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Objectives: To establish the incidence and long-term outcomes (up to 21 years) of children presenting to a University hospital paediatric neurology service with symptoms due to functional neurological disorder (FND) with particular reference to occurrence of FND or similar symptoms in adulthood., Methods: Retrospective chart review to determine characteristics of the original paediatric FND presentation plus record-linkage with providers of Child and Adolescent Mental Health Services. Chart review of adult medical records for documentation of functional symptoms in adulthood., Results: 124 individuals (56% female) met entry criteria. The most common presentations were seizures (18%), sensory loss (18%) and motor symptoms (16%). Frequency gradually increased with age of onset with an incidence in paediatric neurological services of 6 per 100 000 children under 16. In up to 21 years' follow-up (median 8.3 years), 114/124 attained their 16th birthdays by the study census date and were thus eligible for inclusion in an analysis of symptom persistence/recurrence in adulthood. 26/114 (23%) showed evidence of FND in adulthood of sufficient significance to be recorded in medical records., Conclusion: Paediatric FND is commoner than previous estimates. Even in this selected population of children reaching specialist paediatric neurology services, a high long-term remission rate is observed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Utah's Controlled Substance Database prescription registry does not include master identifiers to link records for individual patients. We describe and evaluate a linkage protocol for Utah's Controlled Substance Database. Prescriptions (N = 22,401,506) dated 2005-2009 were linked using The Link King software and patient identifiers (e.g. names, dates of birth) for 2,232,725 patients. Review of 998 randomly selected record pairs classified 46 percent as definitely correct links and 54 percent as probably correct links. A correct link could not be confirmed for <1 percent. None were classified as probably incorrect links or definitely incorrect links. Record set reviews (N = 100 patients/set for 10 set sizes, randomly selected) classified 27-49 percent as definitely correct links and 39-63 percent as probably correct links. Fewer had too little information to confirm a link (5%-22%) or were probably incorrect (0%-6%). None were definitely incorrect. Overall, results suggest that Utah's Controlled Substance Database records were correctly linked. These data may be useful for cross-sectional and longitudinal studies of patient-controlled substance prescription histories.

Background: Remote follow-up of implanted implantable cardioverter defibrillators (ICDs) may offer a solution to the problem of overcrowded outpatient clinics, and may also be effective in detecting clinical events early. Data obtained from remote follow up systems, as developed by all major device companies, are stored in a central database system, operated and owned by the device company. A problem now arises that the patient's clinical information is partly stored in the local electronic health record (EHR) system in the hospital, and partly in the remote monitoring database, which may potentially result in patient safety issues., Methods: To address the requirement of integrating remote monitoring data in the local EHR, the Integrating the Healthcare Enterprise (IHE) Implantable Device Cardiac Observation (IDCO) profile has been developed. This IHE IDCO profile has been adapted by all major device companies., Results: In our hospital, we have implemented the IHE IDCO profile to import data from the remote databases from two device vendors into the departmental Cardiology Information System (EPD-Vision). Data is exchanged via a HL7/XML communication protocol, as defined in the IHE IDCO profile., Conclusions: By implementing the IHE IDCO profile, we have been able to integrate the data from the remote monitoring databases in our local EHRs. It can be expected that remote monitoring systems will develop into dedicated monitoring and therapy platforms. Data retrieved from these systems should form an integral part of the electronic patient record as more and more out-patient clinic care will shift to personalized care provided at a distance, in other words at the patient's home.

Objective: To assess the applicability of the Technology Acceptance Model (TAM) constructs in explaining HIV case managers' behavioural intention to use a continuity of care record (CCR) with context-specific links designed to meet their information needs., Design: Data were collected from 94 case managers who provide care to persons living with HIV (PLWH) using an online survey comprising three components: (1) demographic information: age, gender, ethnicity, race, Internet usage and computer experience; (2) mock-up of CCR with context-specific links; and items related to TAM constructs. Data analysis included: principal components factor analysis (PCA), assessment of internal consistency reliability and univariate and multivariate analysis., Results: PCA extracted three factors (Perceived Ease of Use, Perceived Usefulness and Perceived Barriers to Use), explained variance = 84.9%, Cronbach's ά = 0.69-0.91. In a linear regression model, Perceived Ease of Use, Perceived Usefulness and Perceived Barriers to Use explained 43.6% (p < 0.001) of the variance in Behavioural Intention to use a CCR with context-specific links., Conclusion: Our study contributes to the evidence base regarding TAM in health care through expanding the type of professional surveyed, study setting and Health Information Technology assessed.

A pharmacist-delivered, outpatient-focused medication therapy management (MTM) program is using a remote blood glucose (BG) meter upload device to provide better care and to improve outcomes for its patients with diabetes. Sharing uploaded BG meter data, presented in easily comprehensible graphs and charts, enables patients, caregivers, and the medical team to better understand how the patients' diabetes care is progressing. Pharmacists are becoming increasingly more active in helping to manage patients' complex medication regimens in an effort to help detect and avoid medication-related problems. Working together with patients and their physicians as part of an interdisciplinary health care team, pharmacists are helping to improve medication outcomes. This article focuses on two case studies highlighting the Diabetes Monitoring Program, one component of the Meridian Pharmacology Institute MTM service, and discusses the clinical application of a unique BG meter upload device., (© 2010 Diabetes Technology Society.)

BioGrid Australia provide infrastructure for research currently spanning 16 hospital-based clinical institutions and 50 databases across Victoria, Australia. To-date BioGrid have utilised a probabilistic record linkage engine (Sun Oracle Java CAPS eIndex) that utilises patient identifiers (albeit in a secure manner) during record linkage. BioGrid are now incorporating privacy-protecting record linkage technology from the University of Melbourne Rural Health Academic Centre (GRHANITE™). For the first time in Australia, the GRHANITE™technology is allowing primary care data linkage projects to happen on a large scale (70 sites, 200 planned to date). By utilising GRHANITE™privacy-protecting record linkage technologies, BioGrid are now able to overcome the privacy issues inherent in linking data across national jurisdictional boundaries. By utilising GRHANITE™privacy-protecting record linkage technologies all inter-jurisdictional public health and hospital clinical data collected by BioGrid can be systematically linked to primary care data for research for the first time. This paper describes the architecture of the combined BioGrid and GRHANITE™systems, provides evidence of the efficacy of the linkage technologies and heralds the start of a new era in privacy-protected, record linked research in Australia.

This article describes our experience in using a Picture Archiving and Communications System, known as Secure Medical Image Information System, based on the Digital Imaging and Communications in Medicine standard that supports the use of secure transmissions, from the point of view of how the use of secure sending methods has an effect on the efficiency in the transmission according to the network employed, to quantify productivity loss due to the encryption, the secure transmission, and the subsequent decryption. To test the Secure Medical Image Information System, a series of medical data transmission were conducted from A Coruña (Spain) to the Virgen de las Nieves Hospital, situated 1,000 km away, in Granada (Spain). Once we studied the networking infrastructure of the hospital and its available image generation devices, we subsequently carried out a series of measurements during the transmissions, which allowed us to analyze the behavior of the system with different network schemes and connection speeds. The results obtained from these investigations demonstrate that the impact of secure data-sending methods on the productivity of the system is higher in networks whose capacities are higher and it is not affected by sending data during different periods in the day. In this regard, the presented approach may serve as a model for other small, and possibly mid-sized, medical centers.

Nowadays, medical practice needs, at the patient Point-of-Care (POC), personalised knowledge adjustable in each moment to the clinical needs of each patient, in order to provide support to decision-making processes, taking into account personalised information. To achieve this, adapting the hospital information systems is necessary. Thus, there is a need of computational developments capable of retrieving and integrating the large amount of biomedical information available today, managing the complexity and diversity of these systems. Hence, this paper describes a prototype which retrieves biomedical information from different sources, manages it to improve the results obtained and to reduce response time and, finally, integrates it so that it is useful for the clinician, providing all the information available about the patient at the POC. Moreover, it also uses tools which allow medical staff to communicate and share knowledge.

Security of personal medical information has always been a challenge for the advancement of Electronic Health Records (EHRs) initiatives. eXtensible Markup Language (XML), is rapidly becoming the key standard for data representation and transportation. The widespread use of XML and the prospect of its use in the Electronic Health (e-health) domain highlights the need for flexible access control models for XML data and documents. This paper presents a declarative access control model for XML data repositories that utilises an expressive XML role control model. The operational semantics of this model are illustrated by Xplorer, a user interface generation engine which supports search-browse-navigate activities on XML repositories.

The rapid proliferation of applications--electronic health record and clinical decision support systems among them--cannot keep up with the growing needs of healthcare delivery organisations. The absence of uniform standards and interoperability has hindered the successful deployment and acceptance of these applications. Eclipse and other open source applications have the potential to fill some of these gaps. The benefits include acceptance of open standards, enabling interoperability and scalability, prevention of vendor lock-in and lower costs. In this paper, we describe an Eclipse-based open source electronic health record application, a prototype. We contrast the Eclipse approach to other development approaches. Implementation is feasible and provides customization, although there are challenges to overcome. We envision organisations adopting open source development tools as alternatives to vendor-driven, proprietary systems.

Medical Markup Language (MML) is a standard for the exchange of medical data among different medical institutions. It was developed in Japan in 1995. Since version 2.21, MML has used eXtensible Markup Language (XML) as a meta-language. The latest version, 3.0, conforms to HL7 Clinical Document Architecture (CDA) and contains 14 modules and 36 data definition tables. In China, a standard which structures entire medical records in XML does not yet exist. Taking advantage of MML's flexibility, we created a localized Chinese version based on MML 3.0. Parts of the original specifications have been enhanced; these include a newly developed health insurance information module and 12 additional or redefined data definition tables. The Chinese version takes local needs into account and now makes it possible to exchange medical data among Chinese medical institutions.

Electronic patient records (EPRs) provide the means for integrated access to patient information that may be scattered across dispersed healthcare organizations that, in general, use heterogeneous systems in order to support their internal functions. XML language and Clinical Document Architecture (CDA) provides a mechanism for defining, structuring, manipulating and visualizing patient medical data using the same semantics through web. In this paper, a prototype implementation of a web-based electronic patient record (EPR) system using XML for data format and CDA for defining and structuring patient clinical documents is presented.

Context: In the normal course of activity, pathologists create and archive immense data sets of scientifically valuable information. Researchers need pathology-based data sets, annotated with clinical information and linked to archived tissues, to discover and validate new diagnostic tests and therapies. Pathology records can be used for research purposes (without obtaining informed patient consent for each use of each record), provided the data are rendered harmless. Large data sets can be made harmless through 3 computational steps: (1) deidentification, the removal or modification of data fields that can be used to identify a patient (name, social security number, etc); (2) rendering the data ambiguous, ensuring that every data record in a public data set has a nonunique set of characterizing data; and (3) data scrubbing, the removal or transformation of words in free text that can be used to identify persons or that contain information that is incriminating or otherwise private. This article addresses the problem of data scrubbing., Objective: To design and implement a general algorithm that scrubs pathology free text, removing all identifying or private information., Methods: The Concept-Match algorithm steps through confidential text. When a medical term matching a standard nomenclature term is encountered, the term is replaced by a nomenclature code and a synonym for the original term. When a high-frequency "stop" word, such as a, an, the, or for, is encountered, it is left in place. When any other word is encountered, it is blocked and replaced by asterisks. This produces a scrubbed text. An open-source implementation of the algorithm is freely available., Results: The Concept-Match scrub method transformed pathology free text into scrubbed output that preserved the sense of the original sentences, while it blocked terms that did not match terms found in the Unified Medical Language System (UMLS). The scrubbed product is safe, in the restricted sense that the output retains only standard medical terms. The software implementation scrubbed more than half a million surgical pathology report phrases in less than an hour., Conclusions: Computerized scrubbing can render the textual portion of a pathology report harmless for research purposes. Scrubbing and deidentification methods allow pathologists to create and use large pathology databases to conduct medical research.

Vital signs monitoring systems need to pool information from a variety of bedside devices. Add options like portability and multiple parameters, and you can choose the best one for any setting.

We have used internet-standard tools to provide access for clinicians to the components of the electronic patient record held on multiple remote disparate systems. Through the same interface we have provided access to multiple knowledgebases, some written locally and others published elsewhere. We have developed linkage between these two types of information which removes the need for the user to drill down into each knowledgebase to search for relevant information. This approach may help in the implementation of evidence-based practice. The major problems appear to be semantic rather than technological. The intranet was developed at low cost and is now in routine use. This approach appears to be transferable across systems and organisations.

Most early reports of implemented World-Wide Web (W3) medical record systems describe single institution architectures. We describe W3-EMRS, a multi-institutional architecture, and its implementation. Thorny problems in data sharing underlined by the W3-EMRS project are reviewed.

The underlying premise of the Managed Competition Act previously cited is that through managed competition providers will be forced to lower care costs while increasing the level of positive care outcomes. Because it may also be that tomorrow's hospitals will find a severe rationing of technology, what can they do to prepare? Most of the systems in place today already have built within them all the necessary potential to address this premise and technology requirement with no change, no conversion, no expense for new equipment and software, and no disruption in day-to-day operations, just a little re-engineering. Today, however, these systems are similar to a 20-mule team pulling in different directions: all the power is there, but the wagon remains motionless and totally unable to reach its objective. It takes a skilled wagonmaster to bring them together, to make the mules work as a cohesive unit, to make the power of 20 mules greater than the sum of 20 mules. So it is and will be for the hospital of tomorrow. System integration is no longer a question of whether but of when. Those hospitals that use it today as a strategic advantage will be in a better position tomorrow to use it as a competitive strategic advantage in an environment that will reward low cost and high positive care outcomes and will penalize those that cannot compete. The technology is already here and economically within reach of nearly every hospital, just waiting to be used. The question that must nag all of us who want to make the health care system of America better is, Why not make the when now? Rich Helppie, president of Superior Consultant Company, summarized the solution well: The old ways will not give way to the new overnight. The re-engineering process in healthcare must evolve. Compared to the last 20 years, however, such evolution may appear to be a massive, forthright, complete, comprehensive, drastic and rapid revolution. Survival is the name of the game, and for healthcare organizations to survive, they must join the re-engineering revolution. When that happens, the "Americanized" health care system might look like the community network shown in Figure 7, which is a networked integration of all the systems used in the community working together and exchanging information, with hospitals exchanging information with other hospitals and sharing it with physicians, clinics, laboratories, radiology centers, universities, employers, payors, and governmental agencies.(ABSTRACT TRUNCATED AT 400 WORDS)