Biomedical subjects

Roberto A Rocha

Publications and source records attributed to Roberto A Rocha.

10 recordsLinked to original sources

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↗

PubMed2004

Development of a compositional terminology model for nursing orders.

AIM: Develop a compositional terminology model for nursing orders that would conform to the existing standard health level seven (HL7) messaging standard for clinical orders. Develop and evaluate the set of attributes needed for a pre-coordinated concept for a single nursing order, using a replicable three-step modeling process. RESULTS: A terminology model for nursing orders was developed using empirical data. The model was validated against nursing research and standards literature, and evaluated using 609 nursing orders that were successfully mapped to the structure. The representative services came from 20 Intermountain Health Care (IHC) hospitals, demonstrating the generalizability of the model and its attributes across many care settings.

Health Personnel↗

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↗

PubMed2004

Detailed clinical models for sharable, executable guidelines.

The goal of shareable, executable clinical guidelines is both worthwhile and challenging. One of the largest hurdles is that of representing the necessary clinical information in a precise and shareable manner. Standard terminologies and common information models, such as the HL7 RIM, are necessary, they are not sufficient. In addition, common detailed clinical models are needed to give precise semantics and to make the task of mapping between models manageable. We discuss the experience of the SAGE project related to detailed clinical models.

Decision Support Systems, Clinical↗

PubMed2004

Integration challenges of clinical information systems developed without a shared data dictionary.

Legacy systems have proven to be long-term integration challenges for Intermountain Health Care (IHC) despite commitment and attention to share clinical information across settings and among clinicians. This study measures the extent of the disparity of data elements across three independent data systems in current use. A sample of relevant data elements was selected across systems covering prenatal, labor and delivery, and newborn intensive care units (NICU). The findings revealed only 17% of these sample data elements had compatible structure across all three systems. The implications from differences in granularity, missing data, and duplicate data entry, include diminished data quality, greater risk for medical error, increased costs of integration and inefficient use of clinician time. Retrospective guidelines for managing conceptual context and granularity are given to assist in designing an integrated longitudinal patient electronic medical record.

Delivery of Health Care, Integrated↗

PubMed2004

Integrating detailed clinical models into application development tools.

Several groups are currently working on defining detailed clinical models (also called templates or archetypes) that are refinements of abstract medical models like the HL7 (Health Level Seven) Reference Information Model. At IHC, we have created over 3,000 detailed clinical models in the last five years. These models have become an essential part of the architecture of our electronic medical record (EMR) system. As a result, we have created an increasingly sophisticated set of tools that allow the models to be searched, viewed, and ultimately incorporated into medical applications. These browsers have some commonality with terminology browsers, but are distinct in that the explicit structure of the information models must be accommodated. In this paper we report our experience in making browsers for detailed clinical models that are integrated with application authoring tools.

Information Management↗

PubMed2003

Practical evaluation of clinical guideline document models.

This project evaluates existing XML document models for the representation of clinical guidelines, as part of an effort to determine the best model to encode IHC's Care Process Models. The best model will be selected on the basis of its ability to support "Infobutton" queries at the point of care.

Evaluation Studies as Topic↗

PubMed2003

Application of an XML-based document framework to knowledge content authoring and clinical information system development.

The role of XML in health care is evolving rapidly. Coupled with other W3C standards, informaticists can design systems that may be used not only for storage and retrieval of structured knowledge, but also for quick transformation of such knowledge into many different usable formats. At Intermountain Health Care, we are currently developing an XML-based document framework to accommodate both the capture of structured knowledge as well as its transformation into several usable formats. Our objective relies upon the premise that information systems can be implemented using workflows based on structured documents.

Artificial Intelligence↗

PubMed2003

The design and implementation of a picklist authoring tool.

It is well recognized that controlled medical terminologies play a critical role in Health Information Systems and Clinical Patient Record systems, but the creation and management of customized lists of terms ("picklists") remains a potential obstacle. We have been developing a sophisticated authoring tool that is fully integrated with our terminology server and that will be made available to our system analysts and clinicians.

Dictionaries as Topic↗