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Background: Clinical medical handover between doctors forms a critical part of the patient care process. However, with the evolution of junior medical staff (JMS) working conditions, time pressure and increasing clinical and administrative loads mean that quality clinical handover is increasingly important yet more challenging to achieve. This study evaluated the impact of a newly integrated electronic handover tool on JMS adoption and usage of the tool, as well as impacts on the quality (accuracy and redundancy) of handover data, JMS perceived workflow (time management and communication) and JMS satisfaction.Findings: The majority of JMS surveyed used the tool at 1 (87.0%) and 3 (67.4%) months post implementation. After the introduction of the electronic handover tool, 67.5% of users spent less than 15min updating handover data in the electronic handover tool, compared to just 6.7% prior to the introduction. 28.3% of respondents noted that there was >25% redundant data, compared to more than half (52.2%) prior to introduction of the electronic tool. Overall JMS satisfaction with their handover process was significantly higher post implementation of the integrated electronic handover report (17.4% pre, 80.4% at 1 month, 67.4% at 3 months).Conclusion: A newly introduced integrated electronic medical record handover tool had a high uptake amongst JMS, and resulted in improvement in perceived handover efficiency, a reduction in redundant data entry and improved JMS handover satisfaction. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the electronic health record (EHR) systems in use in an affluent region of India in order to understand the state-of-the-art within the Indian market.Methods: A survey on EHR features was created by combining an instrument developed by the Organisation for International Cooperation and Development and an instrument developed by an American team of researchers. An interviewer directly administered the survey to leaders from hospitals in greater Chandigarh which possessed electronic health information systems. Summary statistics from the survey are reported.Results: 24 hospitals offering multi-specialty inpatient care were identified in greater Chandigarh. 18 of these hospitals had electronic health information systems, 17 of which were interviewed. Of the hospitals with systems, 17 (100%) could access patient demographic information internally, but 12 (71%) could not access vital sign, allergy, or immunization data internally. 11 (65%) of the systems were capable of sharing patient summaries internally, but 13 (76%) could not send electronic referrals internally. Among organizations which have adopted systems, major barriers tend to have been around financial and staff matters. Concerns over interoperability, privacy, and security were infrequently cited as barriers to adoption.Conclusions: EHRs are ubiquitous in at least one region of India. Systems are more likely to have capabilities for intra-organizational information sharing than for inter-organizational information sharing. The availability of EHR data may foster clinical research. [ABSTRACT FROM AUTHOR]

Highlights: [•] Prompted clinicians added a problem 57.5% of the time after a hypertension alert. [•] The alert error rate was less than optimal with an average of 17.3%. [•] Clinicians were more likely to add a problem for medications used for hypertension alone. [•] Attending physicians produced more frequent and accurate problem list additions. [ABSTRACT FROM AUTHOR]

Highlights: [•] A CDSS could be reached directly from the GP's EMR via hyperlink. [•] The GP's visited the CDSS. [•] PSA-testing might not be the best case for evaluating the effect of an CDSS. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Implementing an efficient Electronic Medical Record (EMR) system is regarded as one of the key strategies for improving the quality of healthcare services. However, the system''s interoperability between medical devices and the EMR is a big barrier to deploying the EMR system in an outpatient clinical setting. The purpose of this study is to design a framework for a seamless and comprehensively integrated medical device interface system, and to develop and implement a system for accelerating the deployment of the EMR system. Methods: We designed and developed a framework that could transform data from medical devices into the relevant standards and then store them in the EMR. The framework is composed of 5 interfacing methods according to the types of medical devices utilized at an outpatient clinical setting, registered in Samsung Medical Center (SMC) database. The medical devices used for this study were devices that have microchips embedded or that came packaged with personal computers. The devices are completely integrated with the EMR based on SMC''s long term IT strategies. Results: First deployment of integrating 352 medical devices into the EMR took place in April, 2006, and it took about 48 months. By March, 2010, every medical device was interfaced with the EMR. About 66,000 medical examinations per month were performed taking up an average of 50GB of storage space. We surveyed users, mainly the technicians. Out of 73 that responded, 76% of the respondents replied that they were strongly satisfied or satisfied, 20% replied as being neutral and only 4% complained about the speed of the system, which was attributed to the slow speed of the old-fashioned medical devices and computers. Conclusion: The current implementation of the medical device interface system based on the SMC framework significantly streamlines the clinical workflow in a satisfactory manner. [Copyright &y& Elsevier]

Abstract: CCOW standards have been touted to currently be the best way to integrate disparate clinical applications by passing user identification and passwords as well as patient context between these applications at the desktop. However, nothing has been published in academic journals on the actual realities of implementation of CCOW. In this report, we describe the implementation of CCOW for our three main clinical applications and compare this with the simultaneous development and implementation of a portal session manager for the same purpose. We found the portal session manager much easier to develop and implement than CCOW. The resulting functionality was almost equivalent as judged by our clinical end users who compared both solutions. We now have the portal session manager functional across the institution and have stopped any further work on CCOW. [Copyright &y& Elsevier]

Aim Background: Many health care services are implementing or planning to undergo digital transformation to keep pace with increasing Electronic Medical Record (EMR) functionality. The aim of this study was to objectively measure nursing care delivery before and following introduction of an EMR.Design and Methods: An extensive program of work to expand an EMR across our health service using a 'big bang' methodology was undertaken. The program incorporated digital care delivery workflows including physiological observations, clinical notes and closed loop medication management. The validated Work Observation Method by Activity Timing (WOMBAT) method was applied to undertake a direct observational time and motion study of nurses' work in a major Australian hospital immediately prior to and six months following the introduction of a full clinical EMR.Results: Time and motion results were from observing approximately one week of nursing time pre (paper) to six months post (EMR) implementation. A non-significant 6.4% increase in the proportion of time spent on direct care was observed when using the EMR with a statistically significant increase in mean time per direct care task (2.5 min vs 3.9 min, p = 0.001). The proportion of time spent on medication-related activities did not significantly change although the average time per task rose from 2.0 to 2.9 min (p = 0.008). A significant reduction in proportion of time spent in transit and indirect care tasks when using the electronic workflows was reported. No statistically significant changes to the proportions of time spent on professional communication, direct care or documentation were observed.Conclusions: Successful EMR implementation is possible without adversely affecting allocation of nursing time. Our findings from deploying a large scale EMR across all healthcare craft groups and workflows have described for nurses that an EMR enables them to spend longer with patients per direct care episode and use their time on other activities more effectively. [ABSTRACT FROM AUTHOR]

Background: As the coronavirus pandemic progressed through the United States, Indianapolis Emergency Medical Services (IEMS) identified a gap between the health system capacity and the projected need to support an overwhelmed health care system. In addressing emergencies or special cases, each medical institution in a metropolitan area typically has a siloed process for capturing emergency patient records. These approaches vary in technical capabilities and may include use of an electronic medical record system (EMR) or a hybrid paper/EMR process. Given the projected volume of patients for the COVID-19 pandemic and the proposed multi-institutional team approach needed in case of significant provider illness, IEMS sought a simple, efficient, consolidated EMR solution to support planning for the potential capacity gap. IEMS approached Regenstrief Institute (RI), an established partner with experience in supporting OpenMRS, a global good EMR platform that had been deployed in multiple settings globally.Objective: The purpose of this project was to determine if OpenMRS, a global good, could be used to quickly stand up a system that would meet the needs for health emergency data collection and reporting.Design and Implementation Methods: The team used an "all hands on deck" approach, bringing together technical and subject matter experts, and a human-centered and iterative process to ensure the system met the key needs of IEMS. The OpenMRS Reference Application was adapted to the specific need and deployed as Docker containers to servers within the Indiana Health Information Exchange.Project Outcomes and Lessons Learned: In less than two weeks, the Regenstrief team was able to install, configure and set up a working version of OpenMRS to support the desired electronic record requirements for the IEMS disaster field clinics. Using a human-centered approach, the RI team developed, tested, and released a user-friendly, installation-ready solution complete with an end user manual and a base support plan. IEMS and RI are sharing this approach to demonstrate how a global good can quickly generate a solution for COVID-19 and other disaster responses.Conclusions: Open source global goods can rapidly be adapted to meet local needs in an emergency. OpenMRS can be adapted to meet the needs of basic emergency medical services registration, triage, and basic data collection. [ABSTRACT FROM AUTHOR]