PubMed Health⌕ Search

Biomedical subjects

Stanley M Huff

Publications and source records attributed to Stanley M Huff.

12 recordsLinked to original sources
PubMed2005

A case for manual entry of structured, coded laboratory data from multiple sources into an ambulatory electronic health record.

Laboratory results provide necessary information for the management of ambulatory patients. To realize the benefits of an electronic health record (EHR) and coded laboratory data (e.g., decision support and improved data access and display), results from laboratories that are external to the health care enterprise need to be integrated with internal results. We describe the development and clinical impact of integrating external results into the EHR at Intermountain Health Care (IHC). During 2004, over 14,000 external laboratory results for 128 liver transplant patients were added to the EHR. The results were used to generate computerized alerts that assisted clinicians with managing laboratory tests in the ambulatory setting. The external results were sent from 85 different facilities and can now be viewed in the EHR integrated with IHC results. We encountered regulatory, logistic, economic, and data quality issues that should be of interest to others developing similar applications.

Ambulatory Care Information Systems↗
PubMed2005

Development of an information model for storing organ donor data within an electronic medical record.

OBJECTIVE: To develop a model to store information in an electronic medical record (EMR) for the management of transplant patients. The model for storing donor information must be designed to allow clinicians to access donor information from the transplant recipient's record and to allow donor data to be stored without needlessly proliferating new Logical Observation Identifier Names and Codes (LOINC) codes for already-coded laboratory tests. DESIGN: Information required to manage transplant patients requires the use of a donor's medical information while caring for the transplant patient. Three strategies were considered: (1) link the transplant patient's EMR to the donor's EMR; (2) use pre-coordinated observation identifiers (i.e., LOINC codes with *(wedge)DONOR specified in the system axes) to identify donor data stored in the transplant patient's EMR; and (3) use an information model that allows donor information to be stored in the transplant patient's record by allowing the "source" of the data (donor) and the "name" of the result (e.g., blood type) to be post-coordinated in the transplant patient's EMR. RESULTS: We selected the third strategy and implemented a flexible post-coordinated information model. There was no need to create new LOINC codes for already-coded laboratory tests. The model required that the data structure in the EMR allow for the storage of the "subject" of the test. CONCLUSION: The selected strategy met our design requirements and provided an extendable information model to store donor data. This model can be used whenever it is necessary to refer to one patient's data from another patient's EMR.

Databases as Topic↗
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

Modeling guidelines for integration into clinical workflow.

The success of clinical decision-support systems requires that they are seamlessly integrated into clinical workflow. In the SAGE project, which aims to create the technological infra-structure for implementing computable clinical practice guide-lines in enterprise settings, we created a deployment-driven methodology for developing guideline knowledge bases. It involves (1) identification of usage scenarios of guideline-based care in clinical workflow, (2) distillation and disambiguation of guideline knowledge relevant to these usage scenarios, (3) formalization of data elements and vocabulary used in the guideline, and (4) encoding of usage scenarios and guideline knowledge using an executable guideline model. This methodology makes explicit the points in the care process where guideline-based decision aids are appropriate and the roles of clinicians for whom the guideline-based assistance is intended. We have evaluated the methodology by simulating the deployment of an immunization guideline in a real clinical information system and by reconstructing the workflow context of a deployed decision-support system for guideline-based care. We discuss the implication of deployment-driven guideline encoding for sharability of executable guidelines.

Decision Making, Computer-Assisted↗
PubMed2004

Medical data abstractionism: fitting an EMR to radically evolving medical information systems.

Growing and maintaining a simple and flexible EMR (Electronic Medical Record) becomes a complicated task in light of diverse and distributed legacy data representation, advancing technologies, changes in medical practice and procedure, and changes in data regulation. Utilizing several abstraction mechanisms can simplify application development and maintenance, and provide flexibility for data evolution and migration. Newer applications built on these abstractions can be the beneficiary of slower obsolescence and lower maintenance costs.

Abstracting and Indexing↗
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

Standards for detailed clinical models as the basis for medical data exchange and decision support.

INTRODUCTION: Detailed clinical models are necessary to exchange medical data between heterogeneous computer systems and to maintain consistency in a longitudinal electronic medical record system. At Intermountain Health Care (IHC), we have a history of designing detailed clinical models. The purpose of this paper is to share our experience and the lessons we have learned over the last 5 years. DESIGN: IHC's newest model is implemented using eXtensible Markup Language (XML) Schema as the formalism, and conforms to the Health Level Seven (HL7) version 3 data types. The centerpiece of the new strategy is the Clinical Event Model, which is a flexible name-value pair data structure that is tightly linked to a coded terminology. DISCUSSION: We describe IHC's third-generation strategy for representing and implementing detailed clinical models, and discuss the reasons for this design.

Decision Support Systems, Clinical↗
PubMed2003

LOINC, a universal standard for identifying laboratory observations: a 5-year update.

The Logical Observation Identifier Names and Codes (LOINC) database provides a universal code system for reporting laboratory and other clinical observations. Its purpose is to identify observations in electronic messages such as Health Level Seven (HL7) observation messages, so that when hospitals, health maintenance organizations, pharmaceutical manufacturers, researchers, and public health departments receive such messages from multiple sources, they can automatically file the results in the right slots of their medical records, research, and/or public health systems. For each observation, the database includes a code (of which 25 000 are laboratory test observations), a long formal name, a "short" 30-character name, and synonyms. The database comes with a mapping program called Regenstrief LOINC Mapping Assistant (RELMA(TM)) to assist the mapping of local test codes to LOINC codes and to facilitate browsing of the LOINC results. Both LOINC and RELMA are available at no cost from http://www.regenstrief.org/loinc/. The LOINC medical database carries records for >30 000 different observations. LOINC codes are being used by large reference laboratories and federal agencies, e.g., the CDC and the Department of Veterans Affairs, and are part of the Health Insurance Portability and Accountability Act (HIPAA) attachment proposal. Internationally, they have been adopted in Switzerland, Hong Kong, Australia, and Canada, and by the German national standards organization, the Deutsches Instituts für Normung. Laboratories should include LOINC codes in their outbound HL7 messages so that clinical and research clients can easily integrate these results into their clinical and research repositories. Laboratories should also encourage instrument vendors to deliver LOINC codes in their instrument outputs and demand LOINC codes in HL7 messages they get from reference laboratories to avoid the need to lump so many referral tests under the "send out lab" code.

Clinical Laboratory Information Systems↗
PubMed2003

Development of an information model for solid organ transplantation.

Information required to manage transplant patients and donors is complex, voluminous and requires the reporting and use of one person's medical information within another person's record. One strategy using a vocabulary model (i.e., LOINC codes with *DONOR specified in the system axes) will lead to problems with combinatorial explosion. After evaluating workflow processes, data collection forms, decision support and functional requirements, we designed and implemented an extendable information model to support the process of care following liver transplantation.

Decision Making, Computer-Assisted↗
PubMed2003

The design and implementation of a picklist authoring tool.

It is well recognized that controlled medical terminologies play a critical role in Health Information Systems and Clinical Patient Record systems, but the creation and management of customized lists of terms ("picklists") remains a potential obstacle. We have been developing a sophisticated authoring tool that is fully integrated with our terminology server and that will be made available to our system analysts and clinicians.

Dictionaries as Topic↗
PubMedDate not supplied

Representing nursing assessments in clinical information systems using the logical observation identifiers, names, and codes database.

In recent years, the Logical Observation Identifiers, Names, and Codes (LOINC) Database has been expanded to include assessment items of relevance to nursing and in 2002 met the criteria for "recognition" by the American Nurses Association. Assessment measures in LOINC include those related to vital signs, obstetric measurements, clinical assessment scales, assessments from standardized nursing terminologies, and research instruments. In order for LOINC to be of greater use in implementing information systems that support nursing practice, additional content is needed. Moreover, those implementing systems for nursing practice must be aware of the manner in which LOINC codes for assessments can be appropriately linked with other aspects of the nursing process such as diagnoses and interventions. Such linkages are necessary to document nursing contributions to healthcare outcomes within the context of a multidisciplinary care environment and to facilitate building of nursing knowledge from clinical practice. The purposes of this paper are to provide an overview of the LOINC database, to describe examples of assessments of relevance to nursing contained in LOINC, and to illustrate linkages of LOINC assessments with other nursing concepts.

Computational Biology↗