Impact of Laboratory Value Flowsheet in Electronic Health Record (EHR) Documentation Time

Research on the use of EHR is contradictory since it presents contradicting results regarding the time spent documenting. There is research that supports the use of electronic records as a tool to speed documentation;and research that found that it is time consuming. The purpose of this quantitative retrospective before-after project was to measure the impact of using the laboratory value flowsheet within the EHR on documentation time. The research question was: “Does the use of a laboratory value flowsheet in the EHR impact documentation time by primary care providers (PCPs)?” The theoretical framework utilized in this project was the Donabedian Model. The population in this research was the two PCPs in a small primary care clinic in the northwest of Puerto Rico. The sample was composed of all the encounters during the months of October 2019 and December 2019. The data was obtained through data mining and analyzed using SPSS 27. The evaluative outcome of this project is that there is a decrease in documentation time after implementation of the use of the laboratory value flowsheet in the EHR. However, patients per day increase therefore having an impact on the number of patients seen per day/week/month. The implications for clinical practice include the use of templates to improve workflow and documentation as well as decreasing documentation time while also increasing the number of patients seen per day. .

An Investigation on the Barriers and Facilitators of the Implementation of Electronic Health Records (EHR)

The application of technology in health care, in the form of electronic health records (EHR), is the most important and necessary issue in order to improve the quality of health care, and studies have shown that, not only is it a way to integrate information and represent the condition of patients, and a dynamic source for health care, however it leads to gain access to clinical information and records, electronic communications, comprehensive training and management, and ultimately enhancing the public health;the aim of this study is to investigate the factors influencing the implementation of EHR, which are known as barriers and facilitators. The research is conducted in the form of a review research, and with the help of the Keywords of EHR;barriers and facilitators, articles, from 2008 to 2013, were searched and studied in the Internet-databases. The results of the studies show that the most effective factors include: efficiency, motivation, management, and the participation of end users. Factors such as technical aspects ease of use, available resources, and human resources, have limited effects. And security and privacy, the expected output, lack of time, and workload have relative effects, and also the relation between the patient and clinical staff, has no effects in the process of implementing EHR.

Hyperledger Fabric Blockchain: Secure and Efficient Solution for Electronic Health Records

Background:Electronic Health Record(EHR)systems are used as an efficient and effective technique for sharing patient’s health records among different hospitals and various other key stakeholders of the healthcare industry to achieve better diagnosis and treatment of patients globally.However,the existing EHR systems mostly lack in providing appropriate security,entrusted access control and handling privacy and secrecy issues and challenges in current hospital infrastructures.Objective:To solve this delicate problem,we propose a Blockchain-enabled Hyperledger Fabric Architecture for different EHR systems.Methodology:In our EHR blockchain system,Peer nodes from various organizations(stakeholders)create a ledger network,where channels are created to enable secure and private communication between different stakeholders on the ledger network.Individual patients and other stakeholders are identified and registered on the network by unique digital certificates issued by membership service provider(MSP)component of the fabric architecture.Results:We created and implemented different Chaincodes to handle the business logic for executing separate EHR transactions on the network.The proposed fabric architecture provides a secure,transparent and immutable mechanism to store,share and exchange EHRs in a peer-to-peer network of different healthcare stakeholders.It ensures interoperability,scalability and availability in adapting the existing EHRs for strengthening and providing an effective and secure method to integrate and manage patient records among medical institutions in the healthcare ecosystem.

Effect of Electronic Medical Record Utilization on Depression, Anxiety and Stress among Doctors and Nurses in Johor, Malaysia

Background： The usage of modem technology in healthcare record system is now a must throughout the world. However, many doctors and nurses has been reporting facing numerous challenges and obstacles in the implementation. The aim of the present study is to determine the prevalence of depression, anxiety and stress among doctors and nurses who utilize EMR （electronic medical record） and its associated factor. Methods： A comparative cross-sectional study was conducted ~om January till April 2012 among doctors and nurses in two public tertiary hospitals in Johor in which one of them uses EMR and the other one still using the MMR （manual medical record） system. Data was collected using self-administered validated Malay version of DASS-21 （Depression, Anxiety, and Stress Scales-21） items questionnaire. It comprises of socio-demographic and occupational characteristics. Findings： There were 130 respondents with a response rate of 91% for EMR and 123 respondents with a response rate of 86% for MMR. The mean （SD） age of respondents in EMR and MMR groups were 34.7 （9.42） and 29.7 （6.15） respectively. The mean （SD） duration of respondents using EMR was 46.1 （35.83） months. The prevalence of depression, anxiety and stress among respondents using EMR were 6.9%, 25.4% and 12.3%. There were no significant difference between the study groups related to the depression, anxiety and stress scores. In multivariable analysis, the significant factors associated with depression among respondents using EMR was age （OR 1.10, 95% CI 1.02, 1.19）. The significant factors associated with stress among respondents using EMR was marital status （OR 3.33, 95% CI 1.10, 10.09） and borderline significant was computer skill course （OR 2.94, 95% CI 0.98, 8.78）. Conclusion： The prevalence of depression, anxiety and stress of those who uses EMR were within acceptable range. Age, marital status and computer skill are the identified factor associated with the depression and stress level which need to be considered in its implementation.

支持用户撤销的可搜索电子健康记录共享方案

随着物联网与云存储技术的快速发展和广泛应用,每年都有大量的传感器设备被部署到医疗物联网(IoMT)系统,虽然这促进了电子健康记录(EHR)应用的普及,但EHR的安全存储与检索尚未得到妥善的解决。针对以上问题,基于可搜索加密构造长度固定的陷门用于对密文的搜索验证,减小了用户所需的通信开销;采用在线/离线加密技术,减小了用户端在线加密所需的计算开销;同时基于变色龙哈希函数,构造具有抗碰撞、语义安全等特点的私钥,避免了未撤销用户私钥频繁更新的问题,极大地减小了用户的计算开销。理论分析与实验结果表明所提方案在DBDH(Decisional Bilinear Diffie-Hellman)假设下是选择明文攻击是安全的,且与类似属性基加密方案相比,所提方案效率更高,在功能上支持在线加密、高效的用户撤销并具有更低的计算开销和存储开销。

EHR临床检验结果共享的实现

为提高临床文档的利用率,满足随时随地获取患者临床信息的业务需求,在充分参考HL7RIM标准的基础上,遵循IHE实验室检验报告交易及互操作规范,利用SOA体系框架和WebServices技术,构建共享数据中心和共享临床检验结果CDA文档。实现了特定区域范围内的电子病历EHR临床检验结果的互联互通,为EHR临床文档的全面共享进行一次概念验证。

人工智能驱动档案数据智治探索——基于智慧医疗档案管理“提智增效”的考察

在数字化、网络化日益普及的今天,档案数据已不再是孤立、静态的信息孤岛,而是需要与其他数据资源进行整合、关联和共享的重要资产。本研究将关注人工智能技术在实现医疗档案数据与其他数据资源的互联互通、共建共享方面的作用和价值,探索构建基于人工智能的档案数据智治新模式。对人工智能在档案数据管理和应用中可能带来的挑战和风险进行深入剖析,并提出相应的应对策略和解决方案。

Using AI and Precision Nutrition to Support Brain Health during Aging

Artificial intelligence, often referred to as AI, is a branch of computer science focused on developing systems that exhibit intelligent behavior. Broadly speaking, AI researchers aim to develop technologies that can think and act in a way that mimics human cognition and decision-making [1]. The foundations of AI can be traced back to early philosophical inquiries into the nature of intelligence and thinking. However, AI is generally considered to have emerged as a formal field of study in the 1940s and 1950s. Pioneering computer scientists at the time theorized that it might be possible to extend basic computer programming concepts using logic and reasoning to develop machines capable of “thinking” like humans. Over time, the definition and goals of AI have evolved. Some theorists argued for a narrower focus on developing computing systems able to efficiently solve problems, while others aimed for a closer replication of human intelligence. Today, AI encompasses a diverse set of techniques used to enable intelligent behavior in machines. Core disciplines that contribute to modern AI research include computer science, mathematics, statistics, linguistics, psychology and cognitive science, and neuroscience. Significant AI approaches used today involve statistical classification models, machine learning, and natural language processing. Classification methods are widely applicable to problems in various domains like healthcare, such as informing diagnostic or treatment decisions based on patterns in data. Dean and Goldreich, 1998, define ML as an approach through which a computer has to learn a model by itself from the data provided but no specification on the sort of model is provided to the computer. They can then predict values for things that are different from the values used in training the models. NLP looks at two interrelated concerns, the task of training computers to understand human languages and the fact that since natural languages are so complex, they lend themselves very well to serving a number of very useful goals when used by computers.

面向医疗系统的区块链的可搜索加密方案

在云计算作为辅助的电子医疗系统中,患者的电子医疗记录(Electronic Healthcare Records,EHRs)通常会外包给云服务器提供商(Cloud Server Provider,CSP),其中EHRs一般会以加密的形式上传到云服务器,再通过可搜索加密方案进行搜索.然而,由于过度依赖于被认为可完全信任的中心化服务器,现有的大多数可搜索加密方案仍面临着严重的安全问题.论文提出了一个面向医疗系统的区块链的可搜索加密方案,它不仅可以确保EHRs的安全,还可以提高存储在云服务器上的密码文本的搜索效率.在方案中,患者可以利用智能合约构建自动执行与自动查找的算法,这使医生收到可信的、正确的搜索结果.同时,方案采用了基于关键词转换的高效的模糊多关键词可搜索加密,优化EHRs的提取方式进而减少计算开销.此外,方案做了安全性分析和性能评估,证明方案的有效性和安全性.

南京市电子病历文件管理系统国产商用密码应用改造实践

随着新兴技术在医疗行业的广泛应用,医疗卫生数据的价值凸显,安全挑战随之而来。如何实现医疗卫生领域密码应用的安全自主可控,推进建立卫生行业商用密码安全性应用的统一标准规范,成为医疗安全领域的重要议题。南京市卫生信息中心利用国产商用密码技术,以南京市电子病历文件管理系统为实践载体,从硬件、网络、设备、应用数据、密钥管理和部署等角度进行改造,建立了商用密码应用安全支撑体系,并通过安全性评估三级,可为各卫生机构数据安全和国产商用密码应用改造提供参考。

利用EHR／EMR数据的慢性病防控临床研究进展

介绍电子健康档案(EHR)和电子病历(EMR)的概念及其医疗应用,从横向研究、病例对照及前瞻性研究、精准医学研究3方面阐述目前国内外应用EHR/EMR数据进行慢性病防控的临床研究现状,为更好地应用医疗大数据进行医学研究做一些探索。

Unidirectional Identity-Based Proxy Re-Signature with Key Insulation in EHR Sharing System

The introduction of the electronic medical record(EHR)sharing system has made a great contribution to the management and sharing of healthcare data.Considering referral treatment for patients,the original signature needs to be converted into a re-signature that can be verified by the new organization.Proxy re-signature(PRS)can be applied to this scenario so that authenticity and nonrepudiation can still be insured for data.Unfortunately,the existing PRS schemes cannot realize forward and backward security.Therefore,this paper proposes the first PRS scheme that can provide key-insulated property,which can guarantee both the forward and backward security of the key.Although the leakage of the private key occurs at a certain moment,the forward and backward key will not be attacked.Thus,the purpose of key insulation is implemented.What’s more,it can update different corresponding private keys in infinite time periods without changing the identity information of the user as the public key.Besides,the unforgeability of our scheme is proved based on the extended Computational Diffie-Hellman assumption in the random oracle model.Finally,the experimental simulation demonstrates that our scheme is feasible and in possession of promising properties.

Earlier IV Fluid and Antibiotic Administration with an ED Electronic Sepsis Screening Tool

We set out to overcome barriers previously shown to impede sepsis therapy. Application of a universally standardized therapy model is an ongoing controversy. By taking advantage of the novel and adaptable aspects of a new technology, we predict that the introduction of an electronic health record based sepsis identification tool in the emergency department will aid clinicians in earlier implementation of sepsis directed therapy, namely intravenous fluids and antibiotics. A retrospective cohort study of 3,076 patients with the diagnosis of sepsis was performed. Patient charts were identified for this study who met the criteria of： _〉 18 years old; emergency department evaluation; ICD-9 code of sepsis, severe sepsis, or septic shock. Data was divided into two treatment groups, pre- and post-best practice advisory （BPA） sepsis identification tool. Our primary outcome was time to intravenous fluids and time to antibiotics administration. The secondary outcome of in-patient all-cause mortality was measured. 1,266 patients were treated prior to, and 1,810 treated after, the BPA implementation with a decrease in time to intravenous fluids from 34% to 49.9% of patient receiving treatment in the first 60 min of emergency department arrival （difference of 15.9%; P 〈 0.05）. The time to administration of antibiotics in the first 180 min of arrival improved from 40.3% to 56.8% （difference of 16.5%; P 〈 0.05）. Secondarily, we found that in-patient mortality improved from 10.5% to 7.5%, pre- and post BPA respectively （difference of 3%; P 〈 0.05）. Our study has demonstrated that the implementation of an active electronic health record screen tool that alerts clinicians to the possibility of sepsis may improve the time to initiate fluid blouses and antibiotics, and may lead to improved outcomes.

EHR Technology： Improvement Review of a Small Rural Hospital

The focus of this study was to examine the technology improvements in a small rural hospital preparing to implement the first two stages of Health Information Technology for Economic and Clinical Health （HITECH） [ 1 ] in their organization. The existing hospital organization＇s health information technology （HIT） is on a continuum between a traditional system and one that can support evidence-based clinical decisions. A methodology based on hierarchy and experience, is routine and relies upon trial, and error is a traditional approach [2]. Prior experience with Electronic Health Records/Health Information Management Systems （EHR/HIMS） improvements in this hospital lacked a systematic evidence-based approach leading to inoperability and security concerns. Future improvements include adoption of nationally recognized standards for HIT protocols and planning incorporates a process to test improvements and upgrades with feedback from end-users prior to initiating full scale operations.

电子健康档案标准符合性测试研究

电子健康档案标准符合性测试是为了推动卫生信息标准化,加快卫生信息标准的宣贯和落地实施。全文分析了电子健康档案信息标准符合性测试的研究背景,确定了标准符合性测试研究的目的、策略和基本原则。通过标准符合性测试方法研究,提出了标准符合性测试技术主要是人工评审和自动化测试两类;测试流程包括测试申请、测试准备、测试实施和测试评级四个阶段。通过标准符合性测试研究和预测试,了解卫生信息标准的应用状况,推进卫生信息标准的落地实施,完善卫生信息标准体系,为实现卫生信息的互联互通和规范化健康档案建设提供支持和保障。

电子健康档案数据分析应用总体框架研究

梳理电子健康档案数据分析应用的内涵,在对国内外电子健康档案数据分析应用现状进行总结的基础上,构建包含业务领域、分析主题、分析指标3个层次的电子健康档案数据分析应用总体框架,归纳出数据统计、数据分析、综合报告3种数据展现方式,指出大数据技术、数据仓库是实现电子健康档案数据分析应用的关键技术,最后提出电子健康档案分析利用相关建议。

社区健康管理平台及电子健康档案的建立和管理应用

分析我国电子健康档案建设存在的问题,介绍社区健康管理平台的构建基础和主要功能模块,并着重对其在居民电子健康档案的建立和管理中的应用进行详细展示说明,进一步展望社区健康管理平台的应用前景,指出其在合理有效利用卫生资源中具有重要的实践意义。

结构化电子病历数据录入方法

以HL7 CDA R2标准作为临床信息的结构化表达方式,提出了一种兼容标准术语的结构化录入(SDE)方法,用来解决由于标准术语的概念划分较粗,不足以通过标准术语编码的结构化内容重建自然语言满足临床日常信息交换需求的问题.该方法抛弃传统的通过标准化结构化结果重建叙述性内容的模式,采用同步生成叙述性内容和标准化结构化内容的模式,因而叙述性内容的生成不受限于结构化内容标准术语的概念划分,从而实现了在结构化数据录入中应用标准术语满足计算机可处理的同时满足临床日常工作对于自然语言信息的人工阅读需要.该方法为标准化结构化电子病历信息模型的数据获取兼容叙述性病历提供了一种新的解决思路.

基于联盟链的电子健康记录隐私保护和共享

医院正在逐渐采用电子健康记录(EHR)的方式去记录患者的医疗信息。然而,医疗数据的隐私性和EHR标准的差异化阻碍了医疗数据在病人和医院之间的共享。因此,针对隐私信息泄露和难于共享的问题,提出了一个基于联盟链的隐私保护数据共享模型。此外,基于匿名算法提出了(p,α,k)匿名隐私算法,能够解决EHR隐私信息泄露的问题。通过理论分析和实验证明,提出的基于联盟链和(p,α,k)隐私匿名算法模型能够在保护数据隐私的前提下,实现病人和医院之间的数据安全共享。对比前人的模型,该模型具有所需节点少、减少主链压力、容错性强和病人对EHR完全控制等优势。

电子健康档案实施障碍与管理

电子健康档案对缓解"看病难、看病贵"的重要意义,激发了全国多个城市进行电子健康档案实践,而理论尤其是管理优化理论研究的缺乏加大了投入巨大的电子档案的实施风险。明确目标,将目标分解到有关主体和行动,再具体分析行为和目标之间的桥梁和障碍,并削弱或者消除障碍,可以最大化电子健康档案的效用成本比。为此,夯实基础、动态推进以及积极引导是电子健康档案实施管理中的关键,也是值得进一步深入研究的系统工程。