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At least 541 records · Page 30Linked to original sources

PubMed2003

Physicians' prescribing attitudes to combined therapy with statins and fibrates.

OBJECTIVE: To assess the impact of a package insert revision and a drug-drug interaction warning embedded in a computerized prescription ordering system, on physicians' prescribing of concomitant statins and fibrates. METHODS: Data were obtained using a computerized prescription order entry system before and after administrative intervention advising of potentially adverse effects of this combined therapy. The number of prescriptions for statins and fibrates were counted monthly from January 1998 to June 2002 at the National Cardiovascular Center (NCVC). Counting was based on information from a prescription database file compiled from a computerized order entry system. The total number of prescriptions and frequency of requests for statins and fibrates were compared with the timing of either package insert revision or introduction of the warning on a computerized prescription ordering system. In addition, laboratory testing of renal function using serum creatinine (Scr) assays in patients treated with combined statins and fibrates was obtained from medical records at two stages during the study period (stage 1, January 1998 to June 1998; stage 2, January 2002 to June 2002). RESULTS: There were 204 prescriptions for concomitant statins and fibrates at the beginning and 50 prescriptions at end of the study period. The number of prescriptions began to decrease in the latter half of 1999 with the percentage of concomitant use of statins and fibrates showing an evident downward trend from January 2001. This acceleration in the downward trend coincided with the introduction of the computerized warning message. Scr levels were measured in 43.8% of patients in stage 1 and in 48.3% of patients in stage 2 in the past month. The percentage of patients having Scr levels measured in the past 6 months was 85.3% in stage 1 and 84.5% in stage 2. There was no significant difference in the percentages of patients whose Scr levels had been measured between the two stages. CONCLUSION: Revision of package inserts concerning combined therapy of statins and fibrates led to physicians' prescribing fewer of these combinations. A warning message displayed on a computerized prescription order entry system accentuated this effect.

Anticholesteremic Agents↗

PubMed2004

[Construction of a bed management system using widely available software: departmental information integration including the department of radiological technology].

In recent years, the distribution of medical information through Internet technology has been increasingly promoted as a result of the December 2001 initiative of the Ministry of Health, Labor and Welfare known as "the grand design for the application of welfare and medical care information technology in the field of health." In June 1999, we developed a bed management system that uses a local area network (LAN). The ultimate goals of this systems configuration were the development of an order-entry system, an electronic health-record system, and improved information sharing. The system, which was created by employing widely used software, rationalized daily work by integrating patient information, hospitalization information, radiological examination reservation information, physiological examination reservation information, and rehabilitation reservation information. The radiological examination reservation information system that our radiology department uses is one of these systems. Electronic preservation of the reservation list is carried out in the radiology department, and information on examinations is input. The resulting full-scale order-entry system was introduced in July 2002, and it has improved the sharing of information among staff members.

Bed Occupancy↗

PubMed2004

Experience in implementing inpatient clinical note capture via a provider order entry system.

Care providers' adoption of computer-based health-related documentation ("note capture") tools has been limited, even though such tools have the potential to facilitate information gathering and to promote efficiency of clinical charting. The authors have developed and deployed a computerized note-capture tool that has been made available to end users through a care provider order entry (CPOE) system already in wide use at Vanderbilt. Overall note-capture tool usage between January 1, 1999, and December 31, 2001, increased substantially, both in the number of users and in their frequency of use. This case report is provided as an example of how an existing care provider order entry environment can facilitate clinical end-user adoption of a computer-assisted documentation tool-a concept that may seem counterintuitive to some.

Academic Medical Centers↗

PubMed1997

Effect of computerized requisition of radiology examinations on the transmission of clinical information.

RATIONALE AND OBJECTIVES: The authors developed a method to evaluate the availability and accuracy of clinical data proffered by clinicians when ordering radiologic examinations with a computer order-entry system. METHODS: Two thousand consecutive clinical indications for a spectrum of pediatric imaging studies were scrutinized for accuracy by means of computerized chart review, verbal communication with clinical attending staff, and reference to surgical and laboratory results. The indications were classified as appropriate, incorrect, misleading, or incomplete. RESULTS: Of the 2,000 stated indications, 1,464 (73%) provided a reasonable, if minimal, amount of clinical information; however, in 376 (19%) cases the diagnosis or proximate indication was incorrect, in 108 (5%) cases the data were incomplete, and in 52 (3%) cases the information was misleading. CONCLUSION: Computer order-entry systems can improve the transmission of clinical information but they allow misinformation to be provided.

Hospital Information Systems↗

PubMedDate not supplied

Key attributes of a successful physician order entry system implementation in a multi-hospital environment.

The benefits of computerized physician order entry have been widely recognized, although few institutions have successfully installed these systems. Obstacles to successful implementation are organizational as well as technical. In the spring of 2000, following a 4-year period of planning and customization, a 9-month pilot project, and a 14-month hiatus for year 2000, the Ohio State University Health System extensively implemented physician order entry across inpatient units. Implementation for specialty and community services is targeted for completion in 2002. On implemented units, all orders are processed through the system, with 80 percent being entered by physicians and the rest by nursing or other licensed care providers. The system is deployable across diverse clinical environments, focused on physicians as the primary users, and accepted by clinicians. These are the three criteria by which the authors measured the success of their implementation. They believe that the availability of specialty-specific order sets, the engagement of physician leadership, and a large-scale system implementation were key strategic factors that enabled physician-users to accept a physician order entry system despite significant changes in workflow.

Hospital Information Systems↗

PubMed1995

Current developments in departmental PACS for ultrasound.

1. INTRODUCTION TO DEPARTMENTAL PACS. Full or partial Departmental PACS is generally taken to mean an image management system focused on serving the needs of a specific modality or modality application. It will provide a modality specific means of image acquisition, specialized redisplay of images, distribution, and local long term storage of images. A Departmental PACS can be considered in isolation or as a component in a distributed Radiology PACS which consists of one or more departmental work groups on a back bone, potentially with shared resources. 2. DEPARTMENTAL PACS Issues Implementation of a Departmental PACS requires an in-depth knowledge of departmental clinical practice and work flow in all affected areas in the department, including patient intake, image collection, data routing, retrieval of previous image data, reporting, and long term data management and storage. Optimization of modality specific image display systems requires significant involvement from representative physician users. System architectures and user interfaces must be flexible enough to support the span of variation in clinical practice encountered in the site. A departmental PACS should offer a variety of "open" communications interfaces, both local and wide area, recognizing that outreach efforts are often driven by specific imaging departments. Interfaces to other departmental PAC systems and other information systems must be considered in order to facilitate institutions developing "Best of Breed" PACS systems. As hospitals move toward the integrated electronic medical record, means need to exist for a client process launched from a physician desktop to acquire images and/or reports from a departmental system. At minimum, HIS/RIS interfaces need to be considered to minimize re-keying of data and reduce data entry errors. 3. DESIGN OBJECTIVES FOR ALI ULTRAPACS. The key objectives were to design a product which could function either as a free standing PACS or as a departmental subnet on a larger PACS backbone, one which could function in a local or mixed local and wide area environment and one which could provide a cost effective implementation based on currently available technologies. 4. IMPLEMENTATION STRATEGIES. In order to attain the product design objectives, ALI made the following critical implementation decisions: 1) to build the UltraPACS application as a suite of separable UNIX processes based on a message passing client server model; 2) to host the application and operating system on a Digital Equipment Corporation PC using an Intel microprocessor because of the competition and broad variety of suppliers in the PC arena; and 3) to use NEXTSTEP as the UNIX variant of choice because of NEXTSTEPUs strong object orientation, superb development tools, and the excellent integration between the Graphical User Interface level and the underlying operating system layers. 5. CONCLUSION. ALI is convinced that a departmental approach to PACS offers significant advantages over monolithic PACS in several key areas including: optimization for modality specific clinical practice and workflow, cost effectiveness, the potential for an institution to implement PACS in a stepwise fashion, starting with the department with the potential for the greatest savings, and the capability for an institution to build a "best of breed" solution for large scale PACS.

Radiology Department, Hospital↗

PubMed2005

Career History Archival Medical and Personnel System.

The Career History Archival Medical and Personnel System is a database that provides information on cancer, chronic diseases, occupational and preventive medicine, epidemiological research, and the use of health care in the Navy and Marine Corps. It was created at the Naval Health Research Center for enlisted Navy personnel, and it is being expanded to encompass all military personnel. Its objective is to provide a comprehensive, chronologically ordered database of career and medical events in all active duty military service members and to track career and disease events in order from the date of entry to service to the date service ended. Events include the dates of beginning and ending of each specific military occupation, all assignments to a military units or ships, all hospitalized diseases, and other events. The database contains detailed epidemiological data on more than six million members of the military services. It is the largest known epidemiological database in the United States.

Archives↗

PubMed2001

How can information technology improve patient safety and reduce medication errors in children's health care?

BACKGROUND: Medication errors are common, costly, and injurious to patients. OBJECTIVE: To review the role of information technology in decreasing pediatric medication errors in both inpatient and outpatient settings. DESIGN: We performed a literature review of current information technology interventions. RESULTS: Several types of information technology will likely reduce the frequency of medication errors, although insufficient data exists for many technologies, and most available data come from adult settings. Computerized physician order entry with decision support substantially decreases the frequency of serious inpatient medication errors in adults. Certain other inpatient information technologies may be beneficial even though less evidence is currently available. These include computerized medication administration records, robots, automated pharmacy systems, bar coding, "smart" intravenous devices, and computerized discharge prescriptions and instructions. In the outpatient setting, where adherence is especially important, personalized Web pages and World Wide Web-based information have substantial potential. CONCLUSIONS: Medication errors are an important problem in pediatrics. Information technology interventions have great potential for reducing the frequency of errors. The magnitude of benefits may be even greater in pediatrics than in adult medicine because of the need for weight-based dosing. Further development, application, evaluation, and dissemination of pediatric-specific information technology interventions are essential.

Adolescent↗

PubMedDate not supplied

Nurses' perceptions of causes of medication errors and barriers to reporting.

This study describes nurses' perceptions about medication errors and the effects of physician order entry and barcode medication administration on medication errors. A convenience sample of 61 medical-surgical nurses was surveyed. All nurses surveyed perceived that information technology decreases medication errors. However, medication errors continue to occur despite the availability of sophisticated information technology systems.

Adverse Drug Reaction Reporting Systems↗

PubMed1979

Computer-based system for adverse drug reaction detection and prevention.

An online computer-based system for monitoring patients for potential adverse drug reactions during their hospital stay is described. The adverse drug reaction monitoring system uses a Digital Equipment Corporation (DEC) PDP-11 computer which is programmed in MUMPS (Masschusetts General Hospital Utility Multi-programming System). Primary references from the medical and scientific literature are analyzed and evaluated before being included in the data base. The patient's adverse reaction history, obtained by nursing personnel during a patient interview, is entered into the computer by pharmacy staff. The computer screens new prescription orders for potential adverse reactions; any adverse reaction reports are sent to the patient's physician. Other special programs that are used in the patient monitoring system include medication profiles, drug-drug interaction screening and prescription discontinuation date entry. The computer system enable detection of potential adverse drug reaction and notification of the patient's physician prior to administration of the prescribed drug.

Computers↗

PubMed2005

Computer applications in clinical practice.

PURPOSE OF REVIEW: The prospects of improved practice efficiencies and better treatment outcomes have recently focused political attention at high levels upon the use of information technology (IT) in routine clinical care in the US, UK and elsewhere. Providers who treat musculoskeletal diseases need to become familiar with emerging governmental policies, IT industry trends, data standards and communication protocols to equip themselves with a basis on which to evaluate and influence the development of these technologies, which in turn will influence the shape of clinical practice. RECENT FINDINGS: The articles cited are categorized into the topics of government policy regarding electronic medical records (EMRs); data definitions and databases; computers in outpatient clinical encounters; EMRs; patient self-entry of historical data; computer physician order entry; personal digital assistants; and e-mail, the Internet, and the patient/physician encounter. SUMMARY: Government agencies in the US, UK, and elsewhere are at various stages in the implementation of national health information infrastructures. US officials are playing a greater role in prompting physicians to use EMRs and in setting standards for EMR systems. A study by the American College of Rheumatology observed, 'Increasing requirements for provider compliance with quality and outcomes reporting, HIPAA regulations, medical error reduction, including Medicare e-prescribing mandates, and downward pressure on practice revenues will ultimately drive the adoption of EMRs in office practice.' Nonuse will equate to a non-viable practice. Rheumatologists who would control their own destinies must acquaint themselves with, adopt, and exert influence on the development of these technologies with all deliberate speed.

Health Policy↗

PubMed2003

Mobile physician order entry.

Because both computerized physician order entry (CPOE) systems and mobile technologies such as handheld devices have the potential to greatly impact the industry's future, IT vendors, hospitals, and clinicians are simply merging them into a logical convergence--"CPOE on a handheld"--with an expectation of full functionality on all platforms: computer workstations, rolling laptops, tablet PCs, and handheld devices. For these trends to succeed together, however, this expectation must be revised to establish a distinct category--mobile physician order entry (MPOE)--that is different from CPOE in form, function, and implementation.

Clinical Pharmacy Information Systems↗

PubMed2006

DEC-net: the development of the European register of clinical trials on medicines for children.

BACKGROUND: The need to register a clinical trial in a public database has been widely discussed in the last few years. Several general clinical trial registers have been developed, but none are dedicated to children. A web-based register of trials on drug therapy in children was therefore developed. PURPOSE: The general objective of the project, called DEC-NET (European register of clinical trials on medicines for children - drug evaluation in children) and supported by the European Community, is to provide the scientific community with a flexible tool for promoting communication and collaboration among researchers, disseminating clinical trial results and facilitating patient access and recruitment to trials. METHODS: We identified a set of trial data to be collected, including general trial information, recruitment information, eligibility criteria, clinical trial characteristics, location and contact information, study drugs, study sponsor and results. The system was set up to allow authorized users (working in Italy, Spain, France and UK) to enter, handle and monitor the trial information. Medical data dictionaries (ie, ICD-9 and ATC) were used in order to make the data-entry and the search and data analysis procedures easier. A multilingual approach in data handling and presentation made accessing trial information in English and in the language of the country where the study is located feasible. Search and browsing tools were set up to allow investigators, researchers, and citizens to freely search and browse the entire register and access the details of trials meeting the search criteria. RESULTS: The DEC-net register (http://www.dec-net.org) was opened for trial notification and consultation. LIMITATIONS: DEC-net currently involves four European countries and is a pilot project. CONCLUSIONS: It is hoped that what has been achieved so far represents only the beginning of a long-term project, and the next step will be to extend the register's use to other European countries.

Child↗

PubMed1995

The deployment of a World Wide Web (W3) based medical information system.

The development of Web technologies has revolutionized information dissemination on the Internet. The University of Minnesota Hospital and Clinic's Web Clinical Information System (CIS) demonstrates the use of the Web as an infrastructure for deploying a medical information system at a fraction of the developmental cost of more traditional client server systems. This Web CIS has been deployed since December 1994. It makes available laboratory results, including a radically improved clinical microbiology reporting system, ad hoc laboratory order entry, and an embedded expert system protocol laboratory ordering system. It provides these services to any physician or patient care area with TCP (or SLIP/PPP) connection to our hospital network backbone, whether the client computer is running MS Windows, the Macintosh OS, or X-Windows. A formal evaluation of one of this systems subcomponents, the display of clinical microbiology information, demonstrated a significant savings in clinician time (43% p < .001) and substantial reduction in interpretive errors (0 vs 15 p < .01).

Clinical Laboratory Information Systems↗

PubMed2002

Mobile computing acceptance grows as applications evolve.

Handheld devices are becoming more cost-effective to own, and their use in healthcare environments is increasing. Handheld devices currently are being used for e-prescribing, charge capture, and accessing daily schedules and reference tools. Future applications may include education on medications, dictation, order entry, and test-results reporting. Selecting the right handheld device requires careful analysis of current and future applications, as well as vendor expertise. It is important to recognize the technology will continue to evolve over the next three years.

Clinical Pharmacy Information Systems↗

PubMed2005

Comprehensive analysis of a medication dosing error related to CPOE.

This case study of a serious medication error demonstrates the necessity of a comprehensive methodology for the analysis of failures in interaction between humans and information systems. The authors used a novel approach to analyze a dosing error related to computer-based ordering of potassium chloride (KCl). The method included a chronological reconstruction of events and their interdependencies from provider order entry usage logs, semistructured interviews with involved clinicians, and interface usability inspection of the ordering system. Information collected from all sources was compared and evaluated to understand how the error evolved and propagated through the system. In this case, the error was the product of faults in interaction among human and system agents that methods limited in scope to their distinct analytical domains would not identify. The authors characterized errors in several converging aspects of the drug ordering process: confusing on-screen laboratory results review, system usability difficulties, user training problems, and suboptimal clinical system safeguards that all contributed to a serious dosing error. The results of the authors' analysis were used to formulate specific recommendations for interface layout and functionality modifications, suggest new user alerts, propose changes to user training, and address error-prone steps of the KCl ordering process to reduce the risk of future medication dosing errors.

Aged↗

PubMedDate not supplied

Mapping the future of hospital information systems: priorities for nursing applications.

The purpose of this study was to determine the value of computerized applications to nurse users in a large acute-care university-affiliated hospital. A hospital information system has been in place since 1983. A convenience sample of 77 staff nurses and 33 nurse managers from various clinical areas rated the benefits for decision making and patient care of approximately 19 existing automated applications, and prioritized for future acquisition, approximately 40 applications not currently available. Results of the study revealed that of the applications currently automated, respondents ranked the applications of results reporting, order entry, nursing station census, and message switching as most useful for decision making and patient care. Applications identified as high priorities for future acquisition were on-line charting, automated medication record, and enhanced results reporting.

Adult↗

PubMed2004

In pursuit of a safe Canadian healthcare system.

This paper provides evidence that Canada's healthcare system is not as safe as it needs to be, and suggests ways to make it safer. Healthcare leaders must recognize that patient safety is indistinguishable from the delivery of high quality, affordable healthcare, and they must become more knowledgeable about the extent of the patient safety problem in Canada. The creation of a Patient Safety Board, modelled after Canada's Transportation Safety Board, will provide the authority healthcare leaders require to reduce medical errors. Without a national Patient Safety Board we cannot efficiently and effectively identify, quantify and address medical errors in Canada. This paper also urges healthcare leaders to recognize that a fundamental tool in improving patient safety is the electronic health record (EHR). Return on investment data for a national EHR strategy are presented. The author focuses on three EHR initiatives: outpatient electronic prescribing; in-patient computerized physician order entry; and home-based diabetes disease management. Potential net savings to Canada from these three EHR initiatives alone approach $2 billion annually. We must accelerate our EHR investment. Coordinated national EHR initiatives will cost less, save lives and prevent harm when compared to the status quo. These initiatives will also provide the foundation for transforming our healthcare system and will assist in building a better-educated, healthier and therefore more economically competitive nation.

Canada↗