Doctors' use of electronic medical records systems in hospitals: cross sectional survey

ObjectivesTo compare the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks.DesignCross sectional questionnaire survey. Semistructured telephone interviews with key staff in information technology in each hospital for details of local implementation of the systems.Setting32 hospital units in 19 Norwegian hospitals with electronic medical records systems.Participants227 (72%) of 314 hospital doctors responded, equally distributed between the three electronic medical records systems.ResultsMost tasks listed in the questionnaire (15/23) were generally covered with implemented functions in the electronic medical records systems. However, the systems were used for only 2-7 of the tasks, mainly associated with reading patient data. Respondents showed significant differences in frequency of use of the different systems for four tasks for which the systems offered equivalent functionality. The respondents scored highly in computer literacy (72.2/100), and computer use showed no correlation with respondents'' age, sex, or work position. User satisfaction scores were generally positive (67.2/100), with some difference between the systems.ConclusionsDoctors used electronic medical records systems for far fewer tasks than the systems supported.

What is already known on this topic

Electronic information systems in health care have not undergone systematic evaluation, and few comparisons between electronic medical records systems have been madeGiven the information intensive nature of clinical work, electronic medical records systems should be of help to doctors for most clinical tasks

What this study adds

Doctors in Norwegian hospitals reported a low level of use of all electronic medical records systemsThe systems were mainly used for reading patient data, and doctors used the systems for less than half of the tasks for which the systems were functionalAnalyses of actual use of electronic medical records provide more information than user satisfaction or functionality of such records systems     

皮肤病专科医院电子病历的设计与应用

???????目的 研究与开发具有皮肤病专科特色的电子病历系统,以实现皮肤科病人医疗信息的采集、加工、存储、传输和服务。方法 以windows sqlserver2005为后台数据库,以XML、C#为开发语言,建立皮肤病结构化病历。结果 该系统运行良好,安全稳定、易维护、通用性好。有效地提高了医生书写病历的速度和质量,并具有皮疹数码照片嵌入等功能。结论 本研究实现了具有皮肤病专科特色的电子病历系统,值得皮肤病医院推荐使用。     

A check-list of Greek liverworts

Abstract

A list of hepatics recorded from Greece, based entirely on published records, is given. All works containing original records are listed and the regions of Greece in which the 138 species have been recorded are indicated.     

流程重组在病案质量控制中的实践应用

??????? 目的 对病案质控流程重组,总结完善工作流程,提高工作效率,改善工作质量。方法 在分析病案出院前质控流程现状基础上,从缩短审核时间、增加病床合理使用和保证病历质量等方面阐述如何在现有条件下来改善病案质控流程。结果 加强病案质量控制,不断提高病历书写质量。结论 使病案质控最大限度服务于临床需要。     

对临床输血病案文书质量的调查与分析

目的 探讨临床输血病案文书的内涵质量。方法 采取随机抽查的方法对某院2009—2010年已经归档的输血病案,按卫生部“医院管理年和医疗质量万里行”活动内容进行调查。结果 发现多份病历不合格。结论 临床输血病案文书是临床医师对患者治疗过程的原始记录,是当时事态的真迹,是医疗事故或纠纷在认定是非、判明责任,以及医疗技术鉴定或司法鉴定时赖以立论的依据。因此,写好病案文书可减少医疗纠纷的发生。     

基于影像扫描技术的病案数字化质量管理

目的 纸质历史病案数字化制作加工中,采取严格的质控措施,降低每个环节的错误率,保证数字化病案的完整、准确、清晰。方法 加工流程采取流水线作业,设置专人质控等人为干预和系统程序干预两方面。结果 病案数字化质控管理为临床医生工作站调阅病案、患者复印病案等提供准确数据。结论 数字化病案能否从质量上和完整性上代表原件,有效的全程质量控制起着至关重要的作用。     

Agreement between different survey instruments to assess incident and prevalent tumors and medical records – results of the Heinz Nixdorf Recall Study

ObjectiveThe validity of participants’ self-reports via questionnaires or interviews in epidemiological studies remains questionable. We examined the agreement of tumors, reported via different survey instruments, with medical records.MethodsWithin the Heinz Nixdorf Recall Study, comprising 4814 subjects aged 45–75 years, tumors were assessed via different survey tools at baseline and 8-year-follow up (FU): personal interviews (CAPI), self-administered questionnaires (SA-Q), physical examinations, short questionnaire/non-responder questionnaire (S-/N-Q) and telephone interviews. Information on each self-reported tumor was coded via ICD-10, WHO-Version 2010, and evaluated against medical records.ResultsDuring FU, 95% of 1083 self-reported incident tumors in 623 individuals, at baseline, 65% of 473 prevalent tumors in 406 individuals could be evaluated. Agreement of the main assessment tools, CAPI and SA-Q, with medical records was 90.1% and 88.4% (FU) and 91.0% (baseline-CAPI).Best agreement was in tumors of prostate (baseline-CAPI: 97.8%; 5-year-FU-CAPI: 96.9%, SA-Q: 95.7%) and breast (baseline-CAPI: 93.2%; 5-year-FU-CAPI: 100.0%, SA-Q: 98.8%).DiscussionAgreement of CAPI and SA-Q with medical records was good. To assess incident tumors, SA-Q emerged as favorable, as it is least expensive and easy to be applied. Especially for tumors of prostate and breast, cost-intensive and time-consuming validation with medical records may not be necessary.     

Value of Hemoglobin A1C In Diagnosing Diabetes Mellitus within a Chronic Disease Management System Illustrated by the Receiver Operating Characteristic Curve

ObjectiveTo develop a receiver operating characteristic (ROC) curve of glycosylated hemoglobin (HbA_1c) for diagnosing diabetes mellitus within a chronic disease management system.MethodsA case-control study including medical records from January 1, 1997, to December 31, 2005, was conducted at the Sioux Falls Veterans Affairs Medical Center. Medical records for the case group (patients with diabetes) were selected based on 1 of 3 criteria: International Classification of Diseases, Ninth Revision, Clinical Modification or Current Procedural Terminology codes specific for type 1 and type 2 diabetes; patients’ use of medications (oral hypoglycemic agents, antidiabetes agents, or insulin); or results from random blood or plasma glucose tests (at least 2 measurements of blood glucose ≥ 200 mg/dL). Records for the control group were selected based on patients having HbA_1c measured, but not meeting the above diagnostic criteria for diabetes during the study period. Records for cases and controls were randomly frequency-matched, one-to-one. The control group was randomly divided into 5 sets of an equal number of records. Five sets of an equal number of cases were then randomly selected from the total number of cases. Each test data set included 1 case group and 1 control group, resulting in 5 independent data sets.ResultsIn total, 5040 patient records met the case definition in the diabetes registry. Records of 15 patients who were prescribed metformin only, but did not meet any other case criteria, were reviewed and excluded after determining the patients were not diabetic. The control group consisted of 5 sets of 616 records each (totaling 3080 records), and the case group consisted of 5 sets of 616 records each (totaling 3080 records). Thus, each of the 5 independent data sets of 1 case group and 1 control group contained 1232 records. The case group was predominantly composed of white men (mean age, 69 years; mean body mass index, 31 kg/m²). Demographic data were similar for control patients. The ROC curve revealed that a HbA_1c ≥ 6.3% (mean + 1 SD) offered the most accurate cutoff value for diagnosing type 2 diabetes mellitus, with the following statistical values: C statistic, 0.78; sensitivity, 70%; specificity, 85%; and positive likelihood ratio, 4.6 (95% confidence interval, 4.2-5.0).ConclusionA HbA_1c value ≥ 6.3% may be a useful benchmark for diagnosing diabetes mellitus within a chronic disease management system and may be a useful tool for monitoring high-risk populations. (Endocr Pract. 2010;16:14-20)     

A record of the Plain Tiger,Danaus chrysippus,in Western Anatolia

Abstract

The Plain Tiger Danaus chrysippus was recorded in Western Anatolia in 1993 for the first time. There are only a few records from Turkey.     

Su alcune piante nuove o interessanti per Lazio e Abruzzo

Abstract

New plant records for Latium and Abruzzi. News are given on ten plants which are rare or interesting for Latium and for Abruzzi. Soleirolia soleirolii, Dictamus albus, Tragopogon samaritanii, Allium fuscum, Stipa setigera are new records for Latium; Tragopogon samaritanii is new also for Abruzzi.     

The first UK survey and population estimate of breeding Snow Bunting Plectrophenax nivalis

Capsule: The first national survey for Snow Bunting Plectrophenax nivalis in the UK was carried out in 2011 and estimated the breeding population at 60 territories (95% confidence intervals?=?48–83).

Aims: To estimate breeding population size for Snow Buntings in the UK by surveying all sites with a history of breeding season occupation.

Methods: Surveys were carried out in June 2011 to detect males on territory at sites where Snow Bunting had been recorded during the breeding season since 1970. Each site was visited at least once during the survey period; suitable habitat was searched and vantage point watches were conducted in order to detect singing males. Repeated visits to a sample of sites allowed a correction factor to be calculated in order to account for birds undetected during surveys.

Results: In 2011, the number of Snow Bunting breeding in the UK (including adjusting for imperfect detection) is a minimum of 60 territories (95% CI?=?48–83) using confirmed and probable breeding records of males. A less conservative estimate of 99 territories (95% CI?=?88–114) results from including all records of males in suitable habitat. The vast majority of the population was found in the Cairngorm region, with isolated records in the north and west Highlands.

Conclusion: The results of the 2011 survey are consistent with well-informed estimates of the Snow Bunting population made previously. This work provides a baseline and repeatable fieldwork and analytical methods enabling future change in the population to be quantified more rigorously.     

A Bryophyte Flora of the Sandstone Rocks of Kent and Sussex

Abstract

A list is given of the Pleistocene records of subfossil bryophytes from 10 sites in Belgium and one from France.     

New records of cestodes of New Zealand birds

Abstract

Ten species of cestodes are reported from aquatic birds in New Zealand. All are new records for the country.     

Reverse migration as a cause of vagrancy

Capsule Reverse migration in autumn does not occur to the same degree in all species of migrants, but is related to migratory direction.

Aims To identify factors determining degree of reverse migration and specifically to test whether it occurs in long-distance migrant species irrespective of their standard (normal) migration direction. Methods Multiple regression analysis on the number of individuals occurring as reverse migrants observed in northwest European countries.

Methods Multiple regression analysis on the number of individuals occurring as reverse migrants observed in northwest European countries.

Results The number of reverse migrants observed in northwest European countries is strongly correlated with standard migratory direction, estimated population size and detectability, but an effect of the distance travelled from the breeding areas is not supported. The pattern holds true for subsamples of the data set, including British and Irish records or Scandinavian records only, and when controlling for phylogeny.

Conclusion Birds that migrate eastward in autumn from their breeding grounds, mostly in eastern Europe, are more likely to consistently reverse migrate than those species migrating southward mostly from southern Europe.     

Nuove segnalazioni di funghi entomogeni

Abstract

New records of entomogenous fungi. — New records of six entomogenous fungi, three Ascomycetes (Cordyceps lloydii Fawcett, C. memorabilis Ces., C. riverae Pacioni) and three Deuteromycetes (Akantomyces aranearum (Petch) Mains, Hirsutella citriformis Speare, Troglobiomyces guignardii (Maheu) Pacioni) are given. The new records allow to expand the known area of distribution of these parasites, to confirm the particular condition for fructification needed by some of them and to give new details for the less common species.     

Validity of cancer diagnosis in a primary care database compared with linked cancer registrations in England. Population-based cohort study

AimsThe present study aimed to evaluate the validity of cancer diagnoses and death recording in a primary care database compared with cancer registry (CR) data in England.MethodsThe eligible cohort comprised 42,556 participants, registered with English general practices in the General Practice Research Database (GPRD) that consented to CR linkage. CR and primary care records were compared for cancer diagnosis, date of cancer diagnosis and death. Read and ICD cancer code sets were reviewed and agreed by two authors.ResultsThere were 5216 (91% of CR total) cancer events diagnosed in both sources. There were 494 (9%) diagnosed in CR only and 213 (4%) that were diagnosed in GPRD only. The predictive value of a GPRD cancer diagnosis was 96% for lung cancer, 92% for urinary tract cancer, 96% for gastro-oesophageal cancer and 98% for colorectal cancer. ‘False negative’ primary care records were sometimes accounted for by registration end dates being shortly before cancer diagnosis dates. The date of cancer diagnosis was median 11 (interquartile range ?6 to 30) days later in GPRD compared with CR. Death records were consistent for the two sources for 3337/3397 (99%) of cases.ConclusionRecording of cancer diagnosis and mortality in primary care electronic records is generally consistent with CR in England. Linkage studies must pay careful attention to selection of codes to define eligibility and timing of diagnoses in relation to beginning and end of record.     

A note on the Quaternary history of Meesia longiseta Hedw. in Britain

Abstract

The Quaternary history of Meesia longiseta in the British Isles is briefly reviewed, and two new records described, one Flandrian, the other Ipswichian. A note on identification is provided.     

On the occurrence of the Medicinal Leech,Hirudo medicinalis L., in the Levant

Abstract

Historical records of H. medicinalis are reviewed and specimens have been identified from recent collections of leeches in northern Israel, confirming that this species has not disappeared from our area.     

A Center of Primary Sources for Plains Indian History

Abstract

Preservation of the nation’s Indian records is recogni: zed as a task of national importance. Public access to government documents and data is now possible at ten regional records centers across the country. The material stored provides detailed and analytic accounts of daily activity and business at Indian agencies. The nature and content of the data relevant to Plains Indian agencies is described in this paper.