A study of general practitioners' perspectives on electronic medical records systems in NHS Scotland

<b>Background</b> Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. <p></p><b> Methods</b> We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs' perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees' responses, using Normalisation Process Theory as the underpinning conceptual framework. <p></p> <b>Results</b> The majority of GPs' interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities - for example: in relation to usability, system navigation and information visualisation. <b>Conclusion </b>Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs' interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors

Toward a framework for data quality in cloud-based health information system

This Cloud computing is a promising platform for health information systems in order to reduce costs and improve accessibility. Cloud computing represents a shift away from computing being purchased as a product to be a service delivered over the Internet to customers. Cloud computing paradigm is becoming one of the popular IT infrastructures for facilitating Electronic Health Record (EHR) integration and sharing. EHR is defined as a repository of patient data in digital form. This record is stored and exchanged securely and accessible by different levels of authorized users. Its key purpose is to support the continuity of care, and allow the exchange and integration of medical information for a patient. However, this would not be achieved without ensuring the quality of data populated in the healthcare clouds as the data quality can have a great impact on the overall effectiveness of any system. The assurance of the quality of data used in healthcare systems is a pressing need to help the continuity and quality of care. Identification of data quality dimensions in healthcare clouds is a challenging issue as data quality of cloud-based health information systems arise some issues such as the appropriateness of use, and provenance. Some research proposed frameworks of the data quality dimensions without taking into consideration the nature of cloud-based healthcare systems. In this paper, we proposed an initial framework that fits the data quality attributes. This framework reflects the main elements of the cloud-based healthcare systems and the functionality of EHR

Advances in Teaching & Learning Day Abstracts 2004

Proceedings of the Advances in Teaching & Learning Day Regional Conference held at The University of Texas Health Science Center at Houston in 2004

Comparison of Open-Source Electronic Health Record Systems Based on Functional and User Performance Criteria

Objectives: Open-source Electronic Health Record (EHR) systems have gained importance. The main aim of our research is to guide organizational choice by comparing the features, functionality, and user-facing system performance of the five most popular open-source EHR systems. Methods: We performed qualitative content analysis with a directed approach on recently published literature (2012-2017) to develop an integrated set of criteria to compare the EHR systems. The functional criteria are an integration of the literature, meaningful use criteria, and the Institute of Medicine's functional requirements of EHR, whereas the user-facing system performance is based on the time required to perform basic tasks within the EHR system. Results: Based on the Alexa web ranking and Google Trends, the five most popular EHR systems at the time of our study were OSHERA VistA, GNU Health, the Open Medical Record System (OpenMRS), Open Electronic Medical Record (OpenEMR), and OpenEHR. We also found the trends in popularity of the EHR systems and the locations where they were more popular than others. OpenEMR met all the 32 functional criteria, OSHERA VistA met 28, OpenMRS met 12 fully and 11 partially, OpenEHR-based EHR met 10 fully and 3 partially, and GNU Health met the least with only 10 criteria fully and 2 partially. Conclusions: Based on our functional criteria, OpenEMR is the most promising EHR system, closely followed by VistA. With regards to user-facing system performance, OpenMRS has superior performance in comparison to OpenEMR

Considerations for introducing a cloud service in health informatics: user experience monitoring of information systems

This thesis will show concrete examples about how user experience monitoring will improve security of health information systems, patient safety, efficiency, and ease of use. This thesis will prove how the current EMR systems that are stand alone in nature lack the ability of advanced error monitoring capabilities. As part of this research, I will demonstrate with detailed interviews and data collection surveys how automated user monitoring systems improve data record accuracy consistently. Key terminology to Electronic Medical Records (EMR’s) and the usability of cloud computing software solutions will be defined. EMR’s are the primary software used in hospitals for charting patient information and this research focuses on the summarization of key information to the history of healthcare technologies and their functionalities. Usability testing, cloud computing, and how security and trust are affecting the adoption of cloud-based services will also be discussed in more detail. Along with the importance of market research, how to create buyer personas, and what drives their need to buy. The study was conducted in collaboration with Adusso Ltd. in Helsinki, Finland to gain better understanding about what motivates hospital IT departments to buy and the main issues with EMR systems. In collaboration with Adusso we investigated a use case example of their existing customer Apotti leveraging the user error reduction and cost saving benefits they experienced after deploying Adusso’s UX2play system. We sought answers to these topics using semi-structured interviews and analyzing our customer profiles. We found that UI layout, interoperability, and the number of clicks that nurses spend in the EMR are major issues that most EMR systems have. This implies that companies using EMR’s should implement user monitoring to pinpoint the issues they do have so that they can be fixed and the work of physicians and clinicians can be improved

Feedback GAP : study protocol for a cluster-randomized trial of goal setting and action plans to increase the effectiveness of audit and feedback interventions in primary care

Peer reviewedPublisher PD

Implementation Plan for EMR and Beyond

Change is never easy for anyone, but how we implement change can make the difference in how an innovation is accepted. Over the last two years, a small community hospital in California has introduced a new electronic medical record (EMR) to meet the requirements of meaningful use mandated by the Centers for Medicare and Medicaid (CMS) for all hospitals across the United States. EMRs are expected to improve quality in many areas, especially to improve outcomes, while safely reducing costs (U.S. Department of Health & Human Services, 2012). Adoption of EMR’s is not optional, if facilities want to avoid penalties and continue operating. As a result, EMR’s have been implemented in numerous healthcare facilities over the last decade. However, implementation does not guarantee acceptance. Many organizations have tried to implement something new and failed. Healthcare facilities need to build implementation plans into their development of any new innovations. In particular, end users need to buy in and accept new system usability in order to improve compliance and employee satisfaction. Our EMR is being developed in stages, so our processes are constantly changing with requires fast transitions in the end user learning. We have moved through the first two stages and are moving into the third stage in the next few months. This project describes an implementation plan for an electronic medical record development that we have used during our first two stages. The project plan has a strategic focus on end user acceptance of meaningful use guidelines that is sustainable for continued growth. The elements of this plan can be applied to other types of innovative change in healthcare

Study protocol for the Anesthesiology Control Tower—Feedback Alerts to Supplement Treatments (ACTFAST-3) trial: A pilot randomized controlled trial in intraoperative telemedicine [version 1; referees: 2 approved]

Background: Each year, over 300 million people undergo surgical procedures worldwide. Despite efforts to improve outcomes, postoperative morbidity and mortality are common. Many patients experience complications as a result of either medical error or failure to adhere to established clinical practice guidelines. This protocol describes a clinical trial comparing a telemedicine-based decision support system, the Anesthesiology Control Tower (ACT), with enhanced standard intraoperative care. Methods: This study is a pragmatic, comparative effectiveness trial that will randomize approximately 12,000 adult surgical patients on an operating room (OR) level to a control or to an intervention group. All OR clinicians will have access to decision support software within the OR as a part of enhanced standard intraoperative care. The ACT will monitor patients in both groups and will provide additional support to the clinicians assigned to intervention ORs. Primary outcomes include blood glucose management and temperature management. Secondary outcomes will include surrogate, clinical, and economic outcomes, such as incidence of intraoperative hypotension, postoperative respiratory compromise, acute kidney injury, delirium, and volatile anesthetic utilization. Ethics and dissemination: The ACTFAST-3 study has been approved by the Human Resource Protection Office (HRPO) at Washington University in St. Louis and is registered at clinicaltrials.gov (NCT02830126). Recruitment for this protocol began in April 2017 and will end in December 2018. Dissemination of the findings of this study will occur via presentations at academic conferences, journal publications, and educational materials

Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating

For more information about the Information Experience Laboratory, visit http://ielab.missouri.edu/Electronic medical record (EMR) adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available. Achieving the healthcare reform goals of broad EMR adoption and “meaningful use” will require that efficiency and usability be effectively addressed at a fundamental level. We conducted a literature review of usability principles, especially those applicable to EMRs. The key principles identified were simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, effective information presentation, and preservation of context. Usability is often mistakenly equated with user satisfaction, which is an oversimplification. We describe methods of usability evaluation, offering several alternative methods for measuring efficiency and effectiveness, including patient safety. We provide samples of objective, repeatable and cost‐efficient test scenarios applicable to evaluating EMR usability as an adjunct to certification, and we discuss rating schema for scoring the results. (42 pages