10 Chapter 1 Implementations of potentially transformative eHealth technologies are currently underway internationally, often with significant impact on national expenditure. 1 2 Such large-scale efforts and expenditures have been justified on the grounds that picture archiving and communication systems (PACS), electronic prescribing (ePrescribing) and associated computerized provider (or physician) order entry systems (CPOE), and computerized decision support systems (CDSS) are supposed to help to address the problems of variable quality and safety in modern health care. 3 However, the scientific basis of such claims, which are repeatedly made, remains to be firmly established. 2,4–7 This thesis has the objective to contribute to the scientific discourse on the relationship between the digitalization of hospital care and quality and safety of such care by exploring the experience in one European country with fairly advanced EMR capabilities: The Netherlands. The hypothesis to be tested is: advanced electronic medical record (EMR) capabilities are positively associated with quality and safety of hospital care. While electronic medical records (EMRs) and electronic health records (EHRs) are used interchangeably, there is a difference between the two terms. EMRs are the digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. However, EHRs focus on the total health of the patient-going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. This thesis focuses on the EMR i.e. the legal record created in medical centers and ambulatory environments. To measure the capabilities of EMRs in Dutch hospitals a specially developed maturity model, the socalled Electronic Medical Record Adoption Model, the EMRAM, is used. The Electronic Medical Record Systems The Electronic Medical Record (System) is an application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications.8 This environment supports the patients electronic medical record across inpatient and outpatient environments, and is used by healthcare practitioners to document, monitor, andmanage health care delivery within a care delivery organization (CDO). The data in the EMR is the record of what happened to the patient during their encounter at the CDO and is owned by the CDO. The EMR environment is a complex and sophisticated environment. Its foundation is the clinical data repository (CDR), a realtime transaction processing database of patient clinical information for practitioners.
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