Why do people want a paper copy of their electronic patient record?

Changes have recently been passed in the Norwegian legislation, allowing for more exchange of patient information between health personnel. These legal changes came as a result of a long and still ongoing debate concerning the potential conflict between confidentiality issues and patient safety as health care is getting more fragmented. At the same time, an increasing number of patients now make use of their legal right to access their patient record. In this paper, we shed light on some of the reasons why patients request a copy of their record. We report the preliminary results from an interview study in which seventeen patients who have asked for a copy of their patient record following a hospital stay have been interviewed. In our interview study, securing transmission of information between health care workers is one of the main reasons for requesting a copy of the record. We will discuss how this finding might contribute to the ongoing debate.

Ghost charts and shadow records: implication for system design.

Ghost charts, sometimes referred to as shadow charts, are duplicate medical records. Governance documents in several countries suggest that ghost charts present a risk to patient safety, to the extent that they contain information which may not appear in an official hospital record. Although most would agree ghost charts should not exist, their existence is widespread. This paper reports on an in depth multi-method qualitative study of ghost charts undertaken in two ambulatory care settings in a Canadian hospital. The study was undertaken in order to inform the design and implementation of a clinical information system which it is hoped will eliminate the need for duplicate charts. Our research demonstrated that ghost charts filled a variety of needs only some of which are typically accounted for in electronic record design. We suggest that if the functions ghost charts fill are not addressed, their existence will persist. This work is significant in that few studies of ghost charts have been undertaken, and in the in-depth understanding it contributes to design requirements for electronic record systems.

Where have all the copy letters gone? A review of current practice in professional-patient correspondence.

OBJECTIVE: This article reviews the literature in relation to patients receiving copies of health professional correspondence. It examines progress in adopting the practice 3 years on from its introduction as policy in the UK, and considers potential benefits and obstacles to implementation. METHODS: A review of the literature on copy correspondence, accessed via Medline, PubMed, CINAHL and also online resources, using the search terms "patient letter", "copy letter", "copy correspondence" and "doctor letter". RESULTS: Studies describe a range of benefits from copying letters, but implementation remains inconsistent, ranging from 8 to 87% of patients reporting receiving copy correspondence. A number of concerns are identified which may be delaying whole scale adoption of the policy by health professionals. CONCLUSION: This review suggests that researchers should move from examining the benefits and concerns around copying letters to patients, and instead focus on exploring the quality of correspondence and the optimum process of implementing the practice. As patients can "opt out" of receiving copy correspondence, audit of service delivery may be better assessed by whether patients have been offered a letter, rather than the current measure of whether one has been received. PRACTICE IMPLICATIONS: Copying letters to patients may have a number of important benefits and should be routine practice where patients wish to receive correspondence. Further discussion regarding the style and content of letters would be beneficial, together with attention paid to the mechanisms for recording patient preference. There is also a need for studies in non-medical professions.

Obtaining journal reprints: the 'dos' and 'don'ts'.

In a search for knowledge, and to expand their own work, scientists and academicians have depended on the work of colleagues with similar interests. While attending conferences enables one to acquire useful knowledge, the information so gained is unlikely to be lasting. Furthermore, many persons learn better by reading than by listening, and reading can be done at one's own convenience. These and many other reasons account for the increasing number of reprints requested by researchers, and in medicine, by practicing clinicians.

Development of a high quality film duplication system using a laser digitizer: comparison with computed radiography.

A high quality film-duplication system was developed in order to improve the image quality of duplicated radiographs and to recover improperly exposed films. The system consists of a laser film digitizer, a laser film printer, a workstation, and a magneto-optical disk. Radiographs are digitized by the laser digitizer, processed by the computer for image enhancement, and then printed on a film by the laser printer. A nonlinear density-correction technique is employed in recovering improperly exposed radiographs using the H&D curve of the screen-film system. Using the new duplication system in our department, the average recovery rate was over 80% for chest and abdominal films rejected due to over- or underexposed. The basic imaging properties of the duplication system were compared with those of a Computed Radiography (CR) system and a conventional screen-film system. For low spatial frequencies, the MTF of the CR system is superior to that of the digital duplication system; however, for high spatial frequencies, the MTF of the duplication system is superior. The noise in the duplication system is about half of that in the CR system.