جستجوی مقالات مرتبط با کلیدواژه « Electronic medical records » در نشریات گروه « پزشکی »

The implementation of electronic health (e-Health) in healthcare organizations consistently encounters numerous challenges. These barriers hinder the widespread adoption of this promising technology within healthcare settings. This study addresses the challenges of implementing e-Health across various hospitals and also aims to evaluate the maturity of hospital information systems (HIS) in Iranian hospitals based on the electronic medical record adoption model (EMRAM). Through two rounds of literature review and case studies, a comprehensive understanding of these previously unexplored issues has been developed. The findings identify 13 social and technical challenges, including the lack of standard applications, high costs associated with e-Health and training, legal issues, security concerns, inconsistencies and diversities in perceived e-Health benefits and barriers, lack of proficiency, and difficulties healthcare professionals face in integrating e-Health into their daily tasks. There are also negative perceptions among physicians and patients regarding the use of e-Health software, the lengthy implementation times for HIS systems, technical difficulties due to platform diversity, resistance to change, and the limited use of pilot projects, particularly in Iran. Moreover, the maturity of hospital cases in Iran is at 3 stages, in contrast to the 7 stages of EMRAM. These results underscore the need to develop an effective strategy to address the challenges identified in this research. Additionally, a specific program should be implemented for developers to enhance the maturity of HISs and advance them to higher stages of EMRAM.

Over the last few decades, several theoretical frameworks have been proposed to evaluate electronic health records (EHRs). These frameworks provide a theoretical basis for assessing the impact and outcomes of technology adoption in healthcare settings. This can help identify areas for improvement and ensure that EHRs effectively support healthcare delivery and patient care.

The purpose of this study is to present a comprehensive review of the use of validation methods in Electronic health records.

Out of a total of 62 EHR evaluation frameworks in our previous literature review, at the final stage, 34 relevant articles were included for analysis. Variables such as participants and study setting, analysis software, data gathering methods, missing data, and outlier handling, theoretical basis models to develop the EHR evaluation model, the relationship between variables of the EHR evaluation models with evaluation items, sampling technique and sample size reliability assessment methods and values, and statistical validation methods and criteria values were extracted.

Among the 34 papers that disclosed the validation methods utilized, the most widely used technique was Structural Equation Modeling (SEM), employed in 26.5% of the studies. Other methods utilized were Confirmatory Factor Analysis (CFA), and Exploratory Factor Analysis (EFA). A reliability assessment was performed in 82% of the articles. Cronbach's alpha and composite reliability (CR) were popular reliability (internal validation) methods on identified papers.

It is our belief that the results of this study can assist researchers in examining and modifying EHR evaluation frameworks to suit their specific needs. Additionally, we believe that our findings serve as a solid foundation for the creation of new EHR evaluation frameworks. Furthermore, we recommend that researchers utilize the findings presented in this article to enhance the implementation and utilization of SEM, CFA, and EFA methods in EHR evaluation models.

  Integrated home care (IHC) is one strategy to provide care to people with multiple chronic conditions, and it contributes to the reduction of unnecessary emergency department (ED) use, but there are conflicting results on its effectiveness. In this study, we assessed the frequency and characteristics of ED visits occurring before, during, and after IHC in a large cohort of IHC patients enrolled over 6 years.

  The analysis included 39 822 IHC patients identified in Italian administrative databases. Patients were grouped in tertiles according to IHC duration (short, intermediate, and long) and the number of ED visits during IHC was compared to that the 12 months before IHC enrolment and in the 12 months after IHC discharge across IHC duration groups.

We observed a reduction in ED visits during IHC. IHC was significantly associated with a reduction in ED visits in the long and short IHC duration groups. A non-significant reduction in ED visits was observed in the intermediate IHC duration group. A 90% reduction in ED visits during IHC and a 45% reduction after IHC was observed in the short IHC duration group. Corresponding reductions were 17% and 64% during and after IHC, respectively, in the long IHC duration group.

  IHC was effective in reducing ED visits, but expansion of IHC to include additional necessary services could further reduce ED visits. Investment in the creation of a structured, effective network of engaged professionals (including community care services and hospitals) is crucial to achieving this.

With the promising outcomes of the pre-ESRD (end-stage renal disease) pay-for-performance (P4P) program, the National Health Insurance Administration (NHIA) of Taiwan launched a P4P program for patients with early chronic kidney disease (CKD) in 2011, targeting CKD patients at stages 1, 2, and 3a. This study aimed to examine the long-term effect of the early-CKD P4P program on CKD progression.

We conducted a matched cohort study using electronic medical records from a large healthcare delivery system in Taiwan. The outcome of interest was CKD progression to estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2 between P4P program enrolees and non-enrolees. The difference in the cumulative incidence of CKD progression between the P4P and non-P4P groups was tested using Gray’s test. We adopted a cause-specific (CS) hazard model to estimate the hazard in the P4P group as compared to non-P4P group, adjusting for age, sex, baseline renal function, and comorbidities. A subgroup analysis was further performed in CKD patients with diabetes to evaluate the interactive effects between the early-CKD P4P and diabetes P4P programs.

The incidence per 100 person-months of disease progression was significantly lower in the P4P group than in the non-P4P group (0.44 vs. 0.69, P < .0001), and the CS hazard ratio (CS-HR) for P4P program enrolees compared with non-enrolees was 0.61 (95% CI: 0.58–0.64, P < .0001). The results of the subgroup analysis further revealed an additive effect of the diabetes P4P program on CKD progression; compared to none of both P4P enrolees, the CS-HR for CKD disease progression was 0.60 (95% CI: 0.54–0.67, P < .0001) for patients who were enrolled in both early-CKD P4P and diabetes P4P programs.

The present study results suggest that the early-CKD P4P program is superior to usual care to decelerate CKD progression in patients with early-stage CKD.

The Electronic Health Record is a collection of medical information about a person's health status. The development of electronic health records has occurred worldwide, and developing countries, including Iran, have been no exception and have tried to take action in this regard. Therefore, this study aimed to review the types of Electronic Health Records designed in Iran.

Information & Methods:

This systematic review was conducted without any time limitation until 12 June 2022 by searching the keywords "Electronic Health Record", and "Iran", and their synonyms in the Web of Science, PubMed, Scopus, SID, and Magiran databases, and Google Scholar search engine. Published articles on the development or design of electronic health records in Iran were reviewed.

Among 28 papers, 11, 6, and 11 records were designed in Electronic Health Record, Electronic Medical Record, and Personal Electronic Record formats, respectively. Approximately 46% of the studies only designed electronic records but never implemented them, and the rest (54%) had completed the electronic record development. Among 15 implemented records, 7, 4, and 4 were in Personal Electronic Record, Electronic Health Record, and Electronic Medical Records formats, respectively. In addition, implementation platforms for records were in the form of web-based, mobile-based, and windows-based applications. Most of the minimum data set in the designed records were demographic data, medical history, therapeutic procedures, and laboratory tests.

Designing various Electronic Health Record systems for different diseases and clinical conditions can be an effective step toward developing a national Electronic Health Record.

This study was conducted to determine the usability of the rapid response team (RRT) electronic medical records (EMRs) system at an Abu-Ali-Sina organ transplant hospital, Shiraz, Iran.

This cross-sectional study was carried out in partnership with 25 direct members of RRT includes nurses and anesthesia technicians who were on the shift during the data collection for two months. To evaluate, the Questionnaire for User Interaction Satisfaction (QUIS) version 7 was used. Data were analyzed by SPSS version 19.

A total of 20 out of 25 questionnaires were obtained. Seven (25.0 %) of 27 sections were higher than seven, and all areas were higher than five. The highest rankings were for 1) reading characters on the computer screen 2) highlighting on the screen simplify task 3) overall reactions: wonderful and learning to operate the system.

This study demonstrates the usability of the hospital RRT for the EMRs system and over the moderate. However, the flexibility and capability of the rapid response for EMRs tool require to be improved.

Today, there are different benchmarks created to evaluate the maturity of hospital information systems, however, until very recently, there was no reference framework or model to evaluate these system. In the end, a universally famous model called the electronic medical record adoption model appeared as a cornerstone to assess the maturity rate of hospital information system applications in hospitals. However, many developing countries and even some developed nations have not yet been able to present it in countries around the globe.
The purpose of this study was to assess and compare the maturity of military and civilian (governmental and private) hospitals with regards to electronic medical record adoption model in Isfahan and Tehran provinces of Iran.
This research was a descriptive analytical study to evaluate 2 military, 5 governmental, and 3 private hospitals in the provinces of Isfahan and Tehran in 2016. The selection method was simple random sampling for military hospitals and stratified sampling for civilian hospitals. The measurement tool was electronic medical record adoption model checklist.
The findings showed that 100% of military and civilian hospitals reached the 1st stage requirements of EMRAM. However, 50% of all military hospitals, 60% of governmental and 66% of private hospitals have overcome the 2nd stage of HIS maturity. Consequently, these hospitals have the least suitable conditions and stages. However, the military hospitals’ maturity was clearly diverse. Moreover, private hospitals showed more obvious immaturity of HISs than military and governmental hospitals. Also, the maturity of military and governmental hospitals was roughly similar.
By comparing the Iranian military and civilian hospitals, it was found that maturity of HISs was rather same. The HISs did not apply full potential benefits of HIS and were put up to the third stage of EMRAM in these hospitals. However, the governmental hospital was still standing against it. Eventually, there was no strategy to develop a HIS plan in these hospitals. However, more research is needed to investigate the military hospitals in Iran due to the fact that 2 different types of military along with police health care systems are operating in Iran.

The goal of the study is to evaluate the sensitivity of Czech physicians to the early diagnosis of dementia in patients with memory impairment. A retrospective observational study was designed. We have reviewed the electronic medical records of patients who have been hospitalized for the first time due to dementia of any type at the Kromeriz Mental hospital from January 1, 2012 to December 31, 2013 (24-month period). Pluralistic methods combining the qualitative and quantitative approach were used in this study. Dementia of any type was diagnosed in 125 patients in the monitored period. The mean time between patient memory complaints and his / her admission to our facility for their first hospitalization due to dementia was 7.1 years (+- 3.7 years). Most patients with dementia had no prior outpatient treatment of their memory impairment (56.2%); a minority of patients (43.8%) had treatment of their memory impairment by an outpatient physician. The sensitivity of Czech physicians to the early diagnosis of dementia is very low. Any delay in starting the treatment of dementia means a worsened effectiveness of this treatment, a worsened quality of life of patients with dementia and their caregivers. Our recommendations for both the early diagnosis and treatment of dementia should be involved in guidelines and should become a part of the pregraduate and postgraduate education of all physicians.

Development of information and communication technology led to enormous changes in different areas. In the health sector, the use of efficient information technology and information systems to achieve the goals of efficiency, effectiveness, service quality and patient satisfaction is an undeniable necessity. One of these technologies is electronic medical records system. This study aimed to investigate and compare the educational hospitals of Uemia University of Medical Sciences in case of organizational and to establish electronic medical records. The study is a descriptive cross-sectional study that periodically was conducted in 2012. The study population consisted of 98 senior and central managers of hospitals. In this study population census was used and all of the population were considered as the sample. A questionnaire contains two sections was used for data collection. The first section was to determine level of awareness and the second section was to check the requirements related to organizational standards required for implementation of electronic medical records. Validity and reliability were assessed and the data was analyzed by SPSS statistical software. Of the five hospitals in the study, samples awareness in hospitals was assessed as moderate. In terms of organizational requirements, there was no significant difference between the mean of Electronic Medical Records between hospitals studied. Out of 5 hospitals, in terms of organizational standard requirement of EMR, the hospital «F», «A» and «C» is more prepared than hospitals «B» and «D» for the implementation of electronic medical records. However, the implementation of electronic medical records, increases health care quality, patient safety and patient care and also decreases health costs. So it is suggested that hospitals do necessary efforts to establish electronic medical records.