Studies in health technology and informatics
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Stud Health Technol Inform · Jan 2001
Sharable computer-based clinical practice guidelines: rationale, obstacles, approaches, and prospects.
Clinical practice guideline automation at the point of care is of growing interest, yet most guidelines are authored in unstructured narrative form. Computer-based execution depends on a formal structured representation, and also faces a number of other challenges at all stages of the guideline lifecycle: modeling, authoring, dissemination, implementation, and update. This is because of the multiplicity of conceptual models, authoring tools, authoring approaches, intended applications, implementation platforms, and local interface requirements and operational constraints. ⋯ Because of limitations in what can be done by a single team with finite resources, however, and the variety of additional perspectives that need to be accommodated, the InterMed team has determined that further development of a shared representation would be best served as an open process in which the world community is engaged. Under the auspices of the HL7 Decision Support Technical Committee, a GLIF Special Interest Group has been established, which is intended to be a forum for collaborative refinement and extension of a standard representation that can support the needs of the guideline lifecycle. Significant areas for future work will need to include demonstrations of effective means for incorporating guide-lines at point of care, reconciliation of functional requirements of different models and identification of those most important for supporting practical implementation, im-proved means for authoring and management of complexity, and methods for automatically analyzing and validating syntax, semantics, and logical consistency of guidelines.
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Stud Health Technol Inform · Jan 2001
Design of a consumer health record for supporting the patient-centered management of chronic diseases.
This paper describes and discusses the design and usage of a shareable consumer health record system to investigate whether these systems can assist in the management of chronic diseases. This web-based system that can be used both by care providers and patients contains medical and patient information, provides access to websites that contain quality information, provides guideline-based advice, allows discussion between patients and allows us to interrogate both patients and care providers on a regular basis in order to get a good impression of the utility of such a consumer record for both chronic patients and the physicians and nurses. A health record system that was developed for the area of Diabetes is presented as an example.
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An increase in interest in the establishment of telephone advice services has resulted in the proliferation of call centers. Despite their wide usage, research for the most part has not addressed the quality of care in relation to consumer satisfaction. This paper examines consumer outcomes of satisfaction, and follow-up with recommendations, within a framework of the nursing process and its associated components of assessment (including problem identification), care planning, intervention, and evaluation. ⋯ Exploratory regression analysis showed that the component of intervention was significantly related to consumer satisfaction. The present study pioneers the way to rate the quality of the advice nurses' interactions with consumers, and lays the groundwork for further investigations of health care provider behavior and consumer outcomes. Further studies are recommended to investigate predictors of consumer satisfaction, and cost-benefit in terms of consumer expenditures of time, funds, and energy.
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Stud Health Technol Inform · Jan 2001
Comparative StudyInformation needs in primary care: a survey of rural and nonrural primary care physicians.
To compare the self-reported information needs of rural and nonrural primary care physicians. ⋯ Rural and nonrural primary care physicians reported equal information needs, similar information seeking, and similar resource preferences. Rural physicians reported less access to some information resources, but little difference in use of resources. Further studies are needed to determine how these differences impact rural practitioners and their patients.
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Stud Health Technol Inform · Jan 2001
Ranking of information in the computerized problem-oriented patient record.
We propose a framework for a problem-oriented patient record for general practice 1 and defend that the problem-oriented medical record represents an intuitive way to organize the patient record. By adding a layer of knowledge to the electronic patient record the record system is able to better utilize the information stored in the record. If a record system is process aware, having knowledge of work processes and is able to distinguish between different contexts in use, the system can provide relevant and useful information during the handling of patients' medical problems. ⋯ Traces give valuable indications of what is going on during the process of patient care. Decision frames represents relevant contexts based on the information in the record. Both decision frames and traces provide an environment in which more optimal medical decisions can be made.