Nationwide Electronic Health Record System Research Articles

850-P: Trends in GLP-1RA Use among Individuals with Type 2 Diabetes (T2D) and/or Obesity—Insights from a Nationwide Electronic Health Record System, 2010–2023

850-P: Trends in GLP-1RA Use among Individuals with Type 2 Diabetes (T2D) and/or Obesity—Insights from a Nationwide Electronic Health Record System, 2010–2023

Correction: A Call to Reconsider a Nationwide Electronic Health Record System: Correcting the Failures of the National Program for IT.

Correction: A Call to Reconsider a Nationwide Electronic Health Record System: Correcting the Failures of the National Program for IT.

A Call to Reconsider a Nationwide Electronic Health Record System: Correcting the Failures of the National Program for IT.

Abstract The National Programme for IT (NPfIT) was launched in 2005 to implement 7 nationwide IT services across the National Health Service (NHS). Despite the success of many of these designated “deliverables,” the establishment of a single nationwide electronic health record (EHR) system never fully materialized. As a result, NHS medical records are now stored using a diverse array of alternate EHR systems, which frequently restricts health care practitioners from accessing extensive portions of their patients’ notes. This not only limits their ability to make well-informed clinical decisions but also impacts the quality of care they are able to provide. This article assesses the medical, economic, and bureaucratic implications of an NHS-wide EHR system. Additionally, it explores how the shortcomings of the NPfIT should be addressed when attempting to introduce such a system in the future.

IMPLEMENTATION OF THE NATIONWIDE ELECTRONIC HEALTH RECORD SYSTEM IN SERBIA: CHALLENGES, LESSONS LEARNED, AND EARLY OUTCOMES.

Many countries around the world have recognized the need for using an electronic health record (EHR) system. However, there is limited literature that could serve as a guide during a lengthy and challenging process of planning, development, and implementation of the e-Health system. Since the EHR system was recently introduced in Serbia, the purpose of this communication is to describe our experience and lessons learned along the way. The key personnel involved in the implementation of the EHR system in Serbia that began in 2015 conducted in 2019 a retrospective narrative review of the process and early outcomes. An incremental approach in the planning, development, and implementation of the nationwide EHR system was taken. The process was split into phases with the gradual introduction of different regions of the country. The gradual shift from the existing to a new workflow for the prospective users was also implemented. The significant milestones were the achievement of quick legislative changes, the hiring of a professional team of experts in the field, the provision of timely and appropriate information and training to prospective users, the close collaboration between the implementation team and the Ministry of Health and mutual understanding of the aims and expectations, and the flexibility in accepting the evolving nature of the process, goals, and the system model. A successful implementation of the nationwide EHR system is feasible providing careful planning, the assembly of a multi-disciplinary team, the use of a stepwise approach, the early and continued involvement of the intended users, and the willingness to make adjustments along the way. The end-result sets the stage for the reform of the health care system itself.

The Veterans Affairs Precision Oncology Data Repository, a Clinical, Genomic, and Imaging Research Database

SummaryThe Veterans Affairs Precision Oncology Data Repository (VA-PODR) is a large, nationwide repository of de-identified data on patients diagnosed with cancer at the Department of Veterans Affairs (VA). Data include longitudinal clinical data from the VA's nationwide electronic health record system and the VA Central Cancer Registry, targeted tumor sequencing data, and medical imaging data including computed tomography (CT) scans and pathology slides. A subset of the repository is available at the Genomic Data Commons (GDC) and The Cancer Imaging Archive (TCIA), and the full repository is available through the Veterans Precision Oncology Data Commons (VPODC). By releasing this de-identified dataset, we aim to advance Veterans' health care through enabling translational research on the Veteran population by a wide variety of researchers.

A phenotyping algorithm to identify acute ischemic stroke accurately from a national biobank: the Million Veteran Program.

BackgroundLarge databases provide an efficient way to analyze patient data. A challenge with these databases is the inconsistency of ICD codes and a potential for inaccurate ascertainment of cases. The purpose of this study was to develop and validate a reliable protocol to identify cases of acute ischemic stroke (AIS) from a large national database.MethodsUsing the national Veterans Affairs electronic health-record system, Center for Medicare and Medicaid Services, and National Death Index data, we developed an algorithm to identify cases of AIS. Using a combination of inpatient and outpatient ICD9 codes, we selected cases of AIS and controls from 1992 to 2014. Diagnoses determined after medical-chart review were considered the gold standard. We used a machine-learning algorithm and a neural network approach to identify AIS from ICD9 codes and electronic health-record information and compared it with a previous rule-based stroke-classification algorithm.ResultsWe reviewed administrative hospital data, ICD9 codes, and medical records of 268 patients in detail. Compared with the gold standard, this AIS algorithm had a sensitivity of 91%, specificity of 95%, and positive predictive value of 88%. A total of 80,508 highly likely cases of AIS were identified using the algorithm in the Veterans Affairs national cardiovascular disease-risk cohort (n=2,114,458).ConclusionOur algorithm had high specificity for identifying AIS in a nationwide electronic health-record system. This approach may be utilized in other electronic health databases to accurately identify patients with AIS.

Implementation of a nationwide electronic health record (EHR)

PurposeThe purpose of this paper is to identify the best practices applied during the implementation process of a national electronic health record (EHR) system. Furthermore, the main goal is to explore the knowledge gained by experts from leading countries in the field of nationwide EHR system implementation, focusing on some of the main success factors and difficulties, or failures, of the various implementation approaches.Design/methodology/approachTo gather the necessary information, an international survey has been conducted with expert participants from 13 countries (Denmark, Austria, Sweden, Norway, the UK, Germany, the Netherlands, Switzerland, Canada, the USA, Israel, New Zealand and South Korea), who had been playing varying key roles during the implementation process. Taking into consideration that each system is unique, with each own (different) characteristics and many stakeholders, the methodological approach followed was not oriented to offer the basis for comparing the implementation process, but rather, to allow us better understand some of the pros and cons of each option.FindingsTaking into account the heterogeneity of each country’s financing mechanism and health system, the predominant EHR system implementation option is the middle-out approach. The main reasons which are responsible for adopting a specific implementation approach are usually political. Furthermore, it is revealed that the most significant success factor of a nationwide EHR system implementation process is the commitment and involvement of all stakeholders. On the other hand, the lack of support and the negative reaction to any change from the medical, nursing and administrative community is considered as the most critical failure factor.Originality/valueA strong point of the current research is the inclusion of experts from several countries (13) spanning in four continents, identifying some common barriers, success factors and best practices stemming from the experience obtained from these countries, with a sense of unification. An issue that should never be overlooked or underestimated is the alignment between the functionality of the new EHR system and users’ requirements.

Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach.

The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving. This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture. The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution. The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data. The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.

Interactive telemedicine solution based on a secure mHealth application.

In dynamic healthcare environments, caregivers and patients are constantly moving. To increase the healthcare quality when it is necessary, caregivers need the ability to reach each other and securely access medical information and services from wherever they happened to be. This paper presents an Interactive Telemedicine Solution (ITS) to facilitate and automate the communication within a healthcare facility via Voice over Internet Protocol (VOIP), regular mobile phones, and Wi-Fi connectivity. Our system has the capability to exchange/provide securely healthcare information/services across geographic barriers through 3G/4G wireless communication network. Our system assumes the availability of an Electronic Health Record (EHR) system locally in the healthcare organization and/or on the cloud network such as a nation-wide EHR system. This paper demonstrate the potential of our system to provide effectively and securely remote healthcare solution.

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Towards Implementing a Nationwide Electronic Health Record System in Nigeria

The World Health Organization identified inadequate Health Information Systems as a challenge in Nigeria. Many developed countries have either implemented or are in the process of implementing an Integrated Electronic Health Record (EHR) system because of its potential benefits. Pilot projects in many developing countries like Kenya, Malawi, Peru, and Haiti are demonstrating the viability of EHR in resource constrained areas. This study shows that the health system in Nigeria is pluralistic and complex with Federal, State and Local Governments, Health Related Agencies, Non-Governmental Organizations, private healthcare providers, patients, and researchers as the major stakeholders. The drivers for adoption of a nationwide EHR include the need to report data; improve patient safety, improve work place efficiency; comply with government reforms aimed at reducing the cost and increasing access to health services. Corruption, poor coordination among stakeholders, and lack of constant supply of electricity are some of the barriers to a successful implementation of a nationwide EHR. Factors considered critical to a successful implementation of a nationwide EHR include enforceable legislation, a trained and motivated workforce, and significant and sustainable funding.

National Health IT Services in Finland

In 2002 a decision was reached to set up a nation-wide electronic health record system in Finland. The legal framework of actors with the necessary mandate was approved in the parliament in December 2006. A set of standards and norms have been selected that all health care actors need to follow. Functional specifications of the services were completed in 2006. Setting up the centralized health IT services begins in 2007. Centralization of patient record data allows the reorganization of health service providers to take place at local and regional levels according to need. The services allow users to access patient records securely from anywhere with the provision that they have the right to access private patient data. The functionality of the services and the necessary infrastructure has been agreed to in projects and working groups involving users, experts, key stakeholders and vendors. The legal framework was approved in the parliament in December 2006. The functional specifications of the centralized health IT services were finalized in 2006. The implementation of the services will start in 2007.