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Journal: International journal of medical informatics


BACKGROUND: The medical application domain has been a great challenge for information technology solutions for decades, especially when the target process has been complex and multidisciplinary such as chemotherapy processes. OBJECTIVE: To evaluate the impact of a homegrown protocol based information system on the efficiency of chemotherapy workflow processes in an outpatient setting. METHODS: A day care unit of the Hematology/Oncology outpatient clinic of Erasmus Medical Center was the setting for this study. The study consisted of comparison of pre- and post-implementation of four workflow efficiency related external indicators: turn-around times of a commonly administered chemotherapy course (Paclitaxel-Carboplatin), chemotherapy course administration postponing rate, the rate of recording course administration time, and patient admission rate of the outpatient clinic. The data was gathered retrospectively from patient charts and information systems' log files. For the purpose of turn-around-time 109 Paclitaxel-Carboplatin chemotherapy courses of pre-implementation were compared to 118 those of post-implementation. For the other indicators: 247 chemotherapy courses pre-implementation were compared to 324 courses post-implementation. The process maps of pre- and post-implementation were also compared to each other. RESULTS: The implementation of the system improved the process by removing repetition and sequencing of the tasks. Following the implementation, chemotherapy postponing decreased by 17.2% (Z=-4.723, P=.000) and there were 5.7% less records with missing administration time (Z=-3.047, P=.002). The admission rate increased 1.9 patient per working day (t(94)=-5.974, P=.000). The overall turn-around-time reduced 18.9min following the implementation (t(169)=3.48, P=.001). In a multivariate multiple regression model the reduction in turn-around time was related to the implementation of the system (Pillai’s Trace=0.159, F(4,161)=7.613, P=.000). CONCLUSION: Information systems based on treatment protocols can reduce communication and synchronization needs between the stakeholders in a complex workflow process. These systems can help reengineering the process and improve workflow efficiency by removing unnecessary sequencing and repetitions of tasks.

Concepts: Better, Regression analysis, Management, Process architecture, Business process modeling, Information system, Workflow, Business process reengineering



We examined patients' perceived need for a Health Information Exchange (HIE), their preferences regarding information exchange operations, endorsement of the technology, and expected and perceived benefits and concerns about the technology. Through an HIE pilot program in South Korea, we also explored the influence of demographic characteristics and HIE experience on patients' perceptions.

Concepts: Psychology, Perception, Concepts in metaphysics, Information, Health informatics, Health information exchange


Effective use of routine data to support integrated chronic disease management (CDM) and population health is dependent on underlying data quality (DQ) and, for cross system use of data, semantic interoperability. An ontological approach to DQ is a potential solution but research in this area is limited and fragmented.

Concepts: Medicine, Demography, Chronic, Disease management, Ontology, Metaphysics, Plato, Interoperability


The literature shows that communication in health care is one of the most important factors associated with quality of care and patients safety. Especially in Intensive Care Units (ICUs) communication is of importance, due to the characteristics of the setting. However, relatively little is known about the different aspects of communication in health care and how Computerized Provider Order Entry (CPOE) implementation may impact communication, and consequently, quality of care. In this study we adapted an existing questionnaire developed by Shortell et al. [11] to examine the impact of CPOE implementation on communication in a repeated cross-sectional design (6 months before implementation, 3 months after implementation and one-year after implementation). Results show overall that CPOE did not have a negative effect on communication, especially in the long term.

Concepts: Health care, Healthcare, Effect, Cross-sectional study, Effects unit, Negative feedback, Term, Computer physician order entry


Nurses register data in electronic health records, which can use various terminology and coding systems. The net result is that information cannot be exchanged and reused properly, for example when a patient is transferred from one care setting to another. A nursing subset of patient problems was therefore developed in the Netherlands, based on comparable and exchangeable terms that are used throughout the healthcare sector and elsewhere (semantic interoperability). The purpose of the current research is to develop a mapping between the subset of patient problems and three classifications in order to improve the exchangeability of data. Those classifications are the Omaha System, NANDA International, and ICF (the International Classification of Functioning, Disability and Health).

Concepts: Health care, Nursing, Health informatics, Medical classification, SNOMED CT, NANDA, Nursing diagnosis, Omaha System


School violence has a far-reaching effect, impacting the entire school population including staff, students and their families. Among youth attending the most violent schools, studies have reported higher dropout rates, poor school attendance, and poor scholastic achievement. It was noted that the largest crime-prevention results occurred when youth at elevated risk were given an individualized prevention program. However, much work is needed to establish an effective approach to identify at-risk subjects.


It is widely acknowledged that breaches and misuses of health-related data can have serious implications and consequently they often carry penalties. However, harm due to the omission of health data usage, or data non-use, is a subject that lacks attention. A better understanding of this ‘other side of the coin’ is required before it can be addressed effectively.

Concepts: Psychology, Data, The Other Side


Type 2 diabetes (T2DM) is a major health concern in most regions. In addition to direct healthcare costs, diabetes causes many indirect costs that are often ignored in economic analyses. Patients' travel and time costs associated with the follow-up of T2DM patients have not been previously calculated systematically over an entire healthcare district. The aim of the study was to develop a georeferenced cost model that could be used to measure healthcare accessibility and patient travel and time costs in a sparsely populated healthcare district in Finland. Additionally, the model was used to test whether savings in the total costs of follow-up of T2DM patients are achieved by increasing self-monitoring and implementing electronic feedback practices between healthcare staff and patients.


Physician and nurses have worked together for generations; however, their language and training are vastly different; comparing and contrasting their work and their joint impact on patient outcomes is difficult in light of this difference. At the same time, the EHR only includes the physician perspective via the physician-authored discharge summary, but not nurse documentation. Prior research in this area has focused on collaboration and the usage of similar terminology.