摘要:

AbstractThis article summarizes the origins of informatics, which is based on the science, engineering, and technology of computer hardware, software, and communications. In just four decades, from the 1950s to the 1990s, computer technology has progressed from slow, first-generation vacuum tubes, through the invention of the transistor and its incorporation into microprocessor chips, and ultimately, to fast, fourth-generation very-large-scale-integrated silicon chips. Programming has undergone a parallel transformation, from cumbersome, first-generation, machine languages to efficient, fourth-generation application-oriented languages. Communication has evolved from simple copper wires to complex fiberoptic cables in computer-linked networks. The digital computer has profound implications for the development and practice of clinical medicine.

ISSN:1527-974X    

DOI:10.1136/jamia.1994.95236152

出版商:BMJ Group    

年代:1994

数据来源: BMJ

摘要:

AbstractDirect computer-based physician order entry has been the subject of debate for over 20 years. Many sites have implemented systems successfully. Others have failed outright or flirted with disaster, incurring substantial delays, cost overruns, and threatened work actions. The rationale for physician order entry includes process improvement, support of cost-conscious decision making, clinical decision support, and optimization of physicians' time. Barriers to physician order entry result from the changes required in practice patterns, roles within the care team, teaching patterns, and institutional policies. Key ingredients for successful implementation include: the system must be fast and easy to use, the user interface must behave consistently in all situations, the institution must have broad and committed involvement and direction by clinicians prior to implementation, the top leadership of the organization must be committed to the project, and a group of problem solvers and users must meet regularly to work out procedural issues. This article reviews the peer-reviewed scientific literature to present the current state of the art of computer-based physician order entry.

ISSN:1527-974X    

DOI:10.1136/jamia.1994.95236142

出版商:BMJ Group    

年代:1994

数据来源: BMJ

摘要:

AbstractThe introduction by the Health Care Financing Administration, in 1993, of separate conversion factors for “medical” and “surgical” services to be used in calculating Medicare charges would ordinarily necessitate the use of year-specific software source code. By designing the system to utilize macro-substitution of the year in the names ofCurrent Procedural Terminology for PhysiciansCode databases, database fields, and system variables, it is possible to calculate Medicare charges without annually rewriting source code. Once such a system is in place, simply by changing the operational year, the correct data and means of computation are automatically available.

ISSN:1527-974X    

DOI:10.1136/jamia.1994.95236143

出版商:BMJ Group    

年代:1994

数据来源: BMJ

摘要:

AbstractObjective: Evaluate the accuracy of the detailed diagnostic reasoning of the Heart Failure Program incorporating a new mechanism to handle temporal relationships and severity constraints.Design: Tools were developed to summarize diagnoses and automatically generate evaluation forms. Five expert cardiologists were asked to review the reasoning of the program, with two analyzing each case. Cases were gathered retrospectively for diversity and difficulty and 26 randomly selected cases were evaluated. The underlying issues were identified and classified.Results: Both reviewers rated the first diagnosis correct in 25% of the cases and at least one rated it wrong in 10%. Analyzing the detailed reasoning, 137 issues were raised, about 5.3 per case. Of these, 53% were possible concerns raised by one reviewer. Of the 5.3 issues per case, 2.5 were attributable to controversies, misunderstandings, or mistakes; 1 was due to the overly simplistic representation of the summaries; and 1.8 were issues related to the program.Conclusion: Overall, the program is capable of providing high-quality detailed diagnostic hypotheses for complex cardiovascular cases. The results highlight several issues: 1) the difficulty of effectively summarizing hypotheses, 2) the nature of a physician's causal explanation, and 3) some problems in evaluating detailed diagnostic reasoning. The mistakes the program made imply that some additional refinement is needed but that the reasoning mechanisms developed can support the appropriate reasoning. The appropriate next step is a prospective evaluation addressing the program's usefulness.

ISSN:1527-974X    

DOI:10.1136/jamia.1994.95236144

出版商:BMJ Group    

年代:1994

数据来源: BMJ

摘要:

AbstractObjective: Develop a representation of clinical observations and actions and a method of processing free-text patient documents to facilitate applications such as quality assurance.Design: The Linguistic String Project (LSP) system of New York University utilizes syntactic analysis, augmented by a sublanguage grammar and an information structure that are specific to the clinical narrative, to map free-text documents into a database for querying.Measurements: Information precision (I-P) and information recall (I-R) were measured for queries for the presence of 13 asthma-health-care quality assurance criteria in a database generated from 59 discharge letters.Results: I-P, using counts of major errors only, was 95.7% for the 28-letter training set and 98.6% for the 31-letter test set. I-R, using counts of major omissions only, was 93.9% for the training set and 92.5% for the test set.

ISSN:1527-974X    

DOI:10.1136/jamia.1994.95236145

出版商:BMJ Group    

年代:1994

数据来源: BMJ

摘要:

AbstractObjective: Development of a general natural-language processor that identifies clinical information in narrative reports and maps that information into a structured representation containing clinical terms.Design: The natural-language processor provides three phases of processing, all of which are driven by different knowledge sources. The first phase performs the parsing. It identifies the structure of the text through use of a grammar that defines semantic patterns and a target form. The second phase, regularization, standardizes the terms in the initial target structure via a compositional mapping of multi-word phrases. The third phase, encoding, maps the terms to a controlled vocabulary. Radiology is the test domain for the processor and the target structure is a formal model for representing clinical information in that domain.Measurements: The impression sections of 230 radiology reports were encoded by the processor. Results of an automated query of the resultant database for the occurrences of four diseases were compared with the analysis of a panel of three physicians to determine recall and precision.Results: Without training specific to the four diseases, recall and precision of the system(combined effect of the processor and query generator) were 70% and 87%. Training of the query component increased recall to 85% without changing precision.

ISSN:1527-974X    

DOI:10.1136/jamia.1994.95236146

出版商:BMJ Group    

年代:1994

数据来源: BMJ

摘要:

AbstractObjective: Develop standard terms and codes for recording nursing care information in patient records to permit relevant data to be abstracted into a shared database for effectiveness research.Design: A collaborative effort by the University of Virginia, Thomas Jefferson University Hospital, and the University Hospital Consortium to develop a set of terms to represent specific examples of nursing diagnoses/patient care problems, nursing interventions/patient care activities, and patient outcomes. Terms found in standards of care are being compiled, classified, and coded.Results: Standard terminology and codes have been developed for 209 nursing diagnoses/patient care problems, 122 expected patient outcomes, and 545 interventions/patient care activities. The terms come from five nursing units in one hospital and from two units in a second hospital. Preliminary findings suggest that in the specialty areas for which terms have been developed, the terms are adequate to capture these types of nursing data in the patient record.

ISSN:1527-974X    

DOI:10.1136/jamia.1994.95236147

出版商:BMJ Group    

年代:1994

数据来源: BMJ

摘要:

AbstractObjective: To design and develop a computer-based health-care record system to address the needs of the patients and providers of a homeless population.Design: A computer-based health-care record system being developed for Boston's Healthcare for the Homeless Program (BHCHP) uses client-server technology and distributed database strategies to provide a common medical record for this transient population. The differing information requirements of physicians, nurses, and social workers are specifically addressed in the graphic application interface to facilitate an integrated approach to health care. This computer-based record system is designed for remote and portable use to integrate smoothly into the daily practice of providers of care to the homeless. The system uses remote networking technology and regular phone lines to support multiple concurrent users at remote sites of care.Results: A stand-alone, pilot system is in operation at the BHCHP medical respite unit. Information on 129 patient encounters from 37 unique sites has been entered. A full client-server system has been designed. Benchmarks show that while the relative performance of a communication link based upon a phone line is 0.07 to 0.15 that of a local area network, optimization permits adequate response.Conclusion: Medical records access in a transient population poses special problems. Use of client-server and distributed database strategies can provide a technical foundation that provides a secure, reliable, and accessible computer- based medical record in this environment.

ISSN:1527-974X    

DOI:10.1136/jamia.1994.95236148

出版商:BMJ Group    

年代:1994

数据来源: BMJ

ISSN:1527-974X    

DOI:10.1136/jamia.1994.95236149

出版商:BMJ Group    

年代:1994

数据来源: BMJ

ISSN:1527-974X    

DOI:10.1136/jamia.1994.95236150

出版商:BMJ Group    

年代:1994

数据来源: BMJ