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Biomedical subjects

D W Simborg

Publications and source records attributed to D W Simborg.

32 records · Page 2Linked to original sources
PubMed1977

A minirecord: an aid to continuity of care.

A simple, low cost computerized minirecord system (minimal essential record) has been in full operation for two years in the Medical Clinic of The Johns Hopkins Hospital. The primary objective of the minirecord system is to permit rapid retrieval of current information concerning Medical Clinic patients. The system provides a computer-printed listing of problems and medications in the front of each chart and on-line display of this information at strategically located computer terminals. The information is generated via existing simple systems with minimal additional effort and with the use of any terminology deemed appropriate. Chart review revealed that minirecords were actually present in 92% of the charts and that significant improvement occurred in the recognition of a subsequent visit of clearly defined problems and therapies noted on the initial minirecord. Current modifications will replace the separate minirecord and encounter form (registration and visit note) with a single form that will facilitate completion an updating. The rapid availability of this information provides a mechanism for coordinating continuing care in a university hospital system that is otherwise inevitably fragmented and composed of multiple health care providers.

Comprehensive Health Care↗
PubMed1976

Continuity and coordination in primary care: their achievement and utility.

Coordination is a hallmark of primary care. Efforts to improve primary care services should involve assessment of the extent to which coordination is achieved. Our study in three adult and three pediatric clinics demonstrates that existing information concerning patients' problems, therapies, tests, and referrals is often not recognized by primary care practitioners. Recognition of these types of information is better when the practitioner who provides follow-up care is the same from one visit to the next. Information about visits which were anticipated by the practitioner, and particularly the content of these visits, is often neglected. The largest deficit, however, is in recognition of both the occurrence and content of visits unanticipated by the primary care practitioner. Greater efforts to achieve better coordination of care, by improving either continuity of practitioner, communication among practitioners, or the information system, are required before this essential element of primary care becomes a reality.

Adult↗
PubMed1976

Information factors affecting problem follow-up in ambulatory care.

The influence of information factors on the follow-up of patient problems was studied in six ambulatory clinics providing primary patient care. By means of chart review, the encounter notes were examined for two consecutive visits to the same clinic to determine problems identified at the first visit and detect evidence of follow-up of these problems at the second visit. In those clinics using a problem list, at the front of the chart, those problems on the problem list had a higher follow-up rate than those not on the list particularly at longer intervals between patient visits. An encounter note written in the problem-oriented format did not enhance follow-up. Since information factors as well as clinical factors affect the follow-up of patient problems these factors must be carefully considered when designing information systems to serve ambulatory care.

Adult↗
PubMed1976

The Johns Hopkins radiology reporting system.

Radiologists can comprehensively report diagnostic radiographs by computer with a speed approaching that of dictation. This is the main mode of radiographic reporting used at the Johns Hopkins Hospital. Support functions include information storage, retrieval, statistics, and billing. Costs are comparable to stenography. The system can be run from a large time-sharing computer or dedicated minicomputer. A commercial stand-alone version will soon be available.

Costs and Cost Analysis↗
PubMed1976

Medication prescribing on a university medical service-the incidence of drug combinations with potential adverse interactions.

The medication prescribing practices on a University medical service were reviewed for a two year period. 103,484 medication orders were analyzed for 6,864 patient admissions. Forty drugs account for 64% of all medication orders. One hundred drugs account for 86% of all medication orders. During the two year period the incidence of prescribing specific drug combinations with potential adverse interactions varied from three to one hundred seventeen instances among the combinations examined. Review of a sample of those patients receiving the combination of spironolactone and oral potassium chloride showed that 52% developed hyperkalemia. These results suggest that when physicians prescribe drug combinations with potentially adverse interactions they may not always institute appropriate surveillance to prevent adverse consequences. A trial of automated monitoring of medication orders with appropriate physician feedback has begun as a result of these findings.

Computers↗
PubMed1975

A highly automated hospital medication system. Five years' experience and evaluation.

Since 1969, medications have been provided to patients at the Johns Hopkins Hospital using a computer system that controls the entire medication process from entry of physician's order to hourly drug distribution. Special envelopes containing patient and dosage information are computer generated for each dose to be administered. These envelopes, containing individually labelled ready-to-administer doses, are delivered to the nursing units hourly. The system provides daily medication profiles, drug administration histories, discharge summaries, and management and billing reports. Medication errors of commission were 4.6 times more frequent on the traditional nursing units compared to the units with the computer system. Registered nurses spend 56% less time performing medication-related activities on the units served by the computer. For 250 beds, total costs are 7% higher using the computer system. For 450 beds, total costs are 14% lower using the computer system.

Costs and Cost Analysis↗
PubMedDate not supplied

The federal role in the health information infrastructure: a debate of the pros and cons of government intervention.

Some observers feel that the federal government should play a more active leadership role in educating the medical community and in coordinating and encouraging a more rapid and effective implementation of clinically relevant applications of wide-area networking. Other people argue that the private sector is recognizing the importance of these issues and will, when the market demands it, adopt and enhance the telecommunications systems that are needed to produce effective uses of the National Information Infrastructure (NII) by the healthcare community. This debate identifies five areas for possible government involvement: convening groups for the development of standards; providing funding for research and development; ensuring the equitable distribution of resources, particularly to places and people considered by private enterprise to provide low opportunities for profit; protecting rights of privacy, intellectual property, and security; and overcoming the jurisdictional barriers to cooperation, particularly when states offer conflicting regulations. Arguments against government involvement include the likely emergence of an adequate infrastructure under free market forces, the often stifling effect of regulation, and the need to avoid a common-and-control mentality in an infrastructure that is best promoted collaboratively.

Delivery of Health Care↗
PubMedDate not supplied

Rational staffing of hospital nursing services by functional activity budgeting.

Nursing services are a costly item in the hospital budget, yet their justification is usually based on precedent and anecdote. Patient classification systems enable quantification of the nursing load on a daily basis. This methodology for determining the size of the nursing staff, however, has not gained widespread use because it tends to formalize existing staffing patterns. At the Johns Hopkins Hospital, physicians and nurses drew up a list of activities that should be performed for patients and that need to be considered in budgeting for nursing services. The largest and most variable components of the nursing workload are the tasks specified by physicians' orders and the nursing care plan. A computerized information system which communicates these orders can also be used to quantify these components of the nursing workload, since standard times to perform these tasks have been documented. The variability of these tasks from day to day and from patient to patient is the source of most of the problems of staffing. Other components of the workload, such as patient education, depend on the nursing program desired and must be added separately. Budget decisions can then be based upon the specific nursing functions which the hospital desires to perform. The technique of functional activity budgeting can also be used for the utilization review of physicians' use of nursing services.

Economics, Hospital↗