Integrated Electronic Medical Records Research Articles

Exploring the potential impact of adding upper limit single trigger MET thresholds to a paediatric early warning scoring tool at a tertiary children's hospital: a retrospective review.

This study aims to determine the impact of incorporating upper threshold vital sign triggers into the digital Children's Early Warning Tool (CEWT) on the number of medical emergency team (MET) alerts. De-identified vital set data from the Cerner Millennium Integrated Electronic Medical Records were obtained for all paediatric patients aged ≤16 years at a tertiary children's hospital in Brisbane over a 12-month period in 2022. Patients in the paediatric intensive care unit, post-anaesthetic care unit, or the emergency department were excluded as they would not trigger MET alerts in these locations. Microsoft Excel scripts were used to tabulate and graph the data to compare the number of MET alerts in the current system vs. the system with proposed upper thresholds for heart rate, respiratory rate, systolic blood pressure, and severe respiratory distress. A total of 389,352 vital sets were used for analysis after exclusions. Total cumulative MET alerts increased by 229% from 1,707 to 5,623. The number of increased alerts was inversely proportional to the age group. Respiratory rate and systolic blood pressure were the vital signs most associated with increased alerts. The largest number of new alerts came from patients with lower CEWT scores, while the largest proportional increase in alerts came from those with higher CEWT scores. Incorporating upper threshold vital sign triggers into the digital CEWT leads to a substantial increase in MET alerts. The consequent workload is not justified, given the lack of evidence suggesting a failure of the current CEWT system in recognising deteriorating patients.

Integrated Electronic Medical Record Design With Nutritional Screening System at NCC’s Teaching Factory

One of Politeknik Negeri Jember's Teaching Factories (TEFA) that offers community nutrition services is the Nutrition Care Centre (NCC). The design of electronic medical records (EMRs) for continuous care patients, especially those with non-communicable diseases, is being studied in order to meet the ever-increasing needs of health care, assist patients who require continuous care, and improve the way that modern medical technology serves humans. The Waterfall framework concept is used in the research process, and an electronic medical record system is designed in accordance with the goals and the overall architecture of the system. Black-box testing and white-box testing are then conducted to evaluate the features, dependability, and stability of the designed electronic medical record system. Furthermore, when combined with other research findings, the design's viability is demonstrated. It is evident that the electronic medical record system created for the study's patients who require ongoing care is entirely workable. As electronic medical records continue to develop, there will be more opportunities to research and enhance this system, which will benefit patients and hospitals alike in the long run.

EDUKASI PENTINGNYA SIMRS DALAM PENERAPAN REKAM MEDIK ELEKTRONIK TERINTEGRASI DI RUMAH SAKIT UMUM SEMBIRING

The objective of this community service is to increase the understanding of the role of Hospital Management Information Systems (SIMRS) and how they contribute to the implementation of integrated Electronic Medical Records (RME) in hospitals. Key stakeholders, such as medical record personnel, IT staff, and hospital management, were involved in the counseling through Focus Group Discussion (FGD). The results of the Focus Group Discussion (FGD) showed that the application of SIMRS while implementing RME improved the quality of healthcare services and operational efficiency of the hospital. Key advantages found included better interdepartmental collaboration, accurate data management, and quick and easy patient access. Stakeholders agreed that education is the best way to maximize the benefits of this system. Medical personnel require specialized training to master the use of SIMRS and RME. The final conclusion of this community service activity is that the utilization of electronic medical records at the Sembirin Hospital facility in Deli Serdang Regency will facilitate employee activities.

Epidemiological survey of elderly patients diagnosed with COVID-19 at mobile field hospitals.

During the COVID-19 pandemic, the mobile field hospital, a rapidly deployable healthcare facility for emergency care, was effective in ensuring rapid diagnosis and treatment of patients with mild or asymptomatic SARS-CoV2 infections, effectively preventing the spread of COVID-19. We conducted a survey to gain a thorough understanding of the epidemiological traits among the elderly who contracted the Omicron variant of the SARS-CoV-2 virus at a mobile field hospital set up at the National Exhibition and Convention Center (Shanghai). A cross-sectional study approach was employed to examine various factors such as demographic characteristics, clinical features, vaccination status, and nucleic acid testing. We utilized the DezhenTech Integrated Electronic Medical Record Platform (Municipal Isolation Hospital) to collect data and focused on elderly individuals infected with COVID-19 in the fifth isolation zone of the mobile field hospital set up at the National Exhibition and Convention Center (Shanghai). The patients were categorized into different age groups for analysis. Among the 3,183 elderly patients, 54.7% were males and 45.3% were females, with an average age of 65.32 ± 4.41years. Among them, 47.8% (1523/3183) were 60-64 years old, 34.0% (1082/3183) were 65-69 years old, 14.0% (444/3183) were 70-74 years old, 3.2% (103/3183) were 75-79 years old, and 1.0% (31/3183) were ⩾ 80 years old. The majority (95.7%) of the elderly patients with chronic conditions had hypertension, diabetes, and coronary heart disease. The first viral nucleic acid screening showed a higher positive rate in the community and hospital fever clinics. The cumulative positive rate of the nucleic acid test in the mobile field hospital was 38.7%. The average CT value of the COVID-19 ORF1ab gene was 34.56 ± 5.98, while the average CT value of the N gene was 33.10 ± 6.50. The patients took an average of 3.40 ± 0.45 days to test negative, with a positive rate of 15.4% and an average hospital stay of 7.45 ± 0.53 days. The overall rate of COVID-19 vaccine coverage was 68.0%, with an enhanced coverage rate of 40% and a non-coverage rate of 29.3%. The overall prognosis for elderly patients who experienced a mild or asymptomatic SARS-CoV-2 Omicron infection at the mobile field hospital was favorable, although the vaccination rate in general was not high. By effectively managing underlying health conditions, the duration of their hospital stay in the mobile field hospital was reduced.

Real-World Switching Pattern, Persistence, and Associated Healthcare Resource Utilization of Bruton Tyrosine Kinase Inhibitors for the Treatment of Mantle Cell Lymphoma in the United States

Introduction: Mantle cell lymphoma (MCL) is an aggressive form of B-cell non-Hodgkin's lymphoma. While incurable, MCL can be controlled for a prolonged period of time, but typically becomes refractory or relapsed and requires additional treatment. Bruton tyrosine kinase inhibitors (BTKi) are approved for relapse/refractory MCL and recommended by the National Comprehensive Cancer Network (NCCN ®); However, it is unclear how BTKi are being utilized and switched in the real-world patient populations. This study aimed to examine treatment patterns, persistence, and associated healthcare resource utilization of BTKi use in patients with MCL in the US. Methods: A retrospective observational study was conducted using Symphony Integrated Dataverse (IDV ®), a comprehensive, longitudinal, open-claims database and integrated Electronic Medical Record (EMR) data. Patients aged ≥18 years with ≥1 diagnosis for MCL and initiated a BTKi between 1/1/20 and 12/31/22 were included in the study. Patients were required to be continuously enrolled for 365 days leading up to the index date and ≥90 days following the index date (date of BTKi initiation). The full patient history in the database was used to identify previous BTKi use and analyze switching patterns for each patient. Three mutually exclusive cohorts (ibrutinib, acalabrutinib, zanubrutinib) were developed based on first-initiated BTKi. Patients were followed until the end of the study period (3/31/23) or lost to follow-up. Treatment switching pattern, duration, persistence, time to discontinuation (TTD), and healthcare resource utilization (HCRU) were examined by each BTKi cohort. Treatment duration was defined as time from BTKi initiation to the end date of last BTKi prescription. TTD was defined as time from BTKi initiation to the end date of the BTKi prescription that had a gap of >60 days with a subsequent BTKi prescription. Treatment persistence was evaluated as the proportion of patients that were continually prescribed BTKi (≥80% proportion of days covered) across 30-day intervals. HCRU was measured by number of outpatient visits and inpatient services, per patient per month (PPPM), during the treatment regimen. Results: BTKi switching patterns were analyzed for the 1,674 patients that initiated any BTKi therapy during study period (acalabrutinib [n= 697]; ibrutinib [n=693]; zanubrutinib [n=284]). Switching rates were 23.8% for ibrutinib, 5.6% for acalabrutinib, and 2.8% for the zanubrutinib cohort. In the ibrutinib cohort, the majority of patients switched to acalabrutinib (72.7%). Of those who switched from acalabrutinib, more than half (59.9%) switched to zanubrutinib. Of those who switched in zanubrutinib cohort, they were equally switched to ibrutinib and acalabrutinib (Table 1). Mean outpatient visits PPPM were 1.39 for patients who initiated with ibrutinib then switched to zanubrutinib, and 1.49 for those who switched to acalabrutinib. Mean inpatient services PPPM were 0.39 for patients who switched from ibrutinib to zanubrutinib, and 0.59 for those who switched to acalabrutinib. The 3 BTKi cohorts were similar across sociodemographic characteristics. The zanubrutinib cohort had higher median TTD (days) (188.5) compared to ibrutinib (161.5) and acalabrutinib (179), as well as higher median treatment duration (200) compared to ibrutinib (171) and acalabrutinib (194). Among MCL patients continuously enrolled for ≥ 360 days, zanubrutinib patients consistently had higher persistence rates (p=0.0079. Figure 1). Persistence at 90-days was 66.9% for zanubrutinib compared to 56.3% for ibrutinib and 62.7% for acalabrutinib. After 360 days, zanubrutinib continued to have the highest persistence (16.9%) compared to ibrutinib (10.8%) or acalabrutinib (13.2%). Zanubrutinib had the least number of mean inpatient services PPPM (0.56) compared to ibrutinib (0.83) and acalabrutinib (0.71) and mean outpatient visits-zanubrutinib (1.53), ibrutinib (1.81), acalabrutinib (1.59). Conclusions: This real-world study suggested that US patients with MCL receiving zanubrutinib showed longer treatment persistence, treatment duration and TTD, as well as lower switching rates and HCRU compared to those receiving acalabrutinib and ibrutinib.

Woman-centred care and integrated electronic medical records within Australian maternity settings: Point prevalence audit and observational study

ObjectiveTransition to paperless records brings new challenges to midwifery practice across the continuum of woman-centred care. There is limited and conflicting evidence on the relative benefits of electronic medical records in maternity settings. This article aims to inform the use of integrative electronic medical records within the maternity services’ environment with attention to the midwife-woman relationship. DesignThis descriptive two-part study includes 1) an audit of electronic records in the early period following implementation (2-time points); and 2) an observational study to observe midwives’ practice relating to electronic record use. SettingTwo regional tertiary public hospitals ParticipantsMidwives providing care for childbearing women across antenatal, intrapartum and postnatal areas. Findings400 integrated electronic medical records were audited for completeness. Most fields had high levels of complete data in the correct location. However, between time 1 (T1) and time 2 (T2), persistent missing data (foetal heart rate documented 30 minutely T1 36%; T2 42%), and incomplete or incorrectly located data (pathology results T1:63%; T2 54%; perineal repair T1 60%; T2 46%) were identified. Observationally, midwives were actively engaged with the integrative electronic medical record between 23% to 68% (median 46%; IQR 16) of the time. ConclusionMidwives spent a significant amount of time completing documentation during clinical episodes of care. Largely, this documentation was found to be accurate, yet exceptions to data completeness, precision and location remained, indicating some concerns with software usability. Implications for practiceTime-intensive monitoring and documentation may hinder woman-centred midwifery care.

ИСПОЛЬЗОВАНИЕ МЕДИЦИНСКОЙ ИНФОРМАЦИОННОЙ СИСТЕМЫ НОВОСИБИРСКОЙ ОБЛАСТИ В ОПТИМИЗАЦИИ ДОКУМЕНТООБОРОТА И ФОРМИРОВАНИЯ ИНТЕГРИРОВАННОЙ ЭЛЕКТРОННОЙ МЕДИЦИНСКОЙ КАРТЫ ПАЦИЕНТА ПРИ ПРОВЕДЕНИИ ПРИЖИЗНЕННОЙ ПАТОЛОГО-АНАТОМИЧЕСКОЙ ДИАГНОСТИКИ БИОЛОГИЧЕСКОГО МАТЕРИАЛА

Early diagnosis of malignant neoplasms is ensured by the quality, accessibility and continuity between medical institutions in the organization of the lifetime pathoanatomical diagnostics of biological material. Improving medical information systems with the involvement of the lifetime pathoanatomical diagnostics in the process of informatization of regional health care, developing mechanisms for documenting, storing and electronic exchange of personal medical information between medical institutions in the Novosibirsk region, is the main task of the system for organizing this type of diagnostics. The urgency of solving this problem is due to the shortage of personnel in the pathoanatomical services, the distance barriers between medical specialists and pathologist; need to ensure the formation of a created system for the exchange of medical documentation. The article presents the experience of using the functionality of the components of the Medical Information System of the Novosibirsk Region (MIS NR) in a regional state budgetary healthcare institution to form a unified information environment, integrate approved accounting forms and ensure efficient workflow in the course of lifetime pathoanatomical diagnostics. The aim of this research is to study the possibilities of additional functionality of the components of the MIS NR, implemented by the employees of the Center for Informatization of Medical Information Analytical Center, to identify the advantages of using the developed functions in optimizing the workflow during the lifetime pathoanatomical diagnostics of biopsy (operative) material, in the formation of a regional Integrated electronic medical record.

Data Transfer from Clinic to Clinic – Queensland Perspective

AbstractData transfer has been forced to evolve as digital technologies are implemented throughout various aspects of the healthcare system. Despite the uniqueness of both the geography and the population of Queensland, information exchange and data communication has continued to follow this evolutionary trend. There have been a number of different health reforms designed to integrate digital innovations and allow critical data and information to be shared with the appropriate health professionals when necessary. Strict healthcare legislation has been navigated and to provide newly upgraded technologies and processes while maintaining privacy, confidentiality and security standards. A large portion of the digital revolution has been the implementation of the national run project, the My Health Record and the state run project, the Integrated Electronic Medical Record. Both are platforms that allow secure information exchange allowing patients to have improved quality of care. To maintain the steady progress, both the state and federal governments have developed strategies and visions to help provide guidance and direct for ongoing and future digital projects. They also outline areas that require further advancements to ensure Queensland is delivering equitable, high quality healthcare.

Not All Patients with Hemiplegia Need Alteplase: A Case of Hemiplegic Migraine.

Hemiplegic migraine (HM) is a rare type of migraine which presents with motor and sensory impairment like a cerebrovascular accident (CVA). We present a case of a 36-year-old female, with a prior CVA treated with alteplase, who presented to the emergency department with stroke-like symptoms with a duration of 1 hour. The NIH Stroke Scale score was 22 at presentation. The patient received alteplase under the supervision of a neurologist after head CT confirmed no bleed. Further work-up revealed no acute or remote ischaemia or infarction. This case demonstrates the importance of a thorough history, intercommunication between health systems and integrated Electronic Medical Records (EMR) for early diagnosis and management of HM.LEARNING POINTSHemiplegic migraine (HM) is difficult to diagnose and can mimic stroke, resulting in administration of dangerous medications such as thrombolytics/alteplase.A thorough history, intercommunication between health systems and integrated EMR are essential for early diagnosis and management of HM.

Development of a techno-humanist model for e-health adoption of innovative technology

Background and PurposeAfter investing billions of dollars in an integrated Electronic Medical Records (physicians) and Personal Health Records (patients) system to allow both parties to manage and communicate through e-health innovative technologies, Canada is still making slow adoption progress. In an attempt to bridge the human and technological perspectives by developing and testing a holistic model, this study purports to predict patients’ behavioral intentions to use e-health applications. MethodsAn interdisciplinary approach labelled as a techno-humanism model (THM) is testing twelve constructs identified from the technological, sociological, psychological, and organizational research literature and deemed to have a significant effect upon and positive relationship with patients’ e-health applications adoption. Subjects were Canadians recruited in a mall-intercept mode from a region representing a demographically diverse population, including rural and urban residents. The SmartPLS measurement tool was used to evaluate the reliability and validity of study constructs. The twelve constructs were separately tested with quantitative data such as factor analysis, single, multiple, and hierarchical multiple regression. ResultsThe hierarchical multiple regression analysis process led us to formulate four models, each hinged on a combination of interdisciplinary variables. Model 1 consisted of the technological predictors and explained 62.3% (p < .001) of variance in the behavioral intention to use e-health. Model 2 added the sociological predictors to the equation and explained 72.3% (p < .001) of variance. Model 3 added the psychological predictors to Model 2 and explained 72.8% (p < .001). Finally, Model 4 included all twelve predictors and explained 73% (p < .001) of variance in the behavioral intention to use e-health applications. ConclusionsOne of the greatest barriers to applying e-health records in Canada resides in the lack of coordination among stakeholders. The present study implies that healthcare policy makers must consider the twelve variables with their findings and implications as a whole. The techno-humanist model (THM) we are proposing is a more holistic and continuous approach. It pushes back to a breakdown of the various technological, sociological, psychological, and managerial factors and stakeholders that are at the root cause of behavioral intentions to use e-health, as opposed to merely observing behavioral outcomes at the end of the “assembly line”. Active participation and coordination of all stakeholders is a key feature.

Patient Clinical Data Integration in Integrated Electronic Medical Record System for Health Care Facilities in Indonesia

Complete patient service requires continuous support of clinical history. This can be realized by integrating electronic medical record data. The limitation is the wide variety of software, formats, and data dictionaries used in healthcare facilities. This was a descriptive analysis study with cross sectional approach to find open source electronic medical record integration model for clinical data exchange between health care facilities. Respondents were doctors, nurses, pharmacists, laboratory staffs, and person in charge of hospital information system as informant for content analysis. From the study, we managed a web-based service portal to implement clinical data integration that can be accessed by clinician registered within the Ministry of Health. The patients clinical history is stored in the hospital database and requires unique OpenIDRM code on the Health Service Server to integrate it. OpenIDRM contains all of the patients medical record number, as one patient may have several different medical record numbers in several hospitals. In conclusion, clinician can access the patients clinical history by opening a web portal system through a unique OpenIDRM code.

Towards an Integrated Electronic Medical Records System for Quality Healthcare in Ghana

This article explores the factors militating against the diffusion integration electronic medical records in Ghana. Structured questionnaires were used to collect data from respondents in the healthcare ecosystem and analyzed quantitatively using descriptive and inferential statistics. The findings revealed non-integration of electronic medical records systems among the stakeholders of the healthcare ecosystem mostly due to and interoperability issues. There is also substantial usage of technology in capturing and storing medical records. The key factors militating against the integration of electronic medical records systems are inadequate funds to purchase database management systems, acquisition and maintenance costs of electronic medical records systems, and an unclear return on investment on the integrated electronic medical records systems. The article recommends sustained government financial support, standardization policy and implementation guidelines to facilitate the integration of electronic medical records systems in the various health institutions.

Drug induced diseases (DID): Need for more awareness & research.

Drug induced diseases (DID): Need for more awareness & research.

Sa1109 Colonoscopy Utilization Across Different Racial Groups in the United States Using an Integrated Electronic Medical Records Database

Sa1109 Colonoscopy Utilization Across Different Racial Groups in the United States Using an Integrated Electronic Medical Records Database

The Influence of Integrated Electronic Medical Records and Computerized Nursing Notes on Nurses’ Time Spent in Documentation

We investigated nurses' time spent in documentation as it relates to the use of electronic charting. A cross-sectional analysis was completed using time and motion data collected during a nursing process improvement initiative for 105 units in 55 hospitals. Ordinary least squares regression with a cluster adjustment revealed very little difference in time spent in documentation with or without the use of electronic medical records or computerized nursing notes. Nurses spent 19% of their time completing documentation, regardless of electronic charting usage, compared with all other categories of care. These findings suggest that integrated electronic medical records and computerized nursing notes do not appear to increase the time nurses spend documenting.

Property, Privacy and the Pursuit of Integrated Electronic Medical Records

Who owns a patient's medical information? The patient, the provider, or the insurer? All of the above? None of the above? In the emerging era of electronic medical records, no other legal question is more critical, more contested, or more poorly understood. Ownership was never much in doubt in an age of paper-based records, but now that information content can be easily digitized and freed from any particular storage medium, confusion reigns. How this issue is resolved can have huge impacts on how or whether massive anticipated developments in electronic and personal health records will take shape. The respective property rights of patients, providers and insurers will strongly influence, if not determine, what form of electronic health informatics ends up predominating. And, whether rights to access and use medical information can be commercialized may determine whether effective, comprehensive medical information networks can emerge at all, absent overt government mandate. This paper analyzes optimal property rights in medical information from the perspective of network economics. It proposes that patients be allowed to monetize their access and control rights by assigning them to a trusted intermediary who may then place these rights in a stream of commerce that determines their value and best use. The funds generated can then be distributed both to patients and providers to encourage their adoption and use of interconnected electronic records.

Innovative Reporting of Penicillin Allergy in an Integrated Electronic Medical Record

Innovative Reporting of Penicillin Allergy in an Integrated Electronic Medical Record

Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample

The Veterans Health Administration (VHA) has introduced an integrated electronic medical record, performance measurement, and other system changes directed at improving care. Recent comparisons with other delivery systems have been limited to a small set of indicators. To compare the quality of VHA care with that of care in a national sample by using a comprehensive quality-of-care measure. Cross-sectional comparison. 12 VHA health care systems and 12 communities. 596 VHA patients and 992 patients identified through random-digit dialing. All were men older than 35 years of age. Between 1997 and 2000, quality was measured by using a chart-based quality instrument consisting of 348 indicators targeting 26 conditions. Results were adjusted for clustering, age, number of visits, and medical conditions. Patients from the VHA scored significantly higher for adjusted overall quality (67% vs. 51%; difference, 16 percentage points [95% CI, 14 to 18 percentage points]), chronic disease care (72% vs. 59%; difference, 13 percentage points [CI, 10 to 17 percentage points]), and preventive care (64% vs. 44%; difference, 20 percentage points [CI, 12 to 28 percentage points]), but not for acute care. The VHA advantage was most prominent in processes targeted by VHA performance measurement (66% vs. 43%; difference, 23 percentage points [CI, 21 to 26 percentage points]) and least prominent in areas unrelated to VHA performance measurement (55% vs. 50%; difference, 5 percentage points [CI, 0 to 10 percentage points]). Unmeasured residual differences in patient characteristics, a lower response rate in the national sample, and differences in documentation practices could have contributed to some of the observed differences. Patients from the VHA received higher-quality care according to a broad measure. Differences were greatest in areas where the VHA has established performance measures and actively monitors performance.

Thick Client Development of an Integrated Electronic Anesthesia System into a Multispecialty Academic Surgical Practice and a Fully Integrated Electronic Medical Record

Thick Client Development of an Integrated Electronic Anesthesia System into a Multispecialty Academic Surgical Practice and a Fully Integrated Electronic Medical Record

電子カルテと画像情報の役割

電子カルテと画像情報の役割