Currently, C Hospital lacks a standardized nursing informatics competency program to validate nurses' skills and knowledge in using electronic medical records (EMRs). At the study locale, the organization is about to embark on the implementation of a new, more comprehensive EMR system. All departments will be required to use the new EMR, unlike the current policy that allows some areas to still document on paper. The Institute of Medicine, National League of Nursing, and American Association of Colleges of Nursing support and recommend that information technology be an essential core competency for nurses. Evidence of the need for nursing informatic competencies was found through a literature search using CINHAL, Proquest Nursing, Medline, and Pubmed search lines. Concepts searched were competencies, nursing informatics, health information technology, electronic health record, information technology literacy, nursing education, information technology training, and curriculum. The Staggers Nursing Computer Experience Questionnaire was distributed to 300 nurses practicing within the hospital setting to obtain baseline data on current nursing computer knowledge and skill level. This validated tool was created by Nancy Staggers in 1994 and used in other process improvement efforts similar to this one. The assumption was that nursing competency levels with computers were varied through the hospital. The data obtained from the questionnaire, through Zoho Survey tool, confirmed this assumption and were used to help create the education, support, and competency plan for the future. Data was analyzed through the built-in reports and interactive charts that the Zoho survey tool provides. The new EMR and all the new processes that come with it will be the framework of nursing care. Having competent nurses in the use of the EMR will optimize the quality of patient care delivered.

O Acidente Vascular Cerebral (AVC) é uma doença prevalente e incapacitante, cujo atendimento no Brasil é insuficiente e concentrado em poucos centros de alta complexidade. A telemedicina possibilita assistência à saúde através do uso de tecnologias de comunicação entre dois ou mais profissionais, ou entre o profissional e o paciente, que estejam em locais distintos, permitindo aumento do acesso a tratamentos especializados, podendo ser útil na assistência do AVC agudo. Os objetivos deste estudo foram avaliar a viabilidade de uma rede de telemedicina para o AVC no Sistema Único de Saúde na região de Ribeirão Preto e desenvolver um sistema de telemedicina para o AVC. Para a análise da viabilidade, foram realizados o levantamento de indicadores demográficos e epidemiológicos da população de municípios que constituem o Departamento Regional de Saúde de Ribeirão Preto (DRS XIII) e uma análise técnica e econômica relacionada à estrutura necessária. O sistema de registro eletrônico e videoconferência foi desenvolvido por equipe multiprofissional, baseado em diretrizes nacionais para sistemas de informação em saúde e protocolos padronizados para o atendimento do AVC agudo. Concluiu-se que uma rede de telemedicina entre o Hospital das Clínicas de Ribeirão Preto e os outros hospitais que possuem os pré-requisitos para cadastramento como Unidade de AVC no DRS XIII será estratégica para a expansão do atendimento qualificado do AVC na região, e sua viabilidade depende do cadastro destes serviços junto ao Ministério da Saúde, financiamento dos equipamentos e treinamento das equipes assistenciais. O sistema de telemedicina desenvolvido possibilitará o registro seguro dos atendimentos, a educação permanente das equipes e base de dados para pesquisas clínicas, contribuindo para a concretização desta e de outras redes de telemedicina brasileiras. / Stroke is a prevalent and disabling disease, whith insufficient treatment in Brazil, where is concentrated in a few high complexity centers. Telemedicine enables health care through communication technology between two or more professionals, or between the professionals and patients, in different locations, allowing increased access to specialized treatments, therefore useful in acute stroke treatment. This study objectives were to evaluate the feasibility of a public stroke telemedicine network at Ribeirão Preto region and to develop a stroke telemedicine eletronic system. For feasibility study, populational demographic and epidemiological indicators were compiled for the cities that constitute the Regional Health Department of Ribeirão Preto (DRS XIII) and a technical and economic analysis related to the necessary structure was performed. The electronical record and videoconference system was developed by a multiprofessional team, based on national guidelines for health information systems and standardized protocols for acute stroke care. A telemedicine network between the Hospital das Clínicas of Ribeirão Preto and the other hospitals that meet criteria for enrollment as Stroke Units in DRS XIII will be strategic for the expansion of regional qualified stroke care. Its viability depends on the registration of these services at the Health Ministry, equipment financing and assistance teams training. The developed telestroke system will enable the secure record of calls, the permanent education of the teams and a database for clinical research, contributing to the realization of this and other telemedicine networks.

El Perú posee un sistema de salud fragmentado, compuesta por seis instituciones, entre ellas el Ministerio de Salud (MINSA), el cual en el marco de la Ley N° 30024, Ley que crea el Registro Nacional de Implementación de Historias Clínicas Electrónicas y la Ley de Gobierno Digital, desarrolla el Plan Nacional de Implementación el Sistema de Información de Historias Clínicas Electrónicas SIHCE e-Qhali para las IPRESS del Primer Nivel de Atención 2019-2021, con la finalidad de contribuir a mejorar la calidad de la atención de salud a los usuarios de los servicios de salud a través del mencionado sistema; sin embargo, durante dicho proceso se han presentado diversas limitaciones que han impedido el avance de dicha implementación. En ese sentido, la presente investigación toma como caso de estudio una IPRESS de Lima Norte con el objetivo de diagnosticar la situación de la Implementación del Sistema de Información de Historias Clínicas Electrónicas (SIHCE) e-Qhali en el Centro Materno Infantil El Progreso, durante el periodo del 2019 al 2020, a través del análisis de las fases de Preparación, Planificación, Ejecución, Seguimiento y Control considerados en el precitado plan de implementación; así como la utilidad de dicho sistema en el CMI El Progreso. / Peru has a fragmented health system, made up of six institutions, including the Ministry of Health (MINSA), which within the framework of Law N°. 30024, Law that creates the National Registry for the Implementation of Electronic Medical Records and the Digital Government Law, develops the National Plan for the Implementation of the Electronic Medical Records Information System - SIHCE e-Qhali for the IPRESS of the First Level of Care 2019-2021, in order to contribute to improving the quality of health care to the users of health services through the aforementioned system; however, during said process, various limitations have arisen that have impeded the advancement of said implementation. In this sense, the present research takes as a case study an IPRESS of North Lima with the objective of diagnosing the situation of the Implementation of the Electronic Medical Records Information System (SIHCE) e-Qhali in the El Progreso Maternal and Child Center, during the period from 2019 to 2020, through the analysis of the preparation, planning, execution, monitoring and control phases considered in the aforementioned implementation plan; as well as the usefulness of said system in the CMI El Progreso. / Trabajo de investigación

Slow adoption of electronic medical records (EMR) by primary care physicians in medical office practices has not facilitated the EMR adoption process. The problem is the slow pace of EMR adoption by primary care physicians in the Atlanta, Georgia area has become a public health concern. Research regarding the lived experiences of these physicians with EMR implementation and utilization may identify reasons for the slow adoption. The purpose of this phenomenological study was to explore the lived experiences of primary care physicians, who practice in the Atlanta area, regarding their perception, successes, barriers, and urgency of adoption of EMR in their healthcare practice. Lewin's change management model of health services served as the framework for the study. Data was collected during face-to-face interviews with 19 primary care physicians at Grady's Ponce de Leon Clinic and Grady's East Point Clinic in Atlanta, Georgia. Participants were physicians or residents and not those in authority to make decisions about the EMR at the two clinics. NVivo 10 and automatic coding was used for data analysis to develop themes from the interviews. The findings revealed that the adoption of EMR has enabled primary care physicians to spend more time with their patients, but the barriers such as a lack of interoperability and lack of training, has fostered a feeling of disinterestedness towards EMR adoption. This study supports positive social change that EMR adoption aids in improving patient safety and outcome.

No description available.

No / Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurse's gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.

The benefits of using electronic medical records (EMRs) have been well documented; however, despite numerous financial benefits and cost reductions being offered by the federal government, some healthcare professionals have been reluctant to implement EMR systems. In fact, prior research provides evidence of failed EMR implementations due to resistance on the part of physicians, nurses, and clinical administrators. In 2010, only 25% of office-based physicians have basic EMR systems and only 10% have fully functional systems. One of the hindrances believed to be responsible for the slow implementation rates of EMR systems is resistance from healthcare professionals not truly convinced that the system could be of substantive use to them. This study used quantitative methods to measure the relationships between six constructs, namely computer self-efficacy (CSE), perceived complexity (PC), attitude toward EMR (ATE), peer pressure (PP), anxiety (AXY), and resistance to use of technology (RES), are predominantly found in the literature with mixed results. Moreover, they may play a significant role in exposing the source of resistance that exists amongst American healthcare professionals when using Electronic Medical Records (EMR) Systems. This study also measured four covariates: age, role in healthcare, years in healthcare, gender, and years of computer use. This study used Structural Equation Modeling (SEM) and an analysis of covariance (ANCOVA) to address the research hypotheses proposed. The survey instrument was based on existing construct measures that have been previously validated in literature, however, not in a single model. Thus, construct validity and reliability was done with the help of subject matter experts (SMEs) using the Delphi method. Moreover, a pilot study of 20 participants was conducted before the full data collection was done, where some minor adjustments to the instrument were made. The analysis consisted of SEM using the R software and programming language. A Web-based survey instrument consisting of 45 items was used to assess the six constructs and demographics data. The data was collected from healthcare professionals across the United States. After data cleaning, 258 responses were found to be viable for further analysis. Resistance to EMR Systems amongst healthcare professionals was examined through the utilization of a quantitative methodology and a cross-sectional research measuring the self-report survey responses of medical professionals. The analysis found that the overall R2 after the SEM was performed, the model had an overall R2 of 0.78, which indicated that 78% variability in RES could be accounted by CSE, PC, ATE, PP, and AXY. The SEM analysis of AXY and RES illustrated a path that was highly significant (β= 0.87, p < .001), while the other constructs impact on RES were not significant. No covariates, besides years of computer use, were found to show any significance differences. This research study has numerous implications for practice and research. The identification of significant predictors of resistance can assist healthcare administrators and EMR system vendors to develop ways to improve the design of the system. This study results also help identify other aspects of EMR system implementation and use that will reduce resistance by healthcare professionals. From a research perspective, the identification of specific attitudinal, demographic, professional, or knowledge-related predictors of reference through the SEM and ANCOVA could provide future researchers with an indication of where to focus additional research attention in order to obtain more precise knowledge about the roots of physician resistance to using EMR systems.

Many of the technological and social systems our society has come to depend on can be classified as complex adaptive systems (CAS). These systems are made of many individual parts that self-organize to respond and adapt to changing outside and inside influences affecting the system and its actors. These CAS can be placed on a spectrum ranging from loosely- to tightly-coupled, depending on the degree of interrelatedness and interdependence between system components. This research has explored how the process of collaboration occurs in both a loosely- and tightly-coupled setting using one exemplar of each system. The loosely-coupled exemplar related to disaster risk reduction in two Canadian communities while the tightly-coupled one involved the implementation of a surgical information management system in a Canadian hospital. A list of core elements of collaboration that should be considered essential to the success of all collaborative endeavours was developed as a result: Engagement, Communication, Leadership, Role Clarity, Awareness, Time, and Technical Skills and Knowledge. Based on observing how the core elements of collaboration interacted with one another within each of these example systems, two models were created to represent their relationships. A list of considerations that collaborative tool designers should consider was also developed and the implications of these considerations were discussed. As businesses and other organizations increasingly incorporate team-based work models, they will come to depend more heavily on technology-based solutions to support collaboration. By incorporating collaborative technologies that properly support the activity of these teams—based on the specific type of complex adaptive system in which their organization exists—organizations can avoid wasting time and resources developing tools that hinder collaboration.

Un requerimiento esencial para las organizaciones de salud es garantizar la privacidad y la óptima distribución de los registros médicos electrónicos (RME) debido a que almacenan toda la información médica sensible de los pacientes. Sin embargo, las organizaciones privadas de salud presentan riesgos y deficiencias en la seguridad e interoperabilidad de los RME afectando la adecuada distribución y autenticación de los registros médicos. Las arquitecturas y soluciones encontradas en la literatura se desarrollan utilizando la tecnología Blockchain; sin embargo, estas no contemplan todas las necesidades requeridas por las organizaciones privadas de salud y no ofrecen al paciente el control completo de toda la información en sus registros médicos. El objetivo de esta investigación es determinar la utilidad e importancia de la tecnología Blockchain en la propuesta de una arquitectura tecnológica para la gestión de los RME en organizaciones privadas de salud. La metodología empleada se basa en el análisis de trabajos y soluciones de diversos autores relacionados con el uso de la tecnología Blockchain para la gestión de los registros médicos en organizaciones de salud. De esta manera, se puede determinar el aporte brindado ante la deficiente gestión y seguridad de los registros médicos, detallar todo el proceso del resultado de la propuesta de una arquitectura tecnológica que use la tecnología Blockchain para garantizar la integridad y confidencialidad de los datos médicos junto con la protección de la privacidad del paciente; y, proponer investigaciones a futuro que complementen la propuesta y su implementación en el sector de salud. / An essential requirement for healthcare organizations is to ensure the privacy and optimal distribution of electronic medical records (EMRs) because they store all sensitive medical information of patients. However, private health organizations present security risks and have deficiencies with the interoperability of EMRs, affecting the proper distribution and authentication of medical records. The architectures and solutions found in the literature are developed using Blockchain technology; however, these do not meet all the needs required by private health organizations and do not offer the patient complete control of all the information in their medical records. The objective of this research is to determine the use and importance of Blockchain technology in the proposal of a technology architecture for the management of EMRs in private health organizations. The methodology used is based on the analysis of works and solutions of various authors related to the application of Blockchain technology for the management of medical records in health organizations. In this way, it is possible to determine the contribution provided to the deficient management and security of medical records, to detail the entire process of the result of the proposal of a technological architecture that uses Blockchain technology to guarantee the integrity and confidentiality of medical data along with protection of patient privacy; and to propose future research that complements the proposal and its implementation in the health sector. / Trabajo de investigación

No description available.