Computers and software
Dictation software
Hospital discharge summaries convey important information on continuing patient care upon release from hospital. These are usually done by voice dictation, and studies have revealed that this can lead to problems in terms of content, accuracy and timeliness. Recently, clinical databases have been used to generate discharge summaries that avoid many of the problems associated with the voice-dictated version. A randomized trial comparing database and dictated summaries at an Ottawa hospital found that they were similar in quality, completeness, organization and timeliness. However, the summaries generated from a clinical database were produced significantly sooner than the traditional, dictated summaries. [CMAJ 1999;160(3):319-26]
E-Psychiatry
Foreseeing e-psychiatry as inevitable in the electronic age, two researchers discuss the difficult issues of liability, reimbursement and privacy using hypothetical email dialogue between patients and psychiatrists. Although physician nonresponse to patient-initiated queries might be most judicious, this may be considered negligent in the troubling case of a patient expressing suicidal intent by email. [CMAJ 1999;161(9):1147-9]
Electronic patient records
The Advisory Council on Health Infostructure released its final report recommending creation of a nationally linked system of electronic medical records. The council, cochaired by Dr. Tom Noseworthy of the University of Alberta, identified four main goals for a new "infostructure" that will use technology to make health information more accessible. "The report is a road map to improved health care for Canadians through the better use of health information and technologies," said Noseworthy.
Although better access to records may provide advantages, particularly in emergency rooms where physicians often don't have ready access patient information, the CMA underscored the need to protect the privacy of all health information in a submission to the advisory council last year. [CMA News 1999;9(3):5]
Furby-friendly
Health Canada researchers have determined that the Furby, a stuffed animal toy with a computer chip inside, is unlikely to interfere with the performance of medical devices.
Responding to concerns raised by biomedical engineers and the media, the researchers tested 13 medical devices for electronic interference from the fuzzy toy. The authors report that the electric and magnetic field strengths generated by the Furby were very small - about 70 times weaker than those from a digital telephone - and therefore pose little risk to the performance of medical devices. [CMAJ 1999;161(8):971]
Internet use
Almost 10% of the CMA's 46,000 member physicians are now using the association's s one-year-old OSLER (Ovid Search: Link to electronic Resources) service (www.cma.ca/osler). The physicians use OSLER to delve into MEDLINE, AIDSLINE, CancerLit and HealthSTAR. In that first year, OSLER users signed on and completed 18,735 searchers and downloaded 164,569 bibliographic records. [CMAJ 1999;160(6):873]
Results from the CMA's 1999 Physician Resource Questionnaire point to a notable increase in the number of physicians who use the Internet, with the proportion rising from 56% in 1998 to 66% in 1999. Of those who do not yet log on, 42% indicated they plan to do so in the coming year. [CMAJ 1999;161(11):1383]
New computerized medical qualifying exam
In the fall of 2000, Canada's new doctors can look forward to writing qualifying exams that take half as long and are offered twice as frequently thanks to a new computerized examination system from the Medical Council of Canada. [CMAJ 1999;161(11):1430]
Quick medical reference as diagnostic tool
How well does computer technology mimic a physician's integration of clinical information? In an assessment of the diagnostic effectiveness of the computer program Quick Medical Reference (QMR), two physicians used abstracted chart data and QMR to derive lists of the most likely diagnoses. The correct diagnosis was obtained in 43% and 36% of the cases. The authors observed that rare diseases were absent from the QMR knowledge base, that in some cases more than 150 diagnoses were suggested and that comorbidities created a challenge for the program. They wonder whether using QMR in an iterative fashion might improve its effectiveness. [CMAJ 1999;161(6):725-8]
