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At least 775 records · Page 43Linked to original sources
PubMed2000

Modeling study of peripheral nerve recording selectivity.

Recording of sensory information from afferent fibers can be used as feedback for the closed-loop control of neural prostheses. Clinical applications suggest that recording selectively from various nerve fascicles is important. Current nerve cuff electrodes are generally circular in shape and use a tripolar recording configuration. Preliminary experiments suggest that slowly changing the shape of the nerve to a flatter cross section can improve its selectivity. The objective of this work is to determine the effects of nerve reshaping and other cuff design parameters on the fascicular recording selectivity of a nerve cuff. A finite-element computer model of a multifasciculated nerve with different cuff electrodes was implemented to simulate the recordings. The model included the inhomogeneous and anisotropic properties of peripheral nerves. The recording selectivity was quantified with the use of a Selectivity Index. The results from the model provided information regarding the effect of using monopolar versus tripolar recording configurations, the length of the tripoles in tripolar recordings, the number of contacts that maximize the selectivity index, and the cuff length. Nerve reshaping was found to cause important recording selectivity improvements (106% average). These results provide specific criteria for the design of selectively recording nerve cuff electrodes.

Afferent Pathways↗
PubMed1996

Earlier activation of the distal than the proximal site of the coronary sinus may represent retrograde conduction through AV node: significance of recording of far distal coronary sinus.

During retrograde conduction through an accessory pathway (AP) or the atrioventricular (AV) node, earlier activation of the distal recording site than a more proximal site of the coronary sinus (CS) generally indicates retrograde conduction via a distally located AP. Thus, after successful ablation of a left-sided AP, if the distal CS recording site is activated earlier than a more proximal site retrogradely, it is considered to suggest-in the absence of His-bundle recording or more frequently in the setting of poor recording of the low septal right atrial electrogram-a conduction via a second AP (located more distally), and not conduction via the AV node. Yet, we hypothesized that retrograde conduction through the AV node may activate the far distal site of the CS (CSD) earlier than a more proximal site, as the anterior atrial wavefront, coming retrogradely from the AV node and traveling along the anterior mitral annulus, could reach the CSD earlier than a more proximal site. To test this we studied 18 patients with intact retrograde conduction via the AV node, but without evidence of an AP. The CSD was recorded by means of a quadripolar catheter (interelectrode distance of 2-5 mm); retrograde activation sequence at the distal (CSD1-2) versus proximal (CSD3-4) bipolar recording site was determined during ventricular stimulation. In 12 of 18 patients the CSD1-2 recording site was activated 5-10 ms earlier than the CSD3-4 recording site, in 3 of 18 patients the CSD1-2 site was activated 5 ms later than the CSD3-4 site; in the remaining 3 patients both recording sites were depolarized simultaneously. The results indicate that the CSD was often depolarized earlier than a more proximal site by impulses that conducted to the atria retrogradely via the AV node while the quadripolar recording catheter was placed at the CSD. This observation, although not well documented previously, suggests that the sequence of retrograde atrial activation in the CS should be studied carefully in consideration of the actual location of the mapping catheter in order to correctly diagnose the presence or absence of conduction via an AP.

Adolescent↗
PubMed2000

The recording of monophasic action potentials with fractal-coated iridium electrodes in humans.

The present study was designed to evaluate the feasibility of the recording of monophasic action potentials (MAP) with fractal-coated iridium electrodes in a clinical setting. In 18 patients who underwent an electrophysiological study for various arrhythmias, we performed MAP recordings with both 1.3-mm2 and 6-mm2 tip surface area fractal-coated iridium and standard silver--silver chloride (Ag/AgCl) electrodes in the high right atrium and two ventricular positions. Amplitude and MAP duration at 90%, 50%, and 25% of repolarization were calculated during steady-state pacing at 600, 500, and 400 ms cycle lengths with extrastimuli application. Morphology comparisons of MAP signals recorded with both types of electrodes were performed by regression analysis using 5% of the repolarization segments of the MAP trajectory. Differences between MAP duration at 90%, 50%, and 25% of repolarization recorded with fractal-coated and Ag/AgCl electrodes were statistically insignificant. Amplitude values recorded with 6-mm2 tip electrodes were significantly smaller than those recorded with Ag/AgCl electrodes for all comparisons. During steady-state pacing, the correlation coefficients between Ag/AgCl and fractal-coated 1.3-mm2 and 6-mm2 tip electrodes were within the range of 0.93-0.999 and 0.87-0.999, respectively. The correlation of MAP amplitude and duration at 90%, 50%, and 25% of repolarization following the extrastimulus S2, recorded with both types of electrodes, was significantly weaker for right atrial recordings (r value range 0.78-0.92) as compared to ventricular recordings (r value range 0.92-0.99). The MAP sensing features of fractal-coated iridium and Ag/AgCl electrodes are comparable. The best results for recording of MAPs with fractal-coated electrodes can be achieved with small surface area tip electrodes.

Action Potentials↗
PubMed1996

Unique properties of cardiac action potentials recorded with voltage-sensitive dyes.

INTRODUCTION: Optical mapping with voltage-sensitive dyes has made it possible to record cardiac action potentials with high spatial resolution that is unattainable by conventional techniques. Optically recorded signals possess distinct properties that differ importantly from electrograms recorded with extracellular electrodes or action potentials recorded with microelectrode techniques. Despite the growing application of optical mapping to cardiac electrophysiology, relatively little quantitative information is available regarding the characteristics of optical action potentials recorded from cardiac tissue. METHODS AND RESULTS: A high-resolution optical mapping system and microelectrode techniques were used to determine the characteristics of guinea pig ventricular action potentials recorded with the voltage-sensitive dye di-4-ANEPPS. The effects of optical magnification, tissue-light interaction, sampling rate, voltage resolution, spatial resolution, and cardiac motion on action potential signal characteristics were determined. The optical action potential signal represents the relative change in transmembrane potential arising from a volume of cells, where the area of a recording site is determined by optical magnification and detector area, and the depth of recording is determined by system optics and the visible light transmission characteristics of cardiac muscle. Using photographic lenses, the depth of tissue contributing to the signal is < 250 microns. The action potential plateau and final repolarization can be accurately reconstructed from data digitized at modest sampling rates (450 to 750 Hz), since the frequency content of optical action potentials is band-limited to approximately 150 Hz. However, faster sampling rates are needed to depict the subtle details of the action potential upstroke. In addition to temporal resolution, it is essential to achieve sufficient dynamic range and voltage resolution to accurately represent the time course of membrane potential change. Voltage resolution is inversely related to the square of spatial resolution, hence, there exists an inherent trade-off between increased spatial resolution and diminished voltage resolution. Cardiac motion, which can otherwise limit spatial resolution as well as signal fidelity, can be effectively reduced using mechanical stabilization of the heart without distorting action potential characteristics. CONCLUSIONS: Optical mapping with voltage-sensitive dyes provides high-fidelity multisite action potential recording with flexible spatial resolution. When recording cardiac action potentials with voltage-sensitive dyes, the interdependence of temporal, spatial, and voltage resolutions must be carefully considered.

Action Potentials↗
PubMed1991

Cortical somatosensory evoked potentials. I. Recordings in the monkey Macaca fascicularis.

1. The anatomic generators of somatosensory evoked potentials (SEPs) to median nerve stimulation in the 10- to 30-ms latency range were investigated in monkeys (Macaca fascicularis) by means of cortical-surface and laminar recordings. 2. Three groups of SEPs evoked by stimulation of the contralateral median nerve were recorded from the hand representation area of sensorimotor cortex: P10-N20, recorded anterior to the central sulcus (CS); N10-P20, recorded posterior to the CS; and P12-N25, recorded near the CS. These potentials were similar in morphology and surface distribution whether the animal was awake or anesthetized. 3. P10-N20 exhibited a polarity inversion to N10-P20 across the CS, both in cortical-surface recordings and in laminar recordings within cortex and white matter of motor and somatosensory cortex. In contrast, P10-N20 and N10-P20 did not exhibit polarity inversion in recordings from the surface and white matter of the crowns of motor and somatosensory cortex, respectively. These results strongly suggest that these potentials are produced by a tangential generator located in the posterior wall of the CS, primarily in area 3b of somatosensory cortex. 4. P12-N25 was largest over the hand area of somatosensory cortex and showed polarity inversion across the crown of somatosensory cortex but not across the crown of motor cortex or across the walls of the CS, suggesting that P12-N25 is due to a radially oriented generator located in areas 1 and 2 of somatosensory cortex. 5. P10-N20 and P12-N25 are thought to be equivalent to the "primary evoked response" recorded from somatosensory cortex of other mammals. 6. These results are very similar to those obtained in human cortical-surface recordings and demonstrate that the monkey P10-N20, N10-P20, and P12-N25 potentials correspond to the human P20-N30, N20-P30, and P25-N35 potentials, respectively. The only appreciable difference in human and monkey SEPs is that the monkey P12-N25 appears to be generated in areas 1 and 2, whereas the human P25-N35 appears to be generated only in area 1. 7. There was no evidence of locally generated activity in areas 3a and 4.

Animals↗
PubMed1988

New catheter technique for recording left free-wall accessory atrioventricular pathway activation. Identification of pathway fiber orientation.

The ability to record accessory atrioventricular (AV) pathway activation consistently may be uniquely beneficial in improving pathway localization, identifying anatomic relations, and providing insight into unusual conduction properties. For the purpose of recording left AV accessory pathway activation, an electrode catheter was specially designed for use in the coronary sinus. The orthogonal catheter has three sets of four electrodes spaced evenly around the circumference. Electrograms were recorded at low gain (less than 1 cm/mV) between adjacent electrodes on the same set (interelectrode distance, 1.5 mm, center to center). This provides a recording dipole perpendicular to the atrioventricular groove to enhance recording of accessory pathway activation while minimizing overlapping atrial or ventricular potentials. The orthogonal electrode catheter was used in the electrophysiological study of 48 consecutive patients with 59 left AV accessory pathways. The catheter could be advanced along the coronary sinus beyond the site of earliest retrograde atrial activation in 49 of the 59 accessory pathways. Activation potentials were recorded from 45 of the 49 (92%) accessory pathways accessible to the catheter (5 of 5 anterior, 8 of 8 anterolateral, 15 of 16 lateral, 5 of 5 posterolateral, 5 of 5 posterior, and 7 of 10 posteroseptal). Accessory pathway potentials were validated by dissociating them from both atrial and ventricular activation by programmed-stimulation techniques. During surgery, accessory pathway potentials were identified from orthogonal catheter electrodes in the coronary sinus in 14 of 16 accessory pathways (12 patients). Epicardial mapping confirmed the location of the accessory pathway, and direct pressure over the orthogonal catheter electrode that recorded the accessory pathway potential resulted in transient conduction block in nine of the 14 accessory pathways. Orthogonal electrode maps of the coronary sinus identified an oblique course in 39 of 45 recorded accessory pathways. Thirty-two of 38 left free-wall accessory pathways were oriented with atrial insertion 4-30 mm (median, 14 mm) proximal (posterior) to the ventricular insertion. In the remaining six free-wall accessory pathways, the lateral excursion could not be determined because either only the atrial end of the accessory pathway was recorded or activation of multiple pathway fibers prevented tracking of individual strands. The seven recorded posteroseptal pathways exhibited accessory pathway potentials throughout an 8-18-mm (median, 10 mm) length of the proximal coronary sinus, but fiber orientation was difficult to determine.(ABSTRACT TRUNCATED AT 400 WORDS)

Atrioventricular Node↗
PubMed2005

Cardiac event recording yields more diagnoses than 24-hour Holter monitoring in patients with palpitations.

Palpitation is a common symptom that sometimes results from a substantial cardiac arrhythmia. We compared the diagnostic yield of trans-telephonic event monitors with those of Holter monitoring in patients with intermittent palpitations. In all, 310 patients were randomly assigned to receive an event recorder or 24-hour Holter monitoring. Event recorders were used for seven days or until two recordings were obtained while symptoms occurred. The main end-point was an electrocardiogram (ECG) recorded during symptoms. The patients with palpitation recorded the one-lead ECG trace and sent it to a telemedicine call centre, where a nurse responded. There were 119 symptomatic patients in the event recorder group and 74 in the Holter group. The total costs were 6019 for event recording and 9605 for Holter monitoring. The average costs were 51 per symptomatic patient detected by event recorder monitoring and 130 per symptomatic patient detected by Holter monitoring. More patients therefore received a clear diagnosis, and more quickly, when using event recording than with Holter monitoring. For this reason, event recorders are preferable to Holter monitors for patients with palpitations.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Validation of 2 techniques for electrocardiographic recording in dogs and cats.

BACKGROUND: Standard electrocardiographic (ECG) recording in the dog and cat is commonly performed in right lateral recumbency, by connecting the ECG leads to the skin of the patient via metallic alligator clips. The jaws of the alligator clips are usually filed or flattened to reduce their uncomfortable pressure on the patient's skin. However, filed and flattened alligator clips can occasionally lose their grip to the skin, causing lead detachment during standard ECG recording. HYPOTHESIS: The aim of the study was to validate two novel ECG recording techniques ("gel" and "pads"). ANIMALS: Six-lead standard ECG recording was obtained from 42 dogs and 40 cats using the standard technique, as well as the two novel methods. METHODS: Measurements were taken of the amplitude and duration of P waves and QRS complexes, duration of PQ and QT intervals, and mean electrical axis (MEA). In each recording, five representative complexes were measured, and the results were averaged for each parameter. RESULTS: A good quality ECG recording was obtained with all the three different techniques, although a degree of wandering trace was observed in one third of cats with the "pads" technique. Bland-Altman analysis showed good agreement between the ECG values recorded with the two novel techniques and those recorded with the standard traditional technique. Furthermore, the observed differences were not clinically relevant, except for the R wave amplitude recorded with the "pads" method in cats (-0.35 to 0.37 mV). CONCLUSIONS AND CLINICAL IMPORTANCE: In conclusion, this study supports the reliability and clinical validity of the "gel" and "pads" techniques for ECG recording both in the dog and the cat, with some limitations for the "pads" technique in cats.

Animals↗
PubMed1971

The effect of self-recording on the classroom behavior of two eighth-grade students.

The effects of self-recording on classroom behavior of two junior high school students was investigated. In the first experiment, study behavior of an eighth-grade girl in history class was recorded. Following baseline observations her counselor provided slips for the girl to record whether or not she studied in class. This resulted in an increase in study. When slips were withdrawn, study decreased and then increased once self-recording was reinstated. After teacher praise for study was increased, self-recording was discontinued without significant losses in study behavior. In the final phase, increased praise was also withdrawn and study remained at a high level. In the second experiment, the number of talk outs emitted by an eighth-grade boy were recorded during math period. Following baseline, slips for recording talk outs were issued for the first half of the period, for the second half, and then for the entire period. Talk outs decreased when self-recording was in effect and increased again when self-recording was discontinued. When self-recording was reinstituted in the final phase there was a slight, though not significant decrease in talking out when compared to the baseline condition.

Journal Article↗
PubMed2006

The use of MP3 recorders to log data from equine hoof mounted accelerometers.

REASONS FOR PERFORMING STUDY: MP3 recorders are readily available, small, lightweight and low cost, providing the potential for logging analogue hoof mounted accelerometer signals for the characterisation of equine locomotion. These, however, require testing in practice. OBJECTIVES: To test whether 1) multiple MP3 recorders can maintain synchronisation, giving the ability to synchronise independent recorders for the logging of multiple limbs simultaneously; and 2) features of a foot mounted accelerometer signal attributable to foot-on and foot-off can be accurately identified from horse foot mounted accelerometers logged directly into an MP3 recorder. METHODS: Three experiments were performed: 1) Maintenance of synchronisation was assessed by counting the number of samples recorded by each of 4 MP3 recorders while mounted on a trotting horse and over 2 consecutive 30 min periods in 8 recorders on a bench. 2) Foot-on and foot-off times obtained from manual transcription of MP3 logged data and directly logged accelerometer signal were compared. 3) MP3/accelerometer acquisition units were used to log accelerometer signals from racehorses during extended training sessions. RESULTS: Mean absolute error of synchronisation between MP3 recorders was 10 samples per million (compared to mean number of samples, range 1-32 samples per million). Error accumulation showed a linear correlation with time. Features attributable to foot on and foot off were equally identifiable from the MP3 recorded signal over a range of equine gaits. CONCLUSIONS: Multiple MP3 recorders can be synchronised and used as a relatively cheap, robust, reliable and accurate logging system when combined with an accelerometer and external battery for the specific application of the measurement of stride timing variables across the range of equine gaits during field locomotion. POTENTIAL RELEVANCE: Footfall timings can be used to identify intervals between the fore and hind contacts, the identification of diagonal advanced placement and to calculate stride timing variables (stance time, protraction time and stride time). These parameters are invaluable for the characterisation and assessment of equine locomotion.

Acceleration↗
PubMed1995

Posturography: head stabilisation compared with platform recording. Application in vestibular disorders.

Posturography with simultaneous recording of the head movements (H-recording) and of the pressure of the feet on the platform (P-recording) has been applied in patients with peripheral vestibular disorders. For the whole testing (four tests with visual and proprioceptive interaction) 40% showed an identical degree of abnormality for the measurements of surface in P- and H-recording. In a large majority of the patients, showing a difference between H- and P-recording, this difference indicated a lower degree for the H-recording. Concerning the four tests separately, the differences for eyes closed tests were more frequently positive (larger surface for head movements) than for eyes open tests. Also on foam rubber there was more difference than on stable platform. Especially the test with eyes closed on foam rubber showed more differences. These data show that in a minority of patients the comparison of H-recording and P-recording affords complementary information showing in these cases some independence of head stabilisation and foot-stabilisation. Head-recording can be used as a posturographic technique but one has to keep in mind the possible differences with platform-recording.

Functional Laterality↗
PubMed1988

[Recording of subcortical somatosensory evoked potentials using nasopharyngeal electrodes--a study in sedated patients].

Nasopharyngeal recording of evoked potentials is only seldom used, and a systematic description of subcortical SEP derivations using this method is essentially lacking. In twelve patients, sedated after neurosurgical operations and without signs of brainstem or cervical spinal cord dysfunction, subcortical SEP were recorded from nasopharynx (Pgz) and neck after stimulation of median and tibial nerves. Generally, a midfrontal reference (Fz) was used; in four cases, evoked potentials were additionally recorded against a non-cephalic reference. The main feature in Pgz-Fz recordings was a negative wave corresponding to the N13 (N30) component in neck derivations after stimulation of median (tibial) nerve. This wave is interpreted as reflection of medial lemniscal activity; so Pgz-Fz derivations make possible the isolated recording of the subcomponent N13b (medial lemniscus, or cuneate nucleus), without overlap with N13a (dorsal horn) - as do neck-to-scalp recordings-; and without the considerable artifacts known from farfield recordings. This interpretation is confirmed by SEP recordings in a brain death patient, showing a clear N13 component in neck-to-scalp derivations while lacking any negative wave at Pgz-Fz. In Pgz recordings against a non-cephalic reference, the P9 and P11 components (corresponding to the well known scalp farfield potentials) were clearly seen, whereas the P14 component was of low amplitude in three cases and lacking at all in one case. In conclusion, nasopharyngeal electrodes provide a useful tool in subcortical SEP recording; due to their position medio-ventrally to the lower brainstem, they complete standard electrode montages giving further informations about generator dipole location.

Adult↗
PubMed1985

Brain stem auditory-evoked potentials of dogs: wave forms and effects of recording electrode positions.

Wave forms of canine brain stem auditory-evoked potentials (BAEP) and the effects of electrode positions on the wave forms were studied as a basis for experimental and clinical use of BAEP recording. The BAEP regularly consisted of 5 waves (I to V) with latencies and polarities similar to those of other species. In some dogs, waves II, III, and IV contained distinct subpeaks (a, b, c). Waves similar to waves VI and VII of other species were recorded in some dogs. With respect to BAEP, no site on the head was electrically inactive and BAEP could be recorded as far caudally as the caudal cervical region in some dogs. Wave I, positive in recordings from the dorsal midline of the calvaria (vertex) underwent polarity reversal and increased amplitude and duration in recordings made from caudal ventrolateral regions of the head (mastoid region). As a result, wave I partially or totally obscured wave II so that the latter could no longer be clearly identified. Waves IIIa and IIIb were differentially affected by moving the recording site, indicating that their generators were spatially separated. Waves IV and V were also affected by electrode site, consistent with previous reports that they have spatially separated generators in other species. In recordings made with vertex electrodes referenced to the mastoid region ipsilateral to the stimulated ear, wave I appeared as a high-amplitude positive peak with onset latency equalling that in noncephalic reference recordings, but with somewhat later peak latency and longer duration. As a result, wave II was partially or totally obscured so that only 4 major peaks were evident in the BAEP. In contralateral mastoid reference recordings, latency to peak of wave I was unchanged; however, amplitude of all waves was reduced and waves IIa and IIb were not as clearly differentiated as they were in noncephalic reference recordings.

Acoustic Stimulation↗
PubMed1989

The present and future medicolegal importance of record keeping in anesthesia and intensive care: the case for automation.

The anesthesia record is often crucial to successful defense in a meritless claim, because the adversarial role of the plaintiff's medical expert witness requires an attack on the record. Likewise the record may be pivotal in determining whether a defense should even be mounted as an alternative to an early settlement, because the failure of meaningful, supportive, or exculpatory documentation raises serious questions about the quality of care rendered. Advancing technology has made possible revolutionary changes in real-time monitoring and data recording. Concepts favoring the development and adoption of automated record systems for anesthesia are outlined through historic medicolegal perspectives on record keeping in general and computerization of the monitoring and recording methods in specific as a means of providing the best medicolegal evidence in defense of the anesthesiologist's performance. The analogy is often made between the successful development and acceptance of the flight data recorder and cockpit voice recorder combination in aviation and ongoing software development for automated recordkeeping and the quest for its use and professional acceptance in both anesthesia and intensive care settings.

Anesthesiology↗
PubMed1992

Updating the accident and emergency record.

Eight records used in six accident and emergency (A/E) departments in the Mersey Region were reviewed. We studied (1) the structure of records; (2) the printed matter on the record; (3) the designated areas for documentation by the administrative, nursing and medical staff; and (4) the advantages of the records in transferring information to other departments and general practitioners. The use of computers in the departments was investigated. None of the hospitals used the same accident and emergency record. One of the records had a designated area for documenting the nursing care of the patients. None of the accident and emergency departments used computers for either delayed or real-time recording of patients' details. A computer-structured A/E Record will produce a legible, factual patient history, examination and care plan. The information recorded will be easily transferred to relevant hospital departments and ultimately to the community practitioners.

Emergency Service, Hospital↗
PubMed1983

A transcribed emergency record at minimum cost.

We have developed a new method of implementing a transcribed emergency record at minimum cost. Dictated emergency records are typed immediately by a transcriber located in the emergency department. This member of the medical record transcriber pool is given other non-urgent medical record material to type when there are no emergency records to type. The costs are reduced to the same level as routine medical records transcription. In 1982, 19,892 of the total 28,000 emergency records were transcribed by adding only 1.35 full-time equivalents (FTEs) to the transcriber pool. The remaining charts were handwritten because insufficient funds had been allocated to type all emergency records. The transcriber is capable of typing a maximum of 64 charts, averaging 13 lines (156 words) each, per 8-hour shift. The service can be phased in gradually as funds for transcribing the emergency record are allocated to the central transcriber pool.

Cost Control↗
PubMed2002

Comparing clinical automated, medical record, and hybrid data sources for diabetes quality measures.

BACKGROUND: Little is known about the relative reliability of medical record and clinical automated data, sources commonly used to assess diabetes quality of care. The agreement between diabetes quality measures constructed from clinical automated versus medical record data sources was compared, and the performance of hybrid measures derived from a combination of the two data sources was examined. METHODS: Medical records were abstracted for 1,032 patients with diabetes who received care from 21 facilities in 4 Veterans Integrated Service Networks. Automated data were obtained from a central Veterans Health Administration diabetes registry containing information on laboratory tests and medication use. RESULTS: Success rates were higher for process measures derived from medical record data than from automated data, but no substantial differences among data sources were found for the intermediate outcome measures. Agreement for measures derived from the medical record compared with automated data was moderate for process measures but high for intermediate outcome measures. Hybrid measures yielded success rates similar to those of medical record-based measures but would have required about 50% fewer chart reviews. CONCLUSIONS: Agreement between medical record and automated data was generally high. Yet even in an integrated health care system with sophisticated information technology, automated data tended to underestimate the success rate in technical process measures for diabetes care and yielded different quartile performance rankings for facilities. Applying hybrid methodology yielded results consistent with the medical record but required less data to come from medical record reviews.

Aged↗
PubMed1999

The application of a computerized problem-oriented medical record system and its impact on patient care.

The present computer system is the first of its kind based on problem-oriented medical record (POMR) design developed and operated in a hospital in Hong Kong. It went live in May 1996 with two workstations installed in the medical record office (MRO). Doctors have no direct access to it. They dictate medical notes on tape using either structured or free dictation format, and the tape is brought to the MRO for processing. The principal aim of this study is to study the impact of the computer system on patient care. Retrospective review of medical records and in-depth interviews were conducted to study the quality of medical records and doctor's opinions. A total of 400 manual and 398 computerized patient records were randomly selected for review. The completeness of the manual notes and computerized notes using free dictation format were about the same. The computerized records using structured dictation format may be more complete than those using free dictation format. The in-depth interview shows that most doctors preferred structured medical records but some disagreed with too detailed a level of structuring. They were not familiar with POMR, and some even thought that breaking down the record by problem was not possible. All felt that the present system would not directly affect patient care, but some said that it would facilitate research. In conclusion, since the utility of the information mainly depends on the doctors' efforts, commitment to the agreed structure and subsequent routine audit of computerized medical records are essential to make sure that diagnoses are accurately coded and information is correctly structured.

Attitude of Health Personnel↗