DAMPAK PERKEMBANGAN SISTEM INFORMASI DAN MANAJEMEN TERHADAP KESELAMATAN PASIEN

Salah satu penyempurnaan kerangka administrasi adalah pemanfaat Rekam Medis Elektronik (EMR). EMR adalah catatan klinis kebutuhan hidup pasien dalam konfigurasi elektronik, dan dapat diperoleh melalu PC dari rumah sakit dengan tujuan prinsip memberikan atau meningkatkan perawatan dan administarsi medis secara efektif dan terkoordinasi. Pengaruh penggunaan EMR pada keamanan persisten dan sifat administrasi keperawatan mendukung perawat medit untuk asosiasi yang bekerja secara efektif. Pekerjaan perawat medis ternyata lebih ideal sebagai kewajiban petugas mengharapkan, mengontrol dan menengahi yang menjamin keamaan pasien. EMR dapat dengan cepat memberi tahu ketepatan dan pengakuan terkait kesalahan dalam aktivitas layanan medis, yang memiliki jumlah kapasitas lebih besar daripada Electronic Patient Record (EPR).

Improving recording and reporting of dementia and frailty via electronic patient record by ambulance staff in a single service (IDEAS)

Background: Dementia is common in older adults assessed by ambulance services. However, inconsistent reporting via the patient record may result in this diagnosis being overlooked by healthcare staff further down the care pathway. This can have a deleterious effect on subsequent patient care, increasing morbidity and mortality. We sought to understand how and where ambulance staff would like to record this finding on the electronic patient record (ePR).Methods: We designed and implemented a survey of ambulance staff in a single service to understand how they identify patients with dementia, how they record dementia on the ePR and how the ePR could be improved to better capture dementia. Scoping questions on frailty were included. The survey was tested using cognitive interviewing. Analysis was conducted using descriptive statistics for closed questions and thematic analysis for open questions as appropriate.Results: 131 surveys were completed; 60% of participants were paramedics and 40% were other grades of front line staff. Participants reported consulting electronic/paper sources, and individuals such as carers involved in the patients’ care, to establish whether dementia had been diagnosed. Frailty assessments were prompted by social context, reduced mobility, a fall or diagnosis of dementia. Staff reported documenting dementia in 20 different areas on the ePR and 46% of participants stated a preference for a designated area to record the information. However, 15% indicated it was not necessary to record dementia or that no ePR changes were required.Conclusions: We have highlighted the variation in ambulance staff practice in recording of dementia. Alterations to the ePR are required to ensure that dementia is recorded consistently and is easily retrievable. Clearer guidance on when to assess frailty may also enhance information provision to care staff in other sectors, resulting in more appropriate clinical and social care.

A User-Centered, Integrated Model to Improve Medication Prescription, Administration and Adherence in Switzerland

Medication adherence remains an obstacle for the ideal medical care. Communication issues arise between care-providers, and the patient is left to deal with potentially conflicting information. The new electronic patient record (EPR) that will soon be implemented nationally opens new perspectives to improve patient medication management. In this context, we propose an integrated model that could help further empower the patient with better communication about medications and considerations for reconciliation processes. We discuss important considerations for our proposed solution.

Implementation of a client-accessible and multidisciplinary youth health record in the Netherlands; a mixed-methods process evaluation

Background: Client-accessible patient records potentially contribute to patient-centered care by facilitating shared decision-making, enhancing interdisciplinary collaboration, and promoting patient’s autonomy. To achieve this, three Dutch organizations providing ‘care for youth’ developed an electronic patient record (EPR-Youth). EPR-Youth supports working processes of all three organizations and is fully accessible for adolescents and for parents of children aged 0-16 years. Co-creation was chosen as implementation approach for this e-Health intervention that not only intervenes with technology (hardware) but also transforms working processes (orgware) and professional behavior (software). Objective: to investigate the implementation process of EPR-Youth and to determine barriers and facilitators.Methods: a mixed methods design was used. To guide the process evaluation, Pfadenhauers’ Context and Implementation of Complex Interventions framework and Proctor’s theoretic framework on implementation were used to define implementation outcomes and describe setting and context. Target groups were parents, adolescents, professionals using EPR-Youth, and all stakeholders in the implementation process.Results: Barriers in the implementation process of EPR-Youth were the complexity of collaboration between stakeholders and the lack of clarity about leadership and project planning. Facilitating factors were clarifying the vision, setting deadlines, and a pioneering spirit.Acceptability of the client-portal was high among all users. Adoption of the client-portal was highest among parents of children aged 0-3 years and among higher educated parents.Professionals’ doubts about user-friendliness and about the match with vision and working processes were partly due to lack of knowledge of all system functionalities. Conclusion: The implementation of EPR-Youth, the first Dutch electronic patient record facilitating both preventive child health and youth care, was successful on ‘hardware’ level. To complete implementation on ‘software’ and ‘orgware’ level, client information needs attention, as well as training of professionals. Further research is needed to gain insight into barriers to access the client-portal. Although co-creation was an essential ingredient to reach project goals, situational leadership with more direction at the start and room for disruption is needed to guide this process.

SP10.2.12 Information Sustainability: The revitalisation and upcycling of 373,342 historic surgical pathology records into the contemporary electronic patient record in one UK NHS Hospital Trust

Aims Surgical and Cellular pathology (‘e-pathology’) record sets are a valuable data resource with which to populate the Electronic Patient Record (EPR). Accessible reports, even decades old, can be of great value in contemporary clinical decision making and as a resource for longitudinal clinical research. They commonly identify the operation, the location and the pathology, even if not to modern reporting standards. Methods Since 2010, we have built and implemented a timeline structured EPR for the ‘whole-of-life’ visualisation of the electronic documents (e-Docs) of 2.5M+ patients on our Master Index. Prior to this project, our earliest e-Docs dated to 1995. We tracked down 373,342 inert e-pathology reports from our legacy Ferranti (1990-1997) and Masterlab (1997-2004) systems. These were uploaded into our active file servers, following appropriate data quality and patient identity reconciliation checks. Results We have progressively restored 373,342 previously inaccessible e-pathology records to clinical use and to immediacy of access, and in the process extending our “addressable EPR” back to 1990 for living and deceased patients. This process has also allowed us to populate and validate an EPR-integral breast cancer data system of 20,000 cases with e-pathology records dating back to 1990. Conclusions The sustainable revitalisation of old e-pathology reports into a timeline structured EPR creates preserves and upcycles the investment in pathology reporting which is otherwise progressively lost to clinical use. E-pathology records provide reliable, life-long evidence of critical transition points in individual lives and disease progression for clinical and research use, when they can be instantly accessed.

Patients presenting with acute coronary syndromes have unreported coronary artery calcium on historical CT imaging

Introduction Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2. Incidental coronary calcification can be detected and quantified on non-gated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed. Purpose We sought to investigate whether patients presenting to our centre with an acute coronary syndrome (ACS) event had historical CT imaging demonstrating coronary artery calcification. Methods We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019–31/03/2019). The national imaging database was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported. Demographic information was collected from our electronic patient record including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record. Results 385 patients with first presentation of ACS were identified. 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months. CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (Table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (Figure 1). Patients with CAC frequently had additional risk factors for IHD. Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin. Conclusions A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events. FUNDunding Acknowledgement Type of funding sources: None. Table 1

Role of Individual Motivations and Privacy Concerns in the Adoption of German Electronic Patient Record Apps—A Mixed-Methods Study

Germany’s electronic patient record (“ePA”) launched in 2021 with several attempts and years of delay. The development of such a large-scale project is a complex task, and so is its adoption. Individual attitudes towards an electronic health record are crucial, as individuals can reject opting-in to it and making any national efforts unachievable. Although the integration of an electronic health record serves potential benefits, it also constitutes risks for an individual’s privacy. With a mixed-methods study design, this work provides evidence that different types of motivations and contextual privacy antecedents affect usage intentions towards the ePA. Most significantly, individual motivations stemming from feelings of volition or external mandates positively affect ePA adoption, although internal incentives are more powerful.

60 The Effect of the 2020 COVID-19 Pandemic on Periprosthetic Joint Infection in Hip Fracture Surgery

Aim To assess whether this change of practice had an effect on the infection rate in hip fracture surgery. Method An audit was conducted to assess the re-operation rate on hip fracture patients over the three months of the initial “lockdown” (23rd March to 23rd May 2020) and compared to the 2 months immediately before and the same period in 2019. Cases were identified from the Theatre ORACLE system (GE Healthcare). Anonymised patient data was collected from the Electronic Patient Record (EPR) and paper case notes. Results During the pandemic period, a total of 45 patients underwent surgery for hip fractures with a median age 84 years (range 28-95 years). These represent similar cohorts to the periods immediately before lockdown and the previous year. The infection rate increased from 0% in the 2019 period to 2.5% prior to lockdown and 11.1% after the lockdown measures were implemented. All infections were in patients who received hemiarthroplasty. The rate of total hip replacement went down from 19.1% in 2019 to 10.0% just before the pandemic and just 4.4% during the pandemic Conclusions There was a marked increase in the number of re-operations for infection in patients who received hemiarthroplasty for hip fractures during the lockdown period.