Biomedical subjects

Roberto A Rocha

Publications and source records attributed to Roberto A Rocha.

At least 19 recordsLinked to original sources

PubMed2006

Integration of interdisciplinary guidelines with clinical applications: Current and future scenarios.

Intermountain Healthcare (Intermountain) has developed a referential free-text interdisciplinary document collection to define standards for patient care. In order to improve access and use in bedside clinician workflow, Intermountain converted the document collection into a ubiquitous web-compatible format. The content has been structured using XML so it can be utilized by Intermountain's existing clinical applications, as well as positioning it for use in future deployed applications. It has become evident the strategy of structuring the content in this web-compatible format will support its use to drive current and future system functionality. As Intermountain moves forward in creating and deploying clinical applications, it is important to maintain and improve the current collection structure, sustaining the efficient integration and use of the content necessary to support clinician workflow and to meet information needs.

Documentation↗

PubMed2006

Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients.

At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.

Decision Support Systems, Clinical↗

PubMed2006

Linking interdisciplinary patient care standards to clinical information systems using structured actions.

Intermountain Healthcare (Intermountain) has developed and deployed a document collection of over 700 evidence-based inpatient interdisciplinary patient care standards as a means of improving patient care by reducing practice variability. We propose to identify and structure action concepts from these care standards, define their embedded work items and relative financial values, and use the coded concepts as the application development construct that enables patient workload requirement and cost prediction. Valid action concepts will conform to a compositional terminology model that details clinically meaningful information at various levels of granularity as well as the minimum required experience (e.g., licensure) and relative probable effort required for performing the action. The projected total actions that a patient requires will form the basis for workload and cost prediction.

Humans↗

PubMed2006

Development of coded action concepts to support workload and cost prediction applications.

We propose to use a compositional terminology model to encode care-directive concepts or "actions" from patient care standards. Action concepts are made up of one or more work items that can be part of a work list or care plan. The nature of an action is specified by the elements of the terminology model. Actions can have implied financial value. The projected total actions that a patient requires will form the basis for workload and cost prediction.

Costs and Cost Analysis↗

PubMed2005

KAT: a flexible XML-based knowledge authoring environment.

As part of an enterprise effort to develop new clinical information systems at Intermountain Health Care, the authors have built a knowledge authoring tool that facilitates the development and refinement of medical knowledge content. At present, users of the application can compose order sets and an assortment of other structured clinical knowledge documents based on XML schemas. The flexible nature of the application allows the immediate authoring of new types of documents once an appropriate XML schema and accompanying Web form have been developed and stored in a shared repository. The need for a knowledge acquisition tool stems largely from the desire for medical practitioners to be able to write their own content for use within clinical applications. We hypothesize that medical knowledge content for clinical use can be successfully created and maintained through XML-based document frameworks containing structured and coded knowledge.

Artificial Intelligence↗

PubMed2005

An XML model that enables the development of complex order sets by clinical experts.

Medication errors are significant and well-known problems in health care. Despite the evidence supporting the use of computerized physician order entering (CPOE) to help reduce medication errors, only a small number of hospitals in the U.S. have successfully implemented a CPOE system. Different authors have indicated that the utilization of order sets derived from best-practice standards can reduce medication errors and improve physicians' acceptance of CPOE systems. However, a variety of issues related to the development and continuous maintenance of best-practice order sets still need to be understood. This paper presents a model that supports an order set development process driven by clinical experts. Model requirements and details are presented and discussed.

Computer Simulation↗

PubMed2005

Customized document validation to support a flexible XML-based knowledge management framework.

This paper describes a validation architecture used within Intermountain Health Care's Clinical Knowledge Repository (CKR). The architecture provides additional functionality that complements XML Schema validation, producing user-friendly error messages and enabling validation rules reuse. The validation architecture helps document authors to fix their own errors. As a result, less than 1% of all documents in the CKR are considered invalid.

Information Management↗

PubMed2005

Development and validation of XML-based calculations within order sets.

We have developed two XML Schemas to support the implementation of calculations within XML-based order sets. The models support the representation of variable-based algorithms and include data elements designed to support ancillary functions such as input range checking, rounding, and minimum/maximum value constraints. Two clinicians successfully authored 57 unique calculated orders derived from a set of 11 calculations using the models within our authoring environment. The resultant knowledge base content was subsequently tested and found to produce the desired results within the electronic physician order entry environment.

Algorithms↗

PubMed2005

Understanding nurses' information needs and searching behaviour in acute care settings.

UNLABELLED: We report the results of a pilot study designed to describe nurses' information needs and searching behaviour in acute care settings. Several studies have indicated that nurses have unmet information needs while delivering care to patients. AIM: Identify the information needs of nurses in acute care settings. METHODS: Nurses at three hospitals were asked to use an information retrieval tool (CPG Viewer). A detailed log of their interactions with the tool was generated. RESULTS AND CONCLUSIONS: Our findings suggest that nurses' information needs are different from what is reported in the literature in terms of physicians' information needs. Questions regarding a nursing procedure or protocol were the most common needs nurses had.

Attitude of Health Personnel↗

PubMed2005

Enhancing access to patient education information: a pilot usability study.

Health care organizations are developing Web-based portals to provide patient access to personal health information and enhance patient-provider communication. This pilot study investigates two navigation models ("serial" and "menu-driven") for improving access to education materials available through a portal. There was a trend toward greater user satisfaction with the menu-driven model. Model preference was influenced by frequency of Web use. Results should aid in the improvement of existing portals and in the development of new ones.

Attitude to Computers↗

PubMed2005

Using XML technologies to organize electronic reference resources.

Provision of access to reference electronic resources to clinicians is becoming increasingly important. We have created a framework for librarians to manage access to these resources at an enterprise level, rather than at the individual hospital libraries. We describe initial project requirements, implementation details, and some preliminary results.

Information Storage and Retrieval↗

PubMed2005

Integration of HTML documents into an XML-based knowledge repository.

The Emergency Patient Instruction Generator (EPIG) is an electronic content compiler / viewer / editor developed by Intermountain Health Care. The content is vendor-licensed HTML patient discharge instructions. This work describes the process by which discharge instructions where converted from ASCII-encoded HTML to XML, then loaded to a database for use by EPIG.

Database Management Systems↗

PubMed2004

Development of a compositional terminology model for nursing orders.

AIM: Develop a compositional terminology model for nursing orders that would conform to the existing standard health level seven (HL7) messaging standard for clinical orders. Develop and evaluate the set of attributes needed for a pre-coordinated concept for a single nursing order, using a replicable three-step modeling process. RESULTS: A terminology model for nursing orders was developed using empirical data. The model was validated against nursing research and standards literature, and evaluated using 609 nursing orders that were successfully mapped to the structure. The representative services came from 20 Intermountain Health Care (IHC) hospitals, demonstrating the generalizability of the model and its attributes across many care settings.

Health Personnel↗

PubMed2004

Exploratory case method to determine the frequency of redundant orders within manually consolidated order lists.

A computerized provider order entry (CPOE) system can provide an efficient means of retrieving and consolidating order lists from multiple electronic clinical practice standards and protocols. However, the consolidated order list may contain exact duplicate or overlapping orders. Benner's framework for levels of nursing expertise can be used to explicate the variability of the nurse's responses to redundancies in order lists and the potential compromise to patient safety. An exploratory case method was performed to consolidate 74 orders from 11 sources. The consolidated order list contained 35% fewer orders after the redundant orders were removed. Our work has shown that many redundant orders may arise by consolidating order lists from multiple electronic standards. It is imperative that consolidated electronic order lists be manageable by the nurse according to their level of clinical and computer expertise, and that redundant orders are resolved before being displayed to the nurse.

Humans↗

PubMed2004

Detailed clinical models for sharable, executable guidelines.

The goal of shareable, executable clinical guidelines is both worthwhile and challenging. One of the largest hurdles is that of representing the necessary clinical information in a precise and shareable manner. Standard terminologies and common information models, such as the HL7 RIM, are necessary, they are not sufficient. In addition, common detailed clinical models are needed to give precise semantics and to make the task of mapping between models manageable. We discuss the experience of the SAGE project related to detailed clinical models.

Decision Support Systems, Clinical↗

PubMed2004

Integration challenges of clinical information systems developed without a shared data dictionary.

Legacy systems have proven to be long-term integration challenges for Intermountain Health Care (IHC) despite commitment and attention to share clinical information across settings and among clinicians. This study measures the extent of the disparity of data elements across three independent data systems in current use. A sample of relevant data elements was selected across systems covering prenatal, labor and delivery, and newborn intensive care units (NICU). The findings revealed only 17% of these sample data elements had compatible structure across all three systems. The implications from differences in granularity, missing data, and duplicate data entry, include diminished data quality, greater risk for medical error, increased costs of integration and inefficient use of clinician time. Retrospective guidelines for managing conceptual context and granularity are given to assist in designing an integrated longitudinal patient electronic medical record.

Delivery of Health Care, Integrated↗

PubMed2004

Integrating detailed clinical models into application development tools.

Several groups are currently working on defining detailed clinical models (also called templates or archetypes) that are refinements of abstract medical models like the HL7 (Health Level Seven) Reference Information Model. At IHC, we have created over 3,000 detailed clinical models in the last five years. These models have become an essential part of the architecture of our electronic medical record (EMR) system. As a result, we have created an increasingly sophisticated set of tools that allow the models to be searched, viewed, and ultimately incorporated into medical applications. These browsers have some commonality with terminology browsers, but are distinct in that the explicit structure of the information models must be accommodated. In this paper we report our experience in making browsers for detailed clinical models that are integrated with application authoring tools.

Information Management↗

PubMed2003

Practical evaluation of clinical guideline document models.

This project evaluates existing XML document models for the representation of clinical guidelines, as part of an effort to determine the best model to encode IHC's Care Process Models. The best model will be selected on the basis of its ability to support "Infobutton" queries at the point of care.

Evaluation Studies as Topic↗