In the last decade, the deployment of Electronic Health Records has increased tremendously in many developed countries. This increasing trend intensifies the need for developing countries like South Africa to implement electronic health record systems in state owned hospitals to facilitate e-referral processes to improve health care delivery. The aim of this research was to investigate the current process of patient record keeping, management, and the referral process of patients within the same hospital and to other hospitals and based on the findings compile an Electronic Health Record (EHR) framework to facilitate e- referral processes. This research study was based on a qualitative case study approach. A multiple data collection technique was used which included group interviews, questionnaires, document analysis and informal discussions with the hospital workers. Data were analysed by categorization and thematic approach. The findings obtained from state hospitals indicated that there is no EHR system which accommodates patient health record systems to facilitate e-referral processes. These findings led to a compilation of the Limpopo Electronic Health Record System (LEHRS) to aid e-referral processes in state hospitals. The increasing need for accurate, reliable, available and accessible EHR will be addressed by the implementation of LEHRS as information will be stored in a central database in a useable format and will be easily accessed. / Computing / M. Tech. (Information Technology)

Indiana University-Purdue University Indianapolis (IUPUI) / Health Information Technology (HIT) has become an integral component of healthcare today. The HITECH Act (2009) and Meaningful Use objectives stand to bring wide-sweeping adoption and implementations of HIT in small, medium and large sized healthcare organizations across the country. Though recent literature has provided evidence for the benefits of HIT in the profession, there have also been a growing number of reports exploring the adverse effects of HIT. There has not, however, yet been a systematic account of the adverse effects of HIT in the healthcare system. The current push for HIT coupled with a lack of critical appraisal of the potential risks of implementation and deployment within the medical literature has led to a general unquestioning and unregulated acceptance of the implementation of technology in medicine and healthcare as a positive addition with little or no risk. While the benefits of HIT are clear, a review of the existing studies in the literature would provide a holistic vision of the adverse effects of HIT as well as the types and impact within the nation’s health care system to inform future HIT development and implementation. The development of a general understanding of these adverse effects can serve as a review and summary for the use of informatics professionals and clinicians implementing HIT as well as providing future direction for the industry in HIT implementations. Additionally, this study has value for moving forward in informatics to develop frameworks for implementation and guidelines and standards for development and regulation of HIT at a federal level. This study involves the use of an integrative literature review to identify and classify the adverse effects of HIT as reported in the literature. The purpose of this study is to perform an integrative review of the literature to 1) identify and classify the adverse effects of HIT; 2) determine the impact and prevalence of these effects; 3) identify the recommended actions and best practices to address the negative effects of HIT. This study analyzed 18 articles for HIT-induced error and adverse consequences. In the process, 228 errors and/or adverse consequences were identified, classified and represented in an operational taxonomic schema. The taxonomic representation consisted of 8 master categories and 30 subcategories. Additionally, the prevalence and impact of these errors were evaluated as well as recommendations and best practices in future systems design. This study builds on previous work in the medical literature pertaining to HIT-induced errors and adverse consequences and offers a unique perspective in analyzing existing studies in the literature using the integrative review model of research. It is the first work in combining studies across healthcare technologies and analyzing the adverse consequences across 18 studies to form a cohesive classification of these events in healthcare technology.

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.

Indiana University-Purdue University Indianapolis (IUPUI) / A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services Research, and (4) Organizational Change/Theory. The study design builds upon the constructs of a conceptual framework developed by Jane Zapka, namely, (1) organizational and/or practice settings, (2) provider characteristics, and (3) patient population characteristics. These constructs have been operationalized as measures in a 2005 HRSA/NCI Health Disparities Cancer Collaborative inventory of 44 community health centers. The first, statistical models will use: sequential, multivariable regression models to test for the organizational determinants that may account for the presence and intensity-of-use of clinical decision support (CDS) and information systems (IS) within community health centers for use in colorectal, breast, and cervical cancer screening. A subsequent test will assess the impact of CDS/IS on provider reported cancer screening improvement rates. The second, computational models will use a multi-agent model of network evolution called CONSTRUCT® to identify the agents, tasks, knowledge, groups, and beliefs associated with cancer screening practices and CDS/IS use to inform both CDS/IS implementation and cancer screening intervention strategies. This virtual experiment will facilitate hypothesis-generation through computer simulation exercises. The outcome of this research will be to identify barriers and facilitators to improving community health center facility-level cancer screening performance using CDS/IS as an agent of change. Stakeholders for this work include both national and local community health center IT leadership, as well as clinical managers deploying IT strategies to improve cancer screening among vulnerable patient populations.

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.