PubMed Health⌕ Search

Biomedical subjects

R R Grams

Publications and source records attributed to R R Grams.

At least 19 recordsLinked to original sources
PubMed1999

Medical record innovations that can improve physician productivity.

Medical records are the fulcrum of patient care activities. They represent the primary reference point with respect to the patient's medical status and long-term planning. A significant portion of the patient care dollar is invested in the medical record document and its handling. The most critical part of this process takes place in the physician's examination room during the patient encounter. The use of SmartCharts is a way to expedite the chart generation process and improve the quality and consistency of the source information from which all future care and plans are generated. The process removes a substantial portion of the human memory cycle that is needed for chart development and improves the encounter process by exploring the full range of diagnostic signs and symptoms that are associated with a preselected diagnosis or patient problem. The system is designed for stand-alone operation or insertion into an already-functioning electronic medical record system.

Decision Support Systems, Clinical↗
PubMed1998

Shopping in the healthcare information systems market--a search for well-camouflaged land mines.

The selection of a healthcare information system is analogous to a big game hunt. The buyers perceive themselves as the hunters while the truth is just the opposite. To strip away the carefully crafted facade of corporate marketing is an art form and requires due diligence on the part of the shopper. Suggestions are offered to the consumer on how to pierce the shell of corporate silence and find the facts that will make a significant difference in product selection. The objectives on the seller's side are to make as much profit as possible and give as little as required to make the sale. The buyer is looking for the best product, the best company, and the most painless installation. The ground between these two vastly different goals is the battlefield of healthcare computer procurement. May the best shopper win! Caveat emptor.

Computer Systems↗
PubMed1997

The search for the elusive electronic medical record system--medical liability, the missing factor.

Over the past few years, the traditional paper-based medical record system has come under close scrutiny by every participant in the healthcare industry. Some groups, especially federal agencies such as Medicare and Medicaid, HMOs, and other third party payors, have begun to demand changes in medical record documentation, and have become very assertive as to what goals and objectives will be met. In contrast, the medical liability insurance industry has remained almost invisible during this period of transition. At a recent electronic medical records (EMR) conference participants attending a software development workshop were asked if they had their systems reviewed from a medicolegal standpoint by a malpractice insurance carrier. In response to this inquiry, not one software vendor raised their hand to indicate this had been accomplished, or was even contemplated. In the author's opinion, the key missing factor in the current quest for a paperless medical office system rests in the domain of those who represent the medical liability industry. All of these gate-keepers of medical loss and risk prevention will eventually be called upon, either by choice or necessity, to validate every working EMR system that is used in medical practices in the future. This article will explore the best information published from this currently silent sector of the industry, and proposes an active involvement by the medical liability industry in the current EMR design and development processes taking place. In addition, there are 10 minimum EMR design criteria contained in this article that are recommended for implementation based upon 16 years of medical malpractice experience and loss prevention input.

Humans↗
PubMed1996

A primary care application of an integrated computer-based pharmacy system.

Primary care demands a continuous flow of current pharmaceutical information to the front lines of patient services. With a wide spectrum of drugs to prescribe and a continuous production of new drug-related information, the practicing physician is faced with a social and professional mandate to deliver the most acceptable drug in a safe and efficacious manner. The legal implications of this product and knowledge explosion have exposed the human brain's inability to store, update, and recall what is currently available. Physicians can no longer trust their memory or their paper-based medical record to protect them from potential liability. The tools to correct this mental imbalance are now available and it should be standard practice to implement a sophisticated computer-based pharmacy system (CBPS) for every outpatient in the United States.

Clinical Pharmacy Information Systems↗
PubMed1996

MDX--a medical diagnostic decision support system.

The MDX diagnostic decision support system contains a multitude of clinical facts as reported in a variety of medical textbooks and national medical journals. The database was custom designed for the medical diagnostic process and offers users the widest range of diagnostic knowledge available from a single source in the industry. The database consists of diseases, conditions, chemicals, drugs, and toxins that are known to cause medical illness. Each causal element has an associated file for signs, symptoms and findings. This fully referenced source of encoded clinical knowledge used in MDX comes from the world's experts as they transmit their experience in the written word of books and journals.

Databases, Factual↗
PubMed1994

A proposed computer diagnostic system for malignant melanoma (CDSMM).

This paper describes a computer diagnostic system for malignant melanoma. The diagnostic system is a rule base system based on image analyses and works under the PC windows environment. It consists of seven modules: I/O module, Patient/Clinic database, image processing module, classification module, rule base module and system control module. In the system, the image analyses are automatically carried out, and database management is efficient and fast. Both final clinic results and immediate results from various modules such as measured features, feature pictures and history records of the disease lesion can be presented on screen or printed out from each corresponding module or from the I/O module. The system can also work as a doctor's office-based tool to aid dermatologists with details not perceivable by the human eye. Since the system operates on a general purpose PC, it can be made portable if the I/O module is disconnected.

Algorithms↗
PubMed1993

Clinical laboratory test reference (CLTR).

As the healthcare system undergoes a transformation in scope and funding, there remain many unfinished projects which will be essential for the next generation of automated medical support services. The most demanding and labor intensive tasks for this new frontier deal with the accumulation of knowledge which can be used as a clinical database to support supervisory functions in a physician operated interactive care delivery environment. These databases will contain the worlds accumulated knowledge in specialized areas. They will be organized by topic or clinical service, and have significant impact on the quality of care as well as medical malpractice exposure. This article will describe a clinical pathology database that has been adapted for medical practice. The database contains information about laboratory tests and their interpretation. The data is structured for rapid reading and has references where indicated. The database can be used in a stand alone program or integrated into an information system within an application program. The files are reviewed on a continuing basis and quarterly updates are made available to subscribers.

Clinical Laboratory Information Systems↗
PubMed1992

Field-testing the new DECtalk PC system for medical applications.

Synthesized human speech has now reached a new level of performance. With the introduction of DEC's new DECtalk PC, the small system developer will have a very powerful tool for creative design. It has been our privilege to be involved in the beta-testing of this new device and to add a medical dictionary which covers a wide range of medical terminology. With the inherent board level understanding of speech synthesis and the medical dictionary, it is now possible to provide full digital speech output for all medical files and terms. The application of these tools will cover a wide range of options for the future and allow a new dimension in dealing with the complex user interface experienced in medical practice.

Artificial Intelligence↗
PubMed1992

A physician's workstation designed for NASA and earth-based applications.

One of the prime missions for NASA is the safety and care of astronauts. In addressing this challenge, a tool has been developed which has great potential for earth-based applications. The multimedia physician's workstation is the result of 13 years of planning and technical revolution in the field of computer science. Today, we have the hardware and the software to make a major change in the office-based practice of physicians. By offering the online features of a medical library as well as a complete multimedia medical record system, we are now in a position to introduce advance decision support technology that can be used on a daily basis for routine outpatient care. The system supports a new platform for patient education and offers the doctor an opportunity to share his expertise with his patient and their family. Although NASA will need several more years before this technology can be applied to a remote space environment, we plan to introduce this system into the doctor's office as an initial test of its feasibility. The basic design and general specifications of this multimedia workstation/office system are described and illustrated as they currently exist.

Aerospace Medicine↗
PubMed1990

The Health Maintenance Facility.

The Health Maintenance Facility (HMF) is the code name for a space-based medical clinic. The HMF is an integral part of the U.S. sponsored space station program due to be launched in the late 1990s. Contained in this module will be equipment, facilities, and supplies that can be used to support space station crew health. The range of medical care will depend upon the skill of the crew, the tools available, and the support systems that can be used from earth. The design of this system and its heavy dependence upon computer resources provide an excellent model for looking forward into the earth based medical clinics of the future.

Aerospace Medicine↗
PubMed1989

The natural language processing of medical databases.

The consideration of natural language as a domain for computer processing has been one of the long-term projects in the history of data processing. Computers were developed in the late 40's and early 50's in the United States and from the very beginning there was a desire and intent that someday the computer would handle speech and be able to understand normal English literature and text with the coherency of a student or perhaps even an expert. Such breakthroughs have also been anticipated in the medical area. This paper will present a series of design specifications that facilitate the processing of natural language medical databases. Using these techniques it will be possible to expand the use of our traditional tools and exploit the effort that has been invested in these literary creations.

Information Systems↗
PubMed1989

Diagnostic and treatment support for the NASA space program astronauts.

For over 9 years our research unit has been investigating medical databases that would be required to support astronauts on long-term missions. The configuration that has been developed will allow complete separation from earth-based experts and the capability of an on-board stand-alone system for knowledge engineering and medical decision support. Our data processing base of operation has advanced from the early stages on mainframe computers to the now ubiquitous microcomputer. Over this nine-year period we have seen several generations of improvements in every level of technology to the point where we can now package and deliver for space travel a rather broad-based decision support tool for astronauts that can provide the basic needs of medical treatment and diagnostic support which is vital for the proper execution of manned space missions.

Aerospace Medicine↗
PubMed1987

A PC-based free text retrieval system for health care providers. Design and development.

The purpose of this paper is to describe the design and development of the Clinical Practice Library of Medicine (CPLM). CPLM is an investigational project aimed at providing health care practitioners with critical in-depth information similar to that obtained from a medical reference library or consultant. When used in conjunction with the physician's knowledge, CPLM can provide valuable diagnostic prompting information to assist in rapidly reaching a suitable diagnosis for timely administration of appropriate treatment. This system may also be used to assist paramedical professionals working in remote areas where other expert medical assistance may not be available.

Computer Systems↗
PubMed1987

A PC-based free text DSS for health care. Case studies and applications.

A free text decision support system (DSS) has been constructed for health care professionals that allows the analysis of complex medical cases and the creation of a diagnostic list of potential diseases for clinical evaluation. The system uses a PC-based text management system specifically designed for desktop operation. The texts employed in the decision support package include The Merck Manual (published by Merck Sharpe & Dohme) and Control of Communicable Diseases in Man (published by the American Public Health Association). The background and design of the database are discussed, along with a structured analysis procedure for handling free text DSS systems. A case study is presented to show the application of this technology and conclusions are drawn in the summary that point to expanded areas of professional interaction and new frontiers yet to be explored in this rapidly progressing field.

Decision Making, Computer-Assisted↗
PubMed1986

National Survey of Hospital Data Processing--1985.

The National Survey of Hospital Data Processing contains a great wealth of information that the hospitals have contributed in respect to the trends and changes that are now occurring within our hospital data-processing environment. 2-5 We wish to thank all of those hospitals that have participated in this study and have been willing to provide the kind of information that is so essential in tabulating these results. It is our hope that this report will provide some measure of return on your investment and that it will supply some answers to you as you face the difficult questions of planning and projecting for the future. A great deal more information is contained within the study, but it cannot be presented because of the sheer volume of information that remains. For this reason, the survey has been structured as an on-line database rather than a report. We ask that those who have interests in seeking more in-depth information from these files contact our publishing office so that we can advise you of ways that this information can be conveniently made available to you for your special project. There will be a follow-up report for 1986 when that database is complete. For those who wish to do longitudinal studies, a parallel volume was published in August 1985 that should provide a 4-year perspective on the field of hospital data processing.

Clinical Laboratory Information Systems↗
PubMed1985

Diagnostic library support system for medical practice.

Here is a tragic case where the diagnosis was missed on three separate occasions over a 19-month period. Both terminal conditions are treatable and potentially separable if discovered and aggressively managed. It is not the intent of this presentation to criticize the evaluation of this patient, but rather to point out the need and, also, the potential benefits of an alternate approach, which could have significantly changed the course of this particular patient's evaluation. We have conducted similar analyses with other CPC cases with almost equivalent specificity. These same evaluations have been performed in a real clinical setting with live patient data. What we have learned so far we think will be extremely helpful in extending the potential application of this technology: A text-based decision support tool is only as good as its practitioner. It takes practice and training to learn to use this system effectively. There are many traps in logic, and the use of words and terms within the text must be understood to effectively utilize this tool. There are shortcuts in logical analysis which we mentally use all the time but which cannot be accepted using this system (e.g., you must not rely on your memory or any specific associations to circumvent the system). The system will only become clinically relevant when the entire field of medicine is included in the data base. This is one of our current limitations with only two-thirds of the Merck medical text available for reference. This makes it difficult to apply to a general medical problem since we are not sure which direction the case might take, and often these are multisystem diseases or problems that put us at a severe disadvantage if we don't have the necessary data base. The structure and integrity of the data base are critical to the success of the system. Since numbers are ubiquitous, these cannot be used for key word elements. Techniques must be introduced to create word-oriented numbers that can be uniquely identified (e.g., "AGE14-20"). The publisher of the data must supply a continuous flow of up-to-date material that can be incorporated within the framework of the working system. It is possible to train medical technicians to use the system if they are familiar with medical terminology. The speed and, perhaps, the precision of their analysis could not be expected to rival that of a medical specialist.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗