SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In addition to Patient Classification System's information, nurse managers can use activity tools to develop and justify budget needs. A basic accounting-type workflow analysis format, which goes beyond the "Midnight Census," accurately details a unit's patient volume and productive hours.
ASOP is a proposed method for future medical record notation. This permutation of the original POMR-SOAP method is necessary to provide the standardized workflow and medical nomenclature which will be essential for automated medical record systems and forms-based encounter recording. The development of an ASOP system is dependent on tools to map assessment to appropriate terminology within a universal medical dictionary and generate intelligent queries across the World-Wide-Web. In this study we intend to demonstrate the need for change in the POMR system and highlight some of the current tools in development to make the ASOP method the medical record notation system of choice.
1. INTRODUCTION TO DEPARTMENTAL PACS. Full or partial Departmental PACS is generally taken to mean an image management system focused on serving the needs of a specific modality or modality application. It will provide a modality specific means of image acquisition, specialized redisplay of images, distribution, and local long term storage of images. A Departmental PACS can be considered in isolation or as a component in a distributed Radiology PACS which consists of one or more departmental work groups on a back bone, potentially with shared resources. 2. DEPARTMENTAL PACS Issues Implementation of a Departmental PACS requires an in-depth knowledge of departmental clinical practice and work flow in all affected areas in the department, including patient intake, image collection, data routing, retrieval of previous image data, reporting, and long term data management and storage. Optimization of modality specific image display systems requires significant involvement from representative physician users. System architectures and user interfaces must be flexible enough to support the span of variation in clinical practice encountered in the site. A departmental PACS should offer a variety of "open" communications interfaces, both local and wide area, recognizing that outreach efforts are often driven by specific imaging departments. Interfaces to other departmental PAC systems and other information systems must be considered in order to facilitate institutions developing "Best of Breed" PACS systems. As hospitals move toward the integrated electronic medical record, means need to exist for a client process launched from a physician desktop to acquire images and/or reports from a departmental system. At minimum, HIS/RIS interfaces need to be considered to minimize re-keying of data and reduce data entry errors. 3. DESIGN OBJECTIVES FOR ALI ULTRAPACS. The key objectives were to design a product which could function either as a free standing PACS or as a departmental subnet on a larger PACS backbone, one which could function in a local or mixed local and wide area environment and one which could provide a cost effective implementation based on currently available technologies. 4. IMPLEMENTATION STRATEGIES. In order to attain the product design objectives, ALI made the following critical implementation decisions: 1) to build the UltraPACS application as a suite of separable UNIX processes based on a message passing client server model; 2) to host the application and operating system on a Digital Equipment Corporation PC using an Intel microprocessor because of the competition and broad variety of suppliers in the PC arena; and 3) to use NEXTSTEP as the UNIX variant of choice because of NEXTSTEPUs strong object orientation, superb development tools, and the excellent integration between the Graphical User Interface level and the underlying operating system layers. 5. CONCLUSION. ALI is convinced that a departmental approach to PACS offers significant advantages over monolithic PACS in several key areas including: optimization for modality specific clinical practice and workflow, cost effectiveness, the potential for an institution to implement PACS in a stepwise fashion, starting with the department with the potential for the greatest savings, and the capability for an institution to build a "best of breed" solution for large scale PACS.
Cost problems in business, industry and government service force everyone to probe into the economy of traditional patterns of work and procedures. Occupational medicine is no exception. However, there has been a lack of criteria for assessing the economic aspects of occupational medicine. We are therefore suggesting an approach. Caring for the "human capital" factor is a cornerstone of free socioeconomy. Workers should not only be suitably qualified for their job but there must be the smallest possible minimum of absenteeism. Occupational medicine can do something to positively influence the following factors: by preventing incapacity to work by preventing job accidents and professional diseases by reducing the time required to cover distances between or within workflow phases or stages by reducing waste of time by waiting. Model calculations, based on highly plausible basic postulates, show that fully integrated occupational medical services are throughout economic and cost-saving. Using a concrete example, we arrived at a cost/benefit ratio of 1:2 while confining ourselves to benefits attainable within a relatively short time. We ignored other, future benefits requiring certain preventive measures, as well as other parameters that are difficult to assess, such as corporate identity. At present occupational medicine faces a certain amount of identity crisis which should not be counteracted by pointing to legislation that justifies its existence, but rather by proving that it is indeed highly economical because it saves time and money.
Health care providers are more likely to follow a clinical guideline if the guideline's recommendations are consistent with the way in which their organization does its work. Unfortunately, developing guidelines that are specific to an organization is expensive, and limits the ability to share guidelines among different institutions. We describe a methodology that separates the site-independent information of guidelines from site-specific information, and that facilitates the development of site-specific guidelines from generic guidelines. We have used this methodology in a prototype system that assists developers in creating generic guidelines that are sharable across different sites. When combined with site information, generic guidelines can be used to generate site-specific guidelines that are responsive to organizational change and that can be implemented at a level of detail that makes site-specific computer-based workflow management and simulation possible.
The practice of emergency medicine requires rapid decision making. The speed of decision making in the face of limited information contributes to the high risk of medical malpractice suits. We explore design approaches to an emergency physician electronic medical record product, EMstation, that may reduce the risk of adverse medical events by providing cues and tools while the patient may still be in the emergency department. EMstation is an Emergency Medicine Physician Workstation base on a Microsoft Windows 3.1 user interface. Because adaptation and adaptability to physician needs are critical to user acceptance, design to workflow, multisite end user customization, and integrated database support are used to support risk management documentation in EMstation. This article describes techniques that can be incorporated into electronic medical products which may prevent adverse medical events.
Developing and deploying informatics solutions which are useful and acceptable to busy physicians are challenging tasks. We describe the design, deployment, and evaluation process by which the delivery of routine clinical laboratory reports is automated using electronic mail. Data from TMR, an operational computer-based patient record (CPR), are presented to providers using an individualized, modern interface. This system is compared to the existing, paper-based system for delivery of data from the same CPR. Differences between the two systems of data delivery are analyzed, with emphases on 1) electronic documentation of data delivery and receipt, 2) electronic and/or paper documentation of clinical action taken as a result of laboratory reports, 3) timeliness of report availability, 4) costs, 5) workflow compatibility, and 6) physician satisfaction. The new delivery system employs inexpensive, commercially available software applications and entails only trivial changes to the proprietary CPR. Built into the new system are features which allow quantitative measurements of its performance for analysis along with survey-based user satisfaction data. The open systems design is deliberately non-proprietary, inexpensive, and generalizable. Accordingly, it offers practical possibilities for settings in which clinical information systems are just being planned, as well as for those in which such systems are already established.
Reengineering of the health care delivery system is underway, as is the transformation of the processes and methods used for recording information describing patient care (i.e., the development of a computer-based record). This report describes the use of object-oriented analysis and design to develop and implement clinical process reengineering as well as the organization of clinical data. In addition, the facility of the proposed framework for implementing workflow computing is discussed.
An integrated method was constructed for the study of in situ clinical reasoning. A meta-analysis of existing theories and an exploratory case study were performed. Twelve physicians at the department of otorhinolaryngology, and three physicians and three biomedical technologists at the clinical microbiological laboratory of an 800-bed university hospital were involved in the evaluation of the method. The meta-analysis identified situations where practitioners face assignments for which they follow no routine strategy as suitable starting points for the development of the method, in which organizational processes are presented as workflow graphs. Using the critical incident technique, problem situations in the processes are identified, and stimulated recall interviews are employed to construct a model of the situation-dependent logic used in decision-making. The case study showed that the first levels of the method could easily be used by physicians without training in organizational development or cognitive psychology. It is concluded that the method can be a means for case construction in problem-oriented learning programs that have an empirical background. It can also be used in the development of clinical organization, where training is combined with the establishment of critical paths and computer support.
The clinical laboratory is changing from a place of activity based on sample analysis to an in vitro diagnostic network. To convince our team, partners, and administrators, we need new comprehensive tools to define a strategy with limited risk of failure or conflicts. Specific quality goals should be established before choosing automated tools for sample handling, analytical systems, laboratory information systems, communication systems, or advanced technologies. A system approach maps and simplifies the process, based more on a functional study than on classical disciplines. A customer-supplier approach establishes the requirements between partners either inside or outside the laboratory. The quality system must be a management tool, linking samples, tasks, information, and documents. Quantitative simulation modeling explores different automation alternatives and their impact on laboratory workflow. Finally, integration of results in interactive semirealistic simulation tools for laboratory design or reengineering can be used as communications tools to involve laboratory professionals in the change of their practice.
Steps to safeguard quality assurance have always been an inseparable part of any action taken by physicians who are aware of their responsibility towards their patients. Quality assurance can be improved further by introducing additional procedures, some of which were developed by the industry, to ultimately achieve a comprehensive quality management. Of course, additional quality assurance measures involve additional cost and effort, so that the increasingly straitened financial circumstances of the hospitals restricting outpatient and inpatient care services imply a critical assessment and discussion of the pros (efficiency) and cons (cost factors) of such services. The article discusses in particular such procedures that are particularly well suited for application in pneumology. The establishment of "standards" via guidelines and recommendations and their continual updating are basic prerequisites for quality assurance. Many guidelines and recommendations to this effect have been worked out by the pneumological associations. As far as internal quality management in hospitals is concerned, it appears meaningful to delegate quality assurance work to selected supervisory staff members in different spheres of activity (medical care, nursing, hotel services, organisation of workflow) who also keep quality recordes. To establish external quality control of inpatient pneumological care it would be feasible to establish "peer review" techniques assessing random samples of patient records and of the attending rounds, as well as of the results of general inspections of the hospital. Discipline-specific quality indicators and participation in oncological aftercare programmes are also important. In the outpatient sphere, discipline-specific quality circles offer extensive possibilities for effecting quality assurance measures.
Digital radiology is the integration of established and new digital imaging modalities into a system which enables the filmless communication of radiological information. It is becoming an indispensable tool in daily medical practice, and yields improved, faster medical communication, reduces the patient's dose and saves 307 307 archivation costs. Some knowledge of the inherent features of digital images and some open-mindedness for a change in viewing and workflow habits is necessary to make full profit of these possibilities. This paper describes digital radiography and the aspects of radiological networking based on 5 years experience with one of the very first filmless radiology departments worldwide.
Ongoing improvements in the content of the Unified Medical Language System, coupled with the recent release of the Internet-based Knowledge Source Server (KSS), have prompted us to develop an interface between the KSS and our computer-based patient record. We confronted many challenges while developing a robust interface to an Internet-based server, and in integrating the process of codification into the workflow of clinicians. An initial evaluation of the interface in the clinical environment suggests that acceptable performance is attainable. The benefits of using an Internet-accessible tool in a clinical information system appear to justify the effort required.
Since 1996 a picture archiving and communications system (PACS) is installed at the university hospital of Freiburg. The PACS is integrated in the hospital information system (HIS) and several modalities of different vendors are attached to it. During the implementation phase three critical factors to the success of our PACS installation where identified: the support of the workflow, the interface of the radiological information system (RIS) to the modalities, and the security policy to allow hospital-wide access to the images and results in the PACS.
This plan for computerizing the dental patient record is designed to be implemented in a stepwise fashion. It assumes a fully developed and well accepted practice management system is already present in the business office to ensure organizational readiness and a culture embracing technology and its accompanying changes. Electronic claims submission is implemented next to not only realize the competitive advantages of EDI in the dental office; but also, to introduce the process of multi-user communication. Electronic charting in the dental operatory is first implemented as a stand alone system. This allows users to understand the new workflow requirements and oral exam redesign when a computer is introduced in the treatment room. The dental team must understand that the ultimate goal of this plan is to network the entire system and enhance communication both within and external to the dental office. No specific time requirements were given for this plan because of the variability from office to office. People need time to develop awareness, prepare for, and become skilled in using new technology. Financial constraints may also limit the speed at which the plan can be implemented. Finally, individuals in the practice must work together as a team to assess the practice's level of acceptance and ability at each step in the process. Modification will be necessary along the way as technology is constantly changing. This is a significant paradigm shift, considering that many pieces of equipment purchased for the dental office can last the dentist's entire career. This plan allows for alteration, encourages team involvement and requires a long-term strategic vision for information technology's role in the dental office.
With the advent of network technology, there is considerable interest within the medical community to manage the storage and distribution of medical images by digital means. Higher workflow efficiency leading to better patient care is one of the commonly cited outcomes [1,2]. However, due to the size of medical image files and the unique requirements in detail and resolution, medical image management poses special challenges. Storage requirements are usually large, which implies expenses or investment costs make digital networking projects financially out of reach for many clinical institutions. New advances in network technology and telecommunication, in conjunction with the decreasing cost in computer devices, have made digital image management achievable. In our institution, we have recently completed a pilot project to distribute medical images both within the physical confines of the clinical enterprise as well as outside the medical center campus. The design concept and the configuration of a comprehensive digital image network is described in this report.
The Penn Nursing Network Information System Project is a collaborative effort of practitioners, academic researchers, and a health-care software developer. The Penn Nursing Network, a group of nurse-managed practices owned and operated by the University of Pennsylvania School of Nursing, has taken a leadership role in the project. PNN is developing an information system specific to the needs of nurse-managed care and creating a data warehouse for nursing centres in the Philadelphia region. Important components of this project include the identification of key data elements to represent the problems treated, interventions performed, and outcomes sensitive to the nursing care provided. The Omaha System provided a useful framework for capturing the necessary data elements. However, additional data were needed. In addition, attention was paid to the development of a software program that would complement the workflow of the practitioner while capturing data efficiently. The main goal of the project is development of a longitudinal database reflective of clinical practice, to be used for both research and evaluation.
BACKGROUND: Rural physicians need access to quality medical information, but accessing information is difficult in rural settings. Digital health sciences libraries (DHSLs) offer the potential to make information more accessible to rural physicians. A telemedicine network was deployed to six rural hospitals in Iowa. Computers were installed allowing access to a DHSL and training sessions were held. The purpose of this study was to examine the barriers to use of a DHSL by rural physicians. METHODS: Approximately one year after deployment of the telemedicine network, physicians were surveyed using a modified critical incident technique. RESULTS: Seventy percent of the eligible physicians responded and 33% had used the DHSL. Primary barriers included insufficient training, being too time consuming to use, and distance of computers from physicians' practice sites. Non-DHSL users cited the difficulty of using the DHSL as their greatest barrier, while DHSL users cited the quality of the information resources. CONCLUSIONS: This study identifies a number of barriers that exist to rural physicians use of a DHSL. Potential solutions to these barriers are discussed. DHSLs will finally reach their potential when they can be delivered by easy to use handheld computers seamlessly integrated into the rural physician's workflow.