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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 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 -
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 -
Sensors (Basel, Switzerland) Nov 2021With the popularity of the internet 5G network, the network constructions of hospitals have also rapidly developed. Operations management in the healthcare system is...
With the popularity of the internet 5G network, the network constructions of hospitals have also rapidly developed. Operations management in the healthcare system is becoming paperless, for example, via a shared electronic medical record (EMR) system. A shared electronic medical record system plays an important role in reducing diagnosis costs and improving diagnostic accuracy. In the traditional electronic medical record system, centralized database storage is typically used. Once there is a problem with the data storage, it could cause data privacy disclosure and security risks. Blockchain is tamper-proof and data traceable. It can ensure the security and correctness of data. Proxy re-encryption technology can ensure the safe sharing and transmission of relatively sensitive data. Based on the above situation, we propose an electronic medical record system based on consortium blockchain and proxy re-encryption to solve the problem of EMR security sharing. Electronic equipment in this process is connected to the blockchain network, and the security of data access is ensured through the automatic execution of blockchain chaincodes; the attribute-based access control method ensures fine-grained access to the data and improves the system security. Compared with the existing electronic medical records based on cloud storage, the system not only realizes the sharing of electronic medical records, but it also has advantages in privacy protection, access control, data security, etc.
Topics: Blockchain; Cloud Computing; Computer Security; Electronic Health Records; Technology
PubMed: 34833841
DOI: 10.3390/s21227765 -
International Journal For Quality in... Dec 2022To explore the application of diagnosis-related groups (DRGs) in hospital medical record management and the impact on service quality.
BACKGROUND
To explore the application of diagnosis-related groups (DRGs) in hospital medical record management and the impact on service quality.
OBJECTIVE
This study introduced DGRs management into hospital medical record management in order to improve the quality of hospital medical record management.
METHOD
The medical record management of our hospital was analysed retrospectively between August 2020 and April 2021. A total of 7263 cases without DRG management before January 2021 were included in a control group, and 7922 cases with DRG management after January 2021 were included in a study group. The error rate of medical records, the specific error items and the scores of service capability, service efficiency and service quality were compared along with the comprehensive scores of the two groups.
RESULTS
The error rate of medical records in the study group was significantly lower than that in the control group (19.35% vs. 31.24%, P < 0.05). The error rates in terms of diagnosis on admission, surgical procedures, main diagnosis and other diagnoses in the study group were significantly lower than those in the control group. The scores for service ability, service efficiency and service quality were significantly higher in the study group than in the control group (P < 0.05). The comprehensive evaluation score of the study group was significantly higher than that of the control group (P < 0.01).
CONCLUSION
Applying DRGs in the hospital medical record management can effectively reduce the error rate of medical records and improve the quality of hospital services.
Topics: Humans; Retrospective Studies; Diagnosis-Related Groups; Medical Records; Hospitals; Hospitalization
PubMed: 36373874
DOI: 10.1093/intqhc/mzac090 -
Clinical Journal of the American... Jul 2020An unintended consequence of electronic medical record use in the United States is the potential effect on graduate physician training. We assessed educational burdens...
BACKGROUND AND OBJECTIVES
An unintended consequence of electronic medical record use in the United States is the potential effect on graduate physician training. We assessed educational burdens and benefits of electronic medical record use on United States nephrology fellows by means of a survey.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
We used an anonymous online opinion survey of all United States nephrology program directors (=148), their faculty, and fellows. Program directors forwarded survey links to fellows and clinical faculty, indicating to how many they forwarded the link. The three surveys had parallel questions to permit comparisons.
RESULTS
Twenty-two percent of program directors (=33) forwarded surveys to faculty (=387) and fellows (=216; 26% of United States nephrology fellows). Faculty and fellow response rates were 25% and 33%, respectively; 51% of fellows agreed/strongly agreed that the electronic medical record contributed positively to their education. Perceived positive effects included access flexibility and ease of obtaining laboratory/radiology results. Negative effects included copy-forward errors and excessive, irrelevant documentation. Electronic medical record function was reported to be slow, disrupted, or completely lost monthly or more by >40%, and these were significantly less likely to agree that the electronic medical record contributed positively to their education. Electronic medical record completion time demands contributed to fellow reluctance to do procedures (52%), participate in conferences (57%), prolong patient interactions (74%), and do patient-directed reading (55%). Sixty-five percent of fellows reported often/sometimes exceeding work-hours limits due to documentation time demands; 85% of faculty reported often/sometimes observing copy-forward errors. Limitations include potential nonresponse and social desirability bias.
CONCLUSIONS
Respondents reported that the electronic medical record enhances fellow education with efficient and geographically flexible patient data access, but the time demands of data and order entry reduce engagement in educational activities, contribute to work-hours violations, and diminish direct patient interactions.
Topics: Attitude of Health Personnel; Education, Medical, Graduate; Electronic Health Records; Faculty, Medical; Fellowships and Scholarships; Humans; Medical Records Systems, Computerized; Nephrology; Physician-Patient Relations; Surveys and Questionnaires; Time Factors; United States; Workload
PubMed: 32576553
DOI: 10.2215/CJN.14191119 -
Journal of Digital Imaging Oct 2016Care providers today routinely obtain valuable clinical multimedia with mobile devices, scope cameras, ultrasound, and many other modalities at the point of care. Image... (Review)
Review
Care providers today routinely obtain valuable clinical multimedia with mobile devices, scope cameras, ultrasound, and many other modalities at the point of care. Image capture and storage workflows may be heterogeneous across an enterprise, and as a result, they often are not well incorporated in the electronic health record. Enterprise Imaging refers to a set of strategies, initiatives, and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange, and analyze all clinical imaging and multimedia content to enhance the electronic health record. This paper is intended to introduce Enterprise Imaging as an important initiative to clinical and informatics leadership, and outline its key elements of governance, strategy, infrastructure, common multimedia content, acquisition workflows, enterprise image viewers, and image exchange services.
Topics: Decision Making; Diagnostic Imaging; Electronic Health Records; Humans; Medical Records; Multimedia; Workflow
PubMed: 27245774
DOI: 10.1007/s10278-016-9882-0 -
Journal of the American Medical... 2011Electronic personal health record systems (PHRs) support patient centered healthcare by making medical records and other relevant information accessible to patients,... (Review)
Review
Electronic personal health record systems (PHRs) support patient centered healthcare by making medical records and other relevant information accessible to patients, thus assisting patients in health self-management. We reviewed the literature on PHRs including design, functionality, implementation, applications, outcomes, and benefits. We found that, because primary care physicians play a key role in patient health, PHRs are likely to be linked to physician electronic medical record systems, so PHR adoption is dependent on growth in electronic medical record adoption. Many PHR systems are physician-oriented, and do not include patient-oriented functionalities. These must be provided to support self-management and disease prevention if improvements in health outcomes are to be expected. Differences in patient motivation to use PHRs exist, but an overall low adoption rate is to be expected, except for the disabled, chronically ill, or caregivers for the elderly. Finally, trials of PHR effectiveness and sustainability for patient self-management are needed.
Topics: Canada; Electronic Health Records; Health Records, Personal; Humans; Outcome and Process Assessment, Health Care; Patient Acceptance of Health Care; Patient Satisfaction; Practice Patterns, Physicians'; United States; User-Computer Interface
PubMed: 21672914
DOI: 10.1136/amiajnl-2011-000105