Administrative programs that govern the day-to-day-management of agencies are founded in law and the federal records management program is no exception. This dissertation explores whether the existing legal framework accommodates the changes occurring in the federal records management program as a result of electronic records and whether the solutions proposed by the University of British Columbia and University of Pittsburgh are viable for the federal records officer. These two universities pioneered the research being done on electronic recordkeeping. The record requirement established under the Federal Records Act is very difficult for agencies to maintain when it comes to electronic records. At the same time, agencies are being pressured to do more work electronically. Most federal records officers are not equipped to meet the dual challenge of maintaining accessibility while also ensuring the records remain authentic. The two approaches for dealing with electronic records, UBC's Diplomatics as implemented with the Department of Defense standard and Pittsburgh's literary warrants, are too complex and difficult. Even if the records managers implemented either of these approaches, they require too much effort on behalf of the record creator for the implementations to be successful. The National Archives can provide advice and guidance to agencies on electronic recordkeeping requirements. However, the success of the records management program depends on the federal agencies because it is a decentralized administrative process. The ability of federal agencies to cope with electronic records is problematic. Therefore, the viability of the federal records management program is problematic. / Ph. D.

published_or_final_version / Public Health / Master / Master of Public Health

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Typescript (photocopy). / Digitized by Kansas Correctional Industries

Thesis (M Cur)--University of Limpopo, 2011. / An evaluation of the effective use of Computer-based Nursing Information System (CNIS) in patient care by Professional nurses at Dr George Mukhari Hospital. The aim of the study was to evaluate if the CNIS is being used effectively for patient care by professional nurses in different nursing units. The objectives of the study were to describe the perceptions of professional nurses regarding the role of CNIS, to determine the effective use of CNIS, and to identify barriers to the effective use of CNIS in patient care. Quantitative descriptive simple survey research design was used. The setting was at Dr George Mukhari Hospital. The population was all professional nurses who are working on day and night shifts in the wards that have computers installed for the purpose of patient care. Non probability, convenience sample of 120 professional nurses was used. Data was collected utilising a self report questionnaire with 41 closed ended and one open ended questions. Raw data was fed into a SPSS with the assistance of a statistician. Data analysis was conducted through the use of descriptive statistics. The findings are that professional nurses are not using CNIS effectively in patient care. In a unit with a bed occupancy rate of 30-40 patients, and where 30-40 patients are attended to on a daily basis, only 0-2 Nursing Care Plans (NCP) or entries are performed by professional nurses. The majority of professional nurses (56%) never updated NCPs or made an entry before. This is despite the fact that they have indicated positive perceptions with regard to the role of CNIS in patient care. Increased workload, inadequate number of computers, and lack of continuous in-service training were cited by the majority as barriers to the effective use of CNIS in patient care. A problem of increased workload will remain a challenge for as long as available technology is not used appropriately. Hence, hand held devices such as Personal Digital Assistants (PDAs), Electronic Health Records (EHRs) and bedside terminals, are highly recommended. Key concepts: Computer, Nursing, Information, System, Evaluation, Effective, Professional Nurses, Patient care.

Thesis (Ph. D.)--University of Oklahoma, 1990. / Includes bibliographical references (leaves 183-194).

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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