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Electronic medical record systems as a basis for computer-based patient records.

In summation, some document imaging systems offer the capability to form what may be called electronic medical record (EMR) systems. These systems are adaptations of current paper-based record management systems into the digital environment, but they offer far more capabilities than strictly archival, historical functions. Some of the capabilities that create EMR systems will also be necessary for development of CPRs, these capabilities are listed as follows: mass storage and image management; direct capture, storage, and retrieval of digital information (native format); large volume, high-speed, client-server networks; multi-media information management; high-power, flexible database tools; workflow process software; flexible, full function security; user customizable features; and alerts and reminders. Selection and implementation of document imaging systems should, at present, be undertaken with great care to insure that the platform may be utilized to form an electronic medical record with a clear migration path to the CPR.

Database Management Systems↗

Six standard panels for hepatoviral diagnosis.

From the many available tests for hepatoviral diagnosis the most reliable and established were incorporated into a series of panels. Six groups or batteries of tests are proposed, each directed to one clinical question. These are hepatitis B detection and chronic hepatitis B monitoring, hepatitis detection and chronic hepatitis monitoring, as well as a hepatitis and chronic hepatitis monitoring, as well as a hepatitis screening panel for blood banks and an immune status panel to determine individual immune status and risk. This approach limits the number of immuno-diagnostic tests needed and simplifies laboratory workflow. The limitations, including specificity problems encountered with tests based on the polymerase chain reaction (PCR), and probable future developments of tests excluded from the simplified panel concept are discussed.

Hepatitis, Viral, Human↗

Next-generation informatics. A new picture of quality medicine.

It's up to the physician executive to make an informed choice when selecting a "next-generation" information system. Look for systems that truly integrate (not merely interface) managed care components, clinical capabilities, and other features in a model that mimics the workflow of an actual practice. Take the time to learn about the technology. Consider how a vendor's product will work at every point within your organization. Seven critical features that physician executives should consider in their decision-making are described.

Decision Making↗

The quality and cost of medical care. The potential for information technology to meet the challenge.

The rising cost of health care has precipitated a variety of cost containment initiatives. With the accelerated transition to managed care, the question of quality has emerged. The feeling of many is that cost reduction alone can have only one effect, a reduction in quality. In response, many have focused on the need to reassess and reengineer the processes involved in the delivery of care and to integrate these processes to ensure better management of the patient through the monitoring of the continuum of care. In this paper, we describe the potential for the application of an information technology, known as workflow management technology, in the design and control of health care delivery processes.

Communication↗

What pathologists should know and be able to do in laboratory data processing and computers: peripheral devices and storages.

This article is the second in a five-part educational series on laboratory data processing and computers. The authors describe the major components of peripheral storage and the limitations of input/output devices, and analyze in terms of laboratory workflow the type and placement of input/output devices. Preceding the article are competency areas and performance objectives, defined by the Laboratory Computer Applications and Data Processing Committee. Following the article are questions with which readers can test their understanding of the material. Next month the authors will focus on software.

Computers↗

Hospital design to support greater operating efficiency.

With the new imperative on cost containment and particular emphasis on prospective payment, hospital design must support greater productivity. It is incumbent on architects and engineers to reduce construction costs; but more importantly, to design facilities that improve personnel productivity. Several approaches to designing for efficiency are discussed including improving the development process; systems building, ease of maintenance, and conserving energy; developing the model hospital; minimizing travel throughout the hospital; centralization vs. decentralization; automating support systems; designing for growth and change; analyzing workflow; utilizing swing space; and emphasizing consumer centered care.

Efficiency↗

Graphic analysis of pharmacy workload as a management tool.

As pharmacy planners implement modern services and cost containment measures, a graphic analysis of pharmacy workload can assist the planner in better utilizing personnel time and assuring adequate time for the completion of additional functions by depicting the peak-trough relationship of workflow. Such analysis can be an effective tool to communicate to both peers and superiors.

Hospital Bed Capacity, 300 to 499↗

Understanding the medical records department improves efficiency.

To asses the efficiency and effectiveness of the medical records department, financial managers need to first learn and understand its internal operations. While some of the tasks, such as coding, filing, and transcribing appear basic, they are all critical factors in avoiding congested workflows and backlogs that could easily result in inaccurate and late payments to the hospital. By asking the right questions and recognizing areas needing improvement, financial managers can help enhance productivity and thereby improve the financial health of the healthcare organization.

Abstracting and Indexing↗

Strand displacement amplification and homogeneous real-time detection incorporated in a second-generation DNA probe system, BDProbeTecET.

BACKGROUND: Amplified DNA probes provide powerful tools for the detection of infectious diseases, cancer, and genetic diseases. Commercially available amplification systems suffer from low throughput and require decontamination schemes, significant hands-on time, and specially trained laboratory staff. Our objective was to develop a DNA probe system to overcome these limitations. METHODS: We developed a DNA probe system, the BDProbeTecTMET, based on simultaneous strand displacement amplification and real-time fluorescence detection. The system uses sealed microwells to minimize the release of amplicons to the environment. To avoid the need for specially trained labor, the system uses a simple workflow with predispensed reagent devices; a programmable, expandable-spacing pipettor; and the 96-microwell format. Amplification and detection time was 1 h, with potential throughput up to 564 patient results per shift. We tested 122 total patient specimens obtained from a family practice clinic with the BD ProbeTecET and the Abbott LCx(R) amplified system for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae. RESULTS: Based on reportable results, the BDProbeTecET results for both organisms were 100% sensitive and 100% specific relative to the LCx. CONCLUSIONS: The BDProbeTecET is an easy-to-use, high-throughput, closed amplification system for the detection of nucleic acid from C. trachomatis and N. gonorrhoeae and other organisms.

Chlamydia trachomatis↗

The future of knowledge-based components in the electronic health record.

Traditional monolithic healthcare information systems (HIS) no longer meet the requirements of today's distributed enterprises and the rapidly changing healthcare environment. The ability of applications to communicate, interpret, and act intelligently upon complex healthcare information has assumed paramount importance. The future lies in the development of flexible component-based architectures that can operate seamlessly within the workflow of a healthcare environment. A key design goal is "graceful degradation," i.e., providing the best decision support possible within the context of available patient data. The First DataBank Drug Toolkit is used as a case study. Several technical challenges associated with building truly plug and play components are discussed.

Artificial Intelligence↗

Privacy and efficiency in patients focused health care processes.

Today's health care industry is striving to achieve the development and deployment of computer-based patient records for improvements in health care quality, cost, and access. This rapidly increasing use of computer techniques in the field of medicine and health care has created an urgent need for the dissemination of information on data protection. We present in this paper a workflow-based approach to ensure privacy and efficiency in clinical information systems and discuss the presented solution according to its practicability in daily clinical use.

Computer Security↗

[Databank-oriented physician generated medical record as the basis for outcome quality in rehabilitation medicine].

A new approach is presented for the medical reports in rehabilitation medicine. It is realized with the integration of formatted textblocks into a client-server based workflow. This technology is able to reduce hardware and costs. The data material, extracted from the daily routine of the hospital, is characterized by high quality and it supports statistics and quality management. It is a uniform database for rehabilitation medicine and for rehabilitation research. Since 1996 the medical report software has been established in all rehabilitation hospitals accredited by the LVA Württemberg pension insurance agency.

Databases, Factual↗

Perceptions of house officers who use physician order entry.

OBJECTIVE: Describe the perceptions of housestaff physicians about their experience using computerized physician order entry (POE) in hospitals. METHODS: Qualitative study using data from participant observation, focus groups, and both formal and informal interviews. Data were analyzed by three researchers using a grounded approach to identify patterns and themes in the texts. RESULTS: Six themes were identified, including housestaff education, benefits of POE, problems with POE, feelings about POE, implementation strategies, and the future of POE. CONCLUSION: House officers felt that POE assists patient care but may undermine education. They found that POE works best when tailored to fit local and individual workflow. Implementation strategies should include mechanisms for engaging housestaff in the decision process.

Attitude of Health Personnel↗

Organizational and technological insight as important factors for successful implementation of IT.

Politicians and hospital management in Sweden and Denmark focus on IT and especially Electronic Patient Record, EPR as a tool for changes that will lead to better economy as well as better quality and service to the patients. These changes are not direct effects of the new medium for patient records but indirect effects due to the possibilities embedded in the new technology. To ensure that the implementation is successful, i.e. leads to changes in organization structure and workflow, we need tools to prepare clinicians and management. The focus of this paper is the individual insight in technology and organization and it proposes a model to assess and categorize the possibilities of individuals and groups to participate in and make an implementation process powerful.

Computer Literacy↗

The transition to automated practitioner order entry in a teaching hospital: the VA Puget Sound experience.

We recently installed an automated practitioner order entry system on our busiest inpatient wards and critical care units. The installation followed 20 months preparation in which we created the workstation, network, and host infrastructure, developed requisite policies, recruited personnel to support the system, and installed the software in areas where the pace of order entry was less intense. Since implementing automated order entry, we have experienced problems such as an increase in time required for practitioners to enter orders, workflow changes on inpatient units, difficulties with patient transfers, and others. Our user support system has been heavily used during the transition period. Software tailoring and enhancements designed to address these problems are planned, as is installation of the order entry system in remaining clinical units in our medical centers.

Attitude to Computers↗

Integration of clinical decision support with on-line encounter documentation for well child care at the point of care.

Electronic medical record systems and clinical practice guideline (CPG) support applications are emerging in the clinical environment to document and support care. Applications which integrate online documentation with CPG are often complex systems bound to a proprietary infrastructure and as such, can be difficult to adapt to changing care guidelines. This paper describes integration of point-of-care clinical documentation to an Internet-based CPG system that was easily modified, utilized available software resources, and separated patient information from CPG. The system combined a text-based encounter documentation tool, Inbox, with a web-based CPG system, SIEGFRIED (System for Interactive Electronic Guidelines with Feedback and Resources for Instructional and Educational Development), which interactively presented care guidelines to providers. Age-specific well child care documentation templates were developed using Inbox for point-of-care documentation. SIEGFRIED contained the knowledge base of child safety education guidelines and executed independent of the program presenting the guidelines. The CPG were accessed from within the documentation template via an Internet hyperlink. Patient chart evaluation indicated that 77% of safety topics were reviewed and 32% of the charts contained documentation indicating all the safety topics were reviewed. Last, routine use of the Inbox-SIEGFRIED system was not realized due to the clinical time constraints and workload of the medical providers, and lack of data entry experience. A user survey indicated time cost (network access and software execution) were negative aspects of the system. However, the system function was highly regarded and the Internet-based patient education materials were described as useful and accurate. In summary, the system was functional, met original development goals, and provided valuable patient education materials; however, routine system use was prevented by time requirements. We recommend further development be oriented towards integrating the identified beneficial components of the system into clinician workflow.

Accident Prevention↗