Why physicians continue to reject the computerized medical record.
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EKGenius is a computer-interactive learning environment in electrocardiography for the cardiovascular specialist including those who design and evaluate monitoring equipment. It provides a comprehensive review and assessment in electrocardiographic principles, 12-lead EKG interpretation, and arrhythmia detection. The program combines a simulated examination, tutorial lessons, and practice quizzes. An authoring system facilitates implementation of an a database of 250 questions and 100 lessons. The program provides the user with his/her score at the end of the exam, and the user has the option to review incorrect responses with the associated lessons. In the quiz mode, 10 questions are selected from the bank in the category selected by the user. Immediate feedback is provided with each response, and the user has the option of receiving a hint or reviewing an associated lesson. A mode is also available to view the tutorial lessons independently.
Improvements in technology have enabled creation of speech recognition hardware and software products which are easily affordable. This paper briefly reviews these techniques and describes several commercially available products which utilize them. Both speaker-dependent and speaker-independent techniques are included. The author concludes by describing a microprocessor-controlled, trainable, voice recognition board which he built for medical applications which is based on a commercial $5 speech recognition integrated circuit.
ISIS is a patient education computer program about hypertension. It aims to be complementary to the habitual educational techniques by bringing into patient education the facility of multimedia features. Its efficiency in improving the knowledge about hypertension was tested among 158 hypertensive patients. Their prior knowledge was evaluated using a questionnaire. They were then randomly separated in a control group (CG) which had the regular education program and ISIS group or (IG) which, in addition, had an interactive session using ISIS. Two months after discharge, all the patients were asked the same questions over the telephone. A total of 138 observations (69 CG, 69 IG) were reported in the final analysis. The initial scores were significantly improved for both groups. The improvement is more evident in the IG, particularly among patients whose initial score was low and patients whose hypertension was discovered for more than 6 months. ISIS is actually used by hospitalized patients and by nurse students.
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This paper describes OncoLink, the first multimedia World-Wide-Web (WWW) and gopher server focusing on cancer information for both the health care professional and the patient. OncoLink provides an internetworked hypertext and multimedia resource linking people, computers and information together in an easy to use fashion. Our objective in developing OncoLink is to provide comprehensive and timely information about many aspects of oncology for both patients and healthcare providers. Specifically, OncoLink's purposes are: (1) the rapid dissemination of information relevant to treatment of cancer and concomitant problems; (2) education of health care personnel (at all levels) in the field; (3) education of patients and families of patients who have cancer; (4) posting of clinical trials and eligibility criteria; (5) the rapid collection and dissemination of quality, peer-reviewed information pertinent to oncology in general and specific subspecialties; (6) provide a well-organized, frequently updated hypertext system to access other quality cancer information resources on the Internet. OncoLink attempts to provide one-stop shopping for the patient, healthcare provider, researcher or Internet browser searching for cancer-related information. Since its inception on March 7, 1994, OncoLink has averaged more than 36,000 accesses per month from around the world. While also accessible by text-based gopher servers, preliminary observations infer increased use of multimedia and hypertext documents over traditional text-only resources. From the large following of users, it is clear that electronic dissemination of high quality, peer-reviewed cancer information is very popular. We conclude OncoLink is both useful and has wide interest in the international community.(ABSTRACT TRUNCATED AT 250 WORDS)
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Terminologies have traditionally been considered as static datasets held in books or databases. The GALEN Terminology Server presents a prototype for a new view of terminologies delivered as a set of functions and services provided to other applications. This facilitates their development and integration as part of a strategy for sharing and re-using information and knowledge. The essential features of the Terminology server are the functions which it can perform; questions which it can answer and statements which it can be told. The GALEN Terminology Server supports these operations through a modular architecture and uniform applications programming interface which allows client applications to ignore the internal structure and simply use the Server for terminological, coding, and linguistic functions.
The UltraSTAR structured data entry system is now in routine use for reporting ultrasound studies at Brigham and Women's Hospital, having been used for 3722 reports in its first ten months of service. Reports entered through GUI-based forms are uploaded via HL7 to a radiology information system and distributed through a hospital network. UltraSTAR introduces collaborative reporting, in which nonmedical and medical staff collaborate to produce a single report for each patient visit. Performance of UltraSTAR was measured as user satisfaction, data entry time, report completeness, free text annotation rate, and referring-physician satisfaction with reports. Results show high satisfaction with UltraSTAR among radiologists and acceptance of the system among ultrasound technicians. Data entry times averaged 5.3 minutes per report. UltraSTAR reports were slightly more complete than comparable narrative reports. Free text annotations were needed in only 25.2% of all UltraSTAR reports. Referring physicians were neutral to slightly positive toward UltraSTAR's outline-format reports. UltraSTAR is successful at structured data entry despite somewhat long reporting times. Its success can be attributed to efficiencies from collaborative reporting and from integration with existing information systems. UltraSTAR shows that the advantages of structured data entry can outweigh its difficulties even before problems of data entry time and concept representation are solved.
Many integrated clinical information systems depend on large knowledge bases containing dictionary of terms as well as specific information about each term and the relationships between terms. We propose a knowledge base model called MD Concept which is based on a semantic network and uses an object-oriented paradigm and relational tables. A prototype has been developed which integrates the Unified Medical Language System (UMLS) with other databases including the Systematized Nomenclature of Medicine (SNOMED II), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR) and a pharmaceutical database. We demonstrate how a user can easily navigate in this knowledge world using a browser.
By employing process flow analysis and work redesign techniques during the design and implementation of a computerized patient record in the pediatric outpatient clinics at the University of Virginia Health Sciences Center, we have developed a database of clinical observations while simultaneously shortening the time that patients spend waiting in the pediatric clinics and decreasing the number of support staff employed within the clinics.
A clinical database was designed as part of a comprehensive workstation for diagnostic laboratory hematology. The database stores coded findings pertinent to hematologic disorders including inherited abnormalities, previous surgery, malignancies, current therapy, and laboratory test results. The workstation includes knowledge-based systems for peripheral blood analysis, flow cytometry studies, and bone marrow morphology. The peripheral blood system renders an interpretive report based on data from a complete blood count with manual review of a blood smear by a technologist. The flow cytometry module interprets the immunophenotyping and DNA content results, and correlates them with the clinical findings and the peripheral blood data. The bone marrow system bases its report on all of the available information including the morphologic review of the bone marrow specimen by a physician, the peripheral blood data, immunophenotype, and clinical/laboratory findings. Before generating an interpretive report, each of the knowledge-based systems automatically searches the clinical database for specific information pertinent to the findings in the case. Since the workstation must function in situations where access to distributed databases is not feasible or not yet practical, a data entry module with a graphical user interface has been created.
We describe work to enhance existing software protocols and develop a suite of new software utilities based upon a set of standards known as the World Wide Web (WWW). Specifically, we have developed an effective X-windows based WYSIWYG WWW browser/editor and a prototype for integrated wide-area authentication and authorization support for delivery and maintenance of WWW service. These software development activities, along with parallel work in content development, are empowering individuals to better use the Internet as a resource to easily author, publish, and access materials. As an illustrative application, we describe one Web-based self-instructional unit designed to increase users' knowledge of hazardous substances in the environment. This on-line monograph was adapted from a series of paper-based case studies developed by the Agency for Toxic Substances and Disease Registry of the U.S. Department of Health & Human Services. The on-line version illustrates many of the innovative features provided by the Web, and demonstrates how such materials can significantly impact medical education at all levels.
It is projected that by the turn of the century, ninety percent of diagnostic procedures and seventy percent of therapeutic procedures will occur outside a hospital setting [2,3]. Additionally, according to a 1992 study by Arthur D. Little, during any given physician office visit, as much as 30 percent of the required diagnostic data and information required by the physician is unavailable [4]. Driven by ever increasing demands for convenience and accessibility, health care continues to evolve into an environment where the importance of data and its relative availability to the requester are diverging. This paper will present the concept of a regional or community health information network (RHIN or CHIN). Specifically, the Wisconsin Health Information Network (WHIN) will be used as a case study.