Electronic medical records, in addition contributing to a hospital¡¦s overall electronic development and moving towards a paperless environment, also allow hospitals to share electronic medical information. To solve the problem of different medical information systems that hamper information sharing, the Executive Yuan Heath Department Commission has requested the assistance of the Taiwan Association for Medical Information to establish a standard Electronic Medical Record Template, in hopes that there is a national unified Electronic Medical Record Template that also uses the international medical information standard, so that all hospital¡¦s information is accessible, allowing for easy sharing of electronic medical records. The administration department also supports in recommending and creating related steps of incentive, to encourage professional electronic medical record researchers making up a standard internet medical information exchange mechanism, with a goal of achieving national medical information exchange. Though the Executive Yuan Heath Department Commission had a nice scheme, but the standard Electronic Medical Record Template established by Taiwan Association for Medical Information is nothing more than a Form Structure Diagram what is far from the software architecture discipline. This research aims to re-define the electronic medical record system, adopting a software architecture modeling approach. Through Structure Element Diagram, Structure Element Service Diagram, Structure Behavior Coalescence Diagram, and Sequence Diagram as four gold rules, we are able to build up any electronic medical record system architecture. Besides providing medical information personnel a more definite electronic medical record system, this research aids hospitals quickly attain an effective electronic medical record system.

Full service family physicians in British Columbia (BC) are claiming financial incentives in return for providing enhanced care for patients with chronic diseases. These same physicians are also being actively encouraged to adopt electronic medical record systems (EMRs) with an expectation that their adoption will, among other things, aid in improved chronic disease management (CDM). Indeed, both incentives and clinical information systems have been demonstrated in the literature to be crucial components in effective CDM programs. However, within BC little evidence is available that demonstrates whether EMR adoption is in fact associated with improved provision of CDM services. Furthermore, it is not well understood how the CDM incentive program affects a family practice’s adoption of CDM-related EMR functionality. Through a mixed methods study the relationship between EMR adoption and CDM incentives in a small family practice is explored. Additionally, an audit and feedback intervention is used to test the hypothesis that both incentive use and EMR adoption can simultaneously be improved. Results of the study suggest that the presence of an EMR may not guarantee improvements in delivery of incentivized CDM services; that the incentive program has limits in its ability to promote adoption of CDM-related EMR features; and, that a program of audit and feedback may promote improvements in aspects of EMR adoption and incentive utilization. / Graduate / 0723 / 0769

Modern health care systems are information dense and increasingly relying on computer-based information systems. Regrettably, many of these information systems behave only as an information repository, and the interoperability between different systems remains a challenge even with decades of investment in health information exchange standards. Medical records are complex data models and developing medical data import / export functions a is difficult, prone to error and hard to maintain process. Bidirectional transformations (bx) theories have been developed within the last decade in the fields of software engineering, programming languages and databases as a mechanism for relating different data models and keeping them consistent with each other. Current bx theories and tools have been applied to hand-picked, small-size problems outside of the health care sector. However, we believe that medical record exchange is a promising industrial application case for applying bx theories and may resolve some of the interoperability challenges in this domain. We introduce BXE2E, a proof-of-concept framework which frames the medical record interoperability challenge as a bx problem and provides a real world application of bx theories. During our experiments, BXE2E was able to reliably import / export medical records correctly and with reasonable performance. By applying bx theories to the medical document exchange problem, we are able to demonstrate a method of reducing the difficulty of creating and maintaining such a system as well as reducing the number of errors that may result. The fundamental BXE2E design allows it to be easily integrated to other data systems that could benefit from bx theories. / Graduate / 0984

Ο Ηλεκτρονικός Φάκελος Υγείας πρόκειται για μια δομημένη συλλογή ηλεκτρονικών δεδομένων που αφορούν μια περιοχή της υγείας που παρέχεται με σκοπό τη συνεχή, αποτελεσματική και ποιοτική παροχή φροντίδας. Η ανάπτυξη της τεχνογνωσίας στα νοσηλευτικά ιδρύματα της χώρας σχετικά με τους ηλεκτρονικούς φακέλους υγείας είναι ραγδαία. Δυστυχώς στην χώρα μας η ανάπτυξη είναι μικρότερη από ότι στην υπόλοιπη Ευρωπαϊκή Ένωση. Παρόλα αυτά η χρήση προγραμμάτων για την ηλεκτρονική καταχώρηση και διαχείριση ασθενών είναι ένα φαινόμενο που εξαπλώνεται. Η διπλωματική εργασία που ακολουθεί είναι μια ανασκόπηση της πορείας των Ηλεκτρονικών Φακέλων Υγείας. Στα κεφάλαια που ακολουθούν αναλύονται τα εξής θέματα: Στο 1ο κεφάλαιο αναλύεται αρχικά η έννοια του συμβατικού φακέλου υγείας και έπειτα η έννοια του ηλεκτρονικού φακέλου υγείας και δίνεται εξήγηση σε όρους όπως Ηλεκτρονική Υγεία και Ηλεκτρονική Κάρτα Υγείας. Τέλος γίνεται αναφορά στα στάδια εξέλιξης των Ηλεκτρονικών Φακέλων Υγείας. Στο 2ο κεφάλαιο γίνεται ιστορική αναδρομή του Φακέλου Υγείας και του Ηλεκτρονικού Φακέλου Υγείας. Επισημαίνονται τα μειονεκτήματα και τα πλεονεκτήματα του. Στο 3ο κεφάλαιο γίνεται αναφορά στην ασφάλεια και νομοθετική προστασία του ηλεκτρονικού φακέλου υγείας. Διακρίνονται οι στόχοι που πρέπει να επιτευχθούν για έναν ασφαλή ΗΦΥ, εκτιμούνται οι κίνδυνοι στην ανταλλαγή των δεδομένων. Τέλος αναφέρονται τα συμπεράσματα των χρηστών μετά από τη χρήση των ΗΦΥ. Στο 4ο κεφάλαιο γίνεται αναφορά στα πρότυπα και την κωδικοποίηση της πληροφορίας, όπως επίσης και ο σκοπός των προτύπων. Στο 5ο κεφάλαιο γίνεται η παρουσίαση προγραμμάτων Ηλεκτρονικών Φακέλων Υγείας στην Ελλάδα και στην Ευρωπαϊκή Ένωση. Στο 6ο κεφάλαιο αναγράφονται τα συμπεράσματα από την χρήση των ΗΦΥ, μια γρήγορη ανασκόπηση της εκπαίδευσης που γίνεται στους επαγγελματίες υγείας στην χώρα μας και τέλος η περιγραφή της Ιστοσελίδας που πραγματοποιήθηκε έχοντας ως στόχο την ενημέρωση των επαγγελματιών υγείας με θέματα που σχετίζονται με τον ΗΦΥ. / The electronic medical record is structured electronic data of health. Data provided in order to offer constant, effective care and quality in health. The development of technology and know-how about the EMR in the hospitals is rapid. Unfortunately in Greece the development seems to follow a slower rhythm than in the rest European union. Nonetheless, the use of programs of electronic records and patient management is a phenomenon rapidly spread. This diplomatic essay is a review of the course of EMR. The chapters will analyze the following issues: Chapter 1st : Analysis of the conventional medical record and the meaning of the EMR, terms such as Electronic Health and Electronic Health Card are being clarified. Finally, there is the report of the stages of the Medical Electronic Record. Chapter 2nd : A quick reference of the retrospection of the conventional medical record and it’s evolution to an electronic medical record. The advantages and the disadvantages of the EMR are pointed out. Chapter 3rd : A reference of security and legislative protection of the EMR. The goals that need to be achieved for a safe and secure EMR are brought to prominence and the assessment of the potential risk. Lastly, the conclusions of the users of EMR are being presented. Chapter 4th : A reference of EMR standards and the classification of the electronic information. Furthermore the purpose of the standards is being elaborated. Chapter 5th : A presentation of the programs of EMR currently in use in Greece and the rest European Union. Chapter 6th : Conclusions of the use of EMR a review of the education to the medical personnel concerning the EMR in Greece and and also the description of a website that had been created for the briefing of the medical personnel as far as it concerns medical electronic records

Η παρούσα εργασία αποτελεί μια εισαγωγή στο ηλεκτρονικό φάκελο υγείας και την εφαρμογή του στα νοσηλευτικά ιδρύματα της χώρας με εκτενέστερη αναφορά στους επαγγελματίες υγείας που συνδέονται άμεσα με την εφαρμογή και τα αποτελέσματα του στις Μονάδες Υγείας και με ειδικότερη μνεία στο ρόλο του νοσηλευτή. Tο πρώτο κεφάλαιο περιλαμβάνει την εισαγωγή του ηλεκτρονικού φακέλου υγείας με τον ορισμό του και την ιστορική του αναδρομή σε γενικές γραμμές αλλά και με ειδικότερη αναφορά στην Ελλάδα. Στο δευτερο κεφάλαιο παρουσιάζεται εκτενέστερα η έννοια και η δομή του ηλεκτρονικού φακέλου υγείας με τα πλεονεκτήματα και τα μειονεκτηματά του. Επίσης γίνεται μια απλή αναφορά στα πρότυπα τυποποίησης του ηλεκτρονικού φακέλου υγείας, στα ολοκληρομένα πληροφοριακά συστήματα υγείας,στη διοίκηση της υγειονομικής περιφέρειας (πρώην ΔΥΠΕ ), στα επίπεδα της πληροφοριακής οργάνωσης στα νοσοκομεία με εκτενέστερη περιγραφή του συστήματος καθώς και με εκτενέστερη περιγραφή του συστήματος των ραντεβού. Τέλος έχουμε μια αναφορά στο διεθνές σύστημα κατηγοροποίησης των ασθενειών (ICD), στην ηλεκτρονική υγεία (e-health ) και στα εμπόδια της ανάπτυξης του ηλεκτρονικού φακέλου υγείας. Στο τρίτο κεφάλαιο παρουσιάζεται ο ορισμός της έξυπνης κάρτας υγείας και οι προτάσεις για την εφαρμογή της. Το τέταρτο κεφάλαιο αναφέρεται στη νομοθετική προστασία των ευαίσθητων προσωπικών δεδομένων με ειδική αναφορά στο ιατρικό και νοσηλευτικό προσωπικό. Στο πέμπτο κεφάλαιο έχουμε την εφαρμογή του ηλεκτρονικού φακέλου υγείας στην ελληνική πραγματικότητα από τους επαγγελματίες υγείας (ιατρονοσηλευτικό προσωπικό, διοικητικό και εργαστηριακό προσωπικό, στατιστικολόγους και ερευνητές). Στο έκτο κεφάλαιο παρουσιάζεται η ειδική μνεία στο νοσηλευτικό προσωπικό και στη χρήση του ηλεκτρονικού φακέλου υγείας από τους νοσηλευτές. Το έβδομο κεφάλαιο είναι μια σύντομη αναφορά στον ηλεκρονικό φάκελο υγείας, στην κωδικοποίηση της πληροφορίας καθώς και στον ενοποιημένο ηλεκτρονικό ιατρικό φάκελο υγείας που εφαρμόζεται στο Γενικό Νοσοκομείο Παπαγεωργίου και στο Κ. Υ. Ιτέας. Το όγδοο κεφάλαιο αποτελείται από το παράδειγμα εφαρμογής του Ιατρικού φακέλου υγείας στο Γενικό Νομαρχιακό Νοσοκομείο Αμαλιάδος. Το ένατο κεφάλαιο αποτελείται από το παράδειγμα εφαρμογής του Ιατρικού φακέλου υγείας στην Ορθοπαιδική κλινική του Πανεπιστημιακού Νοσοκομείου Πατρών. Οι εξελίξεις και τα συμπεράσματα που αφορούν τον ηλεκτρονικό φάκελο υγείας αποτελούν το δέκατο κεφάλαιο και τον επίλογο της παρούσης εργασίας. / The current diplomatic dissertation is an introduction to Electronic Medical Records and its apply to the medical institutes of Greece, a comprehensive description is being made for the medical personnel which is directly associated with its apply to Health Units and with specific mention to the role of nurse. The first chapter consist an introduction to the Electronic medical records, the definition and the retrospect in the rest world and more specific in Greece. In the second chapter, it is widely presented the concept and the structure of the EMR with its advantages and disadvantages. Also there is a reference to the standards of formulism of the EMR, to the aggregate informational health systems, to the health administration, to the levels of the informational system in the hospitals, a widely description of the appointment system is being made. Finally, references for the international classification of disease, electronic health and the obstacles in development of the EMR. In the third chapter the definition of the smart health card and the proposals of its apply are being presented. The fourth chapter refers to the legal protection of the private data and especially how the medical personnel is being involved. The fifth chapter included the apply of the EMR in Greece, by the medical personnel (nurse, doctor, laboratories, administration, researchers) The sixth chapter is the presentation of the use of EMR from the nurses in Greece. The seventh chapter is a quick reference to the EMR, to the classification of the information, as well as in the aggregate EMR that the hospital Papageorgiou in Thessaloniki and the K.Y Iteas use. The eighth chapter consists from the example of the application of EMR in the hospital of Amaliada. The ninth chapter consists from the example of the application of the university hospital of Patra. The development and the conclusions that involve the EMR consist the tenth chapter and the afterword of this diplomatic dissertati

Class of 2013 Abstract / Specific Aims: To examine the relationship between hospital readmission rates and responses to a medication adherence questionnaire (Morisky) in patients with congestive heart failure (CHF). Methods: The Morisky questionnaire, assessing medication adherence, was administered to all CHF patients admitted from September 15, 2012 to March 7, 2013. Information collected from the electronic medical record (EMR) for all patients with complete Morisky questionnaires included: age, sex, ethnicity, insurance, height, weight, marital status, tobacco use, alcohol use, number of home medications, all-cause and CHF admission in the previous 365 days from when the questionnaire was administered as well as the following events/disease states: myocardial infarction, hypertension, atrial fibrillation, stroke, diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease, congestive heart disease and chronic kidney disease. Main Results: Of the 120 patients enrolled, 52% scored 1-5 on the Morisky questionnaire indicating some problem with medication adherence while 48% scored 0 (no problems). There was no correlation between the Morisky score and age (95% CI: -3.3-5.7), number of medications (95% CI: -0.26, 2.85), or number of comorbidities (95% CI: -1.02,0.03). The Morisky questionnaire was not predictive of all cause readmissions (95% CI: 0.35, 2.01) p = 0.691). For CHF readmissions the Morisky score was not significant (95% CI: 0.6, 4.11, p=0.358) but the confidence interval suggests a trend. Conclusion: There is no correlation between Morisky scores, age, comorbidities, and medication number. Readmission rates were not predicted by Morisky scores; with more participants a trend may be detected for CHF readmissions.

The design and development of “e-Vaccination” applications are not extensively researched within developing economies, in part because of the difficulty in gaining access to government officials and medical experts. Vaccination cards have been used to keep track of minors’ immunisation records in South Africa for over 30 years. The South African government is moving towards the use of electronic systems for the storage of such information. South Africa has a clearly defined electronic health strategy, which is to utilise information and communications technologies in healthcare to inter alia, engage in medical research, promote health education, monitoring of diseases and tracking public health. Supporting this strategy means digitising current paper-based systems. The result would be information that can be stored safely, backed up and analysed more easily than paper-based journals, documents and vaccination cards. The purpose of this research is to develop a better understanding of key stakeholders’ perceptions to the replacement of paper-based vaccination cards with an electronic system. This is important because digital records can be considered as a more effective method of storing vaccination data. This study is quantitative in nature and primary data in the form of Likert scale questionnaires were collected from 118 key stakeholders being nurses, doctors, parents and school administration staff. The Likert scale questionnaire data was analysed using the following statistical techniques: Cronbach Alpha Test, Chi-Square Test, Analysis of Variance Test and Principle Component Analysis. The analysis provided a deeper understanding of the key stakeholder’s perceptions to the use of e-Vaccination applications. e-Vaccination applications are affected by user friendliness of the application, the graphical design of the application, practicality of the application, user experience of the application as well as the usability of the application. The practical implications of this research on e-Vaccination applications is that designers, developers, policymakers and government have a deeper understanding of nurses, doctors, parents and school administration staff perceptions to the use of e-Vaccination. / School of Computing

Background: To efficiently capture evaluation and management (E&M) and procedural billing in our surgical intensive care unit (SICU), we have developed an electronic billing system that links to the electronic medical record (EMR). In this system, only notes electronically signed and coded by an attending generate billing charges. We hypothesized that capture of missed billing during nighttime and weekends might be sufficient to subsidize 24/7 in-house attending coverage. Methods: A retrospective chart EMR review was performed of the EMRs for all SICU patients during a 2-month period. Note type, date, time, attending signature, and coding were analyzed. Notes without attending signature, diagnosis, or current procedural terminology (CPT) code were considered incomplete and identified as "missed billing." Results: Four hundred and forty-three patients had 465 admissions generating 2,896 notes. Overall, 76% of notes were signed and coded by an attending and billed. Incomplete (not billed) notes represented an overall missed billing opportunity of $159,138 for the 2-month time period (∼$954,000 annually). Unbilled E&M encounters during weekdays totaled $54,758, whereas unbilled E&M and procedures from weeknights and weekends totaled $88,408 ($44,566 and $43,842, respectively). Missed billing after-hours thus represents ∼$530K annually, extrapolating to ∼$220K in collections from our payer mix. Surprisingly, missed E&M and procedural billing during weekdays totaled $70,730 (∼$425K billing, ∼$170K collections annually), and typically represented patients seen, but transferred from the SICU before attending documentation was completed. Conclusions: Capture of nighttime and weekend ICU collections alone may be insufficient to add faculty or incentivize in-house coverage, but could certainly complement other in-house derived revenues to such ends. In addition, missed daytime billing in busy modern ICUs can be substantial, and use of an EMR to identify missed billing opportunities can help create solutions to recover these revenues.

No description available.

Some hospital leaders lacked strategies for implementing electronic medical record (EMR) systems. The purpose of this case study was to explore successful strategies that hospital leaders used in implementing EMR systems. The target population consisted of hospital leaders who succeeded in implementing EMR systems in a single healthcare organization located in the Los Angeles, California region. The conceptual framework used was Kotter's (1996) eight-step process for leading change, and data were collected from face-to-face recorded interviews with 5 participants and from company documents related to EMR design and development. Data were analyzed through methodological triangulation of data types, and exploring codes exhibiting high frequencies to identify principal themes and subthemes. The data coding revealed three primary themes. The first theme related to strategies addressing training, technology, and catalyzing team effort. The second theme related to strategies focusing on employees' concerns, and the third theme related to strategies for designing, developing, and disseminating workflow. The findings affirmed the conceptual framework of Kotter (1996) inasmuch as they showed that participating hospital leaders used one or more steps in Kotter's eight-stage process of creating, implementing, and sustaining significant change. The findings could effect social change by improving the quality of healthcare services provided to patients, which can subsequently benefit patients' families and communities through reducing the costs of healthcare.