Digital Transformation Challenges for the Implementation of Quality Electronic Medical Records

2020 ◽  
pp. 63-91
Author(s):  
Dimitrios G. Katehakis ◽  
Angelina Kouroubali
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Digital Transformation ◽  
Full Potential ◽  
Medical Decisions ◽  
Significant Information ◽  
Factors Affecting ◽  
Key Stakeholders ◽  
Electronic Medical Record Systems ◽  
Clinically Significant

The purpose of this work is to analyze the digital transformation challenges related to the implementation of quality electronic medical record systems in Greece, within the wider frame of the European digital single market. The authors explore characteristics of quality, interoperable and secure electronic medical records, and provide an overview of the challenges and factors affecting their adoption, implementation, and operation. Key challenges relate to linking electronic medical records with the workflow, building trust and acceptance by making the best use of champions and key stakeholders, and financing the digital transformation transition and sustainability. The foreseen benefits include better support of medical decisions across all stages of the patient pathway, patients empowered to carry with them clinically significant information, fostering research, and unlocking the full potential of vendors to implement innovative tools to support continuity of care.

scholarly journals Uncovering interpretable potential confounders in electronic medical records

2021 ◽  
Author(s):  
Jiaming Zeng ◽  
Michael F. Gensheimer ◽  
Daniel L. Rubin ◽  
Susan Athey ◽  
Ross D. Shachter
Keyword(s):  
Electronic Medical Records ◽  
Selection Bias ◽  
Language Processing ◽  
Medical Records ◽  
Randomized Clinical Trials ◽  
Research Database ◽  
High Stake ◽  
Medical Decisions ◽  
Clinical Text ◽  
Using Data

AbstractIn medicine, randomized clinical trials (RCT) are the gold standard for informing treatment decisions. Observational comparative effectiveness research (CER) is often plagued by selection bias, and expert-selected covariates may not be sufficient to adjust for confounding. We explore how the unstructured clinical text in electronic medical records (EMR) can be used to reduce selection bias and improve medical practice. We develop a method based on natural language processing to uncover interpretable potential confounders from the clinical text. We validate our method by comparing the hazard ratio (HR) from survival analysis with and without the confounders against the results from established RCTs. We apply our method to four study cohorts built from localized prostate and lung cancer datasets from the Stanford Cancer Institute Research Database and show that our method adjusts the HR estimate towards the RCT results. We further confirm that the uncovered terms can be interpreted by an oncologist as potential confounders. This research helps enable more credible causal inference using data from EMRs, offers a transparent way to improve the design of observational CER, and could inform high-stake medical decisions. Our method can also be applied to studies within and beyond medicine to extract important information from observational data to support decisions.

scholarly journals Factors affecting the utilisation of electronic medical records system in Malawian central hospitals

2017 ◽  
Vol 29 (3) ◽  
pp. 247 ◽  
Author(s):  
Khwima E. Mkalira Msiska ◽  
Andrew Kumitawa ◽  
Benjamin Kumwenda
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Factors Affecting ◽  
Medical Records System

Factors Affecting the Timing of a Central Line Associated Bloodstream Infection Onset in Children with Cancer

2020 ◽  
Vol 38 (1) ◽  
pp. 26-35
Author(s):  
Mina Park ◽  
Young-mi Seo ◽  
Yoon Jung Shin ◽  
Jung Woo Han ◽  
Eunhee Cho ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Multivariable Analysis ◽  
Central Line ◽  
Catheter Insertion ◽  
Children With Cancer ◽  
Factors Affecting ◽  
Pediatric Cancer Patients ◽  
The Impact

Purpose: The purpose of this study is to identify controllable treatment-environment-related factors affecting the timing of a central line-associated bloodstream infection (CLABSI) onset in children with cancer with central venous catheters (CVC). Design: This study is a secondary data analysis with the data extracted from electronic medical records in a tertiary hospital in South Korea. This study was conducted by reviewing electronic medical records of 470 pediatric cancer patients younger than the age of 18 years from 2010 to 2016. Method: The timing of a CLABSI onset was identified through the onset of CLABSI and the duration of catheterization. Cox proportional hazards regression analysis was used to estimate the impact of variables on the timing of CLABSI onset. The duration of catheterization was estimated using the Kaplan–Meier method. Finding: Multivariable analysis by Cox proportional model analysis showed that there are six independent variables affecting the timing of a CLABSI onset: length of stay in hospital, catheter insertion location, use of antibiotics on day of catheter insertion, catheter function, number of blood transfusions per 100 days, and number of blood tests per 100 days. Conclusions: The findings of this study provide a foundation for the development of EBP-based CVC guidelines to effectively reduce CLABSIs and maintain a long-term CVC without a CLABSI.

scholarly journals Factors affecting cross-hospital exchange of Electronic Medical Records

2009 ◽  
Vol 46 (2) ◽  
pp. 109-115 ◽  
Author(s):  
I-Chiu Chang ◽  
Hsin-Ginn Hwang ◽  
Ming-Chien Hung ◽  
Kuang-Ming Kuo ◽  
David C. Yen
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Factors Affecting

scholarly journals Digital transformation of the emergency department-inpatient interface (EDii): integration for future innovation

2020 ◽  
Vol 44 (5) ◽  
pp. 666
Author(s):  
Andrew Staib ◽  
Clair Sullivan ◽  
Cara Joyce Cabilan ◽  
Rohan Cattell ◽  
Rob Eley
Keyword(s):  
Electronic Medical Records ◽  
Patient Outcomes ◽  
Medical Records ◽  
Emergency Admission ◽  
Tertiary Hospital ◽  
Digital Transformation ◽  
Relative Reduction ◽  
Process Measures ◽  
The Impact

As the focus of clinicians and government shifts from speciality-based care to system-based key performance indicators such as the National Emergency Access Target (NEAT) or the 4-h rule, integration between emergency department (ED) and inpatient clinical workflows and information systems is becoming increasingly necessary. Such system measures drive the implementation of integrated electronic medical records (ieMR) to digitally integrate these workflows. The objective of this case study was to describe the impact of digital transformation of the ED–in-patient interface (EDii) of a large tertiary hospital on process measures and clinical outcomes for patients requiring emergency admission to hospital. Data were collected from routine clinical and administrative information systems to measure process and clinical outcome measures, including ED length of stay, compliance with the 4-h rule and in-patient mortality between 28 November 2014 and 28 February 2017. The 4-h rule compliance for all patients, as well as for the EDii group (admitted to hospital excluding short stay ward), declined after digitisation. There were 55 fewer deaths in the postintervention group (15% relative reduction; P = 0.02) and a 10% relative reduction in adjusted mortality as measured by the Hospital Standardised Mortality Ratio for emergency patients (eHSMR), which did not reach statistical significance. Digital deceleration in ED performance did occur with an ieMR rollout, but worsening of key patient outcomes was not observed. What is known about this topic? Much has been written about the introduction of electronic medical records (EMRs) in emergency departments. This work sits alongside a substantial body of evidence outlining the relationship between process measures of ED performance and important patient outcomes. However, much less is known about the impact of digital transformation on the complex adaptive system that is the EDii and the impact of digitisation on the vulnerable group of patients who require emergency admission to hospital. What does this paper add? The objective of this case study was to describe the effect of a rapid rollout of an integrated EMR. This EMR simultaneously transformed care delivery both in the ED and the inpatient space and impacted on the politically and clinically sensitive performance and outcome measures of the EDii in a large tertiary hospital. The present study is the first that specifically examined the effect of digitisation at the EDii. What are the implications for practitioners? The understanding that digital deceleration will occur, but that with good patient outcome monitoring worsening of key patient outcomes is not likely to occur, now holds a key place in digital transformation planning. The measures of the EDii examined in this case study provide a foundation for this montoring.

scholarly journals FACTORS AFFECTING THE SUCCESS OF THE USE OF ELECTRONIC MEDICAL RECORD (EMR) IN NURSING SERVICES IN HOSPITAL

2019 ◽  
Vol 2 (01) ◽  
pp. 23-27
Author(s):  
Astri Safariah
Keyword(s):  
Health Service ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Service System ◽  
Nursing Service ◽  
Factors Affecting ◽  
It Systems ◽  
Technological Advances ◽  
Nursing Services

The hospital is a health service facility that is integrated with the nursing service system. With the advancement of technology, the services of the congregation must be effective and efficient both in terms of service time so that the quality of service to patients is still prioritized. Nurses must be prepared to face challenges in the era of technological advances so that included in the use of electronic medical records, especially in the nursing service order, the factors that influence the success of EMR are nurses as users must be proficient in using computers, management must always evaluate and communicate with EMR use and IT systems themselves must be easier, faster and more flexible to use so nurses are more confident in using EMR

scholarly journals A Retrospective Review of Lead Migration Rate in Patients Permanently Implanted with Percutaneous Leads and a 10 kHz SCS Device

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Mayank Gupta ◽  
Alaa Abd-Elsayed ◽  
Meghan Hughes ◽  
Anand Rotte
Keyword(s):  
Pain Relief ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Response Rate ◽  
Surgical Techniques ◽  
Analysis Data ◽  
Average Pain ◽  
Clinically Significant ◽  
Lead Location

Background. Spinal cord stimulation (SCS) has been used over decades for pain management, but migration of percutaneous leads has been the most common complication. Better surgical techniques and newer SCS technologies likely reduced the incidence of lead migration requiring surgical revision, although data are sparse. This study aimed to retrospectively evaluate the incidence of clinically significant percutaneous lead migration in patients permanently implanted with a 10 kHz SCS system. Methods. Consecutive patients with chronic trunk and/or limb pain, permanently implanted between January 2016 and June 2019, were included in the analysis. Data were collected from the hospital’s electronic medical records and the manufacturer’s database. Clinically significant lead migration, defined as diminished pain relief followed by surgery to correct lead location, was assessed at the 6-month follow-up. Results. At the 6-month follow-up, there were no cases of clinically significant lead migration, average pain relief was 65.2%, 82% of patients had response (≥50% pain relief), improvement of function was noted in 72% of patients, and decrease of medication was observed in 42% of patients. Therapy efficacy was sustained in patients with >12 months follow-up; the average pain relief was 58.5%, and the response rate was 82%. Conclusions. The surgical techniques in use today are designed to minimise the risk of percutaneous lead migration and may have reduced its incidence. In addition, new SCS systems may give greater opportunity to mitigate cases of minor lead movement using alternative stimulation programs.

Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation

2019 ◽  
Vol 43 (3) ◽  
pp. 302 ◽  
Author(s):  
Ian A. Scott ◽  
Clair Sullivan ◽  
Andrew Staib
Keyword(s):  
Information Technology ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Clinical Care ◽  
Digital Transformation ◽  
Technical Innovation ◽  
Evidence Based ◽  
Methodological Framework ◽  
Multidisciplinary Group ◽  
Interactive Workshop

Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.

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