Physicians' Use of Key Functions in Electronic Health Records from 2005 to 2007: A Statewide Survey

Objective

Electronic health records (EHRs) have potential to improve quality and safety, but many physicians do not use these systems to full capacity. The objective of this study was to determine whether this usage gap is narrowing over time.

Design

Follow-up mail survey of 1,144 physicians in Massachusetts who completed a 2005 survey.

Measurements

Adoption of EHRs and availability and use of 10 EHR functions.

Results

The response rate was 79.4%. In 2007, 35% of practices had EHRs, up from 23% in 2005. Among practices with EHRs, there was little change between 2005 and 2007 in the availability of nine of ten EHR features; the notable exception was electronic prescribing, reported as available in 44.7% of practices with EHRs in 2005 and 70.8% in 2007. Use of EHR functions changed inconsequentially, with more than one out of five physicians not using each available function regularly in both 2005 and 2007. Only electronic prescribing increased substantially: in 2005, 19.9% of physicians with this function available used it most or all the time, compared with 42.6% in 2007 (p < 0.001).

Conclusions

By 2007, more than one third of practices in Massachusetts reported having EHRs; the availability and use of electronic prescribing within these systems has increased. In contrast, physicians reported little change in the availability and use of other EHR functions. System refinements, certification efforts, and health policies, including standards development, should address the gaps in both EHR adoption and the use of key functions.     

聚焦电子健康档案

电子健康档案与区域卫生信息网络在全世界范围内正在成为医疗卫生信息化的前沿阵地.从EMR与EHR的区别及其相互关系对电子健康档案的基本内涵加以辨析,并就目前国内外对电子健康档案研究和实践的现状进行介绍,阐明实现电子健康档案的意义,最后指出需要解决的关键问题.     

电子病案在临床实施中的影响调查

目的了解电子病案系统在临床应用后对病历书写的快捷性、方便性和病案的安全性及内涵质量的影响。方法采用现场观察和问卷调查的方法对临床医师进行电子病案实施前后对比调查,并采用病案个案评价方法对电子归档病案进行内涵质量评价。结果实施电子病案系统后,入院记录和首次病程记录书写时间分别平均缩短了16.1分钟和11.9分钟;编辑、审查病案和书写医嘱较实施前更方便（P〈0.01）,然而电子病案查房、签名等方面不方便;容易出现病历未及时签名、被篡改、拷贝,医嘱开错等安全隐患。结论电子病案系统在临床应用中更快捷、更方便,容易出现一些质量问题和安全隐患,因此当前有必要研发出新的质量监测体系,促成电子病案对医疗质量的提高作用。     

Threat Modeling for Electronic Health Record Systems

The security of electronic health record (EHR) systems is crucial for their growing acceptance. There is a need for assurance that these records are securely protected from attacks. For a system as complex as an EHR system, the number of possible attacks is potentially very large. In this paper, a threat modeling methodology, known as attack tree, is employed to analyze attacks affecting EHR systems. The analysis is based on a proposed generic client-server model of EHR systems. The developed attack tree is discussed along with some system properties that enable quantitative and qualitative analysis. A list of suggested countermeasures are also highlighted.     

Consent Mechanisms for Electronic Health Record Systems: A Simple Yet Unresolved Issue

Electronic health record (EHR) systems are now in widespread use in healthcare institutions worldwide. EHRs include sensitive health information and if they are integrated among healthcare providers, data can be accessible from many different sources. This leads to increased concern regarding invasion of privacy and confidentiality. Incorporating consent mechanisms into EHRs has the potential to enhance confidentiality. However there are both positive and negative effects from employing such mechanisms—they need to balance privacy, safety, consumer and public interest.     

An Approach to Access Control in Electronic Health Record

OASIS is a non-for-profit consortium that drives the development convergence and adoption of open standards for the global information society. It involves more than 600 organizations and individuals as well as IT leaders Sun, Microsoft, IBM and Oracle. One of its standards is XACML which appeared a few years ago and now there are about 150,000 hits on Google. XACML (eXtensible Access Control Markup Language) is not technology related. Sun published in 2004 open source Sun XACML which is in compliance with XACML 1.0. specification and now works to make it comply with XACML 2.0. The heart of XACML are attributes values of defined type and name that is to be attached to a subject, a resource, an action and an environment in which a subject request action on resource. In that way XACML is to replace Role Based Access Control which dominated for years. The paper examines performances in CEN 13 606 and ISO 22 600 based healthcare system which uses XACML for access control.     

An Electronic Health Record Based on Structured Narrative

Objective

To develop an electronic health record that facilitates rapid capture of detailed narrative observations from clinicians, with partial structuring of narrative information for integration and reuse.

Design

We propose a design in which unstructured text and coded data are fused into a single model called structured narrative. Each major clinical event (e.g., encounter or procedure) is represented as a document that is marked up to identify gross structure (sections, fields, paragraphs, lists) as well as fine structure within sentences (concepts, modifiers, relationships). Marked up items are associated with standardized codes that enable linkage to other events, as well as efficient reuse of information, which can speed up data entry by clinicians. Natural language processing is used to identify fine structure, which can reduce the need for form-based entry.

Validation

The model is validated through an example of use by a clinician, with discussion of relevant aspects of the user interface, data structures and processing rules.

Discussion

The proposed model represents all patient information as documents with standardized gross structure (templates). Clinicians enter their data as free text, which is coded by natural language processing in real time making it immediately usable for other computation, such as alerts or critiques. In addition, the narrative data annotates and augments structured data with temporal relations, severity and degree modifiers, causal connections, clinical explanations and rationale.

Conclusion

Structured narrative has potential to facilitate capture of data directly from clinicians by allowing freedom of expression, giving immediate feedback, supporting reuse of clinical information and structuring data for subsequent processing, such as quality assurance and clinical research.     

电子病案信息与社区医疗共享

社区医疗服务中心能够为患者提供方便快捷的基本医疗服务,大力发展社区医疗服务是我国医疗改革的一项重要内容。三级医院的医疗信息不能与社区医疗共享,制约了社区医疗服务的信息化程度。电子病案的实施可以解决这一缺陷。     

社区居民电子健康档案系统的设计与实现

介绍面向社区卫生服务机构的居民电子健康档案管理系统的设计与实现。阐明系统开发平台、整体架构,指出系统具有符合标准、可扩展性等特点以及健康档案数据管理、文档管理等功能。认为该系统的应用有助于提高档案利用率和实现区域医疗共享,总结系统使用效果和下一步拓展方向。     

电子健康档案云安全研究

近年来,云计算逐步进入了电子健康档案建设与共享的应用领域,为电子健康档案系统建设的标准化、智能化、高性价比及资源的可持续利用带来了契机。从信息技术能力、法律法规缺失、安全威胁以及隐私性等角度分析丫云环境电子健康档案的安全问题,提出通过电子健康云服务等级协议来保障服务效能,明确了关键指标,并探讨丁云环境的电子健康档案存储安全和终端安全。     

科研型电子健康档案系统发展与展望

随着越来越多的医疗机构开始应用电子健康档案系统（Electronic Health Records,EHR）来管理患者资料,基于在临床研究工作对患者资料的需求,各研究机构也开始以电子健康档案系统作为临床研究的数据来源。EHRCR（Electronic Health Records／Clinical Research）项目是在2006年12月由HL7技术委员会（Health Level Seven Technical Committee,HL7TC）和欧洲健康档案研究所（European Institute for Health Records,EuroRec）发起,旨在研究未来可以支持临床研究的电子健康档案系统应具有的功能,以及与此相关的系统、网络和业务流程。因此,对该项目的最新研究成果加以介绍,作为我国电子健康档案行业发展的参考。     

为《电子健康档案蓝图》中文版作序

“蓝图”，原本是一个很具体的概念，是指建筑工程、机械工程中用以规范施工与制造、装配的图纸。但近年来，一则由于计算机辅助设计（CAD）的广泛采用，真正的“蓝图”不常用了；二则由于长久以来“蓝图”被太多的乌托邦式的想象冠以“伟大的”、“宏伟的”、“最新最美的”前缀，使人们潜意识里感觉“蓝图”是虚无飘渺、不可实现的幻想，因此“蓝图”二宇已经不大常见于媒体、文字与口语中。加拿大卫生Infoway公司（Canada Health Infoway，Inc．）在政府授权与支持下所撰写的这本《电子健康档案蓝图》，     

社区护理在电子健康档案中的应用模式研究

社区护理是社区保健工作的重要组成部分,承担着医院外的医疗预防、保健、康复护理工作。我国社区护理从业人员比率低,护理服务范围广,工作量大,这是造成目前社区护理工作无法有效开展的主要矛盾,电子健康档案的实施在一定程度上可以缓解这种矛盾。电子健康档案的应用是社区卫生服务发展的大势所趋,应尽快探索和发展出一条适合我国国情的社区护理模式。     

电子病历与健康档案数据交换规范化的研究与应用

运用现代信息学理论和技术,以临床信息与病案书写规范为指南,并参照国家相关信息交换标准规范及国际标准化组织信息规范。针对电子病历与健康档案数据交换,采用可扩展标记语言（XML）技术,制定了《健康档案与病案的电子数据交换规范化应用指南》。并依据指南定义了电子病历与健康档案数据元素信息的XML结构文档,对提高医药卫生行业管理水平、信息安全传输和交换共享利用具有良好的应用价值。     

基于本体论的电子健康档案知识库构建初探

电子健康档案具有明显的文献特征,有较强的研究价值和挖掘价值。在概述电子健康档案文献特点和生物医药语义知识库研究现状的基础上,论述了电子健康档案知识库构建的步骤、技术难点及解决思路。讨论了电子健康档案如何引入本体和本体技术以及进行语义抽取,在此基础上提出基于本体的数据挖掘技术应用于健康档案的构想,实现健康档案中医学知识的多维度关联与智能检索功能。     

DICOM医学图像在居民电子健康档案中自适应显示设计

建立居民电子健康档案,将提高医疗卫生相关业务工作效率和行政管理部门管理效率。医学影像信息是居民健康信息中重要的组成部分,在B／S架构设计的电子健康档案系统,针对如何让居民在浏览器中随时随地查阅个人健康档案中医学图像的问题,提出了相应的解决方案。     

澳大利亚全民电子健康档案系统建设及启示

介绍澳大利亚全民电子健康档案系统建设与应用的历程和经验,分析总结该系统在建设与应用过程中面临的问题及解决方式,以期为我国居民健康档案建设提供经验和启示。     

电子健康档案人机交互现状的分析思考

目的：研究分析EHR系统人机变互界而不友好的原因,给出解决方案。方法：调查EHR用户人机交互方面的需求,论证RIA开发方案,分析RIA两种主流技术Ajax与Flex的特点。结果：EHR系统人机交互界面存存的问题与HTML开发方案有关。结论：选择RIA开发方案、应用Flex技术可使EHR用户获得较理想的人机交互体验。     

我国电子健康档案研究现状分析

电子健康档案研究是目前国内外关注的热点.介绍我国建立电子健康档案的国际背景,从文献发表情况和国内相关事件回顾两方面阐述我国电子健康档案研究现状,对其发展前景进行展望,指出电子健康档案的建立可从疾病预防评估和慢性病管理方面增进全民健康水平.