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Biomedical subjects

R D Zielstorff

Publications and source records attributed to R D Zielstorff.

35 records · Page 2Linked to original sources
PubMed1988

IAIMS development at Harvard Medical School.

The long-range goal of this IAIMS development project is to achieve an Integrated Academic Information Management System for the Harvard Medical School, the Francis A. Countway Library of Medicine, and Harvard's affiliated institutions and their respective libraries. An "opportunistic, incremental" approach to planning has been devised. The projects selected for the initial phase are to implement an increasingly powerful electronic communications network, to encourage the use of a variety of bibliographic and information access techniques, and to begin an ambitious program of faculty and student education in computer science and its applications to medical education, medical care, and research. In addition, we will explore means to promote better collaboration among the separate computer science units in the various schools and hospitals. We believe that our planning approach will have relevance to other educational institutions where lack of strong central organizational control prevents a "top-down" approach to planning.

Boston↗
PubMed1985

Cost effectiveness of computerization in nursing practice and administration.

Are computer systems in nursing cost effective? The question is appropriate for some types of systems, specifically those that are circumscribed and well-defined. But most automated systems that impact nursing practice are large and diffuse, and do not lend themselves to cost effectiveness analysis. The author contends that cost benefit analysis is the more appropriate technique. This paper provides definitions of the terms used, and reviews documented examples of each type of evaluation. Nurses should learn when cost effectiveness analysis is appropriate and when it is not. They should also recognize that the more sophisticated a clinical system is in terms of data manipulation/management capabilities, the more expensive it will be, and the harder it will be to assign a dollar value to the benefits that accrue.

Computers↗
PubMed1984

Why aren't there more significant automated nursing information systems?

This article answers the question posed in the title. The author maintains the following factors must exist if a significant computerized nursing information system is to prove successful in clinical settings: a) a strong leader whose training includes research and computer sciences; b) a "good idea" that is practical, researchable, and will attract support; c) a data base amenable to computer manipulation; d) adequate resources, including administrative support, money, hardware, personnel, and authority; and e) successful implementation of the system.

Computers↗
PubMed1983

A computer-based monitoring system for follow-up of elevated blood pressure.

An automated surveillance system utilizing a computer-based medical record system (COSTAR) was designed to improve the follow-up of patients with newly identified elevated diastolic blood pressure. A population of patients was selected where, in the 6-month period following the initial measurement of an elevated diastolic blood pressure, there were fewer than two visits during which blood pressure was recorded. In a randomized controlled clinical trial, this poor follow-up population was divided into two groups, with computer-generated reminders being automatically generated for only patients in the experimental group. Follow-up was significantly improved in the group receiving the reminders, both in terms of rate of follow-up attempted or achieved by the responsible physician and in the repeated recording of blood pressure. We conclude that a computer-based reminder system improves follow-up of newly discovered elevation in diastolic blood pressure.

Adolescent↗
PubMedDate not supplied

Capturing and using clinical outcome data: implications for information systems design.

There is an urgent need to capture and record data related to clinical outcomes, but there are many barriers. The range of problems includes lack of agreement on conceptualization of the term "outcome," inadequate measures of outcomes, and inadequate information systems to capture and manipulate data that would reflect outcomes. This article focuses on information system requirements to capture, store, and utilize clinical outcome data. For greatest accuracy, outcome data should be captured as close to the source as possible, including direct data capture from patients themselves and from their families. To make maximum use of outcome data, systems must be designed to 1) store data in multipurpose databases; 2) share data across different platforms; 3) link outcome data to other data that might influence or explain outcomes; 4) allow querying of the data by authorized personnel; and 5) protect patient confidentiality.

Decision Support Systems, Management↗
PubMedDate not supplied

Online practice guidelines: issues, obstacles, and future prospects.

The "guidelines movement" was formed to reduce variability in practice, control costs, and improve patient care outcomes. Yet the overall impact on practice and outcomes has been disappointing. Evidence demonstrates that the most effective method of stimulating awareness of and compliance with best practices is computer-generated reminders provided at the point of care. This paper reviews five steps along the path from the development of a guideline to its integration into practice and the subsequent evaluation of its impact on practice and outcomes. Issues arising at each step and obstacles to moving from one step to the next are described. Last, developments that could help overcome the obstacles are highlighted. These include 1) more rapid knowledge acquisition using data mining, 2) better accommodation to imprecise knowledge in clinical algorithms using fuzzy logic, 3) development of a shareable model for guideline representation and execution, and 4) more widespread availability of clinically robust information systems that support decision-making at the point of care.

Algorithms↗
PubMedDate not supplied

Guidelines for reporting innovations in computer-based information systems for nursing.

Inconsistent, incomplete reporting of computer applications in nursing is a barrier to building a knowledge base in the field. Progress in building this knowledge base might be accelerated if system developers could use the available literature to build upon work previously done and to profit from lessons already learned. This article presents guidelines for developing articles and reports on computer applications in nursing. Important topics include statement of the problem, proposed solution, description of the system, system impact, relationship to previous work, problems encountered, lessons learned, professional issues, transferability, and future plans. A checklist is provided. The authors welcome comments on these guidelines.

Communication↗