Impact of a New Medical Record System for Emergency Departments Designed to Accelerate Clinical Documentation: A Crossover Study.

Recording information in emergency departments (EDs) constitutes a major obstacle to efficient treatment. A new electronic medical records (EMR) system focusing on clinical documentation was developed to accelerate patient flow. The aim of this study was to examine the impact of a new EMR system on ED length of stay and physician satisfaction.We integrated a new EMR system at a hospital already using a standard system. A crossover design was adopted whereby residents were randomized into 2 groups. Group A used the existing EMR system first, followed by the newly developed system, for 2 weeks each. Group B followed the opposite sequence. The time required to provide overall medical care, length of stay in ED, and degree of physician satisfaction were compared between the 2 EMR systems.The study involved 6 residents and 526 patients (277 assessed using the standard system and 249 assessed with the new system). Mean time for clinical documentation decreased from 133.7 ± 5.1 minutes to 107.5 ± 5.4 minutes with the new EMR system (P < 0.001). The time for overall medical care was significantly reduced in all patient groups except triage level 5 (nonurgent). The new EMR system significantly reduced the length of stay in ED for triage level 2 (emergency) patients (145.4 ± 13.6 minutes vs 184.3 ± 13.6 minutes for standard system; P = 0.047). As for the degree of physician satisfaction, there was a high degree of satisfaction in terms of the physical findings support system and the ability to capture images and enter negative findings.The new EMR system shortened the time for overall medical care and was associated with a high degree of resident satisfaction

Health Care Crisis: Potential Solutions to the Perverse Reimbursement System and the Fragmented Care Delivery System

The American health care system is in a serious crisis. We have very high health care expenditures, but receive very low quality health outcomes. It is time for America to address the problems of our health care system head on, starting with the fee-for-service reimbursement structure and the fragmented care delivery system. This paper provides a comparative analysis of the systems in place in France and Japan to draw conclusions about possible solutions for the United States. This paper also discusses successful health care institutions within America and why they work. Finally, the potential results of the Affordable Care Act are discussed

Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review

<p>Abstract</p> <p>Background</p> <p>Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users.</p> <p>Methods</p> <p>Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users.</p> <p>Results</p> <p>Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities.</p> <p>Conclusions</p> <p>This systematic review presents innovative research on the barriers and facilitators to EHR implementation. While important similarities between user groups are highlighted, differences between them demonstrate that each user group also has a unique perspective of the implementation process that should be taken into account.</p

Implementação do Registo Eletrónico de Saúde em África - uma Análise SWOT

A inovação tecnológica em saúde está a revolucionar significativamente a forma como os cuidados de saúde estão a ser prevenidos, diagnosticados e tratados. Apesar dos muitos benefícios destacados, a implementação de EHR requer um grande investimento, não só em recursos tecnológicos, mas também em recursos humanos qualificados. O objetivo principal do estudo é conhecer as forças, oportunidades, fraquezas e ameaças dos registos eletrónicos em saúde nos países africanos. A metodologia baseou-se na realização de uma revisão sistemática para análise SWOT. Com base nos resultados obtidos, o ponto forte com maior relevância esta relacionado com acesso oportuno e rápido das informações. Já a fraqueza mais evidente é a queda da corrente elétrica seguida da fraca conexão a internet. Ter experiência prévia em EHR é a oportunidade identificada com maior relevância na utilização destes sistemas. Por último, a maior ameaça evidenciada é a inexistência de conhecimento prévio em EHR e em informática. Os sistemas implementados na África. os resultados mostram que o sistema EHR Open source como o mais implementado na África em 83,3% em (10/12) artigos que caracterizaram os tipos de sistemas implementados.Technological innovation in healthcare is significantly revolutionising the way healthcare is being prevented, diagnosed and treated. Despite the many benefits highlighted, EHR implementation requires a major investment, not only in technological resources, but also in qualified human resources. The main objective of the study is to know the strengths, opportunities, weaknesses and threats of electronic health records in African countries. The methodology was based on conducting a systematic review for SWOT analysis. Based on the results obtained, the strong point with the greatest relevance is related to timely and rapid access to information. The most obvious weakness is the power outage followed by poor internet connection. Having previous EHR experience is the most relevant opportunity identified when using these systems. Finally, the greatest threat evidenced is the lack of prior knowledge in EHR and computer science. The systems implemented in África. the results show that the Open source EHR system as the most implemented in África in 83.3% in (10/12)c articles that characterized the types of systems implemented

Quality framework for semantic interoperability in health informatics: definition and implementation

Aligned with the increased adoption of Electronic Health Record (EHR) systems, it is recognized that semantic interoperability provides benefits for promoting patient safety and continuity of care. This thesis proposes a framework of quality metrics and recommendations for developing semantic interoperability resources specially focused on clinical information models, which are defined as formal specifications of structure and semantics for representing EHR information for a specific domain or use case. This research started with an exploratory stage that performed a systematic literature review with an international survey about the clinical information modelling best practice and barriers. The results obtained were used to define a set of quality models that were validated through Delphi study methodologies and end user survey, and also compared with related quality standards in those areas that standardization bodies had a related work programme. According to the obtained research results, the defined framework is based in the following models: Development process quality model: evaluates the alignment with the best practice in clinical information modelling and defines metrics for evaluating the tools applied as part of this process. Product quality model: evaluates the semantic interoperability capabilities of clinical information models based on the defined meta-data, data elements and terminology bindings. Quality in use model: evaluates the suitability of adopting semantic interoperability resources by end users in their local projects and organisations. Finally, the quality in use model was implemented within the European Interoperability Asset register developed by the EXPAND project with the aim of applying this quality model in a broader scope to contain any relevant material for guiding the definition, development and implementation of interoperable eHealth systems in our continent. Several European projects already expressed interest in using the register, which will now be sustained by the European Institute for Innovation through Health Data