[edit] Ideal characteristics of an electronic health record (EHR)

-Information should be able to be continuously updated.
-The data from an electronic health records system should be able to be used anonymously for statistical reporting for purposes of quality improvement, outcome reporting, resource management, and public health communicable disease surveillance.[16]
-The ability to exchange records between different electronic health records systems ("interoperability"[17]) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities.

Advantages of electronic medical records over paper records

A medical record includes any of an individual's health documents of the types listed above. Medical records may be on "physical" media such as film (X-rays), paper (notes), or photographs, often of different sizes and shapes. Physical storage of documents is problematic, as not all document types fit in the same size folders or storage spaces. In the current global medical environment, patients are shopping for their procedures. Many international patients travel to US cities with academic research centers for specialty treatment or to pariticiate in Clinical Trials. Coordinating these appointments via paper records is a time-consuming procedure and may violate the patient's HIPAA privacy.

Physical records usually require significant amounts of space to store them. When physical records are no longer maintained, the large amounts of storage space are no longer required. Paper, film, and other expensive physical media usage (and therefore cost) is also reduced with electronic record storage.

When paper records are stored in different locations, furthermore, collecting and transporting them to a single location for review by a healthcare provider is time-consuming. When paper (or other types of) records are required in multiple locations, copying, faxing, and transporting costs are significant, as are the concerns of HIPAA compliance.

In 2004, an estimate was made that 1 in 7 hospitalizations occurred when medical records were not available. Additionally, 1 in 5 lab tests were repeated because results were not available at the point of care. Electronic medical records are estimated to improve efficiency by 6% per year, and the monthly cost of an EMR is offset by the cost of only a few unnecessary tests or admissions.[5][6]

Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors.[7] Pre-printed forms, the standardization of abbreviations, and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records help with the standardization of forms, terminology and abbreviations, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies.

Electronic records keeping and order entry were found to reduce errors associated with handwritten documents and were recommended for widespread adoption.[1][8]

Types of data stored in an electronic medical record

An electronic medical record might include:

-Patient demographics.
-Medical history, examination and progress reports of health and illnesses.
-Medicine and allergy lists, and immunization status.
-Laboratory test results.
-Radiology images (X-rays, CTs, MRIs, etc.)
-Photographs, from endoscopy or laparoscopy or clinical photographs.
-Medication information, including side-effects and interactions.
-Evidence-based recommendations for specific medical conditions
-A record of appointments and other reminders.
-Billing records.
-Advanced directives, living wills, and health powers of attorney

Electronic health record

An electronic health record (EHR) refers to an individual patient's medical record in digital format. Electronic health record systems co-ordinate the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed on a computer, often over a network. It may be made up of electronic medical records (EMRs) from many locations and/or sources. A variety of types of healthcare-related information may be stored and accessed in this way.

EHR systems can reduce medical errors. In one ambulatory healthcare study, however, there was no difference in 14 measures, improvement in 2 outcome measures, and worse outcome on 1 measure.

EHR systems are believed to increase physician efficiency and reduce costs, as well as promote standardization of care. Even though EMR systems with computerized provider order entry (CPOE) have existed for more than 30 years, less than 10 percent of hospitals as of 2006 have a fully integrated system.

Electronic Records

It's estimated that more than 90% of the records being created today are electronic. Coupled with the overwhelming growth of electronic messages - most notably e-mail and instant messaging - the management of electronic records has become a critical business issue. How that information is managed has significant business, legal, and technology ramifications. Ultimately, it doesn't matter what medium is used to create, deliver, or store information when determining if content is a record and should be managed accordingly. Read articles on e-mail management, electronic discovery and metadata.

Special (other) Archives

Some archives defy categorization.

There are tribal archives within the Native American nations in North America, and there are archives that exist within the papers of private individuals.

Many museums keep archives in order to prove the provenance of their pieces. Any institution or persons wishing to keep their significant papers in an organized fashion that employs the most basic principles of archival science may have an archive.

Non-Profit Archives

Non-profit archives include those in historical societies, not-for-profit businesses such as hospitals, and the repositories within foundations.

Non-profit archives are typically set up with private funds from donors to preserve the papers and history of specific persons or places.

Depending on the funds available, non-profit archives may be as small as the historical society in a rural town to as big as a state historical society that rivals a government archives.

Government Archives

The category of government archives includes those institutions run on a local and state level as well as those run by the national (federal) government.

Anyone may use a government archive, and frequent users include reporters, genealogists, writers, historians, students, and anyone wanting more information on the history of their home or region.

While it is a good idea to make an appointment before visiting government archives, at many government archives no appointment is required, as they are open to the public.

Business (For Profit) Archives

Archives located in for-profit institutions are usually those owned by a private business.

Examples of prominent business archives in the United States include Coca-Cola (which also owns the separate museum World of Coca-Cola), Proctor and Gamble, Motorola Heritage Services and Archives, and Levi Strauss & Co..

These corporate archives maintain historic documents and items related to the history of their companies.

Business archives serve the purpose of helping their corporations maintain control over their brand by retaining memories of the company's past.

These archives are typically not open to the public and only used by workers of the owner company, although some will allow approved visitors by appointment.

Academic Archives

Archives existing in colleges, universities, or other educational facilities are usually grouped as academic archives. Academic archives typically exist within a library, and duties may be carried out by an archivist or a librarian.

Academic archives exist to celebrate and preserve the history of their school and academic community.

The inventory of an academic archive may contain items such as papers of former professors and presidents, memorabilia related to school organizations and activities, and items the academic library wishes to remain in a closed-stack setting, such as rare books or thesis copies.

It is always a good idea to contact an academic archive before visiting, as the majority of these institutions are available by appointment only.

Many academic archives work closely with alumni relations to help raise funds for their library or school.

Types of Archival Institutions

There are several types of Archival Institutions:
-Academic Archives
-Business (For Profit) Archives
-Government Archives
-Non-Profit Archives
-Special (other) Archives

The Roles of Archival Institutions

The fundamental archival roles and responsibilities are more important than ever. The roles or Archival Institutions are:

-Manage cost-effective of archival programs for the selection, retention, and use of both electronic and paper documentary materials.
-Ensure that an authentic and reliable record is created and available for use.
-Evaluate the universe of available documents and record-keeping systems to select those to preserve for future use.
-Preserve and document the context and arrangement of the materials retained for long-term use.
-Provide descriptive tools, such as registers, indices, and databases, to allow records-keepers, researchers, archivists, and others to locate and identify the information and evidence in archival holdings.
-Preserve information and evidence in a protective environment and in a format or media that will remain usable over time.
-Promote and help people use archives to explain the past, support accountability for the present, and provide guidance for the future.

Qualities and Characteristics of Records With Intrinsic Value

All record materials having intrinsic value possess one or more of the following specific qualities or characteristics. These qualities or characteristics relate to the physical nature of the records, their prospective uses, and the information they contain:

-Provide meaningful documentation or significant examples
-Documents may be preserved in their original form as evidence of technological development.
-For instance, a series of early press copies, glass-plate negatives, or sound recordings may be retained.
-All records having a particular physical form would not be considered to have intrinsic value because of this characteristic; however, a selection broad enough to provide evidence of technological development would be considered to have some value. 

-Aesthetic or artistic quality
Records having aesthetic or artistic quality may include photographs; pencil, ink, or watercolor sketches; maps; architectural drawings; and printed forms, such as bounty-land warrants.

-Unique or curious physical features
Physical features that are unique or curious might include quality and texture of paper, color, wax seals, imprints and watermarks, inks, and unusual bindings.
All records having a particular physical feature would not be considered to have intrinsic value because of this feature; however, an exemplary selection of each type would be considered to have such value.

-Age that provides a quality of uniqueness
Age is a relative rather than an absolute quality.
Generally, records of earlier date are of more significance than records of later date.

-This can be because of a historical change in the functions and activities of the creator of the records, the scarcity of earlier records, a change in recordkeeping practices, or a combination of these.
-Age can be a factor even with comparatively recent records. The earliest records concerning, for example, the development of the radio industry or of nuclear power could have intrinsic value because of age.

Value for use in exhibits
Records used frequently for exhibits normally have several qualities and characteristics that give them intrinsic value.

Records with exhibit value impressively convey the immediacy of an event, depict a significant issue, or impart a sense of the person who is the subject or originator of the record. In these cases, the impact of the original document cannot be equaled by a copy.

General and substantial public interest because of direct association with famous or historically significant people, places, things, issues, or events
This criterion is not only the most difficult to apply, but also the most important in terms of the volume of records to which it could be applied.

It could be used to justify preserving in original form almost all permanently valuable records because of their historical importance.

Archival judgment is the crucial factor in determining whether there is general and substantial public interest, whether the association is direct, and whether the subject is famous or historically significant.

Generally, those series with a high concentration of such information should be preserved.

Value of Archival Materials

The term "intrinsic value" has long been used by archivists to describe historical materials that should be retained in their original form rather than as copies.

Intrinsic value is the archival term that is applied to permanently valuable records that have qualities and characteristics that make the records in their original physical form the only archivally acceptable form for preservation.

Although all records in their original physical form have qualities and characteristics that would not be preserved in copies, records with intrinsic value have them to such a significant degree that the originals must be saved.

The qualities or characteristics that determine intrinsic value may be physical or intellectual; that is, they may relate to the physical base of the record and the means by which information is recorded on it or they may relate to the information contained in the record.

Records with intrinsic value may be retained for either their evidential or informational value.

Types of Archival Materials

The Archives houses and services to the public the following materials, which do not circulate and must be used in the Archives Reading Room during regular service hours.

The archival materials can be divided into two categories;

1.Archives of an Individuals
eg: letters, papers, photographs, computer files, scrapbooks, financial records, diaries or any other kind of documentary materials

2.Archives of an Organizations
administrative files, business records, memos, official correspondence, meeting minutes,

There are several types of archival materials;
-Records (in the form of paper)
-Electronic Records
-Photograph Collection
-Map Collection
-Newspaper Cutting
-Audio Records
-Video Records

Characteristics of Archival Materials

Those listed below are most frequently encountered during the examination of a collection.  These characteristics in turn directly influence descriptive practices.

Below are the characteristics Of archival materials;

-Items generated in context of an activity 
-Documents are created or compiled as a result of some activity or function; as such, they are the evidence of the activities of individuals or corporate bodies. 

For example,
-individuals often keep receipts to document expenses over the course of a year for income tax purposes.  
-Department stores maintain inventory records to document what has been bought and sold. 
-In both cases, the documents preserved reflect activity.


Groups of items related to one another
Archival materials exist as groups of related items.  Unlike museum curators and librarians, archivists view their collections not as individual items but rather as groups of documents.   

While an individual item may be significant in and of itself, it is generally grouped together with other documents created by the same activity. 

Consider, for instance, documents generated in the course of buying a house. These may include a title to the property, loan papers,  correspondence, inspection papers, and survey documents.

Instead of focusing on each individual document, the archivist views such a group of documents as a record of the sales transaction.

Documents that are arranged in accordance with a filing system or maintained as a unit because they result from the same activity or accumulation or filing process, or because they have a particular form, or some other relationship arising out of their creation, receipt, or use are called series.  

Varied content: collection contain information about topics, events, activities, or people
Because  materials in archival collections are evidence of the entire range of personal and institutional activities and functions, the information contained in them is diverse. 

For example, among the personal papers of an individual there may be groups of documents created as the result of religious, professional, and a vocational activities. 

These papers may contain information about a particular church and its members, the accomplishments of committees on which the individual served, professional projects undertaken here and abroad, and papers and artifacts related to hobbies from bungee jumping to stamp collecting. 

Content analysis is conducted to extract this varied information so that it can be brought to the attention of the user.  The more varied the information in the collection, the more extensive the analysis.

Varied formats: collection may be of many formats and types  
A collection might consist primarily of  material of one type, such as letters, or it may contain a mixture of material types such as computer files, photographs, maps, and textual records. 

For Instance, A collection of documents relating to a wedding, for instance, may contain a marriage license, catering bills, invitations, registration books, photographs, and a video recording of the marriage ceremony and reception.

Different formats and types of materials may require different descriptive practices and therefore use different descriptive standards.

Consist of large numbers of items
Archival collections often consist of hundreds and even thousands of individual items. The larger the collection, and the more varied its content and  material types, the greater the potential for complex internal relationships.

It is neither efficient nor necessary to describe each individual item in a collection. 

Instead, summary descriptions are written to represent and convey the primary content of the collection to the user.

Most collections lack any formal means of identification
Unlike books and other published materials, items in archival collections usually lack title pages or imprint information to identify that particular collection or group of documents. 

Archivists provide identifying information for collections. Because there is no formal identification, archivists extract, compile, and extrapolate information from the collection rather than transcribe information from a standardized source, such as a title page.

Receiving Archival Materials

Materials arriving from sources within the public sector should be prepared by the records centre or transferring agency in accordance with current standards.

If materials are coming from the records centre, the following preparatory work should be done on them by Record Centre staff:
-Appraisal and selection for transfer according to the disposal schedule
-Cleaning and tidying
-Removal of ferrous pins, clips, staples, treasury tags, and so on, which might rust and damage the records, and their replacement by plastic or a non-ferrous metal such as brass
-Insertion of dummies to replace materials that have been selected for transfer but are missing or have been lawfully retained by the transferring agency

Dummy: A card, sheet or other indicator placed on or near the place where an item is normally stored to denote its removal.

-Labelling items with necessary identifying information (labelling is discussed in more detail later)
-Boxing
-Listing (at least a summary list, giving the original agency file number and title and the covering dates)
-Completion of the relevant parts of the accessions form.

The records centre supervisor should send the summary list, transfer list and accessions form to the repository ahead of the records and arrange a convenient date for delivery.

-As soon as any archives arrive at the archival institution, repository staff should take the following action:
-Check the archives for signs of insect infestation or mould, and notify preservation department if they need treatment before coming into contact with other, unaffected, accessions
-Check that the archives are properly labelled
-Place the records in a secure temporary storage area set aside for new accessions
-Check the records against the accessions form, transfer list or summary list to make sure that the paperwork does refer to these materials and that all items have been included
-Open an accessions form, if one has not already been opened, and obtain a signature from a representative of the agency sending the archives
-Make an entry in the accessions register identifying the new accession
-Acknowledge receipt of the accession so that the transferring agency has a record of the transfer.

MANAGING THE REFERENCE AREA

The reference area, often called the search room, is a controlled sector within the institution in which users can consult archival materials in an atmosphere conducive to study.

Search room: The area in an archival repository open to users for the consultation of archives and the finding aids that relate to them. Also known as a reading room.
When researchers arrive at the archival institution, there should be clear signs directing them to the search room.
Directions not only put them at their ease but also help prevent their straying into restricted, ‘staff only’ areas.

The reference area should have the following features:
-The entrance door should be clearly labeled.
-Opening times should be shown on or near the entrance door.
-Reference staff should have their own desks, marked with labels such as ‘Search Room Officer on Duty’ or ‘Enquiries
-The room should be clean, tidy and un-crowded, with furniture arranged so that staff can supervise the research area from a single point.
Silence should be maintained by both researchers and staff. If possible, a separate reference area should be used for meetings or interviews.
-The location of lists and finding aids, including reference books, should be clearly marked.
-Archival documents should not be left in the research area, nor should they be left unattended on desks in the search room.
-If researchers have to leave the room they should advise the staff of their absence and ask them to watch the documents or return them to the document issue area for safekeeping.
-The area where requests for documents are submitted and the documents themselves are issued to and returned by researchers should be clearly marked

PRINCIPLES OF ARRANGEMENT/ RESPECT DES FONDS

Arrangement: The whole process of analyzing the organization of sets of archives, whereby their provenance and original order are understood and the archives are set into groups, series and items in an order that preserves and reflects that understanding.
The arrangement of archives is governed by the key principle of respect des fonds. Originally a French term, respect des fonds is often defined simply as ‘respect for the creator of the records.’
The principle of respect des fonds consists of two related concepts:
1. Provenance
2. Original order.

Provenance refers to the ‘office of origin’ of the materials;
The organization or individual that created or received, maintained and used records while they were still current.
Original order refers to the order and organisation in which the documents were created or stored by that office of origin.

Respect des fonds that need to be followed by the archivist to manage the records:
Do not combine the archives of two agencies or organizations.
Similarly, the private archives of different individuals must not be integrated, even if the individuals were related or experienced the same events.

-Do not rearrange archives that show a discernible original order.
-In particular, materials must not be ordered by subject, date or medium of material if that was not how they were organized when created.
-Identify levels of archives according to the hierarchical levels of arrangement used in archival work.
Group -> Sub-group -> Series -> File -> Items