Too 'wired' to sleep. Interview by Bill Siwicki.
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Clinical Protocols↗
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Results for “Integrated Advanced Information Management Systems”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Open architecture and integrated information at Columbia-Presbyterian Medical Center.
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Academic Medical Centers↗
Development, effects, and educational outcomes of reporting from a clinical database.
To develop clinically applicable and educationally useful reports from a clinical database, the authors explored the development of such databases at a medical center. The patient-centered database (PCD) integrates disparate data resources in the service of academic clinicians, postgraduate trainees, and students. From the PCD, daily and monthly reports are generated, which include 1) census update reports, serving as an educational format for a daily case-based morning report discussion and routine rounds; 2) reports of daily admissions and patient census stratified by appropriate housestaff providing the clinical care; and 3) quality assurance measures such as monitoring of length of stay of each patient regardless of the initial housestaff service to which the patient is initially admitted. The results of expanding the number of report beneficiaries, outcomes from a five-month test period, and possibilities for further development and implementation are considered.
Computer Communication Networks↗
Coding systems and classifications in healthcare: the link to the record.
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European Union↗
The electronic medical record: perspective from Mayo Clinic.
On 1 January 1993, the Electronic Medical Record Task Force at Mayo Clinic published its report. Charged by the Mayo Foundation to define the Electronic Medical Record (EMR) for Mayo, the task force mapped the goals, strategies and time-lines for implementation of the EMR in that institution. The task force was composed predominantly of caregivers (physicians and nurses) with assistance from members of Mayo's information systems and administrative departments. The focus of the effort was care of the patient with the consensus belief that the EMR will improve that process and, if designed robustly, will serve the other information needs of claims, research, education and practice management. The recommendations of this report have been accepted by the Mayo Foundation leadership resulting in the generation of a master plan and the creation of the governance structure for implementation at Mayo. This paper abstracts key portions of the report.
Computer Systems↗
User metaphors for health care professional workstations.
The problem encountered by health care professionals and software developers has been a lack of demonstrable visions (prototypes) for Computer-based Patient Record (CPR) and Clinical Information System (CIS) applications. This deficiency has resulted in a quest for and consideration of models, metaphors, and mind maps for the Healthcare Professional Workstation (HPW)--the access mechanism for the CPR and the CIS. The familiar physician desktop and traditional paper-based metaphors are not adequate for all aspects of clinical information processes. In the clinical care environment, the flowsheet is a transporting metaphor because many different applications and tasks can be 'transported' into the flowsheet. 3D Rooms, Gopher and Genes are familiar and transporting metaphors to be exploited for HPWs. Using transporting metaphors for HPW software emphasizes commonality and de-emphasizes diversity. Each model and metaphor has an associated mind map. Only the mental model, mental metaphor or mind map for HPW software is important. Metaphors communicate real-world analogies, and communication is at the core of what defines usability. A mind map facilitates communication by building a model in the user's mind. The barriers to HPWs are not technical; they are related to economics, ownership of patient information, liability and information standards.
Computer Systems↗
Functional workstation requirements: clinical perspectives.
This white paper details specific requirements for clinical workstations identified by employees in the Department of Veterans Affairs. The requirements can be grouped into the following five categories: general environmental capabilities, input methods, display features, output abilities, and miscellaneous functionality and features. Clinical workstations meeting these functional requirements can offer a significant enhancement over existing hardware interfaces. Use of these workstations by health care providers could improve their willingness to directly enter data into clinical information systems, increasing the benefits of such systems.
Computer Systems↗
A model for the assessment of medical workstations for health care support.
The development of medical workstations for the support of patient care, the assessment of care, management support, and education is just at its beginning. During the Working Conference on the Health care Professional Workstation held in Washington DC, June 1993, several aspects of such workstations were discussed, but it was also recognized that prototyping or learning by experience could be a rich source to further promote the progress in this field. Eight such prototypes or already operational medical workstations were demonstrated and a preliminary user assessment was done to obtain a first insight in the advantages and the type of criteria of such evaluations. It was concluded that such assessments were of great value to (i) give feedback to the designers of medical workstations, (ii) indicate areas of strength and for further research, and (iii) to offer criteria to potential users of such workstations for making decisions on using such systems. The assessment criteria deal with functionality, architecture, user interfaces, communications and integration, and data and knowledge management.
Artificial Intelligence↗
Integrating guidelines and the clinical record: the role of semantically constrained terminologies.
The extent to which protocols and guidelines will be used depends critically on how well they are integrated with existing medical records and each other. Effective integration requires consistent information structures and content, but if the union between components becomes too intimate it may restrict interaction with other applications. Such isolation leads to operational inefficiencies and can be financially unattractive. Systematic representation methods for protocols address part of the problem but are hampered by the unsuitability of existing medical terminologies; the effort required for bespoke development is prohibitive. Unifying and generalising terminological functions in a single "Terminology Server" that can support both construction of systems and their operational use promises to reduce development effort whilst allowing individual designers considerable independence. However, significant theoretical and practical questions remain about how far the problems of communication can be mitigated by a generalised, use-independent terminological system.
England↗
Evaluating IAIMS at Yale: information access.
OBJECTIVE: To evaluate use of information resources during the first year of IAIMS implementation at the Yale-New Haven Medical Center. The evaluation asked: (1) Which information resources are being used? (2) Who uses information resources? (3) Where are information resources used? (4) Are multiple sources of information being integrated? DESIGN: Measures included monthly usage data for resources delivered network-wide, in the Medical Library, and in the Hospital; online surveys of library workstation users; an annual survey of a random, stratified sample of Medical Center faculty, postdoctoral trainees, students, nurses, residents, and managerial and professional staff; and user comments. RESULTS: Eighty-three percent of the Medical Center community use networked information resources, and use of resources is increasing. Both status (faculty, student, nurse, etc.) and mission (teaching, research, patient care) affect use of individual resources. Eighty-eight percent of people use computers in more than one location, and increases in usage of traditional library resources such as MEDLINE are due to increased access from outside the Library. Both survey and usage data suggest that people are using multiple resources during the same information seeking session. CONCLUSIONS: Almost all of the Medical Center community is using networked information resources in more settings. It is necessary to support increased demand for information access from remote locations and to specific populations, such as nurses. People are integrating information from multiple sources, but true integration within information systems is just beginning. Other institutions are advised to incorporate pragmatic evaluation into their IAIMS activities and to share evaluation results with decision-makers.
Academic Medical Centers↗
Improving acute care through use of medical device data.
The Medical Information Bus (MIB) is a data communications standard for bedside patient connected medical devices. It is formally titled IEEE 1073 Standard for Medical Device Communications. MIB defines a complete seven layer communications stack for devices in acute care settings. All of the design trade-offs in writing the standard were taken to optimize performance in acute care settings. The key clinician based constraints on network performance are: (1) the network must be able to withstand multiple daily reconfigurations due to patient movement and condition changes; (2) the network must be 'plug-and-play' to allow clinicians to set up the network by simply plugging in a connector, taking no other actions; (3) the network must allow for unambiguous associations of devices with specific patients. A network of this type will be used by clinicians, thus giving complete, accurate, real time data from patient connected devices. This capability leads to many possible improvements in patient care and hospital cost reduction. The possible uses for comprehensive automatic data capture are only limited by imagination and creativity of clinicians adapting to the new hospital business paradigm.
Adverse Drug Reaction Reporting Systems↗
Data storage and knowledge representation for clinical workstations.
The representation of patient information for use in clinical workstations is a complex problem. Ideally, it should be addressed in a way that allows multiple uses of the data, including simple manual review, sharing and pooling across institutions, and as input to knowledge-based decision support systems. To a great extent, this means coding information with controlled medical vocabularies, but it does not mean that all information must be codable before workstations are feasible. This paper defines some of the choices, both current and future, that are available to address the needs of controlled medical vocabularies for representing data and knowledge in clinical workstations and explores some of the implications of those choices.
Computer Communication Networks↗
New opportunities for processing the OSI-7 layer protocols using parallel processing (transputers).
The attractiveness of the OSI-7 layer model is closely dependent upon a highly ambitious intent to promote a series of quasi-universal standards to coordinate the communication between heterogeneous applications, whatever the distributed architectures might be. However, a major criticism of the OSI-model is the performance and the handling of the presentation layer. This paper deals with the evaluation of parallel processing techniques operating at the upper levels of the OSI-model using transputers in a parallel co-processor. It is shown that the performance problem is highly dependent on the structure of the protocol stack and its implementation. With the object-oriented modularization of the protocol stack, an architecture of a possible co-processor using transputers is considered and its performance is considered adequate. An ideal configuration is briefly presented. A final performance appraisal of the parallelism effect is discussed with some insight into the future.
Computer Communication Networks↗
Evaluation plan for a cardiological multi-media workstation (I4C project).
The goal of the I4C project (Integration and Communication for the Continuity of Cardiac Care) is to build a multi-media workstation for cardiac care and to assess its impact in the clinical setting. This paper describes the technical evaluation plan for the prototype.
Computer Systems↗
Electronic patient record for N.N. Burdenko Neurosurgical Institute: on the verge of implementation.
This presentation is the first report about development of Electronic Patient Record System (EPRS) for N.N. Burdenko Neurosurgical Institute (NSI). This EPR system is the core of Integrated Automatic Information System intended to support all business processes running in the Institute. A new technology for developing information systems in poorly formalized subject domains, named IBS/Records, was was created.
Computer Systems↗
Meeting clinician information needs by integrating access to the medical record and knowledge resources via the Web.
MINDscape is a web based integrated interface to diverse sources of clinical information including both patient specific information (electronic medical record) as well as medical knowledge (the "digital library") to provide "just in time" information at the point of care. It was developed at the University of Washington to meet clinical information needs both as identified locally and by a review of the literature. Beta testing by over 600 clinicians is in progress and medical centers wide access scheduled for Fall 1997. We describe the information needs we sought to meet and the ongoing evaluation approach we are taking to ensure the information needs of a diverse group of clinicians are met. The iterative evolution of the interface from prototype, to alpha to large scale beta testing is reported. Integration of information occurs at three levels: integration of information by patient, integration of information by provider, and integration of patient specific information with medical reference material and decision support tools.
Computer Communication Networks↗
Information technology in the age of emergency public health response. The framework for an integrated disease surveillance system for rapid detection, tracking, and managing of public health threats.
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Communication↗
The professional workstation as enabler: conference recommendations. International Medical Informatics Association.
This paper reports on the Working Conference on Healthcare Professional Workstation sponsored by the International Medical Informatics Association (IMIA) and held in Washington DC, 14-16 June 1993. It sets forth the vision of a health care infostructure in which the workstation acts as enabler, giving professionals access to information when, where, and how it is needed. The paper explains upon the conference methodology and provides the conference cochairs' summary recommendations, both short- and long-term. These recommendations are based upon the work of five breakout groups, which addressed Functional Requirements, User Interfaces, Data and Knowledge Management, Processing, and Sharing and Communications. Presented in detailed and display formats, these summary recommendations address issues in the areas of architecture, linkages, evaluation, security, standards, education, and training. The paper also sets forth immediate next steps for the workstation initiative, including the formation of a formal IMIA Working Group on Workstations.
Computer Communication Networks↗