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How does paper usage change following the introduction of Computerized Physician Order Entry and the Electronic Medical Record (EMR/CPOE)? To answer that question we analyzed data collected from fourteen sites across the U.S. We found paper in widespread use in all institutions we studied. Analysis revealed psychological, ergonomic, technological, and regulatory reasons for the persistence of paper in an electronic environment. Paper has unique attributes allowing it to fill gaps in information timeliness, availability, and reliability in pursuit of improved patient care. Creative uses have led to "better paper."

This article describes techniques and strategies used to judge the potential applicability of new information management technologies in the clinical setting and to develop specific design recommendations for new features and services. We focus on a project carried out to identify the potential uses of handheld computers (i.e., the Palm Pilot or a small WinCE-based device) in the ambulatory practice setting. We found that the potential for a robust handheld computing device to positively affect the outpatient ambulatory clinical setting is enormous, and that the information derived from the exploratory research project is useful in creating specific design recommendations for further development.

OBJECTIVE: Experts disagree on the parameters to use to identify the "best" serials within a scientific field. The author set out to develop an extension to Dhawan's journal selection model for ranking serials in any scientific field. METHODS: Comparison of three different instantiations of Dhawan's model were used to rank thirty-four biomedical informatics serials. RESULTS: The first instantiation of Dhawan's model identified seven serials and divided them into two groups. The second instantiation of Dhawan's model identified twelve serials and separated them into two groups. Using fuzzy set theory the new extended model produced a rank ordered list of the top twelve biomedical informatics serials. CONCLUSIONS: Use of fuzzy set theory to assign set membership and combine data in Dhawan's journal selection model allows one to: (1) eliminate the need to determine arbitrary cutoff points for inclusion of serials within each of Dhawan's evaluation criteria categories, (2) combine data from disparate sources, and (3) obtain a rank-ordered list of the biomedical informatics serials rather than simply identifying a set of the "top" serials. Such a ranked list provides librarians and researchers alike with the information necessary to help them make their biomedical informatics serial selection decisions based on objective, quantifiable data.

Physician order entry is a key factor in improving the quality of healthcare, while simultaneously reducing its cost. This paper describes an editor, a database, and a run-time system for creating and executing highly customized, user modifiable, order entry templates. The system allows non-programmers to create new order entry templates rapidly. Over the past 18 months, the templates have been used on over 2500 patients to enter over 40,000 separate orders.

Successful implementation of integrated clinical information system requires modification of the institution's long range strategic plans and its personnel's behavior. The changes warrant a concerted effort on the part of many different individuals; this paper describes the role of the Information Architect whose primary functions are to steer the process to fulfill stated objectives and build consensus where divergent forces are at work. The workings of the Architect is presented in context of a unique Middle-Eastern institution currently undergoing automation of clinical information.

The strategic planning process that is part of Vanderbilt University's fast track to IAIMS is evolving based on feedback from the process itself. Led by a committee of VUMC's top management, broad-based sub-committees for administration, education, patient care, and research worked initially on the following strategic issues: identifying key external pressures that constrain and provide opportunities, visioning how VUMC might operate in the future, and establishing a mission and high-level goals for information management. Next steps include identifying the critical mass of function that will prompt daily use of the IAIMS by everyone at VUMC and adding groups to focus on information and technology architectures and developing academic informatics. This manuscript gives detailed, practical information about the evolution of the planning process, committees' responsibilities, working relationships, and lessons learned.

An increasing number of healthcare institutions are in the process of implementing clinical computing systems. The need for an accurate assessment of the clinical, administrative, social, and financial effects of such systems has been recognized. Techniques have been developed to evaluate these effects on the work patterns of healthcare workers including: 1) time-motion analysis, 2) subjective evaluations, 3) review of departmental statistics, 4) personal activity records, and 5) work-sampling. This manuscript reviews these techniques, discusses both positive and negative aspects, and presents a step-by-step description of work-sampling.