Quality of Health Care: Informatics Foundations^[*]

Summary

Objective: To discuss in what ways computer systems can contribute to the quality of healthcare and on which principles of informatics successful systems are based.

Methods: Part of the information was obtained via a literature search and part is based on the knowledge of the authors.

Results: The results of the literature search are reported. The answers to the questions whether decision support is useful and which factors determine its success, the foundations of computerized guidelines systems and applications of physician order entry and medical risk management are presented. Conclusions: Despite many publications concerning diagnostic support systems their use in clinical practice is limited. Reminder systems do appear to have an impact on health outcomes. Standards for guideline models are being developed for effective sharing of guidelines across systems. Electronic patient records and physician order entry systems are useful aids in medical risk management.

Keywords

Literature review - decision support - risk management - computerized guideline systems - guideline models - physician order entry systems - decision support methods

• References

• 1 Miller RA, Pople HE, Myers JD. INTERNIST-1, an experimental computer-based diagnostic consultant for general internal medicine. N Engl J Med 1982; 307: 468-76.
• 2 Berman L, Miller RA. Problem area formation as an element of computer aided diagnosis: a comparison of two strategies within Quick Medical Reference (QMR). Methods Inf Med 1991; 30: 90-5.
• 3 Lau LM, Warner HR. Performance of a diagnostic system (Iliad) as a tool for quality assurance. Comput Biomed Res 1992; 25: 314-23.
• 4 Feldman MJ, Barnett GO. An approach to evaluating the accuracy of Dxplain. Comput Methods Programs Biomed 1991; 35: 261-6.
• 5 Blois MS. Information and medicine. The nature of medical descriptions. Berkeley, CA: University of California Press; 1984
• 6 Kohn LT, Corrigan JM, Donaldson MS. (eds). To Err Is Human: Building a Safer Health Care System. Committee on Quality of Health Care in America, Institute of Medicine. Washington DC: National Academy Press; 1999
• 7 Staender S, Davies J, Helmreich B, Sexton B, Kaufmann BM. The anaesthesia critical incident reporting system: an experience based database. Int J Med Inf 1997; 47: 87-90.
• 8 Fox J, Das S. Safe and sound: artificial intelligence in hazardous applications. Menlo Park, CA: AAAI Press/ The MIT Press; 2000
• 9 Kobus DA, Amundson D, Moses JD, Rascona D, Gubler KD. A computerized medical incident reporting system for errors in the intensive care unit: initial evaluation of interrater agreement. Mil Med 2001; 166: 350-3.
• 10 Stanhope N, Crowley-Murphy M, Vincent C, O’Connor AM, Taylor-Adams SE. An evaluation of adverse incident reporting. J Eval Clin Pract 1999; 5: 1-4.
• 11 Deming W. Out of the Crisis. Boston: MIT Press; 1982
• 12 Blumenthal D, Scheck AC. Improving Clinical Practice. San Francisco: Jossey-Bass; 1995
• 13 Berner ES, Webster GD, Shugerman AA. et al. Performance of four computer-based diagnostic systems. N Engl J Med 1994; 330: 1792-6.
• 14 Elstein AE, Friedman CP, Wolf FM. et al. Effects of a decision support system on the diagnostic accuracy of users: a preliminary report. JAMIA 1996; 3: 422-8.
• 15 Friedman CP, Elstein AE, Wolf FM. et al. Enhancement of clinician’s diagnostic reasoning by computer based consultation. A multi-site study of 2 systems. JAMA 1999; 282: 1851-6.
• 16 Balas EA, Austin SM, Mitchell JA, Ewigman BG, Bopp KD, Brown GD. The clinical value of computerized information services. A review of 98 randomized clinical trials. Arch Fam Med 1996; 5: 271-6.
• 17 Shea S, Dumouchel W, Bahamonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. JAMIA 1996; 3 (Suppl. 06) 399-409.
• 18 Austin SM, Balas EA, Mitchel JA, Ewigman BG. Effect of physician reminders on preventive care: meta-analysis of randomised clinical trials. JAMIA 1994; 1 suppl 121-4.
• 19 Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinical performance and patient outcome. Ann Intern Med 1994; 120: 135-42.
• 20 Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes. JAMA 1998; 280: 1339-46.
• 21 Balas EA, Weingarten S, Garb CT, Blumenthal D, Boren SA, Brown GD. Improving preventive care by prompting physicians. Arch Intern Med. 2000; 160: 301-8.
• 22 Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. Can Med Assoc J 1995; 153 (Suppl. 10) 1423-31.
• 23 Field MJ, Lohr KN. (eds). Clinical practice guidelines: directions for a new program. Washington DC: National Academy Press; 1990
• 24 Grimshaw JM, Russel IT. Effects of clinical guidelines on medical practice: a systematic review of rigorous evaluation. Lancet 1993; 342: 1317-22.
• 25 Field MJ, Lohr KN. (eds). Guidelines for clinical practice guidelines: from development to use. Washington DC: National Academy Press; 1992
• 26 Payne TH. Computer decision support systems. Chest 2000; 118: 47S-52S.
• 27 Teich JM, Wrinn MM. Clinical decision support systems come of age. MD computing 2000; 17 (Suppl. 01) 43-6.
• 28 Reggia JA, Tuhrim S. Computer-assisted medical decision making. Volumes 1 and 2. New York: Springer Verlag; 1985
• 29 Miller PL. Selected topics in medical artificial intelligence. New York: Springer Verlag; 1988
• 30 Wang D, Peleg M, Tu SW. et al. Representation primitives, process models and patient data in computer-interpretable clinical practice guidelines: a literature review of guideline representation models. International Journal of Medical Informatics 2002; 68: 59-70.
• 31 Hripcsak G, Ludemann P, Pryor TA, Wigertz OB, Clayon PD. Rationale for the Arden Syntax. Comput Biomed Res 1994; 27 (Suppl. 04) 291-324.
• 32 Ohno-Machado L, Gennari JH, Murphy S, Jain NL, Tu SW. et al. The Guideline Interchange Format: A model for representing guidelines. JAMIA 1998; 5 (Suppl. 04) 357-72.
• 33 Peleg M, Boxwala A, Ogunyemi O, Zeng Q, Tu SW. et al. GLIF3: the evolution of a guideline representation format. In: Proc AMIA Annual Symposium. 2000: 645-9.
• 34 Fox J, Johns N, Lyons C, Rahmanzadeh A. et al. PROforma: a general technology for clinical decision support systems. Comput Methods Programs Biomed 1997; 54 1-2 59-67.
• 35 Shahar Y, Miksch S, Johnson P. The Asgaard project: a task specific framework for the application and critiquing of time-oriented clinical guidelines. Artif Intell Med 1998; 14 1-2 29-51.
• 36 Musen MA, Tu SW, Das AK, Shahar Y. EON: a component based approach to automation of protocol-directed therapy. JAMIA 1996; 3 (Suppl. 06) 367-88.
• 37 Grosso WE, Eriksson H, Fergerson RW, Gennari JH, Tu SW, Musen MA. Knowledge Modeling at the Millennium (The Design and Evolution of Protégé-2000). Twelfth Workshop on Knowledge Acquisition, Modeling and Management (KAW ’99); 1999
• 38 De Clercq PA, Hasman A, Blom JA, Korsten HHM. Design and implementation of a framework to support the development of clinical guidelines. Int J Med Inf 2001; 64 2-3 285-318.
• 39 McDonald CJ, Overhage JM, Tierney WM. et al. The Regenstrief Medical Record System: a quarter century experience. Int J Med Inf 1999; 54 (Suppl. 03) 225-53.
• 40 Bates DW, Leape LL, Cullen DJ. et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280 (Suppl. 15) 1311-6.
• 41 Lee F, Teich JM, Spurr CD, Bates DW. Implementation of physician order entry: user satisfaction and self-reported usage patterns. JAMIA 1996; 3 (Suppl. 01) 42-55.
• 42 Overhage JM, Perkins S, Tierney WM, McDonald CJ. Control trial of direct physician order entry. JAMIA 2001; 8: 361-71.
• 43 Matsumura Y, Takeda H, Inoue M. Implementation of the totally integrated hospital information system (HUMANE) in Osaka university hospital,. In: Greenes RA, Peterson AH, Prottie DJ. (eds) Medinfo ’95; North-Holland, Amsterdam;: 1995: 590-3.
• 44 Sittig DF, Stead WW. Computer-based physician order entry: the state of the art. JAMIA 1994; 1: 108-23.
• 45 Haruki Y, Ogushi Y, Okada Y, Kimura M, Kumamoto I, Sekita Y. Status and perspective of hospital information systems in Japan. Methods Inf Med 1999; 38: 200-6.
• 46 Evidence Report/Technology Assessment No. 43, Making Health Care Safer: A Critical Analysis of Patient Safety Practices, AHRQ Publication No. 01-E058.
• 47 Nakajima K, Kuwata S, Matsumura SY, Oshima H, Takeda H. Operation and effects of computerized incident reporting system for prevention of medical adverse events. J Japanese Medical Informatics Assoc 2001; 21: 77-82.
• 48 Takeda H, Matsumura Y, Okada T, Kuwata S, Inoue M. A Japanese approach to establish an electronic patient record system in an intelligent hospital. Int J Med Inform 1998; 49: 45-51.
• 49 Matsumura Y, Takeda H, Okada T, Kuwata S, Hiroaki N, Hazumi N, Inoue M. Devices for structured data entry in electronic patient record. In: Cesnik B, McCray AT, Scerrer JR. (eds) IOS Press, Amsterdam, Medinfo ’98.; 1998: 85-8.
• 50 Matsumura Y, Kuwata S, Kusuoka H, Takahashi Y, Onishi H, Kawamoto T, Takeda H. Dynamic Viewer of Medical Events in Electronic Medical Record. In: Patel VL, Rogers R, Haux R. (eds) IOS Press; Amsterdam: Medinfo 2001 2001: 648-52.
• 51 Kondoh H, Takeda H, Matsumura Y, Kuwata S, Yoshimua H, Narumi Y, Nakamura H, Okura Y, Inamura K, Washiashi T, Okada S. PACS linked to EPR. In: Patel VL, Rogers R, Haux R. (eds) IOS Press, Amsterdam, Medinfo 2001; 2001: 915-8.
• 52 Bates DW, Scott Evans R, Murff H. et al. Detecting adverse events using information technology. JAMIA 2003; 10: 115-28.