scholarly journals Patient Rationales Against the Use of Patient-Accessible Electronic Health Records: Qualitative Study

10.2196/24090 ◽  
2021 ◽  
Vol 23 (5) ◽  
pp. e24090
Author(s):  
Hanne Støre Valeur ◽  
Anne Kveim Lie ◽  
Kåre Moen
Keyword(s):  
Health Services ◽  
Electronic Health Records ◽  
Social Life ◽  
Digital Health ◽  
Emotional Reactions ◽  
The Internet ◽  
Medical Terminology ◽  
Digital Competence ◽  
Health Records ◽  
Electronic Health

Background Patient-accessible electronic health records (PAEHRs) enable patients to access their health records through a secure connection over the internet. Although previous studies of patient experiences with this kind of service have shown that a majority of users are positive toward PAEHRs, little is known about why some patients occasionally or regularly choose not to use them. A better understanding of why patients may choose not to make use of digital health services such as PAEHRs is important for further development and implementation of services aimed at having patients participate in digital health services. Objective The objective of the study was to explore patients’ rationales for not embracing online access to health records. Methods Qualitative interviews were conducted with 40 patients in a department of internal medicine in a Norwegian hospital in 2018-2019. Interview transcripts were subjected to thematic content analysis. In this paper, we focus on the subject of nonuse of PAEHRs. Results We identified 8 different rationales that study participants had for not embracing PAEHRs. When patients reflected on why they might not use PAEHRs, they variously explained that they found PAEHRs unnecessary (they did not feel they were useful), impersonal (they preferred oral dialogue with their doctor or nurse over written information), incomprehensible (the records contained medical terminology and explanations that were hard to understand), misery oriented (the records solely focused on disease), fear provoking (reading the records could cause unwanted emotional reactions), energy demanding (making sense of the records added to the work of being a patient), cumbersome (especially among patients who felt they did not have the necessary digital competence), and impoverishing (they were skeptical about the digital transformation of individual and social life). Conclusions It is often assumed that the barriers to PAEHR use are mostly practical (such as lack of hardware and access to the internet). In this study, we showed that patients may have many other valid reasons for not wanting to adopt this kind of service. The results can help guide how PAEHRs and other digital health services are promoted and presented to patients, and they may suggest that the goal of a given new digital health service should not necessarily be full uptake by all patients. Rather, one should recognize that different patients might prefer and benefit from different kinds of “analog” and digital health services.

scholarly journals Patient Rationales Against the Use of Patient-Accessible Electronic Health Records: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Hanne Støre Valeur ◽  
Anne Kveim Lie ◽  
Kåre Moen
Keyword(s):  
Health Services ◽  
Electronic Health Records ◽  
Social Life ◽  
Digital Health ◽  
Emotional Reactions ◽  
The Internet ◽  
Medical Terminology ◽  
Digital Competence ◽  
Health Records ◽  
Electronic Health

BACKGROUND Patient-accessible electronic health records (PAEHRs) enable patients to access their health records through a secure connection over the internet. Although previous studies of patient experiences with this kind of service have shown that a majority of users are positive toward PAEHRs, little is known about why some patients occasionally or regularly choose not to use them. A better understanding of why patients may choose not to make use of digital health services such as PAEHRs is important for further development and implementation of services aimed at having patients participate in digital health services. OBJECTIVE The objective of the study was to explore patients’ rationales for not embracing online access to health records. METHODS Qualitative interviews were conducted with 40 patients in a department of internal medicine in a Norwegian hospital in 2018-2019. Interview transcripts were subjected to thematic content analysis. In this paper, we focus on the subject of nonuse of PAEHRs. RESULTS We identified 8 different rationales that study participants had for not embracing PAEHRs. When patients reflected on why they might not use PAEHRs, they variously explained that they found PAEHRs unnecessary (they did not feel they were useful), impersonal (they preferred oral dialogue with their doctor or nurse over written information), incomprehensible (the records contained medical terminology and explanations that were hard to understand), misery oriented (the records solely focused on disease), fear provoking (reading the records could cause unwanted emotional reactions), energy demanding (making sense of the records added to the work of being a patient), cumbersome (especially among patients who felt they did not have the necessary digital competence), and impoverishing (they were skeptical about the digital transformation of individual and social life). CONCLUSIONS It is often assumed that the barriers to PAEHR use are mostly practical (such as lack of hardware and access to the internet). In this study, we showed that patients may have many other valid reasons for not wanting to adopt this kind of service. The results can help guide how PAEHRs and other digital health services are promoted and presented to patients, and they may suggest that the goal of a given new digital health service should not necessarily be full uptake by all patients. Rather, one should recognize that different patients might prefer and benefit from different kinds of “analog” and digital health services.

scholarly journals Designing Decentralized Ledger Technology for Electronic Health Records

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Vikram Dhillon
Keyword(s):  
Electronic Health Records ◽  
Open Source ◽  
Digital Health ◽  
Health Records ◽  
Distributed Ledger ◽  
Distributed Ledger Technology ◽  
Electronic Health

No abstract available. Editor’s note: A proposal to implement distributed ledger technology for electronic health records is outlined here. The rationale for integration of distributed ledgers in the healthcare domain is introduced, followed by a discussion of the features enabled by the use of a blockchain. An open source implementation of a distributed ledger is then presented. The article concludes with an examination of opportunities and challenges ahead in deploying blockchains for digital health.

scholarly journals Electronic health records in ambulances: the ERA multiple-methods study

2020 ◽  
Vol 8 (10) ◽  
pp. 1-140
Author(s):  
Alison Porter ◽  
Anisha Badshah ◽  
Sarah Black ◽  
David Fitzpatrick ◽  
Robert Harris-Mayes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Services ◽  
Electronic Health Records ◽  
Case Studies ◽  
Routine Data ◽  
Health Economy ◽  
Multiple Methods ◽  
Health Records ◽  
Electronic Health ◽  
Future Work

Background Ambulance services have a vital role in the shift towards the delivery of health care outside hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department. The introduction of information technology in ambulance services to electronically capture, interpret, store and transfer patient data can support out-of-hospital care. Objective We aimed to understand how electronic health records can be most effectively implemented in a pre-hospital context in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised. Design and setting We carried out a study using multiple methods and with four work packages: (1) a rapid literature review; (2) a telephone survey of all 13 freestanding UK ambulance services; (3) detailed case studies examining electronic health record use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and (4) a knowledge-sharing workshop. Results We found limited literature on electronic health records. Only half of the UK ambulance services had electronic health records in use at the time of data collection, with considerable variation in hardware and software and some reversion to use of paper records as services transitioned between systems. The case studies found that the ambulance services’ electronic health records were in a state of change. Not all patient contacts resulted in the generation of electronic health records. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the electronic health records. Ambulance clinicians continued to use indirect data input approaches (such as first writing on a glove) even when using electronic health records. The primary function of electronic health records in all services seemed to be as a store for patient data. There was, as yet, limited evidence of electronic health records’ full potential being realised to transfer information, support decision-making or change patient care. Limitations Limitations included the difficulty of obtaining sets of matching routine data for analysis, difficulties of attributing any change in practice to electronic health records within a complex system and the rapidly changing environment, which means that some of our observations may no longer reflect reality. Conclusions Realising all the benefits of electronic health records requires engagement with other parts of the local health economy and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set and need to be presented with only the information that they need. Future work There is scope for future work analysing ambulance service routine data sets, qualitative work to examine transfer of information at the emergency department and patients’ perspectives on record-keeping, and to develop and evaluate feedback to clinicians based on patient records. Study registration This study is registered as Health and Care Research Wales Clinical Research Portfolio 34166. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 10. See the NIHR Journals Library website for further project information.

scholarly journals Secure Exchange of Medical Data Using a Novel Real-Time Biometric-Based Protection and Recognition Method

Electronics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 2013
Author(s):  
Shams Ud Din ◽  
Zahoor Jan ◽  
Muhammad Sajjad ◽  
Maqbool Hussain ◽  
Rahman Ali ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Real Time ◽  
Signal To Noise Ratio ◽  
Security And Privacy ◽  
The Internet ◽  
Healthcare Organizations ◽  
Health Records ◽  
Clinical Notes ◽  
Electronic Health ◽  
Value Decomposition

Security and privacy are essential requirements, and their fulfillment is considered one of the most challenging tasks for healthcare organizations to manage patient data using electronic health records. Electronic health records (clinical notes, images, and documents) become more vulnerable to breaching patients’ privacy when shared with an external organization in the current arena of the internet of medical things (IoMT). Various watermarking techniques were introduced in the medical field to secure patients’ data. Most of the existing techniques focus on an image or document’s imperceptibility without considering the watermark(logo). In this research, a novel technique of watermarking is introduced, which supersedes the shortcomings of existing approaches. It guarantees the imperceptibility of the image/document and takes care of watermark(biometric), which is further passed through a process of recognition for claiming ownership. It extracts suitable frequencies from the transform domain using specialized filters to increase the robustness level. The extracted frequencies are modified by adding the biomedical information while considering the strength factor according to the human visual system. The watermarked frequencies are further decomposed through a singular value decomposition technique to increase payload capacity up to (256 × 256). Experimental results over a variety of medical and official images demonstrate the average peak signal-to-noise ratio (PSNR 54.43), and the normal correlation (N.C.) value is 1. PSNR and N.C. of the watermark were calculated after attacks. The proposed technique is working in real-time for embedding, extraction, and recognition of biometrics over the internet, and its uses can be realized in various platforms of IoMT technologies.

scholarly journals ADHD as a Risk Factor for Infection With Covid-19

2020 ◽  
pp. 108705472094327 ◽  
Author(s):  
Eugene Merzon ◽  
Iris Manor ◽  
Ann Rotem ◽  
Tzipporah Schneider ◽  
Shlomo Vinker ◽  
...  
Keyword(s):  
Risk Factor ◽  
Health Services ◽  
Electronic Health Records ◽  
Drug Treatment ◽  
Test Data ◽  
Adhd Medication ◽  
Treatment Results ◽  
Health Records ◽  
Study Population ◽  
Electronic Health

Background: ADHD limits the ability to comply with Covid-19 prevention recommendations. We hypothesized that ADHD constitutes a risk factor for Covid-19 infection and that pharmacotherapy may lower that risk. Methods: Study population included all subjects ( N = 14,022) registered with Leumit Health Services between February 1st and April 30, 2020, who underwent at least one Covid-19 test. Data were collected from the electronic health records. Purchasing consecutively at least three ADHD-medication-prescriptions during past year was considered drug-treatment. Results: A total of 1,416 (10.1%) subjects (aged 2 months–103 years) were Covid-19-positive.They were significantly younger, and had higher rates of ADHD (adjOR 1.58 (95% CI 1.27–1.96, p < .001) than Covid-19-negative subjects. The risk for Covid-19-Positive was higher in untreated-ADHD subjects compared to non-ADHD subjects [crudeOR 1.61 (95% CI 1.36–1.89, p < .001)], while no higher risk was detected in treated ones [crudeOR 1.07 (95% CI 0.78–1.48, p = .65)]. Conclusion: Untreated ADHD seems to constitute a risk factor for Covid-19 infection while drug-treatment ameliorates this effect.

scholarly journals Research on Problems and Countermeasures of Health Records in Community Health Services in Tai'an City

2016 ◽  
Vol 9 (2) ◽  
pp. 19
Author(s):  
Xu Tingting ◽  
Ma Cunhong ◽  
Shang Yulian
Keyword(s):  
Health Services ◽  
Electronic Health Records ◽  
Community Health ◽  
Community Health Center ◽  
Medical Personnel ◽  
Community Health Services ◽  
Health Examination ◽  
Font Size ◽  
Health Records ◽  
Electronic Health

<p><span style="font-size: 10.5pt; font-family: 'Times New Roman','serif'; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 宋体; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;" lang="EN-US">Objective: To standardize and improve the management of health records in community health services in Tai’an city, also to improve community health service level, and enhance residents' awareness of health. Method: taking the residents within the service range of TaiQian Community Health Center in Taian city and the relevant medical staff as research respondent, 120 questionnaires have been sent out to the residents and 15 questionnaires to the staff, then statistical analysis would be made according to the survey results. Results: at current, there are two main ways to establish personal health records, i.e. residents health examination and community personnel pay visit, which are effective; community residents seldom use their personal records, only 93.5% for once a year; 35% of community doctor hold the opinion that the health records have no big value, so there is no need to read, reflecting that the community medical personnel lack of the awareness of use it; the security and completeness of electronic health records are poor. Conclusion: Government should play a leading role in establishing and managing the community health record, improve awareness of community medical personnel in using health records through training, seminars, On-line advertising and other forms, and strengthen and improve the comprehensive management of electronic health records.</span></p>

scholarly journals A Mechanism for Verifying the Integrity and Immutability of Tuberculosis Data Using IOTA Distributed Ledger Technology

2021 ◽  
Author(s):  
Vinícius Lima ◽  
Filipe Bernardi ◽  
Rui Rijo ◽  
Jó Ueyama ◽  
Domingos Alves
Keyword(s):  
Electronic Health Records ◽  
Digital Health ◽  
Health Records ◽  
Related Information ◽  
Research And Innovation ◽  
Distributed Ledger ◽  
Collective Process ◽  
Supporting Tool ◽  
Electronic Health ◽  
Digital Transactions

Background: Intensified research and innovation and rapid uptake of new tools, interventions, and strategies are crucial to fight Tuberculosis, the world’s deadliest infectious disease. The sharing of health data remains a significant challenge. Data consumers must be able to verify the consistency and integrity of data. Solutions based on distributed ledger technologies may be adequate, where each member in a network holds a unique credential and stores an identical copy of the ledger and contributes to the collective process of validating and certifying digital transactions. Objectives: This work proposes a mechanism and presents a use case in Digital Health to allow the verification of integrity and immutability of TB electronic health records. Methods: IOTA was selected as a supporting tool due to its data immutability, traceability and tamper-proof characteristics. Results: A mechanism to verify the integrity of data through hash functions and the IOTA network is proposed. Then, a set of TB related information systems was integrated with the network. Conclusion: IOTA technology offers performance and flexibility to enable a reliable environment for electronic health records.

scholarly journals Digital Health and the State of Interoperable Electronic Health Records (Preprint)

2018 ◽  
Author(s):  
Jessica Germaine Shull
Keyword(s):  
Health Care ◽  
Best Practices ◽  
Electronic Health Records ◽  
Health Systems ◽  
Health Care Services ◽  
Care Delivery ◽  
Digital Health ◽  
Health Records ◽  
Number Of Patients ◽  
Electronic Health

UNSTRUCTURED Digital health systems and innovative care delivery within these systems have great potential to improve national health care and positively impact the health outcomes of patients. However, currently, very few countries have systems that can implement digital interventions at scale. This is partly because of the lack of interoperable electronic health records (EHRs). It is difficult to make decisions for an individual or population when the data on that person or population are dispersed over multiple incompatible systems. This viewpoint paper has highlighted some key obstacles of current EHRs and some promising successes, with the goal of promoting EHR evolution and advocating for frameworks that develop digital health systems that serve populations—a critical goal as we move further into this data-rich century with an ever-increasing number of patients who live longer and depend on health care services where resources may already be strained. This paper aimed to analyze the evolution, obstacles, and current landscape of EHRs and identify fundamental areas of hindrance for interoperability. It also aimed to highlight countries where advances have been made and extract best practices from these examples. The obstacles to EHR interoperability are not easily solved, but improving the current situation in countries where a national policy is not in place will require a focused inquiry into solutions from various sources in the public and private sector. Effort must be made on a national scale to seek solutions for optimally interoperable EHRs beyond status quo solutions. A list of considerations for best practices is suggested.

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