Development of a statewide Maternal and Child Health Information Network

The Maternal and Child Health Information Network (MATCH) was a national demonstration project funded in 1983 by a Special Projects of Regional and National Significance (SPRANS) grant. The network's major objectives have been to correlate collected clinical service data items into usable information, to expand the database through linkage with other systems within the Ohio Department of Health, and to analyze the conjugated data in an effort to expand current knowledge of maternal and child health. The network is interactive between local funded agencies and the state Health Department. Both data entry and data retrieval are distributed at the end-user information centers. Training and support, major components of the project, are provided to each participant and user of the network. One advantage of MATCH is that it allows linkage of clinical service records with vital records as an outcome of prenatal care and/or a history for child health clients. This aspect of the system permits an expanded look at the population being served by funds designated for maternal and child health programs and the ultimate outcome of such services, and permits comparison with those not receiving preventive health services.     

Developmental History Collection on a Child Psychiatric Inpatient Service

This retrospective study was the first step of a larger project aimed at constructing a data collection tool to be used by child psychiatric nurses on an acute psychiatric inpatient service. A sample of 41 records was reviewed by a single reviewer using explicit criteria to determine the quality of data currently being gathered. The sample was randomly selected from 180 records of children admitted to an acute child psychiatric inpatient service in a major teaching institution. Of the 41 records reviewed, 14 had little or no information concerning the child's developmental course, and in about 50% of the charts similar information was recorded by different team members. It was noted that this service is fairly new, and no assessment tool that reflects a consensus of the multidisciplinary team is currently in use. Without a systematic method of gathering data upon admission, data collection will continue to be inconsistent and incomplete.     

Psychosocial health information in free text notes of Swedish children’s health records

Background: High‐quality documentation of children’s health is an important priority in health care given trends of declining mental health and reduced well‐being in children. There is a lack of information concerning psychosocial health in the standardized part of the national health record in the Child Health Service and the School Health Service in Sweden. Further, little is known if the free text notes in the health record, besides information on physical health, also include information on children’s psychosocial health. The aim of this study was to describe what is recorded concerning children’s health and development in free text notes. Methods: The study was based on a retrospective analysis of text using an inductive approach for qualitative analyses of content. Results: The analysis of the free text notes in the health records yielded seven categories: development, family, health problems, living habits, medical issues, preschool/school and leisure, and well‐being. The categories mainly covered psychosocial aspects of health and were not only about health and development problems of the child but also what was covered during the visits. The information was unevenly distributed across the ages. A stronger focus on the youngest age groups within a family and preschool setting is needed. There was novel information in the free text notes such as pain, general health, emotions, mother’s mental health and leisure activities, which was not covered in the standardized part of the health records. Conclusion: The free text notes mainly reflected a psychosocial perspective on health. The findings of this study suggest that requesting more information on children’s psychosocial health in the standardized part of the health records could contribute to more comprehensive and informative health records in the Child health Service and the School Health Service in Sweden.     

Routine ultrasonography in utero and speech development.

The purpose of this paper is to examine a possible association between prenatal ultrasonography and delayed speech among children. A follow-up study was carried out on primary school children born to women who took part in two randomized controlled trials of routine ultrasonography during pregnancy. Of 2428 eligible singletons, 2161 (89%) were followed up with a parental questionnaire and with information from maternal and child health centers. Parents assessed the development of speech during the childhood years and reported their observations in a questionnaire. Maternal and child health center records provided data on the children's development of speech and any referrals of children to a speech therapist. No significant differences between ultrasound-screened children and their controls were found in the parental assessment of speech development. According to health center records, screened children were less likely to be referred to a speech therapist (odds ratio, 0.51; 95% confidence interval 0.31, 0.85), but there were no other significant differences in speech development as reported in the health center records. We conclude that routine ultrasonography in utero is not associated with delayed speech in children.     

Ill health and use of medical care. Community-based assessment of morbidity in children

The purpose of this study was to assess the relationship between morbidity and ambulatory care utilization in a randomly selected sample of children with stable patterns of use of services in a prepaid multispecialty group practice. The unique features of the approach were a focus on long-term relationships (over 8 years) and on assessment of health status by a combination of parent reports, child reports, teacher reports, and physical examination. Domains of health status that were assessed included types and frequencies of health conditions and disability associated with them, functional status (physical health, mental health, social health, general well-being), school absence, vision and hearing screening, and physical abnormalities. Children with persistently high levels of use of services in a 6-year period (1974-79) were more likely to have health problems of all types, both concurrent and in a subsequent 2-year period (1980-81) than children with lower levels of use. As these findings were in agreement with those obtained in a study where morbidity was determined by diagnoses recorded in medical records, it is likely that the measures could be more generally useful to assess child health status in the community. Moreover, they distinguish groups of children who differ in their pattern of use of services and hence may be useful in the planning and budgeting of services for child populations.     

Record Keeping and Health Service Mirrored by Data from Swedish Child Health Care Records

Abstract. In order to study the completeness and accuracy of the recording of Child Health Care data, 212 randomly sampled records from all of Sweden were collected. The degree of completeness and accuracy was determined by scoring information from the records. The results showed that the recorded data lacked accuracy to a large extent, and completeness to a somewhat lesser extent. Information on the development of the child, especially speech and language development, but also psychomotor development, were the main areas lacking completeness. Health information, environmental conditions, behaviour, illnesses, accidents and evaluation of the neonatal period were also very poorly recorded. The results indicate that the records of the Child Health Care service do not constitute, in the respects studied, a complete and secure basis for clinical work, research, planning or evaluation of the quality of the health services.     

CA3-01: Family History Relationship Data in the VDW

Background/Aims Family relationship data in the Scott & White Virtual Data Warehouse (VDW) gathered from multiple sources across the institution is a rich resource that provides an opportunity to study patterns of inherited disease and the ability to evaluate the efficacy of targeted screening strategies. In an integrated healthcare delivery system, linkage of the parent and child (family) electronic health records (EHR) provides an opportunity to improve outcomes by implementing proactive/preventative screening and/ or treatment in offspring. Our study focuses on how linkage of the parent/ child EHR can be used to identifying youth at risk for a number of autosomal dominant inherited diseases. Methods The comprehensive procedure developed at Scott & White includes gathering relationship information from members at time of enrollment with the Scott & White Health Plan (SWHP). Relationship codes provide the linkage between the family enrollment records and medical data. The relationships are identified by insurance subscribers and covered dependents from SWHP data, and by guarantor and covered dependents from EHR data. This field is then matched against ICD-9 codes for a wide variety of inherited diseases to generate a list of parent-child pairs that can be used to implement early focused screening strategies. Results We were able to evaluate how often offspring were screened for a number of autosomal dominant diseases including familial hypercholesterolemia, hypertrophic obstructive cardiomyopathy, and long QT as well as a number of other inherited diseases. The major problem with this approach is that biological linkage cannot be established (i.e., adoption or step-parent, grandparent may be insured adult). However, this approach provides an opportunity to create flags in the EHR for a first- pass screening that can be enhanced by extraction of additional information (i.e., biological linkage) obtained by a provider during a point-of-care service. Discussion An integrated healthcare delivery system combined with a family-linkage field in the VDW provides an opportunity to improve outcomes for inherited diseases through focused screening potentially involving the use of flags for the healthcare provider. Implementation of early, targeted screenings may improve long-term health outcomes and potentially provide a cost-effective strategy for preventive healthcare.     

Nurses' perceptions of the impact of electronic health records on work and patient outcomes

This study addresses community hospital nurses' use of electronic health records and views of the impact of such records on job performance and patient outcomes. Questionnaire, interview, and observation data from 46 nurses in medical-surgical and intensive care units at two community hospitals were analyzed. Nurses preferred electronic health records to paper charts and were comfortable with technology. They reported use of electronic health records enhanced nursing work through increased information access, improved organization and efficiency, and helpful alert screens. They thought use of the records hindered nursing work through impaired critical thinking, decreased interdisciplinary communication, and a high demand on work time (73% reported spending at least half their shift using the records). They thought use of electronic health records enabled them to provide safer care but decreased the quality of care. Administrative implications include involving bedside nurses in system choice, streamlining processes, developing guidelines for consistent documentation quality and location, increasing system speed, choosing hardware that encourages bedside use, and improving system information technology support.     

Observation of health technologies after their introduction into clinical practice: a systematic review on data collection instruments

Rationale, aims and objectives Early assessment of health technologies after they are covered by the health system is deemed crucial to promptly identify and analyse unforeseen problems that may arise when these are used in real world settings. This paper aims to describe the various instruments which could be used for collecting information intended for prospective observation of health technologies, so as to choose the specific instrument best suited to each context. Methods Systematic review of the medical literature aimed at retrieving general reference documents on data collection instruments for post-introduction observation of health technologies. A purpose-designed systematic bibliographic search was elaborated for the main three data collection instruments identified. Results The three instruments are briefly described along with the main results of the studies retrieved, in terms of the advantages, drawbacks and considerations to be borne in mind when it comes to use these tools in post-introduction observation of new technologies. Conclusions At present, the most appropriate data collection method for conducting post-introduction observation of new technologies is the use of prospective clinical registries. Electronic clinical records may replace clinical registries in the near future, but currently there are still many doubts as to the quality of the information retrieved.     

The Omaha system and meaningful use: applications for practice, education, and research

Meaningful use has become ubiquitous in the vocabulary of health information technology. It suggests that better healthcare does not result from the adoption of technology and electronic health records, but by increasing interoperability and informing clinical decisions at the point of care. Although the initial application of meaningful use was limited to eligible professionals and hospitals, it incorporates complex processes and workflow that involve all nurses, other healthcare practitioners, and settings. The healthcare community will become more integrated, and interdisciplinary practitioners will provide enhanced patient-centered care if electronic health records adopt the priorities of meaningful use. Standardized terminologies are a necessary component of such electronic health records. The Omaha System is an exemplar of a standardized terminology that enables meaningful use of clinical data to support and improve patient-centered clinical practice, education, and research. It is user-friendly, generates data that can be shared with patients and their families, and enables healthcare providers to analyze and exchange patient-centered coded data. Use of the Omaha System is increasing steadily in diverse practice, education, and research settings nationally and internationally.     

The influence of mothers' health beliefs on use of preventive child health care services and mothers' perception of children's health status

During the first three years of life, many health problems are preventable, and health maintenance visits present an excellent opportunity to prevent disease and disability. Unfortunately, preventive child health care services are underutilized. Children who do not adequately use preventive health care services are often seen late in the course of an illness. Thus, they do not receive the continuing care that could eliminate the onset of preventable health problems. In our research, we sought to determine whether mothers' health beliefs influence their use of preventive child health care services and whether their use of preventive child health care services influence their perceptions of the child's health status. The sample was composed of low-income mothers living in an urban environment. No significant relationships were found between the variables. These results indicate the need to develop more sensitive tools to measure these variables in a similar sample.     

Gaps in health care for the somatic health of outpatients with severe mental illness

The physical health of outpatients with severe mental illness (SMI) can be improved by changes in the health‐care system. Analysis of current practice is necessary to develop these strategies. We compared the number of somatic health problems of outpatients with SMI with the frequency of consulting a general practitioner (GP). This was a cross‐sectional study based on interviews, and records from the GP and the pharmacy. We checked whether Dutch community pharmacies had complete and correct information about the patients' medication. We observed that all patients (n = 118) had somatic problems in need of clinical attention. Patients who visited their GP less than once a year (35%, n = 42), had a mean of 2.8 somatic health problems. This was less than patients who consulted their GP more than once a year (P ≤ 0.01). In 37% of cases, the pharmacy did not have adequate information on the drug use. Many patients with SMI seemed to have insufficient contact with their GP for their somatic health problems. Insufficient information about the patients' medication suggested that the pharmacist and GP should increase exchange of information. Mental health nurses can take a lead in coordinating the care to improve somatic health for their patients.     

Child Health Insurance Outreach through the Emergency Department A Pilot Study

In 1997 the U.S. government funded the Children's Health Insurance Program (CHIP), but the 48 billion dollars initiative has had limited success in finding and enrolling uninsured children. While such children are more likely to receive care in emergency departments (EDs), no national initiative has targeted EDs for child health insurance outreach. OBJECTIVE: As a pilot study for a national multicenter study, this study evaluated the effectiveness of child health insurance outreach in an ED setting. METHODS: This was a prospective observational study of the outreach efforts of a single case manager from August 1998 to July 1999, performed at Foote Hospital ED in Jackson, Michigan (45,000 visits/year). All patients 相似文献   

Use of content management systems to address nursing workflow

Nurses are at the forefront of providing healthcare services to individuals of all age groups and with varying medical conditions. Aside from the critical knowledge and technical skills from nursing science, advancement in technology has assisted nurses in delivering quality nursing care by streamlining workflow processes and ensuring that data can easily be retrieved or modified. Electronic health records dramatically changed the landscape of the healthcare practice by providing an electronic means to store data and for healthcare professionals to retrieve and manipulate health information in a secured and collaborative environment. But with the nature of data being stored in the electronic health records, nurses still need to organize and process these data into relevant information, knowledge or wisdom so they can provide better holistic care to patients. This discussion paper details the role of content management systems in addressing nursing workflow by providing a mechanism for nurses to be developers themselves, and not just users or consumers of health innovative technologies. By using content management systems as platform for application development, nurses or other healthcare professionals, may be able to address problems with internal workflow without having to incur huge amounts in software development, or having to extensively learn programming languages.     

Evaluating HIPAA compliance: a guide for researchers, privacy boards, and IRBs

The purpose of this article is to describe implications of the Health Information Portability and Accountability Act of 1996 (HIPAA) for nurses engaged in human and health services research. In general, a person's private health information (PHI) may only be disclosed for treatment, payment, and business procedures related to healthcare service delivery. Access and/or use of the same information for research purposes necessitates another layer of review and may require a separate process of authorization. A brief historical overview of regulatory requirements regarding health information privacy and security standards for the electronic transformation of data and protection of electronically kept medical records is discussed and related to the role and responsibilities of researchers and organizations where research is conducted. In addition, a generic document template adaptable for use by an individual or organization is presented that can provide a quick, systematic review of HIPAA compliance when a research proposal is being developed or is received that seeks access to PHI.     

成都市新津县公益性医疗卫生服务体系改革绩效评估系列之八:新津县2009～2011年基本公共卫生服务绩效评估

目的综合评估2009~2011年4月成都市新津县基本公共卫生服务绩效,为完善和推行成都市公益性医疗卫生服务体系提供证据。方法根据成都市新津县区域卫生信息平台数据,定量描述和比较新津县健康档案、慢病管理、分娩管理和精神卫生情况。结果①新津县2010年体检88?772人,检出健康问题14?497例(检出率16%),每检出1例成本为122.5元。②截至2011年4月,新津县健康档案建档率达98.2%,但不同机构建档率差异较大(68.08%~109.02%),部分档案内容不完整。③高血压患者共7 318例,建档率90.1%;糖尿病患者共2?187例,建档率95.1%。④2009~2011年死胎、死产和新生儿产后死亡率均低于4‰,连续8年产妇零死亡,剖宫产率达61%。⑤2010年精神病患者管理率97.3%,比2009年减少2.7%。结论①新津县全民免费体检率不高,疾病检出率低。②健康档案建档率较高,覆盖人群较广,接近全民覆盖。③慢病建档率较高,但慢病发现率较低。④对精神病患者的管理率接近100%。⑤新津县实施产科上收至县级医疗机构,有效控制和降低了产妇与新生儿死亡风险,但剖宫产比例过高。⑥新津县基于区域卫生信息系统的公共卫生服务与管理具有一定示范意义,但数据收集、使用和挖掘需进一步改进。     

Completeness of information on adjuvant therapies for colorectal cancer in population-based cancer registries

BACKGROUND: Population-based cancer registries represent a potentially valuable tool to evaluate treatment; however, information on the completeness of registry treatment data is sparse. OBJECTIVE: To evaluate the completeness of registry treatment data for patients with colorectal cancer and to identify predictors of complete reporting. RESEARCH DESIGN: We surveyed physicians or reviewed office records of 1956 northern California patients diagnosed with colorectal cancer during 1996 to 1997 to assess the completeness of registry data regarding use of adjuvant chemotherapy and radiation therapy. RESULTS: For patients with a record of receipt of chemotherapy in either the registry or physician survey, information was in the original registry records for 82.0%. In the multivariate analysis, completeness of chemotherapy reporting was lower for patients aged 65 to 74, those with colon cancer, [corrected] and higher for patients treated in hospitals that are part of a large health maintenance organization (HMO). For patients with a record of receipt of radiation therapy, information was in the original registry records for 90.2%. In the multivariate analysis, completeness of radiation therapy reporting was higher for patients aged 18 to 54 and those treated in HMO hospitals. CONCLUSIONS: Because the completeness of the registry treatment data varied by patient and hospital characteristics, use of registry data without supplementation could bias estimates of the proportion of patients treated, and of the patient and provider characteristics associated with treatment. Enhanced cancer registry data could be a valuable component of population-based cancer data systems for assessing quality of cancer care.     

Nursing standards to support the electronic health record

Quality and low cost health care that is free of medical mistakes requires continuity of person-centric healthcare information across the life span and healthcare settings. Interoperable clinical information systems that rely on the use of multiple standards to support health information exchange and, in particular, nurse sensitive data, information, and knowledge are key components to support high quality, safe care. A 2004 Executive Order called for a National Health Information Network and the widespread adoption of electronic health records (EHRs) by 2014. While there are numerous standards influencing the exchange of health data, the primary focus of this article is to synthesize the state-of-the-art in nursing standardized terminologies to support the development, exchange, and communication of nursing data. Research exemplars are described for information systems to support nursing practice using standardized terminologies and secondary use of standardized nursing data from EHRs for knowledge development.     

Legal issues: office management practices.

Student health records, whether paper or electronic, are restricted and protected to a greater degree than are educational records. Some school health office software is designed to provide greater data protection than is possible in paper records. However, unless basic district and health office practices are established to prevent access to or corruption of electronic health data, technological safeguards will be useless. This article describes school and health office policies and practices that are necessary for the integrity, confidentiality, and security of student health information.     

THE CHALLENGE OF PROVIDING CONTINUITY IN THE CARE OF A DISABLED CHILD: SMITH-LEMLI-OPITZ SYNDROME

The health of a disabled child can be adversely affected if parents and health care providers are not informed regarding the need for ongoing care and consultation. This case illustrates the ways in which failure to obtain appropriate consultation and breakdown in communication between parents, health care providers, and community agencies negatively impacted the health of a young child with Smith-Lemli-Opitz Syndrome (SLOS). Although the disorder was detected in the child, information regarding treatment was not communicated to those caring for the child, resulting in serious and potentially life-threatening consequences. In this case study, we review the pathophysiology of SLOS, the positive impact of making use of expert consultation, and the complexities of navigating multiple systems when advocating for a child with a serious developmental disorder. The role of nursing in facilitating collaboration among families, members of the health care team, and advocacy agencies, particularly in children with complex medical and psychiatric difficulties, is highlighted.