The document discusses computer-based patient record systems (CPRs), defining them as electronic repositories of health information that support flexible data accessibility and clinical decision-making. It highlights the advantages, such as reduced errors and improved data analysis, alongside disadvantages including high initial costs and user resistance. Additionally, it addresses functional components like integrated communication and challenges in data entry and display, while emphasizing the need for improved user interfaces and security measures.

1. Computer-Based Patient Record Systems Ileana Lulic, Ivor Kovic University of Rijeka, School of Medicine My patients

2. Definition Advantages and disadvantages Functional components Data entry and display Challenges ahead Discussion Outline Friday, July 22, 2005

3. Definition Patient record = Patient’s chart = Medical record Time-Oriented Source-Oriented Problem-Oriented 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion Friday, July 22, 2005

4. Definition CPR is a repository of electronically maintained information about individual’s lifetime health status and health care stored such that it can serve multiple legitimate users of the record. Friday, July 22, 2005 Computer Based Patient Record = CPR 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

5. Advantages of CPR Flexible and adaptable Aggregation of data Data analyses Accessibility Remote access Legibility Structured data Fewer data errors Reusability of data Decision support Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

6. Disadvantages of CPR Larger initial investment Risk of failure Resistance of users Input problems Security problems Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

7. CPR assessment Factors used to determinate the degree to which a CPR demonstrates benefits Comprehensiveness of information Duration of use and retention of data Degree of structure of data Ubiquity of access Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

8. Functional components Integrated view of patient data Clinical decision support Clinician order entry Access to knowledge resources Integrated communication support Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

9. Functional components Primary purpose of a CPR HL7 SNOMED, LOINC, ICD Interface engines User friendly view of patient data Friday, July 22, 2005 1. Integrated view of patient data 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

10. Functional components Reminders and alerts At the right time Possibility of override Friday, July 22, 2005 2. Clinical decision support, 3. Clinician order entry, 4. Access to knowledge resources 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

11. Functional components Communication between team members Remote location office, hospital, ER, physician’s home, patient’s home Example: ER at Brighman and Womens Hospital Friday, July 22, 2005 5. Integrated communication support 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

12. Data entry Most difficult and labor-intensive step in the maintenance Requires two separate procedures: Data Capture Data Input Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

13. Data Capture Difficult when there are multiple sources of data Information can: Go unnoticed Be illegible Be available in insufficient detail Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

14. Data Input Costly in personnel time Entered by physician or other personnel Data may be entered in: Free text form Coded form Form that combines both Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

15. Data Input Include 1. Patient history 2. Findings from the physical examination 3. Interpretation of the patient’s findings 4. Diagnostic and treatment plan Can be entered: By transcription of dictated or written notes By transcription of encounter forms Direct data entry by physicians Continuous speech recognition Friday, July 22, 2005 Physicians’ notes 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

16. Data Input Validity checks: - range checks - pattern checks - computed checks - consistency checks - delta checks - spelling checks Friday, July 22, 2005 Error prevention 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

17. Data Display Can be presented in numerous formats 1. Flowsheets - data organized according to time - problem, patient or specialty specific 2. Summaries and Abstracts - highlight important components 3. Turnaround documents - present information and ask questions 4. Dynamic displays - search tools - flowsheets or graphics Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

18. Challenges ahead Evolution of technology Users’ information needs User interfaces Standards Legal and social issues Costs and benefits Leadership Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

19. Discussion 1 Security of CPR - issues - how to improve it - compared to paper-based record Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

20. Discussion 2 User interface - how important it is ? - examples of what can go wrong if it is poorly designed Suggested reading: Medical Usability: How to Kill Patients Through Bad Design http://www.useit.com/alertbox/20050411.html Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

21. Contact Ileana Lulic Tel: + 385 91 2530660 Kustosijski venec 34 e-mail: [email_address] 10 000 Zagreb Croatia Ivor Kovic Tel: + 385 91 1234598 S.J.Bujkove 3 e-mail: [email_address] 51 000 Rijeka Croatia Department of Medical Informatics, Rijeka School of Medicine http://mi.medri.hr Science Trek Journal Club http:// mi.medri.hr/stc Friday, July 22, 2005 English version coming soon