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Software engineering risk factors in the implementation of a small electronic medical record system: the problem of scalability.

The successful implementation of clinical information systems is difficult. In examining the reasons and potential solutions for this problem, the medical informatics community may benefit from the lessons of a rich body of software engineering and management literature about the failure of software projects. Based on previous studies, we present a conceptual framework for understanding the risk factors associated with large-scale projects. However, the vast majority of existing literature is based on large, enterprise-wide systems, and it unclear whether those results may be scaled down and applied to smaller projects such as departmental medical information systems. To examine this issue, we discuss the case study of a delayed electronic medical record implementation project in a small specialty practice at Columbia-Presbyterian Medical Center. While the factors contributing to the delay of this small project share some attributes with those found in larger organizations, there are important differences. The significance of these differences for groups implementing small medical information systems is discussed.

Computer Systems↗

Open source software for the analysis of microarray data.

DNA microarray assays represent the first widely used application that attempts to build upon the information provided by genome projects in the study of biological questions. One of the greatest challenges with working with microarrays is collecting, managing, and analyzing data. Although several commercial and noncommercial solutions exist, there is a growing body of freely available, open source software that allows users to analyze data using a host of existing techniques and to develop their own and integrate them within the system. Here we review three of the most widely used and comprehensive systems, the statistical analysis tools written in R through the Bioconductor project (http://www.bioconductor.org), the Java-based TM4 software system available from The Institute for Genomic Research (http://www.tigr.org/software), and BASE, the Web-based system developed at Lund University (http://base.thep.lu.se).

Database Management Systems↗

[Planning the nursing care for burned patients with a software: application in 4 patients].

In order to evaluate the applicability of a Software to the execution of a nursing process of care to burn patients, a case study method has been used. Four (4) subjects who had been admitted to a burn unit were evaluated. All the four cases were inserted into a computer program where the plan of nursing care was executed. The Software was adequate, enabling the planning of the nursing care in a reduced time.

Burns↗

[Diabetes mellitus educational software for health professionals: stages of design and development].

This research aimed at creating a software about Diabetes mellitus in order to stimulate the continuing education of health professionals as well as educative practices. The system was developed using Delphi application, through a data bank utilizing key-words and the Pascal language. The software includes key-words searching tools, improving the process of accessing the data bank.

Computer-Assisted Instruction↗

Customization of a standard practice management software program to satisfy the needs of a dental hygiene program.

The University of New England (UNE) Dental Hygiene Program converted from a paper format to a digital format to manage the daily, dental hygiene clinic transactions. The use of this practice management software created new opportunities to enhance the program's teaching mission, monitor the progress of individual students, and facilitate the data collection necessary to meet accreditation standards. This report will describe how this dental hygiene program customized a standard practice management software program to enhance the specific requirements of a clinical teaching institution.

Accreditation↗

[Development and application of software in EDXRF spectrometer].

The present paper describes application softwares on file management system, multicomponent linear regression, rapid semi-quantitative analysis, analysis of coating thickness and multifunctional Lucas-tooth intensity correction, developed in EDXRF. Utilization of these software improves the analytical quality, management efficiency and development ability of scientific research.

Chromium↗

[Development of computer software in ramp slope controller for treadmill ergometer].

We developed computer software to produce a treadmill ramp protocol through which oxygen uptake (VO2) is increased in a linear fashion, thus enabling subjects to walk until the end of exercise. The developed software simulates the increases in speed and grade of the treadmill displayed on a personal computer screen, and produces the ramp protocol by arbitrarily determining the variables of the following formula: 1) Increments of VO2 = a1t+a2 (ml/min/kg) [t = exercise time (min)] 2) Predicted VO2 by speed (S) and grade (G) = a3S2 + a4G2 + a5SG + a6S + a7G + a8 (ml/min/kg) [S = speed (km/hr); G = grade (%)] 3) Speed suitable for desired exercise time (S or S2) = a9t2 + a10t + a11 (km/hr) 4) Grade suitable for desired exercise time (G or G2) = a12t2 + a13t + a14 (%) In this study, the increment of VO2 was determined by considering the subject's exercise capacity (VO2 = 4t + 7 ml/min/kg), using the Ito's formula (VO2 = 0.067S2 + 0.289SG + 7.73 ml/min/kg). The formula of grade was determined following the formula arbitrarily (G2 = 25t + 5%). The formula of speed for exercise time was calculated automatically. The new ramp protocol, which was applied to 10 healthy subjects (mean age: 24.8 +/- 4.8 years old), disclosed a similar linear relationship between the predicted VO2 and the measured VO2.

Adult↗

Use of monitoring software to improve the measurement of carotid wall thickness by B-mode imaging.

METHODOLOGY: High-resolution B-mode imaging is a reliable, easily performed and non-invasive means of studying atherosclerosis in superficial blood vessels. Recently it has been used for in vivo studies on the thickness of the common carotid artery wall. It is very sensitive, although the results of practical investigations are highly dependent on both the operator and the direction and angle of ultrasound beams directed towards the vessel. PROTOCOL: We have assessed inter- and intra-observer reproducibility of the measurement of common carotid artery wall thickness in 13 subjects, using two procedures. The first was a standard echographical investigation. In the second procedure, the principal parameters recorded from the first investigation were used to reposition the beam with the same incident angle. RESULTS: Intra-observer variability (correlation coefficient, r = 0.61 for procedure 1 and r = 0.77 for procedure 2) and inter-observer variation (r = 0.58 for procedure 1 and r = 0.71 for procedure 2) were reduced when the second investigation was assisted by reproducibility software. CONCLUSIONS: The proposed method is a reliable and reproducible way of assessing combined intimal and medial wall thickness in the common carotid artery. It may be possible to improve reproducibility using specific software to aid the operator. Since the intimal and medial thickness of the common carotid artery appears to be a sensitive marker of vascular risk, the proposed standardized method of measuring these parameter may allow early detection and assessment of changes.

Aged↗

Scheduling software in public health practice: from book to bytes and back.

Although greater emphasis is being placed on public health information transfer, little is known about its implementation in the field. To better understand the information needs of the public health workforce, semi-structured interviews were conducted at a country public health department. Preliminary investigation revealed the underutilization of available scheduling software in this setting. Privacy concerns and idiosyncratic scheduling patterns may have interfered with the adoption of commercially available scheduling software.

Ambulatory Care Facilities↗

A software tool for the graphical visualization of large and complex populations.

Pedigree drawing is an essential tool in genetic and genealogical studies. A genetic analysis of a disease often starts with drawing a pedigree to show the overall population structure, the relationship among individuals, and gene flows from generation to generation. Such a graphical presentation of a pedigree is valuable for understanding the nature of the disease such as inheritance mode and familial trends and of the disease, for tracing the source of a detrimental gene, and for identifying the founders of the population. A genealogy study typically requires a pedigree drawing to show relationships among individuals. However, as the size and complexity of a pedigree increase, drawing a clear pedigree becomes a challenge. Pedigraph has been created to solve this problem. We developed a software tool named Pedigraph capable of creating artistic graphical pedigree drawings of large and complex populations with flexible options for pedigree analysis. Preliminary tests show that this software tool has great potential to be a useful tool for research in breeding, genetics and genomics in plants, animals, and zoo species, as well as a useful tool for studying history and human populations.

Computer Graphics↗

[Analysis of the difference in NIH3T3 cell protein expression profiles before and after TPA treatment using two-dimensional polyacrylamide gel electrophoresis and image analysis software].

OBJECTIVE: To establish and optimize two-dimensional (2-D) polyacrylamide gel electrophoresis (PAGE) for comparative analysis of the protein expression profiles in mouse fibroblast NIH3T3 cells before and after 12-O-tetradecanoy- lphorbol-13-acetate (TPA) treatment using image analysis software, so as to prepare for more intensive study in the identification of the proteins that mediate the biological effect of TPA. METHODS: The total cellular protein extracted from NIH3T3 cells with or without TPA treatment underwent 2-D PAGE and silver nitrate staining prior to the analysis of the differential protein expressions using image analysis software. RESULTS: Image analysis revealed obvious differential protein expressions of the cells in response to TPA treatment. CONCLUSION: High-quality instruments for 2-D PAGE, skilled electrophoretic operation and efficient image processing are all essential in the reliable identification of stable functional proteins.

Animals↗

[The software QSR Nvivo 2.0 in qualitative data analysis: a tool for health and human sciences researches].

The QSR Nvivo 2.0 is one of the latest versions of qualitative data analysis software package. Taking on board our experience as QSR Nvivo 2.0 users we describe here the software's most important tools. The QSR Nvivo 2.0 was used to facilitate the qualitative analysis of data gathered in a Health and Education research. Considering the shortage of published materials about the issue, which suggests a lack of knowledge about the program in our context, our aim is to show how the QSR Nvivo 2.0 can assist qualitative data analysis.

Data Collection↗

[Logical-mathematical "ND" software development].

In this article, we propose a mathematical analysis model for the generation of a proportional value of defining characteristics in nursing diagnoses. The study results are based on the logical-mathematical development of software specifically built for the generation of diagnosis hypotheses. The final calculation creates the sum of all defining characteristics found in each diagnosis, comparing it with the value of the V variable of the diagnosis, according to a mathematical rule that was set. It is concluded that the software needs to go through clinical validation in order to evaluate the pertinence of the rule proposed here.

Models, Theoretical↗

TOSCA-Imaging--developing Internet based image processing software for screening and diagnosis of diabetic retinopathy.

The primary aim of TOSCA-Imaging, which was a part of the TOSCA Project financed by EU's Fifth Framework IST Programme, was to develop Internet based software and image data bases for screening and diagnosis of diabetic retinopathy and implementing it into a real life situation. The work consisted of: 1) Construction of an Internet based communication platform for transmitting and analyzing retinal images. 2) Implementation of routines for detecting the first microaneurysm (transition from normal to pathologic), detecting patients needing referral for treatment (presence of venous beading or hard exudates near the fovea), and for serial analysis (image alignment). 3) Construction of a reference image data base. A preliminary validation showed that decisions that depended on a precise detection of individual lesions, e.g. the detection of normality, had a sensitivity and specificity of around 80%, whereas decisions that depended on the detection of lesion patterns, e.g. clinically significant macular oedema, had a sensitivity and specificity of more than 95%. Validation of the reference image data base by double grading by two expert graders suggested a sensitivity and a specificity of just below 90% for any lesion and of more than 95% for predicting the overall retinopathy grade. TOSCA-Imaging has succeeded in its primary aim of developing Internet based software and implementing it into a real life situation, integrating work within image processing done in four different European countries (England, Germany, Ireland, and Denmark) to be accessed from one Internet web site.

Algorithms↗

10 steps to implementing OSH software.

Properly implementing software is no simple task. Even the best software will fail miserably when not implemented properly. You must have the right individuals on your project team to increase the odds of success. I have identified the most common steps that should be reviewed to avoid typical pitfalls, ensuring the project is completed within the budget and timeline agreed to and not only meets the technical scope, but is well received by the users. If done properly, the entire process should only take a few months, depending on the complexity and size of your project.

Humans↗

Internet-based virtual classroom and educational management software enhance students' didactic and clinical experiences in perfusion education programs.

A challenge faced by many university-based perfusion education (PE) programs is the need for student clinical rotations at hospital locations that are geographically disparate from the main educational campus. The problem has been addressed through the employment of distance-learning environments. The purpose of this educational study is to evaluate the effectiveness of this teaching model as it is applied to PE. Web-based virtual classroom (VC) environments and educational management system (EMS) software were implemented independently and as adjuncts to live, interactive Internet-based audio/video transmission from classroom to classroom in multiple university-based PE programs. These Internet environments have been used in a variety of ways including: 1) forum for communication between the university faculty, students, and preceptors at clinical sites, 2) didactic lectures from expert clinicians to students assigned to distant clinical sites, 3) small group problem-based-learning modules designed to enhance students analytical skills, and 4) conversion of traditional face-to-face lectures to asynchronous learning modules. Hypotheses and measures of student and faculty satisfaction, clinical experience, and learning outcomes are proposed, and some early student feedback was collected. For curricula that emphasize both didactic and clinical education, the use of Internet-based VC and EMS software provides significant advancements over traditional models. Recognized advantages include: 1) improved communications between the college faculty and the students and clinical preceptors, 2) enhanced access to a national network of clinical experts in specialized techniques, 3) expanded opportunity for student distant clinical rotations with continued didactic course work, and 4) improved continuity and consistency of clinical experiences between students through implementation of asynchronous learning modules. Students recognize the learning efficiency of on-line information presentation but still prefer the traditional face-to-face classroom environment. Traditional paradigms impose limitations that are rooted in dependence upon the students and instructors being physically located in the same place at the same time. These represents significant impediments for PE programs that use geographically separate clinical sites to provide clinical experience. Historically this has led to a disintegration of the presentation of theory, and a reduction in the quantity or quality of clinical experience opportunities. New PE models help to eliminate limitations and improve the quality of education especially in the face of economic challenges. Perfusion education students and faculty will have to work together to find computer-based offerings that are equivalent to traditional classroom methods.

Allied Health Personnel↗

MS2/Cardio: towards a multi-service medical software for cardiology.

Many clinics are interested to use software packages in daily practice, but lack of integration of such packages seriously limits their scope. In practice this often entails switching between programs and interrupting the run of an individual program. A multi-task approach would not solve this problem as it would not eliminate the need to input the same data many times, as often occurs when using separate packages. The construction of a Multi-Service Medical Software package (MSx2) is described, which was also developed as an example of practical integration of some clinically relevant functions. The package runs on a personal computer in an MS-DOS environment and integrates a time-oriented medical record management unit (TOMRU) for data of ambulatory patients, and a drug information management unit (DIMU) concerning posology, content, effects, and possible interactions. Of the possible database configurations allowed by MSx2, the cardiology patient database (MSx2/C) and hypertensive patient database (MSx2/H) were developed and described here. Clinical information to be included in the configurations was obtained after discussion and consensus of clinical practitioners. MSx2/C was distributed to several hundred clinical centers during computerized courses to train future users. MSx2 can easily transfer patient data to statistical processing packages.

Ambulatory Care Information Systems↗