Workflow issues related to adoption of the electronic health record (EHR) has led to unsafe workarounds, decreased productivity, inefficient clinical documentation and slow rates of EHR adoption. The problem addressed in this quality improvement project was nurses' lack of knowledge about workflow changes due to EHR adoption. The purpose of this project was to identify changes in workflow and to develop an educational module to communicate the changes. This project was guided by both the ADDIE model (analysis, design, development, implementation, and evaluation) and the diffusion of innovations theory. Five stages were involved: process mapping, cognitive walkthrough, eLearning module development, pilot study, and evaluation. The process maps and cognitive walkthrough revealed significant workflow changes particularly in clinical practice guidelines, emergency department treatment plan, and the interdisciplinary care plan. The eLearning module was developed to describe workflow changes using gamification, scenario-based learning, and EHR simulation. The 14-item course evaluation included a 6-point Likert scale and closed- and open-ended questions. A purposive sample of nurses (N = 30) from the emergency department and inpatient care areas were invited to complete the eLearning module and course evaluation. Data were collected until saturation was achieved (n = 15). Descriptive statistics revealed the participants' positive learning experience. This quality improvement project is expected to contribute to positive social change by facilitating the effective use of the new EHR which can improve the quality of patient care, promote patient safety, reduce healthcare costs, and improve patient outcomes.

Our ultimate goal as obstetric and neonatal care providers is to improve care for mothers and their babies. Continuous quality improvement (CQI) involves iterative cycles of practice change and audit of ongoing clinical care identifying practices that are associated with good outcomes. A vital prerequisite to this evidence based medicine is data collection. In Canada, much of the country is covered by separate fragmented silos known as regional reproductive care databases or perinatal health programs. A more centralized system which includes collaborative efforts is required. Moving in this direction would serve many purposes: efficiency, economy in the setting of limited resources and shrinking budgets and lastly, interaction among data collection agencies. This interaction may facilitate translation and transfer of knowledge to care-givers and patients. There are however many barriers towards such collaborative efforts including privacy, ownership and the standardization of both digital technologies and semantics. After thoroughly examining the current existing perinatal data collection among Perinatal Health Programs (PHPs), and the Canadian Perinatal Network (CPN) database, it was evident that there is little standardization of definitions. This serves as one of the most important barriers towards data sharing. To communicate effectively and share data, researchers and clinicians alike must construct a common perinatal language. Communicative tools and programs such as SNOMED CT® offer a potential solution, but still require much work due to their infancy. A standardized perinatal language would not only lay the definitional foundation in women’s health and obstetrics but also serve as a major contribution towards a universal electronic health record.

Η μηχανοργάνωση των φορέων υγείας αποτελεί προαπαιτούμενο για τη βελτίωση των παρεχόμενων υπηρεσιών τους ως προς τους πολίτες. Αν και η διεργασία έχει καθυστερήσει σημαντικά, φαίνεται πως οι εμπλεκόμενοι έχουν αντιληφθεί τη σπουδαιότητα της και πλέον ήδη βρίσκονται σε εξέλιξη προγράμματα προς αυτή την κατεύθυνση. Η ορθοπαιδική κλινική του ΠΓΝΠ, αποτελεί υπόδειγμα στο συγκεκριμένο τομέα καθώς ήδη από δεκαετίας έχει ηλεκτρονικό αρχείο με βασικά στοιχεία των ασθενών που νοσηλεύτηκαν, ενώ το 2005 πήγε ένα βήμα παραπέρα και επέκτεινε τη μηχανοργάνωση της με ηλεκτρονικό φάκελο υγείας ασθενή, εντάσοντας και τις απεικονιστικές εξετάσεις. Στο παρόν κείμενο στην εισαγωγή γίνεται μια ανάλυση της υπάρχουσας κατάστασης και μια λεπτομερής περιγραφή των προγραμμάτων που βρίσκονται σε εξέλιξη σχετικά με το θέμα. Δίνεται μια εξήγηση για την υστέρηση που έχει παρουσιαστεί και τα προβλήματα που αντιμετωπίζουν ανάλογα εγχειρήματα. Στην ενότητα 4 περιγράφεται σε γενικές γραμμές η εφαρμογή (λογισμικό) που εγκαταστάθηκε στην ορθοπαιδική κλινική και πως αυτή μηχανογραφεί της λειτουργικές διαδικασίες που ακολουθούνται στην καθημερινότητα του τμήματος. Στην επόμενη ενότητα η αναφορά εστιάζει περισσότερο στο “μικρόκοσμο” της κλινικής. Μιλάει με στατιστικά στοιχεία για το προσφερόμενο έργο της και ουσιαστικά αναλύει τον τρόπο με τον οποίο έγνε η εφαρμογή της μηχανοργάνωσης. Πώς ξεπεράστηκαν προβλήματα, τι χειρισμοί έγιναν με το προσωπικό, τι διαρθωτικές αλλαγές έγιναν ώστε να δημιουργηθεί ένα νέο τμήμα που ανέλαβε να κάνει το data entry. Η συνέχεια είναι με τις προοπτικές εξέλιξες οι οποίες χάρη σε μια θετική συγκυρία φαντάζουν εξαιρετικά ευοίωνες και στο τέλος παραθέτονται κάποια τεχνικά παραρτήματα που αφορούν περισσότερο το προσωπικό της κλινικής κι έχουν στόχο τη μετάδοση γνώσεων που θα βοηθήσουν στην εύρυθμη λειτουργία. / Computerization of health organizations consists precondition for the improvement of provided health services to citizens. Despite the process has an important delay, it seems the concerned parts are aware of the importance and projects aiming on this direction running already. The clinic of Orthopaedics at University Hospital of Patras, insists a positive sample in this sector. Since 90’s keeps a basic electronic database of patients’ data and in 2005 stepped forward adding health records and imaging platings (PAKS). Present thesis makes an analysis of present status and a description of relative projects in progress. An explanation for the hysteresis is given and solutions for past resolved problems. In chapter 4 presented the installed software in the clinic of Orthopaedics and how it is engaged with the procedures taking place in day life. In the next chapter the present thesis focuses on the clinic. It speaks in the language of statistics for the offered work towards the society and analysis the steps followed for the project of computerization. Finishing with the potential for evolution which seems to be very high thanks to a trend.

Our ultimate goal as obstetric and neonatal care providers is to improve care for mothers and their babies. Continuous quality improvement (CQI) involves iterative cycles of practice change and audit of ongoing clinical care identifying practices that are associated with good outcomes. A vital prerequisite to this evidence based medicine is data collection. In Canada, much of the country is covered by separate fragmented silos known as regional reproductive care databases or perinatal health programs. A more centralized system which includes collaborative efforts is required. Moving in this direction would serve many purposes: efficiency, economy in the setting of limited resources and shrinking budgets and lastly, interaction among data collection agencies. This interaction may facilitate translation and transfer of knowledge to care-givers and patients. There are however many barriers towards such collaborative efforts including privacy, ownership and the standardization of both digital technologies and semantics. After thoroughly examining the current existing perinatal data collection among Perinatal Health Programs (PHPs), and the Canadian Perinatal Network (CPN) database, it was evident that there is little standardization of definitions. This serves as one of the most important barriers towards data sharing. To communicate effectively and share data, researchers and clinicians alike must construct a common perinatal language. Communicative tools and programs such as SNOMED CT® offer a potential solution, but still require much work due to their infancy. A standardized perinatal language would not only lay the definitional foundation in women’s health and obstetrics but also serve as a major contribution towards a universal electronic health record.

As individuals are increasingly benefiting from the use of online services, there are growing concerns about the treatment of personal information. Society’s ongoing response to these concerns often gives rise to privacy policies expressed in legislation and regulation. These policies are written in natural language (or legalese) as privacy agreements that users must agree to, or presented as a set of privacy settings and options that users must opt in or out of in order to receive the service they want. But comprehensibility of privacy policies and settings is becoming increasingly challenging as agreements become longer and there are many privacy options to choose from. Additionally, organizations face the challenge of assuring compliance with policies that govern collecting, using, and sharing of personal data. This thesis proposes frameworks for personalized privacy and privacy auditing to address these two problems. In this thesis, we focus our investigation on the comprehensibility issues of personalized privacy using the concrete application domain of personal health data as recorded in systems known as personal health records (PHR). We develop the Privacy Goals and Settings Mediator (PGSM) model, which is based on i* multi-agent modelling techniques, as a way to help users comprehend privacy settings when employing multiple services over a web platform. Additionally, the PGSM model helps privacy experts contribute their privacy knowledge to the users’ privacy decision-making task. To address the privacy auditing problem, we propose two light-weight ontologies, L2TAP and SCIP, that are designed for deployment as Linked Data, an emerging standard for representing and publishing web data. L2TAP (Linked Data Log to Transparency, Accountability and Privacy) provides flexible and extensible provenance-enabled logging of privacy events. SCIP (Simple Contextual Integrity Privacy) provides a simple target for mapping the key concepts of Contextual Integrity and enables SPARQL query-based solutions for two important privacy processes: compliance checking and obligation derivation. This thesis validates the premise of PHR users’ privacy concerns, attitudes and behaviour through an empirical study. The usefulness of the PGSM model for privacy experts is evaluated through interviews with experts. Finally, the scalability and practical benefits of L2TAP+SCIP for log-based privacy auditing are validated experimentally.

As individuals are increasingly benefiting from the use of online services, there are growing concerns about the treatment of personal information. Society’s ongoing response to these concerns often gives rise to privacy policies expressed in legislation and regulation. These policies are written in natural language (or legalese) as privacy agreements that users must agree to, or presented as a set of privacy settings and options that users must opt in or out of in order to receive the service they want. But comprehensibility of privacy policies and settings is becoming increasingly challenging as agreements become longer and there are many privacy options to choose from. Additionally, organizations face the challenge of assuring compliance with policies that govern collecting, using, and sharing of personal data. This thesis proposes frameworks for personalized privacy and privacy auditing to address these two problems. In this thesis, we focus our investigation on the comprehensibility issues of personalized privacy using the concrete application domain of personal health data as recorded in systems known as personal health records (PHR). We develop the Privacy Goals and Settings Mediator (PGSM) model, which is based on i* multi-agent modelling techniques, as a way to help users comprehend privacy settings when employing multiple services over a web platform. Additionally, the PGSM model helps privacy experts contribute their privacy knowledge to the users’ privacy decision-making task. To address the privacy auditing problem, we propose two light-weight ontologies, L2TAP and SCIP, that are designed for deployment as Linked Data, an emerging standard for representing and publishing web data. L2TAP (Linked Data Log to Transparency, Accountability and Privacy) provides flexible and extensible provenance-enabled logging of privacy events. SCIP (Simple Contextual Integrity Privacy) provides a simple target for mapping the key concepts of Contextual Integrity and enables SPARQL query-based solutions for two important privacy processes: compliance checking and obligation derivation. This thesis validates the premise of PHR users’ privacy concerns, attitudes and behaviour through an empirical study. The usefulness of the PGSM model for privacy experts is evaluated through interviews with experts. Finally, the scalability and practical benefits of L2TAP+SCIP for log-based privacy auditing are validated experimentally.

This paper describes Inuit cultural considerations when defining and communicating electronic health concepts and personal health information services to urban Inuit audiences. Applying a two-eyed seeing model to build on and describe contextual meanings for Western and Inuit versions of health information and information communication technologies is critical to sustained relevance of electronic health information. Overarching concerns include reclaiming Inuit ownership and vision; sustainability; and; authority and capacity. It is within an electronic health space that Inuit can attain self-determination for the management of their own personal health data and develop a set of culturally safe and empowering practices for communicating ownership and cultural relevancy of health and health information in an evolving health care system.

Orientadores: Ivan Luiz Marques Ricarte, Maria Cristiane Barbosa Galvão / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Elétrica e de Computação / Made available in DSpace on 2018-08-26T07:52:51Z (GMT). No. of bitstreams: 1 Piconi_AndressaCristiani_M.pdf: 1915313 bytes, checksum: 8c75fc45b07dd43aba52a24a307e8bed (MD5) Previous issue date: 2014 / Resumo: Os prontuários eletrônicos do paciente (PEP) são mais do que um repositório de informações e provas relativas à assistência em saúde, são fontes de informação para a pesquisa, para a gestão e para a memória da sociedade. Considerados documentos arquivísticos digitais, a preservação desta informação, produzida e mantida por instituições de saúde ao longo do tempo, é fundamental para garantir a qualidade da assistência, da eficiência em diagnósticos e tratamentos e dos direitos dos pacientes. Dentre os mecanismos tecnológicos existentes para apoiar a preservação de documentos em meio digital ao longo do tempo está o da associação de metadados, desde o momento de sua produção até sua destinação final. É de fundamental importância que instituições produtoras e detentoras de documentos digitais de caráter arquivístico determinem estratégias consolida-das de preservação digital, atendendo à adoção de métodos e tecnologias que integrem a preservação física, lógica e conceitual dos documentos digitais, utilizando-se dos metadados como in-sumo primordial para o desenvolvimento dessas estratégias. O presente trabalho tem como objetivo responder a seguinte questão de pesquisa: quais são os metadados necessários para assegurar a preservação digital de prontuários eletrônicos do paciente, pelo tempo que for necessário, e como esses metadados podem ser organizados em uma ontologia? A partir de uma revisão de literatura foi definido um conjunto de metadados visando à preservação dos documentos (que pode ser aplicado tanto para os natos digitais quanto para os digitalizados) que compõem os PEPs, utilizando como modelo o Clinical Document Architecture (CDA) e os metadados do e-ARQ Brasil: Modelo de Requisitos para Sistemas Informatizados de Gestão Arquivística de Documentos. Uma ontologia foi proposta para formalizar esses conceitos e cenários hipotéticos foram elaborados para sua validação, representando os principais aspectos associados à definição de metadados para a preservação de documentos clínicos, buscando relacionar assim as áreas de Engenharia da Computação, de Arquivologia e da Saúde. Essa ontologia poderá ser utilizada por desenvolvedores para estabelecer e avaliar a presença de metadados e estratégias de preservação nos PEPs produzidos e gerenciados por sistemas de saúde. Além disso, poderá também orientar gestores e responsáveis pelo estabelecimento de políticas para a definição de normas e procedimentos específicos para a preservação de PEPs / Abstract: Electronic Health Records (EHR) are more than a repository of information and evidence related to health care, they are sources of information for research, for management and for the memory of society. Considered digital records, preservation of this information, produced and maintained by health institutions over time, is critical to ensure the quality of assistance and efficiency in diagnosis and treatment and patients' rights. Among the existing support for the preservation of documents in digital media over time technological mechanisms is the association of metadata from the time of its production until its final destination. It is vital that institutions produce and hold the digital archival records character consolidates determine strategies for digital preservation, given the adoption of methods and technologies that integrate the physical, logical and conceptual preservation of digital records, using metadata as a key for the development of these strategies. This paper aims to answer the following research question: what are the metadata required to ensure the digital preservation of electronic health records, for as long as necessary, and how these metadata can be organized into an ontology? From a literature review was defined a set of metadata aiming at the preservation of the documents (which can be applied to both born digital and digitized for) that make up the EHRs, using as a model the Clinical Document Architecture (CDA) and metadata of e-ARQ-Brasil: Model Requirements for Computerized Systems Archiving Document Management. An ontology is proposed to formalize these concepts and hypothetical scenarios were developed to validate it, representing the major aspects associated with the metadata definition for the preservation of clinical documents, seeking related the areas of Computer Engineering, Archivology and Health . This ontology can be used by developers to establish and evaluate the presence of metadata and preservation strategies for EHRs produced and managed by systems. It also can guide managers and responsible for establishing policies for the definition of specific rules and procedures for the preservation of EHRs / Mestrado / Engenharia de Computação / Mestra em Engenharia Elétrica

Our ultimate goal as obstetric and neonatal care providers is to improve care for mothers and their babies. Continuous quality improvement (CQI) involves iterative cycles of practice change and audit of ongoing clinical care identifying practices that are associated with good outcomes. A vital prerequisite to this evidence based medicine is data collection. In Canada, much of the country is covered by separate fragmented silos known as regional reproductive care databases or perinatal health programs. A more centralized system which includes collaborative efforts is required. Moving in this direction would serve many purposes: efficiency, economy in the setting of limited resources and shrinking budgets and lastly, interaction among data collection agencies. This interaction may facilitate translation and transfer of knowledge to care-givers and patients. There are however many barriers towards such collaborative efforts including privacy, ownership and the standardization of both digital technologies and semantics. After thoroughly examining the current existing perinatal data collection among Perinatal Health Programs (PHPs), and the Canadian Perinatal Network (CPN) database, it was evident that there is little standardization of definitions. This serves as one of the most important barriers towards data sharing. To communicate effectively and share data, researchers and clinicians alike must construct a common perinatal language. Communicative tools and programs such as SNOMED CT® offer a potential solution, but still require much work due to their infancy. A standardized perinatal language would not only lay the definitional foundation in women’s health and obstetrics but also serve as a major contribution towards a universal electronic health record. / Medicine, Faculty of / Obstetrics and Gynaecology, Department of / Graduate

The landscape of the United States public school system was greatly improved upon with the creation of The Individuals with Disabilities Education Act of 2004 (IDEA 2004). This act established a standard that allowed all school aged children living with chronic illnesses to integrate into public school systems. This mandate currently impacts over 12 million children living with chronic illness including and not limited to asthma, seizure disorders, developmental delay, cystic fibrosis, traumatic brain injuries, anxiety and cancer. IDEA 2004 extended healthcare into public school systems and as a result, increased the average acuity of students that school nurses (SNs) care for. It is estimated that 15% of school-aged children miss 11 or more school days per year because of illness or injury demonstrating evidence of increased student acuity and a need to provide more appropriate care for these students in order to increase their time spent in the academic setting. Adequate SN and primary care provider (PCP) communication is essential to reduce absenteeism for this population and to ensure that students are safe during their time spent away from home and healthcare clinics. From this quality improvement project, more is understood pertaining to the communication patterns between SNs and PCPs and recommendations are provided in order to increase effective SN and PCP communication.