The Computer-Based Patient Record An Essential Technology for Health Care, Revised Edition (1997) / Chapter Skim
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A Progress Report on Computer-Based Patient Records in Europe
A Progress Report on Computer-Based Patient Records in Europe
Pages 21-44
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From page 21... ...
van Ginneken, and Johan van der Lei After more than two decades of pioneering efforts, in both the United States and Europe, a new era in the use of computer-stored patient data has clearly begun. The proliferation of inexpensive personal computers and workstations, the development of more user-friendly interfaces, the standardization of network technology, the original release of this report 6 years ago, and the stimulation of health care telematics (i.e., network communications)
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From page 22... ...
The data in CPRs are not begging to be used for electronic data exchange, resarch, and shared care. The use of CPRs for purposes other than direct patient care has been associated with several problems (van der Lei et al., 1991a; Vlug
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From page 23... ...
As the knowledge gained from experience accumulates, CPR developers learn important lessons, particularly the need to develop structured patient records based on a clear conceptual model. If CPR systems are not based on a conceptual model, and if the data in CPRs are not well structured, it will not be possible to use CPR data for different goals, nor will it be possible for such data to be exchanged between health care providers to support shared care.
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From page 24... ...
Furthermore, GPs keep less extensive records so that data entry is less timeconsuming and less detailed. The actual situation in The Netherlands offers a good example of both the success and the potential use of CPRs (van der Lei et al., 1993~.
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From page 25... ...
, and enables the production of referral letters, the use of electronic data interchange, and the tracking of certain categories of patients. Potential users should realize that, certainly at the beginning, investments must be made.
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From page 26... ...
Patients in The Netherlands and the United Kingdom have a single GP who coordinates their health care, acting as a gatekeeper to other specialists; the latter report back to the GP. Several projects are now under way to use electronic data interchange for this GP-specialist communication (see the section on "CPR Systems for Shared Care," page 32~.
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From page 27... ...
The Hermes workstation was initially developed to support clinical data analysis, but its architecture has also been extended to support patient care. It is iISO: International Standards Organization.
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From page 28... ...
The Helios platform is being used as one of the building blocks of a new generation of hospital information systems. The Hermes approach, originally developed on a Unix platform, has now migrated to a Windows NT/95 environment, forming the basis for the European project I4C (van Bemmel et al., 1996)
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From page 29... ...
To accomplish this, different approaches to data entry have received attention: form-driven data entry, natural language processing, and structured data entry. The last two methods are also the focus of several research projects in Europe (Nowlan and Rector, 1991; Baud et al., 1992; Moorman et al., 1994~.
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From page 30... ...
::::::::::::::::::: 1 1.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:. 1::::::::::::::::::::::::::::::::::::::::::::::: 1.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: :.: l::::::::::::::::::::::::::::::::::::::::::::::: Schedule 1:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-:::-::: ::: ::: ::: ::: :: Ultrasound ~ Diagnosis Data retrieval Research retrieval Brokerage ~ayer I Server Communication ~ayer Data repository of patient records thesauri/protoco~s know~edge bases DIS encapsulator .............
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From page 31... ...
Therefore, it is difficult to impose structure on data that are used as input for natural language processing. Structured Data Entry Another way of data entry is context sensitive and is adaptable to different clinical domains.
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From page 32... ...
In the next two sections we provide two examples of European projects involving the use of CPR data for shared care. The first describes the project CoCo, concerning the coordination and continuity of health care (Bernstein and Jensen, 1994~.
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From page 33... ...
~ ~ ~ s it: ~ :: :~ : ~ :: ~ aft: ~ ~ ~:~:~: ~ I: :::: : :~ Q: Do TO :~°~'R1~:°~ :°:~ ~ >~ Hospital Pharmacy r: ~:~:::~: ::: :) Laboratory FIGURE 3 Regional electronic data-interchange network to support shared care.
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From page 34... ...
We briefly discuss here a project dealing with critiquing a physician's care (van der Lei et al., 1991; van der Lei and Musen, 1991; van Bemmel, 1993~. Another European project intends to integrate treatment protocols with CPR systems.
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From page 35... ...
Both systems rely on CPRs for patient data. HyperCritic was assessed in a research project, and we summarize here some of the main outcomes (van der Lei et al., 1991~.
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From page 36... ...
Pressure from law enforcement bodies, thirdparty payers, peer-review organizations, hospitals, and physicians and patients themselves may lead to this use of automated review of CPRs. We briefly discuss a large ongoing project on the assessment of drug prescriptions in the population (Vlug and van der Lei, 1995; Visser et al., 1996~.
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From page 37... ...
The data in that database are subsequently used to conduct postmarketing surveillance studies (Vlug and van der Lei, 1995~. The Dutch authorities responsible for drug safety are investigating the potential use of this type of database.
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From page 38... ...
Yet, it will be difficult to totally prevent the improper use of data stored in CPRs. Because modern health care often requires shared care instead of care by a single physician only, the individual physician is no longer capable of personally guaranteeing the privacy of a patient's data.
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From page 39... ...
Syntax for Health Care Data Interchange Electronic messages in health care can be coded in many different ways. Therefore, consensus is required on the exchange formats for health care data between different systems.
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From page 40... ...
The evidence of political support and support by the medical professional organizations for CPRs sends a strong message to system developers and users, as well as to the general public. Third, the emerging focus on conceptual models that build upon rather than are driven by the technology is a significant breakthrough in CPR development and will likely result in systems that can be adopted throughout Europe.
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From page 41... ...
van der Lei.
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From page 42... ...
van der Lei, J., and M
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From page 43... ...
van der Lei.
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