Patient-centred care: using online personal medical records in IVF practice.

BACKGROUND: Generic patient-accessible medical records have shown promise in enhancing patient-centred care for patients with chronic diseases. We sought to design, implement and evaluate a patient-accessible medical record specifically for patients undergoing a course of assisted reproduction (IVF or ICSI). METHODS: The personal medical record (PMR) database was developed using three formative evaluation steps, and its user-experience was evaluated through a cross-sectional study. Fifty-four patient-couples receiving an IVF or ICSI treatment in our hospital were granted access to the PMR. Main outcomes concern the usage of the PMR, the perceived usefulness of its functions and user attitudes towards privacy and financial issues. RESULTS: The PMR consists of 15 major functions that can be classified into personal information, general information and communication functions. Fifty-three patient-couples accessed the website and 51 couples filled out the evaluation questionnaire. They rated most functions as useful and preferred personalized to general functions. The results also show that some functions require further development. Patients using the PMR have little concerns regarding privacy, and 76% are willing to pay for such a service in the future. CONCLUSIONS: The patients in this study frequently and intensively used the Internet-accessible PMR. This suggests that the PMR offers very useful functions from an IVF/ICSI patient's perspective.

Pain clinic EPR: requirements determination & configuration.

UNLABELLED: The focus of this study was to determine requirements for a general pain EPR (electronic patient record), design this EPR and develop a prototype for demo purposes in pain clinics in The Netherlands. The specifications for this EPR were derived from the 'Nijmegen Classification of Pain', analysis of patient paper records and in-depth interviews with six anaesthesiologists, three physiotherapists and two psychologists. For development a generic configuration tool was used. The actual EPR consisted of five components (two for the anaesthesiologists, one for the physiotherapist, one for the psychologist and one for the whole team). The five components comprised of numerous dialogues. The medical care process directed these dialogues. CONCLUSIONS: The different organisational settings and the variability in provided patient care compromised the development of an EPR for all pain clinics. Defining the granularity of the dialogues was influenced mainly by the factors mentioned previously. However, most respondents agreed on the importance of the following functional demands: registration speed, security, flexibility and supporting of communication between the care providers.

Quality control in management of pain.

Since 1987 several pain clinics in The Netherlands have started with some kind of computer-assisted recording of data, mainly for purposes of quality control. However, this has not yet led to routinely generated reports about the quality of these clinics because a consensus on how to assess quality in pain-treatment is missing. Using classical system-development methods a global specification for an information system for quality assessment was defined on which a prototype application was based. Various changes were adopted into this prototype, which ultimately resulted in explicit requirements stating: 1. Which data to record, 2. What organisational prerequisites to fulfil for such a system, 3. The user-interface, and 4. Interactions with other information systems. The final application was implemented in a number of pain clinics where its usefulness in quality control is currently assessed.

Progress with formalization in medical informatics?

The prevailing view of medical informatics as a primarily subservient discipline in health care is challenged. Developments in both general informatics and medical informatics are described to identify desirable properties of modeling languages and tools needed to solve key problems in the application field. For progress in medical informatics, it is considered essential to develop far more formal modeling languages, modeling techniques, and tools. A major aim of this development should be to expel ambiguity from concepts essential to medicine, positioning medical informatics "at the heart of health care."

Requirements for medical modeling languages.

OBJECTIVE: The development of tailor-made domain-specific modeling languages is sometimes desirable in medical informatics. Naturally, the development of such languages should be guided. The purpose of this article is to introduce a set of requirements for such languages and show their application in analyzing and comparing existing modeling languages. DESIGN: The requirements arise from the practical experience of the authors and others in the development of modeling languages in both general informatics and medical informatics. The requirements initially emerged from the analysis of information modeling techniques. The requirements are designed to be orthogonal, i.e., one requirement can be violated without violation of the others. RESULTS: The proposed requirements for any modeling language are that it be "formal" with regard to syntax and semantics, "conceptual," "expressive," "comprehensible," "suitable," and "executable." The requirements are illustrated using both the medical logic modules of the Arden Syntax as a running example and selected examples from other modeling languages. CONCLUSION: Activity diagrams of the Unified Modeling Language, task structures for work flows, and Petri nets are discussed with regard to the list of requirements, and various tradeoffs are thus made explicit. It is concluded that this set of requirements has the potential to play a vital role in both the evaluation of existing domain-specific languages and the development of new ones.

Primary care guidelines from an organizational point of view.

Guidelines in primary health care have been developed to reduce assumed and undesired variation in certain aspects of care delivery by professionals. If systematically applied guidelines no doubt effect the quality of care. It is argued however that taking an organizational point of view on quality management yields new requirements with respect to development and application of guidelines. It is considered to be essential for managerial control purposes that guidelines have simple and valid indicators to monitor the actual application and to measure the preferred outcome. It is essential that the choice of guidelines to be implemented in an organization is determined in the context of an explicit plan for quality management.

[How accurate is the Central Bureau of Statistics' registration for cancer?]. / Hoe nauwkeurig is de CBS-registratie voor kanker?

PIP: An analysis of official data on cancer mortality in the Netherlands is presented. Some questions related to information on the diagnosis of cancer and to the classifications used by reporting physicians and clinics are discussed. A comment by J. W. Steffelaar is also included (pp. 454-5).^ieng