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Biomedical subjects

M A Krall

Publications and source records attributed to M A Krall.

9 recordsLinked to original sources
PubMed1997

Improving clinician acceptance and use of computerized documentation of coded diagnosis.

After the Northwest Division of Kaiser Permanente implemented EpicCare, a comprehensive electronic medical record, clinicians were required to directly document orders and diagnoses on this computerized system, a task they found difficult and time consuming. We analyzed the sources of this problem to improve the process and increase its acceptance by clinicians. One problem was the use of the International Classification of Diseases (ICD-9) as our coding scheme, even though ICD-9 is not a complete nomenclature of diseases and using it as such creates difficulties. In addition, the synonym list we used had some inaccurate associations, contributing to clinician frustration. Furthermore, the initial software program contained no adequate mechanism for adding qualifying comments or preferred terminology. We sought to address all these issues. Strategies included adjusting the available coding choices and descriptions and modifying the medical record software. In addition, the software vendor developed a utility that allows clinicians to replace the ICD-9 description with their own preferred terminology while preserving the ICD-9 code. We present an evaluation of this utility.

Abstracting and Indexing↗
PubMed1995

Acceptance and performance by clinicians using an ambulatory electronic medical record in an HMO.

The Northwest Region of Kaiser Permanente implemented a comprehensive clinical information system in two sites between February and December 1994. By year end 46 primary care clinicians and 95 supporting personnel used the system on a daily basis to provide patient care. Clinicians use the product to select coded diagnoses, and directly order laboratory, imaging, and other tests, internal referrals, and prescriptions. They enter progress notes into the system, and use it to generate patient focused visit summaries. Clinicians took approximately 2 minutes longer, on average, to complete patient visits post-implementation. Most of this time was spent performing "orders and diagnosis" work, which included new required elements in the post-implementation period. Clinicians worked approximately 30 days before reaching their baseline visit rate and "lost" approximately 48 hours of productivity during the learning, including classroom training. User acceptance improved from 2 to 4 months of use.

Ambulatory Care Information Systems↗
PubMed1980

Respiratory and hemodynamic effects of methadone in pregnant women.

Minute ventilation, end-tidal PCO2, O2 and CO2 concentrations in expired air, pulse rate and arterial blood pressure were measured in the last half of pregnancy in eight women taking methadone daily. Measurements were made with the subjects seated at rest, during the steady state of 50-watt bicycle exercise, and during recovery. Calculations of O2 consumption. CO2 production, alveolar ventilation and oxygen debt were made. Studies were repeated in five subjects postpartum. Methadone diminishes the normal hyperventilation of pregnancy and its effect persists for more than 24 h. When comparisons are made of pregnant and postpartum values, some respiratory stimulation during pregnancy is apparent. Maternal oxygen debt following standard exercise during pregnancy is diminished after the daily dose of methadone and the maternal heart rate response to exercise is diminished concurrently. The maternal hypoventilation induced by methadone and maintained during exercise may be relevant to the low birth weights and high incidence of sudden infant death syndrome observed by others in the offspring of methadone-dependent women.

Blood Pressure↗
PubMed1978

Physiological effects of lowered blood oxygen affinity in dogs.

Ten adult Labrador retrievers were studied under control conditions and while blood oxygen affinity was lowered by intravenous infusions of glycolytic intermediates. Blood P50 was increased from 32.4 +/- 1.3 mm Hg (mean +/- SD) to 34.3 +/- 1.2 mm Hg, a highly significant increase (P less than 0.001). Blood oxygen capacity, mixed venous oxygen tension and arterial PCO2 were not significantly different in the two conditions. Cardiac output (Q) was lower with the higher P50 (89 +/- 16 ml/kg/min) than in the control state (111 +/- 31 ml/kg/min) but the difference was not statistically significant. The arteriovenous oxygen concentration difference (CaO2 - C-V(O2)) was significantly increased (P less than 0.05) from 4.4 +/- 0.6 vol % to 4.9 +/- 0.8 vol %. Oxygen consumption, the product of Q and (CaO2 - C-V(O2)), was the same in the two conditions: 4.9 +/- 1.3 ml/kg/min (control) versus 4.4 +/- 0.9 ml/kg/min. The animals responded to lowered blood oxygen affinity with increased oxygen extraction by peripheral tissues and a concomitant, although not statistically significant, fall in cardiac output.

Animals↗
PubMedDate not supplied

Successful implementation of a comprehensive computer-based patient record system in Kaiser Permanente Northwest: strategy and experience.

Kaiser Permanente Northwest (KPNW) has implemented a computer-based patient record (CPR) system for outpatients. Clinicians at KPNW use this comprehensive CPR to electronically document patient encounters; code diagnoses and procedures; maintain problem lists; order laboratory tests, radiology tests, and prescriptions; and send patient-specific messages and referrals to other medical providers. More than 700 clinicians, representing more than 20 medical and surgical specialties, and 2600 support staff in 31 geographically separate sites use this system as the information foundation of delivery and documentation of health care for KPNW's membership of 430,000. As of May 1998, more than four million visits and two million telephone calls had been processed and documented into the system. More than 5000 outpatient visits are processed and documented each weekday. From an integrated clinical workstation, clinicians also access e-mail, an extensive results-reporting system, and sites on both the internet and KPNW's intranet. This article describes a strategy for and experience with the implementation of a large-scale, comprehensive CPR in an integrated HMO. This information may be useful for persons attempting to implement CPRs in their own institutions.

Ambulatory Care Information Systems↗