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1.  Generating Clinical Notes for Electronic Health Record Systems 
Applied Clinical Informatics  2010;1(3):232-243.
Clinical notes summarize interactions that occur between patients and healthcare providers. With adoption of electronic health record (EHR) and computer-based documentation (CBD) systems, there is a growing emphasis on structuring clinical notes to support reusing data for subsequent tasks. However, clinical documentation remains one of the most challenging areas for EHR system development and adoption. The current manuscript describes the Vanderbilt experience with implementing clinical documentation with an EHR system. Based on their experience rolling out an EHR system that supports multiple methods for clinical documentation, the authors recommend that documentation method selection be made on the basis of clinical workflow, note content standards and usability considerations, rather than on a theoretical need for structured data.
doi:10.4338/ACI-2010-03-RA-0019
PMCID: PMC2963994  PMID: 21031148
Computer based documentation; electronic health records; medical informatics applications; computerized medical records systems; user-computer interface
3.  The Vanderbilt University fast track to IAIMS: transition from planning to implementation. 
Vanderbilt University Medical Center is implementing an Integrated Advanced Information Management System (IAIMS) using a fast-track approach. The elapsed time between start-up and completion of implementation will be 7.5 years. The Start-Up and Planning phases of the project are complete. The Implementation phase asks one question: How does an organization create an environment that redirects and coordinates a variety of individual activities so that they come together to provide an IAIMS? Four answers to this question are being tested. First, design resources to be "scalable"--i.e., capable of supporting enterprise-wide use. Second, provide information technology planning activities as ongoing core functions that direct local efforts. Third, design core infrastructure resources to be both reusable and expandable at the local level. Fourth, use milestones to measure progress toward selected endpoints to permit early refinement of plans and strategies.
PMCID: PMC116315  PMID: 8880678
8.  Computer-based physician order entry: the state of the art. 
Direct computer-based physician order entry has been the subject of debate for over 20 years. Many sites have implemented systems successfully. Others have failed outright or flirted with disaster, incurring substantial delays, cost overruns, and threatened work actions. The rationale for physician order entry includes process improvement, support of cost-conscious decision making, clinical decision support, and optimization of physicians' time. Barriers to physician order entry result from the changes required in practice patterns, roles within the care team, teaching patterns, and institutional policies. Key ingredients for successful implementation include: the system must be fast and easy to use, the user interface must behave consistently in all situations, the institution must have broad and committed involvement and direction by clinicians prior to implementation, the top leadership of the organization must be committed to the project, and a group of problem solvers and users must meet regularly to work out procedural issues. This article reviews the peer-reviewed scientific literature to present the current state of the art of computer-based physician order entry.
PMCID: PMC116190  PMID: 7719793
9.  JAMIA--why? 
PMCID: PMC116186  PMID: 7719789
10.  Designing medical informatics research and library--resource projects to increase what is learned. 
Careful study of medical informatics research and library-resource projects is necessary to increase the productivity of the research and development enterprise. Medical informatics research projects can present unique problems with respect to evaluation. It is not always possible to adapt directly the evaluation methods that are commonly employed in the natural and social sciences. Problems in evaluating medical informatics projects may be overcome by formulating system development work in terms of a testable hypothesis; subdividing complex projects into modules, each of which can be developed, tested and evaluated rigorously; and utilizing qualitative studies in situations where more definitive quantitative studies are impractical.
PMCID: PMC116182  PMID: 7719785
11.  Adopting TMR for physician/nurse use. 
A major problem which must be overcome before on-line medical records become widely accepted and used is the interface between the human and the computer. This paper presents the evolution of an interface, over time, which recognizes and addresses important characteristics a system must exhibit to encourage human acceptance. Areas discussed include data entry, displays, and function and parameter specifications.
PMCID: PMC2247647  PMID: 1807724
12.  Bedside computerization of the ICU, design issues: benefits of computerization versus ease of paper & pen. 
This paper describes the design considerations for the implementation of a bedside computer system in an intensive care environment. Specific issues discussed include application design, implementation problems, design revisions, and design solutions. Specific examples of the above issues include passive data acquisition from bedside devices and computer systems, automated nursing assessments, respiratory therapy assessments and integrated reports.
PMCID: PMC2247639  PMID: 1807714
13.  The Synchronization of Distributed Databases 
This paper describes, with examples from a real-world medical environment, major problems of employing distributed, replicated databases for clinical care information. Specific problems discussed include patient identification, synchronization of data transfer among systems relating to clock time and event, distributed concurrency control, and system unavailability. Solutions, where available, are presented.
PMCID: PMC2245569
14.  Medication Charting Via Computer Gesture Recognition 
The need for computerized medical records in hospitals is widely acknowledged. The nurses and phsicians who will enter and access these records are not often experienced with computers. This paper describes a computer interface, employing a tablet which recognizes handwriting and gestures, which was designed to allow the unskilled user to naturally interact with the computer. The specific application for the study is medication charting.
PMCID: PMC2245513
15.  Query: The Language of Databases 
Query languages have become increasingly important as comprehensive medical databases have become a part of the available knowledge base for patient care. As the user community expands and the need for bedside query arises, the requirement for a fast, easy-to-use, interactive query system must be met. This paper describes the evolution of a query language for the TMR database, discusses problems and limitations of the system, and proposes new approaches to the problem.
PMCID: PMC2245743
16.  The Evolution of a Computerized Medical Information System 
This paper presents the eighteen year history leading to the development of a computerized medical information system and discusses the factors which influenced its philosophy, design and implementation. This system, now called TMR, began as a single-user, tape-oriented minicomputer package and now exists as a multi-user, multi-database, multi-computer system capable of supporting a full range of users in both the inpatient and outpatient settings. The paper discusses why we did what we did, what worked, and what didn't work. Current projects are emphasized including networking and the integration of inpatient and outpatient functions into a single system. A theme of the paper is how hardware and software technological advancements, increasing sophistication of our users, our increasing experience, and just plain luck contributed to the success of TMR.
PMCID: PMC2244968
17.  An Automatic Programming System to Create Medically-Oriented Report Generators 
A medical information system must be able to meet the demand for new reports. This paper presents the advantages and disadvantages of several techniques which allow users to write medically-oriented reports without programming. The development of the TMR report generator, an automatic programming system is described.
PMCID: PMC2578130
18.  Creating a Link Between Medical and Analytical Databases 
Patient care databases and clinical research databases often share a large portion of data. An automatic transfer of data eliminates the duplicate entry process and increases consistency between the databases. This paper provides a description of the different components necessary for the transfer between patient care records of TMR and the records of a statistical analysis database SAS: record structure, record selection and record interpretation.
PMCID: PMC2577994
19.  Planned Networking for Medical Information Systems 
Local area networks and distributed systems provide major advantages in flexibility, expansion, reliability, and improved response time. This paper presents our experiences in developing and implementing Ethernet using Digital hardware and DECnet networking software. A laboratory system implementation using two microcomputers and a superminicomputer is discussed in detail.
PMCID: PMC2577960
20.  A Chartless Record—Is It Adequate? 
The computerized medical record supported by The Medical Record (TMR) has been the only record of physician patient encounters on the nephrology service of the Durham Veteran's Administration Medical Center since April 1981. Physicians using the system evaluated the adequacy of the computerized record as a replacement for the paper chart. The computerized record was able to capture and display all pertinent data. Manual or computerized narratives provided a useful supplement to the core computerized record only in those rare instances that a physician needed to point out which of the data in the record were important to his decision making.
PMCID: PMC2580254
21.  An Interface Between a Hospital Information System and a Computerized Medical Record 
There is a growing overlap between hospital information systems and medical information systems in both data storage and function. The development of an integrated system is the best approach to reducing redundancy without compromising function. An initial interface has been established between the hospital information system and a medical information system at Duke Univeristy as the first step toward achieving an integrated data base.
PMCID: PMC2203914
23.  Positioning the library at the epicenter of the networked biomedical enterprise. 
The changing economic environment in which our biomedical enterprises operate presents unparalleled opportunities to the profession of medical librarianship. Evidence-based medicine, patient empowerment, asynchronous learning networks, and research colaboratories each involve a new type of shared information, or access to information in new ways or by different people. These tasks are ones with which librarianship is directly involved. Librarians are therefore placed perfectly to provide new products and services. To position the library at the epicenter of the networked biomedical enterprise we must meet three challenges: We must align the library's business strategy with that of the larger enterprise. We must provide services in ways that will scale-up to enable new business strategies. We must measure the effectiveness of services in ways that document their role in supporting the enterprise.
PMCID: PMC226322  PMID: 9549009
24.  Implementation of organizational practices to protect information in health organizations. 
In March of 1997, the National Research Council (NRC) of the National Academy of Sciences issued the report, "For the Record: Protecting Electronic Health Information." In its report, the Council recommended both technical and organizational practices to protect electronic health information. At the time the report was issued, Vanderbilt University Medical Center was deeply immersed in the development of organizational practices consistent with the Council's recommendations. We agreed that the recommended technical and organizational practices are important for protecting other information types in addition to health information, and that they suggest appropriate practices for non-electronic information, as well. In this paper, we focus on our process for developing and implementing the seven organizational practices recommended for immediate implementation.
PMCID: PMC2232171  PMID: 9929244
25.  Design of a general clinical notification system based on the publish-subscribe paradigm. 
We describe the design and initial implementation of a notification sub-system, as a component of a modern information management architecture. The system, based on the publish-subscribe paradigm, provides a framework of event-based communications for the implementation of various important clinical applications including the notification of alerts and reminders with escalation algorithms, the reliable distribution of documents, and the implementation of intelligent patient-specific monitoring processes. The initial implementation of the system, providing the notification of the unit staff about new orders, indicates that the model is viable both in terms of functionality and ability to scale up.
PMCID: PMC2233318  PMID: 9357602

Results 1-25 (32)