Clinical Information Systems (clinical + information_systems)

Distribution by Scientific Domains


Selected Abstracts


Clinical Information Systems: Instant Ubiquitous Clinical Data for Error Reduction and Improved Clinical Outcomes

ACADEMIC EMERGENCY MEDICINE, Issue 11 2004
Craig F. Feied MD
Abstract Immediate access to existing clinical information is inadequate in current medical practice; lack of existing information causes or contributes to many classes of medical error, including diagnostic and treatment error. A review of the literature finds ample evidence to support a description of the problems caused by data that are missing or unavailable but little evidence to support one proposed solution over another. A primary recommendation of the Consensus Committee is that hospitals and departments should adopt systems that provide fast, ubiquitous, and unified access to all types of existing data. Additional recommendations cover a variety of related functions and operational concepts, from backups and biosurveillance to speed, training, and usability. [source]


History and Trends in Clinical Information Systems in the United States

JOURNAL OF NURSING SCHOLARSHIP, Issue 1 2001
Nancy Staggers
Purpose: To provide a synopsis of issues about clinical information systems for nurses not schooled in nursing informatics. Organizing construct: The past, present, and future of clinical computing, including major factors resulting in the early hospital information systems (HIS) and decision support systems (DSS) in the United States, current advances and issues in managing clinical information, and future trends and issues. Methods: Literature review and analysis. Findings and Conclusions: The first HIS and DSS were used in the late 1960s and were focused on applications for acute care. The change from fee-for-service to managed care required a change in the design of clinical information systems toward more patient-centered systems that span the care continuum, such as the computer-based patient record (CPR). Current difficulties with CPR systems include lack of systems integration, data standardization, and implementation. Increased advances in information and technology integration and increased use of the Internet for health information will shape the future of clinical information systems. [source]


Multilevel Analysis of the Chronic Care Model and 5A Services for Treating Tobacco Use in Urban Primary Care Clinics

HEALTH SERVICES RESEARCH, Issue 1 2009
Dorothy Y. Hung
Objective. To examine the chronic care model (CCM) as a framework for improving provider delivery of 5A tobacco cessation services. Methods. Cross-sectional surveys were used to obtain data from 497 health care providers in 60 primary care clinics serving low-income patients in New York City. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate the probability of full 5A service delivery, adjusting for provider covariates and clustering effects. We examined associations between provider delivery of 5A services, clinic implementation of CCM elements tailored for treating tobacco use, and the degree of CCM integration in clinics. Principal Findings. Providers practicing in clinics with enhanced delivery system design, clinical information systems, and self-management support for cessation were 2.04,5.62 times more likely to perform all 5A services ( p<.05). CCM integration in clinics was also positively associated with 5As delivery. Compared with none, implementation of one to six CCM elements corresponded with a 3.69,30.9 increased odds of providers delivering the full spectrum of 5As ( p<.01). Conclusions. Findings suggest that the CCM facilitates provider adherence to the Public Health Service 5A clinical guideline. Achieving the full benefits of systems change may require synergistic adoption of all model components. [source]


Interview with a Quality Leader: Dr. Ashish Jha

JOURNAL FOR HEALTHCARE QUALITY, Issue 5 2010
Kevin C. Park
Abstract: Dr. Jha is an Associate Professor of Medicine at Harvard Medical School. The major themes of his research are: 1. Quality of care provided by healthcare systems, with a focus on healthcare disparities as a marker of poor care. 2. Information technology among other tools as potential solutions for reducing medical errors and disparities while improving overall quality. 3. Organizations that provide care for minorities and underserved populations and the role clinical information systems can play in improving their care. [source]


History and Trends in Clinical Information Systems in the United States

JOURNAL OF NURSING SCHOLARSHIP, Issue 1 2001
Nancy Staggers
Purpose: To provide a synopsis of issues about clinical information systems for nurses not schooled in nursing informatics. Organizing construct: The past, present, and future of clinical computing, including major factors resulting in the early hospital information systems (HIS) and decision support systems (DSS) in the United States, current advances and issues in managing clinical information, and future trends and issues. Methods: Literature review and analysis. Findings and Conclusions: The first HIS and DSS were used in the late 1960s and were focused on applications for acute care. The change from fee-for-service to managed care required a change in the design of clinical information systems toward more patient-centered systems that span the care continuum, such as the computer-based patient record (CPR). Current difficulties with CPR systems include lack of systems integration, data standardization, and implementation. Increased advances in information and technology integration and increased use of the Internet for health information will shape the future of clinical information systems. [source]


Using the chronic care model to tackle depression among older adults who have long-term physical conditions

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2007
P. MCEVOY phd bsc
Effective psychological and pharmacological treatments are available, but for depressed older adults with long-term physical conditions, the outcome of routine care is generally poor. This paper introduces the chronic care model, a systemic approach to quality improvement and service redesign, which was developed by Ed Wagner and colleagues. The model highlights six key areas that need to be addressed, if depression is to be tackled more effectively in this neglected patient group: delivery system design, patient,provider relationships, decision support, clinical information systems, community resources and healthcare organization. Three influential programmes, the Improving Mood Promoting Access to Collaborative Treatment programme, the Prevention of Suicide in Primary Care Elderly Collaborative Trial, and the Program to Encourage Active, and Rewarding Lives for Seniors, have shown that when the model is adopted, significant improvements in outcomes can be achieved. The paper concludes with a case study, which illustrates the difference that adopting the chronic care model can make. Radical changes in working practices may be required, to implement the model in practice. However, Greg Simon, a leading researcher in the field of depression care, has suggested that there is already sufficient evidence to justify a shift in emphasis from research towards dissemination and implementation. [source]


Informatics and Knowledge Translation

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Michael J. Bullard MD
To ensure that the benefits of knowledge translation synthesis are accessible to care providers at the point of decision-making, fast, efficient, usable clinical information systems are required. Medical informatics appears to hold the greatest promise to be able to create systems with the necessary capacity and functionality. Emergency medicine needs to be actively engaged at all levels of the process. This includes driving the development and filtering of emergency-specific synopses and summaries. It requires advocating for hardware and software that suit the needs of the emergency department environment. It is increasingly important to educate and participate on committees with funders and policy-makers to ensure they support this growing evolution. To determine the outcome of these initiatives, careful evaluation is required to inform the discussion. End-users need to be actively involved in the development and usability testing of clinical information retrieval technology and clinical decision-support systems and make certain relevant best evidence is readily accessible and formatted to meet the needs of the working emergency physician. The integration of knowledge translation into clinical practice, and the impact of delivering electronic clinical decision-support, requires methodologically sound studies to confirm or refute its benefits and guide future development of medical informatics. [source]


Public Health Considerations in Knowledge Translation in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Steven L. Bernstein MD
Effective preventive and screening interventions have not been widely adopted in emergency departments (EDs). Barriers to knowledge translation of these initiatives include lack of knowledge of current evidence, perceived lack of efficacy, and resource availability. To address this challenge, the Academic Emergency Medicine 2007 Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake," convened a public health focus group. The question this group addressed was "What are the unique contextual elements that need to be addressed to bring proven preventive and other public health initiatives into the ED setting?" Public health experts communicated via the Internet beforehand and at a breakout session during the conference to reach consensus on this topic, using published evidence and expert opinion. Recommendations include 1) to integrate proven public health interventions into the emergency medicine core curriculum, 2) to configure clinical information systems to facilitate public health interventions, and 3) to use ancillary ED personnel to enhance delivery of public health interventions and to obtain successful funding for these initiatives. Because additional research in this area is needed, a research agenda for this important topic was also developed. The ED provides medical care to a unique population, many with increased needs for preventive care. Because these individuals may have limited access to screening and preventive interventions, wider adoption of these initiatives may improve the health of this vulnerable population. [source]


Review: evaluating information systems in nursing

JOURNAL OF CLINICAL NURSING, Issue 5 2008
Cristina Oroviogoicoechea MSc
Aims., To review existing nursing research on inpatient hospitals' information technology (IT) systems in order to explore new approaches for evaluation research on nursing informatics to guide further design and implementation of effective IT systems. Background., There has been an increase in the use of IT and information systems in nursing in recent years. However, there has been little evaluation of these systems and little guidance on how they might be evaluated. Methods., A literature review was conducted between 1995 and 2005 inclusive using CINAHL and Medline and the search terms ,nursing information systems', ,clinical information systems', ,hospital information systems', ,documentation', ,nursing records', ,charting'. Results., Research in nursing information systems was analysed and some deficiencies and contradictory results were identified which impede a comprehensive understanding of effective implementation. There is a need for IT systems to be understood from a wider perspective that includes aspects related to the context where they are implemented. Conclusions., Social and organizational aspects need to be considered in evaluation studies and realistic evaluation can provide a framework for the evaluation of information systems in nursing. Relevance to clinical practice., The rapid introduction of IT systems for clinical practice urges evaluation of already implemented systems examining how and in what circumstances they work to guide effective further development and implementation of IT systems to enhance clinical practice. Evaluation involves more factors than just involving technologies such as changing attitudes, cultures and healthcare practices. Realistic evaluation could provide configurations of context-mechanism-outcomes that explain the underlying relationships to understand why and how a programme or intervention works. [source]