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At least 19 recordsLinked to original sources
PubMed2005

Comparing different approaches to two-level modelling of electronic health records.

Electronic Health Record (EHR) systems are being developed to improve the communication of patient data. The health care domain includes many different types of data and concepts, of which some are constantly changing, and some are more lasting. This makes the development of an EHR a complex task. In order to improve the handling of this complexity, a new two-level modelling approach in EHR system development has emerged, using a concept of archetypes as the pivot in the representation of the health care knowledge. The key issue in this approach involves dividing the problem field into two separate models: A generic information model and a domain knowledge model. By analysis of how this layering has been carried out in two different two-level EHR systems - the OpenEHR (formerly the Australian GEHR, Good Electronic Health Record) and the EHR project of Aarhus County, Denmark. We have identified critical meta model parameters influencing the ability of the modelling paradigm to meet the expectation for easy handling of the development process (flexibility) and the capability to manage changing models (dynamics). The OpenEHR has defined the division line in such a way that it makes the generic model small and the domain model large. The opposite is the case of the Aarhus EHR system, where the information model is large, and the knowledge model is small. A small information model and a large knowledge model make more of the system changeable, but it also makes it less flexible to develop. The opposite is the case for a large information model and a small knowledge model.

Australia↗
PubMed2006

Patient-centeredness and timeliness in a primary care network: baseline analysis and power assessment for detection of the effects of an electronic health record.

Electronic health records are expected to improve all six dimensions of quality care identified by the Institute of Medicine (safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness). HealthTexas Provider Network, the ambulatory care network affiliated with the Baylor Health Care System in Dallas-Fort Worth, Texas, is implementing a networkwide ambulatory electronic health record (AEHR). To evaluate the quality of care and financial impact of the AEHR implementation, we examined the available indicators for quantitatively measuring performance in each dimension of quality. For patient-centeredness, the primary data source available is the patient satisfaction survey. To achieve a broad view of patient-centeredness, we identified two measures of satisfaction (overall satisfaction with the physician and willingness to refer the physician) to be examined individually and used additional survey items to construct physician interaction and organizational scales. These scales showed good reliability (Cronbach alpha = 0.95 and 0.89, respectively) and predictive ability ranging from 77% to 93% when applied to the overall satisfaction measures. Data from September 2003 to June 2006 showed mean pre-AEHR implementation baseline performance of 22.9 (±3.3) on the 25-point physician interaction scale and 38.0 (±5.8) on the 45-point organizational scale; 70.9% of patients reported excellent satisfaction with their physician, and 97.6% of patients reported willingness to refer. Timeliness data were collected using the same survey. Baseline performance showed that 43.4% of patients waited <2 days between making and keeping an appointment, and 50.6% of patients waited <5 minutes past appointment time. However, 12.5% waited >30 days between making and keeping an appointment, and 14.0% waited >30 minutes past appointment time. The power to detect changes in the patient-centeredness and timeliness measures in the 3-year multiple time series evaluation of the quality and financial impact of the AEHR was investigated and showed that even small changes in these measures will be detectable.

Journal Article↗
PubMed2005

Tracking referents in electronic health records.

Electronic Health Records (EHRs) are organized around two kinds of statements: those reporting observations made, and those reporting acts performed. In neither case does the record involve any direct reference to what such statements are actually about. They record not: what is happening on the side of the patient, but rather: what is said about what is happening. While the need for a unique patient identifier is generally recognized, we argue that we should now move to an EHR regime in which all clinically salient particulars - from the concrete disorder on the side of the patient and the body parts in which it occurs to the concrete treatments given - should be uniquely identified. This will allow us to achieve interoperability among different systems of records at the level where it really matters: in regard to what is happening in the real world. It will also allow us to keep track of particular disorders and of the effects of particular treatments in a precise and unambiguous way.

Electronic Health Records↗
PubMed2005

Medical guidelines presentation and comparing with Electronic Health Record.

Electronic Health Record (EHR) systems are now being developed in many places. More advanced systems provide also reminder facilities, usually based on if-then rules. In this paper we propose a method how to build the reminder facility directly upon the guideline interchange format (GLIF) model of medical guidelines. The method compares data items on the input of EHR system with medical guidelines GLIF model and is able to reveal if the input data item, that represents patient diagnosis or proposed patient treatment, contradicts with medical guidelines or not. The reminder facility can be part of EHR system itself or it can be realized by a stand-alone reminder system (SRS). The possible architecture of stand-alone reminder system is described in this paper and the advantages of stand-alone solution are discussed. The part of the EHR system could be also a browser that would present graphical GLIF model in easy to understand manner on the user screen. This browser can be data driven and focus attention of user to the relevant part of medical guidelines GLIF model.

Czech Republic↗
PubMed2005

Document ontology: supporting narrative documents in electronic health records.

Electronic health records (EHRs) are beginning to manage an increasing volume of narrative data, such as clinical notes pertaining to admission, patient progress, shift change, follow-up, consultation, procedures, etc. These documents fall into a wide variety of classes, based on who is writing them, for what purpose, and in which location, suggesting the need for a document ontology (DO) to model our knowledge of health care documents and their properties. This paper focuses on one aspect of the Health Level 7 (HL7)/ Logical Observation Identifiers, Names, and Codes (LOINC) DO, the Subject Matter Domain (SMD). We created a new polyhierarchical structure for the SMD that combines the current value lists from the LOINC database with another value list from the American Board of Medical Specialties (ABMS). We refined and evaluated the new structure through expert review of the ontology, a survey of medical specialty boards, and specification of SMDs for a corpus of clinical notes.

Attitude of Health Personnel↗
PubMed2006

Implementing pediatric growth charts into an electronic health record system.

Electronic health record (EHR) systems are increasingly being adopted in pediatric practices; however, requirements for integrated growth charts are poorly described and are not standardized in current systems. The authors integrated growth chart functionality into an EHR system being developed and installed in a multispecialty pediatric clinic in an academic medical center. During a three-year observation period, rates of electronically documented values for weight, stature, and head circumference increased from fewer than ten total per weekday, up to 488 weight values, 293 stature values, and 74 head circumference values (p<0.001 for each measure). By the end of the observation period, users accessed the growth charts an average 175 times per weekday, compared to 127 patient visits per weekday to the sites that most closely monitored pediatric growth. Because EHR systems and integrated growth charts can manipulate data, perform calculations, and adapt to user preferences and patient characteristics, users may expect greater functionality from electronic growth charts than from paper-based growth charts.

Adolescent↗
PubMed1997

Security of the electronic health record.

The Electronic Health Record (EHR) raises new challenges for security. Only authorized persons having a "right to know" can have access to identifiable patient data. Differences between the paper record and the EHR are first described. Several solutions in order to assure confidentiality, integrity and accessibility to patient information are then proposed.

Computer Communication Networks↗
PubMedDate not supplied

Electronic health record and electronic patient record.

This article considers the government plans for the development of electronic health and patient records as set out in the NHS Plan and the progress and problems which have been encountered in their realization.

Computer Security↗
PubMed2005

Standardized exchange of medical data between a research database, an electronic patient record and an electronic health record using CDA/SCIPHOX.

The exchange of medical data from research and clinical routine across institution borders in a structured way, based on national and international standards, is essential to build an integrated and connected health platform. In this project we developed a HL7 CDA/SCIPHOX based integration platform to exchange data between a research database, an electronic health record and an electronic patient record (Soarian).

Biomedical Research↗
PubMed2005

[Electronic health records in Germany].

Electronic health records (EGA), as overall medical applications for the documentation of medical information under the guidance and sovereignty of the patient, change the traditional doctor-patient relationship. Unlike the electronic patient record (EPA), which the treating physician is in charge of, the patient has the sole right to decide who may insert which data into it and who may see his electronic health record (EGA). Thus, the patient's right of informational self-determination and his possibilities to get involved in the treatment process are substantially strengthened. The current situation of the EGA in Germany is described and the parallel development of EGA and EPA is discussed. The electronic health record acquires extensive significance, especially in line with the imminent introduction of the electronic health card on the basis of a standardised telematics infrastructure in Germany.

Computer Communication Networks↗
PubMed2002

Electronic health record.

The chapter covers the electronic health record and electronic health record system that facilitates the use of EHR. The EHR is compared with the traditional handwritten health care record. Definition of Electronic Health Records and its association with the terminology, classification and coding is presented. The architecture of the Electronic Health Record is of strong significance as well as its attributes. Strategic approaches of designing systems supporting the use of electronic health records are depicted. A short presentation of current state of implementation and the obstacles for further implementation are given in the final part of the chapter.

Health Plan Implementation↗
PubMed2006

Nursing minimum data set in the multidisciplinary electronic health record.

The development of an electronic health record requires consensus about its structure and content. The structure and content of the electronic health record refers to the standardization of views, main headings and subheadings. Views are subrecords of electronic health records that are comprised of specific data elements. Agreement on the unified structure of the electronic health record was reached by means of the consensus-based Delphi method and nominal group meetings. The structure includes general views, views by specialists, views by services, views by preventive health care and views by different health care professionals. The main headings are admission, planning, delivery and outcomes of care. In addition, there are 28 subheadings. The first experiences of the applicability of the structure will be obtained after it has been implemented in electronic health record systems by 2007. The goal is through the unified structure of electronic health records to facilitate the transfer of data between health care providers and to maintain the quality of care.

Consensus↗
PubMed2006

Adoption of electronic health records in primary care pediatric practices.

BACKGROUND: Electronic health records may improve care delivery. Although professional organizations and federal agencies encourage widespread adoption, no national data are available regarding the penetration of electronic health records into primary care pediatric practices. METHODS: We used a national mail survey of 1000 randomly selected primary care pediatricians conducted from August to November 2005. RESULTS: The response rate was 58%. Overall, 21.3% of respondents had an electronic health record in their practice. The likelihood of having an electronic health record increased with practice size. Those in a practice network were more likely to have an electronic health record than those in other settings. Smaller and independent practices were less likely to be considering implementing an electronic health record. Although most electronic health records include some pediatric-specific functionality such as the ability to record immunizations, many do not offer decision support; only approximately one third included immunization prompts or alerts for abnormal laboratory results. Cost was a barrier for nearly all of those without an electronic health record; half of the respondents questioned whether electronic health records lead to improvement in quality of care, and many could not identify an electronic health record that would meet their practice requirements. CONCLUSIONS: Electronic health records are concentrated in larger and networked pediatric practices. Smaller and independent pediatric practices, the most common types of practice, are unlikely to adopt electronic health records until the cost of implementing and maintaining the systems decreases, developing standards for interoperability are adopted, and electronic health records are widely perceived to improve quality of care by practicing general pediatricians. The lack of decision support in current electronic health records may limit the ability of these tools to improve care delivery.

Attitude of Health Personnel↗
PubMed2006

Developing the electronic health record: what about patient safety?

This paper examines the development of electronic health records within the National Health Service (NHS) by an analysis of a series of pilot projects funded by the Electronic Record Development and Implementation Project (ERDIP), one aspect of the work of the NHS Information Authority (NHSIA) (As of 1 April 2005, the NHSIA ceased to operate. Much of its work is continued by Connecting for Health and the Health and Social Care Information Centre.) The focus of the analysis is on the extent to which identifying and correcting error within health records was explored through these projects. The inherent potential for error and resultant impact on patient safety is highlighted, by considering the context of the record, the content of the record and the process of change from paper-based or piecemeal electronic health records to integrated electronic health records. While the process of change highlights issues of data security and access, it is the variability in starting points for different organizations that possibly poses most risk to patient safety. Issues relating to the content of the record can to some extent be minimized by the effective use of technology, but the tension between coding and qualitative data requires further consideration in terms of its impact on patient safety. This paper concludes that the development of electronic health records has to be viewed within the context of governance and patient safety, and the implications articulated.

Diffusion of Innovation↗
PubMed2003

Pragmatic objects modeling environment for Electronic Health Records Systems.

Customizable shared Electronic Health Care Records require new mechanisms to dynamically generate user defined objects. An object model based on a semantic network of concepts has been implemented (pragmatic database model). This model offers an easier way to represent "archetypes" of user objects including the concepts, their relationships and the specific organization and representation of the associated knowledge that are necessary to model the context of production of record elements. The aim of this paper is the presentation of this framework and its implementation in an online electronic health record system using Java Web Services technologies. A web-based registry on tobacco was implemented according to this framework and is today daily used in 150 tobacco addiction centers.

Database Management Systems↗
PubMed2005

User interface of MUDR electronic health record.

Development of the electronic health record architecture at the EuroMISE Center was inspired by existing European standards and several European projects. The developed EHR named MUDR implements a 3-layer architecture, using XML for communication between application layer and clients. A decision support module implementing the "1999 WHO/ISH Guidelines for the Management of Hypertension" is part of an application layer. Universal graph structure is used both to represent the set of medical concepts in the EHR and to represent the collected data. Advanced methods of interaction between EHR and its user are studied, software prototypes of client applications are developed and their effectiveness evaluated.

Czech Republic↗
PubMedDate not supplied

An infrastructure for Integrated Electronic Health Record services: the role of XML (Extensible Markup Language).

BACKGROUND: The sharing of information resources is generally accepted as the key to substantial improvements in productivity and better quality of care. In addition, due to the greater mobility of the population, national and international healthcare networks are increasingly used to facilitate the sharing of healthcare-related information among the various actors of the field. In the context of HYGEIAnet, the regional health telematics network of Crete, an Integrated Electronic Health Record environment has been developed to provide integrated access to online clinical information, accessible throughout the island. OBJECTIVES: To make available comprehensive medical information about a patient by means of incorporating all the distributed and heterogeneous health record segments into an Integrated Electronic Health Record that can be viewed on-line through a unified user interface and visualization environment. METHODS: The technological approach for implementing this Integrated Electronic Health Record environment is based on the HYGEIAnet Reference Architecture, which provides the necessary framework for the reuse of services, components, and interfaces. Seamless presentation of information is achieved by means of the Extensible Markup Language (XML), while its underlying capabilities allow for dynamic navigation according to personalized end-user preferences and authorities. RESULTS: The Integrated Electronic Health Record environment developed in HYGEIAnet provides the basis for consistent and authenticated access to primary information over the Internet in order to support decision-making. Primary information is always kept at the place where it has been produced, and is maintained by the most appropriate clinical information system, contrasting traditional store and forward techniques, or centralized clinical data repositories. CONCLUSIONS: Since documents are much more easily accessible rather than data inside a database, Extensible Markup Language has the potential of becoming a very cheap technology provided, of course, that the underlying Healthcare Information Infrastructure exists. XML can be introduced incrementally and its implementation is completely transparent to the end user.

Databases as Topic↗