The management process of chronic diseases is longitudinal in nature. Patient records in electronic format provide information at the point of care and support decision-making processes. In our research, we analyzed the clinical pragmatics of Chronic Disease Management (CDM) and formulated a knowledge model to develop Ontology-based EMR. Our research involved knowledge abstraction, knowledge modeling, and ontology engineering. We applied the Knowledge Management approach to knowledge sources including medical literature, the Chronic Care Model (CCM), CPR Ontology and HL-7 RIM. We studied CDM in detail to abstract conceptual knowledge involved in the process of CDM. The abstracted knowledge was modeled into a formal model called CD-EMR Model. We adapted Methontology and developed an OWL-based ontology from the CD-EMR Model. We evaluated the ontology by instantiating longitudinal clinical cases of chronic diseases. CD-EMR ontology allows (a) computerization of longitudinal patient records, (b) semantic interoperability, and (c) reasoning for clinical decision support.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2008. / Härtill 4 uppsatser.

Thesis (M.H.A.)--University of Michigan, 1963.

Thesis (M.H.A.)--University of Michigan, 1963.

Elektroniska journalsystem är verktyg och beslutssystem för att hantera patientinformation isamband med vård och behandling inom vården. Ämnet som studien berör är användbarhet kringjournalsystemet Melior. Syftet med studien är att ta reda på vad användares uppfattning kringMelior är, och om användare tycker att Melior är användbart eller inte. För att besvaraforskningsfrågan utförs en kvalitativ studie i form av intervjuer med öppna frågor. Frågorna hartagits fram genom att studera tidigare studier inom ämnet samt användning av Kennedy (2006)riktlinje för konstruktion av frågor och utförande av intervjuer. Data som har fåtts in igenomintervjuer har transkriberats och analyserats med en kodningsmetod som är hämtad från metodengrundad teori. Resultatet som studien kommit fram till är att användares uppfattning om Melior ärolika. Men majoriteten av användarna som intervjuades anser att journalsystemet inte Melior äranvändbart. Denna studie kan bidra till fortsatta studier inom ämnet användbarhet, till exempelutöka studien till andra sjukhus för att ta reda på om deras användare av journalsystem anser att detär användbart. / Electronical medical records (EMR) are tools and decision systems for managing patientinformation related to care and treatment in healthcare. The topic that this study concerns is theusability of the EMR Melior. The aim of this study is to find out users' opinion about Melior and ifusers find Melior useful or not. To answer the research question, a qualitative study is conducted inthe form of open-ended interviews. The questions have been developed by studying previousstudies on the topic as well as using Kennedy’s (2006) guidelines for construction questions andconducting interviews. Data collected through interviews have been transcribed and analyzed by acoding method which is retrieved from the method grounded theory. The result of the study is thatusers' opinion of Melior varies. However, the majority of users interviewed consider Melior notuseful. This study could contribute to further studies in the field of user usability, such as expandingthe study to other hospitals to find out if their users of EMR system consider it useful.

The objective of the thesis was to evaluate the quality of diabetes care in the Canadian Forces by determining the extent to which physicians adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines. In addition, the effect of patient age, sex, rank and size of base on quality of care was assessed and the accuracy of a diagnosis of diabetes in an extract of the electronic medical record (EMR) was evaluated. Fourteen bases within the Canadian Forces were selected for investigation, representing roughly half of the Canadian Forces population. Cases of diabetes were ascertained based on laboratory criteria following a chart review. Twenty-one CDA guideline recommendations were considered. The Canadian Forces demonstrated greater than 75% adherence with each of 9 recommendations, 50-75% adherence with each of 7 recommendations and less than 50% adherence with each of 5 recommendations. The overall adherence with all applicable recommendations per patient was 60.3% (SE 0.66). Age, sex, rank and size of base were not important factors influencing guideline adherence. The sensitivity of a diabetes diagnosis in an extract of the EMR was 84.5%, the specificity was 99.8%, the positive predictive value was 85.1% and the negative predictive value was 99.8%. This is similar to the performance of provincial and national diabetes registries. The quality of diabetes care in the Canadian Forces compared favourably with that of the civilian population within Canada and internationally. The creation of a diabetes registry is expected to lead to further improvements in diabetes care.

付記する学位プログラム名: デザイン学大学院連携プログラム / 京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第22097号 / 情博第707号 / 新制||情||121(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 黒田 知宏, 教授 吉川 正俊, 教授 矢守 克也 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

Healthcare is a highly dynamic industry that currently heavy relies heavily on the use of modern information and communication technologies. The electronization of healthcare aims to increase the efficacy, quality and accesibility of healthcare. One of the essential elements of e- health is a eletronic health record. It is a systematic collection of medical records of patients / population in a digital form. These records may be shared across healthcare providers or other stakeholders in order to utilize the gathered information. Medical records are shared through information systems or information networks. A shared medical record has not yet been adopted in the Czech Republic. The diploma thesis describes the possible effects of the implementation of a electronic health record and provides an overview of current and planned steps of public sector to introduce it. Based on the analysis of the steps of public sector, a separate approach to the implementation of an electronic health record is developed.

A 15-facility healthcare organization utilized organizational change management techniques to aid with the adoption of a clinical information system to accomplish desired cultural transformation. The aim of this article was to provide a description of team member and physician attitudes toward change during conversion to a new clinical information system of electronic documentation. The tool developed and utilized was a change readiness survey to assess randomly selected team member and physician perceived readiness for the transition to an electronic documentation system. This article reviewed the rationale for using organizational change management techniques to facilitate adoption of a new clinical information system and discussed development of a change readiness survey tool. It explored the findings from the first 3 years of the survey.

Frontline RNs knowledgeable in the strategic objectives of their organization made a difference in the selection of an electronic medical record business partner for a large, complex healthcare system. Their impact was significant because of the chief nurse executive's personal articulation of the organization's strategic goals and of her investment in their education. These factors provided the frontline RNs with a foundational base of knowledge about a variety of electronic medical record systems. The preparation and exposure enabled the frontline RNs to make a valuable contribution to the selection of an electronic medical record business partner. The RNs were a major force in affecting philosophical change from the organization's original pursuit of "best-of-breed" interfaced systems to a fully integrated, "best-of-class" vendor business partner. The learning experiences of the frontline RNs are explored to answer the following question: Why must frontline RNs play a key role in this process?