Medical Care and Health

EHR Database and Data Management

Database Management Approach

The issue to address is the negative effects of drugs. Adverse reaction to drugs is "a significantly unpleasant or dangerous response caused by an intervention that is linked with using some kind of medicine, which predicts danger from future usage and assures prevention or a particular kind of treatment, a dosage regimen modification, or withdrawing from the drug" (Edwards & Aronson, 2000).

Description of the patient problem

ADRs (Adverse Drug Reaction) are among the top mortality and morbidity causes in medical care. On January 2000, the Medicine Institute stated that between 44,000 and 98,000 mortalities take place each year due to health care errors (Committee on Quality of Health Care in America (Institute of Medicine), 2000). ADRs caused around 7000 mortalities out of the stated total. Keep in mind that in America, job related injuries cause around 6000 annual mortalities. The next question to ask should be, how much does it cost medical care due to such negative reactions to drugs? Again, there are methodological constraints that make it difficult for estimates to be completely accurate. However, one annual cost estimate with regard to drug-caused mortality and morbidity is $136 billion, which amounts to more than USA's diabetic and cardiovascular care costs combined. Furthermore, a fifth of the annual mortalities and injuries among patients who have been hospitalized are likely to be due to negative reactions to drugs. In conclusion, there is twice the average time of stay, mortality rate and expenses among hospitalized patients afflicted with negative reactions to drugs, in comparison to those without ADRs within a control patient group. Current publications indicate that several ADRs are detectible and preventable by means of systems help. For instance, several medical systems have established new technologies for ensuring minimal patient injury caused by interactions of drugs and health care errors. Tools such as computerized prescription entry and doctor order as well as systems for bar coding have brought about significant benefits. It has been acknowledged that there is great potential for reducing medication errors through computerized health records and software for medicine-interaction screening that informs pharmacists and doctors of severe medicine interactions (FDA.gov, 2016).

Management: The Electronic Health Record (EHR).

The record should indicate the history of a patient's medical condition, and other medical care providers should be able to access it in order to be aware of the health problems or concerns of a patient. The records of every patient, whether or not they have been seen, need to include a significant and focused medical history, a documented evaluation and a suitable focused physical diagnosis; if it is indicated, with a provisional exam; also if indicated as well as, a management strategy (CPSO, 2012). Thus, this information includes:

• Identification details of the patient (name, contact number, OHIP (?) number, address); Comment by GL: Full name

• Personal information and family details (job, habits, life events, family health history);

• Previous medical history (previous critical illnesses, surgeries, genetic history, accidents);

• Risk aspects;

• Drug reactions and allergies;

• Current medical conditions (diagnoses, problems, onset date);

• Health protection (yearly diagnoses, vaccinations, disease monitoring, e.g., bone density, colonoscopy, mammogram);

• Names of consultants;

• Long-term health care (current drugs, frequency, dosage);

• Major exams;

• Emergency contact.

These details should be filled out the first time or second time a medical care provider meets a patient, and it should be seen clearly in the record of the patient for easy reference and access. Nonetheless, doctors should start to keep patient CPPs (?) in a practice that exists, even in places where this practice is new. Many EMRs (Electronic Medical Records) will routinely compile patient details in CPPs while it is put down on other parts of the patients' records. Comment by GL: Full name

Doctors need to read through the CPP contents during every consultation and reread the details subsequently. This is similarly significant for doctors that use EMRs. Frequent rereading and review is especially significant where doctors need to forward the details to such third parties as ERs, health consultants, insurance companies as well as lawyers. In such cases, doctors need to make sure they forward up-to-date and accurate details (CPSO, 2012).

Other details that are normally indicated in EHRs for hospitalized patients are;

They can be recognized by those patients who might have experienced ADE (?) within 24-hour surveillance of signals by patients." These signals, which are regularly put down in health records, show the possibility that there may have been an ADE: Comment by GL: Full-form, please

• Change in heart rate, hearing, breathing rate, or mental condition.

• Specific lab results, low or high levels of blood of specific, wrong drug dosage for a patient's weight or age as well as chemist's medical recommendations for treating an allergic reaction.

A virtual alert system installed in a regional Heath Centre known as Good Samaritan was meant for identifying and informing medical care provider of ADEs and errors in prescription. Details included in the database are the patient's lab results, radiology orders, pharmacy orders, medicine allergies, as well as demographic factors (Raschke, Collihare, & Wunderlich, 1998).

EHR-Supplied Data: Structured or Unstructured

The easiest data type to identify and classify within a computer database is structured data. A class of this kind of data, accounting data, entails numerals in a specified value, entered in a specific column. The use of structured type of data in medical care would involve patient demographic and lab value information, which is entered using a radio button or drop box. This kind of data is unswerving and is used in pre-defined parts of a record.

Unstructured data, on the other hand, is unorganized. It may also be vague and full of errors, and usually, 'text-heavy'. Health IT, a type of this form of data, includes a paragraph on the patient's illness history. The doctors' evaluations and patients' complaints are difficult to compress into a sequence of radio buttons as well as checkboxes, while it is greatly important that patient details are evaluated without the trouble of free text management. It is important to find out pertinent details regarding a heart procedure indicated on the doctor's note. This should be regardless of whether or not the information was put down on the structured information of the list of problems.

Most of the information that is given by EHR about ADR is in unstructured form. The details included are:

• Patient identification details (name, contact number, OHIP number, address);

This information is used in identifying a patient. Matching the patient to the intended medication is a routine every health care setting follows. Safety hazards for patients take place when the patient is matched with the wrong treatment, whether supportive, therapeutic or diagnostic care. The data is well structured within the EHR.

• Medical History

This data is slightly structured since it has a lot of text, which is difficult to fill out or collect from check boxes.

• Risk aspects;

• Medicine reactions or allergies;

It is structured and easy to select. There are numerous electronic health platforms for cataloging such details. Since this data is easy to select, it can be easily put down on EHR.

• Current health conditions (diagnoses, problems, onset date);

This data takes both unstructured and structured form. It takes the structured form when existing problems can be selected from a record and used in determining appropriate prescription. the unstructured form appears when the future state is difficult to list and describe.

• Health maintenance (yearly diagnoses, vaccinations, disease monitoring such as bone density, mammogram, colonoscopy);

Most information is given numerically; making it easy to manage and determine.

• Names of consultants; long-term treatment (current drugs, frequency, dosage; Major exams; Emergency contact.

The name of the consultant has few characters, which makes it structured. Information on long-term treatment takes both the unstructured and structured form. Current drugs information is structured; it indicates the patient's current treatment, which is easy to determine and review in a record. The information on dosage shows the method/procedure of ingesting the prescribed drugs, as well as the frequency. This can be picked out from a record. The details entail the method, timing, and how many times to take the drug in a day. Emergency contact details have the same structure and method of handling as the consultant's name.