The debate about healthcare reform revolves around a triple aim of improving the health of populations, improving the patient experience, and reducing the cost of care. A major tool discussed in this debate has been the adoption of electronic health record (EHR) systems to record and guide care delivery. Due to low adoption rates and limited examples of success, the problem was a lack of understanding by healthcare organizations of how the EHR fundamentally changes an organization through the interactions of people, processes, and technology over time. The purpose of this case study was to explore the people, processes, and technology factors that change as a result of an EHR implementation. Complexity theory was used as the lens to evaluate the effects of the EHR on the holistic system of healthcare. Data were collected using semistructured interviews and observations of physicians, nurses, and administrators, as well as document reviews of organizational documents related to the EHR. Data were analyzed using open coding to identify themes and patterns of usage that redesign or restructure institutional resources. The results of this study demonstrated positive changes in the interactions of healthcare providers with increasing collaboration on process changes and reliance on EHR for communication. These findings may positively affect government policy and the organizational approach to adoption and ongoing use of EHRs to create organizational change beyond the implementation of such systems, thus benefiting both health care employees and patients.

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The recent trend in health care has been on the development and implementation of clinical guidelines to support and comply with evidence-based care. Evidence-based care is established with a view to improve the overall quality of care for patients, reduce costs, and address medico-legal issues. One of the main questions addressed by this thesis is how to support guideline-based care. It is recognised that this is better achieved by taking into consideration the provider workflow. However, workflow support remains a challenging (and hence rarely seen) accomplishment in practice, particularly in the context of chronic disease management (CDM). Our view is that guidelines can be knowledge-engineered into four main artefacts: electronic health record (EHR) content, computer-interpretable guideline (CiG), workflow and hypermedia. The next question is then how to coordinate and make use of these artefacts in a health information system (HIS). We leverage the EHR since we view this as the core component to any HIS. / PhD Doctorate

Submitted by Valdinei Souza (neisouza@hotmail.com) on 2016-10-03T21:09:37Z No. of bitstreams: 1 Pablo Soledade - DISSERTACAO - VERSAO FINAL - 16082016.pdf: 1255399 bytes, checksum: 4109a7da04441202e79725bd231cffc5 (MD5) / Approved for entry into archive by Urania Araujo (urania@ufba.br) on 2016-10-04T20:07:55Z (GMT) No. of bitstreams: 1 Pablo Soledade - DISSERTACAO - VERSAO FINAL - 16082016.pdf: 1255399 bytes, checksum: 4109a7da04441202e79725bd231cffc5 (MD5) / Made available in DSpace on 2016-10-04T20:07:55Z (GMT). No. of bitstreams: 1 Pablo Soledade - DISSERTACAO - VERSAO FINAL - 16082016.pdf: 1255399 bytes, checksum: 4109a7da04441202e79725bd231cffc5 (MD5) / A pesquisa apresentada nesta dissertação de mestrado teve como objetivo a investigação do uso e importância do prontuário do paciente em instituições de saúde, através da publicação de atos ou informações nos sítios eletrônicos oficiais destas. Esse trabalho foi desenvolvido metodologicamente utilizando uma abordagem qualitativa, tendo por base a pesquisa descritiva na forma documental, utilizando a técnica de observação direta para a coleta de dados. A pesquisa fez uma investigação da publicidade das ações relacionadas aos prontuários e arquivos, nos sítios eletrônicos de doze instituições de saúde previamente escolhidas, respondendo objetivamente a dezoito questões formuladas, conhecendo assim a realidade de cada uma, e do conjunto destas no que tange a relação prontuário e arquivo da instituição de saúde com os respectivos sítios eletrônicos. Essa investigação revelou que nenhuma instituição apresentou em seu sítio eletrônico a totalidade de respostas positivas. A instituição que chegou mais próximo do resultado alcançou doze das dezoito respostas, que representa 66,67%, revelando assim a necessidade dos sítios eletrônicos serem melhorados para a garantia do acesso a informação dos clientes ou pacientes. O trabalho apresentou ainda o panorama atual da legislação sobre prontuário, as correlações com a prática e a identificação de ações quanto a soluções para inserção dessa espécie documental como instrumento relevante de registro de informação para a eficácia de um atendimento de qualidade e com segurança jurídica ao paciente. / ABSTRACT The research presented in this Master’s thesis investigated the use and importance of patients’ medical records at health institutions, by publishing actions or information on their official websites. This study was developed methodologically using a qualitative approach, having descriptive research in documentary form as a base, and utilizing the technique of direct observation for data collection. The research analyzed the disclosure of actions related to medical records and archives on the websites of 12 previously selected health institutions, objectively responding to 18 formulated questions. The reality of each institution and the group as a whole with regards to the health institutions’ medical records and files’ relation with their websites was discovered in this way. The analysis revealed that none of the institutions presented totally positive replies on their websites. The institution which came closest to the outcome attained 12 of the 18 responses, representing 66.67%. Therefore, this revealed the need for improvements to the websites, in order to guarantee access to information on clients or patients. This study also presents an overview of legislation on medical records, correlations with practice and identifying actions for solutions to insert a patient’s medical records as a relevant instrument to record information for an effective, high quality service and legal certainty for patients.

Title: Voice controlled electronic health record in dentistry Author: MUDr. Radek Hippmann Department: Department of paediatric stomatology, Faculty hospital Motol Supervisor: Prof. MUDr. Taťjana Dostalová, DrSc., MBA Supervisor's e-mail: Tatjana.Dostalova@fnmotol.cz This PhD thesis is concerning with development of the complex electronic health record (EHR) for the field of dentistry. This system is also enhanced with voice control based on the Automatic speech recognition (ASR) system and module for speech synthesis Text-to- speech (TTS). In the first part of the thesis is described the whole issue and are defined particular areas, whose combination is essential for EHR system creation in this field. It is mainly basic delimiting of terms and areas in the dentistry. In the next step we are engaged in temporomandibular joint (TMJ) problematic, which is often ignored and trends in EHR and voice technologies are also described. In the methodological part are described delineated technologies used during the EHR system creation, voice recognition and TMJ disease classification. Following part incorporates results description, which are corresponding with the knowledge base in dentistry and TMJ. From this knowledge base originates the graphic user interface DentCross, which is serving for dental data...

The information in the medical records serve many purposes: they can be used for diagnosis and therapy, medical documentation contains information that can be the basis for financial authorities for treatment or for pumping reimbursement from health insurance. The data can be used in statistics and other scientific purposes. The aim of study is to verify the simplicity of data process implementation and time of data storing for modification of classical paper WHO dental card, lifetime dental EHR controlled by keyboard and lifetime dental EHR controlled by voice. All three methods were applied on 126 patients. At first the patients were inspected by a standard technique (communication between dentist and nurse) and the data recorded into the paper WHO dental card. The same person recorded all data to lifetime dental EHR using keyboard and using voice. Then we compared the time, which was needed for recording the data using these three methods. Using Friedman test we found very significant differences in time of recording among three methods (p<0.001). We can see that the paper WHO dental card was recorded quickly, but its rise due to missing electronic form is difficult. Times for recording data using keyboard or voice in lifetime dental EHR were not significantly different. The clinical practice...

Objectif : Notre objectif était d’évaluer la qualité des données de la base de données haute résolution (BDHR) implantée dans l’unité de soins intensifs pédiatriques (USIP) de l’Hôpital Sainte-Justine (HSJ). Type d’étude : Un rapport descriptif et une analyse d’une étude prospective de validation d’une BDHR. Environnement : Une USIP de 32 lits, adaptée aux soins médicaux, chirurgicaux et cardiaques dans un centre tertiaire mère-enfant du Canada. Population : Tous les patients admis à l’USIP et ayant un monitorage d’au moins 1 signe vital par un moniteur cardio-respiratoire. Mesures et résultats principaux : Entre juin 2017 et août 2018, les données de 295 jours de patients ont été enregistrées à partir des appareils médicaux et 4465 données ont été filmées et comparées aux données correspondantes dans la BDHR de l’USIP de l’HSJ. Les analyses statistiques ont démontré en général une bonne corrélation, une excellente fiabilité et un bon agrément. Les graphiques de Bland-Altman ont aussi démontré l’exactitude et la précision entre les données récoltées et les données filmées selon les limites d’agrément cliniquement significatives préalablement définies. Conclusions : Cette étude de validation exécutée sur un échantillon représentatif a démontré que la qualité des données était globalement excellente. / Objective: Our objective was to evaluate the data quality of our high-resolution electronic database (HRDB) implemented in the pediatric intensive care unit (PICU) of HSJ. Design: A descriptive report and analysis of a prospective validation of a HRDB. Setting: A 32 beds pediatric medical, surgical and cardiac PICU in a tertiary care free-standing maternal-child health center in Canada. Population: All patients admitted to the PICU with at least one vital sign recorded using a cardiorespiratory monitor connected to the central monitoring station. Measurements and Main Results: Between June 2017 and August 2018, data from 295 patient days were recorded from medical devices and 4,645 data points were video recorded and compared to the corresponding data collected in the HSJ-PICU HRDB. Statistical analysis showed excellent overall correlation, agreement and reliability. Bland-Altman analysis showed excellent accuracy and precision between recorded and collected data within clinically significant pre-defined limits of agreement. Conclusions: This prospective validation study performed on a representative sample showed excellent overall data quality.

The objective of the dissertation thesis has been the information-lexical analysis of Czech medical reports and the usability of international classification systems in the Czech healthcare environment. The analysis of medical reports has been based on the attributes of the Minimal Data Model for Cardiology (MDMC). Narrative medical reports and structured medical reports from the ADAMEK software application have been used. For the thesis SNOMED CT and ICD-10 classification systems have been used. There has been compared how well attributes of MDMC are recorded in narrative and structured medical reports. The language analysis of the Czech narrative medical reports has been made. A new application for measuring diversity in medical reports written in any language is proposed. The application is based on the general concepts of diversities derived from f-diversity, relative f- diversity, self f-diversity and marginal f-diversity. The thesis has come to the conclusion that using a free text in medical reports is not consistent and not standardized. The standardized terminology would bring benefits to physicians, patients, administrators, software developers and payers and it would help healthcare providers as it could provide complete and easily accessible information that belongs to the process of...

Title: Voice controlled electronic health record in dentistry Author: MUDr. Radek Hippmann Department: Department of paediatric stomatology, Faculty hospital Motol Supervisor: Prof. MUDr. Taťjana Dostalová, DrSc., MBA Supervisor's e-mail: Tatjana.Dostalova@fnmotol.cz This PhD thesis is concerning with development of the complex electronic health record (EHR) for the field of dentistry. This system is also enhanced with voice control based on the Automatic speech recognition (ASR) system and module for speech synthesis Text-to- speech (TTS). In the first part of the thesis is described the whole issue and are defined particular areas, whose combination is essential for EHR system creation in this field. It is mainly basic delimiting of terms and areas in the dentistry. In the next step we are engaged in temporomandibular joint (TMJ) problematic, which is often ignored and trends in EHR and voice technologies are also described. In the methodological part are described delineated technologies used during the EHR system creation, voice recognition and TMJ disease classification. Following part incorporates results description, which are corresponding with the knowledge base in dentistry and TMJ. From this knowledge base originates the graphic user interface DentCross, which is serving for dental data...

The information in the medical records serve many purposes: they can be used for diagnosis and therapy, medical documentation contains information that can be the basis for financial authorities for treatment or for pumping reimbursement from health insurance. The data can be used in statistics and other scientific purposes. The aim of study is to verify the simplicity of data process implementation and time of data storing for modification of classical paper WHO dental card, lifetime dental EHR controlled by keyboard and lifetime dental EHR controlled by voice. All three methods were applied on 126 patients. At first the patients were inspected by a standard technique (communication between dentist and nurse) and the data recorded into the paper WHO dental card. The same person recorded all data to lifetime dental EHR using keyboard and using voice. Then we compared the time, which was needed for recording the data using these three methods. Using Friedman test we found very significant differences in time of recording among three methods (p<0.001). We can see that the paper WHO dental card was recorded quickly, but its rise due to missing electronic form is difficult. Times for recording data using keyboard or voice in lifetime dental EHR were not significantly different. The clinical practice...