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:
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.
BASIC ADVANCED INTERNET SEARCH METHODS
Regardless of search engine used, certain search methodologies, if applied correctly, increase the efficiency of needed information.
Basic to Advanced Strategies when searching:
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
TYPES OF DOMAINS
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
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.
BASIC ADVANCED INTERNET SEARCH METHODS
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:
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
TYPES OF DOMAINS
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
| .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:
* 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:
- Digital windmill (http://digitalwindmill.com/)
- eMetasearch (http://emetasearch.com/)
INTERNET AVALABLE CLINICAL PRACTICE TOOLS
ASSESSMENT TOOLS:
Classification systems according to Knowledge-based Practice
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)
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Nursing Process
Nursing Process
ASSESSMENT TOOLS:
- For comprehensive nursing assessment forms (http://www.hospitalsoup.com/public/nursingassess2001.pdf)
- Resource information for alcohol abuse (http://www.niaaa.nih.gov)
- Domestic abuse assessment (http://www.state.vt.us/health/abuse.htm)
- For advanced nursing practice (http://ctclearinghouse.org)
- Body mass index calculator (http://nhlbisupport.com/bmi/bmicalc.htm)
- Cancer risk tools (http://www.yourcancerrisk.harvard.edu/)
- Coronary heart disease risk calculator (http://hin.nhlbi.nih.gov/atpiii.calculator.asp?usertype=prof)
- Health risk calculators (http://www.umm.edu/healthcalculators/)
Classification systems according to Knowledge-based Practice
- Medical classification of diseases (e.g. International Classifications of Disease)
- Nursing classifications of human responses to illness and health (e.g. the NANDA Classification of Nursing Diagnoses)
- Functional health and disability (e.g. the International Classification of Functioning in Health and Disability)
- New threats to health (http://www.bt.cdc.gov)
- Mass trauma preparedness and response
- Bioterrorism agents/ diseases
- Chemical agents
- Recent outbreaks and incidents
- 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/)
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)
- Disease directories: Centers for Disease Control and Prevention(CDC), Diseases and Conditions (http://www.cdc.gov/node.do/id/0900f3ec8000e035)
- National Cancer Institute (www.nci.nih.gov)
- The Karolinska Institute University Library in Sweden (http://www.mic.ki.se/Diseases/)
- Online Medical Dictionaries (http://cancer-web.ncl.ac.uk/omd)
- National Institute of Diabetes, Digestive, and Kidney Diseases, National Digestive Diseases Information Clearinghouse (NDDIC)
- (http://digestive.niddk.nih.gov/ddiseases/a-z.asp)
- New York online access to Health (www.noah-health.org)
- Brain Attack: Stroke Scales, National Institute of Neurological disorders and Stroke (http;//www.stroke-site.org/stroke_scales/stroke_scales.html)
- Genomics and Disease Prevention (http://www.cdc.gov/genomics/default.htm)
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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
- Assessment Forms
- 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
- Calculators
- Outcomes/Evaluation
- Patient Safety
- Standardized Outcome Terminologies
- OASIS
- HEDIS
- Patient Safety
| ASSESSMENT | Assessment Forms | Hospital Soup http://www.hospitalsoup.com/public/mr-ipa-mcch.pdf |
| Miscellaneous Screening Tools | Alcohol abuse and alcoholism |
|
| Population-Based Assessment | Missouri Department of Health and Senior Citizens http://www.dhss.mo.gov/DataAndStatisticalReports/index.html |
|
| 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 http://medlineplus.gov/ |
Diagnosis/Treatment
| 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 http://www.cdc.gov/DiseasesConditions / |
| Disease/Conditions specific, examples of | New York Online Access to Health (NOAH) http://www.noah-health.org/ |
| 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 http://www.cms.hhs.gov/medlearn/icd9code.asp ICF (International Classification of Functioning, Health, and Disabilities, published by WHO) http://www.cdc.gov/nchs/about/otheract/icd9/icfhome.htm, 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 http://www.cms.hhs.gov/ |
| 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 http://www.alternativelink.com/ali/home/ |
| 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 http://www.cdc.gov/std Tuberculosis 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 http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm Guidelines for the Diagnosis and Management of Asthma— Update on Selected Topics 2002 http://www.nhlbi.nih.gov/guidelines/asthma/index.htm Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm Recommendations Regarding Public Screening for Measuring Blood Cholesterol http://www.nhlbi.nih.gov/health/prof/heart/index.htm#chol High blood pressure guidelines: Joint National Commission (JNC) 7: http://www.nhlbi.nih.gov/guidelines/hypertension/index.htm Overweight and Obesity Clinical Guidelines http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm 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) http://www.fpnotebook.com/END135.htm |
Outcomes/Evaluation
| 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) http://www.inmds.org/PostNuke/html/index.php 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 /NursingHomeQualityInits/10_NHQIQualityMeasures.asp#TopOfPage 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 Reportshttp://www.ncqa.org/Programs/HEDIS/index.htm |
| 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 http://statpages.org 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 http://medschool.slu.edu/agingsuccessfully/index.phtml?page=healthsurveys Clinical Glidepath® Tools Sampler per Acrobat Reader http://medschool.slu.edu/agingsuccessfully/index.phtml?page=healthsurveys |
| 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 http://eldertech.missouri.edu/links.php |
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 http://www.niso.org/committees/MetaSearch-info.html |
| 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 http://www.nlinks.org/research_main.phtml |
| Continuing Education | CDC http://www.cdc.gov/search.do?action=search&queryText=continuing+education&x=17&y=8 University of North Carolina – Chapel Hill http://www.med.unc.edu/cme/ Medscape. Subscribe free and sign up for “nurses” page. www.medscape.com 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. http://www.cancer.org/docroot/HOME/pro/pro_0.asp |
