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PubMed2003

Moving to paperlessness: a case study from a large general practice.

This case study reports the reasons why this large, multi-site general practice decided to move towards paperless practice in late 2001, and describes the progress and lessons learned to date. The principal operational reasons for this decision were problems associated with moving paper medical records between surgeries, and the realisation that resources to improve the computerised medical record could only come from redeploying the time spent handling paper records. A comprehensive plan was put in place to shift toward paperlessness. Motivating and changing working practices for clinical and support staff was as a great a challenge as upgrading the technology. The practice upgraded its computer system, and has installed scanning and automated generation of referral and other letters. The support staff skills have evolved from moving records to scanning documents and coding data. All clinical staff now consult on their computer, and code diagnoses and key clinical data. A networked digital dictation system allows typing to be centralised at one location, with the networking allowing printing at any site. Audit and quality improvement activities have increased, as the output from computer searches increasingly represents the quality of care provided. The implications of this case study are that a committed general practice can achieve a largely paperless environment in approximately two years. The practice is now fit to be part of any move towards integration of records within its local health community, and can demonstrate from its computer records that it meets the quality targets for primary care.

Ambulatory Care Information Systems↗
PubMed2001

The use of AEDs by police officers in the City of London. Automated external defibrillators.

The Guidelines 2000 for cardiopulmonary resuscitation recommend shock delivery to victims in ventricular fibrillation within 5 min of call receipt by the Emergency Medical Services. In an effort to achieve this goal, in some parts of the United States, police officers have been trained to use automated external defibrillators (AEDs). We undertook a 3-year pilot evaluation of the use of AEDs by City of London police (CPOL) officers. Over a period of 3 years, 147 CPOL officers were trained in the use of an AED. Four AEDs were placed on rapid response vehicles covering the City of London. An overall call-response interval target was set at 8 min. The CPOL attended 1103 (90%) of the total of 1232 calls to which they were summoned. The mean interval between the first call received and arrival of the CPOL on scene was 8.9+/-4.0 min. The CPOL applied AEDs to 25 victims, 13 of whom were initially in ventricular fibrillation; at least one shock was delivered to all 13. The interval between call reception and delivery of the first shock was 5.5+/-2.5 min. The mean interval between switching on the AED and delivery of the first shock was 24+/-12 s. Two (15%) of these victims survived to hospital discharge. This study has confirmed the feasibility of training police officers in the UK to use AEDs as first responders. The call received to arrival on scene interval should be reduced by improvements in communication between LAS and CPOL.

Adolescent↗
PubMed1994

The utility of electronic mail as a medium for patient-physician communication.

OBJECTIVE: To examine patients' knowledge, use, and attitudes regarding electronic mail communication with their family physicians. DESIGN: Mail survey. SETTING: A university-based family practice center. PARTICIPANTS: Adult patients (18 years and older) of full-time faculty physicians at a university-based family practice center who had seen their physicians at lease once in the 10-month period between July 1, 1992, and April 30, 1993 (N = 4094). Subjects were eligible for participation if both they and their physicians had an electronic mail address at the University of Kentucky, Lexington (n = 117). INTERVENTION: None. MAIN OUTCOME MEASURES: Patient-reported knowledge, use, and attitudes regarding the utility of electronic mail as a means of patient-physician communication. RESULTS: The response rate to the survey was 74% (n = 87). Patient-physician communication via electronic mail was positively perceived by patients for whom electronic mail was accessible Patient-physician communication via electronic mail was perceived to increase speed, convenience, and access to medical care. Electronic mail communication was perceived to be good for simple and nonurgent problems, such as refilling prescriptions, communicating laboratory results, and making appointments. Ninety percent of the patients who had corresponded with their physicians via electronic mail used the medium to discuss a medical problem. CONCLUSIONS: Although electronic mail is not presently in wide use for patient-physician communication, there is great potential for its widespread acceptance.

Attitude↗
PubMed1994

Globin gene server: a prototype E-mail database server featuring extensive multiple alignments and data compilation for electronic genetic analysis.

The sequence of virtually the entire cluster of beta-like globin genes has been determined from several mammals, and many regulatory regions have been analyzed by mutagenesis, functional assays, and nuclear protein binding studies. This very large amount of sequence and functional data needs to be compiled in a readily accessible and usable manner to optimize data analysis, hypothesis testing, and model building. We report a Globin Gene Server that will provide this service in a constantly updated manner when fully implemented. The Server has two principal functions. The first (currently available) provides an annotated multiple alignment of the DNA sequences throughout the gene cluster from representatives of all species analyzed. The second compiles data on functional and protein binding assays throughout the gene cluster. A prototype of this compilation using the aligned 5' flanking region of beta-globin genes from five species shows examples of (1) well-conserved regions that have demonstrated functions, including cases in which the functional data are in apparent conflict, (2) proposed functional regions that are not well conserved, and (3) conserved regions with no currently assigned function. Such an electronic genetic analysis leads to many readily testable hypotheses that were not immediately apparent without the multiple alignment and compilation. The Server is accessible via E-mail on computer networks, and printed results can be obtained by request to the authors. This prototype will be a helpful guide for developing similar tools for many genomic loci.

Animals↗
PubMed1991

Establishing an international computer network for research and teaching in public health and epidemiology.

Most universities and major research institutions in North America, Western Europe and around the Pacific are connected via computer communication networks. The authors have used these networks' accessible, low cost, electronic mail system to develop a network of public health researchers and teachers. Current and potential uses of this network are discussed. These networks can not only facilitate international cooperation within public health; they also make it possible to conduct international collaborative research projects that would be too cumbersome and time consuming to initialize and conduct without this communication facility. One participant from Hungary has been able to participate in the network by using telefax. This has some drawbacks compared to electronic mail. In this era of rapid change in Eastern Europe, we urge that electronic communication be made freely available to colleagues in Eastern Europe.

Computer Communication Networks↗
PubMed1994

Research integration.

Explore the source record for details and available documents.

Academic Medical Centers↗
PubMed1992

CompreLink--a physician to physician communication network.

The Cleveland Clinic Foundation has developed a physician to physician communication network designed to meet the needs of their affiliate physicians--physicians who do not have admitting privileges at the Cleveland Clinic Hospital. This paper provides an overview of the CompreLink network as it exists today, as well as a glimpse into some of their plans for network expansion and development.

Group Practice↗
PubMed1992

Synapse Health Resources Online.

The University of Nebraska Medical Center maintains the Synapse Health Information Network to provide timely clinical and library resource information to health professionals across Nebraska and surrounding regions. The system is in over 115 sites across Nebraska and surrounding regions and maintains over 320 network users.

Health Education↗
PubMed1994

Status quo and future prospects of the total hospital information system of a Japanese medical college.

Six years have passed since the total hospital information system of Miyazaki Medical College, nicknamed PHOENIX, began its functions for the first time. It started with order entry systems, and has accomplished various systems, leaving one entry system unfinished; the injection order entry system which will be completed in the near future. It was revealed that the waiting period was most reduced at the hospital pharmacy. The waiting period for the visitors was also reduced. Usefulness of the PHOENIX system was greatly advanced by the function of a unique system of personal computer LAN, nicknamed PALM. This personal computer environments consisted of 200 or more Apple Macintosh computers. In this PALM environment, file servers, CD-ROM MEDLINE, clinical information databases, electronic mails (available in LAN and Internet) and sharing of printers are on service 24 hr a day.

Academic Medical Centers↗
PubMed1993

The effects of electronic mail on communication in two health sciences institutions.

A study was done during 1991-1992 to determine the perceived impact of electronic mail (E-mail) relative to other forms of communication in health sciences institutions. E-mail subscribers at two major health sciences institutions were sent 2919 surveys, and 823 (28%) completed survey instruments were returned. A significant positive impact of E-mail was found relative to other forms of communication (e.g., paper, phone) with regard to E-mail messaging, response rates, influence, value, formality, perceptions, errors in communication, cost-effectiveness, communication style, and other factors. Areas where no differences were found between communication mechanisms were also revealing. Technical problems, maintenance, and confidentiality of E-mail messaging were not found to be significant problems. Trends, value, and impact of E-mail use in health sciences institutions are also discussed.

Academic Medical Centers↗
PubMed1989

Effective staff communications in a large I.C.U.

A byproduct of the Quality Assurance process is the continual review of individual and group practice. The aim is to eliminate errors and to improve care. For managers and directors to know what issues are currently important to the staff members an upward channel of communication is also needed. In our SICU with over 120 staff there was no documentation of communication in either direction. Casual survey did not reveal a major problem - but the need to document the dissemination of information, particularly new policies - especially to satisfy accrediting agencies - led us to develop MEMOS, an electronic mail system for staff members within the local area network (LAN) in the SICU. The system will run on an individual PC. The network is used because of the physical configuration of the intensive care units. The system is used by nurse managers to keep staff members up to date. Features include: Easy file maintenance. Individual password access. A defined group of system operators with access to all system functions Limited access to all other users. As many as 40 definable sub-groups for the purposes of mail distribution. Easy operator tallying of those delinquent in reading their mail. Hard copy with distribution list for all memos added to system. Browse feature to allow re-reading of old memos. Feedback channel regularly read by system operators. This system has improved the level of staff awareness in the SICU and helped build morale.

Computer Systems↗
PubMed1988

Using word processor text files as an active bibliography.

Data base systems for microcomputers are generally available. Most are reasonable priced and easy to use. Their disadvantages are restrictions placed on the amount of data stored in a single field, and the output format--usually tabular or label in style. This article describes the use of word processor text files as a data base allowing search and retrieval, with special reference to abstracting and storage of literature citations. Size of text entry and ultimate output format are extremely flexible using this method.

Information Systems↗