Clinical information databases and systems must be designed for system-wide and discipline-specific needs. To meet discipline-specific needs, the design of clinical information databases and systems requires the input of members of each involved discipline. The reason is that each discipline is alone responsible for its knowledge base, practice, and standards of practice. Without this interdisciplinary approach to the development of clinical information systems, the resultant system will be ineffective in addressing the patient needs for which it is designed and inefficient.

                Wireless applications permit Internet connectivity. Within some academic health science centers this allows for Web-based clinical decision support, patient and clinician e-mail communication, and point-of-care electronic health record data entry, data sharing, and messaging, including prescription writing.

                Wireless technology is electromagnetically safe. Bluetooth radio technology, on which wireless devices rely, was found to be safe and robust even within intensive care environments (Wallin and Wajntraub, 2004). Other issues surrounding wireless technology use are not minor (Delbanco and Sands, 2004; Newbold, 2004).

Considerations for use:

  • Secure portals and encryption, which are mandatory to safeguard patient privacy/ confidentiality
  • Incorporation of a wide range of practice guidelines to frame clinician and patient expectations and responsibilities
  • Cost per clinician time considerations

                Basic and advanced Internet skills are needed to adapt to a frequently changing Internet environment and to retrieve the wealth of internet information applicable to clinical practice in an efficient manner.

                Regardless of search engine used, certain search methodologies, if applied correctly, increase the efficiency of needed information.

Basic to Advanced Strategies when searching:

  • Name the precise information being sought. If the search terms used are precisely chosen, the searcher goes directly to the desired information.
  • Use search strings (one or more search terms) rather than single words to increase the preciseness of a search.
  • Enhance search strings by using BOOLEAN or natural language methods. Use the Boolean terms:
           1.) AND- when search strings needed to be added together

           2.) OR- when equivalent terms or synonyms are used to capture the information required

           3.) NOT- when a specific result for searching is not desired to be included       


                In the Domain Name System, there is a hierarchy of names. The root of system is unnamed. There are a set of what are called "top-level domain names" (TLD’s). These are the generic TLD’s (EDU, COM, NET, ORG, GOV, MIL, and INT), and the two letter country codes from ISO-3166. It is extremely unlikely that any other TLD’s will be created (Jon Postel; Domain Name System Structure and Delegation; RFC 1591; March 1994).

                Internet domain names are the alphanumeric identifiers we use to refer to hosts on the Internet. The structure of Internet domain names was first described in RFC 819, and their syntax was first described in RFC 822.

Top-level domains. Internet domain names are organized by their levels, with the higher levels on the right.

                For example, for the domain "mail.twenty.net" the top-level domain is "net", the second-level domain is "twenty.net", and the third-level domain is "www.twenty.net".

Originally, the top-level Internet domains were associated with organizations, mainly ".arpa", ".csnet", ".bitnet", and ".uucp".

Eight Subject-Specific Top-Level Domains
Second-level domains. Top-level Internet domains like ".com" are shared by all the organizations in the domain. Second-level domain names like "yahoo.com" and "livinginternet.com" are registered by individuals and organizations. Second-level domains are the addresses commonly used to host Internet applications like web hosting and email addressing.

Third-level domains. Third-level Internet domain names are created by those that own second-level domains. Third-level domains can be used to set up individual domains for specific purposes, such as a domain for web access and one for mail, or a separate site for a special purpose.

Country domains. Each country in the world has its own top-level Internet domain with a unique alphabetic designation. A few countries and example domains are shown below.
.bitnet Used for computers on the BITNET network.
.com Originally stood for "commercial" to indicate a site used for commercial purposes, but it has since become the most well-known top-level Internet domain, and is now used for any kind of site.
.int Used by "International" sites.
.edu Used for educational institutions like universities.
.gov Used for US Government sites.
.mil Used for US Military sites.
.net Originally intended for sites related to the Internet itself, but now used for a wide variety of sites.
.org http://www.livinginternet.com/i/iw_mgmt_isoc.htmOriginally intended for non-commercial "organizations", but now used for a wide variety of sites. Was managed by the Internet Society for awhile.
.ae United Arab Emirates http://www.abudhabi.ae/
.at Austria http://www.austria.at/
.au Australia http://www.morning.com.au/
.bb Barbados http://www.barbados.gov.bb/
.bm Bermuda http://www.kbb.bm/
.br Brazil http://home.iis.com.br/
.ca Canada http://www.canoe.ca/
.ch Switzerland http://www.badminton.ch
cl Chile http://www.santiago.cl/
.us United States http://www.co.maui.hi.us/;
Resources that provide more information about country domains and organizations:
* ISO 3166 Maintenance Agency -- Maintains the list of alphabetic country codes used for the top-level country domain names.

* IANA Country Code Top-Level Domains -- Lists all of the country top-level domains, with information on the governing agency and contacts.

Historical references:
* International E-mail accessibility -- Lists all of the top-level domains for each country that is accessible by email as of 2004.

Metasearch engines create what is known as a virtual database. They do not compile a physical database or catalogue of the web. Instead, they take a user's request, pass it to several other heterogeneous databases and then compile the results in a homogeneous manner based on a specific algorithm.

Internet sites that provide how-to information on adding a metasearch capability to a website:



Classification systems according to Knowledge-based Practice
  1. Medical classification of diseases (e.g. International Classifications of Disease)
  2. Nursing classifications of human responses to illness and health (e.g. the NANDA Classification of Nursing Diagnoses)
  3. Functional health and disability (e.g. the International Classification of Functioning in Health and Disability)

Diagnostic Sections:
  • New threats to health (http://www.bt.cdc.gov)
  • Mass trauma preparedness and response
  • Bioterrorism agents/ diseases
  • Chemical agents
  • Recent outbreaks and incidents

Bioterrorism Information Available through Academic Health Science Centers

  • Agency of Healthcare Research and Quality in collaboration with the University of Alabama has a Web site devoted to bioterrorism education (http://bioterrorism.uab.edu/)
  • George Mason University National Center for Biodefense (http://www.gmu.edu/centers/biodefense/)
  • Saint Louis University Center for the Study of bioterrorism and Emerging Infections (http://bioterrorism.slu.edu/)
  • University of Pittsburgh Center for Biosecurity (http://www.upmc-biosecurity.org/)

Disease Diagnosis

The most familiar disease terminology is the International Classification of Disease (ICD). Use of the ICD code allows the aggregation of disease data across patient care settings. Because disease definitions are not static, codes are never finished products. Each year, the Centers for Medicaid and Medicare Services (CMS) Medicare Learning Network posts lists of new and revised ICD diagnosis codes and titles (http://www.cms.hhs.gov/medlearn/icd9code.asp)


Nursing Process
  • Assessment
  • Diagnosis/Treatment
  • Outcomes/Evaluation

Nursing Process

  • Assessment
    • Assessment Forms
    • Miscellaneous Screening Tools
    • Population-Based Assessment, example
    • Risk Assessment
    • Signs and Symptoms Manifestations
  • Diagnosis/Treatment
    • Calculators
    • Bioterrorism/Emergency Preparedness
    • Diseases/Conditions, pick lists
    • Diseases, specific examples of
    • Easy diagnosis
    • Genomics
    • Standardized Diagnosis Terminologies
    • Unified Medical Language System
    • Standardized Treatment Terminologies
    • Nursing Care Plan Forms
    • Practice/Treatment Guidelines
    • Drug Management

  • Outcomes/Evaluation

    • Patient Safety
    • Standardized Outcome Terminologies
    • OASIS
    • HEDIS

Nursing Process
ASSESSMENT Assessment Forms Hospital Soup http://www.hospitalsoup.com/public/mr-ipa-mcch.pdf
Miscellaneous Screening Tools

Alcohol abuse and alcoholism
National Institute of Alcohol Abuse and Alcoholism
Domestic abuse, Vermont Department of Health
Multiple assessment screening tools
Insert health topic desired in search box.
Wheeler Clinic Connecticut Clearinghouse,

Population-Based Assessment Missouri Department of Health and Senior Citizens
Risk Assessment Body Mass Index Calculator
National Heart, Lung and Blood Institute
Cancer Risk Tools
Harvard Center for Cancer Prevention. Risks
Coronary Heart Disease Risk Calculator
National Heart, Lung, and Blood Institute
Health risk calculators
University of Maryland Medicine
Signs and Symptoms Manifesta-tions National Library of Medicine
MEDLINE Plus Health Information
Calculators Cornell University Medical College
Pediatric Critical Care Medicine
Manuel’s Web, Nursing calculators
Martindale’s Calculators Online Part I: Nutrition
Bioterrorism and Emergency Preparedness Emergency Preparedness and Response
Centers for Disease Control and Prevention
Center for Biosecurity
University of Pittsburghhttp://www.upmc-biosecurity.org/
Center for the Study of Bioterrorism and Emerging Infections
Saint Louis Universityhttp://bioterrorism.slu.edu/
National Center for Biodefense
George Mason Universityhttp://www.gmu.edu/centers/biodefense;
Disease/Conditions pick lists Diseases and Conditions
Disease/Conditions specific, examples of New York Online Access to Health (NOAH)
Easy Diagnosis http://easydiagnosis.com
Genomics Specific Genetic disorders
National Human Genome Research Institute
Genetic, Rare and Orphan Disease Resources Online
National Human Genome Research Institute
(very basic information)http://www.nhgri.nih.gov/10001200
Genonmics Search Centers for Disease Control
Standardized Diagnosis Terminolo-gies Nursing Diagnosis Terminologies
Clinical Care Classification (HHCC) System http://www.sabacare.com/
NANDA International www.nanda.org
Omaha System www.omahasystem.org
Surgical Information Systems (SSM) Online
AORN’s Information Resource for Perioperative Leaders: Document Sharing Service http://www.ssmonline.org/Documents/ListDocuments.asp
NANDA Diagnosis Submission Forms
NANDA International www.nanda.orgwww.nanda.org
Concept Analysis Center
Network for Language in Nursing Knowledge Systems (NLINKS)
ICD-9-CM diagnosis codes and titles, new and revised
US Department of Centers of Health and Human Services
Centers for Disease Control and Prevention
Centers for Medicaid and Medicare Services
ICF (International Classification of Functioning, Health, and Disabilities, published by WHO) 
Lumpkin, J.R. (2001). Report of the National Committee for Vital and Health Statistics: Classifying and Reporting Functional Status National Committee for Vital and Health
Statistics, http://www.ncvhs.hhs.gov/010716rp.htm
Health Care Financing Review
Unified Medical Language System Nursing treatment terminologies
Clinical Care Classification (Saba, 2003) www.sabacare.com
Nursing Interventions Classification (NIC) http://www.nursingworld.org/mods/archive/mod30/cec211.htm
Omaha System (Martin, Elfrink & Monsen, 2001)
Perioperative Nursing Data Set
Association of periOperative Registered Nursing (AORN)
Gerontological Nursing Intervention Research Center http://www.nursing.uiowa.edu/about_us/nursing_interventions/index.htm
Center for Nursing Classification and Clinical Effectiveness
Includes: Nursing Interventions Classification
Classification http://www.nursing.uiowa.edu/about_us/nursing_knowledge/clinical_effectiveness/index.htm
Advanced Billing Concepts (ABC) Codes for Alternative
Medicine, Nursing and Other Integrative Healthcare
Practice/Treatment Guidelines CDC - Centers for Disease Control and Prevention www.cdc.gov
Diseases and Conditions http://www.cdc.gov/node.do/id/0900f3ec8000e035
Sexually Transmitted Diseases Treatment Guidelines 2006
Core Curriculum on Tuberculosis http://www.cdc.gov/nchstp/tb/pubs/corecurr/
NCI - National Cancer Institute
Treatment Cancer Treatment. Select from an A-Z listing. www.nci.nih.gov. National Guidelines Clearinghouse www.ngc.gov
National Heart, Lung and Blood Institute, www.nhlbi.nih.gov
National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma
Guidelines for the Diagnosis and Management of Asthma— Update on Selected Topics 2002
Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
Recommendations Regarding Public Screening for Measuring Blood Cholesterol
High blood pressure guidelines: Joint National Commission (JNC) 7:
Overweight and Obesity Clinical Guidelines
American Academy of Family Physicians, Clinical Recommendations http://www.aafp.org/x132.xml
American Diabetes Association, Clinical Recommendations http://www.diabetes.org/for-health-professionals-and-scientists/cpr.jsp
American Cancer Society http://www.cancer.org/docroot/CRI/CRI_3.asp
Drug Management The Centers for Disease Control and Prevention
Vaccines and Immunizations: http://www.cdc.gov/vaccines
More Information on Vaccines
Drug Enforcement Agency, www.dea.gov
Diversion Control: Drugs and Chemicals of Concern FDA
Food and Drug Administration www.fda.gov www.fda.gov
Center for Drug Research and Evaluation, Food and Drug Administration
The FDA Safety Information and Adverse Event Reporting Program, Medwatch
Adverse Event and Product Problem Forms, Medwatch, Food and Drug Administration
VAERS (Vaccine Adverse Event Reporting System) http://www.vaers.hhs.gov/ NLM
National Library of Medicine
Clinical Alerts Database, National Library of Medicine www.pubmed.gov or http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html NIH
National Institutes of Health www.nih.gov
  Medscape www.medscape.com
Rxlist www.rxlist.com
Family Practice Notebook (Provides link to 2AIDA 2001 insulin dosing simulations)
Patient Safety Agency for Healthcare Research and Quality (AHRQ), Web Morbidity and Mortality Rounds Patient safety page, Medscape.com
Institute for Healthcare Improvement
Standardized Outcome Terminologies Center for Nursing Classification and Clinical Effectiveness
Includes: Nursing Interventions Classification and Nursing Outcomes
Classification http://www.nursing.uiowa.edu/about_us/nursing_knowledge/clinical_effectiveness/index.htm International Nursing Minimum Data Set (NMDS)
Minimum Data Set (MDS) Information Site, Centers for Medicare and Medicaid Services
MDS Quality Measures, Centers for Medicare and Medicaid Services http://www.cms.hhs.gov
Outcomes Assessment Information Set (OASIS), Centers for Medicare and Medicaid Services http://www.cms.hhs.gov/OASIS
Health Plan Employer Data and Information Set (HEDIS®), National Committee for Quality Assurance (NCQA)
2007 HEDIS measures http://web.ncqa.org/tabid/59/Default.aspx Example: Missouri 2006 Consumers’ Guide
Commercial: http://www.dhss.mo.gov/ManagedCare/com_06.pdf
MC+: http://www.dhss.mo.gov/ManagedCare/mcaid_06.pdf
Medicare: http://www.dhss.mo.gov/ManagedCare/mdcre_06.pdf
Example: Select list of HEDIS measures used by Blue Choice
http://www.opm.gov/insure/health/hedis2002/9G.asp Example: Minnesota Department of Health, HEDIS
Chart or Medical Record Auditshttp://www.omic.com/resources/risk_man/forms/medical_office/MedicalRecordAudit.rtf
Example: Ophthalmic Mutual Insurance Company (OMIC),Medical Record Audit
Biostatistical measurement and analysis Centers for Disease Control, Epidemiologic analysis software
Centers for Disease Control and Prevention,
Qualitative data creation, management, and analysis software
Centers for Disease Control and Prevention,
Qualitative database software
Statistical test calculators: http://www.ifigure.com/math/stat/testing.htm America Online,
Free biostatistical software and biostatistical tests online
College of St. Benedict/St. John’s University,
Student’s t test calculator http://www.physics.csbsju.edu/stats/t-test.html
Missouri Geriatric Initiatives
Aging Successfully and Glidepath Tools http://medschool.slu.edu/agingsuccessfully/index.phtml?page=glidepathintroduction
Geriatric Screening Tools
Clinical Glidepath® Tools Sampler per Acrobat Reader
Quality Improvement Program for Missouri http://www.nursinghomehelp.org/
Center for Eldercare Rehabilitation and Technology Includes a variety of evidence-based and knowledge-based resources
Metasearch, Continuing Education and Information Standards Organizations
Meta-search Engine Providers EMetasearch http://emetasearch.com
Meta-search search engines National Library of Medicine Gatewary http://gateway.nlm.nih.gov/gw/Cmd Ithaki http://www.ithaki.net/indexu.htm
Metacrawler, www.metacrawler.com
Meta-search standards National Information Standards Organization
Public Domain Search Engines/Databases MEDLINE, National Library of Medicine, www.pubmed.gov,
PubMed, National Library of Medicine, www.pubmed.gov
PubMed’s Clinical Queries, National Library of Medicine,
Access in the left hand margin of the pubmed.gov homepage or click on http://www.ncbi.nlm.nih.gov/entrez/query/static/clinical.html
PubMed’s Special Queries, National Library of Medicine
Access in the left hand margin of the pubmed.gov homepage or click on http://www.nlm.nih.gov/bsd/special_queries.html
NLINKS Research Center databases
Network for Language in Nursing Knowledge Systems
Continuing Education CDC
University of North Carolina – Chapel Hill http://www.med.unc.edu/cme/ Medscape. Subscribe free and sign up for “nurses” page.
National Council of State Boards of Nursing, www.ncsbn.org
CDC TB Continuing Education http://www.cdc.gov/nchstp/tb/pubs/corecurr/ Cancer continuing education.