Computer assisted clinical data analysis

The Diagnosis Related Groups patient classification scheme coupled with desk top PC technology permits sophisticated analysis of patient medical data. Individuals with no programming knowledge can produce sophisticated analysis. The functionality and structure of the 3M Analytical Workstation are described and example analysis reports are presented.

BERTE--a database for children with congenital heart defects

To secure the follow-up of children with congenital heart defects in Norway the Dept. of Pediatric Cardiology has developed a tailor-made database. This also simplifies the regular flow of information about these patients both inside the hospital and between the hospital and the others who are in charge of the patient care on various levels.

The introduction of computer-based patient records in The Netherlands

Computer-based patient records, although an area of active research, are not in widespread use. In June 1992, 38% of Dutch general practitioners had introduced computer-based patient records. Of these, 70% had replaced the paper patient record with a computer-based record to retrieve and record clinical data during consultations. Possible reasons for the use of computer-based patient records include the nature of Dutch general practice and the early and active role of professional organizations in recognizing the potential of computer-stored patient records. Professional organizations issued guidelines for information systems in general practice, evaluated available systems, and provided postgraduate training that prepares physicians to use the systems. In addition, professional organizations successfully urged the government to reimburse general practitioners part of the expenses related to the introduction of computer-based patient records. Our experience indicates that physicians are willing and able to integrate information technology in their practices and that professional organizations can play an active role in the introduction of information technology.

[Electronic data processing in urologic clinics. Results of a survey. Electronic Data Processing in Urology Group of the Graduate and Continuing Education Commission of German Urologists]

Computer equipment in Departments of Urology in Germany was evaluated by a nation-wide questionnaire. One hundred and fifty-three questionnaires were returned with detailed information on computer hardware, software and applications in Urology. Most departments were equipped with at least one computer. Computer equipment varied considerably among the participants including both stand alone personal computers (PCs) and local area networks (LANs) with several PCs connected by cable. Typically, PCs were IBM-compatible and ran the MS-DOS operating system Word processing and related applications were the most frequently mentioned computer tasks in urology. In some departments computers are also used in research for production of databases and graphics and for statistical applications. When computers were used for documentation of therapy and/or medical records, software was often custom-made according to the department's specific needs. In the future, more computers will be needed in departments of urology, because medical records will have to meet higher standards of documentation.

Do primary care physicians prefer dictated or computer-generated discharge summaries?

OBJECTIVE

To determine the preference of primary care physicians for computer-generated vs dictated discharge summaries from a neonatal intensive care unit.

DESIGN

Survey mailed to primary care physicians.

SETTING

Regional referral area of a level III neonatal intensive care unit.

PARTICIPANTS

Pediatricians and family medicine physicians caring for infants discharged from the neonatal intensive care unit.

RESULTS

Of 58 questionnaires sent, 45 (78%) were returned. Overall, 33 physicians (73%) either strongly or mildly preferred the computer-generated discharge summary; eight (18%) had no preference; and four (9%) preferred the dictated discharge summary (P < .001). The category of strongest preference was relevance of information for continued patient care. Preference for type of discharge summary was not significantly influenced by time in practice, type of practice, preference to read or scan summaries, or frequency of computer use.

CONCLUSION

Primary care physicians prefer computed-generated discharge summaries to dictated discharge summaries.

A computerized record chart for the study of chronic daily headache

A comprehensive record chart for the study of chronic daily headache (CDH) is presented. The record chart contains 11 parts (232 items) concerning: sociodemographic data, physiological history, female reproductive life history, family history, pathological history, drug abuse, headache history, headache clinical features, prophylactic therapy, instrumental investigations, and physical and neurological examination. Furthermore, three attached special charts are illustrated which concern, respectively, the cervical spine examination, oromandibular function examination and the assessment of analgesic use.

The electronic patient records solution

Automation has been the solution for many business problems, yet few home care agencies have extended computerization beyond the traditional billing and financial functions to the clinical nursing process. Excessive nursing time spent in documentation is arguably the single biggest business problem facing the industry. Why haven't computers been accepted by home care clinicians? How could new advances in technology create virtually paperless home care nursing?

Reaping the benefits of electronic medical record systems

An electronic medical record system can provide benefits beyond the obvious functions of efficient and less labor-intensive scanning, archiving, retrieving, and printing of patient care information. The less tangible benefit of providing record access to several users simultaneously is difficult to quantify, but can enhance operations and improve the quality of patient care throughout a healthcare facility.

Users and uses of patient records. Report of the Council on Scientific Affairs. Council on Scientific Affairs, American Medical Association

At present, there is significant momentum for developing and implementing computer-based patient records systems. It is essential that their development be guided by the functional requirements of the users and uses of patient records. Users can be grouped into seven categories: providers, patients, educators, researchers, payers, managers and reviewers, and licensing and accrediting agencies and professional associations. Uses of patient records include fostering continuity of care, supporting diagnosis and choice of therapy, assessing and managing health risks, documenting the services provided, maintaining accurate medical histories, billing and verifying payment, documenting professionals' experience, teaching students, preparing conferences and presentations, conducting research, formulating practice guidelines, and providing data to support utilization review, quality assurance, accreditation, and licensure. Patient records can be classified as primary records used by professionals while providing health care services or secondary records derived from primary records to aid nonclinical users. Protecting the confidentiality of patient information will restrict access to primary records for some users and should prevent inclusion of sensitive data in secondary records. The design features to be incorporated into computer-based record systems should expand the record's function from that of a simple device for documenting events into a powerful tool for providing and managing care.

The accuracy of ascertaining vital status in a historical cohort study of synthetic textiles workers using computerized record linkage to the Canadian Mortality Data Base

Vital status of a cohort of 10,211 Quebec, synthetic textiles workers was ascertained through a probabilistic record linkage to the Canadian Mortality Data Base (CMDB); 5,033 of these workers were also traced using other sources. There was agreement in the vital status of all but 60 of the subjects traced jointly through the CMDB and the alternate sources. 41 subjects were declared 'deceased' from the CMDB but 'alive' from the alternate sources; it is likely that these subjects were indeed deceased. 19 subjects, declared 'deceased' with a fair degree of certainty from the alternate sources, were not identified from the computer search of the CMDB; 17 were found manually on the microfiche death records and two died outside of Canada. The probability of identifying deceased and living subjects from the CMDB was therefore estimated to be 98.2% (95% confidence interval: 97.5-98.7%) and about 100%, respectively. Estimates of cost are also presented, and it is concluded that use of the CMDB is the method of choice for tracing moderate to large cohorts.

Physician inpatient order writing on microcomputer workstations. Effects on resource utilization

OBJECTIVE

To assess the effects on health care resource utilization of a network of microcomputer workstations for writing all inpatient orders.

DESIGN

Randomized controlled clinical trial.

SETTING

Inpatient internal medicine service of an urban public hospital.

SUBJECTS

A total of 5219 internal medicine patients and the 68 teams of house officers, medical students, and faculty internists who cared for them.

INTERVENTION

Microcomputer workstations, linked to a comprehensive electronic medical record system, for writing all inpatient orders.

MAIN OUTCOME MEASURES

Total inpatient charges for each admission and charges for specific categories of orders. A time-motion study of selected interns assessed the ordering system's time consumption.

RESULTS

Intervention teams generated charges that were $887 (12.7%) lower per admission than did control teams (P = .02). Significant reductions (P < .05) were demonstrated separately for bed charges, diagnostic test charges, and drug charges. Reductions of similar proportion and statistical significance were found for hospital costs. The mean length of stay was 0.89 day shorter for intervention resident teams (P = .11). Interns in the intervention group spent an average of 33 minutes longer (5.5 minutes per patient) during a 10-hour observation period writing orders than did interns in the control group (P < .0001).

CONCLUSIONS

A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs. This would amount to savings of more than $3 million in charges annually for this hospital's medicine service and potentially tens of billions of dollars nationwide. However, the system required more physician time than did the paper charts. Research at other sites and system advances to reduce time requirements are warranted.

Computers in the consultation. The UK experience

In the UK 50% of primary care physicians are using electronic medical records in real time during the consultation. Some have given up using manual records at all. This paper describes the reasons they have implemented electronic medical records for progress notes during a consultation and the way such records improve the care given to individual patients. The essence of the argument is that doctors make decisions whilst they are with the patient. It is therefore essential that any assistance the computer can offer is available during every consultation.

Physician-directed software design: the role of utilization statistics and user input in enhancing HELP results review capabilities

The M.D. Rounds Report program was developed and implemented in June of 1992 as an adjunct to the HELP System at Rex Hospital. The program facilitates rapid access to information on allergies and current medications, laboratory results, radiology reports and therapist notes for a list of patients without physicians having to make additional menu or submenu selections. In planning for an upgrade of the program, utilization statistics and user feedback provided valuable information in terms of frequency of access, features used and unused, and the value of the program as a reporting tool in comparison to other online results reporting applications. A brief description of the functionality of the M.D. Rounds Report, evaluation of the program audit trail and user feedback, planned enhancements to the program, and a discussion of the prototyping and monitoring experience and the impact on future physician subsystem development will be presented.

Real and imagined barriers to an electronic medical record

We developed an electronic medical record for ambulatory patients as part of the integrated clinical information system at Beth Israel Hospital. During the four years since it was installed, clinicians have entered 76,060 patient problems, 137,713 medications, and 33,938 notes. Residents, who had to type notes in themselves, entered 49.5% of their notes into OMR. Several factors that we had predicted would be barriers to an electronic medical record, such as clinician reluctance to type or perform data entry, have not proved to be significant problems. Other anticipated barriers, such as difficulties with dual charting on paper during transition to an electronic medical record, have been realized. The major unexpected barrier that has been encountered is increased clinician concern about the privacy and security of full text notes relative to other data elements in the clinical information system. We have attempted to modify the electronic medical record so as to overcome some of these barriers.

[The general practitioner and clinical records: a survey of the knowledge of users of a software package]

The FATMA project--subproject 6, Line of Research 2--aims at implementing a new computerized information network for general practitioners using the same kind of software and homogeneously located throughout Italy. Thus, patients' case form data can be collected for public health purposes. After a study of literature in order to check whether other countries had implemented similar projects and what they consisted of, a survey based on a computerized questionnaire was carried out on a group of g.p.s. who had already received a software for the management of their clinical and professional activities from Janssen Informedica. This survey aimed at judging some aspects of users in order to select potential monitors of the information network who would test a new software. The analysis regards both g.p.s' social and professional data and the use of a computer package with reference to the quality and quantity of the clinical data they input. 2,010 questionnaires were filled in all their parts and mailed back to Informedica. It came out that g.p.s. believe more and more they can improve the organization and management of their work by using a software equipped with routines and easy access procedures so that clinical data, diagnostic reports and treatment can be collected, placed on files and updated. Thus, a new software should be developed. While meeting g.p.s' needs, it must overcome the limits of packages now available concerning the possibility of carrying out epidemiological studies. The software can become a tool to collect clinical data of patients, diseases and diagnostic procedures through standard protocols directly from g.p.s records.

Better planning needed to strengthen patient-care systems

The word "change" is on everyone's lips this year. The desire for change in patient-care information applications is very strong, too, according to a recent Computers in Healthcare patient-care systems survey. Three nursing executives have studied the CIH survey results and give their view on why strategic planning for patient-care systems is so poor when the desire for these applications is so great.

Trends in healthcare computing

Almost 550 healthcare professionals were polled for their perceptions of information technology--as it relates to their facilities--at the 1992 Annual Healthcare Information and Management Systems Society Conference. Conducted by J.C. Pollock Associates, Princeton, N.J., and commissioned by HIMSS and Hewlett-Packard Co., the survey responses reflect general optimism about information system procurement and use in America's hospitals. Actual responses to multiple-choice, technology-related survey questions are charted on this and following pages.