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1 – 10 of over 6000Gerard Lambe, Niall Linnane, Ian Callanan and Marcus W. Butler
Ireland’s physicians have a legal and an ethical duty to protect confidential patient information. Most healthcare records in Ireland remain paper based, so the purpose of this…
Abstract
Purpose
Ireland’s physicians have a legal and an ethical duty to protect confidential patient information. Most healthcare records in Ireland remain paper based, so the purpose of this paper is to: assess the protection afforded to paper records; log highest risk records; note the variations that occurred during the working week; and observe the varying protection that occurred when staff, students and public members were present.
Design/methodology/approach
A customised audit tool was created using Sphinx software. Data were collected for three months. All wards included in the study were visited once during four discrete time periods across the working week. The medical records trolley’s location was noted and total unattended medical records, total unattended nursing records, total unattended patient lists and when nursing personnel, medical students, public and a ward secretary were visibly present were recorded.
Findings
During 84 occasions when the authors visited wards, unattended medical records were identified on 33 per cent of occasions, 49 per cent were found during weekend visiting hours and just 4 per cent were found during morning rounds. The unattended medical records belonged to patients admitted to a medical specialty in 73 per cent of cases and a surgical specialty in 27 per cent. Medical records were found unattended in the nurses’ station with much greater frequency when the ward secretary was off duty. Unattended nursing records were identified on 67 per cent of occasions the authors visited the ward and were most commonly found unattended in groups of six or more.
Practical implications
This study is a timely reminder that confidential patient information is at risk from inappropriate disclosure in the hospital. There are few context-specific standards for data protection to guide healthcare professionals, particularly paper records. Nursing records are left unattended with twice the frequency of medical records and are found unattended in greater numbers than medical records. Protection is strongest when ward secretaries are on duty. Over-reliance on vigilant ward secretaries could represent a threat to confidential patient information.
Originality/value
While other studies identified data protection as an issue, this study assesses how data security varies inside and outside conventional working hours. It provides a rationale and an impetus for specific changes across the whole working week. By identifying the on-duty ward secretary’s favourable effect on medical record security, it highlights the need for alternative arrangements when the ward secretary is off duty. Data were collected prospectively in real time, giving a more accurate healthcare record security snapshot in each data collection point.
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This paper seeks to analyze attempts, in the USA and globally, to create new and improved methods used to manage patient health information: electronic medical records (EHRs)…
Abstract
Purpose
This paper seeks to analyze attempts, in the USA and globally, to create new and improved methods used to manage patient health information: electronic medical records (EHRs). This new system of records management is to be examined to determine the possible benefits for patients, providers, insurers, employers, and others, as well as barriers to the use of EHRs, particularly in those embedded in US law.
Design/methodology/approach
In the USA, and in various other jurisdictions, new laws have been enacted to incentivize the use of EHRs, and the paper examines the regulations and provisions incentivizing the adoption of this type of integrated system for lifelong tracking of health‐related information. There are issues to be dealt with, such as cost, privacy, and legality, but each of these can and must be overcome to effectively manage and communicate health care information
Findings
The use of EHRs is increasing in the USA and globally, both in acute care hospitals and in primary care medical practices, largely accomplished through positive incentives, and penalties for non‐compliance. There are also various countries well on the way to wide‐spread use of electronic health records management.
Social implications
The use of EHRs creates a societal benefit, initially one on an individual level, but one which over time could rise to a level positively affecting health care on a national, even global level.
Originality/value
The paper is based on an analysis of relevant laws/regulations, best practices, and anecdotal/observational evidence. No empirical evidence survey or study was conducted, primarily because the process of implementation of EHRs is too new. It is of value to practitioners, policy makers, and interested public parties.
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Kisha Hortman Hawthorne and Lorraine Richards
This paper examines existing research on the topic of personal health records (PHRs). Areas covered include PHR/patient portal, recordkeeping, preservation planning, access and…
Abstract
Purpose
This paper examines existing research on the topic of personal health records (PHRs). Areas covered include PHR/patient portal, recordkeeping, preservation planning, access and provider needs for future reuse of health information. Patient and physician PHR use and functionality, as well as adoption facilitators and barriers, are also reviewed.
Design/methodology/approach
The paper engages in a review of relevant literature from a variety of subject domains, including personal information management, medical informatics, medical literature and archives and records management literature.
Findings
The review finds that PHRs are extensions of electronic records. In addition, it finds a lack of literature within archives and records management that may lead to a less preservation-centric examination of the new PHR technologies that are desirable for controlling the lifecycle of these important new records-type.
Originality/value
Although the issues presented by PHRs are issues that can best be solved with the use of techniques from records management, there is no current literature related to PHRs in the records management literature, and that offered in the medical informatics literature treats the stewardship aspects of PHRs as insurmountable. This paper offers an introduction to the aspects of PHRs that could fruitfully be examined in archives and records management.
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Andrea Jones, Flis Henwood and Angie Hart
This paper examines the factors that made services more or less effective in using electronic patient record systems to produce clinical information for clinical audit and…
Abstract
Purpose
This paper examines the factors that made services more or less effective in using electronic patient record systems to produce clinical information for clinical audit and research.
Design/methodology/approach
Case studies of the use of electronic patient record systems in three maternity services in England, using qualitative research methods (semi‐structured interviews, observations and shadowing).
Findings
There were many contributing factors in each case site. The three main groups of determining factors were these: the resources devoted to, and acceptability to midwives of, the “IT midwife”; maternity managers prioritisation of information related matters; the relationship of maternity information systems with Trust‐wide systems.
Originality/value
Provides services with lists of factors they need to consider if they want to maximise the benefits realised for clinical audit and research from existing and new electronic patient record systems.
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Chih-Yang Tsai, Paul Pancoast, Molly Duguid and Charlton Tsai
The purpose of this paper is to understand the time spent on various tasks during physician inpatient rounds and to examine the new electronic health records (EHRs) impact on time…
Abstract
Purpose
The purpose of this paper is to understand the time spent on various tasks during physician inpatient rounds and to examine the new electronic health records (EHRs) impact on time distribution.
Design/methodology/approach
Trained observers shadowed hospital physicians to record times for various tasks before and after EHR implementation.
Findings
Electronic records did not improve efficiency. However, task times were redistributed. Physicians spent more time reviewing patient charts using time saved from miscellaneous work.
Research limitations/implications
The study focusses solely on work distribution and the changes it underwent. It does not include quality measures either on patient results or physician satisfaction.
Practical implications
As EHR provides rich information and easier access to patient records, it motivates physicians to spend more time reviewing patient charts. Hospital administrators seeking immediate returns on EHR investment, therefore, may be disappointed.
Originality/value
Unlike previous work, this study was conducted in a non-teaching hospital, providing a task-time comparison without any educational and team factor influence. The result serves as a benchmark for many community hospital managers seeking to address the same issue.
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Rhonda J. Richards, Victor R. Prybutok and Sherry D. Ryan
The purpose of this article is to present a conceptual model that posits the strategic relationships between information technology, clinic operations and physicians and the…
Abstract
Purpose
The purpose of this article is to present a conceptual model that posits the strategic relationships between information technology, clinic operations and physicians and the subsequent outcomes to patients, physicians and clinics which can lead to competitive advantages in the healthcare environment.
Design/methodology/approach
This paper is based on a review of the literature and proposes a conceptual model of the strategic relationships essential for success. The scope of the paper is based on the legal, economic and political triggers impacting the strategic relationship between electronic medical records, clinic interoperability and physicians as owners/users.
Findings
The paper presents the formation of a conceptual model which identifies the strategic alignment between clinics, physicians and information technology, more specifically, electronic medical records.
Research limitations/implications
This paper is limited in that it is not an empirical investigation but a conceptual model of future research endeavours. Future research endeavours should seek empirical findings related to the relationships proposed in the model.
Practical implications
Physicians, clinics and patients should be aware of the impact electronic medical records have on the health environment as well as the potential competitiveness due to health consumerism enabled by electronic medical records.
Social implications
Electronic medical records, personal health records and electronic health records are infiltrating society; subsequently health consumers should determine how this technology may impact their healthcare.
Originality/value
The value of this paper is to provide a conceptual model as a basis for future empirical research and awareness of changes in the competitiveness of the healthcare environment.
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Aishath Selna, Zulhabri Othman, Jacquline Tham and Adam Khaleel Yoosuf
This paper is based on a study done to investigate patient safety in two of the largest hospitals in the Maldives, and part of that study was on challenges faced by nurses in…
Abstract
Purpose
This paper is based on a study done to investigate patient safety in two of the largest hospitals in the Maldives, and part of that study was on challenges faced by nurses in using electronic health records (EHRs) to enhance patient safety. Patient safety is a vital component of an established patient safety culture (PSC).
Design/methodology/approach
This study was conducted among nurses who also work as patient safety champions/link nurses from hospitals in Central Malé area, in the Maldives, by using focus group discussions. A purposive sampling technique was adopted, and five nurses from each hospital participated in the discussion.
Findings
Key findings included poor usability of EHRs; importance of training to use EHRs; and importance of information sharing.
Research limitations/implications
The implications for positive social change include establishing an EHR, which has the capacity to collaborate with the National Health Information Network while providing access to every patient in the Maldives.
Practical implications
EHR systems can help in collaboration among health-care professionals resulting in better patient outcomes which can contribute to establishing a PSC. Most of the patient documentation is done as paperwork in this clinical area; EHRs can contribute to minimizing paperwork and contributing quality time for better patient care. Establishing an EHR which has the capacity to collaborate with the national health information network while providing access to every patient in the Maldives.
Social implications
Establishing an EHR which has the capacity to collaborate with the national health information network while providing access to every patient in the Maldives.
Originality/value
Nurses are the bridge between patients and clinicians during patient care and therefore require as much information as possible to improve patient outcomes. While the EHRs in these two hospitals were electronic patient records (EPRs) developed by staff within the hospitals for their own use, the findings from such a bottom-up approach to develop and use EPRs can be relevant, to ensure patient safety targets of EHRs are met.
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This paper seeks to explore the challenges and transformations in healthcare resulting from building information infrastructures for patient‐centred care.
Abstract
Purpose
This paper seeks to explore the challenges and transformations in healthcare resulting from building information infrastructures for patient‐centred care.
Design/methodology/approach
Four types of information infrastructures are analysed with special attention given to the efforts and controversies related to their mobilization and to their consequences for patient‐centred care. Data are gathered through a literature review and by empirical research.
Findings
The development of information infrastructures for patient‐centred care requires mobilization of technical, legal, clinical and ethical standards as well as a change in organizational and professional boundaries. Furthermore, the mobilization of information infrastructures entails unexpected transformation in the nature of patients, professionals, health records and consultations.
Practical implications
Patient‐centred information infrastructures call for institutional innovation and decision making regarding basic structures and relationships in healthcare. At the same time, the ambitions of patient‐centred care should be broad enough to learn from the consequences of emerging infrastructures for the patient and professional identities and for the quality of care.
Originality/value
The paper contributes to the understanding of healthcare governance by conceptualizing and empirically exploring the role of information infrastructure as a formative part of patient‐centred care.
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Proposes using the analytic concept of genre of organizational communication to study the organizational consequences of implementing clinical information systems and shifting…
Abstract
Proposes using the analytic concept of genre of organizational communication to study the organizational consequences of implementing clinical information systems and shifting from paper‐based to electronic patient records in clinical practices. By focusing research attention on interpersonal communication and social interaction issues not addressed in medical informatics research, this approach contributes to the understanding of organizational and institutional issues that implementing such systems may entail. The paper develops an example drawn from an in‐depth case study of a computerized order entry system to illustrate the insights this approach may provide.
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Peter Otto and Dorit Nevo
The purpose of this paper is to understand one aspect of electronic health record adoption by studying the impact of policy interventions on the adoption among hospitals…
Abstract
Purpose
The purpose of this paper is to understand one aspect of electronic health record adoption by studying the impact of policy interventions on the adoption among hospitals, physicians and patients, using a system dynamics simulation model.
Design/methodology/approach
A system dynamics simulation model of the existing distribution network was built. Policy experiments were conducted to compare the performance of each.
Findings
Using data from the Greater Capital Region, Northern New York State, the findings from the simulation experiments suggest that while there is no single right intervention, a combination of measures can promote the adoption of electronic health records by different stakeholders.
Research limitations/implications
The results are based on simplified operational and structural assumptions regarding the diffusion of electronic health records among stakeholder groups. Some of the variables are based on theoretical rather than quantifiable values.
Social implications
The results of this study have practical implications when it comes to designing effective policies to improve the adoption rate of electronic health records. The theoretical contribution will help stakeholders to take leadership roles in policy discussion.
Originality/value
This paper is a theoretical study describing a unique application of simulation methods to an important area of application. Use and evaluation for model‐based approaches could provide additional insight about the potential value of simulation for social learning and effective approaches to making public policy decisions.
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