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PubMed2005

The impact of structured laboratory routines in computerized medical records in a primary care service setting.

Inappropriate laboratory ordering is a problem affecting medical systems worldwide. An intervention was called for as a result of increasing laboratory costs. Thus, we aimed to assess the impact of introducing computerized laboratory routines to a computerized primary care setting. The study included 380 primary care physician practices of Clalit Health Service (HMO) southern district (CHS-SD) in Israel, caring for 470,000 members. Consensus laboratory routines order sets were electronically introduced into all physicians' computerized medical record (CMR) software, after consensus and internal marketing process. The primary findings were that a previously observed annual increase in laboratory test utilization was stopped, a 2% reduction in total number of tests and a 4 % reduction in the total number of tests per age adjusted person was observed. In conclusion the wide use of CMRs and communication technology combined with an appropriate organizational process can be used to increase appropriate utilization of laboratory tests.

Diagnostic Techniques and Procedures↗
PubMed2000

Computerized medical record in a private neurotology practice.

OBJECTIVE: To develop a computerized medical record for a private neurotology practice using a relational database with templates. BACKGROUND: Computers have been used in the medicine many years for billing, scheduling appointments, and word processing. Neurotology represents a relatively narrow field of medicine, which is particularly suited to a computerized record. A computerized medical record should allow for better data storage and retrieval as well as better documentation of the patient care given. METHODS: Using a commercially available, record-keeping software in a local area computer network. templates were developed for several common neurotologic problems. A template for a neurotologic examination was also developed. These were adapted from templates developed by a group otolaryngology practice in a neighboring city. Data entry templates for vestibular and audiologic tests were also developed. Implementation of the computerized record was accomplished in phases, allowing elimination of the paper record. RESULTS: A fully computerized medical record has been developed and maintained in a private neurotology practice over the past year. Patient response to the computerized record system has been favorable. Office personnel have adapted well to a paperless record, and referring physicians have welcomed the documents generated by the computer. CONCLUSION: Computerizing the medical records of a neurotology practice is possible and allows for improved documentation, ongoing assessment of treatment results, and improved efficiency among office staff.

Humans↗
PubMed1997

[Evaluation of the quality of filling out medical records in a hypertension consultation].

The aim of the study was to evaluate the completion of medical records of a hypertension clinic and to compare standardized computerized records versus standard medical records. The medical records of 163 consecutive hypertensive patients attending at the Broussais hospital hypertension clinic between December 1995, 6th and January 1996, 21st were checked. At the last visit, the patients were attended by 16 physicians working in 4 different teams. The medical data were recorded by physicians in the computerized system called ARTEMIS in 120 patients and in standard structured forms in 43 patients. The patients notes were checked to see if 9 clinical items were recorded at the first visit (V1), at the visit before last (V2) and at the last visit (V3). The overall completion rate was high at V1 (92.2%) and significantly decreased at follow-up visits (82.6% at V2 and 83.2% at V3). The completion rate was significantly higher in the computerized records than in the standard notes: 95.8% vs 82.2% at V1, 91.9% vs 56.3% at V2 and 91.6% vs 59.7% at V3. During follow-up (V2 vs V1), a significant decrease in the completion rate of 6 items was observed in the standard notes (tobacco use, alcohol consumption, physical activity, compliance to treatment, body weight, manual blood pressure measurement). In the computerized records, only physical activity completion rate decreased. In conclusion, the computer may help to increase the quality of the medical records as reflected by the completion rate of items related to hypertension care.

Cardiology Service, Hospital↗
PubMedDate not supplied

The medical record: a comprehensive computer system for the family physician.

BACKGROUND: Despite the early excitement regarding the possible uses of computers in medical care in the 1980s, the computer has not had much effect on routine outpatient medicine except for billing and accounting. METHODS: An emerging comprehensive ambulatory care computer system, The Medical Record (TMR), is used extensively in a large family practice, the Duke Family Medicine Center. TMR is the central system for accounting, appointments, billing, and reporting of laboratory results, radiographic findings, and medications. TMR also records problem lists and generates prompts to the clinicians for needed health maintenance, laboratory tests, and reminder letters. The most innovative function of TMR is the computerized obstetric patient record, which can be accessed from multiple sites. Cost savings compared with a manual system were found to be in excess of $7 per patient visit or approximately $500,000 per year for the Duke Family Medicine Center. RESULTS AND CONCLUSIONS: A comprehensive computer system in a large family practice is cost effective and facilitates better patient care through improved access to patient data.

Costs and Cost Analysis↗
PubMed2006

Initial evaluation of a computer-based medication management tool in a geriatric clinic.

BACKGROUND: Optimal management of medication regimens remains a challenge for elderly patients and their providers. Tools that aid communication and adherence can be valuable but often do not meet expectations. OBJECTIVE: The purpose of this article was to describe the development and preliminary evaluation of a computer-based medication management tool, the Visual Medication Profile (VMP), and to report initial feedback from geriatric patient and provider focus groups. METHODS: For VMP development, an interdisciplinary team (ie, physicians, nurses, pharmacists, computer analysts, and programmers) designed the fully automated, Web-based intervention that integrates the Veterans Affairs Medical Center (VAMC) computer pharmacy system with the computerized patient record system. In addition to development of the required technology, a mixed methods design and a convenience sample were used to collect pilot data related to patient-provider issues about medication management, and the acceptance, feasibility, and usefulness of the VMP. This involved the use of focus groups and a pilot study group. RESULTS: First, the interdisciplinary team developed the VMP by integrating data from the pharmacy database, the patient's database, and a pill photograph database. Second, patients and providers in the focus groups discussed medication management issues and evaluated a sample VMP. Patients (n = 8; mean age, 76 years; 5 black, 3 white) noted the following medication management problems: (1) not understanding the information provided by the physician; (2) multiple providers; and (3) unpronounceable names of medications. Providers (n = 8 [4 physicians, 4 nurse practitioners]) noted that patients and providers use different language to discuss medications; that there is a lack of congruence between patients' self-report of current medications and their medical record; and that there are severe time constraints for clinic appointments and concern regarding introducing a new clinical tool. Both groups favored a VMP-like tool to improve communication. In the VMP prototype pilot study, a patient-specific VMP was developed for each of 6 subjects (mean age, 79.7 years; 3 black, 3 white) from the outpatient geriatric clinic. Congruence rates ranged from 51% to 100%. Five of the 6 subjects participated in follow-up. The nurse's telephone log from the pilot study revealed that although 4 out of the 5 subjects and/or caregivers reported that they favored the VMP as a medical management tool, the use of the VMP at home varied considerably. CONCLUSIONS: The VMP is a promising tool for use by both patients and providers to improve medication management. Although it was developed in the VAMC system, its Web-based platform has the potential for export to other systems.

Academic Medical Centers↗
PubMed1998

Coding medical information: classification versus nomenclature and implications to the Israeli medical system.

The efficient retrieval of medical information is essential for all functional aspects of a health system. Such retrieval is possible only by coding data (as it is produced or after it is produced) and entering it into a data-base. The completeness and accuracy of retrieved information depend, therefore, on the coding system employed. The main coding system that is in use in Israel is the ICD-9: International Classification of Diseases and its clinical modification (ICD-9-CM). Using such a statistical classification system for coding has met the basic needs for statistical and administrative purposes, but causes distortion and loss of information. With the recent growth and availability of information technology, more detailed data can be coded and processed than was possible before. A detailed nomenclature system such as SNOMED (the Systematized Nomenclature Of Human and Veterinary Medicine) can be used as a coding system that enables a more comprehensive and flexible medical information data base. This article discusses some aspects of coding medical information and suggests that a national revision of medical coding systems be considered as the computerized-patient-record is further developed and implemented.

Abstracting and Indexing↗
PubMed1990

Computerizing medical records: software criteria for systems to document patient encounters.

It is difficult to design and build computer systems to document medical care, especially if the entries are to be made by health care professionals. Not all software approaches are equally well suited to the task. Twenty-one specific software characteristics were identified that promote efficient development and support clinical needs. Using a software tool that satisfied these characteristics, we developed a computerized medical chart system that physicians can use to write notes and document patient encounters. The success of this system was due to a good fit between the basic capabilities of the software approach and the requirements of the project. These criteria can serve as the starting point for evaluating or developing other software applications that depend on physician input of clinical information.

Documentation↗
PubMedDate not supplied

Attitudes of first-year medical students toward the confidentiality of computerized patient records.

OBJECTIVES: To investigate the attitudes of students entering medical school toward the confidentiality of computerized medical records. DESIGN: First-year medical students at the Vanderbilt University School of Medicine responded to a series of questions about a hypothetic breach of patient's privacy through a computerized patient record system. MEASUREMENTS: The individual authors independently grouped the blinded responses according to whether they were consistent with then-current institutional policy. These preliminary groupings were discussed, and final categorizations were made by consensus. RESULTS: While most students had a sense of what was right and wrong in absolute terms, half the class suggested at least one course of action that was deemed to be inconsistent with institutional policies. CONCLUSIONS: The authors believe that medical schools should directly address ethical and legal issues related to the use of computers in clinical practice as an integral part of medical school curricula. Several teaching approaches can facilitate a greater awareness of the issues surrounding technology and medicine.

Academic Medical Centers↗
PubMed1991

[Realistic possibilities of utilization of a personal computer in the office of a general practitioner].

In May 1990 work on the programme "Computer system of the health community doctor Mic DOKI was" completed which resolves more than 70 basic tasks pertaining to the keeping of health documentation by health community doctors; it resolves automatically the entire administrative work in the health community, makes it possible to evaluate the activity of doctors and nurses it will facilitate the work of control organs of future health insurance companies and contribute to investigations of the health status of the population. Despite some problems ensuing from the contemporary economic situation of the country, the validity of contemporary health regulations and minimal training of our health personnel in the use of personal computers computerization of the health community system can be considered an asset to the reform of the health services which is under way.

Family Practice↗
PubMed1997

Computerized patient records benefit physician offices.

The use of computerized patient record systems in ambulatory settings is still a relatively new concept; however, such systems offer a variety of benefits to physician practices. Computerized patient record systems can help improve the quality of care provided, for example, by providing real-time patient status reports, test results as soon as they are available, and graphs and flowsheets of test trends. They can help reduce costs by eliminating many manual functions and the supply and staff expenses associated with these functions. Finally, they can provide practices the data necessary to attract and negotiate favorable managed care contracts. Because computerized patient record technology is still new, substantive empirical evidence upon which to base payback calculations is scarce. Time and motion studies were conducted at a model five-physician, primary care clinic to determine where efficiencies and cost savings could be realized through the use of a computerized patient record system. In addition, actual and anecdotal information from several clinics of comparable size that have such systems was used to reach some preliminary conclusions. Findings suggest that computerized patient record systems may return productivity gains and help physicians attain their patient care and financial goals.

Ambulatory Care Information Systems↗
PubMed1994

Positive efficiency findings using computer assisted ICD-encoding: 3.5 years of experience with the computerized patient record system PADS (Patient Archiving & Documentation System).

In daily routine there is a major discrepancy between what physicians do and what they document. From a medical information processing point of view amongst the more important functions physicians perform in their daily routine is the encoding of diagnoses using a standard vocabulary such as ICD-9. This paper presents evidence that through the use of the ICD-encoding module of a computerized patient record system (PADS, Patient Archiving and Documentation System) user compliance can be improved. "Bypassing" mechanisms can be partly reversed (up to 43%), more coded diagnoses are documented (by 51%) and those diagnoses documented are more complete (increase by 57%).

Germany↗
PubMed1994

The efficiency of preoperative evaluation: a comparison of computerized and paper recording systems.

OBJECTIVE: We designed and implemented a preoperative evaluation record system with seven networked computers for use by physicians and other medical staff. This study compared the efficiency of the new computerized system with that of the paper system. METHODS: We reviewed data from preoperative evaluations completed from November 1990 through December 1992. Data were analyzed automatically (Borland C program) for two intervals: (1) the waiting period, defined as the time the patient entered the waiting room until he or she entered the examination room; and (2) the examination period, defined as the time the patient entered the examination room until an evaluation form was printed. Data were obtained for 2,511 evaluations on paper and 8,342 by computer. RESULTS: The average waiting period with the paper system was 56.1 +/- 44.8 min; the average waiting period with the computerized system was 59.1 +/- 47.0 min. The average examination period was nearly identical for both systems: 27.5 +/- 23.6 min for the paper system; 28.5 +/- 22.7 min for the computerized system. CONCLUSION: The computerized system required no more examination time than the manual system. In addition, we speculate that time is saved at other points of patient care by the legible, instantly retrievable preoperative evaluations that the computerized system produces.

Hospital Information Systems↗
PubMed1996

The computer research network of the Royal New Zealand College of General Practitioners: an approach to general practice research in New Zealand.

Computers are now in widespread use by general practitioners (GPs) in many countries. In New Zealand this development has advanced general practice research by enabling collaboration among a small population of doctors practising in geographically diverse locations. This paper reviews the establishment of the Computer Research Network of the Royal New Zealand College of General Practitioners (RNZCGP) and its development between 1990 and 1995. The Network consists of 181 general practices (approximately 450 GPs) from throughout urban and rural New Zealand. All participants use computers in their practices to record consultation notes and to generate prescriptions, investigations and referral forms. Computer programs developed in the RNZCGP Research Unit are run on commercial software in doctors' surgeries to provide anonymous, individual data. In addition to the routine analysis of utilization for feedback to participants, 13 research projects have been completed. These include investigations of access to general practice care, use of health services by individuals and families, surveillance of immunization uptake, epidemiology of common conditions, and the use of pharmaceuticals in general practice. The RNZCGP Computer Research Network is an example of a computerized general practice research network that has been productive without receiving significant financial resources or having a formal management structure.

Confidentiality↗
PubMedDate not supplied

A study of the paper chart and its potential for computerization.

The traditional paper chart is an expensive and inefficient method of managing the mountains of information gathered about each patient admitted to the hospital. Greater efficiency can be obtained through the use of computerized systems of documentation that facilitate the rapid processing of information and make that information immediately available to care providers. A systematic analysis of the medical record at the Medical Center at Princeton provided valuable information to determine the outcome potential of a computerized documentation system.

Costs and Cost Analysis↗
PubMed2000

Digitized images of wounds: a nursing practice innovation.

Although clinical photography is not new, the incorporation of digital wound images into computerized patient records is an innovation recently developed in nursing practice. At the Washington, DC Veterans Affairs Medical Center (Washington DC VAMC), a nurse imaging program is being developed through a unique partnership between a clinical nurse specialist and a nurse informaticist. Digitized images are stored as parts of the ViastA computerized patient record system, making them immediately available throughout the entire medical center, on more than 1500 computers in the clinical environment. Any patient condition that can be represented visually, for example, pressure ulcers, which are the most frequently imaged, can be placed into the medical record. The major benefit of this nurse imaging program is that the status of wound healing can be tracked visually over time, from acute care to the clinic setting, and to the home. Progression from the problem, as originally defined, through the innovation process, and a statement of future plans are presented in the article.

Data Display↗