Electronic Patient Data Research Articles

AsthmaCritic: issues in designing a noninquisitive critiquing system for daily practice

The noninquisitive critiquing system, AsthmaCritic, uses routinely recorded electronic patient data to select and analyze records of patients with asthma or chronic obstructive pulmonary disease (COPD). The system generates critiquing comments and adds these comments to the patient record. The system was developed by using and expanding an existing generic critiquing system. After a brief overview of the system, this report focuses on the authors' design choices in light of existing literature and the issues that underlie these design choices. Currently, AsthmaCritic is used by primary care physicians and is undergoing clinical evaluation.

Medical Record Database Efficient but Troubling

Medical Record Database Efficient but Troubling

Systematic review of scope and quality of electronic patient record data in primary care

Objective To systematically review measures of data quality in electronic patient records (EPRs) in primary care.Design Systematic review of English language publications, 1980-2001.Data sources Bibliographic searches of medical databases, specialist...

Assessment of the possibility to classify patients according to cholesterol guideline screening criteria using routinely recorded electronic patient record data

Computerised decision support systems (CDSS) can be categorised as either being inquisitive or non-inquisitive. The non-inquisitive system uses routinely entered electronic patient data, to generate patient specific feedback based on guidelines. The Dutch College of General Practitioners' (DCGP) cholesterol guideline classifies patients into risk groups, eligible for screening. The availability of sufficient routinely recorded electronic patient data to classify patients according to the DCGP cholesterol guideline is unknown. To assess whether it is possible to classify patients according to the screening criteria of the DCGP cholesterol guideline, using data routinely recorded by general practitioners. We analysed the DCGP cholesterol guideline to identify selection criteria for screening. These selection criteria were subsequently used to create a cohort of patient records eligible for screening in the Integrated Primary Care Information (IPCI) Database. We calculated incidence and prevalence of risk factors and selected patient records for active management according to the identified screening selection criteria. 145866 valid patient records were selected for classification. In the retrieved records 9741 (13.6%) males and 5756 (7.8%) females were identified for active management according to the selection criteria of the DCGP cholesterol guideline. The classification of patients into risk groups, eligible for screening, according to the criteria of the DCGP cholesterol guideline using routinely recorded electronic patient data is feasible. Care should be taken when using only diagnostic codes, as it gives higher than expected incidence and prevalence of risk factors. Based on these findings we are currently building Cholgate, a non-inquisitive decision support system for cholesterol management.

Availability and usability of data for medical practice assessment.

We analyzed availability and usability of the electronic patient data required for assessment of medical practice for a specific patient group. Case study in which physicians defined performance indicators and additional exploratory information. Data availability in the hospital information system was determined. Data usability was evaluated based on reason for recording, administrative procedures, and comparison with paper data. A 155 bed pediatric department in a public academic medical center. Pediatricians and children with suspected meningitis. Availability and usability of electronic patient data. Usability criteria were standardization, completeness, and accuracy. A total of 14 performance indicators were defined. Of 39 data items required for indicator quantification, 29 were available, and 19 were usable without manual handling. Completeness and accuracy of the registration of reason for admission and discharge diagnoses were insufficient, leading to problematic patient selection and complication detection. Time-points of patient events were inaccurate or not available. Data regarding outpatient diagnosis, signs and symptoms, indications for test ordering, and medication administration were missing. Test result reports were not adequately standardized. Based on electronic patient data, five out of 14 performance indicators could be quantified reliably, but only after patient selection problems were overcome. For exploratory information, 16 out of 25 required data items were available and 13 were usable. Availability and usability of electronic patient data are insufficient for physician-led and detailed assessment of medical practice for specific patient groups. Extended registration of the reason for admission will improve patient selection and assessment of diagnostic process.

One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia.

To evaluate the feasibility and safety of unmonitored local anesthesia (ULA) for elective open inguinal hernia repair, we made a prospective, consecutive data collection from 1000 operations on primary and recurrent hernias. Follow-up consisted of a questionnaire 1 mo after surgery and retrieval from the electronic patient data management system. In 921 ASA Group I and II and 79 ASA Group III and IV patients, the median age was 60 yr (range, 18-95 yr). ULA was converted to general anesthesia in 5 of 1000 cases, and 961 patients were discharged on the day of surgery after 95 min (median; interquartile range, 75-150); 29 patients had complications requiring surgical intervention. Within the first month, three patients died of causes unrelated to hernia surgery, and six had cardiovascular or respiratory events. The questionnaire was returned by 940 patients; 124 were dissatisfied with local anesthesia, day-case setup, or both, primarily because of intraoperative pain (n = 74; 7.8%). We conclude that open inguinal hernia repair can be conducted under ULA, regardless of comorbidity, with a small rate of deviation from day-case setup and minimal morbidity. It provides a safe alternative to other anesthetic techniques with an acceptable rate of satisfaction, but intraoperative pain relief needs improvement. Inguinal hernia repair can be safely performed under unmonitored local anesthesia with infrequent postoperative morbidity and acceptable satisfaction, but intraoperative pain may be a problem.

Feasibility of local infiltration anaesthesia for recurrent groin hernia repair.

To describe the the feasibility of and patients' satisfaction with day case repair of recurrent inguinal hernias under unmonitored local anaesthesia. Prospective study. Public service university hospital, Denmark. All patients with a reducible recurrent inguinal or femoral hernia unselectedly referred for elective repair during the 4-year period 1 September 1994 to 31 August 1998. Data were collected prospectively and consecutively from standardised, detailed files, a questionnaire 4 weeks postoperatively, and the Copenhagen Hospitals electronic patient data management system. Feasibility of local anaesthesia in the day case setting, patient satisfaction and morbidity. 215 consecutive operations for recurrent hernias were performed under unmonitored local anaesthesia. No conversion to general anaesthesia took place and no patients developed urinary retention. After 207 operations, the patients were discharged on the day of operation (96%), and the median time from the end of operation to discharge was 90 minutes (IQR 75-140). After 6 operations (3%), patients had complications that required surgical intervention. The 4-week questionnaire was returned after 208 operations (97%). 30 patients were dissatisfied, mainly because of intraoperative pain (17 patients, 8%). No mortality or cardiopulmonary morbidity was recorded during the first 30 days postoperatively. Open day-case repair of recurrent inguinal hernias can safely be conducted under unmonitored local anaesthesia with minimal morbidity. Intraoperative pain is the main topic that requires improvement.

Laparoscopic Italian experience with the Lap-Band.

An increasing number of surgeons with different levels of experience with laparoscopic surgery and open obesity surgery have started to perform laparoscopic implantation of the Lap-Band. An electronic patient data sheet was created and was mailed and e-mailed to all surgeons performing laparoscopic adjustable silicone gastric banding (LASGB) in Italy. Patients were recruited since January 1996. Data on 1,265 Lap-Band System operated patients (258 M/1,007 F; mean BMI 44.1, range 27.0-78.1; mean age 38, range 17-74 years) were collected from 23 surgeons performing this operation. Intra-operative mortality was absent. Post-operative mortality was 0.55% (7 patients) for causes not specifically related to LASGB implantation. The laparotomic conversion rate was 1.7% (22 patients). LASGB related complications occurred in 143 patients (11.3%). Pouch dilatation was diagnosed in 65 (5.2%), and 28 (2.2%) of these underwent re-operation. Band erosion was observed in 24 patients (1.9%). Port or connecting tube-port complications occurred in 54 patients (4.2%), 12 of whom required revision under general anesthesia. Follow-up was obtained at 6, 12, 18, 24, 36 and 48 months, and mean BMI was respectively 38.4, 35.1, 33.1, 30.2, 32.1 and 31.5. The percentage of patients observed at each follow-up was > 60%. There was no intra-operative mortality and no complication-related mortality, with acceptable weight loss. The LASGB operation is safe and effective, and deserves wider use for treatment of morbid obesity.

A tecnologia da informação na área hospitalar: um caso de implementação de um sistema de registro de pacientes

O sistema de registro médico computadorizado, ou seja, o desenvolvimento do prontuário eletrônico, é um dos temas mais discutidos nos dias de hoje na área de informática médica. Há afirmações de que a combinação de computadores, redes de telecomunicações, informações médicas e dados eletrônicos de pacientes pode melhorar a qualidade do cuidado de saúde, a produtividade dos profissionais de saúde, facilitar o acesso aos serviços disponíveis e reduzir custos administrativos associados à prestação de serviços. O registro de pacientes é considerado o módulo básico de um sistema computadorizado de gerenciamento de pacientes e, conseqüentemente, do prontuário eletrônico. Uma tentativa é feita, neste trabalho, para descrever a implementação de um sistema de registro de pacientes, denominado R-ATA (registro-admissão, transferência e alta), no Hospital Universitário Lauro Wanderley da Universidade Federal da Paraíba.

Patient Data Management Systems in Critical Care

Abstract. Electronic patient data management systems (PDMS) were clinically used for the first time in the 1970s. Their purpose was to automatically document vital parameters sampled by monitors and to replace handwritten medical files. Because of the continuous development of computer technology, however, demands on PDMS have increased immensely. PDMS are currently expected to assist clinicians at every level of intensive care, i.e., at the strategic level of physicians' orders and prescriptions, at the operational level, and at the administrative level. In 1994, a PDMS (CareVue; Agilent Technologies) was installed and further developed in the anesthesiologic intensive care unit of the university hospital in Tübingen. The goals of this article were to describe the current demands on PDMS, to communicate our experiences in implementing a PDMS, to list the costs of purchasing and maintaining the system, and to report on the acceptance among physicians and nursing personnel. This article may assist new users in planning for, purchasing, and implementing a PDMS.

E-Mail-Based Oral Medicine Consultation

A pilot study was undertaken to assess whether text-based electronic patient data transmission (e-mail) is a reliable source of information for the diagnostic decision-making process. The main objective was to determine if information contained within a transmitted text could be reliably used as basis for making general recommendations for diagnostic tests and follow-up or referral plans pertaining to a variety of oral mucosal pathologic conditions. The results suggest that face-to-face patient examination is more accurate in establishing a correct diagnosis for oral mucosal pathologies than transmitted descriptive patient data alone.

Building a flexible protocol information system with ‘ready for use’ web-technology

This paper describes how web technology, currently available, can be used to build a fast and easy flexible protocol information system. The interface design and functionalities of the system were based on experiences with a previous version of a protocol information system (ProtoVIEW). A wide range of diagnostic or therapeutic protocols could be retrieved and viewed with ProtoVIEW. The Web-based version contains all functionalities of the non web-based version plus several new functionalities. The web version contains an X-ray viewer and a great deal of interactivity such as validation of electronic patient data forms. The most important additional function is the context sensitive protocol support that may lead to improved protocol adherence. Finally, the web-based version can be accessed from any working place since patient data and protocols are stored centrally.

Postmarketing Surveillance Based on Electronic Patient Records: The IPCI Project

Researchers claim that data in electronic patient records can be used for a variety of purposes including individual patient care, management, and resource planning for scientific research. Our objective in the project Integrated Primary Care Information (IPCI) was to assess whether the electronic patient records of Dutch general practitioners contain sufficient data to perform studies in the area of postmarketing surveillance studies. We determined the data requirements for postmarketing surveillance studies, implemented additional software in the electronic patient records of the general practitioner, developed an organization to monitor the use of data, and performed validation studies to test the quality of the data. Analysis of the data requirements showed that additional software had to be installed to collect data that is not recorded in routine practice. To avoid having to obtain informed consent from each enrolled patient, we developed IPCI as a semianonymous system: both patients and participating general practitioners are anonymous for the researchers. Under specific circumstances, the researcher can contact indirectly (through a trusted third party) the physician that made the data available. Only the treating general practitioner is able to decode the identity of his patients. A Board of Supervisors predominantly consisting of participating general practitioners monitors the use of data. Validation studies show the data can be used for postmarketing surveillance. With additional software to collect data not normally recorded in routine practice, data from electronic patient record of general practitioners can be used for postmarketing surveillance.

Medicine and health on the Internet: the good, the bad, and the ugly.

COMBINING COMPUTERS, communication networks, online medical information, and electronic patient data can improve health care decisions, prevent dangerous oversights, increase access to care, and reduce unnecessary cost.1 It is becoming easier to envision a future in which this powerful combination of digital technology and data is available throughouttheUnitedStates.Recentdevelopments illustrate the technical, organizational, and public policy challenges that will accompany this future. Predictably, user expectations and technical advances are outpacing the resolution of organizational and public policy issues.

Implementation of an electronic patient data management system (PDMS) on an intensive care unit (ICU)

Implementation of a data management system on an Intensive Care Unit (ICU) needs a good organisation. The expectations and the specifications of the system should be defined and clear before the process is started. Analysis of produced data of communication and information pathways on the ICU is necessary. A complete system should include data acquisition, data base management and archiving of data. In our project, the development of these criteria was performed by participation in a national project. Coupling with a hospital information system and the possibility of data exchange is mandatory. We were able to implement a paperless patient record. Although it takes more time to do the patients administration with a Patient Data Management System (PDMS), medical personal seem to be better informed. Readable information is easy to access at the bedside of the patient.