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PubMed1986

The National Library of Medicine and the American medical information system: the physician's perspective.

During the past 150 years an excellent health sciences information system has been developed in the United States. Led by the National Library of Medicine (NLM), the system grew along traditional lines until after World War II, when medical researchers, educators, and practitioners produced an enormous amount of new information. To cope with this growth, the power of computers joined traditional librarianship and MEDLARS was born. In 1965 Congress passed the Medical Library Assistance Act, which enabled NLM to lead the nation's and the world's health sciences professionals into the Information Age. Much as been accomplished by NLM, yet much remains to be done to make health information available cheaply, easily, and quickly to all who need it.

Education, Medical↗
PubMed2006

Evaluation of laboratory monitoring alerts within a computerized physician order entry system for medication orders.

BACKGROUND: Errors involving medication use are common. Computerized physician order entry (CPOE) can improve prescribing practices. Few studies have examined the effect of CPOE in combination with decision support tools on prescribing practices in the outpatient setting. Less is known about prescribers' adherence to laboratory monitoring recommendations. OBJECTIVE: To evaluate if reminders presented during CPOE for medications would increase physicians' compliance with guidelines for laboratory monitoring at initiation of therapy. STUDY DESIGN: Randomized prospective intervention study. METHODS: Two hundred seven primary care physicians in a group-model managed care organization were randomized to receive or not receive drug laboratory monitoring alerts within the CPOE system. Adherence to laboratory monitoring recommendations for patients prescribed selected medications was compared between physician groups. RESULTS: There was no significant difference between the control and intervention group physicians in the overall rate of compliance with ordering the recommended laboratory monitoring for patients prescribed study medications. Laboratory monitoring was performed as recommended 56.6% of the time in the intervention group compared with 57.1% of the time in the control group (P = .31). In cases in which a statistically significant difference was demonstrated, improved compliance favored the intervention group (eg, 71.2% vs 62.3% [P = .003] for gemfibrozil and 75.7% vs 73.9% [P = .05] for statins). CONCLUSIONS: As CPOE becomes more prevalent, additional research is needed to determine effective decision support tools. These findings then should be communicated to the developers and users of computerized medical record systems.

Adolescent↗
PubMed1996

Enzyme-epoxy membrane based glucose analyzing system and medical applications.

A semi-automatic glucose analyzing system has been developed. It consists of thin film glucose sensors and a flow injection system with a computerized data processing unit. The sensor is made of titanium and platinum, using the well-established semiconductor process technology. Glucose oxidase is immobilized into the network of epoxy on the electrode surface together with ferrocene, which is used as an electron mediator for reducing the operation voltage of the sensor. The system can measure glucose from 50 to 4000 mg/dl with good linearity up to 400 mg/dl. This can cover the range needed in medical and biotechnological applications. The system can measure samples at a speed of more than 60 samples per hour and has a coefficient of variation of 3%. Selectivity tests were performed and the results showed that there was no interference from sucrose, lactose, maltose, ascorbic acid and uric acid. The sensors were then employed in detecting glucose in human blood plasma samples. The results show good correlation with the results from commercial machines.

Biosensing Techniques↗
PubMed1995

Information, intelligence, and interface: the pillars of a successful medical information system.

This paper addresses three key issues facing developers of clinical and/or research medical information systems. 1. INFORMATION. The basic function of every database is to store information about the phenomenon under investigation. There are many ways to organize information in a computer; however only a few will prove optimal for any real life situation. Computer Science theory has developed several approaches to database structure, with relational theory leading in popularity among end users [8]. Strict conformance to the rules of relational database design rewards the user with consistent data and flexible access to that data. A properly defined database structure minimizes redundancy i.e.,multiple storage of the same information. Redundancy introduces problems when updating a database, since the repeated value has to be updated in all locations--missing even a single value corrupts the whole database, and incorrect reports are produced [8]. To avoid such problems, relational theory offers a formal mechanism for determining the number and content of data files. These files not only preserve the conceptual schema of the application domain, but allow a virtually unlimited number of reports to be efficiently generated. 2. INTELLIGENCE. Flexible access enables the user to harvest additional value from collected data. This value is usually gained via reports defined at the time of database design. Although these reports are indispensable, with proper tools more information can be extracted from the database. For example, machine learning, a sub-discipline of artificial intelligence, has been successfully used to extract knowledge from databases of varying size by uncovering a correlation among fields and records[1-6, 9]. This knowledge, represented in the form of decision trees, production rules, and probabilistic networks, clearly adds a flavor of intelligence to the data collection and manipulation system. 3. INTERFACE. Despite the obvious importance of collecting data and extracting knowledge, current systems often impede these processes. Problems stem from the lack of user friendliness and functionality. To overcome these problems, several features of a successful human-computer interface have been identified [7], including the following "golden" rules of dialog design [7]: consistency, use of shortcuts for frequent users, informative feedback, organized sequence of actions, simple error handling, easy reversal of actions, user-oriented focus of control, and reduced short-term memory load. To this list of rules, we added visual representation of both data and query results, since our experience has demonstrated that users react much more positively to visual rather than textual information. In our design of the Orthopaedic Trauma Registry--under development at the Carolinas Medical Center--we have made every effort to follow the above rules. The results were rewarding--the end users actually not only want to use the product, but also to participate in its development.

Artificial Intelligence↗
PubMed1994

The development of a client application for the collaborative social and medical services system.

This paper describes the design and implementation of a client application for the Baylor College of Medicine Teen Health Clinics. The application is the front end to the Collaborative Social and Medical Services System (CSMSS) under development by Baylor's Medical Informatics and Computing Research Program [8]. The application provides distributed access to an underlying object oriented database system. A process driven and patient centered design will provide staff members with a complete set of services, including forms for data entry and viewing, query, and access management to facilitate efficient and effective delivery of services. Role-specific interfaces will be supplied for clerks, nurses, nurse practitioners, physicians, and social workers. The client application is being designed using object oriented methodologies and technologies with the C++ programming language, and will operate within a Microsoft Windows operating environment utilizing Object Linking and Embedding for application interoperability.

Adolescent↗
PubMed2002

A system of medical error disclosure.

External mandates for medical error disclosure are often justified by potential cost savings, the belief in individual moral obligations in health care, and the concept that patients have rights and providers have responsibilities. Such an approach does not recognise the systems nature of error and outcomes and the important quality role disclosure can play in a system of medical error disclosure. Systems concepts, the patient-provider partnership, and overall quality of care can be enhanced using a system of disclosure that provides for education about the systems nature of error, fulfills the delivery system philosophy of mutual respect, and integrates the patient and his/her family as a partner in the error reduction enterprise. Such a system can result using clear disclosure policies and procedures sensitive to patient and family needs, open communications with concerned, committed, and compassionate system representatives, and use of mediation methods that foster communication, allow for venting, and are flexible in their approach to resolving conflict, including using apology. Although a system may also result in conflict resolution costs, more importantly it may foster and solidify a team approach to reducing errors and promoting patient safety.

Humans↗
PubMed1996

[The organizational bases for the building of a modern medical support system for the Armed Forces].

In the article the problems concerning characteristic features of the local wars and armed conflicts, organization bases of construction of The Army and Fleet medical support modern system are discussed. The organization of personnel medical security is considered depending on the duration, intensity and spatial scope of military conflict, peculiarities of group (forces) application and ways of military actions conduction. The distribution of federal troops sanitary losses during the war in Chechenskaya Republic is shown depending on the type, localization and degree of injuries gravity as well as volume of the wounded and invalids evacuation by air transport and work of military medical institutions. The following principles of construction of the Armed Forces medical support system are formulated: The system must be in compliance with troops goals, structure, strategy and tactics, its specificity; development of medical security forms and methods, their historicism; interdependency, completeness and integrity of the system's elements; territorial aspects of its construction and management optimization. Considering character of the goals being laid on the Mobile Forces the paramount importance is attached to the level of readiness of medical service and its formations and units to act in crisis situations.

Humans↗
PubMed2003

Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review.

BACKGROUND: Iatrogenic injuries related to medications are common, costly, and clinically significant. Computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) may reduce medication error rates. METHODS: We identified trials that evaluated the effects of CPOE and CDSSs on medication safety by electronically searching MEDLINE and the Cochrane Library and by manually searching the bibliographies of retrieved articles. Studies were included for systematic review if the design was a randomized controlled trial, a nonrandomized controlled trial, or an observational study with controls and if the measured outcomes were clinical (eg, adverse drug events) or surrogate (eg, medication errors) markers. Two reviewers extracted all the data. Discussion resolved any disagreements. RESULTS: Five trials assessing CPOE and 7 assessing isolated CDSSs met the criteria. Of the CPOE studies, 2 demonstrated a marked decrease in the serious medication error rate, 1 an improvement in corollary orders, 1 an improvement in 5 prescribing behaviors, and 1 an improvement in nephrotoxic drug dose and frequency. Of the 7 studies evaluating isolated CDSSs, 3 demonstrated statistically significant improvements in antibiotic-associated medication errors or adverse drug events and 1 an improvement in theophylline-associated medication errors. The remaining 3 studies had nonsignificant results. CONCLUSIONS: Use of CPOE and isolated CDSSs can substantially reduce medication error rates, but most studies have not been powered to detect differences in adverse drug events and have evaluated a small number of "homegrown" systems. Research is needed to evaluate commercial systems, to compare the various applications, to identify key components of applications, and to identify factors related to successful implementation of these systems.

Cost-Benefit Analysis↗
PubMed2002

Measuring, monitoring, and reducing medical harm from a systems perspective: a medical director's personal reflections.

The author describes five critical elements for reducing and, ultimately, preventing harm to patients-from a systems perspective. In the element called leadership and culture, leaders must advocate patient safety as a primary goal and foster an institutional culture where change that promote patient safety can occur. In internal surveillance, systems are established to actively monitor for deviations in quality and guide efforts to engineer risk of harm out of the institution's practices; they can also demonstrate absence of risk or harm. Although incident reporting can be controversial and is sometimes avoided because its use in "blame attacks," etc., it can be valuable if built on a continuous improvement approach and a system approach to error prevention. External surveillance involves the identification and response to "sentinel events," such as wrong-sided surgery, and serves to remind all those involved in care just how risky and unforgiving medical practice can be. Finally, those involved in promoting safety must believe that hazard and risk are not inevitable and can be managed. The author illustrates this approach by describing his hospital's successful efforts to prevent the rise of aspergillus infections during a major hospital construction project. The author closes by describing selected challenges and opportunities to reduce harm from a systems perspective, such as using teams, involving patients and the public, using lessons learned from other industries with strong safety cultures, and using advances in information systems for a variety of safety-oriented tasks.

Culture↗
PubMed2000

The regenstrief medical record system 2000:Expanding the breadth and depth of a community wide EMR

The Regenstrief Medical Record System (RMRS) continues to grow in breadth and depth. As we expand its breadth -- the system links 5 health care systems, 11 acute care hospitals, 13 homeless care sites, nearly 100 clinics/offices and the county and state health departments -- we have had to overcome critical problems inherent to creating a community wide electronic medical record (EMR). Data for more than 2 million patients consisting of 300 million coded observations, 5.8 million text reports, 300,000 electrocardiogram tracings and 700,000 images. We are now processing almost 8 million observations monthly. In order to accommodate this expansion, significant we have made extended the system architecture over the last several years. These improvements include enhanced message routing, extended message processing, a multiple entity database, a master patient index, master provider index, and methods for displaying and attributing data from multiple entities.

Journal Article↗
PubMed2005

Computerized physician order entry and electronic medical record systems in Korean teaching and general hospitals: results of a 2004 survey.

OBJECTIVE: To determine the availability of computerized physician order entry (CPOE) and electronic medical record (EMR) systems in teaching and general hospitals in the Republic of Korea. DESIGN: A combined mail and telephone survey of 283 hospitals. MEASUREMENTS: The surveys assessed the availability of CPOE and EMRs in the hospitals, as well as inducement, participation, and saturation regarding CPOE use by physicians. RESULTS: A total of 122 (43.1%) hospitals responded to the survey. The complete form of CPOE was available in 98 (80.3%) hospitals. The use of CPOE was mandatory in 92 (86.0%) of the 107 hospitals that responded to the questions regarding the requirement of CPOE use. In 85 (79.4%) of the hospitals in which CPOE was in use, more than 90% of physicians used the system. In addition, physicians entered more than 90% of their total orders through CPOE in 87 (81.3%) hospitals. In contrast, a complete EMR system was available in only 11 (9.0%) of the hospitals. CONCLUSION: Of the teaching and general hospitals in the Republic of Korea that responded to the survey, the majority (80.3%) have CPOE systems, and a complete EMR system is available in only 9%.

Health Care Surveys↗
PubMed2001

Parallel cascades: new ways to describe noise transfer in medical imaging systems.

A generalized approach to describing transfer of the noise power spectrum through medical imaging systems has been developed over the past several years in which image-forming processes are represented in terms of a cascade of amplified point processes. Until recently, this approach has been restricted to serial cascades only. Here we develop a generalized expression for the cross covariance of amplified point processes and an expression for the cross spectral density for wide-sense stationary conditions. These results extend the generalized transfer-theory approach to include the description of more complex image-forming processes involving parallel cascades of quantum amplification processes. This parallel-cascade approach is used to develop a theoretical expression for noise-power transfer in a simple radiographic screen that includes the effect of characteristic x-ray reabsorption. The result confirms earlier work by Metz and Vyborny, who showed that reabsorption increases image noise and decreases the detective quantum efficiency at low spatial frequencies. Use of the transfer-theory approach facilitates a straightforward generalization to many new digital imaging systems including conventional angiographic and active-matrix flat-panel systems.

Biophysical Phenomena↗
PubMed2000

Knowledge acquisition to qualify Unified Medical Language System interconceptual relationships.

Adding automatically relations between concepts from a database to a knowledge base such as the Unified Medical Language System can be very useful to increase the consistency of the latter one. But the transfer of qualified relationships is more interesting. The most important interest of these new acquisitions is that the UMLS became more compliant and medically pertinent to be used in different medical applications. This paper describes the possibility to inherit automatically medical inter-conceptual relationships qualifiers from a disease description included into a database and to integrate them into the UMLS knowledge base. The paper focuses on the transmission of knowledge from a French medical database to an English one.

Artificial Intelligence↗
PubMed2005

Role-tailored software systems for medical response to disasters: enhancing the capabilities of "mid-tier" responders.

WIISARD (Wireless Internet Information System for Medical Response in Disasters) is developing wireless technology to coordinate and enhance the care of mass casualties at disaster sites. Mid-tier personnel (area supervisors) play a critical role in disaster response, supervising care processes in the triage, Treatment and Transport areas of the attack site. The design of a software tool to support mid-tier activities focuses on providing supervisors aggregate information on patient conditions and needs, real-time data on ambulance availability and location, and hospital status and on coordinating care delivery among triage, treatment and transport areas.

Computer Systems↗
PubMed1991

[Medical expert systems and clinical needs].

The rapid expansion of computer-based systems for problem solving or decision making in medicine, the so-called medical expert systems, emphasize the need for reappraisal of their indication and value. Where specialist knowledge is required, in particular where medical decisions are susceptible to error these systems will probably serve as a valuable support. In the near future computer-based systems should be able to aid the interpretation of findings of technical investigations and the control of treatment, especially where rapid reactions are necessary despite the need of complex analysis of investigated parameters. In the distant future complete support of diagnostic procedures from the history to final diagnosis is possible. It promises to be particularly attractive for the diagnosis of seldom diseases, for difficult differential diagnoses, and in the decision making in the case of expensive, risky or new diagnostic or therapeutic methods. The physician needs to be aware of certain dangers, ranging from misleading information up to abuse. Patient information depends often on subjective reports and error-prone observations. Although basing on problematic knowledge computer-born decisions may have an imperative effect on medical decision making. Also it must be born in mind that medical decisions should always combine the rational with a consideration of human motives.

Artificial Intelligence↗
PubMedDate not supplied

Combination therapy: medicated urethral system for erection enhances sexual satisfaction in sildenafil citrate failure following nerve-sparing radical prostatectomy.

The objective of our study was to assess the effectiveness of combining medicated urethral system for erection (MUSE) with sildenafil citrate in men unsatisfied with the sildenafil alone. Baseline and follow-up data from 23 patients (mean age, 62.5 +/- 5.23 years) unsatisfied with the use of the sildenafil citrate alone for the treatment of erectile dysfunction following nerve-sparing radical prostatectomy (mean use, 4 attempts/100-mg dose) was obtained. All patients started oral sildenafil citrate more than 6 months after radical prostatectomy. Combination therapy was initiated using 100 mg sildenafil citrate orally 1 hour prior to intercourse. Patients used combination therapy for a minimum of 4 attempts prior to assessment with the Sexual Health Inventory of Men (International Index for Erectile Function-5) and visual analog scale to gauge rigidity (0-100). The effect of therapy on the total International Index for Erectile Function (IIEF) score and penile rigidity score was assessed. Of the 23 patients, 4 (17%) had no improvement with the addition of medicated urethral system for erection and discontinued the drug, while 19 (83%) reported improvement with the penile rigidity and sexual satisfaction. The IIEF scores of these 19 patients showed significant improvements in each sexual domain, and the patients reported that erection was sufficient for vaginal penetration 80% of the time. Rigidity scores on a scale of 0-100 with sildenafil alone averaged 38% (23-53) for men and 46% (26-67) for their partners. With the addition of MUSE, scores increased to 76% for men and 62% for their partners. We conclude that the addition of MUSE to sildenafil improved sexual satisfaction and penile rigidity in patients unsatisfied with sildenafil alone.

Alprostadil↗
PubMed1987

The advanced life support base hospital audit for medical control in an emergency medical services system.

A large California county uses an audit of its advanced life support (ALS) base hospitals to maintain medical control of prehospital care and to improve the county emergency medical services. The audit is a rigorous, semi-annual evaluation of ALS base hospital performance using objective, written criteria. The county emergency medical service district and the base hospitals have benefited from the data that have resulted from the audits. The base hospital audit is an excellent method of assessing medical control in an emergency medical services system.

California↗