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.

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.

SP8.1.4 Design features of the EPR-integrated Southampton Breast Cancer Data System (SBCDS), with timeline structured whole-of-life records on 20,000 sequential cases since the 1970s

Introduction The digitisation of the electronic patient record (EPR) provides transformative opportunities for data visualisation. The synchronised timeline and iconographic interface permits the whole-of-life display, navigation and interpretation of all documents and reports of each and every EPR on a single screen, thus substantially facilitating clinical research. Methods Since 2010, we have conceived, programmed and iterated a radical interface, UHS Lifelines, within our Trust EPR using agile methodology. It is live for >2.5M record sets, and enriched with cellular pathology records back to 1990. We have integrated this interface into a unique, HTML-enabled, dynamic and continually updated database for the recording of treatments and pathologies of all cases of breast neoplasia from our current and historic record sets. Results As of January 2021, our data system contains ∼20,000 sequential whole of life records of patients with breast neoplasia, including ∼15,000 locally diagnosed and ∼ 5,000 externally referred cases. The unique Cancer Lifetrack timelines displays the disease course of every case from primary diagnosis, through loco-regional recurrence, to distant metastasis, other morbid cancers and cause of death, where relevant. An integral data mining system permits a wide range of analyses. Conclusions We believe our Breast Cancer Data System to be the first-in-class exemplar of a new and proven approach to clinical data visualisation. It permits near-instantaneous oversight and real time updating of every patient record in the system. We recognise its potential application for the whole-of-life study of all chronic diseases of childhood and adulthood as the model is more widely adopted.

Increase in the Use of Virtual Care Technologies in Nursing Care in 2020: What are the Main Drivers? (Preprint)

BACKGROUND Canadian nurses are at the forefront of patient care delivery. While the Canadian health care system is embracing digital health, nurses are bound to integrate virtual care into practice. In early 2020, more Canadian nurses delivered care virtually than three years before. OBJECTIVE This study sought to uncover the professional and care setting related characteristics of the nurses who delivered care virtually in 2020 and to investigate the factors driving the uptake of virtual care by nurses prior to the pandemic of COVID-19. METHODS We utilized data from the 2017 and 2020 National survey of Canadian nurses. This survey collected data on the use of digital health technologies in nursing practice. It concerned regulated nursing professionals working in different health care settings and from different domains of nursing practice. We combined Chi-square independence test and logistic regression analysis to uncover the main drivers of virtual care uptake by nurses in 2020. RESULTS In early 2020, prior to the pandemic of COVID-19, nurses who delivered care virtually were predominantly nurse practitioners (85%), more likely to work in a primary or community care setting (62%), or in an urban setting (62%). Factors like nursing designation (P < .01), perceived quality of care at the health facility where the nurses practiced (P < .01), and the type of patient record keeping system they had access to (P < .05) had a statistically significant effect on the probability for nurses to deliver care virtually in early 2020. Furthermore, nurses’ perception of the quality of care they delivered through virtual technologies was statistically associated with their perception of the skills (Chi-square=308.66, P < .01) and knowledge (Chi-square=283.39, P < .01) to use these technologies. CONCLUSIONS The study revealed some disparities in the uptake of virtual care by nurses across geographic regions. From an allocation standpoint, this finding should help decision-makers to pinpoint gaps in digital health utilization. Similarly, discrepancies in the use of virtual health across nursing designation have some implications for leadership at the care settings and for nurse educators in terms of competences and training for nurses at all levels of practice. Moreover, care settings are strongly encouraged to modernize their patient record keeping system as access to EMRs tended to influence the adoption of virtual care, which could foster interoperability. Finally, policy-related factors should not be overlooked when it comes to virtual care technologies integration in nursing practice.