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PubMed2001

Doctors' use of electronic medical records systems in hospitals: cross sectional survey.

OBJECTIVES: To compare the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks. DESIGN: Cross sectional questionnaire survey. Semistructured telephone interviews with key staff in information technology in each hospital for details of local implementation of the systems. SETTING: 32 hospital units in 19 Norwegian hospitals with electronic medical records systems. PARTICIPANTS: 227 (72%) of 314 hospital doctors responded, equally distributed between the three electronic medical records systems. MAIN OUTCOME MEASURES: Proportion of respondents who used the electronic system, calculated for each of 23 tasks; difference in proportions of users of different systems when functionality of systems was similar. RESULTS: Most tasks listed in the questionnaire (15/23) were generally covered with implemented functions in the electronic medical records systems. However, the systems were used for only 2-7 of the tasks, mainly associated with reading patient data. Respondents showed significant differences in frequency of use of the different systems for four tasks for which the systems offered equivalent functionality. The respondents scored highly in computer literacy (72.2/100), and computer use showed no correlation with respondents' age, sex, or work position. User satisfaction scores were generally positive (67.2/100), with some difference between the systems. CONCLUSIONS: Doctors used electronic medical records systems for far fewer tasks than the systems supported.

Cross-Sectional Studies↗
PubMed2006

[General information system through whole hospital and electronic medical record system].

A new system has been introduced and implemented at the Nagoya City University Hospital since January 2004 in order to improve services for patients and general operation for management of the hospital. General Information System has been consisted with Electronic Medical Record System (EMRS), which is the core of all system and divisional system such as Clinical Laboratory Tests, Images, Medical Accounting and so on. A new system has been built and operated to work with the EMRS at the Department of Central Clinical Laboratory (CCL). To cooperate with the new system, we have constructed and operated directly the EMRS such as automatic registration the latest information on infectious diseases and blood transfusions, clinical reports on laboratory test through the hospital news and/or e-mail, introducing laboratory pre test before the consultation, rapid reports of panic values to the doctor in charge of the patients directly, the new system build up a closer cooperation between division of blood transfusion division and that of immuno-chemistry in CCL through EMRS. The new system has been brought not only efficiency and strengthen of function in CCL but also strengthen the service to patients in the hospital.

Clinical Laboratory Information Systems↗
PubMed1998

Survey of hospital systems and common serious medication errors.

The Institute for Safe Medication Practices and the University of Illinois at Chicago, College of Pharmacy, undertook a hospital survey of medical-surgical hospitals to determine systems-oriented factors that allow the highest level of medication safety. The study incorporated a peer-reviewed and pretested questionnaire, which focused on critical information necessary to yield quality data for comparison. Through analysis, it was shown that over one third of all medication errors reported in the survey involve just six categories--allergies, insulin, heparin, opiates, PCA devices, and potassium concentrates.

Chicago↗
PubMed1992

Alternative payment systems for hospital medical staffs.

This paper examines the implications of using a Medical Staff Payment System (MSPS) for reimbursing physicians for services provided to inpatients. Inpatient episodes are defined to include seven days before admission and 30 days postdischarge. Simulations are performed using Medicare Part A and B data from nine states in 1988. DRGs are strong predictors of expenditures on physician services during the inpatient episode, achieving an R2 of .61. Gains and losses for various types of facilities are simulated, and the characteristics of winning and losing hospitals under an MSPS are identified.

Diagnosis-Related Groups↗
PubMed1996

Use of data from a hospital online medical records system by physicians during preanesthetic evaluation.

OBJECTIVE: There is no data on the use of hospital-wide online medical record (OLMR) systems by anesthesiologists. We measured how often anesthesiologists accessed the OLMR database maintained by the hospital, how often data was copied from this database into the clinic's computer system, and how much data was copied. METHODS: In a preanesthetic evaluation clinic that has a computerized evaluation system designed for physician-entered data, a graphical user-interface prototype link provided access to the hospital OLMR database for users and was studied over a 37-day period. The software allowed the user to search the OLMR system by patient name, retrieve a text listing of the patient's record, and then copy and paste desired information into the forms of the preanesthetic system. Using embedded routines, we recorded how many times physicians searched for and retrieved medical records from the hospital OLMR database, as well as how many times they copied data to the preoperative database. As a measure of how much data was copied, the number of characters was also recorded. RESULTS: Of 1,080 patients evaluated in the clinic during the study period, electronic searches of the hospital OLMR database for 221 patients (20.5%) were noted. Of these searches, 208 (94.1%, or 19.3% of 1,080 patients) successfully retrieved data from the patient's record. Data was copied for 170 patients - 81.7% of the successful searches. Of 7,525,153 characters retrieved, 262,269 were copied-an average of 1,543 characters per instance of copying. CONCLUSION: We conclude that anesthesiologists, given even crude graphical access to a hospital OLMR data-base, will retrieve and copy data, potentially increasing the accuracy of the medical records and saving time.

Anesthesiology↗
PubMed2006

Preventing medication errors in hospitals through a systems approach and technological innovation: a prescription for 2010.

Medication errors in hospital settings are considered both widespread and costly to the American healthcare system; yet, it is tractable to available solutions. This article offers a novel prescription for the problem that could be implemented by 2010. It consists of a systems approach--failure mode effects analysis (FMEA)--in combination with emerging technologies, such as a decision support system (DDS) with integrated real-time medical informatics, electronic medical records (EMR), computer physician order entry (CPOE), bar coding, automated dispensing machines (ADM), and robotics. Cost and benefit analysis reveals that this proposed integrated solution will radically reduce medication errors in hospitals and save the lives of thousands of Americans who frequent such facilities on an annual basis, as well as reduce healthcare costs.

Diffusion of Innovation↗
PubMed2004

Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report.

BACKGROUND: Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. METHODS: We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. RESULTS: The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. CONCLUSIONS: Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS.

Attitude of Health Personnel↗
PubMedDate not supplied

Implementation of physician order entry: user satisfaction and self-reported usage patterns.

OBJECTIVES: To evaluate user satisfaction, correlates of satisfaction, and self-reported usage patterns regarding physician order entry (POE) in one hospital. DESIGN: Surveys were sent to physician and nurse POE users from medical and surgical services. RESULTS: The users were generally satisfied with POE (mean = 5.07 on a 1 to 7 scale). The physicians were more satisfied than the nurses, and the medical staff were more satisfied than the surgical staff; satisfaction levels were acceptable (more than 3.50) even in the less satisfied groups. Satisfaction was highly correlated with perceptions about POE's effects on productivity, ease of use, and speed. POE features directed at improving the quality of care were less strongly correlated with satisfaction. The physicians valued POE's off-floor accessibility most, and the nurses valued legibility and accuracy of POE orders most. Some features, such as off-floor ordering, were perceived to be highly useful and reported to be frequently used by the physicians; while other features, such as "quick mode'' ordering and personal order sets, received little self-reported use. CONCLUSIONS: Survey of POE users showed that satisfaction with POE was good. Satisfaction was more correlated with perceptions about POE's effect on productivity than with POE's effect on quality of care. Physicians and nurses constitute two very different types of users, underscoring the importance of involving both physicians and nonphysicians in POE development. The results suggest that development efforts should focus on improving system speed, adding on-line help, and emphasizing quality benefits of POE.

Attitude of Health Personnel↗
PubMed2004

[Assessment of psychiatric emergencies by physicians in the pre-hospital emergency medical system. A re-evaluation after 7 years].

OBJECTIVE: In the German emergency medical system (EMS) psychiatric emergency situations (PES) are now responsible for up to 15% of all calls for the emergency physician (EP). A survey which was first conducted in 1996 to reveal knowledge about PES, reported a significant need for training. Seven years later it is interesting to investigate whether different conditions in the EMS may have changed assessments and attitudes. METHODS: The questionnaire of 1996 was modified to enable a comparison of PES and other frequent emergency situations with respect to the estimated number and the subjective stress. Open and multiple-choice questions or visual analogue scales were used to obtain the following data: demographic data, frequency of and stress by PES and other medical emergencies, own knowledge, and interest about training programs. RESULTS: Of the EPs 274 responded (male/female: 74/26%, mean age: 38 years, mean experience as an EP 6 years, anaesthesiologists 69%). The frequency of PES was estimated at 5% and 44% of EPs thought that there had been an increase in recent years. Personal knowledge was judged to be good by only 24%. The interest in training programs even increased slightly compared to the first survey; of particular interest was training in drug abuse disorders. Subsequent to internal, neurological and surgical emergencies, PES are considered to rank fourth in frequency, however the strain imposed by PES is significantly higher than for these other emergency situations. DISCUSSION: The results indicate an increase of relevance of PES in the German EMS, however, assessments made by the EP only changed marginally over the time period. The subjective awareness of the frequency of PES underestimates the reality in emergency medicine. The importance of training programs remains high to improve knowledge and to reduce feelings of incapability.

Adult↗
PubMed1996

Military medicine in operations other than war. Part I: Use of deployable medical systems facilities to assist in urban crises and enhance reserve medical training.

Navy medicine is challenged to provide ongoing and realistic training for medical personnel who will be deployed to provide battlefield care. Current events in this country suggest that the need for realistic training could be met while simultaneously providing support to civilian communities with great need. Deployable Medical Systems hospital modules could be set up in areas where the medical care system is overwhelmed and provide real patient management on the deployment platform. This innovative approach to providing "mutual support" to our own citizens will also enhance the cooperation between the civilian and military sectors should a civil disaster occur.

Disaster Planning↗
PubMed2004

Efficiency of different systems for medication distribution in an academic children's hospital in The Netherlands.

BACKGROUND: In the Sophia Children's Hospital, both a ward stock system and a decentralized, patient-orientated, ready-to-use drug distribution system (a 'satellite pharmacy system') exist. Hospital management considered expanding the concept of the satellite pharmacies. Little was known, however, about the efficiency of this drug distribution system, whereas there is increasing pressure to demonstrate the cost-effectiveness of pharmacy services. OBJECTIVE: To analyze the efficiency of satellite pharmacies compared with other medication distribution systems. METHODS: All medication orders and prepared doses were counted. The workload of the two current distribution systems was calculated using the direct time study method. Furthermore, the consequences of altering the distribution system were calculated by formulating nine variants in which certain activities surrounding the medication distribution were moved between nurses and pharmacy technicians. Moreover, we varied the degree of computerization of the medication order registration. RESULTS: The required working hours are the largest in the variants in which nurses do the preparation of the drugs. Moving the distribution of some drug categories, such as ready-to-use drugs, prepared oral drugs, and prepared inhalation drugs, from pharmacy technicians to nurses appeared not to produce noticeable benefits compared with the current distribution system. Expanding the concept of the satellite pharmacies involves a small rise in total working hours compared with the current situation, but does not raise personnel costs. The largest cost savings can be achieved by introducing an on-line computerized physician order-entry system. CONCLUSIONS: The concept of satellite pharmacies offers an efficient distribution system for the Sophia Children's Hospital.

Costs and Cost Analysis↗
PubMed1999

Development of the local medical service network system. Integration of medical service with the network system between university hospital and other medical institutions.

Although every medical institution always make efforts to provide best services for the patients, it tends to be insufficient to send the patient's information and share them with other medical institutions. It is partly because in the Japanese medical care system there is no obligation to inform patients' medical information to other medical institutions. To provide effective and cost-effective medical service, we made a local network system between university hospital and other medical institutions. The system contributes to clarify the role of medical institutions and the continuity of medical service. For the next step, we must construct the home-care information service network towards the total service for the patients.

Community Networks↗