Advances in technology can have direct and indirect benefits to clinical practice. The challenge that clinicians face is to properly match resources and outcomes, along with patient preferences. This article explores the use of an innovative interactive voice response system to increase patient compliance with antidepressant medication prescribed in primary care settings. The development of the interactive voice response system, its implementation, and clinical outcomes are described. The findings underscore the need to carefully match intervention strategies with the needs of specific patient populations, and the importance of human dialog in the context of healing.
Electronic prescribing tools are currently available but most medical practices are not using them. The literature was reviewed for data on adverse drug events and the expected dollar savings that could occur if these events were prevented. In addition to cost savings from improved patient safety, the effect of these systems on formulary compliance and drug cost savings was examined. Improved physician, nurse, and staff efficiencies were calculated using time trial comparisons between a paper system of handling prescription refills and a representative electronic prescribing system. The conclusion is made that electronic prescribing software is cost-effective for all size practices with a more rapid return on investment in larger practices.
To evaluate group visits in the management of underinsured patients with uncontrolled type 2 diabetes, 120 eligible patients enrolled were randomly assigned to receive care in groups or continue usual care. Feasibility, acceptability, and concordance with American Diabetes Association standards of care (Diab Camre. 25[suppl 1]:533-549) were evaluated. Patients who received care in groups exhibited improvement in American Diabetes Association standards of care (p < .001), improved sense of trust in physician (p = .02), and tended to report better coordination of care (p = .07), better community orientation (p = .09), and more culturally competent care (p = .09). Group visits offer a promising model for delivering health care to these patients.
To improve the functionality of our MAternal Record System (MARS), we reviewed the clinical problems entered into the MARS database from approximately 2800 patient records and interviewed representative clinicians about their use of the Clinical Comments and Problem List sections of MARS. Problems were assigned a unique term that corrected for spelling, spacing, synonyms, and abbreviation variations. Analysis of these terms suggested design changes that would increase the number of unique entries into the Problem List, including (1) modifications in the automated problem entry functions within MARS and (2) integration of the Problem List and Clinical Comments sections.
Organizations are impacted by their environments, and health care settings are no different. Individuals charged with improving a practice are often impeded by environmental barriers, including incomplete information for decision making. One strategy to empower an organization for change is to form a self-managing team. This paper discusses the self-managing team concept and uses a case study to illustrate its application in primary care. Factors contributing to team success are presented as a guide, and a reminder--there is more to an effective team than gathering people in a room.
As a result of the Human Genome Project, genetic testing could result in the availability of detailed genetic information (presence of disease, genetic risk or predisposition to disease, and characteristics or traits) that can ultimately be used for healthcare-related decisions. This study explored whether gender, role, and professional discipline would influence attitudes toward genetic testing when making reproductive decisions, as interpreted by 2 roles--as a parent making decisions or as a professional giving advice. An original research instrument was administered to masters and doctoral genetics students, pediatric residents, and masters-level ministry students. Statistical analyses revealed that discipline strongly influenced decision making while gender rarely did. In addition, differences in attitudes were also found based on parental and professional roles.
This article presents a case study from a primary care practice that achieves blood pressure control (ie, less than 130/85 mm Hg) in a majority of patients with diabetes. Fifty-three percent of the last blood pressures measured in 2001 were controlled and 38% of patients achieved blood pressure control without medications or with a single agent. Blood pressure control is achieved in a majority of patients in this practice secondary to their focus on guidelines, involvement of nursing staff in case management, and medication use consistent with recommendations.
This article focuses on the importance of monitoring and identifying those early discharged infants who are at risk for developing complications of jaundice. By utilizing standing orders in monitoring babies within 24 hours of discharge, bilirubin levels can be assessed in the home setting, required interventions can be implemented, and unplanned, emergency room visits and hospital readmissions can be averted.
For over a decade, most health care information technology (IT) professionals erroneously learned that document imaging, which is one of the many component technologies of an electronic document management system (EDMS), is the only technology of an EDMS. In addition, many health care IT professionals erroneously believed that EDMSs have either a limited role or no place in IT environments. As a result, most health care IT professionals do not understand documents and unstructured data and their value as structured data partners in most aspects of transaction and information processing systems.
The goal of this article is to provide insight in the evaluation of Electronic Document Management Systems (EDMSs) and the current EDMS vendors and their product offerings. Comparisons are made between the vendors and the products over the past decade. Appendix A and Appendix B outline many of today's key vendor offerings. Issues such as HIPAA and medical errors are discussed as it becomes clearer that the quality of patient care can be positively impacted with the application of information technology such as EDMSs.
Electronic document management systems (EDMS) have a profound impact on administrative operations of health care provider organizations. Thorough yet conservative system requirements and cost-benefit data can prove the necessity and priority of the EDMS. This case study-based article provides a methodology for all EDMS implementations, including the preparation of the vision and scope, business analysis, cost-benefit analysis, and system specification and project plan. These are illustrated with EDMS examples. To successfully minimize project risk, the article reviews the importance of phasing, standards, and integration, and it provides six detailed examples of this methodology.
The challenges faced by facilities wishing to implement an electronic medical record system are complex and overwhelming. Issues such as customer acceptance, basic computer skills, and a thorough understanding of how the new system will impact work processes must be considered and acted upon. Acceptance and active support are necessary from Senior Administration and key departments to enable this project to achieve measurable success. This article details one hospital's "journey" through design and successful implementation of an electronic medical record system.
Over the last 10 to 15 years, the health care industry has experienced dramatic changes in health care delivery, consumer needs, and demands. The medical record, a recapitulation of the care patients receive, continues to be one of the most vital components of the health care delivery system. It serves as a crucial administrative, clinical, financial, and research tool. Health information managers, striving to meet ever-changing requirements, have turned to electronic record processing to meet these changes. The following article describes one hospital's journey from a cumbersome paper environment to an electronic environment that not only resulted in improved customer service but also provided employees with renewed job satisfaction and increased skill levels.
No one would deny the need to transform health care. Information technology is capable of transforming health care organizations and delivering measurable value. However, these organizations will have to deploy effective, proactive strategies for managing information and adapting to the opportunities the technology offers. If, for example, an organization wants to become paperless, its information strategy must include appropriate tools to store and access unstructured data components of the medical record as well as structured data. An Electronic Document Management System (EDMS) is a critical element of this strategy. Also, a plan for managing change must be developed to mitigate technology risks. This can be realized through the development of a clear vision of the future and strong leadership, among other key items.
The decision to implement an Electronic Document Management System (EDMS) should not be made lightly. Such is the advice of a health are provider organization that pioneered the technology a decade ago. University Health Systems of Eastern Carolina's largest facility, Pitt County Memorial Hospital (PCMH), implemented an EDMS in February 1992 and converted to its current EDMS in December 1999. This article describes PCMH's transition from paper to automation, the many trials along the way, and the advantages an EDMS offers.
The days of using optical disk based mass storage devices for high volume applications like health care document imaging are coming to an end. The price/performance curve for redundant magnetic disks, known as RAID, is now more positive than for optical disks. All types of application systems, across many sectors of the marketplace are using these newer magnetic technologies, including insurance, banking, aerospace, as well as health care. The main components of these new storage technologies are RAID and SAN. SAN refers to storage area network, which is a complex mechanism of switches and connections that allow multiple systems to store huge amounts of data securely and safely.
The International Classification of Diseases 10th Revision Procedure Classification System (ICD-10-PCS) has been developed as a replacement for Volume 3 of the International Classification of Diseases 9th Revision. The development of ICD-10-PCS was funded by the U.S. Health Care Financing Administration. ICD-10-PCS has a multi-axial seven character alphanumerical code structure, which provides a unique code for all substantially different procedures and which allows new procedures to be easily incorporated as new codes. ICD-10-PCS was under development for over five years and the initial draft was formally tested and evaluated by an independent contractor. The final version of the ICD-10-PCS was released in the spring of 1998. The design, development and testing of ICD-10-PCS are discussed.
Global optimization-based techniques are studied in order to increase the accuracy of medical diagnosis and prognosis with data from various databases. First, we discuss feature selection, the problem of determining the most informative features for classification in the databases under consideration. Then, we apply a technique based on convex and global optimization for classification in these databases. The third application of this technique is a method that calculates centers of clusters to predict when breast cancer is likely to recur in patients for which cancer has been removed. The technique achieves high accuracy with these databases. Better classifiers will lead to improved assistance in making medical diagnostic and prognostic decisions.
Data mining can be/used to detect health care fraud and abuse through visualization of very large data sets to isolate new and unusual patterns of activity. Data mining has allowed better direction and use of health care fraud detection and investigative resources by recognizing and quantifying the underlying indicators of fraudulent claims, fraudulent providers, and fraudulent beneficiaries. A large amount of work must be performed prior to the actual data mining. These precursory tasks include: customer discussions, data extraction and cleaning, transformation of the database, and auditing (basic statistics and visualization of the information) of the data. This paper describes the tasks performed in support of a project for HCFA (Health Care Financing Administration).
