The Informatics Review Vol. 6 No. 4 - Feb 15 2003 -- Current Reviews in Clinical Informatics

Information Resource: About Herbs, Botanicals & Other Products
This web site provides objective information for oncologists and healthcare professionals, including a clinical summary for each agent and details about constituents, adverse effects, interactions, and potential benefits or problems. Evaluations of alternative or unproved cancer therapies are also provided.

HHS budget battles bioterror
The Bush administration is continuing efforts to protect against bioterrorism by increasing funding for food safety systems and information sharing in the public health sector.

Computerized Prescriber Order Entry Systems
The American Society of Health-System Pharmacists has just issued a call for contributions to the next revision of Landmines and Pitfalls of CPOE systems. Contact Toby Clark for more information.

Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial
No impact was found of a computerised decision support system delivering evidence based guidelines for chronic diseases on either the process or outcomes of care. It is unclear whether there are benefits from integrating such systems into clinical encounters where busy practitioners manage patients with complex and multiple conditions.

Practice based, longitudinal, qualitative interview study of computerised evidence based guidelines in primary care
Negative comments about the decision support system significantly outweighed the positive or neutral comments. Three main areas of concern among clinicians emerged: timing of the guideline trigger, ease of use of the system, and helpfulness of the content. Respondents did not feel that the system fitted well within the general practice context. Experience of "on-demand" information sources, which were generally more positively viewed, informed the comments about the system. Significant barriers exist to the use of complex clinical decision support systems for chronic disease by general practitioners. Key issues include the relevance and accuracy of messages and the flexibility to respond to other factors influencing decision making in primary care.

Vaccine Adverse Event Reporting System (VAERS) Web site
VAERS is a post-marketing safety surveillance program, collecting information about adverse events (possible side effects) that occur after the administration of US licensed vaccines. This Web site provides a nationwide mechanism by which adverse events following immunization (AEFI) may be reported, analyzed and made available to the public.

The Smallpox Research Grid
The global threat of a smallpox outbreak as a result of a bioterrorist or military attack demands that scientists find new and faster ways to identify a cure. There is a possible molecular target whose blockade would prevent the ravages of an infection. We intend to use grid computing to screen millions of potential anti-smallpox drugs against this target. You yourself can participate and assist in this important effort. By downloading and running the UD Agent, you add your CPU to the global grid.

The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital
400 consecutive patients discharged home from the general medical service were studied. 76 patients had adverse events after discharge (19% [95% CI, 15% to 23%]). 3% of injuries were serious laboratory abnormalities, 65% were symptoms, 30% were symptoms associated with a nonpermanent disability, and 3% were permanent disabilities. Adverse drug events were the most common type of adverse event (66% [CI, 55% to 76%]), followed by procedure-related injuries (17% [CI, 8% to 26%]). Adverse events occurred frequently in the peridischarge period, and many could potentially have been prevented or ameliorated with simple strategies.

Mobile Phones Used to Monitor Heart Patients
Doctors have successfully used mobile phones to monitor the blood pressure and heart rate of people with high blood pressure and give them almost instant advice. Patients monitored key values, such as their blood pressure, pulse or bodyweight, on a regular basis at home. They then entered the figures on a mobile phone using special software. A monitoring unit warned doctors to intervene if a patient's values were too high or low. Doctors were notified by a text message or an e-mail.

Progress in Promoting Adoption of Smart Card Technology
Smart cards - credit-card-like devices that use integrated circuit chips to store and process data - offer a range of potential uses for the U.S. government, particularly in increasing security for its many physical and information assets. GAO was asked to review the use of smart cards across the federal government (including identifying potential challenges), as well as the effectiveness of the General Services Administration (GSA) in
promoting government adoption of smart card technologies. To successfully implement such systems, agency managers have faced a number of substantial challenges:
• sustaining executive-level commitment in the face of organizational resistance and cost concerns;
• obtaining adequate resources for projects that can require extensive modifications to technical infrastructures and software;
• integrating security practices across agencies, a task requiring collaboration among separate and dissimilar internal organizations;
• achieving smart card interoperability across the government;
• maintaining the security of smart card systems and privacy of personal information.

Training Symposium Series Issues in Randomized Clinical Trials Involving Behavioral Interventions
The series assumes the audience has basic or general understanding of RCT design and implementation. The emphasis is on issues of particular concern to RCTs in which the intervention (i.e., “treatment”) is behavioral, whether alone or in combination with biomedical treatments.

CME Credits as Indicators of Improved Physician Competence: An Online Survey

Physicians and Care Management: More Acceptance than You Think
According to a new study by the Center for Studying Health System Change (HSC), a majority of physicians affected by these tools believe the overall effect of each on the quality and efficiency of care they provide has been positive. Physicians affected by related financial incentives are more likely to view care management techniques positively if they are risk adjusted to reflect the greater need for services by people with health problems.

HIPAA Security Standards Final Rule Published
The final Rule adopting HIPAA standards for the security of electronic health information will be published in the Federal Register on February 20, 2003. This final rule specifies a series of administrative, technical, and physical security procedures for covered entities to use to assure the confidentiality of electronic protected health information. The standards are delineated into either required or addressable implementation specifications.
Other issues from Volume 6 -- 2001

1 -- Jan 1

5 -- Mar 1

9 --- May 1

13 -- Jul 1

17 -- Sep 1

21 -- Nov 1

2 -- Jan 15

6 -- Mar 15

10 -- May 15

14 -- Jul 15

18 -- Sep 15

22 -- Nov 15

3 -- Feb 1

7 -- Apr 1

11 -- Jun 1

15 -- Aug 1

19 -- Oct 1

23 -- Dec 1

4 -- Feb 15

8 -- Apr 15

12 -- Jun 15

16 -- Aug 15

20 -- Oct 15

24 -- Dec 15

2/16/03 dfs

1 -- Jan 1	5 -- Mar 1	9 --- May 1	13 -- Jul 1	17 -- Sep 1	21 -- Nov 1
2 -- Jan 15	6 -- Mar 15	10 -- May 15	14 -- Jul 15	18 -- Sep 15	22 -- Nov 15
3 -- Feb 1	7 -- Apr 1	11 -- Jun 1	15 -- Aug 1	19 -- Oct 1	23 -- Dec 1
4 -- Feb 15	8 -- Apr 15	12 -- Jun 15	16 -- Aug 15	20 -- Oct 15	24 -- Dec 15