Health Informatics Journal

eMed provides for the first time a complete framework for organizations involved in the healthcare sector to utilize eCommerce and m-Commerce technologies and to enable information sharing and partnerships. It devises a sustainable supply-chain model that can best satisfy an ever-changing marketplace. It aids organizations in migrating to an improved system while focusing on driving costs out of the supply chain. eMed is an advanced experiment in the field of healthcare administration that aims at the connection of regional medical communities to the global digital economy. It aims at the creation of local medical digital communities in selected European regions as well as their interconnection. The main objective is to systematically assess the risks and opportunities involved in the implementation of a service for reimbursement of medical services in Europe, based on advanced telematics technologies and digital economy’s techniques.

The popularity of social networks and the huge number of exchanges have made them immensely important for the communication of information. This French study explored prevention in hereditary breast cancer using a social Internet network to communicate information. The principal objective was to inform French women aged from 20 to 50 years, using the social network Facebook, about the warning signs of breast cancer in cases of a predisposition to the disease due to a genetic mutation. The secondary objectives were to inform people about screening. An information page entitled “hereditary breast cancer: and if I was concerned?” was distributed in 3 different ways: from friend to friend, via groups of persons, and by targeted advertising. Four articles and 11 messages were distributed over 27 days. The total number of visits for this period amounted to 1019. A total of 81 percent of the Internauts were women and 55 percent of the visitors were aged between 25 and 44 years. Other information campaigns concerning public health issues could be conducted using this tool. A legal framework is necessary to preserve the quality of the medical information provided. This new means of communication, used for prevention purposes, will add to other frequently used methods of communication.

With an increase in the number of district hospitals equipped with CT scanners, neurosurgical centres are frequently being approached to interpret emergency brain scans. Patient management is improved if the images can be transferred rapidly and reliably between hospitals. Although the technology for electronic image transfer (teleradiology) has been available for some years, it remains expensive, particularly as many hospitals would only use such a system a few times a year. This paper examines the established and potential methods for emergency image transfer and proposes a simple and cheap alternative method. This method employs an optical scanning device and a conventional modem linking personal computers at the transmitting and receiving sites. Such a system would be cheap enough for consultant neurosurgeons to have a system at home, allowing their opinion to be more easily and rapidly obtained at all hours.

Speech recognition software can increase the frequency of errors in radiology reports, which may affect patient care. We retrieved 213,977 speech recognition software–generated reports from 147 different radiologists and proofread them for errors. Errors were classified as “material” if they were believed to alter interpretation of the report. “Immaterial” errors were subclassified as intrusion/omission or spelling errors. The proportion of errors and error type were compared among individual radiologists, imaging subspecialty, and time periods. In all, 20,759 reports (9.7%) contained errors, of which 3992 (1.9%) were material errors. Among immaterial errors, spelling errors were more common than intrusion/omission errors (p < .001). Proportion of errors and fraction of material errors varied significantly among radiologists and between imaging subspecialties (p < .001). Errors were more common in cross-sectional reports, reports reinterpreting results of outside examinations, and procedural studies (all p < .001). Error rate decreased over time (p < .001), which suggests that a quality control program with regular feedback may reduce errors.

Pattern recognition and machine learning methods provide an attractive approach for building decision support systems. Classification trees are frequently used algorithms for such tasks owing to their intuitive structure and effectiveness. It has been shown that for complex medical data, combining a number of base classifiers improves their overall accuracy. Classification tree ensembles have a certain number of free parameters to set, which can significantly affect their performance. In recent years such ensembles were often used by practitioners without a mathematical background (e.g. physicians), who may be unaware of how to obtain the optimal settings. Therefore, it is difficult for them to choose the satisfactory properties, while in most of the cases the default parameters proposed for them are not necessarily the most efficient. The aim of this article is to ascertain which types of combined tree classifiers give the best performance for medical decision support and which parameters should be chosen for them. A set of rules for end-users on how to tune their ensembles is proposed.

The Cumberlege Seminars in England focused attention on the need to improve co-ordination and the quality of NHS library and information resources and to develop more efficient modes of access to the knowledge base of health. This paper reviews the background to the two Cumberlege Seminars, briefly describes the aims and recommendations from each, discusses progress in implementing the recommendations and offers suggestions for improving library and information support to the knowledge base.

Some technologies, like scissors and chopsticks, appear inherently simple. Others, like nuclear reactors or life-support electronics, are inherently complex. By nature, the safety issues associated with complex systems are more involved than those associated with simple systems. There are always added cost requirements in complexity, such as special requirements for ensuring safe operation of the system. The very subsystems added to increase safety, however, necessarily add to complexity and, ironically, enrich the number of possible failure modes in the overall system. Thus there is a concern that the failure of any additional safety system may itself lead to new system failure modes that would not have otherwise occurred [1].

These comments explain why simply adding complexity to a system may not always improve on the system’s performance. The following illustrates some of the concerns that I have developed about the potential misapplication of computers in medical technology. These concerns are based on my clinical experience over the last decade in dealing with high-tech aspects of medical care.

Whiteboards are a central tool at emergency departments. We investigate how the substitution of electronic for dry-erase whiteboards affects emergency department clinicians’ mental workload and distribution of their time. With the electronic whiteboard, physicians and nurses spend more of their time in the work areas where other clinicians are present and whiteboard information is permanently displayed, and less in the patient rooms. Main reasons for these changes appear to be that the electronic whiteboard facilitates better timeouts and handovers. Physicians and nurses are, however, in the patient rooms for longer periods at a time, suggesting a more focused patient contact. The physicians’ mental workload has increased during timeouts, whereas the nurses’ mental workload has decreased at the start of shifts when they form an overview of the emergency department. Finally, the secretaries, but neither physicians nor nurses, access whiteboard information on computers other than the permanent displays.

Checklists are commonly used to structure the communication process between anesthesia nursing healthcare providers during the transfer of care, or handoff, of a patient after surgery. However, intraoperative information is often recalled from memory leading to omission of critical data or incomplete information exchange during the patient handoff. We describe the implementation of an electronic anesthesia information transfer tool (T2) for use in the handover of intubated patients to the intensive care unit. A pilot observational study auditing handovers against a pre-existing checklist was performed to evaluate information reporting and attendee participation. There was a modest improvement in information reporting on part of the anesthesia provider, as well as team discussions regarding the current hemodynamic status of the patient. While T2 was well-received, further evaluation of the tool in different handover settings can clarify its potential for decreasing adverse communication-related events.

Children’s mental health has risen to the top of the social agenda in recent years but surprisingly little has been done systematically to collect and analyse their views of professional help. In this study the NUD•IST qualitative data analysis software was used to analyse 35 interviews with children and young adults aged between 7 and 20 and build a model of what makes a helpful grown up. It was also possible to discern what makes grown ups unhelpful and list some of the complaints the children had about their treatment. On coding the qualities of the helpful adult four major themes appeared: general qualities; counselling skills; ethical stance; and the ability to make things happen (helpful outcomes). The unhelpful adult was categorized in terms of: physical behaviour; verbal behaviour; social behaviour and attitudes. In terms of adult roles the three types of unhelpful behaviour are associated with parents, foster parents, residential workers in children’s homes and teachers. Unhelpful attitudes are associated with all adults whether carers or professionals. The children complained about foster and residential placements, the difficulty of actually telling adults they had a problem, the unfairness of the way some adults treated them and the help they should have had but either never received or which took too long to arrive. While making no claims for profundity this model of the helpful grown up is presented with considerable confidence. A finding was that the profession of the adult matters far less than whether or not they possess the qualities of the helpful grown up, and there is a clear need for all healthcare professionals working with children to possess these core skills if they are to be effective.

The value of clinical nursing information is not just within professional care delivery, but as a source for educational and professional development for practitioners. At the core of this argument is the informative connection nurses make through discussion, questioning and reflecting together. Nurses contribute to the production of much healthcare information; there is a danger, however, of their own expert information and knowledge being subsumed.

There are ways to move forward: through facilitating the capture of nursing’s ‘professional’ information, organizing a nurses’ system, and establishing a nursing information electronic clinical exchange. This ‘living’ encyclopaedia would revalue knowledge and experience and support professional information development for the benefit of healthcare delivery.

The issue for nurses becoming involved in electronic information exchange is the need for support from their healthcare organizations to facilitate professional networking. A nurses’ information system needs to be ‘open’, though managed within a ‘closed’ organizational environment. Informal networking does not serve the purpose of exchanging ‘professional’ information at the workface. This demands new approaches.

Worldwide healthcare professions are examining ways in which communication can be more effective and the electronic networking of a nurses’ information system is right for this age in healthcare.

Accurate and timely clinical data are required for clinical and organisational purposes and is especially important for patient management, audit of surgical performance and the electronic health record. The recent introduction of computerised theatre management systems has enabled real-time (point-of-care) operative procedure coding by clinical staff. However the accuracy of these data is unknown. The aim of this Scottish study was to compare the accuracy of theatre nurses’ real-time coding on the local theatre management system with the central Scottish Morbidity Record (SMR01). Paired procedural codes were recorded, qualitatively graded for precision and compared (n = 1038). In this study, real-time, point-of-care coding by theatre nurses resulted in significant coding errors compared with the central SMR01 database. Improved collaboration between full-time coders and clinical staff using computerised decision support systems is suggested.