The use of electronic medical records (EMRs) has yet to reach its potential for information visualization and achieve corresponding expected outcomes. Current EMR systems show numerous health data with large amounts of texts, which are sometimes integrated in various tables. This type of presentation presents difficulties in promptly determining medical conditions or quickly finding desired information given the volume of texts that needs to be read. Amid these problems, researchers and developers have not explored the creation of easy and intuitive user interfaces for visualizing EMRs. To bridge the gap between current EMR and ideal EMR systems, we propose a prototype web-based pictorial visualization system that can be used by both patients and doctors. The system allows spatial interactivity through representations of human body images (front and back views) and temporal interactivity through interconnected time axes. Medical histories are classified using 11 physiological systems to enable efficient browsing of selected information. This classification enables physicians to quickly understand patients’ health conditions and accordingly make medical decisions, which are useful in emergency rooms and intensive care units.

Nurse practitioners are trained to use the electronic medical record (EMR) to document. Documentation in the EMR is often found to be incomplete, inaccurate, and unreliable, which affects the quality of care and patient safety outcomes. The purpose of the project was to improve the efficiency and effectiveness of nurse practitioners' documentation in the EMR. Malcolm Knowles' adult learning theory was used in this project to develop the education program. Kirkpatrick's training evaluation model was also used to analyze and evaluate the project. The study population included 5 primary care nurse practitioners in an ambulatory care setting using Cerner EMR. The practice-focused question was centered on whether a structured scenario-based training in Cerner would improve the completeness, accuracy, and reliability of EMR documentation. The 5 nurse practitioners were educated using structured, scenario-based training in EMR. The Cerner Advance database showed that there was an average decrease of two seconds in the documentation post-education when compared to the documentation time pre-education. Results for patient quality outcomes indicated that 2 out of 3 quality measures were performed above the national mean. The implication of this study for positive social change includes providing structured education using scenario-based training to help nurse practitioners provide quality care and promote better patient outcomes.

Effective chronic disease management ensures better treatment and reduces medical costs. Representing knowledge through building an ontology for Electronic Medical Records (EMRs) is important to achieve semantic interoperability among healthcare information systems and to better execute decision support systems. In this thesis, an ontology-based EMR focusing on Chronic Disease Management is proposed. The W3C Computer-based Patient Record ontology [32] is customized and augmented with concepts and attributes from the Western Health Infostructure Canada chronic disease management model [27] and the American Society for Testing and Materials International EHR. The result is an EMR ontology capable of representing knowledge about chronic disease. All of the clinical actions of the proposed ontology were found to map to HL7 RIM classes. Such an EMR ontology for chronic disease management can support reasoning for clinical decision support systems as well as act as a switching language from one EMR standard to another for chronic disease knowledge.

The implementation of Electronic Document Management Systems (EDMSs) is a complex process. Scripps Health started a project to implement the web based McKesson Horizon Patient Folder (HPF) software system in early 2011 in order to digitally capture all the information in patient charts. This research used semi-structured interviews to assess the perceived benefits of using an EDMS and its effect on work-flow from the perspective of physicians and health information management (HIM) staff at two hospitals in San Diego, California. The study was designed to assess the new work-flow processes, work-flow challenges associated with EDMS implementation, and other key factors associated with successful implementation of such systems. The research found the opinion of physicians and HIM staff about the effect of an EDMS on their work-flow to be mostly positive. The data analysis further showed that perceived benefits of an EDMS included improved patient care quality and patient care efficiency due to capabilities such as immediate access to patient information by multiple users, reduced patient data error and improved communication between HIM staff and physicians. The analysis of study data also highlighted some shortcomings of EDMSs; these included the system not being user friendly, not having full EMR capabilities and benefits and the inability of EDMSs to interface with other existing systems. The study proposes that despite some challenges post implementation, overall, an EDMS is favoured over paper based chart system. / Graduate / 0566 / 0769 / maryam.katani@gmail.com

An electronic medical record (EMR) is “an electronic record of health-related information on an individual.” EMRs are widely used in healthcare organizations and have many advantages over traditional paper-based medical records, such as their efficiency and reduced storage needs. However, the use of EMRs has not yet reached its full potential. The numerous items of medical data are always shown with redundant and complex text contained in various monotonous forms and tables. It is hard for users to obtain useful information in a short timeframe. We propose a prototype system to intuitively and interactively visualize patients’ medical records. Navigation is improved through graphics-based and interaction-based visualization. Our interface features clickable two-dimensional (2D) images of a human body, on which the symptom locations are the starting point of the navigation. In addition, interactive and classified history visualization is also provided. Finally, some pertinent suggestions and comments from medical professionals are discussed.

Some hospital leaders are ineffective in implementing the electronic medical record (EMR) systems in the hospitals. The purpose of this multiple case study was to explore strategies hospital leaders use to successfully implement EMR systems. The target population consisted of hospital leaders and healthcare professionals from two hospitals who have successfully implemented EMR systems. The conceptual framework of this research study was Kotter's 8-stage process for leading change, building on the model of an effective change management method. Data were collected from 5 interviewed participants and company documents related to strategies regarding the EMR system implementation. The results of reviewing open-ended interview questions and archived documents were analyzed using codes and themes to facilitate triangulation. Three primary themes were developed from the coded data: (a) strategies hospital leaders use to implement the EMR system, (b) strategies hospital leaders use to achieve quality and best practice, and (c) strategies hospital leaders use to manage change and resistance to change. Results revealed 4 steps for successful implementation: (1) creating a vision, (2) communicating the vision, (3) establishing strong leadership, and (4) consolidating gains. Utilizing the successful strategies hospital leaders use to implement the EMR systems could produce quality patient care, efficiencies in hospital operations, and reduced organizational operation cost. The findings could effect positive social change through delivery of quality health and patient care that results in community cost benefits and healthier patient lifestyles.

No description available.

Τα Δημόσια Νοσοκομεία αντιμετωπίζουν σοβαρά προβλήματα διαχείρισης και εκσυγχρονισμού των παρεχόμενων υπηρεσιών υγείας με κύριο αποτέλεσμα την αναποτελεσματικότητα της λειτουργίας των και το χαμηλό βαθμό της ικανοποίησης των πολιτών. Ο πολίτης που καταφεύγει σε ένα Δημόσιο Νοσοκομείο ζητώντας την απαραίτητη υγειονομική φροντίδα και περίθαλψη δηλώνει σιωπηρά την εμπιστοσύνη του στις υπηρεσίες παροχής υγείας, καθώς και την αποδοχή του στο σύστημα της Δημόσιας Διοίκησης. Το σύστημα όμως δημιουργεί παραλείψεις, καθυστερήσεις, χαοτική γραφειοκρατία και υπέρογκες χρηματικές και μη- επιβαρύνσεις που έχουν σαν αποτέλεσμα τη χαμηλή απόδοση παραγωγής υπηρεσιών υγείας και την άναρχη λειτουργία του ιδιωτικού τομέα. Η αιτία του προβλήματος έγκειται τόσο στη παραβίαση ή στην έλλειψη κανόνων που ρυθμίζουν το κανονιστικό εργασιακό πλαίσιο όσο και στην αδυναμία κατασκευής και εφαρμογής μηχανισμών οι οποίοι να επιβάλλουν την ανελαστική εφαρμογή των διατάξεων. Επίσης, η αδιαφορία των διοικήσεων για την εφαρμογή της τεχνολογικής εξέλιξης και της καινοτομίας καθώς και η έλλειψη σχεδιασμού υλοποίησης και οργάνωσης της παροχής δημόσιας υγείας το ενισχύουν. Γενικά, το πρόβλημα των οργανωτικών αλλαγών στο νοσοκομειακό χώρο είναι βαθύ, αφού απαιτείται αναδιοργάνωση, αλλαγή, προσαρμογή στην τεχνολογική διοίκηση, έλεγχος και αξιολόγηση του παραγομένου έργου σε όλες τις βαθμίδες και ιδιαίτερα στην παροχή υπηρεσιών υγείας. Για παράδειγμα, οι ιατρικοί φάκελοι στα περισσότερα νοσοκομεία ακόμα και σήμερα εξακολουθούν να είναι χειρόγραφοι, ογκώδεις, ασαφείς, δυσεύρετοι, δυσανάγνωστοι ενώ πολλές φορές χάνονται, φθείρονται και αλλοιώνονται. Επίσης, η αναζήτηση ιστορικών και κλινικών δεδομένων που αφορούν τους νοσηλευόμενους και τους εξωτερικούς ασθενείς είναι πολύ δύσκολη, ενώ η εξαγωγή στατιστικών συμπερασμάτων εντελώς αβέβαιη και πολύπλοκη. Ωστόσο οι όποιες προσπάθειες για την βελτίωση και τον εκσυγχρονισμό του συστήματος υγείας πρέπει να συνοδεύονται από σταδιακές τεχνολογικές μεταρρυθμίσεις οι οποίες θα βελτιώνουν την πολυποίκιλη νοσοκομειακή εργασία και παράλληλα θα βοηθούν στο σχεδιασμό πολιτικών διοικητικού ελέγχου και ιεραρχικών δομών οργάνωσης. Ο σκοπός της διατριβής αυτής είναι η σταδιακή αλλαγή νοοτροπίας στο νοσοκομειακό περιβάλλον δια μέσου της αποδοχής των επιτευγμάτων της πληροφορικής, παράλληλα με την ανάπτυξη ενός μοντέλου διαχείρισης της κλινικής πληροφορίας που βασίζεται στη χρήση κατάλληλων κωδικοποιήσεων του υλικού και των ιατρικών πράξεων. Το προτεινόμενο μοντέλο μπορεί να χρησιμοποιηθεί στα νοσοκομεία και να αποτελέσει ένα χρήσιμο εργαλείο για τη λήψη αποφάσεων και το σχεδιασμό βάσεων δεδομένων που θα υποστηρίζουν με ακεραιότητα, αξιοπιστία, ευελιξία και ασφάλεια τα προσωπικά δεδομένα. Το προτεινόμενο μοντέλο έχει αναπτυχθεί με την Ingres II Enterprise Edition [1] και χρησιμοποιεί δομές Β-δέντρων πολλών δρόμων [2], πίνακες hash [3] και τεχνικές row locking [4] με στόχο την ελαχιστοποίηση συγκρούσεων και υπερχειλίσεων των εγγραφών. Σε αυτό, καταγράφονται κανόνες, συμβάντα και ειδικοί περιορισμοί που αυξάνουν την ασφάλεια των δεδομένων. Επίσης ορίζονται κατάλληλοι ρόλοι για τις διαφορετικές ομάδες χρηστών. Η αξιοπιστία του μοντέλου αποτιμάται θεωρώντας το ως ένα μη συντηρούμενο σύστημα, εφόσον οι συνιστώσες του δεν λειτουργούν ανεξάρτητα μεταξύ των. Παράλληλα, θεωρώντας το ως Markov μοντέλο συνεχούς χρόνου [5], χρησιμοποιούνται διαγράμματα μπλοκ αξιοπιστίας σε τεχνολογία RAID [6]. Η ευελιξία του μοντέλου έχει μελετηθεί ποσοτικά σε σχέση με την αξιοπιστία του στο επίπεδο ερωτημάτων-ενημερώσεων, ενώ παράλληλα αναπτύσσεται η ευελιξία επέκτασης του μοντέλου, με την εφαρμογή της τεχνολογίας των γραμμωτών κωδίκων για την αναγνώριση των ασθενών, αλλά και για τη ταυτοποίηση των υλικών που χρησιμοποιούνται στις εκάστοτε νοσηλείες. / Public hospitals are facing a lot of problems in management and modernisation of Health services, not least their inefficiency as well as the low degree of satisfaction of citizens. Any citizen, who takes to a hospital asking for the essential health care and hospitalization, declares silently his trustiness in Health services as well as his acceptance in public services system. However, this system is mostly responsible for failures, delays, chaotic bureaucracy as well as for oversized burden and charges, which result in the low performance of health care services and the uncontrolled operation of private sector. The reason of this problem lies partly in the lack or violation of rules which regulate the defined framework and partly in the failing of construction of mechanisms that could enforce the inelastic implementation of rules. Likewise it lies in the lack of interest in technological development of applications and innovation, by administration, as well as in the lack of planning in organization and implementation of Health services However, the efforts for improvement and modernization of health system must be accompanied with gradual technological reforms, which should improve the miscellaneous hospital work and help not only the planning of administrative control politics but also the settlement of hierarchical structures. The problem of administrative changes in hospital environment is deeper, due to the great demand of re-definition of work flow and organisational structure, of understanding of change including roles and responsibilities, as well as of control and evaluation of any health project. Even nowadays medical records are keeping on being handwritten, massive, fuzzy, illegible, while many times they are lost, or wasted or misquoted. Likewise, searching for history and clinical data for inpatients and outpatients is very difficult, while the exportation of statistical conclusions is purely hazy and complicated. The goal of this dissertation is the development of change of thinking in hospital environment, through the acceptance of informatics achievements. Another goal is the development of a clinical information management model through the usage of relevant coding for medical tests and supplies. The proposed model aims to improve clinical care by facilitating the clinical decision and the planning of suitable hospital databases that could maintain patient’s information in a reliable, flexible and secure manner. This model is implemented within Ingres II Enterprise Edition, while btree structures, hash tables and row locking techniques are developed, aiming to minimize the possible deadlocks and the unwanted overflows. In addition, rules, events and special restrictions in conjunction with different groups and users are developed. Due to the dependence of the model components, its reliability is evaluated as a dependently maintained system, as well as a continuous time Markov chain system, via the usage of reliability block diagrams of RAID technology. Models flexibility is considered in relation with its reliability at a level of queries and updates, while its flexibility is extended through barcode technology, not only for patient’s identification but also for medical supplies recognition.

This study builds on the theory of planned behavior, institutional and innovation diffusion theories to investigate physicians' responses to introduction of electronic medical records (EMR) in large healthcare organizations. Using a case study methodology, we show that physicians' attitudes towards using EMR are influenced by their perceptions of EMR complexity, relative advantage, compatibility with professional beliefs and individual predisposition to change. Specifically, we found that EMR usability characteristics such as system interface, "navigation," "search" and "speed" are major dimensions underlying physicians' perceptions of EMR complexity. To the extent that navigating and searching for clinical results are seen as difficult, physicians' perceptions of the complexity of using EMR are enhanced, with the result of physicians forming more negative attitudes towards EMR and using EMR less. Accessibility to EMR (i.e. logging in) and availability of hardware are two emergent constructs. These factors are immediate barriers for physicians not using EMR or using EMR minimally. At the same time, these barriers contribute to impacting physicians' perceptions that EMR is difficult to use and disadvantageous (i.e. time inefficient) compared to the paper chart. Results also show that most EMR usage at Alpha is rather "shallow." Physicians tend to use data-retrieval EMR minimally, mainly to supplement the paper chart. The availability of this "competing artifact," that is much easier to use and conveniently located near a patient's room limits the extent to which physicians use EMR at Alpha. Use of an imaging EMR system (EMR3) is more committed. EMR3 is used to replace the "old way" of accessing films. Lack of accessibility and hardware barriers, the relative advantage of EMR3 and other system usability considerations contribute to physicians using this system more faithfully. As regards the question "what do physicians want?" it seems that physicians want a system that that is easy to access and simple to use but most importantly, a system that they can directly identify with, an EMR that is personally relevant. In order to promote a "deeper" level of EMR usage, the benefits of EMR need to be emphasized to physicians while any potential costs or barriers reduced or eliminated.

No description available.