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As part of a casefinding effort, one hospital-based DM initiative found medical records to be chock full of clues and warning signs of impending major health care problems. Using its newfound data source, the hospital developed a diabetes DM plan that has mushroomed into a full-scale disease prevention strategy.
Patient tracking systems improve follow-up care. When providers let patients fall through the cracks after treatment, outcomes are poorer and health care costs are higher. Read what several providers are doing to track patients successfully.
We developed and evaluated a feature that allows users to control what types of clinical information are delivered to them. Using a paper or web-based configuration form, users turn individual alerts and sets of results on or off, and set how they are delivered. We used usage rates to evaluate this feature. Of 16 residents who had received clinical information from our clinical event monitor, 4 (25%) made at least one change (range 10-25). Of 41 interns, 5 (12.2%) made at least one change (range 5-91). The difference was borderline significant (p < 0.1). 5/7 web users changed preferences through a dial-up connection from home. More users used the web-based preference form than the paper form. This difference may be due to the better accessibility of the web-based form. A survey established that this feature was not as highly utilized as anticipated partly because the initial (default) preference setting was acceptable and partly because the users were too busy to customize their alert settings. We conclude that user configuration of a system that delivers information using a web-based preference form is feasible and may become important as the volume of information and number of available communication channels increase.
IMM/Serve is a computer program which implements the clinical guidelines for childhood immunization. IMM/Serve accepts as input a child's immunization history. It then indicates which vaccinations are due and which vaccinations should be scheduled next. The clinical guidelines for immunization are quite complex and are modified quite frequently. As a result, it is important that IMM/Serve's knowledge be represented in a format that facilitates the maintenance of that knowledge as the field evolves over time. To achieve this goal, IMM/Serve uses four representations for different parts of its knowledge base: (1) Immunization forecasting parameters that specify the minimum ages and wait-intervals for each dose are stored in tabular form. (2) The clinical logic that determines which set of forecasting parameters applies for a particular patient in each vaccine series is represented using if-then rules. (3) The temporal logic that combines dates, ages, and intervals to calculate recommended dates, is expressed procedurally. (4) The screening logic that checks each previous dose for validity is performed using a decision table that combines minimum ages and wait intervals with a small amount of clinical logic. A knowledge maintenance tool, IMM/Def, has been developed to help maintain the rule-based logic. The paper describes the design of IMM/Serve and the rationale and role of the different forms of knowledge used.
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Information management is critical in today's health care environment. Traditional paper-based medical records are inadequate information management tools. Electronic medical records (EMRs) overcome many problems with paper records and are ideally suited to help physicians increase productivity and improve the quality of care they provide. The Department of Family Medicine at the Medical University of South Carolina uses the Practice Partner Patient Record EMR system. Department members have developed a quality improvement model based on this EMR system. The model has been used to improve care for acute bronchitis, diabetes mellitus, tobacco abuse, asthma, and postmenopausal osteoporosis.
Like poor communication, poor office management can create ill-will among patients and can actually contribute to negligence itself. It is imperative that every office have a system for tracking test results and referrals to ensure that patients do not "fall though the cracks". There are several types of effective tracking systems. But, the key to a good follow-up system is to use the system.
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BACKGROUND: The aim of this study was to examine the acceptability of point of care computerized prompts to improve health services delivery among a sample of primary care patients. METHODS: Primary data collection. Cross-sectional survey. Patients were surveyed after their visit with a primary care provider. Data were obtained from patients of ten community-based primary care practices in the spring of 2001. RESULTS: Almost all patients reported that they would support using a computer before each visit to prompt their doctor to: "do health screening tests" (92%), "counsel about health behaviors (like diet and exercise)" (92%) and "change treatments for health conditions" (86%). In multivariate testing, the only variable that was associated with acceptability of the point of care computerized prompts was patient's confidence in their ability to answer questions about their health using a computer (beta = 0.39, p =.001). Concerns about data security were expressed by 36.3% of subjects, but were not related to acceptability of the prompts. CONCLUSIONS: Support for using computers to generate point of care prompts to improve quality-oriented processes of care was high in our sample, but may be contingent on patients feeling familiar with their personal medical history.
OBJECTIVES: Emergency physicians unaware of patients' insurance status may prescribe expensive proprietary antibiotics for patients who cannot afford them. The objective of this study was to develop a clinical decision support system to display patient insurance status before prescription writing for outpatient conditions. METHODS: This was a 26-week "before-and-after" trial at an urban emergency department (ED) with 78,000 visits/year treating a medically underserved population. Sixty-one prescribers, including attending physicians, residents, and physician assistants, participated. All patients older than 18 years of age discharged from the ED receiving antibiotic prescriptions were eligible. The electronic ED chart is linked to prescription-writing software, which includes a menu of 74 antibiotics. The system was programmed so that when an emergency physician accessed the prescription menu, a prompt appeared displaying insurance status. Prescribers also received educational interventions. The main outcome measure was the percentage of prescribers who reduced their prescription writing of proprietary antibiotics to self-pay patients. Data were analyzed with cluster techniques using SPSS 10.0 (SPSS Inc., Chicago, IL). RESULTS: Of 594 prescriptions written for self-pay patients before prompt insertion, 158 (26.6%) were for proprietary antibiotics. After the intervention, self-pay patients received 564 antibiotic prescriptions, of which 117 (20.7%) were for proprietary drugs. Analyzed by prescriber, the reduction in the prescription rate for proprietary antibiotics was statistically significant (p = 0.03, chi(2) test). Patients with respiratory or urinary infections also had a statistically significant reduction in proprietary antibiotic prescription (p = 0.03). CONCLUSIONS: A clinical decision support system, integrated into a prescription-writing program, can decrease the prescription of proprietary antibiotics for self-pay patients in the ED.
OBJECTIVES: a) The use of information technology (IT) based solutions for quality health delivery in regional health information networks and the study of the enabling factors for their use in a regional health care network from key classes of users such as the medical personnel and the citizens. b) Identification of potential technologies for usage from all citizens and health providers in a regional environment, in all aspects of everyday life. c) Presentation of a generic user model for reference when developing and assessing IT based health delivery solutions. METHODS: After defining the major questions to be addressed, an overview of tele-health and tele-medicine technologies and solutions currently available shall be presented. Further, a generic user model applied to the use of IT based regional health delivery solutions both for the daily life and home care, and for research and clinical routine purposes are presented. Enabling technologies for integration of different IT modules, medical data processing and management procedures and the wireless application protocol (WAP) technology is discussed. RESULTS: Different levels of user applications are presented such as mobile telephony driven health information monitoring and systems integrating electronic health care records with multimedia medical information management and processing modules. CONCLUSIONS: Although IT solutions are advanced and continue to evolve, still the user acceptance and user friendliness issues are unresolved. Mobile telecommunication solutions however may hold the key for wide scale implementation of IT solutions in regional health information networks and increased quality of health services.
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INTRODUCTION: Recent evaluations of computer-generated reminder/recall messages have suggested that they are an inexpensive, labor-saving method of improving office visitation rates of childhood immunization providers. This study assesses the sustained impact of computer-generated messages on immunization coverage during the first two years of life. DESIGN: Randomized, controlled trial. SETTING: County health department in the Denver metropolitan area. STUDY PARTICIPANTS: Children (n = 1227) 60 to 90 days of age who had received the first dose of diphtheria-tetanus-pertussis (DTP) and/or poliovirus vaccines. INTERVENTION: Households of children were randomized into four groups to receive: telephone messages followed by letters (Group A); telephone messages alone (Group B); letters only (Group C); or no notification (Group D). Households in the intervention groups (A, B, and C) received up to five computer-generated telephone messages and/or up to four letters each time their children became due for immunization(s). MAIN OUTCOME MEASURE: Immunization series completion at 24 months of age. RESULTS: Children whose families were randomized to receive any of the interventions were 21% more likely to have completed the immunization series by 24 months of age than were children randomized into the control group (49.2% vs 40.9%; RR [rate ratio] = .21; CI [confidence interval] = 1.01, 1.44). While not statistically significant, children in Group A were 23% more likely to complete their immunization series by 24 months of age than those in the control group (50.2% vs 40.9%; RR = 1.23; CI = 1.00, 1.52). No differences were detected among the intervention groups. The costs per additional child completing the series by 24 months of age in Group A was $226 ($79 after start-up costs were discounted). CONCLUSION: Computer-generated contacts, either by phone or by mail (or both combined), used each time vaccines become due, are efficacious in increasing immunization coverage of children under 2 years of age.
The purpose of this qualitative study was to examine user acceptance of a clinical computer system in two pediatric practices in the southeast. Data were gathered through interviews with practice and IS staff, observations in the clinical area, and review of system implementation records. Five months after implementation, Practice A continued to use the system but Practice B had quit using it because it was unacceptable to the users. The results are presented here, in relation to a conceptual framework, which was originally developed to describe the process of successful implementation of research findings into practice. Five main themes were identified relative to the differences in user acceptance at the two practices: 1) Benefits versus expense of system use varied, 2) Organizational cultures differed, 3) IS staff's relationship with practices differed, 4) Post-implementation experiences differed, and 5) Transfer of technology from the academic center to private practice proved challenging in Practice B. The findings indicate a need for the development and validation of tools to measure healthcare organizational climate and readiness for change.
A new database has made the job of tracking preventive care visits much easier for Hughes Spalding Children's Hospital in Atlanta and resulted in an average 27% increase in visits every month.
This article represents a compilation of study, research, and patient care during a 30-year period. Its development was based on two tenets: (1) keep it simple and (2) be inclusive. The purpose of the classification system was to provide professionals with a vehicle for describing tinnitus and its location, probable cause, loudness, degree of annoyance, and pitch. The system uses two mnemonics to follow the word tinnitus: (1) A, B, or C for tinnitus Aurium, Binaural, or Cerebri; and C-CLAP for Cause, Composition, Loudness, Annoyance, and Pitch. Four descriptions are presented on how this classification system may be used in the clinician's report.
In 1999, the Institute of Medicine released its report To Err is Human. The report estimated the staggering national impact of medical errors and laid out a comprehensive strategy to reduce these errors. The report discussed two types of errors: errors of execution (a planned action not completed as intended) and errors of planning (the wrong plan is used).
Pagers, personal data assistants (PDAs) and other devices that have wireless connectivity are becoming a popular method for delivering patient related information to medical decision makers. Although medical informatics research has emphasized the design, and implementation of pagers as event notification mechanisms, researchers have not paid as much attention to how this technology impacts medical work. We present a case study of physicians in a Surgical Intensive Care Unit (SICU) using wireless alert pagers. The pagers provide a variety of alphanumeric clinical alert messages and are widely used by SICU physicians. However, the use of the pagers has created unanticipated challenges to the physicians' traditional work practices. These challenges include: (1) flattening of hierarchical workflows, (2) coping with information overload and missing context, and (3) lack of feedback. These challenges are tied to both the specific technical design of the system and the traditional structure of medical work.