Development Of Clinical Information Systems Research Articles

Design of a Tablet Computer App for Facilitation of a Molecular Blood Culture Test in Clinical Microbiology and Preliminary Usability Evaluation.

BackgroundUser mobility is an important aspect of the development of clinical information systems for health care professionals. Mobile phones and tablet computers have obtained widespread use by health care professionals, offering an opportunity for supporting the access to patient information through specialized applications (apps) while supporting the mobility of the users. The use of apps for mobile phones and tablet computers may support workflow of complex tasks, for example, molecular-based diagnostic tests in clinical microbiology. Multiplex Blood Culture Test (MuxBCT) is a molecular-based diagnostic test used for rapid identification of pathogens in positive blood cultures. To facilitate the workflow of the MuxBCT, a specialized tablet computer app was developed as an accessory to the diagnostic test. The app aims to reduce the complexity of the test by step-by-step guidance of microscopy and to assist users in reaching an exact bacterial or fungal diagnosis based on blood specimen observations and controls. Additionally, the app allows for entry of test results, and communication thereof to the laboratory information system (LIS).ObjectiveThe objective of the study was to describe the design considerations of the MuxBCT app and the results of a preliminary usability evaluation.MethodsThe MuxBCT tablet app was developed and set up for use in a clinical microbiology laboratory. A near-live simulation study was conducted in the clinical microbiology laboratory to evaluate the usability of the MuxBCT app. The study was designed to achieve a high degree of realism as participants carried out a scenario representing the context of use for the MuxBCT app. As the MuxBCT was under development, the scenario involved the use of molecular blood culture tests similar to the MuxBCT for identification of microorganisms from positive blood culture samples. The study participants were observed, and their interactions with the app were recorded. After the study, the participants were debriefed to clarify observations.ResultsFour medical laboratory technicians, for example, representative of end users of the app, participated in the clinical simulation study. Using the MuxBCT app, the study participants successfully identified and reported all microorganisms from the positive blood cultures examined. Three of the four participants reported that they found the app useful, while one study participant reported that she would prefer to make notes on paper and later enter them into the LIS.ConclusionsThe preliminary usability evaluation results indicate that use of the MuxBCT tablet app can facilitate the workflow of the MuxBCT diagnostic test.

Formulation: A Proposal for a More Structured, Longitudinal Approach

The aim of this study was to consider formulation enabling a longitudinal perspective to improve the quality of clinical information. An overview of RANZCP guidelines for formulation, our observations of formulation in practice, and consideration of the requirements of current clinical documentation systems were employed. A five paragraph structured approach to formulation, with an example, is proposed. A structured schema for longitudinal formulation offers advantages for mental health services working over time with consumers with severe and enduring illnesses and should be considered in the development of clinical information systems.

The Database of the Catalogue of Clinical Practice Guidelines Published via Internet in the Czech Language - The Current State

Since the nineties the publication activity of expert authorities in the field of Clinical practice guidelines (CPGs) has increased. During the first decade of the 21st century the Internet has become one of the most important publishing media for CPGs due to the popularity of sharing information in an e l ectronic f orm. Nowadays, approximately 107 Czech expert societies publish about 731 CPGs on the Internet according to previous explorations of web sites of Czech expert medical societies and practical experience with previous operation of the Catalogue of Clinical Practice Guidelines. CPG documents can be used by physicians and other clinical employees in clinical praxis and education, by administrative authorities, by health policy makers or by patients. Information in these documents is also essential in the development of clinical information systems and decision support systems. The database of the Catalogue of Clinical Practice Guidelines takes a survey in the appearance of CPGs on free accessible web sites of expert societies or periodicals guaranteed by expert societies. The database stores bibliographical data, information about the recency and the quality of CPGs and information about the existence of web tools or formal models based on these CPGs. The database contains 562 records of CPGs published by Czech expert medical societies. 212 records are accessible via the web interface of the Catalogue of Clinical Practice Guidelines.

Implementation of an Electronic Prescription System in a Brazilian General Hospital: Understanding Sources of Resistance

AbstractThe swift development of clinical information systems has contributed to the emergence of various transformations within hospitals. However, scientific literature has shown that the implementation of many of these undertakings has yielded frustrating results. This research investigates the main causes for the unsuccessful implementation of an electronic prescription system in a Brazilian general hospital – from an explanatory‐exploratory case study standpoint – adopting resistance to information systems as its theoretical background. In the case under analysis, the study shows that the main motives for resistance to the system were: lack of training of the physicians; the age of the physicians; problems with the design and safety of the system; inadequate technological infrastructure; the employment relationship of the physicians; and the interference of the system with the power and autonomy of the physicians. The paper concludes that the intra‐organizational context of the hospitals must be analyzed in a systemic way in order to understand fully how the system will be accepted and used by its main potential users, namely physicians.

Current Challenges and Opportunities for Better Integration of Human Factors Research with Development of Clinical Information Systems

Clinical information system (CIS) developers and implementers have begun to look to other scientific disciplines for new methods, tools, and techniques to help them better understand clinicians and their organizational structures, clinical work environments, capabilities of clinical information and communications technology, and the way these structures and processes interact. The goal of this article is to help CIS researchers, developers, implementers, and evaluators better understand the methods, tools, techniques, and literature of the field of human factors. We developed a framework that explains how six key human factors topics relate to the design, implementation, and evaluation of CISs. Using this framework we discuss the following six topics: 1) informatics and patient safety; 2) user interface design and evaluation; 3) workflow and task analysis; 4) clinical decision making and decision support; 5) distributed cognition; and 6) mental workload and situation awareness. Integrating the methods, tools, and lessons learned from each of these six areas of human factors research early in CIS design and incorporating them iteratively during development can improve user performance, user satisfaction, and integration into clinical workflow. Ultimately, this approach will improve clinical information systems and healthcare delivery.

Issues in the Development of a Computerized Clinical Information System for a Network of Juvenile Homes

This article presents and reflects upon the formative evaluation of the development of a clinical information system for a network of juvenile homes. Several key problems were identified: The development of the system initially focused on inputs rather than expected outputs, and end users played only a minor role in the process. The system was overly ambitious, designed to fulfill many different expectations at one and the same time. Consequently, the instruments were cumbersome and not sensitive enough to note cultural differences among target populations. Administrative and organizational supports were not always adequate to the complexity of the system. The discussion considers the reasons for these problems and recommends ways of preventing and dealing with them. Some changes were introduced in the course of development and in response to interim reports of the evaluation, and to feedback from end users. The article points to the need for a coherent body of knowledge on the development of clinical information systems.

Quality agenda: priorities for action recommendations of the American Academy of Nursing Conference on Health Care Quality

The national focus on improving the quality of health care and a growing body of research on quality methods and outcomes have produced both momentum and urgency for action. In a relatively short time, the science of quality methods and outcomes has made substantial strides. Advances in theory development, increasing use of large datasets, and focused studies of major system problems set the stage for change. What we have learned suggests that improving quality will require a complex blend of short-term and long-term action in many areas: building public awareness, improving the science, changing delivery systems, and altering incentives. This paper highlights conclusions and recommendations from the April 2002 Conference on Measuring and Improving Health Care Quality convened by the American Academy of Nursing Expert Panel on Quality Health Care. Strategic priorities for a unified practice, research, and policy agenda to improve quality of health care are identified. Based on critical analysis of research and dialogue among experts and innovators, priorities for action clustered in five areas: (1) The context for the quality agenda; (2) database issues; (3) advancing research; (4) development of clinical information systems; and (5) public visibility. Attention is needed in each of these areas to stimulate ongoing debate and a meaningful agenda for change.

Supporting special-purpose health care models via adaptive interfaces to the web

The potential of the Internet and intranets to facilitate development of clinical information systems has been evident for some time. Most Web-based clinical workstation interfaces, however, provide merely a loose collection of access channels. There are numerous examples of systems for access to either patient data or clinical guidelines, but only isolated cases where clinical decision support is presented integrally with the process of patient care, in particular, in the form of active alerts and reminders based on patient data. Moreover, pressures in the health industry are increasing the need for doctors to practice in accordance with ‘best practice’ guidelines and often to operate under novel healthcare arrangements. We present the Care Plan On-Line ( cpol) system, which provides intranet-based support for the SA HealthPlus Coordinated Care model for chronic disease management. We describe the interface design rationale of cpol, which is based on constrained adaptation of the user interface while maintaining user control. We also describe the cpol implementation framework, which is flexible and broadly applicable to support new healthcare models over intranets or the Internet.

Extending the Computerisation of Healthcare Delivery

The purpose of this paper is to discuss issues relating to the further computerisation of healthcare delivery. It is argued that the adoption of various patient management paradigms and the fulfillment of productivity targets can only be realistically achieved through the development of clinical information systems whose computerised functionality goes beyond that of simple subcontrol functions. It will be further argued that many of the advantages which are distinct to computerised implementations are more fundamental and wide-reaching in nature than those of processing speed and storage capabilities which are usually highlighted.

Health Informatics Training at the University of Missouri

Health informatics training has a long tradition at the University of Missouri. The current program prepares future researchers for the rapidly changing field of health informatics. This paper describes the training program, the fellowships, the interdisciplinary strengths of the program, and representative projects. Research opportunities range from information analyses of basic medical sciences through development of clinical information systems to the evaluation of information systems. The informatics training program at the University of Missouri promotes evidence-based medical informatics and has a strong emphasis on the organizational aspects of successful information system implementation.

Integrating medical expert systems, patient data-bases and user interfaces

Expert system applications in the clinical domain have not been very popular for lack of an adequate integration with other applications used in clinical environments. In the last few years, there is a growing trend towards the introduction of knowledge based systems as systems embedded in conventional applications. In this paper we propose an integration strategy of an expert system in oncology therapy with a clinical history data base and a user interface adapted to the needs of the medical environment. Our objective has been to design a system that is easy to use and provides all functions needed by the medical staff. The final system has consisted in first integrating three development tools and then using them in order to construct the complete application. The result is a global tool for the development of clinical information systems with embedded intelligent modules.

Internet as clinical information system: application development using the World Wide Web.

Clinical computing application development at Columbia-Presbyterian Medical Center has been limited by the lack of a flexible programming environment that supports multiple client user platforms. The World Wide Web offers a potential solution, with its multifunction servers, multiplatform clients, and use of standard protocols for displaying information. The authors are now using the Web, coupled with their own local clinical data server and vocabulary server, to carry out rapid prototype development of clinical information systems. They have developed one such prototype system that can be run on most popular computing platforms from anywhere on the Internet. The Web paradigm allows easy integration of clinical information with other local and Internet-based information sources. The Web also simplifies many aspects of application design; for example, it includes facilities for the use of encryption to meet the authors' security and confidentiality requirements. The prototype currently runs on only the Web server in the Department of Medical Informatics at Columbia University, but it could be run on other Web servers that access the authors' clinical data and vocabulary servers. It could also be adapted to access clinical information from other systems with similar server capabilities. This approach may be adaptable for use in developing institution-independent standards for data and application sharing.

The development of clinical information systems (casemix) in Hong Kong public hospitals.

The development of clinical information systems (casemix) in Hong Kong public hospitals.