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PubMed2004

An ontological framework for the implementation of clinical guidelines in health care organizations.

The paper presents the outlines of an ontology of plans and guidelines, which is then used as the basis for a framework for implementing guideline-based systems for the management of workflow in health care organizations. The framework has a number of special features, above all in that it enables us to represent in formal terms assignments of work-items both to individuals and to teams and to tailor guideline to specific contexts of application in health care organizations. It is designed also to enable implementations to do justice to the fact that the processes carried out in health care organizations may deviate in different ways from the norms set forth in corresponding guideline definitions. This means that implementations built in conformity with the framework will be marked by a type of flexibility that might make them more likely to be accepted by healthcare professionals than are standard guideline-based management systems.

Medical Informatics↗

PubMed2005

Design and implementation of a telemedicine system using Bluetooth protocol and GSM/GPRS network, for real time remote patient monitoring.

This paper introduces the design and implementation of a generic wireless and Real-time Multi-purpose Health Care Telemedicine system applying Bluetooth protocol, Global System for Mobile Communications (GSM) and General Packet Radio Service (GPRS). The paper explores the factors that should be considered when evaluating different technologies for application in telemedicine system. The design and implementation of an embedded wireless communication platform utilising Bluetooth protocol is described, and the implementation problems and limitations are investigated. The system is tested and its telecommunication general aspects are verified. The results showed that the system has (97.9 +/- 1.3)% Up-time, 2.5 x 10(-5) Bit Error Rate, 1% Dropped Call Rate, 97.4% Call Success Rate, 5 second transmission delay in average, (3.42 +/- 0.11) kbps throughput, and the system may have application in electrocardiography.

Analysis of Variance↗

PubMed2005

[Implementation of integrated hospital information system in the existing hospital organization--experience at Dubrava Clinical Hospital in Zagreb].

In the modern hospital information systems govern extremely important functions such as patient management, control of work flows, administration, etc., with a great variety of recommended standards used in functional integration of healthcare information systems. The main parts of the original idea of the integrated Hospital Information System have been implemented at Dubrava University Hospital in Zagreb through several phases, resulting in data production covering distinct areas of hospital administration. This paper describes the basic idea of information, organization problems and steps taken in the implementation. International standards in communication have been implemented in the system.

Computer Communication Networks↗

PubMed2005

Implementation of an inpatient management and discharge strategy for patients with community-acquired pneumonia.

OBJECTIVE: To assess the effectiveness and safety of implementing an inpatient management and discharge strategy based on empiric antibiotic therapy with ceftriaxone sodium and a guideline to promote timely discharge for clinically stable patients hospitalized with community-acquired pneumonia. STUDY DESIGN: A cluster randomized controlled clinical trial with 30 days of patient follow-up at 8 teaching hospitals and 17 nonteaching hospitals nationwide. METHODS: Participants included 240 intervention patients and 209 control patients admitted by 85 physician groups between December 1998 and December 1999. Within each hospital, defined physician practice groups were randomized to the intervention arm (physician notification coupled with ceftriaxone sodium as empiric therapy) or control arm (neither component). Physicians in the intervention arm were notified when their patients met guideline criteria for clinical stability; physicians in the control arm were not contacted. RESULTS: The median length of stay was 4 days in both study arms. The observed reduction in costs associated with the intervention was not statistically significant when cost outliers were excluded. Mortality, serious adverse event, and rehospitalization rates did not differ significantly across study arms. CONCLUSIONS: Implementation of an inpatient management strategy based on physician reminders coupled with empiric use of ceftriaxone sodium did not reduce length of stay or associated medical care costs for patients hospitalized with community-acquired pneumonia. These negative findings are most likely due to insufficient potency of the intervention, inadequate guideline implementation, or imbalances in baseline patient characteristics.

Adolescent↗

PubMed2005

Operation management system evaluation in the central Finland health care district - end users' view of system implementation.

In this paper we evaluate the implementation of the operation management system in the Central Finland Health Care District. The implementation of the operation management system changed the practice of operation management for the surgical clinic and concerned 500 personnel in total. A survey was carried out to investigate the end users' views on the system's usefulness, usability and the training and user support provided. The users' possibilities to accomplish their tasks and the kind of obstacles they face in operation management were explored. The assessment revealed that more end support is needed after the system implementation, even though a generally positive attitude towards the system was manifested among the staff.

Attitude of Health Personnel↗

PubMed2005

Faculty internships in environmental health: planning and implementation.

Faculty internships, in which a faculty member works temporarily for a government organization or a private business, are a concept that is becoming popular at universities. This paper discusses how a faculty internship can be developed and implemented, and it reports on the advantages of the internship for academia, the sponsoring institution, and the professor. In addition, suggestions on structuring and implementing the internship are offered. The major objective of the paper is to encourage environmental health educators to seriously consider faculty internships as a means of bridging the gaps between academia and the business world. Faculty internships should be beneficial primarily for two groups of professors. First are those professors who, after earning doctorates, enter the teaching profession without any environmental health practicum experience. Second are those who once worked full time as environmental health practitioners but have been out of the field for a significant number of years with little or no contact with the "real world" of environmental health practice. The information presented is based on the experience of the author, who served as a faculty intern for the environmental health division of a county health department in rural west-central Indiana, Some of the benefits of faculty internships are improved teaching methods, practical experience, community contacts, and increased internship opportunities for students. The experience can enhance classroom theory for students, and the implementation of practice can be clarified for the educator.

Commerce↗

PubMed2006

Benefiting from ambulatory EHR implementation: solidarity, six sigma, and willingness to strive.

Ambulatory electronic health record systems have the potential to improve healthcare quality. Optimizing the value of EHR implementation requires that providers and staff become effective and efficient EHR users so paper charts are no longer required or desired. Transitioning from paper charts to EHR systems requires new learning, significant effort, and workflow changes associated with an initial adverse effect on provider efficiency. This case study describes how timely EHR implementation and regular use in a large academic internal medicine clinic was encouraged, achieved, and demonstrated. Critical success factors included readiness to change, solidarity in EHR use, a commitment to striving, and process improvement strategies that used the EHR system to repair suboptimal clinic workflows. Observed benefits include improvements in patient access, workflow efficiency, communication, decision support use, and financial performance. These success factors and implementation strategies may help others seeking to encourage greater adoption and use of EHRs.

Cost-Benefit Analysis↗

PubMed2006

Implementation of a Project Management Office (PMO)--experiences from year 1.

Recognized as an early leader in clinical information systems, the University of Illinois Medical Center was challenged to meet the ever-increasing demand for information systems. Interviews with key stakeholders revealed unfavorable attitudes toward the Information Services department. Reasons given were that projects often are not aligned with business strategy, projects are delayed, IS itself is a barrier to progress, and a lack of proactive planning precipitates crises. Under the leadership of a new CIO, IS began developing a Project Management Office, or PMO, to better meet medical center business objectives and to more effectively manage technology projects. Successes during the first year included comprehensive IT strategic planning. Collaborative relationships were established with departmental leaders for planning, prioritizing, budgeting, and executing projects. A formal Web-based process for requesting IS projects was implemented, project management training was provided, and elements of standard project management methodology were implemented. While a framework for effective project management was created, significant effort is still required to firmly root these new processes within the organizational culture. Project management office goals for the second year include implementing a project portfolio management tool, refining the benefits methodology, and continuing the advancement of the project management methodology.

Academic Medical Centers↗

PubMedDate not supplied

Implementing family-centred care: an exploration of the beliefs and practices of paediatric nurses.

OBJECTIVE: This study explored paediatric nurses' perceptions of how they include and involve parents in the care of hospitalised children. DESIGN: This qualitative study used individual unstructured interviews to gather data, the data was analysed using thematic coding. SETTING: Paediatric wards within two regional area health services of New South Wales, Australia. SUBJECTS: Fourteen paediatric nurses were asked to describe their beliefs and practices regarding the clinical application of family-centred care. MAIN OUTCOME MEASURE: Paediatric nurses' beliefs and practices about family-centred care were explored in an effort to explain how the concept was implemented. RESULTS: The findings are presented as four interconnected themes. The first describes how participants either allocated tasks to parents or retained them, the second relates to the nurses' professional identity, the third theme identifies barriers and constraints to the implementation of family-centred care, while the fourth describes the nurses' beliefs about their responsibilities when delivering family-centred care. CONCLUSIONS: Together these findings suggest that while nurses endorse the concept of family-centred care, the implementation into practice is more problematic. While it is not possible to generalise these findings to other paediatric nurses, the authors believe the insight gained will resonate with paediatric nurses internationally. The findings from this study are being used as the basis for the development of clinical practice guidelines to assist paediatric nurses to more consistently apply the concepts of family-centred care to their practice.

Adult↗

PubMed2006

[The design and implementation of a computer application for managing a register of patients diagnosed with genetic mental retardation].

INTRODUCTION: In order to conduct studies of mental retardation of a genetic origin over the GIRMOGEN network, a computerised register of cases needs to be set up. MATERIALS AND METHODS: This register requires the implementation of a computer application consisting of a series of management programs together with the actual database. The aims of this work are: a) To analyse all the infrastructural, scientific and technical conditioning factors that allow the computer application and the databases associated to the register to be designed; b) To design all the elements that go to make up the application, namely, the application engine, consisting of all the programs responsible for providing all the operative capabilities, and the database for storing all the data structures with the variables related to the research; c) Implementing all the designs that are developed; and d) Drawing up the security protocols and work procedures involved in running the application. RESULTS: The result of all this process is the Girmogen-Pro software application, which includes all the capabilities needed to enable it to fulfil the scientific goals of the study. It includes the security measures required to comply with the current laws regarding the handling of files containing personal information. Furthermore, the data structures that will constitute the registers to be used in the study were also been built. CONCLUSIONS: This process does not end with the implementation of the designs, since an ongoing assessment process is also performed with the aim of optimising the data structures that contain the variables that go to make up the register, so as to ensure it fits the scientific objectives of the study as well as possible.

Humans↗

PubMed2006

Implementation of curriculum by family medicine fellows: what factors help and what factors hinder?

BACKGROUND AND OBJECTIVES: The need for change in medical curricula is increasing, due partially to tougher curriculum and evaluation standards. Participants in our academic medicine fellowship learn to develop curricula, but not all are successful at fully implementing them. This study looked for facilitators of and barriers to curriculum implementation by individual fellows. A literature review uncovered studies identifying institutional variables relating to successful curriculum innovation but little that identified variables pertaining to the individual curriculum developer. METHODS: We interviewed alumni of the curriculum development track of the Primary Care Faculty Development Fellowship at Michigan State University, asking what promoted or hindered their curriculum implementation. We analyzed interview notes to identify themes according to a theoretical framework. RESULTS: Common facilitators were (1) having a strong advocate, (2) perception of need for the curriculum by both fellow and institution, and (3) having a curriculum plan. Common barriers were (1) no time slot for curriculum, (2) fellow had left job, and (3) curriculum was too large or complex. CONCLUSION: Successful curriculum developers have powerful advocates of well-designed curriculum plans that address recognized institutional needs.

Curriculum↗

PubMed2006

Importance of implementation and residual risk analyses in sediment remediation.

Management strategies for addressing contaminated sediments can include a wide range of actions, ranging from no action, to the use of engineering controls, to the use of more aggressive, intrusive activities related to removing, containing, or treating sediments because of environmental or navigation considerations. Risk assessment provides a useful foundation for understanding the environmental benefits, residual hazards, and engineering limitations of different remedy alternatives and for identifying or ranking management options. This article, part of a series of panel discussion papers on sediment remediation presented at the Third International Conference on Remediation of Contaminated Sediments held 20-25 January 2005 in New Orleans, Louisiana, USA, reviews 2 types of risk that deserve careful consideration when evaluating remedy alternatives. The evaluation of remedy implementation risks addresses predominantly short-term engineering issues, such as worker and community health and safety, equipment failures, and accident rates. The evaluation of residual risks addresses predominantly longer-term biological and environmental issues, such as ecological recovery, bioaccumulation, and relative changes in exposure and effects to humans, aquatic biota, and wildlife. Understanding the important pathways for contaminant exposure, the human and wildlife populations potentially at risk, and the possible hazards associated with the implementation of different engineering options will contribute to informed decision making with regard to short- and long-term effectiveness, implementability, and potential environmental hazards.

Ecology↗

PubMed2006

[The study and implementation of DICOM conformance in the network printing of PACS].

To implement the network printing in PACS (Picture Archiving and Communication System), each level of DICOM (Digital Imaging and Communication in Medicine) print management service is defined by means of object oriented method, and the corresponding events and properties are implemented with C++ language. It is tested on laser printers of AGFA, KODAK and FUJI to determine whether the network environment supports the print management service and implements the presentation LUT (Look Up Table) correctly. The quality control of printing at the level of data flow is also assessed. The program finally succeeds in realizing the network printing based on DICOM in hospital environment.

Computer Communication Networks↗

PubMedDate not supplied

[Implementation and evaluation of critical hazards and check points analysis (CHCPA) in gofio-producing industries from Tenerife].

OBJECTIVE: To satisfactorily implement the critical hazards and check points analysis. SETTING: Tenerife Island Subjects: 15 industries INTERVENTION: visits to gofio-manufacturing industries were done with the aim of giving advice to employers and workers, and thereafter, the intervention was assessed verifying the hygiene and sanitary conditions of the industry and the correct application of the established auto-control system. RESULTS: After the advising intervention, we observed that certain parameters taken into account from the hygiene and sanitary perspective have been corrected, such as modifying the facilities to adapt them to in force regulations, or asking the suppliers to certify raw materials. With regards to food production process, the intervention was effective in such a way that more than have of the industries reduced the time of those phases with higher contamination susceptibility and to carry out the control registries that were established. CONCLUSIONS: All industries implemented the auto-control system by means of registration charts of each one of the elaboration phases. 86% of the industries have introduced more hygienic materials. 60% implemented a reduction in intermediate times of production phases. 26% perfmored some obsolete machinery replacement modernaizing the facilities.

Edible Grain↗

PubMed2005

Vocabulary requirements for implementing clinical guidelines in an electronic medical record: a case study.

As part of a larger effort to automate guidelines we determined the number and types of clinical variables required to implement two complex clinical guidelines and the adequacy of the electronic medical record (EMR) to capture them. 178 unique variables were required by both guidelines. Variables were classified as simple (existing observation terms in the EMR), calculated (transformations of simple variables), and complex (requiring multiple simple variables and logical rules for combining them). Many variables are unlikely to be instantiated in an EMR without focused efforts to collect them. In addition, many variables required knowledge that was neither provided in the guideline nor referenced. We conclude that, although the EMR contains the necessary variables to implement these guidelines, successful automated implementation requires unambiguous definition of required terms, incorporation of additional knowledge not provided in the guideline and modification of workflow to collect variables not normally captured in routine clinical care.

Decision Support Systems, Clinical↗

PubMed2005

Implementation of computerized provider order entry in the emergency department: impact on ordering patterns in patients with chest pain.

The impact of implementing a Computerized Provider Order Entry System on ordering patterns is unknown. This study evaluated ordering patterns for CBC, ECG, chest x-ray, BMP, and cardiac enzymes in randomly selected chest pain patients in an adult Emergency Department pre- and post-implementation. The average number of orders documented was significantly higher after implementation for ECG and chest x-ray, but not for the other exams. Order completion times did not change.

Blood Chemical Analysis↗

PubMed2006

Implementation of the EU Council Directive 96/29/EURATOM in industry.

The 1996 EU Council Directive 96/29/EURATOM defines a series of specific requirements related to the safe use of radiation sources and to public and occupational exposure. The implementation of these requirements is seen in comprehensive radiation protection measures undertaken at user site and in regulatory practice. The implementation of the 96/29/EURATOM in the last years in Slovenia led to a comprehensive two-step process of authorisation of practices involving ionising radiation. The process is based on the assessment of risk associated with a practice involving radiation and a source. One of the steps includes either a registration or a permit issued by the regulatory authority to use a specific radiation source. The authorisation process has been described in detail in Slovene legislation. The 96/29/EURATOM also includes reporting intention to carry out a practice involving radiation, which is a new tool in Slovene legislation. The implementation of the 96/29/EURATOM has improved overall radiation protection in industry was improved thanks to well-defined requirements such as classification areas for control.

European Union↗

PubMed2005

Problems and obstacles in implementation of nosocomial infection control in Thailand.

OBJECTIVES: To study the problems in implementation of nosocomial infection (NI) control in Thailand and strategies to overcome the obstacles. MATERIAL AND METHOD: Interviewing administrators, chair-persons of infection control committee and doctors. RESULTS: During June 2002 and August 2003, 255 persons were interviewed by infection control nurses using a set of questionnaires. Administrators, chair-persons of infection control committee, doctors in 32 hospitals across the country were enrolled by stratified random sampling. Policy on NI control was known to 95.3% and implementation to 81.2% of subjects. The main obstacles of NI control was the lack of incentive (66.7%) and support from administrators (30.2%). Hospital administrators set NI control at high priority, in only 40.9%, they could be motivated by regular presentation of NI data. Infection control nurses (ICN) should ideally work full-time (88.6%) but in reality, only 20.8% did so. The main problem for NI control was the shortage of ICN posts in most hospitals. This resulted in no career ladder and incentive for ICN. To overcome these problems, support from administrators, more education programs in NI control and provision of posts for ICN, are needed. CONCLUSION: The main problems and obstacles an implementation of NI control were the lack of support from administrators and the lack of the ICN post.

Cross Infection↗