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PubMed2003

Implementation of a computerized physician medication order entry system at the Academic Medical Centre in Amsterdam.

In the period 1997-2001 the Academic Medical Centre in Amsterdam implemented the computerized physician medication order entry (CPmOE) system Medicator. This article describes several important aspects of this program: technological architecture, features, implementation project, authentication and training, continuous support, human resource investments, route of prescription, logistics and administration. Furthermore important advantages and disadvantages of the CPmOE system are discussed. Advantages mainly concern patient safety and drug logistics, while disadvantages are related to access to a computer, user friendliness of the software and printer problems.

Academic Medical Centers↗
PubMed2004

Incorporating evaluation into the design of a decision-support system.

Medical decision support systems will only be accepted by the medical community if properly evaluated. However, little attention has been given in the scientific literature to the topic of how to incorporate evaluation issues into the design of a decision-support system. In this paper, we describe work in developing a decision-support system that is intended to support the management (diagnosis and treatment selection) of ventilator-associated pneumonia in patients. From the beginning of the development of this system, we have taken care to incorporate evaluation issues into the design of the system. In the paper, we analyse the problems that need be taken into account when evaluating a system. Next, we describe the consequences for the functionality of the system.

Decision Support Systems, Clinical↗
PubMed1995

Automation in pharmacy: two institutions' experiences with novel distribution systems.

A computerized medication system, implemented at Rochester (MN) Methodist Hospital in 1987, has been adopted by the hospitals at the Mayo Medical Center, Rochester, MN. A key component of the medication system, which uses individualized patient medication envelopes, is the delivery of doses of medications to nursing units just before their administration time. The system has been shown to provide greater nursing support, increase patient safety by reducing medication errors, and decrease both full-time equivalent costs and operating costs. The immediate impact of the system has been to shift dose scheduling from a nursing to a pharmacy responsibility. At Duke University, an automated pharmacy system (APS) has been in operation since October 1993 and is used to dispense the majority of unit dose drugs. The APS provides up-to-the-minute information about the drugs that patients are receiving, which is used to fill each patient's unit dose drawer. It has not dispensed an incorrect drug since its installation and has allowed centralization of the unit dose cart system. Other benefits include decreased billing labor and increased drug usage reporting.

Automation↗
PubMed2003

[How do medical facilities cope with a new medical fee system? A case study of the Kumamoto medical area].

In April 2000, a new medical fee system for hospitals designated for specific functions was introduced into the remuneration of medical services. A basic concept of this system is to pay a supplementary fee for hospital treatment during the acute treatment. In this study, in order to clarify the effect of this new system on hospital management, we performed the case study of three hospitals (Kumamoto National Hospital, Saiseikai Kumamoto Hospital and Kumamoto Chuo Hospital) located in Kumamoto medical area. As a result, in this area, the basic qualitative aspects of medical care environment, such as the number of hospital beds and long-term facilities, was found to be well equipped. In addition, three hospitals differ in following points: 1) characteristics of clinical department, 2) management strategy. In conclusion, the case of the Kumamoto medical area was considered to provide an important model of collaboration and co-operation between medical facilities toward the new medical fee system.

Economics, Hospital↗
PubMedDate not supplied

Expert systems for medical applications.

Expert systems, also known as intelligent knowledge based systems (IKBS), are computer programs which act as decision-support systems. They are currently being applied to a number of medical domains, most notably diagnosis and treatment planning. Their function is to assist the medical practitioner by giving ready access to the levels of skill shown by experts in a particular field. Much research effort has been expended but few systems have reached routine medical use. This paper presents a tutorial introduction to expert systems in medicine, explaining the basis of the technology, its current limitations and its prospective uses.

Expert Systems↗
PubMed2006

A comprehensive framework for determining the cost of an emergency medical services system.

To determine the cost of an emergency medical services (EMS) system, researchers, policymakers, and EMS providers need a framework with which to identify the components of the system that must be included in any cost calculations. Such a framework will allow for cost comparisons across studies, communities, and interventions. The objective of this article is to present an EMS cost framework. This framework was developed by a consensus panel after analysis of existing peer-reviewed and non-peer-reviewed resources, as well as independent expert input. The components of the framework include administrative overhead, bystander response, communications, equipment, human resources, information systems, medical oversight, physical plant, training, and vehicles. There is no hierarchical rank to these components; they are all necessary. Within each component, there are subcomponents that must be considered. This framework can be used to standardize the calculation of EMS system costs to a community. Standardizing the calculation of EMS cost will allow for comparisons of costs between studies, communities, and interventions.

Ambulances↗
PubMed2000

Incorporation of intraoperative computerized tomography in a newly developed spinal navigation technique.

OBJECTIVE: We report on the first successful incorporation of intraoperative computerized tomography in spinal navigation procedures. MATERIALS AND METHODS: All operations were performed with the aid of a Tomoscan M mobile CT system (Philips Medical Systems, Eindhoven, The Netherlands). The system comprises a mobile gantry, a mobile patient examination table, and a mobile workstation. Three different navigation systems were used: the EasyGuide (Philips Medical Systems, Eindhoven, The Netherlands), the Surgical Tool Navigator (Zeiss, Oberkochen, Germany), and a prototype of an ultrasound navigation system developed by ourselves (IVS GbR, Chemnitz, Germany). All surgical operations were performed with the patient positioned on the mobile table of the CT system. Following dorsal preparation of the vertebral region, the surgeon implanted small titanium screws in the vertebrae to serve as fiducial markers. Image data acquisition and image-to-patient registration were performed after implantation of the marker screws. The pedicle screws were inserted using the navigation system, and the position of each implant was confirmed by intraoperative CT scans. RESULTS: To date, 35 patients with various spine disorders have been operated upon using the technique described, and 161 pedicle screws have been inserted. There were no misplacements of pedicle screws. In three (1. 9 %) cases we observed lateral perforation (maximum 2 mm) of the lateral pedicle wall. We achieved a registration error of 0.85 mm (RMSE) +/- 0.42 mm (SD). CONCLUSIONS: The combination of intraoperative computerized tomography and spinal navigation allows easy navigation with a high application accuracy of 0.8 mm +/- 0.4 mm (SD) at the target point (measured in experiments with a plastic spine model). The possibility of performing an intraoperative quality check on demand markedly improves the safety of these procedures.

Adolescent↗
PubMed2004

The specification of a frame-based medical terminological system in Protégé.

A medical terminological system (TS) is essentially a representation of concepts, attributes and relationships pertaining to medical terms. Although the requirements and structures of TSs have enjoyed some attention in the literature, the actual implementation of TSs consisted so far of ad-hoc approaches starting from scratch. Recently, Protégé has been suggested as a software environment for the development of knowledge-based systems. In Protégé various component types interact, and knowledge can be represented at various levels. This paper investigates how to specify a frame-based TS in Protégé and demonstrates this in a specific application in the intensive care. Our approach is characterized by the utilization of a conceptual framework for understanding TSs and mapping its components onto Protégé constructs. This results in specifications of knowledge components for the implementation of terminological systems. The significance of the work stems from the generality of the specifications, thus facilitating the principled design and development of terminological systems in various medical domains

Artificial Intelligence↗
PubMed1988

Swedish physicians' perspectives on work and the medical care system--III: Private practitioners on the public system.

This paper reports the results of focused interviews in 1978-1979 with Swedish physicians in private practice about the public system of medical care in Sweden. They were asked about the system as a work environment for physicians and as a system of care for patients. Respondents, who were outside the public system (although financed mainly by public mechanisms) said the public system as a place to work had advantages in its high technical quality, facilities for research and training, and the capacity to treat complicated disease; its disadvantages were said to be inefficiency, lack of communication, poor patient care, and blocked mobility for physicians without doctorates. As a system of care, its one advantage was said to be that it provided care at less out-of-pocket cost to patients; its reported disadvantages were poor quality care and a tendency to be overly comprehensive. These perspectives are discussed with respect to their structural and historical contexts.

Ambulatory Care↗
PubMedDate not supplied

[An automated expert system for medical professional orientation of teenagers and youth].

The paper outlines a concept of the automatic medical examination system (MES) designed to aid a physician during his/her medical professional orientation. The authors propose a general MES schedule, define the term "professional inability" (in the medical sense). They provide evidence for that it is necessary to use the assessments made experts as to the professional disability of adolescents and young people who have chronic diseases and dysfunctions. The common principles in the construction of expert MES matrices are outlined. After its completion, MES may be used for purposes of medical professional orientation.

Adolescent↗
PubMed1995

[The organizational principles for the formation of a territorial medical support system for the Armed Forces].

The author of this article, Surgeon General of the Russian Armed Forces, colonel-general, MD, describes the basic principles of territorial system of medical support (TSMS) of the Army and Navy. The essence of TSMS is to realize a structural unification of medical assets, and, thus, obtain a decentralized, but autonomous command in the zones of responsibility in order to assure the most effective medical support of troops (forces) within a certain territory in peaceful time, as well as during mobilization deployment, and in the initial period of war. Medical and diagnostical procedures in the zone of responsibility will be performed by a base (zonal) military hospital (BMH) as a largest medical establishment on the given territory (capacity 400 beds and more). BMH will provide not only secondary (qualified) medical care, but also some (basic) types of tertiary (specialized) medical care. In case of disaster relief the emergency medical care will be provided at the level of a military district using the assets of a special medical detachment formed by a district military hospital. In case of disaster BMH (zone of responsibility) will form the emergency medical care teams, the other military hospitals or polyclinics will form medico-nursing teams. The system of sanitary-epidemiologic supervision, as well as sanitary-hygienic and counter-epidemic measures is formed on the basis of rational distribution of zones of responsibility between sanitary-epidemiological establishments independently of their different ministerial subordination. The basic scheme of direction over medical supply in TSMS can remain unchanged (planning and centralization), but a part of supply functions must be given to BMH in the zone of responsibility.(ABSTRACT TRUNCATED AT 250 WORDS)

Delivery of Health Care↗
PubMed1992

Image-based document management systems for medical records.

Using image scanning as a document capture mechanism at time of treatment or on day of discharge automates the medical record to achieve the larger objectives of simultaneous concurrent access to an electronic chart. This form of keyless document capture, although appearing labor intensive, is justified for improving business management and quality of care. Coupled with optical character recognition or barcode recognition for keyless data capture, medical information may be more easily made available for clinical research. Not merely a microfilm alternative, a medical record management system accelerates chart completion. Labor reduction is realized by eliminating filing and retrieval of active charts, loose sheet handling, photocopying, chart assembly, and chart location control. By reducing the reasons for chart completion delays, accelerated billing of Medicare accounts will occur, resulting in a reduction in receivables. Image-based document management systems accomplish the three things required of a senior manager in health care: (1) solve problems, (2) save money, and (3) make money.

Archives↗
PubMed1985

A computerized summary medical record system can provide more information than the standard medical record.

We assessed the ability of a computerized outpatient medical record (MR) system, the Summary Time-Oriented Record (STOR), to communicate information to clinicians in two randomized single-blind studies. In the first study, physicians were better able to predict their patients' future symptom changes and laboratory test results from outpatient visits to an arthritis clinic when STOR was added to the standard MR than when the standard MR was used alone. In a separate study, the removal of the standard MR did not result in important decrease in the physicians' ability to predict their patients' symptoms and laboratory test results if they had the option of using the full paper record when they thought they needed it. In 134 (26%) of 514 visits, the physicians exercised this option. We conclude that for outpatient visits, the computerized record system STOR operationally added information to that supplied by the full paper MR. This improved flow of information could improve the clinical decision process.

Arthritis↗
PubMed2003

Medication errors: experience of the United States Pharmacopeia (USP) MEDMARX reporting system.

Medication errors are pervasive in America's health care system. MEDMARX is an Internet-accessible, anonymous medication error reporting program designed for hospitals and health systems to systematically collect, analyze, and report medication errors. This study examined 154,816 medication error reports that were submitted to MEDMARX between January 1, 1999, and December 31, 2001. Data fields analyzed were error category (based on the National Coordinating Council for Medication Error Reporting and Prevention's Error Category Index), type(s) of error, cause(s) of error, contributing factor(s), and product(s) involved. Approximately two-thirds of the errors reported reached the patient, with relatively few causing harm. Death was reported in 19 occurrences. Errors of omission and improper dose/quantity were the most commonly reported. Performance deficit and procedure/protocol not followed were consistently identified as causes of error. Distractions and workload increase were often cited as contributing factors. There was a similar pattern of products reported in each of the years. Implications for quality assurance, clinical practice, and health policy are presented.

Adverse Drug Reaction Reporting Systems↗