Nursing and Health: Record Keeping – Survival Guide Merrix Pauline and Lillyman Sue Nursing and Health: Record Keeping – Survival Guide 42pp £5.99 Pearson 978 0 2737 6064 1 0273760645

2013 ◽  
Vol 28 (6) ◽  
pp. 32-32
Author(s):  
Grant Byrne
Keyword(s):  

Author(s):  
Gabriela Marcu ◽  
Anind K. Dey ◽  
Sara Kiesler

AbstractTaking an action research approach, we engaged in fieldwork with school-based behavioral health care teams to: observe record keeping practices, design and deploy a prototype system addressing key challenges, and reflect on its use. We describe the challenges of capturing behavioral data using both paper and electronic records. Creating records of behaviors requires direct observation, and as a result the record keeping responsibility is challenging to distribute across a care team. Behavioral data on paper must be transferred and prepared for reporting, both inside the organization and to stakeholders outside of the organization. In prototyping a computerized working record, we targeted user needs for capturing details of a behavioral incident in the moment. Challenges persisted through the transition from paper to our prototype, and based on these empirical findings over two years of fieldwork, we present five tensions in representing behavioral data in an electronic health record. These tensions reflect the differences between entering behavioral data into the record for intraorganizational use versus interorganizational use.



1963 ◽  
Vol 33 (3) ◽  
pp. 125-127 ◽  
Author(s):  
ANN T. GARBER


2014 ◽  
Vol 28 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Nicole M. Homb ◽  
Shayan Sheybani ◽  
Dustin Derby ◽  
Kurt Wood

Objective The objective of this study was to investigate the association of a clinical documentation quality improvement program using audit–feedback with clinical compliance to indicators of quality chart documentation. Methods This was an analysis of differences between adherence to quality indicators of chiropractic record documentation and audit–feedback intervention (feedback report only vs. feedback report with one-on-one educational consultation) at different campuses. Comparisons among groups were analyzed using analysis of variance (ANOVA), Tukey or Dunnett post hoc tests, and Cohen's d effect size estimates. Results There was a significant increase in the mean percentile compliance in 2 of 5 compliance areas and 1 of 11 compliance objectives. Campus B demonstrated significantly higher levels of compliance relative to campus A and/or campus C in 5 of 5 compliance areas and 7 of 11 compliance objectives. Across-campus comparisons indicated that the compliance area Review (Non-Medicare) Treatment Plan [F(2,18) = 17.537, p < .001] and compliance objective Treatment Plan Goals [F(2,26) = 5.653, p < .001] exhibited the highest practical importance for clinical compliance practice. Conclusions Feedback of performance improved compliance to indicators of quality health record documentation, especially when baseline adherence is relatively low. Required educational consultations with clinicians combined with audit–feedback were no more effective at increasing compliance to indicators of quality health record documentation than audit–feedback alone.



1998 ◽  
Vol 56 (5) ◽  
pp. 288-292 ◽  
Author(s):  
Sari E. Helminen, Miira Vehkalahti,


2020 ◽  
Vol 5 (7) ◽  
pp. 790-794
Author(s):  
Folake Akinbohun ◽  
Ambrose Akinbohun ◽  
Omoniyi Akintunde Ojo ◽  
Babalola Daodu

A Web Based Interactive Health Record System (WIHRS) is a digital web-based record of patients presenting in a hospital. The information so generated on patients can then be accessed by medical personnel to provide treatment for them in any health care delivery setting at any location.  Analogue ways of record keeping were the traditional way of documenting patients’ information by health information officers. The problems of unavailability of a centralized database system and inability to access patients records and provide prompt treatment to patients at any healthcare centre could be solved by WIHRS. The objective of the paper is to design a WIHRS. The methods included cloud computing model, service model, deployment model and cloud hosting. The web technologies languages such as Hypertext Pre-processor (PHP), Hypertext Mark-up Language (HTML), Cascading Style Sheet (CSS) and Ajax were deployed to implement the proposed system. The use of WIHRS improves the standard of healthcare to patients with optimal efficiency.



Author(s):  
Umme Afifa Jinan ◽  
Sultana Jahan Soheli

Now-a-days cloud computing is a prominent way of providing resources and services in very secure manner. Gradually more and more organizations, companies and industries are picking up cloud technology for the safe keeping of their data. The objective of this work is to apply cloud service in healthcare system by building a practical patient health record (PHR) application and deploying it in the cloud. The system is ‘doctor-centric’ health record portal where only the doctor or hospital authority is responsible for securing their patients’ health data and this labor-free, paperless system is giving relief to the doctors and hospital authorities from various error-prone traditional health record keeping systems. Jelastic cloud is used to provide cloud service to the developed application which provides security, scalability, quality of service and ease of maintenance of the application. Jelastic cloud also provides load balancing whenever the user load is high. We are developing an interactive PHR application which is dynamically storing, creating, modifying and maintaining data and deploying it in the Jelastic CloudJiffy server by the use of InMotion Hosting server. CloudJiffy is India based fully redundant, high performance and scalable cloud “Platform-as-a-Service (PaaS)” under Jelastic Cloud Union. The whole system will be an efficient way for safe keeping Patients’ health records, their medical history and sensitive health information in a pervasive, confidential manner. The system is highly compatible for preserving medical records of eminent persons of our society and for those whose health information must be kept confidential in a highly secure way.



1975 ◽  
Vol 39 (9) ◽  
pp. 613-616 ◽  
Author(s):  
EG Barron ◽  
RR Waller
Keyword(s):  


2011 ◽  
Vol 21 (1) ◽  
pp. 18-22
Author(s):  
Rosemary Griffin

National legislation is in place to facilitate reform of the United States health care industry. The Health Care Information Technology and Clinical Health Act (HITECH) offers financial incentives to hospitals, physicians, and individual providers to establish an electronic health record that ultimately will link with the health information technology of other health care systems and providers. The information collected will facilitate patient safety, promote best practice, and track health trends such as smoking and childhood obesity.





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