Distributing knowledge maintenance for clinical decision-support systems: the "knowledge library" model.
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The maintenance of knowledge-rich clinical decision-support systems is challenging, in particular in the complex setting of a large academic medical center. Distributing the maintenance tasks to the source of expertise can address scalability, accuracy and currency issues. It also helps to foster a more global sense of ownership among the system users. The knowledge maintenance model must provide processes and tools to deal with a wide range of stakeholders (resident and attending physicians, consulting specialists, other care providers, case managers, ancillary departments), with knowledge embedded in legacy departmental systems, and with the continuous evolution of the content and form of the knowledge base. We describe and illustrate the "knowledge library" model in use at Vanderbilt University Medical Center for the distributed maintenance of the integrated knowledge base that drives the WizOrder clinical decision-support, physician order entry, and notes capture system. (+info)
Merging multiple institutions: information architecture problems and solutions.
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Amalgamating organizations face great challenges when trying to merge their formerly separate information systems. An architectural approach is essential in order to understand the business process and data implications of the new organization's business decisions and application choices. HL7 is useful as a common messaging standard, but does not help to reconcile conflicting local identifier coding systems. The Information Services department has an important role in catalyzing decisions about inconsistent business processes and conflicting universal coding systems within an enterprise framework. (+info)
Using external data sources to improve audit trail analysis.
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Audit trail analysis is the primary means of detection of inappropriate use of the medical record. While audit logs contain large amounts of information, the information required to determine useful user-patient relationships is often not present. Adequate information isn't present because most audit trail analysis systems rely on the limited information available within the medical record system. We report a feature of the STAR (System for Text Archive and Retrieval) audit analysis system where information available in the medical record is augmented with external information sources such as: database sources, Light-weight Directory Access Protocol (LDAP) server sources, and World Wide Web (WWW) database sources. We discuss several issues that arise when combining the information from each of these disparate information sources. Furthermore, we explain how the enhanced person specific information obtained can be used to determine user-patient relationships that might signify a motive for inappropriately accessing a patient's medical record. (+info)
A programmable rules engine to provide clinical decision support using HTML forms.
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The authors have developed a simple method for specifying rules to be applied to information on HTML forms. This approach allows clinical experts, who lack the programming expertise needed to write CGI scripts, to construct and maintain domain-specific knowledge and ordering capabilities within WizOrder, the order-entry and decision support system used at Vanderbilt Hospital. The clinical knowledge base maintainers use HTML editors to create forms and spreadsheet programs for rule entry. A test environment has been developed which uses Netscape to display forms; the production environment displays forms using an embedded browser. (+info)
WebCIS: large scale deployment of a Web-based clinical information system.
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WebCIS is a Web-based clinical information system. It sits atop the existing Columbia University clinical information system architecture, which includes a clinical repository, the Medical Entities Dictionary, an HL7 interface engine, and an Arden Syntax based clinical event monitor. WebCIS security features include authentication with secure tokens, authorization maintained in an LDAP server, SSL encryption, permanent audit logs, and application time outs. WebCIS is currently used by 810 physicians at the Columbia-Presbyterian center of New York Presbyterian Healthcare to review and enter data into the electronic medical record. Current deployment challenges include maintaining adequate database performance despite complex queries, replacing large numbers of computers that cannot run modern Web browsers, and training users that have never logged onto the Web. Although the raised expectations and higher goals have increased deployment costs, the end result is a far more functional, far more available system. (+info)
Extended SQL for manipulating clinical warehouse data.
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Health care institutions are beginning to collect large amounts of clinical data through patient care applications. Clinical data warehouses make these data available for complex analysis across patient records, benefiting administrative reporting, patient care and clinical research. Data gathered for patient care purposes are difficult to manipulate for analytic tasks; the schema presents conceptual difficulties for the analyst, and many queries perform poorly. An extension to SQL is presented that enables the analyst to designate groups of rows. These groups can then be manipulated and aggregated in various ways to solve a number of useful analytic problems. The extended SQL is concise and runs in linear time, while standard SQL requires multiple statements with polynomial performance. The extensions are extremely powerful for performing aggregations on large amounts of data, which is useful in clinical data mining applications. (+info)
Construction of a virtual EPR and automated contextual linkage to multiple sources of support information on the Oxford Clinical Intranet.
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We have used internet-standard tools to provide access for clinicians to the components of the electronic patient record held on multiple remote disparate systems. Through the same interface we have provided access to multiple knowledgebases, some written locally and others published elsewhere. We have developed linkage between these two types of information which removes the need for the user to drill down into each knowledgebase to search for relevant information. This approach may help in the implementation of evidence-based practice. The major problems appear to be semantic rather than technological. The intranet was developed at low cost and is now in routine use. This approach appears to be transferable across systems and organisations. (+info)
New uses of legacy systems: examples in perinatal care.
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In this article, new uses of the Perinatal Information System at the Uruguayan Social Security health care facilities are described. The perinatal information system has been in place for over 13 years, with about 40 thousand clinical records on electronic files. A newly created Web interface allows a distributed access to existing perinatal information within the National Social Security Wide Area a Network. Perinatal data is also exported to a management information system, allowing to dynamically answer questions and make managerial decisions, and eventually link these data with other sources. Future steps regarding clinical information systems are outlined. (+info)