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At least 595 records · Page 33Linked to original sources

PubMed2001

XML-based application interface services--a method to enhance integrability of disease specific systems.

Disease specific systems usually offer excellent functionality for the management of the covered diseases. But the restriction to a certain disease also often hampers their wide spread use since they aren't optimised for clinical workflow. The Giessener Tumordokumentationssystem (GTDS) is such a disease specific system. It is not only designed for the use in tumour registries but also to support clinical care. In order to integrate it into hospital information systems, we implemented standard communication interfaces, but this measure is not sufficient since it doesn't consider aspects of the normal workflow of a clinical user. Therefore, we developed a strategy that should ease the access to the system in the environment of existing systems. From the technical point of view, XML with its capabilities to represent even complex data in a rather simple way helped to implement this strategy. We use it to communicate with API-like services and also created a WWW environment to demonstrate the access to these services. Since this environment itself is a means to integrate systems, we intend to expand this environment to an appropriate region based means to improve the communication with registries. multidisciplinary environments [3]. The large amount of useful functions and its adaptability has made GTDS (http://www.gtds.de) a successful system in more than 30 various registries.

Computer Communication Networks↗

PubMedDate not supplied

Increased productivity of a digital imaging system: one hospital's experience.

During peak hours of operation, it was not uncommon for the radiology department at St. Luke's Episcopal Hospital in Houston, Texas, to have a backlog of six to ten patients. While some of this was due to competing schedules from the emergency department (ED) and inpatients, the major problem was an inefficient workflow, especially for emergency department patients. Our staff in the radiology department worked with the hospital management to include plans for a new radiology room in an ED renovation project. In designing the new radiology room the most important issues under consideration were the physical location of the room and the type of radiography system to be installed. With plans to implement PACS, we evaluated computed radiography and digital radiography options. At St. Luke's, we had had our first experience with digital radiography after the purchase of a dedicated digital chest system. As a beta test site for the manufacturer, we had an opportunity to test--what was at the time--a new digital radiography system. The powerful impact of digital radiography became most evident by the decreased patient backlog. Even without PACS, workflow became dramatically more efficient. Images now are available for review within seconds after exposure, since there are no films to process. This has reduced our average exam time from ten minutes to one and a half minutes, not including patient transport time. The efficiency demonstrated with the digital chest system provided evidence that digital systems could handle significantly more patients than computed radiography or screen-film systems, without a compromise in image quality. Therefore, we decided to put a digital radiography system in the new ED radiology room. We estimate that the new unit will pay for itself in less than three years.

Efficiency, Organizational↗

PubMed2001

Evaluation of a filmless radiology pilot--a preliminary report.

The development of the Multimedia Electronic Medical Record System (MEMRS) promises new opportunities to significantly reduce the routine use of film as the medium for viewing radiological medical images. The effect of this change to digital media on physician workflow and the perceived value and utility of medical images is an area of ongoing investigation. In this study we examined oncology clinicians use of medical images in a MEMRS. We conducted observational studies of clinicians during a filmless radiology pilot study in which a filmless environment was simulated but the actual film was available on request. This observational study was the first step in a comprehensive evaluation designed to elucidate the issues surrounding the implementation of a filmless radiology environment. We identified and examined several of these issues, including physician concern regarding the utility of digital images for clinical use and comparison with film, the need to address the effects of image compression with clinicians, and the workflow changes necessary to incorporate digital image use into a clinical practice.

Attitude of Health Personnel↗

PubMed2002

Picture archiving and communication systems.

Picture archiving and communication systems (PACS) are highly versatile data storage and retrieval systems that facilitate the transfer of digital images and patient data throughout a healthcare enterprise. Typically, they process images from diagnostic imaging modalities and are interfaced to radiology information systems (RISs) and hospital information systems (HISs) to help create a single patient record and improve overall workflow. For this Update Evaluation, we tested eight PACS from eight major suppliers. Ideally, a PACS should allow the facility to achieve a fully automated workflow, in which patient data could move seamlessly from one system to another in a single electronic medical record. Although our testing found that this ideal has not yet been realized, many of the evaluated systems have taken significant steps in that direction. Three of the systems covered in this issue were originally tested for our November 2000 Evaluation. Because PACS technology evolves so rapidly, we haven't simply provided updated data on these three systems, as we customarily would for an Update Evaluation. Instead, we have reexamined the systems from top to bottom and are presenting the results in brand-new Product Profiles, alongside the profiles for the five other systems evaluated here for the first time.

Computer Communication Networks↗

PubMedDate not supplied

Non-punctual patients: planning for variability in appointment arrival times.

Tighter competition and rationed resources place a premium on health clinic management of patient arrival times to maximize smooth workflow dynamics and consistency in patient processes. Early efforts to analyze patient arrival characteristics relied on assumptions that may have been too simplistic. For instance, it was assumed that a scheduled patient's arrival was likely to fit a bell-shaped curve in terms of being early, late, or on time and that any one patient's likelihood of being "on time" was purely a random event. However, our analysis of patient arrival times, obtained from detailed workflow observations in nine community clinics, indicates that the likelihood of a patient arriving early, late, or on time is neither entirely random nor does the pattern of arrivals fit a bell-shaped curve. Rather, patients tend to arrive in "clumps," possibly due to factors such as traffic patterns and parking availability. These findings are important with respect to 1) clinic practice management, 2) scheduling optimization strategies, and 3) computer simulation and analysis of clinic processes.

Appointments and Schedules↗

PubMed2002

Electronic signature for medical documents--integration and evaluation of a public key infrastructure in hospitals.

OBJECTIVES: Our objectives were to determine the user-oriented and legal requirements for a Public Key Infrastructure (PKI) for electronic signatures for medical documents, and to translate these requirements into a general model for a signature system. A prototype of this model was then implemented and evaluated in clinical routine use. METHODS: Analyses of documents, processes, interviews, observations, and of the available literature supplied the foundations for the development of the signature system model. Eight participants of the Department of Dermatology of the Heidelberg University Medical Center evaluated the implemented prototype from December 2000 to January 2001, during the course of an intervention study. By means of questionnaires, interviews, observations and database analyses, the usefulness and user acceptance of the electronic signature and its integration into electronic discharge letters were established. RESULTS: Since the major part of medical documents generated in a hospital are signature-relevant, they will require electronic signatures in the future. A PKI must meet the multitude of responsibilities and security needs required in a hospital. Also, the signature functionality must be integrated directly into the workflow surrounding document creation. A developed signature model, fulfilling user-oriented and legal requirements, was implemented using hard and software components that conform to the German Signature Law. It was integrated into the existing hospital information system of the Heidelberg University Medical Center. At the end of the intervention study, the average acceptance scores achieved were mean = 3.90; SD = 0.42 on a scale of 1 (very negative attitude) to 5 (very positive attitude) for the electronic signature procedure. Acceptance of the integration into computer-supported discharge letter writing reached mean = 3.91; SD = 0.47. On average, the discharge letters were completed 7.18 days earlier. CONCLUSION: The electronic signature is indispensable for the further development of electronic patient records. Application-independent hard and software components, in accordance with the signature law, must be integrated into electronic patient records, and provided to certification services using standardized interfaces. Signature-oriented workflow and document management components are essential for user acceptance in routine clinical use.

Authorship↗

PubMedDate not supplied

PACS support: the radiology approach.

In 1999, Rex Healthcare, a 394-bed facility located in Raleigh, N.C., faced a growing problem. The radiology department was performing a total of 130,000 procedures a year, running out of space to store the film, and having trouble managing the file room. While the IT department was focused on the Y2K scare, radiology forged ahead with a plan to implement PACS on its own at Rex Hospital. Rex had installed a mini-PACS system for ultrasound in 1996, but there was no internal support for the system's hardware or software. Being the first in the area to implement PACS, Rex wasn't able to recruit anyone locally to support the system, so they decided to take two areas that PACS had a great impact on and use their own people. The director of radiology asked the RIS analyst and the Film Library manager, both of whom were registered technologists, to implement and support the PAC system. The key to PACS support is not computer knowledge, although it helps. The key is to understand the radiology department as a whole and the workflow from within, which makes it hard to fully support from an IT perspective. The current PACS team at Rex is composed of a PACS analyst, system support specialist and an electronic imaging center manager. When we went live with PACS, it was obvious that not all of the existing file room personnel would make the technology leap, which they realized themselves. We didn't push anybody out, but we did raise the bar of expectations. By redefining job descriptions and having the EITs (electronic imaging technologists) become more involved, increased respect was quite evident among the hospital staff. The clerks that once only hung and filed films are now troubleshooting CD burners, teaching physicians the PACS, and filming necessary exams. The final key to success is to take ownership of your system. By taking ownership, I mean that a PACS team should be established to do troubleshooting and first-line support, know the servers and application, and feel comfortable performing daily checks and tasks. Being an advanced radiology PACS site in our area, we have become an important facility for site visits. We take site visits very seriously, and have composed a package that includes information about the hospital, network/modality diagrams, EIT job descriptions, PACS information and various time studies that we have completed since going firmless. An administrator with a vision and strong support from within will get a PACS up and running, but ongoing upkeep requires a team that is dedicated to the success of the project. By taking ownership of the system and following the keys to success, a department has the ability to reengineer radiology workflow not just in the hospital, but in the community as well.

Hospital Bed Capacity, 300 to 499↗

PubMed2003

Gene expression databases and data mining.

The DNA microarray technology has arguably caught the attention of the worldwide life science community and is now systematically supporting major discoveries in many fields of study. The majority of the initial technical challenges of conducting experiments are being resolved, only to be replaced with new informatics hurdles, including statistical analysis, data visualization, interpretation, and storage. Two systems of databases, one containing expression data and one containing annotation data are quickly becoming essential knowledge repositories of the research community. This present paper surveys several databases, which are considered "pillars" of research and important nodes in the network. This paper focuses on a generalized workflow scheme typical for microarray experiments using two examples related to cancer research. The workflow is used to reference appropriate databases and tools for each step in the process of array experimentation. Additionally, benefits and drawbacks of current array databases are addressed, and suggestions are made for their improvement.

Breast Neoplasms↗

PubMed2003

An implementation of a virtual patient record using Web services.

Virtual patient records provide a means for integrated access to patient information that may be scattered around different healthcare settings. Within the boundaries of a health district providing all levels of care, this concept can be implemented in a corporate Intranet environment to support longitudinal patient care activities across the participating healthcare providers. In this context, a virtual patient record implementation enables autonomous healthcare providers to operate in a cooperative working environment and apply continuity of care. Workflow and web services technologies provide an appropriate infrastructure for satisfying collaboration and coordination requirements by integrating heterogeneous healthcare applications and by automatically routing the medical information needed to authorized actors in a healthcare process. This paper presents a virtual patient record architecture that allows integrating geographically dispersed medical information within a health district and enhancing collaboration and coordination of authorized workgroups using workflow and web services technologies. An implementation of the proposed architecture is also presented.

Efficiency, Organizational↗

PubMed2003

Using adaptive turnaround documents to electronically acquire structured data in clinical settings.

We developed adaptive turnaround documents (ATDs) to address longstanding challenges inherent in acquiring structured data at the point of care. These computer-generated paper forms both request and receive patient tailored information specifically for electronic storage. In our pilot, we evaluated the usability, accuracy, and user acceptance of an ATD designed to enrich a pediatric preventative care decision support system. The system had an overall digit recognition rate of 98.6% (95% CI: 98.3 to 98.9) and a marksense accuracy of 99.2% (95% CI: 99.1 to 99.3). More importantly, the system reliably extracted all data from 56.6% (95% CI: 53.3 to 59.9) of our pilot forms without the need for a verification step. These results translate to a minimal workflow burden to end users. This suggests that ATDs can serve as an inexpensive, workflow-sensitive means of structured data acquisition in the clinical setting.

Ambulatory Care Information Systems↗

PubMed2003

Bioinformatics for medical diagnostics: assessment of microarray data in the context of clinical databases.

MOTIVATION: To identify genes suitable for medical diagnostics microarray data is assessed in the context of clinical databases, which store complex information about the patient phenotype. The wealth of data and lacking standards make it difficult to analyse this kind of data. RESULTS: We present a workflow for exploratory analysis of microarray data together with clinical data consisting of four steps: definition of clinically meaningful research questions in a masterfile, generation of analysis files, selection and characterization of differentially expressed genes, and estimation of classification accuracy. We applied this workflow to large data sets from the field of cardiology and oncology (n~500 patients). Systematic data management of microarray data and clinical data helps to make results more transparent and comparable.

Cardiology↗

PubMed2003

A framework for classifying decision support systems.

BACKGROUND: Computer-based clinical decision support systems (CDSSs) vary greatly in design and function. A taxonomy for classifying CDSS structure and function would help efforts to describe and understand the variety of CDSSs in the literature, and to explore predictors of CDSS effectiveness and generalizability. OBJECTIVE: To define and test a taxonomy for characterizing the contextual, technical, and workflow features of CDSSs. METHODS: We retrieved and analyzed 150 English language articles published between 1975 and 2002 that described computer systems designed to assist physicians and/or patients with clinical decision making. We identified aspects of CDSS structure or function and iterated our taxonomy until additional article reviews did not result in any new descriptors or taxonomic modifications. RESULTS: Our taxonomy comprises 95 descriptors along 24 descriptive axes. These axes are in 5 categories: Context, Knowledge and Data Source, Decision Support, Information Delivery, and Workflow. The axes had an average of 3.96 coded choices each. 75% of the descriptors had an inter-rater agreement kappa of greater than 0.6. CONCLUSIONS: We have defined and tested a comprehensive, multi-faceted taxonomy of CDSSs that shows promising reliability for classifying CDSSs reported in the literature.

Classification↗

PubMed2003

Smaller and faster: using a handheld computer to support a bedside vascular access team.

An application for a handheld computer was developed to support the Vascular Access team in an academic medical center. The development involved workflow analysis and usability testing centered on the users. The application interfaced with the desktop to generate the documentation needed for the charts and to populate the database used to track productivity, volume, outcomes, etc. Post-implementation evaluations provided feedback to validate the utility of the system to support workflow of the team.

Catheterization, Central Venous↗

PubMedDate not supplied

The impact of tech aides in radiology.

As the staffing shortage continues to impact radiology departments and outpatient imaging centers, managers look for ways to solve staffing issues internally. Lehigh Valley Hospital and Health Network investigated the feasibility of adding a position of radiology tech aide. This proposal was driven by a desire to improve retention of staff, improve employee satisfaction and reduce turnover. A 6-month pilot program was conducted at the network's highest-volume facility. One tech aide underwent extensive training and eventually began performing some of the tasks identified in the analysis. Each area within radiology worked with an intern to identify each step in its work process. Each step identified led to the question, "What happens if?" The workflow process provided a detailed look a the number of steps required for a technologist to perform a study from start to finish. In May 2002, the administrator submitted a project proposal to management engineering to evaluate radiologic technologists' workloads and identify tasks that could be performed by a tech aide. Activity-Based Management (ABM)--a process that emphasizes activities over resources--was utilized to study work activities. The analysis identified the appropriate tasks and revealed that 5 FTEs were needed to assist the technologists in all areas of radiology. A workflow was completed for each area within radiology. Some areas identified bottlenecks, which caused delays in the process and some redundant work for the staff. Data were presented to the network administration. Staffing realities, labor pool availability within the existing network staff, and detailed task identifications also were provided. A total of 5 FTE tech aides were approved. The final program included in-depth tech-aide training; effective and open communication between management and technologists; and a collaborative, education-oriented relationship between technologists and tech aides.

Appointments and Schedules↗

PubMed2004

[Coxiella burnetii: what is the reality?].

After the Second World War, in Italy Q Fever or Coxiellosis has been shown a significant relevance, a recrudescence with an epidemic state for over ten years. Later, the infectious disease occurred as endemic since the 80s, the outbreaks were just isolated. Workflows analysis of some authors has demonstrated the spread out of the infection throughout Italian herds with a prevalence ranging from 1.2 per cent to 10 per cent. Our survey carried out throughout Campania area in cattle has shown a real positivity over 14 per cent performing the IFAT for the detection of IgG antibodies for Coxiella burnetii. Therefore, it has been so important to stress the influence of cattle farming management in stables as a real risk of Coxiellosis. For example, the Relative Risk (RR) has been registrated about 6.84 (2.18<RR<21.4) in comparison with some herds permanently housed than those kept unhoused and about 8.4 (1.8<RR<38.6) in housed herds and those permanently kept at pasture. Therefore, we have detected a seroprevalence of Q Fever about 11.8 per cent within sheep and about 6.3 per cent within goats. The investigations have focused buffaloes too, tested by several authors, especially from India, but in Italy, only Galiero has recorded significant results: the overall seroprevalence (1.2 per cent) was observed within 1012 buffaloes. Other studies have demonstrated that dogs may transmit Q Fever to humans by infected birth fluids and membranes and by urine. Because of this observation, addressed some of our search projects to assess possible relation among other pathogens, such as Leishmania infantum, Rickettsia conori and Ehrlichia canis. The results have confirmed the presence of C. burnetii (seroprevalence about 7 per cent) within tested dogs in southern Italy. There was no direct estimated relationship between C. burnetii and E. canis and R. conori, instead of significant relation has been shown for L. infantum. The investigation focused on the direct interaction between seropositivity and the age of ruminants. For example, the highest prevalence has been observed in cows and sheep ranging from 3-5 years in which the infection risk was higher than in younger herds. In accordance with the workflows serological analysis, C. burnetii is widespread in Italy among housed ruminants. PCR assay was, therefore performed to test cows with clinical signs of abortion and neonatal mortality. All the survey involved 305 animals (267 foeti and 38 stillborn) with 77 positive herds showing DNA of C. burnetii. To detect C. burnetii pathogen in milk samples, two methods have been combined: the immunomagnetic separation (IMS) and PCR assay, obtaining an increasing of sensitivity (10(-17)) more than only PCR technique (10(-8)). The overall analysis of serological and biomolecular results has demonstrated that C. burnetii is really widespread and may have detrimental effects on farm management system.

Abortion, Veterinary↗

PubMed2004

Modeling and analyzing biomedical processes using workflow/Petri Net models and tools.

Computer simulation enables system developers to execute a model of an actual or theoretical system on a computer and analyze the execution output. We have been exploring the use of Petri Net (PN) tools to study the behavior of systems that are represented using three kinds of biomedical models: a biological workflow model used to represent biological processes, and two different computer-interpretable models of health care processes that are derived from clinical guidelines. We developed and implemented software that maps the three models into a single underlying process model (workflow), which is then converted into PNs in formats that are readable by several PN simulation and analysis tools. These analysis tools enabled us to simulate and study the behavior of two biomedical systems: a Malaria parasite invading a host cell, and patients undergoing management of chronic cough.

Algorithms↗

PubMed2004

A patient-controlled journal for an electronic medical record: issues and challenges.

Partners Healthcare System, Boston, MA, has developed a patient Web portal that features a patient-controlled electronic "journal" to allow patients to interact with their physician's electronic medical record. Patients can view and respond to health reminders, critique electronic chart information maintained by their doctor's office, enter additional clinical information, and prepare information summaries before an office visit. Creating shared information resources to support a collaborative care model required analysis of the business, architectural, and workflow requirements of the patient-controlled clinical portal and the physician-controlled electronic medical record system. In this paper we describe the challenges in aligning the two systems and serving the different user groups. Coupling the Patient Gateway system, serving over 8700 patients of 90 physicians as of September, 2003, with the Longitudinal Medical Record system, serving over 4000 physicians, has required a clear definition of user goals and workflow, well-defined interfaces, and careful consideration of system assumptions to succeed.

Ambulatory Care Information Systems↗

PubMed2004

Picture archiving and communication systems.

Picture archiving and communication systems (PACS) are highly versatile data storage and retrieval systems that facilitate the transfer of digital images and patient data throughout a healthcare enterprise. Typically, they process images from diagnostic imaging modalities and are interfaced to radiology information systems (RISs) and hospital information systems (HISs) to improve overall workflow. For this Evaluation, we tested six PACS from six suppliers. Ideally, a PACS should allow the healthcare facility to achieve a fully automated workflow, in which patient image data is shared seamlessly from one system to another within a single electronic medical record (EMR). Although our testing found that this ideal has not yet been completely realized, many of the evaluated systems have taken significant steps in that direction. This Evaluation was limited to radiology PACS; however, more and more facilities are considering single PACS solutions to cover the needs of all their imaging departments.

Humans↗