The voluntary North American accreditation movement, born at the beginning of this century with the intent to improve the standards of medical care and teaching, decreed that the clinical records should reflect the care given to the patients. As a consequence, the occupation of Medical Record Librarian, recently renamed Health Record Administrator, has grown rapidly over the past few decades. In Canada, this growth was more numerical than substantive, and the types and quality of health record administration services—discussed later, did not meet the needs of the health care system. Within the occupation, there is serious concern about its continued viability. For these various reasons, the adaptability of the health record administrator to the scientific, technological and social changes taking place in the health field is investigated here. To study the question, the health record administrator occupation was examined in the context of the changing status of health information within the Canadian health care delivery system and the jostling professionalization of the health occupations. These two major forces are believed to have great impact upon the health record administrator occupation in its quest for survival. The Delphi-method developed by the Rand Corporation was used to elicit the predictions of some members of the health occupations as to the potential development or regression of the role of the Health Record Administrator in the future. The findings of this study show that the health occupations, and particularly the medical profession have acknowledged needs for health information and health information management services. They have forecast a strong administrative role for the future Health Record Administrator, while giving equal importance to a participative role as collaborator providing the health occupations with the information services that they require for the performance of their own duties. They also visualize the integration of the various sectors of the health field with the Health Record Administrator being a potential agent of this integration process. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Modern health care systems are information dense and increasingly relying on computer-based information systems. Regrettably, many of these information systems behave only as an information repository, and the interoperability between different systems remains a challenge even with decades of investment in health information exchange standards. Medical records are complex data models and developing medical data import / export functions a is difficult, prone to error and hard to maintain process. Bidirectional transformations (bx) theories have been developed within the last decade in the fields of software engineering, programming languages and databases as a mechanism for relating different data models and keeping them consistent with each other. Current bx theories and tools have been applied to hand-picked, small-size problems outside of the health care sector. However, we believe that medical record exchange is a promising industrial application case for applying bx theories and may resolve some of the interoperability challenges in this domain. We introduce BXE2E, a proof-of-concept framework which frames the medical record interoperability challenge as a bx problem and provides a real world application of bx theories. During our experiments, BXE2E was able to reliably import / export medical records correctly and with reasonable performance. By applying bx theories to the medical document exchange problem, we are able to demonstrate a method of reducing the difficulty of creating and maintaining such a system as well as reducing the number of errors that may result. The fundamental BXE2E design allows it to be easily integrated to other data systems that could benefit from bx theories. / Graduate / 0984

Thesis (Ph. D.)--University of Hawaii at Manoa, 1991. / Includes bibliographical references (leaves 128-132) / Microfiche. / xiii, 132 leaves, bound ill. 29 cm

Research Problem: The South African health system faces numerous challenges associated with its status as a middle-income developing nation. Wasteful expenditure and poor clinical outcomes arise from inefficient inter-organizational communication of patient information and the lack of a centralized health database. Research question: How does the experience of chronic disease patients with their health information inform the development of future health records in low income population groups? Proposition: Exploration of patient and health care workers experiences of medical records can inform their future development to enhance continuity of care. Objectives, methodology, procedures and outcome: Identification of an appropriate format, technological basis and functional design of a prototype medical record system by means of a phenomenological study conducted through in-depth interviews of patients and doctors in order to improve clinical care. Left and right hermeneutics were used to analyse the data and develop themes. Findings: Health records play a critical role in the clinics workflow processes, document the patients' management and clinical progress. They are an important intermediary in the relationship between the patient and the facility. Inefficiencies in the paper-based system lead to ineffective consultations, loss of continuity of care and discord between practitioners and patients. Improvement of the records format is required to provide ubiquitous access to health and improve patient health literacy.

Indiana University-Purdue University Indianapolis (IUPUI) / Polypharmacy leads to increased risk of drug-drug interactions (DDI’s). In this dissertation, we create a database for quantifying fraction of metabolism (fm) of CYP450 isozymes for FDA approved drugs. A reproducible data collection protocol was developed to extract key information from publicly available in vitro selective CYP enzyme inhibition studies. The fm was then estimated from the curated data. Then, proposed a random control selection approach for nested case-control design for electronical health records (HER) and electronical medical records (EMR) databases. By relaxing the matching by case’s index time restriction, random control dramatically reduces the computational burden compared with traditional control selection approaches. Using the Observational Medical Outcomes Partnership gold standard and an EMR database, random control is demonstrated to have better performances as well. Finally, combining epidemiological studies and pharmacokinetic modeling with fm database, we detected and evaluated high-dimensional drug-drug interactions among thirty high frequency drugs. Multi-drug combinations that increased risk of myopathy were identified in the FAERS and EMR databases by a mixture drug-count response model (MDCM) model. Twenty-eight 3-way and 43 4-way DDI’s increased ratio of area under plasma concentration–time curve (AUCR) >2-fold and had significant myopathy risk in both databases. The predicted AUCR of omeprazole in the presence of fluconazole and clonidine was 9.35; and increased risk of myopathy was 6.41 (LFDR = 0.002) in FAERS and 18.46 (LFDR = 0.005) in EMR. We demonstrate that combining health record informatics and pharmacokinetic modeling is a powerful translational approach to detect high-dimensional DDI’s. / 2 years

Electronic medical records, in addition contributing to a hospital¡¦s overall electronic development and moving towards a paperless environment, also allow hospitals to share electronic medical information. To solve the problem of different medical information systems that hamper information sharing, the Executive Yuan Heath Department Commission has requested the assistance of the Taiwan Association for Medical Information to establish a standard Electronic Medical Record Template, in hopes that there is a national unified Electronic Medical Record Template that also uses the international medical information standard, so that all hospital¡¦s information is accessible, allowing for easy sharing of electronic medical records. The administration department also supports in recommending and creating related steps of incentive, to encourage professional electronic medical record researchers making up a standard internet medical information exchange mechanism, with a goal of achieving national medical information exchange. Though the Executive Yuan Heath Department Commission had a nice scheme, but the standard Electronic Medical Record Template established by Taiwan Association for Medical Information is nothing more than a Form Structure Diagram what is far from the software architecture discipline. This research aims to re-define the electronic medical record system, adopting a software architecture modeling approach. Through Structure Element Diagram, Structure Element Service Diagram, Structure Behavior Coalescence Diagram, and Sequence Diagram as four gold rules, we are able to build up any electronic medical record system architecture. Besides providing medical information personnel a more definite electronic medical record system, this research aids hospitals quickly attain an effective electronic medical record system.

Full service family physicians in British Columbia (BC) are claiming financial incentives in return for providing enhanced care for patients with chronic diseases. These same physicians are also being actively encouraged to adopt electronic medical record systems (EMRs) with an expectation that their adoption will, among other things, aid in improved chronic disease management (CDM). Indeed, both incentives and clinical information systems have been demonstrated in the literature to be crucial components in effective CDM programs. However, within BC little evidence is available that demonstrates whether EMR adoption is in fact associated with improved provision of CDM services. Furthermore, it is not well understood how the CDM incentive program affects a family practice’s adoption of CDM-related EMR functionality. Through a mixed methods study the relationship between EMR adoption and CDM incentives in a small family practice is explored. Additionally, an audit and feedback intervention is used to test the hypothesis that both incentive use and EMR adoption can simultaneously be improved. Results of the study suggest that the presence of an EMR may not guarantee improvements in delivery of incentivized CDM services; that the incentive program has limits in its ability to promote adoption of CDM-related EMR features; and, that a program of audit and feedback may promote improvements in aspects of EMR adoption and incentive utilization. / Graduate / 0723 / 0769

Ο Ηλεκτρονικός Φάκελος Υγείας πρόκειται για μια δομημένη συλλογή ηλεκτρονικών δεδομένων που αφορούν μια περιοχή της υγείας που παρέχεται με σκοπό τη συνεχή, αποτελεσματική και ποιοτική παροχή φροντίδας. Η ανάπτυξη της τεχνογνωσίας στα νοσηλευτικά ιδρύματα της χώρας σχετικά με τους ηλεκτρονικούς φακέλους υγείας είναι ραγδαία. Δυστυχώς στην χώρα μας η ανάπτυξη είναι μικρότερη από ότι στην υπόλοιπη Ευρωπαϊκή Ένωση. Παρόλα αυτά η χρήση προγραμμάτων για την ηλεκτρονική καταχώρηση και διαχείριση ασθενών είναι ένα φαινόμενο που εξαπλώνεται. Η διπλωματική εργασία που ακολουθεί είναι μια ανασκόπηση της πορείας των Ηλεκτρονικών Φακέλων Υγείας. Στα κεφάλαια που ακολουθούν αναλύονται τα εξής θέματα: Στο 1ο κεφάλαιο αναλύεται αρχικά η έννοια του συμβατικού φακέλου υγείας και έπειτα η έννοια του ηλεκτρονικού φακέλου υγείας και δίνεται εξήγηση σε όρους όπως Ηλεκτρονική Υγεία και Ηλεκτρονική Κάρτα Υγείας. Τέλος γίνεται αναφορά στα στάδια εξέλιξης των Ηλεκτρονικών Φακέλων Υγείας. Στο 2ο κεφάλαιο γίνεται ιστορική αναδρομή του Φακέλου Υγείας και του Ηλεκτρονικού Φακέλου Υγείας. Επισημαίνονται τα μειονεκτήματα και τα πλεονεκτήματα του. Στο 3ο κεφάλαιο γίνεται αναφορά στην ασφάλεια και νομοθετική προστασία του ηλεκτρονικού φακέλου υγείας. Διακρίνονται οι στόχοι που πρέπει να επιτευχθούν για έναν ασφαλή ΗΦΥ, εκτιμούνται οι κίνδυνοι στην ανταλλαγή των δεδομένων. Τέλος αναφέρονται τα συμπεράσματα των χρηστών μετά από τη χρήση των ΗΦΥ. Στο 4ο κεφάλαιο γίνεται αναφορά στα πρότυπα και την κωδικοποίηση της πληροφορίας, όπως επίσης και ο σκοπός των προτύπων. Στο 5ο κεφάλαιο γίνεται η παρουσίαση προγραμμάτων Ηλεκτρονικών Φακέλων Υγείας στην Ελλάδα και στην Ευρωπαϊκή Ένωση. Στο 6ο κεφάλαιο αναγράφονται τα συμπεράσματα από την χρήση των ΗΦΥ, μια γρήγορη ανασκόπηση της εκπαίδευσης που γίνεται στους επαγγελματίες υγείας στην χώρα μας και τέλος η περιγραφή της Ιστοσελίδας που πραγματοποιήθηκε έχοντας ως στόχο την ενημέρωση των επαγγελματιών υγείας με θέματα που σχετίζονται με τον ΗΦΥ. / The electronic medical record is structured electronic data of health. Data provided in order to offer constant, effective care and quality in health. The development of technology and know-how about the EMR in the hospitals is rapid. Unfortunately in Greece the development seems to follow a slower rhythm than in the rest European union. Nonetheless, the use of programs of electronic records and patient management is a phenomenon rapidly spread. This diplomatic essay is a review of the course of EMR. The chapters will analyze the following issues: Chapter 1st : Analysis of the conventional medical record and the meaning of the EMR, terms such as Electronic Health and Electronic Health Card are being clarified. Finally, there is the report of the stages of the Medical Electronic Record. Chapter 2nd : A quick reference of the retrospection of the conventional medical record and it’s evolution to an electronic medical record. The advantages and the disadvantages of the EMR are pointed out. Chapter 3rd : A reference of security and legislative protection of the EMR. The goals that need to be achieved for a safe and secure EMR are brought to prominence and the assessment of the potential risk. Lastly, the conclusions of the users of EMR are being presented. Chapter 4th : A reference of EMR standards and the classification of the electronic information. Furthermore the purpose of the standards is being elaborated. Chapter 5th : A presentation of the programs of EMR currently in use in Greece and the rest European Union. Chapter 6th : Conclusions of the use of EMR a review of the education to the medical personnel concerning the EMR in Greece and and also the description of a website that had been created for the briefing of the medical personnel as far as it concerns medical electronic records

Η παρούσα εργασία αποτελεί μια εισαγωγή στο ηλεκτρονικό φάκελο υγείας και την εφαρμογή του στα νοσηλευτικά ιδρύματα της χώρας με εκτενέστερη αναφορά στους επαγγελματίες υγείας που συνδέονται άμεσα με την εφαρμογή και τα αποτελέσματα του στις Μονάδες Υγείας και με ειδικότερη μνεία στο ρόλο του νοσηλευτή. Tο πρώτο κεφάλαιο περιλαμβάνει την εισαγωγή του ηλεκτρονικού φακέλου υγείας με τον ορισμό του και την ιστορική του αναδρομή σε γενικές γραμμές αλλά και με ειδικότερη αναφορά στην Ελλάδα. Στο δευτερο κεφάλαιο παρουσιάζεται εκτενέστερα η έννοια και η δομή του ηλεκτρονικού φακέλου υγείας με τα πλεονεκτήματα και τα μειονεκτηματά του. Επίσης γίνεται μια απλή αναφορά στα πρότυπα τυποποίησης του ηλεκτρονικού φακέλου υγείας, στα ολοκληρομένα πληροφοριακά συστήματα υγείας,στη διοίκηση της υγειονομικής περιφέρειας (πρώην ΔΥΠΕ ), στα επίπεδα της πληροφοριακής οργάνωσης στα νοσοκομεία με εκτενέστερη περιγραφή του συστήματος καθώς και με εκτενέστερη περιγραφή του συστήματος των ραντεβού. Τέλος έχουμε μια αναφορά στο διεθνές σύστημα κατηγοροποίησης των ασθενειών (ICD), στην ηλεκτρονική υγεία (e-health ) και στα εμπόδια της ανάπτυξης του ηλεκτρονικού φακέλου υγείας. Στο τρίτο κεφάλαιο παρουσιάζεται ο ορισμός της έξυπνης κάρτας υγείας και οι προτάσεις για την εφαρμογή της. Το τέταρτο κεφάλαιο αναφέρεται στη νομοθετική προστασία των ευαίσθητων προσωπικών δεδομένων με ειδική αναφορά στο ιατρικό και νοσηλευτικό προσωπικό. Στο πέμπτο κεφάλαιο έχουμε την εφαρμογή του ηλεκτρονικού φακέλου υγείας στην ελληνική πραγματικότητα από τους επαγγελματίες υγείας (ιατρονοσηλευτικό προσωπικό, διοικητικό και εργαστηριακό προσωπικό, στατιστικολόγους και ερευνητές). Στο έκτο κεφάλαιο παρουσιάζεται η ειδική μνεία στο νοσηλευτικό προσωπικό και στη χρήση του ηλεκτρονικού φακέλου υγείας από τους νοσηλευτές. Το έβδομο κεφάλαιο είναι μια σύντομη αναφορά στον ηλεκρονικό φάκελο υγείας, στην κωδικοποίηση της πληροφορίας καθώς και στον ενοποιημένο ηλεκτρονικό ιατρικό φάκελο υγείας που εφαρμόζεται στο Γενικό Νοσοκομείο Παπαγεωργίου και στο Κ. Υ. Ιτέας. Το όγδοο κεφάλαιο αποτελείται από το παράδειγμα εφαρμογής του Ιατρικού φακέλου υγείας στο Γενικό Νομαρχιακό Νοσοκομείο Αμαλιάδος. Το ένατο κεφάλαιο αποτελείται από το παράδειγμα εφαρμογής του Ιατρικού φακέλου υγείας στην Ορθοπαιδική κλινική του Πανεπιστημιακού Νοσοκομείου Πατρών. Οι εξελίξεις και τα συμπεράσματα που αφορούν τον ηλεκτρονικό φάκελο υγείας αποτελούν το δέκατο κεφάλαιο και τον επίλογο της παρούσης εργασίας. / The current diplomatic dissertation is an introduction to Electronic Medical Records and its apply to the medical institutes of Greece, a comprehensive description is being made for the medical personnel which is directly associated with its apply to Health Units and with specific mention to the role of nurse. The first chapter consist an introduction to the Electronic medical records, the definition and the retrospect in the rest world and more specific in Greece. In the second chapter, it is widely presented the concept and the structure of the EMR with its advantages and disadvantages. Also there is a reference to the standards of formulism of the EMR, to the aggregate informational health systems, to the health administration, to the levels of the informational system in the hospitals, a widely description of the appointment system is being made. Finally, references for the international classification of disease, electronic health and the obstacles in development of the EMR. In the third chapter the definition of the smart health card and the proposals of its apply are being presented. The fourth chapter refers to the legal protection of the private data and especially how the medical personnel is being involved. The fifth chapter included the apply of the EMR in Greece, by the medical personnel (nurse, doctor, laboratories, administration, researchers) The sixth chapter is the presentation of the use of EMR from the nurses in Greece. The seventh chapter is a quick reference to the EMR, to the classification of the information, as well as in the aggregate EMR that the hospital Papageorgiou in Thessaloniki and the K.Y Iteas use. The eighth chapter consists from the example of the application of EMR in the hospital of Amaliada. The ninth chapter consists from the example of the application of the university hospital of Patra. The development and the conclusions that involve the EMR consist the tenth chapter and the afterword of this diplomatic dissertati

Class of 2013 Abstract / Specific Aims: To examine the relationship between hospital readmission rates and responses to a medication adherence questionnaire (Morisky) in patients with congestive heart failure (CHF). Methods: The Morisky questionnaire, assessing medication adherence, was administered to all CHF patients admitted from September 15, 2012 to March 7, 2013. Information collected from the electronic medical record (EMR) for all patients with complete Morisky questionnaires included: age, sex, ethnicity, insurance, height, weight, marital status, tobacco use, alcohol use, number of home medications, all-cause and CHF admission in the previous 365 days from when the questionnaire was administered as well as the following events/disease states: myocardial infarction, hypertension, atrial fibrillation, stroke, diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease, congestive heart disease and chronic kidney disease. Main Results: Of the 120 patients enrolled, 52% scored 1-5 on the Morisky questionnaire indicating some problem with medication adherence while 48% scored 0 (no problems). There was no correlation between the Morisky score and age (95% CI: -3.3-5.7), number of medications (95% CI: -0.26, 2.85), or number of comorbidities (95% CI: -1.02,0.03). The Morisky questionnaire was not predictive of all cause readmissions (95% CI: 0.35, 2.01) p = 0.691). For CHF readmissions the Morisky score was not significant (95% CI: 0.6, 4.11, p=0.358) but the confidence interval suggests a trend. Conclusion: There is no correlation between Morisky scores, age, comorbidities, and medication number. Readmission rates were not predicted by Morisky scores; with more participants a trend may be detected for CHF readmissions.