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Biomedical subjects

Arie Hasman

Publications and source records attributed to Arie Hasman.

32 records · Page 2Linked to original sources
PubMed2003

PropeR: a multi disciplinary EPR system.

This article describes the architecture of an EPR system developed for the PropeR project. This EPR system not only aims at supporting home care of stroke patients, but is also designed in such a way that it can be ported to other medical services without much effort. We will briefly describe the Stroke Service and the related PropeR project. Starting from a list of requirements to construct a generic EPR system we will outline the architecture and describe the standards and methods used. Subsequently we describe the implementation and the problems encountered. In the discussion, we will go into the advantages and disadvantages of the tools and techniques we have used.

Computer Systems↗
PubMed2003

Towards a PropeR combination of patient records and protocols.

PROBLEM: The combination of a computer-based patient record and a decision-support system (DSS) may give physicians the decisive push they need to accept such systems. In the PropeR-project we determine the requirements for a generic interface between both these systems and evaluate its potential impact on patient care. This article reports results from the first year in one of the domains under study. It also provides background information about the project, including design considerations and experimental approach of forthcoming years. PURPOSE: The objectives of the first year were to determine bottlenecks of the current situation and to determine expected improvements and conditions for implementation of a future situation with computer support. METHODS: These topics were investigated in general by literature review and in the local situation by a requirements analysis. For the analysis we used a combination of observation, interviews, and patient record study. For the literature survey we searched for reviews, meta-analyses and original studies concerning experiences with computer-based patient records and DSSs in conventional settings and in integrated care. RESULTS: Main bottleneck was the poor use of shared patient record and paper guidelines. Expected improvements were better protocol adherence and communication. Conditions for implementation of computer support were a proper system interface and adoption by the user. CONCLUSION: Our main conclusion was that the aspect of cooperation needs more decision support than the clinical work itself.

Clinical Protocols↗
PubMed2003

Validity and reliability of the Nursing Minimum Data Set for the Netherlands (NMDSN).

UNLABELLED: The Nursing Minimum Data Set for the Netherlands (NMDSN) describes nursing care based on nursing phenomena, interventions and outcomes. The validity and reliability of its data collection has not been tested yet. PURPOSE: To report about the discriminative validity and the interrater reliability of the NMDSN. DESIGN: Data were collected in an intensive care ward, in a nursing home and in a residential home. The unit of measurement and analysis is the 'patient day'. The analysis for validity consisted of ridits calculations, and their graphical representations. Interrater reliability was measured by percentage agreement and Cohen's kappa. RESULTS: Graphs illustrate the differences on most nursing phenomena and interventions as expected beforehand. The percentage agreements for the residential home vary from 60.4 to 100%, and the kappa statistics from -0.09 to 0.85, indicating a poor to almost perfect interrater reliability. CONCLUSION: Intensive care patients and patients in the nursing home have more problems and need more nursing interventions compared with general hospital patients, while the patients in the residential home have lesser of both. This illustrates the discriminative validity of the NMDSN. The kappa values for various NMDSN variables are sufficient. A similar test in the general hospital is recommended.

Adult↗
PubMed2003

A consumer health record for supporting the patient-centered management of chronic diseases.

OBJECTIVES: To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. METHODS: A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach (formative evaluation) was used to let users (patients and care providers) assess the system leading to incremental changes in the system. RESULTS: The evaluation provided us with sufficient information about which parts of the system needed adaptation. The final consumer health record system was well accepted by patients and care providers. The system is Web-based and is used at home by patients having diabetes. Both care providers and patients enter data. The system can download the data from a glucose meter. It provides feedback to patients on the basis of entered data and incorporated guidelines. It also allows discussion forums. CONCLUSION: Formative evaluation is useful for obtaining feedback from users about prototype systems. Care providers and patients together worked with the consumer health record. Both parties appreciated the system. The approach described here can be used for developing systems for other chronic patient groups.

Anthropology, Cultural↗
PubMed2003

User satisfaction with a real-time automated feedback system for general practitioners: a quantitative and qualitative study.

OBJECTIVE: The GRIF automated feedback system produces real-time comments on the appropriateness of diagnostic tests ordered by general practitioners (GPs) based on recommendations from accepted national and regional practice guidelines. We investigated the experiences of GPs with this system and, more specifically, with the recommendations produced by the system as well as their views on using this system in daily practice. SETTING: We tested the GRIF system in an experiment in a laboratory setting and in a daily practice trial. STUDY PARTICIPANTS: General practitioners. INTERVENTION: In the laboratory experiment, GPs used the GRIF system to assess the appropriateness of 30 request forms. Each of the GPs was confronted with requests they had submitted to the diagnostic unit of the hospital in the past. In the field trial, the GRIF system was applied during patient consultations for 1 year. MAIN OUTCOME MEASURES: We measured GPs' satisfaction with the system using a questionnaire, and also conducted group discussions (in the laboratory experiment) and in-depth interviews (in the field trial) to elicit GPs' opinions of and experiences with the system. In addition, we explored GPs' reasons for not accepting the comments offered by the GRIF system. RESULTS: The results show that the GPs in the laboratory experiment had more positive attitudes towards the system compared with participants in the field trial. All discussion groups and most of the GPs in the field trial regarded receiving the immediate feedback during the test ordering process as an important advantage. The most frequently mentioned reason to reject the recommendation was disagreement with the content and/or the recommendations in the practice guidelines. CONCLUSION: Apart from securing agreement on guideline content, a prerequisite for using GRIF in daily practice on a large scale is that more attention is paid to promotion of the guidelines and their adoption, and stimulation of a positive attitude towards the practice guidelines among the users.

Attitude of Health Personnel↗
PubMed2003

The efficacy of an automated feedback system for general practitioners.

OBJECTIVE: An automated feedback system that produces comments about the non-adherence of general practitioners (GPs) to accepted practice guidelines for ordering diagnostic tests was developed. Before implementing the automated feedback system in daily practice, we assessed the potential effect of the system on the test ordering behaviour of GPs. DESIGN: We used a randomised controlled trial with balanced block design. SETTING: Five times six participant groups of GPs in a computer laboratory setting. INTERVENTION: The GPs reviewed a random sample of 30 request forms they filled in earlier that year. If deemed necessary, they could make changes in the tests requested. Next, the system displayed critical comments about their non-adherence to the guidelines as apparent from the (updated) request forms. SUBJECTS: Twenty-four randomly selected GPs participated. MAIN OUTCOME MEASURES: The number of requested diagnostic tests (17% with 95% confidence interval [CI]: 12-22%) and the fraction of tests ordered that were not in accordance with the practice guidelines (39% with 95% CI: 28-51%) decreased due to the comments of the automated feedback system. The GPs accepted 362 (50%) of the 729 reminders. IMPLICATIONS: Although our experiment cannot predict the size of the actual effect of the automated feedback system in daily practice, the observed effect may be seen as the maximum achievable.

Decision Support Systems, Clinical↗
PubMed2003

PropeR revisited.

The PropeR EHR is a multidisciplinary EHR system that is built using existing open source components. This paper discusses the implementation of this system and the advantages and challenges encountered when using open source components.

Computers↗
PubMed2002

Application of computer simulation analysis to assess the effects of relocating a hospital phlebotomy department.

BACKGROUND: This study describes a systematic approach to assess the effects of relocating a hospital department. METHODS: Using the phlebotomy service as an example, computer simulation was applied to predict changes in performance indicators, such as patient turn-around time (TAT), when planning a procedural and/or architectural redesign. RESULTS: Average patient TAT fell from 12 to 8 min, enabling the department to cope with any increase in numbers of patients. CONCLUSION: This type of study can provide useful information in assessing the consequences of future changes in the location of a hospital department.

Appointments and Schedules↗
PubMed2002

Turn-around time for chemical and endocrinology analyzers studied using simulation.

Simulation can be a means for the laboratory management to investigate the effects of proposed changes in the laboratory. Also, when specifications of analyzers are available one can investigate which analyzer should be purchased to fulfill existing needs. The potential of simulation is shown here by simulating the turn-around time of batched samples under several conditions. Three routine analyzers (DAX, AXON and Immuno-1) were modeled. The temporal pattern of the arrival of the samples at the different analyzers was determined. The impact of these patterns and the two batching methods on the turn-around time was investigated. Simulation proved to be a useful method to study the effects of batching and arrival patterns on the turn-around time.

Blood Chemical Analysis↗
PubMed2002

Health informatics.

Explore the source record for details and available documents.

Computer Communication Networks↗
PubMed2002

Towards a PropeR combination of patient records and protocols.

The combination of a computer-based patient record system with a decision support system may give physicians the decisive push they need to accept such systems. In the PropeR-project we determine the requirements for a generic interface between both such systems and measure its potential impact on patient care. In this overview we describe the objectives, the experimental approach, and the current state of the PropeR-project. We also discuss the original positions behind the project.

Clinical Protocols↗
PubMed1998

Assessing the importance of features for multi-layer perceptrons.

In this paper we establish a mathematical framework in which we develop measures for determining the contribution of individual features to the performance of a classifier. Corresponding to these measures, we design metrics that allow estimation of the importance of features for a specific multi-layer perceptron neural network. It is shown that all measures constitute lower bounds for the correctness that can be obtained when the feature under study is excluded and the classifier rebuilt. We also present a method for pruning input nodes from the network such that most of the knowledge encoded in its weights is retained. The proposed metrics and the pruning method are validated with a number of experiments with artificial classification tasks. The experiments indicate that the metric called replaceability results in the tightest error bounds. Both this metric and the metric called expected influence result in good rankings of the features.

Journal Article↗
PubMedDate not supplied

The reliability of assessing the appropriateness of requested diagnostic tests.

Despite a poor reliability, peer assessment is the traditional method to assess the appropriateness of health care activities. This article describes the reliability of the human assessment of the appropriateness of diagnostic tests requests. The authors used a random selection of 1217 tests from 253 request forms submitted by general practitioners in the Maastricht region of The Netherlands. Three reviewers independently assessed the appropriateness of each requested test. Interrater kappa values ranged from 0.33 to 0.42, and kappa values of intrarater agreement ranged from 0.48 to 0.68. The joint reliability coefficient of the 3 reviewers was 0.66. This reliability is sufficient to review test ordering over a series of cases but is not sufficient to make case-by-case assessments. Sixteen reviewers are needed to obtain a joint reliability of 0.95. The authors conclude that there is substantial variation in assessment concerning what is an appropriately requested diagnostic test and that this feedback method is not reliable enough to make a case-by-case assessment. Computer support maybe beneficial to support and make the process of peer review more uniform.

Decision Support Systems, Clinical↗