Grand challenges in medical informatics?
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Medical Informatics↗
Biomedical subjects
D F Sittig
Publications and source records attributed to D F Sittig.
Computer-based physician order entry: the state of the art.
Direct computer-based physician order entry has been the subject of debate for over 20 years. Many sites have implemented systems successfully. Others have failed outright or flirted with disaster, incurring substantial delays, cost overruns, and threatened work actions. The rationale for physician order entry includes process improvement, support of cost-conscious decision making, clinical decision support, and optimization of physicians' time. Barriers to physician order entry result from the changes required in practice patterns, roles within the care team, teaching patterns, and institutional policies. Key ingredients for successful implementation include: the system must be fast and easy to use, the user interface must behave consistently in all situations, the institution must have broad and committed involvement and direction by clinicians prior to implementation, the top leadership of the organization must be committed to the project, and a group of problem solvers and users must meet regularly to work out procedural issues. This article reviews the peer-reviewed scientific literature to present the current state of the art of computer-based physician order entry.
Computer User Training↗
Medical informatics on the Internet: creating the sci.med. informatics newsgroup.
A Usenet newsgroup, sci.med.informatics, has been created to serve as an international electronic forum for discussion of issues related to medical informatics. The creation process follows a set of administrative rules set out by the Usenet administration on the Internet and consists of five steps: 1) informal discussion, 2) request for formal discussion, 3) formal discussion, 4) voting, and 5) posting of results. The newsgroup can be accessed using any news reader via the Internet.
Communication↗
The evaluation of clinical decision support systems: what is necessary versus what is interesting.
The evaluation of clinical decision support systems has long been recognized as an important part of the overall field of medical computing, as well as a complex and varied field in its own right. There are a number of purposes for which such an evaluation might be performed. This paper focuses on one of those purposes, the assurance of safety when preparing to release the system for general use. The assurance of safety involves two major stages: (1) a comprehensive validation of the system's knowledge and advice, and (2) a period of use which exposes the system's advice and interface to the clinical environment.
Decision Making, Computer-Assisted↗
Computer-based data entry for nurses in the ICU.
Efforts are being made to improve the efficiency and quality of care in intensive care units (ICUs) at Latter Day Saints Hospital. The ICUs have been computerized, and the collection, storage, and presentation of patients' data have been improved. Nurses use computers for entering clinical data and plans for nursing care, and the effects of these changes on the work patterns of nurses in the ICU have been evaluated. Contrary to our expectation, our studies showed a decrease in the proportion of time that nurses spent in direct patient care (from 49.1% to 43.2%) and an increase in the proportion they spent entering clinical data (from 18.2% to 24.2%) after computerization. These changes, however, were attributed to a decrease in the severity of patients' illnesses, rather than the availability of the computer. There was no measurable difference in the proportion of time spent at other nursing activities.
Data Interpretation, Statistical↗
The biomedical engineering technician as a member of the clinical research team.
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Biomedical Engineering↗
Evaluating a computer-based experiential learning simulation: a case study using criterion-referenced testing.
A case study of a computer-based experiential learning program involving the use of criterion-referenced testing as a quantitative evaluation tool is described. The simulation was designed to introduce nurses to basic computer operations. One hundred and thirty-eight nurses participated in the evaluation using a specially prepared version of the program that recorded the time required to perform actions, the number of unsuccessful attempts to complete instructions, and the number of correct responses to specific questions. The ability of the nurses to "drag and drop" increased significantly from less than 20% to more than 90% (p < .05, Student's t-test). Their knowledge of the definitions of four computer-related terms (i.e., trackball, desktop, window, and icon) increased significantly (from 65% to 80%, p < .1). In subjective evaluations, 82% of respondents reported that they enjoyed the lesson and 89% wanted more computer-based instructional units to be developed. Use of criterion-referenced testing helped to shed new light on the utility of such computer aided instructional systems.
Academic Medical Centers↗