Mobile Electronic Health Record Research Articles

A comparison of use of the mobile electronic health record by medical providers based on clinical setting

Technology can help streamline processes and improve communication between healthcare providers and patients. The electronic health record (EHR), along with its mobile application, have demonstrated the ability to improve the efficiency and accuracy of health care delivery. Given these capabilities, further research in technology adoption and utilization is warranted to determine best strategies for usage and deployment. By usage analysis one can ascertain if certain groups find mobile EHR (mEHR) tools more usable and useful than other groups. To determine if medical providers in different work settings at an academic pediatric hospital have similar or dissimilar frequencies of mEHR use, we categorized providers as inpatient, ambulatory, critical care, or emergency medicine according to their EHR profile departments. This study included data from 874 health care providers over a 12-month period regarding their usage of mobile phone (EPIC® Haiku) and tablet (EPIC® Canto) mEHR. Tablet mEHR use was relatively low compared to mobile phone EHR access, accounting for only 8% of total mEHR logins. Furthermore, ambulatory and inpatient care providers had the greatest usage levels over the 12-month period. Critical care providers do not utilize mEHR tools nearly as much as ambulatory or inpatient providers, likely due to workflow differences. Since clinical setting does affect usage levels of the mEHR, understanding of provider workflow can be helpful in maximizing the potential of these digital tools. Awareness of workflow allows for optimization of mEHR design and implementation, which should increase mEHR adoption and usage, leading to better health outcomes for patients.

Going paper-lite: housebound patient perspectives on the introduction of mobile working.

Healthcare policies promote technology use as a means to modernise healthcare and support seamless, person-centred care. However, despite information technology (IT) use being common practice in clinical settings, its use in patients' homes is still developing. This study explored patients' perspectives on the use of IT and electronic health records (EHR) in their home environment. Semi structured interviews were conducted with housebound patients who received regular care from the district nursing team, and thematic data analysis was undertaken. Participants reported variable knowledge and experiences with mobile working and EHR. Most were positive and identified clear benefits for clinicians. However, few participants reported benefits to themselves. Contrary to popular belief, IT use is expected by older patients and, while barriers were identified, the overall opinion was positive. A digital divide was apparent, with some at risk of being disadvantaged by the increasing use of technology.

MUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale.

BackgroundThe predominant implementation paradigm of electronic health record (EHR) systems in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. Mobile health (mHealth) technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHR systems that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHR systems are needed to improve access, improve quality of care, and ameliorate the digital divide.ObjectiveWe report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHR system in LMICs (OpenMRS).MethodsThe “Guidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA)” checklist was employed to report on the mUzima application. The World Health Organization (WHO) Principles for Digital Development framework was used as a secondary reference framework. Details of mUzima’s architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems.ResultsmUzima is an open-source, highly configurable Android application with robust features including offline management, deduplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geolocate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO’s Principles of Digital Development, and its scaled implementation success has led to its recognition as a digital global public good and its listing in the WHO Digital Health Atlas.ConclusionsGreater emphasis should be placed on mHealth applications that robustly extend reach of EHR systems within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. The mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains.

The factors influencing community nurses' usage of electronic health records: findings from focus groups.

Electronic health records (EHRs) are integral to community nursing, and mobile access aids seamless, responsive care, prevents repetition and reduces hospital admissions. This saves time and money, enabling smoother workflows and increased productivity. Common practice among community nurses is to return to workbases to access EHRs. This research was conducted to explore what leads to inconsistency in EHR use. Focus groups were held with community nurses, and reflexive thematic analysis of the data was undertaken. Nurses who used EHRs during consultations described the practice as integrative and informed, promoting collaborative care. Those who did not described EHRs as time-consuming, template-laden and a barrier to nurse-patient communication. One barrier to mobile working is the threat to collegiate teamworking and the social and clinical supports it provides. This study suggests specific strategies could increase mobile EHR engagement: role-specific training for effective EHR use; clear organisational directives; innovative team communication; and peer-to-peer coaching.

Adult patient access to electronic health records.

Adult patient access to electronic health records.

Sijilli: a mobile electronic health records system for refugees in low-resource settings

Sijilli: a mobile electronic health records system for refugees in low-resource settings

Safeuristics! Do Heuristic Evaluation Violation Severity Ratings Correlate with Patient Safety Severity Ratings for a Native Electronic Health Record Mobile Application?

Usability of electronic health records (EHRs) remains challenging, and poor EHR design has patient safety implications. Heuristic evaluation detects usability issues that can be classified by severity. The National Institute of Standards and Technology provides a safety scale for EHR usability. Our objectives were to investigate the relationship between heuristic severity ratings and safety scale ratings in an effort to analyze EHR safety. Heuristic evaluation was conducted on seven common mobile EHR tasks, revealing 58 heuristic violations and 28 unique usability issues. Each usability issue was independently scored for severity by trained hospitalists and a Human Factors researcher and for safety severity by two physician informaticists and two clinical safety professionals. Results demonstrated a positive correlation between heuristic severity and safety severity ratings. Regression analysis demonstrated that 49% of safety risk variability by clinical safety professionals (r = 0.70; n = 28) and 42% of safety risk variability by clinical informatics specialists (r = 0.65; n = 28) was explained by usability severity scoring of problems outlined by heuristic evaluation. Higher severity ratings of the usability issues were associated with increased perceptions of patient safety risk. This study demonstrated the use of heuristic evaluation as a technique to quickly identify usability problems in an EHR that could lead to safety issues. Detection of higher severity ratings could help prioritize failures in EHR design that more urgently require design changes. This approach is a cost-effective technique for improving usability while impacting patient safety. Results from this study demonstrate the efficacy of the heuristic evaluation technique to identify usability problems that impact safety of the EHR. Also, the use of interdisciplinary teams for evaluation should be considered for severity assessment.

Variability in Doctors' Usage Paths of Mobile Electronic Health Records Across Specialties: Comprehensive Analysis of Log Data.

BackgroundWith the emergence of mobile devices, mobile electronic health record (mEHR) systems have been utilized by health care professionals (HCPs), including doctors, nurses, and other practitioners, to improve efficiency at the point of care. Although several studies on mEHR systems were conducted, including those analyzing their effects and HCPs’ usage frequency, only a few considered the specific workflows of doctors based on their specialties in which the work process differs greatly.ObjectiveThis study aimed to investigate the differences in mEHR usage paths across clinical specialties.MethodsWe collected the log data of 974 doctors who worked from August 2016 to August 2017 and used the mEHR system at the Samsung Medical Center, one of the biggest hospitals in South Korea. The doctors were classified into 3 groups based on their specialty: the physician, the surgeon, and other hospital-based physician (OHBP) groups. We used various descriptive and visualization methods to understand and compare doctors’ usage paths of mEHRs. First, the average numbers of log-ins per day and features used per log-in were examined over different specialties and positions. Second, the number of features used by each doctor was visualized via a heat map to provide an overview of mEHR usage across feature types and doctors’ specialties. Third, we conducted a path analysis via a Sankey diagram to describe main usage paths and association rule mining to find frequent paths in mEHR usage.ResultsThe physician group logged on most frequently, whereas the OHBP group logged on least frequently. In fact, the number of log-ins per day of residents in the physician group was 4.4 times higher than that of staff members in the other groups. The heat map visualization showed a visible difference among specialty groups. The physician group used more consultation-related features, whereas the surgeon group used more surgery-related features. Generally, 50% of the doctors spent about 15 seconds at a time when using mEHRs. In the Sankey diagram, the physician group showed diverse usage patterns with higher complexity compared with the other 2 groups; in particular, their paths contained more loops, which reflected repetitive checks on multiple patients. The most frequent path included inpatient summary, which means that most users stopped at the point of summary and did not proceed to view more details.ConclusionsThe usage paths of mEHRs showed considerable differences among the specialty groups. Such differences can be accommodated into an mEHR design to enhance the efficiency of care.

Feasibility study of an EHR-integrated mobile shared decision making application

IntroductionIntegrating mobile applications (apps) into users’ standard electronic health record (EHR) workflows may be valuable, especially for apps that both read and write data. This report details the lessons learned during the integration of a patient decision aid - prostate specific antigen (PSA) testing for prostate cancer screening - into our users' standard EHR workflow for a small usability assessment. Materials and MethodsThis feasibility study included two steps. First we enabled realtime, secure bidirectional data exchange between the mobile app and EHR for 14 data elements, and second we pilot tested the production environment app with 9 primary care patients aged 60–65 years. Our primary usability metric was a net promoter score (NPS), based on users’ recommendation of the app to a friend or family member; we also assessed the proportion of users who 1) updated their prostate cancer risk factor information present in the EHR and 2) submitted more than one unique response regarding their preference to have PSA testing. ResultsThe seven web services necessary to read and write data required considerable configuration, but successfully delivered risk factor-specific educational content and recorded patients’ values and decision preference directly within the EHR. Seven of the 9 patients (78%) would recommend this app to a friend/family member (NPS = 55.6%), one patient used the app to update risk factor information, and 4/9 (44%) changed their decision preference while using the app. ConclusionsIt is feasible to implement a decision aid directly into users’ standard EHR workflow for limited usability testing. Broad scale implementation may have a positive effect on patient engagement and improve shared decision making, but several challenges exist with proprietary EHR vendor application programming interfaces (API)s.

Implementation of Digital Health Technology at Academic Medical Centers in Saudi Arabia.

Academic Medical Centers (AMCs) in Saudi Arabia are dedicated to providing high-quality patient care and promoting the health and wellbeing of its citizens. Additionally, they provide medical education and conduct research in a wide range of clinical disciplines. A recent global trend in academic hospitals with mandates similar to those in Saudi Arabia is that they have started utilizing digital health technology in a bid to increase efficiency and improve the quality of patient care. This paper takes the position that such digital health technologies should also be utilized in AMC settings in Saudi Arabia. Electronic health records (EHRs), smartphones, video-imaging technologies, virtual desktop infrastructures, mobile EHR access, and smart-beds can help AMCs serve patients more effectively. Rural people can be connected to consultants at AMCs using these technologies using virtual self-care tools. Validation of new digital health devices can be performed in collaboration with digital health partners and serve to enrich the knowledge of medical students in the area of digital health. This review aims to draw the attention of stakeholders to the need to implement digital health technology in AMCs in Saudi Arabia and help improve the quality of healthcare.

Adult patient access to electronic health records

Adult patient access to electronic health records

Towards secure and flexible EHR sharing in mobile health cloud under static assumptions

Electronic health record (EHR) systems are promising in the management of individual’s health. However, before widely deployed in practical applications, EHR systems have to tackle the privacy and efficiency challenges. Most of existing EHR sharing schemes suffer from severe efficiency drawbacks, resulting in inapplicability in mobile EHR system. Furthermore, the security assumptions in the previous schemes are usually based on non-static assumptions. In this paper, we propose a flexible EHR sharing scheme supporting offline encryption of EHR and outsourced decryption of EHR ciphertexts in mobile cloud computing. The proposed scheme is proven secure in the random oracle model under the static decisional bilinear Diffie–Hellman assumption. In our EHR sharing system, an EHR owner only need one multiplication in bilinear groups to generate the final EHR ciphertexts based on the offline ciphertexts computation, and an EHR user can easily decrypt the EHR cipheretext without requiring bilinear pairing operations based on the transformed ciphertexts from the EHR cloud. Our EHR sharing scheme allows access structures encoded in linear secret sharing schemes. Performance comparisons indicate that our scheme is very suitable for mobile health clouds.

Implementation of a Hospital Electronic Surgical Registry in a Lower-Middle-Income Country.

While the benefits of using electronic health records (EHRs) in both developed and low- and middle-income countries are known, the barriers to implementing EHRs in lower-middle-income countries have not been fully characterized. We assessed organizational readiness for implementation of a mobile (tablet-based) EHR, to create a real-time electronic surgical registry, in a busy lower-middle-income country hospital. Six semi-structured focus groups were conducted with hospital administrators, faculty surgeons, surgical residents, interns, nurses and medical students in a large urban hospital in Asuncion, Paraguay. Focus groups were conducted over the course of three weeks during the pre-implementation phase to identify barriers to implementation. Focus group data were coded using the Theoretical Domains Framework (TDF), which are 12 validated domains related to behavior change. Reinforcement, environmental context/resources and roles/responsibilities were the most relevant TDF domains that emerged. Residents and students were more uncertain than faculty and department heads about who would enforce the use of the tool in place of paper charting. Internet quality was a concern raised by all. The local, normative hierarchical structure within the surgical department, including piecemeal communication between the department heads and the residents about roles and responsibilities, was a major perceived barrier to implementation. Uncertainties about reinforcement, roles and responsibilities for using a novel EHR tool, and technology infrastructure are potential barriers to address in the pre-implementation phase of introducing an EHR to a lower-middle-income country surgical service. Addressing these potential barriers with all stakeholders prior to implementation will be a critical next step in this effort.

Early Experiences with Mobile Electronic Health Records Application in a Tertiary Hospital in Korea.

ObjectivesRecent advances in mobile technology have opened up possibilities to provide strongly integrated mobile-based services in healthcare and telemedicine. Although the number of mobile Electronic Health Record (EHR) applications is large and growing, there is a paucity of evidence demonstrating the usage patterns of these mobile applications by healthcare providers. This study aimed to illustrate the deployment process for an integrated mobile EHR application and to analyze usage patterns after provision of the mobile EHR service.MethodsWe developed an integrated mobile application that aimed to enhance the mobility of healthcare providers by improving access to patient- and hospital-related information during their daily medical activities. The study included mobile EHR users who accessed patient healthcare records between May 2013 and May 2014. We performed a data analysis using a web server log file analyzer from the integrated EHR system. Cluster analysis was applied to longitudinal user data based on their application usage pattern.ResultsThe mobile EHR service named M-UMIS has been in service since May 2013. Every healthcare provider in the hospital could access the mobile EHR service and view the medical charts of their patients. The frequency of using services and network packet transmission on the M-UMIS increased gradually during the study period. The most frequently accessed service in the menu was the patient list.ConclusionsA better understanding regarding the adoption of mobile EHR applications by healthcare providers in patient-centered care provides useful information to guide the design and implementation of future applications.

High Time to Discuss Future-Oriented Telemedicine.

High Time to Discuss Future-Oriented Telemedicine.

Evaluation of a Mobile Station Electronic Health Record on Documentation Compliance and Nurses’ Attitudes

Electronic Health Record (EHR) Systems have been adopted by healthcare organizations for documentation of patient care. Often these information systems are embedded in mobile nurse stations. As part of assessing the impact of this technology it is important to determine the effect it has on charting compliance and user acceptance. Data were collected at a medical center in Taiwan in two stages. The first stage involved use of a 28-item medical review tool to measure charting compliance in 99 charts before and after implementation of the EHR system. In stage two, a survey was conducted with 709 nurse users to determine their level of mobile EHR acceptance 3 months after this documentation technology was initiated. Results demonstrated that EHR significantly improved documentation compliance in standardized data entry format (name, date, time), abbreviation, content correction/revision, patient care needs, and care goals. Analysis of data from the five categories of a user acceptance survey revealed the following results (based on a 4-point Likert scale): patient care (2.92), nursing efficiency (2.78), education and training (2.98), usability (2.61), and usage benefits (2.87). The study concluded that use of mobile nurse stations with EHR can improve documentation compliance and that although frequent system downtime needs improvement, nurses generally have positive attitudes toward this technology application.

Development of Mobile Electronic Health Records Application in a Secondary General Hospital in Korea

ObjectivesThe recent evolution of mobile devices has opened new possibilities of providing strongly integrated mobile services in healthcare. The objective of this paper is to describe the decision driver, development, and implementation of an integrated mobile Electronic Health Record (EHR) application at Ulsan University Hospital. This application helps healthcare providers view patients' medical records and information without a stationary computer workstation.MethodsWe developed an integrated mobile application prototype that aimed to improve the mobility and usability of healthcare providers during their daily medical activities. The Android and iOS platform was used to create the mobile EHR application. The first working version was completed in 5 months and required 1,080 development hours.ResultsThe mobile EHR application provides patient vital signs, patient data, text communication, and integrated EHR. The application allows our healthcare providers to know the status of patients within and outside the hospital environment. The application provides a consistent user environment on several compatible Android and iOS devices. A group of 10 beta testers has consistently used and maintained our copy of the application, suggesting user acceptance.ConclusionsWe are developing the integrated mobile EHR application with the goals of implementing an environment that is user-friendly, implementing a patient-centered system, and increasing the hospital's competitiveness.

HIR Collaborating with the CODATA Conference

HIR Collaborating with the CODATA Conference