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About This Book

Handbook of Research on Informatics in Healthcare and
• Description &
Biomedicine
Key Features

• Topics Covered Edited By: Athina A. Lazakidou, University of Peloponnese, Greece

• Accolades
Table of Contents:
• Contributors

• Editorial Advisory
Board SECTION I: MEDICAL DATA AND HEALTH INFORMATION SYSTEMS

• Table of Contents Chapter I

Electronic Health Records / Olga Galani and Ageliki Nikiforou
• Preface
ISBN: 1-59140-982-9
• About the Editors Chapter II
Security in Health Information Systems / Christina Ilioudi and Athina A. Lazakidou Hard Cover
• View the Brochure Publisher: Information
Chapter III Science Reference
• View the Excerpt
Development of a Health Information System in a Post-Communist Country / Ranko Stevanovic, Copyright: 2006
Ivan Pristas, Ana Ivicevic Uhernik, and Arsen Stanic
Pages: 479
• Reference Home Page
Chapter IV List Price: $215.00
• Recommend to your Computerized Systems Validation in the Pharmaceutical Industry / Kashif Hussain, Shazia Yasin add to cart
Library Mughal, and Sylvie Leleu-Merviel
Perpetual Access:
Authoritative - Chapter V
Innovative - $325.00
Chronic Disease Registers in Primary Healthcare / M. F. Harris, D. Penn, J. Taggart, Andrew
Comprehensive Georgiou, J. Burns, and G. Powell Davies add to cart

SECTION II: STANDARDIZATION AND CLASSIFICATION SYSTEMS IN MEDICINE Print + Perpetual Access:
$430.00
Chapter VI
Standardization in Health and Medical Informatics / Josipa Kern add to cart

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Information Science Reference

Chapter VII
Basic Principles and Benefits of Various Classification Systems in Health / Dimitra Petroudi and
Athanasios Zekios

SECTION III: VIRTUAL REALITY APPLICATIONS IN MEDICINE

Chapter VIII
Virtual Reality in Medicine / Theodoros N. Arvanitis

Chapter IX
Modelling and Simulation of Biological Systems / George I. Mihalas

Chapter X
Virtual Reality Simulation in Human Applied Kinetics and Ergo Physiology / Bill Ag. Drougas

SECTION IV: VIRTUAL LEARNING ENVIRONMENTS IN HEALTHCARE AND BIOMEDICINE

Chapter XI
Care2x in Medical Informatics Education / Andreas Holzinger, Harald Burgsteiner, and Helfrid
Maresch

Chapter XII
An Object-Oriented Approach to Manage E-Learning Content Using Learning Objects / Andreas
Holzinger, Josef Smolle, and Gilbert Reibnegger

Chapter XIII
Motivating Healthcare Students in Using ICTs / Boštjan Žvanut

Chapter XIV
The User Agent Architecture and E-Learning in Healthcare and Social Care / Konstantinos M.
Siassiakos, Stefanos E. Papastefanatos, and Athina A. Lazakidou

Chapter XV
E-Learning in Healthcare and Social Care / Maria Kalogeropoulou, Maria Bastaki, and Polyxeni
Magoulia

Chapter XVI
Potential Benefits and Challenges of Computer-Based Learning in Health / Athina A. Lazakidou,
Christina Ilioudi, and Andriani Daskalaki

SECTION V: COMPUTER-ASSISTED DIAGNOSIS

Chapter XVII
Brain Mapping in Functional Neurosurgery / George Zouridakis, Javier Diaz, and Farhan Baluch

Chapter XVIII
ECG Diagnosis Using Decision Support Systems / Themis P. Exarchos, Costas Papaloukas, Markos G.
Tsipouras, Yorgos Goletsis, Dimitrios I. Fotiadis, and Lampros K. Michalis

SECTION VI: DATA MINING AND MEDICAL DECISION MAKING

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Chapter XIX
Information Processing in Clinical Decision Making / Vitali Sintchenko

Chapter XX
Data Mining Techniques and Medical Decision Making for Urological Dysfunction / N. Sriraam, V.
Natasha, and H. Kaur

Chapter XXI
Spline Fitting / Michael Wodny

Chapter XXII
Parameter Estimation / Karl-Ernst Biebler

Chapter XXIII
The Method of Least Squares / Bernd Jaeger

SECTION VII: CURRENT ASPECTS OF KNOWLEDGE MANAGEMENT IN MEDICINE

Chapter XXIV
The Data-Information-Knowledge Model / Andrew Georgiou

Chapter XXV
Goals and Benefits of Knowledge Management in Healthcare / Odysseas Hirakis and Spyros
Karakounos

Chapter XXVI
Knowledge Management in Medicine / Nikolaos Giannakakis and Efstratios Poravas

Chapter XXVII
Knowledge Management in Telemedicine / Jayanth G. Paraki

SECTION VIII: TELEMEDICINE AND E-HEALTH SERVICES

Chapter XXVIII
Use of Telemedicine Systems and Devices for Patient Monitoring / Dionisia Damigou, Fotini
Kalogirou, and Georgios Zarras

Chapter XXIX
Current Telehealth Applications in Telemedicine / Georgios Economopoulos

Chapter XXX
Mobile Telemonitoring Insights / Pantelis Angelidis

Chapter XXXI
Telepathology and Digital Pathology / Vincenzo Della Mea

Chapter XXXII
Collaborative Environments for the Health Monitoring of Chronically Ill Children / G. Ganiatsas, K.

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Information Science Reference

Starida, and Dimitrios I. Fotiadis

Chapter XXXIII
Electronic Submission of New Drugs in Europe / A. Susanne Esslinger and Daniela Marschall

Chapter XXXIV
Semantic Web Services for Healthcare / Christina Catley, Monique Frize, and Dorina Petriu

SECTION IX: IMAGE PROCESSING AND ARCHIVING SYSTEMS

Chapter XXXV
Imaging Technologies and their Applications in Biomedicine and Bioengineering / Nikolaos
Giannakakis and Efstratios Poravas

Chapter XXXVI
Medical Image Compression Using Integer Wavelet Transforms / B. Ramakrishnan and N. Sriraam

Chapter XXXVII
Three Dimensional Medical Images / Efstratios Poravas, Nikolaos Giannakakis, and Dimitra Petroudi

Chapter XXXVIII
Imaging the Human Brain with Magnetoencephalography / Dimitrios Pantazis and Richard M. Leahy

Chapter XXXIX
Region of Interest Coding in Medical Images / Sharath T. Chandrashekar and Gomata L. Varanasi

Chapter XL
Imaging the Human Brain with Functional CT Imaging / Sotirios Bisdas and Tong San Koh

SECTION X: SIGNAL PROCESSING TECHNIQUES

Chapter XLI
Nonlinear Signal Processing Techniques Applied to EEG Measurements / Christos L. Papadelis,
Chrysoula Kourtidou-Papadeli, Panagiotis D. Bamidis, and Nicos Maglaveras

SECTION XI: USE OF NEW TECHNOLOGIES IN BIOMEDICINE

Chapter XLII
Medical and Biomedical Devices for Clinical Use / Evangelos K. Doumouchtsis

Chapter XLIII
Artificial Intelligence in Medicine and Biomedicine / Athanasios Zekios and Dimitra Petroudi

Chapter XLIV
Comparative Genomics and Structure Prediction in Dental Research / Andriani Daskalaki and Jorge
Numata

Chapter XLV
Genomic Databanks for Biomedical Informatics / Andrea Maffezzoli and Marco Masseroli

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Information Science Reference

Chapter XLVI
Basic Principles and Applications of Microarrays in Medicine / Andriani Daskalaki and Athina A.
Lazakidou

Chapter XLVII
System Patterns of the Human Organism and their Heredity / Manfred Doepp and Gabriele Edelmann

Chapter XLVIII
Evaluation Methods for Biomedical Technology / Maria Sevdali

SECTION XII: ERGONOMIC AND SAFETY ISSUES IN COMPUTERIZED MEDICAL EQUIPMENT

Chapter XLIX
Ergonomic User Interface Design in Computerized Medical Equipment / D. John Doyle

Chapter L
Safety Issues in Computerized Medical Equipment / D. John Doyle

Chapter LI
Alarm Design in Computerized Medical Equipment / D. John Doyle

SECTION XIII: HEALTH ECONOMICS AND HEALTH SERVICES RESEARCH

Chapter LII
Organizational Factors in Health Informatics / Michelle Brear

Chapter LIII
Measurement of Cost and Economic Efficiency in Healthcare / Panagiotis Danilakis and Pericles
Robolas

Chapter LIV
Understanding Telemedicine with Innovative Systems / Irene Berikou and Athina A. Lazakidou

Chapter LV
A Capacity Building Approach to Health Literacy through ICTs / Lyn Simpson, Melinda Stockwell,
Susan Leggett, Leanne Wood, and Danielle Penn

The premier reference source for information science & technology research

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About This Book

Handbook of Research on Informatics in Healthcare and
• Description &
Biomedicine
Key Features

• Topics Covered Edited By: Athina A. Lazakidou, University of Peloponnese, Greece

• Accolades
Preface:
• Contributors

• Editorial Advisory
Board Advances in information and communication technologies (ICT) have provided the tools and the
environment to study, analyze, and better understand complex medical problems. This technological
• Table of Contents development has enabled researchers to provide increasingly advanced services, including computer-
assisted radiology, telemedicine, robotized tele-operating systems, and so forth.
• Preface
ISBN: 1-59140-982-9
In recent years, research in computer applications applied to healthcare and biomedicine has
• About the Editors
dramatically intensified. The Handbook of Research on Informatics in Healthcare and Biomedicine Hard Cover
• View the Brochure aims to provide a platform for researchers to describe and analyze recent breakthroughs in these Publisher: Information
areas. This handbook will be most helpful as it provides comprehensive coverage and definitions of Science Reference
• View the Excerpt the most important issues, concepts, new trends and advanced technologies in healthcare and
biomedicine. This important new handbook will be distributed worldwide among academic and Copyright: 2006
professional institutions and will be instrumental in providing researchers, scholars, students, and Pages: 479
• Reference Home Page professionals access to the latest knowledge related to information science and technology in the
areas of healthcare and biomedicine. List Price: $215.00
• Recommend to your
add to cart
Library
This handbook provides a compendium of terms, definitions, and explanations of concepts,
processes, and acronyms. Additionally, this volume features short chapters authored by leading Perpetual Access:
Authoritative - experts offering an in-depth description of key terms and concepts related to different areas, issues,
Innovative - $325.00
and trends in information science and technologies in hospitals and other organizations worldwide.
Comprehensive add to cart
The Handbook of Research on Informatics in Healthcare and Biomedicine is an excellent source of
comprehensive knowledge and literature on the topic of health and biomedical informatics. Print + Perpetual Access:
$430.00
The topics in this handbook cover useful areas of general knowledge including medical data and
add to cart
health information systems, standardization and classification systems in medicine, virtual reality
applications in medicine, virtual learning environments in healthcare and biomedicine, computer-
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Information Science Reference

assisted diagnosis, data mining and medical decision making, current aspects of knowledge
management in medicine, telemedicine and e-health services, image processing and archiving
systems, signal processing techniques, use of new technologies in biomedicine, ergonomic and
safety issues in computerized medical equipment, health economics, and health services research.
Speicifically, these useful terms and key words have been included and analyzed in the concrete
sections of this publication.

A healthcare provider’s competitiveness, level of efficiency, and quality of care may be in direct
relationship to the rate of progress toward a paperless system—with digital documentation of all
clinical and administrative care processes. Each small step toward the electronic health record should
be analyzed according to its benefits and costs. Hospitals and delivery networks must share secure
health information and improve processes and efficiency in handling IT. The first section, “Medical
Data and Health Information Systems”, contains chapters related to the current status and future
prospects of the electronic health record systems, the security in health information systems, and
various applications in the area of health informatics.

For more than 130 years the systematic collection and record of medical information has been based
on the use of traditional classifications, nomenclatures, and coding schemes of various kinds. Until
relatively recently, such schemes were used mainly for recording causes of death and gathering
minimal diagnostic information for statistical and epidemiological purposes. Despite their many
limitations, schemes such as the international classification of diseases (ICD) have been successful
in supporting the collation and comparison of national and international statistics on morbidity and
mortality, and advancing our understanding of the distribution and causes of diseases. The second
section, “Standardization and Classification Systems in Medicine”, contains chapters related to
standardization and classification systems in health.

Medicine will benefit from virtual reality. As recorded in the military, virtual reality can provide an
excellent training mechanism when there is no room for mistakes. Doctors will be able to practice
alone or in teams to fine tune their skills for highly sensitive operations without having to risk a
human life. Virtual reality can improve the doctor’s performance during operations by superimposing
vital information on the patient during an operation. Superimposed images can increase the
effectiveness of radiation treatment and reduce the scarring of a surgery. In the third section,
“Virtual Reality Applications in Medicine”, various virtual reality applications in (bio) medicine and
their benefits are presented.

The application of computer technology to education often refers to computer-assisted learning

(CAL), computer-based education (CBE), or computer-aided instruction (CAI). Computer-based
learning has been developed for the beginning medical student and the experienced practitioner, for
the lay person and the medical expert. In the fourth section, “Virtual Learning Environments in
Healthcare and Biomedicine”, examples of actual programs that are being used to support medical
education for each of these categories of learners are presented.

Digital imaging still remains one of the key technologies for progress in healthcare. With further
advances in processing, display, and communication of medical imaging it becomes the key to solve
many problems in diagnosis and therapy. As well as computer-assisted diagnosis, computer-assisted
surgery relies increasingly on some type of image management. Typical examples can be found in
craniofacial surgery, neurosurgery, orthopaedic surgery of the hip and spine, plastic/reconstructive
surgery, otolaryngology, and so forth. The fifth section, “Computer-Assisted Diagnosis”, includes a
large number of examples in the area of computer-assisted diagnosis.

The process of extracting useful information from a set of data is called “data mining”. Data mining
techniques have been used as a recent trend for gaining diagnostic results especially in medical
fields such as kidney dialysis, skin cancer, and breast cancer detection and also biological sequence
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Information Science Reference

classification. Various “Data Mining and Medical Decision Making” are presented in the Section VI.

Knowledge management is a basic tool for all those who work in the health field and in hospitals. It
helps sending the right information, to the right part, to the right person, at the right time, so that
the right decisions can be made, depending on the existing problems. It is certain that with the help
of knowledge management the effectiveness in the health field will be increased through unified
systems, processes and methods, the cultivation of exchanging knowledge, and the promotion of the
effective use of available information. In Section VII, basic principles and theoretical aspects of the
use of knowledge management in medicine are clearly presented.

Rapidly emerging information and communication technologies (ICT) have spurred the recent
escalation of various telehealth applications. It is true that there is an enormous interest in finding
new ways to apply telehealth as much as telemedicine as a special part of telehealth. Section VIII,
“Telemedicine and E-Health Services”, has, along with providing a better understanding of what
telehealth is, investigated the ways in which such an avant-garde, advancing, and newly emerging
technology could be used in order to make an upper healthcare level to be available. This section
aims to help someone to clarify confused terms such as telehealth and telemecine or even telecare
and e-health.

The rapid progress in imaging technologies during the last decades has stimulated many
developments and applications in medicine, biology, industry, aerospace, remote sensing,
meteorology, oceanography, and environment. New developments are continually making the
technology faster, more powerful, less invasive, and less expensive. Imaging technology was
primarily used in medical diagnosis initially, but it is being increasingly used in pure neuroscience,
psychological research, and in many other fields. The quantitative nature of data will be relevant to
the effective diagnostic as well as therapeutic management of patients—whatever disease they may
have. In the ninth section, “Image Processing and Archiving Systems”, various imaging technologies
and their applications in Biomedicine are clearly presented.

In digital signal processing, numerous powerful algorithms, both linear and non-linear, have been
developed during the past three decades. These have given rise to tremendous progress in speech
and image processing. But digital signal processing is not restricted to communications and
information processing. It also plays a leading role in such diverse fields as measurement, automatic
control, robotics, medicine, biology, and geophysics to mention just the most important ones. New
signal processing techniques for use in medicine are clearly presented in Section X.

Medical technology is a science discipline that has been rapidly growing over the last decades. It is
characterized by a constant flow of innovations and a high level of research and development. Many
technological achievements have dramatically changed the way that medicine diagnoses and treats
human disease. Improved healthcare technology has presented many revolutionary medical devices
that reduced mortality and morbidity. New various technologies applied in biomedicine are presented
in Section XI.

As the cost of microcomputer technology continues to drop, computers are being used increasingly
in medical systems and equipment such as ventilators or pacemakers, sometimes with safety-critical
results. “Ergonomic and Safety Issues in Computerized Medical Equipment” are clearly presented
and discussed in Section XII. Health services research is research that seeks to improve the quality,
organisation and financing of health services. Its concern extends from the care of individuals
through health care organisations to national and international policies. Section XIII contains
chapters related to health economics and health services research.

Athina A. Lazakidou, Ph.D.

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About This Book

Handbook of Research on Informatics in Healthcare and
• Description &
Biomedicine
Key Features

• Topics Covered Edited By: Athina A. Lazakidou, University of Peloponnese, Greece

• Accolades
Contributors:
• Contributors

• Editorial Advisory
Board Angelidis, Pantelis / Vidavo Ltd., Greece

• Table of Contents Arvanitis, Theodoros N. / University of Birmingham, UK

• Preface
Baluch, Farhan / University of Houston, USA ISBN: 1-59140-982-9
• About the Editors
Hard Cover
Bamidis, Panagiotis D. / Aristotle University of Thessaloniki, Greece
• View the Brochure Publisher: Information
Science Reference
• View the Excerpt Bastaki, Maria / National and Kapodistrian University of Athens, Greece
Copyright: 2006
Berikou, Irene / Athens University of Economics and Business, Greece Pages: 479
• Reference Home Page
List Price: $215.00
• Recommend to your Biebler, Karl-Ernst / Ernst-Moritz-Arndt-University, Germany
add to cart
Library
Bisdas, Sotirios / Johann Wolfgang Goethe University Hospital, Germany Perpetual Access:
Authoritative -
Innovative - $325.00
Brear, Michelle / University of New South Wales, Australia
Comprehensive add to cart
Burgsteiner, Harald / Graz University of Applied Sciences, Austria
Print + Perpetual Access:
Burns, J. / University of New South Wales, Australia $430.00
add to cart
Catley, Christina / Carleton University, Canada

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Chandrashekar, Sharath T. / Sarayu Softech Pvt Ltd., India

Damigou, Dionisia / National and Kapodistrian University of Athens, Greece

Danilakis, Panagiotis / National and Kapodistrian University of Athens, Greece

Daskalaki, Andriani / Max Planck Institute of Molecular Genetics, Germany

Davies, G. Powell / University of New South Wales, Australia

Della Mea, Vincenzo / University of Udine, Italy

Diaz, Javier / University of Houston, USA

Doepp, Manfred / Holistic DiagCenter, Germany

Doumouchtsis, Evangelos K. / National and Kapodistrian University of Athens, Greece

Doyle, D. John / Cleveland Clinic Foundation, USA

Drougas, Bill Ag. / ATEI Education Institute of Epirus, Greece

Economopoulos, Georgios / National and Kapodistrian University of Athens, Greece

Edelmann, Gabriele / Holistic DiagCenter, Germany

Esslinger, A. Susanne / Friedrich-Alexander-University, Germany

Exarchos, Themis P. / University of Ioannina, Greece

Fotiadis, Dimitrios I. / University of Ioannina, Biomedical Research Institute—FORTH, and

Michaelideion Cardiology Center, Greece

Frize, Monique / Carleton University and University of Ottawa, Canada

Galani, Olga / National and Kapodistrian University of Athens, Greece

Ganiatsas, G. / University of Ioannina, Greece

Georgiou, Andrew / University of New South Wales, Australia

Giannakakis, Nikolaos / National and Kapodistrian University of Athens, Greece

Goletsis, Yorgos / University of Ioannina, Greece

Harris, M. F. / University of New South Wales, Australia

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Hirakis, Odysseas / National and Kapodistrian University of Athens, Greece

Holzinger, Andreas / Medical University Graz (MUG), Austria

Hussain, Kashif / University of Valenciennes, France

Ilioudi, Christina / University of Piraeus, Greece

Jaeger, Bernd / Ernst-Moritz-Arndt-University, Germany

Kalogeropoulou, Maria / National and Kapodistrian University of Athens, Greece

Kalogirou, Fotini / National and Kapodistrian University of Athens, Greece

Karakounos, Spyros / National and Kapodistrian University of Athens, Greece

Kaur, H. / Multimedia University, Malaysia

Kern, Josipa / Andrija Stampar School of Public Health, Zagreb University Medical School, Croatia

Koh, Tong San / Nanyang Technological University, Singapore

Kourtidou-Papadeli, Chrysoula / Greek Aerospace Medical Association and Space Research, Greece

Lazakidou, Athina A. / University of Piraeus, Greece

Leahy, Richard M. / University of Southern California, USA

Leggett, Susan / Queensland University of Technology, Australia

Leleu-Merviel, Sylvie / University of Valenciennes, France

Maffezzoli, Andrea / Politecnico di Milano, Italy

Maglaveras, Nicos / Aristotle University of Thessaloniki, Greece

Magoulia, Polyxeni / National and Kapodistrian University of Athens, Greece

Maresch, Helfrid / Graz University of Applied Sciences, Austria

Marschall, Daniela / Friedrich-Alexander-University, Germany

Masseroli, Marco / Politecnico di Milano, Italy

Michalis, Lampros K. / Michaelideion Cardiology Center and University of Ioannina, Greece

Mihalas, George I. / “Victor Babes” University of Medicine and Pharmacy, Romania

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Mughal, Shazia Yasin / University of Valenciennes, France

Natasha, V. / Multimedia University, Malaysia

Nikiforou, Ageliki / National and Kapodistrian University of Athens, Greece

Numata, Jorge / Free University, Germany

Pantazis, Dimitrios / University of Southern California, USA

Papadelis, Christos L. / Aristotle University of Thessaloniki, Greece

Papaloukas, Costas / University of Ioannina, Greece

Papastefanatos, Stefanos E. / University of Piraeus, Greece

Paraki, Jayanth G. / Telemedicine Research Laboratory, India

Penn, D. / University of New South Wales, Australia

Penn, Danielle / Queensland University of Technology, Australia

Petriu, Dorina / Carleton University, Canada

Petroudi, Dimitra / National and Kapodistrian University of Athens, Greece

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Reibnegger, Gilbert / Medical University Graz (MUG), Austria

Robolas, Pericles / National and Kapodistrian University of Athens, Greece

Sevdali, Maria / Scientific Collaborator of Technological Educational Institution Kalamata, Greece

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Simpson, Lyn / Queensland University of Technology, Australia

Sintchenko, Vitali / University of New South Wales, Sydney, Australia

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 1

Chapter I
Electronic Health Records
Olga Galani
National and Kapodistrian University of Athens, Greece

Ageliki Nikiforou
National and Kapodistrian University of Athens, Greece

ABSTRACT

The Electronic Health Record is a means of organizing patient data making profound use of
the advances in the field of information technology. Its purpose is to fulfill the various needs
for information not only of patients and healthcare providers but also of other beneficiaries.
The implementation of EHR systems in healthcare organizations is very complex and involves
many parameters. This article is about the challenges faced by those undertaking such a task
and about the potential benefits from a successful implementation.

INTRODUCTION have a number of significant disadvantages.

First of all, paper is a very fragile medium that
Advances in computer technology have the requires large storage facilities. In addition,
potential to solve some of the most persistent paper-based health records require large hu-
problems in healthcare. There is a consensus in man effort to keep the files and archives orga-
healthcare that there is a need for creating nized and updated, they are available only in
information and communication systems that one place at a time, and the aggregation of data
reduce cumbersome and outdated paperwork. for research is difficult. Furthermore, we are
Paper-based health records have been in use moving to a model where the patient is no longer
for centuries since they require relatively little a passive recipient of the services provided by
investment to use and produce compared to nurses, physicians, and others, but is an active
more sophisticated supports, and they are fa- partner (a consumer or a client) with the
miliar to users who do not have to acquire new healthcare practitioners. A successful partner-
skills or behaviors to use them properly. De- ship requires open access to the healthcare
spite all these, paper-based health records also information. The creation and implementation

Copyright © 2006, Idea Group Inc., distributing in print or electronic forms without written permission of IGI is prohibited.
 Electronic Health Records

Figure 1. Creation of an electronic health record

of electronic health record (EHR) systems is at • Outpatient and emergency depart-

the heart of addressing these needs (Daskalaki, ments
Lazakidou, Philipp, Jacob, & Berlien, 2001; • Community and allied health
Mantas, 2002; Medical Records Institute, http:/ • General practice
/www.medrecinst.com/index.asp; Wang et al., • Dental clinics
2003). • Diagnostic results (pathology and ra-
diology)
• Documents such as assessments, dis-
COMPONENT PARTS OF AN charge referrals, and letters
ELECTRONIC HEALTH RECORD • Multidisciplinary and multiservice
care plans
Figure 1 depicts an oversimplified view of how
the EHR is created.
To gain a more accurate appreciation of the USE AND BENEFITS OF
EHR’s complexity and breadth of information, THE EHR
one must recognize the wide range of health
information sources. Each time an individual The primary purpose of the EHR is to provide
visits a healthcare provider, data are gener- a documented record of care that supports
ated. Figure 2 identifies some of the sources of present and future care by the same or other
data for an EHR as listed by the Institute of
Medicine.
The component parts of utmost importance Figure 2. Sources of health-related data
of an EHR are the following.

• Patient’s demographic details

• Family history
• Allergies and alerts
• Medical history
• Procedures
• A summary of services provided to an
individual by
• Hospitals during admissions for treat-
ment

2
Electronic Health Records

clinicians. This documentation provides a means Patients

of communication among clinicians contribut-
ing to the patient’s care. The primary benefi- • integrated health services
ciaries are the patient and the clinicians. • improved healthcare and decreased risks
Any other purpose for which the medical (e.g., adverse drug reactions)
record is used may be considered secondary as • not having to repeat basic information,
are any other beneficiaries. Much of the con- such as name and address
tent of EHRs is currently defined by secondary • increased confidence knowing that all
users as the information collected for primary healthcare professionals have access to
purposes was insufficient for purposes such as all relevant parts of one’s medical history
billing, policy and planning, statistical analysis, • access to their own health records helps
accreditation, and so forth. patients to make informed decisions about
Secondary uses of EHRs include the following: their health
• avoidance of duplicate, invasive, and/or
• Medico-Legal Uses: Evidence of care expensive tests
provided, indication of compliance with
legislation, reflection of the competence Public
of clinicians
• Quality Management: Continuous qual- • expanded reach of effective healthcare
ity-improvement studies, utilisation review, • more secure information
performance monitoring, benchmarking, • access to information about how the
accreditation healthcare system works
• Education
• Research: Development and evaluation Health Professionals
of new diagnostic modalities, disease-pre-
vention measures, epidemiological stud- • view of patient data
ies, population health analysis • access to other related and integrated
• Public and Population Health: Access patient information
to quality information enables the effec- • access through a portal to related health
tive management of real and potential services
public health risks • seamless care through the coordination of
• Policy Development: Health-statistics multiprofessional and multiagency care
analysis, trends analysis, casemix analysis • development of decision-support sys-
• Health-Service Management: Re- tems
source allocation and management, cost
management Health Administrators
• Billing, Finance, and Reimbursement:
Insurers, government agencies, funding • increased patient care time
bodies (Schloeffel & Jeselon, 2002) • access to data to support clinical gover-
nance and local planning
The use of EHR can yield to a number of • reduced healthcare costs
benefits, which can be described in terms of the
following attributes.

3
 Electronic Health Records

Policy Makers Figure 3. Clinical data repositories in use

and planned for use within 1 to 4 years
• improved and effective health mainte-
nance and education
• support for medical and administrative
decision-making processes
• improved long-term planning

Researchers

• access to timely, high-quality data for

research
• access to up-to-date research findings,
and treatment and medication options
• data aggregation
• improved trend analysis
(which requires a period of time to learn), or
Governments searching for the appropriate location to record
most pieces of information (which requires
• improved accountability time to search). Training is an important issue
• improved health-resource allocation as this is required by a large amount of the
(Upham, 2004) population. In addition, one should always keep
in mind the fact that the population has different
levels of computer literacy (Upham, 2004). All
THE EHR TODAY the above characteristics of the EHR have
contributed to a slow increase in the adoption of
The barrier to the adoption of the EHR that is such systems in many hospitals. One example
probably the most difficult to overcome is the of an important shift in the EHR market is seen
lack of easily apparent returns on investment in Figure 3, which includes responses to the
(ROI). Many writers on the subject have noted survey question, “What functions or compo-
that healthcare decision makers find it difficult nents of an EHR system do you have in use or
to readily demonstrate ROI or justify the ex- are planned for implementation?” Of the 436
penditure of dollars and time to undertake a who responded to the question, 35.6% said they
comprehensive EHR system within their orga- have already implemented the basic repository
nizations, particularly while healthcare costs capabilities of storing data, text, and reimburse-
continue to spiral out of control and taking into ment codes. Combined with those planning to
consideration the fact that the initial investment add these basic capabilities, the percentage is
on equipment can be quite expensive. Another expected to grow to 67% in the next 4 years. On
factor that complicates the adoption of the top of the fundamentals are plans to add storage
EHR is the fact that data are heavily structured, for clinical codes, voice or sound, and clinical
being recorded in their allocated space. This images.
implies a deep knowledge of the system to The EHR survey also included an analysis
know where to record any piece of information by market segment with some interesting find-

4
Electronic Health Records

Figure 4. Some barriers, by market segment, to implementing EHRs

ings. Figure 4 shows some of the results from such records, we may also expect to find data
the 477 respondents to the question, “What are regarding populations of patients, integrated
the major barriers to your plans for implement- access to the biomedical literature, and interac-
ing an EHR?” tive environments for offering clinical guide-
For example, respondents from ambulatory- lines or frank consultative advice. We can
care facilities indicated that they face more envision a world in which the enterprise LAN
barriers in implementing EHRs than respon- (local area network) is seamlessly connected to
dents from hospitals or integrated delivery net- the full Internet, with integrated access to a
works. In particular, ambulatory-care respon- wide variety of information sources that are
dents reported challenges in finding an afford- geographically distributed well beyond local
able solution, creating a migration plan, finding institutions. Although such a concept raises
a solution that is not fragmented among ven- important issues related to patient privacy and
dors, evaluating solutions, and finding a solution confidentiality, there are technical and policy
that meets their technical requirements (Blair, measures that can be taken to help to assure
2003). that such virtual records are kept secure but
also available at times of medical need.
Realizing the vision described above will
THE EVOLUTION OF THE EHR depend on at least four factors.

Although we should always expect a medical • An Enhanced Internet: An Internet with

record to be populated with data about a spe- much higher bandwidth and reliability, in-
cific patient, in the electronic implementation of creased response time, and financial mod-

5
 Electronic Health Records

els that make the applications cost effec- oping greater intelligence within their sys-
tive and practical is required. Major re- tems to serve this dynamic industry.
search efforts are underway to address
some of these concerns, including the Since the actual realization of EHRs re-
federal Next Generation Internet activity quires full interoperability within and among
in the United States Exploratory efforts healthcare enterprises, total industry adoption
that continue to push the state of the art in is not likely to be achieved within the near
Internet technology, and all have signifi- future (most predict it will be 5 to 10 years).
cant implications for the future of Unlike EHRs, the continuity-of-care record
healthcare delivery in general and for (CCR) is designed to provide a snapshot of
computer-based health records in particu- essential patient information that will enable a
lar. physician to understand a patient’s context and
• Better Education and Training for provide appropriate care. Some of the core
Healthcare Providers: There is a dif- elements of the CCR are document-identifying
ference between computer literacy (fa- information (to and from fields, date sent, pur-
miliarity with computers and their routine pose), patient-identifying information, patient
uses in our society) and the knowledge of insurance and financial information, advance
the role that computing and communica- directives, patient health-status information (may
tions technology can and should play in our include conditions, diagnoses, problems, family
healthcare system. More medical- medical history, adverse reactions and aller-
informatics training programs and the ex- gies, social history and health-risk factors, medi-
pansion of existing programs are needed. cations, immunizations, vital signs and physi-
In addition, junior faculty in health-sci- ological measurements, laboratory results and
ence schools who may wish to seek addi- observations, and procedures and imaging),
tional training in this area should be sup- care documentations, care-plan recommenda-
ported. tions, and a list of healthcare practitioners. The
• Changes in the Management and Or- CCR is gaining momentum across the industry
ganization of Healthcare Institutions: because it will achieve many of the immediate
Healthcare provides some of the most short-term goals and benefits envisioned by
complex organizational structures in soci- HL7 as we continue to define and develop the
ety, and it is simplistic to assume that off- EHR: It may even provide the impetus needed
the-shelf products will be smoothly intro- to stimulate more rapid EHR development. It is
duced into a new institution without major increasingly being viewed as a practical, more
analysis, redesign, and cooperative joint- immediately achievable solution while the in-
development efforts. dustry continues to wait for a defined EHR
• Just Like the Healthcare Industry, (Carpenito, 2004; Golden, 2004; Shortliffe,
Technology Cannot Stand Still: Sys- 1999).
tems must continue to evolve to meet the
industry’s changing needs. While today’s
imaging and work-flow applications are CONCLUSION
excellent for viewing and accessing infor-
mation, healthcare institutions continue to The implementation of EHR systems is not
push for more. Suppliers must keep devel- simple; it concerns not a single system but,

6
Electronic Health Records

rather, a collection of interlocking systems that health informatics: A nursing perspective

are tied to a series of complex clinical and (pp. 250-257). Amsterdam: IOS Press.
administrative work flows. This implementa-
Office of Health & Information Highway Health
tion will involve a long-term, highly coordinated
Canada. (2001). Toward electronic health
commitment from a large number of stakehold-
records. Retrieved from http://www.hc-
ers and a significant financial investment. The
sc.gc.ca
changes required are massive since the EHR-
related initiative is trying to implement a total Schloeffel, P., & Jeselon, P. (2002). ISO/TC
healthcare solution. To this end, projects are 215 ad hoc group report: Standards re-
under way that address part of the puzzle (i.e., quirements for the electronic health record
pharmaceutical systems), others are develop- & discharge/referral plans. Retrieved from
ing application models (emergency health http://www.iso.org
records) on which to base further development,
Shortliffe, E. (1999). The evolution of elec-
and still other projects are using new technol-
tronic medical records. Academic Medicine,
ogy models such as smart cards (Office of
74(4), 414-419.
Health & Information Highway Health Canada,
2001). Upham, R. (2004). The electronic health
record: Will it become a reality? Phoenix
Health Systems. Retrieved from http://
REFERENCES www.hipaadvisory.com
Wang, S., Middleton, B., Prosser, L., Bardon,
Blair, J. (2003). The EHR today. Health care
C., Spurr, C., Carchidi, P., et al. (2003). Aca-
informatics online. Retrieved from http://
demic publication proves that EMRs are cost
www.healthcare-informatics.com/index.htm
effective: A cost-benefit analysis of electronic
Carpenito, L. (2004). A report on the CCR. medical records in primary care. American
Symantec enterprise solutions. Retrieved from Journal of Medicine, 114(5), 397-403.
http://www.symantec.com
Committee of European Normalization, Tech- URL REFERENCES
nical Committee on Medical Informatics (CEN/
TC 251). (n.d.). Medical informatics vocabu- Center for Health Information Technology: http:/
lary working document (PT 011/N 300 /www.centerforhit.org
V.1.00).
Medical Records Institute: http://www.
Daskalaki, A., Lazakidou, A., Philipp, C., Jacob, medrecinst.com/index.asp
C., & Berlien, H. P. (2001). Introducing elec-
NSW Electronic Health Record: http://
tronic health record into laser medicine. Med.
www.nsw.com
Inform., 5, 85-86.
Golden, R. (2004). The evolving electronic
patient record system. Retrieved from http://
KEY TERMS
www.infotivity.com
CCR: The continuity-of-care record is an
Mantas, J. (2002). Electronic health record. In emerging standard for communicating patient
J. Mantas & A. Hasman (Eds.), Textbook in information electronically among providers. The

7
 Electronic Health Records

CCR is intended to provide a snapshot of es- Healthcare Record: Systematic record of

sential patient information, rather than a com- the history of the health of a patient kept by a
plete patient record, that will enable a physi- physician or other healthcare practitioner.
cian to understand a patient’s context and
HL7: A specification for a health-data in-
provide appropriate care. The format of the
terchange standard designed to facilitate the
CCR allows it to be used universally to help
transfer of health data resident on different and
to bridge the gaps between EHR systems and
disparate computer systems in a healthcare
improve the portability of patient information.
setting.
Decision-Support System: Any computer-
LAN (Local Area Network): A system of
based support of medical, managerial, adminis-
connecting computers and computer equipment
trative, and financial decisions in health using
together with physical links that do not use a
knowledge bases and/or reference material.
telecommunications network.
EHR: A healthcare record in computer-
Smart Card: An integrated circuit card that
readable format.
incorporates a processor unit. The processor
EHR System: Information system that may be used for security algorithms, data ac-
manages and operates on the EHR. cess, or for other functions according to the
nature and purpose of the card.

8
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