FGPB-EMR: Fine-grained privacy blockchain for electronic medical record sharing

This study aims to obtain information on: first, the obligation to create and conceal Electronic Medical Record and its juridical consequences; Secondly, due to the law of absence or error in the manufacture of Electronic Medical Records and the position of Electronic Medical Record as a tool in the theoretical transactions.The research method used is normative juridical approach method, analytical descriptive research specification, research phase is done through literature study to examine primary law material, secondary law material, and tertiary law material. Data collection techniques are conducted through document studies, conducted by reviewing documents on positive law. Furthermore, the method of data analysis is done through normative qualitative.The results of the study indicate: Legal aspects of Medical Record or Electronic Medical Record in Teurapetik Transactions related to: first, the obligation of health workers in coaching and health services to make Medical Record or Electronic Medical Record correctly and responsible for secrecy because it is the opening of Medical Record or Electronic Medical Record without With the permission of the patient having the consequences of criminal law. The absence or misuse of the Medical Record or Electronic Medical Record means that health workers may be subject to criminal, civil and administrative sanctions. Second, the position of Medical Record or Electronic Medical Record is evidence in the form of a letter (if given outside the court), and expert information (if delivered in court).

This study aims to obtain information on: first, the obligation to create and conceal Electronic Medical Record and its juridical consequences; Secondly, due to the law of absence or error in the manufacture of Electronic Medical Records and the position of Electronic Medical Record as a tool in the theoretical transactions.The research method used is normative juridical approach method, analytical descriptive research specification, research phase is done through literature study to examine primary law material, secondary law material, and tertiary law material. Data collection techniques are conducted through document studies, conducted by reviewing documents on positive law. Furthermore, the method of data analysis is done through normative qualitative.The results of the study indicate: Legal aspects of Medical Record or Electronic Medical Record in Teurapetik Transactions related to: first, the obligation of health workers in coaching and health services to make Medical Record or Electronic Medical Record correctly and responsible for secrecy because it is the opening of Medical Record or Electronic Medical Record without With the permission of the patient having the consequences of criminal law. The absence or misuse of the Medical Record or Electronic Medical Record means that health workers may be subject to criminal, civil and administrative sanctions. Second, the position of Medical Record or Electronic Medical Record is evidence in the form of a letter (if given outside the court), and expert information (if delivered in court).

Meaningful Use and Electronic Medical Records for the Gastroenterology Practice

e-Liability and e-Documentation.

State Medical Boards and Regulation In An Electronic Medical Record Environment

Clinical supporting (CSS) is the utility software such as the cancer patient database or bedsore patient database designed by hospital staffs. Clinical supporting is usually constructed and operated separately from electronic patient record (EPR) system, because clinical supporting needs a flexible formation to fulfill the user's requests which is impossible by using the stiff vender-made EPR system. We had been using clinical supporting database made by FileMaker Pro server-client since 1998. This included the scheduling of surgical operations, bedsore record, surgical site infection record, and catheter infection record. On April 2006, we introduced the EPR and developed the clinical supporting connected to the main EPR system. We developed EPR system by adding customized interface layer made by FileMaker Pro on the vender-made EPR system, EG-MainEX (Fujitsu Co. ltd.). In this card-type system, the input-output layouts can be modified easily as user need, and several functions which were not provided by the main system, can be introduced very easily. We have been used this EPR in out-patient consultation in Departments of Medicine, Cardiology, and Obstetrics since April 2000. When the main EPR was renewed to EG-Main EX Ver.6 on April 2006, the interface layer was newly customized not only for doctors of all Departments but also for medical social workers and clinical psychologists to use the clinical supporting system. We also unified the clinical supporting already existed to the EPR system. In addition to the database of medical patient record for general doctors, the database of bedsore record, surgical site infection record, palliative care record, and cancer treatment record were implemented for infection nurses, psychologists and oncologists, respectively. These systems were designed not only as easy as to entry the data but also as to create effective database. Survey about clinical requirement for the database and the was performed for six month before the introduction of the EPR system. We checked carefully the layouts and the function of the EPR to keep the uniformity of them. The new EPR systems designed to be used by all Departments were put into practice on April 2006. The doctors of Departments of Ophthalmology, Otorhinolaryngology or obstetrics are using the EPR system, even though these Departments need special layouts of patient record. Practical usage started smoothly, because the EPR layouts are not very different from the form of ordinary patient record in paper. The input layouts of clinical supporting in the new EPR are the same as those used before. Some records including clinical supporting data are transferred to FileMaker Pro server, and when browsing, the layouts are same as those used to input the data. This is very helpful for end-user to find out where is the data searching, and how to search them. Our is so flexible that we can easily customize all the layouts as requested by any Department of a large-scaled general hospital and those of clinical supporting system. In addition to the flexibility of the interface layer, it is another benefit of our that FileMaker layer can be used as the viewer of multi-vender system. Various data such as patient records, cardiotocogram (feto-maternal monitor) records, surgical operation records, admission summary and bedsore records are indicated shortly on the main layout of the EPR system, and easily transferred to user's files by clicking the indicator. Furthermore, basic EPR guarantees the access speed, stability and detailed log recording which lack in FileMaker Pro server database. New or breakthrough work to be presented; We developed EPR system by adding interface layer made by FileMaker Pro on the vender-made EPR system. This is the first EPR which fulfils the requests from all Departments of a large-scale general hospital in Japan. Our EPR also includes the clinical supporting system. Reference database supported by FileMaker Pro is very easy to use. Some major weak points of FileMaker Pro database are complemented by conjugating it with the vender-made EPR system.

Mouse Clicks and Key Strokes

An admission at 2:00 am, a stack of paper charts to shuffle through (at least they were not lost), illegible handwriting to decipher, a trip to radiology to try and find the chest film and hoping it was not at the back of the roller board, a critical laboratory test that had to be repeated because

Objective The medical record is critical for documentation and communication between healthcare professionals. This study compared the completeness of orthopaedic documentation between the electronic medical record (EMR) and paper medical record (PMR). Methods A review was undertaken of 400 medical records (200 EMR, 200 PMR) of patients with operatively managed traumatic lower limb injury. The operative report, discharge summary and first and second out-patient reviews were evaluated using criteria designed by a senior orthopaedic surgeon and senior physiotherapist. The criteria included information deemed critical to the post-operative care of the patient in the first 6 weeks post-surgery. Results In all cases, an operative report was completed by a senior surgeon. Notable findings included inferior documentation of patient weight-bearing status on the operative report in the EMR than PMR group (P = 0.018). There was a significant improvement in the completion of discharge summaries in the EMR compared with PMR cohort (100% vs 82.5% respectively; P < 0.001). In the PMR group, 70.0% of discharge summaries were completed and adequately documented, compared with 91.5% of those in the EMR group (P < 0.001). At out-patient review, there was an improvement in documentation of weight-bearing instructions in the EMR compared with PMR group (81.1% vs 76.2% respectively; P = 0.032). Conclusion The EMR is associated with an improvement in the standard of orthopaedic medical record documentation, but deficiencies remain in key components of the medical record. What is known about the topic? Medical records are an essential tool in modern medical practice and have significant implications for patient care and management, communication and medicolegal issues. Despite the importance of comprehensive documentation, numerous examples of poor documentation continue to be demonstrated. Recently, significant changes to the medical record in Australia have been implemented with the conversion of some hospitals to an EMR and the implementation of the My Health Record. What does this paper add? Standards of patient care should be monitored continuously and deficiencies identified in order to implement measures for improvement and to close the quality loop. This study has highlighted that although there has been improvement in medical record keeping with the implementation of an EMR, the standard of orthopaedic medical record keeping continues to be below what is expected, and several key areas of documentation require improvement. What are the implications for practitioners? The implications of these findings for practitioners are to highlight current deficiencies in documentation and promote change in current practice to improve the quality of medical record documentation among medical staff. Although the EMR has improved documentation, there remain areas for further improvement, and hospital administrators will find these observations useful in implementing ongoing change.

To audit and present the relationship and requirement for incorporating EMR, EHR and PHR data, by featuring its utilization and esteem difficulties and dangers. Electronic Medical Records (EMR) and Electronic Health Records (EHR) are utilized by doctors to enhance nature of care and contain costs. Though EMR is generally viewed as an interior hierarchical framework, the EHR is characterized as a between authoritative framework. As of late, a modernized stage for understanding focused medicinal care known as Personal wellbeing records (PHR) was presented, as an empowering influence for self-administration of medicinal records. PHRs are online frameworks utilized by patients. Their straightforwardness of data should prompt better educated and locked in patients. PHR, EMR and EHR can live on various stages under different advancements and benchmarks. In spite of the fact that EMR contains nearby data and gives quick and precise conveyance, the major preferred standpoint of EHR in therapeutic practice is the accessibility of cross-supplier restorative data. Persistent focused wellbeing activities, for example, PHR empower the combination of the prime data parts in the EMR and the EHR frameworks. This incorporation of restorative data consolidates statistic, way of life and behavioral information with wellbeing records, in this manner furnishing a thorough view that corresponds with the meaning of patient-focused therapeutic care. It can prompt an emotional enhancement in customized mind and also general wellbeing basic leadership, bringing about enhanced wellbeing and health, yet additionally postures genuine difficulties and dangers to security and protection.

The Electronic Health Record and Education: Rethinking Optimization.

BackgroundClinical trials constitute an important pillar in medical research. It is beneficial to support recruitment for clinical trials using software tools, so-called patient recruitment support systems; however, such information technology systems have not been frequently used to date. Because medical information systems' underlying data collection methods strongly influence the benefits of implementing patient recruitment support systems, we investigated patient recruitment support system requirements and corresponding electronic record types such as electronic medical record, electronic health record, electronic medical case record, personal health record, and personal cross-enterprise health record.ObjectiveThe aim of this study was to (1) define requirements for successful patient recruitment support system deployment and (2) differentiate and compare patient recruitment support system–relevant properties of different electronic record types.MethodsIn a previous study, we gathered requirements for patient recruitment support systems from literature and unstructured interviews with stakeholders (15 patients, 3 physicians, 5 data privacy experts, 4 researchers, and 5 staff members of hospital administration). For this investigation, the requirements were amended and categorized based on input from scientific sessions. Based on literature with a focus on patient recruitment support system–relevant properties, different electronic record types (electronic medical record, electronic health record, electronic medical case record, personal health record and personal cross-enterprise health record) were described in detail. We also evaluated which patient recruitment support system requirements can be achieved for each electronic record type.ResultsPatient recruitment support system requirements (n=16) were grouped into 4 categories (consent management, patient recruitment management, trial management, and general requirements). All 16 requirements could be partially met by at least 1 type of electronic record. Only 1 requirement was fully met by all 5 types. According to our analysis, personal cross-enterprise health records fulfill most requirements for patient recruitment support systems. They demonstrate advantages especially in 2 domains (1) supporting patient empowerment and (2) granting access to the complete medical history of patients.ConclusionsIn combination with patient recruitment support systems, personal cross-enterprise health records prove superior to other electronic record types, and therefore, this integration approach should be further investigated.

Background: Patients’ understanding of their breast cancer (BC) diagnosis is important in improving treatment adherence, shared decision-making, and clinical trial matching. However, studies have reported discrepancies between electronic medical record (EMR) and patient reported information. Using data collected from a pilot study of the Outcomes4Me patient empowerment and clinical trial matching App, we analyzed concordance of patient reported disease characteristics compared to EMR data. Methods: Data was analyzed from a single institution pilot study (NCT04262518) evaluating the feasibility of introducing the Outcomes4Me app into routine BC care. Eligibility included BC patients with any subtype or stage of invasive cancer presenting with a new diagnosis or for follow-up on active therapy. We compared patient reported characteristics within a study specific survey and/or the Outcomes4Me app for stage (metastatic or not metastatic), recurrence history, hormone receptor status, HER2, and surgery history with the data recorded in the EMR. All statistics were descriptive. We conducted the same comparison between patient reported clinical characteristics among real world users of the Outcome4Me app and EMR records downloaded by that cohort of patients. Results: Between June 2020 and December 2020, 107 patients were enrolled. Baseline demographics: 90% White, 4% Black, 3% Asian; 37% with a college degree, and 43% with post college education; 66% hormone positive/HER2-, 20% HER2+, and 13% triple negative BC; 31% were stage 4. Concordance between the survey or App questionnaire and the EMR is shown in the Table. Comparing EMR and survey data, 62% of patients matched on both HER2 and HR status, and 94% of patients matched with the EMR on metastatic and recurrence status. When surgery and treatment information was included with these features, only 57% of patients matched across all these characteristics. Similar concordance was observed between the App questionnaire and EMR. Excluding the 21% of patients reporting “unsure” HER2 status improved the concordance to 85%. Overall concordance of recurrent or metastatic status was higher than for receptor status. Despite the discordance between EMR and patient-reported disease information, 97% of patients reported that they somewhat or strongly understood their cancer diagnosis. A similar pattern of concordance between the App questionnaire and EMR was observed among a real-world cohort of 636 patients using the Outcomes4Me App who provided medical record access. Conclusion: Self report of hormone receptor and HER2 status had limited concordance with the EMR, in contrast to a high degree of accuracy for self-report of metastatic disease. The limited accuracy of self-report suggests a need for improved patient education regarding their cancer characteristics and a need for caution when relying on self-report for clinical trials matching and targeted patient education. The use of a digital platform that integrates self-report with medical record access may help address these critical needs impacting patient empowerment and care. Concordance Between App Questionnaire, Study Survey and EMR (% of patients)Disease Characteristic Matching CriteriaApp v. EMR (n=85)Survey v. EMR (n=107)App Real World Cohort (n=636)HER2 Status73%66%79%HR Status80%85%80%Combined Receptor Status67%62%73%Metastatic Status94%(n=79)97%(n=98)94%Surgery History83%(n=47)95%96%(n=310)Recurrent Status98%(n=48)97%(n=98)98%(n=411)Recurrent/Metastatic Status93%(n=42)94%(n=98)98%(n=411)Receptor/Recurrent Metastatic Status and Surgery History74%(n=33)57%(n=93)70%(n=201) Citation Format: Steven J Isakoff, Eva Glieberman, Maya Said, Agnes H. Kwak, Emily A. O’Rourke, Amanda Stroiney, Laura Spring, Beverly Moy, Aditya Bardia, Nora Horick, Jeffrey Peppercorn. Accuracy of Patient Self-Reported Breast Cancer Disease Characteristics Compared to the Medical Record in a Trial of the Outcomes4MeDigital Health App [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-08.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

Genetic exceptionalism. Too much of a good thing?