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Data from a national patient survey (N = 1,155) of the Swedish PAEHR “Journalen” users were analysed, and an extended version of the theory of technological frames was developed to explain the variation in the technological and informational framing of information technologies found in the data.

Patient Accessible Electronic Health Records (PAEHRs) are implemented globally to address challenges with an ageing population. However, firstly, little is known about age-related variation in PAEHR use, and secondly, user perceptions of the PAEHR technology and the health record information and how the technology and information–related perceptions are linked to each other. The purpose of this study is to investigate these two under-studied aspects of PAEHRs and propose a framework based on the theory of technological frames to support studying the second aspect, i.e. the interplay of information and technology–related perceptions.

The results suggest that younger respondents were more likely to be interested in PAEHR contents for general interest. However, they did not value online access to the information as high as older ones. Older respondents were instead inclined to use medical records information to understand their health condition, prepare for visits, become involved in their own healthcare and think that technology has a much potential. Moreover, the oldest respondents were more likely to consider the information in PAEHRs useful and aimed for them but to experience the technology as inherently difficult to use.

The sample excludes non-users and is not a representative sample of the population of Sweden. However, although the data contain an unknown bias, there are no specific reasons to believe that it would differently affect the survey's age groups.

Age should be taken into account as a key factor that influences perceptions of the usefulness of PAEHRs. It is also crucial to consider separately patients' views of PAEHRs as a technology and of the information contained in the EHR when developing and evaluating existing and future systems and information provision for patients.

This study contributes to bridging the gap between information behaviour and systems design research by showing how the theory of technological frames complemented with parallel informational frames to provide a potentially powerful framework for elucidating distinct conceptualisations of (information) technologies and the information they mediate. The empirical findings show how information and information technology needs relating to PAEHRs vary according to age. In contrast to the assumptions in much of the earlier work, they need to be addressed separately.

Few earlier studies focus on (1) age-related variation in PAEHR use and (2) user perceptions of the PAEHR technology and the health record information and how the technology and information–related perceptions are linked to each other.

Healthcare is among the fastest‐growing sectors in both developed and emerging economies. E‐healthcare is contributing to the explosive growth within this industry by utilizing the internet and all its capabilities to support its stakeholders with information searches and communication processes. The purpose of this paper is to present the state‐of‐the‐art and to identify key themes in research on e‐healthcare.

A review of the literature in the marketing and management of e‐healthcare was conducted to determine the major themes pertinent to e‐healthcare research as well as the commonalities and differences within these themes.

Based on the literature review, the five major themes of e‐healthcare research identified are: cost savings; virtual networking; electronic medical records; source credibility and privacy concerns; and physician‐patient relationships.

Based on these major themes, managerial implications for e‐healthcare are formulated. Suggestions are offered to facilitate healthcare service organizations' attempts to further implement and properly utilize e‐healthcare in their facilities. These propositions will also help these stakeholders develop and streamline their e‐healthcare processes already in use. E‐healthcare systems enable firms to improve efficiency, to reduce costs, and to facilitate the coordination of care across multiple facilities.

This chapter more clearly identifies the distinction between Electronic Health Record (EHR) and Electronic Medical Record (EMR), and states their value in obtaining individual-level data. Synthetic medical records may be used as a surrogate for EHR data in order to ensure digital data privacy is maintained during the development of the LHS. Synthea is an open-source simulation tool available through GitHub.¹ Extensive descriptive analysis of synthesized data is provided as a foundation for the analysis in Chapter 7.

The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized physicians order entry (CPOE) and electronic medical/health records (EMRs/EHRs) in different sized healthcare institutions in the USA were studied in terms of understanding its impact on enhancement of quality of patient care.

This study has used secondary data to obtain insights on the processes and technologies used in hospitals of different sizes in the USA and enlighten those in the developing countries to adopt a strategy that would be most appropriate for them. The Dorenfest Institute for H.I.T. Research and Education Analytics database (The Dorenfest Institute, 2011) provided the data for 5,038 US hospitals. Logistic regression was performed to study the impact of the different types of processes and technologies on institutions of different sizes, classified based on the number of beds, physicians, and nurses.

The findings show that small sized hospitals had a positive relationship with drug dosing interactions process and nursing and clinician content process. On the contrary, medium sized hospitals had a negative relationship with the usage of CPOE for entering medical records, i.e. <25 percent (p<0.05). In order to be effective, these institutions should increase the usage of EMRs by more than 25 percent to get positive outcomes. Large hospitals showed a positive relationship with the usage of >75 percent of CPOE to enter medical records and usage of medical records >75 percent.

The authors demonstrate the need for an evaluation of utility of acute care hospitals based on hospital size in terms of number of physicians, and nurses, which have not been dealt earlier by the past studies. Moreover, there is also a need for an evaluation of utility of acute care hospitals for implementation of CPOEs and EMRs that are integrated with clinical decision support systems.

Although the data are US-centric, the insights provided by the results are very much relevant to the Indian scenario to support the improvement of the quality of care. The findings may help those implementing processes in healthcare institutions in India. No study has addressed the measurement of the positive and negative outcomes arising due to the implementation of different percentages of CPOEs and EMRs in different sized institutions. Further the number of physicians and nurses have not been considered earlier. Therefore, the authors have classified the hospitals based on physicians and nurses and studied their impact on the adoption of CPOEs, clinical decision support systems, and EMRs.

The purpose of this article is to assess the reliability of an in‐depth analysis on causation, preventability, and disability by two separate review teams on five selected adverse events in acute hospitals: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator‐associated pneumonia and postoperative wound infection.

The analysis uses a retrospective medical record review of 1,515 patient records by two independent teams in eight acute Belgian hospitals for the year 2005. The Mann‐Whitney U‐test is used to identify significant differences between the two review teams regarding occurrence of adverse events as well as regarding the degree of causation, preventability, and disability of found adverse events.

Team 1 stated a high probability for health care management causation in 95.5 per cent of adverse events in contrast to 38.9 per cent by Team 2. Likewise, high preventability was considered in 83.1 per cent of cases by Team 1 versus 51.7 per cent by Team 2. Significant differences in degree of disability between the two teams were also found for pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis and postoperative wound infection, but not for postoperative sepsis and ventilator‐associated pneumonia.

New insight on the degree of and reasons for the huge differences in adverse event evaluation is provided.

Up‐to‐date patient records are essential for safe and professional practice. They are an intrinsic component for providing adequate care and ensuring appropriate and systematic treatment plans. Furthermore, accurate and contemporaneous notes are essential for achieving professional standards from a medico‐legal perspective. The study's main aim was to investigate current record‐keeping practices by looking at whether out‐patient communication pathways to general practitioners, from letter dictation to insertion in the chart, were being satisfied.

From current out‐patient attendees over six months, 100 charts were chosen randomly, and reviewed. A pro‐forma was used to collect data and this information was also checked against electronic records.

Of the charts reviewed, 15 per cent had no letter. If one considers that one‐month is an acceptable time for letters to be inserted into the chart, then only 11 per cent satisfied this condition. Electronic data were also missing.

It is impossible to discern whether letters to GPs were dictated by the out‐patient doctor for each patient reviewed. Another limitation was that some multidisciplinary hospital teams have different out‐patient note‐keeping procedures, which makes some findings difficult to interpret.

The review drew attention to current record‐keeping discrepancies, highlighting the need for medical record‐keeping procedures and polices to be put in place. Also brought to light was the importance of providing a workforce sufficient to meet the out‐patient team's administrative needs. An extended audit of other medical record‐keeping aspects should be carried out to determine whether problems occur in other areas.

The study highlights the importance of establishing agreed policies and procedures for out‐patient record keeping and the need to have a checking mechanism to identify system weaknesses.

The authors have previously validated a design of the health-care supply chain which treats patients as inventory without loss of respect for the patients. This work continues examination of patients as inventory while addressing the dual objectives of reducing redundancy in services and creating greater efficiency in the health-care supply chain. Historical data is used to forecast health care needs in light of the increasingly specialized health-care professionals, which have resulted in much more flexible and expensive supply chains. The lack of common data storage, or electronic medical records (EMRs), has created a need for redundancy (or rework) in medical testing. The use of EMR will also enhance our ability to forecast needs in the future. We perform simulations using SigmaFlow software to address our goals relative to the resource constraints, monetary constraints, and the overall culture of the medical supply chain. The simulation outcomes lead us to recommendations for data warehousing as well as providing mechanisms, like inventory postponement strategies, to establish structures for more efficiency, and reduced flexibility in the supply chains.

In this paper, using values of individuals in a Swedish health-care organization, electronic identity management objectives related to security are defined.

By using value-focused thinking, eliciting values from interviews of three groups of health-care staff’s objective hierarchies for three stakeholder groups are identified and defined. Objective hierarchies allow comparison across multiple stakeholder groups such that strategic objectives for identity management can be compared and contrasted.

This qualitative investigation, which used value-focused thinking, revealed 94 subobjectives, grouped into 12 fundamental and 14 means objectives, which are essential for developing measures that address potential value conflicts in a health-care organization around electronic identity management. The objectives developed in this study are grounded socioorganizationally and provide a way forward in developing measures aimed to reducing potential conflicts at a policy level.

In a final synthesis, congruence (or lack thereof) in the electronic identity management approach for a Swedish health organization is suggested. This also creates a foundation to evaluate and weight different objectives for strategic decision management.

The study explores how Taiwan’s electronic health data systems can be used to build algorithms that reduce or eliminate medical errors and to advance precision medicine.

This study is a narrative review of the literature.

The body of medical knowledge has grown far too large for human clinicians to parse. In theory, electronic health records could augment clinical decision-making with electronic clinical decision support systems (CDSSs). However, computer scientists and clinicians have made remarkably little progress in building CDSSs, because health data tend to be siloed across many different systems that are not interoperable and cannot be linked using common identifiers. As a result, medicine in the USA is often practiced inconsistently with poor adherence to the best preventive and clinical practices. Poor information technology infrastructure contributes to medical errors and waste, resulting in suboptimal care and tens of thousands of premature deaths every year. Taiwan’s national health system, in contrast, is underpinned by a coordinated system of electronic data systems but remains underutilized. In this paper, the authors present a theoretical path toward developing artificial intelligence (AI)-driven CDSS systems using Taiwan’s National Health Insurance Research Database. Such a system could in theory not only optimize care and prevent clinical errors but also empower patients to track their progress in achieving their personal health goals.

While research teams have previously built AI systems with limited applications, this study provides a framework for building global AI-based CDSS systems using one of the world’s few unified electronic health data systems.