-
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 -
International Journal of Medical... Dec 2020To summarize the findings from literature reviews with a view to identifying and exploring the key factors which impact on the success of an EHR implementation across... (Review)
Review
AIM
To summarize the findings from literature reviews with a view to identifying and exploring the key factors which impact on the success of an EHR implementation across different healthcare contexts.
INTRODUCTION
Despite the widely recognised benefits of electronic health records (EHRs), their full potential has not always been achieved, often as a consequence of the implementation process. As more countries launch national EHR programmes, it is critical that the most up-to-date and relevant international learnings are shared with key stakeholders.
METHODS
A rapid umbrella review was undertaken in collaboration with a multidisciplinary panel of knowledge-users and experts from Ireland. A comprehensive literature review was completed (2019) across several search engines (PubMed, CINAHL, Scopus, Embase, Web of Science, IEEE Xplore, ACM Digital Library, ProQuest, Cochrane) and Gray literature. Identified studies (n = 5,040) were subject to eligibility criterion and identified barriers and facilitators were analysed, reviewed, discussed and interpreted by the expert panel.
RESULTS
Twenty-seven literature reviews were identified which captured the key organizational, human and technological factors for a successful EHR implementation according to various stakeholders across different settings. Although the size, type and culture of the healthcare setting impacted on the organizational factors, each was deemed important for EHR success; Governance, leadership and culture, End-user involvement, Training, Support, Resourcing, and Workflows. As well as organizational differences, individual end-users have varying Skills and characteristics, Perceived benefits and incentives, and Perceived changes to the health ecosystem which were also critical to success. Finally, the success of the EHR technology depended on Usability, Interoperability, Adaptability, Infrastructure, Regulation, standards and policies, and Testing.
CONCLUSION
Fifteen inter-linked organizational, human and technological factors emerged as important for successful EHR implementations across primary, secondary and long-term care settings. In determining how to employ these factors, the local context, individual end-users and advancing technology must also be considered.
Topics: Ecosystem; Electronic Health Records; Humans; Ireland; Long-Term Care
PubMed: 33017724
DOI: 10.1016/j.ijmedinf.2020.104281 -
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 -
British Journal of Haematology Jan 2021Digitalization of the medical record and integration of genomic methods into clinical practice have resulted in an unprecedented wealth of data. Machine learning is a... (Review)
Review
Digitalization of the medical record and integration of genomic methods into clinical practice have resulted in an unprecedented wealth of data. Machine learning is a subdomain of artificial intelligence that attempts to computationally extract meaningful insights from complex data structures. Applications of machine learning in haematological scenarios are steadily increasing. However, basic concepts are often unfamiliar to clinicians and investigators. The purpose of this review is to provide readers with tools to interpret and critically appraise machine learning literature. We begin with the elucidation of standard terminology and then review examples in haematology. Guidelines for designing and evaluating machine-learning studies are provided. Finally, we discuss limitations of the machine-learning approach.
Topics: Computational Biology; Hematology; Humans; Machine Learning; Medical Records
PubMed: 32602593
DOI: 10.1111/bjh.16915 -
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 -
Romanian Journal of Ophthalmology 2020There are some questions that have to be asked when considering if EMR is suitable for a National Health System: First the Viability, Reliability, and Integrity of the... (Review)
Review
There are some questions that have to be asked when considering if EMR is suitable for a National Health System: First the Viability, Reliability, and Integrity of the EMR. When thinking about EMR, it has to be compounded based on some standards, that can be taken from other Health Systems or own. Secondly, the proper type of Ophthalmic EMC System (Web based EMR/ Client Server EMR) should be taken into consideration. Another question that raises is if EMR can not only be specialized in Ophthalmology, but also Subspecialties such as Glaucoma, Retina and other. This offers a possibility of completing a Database that can be used for Studies and Audit and improve the Health System. Using EMR can also offer accurate data that can estimate the prevalence of some specific conditions and rare diseases.
Topics: Databases, Factual; Delivery of Health Care; Electronic Health Records; Humans; National Health Programs; Ophthalmology; Reproducibility of Results
PubMed: 32292853
DOI: No ID Found -
JCO Oncology Practice Mar 2021
Topics: Burnout, Professional; Burnout, Psychological; Documentation; Electronic Health Records; Humans
PubMed: 33332173
DOI: 10.1200/OP.20.00832 -
Journal of the American Board of Family... 2020This special issue contains several articles on well-being. Not surprisingly, many of these articles are specifically about burnout. The evidence shows differences in...
This special issue contains several articles on well-being. Not surprisingly, many of these articles are specifically about burnout. The evidence shows differences in the rates of burnout between men and women family physicians as well as their responses. Clinical team structure and organizational change also contribute to burnout. What about the electronic medical record? We are also reminded that burnout is an international issue. There are also several articles on how technology is changing the way family physicians practice. Two articles report on issues regarding screening for frequently seen clinical entities, specifically breast cancer and alcohol misuse. There are also articles looking at the cost of medical assistant turnover in practices, the impact of continuity with a provider on the retention of patients in clinical trials, and much more of interest to family physicians.
Topics: Burnout, Professional; Electronic Health Records; Female; Humans; Male; Organizational Innovation; Personnel Turnover; Physicians, Family
PubMed: 32430363
DOI: 10.3122/jabfm.2020.03.200105 -
Journal of Medical Internet Research Dec 2022Personal electronic health records (PEHRs) allow patients to view, generate, and manage their personal and medical data that are relevant across illness episodes, such... (Review)
Review
BACKGROUND
Personal electronic health records (PEHRs) allow patients to view, generate, and manage their personal and medical data that are relevant across illness episodes, such as their medications, allergies, immunizations, and their medical, social, and family health history. Thus, patients can actively participate in the management of their health care by ensuring that their health care providers have an updated and accurate overview of the patients' medical records. However, the uptake of PEHRs remains low, especially in terms of patients entering and managing their personal and medical data in their PEHR.
OBJECTIVE
This scoping review aimed to explore the barriers and facilitators that patients face when deciding to review, enter, update, or modify their personal and medical data in their PEHR. This review also explores the extent to which patient-generated and -managed data affect the quality and safety of care, patient engagement, patient satisfaction, and patients' health and health care services.
METHODS
We searched the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, and Google Scholar web-based databases, as well as reference lists of all primary and review articles using a predefined search query.
RESULTS
Of the 182 eligible papers, 37 (20%) provided sufficient information about patients' data management activities. The results showed that patients tend to use their PEHRs passively rather than actively. Patients refrain from generating and managing their medical data in a PEHR, especially when these data are complex and sensitive. The reasons for patients' passive data management behavior were related to their concerns about the validity, applicability, and confidentiality of patient-generated data. Our synthesis also showed that patient-generated and -managed health data ensures that the medical record is complete and up to date and is positively associated with patient engagement and patient satisfaction.
CONCLUSIONS
The findings of this study suggest recommendations for implementing design features within the PEHR and the construal of a dedicated policy to inform both clinical staff and patients about the added value of patient-generated data. Moreover, clinicians should be involved as important ambassadors in informing, reminding, and encouraging patients to manage the data in their PEHR.
Topics: Humans; Electronic Health Records; Health Records, Personal; Patients; Patient Participation; Health Personnel
PubMed: 36574275
DOI: 10.2196/37783