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PubMed1994

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↗
PubMed1995

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↗
PubMedDate not supplied

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↗
PubMed1998

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↗
PubMed1994

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↗
PubMed1994

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↗
PubMed1999

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↗
PubMed1997

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↗
PubMed1994

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↗
PubMed1994

Design and processing issues for the health care professional workstation: summary and recommendations.

The health care professional workstation is a window to a heterogeneous set of functions that need to be ported to various types of hardware for different types of users. Processing aspects, which belong with the interface, storage and communication, to the architectural dimension of the workstation should not be considered outside of a more comprehensive model including the user, function and time dimensions. Several recommendations, which could provide the appropriate environment for development and help maintain a viable approach as the variables change along the four dimensions of the workstation model, are proposed. They concern the adaptation of the enterprise infrastructure to integrate workstations, the need for a reference architecture for health care workstation development and recommendations for the evaluation and dissemination of results.

Computer Communication Networks↗
PubMed1999

TIDE: an intelligent home-based healthcare information & diagnostic environment.

The 21st century promises to usher in an era of Internet based healthcare services--Tele-Healthcare. Such services augur well with the on-going paradigm shift in healthcare delivery patterns, i.e. patient centred services as opposed to provider centred services and wellness maintenance as opposed to illness management. This paper presents a Tele-Healthcare info-structure TIDE--an 'intelligent' wellness-oriented healthcare delivery environment. TIDE incorporates two WWW-based healthcare systems: (1) AIMS (Automated Health Monitoring System) for wellness maintenance and (2) IDEAS (Illness Diagnostic & Advisory System) for illness management. Our proposal comes from an attempt to rethink the sources of possible leverage in improving healthcare; vis-à-vis the provision of a continuum of personalised home-based healthcare services that emphasise the role of the individual in self health maintenance.

Artificial Intelligence↗
PubMed1994

The health care professional's workstation: a call to action.

The environment of health care delivery is changing dramatically, matched by design trends in the organizations that are responsible for care delivery, whether at the hospital or the national level. However, the emerging goals of these organizations have a certain amount of uniformity independent of background, cultural assumptions or organizational size: they are all committed to the delivery of services that maximize satisfaction of system beneficiaries at a minimum of expense. Achievement of these goals will in part require the development of a management and delivery coordination infrastructure that links the key resource utilizers and administrative operators at the point of production. Merged computer and telecommunications systems connecting at user interface nodes called workstations represent a critical enabling technology for meeting the organizational goals described above. Future delivery systems will need to provide compassionate care, retaining the most highly regarded traditions of medical practice without ignoring considerations of cost, clinical outcome and financial sustainability. This paper describes some of the limitations of the current delivery system, and attempts to identify key design concepts and paradigms that might serve to guide future system development.

Computer Communication Networks↗
PubMed1998

HL7 version 3--an object-oriented methodology for collaborative standards development.

In January of 1997, Health Level Seven (HL7) began developing Version 3.0 of its standard. The Version 3 effort represents a transformation of the way that HL7 and its Technical Committees will develop future HL7 information interchange standards. This transformation involves applying object-oriented modelling to the development and specification of information interchange standards. This paper discusses the rationale that led HL7 to undertake this change and provides an overview of the Version 3 Message Development Framework which is HL7's new methodology. It also considers the features of the Version 3 methodology that can facilitate the development of international collaboration and consensus in health informatics standards.

Computer Simulation↗
PubMed2000

[A combined PACS and Internet information system in a university medical center].

PURPOSE: The Department of Radiology at the University Hospital Innenstadt Munich provides all clinical departments of a large university hospital with several radiology units at different locations. During the last four years all units have been fully digitalized with a stepwise installation of a PACS. The PACS also processes images from the Nuclear Medicine Department. METHODS: As image modalities, archive systems and review workstations, we use devices from multiple vendors, which are integrated into a consistent system using the DICOM standard. The hospital has developed its own RIS and an Internet information system, which provides access to all reports and images from radiology for all clinical departments inside the hospital. Additionally, other clinical information such as laboratory results or ECG examinations are available through the system. RESULTS: After one year of operation, the system succeeded in the clinical routine work as the primary source for radiological reports and images as well as for laboratory values. CONCLUSION: The advantages of digitalization were, besides reduction of film cost, especially optimizations of work flow with access to digital images from everywhere at any time.

Academic Medical Centers↗
PubMed2003

Decision support at the point of care: challenges in knowledge representation, management, and patient-specific access.

Many applications in a clinical information system can benefit from the incorporation of medical knowledge to provide patient-specific, point-of-care decision support. These include computer-based provider order entry, referral, clinical result interpretation, consultation, adverse event monitoring, scheduling, shared patient-doctor decision-making, and generation of alerts and reminders, among others. To be executable, knowledge must be represented in the form of rules, constraints, calculations, guidelines, and other logical/algorithmic formats. The main difficulty is that the integration of such knowledge into clinical applications, when it occurs, tends to be very system- and application-specific, often encoded in a programming language, or even in the formating specifications of a user interaction display. Also, the data references and services invoked are highly dependent on the system/platform and electronic medical record implementation. This makes it difficult and time-consuming to encode authoritative evidence-based knowledge, severely limits the ability to disseminate and share successes, and hampers efforts to review and update the logic as medical knowledge changes. Solutions to this problem involve the development of standards-based representations for medical knowledge, and tools for authoring/editing, dissemination, adaptation to local environments, and execution. Numerous approaches are being pursued, all of which will be described in this presentation.

Decision Support Systems, Clinical↗
PubMed2000

Introduction of a clinical information system in a regional general state hospital of Athens, Greece.

The introduction of a Clinical Information System (CIS) in a healthcare organisation is a particularly complex process, requiring thorough design and the close co-operation of many key-position people within the organisation. Moreover the whole process is extremely time-consuming. This contribution presents the first phases of such an introduction in a regional state hospital in Greece. During these phases a number of preparatory actions took place in order to establish and set available in the hospital all the necessary infrastructure. Then the CIS was introduced in two pilot clinics, interconnected with the existed administrative system and customised in order to meet the needs of the various clinical departments.

Computer Communication Networks↗