With the development of information technology, Electronic Patient Record (EPR) is becoming more and more common in the healthcare area, comparing to traditional paper-based patient record. EPR can include a wide range of data and information. Because of the complexity of the clinical data, EPR needs to be presented in a better way using visualization for physicians to actually benefit from it. The goal of this master thesis is to find out what the requirements are for visualization of electronic patient records and how it should look like. Propose visualization paper-prototypes for patient record based on the identified requirements. The result of this thesis will help companies that are developing EPR systems to understand what is needed in visualization of electronic patient records. It will help research groups and companies in this area capture what the physicians require regarding visualization of patient records. This master thesis is conducted with an exploratory approach. A qualitative approach was chosen to help us understand what was needed for visualization of EPR from the perspectives of healthcare personnel. Data was be collected through interviews and brainstorming sessions among four physicians. Two prototypes of visualizing patient records are proposed based on the obtained requirements: Prototype I diagnosis-based time line and Prototype II human body structure. Evaluation was be performed for those two proposed prototypes together with an existing research prototype “Lifelines” From the findings of this master thesis, we can notice that different physicians have different requirements and preferences on visualization of electronic patient record. The most critical and desired feature is to be able to individualize the system as well as the addition of a search engine to search the record. A combination of the proposed Prototype I diagnosis-based time line and Prototype II human body structure was the most preferred among the physicians.

The Electronic Patient Record was created with the intention to facilitate and to improve the performance of doctors and professionals that provide health care. Its goal is to facilitate the clinical and administrative information access and sharing, to help on the decision taken process, as well as to support the scientific studies. In order, the professionals of the HUSM Cardiology sector decided to create a computerized system to their patients registering. This process started with a Data Bank construction developed by the own medical team of the Intensive Cardiology Unit. Meanwhile, Software Usability aspects weren t observed and the result was a not user friendly data insertion interface, tookking to a down productivity than the expected. According the Usability Engineering principles, an Electronic Patient Record system should be of easy learning and memorization, allowing an efficient use and avoiding the users errors. When these characteristics are considered in software development, better productivity levels and users satisfaction are gotten. This work explores the Usability Engineering theory to get a productivity improvement on registering clinical information on HUSM Cardiology sector. For such, it evaluates the usability of the existing data bank interfaces, in order to verify its strong and weak points, it models and implements a new version of the system, this time based on the usability principles and on the users profile that will use it, and realizes a new usability evaluation of the new software version. As result, a reduction is observed on the users error average (37,5%) and on the necessary time to realize some pre-established tasks (33%), besides the increase on the percentage of well succeed tasks (13%). We also have observed an increasing on users satisfaction because the percentage of users that had declared to be find problems or difficulties when using the system reduce from 100% to 28%. These results show the use of usability engineering techniques on development of the Electronic Patient Record gets direct influence on health professionals productivity. / O Prontuário Eletrônico do Paciente foi criado com a intenção de facilitar e agilizar o trabalho de médicos e demais profissionais que prestam atendimento de saúde. O objetivo é facilitar o acesso e compartilhamento das informações clínicas e administrativas, auxiliar no processo de tomada de decisão, bem como apoiar a realização de estudos científicos. Neste sentido, os profissionais responsáveis pelo setor de Cardiologia do HUSM decidiram criar um sistema informatizado para o registro de seus pacientes. Este processo iniciou com a construção de um Banco de Dados desenvolvido pela própria equipe médica da Unidade de Cardiologia Intensiva. Entretanto, quando de seu desenvolvimento não foram observados aspectos referentes à Usabilidade de Software, o que dificultou a inserção de dados e levou a uma produtividade abaixo do esperado. Segundo os princípios da Engenharia de Usabilidade, um sistema de Prontuário Eletrônico deveria ser de fácil aprendizagem e memorização, permitindo uma utilização eficiente e evitando a ocorrência de erros por parte dos usuários. Quando essas características são levadas em consideração, obtém-se melhores níveis de produtividade e satisfação dos usuários. Este trabalho explora a teoria da Engenharia de Usabilidade para obter melhora de produtividade no registro de informações clínicas do setor de Cardiologia do HUSM. Para tal, avalia a usabilidade das interfaces do banco de dados existente, a fim de verificar seus pontos fortes e fracos, modela e implementa uma nova versão do mesmo, desta vez baseado-se nos princípios de usabilidade e no perfil dos usuários que o utilizarão, e realiza uma nova avaliação de usabilidade da nova versão do software. Como resultado observa-se uma redução na média de erros cometidos (37,5%) e no tempo necessário para realizar algumas tarefas pré-estabelecidas (33%), além do aumento no percentual de tarefas completadas com sucesso (13%). Observa-se também uma melhora na satisfação dos usuários, pois reduziu de 100% para 28% o número de usuários que declararam ter encontrado problemas ou dificuldades na utilização do sistema. Tais resultados demonstram que o uso de técnicas da engenharia usabilidade na produção do prontuário eletrônico do paciente influencia diretamente na melhoria de produtividade dos profissionais de saúde.

Philosophiae Doctor - PhD / A phenomenological philosophy underlies this research study which attempts to understand clinicians’ perception and understanding of an electronic patient record (EPR) system currently operational at a hospital in the Western Cape Province in South Africa (SA). Healthcare is a human right, thus patient records contain critical data and mostly paper-based in many SA hospitals. Clinicians are the EPR primary users and their attitude in its use is important for its success. This study explores, identifies and determines clinicians’ cognitive attributes towards EPR with a technology use framework developed. An initial quantitative approach was applied but unsuccessful due to low sample size. A pilot study was then conducted using 11 respondents. Purposive sampling was first initiated then snowball introduced later to improve the sample size qualitatively. Interviews were administered to 15 clinicians and tape recorded. Narrative content analysis was used as the preferred analysis technique because of the advantage of gaining direct information from study participants, unobtrusive and a nonreactive way to study the phenomenon of interest. Research findings tested 12 propositions and found high impact relationships between attitude (ATT) and each listed theme namely: perceived usefulness (PU), perceived ease of use (PEOU), complexity (COM), facilitating condition (FC), use behaviour (USE). Use behaviour had high impact relationships with storage (STO) and retrieval (RET). There were moderate impact relationships between PU and USE; PEOU and PU; RA and ATT; job fit (JF) and ATT; USE and share (SHA). The implication here is that any EPR system to be implemented should be tested using this framework to ascertain its usefulness and fit with a hospital's objectives and users expectations. By so doing, anticipated problems can be mitigated against and resolved before implementation. The study contributes to the information system (IS) body of knowledge through the technology use framework. The framework is for adoption by hospital management and its use by clinicians where EPR is operational. Traditional IS frameworks can be adopted for hospitals about to implement EPR because of the relevance of the "intent to use" theme.

This article describes the knowledge-based system THEMPO (Therapy Management in Pediatric Oncology), which supports protocol-directed therapy planning and configuration in pediatric oncology. THEMPO provides a semantic network controlled by graph grammars to cover the different types of knowledge relevant in the domain, and offers a suite of acquisition tools for knowledge base authoring. Medical problem solvers, operating on the oncological network, reason about adequate therapeutic and diagnostic timetables for a patient. Furthermore, a corresponding patient record, also based on semantic networks and graph grammars, has been implemented to represent the course of therapy of an oncological patient.

Wenn ein Chirurg heutzutage während der Operation Informationen aus der Patientenakte benötigt, ist er gezwungen, sich entweder unsteril zu machen oder Personal anzuweisen, ihm die entspre-chenden Informationen zugänglich zu machen. Aus technischer Sicht ist ein System zur intraoperati-ven Bedienung und Darstellung sehr einfach zu realisieren. Grundlage dafür ist eine elektronische Patientenakte (EPA), welche beispielsweise softwaregenerierten oder eingescannten Dokumenten verwaltet. Die vorliegende Arbeit widmet sich den folgenden Fragen: Wird ein solches System im Operationssaal sinnvoll genutzt? Welche Methoden zur sterilen Bedienung kommen infrage? Wie muss die grafische Darstellung auf den Operationssaal abgestimmt werden? Kann durch das Imple-mentieren aktueller Kommunikationsstandards auf alle verfügbaren Patientendaten zugegriffen werden? Dazu wurden in einer ambulanten HNO-Klinik zwei Pilotstudien durchgeführt. In der ersten Studie wurde das erste auf dem Markt befindliche kommerzielle Produkt „MI-Report“ der Firma Karl Storz evaluiert, welches per Gestenerkennung bedient wird. Für die zweite Studie wurde ein EPA-System entwickelt (Doc-O-R), welches eine Vorauswahl der angezeigten Dokumente in Abhängigkeit des Eingriffs traf und mit einem Fußschalter bedient werden konnte. Pro System wurden ca. 50 Eingriffe dokumentiert. Dabei wurde jedes angesehene Dokument und der Nutzungsgrund protokolliert. Die Systeme wurden durchschnittlich mehr als einmal pro Eingriff genutzt. Die automatische Vorauswahl der Dokumente zur Reduzierung der Interaktionen zeigte sehr gute Ergebnisse. Da das behandelte Thema noch in den Anfängen steckt, wird in der Arbeit am Ende auf die Vielzahl von Möglichkeiten eingegangen, welche bezüglich neuartiger Darstellungsmethoden, Bedienvorrich-tungen und aktueller Standardisierungsaktivitäten noch realisiert werden können. Dadurch werden zukünftig auch die Abläufe in der Chirurgie beeinflusst werden.

Den elektroniska journalen är en del av distrikts- och sjuksköterskors dagliga arbete och ökar förutsättningen för ett patientsäkert arbete. Distrikts- och sjuksköterskor arbetar efter kärnkompetenserna informatik och säker vård, men brister i den elektroniska journalen kan påverka dessa negativt. Syftet var att undersöka sjuksköterskors och distriktssköterskors kunskap om och förståelse av att använda elektronisk journal i kommunal hemsjukvård. Metod: kvantitativ tvärsnittsstudie. Urvalet bestod av sjuksköterskor och distriktssköterskor från fem kommuner i Kronobergs län (n 67). Datainsamlingen skedde med frågeformulär som analyserades med beskrivande statistik. Resultat: elektroniska journalen ansågs i hög grad vara ett bra stöd i det dagliga arbetet, och bidrog till en god och säker vård. Navigeringen i journalen och informationsöverföring mellan olika vårdgivare innebar oftast inte några större problem. Dubbeldokumentation mellan olika system förekom ofta och kunskap om journalens funktioner saknades. Det var i de flesta fall inte möjligt att använda journalen mobilt i hemsjukvården, trots att behov fanns. Över 80 % uppgav att läkemedelslistan ibland eller sällan var uppdaterad. Dessa brister kan påverka patientsäkerheten negativt eftersom förutsättningen för att bedriva en säker vård är att informationen i journalen är tydlig och korrekt. Studiens resultat kan ligga till grund för fortsatt forskning inom patientsäkerhet och utveckling av journalens användarvänlighet. / The electronic patient record is a part of nurses´ daily work, and increases the premise of patient safety. Nurses work by the core competencies informatics and safety, but flaws in the electronic patient record can affect these adversely. The aim of the study was to investigate the nurses' knowledge and understanding of using electronic patient records in municipal home care. Method: quantitative cross-sectional study. The sample consisted of nurses and district nurses from five municipalities in the county of Kronoberg (n 67). The data collection was done using questionnaires, which were analyzed with descriptive statistics. Results: the electronic patient record was to a high degree considered to be a good support in the daily work, and to contribute to a good and safe care. Navigation in the patient record and transfer of information between different health care providers, was usually not regarded as a major problem. Double documentation between various systems were common. There was a lack of knowledge of the patient record´s functions. It was in most cases not possible to use wireless connections for the patient record in the patient´s home, although the need existed. Over 80 % stated that the medication list was updated sometimes or rarely. These shortcomings can affect patient safety in a negative way, because the prerequisite for providing a safe care is that the information in the patient record is clear and accurate. The results of the study could be the basis for further research in safety, and for the development of the electronic patient record´s usability.

This research related the implications of the deployment and use of Electronic Patients Record at University Hospital of Santa Maria, and his involvement with the archives science principles and concepts. This is justified by the presumption that the theoretical models existing are devoid of theoretical and archival authenticity and reliability. The focus of this study was grounded on objectives that intertwine and complement: strategies that include aspects of preservation of electronic documents and their relationship with the authenticity and reliability of the information, the study and analysis of some models of software for PEP, which was a parallel track with the current legislation, presentation of a metadata schema with potential for use in PEP, from the analysis and study of e-Arqu Brasil, a study of PEP as memory and cultural heritage. A qualitative research was applied, and was used a compound of issues related to the objectives, too. The results are founded on the principle that all archival work should be related to reality documentary that is known through the collection of information essential to the development of a scientific investigation. It was possible to verify the absence of involvement of archivists in the implementation and development of a PEP system, a difficult task that requires capability and technical skills of professionals and intellectuals engaged. It is concluded by advocating the PEP with the document archive for permanent preservation, and as an object of study for professionals in health, information technology, historians, sociologists and archivists. / A presente pesquisa aborda aspectos relacionados às implicações da implantação e uso do Prontuário Eletrônico de Pacientes no Hospital Universitário de Santa Maria, e seu envolvimento com princípios e conceitos da arquivística. Este trabalho justifica-se pela presunção teórica de que os modelos de PEPs existentes estão desprovidos de referenciais teóricos arquivísticos como autenticidade e confiabilidade. O foco do estudo foi alicerçado em objetivos que se entrelaçam e se complementam: aspectos que incluem as estratégias de preservação de documentos eletrônicos e seu relacionamento com a autenticidade e confiabilidade das informações; o estudo e a análise de alguns modelos de software para PEP, onde foi traçado um paralelo com a legislação vigente; apresentação de um esquema de metadados com potencial de uso no PEP, a partir da análise e estudo do e-Arqu Brasil; o estudo do PEP como memória e patrimônio cultural. Realizou-se uma pesquisa aplicada de caráter qualitativo e para a coleta de dados foi utilizado um formulário compostos de questões relacionadas aos objetivos desta pesquisa. Os resultados obtidos estão alicerçados no princípio de que todo o trabalho arquivístico deve estar relacionado à realidade documental, conhecida através da coleta de informações essenciais ao desenvolvimento de uma investigação cientifica. Constatou-se a ausência do envolvimento de arquivistas na implantação e desenvolvimento de um sistema de PEP, tarefa difícil que exige competências e habilidades técnicas e intelectuais dos profissionais engajados. Conclui-se, defendendo o PEP como documento arquivístico de preservação permanente e como objeto de estudo de profissionais da área de saúde, tecnologia da informação, historiadores, sociólogos e arquivistas.

O Prontuário Eletrônico do Paciente (PEP) é atualmente um dos principais temas de pesquisa e desenvolvimento no âmbito da Informática em Saúde. No entanto, no Brasil e em odontologia, poucos são os estudos publicados. Frente às deficiências apresentadas no fluxo das informações clínicas nos prontuários baseados em papel e visando o aperfeiçoamento deste fluxo para benefício do paciente e da própria instituição, nos propusemos a desenvolver um prontuário eletrônico direcionado ao atendimento odontológico de pacientes portadores de necessidades especiais do Centro de Atendimento a Pacientes Especiais da Faculdade de Odontologia da USP. Para tanto foi utilizada a metodologia de desenvolvimento denominada ?modelagem orientada ao objeto?. O software foi desenvolvido em conjunto com o Centro de Tecnologia XML do Instituto de Pesquisas Tecnológicas de São Paulo. Uma vez terminado, o software foi submetido ao processo de obtenção de registro na Agência USP de Inovações. / The Electronic Patient Record (EPR) is currently one of the main subjects of research and development in the scope of Health Informatics. In Dentistry, however, few are the published studies in Brazil. Facing deficiencies presented in the clinical information flow in paper based patient record and aiming to improve this flow for both patient and institution benefit, we proposed to develop a electronic patient record system suited to Dentistry attendance of patients with special needs of the Special Care Dentistry Center of University of São Paulo. For such task, it was utilized the ?Object-oriented modeling? software development methodology. The software was developed with the Center of Technology XML of the Institute of Technological Research of São Paulo. Once finished, it was submitted to patent attainment at the University of São Paulo Innovations Agency.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2016-11-18T11:35:24Z No. of bitstreams: 1 Douglas Fabiano Lourenço.pdf: 1604469 bytes, checksum: b615b17c4a8ddd4a5b7ec91905da223a (MD5) / Made available in DSpace on 2016-11-18T11:35:24Z (GMT). No. of bitstreams: 1 Douglas Fabiano Lourenço.pdf: 1604469 bytes, checksum: b615b17c4a8ddd4a5b7ec91905da223a (MD5) Previous issue date: 2016-09-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Computational intelligence participates as a support tool in various areas of knowledge, particularly specialized area of health. This thesis raises some basis for development of a model to meet the pregnant women, users of the Mobile Emergency Care Service - SAMU. Patient medical records are essential and should contain all the health history from birth, in addition to treatment and care prescribed and received in the institutions, and the informational way to store electronic health records, assists in the health services, beyond the individual and chronologically, generating information, called the Electronic Patient Record - PEP. Thus, the goal is to develop a computer model by algorithm based on the score Malines and Manchester classification that can be used to care for pregnant women. Through this approach, it concluded, determine a computational algorithm, then the implementation of a prototype software to record data derived from pregnant women and suggest an effective service to the requester, able to perform in this manner, a solution in service, using intelligence computer / A inteligência computacional participa como ferramenta de apoio em várias áreas do conhecimento, em especial a área especializada da saúde. Essa pesquisa busca levantar fundamentos para elaboração de um modelo para atendimento as mulheres gestantes, utilizadoras do Serviço de Atendimento Móvel de Urgência – SAMU. Registros médicos do paciente são essenciais e devem conter todo o histórico de saúde, além dos tratamentos e cuidados prescritos e recebidos nas instituições. A forma informacional para armazenar os registros eletrônicos de saúde, auxiliam nos serviços da área especializada, gerando informação, assim, denominando-se como Prontuário Eletrônico do Paciente – PEP. Dessa forma, o objetivo é desenvolver um modelo computacional, através de algoritmo, baseado na pontuação de Malinas e classificação de Manchester, para aplicação no atendimento às gestantes. Por meio dessa abordagem, se conclui na determinação de um algoritmo computacional, posteriormente a implementação de um protótipo de software para registro de dados oriundos das mulheres gestantes e sugerir um atendimento eficaz à solicitante, capaz de realizar dessa maneira, uma solução no atendimento, utilizando a inteligência computacional

O Prontuário Eletrônico do Paciente (PEP) é atualmente um dos principais temas de pesquisa e desenvolvimento no âmbito da Informática em Saúde. No entanto, no Brasil e em odontologia, poucos são os estudos publicados. Frente às deficiências apresentadas no fluxo das informações clínicas nos prontuários baseados em papel e visando o aperfeiçoamento deste fluxo para benefício do paciente e da própria instituição, nos propusemos a desenvolver um prontuário eletrônico direcionado ao atendimento odontológico de pacientes portadores de necessidades especiais do Centro de Atendimento a Pacientes Especiais da Faculdade de Odontologia da USP. Para tanto foi utilizada a metodologia de desenvolvimento denominada ?modelagem orientada ao objeto?. O software foi desenvolvido em conjunto com o Centro de Tecnologia XML do Instituto de Pesquisas Tecnológicas de São Paulo. Uma vez terminado, o software foi submetido ao processo de obtenção de registro na Agência USP de Inovações. / The Electronic Patient Record (EPR) is currently one of the main subjects of research and development in the scope of Health Informatics. In Dentistry, however, few are the published studies in Brazil. Facing deficiencies presented in the clinical information flow in paper based patient record and aiming to improve this flow for both patient and institution benefit, we proposed to develop a electronic patient record system suited to Dentistry attendance of patients with special needs of the Special Care Dentistry Center of University of São Paulo. For such task, it was utilized the ?Object-oriented modeling? software development methodology. The software was developed with the Center of Technology XML of the Institute of Technological Research of São Paulo. Once finished, it was submitted to patent attainment at the University of São Paulo Innovations Agency.