Access to information is fundamental in health care. This thesis presents research on Swedish medical records with the overall goal of building intelligent information access tools that can aid health personnel, researchers and other professions in their daily work, and, ultimately, improve health care in general. The issue of ethics and identifiable information is addressed by creating an annotated gold standard corpus and porting an existing de-identification system to Swedish from English. The aim is to move towards making textual resources available to researchers without risking exposure of patients’ confidential information. Results for the rule-based system are not encouraging, but results for the gold standard are fairly high. Affirmed, uncertain and negated information needs to be distinguished when building accurate information extraction tools. Annotation models are created, with the aim of building automated systems. One model distinguishes certain and uncertain sentences, and is applied on medical records from several clinical departments. In a second model, two polarities and three levels of certainty are applied on diagnostic statements from an emergency department. Overall results are promising. Differences are seen depending on clinical practice, annotation task and level of domain expertise among the annotators. Using annotated resources for automatic classification is studied. Encouraging overall results using local context information are obtained. The fine-grained certainty levels are used for building classifiers for real-world e-health scenarios. This thesis contributes two annotation models of certainty and one of identifiable information, applied on Swedish medical records. A deeper understanding of the language use linked to conveying certainty levels is gained. Three annotated resources that can be used for further research have been created, and implications for automated systems are presented.

Growing adoption of health information technologies is allowing healthcare providers to capture and store enormous amounts of patient data. In order to effectively use this data to improve healthcare outcomes and processes, clinicians need to identify the relevant measures and apply the correct analysis methods for the type of data at hand. In this dissertation, we present various data mining and statistical methods that could be applied to the type of datasets that are found in healthcare research. We discuss the process of identification of appropriate measures and statistical tools, the analysis and validation of mathematical models, and the interpretation of results to improve healthcare quality and safety. We illustrate the application of statistics and data mining techniques on three real-world healthcare datasets. In the first chapter, we develop a new method to assess hydration status using breath samples. Through analysis of the more than 300 volatile organic compounds contained in human breath, we aim to identify markers of hydration. In the second chapter, we evaluate the impact of the implementation of an electronic medical record system on the rate of inpatient medication errors and adverse drug events. The objective is to understand the impact on patient safety of different information technologies in a specific environment (inpatient pediatrics) and to provide recommendations on how to correctly analyze count data with a large amount of zeros. In the last chapter, we develop a mathematical model to predict the probability of developing post-operative nausea and vomiting based on patient demographics and clinical history, and to identify the group of patients at high-risk.

Thesis (Ph.D.)--University of Wollongong, 2009. / Typescript. Includes bibliographical references: p. 235-248.

Thesis (doctoral)--Universität St. Gallen, 2003. / Includes bibliographical references (p. xxxiii-l).

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

The KwaZulu-Natal Department of Health highlighted in the 2005-2009/2010 Strategic Plan many challenges. One of the major challenges was an inadequate management information system at Emergency Medical Rescue Services (EMRS). It was further stated that decision-making becomes risky in the absence of reliable and accurate information. EMRS provides an ambulance service to the citizens of KwaZulu-Natal. This research will focus on EMRS in eThekwini District. In order to provide the best possible service to the citizens there has to be effective information management. The questionnaire survey used in this research project attempted to reach a broad cross-section of the various groups of people (management, operations and administrative staff) who take part in information work, and hence develop a broad sense of their perceptions and beliefs about how information is managed and used at eThekwini EMRS. The answering of questions varied between the groups. This showed that managers, operational staff and administrative staff have different perceptions on information management. Some of the recommendations included: EMRS has to adopt information as a strategic resource; information must be used in addressing problem areas; staff must have access to information that EMRS gathers; and further research has to be conducted at EMRS to address the challenges the organisation faces. / Thesis (MPA)-University of KwaZulu-Natal, Westville, 2010.

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

Thesis (Ph.D.)--University of Wollongong, 2006. / Typescript. Includes bibliographical references: leaf 343-380.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb 11, 2009). Includes bibliographical references (p. 73-94).

Made available in DSpace on 2016-06-02T20:44:14Z (GMT). No. of bitstreams: 1 5810.pdf: 4577582 bytes, checksum: a715a6af82868f2ff89c181e7fa995ba (MD5) Previous issue date: 2014-02-27 / The quality of records conducted on medical record reflects the quality of care provided, and can inform about the health service. The literature raised for this study is emphatic when saying that the record of the professional writing is the only acceptable proof of intervention in treatment. This research is a transversal study, descriptive and exploratory based on technique of documentary analysis. The study aimed to describe what occupational therapists who work in outpatient service are registering in the medical records. For data collection was used a "check-list", which contains information on: Assessment, Intervention and Results. The records analyzed were those of patients who received occupational therapy treatment between June 2012 to June 2013. There were selected only those who were discharged, in order not to bring any bother. 15 medical charts were analyzed. It was found that the initial assessment (93, 3%) was the subtype most frequently used by professionals of the clinic and the method for recording was the use of pre-defined roadmap for the institution (80%), followed by information about the routine, complain and goals of the patient (80%). For intervention records, the subtype record used was the daily evolution (100%), being the narrative (100%) the method used to record the evolutions. Were analyzed 269 records of evolutions. There were found more information about the type of technical procedure used (100%) in the intervention was a free annotation, without a pattern. As for the discharged record it was observed that all professionals use a registry model (100%) as subtype to discharged record and all records (100%) the method used to discharged record was the guide pre- defined by the institution. Information to identify the record and information to identify the patient were the most frequent (93%), followed by information about the intended objectives and if they had been reached or not (26%). The study suggests a closer relationship with the subject rarely discussed in Brazilian literature and may point to a lack of important information in the records, suggesting that this issue needs to be better crafted, stimulating the search for capacity building on the subject. This research also provided knowledge that may guide the practice of occupational therapists, enabling greater accuracy when performing patient records. / A qualidade dos registros efetuados em prontuário é reflexo da qualidade da assistência ofertada, podendo informar acerca do serviço prestado em saúde. A literatura levantada para este estudo é enfática ao apontar que o registro do profissional, escrito, é a única prova aceitável da intervenção no tratamento. Esta pesquisa é um estudo transversal, descritivo e exploratório, baseada na técnica de análise documental. O estudo teve como objetivo descrever o que os Terapeutas Ocupacionais atuantes em serviço ambulatorial infanto-juvenil estão registrando em prontuário. Para a coleta de dados foi utilizado um check-list , que contem informações relativas à: Avaliação; Intervenção; Resultados/alta. Os prontuários analisados foram aqueles de pacientes que receberam atendimento terapêutico ocupacional no período de junho de 2012 a junho de 2013; deste período foram selecionados apenas aqueles que receberam alta, a fim de não trazer qualquer problema no aspecto ético. Foram analisados 15 prontuários e possível constatar que a avaliação inicial (93, 3%) foi o subtipo de avaliação mais utilizado pelos profissionais do ambulatório e o método para o registro foi o uso de roteiro pré definido pela instituição (80%). As informações mais encontradas no momento da avaliação foram: identificação pessoal do paciente; condição de saúde e histórico clínico (86%), seguidas de informações sobre o encaminhamento, queixas e objetivos do paciente (80%). Para os registros de intervenção, o subtipo de registro utilizado foi a evolução diária (100%), sendo a narrativa livre (100%) o método utilizado para o registro das evoluções. Foram analisados 269 registros de evoluções. As informações mais encontradas foram sobre o tipo de procedimento técnico utilizado (100%) na intervenção. Já para o registro da alta, foi observado que todos os profissionais usam um modelo de registro (100%), como subtipo de registro da alta, e em todos os prontuários (100%) o método utilizado para o registro da alta foi o Roteiro pré-definido pela instituição. Informações para identificar o registro e informações para identificar o paciente foram as mais encontradas (93%), seguidas por informações quanto aos objetivos pretendidos e se foram alcançados ou não (26%). O estudo possibilitou maior aproximação com o tema pouco abordado na literatura brasileira e pôde apontar para uma ausência de informações importantes nos prontuários, sugerindo que essa questão precisa ser melhor investigada, em outros contextos de intervenção, estimulando a busca pela capacitação acerca do assunto. A pesquisa também forneceu conhecimentos que poderão orientar a prática dos terapeutas ocupacionais, possibilitando maior acuidade ao se realizar registros em prontuários.