Consultation of Medical Narratives in the

Electronic Medical Record

By :
Daniel Priya Jatmika (31210003)
Ervina Damayanti (31210005)
Veronica Ayuningtyas (31210012)
● Journal tittle : Consultation of Medical Narratives in the
Electronic Medical Record
● Juornal writer : H. J. Tange
● Publication : Department of Medical Informatics,
Maastricht University, The Netherlands
 ABSTRACT
● This article presents an overview of a research project concerning the
consultation of medical narratives in the electronic medical record
(EMR). It describes an analysis of user needs, the design and
implementation of a prototype EMR system, and the evaluation of the
ease of consultation of medical narratives when using this system. In a
questionnaire survey, 85 hospital physicians judged the quality of their
paper-based medical record with respect to data entry, information
retrieval and some other aspects.
 1. Introduction
● The primary purpose of the medical record is to supply
information for daily medical practice. At present, it
increasingly serves as a communication tool used by a
variety of healthcare providers. This new functionality places
more requirements on the format and content of the medical
record.
 EMR ( Electronic Medical Record )
● A concise survey of terms and their
definitions is given by the Medical
Records Institute (USA), which
proposed the following definition: “An
Electronic Medical Record is a
repository of clinical data within one
single healthcare enterprise that is
characterized by direct data entry and
integration from different sources”
● One of the impediments for the
development and distribution of EMR
systems is the inability of existing
systems to incorporate physician
gathered medical narratives
satisfactorily
2. User needs: Why the Paper Medical Record is still Appreciated

● as a provider of management information,

● as a source for research, or for other secondary purposes,
● the advantages of electronic medical-records systems are
unques- tionable.
3. Prototype EMR System: Design Considerations and Implementation

For the design of the system we addressed two architectural problems:

● 1. The granularity of medical narratives
● 2. The organization of medical narratives
 3.1 Organization of Medical Narratives
One of the advantages of an EMR is that it can
present the same medical data in different
arrangements. In the problem-oriented flowsheet
the segments are organized according to the
problem they are relevant.

3.2 Granularity of Medical Narratives

The Maastricht prototype EMR system to
present ‘medical history’ at three different
levels of granularity – all oc-curring among
existing EMR systems :
• undivided (level 1),
• divided into segments describing organ
systems(level 2),
• and divided into segments containing the
patient’s answers to distinct questions (level
3).
3.3 Technical Specifications of the Prototype EMR System
The Maastricht prototype EMR system was developed in Visual Basic
3.0TM, under MS-Windows 3.11TM. Segment labels and the organization
of segments were specified in a Btrieve 5.0TM database in which also the
patient data were stored. Medical narratives were stored as free text.
Advanced text-processing functions to facilitate searching were not
available.
● 4. Evaluating the Ease of Consultasion of Medical Narratives

● The method to investigate the effect of the granularity of medical

narratives on the ease of consultation, can be done by measuring
3 aspects of the search, namely: speed, completeness and
appreciation.

● The granularity of medical narratives does affect the speed and

accuracy in finding information.
 5. Discussion
○ This project aims to implement the requirements of the
ESDM system in the future, namely to realize the
advancement of human resources. From this study it can
be concluded that EMR can speed up medical record
consultations.
THANKYOU