ELECTRONIC PATIENT RECORD (EPR)

Safer, less expensive, and higher-quality health care can be achieved using clinical decision support (CDS), although the use of CDS often leads to disappointing results. Various problems and limitations can be pointed being the most frequently referred by the physicians the inadequate implementation of the clinical workflow. Electronic Health Records (EHR) and Patient Health Record Systems (PHRS) can play an important role in CDS mitigating those limitations and enabling the effective use of the archived information in the support of the clinical practice and generating the right knowledge to make decisions. The availability of such knowledge is crucial either, for the hospitals and for the government institutions. This brings new requirements for the EHR and PHRS conception and for the use of the information out of the boundaries of the hospitals and health centers. Interoperation and open models constitute the greater challenges that EHR enfaces in the very next future. This paper presents a survey on the design, development and implementation of PHRS in terms of organizational, regional, national and worldwide initiatives. Finally is presented the EHR implementation in the Hospital Geral de Santo António, EPE, one of the major hospitals in the North Region of Portugal.

Hospitals are one of the most complex organizations to administer, and management systems can be indispensable tools for the management of these organizations. The present study has as main objective to demonstrate the importance of management systems and to verify the impact caused by the use of the Electronic Patient Record (EPR) module in the Adult Intensive Care Unit (AICU) and in the billing sector of a University Hospital located in the city of Bragança Paulista - SP. The paper deals with the main characteristics of the management systems and will discuss topics related to the use of Information Technology for business management and the use of the Electronic Patient Record in hospital billing. It is an exploratory research, using bibliographic research techniques, and a case study. With the accomplishment of this work, it can be concluded that the information systems are very important for the management of companies and the use of the Electronic Patient Record module in the billing of the hospital patient accounts contributes to the achievement of greater efficiency and better management of the sector, reducing the time spent in the invoicing process of accounts, contributing to the reduction of errors and hospital glosses. Keywords: Information Systems, Electronic Patient Record (EPR), Information Technology, Hospital Billing.

Hospitais são umas das organizações mais complexas de serem administradas, e sistemas de gestão podem ser ferramentas indispensáveis para a administração dessas organizações. O presente estudo tem como objetivo principal demonstrar a importância dos sistemas de gestão e verificar o impacto causado pela utilização do módulo de Prontuário Eletrônico do Paciente (PEP) no setor de Unidade de Tratamento Intensivo de Adultos - UTI Adulto e sobre o setor de faturamento de um Hospital Universitário localizado na cidade de Bragança Paulista - SP. O trabalho aborda as principais características dos sistemas de gestão e discorrerá sobre temas relacionados ao uso da Tecnologia da Informação para a gestão de empresas, e a utilização do Prontuário Eletrônico do Paciente no faturamento hospitalar. Trata-se de uma pesquisa exploratória, utilizando técnicas de pesquisa bibliográfica, e um estudo de caso. Com a realização deste trabalho, pode-se concluir que os sistemas de informação são muito importantes para a gestão das empresas e a utilização do módulo de Prontuário Eletrônico do Paciente no faturamento das contas de pacientes do hospital contribui para a obtenção de maior eficiência e melhor gestão do setor, reduzindo o tempo gasto no processo de faturamento de contas, contribuindo para a redução de erros e glosas hospitalares.

ISSN: 2594-8504

This paper explores the use of cognitive mapping for eliciting users' sensemaking during information system (IS) appropriation. Despite the potential usefulness of sensemaking, few studies in IS research use it as a theoretical lens to address IS appropriation. A possible reason ...

Authenticating medical images using watermarking techniques has become a very popular area of research, and some works in this area have been reported worldwide recently. Besides authentication, many data-hiding techniques have been proposed to conceal patient's data into medical images aiming to reduce the cost needed to store data and the time needed to transmit data when required. In this paper, we present a new hybrid watermarking scheme for DICOM images. In our scheme, two well-known techniques are combined to gain the advantages of both and fulfill the requirements of authentication and data hiding. The scheme divides the images into two parts, the region of interest (ROI) and the region of non-interest (RONI). Patient's data are embedded into ROI using a reversible technique based on difference expansion, while tamper detection and recovery data are embedded into RONI using a robust technique based on discrete wavelet transform. The experimental results show the ability of hiding patient's data with a very good visual quality, while ROI, the most important area for diagnosis, is retrieved exactly at the receiver side. The scheme also shows some robustness against certain levels of salt and pepper and cropping noise.

Goldschmidt (2005) defined the hospital information system as “The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for ...

Institutional theory has proven to be a central analytical perspective for investigating the role of larger social and historical structures of Information System (IS) adaptation. However, it does not explicitly account for how organizational actors make sense of and enact IS in their local context. We address this limitation by showing how sensemaking theory can be combined with institutional theory to understand IS adaptation in organizations. Based on a literature review, we present the main assumptions behind institutional and sensemaking theory when used as analytical lenses for investigating the phenomenon of IS adaptation. Furthermore, we explore a combination of the two theories with a case study in a health care setting where an Electronic Patient Record (EPR) system was introduced and used by a group of doctors. The empirical case provides evidence of how existing institutional structures influenced the doctors’ sensemaking of the EPR system. Additionally, it illustrates h...

Institutional theory has proven to be a central analytical perspective for investigating the role of larger social and historical structures of Information System (IS) adaptation. However, it does not explicitly account for how organizational actors make sense of and enact IS in their local context. We address this limitation by showing how sensemaking theory can be combined with institutional theory to understand IS adaptation in organizations. Based on a literature review, we present the main assumptions behind institutional and sensemaking theory when used as analytical lenses for investigating the phenomenon of IS adaptation. Furthermore, we explore a combination of the two theories with a case study in a health care setting where an Electronic Patient Record (EPR) system was introduced and used by a group of doctors. The empirical case provides evidence of how existing institutional structures influenced the doctors' sensemaking of the EPR system. Additionally, it illustrates how the doctors made sense of the EPR system in practice. The paper outlines that: 1) institutional theory has its explanatory power at the organizational field and organizational/group level of analysis focusing on the role that larger institutional structures play in organizational actors' sensemaking of IS adaptation, 2) sensemaking theory has its explanatory power at the organizational/group and individual/socio-cognitive level focusing on organizational actors' cognition and situated actions of IS adaptation, and 3) a combined view of the two theories helps us oscillate between levels of analysis, which facilitates a much richer interpretation of IS adaptation.

Background: The International Classification for Primary Care (ICPC) standard aims to facilitate simultaneous and longitudinal comparisons of clinical primary care practice within and across country borders; it is also used for administrative purposes. This study evaluates the use of the original ICPC-1 and the more complete ICPC-2 Norwegian versions in electronic patient records. Methods: We performed a retrospective study of approximately 1.5 million ICPC codes and diagnoses that were collected over a 16-year period at 12 primary care sites in Norway. In the first phase of this period (transition phase, 1992-1999) physicians were allowed to not use an ICPC code in their practice while in the second phase (regular phase, 2000-2008) the use of an ICPC code was mandatory. The ICPC codes and diagnoses defined a problem event for each patient in the PROblem-oriented electronic MEDical record (PROMED). The main outcome measure of our analysis was the percentage of problem events in PROMEDs with inappropriate (or missing) ICPC codes and of diagnoses that did not map the latest ICPC-2 classification. Specific problem areas (pneumonia, anaemia, tonsillitis and diabetes) were examined in the same context. Results: Codes were missing in 6.2% of the problem events; incorrect codes were observed in 4.0% of the problem events and text mismatch between the diagnoses and the expected ICPC-2 diagnoses text in 53.8% of the problem events. Missing codes were observed only during the transition phase while incorrect and inappropriate codes were used all over the 16-year period. The physicians created diagnoses that did not exist in ICPC. These 'new' diagnoses were used with varying frequency; many of them were used only once. Inappropriate ICPC-2 codes were also observed in the selected problem areas and for both phases. Conclusions: Our results strongly suggest that physicians did not adhere to the ICPC standard due to its incompleteness, i.e. lack of many clinically important diagnoses. This indicates that ICPC is inappropriate for the classification of problem events and the clinical practice in primary care.

In this paper, we investigate the authorisation service provided by Microsoft ® .NET MyServices [1]. We propose modifications and extensions to eXtensible Markup Language (XML) [2] based data structures' schemas to support a range of commonly used access policies in commercial systems. We have developed the modified access evaluation algorithms that take the proposed extensions into account. The extensions proposed in this paper have been used in the specification and analysis of a practical application involving access control to electronic patient records in hospitals.

This paper considers some of the everyday practicalities of delivering an electronic health record project within an NHS Hospital Trust. Using ethnographic, observational, data we document how and in what ways the orderly character of project work is achieved against a background of battles and negotiations to deliver the project within and despite various organisational contingencies and constraints.

This paper compares the usability of some location and token-based interaction techniques for systems that provide point-of-care access to medical information. The investigation is based around a scenario from clinical work—administration of medicine to ...

Patients at a disaster scene can greatly benefit from technologies that continuously monitor their vital status and track their locations until they are admitted to the hospital. We have designed and developed a real-time patient monitoring system that integrates vital signs sensors, location sensors, ad-hoc networking, electronic patient records, and web portal technology to allow remote monitoring of patient status. This system shall facilitate communication between providers at the disaster scene, medical professionals at local hospitals, and specialists available for consultation from distant facilities.

Objectives: We aimed to describe treatment strategies for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), adherence to and persistence with pharmacological treatment and the association between the type of LUTS/BPH complaints and early treatment discontinuation. Methods: Within a large GP database (IPCI) in the Netherlands we identified all males !45 years newly diagnosed with LUTS/BPH during 1995-2000. Details on treatment were assessed from the electronic patient records. Logistic regression analysis was used to estimate the association between the type of main urinary complaints and early treatment discontinuation. Results: Of the 2214 men with incident LUTS/BPH, 1075 received pharmacological treatment and 238 underwent prostate surgery. The average adherence differed slightly between drugs: 67% for a-blockers, 73% for 5a-reductase inhibitors and 71% for combination therapy. 26% of the treated patients discontinued treatment early. The probability of early discontinuation was higher if patients mainly expressed one type of complaint: voiding (OR adj 3.38; 95%CI: 1.89-6.04), post micturition (OR adj 2.37; 95%CI: 1.15-4.87) or storage symptoms (OR adj 1.85; 95%CI: 1.16-2.95) as compared to patients expressing a combination of symptoms. The risk of early discontinuation was higher if patients had a normal PSA measurement. Older age and a higher chronic disease score protected against early treatment discontinuation. Conclusions: Almost half of newly diagnosed LUTS/BPH patients are pharmacologically treated, and a quarter discontinues very rapidly. Stopping early is more frequent among younger persons, persons with only one type of main urinary complaint, no other co-morbidity and a normal PSA. #

A l i H a s s a n M u o s a , R a n a H a m e e d H u s s a i n , K a d e m K. R e h e f Abstract:-An Integrated System for Managing Electronic Patient Record (EPR) Presented to Imam Hussein Teaching Hospital in Annasiriyah to Improving Quality and Efficiency of Health Care. Hospital actually uses a manual system for the management and servicing of crucial information. The existing systems require many of paper forms, with data stores diffusion during the hospital management infrastructure. Many times information is imperfect, or does not follow management criterion. Forms are many times lost in passage through departments requiring an extensive auditing process to guarantee that no vital information is lost. Several of file of the same information exist in the hospital and might lead to conflict in data in different of data stores. This paper proposes An Integrated System for Managing EPR, through provision of confidential records and to ensure, which include the revision date and name of the person and health care provided to him. These include information from several sources, which contain emergency, doctors, pharmacy, laboratory and others. This information, which is necessary for the care of patients, ready for use by those working in the field of health care in this hospital. The basic idea of a Managing EPR is automation and document all patient information and purpose of the accuracy of the information, and speed transported between the department and another, and shorten the time as much as possible, and get the correct information without mistakes or misrepresentation, Archiving has become more quickly and accurately, and the like this archiving be able to strictly of statistic and investigation medically, so that the patient who enters the hospital even once shall be a healthy number stays with him as is the case in developed countries.

In this paper, we address the following research question: “How can we understand the nature of risk in IS projects in the context of globalization? ” Based on a case study conducted over a period of two years in a Norwegian hospital on the development and implementation of a Electronic Patient Record (EPR), the paper contributes to the current discussion on the conceptualization of risk in IS projects. Drawing upon the concept of reflexive modernization (Beck 1999) the paper makes two key contributions: firstly, it shows the limits of current risk management approaches in understanding the nature of new risks in IS generated by globalization processes; secondly, it suggest a possible theoretical framework for analyzing such nature. The research question is addressed by providing a historical and contingent analysis of the risk management dynamics emerging from the case.

This article explores the perspectives of two user groups, general practitioners (GPs) and consultant radiologists (CRs), on the rollout of picture archiving and communications systems (PACS) within acute trusts and eventually to primary care as part of the electronic patient record. Qualitative interviews were conducted with 16 CRs and 31 GPs. Analysis was carried out using a grounded theory approach.

When buying COTS-based software, the customer has to choose between what is available. The supplier may add some minor parts, but rarely everything the customer wants. This means that the customer cannot write down his requirements and expect that they can all be met. A scoring system is necessary rather than traditional mandatory requirements. Requirements for integrating the new COTS system with other systems are particularly hard because suppliers may integrate in different ways and with different other systems. A related problem is that once the new COTS system is purchased, the COTS supplier may have a de-facto monopoly. Only he can expand the system or integrate it with other systems. The traditional way to purchase COTS is to iteratively find the right product. However, in a tender process this is not possible, and another solution is necessary. Experience shows that customers fail to deal with these issues adequately. As an example they may believe that asking for open interfaces is sufficient to guard them against monopoly. In this paper we analyze the problems and show ways to deal with them. We illustrate the problems and solutions with real-life examples from Electronic Patient Recording systems (EPR).

The report presents a high-level review of patient-centred Electronic Health Records for NHS Grampian. The report showcases 13 case studies on the design of person-centred electronic health records as used by multidisciplinary health and care teams.

Purpose—MRI has been used to identify multiple sclerosis (MS) lesions in brain and spinal cord visually. Integrating patient information into an electronic patient record system has become key for modern patient care in medicine in recent years. Clinically, it is also necessary to track patients' progress in longitudinal studies, in order to provide comprehensive understanding of disease progression and response to treatment. As the amount of required data increases, there exists a need for an efficient systematic solution to store and analyze MS patient data, disease profiles, and disease tracking for both clinical and research purposes. Method—An imaging informatics based system, called MS eFolder, has been developed as an integrated patient record system for data storage and analysis of MS patients. The eFolder system, with a DICOM-based database, includes a module for lesion contouring by radiologists, a MS lesion quantification tool to quantify MS lesion volume in 3D, brain parenchyma fraction analysis, and provide quantitative analysis and tracking of volume changes in longitudinal studies. Patient data, including MR images, have been collected retrospectively at University of Southern California Medical Center (USC) and Los Angeles County Hospital (LAC). The MS eFolder utilizes web-based components, such as browser-based graphical user interface (GUI) and web-based database. The eFolder database stores patient clinical data (demographics, MS disease history, family history, etc.), MR imaging-related data found in DICOM headers, and lesion quantification results. Lesion quantification results are derived from radiologists' contours on brain MRI studies and quantified into 3-dimensional volumes and locations. Quantified results of white matter lesions are integrated into a structured report based on DICOM-SR protocol and templates. The user interface displays patient clinical information, original MR images, and viewing structured reports of quantified results. The GUI also includes a data mining tool to handle unique search queries for MS. System workflow and dataflow steps has been designed based on the IHE post-processing workflow profile, including workflow process tracking, MS lesion contouring and quantification of MR images at a post-processing workstation, and storage of quantitative results as DICOM-SR in DICOM-based storage system. The web-based GUI is designed to display zero-footprint DICOM web-accessible data objects (WADO) and the SR objects. Summary—The MS eFolder system has been designed and developed as an integrated data storage and mining solution in both clinical and research environments, while providing unique features, such as quantitative lesion analysis and disease tracking over a longitudinal study. A comprehensive image and clinical data integrated database provided by MS eFolder provides a platform for treatment assessment, outcomes analysis and decision-support. The proposed system serves as a platform for future quantitative analysis derived automatically from CAD algorithms that can also be integrated within the system for individual disease tracking and future MS-related research. Ultimately the eFolder provides a decision-support infrastructure that can eventually be used as add-on value to the overall electronic medical record.

The efficacy of antihypertensive drug therapy is undisputed, but observational studies show that few patients reach a target blood pressure o140/90 mm Hg. However, there is limited data on the drug prescribing patterns and their effectiveness in real practice. This retrospective observational survey of electronic patient records extracted data from 24 Swedish primary healthcare centres, with a combined registered population of 330 000 subjects. We included all patients X30 years with a recorded diagnosis of hypertension who consulted the centres in 2005 or 2006 (n ¼ 21 167). Main outcome measures were systolic and diastolic blood pressures, and prescribed antihypertensive drug classes. Only 27% had a blood pressure o140/ 90 mm Hg. The number of prescribed drugs increased with age, except among the oldest (X90 years). Only 29% of patients given monotherapy had a blood pressure o140/90 mm Hg. Women more often received diuretics (52 vs 42%), and less often angiotensinconverting enzyme inhibitors (22 vs 33%) and calcium channel blockers (26 vs 31%) than men. b-Blockers and diuretics were the most common drug classes prescribed, independent of comorbidity. In conclusion, one out of four primary care patients with hypertension reach target blood pressure. More frequent use of drug combinations may improve blood pressure control.

Background: A system ensuring tight control access is used since 5 years at the University Geneva Hospitals (HUG) over a four campuses health care system with ambulatory care settings behaving like a small community care network. Access to identified clinical information is limited to care providers that have a therapeutic relationship with the patient and to those data needed for that relation. The same policy applies to administrative or scientific research accesses. This paper presents how the HUG met the challenging goal of protecting patient privacy within regulatory limits while keeping the system operational in terms of use and management. Solution: The main characteristics of the system are: (a) an institution-wide policy for access rights to the computerized patient record; (b) an institutional management of the contracts of the collaborators; (c) access profiles based on application-independent, fine-grained access rights; (d) a decentralized attribution of profession-specific access profiles; (e) a complete, centralized log of all accesses to the clinical information system; and (f) a decentralized verification of the accesses. Many of these characteristics can be maintained when evolving towards a trans-institutional computerized patient record, but new constraints need to be taken into account.

Generalised architecture for languages, encyclopaedias and nomenclatures in medicine (GALEN) has developed a new generation of terminology tools based on a language independent model describing the semantics and allowing computer processing and multiple reuses as well as natural language understanding systems applications to facilitate the sharing and maintaining of consistent medical knowledge. During the European Union 4 Th. framework program project GALEN-IN-USE and later on within two contracts with the national health authorities we applied the modelling and the tools to the development of a new multipurpose coding system for surgical procedures named CCAM in a minority language country, France. On one hand, we contributed to a language independent knowledge repository and multilingual semantic dictionaries for multicultural Europe. On the other hand, we support the traditional process for creating a new coding system in medicine which is very much labour consuming by artificial intelligence tools using a medically oriented recursive ontology and natural language processing. We used an integrated software named CLAW (for classification workbench) to process French professional medical language rubrics produced by the national colleges of surgeons domain experts into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation, on one hand, we generate with the LNAT natural language generator controlled French natural language to support the finalisation of the linguistic labels (first generation) in relation with the meanings of the conceptual system structure. On the other hand, the Claw classification manager proves to be very powerful to retrieve the initial domain experts rubrics list with different categories of concepts (second generation) within a semantic structured representation (third generation) bridge to the electronic patient record detailed terminology.

The objective of this study was to describe and present the initial results of a computer-based system that tracks ureteral stents and automatically sends a reminder through a short message service (SMS) to both the patient's and the urologist's mobile phones Using an integrated stent register program (SRP) and a stent extraction reminder program (SERP) with an electronic patient record program (EPRP) located within our hospital's computer network. In this system, the demographic data of all of the patients are recorded into the password-protected EPRP. After a stent is inserted, the surgeon enters the details of the operation into the EPRP. The SRP automatically asks the user to define the ''optimal stent life (OSL)''. The SERP checks the recorded patients daily and sends an SMS reminder to staff and patient when the OSL is reached. The SERP continues to send reminders via the SMS until stent is removed. We analyzed the success of the SMS recall system. A total of 186 patients received stents over an 11-month period. The patients in group-2 (n = 108) were recalled by the SERP, and the remainder of the patients (n = 78, group-1) were not included in the project. The mean delay from the designated OSL to the time of stent removal was 307 ± 118.6 (72-1,344) and 14.6 ± 2.06 (5-36) h in groups 1 and 2, respectively (p \ 0.0001). Our initial results showed that the SRP and SERP prevent stent removal from being forgotten, thus preventing related medical and legal problems. Keywords Forgotten ureteral stents Á Reminder message Á Solution Á SMS Á Complications Abbreviations SMS Short message service D-J Double-J OSL Optimal stent life MSL Maximal stent life EPRP Electronic patient record program SRP Stent register program SERP Stent extraction reminder program This study has been accepted for presentation at the 2011 AUA and EAU congresses.

Concern has been reported about the safe use of medical abbreviations in documents such as handover sheets and medical notes, especially when information is being communicated between staff of different specialties (BBC, 2008, Sheppard et al, 2008). This paper describes a study to investigate whether the use of symbols in handover documentation that is shared within and between multidisciplinary teams (MDTs) has similar safety implications. We asked 19 healthcare professionals from a range of specialties to identify 45 different combinations of 38 individual symbols. The symbols and combinations of symbols were extracted from 102 handover sheets taken from 6 different healthcare contexts in 4 London hospitals. 3 symbols proposed in Microsoft's Common User Interface guidelines for alert symbols were also included. Results reveal that while some symbols are well-understood, many others are either ambiguous or unknown. These results have implications for the safe use of symbols in medical documents, including paper and electronic handover documents and Electronic Patient Records (EPRs), especially where teams comprise individuals from different professional backgrounds, i.e. MDTs. We offer initial suggestions for standardization and further research.

In recent years there has been a huge drive from both within and outside the National Health Service (NHS) to develop and refine Information Technology systems for healthcare. In an ever more complex global setting, advances in care depend on well conducted and robust ...

In many countries nurses lack an adequate tool to assist in determining the essentials of an information policy in health care institutions and to outline the nursing component of the electronic patient record. In the United States criteria exist for systems that support the nursing process and ...

Abstract. This paper proposes how research based developments are needed to use current computer technology to optimize the psychological / psychiatric service. Research areas that can contribute to an optimized and integrated service within a personal electronic patient record are: intelligent assessment systems with feedback routines, matching and booking functionality, and evidence based intervention teaching for therapists. The proposed benefits of this research integration is a positive spiral of improved patient satisfaction, reduced cost of treatment, and a basis for better research. An integrative development program is proposed.

This work describes a developed software technology to support the clinic accompaniment of newborns in a neonatal intensive care unit (NICU), where it can help the physicians, nurses and pharmacist directly to the treatment of these babies. With the objective to have the format of a EPR (electronic patient record) and to store information of the patients in an international

In this paper we discuss our approach for integrating electronic patient records into health professional education. Electronic patient record (EPR) use is increasing globally. The EPR is considered the cornerstone of the modernization and streamlining of healthcare worldwide. However, despite the importance of the EPR, health professional education in much of the world provides health professional students (who will become the practicing health professionals of the future) with limited access or knowledge about the EPR. New ways of exposing students to EPRs will be needed in order to ensure that health professionals will adopt and use this complex technology wisely and effect the positive benefits EPRs are expected to bring to healthcare globally. In this paper we describe: (a) a framework we have developed for integrating EPRs into health professional education and (b) an innovative Web portal, known as the University of Victoria Electronic Health Record (EHR) Educational Portal (which houses a number of EPRs) that can be used to explore the integration of EPRs in health professional education. It is hoped that adoption and use of EPRs will ultimately be improved through the use of the portal to allow students virtual and ubiquitous access to example EPRs, coupled with principled educational approaches for integrating EPR technology into health professional curricula.

The term electronic patient record (EPR) means the electronic collection of clinical narrative and diagnostic reports specific to an individual patient. A true EPR should allow physicians and nurses to practice in a paperless fashion. The wide adoption of Internet technologies should allow truly distributed sharing of patient data across traditional organizational barriers. Hence, the meaning of an EPR, as a representation of documents, should be transformed into a collaborative environment that supports workflow, enables new care models and allows secure access to distributed health data. This paper reviews the current realization of EPRs in the context of paper-based medical records. The Internet architecture that Boston-based medical informatics researchers refer to as W3-EMRS is described in the context of a successful implementation of CareWeb at the Beth Israel Deaconess Medical center. Finally, we describe how this Internet-based approach can be extended beyond the boundaries of traditional care settings to help evolve new collaborative models of eHealth.

Electronic Patient Records systems configured into large enterprise models have become the assumed best route forward. In England, as in several other countries, this has expanded to a major meta-enterprise procurement programme. However, concerns are raised that such systems lack user ownership, and experience from other sectors shows difficulties with large enterprise systems. At a time of great change and once again shifting organizations, is this move simply building large and ponderous edifices with unstable materials? Latest software engineering research is now demonstrating the potential of an alternative model, enabling trusted information brokers to search out in real time at point of use data held in registered local and departmental systems. If successful, this could enable a new and less cumbersome paradigm. The data could move where needed whatever the service configuration. A concept demonstrator has been built set in the context of health and social care in England. It is important for all technological support to the health sector to be reviewed as new technologies emerge so as to identify and exploit new opportunities, and the results of this 3 year project show that the health record information broker route merits further investigative research.

The traditional paper-based patient record can no longer keep pace with today's changing needs in the medical environment; non-availability, poor structure, missing or illegible documents, and a high degree of redundancy are just some of the problems encountered. Medical archives are reaching the limits of their capacity due to the long storage times and enormous volume of the records involved. To solve these problems and, ultimately, to improve the quality of patient care, the electronic patient record has been developed, which has numerous advantages over the conventional record: It is a paperless form of documentation, it can transfer exact service data to Patient Data Management, and it saves the nursing staff time. The patient record is and will remain to be the main tool for coordinating medical actions. The new clinical information system is both flexible and efficient and has taken into account the varied demands of the clinical partners from the Department of Orthopaedic in order to guarantee user acceptance.

Secondary use of patient databases is essential in healthcare if clinical trials are to progress efficiently to planned time and target and imperative if the planned UK expansion of research and development (R&D) at point of care is to be achieved. Integration of effective databases primarily designed to facilitate patient care with R&D requirements is needed but represents a complex challenge. We present a system that achieves an integrated approach with online management of complex datasets for clinical trials within care records using a specific study as an example to show functionality in practice; illustrating how this system provides an ideal resource to meet the needs of both clinicians and researchers.

Ontologies are the essential glue to build interoperable systems and the talk of the day in the medical community. In this paper we present the ontology of medical therapies developed in the course of the Oncocure project, aimed at building a guideline based decision support integrated with a legacy Electronic Patient Record (EPR). The therapy ontology is based upon the DOLCE top level ontology. It is our opinion that our ontology, besides constituting a model capturing the precise meaning of therapy-related concepts, can serve for several practical purposes: interfacing automatic support systems with a legacy EPR, allowing the automatic data analysis, and controlling possible medical errors made during EPR data input.

An invasive cardiology department produces an intense and heterogeneous information flow. Our Institute manages all the activities yearly performed (700 diagnostic and 300 interventional procedures) through a large database allowing a real time tracing of the work process features (waiting list, procedure protocols, medical reports, images file, administrative and organizational procedures). A selected information subset, automatically transferred from the hEmodyinamic Information System (SIE) to the central database of the institute (ARCA), receives data from in and out patient departments, laboratories and medical diagnostic technique image departments, and feeds the electronic patients record. SIE, which lays on multiplatform and open source products, makes clinical work easier by organizing information data flow and data viewing, improves the interpretation of clinical data, reduces the decision-making process and increases operational efficiency. 1.

The paper discusses the conventions used by medical practitioners to improve their collaboration mediated by Clinical Records. The case study focuses on the coordinative conventions identified in two wards of an Italian hospital and highlights their role and importance in the definition of the requirements of any system supportive of collaborative work practices. These requirements are expressed in terms of

This paper discusses how Clinical Pathways (CPs) are defined, used and maintained in two hospital settings. A literature review and observational study are combined to illustrate the composite nature of CPs and the different roles they play in different phases of their life-cycle, with respect to the theme of bridging medical knowledge with the related practices by which physicians deal with a specific care problem. We take the case of the CP as a paradigmatic case to stress the urgent need for an integrated approach with the computer- ...

This paper discusses how Clinical Pathways (CPs) are defined, used and maintained in two hospital settings. A literature review and observational study are combined to illustrate the composite nature of CPs and the different roles they play in different phases of their life-cycle, with respect to the theme of bridging medical knowledge with the related practices by which physicians deal with a specific care problem. We take the case of the CP as a paradigmatic case to stress the urgent need for an integrated approach with the computer- ...

The time-oriented analysis of electronic patient records at a (neonatal) intensive care unit is a tedious and time-consuming task. The vast amount of data available makes it hard for the physician to recognize the essential changes over time. VIE-VISU is a data visualization system which uses multiples to present the change in the patient’s status over time in graphic form. Metaphor graphics is used to sketch the parameters most relevant in characterizing the situation of a patient.

Background: In the UK the health service is investing more than ever before in information technology (IT) and primary care nurses will have to work with computers. Information about patients will be almost exclusively held in electronic patient records; and much of the information about best practice is most readily accessible via computer terminals. Objective: To examine the influence of age and nursing profession on the level of computer use. Methods: A questionnaire was developed to examine: access, training received, confidence and use of IT. The survey was carried out in a Sussex Primary Care Trust, in the UK. Results: The questionnaire was sent to 109 nurses with a 64% response rate. Most primary care nurses (89%) use their computer regularly at work: 100% of practice nurses daily, compared with 60% of district nurses and 59% of health visitors (p < 0.01). Access to IT was not significantly different between different age groups; but 91% of practice nurses had their own computer while many district nurses and health visitors had to share (p < 0.01). Nurses over 50 had received more training that their younger colleagues (p < 0.01); yet despite this, they lacked confidence and used computers less (p < 0.001). 96% of practice nurses were confident at in using computerised medical records, compared with 53% of district nurses and 44% of health visitors (p < 0.01.) One-to-one training and workshops were the preferred formats for training, with Internet based learning and printed manuals the least popular (p < 0.001). Conclusions: Using computers in the surgery has become the norm for primary care nurses. However, nurses over 50, working out in the community, lack the confidence and skill of their younger and practice based colleagues.

Background: In the UK the health service is investing more than ever before in information technology (IT) and primary care nurses will have to work with computers. Information about patients will be almost exclusively held in electronic patient records; and much of the information about best practice is most readily accessible via computer terminals. Objective: To examine the influence of age and nursing profession on the level of computer use. Methods: A questionnaire was developed to examine: access, training received, confidence and use of IT. The survey was carried out in a Sussex Primary Care Trust, in the UK. Results: The questionnaire was sent to 109 nurses with a 64% response rate. Most primary care nurses (89%) use their computer regularly at work: 100% of practice nurses daily, compared with 60% of district nurses and 59% of health visitors (p < 0.01). Access to IT was not significantly different between different age groups; but 91% of practice nurses had their own computer while many district nurses and health visitors had to share (p < 0.01). Nurses over 50 had received more training that their younger colleagues (p < 0.01); yet despite this, they lacked confidence and used computers less (p < 0.001). 96% of practice nurses were confident at in using computerised medical records, compared with 53% of district nurses and 44% of health visitors (p < 0.01.) One-to-one training and workshops were the preferred formats for training, with Internet based learning and printed manuals the least popular (p < 0.001). Conclusions: Using computers in the surgery has become the norm for primary care nurses. However, nurses over 50, working out in the community, lack the confidence and skill of their younger and practice based colleagues.

Starting February 2006, the departments Cardiology and Thoracic Surgery of the Leiden University Medical Center use a self-developed electronic patient record system: &quot;EPD-Vision&quot;. EPD-Vision offers a complete replacement of the patient chart on paper. EPD-Vision provides an overview of all patient information at every moment and at any location. Patient information in other systems is directly available in EPD-Vision (ECG&#39;s, echocardiography and cathlab images and data, lab data). The use of EPD-Vision has resulted in a significant improvement in the quality of care for cardiac patients. Substantial savings have been realized in the secretary staff. Various new modules of EPD-Vision are under development, such order management and an on-line appointment system. With the latter, patients can make appointments (e.g. for the outpatient clinic and pacemaker follow-up) through Internet. Also, parts of EPD-Vision will be available via Internet for patients and professionals.

In the Cardiology department, many different sources of clinical information are used in the daily routine. Integration of these (digital) sources into an electronic patient record is a logical step. One of the issues regarding the integration of data is the integrity of patient data: there shouldn't be any mis-registration of patient related data such as patient ID, patient name. To achieve integrity of patient data, we have now created a method to automatically transfer patient related data from one system to the other, mostly by using industry standards for communication of these data. With the integrity of these data secured, we can now proceed with the integration of the data into one system.

With the continued expansion of Electronic Patient Record systems ahead of comprehensive evidence, metrics, or future-proofing, European health informatics is embarking on a faith-driven adventure that also risks data swamping of end-users. An alternative approach is an information broker system, drawing from departmental data sources. A three-year study in health and social care has produced a first demonstrator which can search for specified information in heterogeneous distributed data stores, with source-specific permission can copy it, and then merge the search results in a real-time process.