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PubMed1986

Implementation of an advanced clinical and administrative hospital information system.

Over the last six years since University Hospital opened, the University Hospital Information System (UHIS) has continued to evolve to what is today an advanced administrative and clinical information system. At University Hospital UHIS is the way of conducting business. A wide range of patient care applications are operational including Patient Registration, ADT for Inpatient/Outpatient/Emergency Room visits, Advanced Order Entry/Result Reporting, Medical Records, Lab Automated Data Acquisition/Quality Control, Pharmacy, Radiology, Dietary, Respiratory Therapy, ECG, EEG, Cardiology, Physical/Occupational Therapy and Nursing. These systems and numerous financial systems have been installed in a highly tuned, efficient computer system. All applications are real-time, on-line, and data base oriented. Each system is provided with multiple data security levels, forward file recovery, and dynamic transaction backout of in-flight tasks. Sensitive medical information is safeguarded by job function passwords, identification codes, need-to-know master screens and terminal keylocks. University Hospital has an IBM 3083 CPU with five 3380 disk drives, four dual density tape drives, and a 3705 network controller. The network of 300 terminals and 100 printers is connected to the computer center by an RF broadband cable. The software is configured around the IBM/MVS operating system using CICS as the telecommunication monitor, IMS as the data base management system and PCS/ADS as the application enabling tool. The most extensive clinical system added to UHIS is the Physiological Monitoring/Patient Data Management System with serves 92 critical care beds. In keeping with the Hospital's philosophy of integrated computing, the PMS/PDMS with its network of minicomputers was linked to the UHIS system. In a pilot program, remote access to UHIS through the IBM personal computer has been implemented in several physician offices in the local community, further extending the communications horizons of University Hospital's Information System. The implications of remote access to PDMS through the IBM PC emulating a Siemens Model 420 Patient Data Management Terminal are being examined.

Artificial Intelligence↗
PubMed2003

Reducing medication errors and increasing patient safety: case studies in clinical pharmacology.

Today, reducing medication errors and improving patient safety have become common topics of discussion for the president of the United States, federal and state legislators, the insurance industry, pharmaceutical companies, health care professionals, and patients. But this is not news to clinical pharmacologists. Improving the judicious use of medications and minimizing adverse drug reactions have always been key areas of research and study for those working in clinical pharmacology. However, added to the older terms of adverse drug reactions and rational therapeutics, the now politically correct expression of medication error has emerged. Focusing on the word error has drawn attention to "prevention" and what can be done to minimize mistakes and improve patient safety. Webster's New Collegiate Dictionary has several definitions of error, but the one that seems to be most appropriate in the context of medication errors is "an act that through ingnorance, deficiency, or accident departs from or fails to achieve what should be done." What should be done is generally known as "the five rights": the right drug, right dose, right route, right time, and right patient. One can make an error of omission (failure to act correctly) or an error of commission (acted incorrectly). This article now summarizes what is currently known about medication errors and translates the information into case studies illustrating common scenarios leading to medication errors. Each case is analyzed to provide insight into how the medication error could have been prevented. "System errors" are described, and the application of failure mode effect analysis (FMEA) is presented to determine the part of the "safety net" that failed. Examples of reengineering the system to make it more "error proof" are presented. An error can be prevented. However, the practice of medicine, pharmacy, and nursing in the hospital setting is very complicated, and so many steps occur from "pen to patient" that there is a lot to analyze. Implementing safer practices requires developing safer systems. Many errors occur as a result of poor oral or written communications. Enhanced communication skills and better interactions among members of the health care team and the patient are essential. The informed consent process should be used as a patient safety tool, and the patient should be warned about material and foreseeable serious side effects and be told what signs and symptoms should be immediately reported to the physician before the patient is forced to go to the emergency department for urgent or emergency care. Last, reducing medication errors is an ongoing process of quality improvement. Faculty systems must be redesigned, and seamless, computerized integrated medication delivery must be instituted by health care professionals adequately trained to use such technological advances. Sloppy handwritten prescriptions should be replaced by computerized physician order entry, a very effective technique for reducing prescribing/ordering errors, but another far less expensive yet effective change would involve writing all drug orders in plain English, rather than continuing to use the elitists' arcane Latin words and shorthand abbreviations that are subject to misinterpretation. After all, effective communication is best accomplished when it is clear and simple.

Adult↗
PubMed2006

Developing a medical image content repository for e-learning.

The integration of medical informatics and e-learning systems could provide many advanced applications including training, knowledge management, telemedicine, etc. Currently, both the domains of e-learning and medical image have sophisticated specifications and standards. It is a great challenge to bring about integration. In this paper, we describe the development of a Web interface for searching and viewing medical images that are stored in standard medical image servers. With the creation of a Web solution, we have reduced the overheads of integration. We have packaged Digital Imaging and Communications in Medicine (DICOM) network services as a component that can be used via a Web server. The Web server constitutes a content repository for searching, editing, and storing Web-based medical image content. This is a simple method by which the use of Picture Archiving and Communication System (PACS) can be extended. We show that the content repository can easily interact and integrate with a learning system. With the integration, the user can easily generate and assign medical image content for e-learning. A Web solution might be the simplest way for system integration. The demonstration in this paper should be useful as a method of expanding the usage of medical information. The construction of a Web-based repository and integrated with a learning system may be also applicable to other domains.

Computer Security↗
PubMedDate not supplied

Physician executives straddle the digital divide.

e-Health is here to stay and experts predict that the Internet will become the hub of health care. Rapid advancements in biotechnology and medical research, increasingly curious patients who surf the Internet for medical information, and pressures from managed care companies to contain costs and speed treatments are the central components driving e-health. Despite physician reluctance to embrace the e-revolution, many hospitals and medical groups are employing the Internet and information technology to improve their customer interface, as well as to reduce business costs. This article offers seven e-strategies for health care performance improvement: (1) Supply chain management; (2) e-transactions; (3) care management; (4) improving quality; (5) boosting revenues; (6) outsourcing; and (7) provider networks (Intranets). By helping to incorporate these key e-solutions, physician executives can position their organizations for success in the new millennium.

Attitude of Health Personnel↗
PubMed2001

Web architecture for the remote browsing and analysis of distributed medical images and data.

To provide easy retrieval, integration and evaluation of multimodal medical images and data in a web browser environment, distributed application technologies and Java programming were used to develop a client-server architecture based on software agents. The server side manages secure connections and queries to heterogeneous remote databases and file systems containing patient personal and clinical data. The client side is a Java applet running in a web browser and providing a friendly medical user interface to perform queries on patient and medical test data and integrate and visualize properly the various query results. A set of tools based on Java Advanced Imaging API enables to process and analyze the retrieved bioimages, and quantify their features in different regions of interest. The platform-independence Java technology makes the developed prototype easy to be managed in a centralized form and provided in each site where an intranet or internet connection can be located. Giving the healthcare providers effective tools for browsing, querying, visualizing and evaluating comprehensively medical images and records in all locations where they can need them - e.g. emergency, operating theaters, ward, or even outpatient clinics- the implemented prototype represents an important aid in providing more efficient diagnoses and medical treatments.

Ambulatory Care Facilities↗
PubMed2004

Concept-oriented indexing of video databases: toward semantic sensitive retrieval and browsing.

Digital video now plays an important role in medical education, health care, telemedicine and other medical applications. Several content-based video retrieval (CBVR) systems have been proposed in the past, but they still suffer from the following challenging problems: semantic gap, semantic video concept modeling, semantic video classification, and concept-oriented video database indexing and access. In this paper, we propose a novel framework to make some advances toward the final goal to solve these problems. Specifically, the framework includes: 1) a semantic-sensitive video content representation framework by using principal video shots to enhance the quality of features; 2) semantic video concept interpretation by using flexible mixture model to bridge the semantic gap; 3) a novel semantic video-classifier training framework by integrating feature selection, parameter estimation, and model selection seamlessly in a single algorithm; and 4) a concept-oriented video database organization technique through a certain domain-dependent concept hierarchy to enable semantic-sensitive video retrieval and browsing.

Abstracting and Indexing↗
PubMed2000

Combining high-performance computing and networking for advanced 3-D cardiac imaging.

This paper deals with the integration of a powerful parallel computer-based image analysis and visualization system for cardiology into a hospital information system. Further services are remote access to the hospital Web server through an internet network. The visualization system includes dynamic three-dimensional representation of two types of medical images (e.g., magnetic resonance and nuclear medicine) as well as two images in the same modality (e.g., basal versus stress images). A series of software tools for quantitative image analysis developed for supporting diagnosis of cardiac disease are also available, including automated image segmentation and quantitative time evaluation of left ventricular volumes and related indices during cardiac cycle, myocardial mass, and myocardial perfusion indices. The system has been tested both at a specialized cardiologic center and for remote consultation in diagnosis of cardiac disease by using anatomical and perfusion magnetic resonance images.

Cardiac Output↗
PubMed2004

Bio-Mirror project for public bio-data distribution.

Timely worldwide distribution of biosequence and bioinformatics data depends on high performance networking and advances in Internet transport methods. The Bio-Mirror project focuses on providing up-to-date distribution of this rapidly growing and changing data. It offers FTP, Web and Rsync access to many high-volume databanks from several sites around the world. Experiments with data grids and other methods offer future improvements in biology data distribution.

Biology↗
PubMed2005

Biomedical informatics research network: building a national collaboratory to hasten the derivation of new understanding and treatment of disease.

Through support from the National Institutes of Health's National Center for Research Resources, the Biomedical Informatics Research Network (BIRN) is pioneering the use of advanced cyberinfrastructure for medical research. By synchronizing developments in advanced wide area networking, distributed computing, distributed database federation, and other emerging capabilities of e-science, the BIRN has created a collaborative environment that is paving the way for biomedical research and clinical information management. The BIRN Coordinating Center (BIRN-CC) is orchestrating the development and deployment of key infrastructure components for immediate and long-range support of biomedical and clinical research being pursued by domain scientists in three neuroimaging test beds.

Biomedical Research↗
PubMed2000

Requirements of a Web-based experiment management system.

Recent advances in tools for scientific data acquisition, visualization, and analysis have lead to growing information management problems for medical research laboratories. An exponential increase in the volume of data, combined with a proliferation of heterogeneous formats and autonomous systems, has driven the need for flexible and powerful Experiment Management Systems (EMS). This paper provides a detailed analysis of the informatics requirements of an EMS, and proposes a new type of middleware called an EMS-Building Environment (EMSBE), which enables the rapid development of web-based systems for managing laboratory data and workflow. We describe the Web-Interfacing Respository Manager (WIRM), an open-source application server for building customizable experiment management systems. WIRM is being used to manage several ongoing experiments, including a natural language processor of radiological findings, and an interdisciplinary project for studying brain function.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

[Diagnostic image management and communication systems: experience at the University of Pisa].

Our work was aimed at implementing and validating a system for the acquisition, local management and remote transmission of diagnostic images. Integration of imaging equipment was performed in each of the two sites (5 km apart) in which the Department of Radiology of the University of Pisa is divided. Teleradiology was carried out using 64 Kbit/s lines as well as a 140 Mbit/s Metropolitan Area Network compliant with the Distributed Queue Dual Bus standard. Application domains included remote expert consultation and teleprocessing of diagnostic images. Remote expert consultation was performed in particular by using the 34 Mbit/s interconnection with the Metropolitan Area Network of Florence. Remote processing of diagnostic images using the high speed link allowed the cooperative work with scientific institutions in a field often limited by the complexity of image transfer and by the lack of a timely feed-back concerning the clinical value of processed images. Advanced processing of diagnostic images was performed in the field of stereographic display of CT and MR data sets. Moreover, experience was gained in the visualization, on a single composite image, of the multiparametric data obtained by means of different MR sequences (T1, Spin Density, T2), thus allowing to summarize, by using false colors, different tissue contrast information.

Computer Communication Networks↗
PubMed2026

Osteoarthritis phenotypes: advancing precision medicine through clinical, structural, and molecular stratification.

PURPOSE: Osteoarthritis (OA) is now understood as a heterogeneous syndrome driven by diverse biological, biomechanical, metabolic, genetic, and molecular mechanisms. This variability explains differences in disease progression and treatment response, challenging the traditional "one-size-fits-all" approach. This review highlights OA phenotyping as a key step toward precision medicine, focusing on clinical, structural, and molecular classifications that inform individualized care. METHODS: A narrative review was conducted using a non-systematic search of major databases and Osteoarthritis Research Society International sources (2010-2026). Evidence was thematically synthesized across clinical, imaging, and molecular domains to characterize OA phenotypes and their potential relevance to precision medicine. RESULTS: Multiple OA phenotypes were identified: inflammatory, metabolic, biomechanical, cartilage-subchondral, pain-sensitization, and aging/senescence. These exhibit distinct clinical features, risk factors, and therapeutic responses. Imaging-based phenotypes (e.g., inflammatory, meniscus-cartilage, subchondral bone, atrophic, hypertrophic) and molecular endotypes (low turnover, structural damage, systemic inflammation) further refine stratification. Pain-structure discordance is notable in sensitization phenotypes and may predict poorer surgical outcomes. Joint-specific variations and emerging genomic and epigenetic insights underscore disease complexity. Advances in imaging, biomarkers, and machine learning may enable earlier detection and patient clustering, though clinical application remains limited. CONCLUSION: Phenotype- and endotype-based classification represents a critical advancement toward precision OA management. Tailored interventions based on stratification hold promise for improving outcomes; however, clinical translation remains limited by overlapping phenotypes, lack of validated biomarkers, and inconsistent results from phenotype-driven trials. Wider clinical adoption requires standardized definitions, validation across joints, and integration of multimodal diagnostic tools into routine practice.

Humans↗
PubMed2001

Advancing the science of symptom management.

UNLABELLED: Since the publication of the original Symptom Management Model (Larson et al. 1994), faculty and students at the University of California, San Francisco (UCSF) School of Nursing Centre for System Management have tested this model in research studies and expanded the model through collegial discussions and seminars. AIM: In this paper, we describe the evidence-based revised conceptual model, the three dimensions of the model, and the areas where further research is needed. BACKGROUND/RATIONALE: The experience of symptoms, minor to severe, prompts millions of patients to visit their healthcare providers each year. Symptoms not only create distress, but also disrupt social functioning. The management of symptoms and their resulting outcomes often become the responsibility of the patient and his or her family members. Healthcare providers have difficulty developing symptom management strategies that can be applied across acute and home-care settings because few models of symptom management have been tested empirically. To date, the majority of research on symptoms was directed toward studying a single symptom, such as pain or fatigue, or toward evaluating associated symptoms, such as depression and sleep disturbance. While this approach has advanced our understanding of some symptoms, we offer a generic symptom management model to provide direction for selecting clinical interventions, informing research, and bridging an array of symptoms associated with a variety of diseases and conditions. Finally, a broadly-based symptom management model allows the integration of science from other fields.

Holistic Nursing↗
PubMed2002

Policy initiatives to promote healthy aging.

An overwhelming array of policies and programs can be used to help older people (and future older people) maintain healthy lifestyles. How can clinicians help ensure that their patients take advantage of these opportunities? How can these broad-scope policies, educational and information initiatives, and direct service programs be turned into tools to help older people maximize health and independence? First, physicians do not need to do it all themselves. They need to know where to send their patients. For example, case managers in local aging service organizations and social workers, nurses, and discharge planners in hospitals can help connect elderly patients to appropriate benefits and services. Physicians play a critical role in creating a bridge between patients and the array of programs and information that can help them change their individual patterns of behavior. A serious lack of integration exists between what is known about healthy behaviors and lifestyles and what is really happening and available to older people today. From the earlier articles in this issue we know that much can be done to prevent many types of age-related disease and disability. This article provides examples of mechanisms that can be used to broadly disseminate knowledge about effective behavior and treatment changes and create mechanisms to turn this knowledge into real and widespread client-level, practice-level, health system, and community-wide interventions. Second, physicians need to understand that they are not merely subject to these policies and initiatives. They can help formulate and shape them. This political involvement includes active participation in policy initiatives of professional associations, involvement in research and demonstration activities, keeping informed about policy proposals at the federal and state levels, and helping advance ideas for improving health behaviors by speaking up and working toward change. These changes go beyond health initiatives to involve improving housing, nutrition, transportation, and other arenas that play a role in the health of communities and cities. According to the IOM, the most successful interventions are aimed at families, neighborhoods and communities. Interventions are also most likely to be successful when legislative, media, and marketing efforts support them [50]. These broader policies may actually have the most potential impact in terms of developing sustainable lifestyle changes that reach all Americans, especially those with the greatest health needs. Within the aging population, those with greatest health needs include members of minority groups, recent immigrants, and the old-old. These groups are often overlooked when designing and implementing health promotion programs. It is important, however, to remember, for patients and for ourselves, you are never too old to benefit from prevention.

Aged↗
PubMed2004

Case study: a health check-up for the corporate IT department.

As advances such as the electronic charting, closed-loop medication safety, physician order entry, consumer portals, electronic collaboration, and wireless access become the norm, central IS organizations are finding it difficult to keep pace. This challenge is exacerbated by declining margins, severe cost pressures, increased regulation, and added public scrutiny. Is your centralized IS organization healthy enough to meet the challenges presented by today's complex, demanding, dynamic healthcare delivery environments? How do you know? What factors do you consider?

Benchmarking↗
PubMedDate not supplied

Informatics: essential infrastructure for quality assessment and improvement in nursing.

In recent decades there have been major advances in the creation and implementation of information technologies and in the development of measures of health care quality. The premise of this article is that informatics provides essential infrastructure for quality assessment and improvement in nursing. In this context, the term quality assessment and improvement comprises both short-term processes such as continuous quality improvement (CQI) and long-term outcomes management. This premise is supported by 1) presentation of a historical perspective on quality assessment and improvement; 2) delineation of the types of data required for quality assessment and improvement; and 3) description of the current and potential uses of information technology in the acquisition, storage, transformation, and presentation of quality data, information, and knowledge.

Computer Communication Networks↗
PubMed2001

Identifying and using tools for reducing risks to patients and health care workers: a nursing perspective.

BACKGROUND: Research efforts and policy initiatives in health care errors and injury to health care workers have attracted increasing attention in recent years. An emerging theme in both these areas is the importance of organizational and other systems factors in the occurrence of medical error and health care worker injury. These commonalities call for the identification of common research efforts and, when appropriate, policy efforts. MOVING FROM HYPOTHESIS TO CONCLUSION: The proposition that health care error and worker injury are linked to the same organizational variables requires further research and deserves the same type of human factors approach that has characterized much of the investigative efforts that have occurred in the patient safety arena during the past decade. Serious problems exist with respect to access to data on staffing levels, skill mix, consecutive work hours, and other information that is crucial to examining the link between practice conditions, health care error, and health care worker injury. HUMAN FACTORS: One important resource in identifying effective approaches to prevent error and health care worker injury is the field of human factors, the discipline concerned with the design of tools, machines, and systems that takes into account human capabilities, limitations, and characteristics. CONCLUSION: The potential benefits of linking patient safety and health care worker safety efforts are significant. The research, experience, and successful practices from multiple disciplines must be utilized in identifying areas of common interest and concern in advancing work in both of these important areas.

Accidents, Occupational↗
PubMed2004

[An experience of the prescription process].

The high prevalence of drug-related illness in hospitals is now widely acknowledged. The medication pathway, from prescription to administration, can now be computerized in order to reduce the incidence of errors. The Forcilles Medical Center, with a capacity of 391 beds, is a private non profit institution integrated into the French public healthcare system, specializing in nutrition and cancer treatment directly after major surgery. Since 1980, it has gradually developed and integrated a computerized network that encompasses nearly every aspect of the administration. The computerization of the prescription process was made possible by further technological advances in 1999, giving doctors access to patients' charts and allowing them to prescribe medications within the network. A program created by the Center manages each step of the process, from prescription by the physician to dispensation by the pharmacist and, to some extent, administration by the nurse. Built-in checks at each level verify that the proper guidelines and instructions have been followed. The objective of this system is three-fold: prevention of drug-related illness at all levels of care; a more efficient prescription process; and a resulting cost reduction. This computerized system is almost complete and will be further developed. The Center's projected goals for 2004-2008 include propositions to continue to strive for optimal safety, through administration of the right medication to the right patient with the right dose at the right time.

Cost Control↗