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.

Electronic medical records (EMR) can be used by Primary Care Physicians (PCP) to support diabetes care in a proactive and planned way. Although the majority of Canadian PCPs have adopted an EMR, advanced use of the EMR is limited. The literature widely suggests that end-user-support (EUS) is a critical success factor for increasing use of advanced EMR features, such as diabetes registries and recalls or reminders. Training is one type of EUS that is intended to help PCPs to better use their EMRs; however, many PCPs receive little or inadequate EMR training, especially following the implementation of an EMR. Specifically, there is a dearth of literature on the use of video tutorials to improve EMR use. The purpose of this mixed methods (QUAN(qual)) study was to evaluate the potential for EMR video tutorials to improve process measures for type 1 and type 2 diabetes care for PCPs using OSCAR EMR in British Columbia. EMR video tutorials were developed based on the Chronic Care Model, value-adding EMR use, evidence-based video tutorial design, clinician-led EMR training, the Structure-Process-Outcome Model, and the New World Kirkpatrick Model. In total, 18 PCPs participated in the study, and 12 of them participated in 21 follow up interviews. The study results demonstrated that the study intervention and Hawthorne effect elicited a statistically significant increase in EMR feature use for diabetes care, with a large effect size (i.e., F(3, 51) = 6.808, p <.001, partial η2 = .286). Multiple barriers and facilitators to applying the tutorial skills into practice were also found at the physician, staff, patient, EMR, and policy levels, such as time, funding, computer literacy of staff, patient responsibility, and user-friendliness of the EMR. Three pairs of PCP characteristics had a strong and positive association, which was statistically significant: (1) age and years of practice; (2) years of experience using OSCAR EMR and number of EMRs used; and (3) computer skills and EMR skills. PCPs' years of medical practice was statistically significant in predicting their baseline use of the EMR for diabetes care. Graphical trends indicated that higher increases in mean composite EMR use (MCEU) score for diabetes care over the duration of the study were associated with PCPs with the following characteristics: (1) being female, (2) being aged 35-44, (3) being from Vancouver Island, (4), having less than four years of medical practice, (5) having 3-4 years of EMR experience, (6) having 1-2 years of OSCAR EMR experience, (7) using four EMRs, and (8) having prior post-implementation EMR training. This small-scale efficacy study demonstrates the potential of CCM-based EMR video tutorials to improve EMR use for chronic diseases such as diabetes. A larger-scale effectiveness study with a control group is needed to further validate the study findings and determine their generalizability. / Graduate

Made available in DSpace on 2018-06-18T13:12:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2015 / Introdução. É crescente a introdução de novas tecnologias e conhecimentos no campo da saúde, desta forma, a Educação Permanente em Saúde (EPS) que se constitui em um processo de análise e problematização do trabalho, é uma ferramenta eficaz na incorporação das Tecnologias de Informação e Comunicação (TIC). Objetivos: Construir e implantar um Programa de Educação Permanente em Saúde voltado ao desenvolvimento do uso de novas tecnologias no campo da saúde. Assim, como identificar a percepção da equipe interprofissional em saúde que participou de capacitações e treinamentos referentes ao uso do Prontuário Eletrônico do Paciente (PEP), quanto: à metodologia utilizada e o processo de construção do programa; à contribuição do treinamento na qualificação da assistência à saúde; ao uso do PEP e a sua relação com a introdução de TIC no estímulo a interprofissionalidade; e ao uso do PEP e a sua relação com a promoção da EPS. Método: Estudo descritivo e exploratório de abordagem quantitativa, utilizando o instrumento de percepção do tipo atitudinal Likert para coleta de dados. Resultados: Foram construídas 4 dimensões (Dimensão-1 “Serviço de Educação Continuada como um espaço estimulador de conhecimento sobre TIC na saúde”, Dimensão-2 “O uso de TIC na saúde como ferramenta estimuladora do trabalho interprofissional”, Dimensão-3 “O uso do PEP e a sua relação com a promoção do processo de EPS” e Dimensão-4 “O PEP como instrumento qualificador para assistência à saúde”), contendo 17 asserções positiva. O instrumento atitudinal foi aplicado em uma população de 71 profissionais da área da saúde. O teste de confiabilidade do instrumento foi de 0,82 e a validação estatística mostrou perda de uma asserção, denotando qualidade do processo de validação de conteúdo e densidade estatística. Conclusão: Os respondentes reconheceram a importância do programa, assim como PEP um elemento qualificador para assistência à saúde. Salientamos a necessidade das instituições hospitalares, adotarem políticas que contribuam para a qualificação de seus profissionais, com ênfase no trabalho colaborativo e interprofissional à luz da integralidade do cuidado e sustentabilidade de uma saúde, de fato para todos. / Introduction: With the constant increase in new technologies and knowledge in the health field, the Continuing Health Education (CHE) which constitutes a process of analysis and questioning of work, is an effective tool in the incorporation of Information and Communication Technologies (ICT). Objectives: To build and deploy a program of continuing healthcare education focused on the development of the use of new technologies in the health field, as well as identifying the perception of interprofessional health team that took part in training and training on the use of Electronic Patient Record (EPR) on the methodology used and the program of the construction process; the training contribution to the qualification of health care; the use of EPR and its relation with the introduction of ICT in stimulating inter professionalism; and the use of EPR and its relation to the promotion of CHE. Method: Descriptive and exploratory study of quantitative approach, using the attitudinal Likert-type perception instrument for data collection. Results: Four dimensions were built (Dimension-1 "Continuing Education Service as a stimulator of learning area of ICT in health, Dimension-2" The use of ICT in health field as a stimulating tool for interprofessional work, "Dimension-3" The use of EPR and its relation to the promotion of the CHE process" and Dimension-4" The EPR as qualifier tool for health care), containing 17 positive assertions. The attitudinal tool was applied to a population of 71 health care professionals. The instrument reliability test was 0.82 and statistical validation showed loss of one assertion, denoting quality of the validation process content and statistical density. Conclusion: Respondents recognized the importance of the program, as well the EPR as a qualifying element to health care. We emphasize the need for hospitals adopt policies that contribute to the qualification of its professionals, with an emphasis on collaborative and interprofessional work in the light of comprehensive care and sustainability of health for all.

Made available in DSpace on 2014-06-11T19:25:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-01Bitstream added on 2014-06-13T19:32:21Z : No. of bitstreams: 1 vieira_jb_me_araca.pdf: 907868 bytes, checksum: 4ec71e58f61fc6cb5e07dbb917a33df9 (MD5) / O prontuário odontológico teve no decorrer de vários anos uma rotina de preenchimentos que se adequados para o auxilio ao diagnóstico das enfermidades, muitas vezes são inadequados para os aspectos jurídicos que hoje tanto aumentou nos corredores forenses. Foram avaliados os prontuários dos pacientes com diagnóstico de câncer tratados na Faculdade de Odontologia de Araçatuba – UNESP, no período de janeiro de 1997 a dezembro de 2007 a partir do levantamento dos resultados dos exames histopatológicos no Departamento de Patologia e Propedêutica Clínica. Foram verificadas as presenças de laudos histopatológicos e exames radiográficos bem como os locais e tempo de guarda destes prontuários. O prontuário odontológico é o documento utilizado para o conhecimento, a qualquer tempo, do diagnóstico, tratamentos realizados, prognóstico e intercorrências. Quando estas informações são transferidas para o computador estamos diante do prontuário eletrônico. Esta conduta tem aumentado em instituições como hospitais, autarquias, secretarias do governo que procuram com esta medida ter um maior controle dos procedimentos oferecidos, com a redução de erros, transparência, economia, facilitando a otimização de espaços. Foi realizado o levantamento na legislação vigente no país com o objetivo de apresentar ao cirurgião dentista, centros de atendimento odontológico e faculdades de odontologia quais os cuidados com prontuário convencional e eletrônico dos pacientes atendidos. / The odontological promptuary had a fulfillments rotine for several years that they were adequate to aid the disease diagnosis, and they are inadequate, many times, for the juridical aspects that increased in forensic corridors. The pacients promptuaries with cancer diagnosis treated at Odontology Faculty in Araçatuba – UNESP were evaluated in period from January, 1997 to December 2007 as from the histopathological examinations results surveying at Pathological and Propaedeutic Clinic Department. Histopathological awards presences were verified and the radiographic examinations and places and guard time of theses promptuaries, too. The odontological promptuarys is a document used to the knowledge, in any time, of diagnosis, realized treatments, prognostics and intercurrences. When these in formations are transferred to the computer, we are in front of the electronic promptuary. This management has increased in instituitions like hospitals, autarchy, government secretaries that seek to have a greater procedures control with this measure, with errors reduction, transparency, economics, facilitating the spaces optimization. The actual legislations surveying in country was realized, with the aim to present to the surgeon dentist, odontological assistance centers and to the dentistry faculties which the cares with conventional and electronic promptuary of assisted pacients.

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2011. / The research was conducted as part of a socio-tech initiative undertaken at the Cape Peninsula University of Technology. The socio-tech initiative overall focus was on addressing issues faced by rural and under-resourced communities in South Africa, specifically looking at Home-Based Healthcare (HBHC) primarily in the Western Cape. As research into the HBHC context in rural and under-resourced communities continued numerous issues around data and data-elements came to light. These data issues were especially prevalent in relation to the various paper forms being used by the HBHC initiatives that attempt to deliver care in these communities. The communities have the tendency to suffer from poor access to formal healthcare services and healthcare facilities. The data issues were primarily in terms of how data was defines and used within the HBHC initiatives. Within the HBHC initiatives that cater for rural and under-resourced communities there was a clear prevalence of paper-based systems, and a very low penetration of IT-based solution. Because similar and related data-elements are used throughout the paper forms and within different context these data-elements are inconsistently used and presented. The paper forms further obfuscate these inconsistencies as the paper forms regularly change due to internal and external factors. When these paper forms are changed date elements are added or removed without the changes to the underlying ontologies being considered.

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016. / In the Western Cape, South Africa, despite the prospective benefits that e-Health information systems (e-Health IS) offer to support the healthcare sector; there are limitations in terms of usability, functionality and peculiar socio-technical factors. Thus, healthcare professionals do not make the most use of the implemented e-Health IS. Unfortunately, explanations remain tentative and unclear, yet non-usage of the e-Health IS defeats the objectives of its adoption, in the sense that the plan to improve and deliver quality healthcare service in the public sector may not be achieved as envisaged. The aim of the study was to acquire explanations to the causes of the limitations regarding the adoption and, particularly, the use (or non-use) of e-Health IS by clinical staff in the public healthcare institutions in South Africa. The choice of research approach was informed by the research problem, objectives, and the main research question. By the reasons of the subjective and socio-technical nature of the phenomenon, a deductive approach was adopted for this investigation. The nominalist ontology and interpretivist epistemology positions were taken by the researcher as a lens to conduct this research; which informed a qualitative methodology for this investigation. The purposive sampling technique was used to identify the appropriate participants from different hospital levels consisting of Hospital Administrative staff, and Clinical staff (Clinicians and Nurses) of relative experiences in their clinical units. Subsequently, the Unified Theory of Acceptance and Use of Technology (UTAUT) and content analysis technique were used to contextualize, simplify, and analysis the text data transcripts. The findings indicate that healthcare professionals have a high level of awareness and acceptance to use implemented e-Health IS. There are positive perceptions on the expected outcomes, that e-Health IS would improve processes and enhance healthcare services delivery in the public healthcare sector. Also, findings indicate that social influence plays a vital role especially on the willingness of individuals (or groups); as the clinical staff are influenced by their colleagues despite the facilitating conditions provided by the hospital management. Further, findings indicate that it is somewhat problematic to maintain balance in running a parallel paper-electronic system in the hospital environment. Hence, the core factors that influence successful adoption and use of e-Health IS include; willingness of an individual (or group) to accept and use a technology, the performance expectancy, social influence among professionals in the healthcare scenery and adequate facilitating conditions. In summary, it is recommended that there should be an extensive engagement inclusive of all respective stakeholders involved in the adoption processes. This would ensure that e-Health IS are designed to meet both practical organizational and clinical needs (and expectations) with respect to the hospital contexts.

Com o avanço tecnológico, a valorização da informação, o ritmo acelerado das mudanças e a globalização, características que fazem com que os hospitais (sejam eles, filantrópicos, governamentais ou privados), aliada às exigências cada vez maiores dos pacientes, aumentem a busca pela qualidade na prestação dos serviços. Sobre este pretexto, os hospitais integrantes do Sistema Único de Saúde (SUS), devem elaborar seus respectivos Censos Hospitalares e apresentar seus dados estatísticos ao Ministério da Saúde, baseado nas definições da Portaria no. 312 de 02 de maio de 2002. Estes indicadores não são os únicos necessários ou importantes para a gestão hospitalar, entretanto são considerados como informaçãoes básicas em uma instituição desta natureza. Contudo, a disponibilidade destas informações de forma contínua, sustentável e confiável não tem se mostrado uma tarefa trivial, principalmente devido alguns fatores: falta de registro, registro inadequado e incompleto, falta de padronização na aplicação do vocabulário médico e mudanças constantes nas rotinas administrativas. Em hospitais considerados de grande porte, este problema pode tomar uma extensão ainda maior. Por ser bastante complexo o Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, considerado o maior complexo hospitalar da América Latina, com aproximadamente 2.200 leitos e atendendo em média 6.000 pacientes ambulatoriais por dia, constitui um bom objeto para estudo de caso, pois permite que vários desafios em relação ao tratamento da informação, como por exemplo: compartilhamento, conectividade, interoperabilidade e integração, possam surgir de maneira mais acentuada a outros hospitais de menor complexidade. Segundo esta abordagem, o trabalho também pretende explorar o nível de contribuição dos diversos Sistemas de Informação Hospitalar utilizados pelo hospital na obtenção de variáveis, para a composição de informações que serão utilizadas como base para as ações administrativas e avaliação de desempenho. O alto grau de heterogeneidade presente nas soluções no domínio da saúde, distribuídos nos diferentes sistemas de informação, apontam para a v necessidade de compartilhar e troca informações entre ambientes heterogêneos. Neste contexto, a interoperabilidade tem um papel fundamental, pois permite a comunicação de forma transparente entre sistemas e ambientes heterogêneos, autônomos e distribuídos. Foram utilizados neste estudo documentos oficiais relativos aos sistemas de informação assistencial e sua gestão no HC-FMUSP, além de atas de Reuniões do Comitê de Tecnologia da Informação do hospital (CTI). Para a coleta de dados foi aplicada a técnica de entrevista semi-estruturada aos sujeitos responsáveis pelo Serviço de Arquivo Médico SAME de áreas estratégicas do hospital e do Núcleo de Informação em Saúde NIS. A crescente complexidade da assistência à saúde torna premente a necessidade de integração dos sistemas corporativos, bem como a adoção de padrões de registro e procedimentos, porém, não basta resolver as questões somente do ponto de vista tecnológico, o desafio é trabalhar estes problemas considerando toda a sua complexidade e articulando diferentes áreas, em busca de resultados efetivos / With the technological advance, the valuation of the information, the sped up rhythm of the changes and the globalization, characteristics that make with that the hospitals (they are they, philanthropy, governmental or private), allied to the bigger requirements each time of the patients, increase the search for the quality in the installment of the services. On this excuse, the integrant hospitals of the Only System of Health (SUS), must elaborate its respective Hospital Censuses and present its statistical data to the Health department, based on the definitions of governmental decree no. 312 of 02 of May of 2002. These pointers are not only the necessary ones or important for the hospital management, however they are considered as basic information in an institution of this nature. However, the availability of these information of continuous, sustainable and trustworthy form if has not shown a trivial task, mainly had some factors: lack of register, inadequate and incomplete register, constant lack of standardization in the application of the medical vocabulary and changes in the administrative routines. In considered hospitals of great transport, this problem can take an extension still bigger. Of to be sufficiently complex the Hospital of the Clinics of the College of Medicine of the University of Sao Paulo - HCFMUSP, considered the hospital complex greater of Latin America, with approximately 2,200 stream beds and taking care of in average 6,000 patients per day in the ambulatory, constitutes a good object for case study, therefore it allows that some challenges in relation to the treatment of the information, as for example: sharing, connectivity, interoperability and integration, can appear more of accented way to other hospitals of lesser complexity. According to this boarding, the work also intends to explore the level of contribution of the diverse systems of hospital information used by the hospital in the attainment of the variables, for the composition of information that will be used as base for the administrative cases and evaluation of performance. The high degree of present heterogeneity in the solutions in the domain of health distributed in the different systems of information, points with respect to the necessity to share and changes information between heterogeneous environments. In this vii context, the interoperability has a basic paper, therefore it allows to the communication of transparent form between systems and heterogeneous, independent and distributed environments. Official documents to the systems of health care information and its management in the HCFMUSP had been used in this study relative, beyond acts of meetings of the Committee of Technology of the Information of the hospital (CTI). For the collection of data the technique of interview half-structuralized to the responsible citizens for the Service of Medical Archive was applied - SAME of strategical areas of the hospital and the Nucleus of Information in Health - NIS. The increasing complexity of the health care becomes pressing the necessity of integration of the corporative systems, as well as the adoption of register standards and procedures, however, are not enough to only decide the questions of the technological point of view, the challenge are to work these problems considering all its complexity and articulating different areas, in search of effective results

Whereas there are various initiatives to standardize the storage, processing and use of electronic patient information in the South African health sector, the sector is fragmented through the adoption of various approaches on national, provincial and district levels. Divergent IT systems are used in the public and private health sectors (“Recommendations of the Committee on …” 2003). Furthermore, general practitioners in some parts of the country still use paper as a primary means of documentation and storage. Nonetheless, the use of computerized systems is increasing, even in the most remote rural areas. This leads to the exposure of patient information to various threats that are perpetuated through the use of information technology. Irrespective of the level of technology adoption by practitioners in private healthcare practice, the security and privacy of patient information remains of critical importance. The disclosure of patient information whether intentional or not, can have dire consequences for a patient. In general, the requirements pertaining to the privacy of patient information are controlled and enforced through the adoption of legislation by the governing body of a country. Compared with developed nations, South Africa has limited legislation to help enforce privacy in the health sector. Conversely, Australia, New Zealand and Canada have some of the most advanced legislative frameworks when it comes to the privacy of patient information. In this dissertation, the Australian, New Zealand, Canadian and South African health sectors and the legislation they have in place to ensure the privacy of health information, will be investigated. Additionally, codes of practice and guidelines on privacy of patient information for GPs, in the afore-mentioned countries, will be investigated to form an idea as to what is needed in creating and formulating a new code of practice for the South African GP, as well as a pragmatic tool (checklist) to check adherence to privacy requirements.