Budgeting for ICD-10

Breaking down costs by category helps tackle a complex task. Different expenses will peak in different years, and not all costs will be obvious.

Evaluation of response time delay of a pen-tablet system in thin-client computing environments: implications for usability

Changeover from the traditional paper-based patient records to the computerized patient records has been spreading rapidly in medical facilities. Since ordinary input devices such as a keyboard and mouse are often thought insufficient for the needs of medical workers using electronic patient records (EPR) compared with traditional pens and paper-based patient records, a pen-tablet system (PTS) as a digital pen interface tends to be used instead. On the other hand, with the growing adoption of thin-client computing (TCC) in medical facilities, the usability of PTS with TCC has come to be a concern because of possible reduction of the usability due to delays of response time occurring in TCC environments. To analyze the factors that influence the usability of PTS with TCC, the authors focused on the relationship between length and its scattering of the response time delay. The results indicated that the delay scattering could be a more influencing factor than the delay length itself and that values of the scattering should be within approximately 35 milliseconds for the best usability. This study would provide useful indicators for evaluating the usability of PTS in incorporating it into the EPR system with TCC environments.

A survey of stimulation methods used in SSVEP-based BCIs

Brain-computer interface (BCI) systems based on the steady-state visual evoked potential (SSVEP) provide higher information throughput and require shorter training than BCI systems using other brain signals. To elicit an SSVEP, a repetitive visual stimulus (RVS) has to be presented to the user. The RVS can be rendered on a computer screen by alternating graphical patterns, or with external light sources able to emit modulated light. The properties of an RVS (e.g., frequency, color) depend on the rendering device and influence the SSVEP characteristics. This affects the BCI information throughput and the levels of user safety and comfort. Literature on SSVEP-based BCIs does not generally provide reasons for the selection of the used rendering devices or RVS properties. In this paper, we review the literature on SSVEP-based BCIs and comprehensively report on the different RVS choices in terms of rendering devices, properties, and their potential influence on BCI performance, user safety and comfort.

Effects of input methods on inter-key press intervals during continuous typing

Two popular input methods for Chinese typing, Microsoft New Phonetic and Boshiamy, were compared in terms of hand and finger loading, key-pressing speed and typing efficiency. Sixteen subjects typed an English and a Chinese text for 30 min each during two test sessions and all keystrokes and their inter-key press intervals were recorded by electronic activity monitoring software. Typing with Microsoft New Phonetic and with Boshiamy was found to have equal hand loadings, but typing with Microsoft New Phonetic was associated with a higher proportion of keystrokes at the number row. The subjects who used Boshiamy typed significantly more words per min than those who used Microsoft New Phonetic, though both groups had similar English typing speeds. The features of requiring fewer keystrokes to build a character and no need to choose matched words among homophones made Boshiamy a more efficient tool, but the risk of musculoskeletal disorders should be studied further. This study examined two input methods for typing Chinese and showed that typing with Boshiamy had a higher efficiency, including a higher proportion of key presses on the home row, required fewer key presses to build characters and resulted in a faster speed than with Microsoft New Phonetic. However, the potential risk of development of upper limb symptoms warrants further study.

Using a computer kiosk to promote child safety: results of a randomized, controlled trial in an urban pediatric emergency department

OBJECTIVES

The effects of a computer kiosk intervention on parents' child safety seat, smoke alarm, and poison storage knowledge and behaviors were evaluated in a pediatric emergency department serving predominantly low-income, urban families. The effects of parent anxiety and the reason for the child's emergency department visit also were examined.

METHODS

A randomized, controlled trial of a Safety in Seconds program with a 2- to 4-week follow-up interview was conducted with 759 parents of young children (4-66 months of age). The intervention group received a personalized report containing tailored, stage-based safety messages based on the precaution adoption process model. The control group received a report on other child health topics.

RESULTS

The intervention group had significantly higher smoke alarm, poison storage, and total safety knowledge scores. The intervention group was more likely to report correct child safety seat use. Neither parent anxiety nor the reason for the emergency department visit was related to the safety behaviors. Virtually all (93%) intervention parents read at least some of the report; 57% read it all, and 68% discussed it with others. Lower-income intervention parents who read all of the report and discussed it with others were more likely than control parents to practice safe poison storage. Higher-income intervention parents were more likely than control parents to report correct child safety seat use.

CONCLUSIONS

These results bode well for widespread applicability of computer technology to patient education in busy emergency departments and other child health care settings. Reducing financial barriers to certain safety behaviors should continue to be a high priority.

A professional and cost effective digital video editing and image storage system for the operating room

We propose an easy-to-construct digital video editing system ideal to produce video documentation and still images. A digital video editing system applicable to many video sources in the operating room is described in detail. The proposed system has proved easy to use and permits one to obtain videography quickly and easily. Mixing different streams of video input from all the devices in use in the operating room, the application of filters and effects produces a final, professional end-product. Recording on a DVD provides an inexpensive, portable and easy-to-use medium to store or re-edit or tape at a later time. From stored videography it is easy to extract high-quality, still images useful for teaching, presentations and publications. In conclusion digital videography and still photography can easily be recorded by the proposed system, producing high-quality video recording. The use of firewire ports provides good compatibility with next-generation hardware and software. The high standard of quality makes the proposed system one of the lowest priced products available today.

The electronic, 'paperless' medical office; has it arrived?

Modern information technology offers efficiencies in medical practice, with a reduction in secretarial time in maintaining, filing and retrieving the paper medical record. Electronic requesting of investigations allows tracking of outstanding results. Less storage space is required and telephone calls from pharmacies, pathology and medical imaging service providers to clarify the hand-written request are abolished. Voice recognition software reduces secretarial typing time per letter. These combined benefits can lead to significantly reduced costs and improved patient care. The paperless office is possible, but requires commitment and training of all staff; it is preferable but not absolutely essential that at least one member of the practice has an interest and some expertise in computers. More importantly, back-up from information technology providers and back-up of the electronic data are absolutely crucial and a paperless environment should not be considered without them.

Interactive computerized fruit and vegetable preference measure for African-American and Hispanic preschoolers

OBJECTIVE

The objective of this study was to develop a computerized measure for assessing fruit, fruit juice and vegetable (FJV) preferences of African-American (AA) and Hispanic (H) preschool children.

DESIGN/SETTING

Preschool children were selected from Head Start Centers to participate in this study. PARTICIPANTS/MAIN OUTCOME: Descriptive data on FJV preferences were obtained from a sample of 198 preschool children. Test-retest reliability (n = 50) and predicitve validity (n = 47) were assessed in a sample of children.

ANALYSIS

Analysis of variance (ANOVA) was used to evaluate gender and ethnic differences in FJV preference scores. Mean FJV preference scores were correlated using the Pearson's correlation coefficients and intra-class correlation to assess the reliability of the preference measure. ANOVA was applied to test the mean FV consumption difference between the low and high FV preference groups.

RESULTS

Compared to H, AA had a significantly higher preference for vegetables. Boys had a significantly lower preference for fruit than girls. Data show adequate test-retest reliability (r = .70; p < .01) and internal consistency of FJV items (Cronbach alpha = .87). Mean FV consumption was significantly higher in children who reported higher preferences for FV compared to those who reported lower FV preferences (p < 0.05).

CONCLUSION

Data provide evidence for the reliability and validity of an interactive, computerized measure for assessing FJV preferences of young children.

IMPLICATION

Development of a valid and reliable method for assessing FJV preferences of preschool children may be useful in characterizing FJV preferences of young children and in evaluating specific intervention programs.

Electronic health records: just around the corner? Or over the cliff?

We recently implemented a full-featured electronic health record in our independent, 4-internist, community-based practice of general internal medicine. We encountered various challenges, some unexpected, in moving from paper to computer. This article describes the effects that use of electronic health records has had on our finances, work flow, and office environment. Its financial impact is not clearly positive; work flows were substantially disrupted; and the quality of the office environment initially deteriorated greatly for staff, physicians, and patients. That said, none of us would go back to paper health records, and all of us find that the technology helps us to better meet patient expectations, expedites many tedious work processes (such as prescription writing and creation of chart notes), and creates new ways in which we can improve the health of our patients. Five broad issues must be addressed to promote successful implementation of electronic health records in a small office: financing; interoperability, standardization, and connectivity of clinical information systems; help with redesign of work flow; technical support and training; and help with change management. We hope that sharing our experience can better prepare others who plan to implement electronic health records and inform policymakers on the strategies needed for success in the small practice environment.

The accuracy of clinical information systems

The clinical information system (CIS) is becoming more common in intensive care units. These systems have the ability to record, store, and retrieve large amounts of clinical patient data with great ease. This should greatly facilitate outcomes research and quality assurance. Unfortunately, there is not much information available about the accuracy of the data coming from these systems. True accuracy of a patient record requires both completeness of data and correctness of data as well as legibility. Automated systems are clearly superior to human entered data in terms of completeness and legibility but the correctness of entered data remains unclear. There are aspects of automated data entry that facilitate erroneous data entry. This article reviews the existing literature on accuracy of CISs with special attention to the qualities of automated data entry that can lead to false data. Additionally, data are presented from a newly published study by the author evaluating the validity of data from a commercially available CIS.

Computer equipment used in patient care within a multihospital system: recommendations for cleaning and disinfection

Computer hardware has been implicated as a potential reservoir for infectious agents. Leaders of a 22-hospital system, which spans North America and serves pediatric patients with orthopedic or severe burns, sought to develop recommendations for the cleaning and disinfection of computer hardware within its myriad patient care venues. A task force comprising representatives from infection control, medical affairs, information services, and outcomes management departments was formed. Following a review of the literature and of procedures within the 22 hospitals, criteria for cleaning and disinfection were established and recommendations made. The recommendations are consistent with general environmental infection control cleaning and disinfection guidelines, yet flexible enough to be applicable to the different locales, different computer and cleaning products available, and different patient populations served within this large hospital system.

A software solution for the control of visual behavioral experimentation

Psychophysical and neurophysiological research requires precise control of experimental devices for the purpose of delivering stimuli and monitoring behavioral and neural responses. This has previously been accomplished by complex, often proprietary, programmable systems, interfacing with a limited range of hardware. We have developed a software solution entirely within the Matlab environment that can achieve high-speed control of experimental and behavioral variables. We make this Wake-Forest Visual Experimentation (WaVE) software freely available under the GNU public license, and demonstrate how to customize it to individual laboratory needs. WaVE takes advantage of existing Matlab libraries and toolboxes to present visual stimuli, collect experimental data, update behavioral variables, and communicate with other computers. Although we have developed it for use in a Windows-based Personal Computer, the portability of the Matlab code makes possible its customization for use in a variety of other systems. We present simulation results showing sub-millisecond sampling rate and updating precision, running on single-processor, desktop PCs. The WaVE software offers a simple, flexible and powerful solution that compares favorably with many of its costly alternatives.

A flexible auditory research platform using acoustic or electric stimuli for adults and young children

A user-friendly and versatile research platform for use in auditory experiments, referred to as APEX (Application for PsychoElectrical eXperiments), is described. The platform takes care of automatic stimulus presentation and collection of the subject's responses. Acoustical auditory, as well as electrical auditory experiments with CI recipients can be conducted. The platform currently supports LAURA, Nucleus CI22 and Nucleus CI24 cochlear implants. The graphical user interface for the subjects has been extended to allow for testing very young children, by embedding the psychophysical procedures in a computer game. The research platform is available free of charge.

CIS: where are we going and what should we demand from industry?

Clinical information systems designed for use in the critical care setting have been available for many years. Yet, despite significant evidence that these systems contribute to patient safety and efficiency of care, they have not achieved widespread use. This paper examines some of the factors responsible for the slow growth in use of clinical information systems in the intensive care unit. We further examine the elements that will be necessary to support widespread adoption of future clinical information systems. We give an outline of functionalities, processes, and standards that users will demand from industry as they develop the information systems of the future.

Technical Note: A Computerized System for Monitoring Feeding Behavior and Individual Feed Intake of Dairy Cattle

The objective of this study was to develop and validate a computerized system to monitor feeding behavior and feed intake of loose-housed dairy cattle. The system consisted of 28 scales located in front of each self-locking place of a regular feedbunk. All cows had access to all scales indifferently. Each visit to the feedbunk was monitored by a transponder in the ear of each cow that was detected by a proximity reader located at the top right corner of each headlock. The data from the scales and the proximity readers were continuously recorded by a computer with an average scanning time of 3.5 s. The monitoring system was validated using all 28 feeding places and 51 lactating cows in a series of 4-h observations during 5 different d. During the observation periods, for each feeder, 2 observers recorded the cow number and the exact time of the visit. The observed data were then compared with the computer records. To validate the ability of the system to monitor feed consumption, on separate days, the amount of feed consumed by a cow during a visit was also measured manually with an external scale, and the feed that disappeared from each scale in 2 different 24-h periods was compared with the sum of feed consumed in each scale during these 2 periods. The average time spent in a given scale by each cow determined by direct observations was similar to that determined by the computer. The system was accurate and showed a high specificity (98.8%) and sensitivity (99.6%) for cow detections. Feed weights determined by the computer system were similar to those measured manually with an external scale, implying that the system was also accurate in measuring individual intake weights. In conclusion, the system provided a reasonable estimate of the number of visits per animal, length of each visit, amount of feed consumed per visit and animal, the total amount of feed consumed daily by each animal, and the rate at which animals consume feed.

The Thoratec Mobile Computer: Initial In-Hospital and Outpatient Experience

The purpose of this study was to test the operational effectiveness of the Thoratec mobile computer for monitoring and adjusting the portable TLC-II pneumatic driver. The TLC-II portable driver is approved by the Food and Drug Administration for use with either the paracorporeal ventricular assist device (VAD) or the Implantable Thoratec VAD. Currently, data log/file retrieval, changing device parameters, and initial VAD set-up is done with the cart mounted docking station. Thoratec has developed a tablet computer to perform the same tasks. The tablet computer weighs 3.2 lbs and has a 10.4 inch display. The mobile computer was evaluated in the clinic and multiple hospital settings as a mobile substitute for the docking station. For 120 consecutive days, the tablet computer was used exclusively for data file retrieval, changing device parameters, and initial VAD set up of the TLC-II portable drivers. Five patients, four paracorporeal VAD and one Implantable Thoratec VAD, using eight TLC-II portable drivers were evaluated. All patients were discharged home and followed as outpatients. The tablet computer was used by the VAD coordinator, two nurse clinicians, a perfusionist, and a research assistant. A total of 59 individual uses were performed (data retrieval, 46; parameter changes, 5; initial VAD set up, 8). Data were successfully obtained in all cases. Documentation of programmed settings and driver operation was achieved without difficulty.

Evaluation of the use of six diagnostic X-ray spectra computer codes

A knowledge of photon energy spectra emitted from X-ray tubes in radiology is crucial for many research domains in the medical field. Since spectrometry is difficult because of high photon fluence rates, a convenient solution is to use computational models. This paper describes the use of six computer codes based on semiempirical or empirical models. The use of the codes was assessed, notably by comparing theoretical half value layers and air kerma with measurements on five different X-ray tubes used in a research hospital. It was found that three out of the six computer codes give relative spectra very close to those produced by X-ray units equipped with constant potential generators: the mean difference between measured and modelled half value layer was less than 3% with a standard deviation of 3.6% whatever the tube and the applied voltage. Absolute output is less accurate: for four computer codes, the mean difference between the measured and modelled air kerma was between 18% and 36%, with a standard deviation of 9% whatever the tube (except for the single phase generator) and the applied voltage. One of the codes gives a good output and beam quality for X-ray units equipped with 100% ripple voltage generators. The use of computational codes as described in this paper provides a means of modelling relative diagnostic X-ray spectra, the usefulness of the tube output data depending on the accuracy required by the end user.

Automated computer result reporting for haemoglobinopathy screening

The anticipated introduction of universal antenatal screening can be expected to increase the workload of haemoglobinopathy laboratories throughout the country. We have devised a rule-based system to process those results that does not require skilled interpretation, thereby freeing staff time for more specialized work. The system relies on a calculated test to create a total haemoglobin peak value, which incorporates the values for HbA, HbA2 and HbF, the MCV and MCH from the full blood count. Each parameter has a series of defined ranges which, when subjected to an interpretation process within the laboratory computer system, generates an automated result text for the sample. During a 6-month verification period, the automated result interpretation system in conjunction with laboratory information systems (LIS) validation reduced the number of samples requiring manual review by 60%. The system was found to be 100% sensitive and 61.8% specific. We feel that the current specificity is acceptable in order to maintain a safe system. The ability to concentrate on potentially abnormal results will allow laboratories and health care workers more time to develop appropriate and timely frameworks to deal with abnormal results.