Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

Toward a framework for data quality in cloud-based health information system

This Cloud computing is a promising platform for health information systems in order to reduce costs and improve accessibility. Cloud computing represents a shift away from computing being purchased as a product to be a service delivered over the Internet to customers. Cloud computing paradigm is becoming one of the popular IT infrastructures for facilitating Electronic Health Record (EHR) integration and sharing. EHR is defined as a repository of patient data in digital form. This record is stored and exchanged securely and accessible by different levels of authorized users. Its key purpose is to support the continuity of care, and allow the exchange and integration of medical information for a patient. However, this would not be achieved without ensuring the quality of data populated in the healthcare clouds as the data quality can have a great impact on the overall effectiveness of any system. The assurance of the quality of data used in healthcare systems is a pressing need to help the continuity and quality of care. Identification of data quality dimensions in healthcare clouds is a challenging issue as data quality of cloud-based health information systems arise some issues such as the appropriateness of use, and provenance. Some research proposed frameworks of the data quality dimensions without taking into consideration the nature of cloud-based healthcare systems. In this paper, we proposed an initial framework that fits the data quality attributes. This framework reflects the main elements of the cloud-based healthcare systems and the functionality of EHR

Knowledge management and organizational culture

This paper explores the relationship between organisational knowledge, organisational culture, and Process Based Systems (PBS), in the U.K. National Health Service (NHS). Links between PBS and organisational culture have been observed before(Perry, 2003); the contribution made by PBS to organisational knowledge has also been suggested (Perry, 2004). However, links between organisational knowledge and organisational culture in the NHS have not been widely studied. A qualitative study of these links across clinical functions has been used in conjunction with a literature review to consider in particular the use of tacit knowledge and the role that might be played by PBS in mediating and sharing this "embedded" or experiential form of knowledge. While there may be some opportunity for "externalisation" (Nonaka, 1994) - the conversion of tacit to explicit knowledge, this paper argues that PBS may also contribute to "socialisation" - the direct generation of tacit knowledge by tacit knowledge.Process Based Systems, knowledge management, organisational culture

Context-Based Access for Infrequent Requests in Tanzania\u27s Health Care System

Access control is an important aspect of any information system. It is a way of ensuring that users can only access what they are authorised to and no more. This can be achieved by granting users access to resources based on pre-defined organisational and legislative rules. Although access control has been extensively studied, and as a result, a wide range of access control models, mechanisms and systems have been proposed, specific access control requirements for healthcare systems that needs to support the continuity of care in an accountable manner have not been addressed. This results in a gap between what is required by the application domain and what is actually practised, and thus access control solutions implemented for the domain become too restrictive. The continuity of care is defined as the delivery of seamless health care services to patients through integration, coordination and sharing of information between providers. This thesis, therefore, designs a context-based access control model that allows healthcare professionals to bypass access rules in an accountable manner in case of an infrequent access request involving an emergency situation. This research uses the Tanzania\u27s healthcare system as a case study domain

Big Data Privacy Context: Literature Effects On Secure Informational Assets

This article's objective is the identification of research opportunities in the current big data privacy domain, evaluating literature effects on secure informational assets. Until now, no study has analyzed such relation. Its results can foster science, technologies and businesses. To achieve these objectives, a big data privacy Systematic Literature Review (SLR) is performed on the main scientific peer reviewed journals in Scopus database. Bibliometrics and text mining analysis complement the SLR. This study provides support to big data privacy researchers on: most and least researched themes, research novelty, most cited works and authors, themes evolution through time and many others. In addition, TOPSIS and VIKOR ranks were developed to evaluate literature effects versus informational assets indicators. Secure Internet Servers (SIS) was chosen as decision criteria. Results show that big data privacy literature is strongly focused on computational aspects. However, individuals, societies, organizations and governments face a technological change that has just started to be investigated, with growing concerns on law and regulation aspects. TOPSIS and VIKOR Ranks differed in several positions and the only consistent country between literature and SIS adoption is the United States. Countries in the lowest ranking positions represent future research opportunities.Comment: 21 pages, 9 figure