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At least 181 records · Page 10Linked to original sources

PubMed2005

Integrating "best of care" protocols into clinicians' workflow via care provider order entry: impact on quality-of-care indicators for acute myocardial infarction.

OBJECTIVE: In the context of an inpatient care provider order entry (CPOE) system, to evaluate the impact of a decision support tool on integration of cardiology "best of care" order sets into clinicians' admission workflow, and on quality measures for the management of acute myocardial infarction (AMI) patients. DESIGN: A before-and-after study of physician orders evaluated (1) per-patient use rates of standardized acute coronary syndrome (ACS) order set and (2) patient-level compliance with two individual recommendations: early aspirin ordering and beta-blocker ordering. MEASUREMENTS: The effectiveness of the intervention was evaluated for (1) all patients with ACS (suspected for AMI at the time of admission) (N = 540) and (2) the subset of the ACS patients with confirmed discharge diagnosis of AMI (n = 180) who comprise the recommended target population who should receive aspirin and/or beta-blockers. Compliance rates for use of the ACS order set, aspirin ordering, and beta-blocker ordering were calculated as the percentages of patients who had each action performed within 24 hours of admission. RESULTS: For all ACS admissions, the decision support tool significantly increased use of the ACS order set (p = 0.009). Use of the ACS order set led, within the first 24 hours of hospitalization, to a significant increase in the number of patients who received aspirin (p = 0.001) and a nonsignificant increase in the number of patients who received beta-blockers (p = 0.07). Results for confirmed AMI cases demonstrated similar increases, but did not reach statistical significance. CONCLUSION: The decision support tool increased optional use of the ACS order set, but room for additional improvement exists.

Adrenergic beta-Antagonists↗

PubMed2006

Case report: activity diagrams for integrating electronic prescribing tools into clinical workflow.

To facilitate the future implementation of an electronic prescribing system, this case study modeled prescription management processes in various primary care settings. The Vanderbilt e-prescribing design team conducted initial interviews with clinic managers, physicians and nurses, and then represented the sequences of steps carried out to complete prescriptions in activity diagrams. The diagrams covered outpatient prescribing for patients during a clinic visit and between clinic visits. Practice size, practice setting, and practice specialty type influenced the prescribing processes used. The model developed may be useful to others engaged in building or tailoring an e-prescribing system to meet the specific workflows of various clinic settings.

Ambulatory Care↗

PubMedDate not supplied

Impact of community pharmacy automation on workflow, workload, and patient interaction.

OBJECTIVE: To compare workload productivity, workflow efficiency, and pharmacist-patient interaction in automated and nonautomated community pharmacies. DESIGN: Observational study. SETTING: Four community pharmacy sites within a regional pharmacy chain. STUDY PARTICIPANTS: 173 patients and 11 pharmacists. INTERVENTIONS: Patient surveys, pharmacist surveys, and direct observation. MAIN OUTCOME MEASURES: Patient satisfaction, frequency of pharmacist-patient interactions, and prescription dispensing productivity and efficiency. RESULTS: Results from the three nonautomated pharmacies were averaged and compared with results from the automated pharmacy. Patient satisfaction was generally favorable for both automated and nonautomated pharmacies, but scores for the automated site were significantly better on items measuring one domain, technical competence of pharmacy staff. No association was found between patient counseling and prescription workload in automated or nonautomated sites. Personnel at the automated site made significantly more offers to counsel patients, but the number of patients who received counseling did not differ significantly. Automation was associated with a higher number of prescriptions dispensed per full-time equivalent pharmacist and fewer technical dispensing tasks performed by pharmacists. CONCLUSION: Patient satisfaction was not related to the presence of an automated dispensing system. Automation was associated with higher prescription productivity, but actual counseling rates were no different from those observed in nonautomated pharmacies. The likelihood that a patient would receive counseling was not related to staffing levels, automation, or workload. Whether counseling occurred appeared to depend on factors other than automation.

Automation↗

PubMed2005

Internet-based radiology order-entry, reporting, and workflow management system for coordinating urgent study requests during off-hours.

OBJECTIVE: Our aim was to develop a simple, low-cost, Internet-based application for radiology order-entry, reporting, and workflow management during off-hours. CONCLUSION: The system was quickly accepted by users both within and outside the radiology department, and it required very modest resources to develop, deploy, and support. In a busy on-call setting at a high-volume academic institution, the system described was effective in obtaining more thorough patient histories from referring physicians, reducing the number of telephone calls required, and documenting more rigorously the communication between radiologists and clinical services. These benefits allow the generation of more informative and timely radiology reports.

Emergencies↗

PubMed2005

[Characteristic of evaluation of new image filter devised for improvement of workflow in CT examination].

In this study, we processed reconstructed images with a new image filter (Siemens Medical Systems, Adaptive Image Filter: AIF). As one of its characteristics, the filter uses low-pass filtering. When an image that emphasizes a high-frequency element is changed to one with a reduced high-frequency element, an image suitable for clinical use can be obtained. For the resolving characteristic and the noise characteristic, we evaluated the degree of transition, using the modulation transfer factor (MTF) and Wiener spectrum (WS). Moreover, we used the signal-to-noise ratio (SNR) to examine the total loss of signal detection capability after use of the AIF. The results showed that, when we changed to images using the AIF and made it the same level as B30 and U40, we had to hold down the kernel level to at least B60 and U80. The use of an image filter did not recognize less of an SNR in comparison with the reconstruction image. In this study, changes in detailed characteristics of the image and SNR could be evaluated objectively using the AIF. As for the effective method by AIF that raw data isn't used for is available for the control of an image (times) using reconstruction and the change of an image on database. Therefore, we consider the AIF useful to improve workflow in CT examinations.

Phantoms, Imaging↗

PubMed1989

Maimonides Medical Center uses workflow management system.

This optically based system integrates data, image and sound into a unified workflow management system. Running on micros, the system involves a LAN, saves space and time, and has led to a significant reduction in accounts receivable.

Accounts Payable and Receivable↗

PubMed1998

Building patient workflow management systems by integrating medical and organizational knowledge.

Patient management is a distributed activity involving general practitioners, clinicians, analysts, nurses, etc. Thus an integrated Patient Workflow Management System (WfMS), based on a detailed model of both the organizational and medical knowledge, could heavily improve Health Care System's performance in terms of collaborative work and resource utilization. A set of tools was developed to improve 1) acquisition of medical knowledge represented through clinical practice Guideline, and 2) acquisition of organizational knowledge describing the work process.

Computer Simulation↗

PubMed1998

A conceptual representation of clinical and managerial guidelines: the ATREUS workflow model.

In this paper we propose a workflow conceptual model able to represent clinical and managerial activities within healthcare structures, the ATREUS model. This model uses: a) a graphical representation which models the activities and the events that activate them; b) a textual representation of information related to: a set of conditions used for the control of activity execution; the actors who undertake the activity; the resources and tools necessary for its enactment, the clinical and managerial data generated by the activity execution; c) a state diagram which allows the control of the activity execution. The model allows modularity, activity nesting and temporal flexibility using a top-down refinement of processes. This model, unlike others, makes it possible to highlight the different types of decision involved in the performance of an activity.

Hospital Administration↗

PubMed1999

Workflow analysis and evidence-based medicine: towards integration of knowledge-based functions in hospital information systems.

The large extent and complexity of scientific evidence described in the concept of evidence-based medicine often overwhelms clinicians who want to apply best external evidence. Hospital Information Systems usually do not provide knowledge-based functions to support context-sensitive linking to external information sources. Knowledge-based components need specific data, which must be entered manually and should be well adapted to clinical environment to be accepted by clinicians. This paper describes a workflow-based approach to understand and visualize clinical reality as a preliminary to designing software applications, and possible starting points for further software development.

Artificial Intelligence↗

PubMed2000

Multicentre research and the WISECARE experience. Workflow Information Systems for European Nursing Care.

The benefits of collaborative research are becoming recognized increasingly within the profession of nursing due to the associated increased likelihood of funding, variety of practice settings and increased access to resources that collaboration brings. While such benefits have made collaborative research one of the most desirable strategies for achieving the goals of research, the potential problems of language and communication, culturally sensitive instruments, access to subjects, availability of technology and lack of research resources have complicated collaborative international research initiatives. Review of the literature, although encouraging such initiatives, does little to provide information regarding the processes involved in multinational collaboration or the associated advantages and disadvantages to guide those embarking on such large scale, multinational, cross-cultural studies. The diverse meanings of collaboration within research initiatives further hamper this understanding. Positive definitions focus on aspects such as sharing expertise, making a valuable contribution to the research and ultimately shared ownership of the accomplishments of the research. One such research project led by nurses was the WISECARE project. WISECARE (Workflow Information Systems for European Nursing Care) was funded by the European Commission and aimed to improve cancer nursing practice and ultimately patient outcomes through the integration and utilization of state of the art information technology. Such a project was developed as a result of nursing's apparent invisibility within health care delivery and the problems experienced by nurses in articulating their worth within an increasingly cost-conscious health care system. Oncology care was selected as the domain for the project not only because this speciality of nursing already has an established network of nurses throughout Europe in the European Oncology Nursing Society (EONS) but also because the practice of cancer nursing encompasses all aspects of nursing care. This paper will address the advantages and disadvantages associated with collaboration, using the WISECARE project as an example.

Communication Barriers↗

PubMed2003

Soarian--workflow management applied for health care.

OBJECTIVES: To describe and comment on functionality and architecture of the software product Soarian developed by Siemens, to identify key differentiators to related products, and to comment on predecessor systems and beta versions. This has been done in the framework of a conference on health information systems of the IMIA. METHODS: Analyzing existing literature. Site visit of a predecessor system at Haukeland Sykehus, Bergen. Pilot of a beta version at the Erlangen University Medical Center, elaborating on major characteristics in discussion rounds. RESULTS: Soarian is a functional comprehensive, clinically oriented software product to support health care processes and to be used for health care professional workstations. It is a software product, designed and written completely new. Three major key differentiators were identified in comparison to related software products: Soarian's workflow engine, its embedded analytics, and its 'smart' user interface. The targeted reduced installation time is stated to be 12 months or less. CONCLUSIONS: Soarian has good chances to become one of the major software products for health care professional workstations in the international market to support patient-centered, shared care. Its global design may help to better support and maintain national or language specific versions. The first installations of Soarian will be critical, as they will show how the system will be accepted. To use such software products efficiently, organizational aspects within hospitals as well as between health care institutions have to be considered, e.g. strategic IT planning.

Computer Systems↗

PubMed2003

Workflow and cost analysis on MODULAR ANALYTICS.

Four stand-alone analyzers in a centralized laboratory were replaced by two modular analytical systems processing 45 methods of the general chemistry and specific protein segment. This consolidation led to a reduction of the daily workflow and operational costs. The cost saving with 1.3 million reported results per year was 53,000 Euro, which can be assessed as an important contribution to cost reduction in the health care system.

Clinical Laboratory Techniques↗

PubMed2003

Discharge communiqué: use of a workflow byproduct to generate an interim discharge summary.

Medical problems left unresolved during hospitalizations (along with recommended outpatient evaluations, test results pending at discharge, and discharge medication regimens) are often documented in patients' discharge summaries. However, studies have demonstrated that discharge summaries are frequently unavailable or inaccessible at post discharge visit(s). Interim discharge summaries have been shown to improve the flow of information between inpatient and outpatient physicians. We have constructed a web-based solution, discharge communiqués that are very much like interim discharge summaries but are an automatic byproduct of an every day workflow process, signout. The New SignOut System captures signout information and generates discharge communiqués immediately upon discharge. From June 2002-January 2003 7926 discharge communiqués were made available on 7926 patients and there were 12,920 look-ups of communiqués. Studies concur that 40-50% of patients will not have an available discharge summary making communiqués the primary source of clinical information on prior hospitalization for outpatient physicians.

Forms and Records Control↗

PubMed2003

Implementing a personalized portal combined with workflow management tools used in diabetes care.

Diabetes care is one of the most important medical care works in nowadays. However, the dispersal of current diabetes medical practice leads to an uncoordinated work flow. Lacking of personal health information makes patients hard to implement self-care and medical providers have to deal with lots of paperwork. Information technology has mobile characters to assist medical providers collecting and managing patient data conveniently. Using customized and accessible web technology to promote patient abilities of self-care as well as to help care providers plan patient-oriented care. Automatic workflow applied to care guidelines could reduce workload and improve work efficiency of care provider. Make the most out of information technology to build an integrated "Diabetes Care System". Thus we can provide complete disease management service which should be the most useful solution to meet the challenges of conventional care.

Case Management↗

PubMed2004

Predicting the impact of a new information system on workflow using a discrete event simulation.

Computer simulation of an information system prior to its implementation can predict time and workflow changes in a hospital department, while offering a common ground of communication across various levels in the organization. Often, the simulation can predict unexpected effects of changes to the work environment and allow experimentation with alternative scenarios at minimal cost to the department or the organization. In this paper we describe a discrete-event simulation experiment that predicted an unexpected increase in routine specimen processing time with the introduction of an information system in the HLA tissue typing lab at a major transplant center. The computer simulation enabled the reallocation of existing staff prior to the system implementation.

Clinical Laboratory Information Systems↗

PubMed2004

Workflow modeling and analysis of computer guided prostate brachytherapy under MR imaging control.

We demonstrate that classical Business Process Reengineering (BPR) methods can be successfully applied to Computer Aided Surgery while increasing safety and efficiency of the overall procedure through an integrated Workflow Management System. Computer guided Prostate Brachytherapy, as a sophisticated treatment by an interdisciplinary team, is perfectly suited to apply our method. Detailed suggestions for improvement of the whole procedure could be derived by our modified BPR method.

Brachytherapy↗

PubMed2004

FLOSYS--a web-accessible workflow system for protocol-driven biomolecular sequence analysis.

FLOSYS is an interactive web-accessible bioinformatics workflow system designed to assist biologists in multi-step data analyses. FLOSYS allows the user to create complex analysis pathways (protocols) graphically, similar to drawing a flowchart: icons representing particular bioinformatics tools are dragged and dropped onto a canvas and lines connecting those icons are drawn to specify the relationships between the tools. In addition, FLOSYS permits to select input-data, execute the protocol and store the results in a personal workspace. The three-tier architecture of FLOSYS has been implemented in Java and uses a relational database system together with new technologies for distributed and web computing such as CORBA, RMI, JSP and JDBC. The prototype of FLOSYS, which is part of the bioinformatics workbench AnaBench, is accessible on-line at http://malawimonas.bcm.umontreal.ca: 8091/anabench. The entire package is available on request to academic groups who wish to have a customized local analysis environment for research or teaching.

Computational Biology↗

PubMed2004

Scalable mobile information system to support the treatment process and the workflow of wastewater facilities.

In order to support the operation of wastewater systems and the workflow of sewage systems an application for demonstration has been developed to show exemplarily how a mobile information system can be transferred into practice and used by the staff. The paper presents a scalable information visualisation system, which can be used with mobile devices. The regarded information data does not only include process data, but also general information about buildings and units, work directions, occupational safety regulations as well as instructions of first aid in case of a work accident. This is particularly appropriate for the use in remote facilities. The implementation is based on but not limited to SQL, JSP and HTML.

Accidents, Occupational↗