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Biomedical subjects

C Safran

Publications and source records attributed to C Safran.

At least 37 records · Page 2Linked to original sources
PubMed1999

Using the Web to reduce postoperative pain following ambulatory surgery.

To test the hypothesis that educational information provided via the web would not only be accessed by our patients, but could also reduce postoperative pain following ambulatory surgery, we enrolled 195 patients into a randomized controlled study. Fifty-two percent of our ambulatory surgery patients already knew how to use and had access to the Internet. Eighty-five percent of our study patients accessed the resources made available to them on the web site. Patients who had access to the pain management information on the ambulatory surgery web site reported significantly less postoperative pain on arrival to their home after surgery (p < 0.016) and into the night after surgery (p < 0.013). These patients also reported significantly less postoperative pain for the day immediately following surgery (p < 0.037). We conclude that using the Internet to provide just-in-time patient education can significantly effect the clinical outcome of care.

Adolescent↗
PubMed1999

Online medical records: a decade of experience.

The electronic patient record at the Beth Israel Deaconess Medical Center has fundamentally changed the practice of medicine in ways that its developers never foresaw. This type of highly interactive and work flow enabled program is creating new collaborative roles for computers in complex organizations [4]. With the system able to supervise and monitor care, computers are able to perform many care coordination and documentation functions, freeing people to concentrate more on interpersonal interactions and provision of health care services. One of the challenges in the design of electronic patient records to assist health care providers is how to support collaboration while not requiring that people meet face-to-face. Moreover, a greater challenge for each of us as clinicians is to use this technology as a bridge (rather than a barrier) towards better patient-doctor relationships.

Humans↗
PubMed1998

Electronic communication and collaboration in a health care practice.

Using cognitive evaluation techniques, this study examines the effects of an electronic patient record and electronic mail on the interactions of health care providers. We find that the least structured communication methods are also the most heavily used: face-to-face, telephone, and electronic mail. Positive benefits of electronically-mediated interactions include improving communication, collaboration, and access to information to support decision-making. Negative factors include the potential for overloading clinicians with unwanted or unnecessary communications.

Communication↗
PubMed1998

CareWeb, a web-based medical record for an integrated healthcare delivery system.

With the advent of Integrated Healthcare Delivery Systems, medical records are increasingly distributed across multiple institutions. Timely access to these medical records is a critical need for healthcare providers. The CareWeb project provides an architecture for World Wide Web-based retrieval of electronic medical records from heterogeneous data sources. Using Health Level 7 (HL7), web technologies and readily available software components, we consolidated the electronic records of Boston's Beth Israel and Deaconess Hospitals. We report on the creation of CareWeb (freya.bidmc.harvard.edu/careweb.htm) and propose it as a means to electronically link Integrated Health Care Delivery Systems and geographically distant information resources.

Computer Communication Networks↗
PubMed1998

Can a large institution go paperless?

Since 1989, Beth Israel Hospital has been deploying an extensive online patient record (the OMR), which augmented a heavily used integrated hospital information system. Initially begun in a large primary care practice, the system is now used to share patient records among 36 practices on three campuses. Although the system was intended to eliminate the need for paper, we have found that it has, in the short term, increased the amount of paper produced. Elimination of paper record in ambulatory care has saved us $56,000, but we have yet to realize the savings of an additional $200,000 per year. We explore the factors that contribute to this "paper paradox" and discuss the costs associated with increased paper production, areas in which we have reduced paper handling, and strategies for reducing our reliance on paper.

Academic Medical Centers↗
PubMed1998

Telematics in the neonatal ICU and beyond: improving care, communication and information sharing.

In October of 1998, the Beth Israel-Deaconess was awarded one of 19 contracts from the National Library of Medicine (NLM) to develop, implement and test a telemedicine application to support the care of Very Low Birth Weight Infants. This project is the only one to focus on the care of newborns. We believe that this project will provide a new national approach to managing the care of high-risk newborns by leveraging evolving communication technology.

Computer Security↗
PubMed1998

An evaluation of UMLS as a controlled terminology for the Problem List Toolkit.

We are developing a set of software components--the Problem List Toolkit (PL-Tk)--to support operations on clinical problem labels. An adaptation of the National Library of Medicine's Unified Medical Language System (UMLS) provides general vocabulary services to domain-specific software components. Our initial investigation centers on the inclusion in UMLS of problem labels used in the Beth Israel Deaconess Medical Center's Online Medical Record (OMR). We also explore the semantic typing of problem labels matched in UMLS. We have operationally defined a clinical problem to derive its semantic type from classes of terms representing findings or processes typically requiring diagnostic evaluation or therapeutic management in clinical practice. Of 1262 unique OMR problem labels, 999 terms (79%) have matches in UMLS. 986 of 999 terms (99%) map to the UMLS concept of the corresponding lexical match. 952 of 999 terms (95%) have semantic types that comply with our operational definition of clinical problems. These 952 terms (75%) constitute Version 1.0 of the problem list vocabulary B196. Matching terms with inappropriate semantic types raise issues regarding requirements for PL-Tk, typing of existing UMLS terms, and the adequacy of our operational definition for clinical problems. UMLS provides a large repertoire of pre-coordinated terms that are used as problem labels in a heavily used computer-based patient record system. The semantic type hierarchy provides a framework for the consistent use of clinical concepts in problem lists such that clinical problem labels represent "good" clinical problems.

Evaluation Studies as Topic↗
PubMed1998

The millennium bug: a prescription for action.

Healthcare delivery systems involving technology are vulnerable to year 2000 date problems. This paper describes the unique features of this problem as related to healthcare, proposes a classification to the problems, and structures an approach to begin resolving this looming disaster.

Chronology as Topic↗
PubMed1998

Confidentiality principles for medical records on the World Wide Web.

We have proposed elsewhere a strategy for releasing medical records via the World Wide Web. The philosophical underpinnings of this proposal balanced a need for access with a need for confidentiality of medical information. Other balance points could have been chosen, and methods of stronger and weaker protection of confidentiality are presented here along with the rationale behind the selected strategy.

Computer Security↗
PubMed1998

Nurses' requirements for information technology in the next millennium.

The main purpose of this study was to identify nurses' requirements for information technology in the next millennium. We distributed 350 questionnaires in a teaching hospital in Brazil and in the USA. We received 86 from Brazil and 78 from USA. Besides the capabilities of computers to be used in different sectors of human actions, nurses' requirements for information technology can not be considered sophisticated. Nurses in Brazil prefer a standalone system. In contrast, in USA they prefer systems that could be integrated to the whole healthcare system. Also, in the USA, nurses were more comfortable with use of computers than nurses in Brazil. In general terms, nurses in both countries feel that computer systems could make their practice easier and more efficient.

Attitude to Computers↗
PubMed1998

Metaphrase: an aid to the clinical conceptualization and formalization of patient problems in healthcare enterprises.

Patient descriptors, or "problems," such as "brain metastases of melanoma" are an effective way for caregivers to describe patients. But most problems, e.g., "cubital tunnel syndrome" or "ulnar nerve compression," found in problem lists in an Electronic Medical Record (EMR) are not comparable computationally--in general, a computer cannot determine whether they describe the same or a related problem, or whether the user would have preferred "ulnar nerve compression syndrome." Metaphrase is a scalable, middleware component designed to be accessed from problem-manager applications in EMR systems. In response to caregivers' informal descriptors it suggests potentially equivalent, authoritative, and more formally comparable descriptors. Metaphrase contains a clinical subset of the 1997 UMLS Metathesaurus and some 10,000 "problems" from the Mayo Clinic and Harvard Beth Israel Hospital. Word and term completion, spelling correction, and semantic navigation, all combine to ease the burden of problem conceptualization, entry and formalization.

Humans↗
PubMed1998

Implementation of an on-line Emergency Unit nursing system.

We designed and implemented an Emergency Unit nursing system which has been in practice since March of 1995. The system has been very successful and is used on 97% of all Emergency Unit visits. The system is designed for rapid entry and retrieval of information. We have found that the time spent by nurses documenting patient care in this system is minimal. On average, over a six day study period only five minutes per patient visit, and about 30 minutes per nurse per shift was spent actually entering information into the system. We plan to continue to evaluate the use of the system and expand it to include use by other disciplines in the near future.

Emergency Service, Hospital↗
PubMed1998

Nationwide telecare for diabetics: a pilot implementation of the HOLON architecture.

This paper presents results from a demonstration project of nationwide exchange of health data for the home care of diabetic patients. A consortium of industry, academic, and health care partners has developed reusable middleware components integrated using the HOLON architecture. Engineering approaches for multi-organization systems development, lessons learned in developing layered object-oriented systems, security and confidentiality considerations, and functionality for nationwide telemedicine applications are discussed.

Computer Communication Networks↗
PubMed1998

Baby CareLink: development and implementation of a WWW-based system for neonatal home telemedicine.

Baby CareLink is a multifaceted telemedicine application designed to provide individualized information and support to families of Very Low Birth Weight infants. We believe that this innovative use of WWW and telemedicine technologies will improve family satisfaction and clinical care. In conjunction with improvements in family involvement, discharge planning, education, and follow-up enabled by other CareLink components, this system may allow infants to transition home even earlier in their hospital stay and thereby provide a clear cost savings. This paper discusses the CareLink architecture and lessons learned in implementing a telemedicine link with families at home from an in-hospital clinical unit.

Computer Security↗
PubMed1998

HOLON: extending Web document libraries via objects in order to support the health information infrastructure. Health Object Library Online.

In HOLON, user clients, applications, data servers, and fine-grained elements are all objects in a document library. To that end, this paper reviews the past year of progress and lessons learned in HOLON for integrating the Web, HL7, CORBA, Arden, KQML, UMLS Thesaurus, and other standards to determine if object technology reduces common problems in document-centric libraries such as indexing, searching/retrieving, complex data type management, and maintenance, among others.

Computer Systems↗
PubMed1998

A component-based problem list subsystem for the HOLON testbed. Health Object Library Online.

One of the deliverables of the HOLON (Health Object Library Online) project is the specification of a reference architecture for clinical information systems that facilitates the development of a variety of discrete, reusable software components. One of the challenges facing the HOLON consortium is determining what kinds of components can be made available in a library for developers of clinical information systems. To further explore the use of component architectures in the development of reusable clinical subsystems, we have incorporated ongoing work in the development of enterprise terminology services into a Problem List subsystem for the HOLON testbed. We have successfully implemented a set of components using CORBA (Common Object Request Broker Architecture) and Java distributed object technologies that provide a functional problem list application and UMLS-based "Problem Picker." Through this development, we have overcome a variety of obstacles characteristic of rapidly emerging technologies, and have identified architectural issues necessary to scale these components for use and reuse within an enterprise clinical information system.

Computer Systems↗
PubMed1998

Validation of clinical problems using a UMLS-based semantic parser.

The capture and symbolization of data from the clinical problem list facilitates the creation of high-fidelity patient resumes for use in aggregate analysis and decision support. We report on the development of a UMLS-based semantic parser and present a preliminary evaluation of the parser in the recognition and validation of disease-related clinical problems. We randomly sampled 20% of the 26,858 unique non-dictionary clinical problems entered into OMR (Online Medical Record) between 1989 and August, 1997, and eliminated a series of qualified problem labels, e.g., history-of, to obtain a dataset of 4122 problem labels. Within this dataset, the authors identified 2810 labels (68.2%) as referring to a broad range of disease-related processes. The parser correctly recognized and validated 1398 of the 2810 disease-related labels (49.8 +/- 1.9%) and correctly excluded 1220 of 1312 non-disease-related labels (93.0 +/- 1.4%). 812 of the 1181 match failures (68.8%) were caused by terms either absent from UMLS or modifiers not accepted by the parser; 369 match failures (31.2%) were caused by labels having patterns not recognized by the parser. By enriching the UMLS lexicon with terms commonly found in provider-entered labels, it appears that performance of the parser can be significantly enhanced over a few subsequent iterations. This initial evaluation provides a foundation from which to make principled additions to the UMLS lexicon locally for use in symbolizing clinical data; further research is necessary to determine applicability to other health care settings.

Medical Records Systems, Computerized↗