An Efficient, Clinically-Natural Electronic Medical Record System that Produces Computable Data.

Current commercially-available electronic medical record systems produce mainly text-based information focused on financial and regulatory performance. We combined an existing method for organizing complex computer systems-which we label activity-based design-with a proven approach for integrating clinical decision support into front-line care delivery-Care Process Models. The clinical decision support approach increased the structure of textual clinical documentation, to the point where established methods for converting text into computable data (natural language processing) worked efficiently. In a simple trial involving radiology reports for examinations performed to rule out pneumonia, more than 98 percent of all documentation generated was captured as computable data. Use cases across a broad range of other physician, nursing, and physical therapy clinical applications subjectively show similar effects. The resulting system is clinically natural, puts clinicians in direct, rapid control of clinical content without information technology intermediaries, and can generate complete clinical documentation. It supports embedded secondary functions such as the generation of granular activity-based costing data, and embedded generation of clinical coding (e.g., CPT, ICD-10 or SNOMED). Most important, widely-available computable data has the potential to greatly improve care delivery management and outcomes.

Developing a multi-institutional PACS archive and designing processes to manage the shift from a film to a digital-based archive.

The Quality Assurance Review Center (QARC) works to improve the standards of care in treating cancer by improving the quality of clinical trials medicine. QARC operates as a data management and review center providing quality assurance services for multiple external groups including cooperative groups and pharmaceutical companies. As the medical world migrates from analog film to digital files, QARC has developed an innovative and unique digital imaging management system to accommodate this trend. As QARC acquires electronic data from institutions across six continents, the system is continually developed to accommodate Digital Imaging and Communications in Medicine (DICOM) imaging originating from a wide variety of Picture Archival and Communications System (PACS) manufacturers, thus creating one of the largest and most diverse multi-institutional imaging archives in the cancer research community.

Intra-arterial thrombolysis in a 2-year-old with cardioembolic stroke.

Recombinant tissue plasminogen activator, although the standard of care for the management of acute ischemic stroke in adults, is used infrequently in children. The authors describe the use of intra-arterial recombinant tissue plasminogen activator in a young child with embolic stroke. Thrombolysis restored flow to the affected middle cerebral artery and appeared to limit the extent of the infarction and the severity of the subsequent neurologic deficits.

Nitric oxide increases the signal intensity of the T1-weighted magnetic resonance image of blood.

Human blood was infused through a gas permeable membrane to determine if treatment with nitric oxide affects the signal intensity of its T1-weighted magnetic resonance image. Equal volumes of blood with increasing concentrations of methemoglobin were placed in glass tubes. T1-weighted images of the samples were obtained with a 1.5T magnetic resonance scanner. There was a linear correlation between the signal intensity of the T1-weighted images and the amount of methemoglobin in each sample (r2 = 0.94, p = 0.0015). Thus, blood that has been treated with nitric oxide can potentially be used as an autologous intravascular contrast agent for magnetic resonance imaging.

Speech recognition implementation in radiology.

Continuous speech recognition (SR) is an emerging technology that allows direct digital transcription of dictated radiology reports. The SR systems are being widely deployed in the radiology community. This is a review of technical and practical issues that should be considered when implementing an SR system.

CT scan and the pediatric trauma patient--are we overdoing it?

BACKGROUND: Recent literature expresses concern for an increased risk of cancer in children exposed to low-dose radiation during computed tomography (CT). In response, children's hospitals have implemented the ALARA (as low as reasonably achievable) concept, but this is not true at most adult referring institutions. The purpose of this study was to assess the diagnostic necessity of CT in the evaluation of pediatric trauma patients. METHODS: A retrospective review was conducted of the trauma database at a large, level I, freestanding children's hospital with specific attention to the pattern of CT evaluations. RESULTS: From January 1999 to October 2003, 1,653 children with traumatic injuries were evaluated by the trauma team, with 1,422 patients undergoing 2,361 CT scans. Overall, 54% of obtained scans were interpreted as normal. Fifty percent of treated patients were transferred from referring hospitals. Approximately half arrived with previous CT scans with 9% of these requiring further imaging. Of the 897 patients that underwent abdominal CT imaging, only 2% were taken to the operating room for an exploratory laparotomy. In addition, of those patients who had abnormal findings on an abdominal CT scan, only 5% underwent surgical exploration. CONCLUSIONS: CT scans are used with regularity in the initial evaluation of the pediatric trauma patient, and perhaps abdominal CT imaging is being used too frequently. A substantial number of these scans come from referral institutions that may not comply with ALARA. The purported risk of CT radiation questions whether a more selective approach to CT evaluation of the trauma patient should be considered.