Development of a universal child abuse screening tool (U-CAST): A qualitative analysis of medical expert perspectives.

Child Abuse Pediatrics: A new pediatric subspecialty

Electronic Medical Record (EMR) systems are information systems keeping electronic versions of patients€' medical records. The use of EMR systems has been steadily increasing in recent years, due to many potential benefits. A fully functional EMR system can record patient demographic and chart data, keep track of vital signs, current medications, drug allergies and many other important facets of the patient's medical record. In an ideal scenario, such a system would also be able to handle and implement complex decision support tasks, such as clinical guideline implementations, drug interaction checking and critical alerts. One large issue with existing EMR system implementations is that the semantics of the information elements are not made explicit. Internal identifiers are often used as a placeholder for clinical concepts. This is a large problem when aiming to interact with the patient record, whether it is by physicians, new decision support implementations or by other health information systems. Without explicit semantics, both understanding and accessing the right information can require additional effort to adapt to these identifiers. We propose a Linked Data based approach to implement an EMR system to solve these issues. Linked Data, and in particular the Resource Description Framework (RDF) form the basis of the Semantic Web, which is designed to make the semantics of information both human and machine accessible. With RDF knowledge is represented as a set of triples, where each element of the triple can be an explict Uniform Resource Identifier (URI) with which internal and external resources can be linked. By linking to well defined medical terminologies, such as SNOMED CT, an RDF based approach can explicitly refer to a formalized set of concepts. Using databases for RDF documents, called triple stores, multiple large records can be stored as triple sets. With query languages that make use of triple based patterns, such as the SPARQL query language, the necessary clinical guidelines and other decision support can be implemented in a scalable way. We have evaluated this approach by implementing a Linked Data based version of an EMR system for Atrial Fibrillation (AF) patients. We have populated this system with automatically generated data that takes into account clinically feasible parameters. In addition a number of AF specific queries and decision support tasks were implemented to evaluate the scalability of the whole approach. Our results show that such a system has adequate performance for EMR systems deployed for a single small scale clinic, even on desktop level hardware. A key limiting factor is that an EMR can theoretically hold multiple years worth of very fine grained patient data, which can slow down the execution of various decision support tasks. However we have found that the portion of the dataset that is relevant to the decision support queries is often a very small subset of the overall record. A system that is dynamically able to divide the dataset over multiple data stores is needed to keep the system scalable for larger records with a higher number of patients.

Genital examinations for alleged sexual abuse of prepubertal girls: findings by pediatric emergency medicine physicians compared with child abuse trained physicians

BackgroundThere has been indisputable growth in adoption of electronic medical record (EMR) systems in the recent years. However, physicians’ progress in using these systems has stagnated when measured with maturity scales. While this so-called ceiling effect has been observed and its consequences described in previous studies, there is a paucity of research on the elements that could explain such an outcome. We first suggest that in the context of EMR systems we are in presence of a “tiered ceiling effect” and then we show why such phenomenon occurs.MethodsWe conducted in-depth case studies in three primary care medical practices in Canada where physicians had been using EMR systems for 3 years or more. A total of 37 semi-structured interviews were conducted with key informants: family physicians (about half of the interviews), nurses, secretaries, and administrative managers. Additional information was obtained through notes taken during observations of users interacting with their EMR systems and consultation of relevant documents at each site. We used abductive reasoning to infer explanations of the observed phenomenon by going back and forth between the case data and conceptual insights.ResultsOur analysis shows that a ceiling effect has taken place in the three clinics. We identified a set of conditions preventing the users from overcoming the ceiling. In adopting an EMR system, all three clinics essentially sought improved operational efficiency. This had an influence on the criteria used to assess the systems available on the market and eventually led to the adoption of a system that met the specified criteria without being optimal. Later, training sessions focussed on basic functionalities that minimally disturbed physicians’ habits while helping their medical practices become more efficient. Satisfied with the outcome of their system use, physicians were likely to ignore more advanced EMR system functionalities. This was because their knowledge about EMR systems came almost exclusively from a single source of information: their EMR system vendors. This knowledge took the form of interpretations of what the innovation was (know-what), with little consideration of the rationales for innovation adoption (know-why) or hands-on strategies for adopting, implementing and assimilating the innovation in the organization (know-how).ConclusionsThis paper provides a holistic view of the technological innovation process in primary care and contends that limited learning, satisficing behaviours and organizational inertia are important factors leading to the ceiling effect frequently experienced in the EMR system assimilation phase.

Despite the high expectations of electronic medical records as a great prospect for improving performance in healthcare, the level of adoption and utilization, particularly in a developing country, is low. Knowing the willingness to use the electronic medical record system in the private hospital has an impact on the future implementation status and utilization of the electronic medical record in Ethiopia. However, there was no evidence of the status of the willingness to use electronic medical record systems in private hospitals in the Amhara region. This study aimed to assess the willingness to use electronic medical record Systems and its associated factors among health professionals working in Amhara Region Private Hospitals. A cross-sectional institutional study was performed among 406 health professionals selected using proportional allocation with a simple random sampling technique in Amhara region private hospitals by using self-administered structured questionnaires. The data were analyzed using SPSS version 20 software. Descriptive statistics and binary logistic regression were performed to estimate the crude and adjusted odds ratios with a 95% Confidence interval. Out of the 406 participants included in the analysis, 307 (75.6%) showed a willingness to use the electronic medical record system. About three hundred twelve (76.8%) health professionals had good knowledge of electronic medical record systems, and 257 (63.3%) had good computer skills in electronic medical record systems. Health professionals who had electronic medical record knowledge (AOR = 1.85, 95% CI (1.004-3.409)), EMR training (3.29, 95% CI (1.353-8.003)), technical support personnel (1.92, 95% CI (1.122-3.305)), supportive supervision (AOR = 1.97, 95% CI (1.072-3.628)), and computer skill on electronic medical record (1.77, 95% CI (1.002-3.148)) were significantly associated with the outcome variable. This finding shows a good proportion of willingness to use the electronic medical record system. The most significant factors associated with willingness to use the electronic medical record system were a lack of computer skills, computer training, and knowledge of the electronic medical record system.

BackgroundRedesigning electronic medical record (EMR) systems is needed to improve their usability and usefulness. Similar to other artifacts, EMR systems can evolve with time and exhibit situated roles. Situated roles refer to the ways in which a system is appropriated by its users, that is, the unintended ways the users engage with, relate to, and perceive the system in its context of use. These situated roles are usually unknown to the designers as they emerge and evolve as a response by the users to a contextual need or constraint. Understanding the system’s situated roles can expose the unarticulated needs of the users and enable redesign opportunities.ObjectiveThis study aimed to find EMR redesign opportunities by understanding the situated roles of EMR systems in prenatal care settings.MethodsWe conducted a field-based observational study at a Japanese prenatal care clinic. We observed 3 obstetricians and 6 midwives providing prenatal care to 37 pregnant women. We looked at how the EMR system is used during the checkups. We analyzed the observational data following a thematic analysis approach and identified the situated roles of the EMR system. Finally, we administered a survey to 5 obstetricians and 10 midwives to validate our results and understand the attitudes of the prenatal care staff regarding the situated roles of the EMR system.ResultsWe identified 10 distinct situated roles that EMR systems play in prenatal care settings. Among them, 4 roles were regarded as favorable as most users wanted to experience them more frequently, and 4 roles were regarded as unfavorable as most users wanted to experience them less frequently; 2 ambivalent roles highlighted the providers’ reluctance to document sensitive psychosocial information in the EMR and their use of the EMR system as an accomplice to pause communication during the checkups. To improve the usability and usefulness of EMR systems, designers can amplify the favorable roles and minimize the unfavorable roles. Our results also showed that obstetricians and midwives may have different experiences, wants, and priorities regarding the use of the EMR system.ConclusionsCurrently, EMR systems are mainly viewed as tools that support the clinical workflow. Redesigning EMR systems is needed to amplify their roles as communication support tools. Our results provided multiple EMR redesign opportunities to improve the usability and usefulness of EMR systems in prenatal care. Designers can use the results to guide their EMR redesign activities and align them with the users’ wants and priorities. The biggest challenge is to redesign EMR systems in a way that amplifies their favorable roles for all the stakeholders concurrently.

Background Globally, electronic information and communication technology has been applied and much expanded in the healthcare industry. However, in developing counties including Ethiopia, EMR system adoption and utilization for medical practice are still inconsistent, and healthcare institutions which started utilization currently have also failed to sustain. A desirable readiness of healthcare experts is mandatory to expand digital health service delivery. Thus, this study is aimed at estimating the proportion of the willingness of professionals in Bahir Dar city to use EMR and at identifying factors associated with this proportion. Methods An institution-based cross-sectional study was conducted from September 1 to October 30, 2019, among 634 health professionals. Respondents were selected using a simple random sampling method. Data were entered into EpiData version 3.1 and exported to SPSS version 23 for further analysis. Descriptive statistics were computed to describe study variables and presented using tables. Willingness to use the EMR system was computed. Bivariable and multivariable binary logistic regression models were fitted to identify the associated factors. The odds ratio with 95% confidence interval was used to measure the strength of association. Results A total of 616 health professionals participated in the study with a response rate of 97%. The proportion of willingness to use the EMR system was 85.9%. Among health professionals who were not willing to use EMR, lack of access to EMR training (73.4%) was a major barrier to the willingness to use EMR. A multivariable logistic regression analysis showed that those health professionals who had good computer skill (AOR = 2.5; 95% CI: 1.3-4.6), good knowledge on EMR (AOR = 2.1; 95% CI: 1-4.4), gotten EMR training (AOR = 3.8; 95% CI: 1.7-8.1), EMR guideline access (AOR = 2.8; 95% CI: 1.4-5.6), and management support (AOR = 2.6; 95% CI: 1.4-4.8) were more likely willing to use the EMR system. Conclusions Majority of the professionals were willing to use the EMR system. EMR program should involve computer illiterate, less knowledgeable, those unable to access EMR guidelines, and managerially unsupported professionals. Enhancing health professionals' attitude and contextualizing EMR training in the healthcare curricula are highly recommended to scale up EMR use.

Redesigning Electronic Medical Record (EMR) systems is needed to improve their usefulness and usability. For user-centered redesign, designers should consider which EMR features are the most important to the users. However, prioritizing the EMR features is complicated because: (i) EMR systems involve multiple users with different, and sometimes conflicting, priorities and (ii) targeting one feature will affect other features of the EMR system. In this work, we propose a method for prioritizing the features to target when redesigning an EMR system. The method takes into consideration the different priorities of the users and the relationships between the different features. We illustrate the method through a case study on redesigning EMR systems in Japanese antenatal care settings. Our results show the importance of considering the different types of EMR users and the relationships between different EMR features. Designers could use the proposed method as a decision-aid tool in EMR redesign projects.

ObjectivesWe investigated associations between full Electronic Medical Record (EMR) system adoption and drug use in healthcare organizations (HCOs) to explore whether EMR system features such as electronic prescribing, medicines reconciliation, and decision support, might be related to drug use by using the relevant nation-wide data.MethodsThe study design was cross-sectional. Survey data of the level of adoption of EMR systems were collected for the Organization for Economic Co-operation and Development benchmarking information and communication technologies (ICT) study between November 2013 and January 2014, in Korea. Survey respondents were hospital chief information officers and medical practitioners in primary care clinics. From the national health insurance administrative dataset, two outcomes, the rate of antibiotic prescription and polypharmacy with ≥6 drugs, were extracted.ResultsWe found that full EMR adoption showed a 16.1% lower antibiotic drug prescription than partial adoption including paper-based medical charts in the hospital only (p = 0.041). Between EMR adoption status and polypharmacy prescription, only those clinics which fully adopted EMR showed significant associations with higher polypharmacy prescriptions (36.9%, p = 0.001).ConclusionsThe findings suggested that there might be some confounding effects present and sophisticated ICT may provide some benefits to the quality of care even with some mixed results. Although a negative relationship between full EMR system adoption and antibiotic drug use was only significant in hospitals, EMR system functions searching drugs or listing specific patients might facilitate antibiotic drug use reduction. Positive relationships between full EMR system adoption and polypharmacy rate in general hospitals and clinics, but not hospitals, require further research.

Conjoint family therapy: Virginia Satir, Science and Behavior Books, Inc., Palo Alto, California, 1983 (third edition)

BackgroundElectronic medical record (EMR) systems are nowadays available internationally, including in Saudi Arabia. Nevertheless, there are still many obstacles to overcome before their effective implementation. This cross-national study aimed to investigate the perceptions and practices of healthcare workers toward implemented EMR systems.MethodsA cross-sectional study was conducted across selected hospitals in the four cities of Al-Ahsa, Dammam, Medina, and Riyadh in Saudi Arabia. Healthcare workers of all specialties were invited to participate in the study during the six-month study period from August 2019 to February 2020. The questionnaire was submitted online through institutional e-mails.ResultsThe study included a total of 2684 healthcare providers. Almost half of the respondents (47.1%) were aged between 35 and 50 years. High experience with computer use was observed among 38.3% of them, while 54.3% attended EMR training activities. The performance scores of EMR’s compared to previous routines had a median of 24 (interquartile range {IQR} = 0-38). The satisfaction scores with EMR’s ranged between 16 and 80 with a median of 53 (IQR = 48-61). Older participants (>50 years), non-Saudis, and those who attended EMR training had statistically significant higher scores of both EMR performance and EMR satisfaction, (p<0.001). Those working in other medical specialties (not major) had statistically significant higher scores of EMR performance alone (p<0.001), while general practitioners (p<0.001) and females (p = 0.001) had statistically significant higher scores of EMR satisfaction alone. EMR systems’ positive impact on quality of care was the highest agreed-upon benefit reported, while the temporary loss of access to patient records if computers crashed or power failed was the highest agreed-upon barrier.ConclusionsThe attitude and satisfaction of healthcare workers in Saudi Arabia towards EMR systems are acceptable particularly among those who are older, non-Saudi, and have attended EMR training. Improved quality of care was the main noted benefit of EMR’s, followed by improved productivity. The temporary loss of access to patient records if computers crashed or power failed, followed by privacy and security concerns, was the major EMR barrier mentioned.

Certification Standards in Works for Digital MH Records

While electronic medical record (EMR) systems have demonstrated the potential to improve quality of care and reduce medical errors, relatively few practitioners have implemented EMR systems. This article presents a case study that explores the process by which small physician practices may select an ambulatory EMR system. We assessed the appropriate criteria small practices should use in selecting an EMR system and then evaluated a range of commercially available EMR systems according to cost, functionality, and interoperability with existing systems. The process for selecting an EMR system starts by creating a budget for start-up costs and monthly maintenance expenses. Next, a practice should evaluate its strategic objectives and current computer infrastructure. The group should then define the appropriate functionality requirements specific for their practice. Finally, a certified ambulatory EMR system that interfaces with existing office systems can be selected. This case study explores the process of EMR selection for rural, solo physician practices. The ability to generalize the process described herein to broader types of physician practices, such as multi-specialty group practices or to those practices with larger budgets for EMR systems, may be limited. Multiple critical and often competing factors--including cost and interoperability with existing systems, as well as organizational goals and obstacles--influence the selection of an EMR system for small physician practices. However, by following a standardized process for selecting an EMR system, small physician practices will find EMR selection to be a relatively straightforward process.

The objective of the study was to evaluate residents' and practicing physicians' medical knowledge of child abuse and maltreatment. In a freestanding pediatric hospital and community hospital, a 30-question survey was administered to pediatric residents, general pediatricians (GPs), and pediatric emergency medicine (PEM) physicians. The institution's child protection team developed the questions, which were pilot tested for validity. Question content covered major concepts in child abuse and neglect. Information on previous training of child abuse was also collected. There were 95 respondents, 64.2% (n = 61) were residents, 19% (n = 18) were GPs, and 16.8% (n = 16) were PEM physicians. Overall, the average score was 63.3% (SD, 13.8%). There was a statistically significant difference in the knowledge of child abuse and neglect across physician categories (P < 0.001). Pediatric emergency medicine physicians scored the highest (76.9 [SD, 9.1]) compared with GPs (66.7 [SD, 12.4]; P = 0.018) and pediatric residents (60.4 [SD, 12.9]; P < 0.001). There was no difference in the level of knowledge across residency training years (P = 0.076). With a mean score in our study of 63.3%, there appears to be an overall lack of knowledge in child abuse. These findings highlight the need for increased education in child maltreatment.

Comparison of documentation time between an electronic and a paper-based record system by optometrists at an eye hospital in south India: A time–motion study