Electronic Medical Record Management System Research Articles

Application of Failure Mode and Effects Analysis to Improve the Quality of the Front Page of Electronic Medical Records in China: Cross-Sectional Data Mapping Analysis.

The completeness and accuracy of the front pages of electronic medical records (EMRs) are crucial for evaluating hospital performance and for health insurance payments to inpatients. However, the quality of the first page of EMRs in China's medical system is not satisfactory, which can be partly attributed to deficiencies in the EMR system. Failure mode and effects analysis (FMEA) is a proactive risk management tool that can be used to investigate the potential failure modes in an EMR system and analyze the possible consequences. The purpose of this study was to preemptively identify the potential failures of the EMR system in China and their causes and effects in order to prevent such failures from recurring. Further, we aimed to implement corresponding improvements to minimize system failure modes. From January 1, 2020, to May 31, 2022, 10 experts, including clinicians, engineers, administrators, and medical record coders, in Zhejiang People's Hospital conducted FMEA to improve the quality of the front page of the EMR. The completeness and accuracy of the front page and the risk priority numbers were compared before and after the implementation of specific improvement measures. We identified 2 main processes and 6 subprocesses for improving the EMR system. We found that there were 13 potential failure modes, including data messaging errors, data completion errors, incomplete quality control, and coding errors. A questionnaire survey administered to random physicians and coders showed 7 major causes for these failure modes. Therefore, we established quality control rules for medical records and embedded them in the system. We also integrated the medical insurance system and the front page of the EMR on the same interface and established a set of intelligent front pages in the EMR management system. Further, we revamped the quality management systems such as communicating with physicians regularly and conducting special training seminars. The overall accuracy and integrity rate of the front page (P<.001) of the EMR increased significantly after implementation of the improvement measures, while the risk priority number decreased. In this study, we were able to identify the potential failure modes in the front page of the EMR system by using the FMEA method and implement corresponding improvement measures in order to minimize recurring errors in the health care services in China.

The electronic medical record management systems may improve monitoring and control of disease activity in patients with ankylosing spondylitis

To investigate the impact of an electronic medical record management system (EMRMS) on disease activity and the frequency of outpatient visits among patients with ankylosing spondylitis (AS). We identified 652 patients with AS who were followed up for at least 1 year before and after the first Ankylosing Spondylitis Disease Activity Score (ASDAS) assessment and compared the number of outpatient visits and average visit time within 1 year before and after the initial ASDAS assessment. Finally, we analyzed 201 patients with AS who had complete data and received ≥ 3 continuous ASDAS assessments at an interval of 3 months, and we compared the results of the second and third ASDAS assessments with those of the first. The number of annual outpatient visits increased after ASDAS assessment (4.0 (4.0, 7.0) vs. 4.0 (4.0, 8.0), p < 0.001), particularly among those with a high initial disease activity. The average visit time was reduced within 1 year after ASDAS assessment (6.4 (8.5, 11.2) vs. 6.3 (8.3, 10.8) min, p = 0.073), especially among patients whose with an inactive disease activity was < 1.3 (ASDAS C-reactive protein (CRP) 6.7 (8.8, 11.1) vs. 6.1 (8.0, 10.3) min, p = 0.033; ASDAS erythrocyte sedimentation rate (ESR) 6.4 (8.7, 11.1) vs. 6.1 (8.1, 10.0) min, p = 0.027). Among patients who received at least three ASDAS assessments, the third ASDAS-CRP tended to be lower than the first (1.5 (0.9, 2.1) vs. 1.4 (0.8, 1.9), p = 0.058). The use of an EMRMS increased the frequency of ambulatory visits among AS patients with high and very high disease activity and reduced the visit time among those with an inactive disease. Continual ASDAS assessments may help control the disease activity of patients with AS.

Investigation of changes in ankylosing spondylitis disease activity through 2021 COVID-19 wave in Taiwan by using electronic medical record management system

We aim to investigate the alteration in disease activity of ankylosing spondylitis (AS) individuals before, during, and after the COVID-19 wave in Taiwan by using electronic medical-record management system (EMRMS). We identified 126 AS individuals from the single center, and gathered data of the three disease activities (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score with erythrocyte sedimentation rate [ASDAS-ESR], and Ankylosing Spondylitis Disease Activity Score with C-Reactive Protein [ASDAS-CRP]) by using EMRMS before (7 February to 1 May, 2021), during (2 May to 24 July, 2021), and after the COVID-19 wave (25 July to 16 October, 2021). We compared the disease activity measures of the three phases through a paired t test. Among the 126 individuals, CRP was significantly higher during the COVID-19 wave (0.2 (0.1, 0.5) mg/dl, p = 0.001) than before the wave (0.2 (0.1, 0.4) mg/dl), ESR (8.0 (4.0, 15.0) mm/h, p = 0.003) and ASDAS-ESR (1.4 (1.0, 1.9), p = 0.032) were significantly higher after the wave than during the wave (6.0 (3.0, 12.0) mm/h and 1.2 (0.9, 1.8) mm/h) e. ESR, CRP, ASDAS-ESR and ASDAS-CRP were all significant higher after COVID-19 wave than before. The disease activities of AS individuals in Taiwan worsened after 2021 COVID-19 wave in Taiwan.

[Analysis of the incidence and reasons of the same-day cancellation of non-cataract ophthalmic ambulatory surgery].

Objective: To investigate the incidence and reasons of the same-day cancellation of non-cataract ophthalmic ambulatory surgery, and to provide a basis for further improvement of the medical quality of ophthalmic ambulatory surgery. Methods: The data of the appointment for ophthalmic ambulatory surgeries from December 1, 2020 to November 30, 2021, including the patient's general condition, disease diagnosis, proposed surgical arrangement, anesthesia method and the completion of the surgeries, were collected through the electronic medical record management system in Beijing Tongren Hospital, Capital Medical University. The total number and incidence of cancelled surgeries registered in the surgical center were analyzed, the incidence of cancelled surgeries of different ages, sexes, subspecialty surgical types, anesthesia methods, patient sources were analyzed, and the reasons for surgical cancellation were further analyzed. Results: A total of 10, 595 non-cataract ophthalmic day surgeries were applied, of which 827 were temporarily cancelled on the day of surgery, with a cancellation rate of 7.8%. The difference in the same-day surgery cancellation rate at different ages was statistically significant (P<0.001), of which the surgery cancellation rate in toddler and infants was the lowest, which was 2.1% (23/1 110) and 3.4% (2/59), respectively, while the surgery cancellation rate was the highest in elderly patients over 75 years old, at 10.4% (48/462). There was a statistically significant difference in surgical cancellation rates among different sub-specialties (P<0.001), with the lowest surgical cancellation rate in the tumor sub-specialty at 4.5% (33/732), while the corneal sub-specialty had the highest surgical cancellation rate at 14.3% (40/280), followed by the plastic sub-specialty with 11.8% (153/1 297). There were no statistically significant differences in the rate of surgical cancellation between different sexes, anesthesia methods or patients' home address (all P>0.05). The most common reason for same-day surgery cancellation was the absence of the patient on the day of surgery (49.7%, 479/827), followed by changes in the patient's general condition (18.4%, 152/827), and inadequate preoperative preparation (6.0%, 50/827). 64.3% (532/827) of the same-day surgical cancellations were considered to have been avoided by enhancing preoperative communication, consultation and management. Conclusions: The same-day cancellation rate of ambulatory surgery in non-cataract ophthalmology is 7.8%, of which the cancellation rate in elderly patients and in less invasive surgery are higher. The absence of the patient on the same day and the change of the patient's condition are the main reasons for the cancellation of surgery on the same day, and most of them are avoidable.

Medical Record Encryption Storage System Based on Internet of Things

The Internet of Things takes data as the center, and its core is data storage and management. With the emergence and rapid development of wireless communication technology, with the huge number of terminals in human society, massive data will be generated. Undoubtedly, data storage and management technology will attract much attention. In view of this, this paper proposes a data storage scheme based on the Internet of Things. This paper introduces the Internet of Things technology, designs it from the perspective of the massive data storage system of the Internet of Things, realizes the intelligent processing of data storage, and provides security guarantee for information services. By combing the business process management of doctors, nurses and patients, this paper constructs a medical record encryption management system, makes a comparative analysis before and after the system goes online, and carries out simulation experiments. The simulation results show that (1) the cost of paper is significantly reduced, and the related forms of medical records are more unified and standard, (2) medical record inquiry and reading are more convenient and controllable, and (3) the safety of medical records is well guaranteed. Except that the relevant doctors and nurses of patients can view the relevant medical records, and others have no authority to query and access them. Therefore, the encrypted medical record storage system based on Internet of Things technology can effectively solve the collection, statistics, and integration of patient treatment information, which can be summarized into a unified, shared, and interconnected electronic medical record management system to realize the collection of patient treatment information in the whole process.

Lopinavir-ritonavir alone or combined with arbidol in the treatment of 73 hospitalized patients with COVID-19: A pilot retrospective study.

This study aimed to evaluate the antiviral efficacy of lopinavir-ritonavir alone or combined with arbidol in the treatment of hospitalized patients with common coronavirus disease-19 (COVID-19). In this retrospective observational study, hospitalized COVID-19 patients were identified and divided into two groups based on the antiviral agents during their hospitalization. Patients in group LR were treated with lopinavir-ritonavir 400mg/100mg, twice a day, while patients in group LR+Ar were treated with lopinavir-ritonavir 400mg/100mg twice a day and arbidol 200mg three times a day for at least 3 days. Data from these patients were collected from electronic medical record management system. 73 patients were divided into two groups: group LR (34 cases) and group LR+Ar (39 cases), according to the antiviral agents. The overall cure rate of COVID-19 in group LR+Ar and group LR were 92.3% and 97.1%, respectively, with no significant difference (p=0.62). In a modified intention-to-treat analysis, lopinavir-ritonavir combined with arbidol led to a median time of hospital stay that was shorter by 1.5 days than in group LR (12.5 days vs. 14 days). The percentages of -COVID-19 RNA clearance was 92.3 in group LR and 97.1 in group LR+Ar which was similar to the cure rate. The median time to nucleic acid turning negative = (date of first negative PCR test) - (date of last positive PCR test) was 8.0 days in both groups with no significant difference (p=0.59). Treatment of lopinavir-ritonavir combined with arbidol did not significantly accelerate main symptom improvement and promote the image absorption of pulmonary inflammation. No benefit was observed in the antiviral effect of lopinavir-ritonavir combined with arbidol compared with lopinavir-ritonavir alone in the hospitalized patients with COVID-19. More clinical observations in COVID-19 patients may help to confirm or exclude the effect of antiviral agents.

Secure Electronic Medical Records Storage and Sharing Using Blockchain Technology

Electronic medical records (EMRs) are electronically-stored highly sensitive and private information related to the diagnosis and treatment of patient, and needs to be frequently shared among peers. Sharing of medical records between participants is very challenging because the data might be revealed or tampered during the operational process. To address these challenges, a blockchain-based electronic medical records system is the key solution. In this research, we have discussed how blockchain technology can help in better healthcare data management. We have proposed a blockchain-based records management system for efficient management and sharing of electronic medical records (EMRs). We have implemented a prototype of Electronic Medical Records Management System using permissioned blockchain platform “Hyperledger”. This system ensures privacy, security and easy accessibility and availability of medical records.

Construction and application of DRGs management information system

The construction of DRGs management information system proves conducive to hospital medical quality management. In order to better understand the status of the hospital′s DRGs, further improve the quality of medical care, and embrace the DRGs reform in medical insurance, the hospital built the DRGs management information system in 2015, and integrated it with the electronic medical record management system, and the medical record management system. The system consists of such modules as inpatient medical service evaluation, disease surveillance, case analysis, and real-time dynamic monitoring, applied to homepage evaluation and performance management at both hospital and department levels. Such a system can provide practical data for decision support of clinicians, and enable decision makers, thus improving fine management of medical care in the full course. Key words: Diagnosis-related groups; Information system; Integration; Medical quality

An intelligent assistant for physicians.

This paper presents a software tool developed for assisting physicians during an examination process. The tool consists of a number of modules with the aim to make the examination process not only quicker but also fault proof moving from a simple electronic medical records management system towards an intelligent assistant for the physician. The intelligent component exploits users' inputs as well as well established standards to line up possible suggestions for filling in the examination report. As the physician continues using it, the tool keeps extracting new knowledge. The architecture of the tool is presented in brief while the intelligent component which builds upon the notion of multilabel learning is presented in more detail. Our preliminary results from a real test case indicate that the performance of the intelligent module can reach quite high performance without a large amount of data.

Obesity increases the risk of renal involvement in children with Henoch-Schönlein purpura.

The main aim of this study was to evaluate the relationship between obesity and renal involvement in children with Henoch-Schönlein purpura (HSP). A retrospective study of 141 pediatric patients with HSP was conducted in our hospital. The clinical data of all patients were collected from the electronic medical record management system from January 2010 to June 2014. The possible risk factors of renal involvement, especially obesity, were analyzed using univariate and multivariate analyses. Renal involvement occurred in 45/141 of the patients. A univariate analysis showed that an age more than 7 years at onset, persistent purpura, obesity, time from symptoms onset to diagnosis more than 14 days, and decreased C3 all increased the risk of renal involvement in HSP. The forward stepwise logistic regression analysis indicated obesity (odds ratio (OR) 4.43, 95 % confidence interval (CI) 1.896 to 10.358), age more than 7 years at onset (OR 2.81, 95 % CI 1.142 to 6.907), and persistent purpura (OR 2.57, 95 % CI 1.119 to 5.909) were independent risk factors for renal involvement. Our results show that obesity can increase the hazard of renal involvement in children with HSP and reconfirm that older age at onset and persistent purpura are the independent risk factors for renal involvement. • There have been some reports that obesity was associated with the development of renal injury. • It is not clear whether obesity can increase the risk of renal involvement in children with HSP. What is New: • The main finding of this study is that obesity can increase the hazard of renal involvement in children with HSP.

Design of Electronic Medical Record System Based on Cloud Computing Technology

According to current status and problems of electronic medical records management system, it combines with the current the latest information technology, cloud computing, and it explores the solution of electronic medical records management system and puts forward the new ideas and methods; Based on the literature and information on cloud computing technology, we summarize the cloud computing theory, architecture, application model, etc. and select the appropriate application platform for the electronic medical records ; Based on the Google cloud computing technology , it focus on Google cloud computing platform Google App Engine and its solution Plan, it makes the research of collaborative electronic medical record system based on Google App Engine. DOI : http://dx.doi.org/10.11591/telkomnika.v12i5.4392

Research on management system of paperless electronic medical record

This paper discussed on the importance of management system of paperless electronic medical record and pointed out that we would encountered lots of problems during the construction of paperless electronic medical record management system including authenticity,legal effect,similarity,safety,mistakes and missing of medical records.This paper analyzed these problems and proposed corresponding countermeasures including developing safety management system,whole-process monitoring of medical record quality,enhancing archive management,developing backup and recovery mechanisms,improving secrecy and authorization system,promoting borrowing management,performing copy system,strengthening electronic signature management,implementing unique number management and enhancing overall quality of personnel Key words: Paperless; Electronic medical record; Management system