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PubMed1998

Modifiable templates facilitate customization of physician order entry.

Physician order entry is a key factor in improving the quality of healthcare, while simultaneously reducing its cost. This paper describes an editor, a database, and a run-time system for creating and executing highly customized, user modifiable, order entry templates. The system allows non-programmers to create new order entry templates rapidly. Over the past 18 months, the templates have been used on over 2500 patients to enter over 40,000 separate orders.

Database Management Systems↗
PubMed1994

A natural language understanding system combining syntactic and semantic techniques.

A large proportion of the medical record currently available in computerized medical information systems is in the form of free text reports. While the accessibility of this source of data is improved through inclusion in the computerized record, it remains unavailable for automated decision support, medical research, and management of medical delivery systems. Natural language understanding systems (NLUS) designed to encode free text reports represent one approach to making this information available for these uses. Below we describe an experimental NLUS designed to parse the reports of chest radiographs and store the clinical data extracted in a medical data base.

Bayes Theorem↗
PubMed1995

A distributed, scalable, community care network architecture for wide-area electronic patient records: modeling and simulation.

Principal systems issues relative to computerizing patient medical records that are yet to be addressed in the scientific literature include (1) the characteristics of networks, i.e. bandwidth and capacity, and their impact on the performance of the system, (2) the architecture and the underlying algorithm of the system, (3) the location and migration of medical records, (4) scalability of the system, and (5) the nature of the performance variation under heavy and light use of the network. Key parameters that affect performance include the number of patients, doctors, frequency of patient visits, and the number of electronic queries and record entries initiated during a patient-doctor interaction episode. This paper presents AMPReD, a Distributed, Scalable, Community Care Network Architecture that aims to provide Real-Time Access to Geographically-Dispersed Patient Medical Records. The AMPReD model includes stationary hospitals and medical clinics, mobile clinics, migrating doctors as well as patients, the communications network, and the patient medical record database. AMPReD's goals include (1) the accurate modeling of the propagation of medical records and (2) providing real-time access to patient medical records from anywhere in the system. To achieve these goals, an asynchronous, distributed algorithm must be developed that achieves concurrent access of multiple, autonomous databases. AMPReD is modeled and simulated for a representative community care network on a network of workstations configured as a loosely-coupled parallel processor, for different parametric combinations of number of doctors, patients, and number of queries or record entries generated corresponding to every patient-doctor interaction episode. AMPReD defines and obtains key performance measures including the idle times of the doctors, patient waiting times, the access times of queries as functions of their sizes, and the growth of the databases. In addition, AMPReD also measures the deviation of the actual time required for a patient-doctor interaction episode from the scheduled interaction interval, as a function of the network load. For the representative system selected, performance measures indicate that the network, utilizing 1/2T1 links, and the database system poses no bottleneck to the system even where the number of doctors and patients within a 30 minute interval are chosen at 192 and 200 respectively. A T1 is a standard, digital, transmission link that is rated at 1.44Mbits/sec.

Algorithms↗
PubMed1995

Effect of computerized charting on nursing activity in intensive care.

OBJECTIVE: To measure the impact on nursing activity of introducing computerized medical records into intensive care units (ICUs). DESIGN: Prospective data collection monitoring the activity of ICU nurses before and after installation of a computerized charting system. SETTING: A six-bed coronary care unit and an eight-bed medical ICU at the Minneapolis VA Medical Center. SUBJECTS: Registered nurses providing intensive care services. INTERVENTIONS: Installation of a Clinical Information System that computerized the ICU medical records. MEASUREMENTS AND MAIN RESULTS: Before computer installation, nurses spent 24% of their time manipulating data (7% gathering and 17% charting). After installation, charting time decreased to 10%, and data gathering time decreased to 4%, while 10% of time was spent at computer terminals entering or reviewing data. The total time manipulating data post-installation was thus 24% (i.e., unchanged from previous). Computerized charting did not alter time spent in patients' rooms (43% pre- and 43% postinstallation) compared with time spent at the central station (37% pre- and 36% post-installation) or elsewhere (20% pre- and 21% postinstallation). Relative time spent at various tasks varied between units and from shift to shift, but the net effect of computerized charting was that nurses had more time available at the central station for monitoring, and that the computer terminals were used primarily in the patient rooms. CONCLUSIONS: Computerized charting will not necessarily provide ICU nurses with a net excess of time for tasks unrelated to manipulating data.

Computer Terminals↗
PubMed1994

A computerized system for reviewing medical records from physicians' offices.

BACKGROUND: Review of clinical performance in office-based care is increasing in importance as more medical care shifts to outpatient settings. Decisions made in primary care settings can save lives and limit disability through prevention and early intervention in disease. Information is needed to assess quality of care by answering such questions as whether drugs are prescribed and monitored appropriately, follow-up on serious health threats is carried out promptly, or procedures are performed for appropriate indications. Moreover, data from medical records are essential to provide important clinical information not found in the more widely used administrative data sets. Managed care organizations, too, face the need to respond to requests for objective information about the quality of primary care that they provide. Those organizations now planning assessments of primary care will need to consider the cost of obtaining information from medical record review. METHODS: The DEMPAQ Record Review System (DRRS) is a tool for peer review organizations (PROs) to use to review ambulatory care given to Medicare beneficiaries in physicians' offices. The system is described in terms of functions (activities commonly performed in the course of an office visit, such as drug prescribing), indicators (summary measures of quality for each key function of clinical care), and clinical items (for example, specific drugs or tests for each function and indicator)--a total of 263 indicators in all. A framework is provided for measuring the operational costs of a review system based on medical records. RESULTS: The costs directly associated with a fully operational review system were less than $48 per case in Iowa and Alabama and $72 per case in Maryland. On average, reviewers spent about an hour per case signed on to DRRS; average review times declined over time with practice. About half the cost of the review process is accounted for by administrative costs. Therefore, once the effort has been made to obtain records, the additional cost of abstracting more data items is relatively low. Since samples of 300-500 records suffice to measure average performance for a region or state, costs per region/state approximate $15,000 to $25,000 per measurement cycle for assessment of a wide array of clinical areas. SUMMARY: The cost of collecting information on quality of care from medical records using the review system falls within current budgets for PRO review. However, organizations planning to implement a quality improvement campaign should also consider the costs of analyzing the data, reporting information to physicians, and continuing to monitor changes in performance.

Aged↗
PubMed1982

The utility for audit of manual and computerized problem-oriented medical record systems.

Objective assessment of the delivery of care requires an unambiguous record of all related events and decisions in the care process. Both the handwritten Problem-Oriented Medical Record (POMR) and its computerized successor, the Problem Oriented Medical Information System (PROMIS) have been designed to facilitate audit of care delivery. In this study, a national sample of physicians was asked to determine which of these two record systems best serves the function of audit. The study involves assessment of a sample of 69 matched pairs of patient records drawn from two different ward settings, one of which used the manual POMR, the other, PROMIS. No difference was perceived between the two records with respect to the reliability of information or the analytical reasoning of providers. Information in PROMIS records was judged to be slightly more thorough. The format of the manual record was judged better on the basis of conciseness, accessibility, and organization of record information.

Computers↗
PubMedDate not supplied

Computerized medical records and clinic function.

Formal studies of computerized information systems for ambulatory patients are rare. As part of an evaluation of the effects of such a system on clinic function, we divided the residents in our teaching clinic into a study group with access to COSTAR and a control group with access to conventional medical records alone. Nurses and clerical personnel in the clinic were allowed to use the computerized records only for patients of residents in the study group. We sampled the attitudes of nurses and clerical personnel toward use of the computer and performed detailed time studies of patient flow in the clinic. Responses to questionnaires reflected acceptance of computerization by the personnel sampled, who favored COSTAR records over conventional records, primarily because of the increased availability of information for telephone management and demand care. The residents never became facile users of COSTAR--a problem that we attribute to the infrequency of their clinic sessions. As a result, and because the workloads of residents using COSTAR were larger, waiting times were longer in clinics attended by these residents. Overall, the most intensive users of the computerized medical records were not the physicians. Improved productivity and better use of time among the nurses and clerical personnel were thought to outweigh the residents' perceptions.

Attitude to Computers↗
PubMed1991

Estimating frequency of disease findings from combined hospital databases: a UMLS project.

Merging data from the Salt Lake VA hospital database and the LDS hospital HELP system into a UMLS sponsored unified patient database has demonstrated that distribution of variables within a disease is hospital independent. Although disease prevalence is clearly not the same among hospitals, analysis of data within a disease group across hospitals can be done using such a merged database. This unified patient database would allow study of unusual diseases not possible using data from a single institution.

Databases, Factual↗
PubMed1991

Development of a national genetic services database.

The Council of Regional Networks for Genetics Services (CORN) designed and developed a database collection project to collect minimum data regarding genetic services provided throughout the United States. The data collection project has been designed to improve the provision of services and to determine areas of utilization.

Databases, Factual↗
PubMed1991

Data collection in the Great Plains Genetics Service Network: using limited funds to collect data from centers with varying resources.

The Data Committee of the Great Plains Genetics Service Network (GPGSN) coordinates the collection of data relating to delivery of genetic services in eight states. These states are Iowa, Missouri, Arkansas, Oklahoma, Kansas, Nebraska, South Dakota and North Dakota. The funds allocated to this project by the GPGSN are limited. The distance between genetics service sites is great and the population density in the regions being served is low. The local resources available to the genetics services sites participating in data collection vary from robust to "bare-bones". The approach to solving the problem involved the following. First the committee the data items to be collected were identified and defined. Second, a standard format for transmitting the data to the GPGSN regional coordinating center in Iowa City was developed. Third, the services sites and their resources for collecting data were identified. Fourth, resources were allocated to different sites in a manner that seemed most able to help that center to contribute data to the regional center. Fifth, data were aggregated at the regional center and aggregated data reports were returned to collecting sites. Finally, items were modified in response to the feedback received from the genetics services sites. Although the philosophy is that data collection should be a by-product of providing quality genetic services, the region recognizes that service sites will need help to conform with regional standards. Therefore the region encourages each service site to develop its own method to collect data, and provides assistance to it in getting the data into the regional transmission format.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMed1991

Casebook: a system for tracking clinical encounters.

Casebook is a clinically oriented database, written in MUMPS, and designed for recording the clinical encounters of medical students at Harvard Medical School. Its main goals are to 1) increase student use of computer technology, 2) help faculty evaluate the diversity of clinical experiences on their service, 3) provide data to the faculty on the "typical" experience of medical students on their service to aid in the evaluation of the curriculum and, 4) provide report-generation capabilities for the students to improve dialog with their preceptors. Students are able to enter information on "Problems" and "Procedures" selecting from a pop-up menu of medical terms or by entering free text. Casebook is currently in use in the Medicine, OB/GYN, Pediatric and Ambulatory rotations. At sites where the faculty take an active interest in the use of Casebook students perceive it to be valuable and subsequently use it more frequently. It is currently being expanded for use by medical students in their second, third, and fourth years of school.

Attitude to Computers↗
PubMed1993

Integrating Hospital Information Systems. The challenges and advantages of (re-)starting now.

With the new technologies available today, more complex and useful Hospital Information Systems (HIS) can be designed and implemented. These new technologies have allowed that information from different sources and nature such as documents, images and signals be integrated within a single environment. Open standards, reliable networks, powerful hardware and software and lower prices are among the issues that make all this possible. One of the main issues is what to do with old systems that do not adhere to this new HIS concept. At the Heart Institute (InCor), a decision was made towards starting developing a new system called I3S. This paper gives a brief description of that system.

Brazil↗
PubMed1995

A server architecture for ambulatory patient record systems.

Baylor College of Medicine is developing the Collaborative Social and Medical Services System (CSMSS) to provide a computerized patient record (CPR) system for the Teen Health Clinics (THC) [1]. The THCs consist of five geographically distributed clinics providing health care and social services to teenagers in the Harris County Hospital District. The CSMSS is the first application built upon the Ambulatory Systems Architecture (ASA) [2]. The ASA is aimed at providing an architecture and application framework for the development and deployment of CPR systems in ambulatory care settings. This paper describes the ASA server architecture.

Ambulatory Care↗