Electronic Health Record Implementation Research Articles

Electronic health records and data exchange in the WHO European region: A subregional analysis of achievements, challenges, and prospects

Electronic health record (EHR) systems are powerful tools that enhance healthcare quality. They improve efficiency, enable data exchange, and ensure authorized access to patient information. In 2022, the World Health Organization Regional Office for Europe (WHO EURO) conducted a survey to assess the digital health capabilities of the 53 Member States. This article provides a sub-regional analysis of the status of EHR systems and major barriers to their implementation, their readiness for information sharing, and the access and re-use of EHR data.Generally, EHR implementation and national data exchange are at an advanced stage in the region, though achievements and challenges vary across subregions. While more Member States in the Eastern, Western, and Southern Europe subregions reported having centralized national EHR systems, the situation is more diverse in Northern Europe and the Asian subregions, where both centralized and decentralized EHR systems are in use. Significant barriers to EHR implementation, including funding, technical capacity, competing priorities, and lack of interoperability standards are frequently cited, while others like demand, knowledge or acceptance challenges are not reported as significant. Significant barriers were reported the most by the Central Asia subregion, while barriers had least significance in Western Europe. Five out of the six subregions reported a wide adoption of national strategies and have dedicated agencies to ensure interoperability and secure data exchange. However, only 29 Member States have established legal requirements for healthcare providers to adopt EHR systems that conform to national standards for both clinical terminology and electronic messaging, with this being most notable in Western, Eastern, and Northern Europe, and the lowest percentage of Member States in Central Asia. All Member States of the six sub regions have passed privacy and data protection legislation. The use of EHR data is widely regulated, with only five remaining Member States of WHO Europe to develop EHR legislation distributed across subregions (Southern Europe, Western and Central Asia).Looking ahead, Member States are encouraged to define national legislation governing EHR systems and their use, while ensuring the interconnectivity of the local and regional EHR systems. Sustainable funding should be allocated to the development and maintenance of these systems. Efforts should also focus on creating comprehensive roadmaps for the full implementation of health data standards, addressing interoperability at local and regional levels, and developing quality management systems for testing and certification. Additionally, monitoring and evaluation should be conducted to assess whether EHRs are contributing to national health objectives. Finally, engaging patients and intersectoral partners will be key to developing a more patient-centered approach, ensuring that EHR systems meet patient needs and expectations.

Effectiveness of EHR systems on decision support in primary healthcare: a technology acceptance model 3 perspective.

This study aims to evaluate healthcare practitioners' perceptions of electronic health record (EHR) systems and their effectiveness in supporting clinical decision-making in Tanzanian Primary Healthcare (PHC) facilities. A mixed-methods approach was employed, combining quantitative data from structured questionnaires and qualitative insights from open-ended responses. The study was conducted in the Dodoma region of Tanzania, focusing on a diverse representation of PHC facilities, including district hospitals, health centres and dispensaries. Data were analysed using multiple linear regression for quantitative data, and thematic analysis was applied to qualitative responses. The results revealed that while EHR systems are widely used in Tanzanian PHC facilities, their impact on clinical decision-making remains limited. Only a moderate portion of practitioners perceived EHR systems as effective in decision support, and frequent system use was negatively correlated with user satisfaction. Challenges such as inadequate training and support, system crashes, slow performance and poor usability and integration into clinical workflows were significant barriers to effectively utilising EHR systems. This study contributes to the limited literature on EHR system implementation in low-resource settings, specifically Tanzania, by focusing on decision-support features within EHR systems. The findings offer valuable insights for healthcare policymakers, system designers and practitioners to optimise EHR implementation and improve healthcare outcomes in resource-constrained environments.

74 Reducing unplanned extubations in a level 3 neonatal intensive care unit - the nuts and bolts of UE bundle implementation

Abstract Background Unplanned extubations (UEs) are preventable adverse events that may lead to short term consequences (e.g. cardiopulmonary collapse) and long term sequelae (e.g. acquired airway injury, brain injury) for patients admitted to the Neonatal Intensive Care Unit (NICU). UE prevention care bundles have been demonstrated to reduce UE rates in NICUs; however, implementation of bundle elements is unit dependent. Objectives To describe the work of a UE Prevention Team in a Level 3 NICU with rising UE rates despite implementation of UE prevention bundle per Children’s Hospital Solutions for Patient Safety (SPS). Design/Methods A neonatologist / respiratory therapist pair was assembled in March 2022 to tackle rising UE rates in a 69 bed NICU. Contributing unit stressors included implementation of a new electronic health record, COVID-19 policies, and nursing shortages. Baseline UE rates were >3x the centerline for SPS network NICUs and likely underreported. Steps undertaken include: 1) daily audit to ensure reporting of all UEs, 2) structured post-event team debriefs, 3) unit education campaign to raise awareness of UE prevention and bundle elements, 4) prominent posting of last UE date and reporting on daily team huddle, 5) rapid UE case reviews and apparent cause analysis with reporting of findings unit-wide, 6) optimize endotracheal tube (ETT) securement methods, 6) enforce T2-T3 ETT tip position, 7) standardize x-ray frequencies and reporting, 8) trial of daily rounds ETT safety checklist. Results From rapid case reviews, apparent causes were determined to be incorrect ETT securement device sizing, taping method prone to loss of tape integrity in high humidity, high ETT positions, and inadequate ETT monitoring during high risk activities other than repositioning (invasive/painful procedures, diaper changes). Post-event structured debriefs and unit-wide vigilance increased reporting of UE events to 100%. UE rates fell from a peak of >4 UEs/month, >2.4/100 ventilation days to 1 UE/month, 0.465/100 ventilation days, a 80% reduction.(Figure 1) Most impactful interventions were standard x-ray reporting template in the electronic health record, reinforcing T2-T3 ETT tip positioning, correcting ETT holder sizing, and change in ETT method (Figure 2). Daily rounds checklist was not effective. UE reductions were achieved without changing patient ratios as nurse staffing shortages continued. Conclusion A nimble systems approach is needed to ensure success in implementation of UE prevention care bundles. Simple changes can be made to decrease UEs, guided by rapid case reviews.

Does Hospital–Physician Integration Improve Hospital Performance? Results from a USA Longitudinal Study

In a dynamic healthcare industry, aligning the goals and objectives of hospitals and physicians through integration has been suggested to influence performance. Physicians’ leadership and active involvement in governance can direct resource usage, Electronic Health Record (EHR) implementation, price negotiation, better coordination, and continuity of services for patients, thus affecting performance. This study aimed to examine the relationship between physician integration and hospital performance, investigating both financial and quality outcomes. We used a longitudinal study design. Our sample was hospital-level data from 2014 to 2019, which contained 6000 U.S. hospital-year observations. The dependent variables were quality outcomes (readmission rates) and financial outcomes (total and operating margins). The independent variable explored three dimensions of integration: high, low, and overall integration. Findings showed no impact of hospital–physician integration on quality outcomes and financial performance. High-integration hospitals did not show any significant relationships with quality outcomes and financial performance compared to hospitals that did not have high integration. Hospital–physician integration may have little potential to bring clinical integration even though vertical integration is present. A commitment to improving quality as a strategic priority may be vital in impacting quality outcomes, followed by financial performance.

Development and Validation of a Workflow Instrument to Evaluate the Success of Electronic Health Records Implementation from a Nursing Perspective: An Exploratory and Descriptive Study

Introduction Electronic medical records (EMR) have been recognized as practical tools for the improvement of the quality and safety of healthcare despite their occasional use in hospitals worldwide. Epic is an integrated software suite with functionality ranging from patient administration through systems for healthcare providers to billing systems, integration to the primary health sector, and a facility for granting patients access to their data. The implementation process is complicated; creating effective methods requires understanding users’ attitudes about these information technologies. This study aimed to develop and validate a questionnaire that measures the efficacy of using workflow during the EMR (Epic) implementation. Furthermore, it describes the nurses’ views on the use of quality and satisfaction of workflow. Methods Following a literature review, an initial pool of 57 items was generated based on the following three primary constructs: use, quality, and user satisfaction with the tool’s workflow. Internal consistency reliability was assessed by calculating Cronbach’s alpha and correlation coefficients for construct validity. Results The final scale comprised 53 items corresponding to the following five distinct factors: use of workflow, information quality, service quality, use of EMR, and user satisfaction and the influence of workflow on clinical care. The full scale was assessed, and Cronbach’s alpha of 0.95 was found. The construct validity was assessed using the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett’s Test of Sphericity (0.976). Construct validity was tested twice using Exploratory Factor Analysis-Principal Component Analysis. Conclusion The use of workflow, quality of information, quality of service, use of EMR, and user satisfaction scale have good reliability and validity and can be used to implement technology in healthcare.

Role of nurse informaticists in the implementation of Electronic Health Records (EHRs) at resource-limited settings.

Electronic health records (EHRs) play a critical role in the management of patient information and timely decision making in health facilities. In resource-limited settings, especially low- and middle-income countries (LMICs), nurse informaticists play a pivotal role in the implementation of EHRs. This article underscores their multifaceted responsibilities, emphasising critical contributions in vendor selection, system evaluation, workflow analysis, content development, end-user device assessment, training, and post-implementation stability support. By providing nurse informaticists in lower middle-income countries with a clear understanding of their responsibilities and tailored strategies, this article aims to enhance EHR implementation success in these unique contexts.

Women's Health Care Delivery and Coordination After Transitioning From One Electronic Health Record to Another: Perspectives From Staff in the Veterans Health Administration

ObjectivesThe Veterans Health Administration (VA) is transitioning its 1,300 health care facilities from one electronic health record (EHR) to another. The transition aims to improve care delivery and interoperability; however, specific effects on women veterans, who comprise only 7.5% of the patient population, may be obscured without focused evaluation. We aimed to characterize the perspectives of VA staff regarding the impact of transitioning EHRs on women's health care delivery. MethodsWe conducted semistructured interviews with VA staff members involved in delivering or coordinating care for women at three sites that had transitioned EHRs within the past year. Interviews were audio-recorded and transcribed. We used a rapid, templated qualitative analytic approach to identify salient themes in the data. ResultsWe interviewed 16 staff members across VA departments and roles. Although some participants felt the new EHR held promise, most identified challenges with the EHR rollout and implementation (e.g., insufficient training) and the EHR product (e.g., system inefficiencies and latency). Participants highlighted several ways the EHR transition disproportionately affected care delivery for women veterans, including via backlogs of community care referrals, insufficient opportunities for providers to gain proficiency with sex-specific workflows in the new EHR, and outdated listings for veterans who have changed their names. Participants reported that these issues affected their morale and contributed to decreases in productivity and delayed care. ConclusionsMany of our findings reflect challenges that affect VA staff broadly, whereas others may be compounded among women veterans and the VA staff who serve them. To achieve the goal of delivering timely, equitable, high-quality, comprehensive health care services to women veterans, continued efforts to monitor and address the impacts of the EHR transition on this population are needed.

Assessing the Impact of Innovation Processes on Electronic Systems Technology Adoption

Objectives: This study aims to explore the adoption of electronic health records (EHRs) in the Australian private healthcare sector by integrating three prominent innovation models, namely the Technology Acceptance Model (TAM), the Diffusion of Innovation (DOI) model, and the Technology-Organization-Environment (TOE) framework. The objective of the study is to understand how these combined models might better inform the EHR adoption process and identify the key factors influencing successful implementation. Methods/Analysis: An exploratory qualitative research design employing a phenomenological approach was utilized to investigate the research. Data were collected through semi-structured interviews with senior managers at a private hospital in South-East Queensland. Purposive sampling was employed to select participants, ensuring representation from key decision-makers involved in the EHRs planning process. Thematic analysis, guided by the reflexive thematic analysis (RTA) approach of Braun and Clarke, was used to analyze the data and derive insights into the factors influencing EHRs adoption. Findings: Key findings indicate that perceived usefulness and job relevance (from TAM), innovation attributes and communication channels (from DOI), and technological, organizational, and environmental contexts (from TOE) are critical elements for successful EHRs implementation. The study also highlights the importance of user engagement, comprehensive training, leadership support, and financial resources. Novelty/Improvement: This study offers a novel contribution by integrating the TAM, DOI, and TOE models to provide a more holistic understanding of EHRs adoption in the private healthcare sector. It also introduces the concept of time as a critical innovation artefact, highlighting its significance in the adoption process. Doi: 10.28991/ESJ-2024-08-05-02 Full Text: PDF

Optimizing Decision Support Alerts to Reduce Telemetry Duration: A Multicenter Evaluation.

Telemetry monitoring is crucial for high-risk patients but excessive use beyond practice standards increases costs. Prior studies have shown that electronic health record (EHR) alerts reduce low-value telemetry monitoring. However, specific components of these alerts that contribute to effectiveness are unknown. We aimed to revise previously implemented EHR Best Practice Advisories (BPAs) to optimize their effectiveness in reducing telemetry duration. The secondary objective was to assess the impact on clinicians' alert burden. A multicenter retrospective study was conducted at Johns Hopkins Hospital (JHH), Johns Hopkins Bayview Medical Center (JHBMC), and Howard County General Hospital (HCGH). An EHR alert in the form of a BPA was previously implemented at JHH/JHBMC, firing at 24, 48, or 72 hours based on order indication. HCGH used an alert firing every 24 hours. A revised BPA was implemented at all hospitals optimizing the prior JHH/JHBMC alert by including patient-specific telemetry indications, restricting alerts to daytime hours (8:00 a.m.-6:00 p.m.), and embedding the discontinuation order within the BPA alert. A retrospective analysis from October 2018 to December 2021 was performed. The primary outcome was telemetry duration. The secondary outcome was the mean monthly BPA alerts per patient-day. Compared with the original BPA, the revised BPA reduced telemetry duration by a mean of 6.7 hours (95% CI: 5.2-9.1 hours, p < 0.001) at JHH/JHBMC, with a minimal increase of 0.06 mean monthly BPA alerts per patient-day (p < 0.001). The BPA acceptance rate increased from 7.8 to 31.3% postintervention at JHH/JHBMC (p < 0.0001). At HCGH, the intervention led to a mean monthly reduction of 20.2 hours in telemetry duration per hospitalization (95% CI: 19.1-22.8 hours, p < 0.0001). Optimizing EHR BPAs reduces unnecessary telemetry duration without substantially increasing clinician alert burden. This study highlights the importance of tailoring EHR alerts to enhance effectiveness and promote value-based care.

Enhancing nursing home quality through electronic health record implementation.

Background: The quality of care in nursing homes (NHs) in the United States has long been a matter of policy concern. Although electronic health records (EHRs) are argued to improve quality, implementation has lagged due to various factors such as financial constraints and limited research on their impact on NH quality. Objective: This study examined the relationship between EHR implementation and NH quality using Donabedian's structure-process-outcome model. Method: Data on EHR implementation were collected via a 2018 survey of all Federally certified Arkansas NHs (n = 223). Of the 63 responding NHs, 48 reported EHR implementation. Survey data were merged with secondary sources such as Certification and Survey Provider Enhanced Reporting. A total of 744 NH-years for the period 2008-2020 were included in the final sample. A pre-post negative binomial panel data regression was used to examine the relationship between EHR implementation (dichotomous variable) and NH deficiencies (dependent count variable) with facility/community-level control variables. Results were reported as incidence rate ratios (IRR). Results: NHs that had implemented EHR experienced an 18% reduction in the rate of deficiencies compared to those without EHR systems (IRR = 0.82, 95% CI [0.70, 0.99], p = 0.035). Conclusion: EHR implementation had a favourable impact on NH quality. Implications: Past research suggests that higher NH quality may be associated with improved financial performance. Therefore, EHR implementation has the potential to address two critical challenges: enhancing care quality and improving financial outcomes. However, government financial incentives may be necessary to address the high-cost of implementing EHR systems.

Smart FOX - Enabling Citizen-Based Donation of EHR-Standardised Data for Clinical Research in Austria.

Access to healthcare data for secondary use in clinical research is often restricted due to privacy concerns or business interests, hindering comprehensive analysis across patient pathways. The Smart FOX project seeks to address this challenge by developing concepts, methods, and tools to facilitate citizen/patient-driven donations of health data for clinical research. Leveraging the groundwork, laid by the national Electronic Health Record implementation in Austria (called ELGA), Smart FOX aims to harness structured datasets from ELGA for research purposes through an opt-in approach. With funding secured from the Austrian Research Promotion Agency, the project embarks on innovative solutions encompassing governance frameworks, community engagement, and technical infrastructure. The Smart FOX consortium, comprising key stakeholders across various healthcare-associated domains, will evaluate these efforts through demonstrators focusing on clinical registries, patient-generated data, and recruitment services. The project targets to accompany the development of future data donation infrastructure while ultimately advancing clinical research efficiency and bolstering Austria's preparedness for the European Health Data Space. This paper presents the first systematic evaluation of the technical concept and proposal for the federated system architecture of the Austrian Health Data Donation Space, which is the socio-technical goal of Smart FOX.

Assessment of record keeping management in General Hospital, Ikot Abasi, Akwa Ibom State

Introduction: This study examines records management at Ikot Abasi General Hospital. Four specific objectives were established and four research questions were formulated to guide the development of the study. The research focused on current records management practices at the hospital, assessing the existing infrastructure and technology used to maintain these records.Methods: A descriptive survey design with a qualitative approach was used. Data collection was conducted by interviewing a total of 11 participants, which included 2 physicians, 5 nurses, and 4 records managers at Ikot Abasi General Hospital. An interview guide was designed to elicit information on the participants' perspectives on records management practices in the hospital. The data collected were analyzed using thematic analysis.Results: The study revealed a varying level of understanding among respondents about current records management practices, with concerns about accuracy and completeness of documentation. Despite these challenges, evaluation of existing infrastructure and technology showed a positive impact, particularly with the implementation of electronic health record (EHR) systems, which has streamlined processes and reduced reliance on paper documentation.Conclusions: The study identified several challenges faced by healthcare professionals and administrators, including inconsistent documentation practices, lack of adequate storage facilities, limited access to technology and resources, and regulatory compliance issues. It was recommended that healthcare and related organizations implement standardized documentation protocols and provide regular training sessions for healthcare professionals to ensure consistency, accuracy, and completeness in records management. In addition, it was suggested that governments at all levels allocate resources to improve records management infrastructure and invest in modern technological solutions, such as electronic health record (EHR) systems.

Understanding the predictors of health professionals' intention to use electronic health record system: extend and apply UTAUT3 model

BackgroundThe implementation of Electronic Health Record (EHR) systems is a critical challenge, particularly in low-income countries, where behavioral intention plays a crucial role. To address this issue, we conducted a study to extend and apply the Unified Theory of Acceptance and Use of Technology 3 (UTAUT3) model in predicting health professionals' behavioral intention to use EHR systems.MethodsA quantitative research approach was employed among 423 health professionals in Southwest Ethiopia. We assessed the validity of the proposed model through measurement and structural model statistics. Analysis was done using SPSS AMOS version 23. Hypotheses were tested using structural equation modeling (SEM) analysis, and mediation and moderation effects were evaluated. The associations between exogenous and endogenous variables were examined using standardized regression coefficients (β), 95% confidence intervals, and p-values, with a significance level of p-value < 0.05.ResultsThe proposed model outperformed previous UTAUT models, explaining 84.5% (squared multiple correlations (R2) = 0.845) of the variance in behavioral intention to use EHR systems. Personal innovativeness (β = 0.215, p-value < 0.018), performance expectancy (β = 0.245, p-value < 0.001), and attitude (β = 0.611, p-value < 0.001) showed significant associations to use EHR systems. Mediation analysis revealed that performance expectancy, hedonic motivation, and technology anxiety had significant indirect effects on behavioral intention. Furthermore, moderation analysis indicated that gender moderated the association between social influence, personal innovativeness, and behavioral intention.ConclusionThe extended UTAUT3 model accurately predicts health professionals' intention to use EHR systems and provides a valuable framework for understanding technology acceptance in healthcare. We recommend that digital health implementers and concerned bodies consider the comprehensive range of direct, indirect, and moderating effects. By addressing personal innovativeness, performance expectancy, attitude, hedonic motivation, technology anxiety, and the gender-specific impact of social influence, interventions can effectively enhance behavioral intention toward EHR systems. It is crucial to design gender-specific interventions that address the differences in social influence and personal innovativeness between males and females.

Big Bang Implementation of Electronic Health Records in a BSN Prelicensure Program for Documentation Competency.

Only ten percent of nursing schools in the US are currently using EHRs in their curriculum. This is seen to decrease students' effectiveness as new nurses. We began implementation of EHR use in Spring 2024 and have started collecting data as to the effectiveness of this process. This is a starting point using semester 1 junior (J1) students and we plan to have this process follow these students throughout all 4 semesters and assess them in their first year of practice to gain full understanding of the benefits.

Impact of EHRs on Nursing Burnout in a Hospital Setting in Saudi Arabia: Mixed-Methods Study.

This study explores the association between nursing burnout and Electronic Health Record (EHR) use in a Saudi Arabian hospital adopting an advanced EHR system. Utilising a mixed-methods approach, the research combines quantitative analysis of 282 survey responses and qualitative interviews from 21 registered nurses. Despite high EHR acceptance, negative perceptions and stress related to EHR use were identified. Findings indicate a weak link between EHR use and burnout, with resilience acting as a mitigating factor. Specific stressors, including documentation workload and usability issues, were countered by individual and organisational resilience. The study introduces a novel conceptual model emphasising the pivotal role of resilience at both levels in mitigating EHR-related burnout. Recommendations include fostering resilience-building strategies in EHR implementation processes and usability to prevent burnout, emphasising self-care practices, promoting work-life balance, and improving health information infrastructure.

Architectural design of national evidence based medicine information system based on electronic health record.

The global implementation of Electronic Health Records has significantly enhanced the quality of medical care and the overall delivery of public health services. The incorporation of Evidence-Based Medicine offers numerous benefits and enhances the efficacy of decision-making in areas such as prevention, prognosis, diagnosis, and therapeutic approaches. The objective of this paper is to propose an architectural design of an Evidence-Based Medicine information system based on the Electronic Health Record, taking into account the existing and future level of interoperability of health information systems in Greece. A study of the suggested evidence-based medicine architectures found in the existing literature was conducted. Moreover, the interoperability architecture of health information systems in Greece was analyzed. The architecture design reviewed by specialized personnel and their recommendations were incorporated into the final design of the proposed architecture. The proposed integrated architecture of an Evidence-Based Medicine system based on the Electronic Health Record integrates and utilizes citizens' health data while leveraging the existing knowledge available in the literature. Taking into consideration the recently established National Interoperability Framework, which aligns with the European Interoperability Framework, the proposed realistic architectural approach contributes to improving the quality of healthcare provided through the ability to make safe, timely and accurate decisions by physicians.

Blockchain Technology for Integrating Electronic Records of Digital Healthcare System

Background: In most healthcare facilities, the shift from paper-based medical records to electronic health records (EHRs) has taken place. However, there are issues with credibility, management, and secure data storage with the existing EHR systems. In the healthcare industry, interoperability and user control over personal data are also major challenges. Block chain technology has become a potent tool that can provide immutability, security, and user control over records that are saved; yet, its potential usage in EHR systems is still not well understood. Objectives: This research attempts to close this knowledge gap by developing an EHR framework that is built on blockchain technology and is compatible with many national and international EHR standards, including HL7 and HIPAA. Methods: In order to investigate the state of the art in the field of EHRs, including blockchain-based EHR implementations, a systematic literature review is the study approach used. Results: The report analyzes numerous national and international EHR standards, identifies the interoperability needs based on these standards, and outlines the interoperability challenges in the current blockchain-based EHR frameworks. Without the requirement for centralized systems, the suggested framework can give the healthcare industry safer ways to exchange health information while also offering the features of immutability, security, and user control over stored records. Conclusion: This work contributes to the understanding of Blockchain technology's potential application in EHR frameworks and offers an interoperable Blockchain-based EHR framework that can meet the requirements outlined in multiple national and international EHR standards.

Response to "Electronic Health Record Implementation Enhances Financial Performance in High Medicaid Nursing Homes" [Letter

Response to "Electronic Health Record Implementation Enhances Financial Performance in High Medicaid Nursing Homes" [Letter

Development of Electronic Health Record System Functionality through the Creation of a Central Surgery Module

With the advancement of health technology, the use of Electronic Health Records (EHR) systems has become crucial in improving the efficiency and quality of services in various hospital units. However, the adoption of EHR systems is still uneven, especially in developing countries, including Indonesia. At the Pekanbaru Military Hospital, several departments have successfully implemented EHR systems, but the surgical department still uses a paper-based system for medical record keeping. Challenges faced include a lack of infrastructure and technical support. Therefore, the development of a central surgery module within the EHR system at Pekanbaru Military Hospital is necessary to enhance the efficiency and accuracy of medical record-keeping. This study aims to enhance the functionality of the EHR system in managing medical records in the surgical department by developing a central surgery module at the Pekanbaru Military Hospital. The software development methodology used in this study is the Agile model, which includes user requirements analysis, data collection, system implementation, as well as evaluation and validation. The Central Surgery Module that has been developed includes various features such as patient registration for surgery, recording of pre-operative, intra-operative, and post-operative patient data, surgical reports, and integration with laboratory and radiology systems. Through testing conducted using the black box testing technique, the results showed that 93.48% of the system functionality worked well, and using the User Acceptance Testing technique, it was found that 92.5% of the system functionality was acceptable to users.

Implementing Adult Hepatitis B Immunization and Screening Using Electronic Health Records: A Practical Guide.

Hepatitis B is a serious problem in the United States (US), with up to 2.4 million Americans living with a chronic infection. Only 26-32% of people living with hepatitis B in the US are diagnosed. Additionally, just 30% of all adults are vaccinated against the virus. In 2022, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) updated adult hepatitis B vaccination recommendations to include all adults aged 19-59 years and those 60 years and older with risk factors for hepatitis B. Subsequently, in 2023, the CDC recommended that all adults be screened at least one time in their lives. Electronic health record (EHR) tools (prompts, order sets, etc.) have proven to be an effective method of increasing hepatitis B screening and vaccination, but longstanding challenges and questions around hepatitis B vaccines and tests could prevent effectual EHR implementation. As the new recommendations directly impact providers who may have limited familiarity with hepatitis B, guidance on how to identify eligible patients and triggers, order sets to facilitate vaccine/test selection, and proper documentation and patient follow-up is necessary. This communication offers a practical framework for health systems to build an effective EHR strategy for the updated adult hepatitis B recommendations. We also provide comprehensive responses to clinicians' questions that are frequently asked prior to screening or vaccinating for hepatitis B.