The landscape of the United States public school system was greatly improved upon with the creation of The Individuals with Disabilities Education Act of 2004 (IDEA 2004). This act established a standard that allowed all school aged children living with chronic illnesses to integrate into public school systems. This mandate currently impacts over 12 million children living with chronic illness including and not limited to asthma, seizure disorders, developmental delay, cystic fibrosis, traumatic brain injuries, anxiety and cancer. IDEA 2004 extended healthcare into public school systems and as a result, increased the average acuity of students that school nurses (SNs) care for. It is estimated that 15% of school-aged children miss 11 or more school days per year because of illness or injury demonstrating evidence of increased student acuity and a need to provide more appropriate care for these students in order to increase their time spent in the academic setting. Adequate SN and primary care provider (PCP) communication is essential to reduce absenteeism for this population and to ensure that students are safe during their time spent away from home and healthcare clinics. From this quality improvement project, more is understood pertaining to the communication patterns between SNs and PCPs and recommendations are provided in order to increase effective SN and PCP communication.

In healthcare there is a rapid development towards introducing and implementing a wide range of information technology (IT) to aim for higher quality and more effective care. A common health information system (Cambio Cosmic) has been implemented in Landstinget Kronoberg. Clinical microsystems are the frontline units where staff and pa-tient meet. When the conditions in the microsystems are changed, it is interesting to de-scribe and analyse the consequences. The purpose of this study is to describe how health care staff uses a health information sys-tem and how they experience its functionality in their patient work. Initially, a literature re-view about the use of health information system was undertaken, followed by a qualitative case study based on interviews about how healthcare staff describes their reality. In March 2007 general practitioners, district nurses and practical nurses at the health care center in Markaryd were interviewed. The results were analysed using a modified microsystem the-ory. The analysis showed that the health care staff in Markaryd used Cambio Cosmic for medical record, time planning, cash handling, laboratory examinations and results, and medications. Apart from Cosmic, they used several other information systems IT- or pa-perbased. The staff experienced that Cosmic did support their patient work, but technical deficiencies impeded use. The staff required a more rapid system, integration of systems and more per-sonal adaptations. A common health information system was seen as a strength in the care process. Co-operation between staff and with other caregivers was facilitated and Cosmic contributed to a more efficient work pattern. The patients could receive improved service and information. In general, the staff thought that they had access to the right information for the care of the patient, but improvements were needed for access to information at the right point of time. Cosmic was not used to improve work at the health care center. The staff expressed a positive attitude towards working with and in Cosmic. Based on the re-sult, improvements at both micro- and macrosystems levels are recommended. / Inom sjukvården sker en snabb utveckling med att implementera allt mer informationstek-nik (IT) i syfte att höja kvalitet och effektivitet inom sjukvården. Ett gemensamt vårdin-formationsssystem (Cambio Cosmic) har införts i Landstinget Kronoberg. Den plats i vår-dens frontlinje där patienter och vårdpersonal möts är ett kliniskt microsystem. När förut-sättningarna ändras i ett system är det intressant att analysera och beskriva konsekvenserna. Syftet med denna rapport är att beskriva hur vårdpersonal använder ett IT-baserat vårdin-formationssystem och hur de upplever att det fungerar i patientarbetet. En litteraturstudie gjordes om användning av vårdinformationssystem. En fallstudie med intervjuer användes med en kvalitativ ansats för att samla in data om hur vårdpersonalen beskriver sin verklig-het. I mars 2007 intervjuades distriktsläkare, distriktsköterskor och undersköterskor på vårdcentralen i Markaryd, totalt 6 intervjuer, två av varje kategori. Resultatet analyserades utifrån en modifierad microsystemsteori. Vårdpersonalen i Markaryd använde Cambio Cosmics moduler för vårddokumentation, tidbokning, kassafunktion, provtagning och lä-kemedel. Utöver Cosmic användes även flera andra IT-stöd och papperssystem i patientar-betet. Vårdpersonalen upplever att Cosmic fungerar som stöd i patientarbetet, men att tekniska brister är ett hinder i användningen och de efterfrågade ett snabbare system, systemintegre-ring och mer personliga anpassningar. I vårdprocessen upplevdes tillgången till en lands-tingsgemensam journal som en styrka. Samverkan mellan vårdpersonal och med andra vårdgivare underlättades och Cosmic bidrog till ett effektivare arbetssätt. Patienten kunde ges en förbättrad service och information. Överlag ansåg vårdpersonalen att de hade till-gång till rätt information för patientens vård, men för att ha tillgång till information i rätt tid behövdes förbättringar. Cosmic användes inte i förbättringsarbete på vårdcentralen. Vårdpersonalen på Markaryds vårdcentral gav uttryck för en positiv inställning till arbetet i Cosmic. Utifrån resultatet rekommenderas förbättringar på både micro- och macrosys-temsnivå.

abstract: Blockchain technology enables a distributed and decentralized environment without any central authority. Healthcare is one industry in which blockchain is expected to have significant impacts. In recent years, the Healthcare Information Exchange(HIE) has been shown to benefit the healthcare industry remarkably. It has been shown that blockchain could help to improve multiple aspects of the HIE system. When Blockchain technology meets HIE, there are only a few proposed systems and they all suffer from the following two problems. First, the existing systems are not patient-centric in terms of data governance. Patients do not own their data and have no direct control over it. Second, there is no defined protocol among different systems on how to share sensitive data. To address the issues mentioned above, this paper proposes MedFabric4Me, a blockchain-based platform for HIE. MedFabric4Me is a patient-centric system where patients own their healthcare data and share on a need-to-know basis. First, analyzed the requirements for a patient-centric system which ensures tamper-proof sharing of data among participants. Based on the analysis, a Merkle root based mechanism is created to ensure that data has not tampered. Second, a distributed Proxy re-encryption system is used for secure encryption of data during storage and sharing of records. Third, combining off-chain storage and on-chain access management for both authenticability and privacy. MedFabric4Me is a two-pronged solution platform, composed of on-chain and off-chain components. The on-chain solution is implemented on the secure network of Hyperledger Fabric(HLF) while the off-chain solution uses Interplanetary File System(IPFS) to store data securely. Ethereum based Nucypher, a proxy re-encryption network provides cryptographic access controls to actors for encrypted data sharing. To demonstrate the practicality and scalability, a prototype solution of MedFabric4Me is implemented and evaluated the performance measure of the system against an already implemented HIE. Results show that decentralization technology like blockchain could help to mitigate some issues that HIE faces today, like transparency for patients, slow emergency response, and better access control. Finally, this research concluded with the benefits and shortcomings of MedFabric4Me with some directions and work that could benefit MedFabric4Me in terms of operation and performance. / Dissertation/Thesis / Masters Thesis Computer Engineering 2020

The hospitals and their healthcare providers need to optimize simultaneously three outcomes: healthcare costs, healthcare options offered to customers, and information utilization efficiency. The adoption of electronic healthcare record (EHR) technologies is a potential managerial mechanism for balancing these outcomes. EHR offers patient management and decision support capabilities that can ameliorate health delivery outcomes for patients, doctors, and hospitals through better-informed business and care decisions. The analysis of data collected in an EHR system may lower costs and improve health care delivery (or both). In sum, it could be argued that EHR is a source of competitive advantage. Despite this prima facie appeal, many hospitals remain reluctant to adopt and implement EHR due to lack of insights into return on investment, unavailability of tested systems and data entry obstacles. To address this gap between the potential of EHR system and lack of its adoption, the purpose of this research is to investigate the role of EHR as a resource of competitive advantage for hospital. Essay 1, titled "Implementation and Adoption of EHR: A Conceptual Model based on Resource Advantage Theory", describes the antecedents and consequences of EHR adoption and implementation. Essay 2, titled "Exploring the Relationship Between Electronic Healthcare Record Adoption and Quality of Care", delves deeper into the operational performance of a hospital. This essay focuses on the impact of EHR on different aspects of patient care and thereby on the financial performance of the hospital. Essay 3, titled "The Effect of Resources on a Hospital's Financial Performance: The Moderating Role of Electronic Health Records Implementation and Adoption", is an empirical inquiry into the key factors that may influence hospitals' financial performance. These include organizational factors (such as, number of nurses and beds) and environmental factors (such as, location and received donations). Further, this essay explores the interaction effects between EHR and these factors. In summary, this research provides a conceptualization and an empirical investigation of EHR adoption and implementation and its impact on hospitals' operational and financial performance, an area receiving widespread attention from health care organizations, patient rights activists, public policy makers and the media. Future research can take two paths. First, further research should address questions related to the integration of EHR with other production and inventory management systems, and the prospective benefits attained from system integration. Second research is needed to investigate how parallel information transfer across multiple stakeholders may concurrently preserve Health Insurance Portability and Accountability Act, reduce health care delivery costs and optimize service quality.

The American Recovery and Reinvestment Act (ARRA) of 2009 authorized the distribution of about $30 billion incentive funds to accelerate electronic health record (EHR) applications to improve the quality of care, safety, privacy, care coordination, and patients' involvement in healthcare. EHR use has the potential of saving $731 in costs for hospitals per patient admission; however, most hospitals are not applying EHR to reach the level at which cost savings are possible. The purpose of this single case study was to explore strategies that IT leaders in hospitals can use to apply EHR to achieve the cost saving benefits. The participants were IT leaders and EHR super users at a large hospital in Texas with successful experience in applying EHR. Information systems success model formed the conceptual framework for the study. I conducted face-to-face interviews and analyzed organizational documents. I used qualitative textual data analysis method to identify themes. Five themes emerged from this study, which are ensuring information quality, ensuring system quality, assuring service quality, promoting usability, and maximizing net benefits of the EHR system. The findings of this study included four strategies to apply EHR; these strategies include engaging training staff, documenting accurately and in a timely manner, protecting patient data, and enforcing organizational best practice policies to maximize reimbursement and cost savings. The findings of this study could contribute to positive social change for the communities because EHR successful application includes lower cost for hospitals that may lead to the provision of affordable care to more low-income patients.

Dans le domaine médical, la numérisation des documents et l’utilisation des dossiers patient électroniques (DPE, ou en anglais EHR pour Electronic Health Record) offrent de nombreux avantages, tels que le gain de place ou encore la facilité de recherche et de transmission de ces données. Les systèmes informatiques doivent reprendre ainsi progressivement le rôle traditionnellement tenu par les archivistes, rôle qui comprenait notamment la gestion des accès à ces données sensibles. Ces derniers doivent en effet être rigoureusement contrôlés pour tenir compte des souhaits de confidentialité des patients, des règles des établissements et de la législation en vigueur. SGAC, ou Solution de Gestion Automatisée du Consentement, a pour but de fournir une solution dans laquelle l’accès aux données du patient serait non seulement basée sur les règles mises en place par le patient lui-même mais aussi sur le règlement de l’établissement et sur la législation. Cependant, cette liberté octroyée au patient est source de divers problèmes : conflits, masquage des données nécessaires aux soins ou encore tout simplement erreurs de saisie. C’est pour cela que la vérification et la validation des règles d’accès sont cruciales : pour effectuer ces vérifications, les méthodes formelles fournissent des moyens fiables de vérification de propriétés tels que les preuves ou la vérification de modèles.Cette thèse propose des méthodes de vérification adaptées à SGAC pour le patient : elle introduit le modèle formel de SGAC, des méthodes de vérifications de propriétés telles l’accessibilité aux données ou encore la détection de document inaccessibles. Afin de mener ces vérifications de manière automatisée, SGAC est modélisé en B et Alloy ; ces différentes modélisations donnent accès aux outils Alloy et ProB, et ainsi à la vérification automatisée de propriétés via la vérification de modèles ou model checking / In healthcare, data digitization and the use of the Electronic Health Records (EHR) offer several benefits, such as reduction of the space occupied by data, or the ease of data search or data exchanges. IT systems must gradually act as the archivists who manage the access over sensitive data. Those have to be checked to be consistent with patient privacy wishes, hospital rules, and laws and regulations.SGAC, or Solution de Gestion Automatisée du Consentement, aims to offer a solution in which access to patient data would be based on patient rules, hospital rules and laws. However, the freedom granted to the patient can cause several problems: conflicts, hiding of the needed data to heal the patient or simply data-capture error. Therefore, verification and validation of policies are crucial: to conduct this verification, formal methods provide reliable ways to verify properties like proofs or model checking.This thesis provides verification methods applied on SGAC for the patient: it introduces the formal model of SGAC, verification methods of properties such as data reachability or hidden data detection. To conduct those verification in an automated way, SGAC is modelled in B and Alloy; these different models provide access to the tools Alloy and ProB, and thus, automated property verification with model checking

No description available.

The present study takes legibility research and extends it to the medical setting. Internal Medicine Physicians from UCF developed six passages of medical text detailing a History of Present Illness (HPI) Report from an emergency department as well as comprehension questions for the purpose of our study. In our study, we first presented non-medical passages and comprehension questions in six common fonts to identify participants' individual fastest and slowest fonts. We then gave participants medical passages in both their best and worst fonts while measuring reading speed and comprehension. This study was delivered to a population of Amazon Mechanical Turk crowd workers to help us better understand how legibility improvements can be made within specific fields. We hope that with this study we can begin the process of restructuring Electronic Health Records to be more usable and efficient for physicians.

A handoff requires that the responsibility for patient patient’s care is transferred from one healthcare professional to another. The goals of this research were to identify, evaluate, and use analytical methods to describe how physicians (n=10) extracted information from electronic progress notes, one important source of information used during handoffs. Participants also verbally summarized the notes as they would during handoffs. Six methods were used to analyze how participants read progress notes, each uniquely contributing to our understanding of physicians’ visual attention patterns during this process. The participants focused their visual attention on the Impression and Plan section of the progress notes in that over 60% of the participants’ total time was spent reading that section. Physicians could miss an error or critical piece of information if the information is not located in the Impression and Plan. The importance given by the participants to the Impression and Plan section was confirmed in that the majority of participants’ verbal handoff content focused primarily on information that could be found in the Impression and Plan. Participants relied on the Medication Profile section quite heavily if it was present in the progress note. We determined that if the participant was currently reading in one section (s)he most likely would transition his/her visual attention to the physically closest section in the note, meaning the format of progress notes may dictate how notes are read. We determined what the most likely paths were through the progress notes, which could be a first step in reordering of the progress note for evaluation in future studies. Participants’ responses to debriefing questions suggested that they were aware of their reliance on the Impression and Plan, but that they thought the way they read notes is context-specific, depending on factors such as their use of the note and the reputation of the author of the note. These findings suggest a need for more research that evaluates how different note structures and content affect how physicians and other health providers extract and use information in varied clinical contexts.

<p dir="ltr">This study aims to predict the environmental, organizational, and managerial factors that determine the adoption of cloud computing in U.S. healthcare delivery systems. The premise of the analysis is that several internal and external factors determine a health provider’s transition to cloud computing. The U.S. government has funded healthcare providers through HITECH <a href="" target="_blank">(Health Information Technology for Economic and Clinical Health) </a>to implement electronic health records (EHR) which is considered as an important first step in transitioning to cloud computing. This study investigated whether there is a significant difference between hospitals and providers that received HITECH funding to enhance their EHR infrastructure and those that did not in terms of their external environmental complexities, internal organizational structure, and quality of healthcare services they provide. A stratified random sample was applied to select a cohort of 3,385 hospitals from the American Hospital Association (AHA) 2022 roster for the period 2018- 2021 to test the study hypothesis. The sampled hospitals were linked with claim, administrative, cost, and ICD-10 clinical data files to capture variables of interest repeatedly over the study period. The analysis modeled for selected external (location, market concentration as measured by Herfindahl Index), internal (number and composition of staff – physicians, nurses, technicians, etc.) demographic, clinical and financial factors. Quantitative methods such as generalized estimating equations (GEE), logistic regression, and generalized linear mixed model (GLMM) were applied within the framework of unified technology acceptance theory (UTAT), accounting for both discrete and continuous response variables while modeling for possible between-subject heterogeneity and within-subject correlations. The analysis is based on publicly available data sources that are systematically linked to address the research questions. The portion of the HITECH funding that is applied for cloud computing is calculated from the hospital’s EHR funding. This is one of the very few longitudinal time series studies of cloud computing in healthcare since almost all previous studies on American hospitals are cross-sectional. The findings of this study show statistically significant differences between hospitals that received government funding in terms of internal organizational structure, environmental complexity, and quality of healthcare provided. The analysis identified management and quality metrics that help to gauge continuously changing organizational needs and identify emerging trends. This study proposes specific topics that future researchers can consider promoting a successful implementation of cloud computing.</p>