This degree project deals with electronic health record (EHR). The report is divided into two main sections; literature study on electronic health record and an EHR system implementation. In the literature study section, EHR background, development history and service condition are introduced. The paper focuses on the sharing of medical information in different users, data safety and privacy. The adjunctions of computer science, technologies are used to solve the medical informatics’ problems. In the implementation section, based on the study of the current EHR systems, the design and implement of a shared EHR system are presented, which can be accessed by different doctors and patients. Access control function and cryptography protections are included in this system. The system test and evaluation are also given.

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This paper argues that given the proliferation of electronic health records (EHRs) in the health care system, legislative reform must occur to address the inadequacies of Ontario’s current health privacy legislation in accommodating EHRs. A coherent framework for legislation is necessary to capture the important role that privacy plays in public perception when it comes to legislating and managing EHRs in Ontario and, in turn, serve as a tool for legislators to understand the definitions and values of privacy associated with EHRs and the privacy problems worthy of protection in an electronic health environment. The failure to properly address these problems may lead to privacy losses and loss of public confidence in EHR systems. In applying this framework to three legislative options, it is evident that Ontario should amend the Personal Health Information Protection Act, 2004 to better contemplate the privacy protections necessary in an electronic health environment.

This paper argues that given the proliferation of electronic health records (EHRs) in the health care system, legislative reform must occur to address the inadequacies of Ontario’s current health privacy legislation in accommodating EHRs. A coherent framework for legislation is necessary to capture the important role that privacy plays in public perception when it comes to legislating and managing EHRs in Ontario and, in turn, serve as a tool for legislators to understand the definitions and values of privacy associated with EHRs and the privacy problems worthy of protection in an electronic health environment. The failure to properly address these problems may lead to privacy losses and loss of public confidence in EHR systems. In applying this framework to three legislative options, it is evident that Ontario should amend the Personal Health Information Protection Act, 2004 to better contemplate the privacy protections necessary in an electronic health environment.

As Canada continues its drive towards a national electronic health record the costs are mounting. With 256 projects underway the question has to be asked: what are the true costs of such an endeavor? Success hinges on cooperation at all levels and adequate funding in place to see it to completion. Has Canada taken into full consideration the impact that this project will have in the long run? One small part of a much larger project in rural Alberta puts a face on the huge undertaking. Nurses in one former health region adopted not only an Order Entry module but also began using computers for the first time in order to do their work. Nurses are one of the key end-user groups actually inputting the information into these systems. Is data entry something nurses need to be concerned with at all especially at the Order Entry level?

The purpose of this research was to explore nurses' perceptions of the effectiveness of nursing documentation of patient status during a clinical event when using electronic documentation with or without embedded standardized languages. The theoretical framework for this study was based on principles of information theory. This study was significant in two very important ways; first, in contrast to prior studies, the perceptions of nurses were focused on the documentation of a clinical event. Second, this study explored the nurses' opinions about the strengths and limitations of using structured languages (specifically, the North American Nursing Diagnosis Association (NANDA), the Nursing Intervention Classification (NIC), and the Nursing Outcomes Classification (NOC)) for telling the patient's story during a clinical event, as well as collecting nurses' suggestions for improving electronic documentation. Semi-structured interviews of 37 nurses were conducted in two acute care hospitals. Both hospitals used electronic documentation, but only one used embedded standardized nursing languages. Half the interviewees were asked questions from the perspective of the nurse documenting a clinical event; half were asked questions from the perspective of a nurse reviewing another nurse's documentation of a clinical event. Recorded interviews were transcribed, and the transcripts analyzed using qualitative content analysis. A panel of judges was used to establish reliability of the coding scheme. The results showed that nurses perceived aspects of three categories (usability, legibility, and communication) as strengths of the documentation system. Nurses perceived aspects of three categories (usability, communication, and workarounds) as limitations of the documentation system. Potential solutions to improve the documentation system were defined related to three categories (usability, communication, and collaboration). Usability was perceived by the nurses as a strength of the electronic documentation with embedded nursing languages. Usability of the electronic documentation system with nursing languages was also perceived as a limitation. Improving language usability was identified as a potential solution to improve the electronic documentation system with embedded nursing languages.

Yes / Purpose: The purpose of this paper is to investigate the potential of using primary care optometry data to support ophthalmic public health, research and policy making. Methods: Suppliers of optometric electronic patient record systems (EPRs) were interviewed to gather information about the data present in commercial software programmes and the feasibility of data extraction. Researchers were presented with a list of metrics that might be included in an optometric practice dataset via a survey circulated by email to 102 researchers known to have an interest in eye health. Respondents rated the importance of each metric for research. A further survey presented the list of metrics to 2000 randomly selected members of the College of Optometrists. The optometrists were asked to specify how likely they were to enter information about each metric in a routine sight test consultation. They were also asked if data were entered as free text, menus or a combination of these. Results: Current EPRs allowed the input of data relating to the metrics of interest. Most data entry was free text. There was a good match between high priority metrics for research and those commonly recorded in optometric practice. Conclusions: Although there were plenty of electronic data in optometric practice, this was highly variable and often not in an easily analysed format. To facilitate analysis of the evidence for public health purposes a UK based minimum dataset containing standardised clinical information is recommended. Further research would be required to develop suitable coding for the individual metrics included. The dataset would need to capture information from all sectors of the population to ensure effective planning of any future interventions.

Electronic Health Record (EHR) systems could make healthcare delivery safer by providing benefits such as timely access to accurate and complete patient information, advances in diagnosis and coordination of care, and enhancements for monitoring patient vitals. This study explored the nature of EHR adoption in U.S. hospitals and their patient safety performance in relation to one hospital acquired condition: postoperative sepsis – a condition that complicates hospitalizations, increases lengths of stay, and leads to higher mortality rates. Administrative data from several sources were utilized in order to obtain comprehensive information about the patient, organizational, and market characteristics of hospitals, their EHR adoption patterns, and the occurrence of postoperative sepsis among their patients. The study sample consisted of 404 general, short-term, acute care, non-federal, and urban hospitals based in six states, which provided longitudinal data from 2005 to 2009. Hospital EHR and the EHR’s sophistication level were measured by the presence of eight clinical applications. Econometric techniques were used to test six hypotheses that were derived from macro-organizational theories and frameworks. After controlling for potential confounders, the study’s key findings suggested that hospitals had a significant increase in the probability of having EHR as the percent of other hospitals having the most sophisticated EHR (i.e., EHRS3) in the market increased. Conversely, hospitals had a significant decrease in the probability of having EHR when the percent of Medicaid patients increased within a hospital or when the hospital belonged to centralized or moderately centralized systems. Also, the study findings suggested that EHR was associated with a higher rate of postoperative sepsis. Specifically, the intermediate EHR sophistication level (i.e., EHRS2) and the most sophisticated EHR level (i.e., EHRS3) were associated with a significantly higher rate of postoperative sepsis when compared to hospitals that did not have such EHR sophistication. The study results, however, did not support the hypotheses that higher degrees of fit between hospitals’ EHR sophistication level and specific structural dimensions were associated with greater reductions in postoperative sepsis outcomes vis-à-vis hospitals that did not have these types of fit.

Η παρούσα διπλωματική εργασία πραγματοποιήθηκε υπό την επίβλεψη του καθηγητή Νικολάου Παλληκαράκη, Διευθυντή του Μεταπτυχιακού προγράμματος στη Βιοιατρική Τεχνολογία του πανεπιστημίου Πατρών και ΕΜΠ. Ασχολείται με την ανάπτυξη πρότυπων μοντέλων αναφοράς, αναπαράστασης γνωστικής πληροφορίας και επίσης αναφέρονται διάφοροι σχεδιαστικοί περιορισμοί και προδιαγραφές για τον χώρο της υγείας και συγκεκριμένα για τον ηλεκτρονικό ιατρικό φάκελο. Τι εννοούμε με την έννοια ηλεκτρονικός ιατρικός φάκελος; Πρόκειται για μια δομημένη συλλογή ηλεκτρονικών δεδομένων που αφορούν μια περιοχή της υγείας και παρέχεται με σκοπό τη συνεχή, αποτελεσματική και ποιοτική παροχή φροντίδας. Η υπάρχουσα κατάσταση στο τομέα της ιατρικής πληροφορικής, εξαιτίας του μεγάλου πλήθους των προτύπων που αναπτύσσονται από διάφορους οργανισμούς, σε εθνικό αλλά και παγκόσμιο επίπεδο, καθιστά αδύνατη την εφαρμογή ενός κοινά αποδεκτού προτύπου. Στα πλαίσια της εργασίας αυτής παρουσιάζονται αρχικά τα βασικά μέρη του ηλεκτρονικού ιατρικού φακέλου όπως κυκλοφορούν τα διάφορα μοντέλα στο εμπόριο, έπειτα γίνεται μια σύντομη ιστορική αναδρομή και κατόπιν παρουσιάζονται λεπτομερώς τα διάφορα μοντέλα για τρεις μεγάλους, παγκόσμιους οργανισμούς και συγκεκριμένα για τους: CEN, ISO και HL7. Συγκεντρωτικά τα αποτελέσματα για το κάθε μοντέλο περιγράφονται στα κεφάλαια 4, 5 και 6. Η συλλογή των δεδομένων έγινε μετά από την εξέταση διαφόρων εργασιών και την πλοήγηση σε διαφορετικές ιστιοσελίδες στο διαδίκτυο, τα αποτελέσματα τα οποία αναφέρονται στην τελική τους μορφή στο τμήμα της αναφοράς. Στο τέλος της διπλωματικής εργασίας γίνεται λόγος για τη διαλειτουργικότητα και την εναρμόνιση των προτύπων δυο έννοιες που πρόκειται να αποτελέσουν οδηγό για την εφαρμογή ενός κοινά αποδεκτού προτύπου σε κάποια χρονική στιγμή στο σύντομο μέλλον. / Reference information model for the organizations cen/tc251, iso/tc215, hl7, what why mean with the object electronic health record

Information technology [IT] that enables electronic access to patient health records has been widely recognized as a promising means to improve the quality of care for patients with chronic diseases, and reduce health care costs through better health information delivery and encouragement of self-management. IT applied to assist chronic disease management is inadequately studied in Canadian health care settings. This thesis describes the development and modest pilot implementation of an electronic tool, the Diabetes Complication Surveillance System [DCSS]. The DCSS was conceived as a self-monitoring tool that facilitates regular checks on conditions of diabetes patients, including acute and long-term complications. The DCSS is relatively unusual, as it facilitates glycemic control and also allows patients to address the long-term complications of diabetes. The development of the DCSS involved literature reviews and consultations with clinician experts. Questionnaire results from the pilot provided positive feedback.