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PubMed · 8283948

[Computer-assisted surgery documentation in clinical routine practice].

A Röhrborn·C Ohmann·S Epstein·H D Röher
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Abstract

In surgery, computer support is still of minor importance. It is the aim of this publication to outline the concept of a computer-assisted documentation system for surgical procedures, to describe the realization of the concept and to discuss the results of the evaluation. Planning of the system started in 1988 with an analysis of existing computer support at our clinic, definition of the parameters to be documented and determination of the classifications to be used, followed by a design for the system's use and a decision on hardware and software. The system is run on an IBM-compatible personal computer with three terminals, and the software used is MEDOS. The surgical procedures are documented with a four-level hierarchical classification related to the VESKA code and the internal university codes. After extensive training of the doctors, routine use commenced in 1991. Up to now 9837 operations have been documented by 35 surgeons. The system produces all necessary statistics and supports scientific studies and inquiries from individual doctors. A prospective evaluation of 300 consecutive operations demonstrated good compliance of the doctors and high data quality. To achieve optimal benefit from the use of computers it is recommended that departmental communication and documentation systems be gradually built up in surgical departments.

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Attitude of Health PersonnelAttitude to ComputersDatabase Management SystemsDocumentationEvaluation Studies as TopicHumansMedical Records Systems, ComputerizedMicrocomputersOperating Room Information SystemsQuality Assurance, Health CareSoftwareEnglish AbstractJournal Article

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BibTeXRIS

A Röhrborn, C Ohmann, S Epstein, H D Röher. 1993. [Computer-assisted surgery documentation in clinical routine practice].. https://doi.org/10.1007/bf01876440

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A survey of provider experiences and perceptions of preferential access to cardiovascular care in Ontario, Canada.

BACKGROUND: The public health insurance system in Canada is predicated on equal access to care for persons in need. OBJECTIVE: To determine the views and experiences of Ontario physicians and hospital administrators in providing patients with preferential access to specialized cardiovascular care on the basis of nonclinical factors. DESIGN: Survey with self-administered questionnaire. SETTING: Ontario, Canada. PARTICIPANTS: All Ontario cardiologists (n = 268), cardiac surgeons (n = 68), and hospital chief executives (n = 218) and random samples of internists (n = 300) and family physicians (n = 300). MEASUREMENTS: Elicited responses (yes or no) to questions on whether and why preferential access occurred and whether the respondents had been personally involved in such a situation. RESULTS: After undeliverable surveys and respondents no longer involved with acute care were excluded, the eligible response rate was 71.3% (788 of 1105 respondents). More than 80% of physicians and 53% of hospital chief executives had been personally involved in managing a patient who had received preferential access on the basis of factors other than medical need. Patients deemed most likely to receive such treatment were those with personal ties to the treating physicians (93% [95% CI, 91% to 95%]), high-profile public figures (85% [CI, 82% to 87%]), and politicians (83% [CI, 80% to 86%]). Physicians were significantly more likely than chief executives to indicate that hospital board members (81% and 68%; P < 0.001) and donors to hospital foundations (63% and 42%; P < 0.001) would receive preferential access. Most respondents indicated that preferential access was more likely to be provided if patients or families were well informed, aggressive, or potentially litigious. The survey did not permit estimation of the frequency of episodes of preferential access. CONCLUSIONS: Although equality of access is a cornerstone principle of Canada's universal health care system, some access to specialized cardiovascular services occurs preferentially on the basis of factors other than clinical need. The actual magnitude and consequences of this phenomenon remain unknown.

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