Studies in health technology and informatics
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Stud Health Technol Inform · Jan 2010
Medical education & health informatics: time to join the 21st century?
This paper reports a component of a larger study, Informatics: enhancing the Clinical Experience? (ICE), which explored the impact on the therapeutic relationship of the implementation and use of Electronic Medical Records (EMR) in British Columbia, Canada. As anticipated, EMRs were found to negatively affect the relationship in many clinics. ⋯ This led to an interesting finding; that as a result of this difficulty few family care providers actually chart when their patients are with them, preferring to build rapport and chart at a later time. Consequently three recommendations are made: 1) Improve medical education in the area of charting (paper & EMR-based) with the patient present; 2) Explore the affect different technologies and skills have on the ability of providers to chart with the patient present and 3) Develop an understanding that unless the technology and training improve Canadian family medicine will never gain the asserted benefits of EMRs, and that other incentives are needed if Canada is to meet its target of delivering Electronic Health Records (EHR) to 100% of all Canadians by 2015.
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Stud Health Technol Inform · Jan 2010
Socio-technical challenges in implementing safe patient handovers.
Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. Drawing on three ethnographic case studies we identify and discuss socio-technical issues which must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care. We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover and data standards and system integration warrant ongoing research in socio-technical aspects of care handovers.
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Stud Health Technol Inform · Jan 2010
Combining vital events registration, verbal autopsy and electronic medical records in rural Ghana for improved health services delivery.
This paper describes the process of implementing a low-cost 'real-time' vital registration and verbal autopsy system integrated within an electronic medical record within the Millennium Village cluster in rural Ghana. Using MGV-Net, an open source health information architecture built around the OpenMRS platform, a total of 2378 births were registered between January 2007 and June 2009. ⋯ Building additional clinics to reduce distance to facility and using the CHEWs to refer women for delivery in the clinics are possible explanations for the success in the vital registration. The integration of vital registration and verbal autopsies with the MGV-Net information system makes it possible for rapid assessment of effectiveness and provides important feedback to local providers and the Millennium Villages Project.
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Stud Health Technol Inform · Jan 2010
MET3-AE system to support management of pediatric asthma exacerbation in the emergency department.
A decision making process behind the management of pediatric patients with asthma exacerbations in the Emergency Department includes three stages: data collection, diagnosis formulation and treatment planning. These stages are associated with activities involving different types of clinical knowledge: factual, conceptual and procedural. Effective decision support should span over the entire decision making process and facilitate the use of diversified clinical knowledge. ⋯ It was developed using ontology-driven and multi-agent methodologies and implemented with open source software. The system is accessible on tablet and desktop computers and smartphones, and it interacts with other hospital information systems. It was successfully verified in a simulated clinical setting and now it is undergoing testing in a teaching hospital.
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Stud Health Technol Inform · Jan 2010
Patient safety and sociotechnical considerations for electronic handover tools in an Australian ehealth landscape.
The Australian Commission for Safety and Quality in Health Care (ACSQHC) coordinates national improvements in a range of complex health system problems including clinical handover, and has funded a range of handover improvement projects in Australia. One of these, the SafeTECH project in South Australia has developed guidelines for safe use of electronic handover tools. These guidelines were developed using evidence from three hospital case studies into the use of an electronic tool to support different types of shift-to-shift handover. ⋯ The paper then considers these challenges within the broader context of the Australian ehealth landscape. Australia's National eHealth Transition Authority (NEHTA) is actively developing ehealth standards and infrastructure requirements for the electronic collection and secure exchange of health information. The paper argues for flexible standardisation in the design and implementation of electronic handover tools to ensure that all key dimensions of the challenges faced in ensuring patient safety are addressed.