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At least 1,567 records · Page 87Linked to original sources

PubMed2006

[Clinical laboratory system in a complete electronic hospital].

The use of a Laboratory Information System (LIS) and Laboratory Automation System (LAS) are clearly superior to manual results in terms of completeness and legibility. As the current clinical information system (CIS) in Gifu University Hospital consists of a complete electronic medical record system, the clinical laboratory was re-engineered to simplify workflow, pay attention to quality assurance, and decrease various costs by an intelligent laboratory management system. We named the new system Gifu Premiotic Intelligent Laboratory System (GPILS). Further advances will concentrate on the cost-effective use of LIS, and the potential use of GPILS in our laboratories will be discussed. In addition, because one of our clinical laboratories currently provides various useful clinical laboratory-oriented information to physicians and patients, we have developed new tools named the "Reference Data Base (RefDB)". In the near future, several different types of computer technology for various clinical laboratory information will lead to the development of highly specific platforms for LIS corresponding to a complete electronic medical record system.

Clinical Laboratory Information Systems↗

PubMed2006

Implementation of a computerized physician order entry system of medications at the University Health Network--physicians' perspectives on the critical issues.

There are many reasons why most hospitals have not adopted physician order entry systems for medications. It is a costly endeavour (Kuperman and Gibson 2003) that can cause major disruptions to workflow for physicians, pharmacists and nurses. Yet, the technology can reduce medication errors, especially with sophisticated decision support. We have presented many of the lessons learned from our successful implementation experience. To date, over 90% of medication orders are entered by physicians. The technology must be ready for the implementation. System issues such as errors, slowness and freezing give ready opportunity for critics who will claim the system is just not ready for real-time. Through rigorous testing, we were able to avoid issues previously seen in our pilot study. Usability testing with end-users was also critical in both guiding decision-making as well as validating that the system was ready for implementation. Proper training and support were also necessary. To ensure ready adoption, decision support was optimized to reduce the volume of less important alerts. Most importantly, we found that active physician involvement at multiple levels was key. This ensured that physicians understood from a high-level perspective that this change was necessary. Planning for specific implementation details had the benefit of input from physicians working in the area. Day-to-day issues of our residents and staff were also addressed promptly.

Attitude of Health Personnel↗

PubMedDate not supplied

Medical archiving: solutions for medical image management.

Within the field of radiology, innovations in digital imaging have led to the development of the picture archival and communication system (PACS), which is now a part of the fundamental technological infrastructure supporting radiology practice in the digital age. Healthcare providers like hospitals, outpatient centers, and clinics are facing an explosion of medical imaging content as the industry continues the transfer from film to digital format. As a result, providers need to rethink their storage architecture strategies to better address the varied applications of the modern healthcare organization. Digital medical images are typically very large and technological advances are constantly increasing the rate at which such data is being recorded, image volume can present a storage capacity challenge. In addition, the images must be safely stored for a long time and easy to access. Regardless of strategy, the continued deployment of PACS as the primary vehicle to streamline medical imaging workflow, manage image access and increase user productivity is important. Grid computing, typically associated with the capture of idle computational cycles on heterogeneous servers, employs computing techniques that can offer providers unique solutions to their storage problems.

Efficiency, Organizational↗

PubMedDate not supplied

Linking nursing workload and performance indicators in ambulatory care.

More and more ambulatory care organizations are using nursing report cards to monitor and evaluate the quality and effectiveness of nursing care in the ambulatory setting. Nurse staffing levels is usually one of the items included in a nursing report card and the one most scrutinized by ambulatory care administrators. One strategy employed by the nursing leadership at the South Texas Veterans Healthcare System to justify nurse staffing levels is linking administrative staffing monitors with nurse-sensitive outcomes via workload and performance indicators. Through this approach, nurse leaders are able to justify nurse staffing level changes, needed technology changes, process improvements, and/or workflow needs to administrators with positive results and support.

Ambulatory Care↗

PubMed2006

Early experiences with E-prescribing.

Most physicians understand that e-prescribing will reduce medical errors and will be perceived by patients as making the prescription process easier. However, they are skeptical about a number of things. They worry whether their office processes will be improved or streamlined; e-prescribing will interface seamlessly with their existing practice management software; training and support will be available; e-prescribing data will be seamlessly transferable to an electronic health record when they implement a more advanced clinical record system for their practice; and if they will achieve a return on investment. Early adopting clinicians in Massachusetts can convince the majority of clinicians to adopt e-prescribing by sharing their motivations for adopting e-prescribing, the challenges that they needed to overcome, the hardware and software requirements, and integration into their office workflow. Finally, interaction with the physicians and practice managers in the audience makes the adoption of e-prescribing seem both reasonable and exciting. Resources such as vendor lists, questions to ask, and hardware and software requirements also need to be readily available and in a form that non-technical staff can read and understand. Physicians who know the "why" would also like to know

Diffusion of Innovation↗

PubMed2006

How healthcare IT can address the nursing shortage.

But if applied correctly, IT can play an important role in redefining the way nursing is conducted. It can do so by introducing flexible models of nursing education to increase the pool of qualified nursing professionals; automating and standardizing nursing workflows; eliminating paperwork; supporting patient care delivery models that address the needs of an older workforce; establishing point-of-care clinical decision support tools to improve patient safety; and making health, wellness, and patient education information available. If healthcare IT solutions are deployed in direct response to nursing's ills, particularly job dissatisfaction, the positive image of nursing can be restored, once again making it a career of choice. IT can further reverse the tide of nursing defections, which continually drain the healthcare industry of experienced and dedicated professionals. Finally, both individually and collectively, healthcare IT technologies can reorient nursing activity back towards its principal role of delivering quality patient care.

Hospital Information Systems↗

PubMed2006

Nursing admissions process redesigned to leverage EHR.

Among the challenges facing nurses in acute care facilities are duplicate documentation, complex rules for coordinating care, and pressure to accelerate patient discharge. Christiana Care, a two-hospital, 900-bed health system in Delaware, redesigned its nursing admissions process to address these issues and provide a centralized source of assessment information. An interdisciplinary team redesigned the assessment process to leverage the clinical documentation, decision support, and workflow tools of Christiana Care's evolving electronic health record. Nurses use a wireless device at the patient's bedside to enter admission information. A series of decision-support rules evaluate the information and send electronic referrals to appropriate ancillary departments. Departments electronically document interventions that can be tracked by nursing, closing the loop.A dedicated rollout coordinator and system-generated audit reports were critical to early identification and resolution of several implementation problems. The new process has not only simplified the work of nursing but led to more appropriate referrals to the ancillary departments. More than 25 percent of the patients have information imported from a previous encounter, eliminating duplicate documentation and improving patient satisfaction. Admission information also is being used to monitor and support a variety of quality efforts, including core measures.

Delaware↗

PubMed2006

Maintaining excellence in physician nurse communication with CPOE: A nursing informatics team approach.

Designing and implementing CPOE systems is difficult, presenting many challenges to overcome related to workflow redesign. As part of the Mayo Clinic Arizona CPOE design and implementation, it was recognized that physicians would be placing inpatient orders from multiple locations; therefore nurses no longer would have the usual visual clues to identify new physician orders. This could easily lead to a delay in implementing orders that require immediate action. To address this, a multidisciplinary team evaluated various communication options and designed two in-house Web-based applications to solve the communication gap. One application will provide staff nurses with visual alerts for stat and routine orders as they are processed in real time. A second application is a Web-based link to the nursing assignment sheets, which will give physicians and support staff access to staff nurse assignments and phone numbers, specific to each nursing unit.

Arizona↗

PubMed2006

How automated access verification can help organizations demonstrate HIPAA compliance: A case study.

This case study of Sharp HealthCare takes an in depth look at how the organization has embedded security policies into its business process and automated workflow to ensure users are granted only the IT access that is necessary for them to perform their jobs and to ensure patient privacy Some of the most pressing audit and compliance concerns in healthcare organizations today revolve around the need to constantly review and give an account for users' IT access. The need for this at Sharp is exacerbated because of the high rate of change within the organization and the large percentage of non-employee staff such as traveling nurses moving throughout hospital departments on their rotations. By implementing a software solution to verify the accuracy of user access rights or automatically initiate appropriate corrective actions, Sharp is now able to extend the responsibility and accountability for compliance to the most appropriate resources.

Access to Information↗

PubMed2006

Rapid HIV test kits.

Conventional testing for human immunodeficiency virus (HIV)--the causative agent for acquired immunodeficiency syndrome (AIDS)--is an efficient way to screen large numbers of samples at one time. But initial results are often not available for hours or days; moreover, results are typically not released until confirmed, which can be weeks later. Consequently, conventional testing doesn't always provide information on HIV status quickly enough to be clinically useful. This limitation has led to the development of rapid HIV test kits, which can provide results in 20 minutes or less. Rapid HIV tests can be used for testing pregnant women in labor whose HIV status is unknown (to reduce vertical transmission from mother to fetus or infant) and for testing source individuals after occupational exposures (to help with drug treatment decisions). Additionally, the use of rapid test kits for screening high-risk individuals (especially those who may not return for results) is expected to increase the number of individuals who know their HIV status. This Evaluation looks at three rapid HIV tests currently available in the United States: the MedMira Labs Reveal G2 Rapid HIV-1 Antibody Test Kit, the OraSure Technologies OraQuick Advance Rapid HIV-1/2 Antibody Test, and the Trinity Biotech Uni-Gold Recombigen HIV. We rate the kits separately for laboratory use and for point-of-care testing (POCT). For laboratory applications, efficiency and suitability for the lab's workflow are the key selection factors. For POCT, ease of use is paramount. A different product was our top choice for each of these applications.

Anti-HIV Agents↗

PubMed2005

Automating the recognition and prioritization of needed preventive services: early results from the CHICA system.

An ever-growing plethora of preventive services guidelines threatens to overwhelm primary care providers who are expected to recognize and prioritize these needed services for each patient. The Child Health Improvement through Computer Automation (CHICA) system was designed to facilitate this process through a workflow-sensitive interface that gathers and distills the most relevant patient data within pediatric settings. We evaluated family responses to 21 CHICA questions that assess risk factors and health behaviors over a three month period. 3005 patients provided 15,434 responses to these questions, and 1756 or 11.3% of these suggest risk factors which merit attention. This preliminary analysis suggests that, using CHICA, families identify significant risk factors that our clinicians acknowledge are often overlooked given the realities of practicing within this setting.

Adolescent↗

PubMed2005

MASCAL: RFID tracking of patients, staff and equipment to enhance hospital response to mass casualty events.

Most medical facilities practice managing the large numbers of seriously injured patients expected during catastrophic events. During mass casualty events, as the demands on the healthcare team increase, and the challenges faced by managers escalate, workflow bottlenecks begin to develop and system capacity decreases. This paper describes MASCAL, an integrated software-hardware system designed to enhance management of resources at a hospital during a mass casualty situation. MASCAL uses active 802.11b asset tags to track patients, equipment and staff during the response to a disaster. The system integrates tag position information with data from personnel databases, medical information systems, registration applications and the US Navy's TACMEDCS triage application in a custom visual disaster management environment. MASCAL includes interfaces for a hospital command center, local area managers (emergency room, operating suites, radiology, etc.) and registration personnel. MASCAL is an operational system undergoing functional evaluation at the Naval Medical Center, San Diego, CA.

Disasters↗

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

An open source model for open access journal publication.

We describe an electronic journal publication infrastructure that allows a flexible publication workflow, academic exchange around different forms of user submissions, and the exchange of articles between publishers and archives using a common XML based standard. This web-based application is implemented on a freely available open source software stack. This publication demonstrates the Dermatology Online Journal's use of the platform for non-biased independent open access publication.

Access to Information↗

PubMed2005

A clinical problem-oriented decision support model based on extended temporal database functionalities.

Several diagnostic decision support systems have been proposed. Yet, such systems are not commonly used partly due to insufficient temporal reasoning. We have developed a clinical problem-oriented diagnostic decision support model that employs temporal reasoning by using extended temporal database functionalities developed at our lab. In addition, our model supports the workflow of the diagnostic process and employs detailed clinical data. We developed a prototype system that implements the concepts of the model.

Databases as Topic↗

PubMed2005

Primary care clinician attitudes towards ambulatory computerized physician order entry.

Ambulatory computerized physician order entry (ACPOE) represents one strategy to improve physician ordering practices, compliance with guidelines, and patient safety. We surveyed primary care physicians (PCPs) regarding attitudes towards ACPOE and its various features. Most PCPs did not have systems for tracking test results and were concerned about missed tests. However, there was concern that ACPOE might be time consuming, and only one-third of PCPs felt that ACPOE features would be very useful. Speed and workflow issues will be important contributors to the success of ACPOE. In addition, physician buy-in to the utility of its various features will need to be strengthened.

Ambulatory Care Information Systems↗

PubMed2005

The development of a Patient-Identification-Oriented Nursing Shift Exchange Support System using wireless RFID PDA techniques.

The objectives of this study were to technically testing the feasibility of combining RFID and PDA technologies in nursing care and to develop a support system for the nursing shift exchange, which featured with "Positive Patient Identification" and "Point of Care" for patient's safety and security. The most challenging part for the future work would be to embed the system into the real workflow. Future study would be to examine the practical effectiveness of the system.

Computers, Handheld↗

PubMed2005

Integration of hospital information systems, operative and peri-operative information systems, and operative equipment into a single information display.

The integration of disparate information systems in the operative environment allows access to information that is typically unseen or unused. Through a collaborative effort, a variety of information systems and surgical equipment are being integrated. This provides improved context-sensitive information display and decision support and improved access to information to improve workflow, safety and visualization of information that was previously unattainable.

Data Display↗