National Electronic Patient Record Research Articles

Wearable technology data-based sleep and chronic disease relationship

Objective: The aim of the study was to examine the cross-sectional relationship between sleep duration and 12 chronic diseases
 (obesity risk, diabetes, asthma, renal failure, hypertensive diseases, chronic obstructive pulmonary disease, cardiovascular diseases,
 ischaemic heart disease, pulmonary heart disease, immunodeficiencies and immune system disorders) by transferring the data to the
 national electronic patient record system through wearable device technology.
 Materials and Methods: The data of the study were obtained from the Ministry of Health “Turkey National Personal Health Record
 System” (The “e-Nabız”). Between 30.03.2023 and 28.05.2023, 315448 data from 27847 people (15167 male) were collected and
 analysed on the basis of province, rural status, age group, gender and presence of chronic diseases and average, minimum (min),
 maximum (max) sleep duration. Descriptive statistics, chi-square analysis, Independent Samples t-Test, One-way Analysis of Variance
 and Pearson’s correlation coefficient were used.
 Results: The max. and average sleep duration were significantly shorter in men. Max. sleep duration decreased while the average sleep
 duration increased with increasing age. Participants with asthma, chronic renal failure and cerebrovascular diseases had decreased
 average sleep duration. The frequency of those who slept for 7-8 hours, which is the ideal sleep duration, is lower in all chronic diseases.
 Conclusion: Most of the common chronic diseases may affect the sleep duration times and quality, which may further affect the
 prognosis of these patients.

Rural health services' relationships with patients: An enabler and a barrier to advance care planning.

The barriers and enablers to the uptake of advance care plans has been well documented but more so in metropolitan health services. Rural and regional areas have their own challenges of higher rates of chronic illness and an aging population when considering end of life care. This study aimed to explore the creation of advance care plans in a regional location that has service links to smaller health services. A qualitative study involving thematic analysis of interview data. A regional local government area in Victoria, Australia. Twelve representatives from rural and regional health services, including hospital, private practice and community organisation staff. Barriers and enablers to the creation of advance care planning documents. The data analysis yielded two main identified themes around Plan creation and communication of patient wishes: system and societal challenges to the creation and communication in advance care planning; and rural communities' expectation of the health service-patient relationship and advance care planning. Although barriers to advance care planning are well known, rural and regional practitioners need to be aware of the effect long-term continuity of care from health practitioners and connections with health services has on advance care plan creation, and whether the paucity of written Plans effects end-of-life care. A potential solution was seen in the pending linkages to the national electronic patient record.

129 A THREE YEARS RETROSPECTIVE STUDY (2014-2016) ON OUTCOMES OF ACUTE KIDNEY INJURY IN BRUNEI DARUSSALAM

Category: Epidemiology and Outcomes from AKI Presenter: Dr JAYAKRISHNAN K PISHARAM Keywords: Acute kidney Injury, AKI outcome Acute kidney injury (AKI), formerly known as acute renal failure is widely recognized as an important predictor of morbidity and mortality and as an antecedent to chronic kidney disease. The incidence of AKI is on the rise worldwide and this probably reflects the increasing burden of an ageing population and coexisting medical conditions. This retrospective study aims to gather national epidemiological data for AKI, particularly to identify preventable causes and areas of improvements. The study was done retrospectively on patients who were coded with acute kidney injury between 1stJanuary 2014 and 31st December 2016. Data was retrieved from the national electronic patient record system (BRU-HIMS). Inclusion criteria included patients who fulfilled the International Classification of Diseases (ICD) 10 codes for AKI. Patients under the age of 18, with chronic kidney disease and with functioning transplant graft were excluded from the study. The national recorded incidence of AKI was 67 cases per million population. Primary clinical end points were defined as death or end stage renal disease. 21 patients (26.3%) progressed into end stage renal failure or died. Advanced age, absence of diabetes mellitus, progressive Acute Kidney Injury Network(AKIN) Staging and high blood pressure on presentation were risk factors which significantly affected long term outcome with log- rank p values at p= 0.038, p= 0.025, p= 0.002 and p= 0.017 respectively. The overall survival function of patients with AKI were 0.80, 0.78, 0.75 and 0.75 at three, sixth, 12th and 24th months respectively (see Graph attached). This study provides preliminary national data on the status of AKI in the country. We recognized that the quality of the data is limited by suboptimal coding practice, hence rectifying mechanisms have been put in place to ensure that future studies can provide a better estimate on national incidence and outcomes. Even so, existing captured data has given us insightful information on the behavior and characteristics of national AKI cases and allow us to benchmark with international studies.

‘We can only request what's in our protocol’: technology and work autonomy in healthcare

This article explores the tension between standardization and autonomy raised by the implementation of new technology in healthcare organizations. The theoretical frame of this study is grounded in the impact of new technologies on work organization, routinization and autonomy across settings. Empirically it presents evidence from twoNHSTrusts in England that implemented a national Electronic Patient Record (EPR). The paper aims to reinvigorate the debate on the tension between standardization and autonomy in professional workplaces such as healthcare. It argues that the implication of technology in professional work conditions processes of task routinization that constrain autonomy, and enables reallocation of discretion between professional groups. We argue that routinization is not restricted to low‐skill work but may travel across contexts and be evidenced in high‐skill work environments. The interplay between routinization and autonomy is also useful in drawing insights concerning the dynamics of change that occur in professional work.

Risico’s vermijden door depolitisering

In this paper we demonstrate how contemporary politics deals with complex risk issues that emanate from emergent technologies based on the following case study: the implementation of the national electronic patient record (EPR) in the Netherlands. The Dutch Senate unanimously rejected the EPR in 2011. From then on, market playsers have been at the forefront to make the EPR operative in Dutch health care, despite its lack of political legitimacy. This study reports how the relocation of politics to market players and professional arena’s takes place (Hajer and Versteeg 2005; Pierre and Peters 2000; Rhodes 1997; Walls et al. 2005). As we perceive this relocation of politics as a form of governmentality (Foucault 1991), we are able to make visible how power is exerted over professionals and citizens (Rose and Miller 1992) and how they deal with processes of subjectification (Broer 2006). Our analysis of semi-structured interviews with policy makers, implementers and first-line health care professionals, observations of information meetings and a variety of documents shed light on several governmental techniques that aim to allay anxiety regarding the EPR: seduction, emotion management and relieving in combination with strict surveillance of health care professionals. Even though collaboration with the EPR is voluntary we make plausible that these techniques seriously compromise health care professionals’ and citizens’ freedom of choice. We conclude that the technology is strongly depoliticized in order to protect the rollout of the EPR in Dutch health care.

Hybridity as a process of technology's ‘translation’: Customizing a national Electronic Patient Record

This paper explores how national Electronic Patient Record (EPR) systems are customized in local settings and, in particular, how the context of their origin plays out with the context of their use. It shows how representations of healthcare organizations and of local clinical practice are built into EPR systems within a complex context whereby different stakeholder groups negotiate to produce an EPR package that aims to meet both local and generic needs. The paper draws from research into the implementation of the National Care Record Service, a part of the National Programme for Information Technology (NPfIT), in the English National Health Service (NHS). The paper makes two arguments. First, customization of national EPR is a distributed process that involves cycles of ‘translation’, which span across geographical, cultural and professional boundaries. Second, ‘translation’ is an inherently political process during which hybrid technology gets consolidated. The paper concludes, that hybrid technology opens up possibilities for standardization of healthcare.

Changes in healthcare professional work afforded by technology: The introduction of a national electronic patient record in an English hospital

This article considers changes in healthcare professional work afforded by technology. It uses the sociology of professionals’ literature together with a theory of affordances to examine how and when technology allows change in healthcare professional work. The study draws from research into the introduction of a national electronic patient record in an English hospital. We argue that electronic patient record affords changes through its materiality as it interacts with healthcare professional practice. Its affordances entail some level of standardisation of healthcare professional conduct and practice, curtailment of professional autonomy, enlargement of nurses’ roles and redistribution of clinical work within and across professional boundaries. The article makes a contribution to the growing literature advocating a cultural approach to the study of technological affordances in organisations and to studies that explore healthcare professional practice in conjunction with the materiality of technology. Two main lines of argument are developed here. First, that technological affordances do not solely lie with the materiality of technology nor with individual perceptions, but are cultivated and nurtured within a broader cultural–institutional context, in our case a professional context of use. Second, that technological affordance of change is realised when healthcare professionals’ (individual and collective) perceptions of technology (and of its materiality) fit with their sense of (professional) self. In this respect, the article shows the extent to which the materiality of technology plays out with professional identity and frames the level and extent to which technology can and cannot afford restructuring of work and redistribution of power across professional groups.

Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study

BackgroundVarious countries are currently implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs, their overall adoption remains low and meets resistance from health care providers. This study aims to increase our understanding of health care providers' attitude towards the n-EPR, by investigating their perceptions of the benefits and problems of electronic information exchange in health care and the n-EPR in particular.MethodsThe study was conducted in three Dutch health care settings: acute care, diabetes care, and ambulatory mental health care. Two health care organisations were included per setting. Between January and June 2010, interviews were conducted with 17 stakeholders working in these organisations. Relevant themes were deduced by means of thematic qualitative analysis.ResultsHealth care providers perceived electronic information exchange to promote the efficiency and quality of care. The problems they perceived in electronic information exchange mainly concerned the confidentiality and safety of information exchange and the reliability and quality of patient data. Many problems perceived by health care providers did not specifically apply to the n-EPR, but to electronic information exchange in general.ConclusionsThe implementation of the Dutch n-EPR has mainly followed a top-down approach, thereby neglecting the fact that the perceptions and preferences of its users (health care providers) need to be addressed in order to achieve successful implementation. The results of this study provide valuable suggestions about how to promote health care providers' willingness to adopt electronic information exchange, which can be useful for other countries currently implementing an n-EPR. Apart from providing information about the benefits and usefulness of electronic information exchange, efforts should be focused on minimising the problems as perceived by health care providers. The safety and confidentiality of electronic information exchange can be improved by developing tools to evaluate the legitimacy of access to electronic records, by increasing health care providers' awareness of the need to be careful when using patient data, and by measures to limit access to sensitive patient data. Improving health care providers' recording behaviour is important to improve the reliability and quality of electronically exchanged patient data.

News and Views Introduction of a National Electronic Patient Record in The Netherlands: Some Legal Issues

The electronic patient record (EPR) is a major technological development within the healthcare sector. Many hospitals across Europe already use institution-based electronic patient records, which allow not only for electronic exchange of patient data within the hospital, but potentially also for sharing medical data with external healthcare providers, involved in the patient's care, such as general practitioners or pharmacists. In this article, we discuss the attempt made by the Dutch government to introduce a nationwide electronic patient record (n-EPR). Describing and analyzing the new legislation that is currently being developed to establish the infrastructure for the n-EPR and the related legal issues, we conclude that the introduction of a n-EPR give rise to some substantial concerns. These vary from technical and quality issues such as the reliability of patient data and sufficient standardization and interoperability of the systems used, to issues in the field of data security and confidentiality. For a successful introduction of the n-EPR within the healthcare sector, a condicio sine qua non is that the related legislation provides sufficient safeguards and clarity with respect to the responsibilities and liabilities of its main users: the healthcare professionals.

Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial

BackgroundMany emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology - hand-held computers with computerised clinical decision support (CCDS) software - to help paramedics decide who needs hospital attendance, and who can be safely left at home with referral to community falls services.Methods/DesignPragmatic cluster randomised trial with a qualitative component. We shall allocate 72 paramedics ('clusters') at random between receiving the intervention and a control group delivering care as usual, of whom we expect 60 to complete the trial.Patients are eligible if they are aged 65 or older, live in the study area but not in residential care, and are attended by a study paramedic following an emergency call for a fall. Seven to 10 days after the index fall we shall offer patients the opportunity to opt out of further follow up. Continuing participants will receive questionnaires after one and 6 months, and we shall monitor their routine clinical data for 6 months. We shall interview 20 of these patients in depth. We shall conduct focus groups or semi-structured interviews with paramedics and other stakeholders.The primary outcome is the interval to the first subsequent reported fall (or death). We shall analyse this and other measures of outcome, process and cost by 'intention to treat'. We shall analyse qualitative data thematically.DiscussionSince the SAFER 1 trial received funding in August 2006, implementation has come to terms with ambulance service reorganisation and a new national electronic patient record in England. In response to these hurdles the research team has adapted the research design, including aspects of the intervention, to meet the needs of the ambulance services.In conclusion this complex emergency care trial will provide rigorous evidence on the clinical and cost effectiveness of CCDS for paramedics in the care of older people who have fallen.Trial RegistrationISRCTN10538608

Dutch Virtual Integration of Healthcare Information

As information technology creates opportunities for cooperation which crosses the boundaries between healthcare institutions, it will become an integral part of the Dutch healthcare system. Along with many involved organizations in healthcare the National IT Institute for Healthcare in the Netherlands (NICTIZ) is working on the realization of a national IT infrastructure for healthcare and a national electronic patient record (EPR). An underlying national architecture is designed to enable the Dutch EPR virtually, not in a national database, nor on a patient's smartcard. The required secure infrastructure provides generic functions for healthcare applications: patient identification, authentication and authorization of healthcare professionals. The first national applications in the EPR program using a national index of where patient data is stored, are the electronic medication record and the electronic record for after hours GP services. The rollout of the electronic medication record and electronic record for after hours GP services has been started in 2007. To guarantee progress of electronic data exchange in healthcare in the Netherlands we have primarily opted for two healthcare applications: the electronic medication record and the electronic record for after hours GP services. The use of a national switch-point containing the registry of where to find what information, guarantees that the professional receives the most recent information and omits large databases to contain downloaded data. Proper authorization, authentication as well as tracing by the national switchpoint also ensures a secure environment for the communication of delicate information.

Help to build the software programs for patient records

I would like to reassure Stephanie Theobald (letters June 28) that clinicians are involved in building the software programs for the national electronic patient record. I have volunteered to assist and more clinicians are needed.