Sağlık Bilgi Sistemlerinin zayıf yönlerinin belirlenmesi: Bir Deneysel E-sağlık Değerlendirme Çalışması [Determining the weak sides of Healthcare Information Systems: An Emprical e-Health Evaluation Study]

Abstract in Turkish Sağlık tüm sağlık teşkillerinin bir bilgi sistemi kullandığı teknoloji-yoğun bir alandır. Sağlık hizmetinin devamının sağlanması ve günlük sağlık bakımı işlemlerinin yürütülmesi sağlık bilgi sistemleri olmaksızın imkansız bir hale gelmiştir. Sağlık bilgi sistmleri sürelki değişen ihtiyaçları karşılamak için iyi yönetilmeli ve desteklenmeli, sürekli geliştirilmelidir. Bunun için yaşayan sistemler olmalıdırlar. Bu bağlamda, işletilen sistemlerin zayıf ve güçlü yanlarını belirlemek için değerlendirme çalışmaları yapılmaktadır. Sağlık bilişimi alanında değerlendirme çok önemli mbir konudur. Yatırımcılar ve yöneticiler bilgi sistemlerini geliştirebilmek için sistemlerinin başarı seviyesini ve zayıf noktalarını bilmek isterler. Burdan yola çıkarak, bir sağlık bilgi sisteminin değerlendirildiği bir çalışma yapılmıştır. Yeni kurulan labaratuvar bilgi sistemi (LBS), hem hastalara hem de kullanıcılara uygulanan anketler vasıtası ile very toplanarak değerlendirilmiştir. LBS Fonksiyon yeterliliği, İş yükü azaltma, Hız, Öğrenme kolaylığı, Hizmet kalitesini arttırma, Süreklilik, Yardım menüleri, Kulanıcı tatmini ve Hasta tatmini özellikleri bazında değerlendirmeye tabii tutulmuştur. Belirlenen eşik değerinin altında kalan özellikler geliştirme gerektiren özellikler olarak belirlenmişit.r Değişik eşik değerlerine göre hangi özelliklerin geliştirilmesi gerektiği bir tablo olarak verilerek, eşik değeri seçimi duruma özel olması nedeniyle değerlendirmeciye bırakılmıştır. Eşik değeri yükseldikçe geliştirme gereken özellik sayısı artmaktadır. [Healthcare is a technology-intensive area where all the healthcare organisations use an information system. Managing daily works and providing the continuity of healthcare is impossible without healthcare information systems. Healthcare information systems have to be well supported and managed, also have to be improved to meet the changing needs, they must be living systems. In this respect, evaluations are carried out to reveal the weak and strong sides of information systems in operation. Evaluation is an important subject for medical informatics domain. The investors and managers need to know the success level and poor sides of their information system to make improvements. In this sense, a case study is performed in this study, to evaluate a healthcare information system. Particularly, the recently deployed laboratory information system (LIS) is evaluated by means of questionnaires, applied to both patients and users of the laboratory information system. Laboratory information system is evaluated on the basis of Function sufficiency, Decreasing Work Load, Speed, Learning Ease, Improving Service Quality, Availability, Help Manuals, User Satisfaction, and Patient Satisfaction features. The features needing to be improved in terms of the effectiveness and efficiency of LIS are measured based on the threshold value. The results are presented in a variable table according to the threshold value selected by the evaluator. As the target threshold value increases, the number of features needing to be improved also increases.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Pressure Ulcer Prevalence in Turkey A Sample From a University Hospital

WOS: 000306126900008PubMed ID: 22652934PURPOSE: The purpose of this study was to identify pressure ulcer prevalence among hospitalized patients in a university hospital setting. SETTING AND SUBJECTS: The study setting was medical and surgical inpatient wards and critical care units in a university hospital in Adana, Turkey. The sample population comprised 404 patients who were aged 18 years or older and admitted to the intensive care units and internal and surgery units at least 24 hours before data collection. METHODS: Each participating patient's skin was assessed and pressure ulcers were classified according to the National Pressure Ulcers Advisory Panel grading system. Pressure ulcer risk was assessed using the Braden Scale. Data were recorded on a patient observation form designed for this study. INSTRUMENTS: The following tools were used to collect data: (a) data collection form in identifying sociodemographic and medical characteristics of the patients, (b) the classification developed by the National Pressure Ulcers Advisory Panel in identifying the phases and localization of pressure ulcers, and (c) Braden Risk Assessment Scale in assessing risks. RESULTS: The average age of patients was 51.22 +/- 0.84 years (mean +/- SD); 51.7% were male. The mean hospital length of stay was 9.6 +/- 0.5 days. Pressure ulcer risk assessment revealed that 34.2% of the patients were at increased risk. The prevalence of pressure ulcers was 10.4%. Pressure ulcers occurred most frequently in the sacral area (43.9%); 45.2% of them were stage (grade) II. CONCLUSIONS: The pressure ulcer prevalence identified in this study is comparable with studies conducted in other countries.Cukurova UniversityCukurova University [ASYO2007YL3]This project (ASYO2007YL3) was sponsored by Cukurova University Scientific Research Projects. We thank Prof Dr Z. Nazan Alparslan, head of the Cukurova University Medical Faculty Biostatistics Department, for her help with the analysis of the statistical data. We thank all the data collectors who participated in this study

A Versatile, User Driven, Flexible And Scalable Decision Making Tool In Toxicology

Background. Drug poisoning is a frequent problem in emergency services. Rapid decision making in toxicological assessment is very important especially in acute poisoning. Since their limited experience, non-toxicologist physician in emergency services usually needs extra information, i.e. decision support tools, to manage acute situation. Reasoning systems could be go either in a known intoxication to give physicians better advice about drugs ingested or in an unknown intoxication to identify products according to clinical manifestations. The aim of this study is to provide a user driven, flexible, scalable and easy to use computer-based decision support system for toxicological assessment. Methods. Our system offers access to the information available in clinical toxicology. Towards this goal, decision making could be used either to refer to a predefined structured database obtained from relevant reports from the textbook, namely predefined system -default-, or to carry out a part of medical reasoning which could be defined by user, namely user defined structure. This system was developed by using Microsoft Visual Basic programing language and Access is the database management system. The system mainly based on answering predefined or user created questions, i.e. what is the heart rate of the patients, to determine drugs affecting cardiovascular system. It is easy to maintain the whole stucture of the system even if some questions could also be inserted to in any of the others anytime. Advices to an assessment question or a group of related questions could be defined as a decision making purpose. In addition, answers to question could be exported as a report file which very useful for either clinican or for laboratory staff and it also could be exported as a database file for statistical evaluation and future considerations. Results. Preliminary evaluations upon our toxicological assessment system promising and it offers higher clinical success and higher user satisfaction. It is easy to use and easy to maintain. It enables continous improvement in the knowledge of clinical toxicology and to transfer it from experienced staff to non-toxicologist pyhsician. Further evaluation will be conducted to clarify the effectiveness of the system. Conclusion. We have developed a versatile, user driven, flexible, scalable, easy to use and easy to maintain toxicological assessment system which promises higher user satisfaction and higher clinical effectiveness. Since it enables user driven usage, our developed decision making tool could be easily adopted to other medical are

The Advantages of Electronic Prescription, the Problems and Tackling Them

The system of electronic prescription has been recently developed and used in the developed countries especially due to improvements of and with the help of information technologies. When considering the level of information technology, it is surprising that electronic prescription has still been being prepared in the paper environment. Electronic prescription is a fundamental component of the electronic patient record, which seems to be the final target of health area. It has so important benefits such as; determining the most suitable drug and dosage for the patient, eliminating illegible hand-writing, shortening time for accessing the drug knowledge, enable to access the knowledge of drug and prescription at any time by mobile tools, enabling doctor and pharmacist to gain time, self updating the drug knowledge including fees, seeing and comparing the drug information, seeing the indications and contraindications of drugs while prescribing and thus informing the patient, decreasing side effects and drug allergies by this way, composing macros for favorite prescriptions, enable doctors to customize their drug lists, giving the retrospective and prospective statistical and epidemiological research facilities, contribution to medicine education by giving decision support for medical students, decreasing the interim approval mechanisms, contribution to both patient and medical workers’ satisfaction, easing the medico-legal inspections. Besides of its advantage, it brings some difficulties such as; data and communication security, interoperability, the need for legal arrangements, the needs for hardware, software and other sources, scalability, difficulty in adaptation of medical staff to new system. The system of electronic prescription will be an inevitable part of our life in near future. Besides of benefits, it brings some difficulties. To overcome these difficulties, cooperation of universities, public and private institutions is needed

Analysis of Resources in Healthcare by Computer Simulation Studies in Healthcare: An Outpatient Clinic Study

Use of computer simulation method in resource management in healthcare; A study in outpatient clinics Simulation can be used to determine the work load of the health staff and the needs of system resources in healthcare. We performed a simulation study for outpatient clinics of an internal medicine department. The data are obtained from electronic health recording system (EHR) except for the duration of doctor examination. Data from 18,750 patients were used. We used different scenarios to determine the critical factors affecting patient queue size. We found that the number of doctors was the most important factor influencing the waiting duration and patients queue size. Other factors affecting the system performance were the mean examination time and the revolving fund processes. In conclusion, this study shows that simulation is a possible method to determine critical factors for service performance

Factors associated with noninvasive ventilation response in the first day of therapy in patients with hypercapnic respiratory failure

Background and Aim: Noninvasive ventilation (NIV) decreases mechanical ventilation indication in the early period of acute hypercapnic respiratory failure (AHcRF) and factors for success have been studied well. But, less is known about the factors influencing the NIV response in the subacute period. This study was aimed to determine the factors influencing the reduction of PaCO 2 levels within first 24 hours of therapy. Methods: NIV response was defined as reduction of PaCO 2 level below 50 mmHg within first 24 hours. Patients with AHcRF, treated with NIV, were divided into 2 groups according to this criterion; group 1 as the nonresponsive, group 2 as the responsive. The differences in NIV methods and characteristics of the two groups were evaluated and compared in this retrospective study. Results: A total of 100 patients were included in the study; 66 of them in group 1 and 34 in group 2. No significant differences were identified between the length of NIV application and intensive care unit (ICU) stay, intubation and mortality rates, across the groups. Ninety-one percent of the patients in group 2 had received all night long NIV therapy; this was just 74% in group 1 (P=0.036). Results of multivariate analysis showed that while nocturnal application was significantly associated with better response, prior home ventilation and requirement of higher pressure support (PS) levels significantly and independently associated with poorer response to NIV therapy. Conclusion: In patients with AHcRF, all night long use of NIV may accelerate healing by improving PaCO 2 reduction within the first 24 hours. A rapid response in PaCO 2 levels should not be expected in patients requiring higher PS levels and using prior home ventilation