Medication errors increased 64.4% from 2015 to 2018 in the United States due to the use of computerized physician order entry (CPOE) systems and the inability to exchange information among health care facilities. Healthcare information exchange (HIE) and subsequent discrepancies resulted in significant medical errors due to the lack of exchangeable health care information using technology software. The purpose of this qualitative multiple case study was to explore the strategies health care business managers used to manage computerized physician order entry systems within health care facilities to reduce medication errors and increase profitability. The population of the study was 8 clinical business managers in 2 successful small health care clinics located in the mid-Atlantic region of the United States. Data were collected from semistructured interviews with health care leaders and documents from the health care organization as a resource. Inductive analysis was guided by the Donabedian theory and sociotechnical system theory, and trustworthiness of interpretations was confirmed through member checking. Three themes emerged: standardizing data formats reduced medication errors and increased profits, adopting user-friendly HIE reduced medication errors and increase profits, and efficient communication reduced medication errors and increased profits. The findings of this study contribute to positive change through improved health care delivery to patients resulting in healthier communities.

There is a national movement to create improvements in patient safety and outcomes due to evolutionary changes in the healthcare. Many health care organizations are using the framework of a culture of safety in order to create a reliable and stable work environment that emphasizes safety and improves patient outcomes. Patient throughput, defined as the active management of the supply of patient beds (rooms for occupation) to the demand of patients to beds and the length of time it takes for this action to occur, has been identified as one of the areas in need of improvement. This study considered if the use of an interdisciplinary team to execute patient rounds improves patient throughput, helping to expedite the patient discharge process while decreasing needless readmissions to the health care organization. A quantitative longitudinal retrospective data analysis of time stamps obtained from the electronic health record was examined to determine what impact interdisciplinary rounds had on patient throughput. It was determined that a discrepancy existed between the actual planning of a patient's discharge and the execution of the discharge, which contributed to unwanted readmissions to the health care organization. A secondary factor affecting the readmission rate was excluding the patient as a member of the interdisciplinary team. The social significance of the research is how health care organizations engage patients, empowering patients to actively participate in their own care including them in the decision-making process that affects patient care and improves outcomes.

Health care leaders lack the strategies to implement cloud security for electronic medical records to prevent a breach of patient data. The purpose of this qualitative case study was to explore strategies senior information technology leaders in the healthcare industry use to implement cloud security to minimize electronic health record cyberattacks. The theory supporting this study was routine activities theory. Routine activities theory is a theory of criminal events that can be applied to technology. The study's population consisted of senior information technology leaders from a medical facility in a large northeastern city. Data collection included semistructured interviews, phone interviews, and analysis of organizational documents. The use of member checking and methodological triangulation increased the validity of this study's findings among all participants. There were 5 major themes that emerged from the study (a) requirement of coordination with the electronic health record vendor and the private cloud vendor, (b) protection of the organization, (c) requirements based on government and organizational regulations, (d) access management, (e) a focus on continuous improvement. The results of this study may create awareness of the necessity to secure electronic health records in the cloud to minimize cyberattacks. Cloud security is essential because of its social impact on the ability to protect confidential data and information. The results of this study will further serve as a foundation for positive social change by increasing awareness in support of the implementation of electronic health record cloud security.

In a context where technology is increasingly being incorporated into health care practice, many U.S. health care providers and organizations are finding it challenging to connect disparate electronic documentation systems to retrieve patient information when coordinating care across providers and heath care entities. Local and regional health information exchange (HIE) systems were created to facilitate collecting information into one integrated patient record to address information transfer between heath care providers. Yet, adoption and use of HIEs have been low. The purpose of this study was to review the predictive factors accounting for physicians' use of a HIE in the U.S. state of Hawaii. Key factors from the technology acceptance model were evaluated to determine the behavioral intention resulting in actual use of the Hawaii health information exchange (HHIE). Physician characteristics (medical specialty, age, and gender) and location characteristics were also assessed. The total population of the study contained 1034 Hawaii physicians who have signed up to use the HHIE. Linear and logistic regression models were structured to evaluate the predictive nature of (a) use to determine if a physician has ever logged into the HIE and (b) usage to evaluate the extent to which a physician is logging into the HIE. Findings from the study reveal a predictive relationship between the characteristic of medical specialty and HHIE use when comparing primary care and emergency department physicians to physician specialists. Using study results, health care leaders can improve physician outreach and review barriers when using the HIE systems to coordinate care. Policy implications include the possible formulation of future requirements surrounding HIE physician participation.

<p>Ett problem med elektroniska patientjournalsystem är att arkitekturen för patientjournalerna inte är gemensam vilket försvårar automatiskt utbyte av patientdata. En arkitektur har skapats inom ett projekt som heter openEHR. Förhoppningen är att denna arkitektur ska klara av automatiskt utbyte av patientdata mellan elektroniska patientjournalsystem.</p><p>I openEHRs arkitektur används något som kallas arketyper. Arketyper är återanvändbara modeller för att begränsa, strukturera och förklara vad som lagras i elektroniska patientjournaler som bygger på denna arkitektur. Istället för att områdesspecifik information, som vad ett blodtryck är, skapas i systemet flyttas den och annan liknande kunskap ut från systemarkitekturen och in i arketyperna. Arketyper kan skapas och redan existerande arketyper förändras utan att några ändringar i systemarkitekturen behöver göras.</p><p>Huvudproblemet i examensarbetet har varit att hitta en metod för att generera ett grafiskt gränssnitt utifrån en elektronisk patientjournal som är konstruerad med hjälp av arketyper. För att lösa detta behövdes det först skapas arketyper och ett system för att generera journaler utifrån dessa. Därefter har en webbportal utvecklats där det går att logga in och läsa de skapade patientjournalerna. Metoden för att generera gränssnittet i webbsidorna använder sig av en rekursiv funktion för att samla in information ur patientjournalerna. Funktionen lagrar den insamlade information i en objektstruktur som följer designmönstret Composite. Utifrån denna struktur går det sedan att generera ett grafiskt gränssnitt.</p><p>Webbportalen kan användas för att demonstrera hur ett system kan se ut där både patienter och behörig personal får tillgång till och möjlighet att läsa inlagda journaler som bygger på openEHRs arkitektur.</p> / <p>One problem with electronic health record systems is that the health records are not built on a common architecture. This makes automatic exchange of patient data difficult. openEHR is a project that has developed an architecture that tries to solve this problem.</p><p>The openEHR architecture uses something called archetypes. Archetypes are reusable models that limit, structure and explain what will be stored in the electronic health record that is built on this architecture.</p><p>The main goal of this master thesis has been to find a method to generate a graphical user interface from an electronic health record created using archetypes. To solve this problem first archetypes and a system that generates health records from these had to be created. Then a Web portal has been developed that displays the generated health records.</p><p>The Web portal can be used to demonstrate the graphical user interface of a system where both patients and authorized personnel can read patient records that are bases on the openEHR architecture.</p>

<p><p><strong>SAMMANFATTNING</strong></p><p><strong>Syfte. </strong>Utvärdera omvårdnadsdokumentationens kvalité och omfattning i elektronisk patientjournal på kirurgisk vårdavdelning. <strong>Metod.</strong> De senaste 60 journalerna från två kirurgiska vårdavdelningar valdes ut genom bekvämt urval. Varje journal lästes och bedömdes av båda författarna. Varje steg i omvårdnadsprocessen utvärderades efter granskningsmall och bedömdes som fullständig, för omfattande eller ofullständig. <strong>Resultat.</strong> Standardvårdplan användes i alla granskade journaler. Antalet steg i omvårdnadsprocessen som fanns dokumenterade varierade mellan fem och nio. Anamnes, status och effekter av åtgärder fanns beskrivna i majoriteten av journalerna. I samtliga journaler fanns utförda åtgärder dokumenterade. Omvårdnadsepikris fanns i större delen av njurtransplantationsjournalerna, men inte alls i struma/hyperparatyroidism (HPT)-journalerna. Majoriteten av uppdaterade status bedömdes som ofullständiga.<strong> </strong>Sexton av struma/HPT-journalerna innehöll inte anteckningar i rapportbladet. Av dem som hade rapportbladsanteckningar bedömdes majoriteten vara för omfattande. Samtliga njurtransplantationsjournaler hade för omfattande anteckningar i rapportbladet. Ingen av journalerna hade en individuell vårdplan. <strong>Slutsats.</strong> Omvårdnadsdokumentationen i den elektroniska patientjournalen bedömdes som ofullständig då det inte gick att få en tydlig bild av patientens omvårdnadsproblem och omvårdnadsbehov. Kvalitén på dokumentationen behöver förbättras. Detta kan ske genom att minska dokumentationen i rapportbladet och istället använda standardvårdplan och uppdaterat status i större omfattning. Fortsatt utbildning och återkoppling krävs för att förbättra dokumentationen.</p></p> / <p><strong>ABSTRACT</strong></p><p><p><strong>Aim. </strong>To evaluate the quality and extent of the nursing documentation in electronic health record on surgical ward. <strong>Method. </strong>The latest 60 health records from two surgical wards were selected by convenience sample. Both authors read each health record. Every step of the nursing process was evaluated with a nursing documentation audit and was classified as complete, too extensive or incomplete. <strong>Results. </strong>Standardized care plan was used in all electronic health records. Numbers of steps documented in the nursing process were five to nine. Nursing history, status and outcome were documented in most health records. Done interventions were documented in all health records. Goiter/hyperparathyroidism (HPT)-records had no nursing discharge note, while the kidney transplantation-records had one in almost every health record. Majority of updated statuses were evaluated as incomplete. Sixteen of the goiter/HPT-records had no notes of occasional matters, all kidney transplantation-records had too extensive notes. No individualized care plan was found. <strong>Conclusion. </strong>The total nursing documentation in the electronic health records were evaluated as incomplete. The quality of documentation needs to be improved. This can be achieved by less documentation of occasional matters, using the standardized care plan, updating status more often and further education and feedback.</p></p>

SAMMANFATTNING Syfte. Utvärdera omvårdnadsdokumentationens kvalité och omfattning i elektronisk patientjournal på kirurgisk vårdavdelning. Metod. De senaste 60 journalerna från två kirurgiska vårdavdelningar valdes ut genom bekvämt urval. Varje journal lästes och bedömdes av båda författarna. Varje steg i omvårdnadsprocessen utvärderades efter granskningsmall och bedömdes som fullständig, för omfattande eller ofullständig. Resultat. Standardvårdplan användes i alla granskade journaler. Antalet steg i omvårdnadsprocessen som fanns dokumenterade varierade mellan fem och nio. Anamnes, status och effekter av åtgärder fanns beskrivna i majoriteten av journalerna. I samtliga journaler fanns utförda åtgärder dokumenterade. Omvårdnadsepikris fanns i större delen av njurtransplantationsjournalerna, men inte alls i struma/hyperparatyroidism (HPT)-journalerna. Majoriteten av uppdaterade status bedömdes som ofullständiga. Sexton av struma/HPT-journalerna innehöll inte anteckningar i rapportbladet. Av dem som hade rapportbladsanteckningar bedömdes majoriteten vara för omfattande. Samtliga njurtransplantationsjournaler hade för omfattande anteckningar i rapportbladet. Ingen av journalerna hade en individuell vårdplan. Slutsats. Omvårdnadsdokumentationen i den elektroniska patientjournalen bedömdes som ofullständig då det inte gick att få en tydlig bild av patientens omvårdnadsproblem och omvårdnadsbehov. Kvalitén på dokumentationen behöver förbättras. Detta kan ske genom att minska dokumentationen i rapportbladet och istället använda standardvårdplan och uppdaterat status i större omfattning. Fortsatt utbildning och återkoppling krävs för att förbättra dokumentationen. / ABSTRACT Aim. To evaluate the quality and extent of the nursing documentation in electronic health record on surgical ward. Method. The latest 60 health records from two surgical wards were selected by convenience sample. Both authors read each health record. Every step of the nursing process was evaluated with a nursing documentation audit and was classified as complete, too extensive or incomplete. Results. Standardized care plan was used in all electronic health records. Numbers of steps documented in the nursing process were five to nine. Nursing history, status and outcome were documented in most health records. Done interventions were documented in all health records. Goiter/hyperparathyroidism (HPT)-records had no nursing discharge note, while the kidney transplantation-records had one in almost every health record. Majority of updated statuses were evaluated as incomplete. Sixteen of the goiter/HPT-records had no notes of occasional matters, all kidney transplantation-records had too extensive notes. No individualized care plan was found. Conclusion. The total nursing documentation in the electronic health records were evaluated as incomplete. The quality of documentation needs to be improved. This can be achieved by less documentation of occasional matters, using the standardized care plan, updating status more often and further education and feedback.

In November 2012 Uppsala County Council (UCC) introduced an eHealth service, ‘My Health Record’, that gives all inhabitants over age 18 in Uppsala County access to their health records online. However, this service has not been evaluated before this study. We conducted an interview study, based on User Experience (UX) and Patient empowerment, with users of ‘My Health Record’ to get their opinions, and to see if and how the service can be improved. Our findings shows that the users are positive to the service and the aspects that can be improved mostly concern information and communication. Based on these results, we propose design principles as well as concrete design proposals which can be useful for re-designing the service as well as inspiration for similar projects. Additionally, an interesting finding is that the interviewees had very few opinions and complains on the actual interface, which could mean that the content (the health record) is so interesting that the interface becomes almost “invisible”. A conclusion we make is that UX and Patient empowerment is a good fit for each other, and that UX has advantages over traditional usability in services like this.

Ett problem med elektroniska patientjournalsystem är att arkitekturen för patientjournalerna inte är gemensam vilket försvårar automatiskt utbyte av patientdata. En arkitektur har skapats inom ett projekt som heter openEHR. Förhoppningen är att denna arkitektur ska klara av automatiskt utbyte av patientdata mellan elektroniska patientjournalsystem. I openEHRs arkitektur används något som kallas arketyper. Arketyper är återanvändbara modeller för att begränsa, strukturera och förklara vad som lagras i elektroniska patientjournaler som bygger på denna arkitektur. Istället för att områdesspecifik information, som vad ett blodtryck är, skapas i systemet flyttas den och annan liknande kunskap ut från systemarkitekturen och in i arketyperna. Arketyper kan skapas och redan existerande arketyper förändras utan att några ändringar i systemarkitekturen behöver göras. Huvudproblemet i examensarbetet har varit att hitta en metod för att generera ett grafiskt gränssnitt utifrån en elektronisk patientjournal som är konstruerad med hjälp av arketyper. För att lösa detta behövdes det först skapas arketyper och ett system för att generera journaler utifrån dessa. Därefter har en webbportal utvecklats där det går att logga in och läsa de skapade patientjournalerna. Metoden för att generera gränssnittet i webbsidorna använder sig av en rekursiv funktion för att samla in information ur patientjournalerna. Funktionen lagrar den insamlade information i en objektstruktur som följer designmönstret Composite. Utifrån denna struktur går det sedan att generera ett grafiskt gränssnitt. Webbportalen kan användas för att demonstrera hur ett system kan se ut där både patienter och behörig personal får tillgång till och möjlighet att läsa inlagda journaler som bygger på openEHRs arkitektur. / One problem with electronic health record systems is that the health records are not built on a common architecture. This makes automatic exchange of patient data difficult. openEHR is a project that has developed an architecture that tries to solve this problem. The openEHR architecture uses something called archetypes. Archetypes are reusable models that limit, structure and explain what will be stored in the electronic health record that is built on this architecture. The main goal of this master thesis has been to find a method to generate a graphical user interface from an electronic health record created using archetypes. To solve this problem first archetypes and a system that generates health records from these had to be created. Then a Web portal has been developed that displays the generated health records. The Web portal can be used to demonstrate the graphical user interface of a system where both patients and authorized personnel can read patient records that are bases on the openEHR architecture.

IT systems for healthcare are a complex and exciting field. One the one hand, there is a vast number of improvements and work alleviations that computers can bring to everyday healthcare. Some ways of treatment, diagnoses and organisational tasks were even made possible by computer usage in the first place. On the other hand, there are many factors that encumber computer usage and make development of IT systems for healthcare a challenging, sometimes even frustrating task. These factors are not solely technology-related, but just as well social or economical conditions. This report describes some of the idiosyncrasies of IT systems in the healthcare domain, with a special focus on legal regulations, standards and security. / IT Systeme für Medizin und Gesundheitswesen sind ein komplexes und spannendes Feld. Auf der einen Seite stehen eine Vielzahl an Verbesserungen und Arbeitserleichterungen, die Computer zum medizinischen Alltag beitragen können. Einige Behandlungen, Diagnoseverfahren und organisatorische Aufgaben wurden durch Computer überhaupt erst möglich. Auf der anderen Seite gibt es eine Vielzahl an Fakturen, die Computerbenutzung im Gesundheitswesen erschweren und ihre Entwicklung zu einer herausfordernden, sogar frustrierenden Aufgabe machen können. Diese Faktoren sind nicht ausschließlich technischer Natur, sondern auch auf soziale und ökonomische Gegebenheiten zurückzuführen. Dieser Report beschreibt einige Besondenderheiten von IT Systemen im Gesundheitswesen, mit speziellem Fokus auf gesetzliche Rahmenbedingungen, Standards und Sicherheit.