Electronic Medical Information System Research Articles

Emergency Medical Access Control System Based on Public Blockchain

IT has made significant progress in various fields over the past few years, with many industries transitioning from paper-based to electronic media. However, sharing electronic medical records remains a long-term challenge, particularly when patients are in emergency situations, making it difficult to access and control their medical information. Previous studies have proposed permissioned blockchains with limited participants or mechanisms that allow emergency medical information sharing to pre-designated participants. However, permissioned blockchains require prior participation by medical institutions, and limiting sharing entities restricts the number of potential partners. This means that sharing medical information with local emergency doctors becomes impossible if a patient is unconscious and far away from home, such as when traveling abroad. To tackle this challenge, we propose an emergency access control system for a global electronic medical information system that can be shared using a public blockchain, allowing anyone to participate. Our proposed system assumes that the patient wears a pendant with tamper-proof and biometric authentication capabilities. In the event of unconsciousness, emergency doctors can perform biometrics on behalf of the patient, allowing the family doctor to share health records with the emergency doctor through a secure channel that uses the Diffie-Hellman (DH) key exchange protocol. The pendant’s biometric authentication function prevents unauthorized use if it is stolen, and we have tested the blockchain’s fee for using the public blockchain, demonstrating that the proposed system is practical.

Early Cholecystectomy after Endoscopic Retrograde Cholangiopancreatography Is Feasible and Safe.

Laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) is the preferred treatment for cholelithiasis with common bile duct stones. However, the optimal timing of LC after ERCP remains controversial. This study aimed to identify the ideal time interval between ERCP and LC. Data from patients who underwent LC after ERCP between November 2016 and August 2022 were retrieved from the electronic medical information system. The patients were categorized into early cholecystectomy (within 72 h of ERCP) and delayed cholecystectomy (after 72 h). The impact of the time interval between ERCP and LC on perioperative outcomes was analyzed. A total of 197 patients were included in the study, with 45 undergoing early cholecystectomy and 152 undergoing delayed cholecystectomy. No significant differences in the preoperative characteristics or operative morbidity were observed between the groups (p = 0.286). However, a significant correlation was found between the time interval from ERCP to LC and the total length of stay (r = -350, p < 0.001). The findings suggest that early cholecystectomy after ERCP is feasible and safe, and performing LC within the first 72 h does not adversely affect postoperative outcomes.

Joint B Vitamin Intake and Type 2 Diabetes Risk: The Mediating Role of Inflammation in a Prospective Shanghai Cohort.

Type 2 diabetes (T2D) is a global and complex public health challenge, and dietary management is acknowledged as critical in its prevention. Recent studies have highlighted the involvement of micronutrients in T2D pathophysiology; our study aims to assess the association between B vitamin intake and T2D risks and the mediating role of inflammation. In a prospective cohort design, data on B vitamins intake, including thiamine (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), folate (B9), and cobalamin (B12), was obtained using a validated food frequency questionnaire (FFQ), and blood inflammatory biomarkers were analyzed according to standard protocol in the local hospitals at baseline from 44,960 adults in the Shanghai Suburban Adult Cohort and Biobank (SSACB). Incident T2D cases were identified according to a physician's diagnosis or medication records from the electronic medical information system. We employed logistic and weighted quantile sum regression models to explore the associations of single and combined levels of B vitamins with T2D and mediation analyses to investigate the effects of inflammation. Negative correlations between B vitamins and T2D were observed in the single-exposure models, except for B3. The analyses of joint exposure (B1, B2, B6, B9, and B12) also showed an inverse association (OR 0.80, 95% CI 0.71 to 0.88), with vitamin B6 accounting for 45.58% of the effects. Further mediation analysis indicated a mediating inflammatory impact, accounting for 6.72% of the relationship. Dietary intake of B vitamins (B1, B2, B6, B9, B12) was associated with a reduced T2D risk partially mediated by inflammation in Shanghai residents.

Electronic medical information systems and timeliness of care in the emergency department: a scoping review

BackgroundAlthough many emergency department (ED) settings have implemented an electronic medical information system (EMIS) and EMIS tools in an effort to improve timeliness of care outcomes, there remains a paucity of scientific information on this topic. We therefore performed a scoping review to describe the range of EMIS interventions and their impacts on time-based outcomes in the ED.MethodsWe searched four bibliographic databases to identify potentially relevant records published after 2014 in English. Two reviewers assessed records for eligibility using a two-step screening process. We then extracted data on the type of EMIS, outcomes assessed, and reported results. Findings were summarized in tabular form and grouped by time-based outcome.ResultsTwenty-five studies met the eligibility criteria, with approximately half being retrospective studies. Interventions varied among studies; they generally included a new or updated EMIS, EMIS tools related to disease diagnosis and/or management, triage tools, or health information exchange platforms. Included studies compared interventions with relevant comparator groups, such as prior versions of an EMIS, absence of an EMIS, pen-and-paper documentation, and/or communication via telephone and fax. The most common outcomes reported were length of stay (n = 17 studies) and time to medication (n = 6 studies), followed by time to order, time to provider, and time from result to disposition. Reported effects of the interventions were generally inconsistent, showing either improvements, delays, or no change in examined outcomes.ConclusionsAdditional research is needed to determine how electronic medical information may be used in the ED to improve timeliness of care. Findings from this review can be used to inform future systematic reviews that evaluate the impact of these systems and tools on specific quality of care measures.

Digital health and cardiovascular healthcare professionals in Portugal: Current status, expectations and barriers to implementation

Introduction and ObjectivesDigital health (DH) is a broad concept, bringing together technology and healthcare, that is playing an increasingly important role in the daily routine of healthcare professionals (HCPs) and promises to contribute to the prevention and treatment of cardiovascular disease. There are no solid data on the position of Portuguese HCPs toward the implementation of DH in cardiovascular medicine. This national cross-sectional study aims to provide a snapshot of DH implementation in Portuguese cardiovascular HCP routines and to identify both expectations and barriers to its adoption. MethodsAn 18-question survey was created specifically for this study and distributed to 1174 individuals on the Portuguese Society of Cardiology mailing list. ResultsWe collected 117 valid responses (response rate 10%). Almost all participants had smartphones and laptops, and two-thirds had tablets. Electronic medical information systems were the most used DH tool (84% of respondents) and were considered the most important for improving cardiovascular care. Implantable technologies (sensors and devices), telemedicine and social media were used by more than two out of three respondents and considered «very important» or «extremely important» by most of them. Most participants showed positive expectations regarding the impact of DH in cardiovascular medicine: 78% agreed that DH could improve health outcomes, 64% that it promotes health literacy and 63% that it could decrease healthcare costs. The top-rated barriers were patients’ inability to use smartphones, limited access to electronic devices, and lack of legal regulation of DH. ConclusionMost Portuguese cardiovascular HCPs had at least three electronic devices (mainly smartphones, laptops and tablets) and showed positive expectations regarding DH's current and future impact on cardiovascular medicine. Patient DH literacy, technology adoption, and DH regulation were identified as the most important barriers to increasing the adoption of DH tools in cardiovascular medicine.

Electronic health records in nursing from 2000 to 2020: A bibliometric analysis.

Electronic health records (EHR) is the longitudinal data generated by patients in medical institutions and recorded by electronic medical information systems in the form of digital, which is also the most widespread application of big data in medicine. The purpose of this study was to explore the application of electronic health records in the field of nursing and determine the current research status and hotspots. A bibliometric analysis of electronic health records in nursing was undertaken from 2000 to 2020. The literature comes from Web of Science Core Collection database. We used CiteSpace (version 5.7 R5; Drexel University), which is a Java-based software that especially visualized collaborative networks and research topics. A total of 2616 publications were included in the study. We found that publications increased year by year. The Journal of American Medical Informatics Association (n = 921) is the most cited. The United States (n = 1,738) has the most publications in this field. University Penn (n = 63) is the institution with the most publications. There is no influential cooperation network among the authors, of which Bates, David W (n = 12) have the largest number of publications. The relevant publications also focus on the fields of health care science and services, and medical informatics. In keywords, EHR, long-term care, mobile application, inpatient falls, and advance care planning has been researching hotspots in recent years. With the popularization of information systems, the publications of EHR in the nursing field have increased year by year. This study provides the basic structure, potential cooperation, and research trends of EHR in the field of nursing from 2000 to 2020, and provides a reference for nurses to effectively use EHR to help clinical work or scientific researchers explore the potential significances of EHR.

Antipsychotic prescription patterns and associated factors among the elderly with psychiatric illnesses.

Prescribing rate of antipsychotics in elderly patients with psychiatric illnesses has been increasing all over the world. However, there is a lack of research examining the use of antipsychotics at psychiatric hospitals. We aim to find out long-term trends in antipsychotic prescriptions and factors associated with the use of antipsychotics in the elderly population. All outpatient visits with patients aged over 65 years between 2006 and 2015 in a psychiatric hospital were included in the analysis. Demographic and clinical data, including patient age, sex, National Health Insurance status, psychiatric diagnosis and antipsychotic prescription, were retrieved through the electronic medical information system. In this study, we found that prescribing rate of antipsychotics has increased around 5.07% through the study period (from 57.25% in 2006 to 60.15% in 2015, P < 0.001). Among all antipsychotics, there was an increase in the use of second-generation antipsychotics with a simultaneous decline in the use of first-generation antipsychotics. Logistic regression analysis showed advanced age, female gender and certification for catastrophic illnesses were positively associated with the use of antipsychotics. Furthermore, patients most likely to be prescribed an antipsychotic were those with psychotic disorders, followed by dementia, and then affective or neurotic disorders. The results of this study were consistent with the worldwide trend of increasing prescriptions of second-generation antipsychotics among elderly patients with psychiatric illnesses. Despite the potential benefits of these medications on certain psychiatric symptoms, clinicians need to exercise due caution as they may also cause potentially serious side effects among the elderly population.

Efficient Electronic Patient Information Hiding Scheme With Tamper Detection Function for Medical Images

With the rapid development of the electronic medical information systems and Internet technology, the frequency of electronic medical records (EMRs) and electronic patient information (EPIs) transmitted over the Internet and shared among authorized medical parties is gradually increased. Reversible data hiding in medical images is an efficient technique to embed an EPI or EMR into a medical image, such as X-ray, MRI etc. In this paper, a reversible data hiding scheme by using enhanced neighbor mean interpolation (ENMI) technology is proposed to expand each <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$2 \times 2$ </tex-math></inline-formula> block in the original image to a <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$3\times 3$ </tex-math></inline-formula> block. The four original pixels remaining at the four corners in each expanded block. Five derived pixels by using the ENMI interpolation algorithm are used to carry 4-bits secret data and a 1-bit authentication code with our proposed efficient data hiding strategy. Experimental results confirm that the detection performance and the robustness of the hidden data with our proposed scheme are significantly higher than that of the Geeth & Geeth scheme and other six representative schemes.

A Comparative Cross-Sectional Study to compare the Isolated Organism and their Antibiotic Sensitivity Pattern Between Community-Acquired Pneumonia (CAP) and Ventilator-Associated Pneumonia (VAP) in Intensive Care Unit (ICU).

Background: The moment most common cause of in-hospital infection is pneumonia. Pneumonia is prevalent within the ICU (Intensive Care Unit) setting and can be deadly. The Incidence of pneumonia is approximately 17% in the therapeutic ICU2 but can be 6 to 20 times increased in mechanically ventilated patients. The duration of hospital stay and expenditure are both expanded in patients who develop ventilator-associated pneumonia. This study aims to identify the causative microorganism responsible for CAP (Community-Acquired Pneumonia) and VAP (Ventilator-Associated Pneumonia) and their antibiotic sensitivity pattern. Methods: This was a comparative cross-sectional study that was carried out at two ICU in Sylhet city. The data was collected from the patient's medical information, the patient's file, and the hospital information system. Culture and sensitivity (C/S) were collected from the electronic medical information system (MIS). All data from January 2019 to December 2020, including patient's information, course of the disease (in terms of death or recovery-if available), clinical features, and investigation reports, was transferred to an electronic data collection sheet (Microsoft Excel). After completion of all data collection, analysis was conducted through a spreadsheet. Comparison between two disease groups was made by independent t-test. Within the group, the analysis was done by the Chi-Square test. Results: In this thesis study, it was found that the most common organism responsible for CAP was Streptococcus spp. (34.70%) and is sensitive to Meropenem (92.21%), Imipenem (88.16%), Amikacin (70.67%), Piperacillin (70.91%), Moxifloxacin (70.96%), Levofloxacin (67.95%), Amoxiclav (67.92%), and Ceftriaxone(63.95%). The most common causative organism responsible for VAP was Staphylococcus spp. (36.51%) and it was sensitive to Imipenem (100%), Moxifloxacin (100%), Meropenem (94.73%), Amikacin (85.71%), Ceftriaxone (60%), Amoxiclav (66.66%), Levofloxacin (57.14%), and Cefuroxime (50%). Conclusion: Pneumonia is still one of the most common reasons for hospitalization, particularly for those admitted to ICU. It has been observed in several studies that the majority of the cases are communityacquired pneumonia. Many mechanically ventilated patients often develop VAP, which is fatal if timely diagnosis and appropriate antibiotics administration are not made. Streptococcus spp. was the most common organism responsible for CAP, and Staphylococcus spp. mainly was responsible for VAP.

Human Right to Internet Access in Healthcare in the “Right to Health Concept”: Legal Issues

This work reveals the features of the administrative and legal regulation of the human right to access the Internet in the “concept of the right to health”. It is emphasized that the basis of the legal regulation of the human right to access the Internet in the "concept of the right to health" should be the recognition of the principles of the priority of human rights and freedoms, adequate state control, ensuring the choice of criteria that make it possible to realize accessibility, anonymity, and minimize the collection and processing of personal data about the patient. The structure of Internet relations in relation to the healthcare sector has been established, their analysis has been carried out, their object has been established. Legal constructions have been formulated: "information", "Internet" in the norms of international and national regulatory legal acts, as well as the terms "e-Health", "electronic cabinet", "electronic medical information system", the author's definition of "the right to access the Internet in the field of health care ". It has been established that the human rights to access the Internet in the “concept of the right to health” should be attributed to the fourth generation of human rights. The concept of "telemedicine" is formulated, their forms are disclosed, the stages of the evolution of legislation are established, and the problems of their legal regulation in the context of human rights are indicated. It is concluded that the consolidation of the right to access the Internet at the level of the Constitution of Ukraine is a necessity.

Security Privacy and Policy for Cryptographic Based Electronic Medical Information System.

With the development of the internet, applications have become complicated, and the relevant technology has diversified. Compared with medical applications, the significance of information technology has been expanding to include clinical auxiliary functions of medical information. This includes electronic medical records, electronic prescriptions, medical information systems, etc. Although research on the data processing structure and format of various related systems is becoming mature, the integration is insufficient. An integrated medical information system with security policy and privacy protection, which combines e-patient records, e-prescriptions, modified smart cards, and fingerprint identification systems, and applies proxy signature and group signature, is proposed in this study. This system effectively applies and saves medical resources—satisfying the mobility of medical records, presenting the function, and security of medicine collection, and avoiding medical conflicts and profiteering to further acquire the maximum effectiveness with the least resources. In this way, this medical information system may be developed into a comprehensive function that eliminates the transmission of manual documents and maintains the safety of patient medical information. It can improve the quality of medical care and indispensable infrastructure for medical management.

Prescription patterns and trends of anxiolytics and hypnotics/sedatives among child and adolescent patients with psychiatric illnesses in a psychiatric center of northern Taiwan

Background: The prevalence of prescriptions of anxiolytics and hypnotics/sedatives for child and adolescent patients with psychiatric illnesses is increasing over the world. No studies exist to focus on the prescription trends and patterns of anxiolytics and hypnotics/sedatives for child and adolescent patients in psychiatric hospitals of Taiwan. Methods: In this retrospective study for all outpatients who were equal or younger than 18 years of age in a psychiatric service, we collected related study variables from the study psychiatric services from 2006 to 2015. Reviewing the electronic medical information system, we extracted both patients' demographic or clinical data (such as sex, age, as well as psychiatric diagnoses), and prescriptions of anxiolytics and hynotics/sedatives. Results: During the study period, the proportion of patients received anxiolytics and hypnotics/sedatives was decreased significantly (from 9.16% in 2006 to 5.85% in 2015, p < 0.001). The proportion of patients received anxiolytics was significantly decreased (from 5.34% in 2006 to 4.54% in 2015, p > 0.05), while hypnotics/sedatives was also decreased significantly (from 5.35% to 2.27%, p < 0.001). Logistic regression analysis showed that the use of anxiolytics and hypnotics/sedatives was significantly associated with age (p < 0.001), gender (p < 0.001), patients' status of catastrophic illnesses (p < 0.001), and diseases (p < 0.001). Conclusion: Anxiolytics and hypnotics/sedatives have the rôles in the treatment of child and adolescent patients with psychiatric Illnesses. Clinicians should be aware of the adverse events of these medications and prescribe them carefully for this population. Certainly, we need more well-designed clinical studies to study the safety and efficacy of anxiolytics and hypnotics/sedatives medications for children and adolescents.

Modern forensic medical electronic information systems within the framework of medical reform

The purpose of the work. The introduction of modern forensic electronic medical information systems into the work of the forensic medical service as part of the medical reform in Ukraine.Material and methods. Studied domestic experience in the use of electronic information systems in the work of the forensic medical service on literary sources and personal experience in this direction is worked out. Applied analysis and synthesis, correlation and comparison of the studied phenomena.Results. Proposed modern approaches to address issues of effective forensic work, both in determining the causes of the death of a violent origin, and laboratory diagnostics, as well as proper organization of the work of the forensic bureau.Conclusion. Medical reform requires the achievement of a high modern level of work of the forensic medical service. It is necessary to develop and implement electronic forensic medical information systems that will be integrated into domestic information systems and central databases of the medical industry and relevant central authorities and law enforcement agencies.

Antidepressant prescription patterns and associated factors among the elderly with psychiatric illnesses

Objectives: The prevalence of antidepressant prescriptions for elder patients with psychiatric illnesses is increasing over the world. No studies exist to focus on the prescription patterns and trend of antidepressant use for the elderly in psychiatric hospitals of Taiwan. Methods: In this retrospective study for all outpatients equal or over 65 years of age in a psychiatric hospital, we collected related study variables from the study hospital from 2006 to 2015. Reviewing data of the electronic medical information system, we extracted both patients' demographic data (information for sex, age, and insurance status) and their clinical variables (psychiatric diagnosis and prescriptions of antidepressants). Results: In this study, we found that the proportion of antidepressant prescriptions was increased at around 7.85% (from 39.79% in 2006 to 42.92% in 2015, p

Права пацієнтів за умов запровадження електронної системи охорони здоров’я: деякі проблеми дотримання

Права пацієнтів за умов запровадження електронної системи охорони здоров’я: деякі проблеми дотримання

Quality of documentation of electronic medical information systems at primary health care units in Alexandria, Egypt

Limited data are available about the implementation of electronic records systems in primary care in developing countries. The present study aimed to assess the quality of documentation in the electronic medical records at primary health care units in Alexandria, Egypt and to elicit physician's feedback on barriers and facilitators to the system. Data were collected at 7 units selected randomly from each administrative region and in each unit 50 paper-based records and their corresponding e-records were randomly selected for patients who visited the unit in the first 3 months of 2011. Administrative data were almost complete in both paper and e-records, but the completeness of clinical data varied between 60.0% and 100.0% across different units and types of record. The accuracy rate of the main diagnosis in e-records compared with paper-based records ranged between 44.0% and 82.0%. High workload and system complexity were the most frequently mentioned barriers to implementation of the e-records system.

Comparison of Two VA Laboratory Data Repositories Indicates That Missing Data Vary Despite Originating From the Same Source

Assessing accuracy and completeness of data is an important component of conducting research. VA Healthcare System benefits from a highly developed electronic medical information system. The Immunology Case Registry was designed to monitor costs and quality of HIV care. The Decision Support System was developed to monitor utilization and costs of veterans in care. Because these systems extract data from the same source using independent methods, they provide an opportunity to compare the accuracy and completeness of each. To compare overlapping laboratory data from the Veterans Affairs Health Information System between 2 data repositories. For hemoglobin, CD4 lymphocyte counts (CD4), HIV RNA viral load, aspartate aminotransferase, alanine aminotransferase, glycosylated hemoglobin, creatinine, and white blood count, we calculated the percent of individuals with a value from each source. For results in both repositories, we calculated Pearson's correlation coefficients. A total of 22,647 HIV+ veterans in the Virtual Cohort with a visit in fiscal year 2002. For 6 out of 9 tests, 68% to 72% of the observations overlapped. For CD4, viral load, and glycosylated hemoglobin less than 31% of observations overlapped. Overlapping results were nearly perfectly correlated except for CD4. Six of the laboratory tests demonstrated remarkably similar amounts of overlap, though Immunology Case Registry and Decision Support System both have missing data. Findings indicate that validation of laboratory data should be conducted before its use in quality and efficiency projects. When 2 databases are not available for comparison, other methods of validation should be implemented.

Psychiatric disorders, HIV infection and HIV/hepatitis co-infection in the correctional setting

Psychiatric disorders such as bipolar disorder, schizophrenia and depression have long been associated with risk behaviors for HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV). The US prison population is reported to have elevated rates of HIV, hepatitis and most psychiatric disorders. This study examined the association of six major psychiatric disorders with HIV mono-infection, HIV/HCV co-infection and HIV/HBV co-infection in one of the nation's largest prison populations. The study population consisted of 370,511 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 2003 and July 1, 2006. Information on medical conditions and sociodemographic factors was obtained from an institution-wide electronic medical information system. Offenders diagnosed with HIV mono-infection, HIV/HCV, HIV/HBV and all HIV combined exhibited elevated rates of major depression, bipolar disorder, schizophrenia, schizoaffective disorder, non-schizophrenic psychotic disorder and any psychiatric disorder. In comparison to offenders with HIV mono-infection, those with HIV/HCV co-infection had an elevated prevalence of any psychiatric disorder. This cross-sectional study's finding of positive associations between psychiatric disease and both HIV infection and hepatitis co-infection among Texas prison inmates holds both clinical and public health relevance. It will be important for future investigations to examine the extent to which psychiatric disorders serve as a barrier to medical care, communication with clinicians and adherence to prescribed medical regimens among both HIV-mono-infected and HIV/hepatitis-co-infected inmates.

The internet and healthcare in Taiwan: value-added applications on the medical network in the National Health Insurance smart card system

The introduction of smart card technology has ushered in a new era of electronic medical information systems. Taiwan's Bureau of National Health Insurance (BNHI) implemented the National Health Insurance (NHI) smart card project in 2004. The purpose of the project was to replace all paper cards with one smart card. The NHI medical network now provides three kinds of services. In this paper, we illustrate the status of the NHI smart card system in Taiwan and propose three kinds of value-added applications for the medical network, which are electronic exchange of medical information, retrieval of personal medical records and medical e-learning for future development of health information systems.

An interlingua for electronic interchange of medical information: Using frames to map between clinical vocabularies

The proliferation of medical knowledge has led to the development of extensive dictionaries for electronically accessing information resources. The task of standardizing terminology used for electronic hospital records and for knowledge bases for medical expert systems and indexing the medical literature cannot easily be met by developing a single, monolithic “official” medical vocabulary. Developing a monolithic vocabulary would require a massive effort, and its existence would not guarantee its use by third-party payors, by practicing clinicians, or by developers of electronic medical information systems. Recognizing this, the National Library of Medicine (NLM) has begun to develop the Unified Medical Language System (UMLS) as a means of promoting electronic information exchange among systems with controlled vocabularies. The authors describe a frame-based system developed as an experimental approach to mapping between controlled clinical vocabularies.