Showing papers in "Journal of Medical Systems in 1992"

A computer-based, automated, telephonic system to monitor patient progress in the home setting

Abstract: In this report we describe an automated, telephonic system to monitor the progress of patients convalescing at home. The system includes a computerized central station that is capable of automated voice communication over the telephone, using voice reproduction, and touch-tone recognition. Peripheral hardware in multiple monitored homes need include only a touch-tone telephone, but may also be augmented by inexpensive, rudimentary diagnostic aids, such as a scale for body weight, a thermometer, or a blood pressure cuff and manometer. Current central hardware includes a NeXT computer, a fax modem, and a specialized telecommunications modem developed specifically for voice telecommunication using the NeXT. The central station acts like a robotic nurse in that it asks patients a series of questions and records the responses. The subjective questions to be asked are patient individualized and pre-selected by the physician from a question menu including items targeted specifically for the patient's disease or condition. In addition, clinical data such as body weight, blood pressure, and body temperature obtained from in-home diagnostic aids may be transmitted to the central station over the telephone using touch tones. The time-of-day and frequency of calling are pre-selectable, according to the patient's preference and clinical status. Data obtained by the central station can be easily accessed by the duty nurse via menu driven software. Reports depicting significant responses as a function of time are generated in graphical format to facilitate rapid identification of adverse trends. Hard copy reports can be dispersed directly by fax. Results from a pilot study show patients with cardiac disease readily use the system without difficulty or complaints. In one patient a five pound increase in body weight was detected, which prompted the patient's cardiologist to adjust his medication. In this way automated telephone follow-up can provide early detection of complications before they become severe, making the home environment safer and more secure for convalescence and contributing to reduced health-care costs.

Using an artificial neural network to diagnose hepatic masses

Abstract: Using abdominal ultrasonographic data and laboratory tests, radiologists often find differential diagnoses of hepatic masses difficult. A computerized second opinion would be especially helpful for clinicians in diagnosing liver cancer because of the difficulty of such diagnoses. A back-propagation neural network was designed to diagnose five classifications of hepatic masses: hepatoma, metastic carcinoma, abscess, cavernous hemangioma, and cirrhosis. The network input consisted of 35 numbers per patient case that represented ultrasonographic data and laboratory tests. The network architecture had 35 elements in the input layer, two hidden layers of 35 elements each, and 5 elements in the output layer. After being trained to a learning tolerance of 1%, the network classified hepatic masses correctly in 48 of 64 cases. An accuracy of 75% is higher than the 50% scored by the average radiology resident in training but lower than the 90% scored by the typical board-certified radiologist. When sufficiently sophisticated, a neural network may significantly improve the analysis of hepatic-mass radiographs.

Standardized nursing language for healthcare information systems

Abstract: Since a substantial component of health care delivery is reflected in nursing's work, it is imperative that nursing expedites implementation of a standardized language that reflects nursing's work and ultimately allows outcome evaluation. This paper will summarize the state of development and related issues of standardized language in nursing, including: Nursing Minimum Data Set, Taxonomies of Nursing Diagnoses, Nursing Interventions, Outcomes, and the Nursing Management Minimum Data Set. The Nursing Minimum Data Set, including nursing care, patient or client demographic, and service elements, reflects a standardized collection of essential nursing data used by multiple data users in the health care delivery system across all types of settings. The nursing care elements include nursing diagnosis, nursing intervention, nursing outcome, and intensity of nursing care. Currently, more than 100 nursing diagnoses have been accepted for clinical testing by the North American Nursing Diagnosis Association (NANDA) and have been incorporated into a taxonomy of nursing diagnoses that reflects patient responses to actual or potential health problems that nursing can address. A current formulation of a taxonomy of nursing interventions for the treatment of the nursing diagnoses yielded 336 nursing intervention labels organized at three or four levels of abstraction. Concomitant with these endeavors is the necessity for identifying outcomes associated with each diagnosis and its treatment. Concepts and a classification for indicators of these outcomes are being reviewed. Last, to address the contextual covariates of patient outcomes, a collection of core variables needed by nurse managers to make management decisions and compare nursing effectiveness across institutions and geographic regions is under development. In summary, standardized measures to determine cost effective, high quality, appropriate outcomes of nursing care delivered across settings and sites are being developed.

Technology anxiety as a potential mediating factor in response to medical technology

Abstract: Technology anxiety, defined as a fear of working with medical equipment, was measured via the use of the Technology Response Questionnaire. Nurses (N=414) working on nine types of nursing units at two hospitals participated in the study. Nurses working on psychiatric units were found to be most anxious about working with medical equipment, while nurses working on surgical and adult intensive care units were least anxious. A comparison of the nurses who were highest and lowest on technology anxiety indicated that those who were most anxious about technology were less positive toward computers, felt more stressed by their work, were lower on job satisfaction, less positive toward the physicians they worked with, lower on personality scales of autonomy and adaptability, were less likely to do care planning regularly or to use nursing diagnoses, and tended to be older than less anxious nurses.

The effect of a multiple literature database search: a numerical evaluation in the domain of Japanese life science

Abstract: In literature database searching, we show that it is necessary to use plural databases for a more improved search. We also compare the results of a single database search with that of multiple database search in the domain of Japanese life sciences. We searched the MEDLINE and EMBASE using the same search terms. There were some differences in the results, owing to differences in the journals and recording methods. We herein show some of the differences in the journals contained in both databases. Furthermore, we show the differences in the number of papers derived from the same journal. Next, as an example of a practical search, we selected some universities in Japan, searched both databases regarding papers published from these universities and then merged the results by hand. According to our results, only 63% of all papers were common to both databases.

A computerized system for identifying and informing physicians about problematic drug use in nursing homes

Abstract: With growing concern over the quality of medication use in nursing homes, physicians, administrators, pharmacists, and regulators are looking for effective and efficient methods to improve it. Pharmacy consultation alone appears to be ineffective in controlling the use of inappropriate drugs. We describe here a computerized drug utilization review system designed for use in nursing homes. The system evaluates the appropriateness of medication use by criteria developed through the consensus of experts in geriatrics and specifically designed to address the pharmacological needs of elderly, nursing home residents. The program not only determines the frequency of inappropriate prescriptions, but produces written, educational statements to be given to prescribing physicians. These statements can also be given to nurses to educate them about issues in geriatrics pharmacology. Additionally, the system produces medication order forms that may help focus physicians' attention on the need to evaluate drugs individually.

Computer-assisted drug data collection

Abstract: Computerized systems for recording information about medication prescribing and use are important for studies in health services and pharmacoepidemiology. Such systems, if properly designed, can facilitate analysis as well as data collection. Although drug information systems exist for pharmacy service delivery applications, there are currently no descriptions of systems developed primarily for research applications in this area. This paper describes a computerized data collection system, developed for researchers, usable on portable equipment, and containing error checking features; the system has been extensively tested in over 850 study subjects taking part in a study of medication use in nursing homes that examines the impact of educational interventions for doctors and nurses on prescribing practices.

A visual field quantification system for the Goldman perimeter

Abstract: We have developed a visual field quantification system that can accurately quantify the measurement results by the Goldmann Perimeter (GP). This system calculates the plural indexes introduced in published papers. In recent years, several isopter quantification methods have been proposed. In these methods, the isopters are digitized and the data are input into a computer, after which a computer program evaluates the changes in the isopters quantitatively. However, each program is only able to evaluate private indexes. We have developed a system that quantifies data using multiple methods. This system used five methods that have been introduced in published papers. With this system, a physician can analyze GP data with multiple methods and can diagnose diseases accurately. We have already input about 2500 GP recording papers into the computer by this system. We then calculated the plural indexes, and visualized the temporal changes in the perimetry.

Regional variation in VAMC's operative efficiency

Abstract: The Department of Veterans Affairs is managed by a global budget regulated by Congress. How effective the VA handles this budget can provide insight into future plans for any form of universal health insurance. Using Date Envelope Analysis (DEA) this study shows that 51 of 158 continental VAMCs operate relatively efficiently. Variation in operative efficiency could be explained by Service Area size and geographic regional location. This finding suggests more active regional planning may improve veteran hospital operative efficiency.

US HealthLink: a national information resource for health care professionals

Abstract: US HealthLink is a new, comprehensive online medical information system designed specifically for health care professionals. Available to individuals for a fixed fee, it includes literature, news, diagnostic decision support, drug interactions, electronic mail, and bulletin boards. It also provides user-specific current awareness via clipping service, and fax delivery of both clipping and electronic mail information. US HealthLink can now be utilized to access a wide variety of medical information sources inexpensively.

A physician's workstation designed for NASA and earth-based applications

Abstract: One of the prime missions for NASA is the safety and care of astronauts. In addressing this challenge, a tool has been developed which has great potential for earth-based applications. The multimedia physician's workstation is the result of 13 years of planning and technical revolution in the field of computer science. Today, we have the hardware and the software to make a major change in the office-based practice of physicians. By offering the online features of a medical library as well as a complete multimedia medical record system, we are now in a position to introduce advance decision support technology that can be used on a daily basis for routine outpatient care. The system supports a new platform for patient education and offers the doctor an opportunity to share his expertise with his patient and their family. Although NASA will need several more years before this technology can be applied to a remote space environment, we plan to introduce this system into the doctor's office as an initial test of its feasibility. The basic design and general specifications of this multimedia workstation/office system are described and illustrated as they currently exist.

Computer-assisted test interpretation: considerations in patient care

Abstract: Computer-assisted test interpretation (CATI) is a set of developing technologies designed to support medical decision-making. This paper develops a taxonomy of computer-assisted test interpretation, giving specific consideration to the characteristics of the data that are to be interpreted, the nature of the interpretive task, the expected involvement of the health professional in the generation of the interpretation, the inference mechanism used for the interpretation, and the broader context of the interpretation. We go on to examine potential benefits and disadvantages of CATI systems in terms of accuracy, information management, interpretation time, patient management, medical communication, and expense. Finally, we examine electrocardiogram interpretation systems from the perspective of this taxonomy, and offer suggestions regarding areas of further inquiry into the effects of CATI on medical care.

Expert systems and expert behavior

Abstract: Iliad 4.0 and QMR 2.03 are computer-based diagnostic knowledge bases that can play many roles in decision support and other areas of medical practice, but neither appears ready to assume the role of an expert diagnostic consultant. In contrast to human experts, these programs have problems related to recognition of their own limitations, interpretation of continuous data, recognition of dependent findings, selection of tests, and description of the impact of certain tests. Suggestions to improve these aspects of knowledge bases are offered.

Development of a diagnostic and therapeutic simulation system based on patient data and specialist's knowledge I: simulation of diagnostic process

Abstract: A new simulation system of diagnostic and therapeutic processes is developed. The aim is to train medical students for the practical use of their knowledge, utilizing patient data in a total hospital information system. The knowledge in the system is presented by the specialists for every case. In medical school there are many specialists in various fields. With their cooperation the system can grow up to a comprehensive CAI system for clinical education. The system is designed to work on the mainframe for easiness of development, maintenance and extensions of the system. The present framework has been applied to the simulation of diagnostic process. The usefulness of the present system has been confirmed by specialists and students.

Synapse health resources online

Abstract: The University of Nebraska Medical Center maintains the Synapse Health Information Network to provide timely clinical and library resource information to health professionals across Nebraska and surrounding regions. The system is in over 115 sites across Nebraska and surrounding regions and maintains over 320 network users.

Data management of an inflammatory bowel disease registry

Abstract: The history and etiology of inflammatory bowel disease which is characterized by two major disease processes: ulcerative colitis and Crohn's disease, remain unknown. Research is focussing on seven major areas of genetic, environmental and physiologic factors that apparently relate to this disease. Based on this background, a population based Inflammatory Bowel Disease Registry was established in 1987 in the Lehigh Valley area of southeastern Pennsylvania. Consent forms, patient data forms and protocols for operation and implementation were developed, and databases were designed to accommodate demographic, basic history, follow-up and relative history data. The databases were correlated with an IBD registry ID number which both enabled relational analyses and ensured confidentiality of data information. The registry continues to grow, providing feedback for both continued medical research and supportive information for IBD patients and their physicians.

HEALTHCON: an innovative educational resource for Montana health professionals

Abstract: HEALTHCON is a computer bulletin board system which allows Montana health professionals to communicate with each other via any computer and modem.

CompreLink: a physician to physician communication network

Abstract: The Cleveland Clinic Foundation has developed a physician to physician communication network designed to meet the needs of their affiliate physicians—physicians who do not have admitting privileges at the Cleveland Clinic Hospital. This paper provides an overview of the CompreLink network as it exists today, as well as a glimpse into some of their plans for network expansion and development.

The Iowa medical information network: a concept

Abstract: Iowa Methodist Medical Center (IMMC) was one of the nation's early developers of a “hospital/physician” system, entering the arena during October 1985, under the direction of Ginny Wagner, Their “MOLI-Link” system now serves over 150 physicians in 50 locations, and is currently undergoing significant enhancement. MOLI-Link was originally developed using Annson Systems (IBAX) products, and has recently migrated to Wallace Computer Services (Wal-Link) software. Over the past 4 years, IMMC has investigated wide-crea medical information networking, and is now actively investigating development of the Iowa Medical Information Network. It is envisioned that IMIN would provide clinical, administrative, and educational information services throughout the IMMC 37 county referral area.

Information flow in the hospital: a comparative study of the Hungarian and the Dutch situation using a two axes model of hospital information flow

Abstract: This study compares the organization and structure of information flow in a Dutch and in a Hungarian hospital. The study was carried out as a field orientation part of a Health Care Management project of the Hogeschool van Amsterdam. The host of the field orientation was the BAZIS Foundation, the Central Development and Support Group Hospital Information System, Leiden. The visited hospitals were equipped with the BAZIS Hospital Information System. The method of study consisted of series of formalized interviews with all-level actors of a hospital; the interpretation of data was enhanced by a two axes (patient and management) model of information flow defined by the authors. In summary, Dutch hospitals show a more elaborate information flow system, with more information flow channels sideways among equal levels, less bureaucracy in organization of information flow, and significantly more benefits of automation, compared to the Hungarian situation.

TCK: a clinical genetics data collection system

Abstract: This work examines the database design and user interface design for a clinical genetics data collection system known as TCK. A specific design goal is automatic generation of the CORN reports. Emphasis in this paper is on how the logical data model resulting from the database design, and the user interface work together to enforce the enterprise results pertaining to data. Data screens are shown, sample queries are explained and the data mapping to the CORN reports presented.

Forecasting hospital laboratory procedures

Abstract: Improved forecasts of hospital laboratory procedures can provide the basis for better resource planning and enhanced operating efficiency. The research reported here-in describes how multiple regression models can be both a source of insight into causal relationships and a tool for achieving accurate monthly forecasts. Past research in this area may have overstated the statistical significance of findings because of a failure to address the potential effect of serial correlation. The present study uses the Cochrane-Orcutt regression procedure, rather than OLS, to overcome this problem. A model using inpatient admissions, acuity days, length of stay, discharge days and seasonal dummy variables is shown to account for 87% of the variation in the number of billable laboratory procedures. A simpler multiple regression model and a Winters' exponential smoothing model were found to provide excellent forecasts for laboratory procedures. In a one year out of sample evaluation, the annual percent forecast error was 0.7% for the regression model. This compares favorably to a percentage forecast error of 11.6% using subjective forecasting methods.

The science of medical information systems

Abstract: In particular for educational needs the paper proposes a paradigm of the science of medical information systems, what a comprehensive health care informatics is.

Cost justification of a laboratory information system

Abstract: A pre- and postimplementation comparison of tangible and intangible benefits of the laboratory information system are presented. The key activities projected to save costs through work reduction were evaluated as a basis for procuring a laboratory information system. Following implementation and four years of LIS operation the individual activities used for justification were resurveyed. The tangible benefits which were measured prior to LIS justification totaled $153,471.84 per year based upon fiscal year 1985–86 dollars. The objective re-evaluation of these activities four years after implementation and operation resulted in a measured $115,326.93 per year savings. The loss of projected savings is directly related to over estimates in the original justification evaluation and personnel behavior. The intangible benefits projected were all realized including a number of intangible benefits which made a significant impact on several departmental and clinical services at our institution.

Field-testing the new DECtalk PC system for medical applications

Abstract: Synthesized human speech has now reached a new level of performance With the introduction of DEC's new DECtalk PC, the small system developer will have a very powerful tool for creative design It has been our privilege to be involved in the beta-testing of this new device and to add a medical dictionary which covers a wide range of medical terminology With the inherent board level understanding of speech synthesis and the medical dictionary, it is now possible to provide full digital speech output for all medical files and terms The application of these tools will cover a wide range of options for the future and allow a new dimension in dealing with the complex user interface experienced in medical practice

Evaluating productivity in clinical research programs: the National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP)

Abstract: This paper outlines an approach to studying productivity in clinical research programs that incorporates environmental, organizational, provider, and patient specific factors in the model of production process. We describe how this approach has been applied to the National Cancer Institute's (NCI) Community Clinical Oncology Programs (CCOPs). Next, a practical evaluative model of the productive process in CCOPs is outlined and its use in evaluation and monitoring performance in CCOPs is discussed. Each level of the model is described and a number of factors potentially affecting each level are explored. Finally, we discuss the strengths and weaknesses of this approach and show how management can use it to study and improve the productivity of clinical research programs.

PC-based application programs in large health care systems

Abstract: Public health care agencies lack the infrastructure to meet the increasing operational demands on them, but there is little comparative data on alternative operational structures and systems from which to formulate remedies. Improved information management systems could help address both the workload and the gathering of critically needed data. PC-based database and application programs (PC-APs) that communicate with the mainframe are proposed as a methodology for filling the information-processing gap between mainframe computing and manual information systems. We also propose a model for systematic study of information management systems in clinical settings which can be used to evaluate other aspects of clinical program operations as well. A pilot study demonstrating these methodologies suggests that this is a fruitful approach to assessing ambulatory care operations and that PC-APs can improve administrative and clinical functions and enhance FTE productivity at lower overall cost.