Computer-based Patient Record Research Articles

Health care reform—the consolation prize

AORN JournalVolume 65, Issue 5 p. 974-977 Department Health care reform—the consolation prize Candace L. Romig, Candace L. Romig Health policy analyst/Legislative coordinatorSearch for more papers by this author Candace L. Romig, Candace L. Romig Health policy analyst/Legislative coordinatorSearch for more papers by this author First published: 01 May 1997 https://doi.org/10.1016/S0001-2092(06)62981-5 If you have questions about PL 104–191, the government agencies effecting its implementation, or the Computer-Based Patient Record Institute, please contact Leslie Nicoll, RN, MBA, PhD, or Candoce Roming at AORN Headquarters. Dr Nicoll is codirector of AORN's perioperative nursing research program and AORN's official liaison to the Computer-Based Patient Record Institute. Candace Romig also may be contacted through e-mail atcromig@aorn.org. Read the full textAboutPDF 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. Volume65, Issue5May 1997Pages 974-977 RelatedInformation

Organizational factors that influence information technology diffusion in academic health sciences centers.

To identify the organizational factors which influence the diffusion of end user online literature searching, the computer-based patient record, and electronic mail systems in academic health sciences centers in the United States. A total of 1335 individuals working in informatics and library areas at 67 academic health sciences centers in the U.S. were surveyed. Multivariate techniques were used to evaluate the relationship between the set of six organizational factors and two measures of innovation diffusion. A Guttman-like scale was developed to measure infusion, or depth or sophistication, of each of the three innovations at each institution. Diffusion was measured by a question previously developed for another study. Six independent variables were measured via five formerly developed scales and one new one. The overall response rate was 41%. The set of organizational variables produced significant results in the diffusion of each of the three innovations, with individual variables influencing diffusion to varying degrees. The same set produced significant results in relation to infusion only for online searching. There was little or no correlation between infusion and diffusion for each innovation. Organizational attributes are important predictors for diffusion of information technology innovations. Individual variables differ in their effect on each innovation. The set of attributes seems less able to predict infusion. It is recommended that both infusion and diffusion be measured in future studies because there is little relation between them. It is further recommended that individuals charged with implementing information technology in the health sciences receive training in managing organizational issues.

Achieving Effective Medical Information Security: Understanding the Culture

Cet article decrit, du point de vue d'un clinicien generaliste, une solution pour l'implementation de dossiers concernant les patients en toute securite, ainsi que les strategies mises en place pour cette implementation. Cet article souligne donc l'importance de la securite pour la confidentialite de ces dossiers, mais aussi la difficulte de mettre en place un systeme de protection de l'information sur

Trends in health information systems technology.

Major trends in health information systems technology are described. The new paradigm for information systems is integrated, patient-centered computing. The computer system and files are designed around information-capture needs along the continuum of care instead of around charge capture or inventory. The need for patient information in the future will not be limited to the health system but will extend to work sites and homes. Health systems will move to full client-server architecture, higher-speed data transmission, and greater network capacity. Computing standards will be instituted nationwide. With changes in the economics of health care, physician order-entry systems are inevitable. Many health systems and system vendors are making progress in achieving the computer-based patient record (CPR); health systems will require the CPR if they are to be truly integrated. Trends in health care and health care information technology will require that pharmacists innovate and adapt as never before.

Health Status Measurement in Computer-Based Patient Record Systems

As requests for information about quality of health care have increased, purchasers of computer-based patient record (CPR) systems are demanding information regarding the manner in which these systems can assist in measuring health care quality. The type of information requested by purchasers of health care, accrediting agencies, and consumer groups is shifting toward more complex measures of health status. Both provider and patient perceptions of health status are relevant in measuring the impact of health care interventions. Standardized coding and classification systems and standardized health status measurement instruments each offer utility in capturing and representing health status in CPR systems.

Health Status Measurement in Computer-Based Patient Record Systems

As requests for information about quality of health care have increased, purchasers of computer-based patient record (CPR) systems are demanding information regarding the manner in which these systems can assist in measuring health care quality. The type of information requested by purchasers of health care, accrediting agencies, and consumer groups is shifting toward more complex measures of health status. Both provider and patient perceptions of health status are relevant in measuring the impact of health care interventions. Standardized coding and classification systems and standardized health status measurement instruments each offer utility in capturing and representing health status in CPR systems.

Health Status Measurement in Computer-Based Patient Record Systems

As requests for information about quality of health care have increased, purchasers of computer-based patient record (CPR) systems are demanding information regarding the manner in which these systems can assist in measuring health care quality. The type of information requested by purchasers of health care, accrediting agencies, and consumer groups is shifting toward more complex measures of health status. Both provider and patient perceptions of health status are relevant in measuring the impact of health care interventions. Standardized coding and classification systems and standardized health status measurement instruments each offer utility in capturing and representing health status in CPR systems.

Computer-based Patient Records

Computer-based Patient Records

Section 2: Computer-based Patient Records

Section 2: Computer-based Patient Records

The computer-based record: patient moving from concept toward reality

In 1991 the Institute of Medicine issued a report on improving patient records which has proven to be a landmark for the many individuals and institutions involved in the development of computer-based patient records (CPRs). The report called Computer-based Patient Records: An Essential Technology for Health Care, recommended that CPRs become the primary form for patient records, and urged widespread implementation of CPRs within a decade. It also provides a framework for reviewing the current status of CPRs. In reviewing progress that has been made toward CPRs since the Institute of Medicine (IOM) report was released, it is useful to look beyond the IOM report's major focus on efforts in the USA and include international activities related to CPR development and implementation. Looking forward, CPR efforts are likely to be expedited through greater collaboration.

The core of computer based patient records in family practice: episodes of care classified with ICPC

A central element in the definition of primary care is that primary care clinicians address the large majority of personal health care needs of their patients. As a consequence, they should document data on these health care needs reliably and continuously. To establish whether this occurs, the episode of care is the most appropriate unit of assessment: a health problem from its first encounter with a health care provider until the completion of the last encounter for it. An episode of care is distinguished from episodes of disease and of illness. The episode of care as an epidemiological concept for the calculation of rates has evolved into a central element of a computer based record. Episode oriented data classified with the International Classification of Primary Care (ICPC), and specified with ICD-10 as a nomenclature are especially suitable as the core of a generic patient record in family practice. ICPC has been available to the family medicine community for well over a decade as the main ordering principle of its domain. The basic structure of an encounter (within the string of encounters which together form an episode of care) distinguishes reasons for encounter, diagnoses and diagnostic and therapeutic interventions. In this article, a more refined structure of encounters is proposed for a more precise documentation of episodes of care in a computer based patient record. The conversion structure between ICPC and ICD-10 allows both a high level of specificity in the patient's problem list and optimal communication with specialists who contribute to the episodes of care for which the documentation is the primary care provider's responsibility.

Physicians' Guide to the Internet

As stated in the preface, Physicians' Guide to the Internet is offered to help break down the barriers that face the health community in taking advantage of the Internet information explosion. The author is well known in biomedical Internet circles. Since 1990, he has voluntarily organized health-related Internet resources into what is commonly called the Hancock List. In addition, he manages e-mail-based discussion lists focusing on computerized patient records (CPRI-L, the Computer-Based Patient Records Institute List) and online health resources (HMATRIX-L). To help the uninitiated, the book opens with 20 pages of Internet essentials. Necessary computer hardware, software, and means of Internet access are fundamentally described, as are various Internet components (eg, electronic mail, telnet, and gopher). This is followed by listings for approximately 500 Internet resources drawn from the much larger Hancock List. Encompassing 80% of the book's content, the resources are organized into broad categories, such as diseases/disorders,

A Poor Precedent

The single greatest impediment to the successful leveraging of computer-based patient records (CPRs) is the difficulty of creating and maintaining comparable patient descriptions. Specifically, it will be hard to justify the investment required to deploy CPRs widely if the patient descriptions they store are not comparable across successive releases of controlled health-care vocabularies. Thus, it is necessary to solve the controlled health-care vocabulary update problem for CPRs before the comparability of patient descriptions can be sustained. What may seem to be a narrow technical problem of interest only to maintainers of health-care enterprise systems is, instead, a central problem of medical informatics. Cimino's "Formal descriptions and adaptive mechanisms for changes in controlled medical vocabularies" describes a classification of the changes appearing in the 1994 Edition of the International Classification of Diseases (ICD-9-CM). His paper describes the conversion of differences detected between the 1993 and 1994 releases of ICD-9-CM and a conversion of the elements of the classification into the required formal changes to the Medical Entities Dictionary (MED), part of the CPR in use at Columbia Presbyterian Medical Center. Because the process of detecting differences begins with an empirical analysis of the ASCII representations of the 1993 and 1994 releases of ICD-9-CM, it is impossible for a computer program to infer the intent of the changes that caused the differences; instead, a content expert must infer the intent and then update the MED accordingly. A typical task is to infer whether a change in naming also reflects a change in the meaning named. While Cimino's methods and their execution are exemplary in every respect, they nevertheless constitute a kind of "reverse engineering"-an ad hoc attempt to infer intent from details. Reverse engineering of changes to controlled medical vocabularies is a poor precedent. Such methods should be viewed as necessary short-term expedients only, and all parties concerned should work toward an incremental plan by which the intent of changes to controlled health-care vocabularies can be made both explicit and machine processible. Only then can the comparability of patient descriptions be sustained.

Toward an Evaluation of an Integrated Clinical Imaging System: Identifying Clinical Benefits

Integrated clinical imaging systems can provide the foundation for future computer-based patient record systems as recommended by the Institute of Medicine. However, documenting the benefits of such systems is difficult. This paper reports an evaluation of a clinical imaging system that is integrated with an on-line electronic patient record. The evaluation used interviews and observations to identify what physicians thought were the benefits of this system. Reported benefits may be classified into patient care benefits, educational benefits, and productivity and cost-reduction benefits Physicians said that the imaging system provided patient care benefits by: improving clinical communication and decision making, making care more patient-based, reducing the number of procedures and patient risks, and improving record keeping. Educational benefits they reported included: improving communication, providing broad "real" experience, and improving supervision. These benefits may be reflected in increased productivity and cost reduction by increasing time savings, reducing clerical work, improving morale, and reducing the costs of care. The approach described in this study was valuable in identifying potential benefits of a clinical information system. The findings point the way to realization of benefits for other systems, and, ultimately, for computer-based patient records.

The content coverage of clinical classifications. For The Computer-Based Patient Record Institute's Work Group on Codes & Structures.

Patient conditions and events are the core of patient record content. Computer-based records will require standard vocabularies to represent these data consistently, thereby facilitating clinical decision support, research, and efficient care delivery. To address whether existing major coding systems can serve this function, the authors evaluated major clinical classifications for their content coverage. Clinical text from four medical centers was sampled from inpatient and outpatient settings. The resultant corpus of 14,247 words was parsed into 3,061 distinct concepts. These concepts were grouped into Diagnoses, Modifiers, Findings, Treatments and Procedures, and Other. Each concept was coded into ICD-9-CM, ICD-10, CPT, SNOMED III, Read V2, UMLS 1.3, and NANDA; a secondary reviewer ensured consistency. While coding, the information was scored: 0 = no match, 1 = fair match, 2 = complete match. ICD-9-CM had an overall mean score of 0.77 out of 2; its highest subscore was 1.61 for Diagnoses. ICD-10 scored 1.60 for Diagnoses, and 0.62 overall. The overall score of ICD-9-CM augmented by CPT was not materially improved at 0.82. The SNOMED International system demonstrated the highest score in every category, including Diagnoses (1.90), and had an overall score of 1.74. No classification captured all concepts, although SNOMED did notably the most complete job. The systems in major use in the United States, ICD-9-CM and CPT, fail to capture substantial clinical content. ICD-10 does not perform better than ICD-9-CM. The major clinical classifications in use today incompletely cover the clinical content of patient records; thus analytic conclusions that depend on these systems may be suspect.

The use of multimedia computer-based patient records in ambulatory care.

The use of a multimedia computer-based patient record (CPR) within ambulatory care is a topic that has not achieved widespread understanding or acceptance. However, if the topic is divided into its parts, multimedia and computer-based patient record, it reflects both highly recognizable and desirable goals that most health care organizations are undertaking. Multimedia technology is quickly maturing. In addition, the goal of attaining a CPR is of primary interest to most health care organizations. It is inevitable that these two technologies will eventually become synergistic. This article presents the case for a multimedia ambulatory CPR and describes one example of this happy marriage.

The International Classification of Primary Care (ICPC): new applications in research and computer-based patient records in family practice.

The international Classification of Primary Care (ICPC) has now been available to the family medicine community for a decade as the main ordering principle of its domain. Research data and practical experiences with ICPC, as well as the development of new concepts in family medicine, have resulted in new applications. The structure of episodes of care to be included in a computer-based patient record has been further developed and refined. ICPC as the ordering principle of patient data is now available in 19 languages. Its conversion structure with the International Classification of Diseases (ICD-10) allows the highest possible level of specificity in a patient's problem list necessary in patient care, while the compatibility of the ICPC drug codes with the Anatomic Therapeutic Chemical Classification Index allows the systematic inclusion of data on prescription.

DIABCARD--an application of a portable medical record for persons with diabetes.

The medical record is central to the management of patients. For people with a chronic disease their many records, held at different locations, often pose a problem. Electronic patient records have been discussed for a long time. This article reports on the paradigm of a portable computer-based patient record on a smart card. It describes the development of the chip card based medical information system for chronic diseases in ambulatory and hospital care. The system has been implemented, tested and evaluated. DIABCARD could demonstrate that for a speciality patient record the capacity and functionality of the existing card is sufficient. Finally, the perspectives of chip cards in health care are discussed.

The Computer-Based Patient Record: The Role of the Hospital Epidemiologist

The Computer-Based Patient Record: The Role of the Hospital Epidemiologist

The Computer-Based Patient Record: The Role of the Hospital Epidemiologist

Despite advances in computers and software for data analysis, hospital epidemiologists still must use manual methods for data collection. To automate infection control surveillance fully, healthcare institutions need computerized medical records; however, very few institutions currently have such a system. Healthcare institutions appreciate the need for automation, but frequently do not see a clear path to the desired outcome. In this article, we outline the important issues that hospital epidemiologists must understand if they wish to help their institutions to computerize their medical records.