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The benefits and risks of structuring and coding of patient histories in the electronic clinical record: protocol for a systematic review.

Byrne, E; Fernando, B; Kalra, D; Sheikh, A; (2010) The benefits and risks of structuring and coding of patient histories in the electronic clinical record: protocol for a systematic review. Inform Prim Care , 18 (3) 197 - 203.

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Abstract

Data in medical records have in part been recorded in structured and coded forms for some decades. However, the patient history is as yet largely recorded in an uncoded format. There is a need to consider the optimal balance of use of free text and coded data in the patient history. This review protocol summarises our plans to identify, critically appraise and synthesise evidence relating to approaches taken to introduce structure and coding within patient histories in electronic health records, and the empirically demonstrated benefits and risks of structuring and coding of patient histories in health records.

Type:Article
Title:The benefits and risks of structuring and coding of patient histories in the electronic clinical record: protocol for a systematic review.
Location:England
Language:English
Keywords:Humans, Information Storage and Retrieval, Medical Records Systems, Computerized, Risk Assessment
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > CHIME

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