med större mängder patientdata, mer realistiska testuppgifter och mer tid för deltagarna att lära sig systemet i förväg.

Electronic health records (EHRs) have been in use since the 1960s. U.S. rural hospital leaders and administrators face significant pressure to implement health information technology because of the American Recovery and Reinvestment Act of 2009. However, some leaders and managers of small rural hospital lack strategies to develop and implement EHRs. The focus of this descriptive phenomenological study was to explore lived experiences of hospital leaders and administrators who have used successful strategies to implement EHRs in small rural hospitals. Diffusion of innovation theory shaped the theoretical framework of this study. Data were collected through telephone interviews conducted with participants who successfully deployed EHRs at 10 hospitals in the Appalachian regions of Maryland, Virginia, and West Virginia. Data analysis occurred using a modified Husserlian approach in search of common themes from interview transcripts. The main themes were strategies to address standards and incentives, implementation, and challenges. The exploration of these strategies provides insight that small rural hospital leaders and administrators could consider for implementing EHRs. The study findings might enable small rural hospital leaders and administrators to contribute to positive social change by engaging communities in using EHRs; these findings may also expand information sharing among individuals and organizations and build social relationships with an expectation of future benefits. Results from this study are designed to inform other small rural hospital leaders and administrators to conduct further research on successful strategies for implementation of EHRs.

Adoption of electronic medical record (EMR) technology systems of meaningful use has been slow despite the mandate by the U.S. government. The purpose of this single case study was to explore strategies used by health care leaders to implement EMR technology systems of meaningful use to take advantage of federal incentive payments. Diffusion of innovation theory provided the conceptual framework for the study. Semistructured interviews were conducted with 6 health care leaders from a military installation in the Southeast United States. Data were analyzed using software, coding, and inductive analyses. The 3 prominent themes were patient, provider, and champion. Alerts from an EMR technology system can increase providers' awareness and improve patient safety. Providers' involvement in every phase of an EMR system's implementation can improve the adoption rate. Champions play a critical role in successful adoption and implementation of EMR systems. Results of this study may assist health care leaders in implementing EMR systems to take advantage of federal incentive payments. Implications for positive social change include enhanced delivery of safe, high-quality health care.

The electronic health record (EHR) is an important part of the effort to improve health care and reduce costs in the United States. Primary care providers, among the largest group of caregivers in the nation, often experience difficulty with implementation and utilization of EHRs. Efforts to enhance the provider's effectiveness in the use of the EHR should result in improved patient outcomes as well as decreasing the overall cost of health care. Guided by the diffusion of innovation theory, this project was initiated to develop a plan for improved usage of the EHR in a primary care setting. A survey and observations were used to better understand how the providers and staff were using the EHR. Observations and a survey of 11 participants were completed. The observations utilizing a mock patient revealed issues related to the usability of screen information, information availability, and user preference for documentation. The mock patient scenario took 25-35 minutes, on average, to complete. All participants stated they had stayed late to input information on actual clinic patients or to clarify their documentation. The same 11 participants completed the Primary Care Information Project (PCIP) Post-Electronic Health Record Implementation: Survey of Providers responses. Descriptive statistics were used to analyze the results. Most participants indicated that the screen font was difficult to read (72.7%), they had difficulty using the EHR (72.8%) and were not satisfied with its use (63.6%). The project recommendations include working with the vendor to improve information access and ongoing training. Improvements to the EHR should support social change by improving access to information at the point of care, enhancing quality treatment and improving patient care outcomes.

No description available.