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At least 1,693 records · Page 94Linked to original sources
PubMed1996

Experiences with a distributed virtual patient record system.

TeleMed is a distributed diagnosis and analysis system, which permits physicians who are not collocated to consult on the status of a patient. The patient's record is dynamically constructed from data that may reside at several sites but which can be quickly assembled for viewing by pointing to the patient's name. Then, a graphical patient record appears, through which consulting physicians can retrieve textual and radiographic data with a single mouse click. TeleMed uses modern distributed object technology and emerging telecollaboration tools.

Computer Communication Networks↗
PubMed1996

An information system to improve the safety and efficiency of chemotherapy ordering.

We developed a computer application to support the ordering of chemotherapy. Key goals were to guard against errors in chemotherapy ordering and dosing, to, coordinate the outpatient and inpatient chemotherapy services, and to support the overall process flow of a chemotherapy cycle. In a six-month period, 512 daily-dose and 386 weekly-dose warnings were generated; 167 (19%) resulted in a cancellation or re-evaluation of the dose. The system has been well accepted, and has helped to coordinate the efforts of the many members of the oncology care team.

Antineoplastic Agents↗
PubMed1996

Impact of a computerized patient tracking system in a pediatric clinic.

A computerized patient tracking system with an intuitive graphical interface was deployed in a large multidisciplinary pediatric outpatient clinic and has been enthusiastically embraced by both physicians and non-physician staff. Usage of the computerized patient tracking system has been associated with a significant decrease in the total time patients spend in the clinic. The total duration of an average patient visit has declined from 99.25 +/- 57.44 minutes to 66.94 +/- 30.47 minutes (p = 0.03). Most of this decrease has been due to a decrease in total waiting time from 54.17 +/- 37.61 minutes to 27.29 +/- 14.05 minutes (p = 0.006). Usage of the patient tracking system has also been associated with a significant increase in examination room utilization during peak business hours from 58.47 +/- 21.18% to 64.49 +/- 13.38% (p = 0.0329).

Ambulatory Care Facilities↗
PubMed1996

GTDS--a tool for tumor registries to support shared patient care.

German hospital tumor registries play an active role in the treatment of cancer patients. Besides the documentation of the course of a disease, they directly support medical treatment and follow-up care over a long period. As the treatment of oncologic patients is a shared multidisciplinary task, the availability of information is one of the most valuable outputs. Therefore, the documentation has to be integrated into the medical treatment, which only can be achieved when useful services are based on it. Since 1983 the basis of the documentation has been a uniform basic data set which was revised in 1990 and, according to be requirements mentioned above, allows detailed documentation, especially of therapy. During the last four years a new documentation system for tumor diseases has been developed and was implemented in 30 hospital tumor registries by the "Arbeitsgruppe zur Koordination Klinischer Krebsregister". The so-called "Giessener Tumordokumentationssystem" (GTDS) is the basis of the work in those registries. In this paper the functions and services which were implemented in order to support the individual treatment of oncologic patients and the methods of collecting and delivering that information to the physician are presented.

Documentation↗
PubMed1996

Assessment of a knowledge-acquisition tool for writing Medical Logic Modules in the Arden Syntax.

We have created a tool that allows users unfamiliar with the Arden Syntax and our underlying database to create Medical Logic Modules (MLMs). In a study of this tool (N 16), subjects found it easy to use (mean score - 4.69 on a scale of 1-5, 5 being best). Each subject created 3 MLMs of varying complexity following a protocol. On average, subjects required 312, 308 and 318 seconds, respectively, to complete each MLM. Comparison of clinicians to non-clinicians and those with to those without knowledge of Arden showed no significant difference. Of the 48 MLMs, 47 compiled and executed with appropriate output. Independent manual review of the MLM correlated well and found few errors. We conclude that our tool is easily used by inexperienced persons to write MLMs in the Arden Syntax.

Artificial Intelligence↗
PubMed1996

Clinical decision support for physician order-entry: design challenges.

We report on a joint development effort between ALLTEL Information Services Health Care Division and IBM Worldwide Healthcare Industry to demonstrate concurrent clinical decision support using Arden Syntax at order-entry time. The goal of the partnership is to build a high performance CDS toolkit that may be easily customized for multiple health care enterprises. Our work uses and promotes open technologies and health care standards while building a generalizable interface to a legacy patient-care system and clinical database. This paper identifies four areas of design challenges and solutions unique to a concurrent order-entry environment: the clinical information model, the currency of the patient virtual chart, the granularity of event triggers and rule evaluation context, and performance.

Artificial Intelligence↗
PubMed1996

Evolution of a legacy system to a Web patient record server: leveraging investment while opening the system.

A layered system is under development to enhance our legacy system as a backend in a WEB-enabled system. Each layer of the system has defined functionality, leverages the investment in the layer below, and follows the strategy of reducing support requirements for workstations. The mainframe system provides administrative integration of sub-systems, security, and the central data repository for most information. The second layer is a graphical user interface (GUI) to the system for Windows platforms. Support needs are limited by relying chiefly on X-terminals and application servers. The "Intranet" layer is a WEB Server building upon the second layer gateways to provide platform-independent access to selected information and images. The fourth layer, under evaluation, will extend access to the central data repository for Internet users of web browsers that support private-key/public-key encryption.

Computer Communication Networks↗
PubMed1996

Providing location-independent access to patient clinical narratives using Web browsers and a tiered server approach.

Health care today depends upon timely access to patient medical data and the latest medical knowledge. As we make the transition from a hospital-based organization to an integrated health care delivery system, patient care information must move throughout the organization quickly and efficiently over increasing distances. The emergence of widely-dispersed referral networks demands novel solutions to the problems of delivering patient care information to providers. We have developed a mechanism to provide location-independent access to clinical narrative reports using a multi-tiered server model and World Wide Web technologies for delivery. To successfully deploy such a system to sites separated by large distances, it is important to reduce complexity at the client site. Using a "thin client", such as a web browser, in our design facilitates deployment and support while reducing cost per user. This architecture allows the application to be updated without modification to the end-user software and eases maintenance over long distances.

Computer Communication Networks↗
PubMed1996

Implementing a Web-based clinical information system using EMR middle layer services.

The Clinical Summary is a Web-based application for accessing the clinical database at the Massachusetts General Hospital. The application has been developed to give physicians in our health care community access to clinical information for patients they refer to our hospital. "Middle layer" services, written previously for the hospital's clinical workstation, supply much of the application's functionality. Employment of reusable services together with a Web-based front end has afforded a rapid and inexpensive means for developing a new clinical information system. This paper discusses the system's design, function, and methods of implementation.

Computer Communication Networks↗
PubMed1996

Pilot study on the effects of a computer-based medical image system.

Current medical imaging systems are developed for the purpose of data management. Evaluations of these systems are usually done by assessing users' subjective appreciation rather than objectively gauging performance influence. The present report discusses the evaluation of a medical image presentation system prototype utilizing a cognitive approach. Experimental results showed hypothesized performance improvement attributed to advanced presentation techniques. However, this improvement was almost inadvertently masked by users' previous strategies and interactions with new technology. Overall these data demonstrate the potential benefit of implementing such a system in actual practice as well as provide an example of applying the cognitive approach in evaluating the usability of medical systems.

Cognition↗
PubMed1996

3D presentation of the nuclear cell features in quantitative cytometry.

The use of an image cytometer in analysis of smears and needle aspirates provides valuable information to a cytologist. It allows to combine the overall impression, formed by visually inspecting the cells, with measured and numerically expressed nuclear cell features. Both types of information can be used efficiently only if presented to the expert in an appropriate way. Cell images (as they are seen with a microscope) are easily analysed by the experts. However, measured nuclear features can not be presented as a list of numerical values. Instead, an user interface should be developed, providing graphical presentation of the nuclear features. It should show as much information as possible and provide a comprehensive link between nuclear features and cell images. The user interface described in this paper shows nuclear features in three dimensions. It is based on a perspective projection of the three dimensional feature space onto a two dimensional surface. It allows the user to dynamically change the perspective, i.e., to look at the virtual three dimensional structure from different viewpoints. Each nucleus is represented by a single object in the three dimensional space. When an object in the three dimensional feature space is selected, the image (or the visual appearance) of the corresponding cell is shown. When a nucleus image is selected, its position in the feature space is highlighted. This provides an interconnection between nuclear cell features and cell images allowing simultaneous analysis of both types of information.

Cell Nucleus↗
PubMed1996

WWW-based interfaces to clinical information systems: the state of the art.

Nine WWW-based interfaces to clinical information systems were reviewed. Five have progressed past the proof of concept phase and into alpha testing in the clinical environment. All key features desirable in an advanced clinical information were present in at least one interface, however many implementations were rudimentary. Much human computer interface research and WWW tool development needs to occur before implementation of a WWW-based interface to a clinical information system should be considered for a mission-critical, production environment.

Computer Communication Networks↗
PubMed1996

Evaluation of the Newton Pen-Pad as a tool for collecting clinical research data at the bed-side.

A protocol for the study of practice variation between Quebec Intensive Care Units in the treatment of myocardial infarction by thrombolysis was coded into the Newton Pen-Pad. This tool for the direct recording of clinical data was tested in the working environment by research nurses of 4 different teaching hospitals. Data was sent directly from the pen-pad by telecommunication to the information coordinating center. The results of this evaluation confirm the reliability and robustness of this approach which promises to be an important tool for applied clinical research.

Attitude to Computers↗
PubMed1996

Assessment of a cooperative workstation.

Groupware and new Information Technologies have now made it possible for people in different places to work together in synchronous cooperation. Very often, designers of this new type of software are not provided with a model of the common workspace, which is prejudicial to software development and its acceptance by potential users. The authors take the example of a task of medical co-diagnosis, using a multi-media communication workstation. Synchronous cooperative work is made possible by using local ETHERNET or public ISDN Networks. A detailed ergonomic task analysis studies the cognitive functioning of the physicians involved, compares their behaviour in the normal and the mediatized situations, and leads to an interpretation of the likely causes for success or failure of CSCW tools.

Cooperative Behavior↗
PubMed1996

Beyond the Web: building information systems with clinical context.

Much of the current research on clinical information systems concentrates on World Wide Web (W3) development. Although the W3 is well suited to many information applications such as nonsensitive data exchange, it has drawbacks that may make it inappropriate for certain clinical environments. We present a solution that addresses many of the W3's limitations by focusing on clinical requirements first and then applying the appropriate technology. We also make a case for clinical information systems researchers to become more involved in the development of Internet standards.

Computer Communication Networks↗
PubMed1996

Designing an emergency medicine physician workstation to support risk management in decision making.

The practice of emergency medicine requires rapid decision making. The speed of decision making in the face of limited information contributes to the high risk of medical malpractice suits. We explore design approaches to an emergency physician electronic medical record product, EMstation, that may reduce the risk of adverse medical events by providing cues and tools while the patient may still be in the emergency department. EMstation is an Emergency Medicine Physician Workstation base on a Microsoft Windows 3.1 user interface. Because adaptation and adaptability to physician needs are critical to user acceptance, design to workflow, multisite end user customization, and integrated database support are used to support risk management documentation in EMstation. This article describes techniques that can be incorporated into electronic medical products which may prevent adverse medical events.

Decision Making, Computer-Assisted↗
PubMed1996

A decision-supported outpatient practice system.

We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed.

Ambulatory Care Facilities↗
PubMed1996

Voice recognition: an enabling technology for modern health care?

Recent performance breakthroughs in affordable, large vocabulary, speaker independent voice recognition systems have rekindled widespread interest in using voice recognition technology to enhance the palatability and effectiveness of clinician-mediated computing. However, even if industry fully addresses the formidable hardware requirements, less than perfect recognition accuracies, discrete voice recognition requirements, and throughput limitations, there are significant cognitive and implementation issues that must be adequately resolved before voice can become a ubiquitous input modality. Cognitive issues include making allowances for individual differences in verbal communication style and skill levels, the relative cognitive load of using a voice enabled interface compared to alternative modalities, and the user's cognitive style. Implementation issues include a significant training requirement, limited portability, lengthy user switching time, questionable privacy, satisfying hardware requirements and the suitability of voice recognition in specific work environments. The inevitable resolution of these issues coupled with continuously improving voice recognition performance, promises a new era for voice recognition in medicine.

Information Storage and Retrieval↗