基于工作流的患者报告结局中国中心(PNC-China)信息化管理平台框架的初步构建

目的 初步构建基于工作流理念的患者报告结局测量信息系统中国中心(Patient-reported Outcomes Measurement Information System National Center-China,PNC-China)信息化管理系统,优化PNC-China的管理流程。方法 通过质性访谈了解PNC-China工作人员对信息化管理系统的构建需求及功能设想;结合工作流理论的三大要素,构建PNC-China信息化管理系统初步框架。结果 通过质性访谈,归纳提炼出PNC-China信息化管理需求的三大主题,即相关工作流程繁琐,急需信息化工具辅助;文件管理工具较落后,急需实现系统化、信息化管理;合作管理欠规范,急需实现标准化。结合需求及功能设想,构建出PNC-China信息化管理系统的3个功能框架,即PROMIS中文版翻译工作流程框架、临床检验工作流程框架及临床应用工作流程框架。结论贴合PNC-China工作内容和流程构建信息化管理系统框架,将有助于推动我国患者报告结局测量信息系统的相关研究和临床实践。     

Implementation of Electronic Medical Record in Vascular and Interventional Radiology

This article discusses the implementation of a new electronic medical record (EMR) on workflow in vascular interventional radiology (VIR) and briefly discusses the preparation for launching EMR system, obstacles, advantages, and disadvantages based on an electronic survey of employees in the VIR unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Launching the EMR system was preceded by 6-month period of a hospital-wide training introducing the new EMR system to all health care providers and associates. During this period, all hospital units were equipped with new computers, iPads, and special printers compatible with the new system. Integration of the radiology information system and new EMR was carefully conducted and monitored by the radiology team and new preprocedure and postprocedure order sets for every VIR procedure were uploaded to the system; these order sets helped in improving the quality of patient care and patient workflow in VIR. Intensive training of staff and “super users” was done in preparation for the actual launch of the system. On call clinical and information technology teams along with hotlines were available on the day of “Go Live” for troubleshooting.     

Dispatchers impression plus Medical Priority Dispatch System reduced dispatch centre times in cases of out of hospital cardiac arrest. Pre-alert – A prospective,cluster randomized trial

Aim of the study

Dispatch centre processing times for out-of-hospital cardiac arrest or critically ill patients should be as short as possible. A modified ‘pre-alert’ dispatch workflow might be able to improve the processing time.

Methods

Between October 2010 and May 2011 dispatch events, suspicious for cardiac arrest, were prospectively randomized in 24 h clusters. The emergency medical service of the intervention group got, based on the dispatchers impression, a ‘pre-alert’ alarm-message followed by the standard Medical Priority Dispatch System query whereas the control group did not.

Results

In 225 clusters 1500 events were eligible for analysis. Data are presented as median and 25–75 interquartile ranges. Per-protocol analysis demonstrated for the intervention group on ‘pre-alert’ days a median processing time of 143 s (109–187; n = 256) versus 198 s (167–255; n = 502) in the control group on non ‘pre-alert’ days, with a difference of 0.23 log-seconds (p < 0.001; 95% CI 0.74–0.28). In critical ill patients, intention-to-treat analysis showed for the intervention group a median of 168 s (131–264; n = 153) versus 239 s (176–309; n = 164) in the control group, with a difference of 1.4 log-seconds (p < 0.001; 95% CI 1.25–1.55).

Conclusion

Dispatch times can effectively be reduced in cases of out-of-hospital cardiac arrest or critical ill patients with a ‘pre-alert’ dispatch workflow in combination with the Medical Priority Dispatch System protocol. This might play an important role in improving patient care.     

本体构建工具Py2ONTO的设计与实现

目的：开发一个简单易用的本体构建工具Py2ONTO,探索人工方式和自动化方式相结合的本体构建方案。方法：通过将Owlready常用的底层函数封装为功能函数,在此基础上设计一个基于CSV模板的自动构建本体的流程,并在代码中提供功能函数的调用,通过BioPortal、MedPortal等本体数据库实现术语映射功能。结果：开发了基于Python的本体建设工具Py2ONTO,该工具可以通过命令行方式及Python脚本调用功能函数方式构建本体。通过该工具构建了两个本体,测试结果证明本文构建的本体满足其术语覆盖度和可推理性评估要求。结论：为本体构建提供了一种较为简单且可靠的选择,有助于科研人员构建高质量的本体。     

IRB reliance: An informatics approach

Multi-site Institutional Review Board (IRB) review of clinical research projects is an important but complex and time-consuming activity that is hampered by disparate non-interoperable computer systems for management of IRB applications. This paper describes our work toward harmonizing the workflow and data model of IRB applications through the development of a software-as-a-service shared-IRB platform for five institutions in South Carolina. Several commonalities and differences were recognized across institutions and a core data model that included the data elements necessary for IRB applications across all institutions was identified. We extended and modified the system to support collaborative reviews of IRB proposals within routine workflows of participating IRBs. Overall about 80% of IRB application content was harmonized across all institutions, establishing the foundation for a streamlined cooperative review and reliance. Since going live in 2011, 49 applications that underwent cooperative reviews over a three year period were approved, with the majority involving 2 out of 5 institutions. We believe this effort will inform future work on a common IRB data model that will allow interoperability through a federated approach for sharing IRB reviews and decisions with the goal of promoting reliance across institutions in the translational research community at large.     

Stem Cell Transplantation and Informatics: Current Considerations

Informatics strategies and applications available to stem cell transplant (SCT) programs are diverse and changing rapidly. Although most hospitals have electronic medical records (EMRs), few are equipped with specialized SCT applications. Most EMRs do not contain critical elements to support SCT practice and research. Strategies to optimize information technology resources to support SCT programs are reviewed and technical and workflow support discussed. Guidance and rationale for the use of both SCT applications and EMRs are emphasized.     

睡眠监测流程中问题分析与对策

目的:调查睡眠监测室中人员配备和工作状态,探索适合各级医院睡眠监测工作流程,为制定规范睡眠监测工作流程,为培养结构合理的睡眠技师队伍,确保睡眠监测技术适合中国国情正常发展提供参考依据.方法:调查27家医院的睡眠监测室的人员配备和工作现状,对10家医院190份睡眠报告逐项分析.结果:27家医院的睡眠监测室中人员配备情况,三级以上医院15家,其中9(33%)家医院有固定技师同时配备有研究生、博士生;6(22%)家三级医院和12(44%)家二级医院是由兼职工作人员资质分别为医师、护士、非医学专业外聘技师和导师带领下的学生身份完成工作;定岗情况,17(62.9%)家医院以全职护师身份完成监测工作,4(15%)家医院是医生兼值完成,3(11%)家二级医院是由夜班护师轮岗兼职承担;1(4%)家医院完全是在校研究生承担睡眠检测.190份睡眠监测报告显示,睡眠监测项目和报告内容不统一.结论:依据各自医院的临床需求,通过加强睡眠监测中的管理达到实施切合自己医院情况的工作流程.     

The future progress of teleradiology—An empirical study in Sweden

This paper describes a novel teleradiology solution, its services and graphical user interfaces (GUIs), and the strategic decisions taken in the development of the services. The novel services are embedded in a radiology information infrastructure in Västra Götalandsregionen (VGR), Sweden. The application is fully integrated with all different RIS and PACS systems in the region and interconnected through the radiology information infrastructure. In practice, the solution offers new ways of collaborating through information sharing within a region. Knowledge can be used collectively to improve the radiology workflow and its outcomes for clinicians and patients. The new shared approach marks the beginning of a change from local to enterprise workflow. The challenges are to develop useful and secure services for different groups related to the radiological information infrastructure. It involves continuous negotiation with people concerning how they should collaborate within the region. The need for teleradiology as a service provided “by somebody” has disappeared in VGR; today it is a shared service embedded in the innovative radiology information infrastructure. This infrastructure is just a starting point for a novel and limitless telemedicine service including limitless healthcare actors and activities. The method applied for this study was action research. The study was carried out in collaboration between practitioners and researchers.     

Interventional Radiology Workflow Management in the Electronic Medical Record

The electronic medical record (EMR) has significantly improved efficiency in many areas of radiology workflow. Following implementation of an electronic protocol selection process for cross-sectional imaging at the University of Colorado Hospital, the interventional radiology (IR) division desired to have a similar tool. Evaluation of the IR workflow demonstrated the need for a multilayered solution, which accounted for consultation, physician review, authorization and scheduling, pre-procedural nursing evaluation, physician rounding, and resource allocation and prioritization. This paper outlines the rationale for and components of this process.