ELECTRONIC MEDICAL RECORD - SUCCESS OR FAILURE IN THE MEDICAL DECISION FROM THE ROMANIAN HEALTH SYSTEM ?

The investments in informational and communicational technologies in the health field represent a for of investing in human capital because health and medical services will exceed the physician – patient relationship and the improvement of the physical and emotional condition of the individuals of a society will become a prioritary problem of the community. In Romania is noticed a high degree of data fragmenting, with a negligible communication, often inexistent, within and outside the system, and the decision makers of the health system hold exclusivity on their own data, fact that makes them unavailable to the other participants to the system. The software-s, the formats and supports used differ both inside the system and outside it. And because a patient is given a diagnosis without complete and safe medical data, the medical error is one of the causes for the incorrect diagnosis of the patient. The decision makers from the health system must take on responsibilities for the efficient and safe management of these data, to represent a desired issue for all medical institutions. Only the interconnected and standardized electronic medical files will be able to improve the medical decision and the care given to patients. The care will be safer, more efficient, the medical information will be also useful to other clinic physicians in time and space by using the informational and communicational technologies. The complete electronic medical record must include all types of information connected to the patient`s health (medical, family history, health file, hereditary-collateral antecedents, treatments, prescriptions, allergies) and they must be protected, shared by physicians, patients and those interested in a safe and extended environment. It is necessary to computerize the medical information specific to patient and the clinical processes, and performance in the health system will depend on the transformation of the medical services system by bringing the benefits of the medical science and technology to all individuals.critical; inefficient medical service; electronic medical record; medical information computerization, interconnected electronic medical files, medical error, health electronic file, clinical decision, protected and shared medical information, interoperability, standard.

Improving Patient Safety and Hospital Service Quality Through Electronic Medical Record: A Systematic Review

ABSTRACT To understand the Electronic medical records (EMR) role in improving patient safety and hospital’s service quality. Articles that included and assessed for the eligibility in this review was an article that show an effect of patient’ safety, and product quality in hospital in correlation on using EMR. The most important function of EMR implementation is to improve patient safety in hospital, in addition to reducing cost. EMR reduce excess cost of Hospital Acquired Condition (HAC) by 16%, reduce death due to HAC by 34%. Doctor and nurse’s belief that the quality of patient data is better when EMR are easier to use and suit with their dialy routine. EMR can improve patient safety, but its use require some skills in technology so it won’t turn to harm patients’ safety. The implementation EMR requires the ability of skilled human resources in using technologies, computer and programs

SPECIMEN LABELING IMPROVEMENT PROJECT: SLIP

Blood specimens are labeled at the time of acquisition in order to identify and match the specimen, label, and order to the patient. While the labeling process is not new, it is frequently laden with errors (Brown, Smith, & Sherfy, 2011). Wrong blood in tube (WBIT) poses significant risk. Multiple factors contribute to mislabeling errors, including lax policies, limited technological solutions, decentralized labeling processes, multi-tasking, distraction from the clinician, and insufficient education and training of staff. To reduce blood specimen labeling errors, a large academic medical center implemented an innovative technological solution for specimen labeling that integrates patient identification, physician order, and laboratory specimen identification through barcode technology that interfaces with the electronic medical record at the point of care. A failure mode, effects and critical analysis (FMECA) were completed to assess for system failure points, and to design workflow prior to training staff. Four failure points were identified and eliminated through workflow adjustments with the new system. Staff training utilizing simulation highlighted system safety points. This quality improvement process applied across adult and pediatric acute and critical care units provided dramatic reductions in blood specimen labeling errors pre/post intervention

Impact of an Electronic Medical Record Implementation on Drug Allergy Overrides in a Large Southeastern HMO Setting

Renny Varghese Impact of an Electronic Medical Record Implementation on Drug Allergy Overrides in a Large Southeastern HMO Setting (Under the direction of Russell Toal, Associate Professor) Electronic medical records (EMRs) have become recognized as an important tool for improving patient safety and quality of care. Decision support tools such as alerting functions for patient medication allergies are a key part of reducing the frequency of serious medication problems. Kaiser Permanente Georgia (KPGA) implemented its EMR system in the primary care departments at Kaiser\u27s twelve facilities in the greater metro Atlanta area over a six month period beginning in June 2005 and ending December 2005. The aim of this study is to analyze the impact of the EMR implementation on the number of drug allergy overrides within this large HMO outpatient setting. Research was conducted by comparing the rate of drug allergy overrides during pre and post EMR implementation. The timeline will be six months pre and post implementation. Observing the impact of the incidence rate of drug allergy alerts after the implementation provided insight into the effectiveness of EMRs in reducing contraindicated drug allergies. Results show that the incidence rate of drug allergy overrides per 1,000 filled prescriptions rose by a statistically significant 5.9% (ñ \u3e 0.0002; 95% CI [-1.531, -0.767]) following the implementation. Although results were unexpected, several factors are discussed as to the reason for the increase. Further research is recommended to explore trends in provider behavior, KPGA specific facilities and departments, and in other KP regions and non-KP healthcare settings. INDEX WORDS: electronic medical records, drug allergy overrides, patient safety, medication errors, decision support tools, outpatient setting, primary care, computerized provider order entr

The impact of an EMR on the management of adult patients with type two diabetes by family physicians in ruralnewfoundland

PURPOSE This study was designed to determine whether the use of advanced features of an electronic medical record in a primary care setting could improve the process of delivering diabetes care in such a way as to produce improvements in diabetic outcome measures in adult type II diabetic patients. METHODS The study was a Retrospective Cohort Study conducted in primary care clinics that had an established electronic medical record following 307 adult patients with type II diabetes over the course of two years. The clinics had similarly trained primary care physicians, similar patient populations, and used common diabetic care guidelines. The advanced EMR features used during the diabetic study included a diabetic template, premade laboratory requisitions, appeared consultations, flow sheets, and patient alerts. The dependent variables measured included the process of the delivery of diabetic care and the measurement of diabetic outcomes. The process of care measures were: the frequency of visits specific for diabetes care, ordering of HbA1c and LDL cholesterol, the measurement of blood pressure, and the documentation of these activities. The outcome measures included glycemic, lipid and blood pressure control as measured by HbA1c, LDL and blood pressure levels. The two independent variables of interest in the study were the extent to which the advanced features EMR are use by the physician and the second any changes noted in the outcome measures. RESULTS The demographic information for the patients in this study was sex and age as well as baseline HbA1c, LDL, baseline systolic blood pressures, baseline diastolic blood pressures, and the number of visits that each patient had during the study period. The two groups were seen to be similar at baseline except for age and systolic blood pressure. The mean age of the intervention group was four years older than the control group and the comparison group had more people with systolic blood pressure at target. Age and systolic blood pressure were therefore controlled in the analysis. There was no difference in the two groups of patients in terms of measurements of HbA1c but there were differences in the frequency of measurements of LDL and blood pressures. Patients for whom the template was used during at least one clinical encounter, were 1.18 times more likely to have their LDL measured and 1.9 times more likely to have their blood pressure measured. Using logistics regression analysis there was a higher proportion of patients with an LDL at target in the intervention group. CONCLUSIONS The meaningful use of EMRs in primary care, is possible through a process of maturity by design; an individualized approach looking at the needs of a given physician(s) and their practice(s) most likely to aid EMRs in achieving their potential. The technology needs to support care by automation of clinical processes and work flow behind the computer screen in such a way as to not disrupt or significantly change the patient physician interaction and focus both of these individuals on managing meaningful clinical outcomes personalized to each patient

The organizational implications of medical imaging in the context of Malaysian hospitals

This research investigated the implementation and use of medical imaging in the context of Malaysian hospitals. In this report medical imaging refers to PACS, RIS/HIS and imaging modalities which are linked through a computer network. The study examined how the internal context of a hospital and its external context together influenced the implementation of medical imaging, and how this in turn shaped organizational roles and relationships within the hospital itself. It further investigated how the implementation of the technology in one hospital affected its implementation in another hospital. The research used systems theory as the theoretical framework for the study. Methodologically, the study used a case-based approach and multiple methods to obtain data. The case studies included two hospital-based radiology departments in Malaysia. The outcomes of the research suggest that the implementation of medical imaging in community hospitals is shaped by the external context particularly the role played by the Ministry of Health. Furthermore, influences from both the internal and external contexts have a substantial impact on the process of implementing medical imaging and the extent of the benefits that the organization can gain. In the context of roles and social relationships, the findings revealed that the routine use of medical imaging has substantially affected radiographers’ roles, and the social relationships between non clinical personnel and clinicians. This study found no change in the relationship between radiographers and radiologists. Finally, the approaches to implementation taken in the hospitals studied were found to influence those taken by other hospitals. Overall, this study makes three important contributions. Firstly, it extends Barley’s (1986, 1990) research by explicitly demonstrating that the organization’s internal and external contexts together shape the implementation and use of technology, that the processes of implementing and using technology impact upon roles, relationships and networks and that a role-based approach alone is inadequate to examine the outcomes of deploying an advanced technology. Secondly, this study contends that scalability of technology in the context of developing countries is not necessarily linear. Finally, this study offers practical contributions that can benefit healthcare organizations in Malaysia

Factors Associated with Ordering and Completion of Laboratory Monitoring Tests for High-Risk Medications in the Ambulatory Setting: A Dissertation

Since the Institute of Medicine highlighted the devastating impact of medical errors in their seminal report, “To Err is Human” (2000), efforts have been underway to improve patient safety. A portion of medical errors are due to medication errors, and a large portion of these can be attributed to inadequate laboratory monitoring. In this thesis, I attempt to address this small but important corner of this patient safety endeavor. Why are patients not getting their laboratory monitoring tests? Do they fail to complete them or do doctors not order the tests in the first place? Which prescribers and which patients are least likely to do what is needed for testing to happen and what interventions would be most promising? To address these questions, I conducted a systematic review of existing interventions. I then proceeded with three aims: 1) To identify reasons that patients give for missing monitoring tests; 2) To identify patient and provider factors associated with monitoring test ordering; and 3) To identify patient and provider factors associated with completion of ordered testing. To achieve these aims, I worked with patients and data at the Fallon Clinic. For aim 1, I conducted a qualitative analysis of their reasons for missing tests as well as reporting completion and ordering rates. For aims 2 and 3, I used electronic medical record data and conducted a regression with patient and provider characteristics as covariates to identify factors contributing to test ordering and completion. Interviews revealed that patients had few barriers to completion, with forgetting being the most common reason for missing a test. The quantitative studies showed that: older patients with more interactions with the health care system were more likely to have tests ordered and were more likely to complete them; providers who more frequently prescribe a drug were more likely to order testing for it; and drug-test combinations that were particularly dangerous, indicated by a black box warning, were more likely to have appropriate ordering, though for these combinations, primary care providers were less likely to order tests appropriately, and patients were less likely to complete tests. Taken together, my work can inform future interventions in laboratory monitoring and patient safety

Longitudinal Patient Records: A Re-Examination of the Possibility

It has long been recognized that the Longitudinal Patient Record (LPR) has been defined as “A life-long incremental process where each clinical encounter is merely an updating of the file” (Gabrieli, 1997) Understanding the health condition of patient longitudinally is very important to the care of the patient. However, it is not clear to what extent a longitudinal patient record is in fact possible, since a true longitudinal patient record would need to include all information for a patient, from cradle to grave, across all healthcare providers and systems, across all corporate or geographic or national boundaries. Compiling or maintaining such a record is a problem of staggering practical difficulties. Yet, there is no doubt of the potential benefit to the patient of the availability of such a record to the patient’s caregivers and providers. In this thesis, we re-examine the possibility of a longitudinal patient record, both in its pure logical sense, and in a practical sense. One point of view that we stress is to model the longitudinal patient record not so much as a static thing, but rather as a functional entity. That is, the longitudinal patient record is understood as a set of processes that provide the physician or other clinician decision maker (or for that matter the patient himself) with whatever longitudinal view of the patient information is available and practical to serve the current context of decision making. That is, the model we suggest is one of making the most out of whatever patient information is available to the decision maker

Improving Computerized Provider Order Entry Usage in a Community Hospital

The healthcare industry is now faced with the balance between instituting computerized technology and providing safe, high quality, efficient, and lower cost patient care. An important aspect of computer technology is the direct entry of orders electronically by providers into the electronic health record, termed computerized provider order entry (CPOE). This translational research project begins by defining CPOE and discussing CPOE’s effect on patient safety and quality of care by reducing preventable medical errors and adverse drug events and CPOE’s effect on healthcare costs. Regulatory requirements pertaining to CPOE are discussed; providers are expected to be proficient in CPOE in order to meet these requirements. A literature review of barriers to CPOE usage, interventions to implement and improve usage of CPOE, and trends in CPOE usage is conducted and discussed. The purpose of this quality improvement project was to improve CPOE medication order usage among providers within a community hospital by utilizing the provider order entry user satisfaction and usage survey (POEUSUS) to identify barriers to the utilization of CPOE and by employing the technology acceptance model (TAM) and the provision of a CPOE facilitator on the patient care units for twelve hours per week for eight weeks. At the conclusion of the eight-week intervention, the CPOE utilization rates were determined and followed over an eight week interval and were compared to pre-intervention rates. Additionally, providers’ rated their satisfaction of the CPOE facilitator by completing a facilitator survey after each assistance session. The results of this project demonstrated an increase in CPOE medication order usage, from 45.4% CPOE medication order usage during the eight-week pre-intervention period to 55.6% CPOE medication order usage during the eight-week post-intervention period. A statistically significant improvement in provider CPOE satisfaction occurred after the intervention, and providers expressed high degrees of satisfaction with the real-time assistance of the CPOE facilitator. Aspects of CPOE admired by providers and recommendations of providers to changes in CPOE were determined. Finally, age was inversely related and previous computer experiment was positively related to CPOE medication order usage pre-intervention, meaning that younger providers and providers with more computer experience used CPOE more often