Electronic data processing in private hospitals: patient privacy, confidentiality and control.
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This article deals with the ethical and moral dilemmas the nursing profession faces today in regards to issues related to the computer technology. Such ethical dilemmas in nursing have been documented in four major areas: (a) Safeguarding confidentiality, (b) determining the right to know and the right to decide, (c) allocating limited resources, and (d) maintaining professional standards.
A data collection system on microcomputer was developed for patients with malignant diseases in ambulant aftercare. At the same time when patient data are collected to be sent to a central medicostatistical plotting station, as it is usual in Austrian hospitals, a file for further aftercare is opened. By data transfer to other software products, statistical data evaluation is possible. Patients can also be called to hospital for different reasons.
We developed a program for personal computers which selects platelet donors for a given patient according to the following criteria: 1. Anti-CMV-status, 2. ABO-compatibility of various degrees, and 3. HLA-incompatibility. For evaluation of HLA-incompatibility, we created a score which presently provides the following classification: 0 = identical antigen, 5 = same supertypic antigen or blank in the donor, 50 = very frequently cross-reactive antigen, 75 = frequently cross-reactive antigen, very rare antigen or antigen poorly expressed on platelets in the donor, 100 = mismatch.
The definition of terms using the blood bank data dictionary results in a number of advantages in practice. Previously vague terms could be clearly defined when they are broken down into their constituent parts. The relationships within a blood bank can be more precisely documented by working with standard terms. The descriptions within the specification are thereby unambiguous and in this way a precise program specification can be achieved. Standardized terms facilitate the functional comparison of programs from different authors or different software sources. The use of defined terms within wards and the blood bank area results in more transparency even before the introduction of data processing.
A clinical database, using FileMaker Pro and a network of APPLE Macintosh computers, were created for a vascular surgical unit. The databank presented here is based on proven, routine working procedures of the department. An easily learnable entry facility with hands-on, screen-oriented users' guide and help data file provide easy operability and highly efficient databank capability, along with great flexibility. This criterial and user-friendly features make staff acceptance and compliance readily achievable, thus assuring comprehensive data entry.
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A software package was developed for computerized recording and processing of clinical data in a urological out-patient clinic. In a pilot study this program proved to be useful for the rapid evaluation of all important clinical and laboratory results of patients with renal cell carcinoma, and its use also accelerated the preparation of medical reports. The experience gained in this initial project shows that the application of this newly developed concept of data processing can easily be extended to routine out-patient followup in other special areas within the field of oncology.
For a successful computer-installation in the medical area you need a staff, which is used to work with computers in the daily routine. We tried with this project to establish the computer in a medical office by doing the whole patient-related writings on a specially tailored software. Most of the daily routine can now be done with the help of the computer. A certain time-saving effect could be achieved, although this was not our first aim. On this base we are now able to solve other problems such as coding, statistics or archiving routines by using our established computer environment.
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In the eye bank of the second department of ophthalmology a computerized data base system was implemented for registration, documentation and analysis of all data on corneal donors and recipients. The aim was to reduce the necessity of handwritten forms and to increase safety of documentation. In addition, programs for automated HLA matching and digital image analysis for corneal endothelium have been developed.
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