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Unexpected downtime and long response times of electronic health record (EHR) systems not only impact user satisfaction and clinicians’ work efficiency but also bring about potential harm for patients. Despite improvements in the performance of EHR systems’ architecture, hardware, and networks, technical challenges continue to cause problems. We explored the end-user experiences of EHR technical functionality and quality from four large national cross-sectional surveys conducted among Finnish physicians in 2010–21. The results were analyzed by healthcare sector/specialty groups. In most groups, the experiences of stability and reaction speed became worse in 2010–17, which is readily explained by the implementation of the national patient data repository services, but improvements were seen in 2021, suggesting that EHR vendors have solved at least some of the slowness problems. The proportion of physicians reporting having experienced faulty system function with potential or actualized harm for the patient had decreased in operative and medical specialties and in the private sector but remained stable in other groups. Our findings underline the importance of continuing to develop technical qualities – including the implementations of national integrations. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to identify the barriers and challenges in the adoption of the Electronic Health Record system in hospitals of Islamabad and to compare the barriers and challenges faced in adopting and running the electronic health record system in government and private hospitals of Islamabad. Method: This multicentric cross-sectional study was carried out among 210 respondents in four government and four private hospitals in Islamabad from June 2022 to November 2022. Out of 210, 160 respondents filled the questionnaire A structured questionnaire was distributed to the management, health professionals, and staff using the EHR system by simple random sampling. The data were analysed using SPSS version 26. An independent sample t-test was applied for a comparative analysis of challenges and barriers in government and private hospitals. Results: The response rate for the electronic health record system survey was 160 (76%). Of those responding, 85.75% and 72% reported using the EHR system regarding patient care in government and private hospitals, respectively. Around 42.5% and 83.75% of government and private hospitals have fully functional EHR systems, and 72% of government and 90% of private responses reported the use of computers as a major mode of patients’ data entry. A significant difference was found between government and private hospitals regarding social and legal barriers and lack of knowledge of the EHR system (p-value <0.05). Implementation of single modules and multi modules was a big challenge for the government and private hospitals, respectively (p-value <0.05). Conclusion: Government and private hospitals equally face the challenges and barriers to the implementation of the EHR system, with social and legal barriers being more prevalent in government hospitals and barriers and implementation of single modules and multimodule were a big challenge for the government and private hospitals. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic led to delays in routine preventative primary care and declines in HPV immunization rates. Providers and healthcare organizations needed to explore new ways to engage individuals to resume preventive care behaviors. Thus, we evaluated the effectiveness of using customized electronic reminders with provider recommendations for HPV vaccination to increase HPV vaccinations among adolescents and young adults, ages 9–25. Using stratified randomization, participants were divided into two groups: usual care (control) (N = 3703) and intervention (N = 3705). The control group received usual care including in-person provider recommendations, visual reminders in exam waiting rooms, bundling of vaccinations, and phone call reminders. The intervention group received usual care and an electronic reminder (SMS, email or patient portal message) at least once, and up to three times (spaced at an interval of 1 reminder per month). The intervention group had a 17% statistically significantly higher odds of uptake of additional HPV vaccinations than the usual care group (Adjusted Odds Ratio: 1.17, 95% CI: 1.01–1.36). This work supports previous findings that electronic reminders are effective at increasing immunizations and potentially decreasing healthcare costs for the treatment of HPV-related cancers. [ABSTRACT FROM AUTHOR]

In the contemporary era, the abundant availability of health information through internet and mobile technology raises concerns. Safeguarding and maintaining the confidentiality of patients' medical data becomes paramount when sharing such information with authorized healthcare providers. Although electronic patient records and the internet have facilitated the exchange of medical information among healthcare providers, concerns persist regarding the security of the data. The security of Electronic Health Record Systems (EHRS) can be improved by employing the Cuckoo Search Algorithm (CS), the SHA-256 algorithm, and the Elliptic Curve Cryptography (ECC), as proposed in this study. The suggested approach involves usingCS to generate the ECCprivate key, thereby enhancing the security of data storage in EHR. The study evaluates the proposed design by comparing encoding and decoding times with alternative techniques like ECC-GA-SHA-256. The research findings indicate that the proposed design achieves faster encoding and decoding times, completing 125 and 175 iterations, respectively. Furthermore, the proposed design surpasses other encoding techniques by exhibiting encoding and decoding times that are more than 15.17% faster. These results imply that the proposed design can significantly enhance the security and performance of EHRs. Through the utilization of CS, SHA-256, and ECC, this study presents promising methods for addressing the security challenges associated with EHRs. [ABSTRACT FROM AUTHOR]

The study assessed factors that influence the acceptance of interoperable electronic Health Records (EHRs) Systems in Tanzania Public Hospitals. The study applied a hybrid model that combined the Technology Acceptance Model (TAM) and Technology-Organization-Environment (TOE). Snowball sampling technique was applied and a total of 340 questionnaires were distributed to selected clinics, polyclinics and hospitals, of which 261 (77%) received questionnaires were considered to be valid and reliable for subsequent data analysis. IBM SPSS software version 27.0 was employed for data analysis. Findings indicated that relative advantage, compatibility, management support, organizational competency, training and education, perceived ease of use, perceived usefulness, privacy and security concerns, competitive pressure and regulatory framework have positive and significant effects on acceptance of interoperable EHRs. However, complexity and trading & vendor support were found to have nonsignificant effects on acceptance of interoperable electronic health records. The study has further provided implications that may assist scholars and policy makers in the implementation of interoperable electronic health systems in the health sector. [ABSTRACT FROM AUTHOR]

Abstract Background Electronic health record (EHR) systems often face user resistance in hospitals, which results in a failure to acquire their full benefits. To implement the EHR successfully, it is crucial to reduce nurses’ resistance to use the system. This study aimed to investigate the factors associated with nurses’ resistance to use the EHR system. Methods A descriptive correlational study was conducted with nurses working at four university hospitals in Korea using self-administered questionnaires to measure user resistance behavior, resistance to change, perceived usefulness, perceived ease of use, perceived value, colleagues’ opinions, self-efficacy for change, and organizational support for change. Path analysis was performed to examine direct and indirect association with user resistance behavior. Results A total of 223 nurses completed the questionnaires. All seven factors were found to be significantly associated with user resistance, either directly or indirectly. The total effect on user resistance behavior was highest in resistance to change (0.65), followed by perceived usefulness (− 0.33); both had direct but no indirect effects. Conversely, self-efficacy for change (− 0.25), perceived value (− 0.21), colleagues’ opinions (− 0.16), perceived ease of use (− 0.16), and organizational support for change (− 0.05) had indirect but no direct effects. Conclusions The study examined the factors associated with nurses’ user resistance behavior after the implementation of a new EHR system. These findings could help hospitals develop better EHR implementation strategies to reduce user resistance behavior among the nursing staff.

Closed-loop electronic medication management systems (EMMS) have been seen as a potential technology to prevent medication errors (MEs), although the research on them is still limited. The aim of this paper was to describe the changes in reported MEs in Helsinki University Hospital (HUS) during and after implementing an EPIC-based electronic health record system (APOTTI), with the first features of a closed-loop EMMS. MEs reported from January 2018 to May 2021 were analysed to identify changes in ME trends with quantitative analysis. Severe MEs were also analysed via qualitative content analysis. A total of 30% (n = 23,492/79,272) of all reported patient safety incidents were MEs. Implementation phases momentarily increased the ME reporting, which soon decreased back to the earlier level. Administration and dispensing errors decreased, but medication reconciliation, ordering, and prescribing errors increased. The ranking of the TOP 10 medications related to MEs remained relatively stable. There were 92 severe MEs related to APOTTI (43% of all severe MEs). The majority of these (55%, n = 53) were related to use and user skills, 24% (n = 23) were technical failures and flaws, and 21% (n = 21) were related to both. Using EMMS required major changes in the medication process and new technical systems and technology. Our medication-use process is approaching a closed-loop system, which seems to provide safer dispensing and administration of medications. However, medication reconciliation, ordering, and prescribing still need to be improved. [ABSTRACT FROM AUTHOR]

Background: Electronic health record (EHR) systems often face user resistance in hospitals, which results in a failure to acquire their full benefits. To implement the EHR successfully, it is crucial to reduce nurses' resistance to use the system. This study aimed to investigate the factors associated with nurses' resistance to use the EHR system.Methods: A descriptive correlational study was conducted with nurses working at four university hospitals in Korea using self-administered questionnaires to measure user resistance behavior, resistance to change, perceived usefulness, perceived ease of use, perceived value, colleagues' opinions, self-efficacy for change, and organizational support for change. Path analysis was performed to examine direct and indirect association with user resistance behavior.Results: A total of 223 nurses completed the questionnaires. All seven factors were found to be significantly associated with user resistance, either directly or indirectly. The total effect on user resistance behavior was highest in resistance to change (0.65), followed by perceived usefulness (- 0.33); both had direct but no indirect effects. Conversely, self-efficacy for change (- 0.25), perceived value (- 0.21), colleagues' opinions (- 0.16), perceived ease of use (- 0.16), and organizational support for change (- 0.05) had indirect but no direct effects.Conclusions: The study examined the factors associated with nurses' user resistance behavior after the implementation of a new EHR system. These findings could help hospitals develop better EHR implementation strategies to reduce user resistance behavior among the nursing staff. [ABSTRACT FROM AUTHOR]

Introduction The benefits of Electronic Health Records (EHR) use in clinical care are well documented. However, without proper education and training on EHR systems, clinicians may face challenges in utilizing these technological tools effectively. Suboptimal usage of EHR systems can affect productivity. This study assesses the effectiveness of an end-user-designed education bundle as a supplement to existing training in EHR training for house officers. Additionally, it evaluates the effectiveness of using non-conventional teaching modalities (i.e., short TikTok-style videos) to see how effective and accepted it was in comparison to traditional educational material. Methods A single-armed pre-post-study design consisting of 36 house officers was employed to evaluate the effectiveness of the intervention bundle. The bundle consists of a series of EHR tips and tricks as identified by experienced senior medical officers. The three components of the bundle are a handbook with consolidated tips and tricks, a long-form lecture video, and a series of TikTok-style videos. Distribution was done through healthcare collaborative platforms such as TigerConnect™ (Los Angeles, USA) and email. Results Participants found that the inclusion of our supplementary education bundle results in more effective training for EHR usage, with mean effectiveness with and without the educational bundle being 7.77 and 6.44, respectively (p < 0.001). There were also significant improvements in ease of finding information (7.67 vs 7.14, p = 0.016), performing general functions (7.50 vs 6.89, p = 0.0050), and overall efficiency (7.39 vs 6.92, p = 0.022). We also found TikTok-style videos were non-inferior to more traditional forms of education such as a handbook and traditional long-form lecture videos (p = 0.250). Conclusion An end-user-driven education bundle focusing on high-yield, advanced functions may be useful in enhancing the overall EHR system experience for junior doctors. Of note, TikTok-style videos may be no less effective than traditional methods of EHR teaching., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. NA issued approval NA. According to institution guidelines, a formal application for ethical approval is not applicable as this study is a quality-improvement project. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lee et al.)

Abstract Background The accessibility of laboratory test results is crucial to the performance of emergency departments and to the safety of patients. This study aims to develop a better understanding of which laboratory information exchange (LIE) systems emergency care physicians (ECPs) are using to consult their patients’ laboratory test results and which benefits they derive from such use. Methods A survey of 163 (36%) ECPs in Quebec was conducted in collaboration with the Quebec’s Department of Health and Social Services. Descriptive statistics, chi-square tests, cluster analyses, and ANOVAs were conducted. Results The great majority of respondents indicated that they use several LIE systems including interoperable electronic health record (iEHR) systems, laboratory results viewers (LRVs), and emergency department information systems (EDIS) to consult their patients’ laboratory results. Three distinct profiles of LIE users were observed. The extent of LIE usage was found to be primarily determined by the functional design differences between LIE systems available in the EDs. Our findings also indicate that the more widespread LIE usage, the higher the perceived benefits. More specifically, physicians who make extensive use of iEHR systems and LRVs obtain the widest range of benefits in terms of efficiency, quality, and safety of emergency care. Conclusions Extensive use of LIE systems allows ECPs to better determine and monitor the health status of their patients, verify their diagnostic assumptions, and apply evidence-based practices in laboratory medicine. But for such benefits to be possible, ECPs must be provided with LIE systems that produce accurate, up-to-date, complete, and easy-to-interpret information.

The implementation of electronic health record systems (EHRs) may cause multidimensional patient safety issues that deserve research attention. Our research aims to identify the current body of evidence on EHRs-related incident types and how incidents are classified in these studies. A literature search resulted in 44 peer-reviewed papers and six papers were included in the final analysis. The error types do not concern solely the technological features of the EHRs but may involve also non-technical aspects. Our review indicates that standard classification systems would facilitate comparisons across countries. To achieve the goal, more research evidence, testing and development of classifications are required. [ABSTRACT FROM AUTHOR]

Background: Health information technology, especially the electronic health record (EHR) systems, improves health care quality and patient safety.Objectives: This study's objectives are as follows: first, to explore the adoption of EHR systems among physicians in Saudi Arabia (with King Fahd Military Medical Complex as the location of the pilot study), and second, to identify the factors that influence these physicians' adoption of such systems.Methods: This cross-sectional quantitative study is based on a paper survey that was administered to a sample of 213 physicians. The theoretical model is a version of the Technology Acceptance Model (TAM) that features the following additional variables: resistance to change, training, and social influence.Results: The sample includes 133 (62%) physicians who used EHRs and 80 (38%) who did not. The main findings show that users and nonusers of the EHR system differ significantly for several factors such as perceived usefulness, perceived ease of use, social influence, and resistance to change. In addition, age, work experience, and medical specialty are significantly associated with physicians' use of the EHR system.Conclusion: To increase EHR systems' adoption rate, the following elements should be improved: the systems' design, the social environments, and the physicians' awareness of the systems' benefits. This is the first study to produce a valid and reliable instrument for measuring the factors that influences physicians' use of the EHR system at a Saudi hospital in the Eastern Province. Further studies are needed to measure how these factors influence physicians' use of EHRs in other settings. [ABSTRACT FROM AUTHOR]

Aim to compare the validity of data submitted from a UK level 1 trauma centre to the National Hip Fracture Database (NHFD) before and after the introduction of an electronic health record system (EHRS). Patients and methods a total of 3224 records were reviewed from July 2009 to July 2017. 2,133 were submitted between July 2009 and October 2014 and 1,091 between October 2014 and July 2017, representing data submitted before and after the introduction of the EHRS, respectively. Data submitted to the NHFD were scrutinised against locally held data. Results use of an EHRS was associated with significant reductions in NHFD errors. The operation coding error rate fell significantly from 23.2% (494/2133) to 7.6% (83/1091); P < 0.001. Prior to EHRS introduction, of the 109 deaths recorded in the NHFD, 64 (59%) were incorrect. In the EHRS dataset, all the 112 recorded deaths were correct (P < 0.001). There was no significant difference in the error rate for fracture coding. In the EHRS dataset, after controlling for sample month, entries utilising an operation note template with mandatory fields relevant to NHFD data were more likely to be error free than those not using the template (OR 2.69; 95% CI 1.92–3.78). Conclusion this study highlights a potential benefit of EHR systems, which offer automated data collection for auditing purposes. However, errors in data submitted to the NHFD remain, particularly in cases where an NHFD-specific operation note template is not used. Clinician engagement with new technologies is vital to avoid human error and ensure database integrity. [ABSTRACT FROM AUTHOR]

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. [ABSTRACT FROM AUTHOR]

Abstract The rise of genomically targeted therapies and immunotherapy has revolutionized the practice of oncology in the last 10–15 years. At the same time, new technologies and the electronic health record (EHR) in particular have permeated the oncology clinic. Initially designed as billing and clinical documentation systems, EHR systems have not anticipated the complexity and variety of genomic information that needs to be reviewed, interpreted, and acted upon on a daily basis. Improved integration of cancer genomic data with EHR systems will help guide clinician decision making, support secondary uses, and ultimately improve patient care within oncology clinics. Some of the key factors relating to the challenge of integrating cancer genomic data into EHRs include: the bioinformatics pipelines that translate raw genomic data into meaningful, actionable results; the role of human curation in the interpretation of variant calls; and the need for consistent standards with regard to genomic and clinical data. Several emerging paradigms for integration are discussed in this review, including: non-standardized efforts between individual institutions and genomic testing laboratories; “middleware” products that portray genomic information, albeit outside of the clinical workflow; and application programming interfaces that have the potential to work within clinical workflow. The critical need for clinical-genomic knowledge bases, which can be independent or integrated into the aforementioned solutions, is also discussed.