Biomedical subjects

H J Tange

Publications and source records attributed to H J Tange.

14 recordsLinked to original sources

PubMed2005

Three-Layer Model for the design of a Protocol Support System.

OBJECTIVE: The aim of the PropeR project is to investigate the impact of Active Computerized Protocol Support (ACPS) on daily care processes in different settings (home care and hospital care). ACPS consists of an active Protocol Support System (PSS) that is linked to an Electronic Patient Record system. The aim of this paper is to describe how we have taken the organizational and social aspects into account in the hospital setting and the consequences of this approach for the design of the PSS. METHODS: Socio-technical approaches have been applied. Observations and interviews with various health care providers were performed at the hematology and oncology department of the University Hospital Maastricht. Ten extensive sessions with a specialist physician and research nurse took place to further elaborate a study protocol and to discuss how it is integrated in daily practice. The knowledge editor component of Gaston was used to build a computer interpretable version of the selected protocol. RESULTS AND CONCLUSIONS: To support the representation of a study protocol integrated in routine clinical care, a Three-Layer Model was developed. This model distinguishes the protocol description, local adaptations to the protocol and communication as three separate layers. These layers have been incorporated into the knowledge acquisition tool Gaston. The Three-Layer Model makes easy updating possible, and also supports transferability of computerized (study) protocols to other organizations.

Clinical Protocols↗

PubMed2003

Determinants of success of inpatient clinical information systems: a literature review.

We reviewed the English and Dutch literature on evaluations of patient care information systems that require data entry by health care professionals published from 1991 to 2001. Our objectives were to identify attributes that were used to assess the success of such systems and to test the ability of a framework developed by Delone and McLean for management information systems(1) to categorize these attributes correctly. The framework includes six dimensions or success factors: system quality, information quality, usage, user satisfaction, individual impact, and organizational impact. Thirty-three papers were selected for complete review. Types of study design included descriptive, correlational, comparative, and case studies. A variety of relevant attributes could be assigned to the six dimensions in the Delone and McLean framework, but some attributes, predominantly in cases of failure, did not fit any of the categories. They related to contingent factors, such as organizational culture. Our review points out the need for more thorough evaluations of patient care information systems that look at a wide range of factors that can affect the relative success or failure of these systems.

Computer Security↗

PubMed2003

A generic model of clinical practice.

OBJECTIVES: Many shared-care projects feel the need for electronic patient-record (EPR) systems. In absence of practical experiences from paper record keeping, a theoretical model is the only reference for the design of these systems. In this article, we review existing models of individual clinical practice and integrate their useful elements. We then present a generic model of clinical practice that is applicable to both individual and collaborative clinical practice. METHODS: We followed the principles of the conversation-for-action theory and the DEMO method. According to these principles, information can only be generated by a conversation between two actors. An actor is a role that can be played by one or more human subjects, so the model does not distinguish between inter-individual and intra-individual conversations. RESULTS: Clinical practice has been divided into four actors: service provider, problem solver, coordinator, and worker. Each actor represents a level of clinical responsibility. Any information in the patient record is the result of a conversation between two of these actors. Connecting different conversations to one another can create a process view with meta-information about the rationale of clinical practice. Such process view can be implemented as an extension to the EPR. CONCLUSIONS: The model has the potential to cover all professional activities, but needs to be further validated. The model can serve as a theoretical basis for the design of EPR-systems for shared care, but a successful EPR-system needs more than just a theoretical model.

Communication↗

PubMed2003

Two patient care information systems in the same hospital: beyond technical aspects.

OBJECTIVES: To compare two clinical workstations in one hospital with respect to technical, organizational, cultural and human factors. One clinical workstation was a GUI to the HIS. The other was an electronic patient record for stroke. METHODS: Data were collected by means of in-depth interviews with end-users of both clinical workstations. The interviews were audio taped and transcribed for analysis. RESULTS: End users assessed both clinical workstations as user friendly. Coordination between health care workers was perceived to be enhanced. However, in both situations poor communication between management, implementers and users resulted in uncertainty and skepticism about future perspectives. Further-more, it appeared that inpatient and outpatient settings needed clinical workstations with different requirements for an optimal fit between work practices and information system. CONCLUSIONS: Regardless of the domain and content of a workstation, it can support coordination between disciplines. The communication concerning the information technology strategy deserves much attention. Finally, the requirements for inpatient and outpatient workstations differ.

Attitude of Health Personnel↗

PubMed2000

An experimental electronic patient record for stroke patients. Part 1: situation analysis.

In this article the paper record and its position in work practices is discussed, and is related to the situation at an inpatient clinic for which an electronic patient record (EPR) is in development. In addition reported research on innovations is discussed. An analysis of 42 clinical paper records gave insight into existing problems with paper records. The current work practices were analysed based on two periods of observations in the ward and eight in-depth interviews with questions about their daily work, communication in the ward and the role of the paper record in communication. The results indicate that several problems described in the literature were recognised only for a part of the medical and nursing records. One probable cause of insufficient communication between health care workers appeared to be the internal organisation of the paper records. The fact that the experimental EPR system will be small-scaled, introduces specific problems regarding communication with other departments that still work with paper records. Nevertheless, we conclude that also an electronic patient record designed for a specific setting has the potential to improve record keeping and communication between health care workers.

Decision Support Systems, Clinical↗

PubMed2000

An experimental electronic patient record for stroke patients. Part 2: system description.

This article presents an electronic patient record (EPR) for stroke patients. At the neurology department of the Maastricht University Hospital, coordination and communication of the multidisciplinary team for stroke patients is intended to be supported by an EPR. Existing, structured, paper nursing and medical records served as a starting point for the development of the EPR. In close cooperation with future users, the database structure, and data entry and data retrieval aspects of the user interface were adapted to the domain of stroke. The result is a combined electronic medical and nursing record that has potential to improve record keeping and to truly support daily routines. The challenges encountered in the development process were maintaining continuous user involvement and conflicting points of view regarding the relevance of clinical data. Conclusively, we state that intensive user participation improved the EPR, coupling with the existing hospital information system and other systems will be advantageous and the fact that the paper records were structured in advance will smooth the unavoidable changes in work patterns.

Decision Support Systems, Clinical↗

PubMed2000

The user in the design process of an EPR.

To optimise the development and implementation process of an electronic patient record, attitudes toward computers in health care and satisfaction with paper records of nurses and physicians of a department in an academic hospital were determined. For this purpose participants received two questionnaires. These results were supplemented with eight semi-structured in-depth interviews. Users who considered themselves as experienced computer users had more positive attitudes. Inexperienced users were more satisfied with the nursing paper record, while no significant differences existed for the paper medical record.

Attitude to Computers↗

PubMed1999

An experimental electronic patient record for stroke patients.

This contribution describes an electronic patient record for stroke patients at the neurology ward of the Maastricht University Hospital. Daily practice at the ward will be supported with the developed electronic patient record that integrates both the medical and the nursing record, that will provide decision support and it will be connected to the hospital information system. In an evaluation project we will study the effects of the usage of the electronic patient record and additional effects of providing decision support.

Data Collection↗

PubMed1999

Consultation of medical narratives in the electronic medical record.

This article presents an overview of a research project concerning the consultation of medical narratives in the electronic medical record (EMR). It describes an analysis of user needs, the design and implementation of a prototype EMR system, and the evaluation of the ease of consultation of medical narratives when using this system. In a questionnaire survey, 85 hospital physicians judged the quality of their paper-based medical record with respect to data entry, information retrieval and some other aspects. Participants were more positive about the paper medical record than the literature suggests. They wished to maintain the flexibility of data entry but indicated the need to improve the retrieval of information. A prototype EMR system was developed to facilitate the consultation of medical narratives. These parts were divided into labeled segments that could be arranged source-oriented and problem-oriented. This system was used to evaluate the ease of information retrieval of 24 internists and 12 residents at a teaching hospital when using free-text medical narratives divided at different levels of detail. They solved, without time pressure, some predefined problems concerning three voluminous, inpatient case records. The participants were randomly allocated to a sequence that was balanced by patient case and learning effect. The division of medical narratives affected speed, but not completeness of information retrieval. Progress notes divided into problem-related segments could be consulted 22% faster than when undivided. Medical history and physical examination divided into segments at organ-system level could be consulted 13% faster than when divided into separate questions and observations. These differences were statistically significant. The fastest divisions were also appreciated as the best combination of easy searching and best insight in the patient case. The results of our evaluation study suggest a trade-off between searching and reading: too much detailed segments will delay the consultation of medical narratives. Validation of the results in daily practice is recommended.

Attitude of Health Personnel↗

PubMed1997

An experimental electronic medical-record system with multiple views on medical narratives.

In this article we describe a prototype electronic medical-record system that has been developed specifically to facilitate searching through medical narratives, as part of a preparatory study to the development of a medical workstation. This system contains a searching structure in which several views on the medical data are combined. We describe the structure of the database and the user-interface. A second design goal was to prepare the system for conducting research with respect to the use of the medical record. We address the kind of test designs the system can support and describe the research module that was implemented. We also describe a study we conducted with the system and report part of its results. We discuss the significance of this medical-record system compared to systems in the literature, some technical and functional problems encountered, and our future plans with the system.

Humans↗

PubMed1997

Medical narratives in electronic medical records.

In this article, we describe the state of the art and directions of current development and research with respect to the inclusion of medical narratives in electronic medical-record systems. We used information about 20 electronic medical-record systems as presented in the literature. We divided these systems into 'classical' systems that matured before 1990 and are now used in a broad range of medical domains, and 'experimental' systems, more recently developed and, in general, more innovative. In the literature, three major challenges were addressed: facilitation of direct data entry, achieving unambiguous understandability of data, and improvement of data presentation. Promising approaches to tackle the first and second challenge are the use of dynamic data-entry forms that anticipate sensible input, and free-text data entry followed by natural-language interpretation. Both these approaches require a highly expressive medical terminology. How to facilitate the access to medical narratives has not been studied much. We found facilitating examples of presenting this information as fluent prose, of optimising the screen design with fixed position cues, and of imposing medical narratives with a structure of indexable paragraphs that can be used in flowsheets. We conclude that further study is needed to develop an optimal searching structure for medical narratives.

Database Management Systems↗

PubMed1994

Information exchange between physicians and nurses.

The need for communication between physicians and nurses in clinical practice is undisputed. However, they keep separate patient records. In this article a case study is reported on the needs for, and present state of, information exchange between physicians and nurses. Both groups kept paper patient records. The common information needs that were found were not covered by the formal structure of both records, nor by the exchange of written, structured messages. It is likely that most of their common needs are satisfied beyond the formal structures, particularly in unstructured text and verbal conversation. The advantages and disadvantages of these ways of communication are discussed. As the impact of quality assessment grows, the role of formal communication will enlarge.

Ambulatory Care↗

PubMedDate not supplied

The paper-based patient record: is it really so bad?

In a recent review of literature, a committee of the American Institute of Medicine found much support of the weakness of the paper-based patient record. Inspired by these results, a local survey was held among practicing clinicians to test, whether they could subscribe the Committee's conclusions. The clinicians turned out to be far more positive about the quality of the paper-based patient record. Possible explanations for this discrepancy are discussed, as well as the question, whether the results of the Committee's review may be used as a basis for the implementation of computer-based patient records.

Attitude of Health Personnel↗

PubMedDate not supplied

The granularity of medical narratives and its effect on the speed and completeness of information retrieval.

OBJECTIVE: Using electronic rather than paper-based record systems improves clinicians' information retrieval from patient narratives. However, few studies address how data should be organized for this purpose. Information retrieval from clinical narratives containing free text involves two steps: searching for a labeled segment and reading its content. The authors hypothesized that physicians can retrieve information better when clinical narratives are divided into many small, labeled segments ("high granularity"). DESIGN: The study tested the ability of 24 internists and 12 residents at a teaching hospital to retrieve information from an electronic medical record--in terms of speed and completeness--when using different granularities of clinical narratives. Participants solved, without time pressure, predefined problems concerning three voluminous, inpatient case records. To mitigate confounding factors, participants were randomly allocated to a sequence that was balanced by patient case and learning effect. RESULTS: Compared with retrieval from undivided notes, information retrieval from problem-partitioned notes was 22 percent faster (statistically significant), whereas retrieval from notes divided into organ systems was only 11 percent faster (not statistically significant). Subdividing segments beyond organ systems was 13 percent slower (statistically significant) than not subdividing. Granularity of medical narratives affected the speed but not the completeness of information retrieval. CONCLUSION: Dividing voluminous free-text clinical narratives into labeled segments makes patient-related information retrieval easier. However, too much subdivision slows retrieval. Study results suggest that a coarser granularity is required for optimal information retrieval than for structured data entry. Validation of these conclusions in real-life clinical practice is recommended.

Cross-Over Studies↗