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At least 235 records · Page 13Linked to original sources
PubMed1995

Implementation of a clinical workstation for general practice.

It is now well recognized that achieving international best practice in the primary health sector will require the development of methods based on a fundamental integration of communications and information technologies with clinical practice. This will have far reaching effects, both on the pattern of medical practice and domiciliary care and on patient outcomes. In the past, information and communications technology has been presented as a tool for management, rather than as a tool for supporting, improving, and making more efficient the professional practice of medicine and the delivery of health care to the patient and the community. In this paper, we propose that an essential element for the achievement of international best practice in the health sector is the development and widespread use of information, measurement, and communications technology targeted towards the clinical practice of medicine, the provision of health services and domiciliary care in the community, and the analysis of morbidity patterns and health care outcomes. A key element of this strategy is the development of an integrated Clinical Workstation specifically designed for the general practitioner, practice nurses, and domiciliary care nurses in their professional tasks of measurement, diagnosis, management, and delivery of health care to the community. We will present our work on the design of an integrated Clinical Workstation for Primary Health Care. The Workstation is Windows based, has a sophisticated user interface, and supports a wide range of computing platforms, from desktop to laptop to hand-held notebook computers. The Workstation will be modular and expandable, both in its software and hardware components, so that users may select only those modules appropriate to their own roles, clinical practice, and levels of expertise. The design will focus on the provision of clinical services and will integrate the following key components: Patient records and basic practice management; Clinical records. Based on ICD10, ICPC, or Read Code classifications; Clinical measurements. Blood pressure, spirometry, ECG, and basic hematology and biochemistry; Clinical decision support. Based on epidemiologic data, protocols, and medical expert systems; Domiciliary care and evaluation of the functional health status of the elderly; Communications and networks. Wireless LAN, modem, and fax; Clinical reporting. Morbidity profiles prescribing profiles, and laboratory services and procedures. Implementation of these requirements will ultimately take the form of an untethered, portable notepad computer supporting a communications link via modem, LAN, or wireless LAN, and removable instrumentation and clinical measurement modules.

Computer Systems↗
PubMed1997

A new coding tool for computerised clinical systems in primary care--ICPC plus.

Standardised classifications are essential for reliable information management. The International Classification of Primary Care (ICPC) provides a recognised structure for classifying problems managed in general practice but lacks sufficient details for medical records. This paper describes an extended version of ICPC, based on the natural language of GPs in Australia, for use in computerised clinical systems.

Australia↗
PubMedDate not supplied

Adequacy of evolving national standardized terminologies for interdisciplinary coded concepts in an automated clinical pathway.

PURPOSE: The purpose of this analysis was to determine the adequacy of evolving national standardized terminologies with regard to coded data elements (concepts) in an automated clinical pathway designed to drive adherence with the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for Evaluation and Management of Chronic Heart Failure. METHOD: Concepts were identified in a previously developed automated clinical pathway and associated tools. Once identified, concepts were categorized according to the conceptual domains identified by Campbell et al. (1997). A review of evolving national standardized terminologies and coding systems was initiated to determine if the identified concepts had corresponding representation in one of these coding systems. Available codes were then evaluated for adequacy with respect to national guideline adherence measures put forth by the Centers for Medicare/Medicaid Services (CMS) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO). RESULTS: The concept domain model put forth by Campbell et al. (1997) worked well for organizing concepts and for providing a useful framework for data analysis. Using our method, 260 unique pathway concepts were identified, of which, 91.9% (239) are represented by one or more of the standardized coding systems. Logical Observation Identifiers Names and Codes (LOINC) and SNOMED CT alone represented 86.2% of the concepts. Seventy percent (70%) of the clinical pathway concepts are represented using the Health Insurance Portability and Accountability Act (HIPAA) mandated national terminologies alone. Less than 50% of CMS and JCAHO guideline adherence concepts were found to have representation in the HIPAA mandated terminologies. The addition of Logical Observation Identifier Names and Codes (LOINC) and SNOMED CT improved representation up to 86.4%, but did not include representation of all concepts necessary for complete electronic monitoring of guideline adherence. CONCLUSIONS: Evolving national standardized terminologies provided matching terms for the majority of the data elements in the automated clinical pathway. Standard clinical terminologies with granular terms such as LOINC and SNOMED CT are required to represent the depth and detail of certain procedures and guideline-based care. Gaps exist in Health Insurance Portability and Accountability Act (HIPAA) mandated terminologies for representing interdisciplinary concepts in national adherence measures.

Computational Biology↗
PubMed2004

Problems with primary care data quality: osteoporosis as an exemplar.

OBJECTIVE: To report problems implementing a data quality programme in osteoporosis. DESIGN: Analysis of data extracted using Morbidity Information Query and Export Syntax (MIQUEST) from participating general practices' systems and recommendations of practitioners who attended an action research workshop. SETTING: Computerised general practices using different Read code versions to record structured data. PARTICIPANTS: 78 practices predominantly from London and the south east, with representation from north east, north west and south west England. MAIN OUTCOME MEASURES: Patients at risk can be represented in many ways within structured data. Although fracture data exists, it is unclear which are fragility fractures. T-scores, the gold standard for measuring bone density, cannot be extracted using the UK's standard data extraction tool, MIQUEST; instead manual searches had to be implemented. There is a hundredfold variation in data recording levels between practices. Therapy is more frequently recorded than diagnosis. A multidisciplinary forum of experienced practitioners proposed that a limited list of codes should be used. CONCLUSIONS: There is variability in inter-practice data quality. Some clinically important codes are lacking, and there are multiple ways that the same clinical concept can be represented. Different practice computer systems have different versions of Read code, making some data incompatible. Manual searching is still required to find data. Clinicians with an understanding of what data are clinically relevant need to have a stronger voice in the production of codes, and in the creation of recommended lists.

Accidental Falls↗
PubMedDate not supplied

A review of Clinical Terms Version 3 (Read Codes) for speech and language record keeping.

There may be bugs, there may be viruses, but computers are here to stay. Access to computers may vary greatly from 'seen one once' to daily usage. However, with an increasing dependence on electronic records, even the most remote therapist will ultimately be faced with computerization. To make this process as painless as possible some commonality in approach is logical. A common vocabulary, for instance, would ensure that dysphasia in Cape Town is the same as dysphasia in Dundee. This is great in theory but is Clinical Terms Version 3 (Read Codes) (CTV3) sufficient to encode records in clinical practice? It is to this end that the Speech and Language Therapy Department at Burton Hospital took part in a multidisciplinary project with the NHS Centre for Coding and Classification (NHS CCC). (NHS CCC became the NHS Information Authority, Coding and Classification on 1 April 1999.) Their CTV3 offers a standardized clinical terminology. An audit of patient case-notes found that 78% of the terms used by therapists were available in CTV3. Although there are many issues raised concerning electronic patient records, CTV3 presented as a potential vocabulary for recording patient information in this acute setting.

Humans↗
PubMed2003

Who performs endocrine operations in the United States?

BACKGROUND: Endocrine surgery is a discipline that is dedicated to high-quality care of patients with endocrine surgical disease. The relationship between its "identity" as a separate field and clinical practice patterns is not known. METHODS: The National Inpatient Sample was searched by the International Classification of Diseases-9th revision-Clinical Modification codes for parathyroidectomy, thyroidectomy, and adrenalectomy for the years 1988 through 2000. The surgeons who performed these operations were profiled by 2 methods: Method A, by the percentage of the total primary International Classification of Diseases-9th revision-Clinical Modification procedure codes that were the selected endocrine procedures; method B, by absolute number of index endocrine procedures performed per year. Only patients with complete coding data for the surgeons were included. RESULTS: In this sample, surgeons whose practice was comprised of 25% or less of these endocrine procedures performed 11,071 parathyroidectomies (78% of total), 46,210 thyroidectomies (82% of total), and 4209 adrenalectomies (94% of total). In contrast, surgeons whose practice was comprised of more than 75% of these endocrine procedures performed 769 parathyroidectomies (5% of total), 1560 thyroidectomies (3% of total), and 128 adrenalectomies (3% of total). CONCLUSION: If these data can be extrapolated to indicate generalized practice patterns, the majority of common operations for endocrine disease are performed by surgeons whose practice is not focused on endocrine surgery. However, much of this effect is due to the fact that non-endocrine surgeons far outnumber endocrine surgeons. This understanding of clinical practice patterns will be important to consider during future studies that seek to determine the relationship between surgeon volume and patient outcomes.

Adrenalectomy↗
PubMed1990

Accuracy of Medicare reimbursement for cardiac arrest.

Diagnosis related group (DRG) 129 consists exclusively of discharges having a principal diagnosis of International Classification of Diseases, Ninth Revision, Clinical Modification code 427.5 (cardiac arrest). It excludes patients with more specific diagnoses (eg, myocardial infarction and arrhythmia) or patients admitted for a different reason and who subsequently experience cardiac arrest. This study used a one-stage sample design to select all DRG 129 discharges from random hospitals, stratified by their annual number of DRG 129 bills. Using blinded techniques, medical records specialists reabstracted the International Classification of Diseases codes for 857 medical records. For the bills that were not coded DRG 129 on reabstraction, physicians classified the incorrect bills by clinical situation and reason for error. Diagnosis related group 129 had significantly higher rates of coding errors and upcoding than other DRGs. Of discharges erroneously billed to DRG 129, 42.1% of the patients entered the hospital for heart disease other than cardiac arrest and 55.2% died after entering the hospital for other diseases. Attending physicians need to distinguish between the "immediate cause" of death for the death certificate and the "principal diagnosis" for reimbursement purposes.

Cause of Death↗