EMR - Science topic

In most cases, and thanks to the increasing use of open standards (both in information exchange, and in data pasistence), globally systems for healthcare information management are converging on a similar model. You can see this model emerging through HL7 FHIR and SNOMED CT. These model the clinical aspects of the information (there are other standards too, but from a clinical perspective all the models are very similar - because people are the same globally, and have the same diseaes, are exposed to the same diagnistic tests and treaments, have allergies and also drugs are pretty much the same too across the planet - of course all these elements are subject to local codification - you will see some countries have more gender codes than others). Another point of view from the clinical poiint of view is the administrative ouur accountants' point of view. There you are more interestedin how many patients and their associated costs - but there is a large overlap (intesection) and the structured data and codification between the two. This is why you see some places use, for example, ICD-10 coding (the World Health Organisation's statistical codification scheme) being used for clinical coding in some part sof the world for some clincal sub-groups.

I think, by the way, that when the accountants' view is the smae as the clinician's view then there is a good corrependence between "health" and "value". But since accountants like to generalise and average, and since politics plays a role in the value of health in every country, I don't see that the two views will ever overlap 100%. But this is just my very subjective point of view - no science behind it :)

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Thanks

I do not think there is a straight forward answer to the question. Like your last sentence reads " However, there is still little conclusive evidence that EMR positively affected healthcare services." While there is a general perception that EMR/EHR contributes to improved quality of care, the evidences have been weak and there have also been some unintended consequences.

My answer then will be - it depends. It depends on the context of assessment, as such it may be difficult to give a general answer.

One of the barriers to explore is that the EMR that is sold by the vendor as modules would not be as effective as the "complete" package. For example, EMR is installed without scanning solutions that would affect the patient's full data being really electronic.

Hi, I have no comments to the EHR/EMR question, but related to the second part of your question; Health Information System(s) (HIS) is generally used more broadly than systems dealing with patient data, such as EHR/EMR. It could be anything related to information systems within the health domain. Common groups of systems include Health Management Information Systems (HMIS), EMR-like systems, various registries, systems for survey data, etc. Broadly understood, it can also include at least connections to lab, radiology, logistics, HR systems. A good starting point could be the HMN Framework and standards for country Health Information Systems: https://gateway.euro.who.int/en/the-health-metrics-network-hmn-framework-and-standards-for-country-health-information-systems/

So I would say HIS is a broad collection of EHR/EMR, HMIS, lab systems, radiology systems, etc etc.

Hi Fadoua Khennou and Mohammad Mosa Daradkah thank you for answers.

Behavioral Risk Factor Surveillance System (BRFSS). You may find data from CDC WONDER. National Center for Health Statistics (NCHS) and Web-based injury Statistics Query and Reporting System (WISQARS). These data bases may help and offer other data bases. The World Health Organization (WHO) may also be of assistance in data queries such as Global Health Observatory (GHO) data. Hope this help.

good question

HL-7 and FHIR Standards will ease the Integration of a Dicom Image into EHR (correct me if i am wrong)

Dear Bhaskar Gupta ,

Do you know why India has reduced maximum field strength by a factor of 10.

I agree, but nursing has to take its stand, as long as there was no internationally consented standard, facts and evidence was missing. Now, there is a standard available and can empower nurses in IT project groups. In our country, the Government is happy when getting nursing expert advice.

Presently in the U.S. at least (where I am from) there are concerns during the current transition from high pressure sodium (HPS) street lighting (which is yellowish in appearance and has an abundance of long-visible-wavelength energy commonly called "red") to white light emitting diode (LED) illumination. White LEDs have relatively more short-visible-wavelength ("blue") radiation and less long-wavelength output, compared to HPS. The increase in short-wavelength output from streetlights has elicited concerns about glare (the discomfort glare response is more sensitive to short visible wavelengths - see ) and intense short-wavelength light is potentially more danaging to the retina that longer wavelengths (see ). Also, scattered light in the atmosphere from shorter wavelengths can be greater than from longer wavelengths and this can have implications for sky brightening and astronomical observation at night. There are also concerns about the possibility of "bluer/whiter" street lights to disrupt the circadian system in humans, which could perhaps increase the likelihood of certain types of cancer (see ). For these reasons organizations like the American Medical Association have suggested limiting the correlated color temperature (CCT) of LED street lights to "warm white" colors having CCTs of 3000 K or less. Although the evidence that this will truly be beneficial is questionable, once the prospect of cancer is brought up, many municipalities and other stakeholders are willing to forgo potential visibility and security benefits of higher CCTs (see http://www.imsasafety.org/journal/so07/26.pdf) and recommend "warmer" white LED streetlights, which can be created by using LED phosphor combinations with greater long-wavelength ("red") down-conversion output from the blue pump LEDs used in phosphor-converted white LEDs.

Thanks a lot Mohammed for your answer.

I completely agree that only in cooperations it is possible to resolve problems.

See here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192618/

Dear Alfonso,

We were indeed aware of this petition.

Thank you for your contribution!

Kind regards,

Lise

SNOMED CT (one of the main knowledge sources included in UMLS - https://www.nlm.nih.gov/research/umls/knowledge_sources/metathesaurus/release/active_release.html) is being actively implemented in a variety of electronic health record solutions, e.g., in the UK - see: https://digital.nhs.uk/snomed-ct and https://digital.nhs.uk/snomed-ct

You might also find this old (2001) introductory presentation of mine of interest as it explains the basics of this field: http://healthcybermap.org/coding2001.ppt

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Dear,

Currently ICT play very big role in health care sector. Following are the benefits which you can include in your questioners

1. A physician in a remote rural hospital is initially unable to diagnose a patient with a complex array of symptoms. However, using his ICT,  he is able to diagnose and successfully treat the patient for a tropical disease the patient picked up while traveling abroad.

2. A neonatologist, who transmits CT-scans and other medical images by e-mail to his network of personal contacts around the world to help in diagnosing and treating premature newborns, estimates that teleconsultations have helped him to save numerous lives during the past year.

Hi Akkeneel, we don,t have an EMR per se, but we have an in house cardiac surgical register which captures preop, procedural and mort/morbidity data (30 day). We monitor outcomes and risk adjust a little, but our biggest problem is the lack of integration of our seperate clinical systems. We seem to be quite behind in this in Australian hospitals. We do link with the state Death registry and we can get whole of state readmissions to be able to monitor longer term outcomes, but we do not really do this consistently. It is difficult to get the prioritisation to do such studies beyond routine monitoring for peer review. We have done some studies across theICU and Cardiac Surgery databases (Article: Influence of timing of intraaortic balloon placement in cardiac surgical patients), but we have to merge the data first, however we can apply logistic regression to do a fair job of trying to account for confounding, etc. Also, the data is not truly of Regular EMR Quality as it is specifically captured as registry data after the care episode, therefore should be of higher quality. You are leading the way we need to be going by using your routinely collected data at your service front line to inform your care processes. Good luck!