scholarly journals Meaningful Use of a Standardized Terminology to Support the Electronic Health Record in New Zealand

2010 ◽  
Vol 01 (04) ◽  
pp. 368-376 ◽  
Author(s):  
M. Honey ◽  
S. Wilson ◽  
K. Monsen
Keyword(s):  
New Zealand ◽  
Electronic Health Record ◽  
Clinical Information System ◽  
Service Providers ◽  
Meaningful Use ◽  
Free Text ◽  
Health Record ◽  
Snomed Ct ◽  
Omaha System ◽  
Electronic Health

SummaryMeaningful use is a multidimensional concept that incorporates complex processes; workflow; interoperability; decision support; performance evaluation; and quality improvement. Meaningful use is congruent with the overall vision for information management in New Zealand. Health practitioners interface with patient information at many levels, and are pivotal to meaningful use at the interface between service providers, patients, and the electronic health record. Advancing towards meaningful use depends on implementing a meaningful interface terminology within the electronic health record. The Omaha System is an interface terminology that is integrated within Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT®), and has the capacity to disseminate and capture information at the point of care because its codes are simple defined terms. Two community nursing and allied health providers who are considering using the Omaha System in clinical systems for gathering intervention and outcomes data within the personal EHR include Nurse Maude and the Royal New Zealand Plunket Society. Help4U is investigating using the Omaha System as a way to standardise health terminology for consumer use. The Omaha System is also a good fit with the Midwifery and Maternity Providers Organisation (MMPO) existing clinical information system to describe and capture data about interventions currently recorded as free text. As a country that promotes access to affordable primary care and free hospital care, within an environment constrained by resource limitations, maximizing the use of data is key to demonstrating health outcomes for the population.

scholarly journals HAI-Proactive: Development of an Automated Surveillance System for Healthcare-Associated Infections in Sweden

2020 ◽  
Vol 41 (S1) ◽  
pp. s39-s39
Author(s):  
Pontus Naucler ◽  
Suzanne D. van der Werff ◽  
John Valik ◽  
Logan Ward ◽  
Anders Ternhag ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Electronic Health Record ◽  
Predictive Value ◽  
Surveillance System ◽  
Free Text ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Record Data ◽  
Electronic Health ◽  
Healthcare Associated

Background: Healthcare-associated infection (HAI) surveillance is essential for most infection prevention programs and continuous epidemiological data can be used to inform healthcare personal, allocate resources, and evaluate interventions to prevent HAIs. Many HAI surveillance systems today are based on time-consuming and resource-intensive manual reviews of patient records. The objective of HAI-proactive, a Swedish triple-helix innovation project, is to develop and implement a fully automated HAI surveillance system based on electronic health record data. Furthermore, the project aims to develop machine-learning–based screening algorithms for early prediction of HAI at the individual patient level. Methods: The project is performed with support from Sweden’s Innovation Agency in collaboration among academic, health, and industry partners. Development of rule-based and machine-learning algorithms is performed within a research database, which consists of all electronic health record data from patients admitted to the Karolinska University Hospital. Natural language processing is used for processing free-text medical notes. To validate algorithm performance, manual annotation was performed based on international HAI definitions from the European Center for Disease Prevention and Control, Centers for Disease Control and Prevention, and Sepsis-3 criteria. Currently, the project is building a platform for real-time data access to implement the algorithms within Region Stockholm. Results: The project has developed a rule-based surveillance algorithm for sepsis that continuously monitors patients admitted to the hospital, with a sensitivity of 0.89 (95% CI, 0.85–0.93), a specificity of 0.99 (0.98–0.99), a positive predictive value of 0.88 (0.83–0.93), and a negative predictive value of 0.99 (0.98–0.99). The healthcare-associated urinary tract infection surveillance algorithm, which is based on free-text analysis and negations to define symptoms, had a sensitivity of 0.73 (0.66–0.80) and a positive predictive value of 0.68 (0.61–0.75). The sensitivity and positive predictive value of an algorithm based on significant bacterial growth in urine culture only was 0.99 (0.97–1.00) and 0.39 (0.34–0.44), respectively. The surveillance system detected differences in incidences between hospital wards and over time. Development of surveillance algorithms for pneumonia, catheter-related infections and Clostridioides difficile infections, as well as machine-learning–based models for early prediction, is ongoing. We intend to present results from all algorithms. Conclusions: With access to electronic health record data, we have shown that it is feasible to develop a fully automated HAI surveillance system based on algorithms using both structured data and free text for the main healthcare-associated infections.Funding: Sweden’s Innovation Agency and Stockholm County CouncilDisclosures: None

A National Study of Challenges to Electronic Health Record Adoption and Meaningful Use

Medical Care ◽  
2014 ◽  
Vol 52 (2) ◽  
pp. 144-148 ◽  
Author(s):  
Dawn Heisey-Grove ◽  
Lisa-Nicole Danehy ◽  
Michelle Consolazio ◽  
Kimberly Lynch ◽  
Farzad Mostashari
Keyword(s):  
Electronic Health Record ◽  
Meaningful Use ◽  
National Study ◽  
Health Record ◽  
Electronic Health

Enhancing goals of care communication by oncologists using a pathway-based intervention.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 324-324
Author(s):  
Isaac S. Chua ◽  
Elise Tarbi ◽  
Jocelyn H. Siegel ◽  
Kate Sciacca ◽  
Anne Kwok ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Advanced Cancer ◽  
Language Processing ◽  
Clinical Pathways ◽  
Free Text ◽  
Health Record ◽  
Goals Of Care ◽  
Progress Notes ◽  
Electronic Health ◽  
Pilot Sample

324 Background: Delivering goal-concordant care to patients with advanced cancer requires identifying eligible patients who would benefit from goals of care (GOC) conversations; training clinicians how to have these conversations; conducting conversations in a timely manner; and documenting GOC conversations that can be readily accessed by care teams. We used an existing, locally developed electronic cancer care clinical pathways system to guide oncologists toward these conversations. Methods: To identify eligible patients, pathways directors from 12 oncology disease centers identified therapeutic decision nodes for each pathway that corresponded to a predicted life expectancy of ≤1 year. When oncologists selected one of these pre-identified pathways nodes, the decision was captured in a relational database. From these patients, we sought evidence of GOC documentation within the electronic health record by extracting coded data from the advance care planning (ACP) module—a designated area within the electronic health record for clinicians to document GOC conversations. We also used rule-based natural language processing (NLP) to capture free text GOC documentation within these same patients’ progress notes. A domain expert reviewed all progress notes identified by NLP to confirm the presence of GOC documentation. Results: In a pilot sample obtained between March 20 and September 25, 2020, we identified a total of 21 pathway nodes conveying a poor prognosis, which represented 91 unique patients with advanced cancer. Among these patients, the mean age was 62 (SD 13.8) years old; 55 (60.4%) patients were female, and 69 (75.8%) were non-Hispanic White. The cancers most represented were thoracic (32 [35.2%]), breast (31 [34.1%]), and head and neck (13 [14.3%]). Within the 3 months leading up to the pathways decision date, a total 62 (68.1%) patients had any GOC documentation. Twenty-one (23.1%) patients had documentation in both the ACP module and NLP-identified progress notes; 5 (5.5%) had documentation in the ACP module only; and 36 (39.6%) had documentation in progress notes only. Twenty-two unique clinicians utilized the ACP module, of which 1 (4.5%) was an oncologist and 21 (95.5%) were palliative care clinicians. Conclusions: Approximately two thirds of patients had any GOC documentation. A total of 26 (28.6%) patients had any GOC documentation in the ACP module, and only 1 oncologist documented using the ACP module, where care teams can most easily retrieve GOC information. These findings provide an important baseline for future quality improvement efforts (e.g., implementing serious illness communications training, increasing support around ACP module utilization, and incorporating behavioral nudges) to enhance oncologists’ ability to conduct and to document timely, high quality GOC conversations.

scholarly journals Opinions, perceptions and attitudes toward an electronic health record system among practicing nurses

2017 ◽  
Vol 8 (3) ◽  
pp. 12
Author(s):  
Ahmad H. Abu Raddaha ◽  
Arwa Obeidat ◽  
Huda Al Awaisi ◽  
Jahara Hayudini
Keyword(s):  
Electronic Health Record ◽  
Clinical Information System ◽  
Research Work ◽  
Healthcare Delivery ◽  
Future Research ◽  
Health Record ◽  
Randomized Sampling ◽  
Positive Attitudes ◽  
Electronic Health ◽  
The Impact

Background: Despite worldwide expanding implementation of electronic health record (EHR) systems, healthcare professionals conducted limited number of studies to explore factors that might facilitate or jeopardize using these systems. This study underscores the impact of nurses’ opinions, perceptions, and computer competencies on their attitudes toward using an EHR system.Methods: With randomized sampling, a cross-sectional exploratory design was used. The sample consisted of 169 nurses who worked at a public teaching hospital in Oman. They completed self-administered questionnaire. Several standardized valid and reliable instruments were utilized.Results: Seventy-four percent of our study nurses had high positive attitudes toward the EHR system. The least ranked perception scores (60.4%) were linked to perceiving that suggestions made by nurses about the system would be taken into account. Nurses who reported that the hospital sought for suggestions for customization of the system [OR: 2.54 (95% CI: 1.09, 5.88), p = .03], who found the system as an easy-to-use clinical information system [OR: 6.53 (95% CI: 1.72, 24.75), p = .01], who reported the presence of good relationship with the system’s managing personnel [OR: 3.59 (95% CI: 1.13, 11.36), p = .03] and who reported that the system provided all needed health information [OR: 2.97 (95% CI: 1.16, 7.62), p = .02] were more likely to develop high positive attitudes toward the system.Conclusions: To better develop plans to foster the EHR system’s use facilitators and overcome its usage barriers by nursing professionals, more involvement of nurses in system’s customization endeavors is highly suggested. When the system did not disrupt workflows, it would decrease clinical errors and expand nursing productivity. In order to maximize the utilization of the system in healthcare delivery, future research work to investigate the effect of the system on other healthcare providers and inter-professional communications is pressingly needed.

scholarly journals Use of Electronic Health Record Tools to Facilitate and Audit Infliximab Prescribing

2018 ◽  
Vol 23 (1) ◽  
pp. 18-25
Author(s):  
Bethany R. Sharpless ◽  
Fernando del Rosario ◽  
Zarela Molle-Rios ◽  
Elora Hilmas
Keyword(s):  
Literature Review ◽  
Electronic Health Record ◽  
National Survey ◽  
Free Text ◽  
Health Record ◽  
Order Information ◽  
Text Data ◽  
Review Analysis ◽  
Electronic Health ◽  
Implementation Data

OBJECTIVES The objective of this project was to assess a pediatric institution's use of infliximab and develop and evaluate electronic health record tools to improve safety and efficiency of infliximab ordering through auditing and improved communication. METHODS Best use of infliximab was defined through a literature review, analysis of baseline use of infliximab at our institution, and distribution and analysis of a national survey. Auditing and order communication were optimized through implementation of mandatory indications in the infliximab orderable and creation of an interactive flowsheet that collects discrete and free-text data. The value of the implemented electronic health record tools was assessed at the conclusion of the project. RESULTS Baseline analysis determined that 93.8% of orders were dosed appropriately according to the findings of a literature review. After implementation of the flowsheet and indications, the time to perform an audit of use was reduced from 60 minutes to 5 minutes per month. Four months post implementation, data were entered by 60% of the pediatric gastroenterologists at our institution on 15.3% of all encounters for infliximab. Users were surveyed on the value of the tools, with 100% planning to continue using the workflow, and 82% stating the tools frequently improve the efficiency and safety of infliximab prescribing. CONCLUSIONS Creation of a standard workflow by using an interactive flowsheet has improved auditing ability and facilitated the communication of important order information surrounding infliximab. Providers and pharmacists feel these tools improve the safety and efficiency of infliximab ordering, and auditing data reveal that the tools are being used.

scholarly journals EHR Model for India: To address challenges in quality Healthcare (Preprint)

2018 ◽  
Author(s):  
Prashant Kanade ◽  
Dr Divya Bhatnagar ◽  
Dr Arun Kumar
Keyword(s):  
Electronic Health Record ◽  
Service Providers ◽  
Care Service ◽  
Health Care Service ◽  
Electronic Health Record System ◽  
Family Welfare ◽  
Health Record ◽  
Record System ◽  
Quality Healthcare ◽  
Electronic Health

UNSTRUCTURED Abstract: In this paper there is a discussion on providing a standard system for health care service providers and patients. We have carried out the detailed study of guidelines provided by ministry of health and family welfare to adopt the electronic health record system. The major aim is to eliminate the conventional health record system. The major focus in this research is to propose the interoperable electronic health Record system (IEHR), and test the feasibility and acceptance of the EHR. Further there is a scope to promote the services in select locations such as hospitals and primary health centres. Medical centres can store patient’s health information with minimal efforts.

scholarly journals Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data

2019 ◽  
Author(s):  
Daniel M. Bean ◽  
James Teo ◽  
Honghan Wu ◽  
Ricardo Oliveira ◽  
Raj Patel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Natural Language Processing ◽  
Natural Language ◽  
Electronic Health Record ◽  
Open Source ◽  
Language Processing ◽  
Risk Scores ◽  
Free Text ◽  
Health Record ◽  
Electronic Health

AbstractAtrial fibrillation (AF) is the most common arrhythmia and significantly increases stroke risk. This risk is effectively managed by oral anticoagulation. Recent studies using national registry data indicate increased use of anticoagulation resulting from changes in guidelines and the availability of newer drugs.The aim of this study is to develop and validate an open source risk scoring pipeline for free-text electronic health record data using natural language processing.AF patients discharged from 1st January 2011 to 1st October 2017 were identified from discharge summaries (N=10,030, 64.6% male, average age 75.3 ± 12.3 years). A natural language processing pipeline was developed to identify risk factors in clinical text and calculate risk for ischaemic stroke (CHA2DS2-VASc) and bleeding (HAS-BLED). Scores were validated vs two independent experts for 40 patients.Automatic risk scores were in strong agreement with the two independent experts for CHA2DS2-VASc (average kappa 0.78 vs experts, compared to 0.85 between experts). Agreement was lower for HAS-BLED (average kappa 0.54 vs experts, compared to 0.74 between experts).In high-risk patients (CHA2DS2-VASc ≥2) OAC use has increased significantly over the last 7 years, driven by the availability of DOACs and the transitioning of patients from AP medication alone to OAC. Factors independently associated with OAC use included components of the CHA2DS2-VASc and HAS-BLED scores as well as discharging specialty and frailty. OAC use was highest in patients discharged under cardiology (69%).Electronic health record text can be used for automatic calculation of clinical risk scores at scale. Open source tools are available today for this task but require further validation. Analysis of routinely-collected EHR data can replicate findings from large-scale curated registries.

scholarly journals Pilot Study of Meaningful Use of Electronic Health Records in Radiation Oncology

2012 ◽  
Vol 8 (4) ◽  
pp. 219-223 ◽  
Author(s):  
Xinglei Shen ◽  
Adam P. Dicker ◽  
Laura Doyle ◽  
Timothy N. Showalter ◽  
Amy S. Harrison ◽  
...  
Keyword(s):  
Pilot Study ◽  
Electronic Health Records ◽  
Electronic Health Record ◽  
Radiation Oncology ◽  
Meaningful Use ◽  
Health Record ◽  
Health Records ◽  
Widespread Adoption ◽  
Electronic Health

Most large academic radiation oncology practices have incorporated electronic health record systems into practice and plan to meet meaningful use requirements. Further work should focus on needs of smaller practices, and specific guidelines may improve widespread adoption.

Ethics of Electronic Health Record Systems

2020 ◽  
pp. 1467-1484
Author(s):  
Brian J. Galli
Keyword(s):  
Electronic Health Record ◽  
Ethical Issues ◽  
Healthcare Providers ◽  
Meaningful Use ◽  
Health Record ◽  
Ethical Implications ◽  
Incentive Programs ◽  
Time Period ◽  
Electronic Health ◽  
The Government

This article describes how healthcare and IT are combatting the ethical implications of electronic health records (EHRs) in order to make them adopted by over 90% of small practices. There is a lack of trust in EHRs and uneasiness about what they will accomplish. Furthermore, security concerns have become more prevalent as a result of increased hacker activity. The objective of this article is to analyze these ethical issues in an effort to eliminate them as a hinderance to EHR implementation. As of now, 98% of all hospitals use EHRs. Between 2009 and 2015, the government allocated money and resources for incentive programs to get EHRs into every healthcare providers' office. During this time period, over $800 million dollars facilitated EHR implementation. Using this as a tool EHRs negative perception can be revitalized and combated with the meaningful use program. This article will highlight the ethical implications of EHRs and suggest ways in which to avoid them to make EHRs available in every healthcare provider.

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