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At least 181 records · Page 10Linked to original sources
PubMed1998

The use of intensive care information systems alters outcome prediction.

OBJECTIVE: To study the effect of using an Intensive Care Information System (ICIS) on severity scores and prognostic indices: Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Mortality Probability Models II (MPM II). DESIGN: Prospective pilot study. SETTING: A 20-bed medical-surgical intensive care unit (ICU) in a teaching hospital. PATIENTS: 50 consecutive adult patients admitted to the ICU on a bed equipped with an ICIS. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: In each patient all the physiologic variables, as required by the severity scores, were both manually charted and recorded by ICIS. ICIS registration resulted in the extraction of more abnormal values for all physiologic variables (except temperature): p < 0.05. Higher severity scores and mortality prediction were achieved by using ICIS charting: predicted mortality increased by 15% for APACHE II compared to manual charting, 25% for SAPS II, and 24% for MPM0. ICIS charting resulted in higher severity scores and mortality prediction for 29 of the 50 patients using APACHE II with a mean increase in mortality prediction in this subgroup of 27%. In the case of SAPS II, ICIS charting resulted in higher scores in 23 of the 50 patients and in the case of MPM0 in 13 patients, the mean increase in mortality in these subgroups being 64 and 148%, respectively. CONCLUSIONS: The use of ICIS charting to acquire the most abnormal physiologic values for severity scores and the derived prognostic indices results in a higher mortality prediction. Comparison of groups of patients and/or ICUs based on severity scores is impossible without standardization of data collection. The mortality prediction models have to be revalidated for the use of ICIS charting. While awaiting this, we suggest that every patient record in local regional, national, or international ICU databases should be marked as being recorded by manual or by ICIS charting.

Humans↗
PubMed2005

Systems failure in hospitals--using Reason's model to predict problems in a prescribing information system.

Both hospitals and hospital patients are bearing a massive cost as a result of the occurrence of medication prescribing errors in the public health system (Bates, D., et al. J. Am. Med. Inform. Assoc. 8(4):299-308, 2001; Lombardi, T. Medscape Pharm. Online J. 02(1), 2001; Roberts, M., and Stokes, J. eMed. J. Aust. 168:317-318, 1998). Consequently, it is important to examine and address the possible causes of this problem. In this paper we suggest that poor information systems may be a contributing factor in the occurrence of these errors. We research this issue in an HIV ward of a large public hospital through interviews and a survey instrument. We find that in a significant number of instances prescribing errors are linked to situations where information is unavailable or inaccessible. This link, between problems in information delivery and prescribing errors, is a link whose extent has not been measured previously. It is, however, a link which exposes all stakeholders in the hospital system, the patient, the clinicians, the hospital, and governments funding prescription medications, to possible loss and damage and indicates a need for the implementation of more effective systems in this area. We use Reason's model for predicting systems error (Vincent, C. BMJ 316:1154-1157, 1998) as a tool to suggest that prescribing errors have an increased likelihood of occurring if one or more of the types of failure identified in the model are present in the existing prescribing information delivery process in the hospital. While Reason's model has been applied in a medical context, it has not been previously applied to errors which result from information systems failure. We feel that applying it in this way may shed some light on the causes of prescribing error.

HIV Infections↗
PubMed1995

Informatics in family practice--an Asia-Pacific perspective.

Recent advances in computer hardware, software and telecommunications, and particularly in the development of the electronic medical record, mean that family practitioners around the world now have access to a multiplicity of tools which offer the potential for significant time savings and improved quality of health care provision. Areas such as practice management medication management and prescription generation, clinical record keeping, decision support, medical research and continuing medical education can all be aided through the use of information technology in a family practice setting. Yet family medicine, or general practice, has largely been slow to take up the challenge of implementing information technology in most parts of the Asia-Pacific region. This contrasts sharply with many other areas of medicine which have been very active in embracing this technology. This paper examines the potential advantages and the difficulties of computerisation for general practitioners and their patients in the Asia-Pacific region. It is hoped that the lessons already learned in some countries in this region can be adapted and applied elsewhere.

Asia↗
PubMed2005

ADA initiates development of orthodontic informatics standards.

Standards are the key to interoperability across systems. The American Dental Association (ADA) has been accredited by the American National Standards Institute (ANSI) as a standards-developing organization. The ADA sponsors standards programs for all areas of dentistry, including dental materials and products and dental informatics. ANSI/ADA Specification No. 1000, Standard Clinical Data Architecture for the Structure and Content of an Electronic Health Record, is the first ANSI standard that defines the fundamental data structures used to make patient health records. The standard promotes the sharing of like data between dentists, physicians, and hospitals.

American Dental Association↗
PubMed2005

Design and implementation of a smart card based healthcare information system.

Smart cards are used in information technologies as portable integrated devices with data storage and data processing capabilities. As in other fields, smart card use in health systems became popular due to their increased capacity and performance. Their efficient use with easy and fast data access facilities leads to implementation particularly widespread in security systems. In this paper, a smart card based healthcare information system is developed. The system uses smart card for personal identification and transfer of health data and provides data communication via a distributed protocol which is particularly developed for this study. Two smart card software modules are implemented that run on patient and healthcare professional smart cards, respectively. In addition to personal information, general health information about the patient is also loaded to patient smart card. Health care providers use their own smart cards to be authenticated on the system and to access data on patient cards. Encryption keys and digital signature keys stored on smart cards of the system are used for secure and authenticated data communication between clients and database servers over distributed object protocol. System is developed on Java platform by using object oriented architecture and design patterns.

Computer Communication Networks↗
PubMed2006

Pivoting approaches for bulk extraction of Entity-Attribute-Value data.

Entity-Attribute-Value (EAV) data, as present in repositories of clinical patient data, must be transformed (pivoted) into one-column-per-parameter format before it can be used by a variety of analytical programs. Pivoting approaches have not been described in depth in the literature, and existing descriptions are dated. We describe and benchmark three alternative algorithms to perform pivoting of clinical data in the context of a clinical study data management system. We conclude that when the number of attributes to be returned is not too large, it is feasible to use static SQL as the basis for views on the data. An alternative but more complex approach that utilizes hash tables and the presence of abundant random-access-memory can achieve improved performance by reducing the load on the database server.

Algorithms↗
PubMed2005

HL7 ontology and mobile agents for interoperability in heterogeneous medical information systems.

Modern medical information management is a knowledge intensive activity requiring a high degree of interoperability across various health management entities. Ontology-based multi-agent systems provide a framework for interactions in a distributed medical systems environment without the limitations of a more traditional client server approach. In this paper, we describe electronic Medical Agent System (eMAGS) a multi-agent system with an ontology based on an accepted public health message standard, Health Level Seven (HL7), to facilitate the flow of patient information across a whole healthcare organisation.

Computer Communication Networks↗
PubMed2007

Algorithms and heuristics for efficient medical information display in PDA.

Accessing medical information in mobile devices such as PDAs and mobile phones is becoming widespread. Since these devices do not have the same rendering capabilities as of desktop computers, it is necessary for medical information to be fragmented for proper presentation on these types of devices. In this paper, we propose an architecture for displaying medical information in PDA. In the proposed system, a server extracts the information, categorizes the information in order of its relevance for diagnosis, and dynamically generates a hierarchical view of the relevant information based on certain medical domain knowledge. Displaying image and graphics data in PDA poses several challenges. The proposed system supports an image visualization tool, which interactively displays an image or a portion of an image in user's PDA. This visualization tools increases the resource utilization of PDA by offloading a part of the computation to the server. A suitable caching scheme is incorporated for optimum utilization of communication channel bandwidth.

Algorithms↗
PubMed2005

Clinical information technology in hospitals: a comparison between the state of Iowa and two provinces in Canada.

Despite the growing interest in adopting information technology (IT) in healthcare, the degree of technology sophistication varies among healthcare organizations. Changes in the health care sector and continuous pressure to improve the quality of care have driven the evolution of IT in hospitals. This paper provides an overview of clinical IT sophistication in a sample of U.S. hospitals, and compares clinical IT capacities in this sample with a sample of Canadian hospitals. The instrument used for the comparison measures three clinical dimensions of IT sophistication: functional sophistication, technological sophistication and integration level. Clinical areas that were considered include patient management, patient care activities and clinical support activities. The comparison between hospitals in Iowa and Canada shows differences in clinical IT sophistication between the two settings. Hospitals in Iowa appear to have more technologies but fewer computerized processes and integration of patient management activities. Technological sophistication however, was low in both samples. Our findings confirm the construct validity of the measurement instrument and show initial evidence of its generalizability. More initiatives using the instrument would lead to enhancement in IT assessment tools that can be used for evaluation of IT in relation to patient management and quality outcomes.

Biomedical Technology↗
PubMed2005

From a paper-based transmission of discharge summaries to electronic communication in health care regions.

OBJECTIVES: In Austria, the general practitioner (GP) is the first point of contact for persons with health problems. Depending on the severity of the person's medical condition, a GP may refer her or him to a secondary care hospital consultant, who reports findings back to the GP in form of a paper-based discharge letter. Researchers report that paper-based communication of medical documents between different health care providers is insufficient in quality, error prone and too slow in many cases. Our aim was to develop and to realise a strategy for a stepwise replacement of the paper-based transmission of medical documents with a distributed, shared medical record. METHODS: In the first step of a three-steps strategy for development of a consistent, comprehensive and secure regional health care network, an electronic communication of discharge letters and diagnostic results between existing information systems of different health care providers in Tyrol, Austria, has been established: in the form of cryptographically signed S/MIME e-mail messages and, additionally, via a secure web portal system. In two further steps, an extension of the system by a bi-directional communication and by improvements of the web portal system is planned, leading to a comprehensive electronic patient record for shared care. RESULTS: After realisation of step 1, in October 2004, about 3500 electronic discharge letters were sent out from the Innsbruck University Hospital (IUH), which represents about 8% of the total number of discharge letters of the IUH. In addition, a lot of feedback was received and legal, organisational, financial and methodical difficulties were overcome. DISCUSSION: The stepwise approach to replace paper-based with electronic communication in the first step was helpful, since knowledge has been gained and cooperations were formed. For the realisation of a distributed, shared medical record (steps 2 and 3), it will not be sufficient only to replace paper-based transmission of medical documents with electronic communication technologies, but in the further steps, organisational changes will become necessary. As well, legal ambiguities must be resolved before a distributed medical record for cooperative care, used by several institutions as well as by patients, could be established.

Austria↗
PubMed2005

Integrating feedback from a clinical data warehouse into practice organisation.

A patient oriented hospital information system (ARIANE) was inaugurated at the Sherbrooke University hospital (CHUS) in 1990 and a clinical data warehouse (CDW) completed 2004. The CDW is updated from ARIANE every 24h and includes ICD discharge diagnosis data, visit DRG and SNOMED encoding. The data is encrypted on storage. Data is accessed according to institutional approval. To facilitate data access two levels of tool have been made accessible using a web-browser. The first level consists of a 'dashboard' that has a defined design and enables a set of pre-determined dynamic queries about a patient population. This level can be operated with minimal training. The second level uses a convivial database query tool, which requires some prior training. Two prototype dashboards have been designed and evaluated for acceptability. The first for the emergency department enables analysis of patient occupancy. The second for the biochemistry department enables quality assurance evaluation. In most cases worldwide the clinical data warehouse is only beginning to be exploited, often impeded by lack of connection between different enterprise databases. Our CDW is expected rapidly to create a culture change so that clinical practice can be continuously evaluated using compiled data readily available from the electronic health record/hospital information system.

Consumer Behavior↗
PubMed2005

Improving access of associated states to advanced concepts in medical telematics--a day before the accession to EU.

Central and Eastern Europe countries (CEEC) undertook considerable efforts to include themselves in the main research and development activities in the area of health telematics in Europe. Countries of this region demonstrate diversified environments of economy transformation and health care systems status. The transition phase to market economy brings essential risks to the healthcare system performance. It seems that efforts of developing e-health environment in CEEC could be substantially accelerated by extended co-operation with partners from current member states of the European Union. The PRO-ACCESS project was initiated in the late phase of fifth Framework Programme as supporting action. It focused on the transfer of current concepts in medical telematics to countries remaining in the pre-accession phase. The process of dissemination of up-to-date approaches to e-health environment development is carried out by the Krakow Centre of Telemedicine and is supported by leading health telematics centres in Europe. To accelerate the dissemination activities the network of co-operating centres in CEEC was established. The strategy employed within the PRO-ACCESS project is supposed to yield "critical mass" necessary for facilitating the e-health development in this region of Europe. The activities employed to reach this objective included publishing activities, events and trainings as well as intake of solutions from supporting centres.

Database Management Systems↗
PubMed2006

An e-consent-based shared EHR system architecture for integrated healthcare networks.

OBJECTIVES: Virtual integration of distributed patient data promises advantages over a consolidated health record, but raises questions mainly about practicability and authorization concepts. Our work aims on specification and development of a virtual shared health record architecture using a patient-centred integration and authorization model. METHODS: A literature survey summarizes considerations of current architectural approaches. Complemented by a methodical analysis in two regional settings, a formal architecture model was specified and implemented. RESULTS: Results presented in this paper are a survey of architectural approaches for shared health records and an architecture model for a virtual shared EHR, which combines a patient-centred integration policy with provider-oriented document management. An electronic consent system assures, that access to the shared record remains under control of the patient. A corresponding system prototype has been developed and is currently being introduced and evaluated in a regional setting. CONCLUSION: The proposed architecture is capable of partly replacing message-based communications. Operating highly available provider repositories for the virtual shared EHR requires advanced technology and probably means additional costs for care providers. Acceptance of the proposed architecture depends on transparently embedding document validation and digital signature into the work processes. The paradigm shift from paper-based messaging to a "pull model" needs further evaluation.

Computer Communication Networks↗
PubMed2006

Systematic planning of patient records for cooperative care and multicenter research.

PURPOSE: The purpose of this paper is to introduce a method for systematically planning patient records for structured data entry that can be used in cooperative environments (e.g. cooperative care, multicenter trials) in a way that enables multipurpose use and shared data entry. METHODS: Design research, formal logic. RESULTS: The method suggests five steps: analyze the prevailing documentation infrastructure, provide terminology management system (TMS), provide documentation management system (DMS), plan the logical architecture, provide all necessary tools. CONCLUSIONS: The era of eHealth enables cooperative care and collaborative documentation. This can only be efficient if a multiple use and shared entry of data is realized. The task of the medical informatics community is to plan these environments systematically especially in complex environments which are enabled by emerging technologies.

Biomedical Research↗
PubMed2005

Attaining adequate consent for the use of electronic patient records: an opt-out strategy to reconcile individuals' rights and public benefit.

Electronic patient records (EPRs) hold great promise for improving patient care and public health. However, governments in Europe and North America have recently adopted legislation for the processing of personal data. In the United Kingdom there is a consensus that the Data Protection Act (1998) and the Human Rights Act (1998) have significant implications for the consent required for health data to be processed or passed. However, interpretations of these implications have been wide-with considerable differences apparent between regulatory bodies, government, researchers and practitioners. These arguments centre on the form of consent generally required to pass electronic personal data to health care personnel for use in decisions about the health care of populations or the individual, the circumstances in which different methods of consent are appropriate and the sufficiency of the public interest needed to counter the need for direct informed consent. To assist those developing EPRs or similar systems, we present the 'opt-out' consent strategy used for the implementation of the Coronary Heart Disease (CHD) Register developed as part of the Scottish Executive National CHD Demonstration Project. This strategy balanced the individual's right to consent with the public interest by taking all reasonable steps to inform residents about the potential direct and indirect purposes of the register, storage arrangements and types of individuals likely to access personal and anonymised data on the register. Simultaneously, the population was provided with easy and equally available opportunities to opt-out of inclusion.

Coronary Disease↗