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Despite widespread adoption and maturity, paper persistence endures in many Electronic Health Record (EHR) systems, particularly for complex workflows involving multiple steps from different stakeholders separated in time. In our health system, Latent Tuberculosis Infection (LTBI) testing was one such workflow where a Tuberculin Skin Test (TST) must be administered and then correctly read 48-72 hours later and documented. This paper discusses a low-resource workflow analysis and clinical decision support approach to replace a paper workflow and garner the benefits of the EHR for clearer documentation and retrieval of LTBI results. Our approach resulted in a significant increase in completed TST documentation, 57% (24/42) to 95% (18/19), P < 0.003. Human-centered design practices such as work system analysis and formative usability testing are feasible with limited resources and improve the likelihood of success of electronic workflows by designing solutions that fit existing clinical workflows and automating processes wherever possible.

Clinical paper searching is a major task for clinical researchers to collect authoritative and up-to-date evidences to support their research works and clinical practices. Currently, this task needs huge amount of labor work. Researchers usually spend a lot of time searching on the online repository and iterating many times to get the final paper list. Systematic review is a special case, in which the paper searching process is a critical step. To address this challenge, this paper introduces a method to streamline the iterative paper searching process. It automatically selects the most probably matched papers, and then generates new search strategy. All the intermediate results are visualized based on the paper citation graph. It assembles technologies such as PageRank and Topic-based clustering to accelerate the paper searching tasks. The precision, recall, and execution time of the proposed method are then evaluated by comparing with published systematic reviews.

A "Big Data" approach was used in part to study the use of printed paper in a 700 bed paperless hospital, in part to study the usefulness of the approach. Between 1,2 and 1,5 million pages were printed each month, corresponding to 10% of a citizens' monthly paper use. The identified use of printed paper did not seem to be high compared to other organisations. The big data approach was not able to answer all our questions, primarily because we did not get log data for the source programmes for the printing. The approach could consequently not provide the data needed to reduce paper printing.

While the digitization of medical data within electronic health records has been introduced in some areas, massive amounts of paper-based health records are still produced on a daily basis. This data has to be stored for decades due to legal reasons but is of no benefit for research organizations, as the unstructured medical data in paper-based health records cannot be efficiently used for clinical studies. This paper presents a system for the recognition and privacy preservation of personal data in paper-based health records with the aim to provide clinical studies with medical data gained from existing paper-based health records.

Data quality of paper health records remain problematic and little is known about mobile health data quality. A semiotic data quality framework is used as an analytical lens to identify the quality of data in care health service provision in resource-restricted communities. A mobile application was developed using a co-design approach. The results of the empirical study indicate data quality problems on the syntactic, semantic, pragmatic and social semiotic levels. The social aspect of data quality is an important contributor of quality associated problems. It is important to consider this human involvement in the capturing and using of data for the value of care data to be fully utilized. With better quality data a better care service can be provided and ultimately resulting in better quality life.

Changes have recently been passed in the Norwegian legislation, allowing for more exchange of patient information between health personnel. These legal changes came as a result of a long and still ongoing debate concerning the potential conflict between confidentiality issues and patient safety as health care is getting more fragmented. At the same time, an increasing number of patients now make use of their legal right to access their patient record. In this paper, we shed light on some of the reasons why patients request a copy of their record. We report the preliminary results from an interview study in which seventeen patients who have asked for a copy of their patient record following a hospital stay have been interviewed. In our interview study, securing transmission of information between health care workers is one of the main reasons for requesting a copy of the record. We will discuss how this finding might contribute to the ongoing debate.

Controls for most technologies, including medical devices, are becoming increasingly complex, difficult to intuitively understand and don't necessarily follow population stereotypes. The resulting delays and errors are unacceptable when seconds can mean the difference between life and death. In this study participants were asked to "control" a system using a paper prototype (color photographs of controls) and then with a higher fidelity prototype of the same physical controls to determine performance differences among ethnicities and genders. No ethnic nor gender differences were found, and the comparison of paper versus higher fidelity prototypes also showed no significant differences. Thus, paper prototypes can be employed as an early device design usability tool to illustrate stereotype violations long before the first physical prototype. This will not only save money in the development and design processes, but also makes sure that even the most complex devices are intuitively understandable and operable for their basic functions.

Objective: Evaluation of the technical feasibility of tight integration of the digital pen and paper technology in an existing computerized patient record.Technology: The digital pen is a normal pen able to record all actions of the user and to analyze a micro pattern printed on the paper. The digital paper is a normal paper printed with an almost invisible micro pattern of small dots encoding information such as position and identifiers. We report our experience in the implementation and the use of this technology in an existing large clinical information system for acquiring clinical information., Discussion: It is possible to print uniquely identified forms using the digital paper technology. These forms can be pre-filled with clinical readable information about the patient. When care providers complete these forms using the digital pen, it is possible to acquire the data in a structured computerized patient record. The technology is easy to integrate in a component-based architecture based on Web Services., Conclusion: The digital pen and paper is a cost-effective technology that can be integrated in an existing clinical information system and allows fast and easy bedside clinical information acquisition without the need for an expensive infrastructure based on traditional portable devices or wireless devices.

In this paper, we present a novel approach to structure Clinical Guidelines through the automatic recognition of syntactic expressions called deontic operators. We defined a grammar and a set of Finite-State Transition Networks (FSTN) to automatically recognize deontic operators in Clinical Guidelines. We then implemented a dedicated FSTN parser that identifies deontic operators and marks up their occurrences in the document, thus producing a structured version of the Guideline. We evaluated our approach on a corpus (not used to define the grammar) of 5 Clinical Guidelines. As a result, 95.5% of the occurrences of deontic expressions are correctly marked up. The automatic detection of deontic operators can be a useful step to support Clinical Guidelines encoding.

While physician informational needs have been examined in the literature, rarely do the findings have the specificity required to drive development of Electronic Medical Records (EMRs) features. Using Delphi methodology, a comprehensive list of desirable, ranked EMR features was developed for physician residency practices. The identified EMR features and implications for system development are explored in this paper.

Since 1989, Beth Israel Hospital has been deploying an extensive online patient record (the OMR), which augmented a heavily used integrated hospital information system. Initially begun in a large primary care practice, the system is now used to share patient records among 36 practices on three campuses. Although the system was intended to eliminate the need for paper, we have found that it has, in the short term, increased the amount of paper produced. Elimination of paper record in ambulatory care has saved us $56,000, but we have yet to realize the savings of an additional $200,000 per year. We explore the factors that contribute to this "paper paradox" and discuss the costs associated with increased paper production, areas in which we have reduced paper handling, and strategies for reducing our reliance on paper.