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Patient medical records are a valuable resource that can be used for many purposes including managing and planning for future health needs as well as clinical research. Health databases such as the clinical practice research datalink (CPRD) and many other similar initiatives can provide researchers with a useful data source on which they can test their medical hypotheses. However, this can only be the case when researchers have a good set of hypotheses to test on the data. Conversely, the data may have other equally important areas that remain unexplored. There is a chance that some important signals in the data could be missed. Therefore, further analysis is required to make such hidden areas become more obvious and attainable for future exploration and investigation. Data mining techniques can be effective tools in discovering patterns and signals in large-scale patient data sets. These techniques have been widely applied to different areas in medical domain. Therefore, analysing patient data using such techniques has the potential to explore the data and to provide a better understanding of the information in patient records. However, the heterogeneity and complexity of medical data can be an obstacle in applying data mining techniques. Much of the potential value of this data therefore goes untapped. This thesis describes a novel methodology that reduces the dimensionality of primary care data, to make it more amenable to visualisation, mining and clustering. The methodology involves employing a combination of ontology-based semantic similarity and principal component analysis (PCA) to map the data into an appropriate and informative low dimensional space. The aim of this thesis is to develop a novel methodology that provides a visualisation of patient records. This visualisation provides a systematic method that allows the formulation of new and testable hypotheses which can be fed to researchers to carry out the subsequent phases of research. In a small-scale study based on Salford Integrated Record (SIR) data, I have demonstrated that this mapping provides informative views of patient phenotypes across a population and allows the construction of clusters of patients sharing common diagnosis and treatments. The next phase of the research was to develop this methodology and explore its application using larger patient cohorts. This data contains more precise relationships between features than small-scale data. It also leads to the understanding of distinct population patterns and extracting common features. For such reasons, I applied the mapping methodology to patient records from the CPRD database. The study data set consisted of anonymised patient records for a population of 2.7 million patients. The work done in this analysis shows that methodology scales as O(n) in ways that did not require large computing resources. The low dimensional visualisation of high dimensional patient data allowed the identification of different subpopulations of patients across the study data set, where each subpopulation consisted of patients sharing similar characteristics such as age, gender and certain types of diseases. A key finding of this research is the wealth of data that can be produced. In the first use case of looking at the stratification of patients with falls, the methodology gave important hypotheses; however, this work has barely scratched the surface of how this mapping could be used. It opens up the possibility of applying a wide range of data mining strategies that have not yet been explored. What the thesis has shown is one strategy that works, but there could be many more. Furthermore, there is no aspect of the implementation of this methodology that restricts it to medical data. The same methodology could equally be applied to the analysis and visualisation of many other sources of data that are described using terms from taxonomies or ontologies.

Introduction and background: The use of Electronic Health Records (EHRs) sometimes referred to as Electronic Patient Care Records (ePCRs) amongst health and social care providers is increasing.  Many countries are anticipating the benefits of maintaining patients’ records in one place to facilitate real time access by clinicians and other health and social care providers at the point of need; thereby saving resources, seeking to work more efficiently and indeed taking advantage of the rapid advancement in technology to enhance communication.   Objectives:  Investigate challenges facing implementation of England’s EHRs programme by reviewing two design research approaches. Link the findings to possible barriers to augmenting the scope of the use of EHRs in the pre-hospital care at the Ambulance Service under study.   Approach and Methodology:  Literature review on design approaches to rolling out EHRs systems of 4 countries. Followed by an examination available information on England’s EHRs implementation programme whilst considering the findings to draw out any similarities and differences with each of the countries examined. Follow-on enquiry through interviews whose results help draw relationships between success and design/implementation methodologies. In this systematic review, several article sources are used, including ERIC, IEEE Xplore, ACM Digital Library, Google Scholar and Springer Link. Examples of cases are selected after reading titles and abstracts to decide whether the articles are peer reviewed, and relevant to the subject of enquiry. In addition, for articles to be selected they have had to meet the following criteria, a) written in English, b) full text is available online, c) had to have had primary empirical data, and d) focused on EHR implementation programmes.  Iinterviews are carried out to gather first hand data for review, analysis and evaluation, to inductively make an end point explanation of patterns in EHRs implementation programmes.   Findings:  Of the examples of EHRs systems across Europe and North America reviewed, independent and dependent variables closest to the research questions and hypotheses are identified, narrowing them down to design and implementation approaches to make probable causal link to implementation of EHRs system in England in general and the Ambulance Service in particular.   Conclusion: A connection with England’s EHRs implementation programme is made as the study alludes success to user driven bespoke solution as opposed to technology engineered systems. The study concludes that the design approach adopted by a country plays a significant role in gaining ‘buy-in’ when implementing EHRs systems. Subsequently recommendations are made to explore participatory design as a key promoter to ensure uptake of EHRs systems across main stakeholder groups whilst making a specific case for augmenting the scope of using ePCRs at  the Ambulance Service provider in England. Furthermore, the conclusions deduce direct correlation to rollout progress and appetite for using EHRs in healthcare generally and could in theory influence behavior and attitudes that could foster acceptance and improve chances of successful implementation of ePCRs programme in England in general and the Ambulance Service under study.        Keywords: Electronic Health Records (EHRs), Electronic Patient Care Records (ePCRs), Design Approach, Ambulance Service (Pre-Hospital Care), Design Approach

eHealth Strategies in countries have shown a trend that countries are moving to Electronic Health Records(EHR). EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. The use of some format of an Electronic Health Record is used by many countries and others are in the implementation or planning phases. South Africa has kicked of the project to implement a national EHR as part of the national eHealth Strategy. This study aims to analyse the key success factors from other EHR implementation projects and evaluate if South Africa is ready to implement an EHR.

Changes to the technological landscape of the National Health Service (NHS) in the UK have often raised debates on information privacy and patient confidentiality. This has been especially pertinent in the context of HIV health services, where patient records have been historically segregated from hospital notes to protect confidentiality and account for the nature of the condition as a stigmatised terminal illness. However, as current anti-retroviral treatment extends life expectancy, HIV is increasingly managed in ways similar to other chronic conditions and integrated patient management has been proposed as best practice. This shift offers a unique opportunity to study reconfigurations of privacy and confidentiality practices from the perspective of data users. This thesis focuses on a technological integration project between the stand-alone systems used in two HIV specialist outpatient centres and the centralised Electronic Patient Records (EPR) of their respective NHS Hospital Trusts. The case study methodology draws on 46 semi-structured interviews with health and IT professionals, supplemented by an analysis of organisational documents and observation of work practices over a period of six months in the two clinics. In weaving together different theoretical concepts, this thesis contributes to an in-depth, empirically informed understanding of privacy and confidentiality practices in healthcare. Firstly, by looking at how HIV practitioners cultivate their professional identities at the intersection of general medical and HIV-specific confidentiality, this thesis argues that identity work is an important component in the reconfiguration of privacy practices. Secondly, this research draws attention to the role of political negotiations for privacy change, as HIV professionals and EPR developers came in conflict over the ethics of the technological integration project in the hospitals studied here. Thirdly, this thesis illustrates how confidentiality practices are shaped within the co-construction of information infrastructures and medical work, especially in relation to HIV normalisation. A number of implications for practice and policy also emerge from this study.

The concentration on healthcare information technology has never been determined than it is today. This awareness arises from the efforts to accomplish the extreme utilization of Electronic Health Record (EHR). Due to the greater mobility of the population, EHR will be constructed and continuously updated from the contribution of one or many EPRs that are created and stored at different healthcare locations such as acute Hospitals, community services, Mental Health and Social Services. The challenge is to provide healthcare professionals, remotely among heterogeneous interoperable systems, with a complete view of the selective relevant and vital EPRs fragments of each patient during their care. Obtaining extensive EPRs at the point of delivery, together with ability to search for and view vital, valuable, accurate and relevant EPRs fragments can be still challenging. It is needed to reduce redundancy, enhance the quality of medical decision making, decrease the time needed to navigate through very high number of EPRs, which consequently promote the workflow and ease the extra work needed by clinicians. These demands was evaluated through introducing a system model named SVSEPRS (Searching and Viewing Segments of Electronic Patient Records Service) to enable healthcare providers supply high quality and more efficient services, redundant clinical diagnostic tests. Also inappropriate medical decision making process should be avoided via allowing all patients‟ previous clinical tests and healthcare information to be shared between various healthcare organizations. Multidimensional data model, which lie at the core of On-Line Analytical Processing (OLAP) systems can handle the duplication of healthcare services. This is done by allowing quick search and access to vital and relevant fragments from scattered EPRs to view more comprehensive picture and promote advances in the diagnosis and treatment of illnesses. SVSEPRS is a web based system model that helps participant to search for and view virtual EPR segments, using an endowed and well structured Centralised Multidimensional Search Mapping (CMDSM). This defines different quantitative values (measures), and descriptive categories (dimensions) allows clinicians to slice and dice or drill down to more detailed levels or roll up to higher levels to meet clinicians required fragment.

eHealth Strategies in countries have shown a trend that countries are moving to Electronic Health Records(EHR). EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. The use of some format of an Electronic Health Record is used by many countries and others are in the implementation or planning phases. South Africa has kicked of the project to implement a national EHR as part of the national eHealth Strategy. This study aims to analyse the key success factors from other EHR implementation projects and evaluate if South Africa is ready to implement an EHR.

Documentation in electronic journals is perceived as time consuming and sometimes technically difficult to handle, but also leads to an improved quality of care. Objective: The purpose of this study was to investigate nurses' perceptions of documentation with a focus on timing, technique and quality of care and whether any differences in these perceptions were dependent on age. Method: Quantitative descriptive cross-sectional study in the survey form, 28 nurses at a university hospital in central Sweden participated in the study. Regression analysis was performed with Spearman's rank correlation coefficient. Results: Electronic documentation takes 30 to 60 minutes for most nurses and half of them considered it a reasonable time. Computer skills were good enough for most, but the computers and the electronic patient record system Cosmic were experienced to work less well or badly in half the study group. Two-thirds of the studygroup agreed partly or more to that the quality of care is adversely affected because of the time documentation takes from the patient care. However, about half of the study group agreed that electronic patient records increase health care quality and patient safety. Care plans were used to a great extent. Young nurses rated themselves significantly better than the older ones to handle a computer in their daily work. Conclusion: A variety of problems and perceptions exist in connection with electronic documentation. Continuous development of technology, documentation systems and the use of care plans can contribute to the continuing high quality of care and patient safety. / Dokumentation i elektronisk journal uppfattas som tidskrävande och ibland tekniskt svår att hantera, men leder även till en ökad vårdkvalitet. Syfte: Studiens syfte var att undersöka sjuksköterskors uppfattningar av dokumentering med fokus på tidsåtgång, teknik och vårdkvalitet samt om eventuella skillnader i dessa uppfattningar fanns beroende på ålder. Metod: Kvantitativ deskriptiv tvärsnittsstudie i enkätform, 28 sjuksköterskor vid ett universitetssjukhus i Mellansverige deltog i studien. Sambandsanalys utfördes med Spearmans rangkorrelationskoefficient. Resultat: Elektronisk dokumentation tar 30 till 60 minuter för de flesta sjuksköterskorna och hälften ansåg att detta var en rimlig tid. Datorvanan var tillräckligt god hos de flesta, men datorerna och dokumentationssystemet Cosmic upplevdes fungera mindre bra eller dåligt hos hälften av undersökningsgruppen. Två tredjedelar instämde delvis eller mer i att vårdkvalitén påverkas negativt på grund av den tid dokumentation tar från patientvården. Ungefär hälften instämde i att elektronisk dokumentation bidrar till en ökad vårdkvalité samt patientsäkerhet. Vårdplaner används i hög utsträckning. Yngre sjuksköterskor skattade sig signifikant bättre än äldre på att hantera en dator i det dagliga arbetet. Slutsats: Flera olika problem och uppfattningar föreligger i samband med elektronisk dokumentation. Kontinuerlig utveckling av tekniken, dokumentationssystemen och användandet av vårdplaner kan bidra till en fortsatt hög vårdkvalitet samt patientsäkerhet.

Today, technologies are being introduced into historically established settings, which change the conditions for work as well as for work-integrated learning. In health care, electronic patient records (EPRs) has been implemented during the last decades to serve as a tool for planning, decision making and evaluation of care work. The overall aim of the research presented in this thesis is to analyse the complex actions and interactions that occur when EPRs are used in health care practice. Analytically, such an interest is pursued employing a socio-cultural perspective on workplace studies, where the use of technology is studied in action. Through three separate studies, practical actions and practical use of EPRs have been examined and the empirical data draws on observations, video-recordings, audio-recordings and documents from a hospital ward in Sweden. The result shows that technologies such as EPRs both offer and presuppose standardization of terminologies and information structures. This, however, does not mean that EPRs completely format and structure information, or that it is driven by its own logic. When staffs comply with a set of standards, transformations of those standards will gradually occur. Those transformations are collective achievements and since each professional involved act in a conscious and active manner, this affects the use of standards as well as the development of collective proficiency. The results also demonstrate that meaning making in(through) the use of EPRs presupposes extensive knowledge of the indexicality of categories, something that originates in the participants‘ shared institutional history. It is in the process of reliving, creating and exposing the meaning of information, that health care professionals actually bring information in EPRs to life. In further development of EPRs that exceeds institutional and even national boundaries it is important to see this development not as solely technical or organizational questions. To develop systems that enhance the possibilities for professionals in different institutions with different professional domains to make sense of standardized information may be a much more  demanding task than it seems to be. Such boundary-crossing systems are nevertheless of great importance for the further development of health care practice.

Yes / Background: Secondary use of data via integrated health information technology is fundamental to many healthcare policies and processes worldwide. However, repurposing data can be problematic and little research has been undertaken into the everyday practicalities of inter-system data sharing that helps explain why this is so, especially within (as opposed to between) organisations. In response, this article reports one of the most detailed empirical examinations undertaken to date of the work involved in repurposing healthcare data for National Clinical Audits. Methods: Fifty-four semi-structured, qualitative interviews were carried out with staff in five English National Health Service hospitals about their audit work, including 20 staff involved substantively with audit data collection. In addition, ethnographic observations took place on wards, in ‘back offices’ and meetings (102 hours). Findings were analysed thematically and synthesised in narratives. Results: Although data were available within hospital applications for secondary use in some audit fields, which could, in theory, have been auto-populated, in practice staff regularly negotiated multiple, unintegrated systems to generate audit records. This work was complex and skilful, and involved cross-checking and double data entry, often using paper forms, to assure data quality and inform quality improvements. Conclusions: If technology is to facilitate the secondary use of healthcare data, the skilled but largely hidden labour of those who collect and recontextualise those data must be recognised. Their detailed understandings of what it takes to produce high quality data in specific contexts should inform the further development of integrated systems within organisations.