Clinical Decision Support Functions and Digitalization of Clinical Documents of Electronic Medical Record Systems

Objectives The objective of this study was to investigate the clinical decision support (CDS) functions and digitalization of clinical documents of Electronic Medical Record (EMR) systems in Korea. This exploratory study was conducted focusing on current status of EMR systems. Methods This study used a nationwide survey on EMR systems conducted from July 25, 2018 to September 30, 2018 in Korea. The unit of analysis was hospitals. Respondents of the survey were mainly medical recorders or staff members in departments of health insurance claims or information technology. This study analyzed data acquired from 132 hospitals that participated in the survey. Results This study found that approximately 80% of clinical documents were digitalized in both general and small hospitals. The percentages of general and small hospitals with 100% paperless medical charts were 33.7% and 38.2%, respectively. The EMR systems of general hospitals are more likely to have CDS functions of warnings regarding drug dosage, reminders of clinical schedules, and clinical guidelines compared to those of small hospitals; this difference was statistically significant. For the lists of digitalized clinical documents, almost 93% of EMR systems in general hospitals have the inpatient progress note, operation records, and discharge summary notes digitalized. Conclusions EMRs are becoming increasingly important. This study found that the functions and digital documentation of EMR systems still have a large gap, which should be improved and made more sophisticated. We hope that the results of this study will contribute to the development of more sophisticated EMR systems

IOT Service Utilisation in Healthcare

Utilising the new trend technologies in healthcare sector could offer alternative ways in managing the patients’ health records and also improve the healthcare quality. As such, this chapter provides an overview of utilising the Internet of Things (IoT) technology in healthcare sector as an emerging research and practical trend nowadays. The main benefits and advantages have been discussed in this chapter. On the other hand, it has been found that most of the hospitals in different countries are still facing many issues regarding their health information exchange. Recently, various studies in the area of healthcare information system mentioned that the fragmentations of the health information are one of the most important challenges with the distribution of patient information records. Therefore, in this chapter, we gave an in detail overview regarding the current issues facing the health sector in line with the IoT technologies. Additionally, a full description of advantages and disadvantages has been highlighted for using IoT in healthcare that can be considered as solutions for the mentioned issues

Between "the best way to deliver patient care" and "chaos and low clinical value": General Practitioners' and Practice Managers' views on data sharing

OBJECTIVE: In the UK, General Practitioners and Practice Managers are key to enabling health information exchange (typically referred to as 'data sharing'). This study aimed to survey GPs and PMs for familiarity, engagement with and perceptions of patient data sharing. METHODS: Cross-sectional survey. All 107 general practices in England's second largest Clinical Commissioning Group, Cambridgeshire & Peterborough CCG. Descriptive statistics; hierarchical logistic regression; thematic analysis. RESULTS: 405 (64%) responses were received - from 338 (62%) GPs and 67 (71%) PMs. Familiarity and engagement were highest for local frail elderly and end of life care projects (>76% had used). The greatest difference in use concerned the now suspended national care.data initiative: PMs had odds of reporting use 75 times higher than GP partners (95% CI 27-211). Patient confusion was the most pronounced challenge and improved coordination the most pronounced expected benefit. Frequency of discussions with patients varied with IT competence (OR 4.2 for most competent users relative to least, 95% CI 1.7-10.7) and clinical system (OR 0.3, 95% CI 0.1-0.5). Patient reservations were reported more frequently by respondents who rated their IT competence as highest (OR 3.3, 95% CI 1.5-7.6), perceived more data sharing challenges (OR for a 1-point increase in challenges perception score 3.4, 95% CI 2.1-5.6) and by PMs (relative to GP partners, OR 18.0, 95% CI 7.9-41.3). CONCLUSIONS: Familiarity with and use of data sharing projects was high among GPs and PMs. Both their individual and organisational characteristics were associated with the reported frequency of discussions and patients' responses. Improved awareness of the impact of provider characteristics and attitudes on patients' decisions about data sharing may enhance the equity and autonomy of those decisions.This paper presents independent research funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, at Cambridgeshire and Peterborough NHS Foundation Trust, as well as the Health Innovation and Education Cluster (HIEC) hosted by Cambridge University Health Partners (CUHP)

Health Information Exchange Use in Primary Care

Indiana University-Purdue University Indianapolis (IUPUI)The United States has invested over $40 billion in digitizing the health care system, yet the anticipated gains in improved care coordination, quality, and cost savings remain largely unrealized. This is due in part to limited interoperability and low rates of health information exchange (HIE) use, which can support care coordination and improve provider decision-making. Primary care providers are central to the US health care delivery system and frequently function as care coordinators, yet capability and HIE use gaps among these providers limit the potential of these digital systems to achieve their intended goals. I study HIE use in the context of primary care to examine 1) factors associated with provider HIE use, 2) the extent and nature of team-based HIE use, and 3) differences in HIE system use patterns across discrete groups of system users. First, I use a national sample of primary care providers to analyze market and practice factors related to HIE use for patient referrals. Overall, I find that only 43% of primary care provider referrals used HIE. Furthermore, I find substantial variation in HIE use rates across electronic health record (EHR) vendors. Second, I use HIE system log data to understand the breadth and depth of HIE use among teams, a care model underpinning primary care delivery reform efforts. I find that although use of HIE systems remains low, in primary care settings it overwhelmingly takes place in a manner consistent with team-based care workflows. Furthermore, team-based use does not differ in breadth from single provider HIE use, but illustrates less depth before and after visits. Third, I apply cluster analysis to 16 HIE use measures representing 7 use attributes, and identify 5 discrete user groups. I then compare two of these user groups and find user-level variation in volume and efficiency of use, both of which have implications for HIE system design and usability improvements. Ultimately, these findings help to inform how HIE use can be increased and improved in primary care, moving the US health care system closer to realizing the coordination, quality, and cost savings made possible by a digitized delivery system

Internet of Things (IoT) for Automated and Smart Applications

Internet of Things (IoT) is a recent technology paradigm that creates a global network of machines and devices that are capable of communicating with each other. Security cameras, sensors, vehicles, buildings, and software are examples of devices that can exchange data between each other. IoT is recognized as one of the most important areas of future technologies and is gaining vast recognition in a wide range of applications and fields related to smart homes and cities, military, education, hospitals, homeland security systems, transportation and autonomous connected cars, agriculture, intelligent shopping systems, and other modern technologies. This book explores the most important IoT automated and smart applications to help the reader understand the principle of using IoT in such applications

Integration between Health Information Systems: the case of e-SUS Primary Health Care

Introduction: In Brazil, health professionals and public managers coexist with dozens of Health Information Systems in their work environments. Some are called National Health Information System because they are used by thousands of health services to collect and send data to large databases centralized in the Ministry of Health of Brazil. Most were created in a fragmented way and disconnected from a global view of the MS software ecosystem, causing them to be born with little or no integration with each other. Some public policies have been implemented to reduce the fragmentation of National Health Information System in the Brazilian Unified Health System (SUS), among which the e-SUS AB Strategy, carried out by the Primary Health Care Department of the Ministry of Health. Objective: To describe and analyze the situation of the integration of e-SUS AB with others National Health Information Systems of Brazilian Primary Health Care. Methodology: A case study with data analysis and cross-checking of multiple sources of evidence was carried out: official publications and technical documents of MS, interviews with key informants, literature review and answers obtained through the Access to Information Law. Results and Discussion: We found 31 National Health Information Systems in production in Primary Care. It was verified that the e-SUS AB Strategy accomplished complete unification of user interfaces with 11 of these systems, incomplete integration with other 4 systems and no integration with 16 systems. Interface integration was observed in 100% of the Primary Health Care Department own systems, but no complete integration was observed with any systems of the Ministry of Health Surveillance Department. Frequency and intensity of systems use in health services appeared as less important factors, since systems with a marked use at the local level had incipient integration with e-SUS AB. Conclusion: The e-SUS AB Strategy took on the challenge of producing more integration through unified interfaces guided by the "single window" concept. The difficulties in achieving this integration are related to the historic fragmentation of Ministry of Health management, the maintenance of the (false) dichotomy between Surveillance and Health Assistance, the low governance of the e-SUS AB management area and the fragile IT governance of the MS. Decentralized IT hubs play a central role in the development of National Health Information System, but are largely ignored in the master plans and technology management committees.Introdução: Profissionais de saúde e gestores públicos convivem com dezenas de Sistemas de Informação em Saúde (SIS) em seus ambientes de trabalho. Alguns são chamados SIS de base nacional por serem utilizados por milhares de serviços de saúde para captar e enviar dados para grandes bases centralizadas no Ministério da Saúde (MS). A maioria foi criada de forma fragmentada e desconectada de uma visão global do ecossistema de software do MS, o que fez com que nascessem com pouca ou nenhuma integração entre si. Algumas políticas públicas vêm sendo implantadas para diminuir a fragmentação dos SIS no Sistema Único de Saúde, entre as quais a Estratégia e-SUS AB, protagonizada pelo Departamento de Atenção Básica do MS. Objetivo: Descrever e analisar a situação da integração do e-SUS AB com os SIS de base nacional da Atenção Básica do SUS. Metodologia: Foi realizado um estudo de caso com análise e cruzamento de dados de múltiplas fontes de evidências: publicações oficiais e documentos técnicos do MS, entrevistas com informantes-chave, revisão de literatura e respostas obtidas através da Lei de Acesso à Informação. Resultados e Discussão: Foram encontrados 31 SIS de base nacional em produção na Atenção Básica. Verificou-se que a Estratégia e-SUS AB realizou unificação completa de interfaces de usuário com 11 destes SIS, integração incompleta com outros 4 SIS e nenhuma integração com 16 SIS. Observou-se integração de interfaces em 100% dos SIS do próprio DAB, mas não se observou integração completa com nenhum dos SIS da Secretaria de Vigilância à Saúde do MS. Frequência e intensidade do uso dos SIS nos serviços de saúde apareceram como fatores de menor relevância, pois SIS com uso acentuado no nível local tiveram integração incipiente com o e-SUS AB. Conclusão: A Estratégia e-SUS AB assumiu o desafio de produzir mais integração através da unificação de interfaces guiada pelo conceito de “janela única”. As dificuldades em realizar tal integração estão relacionadas à histórica fragmentação da gestão do MS, à manutenção da (falsa) dicotomia entre Vigilância e Assistência, à baixa governabilidade da área gestora do e-SUS AB e à frágil governança de Tecnologia da Informação (TI) do MS. Os núcleos descentralizados de TI têm papel central no desenvolvimento de SIS, mas são praticamente ignorados nos planos diretores e nos comitês de gestão de tecnologias.BV UNIFESP: Teses e dissertaçõe