The concentration on healthcare information technology has never been determined than it is today. This awareness arises from the efforts to accomplish the extreme utilization of Electronic Health Record (EHR). Due to the greater mobility of the population, EHR will be constructed and continuously updated from the contribution of one or many EPRs that are created and stored at different healthcare locations such as acute Hospitals, community services, Mental Health and Social Services. The challenge is to provide healthcare professionals, remotely among heterogeneous interoperable systems, with a complete view of the selective relevant and vital EPRs fragments of each patient during their care. Obtaining extensive EPRs at the point of delivery, together with ability to search for and view vital, valuable, accurate and relevant EPRs fragments can be still challenging. It is needed to reduce redundancy, enhance the quality of medical decision making, decrease the time needed to navigate through very high number of EPRs, which consequently promote the workflow and ease the extra work needed by clinicians. These demands was evaluated through introducing a system model named SVSEPRS (Searching and Viewing Segments of Electronic Patient Records Service) to enable healthcare providers supply high quality and more efficient services, redundant clinical diagnostic tests. Also inappropriate medical decision making process should be avoided via allowing all patients‟ previous clinical tests and healthcare information to be shared between various healthcare organizations. Multidimensional data model, which lie at the core of On-Line Analytical Processing (OLAP) systems can handle the duplication of healthcare services. This is done by allowing quick search and access to vital and relevant fragments from scattered EPRs to view more comprehensive picture and promote advances in the diagnosis and treatment of illnesses. SVSEPRS is a web based system model that helps participant to search for and view virtual EPR segments, using an endowed and well structured Centralised Multidimensional Search Mapping (CMDSM). This defines different quantitative values (measures), and descriptive categories (dimensions) allows clinicians to slice and dice or drill down to more detailed levels or roll up to higher levels to meet clinicians required fragment.

eHealth Strategies in countries have shown a trend that countries are moving to Electronic Health Records(EHR). EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. The use of some format of an Electronic Health Record is used by many countries and others are in the implementation or planning phases. South Africa has kicked of the project to implement a national EHR as part of the national eHealth Strategy. This study aims to analyse the key success factors from other EHR implementation projects and evaluate if South Africa is ready to implement an EHR.

Identification of risks ahead of MRI examinations is identified as a cumbersome and time-consuming process at the Linköping University Hospital radiology clinic. The hospital staff often have to search through large amounts of unstructured patient data to find information about implants. Word embeddings has been identified as a possible tool to speed up this process. The purpose of this thesis is to evaluate this method, and that is done by training a Word2Vec model on patient journal data and analyzing the close neighbours of key search words by calculating cosine similarity. The 50 closest neighbours of each search words are categorized and annotated as relevant to the task of identifying risk patients ahead of MRI examinations or not. 10 search words were explored, leading to a total of 500 terms being annotated. In total, 14 different categories were observed in the result and out of these 8 were considered relevant. Out of the 500 terms, 340 (68%) were considered relevant. In addition, 48 implant models could be observed which are particularly interesting because if a patient have an implant, hospital staff needs to determine it’s exact model and the MRI conditions of that model. Overall these findings points towards a positive answer for the aim of the thesis, although further developments are needed.

This study investigates the history of venereal diseases in Sweden in the period from 1785 to 1903. Medical and political perceptions of these diseases as well as the patients and their continued lives have been studied. Venereal diseases were considered a significant threat to the growth of the population throughout the period. They were recognised through the dramatic sores that they produced on the body of the patient, and were frequently cured with mercurial therapies. In the late nineteenth century, syphilis and gonorrhoea became the two most significant sexually transmitted diseases. They were believed to cause paralysis, mental illness, infant mortality and infertility. Sweden fought venereal diseases with a network of State-controlled health measures. County hospitals that contained special wards for patients diagnosed with venereal diseases were established in the late eighteenth century. These hospitals were financed by mandatory revenue after 1817. Medical care was mandatory and ministers, law officers and heads of households could inform the provincial physicians about the incidence of venereal disease. During the nineteenth century, the regulation of prostitution was enforced which implied that women were blamed for the spread of these diseases. Patients with venereal disease belonged to a cross section of contemporary Swedish society. Most of them were from the lower- or working-classes. They suffered higher age-specific mortality in the first half of the century, and high infant mortality throughout the period. It appears, however, that the constructed image of a patient with venereal disease had little impact upon their lives. Contemporary poverty and societal problems, such as unemployment and poor housing, probably played a larger part in their lives. / digitalisering@umu

Documentation in electronic journals is perceived as time consuming and sometimes technically difficult to handle, but also leads to an improved quality of care. Objective: The purpose of this study was to investigate nurses' perceptions of documentation with a focus on timing, technique and quality of care and whether any differences in these perceptions were dependent on age. Method: Quantitative descriptive cross-sectional study in the survey form, 28 nurses at a university hospital in central Sweden participated in the study. Regression analysis was performed with Spearman's rank correlation coefficient. Results: Electronic documentation takes 30 to 60 minutes for most nurses and half of them considered it a reasonable time. Computer skills were good enough for most, but the computers and the electronic patient record system Cosmic were experienced to work less well or badly in half the study group. Two-thirds of the studygroup agreed partly or more to that the quality of care is adversely affected because of the time documentation takes from the patient care. However, about half of the study group agreed that electronic patient records increase health care quality and patient safety. Care plans were used to a great extent. Young nurses rated themselves significantly better than the older ones to handle a computer in their daily work. Conclusion: A variety of problems and perceptions exist in connection with electronic documentation. Continuous development of technology, documentation systems and the use of care plans can contribute to the continuing high quality of care and patient safety. / Dokumentation i elektronisk journal uppfattas som tidskrävande och ibland tekniskt svår att hantera, men leder även till en ökad vårdkvalitet. Syfte: Studiens syfte var att undersöka sjuksköterskors uppfattningar av dokumentering med fokus på tidsåtgång, teknik och vårdkvalitet samt om eventuella skillnader i dessa uppfattningar fanns beroende på ålder. Metod: Kvantitativ deskriptiv tvärsnittsstudie i enkätform, 28 sjuksköterskor vid ett universitetssjukhus i Mellansverige deltog i studien. Sambandsanalys utfördes med Spearmans rangkorrelationskoefficient. Resultat: Elektronisk dokumentation tar 30 till 60 minuter för de flesta sjuksköterskorna och hälften ansåg att detta var en rimlig tid. Datorvanan var tillräckligt god hos de flesta, men datorerna och dokumentationssystemet Cosmic upplevdes fungera mindre bra eller dåligt hos hälften av undersökningsgruppen. Två tredjedelar instämde delvis eller mer i att vårdkvalitén påverkas negativt på grund av den tid dokumentation tar från patientvården. Ungefär hälften instämde i att elektronisk dokumentation bidrar till en ökad vårdkvalité samt patientsäkerhet. Vårdplaner används i hög utsträckning. Yngre sjuksköterskor skattade sig signifikant bättre än äldre på att hantera en dator i det dagliga arbetet. Slutsats: Flera olika problem och uppfattningar föreligger i samband med elektronisk dokumentation. Kontinuerlig utveckling av tekniken, dokumentationssystemen och användandet av vårdplaner kan bidra till en fortsatt hög vårdkvalitet samt patientsäkerhet.

<p>Within the field of medical informatics, patient medical records are the sole source of information for dealing with clinical activities concerning the documentation, care, progression, and ongoing interactions between the patient and clinicians. Electronic or computer-based patient records (CPRs) have had a presence within health care in some form and magnitude for the past thirty years yet only recently have been incorporated in health care to a larger extent. Due to the wide variation of professions in health care, there is a problem of CPRs not being able to fulfill all the possibilities and demands the individual professionals need, since many CPRs are designed as a generic system, to be used across multiple professions.</p><p>The focus of this report is on the utilization of a generic CPR in a specialist clinical setting, i.e., a physical therapy clinic, and to analyze how the therapists utilize the different components and features in a generic CPR. The purpose of the evaluation was to investigate how viable the CPR was as a documentation tool and to which extent it supported the therapists in their clinical, documentation and delivery of care activities. In this study, a total of seven physical therapists participated in a post-usage evaluation of an existing CPR. The evaluation was achieved by interpretative research with open-ended interviews and observations. The results of the study showed that despite some shortcomings, the generic CPR was an effective tool for the clinicians, not only as a documenting aid, but also enabling them to quickly research the patients' prior diagnosis and treatment history, plan for future care, support decision-making and to communicate with other professionals so as to coordinate treatment and planning.</p>

Abstract          Background: End of life is difficult to establish in patients with dementia and many patients die due to complications related to the disease. To document that care are palliative in this group of patients is not common among nurses and physicians. This may depend on that the palliative course is extended and not similar to the palliative course common among patients with cancer. Aim: To describe how the registered staff in nursing homes document the care of persons with dementia in a late palliative phase. Method: A retrospective record study with a deductive approach. Nursing (n = 50) and medical records (n = 50) for departed patients were reviewed using a review guide based on the Liverpool Care Pathway (LCP). Data were analyzed with a manifest content analysis.  The occurrence of documentation in the records was also counted. Results: Three categories were formulated from the analysis: Initial assessment, Coherent assessment and Follow-up. According to medical records the nurses and physicians knew that patients with dementia were dying, but the position on palliative care was not always decided. Nurses and physicians knew that patients with dementia were dying but they did not take a stand that the patient needed palliative care.  Mainly physical symptoms were documented and to a lesser degree psychological, social or existential/spirituality needs. Discussion: It was difficult to form a true picture of patients’ situation from out the documentation. Partly because all caring actions were not documented and the review guide was limited as all parts provided to give a holistic care was not represented. That relative had been provided information that the patient was palliative was accurately documented. Conclusion: The holistic care that patients with dementia need in a palliative phase is not elucidated in the documentation in nursing homes in spite of nurses and physicians knowledge of that the patient are dying.

Today, technologies are being introduced into historically established settings, which change the conditions for work as well as for work-integrated learning. In health care, electronic patient records (EPRs) has been implemented during the last decades to serve as a tool for planning, decision making and evaluation of care work. The overall aim of the research presented in this thesis is to analyse the complex actions and interactions that occur when EPRs are used in health care practice. Analytically, such an interest is pursued employing a socio-cultural perspective on workplace studies, where the use of technology is studied in action. Through three separate studies, practical actions and practical use of EPRs have been examined and the empirical data draws on observations, video-recordings, audio-recordings and documents from a hospital ward in Sweden. The result shows that technologies such as EPRs both offer and presuppose standardization of terminologies and information structures. This, however, does not mean that EPRs completely format and structure information, or that it is driven by its own logic. When staffs comply with a set of standards, transformations of those standards will gradually occur. Those transformations are collective achievements and since each professional involved act in a conscious and active manner, this affects the use of standards as well as the development of collective proficiency. The results also demonstrate that meaning making in(through) the use of EPRs presupposes extensive knowledge of the indexicality of categories, something that originates in the participants‘ shared institutional history. It is in the process of reliving, creating and exposing the meaning of information, that health care professionals actually bring information in EPRs to life. In further development of EPRs that exceeds institutional and even national boundaries it is important to see this development not as solely technical or organizational questions. To develop systems that enhance the possibilities for professionals in different institutions with different professional domains to make sense of standardized information may be a much more  demanding task than it seems to be. Such boundary-crossing systems are nevertheless of great importance for the further development of health care practice.

Within the field of medical informatics, patient medical records are the sole source of information for dealing with clinical activities concerning the documentation, care, progression, and ongoing interactions between the patient and clinicians. Electronic or computer-based patient records (CPRs) have had a presence within health care in some form and magnitude for the past thirty years yet only recently have been incorporated in health care to a larger extent. Due to the wide variation of professions in health care, there is a problem of CPRs not being able to fulfill all the possibilities and demands the individual professionals need, since many CPRs are designed as a generic system, to be used across multiple professions. The focus of this report is on the utilization of a generic CPR in a specialist clinical setting, i.e., a physical therapy clinic, and to analyze how the therapists utilize the different components and features in a generic CPR. The purpose of the evaluation was to investigate how viable the CPR was as a documentation tool and to which extent it supported the therapists in their clinical, documentation and delivery of care activities. In this study, a total of seven physical therapists participated in a post-usage evaluation of an existing CPR. The evaluation was achieved by interpretative research with open-ended interviews and observations. The results of the study showed that despite some shortcomings, the generic CPR was an effective tool for the clinicians, not only as a documenting aid, but also enabling them to quickly research the patients' prior diagnosis and treatment history, plan for future care, support decision-making and to communicate with other professionals so as to coordinate treatment and planning.

Background: The vertical transmission of HIV from mother to child ranges from 15 to 40%. The preventing mothers to child transmission programme (PMTCT) services have been introduced during the past five years in South Africa; however vertical transmission of HIV remains high. Objectives: The objectives of the study were: 1. To describe the clinical and demographic characteristics of women attending the ANC clinic and delivering at the Germiston Hospital; 2. To determine the proportion of women who were offered voluntary counselling and testing (VCT) in 2004; 3. To determine the proportion of women who subsequently received PMTCT. Methods: This is a cross-sectional study I which a sample of 776 patient files were retrospectively, systematically and randomly sampled from 1, 500 antenatal files for the period 2004 (Jan-Dec), in an urban district hospital in the Gauteng Province. A checklist was used to extract specific information. Data was entered into EpiData and analysed using STATA version 8. Pearson's chi-square test was used to obtain measures of association for all categorical variables. The multiple logistic regression method was used to investigate predictors for missed PMTCT opportunities. Results: The pre_yalence proportion of syphilis was 14.19% {95%CI (11.81-16.85)}; prevalence proportion ofHIV was 33.76% {95% CI (27.53-37.13)}. The mean age ofthe sample population was 26.37 years (min=22, max=30). Forty eight per cent of the sample had registered late in the third trimester of pregnancy. Pregnant women presenting with syphilis were more likely to have a missed PMTCT opportunity {OR=2.2, 95%CI (1.16- 4.20), p=0.02}. Women having made fewer than two ANC visits were more likely to have a missed PMTCT/VCT opportunity than women having made more than two visits {OR=O.Sl, 95%CI (0.30-0.86), p=O.Ol}. Conclusions: The prevalence proportion of HIV is high in this setting (33%) and the prevalence of syphilis is seven times greater than the national prevalence. Every antenatal care visit is an opportunity for the healthcare worker to offer voluntary counselling and testing. All women identified as having syphilis infection are at high risk of acquiring HIV. Therefore every woman identified and treated for syphilis should be counselled and tested for HIV. Women must be offered HIV and AIDS education at every ANC visit. Routine opt-out counselling should be offered at every ANC visit for those who have not been previously tested. Recommendation: In order to increase the uptake of the PMTCT programme healthcare workers should have training and re-orientation on: 1. The need to use every opportunity in antenatal care and maternity wards to offer HIV counselling and testing to mothers; 2. HIV and AIDS in pregnancy, PMTCT, as well as the treatment and care of pregnant women. / Dissertation (MPH)--University of Pretoria, 2006. / School of Health Systems and Public Health (SHSPH) / MPH / Unrestricted