摘要:

AbstractClinical 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.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96073829

出版商:BMJ Group    

年代:1995

数据来源: BMJ

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96073830

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractThe Active Digital Library at the Vanderbilt University Medical Center has created and implemented an educational software evaluation process to facilitate the timely recommendation for product acquisition. Using this process, breadth and depth of subject coverage, clarity of presentation, quality of construction, and ease of use are being assessed by content and technical experts. The process uses a team approach, employing a bi-level evaluation instrument based on existing software evaluation forms and system bug reports.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96073831

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractObjective: Evaluate the effects of long-term maintenance activities on existing portions of a large internal medicine knowledge base.Design: Five physicians who were not among the original developers of the knowledge base independently updated a total of 15 QMR disease profiles; each updated submission was modified by a review of group serving as the “gold standard,” and the pre- and post-study versions of each updated disease profile were compared.Measurements: Numbers and types of changes, defined as any difference between the original version and the final version of a disease profile; reason for each change; and bibliographic references cited by the physicians as supporting evidence.Results: A total of 16% of all entries were modified by the updating process; up to 95% of the entries in a disease profile were affected. The two most common modifications were changes to the frequency of an entry, and creation of a new entry. Laboratory findings were affected much more often than were history, symptom, or physical exam findings. The dominant reason for changes was appearance of new evidence in the medical literature. The literature cited ranged from 1944 to the present.Conclusions: This study provides an evaluation of the rate of change within the QMR medical knowledge base due to long-term maintenance. The results show that this is a demanding activity that may profoundly affect certain portions of a knowledge base, and that different types of knowledge (e.g., simple laboratory vs expensive or invasive laboratory findings) are affected by the process in different ways.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96073832

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractObjective: To systematically locate, register, and abstract information used in comparing effects of various information services (computerized and noncomputerized) and utilization management interventions on the process and outcome of patient care.Design: Manual and electronic database searches located reports that met three main criteria: 1) randomized controlled trial; 2) information or utilization management intervention in the study group with no similar intervention in the control group; and 3) effect of the intervention on the process and/or outcome of patient care had been measured. Published reports were registered in the Columbia Registry.Results: Nearly 600 reports were collected from 24 countries and 189 different publications. Frequently tested interventions included patients or physician education, telephone follow-up, patient or physician reminders, and home care services. Frequently reported effect variables included hospitalization rate, length of stay, immunization rate, and mortality rate. Standardized formal tools were developed for the separation and abstraction of practical information and methodologic details from the collected trial reports.Conclusions: The registry provides a new source of information for meta-analyses, traditional reviews, and executive summaries of quality improvement of health services. The streamlined knowledge engineering process of quality evaluation and abstraction of critical information can generate helpful information for practitioners and researchers simultaneously.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96073833

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractIncreasing amounts of medical knowledge, clinical data, and patient expectations have created a fertile environment for developing and using clinical practice guidelines. Electronic medical records have provided an opportunity to invoke guidelines during the everyday practice of clinical medicine to improve health care quality and control costs. In this paper, efforts to incorporate complex guidelines [those for heart failure from the Agency for Health Care Policy and Research (AHCPR)] into a network of physicians' interactive microcomputer workstations are reported. The task proved difficult because the guidelines often lack explicit definitions (e.g., for symptom severity and adverse events) that are necessary to navigate the AHCPR algorithm. They also focus more on errors of omission (not doing the right thing) than on errors of commission (doing the wrong thing) and do not account for comorbid conditions, concurrent drug therapy, or the timing of most interventions and follow-up. As they stand, the heart failure guidelines give good general guidance to individual practitioners, but cannot be used to assess quality or care without extensive “translation” into the local environment. Specific recommendations are made so that future guidelines will prove useful to a wide range of prospective users.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96073834

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractObjective: To analyze the temporal aspects of symptoms, including their temporal uncertainty, in order to develop a high-level conceptual data model representation of this domain.Design: A basic tenet of existing temporal models is that events occur not only relative to a particular date or time, but also relative to the time of some other event. The time an event occurs, particularly when the event is a symptom being recalled by a patient or collected by a busy provider, is frequently incomplete or uncertain, and this uncertainty must also be represented in a temporal data model. The object-oriented modeling technique used in this study is becoming popular among U.S. medical informatics standards developers.Results: A conceptual data model for the temporal aspects of symptom data, including temporal uncertainty, has been developed. The object-oriented modeling approach used enables the temporal objects and attributes defined in this model to be inherited by other medical objects, such as problems.Conclusion: The temporal comparators presented here have previously been defined, and may serve as the basis for standardizing the terms used to describe how one event temporally relates to another. In an attempt to achieve domain completeness, this study concentrated more on developing a model that is highly expressive than on developing one that is easily queried. This trade-off in representation versus “queryability” will require further analysis and may require modifications to the underlying model.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96073835

出版商:BMJ Group    

年代:1995

数据来源: BMJ

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96073836

出版商:BMJ Group    

年代:1995

数据来源: BMJ

ISSN:1527-974X    

DOI:10.1136/jamia.1995.96073837

出版商:BMJ Group    

年代:1995

数据来源: BMJ