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An implementation study of the PDRD primary care computerized guidelines.

OBJECTIVE: To study the implementation of electronic guidelines designed for general practitioners (GPs). DESIGN: A descriptive 3-year follow-up study. SUBJECTS: All new subscribers to Physician's Desk Reference and Database (PDRD) in 1992. SETTING: Locations of computers, where PDRD software was installed for the first time in 1992. MAIN OUTCOME MEASURES: Expectations of the program and changes in attitudes towards it, getting started with the system, frequency and continuity of use and estimated usefulness of the program. RESULTS: The guidelines were expected to enhance diagnostic accuracy (60% of subscribers), save time (45%), and reduce costs (11%). After 1 year's use, the opinions of the users on these topics had become slightly more positive. Technical problems delayed starting to use the program in 27%. After 1 year 72% were using the program at least weekly. Using frequency was associated with having the computer in the office. The subscribers who renewed their subscription after one year often became regular users. CONCLUSIONS: The study provides insight into the implementation phase of computer-based guidelines in a population of early adopters. Technical support was essential to overcome the barriers associated with computer technology. The perceived need for information was independent of the age and experience of the physicians.

Adult

Drug information skills for pharmacy students: curriculum integration.

For pharmacy students to provide optimal and complete pharmaceutical care, it is vital that they develop drug information skills. At the University of Southern California, the School of Pharmacy and the Norris Medical Library have established an interactive educational program. Library programs support an increasingly complex progression of information retrieval, evaluation, organization, application, and communication. Librarians are systematically involved in all four years of coursework for the doctor of pharmacy degree. Training and experience in computer literacy and online database searching are included in the library components. Description of the educational program covers its beginning a decade ago, current status, and future in an environment of rapidly advancing technology.

California

[Problems of the training of medical personnel in computer technology].

The author discusses the article by Gavrilenko A. F. et al (Soviet Public Health, 1987, N 10, p. 9-12) and tackles the problems of training medical staff in computer science and computing machinery. In is proposed to direct the curriculum at job control, fundamentals of economics, mathematics, algorithmics, programming. The proposal to pay special attention to medical automated management systems, primarily used in medico-sanitary units of industrial enterprises, is argued.

Algorithms

Computer use and education in radiology residency programs.

Computers play an increasingly important role in radiology education and research. We surveyed all U.S. residency programs to assess computer availability, education, and use by residents. Out of 210 questionnaires sent, 132 were returned (63% response). Areas of inquiry included computer equipment and software as well as resident use of facilities. Opinions were also solicited concerning the importance of computer literacy and education. Sixty-nine percent of the respondents have computer facilities (61% within the department). Predominant uses include scientific papers, slides/audiovisual presentations and resume preparation. Popular software includes word processing, spreadsheets, databases and graphics. Of those training programs with computers, 85% provided computer education, and most (70%) felt computer training was very important. Forty-seven percent expected their residents to have at least passing acquaintance with computers. However, in 60% of programs with computers, the computers are used by less than half the residents. Of those programs without a computer, 61% provided no computer training, and only 44% felt computer education was very important. A sizable minority of radiology residency programs are still without computer facilities. Those programs that have computers tend to place a greater emphasis on computer education and literacy for radiology residents. However, even in programs that have computers, it seems they are often underutilized by residents.

Computer User Training

Successful implementation of an integrated physician order entry application: a systems perspective.

Direct physician order entry is required for effective implementation of an integrated electronic medical record. This effort involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the findings of a follow-up study that quantified dimensions associated with successful implementation identified in a previous study. Results identified several implementation strategies associated with success. These include an interdisciplinary implementation group, involvement of large numbers of regular staff, early and intensive training and support, and 24 hour available assistance as important to success. In addition, attitudes of physicians and their level of involvement were found to be associated with success.

Attitude of Health Personnel

[The effect of training with computer equipment on the visual analyzer of 1st-grade pupils].

Examination are carried out on 64 school children Ist class from school "104", town of Sofia where computer training on mathematics and mother tongue is introduced in the frames of pedagogic experiment. The studies are performed parallelly at traditional and computer lessons, realized in two variants (with one and two school hours daily). In order to establish the functional status of the visual analyzer during computer training the following methods are used: studying the distance of the nearest point for clear vision (punctum proximum), stability of clear vision, threshold of the electric eye sensitivity, critical frequency of fusing of the light flickerings. A full preliminary ophthalmological examination is made by "Vision test", as well as chronometric control of each student to establish the real time of work with computers. Taken into consideration are also the data for illumination of the working places in the computer studies and class rooms where the traditional school hours are held. The analysis of the data received shows that the computer training (1 and 2 computer lessons daily) with schoolchildren, Ist class, has no unfavourable effect on the functional status of the visual analyzer in the limits of study hours up to 25 minutes.

Accommodation, Ocular

Delivering health information services and technologies to urban community health centers: the Chicago AIDS Outreach Project.

Health professionals cannot address public health issues effectively unless they have immediate access to current biomedical information. This paper reports on one mode of access, the Chicago AIDS Outreach Project, which was supported by the National Library of Medicine through outreach awards in 1995 and 1996. The three-year project is an effort to link the programs and services of the University of Illinois at Chicago Library of the Health Sciences and the Midwest AIDS Training and Education Center with the clinic services of community-based organizations in Chicago. The project was designed to provide electronic access to AIDS-related information for AIDS patients, the affected community, and their care givers. The project also provided Internet access and training and continued access to library resources. The successful initiative suggests a working model for outreach to health professionals in an urban setting.

Acquired Immunodeficiency Syndrome

Preparing for an ICU bedside computer.

Preparing the nursing staff is essential when implementing bedside computers. Realistically, all staff may not be trained before the clinical information system (CIS) goes "live," but resource personnel and the vendor can alleviate stressors associated with the change. Promoting the system early is vital to gain interest and support.

Computer Terminals

Issues in designing a student database.

Many larger colleges of nursing have centralized student databases in which all elements of students' records are collated. The smaller department or college may leave the design of such databases to course leaders. This paper highlights stages and considerations in the development of student databases. It offers definitions of flat-file and relational databases; it identifies issues in prior planning and then of direct plannings of the database. It offers a discussion of a number of issues related to what sort of information is stored in a student database. It closes with a discussion of the training needs of those staff who are going to use such a database. The principles described in this paper can also be adapted for use in the designing of any health care related database system. The paper also addresses the question of why all colleges are not, already, using such systems.

Computer User Training

The role of the UMLS in 'storing' and 'sharing' across systems.

We will argue that 'sharing', 're-use', 're-purposing', and 'addition' of health care information is difficult, intrinsically; that the best way to overcome the difficulty is to start doing it, as soon as possible, and that the UMLS Knowledge Sources provide the best place to start. We recommend that the UMLS be used as a default source of biomedical concept names and relationships, as a comprehensive, data-based, 'reference model', and as an example of a large, ecumenical, evolving, continuously updated source of re-usable health care information.

Computer User Training

Medical informatics education in the EuroMISE courses.

The first experience with medical education in courses developed using the guidelines of the Joint European Project EuroMISE under the TEMPUS-PHARE program is presented. Training and education in EuroMISE consists of three overlapping methodological branches: medical informatics, medical statistics, and epidemiology. The teaching scheme has been developed in cooperation with Charles University in Prague and cooperating EC universities. Running EuroMISE courses in English (first for Czech university teachers) should have multiple effects in disseminating the acquired knowledge and skills.

Computer User Training

Implementing an integrated clinical information system.

The authors examine the vital role nursing professionals have played in the successful implementation of a sophisticated computer system at a regional medical center in the midwest. From preselection analysis through training and implementation, nurses have assumed primary responsibility for managing the multifaceted adaptation and installation of a comprehensive array of patient care functions. This experience can serve as an invaluable example of the relationship between information management, patient management, cost management, and quality enhancement in the hospital setting.

Computer Systems

[Hygienic principles of the optimal arrangement of working place for students during the training in computer use].

Experimental studies aimed at hygienic substantiation of requirements for optimal organization of a workplace for schoolchildren using computers have been carried out. Hygienic requirements for basic parameters and design of a desk and a chair intended for those working with computers are presented. Practical recommendations on the equipment of computer rooms in secondary schools are given.

Adolescent

An evaluation of four end-user systems for searching MEDLINE.

This study compared features and determined which of four end-user systems (PaperChase, GRATEFUL MED, Med-Base, or Compact Cambridge: MEDLINE) would best serve the Medical Sciences and Optometry Libraries of Indiana University in providing biomedical information to faculty and graduate students through MEDLINE. Cost, ease of use, retrieval, training needs, equipment requirements, and adequacy of documentation were examined. The study consisted of a comparison of the features of each system based on available documentation; a controlled search performed by the investigators on each system and on regular NLM MEDLINE; and a user study based on observations, questionnaires, and interviews with eleven library patrons who performed the same search of their choice on each of the four systems.

Computer User Training

For better data, better utilized.

In Nigeria a training programme was devised whereby staff from health centres could appreciate the value of reliable data as a means of raising the standard of services. A process of learning by doing enabled the participants to turn routine data into tools for management and the improvement of service quality.

Community Health Centers

AIDA and medical courseware.

For more than a decade the Department of Medical Informatics has offered one-week training courses on the subject of computer applications in medicine and health care. Since 1983 two courses are given at a rate of one course every two weeks. One course is on programming and problem solving and consists of three modules of increasing complexity in techniques and methods in programming and structured system development. This course focusses on only some aspects of medical informatics: the development of a medical information system, and the problems occurring in the process of automation. These aspects, however, are dealt with in detail. To this end the students are trained in using the programming system MUMPS and the fourth-generation software package AIDA. The second, introductory course is an intensive training on several distinct areas of man-machine interactions. It contains lessons in the fields of communication and recording; storage and retrieval and databases; computation and automation; recognition and diagnosis; and therapy and control. This paper describes the use of AIDA in developing and maintaining lessons for the latter course, and the assistance of AIDA for teaching purposes in the former course.

Computer User Training

Information use, information perceptions and information flows in primary care medical practice.

A research project funded by the Welsh Office and undertaken by the Department of Information and Library Studies, University of Wales, Aberystwyth examined the information systems in place in a sample of general medical practices in Wales. Shortcomings were identified in patient records, the supply of medical information for patients, staff training and staff communications. Practices lacked coherent information management strategies to relate information to practice goals and to define responsibility and protocols for information tasks. Unless rectified, these deficiencies will inhibit the viability of primary care data as a basis for medical research, audit and for identifying the health needs of communities.

Attitude of Health Personnel

End-user searching in medicine.

Investigation of end-user searching at the New York Hospital-Cornell University Medical Center (NYH-CUMC) revealed that 8% of the physicians surveyed were end users, 63% were interested in learning to search, and 29% were not interested. When training sessions were offered at the Burke Rehabilitation Center, an affiliated institution, 50% of the medical staff attended at least one class, but only 7% of the total staff became frequent searchers. Analysis of the precision and recall ratios of searches conducted by five end users at HYH-CUMC indicated that the best results were obtained by end users who had been taught to search by experienced librarian-searchers. The quality of end user searches did not appear to be affected by the "friendliness" of the systems used, the frequency of searching habits, or the length of time that an end user had been searching.

Attitude