Magister Curationis - MCur / The implementation, adoption and the use of EHR globally has been proven a challenge, despite the numerous advantages that have been noted with the use of an electronic health recording system to improve health care services. Among some of the challenges that have been reported is lack of knowledge and staff attitudes towards this new technology. It has also been noted that the success or failure of an EHR system is dependent on nurses’ or individual user acceptance, as they are pivotal in the healthcare team; therefore, their attitude towards an EHR system is crucial.

>Magister Scientiae - MSc / 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.

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.

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Os Sistemas de Registro Eletrônico em Saúde (S-RES) permitem manipular e analisar um grande volume de dados e informações de saúde. O desenvolvimento, disponibilização e uso de funcionalidades para S-RES pode beneficiar tanto os profissionais de saúde como os pacientes. Estes sistemas devem ser próprios para o contexto onde serão utilizados, podendo estar voltados a diferentes áreas da saúde, assim como para diferentes níveis de atenção à saúde. Para o usuário final, a adequação do S-RES é avaliada pela qualidade em uso que resulta, principalmente, da funcionalidade, confiabilidade, usabilidade e eficiência do sistema. O termo funcionalidade designa o aspecto do sistema computacional que retrata as funções necessárias para a resolução de problemas dentro de um determinado contexto de uso. A funcionalidade se refere àquilo que um programa faz e, no caso de software interativo, o que ele deve oferecer para seus usuários. Frente a este contexto, a presente dissertação se propõe a identificar, através da literatura e de documentos de referência sobre o tema, as funcionalidades para os S-RES com potencial de apoiar os profissionais de saúde na prestação do cuidado ao paciente na Atenção Primária à Saúde (APS). Nenhuma das listas de funcionalidades existentes na literatura é específica para S-RES para APS. Foi realizada uma revisão da literatura nas principais bases de dados da área da saúde. Para a extração das funcionalidades, foram selecionados os documentos mais relevantes e que eram referência para os demais materiais consultados. As funcionalidades apresentadas pelos documentos foram compiladas e formatadas em uma planilha eletrônica de maneira que pudessem ser utilizadas para seleção de funcionalidades para um S-RES para APS. As funcionalidades identificadas foram categorizadas e agrupadas por similaridade de aplicação em sete categorias relacionadas ao contexto de trabalho na APS. Três documentos foram utilizados para a seleção das funcionalidades. A análise das funcionalidades identificadas evidenciou a predominância de funcionalidades relacionadas a aspectos clínicos da prestação do cuidado dos pacientes. De um total de 145 funcionalidades, 91 (62,8%) foram classificadas como de “manejo clínico do paciente”, grande parte dessas voltadas para o diagnóstico e tratamento clínico, como também para o apoio à decisão clínica. O conjunto de funcionalidades relacionadas à “prevenção” e às classificadas como de “educação em saúde e comunicação com o paciente” representaram juntas apenas 20% do total, com respectivamente 11,7% e 8,3% do total de funcionalidades identificadas. Importantes funcionalidades para S-RES de APS que consideram as perspectivas e preferências do paciente e de sua família em relação à saúde, e ainda, o relacionamentos entre os sujeitos, foram classificadas como “aspectos subjetivos e familiares” e representaram 4,8% do total de funcionalidades de APS. Por fim, é possível reconhecer que a maioria das funcionalidades para S-RES adequadas ao contexto da APS está direcionada ao manejo clínico dos pacientes. São poucas as funcionalidades que contemplam as demais dimensões do trabalho em APS e que favorecem uma compreensão da pessoa de modo integral. / Electronic Health Records (EHR) systems allow to manipulate and analyze large volumes of data and health information. The development , availability and use of features for EHR systems can benefit both health professionals and patients. These systems shall be suitable to the context where they will be used, or can be directed to different areas of health, as well as different levels of health care. For the end user, the adequacy of the EHR systems is evaluated for quality in use which results mainly from the: functionality, reliability, usability and system efficiency. Functionality refers to the aspect of the computer system that represents the functions required to solve problems within a specified context of use. Functionality refers to what a program does and, in the case of interactive software, what it must offer to its users. Facing this context, this thesis aims to identify, through literature and reference documents on the subject, the functionality for the EHR systems with the potential to support health professionals in the provision of patient care in Primary health Care (PHC). None of functionalities lists existing in the literature is specific to EHR systems for PHC. A literature review was conducted in the main bases of health care data. For the extraction of functionalities, the most relevant documents were selected and they were reference for other found materials. The functionalities presented by the documents were compiled and formatted in a electronic spreadsheet. So it could be used for selection of functionalities for an EHR systems for PHC. The identified functionalities were categorized and grouped by similarity application in seven categories related to the work context in PHC. Three documents were used for selection of functionalities. The analysis of the identified functionalities showed the predominance of functionalities related to clinical aspects of the provision of patient care. The total of 145 functionalities, 91 (62.8%) were classified as "clinical management of patients", most of these focused on the diagnosis and treatment, but also to clinical decision support. The group of functionalities related to "prevention" and classified as "health education and communication with the patient" together accounted for only 20% of the total, respectively 11.7% and 8.3% of the identified functionalities. Important functionalities to EHR systems for Primary Healh Care which regard the perspectives and preferences of patients and their families in relation to health, and also the relationships between the subjects were classified as "subjective and family aspects" and represented 4.8% of total PHC functionalities. Finally, it is possible to recognize that most of the appropriate EHR systems functionalities to the context of Primary Health Care is directed to the clinical management of patients. There are few functionalities that contemplate other dimensions of Primary Health Care work and support a comprehension of the person as a whole.