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PubMed1997

The place of SGML and HTML in building electronic patient records.

The authors are concerned that, although popular, SGML (Standard Generalized Markup Language) is only one approach to capturing, storing, viewing and exchanging healthcare information and does not provide a suitable paradigm for solving most of the problems associated with paper based patient record systems. Although a discussion of the relative merits of SGML, HTML (HyperText Markup Language) may be interesting, we feel such a discussion is avoiding the real issues associated with the most appropriate way to model, represent, and store electronic patient information in order to solve healthcare problems, and therefore the medical informatics community should firstly concern itself with these issues. The paper substantiates this viewpoint and concludes with some suggestions of how progress can be made.

Computer Communication Networks↗
PubMed2005

Health information systems - past, present, future.

In 1984, Peter Reichertz gave a lecture on the past, present and future of hospital information systems. In the meantime, there has been a tremendous progress in medicine as well as in informatics. One important benefit of this progress is that our life expectancy is nowadays significantly higher than it would have been even some few decades ago. This progress, leading to aging societies, is of influence to the organization of health care and to the future development of its information systems. Twenty years later, referring to Peter Reichertz' lecture, but now considering health information systems (HIS), two questions are discussed: which were lines of development in health information systems from the past until today? What are consequences for health information systems in the future? The following lines of development for HIS were considered as important: (1) the shift from paper-based to computer-based processing and storage, as well as the increase of data in health care settings; (2) the shift from institution-centered departmental and, later, hospital information systems towards regional and global HIS; (3) the inclusion of patients and health consumers as HIS users, besides health care professionals and administrators; (4) the use of HIS data not only for patient care and administrative purposes, but also for health care planning as well as clinical and epidemiological research; (5) the shift from focusing mainly on technical HIS problems to those of change management as well as of strategic information management; (6) the shift from mainly alpha-numeric data in HIS to images and now also to data on the molecular level; (7) the steady increase of new technologies to be included, now starting to include ubiquitous computing environments and sensor-based technologies for health monitoring. As consequences for HIS in the future, first the need for institutional and (inter-) national HIS-strategies is seen, second the need to explore new (transinstitutional) HIS architectural styles, third the need for education in health informatics and/or biomedical informatics, including appropriate knowledge and skills on HIS. As these new HIS are urgently needed for reorganizing health care in an aging society, as last consequence the need for research around HIS is seen. Research should include the development and investigation of appropriate transinstitutional information system architectures, of adequate methods for strategic information management, of methods for modeling and evaluating HIS, the development and investigation of comprehensive electronic patient records, providing appropriate access for health care professionals as well as for patients, in the broad sense as described here, e.g. including home care and health monitoring facilities. Comparing the world in 1984 and in 2004, we have to recognize that we imperceptibly, stepwise arrived at a new world. HIS have become one of the most challenging and promising fields of research, education and practice for medical informatics, with significant benefits to medicine and health care in general.

Computer Systems↗
PubMed1991

A new teaching tool for dental and medical schools: multimedia CD-ROM on dental and skeletal development.

Multimedia teaching tools in Medicine are still very rare. Their presentation on a CD-ROM format is part of the emerging technologies in Medical Informatics. The Multimedia material presented here on Dental and Skeletal Development is mostly a Database and a Tutorial. The Database, which contains more than 2000 hand/wrist radiographs, is mostly intended for Pediatricians, Endocrinologists, Forensic Dentists and Physicians, as well as for Orthodontists and Pedodontists. The material is the result of 20-year of Longitudinal Growth study of children in Montreal. In this Multimedia CD-ROM, the research results are used for Medical teaching purposes.

Bone Development↗
PubMed2006

Safety of high-dose iron sucrose infusion in hospitalized patients with chronic kidney disease.

PURPOSE: The safety of high-dose iron sucrose infusion in hospitalized patients with chronic kidney disease was studied. METHODS: A retrospective analysis was conducted at a 478-bed community hospital. A medical informatics search was performed to identify all hospitalized patients who were prescribed i.v. iron sucrose to deliver elemental iron 300 mg every other day for three doses between January and December 2002. Patients were eligible for inclusion in the analysis if they had chronic kidney disease, had an estimated creatinine clearance of <60 mL/min, and were prescribed the above regimen. Information on iron administration, vital signs, hematologic values, and iron indexes was gathered from patients' medical records. Medical record review was also used to identify possible adverse events. RESULTS: A total of 73 patients met eligibility criteria and received a total of 167 doses of iron sucrose. Twenty adverse events were judged as possibly related to iron sucrose administration and included nausea (n = 8 events), reduced blood pressure (n = 4), vomiting (n = 2), dysgeusia (n = 2), constipation (n = 2), fatigue (n = 1), and anxiety (n = 1). The majority of these adverse events were low in severity, as determined by an objective scale. No severe adverse events occurred. There was no association between infusion rate and the occurrence of potential adverse events (p = 0.44). CONCLUSION: Every-other-day i.v. infusion of iron sucrose, to deliver elemental iron 300 mg/dose, was associated with adverse events that were relatively uncommon, minor in severity, and unlikely to require medical intervention.

Anemia, Iron-Deficiency↗
PubMed1999

A computer-assisted drug prescription system: the model and its implementation in the ATM knowledge base.

Informatisation of drug prescription is an important topic in medical informatics. For several years now, computerized drug databases have been implemented. Usually only a small part of the prescriptions can be stored in prescription systems because of the format of the included information; prescriptions contain essentially free text without any structure and homogeneity of the used vocabulary. In this article a model is presented for knowledge representation in a computerized drug prescription system. The model should be applicable to clinical practice and be didactic for medical students. The problem of standardization of terminology had to be solved. A computer-assisted drug prescription program has been developed. The next step is its validation by clinicians. The program can also be used in a consultation mode.

Database Management Systems↗
PubMed2003

Factors influencing hospitalisation of infants for recurrent gastroenteritis in Western Australia.

OBJECTIVE: To determine factors affecting length of hospitalisation of infants for recurrent gastroenteritis using linked data records from the Western Australia heath information system. METHODS: A seven-year retrospective cohort study was undertaken on all infants born in Western Australia in 1995 who were admitted for gastroenteritis during their first year of life (n = 519). Linked hospitalisation records were retrieved to derive the outcome measure and other demographic variables for the cohort. Unlike previous studies that focused mainly on a single episode of gastroenteritis, the durations of successive hospitalisations were analysed using a proportional hazards model with correlated frailty to determine the prognostic factors influencing recurrent gastroenteritis. RESULTS: Older children experienced a shorter stay with an increased discharge rate of 1.9% for each month increase in admission age. An additional co-morbidity recorded in the hospital discharge summary slowed the adjusted discharge rate by 46.5%. Aboriginal infants were readmitted to hospital more frequently, and had an adjusted hazard ratio of 0.253, implying a much higher risk of prolonged hospitalisation compared to non-Aborigines. CONCLUSIONS: The use of linked hospitalisation records has the advantage of providing access to hospital-based population information in the context of medical informatics. The analysis of linked data has enabled the assessment of prognostic factors influencing length of hospitalisations for recurrent gastroenteritis with high statistical power.

Female↗
PubMed2002

Software engineering risk factors in the implementation of a small electronic medical record system: the problem of scalability.

The successful implementation of clinical information systems is difficult. In examining the reasons and potential solutions for this problem, the medical informatics community may benefit from the lessons of a rich body of software engineering and management literature about the failure of software projects. Based on previous studies, we present a conceptual framework for understanding the risk factors associated with large-scale projects. However, the vast majority of existing literature is based on large, enterprise-wide systems, and it unclear whether those results may be scaled down and applied to smaller projects such as departmental medical information systems. To examine this issue, we discuss the case study of a delayed electronic medical record implementation project in a small specialty practice at Columbia-Presbyterian Medical Center. While the factors contributing to the delay of this small project share some attributes with those found in larger organizations, there are important differences. The significance of these differences for groups implementing small medical information systems is discussed.

Computer Systems↗
PubMed2002

Implementing clinical information systems: a multiple-case study within a US hospital.

The rapid movement of information technologies into health care organizations has raised managerial concern regarding the capability of today's institutions to satisfactorily manage their introduction. Indeed, several health care institutions have consumed huge amounts of money and frustrated countless people in wasted information systems implementation efforts. Unfortunately, there are no easy answers as to why so many health informatics projects are not more successful. The aim of this study is to provide a deeper understanding of clinical information systems implementation. The research reported in this paper focuses on building a theory of the dynamic nature of the implementation process, that is, the how and why of what happened. The general approach taken was inspired by the work of Eisenhardt (1989) on building theories from case study research. We examined the implementation process, use and consequences of three distinct clinical information systems at a large tertiary care teaching hospital. A series of four research propositions reflecting the dynamic nature of the implementation process are offered as each of the three cases are analyzed. Findings add a number of new perspectives and empirical insights to the existing body of knowledge in the fields of IT implementation and medical informatics.

Attitude of Health Personnel↗
PubMed2003

The role of low-bandwidth telemedicine in surgical prescreening.

PURPOSE: Low-bandwidth, Internet-based telemedicine is an inexpensive technology that could help deliver heath care in medically underserved areas. The purpose of this study was to evaluate the usefulness of low-bandwidth telemedicine in remote surgical evaluation. METHODS: A group of surgeons and nurses traveled to Mombasa, Kenya to provide surgical assistance at the Coast Province General Hospital (CPGH). Before the visit of the surgical team, surgeons evaluated patients via low-bandwidth telemedicine. Prescreening was performed through use of an Internet-based desktop computer system that was supported technically by the Virginia Commonwealth University (VCU) Medical Informatics and Technology Applications Consortium (MITAC) telemedicine laboratory. Surgical patients were evaluated remotely regarding appropriateness of surgical intervention by reviewing e-mails that included the patient's age, history, physical examination, digital images of the patient, and digital images of pertinent radiographs. RESULTS: Fifty-one patients, including 7 pediatric patients, were prescreened. Thirty-three of the 51 patients (65%) were deemed inappropriate for surgery before this trip because of advanced disease or absence of necessary local medical resources. Of the 18 patients determined to be appropriate candidates for surgery by remote prescreening, 18 (100%) were operated on successfully during the relief effort. Sixty patients including 9 (15%) pediatric patients underwent surgery over the course of 5 days in CPGH. Pediatric cases included various laparoscopic, oncologic, and soft tissue reconstruction. CONCLUSIONS: Low-bandwidth, Internet-based telemedicine is a cost-effective technology that can efficiently and effectively prescreen surgical patients in remote areas.

Adult↗
PubMed2003

Specifying design criteria for electronic medical record interface using cognitive framework.

As the healthcare industry transitions from paper to electronic medical records (EMRs), medical informatics researchers face the task of ensuring that the electronic presentation of the information remains usable and effective while capitalizing on the ability of EMRs to tailor information to different users. In our research, we focus on utilizing formal cognitive science methodology to guide the conversion of paper-based narrative discharge summaries to a more dynamic, structured electronic version. In this paper, we present the results of a cognitive analytic study (1) that determines a 'core' component in medical narratives and (2) that compares the use of structured and narrative texts by physicians with varying expertise. Specifically, we studied six psychiatrists at three levels of expertise- experts, intermediates, and novices. The subjects were given two clinical case scenarios with discharge summaries and asked to verbalize their thoughts as they read through the summaries. The interview transcripts were analyzed for recalls and inferences generated in the verbalization. Based on experts' verbalizations, the discharge summaries were organized into a more structured form and used in the interview of other subjects. Novice-level subjects had more recall with the structured than with the narrative format. More errors were also made in recall with the narrative than with the structured text. We discuss how these results are valuable in designing an EMR interface to reduce errors and to support users of different expertise.

Cognition↗
PubMed2004

Outcome measures in clinical information systems evaluation.

Systems developed through informatics methods can be evaluated at different levels, depending on the purpose of the evaluation. A key class of measures useful in relating information systems to the quality of patient care is benefit or out-come measures, which reflect differences in the health or welfare of the patient that result from the system being utilized. A framework for describing evaluation measures is presented, definitions are discussed, and the results of a literature review are presented to indicate outcome measures used in medical informatics over several decades. The conclusion suggests that more attention should be given to the standardization of terminology and to outcome measures and methods.

Computer Systems↗
PubMed2007

The guideline of the personal health data structure to secure safety healthcare. The balance between use and protection to satisfy the patients' needs.

PURPOSE: To inform about the impact of a recent movement towards a policy to develop integrative networked electronic health record (EHR) as a basis for cooperation among care teams and with patients and in support of safe patient care in Japan. METHODS: The author headed a commission developing policy for health record (HR) structure and its computerization. It executed two questionnaire surveys as the basis for its work. One survey assessed the current state of computerization of health record in the hospitals certified by Japan Council for Quality Health Care (JCQHC). The other survey assessed the attitudes towards a specific EHR system in the Hiroshima University Hospital and its affiliate hospitals. RESULTS: The survey of the above hospitals showed that most have computer supported administrative procedures, but only few computer-based health records. The attitudes of the Hiroshima EHR users show that while they expect efficiency and quality improvements, there is also apprehension that the system in use might lower practical efficiency and compromise patient safety. Accordingly, health recording requirements and storage policy have been restructured and communicated to the hospitals. CONCLUSION: These insights led to the initiation of curricula educating "Health Information Technologist" which is promoted by Japan Association Medical Informatics and the criterion of Chart Review Promotion of JCQHC. They will also lead to recommendation for improved and advanced EHR.

Confidentiality↗
PubMed1992

CHARTLINE: providing bibliographic references relevant to patient charts using the UMLS Metathesaurus Knowledge Sources.

A successful medical informatics program helps its users to match their information needs as closely and efficiently as possible to the capabilities of the system. CHARTLINE is a computer program whose input is a free text, "natural language" patient chart in ASCII format. Using the UMLS Metathesaurus Knowledge Sources, CHARTLINE can suggest bibliographic references relevant to the patient case described in the chart. The program does not attempt to "understand" the natural language content of the chart. CHARTLINE only recognizes UMLS Metathesaurus Main Concept terms (or their synonyms) as they occur in the medical text, since those terms represent the tokens used to index the literature. The program depends on user feedback to determine which topics of a large number of potentially relevant subjects are of interest to the user.

Diagnosis, Computer-Assisted↗
PubMed2000

Dimensions of time in illness: an objective view.

It is almost impossible to try to represent and analyze clinical data in the absence of a temporal dimension. The temporal aspect is especially important when automated decision support is used for patient care over substantial periods. This paper emphasizes the crucial role that tasks of temporal reasoning and temporal maintenance play in modern medical information and decision support systems; it also discusses the implications of providing automated support to clinicians who must perform such tasks as part of broader clinical tasks (for example, monitoring and therapy). Temporal reasoning tasks mainly involve intelligent analysis of time-oriented clinical data, and temporal maintenance tasks focus on effective storage and retrieval of these data. Both types of tasks, however, are highly relevant for such applications as patient monitoring, proper use of therapeutic guidelines, assessment of the quality of guideline use, and visualization and exploration of time-oriented biomedical data. Scientists in medical informatics should view the integration of these two areas as a major research and development goal. This paper demonstrates one approach to integration by presenting the concept of a temporal mediator, which combines temporal reasoning and temporal maintenance. Use of the temporal mediator in several clinical tasks is also presented and discussed.

Databases, Factual↗
PubMed2003

[Integrating the healthcare enterprise: an overview].

Integrating the healthcare enterprise (IHE) is a developing general norm in medical informatics especially in the field of radiology, which is independent of the manufacturers and has been accepted by a number of manufacturers and systems. In this paper, the authors provide a brief overview of IHE with the integration profiles of IHE technical framework being particularly elaborated.

Delivery of Health Care↗
PubMed1996

[The Internet and clinical medicine. An introduction to the biomedical information services available in electronic form on the "net of all nets"].

Clinical users expectations from medical informatics are evolving due to the wide availability of biomedical information services on the Internet. Thanks to hypertexts and advanced browsing tools users with no informatical expertise can travel on the Internet and easily gain access to textual databases. With a multimedia computer other kinds of information can be grabbed: images, sounds and audiovisual documents. Basic Internet services (electronic mail, discussion lists, file transfer protocol, terminal emulation) can be accessed from a wide range of hardware equipment. However, the real power of a world-scale computer network like the Internet will be unleashed only when its global connectivity will be linked to the powerful retrieval ability of existing clinical and related databases. While biomedical journals editors and other medical information providers are in the way to offer electronic versions of their paper-based products, at the leading edge of this world-scale process is the USA National Library of Medicine, with the Internet-compatible version of its Grateful Med software which is expected to be launched during 1996.

Computer Communication Networks↗
PubMed1998

Aspects of implementing and harmonizing healthcare communication standards.

A variety of healthcare communication standards (HCS) have been developed during the last decade. They have improved the interoperability and the connectivity in open hospital information systems to a large extent. They have also reduced time and efforts during the implementation of standard interfaces. However, the implementation of communication standards is still far from the expected plug and play. The two reasons which are the main cause the current drawbacks are identified--the lack of a standardized terminology and the restricted flexibility of the currently used interchange formats. On the one hand the standardization of the terminology can not be solved by the standards development organizations. It is a general challenge for the medical informatics community. On the other hand the movement to a new interchange format can be initiated by standards development organizations. The application of SGML/XML as an interchange format for communication standards offers a much greater flexibility and adaptability to user needs than the currently used interchange formats. Concepts for a smooth change to a new direction are discussed.

Computer Communication Networks↗
PubMed2006

Enhancing communication in the 21st century.

Quality communication is a critical component in all aspects of public health and clinical care. The quality of the process of communication between the patient/family and the physician affects the quality of the patient/family-physician relationship, patient behavior, and health outcomes. Advances in communication and information technologies can enhance the quality of communication, not only between patients/families and their physicians but also between clinicians and public health professionals. Communication and integration between the domains of personal health and public health have the potential to improve the delivery of health care and public health services and to yield the desired seamless continuum of health care. This article discusses some of the advances and efforts in the use of information technology to facilitate enhanced communication for quality health care.

Adult↗