Within the field of medical informatics, patient medical records are the sole source of information for dealing with clinical activities concerning the documentation, care, progression, and ongoing interactions between the patient and clinicians. Electronic or computer-based patient records (CPRs) have had a presence within health care in some form and magnitude for the past thirty years yet only recently have been incorporated in health care to a larger extent. Due to the wide variation of professions in health care, there is a problem of CPRs not being able to fulfill all the possibilities and demands the individual professionals need, since many CPRs are designed as a generic system, to be used across multiple professions. The focus of this report is on the utilization of a generic CPR in a specialist clinical setting, i.e., a physical therapy clinic, and to analyze how the therapists utilize the different components and features in a generic CPR. The purpose of the evaluation was to investigate how viable the CPR was as a documentation tool and to which extent it supported the therapists in their clinical, documentation and delivery of care activities. In this study, a total of seven physical therapists participated in a post-usage evaluation of an existing CPR. The evaluation was achieved by interpretative research with open-ended interviews and observations. The results of the study showed that despite some shortcomings, the generic CPR was an effective tool for the clinicians, not only as a documenting aid, but also enabling them to quickly research the patients' prior diagnosis and treatment history, plan for future care, support decision-making and to communicate with other professionals so as to coordinate treatment and planning.

Introduction: The Centers for Disease Control and Prevention found that each year over three million people are treated for fall injuries, and of those three million, one in five falls causes serious injury. One clinical report stated only 37% of elderly patients are asked about falls in the primary care setting. The report found barriers to further fall-related care were due to the many factors that go into assessing if a patient is a fall-risk. Thus, assessing the fall risk for a large elderly population can be both challenging and time-consuming. The purpose of this study is to evaluate the effectiveness of assessing fall risk with the Theoretical Timed Up and Go (T-TUG), using Wave 1 of the Irish Longitudinal Database (TILDA). The validation was done by comparing the T-TUG results to that of the Impairments survey and activities of daily living (ADLs) found in the TILDA. Methods: The data used in this study were obtained from Wave 1 of the TILDA. The TILDA is a survey-designed longitudinal study on aging done on a national scale in Ireland. Study participants who passed inclusion criteria were divided into those who had reported falling in the previous year (N=1221) and those who had not (N=4857). The T-TUG is a fall-risk calculator developed from the NSHAP database, with a multiple regression function using the Timed Up and Go as the dependent variable, and age, gender, body mass index, and over the counter and prescription drugs as the predictor variables. The NSHAP regression coefficients were combined with the TILDA participant parameters defined above to calculate new T-TUG scores for the TILDA cohort. Differentiation between the fall and no fall groups for the T-TUG, ADLs and Impairments survey were done using the Mann-Whitney U Test (p < 0.05). Receiver Operator Characteristics (ROC) curve analyses were done to identify cut-off points, sensitivities, and specificities differentiating the fall and no fall groups for these assessments. Results: Mann-Whitney analysis demonstrated that the fall group scores were statistically different from the no fall group for all three assessments (p-value < 0.001). As determined by AUC, the ROC analysis indicated that the T-TUG (AUC=0.570, p Conclusion: All assessments evaluated were effective at differentiating participants within this database reporting a fall within the last year from those who had not. Whereas the T-TUG and Impairments survey were equally effective at detecting true fallers and non-fallers, the ADLs were much more effective at detecting non-fallers. The T-TUG has the potential to be an EMR based fall risk calculator and could be invaluable as an institutional triage tool.

Background: At a primary care center in Brooklyn, New York, approximately 27% of diabetic patients with abnormal Hgb A1C fail to return for follow-up appointments, as recommended by the Centers for Disease Control and Prevention (CDC). According to electronic medical records (EMR), healthcare providers demonstrated inconsistency in ordering and monitoring Hgb A1C and clinic follow-up appointments for patients. Purpose: The purpose of this quality improvement project was to determine retrospectively the healthcare providers’ ordering, monitoring, and follow-up appointments for adult diabetic patients with abnormal Hgb A1Cs; to develop and implement astandardized process for healthcare providers to monitor and follow these patients, especially those with possible nonclinic follow-up compliance and abnormal Hgb A1C; to determine prospectively healthcare providers’ ordering, monitoring, and follow-up appointments; and to evaluate the prospective charts to determine if Hgb AIC results changed from abnormal to normal or elevation over time until the next follow-up appointment.

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Medical records are rapidly being digitized to electronic medical records. Although Electronic Medical Records (EMRs) improve administration, billing, and logistics, an open research problem remains as to how doctors can leverage EMRs to enhance patient care. This thesis describes a system that analyzes a patient's evolving EMR in context with available biomedical knowledge and the accumulated experience recorded in various text sources including the EMRs of other patients. The aim of the Clinician Decision Support (CDS) Dashboard is to provide interactive, automated, actionable EMR text-mining tools that help improve both the patient and clinical care staff experience. The CDS Dashboard, in a secure network, helps physicians find de-identified electronic medical records similar to their patient's medical record thereby aiding them in diagnosis, treatment, prognosis and outcomes. It is of particular value in cases involving complex disorders, and also allows physicians to explore relevant medical literature, recent research findings, clinical trials and medical cases. A pilot study done with medical students at the Virginia Tech Carilion School of Medicine and Research Institute (VTC) showed that 89% of them found the CDS Dashboard to be useful in aiding patient care for doctors and 81% of them found it useful for aiding medical students pedagogically. Additionally, over 81% of the medical students found the tool user friendly. The CDS Dashboard is constructed using a multidisciplinary approach including: computer science, medicine, biomedical research, and human-machine interfacing. Our multidisciplinary approach combined with the high usability scores obtained from VTC indicated the CDS Dashboard has a high potential value to clinicians and medical students. / Master of Science

Information Systems (IS) innovations in healthcare sector are seen as panacea to control burgeoning demand on healthcare resources and lack of streamlining in care delivery. Two particular manifestations of such innovations are telehealth and electronic records in its two forms: the electronic medical records and the electronic health records. Deployment efforts concerning both of these IS-innovations have encountered a rough terrain and have been slow. Problems are also faced while evaluating the effectiveness of innovations on health and care delivery outcomes through strategies such as randomised controlled trials- particularly in case of telehealth. By taking these issues into account, this research investigates the issues that affect IS innovation deployment and its evaluation. The strategy adopted in this research was informed by recursive philosophy and theoretical perspectives within IS that strived to expound this recursive relationship. It involved conducting two longitudinal case studies that are qualitative in nature. The first study involved telehealth deployment and its evaluation in the UK, while the second case study involved the deployment of electronic medical/health records in the US. Data was collected through focus group discussions, interviews and online discussion threads; and was analysed thematically. The results of this research indicate that there are nine issues that arise and affect the deployment and evaluation of IS innovation in healthcare; and these are design, efficiency and effectiveness, optimality and equity, legitimacy, acceptance, demand and efficacy, expertise, new interaction patterns, and trust. These issues are attributes of relationships between the IS innovation, context of healthcare and the user. The significance of these attributes varies during the deployment and evaluation process, and due to iterative nature of IS innovation. This research further indicates that all the attributes have either direct or indirect impact on work practices of the user.

This thesis is focused on the detection of the effectiveness of the established information system that is used by the Emergency Medical Service of the Vysočina Region to keep medical records; in case of the Emergency Medical Assistance there are used intervention records. The aim of this thesis is to determine the effectiveness of information system implementation used for the administration of medical records on the basis of selected indicators. This research will confirm or refute hypotheses whether keeping of medical records in electronic form is effective for the organization in terms of potential time savings, or from the perspective of the administration of medical records. This thesis is to introduce a comprehensive view on the matters of computerization of medical records, namely in a specific environment of the Emergency Medical Service. The introduction describes terms that are used in this thesis. There is defined the environment of the Emergency Medical Service, specified the documentation and forms of the medical records administration which is used by the Emergency Medical Service. There is also introduced the information system that serves the medical records administration and the theory of cost effectiveness. The practical part is focused on the analysis of the information system, and on confirmation and refutation of set hypotheses supported by quantitative research. The summary and recommendation are based on obtained and analyzed results of this research.

While information systems researchers have argued well from socio-technical and organizational culture perspectives that information technology (IT) and organizational structures are interdependent and continually reshape each other, few studies have sought fine-grained, micro-level explanations for the heterogeneity in IT use often observed across seemingly similar end users and seemingly similar work contexts. Using a nested comparative case study design, I explore electronic medical record (EMR) use by physicians in an integrated multi-specialty health care organization. I use multiple methods to observe and develop micro-level understandings of factors associated with EMR use. The study was conducted in eight practices operating within the same organization. Data collection methods included semi-structured interviews, non-participant observations, and questionnaires. A constant comparative approach guided data analysis. Differences in physician values were noted, as were differences in physician perspectives of uncertainty. I categorized physicians as high, medium and low EMR users depending on a variety of factors including degree to which the EMR was integrated into work practices, degree of feature use, and degree of EMR-enabled communication. Drawing on theories of professionalism, I explain between-physician heterogeneity in EMR use as partly a function of differences in dimensionality of professional values. Three dimensions of professional values were identified 1) profession-oriented, 2) patient-oriented and 3) organization-oriented. Drawing on complexity theory, I argue that differences in physician perspectives of uncertainty influence their EMR use. I found that physicians who viewed uncertainty primarily as reducible through information tended to be higher users of the EMR. Physicians who viewed uncertainty as fundamental, or inherent, in care delivery processes tended to be lower users of the EMR. This study contributes to information systems research by extending current understandings of IT use. The professional values held by physicians and their perspectives of uncertainty may be more important in shaping EMR use than previously thought. These findings indicate the need to more aggressively pursue EMR designs, implementation strategies and policies that accommodate these two additional factors. Additionally, findings from this research indicate a need for IT managers in professional settings to consider end-user professional values and perspectives of uncertainty in decisions involving IT assets. / text