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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↗
PubMed2003

Analysis of hospitalised patient flows using data-mining.

UNLABELLED: Face to the development of hospital information system in the "Hôpital Européen George Pompidou" (HEGP), computerized patients records made medical data easier to analyse than before. We use data-mining technology to analyse intra-hospital patients' paths with one year of PMSI data (a French medical information system similar to Diagnosis Related Group). METHODS: 1. "sequential patterns mining" was used to analyse the most frequent patients' paths, 2. an integrated framework of "association rules mining" and "classification rule mining" was used to build prediction rules of patients' paths. RESULT: We construct a rule based prediction model, which gives the tendency of the patient's paths between the different medical units.

Computer Communication Networks↗
PubMedDate not supplied

Computerized patient records: current and future opportunities.

Although computerized patient record (CPR) technology holds tangible promise for improvements in the quality of patient care, its penetration into physician practices has been slow at best. This article describes the operational and quality of care benefits of CPR implementation and the barriers to implementation. These include technology limitations, cultural factors, lack of standards, downtime fears, security and privacy concerns, and the lack of alignment of economic incentives. The article also provides non-radical approaches (i.e., simpler and cheaper) ways to harness technology to improve office efficiencies and patient care.

Attitude to Computers↗
PubMed2003

From computerized patient records to national resource.

To help curb constantly rising costs of medical services, healthcare providers in Israel have been busy incorporating computerized patient record systems (CPR) into their organizations since the early 1990s. Our CPR based integrated system solutions (named Clicks) now serve over 90% of primary and secondary medical care professionals throughout the country, covering over 90% of the population across medical fields with all healthcare providers. Online verification of member rights, embedded business rules and medical protocols as well as Preventive Medical Assistance (PMA) rules are incorporated into the system. These, coupled by bi-directional communication to facilitate implementation and enforcement at all points of service and to transmit administrative and focal medical information, have created a firm foundation for carrying out the organization's cost control and expense management strategies. The CPR systems based on these underlying concepts and on token driven data entry methodology have transformed traditional medical work areas into virtually paperless environments. The enterprise wide solutions use dedicated viewports to address the needs and requirements of any medical field, user population and a wide range of medical facilities. Extensive data collection and detailed documentation are maintained universally at all points of service, for the entire patient population. Current applications, based on a distributed approach and local databases with communication to central systems for bi-directional transfer of information, gradually give way to unified databases located on central systems. Two concepts are being implemented: (a) MDC (Medical Data Core), which contains patients' focal medical data as transmitted from the local database at the physician's workstation, and (b) a complete centrally located database, where continuous communication is required from the physician's workstation to the central system, through dumb terminals. This concept entails massive investment in communication capacity and hardware and requires high reliability of all communication transactions at all times. MDC information by contrast does not require open communication lines around the clock, is communicated bi-directionally at predefined points in time or in the workflow, alleviating load and congestion on communication lines. In addition, access, retrieval and display of MDC information is done using standard browsing techniques under known protocols and requires no extra investment for these capabilities.

Diffusion of Innovation↗
PubMed2005

AOFAS member experience with computerization of the office.

BACKGROUND: The combination of the implementation of the Healthcare Information Portability and Accountability Act (HIPAA) and the widespread publicity surrounding the report by the Institute of Medicine on preventable medical errors has increased interest of AOFAS members in the use of office-based electronic medical record (EMR) systems. Despite the large number of vendors for office-based EMR systems, little has been written to guide orthopaedists in the selection and installation of EMR systems. METHODS: A web-based AOFAS member survey was undertaken in the Spring of 2003, for the purpose of discovering EMR-related issues that are of most concern. Several questions were open-ended, so as to obtain the broadest set of answers. All responses were manually reviewed, collated, analyzed. RESULTS: The 130 respondents were evenly distributed in age. Sixty-six percent were in private practice. Eighty-nine percent used a computerized billing system. Thirty-two percent used an EMR system. Use of an EMR system was more likely for those in academic practices (p = .01029, chi square) but was not statistically influenced by age, size of the practice group, or the number of offices or hospitals used in the practice. The opinions expressed were exceptionally varied. The most common potential benefit of an EMR system cited was the ease of chart handling and accessibility. The most common perceived barriers to successful EMR implementation were cost (50%) and training of staff and physicians (30%). CONCLUSIONS: The survey highlighted the widely divergent opinions regarding the potential benefits (cost savings and improved quality of medical record) and barriers to implantations (e.g. issues dealing with mixed electronic and paper charts and managing the transition to an EMR system). The wide variety of opinions is partly a consequence of the lack of easily accessible information about office-based EMR systems and how to choose among the many vendors. A brief overview of the essential elements to be considered before acquiring an EMR system is included.

Adult↗
PubMedDate not supplied

Does feedback improve the quality of computerized medical records in primary care?

OBJECTIVE: The MediPlus database collects anonymized information from generalpractice computer systems in the United Kingdom, for research purposes. Data quality markers are collated and fed back to the participating general practitioners. The authors examined whether this feedback had a significant effect on data quality. METHODS: The data quality markers used since 1992 were examined. The authors determined whether the feedback of "useful" data quality markers led to a statistically significant improvement in these markers. Environmental influences on data quality from outside the scheme were controlled for by examination of the data quality scores of new entrants. RESULTS: Three quality markers improved significantly over the period of the study. These were the use of highly specific "lower-level" Read Codes (p=0.004) and the linkage of repeat prescriptions (p=0.03) and acute prescriptions (p=0.04) to diagnosis. Clinicians who fall below the target level for linkage of repeat prescriptions to diagnosis receive more detailed feedback; the effect of this was also statistically significant (p<0.01.) CONCLUSIONS: The feedback of four of the ten markers had a significant effect on data quality. The effect of more detailed feedback appears to have had a greater effect. The lessons learned from this approach may help improve the quality of electronic medical records in the United Kingdom and elsewhere.

Humans↗
PubMedDate not supplied

The electronic medical record system: health care marvel or morass?

The author considers the potential advantages and disadvantages, as well as possible unintended consequences, of introducing electronic medical record systems in health care organizations. Special consideration is given to the issues such information systems raise concerning privacy, confidentiality, and quality of care from both patient and provider perspectives. The potential gains from computerizing medical records include the benefit of instantaneous availability of patients' medical history, treatment regimes, and current health status in routine and emergency clinical situations. Ease of access to this information should reduce adverse outcomes. The added value of a complete and up-to-date medical record immediately available to medical caregivers seems undeniable. The potential disadvantages include issues around patient confidentiality and unauthorized access to records, the enormous capital investment for computer hardware, and system maintenance.

Boston↗
PubMed2001

Measuring the success of electronic medical record implementation using electronic and survey data.

Computerization of physician practices is increasing. Stakeholders are demanding demonstrated value for their Electronic Medical Record (EMR) implementations. We developed survey tools to measure medical office processes, including administrative and physician tasks pre- and post-EMR implementation. We included variables that were expected to improve with EMR implementation and those that were not expected to improve, as controls. We measured the same processes pre-EMR, at six months and 18 months post-EMR. Time required for most administrative tasks decreased within six months of EMR implementation. Staff time spent on charting increased with time, in keeping with our anecdotal observations that nurses were given more responsibility for charting in many offices. Physician time to chart increased initially by 50%, but went down to original levels by 18 months. However, this may be due to the drop-out of those physicians who had a difficult time charting electronically.

Attitude of Health Personnel↗
PubMed1993

[Computerization in private urologic practice with multiple practice locations: the use of medical software and a portable microcomputer].

The authors have used a medical programme, Medistory, since June 1990 to computerize a private urological practice. This programme allows personalization of data collection adapted to urology: interview sheets related to the disease, standard report forms, edition of letters, creation of a multi-entry file and entering of accounts. The consultation was always held without a paper support with real-time data acquisition and the accounting was performed at the end of the visit. Letters were printed separately at home, at the end of the day, so as not to delay the patient. A back-up was performed every second day on hard disk. We used a portable Macintosh with 20 mega octets of REM and a 40 mega octet internal hard disk as our practice is based at several sites. This computerisation benefited from the Macintosh interface which facilitated learning and use of the programme. No time loss and no patient discomfort were recorded in comparison with a conventional consultation. The possibility of opening several files at the same time allowed a simple reply to any demands for other information. Two files out of 700 were lost (0.3%) due to an error when saving data. No accounting errors were detected. The use of a medical programme is particularly well adapted to private urological practice with multiple offices. The advantages of a personal computer include the gain of place, rapidity, unlimited storage capacity and the possibility of recovering data with other standard programmes. Medistory, a programme created for general practitioners, is perfectly adapted to this use due to the ease of personalization allowing the creation of interview sheets related to the disease and the edition of reports and various letters.

Computer Security↗
PubMed1993

Feasibility of ensuring confidentiality and security of computer-based patient records. Council on Scientific Affairs, American Medical Association.

Legal and ethical precepts that apply to paper-based medical records, including requirements that patient records be kept confidential, accurate and legible, secure, and free from unauthorized access, should also apply to computer-based patient records. Sources of these precepts include federal regulations, state medical practice acts, licensing statutes and the regulations that implement them, accreditation standards, and professional codes of ethics. While the legal and ethical principles may not change, the risks to confidentiality and security of patient records appear to differ between paper- and computer-based records. Breaches of system security, the potential for faulty performance that may result in inaccessibility or loss of records, the increased technical ability to collect, store, and retrieve large quantities of data, and the ability to access records from multiple and (sometimes) remote locations are among the risk factors unique to computer-based record systems. Managing these risks will require a combination of reliable technological measures, appropriate institutional policies and governmental regulations, and adequate penalties to serve as a dependable deterrent against the infringement of these precepts.

Computer Security↗
PubMed2005

From a paper-based transmission of discharge summaries to electronic communication in health care regions.

OBJECTIVES: In Austria, the general practitioner (GP) is the first point of contact for persons with health problems. Depending on the severity of the person's medical condition, a GP may refer her or him to a secondary care hospital consultant, who reports findings back to the GP in form of a paper-based discharge letter. Researchers report that paper-based communication of medical documents between different health care providers is insufficient in quality, error prone and too slow in many cases. Our aim was to develop and to realise a strategy for a stepwise replacement of the paper-based transmission of medical documents with a distributed, shared medical record. METHODS: In the first step of a three-steps strategy for development of a consistent, comprehensive and secure regional health care network, an electronic communication of discharge letters and diagnostic results between existing information systems of different health care providers in Tyrol, Austria, has been established: in the form of cryptographically signed S/MIME e-mail messages and, additionally, via a secure web portal system. In two further steps, an extension of the system by a bi-directional communication and by improvements of the web portal system is planned, leading to a comprehensive electronic patient record for shared care. RESULTS: After realisation of step 1, in October 2004, about 3500 electronic discharge letters were sent out from the Innsbruck University Hospital (IUH), which represents about 8% of the total number of discharge letters of the IUH. In addition, a lot of feedback was received and legal, organisational, financial and methodical difficulties were overcome. DISCUSSION: The stepwise approach to replace paper-based with electronic communication in the first step was helpful, since knowledge has been gained and cooperations were formed. For the realisation of a distributed, shared medical record (steps 2 and 3), it will not be sufficient only to replace paper-based transmission of medical documents with electronic communication technologies, but in the further steps, organisational changes will become necessary. As well, legal ambiguities must be resolved before a distributed medical record for cooperative care, used by several institutions as well as by patients, could be established.

Austria↗
PubMed1998

Internet integrated in the daily medical practice within an electronic patient record.

Healthcare enters the information age and professionals are finding an ever-growing role for computers in the daily practice of medicine. However, a number of problematic issues are associated with electronic publications, especially through Internet. Whilst access to any information has been improved, access to specific information has become more and more difficult [1], due to the lack of a general meta-knowledge allowing to structure Internet resources. Physicians have to learn and adapt themselves to computers and Internet, but Internet has to meet the specific requirements of Healthcare. Important issues must therefore be addressed to allow a real and daily use of Internet in the medical practice. The paper discusses most of these issues and proposes a solution developed at the University Hospital of Geneva that integrates an Electronic Patient Record with Internet, without compromises on security or on performances and that runs on standard PCs'.

Computer Security↗
PubMed1997

A network of web multimedia medical information servers for a medical school and university hospital.

Modern medicine requires a rapid access to information including clinical data from medical records, bibliographic databases, knowledge bases and nomenclature databases. This is especially true for University Hospitals and Medical Schools for training as well as for fundamental and clinical research for diagnosis and therapeutic purposes. This implies the development of local, national and international cooperation which can be enhanced via the use and access to computer networks such as Internet. The development of professional cooperative networks goes with the development of the telecommunication and computer networks and our project is to make these new tools and technologies accessible to the medical students both during the teaching time in Medical School and during the training periods at the University Hospital. We have developed a local area network which communicates between the School of Medicine and the Hospital which takes advantage of the new Web client-server technology both internally (Intranet) and externally by access to the National Research Network (RENATER in France) connected to the Internet network. The address of our public web server is http:(/)/www.med.univ-rennesl.fr.

Artificial Intelligence↗
PubMed1998

Standardizations of clinical laboratory examinations in Japan.

In this paper we introduce Japanese activities concerning laboratory examinations by illustrating three major categories. The first is the contribution of JCCLS to ISO/TC212 clinical laboratory testing and in vitro diagnostic test systems, with NCCLS and CEN TC140. The second is the establishment and promotion of JLAC Classification and Coding for Clinical Laboratory Tests by The Japan Society of Clinical Pathology. The third is a clinical data exchange format between healthcare facilities using MML/MERIT-9 standard, started as a Ministry research project.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

Standard Generalized Markup Language for self-defining structured reports.

Structured reporting is the process of using standardized data elements and predetermined data-entry formats to record observations. The Standard Generalized Markup Language (SGML; International Standards Organization (ISO) 8879:1986)--an open, internationally accepted standard for document interchange was used to encode medical observations acquired in an Internet-based structured reporting system. The resulting report is self-documenting: it includes a definition of its allowable data fields and values encoded as a report-specific SGML document type definition (DTD). The data-entry forms, DTD, and report document instances are based on report specifications written in a simple, SGML-based language designed for that purpose. Reporting concepts can be linked with those of external vocabularies such as the Unified Medical Language System (UMLS) Metathesaurus. The use of open standards such as SGML is an important step in the creation of open, universally comprehensible structured reports.

Information Storage and Retrieval↗
PubMed2004

An educational intervention to improve data recording in the management of ischaemic heart disease in primary care.

BACKGROUND: Gaps in computerized medical records and a lack of a systematic approach to data recording make progress towards achieving quality standards in primary care difficult to demonstrate. The aim of this study was to examine the effect of an educational intervention on data quality in primary care. METHODS: A before-and-after study of key data quality measures was carried out in 87 general practices in eight primary care organizations in England in phase 1 and 84 general practices in phase 2. The subjects were 19,470 patients with ischaemic heart disease in phase 1 and 19,784 patients in phase 2. The main outcome measures were improvement in the completeness and quality of the computerized medical record. Anonymized data were extracted from clinical information systems and processed to produce comparative information on each practice. Data quality workshops were arranged, in which reflection can take place, backed up by summary statistics. Practice visits provided training and personalized feedback of patients needing intervention. RESULTS: In the patients with heart disease, nearly 16,000 new clinical entries were made in the key improvement areas. The percentage of patients advised to quit smoking increased by 49.3 per cent, from 23.6 per cent to 61.9 per cent. There were also significant improvements in many other aspects of management. CONCLUSION: Focused interventions that provide targeted and relevant clinical information can be implemented in primary care. Such interventions can lead to a rise in data quality in primary care, but their effectiveness needs to be further tested in more rigorous research settings such as randomized controlled trials.

Ambulatory Care Information Systems↗