Journal of the American Medical Informatics Association : JAMIA
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J Am Med Inform Assoc · Jul 2004
ReviewA consensus action agenda for achieving the national health information infrastructure.
Improving the safety, quality, and efficiency of health care will require immediate and ubiquitous access to complete patient information and decision support provided through a National Health Information Infrastructure (NHII). ⋯ Attendees favored a public-private coordination group to guide NHII activities, provide education, share resources, and monitor relevant metrics to mark progress. They identified financial incentives, health information standards, and overcoming a few important legal obstacles as key NHII enablers. Community and regional implementation projects, including consumer access to a personal health record, were seen as necessary to demonstrate comprehensive functional systems that can serve as models for the entire nation. Finally, the participants identified the need for increased funding for research on the impact of health information technology on patient safety and quality of care. Individuals, organizations, and federal agencies are using these consensus recommendations to guide NHII efforts.
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J Am Med Inform Assoc · Mar 2004
Do clinicians use online evidence to support patient care? A study of 55,000 clinicians.
To determine clinicians' (doctors', nurses', and allied health professionals') "actual" and "reported" use of a point-of-care online information retrieval system; and to make an assessment of the extent to which use is related to direct patient care by testing two hypotheses: hypothesis 1: clinicians use online evidence primarily to support clinical decisions relating to direct patient care; and hypothesis 2: clinicians use online evidence predominantly for research and continuing education. ⋯ Clinicians' online evidence use increases with patient admissions, supporting the hypothesis that clinicians' use of evidence is related to direct patient care. Patterns of evidence use and clinicians' self-reports also support this hypothesis.
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J Am Med Inform Assoc · Nov 2003
Effects of scanning and eliminating paper-based medical records on hospital physicians' clinical work practice.
It is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. The authors have evaluated the physicians' clinical work practices and attitudes toward a system in a hospital that has eliminated the paper-based counterpart using scanning technology. ⋯ Scanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage toward fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.
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J Am Med Inform Assoc · Sep 2003
Comparative StudyComparing paper-based with electronic patient records: lessons learned during a study on diagnosis and procedure codes.
Paper-based and electronic patient records generally are used in parallel to support different tasks. Many studies comparing their quality do not report sufficiently on the methods used. Few studies refer to the patient. ⋯ The lessons learned from this study are that medical professionals should be cognizant of the possible discrepancies between paper and electronic information and look toward combining information from both records whenever appropriate. The inadequate methodology (transformations done by a single individual) used in the authors' study is typical of other studies in the field. The limited generalizability and restricted reproducibility of this commonly used approach emphasize the need to improve methods for comparing paper-based with electronic versions of a patient's chart.
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J Am Med Inform Assoc · Jul 2003
Electronically screening discharge summaries for adverse medical events.
Detecting adverse events is pivotal for measuring and improving medical safety, yet current techniques discourage routine screening. The authors hypothesized that discharge summaries would include information on adverse events, and they developed and evaluated an electronic method for screening medical discharge summaries for adverse events. ⋯ Medical discharge summaries contain information regarding adverse events. Electronic screening of discharge summaries for adverse events using keyword searches is feasible but thus far has poor specificity. Nonetheless, computerized clinical narrative screening methods could potentially offer researchers and quality managers a means to routinely detect adverse events.