Computer-based Patient Record Research Articles

Section 2 Computer-based Patient Records

Section 2 Computer-based Patient Records

Changing the paradigm for Computer-based Patient Records

Changing the paradigm for Computer-based Patient Records

Clearing the way for a CPR.

While waiting for a universal computer-based patient record, many hospitals have already implemented one through their clinical information systems. Here's a review of the potential benefits.

IMPLEMENTING A COMPREHENSIVE COMPUTERIZED PATIENT RECORD Lessons for the Individual Practitioner and the Organization

The conversion from a paper medical record system to a computer-based patient record (CPR) system is a complex process. There are many factors to consider; advantages and disadvantages vary depending on the nature of a practice. This article introduces the reader to those issues that must be addressed in bringing information technology into office-based medical records. A number of software programs are available; however, introducing CPR into a practice is far more complex than just selecting a software vendor. The transition to CPR, even using off-the-shelf software, is at least a year-long project and, in most cases, takes several years. In the following discussion, computer terminology is kept at a minimum. Even someone who has never used a computer should be able to understand the principles discussed here. A very basic understanding of personal computers (PCs), however, will deepen the reader's understanding of certain technical aspects of this discussion. There is a growing appreciation for the advantages of CPR. Even 10 years ago the penetration of computers into medical record keeping was less than 1% for office-based practices. The decrease in the cost of computer power, combined with the increased demands for documentation, has fueled a growing interest in CPR. In 1992 the Computer-Based Record Institute 2 (CPRI) was formed to facilitate the implementation of computer-based patient records to improve health care quality, cost, and access. The first step in implementing CPR into an ophthalmology practice is to review the advantages and disadvantages of computer-based records. This step is more than a formality; understanding the advantages of adding CPR to your practice is the basis for all the decisions you will make. For example, perhaps you are considering using voice-recognition software in your practice. If your primary goal is to reduce overhead cost, then voice recognition may help a lot. If, on the other hand, your primary goal is to see more patients, voice recognition may actually slow you down. It is only by having a clear understanding of your goals that you will make the correct decisions about all the various options available in CPR. Determining the advantages and disadvantages of CPR in your practice can help to answer the first question, Should I implement CPR in my practice now?

Enhancing the expressiveness of structured reporting systems.

The overall goal of this research is to build a structured reporting system that reduces the cost, delays, and inconvenience associated with conventional dictation and speech recognition systems. We have implemented such a structured reporting system for radiology that replaces current dictation and transcription processes by allowing radiologists and other imaging professionals to select imaging findings from a medical lexicon. The system uses an imaging-specific information model, called a "description set,' to organize selected terms in a relational database. Unique features of the knowledge representation that enhance its expressiveness include its ability to codify uncertainty about an imaging observation and to represent explicitly the logical relationships among imaging findings. In addition, the system does not require the user to fill in "blanks' in a static text template. Instead, it allows entry of terms in arbitrary order and uses automated text-generation techniques to create a text report that referring physicians are accustomed to receiving. In parallel, the system also produces a multimedia report that the referring physician can use as a quick reference. Unlike the results of conventional dictation or speech recognition, each finding is coded in a relational database for later information processing. Thus, the structured report database can be used to index images by content, to provide real-time decision support, to enhance radiologists' performance, to conduct exploratory clinical research, and to transmit imaging report data to computer-based patient record systems.

The reliability and acceptability of telemedicine for patients with schizophrenia in Korea.

We conducted a pilot study to evaluate telemedicine for patients with schizophrenia. The telemedicine system was connected over the ordinary telephone network at 33 kbit/s. A computer-based patient record was used to view patient summaries and to allow nursing notes to be entered at the patient's home. Fifteen patients with schizophrenia were assessed over the telemedicine system and 15 patients were assessed face to face, using the Brief Psychiatric Rating Scale (BPRS). Our low-bandwidth telemedicine system appeared to be as reliable as higher-bandwidth ISDN systems. In addition, the patients' acceptance of the telemedicine interview, in terms of comfort, ease of self-expression, quality of interpersonal relationship and usefulness, was good in most cases. The only factors significantly affecting the patients' level of acceptance of their particular type of interview were the assessment type (i.e. whether the patient had had a telemedicine assessment or not) and their BPRS score. Since the system was of low cost and was easy to interface with a notebook computer, it could be used support other home-health nursing services.

The Vision for the Department of Defense's Computer-Based Patient Record

To meet the Department of Defense's clinical information management mission for the next century, a vision for the computer-based patient record (CPR) was needed. This article describes the generation of that vision as well as the resulting definition, characteristics, and essential functions of the Department's CPR.

Reducing the Paper Load: Computer-Based Patient Records

Physicians burdened with increasing paper work may find relief in computer-based patient records (CPR). CPRs may aid clinicians in the areas of billing, documentation, reporting, and data retrieval. Value-added features like decision support and event monitoring facilitate patient outcome, decrease health care costs and allow improved administration. The authors discuss obstacles in the use of computers in patient care with a focus on security, confidentiality, and Y2K.

Use of Computer-Based Patient Records in Dietetics Supervised Practice Programs

The move to computer-based patient records has been underway since 1991 when the Institute of Medicine (1) recommended adoption of this format as the standard for medical and all other records related to patient care. There is a body of literature about use of computer-based patient records by physicians and allied health professionals (2–10). However, the need for an electronic record format in the area of dietetics, and the experiences of dietitians who currently use this format, have been reported to a lesser extent (11–14). In 1997, Biesemeier and Chima (15) indicated that 15% of the dietitians they surveyed were documenting nutrition care in a computerized patient record. Technological, organizational, and behavioral barriers to the use of computer-based patient records by health professionals and solutions for overcoming these barriers have also been reported (16–22). Although this technology is the wave of the future, Gilmore et al (23) found that computer communication was among the competencies entry-level dietitians stated as least likely to be taught in their educational programs.

Representing nursing judgements in the electronic health record.

The naming of nursing phenomena and representing the phenomena in a standardized manner suitable for encoding in computer-based systems is a challenge for the nursing profession at the national and the international level. Considerable progress has been made in the development of classification systems for nursing practice. The focus of this article is on language systems developed to represent nursing judgements in computer-based systems, in particular the electronic health record. A review of two current systems and their proposed revisions (North American Nursing Diagnosis Association, NANDA, Taxonomies I and II, and the International Classification for Nursing Practice, ICNP, Alpha and Beta versions), according to the features suggested by the Computer-based Patient Record Institute (CPRI) for classification systems appropriate for implementation in computer-based systems, suggests that the evolving versions extend the current versions in terms of sufficient granularity (depth and level of detail) and atomic and compositional character. However, it is not clear from the literature available to date whether the characteristics that are most closely related to definition of a formal terminology (i.e. clear and non-redundant representation of concepts, syntax and grammar for logical constructions of compositional terms, synonyms and language independence) will be part of the evolving vocabularies. Formal terminology models and related tools have the potential to complement, extend, and refine existing nursing classification systems.

CIS6/413: Design of a Computer-Based Patient Record System (ARISTOPHANES) for Medical Departments: Implementation for Surgery Wards

IntroductionToday, the demand for computer-based patient records to improve the quality of patient care and to reduce costs in health services is generally recognized. The new electronic patient record system (ARISTOPHANES) is based on a self-developed relational data model with a star-shaped topology. An hierarchical structure has been chosen for the user interface. ARISTOPHANES has been developed for use in clinical workstations taking into account varied requirements, user acceptance, and future extension.MethodsFor the design of the electronic patient records was used the software "Oracle Forms 5.0". An Oracle database has been generated and loaded with test data. The designed forms are currently being implemented using "SQL*Plus 8.0" by Oracle.ResultsWe used a self-developed star-shaped relational data model, which is highly flexible with regard to the modification and extension of the data structure. The design of the electronic patient records has taken into account the varied demands of the medical partners in order to guarantee user acceptance. The hierarchical topology that has been chosen renders the designed electronic patient record system flexible and efficient, such that further departments and regulatory changes can be integrated within a short time. General functions required by all departments are contained in the main menu. These include patient data, case details, medical documentation, care documentation, personnel details, and business partners. Specific functions are included at lower levels for the demands of the surgery departments, such as anaesthesia record, operation record, present status record.DiscussionThe complexity of user acceptance is reflected by (i) the different groups of users of Electronic Healthcare Record systems (physicians, nurses, managers, researchers) together with their various requirements, and (ii) the different contexts of use (e.g., support in normal or emergency situations, access for research, and mobile access). Commercial providers have developed electronic patient record systems, that often turn out to be too inflexible for the requirements of a university setting and need to be customized considerably. To ensure user acceptance, we analyzed the demands together with clinical partners from the surgery departments. It is expected that the ARISTOPHANES system will also be attractive to other medical departments in light of the overall advantages such as paperless documentation, reliable patient data transfer, improved settlement of accounts, and easing the burden on care personnel.

Section 2 Computer-based Patient Record

Section 2 Computer-based Patient Record

Developing a framework for worldwide image communication.

The increasing mobility of the population and frequent changes in healthcare coverage, in both the government and private sectors, require integration of medical records not only longitudinally, but also across a variety of healthcare providers. Early in 1998, the federal government decided to solve this problem by constructing a framework for access to medical records by all of the government's health care facilities, called the Government Computer-Based Patient Record (GCPR). The government consortium chose a proposal by Litton PRC, a partnership of 11 companies with complementary areas of expertise. The framework is based on open systems, which use publicly available standards, and includes a Master Patient Information Locator that allows access to medical information from remote facilities, based on creating a unique identifier for each and every individual patient. PRC will use the Digital Imaging and Communications in Medicine (DICOM) imaging standard for radiology, supplemented by Health Level Seven (HL7).

Computer-Based Patient Records: Findings from the HIMSS Leadership Survey

Computer-Based Patient Records: Findings from the HIMSS Leadership Survey

Medication cost information in a computer-based patient record system. Impact on prescribing in a family medicine clinical practice.

Medications account for 8% of national health care expenditures, and prescription drugs are a focus of cost containment measures. Physicians have limited knowledge about drug costs, and no method of providing this information has demonstrated sustained cost reductions. To determine the impact of cost information in a computer-based patient record system on prescribing by family physicians. A yearlong, controlled clinical trial was conducted at the Family Medicine Center, Medical University of South Carolina, Charleston, a group practice staffed by attending physicians and residents. Prescription cost information was included in the computer-based patient record system used at the center. During a 6-month period, cost information was not displayed; during the subsequent 6-month intervention period, costs were displayed at the time of prescribing. An intention-to-treat analysis was used to compare prescription costs between the control and intervention periods for all medications prescribed, and stratified analyses for several medication and physician factors were performed. A total of 22,883 prescriptions were written during the 1-year study period. The mean +/- SD cost per prescription in the control period was $21.83 +/- $27.00 (range, $0.01-$510.00), and in the intervention period was $22.03 +/- $28.12 (range, $0.01-$435.96) (P = .61, Student t test). Increases in mean prescription cost and proportion of total costs were identified in 4 medication classes: antibiotics, cardiovascular agents, headache therapies, and antithrombotic agents. Decreases in mean prescription cost and proportion of total costs were identified in 5 medication classes: nonsteroidal anti-inflammatory drugs, histamine type 2-receptor antagonists and proton pump inhibitors, ophthalmic preparations, vaginal preparations, and otic preparations. In this setting, the provision of real-time computerized drug cost information did not affect overall prescription drug costs to patients, although differences in individual medication classes were observed. The negative results of this study may reflect confounding due to the use of historical controls, suboptimal timing of the intervention in the prescribing process, susceptibility bias at the study site, or the insensitivity of prescribing habits to cost information.

UMLS-based access to CPR data

This paper describes the results of a project that explores the use the Unified Medical Language System (UMLS) for knowledge-driven tasks, such as browsing a computer-based patient record (CPR). The project consisted of a number of steps: the mapping between CPR terms and UMLS concepts, the development of an algorithm that explores the CPR data using this mapping and the implementation of a first prototype browser that visualizes ‘found’ data. A second task addressed in this project has been the direct access to online medical literature (MEDLINE) using the UMLS concepts found in the CPR data. In this project, we used a preliminary version of the Open Records for Patient Care (ORCA) CPR that consisted only of the history and physical examination data of patient suffering from heart failure.

ORCA: The Versatile CPR

The introduction of computer-based patient records (CPRs) that fully replace paper records proves especially difficult in specialized care, despite the potential advantages of CPRs for patient care and research. Improved data legibility, availability, sharing of records, and decision support may directly benefit patient care. Barriers to the introduction of CPR applications at institutions may be caused by lack of infrastructure, or by financial or organizational issues. To have clinicians interactively enter data at the point of care is still a big challenge. This paper presents an overview of ORCA (Open Record of CAre): a generic CPR, designed for integration with existing systems, presentation of multi-media patient data, and the collection of structured data, directly by clinicians. ORCA can easily be tailored to the needs of a variety of medical specialists without the need for changes to its data model, functionality, or interface. The paper describes the essence of the architecture of ORCA and the user benefits with emphasis on the support of structured data entry.

R. S. Dick, E. B. Steen and D. E. Dether (EDS), The Computer‐based patient record: an essential technology for health care. Revised edition. Washington DC: Institute of Medicine, National Academy Press, 1997. ISBN 0‐309‐05532‐6, 234 pages. £28.95.

The International Journal of Health Planning and ManagementVolume 14, Issue 1 p. 74-75 Book Review R. S. Dick, E. B. Steen and D. E. Dether (EDS), The Computer-based patient record: an essential technology for health care. Revised edition. Washington DC: Institute of Medicine, National Academy Press, 1997. ISBN 0-309-05532-6, 234 pages. £28.95. Ruth Roberts, Corresponding Author Ruth Roberts School of Postgraduate Studies in Medical and Health Care, Maes-y-Gwernen Hall, Morriston Hospital, Swansea, Wales SA6 6NL, UKSchool of Postgraduate Studies in Medical and Health Care, Maes-y-Gwernen Hall, Morriston Hospital, Swansea, Wales SA6 6NL, UK.Search for more papers by this author Ruth Roberts, Corresponding Author Ruth Roberts School of Postgraduate Studies in Medical and Health Care, Maes-y-Gwernen Hall, Morriston Hospital, Swansea, Wales SA6 6NL, UKSchool of Postgraduate Studies in Medical and Health Care, Maes-y-Gwernen Hall, Morriston Hospital, Swansea, Wales SA6 6NL, UK.Search for more papers by this author First published: 04 March 1999 https://doi.org/10.1002/(SICI)1099-1751(199901/03)14:1<74::AID-HPM536>3.0.CO;2-MCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume14, Issue1January/March 1999Pages 74-75 RelatedInformation

UMLS-based access to CPR data.

This paper describes the results of a project that explores the use the Unified Medical Language System (UMLS) for knowledge-driven tasks, such as browsing a computer-based patient record (CPR). The project consisted of a number of steps: the mapping between CPR terms and UMLS concepts, the development of an algorithm that explores the CPR data using this mapping, and the implementation of a first prototype browser that visualizes "found" data. A second task addressed in this project has been the direct access to online medical literature (MEDLINE) using the UMLS concepts found in the CPR data. In this project, we used a preliminary version of the Open Records for Patient Care (ORCA) CPR that consisted only of the history and physical examination data of patient suffering from heart failure.

A framework for comprehensive health terminology systems in the United States: development guidelines, criteria for selection, and public policy implications. ANSI Healthcare Informatics Standards Board Vocabulary Working Group and the Computer-Based Patient Records Institute Working Group on Codes and Structures.

Health care in the United States has become an information-intensive industry, yet electronic health records represent patient data inconsistently for lack of clinical data standards. Classifications that have achieved common acceptance, such as the ICD-9-CM or ICD, aggregate heterogeneous patients into broad categories, which preclude their practical use in decision support, development of refined guidelines, or detailed comparison of patient outcomes or benchmarks. This document proposes a framework for the integration and maturation of clinical terminologies that would have practical applications in patient care, process management, outcome analysis, and decision support. Arising from the two working groups within the standards community--the ANSI (American National Standards Institute) Healthcare Informatics Standards Board Working Group and the Computer-based Patient Records Institute Working Group on Codes and Structures--it outlines policies regarding 1) functional characteristics of practical terminologies, 2) terminology models that can broaden their applications and contribute to their sustainability, 3) maintenance attributes that will enable terminologies to keep pace with rapidly changing health care knowledge and process, and 4) administrative issues that would facilitate their accessibility, adoption, and application to improve the quality and efficiency of American health care.