Biomedical subjects

Lorrie K Roemer

Publications and source records attributed to Lorrie K Roemer.

8 recordsLinked to original sources

PubMed2006

Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients.

At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.

Decision Support Systems, Clinical↗

PubMed2005

KAT: a flexible XML-based knowledge authoring environment.

As part of an enterprise effort to develop new clinical information systems at Intermountain Health Care, the authors have built a knowledge authoring tool that facilitates the development and refinement of medical knowledge content. At present, users of the application can compose order sets and an assortment of other structured clinical knowledge documents based on XML schemas. The flexible nature of the application allows the immediate authoring of new types of documents once an appropriate XML schema and accompanying Web form have been developed and stored in a shared repository. The need for a knowledge acquisition tool stems largely from the desire for medical practitioners to be able to write their own content for use within clinical applications. We hypothesize that medical knowledge content for clinical use can be successfully created and maintained through XML-based document frameworks containing structured and coded knowledge.

Artificial Intelligence↗

PubMed2005

An XML model that enables the development of complex order sets by clinical experts.

Medication errors are significant and well-known problems in health care. Despite the evidence supporting the use of computerized physician order entering (CPOE) to help reduce medication errors, only a small number of hospitals in the U.S. have successfully implemented a CPOE system. Different authors have indicated that the utilization of order sets derived from best-practice standards can reduce medication errors and improve physicians' acceptance of CPOE systems. However, a variety of issues related to the development and continuous maintenance of best-practice order sets still need to be understood. This paper presents a model that supports an order set development process driven by clinical experts. Model requirements and details are presented and discussed.

Computer Simulation↗

PubMed2005

Customized document validation to support a flexible XML-based knowledge management framework.

This paper describes a validation architecture used within Intermountain Health Care's Clinical Knowledge Repository (CKR). The architecture provides additional functionality that complements XML Schema validation, producing user-friendly error messages and enabling validation rules reuse. The validation architecture helps document authors to fix their own errors. As a result, less than 1% of all documents in the CKR are considered invalid.

Information Management↗

PubMed2005

Understanding nurses' information needs and searching behaviour in acute care settings.

UNLABELLED: We report the results of a pilot study designed to describe nurses' information needs and searching behaviour in acute care settings. Several studies have indicated that nurses have unmet information needs while delivering care to patients. AIM: Identify the information needs of nurses in acute care settings. METHODS: Nurses at three hospitals were asked to use an information retrieval tool (CPG Viewer). A detailed log of their interactions with the tool was generated. RESULTS AND CONCLUSIONS: Our findings suggest that nurses' information needs are different from what is reported in the literature in terms of physicians' information needs. Questions regarding a nursing procedure or protocol were the most common needs nurses had.

Attitude of Health Personnel↗

PubMed2005

Integration of HTML documents into an XML-based knowledge repository.

The Emergency Patient Instruction Generator (EPIG) is an electronic content compiler / viewer / editor developed by Intermountain Health Care. The content is vendor-licensed HTML patient discharge instructions. This work describes the process by which discharge instructions where converted from ASCII-encoded HTML to XML, then loaded to a database for use by EPIG.

Database Management Systems↗

PubMed2004

Exploratory case method to determine the frequency of redundant orders within manually consolidated order lists.

A computerized provider order entry (CPOE) system can provide an efficient means of retrieving and consolidating order lists from multiple electronic clinical practice standards and protocols. However, the consolidated order list may contain exact duplicate or overlapping orders. Benner's framework for levels of nursing expertise can be used to explicate the variability of the nurse's responses to redundancies in order lists and the potential compromise to patient safety. An exploratory case method was performed to consolidate 74 orders from 11 sources. The consolidated order list contained 35% fewer orders after the redundant orders were removed. Our work has shown that many redundant orders may arise by consolidating order lists from multiple electronic standards. It is imperative that consolidated electronic order lists be manageable by the nurse according to their level of clinical and computer expertise, and that redundant orders are resolved before being displayed to the nurse.

Humans↗

PubMedDate not supplied

Redundancy in a computer-generated order list: meeting the needs of nurses at various levels of practice expertise.

Paper-based clinical practice standards usually pertain to a single diagnosis or clinical condition. When a computerized provider order entry system applies multiple paper-based practice standards to one patient, it generates an order list containing redundant orders. Nurses respond to redundant orders on the basis of their level of nursing expertise with clinical care, computers, and practice standard domains. In this project, orders from three practice standards were manually combined to create a single order list, resulting in 15 duplicate and overlapping orders. A relational database was developed to test the automated removal of redundant orders. As expected, the automatically evaluated order list contained only one of each duplicate order and only the parent of each overlapping order group. Orders were then grouped by related system or function for readability. It is possible to automate the removal of duplicate and overlapping orders from an order list before display to the nurse.

Algorithms↗