Aims The purpose of this study is to explore the possibilities for video-based learning of computer systems in the field of medical education in rural sub-Saharan Africa. Background Low-income countries are forced to perform healthcare services with resources already spread too thin. The use of electronic medical records can increase the cost-effectiveness of delivering healthcare services, but the low computer literacy in sub-Saharan Africa is an obstacle necessary to overcome. E-learning and video-based learning has the potential to partially solve this problem. Methods User observations were conducted on five healthcare workers in rural Uganda. The users watched an instruction video, after which they performed an assessment test of an electronic medical record system. Results Some effectiveness was perceived – but it was slight, and varied greatly between the test subjects. Computer experience is an important prerequisite for the success of e-learning initiatives. Effectiveness was higher for more simple tasks. Conclusion This paper does not propose video-based learning as the only source of training for the target group. However, there is a possibility to envision video-based learning as a building block in a blended-learning strategy – utilising video-based learning for easier tasks and knowledge retention for users who are already familiar with the system.

The digitization of information has provided an overflow of data in many areas of society, including the clinical sector. However, confidentiality issues concerning the privacy of both clinicians and patients have hampered research into how to best deal with this kind of "clinical" data. An example of clinical data which can be found in abundance are Electronic Medical Records, or EMR for short. EMRs contain information about a patient's medical history, such as summarizes of earlier visits, prescribed medications and more. These EMRs can be quite extensive and reading them in full can be time-consuming, especially when considering the often hectic nature of hospital work. Giving clinicians the ability to gain insight into what information is of importance when dealing with extensive EMRs might be very useful. Keyword extraction are methods developed in the field of language technology that aim to automatically extract the most important terms or phrases from a text. Applying these methods on EMR data successfully could help provide the clinicians with a helping hand when short on time. Clinical data are very domain-specific however, requiring different kinds of expert knowledge depending on what field of medicine is being investigated. Due to the scarcity of research on not only clinical keyword extractions but clinical data as a whole, foundational groundwork in how to best deal with the domain-specific demands of a clinical keyword extractor need to be laid. By exploring how the two unsupervised approaches YAKE! and KeyBERT deal with the domain-specific task of implant-focused keyword extraction, the limitations of clinical keyword extraction are tested. Furthermore, the performance of a general BERT model in comparison to a model finetuned on domain-specific data is investigated. Finally, an attempt is made to create a domain-specific set of gold-standard keywords by combining unsupervised approaches to keyword extraction is made. The results show that unsupervised approaches perform poorly when dealing with domain-specific tasks that do not have a clear correlation to the main domain of the data. Finetuned BERT models seem to perform almost as well as a general model when tasked with implant-focused keyword extraction, although further research is needed. Finally, the use of unsupervised approaches in conjunction with manual evaluations provided by domain experts show some promise.

Bakgrund   Det senaste decenniet har internetbaserade patientportaler som erbjuder patienter möjlighet att gå in och läsa sina journalanteckningar implementerats i många länder. Den ökade tillgången har bidragit till att fler patienter läser sina journalanteckningar och det är därför relevant att undersöka patienters erfarenheter av detta.  Syfte  Syftet var att belysa vuxna patienters erfarenheter av att läsa sina journalanteckningar efter kontakt med hälso- och sjukvård.  Metod  Studien som genomfördes var en icke-systematisk litteraturöversikt baserad på 16 vetenskapliga artiklar med olika metod: kvalitativ, kvantitativ och mixad metod. Varje artikel kvalitetsgranskades separat utifrån Sophiahemmet Högskolas bedömningsunderlag. Därefter analyserades materialet med en integrerad analysmetod i vilken olika teman identifierades.  Resultat Tre huvudteman identifierades: Förståelse, Egenmakt och Känslomässiga reaktioner. Dessutom identifierades fyra subteman: Svårigheter med språket, Förbättrad kunskap om sitt hälsotillstånd, Påverkan på delaktighet och förtroende, Lättare att komma ihåg och Ökad känsla av kontroll. De flesta patienter upplevde fördelar med att läsa sina journalanteckningar. Det bidrog till en ökad känsla av förståelse, egenmakt och kontroll. Dessutom kände patienter ett ökat förtroende för vårdgivare. En del upplevde dock att journalanteckningarna var svåra att förstå, vilket skapade oro och frustration. Svårigheter upplevdes på grund av språket som användes med bland annat medicinsk jargong och förkortningar. Negativa känslor upplevdes då journalanteckningarna inte stämde överens med patienters uppfattning av besöket. Slutsats Patienter upplevde både för- och nackdelar med att läsa sina journalanteckningar, varav majoriteten var positiva. Erfarenheterna kunde beskrivas utifrån patienters känsla av sammanhang där deras förmåga att se journalanteckningarna som begripliga, meningsfulla och hanterbara varierade. Resultatet bidrar med kunskap till alla vårdprofessioner då journalföring sker i alla vårdkontexter. Vårdpersonal behöver bli mer medvetna om att journalanteckningarna läses av patienter, samt hur läsningen uppfattas av patienter. / Background During the last decade, many countries have implemented internet-based patient portals, whereby patients are able to read their medical records. This greater access has contributed to an increased number of patients reading their visit notes and it is therefore relevant to investigate patients’ experiences regarding this.  Aim The purpose was to illustrate adult patients’ experiences of reading their visit notes after contact with medical care.  Method The study conducted a non-systematic literature review based on 16 scientific articles with different methods: qualitative, quantitative and mixed method. Each article was reviewed separately for quality according to Sophiahemmet Högskolas assessment criteria. Thereafter, the material was analyzed with an integrated analysis method in which different themes were identified.  Results Three main themes were identified: Comprehension, Empowerment and Emotional reactions. Furthermore, four sub themes were identified: Language difficulties, Improved knowledge of their state of health, Impact on participation and trust, Easier to remember and Increased sense of control. Most patients experienced benefits from reading their visit notes. This contributed to an increased sense of comprehension, empowerment and control. In addition, the patients felt an increased sense of trust for the health care provider. However, some patients found their visit notes hard to understand, which created worry and frustration. The difficulties experienced were partly due to the language used, with medical jargon and abbreviations. Negative emotions were experienced when medical records were not in agreement with the patient’s perception of their medical appointment.  Conclusions Patients experienced both advantages and disadvantages from reading their visit notes, of which the majority had positive experiences. These experiences could be described from patients’ sense of coherence, where their ability to perceive medical records as understandable, meaningful and manageable varied. The result provides knowledge to all healthcare professions, as record keeping occurs in all medical contexts. Healthcare staff need to be more aware that visit notes are read by patients, as well as how their contents are perceived by patients.

Entre 2 et 5% des enfants de 6 mois à 5 ans présentent au moins un épisode de Crise d’Épilepsie en contexte Fébrile (CEF). Bien que généralement bénignes, ces crises sont associées à un risque d’urgences neurologiques graves et curables dont l’élimination requiert la réalisation d’examens complémentaires douloureux et/ou irradiants. Actuellement, ce risque est évalué en fonction de trois facteurs : l’âge de l’enfant, le caractère simple ou complexe de la crise, et l’examen clinique.Cette thèse avait pour objectif de tester l’hypothèse que parmi les enfants consultant pour une CEF, seuls ceux avec un examen clinique anormal présentent un risque d’urgence neurologique grave et urgent. Pour ce faire, nous avons créé un outil informatique permettant une recherche exhaustive de cas parmi un million de dossiers médicaux informatisés dans sept services d’urgences pédiatriques entre 2007 et 2011. Nous avons alors identifié : les visites d’enfants présentant une CEF. Nous avons ensuite évalué le risque d’urgence neurologique grave et curable associé à ces visites, notamment lorsque l’examen clinique au décours était normal. Nous n’avons retrouvé aucune urgence neurologique grave et curable parmi les enfants consultant pour une CEF avec un examen clinique normal au décours, quels que soient l’âge et les caractéristiques de la crise. Ce travail de thèse associé aux données de la littérature confirme notre hypothèse et souligne la nécessité de recommandations quant à la prise en charge de ces enfants. Enfin, cette thèse constitue l’occasion de mener une réflexion méthodologique quant à l’utilisation de dossiers médicaux informatisés pour la recherche clinique. / Febrile seizures (FS) affect 2% to 5% of children aged 6 months to 5 years of age. Although FS are usually benign, they are associated with serious treatable neurological emergencies. Nowadays, three factors are used to evaluate this risk: the age of the child, whether the FS is simple or complex and the features of the clinical exam. The performance of a lumbar puncture and an emergent neuroimaging are required in order to rule out these emergencies. However, a lumbar puncture is painful and neuroimaging is irradiant. The objective of this thesis was to investigate the hypothesis that among children experiencing a FS, only those with an abnormal clinical exam are at risk of serious, treatable neurological emergencies. We first created an informatics tool in order to exhaustively search for cases among more than one million electronic medical records from seven pediatric emergency departments (PED) between 2007 and 2011. Then, we identified visits of children with a FS. Finally, we evaluated the proportion of serious, treatable neurological emergencies associated with these visits, and more specifically with visits of children with a normal clinical exam.We found no serious treatable neurological emergencies among children visiting the ED for a FS with a normal clinical exam, whatever the age and the features of the seizure were. The studies described in this thesis associated with the available data in the literature support our hypothesis and highlight the need of guidelines regarding the management of these children. Finally, this thesis gives us the opportunity to discuss some considerations on the use of electronic medical records for clinical research.

Indiana University-Purdue University Indianapolis (IUPUI) / Reducing medical error remains in the forefront of healthcare reform. The use of health information technology, specifically the electronic health record (EHR) is one attempt to improve patient safety. The implementation of the EHR in the Emergency Department changes physician workflow, which can have negative, unintended consequences for patient safety. Inaccuracies in clinical documentation can contribute, for example, to medical error during transitions of care. In this quasi-experimental comparison study, we sought to determine whether there is a difference in document quality, error rate, error type, cognitive load and time when Emergency Medicine (EM) residents use paper charts versus the EHR to complete physician documentation of clinical encounters. Simulated patient encounters provided a unique and innovative environment to evaluate EM physician documentation. Analysis focused on examining documentation quality and real-time observation of the simulated encounter. Results demonstrate no change in document quality, no change in cognitive load, and no change in error rate between electronic and paper charts. There was a 46% increase in the time required to complete the charting task when using the EHR. Physician workflow changes from partial documentation during the patient encounter with paper charts to complete documentation after the encounter with electronic charts. Documentation quality overall was poor with an average of 36% of required elements missing which did not improve during residency training. The extra time required for the charting task using the EHR potentially increases patient waiting times as well as clinician dissatisfaction and burnout, yet it has little impact on the quality of physician documentation. Better strategies and support for documentation are needed as providers adopt and use EHR systems to change the practice of medicine.

Det finns ett behov av användarvänliga, anpassningsbara och tillgängliga journalsystem inom en variation av branscher. Befintliga system har visat sig vara bristfälliga inom dessa tre aspekter. Bristerna bottnar i att systemen sällan är anpassade för det specifika ändamålet, vilket i många fall grundar sig i att slutanvändarna inte varit med i utvecklingsprocessen. När användare har implementerat befintliga journalsystem inom sina verksamheter har även bristfälligheter gällande tillgänglighet påvisats. På den utvecklade journalsystemprototypen som arbetet resulterade i, utfördes ett antal tester av uppdragsgivarens anställda. Dessa tester påvisade att prototypens användarvänlighet, anpassningsbarhet och tillgänglighet uppnådde de krav som företaget hade på ett journalsystem. Prototypen har, trots det positiva resultatet, fortfarande utvecklingspotential och områden att förbättra. / There is a need for user-friendly, customizable and accessible record systems in a variety of industries. Existing systems have proven to be deficient in these three aspects. The shortcomings are due to the fact that the systems are seldom adapted for the specific purpose, which in many cases is a consequence of the end users not being involved in the development process. When users have implemented existing journal systems within their operations, deficiencies regarding accessibility have also been identified. On the developed record system prototype that the work resulted in, a number of tests were performed by the client's employees. These tests showed that the user-friendliness, adaptability and availability of the prototype met the requirements of the company for a record system. Despite the positive result, the prototype still has development potential and areas for improvement.

Electronic health records (EHRs) led to improvements in patient safety, care delivery, and efficiency; however, they have also resulted in significant increases in documentation time. EHR documentation burden, defined as “added work (e.g., documentation) or extraneous actions (e.g., clicks) performed in the EHR beyond that which is required for good clinical care”, has been linked to increased medical errors, poorer patient outcomes, reduced care quality, cognitive overload, and ultimately, burnout among clinicians. Relative to other clinical practice settings where patient flows are more predictable and of lower intensity, emergency department (ED) clinicians report markedly higher workload. Furthermore, EHR implementation research in the ED indicates that incongruities between EHR design and usability and the clinical workflow may intensify clinician workflow fragmentation. In our prior work, we identified workflow fragmentation, which we define as task switching, as one potential approach for evaluating documentation burden in ED practice settings. Yet, no standardized, scalable measures of documentation burden have been developed. Despite shortcomings, there have been increasing efforts to leverage information from EHR event logs as an alternative to direct clinical observation methods in evaluating user-centric behaviors and interactions with health information technology systems. Using EHR event logs, this dissertation aims to advance the study of evaluating burden by investigating EHR-mediated workflow fragmentation as a measure of EHR documentation burden among physicians and registered nurses (hereinafter interchangeably referred to as “clinicians”) in the ED. First, I review the literature on the existing quantitative approaches employed for measuring clinician documentation burden in clinical practice settings. Next, I explore EHR factors perceived to contribute to clinician documentation burden as well as the perceived role of workflow fragmentation on clinician documentation burden in the ED. Lastly, I investigate data-driven approaches to abstract clinically relevant concepts from EHR event logs for studying EHR documentation burden—culminating into a computational framework to evaluate ED clinician documentation burden in the context of cognitive burden. Collectively, the work conducted in this dissertation contributes computational methods that are foundational for investigating clinician documentation burden measurement at scale using EHR event logs, informed by current evidence and clinician perspectives, and grounded in theory.

<p>Efficient strategies for diabetes management in primary care provide avenues through which the disease may be monitored and controlled, but systems and processes must be more than adequate. The use of Electronic Medical Record systems (EMRs) assist healthcare providers in delivering quality care to patients to help better manage chronic conditions, and integrate services throughout the healthcare system so that relevant chronic disease programs may be made available to individuals and communities. Usability issues have often been blamed for poor EMR adoption rates, underutilization of systems, endangerment of patient health and inadequacies in providing positive health outcomes for patients while improving the quality of chronic disease management.</p> <p>This thesis investigates the use of EMRs in managing diabetes within primary care, and evaluates their usability and its effects in managing diabetes in patients, with special reference to patient safety, healthcare provider workflow and adherence to clinical practice guidelines (CPGs).</p> <p>Existing evidence emphasizing the management of diabetes and the role of the EMR in primary care is presented, while three levels of usability and several usability guidelines are identified and investigated. Data gathered from the local environment, show the relationships between EMR usability, patient safety, clinician workflow and adherence to CPGs in managing diabetes, and three models of EMR usability are suggested.</p> <p>The primary proposition for this study is that EMRs provide promise in helping to control diabetes in patients. However EMR usability may present significant hindrances in maximizing outcomes for individuals and in providing support programs and services to communities.</p> / Master of Science (MSc)

The historical evolution of South Africa’s health sector, dating back to the 17th century, is significantly different from that of other African countries. Throughout the four centuries of development there have been numerous advances in health policy, legislative instruments and health system progress. Against this background this dissertation critically analysed the management of records in public health care institutions in South Africa. The study did this by addressing three objectives: assess the legislative, policy and regulatory contextual framework of South Africa’s health care system; assess the effectiveness of records management within public health care institutions; and identify appropriate interventions to address the challenges facing records management in the health care system. The study used purposive sampling to identify respondents with diverse expertise in three main sectors: the public sector, the private sector as well as in academic and research institutions. Using interview research technique the study solicited data that was analysed in order to provide a composite picture in addressing the research objectives. The analysis of data revealed three overarching themes. First, there is substantial legislative and regulatory dissonance in the management of health records in the country. While there are extensive legislative, regulatory and policy instruments that could be used to manage records, many lack coherence with records management issues such as records retention. Second, understanding the complex interplay of different legal and regulatory instruments is a critical first step, but it remains the beginning of the process towards building a sophisticated implementation process. For this process to be successful, study respondents argued that records compliance would have to be the backbone of all other compliance processes. Third, while there were substantial areas of weakness in the management of records in South Africa’s public health sector, there have been a number of pockets of excellence. These include the efforts towards complying to access to information legislation by the Limpopo Department of Health and Social Development as well as the successful introduction of Enterprise Content Management systems in health care institutions by the Western Cape Department of Health / Information Science / D. Litt. et Phil. (Information Science)

The importance of records management to the provision of healthcare services cannot be overemphasised. If medical records are not managed properly, this might result in the provision of poor healthcare services. This is because usually if medical records are not properly managed, the healthcare institutions attain inaccurate, untimely, incomplete and unauthentic records or the records fade completely. Records that are not managed properly are easily lost, modified, altered, misfiled and/or damaged, which results in a struggle to locate them and, eventually, much time is lost. Records of this kind may not support healthcare service providers properly in decision-making, problem-solving, monitoring and evaluation of service for continuous service improvement. This study utilised the five elements of trusted records management (records management governance practice, staff capacity and competencies, recordkeeping system and technology, and records archival processes) to investigate the development of a framework to embed medical records management into the healthcare service delivery practice for effective records management practice. The study predominantly utilised a quantitative approach with some support from a limited scope of qualitative data to augment numeric data. The data was collected using the four different techniques, namely questionnaire, interview, observation and system/documents analysis. The study revealed that the mode of medical record management was not effectively enabling the institution to manage medical records properly due to lack of integrated medical records management framework into the healthcare business process. The medical records management technology also lacked file tracking system, records backup, and audit trail which compromise records safety and security. The study recommended supply of the necessary resources, with a framework that the healthcare institutions may adopt to embed medical records management into the healthcare service delivery. ECM may also be implemented to incorporate electronic records management systems, information management, web content and other add-ons to support the records management framework in ensuring effective discharge of all records management functional requirements on the healthcare business process. A further study was recommended about the development of an online outpatient consultation system and medical records access to avoid patient long turnaround time for service. / Information Science / D. Litt. et. Phil. (Information Science)