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PubMed2006

HDLalert - a healthcare DL alerting system: from user needs to implementation.

In the health domain, there are many circumstances where clinicians (i.e. doctors, nurses, allied health professionals) and patients wish to track changes in medical knowledge. However, existing 'news' or 'alert' services provide relatively limited means for selecting which information to receive. The result is that clinicians and patients often receive information that is inappropriate, irrelevant or simply too much. In this paper, we detail alert-relevant findings from several international user studies (e.g. UK, Germany and New Zealand) incorporating both clinical staff (across several hospitals) and patients' perceptions. These findings demonstrate the importance of context, in terms of both the user's task and immediate environment. We introduce a novel alerting architecture that can provide a finely tailored stream of alerts to the user, and provides further support to assist the interpretation of received material.

Consumer Behavior↗
PubMed1999

Lesson learnt from a halt of the hospital information system.

The present paper deals with an experience of blackout of the hospital information system at our Medical Centre, trying to evaluate the impact on internal users (physicians, nurses, clerks) and patients population. Limited inconveniences have occurred to out-patients in terms of delay in collecting medical reports after diagnostic test execution. As regards direct users, impact was evaluated through a structured interview. Administrative personnel, that have been using computer-based system for at least ten years, have not declared particular inconveniences, accepting the overtime or the extra-work as simply unavoidable. On the contrary, health-care personnel reported a heavy negative impact of the system failure on their activity. After a great effort to achieve the system acceptance and direct physicians usage, the blackout of the system has pointed out that the situation has changed since a few years ago: now the HIS, and particularly its clinical core, is considered mission critical.

Data Collection↗
PubMed1999

The CCC system in two teaching hospitals: a progress report.

Computing systems developed by the Center for Clinical Computing (CCC) have been in operation in Beth Israel and Brigham and Women's hospitals for over 10 years. Designed to be of direct benefit to doctors, nurses, and other clinicians in the care of their patients, the CCC systems give the results of diagnostic studies immediately upon request; offer access to the medical literature: give advice, consultation, alerts, and reminders; assist in the day-to-day practice to medicine, and participate directly in the education of medical students and house officers. The CCC systems are extensively used, even by physicians who are under no obligation to use them. Studies have shown that the systems are well received and that they help clinicians improve the quality of patient care. In addition, the CCC systems have had a beneficial impact on the finances of the two hospitals, and they have cost less than what many hospitals spend for financial computing alone.

Attitude↗
PubMed1999

Computer-assisted health counselor visits: a low-cost model for comprehensive adolescent preventive services.

OBJECTIVE: To evaluate a low-cost strategy for providing preventive health services to adolescents using computerized health assessments with individualized educational videos, trained health counselors, and nurses. DESIGN: Feasibility study, cost analysis, and comparative evaluation of health problems identified, guidance delivered, and patient satisfaction. SETTING: Eleven sessions at nontraditional sites including schools, universities, shopping malls, and after-hours clinics on Oahu, Hawaii. PARTICIPANTS AND INTERVENTION: Adolescents (N=258, mean age 17 years) completed confidential computerized health assessments, received individualized feedback, and viewed automatically selected educational videos on a laptop computer. The computer additionally printed a prioritized problems list for the graduate student-level health counselor to review with the adolescent. The counselor subsequently reviewed each encounter with a nurse-educator who performed further counseling and physical examinations when indicated. RESULTS: Visit length averaged 44 minutes. Subjects spent an average of 21 minutes completing the automated health assessment and viewing interactive multimedia and 15 minutes with the health counselor. One third of subjects required further evaluation and counseling by the nurse (average, 8 minutes). A team of 2 counselors and 1 nurse provided comprehensive screening, health counseling, and physical examinations to 1 patient every 10 minutes at a salary cost of $7.46 per visit. This model identified risk behaviors at levels consistent with local behavioral data, and addressed and documented them significantly more often than do physicians in traditional settings. Subjects (71%) preferred the computer-assisted visits to standard office visits, and 92% felt the amount of time spent was acceptable. CONCLUSIONS: Computer-assisted delivery of adolescent preventive services using nonphysician health counselors is a feasible, economical, and acceptable alternative to traditional clinical practice for screening young people for health-compromising behaviors and providing individualized health education and routine physical examinations. This model would likely increase adolescents' access to needed preventive services at a very modest cost.

Adolescent↗
PubMed2004

Field investigations of emergency department syndromic surveillance signals--New York City.

INTRODUCTION: The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has operated a syndromic surveillance system based on emergency department (ED) chief-complaint data since November 2001. This system was created for early detection of infectious-disease outbreaks, either natural or intentional. However, limited documentation exists regarding epidemiologic field investigations conducted in response to syndromic surveillance signals. OBJECTIVE: DOHMH conducted field investigations to characterize syndromic surveillance signals by person, place, and time and to determine whether signals represented true infectious-disease outbreaks. METHODS: A DOHMH physician reviews ED-based syndromic surveillance results daily to look for signals. When necessary, field investigations are conducted and consist of a review of the patient line list, telephone interviews with hospital staff, chart reviews, interviews with patients, and collection and testing of specimens. RESULTS: In November 2002, a series of citywide signals for diarrhea and vomiting syndromes, which coincided with institutional outbreaks consistent with viral gastroenteritis, prompted DOHMH to send mass e-mail notification to NYC ED directors and institute collection of stool specimens. Three of four specimens collected were positive for norovirus. In December 2002, DOHMH investigated why an ED syndromic signal was not generated after 15 ill patients were transferred to a participating ED during a gastrointestinal outbreak at a nursing home. Field investigation revealed varying chief complaints, multiple dates of ED visits, and a coding error in a complementary DOHMH syndromic system, and confirmed a seasonal norovirus outbreak. During March 2003, the system generated a 4-day citywide respiratory signal and a simultaneous 1-day hospital-level fever signal in a predominantly Asian community. In those instances, epidemiologic investigation provided reassurance that severe acute respiratory syndrome was not present. CONCLUSION: Detailed field investigations of syndromic signals can identify the etiology of signals and determine why a given syndromic surveillance system failed to detect an outbreak captured through traditional surveillance. Validation of the utility of syndromic surveillance to detect infectious-disease outbreaks is necessary to justify allocating resources for this new public health tool.

Communicable Diseases, Emerging↗
PubMed2003

A systems overview of the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE II).

The Electronic Surveillance System for the Early Notification of Community-Based Epidemics, or ESSENCE II, uses syndromic and nontraditional health information to provide very early warning of abnormal health conditions in the National Capital Area (NCA). ESSENCE II is being developed for the Department of Defense Global Emerging Infections System and is the only known system to combine both military and civilian health care information for daily outbreak surveillance. The National Capital Area has a complicated, multijurisdictional structure that makes data sharing and integrated regional surveillance challenging. However, the strong military presence in all jurisdictions facilitates the collection of health care information across the region. ESSENCE II integrates clinical and nonclinical human behavior indicators as a means of identifying the abnormality as close to the time of onset of symptoms as possible. Clinical data sets include emergency room syndromes, private practice billing codes grouped into syndromes, and veterinary syndromes. Nonclinical data include absenteeism, nurse hotline calls, prescription medications, and over-the-counter self-medications. Correctly using information marked by varying degrees of uncertainty is one of the more challenging aspects of this program. The data (without personal identifiers) are captured in an electronic format, encrypted, archived, and processed at a secure facility. Aggregated information is then provided to users on secure Web sites. When completed, the system will provide automated capture, archiving, processing, and notification of abnormalities to epidemiologists and analysts. Outbreak detection methods currently include temporal and spatial variations of odds ratios, autoregressive modeling, cumulative summation, matched filter, and scan statistics. Integration of nonuniform data is needed to increase sensitivity and thus enable the earliest notification possible. The performance of various detection techniques was compared using results obtained from the ESSENCE II system.

Bioterrorism↗
PubMedDate not supplied

A patient-initiated system for preventive health care. A randomized trial in community-based primary care practices.

OBJECTIVE: To test the effectiveness of a patient-initiated, touch-sensitive computer system (TSCS) for improving screening rates for cancers of the breast, cervix, colon and rectum, and oral cavity. DESIGN: One-year, randomized, controlled trial with primary care practice as the unit of analysis. SETTING: Sixty primary care practices, randomly recruited from 329 nonteaching practices in a southeastern state. SUBJECTS: Random sample of the medical records of 50 male and female adult patients before intervention and 50 adult patients after intervention in each practice and a random sample of 507 TSCS users. INTERVENTIONS: Touch-sensitive computer system and a registered nurse who served as liaison to the study practices. The TSCS provided patient-specific preventive service recommendations and facilitated work flow to increase the completion of these interventions. MAIN OUTCOME MEASURE: Average change, adjusted for health maintenance examination (HME) and use of the TSCS, in the proportion of eligible patients undergoing screening mammography, clinical breast examination, digital rectal examination, fecal occult blood test, flexible sigmoidoscopy, Papanicolaou smear, and oral cavity examination. RESULTS: We observed a significant increase in the completion of screening mammography (6.6%; P < or = 0.5) and clinical breast examination (6.1%; P < or = .01) in women 50 years of age and older, particularly for those who had an HME during the study year. CONCLUSIONS: Patients who have HMEs are more likely to receive cancer screening; however, a computer-based system for preventive services can contribute to improvement in screening. Among those patients who did not have an HME, TSCS users had higher rates of breast cancer screening than nonusers.

Adult↗
PubMed2005

Developing a national integrated classification of health care interventions in Sweden.

BACKGROUND: Existing classifications in Sweden of health care interventions used for quality assurance issues and for decisions on resource allocation does not capture all types of health care interventions. The work of professional groups like nurses, physiotherapists, and occupational therapists is partly invisible. There is a need to develop a classification of health care interventions that comprise all activity within the health care sector. AIM: To describe a multi-professional collaborative work on classification development and to provide suggestions for an organizing structure that can capture interventions in the health care services incorporating different professional perspectives. RESULTS: The professional groups reached a common understanding about the use of the classification of The International Classification of Functioning, Disability and Health (ICF) as a unifying framework in the classification of health care interventions. Proposal was made for a revised structure of a current classification of interventions using ICD as unifying framework. CONCLUSION: The use of ICF as a unifying framework is seen as a fruitful way of overcoming professional differences, and by that supporting the process of reaching a common understanding and use of a common language when describing interventions in health care.

Delivery of Health Care, Integrated↗
PubMed2006

Assessment of osteoporosis-website quality.

INTRODUCTION: The Internet provides great opportunities for patient healthcare education, but poses risks that inaccurate, outdated, or harmful information will be disseminated. Osteoporosis is a topic of great interest to patients, many of whom use the Internet to obtain medical information. The aim of this study was to develop and evaluate measurement tools to determine the quality of osteoporosis websites for patients. METHODS: Quality indicators in the categories of content, credibility, navigability, currency, and readability were incorporated into separate evaluation tools for healthcare professionals and for patients. Websites were selected from an Internet search. Interobserver reliability and validity were assessed, and a sample of osteoporosis websites was evaluated by an osteoporosis nurse educator and compared to patient evaluations. RESULTS: For the quality indicators, there was 79% agreement between the osteoporosis nurse educators, 88% agreement between the physician osteoporosis experts, and 71% agreement comparing the osteoporosis nurse educators to the physician osteoporosis experts. Quality scores for evaluated websites ranged from 18-96 (maximum possible=100), with a mean of 66. Websites with Uniform Resource Locator (URL) suffix .com scored significantly lower compared to those with .gov (P<0.05), .edu (P<0.01), and .org (P<0.01). Healthcare professionals and patients were in agreement on the quality of the highest-rated websites, with less agreement for lower-rated websites. CONCLUSIONS: In summary, a tool for measuring the quality of medical websites was developed and evaluated. Significant variability in osteoporosis-website quality was observed. Higher-quality scores were associated with a higher level of search engine match and specific URL suffixes. A validated tool for evaluating medical websites may have value in assisting patients to select high-quality osteoporosis educational information on the Internet, and may encourage website developers to improve the quality of information that is provided.

Evaluation Studies as Topic↗
PubMed2006

ENN-ICS--implementation and evaluation of a multilingual learning management system for sleep medicine in Europe.

A new web based network aims at the improvement of health care in Europe by integrating advanced e-learning and e-publishing technologies for the training of medical doctors, nurses, and students. The field of application is sleep physiology and sleep medicine. Based on a multilingual, multimedia communication system, ENN-ICS Centre offers direct access to medical information for users, i.e healthcare professionals and citizens, in Europe and worldwide. The use of XML supports the development of media independent contents for multiple target groups. Editorial and distributive processes are supported by customized central editorial, content management and learning management systems (CMS, LMS). ENN-ICS e-health services are evaluated by selected user groups in North, Middle and Southern Europe using reliable and scientifically accepted validation instruments. The compliance with essential quality requirements and criteria is tested and verified by using online questionnaires based on the DISCERN questionnaire for evaluating patient information, the HON principles for health-related websites and the GMDS catalogue of quality criteria for electronic publications in medicine. The system architecture and its exemplary applications can be used as a model for future e-health services dealing with neurological and other medical topics.

Europe↗
PubMedDate not supplied

Applying an evaluation framework for health information system design, development, and implementation.

BACKGROUND: Dramatic advances in health information technologies necessitate a comprehensive evaluation framework covering all phases of development, from conception to routine operational use. OBJECTIVES: The purpose of this article was to illustrate the application of an informatics evaluation framework that provides a heuristic for matching the stage of system design and the level of evaluation. METHODS: An evaluation framework is illustrated in the context of five studies in different stages of system design. RESULTS: The studies discussed in this article represent the various stages of the framework. In addition, they are examples of how evaluation research studies not only contribute to the assessment of system design but also constitute distinct contributions to knowledge. DISCUSSION: The ability to engineer advanced information systems has exceeded the understanding of how to deploy them effectively in complex settings and to adapt them to a range of user populations. A systematic, continuous evaluation increases the likelihood that the conditions for success will be understood, including how to tailor a system, how to maintain the target population's use of the system, and how to innovate continually to enhance the functionality of the system and the users' experience. Without sound evaluation methodologies throughout the stages of system development, information systems have limited potential to influence healthcare processes positively.

Humans↗
PubMed2006

Getting physicians to accept new information technology: insights from case studies.

BACKGROUND: The success or failure of a computer information system (CIS) depends on whether physicians accept or resist its implementation. Using case studies, we analyzed the implementation of such systems in 3 hospitals to understand better the dynamics of physicians' resistance to CIS implementation. METHODS: We selected cases to maximize variation while allowing comparison of CIS implementations. Data were collected from observations, documentation and interviews, the last being the main source of data. Interviewees comprised 15 physicians, 14 nurses and 14 system implementers. Transcripts were produced; 45 segments of the transcripts were coded by several judges, with an appropriate level of intercoder reliability. We conducted within-case and cross-case analyses of the data. RESULTS: Initially, most staff were neutral or enthusiastic about the CIS implementations. During implementation, the level of resistance varied and in 2 instances became great enough to lead to major disruptions and system withdrawal. Implementers' responses to physicians' resistance behaviours played a critical role. In one case, the responses were supportive and addressed the issues related to the real object of resistance; the severity of resistance decreased, and the CIS implementation was ultimately successful. In the other 2 cases, the implementers' responses reinforced the resistance behaviours. Three types of responses had such an effect in these cases: implementers' lack of response to resistance behaviours, antagonistic responses, and supportive responses aimed at the wrong object of resistance. INTERPRETATION: The 3 cases we analyzed showed the importance of the roles played by implementers and users in determining the outcomes of a CIS implementation.

Attitude of Health Personnel↗
PubMed1998

An evidence-based approach to interactive health communication: a challenge to medicine in the information age. Science Panel on Interactive Communication and Health.

OBJECTIVE: To examine the current status of interactive health communication (IHC) and propose evidence-based approaches to improve the quality of such applications. PARTICIPANTS: The Science Panel on Interactive Communication and Health, a 14-member, nonfederal panel with expertise in clinical medicine and nursing, public health, media and instructional design, health systems engineering, decision sciences, computer and communication technologies, and health communication, convened by the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. EVIDENCE: Published studies, online resources, expert panel opinions, and opinions from outside experts in fields related to IHC. CONSENSUS PROCESS: The panel met 9 times during more than 2 years. Government agencies and private-sector experts provided review and feedback on the panel's work. CONCLUSIONS: Interactive health communication applications have great potential to improve health, but they may also cause harm. To date, few applications have been adequately evaluated. Physicians and other health professionals should promote and participate in an evidence-based approach to the development and diffusion of IHC applications and endorse efforts to rigorously evaluate the safety, quality, and utility of these resources. A standardized reporting template is proposed to help developers and evaluators of IHC applications conduct evaluations and disclose their results and to help clinicians, purchasers, and consumers judge the quality of IHC applications.

Evidence-Based Medicine↗
PubMed2005

Nomenclature-based data retrieval without prior annotation: facilitating biomedical data integration with fast doublet matching.

Assigning nomenclature codes to biomedical data is an arduous, expensive and error-prone task. Data records are coded to to provide a common representation of contained concepts, allowing facile retrieval of records via a standard terminology. In the medical field, cancer registrars, nurses, pathologists, and private clinicians all understand the importance of annotating medical records with vocabularies that codify the names of diseases, procedures, billing categories, etc. Molecular biologists need codified medical records so that they can discover or validate relationships between experimental data and clinical data. This paper introduces a new approach to retrieving data records without prior coding. The approach achieves the same result as a search over pre-coded records. It retrieves all records that contain any terms that are synonymous with a user's query-term. A recently described fast algorithm (the doublet method) permits quick iterative searches over every synonym for any term from any nomenclature occurring in a dataset of any size. As a demonstration, a 105+ Megabyte corpus of Pubmed abstracts was searched for medical terms. Query terms were matched against either of two vocabularies and expanded as an array of equivalent search items. A single search term may have over one hundred nomenclature synonyms, all of which were searched against the full database. Iterative searches of a list of concept-equivalent terms involves many more operations than a single search over pre-annotated concept codes. Nonetheless, the doublet method achieved fast query response times (0.05 seconds using Snomed and 5 seconds using the Developmental Lineage Classification of Neoplasms, on a computer with a 2.89 GHz processor). Pre-annotated datasets lose their value when the chosen vocabulary is replaced by a different vocabulary or by a different version of the same vocabulary. The doublet method can employ any version of any vocabulary with no pre-annotation. In many instances, the enormous effort and expense associated with data annotation can be eliminated by on-the-fly doublet matching. The algorithm for nomenclature-based database searches using the doublet method is described. Perl scripts for implementing the algorithm and testing execution speed are provided as open source documents available from the Association for Pathology Informatics (www.pathologyinformatics.org/informatics_r.htm).

Abstracting and Indexing↗
PubMed2002

Quality enhancing conceptual tools for medical decision making.

The scientific and the medical communities are among the first asked both to advance highly specialized knowledge and to make it available to a wider community of users, accessing specialized knowledge and searching for single pieces of information for a whole variety of purposes that require diverse information needs and demands. Health advisors may want to update progress in research in a certain field of medicine, to ask experts the right kinds of questions and, even more fundamentally, to be able to describe those health problems they may encounter in their patients' community with words and expressions that can be both understandable and accurate. Researchers, physicians and nurses all face the need to share information that comes out of stabilized, or established, research, meaning research that has been accurately tested as opposed to new and untested assumptions, and to thus establish a common code. A common code may be used by experts in the field to communicate, exchange and compare results and to translate some of the results into common sense-based explanations that can be made widely available. In order to circulate new discoveries and highly specialized knowledge in medicine and to disseminate it to a larger community, accurate planning of consistent metaphors and analogies are of crucial help. Accurate metaphors and analogies come as a result of a skilled art and science; no metaphor or analogy can represent a specific topic within a highly specialized knowledge domain without having first undergone major processes of redefinition. This is precisely what will be explored in this chapter, the added value of both powerful and reliable conceptual tools in the medical field, such as metaphors and analogies, and a commonly shared code to make qualitative reasoning about medical information possible. To improve progress in research and medical care, everyone needs to establish a common language to work with and from. In terms of medical advice documentation, the use of a visual system, CTML, would be instrumental in providing and documenting information. This system can be understood by and thus connect researchers, health care professionals, and patients.

Decision Support Systems, Clinical↗
PubMed1999

The NCI All Ireland Cancer Conference.

The National Cancer Institute (NCI) has recently decided to embark on an international partnership with the developing cancer programs on the Island of Ireland (Northern Ireland and the Republic of Ireland) in an attempt to further improve the quality and range of cancer services available for patients. This Transatlantic Partnership called the All Ireland-NCI Cancer Consortium offers exciting opportunities in cancer treatment, education and research as the cancer-caring communities from both the Republic of Ireland and Northern Ireland prepare to join with the U.S. NCI in this major endeavor. The inaugural event of the partnership will be the NCI All Ireland Cancer Conference to be held in Belfast, October 3-6, 1999. (See www.allirelandcancer.com, for information on the conference.) Cancer is a significant cause of mortality and morbidity on the Island of Ireland. There are approximately 28,000 new cases and approximately 11,000 deaths from cancer each year. Therefore, Northern Ireland and the Republic of Ireland have among the highest cancer incidence and mortality rates in the Western World. In recent years there has been a major restructuring of cancer services in both parts of the Island. This is the result of several government reports such as the Campbell Report in Northern Ireland and the National Strategy Document for Cancer in the Republic of Ireland. The National Strategy Document proposes that cancer treatment services should be centered around primary care services, regional services, supra-regional centers and a national coordinating structure whereby the supra-regional centers deliver specialist surgery, medical and radiation oncology, rehabilitation and specialist palliative care. Three supra-regional cancer centers are being established in the cities of Dublin, Cork and Galway and a National Cancer Forum, which has served as a multidisciplinary advisory board to the Government, has pushed the development and implementation of this plan. This has already resulted in a major expansion in the number of medical oncologists practicing in Ireland but further development is required to facilitate multidisciplinary care, to establish programs of education and training and to harness the scientific talent available to engage in the international effort against cancer. In Northern Ireland the Chief Medical Officer commissioned a report entitled "Cancer Services-Investing for the Future" whose key recommendations were that Northern Ireland should have one cancer center in Belfast and four smaller cancer units. This report also recommended the implementation of a multidisciplinary approach to cancer diagnosis, treatment and palliative care. As in the Republic, all the recommendations of the Report have been accepted and the planning and implementation of this plan are now well under way. Therefore, development of services for cancer patients is a top priority for both governments on the Island and, given the process of cancer service development, it is timely to bring international expertise such as the NCI on board as partners in this effort. The decision by the NCI to develop an agreement for cancer research and service development in Ireland is a major boost for those involved in cancer care and research and will, no doubt, help speed the process of redevelopment. There have already been several visits from senior NCI personnel to Ireland including Dr. Klausner, the Director of the NCI, to determine the potential impact of this agreement and to identify the most productive areas of interaction between the NCI and the Irish Cancer Community. As a result of these visits, the NCI has decided to focus on several areas of strategic importance whose objectives will be to enhance clinical services, improve patient care, promote North South collaboration and cement strategic Ireland-U.S. collaboration in cancer research and development. The agreement will build on existing informal links in U.S.-Irish scientific, medical education and training and also promote clinical trials and cancer epidemiology programs. Major components of the NCI Ireland Agreement will include some of the following: EDUCATION AND EXCHANGE OF SCHOLARS: Education will form one of the major platforms of this agreement through the support of educational programs for medical, nursing and scientific staff. These will include the exchange of scholars, including Ph.D., M.D. and nursing students. Particular emphasis will be given to the exchange of medical and nursing trainees focused on clinical research. This will have an immediate clinical impact and will naturally extend the support that has already been given to the training of medical and scientific trainees from the Island of Ireland. Further exchanges would include Ph.D. students, laboratory-based M.D.s in training, clinical visiting professors and investigators from the U.S. wishing to extend their studies in Ireland. CLINICAL TRIALS: Another major area for partnership will be the enhancement of a clinical trials infrastructure and clinical trial development. Modernization of cancer care requires that delivery of care should be in the context of evidence-based medicine. This requires a vigorous and contemporary clinical trials infrastructure which would center around the clinical trials infrastructure already established at the Northern Ireland Cancer Centre and the Irish Clinical Oncology Research Group (ICORG) in the Republic of Ireland. The NCI has already commissioned the development of a new Clinical Trials Information System (CTIS) which seeks as its goal to set international standards in the clinical trials process, and it has already committed significant resources to its implementation. The outcome of this element of partnership will be that clinical trials performed in Irish institutions will immediately be compatible for collation, analysis and presentation with studies performed in the U.S. Moreover, this system will allow participating centers to immediately conform to international standards. This proposal therefore permits participating institutions in Northern Ireland and the Republic of Ireland to quickly achieve data management standards of the highest quality. TELECONFERENCING: Teleconferencing capabilities are already established in both the NCI and in Ireland and indeed limited teleconferencing linkages have already been established between the partners. Further investment in this infrastructure will be vital to the success of major elements of this partnership. It will facilitate clinical trial development, education programs, patient services development and exchange of clinical and scientific ideas. Communication between sites will be essential to the success of this partnership. TUMOR REGISTRIES: Another area for major collaboration and partnership will be in the use of the Cancer Tumor Registries in both Northern Ireland and the Republic of Ireland. The monitoring of improvements in cancer care can only be undertaken with a reliable tumor registry that tracks population-based cancer incidence and mortality. These data are now available in both Northern Ireland and the Republic of Ireland, and both Governments recognize their importance. The NCI proposes to assist both Tumor Registries by developing a common database that can assist in consultation, informatic tools and quality control. Consolidation of the Registries, North and South, will improve the overall quality of data collection and provide information on a genetically stable population. This therefore will act as a major tool for epidemiological investigations and programs focused on screening and prevention. DEVELOPMENTS IN CANCER CLINICAL SERVICES: The NCI Ireland partnership also proposes to assist the further development of clinical service programs on the Island of Ireland. These will include the improvement and standardization of Radiation Oncology practice and the development of a consolidated Radiation Oncology program for research. There are a limited number of radiation facilities on the Island of Ireland and there are significant needs in terms of linking practice elements and the implementation of uniform standards of practice. Assistance in standardizing and driving the development of clinical services will also extend to elements of medical and surgical oncology practice as well as palliative care. The development of palliative care services is already at an advanced stage on the Island of Ireland and is one that the NCI will carefully evaluate in terms of its own developing programs. THE NCI ALL IRELAND CANCER CONFERENCE: An important event to highlight the commencement of this special relationship will be the NCI All Ireland Cancer Conference to be held in Belfast October 3-6, 1999. This Conference will address clinical, laboratory, epidemiological and political issues that are pertinent to the care of cancer patients. It will highlight important work by Irish, American and European scientists with further input from well-known international academic and biotechnology investigators from across the world. These international experts will not only be asked to speak on their areas of expertise but also to comment on clinical and scientific programs that may help improve North and South interaction and Transatlantic collaboration. Finally, it is hoped that the Conference will be a marker of a very special interaction on the Island of Ireland focused on the overall development of cancer services for patients. It will also signal the start of an important partnership between the NCI and those involved in cancer care and research in Ireland. This tripartite cooperative agreement is a most exciting venture and it will hopefully be an example of how an effort focused on a human problem common to all societies can generate a spirit of cooperation and help to eliminate strife.

Journal Article↗
PubMed2005

An automated, broad-based, near real-time public health surveillance system using presentations to hospital Emergency Departments in New South Wales, Australia.

BACKGROUND: In a climate of concern over bioterrorism threats and emergent diseases, public health authorities are trialling more timely surveillance systems. The 2003 Rugby World Cup (RWC) provided an opportunity to test the viability of a near real-time syndromic surveillance system in metropolitan Sydney, Australia. We describe the development and early results of this largely automated system that used data routinely collected in Emergency Departments (EDs). METHODS: Twelve of 49 EDs in the Sydney metropolitan area automatically transmitted surveillance data from their existing information systems to a central database in near real-time. Information captured for each ED visit included patient demographic details, presenting problem and nursing assessment entered as free-text at triage time, physician-assigned provisional diagnosis codes, and status at departure from the ED. Both diagnoses from the EDs and triage text were used to assign syndrome categories. The text information was automatically classified into one or more of 26 syndrome categories using automated "naïve Bayes" text categorisation techniques. Automated processes were used to analyse both diagnosis and free text-based syndrome data and to produce web-based statistical summaries for daily review. An adjusted cumulative sum (cusum) was used to assess the statistical significance of trends. RESULTS: During the RWC the system did not identify any major public health threats associated with the tournament, mass gatherings or the influx of visitors. This was consistent with evidence from other sources, although two known outbreaks were already in progress before the tournament. Limited baseline in early monitoring prevented the system from automatically identifying these ongoing outbreaks. Data capture was invisible to clinical staff in EDs and did not add to their workload. CONCLUSION: We have demonstrated the feasibility and potential utility of syndromic surveillance using routinely collected data from ED information systems. Key features of our system are its nil impact on clinical staff, and its use of statistical methods to assign syndrome categories based on clinical free text information. The system is ongoing, and has expanded to cover 30 EDs. Results of formal evaluations of both the technical efficiency and the public health impacts of the system will be described subsequently.

Anniversaries and Special Events↗
PubMed2006

Is primary care ready to embrace e-health? A qualitative study of staff in a London primary care trust.

OBJECTIVES: e-Health refers to the organisation and delivery of health services and information using the internet and related technologies. We investigated the perceptions of primary care staff towards e-health initiatives in the NHS Connecting for Health programme and whether front-line staff are ready to implement such changes. DESIGN: Twenty participants from different professional groups were purposively selected for interview, based on their current computer usage. The same practice staff were subsequently observed in order to gain an insight into how they use computers. SUBJECTS: Practice staff (doctors, nurses, practice managers and receptionists) who will be expected to use new information technology and primary care trust (PCT) staff who are involved in its implementation were selected to participate in this study. SETTING: A north London PCT with 62 general practices. Four practices were selected for the study. RESULTS: Analysis of the interviews and the observational data yielded six recurrent themes that have a bearing on readiness to use information and communication systems to support clinical care: perceptions of technology and NHS Connecting for Health; issues relating to resources; patient choice; matters relating to confidentiality and security; political pressures; and how information technology is currently used within primary care. CONCLUSIONS: At the time of the study the systems that form part of NHS Connecting for Health, apart from the Quality Management and Analysis System (QMAS), were not implemented across the PCT. All the practices in the study acknowledged the benefits new technology would bring to the workplace, but there were also some common concerns, which suggest that staff working in primary care practices are not ready for e-health. Successful implementation of the NHS Connecting for Health programme rests on identifying, acknowledging and overcoming these concerns. A different approach might be required for those practices that have made very little progress in using email or moving towards an electronic patient record. This study suggests that a mistrust of technology and fears as to the heavy initial workload involved in becoming fully computerised have dissuaded some practices from embracing e-health. If NHS Connecting for Health is to be a success, implementation teams might need to focus initially on practices that have been reluctant to use technology to support both clinical care and the day-to-day work of the practice.

Attitude to Computers↗