Section 2: Patient Records: The Computerized Patient Record: Where Do We Stand?

Summary

Objectives

To provide an overview of trends in research, developments and implementations of the computerized patient record (CPR) of the last two years.

Methods

We surveyed the medical informatics literature, spanning the years 2004-2005, focusing on publications on CPRs.

Results

The main trends revealed were: 1) the development of technologies to realize privacy and security goals or remote data entry and access to CPRs; 2) investigations into how to enhance the quality and reuse of CPR data; 3) the development and evaluation of decision support functions to be integrated with CPRs; 4) evaluations of the impact of CPRs on clinicians, patients, clinical work settings and patient outcomes; and 5) the further development and use of standards to move towards shared electronic health records (EHRs).

Conclusion

The CPR is playing a growing part in medical informatics research and evaluation studies, but the goal of establishing a comprehensive lifelong EHR is still a long way off. In moving forward to EHRs, convergence of EHR standards seems required to realize true interoperability of health care applications. User acceptance of present-day CPRs (for all categories of users) and compatibility with work patterns has not been achieved yet, and can only be realized by giving these goals high priority. This will require substantial resources for in-depth work flow analysis, development and evaluation of CPRs. Besides this, the implementation of effective CPRs asks for health care organizations that are willing to invest in new developments and to contribute to evaluation studies, to further improve CPRs’ functionalities and enhance their use in practice.

Haux R, Kulikowski C, editors. IMIA Yearbook of Medical Informatics 2006.

 

MissingLinkText

Keywords

Medical records systems, computerized - Computer security - Decision support systems, clinical - Evaluation studies - Health informatics, standardization

 

 

MissingLinkText

• References

• 1 Institute of Medicine Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21^st century. Washington, DC: National Academy Press; 2001
• 2 Barnett GO, Justice NS, Somand ME, Adams JB, Waxman DB, Beaman PD. et al. COSTARA computer-based medical information systems for ambulatory care. Proc IEEE 1979; 67: 1226-37.
• 3 Dayhoff RE, Sielge EL. Digital imaging within and among medical facilities. In: Kolodner RM. editor. Computerizing large integrated health networks. NewYork: Springer-Verlag; 1996: 473-90.
• 4 Gardner RM, Pryor TA, Warner HR. The HELP hospital information system: update 1998. Int J Med Inform 1999; 54 (03) 169-82.
• 5 Wang SJ, Middleton B, Prosser LA, Bardon CG, Spurr CD, Carchidi PJ. et al. A cost-benefit analysis of electronic medical records in primary care. Am J Med 2003; 114: 397-403.
• 6 Hier DB, Rothschild A, LeMaistre A, Keeler J. Differing faculty and housestaff acceptance of an electronic health record. Int J Med Inform 2005; 74: 657-62.
• 7 Embi PJ, Yackel TR, Logan JR, Bowen JL, Cooney TG, Gorman PN. Impacts of computerized physician documentation in a teaching hospital: perceptions of faculty and resident physicians. J Am Med Inform Assoc 2004; 11: 300-9.
• 8 Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L. et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc 2003; 10: 523-30.
• 9 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health care records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12: 505-16.
• 10 Ammenwerth E, Gaus W, Lovis C, Pfeiffer KP, Tilg B, Wichmann HE. Cooperative care, collaborative research, ubiquitous information. Methods Inf Med 2005; 44: 481-2.
• 11 Lawrence DM. A comparison of organized and traditional health care. Methods Inf Med 2005; 44: 273-7.
• 12 Stefanelli M. Knowledge and process management in health care organizations. Methods Inf Med 2004; 43: 525-35.
• 13 Klar R. Selected impressions on the beginning of the electronic medical record and patient information. Methods Inf Med 2004; 43: 537-42.
• 14 Beale T. The health recordwhy is it so hard?. In: Haux R, Kulikowski C. IMIA Year book of Medical Informatics. 2005: 301-4.
• 15 Kluge EHW. Informed consent and the security of the electronic health record (EHR): some policy considerations. Int J Med Inform 2004; 73: 229-34.
• 16 Coiera E. e-Consent: The design and implementation of consumer consent mechanisms in an electronic environment. J Am Med Inform Assoc 2004; 11: 129-40.
• 17 Bernstein K, Bruun-Rasmussen M, Vingtoft S, Andersen SK, Nøhr C. Modelling and implementing electronic health records in Denmark. Int J Med Inform 2005; 74: 213-20.
• 18 Simons WW, Mandl KD, Kohane IS. The PING personally controlled electronic medical record system: Technical architecture. J Am Med Inform Assoc 2005; 12: 47-54.
• 19 Sax U, Kohane I, Mandl KD. Wireless technology infrastructures for authentication of patients: PKI that rings. J Am Med Inform Assoc 2005; 12: 263-8.
• 20 Jelekäinen P. GSM-PKI solution enabling secure mobile communications. Int J Med Inform 2004; 73: 317-20.
• 21 Pharow P, Blobel B. Electronic signatures for longlasting storage purposes in electronic archives. Int J Med Inform 2005; 74: 279-87.
• 22 Van den Brink JL, Moorman PW, De Boer MF, Pruyn JFA, Verwoerd CDA, Van Bemmel JH. Involving the patient: A prospective study on use, appreciation and effectiveness of an information system in head and neck cancer care. Int J Med Inform 2005; 74: 839-49.
• 23 Giorgino T, Azzini I, Rognonia C, Quaglini S, Stefanelli M, Gretter R. et al. Automated spoken dialogue system for hypertensive patient home management. Int J Med Inform 2005; 74: 159-67.
• 24 McAlearney AS, Schweikhart SB, Medow MA. Organizational and physician perspectives about facilitating handheld computer use in clinical practice: Results of a cross-site qualitative study. J Am Med Inform Assoc 2005; 12: 568-75.
• 25 Carroll AE, Tarczy-Hornoch P, O’Reilly E, Dimitri A. The effect of point-of-care personal digital assistant use on resident documentation discrepancies. Pediatrics 2004; 113: 450-4.
• 26 Reuss E, Menozzi M, Büchi M, Koller J, Krueger H. Information access at the point of care: what can we learn for designing a mobile CPR system?. Int J Med Inform 2004; 73: 363-9.
• 27 Chen ES, Mendonca EA, McKnight LK, Stetson PD, Lei J, Cimino JJ. PalmCIS: A wireless handheld application for satisfying clinician information needs. J Am Med Inform Assoc 2004; 11: 19-28.
• 28 Lu YC, Xiao Y, Sears A, Jacko JA. A review and a framework of handheld computer adoption in healthcare. Int J Med Inform 2005; 74: 409-22.
• 29 Mendonça EA, Chen ES, Stetson PD, McKnight LK, Lei J, Cimino JJ. Approach to mobile information and communication for health care. Int J Med Inform 2004; 73: 631-8.
• 30 Kushnirek AW, Triola MM, Borycki EM, Stein B, Kannry JL. Technology induced error and usability: The relationship between usability problems and prescription errors when using a handheld application. Int J Med Inform 2005; 74: 519-26.
• 31 Van der Meijden MJ, Tange HJ, Troost J, Hasman A. Determinants of success of inpatient clinical information systems: a literature review. J Am Med Inform Assoc 2003; 10: 235-243.
• 32 Nilsson G, Ahlfeldt H, Strender LE. Textual content, health problems and diagnostic codes in electronic patient records in general practice. Scan J Prim Care 2003; 21: 33-6.
• 33 Giere W. Electronic patient informationpioneers and muchmore. Methods Inf Med 2004; 43: 543-52.
• 34 Mikkelsen G, Aasly J. Consequences of impaired data quality on information retrieval in electronic patient records. Int J Med Inform 2005; 74: 387-94.
• 35 Owen RR, Thrush CR, Cannon D, Sloan KL, Curran G, Hudson T. et al. Use of electronic medical record data for quality improvement in schizophrenia treatment. J Am Med Inform Assoc 2004; 11: 351-7.
• 36 Rothschild AS, Dietrich L, Ball MJ, Wurtz H, Farish-Hunt H, Cortes-Comerer N. Leveraging systems thinking to design patient-centered clinical documentation systems. Int J Med Inform 2005; 74: 395-8.
• 37 Ammenwerth E, Eichstadter R, Haux R, Pohl U, Rebel S, Ziegler S. A randomized evaluation of a computer-based nursing documentation system. Methods Inf Med 2001; 40: 61-8.
• 38 Hippisley-Cox J, Pringle M, Cater R, Wynn A, Hammersley V, Coupland C. et al. The electronic patient record in primary care regression or progression: a cross sectional study. Br Med J 2003; 326: 1439-43.
• 39 Porcheret M, Hughes R, Evans D, Jordan K, Whitehurst T, Ogden H. et al. Data quality of general practice electronic health care records: the impact of a program of assessments, feedback and training. J Am Med Inform Assoc 2004; 11: 78-86.
• 40 Palermo TM, Valenzuela D, Stork PP. A randomized trial of electronic versus paper pain diaries in children: impact on compliance, accuracy and acceptability. Pain 2004; 107: 213-9.
• 41 Williams CA, Templin T, Mosley-Williams AD. Usability of a computer-assisted interview system for the unaided self-entry of patient data in an urban rheumatology clinic. J Am Med Inform Assoc 2004; 11: 249-59.
• 42 Porter SC, Kohane IS, Goldmann DA. Parents as partners in obtaining the medication history. J Am Med Inform Assoc 2005; 12: 299-305.
• 43 Shortliffe EH. The adolescence of AI in Medicine: will the field come of age in the ‘90s?. Artif Intell Med 1993; 05: 93-106.
• 44 Hasman A, Safran C, Takeda H. Quality of health care: informatics foundations. Methods Inf Med 2003; 42: 509-18.
• 45 Bakker A. Access to EHR and access control at a moment in the past: A discussion of the need and an exploration of the consequences. Int J Med Inform 2004; 73: 267-70.
• 46 Hazlehurst B, Frost HR, Sittig DF, Stevens VJ. MediClass: A system for detecting and classifying encounter-based clinical events in any electronic medical record. J Am Med Inform Assoc 2005; 12: 517-29.
• 47 Rosenbloom ST, Grande J, Geissbuhler A, Miller RA. Experience in implementing inpatient clinical note capture via a provider order entry system. J Am Med Inform Assoc 2004; 11: 310-5.
• 48 Hulse NC, Rocha RA, Del Fiol G, Bradshaw RL, Hanna TP, Roemer LK. KAT: a flexible XMLbased knowledge authoring environment. J Am Med Inform Assoc 2005; 12: 418-30.
• 49 Quaglini S, Grandi M, Baiardi P, Mazzoleni MC, Fassino C, Franchi G. et al. A computerized guideline for pressure ulcer prevention. Int J Med Inform 2000; 58-59: 207-17.
• 50 Junger A, Benson M, Quinzio L, Michel A, Sciuk G, Brammen D. et al. An Anesthsia Information Management System (AIMS) as a tool for controlling resource management of operation rooms. Methods Inf Med 2002; 41: 81-5.
• 51 Wu R, Peters W, Morgan MW. The next generation of clinical decision support: linking evidence to best practice. J HealthC Inf Manag 2002; 16 (04) 50-5.
• 52 Knaup P, Garde S, Merzweiler A, Graf N, Schilling F, Weber R. et al. Towards shared patient records: An architecture for using routine data for nationwide research. Int J Med Inform. In press; 2005
• 53 Los RK, Ginneken AM, Van der Lei J. Extracting data recorded with OpenSDE: Possibilities and limitations. Int J Med Inform 2005; 74: 473-80.
• 54 Los RK, Van Ginneken AM, Van der Lei J. OpenSDE: a strategy for expressive and flexible structured data entry. Int J Med Inform 2005; 74: 481-90.
• 55 Los RK, Roukema J, Van Ginneken AM, De Wilde M, Van der Lei J. Are structured data structured identically?. Methods Inf Med 2005; 44: 631-8.
• 56 Kulikowski CA. The micro-macro spectrum of medical informatics challenges: from molecular medicine to transforming health care in a globalizing society. Methods Inf Med 2002; 41: 20-4.
• 57 Colombet I, Aguirre-Junco AR, Zunino S, Jaulent MC, Leveneut L, Chatellier G. Electronic implementation of guidelines in the EsPeR system: A knowledge specification. Int J Med Inform 2005; 74: 597-604.
• 58 Ciccarese P, Caffi E, Quaglini S, Stefanelli M. Architectures and tools for innovative health information systems: the Guide project. Int J Med Inform 2005; 74: 553-62.
• 59 Rosille D, Laurent JF, Burgun A. Modelling a decision-support system for oncology using rulebased and case-based reasoning methodologies. Int J Med Inform 2005; 74: 299-306.
• 60 Ohno-Machado L, Gennari JH, Murphy SN, Jain NL, Tu SW, Oliver DE. et al. The GuideLine Interchange Format:A model for representing guidelines. J Am Med Inform Assoc 1998; 05: 357-72.
• 61 Peleg M, Boxwala AA, Tu S, Zeng Q, Ogunyemi O, Wang D. et al. The InterMed approach to sharable computer-interpretable guidelines: a review. J Am Med Inform Assoc 2004; 11: 1-10.
• 62 Aphinyanaphongs Y, Tsamardinos I, Statnikov A, Hardin D, Aliferis CF. Text categorization models for high-quality article retrieval in internal medicine. J Am Med Inform Assoc 2005; 12: 207-16.
• 63 Forster AJ, Andrade J, Van Walraven C. Validation of a discharge summary term search method to detect adverse events. J Am Med Inform Assoc 2005; 12: 200-6.
• 64 Melton GB, Hripcsak G. Automated detection of adverse events using natural language processing of discharge summaries. J Am Med Inform Assoc 2005; 12: 448-57.
• 65 Field TS, Gurwitz JH, Harrold LR, Rothschild JM, Debellis K, Seger AC. et al. Strategies for detecting adverse drug events among older persons in the ambulatory setting. J Am Med Inform Assoc 2004; 11: 492-8.
• 66 Samore MH, Evans RS, Lassen A, Gould P, Lloyd J, Gardner RM. et al. Surveillance of medical devicerelated hazards and adverse events in hospitalized patients. JAMA 2004; 291: 325-34.
• 67 Vandenberghe HE, Van Casteren V, Jonckheer P, Bastiaens H, Van der Heyden J, Lafontaine MF. et al. Collecting information on the quality of prescribing in primary care using semi-automatic data extraction from GPs’ electronic medical records. Int J Med Inform 2005; 74: 367-76.
• 68 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE. et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293: 1197-203.
• 69 Bell DS, Marken RS, Meili RC, Wang CJ, Rosen M, Brook RH. Recommendations for comparing electronic prescribing systems: results of an expert consensus process. Health Aff (Millwood) 2004; Suppl Web Exclusives. W4-305-17.
• 70 Wang CJ, Marken RS, Meili RC, Straus JB, Landman AB, Bell DS. Functional characteristics of commercial ambulatory electronic prescribing systems: a field study. J Am Med Inform Assoc 2005; 12: 346-56.
• 71 Bell DS, Cretin S, Marken RS, Landman AB. A conceptual framework for evaluating outpatient electronic prescribing systems based on their functional capabilities. J Am Med Inform Assoc 2004; 11: 60-70.
• 72 Sellman JS, Decarolis D, Schullo-Feulner A, Nelson DB, Filice GA. Information resources used in antimicrobial prescribing. J Am Med Inform Assoc 2004; 11: 281-4.
• 73 Galanter WL, Polikaitis A, DiDomenico RJ. A trial of automated safety alerts for inpatient digoxin use with computerized physician order entry. J Am Med Inform Assoc 2004; 11: 270-7.
• 74 Galanter WL, Didomenico RJ, Polikaitis A. A trial of automated decision support alerts for contraindicated medications using computerized physician order entry. J Am Med Inform Assoc 2005; 12: 269-74.
• 75 Rothschild AS, Lehmann HP. Information retrieval performance of probabilistically generated, proble mspecific computerized provider order entry picklists: a pilot study. J Am Med Inform Assoc 2005; 12: 322-30.
• 76 Bindels R, Hasman A, Van Wersch JWJ, Talmon J, Winkens RAG. Evaluation of an automated test ordering and feedback system for general practitioners in daily practice. Int J Med Inform 2004; 73: 705-12.
• 77 Hartge F, Wetter T, Haefeli WE. A similarity measure for case based reasoning modelling with temporal abstraction based on cross-correlation. Comp Meth Progr Biomed. In press 2006
• 78 Sittig DF, Krall M, Kaalaas-Sittig J, Ash JS. Emotional aspects of computer-based provider order entry: a qualitative study. J Am Med Inform Assoc 2005; 12: 561-7.
• 79 Dansky KH, Gamm LD, Vasey JJ, Barsukiewicz CK. Electronic medical records: are physicians ready?. J HealthC Manag 1999; 44: 440-54.
• 80 Short D, Frischer M, Bashford J. Barriers to the adoption of computerized decision support systems in general practice consultations: a qualitative study of GP’s perspectives. Int J Med Inform 2004; 73: 357-62.
• 81 Schectman JM, Schorling JB, Nadkarni MM, Voss JD. Determinants of physician use of an ambulatory prescription expert system. Int J Med Inform 2005; 74: 711-7.
• 82 Teich JM, Osheroff JA, Pifer EA, Sittig DF, Jenders RA. Clinical decision support in electronic prescribing: recommendations and an action plan: report of the joint clinical decision support workgroup. J Am Med Inform Assoc 2005; 12: 365-76.
• 83 O’Connell RT, Cho C, Shah N, Brown K, Shiffman RN. Take note(s): differential EHR satisfaction with two implementations under one roof. J Am Med Inform Assoc 2004; 11: 43-9.
• 84 Littlejohns P, Wyatt JC, Garvican L. Evaluating computerized health information systems : hard lessons still to be learnt. Br Med J 2003; 326 (7394): 860-3.
• 85 Rotich JK, Hannan TJ, Smith FE, Bii J, Odero WW, Vu N. et al. Installing and implementing a computer-based patient record system in SubSaharanAfrica:The Mosoriot medical record system. J Am Med Inform Assoc 2003; 10: 295-303.
• 86 Delpierre C, Cuzin L, Fillaux J, Alvarez M, Massip P, Lang T. A systematic review of computer-based patient record systems and quality of care: more clinical trials or a broader approach?. Int J Qual Health Care 2004; 16: 407-16.
• 87 Adams W, Mann A, Bauchner H. Use of an electronic medical record improves quality of urban pediatric care. Pediatrics 2003; 111: 626-32.
• 88 Rousseau N, McColl E, Newton J, Grimshaw J, Eccles M. Practice based, longitudinal, qualitative interview study of computerized evidence based guidelines in primary care. Br Med J 2003; 326: 314-22.
• 89 Lorenzi NM, Riley RT. Managing change: an overview. J Am Med Inform Assoc 2000; 07 (02) 116-24.
• 90 Goldstein MK, Coleman RW, Tu SW, Shankar RD, O’Connor MJ, Musen MA. et al. Translating research into practice: organizational issues in implementing automated decision support for hypertension in three medical centers. J Am Med Inform Assoc 2004; 11: 368-76.
• 91 Jaspers MWM, Steen T, Van den Bos C, Geenen M. The think-aloud method: a guide to user interface design. Int J Med Inform 2004; 73: 781-95.
• 92 Sciamanna CN, Novak SP, Marcus BH. Effects of using a computer in a doctor’s office on patient IMIA Yearbook of Medical Informatics 2006 attitudes towards using computerized prompts in routine care. Int J Med Inform 2005; 74: 357-65.
• 93 Hassol A, Walker JM, Kidder D, Rokita K, Young D, Pierdon S. et al. Patient experiences and attitudes about access to a patient electronic health record system and linked web messaging. J Am Med Inform Assoc 2004; 11: 505-13.
• 94 Hsu J, Huang J, Fung V, Robertson N, Jimison H, Frankel R. Health information technology and physician-patient interactions: impact of computers on communication during outpatient primary care visits. J Am Med Inform Assoc 2005; 12: 474-80.
• 95 Nøhr C, Andersen SK, Vingtoft S, Bernstein K, Bruun-Rasmussen M. Development, implementation and diffusion of EHR systems in Denmark. Int J Med Inform 2005; 74: 229-34.
• 96 Hübner U. Current and future use of ICT for patient care and management in German acute hospitals. A comparison of the nursing and the hospital managers’ perspectives. Methods Inf Med 2005; 44: 528-36.
• 97 Jaana M, Ward MM, Paré G, Wakefield DS. Clinical information technology in hospitals: A comparison between the state of Iowa and two provinces in Canada. Int J Med Inform 2005; 74: 719-31.
• 98 Siika AM, Rotich JK, Simiyu CJ, Kigotho EM, Smith FE, Sidle JE. et al. An electronic medical record system for ambulatory care of HIV-infected patients in Kenya. Int J Med Inform 2005; 74: 345-55.
• 99 DICOM. ftp://medical.nema.org/MEDICAL/ Dicom/Final/ Last access: January 2006
• 100 CEN TC/251 ENV13606. http:// www.centc251.org Last access: January 2006
• 101 Health Level 7. http://www.hl7.org Last access: January 2006
• 102 Open EHR. http://www.openEHR.org Last access: January 2006
• 103 Goossen WTF, Ozbolt JG, Coenen A, Park HA, Mead C, Ehnfors M, Marin HF. Development of a provisional domain model for the nursing process for use within the Health Level 7 reference information model. J Am Med Inform Assoc 2004; 11: 186-94.
• 104 Dolin RH, Alschuler L, Boyer S, Beebe C, Behlen FM, Biron PV. et al. HL7 clinical document architecture, release 2. J Am Med Inform Assoc 2006; 13 (01) 30-9.
• 105 Müller ML, Ückert F, Bürkle T, Prokosch HU. Cross-institutional data exchange using the clinical document architecture (CDA). Int J Med Inform 2005; 74: 245-56.
• 106 Beuscart-Zéphir MC, Pelayo S, Anceaux F, Meaux JJ, Degroisse M, Degoulet P. Impact of CPOE on doctor-nurse cooperation for the medication ordering and administration process. Int J Med Inform 2005; 74: 629-41.
• 107 Alberdi E, Taylor P, Lee R. Elicitation and Representation of Expert Knowledge for Computer Aided Diagnosis in Mammography. Methods Inf Med 2004; 43: 239-46.
• 108 Ammenwerth E, Mansmann U, Iller C, Eichstadter R. Factors affecting and affected by user acceptance of computer-based nursing documentation: results of a two-years study. J Am Med Inform Assoc 2003; 10: 69-84.
• 109 Kuhn KA, Giuse DA. From hospital information systems to health information systemsproblems, challenges, perspectives. In: Haux R, Kulikowski C. IMIA Year book of Medical Informatics. 2001: 63-76.
• 110 Friedman C, Shagina L, Lussier Y, Hripcsak G. Automated encoding of clinical documents based on natural language processing. J Am Med Inform Assoc 2004; 11: 392-402.
• 111 Kaplan B, Shaw NT. Futue directions in evaluation research: people, organizational, and social issues. Methods Inf Med 2004; 43: 215-31.
• 112 Ammenwerth E, Shaw NT. Bad health informatics can killis evaluation the answer?. Methods Inf Med 2005; 44: 1-3.
• 113 Ammenwerth E, Keizer NF. An inventory of evaluation studies of information technology in health care. Methods Inf Med 2005; 44: 44-56.
• 114 Grémy F. Hardware, software, peopleware, subjectivity. Methods Inf Med 2005; 44: 352-8.
• 115 Kaushal R, Shojania K, Bates D. Effects of computerized physician order entry and clinical decision support systems on medication safety. Arch Intern Med 2003; 163: 1409-16.
• 116 Shabo A. A global socio-economic-medico-legal model for the sustainability of longitudinal electronic health records. Methods Inf Med. (accepted).