tence. The document level neural networks are fed one document at a time, so they can learn context cues that reside outside of the sentence boundary. We use 100 dimensional hidden layer for each di- rectional RNN chain. Since we use bi-directional LSTMs and GRUs, this essentially amounts to a 200 dimensional recurrent hidden layer. The hidden layer activation functions for both RNN models are tanh. Output of this hidden layer is fed into a Soft- max output layer which emits probabilities for each of the nine medical labels and the Outside label. We use categorical cross entropy as the objective func- tion. Similar to the CRF implementation, the Neural Net cost function also contains an L2-regularization component. We also use dropout (Srivastava et al., 2014) as an additional measure to avoid over-fitting. Fifty percent dropout is used to manipulate the in- puts to the RNN and the Softmax layer. We use AdaGrad (Duchi et al., 2011) to optimize the net- work cost.
The Veteran Health Information Systems Technology Architecture (VistA,) more formally known as VistA Computerized Patient Record System, is an open source EHR developed by the United States Department of Veterans Affairs (VA). Over the past 35 years, VistA has been designed by clinicians to embody clinical workflow processes that support VA models of care delivery. VistA is one of the largest and most rapid deployments of an EHR as it is utilized by the largest medical system in the United States, providing care to over eight million veterans across 163 hospitals, over 800 clinics, and 135 nursing homes. In 1997, the VA released the source code for VistA under the Freedom of Information Act. Since then, EHR vendors have used the VistA source code to create commercial versions (e.g., Medsphere Systems Corporation has a commercial product known as “OpenVistA”). 19
Blockchain innovation was earlier produced for the cryptographic money bitcoin furthermore, was first displayed in the bit-coin whitepaper by Nakamoto in 2008. Since blockchain innovation showed up, it has been praised as another innovative upset simply like the creation of the steam motor or the web as a result of its immense impaction on society. Beforehand, numerous limitations have been set on sharing enormous EHRs in view of the dangers to information security or spillage of private patient data amid information trade. Furthermore, current EHRs are Blockchain innovation was earlier produced for the cryptographic money bitcoin furthermore, was first displayed in the bit-coin whitepaper by Nakamoto in 2008. Since blockchain innovation showed up, it has been praised as another innovative upset simply like the creation of the steam motor or the web as a result of its immense impaction on society. Beforehand, numerous limitations have been set on sharing enormous EHRs in view of the dangers to information security or spillage of private patient data amid information trade. Furthermore, current EHRs are managed by hospitals and providers, whereas patients are deprived of the right to freely control their own EHRs. Through utilizing blockchain technology, standards for recording data and managing identity are established, and the blockchain of EHRs is constructed. In addition, this technology records the auditing traces of all transactions in an immutable distributed ledger, which guarantees responsibility and transparency in the procession of data exchange. Therefore, the patient has the ability to record healthcare and diagnostic information from doctors in their own EHRs, thus reducing the number of medical accidents and preserving patient privacy.
EMRs used were obtained from the Manitoba Primary Care Research Network (MaPCReN) which is a practice- based research network comprised of consenting primary care providers (mostly family physicians). The MaPCReN repository includes information on health problems, bill- ing data, medications, laboratory results, selected risk fac- tors, referrals, and procedures for primary care patients . EMRs from Manitoba has been previously used to evaluate the quality of these data for measuring hyperten- sion . Approximately 22% of the provincial population is represented in the MaPCReN repository, which covers all geographic regions and various practice configurations within the province .
Cloud computing paradigm is one of the popular Health Information Technology infrastructures for facilitating ElectronicHealth Record (EHR) sharing and EHR integration. Healthcare clouds offer new possibilities, such as easy and ubiquitous access to medical data, and opportunities for new business models. However, they also bear new risks and raise challenges with respect to security and privacy aspects. Ensuring the security and privacy is a major factor in the cloud computing environment. A Secured Cloud based aided medical system is a program designed to aid standard and effective use and access of patient records anytime it is required by medical practitioners. In this paper, a Secured e-Health System called SECHA is proposed. SECHA comprises of five basic component namely; patient, PHR/object, Access Control Module, User/Subject and Cloud. This proposed system ensure the security of electronichealthrecords stored in the cloud using Homomorphic Encryption to secure patients medicalrecords and Bilayer Access Control to gives access right to the records.
One of our most interesting results using the full datasets is the improvement we are able to achieve training with a small amount of ClvC (out-of- domain) EHR data and testing on i2b2 as the tar- get domain (the last two rows of Table 3b and Ta- ble 4b). All of these results on the sentence level are quite low due to similar text that may be found in multiple sections. For example, the text found for Chief Complaint and Past Medical History can be quite similar with the only difference being when the problems occurred. To determine if this kind of misclassification was common we looked at our performance based on whether the correct class was in the top 1, 2, or 3 predictions (F1@3). Both ClvC and MedLit+TR ClvC showed large improvements for the RNN and BERT models as shown in Table 5 with roughly a 27 point im- provement for the RNN models and a 22 point im- provement for the BERT models. We analyzed the confusion matrix and the most common misclassi- fications were to the majority MedLit and ClvC classes (Assessment and Plan and Chief Com- plaint).
The study’s end point was whether or not a preventive serv- ice was provided and documented within a required time period for each eligible patient. The target patient popula- tion consisted of all eligible patients enrolled in the partici- pating practices. Documentation that the patient received the service through another health care provider was acceptable. Information on services is presented in Table 1. We calculated a composite process score 44 by using
The Alberta Medical Association (AMA), Alberta Health and Alberta Health Services (AHS) previously established a program to promote the use of ElectronicMedicalRecords (EMRs) by Alberta’s Physicians called the Physician Office System Program (POSP); this program was sustained and continued by the Master Agreement Regarding the Tri-Lateral Relationship and Budget Management Process For Strategic Physician Agreements Made Effective April 1, 2003 (“the Tri-Lateral Agreement”);
Abstract: More than half of all pregnant women take prescription medications, raising con- cerns about fetal safety. Medical databases routinely collecting data from large populations are potentially valuable resources for cohort studies addressing teratogenicity of drugs. These include electronicmedicalrecords, administrative databases, population health registries, and teratogenicity information services. Medical databases allow estimation of prevalences of birth defects with enhanced precision, but systematic error remains a potentially serious problem. In this review, we first provide a brief description of types of North American and European medical databases suitable for studying teratogenicity of drugs and then discuss manifestation of system- atic errors in teratogenicity studies based on such databases. Selection bias stems primarily from the inability to ascertain all reproductive outcomes. Information bias (misclassification) may be caused by paucity of recorded clinical details or incomplete documentation of medication use. Confounding, particularly confounding by indication, can rarely be ruled out. Bias that either masks teratogenicity or creates false appearance thereof, may have adverse consequences for the health of the child and the mother. Biases should be quantified and their potential impact on the study results should be assessed. Both theory and software are available for such estimation. Provided that methodological problems are understood and effectively handled, computerized medical databases are a valuable source of data for studies of teratogenicity of drugs.
Patient support. The patient-support functional cat- egory assesses use of knowledge bases (eg, paper or electronic educational handouts) for patients, as well as patients’ access to their own data. We found participants were often not aware that EMRs could provide these features or found the features limited. Some users were aware of the features in their EMRs but as providers were responsible for developing and maintaining their own content (ie, handouts), which they found to be unsustain- able. Providers then relied on Web search engines to find handouts or used paper copies. These were not linked to the patient record. No clinics provided patients with electronic access to their EMR data (eg, patient portal or personal health record). Some were considering online self-appointment booking in the near future.
A recent systematic review has shown that there is a lack of current evidence considering differences in daily resource use between patient groups in European hos- pital settings . A further recent study has provided unprecedented per diem unit costs of inpatient mental health care in a European setting but was mainly focused on differences between diagnostic groups and has not included many patient variables . Therefore, future research should delineate patient-specific per diem re- source use and relate the results to detailed patient characteristics.
Nine family physicians, 4 administrative staff members (office managers and clerical and computer staff), and 2 practice management consultants participated in the AIUPC study. Key informants in the AIUPC study were identified by investigators at the Thames Valley Family Practice Research Unit in the Centre for Studies in Family Medicine and by the Ontario Ministry of Health and Long-Term Care in Toronto. In the FEHRI study, in-depth interviews were conducted with 2 participants from the Deliver Primary Healthcare Information (DELPHI) proj- ect’s management and operations team, and 4 members of the team participated in a focus group. In the EHRPC study, 39 health care providers who were newly using EHRs in the DELPHI project were asked to participate; 13 family physicians, 9 nurses, and 7 administrative staff
Medicalrecords have been around since the advent of healthcare. In the very early days, the medical record was used to record the disease and the probable cause of that disease (National Institutes of Health, 2006). In the early part of the twentieth-century, medicalrecords were kept on three by five cards (Hufford, 1999). The 1960’s and 1970’s saw a rapidly changing era in healthcare when the federal government passed legislation that established Medicare (Hufford, 1999). At the same time, other third-party payers entered the healthcare market, healthcare lawsuits starting immerging, healthcare quality became important, and the government passed more stringent laws regulating the industry (Hufford, 1999). This is the time frame when medicalrecords really became a necessity in healthcare, and the first electronichealth record appeared (History of the ElectronicMedical Record, n.d.)
For successful wide scale adoption of new technologies like EHR, this survey highlights the need for a culture shift in the health care environment to one that better supports embracing new technologies. There were a small number of respondents who self-identified as leaders in Canada in the field of EHR. These early adopters play an important role in influencing and encouraging others in the change process. Early adopters of PHR technologies in the United States and United Kingdom, for example, have reported that the majority of participants found that accessing their health record was easy and that their medical record was complete and accurate [13,14]. The majority of partici- pants in that study found the information in their PHR to be understandable. Only a few respondents were con- cerned about confidentiality or about the possibility of learning of negative test results . These results suggest that providing people with access to their EHR is poten- tially less of a problem than is feared by many health care providers. It also suggests that our respondents' percep- tions about patient attitudes regarding access to their PHR may not reflect what patients really want.
Health care organizations around the world continue to invest in health information technologies (HITs) [1, 2]. However, it has been recognized that user acceptance is one of the urgent issues in the implementation and the management of HITs . Ghanaian Nurses work at the frontline of the healthcare system in the country with access to vital records about the patient populace in Ghanaian hospitals, hence, their usage assessment is ne- cessary. Hospitals have invested considerable assets to enhance information technology (IT) infrastructure and set up medical institution record systems to enhance medical nursing care, administration efficiency and ef- fectiveness as well as meet the challenges of an increas- ing number of the competitive enterprise environment and altering healthcare policies . Nursing care is pri- marily based on a procedure that entails assessment, diagnosis, effects and planning, implementation, as well as assessment of the care of the affected person, while the documentation in the health report ought to mirror this system . Besides, these nursing services are emer- ging field that has been substantially influenced by health technology usage. In this regard, some knowledge of technology/computing literacy is, therefore prerequis- ite for a nursing career in many healthcare centres. It is reported that healthcare providers like nurses are estab- lished to resist technology . Pertinently, the successful implementation of any mHealth and electronichealthrecords (EHRs) critically depends on user acceptance . The EHRs seeks to allow the execution of patient- care-related health facility functions, which consists of patient administration, medical institution monetary af- fairs, and legal affairs, amongst different issues. Actually, EHRs is an integrated records system that performs a key function in supporting medical institution affairs via the use of suitable healthcare IT. This report aims; 1. to determine the social influence of Nurses and its impact on usage behavior of hospital electronic information management systems (HEIMS). 2. to assess the facilitat- ing conditions of the hospitals and behavioral intentions (A user’s readiness to carry out a particular behavior) of Nurses that have an influence on usage behavior of HEIMS. The hypotheses were as follows;
Healthcare data interchange standards are important aspect for achieving interoperability for health information exchanges. However, there is a big void in literature that could clearly differentiate among available healthcare standards with a motive of necessity of upgrading to new standards resulting in cost effective and efficient standard to support interoperability for a National Healthcare Information System (NHIS). These standards act as key to achieve semantic interoperability in health sector to ensure patient information availability anytime and right at the point of care. In this paper we present a study and a comparative review of healthcare interoperability standards as a means of meeting the desired semantic interoperability and integration of stovepipe applications of varied ElectronicMedicalRecords in a heterogeneous environment and achieving efficient ElectronicHealth Record. This study gives a flash tour on healthcare standards in terms of their scope, advantages, level of interoperability support and challenges. The paper also shows how the standards can be upgraded to next level by a possible inclusion of web services concept.
results by the exclusion of significant populations of EHR/EMR users. Second, self-selection bias may have occurred in the form of (a) having an email address, (b) responding to the survey and (c) being a member of AAFP. However, we believe that because those with the greatest interest in this topic are the most likely to respond, our findings are an underestimate of the true extent of the problem of non-standardisation of EHR/ EMR software. Third, our age findings may be biased due to the smaller number of respondents over the age of 65. Fourth, our assumption of standardisation among unique EHR/EMR may be flawed. Alterna- tively, it may also be true that ‘standard’ software cannot exchange records with itself easily. Despite the desirability and economic benefits of an integrated clinical software infrastructure, the near-term prospects for widespread use of standard EHR/EMR software appear poor. This is due to the devaluation of EHR/ EMR software through hundreds of unique systems. Fundamental change through the use of EHR/EMR software is widely recognised as necessary, but a specific mechanism for such change is lacking. Free and Open Source Software shows promise as a means to achieving the true potential of EMR software in improving health care.
Data were examined from one academic primary care clinic that contributes EMR data to CPCSSN. Comprising family physicians, nurses, nurse practitioners, dietitians, pharmacists, social workers, receptionists, and referral clerks, this academic family health team (FHT) was an ideal setting for evaluating the usefulness of a smoking intake tool for clinicians and researchers because it was in the beginning phase of implementing the Ottawa Model for Smoking Cessation (OMSC) in primary care (www. ottawamodel.ca). During the first phase of this model’s implementation, a tool was introduced to assess smoking status as part of a vital signs screening process. 15,16 Among
Professional Software for Nurses is a nurse-owned software company whose mission is to make the work of the school nurse easier, efficient and more effective. As president of the company, and a clinical specialist with 9 years of school nursing experience, I strongly believe technical advances must be tempered with a human touch and expert judgment. “Caring Through Technology” is our company’s motto and we are committed to blending the best of nursing informatics with state of the art computer science. Our company prides itself on providing friendly, personalized and knowledgeable service. We continue to expand our product line with innovative software solutions focused on the unique health needs of students within the school environment.