International journal of bio-medical computing最新文献

The UNIDOC system of computer-based medical records that was developed and made operational within the DIOGENE-2 Hospital Information System (HIS), is based upon a fully standardized and distributed open systems architecture. It should also be emphasized that UNIDOC illustrates a feasible marriage of the two technologies, UNIX and MS-DOS, is in many respects successful enough to be recommended as a sound general solution to medical office integration into a HIS.

In 1991 the Institute of Medicine issued a report on improving patient records which has proven to be a landmark for the many individuals and institutions involved in the development of computer-based patient records (CPRs). The report called Computer-based Patient Records: An Essential Technology for Health Care, recommended that CPRs become the primary form for patient records, and urged widespread implementation of CPRs within a decade. It also provides a framework for reviewing the current status of CPRs. In reviewing progress that has been made toward CPRs since the Institute of Medicine (IOM) report was released, it is useful to look beyond the IOM report's major focus on efforts in the USA and include international activities related to CPR development and implementation. Looking forward, CPR efforts are likely to be expedited through greater collaboration.

In this contribution the role of Electronic Data Interchange (EDI) for patient records is discussed. It is our opinion that unlimited access to patient records of different care provides is not a wise thing to do and may even not be acceptable legally. The exchange of EDI messages may be a solution in that the relevant information is exchanged on a need to know basis under the responsibility of the care provider that generated the information. The state of the art with respect to the availability of EDI messages in Europe is presented.

In this paper the results are presented from recent developments to increase the role of the HISCOM integrated hospital information system to support direct patient care. This process has resulted in an operational Electronic Obstetric Record System (EVS) and the introduction of a generic system (MDS) to document the medical care process starting in the outpatient clinics. These systems are based on a model of the clinical care process, agreed upon by clinicians. The EVS replaces the conventional paper record and was accepted mainly by the way the EVS follows and supports the care process. The main contribution is the completeness, the availability, and the support of the care related processes like scheduling next appointments and examinations, the reporting and the automatic creation of letters. The MDS approach addresses the issue of providing kernel information by episode about the care process to clinicians and managers. The MDS is based on the episode concept, which is not restricted to the outpatient departments, but can also be applied hospital wide, and even across the boundaries of the hospital. In this paper the categorisation of ‘a proactive medical record’ will be introduced, and the potential benefits of an integrated approach to the electronic medical record (EMR) will be addressed.

This paper addresses the requirements of healthcare providers and hospital managers vis-à-vis electronic patient records that can be integrated. It starts from some critical failure factors, found with previous attempts to standardise the electronic health record. Standardisation appears to be the key issue: the subject of standardisation requires delicate positioning. Technology must provide us with the means to obtain the standardised foundation for an integrated health record concept, which can be completely configured and customised to meet the requirements of health professionals and institutions involved. NUCLEUS, project A2025 in the AIM programme, has taken on this endeavour, and with good success. This paper summarises the benefits of this approach for various categories of people interested in using electronic patient records. Moreover, it illustrates NUCLEUS' contribution to achieving seamless integration of care. Furthermore, this paper explains the conceptual innovations that have been achieved in the NUCLEUS project. It consolidates the main concept of Act Management, structuring the professional primary process as well as the interprofessional communication. These concepts are subsequently expanded to include the key elements of the NUCLEUS integrated electronic patient record. Next, the paper reflects on what has appeared to be one of the critical success factors of the electronic patient record: its configuration and customisation facilities. These facilities make it possible to access the patient record at various intuitive aggregation levels and to make the integrated patient record ‘look like’ the individually specialised record of the respective healthcare professionals. Finally, the paper addresses various topics required to facilitate the successful implementation and operation of the NUCLEUS integrated electronic patient record like security, integrity, message communication, distribution, heterogeneity and the context of the hospital information system.

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.

A central element in the definition of primary care is that primary care clinicians address the large majority of personal health care needs of their patients. As a consequence, they should document data on these health care needs reliably and continuously. To establish whether this occurs, the episode of care is the most appropriate unit of assessment: a health problem from its first encounter with a health care provider until the completion of the last encounter for it. An episode of care is distinguished from episodes of disease and of illness. The episode of care as an epidemiological concept for the calculation of rates has evolved into a central element of a computer based record. Episode oriented data classified with the International Classification of Primary Care (ICPC), and specified with ICD-10 as a nomenclature are especially suitable as the core of a generic patient record in family practice. ICPC has been available to the family medicine community for well over a decade as the main ordering principle of its domain. The basic structure of an encounter (within the string of encounters which together form an episode of care) distinguishes reasons for encounter, diagnoses and diagnostic and therapeutic interventions. In this article, a more refined structure of encounters is proposed for a more precise documentation of episodes of care in a computer based patient record. The conversion structure between ICPC and ICD-10 allows both a high level of specificity in the patient's problem list and optimal communication with specialists who contribute to the episodes of care for which the documentation is the primary care provider's responsibility.

An epilepsy information system is described that supports routine patient care, research, and medical management. The patient's clinical data is ordered in time by the date of the patient contact when the data was collected. The clinical data is also classified into six categories. An unrestricted text group has text subjects in each of these groups as well as in a general free text area. The system is integrated with other information subsystems (e.g. patient registration, clinical chemistry laboratory, EEG department and pharmacy) as well as with the routinely used text processor. Data inquiries for research and medical management purposes are programmed in a Structured Query Language (SQL). The data needed to answer these queries are taken from the data collected in daily routine. The integration of the system is very useful because data only have to be entered once and can be used when and where needed. Patient data stored in this system is more accessible in general as well as more usable for research purposes compared with the patient data previously stored only on paper

A protocol processing system (ProtoVIEW), containing therapeutic trauma protocols, was used in the Accident and Emergency (A and E) department for a period of 7 months to investigate the impact of automated protocols on firstly, medical decision making of physicians and secondly, on quality of treatments eventually received by the patients. A randomized controlled trial showed that mandatory use of the system led to a more uniform working strategy while fracture treatment only seemed to improve in a subgroup of patient for whom residents established a correct diagnosis.

Dozens of new drugs are taken into clinical use each year. Even if the clinicians were able to learn the most important therapeutic effects of the drugs they prescribe, they would still be unable to remember all of their minor effects. After storing patient related medication data on computerized patient records it is possible to build decision support modules which automatically remind of possible drug influences on laboratory tests and cause alarms or alerts of drug interactions. Medication profiles coded using the Anatomical Therapeutic Chemical-code (ATC-code) constitutes a valuable part of an Electronic Patient Record (EPR). In this paper, we describe the benefits of our system. By building links to commercially available drug and laboratory databases we can automatically inform clinicians on clinically relevant drug influences on laboratory test results