Patient access to electronic health records: Differences across ten countries

Objectives

Patient-accessible electronic health records (PAEHRs) are being implemented at international scale. Comparing policies and systems could allow countries to learn from each other to address global and nation-specific challenges. We compare national PAEHR policy (hard and soft regulation) and services in 10 countries.

基于医学本体的电子病历结构化数据采集研究

目的：对临床描述性信息结构化录入程序（SDE）进行再开发，建立基于医学本体的临床信息结构化采集模型和应用框架。方法：使用0penSDE建立临床医学信息域本体模型，主要是患者病程病史、检查检验等医学术语概念及它们的内容描述，并建立树型结构框架。结果：建立了基于医学本体模型的可扩展临床电子数据采集系统。结论：其结构化可选式数据录入对基于电子病历的临床决策有重要意义。     

电子病案的建立和管理

近 2 0多年来 ,电子病案在发达国家有较多的研究和应用。而在国内有的大医院也已开始研究和试用。作者论述了电子病案在开发和应用中一是做好电子病案的建立过程及输入要求 ,二是阐述了使用电子病案中的分级保密管理、查阅授权、输入授权、修改授权、以及电子病案的使用范围、方式、规定、注意事项等     

A comparison of electronic records to paper records in mental health centers.

OBJECTIVE: Medication documentation is a critical aspect of quality patient care. The current study examined whether electronic medical records provide medication documentation that is more complete and faster to retrieve than traditional paper records. METHOD: This study involves a comparison of archived paper medical records to recent electronic medical records through chart review. A convenient sample of three large community mental health centers in Indiana was used. Medical charts for 180 patients with schizophrenia were rated on a checklist composed of 16 items that was adapted from a national project. Documentation that existed before implementation of the electronic medical record system was compared with that after implementation at each of the three centers. The main outcome measures were completeness and retrieval time of medication documentation. RESULTS: Electronic medical records provided medication documentation that was more complete and faster to retrieve than paper records across all centers and within each center. On average, electronic medical records were 40% more complete and 20% faster to retrieve. CONCLUSION: Electronic records have potential to improve medication management for patients in mental health centers over traditional records. However, medication documentation for patients diagnosed with schizophrenia was found to be deficient in many areas, regardless of documentation format.     

Trust in government and support for governmental regulation: the case of electronic health records

Background

This paper presents results from a public engagement effort in Nebraska, USA, which measured public opinions about governmental involvement in encouraging the use of electronic health records (EHRs).

Objective

We examine the role of trust in government in contributing to public support for government involvement in the development of EHR technologies. We hypothesize that trust in government will lead to support for federal and state governmental encouragement of the use of EHRs among doctors and insurance companies. Further, because individual experiences with health‐care professionals will reduce perceptions of risk, we expect that support for governmental involvement will be tempered by greater personal experience with the health‐care industry.

Design and Results

Examining a small survey of individuals on the issue, we find general support for both of our hypotheses. The findings suggest that trust in government does have a positive relationship with support for government involvement in the policy domain, but that the frequency of personal experiences with health‐care providers reduces the extent to which the public supports governmental involvement in the development of EHR technology.

Discussion and Conclusion

This inquiry contributes to our understanding of public attitudes towards government involvement in EHRs in the United States specifically and contributes to social science examining links between trust in government and support for governmental activity in the emerging policy domain regarding electronic health records systems.     

数字化医院提高电子病历质量的方法

电子病历是数字化医院的重要标志之一,其质量至关重要。提出了电子病历目前存在的问题,有针对性地提出解决对策,包括增加电子储贮内容,力争与纸质病历相同;强化规章制度管理,确保电子病历安全性;提高电子病历"三性",最大限度保障法律地位;定期维护相关数据,满足"以人为本"要求;加大质量监管力度,全面提升病案质量。只有电子病历质量提高,医院方能健康全面发展。     

浅析电子病案质量管理

电子病案质量是医院信息化管理工作的重要组成部分。本文阐述我院电子病案质量管理存在的问题,提出完善电子病案质量管理的对策。     

谈医疗设备档案的建立与管理

本文结合医院实际，论证了医疗设备档案在医院的必要性，并详细介绍了在各个阶段，如何建立和管理医疗设备档案。     

电子病历实现技术分析

本文介绍了电子病历的组元分类,病历段,病历书写器和打印格式,病历的保密和检索方法。     

上海市电子病历应用调查报告

通过对上海市22家医院电子病历应用情况进行的调查,发现目前上海市目前电子病历已经进入到实际应用阶段,但应用层次仍然较低。主要原因是缺少法律和政策支持、电子病历法律地位尚不明确和安全管理不到位。汇总了医疗人员对电了病历应用的优缺点的认识,并对电子病历的推广应用提出了建议。     

利用RAMDISK技术提高电子病历系统的文件访问性能

目的：为了解决制约电子病历系统文件访问速度的瓶颈,通过技术手段提高电子病历系统的文件访问性能。方法：通过改变电子病历的存储架构,采用内存磁盘（RAMDISK）技术,将电子病历文件放置在内存虚拟磁盘,优化系统的整体性能,并通过备份等手段确保系统的数据安全。结果：电子病历系统的磁盘读写速度得到了较大提升。结论：通过采用RAMDISK技术,突破了原有系统中的数据读写瓶颈,使电子病历的整体性能得到了明显提升。     

电子病历系统的建立及临床信息整合

介绍了以基于XML技术的住院电子病历为基础,以病人诊疗信息为主线,集成医嘱、门诊、PACS与医技检查、检验、护理记录、传染病与医院感染报告、抗生素控制审批、药物知识库等信息的电子病历系统的实现方法,以电子病历为载体实现了临床信息的整合.系统的应用为医生提供多角度、广视野、超越纸质病历的掌握病人病情的有效工具,有利于医生对病人的诊断与治疗;提高医护人员工作效率,优化医院工作流程,减少差错发生,促进医疗质量的提高;构建了病历质量实时控制体系,提高了管理效率与质量.     

Evidence for improved patient management through electronic patient records at a Central Australian Aboriginal Health Service

Aim : To examine chronic disease (CD)‐related clinical activity and outcomes associated with introduction of a more systematic approach to chronic disease care in a remote Aboriginal community, using data from Communicare patient record management system. Methods : We examined CD process measures, outcomes and clinical profiles in adults age 15+ years from Communicare data and compared results for two intervals. Process measures were clinic visits and proportions of eligible patients with recorded CD‐related procedures or diagnostic tests. Outcome measures were results of CD care items and CD morbidities. Data in the interval 2007–2009 were compared with data from 2009 to 2011, in which an intensified CD program was conducted in the clinic by its own staff. Results : About one‐third of adult visits were related to CD care; CD‐cycle of care encounters increased significantly in the second interval, from 3.2% to 9.1%, and proportions of adults having CD‐related procedures or tests were also higher. For already commonly performed items, like blood pressure, weight and lipids, proportions of adults tested were 30–50% higher in the second interval, while proportions tested for more recently emphasised items, like waist, HbA1C, urine ACR, rose by more than 200%. Levels of SBP, DBP, HbA1c and HDL‐C significantly improved in the second interval. Proportions of adults with clinical values outside normal ranges decreased for at least half of observations. Conclusions : Parameters of CD care activities and outcomes have increased significantly over the last four years in this setting, accompanied by stabilisation of or improvement in outcomes.     

Patients' perceptions of their doctors' notes and after‐visit summaries: A mixed methods study of patients at safety‐net clinics

Background

Patients are increasingly offered electronic access to their doctors' notes, and many consistently receive paper After‐Visit Summaries. Specific feedback from patients about notes and summaries are lacking, particularly within safety‐net settings.

Design

A mixed methods study

Setting and Participants

Patients with poorly controlled diabetes attending two urban safety‐net primary care clinics in Washington State.

Methods

Patients read their own most recent clinic note and After‐Visit Summary, then completed a brief survey followed by a focus group discussion (3 groups in a large general medicine teaching clinic and 1 in an HIV/AIDS clinic) about their perceptions of the clinic note and After‐Visit Summary.

Results

Twenty‐seven patients participated; 70% were male, 41% were Black, 48% were unemployed or disabled, 56% reported fair/poor health, and 37% had accessed the electronic patient portal. A majority of patients felt their note content was useful (89%); a minority reported that their notes were not accurate (19%), had too much medical jargon (29%), or were too long (26%). Themes identified from the discussions included reliance on the provider to explain confusing content; a desire for more rather than less detail; and perceived inaccuracies, particularly in heavily templated notes. In each focus group, one or more portal users were enthusiastically willing to teach other patients.

Conclusions

The majority of focus group participants at this safety‐net site had not accessed the electronic patient portal, but those who had were willing to promote the portal benefits and assist others. Patients identified specific opportunities to improve clinic notes and After‐Visit Summaries.     

Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Integration of electronic health records (EHRs) in the national health care systems of low‐ and middle‐income countries (LMICs) is vital for achieving the United Nations Sustainable Development Goal of ensuring healthy lives and promoting well‐being for all people of all ages. National EHR systems are increasing, but mostly in developed countries. Besides, there is limited research evidence on successful strategies for ensuring integration of national EHRs in the health care systems of LMICs. To fill this evidence gap, a comprehensive survey of literature was conducted using scientific electronic databases—PubMed, SCOPUS, Web of Science, and Global Health—and consultations with international experts. The review highlights the lack of evidence on strategies for integrating EHR systems, although there was ample evidence on implementation challenges and relevance of EHRs to vertical disease programs such as HIV. The findings describe the narrow focus of EHR implementation, the prominence of vertical disease programs in EHR adoption, testing of theoretical and conceptual models for EHR implementation and success, and strategies for EHR implementation. The review findings are further amplified through examples of EHR implementation in Sierra Leone, Malawi, and India. Unless evidence‐based strategies are identified and applied, integration of national EHRs in the health care systems of LMICs is difficult.     

Faculty attitudes towards medical communication and their perceptions of students' communication skills training at Dalhousie University

SETTING: Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. OBJECTIVES: (1) To assess the attitudes of full-time clinical faculty members towards medical communication using the newly developed Attitudes Towards Medical Communication Scale; (2) to determine faculty members' perceptions of communications training for students and residents. METHODS: An anonymous self-completion survey was sent to 233 full-time clinical faculty members. The questionnaire asked about faculty attitudes towards medical communication, and assessed faculty members' views of student and resident training in communication. RESULTS: Faculty scored highly in the Attitudes Towards Medical Communication Scale, with a mean score of 51.5 (SD 4.1) out of a possible 60. In univariate analysis, rating of personal enjoyment of teaching, rating of the importance of teaching, and having attended at least one faculty communications workshop in the previous 5 years were significantly associated with higher scale scores. When these factors were assessed using linear regression, only having attended a workshop and higher rating of the importance of teaching remained significant. Faculty assessed student training in communications skills poorly overall. When assessing seven specific communications areas, more than 20% rated this training as poor for six of the areas for third- and fourth-year students and for five of the areas for residents. CONCLUSIONS: Clinical faculty at Dalhousie have very positive attitudes towards medical communication, and more highly positive attitudes are found in those who have attended a communications workshop. Despite this evidence that faculty appreciate the importance of medical communication skills, many assessed students' training in this curriculum area as poor.     

Patients’ attitudes towards patient involvement in safety interventions: results of two exploratory studies

Background In recent years, patient‐focused interventions have been introduced aimed at increasing patient involvement in safety‐related behaviours. However, patients’ attitudes towards these interventions and comfort in participating in the recommended behaviours remain largely unexplored. Objective To evaluate patients’ attitudes towards a video and leaflet aimed at encouraging patient involvement in safety‐related behaviours. Design Two exploratory studies employing a within‐subjects mixed‐methods design. Setting Six hospital wards on an inner‐city London teaching hospital. Participants Medical and surgical inpatients: 80 patients in study 1 (mean age 55; 69% men) and 80 patients in study 2 (mean age 52; 60% men). Intervention Patients watched the PINK patient safety video (study 1) or read the National Patient Safety Agency’s ‘Please Ask’ about staying in hospital leaflet (study 2). Main outcome measures Perceived comfort in participating in safety‐related behaviours; attitudes towards the video or leaflet. Results Both video and leaflet increased patients’ perceived comfort in engaging in some (but not all) safety‐related behaviours (P < 0.05). In both studies, the majority of patients questioned whether the intervention could help to reduce medical errors in health care. Suggestions on how the video/leaflet could be improved mainly related to content and layout. Conclusion Video and leaflet could be effective at encouraging patient involvement in some safety‐related behaviours. Further in‐depth research on patients’ attitudes towards different educational materials is required to help inform future policies and interventions in this very important but under‐researched area.     

电子病历的法律效力

在系统考察国外电子病历法律研究和我国电子病历立法现状的基础上，将纸质病历的基本功能分解为11项，并根据纸质病历的特点，运用功能等同法，探讨了通过电子信息技术实现这些功能的可能性。认为，数据电文的合法性在联合国《电子商务示范法》和我国《合同法》中都已作出明确的规定，电子病历虽然与电子合同在很多方面存在差异，但本质上都具有无纸化这一共同的特点，因此，由数据电文构成的电子病历也应当能够替代纸质病历。     

The effect of medical education on the attitudes of medical students towards disabled people

The negative attitudes of society towards disability and the resulting prejudicial behaviour affects the lives of disabled people. One of the declared aims of the Faculty of Medicine of the University of Southampton is to improve attitudes. Hence, an attempt has been made to assess differences in the attitudes held by first- and fourth-year medical students, senior house officers and members of the general public towards disabled people. The measurement instrument used was the 'Attitudes Towards Disabled Persons (ATDP) Scale'. The total number of subjects in the survey was 428, of whom 263 (61%) responded. No significant differences were found between the attitudes of the four groups studied. However, a subpopulation of subjects who agreed with the statement that 'Disabled people cause more problems to doctors than non-disabled people' had attitudes which were significantly more negative.     

Patients, privacy and trust: patients' willingness to allow researchers to access their medical records

The federal Privacy Rule, implemented in the United States in 2003, as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), created new restrictions on the release of medical information for research. Many believe that its restrictions have fallen disproportionately on researchers prompting some to call for changes to the Rule. Here we ask what patients think about researchers' access to medical records, and what influences these opinions. A sample of 217 patients from 4 Veteran Affairs (VA) facilities deliberated in small groups at each location with the opportunity to question experts and inform themselves about privacy issues related to medical records research. After extensive deliberation, these patients were united in their inclination to share their medical records for research. Yet they were also united in their recommendations to institute procedures that would give them more control over whether and how their medical records are used for research. We integrated qualitative and quantitative results to derive a better understanding of this apparent paradox. Our findings can best be presented as answers to questions related to five dimensions of trust: Patients' trust in VA researchers was the most powerful determinant of the kind of control they want over their medical records. More specifically, those who had lower trust in VA researchers were more likely to recommend a more stringent process for obtaining individual consent. Insights on the critical role of trust suggest actions that researchers and others can take to more fully engage patients in research.