The clinical application of mobile technology to disaster medicine

Mobile health care technology (mHealth) has the potential to improve communication and clinical information management in disasters. This study reviews the literature on health care and computing published in the past five years to determine the types and efficacy of mobile applications available to disaster medicine, along with lessons learned. Five types of applications are identified: (1) disaster scene management; (2) remote monitoring of casualties; (3) medical image transmission (teleradiology); (4) decision support applications; and (5) field hospital information technology (IT) systems. Most projects have not yet reached the deployment stage, but evaluation exercises show that mHealth should allow faster processing and transport of patients, improved accuracy of triage and better monitoring of unattended patients at a disaster scene. Deployments of teleradiology and field hospital IT systems to disaster zones suggest that mHealth can improve resource allocation and patient care. The key problems include suitability of equipment for use in disaster zones and providing sufficient training to ensure staff familiarity with complex equipment. Future research should focus on providing unbiased observations of the use of mHealth in disaster medicine. Case T , Morrison C , Vuylsteke A . The clinical application of mobile technology to disaster medicine. Prehosp Disaster Med. 2012;27(5):1-9.     

Telemedicine: Technology versus the business case

Summary. The implementation of telemedicine is spreading throughout the government and commercial sectors. Telemedicine is being implemented in an effort to contain costs and capture all medically related business in a given catchment area. Telemedicine and off-the-shelf DICOM teleradiology systems can allow for patient images and demographic data to be transmitted electronically over telecommunications lines from satellite clinics to medical centres. The technology allows virtual centres of excellence to be extended to the medical community which provide the expertise and training of physicians to remote sites, while realizing cost savings. The technology to implement telemedicine is available today but it can be very costly if the business case for the system is not carefully evaluated and executed. The decision to implement a telemedicine system must be based upon the business case which supports expenditures by realizing cost savings through prudent selection of technology and medical business practices.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

Introduction to Picture Archive and Communication Systems

Picture Archive and Communication Systems (PACS) are comprehensive management systems for diagnostic imaging studies that are increasingly used in hospitals and health care systems. It is essential for PACS to be an integrated part of the total hospital electronic information system in order to be maximally effective. The main objective of any new information system in health care is to improve the effectiveness and efficiency of health care. Although the initial implementation of PACS is costly, the ability for care providers to have faster access to diagnostic imaging information allows care to be delivered more expediently, which improves the overall quality of care patients receive. Nurses will have the ability to see images, rather than just reports about imaging studies. An electronic system for diagnostic imaging procedures and management provides nurses with unique opportunities to improve their involvement in clinical discussions, their ability to provide quality patient care, and potential to further nursing research.     

Remote access to critical care

As we all begin to focus more on errors in medicine, telemedicine applications will expand. Remote access to experts will be required. Although telemedicine has always existed as a component of medicine, it was usually designed for niche areas. Telemedicine consists of information sharing between at least two physically and geographically disparate sites for educational or health purposes. Although telemedicine in the intensive care unit may at first seem absurd to many clinicians, most care providers have, in fact, used some form of telemedicine to provide care for decades. All of us have managed patients by telephone communication with nurses, residents, or other physicians. Besides augmenting routine care in the intensive care unit, telemedicine is providing essential tools that improve the efficiency of health care communication and add safety for the health care provider by making health care available under less than ideal circumstances, such as a terrorist attack with biologic weapons. The future appears quite bright for telemedicine systems, but much work is still required. How payers, lawyers, and ethicists view telemedicine is not yet completely understood. As intensivists, we should expect our practice to be directly impacted by this maturing technology. We should wholeheartedly embrace it and help lead its use in this new millennium.     

A picture archival and communication system shortens delays in obtaining radiographic information in a medical intensive care unit

OBJECTIVE: To assess whether variables such as unit occupancy and aggregate severity of illness that reflect increased work demands on physicians in medical intensive care units (MICU) are associated with increased delays in their obtaining information about nonroutine chest radiographic examinations. To determine whether the presence of a picture archiving and communication system (PACS) workstation in the MICU shortens those delays. DESIGN: A prospective cohort study stratified for presence or absence of PACS. SETTING: MICU of a university hospital. PATIENTS: A total of 118 patients admitted to the MICU who had nonroutine bedside chest radiographs. MEASUREMENTS AND MAIN RESULTS: Multivariate analyses were conducted to determine how unit occupancy, patient acuity, the time of day the examination was taken, and the presence of a PACS workstation influenced the time from radiographic examination completion to the time when MICU physicians first obtained image information. In a multivariate analysis, patient acuity, unit occupancy, the aggregate level of severity of illness in the study cohort, whether the examination was taken at night or day, and the presence of a PACS workstation were significant predictors of the elapsed time from examination completion until review by MICU physicians. Without the PACS workstation, higher occupancy, higher aggregate severity of illness, and examinations taken during the day were associated with longer delays. Overall, the multivariate analysis showed a 24-min decrease in the elapsed time to obtain information during periods with the PACS workstation compared with periods without the workstation (p = .03). CONCLUSIONS: A PACS workstation significantly decreased the delays in obtaining image information that occurred with high unit occupancy and high aggregate severity of illness and may improve unit efficiency under conditions of high physician workload.     

基于虚拟网络计算技术的远程放射学诊断系统的建立

目的 建立基于虚拟网络计算技术、遵从DICOM协议的远程放射学诊断系统。方法 运用VC++6.0、Leadtools开发包、VNC源码在Windows 2000操作系统中开发。结果 本系统在Internet网和广域网环境下成功地实现了远程放射学影像的采集、浏览、处理、诊断与书写图文报告功能,在实际应用中取得了良好的效果。结论 基于VNC技术开发的远程放射学系统交互速度快、实时性强、影像清晰度好,在低带宽的网络条件下也能具备优异的速度和性能。本系统能够提升放射诊断学的信息化与网络化水平,促进放射学的远程交流,具有广阔的应用前景和推广价值。     

Interprofessional education: Lessons learned from conducting an electronic health record assignment

Abstract

Ineffective collaboration and communication contribute to fragmented patient care and potentially increase adverse events, clinical errors, and poor patient outcomes. Improving collaboration and communication is essential; however, interprofessional education (IPE) supporting this cause is not a common practice. Most often healthcare profession students are educated in profession-centered silos limiting opportunities to develop effective communication and collaboration practices. Students from nursing, health informatics, and radiologic technology collaboratively populated an academic electronic health record (AEHR) using fictitious case study data. The assignment was designed to address the Quality and Safety Education for Nurses and IPE Collaborative competencies. The objective was to evaluate students’ informatics competency, teamwork behaviors, and communication skills while exploring the different roles and responsibilities for collaborative practice after participating in an interprofessional case study assignment. Students gained experience using the AEHR for data entry, analysis, and application increasing their informatics competency. The assignment required students to communicate and actively collaborate as an interprofessional team to achieve the assignment objectives. Clinical errors often occur during care transitions, so simulating this process in the assignment was essential. Nursing and radiologic technology students had to analyze patient data and develop a hand-off communication template supporting patient safety and optimizing outcomes. The assignment required students to work as an interprofessional team and demonstrate how communication and collaboration is an essential component to quality and safe patient care.     

History and Trends in Clinical Information Systems in the United States

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.     

Tecnological standards of teleradiology function in orthopedics and trauma care

Digital Image is a relatively new quality in orthopedic diagnostics, which allows transmitting the image instead of the patient. Digital or digitized image can be transmitted via Internet, e-mail or local net. Observations derived form literature and own experience indicate that teleradiology may effectively provide radiologic consultation or even improve the detailed radiologic evaluation. This article describes sufficiently the technologic problems of teleradiology and explains terminology used for this branch, what allows understanding the fundamentals of teleradiology even for person having little technical and informatics knowledge. Authors describe equipment demands and standards of function for teleradiologic services.     

Getting work done: a grounded theory study of resident physician value of nursing communication

ABSTRACT

Poor communication between nurses and physicians results in patient injury and increased healthcare costs. While multiple attempts have been made to improve communication between the two professions, evidence confirms little progress has been made. Previous research focused on standardizing communication processes and protocols between nurses and physicians rather than examining the relational component of these human interactions. The purpose of this study was to explore physician valuing of nursing communication in the context of patient care. Interviews were conducted with 15 internal medicine resident physicians. A constructivist grounded theory approach was used to develop the substantive theory of Getting Work Done. Getting Work Done incorporated three major categories: discerning the team, shifting communication, and accessing nurse knowledge and abilities. Hierarchical behaviors and language, and nurse collusion in both, characterized nurse-physician communication and situated the nurse outside the decision-making team. Complex work environments further devalued nurse-physician communication. Interprofessional education and practice must advance the unique and essential role of all health care professionals such that mutual valuing replaces hierarchical actions with collaborative systems for determining the most effective approaches to patient care.     

Multiple shift patient classification: is it necessary?

Efficient, cost-effective patient classification systems are an essential component of information needed for staffing projections, budgeting, productivity monitoring, and determining the cost of nursing services. Data collection on every shift is typical of GRASP-based patient classification systems. In this study, comparisons among multiple shift measurements showed that no relevant information was being gained by multiple daily assessments of patient care requirements.     

The essential role of information management in point-of-care/critical care testing

Laboratory medicine is undergoing tremendous change in recent years driven primarily by technology, regulations, reimbursement, and market forces. In this paradigm shift, the laboratory is under tremendous pressure to adapt to new requirements for critical care testing. Indeed, laboratories have entered the information age where chemical data is being extracted from specimens in totally automated fashion. In the past, laboratory data has played a more historical role in the care of critically ill patients, arriving at the bedside too late to be of significant use in the active, ongoing care of the patient. However, today's physicians taking care of critically ill patients now require that laboratory results are made available in real-time and, if possible, at the patient's point-of-care. Many new testing point-of-care testing (POCT) devices have been developed to address this need however often laboratories implement such distributed devices with little or no attention to the information technology requirements. In fact, as little as 10% of point-of-care testing is actually managed by the central laboratory computer hence critically importance results are not found on the patient's electronic medical record. In addition, the billing and management data for point-of-care testing is often handled manually with no plans to interface point-of-care devices to the laboratory billing and management systems. Because of recent improvements of information handling and interface capability, such shortcomings in data management are no longer acceptable. Indeed, the demands for laboratories to utilize information technology are such that those laboratories with no overall plan for data management of critical care testing will probably not survive this market-driven paradigm. We present a discussion of the various approaches to computerization of point-of-care testing including the advantages and the disadvantages of each approach.     

Integration of computer-aided diagnosis/detection (CAD) results in a PACS environment using CAD–PACS toolkit and DICOM SR

Purpose  Picture Archiving and Communication System (PACS) is a mature technology in health care delivery for daily clinical imaging service and data management. Computer-aided detection and diagnosis (CAD) utilizes computer methods to obtain quantitative measurements from medical images and clinical information to assist clinicians to assess a patient’s clinical state more objectively. CAD needs image input and related information from PACS to improve its accuracy; and PACS benefits from CAD results online and available at the PACS workstation as a second reader to assist physicians in the decision making process. Currently, these two technologies remain as two separate independent systems with only minimal system integration. This paper describes a universal method to integrate CAD results with PACS in its daily clinical environment. Methods  The method is based on Health Level 7 (HL7) and Digital imaging and communications in medicine (DICOM) standards, and Integrating the Healthcare Enterprise (IHE) workflow profiles. In addition, the integration method is Health Insurance Portability and Accountability Act (HIPAA) compliant. Summary  The paper presents (1) the clinical value and advantages of integrating CAD results in a PACS environment, (2) DICOM Structured Reporting formats and some important IHE workflow profiles utilized in the system integration, (3) the methodology using the CAD–PACS integration toolkit, and (4) clinical examples with step-by-step workflows of this integration. Presented as “Tutorial on CAD–PACS integration” at: CARS 2007, Berlin, Germany, June 27–30, 2007; and CARS 2008, CARS 2008, Barcelona, Spain, June 25–28, 2008.     

PACS的临床应用

目的评价PACS系统在图像存储与传输方面的临床价值与效益.方法对SIEMENS公司出产的PACS系统在我院图像获取、贮存、传输网络中的应用进行临床评估.结果 PACS系统省时、可靠、方便、高效,可降低物品、人员耗费,减少不必要照射,在临床应用中取得良好效果,使医院的现代化、信息化建设迈上新台阶,满足医院整体数字化、网络化的要求.其缺点为投入较高.结论实现PACS系统,提高了医学影像保存的质量,为临床和教学工作提供了高效可靠的保证.     

Passing the clinical baton: 6 principles to guide the hospitalist

Hospitalist systems make it increasingly common for responsibility for a patient to be passed from one physician to another. During such transfers, patients' outcomes and satisfaction can benefit from better communication between hospitalists and the primary care physicians whose patients they care for. We propose 6 principles to guide such communication, to ensure that critical information about patients is not lost and to optimize the quality of care. We also discuss special considerations for patients discharged to a skilled nursing facility or to home with home care.     

Radiology goes filmless. What does this mean for primary care physicians?

Technical advances over the past few years have rapidly increased the possibilities for filmless radiology services provided by PACS. Such systems are also financially feasible for many healthcare practices, primarily because of the goals achieved through increased efficiency and improved patient care. In coming years, most medical facilities are likely to either convert or begin to convert to PACS as conventional film-based systems fade into the annals of medical history.     

Interactive microcomputer for acquisition of patient information

Written records and first-generation hospital information systems do not meet their primary purpose to assist physicians in solving patients' problems. Simply automating the present chart formats is not the answer. An example of the concept needed for charting is the intensive care unit chart. Anesthesiology charts provide little useful information for the continued care of the patient postoperatively. They serve principally as legal archival documents. Automation of the anesthesia record should free the anesthesiologist of the need to search for preoperative information and to manually record most information intraoperatively. Decisions about how much data to archive and how to extract the data pertinent to continuing care are the challenges for physicians. The technologic tools are available for the design and implementation of a software system that focuses on effective communication of the patient's problems throughout the perioperative period as the patient moves from ward to operating room, through the recovery room and intensive care unit, and to the ward and home.     

Improving communication in a pediatric intensive care unit using daily patient goal sheets

PURPOSE: The aim of the study was to determine if a pediatric intensive care unit (PICU) daily patient goal sheet would improve communication between health care providers and decrease length of stay (LOS). MATERIALS AND METHODS: We evaluated a daily patient goal sheet's impact on questionnaire-based measures of effectiveness of communication, nurses' knowledge of physicians in charge, and on LOS in the PICU. RESULTS: Four hundred nineteen questionnaires were completed by nurses and physicians before goal sheet implementation and 387 after implementation. Nurses and physicians perceived an improved understanding of patient care goals (P < .001), reported increased comfort in explaining patient care goals to parents (P < .001), and listed a higher number of patient care goals after goal sheet implementation (P < .01). Nurses identified the patient's attending physician and fellow with increased accuracy after goal sheet implementation (P < .001). Median PICU LOS was unchanged; however, mean LOS trended toward a reduction after goal sheet implementation (4.1 vs 3.7 days, P = .36). Seventy-six percent of respondents found the goal sheets helpful. CONCLUSIONS: Using a PICU daily patient goal sheet can improve communication between health care providers, help nurses identify the in-charge physicians, and be helpful for patient care. By explicitly documenting patient care goals, there is enhanced clarity of patient care plans between health care providers.     

Building managed care networks for rural communities

Managed health care networks in both urban and rural communities seek to improve quality, cost, and access; however, rural community health care systems must also curb patient outmigration. A primary care network (PCN) can effectively keep more of the patient care within the rural community. This PCN can then expand to include secondary contractual relationships with the rural community hospital and specialist physicians. As this expanded PCN affiliates with a tertiary provider network, an integrated delivery system (IDS) emerges. This enables the full health care service continuum to be managed by the rural primary care physicians. Such managed cooperation initiatives are best carried out as a joint effort between community employers and providers.