Electronic Medical Record Technology Research Articles

Challenges in the use Electronic Medical Records in Middle Eastern Countries: A Narrative Review

Electronic Medical Records (EMRs) have great value in healthcare, as they enhance healthcare quality, decrease costs, optimize patient safety and health care research. Worldwide and particularly in the Middle Eastern countries have pushed for usage and implement EMR systems. However, there were some obstacles and challenges toward implementation of the EMR system. This review aims to look at the challenges and constraints of using and adopting EMR in Middle Eastern countries. Electronic databases of PubMed, country reports, newspaper, magazine articles, and hospital reports between 2008 to 2021 were used. Most common challenges highlighted were high cost of EMR implementation, lack of training, insufficient information technology personnel support, poor acceptance of new technology, confidentiality, and privacy concerns. Understanding the hurdles of using EMR technology in health care setting is essential for decision makers to focus on economic and human factors challenges to enhance the use and acceptance of EMR systems.

The effect of performance expectancy and behavioral intention on the use of electronic medical record (EMR) in tertier hospital in Indonesia

Health and well-being are the third Sustainable Development Goals (SDGs) in the 2030 Agenda for Sustainable Development. To accomplish this, Soetomo hospital as the largest referral hospital in the province of East Java is expected to have an Electronic Medical Record (EMR) completeness level of 100 percent by 2024. This study aimed to examine the impact of performance expectation and behavioral intention on hospital EMR technology usage. This was an observational study with a cross sectional research design. From a population of 390 health workers, a sample of 195 was generated using proportional random sampling. Validity and reliability can be determined using SPSS software. Utilizing SEM PLS software, the analysis is evaluated. Results indicate that performance expectation can have a direct effect on technology use EMR (T Statistic = 21,506) and an indirect effect via behavioral intention (T Statistic = 15,038). The relationship between behavioral intention and technology use EMR is direct (T statistic = 5,475). Conclusion: Performance expectations explain 52% of behavioral intention, while behavioral intentions explain 85% of technology use EMR.

Usefulness of Electronic Medical Records Technology for Nurse Managers: A Literature Review

Nurse managers play an important role in evaluating medical records through management activities, namely planning, organizing, actuating and controlling (POAC) that are carried out conventionally. Nurse managers play an important role in evaluating medical records through management activities, namely planning, organizing, actuating and controlling (POAC) that are carried out conventionally. Now medical records have evolved into integrative Electronic Medical Records (EMR). This review aims to explore the usefulness of EMS technology for nurse managers. Literature searches use two database sources namely ProQuest and Google Scholar with boolan search "Electronic Medical Records for nurse manager". Identified 9 articles worthy of review. The total participants of the entire article were 1539 people consisting of doctors and nurses (implementers and managers). It found that EMR is very useful for nurse managers, can increase productivity, facilitate the documenting of nursing care and improve the quality of care through an integrated system

Differences in Life Expectancy Among Cities of Shaanxi Province, China, 2015-2019

Background: To analyze life expectancy in cities in Shaanxi Province from 2015 to 2019 and explore whether it have geographic differences. And assessing the impact factors related to these differences. Methods: Life expectancy was estimated by life table and the spatial dependence was analyzed by constructing the spatial weight matrix. We used ordinary least squares regression and dominance analysis to judge the influence of socioeconomic and health behavior factors on life expectancy, and the final contribution of influencing factors to independent variables was generalized by Meta regression. Findings: From 2015 to 2019, life expectancy in Shaanxi Province increased by an average of 2·23 years. The Moran'I showed that there was a significant spatial correlation in life expectancy from 2017 to 2019. The cities in the region of Guanzhong had a high-high clustering. In 2019, there was a low-high abnormal phenomenon in Xianyang City. The socio-demographic Index had the highest relative contribution to life expectancy in various cities although physical exercise had the highest regression coefficient (β=0·364, P<0·01). The impact of smoking has been relatively weakened in the past five years. The impact of Hypertension on life expectancy in Shaanxi Province has become greater. Interpretation: Geographic difference in life expectancy in every city in Shaanxi Province is obviously. This difference can be explained by socioeconomic factors and healthy behavior factors. Funding Information: This work was funded by National High-tech R&D Program (863 Program) for High-end Electronic Medical Record Technology Development and System Application Demonstration [grant No. 2012AA02A607]. Declaration of Interests: None reported.

Electronic medical records and primary care quality: Evidence from Manitoba

Improvements in quality of care through supporting decision-making processes and increased efficiency have prompted widespread implementation of electronic medical records (EMRs) in Canada. Using a set of indicators of preventive care, chronic disease management, and hospitalizations due to ambulatory care sensitive conditions (ACSC), this study measures the effect of EMR adoption on quality of primary care measures. Population-based data for the Canadian province of Manitoba are used in a difference-in-differences approach with patient- and time-fixed effects. Evidence of changes in the selected quality-of-care indicators is weak, with preventive care, management of asthma, and hospitalizations showing no significant change due to EMR adoption. A statistically significant increase in the quality of diabetes care was found for EMR users, changes being larger for late EMR adopters which is possibly explained by a network effect. This research demonstrates that measuring whether EMRs prompt changes in the quality of care confronts serious challenges. The rapid evolution and gradual adoption of EMR technology, the inevitable learning/acceptance process by individual health practitioners, and its potential reflection on different patient populations create unmeasurable variables that confound EMRs' impact. This study also underscores the importance of data development to support the economic value of EMRs.

Pediatric Orthopaedic Surgeon Time Utilization in Clinic: A Pilot Study

The purpose of this study is to quantify how pediatric orthopaedic surgeons spend time in clinic. Two pediatric orthopaedic surgeons were individually observed and activities were timed during 3 clinic sessions. One medical student observed and recorded the time using a data collection sheet and a watch. The duration of each clinic session was 4 hours and a new patient was seen every 20 minutes. Data was collected in 7 categories including: time with the patient; time with staff; time listening to the resident presentations, time teaching, time multitasking, time dictating, and time on the electronic medical record (EMR). The number of computer mouse clicks needed to complete each patient encounter was also recorded. The Cerner EMR system was used (Cerner Inc. North Kansas City, MO). Thirty-six percent of the physician's time was spent on the EMR. Thirty-five percent of time was spent with the patient, 7% was spent dictating, 7% teaching, 5% multitasking, 6% with staff, and 4% listening to resident presentations. Overall, during a 20-minute patient visit, 7.2 minutes was spent on the EMR. During a 4-hour clinic, 87 minutes was spent on the EMR. During a full day of clinic-two 4-hour sessions-173 minutes were spent on the EMR. The average number of computer mouse clicks to complete a patient encounter was 70 (range: 42 to 110). A total of 1680 clicks were needed to see 24 patients in a typical 2 session clinic. Pediatric orthopaedic surgeons spend more time on the EMR than with patients. About 70 computer mouse clicks are needed per patient encounter. The excessive computer time can diminish the patient-physician relationship. Click fatigue in physicians is real and needs to be resolved by improved EMR technology, utilization of medical scribes, or a return to partial use of paper. Level IV-an observational study.

Trend in age-specific cancer mortality and cancer-free life expectancy in China, 2008–17: a cross-sectional survey of nationwide data

BackgroundCancer is the main chronic disease that affects the health of Chinese residents; however, there have been few systematic studies on cancer-free life expectancy in China. We aimed to explore age-specific cancer mortality and changes in population lifespan after accounting for the removal of the burden of cancer to provide important insights and a basic reference on the development of relevant health policies, such as cancer control or elderly care. MethodsWe used population data from the National Bureau of Statistics and data on cancer mortality from the China Health Statistics Yearbook to produce estimates of the number of deaths from 2008 to 2017 for 18 different age groups, female and male individuals, urban areas and rural areas, and different cancer types. We analysed the change in mortality for the 18 different age groups from 2008 to 2017 and inputted the population mortality and deaths caused by cancer into a life table system to calculate life expectancy for all age groups and cancer-free life expectancy for all age groups. FindingsFrom 2008 to 2017, total mortality associated with cancer in China decreased at a steady trend per year in urban areas and increased in rural areas. Mortality of the various age groups decreased during the 10-year period, whereas overall mortality rate increased due to population ageing. Lung cancer in rural areas increased by 2·8% (SD 1·2–4·4) per year, and liver cancer and stomach cancer significantly decreased by 2·1–2·2% per year in rural areas (p<0·0001). Life expectancy of the entire population increased from 74·6 years in 2008 to 75·6 years in 2017. Life expectancy in women (77·5–78·4 years) was higher than in men (72·0–73·1 years) from 2008 to 2017, and life expectancy in urban areas (76·0–76·2 years) was higher than rural areas (73·1–75·0 years). After removing the effects of cancer, life expectancy of the total population increased by about 3 years. Lung cancer had a greater effect on life expectancy than other types of cancer, and predominantly affects the male population younger than 54 years. If cancer were to be effectively controlled, the life expectancy of the population aged 50–84 years would be significantly improved. InterpretationCancer is a serious disease that harms the health of the population in China. The development of medicine is the main reason for the rapid increase in life expectancy in rural areas. Increased smoking and obesity are the main factors affecting the life expectancy of the Chinese population, although the development of new drugs and some new vaccines can effectively control cancer deaths. The study of life expectancy and healthy life expectancy will be important topics of research in the future. FundingNational High-tech R&D Program (863 Program) for High-end Electronic Medical Record Technology Development and System Application Demonstration (2012AA02A607).

Factors associated with the utilization of electronic medical records in the Eastern Region of Ghana

ObjectivesThis study examined the factors associated with the use of Electronic Medical Records (EMR) in public hospitals in the Eastern Region of Ghana. MethodsThree hundred and ninety-six (396) healthcare professionals were surveyed from the various public hospitals in the Eastern Region of Ghana. The participants included physicians, physician assistants, nurses, laboratory technicians, radiologists, pharmacists, record managers, and ICT staff. Frequency and Chi-Square analyses were performed on the data. ResultsThe results showed that approximately 59% (n=212) of health professionals indicated low use of EMR services in their hospitals. Lack of computer competence (p<0.001), poor communication between users (p=0.050), cost of EMR resources and facilities (p<0.001), lack of technical personnel to install and operate EMR technology resources (p<0.001), and lack of EMR software packages (p<0.001) had significant negative relationships with EMR utilization. ConclusionUtilization of EMR services is low among the healthcare professionals in the Eastern Region. Therefore, the Ghana Health Service needs to provide training to their employees and supply the needed resources to encourage and support the hospitals and healthcare workers to increase the utilization of the EMR services that improve healthcare delivery in the Region. To enhance EMR utilization, it will be essential that government supports health facilities who have challenges using EMR. To better understand the issues, a mixed method approach is recommended to be used to study healthcare workers from both private and public healthcare facilities in the Eastern Region of Ghana.

Trend in Age-Specific Cancer Mortality and Cancer-Free Life Expectancy in China, 2008-2017: An Analysis of Nationwide Data

Background: Cancer is the main chronic disease that affects the health of Chinese residents, however, less systematic study on cancer-free life expectancy in China. We aimed to explore age-specific cancer mortality and changes in population lifespan after removal of cancer to provide important insights and a basic reference on the development of relevant health policies such as cancer control or elderly care. Methods: We use the available data to produce estimates of the number of deaths from 2008 to 2017 for 18 age groups, both sexes, urban areas and rural areas, cancer and the three high-incidence cancers. Data used include the population data from the National Bureau of Statistics and cancer mortality from China Health Statistics Yearbook. We analyzed the change in mortality over the years, and at the same time input the population and deaths into the life table system to calculate life expectancy for all ages and cancer-free. Findings: From 2008 to 2017, the total mortality rate of cancers in China decreased at a steady trend per year in urban areas and increased in rural areas. The mortality rate of the different age groups decreased during the 10-year period while the overall mortality rate increased. The lung cancer in rural areas increased by 2.8% per year, and liver cancer and stomach cancer significantly decrease by 2.1-2.2% per year (P<0.05). Life expectancy of the entire population from 74.6 years in 2008 to 75.6 years in 2017, nearly increases about 1 year. Life expectancy in female is higher than male, urban areas are higher than rural areas. After removing the effects of cancer, life expectancy of the population increases by about 3 years. Lung cancer has a greater impact on life expectancy of the population, mainly concentrated in the male population under 54 years old. If the cancer is effectively controlled, life expectancy of population in 50-84 years will be significantly improved. Interpretation: Cancer is a seriously disease harms the health of the population in China. The development of medical is the main reason for the rapid increase in life expectancy in rural areas. Increasing smoking and obesity are the main factors affecting life expectancy of people, meanwhile, the development of new drugs and some new vaccines can effectively control cancer deaths. The study on life expectancy and healthy life expectancy are important trends in the future. Funding Statement: National High-tech R&D Program (863 Program) for High-end Electronic Medical Record Technology Development and System Application Demonstration (2012AA02A607) Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Missing.

Standardizing Safety Assessment and Reporting for Neonatal Clinical Trials

Standardizing Safety Assessment and Reporting for Neonatal Clinical Trials

The Role of Social Influence and Network Churn in Beliefs about Electronic Medical Record Technology

Abstract The successful implementation of technology often hinges on individual beliefs about the innovation being introduced. Little is known about how social networks shape these beliefs. In this study, we examine: (1) whether individual beliefs about technology are influenced by the beliefs of their peers within their social networks (network content); and (2) whether changes in the composition of the social network over time (network churn) moderates the effect of peer beliefs on individual beliefs. We offer and test hypotheses about these relationships using longitudinal social network survey data from hospital staff collected 2 – 4 months before (N = 256) and 3 – 5 months after (N = 284) the implementation of a new electronic medical record (EMR) system at a large, academic hospital. Our findings suggest that peer beliefs about new technology significantly and negatively affect individual beliefs about technology in the early stages of EMR implementation. We also find that the effect of peer beliefs on individual beliefs is stronger in more stable social networks (i.e., social networks that experience few tie deletions over time) and weaker in less stable social networks (i.e., social networks that experience many tie deletions over time). Our study examines social influence in a novel context – the implementation of EMR systems in the hospital setting – and extends network theory by conceptualizing network churn as a moderating variable that may amplify or dampen the effect of networks.

Pharmacy informatics in multihospital health systems: Opportunities and challenges.

Challenges and opportunities in managing pharmacy-related technology in a multihospital health system are reviewed. With electronic medical record (EMR) implementations, pharmacy technology deployments, and increased numbers of hospitals merging into single health systems, opportunities and challenges for pharmacy informatics (PI) teams have grown. Pharmacy leaders must consider the implications of using technology in a multihospital health-system environment, as well as the impact of the health system's organizational structures on technology implementations and dedicated support teams. Common challenges in achieving EMR and other technology implementation and standardization initiatives in multihospital health systems include harmonization of practices across hospitals of various sizes and types and issues of platform compatibility and interoperability. PI teams must collaborate with information technology teams at the system level to identify practical strategies for making the best use of available resources to implement pharmacy automation and software to help pharmacists continue to provide safe and effective patient care. The organizational structures that affect informatics teams, pharmacy integration and standardization initiatives, formulary management practices, data management and analytics, and clinical decision support systems all must be areas of focus. An integrated pharmacy enterprise can be well positioned to leverage operational efficiencies gained from appropriate use of technology to enhance patient care. Careful attention must be paid to the manner in which these systems are designed, implemented, and managed in order to make the best use of the technological resources used by the health system.

Electronic medical record reminders and smoking cessation activities in primary care

PurposeThe purpose of this paper is to assess electronic medical record (EMR) automatic reminder use in relation to smoking cessation activities among primary-care providers. BackgroundPrimary-care physicians are in the frontline of efforts to promote smoking cessation. Moreover, doctors' prescribing privileges give them additional tools to help patients successfully quit smoking. New EMR functions can provide automated reminders for physicians to counsel smokers and provide prescriptions to support quit attempts. Sample and methodsLogit regression is used to analyze the 2012 National Ambulatory Medical Care Survey (NAMCS). Variables related to the EMR's clinical reminder capability, patient's smoking status, the provision of cessation counseling and the prescribing of drugs that support quitting are analyzed. ResultsFor primary care visit documents, smoking status was recorded 77.7% of the time. Smoking cessation counseling was ordered/provided 16.4% of the time in physicians' offices using electronic reminders routinely compared to 9.1% in those lacking the functionality. Smoking cessation medication was ordered/prescribed for 3.7% of current smokers when reminders were routinely used versus 2.1% when no reminder was used. All the differences were statistically significant. ConclusionsThe presence of an EMR equipped with automated clinical reminders is a valuable resource in efforts to promote smoking cessation. Insurers, regulators, and organizations promulgating clinical guidelines should include the use of EMR technology as part of their programs.

Prediction of Recurrent Clostridium Difficile Infection Using Comprehensive Electronic Medical Records in an Integrated Healthcare Delivery System.

We employed a retrospective cohort design. Granular electronic medical record (EMR) data had been collected from patients hospitalized at 21 Kaiser Permanente Northern California hospitals. The derivation dataset (2007-2013) included data from 9,386 patients who experienced incident CDI (iCDI) and 1,311 who experienced their first CDI recurrences (rCDI). The validation dataset (2014) included data from 1,865 patients who experienced incident CDI and 144 who experienced rCDI. Using multiple techniques, including machine learning, we evaluated more than 150 potential predictors. Our final analyses evaluated 3 models with varying degrees of complexity and 1 previously published model. RESULTS Despite having a large multicenter cohort and access to granular EMR data (eg, vital signs, and laboratory test results), none of the models discriminated well (c statistics, 0.591-0.605), had good calibration, or had good explanatory power. CONCLUSIONS Our ability to predict rCDI remains limited. Given currently available EMR technology, improvements in prediction will require incorporating new variables because currently available data elements lack adequate explanatory power. Infect Control Hosp Epidemiol 2017;38:1196-1203.

Barriers to electronic medical record implementation: a comparison between ophthalmology and other surgical specialties in Canada

ObjectiveIn the present study, the barriers limiting widespread adoption of electronic medical records (EMRs) among Canadian ophthalmologists were evaluated in comparison with physicians from other surgical specialities. The published literature regarding EMR use in ophthalmic practice was also reviewed. DesignPopulation-based, cross-sectional study. ParticipantsA total of 1199 Canadian surgeons participating in the 2014 National Physician Survey (NPS). MethodsData regarding speciality surgeons’ adoption of EMR programs were extracted from the 2014 NPS, a nationwide survey of practicing physicians in Canada. The data were entered into a spreadsheet, and basic statistical analyses, including χ2 analyses, were performed to compare the responses of ophthalmologists to other surgeons. ResultsCompared with other surgeons, ophthalmologists surveyed were significantly more likely to identify the following barriers to EMR adoption: “no suitable product for my practice” (p = 0.01), “too costly” (p = 0.0006), “too time consuming” (p < 0.0001), and “planning to retire soon” (p = 0.001). No statistically detectable differences were found between ophthalmologists and other surgeons for the following barriers: privacy concerns, reliability concerns, and lack of training. ConclusionsThe barriers that limit increased EMR adoption among Canadian ophthalmologists are different from those of other surgeons. This may be attributed to unique features of the field, including heavy reliance on hand-drawn figures in documentation, high patient volume, and the high costs associated with independent practice. Given the well-established benefits of EMR technology, consideration should be given to implementing strategies to mitigate these barriers. Additional research may help determine which specific improvements can be made to increase the use of EMR systems by ophthalmologists.

The journey from precontemplation to action: Transitioning between electronic medical record systems.

Health care organizations, in response to federal programs, have sought to identify electronic medical record (EMR) strategies that align well with their visions for success. Little exists in the literature discussing the transition from one EMR strategy to another. The analysis and planning process used by a major academic medical center in its journey to adopt a new strategy was described in this study. We use the transtheoretical model of change to frame the five phases through which the organization transitioned from a best-of-breed system to an enterprise system. We explore the five phases of change from the perspective of a maturing approach to new technology adoption. Data collection included archival retrieval and review as well as interviews with key stakeholders. Although there was always a focus on some enterprise capabilities such as computerized physician order entry, the emphasis on EMR selection tended to be driven by specialty requirements. Focusing on the patient across the continuum of care, as opposed to focusing on excessive requirements by clinical specialties, was essential in forming and deploying a vision for the new EMR. This research outlines a successful pathway used by an organization that had invested heavily in EMR technology and was faced with evaluating whether to continue that investment or start with a new platform. Rather than focusing on the technology alone, efforts to reframe the discussion to one that focused on the patient resulted in less resistance to change.

Designing Technology to Decrease Pneumonia in Intubated Trauma Patients.

Trauma patients are at increased risk for developing ventilator-associated pneumonia. Sixty adult trauma intensive care unit patients were audited 3 months prepractice change, and 30 were audited postpractice change. Quality improvement interventions included staff education of a redesigned electronic medical record ventilator bundle and chlorhexidine gluconate administration timing practice change. Postpractice change audits revealed 2-hour chlorhexidine gluconate documentation increased from 38.3% to 73.3% and incidence of pneumonia in intubated patients decreased by 62%. Early initiation of chlorhexidine gluconate mouth care utilizing electronic medical record technology may help reduce pneumonia in intubated patients, hospital length of stay, overall health costs, and improve documentation.

Electronic medical record in cardiology: a 10-year Italian experience.

the aim of this study was to report a ten years experience in the electronic medical record (EMR) use. An estimated 80% of healthcare transactions are still paper-based. an EMR system was built at the end of 1998 in an Italian tertiary care center to achieve total integration among different human and instrumental sources, eliminating paper-based medical records. Physicians and nurses who used EMR system reported their opinions. In particular the hospital activity supported electronically, regarding 4,911 adult patients hospitalized in the 2004- 2008 period, was examined. the final EMR product integrated multimedia document (text, images, signals). EMR presented for the most part advantages and was well adopted by the personnel. Appropriateness evaluation was also possible for some procedures. Some disadvantages were encountered, such as start-up costs, long time required to learn how to use the tool, little to no standardization between systems and the EMR technology. the EMR is a strategic goal for clinical system integration to allow a better health care quality. The advantages of the EMR overcome the disadvantages, yielding a positive return on investment to health care organization.

Use of Electronic Health Record Clinical Decision Support Tools in Antimicrobial Stewardship Activities

The Society for Healthcare Epidemiology of America and the Infectious Disease Society of America (SHEA/IDSA) released guidelines outlining the strategies of antimicrobial stewardship program (ASP) activities in 2006. These strategies have been supported by advances in technology, beginning with the novel use of clinical decision support systems (CDSS) at LDS Hospital in Salt Lake City, UT. This sophisticated home-grown program allowed for timely and tailored information to be exchanged between the electronic medical record (EMR) and physicians, resulting in reduced drug costs and improved patient outcomes. This CDSS technology became the basis of many third-party vendors that emerged to offer support and improve clinical and fiscal outcomes. However, third-party programs are expensive, require double documentation of interventions within the third-party platform and the EMR, and lack prescriber interaction at the time of prescribing; although they are more customizable and allow for real-time alerts between the microbiology lab and ASP team members. The advancement of the electronic health records (EHR) has expanded the capability for ASPs to use the EHR for clinical stewardship activities rather than outsource it to a third-party vendor. Epic and Cerner currently lead the market in EMR technology and are expected to continue expanding ASP functionality in their foundation systems.

Right Brain: The E-lephant in the room: One resident's challenge in transitioning to modern electronic medicine.

The electronic medical record (EMR) is changing the landscape of medical practice in the modern age. Increasing emphasis on quality metric reporting, data-driven documentation, and timely coding and billing are pressuring institutions across the country to adopt the latest EMR technology. The impact of these systems on the patient-physician relationship is profound. One year following the latest EMR transition, one resident reviews his experience and provides a personal perspective on the impact the EMR on patient-physician communication.