The Conquest Hospital picture archiving and communications system development, 1992 to 1999.
(25/2705)
Conquest Hospital was a UK regional development site for a pre-Digital Imaging and Communications in Medicine (DICOM) picture archiving and communication system (PACS). The initial system was installed in mid 1992. Identification has been made of data transfer, ergonomic and single point of failure issues in the original PACS, which was called "iLAN." This has informed respecification of a DICOM/HTML PACS, the first stages of which have been hospital renetworking and installation of new DICOM 3.0 computed radiography/fluorography and computed tomography/magnetic resonance imaging segments. Final PACS elements are at contract stage. Plans are being completed for linkage of PACS to a clinical information system to create a comprehensive electronic patient record system. (+info)
Information systems integration in radiology.
(26/2705)
Advances in information systems and technology in conjunction with outside forces requiring improved reporting are driving sweeping changes in the practice of radiology. In most academic radiology departments, there can be at least five separate information systems in daily use, a clinical picture archiving and communication system (PACS), a hospital information system (HIS), a radiology information system (RIS), a voice-recognition dictation system, and an electronic teaching/research file system. A PACS will have incomplete, incorrect, and inconsistent data if manual data entry is used. Correct routing of studies for diagnostic reporting and clinical review requires accurate information about the study type and the referring physician or service, often not easily entered manually. An HIS is a hospital-wide information system used to access patient information, reports from various services, and billing information. The RIS is typically a system specifically designed to place radiology orders, to receive interpretations, and to prepare bills for patients. Voice-recognition systems automatically transcribe the radiologist's dictation, eliminating transcription delays. Another system that is needed in a teaching hospital holds images and data for research and education. Integration of diverse systems must be performed to provide the functionality required by an electronic radiology department and the services it supports. Health Level 7 (HL7) and Digital Imaging and Communications in Medicine (DICOM) have enabled sharing of data among systems and can be used as the building blocks for truly integrated systems, but the user community and manufacturers need to specify the types of functionality needed to build clinically useful systems. Although technology development has produced the tools for interoperability for clinical and research/educational use, more work needs to be done to define the types of interaction that needs to be performed to realize the potential of these systems. (+info)
Management of diabetes mellitus in the Lovelace Health Systems' EPISODES OF CARE program.
(27/2705)
OBJECTIVE: To design and implement the Lovelace Diabetes EPISODES OF CARE program in a managed care setting. This program is intended to address the complex needs of patients with type 2 diabetes mellitus by using specific physician-provider and patient interventions. DESIGN: Observational study. SETTING: Lovelace Health Systems, the second-largest and most fully integrated health care delivery system in New Mexico. The main facility is located in Albuquerque. PARTICIPANTS: Lovelace Health Plan members with type 2 diabetes. INTERVENTIONS: Physician-provider interventions included practice guidelines medical profile screens, and provider support reports. Patients interventions included diabetes education; improved access to care, with focused diabetes clinic visits and "Diabetes Days"; and reminder systems. MAIN OUTCOME MEASURES: Glycohemoglobin values, dilated eye examination rates, and access to education. RESULTS: Significant lowering of glycohemoglobin values, dilated eye examination rates exceeding benchmark measures, and increases in educational access rates have occurred since the Lovelace Diabetes EPISODES OF CARE program was implemented. CONCLUSIONS: An integrated health care delivery system with a comprehensive, diabetes disease management program can substantially improve outcomes. (+info)
Better by half: hypertension in the elderly and the 'rule of halves': a primary care audit of the clinical computer record as a springboard to improving care.
(28/2705)
BACKGROUND: Despite recent studies highlighting the benefits of treating elderly hypertensives, researchers have shown that the taking on board of these findings has been disappointing in primary care, where the 'rule of halves' still applies. Clinical computers could help performance in this area, yet national and local research suggests that they are under-used. OBJECTIVE: Our aim is to develop a pragmatic intervention which aims to: improve patient care by translating research findings into practice, increase meaningful computer use, establish 'paperless' annual audits and improve 'networking' between practices. METHOD: Following a baseline audit to ascertain accuracy, the computer records of participating practices were tested against the 'rule of halves' for hypertension. Results were presented to each practice (individual practice and aggregate data for all practices). Management guidelines, standardization of computer recording, achievable targets and review dates were agreed. The study was conducted in West London practices using the EMIS computer system in 1996/1997. RESULTS: An 81% (22/27) practice response rate was achieved. Baseline audit was completed for 22 practices. Fifteen practices appear to be using their computer regularly (two-thirds). Using strict definitions, 'the rule of halves' still applies. Using looser definitions, three-quarters of hypertensives are known, two-thirds are treated and just under two-thirds are controlled. This project identified wide inter- and intra-practice variation in: use of the computer, patient follow-up, attainment of target BP, rounding BP readings to target levels and prescribing patterns. CONCLUSION: This focused training intervention has introduced practices to evidence-based proactive care and highlighted an important application for clinical computers. A local network of practices has been established for future projects. For elderly patients registered with a GP, the rule of halves has been improved upon, provided that a figure of 160/90 is taken as an adequate control. Attainment of target BP in treated hypertensives was similar to that reported from large trials. There is enormous scope for improving identification and follow-up of hypertensives using clinical computers and systematic models of care. The wide inter-practice variation in hypertension management requires further study. (+info)
The impact of computerized physician order entry on medication error prevention.
(29/2705)
BACKGROUND: Medication errors are common, and while most such errors have little potential for harm they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events. OBJECTIVE: To evaluate the impact of computerized physician order entry (POE) with decision support in reducing the number of medication errors. DESIGN: Prospective time series analysis, with four periods. SETTING AND PARTICIPANTS: All patients admitted to three medical units were studied for seven to ten-week periods in four different years. The baseline period was before implementation of POE, and the remaining three were after. Sophistication of POE increased with each successive period. INTERVENTION: Physician order entry with decision support features such as drug allergy and drug-drug interaction warnings. MAIN OUTCOME MEASURE: Medication errors, excluding missed dose errors. RESULTS: During the study, the non-missed-dose medication error rate fell 81 percent, from 142 per 1,000 patient-days in the baseline period to 26.6 per 1,000 patient-days in the final period (P < 0.0001). Non-intercepted serious medication errors (those with the potential to cause injury) fell 86 percent from baseline to period 3, the final period (P = 0.0003). Large differences were seen for all main types of medication errors: dose errors, frequency errors, route errors, substitution errors, and allergies. For example, in the baseline period there were ten allergy errors, but only two in the following three periods combined (P < 0.0001). CONCLUSIONS: Computerized POE substantially decreased the rate of non-missed-dose medication errors. A major reduction in errors was achieved with the initial version of the system, and further reductions were found with addition of decision support features. (+info)
Hormone replacement therapy: patterns of use studied through British general practice computerized records.
(30/2705)
OBJECTIVE: We aimed to describe the longitudinal pattern of hormone replacement therapy (HRT) consumption in a cohort of long-term users (defined as use for >1 year). METHOD: We carried out longitudinal analysis of prescription data derived from GPs' computer records. Subjects were recruited through 15 general practices in the former Oxford, South West and North West Thames Regions that contributed to the VAMP/OPCS general practice research database. All women in the practices aged 45-64 years in September 1991 were identified. Of these, the analysis concerned the 1224 long-term users and 1154 non-user controls who remained in the practices from September 1991 to March 1995; 868 (71%) of the users and 698 (61%) of the controls also provided questionnaire data. RESULTS: The prevalence of HRT use was 15% in 1992, a rise of 16% from 1991. The prevalence of long-term use was 10%; 22% of the cohort identified as taking HRT between April and September 1991 had left the practices or were not taking HRT 1 year later. But for the group defined as long-term users in 1992, the rate of discontinuation was less than 5% per year over the following 2 1/2 years. Users of opposed therapy were 50% more likely to discontinue than users of unopposed therapy. Almost all women who had or had not undergone hysterectomy were taking unopposed or opposed therapy, respectively. Over 80% of prescriptions were for oral therapy. A third of users of either opposed or unopposed therapy changed the formulation during the 4 years of observation, and two-thirds of those who used both forms changed at least once in addition. Two changes were required to accommodate 94% of users. CONCLUSIONS: Once women have taken HRT for a year, their continuation rate is over 95% per annum. Although the majority of women stayed with one formulation, a substantial minority changed formulation quite frequently, three formulations being required to accommodate 94% of long-term users over 4 years. Any trial of HRT use will need to recruit long-term users and allow for change in formulation of HRT in its protocol. (+info)
Study of early warning of accident and emergency departments by ambulance services.
(31/2705)
OBJECTIVE: To determine the warning time given to accident and emergency (A&E) departments by the ambulance service before arrival of a critically ill or injured patient. To determine if this could be increased by ambulance personnel alerting within five minutes of arrival at scene. METHODS: Use of computerised ambulance control room data to find key times in process of attending a critically ill or injured patient. Modelling was undertaken with a scenario of the first responder alerting the A&E department five minutes after arrival on scene. RESULTS: The average alert warning time was 7 min (range 1-15 min). Mean time on scene was 22 min (range 4-59 min). In trauma patients alone, the average alert time was 7 min, range 2-15 min, with an average on scene time of 23 min, range 4-53 min. There was a potential earlier alert time averaging 25 min (SD 18.6, range 2-59 min) if the alert call was made five minutes after arrival on scene. CONCLUSIONS: A&E departments could be alerted much earlier by the ambulance service. This would allow staff to be assembled and preparations to be made. Disadvantages may be an increased "alert rate" and wastage of staff time while waiting the ambulance arrival. (+info)
Quality of care for chronic illness in primary care: opportunity for improvement in process and outcome measures.
(32/2705)
OBJECTIVE: To describe adherence to a number of quality indicators and clinical outcomes for asthma, diabetes mellitus, hypertension, coronary heart disease, atrial fibrillation, and cerebrovascular disease in the primary care practices of the Practice Partner Research Network (PPRNet). STUDY DESIGN: Cross-sectional epidemiologic design. PATIENTS AND METHODS: PPRNet is a national research network of ambulatory, mostly primary care practices that use the Practice Partner Patient Records electronic medical records. Participating practices send anonymous clinical data on patients to the PPRNet data center monthly. Standard database management and statistical software are used to compile practice reports. These reports include measures of adherence to process and outcome measures for chronic illnesses, the subject of this report. RESULTS: Forty-eight PPRNet practices provided data for the first quarter of 1998. A total of 336,401 patients were active in these practices during this quarter. At least 2000 active patients had each of the conditions studied. Wide variation in guideline adherence among PPRNet practices was present for each of the performance measures. Better performance was present for physical examination measures and laboratory monitoring than for treatment interventions. Overall performance was excellent for blood pressure monitoring, poor for lipid monitoring in patients with CHD, and intermediate for glycosylated hemoglobin monitoring in patients with diabetes mellitus. CONCLUSION: The findings of this study are comparable to others in documenting that most clinical practice guidelines for chronic illness are not followed for a majority of patients and that large majorities do not reach desired clinical outcomes. (+info)