Update on digital image management and PACS

Information technology is becoming a vital component of all health care enterprises, from managed care services to large hospital networks, that provides the basis of electronic patient records and hospital-wide information. The rationale behind such systems is deceptively simple: physicians want to sit down at a single workstation and call up all information, both clinical data and medical images, concerning a given patient. Picture archiving and communication systems (PACS) are responsible for solving the problem of acquiring, transmitting, and displaying radiologic images. The major benefit of PACS resides in its ability to communicate images and reports to referring physicians in a timely and reliable fashion. With the changes in economics and the shift toward managed and capitated care, the teleradiology component of PACS is rapidly gaining momentum. In allowing remote coverage of multiple sites by the same radiologists and remote consultations and expert opinion, teleradiology is in many instances the only option to maintain economically viable radiologic settings. The technical evolution toward more integrated systems and the shift toward Web-based technology is rapidly merging the two concepts of PACS and teleradiology in global image management and communication systems.     

Making the case for a clinical information system: the chief information officer view

Adequate decision support for clinicians and other caregivers requires accessible and reliable patient information. Powerful societal and economic forces are moving us toward an integrated, patient-centered health care information system that will allow caregivers to exchange up-to-date patient health information quickly and easily. These forces include patient safety, potential health care cost savings, empowerment of consumers (and their subsequent demands for quality), new federal policies, and growing regional health care initiatives. Underspending on health care information technologies has gone on for many years; and the creation and implementation of a comprehensive clinical information system will entail many difficulties, particularly in regard to patients' privacy and control of their information, standardization of electronic health records, cost of adopting information technology, unbalanced financial incentives, and the varying levels of preparation across caregivers. There will also be potential effects on the physician-patient relationship. Ultimately, an integrated system will require a concerted transformation of the health care industry that is akin to what the banking industry has accomplished with electronic automation. Critical care units provide a good starting point for how information system technologies can be used and electronic patient information collected, although the robust systems designed for intensive care units are not always used to their potential.     

Information technology in nursing: using the decision-making support system in the OPD nursing instruction information system

In line with Department of Health promotion of electronic medical records, health care institutions have increased their information technology facilities in order to improve medical quality and patient safety, streamline healthcare procedures, reduce hospital management costs, and increase the use of statistical analysis in medical teaching, research and administration. However, applying information technology must consider many factors apart from system design and development. Such other factors include effectiveness in reducing user reliance on memory faculties, ability to streamline work processes, and capacity to recommend viable decisions. This paper provides an example of the nursing instruction information system deployment process. In addition to describing the development and implementation, applications of patient education and nursing decision-making are also presented. It is hoped that this experience may serve as reference to other healthcare institutions in the process of building nursing information systems.     

The role of health informatics in clinical audit: part of the problem or key to the solution?

The concepts of quality assurance (for which clinical audit is an essential part), evaluation and clinical governance each depend on the ability to derive and record measurements that describe clinical performance. Rapid IT developments have raised many new possibilities for managing health care. They have allowed for easier collection and processing of data in greater quantities. These developments have encouraged the growth of quality assurance as a key feature of health care delivery. In the past most of the emphasis has been on hospital information systems designed predominantly for the administration of patients and the management of financial performance. Large, hi-tech information system capacity does not guarantee quality information. The task of producing information that can be confidently used to monitor the quality of clinical care requires attention to key aspects of the design and operation of the audit. The Myocardial Infarction National Audit Project (MINAP) utilizes an IT-based system to collect and process data on large numbers of patients and make them readily available to contributing hospitals. The project shows that IT systems that employ rigorous health informatics methodologies can do much to improve the monitoring and provision of health care.     

Medical informatics in the intensive care unit: overview of technology assessment

Effective patient care in the intensive care unit (ICU) depends on the ability of clinicians to process large amounts of clinical and laboratory data. Recently, medical informatics applications have been developed to store and display patient information and assist clinical decision making. Despite the proliferation of these systems and their potential to improve patient care, there are no comprehensive health technology assessments incorporating considerations of safety, functionality, technical performance, clinical effectiveness, economics, and organizational implications. The objectives and methods of informatics evaluations depend on the type of application and the stage of development. Qualitative and quantitative nonrandomized evaluations of comprehensive information management systems like electronic medical records and picture archiving and communications systems should concentrate on technical and functional issues. Specific applications like clinical decision support systems and computerized patient care systems are designed to improve patient outcomes and clinical performance; randomized controlled trials (RCTs) to assess clinical effectiveness are important in their assessment. Although studies of these applications in the ICU setting are increasing, there are currently very few published randomized trials.     

Clinical information systems and the electronic medical record in the intensive care unit

The integration of computers into critical care is by no means a new concept. Clinical information systems have evolved in the critical care setting over the past three decades. Their use by critical care healthcare providers has increased exponentially in the past few years. More recently, with the advent of the electronic medical record, clinicians in the ICU may obtain and share useful information both bedside and remotely. Clinical information systems and the electronic medical record in the ICU have the potential to improve medical record movement problems, to improve quality and coherence of the patient care process, to automate guidelines and care pathways, and to assist in clinical care and research, outcome management, and process improvement. In this article, we provide some historical background on the clinical information system and the electronic medical record and describe their current utilization in the ICU and their role in the practice of critical care medicine in decades to come.     

PS1-51: Effect of Integrated Health Information Exchange on the Duplication of Radiological Services

Background/Aims Unnecessary duplication of diagnostic procedures such as x-rays increases healthcare costs and jeopardizes patient safety. Electronic health records (EHRs) have the potential to reduce unnecessary duplication of diagnostic studies by improving timely access to the original test results. However, when follow-up care occurs in a different institutional setting, providers may not have access to the same EHR. In such cases, electronic health information exchange (HIE) could improve the quality and timeliness of information available to the follow-up provider, thereby reducing the need to order duplicative diagnostic tests. Our primary goal in this work was to determine if members with diagnoses of bone fractures were less likely to receive follow-up x-rays when findings from the initial diagnostic imaging study were available in the electronic health record. Our secondary goal was to estimate the economic costs and patient safety repercussions of duplicate imaging studies. Methods This retrospective cohort study of Kaiser Permanent members in the Mid-Atlantic States (KPMAS) compared the rate of duplicate x-rays in patients with a diagnosis of bone fractures from the Emergency Department (ED) or from outpatient care between 2006 and 2010. We used the Medicare fee schedule to estimate costs for the total episode of care. We estimated radiation exposure by identifying all relevant radiology procedures during the two months following the index event and assigning radiation levels based on published estimates for each procedure. Results The study included approximately 50,000 patients from KPMAS with a bone fractures diagnosis. 20% of patients were initially seen in the ED, while 80% of patients were seen in outpatient care. Patients initially seen at a KPMAS outpatient facility were more likely than patients initially seen in the ED to have x-ray findings recorded in the KPMAS EHR prior to their follow-up visit. These patients were also significantly less likely to have duplicated (same or similar) radiology procedures ordered at follow-up visits. Discussion When the findings from preliminary imaging studies are available in the EHR, providers are less likely to order similar x-rays at follow-up visits. This reduction in duplicate radiology procedures significantly reduces costs and increases patient safety.     

Possibilities and Implications of Using the ICF and Other Vocabulary Standards in Electronic Health Records

There is now widespread recognition of the powerful potential of electronic health record (EHR) systems to improve the health‐care delivery system. The benefits of EHRs grow even larger when the health data within their purview are seamlessly shared, aggregated and processed across different providers, settings and institutions. Yet, the plethora of idiosyncratic conventions for identifying the same clinical content in different information systems is a fundamental barrier to fully leveraging the potential of EHRs. Only by adopting vocabulary standards that provide the lingua franca across these local dialects can computers efficiently move, aggregate and use health data for decision support, outcomes management, quality reporting, research and many other purposes. In this regard, the International Classification of Functioning, Disability, and Health (ICF) is an important standard for physiotherapists because it provides a framework and standard language for describing health and health‐related states. However, physiotherapists and other health‐care professionals capture a wide range of data such as patient histories, clinical findings, tests and measurements, procedures, and so on, for which other vocabulary standards such as Logical Observation Identifiers Names and Codes and Systematized Nomenclature Of Medicine Clinical Terms are crucial for interoperable communication between different electronic systems. In this paper, we describe how the ICF and other internationally accepted vocabulary standards could advance physiotherapy practise and research by enabling data sharing and reuse by EHRs. We highlight how these different vocabulary standards fit together within a comprehensive record system, and how EHRs can make use of them, with a particular focus on enhancing decision‐making. By incorporating the ICF and other internationally accepted vocabulary standards into our clinical information systems, physiotherapists will be able to leverage the potent capabilities of EHRs and contribute our unique clinical perspective to other health‐care providers within the emerging electronic health information infrastructure. Copyright © 2013 John Wiley & Sons, Ltd.     

Patient safety, errors and mistakes, and perioperative nursing

Today's world of advancing technology in health care represents complex diagnostic, operational, and administrative processes, all of which must be coordinated to ensure the delivery of safe, quality health care. Nonetheless, the health care industry's implementation and practice of quality measures fall below the standards of other industries, such as aerospace, telecommunications, or information technology. With health care performing at this lower level, it is no wonder that headline grabbers dwell on the deaths that occur as a result of medical errors. A new emphasis on quality management is essential in nursing education and in quality management to improve US health care. This article summarizes recent reports on medical errors and suggests strategies to improve patient safety.     

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.     

Health Literacy and Patient Preparation in Radiology

Health literacy is the capacity of an individual to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Unfortunately, more than half of Canadians cannot adequately navigate the health care system because they have limited health literacy. Patients with low health literacy may have limited reading abilities and poorer comprehension of written preparation documents. An important consideration in the radiation sciences for these patients is the ability to follow preparation requirements for diagnostic imaging procedures. It has been suggested that patients with limited health literacy are often less prepared for diagnostic examinations, and as a result, tend to have examinations of poorer diagnostic quality. Medical radiation technologists play an important role in educating patients regarding medical imaging examinations and helping them to properly prepare for these procedures. The purpose of this article is to define health literacy, provide some practical strategies to help medical radiation technologists identify patients with limited health literacy, and how to address limited health literacy issues to improve the quality of diagnostic imaging examinations.     

The Potential for Errors in Children with Special Health Care Needs

Children with special health care needs (CSHCN) are at risk for suboptimal treatment when presenting for emergent care to unfamiliar health care providers. Errors in their management may stem from failure to recognize occult conditions, lack of familiarity with rare or complex medical problems, or lack of prior knowledge of baseline physical findings. An emergency information form (EIF) that contains patient-specific information on essential diagnostic and therapeutic interventions may provide a ready personal reference for the emergent care of CSHCN. Coupled with the use of medical identification jewelry and an electronic transmission system, an EIF has the potential to eliminate management errors in the care of these patients.     

Health information technology: transforming chronic disease management and care transitions

Adoption of health information technology (HIT) is a key effort in improving care delivery, reducing costs of health care, and improving the quality of health care. Evidence from electronic health record (EHR) use suggests that HIT will play a significant role in transforming primary care practices and chronic disease management. This article shows that EHRs and HIT can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety.     

Information technology: passport to the future.

Health care information in this millennium will become increasingly digital and electronically available. To keep pace and survive, occupational health leaders must determine the appropriate information technology strategy for their organization. The development and implementation of an electronic medical record can only be accomplished through a team effort that includes: management support to secure the necessary funding; participation of users to determine the application requirements and design; information systems expertise availability; and user education to ensure acceptance. The implementation of an electronic medical record is a journey, not a project, and it is the beginning of the organization's information infrastructure. Benefits include: increased staff efficiency with electronic versus paper folders; legible written documentation; multiple accessibility of medical records to authorized users; reduced potential for record loss/misfiling; and the ability to operate remotely and take advantage of more advanced technologies in the future. Occupational health staff must have the necessary computer applications on their desktops to increase their skills and enhance productivity.     

上海市基于电子病历直推的传染病报告管理模式初探

目的 探索上海市建立基于电子病历直推的传染病报告管理模式。方法 建立以ICD10诊断编码与传染病病例报告触发标准为技术支撑、以区域卫生信息平台为介质、基于电子病历直推的传染病报告管理方式。结果 基于电子病历直推的传染病报告管理方式提供智能提示病例报告、推送信息功能、优化质量控制管理方法, 与其他业务系统推送信息、开展预警。结论 基于电子病历直推的传染病报告管理模式改变并优化传染病报告和质量控制方式, 为实现区域信息共享打下基础。     

Improving the quality of care and reducing health care costs through a point-of-service health care information system

Health care information systems will become critical to the success of health care providers. These systems must make the process of health care delivery more effective and more efficient, assisting the provider in improving the quality of care while maximizing cost reduction through more appropriate care and reduction in administrative costs. The system must be able to capture accurate encounter data for outcomes analyses and capable of use by multiple health plans for their unique policies or programs such as disease management. The most effective means of achieving all of the above will be to re-empower the physicians through software placed in a mobile computing environment with full integration among all participants.     

The effects of information technology on perioperative nursing

Numerous advances in technology during the past decade require that nurses not only be knowledgeable in nursing science but that they also become educated in information technology (IT). Perioperative IT has the potential to improve the quality of health care, reduce costs, decrease medication administration errors, reduce time spent on paperwork, increase management efficacy, and allow affordable access to health care. Nursing knowledge is needed for designing, implementing, and updating software, including an electronic health record (EHR). With the support of EHR data, nurses will be able to develop best practices for patient care and support research for evidence-based practice. When a standardized terminology, such as the Perioperative Nursing Data Set, is incorporated into an EHR, consistent documentation can be shared among systems. With advances in technology, perioperative nursing roles are expanding in relation to IT requirements and nurses are pursuing additional education. In addition to traditional methods, e-learning is an effective way to provide ongoing technological education.     

Computer-based patient record systems

OBJECTIVES: To provide oncology nurses with an overview of computer-based patient record (CPR) systems, a key infrastructure requirement in information management that is essential to maintaining a scientific basis for health care. DATA SOURCES: Published articles, research studies, and review articles pertaining to CPR systems. CONCLUSIONS: Progress in hardware development, software applications, and interfaces combine to bring us multimedia patient record systems. Many obstacles have been overcome as standards have emerged and technologies conform to those standards. However, there has been limited success in implementation of such systems. Early acceptance of structured data and problem-oriented documentation set the framework for charting in the electronic record. IMPLICATIONS FOR NURSING PRACTICE: Oncology clinicians and cancer patients alike will realize greater efficiencies and increased quality in health care when the CPR is fully implemented.