Policy and the future of adverse event detection using information technology.
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Accidental Falls↗
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Automated syndromic surveillance for the 2002 Winter Olympics.
The 2002 Olympic Winter Games were held in Utah from February 8 to March 16, 2002. Following the terrorist attacks on September 11, 2001, and the anthrax release in October 2001, the need for bioterrorism surveillance during the Games was paramount. A team of informaticists and public health specialists from Utah and Pittsburgh implemented the Real-time Outbreak and Disease Surveillance (RODS) system in Utah for the Games in just seven weeks. The strategies and challenges of implementing such a system in such a short time are discussed. The motivation and cooperation inspired by the 2002 Olympic Winter Games were a powerful driver in overcoming the organizational issues. Over 114,000 acute care encounters were monitored between February 8 and March 31, 2002. No outbreaks of public health significance were detected. The system was implemented successfully and operational for the 2002 Olympic Winter Games and remains operational today.
Algorithms↗
Implementing syndromic surveillance: a practical guide informed by the early experience.
Syndromic surveillance refers to methods relying on detection of individual and population health indicators that are discernible before confirmed diagnoses are made. In particular, prior to the laboratory confirmation of an infectious disease, ill persons may exhibit behavioral patterns, symptoms, signs, or laboratory findings that can be tracked through a variety of data sources. Syndromic surveillance systems are being developed locally, regionally, and nationally. The efforts have been largely directed at facilitating the early detection of a covert bioterrorist attack, but the technology may also be useful for general public health, clinical medicine, quality improvement, patient safety, and research. This report, authored by developers and methodologists involved in the design and deployment of the first wave of syndromic surveillance systems, is intended to serve as a guide for informaticians, public health managers, and practitioners who are currently planning deployment of such systems in their regions.
Bioterrorism↗
QIS: A framework for biomedical database federation.
Query Integrator System (QIS) is a database mediator framework intended to address robust data integration from continuously changing heterogeneous data sources in the biosciences. Currently in the advanced prototype stage, it is being used on a production basis to integrate data from neuroscience databases developed for the SenseLab project at Yale University with external neuroscience and genomics databases. The QIS framework uses standard technologies and is intended to be deployable by administrators with a moderate level of technological expertise: It comes with various tools, such as interfaces for the design of distributed queries. The QIS architecture is based on a set of distributed network-based servers, data source servers, integration servers, and ontology servers, that exchange metadata as well as mappings of both metadata and data elements to elements in an ontology. Metadata version difference determination coupled with decomposition of stored queries is used as the basis for partial query recovery when the schema of data sources alters.
Computer Communication Networks↗
Parents as partners in obtaining the medication history.
OBJECTIVE: Patient-centered information management may overcome barriers that impede high-quality, safe care in the emergency department (ED). The utility of parents' report of medication data via a multimedia, touch screen interface, the asthma kiosk, was investigated. Our specific aims were (1) to estimate the validity of parents' electronically entered medication history for asthma and (2) to compare the parents' kiosk entries regarding medications to the documentation of ED physicians and nurses. METHODS: We enrolled a cohort of parents to use the asthma kiosk and tested the validity of this communication channel for medication data specific to pediatric asthma. Parents' data provided via the kiosk during the ED encounter and the documentation of ED nurses and physicians were compared with a telephone-based interview with the parent after discharge that reviewed all asthma-specific medications physically present in the home. Treating clinicians in the ED were blinded to the parents' kiosk entries. RESULTS: Sixty-six parents were enrolled and 49 of 66 (74.2%) completed the gold standard interview. When analyzed at the level of individual medications, the validity of parental report was 81% for medication name, 79% for route of delivery, 66% for the form of the medication, and 60% for dose. Parents' report improved on the validity of documentation by physicians across all medication details save for medication name. Parents' report was more valid than nursing documentation at triage for all medication details. CONCLUSION: Parents can provide an independent source of medication data that improves on current documentation for key variables that impact quality and safety in emergency asthma care.
Anti-Asthmatic Agents↗
Health information technology and physician-patient interactions: impact of computers on communication during outpatient primary care visits.
OBJECTIVE: The aim of this study was to evaluate the impact of introducing health information technology (HIT) on physician-patient interactions during outpatient visits. DESIGN: This was a longitudinal pre-post study: two months before and one and seven months after introduction of examination room computers. Patient questionnaires (n = 313) after primary care visits with physicians (n = 8) within an integrated delivery system. There were three patient satisfaction domains: (1) satisfaction with visit components, (2) comprehension of the visit, and (3) perceptions of the physician's use of the computer. RESULTS: Patients reported that physicians used computers in 82.3% of visits. Compared with baseline, overall patient satisfaction with visits increased seven months after the introduction of computers (odds ratio [OR] = 1.50; 95% confidence interval [CI]: 1.01-2.22), as did satisfaction with physicians' familiarity with patients (OR = 1.60, 95% CI: 1.01-2.52), communication about medical issues (OR = 1.61; 95% CI: 1.05-2.47), and comprehension of decisions made during the visit (OR = 1.63; 95% CI: 1.06-2.50). In contrast, there were no significant changes in patient satisfaction with comprehension of self-care responsibilities, communication about psychosocial issues, or available visit time. Seven months post-introduction, patients were more likely to report that the computer helped the visit run in a more timely manner (OR = 1.76; 95% CI: 1.28-2.42) compared with the first month after introduction. There were no other significant changes in patient perceptions of the computer use over time. CONCLUSION: The examination room computers appeared to have positive effects on physician-patient interactions related to medical communication without significant negative effects on other areas such as time available for patient concerns. Further study is needed to better understand HIT use during outpatient visits.
Adult↗
A systematic review of the literature on multidisciplinary rounds to design information technology.
Multidisciplinary rounds (MDR) have become important mechanisms for communication and coordination of care. To guide design of tools supporting MDR, we reviewed the literature published from 1990 to 2005 about MDR on information tools used, information needs, impact of information tools, and evaluation measures. Fifty-one papers met inclusion criteria and were included. In addition to patient-centric information tools (e.g., medical chart) and decision-support tools (e.g., clinical pathway), process-oriented tools (e.g., rounding list) were reported to help with information organization and communication. Information tools were shown to improve situation awareness of multidisciplinary care providers, efficiency of MDR, and length of stay. Communication through MDR may be improved by process-oriented information tools that help information organization, communication, and work management, which could be achieved through automatic extraction from clinical information systems, displays and printouts in condensed forms, at-a-glance representations of the care unit, and storing work-process information temporarily.
Humans↗
Commentary on G. Octo Barnett's Report to the Computer Research Study Section.
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Attitude to Computers↗
The iCritical care podcast: a novel medium for critical care communication and education.
Podcasting is a recent creation combining old and new technologies allowing rapid, inexpensive delivery of media content (primarily audio) to the end user, both via the desktop environment and personal media players. The authors' group (the Society of Critical Care Medicine) saw the educational and communication potential for the podcasting concept, and have successfully designed and implemented the first podcast of a national medical society. As of this writing, there are an average of (mean +/- SD) 664 +/- 290 total downloads per podcast, and their podcast feed has been hit over 68,000 times in its first seven months. In this manuscript, the authors provide documentation of their successful endeavor, as well as a structured framework for other organizations to create similar products.
Audiovisual Aids↗
Computerized telephone assessment of the "concrete" needs of chemotherapy outpatients: a feasibility study.
The feasibility of using a computer-automated telephone outreach system to routinely assess the needs of chemotherapy outpatients was evaluated. The automated intervention was designed as a cost-efficient strategy for assessing patients' needs on a periodic basis so that emerging needs could be identified in a timely way. Ninety-seven chemotherapy outpatients were surveyed at least once over the telephone by a computer in a high-quality, digitally stored voice asking 12 questions regarding the patients' "concrete" needs. Early results of this larger ongoing study, in which patients are scheduled to be called every 4 to 6 weeks for approximately four months, indicated that computer-automated surveys had broad-based acceptance among our outpatients and that patients were able to comply accurately with the survey's instructions. Furthermore, the speech recognition system was found to be reliable, and patients' response patterns to the automated surveys valid. Nonparticipation in this study (28.0%) was not substantially higher than in our previous research within this patient population and neither nonparticipation nor attrition appeared significantly attributable to the automation itself. This method offers the potential for cost-efficient, universal, and ongoing assessment of patient needs, facilitating timely intervention, and efficient use of professional staff.
Ambulatory Care↗
Wireless communications in acute health-care.
Before a particular form of wireless communication is implemented within a health-care institution, consideration should be given to the system's capacity for transmitting voice, data and video information, as well as its reliability and coverage. An important associated choice concerns the best combination of user devices that will enable secure and rapid transmission of data to clinical staff at the point of care. Several technologies are available. No new technology that is likely to become available over the next five years will address the two main concerns of health service organizations: the need for non-interference with sensitive equipment; and the need for immediate communication of urgent messages. We therefore believe that health industries with a mobile workforce will gain five to eight years of useful life from cordless telephone systems and that paging or other radio-based devices will remain an important mode of communication for at least the next five years, especially where emergency communication is concerned.
Hospital Communication Systems↗
The information technology challenge for the NHS.
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Health Knowledge, Attitudes, Practice↗
The report of the Information Technology Task Group of the Dentistry Modernization Steering Group.
The Dentistry Modernization Steering Group was set up to monitor, evaluate and facilitate progress in the implementation of the Government's strategy for the dental services. Information Technology was an important part of this remit and the report of its IT Task Group is summarized here.
Advisory Committees↗
PD(X)MD: a new clinical information tool for patient care.
PD(X)MD is a new and promising evidence-based electronic primary care clinical information resource. It is geared primarily to the physician, as is its companion database, MDConsult, but it can also be very useful to medical and non-medical librarians seeking to quickly summarize current, accurate, and quality-filtered clinical information focusing on diagnosis, therapy, prognosis, and prevention.
Databases, Factual↗
"Ask A Librarian": the experiences of four hospital libraries.
The librarians at four hospital libraries describe the electronic reference service, "Ask A Librarian," offered at their institutions. The hospitals are vastly different in size and in number of library staff, and offer the "Ask A Librarian" service to different clientele. The article illustrates that both large hospitals with a large library staff and small hospitals with a solo librarian and some volunteers can offer this type of service.
Databases, Bibliographic↗
The impact of the electronic media on primary dental care in the 21st century.
This paper attempts to predict how electronic media will impact on primary dental care in the twenty-first century. The predictions for the next 10 years are based on developments currently in train or on the premise that equipment and techniques, which have been recently introduced and are at present used by relatively few, will be used by many by 2010. During this decade, the impact of electronic media is considered in the areas of patient support, diagnosis, treatment planning, provision of treatment and its maintenance, quality control and practice management. The paper then speculates briefly about how dentists in primary dental care might practise in the year 2100. It concludes that although electronic media are likely to play an increasingly important role, a clinician's skills, knowledge and ability to communicate with patients will remain the keys to successful practice for the foreseeable future.
Comprehensive Dental Care↗
Recommendations for comparing electronic prescribing systems: results of an expert consensus process.
Commercially available electronic prescribing systems may differ in their effects on patients' health outcomes and on patients' ability to manage costs. An expert panel convened to recommend specific features that would enable electronic prescribing systems to advance these goals. The panel authored sixty recommendations and rated each using a modified Delphi process. Ratings identified fifty-two recommendations as clearly positive for patient safety and health outcomes and forty-three recommendations as achievable in the average clinician's office within three years. Overall, these recommendations offer a synthesis of evidence and expert opinion that can help guide the development of electronic prescribing policy.
Delphi Technique↗
Microprocessor exercise physiology systems vs a nonautomated system. A comparison of data output.
Several microprocessor exercise physiology systems have been introduced recently. Comparison of the data output between these systems and more traditional nonautomated systems has not been reported extensively. Twelve normal adult men were exercised in random sequence on different days on a Sensormedics MMC Horizon system, the Medical Graphics Corporation System 2000, and a nonautomated system. heart rate, minute ventilation, tidal volume, respiratory frequency, oxygen consumption, and carbon dioxide production were compared at each level of work during a maximal incremental test and during a constant work load test. The overall data output between the three systems was comparable. However, minute ventilation was consistently higher on the Medical Graphics system, oxygen consumption was consistently lower on the Horizon system, and a technical error was discovered in the Medical Graphics system which resulted in a systematic overestimation of carbon dioxide production. Different methods of analyzing the data from the same test (60-s average, 15-s average, breath-by-breath, and 8-breath average) resulted in differences of up to 20 percent in the maximal values. This was greater than the differences between the three systems. Despite the comparability of the data output, important differences did exist which can be potentially significant when data output from one system are compared to predicted normal values obtained under different conditions.
Adult↗