Special Issue "Electronic Patient Files"

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A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 30 April 2014

Special Issue Editors

Guest Editor
Prof. Dr. Galina Velikova
Psychosocial and Medical Oncology, University of Leeds, Cancer Research UK Centre and St. James’s Institute of Oncology, Leeds Teaching Hospitals, Leeds, UK
Website: http://www.pogweb.org/index.php/team/lead/galina-velikova/
E-Mail: g.velikova@leeds.ac.uk

Guest Editor
Prof. Dr. Jeremy Wyatt
Yorkshire Centre for Health Informatics, University of Leeds, 2.13 Charles Thackrah, Leeds, UK
Website: http://www.leeds.ac.uk/lihs/people/j-wyatt.html
E-Mail: j.c.wyatt@leeds.ac.uk

Special Issue Information

Dear Colleagues,

Medical Informatics is one of the fast growing areas of information and communication technology. The traditional method of having detailed paper records for patients treated in the hospital and community is increasingly and successfully being replaced by electronic patient files. Various terms are used to refer to those automated health information systems such as Electronic Patient Records, Electronic Medical Records and Electronic Health Records.

Many benefits have been listed for the utilisation of electronic records. The main one the easy and timely access to accurate patient health information. Electronic patient records allow providers, patients and commissioners to interact more efficiently, in real time and can improve patient safety through access to accurate information on previous treatments and medical history. Once a robust system for electronic patient records is set up, it can have many other benefits such as monitoring performance of organisations, using the system for remote health monitoring, appropriate analysis of the large routine datasets allowing progress in medical research and post marketing monitoring of treatments. Electronic patient records can support emergency services, computer-aided clinical decision making, enhance research capacity and support hospital management.

Simultaneously health care information systems raise new challenges such as protection of personal data, regulation of access to electronic health records, ethical and clinical governance issues. Patient confidentiality is of paramount importance and there is an ongoing debate about best ways of obtaining patient consent.

This special issue aims to look at benefits and challenges of implementation of Electronic Patient Records and invites a wide range of papers describing the systems. We particularly welcome studies evaluating those systems. We would like to present the views of patients, health care providers, commercial and government organisations.

Prof. Dr. Galina Velikova
Prof. Dr. Jeremy Wyatt
Guest Editors

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed Open Access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. For the first couple of issues the Article Processing Charge (APC) will be waived for well-prepared manuscripts. English correction and/or formatting fees of 250 CHF (Swiss Francs) will be charged in certain cases for those articles accepted for publication that require extensive additional formatting and/or English corrections.

Keywords

  • electronic health records
  • electronic patient records
  • electronic medical records
  • medical informatics
  • patient information
  • health information systems

Published Papers

No papers have been published in this special issue yet, see below for planned papers.

Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Type of Paper: Article
Title: Speed of Adoption of EHR Documentation by Admitting Physicians
Authors: John S. Hudson *, James A. Neff, Qi Zhang, Larry T. Mercer, Miguel Padilla
Affiliation: Old Dominion University, Norfolk, Virginia, USA; E-Mail: jshudson@odu.edu
Abstract: Although hospital electronic health records (EHRs) are generally perceived to improve care, physician resistance may hinder EHR adoption. This study used constructs from diffusion of innovations and resource dependence theories to predict adoption and rate of adoption of a HIMSS Stage 7 EHR by admitting physicians from three of ten hospitals in a highly integrated health system in the United States. Functions evaluated included: computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS). The study tested hypotheses that speed of adoption would be associated with: working at larger, academic hospitals; financial alignment; larger physician groups; office EHR; youth; males; medical specialty; high volume; hospital-based; high inpatient ratio; and high loyalty. Administrative data collected for 326 physicians admitting at least ten patients during the six months following EHR activation represented over 80% of the total admissions. Cox Regression was used to evaluate how well variables predicted speed of adoption (adoption was defined as 80% utilization or greater). The Cox Regression model predicted significant proportions of variation in rate of adoption of CPOE (10%), EH&P (14%) and EDS (19%). The overall model for CPOE was significant (p=.006) but no individual predictors were significant. EH&P and EDS documentation functions, however, were more likely to be adopted faster by physicians with higher financial alignment or working at the large, academic hospital. We concluded personal factors such as loyalty, age and gender were generally not predictive. Organizational factors such as hospital setting and financial alignment were most predictive of adoption. Study results suggest strong financial alignment may improve the speed of EHR adoption by admitting physicians.

Type of Paper: Article
Title: Consent-Based Workflow Control in EMRs
Authors: B. Yu, D. Wijesekera
Affiliation: George Mason University, Department of Computer Science, 4400 University Dr., Fairfax VA 22030, USA, E-Mail: {byu3, dwijesek}@gmu.edu
Abstract: Receiving a medical treatment, choosing an alternative treatment, and terminating a treatment require the explicit or derived informed-consent of a patient. Electronic Medical Records (EMRs) have been widely adopted by the U.S. healthcare industry. However, consents are still primarily in the form of paper or scanned electronic documents. In order to integrate consent into an EMR system, there are challenges on how to implement consent management into EMR systems. We address these challenges by using a workflow-based EMR system, which directly enforce predefined and prebuilt medical procedures. We then add consent management to such an EMR system. We show how consents can be electronically obtained and enforced using such combined system. We then describe how to build a Consent-Based Workflow Control EMR system using open-source software.

Type of Paper: Article
Title: Improving Patient Safety: A Framework to Assess Patient Reported Adverse Events
Authors: Maria Jose Santana, Basia Okoniewska; E-Mails: mjsantan@ucalgary.ca; bmokonie@gmail.com
Affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
Abstract: Introduction: Electronic transfer-of-care (TOC) communication tools have the potential to avert communication problems at the time of discharge from hospital. They may be helpful in preventing or ameliorating adverse events (defined as poor outcomes caused by medical care). To test the effectiveness of a TOC communication tool, it is necessary to identify and describe patient reported adverse outcomes that occur following discharge. Objective: We developed a conceptual framework to assess patient reported adverse outcomes (PRAO) following hospital discharge. Methods: The PRAO framework builds on a validated adverse event ascertainment method and includes three phases: Phase 1 includes ascertainment of patient-reported adverse outcomes. It is completed by a semi-structured telephone interview 30 days after discharge that captures information on patient reported symptoms that are developing or worsening. Phase 2 involves classification of PRAOs as adverse events or underlying disease. It is performed by physicians who rate PRAO information using validated scales. If the physician rates the cause of PRAO as “medical care”, then the PRAO is classified an adverse event. Phase 3 involves the same physician classifying all adverse events as to their preventability and ameliorability, again using validated scales. Conclusion: This framework may help to standardize captured information on PRAOs. This will enable clinicians, researchers and health care institutions to compare outcome rates between providers and over time.

Type of Paper: Article
Title:
Consent-Based Workflow Control in EMRs
Authors:
B. Yu, D. Wijesekera
Affiliation
: George Mason University, Department of Computer Science, 4400 University Dr., Fairfax VA 22030, USA, E-Mail: {byu3, dwijesek}@gmu.edu
Abstract:
Receiving a medical treatment, choosing an alternative treatment, and terminating a treatment require the explicit or derived informed-consent of a patient. Electronic Medical Records (EMRs) have been widely adopted by the U.S. healthcare industry. However, consents are still primarily in the form of paper or scanned electronic documents. In order to integrate consent into an EMR system, there are challenges on how to implement consent management into EMR systems. We address these challenges by using a workflow-based EMR system, which directly enforce predefined and prebuilt medical procedures. We then add consent management to such an EMR system. We show how consents can be electronically obtained and enforced using such combined system. We then describe how to build a Consent-Based Workflow Control EMR system using open-source software.

Type of Paper: Article
Title:
Improving Patient Safety: A Framework to Assess Patient Reported Adverse Events
Authors:
Maria Jose Santana, Basia Okoniewska; E-Mails: mjsantan@ucalgary.ca; bmokonie@gmail.com
Affiliation:
Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
Abstract:
Introduction: Electronic transfer-of-care (TOC) communication tools have the potential to avert communication problems at the time of discharge from hospital. They may be helpful in preventing or ameliorating adverse events (defined as poor outcomes caused by medical care). To test the effectiveness of a TOC communication tool, it is necessary to identify and describe patient reported adverse outcomes that occur following discharge. Objective: We developed a conceptual framework to assess patient reported adverse outcomes (PRAO) following hospital discharge. Methods: The PRAO framework builds on a validated adverse event ascertainment method and includes three phases: Phase 1 includes ascertainment of patient-reported adverse outcomes. It is completed by a semi-structured telephone interview 30 days after discharge that captures information on patient reported symptoms that are developing or worsening. Phase 2 involves classification of PRAOs as adverse events or underlying disease. It is performed by physicians who rate PRAO information using validated scales. If the physician rates the cause of PRAO as “medical care”, then the PRAO is classified an adverse event. Phase 3 involves the same physician classifying all adverse events as to their preventability and ameliorability, again using validated scales. Conclusion: This framework may help to standardize captured information on PRAOs. This will enable clinicians, researchers and health care institutions to compare outcome rates between providers and over time.

Type of Paper: Article
Title:
Speed of Adoption of EHR Documentation by Admitting Physicians
Authors:
John S. Hudson *, James A. Neff, Qi Zhang, Larry T. Mercer, Miguel Padilla
Affiliation:
Old Dominion University, Norfolk, Virginia, USA; E-Mail: jshudson@odu.edu
Abstract:
Although hospital electronic health records (EHRs) are generally perceived to improve care, physician resistance may hinder EHR adoption. This study used constructs from diffusion of innovations and resource dependence theories to predict adoption and rate of adoption of a HIMSS Stage 7 EHR by admitting physicians from three of ten hospitals in a highly integrated health system in the United States. Functions evaluated included: computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS). The study tested hypotheses that speed of adoption would be associated with: working at larger, academic hospitals; financial alignment; larger physician groups; office EHR; youth; males; medical specialty; high volume; hospital-based; high inpatient ratio; and high loyalty. Administrative data collected for 326 physicians admitting at least ten patients during the six months following EHR activation represented over 80% of the total admissions. Cox Regression was used to evaluate how well variables predicted speed of adoption (adoption was defined as 80% utilization or greater). The Cox Regression model predicted significant proportions of variation in rate of adoption of CPOE (10%), EH&P (14%) and EDS (19%). The overall model for CPOE was significant (p=.006) but no individual predictors were significant. EH&P and EDS documentation functions, however, were more likely to be adopted faster by physicians with higher financial alignment or working at the large, academic hospital. We concluded personal factors such as loyalty, age and gender were generally not predictive. Organizational factors such as hospital setting and financial alignment were most predictive of adoption. Study results suggest strong financial alignment may improve the speed of EHR adoption by admitting physicians.

Type of Paper: Article
Title:
Opportunity for the Use of Mobile Devices and Software Applications by Nurses in Acute Care Hospital Settings
Authors:
T. Kelley 1; W. E. Hammond 2
Affiliation:
1. Adjunct Faculty, Northeastern University, Bouve College of Health Sciences; 2. Director, Duke Center for Health Informatics, Duke University, Durham, NC, USA
Abstract:
Approximately 89 % of worldwide consumers with a smartphone use their mobile device on a daily basis. The devices support mobile applications that are used by consumers to more efficiently manage their daily activities on-the-go.  Nurses working in hospital settings are also on-the-go while providing direct care. Nurses on acute care units manage multiple patients during a single workday. The physical location of the patients, nursing station, medication room and patient records requires nurses to be mobile to complete their work activities and exchange information needed for care. Rarely are nurses able to be stationary for longer than a few minutes at a time. While the use of mobile devices and applications is supported by thought leaders, the actual use of mobile devices in practice settings has been limited to date. This manuscript provides five use cases that demonstrate the opportunities where mobile devices and software applications may provide nurses with more efficient information about their patients. The article is based on primary research data obtained through observations and interviews of nurses working on acute care inpatient units in hospital settings. As the field of mobile technology expands, health care leadership and software vendors could benefit from partnering together to form mobile software applications that support nurses to more efficiently and safely exchange information needed for care to ensure timeliness in the delivery of care.

Last update: 29 October 2013

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