Improving access to longitudinal patient health information within an emergency department.

We designed and implemented an electronic patient tracking system with improved user authentication and patient selection. We then measured access to clinical information from previous clinical encounters before and after implementation of the system. Clinicians accessed longitudinal information for 16% of patient encounters before, and 40% of patient encounters after the intervention, indicating such a system can improve clinician access to information. We also attempted to evaluate the impact of providing this access on inpatient admissions from the emergency department, by comparing the odds of inpatient admission from an emergency department before and after the improved access was made available. Patients were 24% less likely to be admitted after the implementation of improved access. However, there were many potential confounders, based on the inherent pre-post design of the evaluation. Our experience has strong implications for current health information exchange initiatives.

Building a comprehensive clinical information system from components. The approach at Intermountain Health Care.

OBJECTIVES: To discuss the advantages and disadvantages of an interfaced approach to clinical information systems architecture. METHODS: After many years of internally building almost all components of a hospital clinical information system (HELP) at Intermountain Health Care, we changed our architectural approach as we chose to encompass ambulatory as well as acute care. We now seek to interface applications from a variety of sources (including some that we build ourselves) to a clinical data repository that contains a longitudinal electronic patient record. RESULTS: We have a total of 820 instances of interfaces to 51 different applications. We process nearly 2 million transactions per day via our interface engine and feel that the reliability of the approach is acceptable. Interface costs constitute about four percent of our total information systems budget. The clinical database currently contains records for 1.45 m patients and the response time for a query is 0.19 sec. DISCUSSION: Based upon our experience with both integrated (monolithic) and interfaced approaches, we conclude that for those with the expertise and resources to do so, the interfaced approach offers an attractive alternative to systems provided by a single vendor. We expect the advantages of this approach to increase as the costs of interfaces are reduced in the future as standards for vocabulary and messaging become increasingly mature and functional.

Beyond the Web: building information systems with clinical context.

Much of the current research on clinical information systems concentrates on World Wide Web (W3) development. Although the W3 is well suited to many information applications such as nonsensitive data exchange, it has drawbacks that may make it inappropriate for certain clinical environments. We present a solution that addresses many of the W3's limitations by focusing on clinical requirements first and then applying the appropriate technology. We also make a case for clinical information systems researchers to become more involved in the development of Internet standards.

Intelligent monitor for an anesthesia breathing circuit.

A competent breathing circuit is mandatory to the safe and effective delivery of oxygen and anesthetic gases to the patient. Studies have shown that failures in the circuit are the most likely causes of anesthetic mishaps. Unfortunately, the complexity of the system renders traditional monitoring methods ineffective. We have developed a hierarchical artificial neural network monitor that is capable of examining ventilator signals. It was trained to identify 23 faults in the breathing circuit during ventilator controlled breathing and 21 faults during spontaneous breathing. The networks correctly identified a fault condition in 92% and 83% of cases for ventilator and spontaneous data, respectively. The correct fault type was found in 76% and 68% of cases for ventilator and spontaneous data, respectively. Results show that the network met our criteria for a holistic, specific, and vigilant monitoring system.