Willingness to use computerised decision support systems is often jeopardised by lack of effective integration into existing user interfaces for electronic patient record. Concepts illustrated in this paper stem from the need of... more
Willingness to use computerised decision support systems is often jeopardised by lack of effective integration into existing user interfaces for electronic patient record. Concepts illustrated in this paper stem from the need of developing a project for the comparison of the physicians’ compliance to a clinical practice guideline before and after an electronic version of the guideline was introduced. Before
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ABSTRACT The benefits of the electronic patient record versus the traditional paper-based clinical chart have been widely illustrated in the medical informatics literature. However, hospital information systems are often used only to... more
ABSTRACT The benefits of the electronic patient record versus the traditional paper-based clinical chart have been widely illustrated in the medical informatics literature. However, hospital information systems are often used only to administrative purposes (admission/discharge) and most of the clinical information is still paper-based. There is a resistance of healthcare operators to shift from paper to computer, and there are many reasons for this behaviour, that will be discussed in the paper. One of these reasons, that is also the focus of our work, is that while formulating the data model, physicians are often fostered (by computer scientists) to reduce free text data. In other words, computerisation of the medical record is often offered as an opportunity to “encoding” information as much as possible, with the promise that this will facilitate further statistics and data sharing. However, in some cases physicians perceive this encoding as a constraint and a limitation. In this paper we discuss this issue and we illustrate a solution devised for a Stroke Unit.
In this paper we describe a module that allows to collect (a) motivations for non-compliance to guidelines, (b) motivations for poor data entry into the electronic patient record, and (c) comments on medical aspects of guideline... more
In this paper we describe a module that allows to collect (a) motivations for non-compliance to guidelines, (b) motivations for poor data entry into the electronic patient record, and (c) comments on medical aspects of guideline recommendations, on their formalisation into computerised rules, and on the guideline integration into the computerised clinical chart. We organised a well-structured taxonomy of non-compliance motivations in such a way that the main hierarchical levels correspond to different medical or technical roles suitable for feedback managing. We analysed about 400 consecutive cases of patients with ischemic stroke. About 40 non-compliances, as well as several incomplete data forms have been identified and motivated.
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Controlled randomized clinical trials and meta-analyses show that stroke patients benefit from access to specialized Stroke Units, in terms of mortality, disability and dependency. However, many issues relating to stroke diagnosis and... more
Controlled randomized clinical trials and meta-analyses show that stroke patients benefit from access to specialized Stroke Units, in terms of mortality, disability and dependency. However, many issues relating to stroke diagnosis and therapy and to the organization of stroke care remain to be solved and little is known about what interventions make Stroke Units more effective. It is also agreed that compliance with clinical practice guidelines improves health outcomes for these patients, but little is known about the relative weight of the different guideline recommendations. Over the last decade, many hospital- or population-based stroke registers have been set up with the aim of identifying specific key indicators able to monitor the quality and adequacy of acute stroke care. Registers seem to be adequate tools for collecting the data needed to analyze care processes, providing data useful for both national healthcare planning and scientific research. In this paper we applied dat...
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Literature results and personal experience show that intrusive modalities of presenting suggestions of computerized clinical practice guidelines are detrimental to the routine use of an information system. This paper describes a solution... more
Literature results and personal experience show that intrusive modalities of presenting suggestions of computerized clinical practice guidelines are detrimental to the routine use of an information system. This paper describes a solution for smoothly integrating a guideline-based decision support system into an existing computerized clinical chart for patients admitted to a Stroke Unit. Since many years, the healthcare personnel were using a commercial product for the ordinary patients' data management, and they were satisfied with it. Thus, the decision support system has been integrated keeping attention to minimize changes and preserve existing human-computer interaction. Our decision support system is based on workflow technology. The paper illustrates the middleware layer developed to allow communication between the workflow management system and the clinical chart. At the same time, the consequent modification of the graphical users' interface is illustrated.
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The management of chronic patients is a complex process, which requires the cooperation of all primary care professionals and their interaction with specialists, laboratories and personnel of different organizations. In this paper we show... more
The management of chronic patients is a complex process, which requires the cooperation of all primary care professionals and their interaction with specialists, laboratories and personnel of different organizations. In this paper we show how a Careflow Management System (CfMS) may represent an essential component of an innovative Health Information System (HIS) able to handle the information and communication needs underlying chronic diseases management. On the basis of a general architecture designed for chronic diseases, we describe a CfMS implementation in the area of diabetes management; such a system embeds EPR and telemedicine functionalities as end-users applications as well as a module for inter-organizational communication based on contracts and on XML messages.
Research Interests: Information Systems, Primary Care, Organizational Communication, Health Informatics, Diabetes, and 13 moreSelf Care, Telemedicine, Chronic disease management, Library and Information Studies, Humans, Diabetes mellitus, Chronic Disease, Case Management, Computer User Interface Design, Management System, Health Information System, Patient Care Team, and Public health systems and services research
We describe a telemedicine application for emergency management in Stroke Units, where prompt decisions must be taken, often knowing neither the clinical history nor the stroke symptoms onset modality. We have designed and implemented an... more
We describe a telemedicine application for emergency management in Stroke Units, where prompt decisions must be taken, often knowing neither the clinical history nor the stroke symptoms onset modality. We have designed and implemented an Information and Communication Technology architecture for the situation in which a general practitioner is called for a suspected stroke and provides for the admission to a Stroke Unit. By means of a palmtop and a wireless Internet connection, he can send to the Stroke Unit the demographic data, the list of the patient's problems, current and/or recent therapies, and a guideline-based stroke-specific form with the objective examination results. In this way, the Stroke Unit team is alerted and informed before the patient arrival, and can manage the urgency at the best. The proposal involved 20 general practitioners and one Stroke Unit in the Lombardia Region, Italy.
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The success of a decision support system based on clinical practice guidelines does not only depend on the quality of the decision model used to represent and execute guideline recommendations, but also on the design of interactions of... more
The success of a decision support system based on clinical practice guidelines does not only depend on the quality of the decision model used to represent and execute guideline recommendations, but also on the design of interactions of the system with the end-user interface and the electronic patient record. This paper describes technical solutions adopted to add decision support functionalities
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We describe a system that facilitates speech therapists to administer cognitive rehabilitation exercises and to evaluate treatment outcomes. We started by augmenting a commercial tool with a more user-friendly interface, meeting the needs... more
We describe a system that facilitates speech therapists to administer cognitive rehabilitation exercises and to evaluate treatment outcomes. We started by augmenting a commercial tool with a more user-friendly interface, meeting the needs of the healthcare professionals involved. Then we integrated, into the same tool, a new type of exercise, that is particularly patient-tailored, being based on the recognition of
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Xin Li, Hsinchun Chen, Zan Huang, Hua Su, Jesse D. Martinez. Global mapping of gene/protein interactions in PubMed abstracts: A framework and an experiment with P53 interactions...... 453 Mohammad-R. Akbarzadeh-T, Majid Moshtagh-Khorasani. A hierarchical fuzzy rule-based approach to aphasiadiagno...more
The activities of care providers need to be coordinated within a process properly designed on the basis of available best practice medical knowledge. It requires a rethinking of the management of care processes within health-care... more
The activities of care providers need to be coordinated within a process properly designed on the basis of available best practice medical knowledge. It requires a rethinking of the management of care processes within health-care organisations. The current workflow technology seems to offer the most convenient solution to build such cooperative systems. However, some of its present weaknesses still require an intense research effort to find solutions allowing its exploitation in real medical practice. This paper presents an approach to design and build evidence-based workflow management systems (WfMS). They can be viewed as components of a knowledge management infrastructure each health care organisation should be provided with, to increase its performance in delivering high-quality care, by efficiently exploiting the available knowledge resources. On the basis of a general methodology, we describe a WfMS implementation in the area of Stroke management; such a system, after intensive testing in our research laboratory, is now in the process of being transferred in a real working setting (a stroke unit) and integrated with an existing electronic patient record.