Thesis (M.Com. (Information Systems))--University of the Witwatersrand, Faculty of Commerce, Law and Management, School of Economic and Business Sciences, 2014. / Successful implementation of electronic medical record systems (EMRs) can result in many benefits. However, the adoption and use of EMRs by health workers is often problematic. Understanding the perceptions and attitudes of health workers towards the use of these systems is therefore important. This study has contributed by examining (a) perceptions of health workers towards the characteristics of EMR systems, (b) perceptions of the impacts of EMR use on healthcare delivery and other workplace outcomes (i.e. individual work performance and job satisfaction), (c) their intentions to continue using EMRs. The DeLone and McLean Information System Success model and the Information Systems Continuance model were used to underpin the study and to hypothesize inter-relationships amongst these perceptions and attitudes. The empirical context of the study was Tygerberg Hospital in Cape Town, South Africa. A survey was carried out and 142 responses were obtained from the nurses at the hospital. Results showed that system characteristics, namely, system quality, information quality and service quality were significant predictors of user satisfaction, which in turn was found to be a significant predictor of EMR use. Satisfaction together with perceptions of individual impacts and healthcare impacts was found to lead to continuance intention. Users reported statistically significantly higher levels of job satisfaction than non-users. Healthcare impact perceptions was positively associated with job satisfaction. Based on the results of the study, it is recommended that decision makers, policy makers and EMR vendors pay close attention to the service quality and the system quality of EMRs as these are the key determinants of user satisfaction. It is also recommended that managers ensure that all healthcare workers be given access to and encouraged to use EMRs to perform their work related task as EMR users have been shown to have higher levels of job satisfaction than non-users.

O objetivo deste estudo foi analisar os prontuários de pacientes de hanseníase na cidade de Palmas, Tocantins, verificando a completude de preenchimento dos documentos obrigatórios de constarem no mesmo, bem como a qualidade dos registros realizados pelos diversos profissionais durante o tratamento dos pacientes. Para coletar os dados foi utilizado um checklist por meio do qual se registrou o nível de completude do preenchimento de documentos obrigatórios do prontuário do paciente de hanseníase, o Nível do Registro Descritivo, e os dados o Grau de Incapacidade Física e Escore de Olhos, Mãos e Pés do paciente. Foram analisados 233 prontuários de pacientes diagnosticados e tratados entre 2011 e 2014, sendo a maior parte deles, do sexo masculino (61%). O documento com maior percentual de preenchimento parcial foi o Formulário de Vigilância de Contatos Intradomiciliares (79,4%). Quanto aos documentos do prontuário como um todo, apenas 0,86% dos prontuários foram considerados como estando adequados. O Nível do Registro Descritivo foi predominantemente Mínimo (38,4%) e Médio (58,6%). Houve associação estatística significativa (p<0,05) entre esta variável e o Escore de Olhos, Mãos e Pés. Este estudo e seus resultados reforçam a hipótese de que existe relação entre registro mal feito e cuidado mal prestado ao paciente. / The objective of this study was to analyze the records of leprosy patients in the city of Palmas, Tocantins, verifying the completeness of filling out the mandatory documents included in it, as well as the quality of the records made by the various professionals during the treatment of the patients. To collect the data, a checklist was used to record the completeness of fulfillment in the mandatory documents of the leprosy patient record, the Level of Descriptive Record, and the data on the Physical Disability Grade and Eye-Hand-Foot Score of the patient. We analyzed 233 medical records of patients diagnosed and treated between 2011 and 2014, most of them male (61%). The document with the highest percentage of partial completion was the Intradomiciliary Contacts Surveillance Form (79.4%). As for the documents of the patient record as a whole, only 0.86% of the records were considered adequate. The level of Descriptive Record was predominantly Minimum (38.4%) and Medium (58.6%). There was a statistically significant association (p<0.05) between this variable and the Eye-Hand-Foot Score. This study and its results reinforce the hypothesis that there is a relationship between poorly done registry and poor care provided to the patient.

by Raymond Pui-chiu Yuen. / Summary in Chinese and English. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1979. / Bibliography: leaves 129-130.

Cheng Po Chu. / Thesis (M.Sc.)--Chinese University of Hong Kong, 1992. / Includes bibliographical references. / ABSTRACT --- p.1 / Chapters / Chapter I. --- BACKGROUND --- p.2 / Chapter II. --- OVERVIEW OF HISTORY-TAKING EXPERT SYSTEMS --- p.3 / Chapter II.1 --- Structure of Diagnostic systems --- p.3 / Chapter II.2 --- Present Design --- p.4 / Chapter III. --- LOGICAL APPROACH TO HISTORY TAKING --- p.5 / Chapter III.1 --- Objectives of Taking a Medical History --- p.5 / Chapter III.2 --- Process of History Taking --- p.6 / Chapter III.3 --- The Art of Asking Questions --- p.8 / Chapter III.4 --- Implementation Problems --- p.9 / Chapter III.4.1 --- Question of Users --- p.9 / Chapter III.4.2 --- Question of the End Point --- p.10 / Chapter III.4.3 --- Analysis Problems --- p.10 / Chapter IV. --- DESIGN OF THE SYSTEM --- p.11 / Chapter IV.1 --- DATA REPRESENTATION --- p.11 / Chapter IV.1.1 --- Diagnosis --- p.11 / Chapter IV.1.2 --- Symptoms --- p.12 / Chapter IV.1.3 --- Patient History --- p.14 / Chapter IV.2 --- KNOWLEDGE --- p.15 / Chapter IV.3 --- INFERENCE ENGINE --- p.19 / Chapter IV.4 --- TEACHING MECHANISM --- p.24 / Chapter IV.4.1 --- Diagnostic Module --- p.24 / Chapter IV.4.2 --- Teaching Module: --- p.24 / Chapter V. --- STATISTICAL STUDY --- p.26 / Chapter VI. --- SAMPLE RUNNING OF THE PROGRAM: --- p.27 / Chapter VI.l. --- DIAGNOSTIC MODULE --- p.28 / Chapter VI.1.1 --- "Demographic Data, Chief Complaint and History of Present Illness" --- p.28 / Chapter VI.1.2 --- Related Symptoms --- p.30 / Chapter VI.1.3 --- Symptom Descriptors --- p.30 / Chapter VI.1.4 --- Deduction and Ask Cycle --- p.30 / Chapter VI.1.5. --- Summary --- p.31 / Chapter VI.1.6 --- Record in casebook --- p.32 / Chapter VI.2 --- THE TUTORING MODULE --- p.32 / Chapter VI.2.1 --- Demographic Data and Chief Complaint --- p.32 / Chapter VI.2.2 --- Advises and History of Present Illness --- p.33 / Chapter VI.2.2.1 --- Advises --- p.33 / Chapter VI.2.2.2 --- Summary --- p.34 / Chapter VI.2.2.3 --- History of Present Illness --- p.34 / Chapter VI.2.2.4 --- Advises again --- p.35 / Chapter VI.2.2.5 --- History of Present Illness again --- p.36 / Chapter VI.2.2.6 --- Advises again --- p.36 / Chapter VI.2.2.7 --- Summary again --- p.37 / Chapter VI.2.2.8 --- History of Present Illness again --- p.37 / Chapter VI.2.2.9 --- Offer of advice and Summary again --- p.38 / Chapter VI.2.3 --- Termination --- p.38 / Chapter VI.3 --- RETRIEVING CASES AND SUMMARIZING --- p.39 / Chapter VII. --- PERFORMANCE OF THE SYSTEM --- p.43 / Chapter VIII. --- FURTHER DEVELOPMENT --- p.44 / CONCLUSION --- p.46 / REFERENCES: --- p.46 / ACKNOWLEDGMENT: --- p.46

Background: Childhood Traumatic Brain Injury (TBI) has been identified as a crucial public concern, causing interrup-tion in children’s cognitive development, sometimes resulting in permanent impairment or even death. Hence documen-tation in health and school records regarding their functioning or environmental restrictions post injury, seems vital for the facilitation of communication between a child’s systematic and ongoing environment. Especially since children’s health has been described as a holistic construct comprised of psycho, social and physical well-being. Requiring continual inter-disciplinary and collaborative efforts over their course of development. Aim: To explore literature related to cognitive functioning and recommended support for children who have experienced a TBI, and how professional’s document their associated problems within medical and school records regarding activities in or outside the classroom. Method: A sys-tematic review, strictly comprised of empirical studies. Selected due to its sequential structural design for attainment of literature relevant to the research topic of choice and quality assessment procedures which enable reduction of threats to bias findings. Results: A total of 9 articles were yielded after quality assessment and depicted that. Reduced processing speeds in cognitive ability domains can be regarded as the default or baseline outcomes after a childhood TBI. Predictors within these different domains impacted their adequate academic, social function and varied depending on age at injury (2-4yrs or 4-8yrs), Injury severity (mild, moderate/severe), family function and time points. Early and severe TBI showed significant residual impairments across all time points, whilst the mild to moderate groups showed low to average func-tioning, as with the typical sample groups after two-year time points. Executive, attention skills impairment and post injury support within home and school settings. Showed to have the highest impact on both behaviours in, outside the classroom and academic performance. Documentation: Mainly biological and admission details were documented in the medical records. Within school records, all except one most recent study used either parental, teacher reports or direct measures to assess functioning of TBI affected children within school. Hereby a need for documentation of environmental factors within medical records, high quality transition of their TBI information within their school settings and continual docu-mentation of their progress or supports in school is required.

Molecular imaging of the human body is beginning to revolutionize drug development, drug delivery targeting, prognostics and diagnostics, and patient screening for clinical trials. The primary clinical tool of molecular imaging is Positron Emission Tomography (PET), which uses radioactively tagged probes (radioligands) for the in vivo quantification of blood flow, metabolism, protein distribution, gene expression and drug target occupancy. While many radioligands are used in human research, only a few have been adopted for clinical use. A major obstacle to translating these tools from bench-to-bedside is that PET images acquired using complex radioligands can not be properly interpreted or quantified without arterial blood sampling during the scan. Arterial blood sampling is an invasive, risky, costly, time consuming and uncomfortable procedure that deters subjects' participation and requires highly specialized medical staff presence and laboratories to run blood analysis. Many approaches have been developed over the years to reduce the number of blood samples for certain classes of radioligands, yet the ultimate goal of zero blood samples has remained illusive. In this dissertation we break this proverbial blood barrier and present for the first time a non-invasive PET quantification framework. To accomplish this, we introduce novel image processing, modeling, and tomographic reconstruction tools. First, we developed dedicated pharmacokinetic modeling, machine learning and optimization framework based on the fusion of Electronic Health Records (EHR) data with dynamic PET brain imaging information. EHR data is used to infer individualized metabolism and clearance rates of the radioligand from the body. This is combined with simultaneous estimation on multiple distinct regions of the PET image. A substantial part of this effort involved curating, and then mining, an extensive database of PET, EHR and arterial blood sampling data. Second, we outline a new tomographic reconstruction and resolution modeling approach that takes into account the scanner point spread function in order to improve the resolution of existing PET data-sets. This technique allows visualization and quantification of structures smaller than previously possible. Recovery of signal from blood vessels and integration with the non-invasive framework is demonstrated. We also show general applicability of this technique for visualization and signal recovery from the raphe, a sub-resolution cluster of nuclei in the brain that were previously not detectible with standard techniques. Our framework can be generalizable to all classes of radioligands, independent of their kinetics and distribution within body. Work presented in this thesis will allow the PET scientific and clinical community to advance towards the ultimate goal of making PET cost-effective and to enable new clinical use cases.

Inappropriate use of medications (IUM) is a global problem that can lead to unnecessary harm to the patients and unnecessary costs across the health care system. Identifying and reducing IUM has been a long-lasting challenge and currently, no systematic and automated solution exists to address it. IUM can be manually identified by experts using medication appropriateness criteria (MAC). In this research I first conducted a review of approaches used to identify IUM and reduce IUM. Next, I developed a conceptual model for representing the MAC, and then developed a tool and a workflow for translating the MAC into structured form. Because indications are an important component of the MAC, I conducted a critical appraisal of existing knowledge sources that can be used to that end, namely the medication-indication knowledge-bases. Finally, I demonstrated how these structured MAC can be used to identify patients who are potentially subject to IUM and evaluated the accuracy of this approach. This research identifies the knowledge gaps and technological challenges in identifying and reducing IUM and addresses some of these gaps through the creation of a representation for MAC, a repository of structured MAC, and a set of tools that can assist in evaluating the impact of interventions aimed to reduce IUM or assess its downstream effects. This research also discusses the limitations of existing methods for executing computable decision support rules and proposes solutions needed to enhance these methods so they can support implementation of the MAC.

The increasing adoption of electronic health records (EHRs) has led to an unprecedented amount of patient health information stored in an electronic format. The ability to comb through this information is imperative, both for patient care and computational modeling. Creating a system to minimize unnecessary EHR data, automatically distill longitudinal patient information, and highlight salient parts of a patient’s record is currently an unmet need. However, summarization of EHR data is not a trivial task, as there exist many challenges with reasoning over this data. EHR data elements are most often obtained at irregular intervals as patients are more likely to receive medical care when they are ill, than when they are healthy. The presence of narrative documentation adds another layer of complexity as the notes are riddled with over-sampled text, often caused by the frequent copy-and-pasting during the documentation process. This dissertation synthesizes a set of challenges for automated EHR summarization identified in the literature and presents an array of methods for dealing with some of these challenges. We used hybrid data-driven and knowledge-based approaches to examine abundant redundancy in clinical narrative text, a data-driven approach to identify and mitigate biases in laboratory testing patterns with implications for using clinical data for research, and a probabilistic modeling approach to automatically summarize patient records and learn computational models of disease with heterogeneous data types. The dissertation also demonstrates two applications of the developed methods to important clinical questions: the questions of laboratory test overutilization and cohort selection from EHR data.

Communication is a critical aspect of clinical work. In 2010, the Joint Commission (JC) found that gaps in communication were among leading factors contributing to medical errors. Healthcare processes, such as patient discharge, depend on interdisciplinary communication to be successful. Electronic health records (EHRs) have the potential to facilitate communication and information sharing between interdisciplinary care team members; however, challenges remain in designing tools for team-based care and questions remain in understanding how EHRs impact interdisciplinary team communication. This dissertation focuses on understanding how EHRs can be designed to support communication and information sharing within interdisciplinary patient care teams. The first aim of the dissertation investigated how EHRs impact interdisciplinary clinical teams’ communication, shared mental models, and information sharing activities. The results showed that implementing new EHR tools appeared to have little impact on communication and shared mental models, but new information sharing activities mediated by EHR developed. These changes and lack thereof suggest that new EHR tools will be specifically needed to facilitate interdisciplinary team information sharing activities. The second aim of the dissertation investigates the information sharing activities and information needs of interdisciplinary team members during patient discharge. The results showed that the information clinicians sought out during discharge depended on the roles that person played as well as the progress of the discharge process. Future EHR tools should be aware of how patient care teams are progressing through the patient discharge process in order to provide information contextualized to their current tasks. In conclusion, interdisciplinary team communication and information sharing remain poorly supported by current EHRs and new tools designed specifically for interdisciplinary teams should provide information based on the completion of team activities.

Made available in DSpace on 2014-07-29T15:25:15Z (GMT). No. of bitstreams: 1 TESE SANDRA CRISTINA BAHIA.pdf: 1833217 bytes, checksum: c354d174a33e01cc328bf92dd63a17ed (MD5) Previous issue date: 2011-04-26 / This study aimed to analyze the productivity and efficiency of the Comprehensive Dental Care (CDC) of Faculty of Dentistry of Universidade Federal de Goiás and discuss about the Brazilian Curriculum Guidelines in Dentistry ande the comprehensive dental care course. It was a retrospective study of all medical records of patients scheduled for the discipline of CDC from 2004 to 2009. It was found 1406 patients scheduled. However, 754 were excluded because they are not within the criteria for inclusion in the research. The sample ended with 652 records. It was used for data collection form. Three researchers participated in the standardized collection. The variables studied were sociodemographic characteristics of patients, treatment plan, start date, completion and duration of treatment, amount, type and complexity of dental procedures performed and treatment situation. Descriptive and inferential analysis, Spearman's correlation, one way Anova, Kaplan-Meier and Cox regression were performed. The CDC was criated in Brazil in decade 70 The mean age was 40.9 years (SD = 14.4), 67.8% women, 50.4% married / living with a partner, 40.3% self-employed workers mostly women and 20.8%, home. Of the patients treated 71.5% were residents in the state capital. The discipline was the most performed dentistry (32.6%) followed by periodontology (25.2%). Most patients are in treatment, and 253 patients (38.8%) completed their dental treatment. The complexity of clinical case was the factor that influences the duration of treatment, with the median correlation (r = 0.60, p <0.001). The estimated time for completion of all treatments was 23 months (95% CI = 19.6-26.3) and was significantly different (p <0.001) at different levels of complexity (low 13.0, intermediate 19.0, high 47.0). The results indicate that they are made in the integrated clinic procedures characteristic of general practice. Patients treated are mostly employees and freelancers. The complexity of clinical case influences the efficiency of the CDC. / Esse estudo teve como objetivo identificar o perfil dos pacientes, a produtividade e eficiência da Clínica Integrada da Faculdade de Odontologia da Universidade Federal de Goiás (FO/UFG), além de fazer uma reflexão sobre as Diretrizez Curriculares Nacionais dos cursos de Odontologia e a disciplina de Clínica Integrada. Fez-se um estudo bibliográfico e de campo retrospectivo em todos os prontuários dos pacientes agendados para a disciplina de Clinica Integrada (CI) nos anos de 2004 a 2009. Encontrou-se 1406 pacientes agendados. No entanto, 754 foram excluídos, por não estarem dentro dos critérios de inclusão da pesquisa. A amostra finalizou com 652 prontuários. Utilizou-se para a coleta dos dados um formulário. Tres pesquisadores padronizados participaram da coleta. As variáveis pesquisadas foram aspectos sociodemográficos dos pacientes, plano de tratamento, data de inicio, de conclusão e tempo de duração do tratamento, quantidade, tipos e complexidade dos procedimentos odontológicos realizados e situação do tratamento. Análises descritivas e inferenciais, correlação de Sperman s, one way Anova, Kaplan-Meier e Regressão de Cox foram realizadas. A disciplina de CI foi incorporada nos currículos brasileiros na década de 70 e se apresenta de maneira diversa em cada uma das faculdades. A idade média dos pacientes da CI da FO/UFG foi de 40,9 anos (dp=14,4), 67,8% mulheres, 50,4% casados/com companheiro, 40,3% trabalhadores em sua maioria autônomos e 20,8% das mulheres, do lar. Do total dos pacientes atendidos 71,5% eram residentes na capital do estado. A disciplina mais realizada foi a dentística (32,6%) seguida da periodontia (25,2%). A maioria dos pacientes está em tratamento, sendo que 253 pacientes (38,8%) concluíram o tratamento odontológico. A complexidade do caso clínico foi o fator influenciador no tempo de duração do tratamento, com a correlação mediana (r=0.60; p<0.001). O tempo estimado para a conclusão de todos os tratamentos foi de 23 meses (95%CI=19.6-26.3) e foi significativamente diferente (p<0.001) nos diversos níveis de complexidade (baixo 13.0, intermediário 19.0, alto 47.0). Os resultados indicam que são realizados na Clínica Integrada os procedimentos característicos da prática generalista, os pacientes atendidos são em sua maioria empregados e autônomos. A complexidade do caso clínico influencia na eficiência da Clínica Integrada.