Implementation Assessment of Electronic Records Management System in Bayelsa State, Nigeria

The quality of information available to medical practitioners when delivering treatment to patients influences the outcome of service delivery. In the healthcare industry, health information technology has been shown to improve patient safety and treatment quality. The purpose of this research is to identify the facilitators and hurdles to the deployment of an electronic records management system at NDUTH, Okolobiri. For this study, a descriptive cross-sectional research design was used. The stratified random sample was taken from the 204 staff members that participated in the survey at NDUTH Okolobiri. Telephone interviews were also conducted with a small number of hospital staff who had deployed the electronic records system. According to the findings, the majority of participants (51.0%) were female, with an average age of 37(SD+9.0) years. The respondents’ overall understanding of electronic records management systems was 45.9%. The overall implementation rate was 22.8%. The study’s facilitators were leadership support along with the availability of ICT equipment, whereas the barriers were funding, a lack of power, insufficient ICT infrastructures, administrative challenges, poor staff compliance, a lack of government support, and poor maintenance of software and ICT equipment. The findings indicate that government and private enterprises should invest more in healthcare delivery via electronic records management systems. This is critical because the quality of information that medical practitioners have access to when caring for patients influences the effectiveness of health service delivery. It has also been discovered to ensure the proper operation of health institutions

Digital technologies and information translucence in healthcare management: An institutional theory perspective for adopting electronic incidence reporting systems

The purpose of this study was to provide an institutional theory perspective on the adoption of electronic IRS technology for healthcare management. This research employs institutional theory to investigate the adoption of electronic IRS for healthcare management. The study’s conceptual analysis demonstrates that coercive, normative, and imitative forces influence the adoption of electronic IRS for healthcare management. International healthcare regulations and standards reflect the presence of coercive forces. International healthcare societies and professional networks mirror normative forces. Imitative forces exert pressure on smaller enterprises and developing nations to adopt electronic IRS. This research contributes to the literature and theory by extending the application of institutional theory to the adoption of digital technologies such as the electronic IRS. In addition, the study has practical implications because it demonstrates the importance of digital technologies such as electronic IRS for information translucence and healthcare management. Small businesses in developing nations can learn from large businesses in developed nations to adopt electronic IRS for efficient and effective healthcare management

Understanding the Nature of Medication Errors in an ICU with a Computerized Physician Order Entry System

Objectives: We investigated incidence rates to understand the nature of medication errors potentially introduced by utilizing a computerized physician order entry (CPOE) system in the three clinical phases of the medication process: prescription, administration, and documentation. Methods: Overt observations and chart reviews were employed at two surgical intensive care units of a 950-bed tertiary teaching hospital. Ten categories of high-risk drugs prescribed over a four-month period were noted and reviewed. Error definition and classifications were adapted from previous studies for use in the present research. Incidences of medication errors in the three phases of the medication process were analyzed. In addition, nurses' responses to prescription errors were also assessed. Results: Of the 534 prescriptions issued, 286 (53.6%) included at least one error. The proportion of errors was 19.0% (58) of the 306 drug administrations, of which two-thirds were verbal orders classified as errors due to incorrectly entered prescriptions. Documentation errors occurred in 205 (82.7%) of 248 correctly performed administrations. When tracking incorrectly entered prescriptions, 93% of the errors were intercepted by nurses, but two-thirds of them were recorded as prescribed rather than administered. Conclusion: The number of errors occurring at each phase of the medication process was relatively high, despite long experience with a CPOE system. The main causes of administration errors and documentation errors were prescription errors and verbal order processes. To reduce these errors, hospital-level and unit-level efforts toward a better system are needed

Electronic Records Management System Adoption Readiness Framework for Higher Professional Education Institutions in Yemen

Electronic records (e-records) are used to provide proof of organizational activities. E-records are crucial in complementing business functions, essential tool to assess organizational performance and are the core of good governance. E-records in Higher Professional Education (HPE) institutions contain valuable information in running the education business in an efficient and effective manner, supplying services consistently and in supporting effective performance evaluation and decisions. There are serious consequences and risk awaiting when the administrators of HPE are not based on information contained in e-records in making decisions. Well-informed decision makings would thus be impossible if electronic records are not efficiently and effectively managed using system. Therefore, Electronic Records Management System (ERMS) is an effective and efficient tool to hinder such a problem. Voluminous electronic records are created every day in HPE. The record keepers inclusive of records managers, archivists, administrators and IT personnel, who are the people essentially involved in creating, maintaining and preserving the contents of the e-records.  Thus, these personnel participatinginthe records keeping should identify the readiness of the HPE institutions to adopt ERMS. Therefore, the aim of this paper is to investigate the readiness of the Yemeni HPE institutions to adopt the ERMS. The study involves interviewing 20 specialists from Yemeni HPE institutions who are involved in ERMS. The findings showed that in order to promote effective ERMS readiness in the HPE institutions, there should be a framework to be used as guidance in such process

Lessons From Healthcare Providers' Attitudes Toward Pay-for-performance: What Should Purchasers Consider in Designing and Implementing a Successful Program?

We conducted a systematic review to summarize providers' attitudes toward pay-for-performance (P4P), focusing on their general attitudes, the effects of P4P, their favorable design and implementation methods, and concerns. An electronic search was performed in PubMed and Scopus using selected keywords including P4P. Two reviewers screened target articles using titles and abstract review and then read the full version of the screened articles for the final selections. In addition, one reference of screened articles and one unpublished report were also included. Therefore, 14 articles were included in this study. Healthcare providers' attitudes on P4P were summarized in two ways. First, we gathered their general attitudes and opinions regarding the effects of P4P. Second, we rearranged their opinions regarding desirable P4P design and implementation methods, as well as their concerns. This study showed the possibility that some healthcare providers still have a low level of awareness about P4P and might prefer voluntary participation in P4P. In addition, they felt that adequate quality indicators and additional support for implementation of P4P would be needed. Most healthcare providers also had serious concerns that P4P would induce unintended consequences. In order to conduct successful implementation of P4P, purchaser should make more efforts such as increasing providers' level of awareness about P4P, providing technical and educational support, reducing their burden, developing a cooperative relationship with providers, developing more accurate quality measures, and minimizing the unintended consequences

Approach for Electronic Medical Record Data Analysis

As the healthcare environment is being digitalized and changed rapidly, research using medical big data is increasing. One of the most applicable data is electronic medical records which can provide a large amount of clinically practical meaning. Electronic medical data include patient's demographic information, laboratory test results, imaging and biosignal data. In this article, we provide support for a wide variety of researchers in their efforts to use electronic medical record data accurately and usefully in their work. From the basic concept of the research using electronic medical records to challenging aspects like data integration between multiple institutions are described. Also, examples of each type of data are covered; structured such as numeric data and unstructured such as images, biosignals and narrative text. Using these kinds of electronic medical records, analyses are processed by data cleansing, transforming, and reducing in order. Many kinds of variables such as the exposure and outcome of interest, covariate and the research design can be chosen during the preprocessing. As many machine-learning-based studies as well as epidemiologic-based studies have been conducted using electronic medical records, various research frameworks have been proposed. However, data quality management and data standardization for multi-center data analysis are still remaining as challenging tasks.ope

The Impacts of Role Overload and Role Conflict on Physicians\u27 Technology Adoption

Technology adoption is an important solution for physicians to increase work efficiency, and thus deal with role conflict among their multiple job roles. Prior studies have not investigated how multiple job roles and role conflict influence physicians’ technology adoption intentions. Based on role strain theory and role identity theory, we present a model of physicians’ technology adoption intentions to support their primary (clinical care) versus secondary (teaching or research) job roles. We test the model using surveys with 156 physicians at nine medical schools in Korea. The results of our data analysis largely support our hypotheses. Role overload in each of their job roles increases role conflict between any pair of associated roles. Furthermore, role conflict between a physician’s primary and secondary role is affected more by role overload in the secondary role than by overload in the primary role. Moreover, the impact of role conflict on technology adoption intentions is also influenced by the hierarchical relationship between two roles. This study contributes to technology adoption research by demonstrating how physicians’ job characteristics affect technology adoption

Contrast-Induced Nephropathy in Patients Undergoing Intravenous Contrast-Enhanced Computed Tomography in Korea: A Multi-Institutional Study in 101487 Patients

OBJECTIVE: To evaluate the prevalence of known risk factors for contrast-induced nephropathy (CIN) and their association with the actual occurrence of CIN in patients undergoing intravenous contrast-enhanced computed tomography (CECT) in Korea. MATERIALS AND METHODS: Patients who underwent CECT in 2008 were identified in the electronic medical records of 16 tertiary hospitals of Korea. Data on demographics, comorbidities, prescriptions and laboratory test results of patients were collected following a standard data extraction protocol. The baseline renal function was assessed using the estimated glomerular filtration rate (eGFR). We identified the prevalence of risk factors along the eGFR strata and evaluated their influence on the incidence of CIN, defined as a 0.5 mg/dL or 25% increase in serum creatinine after CECT. RESULTS: Of 432425 CECT examinations in 272136 patients, 140838 examinations in 101487 patients met the eligibility criteria for analysis. The mean age of the participants was 57.9 ± 15.5 years; 25.1% of the patients were older than 70 years. The prevalence of diabetes mellitus was 11.9%, of hypertension 13.7%, of gout 0.55% and of heart failure was 1.7%. Preventive measures were used in 40238 CECT examinations (28.6%). The prevalence of risk factors and use of preventive measures increased as the renal function became worse. A CIN was occurred after 3103 (2.2%) CECT examinations, revealing a significant association with decreased eGFR, diabetes mellitus, and congestive heart failure after adjustment. CONCLUSION: Risk factors for CIN are prevalent among the patients undergoing CECT. Preventive measures were seemingly underutilized and a system is needed to improve preventive care.ope

체계적 문헌고찰과 메타분석을 통한 전산처방자동화시스템과 관련된 처방오류 평가 연구

학위논문 (석사) -- 서울대학교 대학원 : 약학대학 약학과, 2020. 8. 김은경.Computerized Physician Order Entry (CPOE) systems and Clinical Decision Support Systems (CDSS) have been proven to contribute to improve patients safety and quality of care; however, the adoption of computerization introduced a new type of error, called system-related or technology-induced errors. A comprehensive evaluation regarding the prevalence of CPOE-related errors (CRE) is lacking. The aim of this study was to describe the prevalence of CRE evaluated by pharmacists and to evaluate the association between the introduction of CPOE and prescribing errors. A systematic review and meta-analysis were conducted of studies retrieved from the MEDLINE, Embase, Cochrane, and Scopus up to March 2020. All studies reporting the rate of prescribing errors related to CPOE were included. The prevalence of CRE among overall prescribing errors occurred in the hospitals was estimated using pooled prevalence estimate with a 95% confidence interval (CI) and relative risk (RR) was calculated for the subgroup analysis. A total of 14 studies were identified and included in the systematic review and meta-analysis. In the meta-analysis of 13 data of estimate, the overall pooled prevalence of CRE across studies were 32.36% (95% CI 22.87 – 42.62). Among the 6 types of error identified throughout the studies: omission, wrong drug, wrong dose, wrong route/form, wrong time, and monitoring error, the main type of error related to CPOE were wrong dose (47.28%, 95% CI 38.38-56.26), followed by wrong drug (14.45%, 95% CI 7.96-22.40). The subgroup analysis revealed that the risk of error was not significantly reduced with CPOE (RR 0.842, 95% CI 0.559 – 1.268), except omission which was significantly reduced after the implementation of CPOE (RR 0.484, 95% CI 0.282 – 0.831). Our study findings support that system-related errors were a major reason for CPOE not delivering a significant reduction in the overall rate of clinical errors. A considerable risk for prescribing errors still exists, which healthcare professionals should be aware that CPOE could also lead to a new type of medication errors. In order to reduce the prescribing error related to CPOE, the system should be continually examined and users should receive periodic and multidisciplinary training on the use of CPOE and CDSS.처방자동화시스템(Computerized Physician Order Entry, CPOE)과 임상의사결정지원시스템(Clinical Decision Support System)의 활성화로 전체적인 처방오류의 비율은 감소하였지만, CPOE와 같은 새로운 시스템으로 인하여 새로운 오류가 출현되었다. 본 연구는 원내 CPOE와 관련된 약물 처방오류 중 약사가 평가한 처방오류의 발생률과 CPOE 도입 전후 오류유형의 변화를 파악하고자 선행연구들을 대상으로 체계적 문헌고찰과 메타분석을 수행하였다. PubMed, EMBASE, Cochrane Register of Controlled Trials, Scopus에서 2020년 3월까지 검색되는 문헌 중 CPOE 도입 후 발생한 처방오류에 해당하는 문헌을 추출하였고 선정 및 제외기준에 따라 총 14개의 최종 문헌을 선정하였다. 처방오류의 합동 발생률 수치와 CPOE 도입 전과 후 유형 별 처방오류 발생의 상대 위험도 및 95% 신뢰 구간은 랜덤 효과 모델을 적용하여 제시하였다. CPOE 도입 후 전체 처방오류 중 CPOE로 인한 처방오류의 발생률 추정치 범위는 12.78%에서 58.54% 사이였고 랜덤 효과 모델에서 계산된 합동 발생률은 32.36%였다 (95% 신뢰 구간 22.87-42.62). National Coordinating Council for Medication Error Reporting and Prevention 분류체계에 기반하여 문헌에서 추출 가능한 처방오류의 유형을 처방 누락오류, 약물 오류, 용량오류, 제형 및 투여경로 오류, 투여 시간 오류, 약물 모니터링과 같이 총 6개 유형으로 분류하였을 때, 용량오류가 47.28% (95% 신뢰 구간 38.38-56.26)로 가장 높았고 그 다음은 약물 오류가 14.45% (95% 신뢰 구간 7.96-22.40)으로 높았다. CPOE 도입 전과 후의 처방오류 유형별 발생을 비교하기 위하여 하위그룹 메타 분석을 하였을 때, CPOE 도입 후 전체적인 처방오류의 발생률은 CPOE 도입 전에 비해 통계적으로 유의하게 증가하지 않았으나 (Relative risk, RR 0.842, 95% 신뢰 구간 0.559-1.168), 6개 처방오류 유형 중 메타분석이 가능한 5개 오류 유형 중 (처방 누락오류, 약물 오류, 용량오류, 제형 및 투여경로 오류, 약물 모니터링) 처방 누락오류만 CPOE 도입 후 유의하게 줄어들었다 (RR 0.484, 95% 신뢰 구간 0.282-0.831). 체계적 문헌고찰 및 메타분석을 통해 새로운 기술인 CPOE 도입 후 CPOE와 관련된 처방오류가 전체 처방오류 중 1/3의 빈도로 발생하는 것으로 파악되었다. 처방오류의 유형 중 처방 누락오류, 약물 오류, 용량오류, 제형 및 투여경로 오류, 약물 모니터링의 오류의 발생 비율은 CPOE 도입 전과 후에 유의한 변화를 보이지 않았으나, 처방 누락의 비율은 CPOE 도입 후에 낮아진 것으로 나타났다. 약물처방의 전자화와 처방 지원 시스템과 같은 새로운 기술의 도입으로 단순 실수로 인한 처방오류는 방지되었으나 다양한 처방오류가 지속해서 발생함으로 환자의 안전을 위한 시스템 사용자의 지속적인 교육과 시스템의 기술적 개선으로 처방오류의 예방, 감지, 및 모니터링의 노력이 필요하다.1. Introduction 1 2. Methods 3 3. Results 8 4. Discussion 25 5. Conclusion 31 References 32 Appendix 40 요약 (국문초록) 48Maste