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Many patients do not receive care consistent with best practice. Health informatics interventions often attempt to address this problem by comparing care provided to patients (e.g., from electronic health record data) to quality standards (e.g., described in clinical guidelines) and feeding this information back to clinicians. Traditionally these interventions are delivered at the patient-level as computerized clinical decision support (CDS) or at the population level as audit and feedback (A&F). Both CDS and A&F can improve care for patients but are variably effective; the challenge is to understand how the efficacy can be maximized. Although CDS and A&F are traditionally considered separate approaches, we argue that the systems share common mechanisms, and efficacy may be improved by cross-fertilizing relevant features and concepts. We draw on the Health Informatics and Implementation Science literature to argue that common mechanisms include functions typically associated with the other system, in addition to other features that may prove fruitful for further research. [ABSTRACT FROM AUTHOR]

A method to determine the electron beam energy and an electron audit based on the current IPEM electron Code of Practice has been devised. During the commissioning on the new Varian 2100CD linear accelerator in The Middlesex Hospital, two methods were devised for the determination of electron energy. The first method involves the use of a two-depth method, whereby the ratio of ionisation (presented as a percentage) measured by an ion chamber at two depths in solid water is used to compare against the baseline ionisation depth value for that energy. The second method involves the irradiation of an X-ray film in solid water to obtain a depth dose curve and, hence determine the half value depth and practical range of the electrons. The results showed that the two-depth method has a better accuracy, repeatability, reliability and consistency than the X-ray method. The results for the electron audit showed that electron absolute outputs are obtained from ionisation measurements in solid water, where the energyrange parameters such as practical range and the depth at which ionisation is 50% of that at the maximum for the depth-ionisation curve are determined. [ABSTRACT FROM AUTHOR]

National Clinical Audit (NCA) data are collected from all National Health Service providers in the UK, to measure the quality of care and stimulate quality improvement initatives. As part of a larger study we explored how NHS providers currently collect NCA data and the resources involved. Study results highlight a dependence on manual data entry and use of professional resources, which could be improved by exploring how routine clinical data could be captured more effectively. [ABSTRACT FROM AUTHOR]

Clinical Decision Support systems (CDSS) have reached a fair level of sophistication and have emerged as the popular system of choice for their aid in clinical decision making. These decision support systems are based on rule engines navigate through a repertoire of clinical rules and multitudes of facts to assist a clinical expert to decide on the set of actuations in response to a medical situation. In this paper, we present the design of a scalable architecture for a rule engine based clinical decision system. [ABSTRACT FROM AUTHOR]