Order Communication System Research Articles

Improvement of Transfusion Practice in Cardiothoracic Surgery Through Implementing a Patient Blood Management Program.

In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery. The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications. The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p<0.001). However, other clinical outcomes displayed no significant differences. PBM implementation effectively reduced the hemoglobin threshold for RBC transfusion and increased the rate of appropriate transfusion in cardiothoracic surgery. Although transfusion practices improved, clinical outcomes were comparable to those observed before PBM implementation.

Trends in behavioral management techniques for dental treatment of patients with autism spectrum disorder: a 10-year retrospective analysis.

Patients with autism spectrum disorder (ASD) present challenges in dental treatment cooperation owing to deficits in communication skills and social interaction. Behavioral guidance, sedation, and general anesthesia may be employed to ensure the quality of dental care for individuals with ASD. This study aimed to examine the trends in dental treatment for patients with ASD who visited the Department of Pediatric Dentistry at Dankook University Jukjeon Dental Hospital, an oral health center for the disabled in the Gyeonggi region, over the past 10 years. This study utilized the order communication system to gather data on sex, age, cooperation level, number of quadrants treated, and administration of sedation or general anesthesia for patients with ASD who visited the Department of Pediatric Dentistry at Dankook University Jukjeon Dental Hospital between January 2013 and December 2022. The total number of patients with ASD increased annually, possibly due to an increase in ASD prevalence and the hospital's designation as a center for disabled oral health. General anesthesia was predominant before 2017, with a shift towards N2O-O2 sedation. The most common age group for sedation or general anesthesia was 6-9 years, with a higher prevalence in males than in females. Notably, N2O-O2 and midazolam sedation resulted in better cooperation and fewer treated teeth than general anesthesia. This study highlights the evolving trends in dental treatment for individuals with ASD, indicating a shift towards outpatient methods, particularly N2O-O2 sedation. The sex distribution aligns with national statistics, emphasizing a higher prevalence of ASD in males than in females. These findings underscore the need for further research to establish evidence-based guidelines for optimal dental care strategies tailored to the unique needs of individuals with ASD.

The Potential Economic Benefits of an Alarm Service in Order Communication Systems in Korea: a Cost-Effectiveness Analysis of Less-Intensive Fracture Liaison Services Based on a Prospective Cohort Study.

An alarm service in an order communication system (OCS) was found to be effective at increasing the rate of dual-energy X-ray absorptiometry (DXA) testing and treatment in South Korea, but its cost-effectiveness remains unknown. We used a Markov model to determine the cost-effectiveness of the alarm service in the OCS compared to no alarm service for the post-fracture management of subjects aged 50years and older with fragility fractures. DXA testing and treatment data were collected from a prospective cohort study. The prevalence of osteoporotic fractures, the subsequent risk of hip fracture, and healthcare costs were obtained using Korea National Health Insurance claims data. The lifetime cost and quality-adjusted life-years (QALYs) gained were estimated from a healthcare perspective. A probabilistic sensitivity analysis was performed to examine the uncertainty of the results. The alarm service increased treatment by 125 per 1000 patients and prevented 3 hip fractures per 1000 patients. The alarm service cost an additional 249,393 KRW and resulted in an increase of 0.008 QALYs per patient compared to no alarm service. The incremental cost-effectiveness ratio was 31,174,125 KRW (26,843 USD) per QALY gained. The alarm service was cost-effective than no alarm service if the willingness to pay setting as 1GDP per capita (29,288 USD) per QALY gained. This study shows that less-intensive fracture liaison services, such as an alarm service, are cost-effective for patients aged 50years and older with osteoporotic fractures in Korea. An intensive model, including enhanced identification and education, could further prevent the risk of refracture and improve cost-effectiveness.

Alarm Services as a Useful Tool for Diagnosis and Management of Osteoporosis in Patients with Hip Fractures: A Prospective Observational Multicenter Study.

BackgroundAlarm services in the Order Communication System improve awareness for related physicians including orthopaedic surgeons, internal medicine doctors, and other relevent doctors. This prospective observational multicenter study was to compare the diagnostic and treatment rates of osteoporosis between an alarm service group and a no alarm service group.MethodsFrom January 2017 to december 2017, The subjects included patients aged 50 years or older with hip fractures from 16 hospital-based multicenter cohorts. Among the 16 hospitals, 5 university hospitals established an alarm service for osteoporosis management (i.e., Alarm group) and 11 university hospitals did not set-up alarm services (i.e., Control group). The rate of dual energy X-ray absorptiometry (DXA) test and the initiation rate of antiosteoporosis medications between the 2 groups were compared at enrollment and at 6 months follow-up.ResultsDuring the study period, 1,405 patients were enrolled. The DXA examination rate and initiation rate of osteoporosis treatment between the Alarm group and the Control group were 484 patients (89.8%) vs. 642 patients (74.1%) (P<0.001) and 355 patients (65.9%) versus 294 patients (33.9%) (P<0.001), respectively. At 6 months follow-up, the rate of anti-osteoporosis management between the 2 groups decreased (57.8% vs. 29.4%).ConclusionsThis prospective multicenter study demonstrates that alarm services can improve awareness of physicians, and it resulted in a significantly higher rate of examination of DXA and initiation of anti-osteoporosis medication in the Alram group. Therefore, alarm service is a simple and effective tool to increase anti-osteoporosis management as part of the fractuure liaison service in South Korea.

Current Status of the Adoption, Utilization and Helpfulness of Health Information Systems in Korea.

As interest in medical informatization has been increasing steadily worldwide, the adoption of health information systems (HISs) in medical institutions is essential. In this study, we intended to identify users’ adoption, utilization and helpfulness derived from HISs to determine the status of medical informatization by using 2016 Korean Physician Survey data. A total of 8564 members responded to the 2016 survey, we extracted the data of 6949 HISs related part for this study. As a result, about 68% of the self-employed physicians adopted the Order Communication System and Electronic Medical Records, while only one-third adopted the Picture Archiving and Communication System. Overall, the proportions of utilization and helpfulness of HISs were higher for females; for employed physicians or professors; for physicians working in hospitals; and for those specializing in surgical medicine. As applying information technology to the medical environment becomes more important, HIS will become a necessary requirement and the demand for information systems considering user and patient oriented information environments will be increasing. Therefore, it is necessary to discuss the HISs use environment considering not only technical aspects but also users’ or patients’ viewpoints. In that respect, this study will give a meaningful evidence of HIS related policies.

Successful development of real-time display of the ongoing phases of laboratory tests and expert comments by laboratory physician on the computerized order communication system

Successful development of real-time display of the ongoing phases of laboratory tests and expert comments by laboratory physician on the computerized order communication system

The Invention of A Semi-Automatic Pill Sorting Device for Re-using Pills in the Hospital Pharmacy

Automatic tablet dispensing & packing system (ATDPS) is becoming essential in the drug management field of the hospital pharmacy and the local pharmacy. The ATDPS device automatically sorts, distributes, and packages in connection with the order communication system (OCS) or electronic medical record (EMR). In the process of using the ATDPS, some pre-packaged drugs cannot be applied to the patient. Such drugs are re-used after disassembling the packaging. However, many problems such as drug contamination, breakage, and mixing with other drugs can arise during the drug re-using process. Therefore, automation is urgently required in the drug re-using process. Automatic sorting device has not yet been introduced to the domestic pharmacy. The aim of this study was to develop a semi-automatic pills sorting device (SPSD) for the purpose of cost-saving, enhancing operation efficiency, and reducing medication errors. The proposed SPSD is affordable and efficient with potential for use in the pharmacy to help drug management. [Key words] Hospital pharmacy, Discrimination, Automatic device, Pills 의료기관 조제실의 정제 재사용을 위한 반자동 정제분류기 개발에 대한 연구 천영주, 김정태, 임성실 가톨릭대학교 약학대학 임상약학 연구실, 강동경희대학교병원 약제부 The Invention of A Semi-Automatic Pill Sorting Device for Re-using Pills in the Hospital Pharmacy Young Ju Cheon, Jung Tae Kim, and Sung Cil Lim The Catholic University of Korea, College of Pharmacy, 43, Jibong-ro, Wonmi-gu, Bucheon, 14662, Korea, Department of Pharmacy, Kyunghee University Hospital at Gang-dong, 892, Dongnamro, Gangnam-gu, Seoul, 05278, Korea 투고일자 2016.6.2; 심사완료일자 2016.6.23; 게재확정일자 2016.6.30 �교신저자 임성실 Tel:02-2164-6595 E-mail:lim5@catholic.ac.kr Original Article

Pop-up messages in order communication systems can increase awareness of osteoporosis among physicians and improve osteoporosis treatment.

The purpose of this study was to verify the effect of pop-up messages (regarding a history of dual-energy X-ray absorptiometry [DXA]) on the identification and management of osteoporosis after osteoporotic hip or spine fractures. We hypothesized that these pop-up messages would increase the awareness and management of osteoporosis among clinicians and patients. We introduced pop-up messages regarding a history of DXA in our Order Communication System (March 2012) and evaluated the records of 404 patients who were treated between January 2011 and December 2012. The patients were categorized as being treated without the pop-up messages (Group I, before March 2012) or with the pop-up messages (Group II, after March 2012). We compared their rates of DXA prescription, osteoporosis medication, exercise, mortality and subsequent refractures during a 2-year follow-up. After introducing the pop-up messages, the DXA prescription rate increased from 35.1 to 57.1% (P < 0.001), the osteoporosis medication rate increased from 21.1 to 25.2% (P = 0.05) and the exercise rate increased from 35.6 to 40.5% (P = 0.018). During the 2-year follow-up, the mortality rates were 4.64% in Group I and 6.67% in Group II (P = 0.4). Subsequent refractures were found in 12.9% of Group I patients and 9.52% of Group II patients (P = 0.87). The pop-up messages positively affected the behaviours of orthopaedic surgeons and were associated with increased rates of prescription of DXA, osteoporosis medication, and might affect the behaviour of patient, increased exercise rate. Therefore, we recommend using this simple and effective method to improve physicians' awareness of osteoporosis.

Hybrid Order Communication System Development Combining MVC Model and Event-Driven Network

병원 업무정보를 신속하게 전달하려면 처방전달시스템은 데이터베이스를 수시로 조회해야하므로 네트워크와 데이터베이스 서버에 큰 부하를 유발한다. 현재 사용하는 MVC 패턴 처방전달시스템은 모든 정보가 컨트롤러를 경유해야하므로 부서 간 직접 정보전송에 부적합하다. 본 연구는 점대점 이벤트 구동망을 MVC 처방전달 시스템에 접목하기 위해 웹기반 점대점 송수신 모듈을 탑재하는 하이브리드 처방전달시스템을 제안하였다. 실시간 이벤트 정보 갱신을 위한 데이터베이스 탐색시간은 접수환자와 클라이언트 수에 따라 증가하는데 반하여 점대점 이벤트 구동망은 데이터베이스 조회를 배제할 수 있었다. 또한, 푸시 방식인 코멧과 웹소켓의 데이터 전송량을 비교하여 보다 효과적인 전송방식으로 하이브리드 처방전달시스템의 이벤트 구동 전송망을 구현하였다. 결과적으로 하이브리드 처방전달시스템은 통신망 전송부하와 데이터베이스 조회를 크게 줄일 수 있었다.

U-Healthcare 서비스 환경에서의 통합의료정보시스템 구축방안 연구

최근 병원은 ICT기술을 접목한 고품질의 의료서비스를 제공하는 허브병원으로서의 기능을 수행하기 위해 병원의 정보화를 통하여 직무능력을 향상하고 경영자의 의사결정지원시스템을 통하여 고도화된 통합의료정보시스템을 구축하고 있다. 본 연구에서는 환자정보와 진료정보의 신속한 조회로 진료편의성을 극대화 할 수 있도록 통합의료정보시스템에 OCS(Order Communication System)시스템과 HIS(Hospital Information System)시스템을 연동하여 최적화된 맞춤형 모바일 헬스케어 진료환경을 설계하여 환자의 치료 및 진료를 신속하고 정확하게 수행할 수 있는 체계적인 의료시스템을 연구하였다. Nowadays hospitals have been improving their job performances through informatization and also establishing an advanced, integrated medical information system through their manager's decision making support system in order to play roles as a hub hospital providing high quality medical services integrated with ICT technology. This study connects the OCS system and HIS system to the integrated medical information system to design an optimized, customized mobile health care and medical treatment environment and also investigates the systematic medical system that can perform patients' cure and medical treatment promptly and accurately in order to maximize convenience of treatment by inquiring into patients' information and information of medical treatment promptly.

상황인지를 이용한 진료 안내 시스템

As the quality of the medical treatment service provided by large hospitals grow, the number of patients utilizing the facilities is increasing dramatically. Various studies such as order communication system and treatment guidance system are under their process in order to shorten the waiting time for patients. However, the existing methods assign the treatments in successive order without recognizing the situation of each treatment, therefore increasing a patient`s standby time at a hospital. This paper proposes a context-aware treatment guidance system, which recognizes the previously undermined estimated waiting time of each treatment for a patient and recommends a treatment with shorter estimated sojourn time first. This context-aware treatment guidance system provides detailed information of treatment services based on the recommended order of treatments to a patient`s smartphone. By utilizing the context-aware treatment guidance system introduced in this paper, patients can reduce their standby time at hospitals to the minimum while hospitals can efficiently service more patients at the same amount of time. The proposed context-aware treatment guidance system proves to be outstanding in treatment order recommendation through comparisons to previously used methods.

개인정보보호법 준수를 위한 병원 내 처방전달시스템의 보안 요구사항

The Order Communication System (OCS) is the important one of hospital information systems, and manage personal information of patients as well as medical records and history. But OCS is more complex because user requirements is more, so its vulnerabilities and threats are more increased together. In this paper, we analyze the medical information of OCS in hospitals and personal information protection act, and propose security requirements to satisfy legal requirements. The results of this study help to protect personal information of patients concerning their lives and lead to implements a more secure medical information systems.

A Study of the HTML5-based Mobile Order Communication System

Recently, online real-time web accessible mobile devices such as smartphones, tablet PCs and application services have been developing rapidly. Hospitals also need to adopt an efficient information system that can provide decent medical services under mobile computing environments to complete future medical services. This study proposes a system in which a doctor can examine a patient and make out a prescription in a ward on a real-time based on the current Order Communication Systems (OCSs) through mobile interfaces. The proposed system implements mobile web pages using HTML5, instead of a mobile app. Web processing speed can be enhanced using the web socket and web storage functions of HTML5.

Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications

PurposeTo assess whether the newly developed Comprehensive Chemotherapy Assistance Program (CAP) decreases errors and increases performance efficiency in ordering oncology medications as compared to the existing Computerized Physician Order Entry (CPOE) system, the Order Communication System (OCS). MethodsAll chemotherapy prescriptions ordered using OCS and CAP systems during the first year of CAP implementation were prospectively analyzed to identify near-miss cases. The efficiency outcomes were determined in a trial setting with eight predefined hypothetical chemotherapy regimens, each with four measures of the average time, movement distance on the screen, maximum input interval time, and number of mouse or keystrokes per order. A total of 14 physicians participated in the study, and each regimen was ordered twice, once using CAP and once using OCS. ResultsFor all near-miss types, CAP orders showed significant improvements as compared with OCS orders (p<0.0001). For CAP orders, incorrect dose and agent errors were reduced by 43.9% and 31.6%, respectively. Compared with OCS orders, regimen defects, drug omissions, and incorrect data input errors were reduced by more than 70% for CAP orders.For all four efficiency measures, a statistically significant competence was identified when physicians ordered a chemotherapy prescription with CAP as compared with OCS (p<0.0001). ConclusionsThese results demonstrate the superiority of CAP over the existing CPOE system for ordering oncology medications with regard to safety and efficiency.

XDS-I Gateway Development for HIE Connectivity with Legacy PACS at Gil Hospital

ObjectivesThe ability to support healthcare document sharing is imperative in a health information exchange (HIE). Sharing imaging documents or images, however, can be challenging, especially when they are stored in a picture archiving and communication system (PACS) archive that does not support document sharing via standard HIE protocols. This research proposes a standard-compliant imaging gateway that enables connectivity between a legacy PACS and the entire HIE.MethodsInvestigation of the PACS solutions used at Gil Hospital was conducted. An imaging gateway application was then developed using a Java technology stack. Imaging document sharing capability enabled by the gateway was tested by integrating it into Gil Hospital's order communication system and its HIE infrastructure.ResultsThe gateway can acquire radiology images from a PACS storage system, provide and register the images to Gil Hospital's HIE for document sharing purposes, and make the images retrievable by a cross-enterprise document sharing document viewer.ConclusionsDevelopment of an imaging gateway that mediates communication between a PACS and an HIE can be considered a viable option when the PACS does not support the standard protocol for cross-enterprise document sharing for imaging. Furthermore, the availability of common HIE standards expedites the development and integration of the imaging gateway with an HIE.

EMR Management System for Patient Pulse Data

The purpose of this study is to build an integrated medical information system for effective database management of clinical information and to improve the existing Electronic Medical Record (EMR)-based system that is currently being used in hospitals. The integrated medical information system of hospitals consists of an Order Communication System (OCS), Picture Archiving Communication System (PACS), and Laboratory Information System (LIS), as well as Electronic Medical Record (EMR). It is designed so that remote health screening and patient data search can be accessed through a high speed network-even in remote areas-in order to effectively manage data on medical treatment that patients received at their respective hospitals. The existing oriental treatment system is one in which the doctor requires the patient to visit the hospital in person, so as to be able to check the patient's pulse and measure it with his hand for proper diagnosis and treatment. However, due to the recent development of digitalized medical measurement equipment, not only can doctors now check a patient's pulse without touching it directly, but the measured data are computerized and stored into the database as the electronic obligation record. Thus, even if a patient cannot visit the hospital, proper medical treatment is available by analyzing the patient's medical history and diagnosis process in the remote area. Furthermore, when a comprehensive medical testing center system including the people medical examination and diverse physical examination is established, the quality of medical service is expected to be improved than now.

Prescription Pattern of NSAIDs and the Prevalence of NSAID-induced Gastrointestinal Risk Factors of Orthopaedic Patients in Clinical Practice in Korea

This is a cross-sectional observational study undertaken to explore the current prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and the prevalence of NSAID-induced gastrointestinal (GI) risk factors of orthopaedic patients in real clinical practice in Korea. Study cohort included 3,140 orthopaedic outpatients at 131 hospitals and clinics between January 2008 and August 2008. A self-administered questionnaire was completed by each patient and physician. A simplified risk scoring scale (the Standardized Calculator of Risk for Events; SCORE) was used to measure patients' risk for GI complications. The pattern of NSAIDs prescription was identified from medical recordings. Forty-five percents of the patients belonged to high risk or very high risk groups for GI complications. The cyclooxygenase-2 enzyme (COX-2) selective NSAID showed a propensity to be prescribed more commonly for high/very high GI risk groups, but the rate was still as low as 51%. In conclusion, physician's considerate prescription of NSAIDs with well-understanding of each patient's GI risk factors is strongly encouraged in order to maximize cost effectiveness and to prevent serious GI complications in Korea. Other strategic efforts such as medical association-led education programs and application of Korean electronic SCORE system to hospital order communication system (OCS) should also be accompanied in a way to promote physician's attention.

New Integrated Information System for Pusan National University Hospital

ObjectivesThis study presents the information system for Pusan National University Hospital (PNUH), evaluates its performance qualitatively, and conducts economic analysis.MethodsInformation system for PNUH was designed by component-based development and developed by internet technologies. Order Communication System, Electronic Medical Record, and Clinical Decision Support System were newly developed. The performance of the hospital information system was qualitatively evaluated based on the performance reference model in order to identify problem areas for the old system. The Information Economics approach was used to analyze the economic feasibility of hospital information system in order to account for the intangible benefits.ResultsAverage performance scores were 3.16 for input layer, 3.35 for process layer, and 3.57 for business layer. In addition, the cumulative benefit to cost ratio was 0.50 in 2011, 1.73 in 2012, 1.76 in 2013, 1.71 in 2014, and 1.71 in 2015. The B/C ratios steadily increase as value items are added.ConclusionsWhile overall performance scores were reasonably high, doctors were less satisfied with the system, perhaps due to the weak clinical function in the systems. The information economics analysis demonstrated the economic profitability of the information systems if all intangible benefits were included. The second qualitative evaluation survey and economic analysis were proposed to evaluate the changes in performance of the new system.

Evaluation of Clinical Decision Supporting System as part of the Order Communication System

Evaluation of Clinical Decision Supporting System as part of the Order Communication System

Asan Medical Information System for Healthcare Quality Improvement

ObjectivesThis purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement.MethodsAsan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security.ResultsAMIS consisted of several distinctive systems: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system.ConclusionsAMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.