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.

Senior Health Care System (SHCS) is created for users to enter participants' conditions and store information in a central database. When users are ready for quarterly assessments the system generates a simple summary that can be reviewed, modified, and saved as part of the summary assessments, which are required by Federal and California law.

The Constitution of the Republic of South Africa, 1996 (Act 108 of 1996) stipulates that every person has the right of access to information held by government. To give effect to this right, legislation in the form of the Promotion of Access to Information Act, 2000 (Act 2 of 2000) was promulgated. This study explores the access to information regime that was established by die aforementioned legislation with specific reference to similar regimes in the United States of America, Australia, New Zealand and Canada. Attention is also devoted to the prerequisites and potential obstacles associated with the implementation of the Promotion of Access to Information Act, 2000. Based on the practices in other states, the conclusion was reached that the nature of information that may be requested in the South African context should be expanded, that cabinet records should only be excluded to the extent that disclosure thereof would be harmful, that frequently requested records should be made automatically available and that decision-making guidelines of government institutions should be published. As far as procedural requirements are concerned, it is proposed that information officers should acknowledge receipt of requests and that, where necessary, records should be translated to ensure that they are useful to a requester. It is further proposed that the wording of the ground of refusal regarding policy formulation and decision-making in government institutions be amended to take account of the consequences of disclosure. It is imperative that appeal and review mechanisms be accessible to members of the public and it is therefore proposed that an information commissioner be instituted to settle disputes in information related matters. Lastly it is proposed that sanctions be imposed against officials who deliberately undermine the public's right of access to information and that separate units be established in government institutions to deal exclusively with requests for access to information. / Public Administration / D. Litt. et Phil. (Public Administration)

The application of information communication technologies (ICTs) in records management in many organisations underscores the need for the assessment of e-records readiness. This provides a useful guide in benchmarking, gauging progress and comprehending e-records management. This study examined e-record readiness in labour organisations with a view to proposing a framework for labour organisations in Botswana. The study was largely guided by a quantitative paradigm and used a survey research strategy. This was complemented by methodological triangulation of both quantitative and qualitative data collection methods. All the 50 registered labour organisations in Botswana were surveyed, 45 of which responded, representing a response rate of 90%. Data was obtained through structured questionnaires, semi-structured interviews, document review and observations. The study established that e-records readiness in labour organisations in Botswana was evident, low and evolving, evidenced by the slow adoption of ICTs; inadequate records management standards and practices; and low integration in the national e-readiness framework. The study confirmed that most labour organisations had embraced the utilisation of ICTs in their work; exhibited some form of records management function and acknowledged the existence of national policy directives and strategies on e-readiness. However, traditional ICTs mainly the fax and telephone, were more prevalently adopted and used than newer ones such as e-mail and the Internet. The use of social media technology (Web 2.0 - Facebook, YouTube, and Twitter) was yet to be explored. The management of both paper-based and electronic records was not satisfactory and fell short of best recognised records management standards and practice. The integration of labour organisations into national e-readiness initiatives as espoused in key policy proclamations within the context of the pursuance of a holistic knowledge and information society was slow and remained challenging. In order to foster successful e-records readiness in labour organisations, several recommendations were advanced that underscored effective ICT adoption and use, implementation of best records management practices and rigorous integration of labour organisations into the information and knowledge society in Botswana. In addition, an integrated framework for examining and understanding e-records readiness in labour organisations was proposed and documented. / Information Science / D. Litt. et Phil. (Information Science)

The Constitution of the Republic of South Africa, 1996 (Act 108 of 1996) stipulates that every person has the right of access to information held by government. To give effect to this right, legislation in the form of the Promotion of Access to Information Act, 2000 (Act 2 of 2000) was promulgated. This study explores the access to information regime that was established by die aforementioned legislation with specific reference to similar regimes in the United States of America, Australia, New Zealand and Canada. Attention is also devoted to the prerequisites and potential obstacles associated with the implementation of the Promotion of Access to Information Act, 2000. Based on the practices in other states, the conclusion was reached that the nature of information that may be requested in the South African context should be expanded, that cabinet records should only be excluded to the extent that disclosure thereof would be harmful, that frequently requested records should be made automatically available and that decision-making guidelines of government institutions should be published. As far as procedural requirements are concerned, it is proposed that information officers should acknowledge receipt of requests and that, where necessary, records should be translated to ensure that they are useful to a requester. It is further proposed that the wording of the ground of refusal regarding policy formulation and decision-making in government institutions be amended to take account of the consequences of disclosure. It is imperative that appeal and review mechanisms be accessible to members of the public and it is therefore proposed that an information commissioner be instituted to settle disputes in information related matters. Lastly it is proposed that sanctions be imposed against officials who deliberately undermine the public's right of access to information and that separate units be established in government institutions to deal exclusively with requests for access to information. / Public Administration and Management / D. Litt. et Phil. (Public Administration)

The application of information communication technologies (ICTs) in records management in many organisations underscores the need for the assessment of e-records readiness. This provides a useful guide in benchmarking, gauging progress and comprehending e-records management. This study examined e-record readiness in labour organisations with a view to proposing a framework for labour organisations in Botswana. The study was largely guided by a quantitative paradigm and used a survey research strategy. This was complemented by methodological triangulation of both quantitative and qualitative data collection methods. All the 50 registered labour organisations in Botswana were surveyed, 45 of which responded, representing a response rate of 90%. Data was obtained through structured questionnaires, semi-structured interviews, document review and observations. The study established that e-records readiness in labour organisations in Botswana was evident, low and evolving, evidenced by the slow adoption of ICTs; inadequate records management standards and practices; and low integration in the national e-readiness framework. The study confirmed that most labour organisations had embraced the utilisation of ICTs in their work; exhibited some form of records management function and acknowledged the existence of national policy directives and strategies on e-readiness. However, traditional ICTs mainly the fax and telephone, were more prevalently adopted and used than newer ones such as e-mail and the Internet. The use of social media technology (Web 2.0 - Facebook, YouTube, and Twitter) was yet to be explored. The management of both paper-based and electronic records was not satisfactory and fell short of best recognised records management standards and practice. The integration of labour organisations into national e-readiness initiatives as espoused in key policy proclamations within the context of the pursuance of a holistic knowledge and information society was slow and remained challenging. In order to foster successful e-records readiness in labour organisations, several recommendations were advanced that underscored effective ICT adoption and use, implementation of best records management practices and rigorous integration of labour organisations into the information and knowledge society in Botswana. In addition, an integrated framework for examining and understanding e-records readiness in labour organisations was proposed and documented. / Information Science / D. Litt. et Phil. (Information Science)