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From page 225... ... Index A Academic research, 8, 112, 114, 150, 159 Access issues, 62, 67, 74, 80, 81-83, 136, 179, 181 computer technology and, 4, 68, 101 insurers, 80, 209, 210 knowledge resources, 7 legal right to, 14, 83, 209-210, 214-216, 217-218 patient records, 6-7, 63 software source code, 220 system redundancy, fault tolerance, 118, 119 system response, 83, 106, 120, 126, 145 146, 220 see also Confidentiality Accreditation, 65, 75, 77, 110, 149, 160, 168169, 208, 214, 217, 218 Accredited Standards Committee, 13 Accuracy issues, 95, 110, 127, 207, 219 see also Errors and error analysis Acute disorders and care, 66, 123-124, 131 Administrative functions, 46, 47, 51, 65, 89, 93, 95, 121, 181, 195 access to, 7, 21-22 billing, 64, 78, 106, 120 costs, 46, 51, 68, 98, 193 standards, 13 Advocacy, patients, 153-154 225 Agency for Health Care Policy and Research, 9, 66-67, 155, 164, 166, 167, 175, 184, 185 AIDS, 215 Ambulatory care records, see Outpatient records American College of Radiologists, 13, 108 American Health Information Management Association, 14 American Medical Society, 67, 206 American Society for Testing and Materials, 13, 108 Arden syntax, 14, 125 ARPANET, 4 Artificial intelligence, 201, 223 see also Knowledge-based systems Attitudes toward diffusion of innovations, 142, 143144, 145, 152 public, 153, 195 systems vendors, 135-137 B Bibliographic databases, 47, 69, 74, 92-93, 95, 119, 124, 181 Billing, 64, 78, 106, 120 Browser software, 4-5 Read the entire page →
From page 226... ... project, 32, 33-34 COSTAR, 112, 115-117 Cost factors, 46, 49, 53, 58, 66, 68, 89, 93, 153, 154, 158, 161, 169-170, 178, 179, 181, 182, 186, 189-190 administrative, 46, 51, 68, 98, 193 clerical, 123, 141 computing technology, 7, 15-16, 69-70, 105-106, 112, 126, 127, 136, 137, 141, 146 containment issues, 1-2, 15-16, 26, 35 data entry, 7, 84, 89, 126 demonstration projects, 157 design and development aspects, 15, 139, 140-142, 164 diffusion of technology, 145-146 hospital systems, 53, 63, 64, 137, 141 insurers, 65-66, 145, 154, 194 malpractice insurance, 124 maternal and child health care program, 156 medical information systems, 141, 146 per patient, 53, 145 secondary databases, 50, 110, 177, 193 sharing, 50, 51, 165-168, 177, 183, 193194, 196 standards, 146 technological innovations, general, 69-70, 105-106, 112, 126, 127, 136, 137, 141, 146 voice recognition, 127 Council on Ethical and Judicial Affairs of the American Medical Association, 206 Court cases, see Litigation Read the entire page →
From page 227... ... INDEX D Database management systems, 101, 103-104, 179 specific, 111-125 Databases, 50, 101-103, 148, 150, 179 AMA guidelines, 206 bibliographic, 47, 69, 74, 92-93, 95, 119, 124, 181 federal role, 67 linkage of, 49, 69, 88, 89, 95, 105, 106-107, 110-111, 124; see also Networks prescription drug, 36-37 problem-oriented medical record, 91 query languages, 106, 117 secondary, 49, 50, 55-56, 69, 74, 95, 77-78, 98, 110-111, 124, 161, 163, 177, 179, 181, 182, 183, 191-193 specific, 111-125 see also Knowledge-based systems Data entry, 117-118, 122, 125-126, 136, 137, 186 approaches, 29-32 cost factors, 84, 89, 126 errors, 84, 89, 105 physician orders, 2, 7, 25, 29-32, 126, 145, 168, 186 transcription, 25 voice recognition, 29, 106, 126-127, 131, 179, 186 Data quality, 84-86 Data retrieval, 47, 48, 53, 105-106, 111, 179, 181 Data storage, general, 81-90, 111 Decentralized Hospital Computer Program, 120-121 Decision support and problem solving, 51, 53, 55, 61-62, 63-64, 68-69, 74, 81, 84, 90-93, 95, 105, 112, 117, 124-125, 136, 149, 181, 223 alerts, 8 knowledge-based systems, 12, 14, 74, 88, 92, 95, 105, 110, 119, 124-125, 181 status in U.S., 8, 12, 14 Defense Advanced Research Projects Agency (DARPA) , 150 Definitional issues, 55-56, 90, 95, 163, 183 change agents versus stakeholders, 151, 184 computer-based patient record, 9, 10-11, 13, 55, 95, 135-136, 139 contract law, 219 227 data integrity, 86-87 development versus diffusion, 138 health care needs, 74-79 hearsay, evidence, 212 patient records, 55, 95, 135-136, 139 privacy, 67 users, 75 Demographic factors, 46, 64, 66, 70, 116, 173174, 195 see also Epidemiology Demonstration projects, 49, 50, 67, 157, 160, 161, 163, 168, 182, 183, 185, 186 Department-level information systems, hospitals, 112, 113, 136 Department of Defense, 10, 121, 129-130, 141, 150, 157, 165, 166, 175 Department of Energy, 150 Department of Health and Human Services, 155, 164, 167, 185 see also specific subordinate agencies Department of Veterans Affairs, 8, 120-121, 129-130, 141, 157-158, 165, 166, 175 Design and development, 49, 51, 67, 100, 138142, 151-169, 182, 185 barriers to, 23, 40 costs, 139, 140-142, 164 defined, 138 modular, 116, 120-121, 124-125 problem-oriented medical record, 91 status, in U.S., 6-8, 12, 40 for system phasing, 93 user interfaces, 12 Diabcards, 34 Dictionaries, see Vocabulary control Diffusion, innovations, 23-25, 45, 48-49, 69, 139, 142-151, 169, 182 attitudes, 142, 143-144, 145, 152 costs, 145-146 defined, 138 insurers, 143, 145, 146, 154-155 see also Education and training; Professional education DIOGENE, 122, 127 Drugs, see Pharmacies and pharmaceuticals EEarly Clinical Information System, 120 Economic issues physician incentives, data entry, 126, 145, 168, 186 Read the entire page →
From page 228... ... 228 productivity, 46, 68, 94, 154, 193 see also Cost factors; Financial factors; Funding Education and training, 49, 51, 67 change agents and stakeholders, 163, 183 diffusion of innovations, general, 142, 143145, 146, 161 patient, 75, 83 users, general, 49, 83, 143-145 see also Professional education Efficiency/effectiveness, 53, 58, 66, 67, 89-90, 95, 127, 161, 163, 167, 179 system response time, 83, 106, 120, 126, 145-146, 220 Electrocardiogram interpretation system, 27 Electronic Data Interchange for Finance, Administration, Commerce, and Trade (EDIFACT) , 31, 33 Electronic mail, 33, 47, 119, 150, 189 Emergency care, see Acute disorders and care Employers and employment, 66, 154-155 Encounter-oriented medical records, 115 Epidemiology, 88, 127 national, 66, 155, 174 risk factors, 66, 84, 93 Errors and error analysis, 219 data entry, 84, 89, 105 on-line, 90, 105 voice recognition, 127 see also Accuracy issues European CPR in hospitals, 26-32 in primary care, 23-26 privacy and confidentiality, 37-38 security, 39 for shared care, 32-34, 38 standardization, 38-39 status, general, 21-23 treatment protocols integrated with, 36-37 uses of data, 34-35 Evaluation, 75, 182 computer applications costs, 141 data validity tags, 87 of patient care, defined, 56 peer review, 65, 157 reliability of records, 59, 81, 109-110 see also Efficiency/effectiveness Event-oriented medical records, 117 Exmouth Project, 122-123 Expert systems, see Knowledge-based systems INDEX F Federal government, 50, 65, 66-67, 120-121, 155-158, 161, 164-168, 173-175, 184 185 Computer-based Patient Record Institute, 8, 10, 14, 50, 167, 168, 177, 182, 183-185, 187, 188, 189, 191-195 cooperation with public sector, 131, 165 168, 182, 184, 185 funding, 50, 155, 164-168, 184-185 interagency coordination, general, 175, 184, 185 national information system, 9-10, 50, 95 98, 166-168, 169, 173, 174, 177, 182 185, 189 organizational role, general, 66-67, 175, 184, 185 research, 67, 155, 164-165, 174, 175 standards, 66, 67, 129-131, 155, 161 see also Laws, specific federal Federal Networking Council, 150, 189 Federal Privacy Act, 208 Financial factors, 46, 49, 51, 65, 82, 98, 119120 federal role, 65, 66-67 see also Billing; Cost factors; Funding; Insurance and insurers, health Flexibility, 87, 113, 137, 179, 181 Flow sheets, 61 Food and Drug Administration, 148-149, 185, 189 Format issues, records, 59, 61-62, 80, 90-91, 115 European, 38-39 outpatient records, 63 problem-oriented, 61-62, 90-91, 93, 115, 117, 124 standards, 12-14, 23, 38-39, 63, 140, 186, 191 tables of contents/indexes, 82 Foundations, 161, 163, 185, 189 Framework Programs on Research and Development of the European Union, 21,23 France, 29, 36 Funding, 49, 50, 143, 155, 161, 165, 174, 177, 179, 182, 184-185 federal, 50, 155, 164-168, 184-185 hospital systems, 141 standards development, 129 Read the entire page →
From page 229... ... , 5 I Images and image processing, 13, 31, 39, 64, 68, 104, 106, 107, 114-115, 150, 179, 189 see also Graphics Indexes, 82 Information Security Foundation, 189 Insurance and insurers, health, 47, 50, 65-66, 75, 77, 78, 158, 169-170, 177, 194 confidentiality and access by, 80, 209, 210 contract provisions, 221 cost factors, 65-66, 145, 154, 194 diffusion of innovation and, 143, 145, 146, 154-155 electronic claims submission, 89 employer provided, 154-155 health maintenance organizations, 115-117 physician incentives, data entry, 145, 168 smart cards, 34 see also Medicaid; Medicare Insurance Information and Privacy Protection Model Act, 210 Insurance, malpractice, 124 Institute of Electronic and Electrical Engineers, 13, 187 Institute of Medicine, 45, 53-54, 59, 67, 135, 158, 176, 195 Integrated Academic Information Management System, 160 Integrated delivery system (IDS) , 3, 4, 6, 15-16 Integrated Services Digital Network, 109 Intellectual property, 220 Intelligence, 49, 80, 81 artificial intelligence, 201, 223 see also Knowledge-based systems Intermountain Health Care Corporation, 118 International Classification for Primary Care, 25 International programs and activities, 21-40, 122-123, 139, 187-188 Internet, 4, 12, 150 see also World Wide Web Intranet, 5 Read the entire page →
From page 230... ... 230 J Joint Commission on Accreditation of Healthcare Organizations, 65, 160, 165, 208, 214, 217, 218 K Knowledge-based systems, 28, 31-32, 74, 88, 92, 95, 105, 110, 119, 124-125, 181 Knowledge resources, access to, 7 L Laboratory tests, 64, 116, 123 Laws, specific federal Federal Privacy Act, 208 High-Performance Computing Act, 150 Insurance Portability and Accountability Act of 1996, 13, 14 Omnibus Budget Reconciliation Act, 66-67, 157 Social Security Act, 173, 174 Uniform Health-Care Information Act, 192, 210, 222 Leadership issues, 8, 14, 16-17 Legacy systems, 27, 31 Legal issues, 49, 142, 147-149, 161, 182, 183, 192-193, 200-223 contracts, 200-201, 219-221 evidentiary, 211-214 licensure laws, 147, 192, 200, 201-206, 220, 221-222 information access, right to, 83, 209-210, 214-216, 217-218; see also Confidentiality intellectual property, 14, 220 malpractice, 124, 144 ownership of data, 14, 147, 192, 211, 220 systems defect liability, 149, 200 vendors, 149, 200-201, 202, 219-221 viruses, computer, 217, 222 see also Laws, specific federal; Litigation; Regulations Legislation, 90 model, 50, 192-193, 210, 221-222 see also Laws, specific federal Licensure laws, 147, 192, 200, 201-206, 220 national, 221-222 INDEX Linkage and integration, 47, 62, 80, 87-89, 95, 181 confidentiality and, 147 of databases, 49, 69, 88, 89, 95, 105, 106107, 110-111, 124, 179, 181; see also Secondary databases development and diffusion resources, 49, 51 financial-care information, 65 I4C project, 28-29, 30-31 multi-site care, 32-34, 68, 88, 120-121 platforms, European, 27-28 unique health identifiers, 13 see also Internet; Organizational factors Litigation, 65, 79 contracts, 219 evidentiary issues, 211-214 systems defect liability, 149, 200 Lockheed Corporation, 120 Longitudinal approaches, 66 institutional planning, 65 patient records, 37, 47, 48, 61, 66, 68, 174 M Malcolm Baldrige Quality Award Program, 16 Malpractice, 124, 144 Managed care, 2, 7, 26 Management of care, general, 65, 78, 93, 94; see also Administrative functions Maternal and child health care program, 156, 173-175 Medicaid, 157, 174, 206 Medical information systems, 111 access to, 7 costs, 141, 146 defined, 56 Medical Logic Modules, 124-125 The Medical Record (TMR) , 114-115 Medicare, 156-157, 158, 165 peer review, 65, 157 regulations, 206-208, 214, 217 Medix, standards, 108 MEDLARS, 155 MEDLINE, 124, 155 MILNET, 150 Modular design, 116, 120-121, 124-125 Multimedia records, 11 Read the entire page →
From page 231... ... INDEX N National Aeronautics and Space Administration, 150 National Association of Insurance Commissioners, 210 National Committee for Quality Assurance, 3 National Committee on Vital and Health Statistics, 14 231 National Conference of Commissioners on Uniform State Laws, 148 National Electrical Manufacturers Association, 108 National Institute of Standards and Testing, 10 National Institutes of Health, 53, 155 National Library of Medicine, 9, 13, 124, 155, 160, 166 National Research and Education Network, 150-151, 189 National Research Council, 54 National Science Foundation, 150 Natural language processing, 29-31 Netherlands, The, 23-24, 26, 29, 36, 37 Networks, 5, 49, 51, 68, 95, 109, 150, 186, 189 design for, 139 diffusion of innovations, 142, 149-151 electronic mall, 47, 119, 150, 189 European, 22-23, 26-27, 32 national information systems, 9, 50, 95-98, 150-151, 163, 166-168, 169, 173, 174, 177, 182-185, 189 security, 4, 88, 96, 148, 216 for shared care, 32-34, 38 standards, data exchange and vocabulary, 5, 9, 12-14,27,39,48,50,51,85-86,96, 106, 107-109, 116, 126, 127, 129-131, 140, 149-151, 155, 163, 168, 169, 174, 175, 177, 179, 181, 183, 186-188, 191192, 196 Nurses, chart writing, time spent, 63 o Office of Technology Assessment, 141 Omnibus Budget Reconciliation Act, 66-67, 157 ORCA, 28 Organizational factors, 49-50, 51, 52, 162-168, 176, 179-180, 182-183 accreditation, 65, 75, 77, 110, 149, 160, 168-169, 208, 214, 217, 218 change agents and stakeholders, 151 -161, 163, 166, 168-169, 179, 183, 184 Computer-based Patient Record Institute, 50, 167, 168, 177, 182, 183-185, 187, 188, 189, 191-195 cost sharing, 50, 51, 165-168, 177, 183, 193-194, 196 federal interagency coordination, 175, 184, 185 federal role, general, 66-67, 175, 184, 185 health care system, general structure, 1-5, 22, 26, 40, 142-143, 179 institutional planning, 65, 136 medical record practices, physicians, 59, 61, 63 private/public cooperation, 131, 165-168, 182, 184, 185 professional associations, 50, 65, 67, 143, 153, 160, 165, 168, 179-181, 194, 206, 208, 210, 214, 217, 218 standard-setting organization, 170 technological innovation, 138, 151 -161, 168-169 see also Administrative functions; Format issues, records; Linkage and integration; Management of care, general Outcomes reporting requirements, 3 Outpatient records, 63, 112, 141 COSTAR, 112, 115-117 summary time-oriented record, 62 Ownership issues, 147, 192, 211, 220 p PaperChase, 119 Paper records, 57-63, 81, 84, 90, 178 Patient record, general, 56-57 defined, 55, 95, 135-136, 139 paper, 57-63, 81, 84, 90, 178 patient-derived information, 11 transcription, 25 users and uses, 29, 34-35, 75-78 Patients, general, 153-154 access to information, legal right, 83, 209210, 214-216, 217-218 cost per, 53, 145 as data users, 65, 83 education, 75, 83 see also Confidentiality Peer review, 65, 157 Personal computers, 123, 124 Read the entire page →
From page 232... ... , 195 Regulations, 50, 79, 90, 147-149, 177, 192193, 204-205 clinical reporting requirements, 3 Read the entire page →
From page 233... ... INDEX 233 Medicare, 206-208, 214, 217 see also Licensure laws; Standards Reliability, 59, 81, 95, 109-110, 179, 218 design for, 139 see also Accuracy issues Research, 47, 48, 49, 50, 54, 68, 75, 77, 79, 110, 169, 182, 185-186, 190, 222 academic, 112, 114, 150, 159 demonstration projects, 49, 50, 67, 157, 160, 161, 163, 168, 182, 183, 185, 186 epidemiology, 66, 88, 84, 93, 127, 155, 174 federal role, 67, 155, 164-165, 174, 175 health services, support of, 45, 46, 94 problem-oriented medical record, 91 uniform record systems, 86 see also Design and development Risk factors, 66, 84, 93 S Secondary databases, 49, 50, 69, 74, 77-78, 95, 98, 110-111, 124, 161, 163, 177, 179, 181, 182, 183, 191-193 costs, 50, 110, 177, 193 defined, 55-56 Security, data, 86-87, 109-110, 126, 127-129, 147-148, 179, 214-217 design for, 14-15, 139 networks, 4, 88, 96, 148, 216 standards, 48, 50, 51, 96, 131, 163, 168, 177, 183, 186, 188-189, 191-192, 196 see also Confidentiality Shared care environments, 32-34, 38 Smart cards, 32, 34, 39, 122-123 Social factors, 147-149, 156, 174 politics, 46, 48-49, 153, 195 public opinion, 153, 195 Social Security Act, 173, 174 Speech recognition, see Voice recognition Stakeholders, 151-161, 166, 179, 183 Standard Guide for Nosologic Standards and Guides for Construction of New Biomedical Nomenclature, 108 Standards, 49, 50, 51, 110, 131-132, 160, 161, 163, 177, 180-181, 186-192, 221-222 accreditation, 65, 75, 77, 110, 149, 160, 208, 214, 217, 218 clinical practice guidelines, 51, 67, 98, 164, 181, 190 confidentiality, 131, 188 content, general, 63, 84-86, 140, 186, 187 cost factors, 146 database queries, 106, 117 data exchange and vocabulary, 12-14, 31, 34, 38, 48, 50, 51, 85-86, 96, 106, 107109, 116, 126, 127, 129-131, 140, 149151, 155, 163, 168, 169, 174, 175, 177, 179, 181, 183, 186-188, 191-192, 196 federal role, 66, 67, 129-131, 155, 161 format, general, 38-39, 63, 84-86, 87, 191 international, 27, 38-39, 123, 187-188 outpatient records, 63 security, 48, 50, 51, 96, 131, 163, 168, 177, 183, 186, 188-189, 191-192, 196 state-level, general, 204 see also Licensure laws State governments, 50, 157, 159, 161, 169, 174-175, 177, 192, 200-223 confidentiality laws, 147-148, 208-209 demonstration projects, 157, 168 licensure laws, 147, 192, 200, 201-206, 217, 221-222 model legislation, 50, 192-193, 210, 221 222 standards, 204 Statistical analysis, 93, 95, 118 Summary time-oriented record, 62 Surgery, 121 Systematized Nomenclature of Medicine, 108 T Task-oriented medical records, 115, 117 Technicon, 120 Technological innovations, 46, 48, 68, 74, 81, 94, 100-132, 135-137, 138 advances, 3-6 barriers, general, 10-17, 126-131 computer processing power, 3 confidentiality and, 110, 126, 127-129 costs, 69-70, 105-106, 112, 126, 127, 136, 137, 141, 146 see also Design and development; Diffusion, innovations; Research Telecommunications, 109 electronic mail, 47, 119, 150, 189 European, 22 reliability, 95 workstation linkages, 88 see also Networks Text processing, 106-107, 108, 126, 127, 131, 179 Read the entire page →
From page 234... ... , 9, 13, 106-107, 108-109, 155, 188 Uniform Clinical Data Set, 131, 156-157 Uniform Commercial Code, 200, 219, 221 Uniform Health-Care Information Act, 192, 210, 222 Unique health identifier, 13 United Kingdom, 23-24, 26, 29, 36, 108, 122 123 Universities, 159-160 academic research, 112, 114, 150, 159 University of California at Los Angeles, 4 UNIX, 28, 137 U.S. CPR systems, status advances, 3 - , 9-10 barriers/challenges, 10-17 implementation, 8-9 market, 6-8 practice environment, 1-5 Users, 46-47, 58, 65, 70, 74-93, 143-145, 181 authentication/identification, 14, 39 computer interface with, general, 4-5, 7, 11-12, 29, 87, 88, 126-127, 179 diffusion of innovations, 142, 143-145 needs, general, 46-47, 76-93 multiple, 65 patients as, 65, 83 projections, 94-98 see also Access issues; Change agents; Stakeholders V Vendors, 100, 160-161, 162, 169, 185 legal issues, 149, 200-201, 202, 219-221 survey of, 135-137 Veterans Administration, see Department of Veterans Affairs Viruses, computer, 217, 222 Vocabulary control, 9, 11, 13-14, 25, 31, 39, 48, 50, 51, 85-86, 96, 106, 107-109, 116, 126, 127, 129-131, 140, 149-151, 155, 163, 168, 169, 174, 175, 177, 179, 181, 183, 186-188, 191-192, 196 Voice recognition, 29, 32, 106, 126-127, 131' 179, 186 W Windowing, 117, 137 Windows NT/95 environment, 28 Word processing, see Text processing Workstations, 26-28, 88, 104-105, 179 World Wide Web, 4-5 Read the entire page →

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... Index A Academic research, 8, 112, 114, 150, 159 Access issues, 62, 67, 74, 80, 81-83, 136, 179, 181 computer technology and, 4, 68, 101 insurers, 80, 209, 210 knowledge resources, 7 legal right to, 14, 83, 209-210, 214-216, 217-218 patient records, 6-7, 63 software source code, 220 system redundancy, fault tolerance, 118, 119 system response, 83, 106, 120, 126, 145 146, 220 see also Confidentiality Accreditation, 65, 75, 77, 110, 149, 160, 168169, 208, 214, 217, 218 Accredited Standards Committee, 13 Accuracy issues, 95, 110, 127, 207, 219 see also Errors and error analysis Acute disorders and care, 66, 123-124, 131 Administrative functions, 46, 47, 51, 65, 89, 93, 95, 121, 181, 195 access to, 7, 21-22 billing, 64, 78, 106, 120 costs, 46, 51, 68, 98, 193 standards, 13 Advocacy, patients, 153-154 225 Agency for Health Care Policy and Research, 9, 66-67, 155, 164, 166, 167, 175, 184, 185 AIDS, 215 Ambulatory care records, see Outpatient records American College of Radiologists, 13, 108 American Health Information Management Association, 14 American Medical Society, 67, 206 American Society for Testing and Materials, 13, 108 Arden syntax, 14, 125 ARPANET, 4 Artificial intelligence, 201, 223 see also Knowledge-based systems Attitudes toward diffusion of innovations, 142, 143144, 145, 152 public, 153, 195 systems vendors, 135-137 B Bibliographic databases, 47, 69, 74, 92-93, 95, 119, 124, 181 Billing, 64, 78, 106, 120 Browser software, 4-5

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... project, 32, 33-34 COSTAR, 112, 115-117 Cost factors, 46, 49, 53, 58, 66, 68, 89, 93, 153, 154, 158, 161, 169-170, 178, 179, 181, 182, 186, 189-190 administrative, 46, 51, 68, 98, 193 clerical, 123, 141 computing technology, 7, 15-16, 69-70, 105-106, 112, 126, 127, 136, 137, 141, 146 containment issues, 1-2, 15-16, 26, 35 data entry, 7, 84, 89, 126 demonstration projects, 157 design and development aspects, 15, 139, 140-142, 164 diffusion of technology, 145-146 hospital systems, 53, 63, 64, 137, 141 insurers, 65-66, 145, 154, 194 malpractice insurance, 124 maternal and child health care program, 156 medical information systems, 141, 146 per patient, 53, 145 secondary databases, 50, 110, 177, 193 sharing, 50, 51, 165-168, 177, 183, 193194, 196 standards, 146 technological innovations, general, 69-70, 105-106, 112, 126, 127, 136, 137, 141, 146 voice recognition, 127 Council on Ethical and Judicial Affairs of the American Medical Association, 206 Court cases, see Litigation

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... INDEX D Database management systems, 101, 103-104, 179 specific, 111-125 Databases, 50, 101-103, 148, 150, 179 AMA guidelines, 206 bibliographic, 47, 69, 74, 92-93, 95, 119, 124, 181 federal role, 67 linkage of, 49, 69, 88, 89, 95, 105, 106-107, 110-111, 124; see also Networks prescription drug, 36-37 problem-oriented medical record, 91 query languages, 106, 117 secondary, 49, 50, 55-56, 69, 74, 95, 77-78, 98, 110-111, 124, 161, 163, 177, 179, 181, 182, 183, 191-193 specific, 111-125 see also Knowledge-based systems Data entry, 117-118, 122, 125-126, 136, 137, 186 approaches, 29-32 cost factors, 84, 89, 126 errors, 84, 89, 105 physician orders, 2, 7, 25, 29-32, 126, 145, 168, 186 transcription, 25 voice recognition, 29, 106, 126-127, 131, 179, 186 Data quality, 84-86 Data retrieval, 47, 48, 53, 105-106, 111, 179, 181 Data storage, general, 81-90, 111 Decentralized Hospital Computer Program, 120-121 Decision support and problem solving, 51, 53, 55, 61-62, 63-64, 68-69, 74, 81, 84, 90-93, 95, 105, 112, 117, 124-125, 136, 149, 181, 223 alerts, 8 knowledge-based systems, 12, 14, 74, 88, 92, 95, 105, 110, 119, 124-125, 181 status in U.S., 8, 12, 14 Defense Advanced Research Projects Agency (DARPA) , 150 Definitional issues, 55-56, 90, 95, 163, 183 change agents versus stakeholders, 151, 184 computer-based patient record, 9, 10-11, 13, 55, 95, 135-136, 139 contract law, 219 227 data integrity, 86-87 development versus diffusion, 138 health care needs, 74-79 hearsay, evidence, 212 patient records, 55, 95, 135-136, 139 privacy, 67 users, 75 Demographic factors, 46, 64, 66, 70, 116, 173174, 195 see also Epidemiology Demonstration projects, 49, 50, 67, 157, 160, 161, 163, 168, 182, 183, 185, 186 Department-level information systems, hospitals, 112, 113, 136 Department of Defense, 10, 121, 129-130, 141, 150, 157, 165, 166, 175 Department of Energy, 150 Department of Health and Human Services, 155, 164, 167, 185 see also specific subordinate agencies Department of Veterans Affairs, 8, 120-121, 129-130, 141, 157-158, 165, 166, 175 Design and development, 49, 51, 67, 100, 138142, 151-169, 182, 185 barriers to, 23, 40 costs, 139, 140-142, 164 defined, 138 modular, 116, 120-121, 124-125 problem-oriented medical record, 91 status, in U.S., 6-8, 12, 40 for system phasing, 93 user interfaces, 12 Diabcards, 34 Dictionaries, see Vocabulary control Diffusion, innovations, 23-25, 45, 48-49, 69, 139, 142-151, 169, 182 attitudes, 142, 143-144, 145, 152 costs, 145-146 defined, 138 insurers, 143, 145, 146, 154-155 see also Education and training; Professional education DIOGENE, 122, 127 Drugs, see Pharmacies and pharmaceuticals EEarly Clinical Information System, 120 Economic issues physician incentives, data entry, 126, 145, 168, 186

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... 228 productivity, 46, 68, 94, 154, 193 see also Cost factors; Financial factors; Funding Education and training, 49, 51, 67 change agents and stakeholders, 163, 183 diffusion of innovations, general, 142, 143145, 146, 161 patient, 75, 83 users, general, 49, 83, 143-145 see also Professional education Efficiency/effectiveness, 53, 58, 66, 67, 89-90, 95, 127, 161, 163, 167, 179 system response time, 83, 106, 120, 126, 145-146, 220 Electrocardiogram interpretation system, 27 Electronic Data Interchange for Finance, Administration, Commerce, and Trade (EDIFACT) , 31, 33 Electronic mail, 33, 47, 119, 150, 189 Emergency care, see Acute disorders and care Employers and employment, 66, 154-155 Encounter-oriented medical records, 115 Epidemiology, 88, 127 national, 66, 155, 174 risk factors, 66, 84, 93 Errors and error analysis, 219 data entry, 84, 89, 105 on-line, 90, 105 voice recognition, 127 see also Accuracy issues European CPR in hospitals, 26-32 in primary care, 23-26 privacy and confidentiality, 37-38 security, 39 for shared care, 32-34, 38 standardization, 38-39 status, general, 21-23 treatment protocols integrated with, 36-37 uses of data, 34-35 Evaluation, 75, 182 computer applications costs, 141 data validity tags, 87 of patient care, defined, 56 peer review, 65, 157 reliability of records, 59, 81, 109-110 see also Efficiency/effectiveness Event-oriented medical records, 117 Exmouth Project, 122-123 Expert systems, see Knowledge-based systems INDEX F Federal government, 50, 65, 66-67, 120-121, 155-158, 161, 164-168, 173-175, 184 185 Computer-based Patient Record Institute, 8, 10, 14, 50, 167, 168, 177, 182, 183-185, 187, 188, 189, 191-195 cooperation with public sector, 131, 165 168, 182, 184, 185 funding, 50, 155, 164-168, 184-185 interagency coordination, general, 175, 184, 185 national information system, 9-10, 50, 95 98, 166-168, 169, 173, 174, 177, 182 185, 189 organizational role, general, 66-67, 175, 184, 185 research, 67, 155, 164-165, 174, 175 standards, 66, 67, 129-131, 155, 161 see also Laws, specific federal Federal Networking Council, 150, 189 Federal Privacy Act, 208 Financial factors, 46, 49, 51, 65, 82, 98, 119120 federal role, 65, 66-67 see also Billing; Cost factors; Funding; Insurance and insurers, health Flexibility, 87, 113, 137, 179, 181 Flow sheets, 61 Food and Drug Administration, 148-149, 185, 189 Format issues, records, 59, 61-62, 80, 90-91, 115 European, 38-39 outpatient records, 63 problem-oriented, 61-62, 90-91, 93, 115, 117, 124 standards, 12-14, 23, 38-39, 63, 140, 186, 191 tables of contents/indexes, 82 Foundations, 161, 163, 185, 189 Framework Programs on Research and Development of the European Union, 21,23 France, 29, 36 Funding, 49, 50, 143, 155, 161, 165, 174, 177, 179, 182, 184-185 federal, 50, 155, 164-168, 184-185 hospital systems, 141 standards development, 129

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From page 229...

... , 5 I Images and image processing, 13, 31, 39, 64, 68, 104, 106, 107, 114-115, 150, 179, 189 see also Graphics Indexes, 82 Information Security Foundation, 189 Insurance and insurers, health, 47, 50, 65-66, 75, 77, 78, 158, 169-170, 177, 194 confidentiality and access by, 80, 209, 210 contract provisions, 221 cost factors, 65-66, 145, 154, 194 diffusion of innovation and, 143, 145, 146, 154-155 electronic claims submission, 89 employer provided, 154-155 health maintenance organizations, 115-117 physician incentives, data entry, 145, 168 smart cards, 34 see also Medicaid; Medicare Insurance Information and Privacy Protection Model Act, 210 Insurance, malpractice, 124 Institute of Electronic and Electrical Engineers, 13, 187 Institute of Medicine, 45, 53-54, 59, 67, 135, 158, 176, 195 Integrated Academic Information Management System, 160 Integrated delivery system (IDS) , 3, 4, 6, 15-16 Integrated Services Digital Network, 109 Intellectual property, 220 Intelligence, 49, 80, 81 artificial intelligence, 201, 223 see also Knowledge-based systems Intermountain Health Care Corporation, 118 International Classification for Primary Care, 25 International programs and activities, 21-40, 122-123, 139, 187-188 Internet, 4, 12, 150 see also World Wide Web Intranet, 5

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From page 230...

... 230 J Joint Commission on Accreditation of Healthcare Organizations, 65, 160, 165, 208, 214, 217, 218 K Knowledge-based systems, 28, 31-32, 74, 88, 92, 95, 105, 110, 119, 124-125, 181 Knowledge resources, access to, 7 L Laboratory tests, 64, 116, 123 Laws, specific federal Federal Privacy Act, 208 High-Performance Computing Act, 150 Insurance Portability and Accountability Act of 1996, 13, 14 Omnibus Budget Reconciliation Act, 66-67, 157 Social Security Act, 173, 174 Uniform Health-Care Information Act, 192, 210, 222 Leadership issues, 8, 14, 16-17 Legacy systems, 27, 31 Legal issues, 49, 142, 147-149, 161, 182, 183, 192-193, 200-223 contracts, 200-201, 219-221 evidentiary, 211-214 licensure laws, 147, 192, 200, 201-206, 220, 221-222 information access, right to, 83, 209-210, 214-216, 217-218; see also Confidentiality intellectual property, 14, 220 malpractice, 124, 144 ownership of data, 14, 147, 192, 211, 220 systems defect liability, 149, 200 vendors, 149, 200-201, 202, 219-221 viruses, computer, 217, 222 see also Laws, specific federal; Litigation; Regulations Legislation, 90 model, 50, 192-193, 210, 221-222 see also Laws, specific federal Licensure laws, 147, 192, 200, 201-206, 220 national, 221-222 INDEX Linkage and integration, 47, 62, 80, 87-89, 95, 181 confidentiality and, 147 of databases, 49, 69, 88, 89, 95, 105, 106107, 110-111, 124, 179, 181; see also Secondary databases development and diffusion resources, 49, 51 financial-care information, 65 I4C project, 28-29, 30-31 multi-site care, 32-34, 68, 88, 120-121 platforms, European, 27-28 unique health identifiers, 13 see also Internet; Organizational factors Litigation, 65, 79 contracts, 219 evidentiary issues, 211-214 systems defect liability, 149, 200 Lockheed Corporation, 120 Longitudinal approaches, 66 institutional planning, 65 patient records, 37, 47, 48, 61, 66, 68, 174 M Malcolm Baldrige Quality Award Program, 16 Malpractice, 124, 144 Managed care, 2, 7, 26 Management of care, general, 65, 78, 93, 94; see also Administrative functions Maternal and child health care program, 156, 173-175 Medicaid, 157, 174, 206 Medical information systems, 111 access to, 7 costs, 141, 146 defined, 56 Medical Logic Modules, 124-125 The Medical Record (TMR) , 114-115 Medicare, 156-157, 158, 165 peer review, 65, 157 regulations, 206-208, 214, 217 Medix, standards, 108 MEDLARS, 155 MEDLINE, 124, 155 MILNET, 150 Modular design, 116, 120-121, 124-125 Multimedia records, 11

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From page 231...

... INDEX N National Aeronautics and Space Administration, 150 National Association of Insurance Commissioners, 210 National Committee for Quality Assurance, 3 National Committee on Vital and Health Statistics, 14 231 National Conference of Commissioners on Uniform State Laws, 148 National Electrical Manufacturers Association, 108 National Institute of Standards and Testing, 10 National Institutes of Health, 53, 155 National Library of Medicine, 9, 13, 124, 155, 160, 166 National Research and Education Network, 150-151, 189 National Research Council, 54 National Science Foundation, 150 Natural language processing, 29-31 Netherlands, The, 23-24, 26, 29, 36, 37 Networks, 5, 49, 51, 68, 95, 109, 150, 186, 189 design for, 139 diffusion of innovations, 142, 149-151 electronic mall, 47, 119, 150, 189 European, 22-23, 26-27, 32 national information systems, 9, 50, 95-98, 150-151, 163, 166-168, 169, 173, 174, 177, 182-185, 189 security, 4, 88, 96, 148, 216 for shared care, 32-34, 38 standards, data exchange and vocabulary, 5, 9, 12-14,27,39,48,50,51,85-86,96, 106, 107-109, 116, 126, 127, 129-131, 140, 149-151, 155, 163, 168, 169, 174, 175, 177, 179, 181, 183, 186-188, 191192, 196 Nurses, chart writing, time spent, 63 o Office of Technology Assessment, 141 Omnibus Budget Reconciliation Act, 66-67, 157 ORCA, 28 Organizational factors, 49-50, 51, 52, 162-168, 176, 179-180, 182-183 accreditation, 65, 75, 77, 110, 149, 160, 168-169, 208, 214, 217, 218 change agents and stakeholders, 151 -161, 163, 166, 168-169, 179, 183, 184 Computer-based Patient Record Institute, 50, 167, 168, 177, 182, 183-185, 187, 188, 189, 191-195 cost sharing, 50, 51, 165-168, 177, 183, 193-194, 196 federal interagency coordination, 175, 184, 185 federal role, general, 66-67, 175, 184, 185 health care system, general structure, 1-5, 22, 26, 40, 142-143, 179 institutional planning, 65, 136 medical record practices, physicians, 59, 61, 63 private/public cooperation, 131, 165-168, 182, 184, 185 professional associations, 50, 65, 67, 143, 153, 160, 165, 168, 179-181, 194, 206, 208, 210, 214, 217, 218 standard-setting organization, 170 technological innovation, 138, 151 -161, 168-169 see also Administrative functions; Format issues, records; Linkage and integration; Management of care, general Outcomes reporting requirements, 3 Outpatient records, 63, 112, 141 COSTAR, 112, 115-117 summary time-oriented record, 62 Ownership issues, 147, 192, 211, 220 p PaperChase, 119 Paper records, 57-63, 81, 84, 90, 178 Patient record, general, 56-57 defined, 55, 95, 135-136, 139 paper, 57-63, 81, 84, 90, 178 patient-derived information, 11 transcription, 25 users and uses, 29, 34-35, 75-78 Patients, general, 153-154 access to information, legal right, 83, 209210, 214-216, 217-218 cost per, 53, 145 as data users, 65, 83 education, 75, 83 see also Confidentiality Peer review, 65, 157 Personal computers, 123, 124

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From page 232...

... , 195 Regulations, 50, 79, 90, 147-149, 177, 192193, 204-205 clinical reporting requirements, 3

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From page 233...

... INDEX 233 Medicare, 206-208, 214, 217 see also Licensure laws; Standards Reliability, 59, 81, 95, 109-110, 179, 218 design for, 139 see also Accuracy issues Research, 47, 48, 49, 50, 54, 68, 75, 77, 79, 110, 169, 182, 185-186, 190, 222 academic, 112, 114, 150, 159 demonstration projects, 49, 50, 67, 157, 160, 161, 163, 168, 182, 183, 185, 186 epidemiology, 66, 88, 84, 93, 127, 155, 174 federal role, 67, 155, 164-165, 174, 175 health services, support of, 45, 46, 94 problem-oriented medical record, 91 uniform record systems, 86 see also Design and development Risk factors, 66, 84, 93 S Secondary databases, 49, 50, 69, 74, 77-78, 95, 98, 110-111, 124, 161, 163, 177, 179, 181, 182, 183, 191-193 costs, 50, 110, 177, 193 defined, 55-56 Security, data, 86-87, 109-110, 126, 127-129, 147-148, 179, 214-217 design for, 14-15, 139 networks, 4, 88, 96, 148, 216 standards, 48, 50, 51, 96, 131, 163, 168, 177, 183, 186, 188-189, 191-192, 196 see also Confidentiality Shared care environments, 32-34, 38 Smart cards, 32, 34, 39, 122-123 Social factors, 147-149, 156, 174 politics, 46, 48-49, 153, 195 public opinion, 153, 195 Social Security Act, 173, 174 Speech recognition, see Voice recognition Stakeholders, 151-161, 166, 179, 183 Standard Guide for Nosologic Standards and Guides for Construction of New Biomedical Nomenclature, 108 Standards, 49, 50, 51, 110, 131-132, 160, 161, 163, 177, 180-181, 186-192, 221-222 accreditation, 65, 75, 77, 110, 149, 160, 208, 214, 217, 218 clinical practice guidelines, 51, 67, 98, 164, 181, 190 confidentiality, 131, 188 content, general, 63, 84-86, 140, 186, 187 cost factors, 146 database queries, 106, 117 data exchange and vocabulary, 12-14, 31, 34, 38, 48, 50, 51, 85-86, 96, 106, 107109, 116, 126, 127, 129-131, 140, 149151, 155, 163, 168, 169, 174, 175, 177, 179, 181, 183, 186-188, 191-192, 196 federal role, 66, 67, 129-131, 155, 161 format, general, 38-39, 63, 84-86, 87, 191 international, 27, 38-39, 123, 187-188 outpatient records, 63 security, 48, 50, 51, 96, 131, 163, 168, 177, 183, 186, 188-189, 191-192, 196 state-level, general, 204 see also Licensure laws State governments, 50, 157, 159, 161, 169, 174-175, 177, 192, 200-223 confidentiality laws, 147-148, 208-209 demonstration projects, 157, 168 licensure laws, 147, 192, 200, 201-206, 217, 221-222 model legislation, 50, 192-193, 210, 221 222 standards, 204 Statistical analysis, 93, 95, 118 Summary time-oriented record, 62 Surgery, 121 Systematized Nomenclature of Medicine, 108 T Task-oriented medical records, 115, 117 Technicon, 120 Technological innovations, 46, 48, 68, 74, 81, 94, 100-132, 135-137, 138 advances, 3-6 barriers, general, 10-17, 126-131 computer processing power, 3 confidentiality and, 110, 126, 127-129 costs, 69-70, 105-106, 112, 126, 127, 136, 137, 141, 146 see also Design and development; Diffusion, innovations; Research Telecommunications, 109 electronic mail, 47, 119, 150, 189 European, 22 reliability, 95 workstation linkages, 88 see also Networks Text processing, 106-107, 108, 126, 127, 131, 179

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From page 234...

... , 9, 13, 106-107, 108-109, 155, 188 Uniform Clinical Data Set, 131, 156-157 Uniform Commercial Code, 200, 219, 221 Uniform Health-Care Information Act, 192, 210, 222 Unique health identifier, 13 United Kingdom, 23-24, 26, 29, 36, 108, 122 123 Universities, 159-160 academic research, 112, 114, 150, 159 University of California at Los Angeles, 4 UNIX, 28, 137 U.S. CPR systems, status advances, 3 - , 9-10 barriers/challenges, 10-17 implementation, 8-9 market, 6-8 practice environment, 1-5 Users, 46-47, 58, 65, 70, 74-93, 143-145, 181 authentication/identification, 14, 39 computer interface with, general, 4-5, 7, 11-12, 29, 87, 88, 126-127, 179 diffusion of innovations, 142, 143-145 needs, general, 46-47, 76-93 multiple, 65 patients as, 65, 83 projections, 94-98 see also Access issues; Change agents; Stakeholders V Vendors, 100, 160-161, 162, 169, 185 legal issues, 149, 200-201, 202, 219-221 survey of, 135-137 Veterans Administration, see Department of Veterans Affairs Viruses, computer, 217, 222 Vocabulary control, 9, 11, 13-14, 25, 31, 39, 48, 50, 51, 85-86, 96, 106, 107-109, 116, 126, 127, 129-131, 140, 149-151, 155, 163, 168, 169, 174, 175, 177, 179, 181, 183, 186-188, 191-192, 196 Voice recognition, 29, 32, 106, 126-127, 131' 179, 186 W Windowing, 117, 137 Windows NT/95 environment, 28 Word processing, see Text processing Workstations, 26-28, 88, 104-105, 179 World Wide Web, 4-5

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Index Pages 225-234

Index
Pages 225-234