scholarly journals Section 2: Patient Records: The Computerized Patient Record: Where Do We Stand?

2006 ◽  
Vol 15 (01) ◽  
pp. 29-39 ◽  
Author(s):  
P. Knaup ◽  
D. Schmidt ◽  
M. W. M. Jaspers
Keyword(s):  
Health Care ◽  
Medical Informatics ◽  
Evaluation Studies ◽  
Data Entry ◽  
Clinical Work ◽  
Patient Record ◽  
Support Functions ◽  
Privacy And Security ◽  
Computerized Patient Record ◽  
The Impact

SummaryTo provide an overview of trends in research, developments and implementations of the computerized patient record (CPR) of the last two years.We surveyed the medical informatics literature, spanning the years 2004-2005, focusing on publications on CPRs.The main trends revealed were: 1) the development of technologies to realize privacy and security goals or remote data entry and access to CPRs; 2) investigations into how to enhance the quality and reuse of CPR data; 3) the development and evaluation of decision support functions to be integrated with CPRs; 4) evaluations of the impact of CPRs on clinicians, patients, clinical work settings and patient outcomes; and 5) the further development and use of standards to move towards shared electronic health records (EHRs).The CPR is playing a growing part in medical informatics research and evaluation studies, but the goal of establishing a comprehensive lifelong EHR is still a long way off. In moving forward to EHRs, convergence of EHR standards seems required to realize true interoperability of health care applications. User acceptance of present-day CPRs (for all categories of users) and compatibility with work patterns has not been achieved yet, and can only be realized by giving these goals high priority. This will require substantial resources for in-depth work flow analysis, development and evaluation of CPRs. Besides this, the implementation of effective CPRs asks for health care organizations that are willing to invest in new developments and to contribute to evaluation studies, to further improve CPRs’ functionalities and enhance their use in practice.Haux R, Kulikowski C, editors. IMIA Yearbook of Medical Informatics 2006.

scholarly journals Benefit-risk of Patients' Online Access to their Medical Records: Consensus Exercise of an International Expert Group

2018 ◽  
Vol 27 (01) ◽  
pp. 156-162 ◽  
Author(s):  
Harshana Liyanage ◽  
Siaw-Teng Liaw ◽  
Emmanouela Konstantara ◽  
Freda Mold ◽  
Richard Schreiber ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Informatics ◽  
Medical Records ◽  
Panel Discussion ◽  
Care Quality ◽  
Care Providers ◽  
Consensus Statements ◽  
Online Access ◽  
The Impact

Background: Patients' access to their computerised medical records (CMRs) is a legal right in many countries. However, little is reported about the benefit-risk associated with patients' online access to their CMRs. Objective: To conduct a consensus exercise to assess the impact of patients' online access to their CMRs on the quality of care as defined in six domains by the Institute of Medicine (IoM), now the National Academy of Medicine (NAM). Method: A five-round Delphi study was conducted. Round One explored experts' (n = 37) viewpoints on providing patients with access to their CMRs. Round Two rated the appropriateness of statements arising from Round One (n = 16). The third round was an online panel discussion of findings (n = 13) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Two additional rounds, a survey of the revised consensus statements and an online workshop, were carried out to further refine consensus statements. Results: Thirty-seven responses from Round One were used as a basis to initially develop 15 statements which were categorised using IoM's domains of care quality. The experts agreed that providing patients online access to their CMRs for bookings, results, and prescriptions increased efficiency and improved the quality of medical records. Experts also anticipated that patients would proactively use their online access to share data with different health care providers, including emergencies. However, experts differed on whether access to limited or summary data was more useful to patients than accessing their complete records. They thought online access would change recording practice, but they were unclear about the benefit-risk of high and onerous levels of security. The 5-round process, finally, produced 16 consensus statements. Conclusion: Patients' online access to their CMRs should be part of all CMR systems. It improves the process of health care, but further evidence is required about outcomes. Online access improves efficiency of bookings and other services. However, there is scope to improve many of the processes of care it purports to support, particularly the provision of a more effective interface and the protection of the vulnerable.

Design Elements for a Computerized Patient Record

1999 ◽  
Vol 38 (03) ◽  
pp. 187-193 ◽  
Author(s):  
D. Hölzel ◽  
K. Überla ◽  
K. Adelhard
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Patient Record ◽  
Record System ◽  
Medical Specialties ◽  
Design Elements ◽  
Computerized Patient Record ◽  
Future Demands ◽  
High Degree ◽  
Computerized Medical Record

AbstractComputerized medical record systems have to present user-and problem-oriented views of a patient record to health-care professionals. Presentation and manipulation of data must be easily adaptable to current and future demands of medical specialties and specific settings. During the definition, development and evaluation of a prototype of a computerized patient record system, design elements were elaborated to support physicians and other health-care professionals. Our approach shows a high degree of flexibility and adaptability to specific needs, problem orientation and connectivity to other systems, via a hospital information network. The explicit description of the contents of a patient record allows to augment the number of items that can be recorded without modifying the data structure. New views on patient data can be added to the system without interfering with the routine use of the system. Application in several medical specialties proved the feasibility of our prototype.

scholarly journals The Safe and Effective Use of Shared Data Underpinned by Stakeholder Engagement and Evaluation Practice

2018 ◽  
Vol 27 (01) ◽  
pp. 025-028
Author(s):  
Andrew Georgiou ◽  
Farah Magrabi ◽  
Hannele Hyppönen ◽  
Zoie Wong ◽  
Pirkko Nykänen ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Informatics ◽  
Stakeholder Engagement ◽  
Working Group ◽  
Large Scale ◽  
European Federation ◽  
Data Governance ◽  
Privacy And Security ◽  
Shared Data ◽  
Collaborative Models

Objectives: The paper draws attention to: i) key considerations involving the confidentiality, privacy, and security of shared data; and ii) the requirements needed to build collaborative arrangements encompassing all stakeholders with the goal of ensuring safe, secure, and quality use of shared data. Method: A narrative review of existing research and policy approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Care and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems. Results: The technological ability to merge, link, re-use, and exchange data has outpaced the establishment of policies, procedures, and processes to monitor the ethics and legality of shared use of data. Questions remain about how to guarantee the security of shared data, and how to establish and maintain public trust across large-scale shared data enterprises. This paper identifies the importance of data governance frameworks (incorporating engagement with all stakeholders) to underpin the management of the ethics and legality of shared data use. The paper also provides some key considerations for the establishment of national approaches and measures to monitor compliance with best practice. Conclusion: Data sharing endeavours can help to underpin new collaborative models of health care which provide shared information, engagement, and accountability amongst all stakeholders. We believe that commitment to rigorous evaluation and stakeholder engagement will be critical to delivering health data benefits and the establishment of collaborative models of health care into the future.

scholarly journals Artificial Intelligence in Primary Health Care: Perceptions, Issues, and Challenges

2019 ◽  
Vol 28 (01) ◽  
pp. 041-046 ◽  
Author(s):  
Harshana Liyanage ◽  
Siaw-Teng Liaw ◽  
Jitendra Jonnagaddala ◽  
Richard Schreiber ◽  
Craig Kuziemsky ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Medical Informatics ◽  
Panel Discussion ◽  
Healthcare Delivery ◽  
Primary Health ◽  
The Impact ◽  
Care Informatics

Background: Artificial intelligence (AI) is heralded as an approach that might augment or substitute for the limited processing power of the human brain of primary health care (PHC) professionals. However, there are concerns that AI-mediated decisions may be hard to validate and challenge, or may result in rogue decisions. Objective: To form consensus about perceptions, issues, and challenges of AI in primary care. Method: A three-round Delphi study was conducted. Round 1 explored experts’ viewpoints on AI in PHC (n=20). Round 2 rated the appropriateness of statements arising from round one (n=12). The third round was an online panel discussion of findings (n=8) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Results: PHC and informatics experts reported AI has potential to improve managerial and clinical decisions and processes, and this would be facilitated by common data standards. The respondents did not agree that AI applications should learn and adapt to clinician preferences or behaviour and they did not agree on the extent of AI potential for harm to patients. It was more difficult to assess the impact of AI-based applications on continuity and coordination of care. Conclusion: While the use of AI in medicine should enhance healthcare delivery, we need to ensure meticulous design and evaluation of AI applications. The primary care informatics community needs to be proactive and to guide the ethical and rigorous development of AI applications so that they will be safe and effective.

An Inventory of Evaluation Studies of Information Technology in Health Care

2005 ◽  
Vol 44 (01) ◽  
pp. 44-56 ◽  
Author(s):  
N. de Keizer ◽  
E. Ammenwerth
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Medical Informatics ◽  
Quantitative Methods ◽  
Evaluation Studies ◽  
Evaluation Research ◽  
Evaluation Study ◽  
Strong Shift ◽  
Strategy Evaluation ◽  
Computer Based

Summary Objectives: During the last years the significance of evaluation studies as well as the interest in adequate methods and approaches for evaluation has grown in medical informatics. In order to put this discussion into historical perspective of evaluation research, we conducted a systematic review on trends in evaluation research of information technology in health care from 1982 to 2002. Methods: The inventory is based on a systematic literature search in PubMed. Abstracts were included when they described an evaluation study of a computer-based component in health care. We identified 1035 papers from 1982 to 2002 and indexed them based on a multi-axial classification describing type of information system, study location, evaluation strategy, evaluation methods, evaluation setting, and evaluation focus. Results and Conclusions: We found interesting developments in evaluation research in the last 20 years. For example, there has been a strong shift from medical journals to medical informatics journals. With regard to methods, explanatory research and quantitative methods have dominated evaluation studies in the last 20 years. Since 1982, the number of lab studies and technical evaluation studies has declined, while the number of studies focusing on the influence of information technology on quality of care processes or outcome of patient care has increased. We interpret this shift as a sign of maturation of evaluation research in medical informatics.

On challenges to respect for autonomous decision making in primary care

2021 ◽  
pp. 147775092110699
Author(s):  
John Spicer ◽  
Sanjiv Ahluwalia ◽  
Rupal Shah
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Decision Making ◽  
Health Care Access ◽  
Clinical Work ◽  
Community Practice ◽  
Full Account ◽  
Autonomous Decision ◽  
Comprehensive Service ◽  
The Impact

Primary health care is characterised by timely and appropriate health care access, delivered continuously over time to a specific population, providing a comprehensive service, with coordination of care for those that need it. Practitioners deal with a multiplicity of clinical issues within longitudinal relationships, embedded in the context of families and communities. We propose that these aspects of primary care have a bearing on how matters of decision making are considered and implemented. Further, the standard account of autonomous decision making is not wholly adequate when applied to clinician–patient encounters in primary care. We add considerations of the impact of illness (however defined) and self-identity as also relevant to a more measured and full account. The context of primary care is quite different from that of secondary care. Although there are generalists who work in hospitals, we argue that this aspect and the other attributes of primary care generate special ethical considerations. One of these is how autonomy, or more fully, how respect for the principle of autonomy is considered and operationalised in community practice. In this study, we describe some theoretical aspects of autonomy and seek to apply, and challenge, these aspects in the context of clinical work in primary care. In doing so we will review the descriptors of primary care: why in essence it is different from other contexts of clinical work.

scholarly journals People and Ideas in Medical Informatics - A Half Century Review

2011 ◽  
Vol 20 (01) ◽  
pp. 175-182
Author(s):  
J. H. van Bemmel
Keyword(s):  
Health Care ◽  
Human Factors ◽  
Medical Informatics ◽  
Interdisciplinary Approach ◽  
Medical Decision ◽  
The Public ◽  
Medical Decision Support ◽  
Care Processes ◽  
Medical Decision Support Systems ◽  
The Impact

SummaryReviewing the onset and the rapid changes to make realistic predictions on the future of medical informatics.Pointing to the contributions of the early pioneers, who had their roots in other disciplines and by illustrating that from the onset an interdisciplinary approach was characteristic for our field.Some of the reasons for the changes in medical informatics are that nobody was able to predict the advent of the personal computer in the 1970s, the world-wide web in 1991, and the public start of the Internet in 1992, but foremost that nobody expected that it was not primarily the hardware or the software, but human factors that would be crucial for successful applications of computers in health care. In the past sometimes unrealistic expectations were held, such as on the impact of medical decision-support systems, or on the overly optimistic contributions of electronic health records. Although the technology is widely available, some applications appear to be far more complex than expected. Health care processes can seldom be fully standardized. Humans enter at least in two very different roles in the loop of information processing: as subjects conducting care - the clinicians - and as subjects that are the objects of care - the patients.Medical informatics lacks a specific methodology; methods are borrowed from adjacent disciplines such as physics, mathematics and, of course, computer science. Human factors play a major role in applying computers in health care. Everyone pursuing a career in biomedical informatics needs to be very aware of this. It is to be expected that the quality of health care will increasingly be assessed by computer systems to fulfill the requirements of medical evidence.

Designing Clinically Useful Systems: Examples from Medicine and Dentistry

2003 ◽  
Vol 17 (1) ◽  
pp. 65-68 ◽  
Author(s):  
S. Koch
Keyword(s):  
Health Care ◽  
Medical Informatics ◽  
Home Health Care ◽  
System Development ◽  
Clinical Information ◽  
Clinical Work ◽  
Special Focus ◽  
Research Projects ◽  
Analysis And Design ◽  
Communication Flow

Despite promising results in medical informatics research and the development of a large number of different systems, few systems get beyond a prototype state and are really used in practice. Among other factors, the lack of explicit user focus is one main reason. The research projects presented in this paper follow a user-centered system development approach based on extensive work analyses in interdisciplinary working groups, taking into account human cognitive performance. Different medical and health-care specialists, together with researchers in human-computer interaction and medical informatics, specify future clinical work scenarios. Special focus is put on analysis and design of the information and communication flow and on exploration of intuitive visualization and interaction techniques for clinical information. Adequate choice of the technical access device is made depending on the user’s work situation. It is the purpose of this paper to apply this method in two different research projects and thereby to show its potential for designing clinically useful systems that do support and not hamper clinical work. These research projects cover IT support for chairside work in dentistry ( http://www.dis.uu.se/mdi/research/projects/orquest ) and ICT support for home health care of elderly citizens ( http://www.medsci.uu.se/mie/project/closecare ).

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