[ECG recordings under working conditions. Portable cassette recorders].
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Costs and Cost Analysis↗
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[Sale of the practice and patient records. Federal court: leaving patient records is only allowed with patient consent].
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Confidentiality↗
[Are home blood pressure measurements and 24-hour ambulatory recordings superior to office measurements? Comparison of 3 blood pressure recording methods in a study of cilazapril versus atenolol].
Self-assessment of blood pressure and ambulatory blood pressure monitoring (ABPM) are being more widely used in the diagnosis and therapy of hypertension, in addition to office blood pressure measurement. The present multicenter double-blind study compared cilazapril 2.5 to 5 mg (n = 26) to atenolol 50 to 100 mg (n = 27) over a period course of eight weeks. Office blood pressures in the morning before medication, ABPM over 24 h and self assessment of the blood pressure in the morning and evening were taken. The aim of the study was to find out if the results of ABPM and self assessment of blood pressure are similar when compared to office blood pressure measurement. After four weeks of therapy both cilazapril and atenolol achieved a significant and comparable reduction of blood pressure, which did not change significantly afterwards. Both medications showed a comparable blood pressure control over 24 h. with a once-a-day regimen. The comparison of the three techniques of blood pressure measurement demonstrates that ABPM results in significantly lower average daily values than office blood pressure measurement and that the self-assessed blood pressure values in most cases lie in-between. Although the diastolic ambulatory daily values were on the average 9 mmHg lower than the corresponding office values, it was not possible for an individual patient to accurately predict the ambulatory value obtained by to his office blood pressure value. Similar results were found for the values according to self assessment of blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Temporal variability of asymptomatic embolization in carotid artery stenosis and optimal recording protocols.
BACKGROUND AND PURPOSE: Although asymptomatic embolization can be detected in patients with carotid artery stenosis, its temporal variability is unclear. An understanding of this is important in designing optimal recording protocols for future prospective studies of the predictive value of embolic signals (ES). We determined the effect of repeating and extending recording times in patients with symptomatic and asymptomatic carotid stenosis. METHODS: In 20 asymptomatic and 20 symptomatic subjects with > 60% carotid stenosis, we used transcranial Doppler ultrasound to record for ES in the ipsilateral middle cerebral artery. Three 1-hour recordings were performed on three separate days, and on one occasion (not necessarily the first) the recording was extended to 2 hours. The recordings were saved onto digital tape for subsequent blinded analysis. RESULTS: Marked temporal variability was seen in symptomatic patients in whom the cumulative proportion of subjects with ES increased from 10 (50%) after a single hour of recording to 12 (60%) and 15 (75%) after two and three recordings, respectively. Extending the recording to 2 hours increased the yield of ES-positive patients from 6 (30%) to 8 (40%). In symptomatic patients there was excellent agreement between whether patients were positive for ES during each of two consecutive 1-hour recordings (kappa = 0.78, P = 0.0003) but poor agreement between the results of two single-hour recordings performed on different days (kappa = 0.22, P = 0.27). In asymptomatic patients, 4 (20%) were ES positive during the first hour; this increased to 5 (25%) after the recording was repeated once, with no further increase after the third recording. Extending the recording to 2 hours increased the yield from 3 (15%) to 7 (35%). In contrast to symptomatic stenoses, in patients with asymptomatic stenoses there was fair agreement between whether patients were ES positive on two consecutive 1-hour recordings (kappa = 0.49, P = 0.01) or two single-hour recordings performed on different days (kappa = 0.48, P = 0.02). Symptomatic subjects were more likely to have ES (when all 1-hour recordings were considered, 24/60 versus 10/60; P = 0.0046). ES in symptomatic subjects had a higher relative intensity increase than in asymptomatic subjects (P = 0.01). CONCLUSIONS: The temporal variability of ES needs to be taken into account in the design of optimal recording protocols and comparisons of results from different studies. Extending the duration of recording beyond an hour in symptomatic stenoses is of less value, but repeating the recording on a different day will often identify additional subjects with ES. In intervention studies in symptomatic patients, the time since last symptoms must be considered. In asymptomatic stenosis, extending the duration of recording beyond an hour will increase the proportion of patients positive for ES.
Adult↗
The electronic patient record in primary care--regression or progression? A cross sectional study.
OBJECTIVES: To determine whether paperless medical records contained less information than paper based medical records and whether that information was harder to retrieve. DESIGN: Cross sectional study with review of medical records and interviews with general practitioners. SETTING: 25 general practices in Trent region. PARTICIPANTS: 53 British general practitioners (25 using paperless records and 28 using paper based records) who each provided records of 10 consultations. MAIN OUTCOME MEASURES: Content of a sample of records and doctor recall of consultations for which paperless or paper based records had been made. RESULTS: Compared with paper based records, more paperless records were fully understandable (89.2% v 69.9%, P=0.0001) and fully legible (100% v 64.3%, P < 0.0001). Paperless records were significantly more likely to have at least one diagnosis recorded (48.2% v 33.2%, P=0.05), to record that advice had been given (23.7% vs 10.7%, P=0.017), and, when a referral had been made, were more likely to contain details of the specialty (77.4% v 59.5%, P=0.03). When a prescription had been issued, paperless records were more likely to specify the drug dose (86.6% v 66.2%, P=0.005). Paperless records contained significantly more words, abbreviations, and symbols (P < 0.01 for all). At doctor interview, there was no difference between the groups for the proportion of patients or consultations that could be recalled. Doctors using paperless records were able to recall more advice given to patients (38.6% v 26.8%, P=0.03). CONCLUSION: We found no evidence to support our hypotheses that paperless records would be truncated and contain more local abbreviations; and that the absence of writing would decrease subsequent recall. Conversely we found that the paperless records compared favourably with manual records.
Adult↗
Estimation of genetic parameters based on individual and group mean records in laying hens.
(1) The study was conducted to estimate the heritability, genetic correlations and breeding values of laying hens based on individual records and group mean records. (2) Records of two pure lines from a commercial breeding programme of White Leghorns from three generations housed in single cages and in group cages were used. A total of 8483 and 8817 individual records of lines A and D, respectively, and a total of 1358 (line A) and 1161 (line D) group mean records were analysed. (3) An animal model using Restricted Maximum Likelihood (REML) was used to estimate variance components of individual records. Group mean records were analysed using the sire model, taking heterogeneity of error variance and correlated residual effects into account. Breeding values of sires were estimated based on the BLUP method using a multivariate sire model. Spearman Rank correlations were used to compare sire breeding values estimated from individual records and from group mean records. The traits studied were monthly egg production, cumulative production and egg weight. (4) Heritability estimates based on individual records were higher than from group mean records. Heritabilities for cumulative production records were higher than for monthly production, based on individual as well as group mean records. The estimates of genetic correlations between monthly egg production and cumulative production were moderate to high. Egg production and egg weight recorded individually were highly genetically correlated with those recorded on group means. Sire breeding values estimated from individual records showed high correlations with those from group mean records. (5) Differences in the ranking of sire breeding values estimated from individual vs group mean records were negligible, indicating that no genotype x environment interaction exists. Selection based on individual performance records of laying hens housed in single cages could give a good response on performance of laying hens housed in group cages. Cumulative egg production over periods 1 to 6 is the best trait for the selection programme.
Animals↗
Comparison of prescription and medical records in reflecting patient antihypertensive drug therapy.
OBJECTIVE: To determine the completeness of prescription records, and the extent to which they agreed with medical record drug entries for antihypertensive medications. SETTING: Three clinics affiliated with two staff model health maintenance organizations (HMOs). PARTICIPANTS: Randomly selected HMO enrollees (n = 982) with diagnosed hypertension. METHODS: Computer-based prescription records for antihypertensive medications were reviewed at each location using an algorithm to convert the directions-for-use codes into an amount to be consumed per day (prescribed daily dosage). The medical record was analyzed similarly for the presence of drug notations and directions for use. RESULTS: There was a high level of agreement between the medical record and prescription file with respect to identifying the drug prescribed by drug name. Between 5 and 14 percent of medical record drug entries did not have corresponding prescription records, probably reflecting patient decisions not to have prescriptions filled at HMO-affiliated pharmacies or at all. Further, 5-8 percent of dispensed prescription records did not have corresponding medical record drug entry notations, probably reflecting incomplete recording of drug information on the medical record. The percentage of agreement of medical records on dosage ranged from 68 to 70 percent across two sites. Approximately 14 percent of drug records at one location and 21 percent of records at the other had nonmatching dosage information, probably reflecting dosage changes noted on the medical record but not reflected on pharmacy records. CONCLUSIONS: In the sites studied, dispensed prescription records reasonably reflect chart drug entries for drug name, but not necessarily dosage.
Antihypertensive Agents↗
Are minidisc recorders adequate for the study of respiratory sounds?
Digital audio tape (DAT) recorders have become the de facto gold standard recording devices for lung sounds. Sound recorded on DAT is compact-disk (CD) quality with adequate sensitivity from below 20 Hz to above 20 KHz. However, DAT recorders have drawbacks. Although small, they are relatively heavy, the recording mechanism is complex and delicate, and finding one desired track out of many is inconvenient. A more recent development in portable recording devices is the minidisc (MD) recorder. These recorders are widely available, inexpensive, small and light, rugged, mechanically simple, and record digital data in tracks that may be named and accessed directly. Minidiscs hold as much recorded sound as a compact disk but in about 1/5 of the recordable area. The data compression is achieved by use of a technique known as adaptive transform acoustic coding for minidisc (ATRAC). This coding technique makes decisions about what components of the sound would not be heard by a human listener and discards the digital information that represents these sounds. Most of this compression takes place on sounds above 5.5 KHz. As the intended use of these recorders is the storage and reproduction of music, it is unknown whether ATRAC will discard or distort significant portions of typical lung sound signals. We determined the suitability of MD recorders for respiratory sound research by comparing a variety of normal and pathologic lung sounds that were digitized directly into a computer and also after recording by a DAT recorder and 2 different MD recorders (Sharp and Sony). We found that the frequency spectra and waveforms of respiratory sounds were not distorted in any important way by recording on the two MD recorders tested.
Algorithms↗
Transition to a computer-based record using scannable, structured encounter forms.
OBJECTIVE: To evaluate the quality of documentation and user satisfaction with a structured documentation system for pediatric health maintenance encounters, using scanned paper-based forms to generate an electronic medical record. DESIGN: (1) A retrospective medical record review comparing 16 structured (ST) records with 16 contemporaneously created unstructured records, (2) a questionnaire evaluation of user satisfaction, and (3) an electronic records review of patients seen 1 year following the full implementation of the system to evaluate persistence of the effect. SETTING: The Yale-New Haven Hospital Pediatric Primary Care Center, New Haven, Conn, an inner-city clinic in an academic center. PARTICIPANTS: (1) A random sample of 16 health maintenance records completed by first- and second-year residents in February 1996 matched for patient's age and provider training level with 16 contemporaneously documented visits, (2) 16 of 18 pediatric level 1 residents and 14 of 16 pediatric level 2 residents who completed questionnaires, and (3) all electronic records of health maintenance visits during February 1997. MAIN OUTCOME MEASURES: The number of data elements documented and the percentage of records that record specific components of the health maintenance encounter. User satisfaction was specified on a Likert scale. RESULTS: Overall, residents in the ST records group documented more data elements per visit than did those in the unstructured records group. The number of developmental items documented was 11.5 per visit in the ST records group and 4.8 per visit in the unstructured records group (P = .004). Likewise, anticipatory guidance was more thoroughly documented in the ST records group--8.3 items per visit vs 2.5 items per visit (P < .001). Ninety percent of the users preferred the ST records. One year after the adoption of the ST recording system, high levels of thoroughness persisted. CONCLUSIONS: Structured, scannable encounter forms can facilitate documentation of patient care and are well accepted by users. They can provide an effective mechanism to ease the transition to a computer-based patient record.
Computers↗
Effect of tape recording on perturbation measures.
Tape recorders have been shown to affect measures of voice perturbation. Few studies, however, have been conducted to quantitatively justify the use or exclusion of certain types of recorders in voice perturbation studies. This study used sinusoidal and triangular waves and synthesized vowels to compare perturbation measures extracted from directly digitized signals with those recorded and played back through various tape recorders, including 3 models of digital audio tape recorders, 2 models of analog audio cassette tape recorders, and 2 models of video tape recorders. Signal contamination for frequency perturbation values was found to be consistently minimal with digital recorders (percent jitter = 0.01%-0.02%), mildly increased with video recorders (0.05%-0.10%), moderately increased with a high-quality analog audio cassette tape recorder (0.15%), and most prominent with a low-quality analog audio cassette tape recorder (0.24%). Recorder effect on amplitude perturbation measures was lowest in digital recorders (percent shimmer = 0.09%-0.20%), mildly to moderately increased in video recorders and a high-quality analog audio cassette tape recorder (0.25%-0.45%), and most prominent in a low-quality analog audio cassette tape recorder (0.98%). The effect of cassette tape material, length of spooled tape, and duration of analysis were also tested and are discussed.
Humans↗
Expectations of patients and physicians regarding patient-accessible medical records.
BACKGROUND: Middle class populations have supported shared medical records, including Internet-accessible medical records. The attitudes of lower income populations, and of physicians, are less clear. OBJECTIVES: The objective of this study was to compare the attitudes toward shared outpatient medical records among (1) socioeconomically disadvantaged patients in community health centers, (2) insured patients in primary care offices, and (3) a broad range of physicians in outpatient practice. METHODS: Written questionnaires were provided to patients in the waiting rooms of six primary care practices in the metropolitan Denver, Colorado area. Three practices were community health centers, and three practices were primary care clinics of an academic medical center. Questionnaires were also mailed to primary care physicians in the state of Colorado. RESULTS: There was a 79% response rate for patient surveys (601 surveys returned) and a 53% response rate for physician surveys (564 surveys returned). Academic medical center patients and community health center patients were equally likely to endorse shared medical records (94% vs 96%) and Internet-accessible records (54% vs 57%). Community health center patients were more likely than academic medical center patients to anticipate the benefits of shared medical records (mean number of expected benefits = 7.9 vs 7.1, P < .001), and they were also somewhat more likely to anticipate problems with shared records. Significant predictors of patient endorsement of Internet-accessible records were previous use of the Internet (OR = 2.45, CI 1.59-3.79), the number of expected benefits (OR = 1.12 per unit, CI 1.03-1.21), anticipation of asking more questions between visits (OR = 1.73, CI 1.18-2.54), and anticipation of finding the doctors' notes to be confusing (OR = 1.50, CI 1.01-2.22). Physicians were significantly more likely than patients to anticipate that access to records would cause problems. Physicians were significantly less likely than patients to anticipate benefits (mean number of expected benefits = 4.2 vs 7.5, P < .001). CONCLUSIONS: Interest in shared medical records is not confined to a white, middle class population. Shared medical records are almost universally endorsed across a broad range of ethnic and socioeconomic groups. A majority of patients are also interested in Internet-accessible records, but a substantial minority is not. The primary determinants of support of Internet-accessible records are not age, race, or education level; rather, they are previous experience with the Internet and patients' expectations of the benefits and drawbacks of reading their medical records. Physicians have more concerns about shared medical records and see less potential for benefit. The attitudes of patients and physicians may need to be reconciled for widespread adoption of shared medial records to be achieved.
Adult↗
Use of a problem-oriented dental record in undergraduate dental education.
This paper describes how the concepts and methods of problem-orientation have been applied in the clinical education of dental students. It makes the point that the problem-oriented dental record is only one part of a complete system which has five interrelated components. The problem-oriented dental record is discussed in detail, and the paper includes examples of all four sections of the record. All sections of the record are interrelated, and the steps in identifying and resolving problems follow a logical sequence: (1) collect the data base, (2) write the cue list, (3) write the problem list, (4) write the initial plan, (5) write the final plan, and (6) record progress. The problem-oriented dental record is seen as a tool for patient care, audit, and education. The main advantage lies in the way information is organized and recorded. The record is highly communicative and permits everyone involved an opportunity to relate the data collected to the problem list and to the decisions made regarding how problems will be resolved. The record and the systems were borrowed from Weed and are being adapted for use in dentistry. Although still in the trial stages, this system has proven to have many more advantages than other record-keeping systems and is invaluable as a tool for education. In the future we plan to use computers to help store and retrieve data from these records. We anticipate that a dental education built on this record will have a lasting impact on the graduates' approach to patient care. This should result in a graduate who is conversant with medical colleagues and systematic in the collection of data, listing of problems, and resolution of patient problems. Finally, we believe that the problem-oriented dental record is also a good tool to help the dental graduate become more empathetic with patients and more aware of their total health needs. The record provides a mechanism for recording physical and emotional information as well as the oral status.
Dental Records↗
Establishing a gold standard for manual cough counting: video versus digital audio recordings.
BACKGROUND: Manual cough counting is time-consuming and laborious; however it is the standard to which automated cough monitoring devices must be compared. We have compared manual cough counting from video recordings with manual cough counting from digital audio recordings. METHODS: We studied 8 patients with chronic cough, overnight in laboratory conditions (diagnoses were 5 asthma, 1 rhinitis, 1 gastro-oesophageal reflux disease and 1 idiopathic cough). Coughs were recorded simultaneously using a video camera with infrared lighting and digital sound recording. The numbers of coughs in each 8 hour recording were counted manually, by a trained observer, in real time from the video recordings and using audio-editing software from the digital sound recordings. RESULTS: The median cough frequency was 17.8 (IQR 5.9-28.7) cough sounds per hour in the video recordings and 17.7 (6.0-29.4) coughs per hour in the digital sound recordings. There was excellent agreement between the video and digital audio cough rates; mean difference of -0.3 coughs per hour (SD +/- 0.6), 95% limits of agreement -1.5 to +0.9 coughs per hour. Video recordings had poorer sound quality even in controlled conditions and can only be analysed in real time (8 hours per recording). Digital sound recordings required 2-4 hours of analysis per recording. CONCLUSION: Manual counting of cough sounds from digital audio recordings has excellent agreement with simultaneous video recordings in laboratory conditions. We suggest that ambulatory digital audio recording is therefore ideal for validating future cough monitoring devices, as this as this can be performed in the patients own environment.
Journal Article↗
How will practices cope with information for the new GMS contract? Coronary heart disease data recording in five Scottish practices.
OBJECTIVES: To investigate whether practices will be ready for the data reporting requirements for the new General Medical Services (GMS) contract, using coronary heart disease (CHD) as an example. DESIGN: Cross-sectional survey. DATA SOURCES: Electronic general practitioner (GP) records of all CHD patients in five Scottish practices, validated by manual searches in 50 randomly selected patients in each practice. MAIN OUTCOME MEASURES: Recording of family history, smoking status, blood pressure (BP), diabetes testing, aspirin therapy and cholesterol measurement. RESULTS: It is extremely easy for practices with completely electronic patient records to extract a disease register (mean 10 min, range 38 sec to 3 hr 6 min). Extraction of a complete dataset takes several days if it involves checking through paper records, whereas setting up and running a search from electronic records is possible in less than two hours. If practices use the same clinical system and identical data entry templates, the data can be directly compared. Some items that are easily recorded as part of routine clinical practice, such as prescribing of aspirin, are well recorded, but others, such as BP recording, are more of a problem. One hundred percent of the CHD patients sampled had a BP recording within the previous year, but some practices had these data in the paper records where they were not readily accessible. CONCLUSIONS: We have shown that in Scotland there is a high level of testing and recording of all the important information regarding patients with recorded CHD, irrespective of whether practices have fully electronic records, paper-based records, or a mixture of the two. If practices have fully electronic patient records, the information can be extracted easily, but unless there is a standard template, the information can only be viewed in isolation and is of little value for comparative purposes.
Coronary Disease↗
Recording of community violence by medical and police services.
OBJECTIVES: To determine the extent to which community violence that results in injury treated in emergency departments appears in official police records and to identify age/gender groups at particular risk of under-recording by the police. METHODS: Non-confidential data for patients with assault related injury treated in the emergency departments of two hospitals in one South Wales city (Swansea) during a six month period were compared with data relating to all recorded crimes in the category "Violence against the person" in the police area where the hospitals were located. RESULTS: Over the six month period a total of 1513 assaults were recorded by Swansea emergency departments and the police (1019, 67.3% injured males and 494, 32.7% injured females). The majority of these assaults (993, 65.6%) were recorded exclusively by emergency departments; 357 (23.6%) were recorded only by the police and 163 (10.8%) were recorded by both emergency departments and the police. Equal proportions of males (67.3%) and females (67.5%) injured in assaults were recorded by both emergency departments and the police, but men were more likely to have their assault recorded exclusively in emergency departments (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.7) while women were more likely to have their assault recorded exclusively by the police (OR 2.5, 95% CI 2.0 to 3.2). There were no significant relationships between exclusive emergency department recording and increasing age (OR 1.0, 95% CI 0.9 to 1.2), exclusive police recording and increasing age (OR 1.1, 95% CI 1.0 to 1.2), or between age and dual recording (OR 0.9, 95% CI 0.8 to 1.0). CONCLUSIONS: Most assaults leading to emergency department treatment, particularly in which males were injured, were not recorded by the police. Assaults on the youngest group (0-10, particularly boys) were those least likely to be recorded by police and females over age 45, the most likely. Emergency department derived assault data provide unique perspectives of community violence and police detection.
Adolescent↗
Adoption of electronic health records in primary care pediatric practices.
BACKGROUND: Electronic health records may improve care delivery. Although professional organizations and federal agencies encourage widespread adoption, no national data are available regarding the penetration of electronic health records into primary care pediatric practices. METHODS: We used a national mail survey of 1000 randomly selected primary care pediatricians conducted from August to November 2005. RESULTS: The response rate was 58%. Overall, 21.3% of respondents had an electronic health record in their practice. The likelihood of having an electronic health record increased with practice size. Those in a practice network were more likely to have an electronic health record than those in other settings. Smaller and independent practices were less likely to be considering implementing an electronic health record. Although most electronic health records include some pediatric-specific functionality such as the ability to record immunizations, many do not offer decision support; only approximately one third included immunization prompts or alerts for abnormal laboratory results. Cost was a barrier for nearly all of those without an electronic health record; half of the respondents questioned whether electronic health records lead to improvement in quality of care, and many could not identify an electronic health record that would meet their practice requirements. CONCLUSIONS: Electronic health records are concentrated in larger and networked pediatric practices. Smaller and independent pediatric practices, the most common types of practice, are unlikely to adopt electronic health records until the cost of implementing and maintaining the systems decreases, developing standards for interoperability are adopted, and electronic health records are widely perceived to improve quality of care by practicing general pediatricians. The lack of decision support in current electronic health records may limit the ability of these tools to improve care delivery.
Attitude of Health Personnel↗
A record-keeping system for a pigeon breeding and research colony.
Seven different records were used to monitor a 2,000-bird pigeon colony. A nest card was placed on each nest box to record current production. This information was collected monthly and transferred to a breeding pair record which was used to evaluate yearly reproductive performance as well as to maintain a record of the number of offspring produced. An individual record was maintained on each bird to record it life history and pedigree. Weekly, when new offspring were banded, a squab data sheet was taken into the pen to record the offspring's permanent leg band number, hatch date, strain, pen number, and parents' band numbers. An individual pen record was used to record the leg band numbers of each bird occupying each pen. A monthly death record and a health record were maintained to monitor the colony's health status. From examination of the death record, one could determine if the mortality was excessive and if any specific pens were involved. On the health record were recorded diet, monthly morbidity and mortality, results of monitoring programs, and any treatments rendered. The system provided ready accessibility do detailed records of production, pedigrees, pen locations of birds, colony health status, and the number, strain, and age of birds available for research.
Animals↗
Computer-based patient record with a cardiologic extension.
Shortcomings of Paper Medical Records have been well recognized: limited readability, completeness, consistency, availability, structure, etc. Although electronic storage solves the problems of availability and legibility, data analysis and decision support require more than free text in electronic form. Although many information systems contain diagnoses and lab data in coded form, findings have often been left to free text. Even though the shortcomings of paper records are more pronounced in specialized care than in primary care, Dutch general practitioners have proven far more receptive to the use of computerized records. Specialists are very diverse in their domains of expertise and usually work in a complex environment: no single record would satisfy them all. Our objective is to support the specialist with the acquisition of patient data in a structured format with emphasis on history and physical exam. Important considerations have been that it will benefit physician and patient if record data can be shared, and that every specialist can record both data within, as well as outside, his domain of expertise. The philosophy of our Computer-based Patient Record model is based on two main principles: 1) A 'mother' record that can be extended with specialized subrecords. 2) A structure that supports flexible retrieval, efficient data entry and data analysis. The mother record contains information that all records have in common, but also offers the option of entering information, which has not been modeled in a subrecord. The 'face' of the mother record is the patient profile which offers the physician an overview of the status of the patient on any specified date. The profile includes diagnoses, medication, test results, and dates of previous visits. From this overview, the physician can directly access the subrecords, zoom in on data, or call another view. To avoid abrupt change in the daily routine of the physician, the interface allows the user to keep records in a rather conventional way, i.e., as free text. Yet, the interface constantly brings to attention the benefits of structured data, which will stimulate the physician to enter the data in a structured way; when most fields in the patient profile are empty, such as medication and past history, he may regret to have only entered free text in a 'summary' field. The mother record and a specialized record for the out-patient clinic of cardiac failure have been developed with the Department of Internal Medicine and the Thorax Centre of the Academic Hospital Rotterdam. The demonstration will show the versatility of both records. The application runs on a Unix platform with the use of an Interbase DBMS, OSF-Motif windows, and the Hermes kernel.
Cardiology Service, Hospital↗