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The elements of electronic note style.
Payne TH, Hirschmann JV, Helbig S.
University of Washington, USA. tpayne@u.washington.ed
MeSH Terms:
- Data Display*
- Guidelines
- Medical Records Department, Hospital/organization &
administration*
- Medical Records Systems, Computerized/standards*
- User-Computer Interface*
- Washington
- Writing
PMID: 12600176 [PubMed - indexed for MEDLINE]
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Implementation and integration of regional health
care data networks in the Hellenic National Health Service.
Lampsas P, Vidalis I, Papanikolaou C, Vagelatos A.
Computer and Communications Engineering Department, University of
Thessaly, Volos, Greece. plampsas@uth.gr
BACKGROUND: Modern health care is provided with close cooperation among
many different institutions and professionals, using their specialized
expertise in a common effort to deliver best-quality and, at the same
time, cost-effective services. Within this context of the growing need
for information exchange, the demand for realization of data networks
interconnecting various health care institutions at a regional level, as
well as a national level, has become a practical necessity. OBJECTIVES:
To present the technical solution that is under consideration for
implementing and interconnecting regional health care data networks in
the Hellenic National Health System. METHODS: The most critical
requirements for deploying such a regional health care data network were
identified as: fast implementation, security, quality of service,
availability, performance, and technical support. RESULTS: The solution
proposed is the use of proper virtual private network technologies for
implementing functionally-interconnected regional health care data
networks. CONCLUSIONS: The regional health care data network is
considered to be a critical infrastructure for further development and
penetration of information and communication technologies in the
Hellenic National Health System. Therefore, a technical approach was
planned, in order to have a fast cost-effective implementation,
conforming to certain specifications.
MeSH Terms:
- Computer Communication Networks*/economics
- Computer Communication Networks*/organization & administration
- Computer Security/economics
- Computer Security/manpower
- Computer Systems/economics
- Computer Systems/supply & distribution
- Databases*/economics
- Databases*/manpower
- Databases*/organization & administration
- Europe
- Greece
- Human
- Information Systems/economics
- Information Systems/manpower
- Information Systems/organization & administration
- Medical Informatics/economics
- Medical Informatics/manpower
- Medical Informatics/organization & administration
- National Health Programs*/economics
- National Health Programs*/organization & administration
- Private Sector/economics
- Private Sector/manpower
- Private Sector/organization & administration
- Regional Medical Programs*/economics
- Regional Medical Programs*/manpower
- Regional Medical Programs*/organization & administration
PMID: 12554551 [PubMed - indexed for MEDLINE]
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Integrated regional services: are working process
changes desirable and achievable?
Harno K, Gronhagen-Riska C, Pohjonen H, Kinnunen J, Kekomaki M.
Department of Medicine, Hospital District of Helsinki and Uusimaa,
Helsinki University Central Hospital, Helsinki, Finland.
In the hospital district of Helsinki and Uusimaa, 32 municipalities with
one or more health centres provide primary care to their residents.
Legal and organizational barriers between primary care and hospital care
impede the continuity of patient care. Integrating primary and secondary
care with the aid of information technology may facilitate a virtual
electronic patient record, in which the viewing of images and other
patient data is possible regardless of the organization that produced
them. For example, in one trial, diabetic patients sent their home blood
glucose measurements by modem to their health centre. Preliminary
observations suggest that they could increase their glucose testing
largely because they were able to transmit the results to the database
and receive teleconsultations. Also, a picture archiving and
communication system (PACS) has been in operation in two clinics of the
Helsinki University Central Hospital for over two years and seven
hospitals had become filmless by the end of 2001. A regional PACS is
planned to be completed by the year 2004.
PMID: 12537896 [PubMed - as supplied by publisher]
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Virtual records. Using an Internet based system to
manage patient records.
Nelson S, Lang G.
MeSH Terms:
- Human
- Internet*
- Kidney Failure, Chronic/therapy
- Medical Records Systems, Computerized*
- Nephrology/trends
- Practice Management, Medical*
- Renal Dialysis
- User-Computer Interface
PMID: 12452112 [PubMed - indexed for MEDLINE]
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Evolution: CIOs seeking smaller, mobile hardware.
Gillespie G.
MeSH Terms:
- Computer Peripherals/standards
- Computer Peripherals/trends
- Computers/standards*
- Computers/trends
- Decision Making, Organizational*
- Hospital Information Systems/standards*
- Hospital Information Systems/trends
- Medical Records Systems, Computerized
- Ohio
- Software/standards
- Software/trends
- United States
- User-Computer Interface
PMID: 12141053 [PubMed - indexed for MEDLINE]
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Data interface bridges the gap between hospital and
physicians.
[No authors listed]
MeSH Terms:
- Efficiency, Organizational
- Hospital Information Systems/organization & administration*
- Hospital-Physician Relations*
- Human
- Louisiana
- Medical Record Linkage*
- Organizational Affiliation
- Practice Management, Medical*
- User-Computer Interface*
PMID: 12138507 [PubMed - indexed for MEDLINE]
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Hospital records anytime, anywhere.
Terry K.
MeSH Terms:
- Computer Communication Networks*
- Confidentiality
- Hospital Information Systems*
- Medical Record Linkage
- Medical Records Systems, Computerized/organization &
administration*
- Practice Management, Medical/organization & administration*
- Systems Integration*
- United States
PMID: 12038276 [PubMed - indexed for MEDLINE]
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A study of the medical record interface to natural
language processing.
Takemura T, Ashida N.
Department of Medical Technology, Graduate School of Medicine, Osaka
University, Suita, Japan. takemura@sahs.med.osaka-u.ac.jp
The information about a patient tends to be handled more on a computer
system. However, it is not sufficiently rational enough because of the
fundamental difference between man and a computer. Up to now, man has
treated information using a natural language. Therefore, if it can be
applied to handle medical information electrically, that will become
more rational. For this reason, we developed a new classification method
that interfaces a computer with the human being, using a natural
language. This method was named as a situation-oriented medical record,
and this depicts changes in a situation by the case frame from a
viewpoint of man's cognition. Moreover, the medical communication by a
natural language, which is currently used when a patient changes a
hospital, was analyzed in order to confirm the validity of this method.
In addition, we developed a prototype system that allows computers to
implement this kind of communication.
MeSH Terms:
- Human
- Medical Informatics Applications
- Medical Records Systems, Computerized*
- Natural Language Processing*
- Software Design
- User-Computer Interface*
PMID: 11993574 [PubMed - indexed for MEDLINE]
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The electronic oral health record.
Heid DW, Chasteen J, Forrey AW.
Department of Restorative Dentistry, University of Washington School of
Dentistry, USA. dheid@cablespeed.com
This paper presents the history of the use of the computer for
maintaining patient medical care information. An electronic record
generated with a computer, which is non-specific for any healthcare
specialty, is referred to as the electronic health record. The
electronic health record was previously called the computer-based
patient record. "Electronic" replaced the earlier term "computer-based"
because "electronic" better describes the medium in which the patient
record is managed. The electronic health record and its application to
dentistry are discussed. The electronic health record is a "database" of
patient information that has been entered by any healthcare provider;
the electronic oral health record is an "electronic record" of oral
health information that has been entered by an oral healthcare provider.
The significant differences between the electronic health record and the
electronic oral health record are outlined and highlighted. Included is
a template describing a procedure to be used by dental personnel during
the decision making process of purchasing an electronic oral health
record. A brief description of a practice template is also provided.
These completed templates can be shared with dental software vendors to
clarify their understanding of and to clearly describe the needs of
today's dental practice. The challenge of introducing information
technology into educational institutions' curricula is identified.
Finally, the potential benefit of using electronic technology for
managing oral healthcare information is outlined.
MeSH Terms:
- American Dental Association
- Dental Records/standards*
- Human
- Medical Records Systems, Computerized*
- Practice Management, Dental*
- Software
- United States
PMID: 12167912 [PubMed - indexed for MEDLINE]
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Designing an Internet-based collaboratory for
biomedical research.
Gantenbein RE.
Center for Rural Health Research and Education, University of Wyoming,
Laramie, WY 82071-3432, USA.
Several recent grants from the National Institutes of Health to the
Universities of Wyoming, Idaho, and Montana have created a unique
opportunity for collaboration in biomedical research among the three
schools, as well as the community colleges in the region. NIH Center of
Biomedical Research Excellence (COBRE) programs at Wyoming have been
established to study the biological effect of nitric oxide and to
investigate stressors that can contribute to the progression of
cardiovascular disease. Funding from these and related grants have
significantly upgraded Wyoming bioimaging and microscopy facilities, as
well as provided support for faculty and students in a variety of
research disciplines. In order to enhance these research efforts, the
Center for Rural Health Research and Education at the University of
Wyoming is spearheading an effort to create an Internet-based system for
sharing data and research resources among the involved sites. This paper
describes how such a "collaboratory" could be designed, using techniques
developed for distributed research and development in the computer
industry. The system, as envisioned, will support remote data
acquisition, management, and visualization, while providing security in
the form of authorization and authentication of users and virtual
private networking for data transmitted between nodes of the network.
MeSH Terms:
- Computer Communication Networks/organization & administration*
- Computer Security
- Cooperative Behavior
- Internet*
- Research/organization & administration*
- United States
- User-Computer Interface*
PMID: 12085639 [PubMed - indexed for MEDLINE]
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4.4 Electronic management systems.
Eplee H, Murray B, Revere JH, Bollmann F, Haddad G, Klimek J, Barna
S, Rhodes G, Looki T, Malone A, Molvar M, Pienkowski B, Schoonheim M,
Teravainen JP.
University of Missouri at Kansas City, USA.
The international development and deployment of an electronic
modularized dental curriculum is central to the development of an
electronic engine to be used for the effective management of dental
education. This will ensure continuity in high quality of care across
all boundaries, through the continuous updating of its content and
linkages to contemporary resources and databases. An electronic engine
to be used for the effective management of dental education in a
comprehensive dental school/hospital setting is at the core of an
international 'virtual' dental education institution. The issue of
policy development necessary to ensure consistency, quality and
management for an electronic engine is at the very centre of: a) systems
management and system databases; b) records of students, patients and
personnel; and c) financial records.
MeSH Terms:
- Computer Security
- Cultural Diversity
- Curriculum
- Dental Records
- Developing Countries
- Education, Dental/organization & administration*
- Human
- Internationality
- Management Information Systems*
- Medical Records Systems, Computerized
- User-Computer Interface
PMID: 12390272 [PubMed - indexed for MEDLINE]
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A pragmatic discussion on establishing a multicenter
digital imaging network.
Ingeholm ML, Levine BA, Fatemi SA, Moser AH.
ISIS Center, Georgetown University, Washington DC 20007, USA. Ingeholm@georgetown.edu
Multicenter clinical trials for therapy evaluation of rare diseases are
necessary. A digital imaging network improves the ability to share
information between collaborating institutions for adrenoleukodystrophy.
The DICOM 3.0 standard is used to move images over the Internet from
contributing sites to the central clinical database and on to the
reviewing physicians' workstations. Patient confidentiality and data
integrity are ensured during transmission using virtual private network
technology. Fifteen sites are participating in the network. Of these
sites, 6 use the proposed protocol. The other 9 sites have either
security policy issues or technical considerations that dictate
alternative protocols. Network infrastructure, Internet access, image
management practices, and security policies vary significantly between
sites. Successful implementation of a multicenter digital imaging
network requires flexibility in the implementation of network
connectivity. Flexibility increases participation as well as complexity
of the network.
MeSH Terms:
- Adrenoleukodystrophy
- Computer Communication Networks*
- Computer Security
- Confidentiality
- Human
- Magnetic Resonance Imaging*
- Multicenter Studies*
- Support, U.S. Gov't, P.H.S.
Grant Support:
PMID: 12105723 [PubMed - indexed for MEDLINE]
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Gaining MD buy-in: physician order entry.
Ferren AL.
Abington Memorial Hospital, USA.
Computerized physician order entry (CPOE) eliminates illegible
handwriting, reduces medical errors, and improves patient care. The
administration, medical staff, nursing, and health information systems
departments of a community teaching hospital cooperated to achieve
organization-wide use of its CPOE system.
MeSH Terms:
- Attitude of Health Personnel*
- Attitude to Computers*
- Clinical Pharmacy Information Systems/utilization*
- Computer User Training
- Cooperative Behavior
- Hospitals, Community/organization & administration*
- Human
- Medical Records Systems, Computerized/utilization*
- Medical Staff, Hospital/psychology*
- Medication Errors/prevention & control
- Pennsylvania
- United States
- User-Computer Interface
PMID: 11941925 [PubMed - indexed for MEDLINE]
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Integrated regional services: are working process
changes desirable and achievable?
Harno K, Gronhagen-Riska C, Pohjonen H, Kinnunen J, Kekomaki M.
Department of Medicine, Hospital District of Helsinki and Uusimaa,
Helsinki University Central Hospital, Helsinki, HUS, Finland. kari.harno@hus.fi
In the hospital district of Helsinki and Uusimaa, 32 municipalities with
one or more health centres provide primary care to their residents.
Legal and organizational barriers between primary care and hospital care
impede the continuity of patient care. Integrating primary and secondary
care with the aid of information technology may facilitate a virtual
electronic patient record, in which the viewing of images and other
patient data is possible regardless of the organization that produced
them. For example, in one trial, diabetic patients sent their home blood
glucose measurements by modem to their health centre. Preliminary
observations suggest that they could increase their glucose testing
largely because they were able to transmit the results to the database
and receive teleconsultations. Also, a picture archiving and
communication system (PACS) has been in operation in two clinics of the
Helsinki University Central Hospital for over two years and seven
hospitals had become filmless by the end of 2001. A regional PACS is
planned to be completed by the year 2004.
MeSH Terms:
- Adolescent
- Adult
- Blood Glucose/analysis
- Delivery of Health Care, Integrated/organization & administration*
- Diabetes Mellitus/therapy
- Finland
- Human
- Information Storage and Retrieval
- Interprofessional Relations
- Medical Records Systems, Computerized
- Outpatient Clinics, Hospital/organization & administration*
- Primary Health Care/organization & administration*
- Telemedicine/organization & administration*
- User-Computer Interface
Substances:
PMID: 12661613 [PubMed - indexed for MEDLINE]
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Networking in shared care--first steps towards a
shared electronic patient record for cancer patients.
van der Haak M, Mludek V, Wolff AC, Bulzebruck H, Oetzel D, Zierhut
D, Drings P, Wannenmacher M, Haux R.
Department of Medical Informatics, University of Heidelberg, Germany.
minne_van_der_haak@med.uni-heidelberg.de
OBJECTIVES: This paper aims at identifying the data protection and
security requirements for a cross-institutional EPR. Three possible
models and the first steps towards a cross-institutional EPR for the
Thoraxklinik Heidelberg and the Department of Clinical Radiology of the
University Medical Center of Heidelberg shall be discussed. METHODS: A
comprehensive analysis of literature and legal documents supplied
information for determining the data protection and security
requirements. By means of information system analysis, the technical
preconditions in both institutions as well as three possible models
towards a cross-institutional EPR were identified. RESULTS: According to
the German penal code it is only allowed to reveal patient information
to external physicians in cases of so-called "treatment connection". An
extension of the written consent, signed by the patient, verifying the
patient agreement that his/her patient data will be stored in a
cross-institutional EPR is needed. Among the three models that we
identified, the model that constitutes of a virtual EPR with distributed
data capture in both institutions was favored. By means of SecuRemote
software a secure connection between the Thoraxklinik Heidelberg and the
Department of Clinical Radiology was established, allowing the
physicians to view the complete cross-institutional health information
of a jointly treated patient during the weekly consultation on
radiotherapy. CONCLUSIONS: Many requirements listed in this paper are
requirements for electronic patient records in general. Besides these
general requirements there are specific requirements for a
cross-institutional EPR. The legal situation in Germany complicates the
development and implementation of a cross-institutional EPR. However, we
think that the efforts are reasonable, because a cross-institutional EPR
will be able to improve the communication between health institutions,
medical disciplines and persons involved in shared care processes. It
provides them with more complete health information about the jointly
treated patients. A cross-institutional EPR is, therefore, expected to
improve the quality of patient care.
MeSH Terms:
- Ambulatory Care Facilities/organization & administration*
- Computer Security*
- Continuity of Patient Care/organization & administration*
- Germany
- Hospitals, University/organization & administration*
- Human
- Interdepartmental Relations
- Medical Records Systems, Computerized*
- Models, Organizational
- Oncology Service, Hospital/organization & administration*
- Organizational Case Studies
- Patient Care Team
- Radiology Department, Hospital/organization & administration*
- Security Measures
- Support, Non-U.S. Gov't
- Systems Integration*
PMID: 12501815 [PubMed - indexed for MEDLINE]
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Development and implementation of an EPR: how to
encourage the user.
van der Meijden MJ, Tange H, Troost J, Hasman A.
Department of Medical Informatics, Maastricht University, P.O. Box 616,
6200 MD, Maastricht, The Netherlands. m.vandermeijden@mi.unimaas.nl
This paper reports on the role users played in the design and
development of an electronic patient record. Two key users participated
in the project team. All future users received questionnaires and a
selection of them was interviewed. Before starting the development of
the EPR, the attitude of users towards electronic record keeping, their
satisfaction with the paper clinical records, their knowledge of
computers, and their needs and expectations of computer applications in
health care were measured by means of a questionnaire. The results of
the questionnaire were supplemented with in-depth interviews. Users had
a neutral attitude towards electronic record keeping. They were more
positive about data entry of the paper records than data retrieval.
During the development phase, but prior to the implementation of the EPR,
a second questionnaire measured satisfaction with the paper records.
Satisfaction appeared to be related to self-rated computer experience.
Inexperienced computer users tended to be more positive about the paper
records. In general, respondents did not have many expectations about
electronic record keeping. A second series of interviews zoomed in on
the expectations users had. Except for more concise reporting no
beneficial effects of electronic record keeping were expected.
MeSH Terms:
- Adult
- Anxiety
- Attitude of Health Personnel
- Computer Literacy*
- Female
- Human
- Interviews
- Male
- Medical Records Systems, Computerized*
- Questionnaires
- Software
- User-Computer Interface*
PMID: 11734384 [PubMed - indexed for MEDLINE]
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Securing interoperability between chip card based
medical information systems and health networks.
Blobel B, Pharow P, Spiegel V, Engel K, Engelbrecht R.
Department of Medical Informatics, Medical Faculty, Institute of
Biometry and Medical Informatics, Otto-von-Guericke University
Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Saxony-Anhalt, Germany.
bernd.blobel@mrz.uni-magdeburg.de
Health information systems supporting shared care are going to be
distributed and interoperable. Dealing with sensitive personal medical
information, such information systems have to provide appropriate
security services, allowing only authorised users restricted access
rights to the patients' data according to the 'need to know' principle.
Especially in healthcare, chip card based information systems occur in
the shape of patient data cards providing informational self
determination and mobility of the users as well as quality, integrity,
accountability, and availability of the data stored on the card, thus
improving the shared care of patients. The DIABCARD project aims at the
implementation and evaluation of a chip card based medical information
system (CCMIS) for facilitating communication and co-operation between
health professionals in different organisations or departments caring
the same patient with diabetes as an example. In co-operation with the
EC-funded TrustHealth(2) project, communication and application security
services needed are provided like strong authentication as well as the
derived services such as authorisation, access control, accountability,
confidentiality, etc. The solution is based on Health Professional Cards
and Trusted Third Party services. In addition to the secure handling of
the patient's chip card and data in DIABCARD workstations, the secure
communication between these workstations and related departmental
systems has been implemented. Based on the results of this feasibility
study, an enhanced security services specification for the DIABCARD
example of a CCMIS is provided which will be implemented in the
framework of a health network being established in the German federal
state Bavaria. Beside the preferred solution of a combination of Patient
Identification Card and Patient Data Card, lower level alternatives
using card-verifiable certificates are explained in some details.
Finally, a few legal issues, future trends like the XML standard set and
their implications for the solution presented as well as for distributed
health information systems in general are shortly discussed.
MeSH Terms:
- Computer Security*
- Confidentiality*
- Continuity of Patient Care
- Diabetes Mellitus/therapy
- Forms and Records Control
- Human
- Information Storage and Retrieval
- Information Systems*
- Interprofessional Relations
- Medical Records Systems, Computerized*
- Patient Identification Systems*
- Software
- Support, Non-U.S. Gov't
PMID: 11734401 [PubMed - indexed for MEDLINE]
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Towards integration of clinical decision support in
commercial hospital information systems using distributed, reusable
software and knowledge components.
Muller ML, Ganslandt T, Eich HP, Lang K, Ohmann C, Prokosch HU.
Department of Medical Informatics and Biomathematics, University of
Munster, Domagkstr. 9, 48129 Munster, Germany. marcel.mueller@uni-muenster.de
PROBLEM: Clinicians' acceptance of clinical decision support depends on
its workflow-oriented, context-sensitive accessibility and availability
at the point of care, integrated into the Electronic Patient Record (EPR).
Commercially available Hospital Information Systems (HIS) often focus on
administrative tasks and mostly do not provide additional knowledge
based functionality. Their traditionally monolithic and closed software
architecture encumbers integration of and interaction with external
software modules. Our aim was to develop methods and interfaces to
integrate knowledge sources into two different commercial hospital
information systems to provide the best decision support possible within
the context of available patient data. METHODS: An existing, proven
standalone scoring system for acute abdominal pain was supplemented by a
communication interface. In both HIS we defined data entry forms and
developed individual and reusable mechanisms for data exchange with
external software modules. We designed an additional knowledge support
frontend which controls data exchange between HIS and the knowledge
modules. Finally, we added guidelines and algorithms to the knowledge
library. RESULTS: Despite some major drawbacks which resulted mainly
from the HIS' closed software architectures we showed exemplary, how
external knowledge support can be integrated almost seamlessly into
different commercial HIS. This paper describes the prototypical design
and current implementation and discusses our experiences.
MeSH Terms:
- Abdominal Pain/etiology
- Algorithms
- Artificial Intelligence*
- Decision Support Systems, Clinical*
- Hospital Information Systems*
- Human
- Medical Records Systems, Computerized
- Software*
- Support, Non-U.S. Gov't
PMID: 11734398 [PubMed - indexed for MEDLINE]
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[Electronic versus paper-based patient records: a
cost-benefit analysis]
[Article in German]
Neubauer AS, Priglinger S, Ehrt O.
Augenklinik, Ludwig-Maximilians-Universitat, Mathildenstrasse 8, 80336
Munchen. Aljoscha.Neubauer@ak-i.med.uni-muenchen.de
BACKGROUND: The aim of this study is to compare the costs and benefits
of electronic, paperless patient records with the conventional
paper-based charts. METHODS: Costs and benefits of planned electronic
patient records are calculated for a University eye hospital with 140
beds. Benefit is determined by direct costs saved by electronic records.
RESULTS: In the example shown, the additional benefits of electronic
patient records, as far as they can be quantified total 192,000 DM per
year. The costs of the necessary investments are 234,000 DM per year
when using a linear depreciation over 4 years. In total, there are
additional annual costs for electronic patient records of 42,000 DM.
Different scenarios were analyzed. By increasing the time of
depreciation to 6 years, the cost deficit reduces to only approximately
9,000 DM. Increased wages reduce the deficit further while the deficit
increases with a loss of functions of the electronic patient record.
However, several benefits of electronic records regarding research,
teaching, quality control and better data access cannot be easily
quantified and would greatly increase the benefit to cost ratio.
CONCLUSION: Only part of the advantages of electronic patient records
can easily be quantified in terms of directly saved costs. The small
cost deficit calculated in this example is overcompensated by several
benefits, which can only be enumerated qualitatively due to problems in
quantification.
MeSH Terms:
- Comparative Study
- Cost-Benefit Analysis
- Costs and Cost Analysis
- English Abstract
- Hospital Information Systems/economics
- Human
- Medical Records Systems, Computerized/economics*
PMID: 11729742 [PubMed - indexed for MEDLINE]
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Concordance of information in parallel electronic and
paper based patient records.
Mikkelsen G, Aasly J.
Department of Clinical Neurosciences, The Norwegian University of
Science and Technology, Trondheim, Norway.
OBJECTIVE: to evaluate the results of parallel use of both paper based
and electronic patient records with respect to concordance of
corresponding information in two continuously updated versions of the
same records. DESIGN: retrospective evaluation of patient records,
comparing documentation in electronic and paper based patient records.
SETTING: Department of Neurology in a Norwegian university hospital
using paper based and electronic patient records in parallel during
migration towards completely electronic patient records. MATERIAL:
electronic and paper based patient records of 90 randomly selected
patients visiting the department between 1 November 1997 and 30 April
1999. RESULTS: seven percent of the electronic documents were
significantly different in some way from the corresponding paper
documents. About 4-13% of the documents in the electronic record were
missing; one percent were missing from the paper record. CONCLUSION:
parallel use of electronic and paper based patient records has resulted
in inconsistencies between the record systems in our setting.
Documentation is missing in both the electronic and paperbased records.
When implementing electronic record systems intended to operate in
parallel with paperbased systems, focus should be on securing the
validity of all versions of the record.
MeSH Terms:
- Chi-Square Distribution
- Comparative Study
- Human
- Information Management/standards*
- Medical Records/standards*
- Medical Records Systems, Computerized/standards
- Quality Control
- Retrospective Studies
- Support, Non-U.S. Gov't
PMID: 11502428 [PubMed - indexed for MEDLINE]
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Computerized provider order entry systems.
[No authors listed]
Computerized provider order entry (CPOE) systems are designed to replace
a hospital's paper-based ordering system. They allow users to
electronically write the full range of orders, maintain an online
medication administration record, and review changes made to an order by
successive personnel. They also offer safety alerts that are triggered
when an unsafe order (such as for a duplicate drug therapy) is entered,
as well as clinical decision support to guide caregivers to less
expensive alternatives or to choices that better fit established
hospital protocols. CPOE systems can, when correctly configured,
markedly increase efficiency and improve patient safety and patient
care. However, facilities need to recognize that currently available
CPOE systems require a tremendous amount of time and effort to be spent
in customization before their safety and clinical support features can
be effectively implemented. What's more, even after they've been
customized, the systems may still allow certain unsafe orders to be
entered. Thus, CPOE systems are not currently a quick or easy remedy for
medical errors. ECRI's Evaluation of CPOE systems--conducted in
collaboration with the Institute for Safe Medication Practices (ISMP)--discusses
these and other related issues. It also examines and compares CPOE
systems from three suppliers: Eclipsys Corp., IDX Systems Corp., and
Siemens Medical Solutions Health Services Corp. Our testing focuses
primarily on the systems' interfacing capabilities, patient safeguards,
and ease of use.
Publication Types:
MeSH Terms:
- Artificial Intelligence
- Computers, Mainframe
- Cost-Benefit Analysis
- Equipment Design
- Equipment Failure Analysis
- Evaluation Studies*
- Hospital Information Systems/organization & administration*
- Human
- Internet
- Medical Errors/prevention & control
- Medical Records Systems, Computerized*/economics
- Medical Records Systems, Computerized*/instrumentation
- Medical Records Systems, Computerized*/standards
- Terminology
- User-Computer Interface
PMID: 11696968 [PubMed - indexed for MEDLINE]
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A DBMS-based medical teleconferencing system.
Chun J, Kim H, Lee S, Choi J, Cho H.
Myongji University, Kyungki-Do, Korea.
This article presents the design of a medical teleconferencing system
that is integrated with a multimedia patient database and incorporates
easy-to-use tools and functions to effectively support collaborative
work between physicians in remote locations. The design provides a
virtual workspace that allows physicians to collectively view various
kinds of patient data. By integrating the teleconferencing function into
this workspace, physicians are able to conduct conferences using the
same interface and have real-time access to the database during
conference sessions. The authors have implemented a prototype based on
this design. The prototype uses a high-speed network test bed and a
manually created substitute for the integrated patient database.
MeSH Terms:
- Computer Graphics
- Computer Systems
- Congresses/organization & administration*
- Database Management Systems*
- Human
- Medical Records Systems, Computerized*
- Multimedia
- Support, Non-U.S. Gov't
- Systems Integration
- Telemedicine*
- User-Computer Interface
PMID: 11522766 [PubMed - indexed for MEDLINE]
-
Comment in:
Physician satisfaction with two order entry systems.
Murff HJ, Kannry J.
Mount Sinai-NYU Health Systems, New York, New York, USA. hmurff@partners.org
OBJECTIVES: In the wake of the Institute of Medicine report, To Err Is
Human: Building a Safer Health System (LT Kohn, JM Corrigan, MS
Donaldson, eds; Washington, DC: National Academy Press, 1999), numerous
advisory panels are advocating widespread implementation of physician
order entry as a means to reduce errors and improve patient safety.
Successful implementation of an order entry system requires that
attention be given to the user interface. The authors assessed physician
satisfaction with the user interface of two different order entry
systems-a commercially available product, and the Department of Veterans
Affairs Computerized Patient Record System (CPRS). DESIGN AND
MEASUREMENT: A standardized instrument for measuring user satisfaction
with physician order entry systems was mailed to internal medicine and
medicine-pediatrics house staff physicians. The subjects answered
questions on each system using a 0 to 9 scale. RESULTS: The survey
response rates were 63 and 64 percent for the two order entry systems.
Overall, house staff were dissatisfied with the commercial system,
giving it an overall mean score of 3.67 (95 percent confidence interval
[95%CI], 3.37-3.97). In contrast, the CPRS had a mean score of 7.21 (95%
CI, 7.00-7.43), indicating that house staff were satisfied with the
system. Overall satisfaction was most strongly correlated with the
ability to perform tasks in a "straightforward" manner. CONCLUSIONS:
User satisfaction differed significantly between the two order entry
systems, suggesting that all order entry systems are not equally usable.
Given the national usage of the two order entry systems studied, further
studies are needed to assess physician satisfaction with use of these
same systems at other institutions.
MeSH Terms:
- Attitude of Health Personnel*
- Attitude to Computers
- Comparative Study
- Consumer Satisfaction*
- Data Collection
- Hospital Information Systems
- Human
- Medical Records Systems, Computerized*
- Medical Staff, Hospital
- Patient Care Management*
- Questionnaires
- United States
- United States Department of Veterans Affairs
- User-Computer Interface*
PMID: 11522770 [PubMed - indexed for MEDLINE]
-
-
Development and deployment of a web-based physician
order entry system.
Lee YL, Hsu CY, Hsieh D, Li YC.
Taipei Medical College, Graduate Institute of Medical Informatics,
Taipei, Taiwan.
The computer-based Physician Order Entry System (POES) has been employed
in many clinical institutes in Taiwan. Most of the POES systems are
developed in the two-tier client-server architecture, and a large
portion of the systems are constructed on a mainframe or even a single
PC.The exponential growth of the Internet has had a tremendous impact on
our society in recent years. In consideration of the future user
interface and system architecture, we have developed a three-tier
web-based Physician Order Entry System and successfully deployed it in
the Wang-Fang Hospital in Taipei.The system is the first POES based on
three-tier and World Wide Web (WWW) in Taiwan. The system provides the
Subjective, Objective, Assessment, and Plan (SOAP) structure for the
physician to enter subject, object, diagnoses, medicine dosage,
treatment and laboratory test request, and prints out the prescription
and necessary document. The doctor can also retrieve the patient's
medical record on the system. One of the special characteristics of the
system is its personalized design. The doctor can define their own
diagnosis, medicine and treatment database and any combination of these
to facilitate their clinical work.The system has been reviewed since
February 1999. The result shows that the clinical procedure has become
more efficient, and the chances of omission have been reduced. The
system is very stable and the Open Database Connectivity (ODBC) database
access did not show any delay in the network. Since we have incorporated
many new web-programming techniques, the progress of the techniques will
improve the system performance in the future.
MeSH Terms:
- Computer Systems
- Hospital Information Systems*
- Human
- Internet*
- Medical Records Systems, Computerized
- Physician's Practice Patterns
- Taiwan
- User-Computer Interface*
PMID: 11470616 [PubMed - indexed for MEDLINE]
-
Comment in:
Consumer informatics supporting patients as
co-producers of quality.
Kaplan B, Brennan PF.
Yale University, New Haven, Connecticut, USA. bonnie.kaplan@yale.edu
The track entitled "Consumer Informatics Supporting Patients as
Co-Producers of Quality" at the AMIA Spring 2000 Congress was devoted to
examining the new field of consumer health informatics. This area is
developing rapidly, as worldwide changes are occurring in the
organization and delivery of health care and in the traditional roles of
patient and provider. This paper describes the key themes of the track;
implications of the growing area of consumer health informatics; and
recommendations for informatics research, design, and policy. Key themes
that emerged from the panels and discussions involved changes in roles
of consumers and providers; supporting a patient-provider-information
technology partnership; virtual, not physical, structure for health care
and health care information delivery; and health care as an integrated
part of one's life. Panelists and participants at the Congress developed
recommendations for informatics research, design, and policy, with an
overarching focus on how to support the patient-provider-information
technology partnership to provide more patient-centered health care.
They recommended that AMIA take an active leadership role in consumer
health informatics. Specific recommendations were made concerning
research, new patient record systems, provider support, information
access and evaluation, and policy and regulation.
MeSH Terms:
- Consumer Participation
- Ethics
- Health Education*/standards
- Health Education*/trends
- Human
- Information Services*/standards
- Internet
- Medical Records Systems, Computerized
- Quality Control
PMID: 11418537 [PubMed - indexed for MEDLINE]
-
[Overview of medical errors]
[Article in German]
Fehn K.
Rechtsanwalt mit den Interessenschwerpunkten Medizinrecht, Strafrecht
und Ordnungsrecht, Bonn. mail@dr-fehn-net.de
The physician is under the legal obligation to his patient to conduct a
professional treatment that is optimally suited to obtain the wanted
recovery. A violation of this and the equally existing obligation to
observe the due diligence is termed malpractice. The degree of diligence
necessary is determined in accordance to the behaviour deemed the
standard in certain circles of conscientious and attentive physicians or
specialists. The virtual knowledge and capability of the single
physician is not referred to. The relevant standard of diligence as well
as the medical standard do not affect the doctor's free choice of
treatment but they set the conditions under which an alternative therapy
deviating from the standard can be resorted to. Malpractice can be
classified into different groups of instances, i.e. diagnostic
mistake/violation of the obligation to put down a record of the
examination's results, bad choice of therapy, or inadequate
organization. A particular example of such inadequate organization is
the performance of an operation by an inexperienced physician. Provided
that a correction of the damage to health or its expansion/manifestation
can be prevented the doctor is legally compelled to reveal the
malpractice to his or her patient. If the malpractice causes any injury
to the patient's health damages can be requested on the basis of
contractual as well as tort claims including compensation for suffering
from injuries itself. Apart from the consequences related to civil law
malpractice can entail repercussions under penal law. To avoid the
reproach of behaviour in contradiction to the exigencies of due
diligence every physician is required to ask himself the question
whether he possesses the professional abilities to conduct the requisite
treatment. Furthermore, he has constantly to strive for a continuation
of his profession-related learning.
Publication Types:
MeSH Terms:
- English Abstract
- Germany
- Human
- Legislation, Medical
- Malpractice/classification
- Malpractice/legislation & jurisprudence
- Medical Errors/prevention & control*
- Physicians/standards
- Safety
PMID: 11512217 [PubMed - indexed for MEDLINE]
-
-
The essential role of information management in
point-of-care/critical care testing.
Blick KE.
Department of Pathology, University of Oklahoma Health Sciences Center,
Oklahoma City, OK 73126, USA. ken-blick@ouhsc.edu
Laboratory medicine is undergoing tremendous change in recent years
driven primarily by technology, regulations, reimbursement, and market
forces. In this paradigm shift, the laboratory is under tremendous
pressure to adapt to new requirements for critical care testing. Indeed,
laboratories have entered the information age where chemical data is
being extracted from specimens in totally automated fashion. In the
past, laboratory data has played a more historical role in the care of
critically ill patients, arriving at the bedside too late to be of
significant use in the active, ongoing care of the patient. However,
today's physicians taking care of critically ill patients now require
that laboratory results are made available in real-time and, if
possible, at the patient's point-of-care. Many new testing point-of-care
testing (POCT) devices have been developed to address this need however
often laboratories implement such distributed devices with little or no
attention to the information technology requirements. In fact, as little
as 10% of point-of-care testing is actually managed by the central
laboratory computer hence critically importance results are not found on
the patient's electronic medical record. In addition, the billing and
management data for point-of-care testing is often handled manually with
no plans to interface point-of-care devices to the laboratory billing
and management systems. Because of recent improvements of information
handling and interface capability, such shortcomings in data management
are no longer acceptable. Indeed, the demands for laboratories to
utilize information technology are such that those laboratories with no
overall plan for data management of critical care testing will probably
not survive this market-driven paradigm. We present a discussion of the
various approaches to computerization of point-of-care testing including
the advantages and the disadvantages of each approach.
MeSH Terms:
- Critical Care*
- Human
- Information Management*
- Point-of-Care Systems*
- Systems Integration
- User-Computer Interface
PMID: 11369352 [PubMed - indexed for MEDLINE]
-
Medical voice recognition software and the electronic
medical record.
Cerra JM.
STI Computer Services, Inc., King-of-Prussia, Pennsylvania, USA.
MeSH Terms:
- Human
- Medical Records Systems, Computerized/organization &
administration*
- Software*
- User-Computer Interface
- Voice*
PMID: 11712259 [PubMed - indexed for MEDLINE]
-
-
Sharing patient care records over the World Wide Web.
Liu CT, Long AG, Li YC, Tsai KC, Kuo HS.
Graduate Institute of Medical Informatics, Taipei Medical University,
Taipei, Taiwan. ctliu@tmu.edu.tw
In order to obtain appropriate medical care, patients can be referred or
transported from one hospital to another based on the capacity,
capability and quality of medical care provided by hospitals. Therefore,
enabling patient care records to be shared among hospitals is essential
not only in delivering the quality of medical care services but also in
saving medical expenses. Currently, most patient care records are
paper-based and not well organized. Hence, they are usually incomplete
and can hardly be accessed in time. The authors in this paper present
methods to structure and represent patient care records, design
mechanisms for interpreting and integrating the XML-based patient care
records into the existing hospital information systems. More
importantly, in our approach, each significant piece of medical record
is associated with a tag based on the syntax and semantics of the XML.
The XML-based medical records enable a computer to capture the meaning
and structure of the document on the web. The authors have developed a
unified referral information system in which patient care records can be
shared among hospitals over the Internet. It can not only facilitate the
referral process but also maintain the integrity of a patient's medical
record from distributed hospitals. The workflow of the system basically
follows the existing manual system and can easily be adapted. The
working group on integration of municipal hospital information systems,
Department of Health, Taipei City Government, has decided to adapt this
system for referral practice among the municipal hospitals.
MeSH Terms:
- Hospital Information Systems*
- Human
- Internet*
- Medical Records Systems, Computerized*
- Patient Transfer
- Referral and Consultation
- Software
PMID: 11311673 [PubMed - indexed for MEDLINE]
-
-
Building a generic architecture for medical
information exchange among healthcare providers.
Li YC, Kuo HS, Jian WS, Tang DD, Liu CT, Liu LL, Hsu CY, Tan YK, Hu
CH.
Graduate Institute of Medical Informatics, Taipei Medical College, 250
Wu-Hsin Street, 1100, Taipei, Taiwan, ROC. jack@tmc.edu.tw
Due to the inability to exchange clinical information among hospitals,
continuity of care cannot be maintained and a tremendous amount of
medical resource has been wasted. This paper describes an architecture
that would facilitate exchange of clinical information among
heterogeneous hospital information systems. It is dubbed 'Medical
Information Exchange Center' or MIEC as part of a six-year Health
Information Network Project hosted by the Department of Health. MIEC was
designed so that it is innovative yet technically feasible today. It is
convenient for authorized users yet secure enough so people can trust
and has minimal impact to participated hospitals. Authorized users will
be able to access information through two web-based interfaces directed
to physician and non-physician users respectively. Hospitals are
connected through a virtual private network to exchange patient
information and users need to obtain a private key from the certificate
authority in order to securely connect to MIEC. A pilot project was
conducted to demonstrate the feasibility of this architecture and the
problems encountered were discussed.
MeSH Terms:
- Computer Communication Networks
- Computer Systems*
- Confidentiality
- Continuity of Patient Care
- Health Personnel*
- Hospital Information Systems*
- Human
- Information Services*
- Interprofessional Relations
- Medical Records Systems, Computerized
- Support, Non-U.S. Gov't
PMID: 11311678 [PubMed - indexed for MEDLINE]
-
-
Problem-oriented prefetching for an integrated
clinical imaging workstation.
Bui AA, McNitt-Gray MF, Goldin JG, Cardenas AF, Aberle DR.
University of California at Los Angeles (UCLA), 90024, USA. buia@cs.ucla.edu
Prefetching methods have traditionally been used to restore archived
images from picture archiving and communication systems to diagnostic
imaging workstations prior to anticipated need, facilitating timely
comparison of historical studies and patient management. The authors
describe a problem-oriented prefetching scheme, detailing 1) a mechanism
supporting selection of patients for prefetching via characterizations
of clinical problems, using multiple data sources (picture archiving and
communication systems, hospital information systems, and radiology
information systems), classifying patients into cohorts on the basis of
their medical conditions (e.g., lung cancer); and 2) prefetching of
multimedia data (imaging, laboratory, and medical reports) from clinical
databases to enable the viewing of an integrated patient record.
Preliminary evaluation of the prefetching algorithm using classic
information retrieval measures showed that the system had high recall
(100 percent), correctly identifying and retrieving data for all
patients belonging to a target cohort, but low precision (50 percent). A
key finding during testing was that the recall of the system was
increased through the use of multiple data sources (compared with one
data source), because of better patient descriptors. Medical problems
and patient cohorts were more specifically defined by combining
information from heterogeneous databases.
MeSH Terms:
- Algorithms
- Diagnostic Imaging
- Hospital Information Syst
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