Despite rapid advances in technology, there is currently a complex, and somewhat disjointed approach to the way health information is collected, stored, and organized for both healthcare consumers and professionals. Incompatible electronic medical records from various healthcare providers add to the complexity of a system tasked with delivering a patient’s relevant medical information in a timely manner to the appropriate point of care. Personal health records (PHR) grew out of the efforts to produce an integrated electronic record to manage the multifaceted aspects of healthcare required by both healthcare consumers and professionals. PHRs are a transformative technology with the potential to alter patient-provider relationships in a way that produces a more efficient and cost effective healthcare system as a result of better patient outcomes. PHRs can potentially include a wide variety of users ranging from the lay public to clinical professionals. As such, it is important to identify potential user groups and their corresponding health information needs in order to design PHRs that maximize accessibility, usability, and clinical relevance. This study focused on laypeople who represented a wide age-range of individuals, evenly split in gender, with an above average level of computer literacy. Most of the participants had not used an electronic PHR prior to this study. However, after a hands-on session with PHR software, most participants found it to be easy to use, accompanied with the functionality they expected from such a system. Most participants were satisfied that an electronic PHR would meet their health information needs and would recommend the use of PHRs to family and friends. Anyone in the general public is a potential PHR user. However, this study found that individuals with chronic conditions and those with complex health needs had the most to gain from using a PHR as an integral part of their healthcare routine. This study also demonstrated that an individual’s health condition has a stronger influence on their perceptions about the usefulness of PHRs than does their demographic background (age, education, computer literacy). Finally, this study established that PHRs are considered by participants of the study to be useful tools in meeting their health information needs. / Graduate / 0723 / 0769 / 0984 / dguarin@uvic.ca

INTRODUCTION: While mobile device use by physicians increases, there is an increased risk that errors committed while using mobile devices can lead to harm. This mixed-method study evaluates the effects of screen size on clinical users’ perceptions of medical application usability and safety when interfacing to critical patient information. In this research, two mobile devices are examined: iPhone® and the iPad®. METHOD: Eleven physicians and one nurse practitioner participated in a chart-review simulation using an app that was an end-point to an electronic health record. Screen-recording, video-recording and a think-aloud protocol were used to gather data during the simulation. Additionally, participants completed Likert-based questionnaires and engaged in semi-structured interviews. RESULTS: A total of 105 usability, usefulness and safety problems were recorded and analysed. A strong preference was found for the larger screen when reviewing patient data due to the large quantity of data and the increased display size. The smaller device was preferred due to the devices portability when participants needed to remain informed when they were away from the point of care. CONCLUSION: There is an association between screen size and the perceived safety of the handheld device. The iPad was perceived to be safer to use in clinical practice. Participants preferred the iPad® because of the larger size, not because they thought it was safer or easier to use. The iPhone® was preferred for its portability and its usefulness was perceived to increase with greater distance from the point of care. / Graduate

Aims The purpose of this study is to explore the possibilities for video-based learning of computer systems in the field of medical education in rural sub-Saharan Africa. Background Low-income countries are forced to perform healthcare services with resources already spread too thin. The use of electronic medical records can increase the cost-effectiveness of delivering healthcare services, but the low computer literacy in sub-Saharan Africa is an obstacle necessary to overcome. E-learning and video-based learning has the potential to partially solve this problem. Methods User observations were conducted on five healthcare workers in rural Uganda. The users watched an instruction video, after which they performed an assessment test of an electronic medical record system. Results Some effectiveness was perceived – but it was slight, and varied greatly between the test subjects. Computer experience is an important prerequisite for the success of e-learning initiatives. Effectiveness was higher for more simple tasks. Conclusion This paper does not propose video-based learning as the only source of training for the target group. However, there is a possibility to envision video-based learning as a building block in a blended-learning strategy – utilising video-based learning for easier tasks and knowledge retention for users who are already familiar with the system.

The digitization of information has provided an overflow of data in many areas of society, including the clinical sector. However, confidentiality issues concerning the privacy of both clinicians and patients have hampered research into how to best deal with this kind of "clinical" data. An example of clinical data which can be found in abundance are Electronic Medical Records, or EMR for short. EMRs contain information about a patient's medical history, such as summarizes of earlier visits, prescribed medications and more. These EMRs can be quite extensive and reading them in full can be time-consuming, especially when considering the often hectic nature of hospital work. Giving clinicians the ability to gain insight into what information is of importance when dealing with extensive EMRs might be very useful. Keyword extraction are methods developed in the field of language technology that aim to automatically extract the most important terms or phrases from a text. Applying these methods on EMR data successfully could help provide the clinicians with a helping hand when short on time. Clinical data are very domain-specific however, requiring different kinds of expert knowledge depending on what field of medicine is being investigated. Due to the scarcity of research on not only clinical keyword extractions but clinical data as a whole, foundational groundwork in how to best deal with the domain-specific demands of a clinical keyword extractor need to be laid. By exploring how the two unsupervised approaches YAKE! and KeyBERT deal with the domain-specific task of implant-focused keyword extraction, the limitations of clinical keyword extraction are tested. Furthermore, the performance of a general BERT model in comparison to a model finetuned on domain-specific data is investigated. Finally, an attempt is made to create a domain-specific set of gold-standard keywords by combining unsupervised approaches to keyword extraction is made. The results show that unsupervised approaches perform poorly when dealing with domain-specific tasks that do not have a clear correlation to the main domain of the data. Finetuned BERT models seem to perform almost as well as a general model when tasked with implant-focused keyword extraction, although further research is needed. Finally, the use of unsupervised approaches in conjunction with manual evaluations provided by domain experts show some promise.

Det finns ett behov av användarvänliga, anpassningsbara och tillgängliga journalsystem inom en variation av branscher. Befintliga system har visat sig vara bristfälliga inom dessa tre aspekter. Bristerna bottnar i att systemen sällan är anpassade för det specifika ändamålet, vilket i många fall grundar sig i att slutanvändarna inte varit med i utvecklingsprocessen. När användare har implementerat befintliga journalsystem inom sina verksamheter har även bristfälligheter gällande tillgänglighet påvisats. På den utvecklade journalsystemprototypen som arbetet resulterade i, utfördes ett antal tester av uppdragsgivarens anställda. Dessa tester påvisade att prototypens användarvänlighet, anpassningsbarhet och tillgänglighet uppnådde de krav som företaget hade på ett journalsystem. Prototypen har, trots det positiva resultatet, fortfarande utvecklingspotential och områden att förbättra. / There is a need for user-friendly, customizable and accessible record systems in a variety of industries. Existing systems have proven to be deficient in these three aspects. The shortcomings are due to the fact that the systems are seldom adapted for the specific purpose, which in many cases is a consequence of the end users not being involved in the development process. When users have implemented existing journal systems within their operations, deficiencies regarding accessibility have also been identified. On the developed record system prototype that the work resulted in, a number of tests were performed by the client's employees. These tests showed that the user-friendliness, adaptability and availability of the prototype met the requirements of the company for a record system. Despite the positive result, the prototype still has development potential and areas for improvement.

<p>Efficient strategies for diabetes management in primary care provide avenues through which the disease may be monitored and controlled, but systems and processes must be more than adequate. The use of Electronic Medical Record systems (EMRs) assist healthcare providers in delivering quality care to patients to help better manage chronic conditions, and integrate services throughout the healthcare system so that relevant chronic disease programs may be made available to individuals and communities. Usability issues have often been blamed for poor EMR adoption rates, underutilization of systems, endangerment of patient health and inadequacies in providing positive health outcomes for patients while improving the quality of chronic disease management.</p> <p>This thesis investigates the use of EMRs in managing diabetes within primary care, and evaluates their usability and its effects in managing diabetes in patients, with special reference to patient safety, healthcare provider workflow and adherence to clinical practice guidelines (CPGs).</p> <p>Existing evidence emphasizing the management of diabetes and the role of the EMR in primary care is presented, while three levels of usability and several usability guidelines are identified and investigated. Data gathered from the local environment, show the relationships between EMR usability, patient safety, clinician workflow and adherence to CPGs in managing diabetes, and three models of EMR usability are suggested.</p> <p>The primary proposition for this study is that EMRs provide promise in helping to control diabetes in patients. However EMR usability may present significant hindrances in maximizing outcomes for individuals and in providing support programs and services to communities.</p> / Master of Science (MSc)

Η πολλαπλή σκλήρυνση (σκλήρυνση κατά πλάκας) είναι ένα αυτοάνοσο νόσημα που χαρακτηρίζεται απομυελινωτικές βλάβες που οδηγούν σε καταστροφή νευραξόνων επηρεάζοντας τις λειτουργίες του ανθρώπινου οργανισμού. Οι ασθενείς παρουσιάζουν νευρολογικά ελλείμματα σε διαφορετικές τοποθεσίες και σε διαφορετικούς χρόνους. Η πολλαπλή σκλήρυνση εμφανίζεται σε κάθε ηλικία, ακόμα και στα παιδιά, αλλά είναι σαφώς συχνότερη σε νέους ανθρώπους 20-40 ετών και ειδικά στις γυναίκες. Μετά από ένα αρχικό επεισόδιο απομυελίνωσης, η σκλήρυνση κατά πλάκας μπορεί να ακολουθήσει ένα από τα τρία διαφορετικά μοτίβα: υποτροπιάζουσα, πρωτογενής προοδευτική, ή δευτερογενής προϊούσα, μετά από μια υποτροπιάζουσα φάση. Η ιατρική παρακολούθηση και παρέμβαση με θεραπείες απαιτεί ένα σύνολο από επαναλαμβανόμενες εργαστηριακές εξετάσεις. Η πορεία της νόσου χαρακτηρίζεται αδιαμφισβήτητα από συσσώρευση αναπηρίας που οδηγεί τον ασθενή σε χρήση βοηθημάτων κίνησης έως και ανάγκη φροντιστή. Ένας σύγχρονος ιατρικός φάκελος είναι ιδιαίτερα χρήσιμος μιας και οι νεότερες και αποτελεσματικότερες θεραπείες απαιτούν λεπτομερές ιστορικό του ασθενούς. Στην παρούσα εργασία θα αναπτυχθεί μια βάση δεδομένων σε γλώσσα mysql, διεπαφή με γλώσσα php. / Multiple Sclerosis is a chronic, inflammatory, demyelinating disease of the central nervous system (CNS) and is one of the most common causes of neurological disability in young adults. It is characterized by multi-focal recurrent attacks of neurological symptoms and signs with variable recovery. Eventually, the majority of patients develop a progressive clinical course . The exact cause of multiple sclerosis is unknown, although an autoimmune process has been implicated. The clinical course of MS is highly variable, ranging from sub-clinical disease to rapidly progressive MS. The major rationale for the MSBase project is the creation of a base platform to facilitate the clinical practice. The MSBase is dedicated to providing doctors who want to help ms patient with the best possible independent logistic solution to the challenges of the disease at no cost.

存取控管是電子病歷 (Electronic Medical Records, EMR)安全防護的核心課題。為了因應醫病關係的變動及確保病患隱私，EMR的存取控管必須滿足動態和細緻化這兩大需求。但這樣的需求並不容易實現，因為負責存取控管的程式碼具有橫跨 (cross-cutting)的特性，必須嵌入到應用系統的各個模組，很容易與應用邏輯發生夾雜不清的現象。礙於現有的程式機制和開發工具對於這樣的安全需求無法提供有效的支援，因此本研究將以剖面導向程式設計 (Aspect Oriented Programming，AOP)技術為基礎，設計一個宣告式EMR安全控管方法，。 在我們的方法中，安全控管邏輯將從EMR系統的核心抽離，並且匯集到單一的剖面 (Aspect)模組，使原有的系統更加模組化 (modularity)。此外，利用我們開發的存取控管程式碼產生器，安全管理者可以藉由宣告組態檔的方式產生EMR的存取控管程式碼。如此一來，安全管理者不僅可以容易地掌握全局、減少分散管理可能造成的疏失，更可以大幅減少維護EMR存取安全所需的時間及成本。 / This paper presents an aspect-oriented approach to providing adaptable access control framework for Electronic Medical Records (EMR) on Web-based platform. In our scheme, access control logic is decoupled from the core of application and collected into separate aspect modules which are automatically synthesized from access control rules in XML format and properly designed aspect templates. The generated aspect modules will then be compiled and integrated into the underlying application using standard aspect tools. At runtime, these aspect codes will be executed to enforce the required access control without any runtime interpretation overhead. Future changes of access control rules can also be effectively realized through these mechanisms without actual coding. This will not only improve the system’s modularity but also make the task of enforcing comprehensive access control more adaptable.

Over 700,000 adverse drug events (ADEs) result in emergency hospital visits annually, and many of these ADEs are preventable through the use of health information technology in hospitals. However, only 12.6% of U.S. hospitals have developed the capacity to adopt closed-loop electronic medical records (EMR). Organizational complexity may be a major factor influencing hospitals' adoption of closed-loop EMR. This quantitative study explored how organizational complexity influenced hospitals' adoption of closed-loop EMR. Diffusion of innovation theory was the foundation for this study. Logistic regression was used to establish possible relationships between organizational complexity and hospitals' adoption of EMR for closed-loop medication therapy management. Secondary data from Health Information and Management Systems Society were examined to explore the relationship between organization complexity and hospitals' adoption of EMR for closed-loop medication therapy. The research questions explored whether vendor selection strategy, structural complexity, and management structure influence hospitals' adoption of EMR for closed-loop medication therapy management. The results indicated that all three variables, vendor selection strategy, structural complexity, and management structure, are statistically significant predictors of hospitals' adoption of EMR for closed-loop medication therapy management. Results from this study may promote positive social change by enhancing hospitals' adoption of EMR for closed-loop medication therapy management, which may therefore help improve the quality, efficiency, and safety of health care delivery in U.S. hospitals.

Renny Varghese Impact of an Electronic Medical Record Implementation on Drug Allergy Overrides in a Large Southeastern HMO Setting (Under the direction of Russell Toal, Associate Professor) Electronic medical records (EMRs) have become recognized as an important tool for improving patient safety and quality of care. Decision support tools such as alerting functions for patient medication allergies are a key part of reducing the frequency of serious medication problems. Kaiser Permanente Georgia (KPGA) implemented its EMR system in the primary care departments at Kaiser's twelve facilities in the greater metro Atlanta area over a six month period beginning in June 2005 and ending December 2005. The aim of this study is to analyze the impact of the EMR implementation on the number of drug allergy overrides within this large HMO outpatient setting. Research was conducted by comparing the rate of drug allergy overrides during pre and post EMR implementation. The timeline will be six months pre and post implementation. Observing the impact of the incidence rate of drug allergy alerts after the implementation provided insight into the effectiveness of EMRs in reducing contraindicated drug allergies. Results show that the incidence rate of drug allergy overrides per 1,000 filled prescriptions rose by a statistically significant 5.9% (ñ > 0.0002; 95% CI [-1.531, -0.767]) following the implementation. Although results were unexpected, several factors are discussed as to the reason for the increase. Further research is recommended to explore trends in provider behavior, KPGA specific facilities and departments, and in other KP regions and non-KP healthcare settings. INDEX WORDS: electronic medical records, drug allergy overrides, patient safety, medication errors, decision support tools, outpatient setting, primary care, computerized provider order entry