Computerized Patient Information Systems Research Articles

Ethnic difference of clinical vertebral fracture risk

SummaryVertebral fractures are the most common osteoporotic fractures. Data on the vertebral fracture risk in Asia remain sparse. This study observed that Hong Kong Chinese and Japanese populations have a less dramatic increase in hip fracture rates associated with age than Caucasians, but the vertebral fracture rates were higher, resulting in a high vertebral-to-hip fracture ratio. As a result, estimation of the absolute fracture risk for Asians may need to be readjusted for the higher clinical vertebral fracture rate.IntroductionVertebral fractures are the most common osteoporotic fractures. Data on the vertebral fracture risk in Asia remain sparse. The aim of this study was to report the incidence of clinical vertebral fractures among the Chinese and to compare the vertebral-to-hip fracture risk to other ethnic groups.MethodsFour thousand, three hundred eighty-six community-dwelling Southern Chinese subjects (2,302 women and 1,810 men) aged 50 or above were recruited in the Hong Kong Osteoporosis Study since 1995. Baseline demographic characteristics and medical history were obtained. Subjects were followed annually for fracture outcomes with a structured questionnaire and verified by the computerized patient information system of the Hospital Authority of the Hong Kong Government. Only non-traumatic incident hip fractures and clinical vertebral fractures that received medical attention were included in the analysis. The incidence rates of clinical vertebral fractures and hip fractures were determined and compared to the published data of Swedish Caucasian and Japanese populations.ResultsThe mean age at baseline was 62 ± 8.2 years for women and 68 ± 10.3 years for men. The average duration of follow-up was 4.0 ± 2.8 (range, 1 to 14) years for a total of 14,733 person-years for the whole cohort. The incidence rate for vertebral fracture was 194/100,000 person-years in men and 508/100,000 person-years in women, respectively. For subjects above the age of 65, the clinical vertebral fracture and hip fracture rates were 299/100,000 and 332/100,000 person-years, respectively, in men, and 594/100,000 and 379/100,000 person-years, respectively, in women. Hong Kong Chinese and Japanese populations have a less dramatic increase in hip fracture rates associated with age than Caucasians. At the age of 65 or above, the hip fracture rates for Asian (Hong Kong Chinese and Japanese) men and women were less than half of that in Caucasians, but the vertebral fracture rate was higher in Asians, resulting in a high vertebral-to-hip fracture ratio.ConclusionsThe incidences of vertebral and hip fractures, as well as the vertebral-to-hip fracture ratios vary in Asians and Caucasians. Estimation of the absolute fracture risk for Asians may need to be readjusted for the higher clinical vertebral fracture rate.

Commentary on Darbyshire P (2004) ‘Rage against the machine?: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information. Journal of Clinical Nursing 13, 17–25

Commentary on Darbyshire P (2004) ‘Rage against the machine?: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information. <i>Journal of Clinical Nursing</i> 13, 17–25

To DeZarn’s commentary on Darbyshire P (2004) ‘Rage against the machine?’: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information.

To DeZarn’s commentary on Darbyshire P (2004) ‘Rage against the machine?’: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information.

Discharge planning and patient satisfaction in an emergency short‐stay unit

To determine the adequacy of discharge planning from an emergency short-stay unit (ESSU), and patient knowledge of and satisfaction with the ESSU. Prospective follow up of patients discharged from an ESSU using patient surveys and a computerized patient information system, with descriptive and comparative data analysis. Eighty-five per cent of respondents stated that they received adequate discharge instruction, and 89% that they benefited from their ESSU admission. However, 29% of patients made unscheduled visits to another medical practitioner post discharge and 9% were readmitted to hospital for the same problem with which they were discharged from the ESSU. Patient satisfaction with all aspects of care in the ESSU was high. Most patients discharged from an ESSU are provided with adequate discharge instruction, but a sizeable proportion require subsequent medical care for the same problem after discharge. Patient satisfaction with all aspects of care in an ESSU is high.

Darbyshire P (2004) ‘Rage against the machine?’: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information. Journal of Clinical Nursing 13, 17–25

This is a response to ‘‘‘Rage against the machine?’’: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information’ (Darbyshire 2004), a study published in this journal. The study determined nurses and midwives’ perceptions and experiences using a computerized patient information system (CPIS). The consensus of the nurses was that the CPIS was cumbersome, did not reflect their practice, data entry was a manager's responsibility and did not yield or retrieve useful data to measure outcomes. It occurred to me while reading this study that these nurses were exhibiting a great deal of resistance to using the new system and that, perhaps, effective change management was not in place to facilitate the introduction and implementation of this new system. Lorenzi and Riley (2000) offer many reasons for the failure of an information system. For a system implementation to be successful, there must be effective change management. Based on the work of Lorenzi and Riley, I would like to discuss three of their reasons that I consider the foundation for effective change management: communication, organizational aspects, and leadership. Change management is the responsibility of all parties affected by the new system. Communication must be ingoing and outgoing. For the staff, it includes communicating problems with the system, offering suggestions for improvement and communicating exactly what is desired of the system (i.e. record keeping, charting, data analysis, outcomes measurement, etc.). Change managers also have a responsibility to listen to identified problems, provide positive feedback regarding suggestions and address or implement suggestions made by the staff. Without active communication, staff may not be prepared for the new system. Organizational aspects are the second layer of the foundation. Organizations bear a responsibility to benchmark existing research and use that information to make informed judgments as to the needs of the facility (Lorenzi & Riley 2000). Many successful systems are analyzing data and using the information to measure patient outcomes (Nelson et al. 2003). Identifying a clear vision as to where this information system is going to take the facility and how it will improve practice is essential. Implementing a system without knowing what the goals are for the system in relation to the goals of the organization is only going to lead to inevitable failure of the system. Leadership is the third layer of the foundation. Leaders must take an active role to ensure complete ownership of the system before implementation (Lorenzi & Riley 2000). If the nurses do not feel like they have any input and feel like they do not own the system, resistance to the system will be much higher. Leaders must ‘know how to manage the organizational impact of information systems’ in order to ‘sharply reduce the behavioral resistance to change’ (Lorenzi & Riley 2000, p. 117). In doing this, leaders will facilitate a smoother and faster implementation process. In summary, I would like to suggest that closer attention to these three aspects of change might still yield a successful implementation. Failure does not have to be complete, unless nothing is done. By focusing more on some of these strategies, and using the literature to effect a change in culture, there is still hope that the CPIS can be a successful and useful tool for the organization, the nurses, and the patients.

Clinical Knowledge Management Using Computerized Patient Record Systems: Is the Current Infrastructure Adequate?

The proliferation of technology in health care, spurred by environmental factors encouraging the adoption of computerized patient records (CPRs), has led to a widely held perception of fully computerized patient information systems as the industry norm. To test the validity of this assumption, using data from a national survey of certified health information managers, we examined the CPR technology adoption rates reported by health information managers, assessing variation across practice settings, regions, and organizational types. Results show that significant nonadoption, and regional variation, exists in the implementation of CPRs. Overall, nonuniform diffusion of computerized health information technology was found, despite national mandates that promote and at times require uniform adoption. A significantly greater number of hospital-based patient records were computerized, compared to clinics and other practice settings. Managers were frequently found to maintain duplicate CPRs and paper-based patient record systems, even after the initial implementation period. Nonuniform regional CPR adoption and redundant paper-based systems were found to be a common practice in medical systems, due in part to cultural factors, mistrust of computerized data, and lack of technology training and knowledge.

Addition of Primary Care–Based Retinal Imaging Technology to an Existing Eye Care Professional Referral Program Increased the Rate of Surveillance and Treatment of Diabetic Retinopathy

Digital retinal imaging is a relatively new technology that can be used to assess patients for diabetic retinopathy. We evaluated the impact of adding a primary care-based retinal imaging technology to an existing eye care professional referral process on the rate of surveillance and treatment of diabetic retinopathy in a large, well-defined patient population over a 5-year period. We performed systematic performance evaluations using a computerized patient information system and a comprehensive procedure log to describe annually the patient population, the number of patients with diabetes, and the proportion of patients with diabetes who received appropriate eye care services, including surveillance and laser treatment for diabetic retinopathy before and after implementation of a digital retinal imaging system at the Phoenix Indian Medical Center Primary Care Medical Clinic. The rate of annual retinal examinations increased from 50% (95% CI 44-56%) to 75% (70-80%; P < 0.000001), representing a 50% increase in the retinal examination rate. The rate of laser therapy increased from 19.6 per 1,000 patients with diabetes in 1999 to 29.5 per 1,000 in 2003 for a 51% increase in the laser treatment rate. Implementing retinal imaging technology in a primary care setting resulted in a significant increase in the rate of diabetic retinopathy surveillance and a proportional increase in the rate of laser treatment for diabetic retinopathy for a large patient population. Application of this technology in primary care settings holds the potential to extend sight-preserving care by increasing access to appropriate retinal care.

Outcome of ASA III patients undergoing day case surgery

Day case surgery is becoming more acceptable, even for patients with complex medical conditions. Current recommendations suggest that patients who are graded as American Society of Anaesthesiologists physical status (ASA) III may be suitable for this approach. There is only a small amount of published data available to support this. We present a retrospective review of ASA III patients who had undergone day surgical procedures in our unit. We carried out a retrospective case controlled review of 896 ASA III patients who had undergone day case procedures between January 1998 and June 2002 using the existing computerized patient information system. The system records admission rates, unplanned contact with healthcare services and post-operative complications in the first 24 h after discharge. We demonstrated no significant differences in unplanned admission rates, unplanned contact with health care services, or post-operative complications in the first 24 h after discharge between ASA III and ASA I or II patients. With good pre-assessment and adequate preparation ASA III patients can be treated safely in the day surgery setting.

‘Rage against the machine?’: nurses’ and midwives’ experiences of using Computerized Patient Information Systems for clinical information

Computerized Patient Information Systems (CPIS) are used increasingly in health care, yet few studies have asked clinicians to describe their experiences of using these systems and what they mean to their practice and patient care. The aim of this study was to explore clinical nurses' and midwives' perceptions and understandings of computerized information systems in everyday practice. The objective was to provide a detailed and faithful account of clinicians' experiences of using such systems. A qualitative design was used, based upon interpretive phenomenology. A total of 13 focus groups involving 53 practitioners was conducted in hospitals across five Australian states with nurses and midwives from a wide range of practice settings. The participants ranged from Level 1 RNs to Clinical Nurse Consultants and nurses with an IT project management role. This study focuses specifically on clinicians' experiences of using CPIS to manage clinical information. Clinicians' experiences were characterized by digital disappointment rather than electronic efficiencies. Clinicians reported generally that computerization had neither enhanced their clinical practice nor patient care, nor had it improved patient outcomes. Participants' experiences were predominantly negative and mostly critical of CPIS and their: perceived inability to capture 'real nursing', difficulty in use, incompatibilities, non-responsiveness and irrelevance to patient care and meaningful clinical outcomes. Technological 'solutions' to health care problems are endlessly seductive and easily entrance policy and decision makers. Computerization will continue to impact upon clinical practice and cannot be wished away. Today's computerized systems may have been developed with scant regard for clinician end-users. A crucial issue facing everyone in health informatics is how point-of-care systems can be developed in ways that involve clinicians meaningfully and which recognize and respond to the complexity and subtlety of the world of nursing and midwifery practice.

Bar Codes Coming To Medications Near You

Back to table of contents Previous article Next article Government NewsFull AccessBar Codes Coming To Medications Near YouChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:4 Apr 2003https://doi.org/10.1176/pn.38.7.0017aMedication errors are among the most common preventable mistakes in health care, according to a 1999 Institute of Medicine report. Experts have estimated that more than one million serious errors related to medication occur annually in hospitals alone.In an effort to reduce medication errors, the Food and Drug Administration (FDA) proposed two new rules last month as part of the agency’s strategic initiative to curb adverse events related to the products it regulates, according to an HHS press release.Tommy Thompson, secretary of Health and Human Services, announced the proposed rules last month. “These proposals are key steps in reducing medication problems through state-of-the-art technology,” said Thompson in the press release.The first rule would require bar codes on all prescription drugs, over-the-counter drugs packaged for hospital use, and vaccines.Thompson said that bar codes are already widely used in hospitals and other health care settings. The code would at minimum contain the National Drug Code (NDC) number, which identifies the drug, its strength, and dosage form.The FDA seeks comment on whether to add information such as lot number and expiration date.“The bar code, when used with a bar code scanner and computerized patient information systems, can prevent many medication errors, including giving the wrong drug to a patient, giving the drug to a patient who is allergic to it, giving the wrong dose or at the wrong time, or using the wrong route of administration, for example, by injection rather than by mouth,” said Thompson in the release.Thompson also announced a second FDA proposed rule designed to revamp the safety reporting requirements for medications. The rule would require companies that produce medications to submit to the FDA, within 15 calendar days, all reports they receive of actual and “near-miss” medication errors in the United Sates, according to the press release.One example of a “near-miss” is when a pharmacist selects the wrong medication because of a similar sounding name but catches the error prior to dispensing the medication.” The company would be required to report the potential error to the FDA if the pharmacist reported to the company what happened, according to the release.The proposal is also intended to promote uniform reporting standards among regulatory agencies in the United States and abroad.In addition, the proposal would require the submission of all suspected serious reactions for blood and blood products on the market.The proposal clarifies the kind of data needed in various safety reports to “lessen industry’s reporting burdens especially for certain suspected adverse reactions that are not serious. Companies can focus on producing high-quality reports for serious suspected adverse reactions, which potentially have a much greater public health impact,” said Thompson in the release.Fact sheets on both proposed rules and other related materials are posted on the FDA Web site at www.fda.gov/oc/initiatives/barcode-sadr. The public can submit comments on the proposed barcode rule until June 14 and on the safety reporting requirements until July 14 (90 and 120 days respectively from the March 14 publication in the Federal Register). Comments can be submitted online by accessing www.accessdata.fda.gov/scripts/oc/dockets/comments/commentdocket.cfm and clicking on “02N-0204—Bar Code Label Requirements for Human Drug Products” and “00N-1484—Safety Reporting Requirements for Human Drug and Biological Products.” Written comments on both proposed rules should be submitted by the same deadlines to the Dockets Management Branch (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Room 1061, Rockville, Md. 20852. ▪ ISSUES NewArchived

A computerized patient information system in a psychiatric hospital.

The authors describe a computerized patient information system at a psychiatric hospital in Israel. The system is a fully implemented work instrument that promotes clinical safety and cost containment. It allows interactive online consultations, clinical cross-checking, the production of computerized reports and schedules, fast response to laboratory results, and safer drug administration, all of which help improve the quality of care. Cost savings have been achieved in areas such as pharmacy and food distribution. The initial investment in the system was $400,000, which is expected to be recouped after 11.4 years.

Patient-centered Information Systems

Patient-centered information systems augment traditional approaches to health information management with specific functions designed to support patient participation in health care decision making and treatment activities. In addition to computer-based record systems and business management applications, patient-centered information systems must include functionality that support communication between clinician and patient, and that provide information and peer support in a timely fashion to the patient. Current progress in information systems demonstrates the existence and feasibility of consumer health informatics, patient access to computerized clinical records, and technical and organizational solutions to integrating computerized patient information systems. We are now proposing a model of patient-centered system that incorporates all those components, and provides a vision of the future.

Developing and implementing a clinical patient information system: a mental health perspective

The Hospitaller Order of St John of God is involved in providing health, educational and social services to people with mental health problems and learning difficulties in the Republic of Ireland. As part of its development plan the Order is engaging in the development of a comprehensive Mental Health Information System encompassing both community and hospital-based services. This system is being developed by local practitioners with the assistance of an external facilitator. The Order is also extensively involved in developing legal and ethical protocols to ensure the system meets all requirements of data protection legislation both nationally and at European levels. Within the overall system, the nursing component is the first part to have been operationalized and some initial evaluation of its efficacy has been conducted. The purpose of this paper is to present the work of the nursing department at St John of God Hospital, Dublin, in the development, implementation and initial evaluation of a computerized patient information system.

Summarizing clinical psychiatric data.

The authors propose a method of summarizing clinical data to serve patient care. The proposed one-page summary uses diverse visual presentations of data, including small graphs for ratings and drug dosages, time lines for clinic visits and hospital stays, and genograms for inherited illness, as well as a textual presentation of recent clinical notes. The summary depicts a patient's recent and lifetime clinical experience. It allows the viewer to assess relationships between interventions and outcomes for psychiatric and medical problems. Computerized patient information systems, which are increasingly being used, can present data in virtually any form. The authors hope to encourage mental health professionals to reshape psychiatric records.

The Contribution of the Computerized Patient Information System to Quality Control in a Psychiatric Unit

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Computerized patient information system in a psychiatric unit: Five-year experience

A computerized psychiatric clinical application based on CLICKS program was developed, consisting of a network of 34 personal computers, run by Novell Netware version 3.11. It includes all clinical records and covers most of the administrative needs of the department; it may be used also in the outpatient clinics. Implementation of the system followed the stages of planning, record structuring, record programming, practice and operation. The system is favorably accepted by the patients, has several important advantages over pencil and paper record keeping, and although it is slightly more time-consuming, it improves record quality and departmental efficiency.

Drug Information from Pharmacies

AIRAKSINEN, MARJA MSC*; AHONEN, RIITTA; LIE, PHARM*; ENLUND, HANNES PHD* Author Information

Nurses' professionalism in Canada: a labor process analysis.

This article draws on a body of research conducted by the author over the past ten years on the social organization of nursing work. It explores questions surrounding nurses' contemporary labor process control and its meaning for nurses' professionalization and proletarianization. Both are dynamic processes, changing as public administration of the Canadian health care system changes and as nurses are successful in winning more complete self-regulation. Nurses are currently being articulated more and more securely to dominant ideas of public sector management through textually mediated technologies. Nurses find new upwardly mobile careers and challenging, responsible, and more respected work. However, as the generation of objective information for professional accountability, cost-accounting, and managerial decision-making becomes unified in computerized patient information systems, producing and using such information becomes a central and determining core of everyday nursing work. It organizes nurses into a "managed" practice of patient care, contradictory for them in many ways. Outstanding among these contradictions is a new professionalized standpoint of cost-efficiency that subordinates nurses' traditional interests and grounding of their work in the standpoint of care.

Optimizing Dialogues for Manual Data Charting in Computerized PatientInformation Systems using Entropy Measures

Article Optimizing Dialogues for Manual Data Charting in Computerized PatientInformation Systems using Entropy Measures was published on January 1, 1992 in the journal Biomedical Engineering / Biomedizinische Technik (volume 37, issue s2).

A radiation oncology oriented anatomico-pathological classification system

In recent years, computerized patient information systems have become important tools in oncology research. The use of these systems requires that coding systems be developed for efficient data retrieval. This paper presents a coding system for anatomic sites and pathologies designed to support a radiation oncology patient information system. At the Mallinckrodt Institute of Radiology, Division of Radiation Oncology, information regarding demographic characteristics, clinical diagnosis, treatment and follow-up is collected on all patients and stored in the patient information system. The data is used to record the patient load, evaluate the feasibility of proposed clinical protocols, furnish information to outside organizations and to provide a research database for the radiation oncologists. The Mallinckrodt Institute of Radiology Oncology Coding System (MIROCS) was developed through a collaborative effort among radiation oncologists, a statistician and computer personnel. There are two broad categories of codes-in the system: anatomic sites and pathology. Within each category, the codes are hierarchical to reflect the detail available in the clinical diagnosis. The site codes are grouped primarily by anatomic region. The pathology section contains codes for malignant neoplasms, benign neoplasms, nonneoplastic diseases and complications of radiation therapy. Cross checks between the anatomic site and pathology codes have been developed to insure the quality of the data. The coding system presented in this paper provides the patient information system with the capability to 1) classify oncology patients by anatomic site and histology of the primary tumor and by sites of extension of disease, 2) classify patients seen in the Division for conditions other than neoplasia and 3) store and retrieve information about complications of radiation therapy.