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PubMed2003

The Maine electronic document delivery project: a cooperative project of Maine hospital libraries and the NN/LM New England Region.

The article discusses an Ariel document delivery project with seven Maine hospital libraries, the University of Massachusetts Medical School Library (UMass), and the New England Regional office of the National Network of Libraries of Medicine. Funding was awarded to six network members to purchase equipment or Ariel software. UMass served as a document provider. During the test, libraries received documents from UMass via Ariel or via the Web as a PDF document. This form of document delivery was faster than standard service with better quality of delivered articles. The column describes the project and outlines possible future steps.

Computer Communication Networks↗
PubMedDate not supplied

Impact of financial incentives on documented immunization rates in the inner city: results of a randomized controlled trial.

OBJECTIVE: This study determined the effect of 2 financial incentives---bonus and enhanced fee-for-service---on documented immunization rates during a second period of observation. METHODS: Incentives were given to 57 randomly selected inner-city physicians 4 times at 4-month intervals based on the performance of 50 randomly selected children. Coverage from linked records from all sources was determined for a subsample of children within physician offices. RESULTS: Up-to-date coverage rates documented in the charts increased significantly for children in the bonus group (49.7% to 55.6%; P <.05) and the enhanced fee-for-service group (50.8% to 58.2%; P <.01) compared with the control group. The number of immunizations given by these physicians did not change significantly, although the number of immunizations given by others and documented by physicians in the bonus group did increase (P <.05). Up-to-date coverage for all groups increased from 20 to 40 percentage points when immunizations from physician charts were combined with other sources. CONCLUSIONS: Both financial incentives produced a significant increase in coverage levels. Increases were primarily due to better documentation not to better immunizing practices. The financial incentives appeared to provide motivation to physicians but were not sufficient to overcome entrenched behavior patterns. However, true immunization coverage was substantially higher than that documented in the charts.

Child, Preschool↗
PubMed2006

Online database for documenting clinical pathology resident education.

BACKGROUND: Training of clinical pathologists is evolving and must now address the 6 core competencies described by the Accreditation Council for Graduate Medical Education (ACGME), which include patient care. A substantial portion of the patient care performed by the clinical pathology resident takes place while the resident is on call for the laboratory, a practice that provides the resident with clinical experience and assists the laboratory in providing quality service to clinicians in the hospital and surrounding community. Documenting the educational value of these on-call experiences and providing evidence of competence is difficult for residency directors. An online database of these calls, entered by residents and reviewed by faculty, would provide a mechanism for documenting and improving the education of clinical pathology residents. METHODS: With Microsoft Access we developed an online database that uses active server pages and secure sockets layer encryption to document calls to the clinical pathology resident. Using the data collected, we evaluated the efficacy of 3 interventions aimed at improving resident education. RESULTS: The database facilitated the documentation of more than 4 700 calls in the first 21 months it was online, provided archived resident-generated data to assist in serving clients, and demonstrated that 2 interventions aimed at improving resident education were successful. CONCLUSIONS: We have developed a secure online database, accessible from any computer with Internet access, that can be used to easily document clinical pathology resident education and competency.

Clinical Competence↗
PubMed2004

The effect of point-of-care personal digital assistant use on resident documentation discrepancies.

BACKGROUND: We recently found documentation discrepancies in 60% of resident daily-progress notes with respect to patient weight, medications, or vascular lines. To what extent information systems can decrease such discrepancies is unknown. OBJECTIVE: To determine whether a point-of-care personal digital assistant (PDA)-based patient record and charting system could reduce the number of resident progress-note documentation discrepancies in a neonatal intensive care unit (NICU). DESIGN/METHODS: We conducted a before-and-after trial in an academic NICU. Our intervention was a PDA-based patient record and charting system used by all NICU resident physicians over the study period. We analyzed all resident daily-progress notes from 40 randomly selected days over 4 months in both the baseline and intervention periods. Using predefined reference standards, we determined the accuracy of recorded information for patient weights, medications, and vascular lines. Logistic and Poisson regression were used in analyses to control for potential confounding factors. RESULTS: A total of 339 progress notes in the baseline period and 432 progress notes in the intervention period were reviewed. When controlling for covariates in the regression, there were significantly fewer documentation discrepancies of patient weights in notes written by using the PDA system (14.4%-4.4% of notes; odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.15-0.56). When using the PDA system, there were no significant changes in the numbers of notes with documentation discrepancies of medications (27.7%-17.1% of notes; OR: 0.63; 95% CI: 0.35-1.13) or vascular lines (33.6%-36.1% of notes; OR: 1.11; 95% CI: 0.66-1.87). CONCLUSIONS: The use of our PDA-based point-of-care patient record and charting system showed a modest benefit in reducing the number of documentation discrepancies in resident daily-progress notes. Further study of PDAs in information systems is warranted before they are widely adopted.

Computers, Handheld↗
PubMed2001

Digital image documentation for quality assessment.

OBJECTIVE: To demonstrate the feasibility of the use of digital images to document routine cases and to perform diagnostic quality assessment. METHODS: Pathologists documented cases by acquiring up to 12 digital images per case. The images were sampled at 25:1, 50:1, 100:1, 200:1, or 400:1 magnifications, according to adequacy in aiding diagnosis. After each acquisition, the referral pathologist marked a region of interest within each acquired image in order to evaluate intrinsic redundancy. The extrinsic redundancy was determined by counting the unnecessary images. Cases were randomly selected and reviewed by one pathologist. The quality of each image, the possibility of accomplishing a diagnosis based on images, and the degree of agreement was evaluated. RESULTS: During routine practice, 1469 cases were documented using 3902 images. Most of the images were acquired at higher power magnifications. From all acquired cases, 143 cases and their 373 related images were randomly selected for review. In 88.1% (126/143) of reviewed cases, it was possible to accomplish the diagnosis based on images. In 30.2% (38/126) of these cases, the reviewer considered that the diagnosis could be accomplished with fewer images. The referral pathologist and the reviewer found intrinsic redundancy in 57.8% and 54.5% of images, respectively. CONCLUSIONS: Our results showed that digital image documentation to perform diagnostic quality assessment is a feasible solution. However, owing to the impact on routine practice, guidelines for acquisition and documentation of cases may be needed.

Diagnosis↗
PubMed1996

Methods of wound assessment documentation: a study.

This study investigated whether relevant parameters of wound assessment are documented more frequently if a wound assessment chart is used. Wound assessment documents from three clinical areas were analysed. Content analysis was carried out on all of the wound assessment documents. Criteria against which to analyse the documents were formulated from a literature review. The hypothesis that relevant parameters of wound assessment were documented more frequently when a wound assessment chart was used was supported. Some criticisms and potential improvements of the wound assessment chart also emerged.

Aged↗
PubMed2000

Literature searching and document delivery: organisational issues.

An overview of financial, staffing and administrative issues regarding online literature searching and document supply is given in this article. Online literature searching and the requesting of documents have been problematic in the past due to costs and lack of information technology. Electronic document delivery requires better Internet access but MIME compatible e-mail can be used. Institutional issues regarding requests include the question 'who should order?'--the end user or intermediary ordering by the institution, and the need for trained information professionals within medical institutions. Payment mechanisms can be by credit card, institutional subscription, institutional account with the supplying library or by voucher system. Organisational Document Supply Networks (LoansomeDoc) now exist that have set charges for certain services between members or different costs for different member types and with agreed payment mechanisms. An area of increasing importance for document delivery (due to international treaties) is copyright. If such legislation is not to adversely affect information access, professionals must be involved in the creation and amendment of such legislation. Finally, a list of references are given many of which include internet addresses.

Humans↗
PubMed2001

Medical records and electronic documents: a proposal.

This article presents a global view of our proposal for a medical information system of the future. This information system focuses on patient medical records management. As most of the existing systems, it proposes to store information from patient records in a database. But records capture is different: we propose to use weakly-structured documents. Such documents contain paragraphs with some specific constraints represented by XML tags. The end-user writes new information under the form of weakly-structured documents. An internal system translates theses documents into new data for the internal database. Such a document-based user interface provides much more freedom to the end-user, and certainly reduces the distance between the physicians' way of working and the capture system.

Database Management Systems↗
PubMed2001

Systematic evaluation of computer-based nursing documentation.

The documentation of the nursing process is an important, but often neglected part of clinical documentation. Paper-based systems have been introduced to support nursing process documentation. Frequently, however, problems, such as low quality, are reported and it is still unclear if computer-based documentation systems can reduce these problems. We therefore introduced a computer-based nursing documentation system on four wards of the University Hospitals of Heidelberg. We systematically evaluated its preconditions and its effects in a pre-test post-test intervention study. We combined objective data (e.g., based on quality checklists) with subjective data drawn from questionnaires and interviews. In this paper, we present preliminary results, focussing on detailed results from the first two wards.

Attitude to Computers↗
PubMed2002

Electronic signature for medical documents--integration and evaluation of a public key infrastructure in hospitals.

OBJECTIVES: Our objectives were to determine the user-oriented and legal requirements for a Public Key Infrastructure (PKI) for electronic signatures for medical documents, and to translate these requirements into a general model for a signature system. A prototype of this model was then implemented and evaluated in clinical routine use. METHODS: Analyses of documents, processes, interviews, observations, and of the available literature supplied the foundations for the development of the signature system model. Eight participants of the Department of Dermatology of the Heidelberg University Medical Center evaluated the implemented prototype from December 2000 to January 2001, during the course of an intervention study. By means of questionnaires, interviews, observations and database analyses, the usefulness and user acceptance of the electronic signature and its integration into electronic discharge letters were established. RESULTS: Since the major part of medical documents generated in a hospital are signature-relevant, they will require electronic signatures in the future. A PKI must meet the multitude of responsibilities and security needs required in a hospital. Also, the signature functionality must be integrated directly into the workflow surrounding document creation. A developed signature model, fulfilling user-oriented and legal requirements, was implemented using hard and software components that conform to the German Signature Law. It was integrated into the existing hospital information system of the Heidelberg University Medical Center. At the end of the intervention study, the average acceptance scores achieved were mean = 3.90; SD = 0.42 on a scale of 1 (very negative attitude) to 5 (very positive attitude) for the electronic signature procedure. Acceptance of the integration into computer-supported discharge letter writing reached mean = 3.91; SD = 0.47. On average, the discharge letters were completed 7.18 days earlier. CONCLUSION: The electronic signature is indispensable for the further development of electronic patient records. Application-independent hard and software components, in accordance with the signature law, must be integrated into electronic patient records, and provided to certification services using standardized interfaces. Signature-oriented workflow and document management components are essential for user acceptance in routine clinical use.

Authorship↗
PubMed2003

The effects of latent print processing on questioned documents produced by office machine systems utilizing inkjet technology and toner.

Counterfeiting of currency and identity documents, death threats, illegitimate business transactions, and terrorist-related activities are some examples of the types of crimes that often involve documents produced from printers and copiers. Although standard protocol typically requires a questioned document (QD) examination prior to latent print (LP) processing, occasionally, items of evidence may be submitted for a QD examination following the application of a series chemicals utilized in the development of latent fingerprints. In such cases, the forensic examiner must take into account any previous treatments prior to initiating an examination on documents produced with a printer or copier. This study was devised to examine the effects of a latent print development technique [ninhydrin, physical developer, and a bleach enhancer] on the physical and chemical examination of documents produced from copiers and printers.

Journal Article↗
PubMedDate not supplied

[Musculoskeletal conditions of the upper and lower limbs as an occupational disease: what kind and under what conditions. Consensus document of a national working-group. ISPESL].

BACKGROUND AND OBJECTIVES: In via of the progressive emergence in Italy of work-related musculoskeletal disorders, the EPM Research Unit decided to set up a national working group with the aim of producing a Consensus Document including methods and criteria as an initial attempt towards managing such diseases as true "listed" work-related diseases as is already done in the other European Union countries. The working group includes experts from INAIL, ISPESL, welfare assistance institutions, local prevention and health protection services: The group's research activity was included in ISPESL's funded research plan. CONTENTS: The Consensus Document includes a review of epidemiologic issues reported in the international literature, comments on the application of current legislation, observations on the guilt profiles of employers and occupational physicians, as well as medical-legal issues. The document proposes an analytical list of musculoskeletal disorders of upper (and lower) limbs and the operational criteria for identification of working activities involving a risk from upper limb biomechanical overload. In this case, more than on other occasions, it was realized how difficult it is to adopt consolidated task/risk/damage matrices since the same task may or may not be at risk depending both on the way the task is done and on the technical aspects (lines, work parts, procedures, tools) and organization (rate, rotas, breaks). CONCLUSIONS: For the specific aims of the present document, it is possible to identify, though not exhaustively and with some limitations, a series of jobs and working conditions where the risk may be reasonably presumed and for which it is possible to adopt a list system (at least as regards "significant exposure"). The document also includes a chapter on health surveillance recommendations for the occupational physician.

Adult↗
PubMed1992

Issues in selecting and using apnea documentation systems.

The primary purpose of apnea monitoring is to ensure adequate warning of certain life-threatening respiratory and cardiac events, often in infants monitored at home. However, parents often become frustrated by frequent alarms, and other may not use the monitor at all. Unfortunately, ECRI has received a number of incident reports in which infants have died while not connected to their monitors or where a failure to monitor was suspected. We believe that some of these deaths may have been prevented if monitoring had been used properly. The most important step that parents can take to achieve effective monitoring is to faithfully follow the directions of their doctor. In an effort to ensure parental compliance, documentation capability has been added to many of today's monitors. In addition, those involved in providing patient care, especially the prescribing physicians, durable medical equipment (DME) providers, report scorers, interpreting physicians, and other clinicians, should carefully review their monitoring programs and the available documentation monitoring systems to determine how they can best meet their patients' needs. Below, we discuss the factors to consider when contemplating documented apnea monitoring and when selecting a documented monitoring system. The documentation features discussed are those we considered to be distinguishing factors among the systems evaluated in this issue and affected how we rated and ranked these units.

Apnea↗
PubMed2003

3D surface and body documentation in forensic medicine: 3-D/CAD Photogrammetry merged with 3D radiological scanning.

A main goal of forensic medicine is to document and to translate medical findings to a language and/or visualization that is readable and understandable for judicial persons and for medical laymen. Therefore, in addition to classical methods, scientific cutting-edge technologies can and should be used. Through the use of the Forensic, 3-D/CAD-supported Photogrammetric method the documentation of so-called "morphologic fingerprints" has been realized. Forensic, 3-D/CAD-supported Photogrammetry creates morphologic data models of the injury and of the suspected injury-causing instrument allowing the evaluation of a match between the injury and the instrument. In addition to the photogrammetric body surface registration, the radiological documentation provided by a volume scan (i.e., spiral, multi-detector CT, or MRI) registers the sub-surface injury, which is not visible to Photogrammetry. The new, combined method of merging Photogrammetry and Radiology data sets creates the potential to perform many kinds of reconstructions and postprocessing of (patterned) injuries in the realm of forensic medical case work. Using this merging method of colored photogrammetric surface and gray-scale radiological internal documentation, a great step towards a new kind of reality-based, high-tech wound documentation and visualization in forensic medicine is made. The combination of the methods of 3D/CAD Photogrammetry and Radiology has the advantage of being observer-independent, non-subjective, non-invasive, digitally storable over years or decades and even transferable over the web for second opinion.

Autopsy↗
PubMed2003

Effect of XML markup on retrieval of clinical documents.

OBJECTIVE: To determine the effect on clinical information retrieval of structuring typical clinical documents in XML, according to the general guidelines of Health Level Seven's Clinical Document Architecture. METHODS: One thousand clinical documents of eight frequently occurring types were deidentified and marked up in XML for access using a Web browser. Fifty information-seeking tasks were posed to subjects. The tasks were comprised of two typical clinical question types-individual patient results reporting and cohort identification. A control group of physician subjects could perform only free-text, keyword searching. The treatment group's interface permitted field-based searching of particular sections within each document. Differences in precision and other measures of search success across and between question types were investigated for statistical significance. RESULTS: No statistically significant differences were found between the control and treatment conditions in mean time elapsed or the mean number of records in the final result set. In fact, tasks performed in the treatment condition required a mean number of more steps in the search sequence to a degree that was statistically significant. Tasks performed in the treatment condition had a statistically significant lower rate of mean precision. There was no statistically significant difference between the means of relevance of the individual patient and cohort identification tasks. CONCLUSION: These findings are in line with Tange et al. who found that coarser granularity of clinical narrative gave better results. The results of this experiment also have implications for automatic text processing. Complex tag sets cannot ultimately resolve problems of unstandardized structure; the lack of existing structure within clinical documents is itself a significant limitation.

Humans↗
PubMed2004

A portable digital microphotography unit for rapid documentation of periungual nailfold capillary changes in autoimmune connective tissue diseases.

OBJECTIVE: While employing a DermLite dermoscopy unit to assess pigment pattern networks in melanocytic skin lesions, it was observed that this compact, portable dermoscopy unit can also be used to quickly detect nailfold capillary changes when entertaining a diagnosis of autoimmune connective tissue diseases (CTD) such as dermatomyositis (DM), scleroderma/systemic sclerosis (SSc), or systemic lupus erythematosus. Aware that the suppliers of the DermLite dermoscopy unit also market a portable digital microphotography unit based on the DermLite optical principles for efficiently documenting cutaneous pigment network patterns, we investigated whether this unit (DermLite Foto flash unit attached to a Nikon Coolpix digital camera) might be used to photographically document nailfold capillary changes in patients with autoimmune CTD. METHODS: A DermLite Foto flash unit attached to a Nikon Coolpix digital camera was used in a controlled observational study to obtain digital photographs of nailfold capillaries in a small sequential sample of patients with autoimmune CTD attending a rheumatic skin disease subspecialty clinic in an academic department of dermatology. RESULTS: The digital microphotography system proved to be highly useful in documenting the nailfold vascular changes observed in a small sample of patients with DM. We observed that the nailfold capillary changes seen in patients with clinically amyopathic DM were qualitatively and quantitatively similar to those seen in patients with classical DM. CONCLUSION: Digital microphotography systems designed for examining pigmented skin lesions can be used easily to document nailfold capillary changes often observed in DM and SSc. Nailfold capillary changes documented in this manner appear to be indistinguishable in clinically amyopathic DM and classical DM.

Autoimmune Diseases↗
PubMed2004

The use of an electrostatic detection device to identify individual and class characteristics on documents produced by printers and copiers--a preliminary study.

The market is inundated with inkjet printers, laser printers, and photocopiers, which are often used in criminal activities. Many of these office machines are built by various manufacturers, hence they are constructed with different hardware designs (e.g. "rolling" and "grabbing" mechanisms) that have changed over the years due to technological advances. Examinations of printed documents that involve the chemical analysis of ink colorants and the identification of physical machine defects such as trash marks are essential for the forensic examiner, but new techniques are needed to more closely identify a machine model or group of models. An electrostatic detection device (EDD) provide forensic examiners with a nondestructive method to examine indentations on a document. In this work, an EDD is used to detect latent physical markings left on documents by printers and photocopiers. Seventeen inkjet printers, 12 laser printers, and 3 photocopy machines were used to produce test documents. Physical markings were detectable in the large majority of the documents and were reproducible 100% of the time.

Journal Article↗
PubMed2004

The operative note as billing documentation: a preliminary report.

Certified professional coders from a multispecialty academic surgical practice used operative notes to identify 10 of the most common deficiencies for reimbursement of services. These 10 deficiencies were then used as evaluation criteria to audit the operative notes used as billing documentation. Twenty-four per cent of operative notes contained no deficiencies, whereas the remaining 76 per cent contained one or more audit criteria deficiencies. The three most common deficiencies identified included an incomplete description of all surgical procedures performed (56%), an inadequate description of the indications for procedures (49%), and only 45 per cent of the operative notes were dictated within 24 hours of the procedure. Thirty-nine per cent were dictated by faculty surgeons, whereas 61 per cent were dictated by surgical residents. Twenty-nine per cent of the operative notes that were dictated by faculty surgeons contained no deficiencies as compared with 20 per cent of the operative notes that were dictated by surgical residents. For a multispecialty academic surgical practice, the operative note is the document of justification for 75 per cent of revenue generated. We conclude that 1) the operative note represents the most important document for justification of reimbursement for surgical services, 2) surgeons should reassess the operative note as a billing document and provide the information necessary to expedite reimbursement, 3) surgical residents should be instructed in the details of an operative report as a billing document, and 4) most of the information needed in the operative note for billing purposes is simple and straightforward data that is important not only for reimbursement but also from a medico-legal and medical records standpoint.

Humans↗