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

Use of an Electronic Medical Record Improves the Quality of Urban Pediatric Primary Care
Computer-based clinicians were significantly more likely to address a variety of routine health care maintenance topics including: diet, sleep, at least 1 psychosocial issue, smoking in the home, lead risk assessment, exposure to domestic or community violence, guns in the home, behavioral or social developmental milestones, infant sleep position, breastfeeding, poison control, and child safety. Users of the system reported that its use had improved the overall quality of care delivered, was well-accepted by families, and improved guidance quality; however, 5 of 7 users reported that eye-to-eye contact with patients was reduced, and 4 of 7 reported that use of the system increased the duration of visits (mean: 9.3 minutes longer). All users recommended continued use of the system.

Incidence and preventability of adverse drug events among older persons in the ambulatory setting
Errors associated with preventable adverse drug events occurred most often at the stages of prescribing and monitoring, and errors involving patient adherence also were common. Cardiovascular medications, followed by diuretics, nonopioid analgesics, hypoglycemics, and anticoagulants were the most common medication categories associated with preventable adverse drug events. Electrolyte/renal, gastrointestinal tract, hemorrhagic, metabolic/endocrine, and neuropsychiatric events were the most common types of preventable adverse drug events.

President Bush Announces Framework to Modernize and Improve Medicare including suppport for electronic health records
"Patient safety also improves when doctors can have access to health records without delay. When a patient has a medical emergency far from home, the attending physician should have quick access to that person's medical records. Yet the health care industry, while progressing in many areas, has lagged in information technology. Right now, as you all know better than most, health care records are kept in different formats -- believe it or not, a lot of times on paper. In files. That can get lost. In the budget for next year I propose an increase of 53 percent for funding to help hospitals use information technology to keep better records, to share that information with doctors so that we can continue to improve patient safety.

Experimental Robots May Offer Aid at Bedsides
Its bedside manner has kinks to work out, but an experimental robot may one day help the U.S. health care industry cope with burgeoning ranks of the elderly and ill. For now the robots operate primarily as a form of mobile video telephone allowing patients and doctors to communicate. But eventually, they may help the health care industry serve millions by wheeling patients to dinner, or even taking temperatures and drawing blood.

Internet2, a high-speed network currently under development, will benefit clinicans and patients
In the near future, a clinician will be able to turn from a patient on the examining table to a specialist on the other side of the world, instantly sharing live video of the patient, detailed radiographic images, and other data that flash up onto the screens of both physicians in milliseconds. The consultation will take place in real time, without anyone having to leave the office, thanks to a new internet now under development.

Hospital outpatient data now available free on the internet
Important new information about a hospital’s outpatient services and charges is available free on the Internet. The data on the AHD Web site is gleaned from every acute care hospital that treats Medicare patients. The AHD Web site reports a hospital’s average charges, payments, and costs for the twenty Ambulatory Payment Classifications with the highest revenue for the 12 months ending March 30, 2002. Accessing the primary level of information is free.

Turning a Physician Practice on Its Head: Kaiser Leader Reveals the Challenges, Benefits of EHR
Kaiser Permanente, the largest nonprofit health maintenance organization (HMO) in the US, is on the forefront of developing and implementing an electronic health record (EHR). Andy Wiesenthal, Associate Executive Director for clinical information support, recently talked with the Journal of AHIMA about the challenge of implementing clinical information systems and its effect on Kaiser and its members.

USP Identifies Leading Medication Errors in Hospital Emergency Departments
Among 105,600 errors documented in the agency's database in 2001, 2%, occurred in ERs. In other areas of the hospital, 39% of prescribing errors were intercepted before reaching the patient, but only 23% were intercepted in the ER. Of the reported errors, 7.6% resulted in patient injury, including one death. Among other proposed remedies, U.S. Pharmacopeia calls for assigning more pharmacists to ERs, entering prescription orders electronically, and buying premixed intravenous solutions and unit doses.

Genetic Algorithms - Evolutionary Number Crunching
Dealing with tough computational problems - those that, as the size of the problem increases, the amount of time it takes to solve it grows exponentially - requires special tools. Genetic algorithms mimic living systems by trying out many possible solutions to tough problems, discarding those that don’t work well, evolving those that do work well, then repeating the process. They have performed well in many tough problems and they will be applied in health care applications such as protein folding analysis, drug development, and analyzing large health care data sets.

REINVENTING the House Call
Pilot studies have found that home telehealth technology helps patients better manage their illnesses, reducing emergency department trips, unnecessary doctor's office appointments and costly visits by home nurses. Keeping long-term-care patients out of the hospital saves countless health care dollars. Web-enabled health monitoring is a hit at home, but questions regarding reimbursement and other issues cloud its potential.

Kaiser Mid-Atlantic Region to Test Rockville Firm's Software
They will use DrFirst's software, which connects personal or handheld computers to a database of medical information that will search for drug interactions and patient allergies. Doctors can also send prescriptions electronically to the patient's pharmacy.

Scientists Develop First Artificial Brain Section
Devised by researchers at the University of Southern California in Los Angeles, a silicon chip that mimics an area that controls memory, mood and awareness is designed to carry on the functions of the region known as the hippocampus and could one day be used to help people with brain damage. It will first be tested on tissue from rats' brains, and then on live animals.

Handheld Computers for Doctors
The book champions the idea that handheld computers have a significant role to play in the future of clinical practice. It shows why and how palm devices can help reduce paperwork, and how to use the technology without waiting for the IT department's latest expensive, complicated and overdue solution.

SimTecT 2003 - A highly focussed Medical Simulation Symposium that will serve as a valuable information exchange between the medical and simulation fraternities.
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

3/15/03 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