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PubMedDate not supplied

Maintaining confidentiality of computerized medical records.

One of the most basic medical values is the sanctity of the doctor/patient relationship and the confidentiality of the communication between the physician and the patient. Another important medical tradition is the production and maintenance of an accurate medical record. In today's health care market, the needs of the payers, the providers and the patients have driven the development of the computerized patient record. the primary advantage of a computerized medical record is the ability to store vast amounts of information and handle the data more efficiently. Such speedy access to data can benefit patient care, but it also threatens the patient's privacy and right to confidentiality. Security of the computerized record poses more of a challenge than protecting the traditional paper chart. There currently is no comprehensive federal legislation dealing with the privacy of a citizen's electronic medical record. It may be necessary to sacrifice some individual privacy in order to receive the benefits of a computerized record. Risks to this confidentiality are many, but can be generally, but not totally, controlled. Acceptable responses to these threats combine technological and practical measures. It is the provider's responsibility to inform his patients of the limitations of security measures and to warn them of the potential threats to maintaining confidentiality of the medical record.

Confidentiality↗
PubMed2002

Hierarchical data security in a Query-By-Example interface for a shared database.

Whenever a shared database resource, containing critical patient data, is created, protecting the contents of the database is a high priority goal. This goal can be achieved by developing a Query-By-Example (QBE) interface, designed to access a shared database, and embedding within the QBE a hierarchical security module that limits access to the data. The security module ensures that researchers working in one clinic do not get access to data from another clinic. The security can be based on a flexible taxonomy structure that allows ordinary users to access data from individual clinics and super users to access data from all clinics. All researchers submit queries through the same interface and the security module processes the taxonomy and user identifiers to limit access. Using this system, two different users with different access rights can submit the same query and get different results thus reducing the need to create different interfaces for different clinics and access rights.

Computer Security↗
PubMed1999

Electronic access to mouse tumor data: the Mouse Tumor Biology Database (MTB) project.

The Mouse Tumor Biology (MTB) Database supports the use of the mouse as a model system of hereditary and induced cancers by providing electronic access to: (i) tumor names and classifications, (ii) tumor incidence and latency data in different strains of mice, (iii) tumor pathology reports and images, (iv) information on genetic factors associated with tumors and tumor development, and (v) references (published and unpublished data). This resource has been designed to aid researchers in such areas as choosing experimental models, reviewing patterns of mutations in specific cancers, and identifying genes that are commonly mutated across a spectrum of cancers. MTB also provides hypertext links to related on-line resources and databases. MTB is accessible via the World Wide Web at http://tumor.informatics.jax.org. User support is available for MTB by Email at mgi-help@informatics.jax.org

Age of Onset↗
PubMed1998

[Epidemiologic studies among foreign immigrants in Germany--rational and obstacles].

About 7.2 million foreign nationals are living in Germany. Only few epidemiological studies have assessed their health status, unlike in other countries with large migrant populations. Hence, it is not known whether foreigners in Germany experience special health risks and whether there is a need for specific public health interventions. The size of the group (9% of the total population) and their increasing length of stay further emphasise the need for epidemiological research on migrants. In this article we describe the obstacles for such studies in Germany: difficulties in characterising the group of interest; problems of availability and accessibility of data sources; and aspects of data protection. Minor changes in mortality statistics and improved access to existing data sources within the limits of data protection would improve research opportunities.

Data Collection↗
PubMed2006

An 'Honest Broker' mechanism to maintain privacy for patient care and academic medical research.

PURPOSE: From the Hippocratic Oath to the World Medical Association's Declaration of Geneva, physicians have sworn to protect patients' privacy. However, as systems move to more integrated architectures, protecting this medical data becomes more of a challenge. The increase in complexity of IT environments, the aggregation of data, and the desire of other entities to access this data, often 24 h/day x 7 day/week x 365 day/year, is putting serious strains on our ability to maintain its security. This problem cuts across all electronic record sources from patient care records to academic medical research records. APPROACH: In order to address this issue, we are rethinking the way we store, transmit, process, access, and federate patient data from clinical and research applications. Our groups at the University of Michigan are developing a system called the "Honest Broker" to help manage this problem. The Honest Broker will offload the burden of housing identifiable data elements of protected health information (PHI) (e.g., name and address) as well as manage data transfer between clinical and research systems. Lab results and other non-identifiable data will be stored in separate systems with either a research study ID or clinical ID number. This two-component architecture increases the burden on attackers who now need to compromise two systems, one of which is seriously hardened, in order to match health data with a patient's actual identity. CONCLUSIONS: While no security system is truly intrusion-proof, this architecture provides a high security choke point reducing the likelihood of a breach. By redesigning the method of integrating clinical care and research, we have enabled projects that would be cost prohibitive to conduct otherwise. The scalability of this mechanism is dependant on nature of the heterogenous nature of the clinical systems serving patients.

Biomedical Research↗
PubMed2005

Patient data synchronization process in a continuity of care environment.

In a distributed patient record environment, we analyze the processes needed to ensure exchange and access to EHR data. We propose an adapted method and the tools for data synchronization. Our study takes into account the issue of user rights management for data access and decreasing the amount of data exchanged over the network. We describe a XML-based synchronization model that is portable and independent of specific medical data models. The implemented platform consists of several servers, of local network clients, of workstations running user's interfaces and of data exchange and synchronization tools.

Access to Information↗
PubMed2003

On-line measurement data of wastewater systems via WAP mobile phones.

In order to support the operation of wastewater systems a system was developed which allows us to access plant data by standard mobile devices such as WAP mobile phones. This system is suited complement the standard application of alarm and message systems based for example on SMS or pager services. This technology provides useful options for mobile remote monitoring and remote control of automated plants. This technology is particularly appropriate for the use in remote facilities where no staff is available. The technology has been implemented succesfully and shows how standard IT and Internet technologies can be utilised to support the operation of spatially distributed plants with reasonable effort. Two implementations are presented which access plant data via WAP mobile phones and via mobile pocket PCs. First application experiences are presented.

Automation↗
PubMed2000

Role-based access to patients clinical data: the InterCare approach in the region of Crete.

The basics of a particular Integrated Electronic Health Record (I-EHR) implementation are presented, as realised by the Patient Clinical Data Directory (PCDD) system. PCDD operates within the context of HYGEIAnet, the Integrated Healthcare Telematics Network of Crete. PCDD is based on a federation of autonomous information systems and provides to its authorized users alternative views of the health record as well as access and retrieval services to its geographically distributed segments. The data model of the PCDD is based on the Subjective Objective Assessment Plan (SOAP) model that originates from the primary healthcare domain. Access to detailed information on particular patients healthcare encounters is delivered via role-based authorization privileges and controls. The administration of the national healthcare organizations' business rules, for different user-groups, is made via a specially tailored and developed rule-editor.

Computer Security↗
PubMed2000

Medical confidentiality and electronic patient files.

When considering electronic patient files some conditions have to be respected. They are, in particular, confidentiality and informed consent by the patient. Furthermore, undue access to data can be prevented by PET, access authorization and the like. Patients should be allowed to exert control over their medical data. National and international good privacy practice guidelines should be drawn up in order to avoid privacy-erosion.

Computer Security↗
PubMed2001

Computerized clinical documentation system in the pediatric intensive care unit.

BACKGROUND: To determine whether a computerized clinical documentation system (CDS): 1) decreased time spent charting and increased time spent in patient care; 2) decreased medication errors; 3) improved clinical decision making; 4) improved quality of documentation; and/or 5) improved shift to shift nursing continuity. METHODS: Before and after implementation of CDS, a time study involving nursing care, medication delivery, and normalization of serum calcium and potassium values was performed. In addition, an evaluation of completeness of documentation and a clinician survey of shift to shift reporting were also completed. This was a modified one group, pretest-posttest design. RESULTS: With the CDS there was: improved legibility and completeness of documentation, data with better accessibility and accuracy, no change in time spent in direct patient care or charting by nursing staff. Incidental observations from the study included improved management functions of our nurse manager; improved JCAHO documentation compliance; timely access to clinical data (labs, vitals, etc); a decrease in time and resource use for audits; improved reimbursement because of the ability to reconstruct lost charts; limited human data entry by automatic data logging; eliminated costs of printing forms. CDS cost was reasonable. CONCLUSIONS: When compared to a paper chart, the CDS provided a more legible, compete, and accessible patient record without affecting time spent in direct patient care. The availability of the CDS improved shift to shift reporting. Other observations showed that the CDS improved management capabilities; helped physicians deliver care; improved reimbursement; limited data entry errors; and reduced costs.

Child↗
PubMedDate not supplied

Data collection strategies for accessing adolescent women's worlds.

A two-year study was initiated in 1999 to investigate adolescent women's health concerns pertaining to their relationships. Data were obtained from four groups of girls (ages 14-19; N = 31) that met for approximately 18 weeks each. To help equalize power in the groups and facilitate a respectful and caring environment, we encouraged each group to use a variety of strategies, including those based on feminist principles. Data collection procedures based on feminist values can enable researchers to gain rich descriptions on the lived experience of adolescent women. Such procedures can help create an environment in which individuals can articulate their concerns and collectively co-construct the meanings of life events in health-promoting and consciousness-raising ways.

Adolescent↗
PubMedDate not supplied

Improving child support enforcement for children receiving SSI.

Less than half of all children who receive Supplemental Security Income (SSI) benefits and live in a single-parent home receive child support services. Although filing for child support is a condition of eligibility for income assistance programs such as Temporary Assistance for Needy Families (TANF), it is not a condition of eligibility for SSI benefits. Requiring single custodial parents applying for SSI on behalf of their children to pursue child support payments might result in more children on SSI receiving child support, and since the Social Security Administration (SSA) excludes one-third of child support when determining benefit amounts, increased receipt of child support would enhance the financial well-being of SSI children. Improving access to data on child support would enhance the integrity of the SSI program by reducing overpayments to children receiving child support. This article looks at the child support provisions in SSI and other means-tested programs and discusses policy options for improving receipt of child support and access to related data. Requiring cooperation with child support enforcement agencies would be consistent with the philosophy that the SSI program should serve as a program of last resort. Whenever possible, both parents should take primary responsibility for their children. While such a requirement has the potential to improve the financial status of children receiving SSI, factors such as their low-income status and their involvement with the TANF program raise questions about how much those children will actually benefit from such a requirement. Even if many additional children do not receive child support, the requirement demonstrates SSA's dedication to the stewardship of the SSI program. However, if custodial parents fail to comply with the requirement, children may be worse off as a result of the requirement. SSA should carefully pursue a requirement to induce cooperation while protecting children to the greatest extent possible. Improving access to child support data would enhance the integrity of the SSI program by reducing overpayments to children receiving child support. Given the reality of limited administrative resources as well as the apparent difficulties of gaining access to the needed child support data, SSA must decide which data matches to pursue and which requirements enhance the program enough to justify the additional resources. Although the options discussed in this article may be chosen independently, there are important interactions to consider. For example, although a requirement to pursue support might result in more children receiving child support, SSA would still rely on parents to report that income unless it was able to gain better access to child support data. Implementing the option to require cooperation with child support enforcement (CSE) agencies could improve verification of income from child support if field offices developed better communication with local CSE offices. However, by itself, it would not have as great an effect on overpayments as would having direct access to child support data. In a 1999 report, the General Accounting Office acknowledged that the potential benefit reductions would be offset by the cost for SSA to administer a child support cooperation requirement and by the costs to the CSE programs to provide services. The report suggested that the goals of promoting parental responsibility and increasing the income of children receiving SSI should be pursued despite the costs. Requiring cooperation may increase administrative costs by $6 million over 5 years and may result in program savings. Gaining access to data may be more expensive and may not prevent overpayments to the same extent as other data-matching workloads on which SSA has placed a priority. SSA should continue to work with federal child support enforcement and with individual states to develop a cost-effective way to identify child support income.

Child↗
PubMed2002

tGRAP, the G-protein coupled receptors mutant database.

The searchable mutant database tGRAP (previously called tinyGRAP) at the University of Tromsø contains data on mutated G-protein coupled receptors (GPCRs). All data have been extracted from scientific papers and entered manually into the database. The current version of the tGRAP mutant database (tGRAP.uit.no, release 10, April 2001) contains around 10 500 mutants extracted from almost 1400 research papers containing mutant data on five families of GPCRs, i.e. Family A, rhodopsin-like; Family B, secretin-like; Family C, metabotropic glutamate-like; Family D, pheromone; Family E, cAMP receptors. A query form provides rapid and simple access to relevant mutant information. In addition to this query form, a tool that enables the user to access mutation data via sequence alignments has been introduced. The ability to access mutant data from such alignments increases the usefulness of the mutant database and facilitates comparison of mutagenesis data between receptors. Moreover, this tool allows the construction of tailor-made sequence alignment views from any combination of receptors belonging to the same class. The database is available at http://tGRAP.uit.no/.

Amino Acid Sequence↗
PubMed2006

TCDB: the Transporter Classification Database for membrane transport protein analyses and information.

The Transporter Classification Database (TCDB) is a web accessible, curated, relational database containing sequence, classification, structural, functional and evolutionary information about transport systems from a variety of living organisms. TCDB is a curated repository for factual information compiled from >10,000 references, encompassing approximately 3000 representative transporters and putative transporters, classified into >400 families. The transporter classification (TC) system is an International Union of Biochemistry and Molecular Biology approved system of nomenclature for transport protein classification. TCDB is freely accessible at http://www.tcdb.org. The web interface provides several different methods for accessing the data, including step-by-step access to hierarchical classification, direct search by sequence or TC number and full-text searching. The functional ontology that underlies the database structure facilitates powerful query searches that yield valuable data in a quick and easy way. The TCDB website also offers several tools specifically designed for analyzing the unique characteristics of transport proteins. TCDB not only provides curated information and a tool for classifying newly identified membrane proteins, but also serves as a genome transporter-annotation tool.

Databases, Protein↗
PubMed2000

ASHP national survey of pharmacy practice in acute care settings: dispensing and administration--1999.

Results of the 1999 ASHP national survey of pharmacy practice in acute care settings that pertain to drug dispensing and administration practices are presented. Pharmacy directors at 1050 general and children's medical-surgical hospitals in the United States were surveyed by mail. The response rate was 51%. About three-fourths of respondents described their inpatient pharmacy's distribution system as centralized. Of those with centralized distribution, 77.4% indicated that their system was not automated. Decentralized pharmacists were used in 29.4% of the hospitals surveyed; an average of 58.9% of their time was spent on clinical, as opposed to distributive, activities. About 67% of directors reported pharmacy computer access to hospital laboratory data, 38% reported access to automated medication-dispensing-unit data, and 19% reported computer access to hospital outpatient affiliates. Only 13% of hospitals had an electronic medication order-entry system; another 27% reported they were in the process of developing such a system. Decentralized medication storage and distribution devices were used in 49.2% of hospitals, while 7.3% used bedside information systems for medication management. Machine-readable coding was used for inpatient pharmacy dispensing by 8.2% of hospitals. Ninety percent reported a formal, systemwide committee responsible for data collection, review, and evaluation of medication errors. Virtually all respondents (98.7%) reported that their staff initiated manual reports. Only two thirds tracked these reports and reported trends to the staff. Fewer than 15% reported that staff were penalized for making or contributing to an error. Pharmacists are making a significant contribution to the safety of medication distribution and administration. The increased use of technology to improve efficiency and reduce costs will require that pharmacists continue to focus on the impact of changes on the safety of the medication-use system.

Ambulatory Care↗
PubMed1997

The impact of anticipatory patient data displays on physician decision making: a pilot study.

Computerized patient records have long offered the promise of facilitated access to patient data for clinical decision-making. Nonetheless, the decision process benefits of improved patient data access have been poorly quantified by prior informatics research. We conducted a pilot study to test the feasibility of study methods and gather data for the planning of a future clinical trial designed to assess the impact of patient data summary displays on serum lipid test interpretation time, on targeted data retrieval time for related data, and on decision quality. The pilot demonstrated feasibility and high face validity of the decision-making simulation methods used. Problem-focused patient data summaries appear to reduce time-based decision performance measures by 40-50%, and may improve decision quality even without the inclusion of knowledge-based recommendations or guideline representations.

Data Display↗
PubMed2000

7th International HUGO Mutation Database Meeting, October 19, 1999, San Francisco, USA.

The 7th International HUGO Mutation Database Meeting was held on October 19, 1999 in conjunction with the annual meeting of the American Society of Genetics in San Fransisco, California, U.S.A. Meeting highlights are described, including discussions of topics such as the ethical aspects of variation databases, ethical guidelines which should be established immediately, data protection laws which may affect access to data, and plans to make variation databases financially self-sustaining. A resolution was passed which encourages HUGO and Mutation database Initiative (MDI) collaboration (under the name HUGO-MDI) to provide an integrated, properly funded system of variation databases.

Alleles↗