Nationwide Electronic Health Record Research Articles

Designing Clinical Concept Models for a Nationwide Electronic Health Records System For Japan

Objectives: We developed an electronic health records (EHR) system for regional healthcare in 2000. This EHR stores the health records of more than 6,300 patients in two regions of Japan; however, clinical updates and improved interoperability with other clinical standards, such as HL7 or others are needed. In 2015, this EHR system was upgraded to create a nationwide-scale healthcare data repository to improve the interoperability of clinical data with openEHR technology. Methods: The clinical data in our EHR system has 16 components constructed with Medical Markup Language (MML) standards and periodic mass screening for employees and students. Therefore, we constructed mindmaps of the clinical MML and surveillance data to analyse the concept models. Based on mindmap analysis, we designed archetypes of the concepts identified using Ocean Archetype Editor. The artefacts were mainly quoted from the openEHR clinical knowledge manager (CKM). As the archetypes on CKM did not include all MML semantics, the archetypes were newly designed to complement the semantics of the MML. Results: We developed clinical information models by archetypes that semantically equalled the EHR system. Twenty-one MML components/modules and concept models using 99 archetypes were constructed for periodic mass screening services. Most of the archetypes were quoted from CKM; however, 22 archetypes were specialised, and eight archetypes were newly designed. The reasons for specialisation were to adjust the demographics to Japanese and to extend the archetypes to the dental domain. Conclusion: We constructed concept models with archetypes semantically equivalent to conventional data and developed new archetypes for mass screening by archetype technology. The suggested archetype technology improved the flexibility of the EHR system to cover the existing standards.

Development of Nationwide Electronic Health Record (ΝEHR): An international survey

The primary aim of this research is to capture the existing experience from countries where nationwide EHR systems have already been implemented or the development is in a mature phase. To capture the necessary information, an international survey has been conducted with expert participants from 13 countries. The results of this research show that private vendors׳ involvement in most of the system development lifecycle phases is inevitable. However, the phase where most private vendors are involved in during the development of an EHR system is System Design. Interestingly, their involvement does not depend on who has the responsibility of the EHR system development (either a national organization or a private vendor). Finally, examining the supported standards by EHR systems and their interoperability with other information systems, in respect to both technical and semantic interoperability, it is found that more efforts should be made for the integration of the most widely supported standards, and the enhancement of interoperability among health information systems, which will lead to the successful integration of a NEHR system.

Literature Review of Patient Record Structures from the Physician's Perspective.

The Finnish Patient Data Repository is a nationwide electronic health record (EHR) system collecting patient data from all healthcare providers. The usefulness of the large amount of data stored in the system depends on the underlying data structures, and thus a solid understanding of these structures is in focus in further development of the data repository. This study seeks to improve that understanding by a systematic literature review. The review takes the physician's perspective to the use and usefulness of the data structures. The articles included in this review study data structures intended to be used in the actual care process. Secondary use and nursing aspects have been covered in separate reviews. After applying the predefined inclusion and exclusion criteria only 40 articles were included in the review. The research on widespread systems in everyday use was especially scarce, most studies concentrated on narrow fields. Majority of these studies were primarily developed for specialist use in secondary care units. Most structures or applications studied were at an early stage of development. In many applications the use of structured data was found to improve the completeness of the documented data and facilitate its automated use. However, there seem to be some applications where narrative text cannot be easily replaced by structured data. Usability results regarding structured representation were conflicting. The scattered nature and paucity of research hinders the generalizability of the findings, and from the system design or implementation point of view the practical value of the scientific literature reviewed is limited.

New model of Electronic Health Record: Macedonian case study

Electronic Health Record (EHR) systems are core applications in any e-Health environment and represent basic services for healthcare information technology platforms. Many EHR introduction projects ran into trouble because of the inappropriate model and concept of implementation, according to the requirements and standards, as well as the lack of the acceptance of the EHR related services among physicians. The aim of this paper is to give a brief overview of the current situation of citizens’ healthcare data and need for the nationwide EHR with focus on R. Macedonia. We are making an analysis of the best practices of EHR's implementation and introduction in many countries in the world. We use these positive and useful experiences in the Macedonian case of EHR's introduction and propose a new collaborative model of EHR for healthcare organizations, adapted to the situation and needs of the Macedonian healthcare information system.

Linking macro-level goals to micro-level routines: EHR-enabled transformation of primary care services

Information and communication technologies are known to be instrumental in the enhancement of healthcare management capabilities in developing countries. Turkey - a developing country - has undergone a major healthcare transformation marked by the redesign of primary care delivery and the implementation of a nation-wide Electronic Health Records (EHR) system. In this research, presenting Turkey's case, we investigate the consequences of EHR implementation in developing countries. We argue that to better understand the consequences, we need to link macro-level healthcare goals with micro-level system usage behaviors that actualize the macro-level goals or alternatively result in unintended negative health outcomes. We posit that this linkage is achieved through the meso-level structures, namely the EHR and the organizational context, in which it is embedded. Hence, we examine the EHR's role in this relationship. Our findings indicate that EHR usage both enables and constrains the achievement of clinicians' professional goals in the context of primary care delivery. Moreover, goal alignment between the government agency as the designer of the system and the clinicians influence the outcomes of the EHR-enabled transformation. When the healthcare goals are aligned, the system enables the clinicians to achieve their professional goals and their system usage behaviors converge, contributing to improvements in health outcomes. Contrarily, when the goals are misaligned, the system constrains goal achievement and the clinicians show divergent usage behaviors, including goal abandonment. In turn, goal abandonment may lead to negative consequences and even adversely affect the achievement of population-level healthcare goals in the long run.

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.

Maximizing Healthcare Professionals’ Use of New Computer Technologies in a Small, Urban Hospitalʼs Critical Care Unit

INTRODUCTIONThe past decade has witnessed a tremendous increase in technology use in hospitals and healthcare centers, due, in part, to a 2004 federal mandate calling for nationwide electronic health record (EHR) adoption (Kirkley & Stein, 2004). According to the Centers for Medicare & Medicaid Services (CMS), 2014 was the last year for eligible providers and hospitals to initiate their participation in the Medicare & Medicaid EHR Incentive Program. In 2015, adjustments to reimbursements began for those that are not meaningful users of EHR technology as defined by the Health Information Technology for Economic and Clinical Health Act of 2009 (CMS, 2016).Health professionals-nurses, medical assistants, and allied health professionals for the purposes of this article-must understand that converting to EHRs is not a choice but a necessity an issue that is still prevalent in some small, urban hospitals. Healthcare staff members are expected to use new computer technologies to better serve their patients, increase productivity, and generate proper reimbursement for their organizations (Blumenthal &, Tavenner, 2010; Fetter, 2009). Their positive contributions to EHR implementation sharpen the focus of the entire organization on patient care (Kirkley & Stein, 2004).Transitioning from paper to EHRs is slow in most healthcare institutions because it requires resources, availability, and workforce training (George, Garth, Fish, & Baker, 2013). Haughom, Kriz, and McMillan (2011) state that new computer technology implementation in any organization has its problem points, especially in settings with hundreds of physicians and healthcare professionals. Moreover, they note that users' attitudes, perceptions, and satisfaction with new technologies influence implementation more than the technologies' design or efficiency does. George et al. (2013) point to the importance of leaders in making sure staff understand the organizational, social, and technological issues related to using new technologies. Meibner and Schnepp (2014) note that equipment availability in the patient care units and technical functionality of the equipment are important factors in the implementation of new technology. Lack of technical support, malfunctioning equipment, and unspecific issues regarding general maintenance matters may increase feelings of frustration and uncertainty in using new technology and therefore delay implementation (Meibner & Schnepp, 2014).Despite the increase in new computer technologies in healthcare and the pressure from the federal government to change from paper to electronic documentation (Huryk, 2010), few studies have been conducted on effective ways to engage staff in the implementation of new computer technologies, particularly in a critical care unit (CCLI) of a small, urban hospital-the focus of this article, CCLIs have unique challenges regarding technology implementation because they are, by nature, data intense (De Georgia, Kaffashi, Jacono, & Loparo, 2015).COMPUTER TECHNOLOGY ADOPTION CHALLENGES IN CCUsTo frame the present study, Davis's (1989) technology acceptance model was used, as it remains a valid means to explain how CCU healthcare professionals perceived usefulness and ease of use of new technologies. The CCU at the small, urban hospital under study has a capacity of 260 acute care beds and approximately 85 healthcare professionals on staff. The unit needs to begin participating in the Medicare & Medicaid EHR Incentive Program. At present, some computer systems in the CCU are designed to save staff time by eliminating phone calls. For example, requests for beds, transporters, housekeeping, maintenance, radiology, and so forth are entered in the hospital's main computer. When received by the designated department, the requested tasks are delegated, thus avoiding the need to make phone calls to different departments. Another computer system enables staff to print forms. …

Accelerating the National Implementation of Electronic Health Records in Canada

Trends such as the aging population, long wait times, rising costs, and labour shortages in health professions are notable challenges facing the sustainability of Medicare in Canada. Healthcare reform, especially in primary care, will ensure efficiency and equitable access to healthcare in. Information and communication technologies (ICTs) such as electronic health records (EHRs) will play a pivotal role in reforming and sustaining Medicare. EHRs make healthcare safer, cost efficient and more integrated, and are necessary for the wider application of ICTs in the health sector. EHRs enhance decision-making capabilities for both providers and patients, especially in managing chronic diseases. Notwithstanding the numerous advantages of EHRs, Canada is slow to adopt a nation-wide EHR system. This paper analyzed existing data to establish the factors that may help to accelerate the national implementation of electronic health records in Canada. It defined EHRs, discussed their advantages and disadvantages, and barriers to its full application. Also, it explored key strategies for accelerating EHR initiatives in Canada, and suggested action plans and time frames for doing so.

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.

EHR adoption across China's tertiary hospitals: A cross-sectional observational study

HeadingEHR adoption across China's tertiary hospitals: a cross-sectional observation study ObjectivesTo assess electronic health record (EHR) adoption in Chinese tertiary hospitals using a nation-wide standard EHR grading model. MethodsThe Model of EHR Grading (MEG) was used to assess the level of EHR adoption across 848 tertiary hospitals. MEG defines 37 EHR functions (e.g., order entry) which are grouped by 9 roles (e.g., inpatient physicians) and grades each function and the overall EHR adoption into eight levels (0–7). We assessed the MEG level of the involved hospitals and calculated the average score of the 37 EHR functions. A multivariate analysis was performed to explore the influencing factors (including hospital characteristics and information technology (IT) investment) of total score and scores of 9 roles. ResultsOf the 848 hospitals, 260 (30.7%) were Level Zero, 102 (12.0%) were Level One, 269 (31.7%) were Level Two, 188 (22.2%) were Level Three, 23 (2.7%) were Level Four, 5 (0.6%) was Level Five, 1 (0.1%) were Level Six, and none achieved Level Seven. The scores of hospitals in eastern and western China were higher than those of hospitals in central areas. Bed size, outpatient admission, total income in 2011, percent of IT investment per income in 2011, IT investment in last 3 years, number of IT staff, and duration of EHR use were significant factors for total score. ConclusionsWe examined levels of EHR adoption in 848 Chinese hospitals and found that most of them have only basic systems, around level 2 and 0. Very few have a higher score and level for clinical information using and sharing.

An implementation guide for a CDA report about cardiopulmonary exercise testing (CPET) results in the Austrian health record

In this article we present an answer to the question how difficult might it be, to define a working CDA report that fulfills the requirements of the Austrian specifications of the nationwide electronic health record called ELGA. We chose the results of standardized cardiopulmonary exercise testing (CPET) results as an example document. We therefore analyzed existing documentation and interviewed sport scientists and medical doctors to find out how this type of medical documentation is best structured and what data must be and can optionally be included. We then worked out the appropriate elements of a CDA report for levels 2 and 3. Only one adaptation had to be made to the official Austrian health records stylesheet, which was necessary to be able to integrate scalable vector graphic (SVG) images. After this project we can conclude, that the time and technical effort to construct documents for the nationwide Austrian electronic health record is quite little. The biggest problem still might be to obtain a consensus of all involved parties when trying to define an official report, which was not necessary in our case.

INSIDE INDUSTRY

ADDF Supports Axxam to Develop Therapeutics for Alzheimer's. Epitomics Signs Agreement with Bayer for Antibody Technology. Sirnaomics Partners Guangdong Zhongsheng to Dvelop siRNA Therapeutics. Jubilant, Endo Achieve Late Stage Discovery Milestone. Merck and Hanwha Chemical Corporation Establish Global Strategic Collaboration for Biosimilar. SIOGEN Awarded 'Most Innovative Biotech in Asia'. GENEWIZ, Inc. and Biomatters Announce Strategic Partnership to Align DNA-Based Services and Analysis Software. Invida Launches AtopiclairTM, a Treatment for Atopic Dermatitis Symptoms. Accenture Implements Nationwide Electronic Health Record System in Singapore. A*STAR & Olympus Singapore Establish Microscopy Suite to Study Human Diseases at the Nano-level.

Go local, European review of electronic health records advises

Grandiose nationwide electronic health record (EHR) systems aimed at aggregating patient data into general summaries may not be feasible, necessary or medically justified, according to a European Commission report. The review of European ehealth investments suggests that decentralized approaches

Development of Fundamental Infrastructure for Nationwide EHR in Japan

The movement of create medical information systems that is now taking place involves both progress in EMR (Electronic Medical Records)-computerization of records at hospitals and clinics, and also in EHR (Electronic Health Records) in which information is shared with individual regions. However, the geographical coming and going of people in modern society is extremely active. Naturally the places these people move to are not necessarily within the same region. For this reason, even if the basic unit for the health care supply system is in practical terms limited to the local level, if services are restricted to only one region, many persons may be unable to receive the benefits of health care cooperation. In this study, we constructed a mechanism for a medical cooperation system which links the EHR systems of individual regions and is able to create a one-patient, one-record system on the national level. In this paper, we will provide a report of this mechanism and of the 4-year operational trial.

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.

Nationwide Health Data Management System: A Novel Approach for Integrating Biomarker Measurements with Comprehensive Health Records in Large Populations Studies

The nation-wide electronic health record database acts as an interoperable repository of health data obtained throughout citizen contacts with health care providers. This system improves accessibility for citizens and researchers to health data with the ability to assign context to disease development. In that system, individual patients who are members of the large population-based health database can be assessed as individuals or as a population in prospective studies of prospective diseases.

APPC—A new standardised coding system for trans-organisational PACS retrieval

As part of a general strategy to integrate the health care enterprise, Austria plans to connect the Picture Archiving and Communication Systems (PACS) of all radiological institutions into a nationwide network. To facilitate the search for relevant correlative imaging data in the PACS of different organisations, a coding system was compiled for all radiological procedures and necessary anatomical details. This code, called the Austrian PACS Procedure Code (APPC), was granted the status of a standard under HL7. Examples are provided of effective coding and filtering when searching for relevant imaging material using the APPC, as well as the planned process for future adjustments of the APPC. The implementation and how the APPC will fit into the future electronic environment, which will include an electronic health act for all citizens in Austria, are discussed. A comparison to other nationwide electronic health record projects and coding systems is given. Limitations and possible use in physical storage media are contemplated.

Workforce Implications of Meaningful Use Criteria

The American Recovery and Reinvestment Act of 2009 (ARRA; the Stimulus) has remained a hot topic in the lay media and in health care circles alike. We previously provided an overview of the broad implications of the Stimulus for the health care sector. There are many aspects to the ambitious plan of nationwide electronic medical record (EMR) and electronic health record (EHR) adoption, including technical and privacy considerations. This column addresses workforce, another critical component of the effort.

Electronic Health Records: Privacy and Security Issues in a Comparative Perspective

Electronic Health Records: Privacy and Security Issues in a Comparative Perspective

Austria’s Path Toward Nationwide Electronic Health Records

This article discusses current planning activities in Austria after legislation has been passed to introduce the electronic health record (EHR). After describing similar activities in several other countries, the authors explore the current situation of healthcare telematics and imminent steps toward the implementation of a lifelong EHR. Substantial efforts have been made to coordinate healthcare telematics in Austria since the mid-1990s. One result of these efforts was the definition of a framework for electronic data exchange. A number of standardization projects were also implemented. Major steps have been taken as part of an ongoing healthcare reform to promote the use of healthcare telematics. One important example is a national initiative whose objective is to implement the EHR. This initiative is extensively discussed along with other national activities related to healthcare telematics. This EHR initiative has prepared the ground for extensive planning that is currently under way to implement a lifelong EHR in Austria on a national level. Introducing the EHR will have a strong impact on Austrian healthcare and should be performed in concert with international activities. The authors offer a number of practical recommendations for the implementation of an EHR on a national level.