Gestão e Tecnologias de Informação
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- O acesso aberto à literatura científica e a plataforma OJSPublication . Sustelo, A; Vardasca, TO século XXI surge associado a uma Internet “rapidíssima” que permite em milésimos de segundos encontrar informação e guardá-la de forma imediata. Além de rentabilizar tempo permite virtualmente estar em diferentes locais ao mesmo tempo.
- EHR adoption in an European environment and public management hospitalPublication . Sousa, CAfter 13 years under private management, Hospital Prof. Fernando da Fonseca (HFF) committed to invest a solid EHR strategic approach aligned with best practices, due to management shift as public management hospital within the NHS network. HFF focused on creating a Clinical Commission for information that could support and lead the change on workflow and mindset of the hospital culture. This team combines the knowledge and experience of multidisciplinary roles, designing a EHR model that fully responds to the needs. Thus ensuring a successful phased implementation which started in the emergency department and was then deployed throughout the rest of the hospital. After three years of project, the hospital has achieved a high level (superior to 85%) of EHR adoption and has proven outcomes in the delivery of quality of care and Social ROI (e.g. direct data interoperability with medical emergency before hospital admission, algorithm implementation to improve organ donor and collection, integration with private clinics for outsourcing auxiliary services, including Lab and radiology prescriptions and results/reports). HFF continues to strongly work on this project and are dedicated to implementing their roadmap with the short term aim of achieving HIMSS Stage 6.
- Estrutura e Governo das TI para a SaúdePublication . Gomes, RNum mercado em crescimento e sempre competitivo, só mesmo as organizações que tiram partido do melhor da informação que utilizam, como base para a decisão, podem beneficiar de lucros e crescer. As instituições que recolhem, manipulam e gerem dados de saúde são responsáveis pela informação sensível que utilizam de tal modo que a devem reconhecer como um recurso valioso que deve ser protegido e utilizado com conveniência. A utilização de um governo para as TI, com base nas melhores práticas da indústria para a gestão e protecção da informação de saúde, são o melhor critério para a preservação da informação contra extravios, exposição ou destruição, mas também para garantir a gestão de continuidade de negócio, minimizando em simultâneo o impacto de incidentes de segurança, e a garantia de consistência nas melhores características de confidencialidade e integridade da informação.
- Excelência da prática clínica evidenciada pelo processo clínico eletrónico: mito ou realidade?Publication . Sousa, CÉ hoje comumente demonstrado num crescendo de literatura especializada, os ganhos diretos e indiretos para a saúde, pelo recurso às tecnologias de informação. Portugal, limitado pelo exíguo mercado, recursos financeiros e dependência da tutela no que refere ao desenvolvimento das TIC em Saúde, vem trilhando um caminho sedimentado de avanços e fracassos, instigando alguma desmotivação e descrença entre os profissionais de saúde, face aos limitados resultados, em oposição a elevadas e justas expectativas, criadas por uma indústria imatura e pela assimetria com outros setores de atividade. Os quais, sendo pioneiros na introdução das TIC em todo o ciclo de suporte operacional e de relação com o cliente, proporcionaram à sociedade mudanças disruptivas, ainda por identificar na saúde. Por outro lado, é possível adotar hoje modelos de maturidade que ajudam a inferir sobre os ganhos em saúde, visando benchmarking e melhoria contínua, tornando mensurável a excelência da prática clínica de uma organização de saúde.
- Explicit design of transfer functions for volume-rendered images by combining histograms, thumbnails, and sketch-based interactionPublication . Lopes, D; Parreira, P; Mendes, A; Pires, V; Paulo, S; Sousa, C; Jorge, JVisual quality of volume rendering for medical imagery strongly depends on the underlying transfer function. Conventional Windows–Icons–Menus–Pointer interfaces typically refer the user to browse a lengthy catalog of predefined transfer functions or to pain-staking refine the transfer function by clicking and dragging several independent handles. To turn the standard design process less difficult and tedious, this paper proposes novel interactions on a sketch-based interface that supports the design of 1D transfer functions via touch gestures to directly control voxel opacity and easily assign colors. User can select different types of transfer function shapes including ramp function, free hand curve drawing, and slider bars similar to those of a mixing table. An assorted array of thumbnails provides an overview of the data when editing the transfer function. User performance is evaluated by comparing the time and effort necessary to complete a number of tests with sketch-based and conventional interfaces. Users were able to more rapidly explore and understand volume data using the sketch-based interface, as the number of design iterations necessary to obtain a desirable transfer function was reduced. In addition, informal evaluation sessions carried out with professionals (two senior radiologists, a general surgeon and two scientific illustrators) provided valuable feedback on how suitable the sketch-based interface is for illustration, patient communication and medical education.
- Imaging Screening of Catastrophic Neurological Events Using a Software Tool: Preliminary ResultsPublication . Fernandes, AP; Gomes, A; Veiga, J; Ermida, D; Vardasca, TBACKGROUND: In Portugal, as in most countries, the most frequent organ donors are brain-dead donors. To answer the increasing need for transplants, donation programs have been implemented. The goal is to recognize virtually all the possible and potential brain-dead donors admitted to hospitals. The aim of this work was to describe preliminary results of a software application designed to identify devastating neurological injury victims who may progress to brain death and can be possible organ donors. METHODS: This was an observational, longitudinal study with retrospective data collection. The software application is an automatic algorithm based on natural language processing for selected keywords/expressions present in the cranio-encephalic computerized tomography (CE CT) scan reports to identify catastrophic neurological situations, with e-mail notification to the Transplant Coordinator (TC). The first 7 months of this application were analyzed and compared with the standard clinical evaluation methodology. RESULTS: The imaging identification tool showed a sensitivity of 77% and a specificity of 66%; predictive positive value (PPV) was 0.8 and predictive negative value (PNV) was 0.7 for the identification of catastrophic neurological events. CONCLUSION: The methodology proposed in this work seems promising in improving the screening efficiency of critical neurological events.
- Manchester triage system version II and resource utilisation in emergency departmentPublication . Santos, A; Freitas, PT; Martins, HEmergency department (ED) triage systems aim to direct the best clinical assistance to those who are in the greatest urgency and guarantee that resources are efficiently applied.The study's purpose was to determine whether the Manchester Triage System (MTS) second version is a useful instrument for determining the risk of hospital admission, intrahospital death and resource utilisation in ED and to compare it with the MTS first version.This was a prospective study of patients that attended the ED at a large hospital. It comprised a total of 25 218 cases that were triaged between 11 July and 13 October 2011. The MTS codes were grouped into two clusters: red and orange into a 'high acuity/priority' (HP) cluster, and yellow, green and blue into a 'low acuity/priority' cluster.The risk of hospital admission in the HP cluster was 4.86 times that of the LP cluster for both admission route and ages. The percentage of patient hospital admission between medical and surgical specialties, in high and low priority clusters, was similar. We found the risk of death in the HP cluster to be 5.58 times that of the risk of the low acuity/priority cluster. The MTS had an inconsistent association relative to the utilisation of x-ray, while it seemed to portray a consistent association between ECG and laboratory utilisation and MTS cluster.There were no differences between medical and surgical specialities risk of admission. This suggests that improvements were made in the second version of MTS, particularly in the discriminators of patients triaged to surgical specialties, because this was not true for the first version of MTS.
- Mobile health platform for pressure ulcer monitoring with electronic health record integration.Publication . Rodrigues, J; Pedro, L; Vardasca, T; Torre-Diez, I; Martins, HPressure ulcers frequently occur in patients with limited mobility, for example, people with advanced age and patients wearing casts or prostheses. Mobile information communication technologies can help implement ulcer care protocols and the monitoring of patients with high risk, thus preventing or improving these conditions. This article presents a mobile pressure ulcer monitoring platform (mULCER), which helps control a patient's ulcer status during all stages of treatment. Beside its stand-alone version, it can be integrated with electronic health record systems as mULCER synchronizes ulcer data with any electronic health record system using HL7 standards. It serves as a tool to integrate nursing care among hospital departments and institutions. mULCER was experimented with in different mobile devices such as LG Optimus One P500, Samsung Galaxy Tab, HTC Magic, Samsung Galaxy S, and Samsung Galaxy i5700, taking into account the user's experience of different screen sizes and processing characteristics