OBJECTIVES: This study aimed to identify problems and issues that arise with the implementation of online health information exchange (HIE) systems in a medical environment and to identify solutions to facilitate the successful operation of future HIE systems in primary care clinics and hospitals. METHODS: In this study, the issues that arose during the establishment and operation of an HIE system in a hospital were identified so that they could be addressed to enable the successful establishment and operation of a standard-based HIE system. After the issues were identified, they were reviewed and categorized by a group of experts that included medical information system experts, doctors, medical information standard experts, and HIE researchers. Then, solutions for the identified problems were derived based on the system development, operation, and improvement carried out during this work. RESULTS: Twenty-one issues were identified during the implementation and operation of an online HIE system. These issues were then divided into four categories: system architecture and standards, documents and data items, consent of HIE, and usability. We offer technical and policy recommendations for various stakeholders based on the experiences of operating and improving the online HIE system in the medical field. CONCLUSIONS: The issues and solutions identified in this study regarding the implementation and operate of an online HIE system can provide valuable insight for planners to enable them to successfully design and operate such systems at a national level in the future. In addition, policy support from governments is needed.
Electronic Health Records ; Health Information Exchange* ; Health Information Management ; Health Level Seven ; Information Systems ; Primary Health Care

No abstract available.
Electronic Health Records* ; Jurisprudence*

No abstract available.
Electronic Health Records*

Speech recognition as an input tool for electronic medical record enables efficient data entry at the point of care. We evaluated the speech recognition accuracy of IBM ViaVoiceTM for doctor-patient dialogues and for pronounced medical vocabularies. The recognition accuracy for doctor-patient dialogues was 95.4%, while that for pronounced medical vocabularies was 55.1%. In order to put speech-based electronic medical record to practical use, mis-recognized vocabulary must be significantly corrected. This paper describes a correction system for mis-recognized medical vocabulary for speech recognition-enabled electronic medical record. The correction system is composed of an extraction and a correction steps. In the extraction step, hamming distance between a parsed substring and the nearest medical vocabulary in the vocabulary database greater than 50% of the length of the substring was used to determine if the substring is a possible mis-recognized medical vocabulary. In the correction step, possible mis-recognized medical vocabularies are scored such that when both the code and location of a syllable is the same with those of a medical vocabulary found in our database, +5 is given and when the code is the same but the location is not, +1 is given. The medical vocabulary with the highest score in the database is used as the correction for the mis-recognized one. When 33 patient-doctor dialogues with 33 medical vocabularies were tested for three times by six testees (i.e., 33 x 6 x 3 = 594 sentences), 94% of the mis-recognized words were correctly detected and repaired. Poor recognition performance for hard medical vocabularies can be markedly improved by the mis-recognized medical vocabulary correction system.
Electronic Health Records* ; Vocabulary*

To realize the benefits of electronic health records, electronic health record information needs to be shared seamlessly and meaningfully. Clinical terminology systems, one of the current semantic interoperability solutions, were reviewed in this article. Definition, types, brief history, and examples of clinical terminologieswere introduced along with phases of clinical terminology use and issues on clinical terminology use in electronic health records. Other attempts to standardize the capture, representation and communication of clinical data were also discussed briefly with future needs.
Electronic Health Records ; Semantics*

No abstract available.
Electronic Health Records

Introduction: There is increasing interest in innovation development and management in the Philippines, especially in the last decade. In the advocacy for universal hearing health, the HeLe, “Hearing for Life’’ Research Program was implemented. HeLe developed novel telehealth technologies and field tested a proof-of-concept service delivery model to improve provision of newborn hearing screening and intervention services in the Philippines. Objective: As the HeLe research period concludes, this appraisal was organized to document and assess the health information technology systems of the HeLe. Methods: The evaluation follows the elements of the Centers for Disease Control and Prevention (CDC) guidelines for evaluation of public health surveillance systems. It centers on the status of the eHealth-based components of the HeLe NHS interventions: HeLe NHS module in the Community Health Information Tracking System (CHITS) electronic medical records system, the Tele-Audiology module in National Telehealth System (NTS), and the HeLe NHS registry. The evaluation is based on interviews of key HeLe research staff and documentation review. Results: The HeLe system has a stable, SQL-Server-based architecture. It is a secure, web-based system with clean separation of back-end database and front-end Web, using Secure Socket Layer (SSL) technology. Standardization of data via mapping ensures reliable, comparable measures. HeLe demonstrates that NHS data collected by the HeLe NHS device can be sent to, stored in, and extracted from the CHITS electronic medical record system and exchanged across platforms. Where actual patient and NHS data were available, this HeLe system is validated to be efficacious to capture and seamlessly exchange data across various eHealth platforms. These eHealth technologies are described to be at Technology Readiness Level 5, “technologies are validated in a relevant environment”. The HeLe program, however, needs to address completeness in documentation as a standard practice, if only to ensure better management of risks introduced by novel eHealth systems in patient care. The CDC public health surveillance checklist used for this assessment is useful in identifying gaps in research management for the HeLe inventors. It is recommended to be incorporated to be standard and implemented early in the next iteration of the HeLe research. Conclusions Overall, the HeLe technologies, in this initial stage of research, have achieved the purpose for which they were developed. As a novel technologybased NHS system, HeLe is a potentially powerful tool to assist in monitoring newborn hearing disease caseloads by community-based primary care clinics, NHS facilities, and hospitals that provide definitive medical services. As other health systems strengthening reforms take root in the Philippines, secure exchange of data electronically across the country would depend on sound technologies, including those used in hearing health. This paper can be instructive to the emerging research community in the eHealth and biomedical development space especially in resource-challenged settings. Likewise, lessons can reinforce institutional support from research agencies, clinicians, and state/county or subnational health departments for policy and resource mobilization to better manage those identified with congenital hearing loss.
Telemedicine ; Electronic Health Records

OBJECTIVES: The objective of the study was to create a roadmap for the adoption of Electronic Health Record (EHR) in India based an analysis of the strategies of other countries and national scenarios of ICT use in India. METHODS: The strategies for adoption of EHR in other countries were analyzed to find the crucial steps taken. Apart from reports collected from stakeholders in the country, the study relied on the experience of the author in handling several e-health projects. RESULTS: It was found that there are four major areas where the countries considered have made substantial efforts: ICT infrastructure, Policy & regulations, Standards & interoperability, and Research, development & education. A set of crucial activities were identified in each area. Based on the analysis, a roadmap is suggested. It includes the creation of a secure health network; health information exchange; and the use of open-source software, a national health policy, privacy laws, an agency for health IT standards, R&D, human resource development, etc. CONCLUSIONS: Although some steps have been initiated, several new steps need to be taken up for the successful adoption of EHR. It requires a coordinated effort from all the stakeholders.
Education ; Electronic Health Records* ; Health Information Exchange ; Health Policy ; Humans ; India* ; Jurisprudence ; Medical Informatics ; Privacy ; Social Control, Formal

OBJECTIVE: Our purpose is to propose the guideline for developing web services components from HL7 (Health Level 7) standard. METHODS: All business processes describing in HL7 are modeled using UML (Unified Modeling Language). Both UML diagrams and web services profiles can be presented with XML (Extensible Markup Language). Therefore we suggest a framework to derive web services from HL7 standards semi-automatically. RESULTS: We show that skeletal XML documents for web services can be generated from HL7 standards. Additionally we propose a way to program with Java for web services using given web service profiles. CONCLUSION: This paper presents the methodology of developing HL7-compatible electronic health record systems using web services.
Commerce ; Electronic Health Records ; Indonesia

OBJECTIVES: Clinical documents (CDs) have evolved from traditional paper documents containing narrative text information into the electronic record sheets composed of itemized records, where each record is expressed as an item with a specific value. We defined medical record (MR) items to be information entities with a specific value. These entities were then used to compile form-based clinical documents as part of an electronic health record system (EHR-s). METHODS: We took a reusable bottom-up developmental approach for the MR items, which provided three things: efficient incorporation of the local needs and requirements of the medical professionals from various departments in the hospital, comprehensive inclusion of the essential concepts of the basic elements required in clinical documents, and the provision of a structured means for meaningful data entry and retrieval. This paper delineates our experiences in developing and managing medical records at a large tertiary university hospital in Korea. RESULTS: We collected 63,232 MR items from paper records scanned into 962 CDs. The MR item database was constructed using 13,287 MR items after removing redundant items. During the first year of service users requested changes to be made to 235 (1.8%) attributes of the MR items and also requested the additional 9,572 new MR items. In the second year, the attributes of 70 (0.5%) of the existing MR items were changed and 3,704 new items were added. The number of registered MR items increased by 72.0% in the first year and 27.9% in the second year. CONCLUSIONS: The MR item concept provides an easier and more structured means of data entry within an EHR-s. By using these MR items, various kinds of clinical documents can be easily constructed and allows for medical information to be reused and retrieved as data. The success of the use of MR items in a large tertiary university hospital system provides evidence that verifies our approach as being an efficient means of user-oriented and structured data entry, enabling the easy reuse of medical records.
Electronic Health Records ; Electronics ; Electrons ; Medical Records