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We will present an application for tracking research samples that has been designed based upon prior research in cognitive theories on error that has been applied successfully to fields such as aviation and anesthesiology. By anticipating where the errors are likely to occur in the human-computer interaction and workflow, we hope to reduce number of errors and minimize the effects of inevitable errors.
The Vanderbilt Center for Better Health conducted a workflow analysis study to determine the benefits of implementing a computerized provider order entry system in the adult Emergency Department. Time savings by role was 1619 hours/year for nurses, 815 for medical receptionist, -95 for attendings, and -100 for residents. Translating time savings into bottom line savings (FTE/overtime reduction, additional charges) resulted in $31,424 in time savings and $40,000 cost savings (paper forms).
The introduction of Computerized Provider Order Entry (CPOE) has been shown to reduce the incidence of medication-related errors in hospitals. Successful implementation of CPOE and electronic health records requires redesigning workflows and analysis of information collected and training of staff to use these new systems. However, well intentioned processes that seem to solve a unique problem can sometimes go in an unanticipated direction for several reasons. This can have unintentional consequences, especially when the built-in safeguards are not engaged. This poster describes one organization's efforts to identify the causes of one such breakdown, and how the obvious solutions were inappropriate.
Computerized drug prescribing alerts can improve patient safety, but are often overridden because of poor specificity and alert overload. We developed a selective knowledge base of only clinically significant drug alerts and designated only critical-high severity alerts to be interruptive to clinician workflow (a tiered approach). Using this approach, we were able to achieve a 67% clinician accept rate for ambulatory computerized prescribing alerts.
Recent advances in mobile computing technologies have made electronic medical records(EMRs) on handheld devices an attractive possibility.However, data entry paradigms popular on desktop machines do not translate well to mobile devices 1,2. Based on a review of the literature on mobile device usability 1-4,we built a prototype user interface for mobile EMRs and held focus groups with clinician users whose feedback provided useful insight about design choices,functionality and optimal workflow integration.
Activity-based methods serve as a dynamic process that has allowed many other industries to reduce and control their costs, increase productivity, and streamline their processes while improving product quality and service. The method could serve the healthcare industry in an equally beneficial way. Activity-based methods encompass both activity based costing (ABC) and activity-based management (ABM). ABC is a cost management approach that links resource consumption to activities that an enterprise performs, and then assigns those activities and their associated costs to customers, products, or product lines. ABM uses the resource assignments derived in ABC so that operation managers can improve their departmental processes and workflows. There are three fundamental problems with traditional cost systems. First, traditional systems fail to reflect the underlying diversity of work taking place within an enterprise. Second, it uses allocations that are, for the most part, arbitrary Single step allocations fail to reflect the real work-the activities being performed and the associate resources actually consumed. Third, they only provide a cost number that, standing alone, does not provide any guidance on how to improve performance by lowering cost or enhancing throughput.
Job-sharing is generally defined as a situation in which a single professional position is held in common by two separate individuals, who alternatively, on a timely basis, deal with the workload and the responsibilities. The aim of the present paper is to discuss prerequisites and characteristics of job-sharing by medical doctors and implications in a department of nuclear medicine. Job-sharing facilitates the combination of family life with professional occupation and prevents burnout. The time schedule applied by job-sharers is relevant: will both partners work for half-days, half-weeks, or rather alternatively during one to two consecutive weeks? This crucial choice, depending on personal as well as on professional circumstances, certainly influences the workflow of the department.
There is a compelling demand for the integration and exploitation of heterogeneous biomedical information for improved clinical practice, medical research, and personalised healthcare across the EU. The Health-e-Child project aims at developing an integrated healthcare platform for European Paediatrics, providing seamless integration of traditional and emerging sources of biomedical information. The long-term goal of the project is to provide uninhibited access to universal biomedical knowledge repositories for personalised and preventive healthcare, large-scale information-based biomedical research and training, and informed policy making. The project focus will be on individualized disease prevention, screening, early diagnosis, therapy and follow-up of paediatric heart diseases, inflammatory diseases, and brain tumours. The project will build a Grid-enabled European network of leading clinical centres that will share and annotate biomedical data, validate systems clinically, and diffuse clinical excellence across Europe by setting up new technologies, clinical workflows, and standards. This paper outlines the design approach being adopted in Health-e-Child to enable the delivery of an integrated biomedical information platform.
Fixation of tissues with formalin results in well-preserved morphology but to a high degree leads to degradation of nucleic acids, which substantially constricts the spectrum of applicable molecular techniques. The novel HOPE-fixative with subsequent paraffin embedding, as an alternative to formalin, has been shown to result in a morphological preservation comparable to formalin-fixed, paraffin-embedded specimens. Due to a similar workflow like in formalin-fixation and paraffin embedding, the HOPE technique can be successfully established within any pathological institute. We have shown that DNA, RNA and proteins are protected in HOPE-fixed, paraffin-embedded tissues for at least eight years. Moreover, we described procedures which permit successful application of all common molecular techniques such as in situ hybridization targeting either DNA or RNA, immunohistochemistry without antigen retrieval and for formalin-refractory antigens, PCR, RT-PCR, Western blot, Northern blot, and transcription microarrays to HOPE-fixed, paraffin-embedded tissues. Furthermore, HOPE-fixed tissues can be used for the construction of tissue microarrays for enhanced high-throughput analyses on the molecular level. Using the HOPE technique as its crucial methodological base, ex vivo model systems could be established, e.g. for the simulation of early events in human infections and detection of chemotherapy resistances in human cancer. In addition to tissues, cell-culture preparations have been prepared utilizing the HOPE technique, which were then successfully applied to in situ hybridization targeting mRNA or immunocytochemistry with excellent preservation of morphological details. Taken together, the HOPE technique to date represents an alternative fixation that is, in contrary to other procedures, scientifically broadly analyzed. Therefore new possibilities are opened up especially within the rapidly growing field of molecular pathology.
EHRs and data sharing improve quality, reduce costs, and enhance workflow. They create a c ommunity of clinical collaboration, fostering the adoption of new knowledge and best practices. With government, provider, and payer support for the nationwide rollout of electronic records, 2006 will be the year in which the United States makes significant progress on the journey to deliver electronic systems to all clinicians.
Clinical-financial integration at St. Vincent's Medical Center involved three basic initiatives: A cultural change initiative to educate individuals throughout the hospital about their contributions to the hospital's financial health. An IT initiative to take full advantage of the capability of St. Vincent's enterprisewide clinical IT system to support an integrated, clinically automated revenue cycle. A staffing initiative to realign staff roles and workflows in financial services departments to capitalize on the IT automation.
To meet the challenges such as raising the efficiency of medical resources, slowing the fastly-increasing medical costs and keeping the sustainability of the aging society and chronic diseases, this paper introduces a Medical Digital Assistant system for "BOP", which includes a mobile monitoring unit,a data transferring unit, and a managing unit, and presents the system's evaluating method. In addition, a new application model and the service workflow are discussed.
OBJECTIVES: Trauma surgeons possess specific anticipative pathoanatomical and procedural domain knowledge that can be used for information extraction from original CT image data. This knowledge so far remains unused in clinical workflow and surgeons do not take an active part in the process of image generation and processing. The objectives of our work are to propose and employ a strategy to directly involve surgeons in a dynamic image exploration process and to exemplarily assess the clinical use of this approach for pre-operative diagnosis of complex articular fractures. METHODS: We used an interactive 3D navigation tool with a novel human-computer interface for the exploration of articular fractures of two selected anatomical structures. The system offers dynamic interaction with a virtual 3D reconstruction model and the possibility to create on-the-fly oblique multiplanar reformations by tracking hand movements. Three expert surgeons performed exemplary explorations and rated the use of the method for preoperative diagnosis in informal interviews. RESULTS: The approach and the system were well received by the three surgeons. The dynamic interaction was rated to be helpful in understanding fracture morphology. Two examples--a radius and a calcaneal fracture--are presented. CONCLUSIONS: Surgeons with their specific domain knowledge should be involved in the process of image processing. The benefit of using oblique multiplanar reformations for pre-operative planning in articular fractures appears to be substantial and they should therefore be included in radiological and surgical textbooks. Further evaluation is necessary to assess the use of interactive exploration systems in routine diagnosis.
Digital radiography has been used in human medical imaging since the 1980s with recent and rapid acceptance into the veterinary profession. Using advanced image capture and computer technology, radiographic images are viewed on a computer monitor. This is advantageous because radiographic images can be adjusted using dedicated computer software to maximize diagnostic image quality. Digital images can be accessed at computer workstations throughout the hospital, instantly retrieved from computer archives, and transmitted via the internet for consultation or case referral. Digital radiographic data can also be incorporated into a hospital information system, making record keeping an entirely paperless process. Digital image acquisition is faster when compared to conventional screen-film radiography, improving workflow and patient throughput. Digital radiography greatly reduces the need for 'retake' radiographs because of wide latitude in exposure factors. Also eliminated are costs associated with radiographic film and x-ray film development. Computed radiography, charged coupled devices, and flat panel detectors are types of digital radiography systems currently available.
In this paper, we introduce the grid technology into the design of the distributed PACS. First, we analyse the architecture and functions of OGSA-DAI, and then, introduce a model of the distributed PACS based on OGSA-DAI, and give a detailed analysis on its basic components and workflow. Finally, we make a conclusion on the distributed PACS based on grid technology.
A clear case has been made for using clinical IT to improve medication safety, particularly bar-code point-of-care medication administration and computerized practitioner order entry (CPOE) with clinical decision support. The equally important role of automation has been overlooked. When the two are tightly integrated, with pharmacy information serving as a hub, the distinctions between software and automation become blurred. A true end-to-end medication management system drives out errors from the dockside to the bedside. Presbyterian Healthcare Services in Albuquerque has been building such a system since 1999, beginning by automating pharmacy operations to support bar-coded medication administration. Encouraged by those results, it then began layering on software to further support clinician workflow and improve communication, culminating with the deployment of CPOE and clinical decision support. This combination, plus a hard-wired culture of safety, has resulted in a dramatically lower mortality and harm rate that could not have been achieved with a partial solution.
The design of genetic association studies using single-nucleotide polymorphisms (SNPs) requires the selection of subsets of the variants providing high statistical power at a reasonable cost. SNPs must be selected to maximize the probability that a causative mutation is in linkage disequilibrium (LD) with at least one marker genotyped in the study. The HapMap project performed a genome-wide survey of genetic variation with about a million SNPs typed in four populations, providing a rich resource to inform the design of association studies. A number of strategies have been proposed for the selection of SNPs based on observed LD, including construction of metric LD maps and the selection of haplotype tagging SNPs. Power calculations are important at the study design stage to ensure successful results. Integrating these methods and annotations can be challenging: the algorithms required to implement these methods are complex to deploy, and all the necessary data and annotations are deposited in disparate databases. Here, we present the SNPbrowser Software, a freely available tool to assist in the LD-based selection of markers for association studies. This stand-alone application provides fast query capabilities and swift visualization of SNPs, gene annotations, power, haplotype blocks, and LD map coordinates. Wizards implement several common SNP selection workflows including the selection of optimal subsets of SNPs (e.g. tagging SNPs). Selected SNPs are screened for their conversion potential to either TaqMan SNP Genotyping Assays or the SNPlex Genotyping System, two commercially available genotyping platforms, expediting the set-up of genetic studies with an increased probability of success.
In Finland, the shared record is a virtual electronic health record (EHR). It consists of health data generated, maintained and preserved by different health care service providers. Two different kinds of technologies for integrating regional EHR-systems are applied, but mainly by using a common middleware. Services provided by this middleware are EHR location services using a link repository and combining EHR-viewing services with security management services including consent management and identification services for health professionals. The Regional Health Information Organization (UUMA) approach is based on a stepwise implementation of integrated regional healthcare services to create a virtually borderless healthcare organization--a patient centered virtual workspace. In the virtual workspace multi-professional teams and patients collaborate and share information regardless of time and place. Presently the regional health information network (RHIN) is comprised of three integrated services between primary, secondary and tertiary care within the county of Uusimaa. The regional healthcare modules consist of an (1) eReferral network, (2) integrated EHR service between health care professionals and (3) PACS system. The eReferral between primary and secondary care not only speeds up the transfer, but also offers an option for communication in the form of eConsultation between general practitioners and hospital specialists. By sharing information and knowledge remote eConsultations create a new working environment for integrated delivery of eServices between the health care providers. Over 100,000 eReferral messages (40 %) were transferred between health care providers. Interactive eConsultations enable supervised care leading to the reduction of outpatient visits and more timely appointments. One third (10/31) of the municipal health centers are connected to the clinics in the Helsinki University Central Hospital by the eReferral system. The link directory service extends the dimensions of networking between organizations by combining legacy systems within regional primary and secondary care. The link directory is an interface to diverse patient information systems, like HUSpacs, containing links pointing to the actual patient data located in remote information systems. The original data including images can be viewed with a web browser, but data can be accessed only with the patient's informed consent. Currently the reference data base includes 9.5 million links from 1.4 million patients with over 2.000 daily users. We aim to create a new working environment for professionals by incorporation of innovative information and communication technology, new organization of work and re-engineering of workflows. In the near-future, the citizen will have an active role participating in decisions on his care, carrying out guided self-care and taking steps of pro-active prevention.