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As part of an enterprise effort to develop new clinical information systems at Intermountain Health Care, the authors have built a knowledge authoring tool that facilitates the development and refinement of medical knowledge content. At present, users of the application can compose order sets and an assortment of other structured clinical knowledge documents based on XML schemas. The flexible nature of the application allows the immediate authoring of new types [...]

Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and knowledge, supporting database elements, operational features to improve usability and [...]

This report provides an evaluation of the National Library of Medicine-sponsored Woods Hole Medical Informatics (WHMI) course and the extent to which the objectives of the program are achieved. Two studies were conducted to examine the participants' perceptions of both the short-term (spring 2002) and the long-term influences (1993 through 2002) on knowledge, skills, and behavior. Data were collected through the use of questionnaires, semistructured telephone interviews, and participant observation [...]

As the public interest in consumer-driven electronic health care applications rises, so do concerns about the privacy and security of these applications. Achieving a balance between providing the necessary security while promoting user acceptance is a major obstacle in large-scale deployment of applications such as personal health records (PHRs). Robust and reliable forms of authentication are needed for PHRs, as the record will often contain sensitive and protected health information [...]

Community health centers serve ethnically diverse populations that may pose challenges for record linkage based on name and date of birth. The objective was to identify an optimal deterministic algorithm to link patient encounters and laboratory results for hemoglobin A1c testing and examine its variability by health center site, patient ethnicity, and other variables. Based on data elements of last name, first name, date of birth, gender, and health center [...]

Achieving evidence-based practice will require new approaches to providing information during health care delivery and to integrating evidence and informatics at the point of care. To support evidence-based practice, Vanderbilt University Medical Center's Eskind Biomedical Library (EBL) introduced the role of clinical informationist, an information specialist with sufficient knowledge and insight to function as a true partner in the health care team. To further disseminate evidence-based knowledge, the Vanderbilt University [...]

Information retrieval studies that involve searching the Internet or marking phrases usually lack a well-defined number of negative cases. This prevents the use of traditional interrater reliability metrics like the kappa statistic to assess the quality of expert-generated gold standards. Such studies often quantify system performance as precision, recall, and F-measure, or as agreement. It can be shown that the average F-measure among pairs of experts is numerically identical to [...]

In an effort to improve patient safety, researchers at the Johns Hopkins University designed and implemented a comprehensive Web-based Intensive Care Unit Safety Reporting System (ICUSRS). The ICUSRS collects data about adverse events and near misses from all staff in the ICU. This report reflects data on 854 reports from 18 diverse ICUs across the United States. Reporting is voluntary, and data collected is confidential, with patient, provider, and reporter [...]

To identify the most frequent obstacles preventing physicians from answering their patient-care questions and the most requested improvements to clinical information resources.

Adverse events are poor health outcomes caused by medical care. Measuring them is necessary for quality improvements, but current detection methods are inadequate. We performed this study to validate a previously derived method of adverse event detection using term searching in physician-dictated discharge summaries.