This degree project deals with electronic health record (EHR). The report is divided into two main sections; literature study on electronic health record and an EHR system implementation. In the literature study section, EHR background, development history and service condition are introduced. The paper focuses on the sharing of medical information in different users, data safety and privacy. The adjunctions of computer science, technologies are used to solve the medical informatics’ problems. In the implementation section, based on the study of the current EHR systems, the design and implement of a shared EHR system are presented, which can be accessed by different doctors and patients. Access control function and cryptography protections are included in this system. The system test and evaluation are also given.

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This paper argues that given the proliferation of electronic health records (EHRs) in the health care system, legislative reform must occur to address the inadequacies of Ontario’s current health privacy legislation in accommodating EHRs. A coherent framework for legislation is necessary to capture the important role that privacy plays in public perception when it comes to legislating and managing EHRs in Ontario and, in turn, serve as a tool for legislators to understand the definitions and values of privacy associated with EHRs and the privacy problems worthy of protection in an electronic health environment. The failure to properly address these problems may lead to privacy losses and loss of public confidence in EHR systems. In applying this framework to three legislative options, it is evident that Ontario should amend the Personal Health Information Protection Act, 2004 to better contemplate the privacy protections necessary in an electronic health environment.

This paper argues that given the proliferation of electronic health records (EHRs) in the health care system, legislative reform must occur to address the inadequacies of Ontario’s current health privacy legislation in accommodating EHRs. A coherent framework for legislation is necessary to capture the important role that privacy plays in public perception when it comes to legislating and managing EHRs in Ontario and, in turn, serve as a tool for legislators to understand the definitions and values of privacy associated with EHRs and the privacy problems worthy of protection in an electronic health environment. The failure to properly address these problems may lead to privacy losses and loss of public confidence in EHR systems. In applying this framework to three legislative options, it is evident that Ontario should amend the Personal Health Information Protection Act, 2004 to better contemplate the privacy protections necessary in an electronic health environment.

As Canada continues its drive towards a national electronic health record the costs are mounting. With 256 projects underway the question has to be asked: what are the true costs of such an endeavor? Success hinges on cooperation at all levels and adequate funding in place to see it to completion. Has Canada taken into full consideration the impact that this project will have in the long run? One small part of a much larger project in rural Alberta puts a face on the huge undertaking. Nurses in one former health region adopted not only an Order Entry module but also began using computers for the first time in order to do their work. Nurses are one of the key end-user groups actually inputting the information into these systems. Is data entry something nurses need to be concerned with at all especially at the Order Entry level?

Background: Electronic Health Records (EHR) are digital versions of patients' charts (HealthIT.gov, 2013). The government has incentivized current use to allow all healthcare organizations to progress from paper charting. Goals of EHR adoption include improving workflow, documentation, and to improve the quality of care being provided (Weiner, Fowles, & Chan, 2012). Objective: The purpose of this DNP project was to conduct a readiness assessment of the asthma and allergy specialty organization's staff members to identify perceived barriers and advantages of adopting an EHR. Design: This project was guided by the Institute for Healthcare Improvement (IHI) Model for Improvement (Institute for Healthcare Improvement [IHI], 2016). This model was incorporated with the PDSA cycle and DOQ-IT EHR Implementation Roadmap. Descriptive statistics were used for data analysis. Setting: Allergy and asthma specialty practice consisting of 12 clinics within the Denver Metro and Northern Colorado area. Participants: 155 members of the organization including physicians, nurse practitioners, physician assistants, nurses, medical assistants, front office and administrative staff. Measurements: 60 out of 155 staff members completed the readiness assessment survey from HealthInsight (HealthInsight, n.d.).Results: A response rate of 38.7% (n=60) of participants completed the readiness assessment survey. The top two barriers were medical records being unavailable (n= 48, 80%) and the inability to read what is written in the medical record (n= 51, 85%). The top barrier for adopting EHR is having the system freeze or crash (n=36, 65%), followed by, 22 participants or 40% stating EHR is depersonalizing in an exam room. The highest advantage identified was the reduction in paper-based medical charting and filing (n=56, 93%). The second highest advantage was more timely access to patient records (n=55, 92%).Conclusion: Perceived barriers and advantages for EHR adoption within the organization are similar to what literature has currently identified. The information gained from this study will provide a better understanding of the decision and adoption process. The information will help the organization decide whether or not to adopt EHR and how to successfully move through the DOQ-IT EHR Implementation Roadmap, IHI Model for Improvement and PDSA cycle.

Alzheimer’s disease is typically detected using a combination of cognitive-behavioral assessment exams and interviews of both the patient and a family member or caregiver, both administered and interpreted by a trained physician. This procedure, while standard in medical practice, can be time consuming and expensive for both the patient and the diagnostician especially because proper training is required to interpret the collected information and determine an appropriate diagnosis. The use of machine learning techniques to augment diagnostic procedures has been previously examined in limited capacity but to date no research examines real-world medical applications of predictive analytics for health records and cognitive exam scores. This dissertation seeks to examine the efficacy of detecting cognitive impairment due to Alzheimer’s disease using machine learning, including multi-modal neural network architectures, with a real-world clinical dataset used to determine the accuracy and applicability of the generated models. An in-depth analysis of each type of data (e.g. cognitive exams, questionnaires, demographics) as well as the cognitive domains examined (e.g. memory, attention, language) is performed to identify the most useful targets, with cognitive exams and questionnaires being found to be the most useful features and short-term memory, attention, and language found to be the most important cognitive domains. In an effort to reduce medical costs and streamline procedures, optimally predictive and efficient groups of features were identified and selected, with the best performing and economical group containing only three questions and one cognitive exam component, producing an accuracy of 85%. The most effective diagnostic scoring procedure was examined, with simple threshold counting based on medical documentation being identified as the most useful. Overall predictive analysis found that Alzheimer’s disease can be detected most accurately using a bimodal multi-input neural network model using separated cognitive domains and questionnaires, with a detection accuracy of 88% using the real-world testing set, and that the technique of analyzing domains separately serves to significantly improve model efficacy compared to models that combine them. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

The purpose of this research was to explore nurses' perceptions of the effectiveness of nursing documentation of patient status during a clinical event when using electronic documentation with or without embedded standardized languages. The theoretical framework for this study was based on principles of information theory. This study was significant in two very important ways; first, in contrast to prior studies, the perceptions of nurses were focused on the documentation of a clinical event. Second, this study explored the nurses' opinions about the strengths and limitations of using structured languages (specifically, the North American Nursing Diagnosis Association (NANDA), the Nursing Intervention Classification (NIC), and the Nursing Outcomes Classification (NOC)) for telling the patient's story during a clinical event, as well as collecting nurses' suggestions for improving electronic documentation. Semi-structured interviews of 37 nurses were conducted in two acute care hospitals. Both hospitals used electronic documentation, but only one used embedded standardized nursing languages. Half the interviewees were asked questions from the perspective of the nurse documenting a clinical event; half were asked questions from the perspective of a nurse reviewing another nurse's documentation of a clinical event. Recorded interviews were transcribed, and the transcripts analyzed using qualitative content analysis. A panel of judges was used to establish reliability of the coding scheme. The results showed that nurses perceived aspects of three categories (usability, legibility, and communication) as strengths of the documentation system. Nurses perceived aspects of three categories (usability, communication, and workarounds) as limitations of the documentation system. Potential solutions to improve the documentation system were defined related to three categories (usability, communication, and collaboration). Usability was perceived by the nurses as a strength of the electronic documentation with embedded nursing languages. Usability of the electronic documentation system with nursing languages was also perceived as a limitation. Improving language usability was identified as a potential solution to improve the electronic documentation system with embedded nursing languages.

Rationale: The Cancer Agency Information System (CAIS) is the primary patient record for the British Columbia Cancer Agency (BCCA) but is only accessible on fixed computer workstations. The BCCA clinics have significant space limitations resulting in multiple healthcare providers sharing each workstation. Furthermore, workstations are not available in the patient examination rooms leading to multiple visit interruptions. Given that timely and efficient access to patient electronic records is fundamental in providing optimal patient care, the iPad Mobility Project was launched to introduce and evaluate the effect of mobile technologies and applications in improving access to CAIS and supporting clinicians’ workflow. Methods The project evaluation framework was created in collaboration with the project stakeholders including BCCA clinicians. The framework included pre- and post-implementation questionnaires, pre- and post-implementation observational sessions, and post-implementation semi-structured interviews. Survey questionnaires mainly included standardized scales used to measure user expectations and perceptions before and after information systems implementation. Also, based on Canada Infoway System and Use Survey, the post-implementation questionnaire included questions that measure the mobile system success in terms of information quality, system quality, service quality, user satisfaction, and use measures. The response rate was 84% (n=44) for the baseline survey and 76% (n=52) for the post-implementation survey. Also, baseline and post-implementation observational sessions (n=5, n=6 respectively) were conducted to provide real-time data about the use of the available record keeping systems before and after the mobile system implementation. Post-implementation semi-structured interviews (n=11) were conducted to allow clinicians to reflect on their use of the iPad and VitalHub Chart application. Results: The results showed an overwhelmingly positive attitude to the use of the iPad and the VitalHub Chart application to support clinicians’ mobile workflow through enhanced access to CAIS. Perceived benefits were related to three major categories: information accessibility and inter-professional communication; workflow efficiency and provider productivity, and patient care quality and safety. Conversely, perceived challenges were related to three major categories: software related challenges, hardware related challenges, and network infrastructure-related issues. Furthermore, the results showed that the success of mobile computing technology depends on its ability to support access to patients’ electronic records and other central clinical information systems, on mobile devices and their applications’ ergonomic features, and on end-user participation in mobile computing projects. Implications Mobile computing technologies have the potential to improve data accessibility, communication mechanisms, patient care quality, and workflow efficiency. However, realizing the full potential benefits of mobile computing technologies rely on several factors. Healthcare organizations need to have clear understanding of end users’ needs, expectations, clinical tasks, and workflow. Engaging end-users in mobile computing technologies projects from the early stages of the project is essential to identify the various complex human, organizational, and contextual factors that affect the success of enterprise-wide mobile computing technology projects. Due to their inherent limitations, mobile computing technologies should be considered as complementary to and not as replacement to fixed computer workstations. Also, evaluating mobile technologies and applications usability is essential for both the success and safety of such innovative solutions. / Graduate / 0723 / 0566 / banimelh@uvic.ca

Background: The increasing use of electronic health records (EHR) provides a novel opportunity to evaluate hospital-based nutritional outcomes, such as malnutrition. There is no universally accepted screening tool for the detection of malnutrition. However, assessment for malnutrition should be made early, be simple, based on scientific evidence, and include data on age, gender, and disease severity. The malnutrition screening tool (MST) used in this study is a two question tool that assesses two parameters commonly seen when diagnosing malnutrition (weight loss and loss of appetite). Objective: The purpose of this study is to determine the ability of the MST used at a tertiary or quaternary hospital to accurately identify patients with malnutrition by comparing it against the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition criteria for malnutrition. Participants/setting: A descriptive cohort study was conducted that included 167 patients admitted to Emory University Hospital between October 1 - 14, 2014. MST score, malnutrition diagnostic criteria, and demographic and anthropometric characteristics were obtained to describe and assess the study population. Statistical Analysis: Frequency statistics were used to describe the demographic and anthropometric characteristics and MST score results. Normality statistics were used to determine the distribution of continuous variables. A Chi Square table was used to determine the significance of the association between the MST score and diagnosis of malnutrition made by the Registered Dietitian (RD) as well as the sensitivity and specificity of the MST. Results: A total of 167 patients (48.5% male, 51.5% Caucasian, non-Hispanic) were admitted during the study period. The vast majority of the patient population with malnutrition (79%), as diagnosed by the RD, was identified as such by the MST (p < 0.01). The sensitivity and specificity of the MST was 79% and 62%, respectively. Conclusion: The MST is a useful screening tool for malnutrition in adults admitted to a large urban university hospital. There is a lack of research validating the MST in the adult outpatient population. Therefore, future studies are necessary to evaluate the effectiveness of the MST in this population.