Experience with an electronic health record for a homeless population.
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A computerized electronic medical record (EMR) system using client-server architecture was designed and implemented by the Laboratory of Computer Science for use by the Boston Health Care for the Homeless Program (BHCHP) to meet the unique medical record needs of the homeless. For the past three years, this EMR has been used to assist providers in the delivery of health care to the homeless population of Boston. As the BHCHP has grown and technology improved, it is important to review what features of the EMR work, and to investigate what improvements can be made for the better delivery of care to the homeless, especially as we approach the next century. (+info)
No free lunch: institutional preparations for computer-based patient records.
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The Veterans Administration (VA) is aggressively pursuing computer-based medical records by deploying the Computerized Patient Record System (CPRS) across its 150 medical centers and 400 outpatient clinics. CPRS's client-server, patient-centered approach to clinical computing is a departure from VA's traditional terminal-compatible, department-centered approach. Although the CPRS software is freely distributed, institutional readiness for computer-based patient records has proven expensive. Preparations include organizational changes, human resource development, hardware deployment, physical plant upgrades, and software testing. This paper details CPRS preparations and their costs at one VA Medical Center. Lessons learned during the process are summarized. (+info)
Information resources assessment of a healthcare integrated delivery system.
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While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations. (+info)
Organizational and technological insight as important factors for successful implementation of IT.
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Politicians and hospital management in Sweden and Denmark focus on IT and especially Electronic Patient Record, EPR as a tool for changes that will lead to better economy as well as better quality and service to the patients. These changes are not direct effects of the new medium for patient records but indirect effects due to the possibilities embedded in the new technology. To ensure that the implementation is successful, i.e. leads to changes in organization structure and workflow, we need tools to prepare clinicians and management. The focus of this paper is the individual insight in technology and organization and it proposes a model to assess and categorize the possibilities of individuals and groups to participate in and make an implementation process powerful. (+info)
The transition to automated practitioner order entry in a teaching hospital: the VA Puget Sound experience.
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We recently installed an automated practitioner order entry system on our busiest inpatient wards and critical care units. The installation followed 20 months preparation in which we created the workstation, network, and host infrastructure, developed requisite policies, recruited personnel to support the system, and installed the software in areas where the pace of order entry was less intense. Since implementing automated order entry, we have experienced problems such as an increase in time required for practitioners to enter orders, workflow changes on inpatient units, difficulties with patient transfers, and others. Our user support system has been heavily used during the transition period. Software tailoring and enhancements designed to address these problems are planned, as is installation of the order entry system in remaining clinical units in our medical centers. (+info)
Integration of clinical decision support with on-line encounter documentation for well child care at the point of care.
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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.
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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)
Electronic medical record implementation barriers encountered during implementation.
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The authors were intimately involved in choosing and implementing a clinical information system for an integrated medical care delivery system. We will describe our experiences in implementing the first stages of an electronic medical record. We will consider the problems encountered, solutions that were found and continuing areas of sub-optimal performance. (+info)