scholarly journals Clinical Information Systems – From Yesterday to Tomorrow

2016 ◽  
Vol 25 (S 01) ◽  
pp. S62-S75 ◽  
Author(s):  
R. M. Gardner
Keyword(s):  
Patient Safety ◽  
Information Systems ◽  
Patient Care ◽  
Clinical Information ◽  
Clinical Decision ◽  
The United States ◽  
Clinical Information Systems ◽  
The Past ◽  
Clinical Computing

Summary Objectives: To review the history of clinical information systems over the past twenty-five years and project anticipated changes to those systems over the next twenty-five years. Methods: Over 250 Medline references about clinical information systems, quality of patient care, and patient safety were reviewed. Books, Web resources, and the author’s personal experience with developing the HELP system were also used. Results: There have been dramatic improvements in the use and acceptance of clinical computing systems and Electronic Health Records (EHRs), especially in the United States. Although there are still challenges with the implementation of such systems, the rate of progress has been remarkable. Over the next twenty-five years, there will remain many important opportunities and challenges. These opportunities include understanding complex clinical computing issues that must be studied, understood and optimized. Dramatic improvements in quality of care and patient safety must be anticipated as a result of the use of clinical information systems. These improvements will result from a closer involvement of clinical informaticians in the optimization of patient care processes. Conclusions: Clinical information systems and computerized clinical decision support have made contributions to medicine in the past. Therefore, by using better medical knowledge, optimized clinical information systems, and computerized clinical decision, we will enable dramatic improvements in both the quality and safety of patient care in the next twenty-five years.

scholarly journals Clinical Information Systems Integration in New York City's First Mobile Stroke Unit

2018 ◽  
Vol 09 (01) ◽  
pp. 089-098 ◽  
Author(s):  
Benjamin Kummer ◽  
Michael Lerario ◽  
Babak Navi ◽  
Adam Ganzman ◽  
Daniel Ribaudo ◽  
...  
Keyword(s):  
New York ◽  
Information Systems ◽  
Patient Care ◽  
Clinical Information ◽  
The United States ◽  
Clinical Information Systems ◽  
Order Entry ◽  
Technical Problems ◽  
Mobile Stroke Unit ◽  
Network Failures

Background Mobile stroke units (MSUs) reduce time to thrombolytic therapy in acute ischemic stroke. These units are widely used, but the clinical information systems underlying MSU operations are understudied. Objective The first MSU on the East Coast of the United States was established at New York Presbyterian Hospital (NYP) in October 2016. We describe our program's 7-month pilot, focusing on the integration of our hospital's clinical information systems into our MSU to support patient care and research efforts. Methods NYP's MSU was staffed by two paramedics, one radiology technologist, and a vascular neurologist. The unit was equipped with four laptop computers and networking infrastructure enabling all staff to access the hospital intranet and clinical applications during operating hours. A telephone-based registration procedure registered patients from the field into our admit/discharge/transfer system, which interfaced with the institutional electronic health record (EHR). We developed and implemented a computerized physician order entry set in our EHR with prefilled values to permit quick ordering of medications, imaging, and laboratory testing. We also developed and implemented a structured clinician note to facilitate care documentation and clinical data extraction. Results Our MSU began operating on October 3, 2016. As of April 27, 2017, the MSU transported 49 patients, of whom 16 received tissue plasminogen activator (t-PA). Zero technical problems impacting patient care were reported around registration, order entry, or intranet access. Two onboard network failures occurred, resulting in computed tomography scanner malfunctions, although no patients became ineligible for time-sensitive treatment as a result. Thirteen (26.5%) clinical notes contained at least one incomplete time field. Conclusion The main technical challenges encountered during the integration of our hospital's clinical information systems into our MSU were onboard network failures and incomplete clinical documentation. Future studies are necessary to determine whether such integrative efforts improve MSU care quality, and which enhancements to information systems will optimize clinical care and research efforts.

Effectivness of Health Information System Applications: Clinical Information and Diagnosis-Treatment Systems in Turkey

2017 ◽  
Vol 5 (1) ◽  
pp. 122
Author(s):  
Assist. Prof. Dr. Demokaan DEMİREL
Keyword(s):  
Decision Making ◽  
Information System ◽  
Information Systems ◽  
Management Information System ◽  
Health Sector ◽  
Health Information System ◽  
Clinical Information ◽  
Clinical Decision ◽  
Clinical Information Systems ◽  
Management Information

The distinctive quality of the new social structure is that information becomes the only factor of production. In today's organizations, public administrators are directly responsible for applying information to administrative processes. In addition to his managerial responsibilities, a knowledge based organization requires every employee to take responsibility for achieving efficiency. This has increased the importance of information systems in the decision-making process. Information systems consist of computer and communication technology, data base management and model management and include activity processing system, management information system, decision support systems, senior management information system, expert systems and office automation systems. Information systems in the health sector aim at the management and provision of preventive and curative health services. The use of information systems in healthcare has the benefits of increasing service quality, shortening treatment processes, maximizing efficiency of the time, labour and medical devices. The use of information systems for clinical decision making and reducing medical errors in the healthcare industry dates back to the 1960s. Clinical information systems involve processing, storing and re-accessing information that supports patient care in a hospital. Clinical information systems are systems that are directly or indirectly related to patient care. These systems include electronic health/patient records, clinical decision support systems, nurse information systems, patient tracking systems, tele-medicine, case mix and smart card applications. Diagnosis-treatment systems are information-based systems used in the diagnosis and treatment of diseases. It consists of laboratory information systems, picture archiving and communication system, pharmacy information system, radiology information system, nuclear medicine information system. This study aims to evaluate the effectiveness of health information system applications in Turkey. The first part of the study focuses on the concept of information systems and the types of information systems in organization structures. In the second part, clinical information systems and applications for diagnosis-treatment systems in Turkey are examined. Finally, the study evaluates applications in the health sector qualitatively from the new organizational structure, which is formed by information systems.

History and Trends in Clinical Information Systems in the United States

2001 ◽  
Vol 33 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Nancy Staggers ◽  
Cheryl Bagley Thompson ◽  
Rita Snyder-Halpern
Keyword(s):  
United States ◽  
Information Systems ◽  
Clinical Information ◽  
The United States ◽  
Clinical Information Systems

scholarly journals Clinical Information Systems – Seen through the Ethics Lens

2020 ◽  
Vol 29 (01) ◽  
pp. 104-114
Author(s):  
Ursula H. Hübner ◽  
Nicole Egbert ◽  
Georg Schulte
Keyword(s):  
Information Systems ◽  
Health Information ◽  
Information Exchange ◽  
Ethics Education ◽  
Health Information Exchange ◽  
Evaluation Studies ◽  
Clinical Information ◽  
Clinical Decision ◽  
Clinical Information Systems ◽  
Smart Systems

Objective: The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately. Methods: A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education. Results: By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders’ attitudes, but not to evaluate specific implementations. Conclusion: Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.

scholarly journals Rapid Assessment of Clinical Information Systems in the Healthcare Setting

2011 ◽  
Vol 50 (04) ◽  
pp. 299-307 ◽  
Author(s):  
J. S. Ash ◽  
D. F. Sittig ◽  
A. Bunce ◽  
K. Guappone ◽  
R. Dykstra ◽  
...  
Keyword(s):  
Health Care ◽  
Information Systems ◽  
Multidisciplinary Team ◽  
Rapid Assessment ◽  
Clinical Information ◽  
The United States ◽  
Small Towns ◽  
Clinical Informatics ◽  
Assessment Process ◽  
Clinical Information Systems

SummaryObjective: Recent legislation in the United States provides strong incentives for implementation of electronic health records (EHRs). The ensuing transformation in U. S. health care will increase demand for new methods to evaluate clinical informatics interventions. Timeline constraints and a rapidly changing environment will make traditional evaluation techniques burdensome. This paper describes an anthropological approach that provides a fast and flexible way to evaluate clinical information systems.Methods: Adapting mixed-method evaluation approaches from anthropology, we describe a rapid assessment process (RAP) for assessing clinical informatics interventions in health care that we developed and used during seven site visits to diverse community hospitals and primary care settings in the U. S.Setting: Our multidisciplinary team used RAP to evaluate factors that either encouraged people to use clinical decision support (CDS) systems or interfered with use of these systems in settings ranging from large urban hospitals to single-practitioner, private family practices in small towns.Results: Critical elements of the method include: 1) developing a fieldwork guide; 2) carefully selecting observation sites and participants; 3) thoroughly preparing for site visits; 4) partnering with local collaborators; 5) collecting robust data by using multiple researchers and methods; and 6) analyzing and reporting data in a structured manner helpful to the oraganizations being evaluated.Conclusions: RAP, iteratively developed over the course of visits to seven clinical sites across the U.S., has succeeded in allowing a multidisciplinary team of informatics researchers to plan, gather and analyze data, and report results in a maximally efficient manner.

scholarly journals THE USAGE OF MEDICAL INFORMATICS IN CRITICAL CARE MEDICINE

2017 ◽  
Vol 1 (4) ◽  
pp. 100-101
Author(s):  
Marsa Gholamzadeh ◽  
Hamidreza Abtahi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Decision Support ◽  
Information Systems ◽  
Medical Informatics ◽  
Clinical Information ◽  
Clinical Information Systems ◽  
Quality Of Patient Care ◽  
The World

Introduction: The intensive care unit can be defined as a complex system that composed of clinical informations, tasks and knowledge. It is also one of the most stressful and most vital parts of healthcare centers which involve a huge amount of information and clinical data daily. These informations should be analyzed and managed in the best way as soon as possible to restore patients to normal by health professionals. Accurate and timely diagnosis, the best treatment and to avoid any possible error in this section can be equivalent to achieve the best possible result and reducing the length of hospitalization and mortality. As a result, due to the complex nature of the critical care and the mass of clinical data; using a combination of medical knowledge with the latest technologies and use of medical informatics capabilities can be the best way to reduce the workload of the sector and improve the quality of patient care. Methods: A systematic search was conducted on the PubMed/MEDLINE, web of science, BMJ, ScienceDirect, and Scopus database for finding studies that have related to critical care and usage of informatics or medical informatics. The collected data and results are summarized by researchers and the results analyzed based on similarities and differences. Results: With increased development of medical informatics and electronic systems has led to substantial progress in the field of critical care since 1980 till now around the world. Several articles, research projects has published. From 1981 to 2016 almost 600 scientific papers were found which included reports, posters and thesis written in context of critical care medical informatics. More than 65 percent of these studies is about designing CDSS in this field. Today, many of these systems are used in medical centers around the world and lead to improving the quality of patient care and reduce medical errors in intensive care units. Among these 600 papers, 230 articles related to our issue in fields of the design of electronic records, clinical information systems, decision support systems, data mining, telemedicine, smart analysis of clinical information and knowledge extraction techniques were selected as the main source of this study. Conclusion: According to results of our study, it seems that critical care is potentially a valuable resource for medical informatics researches. The applied of medical informatics in the different fields of the diagnosis, interpretation, and treatment in different countries have improved the quality of care for patients in critical care field. We can mention some common fields which used such as infection control and early detection in intensive care units, clinical information systems, and CPOE and decision support systems such as APACHE system for grading the severity of illness of patients who hospitalized and even telemedicine. Since this area of research has not been a field of interest in Iran yet, it seems that this study with the aim of review the application of medical informatics in different countries could lead to practical researches in this field.

Tools and Considerations to Develop the Blueprint for the Next Generation of Clinical Care Technology

2019 ◽  
Vol 8 (1) ◽  
pp. 1-8
Author(s):  
Chris Daniel Riha
Keyword(s):  
Information Systems ◽  
Clinical Care ◽  
Clinical Decision Support Systems ◽  
Clinical Information ◽  
Clinical Decision ◽  
Clinical Engineering ◽  
Historical Background ◽  
Clinical Information Systems ◽  
Next Generation ◽  
Care Technology

This article provides a brief historical look at the genesis and evolution of clinical information systems. Based upon this historical background and the expertise of the authors, which encompasses, clinical, IT/cybersecurity, clinical engineering, as well as quality control expertise the article provides a roadmap for the next generation of clinical information systems. This next generation will not only provide consulting services to physicians via computer clinical decision support systems, but also the ability to perform autonomous and semi-autonomous care at the bedside via interfaces to medical devices (e.g. ventilators and infusion pumps), as well as auto ordering protocols.

Measuring the Improving Quality of Outpatient Care in Medical Oncology Practices in the United States

2013 ◽  
Vol 31 (11) ◽  
pp. 1471-1477 ◽  
Author(s):  
Michael N. Neuss ◽  
Jennifer L. Malin ◽  
Stephanie Chan ◽  
Pamela J. Kadlubek ◽  
John L. Adams ◽  
...  
Keyword(s):  
Clinical Information ◽  
The United States ◽  
Measuring Process ◽  
The Past ◽  
The Mean ◽  
Highly Correlated ◽  
American Society ◽  
Oncology Practice ◽  
Over Time

Purpose The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) has provided a method for measuring process-based practice quality since 2006. We sought to determine whether QOPI scores showed improvement in measured quality over time and, if change was demonstrated, which factors in either the measures or participants were associated with improvement. Methods The analysis included 156 practice groups from a larger group of 308 that submitted data from 2006 to 2010. One hundred fifty-two otherwise eligible practices were excluded, most commonly for insufficient data submission. A linear regression model that controlled for varied initial performance was used to estimate the effect of participation over time and evaluate participant and measure characteristics of improvement. Results Participants completed a mean of 5.06 (standard deviation, 1.94) rounds of data collection. Adjusted mean quality scores improved from 0.71 (95% CI, 0.42 to 0.91) to 0.85 (95% CI, 0.60 to 0.95). Overall odds ratio of improvement over time was 1.09 (P < .001). The greatest improvement was seen in measures that assessed newly introduced clinical information, in which the mean scores improved from 0.05 (95% CI, 0.01 to 0.17) to 0.69 (95% CI, 0.33 to 0.91; P < .001). Many measures showed no change over time. Conclusion Many US oncologists have participated in QOPI over the past 6 years. Participation over time was highly correlated with improvement in measured performance. Greater and faster improvement was seen in measures concerning newly introduced clinical information. Some measures showed no change despite opportunity for improvement.

From Nursing Information Systems to Patient Information Systems

1994 ◽  
Vol 33 (03) ◽  
pp. 302-303 ◽  
Author(s):  
P. M. Coward
Keyword(s):  
Health Care ◽  
Information Systems ◽  
Patient Care ◽  
Health Care System ◽  
Patient Information ◽  
Clinical Information ◽  
Systems Development ◽  
Clinical Information Systems ◽  
Patient Centered ◽  
The Future

Abstract:Clinical information systems, developed for specific disciplines, reinforce the fragmentation of patient care and fail to support integrated, patient centered approaches. Fundamental restructuring of systems development is required to prepare the health care system and the practice of nursing for the future.

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