Analyzing Health Information Technology and Electronic Medical Record System-Related Patient Safety Incidents Using Data from the Korea Patient Safety Reporting and Learning System

Purpose: At present, there are a variety of serious patient safety incidents related to problems in health information technology (HIT), specifically involving electronic medical records (EMRs). This emphasizes the need for an enhanced electronic medical record system (EMRS). As such, this study analyzed both the nature of and potential to prevent incidents associated with HIT/EMRS based on data from the Korea Patient Safety Reporting and Learning System (KOPS).Methods: This study analyzed patient safety incidents submitted to KOPS between August 2016 and December 2019. HIT keywords were used to extract HIT/EMRS incidents. Each case was reviewed to confirm whether the contributing factors were related to HIT/EMRS (HIT/EMRS-related incidents) and if the incident could have been prevented (HIT/EMRS-preventable incidents). The selected reports were summarized for general clarity (e.g., incident type, and degree of harm).Results: Of the 25,515 obtained reports, 2,664 incidents (10.4%) were HIT-related, while 2,525 (9.9%) were EMRS-related. HIT/EMRS-related incidents were the third largest type of incident followed by 'fall' and 'medication incidents.' More than 80% of HIT/EMRS-related incidents were medication-related, accounting for approximately one-third of the total number of medication incidents. Approximately 10% of HIT/EMRS-related incidents resulted in patient harm, with more than 94% of these deemed as preventable; further, sentinel events were wholly preventable.Conclusion: This study provides basic data for improving EMR use/safety standards based on real-world patient safety incidents. Such improvements entail the establishment of long-term plans, research, and incident analysis, thus ensuring a safe healthcare environment for patients and healthcare providers.

Facilitators and Barriers to the Adoption of an Electronic Medical Record System by Intensive Care Nurses

Introducing new technology, such as an electronic medical record (EMR) into an Intensive Care Unit (ICU), can contribute to nurses’ stress and negative consequences for patient safety. The aim of this study was to explore ICU nurses’ perceptions of factors expected to influence their adoption of an EMR in their workplace. The objectives were to: 1) measure psychological factors expected to influence ICU nurses’ adoption of EMR, and 2) explore perceptions of facilitators and barriers to the implementation of an EMR in their workplace. Using an explanatory sequential mixed method approach, data were collected using surveys and focus groups. ICU nurses reported high scores for motivation, work engagement and wellbeing. Focus group analyses revealed two themes: Hope the EMR will bring a new world and Fear of unintended consequences. Recommendations relate to strategies for education and training, environmental restructuring and enablement. Overall, ICU nurses were optimistic about EMR implementation.

Development of Nursing Workflows and Device Requirement Principles with the Implementation of an Electronic Medical Record System

The past decade has seen the implementation of electronic medical record (EMR) systems being implemented across large-scale healthcare organisations throughout Australia. A first-time implementation of an organisational-wide EMR system required a multi-modal approach to the development of new nursing workflows and appropriate selection of hardware devices to ensure acceptance and adoption of the EMR. The aim of this work was to develop new nursing workflows and associated device requirement principles to allow for continuation of safe, high quality nursing care with an EMR implementation. The incorporation of multi-disciplinary consultations, an audit, observational study and clinical and governance stakeholder engagement was used to develop device requirement principles. This ensured development of standardised nursing workflows were successfully adopted throughout the organisation with the EMR implementation.

Authorized Shared Electronic Medical Record System with Proxy Re-Encryption and Blockchain Technology

With the popularity of the internet 5G network, the network constructions of hospitals have also rapidly developed. Operations management in the healthcare system is becoming paperless, for example, via a shared electronic medical record (EMR) system. A shared electronic medical record system plays an important role in reducing diagnosis costs and improving diagnostic accuracy. In the traditional electronic medical record system, centralized database storage is typically used. Once there is a problem with the data storage, it could cause data privacy disclosure and security risks. Blockchain is tamper-proof and data traceable. It can ensure the security and correctness of data. Proxy re-encryption technology can ensure the safe sharing and transmission of relatively sensitive data. Based on the above situation, we propose an electronic medical record system based on consortium blockchain and proxy re-encryption to solve the problem of EMR security sharing. Electronic equipment in this process is connected to the blockchain network, and the security of data access is ensured through the automatic execution of blockchain chaincodes; the attribute-based access control method ensures fine-grained access to the data and improves the system security. Compared with the existing electronic medical records based on cloud storage, the system not only realizes the sharing of electronic medical records, but it also has advantages in privacy protection, access control, data security, etc.

Analysis of Related Factors of Depression and Malnutrition in Elderly Hospitalized Patients v1

SUMMARY: BACKGROUND: Depression and malnutrition are very common among elderly hospitalized patients and may lead to undesirable consequences. OBJECTIVE: To explore the correlation between depression and malnutrition through statistical methods to provide a theoretical basis for preventing the occurrence of depression and malnutrition in elderly hospitalized patients so as to improve their quality of life. METHODS: This is a retrospective analysis of 179 elderly inpatients in the Cadre Ward Unit of the First Hospital of Jilin University. Relevant data of the participants required for the study were obtained from the electronic medical record system and comprehensive geriatric assessment (CGA) database of the First Hospital of Jilin University. The correlation between depression and malnutrition was determined using logistic regression analysis. RESULTS: The percentage of included elderly inpatients without depression was 64.8%（median age=78.4 ± 10.3 years）, while the percentage of patients with depression was 35.2%（median age of 81.8 ± 8.4 years） . The prevalence of depression among the participants in the study was 35.2%, and the highest prevalence of depression combined with malnutrition was 58.9%, followed by 42.4% prevalence of depression combined with risk of malnutrition. After controlling for other relevant factors, the Mini Nutritional Assessment(MNA)(P=0.008,OR=0.821), albumin (P=0.005,OR=0.834) and calf circumference (P=0.004,OR=0.790) were independently associated with depression. CONCLUSION: There is a correlation between depression and malnutrition, and MNA, albumin and calf circumference are independent protective factors for depression, respectively. KEYWORDS:depression;malnutrition;elderly

Clinical Predictors of Wheezing Among Children Infected With Mycoplasma Pneumoniae

Background:Mycoplasma pneumoniae (MP) not only was a common pathogen of respiratory tract infections, but also could trigger the exacerbation of asthmatic symptoms in children with or without asthma.Objective: This study aimed to identify possible risk factors associated with wheezing among children diagnosed with MP infection.Methods: A retrospective analysis of medical records of children aged 28 days to 18 years old who visited the Shanghai Children's Hospital between January 2019 and January 2020 was carried out, and all children were then classified into three groups: two wheezing groups (with or without MP infection) and a non-wheezing group with MP infection. Information including patient's demographics, clinical features, laboratory data, and radiography findings was extracted from the electronic medical record system. Chest radiographs were reviewed independently by two board-certified, blinded pediatric radiologists.Results: A total of 1,512 patients were included in our study, and 21.9% of them belonged to the wheezing group without MP infection. Among 1,181 patients with MP infection, 295 people (25.0%) suffered from wheezing, and males accounted for 61%. Through the multivariable logistic regression analyses, we found that six variables were positively associated with wheezing attacks in children with MP infection: male gender (likelihood ratio [LR] = 2.124, 95% confidence interval [CI]: 1.478–3.053), history of allergy (LR= 3.301, 95% CI: 2.206–4.941), history of wheezing (LR = 7.808, 95% CI: 5.276–11.557), autumn in reference to summer (LR = 2.414, 95% CI: 1.500–3.885), non-end-point infiltration in reference to consolidation or pleural effusion (LR = 1.982, 95% CI: 1.348–2.914), and infiltration scope (LR = 1.773, 95% CI: 1.293–2.432). However, the model showed that the probability of wheezing after MP infection decreased as age increased (LR = 0.257, 95% CI: 0.196–0.337). Moreover, the area under the curve (AUC) of the regression model was as high as 0.901 (0.847–0.955).Conclusion: The model integrated with factors including gender, age, season, radiological patterns, infiltration scope, and history of allergy performed well in predicting wheezing attack after MP infection in children.