Development Of Electronic Medical Record Research Articles

Standardizing visual display of gastrointestinal pathology results for improved clinical interpretation.

Pathology is an essential component of disease diagnosis and management in pediatric gastroenterology. Pathology reports have not been standardized in some areas of pediatric gastrointestinal pathology and pathology reporting varies. Development of electronic medical record (EMR) pathology synoptic report templates (PSRT) enables pathology data collection in a specific format and can help standardize pathology reporting. We developed, implemented, and evaluated EMR PSRTs for eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD). PSRTs were developed by a multidisciplinary team of pediatric experts of allergy, gastroenterology, and pathology for both EoE and IBD based on available literature and validated scales. Likert surveys (range 1 low acceptance to 5 high acceptance) based on the Technology Acceptance Model assessed user acceptance of the developed PSRTs. The use of PSRTs was monitored via control charts. Overall, evaluation questionnaires achieved >80% response rates. Clinicians and pathologists reported moderate-to-high levels of Perceived Usefulness (median [interquartile range) for EoE PSRT: clinicians 4.0 (4.0, 5.0) and pathologists 3.5 (3.5, 4.0); and IBD PSRT: clinicians 4.0 (3.0, 4.0) and pathologists 4.0 (4.0, 5.0)) and Perceived Ease of Use (EoE PSRT: clinicians 4.5 (4.0, 5.0) and pathologists 4.0 (4.0, 4.0); and IBD PSRT: clinicians 4.0 (4.0, 5.0) and pathologists 4.0 (4.0, 5.0)) of the developed PSRTs. Control charts demonstrated 100% utilization by 2-5 months from launch. We demonstrate successful implementation of synoptic reporting for both pediatric EoE and IBD pathology. EMR synoptic reporting provides standardization of pathology reporting and improved methods of pathology data presentation, which could potentially optimize provider efficiency, clinician interpretation of pathology results and disease trajectory, patient care, and clinician satisfaction.

Literature Review: Development of Electronic Medical Records In Hospital Management Information Systems

Introduction: Health technology today is developing very quickly from the initially conventional using paper to being computerized. This literature review aims to map and critically summarize the scientific evidence on the cost-effectiveness and acceptability of Computerized Physician Order Entry (CPOE) and Electronic Health Reports. This Journal have Question that need to be answered how does the development of CPOE in medical records affect cost-effectiveness improvement so that it can be accepted by many parties? Method used in this journal is literature review is conducted on journal articles related to costs and receipts in CPOE. The systematic search was conducted from 5 databases namely PubMed, Science Direct, ProQuest, DOAJ and Ebscohost. Journal articles are selected and selected following PRISMA guidelines. Twenty-five journal articles qualified based on predetermined criteria. At the end as result, Cost-effectiveness with CPOE is more likely to be found that it is easier to reach compared to conventional methods. In addition, the acceptance of patients and health workers is also high. These factors can have a positive or negative influence on the hospital management system because developing countries still need adequate resources so that they can run these methods. Discussion and conclusion CPOE systems can improve patient safety by detecting drug interactions and actions. It is necessary to develop medical records in order to provide effective financing and acceptance.

Exploring the Impact of Health Insurance on Health Care Utilization and Outcome Using Electronic Medical Record Data

ABSTRACTObjectiveWith tremendous potential for research and policy use, the development of Electronic Medical Record (EMR) is unprecedentedly growing in China. The rich clinical and financial data in the Chinese EMR provides us a unique chance to examine the impacts of health insurance on health care utilization and outcomes, controlling for patient’s disease severity. ApproachesOur study population included patients with cirrhosis or primary liver cancer (PLC), from a large teaching hospital in Beijing. The comorbidity and disease severity variables were defined using EMR automated extraction methods that were validated in previous study. Health insurance was measured by actual reimbursement ratio (RR), which better captures patients’ actual financial burden than type of health insurance. Generalized linear regression model was used to analyze the impacts of health insurance coverage on total hospital expense, ratio of medication cost to total expense, and number of major procedures (i.e., transcatheter arterial chemoembolization, TACE) for cirrhosis. Logistic regression was used to assess the impact of health insurance on hospital mortality and the rate of TACE. We employed a wide range of risk factors in our models to adjust for disease severity and comorbidities, including Charlson comorbidities, MELD-Na score, and etiological factors of liver diseases.ResultsIn total, 5,465 cirrhosis patients and 3,357 PLC patients were included in the study. Among the PLC patients we identified 534 patients underwent TACE. After adjusted for comorbidities, disease severity and other confounders, RR was found to be associated with hospital mortality with odds ratio 3.2 in cirrhosis patients and 6.0 in PLC patients. Higher RR was correlated to lower total hospital cost (logarithm transferred coefficient -0.08 in cirrhosis patients and -0.15 in PLC patients) but related to higher ratio of medication cost (logarithm transferred coefficient 0.09 in both cirrhosis and PLC patients). Additionally, higher RR was associated with higher rate (odds ratio 1.6 in PLC patients) and also more times of TACE (logarithm transferred coefficient 0.31 in TACE patients). The results were consistent between cirrhosis patients and PLC patients.ConclusionThis study provided evidences that physicians’ behavior was influenced by health insurance. Patients with more generous health insurance coverage (higher RR) were found to have relatively lower total hospital cost but higher ratio of medication cost, higher rate and more times of TACE, and were more prone to die in hospital. These are evidences for physician’s gaming reacting to the economic incentives of the payment systems in China.

A Three-Phase Decision Model of Computer-Aided Coding for the Iranian Classification of Health Interventions (IRCHI).

Introduction:Accurate coded data in the healthcare are critical. Computer-Assisted Coding (CAC) is an effective tool to improve clinical coding in particular when a new classification will be developed and implemented. But determine the appropriate method for development need to consider the specifications of existing CAC systems, requirements for each type, our infrastructure and also, the classification scheme.Aim:The aim of the study was the development of a decision model for determining accurate code of each medical intervention in Iranian Classification of Health Interventions (IRCHI) that can be implemented as a suitable CAC system.Methods:first, a sample of existing CAC systems was reviewed. Then feasibility of each one of CAC types was examined with regard to their prerequisites for their implementation. The next step, proper model was proposed according to the structure of the classification scheme and was implemented as an interactive system.Results:There is a significant relationship between the level of assistance of a CAC system and integration of it with electronic medical documents. Implementation of fully automated CAC systems is impossible due to immature development of electronic medical record and problems in using language for medical documenting. So, a model was proposed to develop semi-automated CAC system based on hierarchical relationships between entities in the classification scheme and also the logic of decision making to specify the characters of code step by step through a web-based interactive user interface for CAC. It was composed of three phases to select Target, Action and Means respectively for an intervention.Conclusion:The proposed model was suitable the current status of clinical documentation and coding in Iran and also, the structure of new classification scheme. Our results show it was practical. However, the model needs to be evaluated in the next stage of the research.

Adherence to Clostridium difficile Infection Treatment Guidelines at a Tertiary Care Hospital: A Retrospective Chart Review

Morbidity secondary to Clostridium difficile infection (CDI) places a burden on the health care system. Updated practice guidelines for CDI have been published by the Infectious Diseases Society of America in 2010, with a supplement published in 2013 by the American College of Gastroenterology on recommendations for diagnosis, management, and prevention of CDI. Both guidelines identify a scoring system to calculate the severity of CDI, with recommended antibiotic choices based on CDI severity. The aim of this study was to evaluate the adherence to guidelines for the management of severe CDI in hospitalized patients at an academic medical center. A retrospective chart review on hospitalized patients fulfilling criteria for severe CDI was completed from 2011 to 2014. Inclusion criteria were positive C difficile toxin A or B enzyme immunoassay or C difficile toxin polymerase chain reaction, albumin <3 g/dL, and white blood cell count ≥15,000 cells/μL. Age, sex, timing of diagnosis, method of diagnosis, previous CDI, antibiotic use at time of diagnosis or within the previous 4 weeks, hospitalization within the past 6 months, labs (including serum albumin, white blood cells, lactate, creatinine), vitals, hospital location (floor vs intensive care unit), hospital service (medicine, surgery, nonteaching service), presence of ileus, time to initiate antibiotics, antibiotic choice, and time to specialty consult (gastrointestinal, infectious diseases, and colorectal surgery) were also collected. A total of 178 patients met inclusion criteria. Mean age was 64 years, with equal numbers of male and female patients (48.9% and 51.1%). The majority (56%) of patients developed CDI >72 hours from admission, with the remainder on admission (23%) and <72 hours from admission (21%). Fifty-three percent (94 of 178) of patients were not started on the appropriate antibiotic regimen for the treatment of severe CDI at the time of diagnosis. Of those patients with severe CDI on the medicine housestaff service, 49% were not started on appropriate antibiotics at the time of diagnosis, compared with 53% on the nonteaching service, and 58% on the surgery housestaff service. Hospital service was not a significant predictor of appropriate antibiotic selection (P = .59). Sixty percent of patients with severe CDI hospitalized on a non−intensive care unit floor were not started on the appropriate antibiotic regimen at the time of diagnosis, compared with 41% in the intensive care unit. Hospital location was a significant predictor of appropriate antibiotic selection (P = .02). Our data indicate a need for better recognition and management of patients with severe CDI. In an effort to improve outcomes, we have developed hospital-based guidelines that represent a fusion of the American College of Gastroenterology/Infectious Diseases Society of America guidelines, including age ≥60 years as a risk factor, and removing oral vancomycin pharmacy restriction within our institution. Implementation of an educational program on the appropriate treatment of severe CDI is also underway, with development of electronic medical record alerts to identify patients at risk for severe CDI.

MODEL-DRIVEN DEVELOPMENT : FASE AWAL VERIFIKASI MODEL DESIGN REKAM MEDIS ELEKTRONIS MENGGUNAKAN PERUMUSAN GRAF LENGKAP

In this paper will be shown a graph formulation as a formal approaches in research Model-Driven Development (MDD) with a case study : the development of Electronic Medical Record (RME) on the scope of the public health center. The model was designed using UML notation and be selected a State Machine diagram that represents prerequisite user needs (requirements). Before the model is derived (driven) into the skeleton code, the accuracy of the state machine must be verified. In order for the State Machine can be verified by formal approach, the State Machine should be first transformed into a propositional formula using the complete graph approach, and partial models. The initial phase of verification will check the suitability of the model with the requirements in Propositional Normal Form (PNF) using SAT Solver, respectively as and . SAT solver will provide a design decision, whether a requirement represented in the model or not. If these requirements are not hold in the model, the requirement is not certainty (uncertain) and model must be redesigned.

Developing a fully integrated medical transport record to support comparative effectiveness research for patients undergoing medical transport.

The consolidation of health care systems to develop centers of clinical excellence has led to an increased reliance on medical transport to move patients requiring time-sensitive interventions and specialized treatments. There is a paucity of outcomes data, specifically comparative effectiveness research, related to the efficacy of different transport services and the overall morbidity and mortality of patients that undergo medical transfer. The rapid development of electronic medical record (EMR) use has also occurred with transport charting. However, limited studies have incorporated transport chart data in outcomes analyses. We have begun development of a fully integrated medical transport record, combining transport and hospitals EMRs, to support research efforts and develop clinical decision support tools for transported patients. In this paper, we describe the elements necessary to develop a fully integrated medical transport EMR to support the conduct of comparative effectiveness research, outline the current limitations and challenges, and provide insight into the future direction in developing clinical decision support tools for patients requiring transport.

Problems Existing in the Use of Electronic Medical Record and Countermeasures

The application of an electronic medical record system is an inevitable trend in the development of hospital information construction. Its application relieves the workload of medical workers and improves the working efficiency to a certain extent. Since the hospital carried out the electronic medical record system in 2010, factors of uncompleted management, nonstandard medical behavior and imperfect information construction, and so on in the work practice gradually expose problems in the application process of electronic medical record. The hospital and its departments should successively promote the application progress of electronic medical records and strengthen the quality control and monitoring; physicians should enhance personal accomplishment and standardize medical behaviour; at the same time, the system flow set is perfected, information concordance is optimized, and the development of electronic medical record is gradually pushed forward so as to have better clinical service.

Clinical Workflow and Work System Assessment of Private Clinics in Hong Kong and Implications for Electronic Medical Record Development

The objective of this study is to perform a pre-implementation assessment of workflows in private primary care clinics in Hong Kong. Data were collected through direct observations and in-depth semi-structured interviews from December 2009 to March 2010. Seventeen health care providers (5 physicians and 12 clinical assistants) of five local private primary care clinics participated in this study. Our findings 1) illustrate the work and information flow and step-by-step details of clinical work processes and 2) reveal gaps and weaknesses in the current clinical work system for possible application of an electronic medical records (EMR) sharing system. This preliminary EMR pre-implementation study demonstrates the inadequacy of the current work system and work processes and indicates the improvement opportunities offered by information technologies.

Development of Electronic Medical Record: EMR for Clinic and Proposes New Patient Service

Development of Electronic Medical Record: EMR for Clinic and Proposes New Patient Service

Development of electronic medical record charting for hospital-based transfusion and apheresis medicine services: Early adoption perspectives

Background: Electronic medical records (EMRs) provide universal access to health care information across multidisciplinary lines. In pathology departments, transfusion and apheresis medicine services (TAMS) involved in direct patient care activities produce data and documentation that typically do not enter the EMR. Taking advantage of our institution′s initiative for implementation of a paperless medical record, our TAMS division set out to develop an electronic charting (e-charting) strategy within the EMR. Methods: A focus group of our hospital′s transfusion committee consisting of transfusion medicine specialists, pathologists, residents, nurses, hemapheresis specialists, and information technologists was constituted and charged with the project. The group met periodically to implement e-charting TAMS workflow and produced electronic documents within the EMR (Cerner Millenium) for various service line functions. Results: The interdisciplinary working group developed and implemented electronic versions of various paper-based clinical documentation used by these services. All electronic notes collectively gather and reside within a unique Transfusion Medicine Folder tab in the EMR, available to staff with access to patient charts. E-charting eliminated illegible handwritten notes, resulted in more consistent clinical documentation among staff, and provided greater real-time review/access of hemotherapy practices. No major impediments to workflow or inefficiencies have been encountered. However, minor updates and corrections to documents as well as select work re-designs were required for optimal use of e-charting by these services. Conclusion: Documentation of pathology subspecialty activities such as TAMS can be successfully incorporated into the EMR. E-charting by staff enhances communication and helps promote standardized documentation of patient care within and across service lines. Well-constructed electronic documents in the EMR may also enhance data mining, quality improvement, and biovigilance monitoring activities.

The limited use of digital ink in the private-sector primary care physician's office.

Two of the greatest obstacles to the implementation of the standardized electronic medical record are physician and staff acceptance and the development of a complete standardized medical vocabulary. Physicians have found the familiar desktop computer environment cumbersome in the examination room and the coding and hierarchic structure of existing vocabulary inadequate. The author recommends the use of digital ink, the graphic form of the pen computer, in telephone messaging and as a supplement in the examination room encounter note. A key concept in this paper is that the development of a standard electronic medical record cannot occur without the thorough evaluation of the office environment and physicians' concerns. This approach reveals a role for digital ink in telephone messaging and as a supplement to the encounter note. It is hoped that the utilization of digital ink will foster greater physician participation in the development of the electronic medical record.