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This article considers the government plans for the development of electronic health and patient records as set out in the NHS Plan and the progress and problems which have been encountered in their realization.
This article describes a procedure for making an interocclusal record for a remount procedure after tryin of the castings. This method can also be used for the initial mounting by substituting autopolymerizing acrylic resin copings for the metal castings.
STUDY OBJECTIVE: To determine whether use of the T-System (Emergency Services Consultants, Irving, TX) template-generated medical documentation system (1) decreases physician evaluation time in the emergency department, (2) increases gross billing under the 1997 Health Care Financing Administration guidelines by minimizing downcoding caused by inadequate documentation, and (3) increases physician satisfaction with the documentation process, compared with the undirected written narrative format. METHODS: A prospective, randomized, unblinded, controlled, convenience trial of documentation with the T-System of ED templates versus undirected written documentation was conducted in the ED of a county-owned, university-affiliated hospital. All patients seen between the hours of 7 AM and 10 PM during a 16-day period were included. The intervention was varying the method of documentation of the emergency physician. Adequacy of randomization to the 2 documentation groups was assessed by comparing ED triage classification, patient disposition, level of training of the evaluating physician, and whether ED consultation with other services occurred. Outcome measurements included emergency physician total evaluation and treatment time, professional bill, and satisfaction, as evaluated by a questionnaire completed after the study period. The 2 documentation groups were compared by an intention-to-treat analysis and by Student's t test and the median test as appropriate. RESULTS: A total of 1,228 patient encounters were included. Emergency physician total evaluation and treatment time with template-directed documentation was 4.6 minutes less than with undirected recording, a difference that was not significant (95% confidence interval [CI], -9.2 to 18.3). Gross billing was $29. 60 more per patient (95% CI, $22.20 to $37.00) with the T-System, as assessed by our hospital coders. This difference was caused by a mean.50 (95% CI,.39 to.60) higher level of evaluation and management coding. Physicians preferred the T-System (P <.0005). CONCLUSION: Use of template-assisted documentation in the ED was associated with higher gross billing and physician satisfaction but no significant decrease in emergency physician total evaluation time.
A recent General Medical Council Fitness to Practice decision has highlighted the need for clinicians and medical illustrators to be particularly aware of not only consenting patients carefully for photographs but also recording the consent adequately. This article goes through the basic consenting process that should be followed, including the capacity assessment and what information should be given to patients. It makes recommendations for dealing with more complicated scenarios such as the unconscious patient and photographing children, and gives guidelines for the use of cameras on mobile phones. Consent is a key ethical and legal issue and as this recent case has shown, can result in disciplinary proceedings if the correct procedures are not adhered to.
Interest in purchasing and installing a perinatal computerized patient record (CPR) and archiving system is growing in the United States as a result of increased patient satisfaction demands, cost containment, and quality improvement. Perinatal nurses are commonly charged with researching available computer software and hardware, making purchasing decisions, developing menus and forms, orienting users, and maintaining and upgrading systems. The decision to chart and archive by computer as well as installation and maintenance issues mandate that nurses increase their computer-related knowledge. The article reviews information related to CPR capabilities and rationales for purchase decisions, implementation and staff development issues, ergonomic and maintenance considerations, and realistic expectations of a CPR to provide perinatal nurses who are involved in purchasing, implementing, and maintaining these systems with a timely understanding of important elements that they need to know to make this effort successful.
BACKGROUND: Electronic patient records (EPRs) are increasingly being used in health care, but little is known about how EPR-based patient information is used in daily care activities, nor about its potential influence on novice training. METHOD: Seventy-two physicians and nurses participated in an eight-month study on a single pediatric ward. Eighty hours of nonparticipant observations and 20 interviews were conducted. Data were analyzed using constructivist grounded theory and visual rhetoric. RESULTS: Three main features of participant interactions with EPR-based information were identified: (1) EPR-based information was routinely transformed into paper documents; (2) these transformations were organized by profession-specific guiding principles; and (3) transformation strategies were learned through an informal curriculum. CONCLUSIONS: This study describes how and why health care professionals work around EPR-based patient information, and suggests that an EPR's visual organization may be incompatible with professional activities. The study addresses the socializing implications of these activities, and highlights their educational potential.
A computer-based system is described which records and analyses electromyographic (EMG) signals and tracking data for mandibular movements during function. EMG signals were obtained bilaterally from six muscles and a Sirognathograph monitored the position of the lower incisor teeth in three dimensions. Directed jaw movement tasks by subjects were monitored. These data were continuously sampled at a rate of 1 KHz per channel over an operator controlled period. Analysis of the data was performed off-line following the experiment. Individual chewing cycles associated with masticatory function were identified and the timing and dimensions of each chewing envelope established. Corresponding EMG values were also determined and displays of EMG and jaw movement were plotted on a common time base. An average chewing cycle and correlated EMG activity could also be displayed on a high resolution monitor and plotted for a hard copy to enable a comparison to be made between subjects with and without jaw dysfunction.
This investigation evaluates three malocclusion treatment need indices, the Handicapping Malocclusion Assessment Record (HMAR), the Occlusal Index (OI) and the Dental Aesthetic Index (DAI), for reliability and inter-index correlation. Pretreatment study models of 30 cases (mean age 12.9 years, SD 1.2) were assessed using each index. All the indices demonstrated a high level of reliability and non could be selected over the other with regards intra-examiner differences. The DAI, however, was more time-saving (2.68 mins, SD 0.41) and simple to use. The highest correlation was between HMAR and OI (r = 0.87, P < 0.001) which is a reflection of the similarity in their design. This study also discusses the limitations of the three indices.
The components of the decline in mortality from ischaemic heart disease in Finland were studied by analysing the changes in incidence and prognosis between 1972 and 1981. Using personal identification numbers, hospital discharge records and death certificates were linked for all men and women aged 40-64. During this period mortality decreased 15.9% in men and 23.5% in women, incidence 14.2% in men and 19.3% in women, being greatest among 40-49 year olds living in urban areas, and case fatality 7.3% in men and 10.3% in women, owing primarily to a decrease in patients dying of ischaemic heart disease without being admitted to hospital; survival was also better among patients admitted to hospital. Factors explaining these changes remain unknown because data on risk factors and factors influencing prognosis are limited and largely ecological.
The new "Occupational Safety and Health Act" was established in October 1972. According to the Act, the employers with 50 and more employees were bound to make an occupational health doctor provide health care for the employees within the enterprises. Considering the national background mentioned above, the author examined the actual status of the medical and health care services in order to discuss the professional function of an occupational health doctor by reviewing the records concerning the workers' health at a certain paper factory managed by the National Government, under the Government Health Insurance scheme. The results were as follows: 1) Aging of the workers had an important impact on medical service and health care provided. 2) The medical service by the occupational doctor attached to the factory differed much from that by other medical institutions outside the factory in several points; particularly in days of receiving medical consultation, medical expenditure expressed in "point score," number of injections given and the frequency of laboratory examinations. 3) as a whole, the occupational health doctor was taking a role as "the first contact doctor" in primary medical care, as well as a health officer preventing disease and promoting health in the factory, whereas the medical institutions outside the factory were rather clinically oriented in treating ill-health.
In accordance with the requirements of the Privacy Act of 1974, we are proposing to establish a new system of records, "HCFA Medicare Mortality Predictor Data File, "HHS/HCFA/ORD No. 09-70-0047. We have provided background information about the proposed system in the "Supplementary Information" section below. Although the Privacy Act requires only that the "routine uses" portion of the system be published for comment, HCFA invites comments on all portions of this notice.
In accordance with the requirements of the Privacy Act of 1974, we are proposing to amend our system of records entitled, "Payments for Interns and Residents," HHS/HCFA/BPO No. 09-70-0524. The amendment will expand the information contained in the system to include the information on interns and residents required in 42 CFR 413.86 (Direct Graduate Medical Education Payments). We have provided information about this amendment in the "Supplementary Information" section below.
Two way-communication between users and developers is a must when creating a truly functional computer-based patient record. The solution for tackling this daunting task may be to use structured requirements analysis supported by CASE tools.
In summary, security concerns surrounding health data are justified, but solutions are surmountable with currently available technologies. Whether systems are paper or electronic, human factors such as errors, negligence and unethical activities can result in breaches of confidentiality, despite optimal implementations. Neither automated teller machines (ATMs) nor EMRs are free from instances of abuse, but policies and protocols for electronic systems can be implemented that may provide better security than analogous paper record systems.
In accordance with the requirements of the Privacy Act of 1974, we are proposing to establish a new system of records, called "Health Plan Management System (HPMS),"HHS/HCFA/CHPP, No. 09-70-4004. We have provided background information about the proposed new system in the Supplementary information section below. Although the Privacy Act requires only that the "routine uses" portion of the system be published for comment, HCFA invites comments on all portions of this notice.
One of the primary objects of the Association of Health Care Information and Medical Records Officers is to ensure the supply of qualified personnel. Frank Sargeant, the association's chairman describes how it fulfils that role.
In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing this notice of a proposal to amend a routine use and change the listing of locations for the "Patients Medical record System PHS Hospitals/Clinics," HHS/HSA/BMS. We are taking these actions in order to comply with the provisions of the Omnibus Budget Reconciliation Act of 1981 (Pub. L.97-35) which requires that the PHS hospitals and clinics be closed by October 31, 1981, or converted to community use by September 30, 1982.
An eight-member task force on medical record education was created in 1985 as part of AMRA's strategic planning process and long history of commitment to education. This report on their activities was presented to the Board of Directors in September 1986. While not intended to be a definitive work plan, the recommendations in the report involve the entire AMRA membership. The task force expects and encourages extensive debate on the issues and recommendations contained herein.