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PubMed2003

Can evaluation studies benefit from triangulation? A case study.

BACKGROUND: Information and communication technologies (ICTs) are increasingly being used in health care. Rigorous evaluations of ICT applications during both introduction and routine use are of great importance for decision makers and users. Within evaluation research, two main (and often rather distinct) traditions can be found: the objectivistic and the subjectivistic tradition. METHODS: The theory of triangulation deals with the integration of methods and approaches as to conduct better evaluation studies. In evaluation research, triangulation in general means the multiple employment of various sources of data, observers, methods, and/or theories in investigations of the same phenomenon. We applied triangulation aspects in the analysis of the effects of a computer-based nursing documentation system. RESULTS: We discuss, based on this case study, what benefits can be obtained from applying triangulation in an evaluation study. We show how both the validation of results and the completeness of results can be supported by triangulation. DISCUSSION: The decision whether triangulation may be useful for a given research question, and how it may be correctly applied, requires-like other evaluation methods-intensive training and methodological experience. Medical informatics evaluation research may profit from this well-established theory.

Documentation↗
PubMed2006

Demonstration: An online clinical log for nurse practitioner students.

The Vanderbilt University School of Nursing (VUSN) has advanced practice nursing students in clinical experiences across the USA who are required to provide written documentation on their encounters. Prior log activities had consisted of responses on optical scan sheets and descriptive logs submitted at the end of each semester. Faculty wanted a more contemporary and efficient environment that would allow students to collect their clinical log data at their point of care and enter into an online database. The solution by VUSN informatics staff was a web/PDA based clinical log that can be used during the course of the semester.

Documentation↗
PubMed1998

Introducing information technology in the clinical setting. Lessons learned in a trauma center.

Using a case study methodology, we examined the implementation of a nursing flow sheet system in the trauma center of a large, not-for-profit, teaching hospital. Findings add new insights to the existing body of knowledge in the information technology and medical informatics fields. First, results reveal that the success of clinical information systems requires a proactive stance where key actors anticipate and address the challenges ahead and capitalize on opportunities. Second, empirical evidence indicates that project outcomes ultimately depend on how the implementation process is managed and what the organization and its members do with the system once it is introduced. Finally, the case at hand shows that the nature and overall quality of the implementation strategy can be largely predicted by the key actors involved in the project, given their own background, skills, interest, and level of motivation.

Developed Countries↗
PubMedDate not supplied

Linking remote practice to research: technology in action.

Nursing faculty practices are rarely set up to collect and analyze data, but evidence about the effects and costs of clinical care provided by faculty is required by health plans and other payers. This article describes a strategy that links faculty research programs with practice and teaching activities in various locations. An informatics infrastructure uses a common language for data collection and a set of coherent processes for implementation. The theoretical basis for conducting practice-based research is explored.

Colorado↗
PubMedDate not supplied

Health Level Seven (HL7): standard for healthcare electronic data transmissions.

The nursing profession needs computer-formatted data that can be exchanged within and between agencies. The exchange of electronic data, both in the United States and in the international community, requires agreement on the format of the data elements to be exchanged. The Health Level Seven (HL7) standard is a proposed voluntary standard for healthcare applications that addresses the way information is exchanged electronically. This brief article will provide background information regarding the development and status of HL7 and its implications for nursing. From the clinical perspective, nurses follow standards of care developed by professional organizations. These standards facilitate clear communication among nurses, consumers, and members of other disciplines. Similarly, the electronic transmission and exchange of clinical information must have a standard to ensure that messages arrive and are decoded correctly. Many standards for electronic data already exist; financial transactions such as banking are familiar examples. The theme of the 1990 Symposium on Computer Applications in Medical Care (SCAMC), was Standards in Medical Informatics. Many pertinent papers and workshops were presented. However, references to electronic data standards are found primarily in conference proceedings and technical manuals. Thus, although activity is widespread, and events are rapidly moving in the healthcare industry, most of the information is not yet widely available. It seems timely, therefore, to provide background material to nurses in order for them to participate in the process.

Computer Communication Networks↗
PubMed2003

Critical gaps in the world's largest electronic medical record: Ad Hoc nursing narratives and invisible adverse drug events.

The Veterans Health Administration (VHA), of the U.S. Department of Veteran Affairs, operates one of the largest healthcare networks in the world. Its electronic medical record (EMR) is fully integrated into clinical practice, having evolved over several decades of design, testing, trial, and error. It is unarguably the world's largest EMR, and as such it makes an important case study for a host of timely informatics issues. The VHA consistently has been at the vanguard of patient safety, especially in its provider-oriented EMR. We describe here a study of a large set of adverse drug events (ADEs) that eluded a rigorous ADE survey based on prospective EMR chart review. These numerous ADEs were undetected (and hence invisible) in the EMR, missed by an otherwise sophisticated ADE detection scheme. We speculate how these invisible nursing ADE narratives persist and what they portend for safety re-engineering.

Adverse Drug Reaction Reporting Systems↗
PubMed2001

Making grandma's data secure: a security architecture for home telemedicine.

Home telemedicine presents special challenges for data security and privacy. Experience in the Informatics for Diabetes Education And Telemedicine (IDEATel) project has demonstrated that data security is not a one-size-fits-all problem. The IDEATel users include elderly patients in their homes, nurse case managers, physicians, and researchers. The project supports multiple computer systems that require a variety of user interactions, including: data entry, data review, patient education, videoconferencing, and electronic monitoring. To meet these various needs, a number of different of security solutions were utilized, including: UserID/Password, PKI certificates, time-based tokens, IP filtering, VPNs, symmetric and asymmetric encryption schemes, firewalls and dedicated connections. These were combined in different ways to meet the needs of each user groups.

Aged↗
PubMed2006

Development of a web-based health information service system for maternal health care.

Information technology skills are essential for effective and efficient practice in maternal and child health. The purpose of this study was to develop a web-based multimedia health information system for maternal health care using principals of user centered design. Research process includes needs assessment, needs analysis, design, development/testing, and application release. This system will be a new way of nursing intervention and contribute to the maternal health promotion.

Female↗
PubMed2005

[Criteria how to choose adequate methodology and relevant variables for assessment of quality of primary healthcare].

INTRODUCTION: Research of satisfaction of patients in the area of primary health care (PHC) and especially criteria how to choose best methodology and the relevant variables guided to the situation where activities were focused on description of the basic structure and processes of health care rather than on identification of needs for services and on result based assessment and satisfaction of patients with provided service. To give advantage to any of methodologies is inexplicable problem and depend of factors beyond of health service control. PURPOSE: Aim of this paper is to review existing measurements of healthcare for ones who intend to use measurements of quality of healthcare for clinical and research purposes and to recommend criteria how to choose adequate methodology and relevant variables for assessment of quality of primary healthcare. METHODOLOGY: For our study we used experience of the Cathedra for Medical Informatics, Medical faculty, University of Sarajevo with emphasis on research of quality of PHC. We selected over 3,000 users of PHC (patients-adults) in PHC units in ten cantons of Federation of Bosnia and Herzegovina. RESULTS: Statistically significant results we got when we crossed general attitude of patients about quality of healthcare with the following variables: place where patient receive healthcare, consultation with patients about patients' rights and life styles. We have not got statistically significant results when we crossed the following variables with general attitude of patients: distance from place of living to place where patients get healthcare, examination schedule in the units of PHC, continuity of healthcare, organization of field service and possibility to choose physician or nurse. CONCLUSION: Very often researchers create their own methods of measurement instead to carry out systematic review of existing ones to enable them to find appropriate one. In this paper we recommended guidelines for finding the most appropriate methods of health measurement using experience of the Cathedra for Medical Informatics, Medical faculty in Sarajevo.

Humans↗
PubMedDate not supplied

Medical informatics in the intensive care unit: state of the art 1991.

Intensive care medicine requires timely, accurate, and integrated patient records to provide the highest quality patient care. Computerized patient records offer the best method to achieve these needs. The expectations of society for medical progress through increased use of computers is growing. For optimal use of computers in the ICU there must be a harmonious collaboration between medical informaticists, physicians, nurses, therapists, and administrators. The future use of computers in ICU care will be evolutionary rather than revolutionary. We are on the frontier of some exciting times in the next decade as computers become commonplace in the clinical care process rather than an unusual event. This paper discusses the progress and challenges of computers in the ICU.

Clinical Protocols↗
PubMed2001

EMR based telegeriatric system.

INTRODUCTION: As medical services improve due to new technologies and breakthroughs, it has lead to an increasingly aging population. There has been much discussion and debate on how to solve various aspects such as psychological, socioeconomic and medical problems related to aging. Our effort is to implement a feasible telegeriatric medical service with the use of the state of the art technology to deliver medical services efficiently to remote sites where elderly homes are based. Telegeriatric system will lead to rapid decision-making in the presence of acute or subacute emergencies. This triage will also lead to a reduction of unnecessary admission. It will enable the doctors who visit these elderly homes on a once-a-week basis to improve their geriatric management skills by communication with geriatric specialist. Nursing skills in geriatric care will also benefit from this system. Integrated EMR service will be indispensable in the face of emergency admissions to hospitals. Evolution of EMR database would lead to future research in telegeriatrics and will help to identify the areas where telegeriatrics can be optimally used. METHODOLOGY: This system is based on current web browsing technology and broadband communication. EMR web based server is developed using Java Technology. EMR database was developed using Microsoft SQL server. Both are based at the Medical Informatics Programme, National University of Singapore. Two elderly homes situated in the periphery of Singapore and a leading government hospital in geriatric care has been chosen for the project. These three institutions and National University of Singapore are connected via ADSL protocol, which support high bandwidth, which is necessary for high quality videoconferencing. Each time a patient needs a teleconsultation, a nurse or doctor in the remote site sends the history to the EMR server. EMR server forwards the request to the Alexandra Hospital for consultation. Geriatrics specialists at Alexandra Hospital carry out teleward rounds twice weekly and on demand basis. SUMMARY OF RESULTS: Following the implementation of the system, a trial run has been done. This shows a high degree of coordination and cooperation between remote site and the Alexandra Hospital Also the patient compliance is very high and they prefer teleconsultation. CONCLUSION: Initial results show that telegeriatric system has definite advantages in managing geriatric patients at a remote site. As the system evolves, further research will show the areas where telegeriatrics can be used optimally.

Aged↗
PubMed1998

Outcomes management of mechanically ventilated patients: utilizing informatics technology.

This article examines an informatics system developed for outcomes management of the mechanically ventilated adult population, focusing on weaning the patient from mechanical ventilation. The link between medical informatics and outcomes management is discussed, along with the development of methods, tools, and data sets for outcomes management of the mechanically ventilated adult population at an acute care academic institution. Pros and cons of this system are identified, and specific areas for improvement of future health care outcomes medical informatics systems are discussed.

Adult↗
PubMed2001

EMR-based TeleGeriatric system.

INTRODUCTION: As medical services improve due to new technologies and breakthroughs, it has lead to an increasingly aging population. There has been much discussion and debate on how to solve various aspects such as psychological, socio-economic and medical problems related to aging. Our effort is to implement a feasible telegeriatric medical service with the use of the state of the art technology to deliver medical services efficiently to remote sites where elderly homes are based. The TeleGeriatric system will lead to rapid decision-making in the presence of acute or subacute emergencies. This triage will also lead to a reduction of unnecessary admission. It will enable the doctors who visit these elderly homes once a week basis to improve their geriatric management skills by communication with geriatric specialist. Nursing skills in the geriatric care will also benefit from this system. Integrated electronic medical record (EMR) system will be indispensable in the face of emergency admissions to hospitals. Evolution of EMR database would lead to future research in telegeriatrics and will help to identify the areas where telegeriatrics can be optimally used. METHODOLOGY: This system is based on current web browsing technology and broadband communication. The TeleGeriatric web based server is developed using Java Technology. The TeleGeriatric database server was developed using Microsoft SQL server. Both are based at the Medical Informatics Programme, National University of Singapore. Two elderly homes situated in the periphery of Singapore and a leading government hospital in geriatric care have been chosen for the project. These 3 institutions and National University of Singapore are connected via ADSL protocol. ADSL connection supports high bandwidth, which is necessary for high quality videoconferencing. Each time a patient needs a teleconsultation a nurse or a doctor in the remote site sends the patient's record to the TeleGeriatric server. The TeleGeriatric server forwards the request to the Alexandra Hospital for consultation. Geriatrics specialists at the Alexandra Hospital carry out teleward rounds twice weekly and on demand basis. SUMMARY OF RESULTS: Following the implementation of the system, a trial run has been done. Total results have demonstrated a high degree of coordination and cooperation between remote site and the Alexandra Hospital. Also the patient compliance is very high and they prefer teleconsultation. CONCLUSION: Initial results show that the TeleGeriatric system has definite advantages in managing geriatric patients at a remote site. As the system evolves, further research will show the areas where telegeriatrics can be used optimally.

Aged↗
PubMed2006

The introduction of the clinical module of a primary care patient management system into a family planning association.

The New Zealand Family Planning Association (FPA) is a national not-for-profit organization providing sexual and reproductive primary care health services as well as health education, professional training and advocacy on issues of sexual and reproductive health. Between July 2003 and August 2004 the Clinical Module of Medtech 32, the Patient Management System (PMS) used by the organisation since 1998, was introduced into 17 Family Planning Clinics throughout the country and 132 (68.6 FTE) nurses and doctors trained in its use. In late 2004 nursing and medical staff completed a questionnaire providing feedback on their experiences of the introduction process itself, their initial use of the clinical module and their use of it between 3-15 months later. This paper describes the introduction of the clinical module and nurse and doctor perceptions of the introduction and subsequent use in their daily clinical practice.

Adult↗