Electronic Health Record-Based Screening for Major Cancers: A 9-Year Experience in Minhang District of Shanghai, China

Background: An electronic health record (e-HR) system has been developed in Minhang District of Shanghai, China, since 2005, making it convenient for local health institutions to provide integrative and comprehensive health care and management for major diseases.Methods: In 2008, an e-HR-based cancer prevention program was initiated to screen multiple cancers, including colorectal, gastric, liver, lung, cervical, and breast cancers, and provide subsequent health education and health management to cancer patients and high-risk individuals. This study was designed in prospective analysis, based on the constructive analysis of key information, observation of cancer screening and healthcare processes and organizations, and stages of cancers detected by the e-HR-based programs.Results: From 2008 to 2016, health education was conducted for over 5 million attendances, and more than 3 million screening tests were performed for eligible residents over 40 years old. A total of 2,948 cancer cases were detected, accounting for 13.3% of all newly diagnosed cancers in the district during the 9-year period. Thirty point seven percent detected cancer cases were at the early stage, significantly higher than the 22.9% in cases identified by e-HR-based follow-up and 13.8% in cases diagnosed due to signs or symptoms. More than 136,000 residents were identified as individuals at high risk of cancer and subject to sustainable clinical follow-up and health management.Conclusions: The successful application of e-HR system in cancer prevention and control in Minhang district of Shanghai, China, implies that the system may act as an extendable and sustainable infrastructure for comprehensive health care and services for a broad spectrum of diseases and health events

Electronic patient records system in Hamad Medical Corporation, Qatar: perspectives and potential use

Since the 1990 the use of Electronic Patient Records (EPR) in health services has become increasingly prevalent world wide. EPR has become an important aspect of the continuous improvement of patient care. Transferring all patient records from paper based to electronic is now a priority for many health services. The research reported in this thesis is sponsored by Hamad Medical Corporation (HMC) to provide opportunity to explore the potential role for EPR in the Medical Records Department. The study has been designed to gain better understanding of the users perspectives with regard to the use of patient records. In order to analyse and understand the complex dynamic involved in the management and use of patient records, it was recognised that systems thinking offered an appropriate framework for this research. Soft System Methodology (SSM) was therefore applied to the analysis of the data and used to inform the development of a conceptual model. Using SSM in combination with the structured questionnaire survey and telephone semi-structured interview, triangulation of methods was achieved. Use of these generated rich data revealing for example the general dissatisfaction expressed with the existing manual patient records system, the lack of confidentiality, poor legibility, shortage of space and the frequent misfiling of records. The need to address these problems has informed the strategic plan for the development and implementation of EPR for HMC. The research has successfully addressed the stated aims and research questions and guided the formulation of proposals for improvements

An evaluation of the performance of a NoSQL document database in a simulation of a large scale Electronic Health Record (EHR) system

Electronic Healthcare Record (EHR) systems can provide significant benefits by improving the effectiveness of healthcare systems. Research and industry projects focusing on storing healthcare information in NoSQL databases has been triggered by practical experience demonstrating that a relational database approach to managing healthcare records has become a bottleneck. Previous studies show that NoSQL databases based on consistency, availability and partition tolerance (CAP) theorem have significant advantages over relational databases such as easy and automatic scaling, better performance and high availability. However, there is limited empirical research that has evaluated the suitability of NoSQL databases for managing EHRs. This research addressed this identified research problem and gap in the literature by investigating the following general research: How can a simulation of a large EHR system be developed so that the performance of NoSQL document databases comparative to relational databases can be evaluated? Using a Design Science approach informed by a pragmatic worldview, a number of IT artefacts were developed to enable an evaluation of performance of a NoSQL document oriented database comparative to a relational database in a simulation of a large scale EHR system. These were healthcare data models (NoSQL document database, relational database) for the Australian Healthcare context, a random healthcare data generator and a prototype EHR system. The performance of a NoSQL document database (Couchbase) was evaluated comparative to a relational database (MySQL) in terms database operations (insert, update, delete of EHRs), scalability, EHR sharing and data analysis (complex querying) capabilities in a simulation of a large scale EHR system, constructed in the cloud environment of Amazon Web Services (AWS). Test scenarios consisted of a number of different configurations ranging from 1, 2, 4, 8 and 16 nodes for 1Million, 10 Million, 100 Million and 500 Million records to simulate database operations in a large scale and distributed EHR system environment. The Couchbase NoSQL document database was found to perform significantly better than the MySQL relational database in most of the test cases in terms of database operations -insert, update, delete of EHRs, scalability and EHR sharing. However, the MySQL relational database was found to perform significantly better than the Couchbase NoSQL document database for the complex query test that demonstrates basic analysis capabilities. Furthermore, the Couchbase NoSQL document database used significantly more disk space than the MySQL relational database to store the same number of EHRs. This research made a number of important contributions to knowledge, theory and practice. The main theoretical contribution to design theory was the design and evaluation of a prototype EHR system for simulating database management operations in a large scale EHR system environment. The prototype EHR system was underpinned by the development of two data models with data structures designed for a NoSQL document database and a relational database and a random healthcare data generator which were based on Australian Healthcare data characteristics and statistics. The design of a data model for EHRs for a NoSQL document database using an aggregated document modelling approach provided an important contribution to data modelling theory for NoSQL document databases using de-normalisation and document aggregation. The design of a random healthcare data generator was another important contribution to design theory and was based on a data distribution algorithm (multinomial distribution and probability theory) informed by National Health Data Dictionary and published Australian Healthcare statistics. The prototype EHR system allowed this study to demonstrate through a simulated performance evaluation that a NoSQL document database has significant and proven performance advantages over relational databases in most of the database management test cases. Hence this study demonstrated the utility and efficacy of a NoSQL document database in the simulation of a large scale EHR system. This research has made a number of important contributions to practice. Foremost is that the IT artefacts (namely, a data model for storing EHRs in a NoSQL document database, a random healthcare data generator and a prototype EHR system) developed and evaluated in this research can be readily adopted by practitioners. Another important practical contribution of this research is that it is based on the open source availability of NoSQL database and relational database alternatives. Hence, this research can provide a sound basis for lower-income countries as well higher-income countries to establish their own cost-effective national EHR systems without the restrictions, limitations, complexity or complications of similar proprietary relational database systems

Electronic patient records system in Hamad Medical Corporation, Qatar : perspectives and potential use

Since the 1990 the use of Electronic Patient Records (EPR) in health services has become increasingly prevalent world wide. EPR has become an important aspect of the continuous improvement of patient care. Transferring all patient records from paper based to electronic is now a priority for many health services. The research reported in this thesis is sponsored by Hamad Medical Corporation (HMC) to provide opportunity to explore the potential role for EPR in the Medical Records Department. The study has been designed to gain better understanding of the users perspectives with regard to the use of patient records. In order to analyse and understand the complex dynamic involved in the management and use of patient records, it was recognised that systems thinking offered an appropriate framework for this research. Soft System Methodology (SSM) was therefore applied to the analysis of the data and used to inform the development of a conceptual model. Using SSM in combination with the structured questionnaire survey and telephone semi-structured interview, triangulation of methods was achieved. Use of these generated rich data revealing for example the general dissatisfaction expressed with the existing manual patient records system, the lack of confidentiality, poor legibility, shortage of space and the frequent misfiling of records. The need to address these problems has informed the strategic plan for the development and implementation of EPR for HMC. The research has successfully addressed the stated aims and research questions and guided the formulation of proposals for improvements.EThOS - Electronic Theses Online ServiceGBUnited Kingdo