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At least 19 recordsLinked to original sources
PubMed2003

Electromagnetic noise superimposed on the electric power supply to electronic medical equipment.

The use of mobile medical electronic equipment driven at low electric power outputs has progressed rapidly in recent years. Voltage change and noise superimposed on the power supply could create obstacles to the operation of medical electronic equipment. We observed the quality of the power supply of medical electronic equipment in a university hospital, and found approximately 5% distortion on voltage. Possible causes of the distortion and factors involved in voltage/current distortion are discussed. Also shown are some points for avoiding power supply problems when using medical electronic equipment.

Electric Power Supplies↗
PubMed2002

Cognitive analyses of a paper medical record and electronic medical record on the documentation of two nursing tasks: patient education and adherence assessment of insulin administration.

The incorporation of electronic medical records into busy physician clinics has been a major development in the healthcare industry over the past decade. Documentation of key nursing activities, especially when interacting with patients who have chronic diseases, is often lacking or missing from the paper medical record. A case study of a patient with diabetes mellitus was created. Well established methods for the assessment of usability in the areas of human-computer interaction and computer supported cooperative work were employed to compare the nursing documentation of two tasks in a commercially available electronic medical record (eRecord) and in a paper medical record. Overall, the eRecord was found to improve the timeliness and quality of nursing documentation. With certain tasks, the number of steps to accomplish the same task was higher, which may result in the perception by the end user that the tool is more complex and therefore difficult to use. Recommendations for the eRecord were made to expand the documentation of patient teaching and adherence assessment and to incorporate web technology for patient access to medical records and healthcare information.

Ambulatory Care Facilities↗
PubMed2005

Pursuing integration of performance measures into electronic medical records: beta-adrenergic receptor antagonist medications.

OBJECTIVE: Electronic medical records seldom integrate performance indicators into daily operations. Assessing quality indicators traditionally requires resource intensive chart reviews of small samples. We sought to use an electronic medical record to assess use of beta-adrenergic antagonist medications (beta-blockers) following myocardial infarction, to compare a standardized manual assessment with assessment using electronic medical records, and to discuss potential for future integration of performance indicators into electronic records. DESIGN: Cross-sectional data analysis. SETTING: An urban academic medical center. PARTICIPANTS: US Medicare beneficiaries 65 years of age or older, admitted to hospital with myocardial infarction between 1995 and 1999. MEASUREMENTS AND MAIN RESULTS: Manual chart review was compared with a computer driven assessment of electronic records. Administration of beta-blockers and cases excluded from use of beta-blockers were measured, based on Medicare criteria. Among 4490 older adults, 391 (4%) of 9018 hospital admissions contained codes for myocardial infarction. In 323 (83%) of the 391 hospital admissions, criteria for excluding beta-blockers were met; 235 (60%) were excluded due to heart failure. Of 68 hospital admissions for myocardial infarction that did not meet exclusion criteria, physicians prescribed beta-blockers in 49 (72%) on admission and 42 (62%) at discharge. Compared with manual chart review, electronic review had a sensitivity of 83-100% and led to fewer false negative findings. CONCLUSIONS: An electronic medical records system can be used instead of chart review to measure use of beta-blockers after myocardial infarction. This should lead to integration of real time automated performance measurement into electronic medical records.

Academic Medical Centers↗
PubMed2005

Study of effect of drug lexicons on medication extraction from electronic medical records.

Extraction of relevant information from free-text clinical notes is becoming increasingly important in healthcare to provide personalized care to patients. The purpose of this dictionary-based NLP study was to determine the effects of using varying drug lexicons to automatically extract medication information from electronic medical records. A convenience training sample of 52 documents, each containing at least one medication, and a randomized test sample of 100 documents were used in this study. The training and test set documents contained a total of 681 and 641 medications respectively. Three sets of drug lexicons were used as sources for medication extraction: first, containing drug name and generic name; second with drug, generic and short names; third with drug, generic and short names followed by filtering techniques. Extraction with the first drug lexicon resulted in 83.7% sensitivity and 96.2% specificity for the training set and 85.2% sensitivity and 96.9% specificity for the test set. Adding the list of short names used for drugs resulted in increasing sensitivity to 95.0%, but decreased the specificity to 79.2% for the training set. Similar results of increased sensitivity of 96.4% and 80.1% specificity were obtained for the test set. Combination of a set of filtering techniques with data from the second lexicon increased the specificity to 98.5% and 98.8% for the training and test sets respectively while slightly decreasing the sensitivity to 94.1% (training) and 95.8% (test). Overall, the lexicon with filtering resulted in the highest precision, i.e., extracted the highest number of medications while keeping the number of extracted non-medications low.

Electronic Data Processing↗
PubMed1997

Medical narratives in electronic medical records.

In this article, we describe the state of the art and directions of current development and research with respect to the inclusion of medical narratives in electronic medical-record systems. We used information about 20 electronic medical-record systems as presented in the literature. We divided these systems into 'classical' systems that matured before 1990 and are now used in a broad range of medical domains, and 'experimental' systems, more recently developed and, in general, more innovative. In the literature, three major challenges were addressed: facilitation of direct data entry, achieving unambiguous understandability of data, and improvement of data presentation. Promising approaches to tackle the first and second challenge are the use of dynamic data-entry forms that anticipate sensible input, and free-text data entry followed by natural-language interpretation. Both these approaches require a highly expressive medical terminology. How to facilitate the access to medical narratives has not been studied much. We found facilitating examples of presenting this information as fluent prose, of optimising the screen design with fixed position cues, and of imposing medical narratives with a structure of indexable paragraphs that can be used in flowsheets. We conclude that further study is needed to develop an optimal searching structure for medical narratives.

Database Management Systems↗
PubMed2001

Dynamic viewer of medical events in electronic medical record.

Medical record should enable doctors to comprehend the patient's history and select suitable medical treatment. In paper based medical records, medical events (examination, treatment etc.) are recorded successively, and problem oriented recording is difficult to be applied to patients with much information and a long history. Consequently it is not easy to understand the patient's history from paper based medical records. In order to solve this problem, we developed the flow sheet system in our electronic medical record (EMR). To make a flow sheet, we analyzed the structure of the medical event data. In this paper we introduced the medical event information model for our EMR. Furthermore, we clarified the specification of the data presentation on the flow sheet. We developed the flow sheet on the basis of these analyses. Because there are 3 layers in the vertical axis of the flow sheet, many items of the medical event can be displayed on the screen. When user clicks the cell, the corresponding detail data including images are shown. This system functions to link medical event items with a problem, and shows the bundled items on the flow sheet when the user selects the problem. We implemented this system in Osaka University Hospital. The number of the types of medical events and those of detail events in inpatients are 5.0+1.7 (mean+SD) and 60+47, respectively. The medical doctors in Osaka University Hospital evaluated this system, and concludes that the flow sheet data presentation makes comprehension of the patient's history easier than paper based records. As to the function of bundling the items relevant to the problem, they feel it is especially useful for patients with chronic disease. Thus the flow sheet data presentation in EMR is useful for medical practice.

Chronic Disease↗
PubMed2004

Enhancing privacy and data protection in electronic medical environments.

Raising awareness and providing guidance to on-line data protection is by all means a crucial issue worldwide. Equally important is the issue of applying privacy-related legislation in a coherent and coordinated way. Both these topics become even more critical when referring to medical environments and thus to the protection of patients' privacy and medical data. Electronic medical transactions require the transmission of personal and medical information over insecure communication channels like the Internet. It is therefore a rather straightforward task to construct "patient profiles " that capture the electronic medical behavior of a patient, or even reveal sensitive information in regard with her/his medical history. Clearly, the consequence from maintaining such profiles is the violation of the patient's privacy. This paper studies medical environments that can support electronic medical transactions or/and the provision of medical information through the Web. Specifically it focuses on the countermeasures that the various actor categories can employ for protecting the privacy of personal and medical data transmitted during electronic medical transactions.

Computer Communication Networks↗
PubMed2002

Update on the electronic medical record.

Electronic medical records (EMRs) are becoming a reality, and many physicians are now actively considering their use. Predicting how quickly EMRs will achieve broad application is difficult, but EMR systems will gain wider acceptance if they are appropriately designed and efficient and benefit both patients and physicians.

Computer Systems↗
PubMed2005

Technical guidelines for enhancing privacy and data protection in modern electronic medical environments.

Raising awareness and providing guidance to on-line data protection is undoubtedly a crucial issue worldwide. Equally important is the issue of applying privacy-related legislation in a coherent and coordinated way. Both these topics gain extra attention when referring to medical environments and, thus, to the protection of patients' privacy and medical data. Electronic medical transactions require the transmission of personal and medical information over insecure communication channels like the Internet. It is, therefore, a rather straightforward task to capture the electronic medical behavior of a patient, thus constructing "patient profiles," or reveal sensitive information related to a patient's medical history. The consequence is clearly a potential violation of the patient's privacy. We performed a risk analysis study for a Greek shared care environment for the treatment of patients suffering from beta-thalassemia, an empirically embedded scenario that is representative of many other electronic medical environments; we capitalized on its results to provide an assessment of the associated risks, focusing on the description of countermeasures, in the form of technical guidelines that can be employed in such medical environments for protecting the privacy of personal and medical information.

Computer Communication Networks↗
PubMed1999

Consultation of medical narratives in the electronic medical record.

This article presents an overview of a research project concerning the consultation of medical narratives in the electronic medical record (EMR). It describes an analysis of user needs, the design and implementation of a prototype EMR system, and the evaluation of the ease of consultation of medical narratives when using this system. In a questionnaire survey, 85 hospital physicians judged the quality of their paper-based medical record with respect to data entry, information retrieval and some other aspects. Participants were more positive about the paper medical record than the literature suggests. They wished to maintain the flexibility of data entry but indicated the need to improve the retrieval of information. A prototype EMR system was developed to facilitate the consultation of medical narratives. These parts were divided into labeled segments that could be arranged source-oriented and problem-oriented. This system was used to evaluate the ease of information retrieval of 24 internists and 12 residents at a teaching hospital when using free-text medical narratives divided at different levels of detail. They solved, without time pressure, some predefined problems concerning three voluminous, inpatient case records. The participants were randomly allocated to a sequence that was balanced by patient case and learning effect. The division of medical narratives affected speed, but not completeness of information retrieval. Progress notes divided into problem-related segments could be consulted 22% faster than when undivided. Medical history and physical examination divided into segments at organ-system level could be consulted 13% faster than when divided into separate questions and observations. These differences were statistically significant. The fastest divisions were also appreciated as the best combination of easy searching and best insight in the patient case. The results of our evaluation study suggest a trade-off between searching and reading: too much detailed segments will delay the consultation of medical narratives. Validation of the results in daily practice is recommended.

Attitude of Health Personnel↗