Use Of Electronic Patient Record Research Articles

The Value of Emergency Care Data Set (ECDS) Presentation Codes for Predicting Mortality and Inpatient Admission.

Early identification of patients at higher risk of death and hospital admission is an important problem in Emergency Departments (ED). Most triage scales were developed before current electronic healthcare records were developed.The implementation of a national Emergency Care Data Set (ECDS) allows for the standardised recording of presenting complaints and the use of Electronic Patient Records (EPR) offers the potential for automated triage. The mortality risk and need for hospital admission associated with the different presenting complaints in a standardised national data set has not been previously reported. This study aimed to quantify the risks of death and hospitalisation from presenting complaints. This would be valuable in developing automated triage tools and decision support software. We conducted an observational retrospective cohort study on patients who visited a single ED in 2021. The presenting complaints related to subsequent attendances were excluded. This patient list was then manually matched with a routinely collected list of deaths. All deaths that occurred within 30 days of attendance were included. Data was collected from 84,999 patients, of which 1,159 people died within 30 days of attendance.The mortality rate was the highest in cardiac arrest [32(78.1%)], cardiac arrest due to trauma [2(50%)] and respiratory arrest [3(50%)]. Drowsy [17(12%)], hypothermia [3(13%)] and cyanosis [1(10%)] were also high-risk categories. Chest pain [34(0.6%)] was not a high-risk presenting complaint. The initial presenting complaint in ECDS may be usefulto identify people at higher and lower risk of death. This information is useful for building automated triage models.

Information system in the context of the use of electronic patient record in Burundi

Abstract Objective The Information System is an essential catalyst for the performance of a hospital. In order to strengthen the hospital information system, the patient record computerization project has been initiated since 2014. Our objective was to assess the hospital information system in the context of using the electronic patient record to highlight the factors to be strengthened. Methods This is a cross-sectional survey using the Health Metrics Network assessment tool. Eleven hospitals were included in the study, including 4 computerized in 2015 and 7 computerized in 2017. We carried out an evaluation of the hospital information system as a whole and an evaluation of the level of filling of patient files. In each hospital, the director of care, the chief nursing officer and the data manager were surveyed. Data collection was done in October 2019. Results This evaluation showed that 4 components (resources, indicators, information product and the use of information) were satisfactory with a score varying from 55% to 67% while 2 components (data source and data management) were present but not satisfactory. The score was 61% for resources, 60% for indicators, 41% for data sources, 43% for data management, 55% for information product and 67% for dissemination and use of information. The proportion of files with the main diagnosis at discharge was 61% before computerization, while it was 81% when using EPR (p < 10-4). It was also noted that the electronic patient record had 2.73 [1.83 - 4.07; p < 10-4] times more likely to report the main diagnosis on exit than the paper file. Conclusions the source components of the data and data management have shortcomings. Corrective strategies should be considered to support the ongoing hospital information system strengthening reforms Key messages The health metric network tool for evaluating the health information system adapted to the national level can also be used to assess the hospital information system. The computerization of the patient record is not enough to make the hospital information system efficient.

Patient Privacy Violation Detection in Healthcare Critical Infrastructures: An Investigation Using Density-Based Benchmarking

Hospital critical infrastructures have a distinct threat vector, due to (i) a dependence on legacy software; (ii) the vast levels of interconnected medical devices; (iii) the use of multiple bespoke software and that (iv) electronic devices (e.g., laptops and PCs) are often shared by multiple users. In the UK, hospitals are currently upgrading towards the use of electronic patient record (EPR) systems. EPR systems and their data are replacing traditional paper records, providing access to patients’ test results and details of their overall care more efficiently. Paper records are no-longer stored at patients’ bedsides, but instead are accessible via electronic devices for the direct insertion of data. With over 83% of hospitals in the UK moving towards EPRs, access to this healthcare data needs to be monitored proactively for malicious activity. It is paramount that hospitals maintain patient trust and ensure that the information security principles of integrity, availability and confidentiality are upheld when deploying EPR systems. In this paper, an investigation methodology is presented towards the identification of anomalous behaviours within EPR datasets. Many security solutions focus on a perimeter-based approach; however, this approach alone is not enough to guarantee security, as can be seen from the many examples of breaches. Our proposed system can be complementary to existing security perimeter solutions. The system outlined in this research employs an internal-focused methodology for anomaly detection by using the Local Outlier Factor (LOF) and Density-Based Spatial Clustering of Applications with Noise (DBSCAN) algorithms for benchmarking behaviour, for assisting healthcare data analysts. Out of 90,385 unique IDs, DBSCAN finds 102 anomalies, whereas 358 are detected using LOF.

Staff Nurses and Physicians Attitudes toward the Use of Electronic Patient Record

Background: Electronic Patient record (EPR) links consumers, payers and providers across the continuum of care and provides relevant information to them. It is essential that information can be accessed from anywhere in the healthcare delivery system, even in remote locations. Aim: The current study aimed to assess and compare staff nurses' and physicians' attitudes toward EPR. Design: The study used a descriptive survey using self-report questionnaire. Setting: The present study was carried out at a private hospital namely Al Salama New Hospital and it is considered the first and the only hospital in Alexandria governorate at Egypt that implemented the EPR documentation system since 2004. It is equipped with around 100 beds, with a wide range of healthcare services. Subjects: One hundred and twenty five nurses and 90 physicians who were working in the previously mentioned setting. Tool: The data gathering tool staff nurses and physicians' attitudes toward EPR questionnaire. It was developed by the researcher based on Noble James nurses' attitudes toward computerization questionnaire (2002) and the current related literature to determine staff nurses and physicians' attitudes toward the use of EPR. It consists of five main dimensions and 56 sub- dimensions. Results: Around two- third 65.6% of staff nurses had positive attitudes toward the use of EPR. On the other hand, more than three quarters of physicians 75.6% had positive attitudes toward the use of EPR. In addition with no significant difference was found between staff nurses and physicians. The total score percent of the physicians' attitudes (75.6) was higher than the total mean score of the staff nurses' attitudes (65.6). Conclusion: Knowledge, training, and attitude need continual reinforcement to improve implementation for EPR. These results provide valuable information that could be used to encourage the implementation of EPR in Egypt. Recommendations: This study recommended for assuring electronic based documentation as criteria for magnet hospitals on the road of accreditation of healthcare organization. Develop clear policies and guidelines to address issues related to computer based documentation. It should be written and communicated to all healthcare organizations.

Getting on with your computer is associated with job satisfaction in primary care: entrants to primary care should be assessed for their competency with electronic patient record systems

Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user's preferences. The use of electronic patient record (EPR) systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences.

An analysis of electronic document management in oncology care

In this research in progress, a reference model for the use of electronic patient record (EPR) systems in oncology is described. The model, termed CICERO, comprises technical and functional components, and emphasises usability, clinical safety and user acceptance. One of the functional components of the model-an electronic document and records management (EDRM) system-is monitored in the course of its deployment at a leading oncology centre in the UK. Specifically, the user requirements and design of the EDRM solution are described.The study is interpretative and forms part a wider research programme to define and validate the CICERO model. Preliminary conclusions confirm the importance of a socio-technical perspective in Onco-EPR system design.

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Unity in Diversity: Electronic Patient Record Use in Multidisciplinary Practice

In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this perspective is illustrated through the analysis of a year-long, longitudinal case study of a multidisciplinary team of surgeons, oncologists, pathologists, radiologists, and nurse specialists adopting a new EPR. Each group adapted their use of the EPR to their diverse specialist practices, but they nonetheless orientated their use of the EPR to each others' practices sufficiently to support unity in multidisciplinary teamwork. Multidisciplinary practice elements were also reconfigured in an episode of explicit negotiations, resulting in significant changes in EPR use within team meetings. Our study contributes to the growing literature that questions the feasibility and necessity of achieving high levels of standardized, uniform health information technology use in healthcare.

Socio-technical considerations in epilepsy electronic patient record implementation

Purpose Examination of electronic patient record (EPR) implementation at the socio-technical interface. This study was based on the introduction of an anti-epileptic drug (AED) management module of an EPR in an epilepsy out-patient clinic. The objective was to introduce the module to a live clinical setting within strictly controlled conditions to evaluate its usability and usefulness. Methods Qualitative and quantitative methods were employed in an observational field study. A purposeful sample of specialists in epilepsy care (2 doctors and 2 nurses) was recruited. Perception of usefulness and ease of use of the AED module, impact on work processes, and accuracy of use were evaluated using feedback meetings, evaluation forms, ethnographic analysis and data validation techniques. Emerging issues were grouped into three key themes: human, organisational and technological. Results The electronic patient record use was studied for 49 patients over the course of 18 out-patient clinics. While participants varied in their approach to interacting with the AED module, they expressed satisfaction with its usability and performance. The necessary co-existence of the paper and electronic record, and changes to customary work practice were considered the biggest challenges. 82% accuracy in the use of the electronic record was determined. Conclusions Achieving successful electronic patient record implementation is complex. While technical challenges exist, it is possibly more important to acknowledge the social considerations. Initially, an increase in medical record fragmentation and disruption to workflow can arise with the introduction of the technology. Realising the benefits of electronic patient records will require the management of a lengthy transition phase.

In this issue: use of electronic patient record (EPR) system data for emergency care, quality improvement and research - things not to take for granted

This issue continues the discussion within our journal about how we can legitimise the use of the routinely collected data for research. We have some of the best long-term computer records in the world – which are potentially goldmines for research. However, we are currently working through how to codify this process. In their Editorial Mathers et al., set out the principles for the secondary use of clinical data for research, following the publication of the Wellcome report. Navarro, comments on the necessity for us to not take public support for granted, and to use appropriate technologies. What these technologies should be was debated in appropriate depth in last year’s journal. Finally, Gibson-White and Majeed remind us of the importance of primary care records for research, and that this is a strength of the UK which we need to further develop.

Instant availability of patient records, but diminished availability of patient information: A multi-method study of GP's use of electronic patient records

BackgroundIn spite of succesful adoption of electronic patient records (EPR) by Norwegian GPs, what constitutes the actual benefits and effects of the use of EPRs in the perspective of the GPs and patients has not been fully characterized. We wanted to study primary care physicians' use of electronic patient record (EPR) systems in terms of use of different EPR functions and the time spent on using the records, as well as the potential effects of EPR systems on the clinician-patient relationship.MethodsA combined qualitative and quantitative study that uses data collected from focus groups, observations of primary care encounters and a questionnaire survey of a random sample of general practitioners to describe their use of EPR in primary care.ResultsThe overall availability of individual patient records had improved, but the availability of the information within each EPR was not satisfactory. GPs' use of EPRs were efficient and comprehensive, but have resulted in transfer of administrative work from secretaries to physicians. We found no indications of disturbance of the clinician-patient relationship by use of computers in this study.ConclusionAlthough GPs are generally satisfied with their EPRs systems, there are still unmet needs and functionality to be covered. It is urgent to find methods that can make a better representation of information in large patient records as well as prevent EPRs from contributing to increased administrative workload of physicians.

Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff

IntroductionElectronic patient records are becoming more common in critical care. As their design and implementation are optimized for single users rather than for groups, we aimed to understand the differences in interaction between members of a multidisciplinary team during ward rounds using an electronic, as opposed to paper, patient medical record.MethodsA qualitative study of morning ward rounds of an intensive care unit that triangulates data from video-based interaction analysis, observation, and interviews.ResultsOur analysis demonstrates several difficulties the ward round team faced when interacting with each other using the electronic record compared with the paper one. The physical setup of the technology may impede the consultant's ability to lead the ward round and may prevent other clinical staff from contributing to discussions.ConclusionsWe discuss technical and social solutions for minimizing the impact of introducing an electronic patient record, emphasizing the need to balance both. We note that awareness of the effects of technology can enable ward-round teams to adapt their formations and information sources to facilitate multidisciplinary communication during the ward round.

Effect of electronic patient record use on mortality in End Stage Renal Disease, a model chronic disease: retrospective analysis of 9 years of prospectively collected data

BackgroundIn chronic disease, health information technology promises but has yet to demonstrate improved outcomes and decreased costs. The main aim of the study was to determine the effects on mortality and cost of an electronic patient record used in daily patient care in a model chronic disease, End Stage Renal Disease, treated by chronic maintenance hemodialysis. Dialysis treatment is highly regulated, and near uniform in treatment modalities and drugs used.MethodsThe particular electronic patient record, patient-centered and extensively coded, was used first in patient care in 3 dialysis units in New York, NY in 1998, 1999, and 2000. All data were stored "live"; none were archived. By December 31, 2006, the patients had been treated by maintenance hemodialysis for a total of 3924 years. A retrospective analysis was made using query tools embedded in the software. The United States Renal Data System dialysis population served as controls. In all there were 1790 patients, with many underlying primary diseases and multiple comorbid conditions affecting many organ systems. Year by year mortality, hospital admissions, and staffing were analyzed, and the data were compared with national data compiled by the United States Renal Data System.ResultsAnalyzed by calendar year after electronic patient record implementation, mortality decreased strikingly. In years 3–9 mortality was lower than in years 1–2 by 23%, 48%, and 34% in the 3 units, and was 37%, 37%, and 35% less than that reported by the United States Renal Data System. Clinical staffing was 25% fewer per 100 patients than the national average, thereby lowering costs.ConclusionTo our knowledge, this is the first demonstration that an electronic patient record, albeit of particular design, can have a favorable effect on outcomes and cost in chronic disease. That the population studied has many underlying diseases affecting all organ systems suggests that the electronic patient record design may enable application to many fields of medical practice.