OBJECTIVES: This study presents the information system for Pusan National University Hospital (PNUH), evaluates its performance qualitatively, and conducts economic analysis. METHODS: Information system for PNUH was designed by component-based development and developed by internet technologies. Order Communication System, Electronic Medical Record, and Clinical Decision Support System were newly developed. The performance of the hospital information system was qualitatively evaluated based on the performance reference model in order to identify problem areas for the old system. The Information Economics approach was used to analyze the economic feasibility of hospital information system in order to account for the intangible benefits. RESULTS: Average performance scores were 3.16 for input layer, 3.35 for process layer, and 3.57 for business layer. In addition, the cumulative benefit to cost ratio was 0.50 in 2011, 1.73 in 2012, 1.76 in 2013, 1.71 in 2014, and 1.71 in 2015. The B/C ratios steadily increase as value items are added. CONCLUSIONS: While overall performance scores were reasonably high, doctors were less satisfied with the system, perhaps due to the weak clinical function in the systems. The information economics analysis demonstrated the economic profitability of the information systems if all intangible benefits were included. The second qualitative evaluation survey and economic analysis were proposed to evaluate the changes in performance of the new system.
Commerce ; Cost-Benefit Analysis ; Electronic Health Records ; Evaluation Studies as Topic ; Hospital Information Systems ; Information Systems ; Internet

OBJECTIVE: The aim of this study was to examine whether or not levofloxacin has any relationship with QT prolongation in a real clinical setting by analyzing a clinical data warehouse of data collected from different hospital information systems. METHODS: Electronic prescription data and medical charts from 3 different hospitals spanning the past 9 years were reviewed, and a clinical data warehouse was constructed. Patients who were both administrated levofloxacin and given electrocardiograms (ECG) were selected. The correlations between various patient characteristics, concomitant drugs, corrected QT (QTc) prolongation, and the interval difference in QTc before and after levofloxacin administration were analyzed. RESULTS: A total of 2,176 patients from 3 different hospitals were included in the study. QTc prolongation was found in 364 patients (16.7%). The study revealed that age (OR 1.026, p < 0.001), gender (OR 0.676, p = 0.007), body temperature (OR 1.267, p = 0.024), and cigarette smoking (OR 1.641, p = 0.022) were related with QTc prolongation. After adjusting for related factors, 12 drugs concomitant with levofloxacin were associated with QTc prolongation. For patients who took ECGs before and after administration of levofloxacin during their hospitalization (n = 112), there was no significant difference in QTc prolongation. CONCLUSIONS: The age, gender, body temperature, cigarette smoking and various concomitant drugs might be related with QTc prolongation. However, there was no definite causal relationship or interaction between levofloxacin and QTc prolongation. Alternative surveillance methods utilizing the massive accumulation of electronic medical data seem to be essential to adverse drug reaction surveillance in future.
Body Temperature ; Data Mining ; Drug Toxicity ; Electrocardiography ; Electronic Prescribing ; Electronics ; Electrons ; Hospital Information Systems ; Hospitalization ; Humans ; Long QT Syndrome ; Ofloxacin ; Smoking

OBJECTIVES: Several researchers have shown that three dimensional (3D) distribution analysis of prostate cancer is helpful when initiating needle biopsy procedures. Knowledge regarding the distribution of prostate cancer could enhance understanding of the pathophysiology involved and improve detection of these malignancies. We propose utilizing digital processing techniques to analyze prostate cancer distribution in a 3D setting. METHODS: Pre-made radical prostatectomy sample slices were digitized with a resolution of 76 dpi. Slices of each sample were aligned and registered by deformation algorithm and interpolated for analysis of relative distribution statistics. We analyzed 80 samples saved in electronic medical record and compared the detection rate of preoperative needle biopsies and radical prostatectomies using our 3D analysis technique. RESULTS: The statistical 3D distribution of prostate cancer was evaluated using a 36-sector process. Results were represented in the following two ways: distribution of a single patient, and statistical distribution of prostate cancers of multiple patients. The overall concordance rate was 62.7% between the two methods; therefore a technique is needed which can raise this percentage. CONCLUSIONS: We suggest using the normalization method to develop a software tool which permits reconstruction of the 3D distribution of prostate cancer from 2D legacy images and reduces the loss of image quality as well. This application will facilitate detection of prostate cancer by aiding in the determination of the most effective clinical position via partial sampling with decreased patient inconvenience.
Biopsy, Needle ; Electronic Health Records ; Humans ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Software

OBJECTIVES: Sharing of cancer-related information among healthcare professionals is crucial to ensuring the quality of long-term care for cancer survivors. Appropriate distribution of the essential facts can be achieved using data models. The purpose of this study was to develop and validate suitable data models for use in the nursing assessment of cancer survivors. METHODS: The models developed in this study were based on a modification of concept analysis developed by Walker and Avant. Our approach involved determining the purpose of the analysis, identifying data elements, defining these elements and their uses, determining critical attributes, value sets, and cardinalities, and ultimately constructing data models which were examined externally by domain experts. RESULTS: We developed 112 data models with 112 data elements, 29 critical attributes, 102 value sets, and 6 data types for the assessment of cancer survivors. External validation revealed that the data elements, critical attributes, and value sets proposed were comprehensive, relevant, and sufficiently useful to encompass nursing issues related to cancer survivors. CONCLUSIONS: Data models developed in this study will contribute to ensuring the semantic consistency of data collected from cancer survivors, which will improve the quality of nursing assessments and in turn translate to improved long-term patient care.
Delivery of Health Care ; Electronic Health Records ; Humans ; Long-Term Care ; Nursing Assessment ; Patient Care ; Quality of Health Care ; Semantics ; Standard of Care ; Survivors

OBJECTIVES: This study was conducted to determine whether or not newly proposed high-resolution activity features could provide a superior analytic foundation compared to those commonly used to assess transitions in children's activities, under circumstances in which the types of courses attended exert different situational effects on activity levels. METHODS: From 153 children at a local elementary school, 10 subjects with attention deficit hyperactivity disorder (ADHD) and 7 controls were recruited. Their activity data was collected using an actigraph while they attended school. Ratios of partitioned activity ranges (0.5-2.8 G) during the entire activity were extracted during three classes: art, mathematics, and native language (Korean). Extracted activity features for each participant were compared between the two groups of children (ADHD and control) using graphs and statistical analysis. RESULTS: Activity distributions between ADHD and control groups for each class showed statistically significant differences spread through the entire range in art class compared to native language and mathematics classes. The ADHD group, but not the control group, experienced many significantly different intervals (> 50%) having low to very high activity acceleration regions during the art and languages courses. CONCLUSIONS: Class content appears to influence the activity patterns of ADHD children. Monitoring the actual magnitude and activity counts in a wide range of subjects could facilitate the examination of distributions or patterns of activities. Objective activity measurements made with an actigraph may be useful for monitoring changes in activities in children with ADHD in a timely manner.
Acceleration ; Actigraphy ; Activities of Daily Living ; Attention Deficit Disorder with Hyperactivity ; Child ; Humans ; Mathematics ; Motor Activity ; Pilot Projects

OBJECTIVES: Measurement of similarities between documents is typically influenced by the sparseness of the term-document matrix employed. Latent semantic indexing (LSI) may improve the results of this type of analysis. METHODS: In this study, LSI was utilized in an attempt to reduce the term vector space of clinical documents and newspaper editorials. RESULTS: After applying LSI, document similarities were revealed more clearly in clinical documents than editorials. Clinical documents which can be characterized with co-occurring medical terms, various expressions for the same concepts, abbreviations, and typographical errors showed increased improvement with regards to a correlation between co-occurring terms and document similarities. CONCLUSIONS: Our results showed that LSI can be used effectively to measure similarities in clinical documents. In addition, correlation between the co-occurrence of terms and similarities realized in this study is an important positive feature associated with LSI.
Abstracting and Indexing as Topic ; Cluster Analysis ; Information Storage and Retrieval ; Periodicals ; Semantics

OBJECTIVES: The purpose of this study was to develop a prototype wireless local area network (LAN)-based tracking system and evaluate its efficacy. METHODS: A wireless LAN-based tracking system was developed with a personal digital assistant (PDA) having a simple text messaging function and a prototype stand-alone tracking device. Evaluation of the effectiveness of the tracking system was performed in two ways. Twenty-five messages were sent to nurses by direct communication and 46 messages were sent by the wireless system. Thirty cases by nurses and 30 cases by the wireless system to locate hospital equipment were performed. The time required to transfer messages and to locate equipment was measured and analyzed with a Mann-Whitney test and a paired t-test, respectively. RESULTS: The mean time required to transfer messages by direct communication and by the wireless system were 37.92 +/- 19.19 seconds and 30.65 +/- 9.80 seconds, respectively which were not statistically different (p = 0.108). The mean time required to locate equipment by the nurses and by the wireless system was 234.00 +/- 59.99 and 23.97 +/- 6.17 seconds, respectively which was statistically different (p < 0.001). CONCLUSIONS: The wireless LAN-based tracking system can save time for nurses to communicate and to check for the location of equipment in wards which allows nurses to spend more time and attention to patient care and safety.
Computers, Handheld ; Equipment and Supplies, Hospital ; Hospital Communication Systems ; Local Area Networks ; Patient Care ; Text Messaging ; Track and Field

OBJECTIVES: The purpose of this study was to review history and trends of personal health record research in PubMed and to provide accurate understanding and categorical analysis of expert opinions. METHODS: For the search strategy, PubMed was queried for 'personal health record, personal record, and PHR' in the title and abstract fields. Those containing different definitions of the word were removed by one-by-one analysis from the results, 695 articles. In the end, total of 229 articles were analyzed in this research. RESULTS: The results show that the changes in terms over the years and the shift to patient centeredness and mixed usage. And we identified history and trend of PHR research in some category that the number of publications by year, topic, methodologies and target diseases. Also from analysis of MeSH terms, we can show the focal interest in regards the PHR boundaries and related subjects. CONCLUSIONS: For PHRs to be efficiently used by general public, initial understanding of the history and trends of PHR research may be helpful. Simultaneously, accurate understanding and categorical analysis of expert opinions that can lead to the development and growth of PHRs will be valuable to their adoption and expansion.
Adoption ; Electronic Health Records ; Expert Testimony ; Growth and Development ; Health Records, Personal ; Humans ; Medical Subject Headings

No abstract available.

OBJECTIVES: Chronic kidney disease (CKD) is an important cause of excess cardiovascular mortality and morbidity; as well as being associated with progression to end stage renal disease. This condition was largely unheard of in English primary care prior to the introduction of pay-for-performance targets for management in 2006. A realist review of how informatics has been a mechanism for national implementation of guidance for the improved management of CKD. METHODS: Realist review of context, the English National Health Service with a drive to implement explicit national quality standards; mechanism, the informatics infrastructure and its alignment with policy objectives; and outcomes are describe at the micro-data and messaging, meso-patient care and quality improvement initiatives, and marco-national policy levels. RESULTS: At the micro-level computerised medical records can be used to reliably identify people with CKD; though differences in creatinine assays, fluctuation in renal function, and errors in diabetes coding were less well understood. At the meso-level more aggressive management of blood pressure (BP) in individual patients appears to slow or reverse decline in renal function; technology can support case finding and quality improvement at the general practice level. At the macro-level informaticians can help ensure that leverage from informatics is incorporated in policy, and ecological investigations inform if there is any association with improved health outcomes. CONCLUSIONS: In the right policy context informatics appears to be an enabler of rapid quality improvement. However, a causal relationship or generalisability of these findings has not been demonstrated.
Blood Pressure ; Clinical Coding ; Creatinine ; Diabetes Mellitus ; Dietary Sucrose ; England ; General Practice ; Health Policy ; Humans ; Informatics ; Kidney Failure, Chronic ; Kidney Function Tests ; Medical Informatics ; Medical Records ; Medical Records Systems, Computerized ; National Health Programs ; Primary Health Care ; Quality Improvement ; Quality of Health Care ; Renal Insufficiency ; Renal Insufficiency, Chronic