scholarly journals Emergency physician use and perceptions of the Alberta Netcare Portal, a province-wide interoperable electronic health record (Preprint)

2018 ◽  
Author(s):  
Timothy AD Graham ◽  
Mark Ballerman ◽  
Eddy Lang ◽  
Michael J Bullard ◽  
Denise Parsons ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Health Information ◽  
Continuity Of Care ◽  
Information Exchange ◽  
Clinical Information System ◽  
Positive Impact ◽  
Health Record ◽  
Structured Interviews ◽  
Electronic Health

BACKGROUND The adoption and use of an Electronic Health Record can facilitate real-time access to key health information and support improved outcomes. Many Canadian provinces use interoperable Electronic Health Records (iEHRs) to facilitate Health Information Exchange (HIE), but, to date, the clinical use and utility of iEHRs has not been well-described. OBJECTIVE Our study's primary objective was to describe the use and reported utility of a provincial iEHR known as the Alberta Netcare Portal (ANP) in four urban Alberta emergency departments (EDs). The secondary objectives were to characterize the time spent using the respective electronic tools, and which aspects were perceived as most useful by ED physicians. METHODS Four EDs were included in the study, two using paper-based ordering (University of Alberta Hospital [UAH] and Grey Nuns Community Hospital [GNCH]) and two using a commercial vendor Clinical Information System (Peter Lougheed Centre [PLC] and Foothills Medical Centre [FMC]). Structured clinical observations of ANP use, semi-structured interviews, and system audit logs analysis were compared at the four sites from October 2014 to March 2016. RESULTS Observers followed 142 physicians for a total of 566 hours over 376 occasions. The median percentage of observed time spent using ANP was 8.5% at UAH (interquartile range IQR: 3.7% - 13.3%), 4.4% at GNCH (2.4%-4.4%), 4.6% at FMC (2.4%-7.6%), and 5.1% at PLC (3.0%-7.7%). By combining administrative and access audit data, the median number of ANP screens (i.e., results and reports displayed on a screen) accessed per patient visit were 20 at UAH (IQR: 6-67), 9 at GNCH (4-29), 7 at FMC (2-18) and 5 at PLC (2-14) indicating that clinicians found significant value in using ANP while providing ED care. To explore this hypothesis, semi-structured interviews were analyzed using an inductive approach. The themes that emerged from the interviews were that the ANP improved the quality and continuity of care and patient safety. Further enhancements related to medication management would support better outcomes for patients. CONCLUSIONS This study shows that the iEHR is well utilized at the four sites studied and physicians participating in the study perceived ANP had a positive impact on knowledge of their patients, patient safety, and quality and continuity of care. Physicians described high utility and usability of ANP. More study about the clinical impacts of using iEHRs in the Canadian context, including longer term impacts on quality of practice and safety are required.

scholarly journals Search Functionality Within the Electronic Health Record and Health Information Exchange Databases

2020 ◽  
Vol 3 ◽  
Author(s):  
Brandon Gregory ◽  
Jordan Hill ◽  
Titus Schleyer
Keyword(s):  
Electronic Health Record ◽  
Health Information ◽  
Patient Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Health Record ◽  
Search Function ◽  
Electronic Health

Background and Hypothesis:  In the US today, over 95% of healthcare institutions operate using the electronic health record (EHR). While proven to be a substantial improvement to medical practice, the substantial amount of retained information within those records has made searching the EHR for relevant material difficult and too time consuming. We hypothesize that by providing a search function within the EHR with added capability of collaborative filtration, physicians will be better able to retrieve important patient information and thus provide more efficient care.     Project Methods:   Emergency Department physicians of Sidney & Lois Eskenazi Hospital and Indiana University Health Hospital were recruited to partake in this study based on their use and familiarity of the EHR Cerner and/or Health Information Exchange (HIE) CareWeb Search function. Participants filled out a pre-interview, Likert-scale questionnaire to determine their general impressions of search functions and the frequency with which they were used. Additional insight was obtained during an interview focusing on participants’ previous experiences searching within the EHR/HIE. Participants were then shown a mock-up of potential collaborative filtering integration into CareWeb in order to collect opinions regarding the feature’s usability/practicality, display/format, and a number of suggested terms.    Results:   From the pilot study, current challenges that limit clinician search function use include limited time in clinician workflow, information overload, and inaccurate results. Clinicians are more likely to conduct searches when treating patients who have limited medical history, complex histories, known recent visitations, and/or who have been seen at other institutions. Participants demonstrated interest in a collaborative filtration search feature; they expressed a preference to have the feature recommend five related search terms.    Potential Impact:   The data from this study aims to refine the way healthcare providers search within the EHR/HIE. This will allow healthcare providers to more efficiently extract relevant patient information for improved healthcare delivery and proficient clinician workflow. 

scholarly journals Health systems’ use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions

2019 ◽  
Vol 26 (10) ◽  
pp. 989-998
Author(s):  
Joshua R Vest ◽  
Mark Aaron Unruh ◽  
Seth Freedman ◽  
Kosali Simon
Keyword(s):  
Electronic Health Record ◽  
Health System ◽  
Health Information ◽  
Health Systems ◽  
Information Exchange ◽  
Fixed Effects ◽  
Health Information Exchange ◽  
Health Record ◽  
Single Vendor ◽  
Electronic Health

Abstract Objective Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. Materials and Methods The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor. Results Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant. Conclusion Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.

Electronic health record adoption and health information exchange among hospitals in New York State

2011 ◽  
Vol 18 (6) ◽  
pp. 1156-1162 ◽  
Author(s):  
Erika L. Abramson ◽  
Sandra McGinnis ◽  
Alison Edwards ◽  
Dayna M. Maniccia ◽  
Jean Moore ◽  
...  
Keyword(s):  
New York ◽  
Electronic Health Record ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
New York State ◽  
Health Record ◽  
York State ◽  
Electronic Health

What Can Human Factors Contribute to Improve Electronic Health Record Usability and Patient Safety?

2012 ◽  
Author(s):  
Robert Schumacher ◽  
Robert North ◽  
Matthew Quinn ◽  
Emily S. Patterson ◽  
Laura G. Militello ◽  
...  
Keyword(s):  
Patient Safety ◽  
Human Factors ◽  
Electronic Health Record ◽  
Health Record ◽  
Electronic Health

Uji Validitas Dan Reliabilitas Kuesioner Pengukuran Kompetensi Sistem Informasi Keperawatan: NICAT Dalam Bahasa Indonesia

2019 ◽  
Vol 8 (1) ◽  
pp. 39-43
Author(s):  
Stephanie Dwi Guna ◽  
Yureya Nita
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Assessment Tool ◽  
Competency Assessment ◽  
Health Record ◽  
Nursing Informatics ◽  
Cronbach’S Alpha ◽  
Cronbach's Alpha ◽  
Electronic Health ◽  
Bahasa Indonesia

Integrasi Teknologi Informasi (TI) di bidang kesehatan terbukti meningkatkan kualitas pelayanan kesehatan dengan meningkatkan patient safety serta mempercepat waktu layanan. Salah satu inovasi TI di bidang kesehatan yaitu rekam medik elektronik (electronic health record). Rekam medik jenis ini sudah umum digunakan di negara maju namun masih jarang digunakan di negara berkembang termasuk Indonesia. Sebelum pengimplementasian suatu sistem informasi baru di pelayanan kesehatan, perlu dipastikan bahwa user dapat mengoperasikannya dengan baik sehingga hasil dari sistem tersebut optimal. Perawat sebagai tenaga kesehatan dengan jumlah paling banyak di suatu pelayanan kesehatan seperti Rumah Sakit merupakan user terbesar bila rekam medik elektronik ini diterapkan.  Oleh karena itu diperlukan suatu alat untuk mengukur kemampuan atau literasi sistem informasi keperawatan (SIK). Salah satu alat ukur kompetensi SIK yaitu NICAT (Nursing Informatics Competency Assessment Tool) yang memiliki 3 bagian serta 30 item pertanyaan. Penulis melakukan alih bahasa pada kuesioner ini, kemudian melakukan uji validitas dan reliabilitas. Jumlah sampel pada penelitian ini yaitu 233 perawat di salah satu Rumah Sakit Pemerintah di Pekanbaru, Indonesia. Hasil uji validitas pada 30 item dengan r tabel 0.128 menunjukkan r hitung diatas nilai tersebut dengan Cronbach’s Alpha 0,975. Dapat disimpulkan kuesioner pengukuran kemampuan SIK (NICAT versi Bahasa Indonesia) telah valid dan reliabel sehingga dapat digunakan mengukur kemampuan SIK perawat Indonesia.

scholarly journals Opinions, perceptions and attitudes toward an electronic health record system among practicing nurses

2017 ◽  
Vol 8 (3) ◽  
pp. 12
Author(s):  
Ahmad H. Abu Raddaha ◽  
Arwa Obeidat ◽  
Huda Al Awaisi ◽  
Jahara Hayudini
Keyword(s):  
Electronic Health Record ◽  
Clinical Information System ◽  
Research Work ◽  
Healthcare Delivery ◽  
Future Research ◽  
Health Record ◽  
Randomized Sampling ◽  
Positive Attitudes ◽  
Electronic Health ◽  
The Impact

Background: Despite worldwide expanding implementation of electronic health record (EHR) systems, healthcare professionals conducted limited number of studies to explore factors that might facilitate or jeopardize using these systems. This study underscores the impact of nurses’ opinions, perceptions, and computer competencies on their attitudes toward using an EHR system.Methods: With randomized sampling, a cross-sectional exploratory design was used. The sample consisted of 169 nurses who worked at a public teaching hospital in Oman. They completed self-administered questionnaire. Several standardized valid and reliable instruments were utilized.Results: Seventy-four percent of our study nurses had high positive attitudes toward the EHR system. The least ranked perception scores (60.4%) were linked to perceiving that suggestions made by nurses about the system would be taken into account. Nurses who reported that the hospital sought for suggestions for customization of the system [OR: 2.54 (95% CI: 1.09, 5.88), p = .03], who found the system as an easy-to-use clinical information system [OR: 6.53 (95% CI: 1.72, 24.75), p = .01], who reported the presence of good relationship with the system’s managing personnel [OR: 3.59 (95% CI: 1.13, 11.36), p = .03] and who reported that the system provided all needed health information [OR: 2.97 (95% CI: 1.16, 7.62), p = .02] were more likely to develop high positive attitudes toward the system.Conclusions: To better develop plans to foster the EHR system’s use facilitators and overcome its usage barriers by nursing professionals, more involvement of nurses in system’s customization endeavors is highly suggested. When the system did not disrupt workflows, it would decrease clinical errors and expand nursing productivity. In order to maximize the utilization of the system in healthcare delivery, future research work to investigate the effect of the system on other healthcare providers and inter-professional communications is pressingly needed.

Securing XML with Role-Based Access Control

2014 ◽  
pp. 334-365 ◽  
Author(s):  
Alberto De la Rosa Algarín ◽  
Steven A. Demurjian ◽  
Timoteus B. Ziminski ◽  
Yaira K. Rivera Sánchez ◽  
Robert Kuykendall
Keyword(s):  
Access Control ◽  
Electronic Health Record ◽  
Information Exchange ◽  
Security Policies ◽  
Health Record ◽  
Role Based Access Control ◽  
Future Trends ◽  
Security Framework ◽  
Electronic Health ◽  
Role Based

Today’s applications are often constructed by bringing together functionality from multiple systems that utilize varied technologies (e.g. application programming interfaces, Web services, cloud computing, data mining) and alternative standards (e.g. XML, RDF, OWL, JSON, etc.) for communication. Most such applications achieve interoperability via the eXtensible Markup Language (XML), the de facto document standard for information exchange in domains such as library repositories, collaborative software development, health informatics, etc. The use of a common data format facilitates exchange and interoperability across heterogeneous systems, but challenges in the aspect of security arise (e.g. sharing policies, ownership, permissions, etc.). In such situations, one key security challenge is to integrate the local security (existing systems) into a global solution for the application being constructed and deployed. In this chapter, the authors present a Role-Based Access Control (RBAC) security framework for XML, which utilizes extensions to the Unified Modeling Language (UML) to generate eXtensible Access Control Markup Language (XACML) policies that target XML schemas and instances for any application, and provides both the separation and reconciliation of local and global security policies across systems. To demonstrate the framework, they provide a case study in health care, using the XML standards Health Level Seven’s (HL7) Clinical Document Architecture (CDA) and the Continuity of Care Record (CCR). These standards are utilized for the transportation of private and identifiable information between stakeholders (e.g. a hospital with an electronic health record, a clinic’s electronic health record, a pharmacy system, etc.), requiring not only a high level of security but also compliance to legal entities. For this reason, it is not only necessary to secure private information, but for its application to be flexible enough so that updating security policies that affect millions of documents does not incur a large monetary or computational cost; such privacy could similarly involve large banks and credit card companies that have similar information to protect to deter identity theft. The authors demonstrate the security framework with two in-house developed applications: a mobile medication management application and a medication reconciliation application. They also detail future trends that present even more challenges in providing security at global and local levels for platforms such as Microsoft HealthVault, Harvard SMART, Open mHealth, and open electronic health record systems. These platforms utilize XML, equivalent information exchange document standards (e.g., JSON), or semantically augmented structures (e.g., RDF and OWL). Even though the primary use of these platforms is in healthcare, they present a clear picture of how diverse the information exchange process can be. As a result, they represent challenges that are domain independent, thus becoming concrete examples of future trends and issues that require a robust approach towards security.

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