Background: Implementations of national electronic health record (EHR) were currently underway worldwide as a core objective of eHealth strategies. It was widely believed that implementation of EHR might lead to considerable financial savings. This paper aimed to conduct a systematic review to assess return-on-investment (ROI) of HER implementation and to identify areas with greatest potential to positive ROI for ongoing deliberation on continuous development of EHR. Methodology: An inclusive string was developed to search English paper published between January 2003 and June 2013. This paper only included studies meet the following criteria 1) Primary study; 2) Involve a computerized system with electronic health record; and 3) include some form of economic evaluation. Critical appraisal was undertaken and articles with higher quality were selected. Hard ROI and soft ROI defined for EHR implementation were adopted as outcome metrics to examine both tangible and intangible return of EHR implementation. Results: A total of 18 articles were examined for data extraction and synthesis. Most of the available evidences came from pre-post evaluation or cross-sectional analysis without uniform standards for reporting. Findings of 56% of the articles indicated that there is cost saving after EHR implementation while 17% of the articles indicated loss in totalrevenue. The remaining articles concluded that there is no association between cost reduction and EHR implementation. Among the defined hard ROI, most studies mentioned the positive effect in resource reduction. Some authors argued that the resource was reallocated to other initiatives and resulted in negligible cost saving. According to the selected literatures, evidences showed that EHR was able to achieve defined soft ROI, especially for improving caring process, but the overall outcome was subject to individual practice. Authors of 12 out of 18 articles have identified the factor leading to positive return and provided recommendation toward successful EHR implementation. Other than implying helpful EHR functions and promoting practice change, additional incentive on quality improvement and performance benchmarking should be considered. The organizations and EHR systems studied in the articles examined were vastly different; it would be desirable if a controlled study adopting EHR with uniform standards can be performed to evaluate the ROI of different clinical settings. Conclusions: The benefits of EHR are not guaranteed, it requires change of practice and substantial efforts. Healthcare industries have to equip themselves for implementing the new technology and to exploit the usage for better clinical outcome. / published_or_final_version / Public Health / Master / Master of Public Health

In this work new approaches to the design and implementation of clinical record systems are examined. Although information technology has long been successfully used in specific areas of medicine, very few situations exist where information systems are routinely used to support the medical record. The underlying thesis of this work is that the major reasons for this failure are the complexity and vastness of the medical field and the limitations of traditional methodologies and models for information systems development. I contend that there is need of an interdisciplinary basis for information systems development methodologies, which account for the multiple characteristics of medical care and for the related information systems. The research has been done from the perspective of a real hospital where the present goal of computerisation has seen the introduction of information systems in routine clinical practice. First, the problem of developing information systems for clinical laboratories is addressed, and a proposed, entity-based methodology developed and implemented. Then, a different entitybased approach is devised for the area of clinical records. This has been successfuly implemented in several clinical applications. However, due to limitations of this approach the natural language paradigm was selected as a basis for a different methodology. A multi-functional information model and system is devised, where information is represented and manipulated by means of different models and representations. These models correspond to three semiotic functions which clinical record systems should support. First, there is the Atomic Object Model which manipulates 'atomic' predications. This model is used primarily for the recording of simple facts (both knowledge and data). Second, there is the Medical Record Model which encompasses mostly structural and temporal properties of information and its major semiotic function is communication. It utilises abstraction principles such as 'generalisation' and 'aggregation'. The third model, the Clinical Model, is designed to incorporate different roles'that information can play in reasoning for clinical problem-solving. An information system was developed in which special care was given to problems of man-machine interaction, both in regard to information modelling and to manipulation of patient information. An integrated information system was developed gradually using different database management systems. A dozen different clinical applications have been developed and implemented and hundreds of physicians and nurses utilise the system in routine clinical work

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The purpose of this study was to determine which variables in the backgrounds of CETA. (Comprehensive Employment Training Act) Medical Records students affected their performance in Medical Terminology course-work. More specifically, the aim of the research was to delineate those variables which had a statistically significant correlation the students' numerical final exam score in Medical Terminology.All data for the study' were generated in the course of teaching a 3-credit hour college class in Medical Terminology at Joliet Junior College, Joliet, Illinois. The 4 3 subjects, all female students in the Medical Records CETA Program at Joliet Junior College, had widely diversified personal backgrounds. They ranged in age from 18 to the late 40’s. Some were married. Some were divorced. Some were separated. Still others remained single. Most of the students were white. A smaller fraction were black, and a still smaller number were Oriental. The educational level of the students varied widely. Several of the subjects had not been beyond the tenth grade, while at the other extreme, a fear students had achieved the rough equivalent of bachelor's degrees. Some of the students achieved high verbal aptitude and general intelligence scores, while many others had low or average scores. Interview scores, intended to "rank" students by various personality characteristics, showed much less individual deviation.Seven independent variables of student race, marital status, age, interview score (determined by a CETA Vocational Counselor), general intelligence and verbal aptitude scores (according to the General Aptitude Test Battery)., and educational level, were each correlated with the dependent variable of Medical Terminology final exam score.A survey of related background literature had suggested that verbal aptitude had an enhancing effect on performance in exams involving usage of grammatical terms. Likewise, educational level was seen to generally raise standardized test scores. General intelligence scores were reported to significantly affect academic and work performance of soma kinds, but to not affect others. Marital status was judged to often be involved in degree of responsibility and attitude toward completion of educational tasks. Race membership was shown to significantly effect performance on verbal tests, at least when these tests were "weighted" in favor of whites over blacks due to a "middleclass bias" of questions emphasizing lifestyles not experienced by many poorer blacks. Chronologic age was reported to be generally an asset to verbal performance, as long as this verbal performance was one benefiting from practical experience rather than one relying on speeded tests to gauge verbal competence. Student attitude was considered to be of importance in perseverance of educational task accomplishment.The final exam in Medical Terminology was subjected to item analysis by the Ball State University Testing Center and found to have sufficient reliability, discrimination, and validity to be effectively employed as a research tool.For example, reliability of the Medical Terminology final exam was determined by both the split-half technique and by the Kuder Richardson formula number 20 and 21 : reliabilities were found to range from the .70's to the .80's. Most items analyzed also had a satisfactory (0.20 - 0.39) or superior (0.40 or higher) level of discrimination. Finally, the majority of items on the computer-analyzed final exam had validity indices in the .70’s and .80's range.A stepwise regression analysis was conducted in order to ascertain the relative correlation of each of the seven independent variables with the dependent variable of Medical Terminology final exams scores. Those independent variables having a statistically significant correlation were inserted into an equation for prediction of Medical Terminology final exam score. Review of the data led to the following conclusions:According to the prediction equation, verbal aptitude was he best predictor of final exam score in Medical Terminology, followed by educational levels. Although the effect of educational level was not in itself its inclusion in the equation added 31/o of the variance. The other five independent variables of race, age, marital status, and interview score, and general intelligence had no effect on Medical Terminology final exam scores.Conclusions of this study were generally that both verbal aptitude scores and level of education could be useful in the counseling and admissions process in the CETA Medical Records Program at Joliet Junior College, as well as in other similar CETA programs located in other cities.For example, CETA admissions personnel could put more weight on a student's verbal aptitude score than on his general intelligence score, verbal aptitude having been shown to be significantly correlated with Medical Terminology final exam score, whereas general intelligence score has not been found to be significantly correlated with this score. In addition, "borderline" applicants to the Medical Records Program could be accepted on the basis of extensive educational experience and good performance on verbal aptitude tests, even when scores in other areas were fairly low.It was also judged that study findings could be used in the counseling of students who would be more likely to fail the Medical Terminology coarse.In the instance of an individual who was admitted to the CETA Medical Records Program in spite of poor performance on verbal aptitude tests, special advice and counseling, or even additional tutorial sessions, could be applied in order to bring the student up to the expected level of verbal performance.Still other possibilities drawn from the findings were that CETA Vocational Counselors could better detect the root causes of poor performance by the students. For example, if an individual received low grades on Medical Terminology tests but had a high level of verbal aptitude, this would suggest that the student's problems lay elsewhere, such as with difficulties in his homelife or in his particular social situation. Thus, the CETA counselors could concentrate on ameliorating these social difficulties rather than on assisting the student in the development of pre-existing verbal skills.

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2007. / Includes bibliographical references.

Thesis (M.S.)--West Virginia University, 2005 / Title from document title page. Document formatted into pages; contains vi, 65 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 64-65).

Thesis (Ph.D.)--Virginia Commonwealth University, 2009. / Prepared for: Dept. of Information Systems. Title from title-page of electronic thesis. Bibliography: leaves 108-117.

Thesis (M.S.)--University of Florida, 2001. / Title from title page of source document. Document formatted into pages; contains ix, 52 p.; also contains graphics. Includes vita. Includes bibliographical references.

Thesis (M.S.)--University of Wisconsin--Madison, 1971. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis--University of Wisconsin--Madison. / Typescript. Vita. Includes bibliographical references (leaves 81-82).