ABSTRACT
Community Health Information Networks (CHINs) require the ability to provide computer network connections to many remote sites. During the implementation of the Washington Heights and Inwood Community Health Management Information System (WHICHIS) at the Columbia-Presbyterian Medical Center (CPMC), a number of remote connectivity issues have been encountered. Both technical and non-technical issues were significant during the installation. We developed a work-flow model for this process which may be helpful to any health care institution attempting to provide seamless remote connectivity. This model is presented and implementation lessons are discussed.
Subject(s)
Community Networks , Computer Communication Networks , Academic Medical Centers , Hospital-Physician Relations , Methods , New York , Practice Management, MedicalABSTRACT
The enhanced availability of health information in an electronic format is strategic for industry-wide efforts to improve the quality and reduce the cost of health care, yet it brings a concomitant concern of greater risk for loss of privacy among health care participants. The authors review the conflicting goals of accessibility and security for electronic medical records and discuss nontechnical and technical aspects that constitute a reasonable security solution. It is argued that with guiding policy and current technology, an electronic medical record may offer better security than a traditional paper record.
Subject(s)
Computer Security , Confidentiality , Databases, Factual , Medical Records , Databases, Factual/legislation & jurisprudence , Databases, Factual/standards , Informed Consent , Medical Records/legislation & jurisprudence , Medical Records/standardsABSTRACT
We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed.
Subject(s)
Ambulatory Care Information Systems , Decision Making, Computer-Assisted , Medical Records Systems, Computerized , Ambulatory Care Facilities , Systems Integration , User-Computer Interface , Vocabulary, ControlledABSTRACT
In summary, security concerns surrounding health data are justified, but solutions are surmountable with currently available technologies. Whether systems are paper or electronic, human factors such as errors, negligence and unethical activities can result in breaches of confidentiality, despite optimal implementations. Neither automated teller machines (ATMs) nor EMRs are free from instances of abuse, but policies and protocols for electronic systems can be implemented that may provide better security than analogous paper record systems.
Subject(s)
Computer Security/standards , Medical Records Systems, Computerized/standards , Privacy , Confidentiality , United StatesABSTRACT
We describe a data model that has been implemented for the CPMC Ambulatory Care System, and exemplify its function for patient problems. The model captures some nuances of clinical thinking about patients that are not accommodated in most other models, such as an evolution of clinical understanding about patient problems. A record of this understanding has clinical utility, and serves research interests as well as medical audit concerns. The model is described with an example, and advantages and limitations in the current implementation are discussed.
Subject(s)
Ambulatory Care Information Systems , Decision Making, Computer-Assisted , Medical Records Systems, Computerized , Clinical Medicine , Humans , Models, Theoretical , Patient Care PlanningABSTRACT
We have mapped clinically used diagnostic terms from a legacy ambulatory care system to the separate controlled vocabulary of our central clinical information system. The methodology combines elements of lexical and morphologic text matching techniques, followed by manual physician review. Results of the automated matching algorithm before and after partial manual review are presented. The results of this effort will permit the migration of coded clinical data from one system to another. Output from the system after the term review process will be fed back to the target vocabulary via automated and semi-automated means to improve its clinical utility.
Subject(s)
Algorithms , Medical Informatics Applications , Subject Headings , Academic Medical Centers , Ambulatory Care Information Systems , Clinical Laboratory Information Systems , Humans , New York CityABSTRACT
We have developed a system that receives "stat" results encoded in Health Level Seven from the Laboratory Information System, prints a report in destination Intensive Care Units (ICUs), and captures the data for review in a custom spreadsheet format at color X-terminals located in ICUs. Available services include a reference nomogram plot of arterial blood gas data, printed summaries, automated access to the Clinical Information System and a Medline database, electronic mail, a simulated electronic calculator, and general news and information. Security mechanisms include an audit trail of user activities on the system. Noteworthy technical aspects and non-technical factors impacting success are discussed.
