Challenges to the development of appropriate yet adaptable policy and tools for security of the individual patient electronic health record (EHR) are proving to be significant. Compounding this is the unique capability of e-health to transgress all existing geo-political and other barriers. Initiatives to develop and advance policy, standards, and tools in relation to EHR access control and authorisation management must address this capability. Currently policy development initiatives take place largely in an isolated manner. This jeopardises the potential of e-health because decisions made in one jurisdiction might hamper, even prevent, an e-health opportunity in another. This paper places access and authorisation issues in an overall policy context through describing current Canadian initiatives. The National Initiative for Telehealth (NIFTE) Guidelines project is developing a framework of national guidelines for telehealth. The Policy and Peer Permission (PPP) project is developing a unique tool that provides persistent protection of data. The new corporate body 'Infoway' is developing a pan-Canadian electronic health record solution. Finally, the Glocal e-Health Policy initiative is developing a tool with which to identify and describe the inter-relationships of e-health issues amongst policy levels, themes, and actors.
We conducted a qualitative study of the system for contagious disease surveillance in Norway. Semi-structured interviews were held with five general practitioners (GPs), including one person responsible for informing GPs in their region about potentially serious disease outbreaks. The interviews suggested that the existing system had several limitations, making it of little relevance to local epidemics or daily medical practice. Specifically, it was difficult and time-consuming for physicians to locate relevant information, and there was a substantial delay between reported diagnoses and eventual feedback about outbreaks. This resulted in information that was too old to be of value. The interviews also investigated design matters related to future realtime disease surveillance systems. The GPs expressed interest in a distributed system for realtime extraction and presentation of data from electronic record systems. They required that any such system be customizable to the specific needs of the doctor in order to be relevant in day-to-day practice, and that correct interpretation of data would be possible in the minimum of time.
Lack of a proper infrastructure of health care providers leads to the breaks in the health care process Informatization. This results in the manifestation of different data entry point. The different data sets that are entered in these different points tend to serve the same task. However, due to the different qualification of staff a consistency of data cannot be preserved. The paper presents an approach where data is split to the different levels.
Norwegian Research Centre for Electronic Patient Records, Faculty of medicine Norwegian University of Science and Technology, Medical-technical research centre, N-7489 Trondheim, Norway. email@example.com
Many hospital departments have implemented small clinical departmental systems (CDSs) to collect and use patient data for documentation as well as for other department-specific purposes. As hospitals are implementing institution-wide electronic patient records (EPRs), the EPR is thought to be integrated with, and gradually substitute the smaller systems. Many EPR systems however fail to support important clinical workflows. Also, successful integration of systems has proven hard to achieve. As a result, CDSs are still in widespread use. This study was conducted to see which tasks are supported by CDSs and to compare this to the support offered by the EPR.
Semi-structured interviews with users of 16 clinicians using 15 different clinical departmental systems (CDS) at a Medium-sized University hospital in Norway. Inductive analysis of transcriptions from the audio taped interviews.
The roles of CDSs were complementary to those of the hospital-wide EPR system. The use of structured patient data was a characteristic feature. This facilitated quality development and supervision, tasks that were poorly supported by the EPR system. The structuring of the data also improved filtering of information to better support clinical decision-making. Because of the high value of the structured patient data, the users put much effort in maintaining their integrity and representativeness. Employees from the departments were also engaged in the funding, development, implementation and maintenance of the systems.
Clinical departmental systems are vital to the activities of a clinical hospital department. The development, implementation and clinical use of such systems can be seen as bottom-up, user-driven innovations.
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This paper aims to describe and analyze the prolonged efforts - spanning close to two decades - of developing and using electronic patient records in the large, university-based hospitals in Norway.
This study belongs to an interpretative approach to the development and use of information systems.
The increase in organizational, institutional, political and technological complexity has been seriously underestimated. This paper describes and analyses the prolonged efforts - spanning close to two decades - of developing and using EPRs in the large, university-based hospitals in Norway. The investments involved were considerable, implying that a crucial aspect of these efforts has been the way alliances have been forged with public institutions and agendas.
The conditions for small-scale, bottom-up and evolutionary approaches never succeeded in constructing themselves as a viable alternative to the larger, more sweeping electronic patient record initiative, reiterating a more general tendency to privilege the more comprehensive and daring projects.
Leading change initiatives across multiple geographic locations has become increasingly frequent among nursing leaders as hospitals merge to form more effective and powerful organizations. This case study illustrates how strong nursing leadership, in conjunction with a transformational change approach, led to the successful implementation of a new documentation system at two hospitals within one organization. The project process is described in detail, including a discussion of lessons learned, and recommendations are provided for the leadership of future multi-site projects.
The authors of the lead essay present a compelling case for the development and implementation of a national strategy on chronic disease prevention and management (CDPM). The literature demonstrates that the Chronic Care Model can improve quality and reduce costs. Substantial evidence supports the role of health information technologies such as electronic health records (EHRs) in achieving these goals. However, an interoperable pan-Canadian health infostructure does not exist; funding is required to establish this across the continuum of care. An investment of $350 per capita would provide a robust health technology platform to support a national CDPM strategy. Such an investment would deliver annual benefits of $6-$7.6 billion; this could be leveraged to support national healthcare priorities such as CDPM. EHRs will improve decisions about care, reduce system errors and increase efficiency. They will also improve our ability to measure, assess and manage care. We cannot run a high-performing health system without sound data. This was a key step to enabling progress on wait times management. Leadership is required if a national CDPM strategy is to become reality. The authors made a convincing case for the development of a national strategy; we need to turn their words into actionable events to gain necessary momentum.
As a preliminary for the design of Computer-Based Patient Records, the aim of this paper is to build an understanding of the roles physical artifacts like paper-based patient records play in supporting cognition and collaboration in the health-care settings.
A small ethnographically-informed study was conducted in the emergency room at a 250-bed hospital in Sweden from the perspective of Distributed Cognition.
To track work-in-progress, clinicians placed patient records on a desk to form a shared public display that represented the current problem state for the health-care team. The results of the study suggest that the patient records and other physical artifacts are used by clinicians in different ways to form cognitive tools that offload memory tasks and support joint attention and collaboration.
To design Computer-Based Patient Records that more appropriately support cognition and teamwork, it is important to investigate how clinicians make use of the paper-based patient records. Practitioners take advantage of existing tools frequently to deal with cognitively demanding tasks and collaboration issues.
Recently attention has been focussed on the significance of primary care to the Canadian healthcare system. Nova Scotia. Like other provinces, is seeking ways to improve the healthcare that it provides within a financially constrained publicly funded system. The Strengthening Primary Care Initiative in Nova Scotia (SPCI) was a primary care demonstration project to evaluate specific goals related to primary care. Although the provincial government conceived the SPCI, the approach to its planning and implementation was participatory and consultative. Funded through the federal Health Transition Fund (HTF) (Health Canada 2002) and the government of Nova Scotia, the SPCI involved changes in four communities over a three-year period (2000-2002). These changes included the introduction of a primary healthcare nurse practitioner in collaborative practice with one or more family physicians; remuneration of the family physician(s) with methods other than a solely fee-for-service (FFS) arrangement; and the introduction and utilization of a computerized patient medical record. The SPCI was committed to a consultative process with stakeholders, and this gave rise to several challenges. Initially there was disagreement on the requirement for nurse practitioners at each of the demonstration sites. The Minister of Health confirmed that a nurse practitioner was a required component at each demonstration site. Differences in perspectives on the role of allied health professionals in the SPCI were encountered, and the significance of the role pharmacists have in primary care was not fully appreciated until after the SPCI had started. At the time the SPCI began there was no legislation for nurse practitioners in Nova Scotia; therefore, an approval mechanism for nurse practitioner practice was authorized through the provincial regulatory bodies for nursing and medicine. Malpractice and liability issues, particularly on the part of providers who had never worked with nurse practitioners before, were an initial concern. Recruitment of nurse practitioners into the three rural sites mirrored the difficulties with recruitment of healthcare providers encountered in other parts of rural Canada. The authors discuss their perspectives on the challenges related to interdisciplinary collaboration in health systems change that were encountered during the planning and implementation of the SPCI. Although nurse practitioner Legislation has existed in Ontario and Newfoundland and Labrador for several years, many provinces are grappling with the challenges associated with the introduction of nurse practitioners and collaborative practice. This paper conveys the experience of one province and will be of interest to administrators, educators and practitioners elsewhere in Canada who are engaged in primary healthcare renewal.