Integration of clinical decision support with on-line encounter documentation for well child care at the point of care.
(65/1443)
Electronic medical record systems and clinical practice guideline (CPG) support applications are emerging in the clinical environment to document and support care. Applications which integrate online documentation with CPG are often complex systems bound to a proprietary infrastructure and as such, can be difficult to adapt to changing care guidelines. This paper describes integration of point-of-care clinical documentation to an Internet-based CPG system that was easily modified, utilized available software resources, and separated patient information from CPG. The system combined a text-based encounter documentation tool, Inbox, with a web-based CPG system, SIEGFRIED (System for Interactive Electronic Guidelines with Feedback and Resources for Instructional and Educational Development), which interactively presented care guidelines to providers. Age-specific well child care documentation templates were developed using Inbox for point-of-care documentation. SIEGFRIED contained the knowledge base of child safety education guidelines and executed independent of the program presenting the guidelines. The CPG were accessed from within the documentation template via an Internet hyperlink. Patient chart evaluation indicated that 77% of safety topics were reviewed and 32% of the charts contained documentation indicating all the safety topics were reviewed. Last, routine use of the Inbox-SIEGFRIED system was not realized due to the clinical time constraints and workload of the medical providers, and lack of data entry experience. A user survey indicated time cost (network access and software execution) were negative aspects of the system. However, the system function was highly regarded and the Internet-based patient education materials were described as useful and accurate. In summary, the system was functional, met original development goals, and provided valuable patient education materials; however, routine system use was prevented by time requirements. We recommend further development be oriented towards integrating the identified beneficial components of the system into clinician workflow. (+info)
Clinical informatics: 2000 and beyond.
(66/1443)
Healthcare has begun to flounder in the mounting flood of data available from automated monitoring equipment, microprocessor controlled life-support equipment, such as ventilators, ever more sophisticated laboratory tests, and the myriad of minor technological wonders that every hospital and clinic seem to collect. It is no longer enough to merely display the data in a large spreadsheet or on a complex, colorful time-sequence graph. The next generation of healthcare information systems must help the clinician to assimilate the myriad of data and to make fast and effective decisions. The following is a list of features that the next generation of computer systems will have to include if they are to have a significant impact on the quality of patient care: data acquisition, data storage, information display, data processing, and decision support. By automating or streamlining repetitive or complex tasks, correlating and presenting complex and potentially confusing data, and tracking patient outcomes, the computer can augment clinicians' skills to improve patient care. (+info)
A novel governance system for enterprise information services.
(67/1443)
The authors created a novel system for governing the enterprise information services (IS) of a large health care system. The governance organization is comprised of key members of the attending medical staff, hospital and health system administration, and the IS department. A method for defining the requirements and business case for proposed new systems was developed for use by departments requesting new or expanded information services. A Technology Architecture Guideline document was developed and approved to provide a framework for supported hardware and software technologies. IS policies are approved by the main governance council. All project proposals are reviewed by specialized governance committees and, if approved, are launched for further development. Fully developed proposals are reviewed, approved and prioritized for funding by the governance council. This novel organization provides the methodology and structure for enlightened peer review and funding for well developed IS project proposals. (+info)
Evaluation of a system to identify relevant patient information and its impact on clinical information retrieval.
(68/1443)
Concept-oriented views of electronic medical records are desirable, yet difficult to create. We have developed a system that creates concept-oriented views by identifying relevant patient information, however, previous such systems have received little evaluation. We present here an evaluation of our system's ability to identify relevant patient data and generate concept-oriented views, along with the clinical impact of the generated views. The evaluation was carried out in three parts: First, using physicians and medical literature as gold standards, the system's sensitivity and specificity in identifying relevant information were measured. In some areas, the system demonstrated sensitivity comparable to that of physicians. Second, concept-oriented views were compared with original records and shown to contain significantly less non-specific information. Third, physician volunteers, when answering questions about patient cases using the concept-oriented views and traditional source-oriented views generated by the system, showed a significantly greater accuracy in information retrieval using concept-oriented views. (+info)
Architecture for a multipurpose guideline execution engine.
(69/1443)
Integration of guideline knowledge into the clinical workflow is essential, for improving adherence to guidelines. Guidelines in structured formats can be utilized by computer programs to provide decision support in clinical information systems, as well as to facilitate workflow. We have designed an architecture for a flexible guideline execution engine that can be utilized in clinical decision support applications. The engine may be utilized for other applications such as referral management, medical education, and conducting clinical trials. The engine executes guidelines that are defined in an extension of the Guideline Interchange Format (GLIF). GLIF was extended to support representation of constructs that are essential to the execution of the guideline. A prototype of the engine was implemented based on this architecture. The engine is being utilized in two clinical applications that draw on guidelines for decision support. The engine was also used for developing an educational application aimed at testing knowledge of guideline recommendations. (+info)
A new architecture for enterprise information systems.
(70/1443)
Irresistible economic and technical forces are forcing healthcare institutions to develop regionalized services such as consolidated or virtual laboratories. Technical realities, such as the lack of an enabling enterprise-level information technology (IT) integration infrastructure, the existence of legacy systems, and non-existent or embryonic enterprise-level IT services organizations, are delaying or frustrating the achievement of the desired configuration of shared services. On attempting to address this matter, we discover that the state-of-the-art in integration technology is not wholly adequate, and itself becomes a barrier to the full realization of shared healthcare services. In this paper we report new work from the field of Co-operative Information Systems that proposes a new architecture of systems that are intrinsically cooperation-enabled, and we extend this architecture to both the regional and national scales. (+info)
Re-engineering the process of surgical informed consent.
(71/1443)
We have created a clinical performance support system that transforms surgical informed consent into an interactive process capable of evolving in response to institution-specified, provider-specified and patient-specified needs. The system functions in several capacities, including: (1) a source of standardized and comprehensive content and format the transmission of procedure-related risk and complications; (2) as expert critique, providing cues in an effort to reduce the effects of biased risk appraisal; (3) captures and archives clinician behavior relating to use, modification and disclosure of standardized knowledge sources; (4) provides just-in-time access to procedural descriptions information relating to risks and complications; (5) captures, archives and makes available to the clinician patient use of procedure-related knowledge resources. By design, the system will be used to assess the relationship between clinician perception and heuristics surrounding risk appraisal and disclosure and patient perceptions based on response to the disclosure process. The system prototype is currently being deployed in a breast surgery unit at the Beth Israel Deaconess Medical Center. (+info)
Collaborative prototyping approaches for ICU decision aid design.
(72/1443)
When computer-based aids do not support the human users' decision-making strategies or anticipate the organizational impacts of technological change, advances in information technology may degrade rather than enhance decision-making performance. Such failures suggest the design of human-computer cooperation for problem solving and decision-making must be driven by human cognitive and organizational process requirements rather than computer technology. Decision- and user-centered development techniques involve domain experts and end-users in the earliest phases of design to evolve an understanding of requirements through iterative prototyping. This paper presents a collaborative approach to cognitive systems engineering applied to developing a clinical aid to assist respiratory care in the surgical ICU. (+info)