scholarly journals Feasibility of real-time capture of routine clinical data in the electronic health record: a hospital-based, observational service-evaluation study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019790 ◽  
Author(s):  
Neil Bodagh ◽  
R Andrew Archbold ◽  
Roshan Weerackody ◽  
Meredith K D Hawking ◽  
Michael R Barnes ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Real Time ◽  
Clinical Data ◽  
Outpatient Clinic ◽  
Information Exchange ◽  
Evaluation Study ◽  
Service Evaluation ◽  
Health Record ◽  
Patient Reports ◽  
Electronic Health

ObjectivesThe electronic health record (EHR) is underused in the hospital setting. The aim of this service evaluation study was to respond to National Health Service (NHS) Digital’s ambition for a paperless NHS by capturing routinely collected cardiac outpatient data in the EHR to populate summary patient reports and provide a resource for audit and research.DesignA PowerForm template was developed within the Cerner EHR, for real-time entry of routine clinical data by clinicians attending a cardiac outpatient clinic. Data captured within the PowerForm automatically populated a SmartTemplate to generate a view-only report that was immediately available for the patient and for electronic transmission to the referring general practitioner (GP).ResultsDuring the first 8 months, the PowerForm template was used in 61% (360/594) of consecutive outpatient referrals increasing from 42% to 77% during the course of the study. Structured patient reports were available for immediate sharing with the referring GP using Cerner Health Information Exchange technology while electronic transmission was successfully developed in a substudy of 64 cases, with direct delivery by the NHS Data Transfer Service in 29 cases and NHS mail in the remainder. In feedback, the report’s immediate availability was considered very or extremely important by >80% of the patients and GPs who were surveyed. Both groups reported preference of the patient report to the conventional typed letter. Deidentified template data for all 360 patients were successfully captured within the Trust system, confirming availability of these routinely collected outpatient data for audit and research.ConclusionElectronic template development tailored to the requirements of a specialist outpatient clinic facilitates capture of routinely collected data within the Cerner EHR. These data can be made available for audit and research. They can also be used to enhance communication by populating structured reports for immediate delivery to patients and GPs.

Securing XML with Role-Based Access Control

2014 ◽  
pp. 334-365 ◽  
Author(s):  
Alberto De la Rosa Algarín ◽  
Steven A. Demurjian ◽  
Timoteus B. Ziminski ◽  
Yaira K. Rivera Sánchez ◽  
Robert Kuykendall
Keyword(s):  
Access Control ◽  
Electronic Health Record ◽  
Information Exchange ◽  
Security Policies ◽  
Health Record ◽  
Role Based Access Control ◽  
Future Trends ◽  
Security Framework ◽  
Electronic Health ◽  
Role Based

Today’s applications are often constructed by bringing together functionality from multiple systems that utilize varied technologies (e.g. application programming interfaces, Web services, cloud computing, data mining) and alternative standards (e.g. XML, RDF, OWL, JSON, etc.) for communication. Most such applications achieve interoperability via the eXtensible Markup Language (XML), the de facto document standard for information exchange in domains such as library repositories, collaborative software development, health informatics, etc. The use of a common data format facilitates exchange and interoperability across heterogeneous systems, but challenges in the aspect of security arise (e.g. sharing policies, ownership, permissions, etc.). In such situations, one key security challenge is to integrate the local security (existing systems) into a global solution for the application being constructed and deployed. In this chapter, the authors present a Role-Based Access Control (RBAC) security framework for XML, which utilizes extensions to the Unified Modeling Language (UML) to generate eXtensible Access Control Markup Language (XACML) policies that target XML schemas and instances for any application, and provides both the separation and reconciliation of local and global security policies across systems. To demonstrate the framework, they provide a case study in health care, using the XML standards Health Level Seven’s (HL7) Clinical Document Architecture (CDA) and the Continuity of Care Record (CCR). These standards are utilized for the transportation of private and identifiable information between stakeholders (e.g. a hospital with an electronic health record, a clinic’s electronic health record, a pharmacy system, etc.), requiring not only a high level of security but also compliance to legal entities. For this reason, it is not only necessary to secure private information, but for its application to be flexible enough so that updating security policies that affect millions of documents does not incur a large monetary or computational cost; such privacy could similarly involve large banks and credit card companies that have similar information to protect to deter identity theft. The authors demonstrate the security framework with two in-house developed applications: a mobile medication management application and a medication reconciliation application. They also detail future trends that present even more challenges in providing security at global and local levels for platforms such as Microsoft HealthVault, Harvard SMART, Open mHealth, and open electronic health record systems. These platforms utilize XML, equivalent information exchange document standards (e.g., JSON), or semantically augmented structures (e.g., RDF and OWL). Even though the primary use of these platforms is in healthcare, they present a clear picture of how diverse the information exchange process can be. As a result, they represent challenges that are domain independent, thus becoming concrete examples of future trends and issues that require a robust approach towards security.

Implementation of Electronic Health Record (EHR) System in the Healthcare Industry

2016 ◽  
pp. 1001-1016
Author(s):  
Robert P Schumaker ◽  
Kavya P. Reganti
Keyword(s):  
Electronic Health Record ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Health Management ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Health Record ◽  
Healthcare Industry ◽  
Efficient Delivery ◽  
Electronic Health

The purpose of this research is to demonstrate the efficiency of the Electronic Health Record (EHR) software that is adopted in the healthcare industry to provide better patient care. The authors examine the impact of EHRs on the efficient delivery of healthcare services. More specifically, they detail the origin of EHR, its significance in modern healthcare delivery along with the selection and implementation criteria for EHR software. They present a survey on the extent of adoption of EHR by clinicians. They also highlight the challenges and barriers faced by organizations in adopting EHR software such as cost, workflow impact and data security. Finally, the authors contemplate the future of EHR, its role in the implementation of health information exchange and its implementation in the cloud. They conclude that the implementation of EHR in the cloud is an important step towards better health management across the population with the end-goal of better health outcomes.

scholarly journals Real-Time Intraoperative Consultation Reporting in the Electronic Health Record

2020 ◽  
Vol 154 (3) ◽  
pp. 387-393
Author(s):  
Molly E Klein ◽  
Joseph W Rudolf ◽  
Maryna Tarbunova ◽  
Tanya Jorden ◽  
Susanna R Clark ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Real Time ◽  
Laboratory Medicine ◽  
Clinical Impact ◽  
Final Report ◽  
Health Record ◽  
Laboratory Information System ◽  
Surgical Team ◽  
Operative Note ◽  
Electronic Health

Abstract Objectives We sought to make pathologists’ intraoperative consultation (IOC) results immediately available to the surgical team, other clinicians, and laboratory medicine colleagues to improve communication and decrease postanalytic errors. Methods We created an IOC report in our stand-alone laboratory information system that could be signed out prior to, and independent of, the final report, and transfer immediately to the electronic health record (EHR) as a preliminary diagnosis. We evaluated two metrics: preliminary (IOC) result review in the EHR by clinicians and postanalytic errors. Results We assessed 2,886 IOC orders from the first 22 months after implementation. Clinicians reviewed 1,956 (68%) of the IOC results while in preliminary status, including 1,399 (48%) within the first 24 hours. We evaluated 150 cases preimplementation and 300 cases postimplementation for discrepancies between the pathologist’s IOC result and the IOC result recorded by the surgeon in the operative note. Discrepancies dropped from 12 of 150 preimplementation to 6 of 150 and 7 of 150 in postimplementation years 1 and 2. One of the 25 discrepancies had a major clinical impact. Conclusions Real-time reporting of IOC results to the EHR reliably transmits results immediately to clinical teams. This strategy reduces but does not eliminate postanalytic interpretive errors by clinical teams.

scholarly journals Management of Laboratory Data and Information Exchange in the Electronic Health Record

2015 ◽  
Vol 139 (3) ◽  
pp. 319-327 ◽  
Author(s):  
Myra L. Wilkerson ◽  
Walter H. Henricks ◽  
William J. Castellani ◽  
Mark S. Whitsitt ◽  
John H. Sinard
Keyword(s):  
Electronic Health Record ◽  
Information Exchange ◽  
Laboratory Data ◽  
Health Record ◽  
Electronic Health

scholarly journals Search Functionality Within the Electronic Health Record and Health Information Exchange Databases

2020 ◽  
Vol 3 ◽  
Author(s):  
Brandon Gregory ◽  
Jordan Hill ◽  
Titus Schleyer
Keyword(s):  
Electronic Health Record ◽  
Health Information ◽  
Patient Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Health Record ◽  
Search Function ◽  
Electronic Health

Background and Hypothesis:  In the US today, over 95% of healthcare institutions operate using the electronic health record (EHR). While proven to be a substantial improvement to medical practice, the substantial amount of retained information within those records has made searching the EHR for relevant material difficult and too time consuming. We hypothesize that by providing a search function within the EHR with added capability of collaborative filtration, physicians will be better able to retrieve important patient information and thus provide more efficient care.     Project Methods:   Emergency Department physicians of Sidney & Lois Eskenazi Hospital and Indiana University Health Hospital were recruited to partake in this study based on their use and familiarity of the EHR Cerner and/or Health Information Exchange (HIE) CareWeb Search function. Participants filled out a pre-interview, Likert-scale questionnaire to determine their general impressions of search functions and the frequency with which they were used. Additional insight was obtained during an interview focusing on participants’ previous experiences searching within the EHR/HIE. Participants were then shown a mock-up of potential collaborative filtering integration into CareWeb in order to collect opinions regarding the feature’s usability/practicality, display/format, and a number of suggested terms.    Results:   From the pilot study, current challenges that limit clinician search function use include limited time in clinician workflow, information overload, and inaccurate results. Clinicians are more likely to conduct searches when treating patients who have limited medical history, complex histories, known recent visitations, and/or who have been seen at other institutions. Participants demonstrated interest in a collaborative filtration search feature; they expressed a preference to have the feature recommend five related search terms.    Potential Impact:   The data from this study aims to refine the way healthcare providers search within the EHR/HIE. This will allow healthcare providers to more efficiently extract relevant patient information for improved healthcare delivery and proficient clinician workflow. 

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