Full service family physicians in British Columbia (BC) are claiming financial incentives in return for providing enhanced care for patients with chronic diseases. These same physicians are also being actively encouraged to adopt electronic medical record systems (EMRs) with an expectation that their adoption will, among other things, aid in improved chronic disease management (CDM). Indeed, both incentives and clinical information systems have been demonstrated in the literature to be crucial components in effective CDM programs. However, within BC little evidence is available that demonstrates whether EMR adoption is in fact associated with improved provision of CDM services. Furthermore, it is not well understood how the CDM incentive program affects a family practice’s adoption of CDM-related EMR functionality. Through a mixed methods study the relationship between EMR adoption and CDM incentives in a small family practice is explored. Additionally, an audit and feedback intervention is used to test the hypothesis that both incentive use and EMR adoption can simultaneously be improved. Results of the study suggest that the presence of an EMR may not guarantee improvements in delivery of incentivized CDM services; that the incentive program has limits in its ability to promote adoption of CDM-related EMR features; and, that a program of audit and feedback may promote improvements in aspects of EMR adoption and incentive utilization. / Graduate / 0723 / 0769

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abstract: The technological revolution has caused the entire world to migrate to a digital environment and health care is no exception to this. Electronic Health Records (EHR) or Electronic Medical Records (EMR) are the digital repository for health data of patients. Nation wide efforts have been made by the federal government to promote the usage of EHRs as they have been found to improve quality of health service. Although EHR systems have been implemented almost everywhere, active use of EHR applications have not replaced paper documentation. Rather, they are often used to store transcribed data from paper documentation after each clinical procedure. This process is found to be prone to errors such as data omission, incomplete data documentation and is also time consuming. This research aims to help improve adoption of real-time EHRs usage while documenting data by improving the usability of an iPad based EHR application that is used during resuscitation process in the intensive care unit. Using Cognitive theories and HCI frameworks, this research identified areas of improvement and customizations in the application that were required to exclusively match the work flow of the resuscitation team at the Mayo Clinic. In addition to this, a Handwriting Recognition Engine (HRE) was integrated into the application to support a stylus based information input into EHR, which resembles our target users’ traditional pen and paper based documentation process. The EHR application was updated and then evaluated with end users at the Mayo clinic. The users found the application to be efficient, usable and they showed preference in using this application over the paper-based documentation. / Dissertation/Thesis / Masters Thesis Computer Science 2018

Class of 2013 Abstract / Specific Aims: To examine the relationship between hospital readmission rates and responses to a medication adherence questionnaire (Morisky) in patients with congestive heart failure (CHF). Methods: The Morisky questionnaire, assessing medication adherence, was administered to all CHF patients admitted from September 15, 2012 to March 7, 2013. Information collected from the electronic medical record (EMR) for all patients with complete Morisky questionnaires included: age, sex, ethnicity, insurance, height, weight, marital status, tobacco use, alcohol use, number of home medications, all-cause and CHF admission in the previous 365 days from when the questionnaire was administered as well as the following events/disease states: myocardial infarction, hypertension, atrial fibrillation, stroke, diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease, congestive heart disease and chronic kidney disease. Main Results: Of the 120 patients enrolled, 52% scored 1-5 on the Morisky questionnaire indicating some problem with medication adherence while 48% scored 0 (no problems). There was no correlation between the Morisky score and age (95% CI: -3.3-5.7), number of medications (95% CI: -0.26, 2.85), or number of comorbidities (95% CI: -1.02,0.03). The Morisky questionnaire was not predictive of all cause readmissions (95% CI: 0.35, 2.01) p = 0.691). For CHF readmissions the Morisky score was not significant (95% CI: 0.6, 4.11, p=0.358) but the confidence interval suggests a trend. Conclusion: There is no correlation between Morisky scores, age, comorbidities, and medication number. Readmission rates were not predicted by Morisky scores; with more participants a trend may be detected for CHF readmissions.

Indiana University-Purdue University Indianapolis (IUPUI) / Being in the midst of a pandemic with patients having minor symptoms that quickly become fatal to patients with situations like a stemi heart attack, a fatal accident injury, and so on, the importance of medical research to improve speed and efficiency in patient care, has increased. As researchers in the computer domain work hard to use automation in technology in assisting the first responders in the work they do, decreasing the cognitive load on the field crew, time taken for documentation of each patient case and improving accuracy in details of a report has been a priority. This paper presents an information extraction algorithm that custom engineers certain existing extraction techniques that work on the principles of natural language processing like metamap along with syntactic dependency parser like spacy for analyzing the sentence structure and regular expressions to recurring patterns, to retrieve patient-specific information from medical narratives. These concept value pairs automatically populates the fields of an EMR form which could be reviewed and modified manually if needed. This report can then be reused for various medical and billing purposes related to the patient.

Diabetes affects approximately 10% of the American population with an annual expenditure of approximately $174 billion dollars. The utilization of electronic medical records (EMR) combined with the meaningful use (MU) initiative may ensure that diabetic patients receive the recommended preventative care. Dorthea Orem's self-care deficit theory and the transtheoretical model of behavior change was utilized to design this quality improvement project. Medical professionals at a small private practice received education on American Diabetic Association (ADA) treatment standards and how to use the EMR system to track patients receiving the recommended diabetes care. The project question examined the effectiveness of provider education on improving ADA treatment standards and on using the EMR system to adhere to MU objectives of providing diabetic preventative care measures of annual dilated eye examinations, annual microalbumin levels, and annual microfilament foot examinations. A convenience sample of 3 providers and 309 patients was used and data were collected on Excel spreadsheets pre and post intervention through the Crystal Reports system to assess the percent improvement in the rates of preventative care. An impact evaluation revealed that the project achieved its objectives showing a 5.07% increase in diabetic preventative care. The program evaluation determined that the project is worth sustaining in the clinical setting as it provides a practical and economical way of improving diabetic patient care. This improvement project suggests that MU and adherence to ADA treatment standards has the potential to make a positive social change through increasing the amount of diabetic patients receiving preventative care.

Delivery of palliative care to patients in a patient’s home, where they live with their family or in a retirement or nursing home, is an improved, shared-care team approach of providing quality healthcare services at the end of a patient’s life to reduce pain and stress. The palliative care shared-care teams in the Local Health Integration Network (LHIN) for Hamilton Niagara Haldimand Brant (HNHB also called LHIN4) manage patient health care through documents and trackers created and retained by providers within the circle of care, using several different systems and communication tools. These systems are not currently integrated and are unable to connect in a way that enables the preview, transfer, and receipt of data between these systems to support the needs of palliative care users. The primary objective of this thesis is to provide a proposal to improve the user experience of palliative care users through enhancement and integration of some of the systems currently in use. These include OSCAR EMR (Open Source Clinical Application Resource Electronic Medical Record) Hospice – InfoAnywhere, CHRIS (Client Health Related Information System) and Clinical Connect. Integration of these systems will address other limitations the shared-care teams are facing, such as communication, system or organizational policies and privacy and information security concerns that stem from the sharing of patient information across the systems, to support a shared-care team’s ability to provide patient care. During this study, an extensive requirements gathering and analysis was carried out: in-person interviews and teleconference meetings, brain storming sessions on the current systems and review of the secondary data with key stakeholders in the palliative care community. The local hospice sites were visited and extensive input was received from hands-on palliative shared-care teams and hospices across the HNHB LHIN, to ensure that the project team implemented their expressed needs into the integrated solution. The used case and prototyping approach of gathering the requirements is then used on the initial requirements gathered by sending out an initial draft to the users and stakeholders for their review, changes and additional requirements, hence fostering communication between the business and the development teams each time the brain storming session is held to review the refined requirements, resulting in the development of a high-quality Business Requirement Document (BRD). The project manager, lead developer, software architect, and users/testers were all utilized throughout the entire delivery process to ensure they were all in sync with the documented requirements. This lays the foundation for programmers to implement a quality end product with a technical solution that will enhance and integrate the systems to improve the user’s experience at the point of care. / Thesis / Master of Science (MSc)

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