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PubMed2006

Requirements specification for automated fall and injury risk assessment.

Fall and injury prevention continues to be a challenge in the acute care environment. Identification of patients at risk can guide preventive care for these individuals. The following study employed usability engineering methods via a series of focus groups, to specify functional and design requirements for an automated Fall-Injury Risk Assessment Instrument. Focus groups were held with interdisciplinary decision makers and end-users to identify functional and design specifications for the automated instrument. The results were mapped to usability heuristics, which were used to guide design decisions. The main elements identified were data completeness, workflow processes, resource access, and cognitive burden. The main usability factors identified were efficiency of user, match with real world, error prevention, recognition not recall and minimalist design. Focus groups are a useful methodology to specify requirements for healthcare applications. Outcomes evaluation of the automated instrument is in process.

Academic Medical Centers↗

PubMed2006

Exploring the impact of health information technology on communication and collaboration in acute care nursing.

A focus group using nursing informatics experts as informants was conducted to guide development of a survey to explore the impact of health information technology on the role of nurses and interdisciplinary communication in acute care settings. Through analysis of focus group transcripts, five key themes emerged: information, communication, care coordination, interdisciplinary relationships, workflow, and practice effectiveness and efficiency. This served as the basis for development of a survey that will investigate perceptions of acute care providers across the United States regarding the impact of health information technology on the role of nurses and interdisciplinar communication in acute care settings. The purpose of this paper is to describe the process of survey development including analysis of transcripts, emergence of key themes, and the processes by which the themes will be employed to inform survey development.

Acute Disease↗

PubMed2006

The electronic patient record in community health services--paradoxes and adjustments in clinical work.

This case study explores the consequences of the introduction of an electronic patient record (EPR) system to support community health services in a Norwegian municipality. The EPR was envisaged as a key tool for developing integration between a nursing home and a home care organization to meet quality care goals and to increase the time available for patient care. This investigation takes a socio-technical approach, particularly drawing on "actor-network" theory and insights from "articulation work". The empirical data comes from structured interviews, participant observation and document review. The findings of the case study indicated reluctance by staff to use the EPR system. The management had eliminated traditional information and communication routines, such as oral handover and informal nursing notes, in a reorganization of duties associated with the EPR implementation. To prevent fragmentation of nursing work, and to maintain continuity of care, the nurses reintroduced these routines spontaneously and ad hoc. The reluctance to use the system and the reintroduction of abandoned routines can be understood by exploring the interaction between the EPR system's user interface, its ability to support nursing work, and the workflow in the new merged health service. So far, the introduction of the EPR has not led to the benefits expected from it.

Community Health Services↗

PubMed2006

Empowering nurses--Improving care with an Integrated Nursing Information System (INIS).

The nursing informatics project team within the Information Management Services Department of the Mater Misericordiae University Hospital, Dublin, Ireland is currently developing and implementing an Integrated Nursing Information System (INIS) in accordance with an "Information and Workflow Model" drawn up by the team in 1998. The three components of the INIS will be defined and progress in the hospital to date will be demonstrated. INIS will become part of the overall electronic patient record.

Humans↗

PubMed2006

Transfusion checkup system using mobile terminals.

Kyoto University Hospital introduces a new hospital information system on January 2005. The system introduces ubiquitous information system using mobile terminals for nursing information support and implements a transfusion checkup system, as a single error in the transfusion process may result in a serious accident. The developed system carefully designed to suit real workflow and to make full use of the benefits of mobile terminals increases efficiency and the safety of transfusion.

Blood Transfusion↗

PubMed2006

Safety portal: the safest goes through the air--ubiquitous high-risk reminders bridging out the patient safety in emergency department.

UNLABELLED: Under the safety net of hospital-based patient safety informatics (PSI) system, RFID is build to adapt emergency department safety needs and the process improvement activities. We implemented the RFID framework as the electronic patient identifier into the process improvement of ED workflow; it defined as the safety portal to introduce PSI safety features on the real-time basis. METHODS: Since 2004, we were applying RFID technology into a 200 daily visits emergency department of the regional medical center in Taipei, Taiwan. We then developed wireless web-based RFID safety portal to implement the real-time safety reminders such as the laboratory and radiology reports to the physician who can make decision promptly to the patients in the ED. RESULTS: Under the ED safety portal, the diagnosis time for physicians to make clinical decision is largely reduced nearly 40 percent due to the safety enhancement RFID system. ED physician who could actively receive patient's updated clinical data to make clinical decision via web-based informatics system reasonably decreases. CONCLUSIONS: The effectiveness of RFID system not only enhance patient identification during ED process but combine ED safety net which providing needed data for ED physician and staff who visit ED patients with valuable real-time data on time. Patient safety on ED can be clearly improved from the embracing modern technology and build up a patient centered ED environment.

Emergency Service, Hospital↗

PubMed2006

Can temporary paper-based patient records sensibly complete an electronic patient record?

OBJECTIVES: In the department of internal medicine of Heidelberg University Hospital (HUH), medical patient records are archived electronically. Since there are still paper-based external documents, a temporary patient record is maintained for these documents during the patient's stay. Afterwards, the paper-based documents are scanned, indexed and integrated in the electronic patient record (EPR). To ensure process quality we evaluated quality and availability of scanned documents in the EPR. METHODS: Observation study, structured interviews, systematic quantitative before-after comparison. RESULTS: The workflow takes place according to the guidelines of HUH. Nevertheless, there are variations in the different wards which may influence the quality. Of 343 scanned documents about 90% showed no loss of information. Most of the documents with loss of information were ECG-curves. Four documents (1.2%) could not be found in the EPR. All documents were assigned to the correct patient and episode of care. The mean time from patient discharge to availability of scanned documents in the EPR system was 36 days. CONCLUSIONS: Due to external paper-based documents, a complete EPR is currently not possible. A temporary paper-based patient record in addition to the EPR is not an optimum procedure but feasible. The quality of the scanned, indexed and integrated documents in the EPR is high and the availability is sufficient.

Documentation↗

PubMed2006

Benefits and weaknesses of health cards used in health information systems.

The acceptance-based success of modern health information systems and health networks highly depends on the respective involvement of all relevant partners into the communication and co-operation processes characterising the medical and administrative workflow. Personal information stored in a networking environment guarantee for fast access fulfilling advanced shared care requirements whereas security token like smart cards stand for identification purposes, data protection, privacy protection, access rights, and limited person-based information storage, e.g., for emergency procedures. Linking these means of information provision allows for making use of the benefits of the different technologies without ignoring their existing weaknesses. The presented paper intends to summarise the respective categories of benefits and weaknesses allowing the reader to implement cards in health information systems as well as with the related aspects of awareness, confidence, and acceptance. Concluding this analysis, the preferred way to deal with the challenges of modern healthcare and welfare requirements shall be a well-balanced combination of cards and networks.

Diffusion of Innovation↗

PubMed2006

A site of communication among enterprises for supporting occupational health and safety management system.

The occupational health and safety management constitutes a field of increasing interest. Institutions in cooperation with enterprises make synchronized efforts to initiate quality management systems to this field. Computer networks can offer such services via TCP/IP which is a reliable protocol for workflow management between enterprises and institutions. A design of such network is based on several factors in order to achieve defined criteria and connectivity with other networks. The network will be consisted of certain nodes responsible to inform executive persons on Occupational Health and Safety. A web database has been planned for inserting and searching documents, for answering and processing questionnaires. The submission of files to a server and the answers to questionnaires through the web help the experts to make corrections and improvements on their activities. Based on the requirements of enterprises we have constructed a web file server. We submit files in purpose users could retrieve the files which need. The access is limited to authorized users and digital watermarks authenticate and protect digital objects. The Health and Safety Management System follows ISO 18001. The implementation of it, through the web site is an aim. The all application is developed and implemented on a pilot basis for the health services sector. It is all ready installed within a hospital, supporting health and safety management among different departments of the hospital and allowing communication through WEB with other hospitals.

Communication↗

PubMed2006

A method for specification of structured clinical content in electronic health records.

The Copenhagen County is using clinical guidelines in the electronic health record development to provide documentation support, process support and decision support for the healthcare professionals. The electronic health record development is based on three main components: The first component is a national information model. The second component is a common classification system (SNOMED). The third key component is the so-called "clinical content". This paper describes the structured "clinical content", how it is linked to the clinical process, and how it is used to create clinical guidelines in the form of standard care plans. The Copenhagen County and MEDIQ has developed a methodology for identifying and specifying structured "clinical content" to be used in electronic health records. The method combines analyses of national clinical guidelines with local experience and practices and it heavily involves healthcare professionals. The method includes four main steps: Analyses of background material, analyses of clinical process-flow, mapping to standards (the national information model and the common classification system), and specification of the structured clinical content itself. Three secondary steps may be added to specify the clinical content in more detail: Workflow analyses, analyses of quality indicators, and decision analyses. This paper reports the experiences using the method and stresses the demand for a common exchange format and IT-tools for documenting clinical content in a formalised way.

Decision Support Systems, Clinical↗

PubMed2006

Online guideline assist in intensive care medicine--is the login-authentication a sufficient trigger for reminders?

INTRODUCTION: Rising cost pressure due to the implementation of the DRG-System and quality assurance lead to an increased use of therapy standards and standard operating procedures (SOPs) in intensive care medicine. The intention of the German Scientific Society supported project "OLGA" (Online Guideline Assist) is to develop a prototype of a knowledge based system supporting physicians of an intensive care unit in recognizing the indication for and selecting a specific guideline or SOP. While the response of the prototype on user entries can be displayed as a signal on the used workstation itself, the location and time for a reminder of scheduled or missed procedures or reactions to imported information is a difficult issue. One possible approach to this task is the display of non acknowledged reminders or recommendations while logging on to a system. The objective of this study is to analyse user behaviour of the physicians working on the surgical intensive care unit to decide whether the login authentication is a sufficient trigger for clinical reminding. METHODS: The surgical intensive care unit examined in this study comprises 14 beds. Medical care is provided by physicians working in shifts 24 hours a day, 7 days a week, with two anaesthetists at a time and an additional senior consultant during daytime. The entire documentation (examinations, medication, orders, care) is performed using the patient data management system ICUData. The authentication process of the physicians was logged and analysed. RESULTS: Throughout the observation period from December 13th 2005 to January 11th 2006 3563 physician logins were counted in total. The mean span between logins was in 11.3 minutes (SD 14.4), the median 7 minutes. The 75% centile was 14 minutes, the 95% centile 38 min. Intervals greater than 60 minutes occurred in 75%, and greater than 90 minutes in 25% of the days. DISCUSSION: It seems reasonable that reminders sent during authentication are able to enforce workflow compliance. It is possible to send notifications caused by external events to the physician depending on the importance of the event. Serious events with high urgency should be reliably passed using wireless pager or handheld technology. It seems that after the implementation of the prototype guideline assist further investigation is needed to monitor changes in authentication behaviour and reactions to the guideline advisory. This is also required to investigate the influence of unit's size, medical specialty and actual ward workload.

Critical Care↗

PubMed2006

Reducing dropouts in outpatient care through an SMS-based system.

The objective of this work is to reduce the number of outpatients dropouts, i.e. appointments that, unexpectedly, are not attended by the scheduled patients, thus causing disturbances to the regular ambulatory workflow, waste of resources, and, eventually, longer waiting lists for ambulatory care. A collateral, but not less important result is the improvement of the relationship between citizens and the public Hospital Company. The method proposed consists in sending short instant messages to remind the appointment. After the promising estimates obtained by a preliminary cost-benefit analysis, a commercial product was purchased for the communication infrastructure, while a software module has been developed for interacting with the legacy system, in order to retrieve the information necessary to compose the text of every sms and send it to the citizen. The system has been implemented since seven months, and its benefits have been measured. Dropouts trend, stable at 7-8% during last years, is clearly decreasing, while the number of citizens providing their mobile number to the healthcare booking facilities is constantly increasing. Our conclusion is that the cost of the system will be amortised in a very short time, leading to a significant cost saving and, hopefully, to shorter waiting lists.

Ambulatory Care↗

PubMed2006

Gamma testing experience with the ACL TOP hemostasis testing system.

As a gamma testing site or a limited early release site for the ACL TOP, St. Michael's Hematology Laboratory evaluated the ACL TOP for its ability to fit into a laboratory whose workflow includes large volumes of routine and specialty hemostasis assays. This evaluation included the determination of the ACL TOP's precision, normal ranges, and reagent sensitivities. Analytical correlation studies for the ACL TOP were performed in comparison to the ACL ADVANCE. The ACL TOP was also tested for its ability to handle large volumes of not only routine assays but also more specialized coagulation assays. Instrument precision, normal reference range assignment, and factor sensitivities met the requirements of this laboratory. The ACL TOP correlated favorably to the ACL ADVANCE, and in a workup for thrombophilia its throughput was twice what was seen with the ACL ADVANCE. The speed of the ACL TOP was impressive, generating results at a rate of almost 5 results/min. In this gamma testing study, the ACL TOP has demonstrated suitability as a precise coagulation analyzer for use in the settings of a high-volume, fast-paced, specialized coagulation laboratory faced with demanding turnaround times.

Autoanalysis↗

PubMed2006

The influence of distance on registration in ISO-C-3D navigation: a source of error in ISO-C-3D navigation.

Computer-assisted treatments have become increasingly common. Consequently, there is an increased desire for navigation methods with simplified workflow. Anatomic-based pair-point registration is often mentioned as a source of error. Alternatively, the use of preoperatively implanted markers for registration remains complex. The self-acting registration of Iso-C-3D at the moment of data acquisition can reduce essential errors. The aim of this study was to evaluate the effect of reference placement on accuracy, and to determine the maximum acceptable distance between the reference and a given isocentre. This study demonstrates the interdependence of the reference distance on the region of interest (ROI). The mean error of registration amounts to 0.04 mm (0.04-0.05 mm) up to a distance of 200 mm and beyond 0.25 mm (0.24-0.26) for distances beyond 200 mm. The accuracy was significantly lower (p<0.0001) with a distance more than 200 mm. For optimal accuracy when utilizing navigation for pelvic and long bone surgery, the reference base should not been placed at a distance more than 200 mm from the isocentre of interest.

Humans↗

PubMed1990

Strategies of organization and service for the critical-care laboratory.

Critical-care medicine requires rapidity of treatment decisions and clinical management. To meet the objectives of critical-care medicine, the critical-care laboratory must consider four major aspects of laboratory organization in addition to analytical responsibilities: specimen collection and delivery, training of technologists, selection of reliable instrumentation, and efficient data dissemination. One must also consider the advantages and disadvantages of centralization vs decentralization, the influence of such a laboratory on patient care and personnel needs, and the space required for optimal operation. Centralization may lead to workflow interruption and increased turnaround time (TAT); decentralization requires redundancy of instrumentation and staff but may shorten TAT. Minimal TAT is the hallmark of efficient laboratory service. We surveyed 55 laboratories in 33 hospitals and found that virtually all hospitals with 200 or more beds had a critical-care laboratory operating as a satellite of the main laboratory. We present data on actual TAT, although these were available in only eight of the 15 routine laboratories that provided emergency service and in eight of the 40 critical-care laboratories. In meeting the challenges of an increasing workload, a reduced clinical laboratory work force, and the need to reduce TAT, changes in traditional laboratory practice are mandatory. An increased reliance on whole-blood analysis, for example, should eliminate delays associated with sample preparation, reduce the potential hazards associated with centrifugation, and eliminate excess specimen handling.

Centralized Hospital Services↗

PubMed1988

Use of bar code labels on collection tubes for specimen management in the clinical laboratory.

A new generation in specimen handling has arrived with the introduction of bar code readers on medical laboratory equipment. The incorporation of this technology into laboratory information systems offers a streamlining of specimen workflow never before achievable in a laboratory environment. The use of evacuated collection tubes as the primary sampling container on a random-access chemistry analyzer interfaced to a laboratory information system creates a very simplified sampling/analysis system with tremendous advantages. There are significant labor savings, superior service to clinicians, and reduced chances for clerical error.

Computers↗

PubMedDate not supplied

Smoking in the workplace: review of critical issues.

The relationship among various occupations, smoking, and disease has been studied extensively, but few investigators have looked closely at smoking in the workplace, particularly among blue-collar workers. The authors discuss the phenomenon of smoking in work settings and suggest reasons why tobacco use has been accepted on the job. The fate of heavy smokers in the wake of workplace smoking bans is considered. The authors discuss the relationship between smoking and work-related stress, particularly among blue-collar workers. The influences of job tasks, workflow, and employee social networks on smoking are examined. The authors suggest that, until recently, work settings have provided little support for cutting back and many opportunities that reinforced smoking habits. Worksite cessation is reviewed briefly, followed by suggestions for improving present worksite-based cessation strategies. The authors pose an agenda for future descriptive and applied research on smoking in the workplace.

Female↗

PubMed1994

Automated Speech-recognition Anatomic Pathology (ASAP) reporting.

Artificial intelligence speech-recognizers integrated with Laboratory information and Telefaxcommunication Systems have allowed for totally automated surgical pathology reporting. Automated Speech-Recognition Anatomic Pathology (ASAP) reporting improves the speed, text accuracy, comprehensiveness, and workflow management of diagnostic reports while eliminating support personnel. Healthcare reform goals of increased productivity and economy are furthered. Reports are rendered "as soon as possible" (ASAP) expediting appropriate clinical management and decreased length of stay and hospital costs.

Artificial Intelligence↗