Integrating knowledge resources at the point of care: opportunities for librarians.
(33/2705)
Health sciences librarians at the University of Washington (UW) are partners in the evolution of Internet-based clinical information systems for two medical centers, University of Washington Medical Center and Harborview Medical Center, as well as the UW Primary Care Network clinics. Librarians lead information resource and systems development projects and play a variety of roles including facilitator, publisher, integrator, and educator. These efforts have been coordinated with parallel development efforts by the Integrated Advanced Information Management Systems (IAIMS) clinical informatics group in developing electronic medical record systems and clinical decision support tools. The outcome is MINDscape, a very heavily used Web view of the patient medical record with tightly integrated knowledge resources as well as numerous Web-accessible information resources and tools. The goal of this article is to provide a case study of librarian involvement in institutional information systems development at UW and to illustrate the variety of roles that librarians can assume in hospital settings. (+info)
Medical libraries, bioinformatics, and networked information: a coming convergence?
(34/2705)
Libraries will be changed by technological and social developments that are fueled by information technology, bioinformatics, and networked information. Libraries in highly focused settings such as the health sciences are at a pivotal point in their development as the synthesis of historically diverse and independent information sources transforms health care institutions. Boundaries are breaking down between published literature and research data, between research databases and clinical patient data, and between consumer health information and professional literature. This paper focuses on the dynamics that are occurring with networked information sources and the roles that libraries will need to play in the world of medical informatics in the early twenty-first century. (+info)
Improving the repeat prescribing process in a busy general practice. A study using continuous quality improvement methodology.
(35/2705)
PROBLEM: A need to improve service to patients by reducing the time wasted by reception staff so that the 48 hour target for processing repeat prescription requests for patient collection could be achieved. DESIGN: An interprofessional team was established within the practice to tackle the area of repeat prescribing which had been identified as a priority by practice reception staff. The team met four times in three months and used continuous quality improvement (CQI) methodology (including the Plan-Do-Study-Act cycle) with the assistance of an external facilitator. BACKGROUND AND SETTING: A seven partner practice serving the 14,000 patients on the northern outskirts of Bournemouth including a large council estate and a substantial student population from Bournemouth University. The repeat prescribing process is computerised. KEY MEASURES FOR IMPROVEMENT: Reducing turn around times for repeat prescription requests. Reducing numbers of requests which need medical records to be checked to issue the script. Feedback to staff about the working of the process. STRATEGIES FOR CHANGE: Using a Plan-Do-Study-Act cycle for guidance, the team decided to (a) coincide repeat medications and to record on the computer drugs prescribed during visits; (b) give signing of prescriptions a higher priority and bring them to doctors' desks at an agreed time; and (c) move the site for printing prescriptions to the reception desk so as to facilitate face to face queries. EFFECTS OF CHANGE: Prescription turnaround within 48 hours increased from 95% to 99% with reduced variability case to case and at a reduced cost. The number of prescriptions needing records to be looked at was reduced from 18% to 8.6%. This saved at least one working day of receptionist time each month. Feedback from all staff within the practice indicated greatly increased satisfaction with the newly designed process. LESSONS LEARNT: The team's experience suggests that a combination of audit and improvement methodology offers a powerful way to learn about, and improve, practice. The interventions used by the team not only produced measurable and sustainable improvements but also helped the team to learn about the cost of achieving the results and provided them with tools to accomplish the aims. The importance of feedback to all staff about CQI measures was also recognised. (+info)
The power and limits of a rule-based morpho-semantic parser.
(36/2705)
The venue of Electronic Patient Record (EPR) implies an increasing amount of medical texts readily available for processing, as soon as convenient tools are made available. The chief application is text analysis, from which one can drive other disciplines like indexing for retrieval, knowledge representation, translation and inferencing for medical intelligent systems. Prerequisites for a convenient analyzer of medical texts are: building the lexicon, developing semantic representation of the domain, having a large corpus of texts available for statistical analysis, and finally mastering robust and powerful parsing techniques in order to satisfy the constraints of the medical domain. This article aims at presenting an easy-to-use parser ready to be adapted in different settings. It describes its power together with its practical limitations as experienced by the authors. (+info)
Desiderata for a clinical terminology server.
(37/2705)
Clinical terminology servers are distinguished from more broadly based terminology servers intended for nomenclature development or mediation across classifications. Focusing upon the consistent and comparable entry of clinical observations, findings, and events, key desiderata are enumerated and expanded. These include 1) word normalization, 2) word completion, 3) target terminology specification, 4) spelling correction, 5) lexical matching, 6) term completion, 7) semantic locality, 8) term composition and 9) decomposition. Comparisons of this functionality to previously published models and specifications are made. Experience with a clinical terminology server, Metaphrase, is described. (+info)
HL7 document patient record architecture: an XML document architecture based on a shared information model.
(38/2705)
The HL7 SGML/XML Special Interest Group is developing the HL7 Document Patient Record Architecture. This draft proposal strives to create a common data architecture for the interoperability of healthcare documents. Key components are that it is under the umbrella of HL7 standards, it is specified in Extensible Markup Language, the semantics are drawn from the HL7 Reference Information Model, and the document specifications form an architecture that, in aggregate, define the semantics and structural constraints necessary for the exchange of clinical documents. The proposal is a work in progress and has not yet been submitted to HL7's formal balloting process. (+info)
The VA's use of DICOM to integrate image data seamlessly into the online patient record.
(39/2705)
The US Department of Veterans Affairs (VA) is using the Digital Imaging and Communications in Medicine (DICOM) standard to integrate image data objects from multiple systems for use across the healthcare enterprise. DICOM uses a structured representation of image data and a communication mechanism that allows the VA to easily acquire radiology images and store them directly into the online patient record. Images can then be displayed on low-cost clinician's workstations throughout the medical center. High-resolution diagnostic quality multi-monitor VistA workstations with specialized viewing software can be used for reading radiology images. Various image and study specific items from the DICOM data object are essential for the correct display of images. The VA's DICOM capabilities are now used to interface seven different commercial Picture Archiving and Communication Systems (PACS) and over twenty different radiology image acquisition modalities. (+info)
Structures of clinical information in patient records.
(40/2705)
In order to support the preparation of the European Prestandard on "Communication of Electronic Health Care Record--Part 2: Domain Termlist" we carried out an analytical study about names of clinical documents, titles of generic sections, names of data elements, according to our terminological methods. We defined three layers of structures for clinical information: i) documents and sections, ii) clinical statements, iii) systematic details within statements. We prepared in correspondence many lists suitable to develop a principled coarse-grained markup for transmission and homogeneous browsing of disparate patient records across many institutions, without any preventive agreement on existing coding systems, data elements, record organization. This achievement is the basis for federated records, in particular for the virtual life-long patient record. (+info)