Read Code quality assurance: from simple syntax to semantic stability

As controlled clinical vocabularies assume an increasing role in modern clinical information systems, so the issue of their quality demands greater attention. In order to meet the resulting stringent criteria for completeness and correctness, a quality assurance system comprising a database of more than 500 rules is being developed and applied to the Read Thesaurus. The authors discuss the requirement to apply quality assurance processes to their dynamic editing database in order to ensure the quality of exported products. Sources of errors include human, hardware, and software factors as well as new rules and transactions. The overall quality strategy includes prevention, detection, and correction of errors. The quality assurance process encompasses simple data specification, internal consistency, inspection procedures and, eventually, field testing. The quality assurance system is driven by a small number of tables and UNIX scripts, with "business rules" declared explicitly as Structured Query Language (SQL) statements. Concurrent authorship, client-server technology, and an initial failure to implement robust transaction control have all provided valuable lessons. The feedback loop for error management needs to be short.

Validation of the laboratory information system

OBJECTIVE

To present an organized and practical approach to the validation of laboratory information systems.

SOURCES

Personal experience, published papers, technical manuals, and Food and Drug Administration guidelines.

DATA

Validation of the laboratory information system is the continuing process of proving the system fit for its intended use, initially and over time. It consists in defining, collecting, maintaining, and independently reviewing evidence that the system will perform consistently according to specification. Validation is tedious, difficult, and costly, but it must be done to assure that the system is fit for use and is working according to specification. In addition to professional and licensing bodies, laboratories making blood products fall under the regulatory requirements of the Food and Drug Administration. The buyer of a system is responsible for verifying that the developer has complied with all regulations and that the software products are validated to an appropriate degree, that the hardware is certified to perform its designated functions, that an appropriate period of acceptance testing has been done and documented, and that the system in use performs to specification and is under control.

CONCLUSION

System validation demonstrates to all concerned, inside and outside the laboratory, that the laboratory information system manages information well, with the expected accuracy and reliability, file integrity, auditability, and management control.

[Topical problems of hygienic certification of computers]

The paper provides evidence that while making a hygienic certification of computers it is necessary to rely not only on their physical and technical data, but on the characteristics obtained by defining the integral physiological parameters of the quality of displayed information perception. According the state standards CaH [symbol: see text] 2.2.2.54-96, their hygienic certification requires differential assessment of computers with the age-specific features of users (pre-school and young school children, middle- and old-aged schoolchildren, adults). It is proposed that CaH [symbol: see text] 2.2.2.54-96 should be supplemented by a regulation on choice of special working places with appropriate protective devices for the children of a risk group.

The ED on line: computerization of the pediatric emergency department

Computers are becoming an increasingly important tool in the management of emergency departments across the United States. Many emergency physicians are unfamiliar with computer systems and are uncomfortable with the idea of implementing computer technology into their departments. This article summarizes the benefits of computerized patient tracking systems and outlines the process by which such a program can be selected and incorporated into an emergency center.

A tool for software and hardware evaluation

The proliferation of information technology has enormously eased the burden of computing for medical users. However, it has also created a confusing, difficult problem in evaluation and selection of appropriate software and hardware components. This paper presents an easy to use software tool based on Anderson's Ranking Methodology implemented in Excel 5 that enables one an objective evaluation and selection.

Faxes, modems, and fax/modems

Although the use of computers for word processing and spreadsheet analysis is widespread, other less well-known uses can also increase efficiency and productivity. In this bimonthly column, Dr. Nicoll discusses a variety of computer applications to help the nurse executive catch up, keep up, and get ahead.

Hardware issues in the movement to computer-based patient records

The health care field is making significant progress in shifting to computer-based patient records. Providers are faced with some difficult decisions about what hardware options are most appropriate. Key issues include the choice of clinical workstations vs. portable computers, the use of new client-server architecture or traditional mainframe-based systems and the role of personal computers. This special report offers an indepth assessment of important hardware trends in the records automation movement. The first story offers an analysis of the hardware implications of client-server architecture and an assessment of the long-term role of mainframe computers. The second story sizes up the potential role for mobile computing, including hand-held devices and wireless technology.

Commissioning and quality assurance of treatment planning computers

The process of radiation therapy is complex and involves many steps. At each step, comprehensive quality assurance procedures are required to ensure the safe and accurate delivery of a prescribed radiation dose. This report deals with a comprehensive commissioning and ongoing quality assurance program specifically for treatment planning computers. Detailed guidelines are provided under the following topics: (a) computer program and system documentation and user training, (b) sources of uncertainties and suggested tolerances, (c) initial system checks, (d) repeated system checks, (e) quality assurance through manual procedures, and in vivo dosimetry, and (f) some additional considerations including administration and manpower requirements. In the context of commercial computerized treatment planning systems, uncertainty estimates and achievable criteria of acceptability are presented for: (a) external photon beams, (b) electron beams, (c) brachytherapy, and (d) treatment machine setting calculations. Although these criteria of acceptability appear large, they approach the limit achievable with most of today's treatment planning systems. However, developers of new or improved dose calculation algorithms should strive for the goal recommended by the International Commission of Radiation Units and Measurements of 2% in relative dose accuracy in low dose gradients or 2 mm spatial accuracy in regions with high dose gradients. For brachytherapy, the aim should be 3% accuracy in dose at distances of 0.5 cm or more at any point for any radiation source. Details are provided for initial commissioning tests and follow-up reproducibility tests. The final quality assurance for each patient is to perform an independent manual check of at least one point in the dose distributions, as well as the machine setting calculation. As a check of the overall treatment planning process, in vivo dosimetry should be performed on a select number of patients.

Aspects of standardization in telepathology

Effective telepathology is only possible, if the partners are supplied by a broad variety of equipment connected by far-spread communication lines. These prerequisites can only be fulfilled if technical and medical standards are available obligate for all participants. The technical and medical aspects of those standards are described in general and include procedures and notations in pathology, standards of the image source, image sampling, clinical information, classification of diagnosis, communication channels, hard- and software equipment. New standards should only be developed for those not existing, or if the already existing ones are not appropriate. The standardization classes should allow flexible formats and be developed as "open modules" allowing "individual" peripheral work stations and progressive development in the future.

A computerized documentation system for cancer pain management units

A cancer pain management unit can benefit markedly from a well-planned documentation system for administrative and scientific purposes. This article presents the principles of such a computerized system based on relational data base programs. The described system has been used by the authors for the last seven years. The successful documentation of more than 1400 patients over treatment periods of up to 2 years has provided detailed administrative and scientific information.

The French communicable diseases computer network: a technical view

This paper describes an information system (IS) established in France in 1984 for the national surveillance of communicable diseases. This IS is based on a videotex server and a relational database management system. The videotex server is the IS front-end. It performs the following functions: interpersonal communications, synthetic information retrieval into an epidemiologic info-base and data entry owing to its specialized applications. The relational database management system allows the user to manage and consult an epidemiologic database updated in quasi-real time. Several specific tools have also been developed in order to enhance data representation and analysis and the decision support capabilities of the IS.

A program to facilitate cytotoxicity assay data reduction

A report of a program which performs the initial computational reduction of the raw data from a cytotoxicity assay and outputs the reduced data as an image of the arrangement of the assay(s) upon the microwell plate. The program accepts the raw data either as manual or diskette file input.

An optimal controller for an electric ventricular-assist device: theory, implementation, and testing

This paper addresses the development and testing of an optimal position feedback controller for the Penn State electric ventricular-assist device (EVAD). The control law is designed to minimize the expected value of the EVAD's power consumption for a targeted patient population. The closed-loop control law is implemented on an Intel 8096 microprocessor and in vitro test runs show that this controller improves the EVAD's efficiency by 15-21%, when compared with the performance of the currently used feedforward control scheme.

Resolving the eight key issues in network management strategic planning

No strategic plan for information systems or networks will be adequate without careful consideration of the pace, content, and direction of network management systems. Here are the eight key issues in strategic planning for network management and how to resolve them.