Data processing in haematology

The output from a Coulter model S is captured by a specially designed silent interface which visualizes the results, automatically prints the data on a continuous paper roll and transmits the information to a card punch located in a data processing room. Further requested test data and patient identification data are subsequently added manually to the punch card. The completed deck of cards is used in an off-line batch mode on a dedicated laboratory computer to format report documents, produce ward listings, and quality control information. A punch card off-line method is also described for blood group and related data.     

Handling information in general practice—using feature cards with computers

A two-tier system of handling information has been developed for use in general practice. Punched feature cards, with the conventional patients' record cards are used for the handling of primary data in the doctor's surgery. At the same time the feature cards provide an input to the computer using a feature card reader, converter, and paper-tape punch. This is especially useful where information has to be collected together centrally, for more advanced statistical analysis and where multiple searches of individual feature cards are required.     

Single tube multiplex PCR detection of 27 cystic fibrosis mutations and 4 polymorphisms using neonatal blood samples collected on Guthrie cards

In response to recommendations for cystic fibrosis (CF) carrier screening of the American College of Medical Genetics/American College of Obstetrics and Gynecology (ACMG/ACOG), we evaluated a commercial kit for mutation panel testing (Roche CF Gold Linear Array Panel). This kit tests for 25 CF mutations and 4 polymorphisms; it comprises an analyte specific reagent for single tube multiplex polymerase chain reaction (PCR) amplification and subsequent allele specific oligonucleotide (ASO) hybridization. Neonatal whole blood samples collected on Guthrie card filter paper served as the DNA source. Following a wash step to remove whole blood PCR inhibitors, multiplex PCR amplification could be performed either on DNA that was heat extracted from Guthrie cards or directly on the filter paper matrix itself. In 13 CF patient samples, the CF mutation results obtained with this kit agreed completely with those obtained from a reference laboratory that performs an 87 CF mutation panel. The kit was reliable, despite the small sample size (3 mm diameter punch of the Guthrie card), the presence of PCR inhibitors in whole blood, and protracted storage of blood samples (up to 9 yr at room temperature). The kit was convenient, cost competitive, and practical for use in a small CF screening laboratory.     

Use of a digital computer to produce a psychological test— Rabbitt's test of selective attention

Summary A PDP-8/S digital computer has been used to produce a psychological test—Rabbitt's test of selective attention —which consists of packs of cards with varying numbers of letters, some of which are classified as relevant and some as irrelevant. Central processing ability is assessed by timing the sorting of the cards on the basis of the relevant information, the irrelevant information being ignored. The program both chooses and positions the symbols randomly and the prints the card face on its Teletype output. A flow diagram of the program and details of the random number generator are described. The use of the computer for this purpose has reduced the time taken to produce one pack of cards by a factor of at least 10. Further developments of the technique are discussed.     

A data processing system adapted to the special needs of the emergency laboratory.

A data processing system for the emergency laboratory was integrated in our clinical laboratory computer system, its prime objective being the service requirements of the laboratory. It included the possibility of simultaneous optical reading of request forms and on-line capturing, processing, and printing of laboratory test data. Priority request forms, which allow the clinician to specify the interval by which emergency test results must be available, are registered by an optical reader and arranged according to urgency by the computer. The production of worksheets is replaced by visual display of information required for accurate specimen analyses on a large colour TV screen. The individual processing status of all tests from as many as 30 request forms is displayed in a colour code. For process control the updated delay time for test performance is faded in. All reports are produced by direct machine transfer of verified test results. For security purposes all steps of sample processing (request, result, report) are recorded via line printers outside the emergency laboratory. The capacity of the computer for managing sample and data processing reduces the work load for technicians. This results in a reduction of the turn-round time of tests. 95% of all requested tests are performed and reported within the requested time period and in emergencies, test results are available within 5-10 min. There has been no major breakdown of the system in over one year of use.     

Validity of hypotheses about the father/mother interpretation of Rorschach cards: tested by using a card selecting method

This study tests the validity of hypotheses about the interpretations of Rorschach father/mother cards by having subjects select the cards. The results showed that regardless of the subject's gender, Card IV is far more often selected as the father card. However Card VII is not more often chosen as the mother card, if anything, the Color Cards are usually selected. The result of a correspondence analysis suggest that a certain combination of father and mother cards is more often selected. When the frequency of card selection is applied to the cluster of cards obtained in the study of Fukui et al (2008), the mother card is predominantly selected from the feminine/maternity-cards cluster. However, the father card was selected equally often from three clusters, indicating variation of the father figure. The results indicate the predominance of Card IV as the father card, and also confirm the lack of individuality with Card VII. Therefore, Card IV fulfills prerequisites for the father card hypothesis, while Card VII does not meet the criteria. The results do not support the validity of the hypothesis about the mother card interpretation.     

The automicrobic system for detection of bacteriuria. Efficacy of revised urine identification cards

The results of clinical urine specimens tested in the Vitek AutoMicrobic System (AMS) using two different urine identification (UID) cards were compared with the results obtained by a quantitative culture method. AMS injector UID card results were evaluated with the use of 1,136 consecutive clinical specimens collected March 4 to May 23, 1983. Revised AMS UID cards were used to test 1,634 clinical specimens from November 8, 1983, to March 2, 1984. The revised UID card was less sensitive, more specific, had a greater predictive value for positive results, and had greater accuracy than the injector UID card in detecting organisms in urine. The revised urine card accurately quantified organisms in 90.1% of specimens versus 85.1% in injector cards. The revised card was superior in the predictive value of positive identification of urinary pathogens. Ninety percent of all organisms were identified within nine hours with either card. Improved accuracy of the revised cards makes it practical to electronically report automated urine screening results (detection, quantitation, and preliminary identification of urinary pathogens) by interfacing the AMS with hospital information systems.     

Information Presentation Features and Comprehensibility of Hospital Report Cards: Design Analysis and Online Survey Among Users

BackgroundImproving the transparency of information about the quality of health care providers is one way to improve health care quality. It is assumed that Internet information steers patients toward better-performing health care providers and will motivate providers to improve quality. However, the effect of public reporting on hospital quality is still small. One of the reasons is that users find it difficult to understand the formats in which information is presented.ObjectiveWe analyzed the presentation of risk-adjusted mortality rate (RAMR) for coronary angiography in the 10 most commonly used German public report cards to analyze the impact of information presentation features on their comprehensibility. We wanted to determine which information presentation features were utilized, were preferred by users, led to better comprehension, and had similar effects to those reported in evidence-based recommendations described in the literature.MethodsThe study consisted of 5 steps: (1) identification of best-practice evidence about the presentation of information on hospital report cards; (2) selection of a single risk-adjusted quality indicator; (3) selection of a sample of designs adopted by German public report cards; (4) identification of the information presentation elements used in public reporting initiatives in Germany; and (5) an online panel completed an online questionnaire that was conducted to determine if respondents were able to identify the hospital with the lowest RAMR and if respondents’ hospital choices were associated with particular information design elements.ResultsEvidence-based recommendations were made relating to the following information presentation features relevant to report cards: evaluative table with symbols, tables without symbols, bar charts, bar charts without symbols, bar charts with symbols, symbols, evaluative word labels, highlighting, order of providers, high values to indicate good performance, explicit statements of whether high or low values indicate good performance, and incomplete data (“N/A” as a value). When investigating the RAMR in a sample of 10 hospitals’ report cards, 7 of these information presentation features were identified. Of these, 5 information presentation features improved comprehensibility in a manner reported previously in literature.ConclusionsTo our knowledge, this is the first study to systematically analyze the most commonly used public reporting card designs used in Germany. Best-practice evidence identified in international literature was in agreement with 5 findings about German report card designs: (1) avoid tables without symbols, (2) include bar charts with symbols, (3) state explicitly whether high or low values indicate good performance or provide a “good quality” range, (4) avoid incomplete data (N/A given as a value), and (5) rank hospitals by performance. However, these findings are preliminary and should be subject of further evaluation. The implementation of 4 of these recommendations should not present insurmountable obstacles. However, ranking hospitals by performance may present substantial difficulties.     

Reporting quality of nursing home care by an internet report card

Objective

This study was designed to test an internet report card containing information about quality indicators (e.g., pressure ulcers, falls) as well as assessments of consumer satisfaction and of quality of care by the Netherlands Health Care Inspectorate in nursing homes.

Methods

Employing a laboratory-type experimental design, 278 current and future consumers and representatives of nursing homes were asked to make quality assessments based on report cards of imaginary nursing homes. They were also asked their opinions of the report cards.

Results

The participants were positive about the internet report card and considered it satisfactory. However, they did make some suggestions for improvement, such as using more understandable terminology. It also became evident that the information on the card must be complete; the omission of information resulted in more negative views of the nursing home.

Conclusion

The results show that an internet report card can be a useful tool that enables consumers to assess the quality of nursing home care. Further research is needed to examine whether the report card will actually be used by consumers to make decisions regarding nursing home care.

Practice implications

The internet report card is a practical tool that can empower consumers, as it facilitates comparisons between nursing homes.     

The impacts of smart cards on hospital information systems--an investigation of the first phase of the national health insurance smart card project in Taiwan

PURPOSE: To investigate the impacts of the first phase of Taiwan's Bureau of National Health Insurance (TBNHI) smart card project on existing hospital information systems. SETTING: TBNHI has launched a nationwide project for replacement of its paper-based health insurance cards by smart cards (or NHI-IC cards) since November 1999. The NHI-IC cards have been used since 1 July 2003, and they have fully replaced the paper-based cards since 1 January 2004. Hospitals must support the cards in order to provide medical services for insured patients. METHODS: We made a comprehensive study of the current phase of the NHI-IC card system, and conducted a questionnaire survey (from 1 October to 30 November, 2003) to investigate the impacts of NHI-IC cards on the existing hospital information systems. A questionnaire was distributed by mail to 479 hospitals, including 23 medical centers, 71 regional hospitals, and 355 district hospitals. The returned questionnaires were also collected by prepaid mail. RESULTS: The questionnaire return rates of the medical centers, regional hospitals and district hospitals were 39.1, 29.6 and 20.9%, respectively. In phase 1 of the project, the average number of card readers purchased per medical center, regional hospital, and district hospital were 202, 45 and 10, respectively. The average person-days for the enhancement of existing information systems of a medical center, regional hospital and district hospital were 175, 74 and 58, respectively. Three months after using the NHI-IC cards most hospitals (60.6%) experienced prolonged service time for their patients due to more interruptions caused mainly by: (1) impairment of the NHI-IC cards (31.2%), (2) failure in authentication of the SAMs (17.0%), (3) malfunction in card readers (15.3%) and (4) problems with interfaces between the card readers and hospital information systems (15.8%). The overall hospital satisfaction on the 5-point Likert scale was 2.86. Although most hospitals were OK with the project, there was about 22% dissatisfied and strongly dissatisfied, that is twice as many hospitals with satisfied (about 10%). CONCLUSIONS: Our recommendations for those who are planning to implement similar projects are: (1) provide public-awareness programs or campaigns across the country for elucidating the smart card policy and educate the public on the proper usage and storage of the cards, (2) improve the quality of the NHI-IC cards, (3) conduct comprehensive tests in software and hardware components associated with NHI-IC cards before operating the systems and (4) perform further investigations in authentication approaches and develop tools that can quickly identify where and what the problems are.     

Experience in creating an automated pathoanatomic archive in prosection at the A. N. Bakulev Institute of Cardiovascular Surgery of the Academy of Medical Sciences of the USSR]

An information system "Automatic pathological anatomy archive" has been created in the cardiac surgery center existing 22 years. A special card has been developed for resording of the results of morphological examinations and the main information on the patient, which is filled by the dissector after autopsy. Treatment of the data contained in the information mass stipulates an urgent search of the cases according to the set of data indicated in the request, interpretation of the content of unified cards for the selected cases, calculation of per cent ratios, etc. Realization of information systems in universal computers opens wide possibilities for principally new organization of pathological archives.     

Cumulative reporting of chemical pathology

A simple system for producing cumulative chemical pathology reports is described. Results of tests are transcribed onto the patient's laboratory record card and each time a new result is entered a copy is made by xerography and returned to the clinician as the laboratory report.     

Card sorting to evaluate the robustness of the information architecture of a protocol website

ObjectivesA website on Methicillin-Resistant Staphylococcus Aureus, MRSA-net, was developed for Health Care Workers (HCWs) and the general public, in German and in Dutch. The website’s content was based on existing protocols and its structure was based on a card sort study. A Human Centered Design approach was applied to ensure a match between user and technology. In the current study we assess whether the website’s structure still matches user needs, again via a card sort study.MethodsAn open card sort study was conducted. Randomly drawn samples of 100 on-site search queries as they were entered on the MRSA-net website (during one year of use) were used as card input. In individual sessions, the cards were sorted by each participant (18 German and 10 Dutch HCWs, and 10 German and 10 Dutch members of the general public) into piles that were meaningful to them. Each participant provided a label for every pile of cards they created. Cluster analysis was performed on the resulting sorts, creating an overview of clusters of items placed together in one pile most frequently. In addition, pile labels were qualitatively analyzed to identify the participants' mental models.ResultsCluster analysis confirmed existing categories and revealed new themes emerging from the search query samples, such as financial issues and consequences for the patient. Even though MRSA-net addresses these topics, they are not prominently covered in the menu structure. The label analysis shows that 7 of a total of 44 MRSA-net categories were not reproduced by the participants. Additional themes such as information on other pathogens and categories such as legal issues emerged.ConclusionsThis study shows that the card sort performed to create MRSA-net resulted in overall long-lasting structure and categories. New categories were identified, indicating that additional information needs emerged. Therefore, evaluating website structure should be a recurrent activity. Card sorting with ecological data as input for the cards is useful to identify changes in needs and mental models. By combining qualitative and quantitative analysis we gained insight into additional information needed by the target group, including their view on the domain and related themes. The results show differences between the four user groups in their sorts, which can mostly be explained by the groups’ background. These findings confirm that HCD is a valuable approach to tailor information to the target group.     

Securing interoperability between chip card based medical information systems and health networks.

Health information systems supporting shared care are going to be distributed and interoperable. Dealing with sensitive personal medical information, such information systems have to provide appropriate security services, allowing only authorised users restricted access rights to the patients' data according to the 'need to know' principle. Especially in healthcare, chip card based information systems occur in the shape of patient data cards providing informational self determination and mobility of the users as well as quality, integrity, accountability, and availability of the data stored on the card, thus improving the shared care of patients. The DIABCARD project aims at the implementation and evaluation of a chip card based medical information system (CCMIS) for facilitating communication and co-operation between health professionals in different organisations or departments caring the same patient with diabetes as an example. In co-operation with the EC-funded TrustHealth(2) project, communication and application security services needed are provided like strong authentication as well as the derived services such as authorisation, access control, accountability, confidentiality, etc. The solution is based on Health Professional Cards and Trusted Third Party services. In addition to the secure handling of the patient's chip card and data in DIABCARD workstations, the secure communication between these workstations and related departmental systems has been implemented. Based on the results of this feasibility study, an enhanced security services specification for the DIABCARD example of a CCMIS is provided which will be implemented in the framework of a health network being established in the German federal state Bavaria. Beside the preferred solution of a combination of Patient Identification Card and Patient Data Card, lower level alternatives using card-verifiable certificates are explained in some details. Finally, a few legal issues, future trends like the XML standard set and their implications for the solution presented as well as for distributed health information systems in general are shortly discussed.     

Feasibility and usefulness of family record cards in general practice

In order to determine the feasibility of family record cards in general practice a research secretary created cards for 1825 households from a practice of 10 600 patients. The capital cost was £108 and the time taken by the secretary was 1638 hours, which is equivalent to a wage of £1330 for a maximum grade secretary, assuming a 70% rebate paid by the family practitioner committee. Approximately six and a half hours of receptionist/secretarial time are needed each week to maintain the system. The doctors spent a mean of three minutes checking and completing the initial update of each card.

Before the cards were introduced, most information about families was held in the doctors' heads, and little was written in the records even though the doctors considered family information relevant in 33% of consultations. After the introduction of family record cards the doctors had access to reasonably complete information about the family at 98% of consultations and the cards were used at 95% of consultations. The doctors believed the information was useful for establishing rapport, identifying patients' concerns, obtaining relevant history, forming diagnostic hypotheses and managing the present complaint. Trainees and locums found the cards more useful than principals.

     

A computer system for clinical microbiology.

The Department of Clinical Microbiology at St Thomas' Hospital has been producing bacteriological reports on a computer for more than three years and is now producing some 2300 reports per week. The system is operated entirely by laboratory staff without special training, and involves the use of optical mark reader (OMR) forms as worksheets, automatic validation and release of most reports, the use of local terminals, and scrutiny of reports by pathologists using a visual display unit. The OMR worksheet records not only the final result but also most of the tests and observations made on the samples; it is the only working document used by technicians. One specialist clinic submits its laboratory requests on an OMR form, which is subsequently used to record the results. The reports are printed and also filed in the computer to produce analyses for hospital, laboratory, and clinical management.     

Child abuse prevention at report card time

Report Card distribution reportedly triggers an outbreak of child abuse. If we can prevent that outburst of anger at this time by initiating a process of family and community attitudinal change through offering positive parenting techniques and crisis intervention by phone, we would significantly reduce the incidence of physical abuse. The Mayor's Office for Children and Youth and The Baltimore City Commission for Children and Youth developed a school related child abuse prevention campaign which included messages to parents on colorful attractive cards suggesting positive parenting techniques and crisis intervention phone numbers which were distributed with each report card. Public Service Announcements (PSAs) for TV were developed with the same positive parenting message and aired just prior to and during the week of Report Card distribution. Agencies and organizations whose mission is child abuse prevention, mental health treatment and social support participated as well as agencies and organizations involved in tutoring and academic support. All of the 180 schools in Baltimore City used the cards and teachers and administrators reported a change in parental attitude, more parent visits and better communication between teachers and parents. The phone numbers on the cards were used at a significantly higher rate each time the cards came home, some as many as 400 times their normal call rate. After one year of the project, the State's Attorney's Office observed that incidents of known child abuse as a result of a bad report card was down from 90 to two. This project was continued for six years first with state funds and after three years with private foundation funds. At this time, the Baltimore City School System has adopted the program and is distributing the cards. © 2000 John Wiley & Sons, Inc.     

通过LIS系统提升检验危急值、急诊结果回报临床质量

目的利用实验室信息系统（LIS）代替手工危急值、急诊结果回报方法。方法与上海杏和软件公司合作,利用实验室信息系统中的相关模块通过信息网络将危急值、急诊结果传送到相关临床科室,并在临床科室确认后将确认消息返回到实验室。结果通过实验室信息系统有效地提高了实验室人员对危急值、急诊结果处理的及时性,提高了危急值、急诊结果回报临床的及时性以及实验室能够及时得到临床的反馈,大大增强了危急值、急结果回报的可管理性。结论将LIS系统与实验室危急值、急诊结果报告的管理有机结合,强化了实验室的规范化管理,大大的提高了实验室工作效率。     

A questionnaire as a data base in problem orientated records

Questionnaires will be adequately filled in by patients if they are properly motivated and will provide useful information. We have found that when patients come for further consultations, much useful information is readily available from these cards to any doctor. We think that this data helps to establish the basis of a good doctor-patient relationship.

The trainees in the Watford area were concerned about the lack of family and social history contained in patients' records which may have been known by the partners, but was often not committed to paper and, if in the notes, was usually not easily found.

As a pilot study we decided to design a card to overcome some of these problems, and to test the acceptability and benefit of this method on newly registered patients. The project was also planned as a learning situation for trainees.

     

Quantitative analysis of histological data using optical-mark-recognition computer cards

A new method is presented which utilises o.m.r. techniques to facilitate quantitative studies in histopathology. The microscope image of the specimen is traced onto computer cards to form a digitised version of the original image. This data is read into a mini computer via an o.m.r. card reader, allowing off-line quantitative analysis to be carried out. A set of subroutines is available for processing the data. Feature counts, proportional and absolute volumes and areas can be found. The digitised version of the image can be dissected within the computer to obtain further morphometric data, which would otherwise require laborious manual measurements.