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1,630 records · Page 91Linked to original sources
PubMed1998

Using web technology and Java mobile software agents to manage outside referrals.

A prototype, web-based referral application was created with the objective of providing outside primary care providers (PCP's) the means to refer patients to the Massachusetts General Hospital and the Brigham and Women's Hospital. The application was designed to achieve the two primary objectives of providing the consultant with enough data to make decisions even at the initial visit, and providing the PCP with a prompt response from the consultant. The system uses a web browser/server to initiate the referral and Java mobile software agents to support the workflow of the referral. This combination provides a light client implementation that can run on a wide variety of hardware and software platforms found in the office of the PCP. The implementation can guarantee a high degree of security for the computer of the PCP. Agents can be adapted to support the wide variety of data types that may be used in referral transactions, including reports with complex presentation needs and scanned (faxed) images Agents can be delivered to the PCP as running applications that can perform ongoing queries and alerts at the office of the PCP. Finally, the agent architecture is designed to scale in a natural and seamless manner for unforeseen future needs.

Computer Communication Networks↗
PubMed1998

Strategies for problem list implementation in a complex clinical enterprise.

Although the Institute of Medicine states that a patient problem list should have a prominent place in the computer-based patient record, the design and function of the problem list is not a matter of universal agreement. Developer experience with implementation has been inconsistent, in part because of confusion on data standards, uncertain user acceptance of data entry, and minimal rewards for the clinician. I propose that necessary features of the problem list include: 1) clinical focus, 2) codification of problems, 3) support for problem resolution, 4) historicity of problems, 5) support for multiple clinical views, 6) integration of maintenance functions with workflow, 7) support for administrative reporting, and 8) integration with useful clinical tools. I describe the strategies that we employed to meet these goals while implementing the problem list in a computerized patient record serving a large, complex clinical enterprise. I further report the successful achievement of those goals based upon audits six months after implementation.

Diagnosis-Related Groups↗
PubMed1998

Clinical application of the UMLS in a computerized order entry and decision-support system.

Vanderbilt University Medical Center uses the UMLS as a dictionary, an interlingua, and a knowledge source within the WizOrder system. WizOrder provides direct care-provider order entry and integrated clinical decision-support capabilities. Linking the two functions enables efficient decision-support during the "normal" workflow of care providers, at the point where decisions are made. WizOrder uses the UMLS as a dictionary to encode free-text entries into controlled vocabularies such as ICD9. As an interlingua, the UMLS provides mapping between vocabularies, allowing to translate patient-specific information to MeSH terms and perform automated literature retrieval. WizOrder uses the tables of co-occurring concepts and the Semantic Network to provide sensible lists of potential drug interactions and adverse drug reactions, and generate fully-formed MEDLINE queries for PubMed.

Decision Support Systems, Clinical↗
PubMed1998

Problem focused knowledge navigation: implementing the problem focused medical record and the O-HEAP note.

The current organization of most Computerized Medical Records (CMR) is based on the Problem Oriented Medical Record (POMR) and the SOAP (Subjective, Objective, Assessment and Plan) note. The organizational structure of the POMR and especially the SOAP note, does not allow for optimal use of computer capabilities in the follow up note. Since follow up visits are the most common office visit by far, this is a major flaw in the CMR. The authors propose a Problem Focused Medical Record and the OHEAP (Orientation, History, Exam, Assessment and Plan) note to resolve this problem. OHEAP starts with a powerful orientation structure that brings forward the timeline, last Assessment and Plan, and Plan Results for each problem along with the patient's historical tables as the starting point of every follow up visit. The Assessment and Plan portion brings problem specific differential diagnoses and their workups along with other relevant tables such as expert systems, treatments, instructions, medical literature or pathways. This leads to Problem Focused Knowledge Navigation that brings powerful efficiencies to the CMR. By recognizing the true workflow in the longitudinal diagnosis and management of any medical problem, the efficiency of the CMR is maximized. OHEAP allows for optimal use of both personal and external data elements in the medical record. Its powerful orientation attributes minimize the time spent in analyzing the current status of the problem while its connections to problem specific databases help resolve the problem.

Decision Making, Computer-Assisted↗
PubMed1998

P-CAPE: a high-level tool for entering and processing clinical practice guidelines. Partners Computerized Algorithm and Editor.

The Partners Computerized Algorithm Processor and Editor (P-CAPE) is a high-level tool intended to remove the programming bottleneck for implementing practice guidelines in our computer-based record system, and to integrate guideline-based advice into the clinician's workflow. P-CAPE has three major components: 1) An Editor that allows an analyst to enter the parameters of a guideline in the form of an algorithm; 2) A Navigator that processes the steps of the guideline and logs all transactions in a patient-specific file; and 3) A clinician Notifier that sends messages to a patient's covering clinician, seeking data or presenting recommendations and order sets that can be processed by the system. P-CAPE's guideline object model was adapted from the InterMed Collaboratory GuideLine Interface Format (GLIF).

Algorithms↗
PubMed2026

Scalable, open-access and multidisciplinary data integration pipeline for climate-sensitive diseases.

Climate-sensitive infectious diseases pose an important challenge for human, animal and environmental health and it has been estimated that over half of known human pathogenic diseases can be aggravated by climate change. While climatic and weather conditions are important drivers of transmission of vector-borne diseases, socio-economic, behavioural, and land-use factors as well as the interactions among them impact transmission dynamics. Analysis of drivers of climate-sensitive diseases require rapid integration of interdisciplinary data to be jointly analysed with epidemiological (including genomic and clinical) data. Current tools for the integration of multiple data sources are often limited to one data type or rely on proprietary data and software. To address this gap, we develop a scalable and open-access pipeline for the integration of multiple spatio-temporal datasets that requires only the declaration of the country and temporal range and resolution of the study. The tool is locally deployable and can easily be integrated into existing climate-disease-modelling applications. We demonstrate the utility of the tool for dengue modelling in Vietnam where epidemiological data are legally required to remain local. We include a pipeline for bias correction of climate data to enhance their quality for downstream modelling tasks. The Dengue Advanced Readiness Tools-Pipeline empowers users by simplifying complex download, correction, and aggregation steps, fostering data-driven discovery of relationships between infectious diseases and their drivers in space and time, and enhancing reproducibility in research. Additional modules and datasets can be added to the existing ones to make the pipeline extendable to use cases other than the ones presented here.

automated workflows↗
PubMed2005

Participatory Work Flow Analysis prior to Implementation of EPR: A Method to Discover Needs for Change.

We need to know how clinicians' use their paper based medical records to secure a local participation in the implementation process of Electronic Patient Record (EPR). In what way their use of paper based medical records is related to, or dependent on, other people and artifacts. The research presented in this paper was done as part of a work flow analysis of the particular sequence of doing rounds at two distinct hospital departments, a thoracic surgical and a cardiology department. It was designed to develop a method that would let the hospital clinicians obtain knowledge on the daily use of the paper based medical records during rounds and thus make use of their local knowledge to start a discussion on changes in organization and knowledge before EPR can be successfully implemented.We are grateful to the following clinicians, Cathrine H. Foss, MD. Pauline Schrødder, MD. Morten Smerup MD and Niels Henrik Stålsen, MD and the medical director Børge H. Jensen, MD, Skejby Sygehus, Aarhus University Hospital for sharing their knowledge with us.The aim was to investigate how paper based medical records are currently used at two wards.

Electronic Health Records↗