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At least 919 records · Page 51Linked to original sources
PubMed2001

The application of ontologies and problem-solving methods for the development of shareable guidelines.

Recently, studies have shown the benefits of using clinical guidelines in the practice of medicine. Computer-based clinical guidelines are increasingly applied in diverse areas such as policy development, utilization management, education, conduct of clinical trials, and workflow facilitation. This paper discusses some of the representations suggested in literature, discusses their weak and strong points, and demonstrates and discusses a new approach that extends earlier developed formalisms by combining primitives, ontologies and the use of problem-solving methods (PSMs). The approach is supported by a framework that facilitates the entire guideline authoring process. The paper demonstrates this framework and presents examples of guidelines, PSMs and systems that were developed by means of this approach. The overall goal of this approach is to improve the acceptance of shareable guidelines and decision support systems in daily care by facilitating the guideline acquisition and execution phases.

Decision Support Systems, Clinical↗
PubMedDate not supplied

Disseminating medical knowledge: the PROforma approach.

Medical knowledge is traditionally disseminated via the publication of documents and through participation in clinical practice. Information technology offers to extend both modes of dissemination, via electronic publishing and virtual reality training, for example. AI promises even more radical changes through the possibility of publishing clinical expertise in the form of expert systems, which assist patient care through active decision support and workflow management. PROforma is a knowledge representation language that is designed to support this new mode of dissemination. It is based on an intuitive model of the processes of care and well-understood logical semantics. This paper provides a description of the language and associated software tools, and discusses its potential roles in, and implications for, medical knowledge publishing.

Artificial Intelligence↗
PubMed2002

DICOM--current status and future developments for radiotherapy.

Today, DICOM is one of the most successful standards in medicine. The standard was developed based on the increasing need for the transfer of digital images between systems of different vendors. Furthermore these images needed to be archived in a system independent format. DICOM has been continuously evolving since the early 80s and is today the main standard in radiology. After the IEC had started an initiative to develop a communication standard for radiotherapy in the late 80s, they joined forces with the DICOM Committee. This led to the foundation of a new working group (Working Group 7--Radiotherapy Objects) that deals with the radiotherapy extensions of DICOM. In 1997 and 1999 the so-called RT extension of DICOM was published, containing seven new objects and related services. Since then all major vendors of systems for radiotherapy have implemented DICOM interfaces that support the DICOM RT extensions. Working Group 7 is currently working on extending the Workflow support for the RT objects. This extension will increase the available services and will improve the handling of DICOM RT data. The developments so far are encouraging and it is hoped that DICOM will be as indispensable in radiotherapy as in radiology.

Germany↗
PubMed1990

Automated differential white cell counts: a critical appraisal.

The differential leukocyte count represents a substantial proportion of the workload in routine haematology laboratories. The traditional procedure, in which a technologist scans a Romanowsky-stained blood film and classifies 100 cells, is both labour-intensive and imprecise. The imprecision of the visual DLC is primarily a function of the small number of cells counted. To achieve a significant improvement, however, it would be necessary to count an enormous number of cells, which would be extremely costly in terms of human time and effort. Automation is thus desirable for both economic and clinical reasons. Of the various technological approaches proposed, only two have been developed to the level of marketable devices: digital image processing, and flow cytochemistry. In digital image processing systems, Romanowsky-stained blood films were scanned by a computer-controlled microscope, and leukocytes identified on the basis of parameters analogous to those used by human observers. These systems were relatively slow, offering only a limited degree of automation, and therefore failed to provide significant improvements in terms of workflow and counting statistics. No such instruments are currently marketed. Flow-cytochemical analysers, which classify leukocytes primarily on the basis of size and myeloperoxidase activity, have been available commercially for 15 years, and their clinical utility is well established. A number of haematology analysers offer screening DLCs, providing neutrophil and lymphocyte counts in cases that do not have major abnormalities of the leukocyte population. The performance of these systems depends in large part on their operating environment. Three new automated DLC analysers employing flow cytometric technology have recently been announced, but these have not yet been formally evaluated.

Autoanalysis↗
PubMed2000

Telemedicine and its impact on cancer management.

The latest dramatic progress in the technologies of the computer industry is likely to increasingly influence the oncologist's daily routine. Besides well known and established telemedical services such as videoconferencing, the most influential trends are the spread of digital hospital infrastructures with unlimited, secured access to all relevant patient information. This article seeks to summarise the most imminent influences of telemedical developments on the future of the oncologist: the effects of telemedical services and electronic infrastructures on clinical workflow and on medical quality management. In addition, the history of telemedicine, recent technologies and the performance of electronic patient records are described.

Computer Security↗
PubMed2003

Technical considerations for the performance of Nucleic acid Amplification Technology (NAT). The NAT Task Force Group.

The complexity of Nucleic acid Amplification Technology (NAT(1)), comprising sample preparation, amplification and detection methods, requires specific design considerations for both the laboratory and the procedures utilized in such testing. The purpose of this paper is to establish technical considerations for the performance of NAT. These include the collection, handling and assay of specimens and the design of laboratories to routinely and reliably detect low levels of nucleic acid sequences. The sensitivity of NAT due to the exponential amplification of nucleic acids makes contamination a major concern from specimen collection to sample detection. Therefore, laboratories need to be designed to prevent and control contamination through adequate equipment and appropriate workflow. These technical considerations should provide a basis for establishing a robust and reproducible NAT system.

Humans↗
PubMed2001

Patient safety and computerized medication ordering at Brigham and Women's Hospital.

BACKGROUND: Medications are important therapeutic tools in health care, yet creating safe medication processes is challenging for many reasons. Computerized physician order entry (CPOE), one important way that technology can be used to improve the medication process, has been in place at Brigham and Women's Hospital (BWH; Boston) since 1993. CPOE AT BWH: The CPOE application, designed and developed internally by the BWH information systems team, allows physicians and other clinicians to enter all patient orders into the computer. Physicians enter 85% of orders, with the remainder entered electronically by other clinicians. CPOE AND SAFE MEDICATION USE: The CPOE application at BWH includes several features designed to improve medication safety--structural features (for example, required fields, use of pick lists), enhanced workflow features (order sets, standard scales for insulin and potassium), alerts and reminders (drug-drug and drug-allergy interaction checking), and adjunct features (the pharmacy system, access to online reference information). RESULTS AT BWH: Studies of the impact of CPOE on physician decision making and patient safety at BWH include assessment of CPOE's impact on the serious medication error and the preventable adverse drug event rate, the impact of computer guidelines on the use of vancomycin, the impact of guidelines on the use of heparin in patients at bed rest, and the impact of dosing suggestions on excessive dosing. CONCLUSION: CPOE and several forms of clinical decision support targeted at increasing patient safety have substantially decreased the frequency of serious medication errors and have had an even bigger impact on the overall medication error rate.

Clinical Pharmacy Information Systems↗
PubMed2004

Financing a large-scale picture archival and communication system.

RATIONALE AND OBJECTIVES: An attempt to finance a large-scale multi-hospital picture archival and communication system (PACS) solely based on cost savings from current film operations is reported. MATERIALS AND METHODS: A modified Request for Proposal described the technical requirements, PACS architecture, and performance targets. The Request for Proposal was complemented by a set of desired financial goals-the main one being the ability to use film savings to pay for the implementation and operation of the PACS. RESULTS: Financing of the enterprise-wide PACS was completed through an operating lease agreement including all PACS equipment, implementation, service, and support for an 8-year term, much like a complete outsourcing. Equipment refreshes, both hardware and software, are included. Our agreement also linked the management of the digital imaging operation (PACS) and the traditional film printing, shifting the operational risks of continued printing and costs related to implementation delays to the PACS vendor. An additional optimization step provided the elimination of the negative film budget variances in the beginning of the project when PACS costs tend to be higher than film and film-related expenses. CONCLUSION: An enterprise-wide PACS has been adopted to achieve clinical workflow improvements and cost savings. PACS financing was solely based on film savings, which included the entire digital solution (PACS) and any residual film printing. These goals were achieved with simultaneous elimination of any over-budget scenarios providing a non-negative cash flow in each year of an 8-year term.

Academic Medical Centers↗
PubMedDate not supplied

Chemical information management in drug discovery: optimizing the computational and combinatorial chemistry interfaces.

Structure-property relationships, central to many of today's drug discovery strategies, are not straightforward to deal with when trying to predict drug efficacy, that is, the combined outcome of target affinity, pharmacodynamic behavior, pharmacokinetic properties, and metabolic fate. In this article, we discuss the handling of chemical property information in reagents-for-synthesis selection, enumeration, and virtual library construction. We describe the use of diversity assessment and/or experimental design in selection of compound-libraries-to-be-synthesized. Our overall objective was to identify good-quality drug candidates through reliable structure-activity relationship data, with the minimum number of compounds synthesized and tested. Chemical filters, property filters, scoring functions, and utilization of interactive visualization tools are discussed. The concept of chemical diversity and aspects of chemical space navigation employing a proprietary tool, Chemical Global Positioning System (ChemGPS), for mapping the drug-related chemical space are examined. Guidelines and workflow recommendations for the practicing medicinal chemist are proposed.

Combinatorial Chemistry Techniques↗
PubMed2005

Transforming the work of early-stage drug discovery through bioprocess informatics.

Drug discovery has historically advanced by synergy and chance. These are proving insufficient to meet the needs of the marketplace and the demands of modern medicine. We describe our strategic approaches to building and employing flexible informatics tools to transform and improve the workflows and efficiencies of the early-stages of target development in drug discovery. We contrast our approach to strategies that have recently evolved at startup biotechnology companies who use similar technological approaches to drug development but who are less encumbered by precedent and history.

Drug Design↗
PubMed2000

Electronic patient records and the impact of the Internet.

The term electronic patient record (EPR) means the electronic collection of clinical narrative and diagnostic reports specific to an individual patient. A true EPR should allow physicians and nurses to practice in a paperless fashion. The wide adoption of Internet technologies should allow truly distributed sharing of patient data across traditional organizational barriers. Hence, the meaning of an EPR, as a representation of documents, should be transformed into a collaborative environment that supports workflow, enables new care models and allows secure access to distributed health data. This paper reviews the current realization of EPRs in the context of paper-based medical records. The Internet architecture that Boston-based medical informatics researchers refer to as W3-EMRS is described in the context of a successful implementation of CareWeb at the Beth Israel Deaconess Medical center. Finally, we describe how this Internet-based approach can be extended beyond the boundaries of traditional care settings to help evolve new collaborative models of eHealth.

Computer Security↗
PubMed2001

Sharing patient care records over the World Wide Web.

In order to obtain appropriate medical care, patients can be referred or transported from one hospital to another based on the capacity, capability and quality of medical care provided by hospitals. Therefore, enabling patient care records to be shared among hospitals is essential not only in delivering the quality of medical care services but also in saving medical expenses. Currently, most patient care records are paper-based and not well organized. Hence, they are usually incomplete and can hardly be accessed in time. The authors in this paper present methods to structure and represent patient care records, design mechanisms for interpreting and integrating the XML-based patient care records into the existing hospital information systems. More importantly, in our approach, each significant piece of medical record is associated with a tag based on the syntax and semantics of the XML. The XML-based medical records enable a computer to capture the meaning and structure of the document on the web. The authors have developed a unified referral information system in which patient care records can be shared among hospitals over the Internet. It can not only facilitate the referral process but also maintain the integrity of a patient's medical record from distributed hospitals. The workflow of the system basically follows the existing manual system and can easily be adapted. The working group on integration of municipal hospital information systems, Department of Health, Taipei City Government, has decided to adapt this system for referral practice among the municipal hospitals.

Hospital Information Systems↗
PubMed2001

Computerising a guideline for the management of diabetes.

This paper reports an experience of computerising a clinical guideline for the management of non-insulin-dependent diabetes mellitus (NIDDM). The guideline, designed by the European NIDDM Policy Group is being used in a National Programme for Diabetes supported by the Portuguese Ministry of Health, who is keen to supporting its widespread use by general practitioners, namely in computerised form. The paper presents the main characteristics of the prototype that was implemented within the European project Prestige, and was developed according to the Prestige Protocol Model. The model is briefly described, together with the generic architecture that supports it. Then the main design decisions of the prototype are explained, regarding the modelling of a general practitioner workflow during a typical consultation and the user interface, two key issues for obtaining acceptance from the users. The limitations of the system are discussed and a number of directions are outlined in order to circumvent such limitations, and broaden the scope of applicability of the system.

Diabetes Mellitus, Type 2↗
PubMed2001

Towards integration of clinical decision support in commercial hospital information systems using distributed, reusable software and knowledge components.

PROBLEM: Clinicians' acceptance of clinical decision support depends on its workflow-oriented, context-sensitive accessibility and availability at the point of care, integrated into the Electronic Patient Record (EPR). Commercially available Hospital Information Systems (HIS) often focus on administrative tasks and mostly do not provide additional knowledge based functionality. Their traditionally monolithic and closed software architecture encumbers integration of and interaction with external software modules. Our aim was to develop methods and interfaces to integrate knowledge sources into two different commercial hospital information systems to provide the best decision support possible within the context of available patient data. METHODS: An existing, proven standalone scoring system for acute abdominal pain was supplemented by a communication interface. In both HIS we defined data entry forms and developed individual and reusable mechanisms for data exchange with external software modules. We designed an additional knowledge support frontend which controls data exchange between HIS and the knowledge modules. Finally, we added guidelines and algorithms to the knowledge library. RESULTS: Despite some major drawbacks which resulted mainly from the HIS' closed software architectures we showed exemplary, how external knowledge support can be integrated almost seamlessly into different commercial HIS. This paper describes the prototypical design and current implementation and discusses our experiences.

Abdominal Pain↗
PubMed2002

The role of methodologies to improve efficiency and effectiveness of care delivery processes for the year 2013.

This paper aims at further expanding the vision of future health care delivery systems presented by Haux et al. (2002). Starting from the observation that information and communication technology (ICT) is deeply transforming the shape of organizations as expected, we argue that the coordination of work activities is a fundamental need for any organization. This is even more important for health care organizations since there is an increasing pressure to increase quality of care they deliver without further increasing its costs. However ICT by itself will not cause the desired changes without rethining the way of managing best practice biomedical knowledge and care delivery processes. Thus the paper focuses on the need of developing intense research efforts in the fields of knowledge management and workflow modelling, which have been identified as fundamental to provide suitable solutions to the problems of designing and building innovative health care information systems. Moreover, the paper discusses the role of mobile communication systems. Moreover, the paper discusses the role of mobile communication and speech understanding technologies to support a satisfactory user-system interaction in daily work.

Biomedical Research↗
PubMed2003

Building man-man-machine synergies: experiences from the Vanderbilt and Geneva clinical information systems.

OBJECTIVES: To demonstrate how a transition to an open hospital information system architecture can help foster stronger collaborations between computer-based clinical tools and the network of care process stakeholders. METHODS: Description of two evolution strategies towards an open, component-based architecture: the vertical decomposition of a monolithic system, and the transversal integration of foundation components such as terminology servers, documentation management, prescription, scheduling, workflow and notification engines. CONCLUSION: The progressive migration of production clinical systems towards a component-based architecture is feasible at a reasonable cost and leads to substantial benefits in terms of user acceptance through participative design and collaborative maintenance of knowledge bases, as well as improved ability to evolve, scale and share individual components. A taxonomy of the components of a health information system and their interactions should be developed to realize the collaborative potential of a marketplace of interoperable components.

Decision Support Systems, Clinical↗
PubMed2003

Health information systems challenges: the Heidelberg conference and the future.

OBJECTIVES: To present a summary of the state of the art in Health Information Systems (HIS), as discussed during the Heidelberg HIS Working Group Conference, and to examine possible strategies for continuous improvement of the field. METHODS: The state of the art in HIS is briefly described, and the historical trends are examined that emerge from a review of the previous HIS Working Group conferences. To extrapolate from those trends and suggest possible new directions, we consider whether perceived difficulties in the diffusion of HIS systems are simply a product of technological factors, or whether fundamental social factors have been ignored. RESULTS: The experience with HIS environments is 'reasonably good' but not excellent, and true HIS success stories are not common. One of the apparent difficulties is that the typical HIS does not regard communication among clinical users as its core mission, even though repeated studies of information needs and practice patterns show that communication is the leading cost in today's health care environment. It is suggested that progress in the HIS arena will benefit from increased emphasis on the social aspects of health care, and better integration of diverse data to promote the organizational communication and workflow. Improvements could also come from a change to a highly participatory and evolutionary software engineering process, focusing on communication behavior and co-operative work practices. CONCLUSIONS: Future HIS development should view provider-provider and provider-patient communication as a core function, and incorporate features such as seamless support and tracking of communication, automatic gathering and presentation of data from multiple sources, data collection in atomic units by the most qualified provider, and integrated management, resource utilization, and tracking. The steps towards HIS that support these features might be smaller than generally suspected, once the appropriate changes in the reference point have been made.

Congresses as Topic↗