Current Electronic Medical Record Research Articles

An anti-impersonation attack electronic health record sharing scheme based on proxy re-encryption and blockchain

<abstract><p>Many current electronic medical record (EMR) sharing schemes that use proxy re-encryption and blockchain do not fully consider the potential threat of malicious node impersonation attacks. This oversight could lead to data leakage as attackers masquerade as legitimate users or proxy nodes during the sharing process. To deal with this problem, we propose an EMR sharing scheme based on proxy re-encryption and blockchain to protect against impersonation attacks. First, we prevent the potential threat of impersonation attacks by generating a shared temporary key and assigning tasks to multiple proxy nodes. Second, we use a random function to ensure that the selection of encrypted proxy nodes is fair. Third, we use a combination of blockchain and the InterPlanetary File System to solve the problem of insufficient storage capacity of shared processes and ensure the storage security of EMRs. Through the security proof, our scheme guarantees anti-impersonation, anti-collusion, and anti-chosen plaintext attack capability in the sharing process of EMRs. Additionally, experiments on the blockchain platform, namely Chain33, show that our scheme significantly increases efficiency.</p></abstract>

Exploring maturity of electronic medical record use among allied health professionals.

Electronic medical records (EMRs) have the potential to improve and streamline the quality and safety of patient care. Harnessing the full benefits of EMR implementation depends on the utilisation of advanced features, defined as "mature usage." At present, little is known about the maturity of EMR usage by allied health professionals (AHPs). To examine current maturity of EMR use by AHPs and explore perceived barriers to mature EMR utilisation and optimisation. AHPs were recruited from three health services. Participants completed a 27-question electronic questionnaire based on the EMR Adoption Framework, which measures clinician EMR utilisation (0 = paper chart, 5 = theoretical maximum) across 10 EMR feature categories. Interviews were conducted with both clinicians and managers to explore the nature of current EMR utilisation and perceived facilitators and barriers to mature usage. Questionnaire responses were obtained from 192 AHPs. The majority of questions (74%) showed a mean score of <3, indicating a lack of mature EMR use. Pockets of mature usage were identified in the categories of health information, referrals and administration processes. Interviews with 18 clinicians and managers revealed barriers to optimisation across three themes: (1) limited understanding of EMR opportunities; (2) complexity of the EMR change process and (3) end-user and environmental factors. Mature usage across EMR feature categories of the EMR Adoption Framework was low. However, questionnaire and qualitative interview data suggested pockets of mature utilisation. Achieving mature allied health EMR use will require strategies implemented at the clinician, EMR support, and service levels.

Electronic medical record documentation of germline genetic evaluations in patients with ovarian cancer.

Germline genetic evaluation is indicated for all patients with epithelial ovarian cancer (EOC). For testing to have clinical utility, results must be documented within the electronic medical record (EMR) and accessible to providers at the point of care, which can be challenging in the context of current EMR limitations and genetic testing processes. We examined the receipt of genetics services and EMR capture of genetic testing results in patients with EOC. We conducted a retrospective chart review to examine germline genetic evaluations among patients with EOC seen by a gynecologic or medical oncologist at the University of Pennsylvania in 2016. EMRs were reviewed to determine: (1) if patients were referred for genetic evaluation; (2) if genetic testing was performed; (3) if results were documented in office notes, scanned third-party test reports, and/or the EMR problem list; (4) if provider notes correctly listed the variant classification. Overall, 413 (62%) of patients had documented genetic testing. Genetic testing was documented in almost all provider notes (96%) and the majority of scanned EMR reports (64%). Pathogenic variants were found in 119 (29%) individuals; the majority (70%) had genetic testing documented within EMR problem lists. Provider notes were highly accurate in describing variant classification. In this study, genetic testing was performed and documented in the EMR for most EOC patients. Approximately one-third of those tested did not have scanned test reports specifying variant found, limiting the utility of test results for cascade testing and therapeutic decisions.

Organizational and health professional readiness for the implementation of electronic medical record system: an implication for the current EMR implementation in northwest Ethiopia

ObjectiveThe WHO developed a manual outlining the preliminary organizational and health professionals’ readiness to implement electronic medical records (EMR). On the other hand, the readiness assessment in Ethiopia only includes...

BPDST: Blockchain-Based Privacy-Preserving Data Sharing on Thin Client for Electronic Medical Records

Sharing medical data can improve the quality of medical services and reduce costs. However, the current Electronic Medical Records (EMRs) are scattered and easily tampered with, which is not conducive to the sharing of EMRs and is not compatible with thin clients. Fortunately, blockchain technology is tamper-proof, decentralized, auditable, and meets the above requirements. To solve these problems, we first propose Blockchain-Based Privacy-Preserving Data Sharing on Thin-Client for Electronic Medical Records (BPDST) approach that combines the k-anonymity and cloud storage, which thin clients can run like a full-node user and safeguard user's EMRs privacy concurrently. Using this approach, patients can control their own EMRs, while the consortium blockchain is responsible for the transaction process and sending the correct results to the patients. BPDST can also share information without leaking or tampering with EMRs' privacy, achieving the purpose of sharing medical data and privacy protection. In the medical field, this study can effectively protect users' privacy when sharing medical data to provide convenience for users and break the "island" phenomenon among various medical institutions. Security analysis and extensive experiments show that BPDST is secure and practical for sharing EMRs.

Development and validation of interpretable machine learning models for inpatient fall events and electronic medical record integration.

Falls are one of the most frequently occurring adverse events among hospitalized patients. The Morse Fall Scale, which has been widely used for fall risk assessment, has the two limitations of low specificity and difficulty in practical implementation. The aim of this study was to develop and validate an interpretable machine learning model for prediction of falls to be integrated in an electronic medical record (EMR) system. This was a retrospective study involving a tertiary teaching hospital in Seoul, Korea. Based on the literature, 83 known predictors were grouped into seven categories. Interpretable fall event prediction models were developed using multiple machine learning models including gradient boosting and Shapley values. Overall, 191,778 cases with 272 fall events (0.1%) were included in the analysis. With the validation cohort of 2020, the area under the receiver operating curve (AUROC) of the gradient boosting model was 0.817 (95% confidence interval [CI], 0.720-0.904), better performance than random forest (AUROC, 0.801; 95% CI, 0.708-0.890), logistic regression (AUROC, 0.802; 95% CI, 0.721-0.878), artificial neural net (AUROC, 0.736; 95% CI, 0.650-0.821), and conventional Morse fall score (AUROC, 0.652; 95% CI, 0.570-0.715). The model's interpretability was enhanced at both the population and patient levels. The algorithm was later integrated into the current EMR system. We developed an interpretable machine learning prediction model for inpatient fall events using EMR integration formats.

Clinical Interactions in Electronic Medical Records Towards the Development of a Token-Economy Model

The use of electronic medical records (EMRs) plays a crucial role in the successful implementation of the Universal Healthcare Law which promises quality and affordable healthcare to all Filipinos. Consequently, the current adoption of EMRs should be studied from the perspective of the healthcare provider. As most studies look into use of EMRs by doctors or patients, there are very few that extend studies to look at possible interaction of doctor and patient in the same EMR environment. Understanding this interaction paves the way for possible incentives that will increase the use and adoption of the EMR. This study uses process mining to understand simulated doctor-patient interaction, with the goal of developing interaction features and a token economy framework to increase EMR adoption. Results from the process mining showed that current EMR interaction remains low, and highlighted the need for interaction features to promote preventive healthcare. Moreover, process mining from the simulated logs showed that consistency and time are important factors in encouraging usage. Activity category, relative frequency of activity, relative case frequency of activity and average time spent on activity are features that may serve as the foundation for a token economy framework for EMRs.

Physician satisfaction with electronic medical records (EMRs): Time for an intelligent health record?

318 Background: EMRs are devised to improve the quality and efficiency of healthcare delivery and to reduce medical errors. Despite the widespread use of EMRs, various factors can limit their effectiveness in improving healthcare quality. General EMR use has been cited as a factor contributing to increased workload and clinician burnout in oncology and other specialties. The objective of this qualitative research study was to identify barriers perceived by medical oncologists and hematologists (mO/H) in utilizing EMR software and factors associated with levels of satisfaction. Methods: Between January and April 2021, mO/H from across the U.S. were invited to complete a web-based survey about various trends and critical issues in oncology care. Demographics about the physicians and characteristics of their practices were captured as well in the survey. Responses were aggregated and analyzed using descriptive statistics. Results: A total of 369 mO/H completed the survey: 72% practice in a community setting; 47% identified as a hospital employee; they have an average of 19 years of clinical experience and spend on average 86% of their working time in direct patient care, seeing 17 patients per day on average on clinic days. Most (99%) of mO/H surveyed use an EMR software at their practice, with Epic (45%) and OncoEMR (16%) being the most common. Regarding satisfaction, 16% and 50% reported feeling highly satisfied and satisfied, respectively, with their current EMR, and 3% and 11% reported feeling very dissatisfied or dissatisfied, respectively. Some (19%) stated that they have considered changing their EMR, and 68% are unsure how EMR licensing fees for their practice are paid. EMR pain points most commonly experienced were: time-consuming, e.g., too many steps/click (70%); interoperability, e.g., difficulty sharing information across institutions or other EMR software (45%); data entry issues, e.g., difficulty entering clinical information, scheduling patient visits and reminders, or ordering multiple labs (38%); and poor workflow support (31%). The most useful aspects/features of their EMR software reported were availability of information, e.g., preloaded protocols, chemotherapy regimens and pathways (64%); data access (64%); and multiple access points, including remote access (37%). Conclusions: Satisfaction with EMR were generally positive among the mO/H surveyed. However, there are multiple deterrents to the efficient use of current EMR systems. This information is essential in the design of next-generation EMR (an Intelligent Medical Records system) to allow for incorporation of aspects most useful to the end-users, such as pathway access, preloaded information on cancer management as well as ease of access and portability, and a user experience that minimizes clicks and reduces physician time with EMR.

Using a Semi-Structured Qualitative Interview to Evaluate Pediatric Interns' Use of the Electronic Medical Record in a Simulated Setting.

IntroductionEffective use of electronic medical record (EMR) is paramount to delivering safe and effective care. Current EMR education is inadequate, with literature showing frequent deficiencies in skills needed to obtain and interpret data. This study aims to evaluate pediatric interns' perception of EMR inclusion in scenario-based simulation training.MethodsA total of 13 pediatric interns participated in an EMR-enhanced, multidisciplinary simulation of a pediatric patient with septic shock during the 2019-2020 academic year. Following the simulation, the interns participated in a semi-structured interview to evaluate the experience of having the EMR incorporated into the simulation and what benefits it offers.ResultsOf the 13 interns, 12 (92%) felt that incorporating the EMR into the simulation increased the realism of the scenario. All (100%) interns reported that EMR inclusion led to increased learning about the EMR, including gaining or re-learning skills needed to access or interpret electronic clinical data. Participants felt that EMR inclusion in the simulation provided valuable learning opportunities not present in traditional EMR education.ConclusionsIntegrating the EMR into simulation is viewed positively by pediatric interns, is perceived to improve simulation realism, and helps teach important EMR skills. EMR training would benefit from incorporation into scenario-based simulations.

Lung-Protective Ventilation Over 6 Years at a Large Academic Medical Center: An Evaluation of Trends, Adherence, and Perceptions of Benefit.

Objectives:The main objective of this study was to evaluate trends in set tidal volumes across all adult ICUs at a large academic medical center over 6 years, with a focus on adherence to lung-protective ventilation (≤ 8-cc/kg ideal body weight). A secondary objective was to survey providers on their perceptions of lung-protective ventilation and barriers to its implementation.Design:Retrospective observational analysis (primary objective) and cross-sectional survey study (secondary objective), both at a single center.Participants:Mechanically ventilated adult patients with a set tidal volume (primary objective) and providers rotating through the Medical and Neurosciences ICUs (secondary objective).Interventions:None.Measurements and Main results:From 2013 to 2018, the average initial set tidal volume (cc/kg ideal body weight) decreased from 8.99 ± 2.19 to 7.45±1.34 (p < 0.001). The cardiothoracic ICU had the largest change in tidal volume from 11.09 ± 1.96 in 2013 to 7.97 ± 1.03 in 2018 (p < 0.001). Although the majority of tidal volumes across all ICUs were between 6.58 and 8.01 (interquartile range) in 2018, 27% of patients were still being ventilated at volumes greater than 8-cc/kg ideal body weight. Most surveyed respondents felt there was benefit to lung-protective ventilation, though many did not routinely calculate the set tidal volume in cc/kg ideal body weight, and most did not feel it was easily calculable with the current electronic medical record system.Conclusions:Despite a trend toward lower tidal volumes over the years, in 2018, over a quarter of mechanically ventilated adult patients were being ventilated with tidal volumes greater than 8 cc/kg. Survey data indicate that despite respondents acknowledging the benefits of lung-protective ventilation, there are barriers to its optimal implementation. Future modifications of the electronic medical record, including a calculator to set tidal volume in cc/kg and the use of default set tidal volumes, may help facilitate the delivery of and adherence to lung-protective ventilation.

Proposed Implementation of Blockchain in British Columbia's Health Care Data Management.

BackgroundThere are several challenges such as information silos and lack of interoperability with the current electronic medical record (EMR) infrastructure in the Canadian health care system. These challenges can be alleviated by implementing a blockchain-based health care data management solution.ObjectiveThis study aims to provide a detailed overview of the current health data management infrastructure in British Columbia for identifying some of the gaps and inefficiencies in the Canadian health care data management system. We explored whether blockchain is a viable option for bridging the existing gaps in EMR solutions in British Columbia’s health care system.MethodsWe constructed the British Columbia health care data infrastructure and health information flow based on publicly available information and in partnership with an industry expert familiar with the health systems information technology network of British Columbia’s Provincial Health Services Authorities. Information flow gaps, inconsistencies, and inefficiencies were the target of our analyses.ResultsWe found that hospitals and clinics have several choices for managing electronic records of health care information, such as different EMR software or cloud-based data management, and that the system development, implementation, and operations for EMRs are carried out by the private sector. As of 2013, EMR adoption in British Columbia was at 80% across all hospitals and the process of entering medical information into EMR systems in British Columbia could have a lag of up to 1 month. During this lag period, disease progression updates are continually written on physical paper charts and not immediately updated in the system, creating a continuous lag period and increasing the probability of errors and disjointed notes. The current major stumbling block for health care data management is interoperability resulting from the use of a wide range of unique information systems by different health care facilities.ConclusionsOur analysis of British Columbia’s health care data management revealed several challenges, including information silos, the potential for medical errors, the general unwillingness of parties within the health care system to trust and share data, and the potential for security breaches and operational issues in the current EMR infrastructure. A blockchain-based solution has the highest potential in solving most of the challenges in managing health care data in British Columbia and other Canadian provinces.

Graphical Presentations of Clinical Data in a Learning Electronic Medical Record.

Complex electronic medical records (EMRs) presenting large amounts of data create risks of cognitive overload. We are designing a Learning EMR (LEMR) system that utilizes models of intensive care unit (ICU) physicians' data access patterns to identify and then highlight the most relevant data for each patient. We used insights from literature and feedback from potential users to inform the design of an EMR display capable of highlighting relevant information. We used a review of relevant literature to guide the design of preliminary paper prototypes of the LEMR user interface. We observed five ICU physicians using their current EMR systems in preparation for morning rounds. Participants were interviewed and asked to explain their interactions and challenges with the EMR systems. Findings informed the revision of our prototypes. Finally, we conducted a focus group with five ICU physicians to elicit feedback on our designs and to generate ideas for our final prototypes using participatory design methods. Participating physicians expressed support for the LEMR system. Identified design requirements included the display of data essential for every patient together with diagnosis-specific data and new or significantly changed information. Respondents expressed preferences for fishbones to organize labs, mouseovers to access additional details, and unobtrusive alerts minimizing color-coding. To address the concern about possible physician overreliance on highlighting, participants suggested that non-highlighted data should remain accessible. Study findings led to revised prototypes, which will inform the development of a functional user interface. In the feedback we received, physicians supported pursuing the concept of a LEMR system. By introducing novel ways to support physicians' cognitive abilities, such a system has the potential to enhance physician EMR use and lead to better patient outcomes. Future plans include laboratory studies of both the utility of the proposed designs on decision-making, and the possible impact of any automation bias.

Using a bi-directional digital health platform for cancer care coordination and monitoring to enhance the cancer care continuum between patients, clinicians and caregivers.

e14105 Background: It has been recognized that current electronic medical record (EMR) systems detract from the patient-provider relationship and that an innovative technology is needed to re-center medical encounters on the patient-provider engagement. This is especially important in oncology during new patient onboarding, care coordination in between medical visits and survivorship planning. Methods: We built a HIPAA compliant role-based digital health platform to support providers in patient engagement and care coordination. In this pilot at a non-profit oncology center in India, nurse navigators onboarded the patients using the mobile application. The technology was used to digitize past medical records and parse the clinical history. In addition, self-reported patient past medical history, family history, as well as social, reproductive and surgical history was collected as needed. The system collated the information into an easy to consume case summary for the oncologists. The system was tested with 3 clinicians and consented cancer patients. Results: Nearly 200 cancer patients participated in the pilot study. Patients’ medical records were digitized by oncology nurse navigators. The summarized longitudinal view of the patient’s medical history was used by oncologists for diagnosis and treatment planning. Participating clinicians noted that the digital case summary saved time and effort in treatment planning. In addition, it was noted that collaboration between nursing staff, medical oncologist, surgical oncologist and radiation oncologist was substantially improved. Conclusions: We demonstrate the value of using digital health technology to support the care coordination of cancer patients in a low-resource, non-profit clinical center in India.

Abstract P6-12-03: Development of technology for bi-directional, tailored support of the relationship between breast cancer patients and their providers

Abstract Background: It has been repeatedly recognized that current electronic medical record (EMR) systems detract from the patient-provider relationship and that innovative technology is needed to re-center medical encounters on the patient-provider relationship. This is especially important during breast cancer diagnosis and treatment.Methods: We interviewed breast cancer patients and their providers to understand the needs of each. Perspectives from both patients and providers were recorded and collated through discussions and subsequent field pilot tests which we used to validate and prioritize features or functions needed in the app to support each side of the medical encounter. Results: Patients reported wanting a system that centrally housed their diagnostic and treatment related information. They wanted the ability to share information with their caregivers (family and friends) as well as report symptoms (patient reported outcomes - PROs) to their providers. Providers reported wanting a way to gather and use PROs to intervene as soon as possible on the symptoms reported by the patients that might cause treatment delays or decrease adherence to the treatment regimen. Providers also wanted a way to easily consume the patient’s breast cancer journey and understand the current status of the patient. Using the interviews, we collated a set of the most critical capabilities and created a bi-directional mobile portal for patients and providers that has a tailored interface for each role. The resulting platform enables breast cancer patients to record their diagnosis, track appointments, and store PROs. In addition, patients can invite caregivers to the platform to view their medical history and help them in their care journey. Patients can also share their information with their providers. The provider side of the mobile app allows the doctor to view the patient’s longitudinal case summary as well as any PROs, manage patient encounters and includes a chat function for the patient’s medical team to communicate with each other regarding the patient’s case. Conclusion: We demonstrate that it is possible to build and deploy a mobile application to support patient-provider engagement. We show initial results that are promising for a bi-directional platform that reduces friction in patient-provider engagement. Citation Format: Sharon Hensley Alford, Rohit Mahatma, Sagar Amode, Rupal Sethia, Kartik Mahatma, Hitesh Mahatma, Varun Mahatma, Nayan Sonawane, Shilpa Mahatma, Tarun Kumar, Kanchan Chawala. Development of technology for bi-directional, tailored support of the relationship between breast cancer patients and their providers [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-12-03.

Designing and Adapting Services to Create Value Outside a Hospital Using Blockchain Architecture

As healthcare systems develop innovative services to create value for patients outside the hospital or clinical care facility, they face a major challenge. They need a communication architecture to support the sharing of information among the healthcare providers, patients, and external partners to fulfill the value created. The current electronic medical record systems of hospitals do not extend to many of these external partners unless they are part of the provider network. This paper proposes the use of blockchain architecture to address this challenge. By modeling service innovations used to create value as a set of service exchanges among providers, patients, and partners, the providers decide when blockchain architecture may complement their own extended EMR system in fulfilling the value they create to address patient needs. The authors use gamification to improve patient adherence to treatment plans designed to fulfill the value created and adapt the value created to reflect the changing patient ecosystem. The paper concludes with discussion and directions for future research.

Disparities and Their Impact on the Adoption of Health Information Technology (HIT) in Minority Cancer Patients and Caregivers

Background: HIT has the potential to improve the health of individuals and the performance of providers, yielding improved quality, cost savings, and greater engagement by patients. Minorities face a variety of financial and nonfinancial barriers to obtaining appropriate and timely health care. Studying the behavior of minority patients will help understand the specific challenges to HIT adoption and engagement in patients and their caregivers. We undertook a patient-reported survey to explore these factors and understand any underlying disparities. Methods: A 21-question paper-based anonymous questionnaire addressing the responder's attitudes, understanding and needs of the electronic medical record (EMR) was used. This was administered to adult patients with lymphoid malignancies and their caregivers at two campuses of Mayo Clinic in Florida (San Pablo and inner-city; Riverside). Categorical and continuous variables between white and minority responders as well as minority responders from the two campuses were compared using the Chi-square test and U Mann Whitney with a significance level of 0.05. Results: The survey was completed by 1004 patients and caregivers. Average time taken to complete the survey was approximately 11 minutes. Of the responders, 716 (71%) were whites and 271 (27%) were minorities, with race-ethnicity not reported by 17 (2%). Among minorities, 30% (n=80) were seen at San Pablo and 64% (n=173) at the Riverside campus, with 6% at a multiple myeloma patient-caregiver symposium. Whites were older (median age 66 vs. 62 years, p&amp;lt;0.001) and had higher education (undergraduate or higher 60% vs. 52%, p=0.023) as compared to minorities. Minority survey responders had lesser access to a computer (84% vs. 92%, p&amp;lt;0.001) or a smartphone (85% vs. 89%, p=0.08). (Figure 1a) Exploring HIT awareness showed that only 51% of minorities were registered to use the EMR as compared to 72% whites (p&amp;lt;0.001) and a lesser number of minorities even knew that they could access their medical records electronically (81% vs. 92%, p&amp;lt;0.001). even among those registered to use the EMR, 13% minorities reported never using the EMR as compared to 4% whites (p&amp;lt;0.001). Encouragingly, a higher willingness to learn about and use the EMR was noted among minorities who were more interested in knowing how to access the EMR (43% vs. 36%, p=0.04), would increase the use of EMR if someone explained how to use it (17% vs. 10%, p=0.002), and if someone explained about test results (14% vs. 6%, p&amp;lt;0.001). (Figure 1b) Comparing minorities among the two campuses, those from the San Pablo campus were older (67.5 yrs. vs. 57 yrs., P&amp;lt;0.001), had higher level of education (undergraduate or higher in 66% vs. 47%, p=0.005) and a higher number had access to a computer (94% vs. 78%, P=0.001) as compared to those from the inner-city Riverside. (Figure 2a) Minorities from the Riverside campus were less likely to be aware of the current HIT EMR (75% vs. 93%, p&amp;lt;0.001), were significantly less likely to have registered for the patient EMR portal (38% vs. 76%, p&amp;lt;0.001) and never used the EMR even if registered for it (22% vs. 7%, p=0.01) as against those from the San Pablo campus. Minorities at the Riverside campus had a higher interest in knowing how to access the EMR (47% vs. 33%, p=0.03). Linguistic barriers were more striking in the inner-city Riverside campus where a higher proportion of minority survey responders noted that it would help if the EMR was in their primary language (66% vs. 48%, p=0.006). (Figure 2b) Conclusions: Minorities continue to struggle with suboptimal utilization of healthcare system including that of HIT. There are barriers related to access, awareness, language and understanding of HIT that prevent the integration and participation of racial-ethnic minorities in the healthcare system to a full extent. It is important to qualify the minorities better, since there exist HIT utilization disparities even within the minorities from different areas representing socioeconomic and demographic differences. Efforts need to be made at several levels to help the minorities overcome educational, access and linguistic barriers so that they can benefit from advancements in the healthcare system. Disclosures Ailawadhi: Celgene: Consultancy; Amgen: Consultancy, Research Funding; Janssen: Consultancy, Research Funding; Pharmacyclics: Research Funding; Cellectar: Research Funding; Takeda: Consultancy. Manochakian:Novocure: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Membership on an entity's Board of Directors or advisory committees; Guardant Health: Membership on an entity's Board of Directors or advisory committees. Chanan-Khan:AbbVie: Research Funding; Xencor: Research Funding; Pharmacyclics: Research Funding; Merck: Research Funding; Jansen: Research Funding; Mayo Clinic: Employment; Ascentage: Research Funding; Millennium: Research Funding.

How do general practitioners access guidelines and utilise electronic medical records to make clinical decisions on antibiotic use? Results from an Australian qualitative study

ObjectiveThis study aimed to explore how general practitioners (GPs) access and use both guidelines and electronic medical records (EMRs) to assist in clinical decision-making when prescribing antibiotics in Australia.DesignThis is...

Agreement between medical records and self-reports: Implications for transgender health research.

A key priority of transgender health research is the evaluation of long-term effects of gender affirmation treatment. Thus, accurate assessment of treatment receipt is critical. The data for this analysis came from an electronic medical records (EMR) based cohort of transgender individuals. A subset of cohort members were also asked to complete a self-administered survey. Information from the EMR was compared with survey responses to assess the extent of agreement regarding transmasculine (TM)/transfeminine (TF) status, hormone therapy receipt, and type of surgery performed. Logistic regression models were used to assess whether participant characteristics were associated with disagreement between data sources. Agreement between EMR and survey-derived information was high regarding TM/TF status (99%) and hormone therapy receipt (97%). Lower agreement was observed for chest reconstruction surgery (72%) and genital reconstruction surgery (84%). Using survey responses as the "gold standard", both chest and genital reconstruction surgeries had high specificity (95 and 93%, respectively), but the corresponding sensitivities were low (49 and 68%, respectively). A lower proportion of TM had concordant results for chest reconstruction surgery (64% versus 79% for TF) while genital reconstruction surgery concordance was lower among TF (79% versus 89% for TM). For both surgery types, agreement was highest among the youngest participants. Our findings offer assurance that EMR-based data appropriately classify cohort participants with respect to their TM/TF status or hormone therapy receipt. However, current EMR data may not capture the complete history of gender affirmation surgeries. This information is useful in future studies of outcomes related to gender affirming therapy.

MedBlock: Efficient and Secure Medical Data Sharing Via Blockchain.

With the development of electronic information technology, electronic medical records (EMRs) have been a common way to store the patients' data in hospitals. They are stored in different hospitals' databases, even for the same patient. Therefore, it is difficult to construct a summarized EMR for one patient from multiple hospital databases due to the security and privacy concerns. Meanwhile, current EMRs systems lack a standard data management and sharing policy, making it difficult for pharmaceutical scientists to develop precise medicines based on data obtained under different policies. To solve the above problems, we proposed a blockchain-based information management system, MedBlock, to handle patients' information. In this scheme, the distributed ledger of MedBlock allows the efficient EMRs access and EMRs retrieval. The improved consensus mechanism achieves consensus of EMRs without large energy consumption and network congestion. In addition, MedBlock also exhibits high information security combining the customized access control protocols and symmetric cryptography. MedBlock can play an important role in the sensitive medical information sharing.

Secondary use of electronic medical records for clinical research: Challenges and Opportunities.

With increasingly ubiquitous electronic medical record (EMR) implementation accelerated by the adoption of the HITECH Act, there is much interest in the secondary use of collected data to improve outcomes and promote personalized medicine. A plethora of research has emerged using EMRs to investigate clinical research questions and assess variations in both treatments and outcomes. However, whether because of genuine complexities of modeling disease physiology or because of practical problems regarding data capture, data accuracy, and data completeness, the state of current EMR research is challenging and gives rise to concerns regarding study accuracy and reproducibility. This work explores challenges in how different experimental design decisions can influence results using a specific example of breast cancer patients undergoing excision and reconstruction surgeries from EMRs in an academic hospital and the Veterans Health Administration (VHA) We discuss emerging strategies that will mitigate these limitations, including data sharing, application of natural language processing, and improved EMR user design.