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Biomedical subjects

J M Overhage

Publications and source records attributed to J M Overhage.

At least 19 recordsLinked to original sources
PubMed1999

Practical, reliable, comprehensive method for characterizing pharmacists' clinical activities.

A method for rating the value of pharmacists' clinical services was studied. An instrument was developed to measure the severity of medication errors and the value of pharmacists' clinical interventions. Pharmacists at a hospital pharmacy department used the instrument at the time they made an intervention. A single pharmacist reviewed and adjusted the scores assigned by the pharmacist who made the intervention. An expert panel consisting of two clinical pharmacists and two physicians also scored all the interventions using the same instrument. All rankings were compared using kappa (kappa) and weighted kappa statistics, and symmetry tests were applied to examine whether specific raters consistently rated higher or lower than other raters. Data were extracted from the pharmacy department's intervention database to rate 300 interventions. Agreement between the raters was substantial, both overall and for each dimension individually. However, the physicians rated severity of error and value of service lower than their pharmacist counterparts. The study indicated that severity of error and value of service are clearly related, but not linearly. Services can be identified as high value even when there are no prescribing errors. Pharmacists found the instrument usable and practical. A literature-based instrument for simultaneously assessing the severity of errors in medication orders and the value of pharmacists' interventions was constructed, tested in a hospital, and determined to be reliable.

Humans↗
PubMed1999

The Regenstrief Medical Record System: a quarter century experience.

Entrusted with the records for more than 1.5 million patients, the Regenstrief Medical Record System (RMRS) has evolved into a fast and comprehensive data repository used extensively at three hospitals on the Indiana University Medical Center campus and more than 30 Indianapolis clinics. The RMRS routinely captures laboratory results, narrative reports, orders, medications, radiology reports, registration information, nursing assessments, vital signs, EKGs and other clinical data. In this paper, we describe the RMRS data model, file structures and architecture, as well as recent necessary changes to these as we coordinate a collaborative effort among all major Indianapolis hospital systems, improving patient care by capturing city-wide laboratory and encounter data. We believe that our success represents persistent efforts to build interfaces directly to multiple independent instruments and other data collection systems, using medical standards such as HL7, LOINC, and DICOM. Inpatient and outpatient order entry systems, instruments for visit notes and on-line questionnaires that replace hardcopy forms, and intelligent use of coded data entry supplement the RMRS. Physicians happily enter orders, problems, allergies, visit notes, and discharge summaries into our locally developed Gopher order entry system, as we provide them with convenient output forms, choice lists, defaults, templates, reminders, drug interaction information, charge information, and on-line articles and textbooks. To prepare for the future, we have begun wrapping our system in Web browser technology, testing voice dictation and understanding, and employing wireless technology.

Computer Terminals↗
PubMed1998

Canopy computing: using the Web in clinical practice.

The rain forest canopy is a seamless web through which arboreal creatures efficiently move to reach the edible fruits without any attention to the individual trees. Individual health care computer systems are rich with patient data, but rather than a canopy linking all the trees in the forest, the data "fruit" come from a diverse forest of individual computer "trees"-laboratory systems, word processing systems, pharmacy systems, and the like. These different sources of patient information are difficult or impossible to reach by individual physicians, especially from their offices. The World Wide Web and other standardization technology provide physicians and their institutions the tools needed for seamless and secure access to their patients' data and to medical information, when and where they need it. We and others have adopted these tools to combine independent sources of clinical data. Physicians who assist in the purchase of clinical information systems should demand products in their practice settings that are Web enabled, use standard coding systems, and communicate with other computer systems via broadly accepted protocols.

Clinical Medicine↗
PubMed1998

What is done, what is needed and what is realistic to expect from medical informatics standards.

Medical informatic experts have made considerable progress in the development of standards for orders and clinical results (CEN, HL7, ASTM), EKG tracings (CEN), diagnostic images (DICOM), claims processing (X12 and EDIFAC) and in vocabulary and codes (SNOMED, Read Codes, the MED, LOINC). Considerable work still remains to be carried out. Abstract models of health care information have to be created, to cover the necessary domain, and yet be simple enough to assimilate, implement, and manage. This requires a high degree of abstraction. Enormous amounts to develop standardized vocabulary are still required to complement such a model, and to define the subsets that apply to given contexts.

Computer Communication Networks↗
PubMed1998

Strategies for improving information management in emergency medicine to meet clinical, research, and administrative needs. Information Management Work Group.

The ED of the future will require the effective integration of information technologies into clinical care. This article proposes strategies for improving information management in emergency medicine to facilitate patient care, public health surveillance, clinical research, medical education, and health care management.

Computer Systems↗
PubMed1998

Strategies for improving information management in emergency medicine to meet clinical, research, and administrative needs. The Information Management Work Group.

The emergency department of the future will require the effective integration of information technologies into clinical care. This article proposes strategies for improving information management in emergency medicine to facilitate patient care, public health surveillance, clinical research, medical education, and health care management. Cordell WH, Overhage JM, Waeckerle JF, for the Information Management Work Group: Strategies for improving information management in emergency medicine to meet clinical, research, and administrative needs.

Computer Systems↗
PubMed1997

A framework for capturing clinical data sets from computerized sources.

The pressure to improve health care and provide better care at a lower cost has generated the need for efficient capture of clinical data. Many data sets are now being defined to analyze health care. Historically, review and research organizations have simply determined what data they wanted to collect, developed forms, and then gathered the information through chart review without regard to what is already available institutionally in computerized databases. Today, much electronic patient information is available in operational data systems (for example, laboratory systems, pharmacy systems, and surgical scheduling systems) and is accessible by agencies and organizations through standards for messages, codes, and encrypted electronic mail. Such agencies and organizations should define the elements of their data sets in terms of standardized operational data, and data producers should fully adopt these code and message standards. The Health Plan Employer Data and Information Set and the Council of State and Territorial Epidemiologists in collaboration with the Centers for Disease Control and Prevention and the Association of State and Territorial Public Health Laboratory Directors provide examples of how this can be done.

Abstracting and Indexing↗
PubMed1997

The risk of hospitalization for congestive heart failure among older adults.

OBJECTIVES: The purpose of the study was to estimate the 8-year rate of hospitalization for congestive heart failure (CHF), to report the resources consumed, and to evaluate previously reported risk factors in a nationally representative sample of 7,286 older white and black adults. METHODS: Secondary analysis of baseline interview data was linked to Medicare hospitalization and death records for 1984 to 1991. Hospitalization for CHF was defined as having one or more episodes with an International Classification of Diseases (ninth revision, clinical modification) discharge code of 428. Combined and separate analyses of first-listed and second-through fifth-listed CHF discharge diagnoses were conducted. Multivariable proportional hazards models were used to evaluate the risks in pooled analyses of all white and black men and women and in separate stratified analyses of white men and white women. RESULTS: Over the 8-year period, 1,102 or 15.1% of the 7,286 older white and black adults were hospitalized for CHF (7.1% with first-listed and 8.1% with second- through fifth-listed diagnoses). The 1- and 5-year combined postdischarge mortality rates were 34.7% and 69.0%, respectively. In descending order, the major risk factors for being hospitalized for CHF in the combined, pooled analysis were age, being a white man, having lower body functional limitations, and having self-reported medical histories of coronary heart disease, heart attack, diabetes, and angina. The increased risk associated with age was not linear, and it diminished significantly over the course of life. Some significant differences were observed in the risk factors for hospitalization for first-listed versus second- through fifth-listed CHF and in the risk factors for white women versus white men. CONCLUSIONS: Hospitalization for CHF among older adults is a common, costly event with a poor prognosis. The differential risk for white men remains unexplained and warrants further study.

Black or African American↗
PubMed1997

The sequelae of hospitalization for congestive heart failure among older adults.

OBJECTIVES: To estimate the independent effect of hospitalization for congestive heart failure (CHF) on subsequent mortality, readmission for CHF, rehospitalization for any reason, and change in functional status. DESIGN: Secondary analysis of the nationally representative Longitudinal Study on Aging, Baseline (1984) interview data are linked to Medicare hospitalization and death records for 1984-1991 and to functional status reports at three biennial follow-ups. SETTING: In-home and telephone interviews. PARTICIPANTS: a total of 7527 noninstitutionalized older adults aged 70 years or older at baseline. MEASUREMENTS: Hospitalization for CHF was defined as having one or more episodes with primary or secondary discharge ICD9-CM codes of 428. Multivariable proportional hazards, logistic and linear regression, as well as multiple classification analysis, were used to estimate the independent effects of having been hospitalized for CHF. RESULTS: The adjusted risk ratios for having a primary or secondary hospital discharge diagnosis of CHF on mortality (compared with not having any CHF hospital discharge diagnoses) were 1.58 (CI95% = 1.40 to 1.78) and 1.29 (CI95% = 1.15 to 1.45), respectively (P < .001). CHF readmission and rehospitalization rates were substantial, ranging from 16.0 to 47.5% at 1 year, depending on the criteria employed. The adjusted odds ratios for having any subsequent hospitalizations associated with having a primary or secondary hospital discharge diagnosis of CHF (compared with not having any CHF hospital discharge diagnoses) were 7.70 (CI95% = 6.20 to 9.57) and 2.99 (CI95% = 2.51 to 3.56), respectively (P < .001). The percent increases in the number of hospital episodes, total charges, and total length of stay attributable to having been hospitalized for CHF were significant (P < .001) and ranged from 15.5 to 66.7%. Having been hospitalized for CHF was also related significantly to greater increases in the mean number of functional limitations at follow-up. CONCLUSION: Hospitalization for CHF among older adults increases substantially the risk of subsequent mortality, readmission for CHF, rehospitalization for any reason, and greater functional decline. Therefore, greater attention to the prevention and management of CHF is needed.

Activities of Daily Living↗
PubMed1996

Computer reminders to implement preventive care guidelines for hospitalized patients.

BACKGROUND: Hospitalizations are an opportunity to provide preventive care. OBJECTIVE: To determine if computer reminders, which we have shown to be effective in our ambulatory care setting, increasing the provision of inpatient preventive care. METHODS: Randomized, controlled trial on the general medicine inpatient service of an urban, university-affiliated public hospital. Study subjects were 78 house staff rotating on the 6 general medicine services. The intervention was reminders to physicians printed on daily rounds reports about preventive care for which their patients were eligible, and suggested orders for preventive care provided through the physicians' workstations. The preventive care guidelines were derived from the US Preventive Care Task Force recommendations. Compliance with preventive care guidelines and house staff attitudes toward providing preventive care to hospitalized patients were the main outcome measures. RESULTS: No significant differences were seen between intervention and control physicians in compliance with preventive care guidelines in the aggregate or when individual preventive care actions individual preventive care actions were analyzed. This was true even though most physicians endorsed providing most kinds of preventive care for hospitalized patients. CONCLUSIONS: Despite past success in increasing preventive care in the outpatient setting, we were unable, using a moderately intensive intervention, to increase the provision of preventive care during hospitalizations. The physicians providing care during the hospitalization were not the patients' primary care physicians, which proved to be an important barrier. More intensive interventions, or more direct linkages between inpatient and outpatient care providers, may be required to overcome this resistance.

Adult↗
PubMed1996

The promise of computerized feedback systems for diabetes care.

Feedback control is an important mechanism for reaching a targeted goal. Biologic examples range from achieving the appropriate blood pressure level to glycemia control. Computer-based feedback control systems have many potential applications in medicine. Closed-loop systems directly sense the state of the patient and then deliver an intervention without human action. Closed-loop systems have been used to control postoperative fluid infusion, reduce malignant hypertension to a reasonable range through nitroprusside infusions, and control continuous insulin infusions-in effect, an artificial pancreas. Sensory problems have limited the direct application of closed-loop systems to date; most current medical uses of computer-based feedback control are open loop, where a human is interposed between the suggested intervention and the delivered treatment. Because many variables important to the management of diabetes are objective, many opportunities exist for open-loop control in diabetes management. Open-loop systems have already been used to suggest insulin dosage adjustments and treatment for hypercholesterolemia and to remind physicians of various mellitus. However, existing applications have only scratched the surface. Many more facets of diabetes management could be standardized and assisted by open-loop control systems if the management rules could be more exactly specified, a task requiring substantial time commitments by diabetologists. Efforts to translate existing knowledge bases into precise guidelines will be helpful, but new primary studies and decision analyses are needed to define the optimal use of some interventions.

Computers↗
PubMed1996

Computerizing guidelines: factors for success.

Clinical practice guidelines are being touted as a cure for the tension between health care cost and quality. Rather than being just a means of controlling clinicians, guidelines also offer the chance to improve the quality of care by reducing practice variation and adherence to standards of good care. To be operationalized via computers, guidelines must be accepted by the clinicians, who must fully intend to follow them. They must be timely and use available data with minimal additional data entry by clinicians. Finally, they should have a measurable effect and be shown to improve care processes and/or outcomes.

Medical Informatics Applications↗
PubMed1996

Representing CARE rules in a decision-theoretic formalism.

Improvement in the performance of reminder systems may be facilitated by the use of new representations. A decision-theoretic representation, for example, may enable a reminder system to represent and reason about the probabilities that a reminder will be a true or a false alarm and the relative utilities of these events. We extended a previously described decision-theoretic model to include such events. The model now represents explicitly the uncertainty, costs, and benefits of sending a reminder. We also extended the model to remove an assumption of reminder independence. As a step towards testing a hypothesis that this approach will support better performance than a rule-based approach, we analyzed a set of CARE rules and showed that our representation can represent these rules.

Decision Support Techniques↗
PubMed1995

Multidimensional work sampling in an outpatient pharmacy.

Multidimensional work sampling was performed at a hospital-based outpatient pharmacy. Data were collected from nine full-time and five part-time pharmacists over a 45-day baseline period. Pharmacists wore silent, random-signal generators that permitted continuous work sampling. We introduced the concept of quick codes to allow pharmacists to record their work using a single letter for repetitive activities. Pharmacists recorded 4,687 observations, 90 percent using quick codes. The most common activity was checking prescriptions (36.2 percent). Detection and correction of prescribing errors was the most common reason for their work (39.4 percent). Most work-related activities were performed alone (80 percent) with little time in contact with patients or physicians. These baseline measures will be compared with future measures to assess the effect of the implementation of computerized prospective drug utilization review and clinical treatment guidelines on pharmacists' work. It is expected that these technologic and process changes will increase opportunities for pharmacists to educate patients and consult with physicians.

Classification↗
PubMed1995

Design and implementation of the Indianapolis Network for Patient Care and Research.

We are creating a health care information network that will link a large community medical record system to three hospital emergency departments, fifty community pharmacies, ten clinics, four health-maintenance organization (HMO) offices, and twelve homeless care sites in Indianapolis, Indiana. This project will test the feasibility of linking care providers across organizational boundaries and measure the benefits of such a network. The network will supply three kinds of information services: a "mini-medical library," patient medical record information, and a citywide prescription database incorporating a computer-based prescription-writing system. The use of medical resources, the cost of care, provider time spent giving care, and providers' opinions of the services will be used as outcomes in randomized clinical trials. Through this project, we hope to expand the information base available to the target care sites; reduce unnecessary testing and increase the efficiency of care in emergency departments; improve emergency department, office, and clinic prescribing patterns; enlarge the consortium of health care providers connected by the network; and develop strategies for successfully implementing a comprehensive city medical record resource.

Ambulatory Care Facilities↗
PubMed1995

A tool for provider interaction during patient care: G-CARE.

We have extended the CARE language to facilitate interaction with providers using the Medical Gopher order entry system during patient care to create G-CARE. We have used G-CARE in several randomized controlled trials and for routine clinical applications. The language has evolved and is now able to support nearly all of the decision support. Its flexibility allows G-CARE results to be used at many points throughout the patient care process. Based on actual use of G-CARE, we have found performance issues and lack of dynamically grouped order sets are limitations which need to be addressed.

Decision Making, Computer-Assisted↗