Total quality management (TQM) approach is often used to carry out company-wide continuous quality improvement plans in manufacturing and service industries. Similarly, TQM can also play a critical role for quality management in health care. Aiming to improve health care quality, experiences showed that major problems of non-patient care, patient records and vital signs monitoring are encountered. In this study, we aim to introduce TQM for quality improvement for intensive care unit (ICU) operations, including some solutions and the prototype of quality management. And vital signs monitoring at ICU is taken as an example of process. For quality improvement of non-patient care, Health Care Quality Development Life Cycle, including (1) quality requirement analysis, (2) quality specification review, (3) quality design, (4) quality implementation, (5) quality testing, (6) quality maintaining, and (7) quality validation, is discussed. The prototype of the first three phases for quality improvement at ICU is explored. Through quality requirement analysis, non-patient care quality at ICU is defined in areas of administration, facility and environment. For quality improvement of patient records maintaining, firstly, scope of health care information systems is categorized as administrative operational system, decision support system, clinical information system, and medical information system. According to this categorization and experience, some interesting result is found. For instance, the current applications of information systems for teaching hospitals in southern Taiwan surveyed are that most applications are administrative and clinical. And the essential information of patient records used in each information system is not complete or not easily accessed. Model of the patient record maintaining is introduced and the prototype design of patient records is recommended for quality improvement of patient records maintaining at ICU. To improve quality of vital signs monitoring is one essential requirement and specification for ICU quality improvement. Effective outcome measures of vital signs monitoring and early detecting of abnormal vital signs is considered important. For quality improvement of vital signs monitoring at ICU, heart rate graphs are taken as examples in our study through the heart rate graphs monitoring. Health professionals can understand the interactions of human autonomic nervous system. By use of digitizer, the computable heart rate data is acquired from each graph and grouped into mortality and near-to-normal cases. Then spectrum form of heart rate data, describing more about heart function, is used for statistical analysis. Several control chart methods have been experimented to detect small heart rate shifts from target, cumulative sum control chart (Cusum) is adopted in our study. The observable variable is the patient¡¦s heart rate, the purpose is to check the alarms pointed out by Cusum that could be partially be ascribed to changes of heart rate trend over time, and to a shift in the monitoring process mean. From summaries of nonconformities in the Cusum charts, mortality cases obviously have more nonconformities. It is obvious that Cusum control charts of mortality cases provide diagnostic information for vital signs monitoring process. In addition, Cusum charts may also inform ICU professionals that there is a small shift of patient heart rate, a continuously increasing or decreasing heart rate, and the adjustment of sympathetic nerve and parasympathetic nerve. In those cases, some special care is needed.

Made available in DSpace on 2016-06-02T20:44:11Z (GMT). No. of bitstreams: 1 4831.pdf: 2096066 bytes, checksum: d367da2e084bdb67e171029ec907527a (MD5) Previous issue date: 2012-12-18 / Financiadora de Estudos e Projetos / The clinical documentation in occupational therapy is developed whenever the service is offered to a client to register and report information pertaining to care. The aim of the study is to identify how this is done and what the perception of occupational therapists about the practice of outpatient clinical documentation is. The research was conducted in two stages: documentary research, through qualitative research of legal documents in Brazil; and field research, descriptive and exploratory study, conducted with 104 active occupational therapists in the state of Sao Paulo who worked in outpatient services. This was carried out using an online questionnaire and data was analyzed using quantitative methods, descriptive statistics and specific tests for comparison and correlation of variables. The results of the field research show: 64.4% of the records are held only on paper; all respondents perform assessment records; one makes no record of intervention / monitoring; and 13.5% do not carry records of patient discharge. Also, 91.9% reported some level of satisfaction with their own record. Virtually all clinical documentation was considered to be necessary and useful. The results revealed a significant correlation (p <0.05) with the level of satisfaction with their own practice of clinical documentation the variables: considered have sufficient knowledge for the development of the records, and values attributed to the practice of clinical documentation (those who consider it complex or difficult present a lower level of satisfaction when compared to those who consider it simple or easy). As for documentary research, 123 documents of different organs of origin were selected and will be analyzed qualitatively, with 103 consisting of reports, technical notes or orders, and the rest, ordinances, resolutions, and Decree. Only 13 of them are specific to the occupational therapy. It was considered that the data obtained allowed an initial approach to the topic, identifying as clinical records are held by occupational therapists working in outpatient care and what their perception of this practice, and identify aspects that influence this perception. The documentary research helped to understand and contextualize the practice of clinical documentation in Brazil, especially in relation to occupational therapy. The study could also contribute to the identification of topics of interest for future research on the topic and to produce knowledge that can guide the development of better quality of clinical documentation by occupational therapists. / A documentação clínica em terapia ocupacional é desenvolvida sempre que o serviço é oferecido a um cliente, para registrar e comunicar as informações pertinentes ao seu atendimento. Este estudo teve por objetivo identificar como é realizada e qual a percepção dos terapeutas ocupacionais sobre a prática da documentação clínica ambulatorial. A pesquisa foi desenvolvida em duas etapas: pesquisa documental, através de investigação e análise qualitativa de documentos jurídicos brasileiros; e pesquisa de campo, descritiva e exploratória, realizada com 104 terapeutas ocupacionais ativos do estado de São Paulo, que atuavam em serviços ambulatoriais. Esta etapa foi realizada através de aplicação on-line de questionário e os dados foram analisados por métodos quantitativos, com uso de estatística descritiva e testes específicos para comparação e correlação das variáveis. Os resultados da pesquisa de campo revelaram que 64,4% dos registros são realizados somente em papel. Todos os respondentes realizam registros de avaliação, um não realiza registros de intervenção/acompanhamento e 13,5% não realizam registros de alta. 91,9% referiram algum nível de satisfação com o próprio registro. Praticamente todos consideram a documentação clínica necessária e útil. Revelaram correlação significativa (p<0,05) com a satisfação em relação à própria prática da documentação clínica as variáveis: considerar possuir conhecimento suficiente para o desenvolvimento dos registros, e valores atribuídos à prática da documentação clínica, sendo que os que a consideram complexa, difícil e desgastante apresentam pior avaliação da satisfação do que aqueles que a consideram simples, fácil e tranqüila. Quanto à pesquisa documental, 123 documentos de diferentes órgãos de origem foram selecionados, sendo 103 constituídos por pareceres, notas técnicas ou despachos, e o restante, portarias, resoluções e decretos. Apenas 13 deles são específicos da terapia ocupacional. Considerou-se que os dados obtidos possibilitaram uma aproximação inicial com o tema, identificando como os registros clínicos são realizados pelos terapeutas ocupacionais que atuam em assistência ambulatorial e qual a percepção deles sobre esta prática, assim como a identificação dos aspectos que interferem nesta percepção. A pesquisa documental auxiliou a compreender e contextualizar a prática da documentação clínica no Brasil, especialmente em relação à terapia ocupacional. O estudo também pôde contribuir para a identificação de focos de interesse para futuras investigações sobre o tema e para a produção de conhecimento que possa orientar o desenvolvimento com melhor qualidade da documentação clínica por terapeutas ocupacionais.

Electronic health records (EHRs) are used in Sweden's healthcare systems to store patients' medical information. Patients in Sweden have the right to access and read their health records. Unfortunately, the language used in EHRs is very complex and presents a challenge for readers who lack medical knowledge. Simplifying the language used in EHRs could facilitate the transfer of information between medical staff and patients. This project investigates the possibility of generating Swedish medical synonyms automatically. These synonyms are intended to be used in future systems for lexical simplification that can enhance the readability of Swedish EHRs and simplify medical terminology. Current publicly available Swedish corpora that provide synonyms for medical terminology are insufficient in size to be utilized in a system for lexical simplification. To overcome the obstacle of insufficient corpora, machine learning models are trained to generate synonyms and terms that convey medical concepts in a more understandable way. With the purpose of establishing a foundation for analyzing complex medical terms, a simple mechanism for Complex Word Identification (CWI) is implemented. The mechanism relies on matching strings and substrings from a pre-existing corpus containing hand-curated medical terms in Swedish. To find a suitable strategy for generating medical synonyms automatically, seven different machine learning models are queried for synonym suggestions for 50 complex sample terms. To explore the effect of different input data, we trained our models on different datasets with varying sizes. Three of the seven models are based on BERT and four of them are based on Word2Vec. For each model, results for the 50 complex sample terms are generated and raters with medical knowledge are asked to assess whether the automatically generated suggestions could be considered synonyms. The results vary between the different models and seem to be connected to the amount and quality of the data they have been trained on. Furthermore, the raters involved in judging the synonyms exhibit great disagreement, revealing the complexity and subjectivity of the task to find suitable and widely accepted medical synonyms. The method and models applied in this project do not succeed in creating a stable source of suitable synonyms. The chosen BERT approach based on Masked Language Modelling cannot reliably generate suitable synonyms due to the limitation of generating one term per synonym suggestion only. The Word2Vec models demonstrate some weaknesses due to the lack of context consideration. Despite the fact that the current performance of our models in generating automatic synonym suggestions is not entirely satisfactory, we have observed a promising number of accurate suggestions. This gives us reason to believe that with enhanced training and a larger amount of input data consisting of Swedish medical text, the models could be improved and eventually effectively applied.

Förord Gruppen vill börja med att tacka alla människor som har varit inblandade och stöttat oss med denna studie. Utan dessa personer hade det inte varit möjligt eftersom vi fick stöd från alla som varit inblandade och deras bidrag med studien. Därefter vill vi tacka vår handledare Erik Bjurström för hans hjälp och rådgivning under studiens gång. Utan honom hade denna studie inte varit möjlig att genomföra så han var till stor hjälp och stötta oss under studiens gång. Dessutom gav han oss bra feedback och konstruktiv kritik som vi bearbetade hädanefter. Utöver det vill vi skänka vår tacksamhet till Västerås Stad för att vi fick chansen att skriva om deras digitalisering av nyckelkvittens. Vill även tacka samtliga respondenter för att de erbjöd oss möjligheten att inspektera deras kommunala verksamhet inom vård och omsorg, för att diskutera innovationsmöjligheter samt innovationsbidrag. Vi vill också tacka de anställda i Västerås Stad för att de ställde upp på intervjuerna och kunde ge oss information som vi hade nytta av, genom att använda insamlad empiri till analys och empiriska material som därefter jämfördes med teorier. Det gav oss en inblick i att se behovet utifrån deras perspektiv. Samtidigt har deras engagemang och öppenhet varit till stor hjälp och avgörande för att denna studie ska bli fullgjort.  I slutändan vill vi tacka våra familjer,vänner och klasskamrater för deras stöd, förståelse, rådgivning, tips och stöttande under denna studie. Utan dem hade det varit omöjligt eftersom vi fick mycket stöd från dem samt inspiration.  Detta har bidragit till lärande för hur användningen av nyckelkvittenser ser ut i Västerås Stad. Det gav oss även en ökad förståelse för vilka nyttor som ökad tillämpning av digitalisering kan vara till nytta för vårdverksamheter. Det bildar en djupare förståelse för hur digitala verktyg kan vara användbara till att tillgodose patienters behov. Analysen och diskussionen indikerar på ett behov av digitala verktyg, vars personal har en positiv inställning till implementering av resultatet. / This study examines the digitalization of key receipts in the care and home care sector in the city of Västerås to increase efficiency and security. The focus is on improving the management of key receipts to address challenges with the current paper-based system. Through a qualitative analysis with interviews of relevant respondents, the study identifies the benefits and challenges of introducing digital key receipts. The results show that digitalization can improve operational efficiency, data security and overall security for both customers and staff. The research concludes with recommendations for developing and implementing a digital system for key receipts that is consistent with the needs and capacities within Västerås city's care services regarding security.

This research explores the role of blockchain technology in advanced information sharing systems with the applications of energy systems and healthcare. Essay 1 proposes a blockchain application to improve resilience in smart grids by addressing cyber security and peer-to-peer trading potentials. The results show that blockchain-based smart contracts are positively related to smart grid resilience. The findings also show that blockchain-based smart contracts significantly contribute to zero trust cybersecurity, which results in a better capability to mitigate cyber-attacks. Essay 2 proposes a blockchain application to improve electronic health record (EHR) systems by increasing patient's empowerment. Confirmatory factor analysis is used for the validity and reliability tests of the model. The results show that blockchain-based information systems can empower patients by providing the perception of control over their health records. The usage of blockchain technology motivates patients to share information with healthcare provider systems and has the advantage of reducing healthcare costs and improving diagnosis management. Essay 3 contributes to the existing literature by using a multimethod approach to propose three new mediators for blockchain-based healthcare information systems: digital health care, healthcare improvement, and peer-to-peer trade capability. Based on the findings from the text analysis, we propose a research model drawing upon stimulus-organism-response theory. Through three experimental studies, we test the research model to explain the patient's willingness to share their health records with others, including researchers. A post hoc analysis is conducted to segment patients and predict their behavior using four machine learning algorithms. The finding was that merely having peer-to-peer trade capability by ignoring healthcare improvement does not necessarily incentivize patients to share their medical reports.

The aim of the paper was to identify tendencies in the type of descriptions, categories, and identities that the doctors at the mental hospital Stockholm’s hospital gave to the mentally ill patients. The time period was chosen for a few specific reasons, one being Bror Gadelius, then chief physician at the mental hospital and his ambitions for a humanistic care of the mentally ill. The other reason is that this period has been forgotten in Swedish history of mental health care as it fell between the 18th and 19th century ‘surveillance and control’, and on the other hand a period of electrical treatments, lobotomies,and sterilisations to ‘treat’ mental illness and fix society during 1930-1950. In the paper, two theories are used to be able to discern tendencies and different attitudes from the doctors in the patient records. The first is the intersectional perspective with some main categories such as Gender, Class, Body, and Sexuality, but also smaller categories that I discovered during the research. These are somewhat abstract yet self-explanatory: Curable/Incurable, meaning whether the attitude in the records suggests that there was any chance for the patient to get well. Talking/Not talking, where the patient's ability or unwillingness to talk to the doctor changes how the patient is described, and finally Docile/Resistant, which means that the patient is described according to how they behave in accordance with the norms of the mental hospital. The second theory is about objective medicine, which developed with the natural sciences, and the need to be scientifically accurate and to be able to define what disease is, what it looks like and its dimensions. However, when objective medicine developed, it was based on a subjective basis, and therefore being ill meant being 'ugly' and not conforming to societal norms. The two theories work well together because they both highlight historically changing meanings within patients' categories and given identities. Although these are two major theories, the paper is still a micro-historical study, I wanted to get up close to the source material and thoroughly examine the different ways in which patients could be described in the mental hospital. And I believe that it is possible, even with a small study of ten patient records, to provide some nuances of how the doctors viewed the mentally ill patients in the early 20th century.

Införandet av elektorniska patientjournaler har bidragit till flera fördelar men trots det arbetar vårdpersonal fortfarande i hektiska och stressiga miljöer. Därmed har taligenkänning blivit ett allt vanligare arbetssätt kopplat till dokumentation, detta med anledning av att underlätta främst dokumentationsprocesser. Med denna studie kommer möjligheter och utmaningar kopplat till anvädning av taligenkänning att identidieras. Syftet med studien är att inhämta kunskap och skapa en bredare förståelse för anvädning av taligenkänning inom sjukvården. Resultatet av studien har lett till en bredare förståelse för vårdprocessen med taligenkänning inom hälso- och sjukvård, främst kopplat till dokumentation och elektronsika patientjournaler. Studiens bidrag kommer med förhoppning att kunna användas som stöd för använding av taligenkänning inom vården. Studien har utförts med en kvalitativ ansats där möjligheter och utmaningar identidierats, både från litteratur och från vårdpersonal. Detta kring hur väl taligenkänning integrerar och fungerar vårdmottanginar emellan. / Despite the many advantages of implementing electronic patient records, healthcare straff are still working in a hectic and stressful environment. Speech recognition has therefore become a more common way of working with documentation, mostly to facilitate the documentation process. In this study, possibilities and challanges with speech recognition will be identified. The main purpose of the study is to gather knowledge and create a greater understanding for the usage of speech recognition in healthcare. The result of the study has led to a greater understanding for the process of speech recogotion in healthcare, mostly connected to documentation and electronic patient records. The contribution of the study could optimistically be used as support for speech recognition in healthcare. The study was executed with a qualitative approach where possibilities and challenges have been identified from both literature and healthcare staff. This was carried out regaring how well speech recognition integrates and works healthcare clinics between.

Implant terms are terms like "pacemaker" which indicate the presence of artifacts in the body of a human. These implant terms are key to determining if a patient can safely undergo Magnetic Resonance Imaging (MRI). However, to identify these terms in medical records is time-consuming, laborious and expensive, but necessary for taking the correct precautions before an MRI scan. Automating this process is of great interest to radiologists as it ideally saves time, prevents mistakes and as a result saves lives. The electronic medical records (EMR) contain the documented medical history of a patient, including any implants or objects that an individual would have inside their body. Information about such objects and implants are of great interest when determining if and how a patient can be scanned using MRI. This information is unfortunately not easily extracted through automatic means. Due to their sparse presence and the unusual structure of medical records compared to most written text, makes it very difficult to automate using simple means. By leveraging the recent advancements in Artificial Intelligence (AI), this thesis explores the ability to identify and extract such terms automatically in Swedish EMRs. For the task of identifying implant terms in medical records a generally trained Swedish Bidirectional Encoder Representations from Transformers (BERT) model is used, which is then fine-tuned on Swedish medical records. Using this model a variety of approaches are explored two of which will be covered in this thesis. Using this model a variety of approaches are explored, namely BERT-KDTree, BERT-BallTree, Cosine Brute Force and unsupervised NER. The results show that BERT-KDTree and BERT-BallTree are the most rewarding methods. Results from both methods have been evaluated by domain experts and appear promising for such an early stage, given the difficulty of the task. The evaluation of BERT-BallTree shows that multiple methods of extraction may be preferable as they provide different but still useful terms. Cosine brute force is deemed to be an unrealistic approach due to computational and memory requirements. The NER approach was deemed too impractical and laborious to justify for this study, yet is potentially useful if not more suitable given a different set of conditions and goals. While there is much to be explored and improved, these experiments are a clear indication that automatic identification of implant terms is possible, as a large number of implant terms were successfully discovered using automated means.