A voice-enabled, structured medical reporting system

Kurzweil Applied Intelligence received a research grant from the National Institute of Standards and Technology (NIST) Advanced Technology Program to develop a prototype voice-enabled, structured medical reporting system. In typical usage, the physician dictates to the system, which then uses automatic speech recognition and medical knowledge bases to produce a structured report. This report can then be formatted and viewed on a computer screen, stored in databases of patient information, transmitted to other systems, used to support outcome studies, or viewed on a Web browser. The output reports are structured according to two standard, platform-independent formats: SGML and CORBA. These formats represent the data in a way that can be read by both computers and humans, and efficiently communicated to a wide range of databases and communications protocols.     

The Stroke Prevention Patient Outcomes Research Team. Goals and methods

BACKGROUND AND PURPOSE: The aim of the present study, based at Duke University and involving 14 other institutions, is to identify the most appropriate and cost-effective clinical strategies for prevention of ischemic (thrombotic or embolic) stroke in high-risk individuals and to design and test an intervention to disseminate this information to providers and the public. METHODS: The study uses (1) secondary data from literature review, Medicare claims, and population-based data from three epidemiological studies and (2) primary data generated in national physician and patient surveys and in demonstration trials. Phases I through III involve data collection and analysis using a decision/cost-effectiveness model and consensus development methods. Phase IV includes intervention in physicians' practice patterns. Data is collected by literature survey and abstraction, review of medical records, claims analysis, and patient and physician surveys. CONCLUSIONS: A structured decision model and a well-defined clinical focus provide a successful organization for a PORT on stroke prevention.     

Medical risk classification of dental patients in The Netherlands

This study centers on the general health of dental patients, evaluated on the basis of the physical status classification system of the American Society of Anesthesiologists (ASA). A total of 4,087 patients completed a risk-related, patient-administered questionnaire. On the basis of their medical data, a computerized ASA classification was determined for each patient: 63.3 percent were in ASA class I, 25.7 percent in class II, 8.9 percent in class III, and 2.1 percent in class IV. After verification and/or consultation with the physician, the dentist also determined the ASA class, and this was compared with the computerized outcome. The agreement expressed as a kappa value was 0.64; the computer result generally placed the patient in a higher category of medical risk. The computer-determined ASA classes differed among the various dental practices (chi 2 = 262.9; df = 138; P < .01). It is possible to estimate the risk class of dental patients on the basis of standardized medical information only; however, the definitive ASA class can only be determined after verification of the patient's reply or, in some cases, after consultation with a physician.     

The doctor in the city

In his own town, the physician plays an important part in the public organizations of public health, in the commissions that grant permits and pensions, in the private charity societies, for the collection of epidemiological informations, etc. Unfortunately his place is small in the hospitals management, and he is not a member of the board for health insurance councils. In the State, he has to be a member of the consultative commissions for developing a health policy, and a public health system cannot work without his complete support. For the justice, the physician is often a necessary cooperator for a good use of the law in many cases. Forensic medicine is sometimes forgotten and badly taught. Justice and society have many requirements which endanger the medical secrecy.     

Electronic data processing system for clinical microbiology

A computerized clinical microbiology data storage and retrieval system, which was introduced at the Institute of Medical Microbiology 14 month ago, is described. This institute has to perform routine diagnostic microbiology for hospitals in the Kanton of Zuerich including the university hospital. In addition, it serves as a public health laboratory for Zuerich and adjacent districts. Patient and physician data are entered into a data station IBM 3741 and stored on discettes. Each afternoon, these data are printed on special report forms, which then are transferred to the diagnostic laboratories. After completion of the investigation, a copy of this form containing the results is sent to the physician. Every two weeks, the information stored on the discettes are converted onto the magnetic tape "discette". In addition, the original report form, containing the codified results and the fees, are read by an optic reader, which transfers the information onto the tape "report". Both tapes then serve the computer to print the accounts as well as to summarize the results monthly in form of the medical statistics. These provide valuable information to enhance patient care. All data are stored in a cumalative microbiology data bank for later retrieval.     

Preliminary report of data collection in hospital quality assurance programs--a project of the Association of Hospitals of the Czech Republic

OBJECTIVES: This was the first attempt of the association representing all acute care hospitals in the Czech Republic to collect mutual data which might be used for quality assurance (QA) purposes and which might lead to the development of national standards of care which could be used for hospital accreditation. Data collected included information which was available universally and which could be measured; in addition, information was intended to be similar in each hospital. In most cases, the data collection systems were based on financial information and data had to be identified which might be used for QA purposes, rather than being able to design a system specific for QA purposes. DESIGN: Since the hospital payment system was established in 1992, hospitals have had to develop data collection systems to measure clinical activity; this current study was based on this data collection, adapted to QA purposes. SETTING: The Executive Committee of the Hospital Association agreed to a pilot study of hospitals in 1993; data were collected from approximately 40 hospitals, beginning in 1994. STUDY PARTICIPANTS: Hospitals were chosen based on their ability to collect data and participate in the program, and it was determined that there should be variability in the hospitals, in size, location and activities, but that the data collected should be generic. INTERVENTIONS: Raw data included 33 different items, most of which were irrelevant to QA. Using a computer program, various combinations of data were reviewed and evaluated to ascertain the most appropriate for QA purposes. MAIN OUTCOME MEASURES: Data were chosen for study which included (a) data from the largest departments in the individual hospitals; (b) length of stay for patients hospitalized in these departments; (c) number of occupied beds/physician in the department and (d) mortality/1000 admissions to the department. RESULTS: The combination of (1) a long length of stay; (2) a high occupied bed/doctor ratio; and (3) a high mortality rate/1000 admissions might be indicators of poor quality. Additional factors to consider include: the type of department-emergency, cancer, geriatric, etc.; the nature of the medical activity-acute, referral, primary care, etc.; whether or not "social" beds are included and, generally, comparability among departments. However, as a pilot study, certain indicators can be determined which then can be used for future study to determine quality of care. The ability to cooperate and collect seemingly comparable data indicates reason for optimism in the future; more detailed and accurate studies can be carried out which will enable assessment of the quality of care given in comparable situations in hospitals throughout the Czech Republic.     

Electronic medical records for prenatal patients: challenges and solutions

A longstanding impediment to successful medical computing is resistance on the part of physicians. Interaction with many medical computing systems is difficult, requiring the physician to spend valuable time and energy trying to figure out how to get the machine to do what needs to be done. In developing encounter forms for use in prenatal medical records, we confronted the challenges involved in designing a computing system that provides an intuitive and physician-friendly method of recording clinical data. In trying to meet those challenges, we also learned about how to evaluate a medical computing system for flexibility and ease of use.     

Information retrieval patterns and needs among practicing general surgeons: a statewide experience

Information retrieval has progressed from a reliance on traditional print sources to the modern era of computer databases and online networks. Surgeons, many from remote areas not served by professional medical libraries, must develop and maintain skills in information retrieval and management in both electronic and standard formats. One hundred thirty-three New Mexico general surgeons were surveyed to identify their information-seeking patterns in five areas: retrieval purposes, retrieval sources, barriers to access, techniques used, and continuing education needs. Ninety-nine (74.4%) surgeons responded to the survey. Ninety-five percent utilize professional meetings, the medical literature, and physician colleagues as information sources. Only 17% utilize the outreach services of the state's only medical school library. Common retrieval barriers were practice demands (71%), isolation from medical schools (30%), computer illiteracy (28%), and rural environment (25%). Continuing education topics related to information management would be valuable to 61% of the surgeons. Sixty-nine percent believe their current ability to access biomedical information is adequate, despite most frequently accessing their personal libraries for information related to decision-making or patient management. These data suggest that, despite significant information needs, surgeons have not embraced newer forms of information retrieval. It is imperative that surgeons acquire and maintain modern information retrieval skills as a means of remaining up-to-date in their profession. Professional surgical organizations and medical librarians should collaborate on these continuing education ventures.     

Accreditation: who's counting?

Active physician involvement and leadership in their accreditation process can produce a cubic win for patients, payors, and providers. For health care quality to improve and everyone win, physicians need to understand the accountability system, the what and why of data collection, and be involved in short- and long-term performance assessments.     

八钢炼钢厂计算机辅助生产管理系统数据库的设计

在计算机辅助生产管理系统中，数据库是核心。本文详细介绍了新疆八钢转炉炼钢厂计算机辅助生产管理系统数据库的设计过程，给出了数据库的需求模型、概念模型，并分别用数据流图和IDEFIX图来表达设计结果。实际应用表明，设计的数据库能有效满足系统对数据采集、管理和信息查询等需求。     

The principal physician in emergency medicine

The implementation of an experienced pre-hospital care emergency physician as an on the-scene medical command officer (MCO) within the emergency medical service (EMS) is an essential prerequisite to guarantee qualified medical supervision during mass-casuality incidents (MCI). The MCO has four basic functions. Within the administration of the EMS system, he is responsible for the medical aspects of strategic planning for the MCI response. During the MCI the MCO is responsible for the overall assessment of the situation, triage, and supervision of medical treatment by physician and non-physician providers. Aside from extensive personal experience in pre-hospital care, the MCO needs special training to be qualified for this position. State EMS laws provide the legal basis for the MCO within the EMS system.     

气流分布测试软件的开发

将微机与数据采集器相联,开发出一套数据自动采集、处理系统,提高了电除尘器气流分布试验结果的准确性和可靠性.     

Communication between treating physician and occupational physician in the management of absenteeism

In case of an employee's absenteeism, both the treating physician and the company doctor possess relevant medical information. With a view to reducing absenteeism, exchange of data is considered important. Provision of data requires the consent of the patient/employee. If the latter is informed of the purpose for which the data are requested and of how they will be used, medical professional secrecy is not violated. In order to enhance the exchange of data between treating physician and company doctor, without bypassing the requirement of consent or cancelling the division between treatment and checking, the treating physician should be permitted to provide more information than just the data asked for in specific questions. This however requires the development of guidelines for careful consultation.     

The Swiss gatekeeper system--a model for improving capacity development and economic effectiveness

The German as well as the Swiss health care system are facing similar problems. However, in Switzerland different gatekeeper systems to improve the capacity and economic efficiency were successfully tried and tested. The main structures of gatekeeping are the HMO health centres and different GP systems. Central to this idea is the primary care physician functioning as a gatekeeper. He has to control the demands of medical services according to the patient's needs to fulfil integral, comprehensive and economic criteria. Although data processing has not yet been completed yet, first results show clear advantages of the gatekeeper system in respect of the costs and quality of health care compared with the customary Swiss health insurance. Although in Switzerland there are still relatively few persons insured according to the gatekeeper system, it is expected that particularly the family physician systems will expand considerably in the future. Reorganisation and rearrangements of the medical care providers are likely.     

Instrumentation problems for physicians

The physician has, for whatever reasons, diminished his or her level of involvement on the team dedicated to developing, refining, and evaluating medical technology. As a result, the challenge confronting the physician and the technology development team today is to orchestrate a team structure that will ensure the greatest input and commitment from physicians and other professionals during current and future technology development. The charges of cost escalation and dehumanization in our system of health care delivery will also be discussed, as will the lack of, or confusion about, access to data concerning cost of a given instrument, and fuzzy semantics and perspectives on technology and instrumentation. The author suggests answers to, or means to ameliorate, the problems.     

蓄热式推钢加热炉工控系统的开发

以PLC和计算机控制技术为基础,开发了辛钢蓄热式推钢加热炉的工控系统。其主要功能包括炉温及燃烧控制、换向系统控制、炉压控制及事故报警等。由PLC完成现场数据的采集处理、数据传送及控制程序的运算和输出等;采用Wincc开发了上位计算机数据交换平台,在可视化界面上实现集中显示和操作,简易直观。在生产应用中程序运行效果良好。     

Billing third party payers for pharmaceutical care services

OBJECTIVE: To describe the steps pharmacists must complete when seeking compensation from third party payers for pharmaceutical care services. DATA SOURCES: Government publications; professional publications, including manuals and newsletters; authors' personal experience. DATA SYNTHESIS: Pharmacists in increasing numbers are meeting with success in getting reimbursed by third party payers for patient care activities. However, many pharmacists remain reluctant to seek compensation because they do not understand the steps involved. Preparatory steps include obtaining a provider/supplier number, procuring appropriate claim forms, developing data collection and documentation systems, establishing professional fees, creating a marketing plan, and developing an accounting system. To bill for specific patient care services, pharmacists need to collect the patient's insurance information, obtain a statement of medical necessity from the patient's physician, complete the appropriate claim form accurately, and submit the claim with supporting documentation to the insurer. Although many claims from pharmacists are rejected initially, pharmacists who work with third party payers to understand the reasons for denial of payment often receive compensation when claims are resubmitted. CONCLUSION: Pharmacists who follow these guidelines for billing third party payers for pharmaceutical care services should notice an increase in the number of paid claims.     

Quality of life studies of the Australian New Zealand Breast Cancer Trials Group: approaches to missing data

The purpose of this paper is to describe the degree of compliance with quality of life measures in two clinical trials conducted by the Australian New Zealand Breast Cancer Trials Group comparing different chemotherapy policies for metastatic breast cancer. Quality of life was assessed by the patient using linear analogue scales and by the physician using the Spitzer QLI. Compliance was generally good, ranging from 66 per cent to 79 per cent in the earlier study, and from 63 per cent to 97 per cent in the later study. Compliance with physician rated quality of life was consistently slightly better than for patient self-assessment. The results of physician and patient assessments were generally consistent, but there was a systematic bias toward lower quality of life (as assessed by the physician) in patients who failed to comply with self-assessment. Our conclusions were that quality of life can be assessed in large scale multi-institution clinical trials in metastatic breast cancer. The results are important in assessing treatment comparisons. Missing data cannot be assumed to be similar to those available. Optimal assessment of quality of life therefore requires careful prospective attention to complete data collection.     

Staff certification for mobile blood collection units

Training and official acknowledgment of the competence of each staff member are essential to the quality and safety of collected blood products prepared and delivered by a blood transfusion center. A procedure was created to indicate in detail the methods employed to implement such accreditation. Based on individual training according to activity, it defines for each type of activity (secretary, physician, collector, driver) the required theoretical and practical knowledge of his/her position. Accreditation, consisting of assessment of the degree of competence attained in these areas of responsibility, was applied to the members of mobile blood collection teams in 1995. No major deficiency was detected, and this certification was well accepted by the staff. In order to complete this initial accreditation, blood collection abnormalities (inadequate blood volumes, clots or defective welding of tubing) were assessed for each collector individually. Comparison of these abnormalities in qualified nurses and laboratory technicians with a blood collection diploma showed no differences. On the other hand, significantly higher numbers of abnormalities were found in intermittent as compared to regular collectors and in senior as compared to new collectors. The applied corrective measures led to obviation of differences and improvement in performance. In 1996, in the first individual evaluation of medical selection carried out by each physician, discrepancies of one to 20 donors (0.7-14.2%) were observed from one doctor to another in the frequency of elimination of candidates for blood donation after the medical interview. Regular meetings with physicians resulted in reducing these discrepancies to one to 3.1 donors (4.6-14.1%) in 1997. In conclusion, the association of an initial accreditation procedure with an individual follow-up of work quality allowed satisfactory assessment of the training and competence of staff members. This kind of method could be extended to those working in other fields of transfusion medicine.