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PubMedDate not supplied

Pandora's box: physician order entry and nursing work redesign.

The Canadian health care industry is undergoing unprecedented restructuring in response to the quest for quality management and cost reduction. Physician order entry and on-line results viewing within a fully integrated hospital clinical information system is often thought to be essential to maximum quality management, cost control, and clinical decision support. Using Hackman and Oldham's Job Characteristics model (1989) as a grounding for discussion, this author examines the impact of computerized physician order entry and on-line results viewing on the intrinsic meaning of nursing work and its subsequent redesign. This paper explores the historical meaning of nursing work related to the manual transcription of physician's orders, and contemplates the implications for future nursing work and research. Until now there has been little discussion in the current informatics literature on this topic.

Attitude of Health Personnel↗
PubMed2002

Increasing the success of physician order entry through human factors engineering.

Even though the success of a physician order entry (POE) system depends on meeting physicians' needs, no studies of POE systems report using standard, formal methods for assessing physician needs and how to design the best technology to meet those needs. To increase the chance of a successful POE implementation, the article proposes that techniques from the field of human factors engineering (HFE) be used to enhance the interaction between technology and the physicians.

Attitude to Computers↗
PubMedDate not supplied

[An evaluation of the efficacy of nitrates (transdermal and peroral) in the management of the patient with a myocardial contusion].

Although thoracic trauma is frequently accompanied by myocardial injury; this later is often oversighted at early stages of trauma and misdiagnosed by the time complications are present. Myocardial abnormalities have been attributed to a reduction of cardiac flow. Nitroglycerin and isosorbide dinitrate, both agents with a known vasodilator effect on coronary arteries, might improve myocardial ischemic resulting from traumatic contusion. In order to compare safety and efficacy between two nitrates and placebo on myocardial contusion resulting from thoracic trauma, we carried out a comparative, prospective, single blind study. Subjects were randomly allocated to one of the following 3 groups: a) transdermal nitroglycerin, b) isosorbide dinitrate and c) placebo. Medication was dispensed for five days. Major endpoint were electrocardiographic abnormalities at entry and their final modifications. Other were severity injury score and myocardial enzyme levels. Twelve patients were included in each group. Four measured enzymes were high at entry, but MB fraction in the nitroglycerin group showed the most rapid normalization. Creatine phosphokinase and lactic dehydrogenase significantly correlated with severity injury index, but not MB fraction. Electrocardiographic normalization was mainly observed in the nitroglycerin group. Transdermal nitroglycerin systems demonstrated to be effective on recovering from electrocardiographic abnormalities resulting of myocardial contusion.

Administration, Cutaneous↗
PubMed2001

[Development and integration of the Oncological Documentation System ODS].

PURPOSE: To simplify clinical routine and to improve medical quality without exceeding the existing resources. Intensifying communication and cooperation between all institutions of patients' health care. The huge amount of documentation work of physicians can no longer be done without modern tools of paperless data processing. METHODS: The development of ODS was a tight cooperation between physician and technician which resulted in a mutual understanding and led to a high level of user convenience. - At present all cases of gynecology, especially gynecologic oncology can be documented and processed by ODS. Users easily will adopt the system as data entry within different program areas follows the same rules. In addition users can choose between an individual input of data and assistants guiding them through highly specific areas of documentation. RESULTS: ODS is a modern, modular structured and very fast multiuser database environment for in- and outpatient documentation. It automatically generates a lot of reports for clinical day to day business. Statistical routines will help the user reflecting his work and its quality. Documentation of clinical trials according to the GCP guidelines can be done by ODS using the internet or offline datasharing. CONCLUSIONS: As ODS is the synthesis of a computer based patient administration system and an oncological documentation database, it represents the basis for the construction of the electronical patient chart as well as the digital documentation of clinical trials. The introduction of this new technology to physicians and nurses has to be done slowly and carefully, in order to increase motivation and to improve the results.

Clinical Trials as Topic↗
PubMed2003

Nursing informatics: the key to unlocking contemporary nursing practice.

Nursing informatics is a relatively new nursing specialty. Recognized by the American Nurses' Association in 1992, this field within nursing has grown exponentially. Once the purview of highly specialized individuals, nursing informatics has now crept into all dimensions of nursing, from domain of advanced nurse practitioners to prominence in critical care nursing. Nowhere is the management and processing of health-related information more important than in the care of the critically ill patient. Fast-paced environments, split-second decision making, wireless communications, monitoring systems run with computerized backbones, and computerized ordering and documentation, all things unimaginable just a decade ago, are now fundamental to nursing practice. Each requires a baseline understanding of informatics for true mastery. The domain of nursing informatics continues to grow as nursing incorporates expanded roles and new technology into practice. Education for nurse informaticians includes preparation from the baccalaureate level through the doctorate level and national board certification. Areas of practice are expansive, including hospitals, industry, education, policy-making, research, administration, and international settings. Although informaticians work with computers, computing technology is not the heart of the domain. Computers are simply tools that are used. Examples of informatics tools include handheld devices, point-of-care documentation, computerized provider order entry, and bar code medication administration. Nursing informatics plays an essential role in the future directions of healthcare by defining the relationship between nurses and information technology as well as the knowledge that can be gained when these domains work together.

Biomedical Technology↗
PubMed2002

[New development of a cytological examination ordering system at Osaka National Hospital].

Effective and rapid use of cytological data are issue in Japan. We addressed this problem by development of an ordering system for cytological examinations at Osaka National Hospital. This system is located in the department of pathology and is a client-server system that consisted of 1 server and 6 clients. Five of the 6 clients are related to cytology and there are connections to microscopes with digital cameras. One client is for acceptance of cytological specimens at the department of pathology. Through a local area network, 100 Mbps, this system is connected to the hospital information system, which is of the order-entry type. After a clinician orders a cytological examination, these data are sent to both the Accounts and Pathology departments. A small bar-code label is simultaneously printed out, which is stuck on the form. By checking this label at the department of pathology by using a label reader, relevant clinical information is sent to the pathology server. After the cytological diagnosis has been made by senior cytotechnologist and cytopathologist, data on the diagnosis and microscopic images are sent to the hospital information system. Thus, clinicians can review the cytological diagnosis together with the photomicrographs. This new cytology system has brought great benefits to both cytotechnologist and clinicians with regard to the rapid transfer of cytological examination, and it seems to contribute to more advanced and efficient medical care.

Cytodiagnosis↗
PubMed2003

Rapid deployment of physician order entry using web-based, disease-specific order sets.

Computerized physician order entry (POE) is a disruptive technology that holds great promise to reduce medical errors and improve workflow. However, Studies have reported significant physician resistance. This presentation will describe a two-pronged strategy to build broad support for POE: To build a secure, open source, browser-based platform to support POE and create a large number of disease-specific order-sets for immediate use. This presentation will demonstrate the conceptual framework and implementation requirements for such an endeavor.

Attitude of Health Personnel↗
PubMed2005

[Register of treated psychoactive drug addicts].

In the order to accomplish data collection for the Treated Psychoactive Drug Addicts Registry, the Drug Abuse Registration Program has been developed according to the adapted Council of Europe Pompidou group questionnaire. The main goals of the system are: introduction of a local database, implementation of standard data consistency control algorithm, personal data protection and connection to public health network. Paper forms are being gradually discarded. The procedure of registration proposed will improve data quality, increase promptness of data entry, and enable feedback from the central registry toward registration institutions. The introduction of the system will gradually modify the operation while strictly respecting personal data confidentiality.

Croatia↗
PubMed2003

Info-tsunami: surviving the storm with data quality probes.

As a result of the rapid expansion of electronically available clinical knowledge, clinicians are faced with potential information overload (info-tsunami). The use of data quality probes (DQPs) in primary care can encourage clinicians' awareness of, and improvement in, data quality entry over time. DQPs can also highlight areas of potential error or omission as well as good practice, which can impact directly upon the quality of patient care. In this paper, five specific conditions have been subjected to the use of a series of DQPs over a five-year period in order to assess and measure the performance of different initiatives on the quality of data capture and patient care.

Asthma↗
PubMed2003

The HEGP component-based clinical information system.

OBJECTIVES: The opening of the Georges Pompidou University Hospital (HEGP) in southwest Paris from the merging of three aging facilities was the opportunity to conceive and deploy a brand new clinical information system (CIS) based on a component-based approach. This paper describes the process of selection of the business components, the main functions currently in use, and the technical infrastructure that proved necessary. METHODS: The HEGP CIS features generic and healthcare-related components. The generic components include a reference manager, a security manager, a document manager, a Corba bus, and various mediation and supervision tools. The healthcare-related components include the patient, healthcare record, act management, and resource scheduler components. RESULTS: Major functions of CIS were operational at the opening of the hospital in July 2000. Two years later, the unique patient record and the provider order entry system were used in 96% of the concerned healthcare units. Sixty-five percent of the biological orders and 55% of the imaging orders were directly entered by the physicians. Access to investigation results including on-line availability of images is used by physicians in 100% of the units. DISCUSSION AND CONCLUSION: A component-based approach was found to be high-performing and cost-effective for the design and deployment of HEGP CIS.

Hospital Information Systems↗
PubMed2003

Overcoming the barriers to the implementing computerized physician order entry systems in US hospitals: perspectives from senior management.

We sought to identify the barriers to CPOE implementation and the strategies for overcoming them. By analyzing 57 transcripts of interviews with management officials at 25 US hospitals, we identified costs and physician resistance as the two most significant barriers. Hospitals often overcome the high cost of CPOE implementation by placing patient safety at the top of their agenda. Other hospitals manage physician resistance by leveraging strong leadership, external influence, vendor commitment and the presence of house staff and hospitalists. Efforts to promote the adoption of CPOE should therefore focus on these strategies.

Costs and Cost Analysis↗
PubMed2004

Context in care--requirements for mobile context-aware patient charts.

The hospital ward is a highly dynamic work environment, in which healthcare personnel rapidly switch from one task to another. The process is partly planned, and partly driven by events and interrupts. A mobile electronic patient chart (MEPC) will be an important tool for supporting order entry and accessing, communicating, and recording clinical information. The users need to switch from one context to another with minimal delay and effort. Context-awareness, the ability to sense relevant situational information, can allow the user interface of the MEPC to adapt to various situations. In this paper, we present a future scenario from the coronary care unit. This scenario is analyzed and discussed in order to develop requirements for design methods, context models, and system properties of the MEPC.

Computers, Handheld↗
PubMed2006

Online guideline assist in intensive care medicine--is the login-authentication a sufficient trigger for reminders?

INTRODUCTION: Rising cost pressure due to the implementation of the DRG-System and quality assurance lead to an increased use of therapy standards and standard operating procedures (SOPs) in intensive care medicine. The intention of the German Scientific Society supported project "OLGA" (Online Guideline Assist) is to develop a prototype of a knowledge based system supporting physicians of an intensive care unit in recognizing the indication for and selecting a specific guideline or SOP. While the response of the prototype on user entries can be displayed as a signal on the used workstation itself, the location and time for a reminder of scheduled or missed procedures or reactions to imported information is a difficult issue. One possible approach to this task is the display of non acknowledged reminders or recommendations while logging on to a system. The objective of this study is to analyse user behaviour of the physicians working on the surgical intensive care unit to decide whether the login authentication is a sufficient trigger for clinical reminding. METHODS: The surgical intensive care unit examined in this study comprises 14 beds. Medical care is provided by physicians working in shifts 24 hours a day, 7 days a week, with two anaesthetists at a time and an additional senior consultant during daytime. The entire documentation (examinations, medication, orders, care) is performed using the patient data management system ICUData. The authentication process of the physicians was logged and analysed. RESULTS: Throughout the observation period from December 13th 2005 to January 11th 2006 3563 physician logins were counted in total. The mean span between logins was in 11.3 minutes (SD 14.4), the median 7 minutes. The 75% centile was 14 minutes, the 95% centile 38 min. Intervals greater than 60 minutes occurred in 75%, and greater than 90 minutes in 25% of the days. DISCUSSION: It seems reasonable that reminders sent during authentication are able to enforce workflow compliance. It is possible to send notifications caused by external events to the physician depending on the importance of the event. Serious events with high urgency should be reliably passed using wireless pager or handheld technology. It seems that after the implementation of the prototype guideline assist further investigation is needed to monitor changes in authentication behaviour and reactions to the guideline advisory. This is also required to investigate the influence of unit's size, medical specialty and actual ward workload.

Critical Care↗
PubMed2004

Computerized physician order entry from a chief information officer perspective.

Designing and implementing a computerized physician order entry system in the critical care units of a large urban hospital system is an enormous undertaking. With their significant potential to improve health care and significantly reduce errors, the time for computerized physician order entry or physician order management systems is past due. Careful integrated planning is the key to success, requiring multidisciplinary teams at all levels of clinical and administrative management to work together. Articulated from the viewpoint of the Chief Information Officer of Lifespan, a not-for-profit hospital system in Rhode Island, the vision and strategy preceding the information technology plan, understanding the system's current state, the gap analysis between current and future state, and finally, building and implementing the information technology plan are described.

Administrative Personnel↗
PubMed1997

Computer-based surgical audit programs: a review of three current options.

BACKGROUND: In order to find the most useful computerized auditing system for the needs of the QE II Hospital surgical department three surgical auditing software programs were assessed. METHODS: The Otago University Surgical Auditing Program, the Australian Surgical Auditing Program, and RACS-Audit were trialled for a period of 1 month each. The software programs were evaluated to find the time requirements for data entry, the level of surgical knowledge needed for effective audit information entry, and the perceived usefulness of the generated reports. RESULTS: It was found that the Otago University program best suited the needs of the department. This system was designed for use in a hospital environment with multiple users. The method of data collection was simple and rapid. Entry of data into the program was logical, well structured and able to be performed by both junior medical staff and clerical staff. Reports generated by this system included information in an appropriate format for the departments' morbidity and mortality meetings. CONCLUSION: Personal computers are an ideal tool for the undertaking of surgical audit. Software programs are designed for different uses and should be critically assessed to ensure that the method of data entry, the time involved, and the reports generated enable an efficient and effective audit to be carried out.

General Surgery↗
PubMed1994

Orienting health care information systems toward quality: how Group Health Cooperative of Puget Sound did it.

BACKGROUND: Group Health Cooperative of Puget Sound (GHC), a large staff-model health maintenance organization based in Seattle, is redesigning its information systems to provide the systems and information needed to support its quality agenda. PLANNING PROCESS: Long-range planning for GHC's information resources was done in three phases. In assessment, interviews, surveys, and a benchmarking effort identified strengths and weaknesses of the existing information systems. We concluded that we needed to improve clinical care and patient management systems and enhance health plan applications. In direction setting, we developed six objectives (for example, approach information systems in a way that is consistent with quality improvement principles). Detailed planning was used to define projects, timing, and resource allocations. MAJOR EFFORTS: Some of the most important efforts in the resulting five-year plan include the development of (1) a computerized patient record; (2) a provider-based clinical workstation for access to patient information, order entry, results reporting, guidelines, and reminders; (3) a comprehensive set of patient management and service quality systems; (4) reengineered structures, policies, and processes within the health plan, supported by a complete set of integrated information systems; (5) a standardized, high-capacity communications network to provide linkages both within GHC and among its business partners; and (6) a revised oversight structure for information services, which forms partnerships with users. CONCLUSIONS: A quality focus ensured that each project not only produced its own benefits but also supported the larger organizational goals associated with "total" quality.

Health Maintenance Organizations↗
PubMed2005

SSE Spine Tango--content, workflow, set-up. www.eurospine.org-Spine Tango.

The Spine Tango registry is now accessible via the SSE webpage under www.eurospine.org-Spine Tango. Links to the Swiss/International, German and Austrian modules are provided as well as information about the philosophy, methodology and content. Following the links, the users are taken to the respective national modules for registration or log-in and data entry. The Swiss/International module, also accessible under www.spinetango.com, is used by all Swiss and international users, who do not have a separate national module. The physician administered forms for surgery, staged surgery and follow-up can be downloaded as PDFs.The officially recommended Spine Tango patient forms are also available. All forms were implemented in an online version and as scannable optical mark reader forms which can be ordered from the corresponding author.

Databases as Topic↗
PubMed2002

Internet and cardiovascular research: the present and its future potentials and limits.

The Internet and the World Wide Web have been proposed as tools to improve medical and cardiovascular research. These new technologies have been mainly applied to large-scale clinical trials, with the development of clinical-trial websites. They include tools for the management of some aspects of clinical trials, such as the dissemination of information on trial progress; randomisation and the monitoring processes; the distribution and accountability of study drugs; and remote data-entry. Several clinical-trial websites have been developed in the cardiovascular field over the last few years, but few have been designed to conduct trials fully online. Advantages of such systems include greater interaction between the coordinating centre and investigators, availability of a clean database in a short time, and cost reduction. Website developers need to take care of security issues and to use security tools (data encryption, firewalls, passwords and electronic signatures) in order to prevent unauthorised users from accessing the system and patient data.

Journal Article↗