the international council on medical & care compunetics

science pages

December, 2014

medical records systems

Giving Patients Granular Control of Personal Health Information: Using an Ethics ‘Points to Consider’ to Inform Informatics System Designers

There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this.

We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to Consider” (P2C) document, and convened a national expert panel to review and critique the P2C.
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Published: 4 September 2013 |
Keyword(s): Benefits, Design, Electronic Health Records, Ethics, Medical records systems, Patient Record Access, Physician-Patient Relationship, Privacy, Risks, United States

Potential application of item-response theory to interpretation of medical codes in electronic patient records

Dregan A et al, BMC Medical Research Methodology, 11

Electronic patient records are generally coded using extensive sets of codes but the significance of the utilisation of individual codes may be unclear. Item response theory (IRT) models are used to characterise the psychometric properties of items included in tests and questionnaires. This study asked whether the properties of medical codes in electronic patient records may be characterised through the application of item response theory models.
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Published: 16 December 2011 |
Keyword(s): Algorithms, Coding, Electronic Health Records, General Practice, Medical records systems, Primary Care, Stroke

Use and Satisfaction with Electronic Health Record by Primary Care Physicians in a Health District in Brazil

Holanda AA et al, Journal of Medical Systems, 2011

It is believed that Electronic Health Records (EHR) improve not only quality of care but also patient safety and health care savings. This seems to be true for developed countries but not necessarily in emerging economies. This paper examined the primary care physicians’ satisfaction with a specific EHR in a health district of a major city in Brazil and describes how they are using it as well as its specific functions. A cross-sectional questionnaire survey with all physicians from all Community Health Centers of the 6th health district of the City of Fortaleza that were using HER was conducted. From the 111 subjects (100%), a total of 99 physicians answered the survey (89% response rate). For overall satisfaction with the EHR, 2 (2%) were satisfied, 50 (50.5%) were satisfied in part and 47 (47.5%) were not satisfied.
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Published: 10 November 2011 |
Keyword(s): Ambulatory Care, Brazil, Developing Countries, Electronic Health Records, Medical records systems, Primary Health Care, Satisfaction

Centralized, nationwide electronic health records schemes under assault

Webster PC. CMAJ, 183(15)

“Canada should revisit its electronic health records (EHRs) strategy in the wake of British recommendations that its similar blueprint should be jettisoned as wasteful and flawed, experts say.
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Published: 18 October 2011 |
Keyword(s): Canada, Electronic Health Records, Great Britain, Medical records systems, National Health Programs

Characteristics of personal health records: findings of the Medical Library Association/National Library of Medicine Joint Electronic Personal Health Record Task Force

Jones DA et al, Journal of the Medical Library Association, 98(3)

The Medical Library Association (MLA)/National Library of Medicine (NLM) Joint Electronic Personal Health Record Task Force examined the current state of personal health records (PHRs).

A working definition of PHRs was formulated, and a database was built with fields for specified PHR characteristics. PHRs were identified and listed. Each task force member was assigned a portion of the list for data gathering. Findings were recorded in the database.
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Published: August 2010 |
Keyword(s): Confidentiality, Electronic Health Records, Medical records systems, Personal Health Records, United States

Model-based design of clinical information systems

Mathe J et al, Methods of Information in Medicine, 47(5)

The goal of this research is to provide a framework to enable the model-based development, simulation, and deployment of clinical information system prototypes with mechanisms that enforce security and privacy policies.
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Published: 2008 |
Keyword(s): Computer-Aided Design, Hospital Information Systems, Medical records systems, Software Design, United States

Extraction of standardized archetyped data from Electronic Health Record systems based on the Entity-Attribute-Value Model

Duftschmid G et al, International Journal of Medical Informatics, 2010

The ISO/EN 13606 Electronic Health Record architecture standard permits semantically interoperable exchange of Electronic Health Record data by using archetypes to define the structure and semantics of Electronic Health Record contents. Practical implementations of the ISO/EN 13606 standard have been scarcely reported on, and none of the publications describes in detail an efficient technique of archetype-compliant data extraction from an Electronic Health Record system. We address this research issue in the present report, and focus on a specific class of largely research-oriented Electronic Health Record systems which are internally based on the Entity-Attribute-Value Model.
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Published: 1 June 2010 |
Keyword(s): Archetypes, Architecture, Electronic Health Records, Medical records systems, Semantic Interoperability, Standards

A piece of my mind. Copy-and-paste

Hirschtick RE. JAMA, 295(20)

The electronic medical record (EMR) arrived at our teaching hospital one year ago and the resultant changes in medical student and physician notes have been remarkable. While EMR is highly efficient in producing notes, virtually all of its notes are longer, recombinant versions of previous notes. Even notes of different authors are morphed by EMR into clones of one another. As physicians have become more adept with the time-saving features of EMR, their notes have been rendered incapable of conveying usable information by their bloated and obfuscated nature.
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Published: 24 May 2006 |
Keyword(s): Copy-and-paste, Electronic Health Records, Medical records systems, United States

Comparison of information technology in general practice in 10 countries

Protti, Denis, ElectronicHealthcare, 5(4)

A study commissioned by Canada Health Infoway provides a comparative analysis of automation in general practice in 10 countries. The most common clinical application is the automation of medication prescriptions–even if it is not a mandatory requirement as it is in Norway.
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Published: 2007 |
Keyword(s): Australia, Austria, Denmark, Electronic Health Records, Family Practice, Germany, Health Care Surveys, Health Information Technology, Medical Practice Management, Medical records systems, Netherlands, New Zealand, Norway, UK, United States

Implementation of the Veterans Health Administration VistA clinical information system around the world

Protti, Denis, and Peter Groen, ElectronicHealthcare, 7(2)

The success story of the Veterans Health Administration (VHA) within the US Department of Veterans Affairs has been well documented and is generally well known. What is generally not known is that the VHA’s clinical information system, known as VistA, and the computerized patient record system clinical user interface front end have been successfully transported and implemented to a number of non-VHA healthcare organizations across the United States.
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Published: 2008 |
Keyword(s): Diffusion of Innovation, Electronic Health Records, Medical Informatics, Medical records systems, United States, Veterans Affairs

A consensus action agenda for achieving the national health information infrastructure

Yasnoff, William A. et al, J Am Med Inform Assoc, 11(4)

Improving the safety, quality, and efficiency of health care will require immediate and ubiquitous access to complete patient information and decision support provided through a National Health Information Infrastructure (NHII).
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Published: 7 June 2004 |
Keyword(s): Electronic Health Records, Health Policy, Health Services Research, Medical Informatics, Medical records systems, National Health Programs, Policy Making, United States

Measuring the impact of the computer on the consultation: An open source application to combine multiple observational outputs

Pflug, Bernhar et al, Informatics for Health and Social Care, 35(1)

A diverse range of tools and techniques can be used to observe the clinical consultation and the use of information technology. These technologies range from transcripts; to video observation with one or more cameras; to voice and pattern recognition applications. Currently, these have to be observed separately and there is limited capacity to combine them. Consequently, when multiple methods are used to analyse the consultation a significant proportion of time is spent linking events in one log file (e.g. mouse movements and keyboard use when prescribing alerts appear) with what was happening in the consultation at that time. The objective of this study was to develop an application capable of combining and comparing activity log-files and with facilities to view simultaneously all data relating to any time point or activity. Interviews, observations and design prototypes were used to develop a specification. Class diagram of the application design was used to make further development decisions. The application development used object-orientated design principles. We used open source tools; Java as the programming language and JDeveloper™ as the development environment. The final output is log file aggregation (LFA) tool which forms part of the wider aggregation of log files for analysis (ALFA) open source toolkit (www.biomedicalinformatics.info/alfa/).
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Published: 19 March 2010 |
Keyword(s): Consultations, Family Practice, General Practice, Health Information Technology, Medical records systems, Open Source, Video

[Cooperation with the electronic medical record and accounting system of an actual dose of drug given by a radiology information system]

By input of the actual dose of a drug given into a radiology information system, the system converting with an accounting system into a cost of the drug from the actual dose in the electronic medical record was built. In the drug master, the first unit was set as the cost of the drug, and we set the second unit as the actual dose. The second unit in the radiology information system was received by the accounting system through electronic medical record. In the accounting system, the actual dose was changed into the cost of the drug using the dose of conversion to the first unit.
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Published: 20 December 2009 |
Keyword(s): Accounting, Electronic Health Records, Hospitals, Japan, Medical records systems, Medication Systems, Radiology Information Systems

Critical areas of national electronic health record programs-Is our focus correct?

Deutsch, Eva et al, International Journal of Medical Informatics, 79(3)

National electronic health record programs are frequently associated with a number of problems. In view of their long duration and costs, efficient implementation of the programs with due regard given to the conclusions drawn thus far would be a meaningful goal from the economic point of view. In the present report we analyze programs from various countries with regard to the problems documented therein and derive, on a cross-country basis, the most common critical aspects of national electronic health record programs. These aspects should be given special attention in the implementation of future national electronic health record programs. Furthermore, measures which have proven to be useful in coping with the respective problems in individual countries will be suggested for each critical area.
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Published: 18 January 2010 |
Keyword(s): Australia, Canada, Denmark, Electronic Health Records, Germany, Medical records systems, National Health Programs, UK

Medical student documentation in the medical record: is it a liability?

Gliatto, Peter, Philip Masters, and Reena Karani, The Mount Sinai Journal of Medicine, 76(4)

Medical students have routinely documented patient encounters in both inpatient and outpatient care venues. This hands-on experience has provided a way for students to reflect on patient encounters, learn proper documentation skills, and attain a sense of being actively involved in and responsible for the care of patients. Over the last several years, the practice of student note writing has come into question. Institutional disincentives to student documentation include insurance regulations that restrict student documentation from substantiating billing claims, concerns about the legal status of student notes, and implementation of electronic medical records that do not allow or restrict student access.
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Published: August 2009 |
Keyword(s): Education, Electronic Health Records, Liability, Medical Records, Medical records systems, Students, United States

Patient Web Services Integrated with a Shared Medical Record: Patient Use and Satisfaction

Ralston, James D. et al, J Am Med Inform Assoc, 14(6)

This study sought to describe the evolution, use, and user satisfaction of a patient Web site providing a shared medical record between patients and health professionals at Group Health Cooperative, a mixed-model health care financing and delivery organization based in Seattle, Washington.
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Published: 21 August 2007 |
Keyword(s): Clinical Information Systems, Electronic Health Records, Internet, Medical records systems, Patient Satisfaction, Physician-Patient Relationship, United States, Web Services

EMRs in the Fourth Stage

Thompson, Douglas et al, Journal of Healthcare Information Management, 21(3)

In the third stage of electronic medical record development, key features of EMR systems have converged, making them more difficult to differentiate from a cost/benefit standpoint. Fourth stage EMR systems are likely to introduce new, more effective decision support capabilities, offering a competitive advantage to hospitals that use them.
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Published: 2007 |
Keyword(s): Access, Decision Support Systems, Diffusion of Innovation, Efficiency, Hospital Information Systems, Medical records systems, United States

An e-consent-based shared EHR system architecture for integrated healthcare networks

Bergmann, Joachim et al, International Journal of Medical Informatics, 76(2-3)

Virtual integration of distributed patient data promises advantages over a consolidated health record, but raises questions mainly about practicability and authorization concepts. Our work aims on specification and development of a virtual shared health record architecture using a patient-centred integration and authorization model.
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Published: 1 January 1970 |
Keyword(s): Architecture, Confidentiality, Consent, Germany, Medical Informatics Applications, Medical records systems, Patient Record Access, Systems Integration

Patients’ attitudes towards sharing their health information

Whiddett, Richard et al, International Journal of Medical Informatics, 75(7)

The current policies of the governments of Australia and New Zealand encourage the use of electronic information systems to exchange patient information between various stakeholders. This research investigated (1) the attitudes of patients toward sharing their medical information and (2) whether patients considered themselves to be well-informed about the uses that are made of their information.
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Published: 28 September 2005 |
Keyword(s): Acceptance, Access, Australia, Confidentiality, Electronic Health Records, Health Information Exchange, Information Sharing, Medical records systems, New Zealand, Patient Record Access

Physicians, Patients, and the Electronic – Health Record: An Ethnographic Analysis

Ventres, William et al, Annals of Family Medicine, 4(2)

Little is known about the effects of the electronic health record (EHR) on physician-patient encounters. The objectives of this study were to identify the factors that influence the manner by which physicians use the EHR with patients.
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Published: March 2006 |
Keyword(s): Ambulatory Care, Decision Making, Electronic Health Records, Family Practice, Medical records systems, Patient Record Access, Physician-Patient Relations, United States

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