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PubMed2003

A platform to develop and to improve effectiveness of online computable guidelines.

The quality criteria of guidelines are identified. Taking these criteria into account we have built a platform to improve computable guideline effectiveness and facilitate their production. Our implementation is based on the GLIF Model (GuideLine Interchange Format). We have designed software components to edit, test, index, perform and present guidelines in a user-friendly Web architecture. These components are based on XML specifications in order to preserve their shareability and their re-usability. Several guidelines have been developed using our approach. We discuss the advantages of such an implementation and future evolutions so as to improve guideline integration within the clinician's workflow.

Decision Support Systems, Clinical↗
PubMed2003

From computerized patient records to national resource.

To help curb constantly rising costs of medical services, healthcare providers in Israel have been busy incorporating computerized patient record systems (CPR) into their organizations since the early 1990s. Our CPR based integrated system solutions (named Clicks) now serve over 90% of primary and secondary medical care professionals throughout the country, covering over 90% of the population across medical fields with all healthcare providers. Online verification of member rights, embedded business rules and medical protocols as well as Preventive Medical Assistance (PMA) rules are incorporated into the system. These, coupled by bi-directional communication to facilitate implementation and enforcement at all points of service and to transmit administrative and focal medical information, have created a firm foundation for carrying out the organization's cost control and expense management strategies. The CPR systems based on these underlying concepts and on token driven data entry methodology have transformed traditional medical work areas into virtually paperless environments. The enterprise wide solutions use dedicated viewports to address the needs and requirements of any medical field, user population and a wide range of medical facilities. Extensive data collection and detailed documentation are maintained universally at all points of service, for the entire patient population. Current applications, based on a distributed approach and local databases with communication to central systems for bi-directional transfer of information, gradually give way to unified databases located on central systems. Two concepts are being implemented: (a) MDC (Medical Data Core), which contains patients' focal medical data as transmitted from the local database at the physician's workstation, and (b) a complete centrally located database, where continuous communication is required from the physician's workstation to the central system, through dumb terminals. This concept entails massive investment in communication capacity and hardware and requires high reliability of all communication transactions at all times. MDC information by contrast does not require open communication lines around the clock, is communicated bi-directionally at predefined points in time or in the workflow, alleviating load and congestion on communication lines. In addition, access, retrieval and display of MDC information is done using standard browsing techniques under known protocols and requires no extra investment for these capabilities.

Diffusion of Innovation↗
PubMedDate not supplied

Improving the patient experience with information technology.

It has been proven in many different studies that information technology solutions can improve information transfer, workflow, and communication, resulting in marked improvements in patient safety and overall quality of care. However, equally important but not often emphasized is the potential for information technology to improve the patient experience by making a positive impact on the care that matters most to patients and their families.

Humans↗
PubMed2003

The nurse, M.D. and IT. Executive dialogue series.

Clinical information systems are proven to enhance workflow and outcomes, and yet hospitals often face staff resistance when systems are installed. This roundtable discussion explores how nurses and physicians can collaborate on developing IT systems.

Attitude to Computers↗
PubMed2003

Linking guidelines to Electronic Health Record design for improved chronic disease management.

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and workflow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR.

Chronic Disease↗
PubMed2003

Patient perceptions of physician use of handheld computers.

BACKGROUND: Handheld computers have advantages for healthcare providers including portability and integration into office workflow. However, negative patient perceptions of physician use of handheld computers in the examining room might limit integration. OBJECTIVE: To survey patients' perceptions of handheld use, and compare those with their providers' perceptions. METHODS: A survey of patient attitudes toward handhelds was conducted among patients at a low-income university clinic. Internal Medicine residents providing care were also surveyed. RESULTS: Patients (N=93) were mostly female (79%) and ethnic minorities (67%) with average age of 39. Only 10% of patients did not like the idea of a handheld computer in the exam room. Other negative attitudes were also seen in a minority of patients. Some physicians (23%) reported reservations about using the handheld computer with patients. CONCLUSIONS: Negative attitudes were rare among patients, but some providers were concerned about using the handheld in the exam room.

Adult↗
PubMed2003

Challenges to physicians' use of a wireless alert pager.

Pagers, personal data assistants (PDAs) and other devices that have wireless connectivity are becoming a popular method for delivering patient related information to medical decision makers. Although medical informatics research has emphasized the design, and implementation of pagers as event notification mechanisms, researchers have not paid as much attention to how this technology impacts medical work. We present a case study of physicians in a Surgical Intensive Care Unit (SICU) using wireless alert pagers. The pagers provide a variety of alphanumeric clinical alert messages and are widely used by SICU physicians. However, the use of the pagers has created unanticipated challenges to the physicians' traditional work practices. These challenges include: (1) flattening of hierarchical workflows, (2) coping with information overload and missing context, and (3) lack of feedback. These challenges are tied to both the specific technical design of the system and the traditional structure of medical work.

Attitude of Health Personnel↗
PubMed2003

A customizable MR brain imaging atlas of structure and function for decision support.

We present a MR brain atlas for structure and function (diffusion weighted images). The atlas is customizable for contrast and orientation to match the current patient images. In addition, the atlas also provides normative values of MR parameters (T1, T2 and ADC values). The atlas is designed on informatics principles to provide context sensitive decision support at the time of primary image interpretation. Additional support for diagnostic interpretation is provided by a list of expert created most relevant 'Image Finding Descriptors' that will serve as cues to the user. The architecture of the atlas module is integrated into the image workflow of a radiology department to provide support at the time of primary diagnosis.

Algorithms↗
PubMed2003

The structure of guideline recommendations: a synthesis.

We propose that recommendations in a clinical guideline can be structured either as collections of decisions that are to be applied in specific situations or as processes that specify activities that take place over time. We formalize them as "recommendation sets" consisting of either Activity Graphs that represent guideline-directed processes or Decision Maps that represent atemporal recommendations or recommendations involving decisions made at one time point. We model guideline processes as specializations of workflow processes and provide possible computational models for decision maps. We evaluate the proposed formalism by showing how various guideline-modeling methodologies, including GLIF, EON, PRODIGY3, and Medical Logic Modules can be mapped into the proposed structures. The generality of the formalism makes it a candidate for standardizing the structure of recommendations for computer-interpretable guidelines.

Decision Making, Computer-Assisted↗
PubMed2003

Web-based physician order entry: an open source solution with broad physician involvement.

Computerized physician order entry (CPOE) is a disruptive technology but holds great promise for reducing medical errors, improving workflow and in the long run, producing cost-savings. However, many studies have reported significant physician resistance to implementing CPOE. In this manuscript we present a two-prong strategy for quick implementation of CPOE: 1) a web-based deployment tool using an open source, secure environment that allows rapid development and deployment of content, and 2) the development of a large set of disease specific order sets and knowledge bases based on established vocabulary standards such as LOINC and SNOMED CT by teams of multidisciplinary content experts at the departmental level. The order sets can be viewed, edited and signed through a standard browser interface. This paper presents the conceptual framework and implementation requirements for such an endeavor.

Attitude of Health Personnel↗
PubMed2003

Modeling and simulation role in designing a Teleradiology system.

In designing complex systems, Engineers, Developers and Systems Architects always have to make quantitative assumptions in order to satisfy anticipated loads and expectations of the final product. Many questions are asked before any complex system design that relate to systems performance, infrastructure and components configuration, behavior prediction and bottlenecks fixes. All these questions can be answered using modeling and simulation tools that allow engineers to predict systems behaviors in different settings and optimize systems in production by identifying bottlenecks and flaws in the infrastructure or workflow.

Computer Simulation↗
PubMed2003

Application of an XML-based document framework to knowledge content authoring and clinical information system development.

The role of XML in health care is evolving rapidly. Coupled with other W3C standards, informaticists can design systems that may be used not only for storage and retrieval of structured knowledge, but also for quick transformation of such knowledge into many different usable formats. At Intermountain Health Care, we are currently developing an XML-based document framework to accommodate both the capture of structured knowledge as well as its transformation into several usable formats. Our objective relies upon the premise that information systems can be implemented using workflows based on structured documents.

Artificial Intelligence↗
PubMed2003

Development of an information model for solid organ transplantation.

Information required to manage transplant patients and donors is complex, voluminous and requires the reporting and use of one person's medical information within another person's record. One strategy using a vocabulary model (i.e., LOINC codes with *DONOR specified in the system axes) will lead to problems with combinatorial explosion. After evaluating workflow processes, data collection forms, decision support and functional requirements, we designed and implemented an extendable information model to support the process of care following liver transplantation.

Decision Making, Computer-Assisted↗
PubMed2003

Common data element (CDE) management and deployment in clinical trials.

The NCI provides the cancer Data Standards Repository (caDSR) to support development and deployment of CDEs in cancer research. The caDSR, part of the NCI caCORE infrastructure, supports data management workflow requirements and adherence to ISO/IEC 11179 metadata standards. CDEs are developed using standard terminology from caCORE vocabulary services, and are then deployed to multi-site clinical trials data management systems. Here we describe the caDSR and how CDEs are managed and deployed in clinical research.

Biomedical Research↗
PubMed2003

Supporting communication in an integrated patient record system.

Over the past two years, Vanderbilt University Medical Center (VUMC) has developed and implemented an integrated user interface front end that gives users a homogeneous view that supports directly the clinical workflow. This system, known as StarPanel, is a Web-based front end that integrates seamlessly all the functions needed for busy outpatient clinics. The key design concept is the ability to support communication as the fundamental activity of a health care team.

Academic Medical Centers↗
PubMed2003

Supporting patient care beyond the clinical encounter: three informatics innovations from partners health care.

As the focus of medicine moves from acute episodic care in the hospital to chronic disease management in outpatients, the primary care physician will play an increasingly important role in the coordination of patient care activities. Traditional outpatient informatics systems have largely focused on the workflow during the clinical encounter. Many tasks, including management of test results,coordination of subspecialty referrals and communication between patients and the practice,remain unsupported. When these tasks are not performed well, quality of care, patient safety and satisfaction may suffer. To address these issues ,Partners Healthcare in Boston, MA has recently developed several applications to address these issues. This demonstration will showcase 3 of these new applications: i) Results Manager, ii) Referrals Manager and iii) Patient Gateway. All interoperate with a browser-based electronic medical record already used by over 500 primary care physicians at Partners Healthcare.

Ambulatory Care↗
PubMed2003

Rapid deployment of physician order entry using web-based, disease-specific order sets.

Computerized physician order entry (POE) is a disruptive technology that holds great promise to reduce medical errors and improve workflow. However, Studies have reported significant physician resistance. This presentation will describe a two-pronged strategy to build broad support for POE: To build a secure, open source, browser-based platform to support POE and create a large number of disease-specific order-sets for immediate use. This presentation will demonstrate the conceptual framework and implementation requirements for such an endeavor.

Attitude of Health Personnel↗