Journal of the American Medical Informatics Association : JAMIA
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J Am Med Inform Assoc · May 2007
Reevaluating recovery: perceived violations and preemptive interventions on emergency psychiatry rounds.
Contemporary error research suggests that the quest to eradicate error is misguided. Error commission, detection, and recovery are an integral part of cognitive work, even at the expert level. In collaborative workspaces, the perception of potential error is directly observable: workers discuss and respond to perceived violations of accepted practice norms. As perceived violations are captured and corrected preemptively, they do not fit Reason's widely accepted definition of error as "failure to achieve an intended outcome." However, perceived violations suggest the aversion of potential error, and consequently have implications for error prevention. This research aims to identify and describe perceived violations of the boundaries of accepted procedure in a psychiatric emergency department (PED), and how they are resolved in practice. ⋯ The analysis of perceived violations expands the data available for error analysis beyond occasional reported adverse events. These data are prospective: responses are captured in real time. This analysis supports a set of recommendations to improve the quality of care in the PED and other critical care contexts.
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J Am Med Inform Assoc · May 2007
A longitudinal social network analysis of the editorial boards of medical informatics and bioinformatics journals.
The goal of this research is to learn how the editorial staffs of bioinformatics and medical informatics journals provide support for cross-community exposure. Models such as co-citation and co-author analysis measure the relationships between researchers; but they do not capture how environments that support knowledge transfer across communities are organized. ⋯ Social network analysis methods provide insight into the relationships between the medical informatics and bioinformatics communities. The number of editorial board members facilitating the publication intersection of the communities has grown, but the intersection remains dependent on a small group of individuals and fragile.
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J Am Med Inform Assoc · Mar 2007
Linking surveillance to action: incorporation of real-time regional data into a medical decision rule.
Broadly, to create a bidirectional communication link between public health surveillance and clinical practice. Specifically, to measure the impact of integrating public health surveillance data into an existing clinical prediction rule. We incorporate data about recent local trends in meningitis epidemiology into a prediction model differentiating aseptic from bacterial meningitis. ⋯ Epidemiological contextual information can improve the performance of a clinical prediction rule. We provide a methodological framework for leveraging regional surveillance data to improve medical decision-making.
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Our goal is to assess how clinical information from previous visits is used in the emergency department. We used detailed user audit logs to measure access to different data types. ⋯ Data were accessed less than half the time (up to 20% to 50%) even when the user was alerted to the presence of data. Our access rate indicates that health information exchange projects should be conservative in estimating how often shared data will be used and the wide breadth of data accessed indicates that although a clinical summary is likely to be useful, an ideal solution will supply a broad variety of data.
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J Am Med Inform Assoc · Jan 2007
ReviewMedication-related clinical decision support in computerized provider order entry systems: a review.
While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs. To realize the medication-related benefits of CDS within CPOE, one must overcome significant challenges. ⋯ Advanced decision support includes dosing support for renal insufficiency and geriatric patients, guidance for medication-related laboratory testing, drug-pregnancy checking, and drug-disease contraindication checking. In this paper, the authors outline some of the challenges associated with both basic and advanced decision support and discuss how those challenges might be addressed. The authors conclude with summary recommendations for delivering effective medication-related clinical decision support addressed to healthcare organizations, application and knowledge base vendors, policy makers, and researchers.