Daniel Sands

To help clinicians care for patients with HIV infection, we developed an interactive knowledge-ba... more To help clinicians care for patients with HIV infection, we developed an interactive knowledge-based electronic patient record that integrates rule-based decision support and full-text information retrieval with an online patient record. This highly interactive clinical workstation now allows the clinicians at a large primary care practice (30,000 ambulatory visits per year) to use online information resources and fully electronic patient records during all patient encounters. The resulting practice database is continually updated with outcome data on a cohort of 700 patients with HIV infection. As a byproduct of this integrated system, we have developed improved statistical methods to measure the effects of electronic alerts and reminders.

Development of an Interdisciplinary Critical Care Problem List

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Theater-Style Demonstration: Clinical Computing at the Beth Israel Deaconess Medical Center

Campus clinical computing system, developed by the Center for Clinical Computing, is a heavily us... more Campus clinical computing system, developed by the Center for Clinical Computing, is a heavily used, integrated hospital information system.' There are more than five thousand tenninals and workstations located throughout the hospital, ambulatory, and satellite facilities. Each week clinicians access patient information more than sixty thousand times and send more than thirty thousand pieces of electronic mail. Clinicians use the computing system to look up the results of all diagnostic studies, to send and receive electronic mail, and to perfonn a variety of decision support tasks, including bibliographic retrieval via PaperChase, clinical data base retrieval, computer assisted expert consultation, and clinical calculation.

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An Integrated Electronic Patient Record at Boston's Beth Israel Hospital

The Beth Israel Hospital clinical computing system, developed by the Center for Clinical Computin... more The Beth Israel Hospital clinical computing system, developed by the Center for Clinical Computing, is a heavily used, integted hospital information system. There are more than 5000 terminals and workstations located throughout the hospital and its ambulatory and satellite facilities. Each week, clinicians access patient information more than 60,000 times and send more than 30,000 pieces ofelectronic mail.

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A clinical trial of a knowledge-based medical record

To meet the needs of primary care physicians caring for patients with HIV infection, we developed... more To meet the needs of primary care physicians caring for patients with HIV infection, we developed a knowledge-based medical record to allow the on-line patient record to play an active role in the care process. These programs integrate the on-line patient record, rule-based decision support, and full-text information retrieval into a clinical workstation for the practicing clinician. To determine whether use of a knowledge-based medical record was associated with more rapid and complete adherence to practice guidelines and improved quality of care, we performed a controlled clinical trial among physicians and nurse practitioners caring for 349 patients infected with the human immuno-deficiency virus (HIV); 191 patients were treated by 65 physicians and nurse practitioners assigned to the intervention group, and 158 patients were treated by 61 physicians and nurse practitioners assigned to the control group. During the 18-month study period, the computer generated 303 alerts in the i...

A study of physicians' interaction with text-based and graphical-based electronic patient record systems

Proceedings of 15th IEEE Symposium on Computer-Based Medical Systems (CBMS 2002), 2002

... Nestor J. Rodriguez, Jose A. Borges, Viviam Murillo, Johanna Ortiz, Center for Computing Rese... more

Housestaff use of medical references in ambulatory care

by Daniel Sands and Timothy Loo

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2003

We surveyed medical house officers at the Beth Israel Deaconess Medical Center during their ambul... more We surveyed medical house officers at the Beth Israel Deaconess Medical Center during their ambulatory rotations about their utilization of reference materials, assessing such factors as frequency, the mode of reference, and specific choice of resources. The collected data were significantly illustrative of the shift from paper-based resources to digital references. These findings confirm that availability should be of utmost priority when designing references for physicians in training.

Value of abdominal CT in the emergency department for patients with abdominal pain

European radiology, 2003

The purpose of our study is to demonstrate the value of CT in the emergency department (ED) for p... more The purpose of our study is to demonstrate the value of CT in the emergency department (ED) for patients with non-traumatic abdominal pain. Between August 1998 and April 1999, 536 consecutive patients with non-traumatic abdominal pain were entered into our study. Using a computer order entry system, physicians were asked to identify: (a) their most likely diagnosis; (b) their level of certainty in their diagnosis; (c) if they thought CT would be normal or abnormal; (d) their treatment plan (prior to knowledge of the CT results); and (e) their role in deciding to order CT. This information was correlated with each patient's post-CT diagnosis and subsequent management. Pre- and post-CT diagnoses were concordant in 200 of 536 (37%) patients. The physicians' certainty in the accuracy of their pre-CT diagnosis was less than high in 88% of patients. Prior to CT, the management plan included hospital admission for 402 patients. Following CT, only 312 patients were actually admitted...

Dissemination of electronic patient records using primary care referrals as a vector for change

Studies in health technology and informatics, 2001

The Online Medical Record (OMR) is a full-featured shared electronic patient record in use since ... more The Online Medical Record (OMR) is a full-featured shared electronic patient record in use since 1989 at Beth Israel Deaconess Medical Center in Boston. The first practice to use the OMR was a primary care practice. We observed the pattern of voluntary adoption of the OMR and the referral patterns from primary care to specialists. Adoption of the OMR among specialists has accelerated in recent years, in many cases mirroring the referral patterns from primary care to specialists. We hypothesize that referral of patients from primary care providers to specialists exposes these specialists to the benefits the electronic patient record and may promote the use of this technology. We conclude that these referral patterns provide a vector for the dissemination of electronic patient records. The important lesson is that EPR implementation in a health care network should begin with primary care to ensure the most efficient diffusion of this technology throughout the enterprise.

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A web-based rapid prototyping and clinical conversational system that complements electronic patient record system

Studies in health technology and informatics, 2001

Even the most extensive hospital information system cannot support all the complex and ever-chang... more Even the most extensive hospital information system cannot support all the complex and ever-changing demands associated with a clinical database, such as providing department or personal data forms, and rating scales. Well-designed clinical dialogue programs may facilitate direct interaction of patients with their medical records. Incorporation of extensive and loosely structured clinical data into an existing medical record system is an essential step towards a comprehensive clinical information system, and can best be achieved when the practitioner and the patient directly enter the contents. We have developed a rapid prototyping and clinical conversational system that complements the electronic medical record system, with its generic data structure and standard communication interfaces based on Web technology. We believe our approach can enhance collaboration between consumer-oriented and provider-oriented information systems.

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Effects of a knowledge-based electronic patient record in adherence to practice guidelines

M.D. computing : computers in medical practice

1. MD Comput. 1996 Jan-Feb;13(1):55-63. Effects of a knowledge-based electronic patient record in... more

Studying clinician-computer interaction in Web-based systems

Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 2000

A growing of health-care organizations are in the process of modifying their clinical information... more A growing of health-care organizations are in the process of modifying their clinical information systems (CIS) to support browser-based access. Consequently, care-providers are expected to modify their workflow to take advantage of the new technology. Intuitive interfaces, fast response and new functionality are few of the features used to promote endorsement of the change. In parallel, administrators are required to constantly assess user compliance and intervene where necessary to prevent rejection. Such monitoring translates to frequent surveys, analysis of logs and prudent utilization of user-groups. These methods tend to further burden users, suffer from "post-hoc" temporality and are difficult to maintain. In this paper we suggest an alternative approach to such data acquisition. "CareQuest" is an interactive Web-based service that can be woven into clinical applications without coding. It acquires information from the clinician at the relevant point in he...

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Weaving the Web into legacy information systems

Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 2000

For many years, client-server systems were developed as the backbone of clinical computing in lea... more For many years, client-server systems were developed as the backbone of clinical computing in leading hospitals around the country. Beth Israel Deaconess Medical Center now faces the challenge of bridging the technology gap between such systems and the Internet. While developing Web interfaces to legacy clinical systems gives a taste of the future, it is clear that complete institutional migration to the Web is not imminent. Asking clinicians to utilize two different systems, Web-based and legacy, in the interim phase is just one of the difficulties in such transition. This paper describes "Mbridge", a solution that allows legacy system users to exploit the benefits of the Internet in a fashion that does not interfere with their workflow and is both simple and affordable to implement. The service allows clinicians to work on the legacy platform while context-sensitive clinical content is streamed to the browser without their intervention. Using the system, we can gradually...

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Electronic patient-centered communication: managing risks, managing opportunities, managing care

The American journal of managed care, 1999

... for the information to be commu-nicated directly to the physician in the patient&amp;#x27... more ... for the information to be commu-nicated directly to the physician in the patient&amp;#x27;s own words via e ... Although ePCC is not yet reimbursable, Moyer et al point out that if we can show a cost ... Manypractices may choose to establish e-mail addresses for the practice, rather than for the ...

Online medical records: a decade of experience

Methods of information in medicine, 1999

The electronic patient record at the Beth Israel Deaconess Medical Center has fundamentally chang... more The electronic patient record at the Beth Israel Deaconess Medical Center has fundamentally changed the practice of medicine in ways that its developers never foresaw. This type of highly interactive and work flow enabled program is creating new collaborative roles for computers in complex organizations [4]. With the system able to supervise and monitor care, computers are able to perform many care coordination and documentation functions, freeing people to concentrate more on interpersonal interactions and provision of health care services. One of the challenges in the design of electronic patient records to assist health care providers is how to support collaboration while not requiring that people meet face-to-face. Moreover, a greater challenge for each of us as clinicians is to use this technology as a bridge (rather than a barrier) towards better patient-doctor relationships.

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Making ICU alarms meaningful: a comparison of traditional vs. trend-based algorithms

Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 1999

Much of the work in the ICU revolves around information that is recorded by electronic devices. S... more Much of the work in the ICU revolves around information that is recorded by electronic devices. Such devices typically incorporate simple alarm functions that trigger when a value exceeds predefined limits. Depending on the parameter followed, these "boundary based" alarms tend to produce vast numbers of false alarms. Some are the result of false reading and some the result of true but clinically insignificant readings. We present a computerized module that analyzes real-time data from multiple monitoring devices using a customizable logic engine. The module was tested on 6 intensive care unit patients over 5 days, running alarm algorithms for heart rate, systolic and diastolic blood pressure as well as arterial oxygen saturation. Results show a ten-fold increase in positive predictive value of alarms from 3% using monitor alarms to 32% using the module. The module's overall sensitivity was 82%, failing to detect 18% of significant alarms as defined by the ICU staff. T...

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Re-engineering the process of surgical informed consent

Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 1999

We have created a clinical performance support system that transforms surgical informed consent i... more We have created a clinical performance support system that transforms surgical informed consent into an interactive process capable of evolving in response to institution-specified, provider-specified and patient-specified needs. The system functions in several capacities, including: (1) a source of standardized and comprehensive content and format the transmission of procedure-related risk and complications; (2) as expert critique, providing cues in an effort to reduce the effects of biased risk appraisal; (3) captures and archives clinician behavior relating to use, modification and disclosure of standardized knowledge sources; (4) provides just-in-time access to procedural descriptions information relating to risks and complications; (5) captures, archives and makes available to the clinician patient use of procedure-related knowledge resources. By design, the system will be used to assess the relationship between clinician perception and heuristics surrounding risk appraisal and...

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Meeting information needs: analysis of clinicians' use of an HIV database through an electronic medical record

Medinfo. MEDINFO, 1995

We developed an on-line medical record (OMR) and integrated it into a mature hospital information... more We developed an on-line medical record (OMR) and integrated it into a mature hospital information system. The OMR provides a number of information resources for the care of patients infected with the human immuno-deficiency virus (HIV), including drug information, an on-line version of a newsletter on AIDS, an on-line version of a textbook on HIV, and an index of research protocols that actively enrolls patients. As part of an 18-month clinical trial of this system, we monitored the use of the information resources and whether or not the resources were being used at the time of a patient's visit. During 16% of office visits of HIV-infected patients, clinicians viewed some HIV-related information. Forty-four of 70 clinicians looked at drug information (the most popular resource) 347 times (eight times per person). Two thirds of each clinician's use of the information was through a patient's electronic record, and about half of those (or one third of each clinician's u...

Closing the loop of patient care: A clinical trial of computerized discharge medication process

Proceedings / the ... Annual Symposium on Computer Application [sic] in Medical Care. Symposium on Computer Applications in Medical Care

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Perspectives on the Future of Personal Health Records

by Daniel Sands and David Kibbe

Development of a knowledge-based electronic patient record

M.D. computing: computers in medical practice

Development of an Interdisciplinary Critical Care Problem List

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Theater-Style Demonstration: Clinical Computing at the Beth Israel Deaconess Medical Center

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An Integrated Electronic Patient Record at Boston's Beth Israel Hospital

Download

A clinical trial of a knowledge-based medical record

A study of physicians' interaction with text-based and graphical-based electronic patient record systems

Proceedings of 15th IEEE Symposium on Computer-Based Medical Systems (CBMS 2002), 2002

... Nestor J. Rodriguez, Jose A. Borges, Viviam Murillo, Johanna Ortiz, Center for Computing Rese... more

Housestaff use of medical references in ambulatory care

by Daniel Sands and Timothy Loo

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2003

Value of abdominal CT in the emergency department for patients with abdominal pain

European radiology, 2003

Dissemination of electronic patient records using primary care referrals as a vector for change

Studies in health technology and informatics, 2001

Download

A web-based rapid prototyping and clinical conversational system that complements electronic patient record system

Studies in health technology and informatics, 2001

Download

Effects of a knowledge-based electronic patient record in adherence to practice guidelines

M.D. computing : computers in medical practice

1. MD Comput. 1996 Jan-Feb;13(1):55-63. Effects of a knowledge-based electronic patient record in... more

Studying clinician-computer interaction in Web-based systems

Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 2000

Download

Weaving the Web into legacy information systems

Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 2000

Download

Electronic patient-centered communication: managing risks, managing opportunities, managing care

The American journal of managed care, 1999

Online medical records: a decade of experience

Methods of information in medicine, 1999

Download

Making ICU alarms meaningful: a comparison of traditional vs. trend-based algorithms

Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 1999

Download

Re-engineering the process of surgical informed consent

Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 1999

Download

Meeting information needs: analysis of clinicians' use of an HIV database through an electronic medical record

Medinfo. MEDINFO, 1995

Daniel Sands

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