Electronic Recordkeeping Systems Research Articles

Engaging in meaningful discussion: What nurse practitioners need to know about retirement and end-of-life planning.

Nurse practitioners (NPs) should be knowledgeable about entering into meaningful conversations with clients about their retirement and end-of-life planning. Through knowledge of advanced care planning, NPs should be prepared to serve as a resource as clients develop life plans. Nurse practitioners should assess their practice for documenting client wishes that align with the 1990 Patient Self-Determination Act and advocate for changes in electronic record-keeping systems.

Identification of Children Using HOG

Abstract: Adults often utilize biometric recognition for a variety of tasks that require a personal identification evidence to be validated. Children's biometric identification, however, is still a challenge. In addition to helping find lost children and their families, developing border control systems to stop child trafficking, and assisting electronic recordkeeping systems, addressing this issue helps safeguard children against identity theft and identity fraud. Researchers are gathering biometric data from newborns' fingerprints, irises, and outer ears in order to start creating biometric recognition systems for kids. Children's ear mode was implemented using the hardware and software that were previously utilized for adults. Existing hardware was utilized in iris mode to find iris pictures. In order to capture children's fingerprints and transform the pictures into a backdrop format that complies with current international standards for issuing and comparing minutiae, new image processing gear and software have been created. Based on analyzing the effectiveness of usage and measuring the amount of performance, the benefits and drawbacks of utilizing each of these strategies throughout the first year of life were compared. Recommendations for the usage of each approach were given, despite the fact that they weren't always best practices.

Examining the Information Communication Technology Use of Rural Child Welfare Workers Using the Experience Sampling Method

The main goals of this article are to promote the use of the experience sampling method (ESM) in library and information science education and research, by describing its origin in flow theory and demonstrating its use in a study of information and communication technology (ICT) use (i.e., electronic record-keeping systems, email, text messaging, social media, online meeting tools, apps) among rural child welfare workers. This article reviews the methodological considerations of ESM and demonstrates, step by step, how to structure such a study and approach data analysis. Findings, conclusions, and implications of the rural child welfare worker study are also reviewed. This paper will be of use in courses on theory, research, information behavior, information practices, technology adoption and use, and the assessment of information programs and services. It can be used to further orient students to theory, to help them make the connection between theory and method, and to promote critical thinking about research findings and conclusions.

Biometric Recognition of Infants using Fingerprint, Iris, and Ear Biometrics

Biometric recognition is often used for adults for a variety of purposes where an individual's identity must be ascertained. However, the biometric recognition of children is an unsolved challenge. Solving this challenge could protect children from identity theft and identity fraud, help in reuniting lost children with their parents, improve border control systems in combatting child trafficking, and assist in electronic record-keeping systems. In order to begin the development of biometric recognition systems for children, researchers collected fingerprint, iris, and outer ear shape biometric information from infants. Each modality provides different challenges. Where possible, the performance of existing hardware and software that was developed for adults was assessed with infants. Where necessary, novel hardware or software was developed. For the ear modality, existing hardware and software which have previously been applied to adults were applied to children. For the iris modality, existing hardware was used to acquire the images, while adjustments to the existing preprocessing algorithms were applied to cater for the localisation and segmentation of infant irises. For the fingerprint modality, novel hardware and image processing software were developed to acquire fingerprints from infants, and convert the images into a format which is backward compatible with existing international standards for minutiae extraction and comparison. The advantages and disadvantages of using each of these modalities during the first year of life were compared, based on both qualitative assessments of usage, and quantitative assessments of performance. While there is no conclusively best modality, recommendations of usage for each modality were provided.

Development of mNavigator: Digital Health Application to Facilitate Compliance With Standardized Pediatric Cancer Treatment Protocols in Tanzania

PURPOSE Use of standardized treatment protocols has been demonstrated to improve outcomes for pediatric patients with cancer. Yet it is challenging to implement standardized treatment protocols in low- and middle-income countries as a result of infrastructure and resource constraints, as well as poor health provider compliance with treatment protocols. At Bugando Medical Centre (BMC) in Tanzania, health provider compliance with standardized paper-based treatment protocols is low at 22%. One-year overall survival rates among pediatric patients with cancer at BMC are 40% and almost one third of patients abandon treatment. We posit that improving protocol compliance in this setting may decrease treatment abandonment and improve survival rates. Use of digital case management systems has been shown to improve compliance with treatment protocols because of the ability to incorporate such features as decision-support algorithms, prompts and alerts, and checklists. The digital health application mNavigator was designed to facilitate health provider compliance with standardized pediatric cancer treatment protocols in Tanzania. METHODS mNavigator was developed by adapting an open-source digital case management platform called CommCare. The three stages of mNavigator development were as follows: workflow mapping and form development; form programming in CommCare; and quality assurance using mock and deidentified patient records to identify errors in information flow or outputs, assess preliminary usability, and determine areas for improvement. Standardized treatment protocols for Burkitt lymphoma and retinoblastoma were initially incorporated into mNavigator. The mNavigator prototype underwent usability testing at BMC before implementation in routine clinical practice. RESULTS Preliminary system usability, acceptance, and satisfaction evaluation demonstrated high usability response scores (> 80%). Perceived benefits of the mNavigator system included a user-friendly interface, improved record keeping, and assistance with patient tracking using standardized treatment protocols. Suggestions for improvement centered on the incorporation of other standardized treatment protocols (eg, Wilms tumor), improving interoperability with existing electronic recordkeeping systems, and making similar systems available for other clinical departments. CONCLUSION To our knowledge, mNavigator is the first digital health case management system specifically developed to improve health provider compliance with pediatric cancer treatment protocols in a low-resource setting. With high usability and acceptability, mNavigator has been implemented in routine clinical practice. Implementation and patient outcomes evaluations are ongoing and will inform the scale-up for use in other low- and middle-income countries.

Why high tech needs high touch: Supporting continuity of community primary health care

BackgroundIntegrated care through community-oriented primary care (COPC) deployed through municipal teams of community health workers (CHWs) has been part of health reform in South Africa since 2011. The role of COPC and integration of information and communication technology (ICT) information to improve patient health and access to care, require a better understanding of patient social behaviour.AimThe study sought to understand how COPC with CHWs visiting households offering health education can support antenatal follow-up and what the barriers for access to care would be.MethodA mixed methodological approach was followed. Quantitative patient data were recorded on an electronic health record-keeping system. Qualitative data collection was performed through interviews of the COPC teams at seven health posts in Mamelodi and telephonic patient interviews. Interviews were analysed according to themes and summarised as barriers to access care from a social and community perspective.ResultsAn integrated COPC approach increased the number of traceable pregnant women followed up at home from 2016 – 2017. Wrong addresses or personal identification were given at the clinic because of fear of being denied care. Allocating patients correctly to a ward-based outreach team (WBOT) proved to be a challenge as many patients did not know their street address.ConclusionPatient health data available to a health worker on a smartphone as part of COPC improve patient traceability and follow-up at home making timely referral possible. Health system developments that support patient care on community level could strengthen patient health access and overall health.

The implementation of electronic recordkeeping systems

PurposeThis study aims to present the findings of the first phase of a project entitled Putting the “Fun” Back in “Functional”, which has been investigating the socio-technical issues surrounding users’ interaction with electronic recordkeeping systems. The ultimate goal of the project is to improve that interaction by positively influencing the way in which individuals perceive their work practices and the tools they use to accomplish them. In its first phase, the project considered the implementation of such systems for the purpose of gaining a better understanding of the factors and processes that contribute to its success.Design/methodology/approachSemi-structured interviews were conducted with 17 public employees from a large provincial government and a large city government in Canada about two information systems (ISs) – a meeting management system and an Electronic Documents and Records Management System.FindingsSeveral salient themes emerged from the research data, including the value accorded to information and records, the implementation of electronic recordkeeping systems as a complex process, the appropriation of electronic recordkeeping systems, understanding users, ease of use and information/records specialists as part of the solution. Analysis of these themes shows that many of them can be explained through theories developed in the IS field.Research limitations/implicationsThe results show that many themes are common across the records management and IS fields. Further, the results indicate the applicability of theories in the IS field to explain and predict the implementation of electronic recordkeeping systems.Originality/valueThis study is one of few that explicitly draw on IS theories to understand the implementation of electronic recordkeeping systems. The results of this study open up many opportunities for future research on electronic recordkeeping systems.

Randomized noninferiority clinical trial evaluating 3 commercial dry cow mastitis preparations: II. Cow health and performance in early lactation

The objective of this randomized noninferiority clinical trial was to compare the effect of treatment with 3 different dry cow therapy formulations at dry-off on cow-level health and production parameters in the first 100d in milk (DIM) in the subsequent lactation, including 305-d mature-equivalent (305ME) milk production, linear score (LS), risk for the cow experiencing a clinical mastitis event, risk for culling or death, and risk for pregnancy by 100 DIM. A total of 1,091 cows from 6 commercial dairy herds in 4 states (California, Iowa, Minnesota, and Wisconsin) were randomly assigned at dry-off to receive treatment with 1 of 3 commercial products: Quartermaster (QT; Zoetis Animal Health, Madison, NJ), Spectramast DC (SP; Zoetis Animal Health) or ToMorrow Dry Cow (TM; Boehringer Ingelheim Vetmedica Inc., St Joseph, MO). All clinical mastitis, pregnancy, culling, and death events occurring in the first 100 DIM were recorded by farm staff using an on-farm electronic record-keeping system. Dairy Herd Improvement Association test-day records of milk production and milk component testing were retrieved electronically. Mixed linear regression analysis was used to describe the effect of treatment on 305ME milk production and LS recorded on the last Dairy Herd Improvement Association test day before 100 DIM. Cox proportional hazards regression analysis was used to describe the effect of treatment on risk for experiencing a case of clinical mastitis, risk for leaving the herd, and risk for pregnancy between calving and 100 DIM. Results showed no effect of treatment on adjusted mean 305ME milk production (QT=11,759kg, SP=11,574kg, and TM=11,761kg) or adjusted mean LS (QT=1.8, SP=1.9, and TM=1.6) on the last test day before 100 DIM. Similarly, no effect of treatment was observed on risk for a clinical mastitis event (QT=14.8%, SP=12.7%, and TM=15.0%), risk for leaving the herd (QT=7.5%, SP=9.2%, and TM=10.3%), or risk for pregnancy (QT=31.5%, SP=26.1%, and TM=26.9%) between calving and 100 DIM.

Intraoperative Hypotension and 1-Year Mortality after Noncardiac Surgery

Intraoperative hypotension (IOH) is frequently associated with adverse outcome such as 1-yr mortality. However, there is no consensus on the correct definition of IOH. The authors studied a number of different definitions of IOH, based on blood pressure thresholds and minimal episode durations, and their association with 1-yr mortality after noncardiac surgery. This cohort study included 1,705 consecutive adult patients who underwent general and vascular surgery. Data on IOH and potentially confounding variables were obtained from electronic record-keeping systems. Mortality data were collected up to 1 yr after surgery. The authors used two different techniques to reduce the influence of confounding variables, multivariable Cox proportional hazard regression modeling and classification and regression tree analysis. The mortality within 1 yr after surgery was 5.2% (88 patients). After adjustment for confounding, the Cox regression analysis did not show an association between IOH and the risk of dying within 1 yr after surgery (hazard ratio around 1.00 with high P values for different definitions of IOH). Additional classification and regression tree analysis identified IOH as a predictor for 1-yr mortality in elderly patients. When the blood pressure threshold for IOH was decreased, the duration of IOH at which this association was found was decreased as well. This observational study showed no causal relation between IOH and 1-yr mortality after noncardiac surgery for any of the definitions of IOH. Nevertheless, additional analysis suggested that for elderly patients, the mortality risk increases when the duration of IOH becomes long enough. The length of this duration depends on the designated blood pressure threshold, suggesting that lower blood pressures are tolerated for shorter durations. The effect of IOH on 1-yr mortality remains debatable, and no firm conclusions on the lowest acceptable intraoperative blood pressures can be drawn from this study.

Adverse Physiological Events under Anaesthesia and Sedation: A Pilot Audit of Electronic Patient Records

Review of perioperative activity including adverse events, throughput and compliance with 'best practice', can theoretically be used to optimise healthcare delivery. Computer-based analysis of electronic patient records could provide a practical means to manage quality improvement. This pilot study examined the effectiveness of such a system in practice. All intraoperative patient notes and physiological data were collected over 17 months in a rural hospital using data from an electronic record-keeping system. Algorithms were developed to automatically identify potential adverse events based on physiological measures. Each computer-identified event was reviewed by a panel of three anaesthetists and assessed for validity, severity and probable cause. Two areas were identified to pilot quality improvement activities-sedation for colonoscopies and inhalational anaesthesia with desflurane. Specific 'in-house' guidelines were created for these procedures and feedback on the patterns of adverse events were provided to anaesthetic staff A total of 138 separate adverse events were identified for all operative cases over 17 months, with an overall adverse event incidence of 3.3%. The adverse event incidence during colonoscopy and laryngospasm/hypoxia during desflurane anaesthesia was 6.3% and 1.3% respectively. This decreased to 2.8% (P <0.005) and 0.13% (P <0.0001) respectively for the nine months following feedback and the introduction of guidelines. Anaesthesia information systems can be an effective quality improvement tool and may enhance existing tools such as incident reporting systems.

The Value of Routine Preoperative Electrocardiography in Predicting Myocardial Infarction After Noncardiac Surgery

The added value of a preoperative electrocardiogram (ECG) in the prediction of postoperative myocardial infarction (POMI) and death was compared with clinical risk factors identified from the patient's history. An ECG is frequently performed before surgery to screen for asymptomatic coronary artery disease. However, the value of ECG abnormalities to predict POMI has been questioned. The study included 2967 noncardiac surgery patients >50 years of age from 2 university hospitals, who were expected to stay in the hospital for >24 hours. All data were obtained from electronic record-keeping systems. Patient history and ECG abnormalities were considered as potential predictors. Multivariate logistic regression analysis was used to obtain the independent predictors of POMI and all-cause in-hospital mortality. The area under the receiver operating characteristic curve (ROC area) was estimated to evaluate the ability of different models to discriminate between patients with and without the outcome. A preoperative ECG was available in 2422 patients (80%) and 1087 (45%) of the ECGs showed at least one abnormality. The ROC area of the model that included the independent predictors of POMI obtained from patient history, ie, ischemic heart disease and high-risk surgery, was 0.80. ECG abnormalities that were associated with POMI were a right and a left bundle branch block. After adding these abnormalities in the regression model, the ROC area remained 0.80. Similar results were found for all-cause mortality. Bundle branch blocks identified on the preoperative ECG were related to POMI and death but did not improve prediction beyond risk factors identified on patient history.

Implementing and Auditing Electronic Recordkeeping Systems Used in Scientific Research and Development

Electronic recordkeeping is increasingly replacing handwritten records in the course of "normal business." As this trend continues, it is important that organizations develop and implement electronic recordkeeping policies and procedures. This is especially true for research and development organizations because of the potential to transform a discovery into a patent, and at times patent application contests are resolved in litigation. This paper provides a basis for the development, implementation, and subsequent assessment of a research and development recordkeeping policy. The approach described in this paper should be tailored by the organization adopting this approach to meet the needs of their organization.

Education reduces unnecessary diagnostic blood sampling in the intensive care unit (ICU)

Diagnostic blood sampling is an indispensable and effective tool for assessing critically ill patients. It has been demonstrated that a substantial blood volume is drawn daily from these patients [1]. A recent review of UK practice suggested a number of measures to reduce this [2]. Furthermore the recent introduction of an integrated electronic record-keeping system in our unit ensured that maximum information could be derived from each sample. In order to assess whether it is possible to optimise the amount of blood sampled, we performed a prospective cohort controlled study to compare blood volumes used for sampling before and after a 2 month education period.

Principles, Methods, and Instruments for the Creation, Preservation, and Use of Archival Records in the Digital Environment

This paper focuses on the need for a systematic redefinition of the archival methods and tools required for building electronic recordkeeping systems. The analysis, which has been developed for archival education in Italy, is carried out through an examination of the historical evolution of the main functions for records creation (classification and the registry system) and the evaluation of their effectiveness in the newly developed and technologically advanced records systems. Special attention is given to the risks posed by new Italian and European rules on electronic records. These rules are based on the use of digital signature as the only guarantee for a record's reliability and authencity. It is argued, however, that the digital organization of the records, even if updated and improved, cannot be efficient if it ignores the traditional functional requirements for recordkeeping.

Debate Flares Over Tracking Foreigners

Congress, the Administration, and members of a national commission are worried that some foreign students studying in the United States may be using their education as a cover for terrorism, leading to a proposal to watch them more closely. But officials from universities already participating in a pilot electronic recordkeeping system for the Immigration and Naturalization Service feel that the new proposal goes too far. They say the terrorist threat is overstated and that the increased surveillance could turn into an administrative nightmare that could harm U.S. institutions.

Computer assisted physiologic monitoring and stability assessment in vascular surgical patients undergoing general anesthesia--preliminary data.

Physiologic monitors present an influx of numerical data that can be overwhelming to the clinician. We combined several parameters in an effort to reduce the amount of information that must be continuously monitored including oxyhemoglobin saturation by pulse oximetry, end-tidal CO2 concentration, arterial blood pressure, and heart rate into an integrated measure--the health stability magnitude (HSM). The HSM is computed for a predetermined basal period, the reference HSM (RHSM), and recalculated continuously for comparison with the baseline value. In this study we present the HSM concept and examine changes in the HSM during abdominal aortic aneurysm surgery. After IRB approval, nine patients were studied. The anesthesiologist recorded all significant intra-operative events. Within a defined time interval, data were recorded and used to calculate a combined parameter, the HSM. The baseline or reference value of this index (RHSM) was calculated after the induction of anesthesia. Individual HSM values were repeatedly calculated for ten second periods after the RHSM value was established. A > 30% deviation of the HSM from the RHSM was considered significant. Deviations in the HSM were compared with events recorded by the anesthesiologist on a paper record and with the record from an electronic record-keeping system. The deviation observed between two consecutive HSMs, called dHSM, was plotted against HSM to construct a contour diagram of data from all patients to which individual cases could be compared. The plot showed that dHSM vs. HSM values were tightly clustered. The inner contour on the distribution plot contained 90% of values. Individual patient's time course, projected on this diagram, revealed deviations form "normal" physiology. Fifty-nine events led to > 30% deviations in the HSM; 27 were anticipated events and 32 were unanticipated. The correlation between HSM and dHSM depicts changes in multiple monitored parameters that can be viewed using a single graphical representation. Projection of individual cases on the contour diagram may help the clinician to distinguish relative intraoperative stability from important events. Data reduction in this manner may guide clinical decision-making in response to unanticipated or unrecognized events.

Electronic recordkeeping – more than electronic document management

Information and communication technology rapidly developed over the past decade and provided the means to easily capture, store and distribute documents in vast quantities and at an ever‐increasing speed. To be able to make good use of this information instead of becoming swamped by it, scientific controls need to be applied. Records management provides these controls. This article explains how one software developer combines traditional records management practices with electronic document management features to create an electronic recordkeeping system.

Definitions of Electronic Records, the European Perspective

For the definition of electronic records, the use of new terms, like “literary warrant”, is not necessary, and for the European perspective even not understandable. If this expression simply means “best practice and professional culture” in recordkeeping, we only to know what creators did for centuries and still do today and probably will do also in the future, by referring to the archival science, diplomatics and archival practice for clarifying definitions in the recordkeeping environment. A multi-disciplinary approach is still required for the electronic recordkeeping system as it was in the past for traditional records, but the theory and the terminology should be consistent and based on the deep understanding of essential characteristics of records and essential requirements of good recordkeeping to produce in the first place and maintain reliable and authentic records. Of course, a record is more than recorded information created in the course of business activity: a record is the recorded representation of an act produced in a specific form – the form prescribed by the legal system – by a creator in the course of its activity.

Messrs. Washington, Jefferson, and Gates: Quarrelling About the Preservation of the Documentary Heritage of the United States

Within the past six months a debate has ensued about the utility of documentary letterpress editions in the late twentieth century as a means for preserving archival records of the United States. The catalyst for this debate was the decision by the U. S. National Historical Publications and Records Commission to revise its funding priorities away from the documentary editions in favor of state regrant projects and research and development in electronic recordkeeping systems. Much of the debate about this proposed change focused on the value of traditional printed sources in the Information Age. This essay looks at this debate in three contexts: the nature of documentary editing; the relationships and respective missions of historians, documentary editors, and archivists; and the nature of records and recordkeeping technologies. My perspective is that of an archivist, and my conclusion is that documentary editing needs to re-orient itself to using new technologies to provide access to the archival documents managed by the editorial projects.

Florida's response to serving citizens in the information age

The Florida Legislature created the Joint Committee on Information Technology Resources for the purpose of, in part, analyzing the impact of advances in information technology on the Florida Public Records Law. In responding to the U.S. Information Industry Association's recently promulgated access principles for state and local government, the author found that although Florida does not actively encourage a diversity of information sources, such diversity is an indirect result of the state's long tradition of open access. The public's right of access is now guaranteed in Florida by a new constitutional amendment that guarantees every person the right to inspect or copy the public records of all three branches of Florida government. Florida's law is silent about an agency's obligation to provide a public record in a particular medium. However, the Joint Committee has proposed legislation that would require an agency to provide a copy of a public record in the medium requested. Additionally, the proposed legislation would allow a reasonable fee for costs for the labor and overhead associated with duplicating or copying a computer database; current law allows only the actual cost of duplication. In an effort to insure equal and timely access, this legislation also contains a provision that requires agencies to consider public access and redaction of exempt information in the design and development of all electronic recordkeeping systems. In an attempt to avoid monopoly control over public information, the author sponsored legislation last year that would have repealed Florida's law allowing the copyright of agency-created software. The Joint Committee's proposed legislation has a provision that would assure meaningful access to data controlled by proprietary software and would also preclude an agency from entering into any contract that would impair the right of the public to inspect and copy public records.