Implementation Of Electronic Patient Record Research Articles

Use of electronic patient records and encrypted email patient communication among Swiss chiropractors: a population-based cross-sectional study

BackgroundThe implementation of electronic health information technologies is a key target for healthcare quality improvement. Among Swiss chiropractors, reliable data on the use of electronic heath information technologies and distribution of the health workforce was lacking.ObjectivesTo estimate the prevalence of electronic patient record (EPR) and encrypted email communication use among Swiss chiropractors and describe the geographic distribution of chiropractors in Switzerland.MethodsPopulation-based cross-sectional study of all active practising members of the Swiss Chiropractic Association (ChiroSuisse) between 3 December 2019 and 31 January 2020. We asked about clinician and practice characteristics, EPR use for clinical record keeping, use of encrypted email for patient communication, and information on EPR and encrypted email communication products used. Multivariable logistic regression analyses assessed the associations between clinician and practice characteristics and (1) EPR use, and (2) encrypted email use.ResultsAmong 286 eligible Swiss chiropractors (193 [68%] men; mean age, 51.4 [SD, 11.2] years), 217 (76%) completed the survey (140 [65%] men; mean age 50.7 [11.2] years). Among respondents, 47% (95% confidence interval [CI], 40–54%) reported using an EPR in their practice, while 60% (95% CI, 54–67%) endorsed using encrypted email technology. Chiropractors aged ≥ 60 (versus those ≤ 39) years were 74% less likely to use an EPR system (OR 0.26, 95% CI 0.08 to 0.77), while clinicians from practices with 4 or more chiropractors (versus those from solo practices) were over 5 times more likely to report EPR use (OR 5.6, 2.1 to 16.5). Findings for factors associated with encrypted email use were similar. The density of chiropractors in Switzerland was 3.3 per 100,000 inhabitants.ConclusionsAs of January 2020, 286 duly licensed chiropractors were available to provide musculoskeletal healthcare in Switzerland — just under 50% of responding Swiss chiropractors used an EPR system in clinical practice, while 60% used encrypted email technology. Better implementation of EPR and electronic health information technologies in Swiss chiropractic practice is possible and encouraged for the purpose of musculoskeletal healthcare quality improvement.

Electronic patient medical records: Agility in the management of medical-expert information in the aeronautical health boards

The Electronic Patient Record (EPR) is already a reality in the practice of many offices, diagnostic centers and hospitals. The Federal Council of Medicine (FCM) regulated its use, through FCM Resolution n° 1,821/2007 In the Health Boards (HB) of the COMAER, agencies responsible for doing the medical-expert examinations of the military force, the paper record is still the rule. There is no automatic sharing of information between HB. In this context, it is perceived the need for the implementation of the unified EPR for the COMAER HB, because it speeds up the sharing of medical-expert information of the military and allows the military to carry out their health inspections in different locations, not interfering in the planning of missions so peculiar to the force, saving time and costs, speeding up the release of the results and control of inspections. The research thus consists of the qualitative approach, with exploratory objective and bibliographic procedure, carried out in the Scielo and Google Scholar databases, based on the discussion in ten articles, in addition to the FCM Resolutions. It was noted that the perspective that EPR has direct advantages for the Institution, however, requires an abrupt cultural change to the model that is made today, to provide a greater speed among the HB, even if in the transition phase, it is chosen to use in parallel in paper and Information and Communication Technologies. Therefore, the implementation of EPR in HB can provide both multidisciplinary teams and users of COMAER HB, a more efficient medical-expert assistance by promoting information sharing and agility in the performance of Health Inspections.

Benefícios e desvantagens da implementação do prontuário eletrônico do paciente para o serviço de saúde

Trata-se de uma pesquisa bibliográfica de abordagem qualitativa e caráter descritivo com o objetivo em identificar os benefícios e desvantagens encontradas na implementação dos Prontuários Eletrônico do Paciente no serviço de saúde. Como metodologia. Os dados foram coletados em Base de Dados Virtuais. Para tal utilizou-se a BVS, nas seguintes Bases de informações LILACS, MEDLINE, BDENF e pelo endereço eletrônico scholar.google.com.br, no período de maio de 2019. Como resultados, foram encontradas vantagens como agilidade no acesso de informações relacionadas ao paciente, uso simultâneo dos prontuários, legibilidade, eliminação da redundância de dados, organização sistematizada e ainda desvantagens como grandes investimentos de hardware, software e treinamento, resistência dos profissionais de saúde e lentidão e inoperância dos sistemas. Conclui-se que devem ser considerados, para implementação do PEP, a padronização dos prontuários, o estabelecimento dos fluxogramas de informação da equipe, o treinamento de todos envolvidos e o controle e avaliação dos resultados.

Introduction of an electronic patient record (EPR) improves operation note documentation: the results of a closed loop audit and proposal of a team-based approach to documentation

An operation note is a medicolegal document. The Royal College of Surgeons (RCS) of England’s Good Surgical Practice 2014 (GSP) sets out 19 points an operation note should include. This...

What to expect from electronic patient record system implementation: lessons learned from published evidence

BackgroundNumerous studies have examined factors related to success, failure and implications of electronic patient record (EPR) system implementations, but usually limited to specific aspects.ObjectiveTo review the published peer-reviewed literature and...

Staff Nurses and Physicians Attitudes toward the Use of Electronic Patient Record

Background: Electronic Patient record (EPR) links consumers, payers and providers across the continuum of care and provides relevant information to them. It is essential that information can be accessed from anywhere in the healthcare delivery system, even in remote locations. Aim: The current study aimed to assess and compare staff nurses' and physicians' attitudes toward EPR. Design: The study used a descriptive survey using self-report questionnaire. Setting: The present study was carried out at a private hospital namely Al Salama New Hospital and it is considered the first and the only hospital in Alexandria governorate at Egypt that implemented the EPR documentation system since 2004. It is equipped with around 100 beds, with a wide range of healthcare services. Subjects: One hundred and twenty five nurses and 90 physicians who were working in the previously mentioned setting. Tool: The data gathering tool staff nurses and physicians' attitudes toward EPR questionnaire. It was developed by the researcher based on Noble James nurses' attitudes toward computerization questionnaire (2002) and the current related literature to determine staff nurses and physicians' attitudes toward the use of EPR. It consists of five main dimensions and 56 sub- dimensions. Results: Around two- third 65.6% of staff nurses had positive attitudes toward the use of EPR. On the other hand, more than three quarters of physicians 75.6% had positive attitudes toward the use of EPR. In addition with no significant difference was found between staff nurses and physicians. The total score percent of the physicians' attitudes (75.6) was higher than the total mean score of the staff nurses' attitudes (65.6). Conclusion: Knowledge, training, and attitude need continual reinforcement to improve implementation for EPR. These results provide valuable information that could be used to encourage the implementation of EPR in Egypt. Recommendations: This study recommended for assuring electronic based documentation as criteria for magnet hospitals on the road of accreditation of healthcare organization. Develop clear policies and guidelines to address issues related to computer based documentation. It should be written and communicated to all healthcare organizations.

Implementation of Electronic Patient Records in two Rural District Hospitals and one Urban University Hospital in Cameroon

Background and objectives: The health system in Cameroon has to deal with several health problems which increasingly affect the economically active population (e.g. AIDS, Multidrug-resistant tuberculosis, increasing rate of diabetes, nephrology, cardiovascular and other chronic diseases). It is globally recognized that care processes of these health problems can be efficiently and effectively managed in care facilities with electronic patient records. In addition, the work of research organizations and strategic institutions such as the Ministry of Health and research or international institutions reply partly on the quality of data and the reports of locally operating facilities. Experience gathered on AIDS and tuberculosis in other developing countries has proven that innovative locally appropriate implementation of cost-effective electronic patient records (EPR) can lead to considerable improvement. For this reason, we implemented and evaluated an already validated innovative eHealth-based solution with EPR in two rural district hospitals and one urban university hospital of Cameroon, in order to contribute to the improvement of the situation presented here, compare and evaluate implementation challenges (difference between rural and urban facilities), measure the impact on the local care process, and identify success and sustainability factors for future projects. Methods: A review of the relevant research literature and project report has been performed. A Stakeholder analysis was conducted using qualitative methods. Process and infrastructure analysis were performed and key requirements identified. Based on these, an implementation plan and evaluation indicators were formulated. Agile methods (SCRUM and KANBAN) and quality management based on continuous improvement processes were applied for the project management (including software development and change management). Result and discussion: The 22 indicators evaluated indicated that 5 activities were realized within the planed timeslot, 14 activities have been partially realized with an average delay of about 7 months, and some activities were postponed for the second phase of the project. The qualitative evaluation conducted at the end of the first phase of this research project showed a clear satisfaction of the stakeholders with the achieved results and specially the methods approach. This enhanced the local ownership which is a key requirement for the project sustainability. The agile methods and the availability for volunteer experts however led often to an extension of the activities deadlines.

Learning to work with electronic patient records and prescription charts: experiences and perceptions of hospital pharmacists

The use of electronic patient records (EPR) and electronic prescribing systems (such as electronic patient medication and administration records (EPMAR)) have many benefits. Changes and problems can result, however. Anecdotally, how pharmacists respond to system introduction varies greatly; there is very little information regarding pharmacists' experience in the literature. This study aimed to establish the changes that electronic systems afforded to hospital pharmacists' working practices and to investigate how and why they had responded to EPR and EPMAR. Four semi-structured focus groups were conducted with pharmacists with different levels of seniority, with 4-6 participants in each. The focus groups were held 8 months after implementation of EPR and EPMAR were complete, and each focus group met once. Transcripts were analyzed manually using thematic analysis and data interpreted through the application of Actor Network Theory (ANT) and human activity systems as described in Engestrom's Expansive Learning Theory (ELT). The three main overarching themes identified involved reduced patient contact, professional representation in the clinical environment and documentation in the EPR. Pharmacists felt less visible to, and had poorer relationships with, patients as they no longer saw them when they checked prescriptions. Interprofessional relationships changed as pharmacists provided informal EPMAR training for doctors and spoke more often with nurses to relay important information. Changes in whether, what and how pharmacists recorded information also were seen, particularly between pharmacists of different generations and years of working at the hospital. Analysis of the changes afforded by electronic systems using ANT and ELT suggest that pharmacists develop individual working practices in response to changes that electronic systems provide. For implementation success of EPR and EPMAR systems, pharmacists need to be taught not just the practicalities of system use, but also how to ensure that patients remain the focus of care, in response to the professional changes that may well occur following computerization.

The FIRE project: A milestone for research in primary care in Switzerland

Research is scarce where most patients are found. One of the main reasons is the difficulty in extracting data from traditionally conducted paper-based medical records. Thus, until now most existing patient records have originated from invoicing-tools. Endeavours to truly reflect a doctor's consultation have been rare. FIRE (Family Medicine ICPC-Research using Electronic Medical Records) is an ambitious project to establish a proper knowledge base in primary care by using the ongoing implementation of EPR (electronic patient records). FIRE will enable many questions on epidemiology and performance within the PC (primary care) setting to be answered. GPs (general practitioners) throughout Switzerland working with EPR were eligible for participation. Workshops were held to train and standardise ICPC-coding (International Classification of Primary Care), a classification system especially designed for the PC-setting. The recorded data included administrative information on the GP and patient, vital signs, ICPC codes, laboratory analysis and medication. Data exporter software was developed for extracting anonymised data automatically from the EPR onto a database for further statistical analysis. From 1.1.2009 until the beginning of April 2010 24 GPs were successfully recruited providing standardised information on 127,922 consultations in 29,398 patients and 159,956 medical problems according to the ICPC-2 classification. The project proves the feasibility of standardised ongoing collection of research data embedded in routine clinical practice. FIRE provides a unique database for research in PC and highlights the potential of broad implementation of EPR in a PC-setting. Studies resulting from the ongoing project have the potential to assess the quality of care provided by GP's.

Social systems and codes of communication in the health system – an empirical study of the communication of hospital personnel during the implementation of an electronic patient record

The point of departure is an empirical study of communication on hospital wards during the implementations of a new media of communication – an electronic patient record (EPR). The implementation of the EPR illustrates, that the chosen code of communication is of great importance in determining weather communication is successful. According to Niklas Luhmann the binary code sick/healthy is guiding the communication in the health system. However, in this paper it is argued that today the health system is made up of several sub-systems, each with their own distinctive code of communication.

Square pegs in round holes: Information systems, hospitals and the significance of contextual awareness

The considerable emphasis in the development and implementation of clinical information systems in hospitals internationally seems to have had a limited effect. In particular, the implementation of electronic patient record (EPR) systems has been slower and more difficult than anticipated and with little change in efficiency and security. This paper suggests why this might be the case. Well established research findings within the field of computer supported cooperative work (CSCW – an interdisciplinary research field between informatics and the social sciences) are cited to construct a case for greater awareness of (1) inter- and intra-professional interests, and (2) broader social and health policy contexts. We draw on Gouldner's work [(1957). Cosmopolitans and locals: toward an analysis of latent social roles – I. Administrative Science Quarterly, 2(3), 281–306; (1958). Cosmopolitans and locals: toward an analysis of latent social roles – II. Administrative Science Quarterly, 2 (4), 444–480] on organisational roles to develop a discussion of professional awareness; a pivotal notion is also the interactionist one of the hospital as a ‘negotiated order’. Drawing for illustrative purposes on the Norwegian experience (that is, reviewing research on hospital information systems in Norway), we contend that enhanced awareness of the hospital itself as a social system may be a precondition of cost-effective hospital information and communication technologies.

Achieving successful EPR implementation with the penta-stage model

Electronic patient record (EPR) systems are currently being implemented in a plethora of healthcare organisations on both sides of the Atlantic. These systems, through their ability to integrate several functions and provide seamless access to information, are expected to enable value-driven patient-centric healthcare delivery. At a time when healthcare globally is under tremendous pressure, EPR appears to be the panacea. However, EPR implementation has major organisational and cultural implications that to date have not been addressed and thus play a major role in the less than optimal results currently being experienced post EPR implementation. To address this issue, we discuss the need to incorporate the Penta-Stage model developed by analysing various EPR implementations in healthcare settings in both the UK and the USA.

Effect of electronic patient record use on mortality in End Stage Renal Disease, a model chronic disease: retrospective analysis of 9 years of prospectively collected data

BackgroundIn chronic disease, health information technology promises but has yet to demonstrate improved outcomes and decreased costs. The main aim of the study was to determine the effects on mortality and cost of an electronic patient record used in daily patient care in a model chronic disease, End Stage Renal Disease, treated by chronic maintenance hemodialysis. Dialysis treatment is highly regulated, and near uniform in treatment modalities and drugs used.MethodsThe particular electronic patient record, patient-centered and extensively coded, was used first in patient care in 3 dialysis units in New York, NY in 1998, 1999, and 2000. All data were stored "live"; none were archived. By December 31, 2006, the patients had been treated by maintenance hemodialysis for a total of 3924 years. A retrospective analysis was made using query tools embedded in the software. The United States Renal Data System dialysis population served as controls. In all there were 1790 patients, with many underlying primary diseases and multiple comorbid conditions affecting many organ systems. Year by year mortality, hospital admissions, and staffing were analyzed, and the data were compared with national data compiled by the United States Renal Data System.ResultsAnalyzed by calendar year after electronic patient record implementation, mortality decreased strikingly. In years 3–9 mortality was lower than in years 1–2 by 23%, 48%, and 34% in the 3 units, and was 37%, 37%, and 35% less than that reported by the United States Renal Data System. Clinical staffing was 25% fewer per 100 patients than the national average, thereby lowering costs.ConclusionTo our knowledge, this is the first demonstration that an electronic patient record, albeit of particular design, can have a favorable effect on outcomes and cost in chronic disease. That the population studied has many underlying diseases affecting all organ systems suggests that the electronic patient record design may enable application to many fields of medical practice.

Data security and protection in cross-institutional electronic patient records

This paper aims at identifying the specific legal requirements concerning data security and data protection of patient health data that apply to a cross-institutional electronic patient record (EPR) and describes possible solutions for meeting these requirements. In Germany, the legal framework for such records provide that disclosure of patient health information to physicians of third-party institutions is only allowed in case that it is necessary for the joint treatment of the patient, i.e. in case of a “treatment connection”. As a first step, the functionality of a remote-access architecture was proven allowing a one-way connection between the EPR systems of two health institutions in Germany, which jointly treat tumor patients. Besides, a signature system model for ensuring the integrity and authenticity of medical documents was developed and implemented in the existing information system architecture of the University Medical Center of Heidelberg. Especially in Germany, the legal framework for cross-institutional EPRs is very complex and has a considerable influence on the development and implementation of cross-institutional EPRs. However, its introduction is thought to be valuable, since a cross-institutional EPR will improve communication within shared care processes, and thus improve the quality of patient care.

Electronic patient records: the view from maternity

The Government has made the development and implementation of electronic patient records (EPRs) central to its strategy for a new, modernised NHS. EPRs are intended to improve the organization and communication of clinical information, reduce duplication, and lead to increased patient involvement in the management of both their health record and their care. The results from this survey of maternity units in England and Wales have enabled the authors to make a preliminary assessment of how far the maternity services are prepared for such developments and how likely they are to accept them. The first of three articles, will report on how current record-keeping practices in maternity, and the legacy of existing maternity information systems are all likely to present considerable challenges for the policy and implementation of EPRs.

The relationship between team and organisational learning

Current government policy requires that all acute Trusts will have an Electronic Patient Record (EPR) by 2005 but there is no additional funding for such expensive technology. Instead funding must be found by reviewing internal policies and procedures. Such extensive organisational process review is an opportunity to bring about organisational learning but there is no government guidance on how to bring this about and a dichotomy exists within organisational learning theory. This paper investigates if teams are the bridge between divergent schools of thought on organisational learning, and considers if they are the mechanism to bring about both organisational learning and the delivery of a successful EPR implementation, the stated aim of government policy.