Bakgrund: Omvårdnadsdokumentation är en viktig del av sjuksköterskans arbete. På grund av utvecklingen inom vården, lagar och patienternas olika problem, behövs alltmer dokumenteras, vilket leder till att omvårdnadsdokumentationen förändras ständigt. För att förbättra dokumentationen och dess kvalité är det viktigt att sjuksköterskornas erfarenheter av omvårdnadsdokumentation undersöks. Syfte: Syftet med litteraturstudien var att belysa sjuksköterskors erfarenheter av faktorer på arbetsplatsen som påverkar omvårdnadsdokumentation i slutenvård. Metod: Litteraturstudien baserades på empiriska studier. Databearbetning utfördes enligt en manifest kvalitativ innehållsanalys. Resultat: Databearbetning av tio artiklar resulterade i tre kategorier: Teknik, Kommunikation, och Organisation. Erfarenheterna var delade mellan sjuksköterskor som ansåg att tekniken bakom de elektroniska dokumentationssystemen var positiv och andra som erfor den som negativ. Dessutom var sjuksköterskornas erfarenheter av omvårdnadsdokumentation inom slutenvården som ett kommunikationsverktyg delad mellan de som ansåg att den var lämplig och andra som upplevde den dålig. Även ledningen och deras kontroll över sjuksköterskorna var faktorer på arbetsplatsen som påverkade omvårdnadsdokumentationen. Konklusion: Vårdkedjan bör hållas samman genom en tydlig kommunikation och en stöttande organisation. Vidare forskning bör utreda hur elektronisk omvårdnadsdokumentation kan förenklas och hur patienten upplever delaktigheten i omvårdnadsdokumentationen. / Background: Nursing documentation is an important part of the nurse's work. Because of developments in healthcare, laws and the patients’ varying problems, documentation is increasingly needed, leading to nursing documentation constantly changing. For improving nursing documentation and its’ quality, it is important to explore the nurses' experiences of factors that affect nursing documentation in an inpatient setting. Aim: The aim of the literature study was to explore nurses' experiences regarding factors at the workplace affecting nursing documentation in inpatient setting. Methods: The literature study was based on empirical studies. Data analysis was performed according to a qualitative manifest content analysis. Results: The analysis of ten articles resulted in three categories: Technique, Communication, and Organization. The experiences differed between nurses who considered thetechnology behind the electronic documentation systems as positive and others who experienced it as negative. In addition, the nurses' experiences of nursing documentation in an inpatient setting as a communication tool differed between those who considered it appropriate and others who experienced it poorly. Moreover, nurses’ experiences of nursing documentation were affected by the management and their control over the nurses. Conclusion: The chain of care should be hold together through a clear communication and a supportive organization. Further research should investigate how electronic nursing documentation can be made simpler and how the patients experience participation in nursing documentation.

Magister Commercii - MCom / Information and communication technologies (ICT) have changed the way healthcare processes are being documented. This results in better quality and ethical vigilance to ensure a more accurate form of data recordkeeping (Stevenson, Nilsson, Petersson & Johansson, 2010). Health care in South Africa, is facing major issues relating to patient care, such as delays in patients receiving medical care. According to the national Department of Health, the improvement of public healthcare facilities is crucial (McIntyre & Ataguba, 2017). Information and communication technology (ICT) has the ability to significantly alter the status of healthcare services in the Western Cape, which can be achieved through the role of an electronic healthcare record (EHR).

This thesis handles about informative technologiesthat the find exercise in health sector. Below conception electronic health service we can introduce systemsthat the expressive in a way castigate and largely oversimplify work doctors with reference to legislature in Czech republic. On this account are pick out only such sizes compatibility use it electronic health documentation (so - called datal standards), which guarantee the quality technical protection and safeguard personal data before pertinent misuse. Part those diploma work work handles about proposal Internet health system realized by the help of web interface, making use programmatic languages HTML, CSS, PHP and database system MySQL. Information system makes it possible to distant repair and administration patients' data. For example browsing anamneses, diagnosis, medicines, survey doctors, medical arrangement and laboratory values. Next his feature is compatibility with informative system IZIPthat the will prove send round news in language XML.

Les dossiers patients électroniques contiennent des informations importantes pour la santé publique. La majeure partie de ces informations est contenue dans des documents rédigés en langue naturelle. Bien que le texte texte soit pertinent pour décrire des concepts médicaux complexes, il est difficile d'utiliser cette source de données pour l'aide à la décision, la recherche clinique ou l'analyse statistique.Parmi toutes les informations cliniques intéressantes présentes dans ces dossiers, la chronologie médicale du patient est l'une des plus importantes. Être capable d'extraire automatiquement cette chronologie permettrait d'acquérir une meilleure connaissance de certains phénomènes cliniques tels que la progression des maladies et les effets à long-terme des médicaments. De plus, cela permettrait d'améliorer la qualité des systèmes de question--réponse et de prédiction de résultats cliniques. Par ailleurs, accéder aux chronologiesmédicales est nécessaire pour évaluer la qualité du parcours de soins en le comparant aux recommandations officielles et pour mettre en lumière les étapes de ce parcours auxquelles une attention particulière doit être portée.Dans notre thèse, nous nous concentrons sur la création de ces chronologies médicales en abordant deux questions connexes en traitement automatique des langues: l'extraction d'informations temporelles et la résolution de la coréférence dans des documents cliniques.Concernant l'extraction d'informations temporelles, nous présentons une approche générique pour l'extraction de relations temporelles basée sur des traits catégoriels. Cette approche peut être appliquée sur des documents écrits en anglais ou en français. Puis, nous décrivons une approche neuronale pour l'extraction d'informations temporelles qui inclut des traits catégoriels.La deuxième partie de notre thèse porte sur la résolution de la coréférence. Nous décrivons une approche neuronale pour la résolution de la coréférence dans les documents cliniques. Nous menons une étude empirique visant à mesurer l'effet de différents composants neuronaux, tels que les mécanismes d'attention ou les représentations au niveau des caractères, sur la performance de notre approche. / Important information for public health is contained within Electronic Health Records (EHRs). The vast majority of clinical data available in these records takes the form of narratives written in natural language. Although free text is convenient to describe complex medical concepts, it is difficult to use for medical decision support, clinical research or statistical analysis.Among all the clinical aspects that are of interest in these records, the patient timeline is one of the most important. Being able to retrieve clinical timelines would allow for a better understanding of some clinical phenomena such as disease progression and longitudinal effects of medications. It would also allow to improve medical question answering and clinical outcome prediction systems. Accessing the clinical timeline is needed to evaluate the quality of the healthcare pathway by comparing it to clinical guidelines, and to highlight the steps of the pathway where specific care should be provided.In this thesis, we focus on building such timelines by addressing two related natural language processing topics which are temporal information extraction and clinical event coreference resolution.Our main contributions include a generic feature-based approach for temporal relation extraction that can be applied to documents written in English and in French. We devise a neural based approach for temporal information extraction which includes categorical features.We present a neural entity-based approach for coreference resolution in clinical narratives. We perform an empirical study to evaluate how categorical features and neural network components such as attention mechanisms and token character-level representations influence the performance of our coreference resolution approach.

The Health Professions Education: A Bridge to Quality (IOM, 2003) proposed strategies for higher education leaders and faculty to transform their institutions in ways that address the healthcare problems. This study provides higher education leaders and faculty with empirical data about the processes of change involved to implement the core competency of healthcare informatics. I chose the core competency of health care informatics as a base from which to conduct semi-structured interviews with faculty and college leaders at three schools of nursing intending to capture their stories about how healthcare informatics has been implemented, what strategies were used, and why they were selected. All three nursing schools used patient case scenarios loaded into electronic health records in their computerized human simulation laboratories. Participants' at all three nursing programs reported increased use of the pedagogical approaches of active learning and problem-based learning in these simulation labs. These approaches encourage greater faculty-student and student-to-student interaction, engender more self-directed learning, and do a better job of providing students with a process for integrating previous learning. University of Kansas and Large State University Schools of Nursing demonstrated results that substantiate the viability of the Mobile Model for Transformational Change. One school used almost all the suggested methods and achieved transformation; the other, which used some of the methods, was not transformed. I suggest the model would benefit from specific ways of detecting the breadth in the application of the change markers and from the addition of strategies for creating a breadth of intensity to the change processes. The components of the model relating to the structural and cultural markers of change need to be further developed to focus on the breadth of change. Finally, I suggest the Mobile Model needs greater emphasis on and clarification of the role and nature of intentionality in the change process, as well as a greater focus on the relationship between the core strategies, support strategies, and the breadth of change. The intent of college leaders is important, in part because without it the breadth of change required for transformational change is not likely to be achieved.

This thesis investigates expectations of and experiences with eHealth services that allow users access to their health information. Although eHealth services are endorsed by many politicians and patients, they are met with strong resistance by health care professionals. Lacking this support hinders the uptake of the full potential of the service, especially with relation to patient participation and empowerment. This research investigates the frames of reference that are constructed by stakeholders in relation to eHealth services, such as direct-to-consumer genetic testing and electronic health records. The results are based on empirical data gathered during an experiment with media informatics students in Germany, and from interviews with physicians in Uppsala, Sweden. The eHealth services in question were framed by the participants of the conducted studies as potentially harmful for its users. The negative expectations were based mainly on a generalized view of patients as not sufficiently knowledgable and hence unable to understand the health information provided by the service. The participants in the reported studies (physicians and students in their role as designers) felt a responsibility to prevent any potential harm for the users of the eHealth service. Due to the framing based on assumed negative consequences for a supposedly vulnerable user group, the participants preferred to advocate against access rather than for patient empowerment and participation. Accessing health information was associated as holding little value for the users. This research enhances the understanding of the elements underlying this skepticism and concern. It shows that a specific view of patients and/or prospective users of an eHealth system can result in incongruent technological frames and value attribution. In line with participatory and value-sensitive design approaches as well as the aim to increase technology acceptance, patients and health care professionals should not only be included in the design process but also engage in joint activities in order to enable reframing. / Avhandlingen undersöker förväntningar på och erfarenheter av e-hälsotjänster som ger användare tillgång till sin egen hälsoinformation. Även om e-hälsotjänster har fått stöd av många politiker och patienter har de mötts av starkt motstånd från sjukvårdspersonal. Utan deras stöd blir det svårt att realisera tjänstens fulla potential, särskilt när det gäller patientens delaktighet och egenmakt.Forskningen undersöker de referensramar som konstrueras av intressenter för att förstå e-hälsotjänster, till exempel genetisk testning direkt till konsument och elektroniska patientjournaler. Resultaten baseras dels på empiriska data som samlats in i ett experiment med studenter i Tyskland, dels på intervjuer med läkare i Uppsala.De undersökta e-hälsotjänsterna upplevdes (were framed) av studiernas deltagare som potentiellt skadliga för användarna. De negativa förväntningarna baserades huvudsakligen på en allmän syn på patienter som inte tillräckligt kunniga och därmed oförmögna att förstå tjänstens hälsoinformation. Deltagarna i de rapporterade studierna (läkare och studenter i rollen som formgivare) kände ansvar för att förhindra eventuella skador för e-hälsotjänstens användare. Beroende på de förväntat negativa följderna för de förmodat utsatta patientgrupperna föredrog undersökningens deltagare att ta ställning emot patienternas åtkomst snarare än att ta ställning för deras deltagande och ökade egenmakt. Att ha tillgång till hälsoinformation bedömdes vara av lågt värde för användarna.Forskningen ökar förståelsen av de element som ligger till grund för deltagarnas upplevda skepsis och oro. Den visar att en specifik bild av patienter och/eller framtida användare av ett e-hälsosystemet kan leda till inkongruenta tekniska referensramar och värdebedömningar. I linje med inriktningarna deltagande design och värdebaserade design samt målet att öka teknisk acceptans, bör patienter och hälso- och sjukvårdspersonal inte bara ingå i designprocessen, utan också delta i gemensamma aktiviteter för att möjliggöra omtolkningar av sina tekniska referens- ramar.

This study is a qualitative research on the faciliating and impeding factors that influence Hong Kong citizen's adoption of Electronic Health Record Sharing System (eHRSS), the principal electronic health record (EHR) system in Hong Kong.  A majority of the previous studies of EHR among information systems (IS) literature either focused within the institutional or technological perspectives, or on the perspectives of healthcare institutions or healthcare professionals. Little research has been done from citizens' perspective on factors of their adoption of EHR. There is also little research specific to Hong Kong's circumstances. This research aims to provide an enhanced understanding on the factors that influence citizens' EHR adoption through looking into eHRSS adoption in Hong Kong. It aims to provide contributions to bridge the knowledge gaps by providing a better understanding on adoption factors from citizens' perspective, and investigate into whether there are any unique factors applicable to Hong Kong. In this study, semi-structured interviews had been performed on participants covering various age groups to collect their views and opinions concering their adoption of eHRSS. With reference to theoretical constructs on user acceptance and adoption, this study identifies four facilitating factors for citizens' adoption of eHRSS, namely (i) knowledge, (ii) trust, (iii) perceived potential health benefits and (iv) flexibility and "stickiness" of continual use. Four impeding factors for citizens' non-adoption were also identified, namely (i) difficulty in registration, low level/lack of trust in EHR implementation, (iii) negativity on acceptance of new technology and (iv) perceived difficulty in usage.  In the concluding remarks, way forward for future research has been outlined. Practical recommendations have also been formulated for reference by relevant authorities in administering eHRSS in Hong Kong.

Computerized physician order entry (CPOE) is used in healthcare organizations to improve workflow processes and transcription, as well as to prevent prescribing errors. Previous research has indicated challenges associated with CPOE for end-users that predispose patients to unsafe practices. Unsafe CPOE practices can be detrimental within the intensive care unit (ICU) setting due to the complexity of nursing care. Consequently, end-user satisfaction and understanding of CPOE and electronic health record (EHR) functionality are vital to avoid error omissions. CPOE initiatives should be refined post system implementation to improve clinical workflow, medication processes, and end-user satisfaction. The purpose of this quality improvement project was to refine CPOE system initiatives and develop an e-learning educational module to facilitate end-user understanding of and satisfaction with CPOE. The Iowa model of evidence-based practice, Lean methodology, and Provider Order Entry User Satisfaction and Usage Survey (POESUS) were used to guide the study. An e-learning module was implemented to increase staff understanding of the newly implemented CPOE system, and a plan was provided for ongoing data collection and investigation of end-user satisfaction and medication inadequacies with the CPOE system. A mixed-method design was recommended to key stakeholders to identify the impact of the e-learning course and refined CPOE initiatives on both end-user satisfaction and patient outcomes in the medical-surgical ICU. Findings from the study informed the impact of e-learning educational modules with CPOE system implementation. Those in organizations implementing advanced technology such as CPOE and EHR systems in critical care settings will find this paper of interest.

The introduction of federal initiatives and incentives regarding health information technology fostered a movement towards the adoption of electronic health records (EHR). Implementation of EHRs sparked discussions among healthcare providers, patients, and others about the benefits or challenges of the move from the traditional paper method to the electronic version in healthcare settings. A knowledge gap in research involving the usefulness of EHRs and their impact to the delivery of care in other settings exists. The purpose of this qualitative study was to explore public health providers' perceptions of the meaningful use of EHRs in a disaster setting. Study participants were public health providers from Louisiana recruited via criterion sampling and snowball sampling. A qualitative, phenomenological design was used to gain understanding of the public health providers' experiences with and perceptions of EHRs in a disaster setting. Data were collected from 7 public health providers using in-depth interviews and reflective journal notes. The data were analyzed for patterns and themes using the hermeneutic circle method. The study findings indicate that individuals want to be involved in designing their system and adjusting workflow in the workplace setting. The majority of participants concluded that EHR systems are beneficial in the disaster setting, but there were no impacts to improving health outcomes. The findings provide policymakers, public health departments, healthcare providers, emergency managers, and communities needed information on the potential impact of EHRs in the disaster setting on improving safe and effective care.

Information technology (IT) has been rapidly integrated into the healthcare industry, including nursing, and has the ability to reduce errors, cut cost, and enhance patient care. However, approximately 45% of the current nurse workforce lacks adequate training in computer skills, which may hinder the adoption of health-related IT in the workplace. Characteristics of Rogers's diffusion of innovation (relative advantage, compatibility, complexity, trialability, and observability) guided this project. This project was conducted to address the problem of IT adoption on a local level and was designed to assess whether simulation training on a generic electronic health record (EHR) system would improve the knowledge, skill, and attitude of nurses with little or no experience with EHR. A convenience sample of nurses (n = 13) unfamiliar with EHR was obtained by posting flyers in long-term care or home health agencies. The nurses completed the P.A.T.C.H. assessment scale v. 3 (2011) before and after participating in the one-time simulation training on EHR. Scores on the P.A.T.C.H. were calculated according to the established scoring system and revealed a positive increase nurses' attitude and self-efficacy toward the EHR system. Posttest scores yielded an increase ranging from 0.5 to 5 points from pretest scores, with an average pretest score of 54.23 on a scale of 0-100. The results of this project are consistent with the literature and current research and illustrate the importance of addressing the need for interactive training. This project contributes to social change in practice by enhancing the awareness of EHR in nurses who are new users of IT and promoting the adoption of technology in healthcare.