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Yearbook of Medical Informatics May 2016Describe the state of Electronic Health Records (EHRs) in 1992 and their evolution by 2015 and where EHRs are expected to be in 25 years. Further to discuss the... (Review)
Review
OBJECTIVES
Describe the state of Electronic Health Records (EHRs) in 1992 and their evolution by 2015 and where EHRs are expected to be in 25 years. Further to discuss the expectations for EHRs in 1992 and explore which of them were realized and what events accelerated or disrupted/derailed how EHRs evolved.
METHODS
Literature search based on "Electronic Health Record", "Medical Record", and "Medical Chart" using Medline, Google, Wikipedia Medical, and Cochrane Libraries resulted in an initial review of 2,356 abstracts and other information in papers and books. Additional papers and books were identified through the review of references cited in the initial review.
RESULTS
By 1992, hardware had become more affordable, powerful, and compact and the use of personal computers, local area networks, and the Internet provided faster and easier access to medical information. EHRs were initially developed and used at academic medical facilities but since most have been replaced by large vendor EHRs. While EHR use has increased and clinicians are being prepared to practice in an EHR-mediated world, technical issues have been overshadowed by procedural, professional, social, political, and especially ethical issues as well as the need for compliance with standards and information security. There have been enormous advancements that have taken place, but many of the early expectations for EHRs have not been realized and current EHRs still do not meet the needs of today's rapidly changing healthcare environment.
CONCLUSION
The current use of EHRs initiated by new technology would have been hard to foresee. Current and new EHR technology will help to provide international standards for interoperable applications that use health, social, economic, behavioral, and environmental data to communicate, interpret, and act intelligently upon complex healthcare information to foster precision medicine and a learning health system.
Topics: Computer Systems; Decision Support Systems, Clinical; Electronic Health Records; Forecasting; History, 20th Century; History, 21st Century; Humans
PubMed: 27199197
DOI: 10.15265/IYS-2016-s006 -
Ciencia & Saude Coletiva Mar 2020Electronic medical records have been touted as a solution to many of the shortcomings of health care systems. The aim of this essay is to review pertinent literature and... (Review)
Review
Electronic medical records have been touted as a solution to many of the shortcomings of health care systems. The aim of this essay is to review pertinent literature and present examples and recommendations from several decades of experience in the use of medical records in primary health care, in ways that can help primary care doctors to organize their work processes to improve patient care. Considerable problems have been noted to result from a lack of interoperability and standardization of interfaces among these systems, impairing the effective collaboration and information exchange in the care of complex patients. It is extremely important that regional and national health policies be established to assure standardization and interoperability of systems. Lack of interoperability contributes to the fragmentation of the information environment. The electronic medical record (EMR) is a disruptive technology that can revolutionize the way we care for patients. The EMR has been shown to improve quality and reliability in the delivery of healthcare services when appropriately implemented. Careful attention to the impact of the EMR on clinical workflows, in order to take full advantage of the potential of the EMR to improve patient care, is the key lesson from our experience in the deployment and use of these systems.
Topics: Communication; Electronic Health Records; Health Information Exchange; Humans; Medication Errors; National Health Programs; Patient Care Team; Quality Improvement; Quality of Health Care; Registries; United States
PubMed: 32267432
DOI: 10.1590/1413-81232020254.28922019 -
Journal of Medical Internet Research Dec 2021Electronic records could improve quality and efficiency of health care. National and international bodies propagate this belief worldwide. However, the evidence base... (Review)
Review
BACKGROUND
Electronic records could improve quality and efficiency of health care. National and international bodies propagate this belief worldwide. However, the evidence base concerning the effects and advantages of electronic records is questionable. The outcome of health care systems is influenced by many components, making assertions about specific types of interventions difficult. Moreover, electronic records itself constitute a complex intervention offering several functions with possibly positive as well as negative effects on the outcome of health care systems.
OBJECTIVE
The aim of this review is to summarize empirical studies about the value of electronic medical records (EMRs) for hospital care published between 2010 and spring 2019.
METHODS
The authors adopted their method from a series of literature reviews. The literature search was performed on MEDLINE with "Medical Record System, Computerized" as the essential keyword. The selection process comprised 2 phases looking for a consent of both authors. Starting with 1345 references, 23 were finally included in the review. The evaluation combined a scoring of the studies' quality, a description of data sources in case of secondary data analyses, and a qualitative assessment of the publications' conclusions concerning the medical record's impact on quality and efficiency of health care.
RESULTS
The majority of the studies stemmed from the United States (19/23, 83%). Mostly, the studies used publicly available data ("secondary data studies"; 17/23, 74%). A total of 18 studies analyzed the effect of an EMR on the quality of health care (78%), 16 the effect on the efficiency of health care (70%). The primary data studies achieved a mean score of 4.3 (SD 1.37; theoretical maximum 10); the secondary data studies a mean score of 7.1 (SD 1.26; theoretical maximum 9). From the primary data studies, 2 demonstrated a reduction of costs. There was not one study that failed to demonstrate a positive effect on the quality of health care. Overall, 9/16 respective studies showed a reduction of costs (56%); 14/18 studies showed an increase of health care quality (78%); the remaining 4 studies missed explicit information about the proposed positive effect.
CONCLUSIONS
This review revealed a clear evidence about the value of EMRs. In addition to an awesome majority of economic advantages, the review also showed improvements in quality of care by all respective studies. The use of secondary data studies has prevailed over primary data studies in the meantime. Future work could focus on specific aspects of electronic records to guide their implementation and operation.
Topics: Delivery of Health Care; Electronic Health Records; Health Services; Hospitals; Humans; Quality of Health Care
PubMed: 34941544
DOI: 10.2196/26323 -
Journal of General Internal Medicine May 2018Clinician bias contributes to healthcare disparities, and the language used to describe a patient may reflect that bias. Although medical records are an integral method...
BACKGROUND
Clinician bias contributes to healthcare disparities, and the language used to describe a patient may reflect that bias. Although medical records are an integral method of communicating about patients, no studies have evaluated patient records as a means of transmitting bias from one clinician to another.
OBJECTIVE
To assess whether stigmatizing language written in a patient medical record is associated with a subsequent physician-in-training's attitudes towards the patient and clinical decision-making.
DESIGN
Randomized vignette study of two chart notes employing stigmatizing versus neutral language to describe the same hypothetical patient, a 28-year-old man with sickle cell disease.
PARTICIPANTS
A total of 413 physicians-in-training: medical students and residents in internal and emergency medicine programs at an urban academic medical center (54% response rate).
MAIN MEASURES
Attitudes towards the hypothetical patient using the previously validated Positive Attitudes towards Sickle Cell Patients Scale (range 7-35) and pain management decisions (residents only) using two multiple-choice questions (composite range 2-7 representing intensity of pain treatment).
KEY RESULTS
Exposure to the stigmatizing language note was associated with more negative attitudes towards the patient (20.6 stigmatizing vs. 25.6 neutral, p < 0.001). Furthermore, reading the stigmatizing language note was associated with less aggressive management of the patient's pain (5.56 stigmatizing vs. 6.22 neutral, p = 0.003).
CONCLUSIONS
Stigmatizing language used in medical records to describe patients can influence subsequent physicians-in-training in terms of their attitudes towards the patient and their medication prescribing behavior. This is an important and overlooked pathway by which bias can be propagated from one clinician to another. Attention to the language used in medical records may help to promote patient-centered care and to reduce healthcare disparities for stigmatized populations.
Topics: Attitude of Health Personnel; Female; Humans; Internship and Residency; Language; Male; Medical Records; Stereotyping; Students, Medical
PubMed: 29374357
DOI: 10.1007/s11606-017-4289-2 -
Journal of Medical Internet Research Apr 2019Engaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by...
BACKGROUND
Engaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication.
OBJECTIVE
The aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research.
METHODS
A systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed).
RESULTS
The systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients' privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes.
CONCLUSIONS
While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.
Topics: Electronic Health Records; Humans; Inpatients; Patient Participation; Patient Portals; Qualitative Research
PubMed: 30973347
DOI: 10.2196/12779 -
Journal of Korean Medical Science Sep 2019
Topics: Humans; Pregnancy; Insurance, Health; Medical Records; Quality of Health Care; Republic of Korea; Spondylitis, Ankylosing; Female
PubMed: 31559712
DOI: 10.3346/jkms.2019.34.e244 -
Journal of Medical Toxicology :... Sep 2018
Topics: Biomedical Research; Humans; Medical Records; Periodicals as Topic; Toxicology
PubMed: 30066311
DOI: 10.1007/s13181-018-0678-0 -
JAMA Network Open Aug 2023Despite the large health burden, reliable data on sepsis epidemiology are lacking; studies using International Statistical Classification of Diseases and Related Health... (Observational Study)
Observational Study
IMPORTANCE
Despite the large health burden, reliable data on sepsis epidemiology are lacking; studies using International Statistical Classification of Diseases and Related Health Problems (ICD)-coded hospital discharge diagnosis for sepsis identification suffer from limited sensitivity. Also, ICD data do not allow investigation of underlying pathogens and antimicrobial resistance.
OBJECTIVES
To generate reliable epidemiological estimates by linking data from a population-based database to a reference standard of clinical medical record review.
DESIGN, SETTING, AND PARTICIPANTS
This was a retrospective, observational cohort study using a population-based administrative database including all acute care hospitals of the Scania region in Sweden in 2019 and 2020 to identify hospital-treated sepsis cases by ICD codes. From this database, clinical medical records were also selected for review within 6 strata defined by ICD discharge diagnosis (both with and without sepsis diagnosis). Data were analyzed from April to October 2022.
MAIN OUTCOMES AND MEASURES
Hospital and population incidences of sepsis, case fatality, antimicrobial resistance, and temporal dynamics due to COVID-19 were assessed, as well as validity of ICD-10 case identification methods compared with the reference standard of clinical medical record review.
RESULTS
Out of 295 531 hospitalizations in 2019 in the Scania region of Sweden, 997 patient medical records were reviewed, among which 457 had sepsis according to clinical criteria. Of the patients with clinical sepsis, 232 (51%) were female, and 357 (78%) had at least 1 comorbidity. The median (IQR) age of the cohort was 76 (67-85) years. The incidence of sepsis in hospitalized patients according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in 2019 was 4.1% (95% CI, 3.6-4.5) by medical record review. This corresponds to an annual incidence rate of 747 (95% CI, 663-832) patients with sepsis per 100 000 population. No significant increase in sepsis during the COVID-19 pandemic nor a decrease in sepsis incidence when excluding COVID-19 sepsis was observed. Few sepsis cases caused by pathogens with antimicrobial resistance were found. The validity of ICD-10-based case identification in administrative data was low.
CONCLUSIONS AND RELEVANCE
In this cohort study of sepsis epidemiology, sepsis was a considerable burden to public health in Sweden. Supplying administrative data with information from clinical medical records can help to generate reliable data on sepsis epidemiology.
Topics: Humans; Female; Aged; Aged, 80 and over; Male; Incidence; Cohort Studies; Pandemics; COVID-19; Sepsis; Medical Records; Anti-Infective Agents
PubMed: 37642964
DOI: 10.1001/jamanetworkopen.2023.31168 -
Journal of Digital Imaging Feb 2015In the era of health information exchanges, there are trade-offs to consider when sharing a patient's medical record among all providers that a patient might choose.... (Review)
Review
In the era of health information exchanges, there are trade-offs to consider when sharing a patient's medical record among all providers that a patient might choose. Exchange among in-network partners on the same electronic medical records (EMR) and other integrated information systems is trivial. The patient identifier is common, as are the relevant departmental systems, to all providers. Difficulties arise when patient records including images (and reports) must be shared among different networks and even with the patients themselves. The National Institutes of Health (NIH) challenged Radiological Society of North America (RSNA) to develop a transport method that could supersede the need for physical media (for patients or other providers), replace point-to-point private networks among providers, and enable image exchange on an ad hoc basis between arbitrary health networks without long legal delays. In concert with the evolving US health care paradigm, patient engagement was to be fundamental. With Integrating Healthcare Enterprise's (IHE's) help, the challenge has been met with an operational system.
Topics: Computer Communication Networks; Electronic Health Records; Humans; Information Dissemination; North America; Radiology; Societies, Medical; Systems Integration
PubMed: 25037586
DOI: 10.1007/s10278-014-9714-z -
Journal of Innovation in Health... Apr 2018Lawrence Weed proposed we develop computerised, problem orientated medical records that guide and teach. The Bawa-Garba case outcomes might have been different if care...
Lawrence Weed proposed we develop computerised, problem orientated medical records that guide and teach. The Bawa-Garba case outcomes might have been different if care had been supported by computerised medical record (CMR) systems. CMR systems can reduce prescribing errors and could be develop to flag gaps in supervision. However, CMR systems are not a panacea and need to be fit for purpose. Our informatics perspective on this case is to call for widespread use of CMR systems - designed to guide and protect.
Topics: Child; Humans; Male; Malpractice; Medical Errors; Medical Order Entry Systems; Medical Records Systems, Computerized; Quality Improvement; Risk Management
PubMed: 29717955
DOI: 10.14236/jhi.v25i1.1040