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Community Hospitals of Indianapolis refined commercially available software to identify when medication orders require a second look and generate an e-mail or page.
The Problem-Oriented Medical Information System (PROMIS) is a computer-based data system which was developed in the United States to provide an improved approach to clinical teaching and patient care. The introduction of this system into Australian medical schools and hospitals is proposed. PROMIS, which is now widely accepted in the United States, has shown its value in overcoming some of the deficiencies inherent in other medical records systems. The merits of the system, and the salient features of its operation, are discussed. Some potential constraints and difficulties in its implementation, none of which appears insurmountable, are outlined briefly.
Since 1988, there has been a noted increase in the use of emergency transportation by tuberculosis patients in Japan. Therefore it is necessary to build a suitable emergency medical care system for these patients. We evaluated the present emergency medical care system available to them in Tokyo. We also studied emergency medical care service areas (MCSAs) to further aid in the revision of the emergency medical care system for tuberculosis. We used data from tuberculous patients who required the use of the emergency medical care system in Tokyo. The data was collected by the Tokyo Fire Department's emergency care information system from 1978 to 1990. We investigated and analyzed data regarding transportation and patient data. We also analized transportation data from the point of view of municipal districts (wards, cities, towns, villages), MCSAs and the Tokubetsuku region. We concluded that the number of emergency transports for tuberculosis patients has gradually been increasing and that the currently MCSA regions were not ideal for use in developing a transportation system for these patients. Using larger areas such as Tokubetsu-ku and Tokyotoka would be more practical emergency medical care system for tuberculosis patients in Tokyo, it will be necessary to take into account the Tokubetsu-ku area, the vagrant population within it, and the time required to transport the patients from this area to the Tokyotoka area.
Medical coding and classification systems are expected to become increasingly important in the health care sector. Together with and as an integrated part of the electronic health information systems, the coding and classification systems will be used to improve the quality and effectiveness of the medical services. Activities connected to the different coding and classification systems are a very important component of the attempts at standardization taking place both in Norway and in the rest of Europe within the discipline medical informatics. These activities must be secured a proper professional and economic foundation. It is also of vital importance that national health authorities should participate in these activities and establish formal cooperation with professional bodies. In Norway, the Ministry of Health and Social Affairs has accepted with some miner modifications, our suggestion for a model where the Norwegian Medical Association would be responsible for the medical aspects of the coding and classification systems and for their development, and the Norwegian Centre for Medical Informatic's for organization, distribution, electronic version, integration in information systems and user assistance.
Medical decision support systems (MDSS) play an increasingly important role in medical practice. By assisting physicians with making clinical decisions, MDSS are expected to improve the quality of medical care. However, there are also concerns that malfunctioning or inappropriate use of MDSS could jeopardize the well-being of the patient. While several authors have already discussed ethical issues arising with the use of computer-assisted medical decision making, there is still no consensus about the ethically appropriate use of MDSS. Based on a review and synthesis of previous relevant work, this paper proposes a comprehensive set of recommendations for the ethical development and application of MDSS.
The study assessed the psychometric properties of the Medical Communication Behavior System. This observation system records time spent by the physicians and patients on specific behaviors in the categories of informational, relational, and negative situation behaviors by using hand-held electronic devices. The study included observations of 101 genetic counseling sessions and also assessed the outcome measures of patient knowledge and satisfaction. In addition, 41 of the sessions were rated using the Roter Interactional Analysis System, and 20 additional control subjects completed the post-counseling information without being observed to examine the effects of recording the session. Results showed good interobserver reliability, and evidence of concurrent, construct, and predictive validity. No differences were found between the observed and unobserved groups of any of the outcome measures.
A medication acceptance scale (MAS) for pediatric oral liquids was developed and used to evaluate effectiveness and infant acceptance of a medication delivery system. The MAS incorporated five behavioral elements associated with pediatric drug administration: cry, facial expression, body movement or level of agitation, reaction to placement of medication in the mouth, and swallowing. A score of 1-10 was possible, with 10 indicating the highest level of infant acceptance. Preliminary field testing was conducted. In an open-label clinical study, a single dose of acetaminophen was administered to 20 infants with approximately one fluid ounce of infant formula or apple juice by pediatric nurses using the Rx medibottle (The Medicine Bottle Company). Past medication acceptance was rated on an infant global acceptance scale. The intended dose, the amount consumed, and the time taken to administer the dose were recorded. Infant acceptance was independently scored by a nurse and two pharmacists. A high preliminary estimate of internal consistency reliability of the MAS was found. Interrater reliability was high, with the highest correlation between the two pharmacists. Sixteen (80%) of the infants received 100% of the intended dose; it took 0.5-9 minutes to administer these doses. The median MAS score was 9 for each of the three raters. Mean MAS scores for the three raters were 7.85 and 7.45 (pharmacists) and 8.50 (nurse). There was a strong correlation between MAS scores and infant global acceptance scale scores. A pediatric oral liquid MAS that had content validity, concurrent validity, high internal consistency reliability, and high interrater reliability was developed; the Rx medibottle was an effective oral liquid medication delivery system and had a high level of infant and rater acceptance.
OBJECTIVE: Medical terminological systems (TSs) play an increasingly important role in health care by supporting recording, retrieval and analysis of patient information. As the size and complexity of TSs are growing, the need arises for means to audit them, i.e. verify and maintain (logical) consistency and (semantic) correctness of their contents. This is not only important for the management of TSs but also for providing their users with confidence about the reliability of their contents. Formal methods have the potential to play an important role in the audit of TSs, although there are few empirical studies to assess the benefits of using these methods. METHODS AND MATERIAL: In this paper we propose a method based on description logics (DLs) for the audit of TSs. This method is based on the migration of the medical TS from a frame-based representation to a DL-based one. Our method is characterized by a process in which initially stringent assumptions are made about concept definitions. The assumptions allow the detection of concepts and relations that might comprise a source of logical inconsistency. If the assumptions hold then definitions are to be altered to eliminate the inconsistency, otherwise the assumptions are revised. RESULTS: In order to demonstrate the utility of the approach in a real-world case study we audit a TS in the intensive care domain and discuss decisions pertaining to building DL-based representations. This case study demonstrates that certain types of inconsistencies can indeed be detected by applying the method to a medical terminological system. CONCLUSION: The added value of the method described in this paper is that it provides a means to evaluate the compliance to a number of common modeling principles in a formal manner. The proposed method reveals potential modeling inconsistencies, helping to audit and (if possible) improve the medical TS. In this way, it contributes to providing confidence in the contents of the terminological system.
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The electronic medical knowledge data base DOPIS is a compliation of knowledge from various special fields of medicine. Using uniform nomenclature, the data are presented on demand as they would be in a book chapter. Concise updates can be performed at low cost. The primary structure of the concept is the division of medical knowledge into data banks on diagnosis, literature, medication and pharmacology, as well as so-called electronic textbooks. All data banks and electronic textbooks are connected associatively. Visual information is obtained via the image data bank connected to the diagnosis data bank and the electronic books. Moreover, DOPIS has an integrated patient findings system, as well as an image processing and archiving system with research values enabling research functions. The diagnosis and literature data banks can be modified by the user or author, or fed with their own data (a so-called Expert System Shell). For authors from special fields working on the project, an extra Medical Electronic Publishing System has been developed and made available for the electronic textbooks. The model for the knowledge data base has been developed in the field of ENT, the programme implemented and initially ENT data have been stored.
Unintended medication discrepancies at hospital admission and discharge potentially harm patients. Explicit medication reconciliation (MR) can prevent unintended discrepancies among care settings and is mandated by JCAHO for 2005. Enterprise-wide, we are linking pre-admission and discharge medication lists in our outpatient electronic health records (EHR) with our inpatient order entry applications (OE) - currently not interoperable - to support MR and inform the development of comprehensive MR among hospitalized patients.
Automated medication dispensing systems (AMDS) technology is increasingly being implemented in health care facilities to reduce the risk of medication errors. However, the case study evidence of their effectiveness has so far been mixed. It has been suggested that the attitudes of nursing staff toward AMDS can be an important factor in influencing whether or not the technology will be successfully implemented. Nurses' attitudes toward AMDS were examined at Riverview Health Centre, a long-term care facility where the Meditrol automated dispensing system had been installed the previous year. It was found that nurses were generally distrustful of AMDS and skeptical that it had reduced medication errors. A number of technological, organizational, and social factors has been put forward to explain this distrust. In addition, the efforts of hospital administrators to raise nurses' confidence in the system's reliability were also delineated.
Decentralized medication management systems (DMMSs) are used in hospitals, long-term care facilities, prisons, outpatient clinics, surgery centers, and other places to manage the distribution of drugs. DMMSs consist of storage compartments for medications, with an internal computer that controls and records the administration of drugs. Some DMMSs are stationary cabinets and others are mobile carts. There have been important advances in DMMS technology since we evaluated these products in 1996, including enhanced computer memory and processing power, wider adoption of wireless networking, better user interfaces, and greater integration with other hospital information systems. To get the most out of a DMMS purchase or upgrade, facilities will need careful planning that involves assessing their own needs, selecting hardware and software configurations that meet those needs, and then choosing the right vendor and model. A properly selected DMMS can help to enforce medication distribution policies, prevent errors, and streamline processes.
Electronic medical record (EMR) systems have much potential, however, there are still a number of issues that need to be resolved before EMRs are widely accepted. One of these issues is the data input task, a potentially serious practical barrier to on-line medical computer usage. This paper reports the empirical modelling of data input requirements for physicians who use a problem-orientated medical record system. Three statistical models (Bayesian conditional probability, multiple linear regression and discriminant analysis) to predict drug treatment given problem diagnoses are derived from EMRs of 2500 general Practice encounters. Two metrics are used to measure the predictive power of the models considering both the number of drugs correctly predicted and the strength with which the models predict them. The models are tested on 500 unseen records from the same patient-physician population and the data used to build the models. The Bayesian model produces the best predictions on unseen data and is also the easiest model to compute. A prototype interface that enables new patient cases to be entered is constructed to demonstrate how the predictive power of the model can translate into benefits in the data entry task.
Expert medical consultation systems have come of age in the last 5 years. There has been considerable progress in developing new and powerful representations for medical knowledge, microprocessor- and instrument-related expert systems, methods for knowledge acquisition and learning, and more sophisticated techniques of reasoning, explanation, and evaluation.
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OBJECTIVES: To determine the frequency of inappropriate transport by Emergency Medical Service (EMS). DESIGN: A retrospective study. SUBJECTS: Patients up to 36 months of age with medical complaints transported by EMS to an urban pediatric emergency department (ED). INTERVENTIONS: None. MEASUREMENTS: Arbitrary criteria for appropriate use of EMS transport system were developed. The age, triage status, number of previous uses of EMS, health insurance status, time of calls, chief complaint, and clinical management of patients in the ED were determined. The frequency of inappropriate use of EMS was determined and also the percentage of patients up to 36 months of age who used EMS transport system on more than one occasion. RESULTS: Charts of 341 patients were reviewed of which 126 patients (37%) could have been transported by nonemergent vehicles according to our arbitrary criteria. In addition 97 (28%) of these patients had used the EMS transport system on at least one other occasion. CONCLUSIONS: EMS is utilized for inappropriate transportation in approximately 37% of our pediatric patients less than 36 months of age with medical complaints. In addition, 28% of these same patients utilized the EMS system on more than one occasion. It would appear that education of care providers in the appropriate use of EMS and use of alternate means of transportation would make the system more efficient and productive.
A chip card based medical information system was developed as a good possibility to create a portable electronic patient record. The produced software module provides an on-line, portable diabetes medical record information system. In particular the patient data card makes the up-to-date patient's record available whenever needed. The developed Core System includes a patient record management system that has the ability to handle topics such as medical anamnesis, administrative, medical and physical examination data. Issues tackled were simplicity, data security and reporting. Customization and internationalization were also covered by presenting a novel approach using native initialization files. Proper care has been addressed during the development of the software modules for matters of security, data integrity and confidentiality.