Masters of Science / With the development of information and network technologies, Electronic Health Records (EHRs) management system has gained wide spread application in managing medical records. One of the major challenges of EHRs is the independent nature of medical institutions. This non-collaborative nature puts a significant barrier between patients, doctors, medical researchers and medical data. Moreover, unlike the unique and strong anti-tampering nature of traditional paper-based records, electronic health records stored in centralization database are vulnerable to risks from network attacks, forgery and tampering. In view of the data sharing difficulties and information security problems commonly found in existing EHRs, this dissertation designs and develops a credible Blockchain-based electronic health records (CB-EHRs) management system. To improve security, the proposed system combines digital signature (using MD5 and RSA) with Role-Based Access Control (RBAC). The advantages of these are strong anti-tampering, high stability, high security, low cost, and easy implementation. To test the efficacy of the system, implementation was done using Java web programming technology. Tests were carried out to determine the efficiency of the Delegated Byzantine Fault Tolerance (dBFT) consensus algorithm, functionality of the RBAC mechanism and the various system modules. Results obtained show that the system can manage and share EHRs safely and effectively. The expectation of the author is that the output of this research would foster the development and adaptation of EHRs management system.

Electronic Health Records (EHRs) is a health information technology that has already begun to change the way healthcare providers care for patients. EHRs can potentially enhance the quality and efficiency of patient care (Simon et al., 2010); however, some research shows that EHRs do not always do so. The lack of improved efficiency and quality of care can lead to frustrated and dissatisfied users. The effects of different aspects of EHR implementation could affect user satisfaction and perceived quality of EHRs. This study investigates the how time since implementation, training, and leadership affect user satisfaction and perceived quality of the EHR system in clinics in Mississippi. The results of the study indicate that training and leadership have an effect on users’ perceived quality and satisfaction with EHRs. These findings reveal that clinics and EHR providers should focus on training and leadership to improve user satisfaction and perceived quality of EHRs.

Indiana University-Purdue University Indianapolis (IUPUI) / Due to frequent utilization, high costs, high prevalence, and negative health outcomes, the care of patients managing type 2 diabetes mellitus (T2DM) remains an important focus for providers, payers, and policymakers. The challenges of care delivery, including care fragmentation, reliance on patient self-management behaviors, adherence to care management plans, and frequent medical visits are well-documented in the literature. T2DM management produces numerous clinical data points in the electronic health record (EHR) including laboratory test values and self-reported behaviors. Recency or absence of these data may limit providers’ ability to make effective treatment decisions for care management. Increasingly, the context in which these data are being generated is changing. Specifically, telehealth usage is increasing. Adoption and use of telehealth for outpatient care is part of a broader trend to provide care at-a-distance, which was further accelerated by the COVID-19 pandemic. Despite unknown implications for patients managing T2DM, providers are increasingly using telehealth tools to complement traditional disease management programs and have adapted documentation practices for virtual care settings. Evidence suggests the quality of data documented during telehealth visits differs from that which is documented during traditional in-person visits. EHR data of differential quality could have cascading negative effects on patient healthcare outcomes. The purpose of this dissertation is to examine whether and to what extent levels of EHR data quality are associated with healthcare outcomes and if EHR data quality is improved by using health information technologies. This dissertation includes three studies: 1) a cross-sectional analysis that quantifies the extent to which EHR data are timely, complete, and uniform among patients managing T2DM with and without a history of telehealth use; 2) a panel analysis to examine associations between primary care laboratory test ages (timeliness) and subsequent inpatient hospitalizations and emergency department admissions; and 3) a panel analysis to examine associations between patient portal use and EHR data timeliness.

Indiana University-Purdue University Indianapolis (IUPUI) / The dissertation consists of three essays attempting to assess the impact of expanded health insurance policy on cancer care continuum and measure the unbiased program effects after taking care of mis-measured cancer screening self-reports. The first essay examines the impact of the Affordable Care Act’s Medicaid expansion on time to oral cancer treatment initiation since diagnosis, quality of hospital care such as length of stay in the hospital, planned and unplanned readmissions post-surgery, and care outcome such as ninety-day mortality since surgery. The study uses two-way fixed effects linear model analysis under a difference-in-difference estimation setting to show that Medicaid expansion eligibility reduced overall oral cancer treatment initiation timing since diagnosis, including radiation initiation as well as first surgery of the primary site. It also shortened the length of stay in the hospital post-surgery. The second essay assesses the value of electronic medical records from Indiana health information exchange (IHIE) and survey self-reports of Indiana residents seen at Indiana University Health in measuring population-based cancer screening for colorectal, cervical, and breast cancer. Between the two measures of screening, the study examines association using Spearman’s rank correlation and concordance using Percent Agreement and Gwet’s Agreement Coefficient. Health information exchange and self-reports, both provided unique information in measuring cancer screening, and the most robust measurement approach entails collecting screening information from both HIE and patient self-report. In this study, we find evidence of measurement error in self-reports in terms of reporting bias. The majority of the publicly available datasets collect information on cancer screening behavior through patient interviews which are self-reported and may suffer from potential measurement errors. The third essay uses a nationwide population-based database and examines the true, unbiased impact of Medicaid expansion on cancer screening for breast, colorectal, cervical, and prostate cancers after correcting for any bias due to possible misclassification of the self-reported screening status. This study conducts a modified two-way fixed effects probit model under a difference-in-difference estimation setting to identify and correct the errors in the self-reports and estimate the unbiased program effect which shows positive impact on cancer screening with increased effect sizes.

Background: Both clinical pathways (CPs) and electronic health records (EHRs) increase the quality and efficiency of health care; however, no known studies have examined the integration of CPs into the EHR during an organizational EHR launch. Aim: To understand how nursing leadership perceives the nursing practice changes that accompanied the transition from paper to EHR-based CPs. Methods: A case study design was utilized, focusing on CPs utilized by one acute care unit within a tertiary care organization. Findings: Transfer of paper CPs into an EHR not built for the Canadian health care context proved to be difficult. In the integration process, a single paper document became spread throughout the EHR. EHR-based CPs are not as clear, and represent a larger documentation burden, than their paper counterparts. Conclusion: Nursing agency has been greatly affected by the change in format of CPs. Further exploration of nursing agency regarding CPs is warranted.

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