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Journal of Dairy Science Jun 2006Replacing cows on a dairy is a major cost of operation. There is a need for the industry to adopt a more standardized approach to reporting the rate at which cows exit... (Review)
Review
Replacing cows on a dairy is a major cost of operation. There is a need for the industry to adopt a more standardized approach to reporting the rate at which cows exit from the dairy, and to reporting the reasons why cows are replaced and their destination as they exit the dairy. Herd turnover rate is recommended as the preferred term for characterizing the cows exiting a dairy, in preference to herd replacement rate, culling rate, or percent exiting, all of which have served as synonyms. Herd turnover rate should be calculated as the number of cows that exit in a defined period divided by the animal time at risk for the population being characterized. The terms voluntary and involuntary culling suffer from problems of definition and their use should be discouraged. Destination should be recorded for all cows that exit the dairy and opportunities to record one or more reasons for exiting should be provided by management systems. Comparing reported reasons between dairies requires considerable caution because of differences in case definitions and recording methods. Relying upon culling records to monitor disease has been and will always be an ineffective management strategy. Dairies are encouraged to record and monitor disease events and reproductive performance and use this information as the basis for management efforts aimed at reducing the need to replace cows.
Topics: Abattoirs; Animals; Cattle; Cattle Diseases; Commerce; Dairying; Female; Lactation; Mortality; Population Density; Records; Reproduction; Terminology as Topic
PubMed: 16702253
DOI: 10.3168/jds.S0022-0302(06)72257-3 -
Journal of the American Medical... Nov 2022Healthcare systems are hampered by incomplete and fragmented patient health records. Record linkage is widely accepted as a solution to improve the quality and...
Healthcare systems are hampered by incomplete and fragmented patient health records. Record linkage is widely accepted as a solution to improve the quality and completeness of patient records. However, there does not exist a systematic approach for manually reviewing patient records to create gold standard record linkage data sets. We propose a robust framework for creating and evaluating manually reviewed gold standard data sets for measuring the performance of patient matching algorithms. Our 8-point approach covers data preprocessing, blocking, record adjudication, linkage evaluation, and reviewer characteristics. This framework can help record linkage method developers provide necessary transparency when creating and validating gold standard reference matching data sets. In turn, this transparency will support both the internal and external validity of recording linkage studies and improve the robustness of new record linkage strategies.
Topics: Humans; Medical Record Linkage; Algorithms; Information Storage and Retrieval; Data Collection; Health Records, Personal
PubMed: 36305781
DOI: 10.1093/jamia/ocac175 -
The Journal of Nursing Research : JNR Jun 2019Most nursing records in Taiwan have been computerized, resulting in a large amount of unstructured text data. The quality of these records has rarely been discussed.
BACKGROUND
Most nursing records in Taiwan have been computerized, resulting in a large amount of unstructured text data. The quality of these records has rarely been discussed.
PURPOSE
This study used a text mining method to analyze the quality of a nursing record system to establish an auditing model and associated tools for nursing records, with the ultimate objective of improving the quality of electronic nursing records.
METHODS
This study utilized a retrospective method to collect the electronic nursing records of 6,277 patients who had been discharged from the internal medicine departments of a medical center in northern Taiwan from January to June 2014. SAS Enterprise Guide Version 6.1 and SAS Text Miner Version 13.2 software were used to perform text mining. Nursing experts were invited to examine the electronic nursing records. The text mining results were compared against a benchmark that was developed by the experts, and the efficiency of SAS Text Miner was examined using the criteria of specificity, sensitivity, and accuracy.
RESULTS
In this study, 27,356 nurse-formulated events were used in the analysis. The results of the nurse-formulated events showed an 8.08% similar error with system-formulated events, 29.72% were identified as necessary and appropriate names, 17.53% were retained, 10.15% involved error event names, and 34.52% were not classified. In this study, the sensitivity of SAS text mining in the training (testing) data set was 96% (95%), and the specificity and accuracy were both 99% (99%).
CONCLUSIONS
The results of this study show that text mining is an effective approach to auditing the quality of electronic nursing records. SAS Text Miner software was shown to identify inappropriate nursing record content quickly and efficiently. Furthermore, the results of this study may be included in in-service education teaching materials to promote the writing of better nursing records to improve the quality of electronic nursing records.
Topics: Data Mining; Humans; Medical Records Systems, Computerized; Nursing Records; Nursing Research; Outcome Assessment, Health Care; Retrospective Studies; Taiwan
PubMed: 30694223
DOI: 10.1097/jnr.0000000000000295 -
Computer Methods and Programs in... Mar 2022COVID-19, a serious infectious disease outbreak started in the end of 2019, has caused a strong impact on the overall medical system, which reflects the gap in the...
BACKGROUND AND OBJECTIVE
COVID-19, a serious infectious disease outbreak started in the end of 2019, has caused a strong impact on the overall medical system, which reflects the gap in the volume and capacity of medical services and highlights the importance of clinical data ex-change and application. The most important concerns of medical records in the medical field include data privacy, data correctness, and data security. By realizing these three goals, medical records can be made available to different hospital information systems to achieve the most complete medical care services. The privacy and protection of health data require detailed specification and usage requirements, which is particularly important for cross-agency data exchange.
METHODS
This research is composed of three main modules. "Combined Encryption and Decryption Architecture", which includes the hybrid double encryption mechanism of AES and RSA, and encrypts medical records to produce "Secured Encrypted Medical Record". "Decentralize EMR Repository", which includes data decryption and an exchange mechanism. After a data transmission is completed, the content verification and data decryption process will be launched to confirm the correctness of the data and obtain the data. A blockchain architecture is used to store the hash value of the encrypted EMR, and completes the correctness verification of the EMR after transmission through the hash value.
RESULTS
The results of this study provide an efficient triple encryption mechanism for electronic medical records. SEMRES ensures the correctness of data through the non-repudiation feature of a blockchain open ledger, and complete integrated information security protection and data verification architecture, in order that medical data can be exchanged, verified, and applied in different locations. After the patient receives medical services, the medical record is re-encrypted and verified and stored in the patient's medical record. The blockchain architecture is used to ensure the verification of non-repudiation of medical service, and finally to complete the payment for medical services.
CONCLUSIONS
The main aim of this study was to complete a security architecture for medical data, and develop a triple encryption authentication architecture to help data owners easily and securely share personal medical records with medical service personnel.
Topics: Blockchain; COVID-19; Computer Security; Electronic Health Records; Health Records, Personal; Humans; SARS-CoV-2
PubMed: 34999532
DOI: 10.1016/j.cmpb.2021.106595 -
Journal of the American Medical... 2014We conducted a systematic review to determine the effect of providing patients access to their medical records (electronic or paper-based) on healthcare quality, as... (Review)
Review
OBJECTIVES
We conducted a systematic review to determine the effect of providing patients access to their medical records (electronic or paper-based) on healthcare quality, as defined by measures of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.
METHODS
Articles indexed in PubMed from January 1970 to January 2012 were reviewed. Twenty-seven English-language controlled studies were included. Outcomes were categorized as measures of effectiveness (n=19), patient-centeredness (n=16), and efficiency (n=2); no study addressed safety, timeliness, or equity.
RESULTS
Outcomes were equivocal with respect to several aspects of effectiveness and patient-centeredness. Efficiency outcomes in terms of frequency of in-person and telephone encounters were mixed. Access to health records appeared to enhance patients' perceptions of control and reduced or had no effect on patient anxiety.
CONCLUSION
Although few positive findings generally favored patient access, the literature is unclear on whether providing patients access to their medical records improves quality.
Topics: Electronic Health Records; Health Records, Personal; Humans; Medical Records; Outcome Assessment, Health Care; Patient Access to Records; Patient Participation; Patient-Centered Care; Quality of Health Care
PubMed: 24154835
DOI: 10.1136/amiajnl-2013-002239 -
Clinical Medicine & Research Jun 2015Death certificates serve the critical functions of providing documentation for legal/administrative purposes and vital statistics for epidemiologic/health policy... (Review)
Review
Death certificates serve the critical functions of providing documentation for legal/administrative purposes and vital statistics for epidemiologic/health policy purposes. In order to satisfy these functions, it is important that death certificates be filled out completely, accurately, and promptly. The high error rate in death certification has been documented in multiple prior studies, as has the effectiveness of educational training interventions at mitigating errors. The following guide to death certification is intended to illustrate some basic principles and common pitfalls in electronic death registration with the goal of improving death certification accuracy.
Topics: Cause of Death; Death Certificates; Humans; Medical Errors; Medical Records Systems, Computerized; Registries; United States; Vital Statistics
PubMed: 26185270
DOI: 10.3121/cmr.2015.1276 -
Critical Care Medicine Mar 2019Incomplete patient data, either due to difficulty gathering and synthesizing or inappropriate data filtering, can lead clinicians to misdiagnosis and medical error. How... (Observational Study)
Observational Study
OBJECTIVES
Incomplete patient data, either due to difficulty gathering and synthesizing or inappropriate data filtering, can lead clinicians to misdiagnosis and medical error. How completely ICU interprofessional rounding teams appraise the patient data set that informs clinical decision-making is unknown. This study measures how frequently physician trainees omit data from prerounding notes ("artifacts") and verbal presentations during daily rounds.
DESIGN
Observational study.
SETTING
Tertiary academic medical ICU with an established electronic health record and where physician trainees are the primary presenters during daily rounds.
SUBJECTS
Presenters (medical student or resident physician), interprofessional rounding team.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We quantified the amount and types of patient data omitted from photocopies of physician trainees' artifacts and audio recordings of oral ICU rounds presentations when compared with source electronic health record data. An audit of 157 patient presentations including 6,055 data elements across nine domains revealed 100% of presentations contained omissions. Overall, 22.9% of data were missing from artifacts and 42.4% from presentations. The interprofessional team supplemented only 4.1% of additional available data. Frequency of trainee data omission varied by data type and sociotechnical factors. The strongest predictor of trainee verbal omissions was a preceding failure to include the data on the artifact. Passive data gathering via electronic health record macros resulted in extremely complete artifacts but paradoxically predicted greater likelihood of verbal omission when compared with manual notation. Interns verbally omitted the most data, whereas medical students omitted the least.
CONCLUSIONS
In an academic rounding model reliant on trainees to preview and select data for presentation during ICU rounds, verbal appraisal of patient data was highly incomplete. Additional trainee oversight and education, improved electronic health record tools, and novel academic rounding paradigms are needed to address this potential source of medical error.
Topics: Electronic Health Records; Humans; Intensive Care Units; Internship and Residency; Medical Audit; Students, Medical; Teaching Rounds
PubMed: 30585789
DOI: 10.1097/CCM.0000000000003557 -
Informatics in Primary Care 2010Data in medical records have in part been recorded in structured and coded forms for some decades. However, the patient history is as yet largely recorded in an uncoded...
BACKGROUND
Data in medical records have in part been recorded in structured and coded forms for some decades. However, the patient history is as yet largely recorded in an uncoded format. There is a need to consider the optimal balance of use of free text and coded data in the patient history. This review protocol summarises our plans to identify, critically appraise and synthesise evidence relating to approaches taken to introduce structure and coding within patient histories in electronic health records, and the empirically demonstrated benefits and risks of structuring and coding of patient histories in health records.
OBJECTIVES
To determine how structured and coded data are being introduced for the recording of patient histories, the benefits observed where structuring and coding have been introduced and the risks encountered when structuring and coding are introduced.
METHODS
We will search the following databases for evidence of published and unpublished material: CINAHL; EMBASE; Google Scholar; IndMED; LILACS; MEDLINE; NIHR; Paklit and PsycINFO. We will, depending on the study designs employed, use the Cochrane EPOC, Joanna Briggs Institute (JBI) and Newcastle-Ottawa instruments to critically appraise studies. Data synthesis is likely to be undertaken using a narrative approach, although meta-analysis will also be undertaken if appropriate and if the data allow this.
RESULTS
This protocol should represent a reproducible approach to reviewing the literature regarding structuring and coding in patient histories. We anticipate that we will be able to report results in early 2011.
CONCLUSION
The review should offer increased clarity and direction on the optimal balance between structuring/coding and free text recording of data relating to the patient history.
Topics: Humans; Information Storage and Retrieval; Medical Records Systems, Computerized; Risk Assessment
PubMed: 21396243
DOI: 10.14236/jhi.v18i3.772 -
BMC Medical Informatics and Decision... Dec 2022The introduction of information technology was one of the key priorities for policy-makers in health care organisations over the last two decades due to the potential...
INTRODUCTION
The introduction of information technology was one of the key priorities for policy-makers in health care organisations over the last two decades due to the potential benefits of this technology to improve health care services and quality. However, approximately 50% of those projects failed to achieve their intended aims. This was a result of several factors, including the cost of these projects. The Saudi Ministry of Health (MoH) planned to implement an electronic health record system (EHRS) in approximately 2100 primary health care centres nationwide. It was acknowledged that this project may face hurdles, which might result in the failure of the project if implementation facilitators were not first determined. According to the Saudi MoH, previous electronic health record system implementation in primary health care centres failed as a consequence of several barriers, such as poor infrastructure, lack of connectivity and lack of interoperability. However, the facilitators of successful electronic health record system implementation in Saudi primary health care centres are not understood.
AIM
To determine the facilitators that enhance the success of the implementation of an EHRS in public primary health care centres in SA.
METHOD
A mixed methods approach was used with both qualitative and quantitative methods (qualitative using semistructured interviews and quantitative with a closed survey). The purpose of the utilisation of exploratory mixed methods was to identify a wide range of facilitators that may influence EHRS implementation. The data were obtained from two different perspectives, primary health care centre practitioners and project team members. A total of 351 practitioners from 21 primary health care centres participated in the online survey, and 14 key informants at the Saudi Ministry of Health who were directly involved in the electronic health record system implementation in the primary health care centres agreed to be interviewed face to face.
RESULTS
The findings from both studies revealed several facilitators. Among these facilitators, financial resources were found to be the most influential factor that assisted in overcoming some barriers, such as software selection. The size of the primary health care centres was the second facilitator of successful implementation, despite the scale of the project. Perceived usefulness was another facilitator identified in both the interviews and the survey. More than 90% of the participants thought that the electronic health record system was useful and could contribute to improving the quality of health care services. While a high level of satisfaction was expressed towards the electronic health record system's usability and efficiency, low levels of satisfaction were recorded for organisational factors such as user involvement, training and support. Hence, system usability and efficiency were documented to be other facilitators of successful electronic health record system implementation in Saudi primary health care centres.
CONCLUSION
The findings of the present study suggest that sufficient financial support is essential to enhance the success of electronic health record system implementation despite the scale of the project. Additionally, effective leadership and project management are core factors to overcome many obstacles and ensure the success of large-scale projects.
Topics: Humans; Electronic Health Records; Saudi Arabia
PubMed: 36476224
DOI: 10.1186/s12911-022-02072-5 -
The Lancet. Public Health Apr 2017
Topics: Algorithms; Cohort Studies; Information Storage and Retrieval; Medical Record Linkage; Medical Records Systems, Computerized; Phoeniceae; Registries
PubMed: 29253446
DOI: 10.1016/S2468-2667(17)30044-0