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Biomedical subjects

P W Moorman

Publications and source records attributed to P W Moorman.

At least 19 recordsLinked to original sources
PubMed2003

An inventory of publications on computer-based medical records: an update.

OBJECTIVES: In 1998, we reported a steady increase in the number of publications indexed in MedLine with the MeSH term 'Medical Records Systems, Computerized'. No signs indicating an increasing interest of high-impact medical journals to publish on the computer-based patient record could be determined. In this review we provide an update. METHODS: We retrieved and analyzed all English publications indexed before Feb 22, 2002 in PubMed with the MeSH term 'Medical Records Systems, Computerized'. RESULTS: We retrieved a total of 5856 publications, of which 1824 (31%) appeared in a journal with an impact factor in the year of publication. The total impact-score shows an upward trend. CONCLUSIONS: The results show that the earlier observed increase in number of publications did not persist in the second half of the nineteen-nineties. Since the mid-nineties, there has been a steady yearly production of publications indexed with the MeSH term, reflecting a sustained interest in the domain. However, the volume of publications appearing in journals with higher impact factors is increasing. Furthermore, high-impact journals, such as the "British Medical Journal", the "Lancet" and "Annals of Internal Medicine" regularly publish on the subject, reflecting an interest well beyond the medical informatics community.

Abstracting and Indexing↗
PubMed2002

The methodical collection of ear surgery data as a basis for quality control.

Data relating to daily clinical practice were collected in an otologic database. Over a period of 3 years, information was gathered about 1,000 ear operations. This led to the following conclusions: the collection of data is difficult; the selection of data and the moment it should be fed into the systems are very important; there is a risk of using too many items and therefore reducing surgeon compliance. On the other hand, too few items result in irrelevant overviews. The collection of ear surgery data makes it easier to understand positive and negative outcomes.

Adult↗
PubMed2001

Effects of electronic communication between the GP and the pharmacist. The quality of medication data on admission and after discharge.

BACKGROUND: When a patient is admitted to a hospital, the need for information about the medications prescribed is an important issue. OBJECTIVES: Our aim was to assess whether electronic communication between the GP and the pharmacist provides better information regarding current medication when a patient is admitted to the hospital than paper-based communication. METHODS: A prospective study was carried out whereby on the day of admission and 10 days after discharge, three different data collectors independently asked the patient, the GP and the pharmacist details of the patient's current medication. Five GPs and a local pharmacy relying on electronic communication, and five GPs and a local pharmacy relying on paper-based communication were studied. RESULTS: A total of 139 patients were included on the first day of their admission, and 116 on the tenth day after discharge. Of the 275 drugs that the patient, the GP and/or the pharmacist reported on admission in the electronic group, 134 (49%) were reported by the patient, the GP and the pharmacist, and 79 (29%) were not reported by the patient. For the paper group, these figures were 340 drugs on admission, of which 107 (31%) were reported by the patient, the GP and the pharmacist, while 130 (38%) were not reported by the patient. CONCLUSIONS: We conclude that electronic communication between the GP and the community pharmacist results in a better agreement between them with respect to the current medication of the patient than paper-based communication. However, electronic communication does not suffice as a solution to obtain reliable information.

Clinical Pharmacy Information Systems↗
PubMed2000

Effects of electronic communication in general practice.

OBJECTIVE: To obtain insight into the effects of electronic communication on GPs by studying those publications in literature describing the effects of structured electronic clinical communication in general practice. METHODS: We retrieved all publications in the English language indexed in MEDLINE under the MESH term 'Computer Communication Networks' AND having either 'family practice' or 'primary health care' as MESH term OR 'GP', or 'GPs' as text word. RESULTS: A total of 176 publications were retrieved of which 30 publications met the criteria. In 28 of these 30 publications potential effects were described; one described claimed effects, three described demonstrated effects with subjective data and five described demonstrated effects with objective data. The studies documented, furthermore, effects on the speed of communication, the content of information and records, a change of processes involved in the communication, quality of care, costs, workload of physicians, appreciation of physicians, confidentiality, and adherence. CONCLUSIONS: We conclude that only a few studies evaluated electronic communication versus paper communication. Of these studies, only a few report improvement. Our final conclusion is that, so far, literature has not shown that the positive effects can be explained by electronic communication as such.

Computer Communication Networks↗
PubMed1999

An inventory of publications on electronic patient records.

This study describes an analysis of 1832 papers dealing with electronic patient records, and indexed in NLM's MEDLINE. Of each retrieved publication the country of origin and the journal in which it was published was determined. Furthermore, insight into the subjects of the publication was obtained by analysing the MeSH terms by which it was indexed. Since 1990 the number of publications on electronic patient records has increased. Publications originated from 43 different countries representing all continents. However, 75% stemmed from only 4 countries. The publications appeared in 379 different journals, of which 26 journals had 10 or more publications. Of all publications, 5.3% had appeared in journals with an impact factor of at least 4.5. The topics most often dealt with were: Hospital Information Systems, Computer Communication Networks, User-Computer Interface, Confidentiality and Computer Security. No obvious trends, other than an increased interest in confidentiality and computer security, were observed.

Abstracting and Indexing↗
PubMed1998

An analysis of 5 years of medical informatics publications.

This study describes an analysis of 1520 papers that were published in six medical informatics journals from 1992 through 1996, and indexed in NLM's MEDLINE. Of retrieved publications the countries of origin were determined, and insight in the subject of the publication was obtained by analysing the used MeSH terms. The main conclusion is that despite the fact that publications in medical informatics stem from a wide international community, scientific recognition can still not be demonstrated by high impact factors of journals.

Abstracting and Indexing↗
PubMed1998

Self-contained patient data in ORCA to cope with an evolving vocabulary.

Because of the benefits of standardization in healthcare data for research, decision support, and quality assessment, much research effort focuses on collection of structured patient data. Many strategies to obtain such data are based on controlled vocabularies to guide data entry in a far more flexible way than a fixed-form approach. Medical controlled vocabularies evolve, but change is difficult to reconcile with standardization. Retrieval of data, collected with different versions of vocabularies, is not straightforward and has consequences for patient care and research. There are several strategies to cope with these problems: keep each version, keep a record of changes, or conversion of previously collected data. Each of these strategies has pros and cons regarding storage consumption, performance during patient care, and research. The approach in ORCA (Open Record for Care) is based on self-contained patient data and combines the strengths of these strategies.

Humans↗
PubMed1996

A multi-strategy approach for medical records of specialists.

Despite a number of well recognized shortcomings of paper medical records, the use of a Computer Patient Record (CPR) is not widespread among specialists. The complexity of specialized care combined with the diversity of their domains of expertise, make it a challenge to design a CPR that satisfies the needs of a specialist. Ideally, CPRs are tailored to the specific tasks of each user, and yet general enough to permit exchange and sharing of information. The basic philosophy behind our CPR is a 'mother' record, which is extended with specialized sub-records. Two different types of subrecords are discussed: one to accommodate standardized data entry in the context of a specialty or research protocol, and another for structured recording of accidental findings outside one's own domain of expertise. The CPR supports the entry of free text and does not impose structured data entry on the physician, but stimulates him to do so by confronting him with the benefits of a structured CPR.

Data Display↗
PubMed1995

Descriptive features of gastric ulcers: do endoscopists agree on what they see?

BACKGROUND: Little is known about the interobserver variation between endoscopists on descriptive morphologic features. METHODS: This study describes the agreement among 10 endoscopists on their description of 12 morphologic features, using 10 photographs of gastric ulcers, and on their eventual interpretation. The endoscopists used a form with predefined options for description. RESULTS: Kappa value was on average 0.36 for descriptive features and 0.31 for interpretation. The proportion of endoscopists agreeing on descriptive features was on average 84%, and 81% on interpretations. The chance of an endoscopist describing all 12 morphologic features of an ulcer on a photograph exactly the same as a colleague ranged from 4% to 46% (average 15%). A positive correlation between agreement in description and interpretation (0.75, p < 0.05) was found. CONCLUSIONS: These results indicate a poor agreement between endoscopists in their translation of visual observations into descriptive terms. The positive correlation between agreement in description and interpretation suggests disagreement in description as an important cause for disagreement in interpretation. We believe that the use of more explicit descriptive terms will improve agreement in description and in subsequent interpretation.

Diagnosis, Differential↗
PubMed1995

A multi-strategy approach for medical records of specialists.

Despite a number of well recognized shortcomings of paper medical records, the use of Computer Patient Records (CPR) is not widespread among specialists. The complexity of specialized care combined with the diversity of their domains of expertise make it a challenge to design a CPR that satisfies the needs of a specialist. Ideally, CPRs are tailored to the specific tasks of each user, yet general enough to permit the exchange and sharing of information. The basic philosophy behind our CPR is a "mother" record, extended with specialized sub-records. Two different types of subrecords are discussed: one to accommodate standardized data entry in the context of a specialty or research protocol, and another for structured recording of accidental findings outside one's own domain of expertise. The CPR does not impose structured data entry on the physician, but stimulates her to do so by confronting her with the benefits of a structured CPR.

Medical Records↗
PubMed1994

The contents of free-text endoscopy reports: an inventory and evaluation by peers.

Insight into the current status of endoscopy reports is needed for a discussion on the desirability and feasibility of (more) standardized endoscopy reporting. We collected, from ten endoscopists, 181 reports in two diagnostic and two indication categories. An inventory was made of the subjects dealt with in the reports, such as: indication, premedication, therapy plan, and descriptive aspects of ventricular ulcers and lower tract polyps. To assess endoscopists' opinions on their reports, 16 randomly selected reports were reviewed by the ten endoscopists, using the Delphi method. The reports varied enormously in content and detail; 19 of the 28 subjects were not explicitly described in more than 50% of the studied reports. Such variation in the contents of reports may decrease the quality of care. The large number of topics that endoscopists indicate to be missing in their reports (on average 14 topics per report) suggests that more detail should be given in endoscopy reports. The current method of reporting causes endoscopists to omit information that they consider important. Due to the low overall consensus among endoscopists on which specific topics to include (eight or more endoscopists agreed on 15% of topics) we conclude that general criteria for the contents of reports cannot yet be formulated. However, the fact that the endoscopists agreed with more than one-third of the remarks made by colleagues opens a perspective towards identifying criteria for the formalization of certain report categories.

Delphi Technique↗
PubMed1994

A model for structured data entry based on explicit descriptional knowledge.

Clinical narratives in patient records are usually recorded in free text, limiting the use of this information for research, quality assessment, and decision support. This study focuses on the capture of clinical narratives in a structured format by supporting physicans with structured data entry (SDE). We analyzed and made explicit which requirements SDE should meet to be acceptable for the physician on the one hand, and generate unambiguous patient data on the other. Starting from these requirements, we found that in order to support SDE, the knowledge on which it is based needs to be made explicit: we refer to this knowledge as descriptional knowledge. We articulate the nature of this knowledge, and propose a model in which it can be formally represented. The model allows the construction of specific knowledge bases, each representing the knowledge needed to support SDE within a circumscribed domain. Data entry is made possible through a general entry program, of which the behavior is determined by a combination of user input and the content of the applicable domain knowledge base. We clarify how descriptional knowledge is represented, modeled, and used for data entry to achieve SDE, which meets the proposed requirements.

Artificial Intelligence↗
PubMed1994

Are referring physicians satisfied with endoscopy reports?

To assess the opinions of referring physicians on the contents of endoscopy reports, 150 consecutive endoscopy reports were accompanied by a questionnaire. Of these, 102 reports were returned: response was 68%. Almost half of the reports were considered not fully satisfactory. However, endoscopy reports may be improved by including information such as indication, therapy plan and follow-up plan on a more regular basis, and add clarity whether findings may account for complaints of the patient. To tailor endoscopy reports to the needs of individual referring physicians, more explicit information of referring physicians is required. If endoscopists are responsible for the information they provide to the referrer, it is also their task to facilitate the explicit formulation of preferences by the referrer.

Attitude of Health Personnel↗
PubMed1993

Integrating QMR with a computer-based patient record.

Most diagnostic decision support (DDS) systems are used as stand-alone applications. At present, the physician can only benefit from the suggestions of a DDS system if he is sufficiently motivated to re-enter patient data and run a diagnostic case analysis. If data from a computer-based patient record (CBPR) could be made available electronically to a DDS system, the use of that DDS system may become much more practical. Integrating a CBPR with a DDS system requires a mapping between two different data structures and dictionaries. We have explored a strategy to create a mapping between our CBPR and QMR. Our research has provided more general insight in the potential and limitations of such a mapping.

Computer Systems↗
PubMed1992

Towards unambiguous representation of patient data.

In the early eighties, the goal set for the development of computer-based patient records was the creation of patient records that were analogous to the paper record. In the Netherlands, where the number of physicians using computer-based patient records is steadily increasing, this strategy has been proven successful. Although these "paper-like" computer-based patient records were suitable for patient care, they were much less suited for other purposes. Experiments showed that the use of data for other purposes than those for which they were recorded, can only be performed reliably when these data permit unambiguous interpretation. Due to a physician's limited time there is a constant tension between benefit and effort. Therefore, we should not expect the physician to provide the large amount of additional information, required for unambiguous interpretation of his record. Many of the inferences made by physicians are based on general knowledge and do not require specific, patient related information. We have focused our research on the potential of using knowledge about concepts in the patient record, to infer information, that is implicit in the patient data. The paper discusses considerations with respect to possible strategies to elicit a maximum of information with a minimum of effort from the physician.

Forms and Records Control↗
PubMedDate not supplied

Shared care for diabetes: supporting communication between primary and secondary care.

OBJECTIVE: To assess the effects on information exchange of electronic communication between physicians co-treating diabetic patients. DESIGN: Comparison of traditional paper-based communication for reporting and electronic communication. SETTING: General practitioners and an internal medicine outpatient clinic of an urban public hospital. SUBJECTS: A total of 275 diabetic patients, and the 32 general practitioners and one internal medicine consultant who cared for them. INTERVENTION: An electronic communication network, linking up the computer-based patient records of the physicians, thus enabling electronic data interchange. MAIN OUTCOME MEASURES: Number of letters sent and received per year by the general practitioners, the number of diabetes-related parameters (e.g. results of laboratory tests) in the patient records, and HBA1C levels. RESULTS: INTERVENTION GPs received more messages per year (1.6 per patient) than control GPs (0.5 per patient, P<0.05). Significant higher availability (P<0.05) was achieved for data on HBA1C levels, fructosamine levels, blood pressure measurements, cholesterol levels, triglyceride levels and weight measurements. INTERVENTION patients showed a slight but significant decrease of HBA1C levels in the second semester of 1994 (from 7.0 to 6.8, P = 0.03), control patients also showed a slightly decreased group mean, but this change was not significant (from 6.6 to 6.5, P = 0.52). The magnitudes of these mean differences, however, were not significantly different (intervention group: 0.21; control group: 0.12, P = 0.68). CONCLUSIONS: The electronic communication network for exchanging consultation outcomes significantly increased frequency of communication and the availability of data to the general practitioner on diagnostic procedures performed in the hospital, thus providing more complete information about the care that patients are receiving. A large-scale experiment over a longer period of time is needed to assess the effects of improved communication on quality of care.

Adult↗