Safe and successful implementation of CPOE for chemotherapy at a children's cancer center.

PubMed

Hoffman, James M; Baker, Donald K; Howard, Scott C; Laver, Joseph H; Shenep, Jerry L

2011-02-01

Computerized prescriber order entry (CPOE) for medications has been implemented in only approximately 1 in 6 United States hospitals, with CPOE for chemotherapy lagging behind that for nonchemotherapy medications. The high risks associated with chemotherapy combined with other aspects of cancer care present unique challenges for the safe and appropriate use of CPOE. This article describes the process for safe and successful implementation of CPOE for chemotherapy at a children's cancer center. A core principle throughout the development and implementation of this system was that it must be as safe (and eventually safer) as existing paper systems and processes. The history of requiring standardized, regimen-specific, preprinted paper order forms served as the foundation for safe implementation of CPOE for chemotherapy. Extensive use of electronic order sets with advanced functionality; formal process redesign and system analysis; automated clinical decision support; and a phased implementation approach were essential strategies for safe implementation of CPOE. With careful planning and adequate resources, CPOE for chemotherapy can be safely implemented.

National trends in safety performance of electronic health record systems in children's hospitals.

PubMed

Chaparro, Juan D; Classen, David C; Danforth, Melissa; Stockwell, David C; Longhurst, Christopher A

2017-03-01

To evaluate the safety of computerized physician order entry (CPOE) and associated clinical decision support (CDS) systems in electronic health record (EHR) systems at pediatric inpatient facilities in the US using the Leapfrog Group's pediatric CPOE evaluation tool. The Leapfrog pediatric CPOE evaluation tool, a previously validated tool to assess the ability of a CPOE system to identify orders that could potentially lead to patient harm, was used to evaluate 41 pediatric hospitals over a 2-year period. Evaluation of the last available test for each institution was performed, assessing performance overall as well as by decision support category (eg, drug-drug, dosing limits). Longitudinal analysis of test performance was also carried out to assess the impact of testing and the overall trend of CPOE performance in pediatric hospitals. Pediatric CPOE systems were able to identify 62% of potential medication errors in the test scenarios, but ranged widely from 23-91% in the institutions tested. The highest scoring categories included drug-allergy interactions, dosing limits (both daily and cumulative), and inappropriate routes of administration. We found that hospitals with longer periods since their CPOE implementation did not have better scores upon initial testing, but after initial testing there was a consistent improvement in testing scores of 4 percentage points per year. Pediatric computerized physician order entry (CPOE) systems on average are able to intercept a majority of potential medication errors, but vary widely among implementations. Prospective and repeated testing using the Leapfrog Group's evaluation tool is associated with improved ability to intercept potential medication errors. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two ‘early adopter’ hospitals

PubMed Central

Cresswell, Kathrin M; Bates, David W; Williams, Robin; Morrison, Zoe; Slee, Ann; Coleman, Jamie; Robertson, Ann; Sheikh, Aziz

2014-01-01

Objective To understand the medium-term consequences of implementing commercially procured computerized physician order entry (CPOE) and clinical decision support (CDS) systems in ‘early adopter’ hospitals. Materials and methods In-depth, qualitative case study in two hospitals using a CPOE or a CDS system for at least 2 years. Both hospitals had implemented commercially available systems. Hospital A had implemented a CPOE system (with basic decision support), whereas hospital B invested additional resources in a CDS system that facilitated order entry but which was integrated with electronic health records and offered more advanced CDS. We used a combination of documentary analysis of the implementation plans, audiorecorded semistructured interviews with system users, and observations of strategic meetings and systems usage. Results We collected 11 documents, conducted 43 interviews, and conducted a total of 21.5 h of observations. We identified three major themes: (1) impacts on individual users, including greater legibility of prescriptions, but also some accounts of increased workloads; (2) the introduction of perceived new safety risks related to accessibility and usability of hardware and software, with users expressing concerns that some problems such as duplicate prescribing were more likely to occur; and (3) realizing organizational benefits through secondary uses of data. Conclusions We identified little difference in the medium-term consequences of a CPOE and a CDS system. It is important that future studies investigate the medium- and longer-term consequences of CPOE and CDS systems in a wider range of hospitals. PMID:24431334

Evaluation and Certification of Computerized Provider Order Entry Systems

PubMed Central

Classen, David C.; Avery, Anthony J.; Bates, David W.

2007-01-01

Computerized physician order entry (CPOE) is an application that is used to electronically write physician orders either in the hospital or in the outpatient setting. It is used in about 15% of U.S. Hospitals and a smaller percentage of ambulatory clinics. It is linked with clinical decision support, which provides much of the value of implementing it. A number of studies have assessed the impact of CPOE with respect to a variety of parameters, including costs of care, medication safety, use of guidelines or protocols, and other measures of the effectiveness or quality of care. Most of these studies have been undertaken at CPOE exemplar sites with homegrown clinical information systems. With the increasing implementation of commercial CPOE systems in various settings of care has come evidence that some implementation approaches may not achieve previously published results or may actually cause new errors or even harm. This has lead to new initiatives to evaluate CPOE systems, which have been undertaken by both vendors and other groups who evaluate vendors, focused on CPOE vendor capabilities and effective approaches to implementation that can achieve benefits seen in published studies. In addition, an electronic health record (EHR) vendor certification process is ongoing under the province of the Certification Commission for Health Information Technology (CCHIT) (which includes CPOE) that will affect the purchase and use of these applications by hospitals and clinics and their participation in public and private health insurance programs. Large employers have also joined this focus by developing flight simulation tools to evaluate the capabilities of these CPOE systems once implemented, potentially linking the results of such programs to reimbursement through pay for performance programs. The increasing role of CPOE systems in health care has invited much more scrutiny about the effectiveness of these systems in actual practice which has the potential to improve their ultimate performance. PMID:17077453

Evaluation and certification of computerized provider order entry systems.

PubMed

Classen, David C; Avery, Anthony J; Bates, David W

2007-01-01

Computerized physician order entry (CPOE) is an application that is used to electronically write physician orders either in the hospital or in the outpatient setting. It is used in about 15% of U.S. Hospitals and a smaller percentage of ambulatory clinics. It is linked with clinical decision support, which provides much of the value of implementing it. A number of studies have assessed the impact of CPOE with respect to a variety of parameters, including costs of care, medication safety, use of guidelines or protocols, and other measures of the effectiveness or quality of care. Most of these studies have been undertaken at CPOE exemplar sites with homegrown clinical information systems. With the increasing implementation of commercial CPOE systems in various settings of care has come evidence that some implementation approaches may not achieve previously published results or may actually cause new errors or even harm. This has lead to new initiatives to evaluate CPOE systems, which have been undertaken by both vendors and other groups who evaluate vendors, focused on CPOE vendor capabilities and effective approaches to implementation that can achieve benefits seen in published studies. In addition, an electronic health record (EHR) vendor certification process is ongoing under the province of the Certification Commission for Health Information Technology (CCHIT) (which includes CPOE) that will affect the purchase and use of these applications by hospitals and clinics and their participation in public and private health insurance programs. Large employers have also joined this focus by developing flight simulation tools to evaluate the capabilities of these CPOE systems once implemented, potentially linking the results of such programs to reimbursement through pay for performance programs. The increasing role of CPOE systems in health care has invited much more scrutiny about the effectiveness of these systems in actual practice which has the potential to improve their ultimate performance.

The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review.

PubMed

Niazkhani, Zahra; Pirnejad, Habibollah; Berg, Marc; Aarts, Jos

2009-01-01

Previous studies have shown the importance of workflow issues in the implementation of CPOE systems and patient safety practices. To understand the impact of CPOE on clinical workflow, we developed a conceptual framework and conducted a literature search for CPOE evaluations between 1990 and June 2007. Fifty-one publications were identified that disclosed mixed effects of CPOE systems. Among the frequently reported workflow advantages were the legible orders, remote accessibility of the systems, and the shorter order turnaround times. Among the frequently reported disadvantages were the time-consuming and problematic user-system interactions, and the enforcement of a predefined relationship between clinical tasks and between providers. Regarding the diversity of findings in the literature, we conclude that more multi-method research is needed to explore CPOE's multidimensional and collective impact on especially collaborative workflow.

Computer-supported weight-based drug infusion concentrations in the neonatal intensive care unit.

PubMed

Giannone, Gay

2005-01-01

This article addresses the development of a computerized provider order entry (CPOE)-embedded solution for weight-based neonatal drug infusion developed during the transition from a legacy CPOE system to a customized application of a neonatal CPOE product during a hospital-wide information system transition. The importance of accurate fluid management in the neonate is reviewed. The process of tailoring the system that eventually resulted in the successful development of a computer application enabling weight-based medication infusion calculation for neonates within the CPOE information system is explored. In addition, the article provides guidelines on how to customize a vendor solution for hospitals with neonatal intensive care unit.

Design and Use of a Joint Order Vocabulary Knowledge Representation Tier in a Multi-tier CPOE Architecture

PubMed Central

Rucker, Donald W.; Steele, Andrew W.; Douglas, Ivor S.; Couderc, Carmela A.; Hardel, Gary G.

2006-01-01

Two major barriers to adoption of computerized physician order entry (CPOE) systems are the initial physician effort to learn the system and ongoing time costs to use the system. These barriers stem from the CPOE system’s need to reformulate physician orders into services that can be electronically communicated to ancillary clinical systems such as pharmacy, nursing, lab or radiology as well as to billing systems. Typical CPOE systems use significant custom user interface programming to match the terms used by physicians to order services as well as the aggregation of those orders into order sets with the underlying orderable services. We describe the design and implementation of a commercial CPOE system that has a formal separate intermediate mapping layer to match physician screen vocabulary and ordering behaviors to underlying services, both individually and in groups, supported by powerful search tools. PMID:17238425

Towards a mLearning training solution to the adoption of a CPOE system.

PubMed

Pakonstantinou, Despoina; Poulymenopoulou, Mikaela; Malamateniou, Flora; Vassilacopoulos, George

2012-01-01

Computerized Physician Order Entry (CPOE) has been introduced as a solution that can fundamentally change the way healthcare is provided, affecting all types of healthcare stakeholders and improving healthcare decisions, patient outcomes, patient safety and efficiency. However, a relatively small proportion of healthcare organizations have implemented CPOE systems, due to its technological complexity and to its low acceptance rate by healthcare professionals who largely disregard the value of CPOE in efficient healthcare delivery. An online training facility embedded within a CPOE service may increase the likelihood of its adoption by healthcare professionals as it offers them guidelines on how to perform each task of the CPOE service. In contrast to CPOE, on the other hand, handheld devices and other mobile technologies have showed an increased adoption rate. This paper considers a CPOE service that can be accessed by authorized healthcare professionals through their mobile devices anytime anywhere, and allows embedded training content, which has been developed through a learning management system (LMS) to be presented to the user automatically upon request.

Computerised Order Entry Systems and Pathology Services - A Synthesis of the Evidence

PubMed Central

Georgiou, Andrew; Westbrook, Johanna I

2006-01-01

Computerised Physician Order Entry (CPOE) systems have been promoted in Australia and internationally for their potential to improve the quality of care. The existing research of the effect of CPOE on pathology laboratories has been variable, pointing to the potential to increase efficiency and effectiveness and contribute to enhancing the quality of patient care on the one hand, while leading to significant disruptions in work organisation with a negative impact on departmental relations on the other hand. In this paper we provide an overview of the research evidence about the impact of CPOE on four areas associated with pathology services; a) efficiency of the ordering process, e.g. test turnaround times, b) effectiveness as measured by test ordering volumes and test order appropriateness, c) quality of care, particularly its effects on patient care and d) work organisation patterns, which can be severely disrupted by CPOE. We discuss the possible ramifications of CPOE and offer three broad, but important recommendations for pathology laboratories, based on our own research experience investigating CPOE implementations over three years. Firstly, pathology laboratories need to be active participants in planning the implementation of CPOE. Secondly, the importance of building a firm organisational foundation for the introduction of the new system that includes openness and responsiveness to feedback. And thirdly, the implementation process needs to be underpinned by a strong commitment to a multi-method evaluation at every stage of the process to be able to measure the impact of the system on work practices and outcomes. PMID:17077878

Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit.

PubMed

Shulman, Rob; Singer, Mervyn; Goldstone, John; Bellingan, Geoff

2005-10-05

The study aimed to compare the impact of computerised physician order entry (CPOE) without decision support with hand-written prescribing (HWP) on the frequency, type and outcome of medication errors (MEs) in the intensive care unit. Details of MEs were collected before, and at several time points after, the change from HWP to CPOE. The study was conducted in a London teaching hospital's 22-bedded general ICU. The sampling periods were 28 weeks before and 2, 10, 25 and 37 weeks after introduction of CPOE. The unit pharmacist prospectively recorded details of MEs and the total number of drugs prescribed daily during the data collection periods, during the course of his normal chart review. The total proportion of MEs was significantly lower with CPOE (117 errors from 2429 prescriptions, 4.8%) than with HWP (69 errors from 1036 prescriptions, 6.7%) (p < 0.04). The proportion of errors reduced with time following the introduction of CPOE (p < 0.001). Two errors with CPOE led to patient harm requiring an increase in length of stay and, if administered, three prescriptions with CPOE could potentially have led to permanent harm or death. Differences in the types of error between systems were noted. There was a reduction in major/moderate patient outcomes with CPOE when non-intercepted and intercepted errors were combined (p = 0.01). The mean baseline APACHE II score did not differ significantly between the HWP and the CPOE periods (19.4 versus 20.0, respectively, p = 0.71). Introduction of CPOE was associated with a reduction in the proportion of MEs and an improvement in the overall patient outcome score (if intercepted errors were included). Moderate and major errors, however, remain a significant concern with CPOE.

User satisfaction with computerized order entry system and its effect on workplace level of stress.

PubMed

Ghahramani, Nasrollah; Lendel, Irina; Haque, Rehan; Sawruk, Kathryn

2009-06-01

To evaluate the impact of Computerized Provider Order Entry (CPOE) on workplace stress and overall job performance, as perceived by medical students, housestaff, attending physicians and nurses, after CPOE implementation at Penn State-Milton S. Hershey Medical Center, an academic tertiary care facility, in 2005. Using an online survey, the authors studied attitudes towards CPOE among 862 health care professionals. The main outcome measures were job performance and perceived stress levels. Statistical analyses were conducted using the Statistical Analytical Software (SAS Inc, Carey, NC). A total of413 respondents completed the entire survey (47.9 % response rate). Respondents in the younger age group were more familiar with the system, used it more frequently, and were more satisfied with it. Interns and residents were the most satisfied groups with the system, while attending physicians expressed the least satisfaction. Attending physicians and fellows found the system least user friendly compared with other groups, and also tended to express more stress and frustration with the system. Participants with previous CPOE experience were more familiar with the system, would use the system more frequently and were more likely to perceive the system as user friendly. User satisfaction with CPOE increases by familiarity and frequent use of the system. Improvement in system characteristics and avoidance of confusing terminology and inconsistent display of data is expected to enhance user satisfaction. Training in the use of CPOE should start early, ideally integrated into medical and nursing school curricula and form a continuous, long-term and user-specific process. This is expected to increase familiarity with the system, reducing stress and leading to improved user satisfaction and to subsequent enhanced safety and efficiency.

Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry.

PubMed

Heffner, John E; Brower, Kathleen; Ellis, Rosemary; Brown, Shirley

2004-07-01

The high cost of computerized physician order entry (CPOE) and physician resistance to standardized care have delayed implementation. An intranet-based order set system can provide some of CPOE's benefits and offer opportunities to acculturate physicians toward standardized care. INTRANET CLINICIAN ORDER FORMS (COF): The COF system at the Medical University of South Carolina (MUSC) allows caregivers to enter and print orders through the intranet at points of care and to access decision support resources. Work on COF began in March 2000 with transfer of 25 MUSC paper-based order set forms to an intranet site. Physician groups developed additional order sets, which number more than 200. Web traffic increased progressively during a 24-month period, peaking at more than 6,400 hits per month to COF. Decision support tools improved compliance with Centers for Medicare & Medicaid Services core indicators. Clinicians demonstrated a willingness to develop and use order sets and decision support tools posted on the COF site. COF provides a low-cost method for preparing caregivers and institutions to adopt CPOE and standardization of care. The educational resources, relevant links to external resources, and communication alerts will all link to CPOE, thereby providing a head start in CPOE implementation.

A usability study of CPOE's medication administration functions: impact on physician-nurse cooperation.

PubMed

Beuscart-Zéphir, Marie Catherine; Pelayo, Sylvia; Degoulet, Patrice; Anceaux, Françoise; Guerlinger, Sandra; Meaux, Jean-Jacques

2004-01-01

Implementation of CPOE systems in Healthcare Institutions has proven efficient in reducing medication errors but it also induces hidden side-effects on Doctor-Nurse cooperation. We propose a usability engineering approach to this problem. An extensive activity analysis of the medication ordering and administration process was performed in several departments of 3 different hospitals. Two of these hospitals are still using paper-based orders, while the 3rd one is in the roll-out phase of medication functions of its CPOE system. We performed a usability assessment of this CPOE system. The usability assessment uncovered usability problems for the entry of medication administration time scheduling by the physician and revealed that the information can be ambiguous for the nurse. The comparison of cooperation models in both situation shows that users tend to adopt a distributed decision making paradigm in the paper-based situation, while the CPOE system supports a centralized decision making process. This analysis can support recommendation for the re-engineering of the Human-Computer Interface.

Medication-related clinical decision support in computerized provider order entry systems: a review.

PubMed

Kuperman, Gilad J; Bobb, Anne; Payne, Thomas H; Avery, Anthony J; Gandhi, Tejal K; Burns, Gerard; Classen, David C; Bates, David W

2007-01-01

While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs. To realize the medication-related benefits of CDS within CPOE, one must overcome significant challenges. Healthcare organizations implementing CPOE must understand what classes of CDS their CPOE systems can support, assure that clinical knowledge underlying their CDS systems is reasonable, and appropriately represent electronic patient data. These issues often influence to what extent an institution will succeed with its CPOE implementation and achieve its desired goals. Medication-related decision support is probably best introduced into healthcare organizations in two stages, basic and advanced. Basic decision support includes drug-allergy checking, basic dosing guidance, formulary decision support, duplicate therapy checking, and drug-drug interaction checking. Advanced decision support includes dosing support for renal insufficiency and geriatric patients, guidance for medication-related laboratory testing, drug-pregnancy checking, and drug-disease contraindication checking. In this paper, the authors outline some of the challenges associated with both basic and advanced decision support and discuss how those challenges might be addressed. The authors conclude with summary recommendations for delivering effective medication-related clinical decision support addressed to healthcare organizations, application and knowledge base vendors, policy makers, and researchers.

Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients.

PubMed

Vermeulen, K M; van Doormaal, J E; Zaal, R J; Mol, P G M; Lenderink, A W; Haaijer-Ruskamp, F M; Kosterink, J G W; van den Bemt, P M L A

2014-08-01

Prescribing medication is an important aspect of almost all in-hospital treatment regimes. Besides their obviously beneficial effects, medicines can also cause adverse drug events (ADE), which increase morbidity, mortality and health care costs. Partially, these ADEs arise from medication errors, e.g. at the prescribing stage. ADEs caused by medication errors are preventable ADEs. Until now, medication ordering was primarily a paper-based process and consequently, it was error prone. Computerized Physician Order Entry, combined with basic Clinical Decision Support System (CPOE/CDSS) is considered to enhance patient safety. Limited information is available on the balance between the health gains and the costs that need to be invested in order to achieve these positive effects. Aim of this study was to study the balance between the effects and costs of CPOE/CDSS compared to the traditional paper-based medication ordering. The economic evaluation was performed alongside a clinical study (interrupted time series design) on the effectiveness of CPOE/CDSS, including a cost minimization and a cost-effectiveness analysis. Data collection took place between 2005 and 2008. Analyses were performed from a hospital perspective. The study was performed in a general teaching hospital and a University Medical Centre on general internal medicine, gastroenterology and geriatric wards. Computerized Physician Order Entry, combined with basic Clinical Decision Support System (CPOE/CDSS) was compared to a traditional paper based system. All costs of both medication ordering systems are based on resources used and time invested. Prices were expressed in Euros (price level 2009). Effectiveness outcomes were medication errors and preventable adverse drug events. During the paper-based prescribing period 592 patients were included, and during the CPOE/CDSS period 603. Total costs of the paper-based system and CPOE/CDSS amounted to €12.37 and €14.91 per patient/day respectively. The Incremental Cost-Effectiveness Ratio (ICER) for medication errors was 3.54 and for preventable adverse drug events 322.70, indicating the extra amount (€) that has to be invested in order to prevent one medication error or one pADE. CPOE with basic CDSS contributes to a decreased risk of preventable harm. Overall, the extra costs of CPOE/CDSS needed to prevent one ME or one pADE seem to be acceptable. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran

PubMed Central

Khammarnia, Mohammad; Sharifian, Roxana; Zand, Farid; Barati, Omid; Keshtkaran, Ali; Sabetian, Golnar; Shahrokh, , Nasim; Setoodezadeh, Fatemeh

2017-01-01

Background: One way to reduce medical errors associated with physician orders is computerized physician order entry (CPOE) software. This study was conducted to compare prescription orders between 2 groups before and after CPOE implementation in a hospital. Methods: We conducted a before-after prospective study in 2 intensive care unit (ICU) wards (as intervention and control wards) in the largest tertiary public hospital in South of Iran during 2014 and 2016. All prescription orders were validated by a clinical pharmacist and an ICU physician. The rates of ordering the errors in medical orders were compared before (manual ordering) and after implementation of the CPOE. A standard checklist was used for data collection. For the data analysis, SPSS Version 21, descriptive statistics, and analytical tests such as McNemar, chi-square, and logistic regression were used. Results: The CPOE significantly decreased 2 types of errors, illegible orders and lack of writing the drug form, in the intervention ward compared to the control ward (p< 0.05); however, the 2 errors increased due to the defect in the CPOE (p< 0.001). The use of CPOE decreased the prescription errors from 19% to 3% (p= 0.001), However, no differences were observed in the control ward (p<0.05). In addition, more errors occurred in the morning shift (p< 0.001). Conclusion: In general, the use of CPOE significantly reduced the prescription errors. Nonetheless, more caution should be exercised in the use of this system, and its deficiencies should be resolved. Furthermore, it is recommended that CPOE be used to improve the quality of delivered services in hospitals. PMID:29445698

The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran.

PubMed

Khammarnia, Mohammad; Sharifian, Roxana; Zand, Farid; Barati, Omid; Keshtkaran, Ali; Sabetian, Golnar; Shahrokh, Nasim; Setoodezadeh, Fatemeh

2017-01-01

Background: One way to reduce medical errors associated with physician orders is computerized physician order entry (CPOE) software. This study was conducted to compare prescription orders between 2 groups before and after CPOE implementation in a hospital. Methods: We conducted a before-after prospective study in 2 intensive care unit (ICU) wards (as intervention and control wards) in the largest tertiary public hospital in South of Iran during 2014 and 2016. All prescription orders were validated by a clinical pharmacist and an ICU physician. The rates of ordering the errors in medical orders were compared before (manual ordering) and after implementation of the CPOE. A standard checklist was used for data collection. For the data analysis, SPSS Version 21, descriptive statistics, and analytical tests such as McNemar, chi-square, and logistic regression were used. Results: The CPOE significantly decreased 2 types of errors, illegible orders and lack of writing the drug form, in the intervention ward compared to the control ward (p< 0.05); however, the 2 errors increased due to the defect in the CPOE (p< 0.001). The use of CPOE decreased the prescription errors from 19% to 3% (p= 0.001), However, no differences were observed in the control ward (p<0.05). In addition, more errors occurred in the morning shift (p< 0.001). Conclusion: In general, the use of CPOE significantly reduced the prescription errors. Nonetheless, more caution should be exercised in the use of this system, and its deficiencies should be resolved. Furthermore, it is recommended that CPOE be used to improve the quality of delivered services in hospitals.

The effect of a computerized prescribing and calculating system on hypo- and hyperglycemias and on prescribing time efficiency in neonatal intensive care patients.

PubMed

Maat, Barbara; Rademaker, Carin M A; Oostveen, Marloes I; Krediet, Tannette G; Egberts, Toine C G; Bollen, Casper W

2013-01-01

Prescribing glucose requires complex calculations because glucose is present in parenteral and enteral nutrition and drug vehicles, making it error prone and contributing to the burden of prescribing errors. Evaluation of the impact of a computerized physician order entry (CPOE) system with clinical decision support (CDS) for glucose control in neonatal intensive care patients (NICU) focusing on hypo- and hyperglycemic episodes and prescribing time efficiency. An interrupted time-series design to examine the effect of CPOE on hypo- and hyperglycemias and a crossover simulation study to examine the influence of CPOE on prescribing time efficiency. NICU patients at risk for glucose imbalance hospitalized at the University Medical Center Utrecht during 2001-2007 were selected. The risks of hypo- and hyperglycemias were expressed as incidences per 100 patient days in consecutive 3-month intervals during 3 years before and after CPOE implementation. To assess prescribing time efficiency, time needed to calculate glucose intake with and without CPOE was measured. No significant difference was found between pre- and post-CPOE mean incidences of hypo- and hyperglycemias per 100 hospital days of neonates at risk in every 3-month period (hypoglycemias, 4.0 [95% confidence interval, 3.2-4.8] pre-CPOE and 3.1 [2.7-3.5] post-CPOE, P = .88; hyperglycemias, 6.0 [4.3-7.7] pre-CPOE and 5.0 [3.7-6.3] post-CPOE, P = .75). CPOE led to a significant time reduction of 16% (1.3 [0.3-2.3] minutes) for simple and 60% (8.6 [5.1-12.1] minutes) for complex calculations. CPOE including a special CDS tool preserved accuracy for calculation and control of glucose intake and increased prescribing time efficiency.

Usability Evaluation at the Point-of-Care: A Method to Identify User Information Needs in CPOE Applications

PubMed Central

Washburn, Jeff; Fiol, Guilherme Del; Rocha, Roberto A.

2006-01-01

Point of care usability evaluation may help identify information needs that occur during the process of providing care. We describe the process of using usability-specific recording software to record Computerized Physician Order Entry (CPOE) ordering sessions on admitted adult and pediatric patients at two urban tertiary hospitals in the Intermountain Healthcare system of hospitals. PMID:17238756

Return on investment for vendor computerized physician order entry in four community hospitals: the importance of decision support.

PubMed

Zimlichman, Eyal; Keohane, Carol; Franz, Calvin; Everett, Wendy L; Seger, Diane L; Yoon, Catherine; Leung, Alexander A; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan E; Bates, David W

2013-07-01

In-hospital adverse events are a major cause of morbidity and mortality and represent a major cost burden to health care systems. A study was conducted to evaluate the return on investment (ROI) for the adoption of vendor-developed computerized physician oder entry (CPOE) systems in four community hospitals in Massachusetts. Of the four hospitals, two were under one management structure and implemented the same vendor-developed CPOE system (Hospital Group A), while the other two were under a second management structure and implemented another vendor-developed CPOE system (Hospital Group B). Cost savings were calculated on the basis of reduction in preventable adverse drug event (ADE) rates as measured previously. ROI, net cash flow, and the breakeven point during a 10-year cost-and-benefit model were calculated. At the time of the study, none of the participating hospitals had implemented more than a rudimentary decision support system together with CPOE. Implementation costs were lower for Hospital Group A than B ($7,130,894 total or $83/admission versus $19,293,379 total or $113/admission, respectively), as were preventable ADE-related avoided costs ($7,937,651 and $16,557,056, respectively). A cost-benefit analysis demonstrated that Hospital Group A had an ROI of 11.3%, breaking even on the investment eight years following implementation. Hospital Group B showed a negative return, with an ROI of -3.1%. Adoption of vendor CPOE systems in community hospitals was associated with a modest ROI at best when applying cost savings attributable to prevention of ADEs only. The modest financial returns can beattributed to the lack of clinical decision support tools.

Assessing the anticipated consequences of Computer-based Provider Order Entry at three community hospitals using an open-ended, semi-structured survey instrument.

PubMed

Sittig, Dean F; Ash, Joan S; Guappone, Ken P; Campbell, Emily M; Dykstra, Richard H

2008-07-01

To determine what "average" clinicians in organizations that were about to implement Computer-based Provider Order Entry (CPOE) were expecting to occur, we conducted an open-ended, semi-structured survey at three community hospitals. We created an open-ended, semi-structured, interview survey template that we customized for each organization. This interview-based survey was designed to be administered orally to clinicians and take approximately 5 min to complete, although clinicians were allowed to discuss as many advantages or disadvantages of the impending system roll-out as they wanted to. Our survey findings did not reveal any overly negative, critical, problematic, or striking sets of concerns. However, from the standpoint of unintended consequences, we found that clinicians were anticipating only a few of the events, emotions, and process changes that are likely to result from CPOE. The results of such an open-ended survey may prove useful in helping CPOE leaders to understand user perceptions and predictions about CPOE, because it can expose issues about which more communication, or discussion, is needed. Using the survey, implementation strategies and management techniques outlined in this paper, any chief information officer (CIO) or chief medical information officer (CMIO) should be able to adequately assess their organization's CPOE readiness, make the necessary mid-course corrections, and be prepared to deal with the currently identified unintended consequences of CPOE should they occur.

Outpatient CPOE orders discontinued due to 'erroneous entry': prospective survey of prescribers' explanations for errors.

PubMed

Hickman, Thu-Trang T; Quist, Arbor Jessica Lauren; Salazar, Alejandra; Amato, Mary G; Wright, Adam; Volk, Lynn A; Bates, David W; Schiff, Gordon

2018-04-01

Computerised prescriber order entry (CPOE) systems users often discontinue medications because the initial order was erroneous. To elucidate error types by querying prescribers about their reasons for discontinuing outpatient medication orders that they had self-identified as erroneous. During a nearly 3 year retrospective data collection period, we identified 57 972 drugs discontinued with the reason 'Error (erroneous entry)." Because chart reviews revealed limited information about these errors, we prospectively studied consecutive, discontinued erroneous orders by querying prescribers in near-real-time to learn more about the erroneous orders. From January 2014 to April 2014, we prospectively emailed prescribers about outpatient drug orders that they had discontinued due to erroneous initial order entry. Of 2 50 806 medication orders in these 4 months, 1133 (0.45%) of these were discontinued due to error. From these 1133, we emailed 542 unique prescribers to ask about their reason(s) for discontinuing these mediation orders in error. We received 312 responses (58% response rate). We categorised these responses using a previously published taxonomy. The top reasons for these discontinued erroneous orders included: medication ordered for wrong patient (27.8%, n=60); wrong drug ordered (18.5%, n=40); and duplicate order placed (14.4%, n=31). Other common discontinued erroneous orders related to drug dosage and formulation (eg, extended release versus not). Oxycodone (3%) was the most frequent drug discontinued error. Drugs are not infrequently discontinued 'in error.' Wrong patient and wrong drug errors constitute the leading types of erroneous prescriptions recognised and discontinued by prescribers. Data regarding erroneous medication entries represent an important source of intelligence about how CPOE systems are functioning and malfunctioning, providing important insights regarding areas for designing CPOE more safely in the future. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effects of computerized prescriber order entry on pharmacy order-processing time.

PubMed

Wietholter, Jon; Sitterson, Susan; Allison, Steven

2009-08-01

The effect of computerized prescriber order entry (CPOE) on the efficiency of medication-order-processing time was evaluated. This study was conducted at a 761-bed, tertiary care hospital. A total of 2988 medication orders were collected and analyzed before (n = 1488) and after CPOE implementation (n = 1500). Data analyzed included the time the prescriber ordered the medication, the time the pharmacy received the order, and the time the order was completed by a pharmacist. The mean order-processing time before CPOE implementation was 115 minutes from prescriber composition to pharmacist verification. After CPOE implementation, the mean order-processing time was reduced to 3 minutes (p < 0.0001). The time that an order was received by the pharmacy to the time it was verified by a pharmacist was reduced from 31 minutes before CPOE implementation to 3 minutes after CPOE implementation (p < 0.0001). The implementation of CPOE reduced the order-processing time (from order composition to verification) by 97%. Additionally, pharmacy-specific order-processing time (from order receipt in the pharmacy to pharmacist verification) was reduced by 90%. This reduction in order-processing time improves patient care by shortening the interval between physician prescribing and medication availability and may allow pharmacists to explore opportunities for enhanced clinical activities that will further positively impact patient care. CPOE implementation reduced the mean pharmacy order-processing time from composition to verification by 97%. After CPOE implementation, a new medication order was verified as appropriate by a pharmacist in three minutes, on average.

Reduction in chemotherapy order errors with computerized physician order entry.

PubMed

Meisenberg, Barry R; Wright, Robert R; Brady-Copertino, Catherine J

2014-01-01

To measure the number and type of errors associated with chemotherapy order composition associated with three sequential methods of ordering: handwritten orders, preprinted orders, and computerized physician order entry (CPOE) embedded in the electronic health record. From 2008 to 2012, a sample of completed chemotherapy orders were reviewed by a pharmacist for the number and type of errors as part of routine performance improvement monitoring. Error frequencies for each of the three distinct methods of composing chemotherapy orders were compared using statistical methods. The rate of problematic order sets-those requiring significant rework for clarification-was reduced from 30.6% with handwritten orders to 12.6% with preprinted orders (preprinted v handwritten, P < .001) to 2.2% with CPOE (preprinted v CPOE, P < .001). The incidence of errors capable of causing harm was reduced from 4.2% with handwritten orders to 1.5% with preprinted orders (preprinted v handwritten, P < .001) to 0.1% with CPOE (CPOE v preprinted, P < .001). The number of problem- and error-containing chemotherapy orders was reduced sequentially by preprinted order sets and then by CPOE. CPOE is associated with low error rates, but it did not eliminate all errors, and the technology can introduce novel types of errors not seen with traditional handwritten or preprinted orders. Vigilance even with CPOE is still required to avoid patient harm.

A detailed description of the implementation of inpatient insulin orders with a commercial electronic health record system.

PubMed

Neinstein, Aaron; MacMaster, Heidemarie Windham; Sullivan, Mary M; Rushakoff, Robert

2014-07-01

In the setting of Meaningful Use laws and professional society guidelines, hospitals are rapidly implementing electronic glycemic management order sets. There are a number of best practices established in the literature for glycemic management protocols and programs. We believe that this is the first published account of the detailed steps to be taken to design, implement, and optimize glycemic management protocols in a commercial computerized provider order entry (CPOE) system. Prior to CPOE implementation, our hospital already had a mature glycemic management program. To transition to CPOE, we underwent the following 4 steps: (1) preparation and requirements gathering, (2) design and build, (3) implementation and dissemination, and (4) optimization. These steps required more than 2 years of coordinated work between physicians, nurses, pharmacists, and programmers. With the move to CPOE, our complex glycemic management order sets were successfully implemented without any significant interruptions in care. With feedback from users, we have continued to refine the order sets, and this remains an ongoing process. Successful implementation of glycemic management protocols in CPOE is dependent on broad stakeholder input and buy-in. When using a commercial CPOE system, there may be limitations of the system, necessitating workarounds. There should be an upfront plan to apply resources for continuous process improvement and optimization after implementation. © 2014 Diabetes Technology Society.

Does user-centred design affect the efficiency, usability and safety of CPOE order sets?

PubMed

Chan, Julie; Shojania, Kaveh G; Easty, Anthony C; Etchells, Edward E

2011-05-01

Application of user-centred design principles to Computerized provider order entry (CPOE) systems may improve task efficiency, usability or safety, but there is limited evaluative research of its impact on CPOE systems. We evaluated the task efficiency, usability, and safety of three order set formats: our hospital's planned CPOE order sets (CPOE Test), computer order sets based on user-centred design principles (User Centred Design), and existing pre-printed paper order sets (Paper). 27 staff physicians, residents and medical students. Sunnybrook Health Sciences Centre, an academic hospital in Toronto, Canada. Methods Participants completed four simulated order set tasks with three order set formats (two CPOE Test tasks, one User Centred Design, and one Paper). Order of presentation of order set formats and tasks was randomized. Users received individual training for the CPOE Test format only. Completion time (efficiency), requests for assistance (usability), and errors in the submitted orders (safety). 27 study participants completed 108 order sets. Mean task times were: User Centred Design format 273 s, Paper format 293 s (p=0.73 compared to UCD format), and CPOE Test format 637 s (p<0.0001 compared to UCD format). Users requested assistance in 31% of the CPOE Test format tasks, whereas no assistance was needed for the other formats (p<0.01). There were no significant differences in number of errors between formats. The User Centred Design format was more efficient and usable than the CPOE Test format even though training was provided for the latter. We conclude that application of user-centred design principles can enhance task efficiency and usability, increasing the likelihood of successful implementation.

Does user-centred design affect the efficiency, usability and safety of CPOE order sets?

PubMed Central

Chan, Julie; Shojania, Kaveh G; Easty, Anthony C

2011-01-01

Background Application of user-centred design principles to Computerized provider order entry (CPOE) systems may improve task efficiency, usability or safety, but there is limited evaluative research of its impact on CPOE systems. Objective We evaluated the task efficiency, usability, and safety of three order set formats: our hospital's planned CPOE order sets (CPOE Test), computer order sets based on user-centred design principles (User Centred Design), and existing pre-printed paper order sets (Paper). Participants 27staff physicians, residents and medical students. Setting Sunnybrook Health Sciences Centre, an academic hospital in Toronto, Canada. Methods Participants completed four simulated order set tasks with three order set formats (two CPOE Test tasks, one User Centred Design, and one Paper). Order of presentation of order set formats and tasks was randomized. Users received individual training for the CPOE Test format only. Main Measures Completion time (efficiency), requests for assistance (usability), and errors in the submitted orders (safety). Results 27 study participants completed 108 order sets. Mean task times were: User Centred Design format 273 s, Paper format 293 s (p=0.73 compared to UCD format), and CPOE Test format 637 s (p<0.0001 compared to UCD format). Users requested assistance in 31% of the CPOE Test format tasks, whereas no assistance was needed for the other formats (p<0.01). There were no significant differences in number of errors between formats. Conclusions The User Centred Design format was more efficient and usable than the CPOE Test format even though training was provided for the latter. We conclude that application of user-centred design principles can enhance task efficiency and usability, increasing the likelihood of successful implementation. PMID:21486886

Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study

PubMed Central

2013-01-01

Background Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE. Methods We used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation. Results Analysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded smoothly when institutions identified and anticipated the consequences of the change. Conclusions The lessons learned in the five domains identified in this study may be useful for other community hospitals embarking on CPOE adoption. PMID:23800211

Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study.

PubMed

Simon, Steven R; Keohane, Carol A; Amato, Mary; Coffey, Michael; Cadet, Bismarck; Zimlichman, Eyal; Bates, David W

2013-06-24

Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE. We used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation. Analysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded smoothly when institutions identified and anticipated the consequences of the change. The lessons learned in the five domains identified in this study may be useful for other community hospitals embarking on CPOE adoption.

Computerized Provider Order Entry Reduces Length of Stay in a Community Hospital

PubMed Central

Peters, K.; Shaha, S.H.

2014-01-01

Summary Objective Does computerized provider order entry (CPOE) improve clinical, cost, and efficiency outcomes as quantified in shortened hospital length of stay (LOS)? Most prior studies were done in university settings with home-grown electronic records, and are now 20 years old. This study asked whether CPOE exerts a downward force on LOS in the current era of HITECH incentives, using a vendor product in a community hospital. Methods The methodology retrospectively evaluated correlation between CPOE and LOS on a perpatient, per-visit basis over 22 consecutive quarters, organized by discipline. All orders from all areas were eligible, except verbals, and medication orders in the emergency department which were not available via CPOE. These results were compared with quarterly case mix indices organized by discipline. Correlational and regression analyses were cross-checked to ensure validity of R-square coefficients, and data were smoothed for ease of display. Standard models were used to calculate the inflection point. Results Gains in CPOE adoption occurred iteratively house-wide, and in each discipline. LOS decreased in a sigmoid shaped curve. The inflection point shows that once CPOE adoption approaches 60%, further lowering of LOS accelerates. Overall there was a 20.2% reduction in LOS correlated with adoption of CPOE. Case mix index increased during the study period showing that reductions in LOS occurred despite increased patient complexity and resource utilization. Conclusions There was a 20.2% reduction in LOS correlated with rising adoption of CPOE. CPOE contributes to improved clinical, cost, and efficiency outcomes as quantified in reduced LOS, over and above other processes introduced to lower LOS. CPOE enabled a reduction in LOS despite an increase in the case mix index during the time frame of this study. PMID:25298809

Physicians Failed to Write Flawless Prescriptions When Computerized Physician Order Entry System Crashed.

PubMed

Hsu, Chia-Chen; Chou, Chia-Lin; Chen, Tzeng-Ji; Ho, Chin-Chin; Lee, Chung-Yuan; Chou, Yueh-Ching

2015-05-01

Clinical care has become increasingly dependent on computerized physician order entry (CPOE) systems. No study has reported the adverse effect of CPOE on physicians' ability to handwrite prescriptions. This study took advantage of an extensive crash of the CPOE system at a large hospital to assess the completeness, legibility, and accuracy of physicians' handwritten prescriptions. The CPOE system had operated at the outpatient department of an academic medical center in Taiwan since 1993. During an unintentional shutdown that lasted 3.5 hours in 2010, physicians were forced to write prescriptions manually. These handwritten prescriptions, together with clinical medical records, were later audited by clinical pharmacists with respect to 16 fields of the patient's, prescriber's, and drug data. A total of 1418 prescriptions with 3805 drug items were handwritten by 114 to 1369 patients. Not a single prescription had all necessary fields filled in. Although the field of age was most frequently omitted (1282 [90.4%] of 1418 prescriptions) among the patient's data, the field of dosage form was most frequently omitted (3480 [91.5%] of 3805 items) among the drug data. In contrast, the scale of illegibility was rather small. The highest percentage reached only 1.5% (n = 57) in the field of drug frequency. Inaccuracies of strength, dose, and drug name were observed in 745 (19.6%), 517 (13.6%), and 435 (11.4%) prescribed drug items, respectively. The unintentional shutdown of a long-running CPOE system revealed that physicians fail to handwrite flawless prescriptions in the digital era. The contingency plans for computer disasters at health care facilities might include preparation of stand-alone e-prescribing software so that the service delay could be kept to the minimum. However, guidance on prescribing should remain an essential part of medical education. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

Implementation of computerized physician order entry in National Guard Hospitals: assessment of critical success factors.

PubMed

Altuwaijri, Majid M; Bahanshal, Abdullah; Almehaid, Mona

2011-09-01

The purpose of this study is to describe the needs, process and experience of implementing a computerized physician order entry (CPOE) system in a leading healthcare organization in Saudi Arabia. The National Guard Health Affairs (NGHA) deployed the CPOE in a pilot department, which was the intensive care unit (ICU) in order to assess its benefits and risks and to test the system. After the CPOE was implemented in the ICU area, a survey was sent to the ICU clinicians to assess their perception on the importance of 32 critical success factors (CSFs) that was acquired from the literature. The project team also had several meetings to gather lessons learned from the pilot project in order to utilize them for the expansion of the project to other NGHA clinics and hospitals. The results of the survey indicated that the selected CSFs, even though they were developed with regard to international settings, are very much applicable for the pilot area. The top three CSFs rated by the survey respondents were: The "before go-live training", the adequate clinical resources during implementation, and the ordering time. After the assessment of the survey and the lessons learned from the pilot project, NGHA decided that the potential benefits of the CPOE are expected to be greater the risks expected. The project was then expanded to cover all NGHA clinics and hospitals in a phased approach. Currently, the project is in its final stages and expected to be completed by the end of 2011. The role of CPOE systems is very important in hospitals in order to reduce medication errors and to improve the quality of care. In spite of their great benefits, many studies suggest that a high percentage of these projects fail. In order to increase the chances of success and due to the fact that CPOE is a clinical system, NGHA implemented the system first in a pilot area in order to test the system without putting patients at risk and to learn from mistakes before expanding the system to other areas. As a result of the pilot project, NGHA developed a list of CSFs to increase the likelihood of project success for the expansion of the system to other clinics and hospitals. The authors recommend a future study for the CPOE implementation to be done that covers the implementation in all the four NGHA hospitals. The results of the study can then be generalized to other hospitals in Saudi Arabia.

Computerized provider order entry systems - Research imperatives and organizational challenges facing pathology services.

PubMed

Georgiou, Andrew; Westbrook, Johanna; Braithwaite, Jeffrey

2010-07-13

Information and communication technologies (ICT) are contributing to major changes taking place in pathology and within health services more generally. In this article, we draw on our research experience for over 7 years investigating the implementation and diffusion of computerized provider order entry (CPOE) systems to articulate some of the key informatics challenges confronting pathology laboratories. The implementation of these systems, with their improved information management and decision support structures, provides the potential for enhancing the role that pathology services play in patient care pathways. Beyond eliminating legibility problems, CPOE systems can also contribute to the efficiency and safety of healthcare, reducing the duplication of test orders and diminishing the risk of misidentification of patient samples and orders. However, despite the enthusiasm for CPOE systems, their diffusion across healthcare settings remains variable and is often beset by implementation problems. Information systems like CPOE may have the ability to integrate work, departments and organizations, but unfortunately, health professionals, departments and organizations do not always want to be integrated in ways that information systems allow. A persistent theme that emerges from the research evidence is that one size does not fit all, and system success or otherwise is reliant on the conditions and circumstances in which they are located. These conditions and circumstances are part of what is negotiated in the complex, messy and challenging area of ICT implementation. The solution is not likely to be simple and easy, but current evidence suggests that a combination of concerted efforts, better research designs, more sophisticated theories and hypotheses as well as more skilled, multidisciplinary research teams, tackling this area of study will bring substantial benefits, improving the effectiveness of pathology services, and, as a direct corollary, the quality of patient care.

The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis

PubMed Central

2014-01-01

Background The Health Information Technology for Economic and Clinical Health (HITECH) Act subsidizes implementation by hospitals of electronic health records with computerized provider order entry (CPOE), which may reduce patient injuries caused by medication errors (preventable adverse drug events, pADEs). Effects on pADEs have not been rigorously quantified, and effects on medication errors have been variable. The objectives of this analysis were to assess the effectiveness of CPOE at reducing pADEs in hospital-related settings, and examine reasons for heterogeneous effects on medication errors. Methods Articles were identified using MEDLINE, Cochrane Library, Econlit, web-based databases, and bibliographies of previous systematic reviews (September 2013). Eligible studies compared CPOE with paper-order entry in acute care hospitals, and examined diverse pADEs or medication errors. Studies on children or with limited event-detection methods were excluded. Two investigators extracted data on events and factors potentially associated with effectiveness. We used random effects models to pool data. Results Sixteen studies addressing medication errors met pooling criteria; six also addressed pADEs. Thirteen studies used pre-post designs. Compared with paper-order entry, CPOE was associated with half as many pADEs (pooled risk ratio (RR) = 0.47, 95% CI 0.31 to 0.71) and medication errors (RR = 0.46, 95% CI 0.35 to 0.60). Regarding reasons for heterogeneous effects on medication errors, five intervention factors and two contextual factors were sufficiently reported to support subgroup analyses or meta-regression. Differences between commercial versus homegrown systems, presence and sophistication of clinical decision support, hospital-wide versus limited implementation, and US versus non-US studies were not significant, nor was timing of publication. Higher baseline rates of medication errors predicted greater reductions (P < 0.001). Other context and implementation variables were seldom reported. Conclusions In hospital-related settings, implementing CPOE is associated with a greater than 50% decline in pADEs, although the studies used weak designs. Decreases in medication errors are similar and robust to variations in important aspects of intervention design and context. This suggests that CPOE implementation, as subsidized under the HITECH Act, may benefit public health. More detailed reporting of the context and process of implementation could shed light on factors associated with greater effectiveness. PMID:24894078

Integrated Clinical Information System Collaboration Project (CPOE)

DTIC Science & Technology

2009-10-01

variation in care, represents an extraordinary opportunity to  positively  impact  current and future quality outcomes.      General  Patient  Outcomes...those of the author(s) and should not be construed as an official Department of the Army position , policy or decision unless so designated by...process for submitting orders. This study examined the impact of the transition from paper order entry to CPOE on patient care by the adoption of

Computerized physician order entry system combined with on-ward pharmacist: analysis of pharmacists' interventions.

PubMed

Bedouch, Pierrick; Tessier, Alexandre; Baudrant, Magalie; Labarere, José; Foroni, Luc; Calop, Jean; Bosson, Jean-Luc; Allenet, Benoît

2012-08-01

To analyse pharmacists' interventions in a setting where a computerized physician order entry system (CPOE) is in use and a pharmacist works on the ward. A prospective cohort study was conducted in seven wards of a French teaching hospital using CPOE along with the presence of a full-time on-ward pharmacy resident. We documented the characteristics of pharmacists' interventions communicated to physicians during the medication order validation process whenever a drug-related problem was identified. Independent predictors of the physician's acceptance of the pharmacist's intervention were assessed using multiple logistic regression analysis. The 448 pharmacists' interventions concerned: non-conformity to guidelines or contraindications (22%), too high doses (19%), drug interactions (15%) and improper administration (15%). The interventions consisted of changes in drug choice (41%), dose adjustment (23%), drug monitoring (19%) and optimization of administration (17%). Interventions were communicated via the CPOE in 57% of cases and 43% orally. The rate of physicians' acceptance was 79.2%. In multivariate analysis, acceptance was significantly associated with the physician's status [higher for residents vs. seniors: OR = 7.23, CI 95 (2.37-22.10), P < 0.01], method of communication [higher for oral vs. computer communication: OR = 12.5, CI 95 (4.16-37.57), P < 0.01] and type of recommendation [higher for drug monitoring vs. drug choice recommendations: OR = 10.32, CI 95 (3.20-33.29), P < 0.01]. When a clinical pharmacist is present on a ward in which a CPOE is in use, the pharmacists' interventions are well accepted by physicians. Specific predictors of the acceptance by physicians emerge, but further research as to the impact of CPOE on pharmacist-physician communication is needed. © 2011 Blackwell Publishing Ltd.

Impact of vendor computerized physician order entry on patients with renal impairment in community hospitals.

PubMed

Leung, Alexander A; Schiff, Gordon; Keohane, Carol; Amato, Mary; Simon, Steven R; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan; Zimlichman, Eyal; Seger, Diane L; Yoon, Catherine; Bates, David W

2013-10-01

Adverse drug events (ADEs) are common among hospitalized patients with renal impairment. To determine whether computerized physician order entry (CPOE) systems with clinical decision support capabilities reduce the frequency of renally related ADEs in hospitals. Quasi-experimental study of 1590 adult patients with renal impairment who were admitted to 5 community hospitals in Massachusetts from January 2005 to September 2010, preimplementation and postimplementation of CPOE. Varying levels of clinical decision support, ranging from basic CPOE only (sites 4 and 5), rudimentary clinical decision support (sites 1 and 2), and advanced clinical decision support (site 3). Primary outcome was the rate of preventable ADEs from nephrotoxic and/or renally cleared medications. Similarly, secondary outcomes were the rates of overall ADEs and potential ADEs. There was a 45% decrease in the rate of preventable ADEs following implementation (8.0/100 vs 4.4/100 admissions; P < 0.01), and the impact was related to the level of decision support. Basic CPOE was not associated with any significant benefit (4.6/100 vs 4.3/100 admissions; P = 0.87). There was a nonsignificant decrease in preventable ADEs with rudimentary clinical decision support (9.1/100 vs 6.4/100 admissions; P = 0.22). However, substantial reduction was seen with advanced clinical decision support (12.4/100 vs 0/100 admissions; P = 0.01). Despite these benefits, a significant increase in potential ADEs was found for all systems (55.5/100 vs 136.8/100 admissions; P < 0.01). Vendor-developed CPOE with advanced clinical decision support can reduce the occurrence of preventable ADEs but may be associated with an increase in potential ADEs. © 2013 Society of Hospital Medicine.

Effectiveness of Provider Education Followed by Computerized Provider Order Entry Alerts in Reducing Inappropriate Red Blood Cell Transfusion.

PubMed

Patel, Vijay M; Rains, Anna W; Clark, Christopher T

2016-01-01

To reduce the rate of inappropriate red blood cell transfusion, a provider education program, followed by alerts in the computerized provider order entry system (CPOE), was established to encourage AABB transfusion guidelines. Metrics were established for nonemergent inpatient transfusions. Service lines with high order volume were targeted with formal education regarding AABB 2012 transfusion guidelines. Transfusion orders were reviewed in real time with email communications sent to ordering providers falling outside of AABB recommendations. After 12 months of provider education, alerts were activated in CPOE. With provider education alone, the incidence of pretransfusion hemoglobin levels greater than 8 g/dL decreased from 16.64% to 6.36%, posttransfusion hemoglobin levels greater than 10 g/dL from 14.03% to 3.78%, and number of nonemergent two-unit red blood cell orders from 45.26% to 22.66%. Red blood cell utilization decreased by 13%. No additional significant reduction in nonemergent two-unit orders was observed with CPOE alerts. Provider education, an effective and low-cost method, should be considered as a first-line method for reducing inappropriate red blood cell transfusion rates in stable adult inpatients. Alerts in the computerized order entry system did not significantly lower the percentage of two-unit red blood cells orders but may help to maintain educational efforts.

Qualitative analysis of vendor discussions on the procurement of Computerised Physician Order Entry and Clinical Decision Support systems in hospitals

PubMed Central

Cresswell, Kathrin M; Lee, Lisa; Slee, Ann; Coleman, Jamie; Bates, David W; Sheikh, Aziz

2015-01-01

Objectives We studied vendor perspectives about potentially transferable lessons for implementing organisations and national strategies surrounding the procurement of Computerised Physician Order Entry (CPOE)/Clinical Decision Support (CDS) systems in English hospitals. Setting Data were collected from digitally audio-recorded discussions from a series of CPOE/CDS vendor round-table discussions held in September 2014 in the UK. Participants Nine participants, representing 6 key vendors operating in the UK, attended. The discussions were transcribed verbatim and thematically analysed. Results Vendors reported a range of challenges surrounding the procurement and contracting processes of CPOE/CDS systems, including hospitals’ inability to adequately assess their own needs and then select a suitable product, rushed procurement and implementation processes that resulted in difficulties in meaningfully engaging with vendors, as well as challenges relating to contracting leading to ambiguities in implementation roles. Consequently, relationships between system vendors and hospitals were often strained, the vendors attributing this to a lack of hospital management's appreciation of the complexities associated with implementation efforts. Future anticipated challenges included issues surrounding the standardisation of data to enable their aggregation across systems for effective secondary uses, and implementation of data exchange with providers outside the hospital. Conclusions Our results indicate that there are significant issues surrounding capacity to procure and optimise CPOE/CDS systems among UK hospitals. There is an urgent need to encourage more synergistic and collaborative working between providers and vendors and for a more centralised support for National Health Service hospitals, which draws on a wider body of experience, including a formalised procurement framework with value-based product specifications. PMID:26503385

Cognitive analysis of physicians' medication ordering activity.

PubMed

Pelayo, Sylvia; Leroy, Nicolas; Guerlinger, Sandra; Degoulet, Patrice; Meaux, Jean-Jacques; Beuscart-Zéphir, Marie-Catherine

2005-01-01

Computerized Physician Order Entry (CPOE) addresses critical functions in healthcare systems. As the name clearly indicates, these systems focus on order entry. With regard to medication orders, such systems generally force physicians to enter exhaustively documented orders. But a cognitive analysis of the physician's medication ordering task shows that order entry is the last (and least) important step of the entire cognitive therapeutic decision making task. We performed a comparative analysis of these complex cognitive tasks in two working environments, computer-based and paper-based. The results showed that information gathering, selection and interpretation are critical cognitive functions to support the therapeutic decision making. Thus the most important requirement from the physician's perspective would be an efficient display of relevant information provided first in the form of a summarized view of the patient's current treatment, followed by in a more detailed focused display of those items pertinent to the current situation. The CPOE system examined obviously failed to provide the physicians this critical summarized view. Following these results, consistent with users' complaints, the Company decided to engage in a significant re-engineering process of their application.

Computerized Orders with Standardized Concentrations Decrease Dispensing Errors of Continuous Infusion Medications for Pediatrics

PubMed Central

Sowan, Azizeh K.; Vaidya, Vinay U.; Soeken, Karen L.; Hilmas, Elora

2010-01-01

OBJECTIVES The use of continuous infusion medications with individualized concentrations may increase the risk for errors in pediatric patients. The objective of this study was to evaluate the effect of computerized prescriber order entry (CPOE) for continuous infusions with standardized concentrations on frequency of pharmacy processing errors. In addition, time to process handwritten versus computerized infusion orders was evaluated and user satisfaction with CPOE as compared to handwritten orders was measured. METHODS Using a crossover design, 10 pharmacists in the pediatric satellite within a university teaching hospital were given test scenarios of handwritten and CPOE order sheets and asked to process infusion orders using the pharmacy system in order to generate infusion labels. Participants were given three groups of orders: five correct handwritten orders, four handwritten orders written with deliberate errors, and five correct CPOE orders. Label errors were analyzed and time to complete the task was recorded. RESULTS Using CPOE orders, participants required less processing time per infusion order (2 min, 5 sec ± 58 sec) compared with time per infusion order in the first handwritten order sheet group (3 min, 7 sec ± 1 min, 20 sec) and the second handwritten order sheet group (3 min, 26 sec ± 1 min, 8 sec), (p<0.01). CPOE eliminated all error types except wrong concentration. With CPOE, 4% of infusions processed contained errors, compared with 26% of the first group of handwritten orders and 45% of the second group of handwritten orders (p<0.03). Pharmacists were more satisfied with CPOE orders when compared with the handwritten method (p=0.0001). CONCLUSIONS CPOE orders saved pharmacists' time and greatly improved the safety of processing continuous infusions, although not all errors were eliminated. pharmacists were overwhelmingly satisfied with the CPOE orders PMID:22477811

The evolution of the market for commercial computerized physician order entry and computerized decision support systems for prescribing.

PubMed

Mozaffar, Hajar; Williams, Robin; Cresswell, Kathrin; Morrison, Zoe; Bates, David W; Sheikh, Aziz

2016-03-01

To understand the evolving market of commercial off-the-shelf Computerized Physician Order Entry (CPOE) and Computerized Decision Support (CDS) applications and its effects on their uptake and implementation in English hospitals. Although CPOE and CDS vendors have been quick to enter the English market, uptake has been slow and uneven. To investigate this, the authors undertook qualitative ethnography of vendors and adopters of hospital CPOE/CDS systems in England. The authors collected data from semi-structured interviews with 11 individuals from 4 vendors, including the 2 most entrenched suppliers, and 6 adopter hospitals, and 21 h of ethnographic observation of 2 user groups, and 1 vendor event. The research and analysis was informed by insights from studies of the evolution of technology fields and the emergence of generic COTS enterprise solutions. Four key themes emerged: (1) adoption of systems that had been developed outside of England, (2) vendors' configuration and customization strategies, (3) localized adopter practices vs generic systems, and (4) unrealistic adopter demands. Evidence for our over-arching finding concerning the current immaturity of the market was derived from vendors' strategies, adopters' reactions to the technology, and policy makers' incomplete insights. The CPOE/CDS market in England is still in an emergent phase. The rapid entrance of diverse products, triggered by federal policy initiatives, has resulted in premature adoption of systems that do not yet adequately meet the needs of hospitals. Vendors and adopters lacked understanding of how to design and implement generic solutions to meet diverse user needs. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effect of closed-loop order processing on the time to initial antimicrobial therapy.

PubMed

Panosh, Nicole; Rew, Richardd; Sharpe, Michelle

2012-08-15

The results of a study comparing the average time to initiation of i.v. antimicrobial therapy with closed-versus open-loop order entry and processing are reported. A retrospective cohort study was performed to compare order-to-administration times for initial doses of i.v. antimicrobials before and after a closed-loop order-processing system including computerized prescriber order entry (CPOE) was implemented at a large medical center. A total of 741 i.v. antimicrobial administrations to adult patients during designated five-month preimplementation and postimplementation study periods were assessed. Drug-use reports generated by the pharmacy database were used to identify order-entry times, and medication administration records were reviewed to determine times of i.v. antimicrobial administration. The mean ± S.D. order-to-administration times before and after the implementation of the CPOE system and closed-loop order processing were 3.18 ± 2.60 and 2.00 ± 1.89 hours, respectively, a reduction of 1.18 hours (p < 0.0001). Closed-loop order processing was associated with significant reductions in the average time to initiation of i.v. therapy in all patient care areas evaluated (cardiology, general medicine, and oncology). The study results suggest that CPOE-based closed-loop order processing can play an important role in achieving compliance with current practice guidelines calling for increased efforts to ensure the prompt initiation of i.v. antimicrobials for severe infections (e.g., sepsis, meningitis). Implementation of a closed-loop order-processing system resulted in a significant decrease in order-to-administration times for i.v. antimicrobial therapy.

Computerized N-acetylcysteine physician order entry by template protocol for acetaminophen toxicity.

PubMed

Thompson, Trevonne M; Lu, Jenny J; Blackwood, Louisa; Leikin, Jerrold B

2011-01-01

Some medication dosing protocols are logistically complex for traditional physician ordering. The use of computerized physician order entry (CPOE) with templates, or order sets, may be useful to reduce medication administration errors. This study evaluated the rate of medication administration errors using CPOE order sets for N-acetylcysteine (NAC) use in treating acetaminophen poisoning. An 18-month retrospective review of computerized inpatient pharmacy records for NAC use was performed. All patients who received NAC for the treatment of acetaminophen poisoning were included. Each record was analyzed to determine the form of NAC given and whether an administration error occurred. In the 82 cases of acetaminophen poisoning in which NAC was given, no medication administration errors were identified. Oral NAC was given in 31 (38%) cases; intravenous NAC was given in 51 (62%) cases. In this retrospective analysis of N-acetylcysteine administration using computerized physician order entry and order sets, no medication administration errors occurred. CPOE is an effective tool in safely executing complicated protocols in an inpatient setting.

The Impact of Order Source Misattribution on Computerized Provider Order Entry (CPOE) Performance Metrics

PubMed Central

Gellert, George A.; Catzoela, Linda; Patel, Lajja; Bruner, Kylynn; Friedman, Felix; Ramirez, Ricardo; Saucedo, Lilliana; Webster, S. Luke; Gillean, John A.

2017-01-01

Background One strategy to foster adoption of computerized provider order entry (CPOE) by physicians is the monthly distribution of a list identifying the number and use rate percentage of orders entered electronically versus on paper by each physician in the facility. Physicians care about CPOE use rate reports because they support the patient safety and quality improvement objectives of CPOE implementation. Certain physician groups are also motivated because they participate in contracted financial and performance arrangements that include incentive payments or financial penalties for meeting (or failing to meet) a specified CPOE use rate target. Misattribution of order sources can hinder accurate measurement of individual physician CPOE use and can thereby undermine providers’ confidence in their reported performance, as well as their motivation to utilize CPOE. Misattribution of order sources also has significant patient safety, quality, and medicolegal implications. Objective This analysis sought to evaluate the magnitude and sources of misattribution among hospitalists with high CPOE use and, if misattribution was found, to formulate strategies to prevent and reduce its recurrence, thereby ensuring the integrity and credibility of individual and facility CPOE use rate reporting. Methods A detailed manual order source review and validation of all orders issued by one hospitalist group at a midsize community hospital was conducted for a one-month study period. Results We found that a small but not dismissible percentage of orders issued by hospitalists—up to 4.18 percent (95 percent confidence interval, 3.84–4.56 percent) per month—were attributed inaccurately. Sources of misattribution by department or function were as follows: nursing, 42 percent; pharmacy, 38 percent; laboratory, 15 percent; unit clerk, 3 percent; and radiology, 2 percent. Order management and protocol were the most common correct order sources that were incorrectly attributed. Conclusion Order source misattribution can negatively affect reported provider CPOE use rates and should be investigated if providers perceive discrepancies between reported rates and their actual performance. Preventive education and communication efforts across departments can help prevent and reduce misattribution. PMID:28566988

Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization.

PubMed

Zuckerberg, Gabriel S; Scott, Andrew V; Wasey, Jack O; Wick, Elizabeth C; Pawlik, Timothy M; Ness, Paul M; Patel, Nishant D; Resar, Linda M S; Frank, Steven M

2015-07-01

Two necessary components of a patient blood management program are education regarding evidence-based transfusion guidelines and computerized provider order entry (CPOE) with clinician decision support (CDS). This study examines changes in red blood cell (RBC) utilization associated with each of these two interventions. We reviewed 5 years of blood utilization data (2009-2013) for 70,118 surgical patients from 10 different specialty services at a tertiary care academic medical center. Three distinct periods were compared: 1) before blood management, 2) education alone, and 3) education plus CPOE. Changes in RBC unit utilization were assessed over the three periods stratified by surgical service. Cost savings were estimated based on RBC acquisition costs. For all surgical services combined, RBC utilization decreased by 16.4% with education alone (p = 0.001) and then changed very little (2.5% increase) after subsequent addition of CPOE (p = 0.64). When we compared the period of education plus CPOE to the pre-blood management period, the overall decrease was 14.3% (p = 0.008; 2102 fewer RBC units/year, or a cost avoidance of $462,440/year). Services with the highest massive transfusion rates (≥10 RBC units) exhibited the least reduction in RBC utilization. Adding CPOE with CDS after a successful education effort to promote evidence-based transfusion practice did not further reduce RBC utilization. These findings suggest that education is an important and effective component of a patient blood management program and that CPOE algorithms may serve to maintain compliance with evidence-based transfusion guidelines. © 2015 AABB.

Principles for a Successful Computerized Physician Order Entry Implementation

PubMed Central

Ash, Joan S.; Fournier, Lara; Stavri, P. Zoë; Dykstra, Richard

2003-01-01

To identify success factors for implementing computerized physician order entry (CPOE), our research team took both a top-down and bottom-up approach and reconciled the results to develop twelve overarching principles to guide implementation. A consensus panel of experts produced ten Considerations with nearly 150 sub-considerations, and a three year project using qualitative methods at multiple successful sites for a grounded theory approach yielded ten general themes with 24 sub-themes. After reconciliation using a meta-matrix approach, twelve Principles, which cluster into groups forming the mnemonic CPOE emerged. Computer technology principles include: temporal concerns; technology and meeting information needs; multidimensional integration; and costs. Personal principles are: value to users and tradeoffs; essential people; and training and support. Organizational principles include: foundational underpinnings; collaborative project management; terms, concepts and connotations; and improvement through evaluation and learning. Finally, Environmental issues include the motivation and context for implementing such systems. PMID:14728129

PHYSICIANS' BELIEFS ABOUT USING EMR AND CPOE: IN PURSUIT OF A CONTEXTUALIZED UNDERSTANDING OF HEALTH IT USE BEHAVIOR

PubMed Central

Holden, Richard J.

2010-01-01

Purpose To identify and describe physicians' beliefs about use of electronic medical records (EMR) and computerized provider order entry (CPOE) for inpatient and outpatient care, to build an understanding of what factors shape information technology (IT) use behavior in the unique context of health care delivery. Methods Semi-structured qualitative research interviews were carried out, following the beliefs elicitation approach. Twenty physicians from two large Midwest US hospitals participated. Physicians were asked questions to elicit beliefs and experiences pertaining to their use of EMR and CPOE. Questions were based on a broad set of behavior-shaping beliefs and the methods commonly used to elicit those beliefs. Results Qualitative analysis revealed numerous themes related to the perceived emotional and instrumental outcomes of EMR and CPOE use; perceived external and personal normative pressure to use those systems; perceived volitional control over use behavior; perceived facilitators and barriers to system use; and perceptions about the systems and how they were implemented. EMR and CPOE were commonly believed to both improve and worsen the ease and quality of personal performance, productivity and efficiency, and patient outcomes. Physicians felt encouraged by employers and others to use the systems but also had personal role-related and moral concerns about doing so. Perceived facilitators and barriers were numerous and had their sources in all aspects of the work system. Conclusion Given the breadth and detail of elicited beliefs, numerous design and policy implications can be identified. Additionally, the findings are a first step toward developing a theory of health IT acceptance and use contextualized to the unique setting of health care. PMID:20071219

Successful Implementation of Clinical Information Technology: Seven Key Lessons from CPOE.

PubMed

Gellert, G A; Hill, V; Bruner, K; Maciaz, G; Saucedo, L; Catzoela, L; Ramirez, R; Jacobs, W J; Nguyen, P; Patel, L; Webster, S L

2015-01-01

To identify and describe the most critical strategic and operational contributors to the successful implementation of clinical information technologies, as deployed within a moderate sized system of U.S. community hospitals. CHRISTUS Health is a multi-state system comprised of more than 350 services and 60 hospitals with over 9 000 physicians. The Santa Rosa region of CHRISTUS Health, located in greater San Antonio, Texas is comprised of three adult community hospital facilities and one Children's hospital each with bed capacities of 142-180. Computerized Patient Order Entry (CPOE) was first implemented in 2012 within a complex market environment. The Santa Rosa region has 2 417 credentialed physicians and 263 mid-level allied health professionals. This report focuses on the seven most valuable strategies deployed by the Health Informatics team in a large four hospital CHRISTUS region to achieve strong CPOE adoption and critical success lessons learned. The findings are placed within the context of the literature describing best practices in health information technology implementation. While the elements described involved discrete de novo process generation to support implementation and operations, collectively they represent the creation of a new customer-centric service culture in our Health Informatics team, which has served as a foundation for ensuring strong clinical information technology adoption beyond CPOE. The seven success factors described are not limited in their value to and impact on CPOE adoption, but generalize to - and can advance success in - varied other clinical information technology implementations across diverse hospitals. A number of these factors are supported by reports in the literature of other institutions' successful implementations of CPOE and other clinical information technologies, and while not prescriptive to other settings, may be adapted to yield value elsewhere.

Quality Assessment of Process Measures in Antimicrobial Stewardship: Concordance of Valacyclovir Indication and Automatic Prospective Approval in Computerized Provider Order Entry

PubMed Central

Lee, Tiffany; McCoy, Christopher; Mahoney, Monica V

2017-01-01

Abstract Background The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) recommend computerized decision support at the time of prescribing as an antimicrobial stewardship (AST) tool. Providing antimicrobial indications during prescribing can optimize infection-specific therapy through appropriate antimicrobial selection, dosing, and frequency. The Leapfrog group identifies this as a quality measure for their report card system. At Beth Israel Deaconess Medical Center (BIDMC), indication-based dosing has been incorporated in the computerized provider order entry (CPOE) system since 2006. At BIDMC, valacyclovir is only approved for the treatment of varicella zoster (VZV) infection or prophylaxis of solid organ transplant (SOT) patients at low risk for cytomegalovirus. These indications bypass the need for AST approval. Accuracy validation of the selected indications has not been formally performed. Methods A retrospective chart review was performed in patients prescribed valacyclovir during an 8-month period in 2016. Electronic medical records, laboratory reports, and pharmacy records were reviewed to identify the suspected/confirmed infection. The primary outcome was the concordance rate of selected CPOE valacyclovir indication compared with suspected/confirmed infection at the time of ordering. The secondary outcome was the proportion of valacyclovir use per institutional protocol. Results Overall, 117 patients were included, with a median age of 57.9 years, 51 (43.6%) were male, and 4 (3.4%) were located in an intensive care unit. Fifty-nine orders (50.4%) selected VZV as the indication, followed by 21 orders (17.9%) for SOT prophylaxis. Of orders with any CPOE indication, only 59/101 (58.4%) were concordant with suspected/confirmed infection. Of the valacyclovir orders with a VZV indication, 37 (62.7%) were concordant. Of the orders with SOT prophylaxis indications, 5 (23.8%) were concordant. Furthermore, only 46 orders (39.3%) were per BIDMC-protocol. Conclusion Concordance of CPOE indication selection and suspected/confirmed infection for valacyclovir was low. Using CPOE to grant automatic prospective approval must be monitored and audited for accuracy if employed as an AST tool. Disclosures All authors: No reported disclosures.

Relationship between medication event rates and the Leapfrog computerized physician order entry evaluation tool.

PubMed

Leung, Alexander A; Keohane, Carol; Lipsitz, Stuart; Zimlichman, Eyal; Amato, Mary; Simon, Steven R; Coffey, Michael; Kaufman, Nathan; Cadet, Bismarck; Schiff, Gordon; Seger, Diane L; Bates, David W

2013-06-01

The Leapfrog CPOE evaluation tool has been promoted as a means of monitoring computerized physician order entry (CPOE). We sought to determine the relationship between Leapfrog scores and the rates of preventable adverse drug events (ADE) and potential ADE. A cross-sectional study of 1000 adult admissions in five community hospitals from October 1, 2008 to September 30, 2010 was performed. Observed rates of preventable ADE and potential ADE were compared with scores reported by the Leapfrog CPOE evaluation tool. The primary outcome was the rate of preventable ADE and the secondary outcome was the composite rate of preventable ADE and potential ADE. Leapfrog performance scores were highly related to the primary outcome. A 43% relative reduction in the rate of preventable ADE was predicted for every 5% increase in Leapfrog scores (rate ratio 0.57; 95% CI 0.37 to 0.88). In absolute terms, four fewer preventable ADE per 100 admissions were predicted for every 5% increase in overall Leapfrog scores (rate difference -4.2; 95% CI -7.4 to -1.1). A statistically significant relationship between Leapfrog scores and the secondary outcome, however, was not detected. Our findings support the use of the Leapfrog tool as a means of evaluating and monitoring CPOE performance after implementation, as addressed by current certification standards. Scores from the Leapfrog CPOE evaluation tool closely relate to actual rates of preventable ADE. Leapfrog testing may alert providers to potential vulnerabilities and highlight areas for further improvement.

Prescription errors before and after introduction of electronic medication alert system in a pediatric emergency department.

PubMed

Sethuraman, Usha; Kannikeswaran, Nirupama; Murray, Kyle P; Zidan, Marwan A; Chamberlain, James M

2015-06-01

Prescription errors occur frequently in pediatric emergency departments (PEDs).The effect of computerized physician order entry (CPOE) with electronic medication alert system (EMAS) on these is unknown. The objective was to compare prescription errors rates before and after introduction of CPOE with EMAS in a PED. The hypothesis was that CPOE with EMAS would significantly reduce the rate and severity of prescription errors in the PED. A prospective comparison of a sample of outpatient, medication prescriptions 5 months before and after CPOE with EMAS implementation (7,268 before and 7,292 after) was performed. Error types and rates, alert types and significance, and physician response were noted. Medication errors were deemed significant if there was a potential to cause life-threatening injury, failure of therapy, or an adverse drug effect. There was a significant reduction in the errors per 100 prescriptions (10.4 before vs. 7.3 after; absolute risk reduction = 3.1, 95% confidence interval [CI] = 2.2 to 4.0). Drug dosing error rates decreased from 8 to 5.4 per 100 (absolute risk reduction = 2.6, 95% CI = 1.8 to 3.4). Alerts were generated for 29.6% of prescriptions, with 45% involving drug dose range checking. The sensitivity of CPOE with EMAS in identifying errors in prescriptions was 45.1% (95% CI = 40.8% to 49.6%), and the specificity was 57% (95% CI = 55.6% to 58.5%). Prescribers modified 20% of the dosing alerts, resulting in the error not reaching the patient. Conversely, 11% of true dosing alerts for medication errors were overridden by the prescribers: 88 (11.3%) resulted in medication errors, and 684 (88.6%) were false-positive alerts. A CPOE with EMAS was associated with a decrease in overall prescription errors in our PED. Further system refinements are required to reduce the high false-positive alert rates. © 2015 by the Society for Academic Emergency Medicine.

Safe use of electronic health records and health information technology systems: trust but verify.

PubMed

Denham, Charles R; Classen, David C; Swenson, Stephen J; Henderson, Michael J; Zeltner, Thomas; Bates, David W

2013-12-01

We will provide a context to health information technology systems (HIT) safety hazards discussions, describe how electronic health record-computer prescriber order entry (EHR-CPOE) simulation has already identified unrecognized hazards in HIT on a national scale, helping make EHR-CPOE systems safer, and we make the case for all stakeholders to leverage proven methods and teams in HIT performance verification. A national poll of safety, quality improvement, and health-care administrative leaders identified health information technology safety as the hazard of greatest concern for 2013. Quality, HIT, and safety leaders are very concerned about technology performance risks as addressed in the Health Information Technology and Patient Safety report of the Institute of Medicine; and these are being addressed by the Office of the National Coordinator of HIT of the U.S. Dept. of Human Services in their proposed plans. We describe the evolution of postdeployment testing of HIT performance, including the results of national deployment of Texas Medical Institute of Technology's electronic health record computer prescriber order entry (TMIT EHR-CPOE) Flight Simulator verification test that is addressed in these 2 reports, and the safety hazards of concern to leaders. A global webinar for health-care leaders addressed the top patient safety hazards in the areas of leadership, practices, and technologies. A poll of 76 of the 221 organizations participating in the webinar revealed that HIT hazards were the participants' greatest concern of all 30 hazards presented. Of those polled, 89% rated HIT patient/data mismatches in EHRs and HIT systems as a 9 or 10 on a scale of 1 to 10 as a hazard of great concern. Review of a key study of postdeployment testing of the safety performance of operational EHR systems with CPOE implemented in 62 hospitals, using the TMIT EHR-CPOE simulation tool, showed that only 53% of the medication orders that could have resulted in fatalities were detected. The study also showed significant variability in the performance of specific EHR vendor systems, with the same vendor product scoring as high as a 75% detection score in one health-care organization, and the same vendor system scoring below 10% in another health-care organization. HIT safety hazards should be taken very seriously, and the need for proven, robust, and regular postdeployment performance verification measurement of EHR system operations in every health-care organization is critical to ensure that these systems are safe for every patient. The TMIT EHR-CPOE flight simulator is a well-tested and scalable tool that can be used to identify performance gaps in EHR and other HIT systems. It is critical that suppliers, providers, and purchasers of health-care partner with HIT stakeholders and leverage the existing body of work, as well as expert teams and collaborative networks to make care safer; and public-private partnerships to accelerate safety in HIT. A global collaborative is already underway incorporating a "trust but verify" philosophy.

Incorporating medication indications into the prescribing process.

PubMed

Kron, Kevin; Myers, Sara; Volk, Lynn; Nathan, Aaron; Neri, Pamela; Salazar, Alejandra; Amato, Mary G; Wright, Adam; Karmiy, Sam; McCord, Sarah; Seoane-Vazquez, Enrique; Eguale, Tewodros; Rodriguez-Monguio, Rosa; Bates, David W; Schiff, Gordon

2018-04-19

The incorporation of medication indications into the prescribing process to improve patient safety is discussed. Currently, most prescriptions lack a key piece of information needed for safe medication use: the patient-specific drug indication. Integrating indications could pave the way for safer prescribing in multiple ways, including avoiding look-alike/sound-alike errors, facilitating selection of drugs of choice, aiding in communication among the healthcare team, bolstering patient understanding and adherence, and organizing medication lists to facilitate medication reconciliation. Although strongly supported by pharmacists, multiple prior attempts to encourage prescribers to include the indication on prescriptions have not been successful. We convened 6 expert panels to consult high-level stakeholders on system design considerations and requirements necessary for building and implementing an indications-based computerized prescriber order-entry (CPOE) system. We summarize our findings from the 6 expert stakeholder panels, including rationale, literature findings, potential benefits, and challenges of incorporating indications into the prescribing process. Based on this stakeholder input, design requirements for a new CPOE interface and workflow have been identified. The emergence of universal electronic prescribing and content knowledge vendors has laid the groundwork for incorporating indications into the CPOE prescribing process. As medication prescribing moves in the direction of inclusion of the indication, it is imperative to design CPOE systems to efficiently and effectively incorporate indications into prescriber workflows and optimize ways this can best be accomplished. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Cloud-based BP system integrated with CPOE improves self-management of the hypertensive patients: A randomized controlled trial.

PubMed

Lee, Peisan; Liu, Ju-Chi; Hsieh, Ming-Hsiung; Hao, Wen-Rui; Tseng, Yuan-Teng; Liu, Shuen-Hsin; Lin, Yung-Kuo; Sung, Li-Chin; Huang, Jen-Hung; Yang, Hung-Yu; Ye, Jong-Shiuan; Zheng, He-Shun; Hsu, Min-Huei; Syed-Abdul, Shabbir; Lu, Richard; Nguyen, Phung-Anh; Iqbal, Usman; Huang, Chih-Wei; Jian, Wen-Shan; Li, Yu-Chuan Jack

2016-08-01

Less than 50% of patients with hypertensive disease manage to maintain their blood pressure (BP) within normal levels. The aim of this study is to evaluate whether cloud BP system integrated with computerized physician order entry (CPOE) can improve BP management as compared with traditional care. A randomized controlled trial done on a random sample of 382 adults recruited from 786 patients who had been diagnosed with hypertension and receiving treatment for hypertension in two district hospitals in the north of Taiwan. Physicians had access to cloud BP data from CPOE. Neither patients nor physicians were blinded to group assignment. The study was conducted over a period of seven months. At baseline, the enrollees were 50% male with a mean (SD) age of 58.18 (10.83) years. The mean sitting BP of both arms was no different. The proportion of patients with BP control at two, four and six months was significantly greater in the intervention group than in the control group. The average capture rates of blood pressure in the intervention group were also significantly higher than the control group in all three check-points. Cloud-based BP system integrated with CPOE at the point of care achieved better BP control compared to traditional care. This system does not require any technical skills and is therefore suitable for every age group. The praise and assurance to the patients from the physicians after reviewing the Cloud BP records positively reinforced both BP measuring and medication adherence behaviors. Copyright © 2016. Published by Elsevier Ireland Ltd.

Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System

PubMed Central

Beccaro, M. A. Del; Villanueva, R.; Knudson, K. M.; Harvey, E. M.; Langle, J. M.; Paul, W.

2010-01-01

Objective We sought to determine the frequency and type of decision support alerts by location and ordering provider role during Computerized Provider Order Entry (CPOE) medication ordering. Using these data we adjusted the decision support tools to reduce the number of alerts. Design Retrospective analyses were performed of dose range checks (DRC), drug-drug interaction and drug-allergy alerts from our electronic medical record. During seven sampling periods (each two weeks long) between April 2006 and October 2008 all alerts in these categories were analyzed. Another audit was performed of all DRC alerts by ordering provider role from November 2008 through January 2009. Medication ordering error counts were obtained from a voluntary error reporting system. Measurement/Results Between April 2006 and October 2008 the percent of medication orders that triggered a dose range alert decreased from 23.9% to 7.4%. The relative risk (RR) for getting an alert was higher at the start of the interventions versus later (RR= 2.40, 95% CI 2.28-2.52; p< 0.0001). The percentage of medication orders that triggered alerts for drug-drug interactions also decreased from 13.5% to 4.8%. The RR for getting a drug interaction alert at the start was 1.63, 95% CI 1.60-1.66; p< 0.0001. Alerts decreased in all clinical areas without an increase in reported medication errors. Conclusion We reduced the quantity of decision support alerts in CPOE using a systematic approach without an increase in reported medication errors PMID:23616845

What do physicians tell laboratories when requesting tests? A multi-method examination of information supplied to the microbiology laboratory before and after the introduction of electronic ordering.

PubMed

Georgiou, Andrew; Prgomet, Mirela; Toouli, George; Callen, Joanne; Westbrook, Johanna

2011-09-01

The provision of relevant clinical information on pathology requests is an important part of facilitating appropriate laboratory utilization and accurate results interpretation and reporting. (1) To determine the quantity and importance of handwritten clinical information provided by physicians to the Microbiology Department of a hospital pathology service; and (2) to examine the impact of a Computerized Provider Order Entry (CPOE) system on the nature of clinical information communication to the laboratory. A multi-method and multi-stage investigation which included: (a) a retrospective audit of all handwritten Microbiology requests received over a 1-month period in the Microbiology Department of a large metropolitan teaching hospital; (b) the administration of a survey to laboratory professionals to investigate the impact of different clinical information on the processing and/or interpretation of tests; (c) an expert panel consisting of medical staff and senior scientists to assess the survey findings and their impact on pathology practice and patient care; and (d) a comparison of the provision and value of clinical information before CPOE, and across 3 years after its implementation. The audit of handwritten requests found that 43% (n=4215) contained patient-related clinical information. The laboratory survey showed that 97% (84/86) of the different types of clinical information provided for wound specimens and 86% (43/50) for stool specimens were shown to have an effect on the processing or interpretation of the specimens by one or more laboratory professionals. The evaluation of the impact of CPOE revealed a significant improvement in the provision of useful clinical information from 2005 to 2008, rising from 90.1% (n=749) to 99.8% (n=915) (p<.0001) for wound specimens and 34% (n=129) to 86% (n=422) (p<.0001) for stool specimens. This study showed that the CPOE system provided an integrated platform to access and exchange valuable patient-related information between physicians and the laboratory. These findings have important implications for helping to inform decisions about the design and structure of CPOE screens and what data entry fields should be designated or made voluntary. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Implementation of a simple electronic transfusion alert system decreases inappropriate ordering of packed red blood cells and plasma in a multi-hospital health care system.

PubMed

Smith, Matthew; Triulzi, Darrell J; Yazer, Mark H; Rollins-Raval, Marian A; Waters, Jonathan H; Raval, Jay S

2014-12-01

Prescriber adherence to institutional blood component ordering guidelines can be low. The goal of this study was to decrease red blood cell (RBC) and plasma orders that did not meet institutional transfusion guidelines by using data within the laboratory information system to trigger alerts in the computerized order entry (CPOE) system at the time of order entry. At 10 hospitals within a regional health care system, discernment rules were created for RBC and plasma orders utilizing transfusion triggers of hemoglobin <8 gm/dl and INR >1.6, respectively, with subsequent alert generation that appears within the CPOE system when a prescriber attempts to order RBCs or plasma on a patient whose antecedent laboratory values do not suggest that a transfusion is indicated. Orders and subsequent alerts were tracked for RBCs and plasma over evaluation periods of 15 and 10 months, respectively, along with the hospital credentials of the ordering health care providers (physician or nurse). Alerts triggered which were heeded remained steady and averaged 11.3% for RBCs and 19.6% for plasma over the evaluation periods. Overall, nurses and physicians canceled statistically identical percentages of alerted RBC (10.9% vs. 11.5%; p = 0.78) and plasma (21.3% vs. 18.7%; p = 0.22) orders. Implementing a simple evidence-based transfusion alert system at the time of order entry decreased non-evidence based transfusion orders by both nurse and physician providers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evaluation of real-time clinical decision support systems for platelet and cryoprecipitate orders.

PubMed

Collins, Ryan A; Triulzi, Darrell J; Waters, Jonathan H; Reddy, Vivek; Yazer, Mark H

2014-01-01

To evaluate cryoprecipitate and platelet ordering practices after the implementation of real-time clinical decision support systems (CDSSs) in a computerized physician order entry (CPOE) system. Uniform platelet and cryoprecipitate transfusion thresholds were implemented at 11 hospitals in a regional health care system with a common CPOE system. Over 6 months, a variety of information was collected on the ordering physicians and the number of alerts generated by the CDSSs when these products were ordered outside of the institutional guidelines. There were 1,889 orders for platelets and 152 orders for cryoprecipitate placed in 6 months. Of these, 1,102 (58.3%) platelet and 74 (48.7%) cryoprecipitate orders triggered an alert. The proportion of orders canceled after an alert was generated ranged from 13.5% to 17.9% for platelets and 0% to 50.0% for cryoprecipitate orders. CDSS alerts reduce, but do not eliminate, platelet and cryoprecipitate transfusions that do not meet institutional guidelines.

A cognitive task analysis of information management strategies in a computerized provider order entry environment.

PubMed

Weir, Charlene R; Nebeker, Jonathan J R; Hicken, Bret L; Campo, Rebecca; Drews, Frank; Lebar, Beth

2007-01-01

Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques. Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers. Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified. Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented. Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system.

Use of Order Sets in Inpatient Computerized Provider Order Entry Systems: A Comparative Analysis of Usage Patterns at Seven Sites

PubMed Central

Wright, Adam; Feblowitz, Joshua C.; Pang, Justine E.; Carpenter, James D.; Krall, Michael A.; Middleton, Blackford; Sittig, Dean F.

2012-01-01

Background Many computerized provider order entry (CPOE) systems include the ability to create electronic order sets: collections of clinically-related orders grouped by purpose. Order sets promise to make CPOE systems more efficient, improve care quality and increase adherence to evidence-based guidelines. However, the development and implementation of order sets can be expensive and time-consuming and limited literature exists about their utilization. Methods Based on analysis of order set usage logs from a diverse purposive sample of seven sites with commercially- and internally-developed inpatient CPOE systems, we developed an original order set classification system. Order sets were categorized across seven non-mutually exclusive axes: admission/discharge/transfer (ADT), perioperative, condition-specific, task-specific, service-specific, convenience, and personal. In addition, 731 unique subtypes were identified within five axes: four in ADT (S=4), three in perioperative, 144 in condition-specific, 513 in task-specific, and 67 in service-specific. Results Order sets (n=1,914) were used a total of 676,142 times at the participating sites during a one-year period. ADT and perioperative order sets accounted for 27.6% and 24.2% of usage respectively. Peripartum/labor, chest pain/Acute Coronary Syndrome/Myocardial Infarction and diabetes order sets accounted for 51.6% of condition-specific usage. Insulin, angiography/angioplasty and arthroplasty order sets accounted for 19.4% of task-specific usage. Emergency/trauma, Obstetrics/Gynecology/Labor Delivery and anesthesia accounted for 32.4% of service-specific usage. Overall, the top 20% of order sets accounted for 90.1% of all usage. Additional salient patterns are identified and described. Conclusion We observed recurrent patterns in order set usage across multiple sites as well as meaningful variations between sites. Vendors and institutional developers should identify high-value order set types through concrete data analysis in order to optimize the resources devoted to development and implementation. PMID:22819199

Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: a mixed methods approach.

PubMed

Devine, Emily Beth; Lee, Chia-Ju; Overby, Casey L; Abernethy, Neil; McCune, Jeannine; Smith, Joe W; Tarczy-Hornoch, Peter

2014-07-01

Pharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption. The study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers. Using a mixed methods approach, we presented seven cardiologists and three oncologists with five hypothetical clinical case scenarios. Each scenario featured a drug for which a gene encoding drug metabolizing enzyme required consideration of dosage adjustment. We used Morae(®) to capture comments and on-screen movements as participants prescribed each drug. In addition to PGx-CDS alerts, 'Infobutton(®)' and 'Evidence' icons provided participants with clinical knowledge resources to aid decision-making. Nine themes emerged. Five suggested minor improvements to the CPOE user interface; two suggested presenting PGx information through PGx-CDS alerts using an 'Infobutton' or 'Evidence' icon. The remaining themes were strong recommendations to provide succinct, relevant guidelines and dosing recommendations of phenotypic information from credible and trustworthy sources; any more information was overwhelming. Participants' median rating of PGx-CDS system usability was 2 on a Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). Usability evaluation results suggest that participants considered PGx information important for improving prescribing decisions; and that they would incorporate PGx-CDS when information is presented in relevant and useful ways. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A Real Time Interface Between a Computerized Physician Order Entry System and the Computerized ICU Medication Administration Record

PubMed Central

Chen, Jeannie; Shabot, M. Michael; LoBue, Mark

2003-01-01

Prior attempts to interface ICU Clinical Information Systems (CIS) to Pharmacy systems have been less than successful. The major problem is that in ICUs, medications frequently have to be administered and charted in the CIS Medication Administration Record (MAR) before pharmacists can enter them into the Pharmacy system. When the Pharmacy system belatedly sends medication orders to the CIS MAR, this may create duplicate entries for medications that ICU nurses have had to enter manually to chart doses actually given. The authors have implemented a real time interface between a Computerized Physician Order Entry (CPOE) system and a CIS operating in ten ICUs that solves this problem. The interface transfers new medication orders including order details and alerts directly to the CIS Medication Administration Record (MAR), where they are immediately available for nurse charting. PMID:14728315

Computerized Provider Order Entry and Health Care Quality on Hospital Level among Pediatric Patients during 2006-2009

ERIC Educational Resources Information Center

Wang, Liya

2016-01-01

This study examined the association between Computerized Physician Order Entry (CPOE) application and healthcare quality in pediatric patients at hospital level. This was a retrospective study among 1,428 hospitals with pediatric setting in Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) and Health Information and…

CPOE in Iran--a viable prospect? Physicians' opinions on using CPOE in an Iranian teaching hospital.

PubMed

Kazemi, Alireza; Ellenius, Johan; Tofighi, Shahram; Salehi, Aref; Eghbalian, Fatemeh; Fors, Uno G

2009-03-01

In recent years, the theory that on-line clinical decision support systems can improve patients' safety among hospitalised individuals has gained greater acceptance. However, the feasibility of implementing such a system in a middle or low-income country has rarely been studied. Understanding the current prescription process and a proper needs assessment of prescribers can act as the key to successful implementation. The aim of this study was to explore physicians' opinions on the current prescription process, and the expected benefits and perceived obstacles to employ Computerised Physician Order Entry in an Iranian teaching hospital. Initially, the interview guideline was developed through focus group discussions with eight experts. Then semi-structured interviews were held with 19 prescribers. After verbatim transcription, inductive thematic analysis was performed on empirical data. Forty hours of on-looker observations were performed in different wards to explore the current prescription process. The current prescription process was identified as a physician-centred, top-down, model, where prescribers were found to mostly rely on their memories as well as being overconfident. Some errors may occur during different paper-based registrations, transcriptions and transfers. Physician opinions on Computerised Physician Order Entry were categorised into expected benefits and perceived obstacles. Confidentiality issues, reduction of medication errors and educational benefits were identified as three themes in the expected benefits category. High cost, social and cultural barriers, data entry time and problems with technical support emerged as four themes in the perceived obstacles category. The current prescription process has a high possibility of medication errors. Although there are different barriers confronting the implementation and continuation of Computerised Physician Order Entry in Iranian hospitals, physicians have a willingness to use them if these systems provide significant benefits. A pilot study in a limited setting and a comprehensive analysis of health outcomes and economic indicators should be performed, to assess the merits of introducing Computerised Physician Order Entry with decision support capabilities in Iran.

Current and emerging business models in the health care information technology industry: a view from wall street.

PubMed

Frank, Seth

2003-01-01

When we think about health care IT, we don't just think about clinical automation with the movement to computerized physician order entry (CPOE), but also the need to upgrade legacy financial and administrative systems to interact with clinical systems. Technology acceptance by physicians remains low, and computer use by physicians for data entry and analysis remains minimal. We expect this trend to change, and expect increased automation to represent gradual change. The HCIT space is dynamic, with many opportunities, but also many challenges. The unique nature of the end market buyers, existing business models, and nature of the technology makes this a challenging but dynamic area for equity investment.

A Cognitive Task Analysis of Information Management Strategies in a Computerized Provider Order Entry Environment

PubMed Central

Weir, Charlene R.; Nebeker, Jonathan J.R.; Hicken, Bret L.; Campo, Rebecca; Drews, Frank; LeBar, Beth

2007-01-01

Objective Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques. Design Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers. Measurements Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified. Results Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented. Conclusion Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system. PMID:17068345

Driving out errors through tight integration between software and automation.

PubMed

Reifsteck, Mark; Swanson, Thomas; Dallas, Mary

2006-01-01

A clear case has been made for using clinical IT to improve medication safety, particularly bar-code point-of-care medication administration and computerized practitioner order entry (CPOE) with clinical decision support. The equally important role of automation has been overlooked. When the two are tightly integrated, with pharmacy information serving as a hub, the distinctions between software and automation become blurred. A true end-to-end medication management system drives out errors from the dockside to the bedside. Presbyterian Healthcare Services in Albuquerque has been building such a system since 1999, beginning by automating pharmacy operations to support bar-coded medication administration. Encouraged by those results, it then began layering on software to further support clinician workflow and improve communication, culminating with the deployment of CPOE and clinical decision support. This combination, plus a hard-wired culture of safety, has resulted in a dramatically lower mortality and harm rate that could not have been achieved with a partial solution.

Information Retrieval Performance of Probabilistically Generated, Problem-Specific Computerized Provider Order Entry Pick-Lists: A Pilot Study

PubMed Central

Rothschild, Adam S.; Lehmann, Harold P.

2005-01-01

Objective: The aim of this study was to preliminarily determine the feasibility of probabilistically generating problem-specific computerized provider order entry (CPOE) pick-lists from a database of explicitly linked orders and problems from actual clinical cases. Design: In a pilot retrospective validation, physicians reviewed internal medicine cases consisting of the admission history and physical examination and orders placed using CPOE during the first 24 hours after admission. They created coded problem lists and linked orders from individual cases to the problem for which they were most indicated. Problem-specific order pick-lists were generated by including a given order in a pick-list if the probability of linkage of order and problem (PLOP) equaled or exceeded a specified threshold. PLOP for a given linked order-problem pair was computed as its prevalence among the other cases in the experiment with the given problem. The orders that the reviewer linked to a given problem instance served as the reference standard to evaluate its system-generated pick-list. Measurements: Recall, precision, and length of the pick-lists. Results: Average recall reached a maximum of .67 with a precision of .17 and pick-list length of 31.22 at a PLOP threshold of 0. Average precision reached a maximum of .73 with a recall of .09 and pick-list length of .42 at a PLOP threshold of .9. Recall varied inversely with precision in classic information retrieval behavior. Conclusion: We preliminarily conclude that it is feasible to generate problem-specific CPOE pick-lists probabilistically from a database of explicitly linked orders and problems. Further research is necessary to determine the usefulness of this approach in real-world settings. PMID:15684134

Standard practices for computerized clinical decision support in community hospitals: a national survey

PubMed Central

McCormack, James L; Sittig, Dean F; Wright, Adam; McMullen, Carmit; Bates, David W

2012-01-01

Objective Computerized provider order entry (CPOE) with clinical decision support (CDS) can help hospitals improve care. Little is known about what CDS is presently in use and how it is managed, however, especially in community hospitals. This study sought to address this knowledge gap by identifying standard practices related to CDS in US community hospitals with mature CPOE systems. Materials and Methods Representatives of 34 community hospitals, each of which had over 5 years experience with CPOE, were interviewed to identify standard practices related to CDS. Data were analyzed with a mix of descriptive statistics and qualitative approaches to the identification of patterns, themes and trends. Results This broad sample of community hospitals had robust levels of CDS despite their small size and the independent nature of many of their physician staff members. The hospitals uniformly used medication alerts and order sets, had sophisticated governance procedures for CDS, and employed staff to customize CDS. Discussion The level of customization needed for most CDS before implementation was greater than expected. Customization requires skilled individuals who represent an emerging manpower need at this type of hospital. Conclusion These results bode well for robust diffusion of CDS to similar hospitals in the process of adopting CDS and suggest that national policies to promote CDS use may be successful. PMID:22707744

Optimizing radiologist e-prescribing of CT oral contrast agent using a protocoling portal.

PubMed

Wasser, Elliot J; Galante, Nicholas J; Andriole, Katherine P; Farkas, Cameron; Khorasani, Ramin

2013-12-01

The purpose of this study is to quantify the time expenditure associated with radiologist ordering of CT oral contrast media when using an integrated protocoling portal and to determine radiologists' perceptions of the ordering process. This prospective study was performed at a large academic tertiary care facility. Detailed timing information for CT inpatient oral contrast orders placed via the computerized physician order entry (CPOE) system was gathered over a 14-day period. Analyses evaluated the amount of physician time required for each component of the ordering process. Radiologists' perceptions of the ordering process were assessed by survey. Descriptive statistics and chi-square analysis were performed. A total of 96 oral contrast agent orders were placed by 13 radiologists during the study period. The average time necessary to create a protocol for each case was 40.4 seconds (average range by subject, 20.0-130.0 seconds; SD, 37.1 seconds), and the average total time to create and sign each contrast agent order was 27.2 seconds (range, 10.0-50.0 seconds; SD, 22.4 seconds). Overall, 52.5% (21/40) of survey respondents indicated that radiologist entry of oral contrast agent orders improved patient safety. A minority of respondents (15% [6/40]) indicated that contrast agent order entry was either very or extremely disruptive to workflow. Radiologist e-prescribing of CT oral contrast agents using CPOE can be embedded in a protocol workflow. Integration of health IT tools can help to optimize user acceptance and adoption.

Evaluating the medication process in the context of CPOE use: the significance of working around the system.

PubMed

Niazkhani, Zahra; Pirnejad, Habibollah; van der Sijs, Heleen; Aarts, Jos

2011-07-01

To evaluate the problems experienced after implementing a computerized physician order entry (CPOE) system, their possible root causes, and the responses of providers in order to incorporate the system into daily workflow. A qualitative study in the medication-use process after implementation of a CPOE system in an academic hospital in The Netherlands. Data included 21 interviews with clinical end-users, paper-based and system-generated documents used daily in the process, and educational materials used to train users. The problems in the medication-use process included cognitive overload on physicians and nurses, unmet information needs, miscommunication of orders and ideas, problematic coordination of interrelated tasks between co-working professionals, a potentially faulty administration phase, and suboptimal monitoring of the medication plans. These problems were mainly rooted in the lack of mobile computer devices, the uneasy integration of coexisting electronic and paper-based systems, suboptimal usability of the system, and certain organizational factors with regard to procuring drugs affecting the technology use. Various types of workarounds were used to address the difficulties, including phone calls, taking multiple paper notes, issuing paper-based and verbal orders, double-checking, using other patients' procured drugs or another department's drug supply, and modifying and annotating the printed orders. This study shows how providers are actively involved in working around the interruptions in workflow by bypassing the technology or adapting the work processes. Although certain workarounds help to maintain smooth workflow and/or to ensure patient safety, others may burden providers by necessitating extra time and effort and/or endangering patient safety. It is important that workarounds having a negative nature are recognized and discussed in order to find solutions to mitigate their effects. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Temporal and other factors that influence the time doctors take to prescribe using an electronic prescribing system

PubMed Central

Coleman, Jamie J; Hodson, James; Thomas, Sarah K; Brooks, Hannah L; Ferner, Robin E

2015-01-01

Background A computerized physician order entry (CPOE) system with embedded clinical decision support can reduce medication errors in hospitals, but might increase the time taken to generate orders. Aims We aimed to quantify the effects of temporal (month, day of week, hour of shift) and other factors (grade of doctor, prior experience with the system, alert characteristics, and shift type) on the time taken to generate a prescription order. Setting A large university teaching hospital using a locally developed CPOE system with an extensive audit database. Design We retrospectively analyzed prescription orders from the audit database between August 2011 and July 2012. Results The geometric mean time taken to generate a prescription order within the CPOE system was 11.75 s (95% CI 11.72 to 11.78). Time to prescribe was most affected by the display of high-level (24.59 s (24.43 to 24.76); p<0.001) or previously unseen (18.87 s (18.78 to 18.96); p<0.001) alerts. Prescribers took significantly less time at weekends (11.29 s (11.23 to 11.35)) than on weekdays (11.88 s (11.84 to 11.91); p<0.001), in the first (11.25 s (11.16 to 11.34); p<0.001) and final (11.56 s (11.47 to 11.66); p<0.001) hour of their shifts, and after the first month of using the system. Conclusions The display of alerts, prescribing experience, system familiarity, and environment all affect the time taken to generate a prescription order. Our study reinforces the need for appropriate alerts to be presented to individuals at an appropriate place in the workflow, in order to improve prescribing efficiency. PMID:25074989

Practitioners’ Views on Computerized Drug–Drug Interaction Alerts in the VA System

PubMed Central

Ko, Yu; Abarca, Jacob; Malone, Daniel C.; Dare, Donna C.; Geraets, Doug; Houranieh, Antoun; Jones, William N.; Nichol, W. Paul; Schepers, Gregory P.; Wilhardt, Michelle

2007-01-01

Objectives To assess Veterans Affairs (VA) prescribers’ and pharmacists’ opinions about computer-generated drug–drug interaction (DDI) alerts and obtain suggestions for improving DDI alerts. Design A mail survey of 725 prescribers and 142 pharmacists from seven VA medical centers across the United States. Measurements A questionnaire asked respondents about their sources of drug and DDI information, satisfaction with the combined inpatient and outpatient computerized prescriber order entry (CPOE) system, attitude toward DDI alerts, and suggestions for improving DDI alerts. Results The overall response rate was 40% (prescribers: 36%; pharmacists: 59%). Both prescribers and pharmacists indicated that the CPOE system had a neutral to positive impact on their jobs. DDI alerts were not viewed as a waste of time and the majority (61%) of prescribers felt that DDI alerts had increased their potential to prescribe safely. However, only 30% of prescribers felt DDI alerts provided them with what they needed most of the time. Both prescribers and pharmacists agreed that DDI alerts should be accompanied by management alternatives (73% and 82%, respectively) and more detailed information (65% and 89%, respectively). When asked about suggestions for improving DDI alerts, prescribers most preferred including management options whereas pharmacists most preferred making it more difficult to override lethal interactions. Prescribers and pharmacists reported primarily relying on electronic references for general drug information (62% and 55%, respectively) and DDI information (51% and 79%, respectively). Conclusion Respondents reported neutral to positive views regarding the effect of CPOE on their jobs. Their opinions suggest DDI alerts are useful but still require additional work to increase their clinical utility. PMID:17068346

CPOE: a clear purpose plus top-notch technical support equals high physician adoption.

PubMed

Birk, Susan

2010-01-01

As with any fundamental change, the transition to computerized physician order entry [CPOE] is not a risk-free endeavor, major questions hover around this facet of the arduous and controversial paper-to-electronic conversion currently preoccupying the healthcare industry: Could physician over-reliance on electronic prompts actually lead to an increase in some types of medical errors? Could automated workstations ultimately hinder safety and the delivery of quality care by diminishing face-to-face communication and nuanced discussions? In an ironic twist, could electronic solutions insidiously leach creativity, intuition and judgment from good medicine by keeping physicians tied to tools that consume their time but do not offer effective clinical decision support?

Computerized Clinical Decision Support: Contributions from 2015

PubMed Central

Bouaud, J.

2016-01-01

Summary Objective To summarize recent research and select the best papers published in 2015 in the field of computerized clinical decision support for the Decision Support section of the IMIA yearbook. Method A literature review was performed by searching two bibliographic databases for papers related to clinical decision support systems (CDSSs) and computerized provider order entry (CPOE) systems. The aim was to identify a list of candidate best papers from the retrieved papers that were then peer-reviewed by external reviewers. A consensus meeting between the two section editors and the IMIA editorial team was finally conducted to conclude in the best paper selection. Results Among the 974 retrieved papers, the entire review process resulted in the selection of four best papers. One paper reports on a CDSS routinely applied in pediatrics for more than 10 years, relying on adaptations of the Arden Syntax. Another paper assessed the acceptability and feasibility of an important CPOE evaluation tool in hospitals outside the US where it was developed. The third paper is a systematic, qualitative review, concerning usability flaws of medication-related alerting functions, providing an important evidence-based, methodological contribution in the domain of CDSS design and development in general. Lastly, the fourth paper describes a study quantifying the effect of a complex, continuous-care, guideline-based CDSS on the correctness and completeness of clinicians’ decisions. Conclusions While there are notable examples of routinely used decision support systems, this 2015 review on CDSSs and CPOE systems still shows that, despite methodological contributions, theoretical frameworks, and prototype developments, these technologies are not yet widely spread (at least with their full functionalities) in routine clinical practice. Further research, testing, evaluation, and training are still needed for these tools to be adopted in clinical practice and, ultimately, illustrate the benefits that they promise. PMID:27830247

Residents' numeric inputting error in computerized physician order entry prescription.

PubMed

Wu, Xue; Wu, Changxu; Zhang, Kan; Wei, Dong

2016-04-01

Computerized physician order entry (CPOE) system with embedded clinical decision support (CDS) can significantly reduce certain types of prescription error. However, prescription errors still occur. Various factors such as the numeric inputting methods in human computer interaction (HCI) produce different error rates and types, but has received relatively little attention. This study aimed to examine the effects of numeric inputting methods and urgency levels on numeric inputting errors of prescription, as well as categorize the types of errors. Thirty residents participated in four prescribing tasks in which two factors were manipulated: numeric inputting methods (numeric row in the main keyboard vs. numeric keypad) and urgency levels (urgent situation vs. non-urgent situation). Multiple aspects of participants' prescribing behavior were measured in sober prescribing situations. The results revealed that in urgent situations, participants were prone to make mistakes when using the numeric row in the main keyboard. With control of performance in the sober prescribing situation, the effects of the input methods disappeared, and urgency was found to play a significant role in the generalized linear model. Most errors were either omission or substitution types, but the proportion of transposition and intrusion error types were significantly higher than that of the previous research. Among numbers 3, 8, and 9, which were the less common digits used in prescription, the error rate was higher, which was a great risk to patient safety. Urgency played a more important role in CPOE numeric typing error-making than typing skills and typing habits. It was recommended that inputting with the numeric keypad had lower error rates in urgent situation. An alternative design could consider increasing the sensitivity of the keys with lower frequency of occurrence and decimals. To improve the usability of CPOE, numeric keyboard design and error detection could benefit from spatial incidence of errors found in this study. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The effect of the electronic medical record on nurses' work.

PubMed

Robles, Jane

2009-01-01

The electronic medical record (EMR) is a workplace reality for most nurses. Its advantages include a single consolidated record for each person; capacity for data interfaces and alerts; improved interdisciplinary communication; and evidence-based decision support. EMRs can add to work complexity, by forcing better documentation of previously unrecorded data and/or because of poor design. Well-designed and well-implemented computerized provider order entry (CPOE) systems can streamline nurses' work. Generational differences in acceptance of and facility with EMRs can be addressed through open, healthy communication.

“Reducing unnecessary testing in a CPOE system through implementation of a targeted CDS intervention”

PubMed Central

2013-01-01

Background We describe and evaluate the development and use of a Clinical Decision Support (CDS) intervention; an alert, in response to an identified medical error of overuse of a diagnostic laboratory test in a Computerized Physician Order Entry (CPOE) system. CPOE with embedded CDS has been shown to improve quality of care and reduce medical errors. CPOE can also improve resource utilization through more appropriate use of laboratory tests and diagnostic studies. Observational studies are necessary in order to understand how these technologies can be successfully employed by healthcare providers. Methods The error was identified by the Test Utilization Committee (TUC) in September, 2008 when they noticed critical care patients were being tested daily, and sometimes twice daily, for B-Type Natriuretic Peptide (BNP). Repeat and/or serial BNP testing is inappropriate for guiding the management of heart failure and may be clinically misleading. The CDS intervention consists of an expert rule that searches the system for a BNP lab value on the patient. If there is a value and the value is within the current hospital stay, an advisory is displayed to the ordering clinician. In order to isolate the impact of this intervention on unnecessary BNP testing we applied multiple regression analysis to the sample of 41,306 patient admissions with at least one BNP test at LVHN between January, 2008 and September, 2011. Results Our regression results suggest the CDS intervention reduced BNP orders by 21% relative to the mean. The financial impact of the rule was also significant. Multiplying by the direct supply cost of $28.04 per test, the intervention saved approximately $92,000 per year. Conclusions The use of alerts has great positive potential to improve care, but should be used judiciously and in the appropriate environment. While these savings may not be generalizable to other interventions, the experience at LVHN suggests that appropriately designed and carefully implemented CDS interventions can have a substantial impact on the efficiency of care provision. PMID:23566021

Electronic Ordering System Improves Postoperative Pain Management After Total Knee or Hip Arthroplasty

PubMed Central

Chiu, T.; Wolfe, S.; Magid, S.

2015-01-01

Summary Objectives The authors investigated the impact of computerized provider order entry (CPOE) on the delivery times of analgesia and subsequent patient outcomes. We hypothesized that patients would report less pain and use less pain medications compared with the previous paper-based system. Methods Two groups of patients after a total hip (THA) or knee arthroplasty (TKA) were retrospectively compared: one comprising 106 patients when the paper-based ordering system was in effect (conventional group), and one comprising 96 patients after CPOE was installed (electronic group). All patients received a regional anaesthetic at surgery (combined spinal-epidural). TKA patients also received a single-injection femoral nerve block. After transfer to the postoperative anaesthesia care unit (PACU), a patient-controlled epidural analgesia (PCEA) infusion was initiated. The following data was collected from the PACU record: time to initiation of analgesia, visual analog scale (VAS) pain scores at initiation of analgesia and hourly for the first postoperative day (POD), volume of pain medication used, length of stay (LOS) in the PACU and the hospital. Results The time to initiation of analgesia from arrival in the PACU was significantly lower in the electronic group compared to the conventional group (24.5 ± 28.3 minutes vs. 51.1 ± 26.2 minutes; mean ± SD, p < 0.001), as were VAS pain scores (0.82 ± 1.08 vs. 1.5 ± 1.52, p < 0.001) and the volume of PCEA needed to control pain (27.9 ± 20.2 ml vs. 34.8 ± 20.3 ml, p = 0.001) at 4 hours postoperatively. PACU LOS and hospital LOS did not significantly differ in the two groups. Conclusions After implementation of CPOE, patients received their postoperative analgesia faster, had less pain, and required less medication. PMID:26448800

[The application of new technologies to hospital pharmacy in Spain].

PubMed

Bermejo Vicedo, T; Pérez Menéndez Conde, C; Alvarez, Ana; Codina, Carlos; Delgado, Olga; Herranz, Ana; Hidalgo Correas, Francisco; Martín, Isabel; Martínez, Julio; Luis Poveda, José; Queralt Gorgas, María; Sanjurjo Sáez, María

2007-01-01

To describe the degree of introduction of new technologies in the medication use process in pharmacy services in Spain. A descriptive study via a survey into the degree of introduction of computer systems for: management, computerized physician order entry (CPOE), automated unit dose drug dispensing, preparation of parenteral nutrition solutions, recording drug administration, pharmaceutical care and foreseen improvements. The survey was sent by electronic mail to the heads of the pharmacy services of 207 hospitals throughout Spain. Response index: 82 hospitals (38.6%). 29 hospitals (36.7%) have a modular management system, 24 (30.4%) an integrated one and 34 (44.9%) a modular-integrated one. CPOE is utilised in 17 (22.4%). According to the size of the hospital, between 17.9 and 26.7% of unit dose dispensing is done online with a management software; between 5.1 and 33.3% of unit dose dispensing is automated. Automation of unit dose dispensing centred in the pharmacy service varies between 10 and 33.3%. Between 13.2 and 35.7% of automated in-ward dispensing systems are utilised. Administration records are kept manually on a computerised sheet at 23 (31.5%) of the hospitals; at 4 (5.4%) on CPOE and 7 (9.5%) online on the integral management programme and 4 (5.4%) on specific nursing softwares. Sixty-three per cent foresee the implementation of improvements in the short to medium term. The introduction of new technologies is being developed in Spain aiming to improve the safety and management of drugs, and there is a trend towards increasing their deployment in the near future. It is hoped that their fomentation could help to bring about process reengineering within pharmacy services in order to increase the time available for devotion to pharmaceutical care.

Towards meaningful medication-related clinical decision support: recommendations for an initial implementation.

PubMed

Phansalkar, S; Wright, A; Kuperman, G J; Vaida, A J; Bobb, A M; Jenders, R A; Payne, T H; Halamka, J; Bloomrosen, M; Bates, D W

2011-01-01

Clinical decision support (CDS) can improve safety, quality, and cost-effectiveness of patient care, especially when implemented in computerized provider order entry (CPOE) applications. Medication-related decision support logic forms a large component of the CDS logic in any CPOE system. However, organizations wishing to implement CDS must either purchase the computable clinical content or develop it themselves. Content provided by vendors does not always meet local expectations. Most organizations lack the resources to customize the clinical content and the expertise to implement it effectively. In this paper, we describe the recommendations of a national expert panel on two basic medication-related CDS areas, specifically, drug-drug interaction (DDI) checking and duplicate therapy checking. The goals of this study were to define a starter set of medication-related alerts that healthcare organizations can implement in their clinical information systems. We also draw on the experiences of diverse institutions to highlight the realities of implementing medication decision support. These findings represent the experiences of institutions with a long history in the domain of medication decision support, and the hope is that this guidance may improve the feasibility and efficiency CDS adoption across healthcare settings.

Duplicate laboratory test reduction using a clinical decision support tool.

PubMed

Procop, Gary W; Yerian, Lisa M; Wyllie, Robert; Harrison, A Marc; Kottke-Marchant, Kandice

2014-05-01

Duplicate laboratory tests that are unwarranted increase unnecessary phlebotomy, which contributes to iatrogenic anemia, decreased patient satisfaction, and increased health care costs. We employed a clinical decision support tool (CDST) to block unnecessary duplicate test orders during the computerized physician order entry (CPOE) process. We assessed laboratory cost savings after 2 years and searched for untoward patient events associated with this intervention. This CDST blocked 11,790 unnecessary duplicate test orders in these 2 years, which resulted in a cost savings of $183,586. There were no untoward effects reported associated with this intervention. The movement to CPOE affords real-time interaction between the laboratory and the physician through CDSTs that signal duplicate orders. These interactions save health care dollars and should also increase patient satisfaction and well-being.

Effectiveness of a real-time clinical decision support system for computerized physician order entry of plasma orders.

PubMed

Yazer, Mark H; Triulzi, Darrell J; Reddy, Vivek; Waters, Jonathan H

2013-12-01

We investigated the effect of implementing adaptive plasma ordering criteria in the computerized physician order entry (CPOE) system, with alerts that were automatically generated if the recipient's antecedent international normalized ratio (INR) did not meet the institutional criteria. In a regional health care system consisting of 11 hospitals using a common CPOE, data on the number of plasma orders and alerts that were generated were collected over a 4-month period before prescribers were required to select an indication for plasma. When adaptive ordering was implemented prescribers had to choose from prepopulated indications for plasma: INR of 1.6 or greater with bleeding, INR of 1.6 or greater before an invasive procedure, therapeutic exchange, massive transfusion, and other. Regardless of the antecedent INR the alert did not trigger if massive transfusion or plasmapheresis was selected. Information on prescribers and recipients was collected during this 5-month period. In the 4-month period before the adaptive alerts were implemented, 42.9% of the plasma orders generated an alert; in the 5-month period thereafter the alert rate was significantly lower at 27.9% (p < 0.0001). The percentage of heeded alerts increased during the adaptive alert period (24.3% vs. 17.1%, respectively, p = 0.004). A significant percentage (45%) of other plasma orders were for periprocedure or bleeding patients whose antecedent INR was less than 1.6. There were significant differences in prescriber specialties among those who ordered plasma using the other indication compared to all plasma orders. Electronic interventions improve compliance with plasma guidelines but as implemented are not sufficient to completely curtail non-evidence-based ordering. © 2013 American Association of Blood Banks.

Using an Evidence-Based Approach to EMR Implementation to Optimize Outcomes and Avoid Unintended Consequences

PubMed Central

Longhurst, Christopher A.; Palma, Jonathan P.; Grisim, Lisa M.; Widen, Eric; Chan, Melanie; Sharek, Paul J.

2013-01-01

Implementation of an electronic medical record (EMR) with computerized physician order entry (CPOE) can provide an important foundation for preventing harm and improving outcomes. Incentivized by the recent economic stimulus initiative, healthcare systems are implementing vendor-based EMR systems at an unprecedented rate. Accumulating evidence suggests that local implementation decisions, rather than the specific EMR product or technology selected, are the primary drivers of the quality improvement performance of these systems. However, limited attention has been paid to effective approaches to EMR implementation. In this case report, we outline the evidence-based approach we used to make EMR implementation decisions in a pragmatic structure intended for replication at other sites. PMID:24771994

Frequency and Severity of Parenteral Nutrition Medication Errors at a Large Children's Hospital After Implementation of Electronic Ordering and Compounding.

PubMed

MacKay, Mark; Anderson, Collin; Boehme, Sabrina; Cash, Jared; Zobell, Jeffery

2016-04-01

The Institute for Safe Medication Practices has stated that parenteral nutrition (PN) is considered a high-risk medication and has the potential of causing harm. Three organizations--American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), American Society of Health-System Pharmacists, and National Advisory Group--have published guidelines for ordering, transcribing, compounding and administering PN. These national organizations have published data on compliance to the guidelines and the risk of errors. The purpose of this article is to compare total compliance with ordering, transcription, compounding, administration, and error rate with a large pediatric institution. A computerized prescriber order entry (CPOE) program was developed that incorporates dosing with soft and hard stop recommendations and simultaneously eliminating the need for paper transcription. A CPOE team prioritized and identified issues, then developed solutions and integrated innovative CPOE and automated compounding device (ACD) technologies and practice changes to minimize opportunities for medication errors in PN prescription, transcription, preparation, and administration. Thirty developmental processes were identified and integrated in the CPOE program, resulting in practices that were compliant with A.S.P.E.N. safety consensus recommendations. Data from 7 years of development and implementation were analyzed and compared with published literature comparing error, harm rates, and cost reductions to determine if our process showed lower error rates compared with national outcomes. The CPOE program developed was in total compliance with the A.S.P.E.N. guidelines for PN. The frequency of PN medication errors at our hospital over the 7 years was 230 errors/84,503 PN prescriptions, or 0.27% compared with national data that determined that 74 of 4730 (1.6%) of prescriptions over 1.5 years were associated with a medication error. Errors were categorized by steps in the PN process: prescribing, transcription, preparation, and administration. There were no transcription errors, and most (95%) errors occurred during administration. We conclude that PN practices that conferred a meaningful cost reduction and a lower error rate (2.7/1000 PN) than reported in the literature (15.6/1000 PN) were ascribed to the development and implementation of practices that conform to national PN guidelines and recommendations. Electronic ordering and compounding programs eliminated all transcription and related opportunities for errors. © 2015 American Society for Parenteral and Enteral Nutrition.

An Analysis of the External Environmental and Internal Organizational Factors Associated with Adoption of the Electronic Health Record

ERIC Educational Resources Information Center

Kruse, Clemens Scott

2013-01-01

Despite a Presidential Order in 2004 that launched national incentives for the use of health information technology, specifically the Electronic Health Record (EHR), adoption of the EHR has been slow. This study attempts to quantify factors associated with adoption of the EHR and Computerized Provider Order Entry (CPOE) by combining multiple…

Review of information technology for surgical patient care.

PubMed

Robinson, Jamie R; Huth, Hannah; Jackson, Gretchen P

2016-06-01

Electronic health records (EHRs), computerized provider order entry (CPOE), and patient portals have experienced increased adoption by health care systems. The objective of this study was to review evidence regarding the impact of such health information technologies (HIT) on surgical practice. A search of Medline, EMBASE, CINAHL, and the Cochrane Library was performed to identify data-driven, nonsurvey studies about the effects of HIT on surgical care. Domain experts were queried for relevant articles. Two authors independently reviewed abstracts for inclusion criteria and analyzed full text of eligible articles. A total of 2890 citations were identified. Of them, 32 observational studies and two randomized controlled trials met eligibility criteria. EHR or CPOE improved appropriate antibiotic administration for surgical procedures in 13 comparative observational studies. Five comparative observational studies indicated that electronically generated operative notes had increased accuracy, completeness, and availability in the medical record. The Internet as an information resource about surgical procedures was generally inadequate. Surgical patients and providers demonstrated rapid adoption of patient portals, with increasing proportions of online versus inperson outpatient surgical encounters. The overall quality of evidence about the effects of HIT in surgical practice was low. Current data suggest an improvement in appropriate perioperative antibiotic administration and accuracy of operative reports from CPOE and EHR applications. Online consumer health educational resources and patient portals are popular among patients and families, but their impact has not been studied well in surgical populations. With increasing adoption of HIT, further research is needed to optimize the efficacy of such tools in surgical care. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of the impact of a CPOE system on nurse-physician communication--a mixed method study.

PubMed

Pirnejad, H; Niazkhani, Z; van der Sijs, H; Berg, M; Bal, R

2009-01-01

To assess the impact of a CPOE system on medication-related communication of nurses and physicians. In six internal medicine wards of an academic medical center, two questionnaires were used to evaluate nurses' attitudes toward the impact of a paper-based medication system and then a CPOE system on their communication in medication-related-activities (medication work). The questionnaires were analyzed using t-tests, followed by Bonferroni correction. Nine nurses and six physicians in the same wards were interviewed after the implementation to determine how their communication and their work have been impacted by the system. The total response rates were 54% and 52% for pre- and post-implementation questionnaires. It was shown that after implementation, the legibility and completeness of prescriptions were significantly improved (P <.001) and the administration system had a more intelligible layout (P <.001), with a more reliable overview (P <.001). The analysis of the interviews supported and confirmed the findings of the surveys. Moreover, they showed communication problems that caused difficulties in integrating medication work of nurses into physicians'. To compensate for these, nurses and physicians devised informal interactions and practices (workarounds), which often represented risks for medication errors. The introduction of CPOE system with paper-based medication administration system improved prescription legibility and completeness but introduced many workflow impediments and as a result error-inducing conditions. In order to prevent such an effect, CPOE systems have to support the level of communication which is necessary to integrate the work of nurses and physicians.

An electronic dashboard to improve nursing care.

PubMed

Tan, Yung-Ming; Hii, Joshua; Chan, Katherine; Sardual, Robert; Mah, Benjamin

2013-01-01

With the introduction of CPOE systems, nurses in a Singapore hospital were facing difficulties monitoring key patient information such as critical tasks and alerts. Issues include unfriendly user interfaces of clinical systems, information overload, and the loss of visual cues for action due to paperless workflows. The hospital decided to implement an interactive electronic dashboard on top of their CPOE system to improve visibility of vital patient data. A post-implementation survey was performed to gather end-user feedback and evaluate factors that influence user satisfaction of the dashboard. Questionnaires were sent to all nurses of five pilot wards. 106 valid responses were received. User adoption was good with 86% of nurses using the dashboard every shift. Mean satisfaction score was 3.6 out of 5. User satisfaction was strongly and positively correlated to the system's perceived impact on work efficiency and care quality. From qualitative feedback, nurses generally agreed that the dashboard had improved their awareness of critical patient issues without the hassle of navigating a CPOE system. This study shows that an interactive clinical dashboard when properly integrated with a CPOE system could be a useful tool to improve daily patient care.

Structured product labeling improves detection of drug-intolerance issues.

PubMed

Schadow, Gunther

2009-01-01

This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. The Regenstrief Institute CPOE drug-intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. The number of drug-intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct intolerances. The difference between drug-intolerance issues detected or missed by either method was qualitatively analyzed. Although <70% of terms were mapped to SPL, the new approach detected four times as many drug-intolerance issues on twice as many patients. The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-intolerance decision support and suggests how terminology and methods of recording drug intolerances could be improved.

Structured Product Labeling Improves Detection of Drug-intolerance Issues

PubMed Central

Schadow, Gunther

2009-01-01

Objectives This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design The Regenstrief Institute CPOE drug-intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements The number of drug-intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct intolerances. The difference between drug-intolerance issues detected or missed by either method was qualitatively analyzed. Results Although <70% of terms were mapped to SPL, the new approach detected four times as many drug-intolerance issues on twice as many patients. Conclusion The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-intolerance decision support and suggests how terminology and methods of recording drug intolerances could be improved. PMID:18952933

The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature.

PubMed

Georgiou, Andrew; Prgomet, Mirela; Paoloni, Richard; Creswick, Nerida; Hordern, Antonia; Walter, Scott; Westbrook, Johanna

2013-06-01

We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED). We searched MEDLINE, EMBASE, Inspec, CINAHL, and CPOE.org for English-language studies published between January 1990 and May 2011. We identified 1,063 articles, of which 22 met our inclusion criteria. Sixteen used a pre/post design; 2 were randomized controlled trials. Twelve studies reported outcomes related to patient flow/clinical work, 7 examined decision support systems, and 6 reported effects on patient safety. There were no studies that measured decision support systems and its effect on patient flow/clinical work. Computerized provider order entry was associated with an increase in time spent on computers (up to 16.2% for nurses and 11.3% for physicians), with no significant change in time spent on patient care. Computerized provider order entry with decision support systems was related to significant decreases in prescribing errors (ranging from 17 to 201 errors per 100 orders), potential adverse drug events (0.9 per 100 orders), and prescribing of excessive dosages (31% decrease for a targeted set of renal disease medications). There are tangible benefits associated with computerized provider order entry/decision support systems in the ED environment. Nevertheless, when considered as part of a framework of technical, clinical, and organizational components of the ED, the evidence base is neither consistent nor comprehensive. Multimethod research approaches (including qualitative research) can contribute to understanding of the multiple dimensions of ED care delivery, not as separate entities but as essential components of a highly integrated system of care. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Personalization and Patient Involvement in Decision Support Systems: Current Trends

PubMed Central

Sacchi, L.; Lanzola, G.; Viani, N.

2015-01-01

Summary Objectives This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care. Methods We considered papers published on scientific journals, by querying PubMed and Web of Science™. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support. Results We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness. Conclusions Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large. PMID:26293857

Examination of changes in pathology tests ordered by Diagnosis-Related Group (DRGs) following CPOE introduction.

PubMed

Vecellio, Elia; Georgiou, Andrew; Toouli, George; Eigenstetter, Alex; Li, Ling; Wilson, Roger; Westbrook, Johanna I

2013-01-01

Electronic test ordering, via the Electronic Medical Record (EMR), which incorporates computerised provider order entry (CPOE), is widely considered as a useful tool to support appropriate pathology test ordering. Diagnosis-related groups (DRGs) are clinically meaningful categories that allow comparisons in pathology utilisation by patient groups by controlling for many potentially confounding variables. This study used DRG data linked to pathology test data to examine changes in rates of test ordering across four years coinciding with the introduction of an EMR in six hospitals in New South Wales, Australia. This method generated a list of high pathology utilisation DRGs. We investigated patients with a Chest pain DRG to examine whether tests rates changed for specific test groups by hospital emergency department (ED) pre- and post-EMR. There was little change in testing rates between EDs or between time periods pre- and post-EMR. This is a valuable method for monitoring the impact of EMR and clinical decision support on test order rates.

Assessing and comparing the usability of Chinese EHRs used in two Peking University hospitals to EHRs used in the US: A method of RUA.

PubMed

Xu, Lufei; Wen, Dong; Zhang, Xingting; Lei, Jianbo

2016-05-01

The objective of this study was to investigate the usability level of Chinese hospital Electronic Health Records (EHRs) by assessing the completion times of EHRs for seven "meaningful use (MU)" relevant tasks conducted at two Chinese tertiary hospitals and comparing the results to those of relevant research conducted in US EHRs. Using Rapid Usability Assessment (RUA) developed by the National Center for Cognitive Informatics and Decision Making (NCCD), the usability of EHRs from two Peking University hospitals was assessed using a three-step Keystroke Level Model (KLM) in a laboratory environment. (1) The total EHR task completion time for 7 MU relevant test tasks showed no significant differences between the two Chinese EHRs and their US counterparts, in which the time for thinking was relatively large and comprised 35.6% of the total time. The time for the electronic physician order was the largest. (2) For specific tasks, the mean completion times of the 2 hospital EHR systems spent on recording, modifying and searching (RMS) the medication orders were similar to those for the RMS radioactive tests; the mean time spent on the RMS laboratory test orders were much less. (3) There were 85 usability problems identified in the 2 hospital EHR systems. In Chinese EHRs, a substantial amount of time is required to complete tasks relevant to MU targets and many preventable usability problems can be discovered. The task completion time of the 2 Chinese EHR systems was a little shorter than in the 5 reported US EHR systems, while the differences in smoking status and CPOE tasks were obvious; one main reason for these differences was the use of structured data entry. The efficiency of Chinese and US EHRs was not significantly different. The key to improving the efficiency of both systems lies in expediting the Computerized physician order entry (CPOE) task. Many usability problems can be identified using heuristic assessments and improved by corresponding actions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Does applying technology throughout the medication use process improve patient safety with antineoplastics?

PubMed

Bubalo, Joseph; Warden, Bruce A; Wiegel, Joshua J; Nishida, Tess; Handel, Evelyn; Svoboda, Leanne M; Nguyen, Lam; Edillo, P Neil

2014-12-01

Medical errors, in particular medication errors, continue to be a troublesome factor in the delivery of safe and effective patient care. Antineoplastic agents represent a group of medications highly susceptible to medication errors due to their complex regimens and narrow therapeutic indices. As the majority of these medication errors are frequently associated with breakdowns in poorly defined systems, developing technologies and evolving workflows seem to be a logical approach to provide added safeguards against medication errors. This article will review both the pros and cons of today's technologies and their ability to simplify the medication use process, reduce medication errors, improve documentation, improve healthcare costs and increase provider efficiency as relates to the use of antineoplastic therapy throughout the medication use process. Several technologies, mainly computerized provider order entry (CPOE), barcode medication administration (BCMA), smart pumps, electronic medication administration record (eMAR), and telepharmacy, have been well described and proven to reduce medication errors, improve adherence to quality metrics, and/or improve healthcare costs in a broad scope of patients. The utilization of these technologies during antineoplastic therapy is weak at best and lacking for most. Specific to the antineoplastic medication use system, the only technology with data to adequately support a claim of reduced medication errors is CPOE. In addition to the benefits these technologies can provide, it is also important to recognize their potential to induce new types of errors and inefficiencies which can negatively impact patient care. The utilization of technology reduces but does not eliminate the potential for error. The evidence base to support technology in preventing medication errors is limited in general but even more deficient in the realm of antineoplastic therapy. Though CPOE has the best evidence to support its use in the antineoplastic population, benefit from many other technologies may have to be inferred based on data from other patient populations. As health systems begin to widely adopt and implement new technologies it is important to critically assess their effectiveness in improving patient safety. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Implementation of a clinical pathway based on a computerized physician order entry system for ischemic stroke attenuates off-hour and weekend effects in the ED.

PubMed

Yang, Jong Min; Park, Yoo Seok; Chung, Sung Phil; Chung, Hyun Soo; Lee, Hye Sun; You, Je Sung; Lee, Shin Ho; Park, Incheol

2014-08-01

Admission on weekends and off-hours has been associated with poor outcomes and mortality from acute stroke. The purpose of this study was to investigate whether an organized clinical pathway (CP) for ischemic stroke can effectively reduce the time from arrival to evaluation and treatment in the emergency department (ED) and improve outcomes, regardless of the time from arrival in the ED. We conducted a retrospective analysis of all consecutive patients included in the prospective registry database in the Brain Salvage through Emergency Stroke Therapy program, which uses the computerized physician order entry (CPOE) system. Patients were classified based on their time of arrival in the ED: group 1, normal working hours on weekdays; group 2, off-hours on weekdays; group 3, normal working hours on weekends; and group 4, off-hours on weekends. Clinical outcomes were categorized according to 30 days in-hospital mortality, in-hospital mortality, and the modified Rankin score during a single length of stay (LOS). No time intervals differed significantly among the 4 patient groups who received intravenous administration of tissue plasminogen activator (IV-tPA). Use of IV-tPA (P = .5110) was not affected by arrival in the ED on off-days or weekends. The overall mortality rate was 3.9%, and the median LOS was 7 days (Interquartile range (IQR), 5-10). By Kaplan-Meier analysis, the cumulative probability of mortality and survival did not differ significantly among the 4 groups over 30 days (P = .1557). An organized CP, based on CPOE, for ischemic stroke can effectively attenuate disparities in the time interval between ED arrival to evaluation and treatment regardless of ED arrival time. This pathway may also help to eliminate off-hour and weekend effects on outcomes from ischemic stroke. Copyright © 2014 Elsevier Inc. All rights reserved.

Creating Resilient IT: How the Sign-Out Sheet Shows Clinicians Make Healthcare Work

PubMed Central

Nemeth, Christopher; Nunnally, Mark; O’Connor, Michael; Cook, Richard

2006-01-01

Information technology (IT) systems have been described as brittle and prone to automation surprises. Recent report of information system failure, particularly computerized physician order entry (CPOE) systems, shows the result of IT failure in actual practice. Such mismatches with healthcare work requirements necessitate improvement to IT research and development. Efforts to develop successful IT systems for healthcare’s sharp end must incorporate properties that reflect workers’ initiative in respose to domain constraints. Resilience is the feature of some systems that makes it possible for them to respond to sudden, unanticipated demands for performance and return to normal operation quickly, with minimum decrement in performance. Workers create resilience at healthcare’s sharp end by daily confronting constraints and obstacles that need to be surmounted in order to accomplish results. The sign-out sheet is an example of resilience that can be used to guide IT development. PMID:17238408

Implementing computerized physician order entry: the importance of special people.

PubMed

Ash, Joan S; Stavri, P Zoë; Dykstra, Richard; Fournier, Lara

2003-03-01

To articulate important lessons learned during a study to identify success factors for implementing computerized physician order entry (CPOE) in inpatient and outpatient settings. Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes. The theme we call Special People is explored here in detail. A taxonomy of types of Special People includes administrative leaders, clinical leaders (champions, opinion leaders, and curmudgeons), and bridgers or support staff who interface directly with users. The recognition and nurturing of Special People should be among the highest priorities of those implementing computerized physician order entry. Their education and training must be a goal of teaching programs in health administration and medical informatics.

A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation

PubMed Central

Yang, Cheng-Yi; Lo, Yu-Sheng; Chen, Ray-Jade

2018-01-01

Background A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients’ integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients’ medication records prescribed by different health care facilities across Taiwan. Objective This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. Methods A CDS engine was developed that can download patients’ up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians’ responses to handling the alerts for each encounter. Results The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians’ responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled. Conclusions The CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient’s medication history, thus further research to assess the factors in increasing the PharmaCloud consent rate is required. PMID:29351893

The effect of using the health smart card vs. CPOE reminder system on the prescribing practices of non-obstetric physicians during outpatient visits for pregnant women in Taiwan.

PubMed

Long, An-Jim; Chang, Polun

2012-09-01

There is an evidence that pregnant women have been prescribed a significant number of improper medications that could lead to potential damage for a developing fetus due to discontinuity of care. The safety of pregnant women raises public concern and there is a need to identify ways to prevent potential adverse events to the pregnant woman. This study used a health smart card with a clinical reminder system to keep continuous records of general outpatient visits of pregnant women to protect them from potential adverse events caused by improper prescription. The health smart card, issued to all 23 million citizens in Taiwan, was used to work with a Computerized Physician Order Entry (CPOE) implemented at a 700-bed teaching medical center in Taipei to provide the outpatient information of pregnant women. FDA pregnancy risk classification was used to categorize the risk of pregnant women. The log file, combined with the physicians' and patients' profiles, were statistically examined using the Mantel-Haenszel technique to evaluate the impact of system in changing physician's prescription behavior. A total of 441 patients ranged in age from 15 to 50 years with 1114 prescriptions involved in FDA pregnancy risk classification C, D, and X during the study period. 144 reminders (13.1%) were accepted by physicians for further assessment and 100 (69.4%) of them were modified. Non-obstetric physicians in non-emergency setting were more intended to accept reminders (27.8%, 4.9 folds than obstetricians). Reminders triggered on patients in second trimester (15.5%) were accepted by all physicians more than third trimester (OR 1.52, p<0.05). A health smart card armed with CPOE reminder system and well-defined criteria had the potential to decrease harmful medication prescribed to pregnant patients. The results show better conformance for non-obstetric physicians (26%) and when physicians accepted the alerts they are more likely to went back and review their orders (69%). In sum, reminder criteria of FDA pregnancy risk classification C for obstetricians and reminder based on different trimesters is suggested to be refined to improve system acceptability and to decrease improper prescription. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A feasibility study for a clinical decision support system prompting HIV testing.

PubMed

Chadwick, D R; Hall, C; Rae, C; Rayment, Ml; Branch, M; Littlewood, J; Sullivan, A

2017-07-01

Levels of undiagnosed HIV infection and late presentation remain high globally despite attempts to increase testing. The objective of this study was to evaluate a risk-based prototype application to prompt HIV testing when patients undergo routine blood tests. Two computer physician order entry (CPOE) systems were modified using the application to prompt health care workers (HCWs) to add an HIV test when other tests selected suggested that the patient was at higher risk of HIV infection. The application was applied for a 3-month period in two areas, in a large London hospital and in general practices in Teesside/North Yorkshire. At the end of the evaluation period, HCWs were interviewed to assess the usability and acceptability of the prompt. Numbers of HIV tests ordered in the general practice areas were also compared before and after the prompt's introduction. The system was found to be both useable and generally acceptable to hospital doctors, general practitioners and nurse practitioners, with little evidence of prompt/alert fatigue. The issue of the prompt appearing late in the patient consultation did lead to some difficulties, particularly around discussion of the test and consent. In the general practices, around 1 in 10 prompts were accepted and there was a 6% increase in testing rates over the 3-month study period (P = 0.169). Using a CPOE-based clinical decision support application to prompt HIV testing appears both feasible and acceptable to HCWs. Refining the application to provide more accurate risk stratification is likely to make it more effective. © 2016 British HIV Association.

Investigating healthcare IT innovations: a "conceptual blending" approach.

PubMed

Cranfield, Steven; Hendy, Jane; Reeves, Barnaby; Hutchings, Andrew; Collin, Simon; Fulop, Naomi

2015-01-01

The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS). To analyse these multi-level dynamics, the authors blend Rogers' diffusion of innovations theory (DoIT) with Webster's sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts. Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application - in particular speed, ease of use, reliability and flexibility and levels of readiness - were highly relevant but their influence was modulated through interaction with complex structural and relational issues. Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of "co-construction" between designers and end-users. The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.

A comparison of the impact of CPOE implementation and organizational determinants on doctor-nurse communications and cooperation.

PubMed

Pelayo, Sylvia; Anceaux, Françoise; Rogalski, Janine; Elkin, Peter; Beuscart-Zephir, Marie-Catherine

2013-12-01

To compare the impact of CPOE implementation and of the workplace organizational determinants on the doctor-nurse cooperation and communication processes. A first study was undertaken in eight different wards aimed to identify the different workplace organizations that support doctor-nurse communications'. A second study compared the impact of these organizations and of a CPOE on medication-related doctor-nurse communications. The doctor-nurse communications could be structured into three typical workplace organizations: the common round, the briefing and the opportunistic exchange organizations. The results (i) confirmed the impact of the organizational determinants on the cooperative activities and (ii) demonstrated the CPOE system has no significant impact within a given workplace organization. The success of the implementation of HIT applications relies partly on the identification of the actual (and sometimes hidden) structuring variables of teamwork and ultimately on their control at the time of implementation to ensure the quality and safety of the patient care provided. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Effectiveness of a multidisciplinary critical pathway based on a computerised physician order entry system for ST-segment elevation myocardial infarction management in the emergency department: a retrospective observational study.

PubMed

Park, Yoo Seok; Chung, Sung Phil; You, Je Sung; Kim, Min Joung; Chung, Hyun Soo; Hong, Jung Hwa; Lee, Hye Sun; Wang, Jinwon; Park, Incheol

2016-08-16

The purpose of this study was to investigate whether a multidisciplinary organised critical pathway (CP) for ST-segment elevation myocardial infarction (STEMI) management can significantly attenuate differences in the duration from emergency department (ED) arrival to evaluation and treatment, regardless of the arrival time, by eliminating off-hour and weekend effects. Retrospective observational cohort study. 2 tertiary academic hospitals. Consecutive patients in the Fast Interrogation Rule for STEMI (FIRST) program. A study was conducted on patients in the FIRST program, which uses a computerised physician order entry (CPOE) system. The patient demographics, time intervals and clinical outcomes were analysed based on the arrival time at the ED: group 1, normal working hours on weekdays; group 2, off-hours on weekdays; group 3, normal working hours on weekends; and group 4, off-hours on weekends. Clinical outcomes categorised according to 30-day mortality, in-hospital mortality and the length of stay. The duration from door-to-data or FIRST activation did not differ significantly among the 4 groups. The median duration between arrival and balloon placement during percutaneous coronary intervention did not significantly exceed 90 min, and the proportions (89.6-95.1%) of patients with door-to-balloon times within 90 min did not significantly differ among the 4 groups, regardless of the ED arrival time (p=0.147). Moreover, no differences in the 30-day (p=0.8173) and in-hospital mortality (p=0.9107) were observed in patients with STEMI. A multidisciplinary CP for STEMI based on a CPOE system can effectively decrease disparities in the door-to-data duration and proportions of patients with door-to-balloon times within 90 min, regardless of the ED arrival time. The application of a multidisciplinary CP may also help attenuate off-hour and weekend effects in STEMI clinical outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A systematic review of the effectiveness of interruptive medication prescribing alerts in hospital CPOE systems to change prescriber behavior and improve patient safety.

PubMed

Page, N; Baysari, M T; Westbrook, J I

2017-09-01

To assess the evidence of the effectiveness of different categories of interruptive medication prescribing alerts to change prescriber behavior and/or improve patient outcomes in hospital computerized provider order entry (CPOE) systems. PubMed, Embase, CINAHL and the Cochrane Library were searched for relevant articles published between January 2000 and February 2016. Studies were included if they compared the outcomes of automatic, interruptive medication prescribing alert/s to a control/comparison group to determine alert effectiveness. Twenty-three studies describing 32 alerts classified into 11 alert categories were identified. The most common alert categories studied were drug-condition interaction (n=6), drug-drug interaction alerts (n=6) and corollary order alerts (n=6). All 23 papers investigated the effect of the intervention alert on at least one outcome measure of prescriber behavior. Just over half of the studies (53%, n=17) reported a statistically significant beneficial effect from the intervention alert; 34% (n=11) reported no statistically significant effect, and 6% (n=2) reported a significant detrimental effect. Two studies also evaluated the effect of alerts on patient outcome measures; neither finding that patient outcomes significantly improved following alert implementation (6%, n=2). The greatest volume of evidence relates to three alert categories: drug-condition, drug-drug and corollary order alerts. Of these, drug-condition alerts had the greatest number of studies reporting positive effects (five out of six studies). Only two of six studies of drug-drug interaction and one of six of corollary alerts reported positive benefits. The current evidence-base does not show a clear indication that particular categories of alerts are more effective than others. While the majority of alert categories were shown to improve outcomes in some studies, there were also many cases where outcomes did not improve. This lack of evidence hinders decisions about the amount and type of decision support that should be integrated into CPOE systems to increase safety while reducing the risk of alert fatigue. Virtually no studies have sought to investigate the impact on changes to prescriber behavior and outcomes overall when alerts from multiple categories are incorporated within the same system. Copyright © 2017 Elsevier B.V. All rights reserved.

Making Sense of Clinical Practice: Order Set Design Strategies in CPOE

PubMed Central

Novak, Laurie L.

2007-01-01

A case study was conducted during the customization phase of a commercial CPOE system at a multi-hospital, academic health system. The study focused on the development of order sets. Three distinct approaches to order set development were observed: Empirical, Local Consensus and Departmental. The three approaches are first described and then examined using the framework of sensemaking. Different approaches to sensemaking in the context of order set development reflect variations in sources of knowledge related to the standardization of care. PMID:18693900

Reducing Wrong Patient Selection Errors: Exploring the Design Space of User Interface Techniques

PubMed Central

Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

2014-01-01

Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients’ identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed. PMID:25954415

Reducing wrong patient selection errors: exploring the design space of user interface techniques.

PubMed

Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

2014-01-01

Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients' identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed.

A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation.

PubMed

Yang, Cheng-Yi; Lo, Yu-Sheng; Chen, Ray-Jade; Liu, Chien-Tsai

2018-01-19

A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients' integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients' medication records prescribed by different health care facilities across Taiwan. This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. A CDS engine was developed that can download patients' up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians' responses to handling the alerts for each encounter. The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians' responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled. The CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient's medication history, thus further research to assess the factors in increasing the PharmaCloud consent rate is required. ©Cheng-Yi Yang, Yu-Sheng Lo, Ray-Jade Chen, Chien-Tsai Liu. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 19.01.2018.

For all the right reasons. Approaching CPOE from a patient safety and care quality perspective is the first critical step toward success.

PubMed

Hagland, Mark

2009-09-01

True CPOE success is about facilitating improved patient safety, care quality, and efficiency in a multidisciplinar environment, and on an ongoing basis. CPOE implementation forces clinician leaders to examine and rework long-ingrained care delivery processes, especially as they build or adapt order sets. The likelihood that CPOE will be a requirement of meaningful use could compel a rapid acceleration in implementation.

Easily configured real-time CPOE Pick Off Tool supporting focused clinical research and quality improvement.

PubMed

Rosenbaum, Benjamin P; Silkin, Nikolay; Miller, Randolph A

2014-01-01

Real-time alerting systems typically warn providers about abnormal laboratory results or medication interactions. For more complex tasks, institutions create site-wide 'data warehouses' to support quality audits and longitudinal research. Sophisticated systems like i2b2 or Stanford's STRIDE utilize data warehouses to identify cohorts for research and quality monitoring. However, substantial resources are required to install and maintain such systems. For more modest goals, an organization desiring merely to identify patients with 'isolation' orders, or to determine patients' eligibility for clinical trials, may adopt a simpler, limited approach based on processing the output of one clinical system, and not a data warehouse. We describe a limited, order-entry-based, real-time 'pick off' tool, utilizing public domain software (PHP, MySQL). Through a web interface the tool assists users in constructing complex order-related queries and auto-generates corresponding database queries that can be executed at recurring intervals. We describe successful application of the tool for research and quality monitoring.

Impact of electronic order management on the timeliness of antibiotic administration in critical care patients.

PubMed

Cartmill, Randi S; Walker, James M; Blosky, Mary Ann; Brown, Roger L; Djurkovic, Svetolik; Dunham, Deborah B; Gardill, Debra; Haupt, Marilyn T; Parry, Dean; Wetterneck, Tosha B; Wood, Kenneth E; Carayon, Pascale

2012-11-01

To examine the effect of implementing electronic order management on the timely administration of antibiotics to critical-care patients. We used a prospective pre-post design, collecting data on first-dose IV antibiotic orders before and after the implementation of an integrated electronic medication-management system, which included computerized provider order entry (CPOE), pharmacy order processing and an electronic medication administration record (eMAR). The research was performed in a 24-bed adult medical/surgical ICU in a large, rural, tertiary medical center. Data on the time of ordering, pharmacy processing and administration were prospectively collected and time intervals for each stage and the overall process were calculated. The overall turnaround time from ordering to administration significantly decreased from a median of 100 min before order management implementation to a median of 64 min after implementation. The first part of the medication use process, i.e., from order entry to pharmacy processing, improved significantly whereas no change was observed in the phase from pharmacy processing to medication administration. The implementation of an electronic order-management system improved the timeliness of antibiotic administration to critical-care patients. Additional system changes are required to further decrease the turnaround time. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Novel Representation of Clinical Information in the ICU

PubMed Central

Pickering, B.W.; Herasevich, V.; Ahmed, A.; Gajic, O.

2010-01-01

The introduction of electronic medical records (EMR) and computerized physician order entry (CPOE) into the intensive care unit (ICU) is transforming the way health care providers currently work. The challenge facing developers of EMR’s is to create products which add value to systems of health care delivery. As EMR’s become more prevalent, the potential impact they have on the quality and safety, both negative and positive, will be amplified. In this paper we outline the key barriers to effective use of EMR and describe the methodology, using a worked example of the output. AWARE (Ambient Warning and Response Evaluation), is a physician led, electronic-environment enhancement program in an academic, tertiary care institution’s ICU. The development process is focused on reducing information overload, improving efficiency and eliminating medical error in the ICU. PMID:23616831

Sustained User Engagement in Health Information Technology: The Long Road from Implementation to System Optimization of Computerized Physician Order Entry and Clinical Decision Support Systems for Prescribing in Hospitals in England.

PubMed

Cresswell, Kathrin M; Lee, Lisa; Mozaffar, Hajar; Williams, Robin; Sheikh, Aziz

2017-10-01

To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing. Six hospitals in England, United Kingdom. Qualitative case study. We undertook qualitative semi-structured interviews, non-participant observations of meetings and system use, and collected organizational documents over three time periods from six hospitals. Thematic analysis was initially undertaken within individual cases, followed by cross-case comparisons. We conducted 173 interviews, conducted 24 observations, and collected 17 documents between 2011 and 2015. We found that perceived individual and safety benefits among different user groups tended to facilitate engagement in some, while other less engaged groups developed resistance and unsanctioned workarounds if systems were perceived to be inadequate. We identified both the opportunity and need for sustained engagement across user groups around system enhancement (e.g., through customizing software) and the development of user competencies and effective use. There is an urgent need to move away from an episodic view of engagement focused on the preimplementation phase, to more continuous holistic attempts to engage with and respond to end-users. © Health Research and Educational Trust.

How Regrouping Alerts in Computerized Physician Order Entry Layout Influences Physicians' Prescription Behavior: Results of a Crossover Randomized Trial.

PubMed

Wipfli, Rolf; Ehrler, Frederic; Bediang, Georges; Bétrancourt, Mireille; Lovis, Christian

2016-06-02

As demonstrated in several publications, low positive predictive value alerts in computerized physician order entry (CPOE) induce fatigue and may interrupt physicians unnecessarily during prescription of medication. Although it is difficult to increase the consideration of medical alerts by physician through an improvement of their predictive value, another approach consists to act on the way they are presented. The interruption management model inspired us to propose an alternative alert display strategy of regrouping the alerts in the screen layout, as a possible solution for reducing the interruption in physicians' workflow. In this study, we compared 2 CPOE designs based on a particular alert presentation strategy: one design involved regrouping the alerts in a single place on the screen, and in the other, the alerts were located next to the triggering information. Our objective was to evaluate experimentally whether the new design led to fewer interruptions in workflow and if it affected alert handling. The 2 CPOE designs were compared in a controlled crossover randomized trial. All interactions with the system and eye movements were stored for quantitative analysis. The study involved a group of 22 users consisting of physicians and medical students who solved medical scenarios containing prescription tasks. Scenario completion time was shorter when the alerts were regrouped (mean 117.29 seconds, SD 36.68) than when disseminated on the screen (mean 145.58 seconds, SD 75.07; P=.045). Eye tracking revealed that physicians fixated longer on alerts in the classic design (mean 119.71 seconds, SD 76.77) than in the centralized alert design (mean 70.58 seconds, SD 33.53; P=.001). Visual switches between prescription and alert areas, indicating interruption, were reduced with centralized alerts (mean 41.29, SD 21.26) compared with the classic design (mean 57.81, SD 35.97; P=.04). Prescription behavior (ie, prescription changes after alerting), however, did not change significantly between the 2 strategies of display. The After-Scenario Questionnaire (ASQ) that was filled out after each scenario showed that overall satisfaction was significantly rated lower when alerts were regrouped (mean 4.37, SD 1.23) than when displayed next to the triggering information (mean 5.32, SD 0.94; P=.02). Centralization of alerts in a table might be a way to motivate physicians to manage alerts more actively, in a meaningful way, rather than just being interrupted by them. Our study could not provide clear recommendations yet, but provides objective data through a cognitive psychological approach. Future tests should work on standardized scenarios that would enable to not only measure physicians' behavior (visual fixations and handling of alerts) but also validate those actions using clinical criteria.

Example of a Human Factors Engineering approach to a medication administration work system: potential impact on patient safety.

PubMed

Beuscart-Zéphir, Marie-Catherine; Pelayo, Sylvia; Bernonville, Stéphanie

2010-04-01

The objectives of this paper are: In this approach, the implementation of such a complex IT solution is considered a major redesign of the work system. The paper describes the Human Factor (HF) tasks embedded in the project lifecycle: (1) analysis and modelling of the current work system and usability assessment of the medication CPOE solution; (2) HF recommendations for work re-design and usability recommendations for IT system re-engineering both aiming at a safer and more efficient work situation. Standard ethnographic methods were used to support the analysis of the current work system and work situations, coupled with cognitive task analysis methods and documents review. Usability inspection (heuristic evaluation) and both in-lab (simulated tasks) and on-site (real tasks) usability tests were performed for the evaluation of the CPOE candidate. Adapted software engineering models were used in combination with usual textual descriptions, tasks models and mock-ups to support the recommendations for work and product re-design. The analysis of the work situations identified different work organisations and procedures across the hospital's departments. The most important differences concerned the doctor-nurse communications and cooperation modes and the procedures for preparing and administering the medications. The assessment of the medication CPOE functions uncovered a number of usability problems including severe ones leading to impossible to detect or to catch errors. Models of the actual and possible distribution of tasks and roles were used to support decision making in the work design process. The results of the usability assessment were translated into requirements to support the necessary re-engineering of the IT application. The HFE approach to medication CPOE efficiently identifies and distinguishes currently unsafe or uncomfortable work situations that could obviously benefit from an IT solution from other work situations incorporating efficient work procedures that might be impaired by the implementation of the CPOE. In this context, a careful redesign of the work situation and of the entire work system is necessary to actually benefit from the installation of the product in terms of patient safety and human performances. In parallel, a usability assessment of the product to be implemented is mandatory to identify potentially dangerous usability flaws and to fix them before the installation. (c) 2009 Elsevier Ireland Ltd. All rights reserved.

[Health personnel assessment about medical order entry systems of pharmacologic treatments in hospitalized patients].

PubMed

Villamañán, E; Larrubia, Y; Ruano, M; Moro, M; Sierra, A; Pérez, E; Herrero, A; Álvarez-Sala, R

2013-01-01

to evaluate health personnel perceptions about medical order entry systems concerning the effect on workflow, medication errors risk and assessment of its potential advantages. A cross-section opinion interview was conducted in a tertiary care hospital. Questionnaire consisted of three sections: perception of its effect on workflow, influence on medication error risk and assessment of potential advantages. We also asked them to assess drawbacks and provide suggestions about this prescription system. 76 health professionals were interviewed (58 physicians, 9 pharmacists and 9 nurses). They were satisfied mainly due to decrease the workload (85.5%; IC 95%: 75.58-92.55). They thought that the main characteristics that contribute to reduce medication errors are clinical decision supports related to predefined aspects which the program provided by default. Among potential benefits of medical order entry systems, legibility and warnings triggered by the program (98.7%; IC 95%: 92.90-99.97 and 97,4%; IC 95%: 90.81-99.68 respectively) were the most valuable. High technology dependence, IT failures and lack of infrastructure and medication therapy discontinuities at times of transition between different hospitals' units were the main drawbacks considered. The most repeated suggestion was related to the improvement of links between other health informatics applications used in the hospital. health personnel were highly satisfied with the CPOE system, which is considered to be effective and safe. Technology dependence and IT failures were the main disadvantages reported. According to them, a greater coordination and unification of all software applications available in the hospital would be desirable. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

Lessons from a Successful Implementation of a Computerized Provider Order Entry System

PubMed Central

Jacobs, Brian R.; Hallstrom, Craig K.; Hart, Kim Ward; Mahoney, Daniela; Lykowski, Gayle

2007-01-01

OBJECTIVES The electronic health record (EHR) can improve patient safety, care efficiency, cost effectiveness and regulatory compliance. Cincinnati Children's Hospital Medical Center (CCHMC) has successfully implemented an Integrating Clinical Information System (ICIS) that includes Computerized Provider Order Entry (CPOE). This review describes some of the unanticipated challenges and solutions identified during the implementation of ICIS. METHODS Data for this paper was derived from user-generated feedback within the ICIS. Feedback reports were reviewed and placed into categories based on root cause of the issue. Recurring issues or problems which led to potential or actual patient injury are included. RESULTS Nine distinct challenges were identified: 1) Deterioration in communication; 2) Excessive system alerts to users; 3) Unrecognized discontinuation of medications; 4) Unintended loss of orders; 5) Loss of orders during implementation; 6) Amplification of errors; 7) Unintentional generation of patient care orders by system analysts; 8) Persistence of specific patient care order instructions; 9) Verbal orders entered under the incorrect clinician. CONCLUSIONS Unanticipated challenges are expected when implementing EHRs. The implementation plan for any EHR should include methods to identify, evaluate and repair problems quickly. While continued challenges with this complex system are expected, we believe that the EHR will continue to facilitate improved patient care and safety. The lessons learned at CCHMC will permit other institutions to avoid some of these challenges and design robust processes to detect and respond to problems in a timely fashion to ensure implementation success. PMID:23055847

High speed clinical data retrieval system with event time sequence feature: with 10 years of clinical data of Hamamatsu University Hospital CPOE.

PubMed

Kimura, M; Tani, S; Watanabe, H; Naito, Y; Sakusabe, T; Watanabe, H; Nakaya, J; Sasaki, F; Numano, T; Furuta, T; Furuta, T

2008-01-01

This paper illustrates a high speed clinical data retrieving system, from 10 years of data of operating hospital information system for the purposes of research, evidence creation, patient safety, etc., even incorporating time sequence of causal relations. Total of 73,709,298 records of 10 years at Hamamatsu University Hospital (as of June 2008) are sent from HIS to retrieval system in HL7 v2.5 format. Hierarchical variable length database is used to install them. A search for "listing patients who were prescribed Pravastatin (Mevalotin and generic drugs, any titer)" took 1.92 seconds. "Pravastatin (any) prescribed and recorded AST >150 within two weeks" took 112.22 seconds. Searching conditions can be set to be more complex, connected by Boolean operator and/or. This system called D*D is in operation at Hamamatsu University Hospital since August 2002. It is used for 48,518 times (monthly average of 703 searches). Neither searching, nor background export of data from HIS caused delay of routine operating CPOE. Search database outside of routine operating CPOE, with daily export of order data in HL7 v2.5 format, is proved to provide excellent search environment without causing trouble. Hierarchical representation gives high-speed search response, especially with time sequence of events.

The impact of electronic health records on time efficiency of physicians and nurses: a systematic review.

PubMed

Poissant, Lise; Pereira, Jennifer; Tamblyn, Robyn; Kawasumi, Yuko

2005-01-01

A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.

The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review

PubMed Central

Poissant, Lise; Pereira, Jennifer; Tamblyn, Robyn; Kawasumi, Yuko

2005-01-01

A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses. PMID:15905487

Clinical Decision Support Improves Initial Dosing and Monitoring of Tobramycin and Amikacin

PubMed Central

Cox, Zachary L.; Nelsen, Cori L.; Waitman, Lemuel R.; McCoy, Jacob A.; Peterson, Josh F.

2010-01-01

Purpose Clinical decision support (CDS) systems could be valuable tools in reducing aminoglycoside prescribing errors. We evaluated the impact of CDS on initial dosing, interval, and pharmacokinetic outcomes of amikacin and tobramycin therapy. Methods A complex CDS advisor to provide guidance on initial dosing and monitoring, using both traditional and extended interval dosing strategies, was integrated into computerized provider order entry (CPOE) and compared to a control group which featured close pharmacy monitoring of all aminoglycoside orders. A random sample of 118 patients from an academic, tertiary care medical center prescribed amikacin and tobramycin prior to advisor implementation was compared to 98 patients admitted following advisor implementation. Primary outcome was an initial dose within 10% of a dose calculated to be adherent to published dose guidelines. Secondary outcomes were a guideline-adherent interval, trough and peak concentrations in goal range, and incidence of nephrotoxicity. Results Of 216 patients studied, 97 were prescribed amikacin and 119 were prescribed tobramycin. The primary outcome of initial dosing consistent with guideline-based care increased from 40% in the pre-advisor arm to 80% in the post-advisor arm (p<0.001), with a number needed to treat of 3 patients to prevent one incorrect dose. Correct initial interval based on renal function also increased from 63% to 87% (p<0.001). The changes in initial dosing and interval resulted in an increase of trough concentrations in the goal range from 59% pre-advisor to 89% post-advisor implementation (p=0.0004). There was no significant difference in peak concentrations in goal range or incidence of nephrotoxicity (25% vs. 17%, p=0.2). Conclusion An advisor for aminoglycoside dosing and monitoring integrated into CPOE significantly improves initial dosing, selection of interval, and trough concentrations at goal compared to unassisted physician dosing. PMID:21411805

Designing an architectural style for dynamic medical Cross-Organizational Workflow management system: an approach based on agents and web services.

PubMed

Bouzguenda, Lotfi; Turki, Manel

2014-04-01

This paper shows how the combined use of agent and web services technologies can help to design an architectural style for dynamic medical Cross-Organizational Workflow (COW) management system. Medical COW aims at supporting the collaboration between several autonomous and possibly heterogeneous medical processes, distributed over different organizations (Hospitals, Clinic or laboratories). Dynamic medical COW refers to occasional cooperation between these health organizations, free of structural constraints, where the medical partners involved and their number are not pre-defined. More precisely, this paper proposes a new architecture style based on agents and web services technologies to deal with two key coordination issues of dynamic COW: medical partners finding and negotiation between them. It also proposes how the proposed architecture for dynamic medical COW management system can connect to a multi-agent system coupling the Clinical Decision Support System (CDSS) with Computerized Prescriber Order Entry (CPOE). The idea is to assist the health professionals such as doctors, nurses and pharmacists with decision making tasks, as determining diagnosis or patient data analysis without stopping their clinical processes in order to act in a coherent way and to give care to the patient.

Conducting an Efficient Proactive Risk Assessment Prior to CPOE Implementation in an Intensive Care Unit

PubMed Central

Hundt, Ann Schoofs; Adams, Jean A.; Schmid, J. Andrew; Musser, Linda M.; Walker, James M.; Wetterneck, Tosha B; Douglas, Stephen V.; Paris, Bonnie L.; Carayon, Pascale

2012-01-01

Purpose To develop, conduct, and evaluate a proactive risk assessment (PRA) of the design and implementation of CPOE in an ICU. Methods We developed a PRA method based on issues identified from documented experience with conventional PRA methods and the constraints of an organization about to implement CPOE in an intensive care unit. The PRA method consists of three phases: planning (three months), team (one five-hour meeting), and evaluation (short- and long-term). Results Sixteen unique relevant vulnerabilities were identified as a result of the PRA team’s efforts. Negative consequences resulting from the vulnerabilities included potential patient safety and quality of care issues, non-compliance with regulatory requirements, increases in cognitive burden on CPOE users, and/or worker inconvenience or distress. Actions taken to address the vulnerabilities included redesign of the technology, process (workflow) redesign, user training, and/or ongoing monitoring. Verbal and written evaluation by the team members indicated that the PRA method was useful and that participants were willing to participate in future PRAs. Long-term evaluation was accomplished by monitoring an ongoing “issues list” of CPOE problems identified by or reported to IT staff. Vulnerabilities identified by the team were either resolved prior to CPOE implementation (n = 7) or shortly thereafter (n = 9). No other issues were identified beside those identified by the team. Conclusions Generally positive results from the various evaluations including a long-term evaluation demonstrate the value of developing an efficient PRA method that meets organizational and contextual requirements and constraints. PMID:22608242

Linked Orders Improve Safety in Scheduling and Administration of Chemotherapeutic Agents

PubMed Central

Whipple, Nancy; Boulware, Joy; Danca, Kala; Boyarin, Kirill; Ginsberg, Eliot; Poon, Eric; Sweet, Micheal; Schade, Sue; Rogala, Jennifer

2010-01-01

The pharmacologic treatment for cancer must adhere to complex, finely orchestrated treatment plans, including not only chemotherapy medications, but pre/post-hydration, anti-emetics, anti-anxiety, and other medications that are given before, during and after chemotherapy doses. The treatment plans specify the medications and dictate precise dosing, frequency, and timing. This is a challenge to most Computerized Physician Order Entry (CPOE), Pharmacy and Electronic Medication Administration record (eMAR) Systems. Medications are scheduled on specific dates, referred to as chemo days, from the onset of the treatment, and precisely timed on the designated chemo day. For patients enrolled in research protocols, the adherence to the defined schedule takes on additional import, since variation is a violation of the protocol. If the oncologist determines that medications must be administered outside the defined constraints, the patient must be un-enrolled from the protocol and the course of therapy is re-written. Pharmacy and eMAR systems utilized in processing chemotherapy medications must be able to support the intricate relationships between each drug defined in the treatment plans. PMID:21347104

Health innovation for patient safety improvement.

PubMed

Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

2013-01-01

Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

Comprehensive analysis of a medication dosing error related to CPOE.

PubMed

Horsky, Jan; Kuperman, Gilad J; Patel, Vimla L

2005-01-01

This case study of a serious medication error demonstrates the necessity of a comprehensive methodology for the analysis of failures in interaction between humans and information systems. The authors used a novel approach to analyze a dosing error related to computer-based ordering of potassium chloride (KCl). The method included a chronological reconstruction of events and their interdependencies from provider order entry usage logs, semistructured interviews with involved clinicians, and interface usability inspection of the ordering system. Information collected from all sources was compared and evaluated to understand how the error evolved and propagated through the system. In this case, the error was the product of faults in interaction among human and system agents that methods limited in scope to their distinct analytical domains would not identify. The authors characterized errors in several converging aspects of the drug ordering process: confusing on-screen laboratory results review, system usability difficulties, user training problems, and suboptimal clinical system safeguards that all contributed to a serious dosing error. The results of the authors' analysis were used to formulate specific recommendations for interface layout and functionality modifications, suggest new user alerts, propose changes to user training, and address error-prone steps of the KCl ordering process to reduce the risk of future medication dosing errors.

Improving Patient Safety in Hospitals: Contributions of High-Reliability Theory and Normal Accident Theory

PubMed Central

Tamuz, Michal; Harrison, Michael I

2006-01-01

Objective To identify the distinctive contributions of high-reliability theory (HRT) and normal accident theory (NAT) as frameworks for examining five patient safety practices. Data Sources/Study Setting We reviewed and drew examples from studies of organization theory and health services research. Study Design After highlighting key differences between HRT and NAT, we applied the frames to five popular safety practices: double-checking medications, crew resource management (CRM), computerized physician order entry (CPOE), incident reporting, and root cause analysis (RCA). Principal Findings HRT highlights how double checking, which is designed to prevent errors, can undermine mindfulness of risk. NAT emphasizes that social redundancy can diffuse and reduce responsibility for locating mistakes. CRM promotes high reliability organizations by fostering deference to expertise, rather than rank. However, HRT also suggests that effective CRM depends on fundamental changes in organizational culture. NAT directs attention to an underinvestigated feature of CPOE: it tightens the coupling of the medication ordering process, and tight coupling increases the chances of a rapid and hard-to-contain spread of infrequent, but harmful errors. Conclusions Each frame can make a valuable contribution to improving patient safety. By applying the HRT and NAT frames, health care researchers and administrators can identify health care settings in which new and existing patient safety interventions are likely to be effective. Furthermore, they can learn how to improve patient safety, not only from analyzing mishaps, but also by studying the organizational consequences of implementing safety measures. PMID:16898984

Designing Real-time Decision Support for Trauma Resuscitations

PubMed Central

Yadav, Kabir; Chamberlain, James M.; Lewis, Vicki R.; Abts, Natalie; Chawla, Shawn; Hernandez, Angie; Johnson, Justin; Tuveson, Genevieve; Burd, Randall S.

2016-01-01

Background Use of electronic clinical decision support (eCDS) has been recommended to improve implementation of clinical decision rules. Many eCDS tools, however, are designed and implemented without taking into account the context in which clinical work is performed. Implementation of the pediatric traumatic brain injury (TBI) clinical decision rule at one Level I pediatric emergency department includes an electronic questionnaire triggered when ordering a head computed tomography using computerized physician order entry (CPOE). Providers use this CPOE tool in less than 20% of trauma resuscitation cases. A human factors engineering approach could identify the implementation barriers that are limiting the use of this tool. Objectives The objective was to design a pediatric TBI eCDS tool for trauma resuscitation using a human factors approach. The hypothesis was that clinical experts will rate a usability-enhanced eCDS tool better than the existing CPOE tool for user interface design and suitability for clinical use. Methods This mixed-methods study followed usability evaluation principles. Pediatric emergency physicians were surveyed to identify barriers to using the existing eCDS tool. Using standard trauma resuscitation protocols, a hierarchical task analysis of pediatric TBI evaluation was developed. Five clinical experts, all board-certified pediatric emergency medicine faculty members, then iteratively modified the hierarchical task analysis until reaching consensus. The software team developed a prototype eCDS display using the hierarchical task analysis. Three human factors engineers provided feedback on the prototype through a heuristic evaluation, and the software team refined the eCDS tool using a rapid prototyping process. The eCDS tool then underwent iterative usability evaluations by the five clinical experts using video review of 50 trauma resuscitation cases. A final eCDS tool was created based on their feedback, with content analysis of the evaluations performed to ensure all concerns were identified and addressed. Results Among 26 EPs (76% response rate), the main barriers to using the existing tool were that the information displayed is redundant and does not fit clinical workflow. After the prototype eCDS tool was developed based on the trauma resuscitation hierarchical task analysis, the human factors engineers rated it to be better than the CPOE tool for nine of 10 standard user interface design heuristics on a three-point scale. The eCDS tool was also rated better for clinical use on the same scale, in 84% of 50 expert–video pairs, and was rated equivalent in the remainder. Clinical experts also rated barriers to use of the eCDS tool as being low. Conclusions An eCDS tool for diagnostic imaging designed using human factors engineering methods has improved perceived usability among pediatric emergency physicians. PMID:26300010

The effect of information technology on hospital performance.

PubMed

Williams, Cynthia; Asi, Yara; Raffenaud, Amanda; Bagwell, Matt; Zeini, Ibrahim

2016-12-01

While healthcare entities have integrated various forms of health information technology (HIT) into their systems due to claims of increased quality and decreased costs, as well as various incentives, there is little available information about which applications of HIT are actually the most beneficial and efficient. In this study, we aim to assist administrators in understanding the characteristics of top performing hospitals. We utilized data from the Health Information and Management Systems Society and the Center for Medicare and Medicaid to assess 1039 hospitals. Inputs considered were full time equivalents, hospital size, and technology inputs. Technology inputs included personal health records (PHR), electronic medical records (EMRs), computerized physician order entry systems (CPOEs), and electronic access to diagnostic results. Output variables were measures of quality, hospital readmission and mortality rate. The analysis was conducted in a two-stage methodology: Data Envelopment Analysis (DEA) and Automatic Interaction Detector Analysis (AID), decision tree regression (DTreg). Overall, we found that electronic access to diagnostic results systems was the most influential technological characteristics; however organizational characteristics were more important than technological inputs. Hospitals that had the highest levels of quality indicated no excess in the use of technology input, averaging one use of a technology component. This study indicates that prudent consideration of organizational characteristics and technology is needed before investing in innovative programs.

Using Healthcare Failure Mode and Effect Analysis to reduce medication errors in the process of drug prescription, validation and dispensing in hospitalised patients.

PubMed

Vélez-Díaz-Pallarés, Manuel; Delgado-Silveira, Eva; Carretero-Accame, María Emilia; Bermejo-Vicedo, Teresa

2013-01-01

To identify actions to reduce medication errors in the process of drug prescription, validation and dispensing, and to evaluate the impact of their implementation. A Health Care Failure Mode and Effect Analysis (HFMEA) was supported by a before-and-after medication error study to measure the actual impact on error rate after the implementation of corrective actions in the process of drug prescription, validation and dispensing in wards equipped with computerised physician order entry (CPOE) and unit-dose distribution system (788 beds out of 1080) in a Spanish university hospital. The error study was carried out by two observers who reviewed medication orders on a daily basis to register prescription errors by physicians and validation errors by pharmacists. Drugs dispensed in the unit-dose trolleys were reviewed for dispensing errors. Error rates were expressed as the number of errors for each process divided by the total opportunities for error in that process times 100. A reduction in prescription errors was achieved by providing training for prescribers on CPOE, updating prescription procedures, improving clinical decision support and automating the software connection to the hospital census (relative risk reduction (RRR), 22.0%; 95% CI 12.1% to 31.8%). Validation errors were reduced after optimising time spent in educating pharmacy residents on patient safety, developing standardised validation procedures and improving aspects of the software's database (RRR, 19.4%; 95% CI 2.3% to 36.5%). Two actions reduced dispensing errors: reorganising the process of filling trolleys and drawing up a protocol for drug pharmacy checking before delivery (RRR, 38.5%; 95% CI 14.1% to 62.9%). HFMEA facilitated the identification of actions aimed at reducing medication errors in a healthcare setting, as the implementation of several of these led to a reduction in errors in the process of drug prescription, validation and dispensing.

Impact of order set design on urine culturing practices at an academic medical centre emergency department.

PubMed

Munigala, Satish; Jackups, Ronald R; Poirier, Robert F; Liang, Stephen Y; Wood, Helen; Jafarzadeh, S Reza; Warren, David K

2018-01-20

Urinalysis and urine culture are commonly ordered tests in the emergency department (ED). We evaluated the impact of removal of order sets from the 'frequently ordered test' in the computerised physician order entry system (CPOE) on urine testing practices. We conducted a before (1 September to 20 October 2015) and after (21 October to 30 November 2015) study of ED patients. The intervention consisted of retaining 'urinalysis with reflex to microscopy' as the only urine test in a highly accessible list of frequently ordered tests in the CPOE system. All other urine tests required use of additional order screens via additional mouse clicks. The frequency of urine testing before and after the intervention was compared, adjusting for temporal trends. During the study period, 6499 (28.2%) of 22 948 ED patients had ≥1 urine test ordered. Urine testing rates for all ED patients decreased in the post intervention period for urinalysis (291.5 pre intervention vs 278.4 per 1000 ED visits post intervention, P=0.03), urine microscopy (196.5vs179.5, P=0.001) and urine culture (54.3vs29.7, P<0.001). When adjusted for temporal trends, the daily culture rate per 1000 ED visits decreased by 46.6% (-46.6%, 95% CI -66.2% to -15.6%), but urinalysis (0.4%, 95% CI -30.1 to 44.4%), microscopy (-6.5%, 95% CI -36.0% to 36.6%) and catheterised urine culture rates (17.9%, 95% CI -16.9 to 67.4) were unchanged. A simple intervention of retaining only 'urinalysis with reflex to microscopy' and removing all other urine tests from the 'frequently ordered' window of the ED electronic order set decreased urine cultures ordered by 46.6% after accounting for temporal trends. Given the injudicious use of antimicrobial therapy for asymptomatic bacteriuria, findings from our study suggest that proper design of electronic order sets plays a vital role in reducing excessive ordering of urine cultures. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice.

PubMed

Keasberry, Justin; Scott, Ian A; Sullivan, Clair; Staib, Andrew; Ashby, Richard

2017-12-01

Objective The aim of the present study was to determine the effects of hospital-based eHealth technologies on quality, safety and efficiency of care and clinical outcomes. Methods Systematic reviews and reviews of systematic reviews of eHealth technologies published in PubMed/Medline/Cochrane Library between January 2010 and October 2015 were evaluated. Reviews of implementation issues, non-hospital settings or remote care or patient-focused technologies were excluded from analysis. Methodological quality was assessed using a validated appraisal tool. Outcome measures were benefits and harms relating to electronic medical records (EMRs), computerised physician order entry (CPOE), electronic prescribing (ePrescribing) and computerised decision support systems (CDSS). Results are presented as a narrative overview given marked study heterogeneity. Results Nineteen systematic reviews and two reviews of systematic reviews were included from 1197 abstracts, nine rated as high quality. For EMR functions, there was moderate-quality evidence of reduced hospitalisations and length of stay and low-quality evidence of improved organisational efficiency, greater accuracy of information and reduced documentation and process turnaround times. For CPOE functions, there was moderate-quality evidence of reductions in turnaround times and resource utilisation. For ePrescribing, there was moderate-quality evidence of substantially fewer medications errors and adverse drug events, greater guideline adherence, improved disease control and decreased dispensing turnaround times. For CDSS, there was moderate-quality evidence of increased use of preventive care and drug interaction reminders and alerts, increased use of diagnostic aids, more appropriate test ordering with fewer tests per patient, greater guideline adherence, improved processes of care and less disease morbidity. There was conflicting evidence regarding effects on in-patient mortality and overall costs. Reported harms were alert fatigue, increased technology interaction time, creation of disruptive workarounds and new prescribing errors. Conclusion eHealth technologies in hospital settings appear to improve efficiency and appropriateness of care, prescribing safety and disease control. Effects on mortality, readmissions, total costs and patient and provider experience remain uncertain. What is known about the topic? Healthcare systems internationally are undertaking large-scale digitisation programs with hospitals being a major focus. Although predictive analyses suggest that eHealth technologies have the potential to markedly transform health care delivery, contemporary peer-reviewed research evidence detailing their benefits and harms is limited. What does this paper add? This narrative overview of 19 systematic reviews and two reviews of systematic reviews published over the past 5 years provides a summary of cumulative evidence of clinical and organisational effects of contemporary eHealth technologies in hospital practice. EMRs have the potential to increase accuracy and completeness of clinical information, reduce documentation time and enhance information transfer and organisational efficiency. CPOE appears to improve laboratory turnaround times and decrease resource utilisation. ePrescribing significantly reduces medication errors and adverse drug events. CDSS, especially those used at the point of care and integrated into workflows, attract the strongest evidence for substantially increasing clinician adherence to guidelines, appropriateness of disease and treatment monitoring and optimal medication use. Evidence of effects of eHealth technologies on discrete clinical outcomes, such as morbid events, mortality and readmissions, is currently limited and conflicting. What are the implications for practitioners? eHealth technologies confer benefits in improving quality and safety of care with little evidence of major hazards. Whether EMRs and CPOE can affect clinical outcomes or overall costs in the absence of auxiliary support systems, such as ePrescribing and CDSS, remains unclear. eHealth technologies are evolving rapidly and the evidence base used to inform clinician and managerial decisions to invest in these technologies must be updated continually. More rigorous field research using appropriate evaluation methods is needed to better define real-world benefits and harms. Customisation of eHealth applications to the context of patient-centred care and management of highly complex patients with multimorbidity will be an ongoing challenge.

Frequency of dosage prescribing medication errors associated with manual prescriptions for very preterm infants.

PubMed

Horri, J; Cransac, A; Quantin, C; Abrahamowicz, M; Ferdynus, C; Sgro, C; Robillard, P-Y; Iacobelli, S; Gouyon, J-B

2014-12-01

The risk of dosage Prescription Medication Error (PME) among manually written prescriptions within 'mixed' prescribing system (computerized physician order entry (CPOE) + manual prescriptions) has not been previously assessed in neonatology. This study aimed to evaluate the rate of dosage PME related to manual prescriptions in the high-risk population of very preterm infants (GA < 33 weeks) in a mixed prescription system. The study was based on a retrospective review of a random sample of manual daily prescriptions in two neonatal intensive care units (NICU) A and B, located in different French University hospitals (Dijon and La Reunion island). Daily prescription was defined as the set of all drugs manually prescribed on a single day for one patient. Dosage error was defined as a deviation of at least ±10% from the weight-appropriate recommended dose. The analyses were based on the assessment of 676 manually prescribed drugs from NICU A (58 different drugs from 93 newborns and 240 daily prescriptions) and 354 manually prescribed drugs from NICU B (73 different drugs from 131 newborns and 241 daily prescriptions). The dosage error rate per 100 manually prescribed drugs was similar in both NICU: 3·8% (95% CI: 2·5-5·6%) in NICU A and 3·1% (95% CI: 1·6-5·5%) in NICU B (P = 0·54). Among all the 37 identified dosage errors, the over-dosing was almost as frequent as the under-dosing (17 and 20 errors, respectively). Potentially severe dosage errors occurred in a total of seven drug prescriptions. None of the dosage PME was recorded in the corresponding medical files and information on clinical outcome was not sufficient to identify clinical conditions related to dosage PME. Overall, 46·8% of manually prescribed drugs were off label or unlicensed, with no significant differences between prescriptions with or without dosage error. The risk of a dosage PME increased significantly if the drug was included in the CPOE system but was manually prescribed (OR = 3·3; 95% CI: 1·6-7·0, P < 0·001). The presence of dosage PME in the manual prescriptions written within mixed prescription systems suggests that manual prescriptions should be totally avoided in neonatal units. © 2014 John Wiley & Sons Ltd.

Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan.

PubMed

Hsu, Min-Huei; Yeh, Yu-Ting; Chen, Chien-Yuan; Liu, Chien-Hsiang; Liu, Chien-Tsai

2011-03-01

Doctor shopping (or hospital shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is common in Hong Kong, Taiwan and Japan. Due to the lack of infrastructure for sharing health information and medication history among hospitals, doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions. The Bureau of National Health Insurance (BNHI) adopted smart cards (or NHI-IC cards) as health cards in Taiwan. With their NHI-IC cards, patients can freely access different medical institutions. Because an NHI-IC card carries information about a patient's prescribed medications received from different hospitals nationwide, we used this system to address the problem of duplicate medications for outpatients visiting multiple hospitals. A computerized physician order entry (CPOE) system was enhanced with the capability of accessing NHI-IC cards and providing alerts to physicians when the system detects potential duplicate medications at the time of prescribing. Physician responses to the alerts were also collected to analyze changes in physicians' behavior. Chi-square tests and two-sided z-tests with Bonferroni adjustments for multiple comparisons were used to assess statistical significance of differences in actions taken by physicians over the three months. The enhanced CPOE system for outpatient services was implemented and installed at the Pediatric and Urology Departments of Taipei Medical University Wan-Fang Hospital in March 2007. The "Change Log" that recorded physician behavior was activated during a 3-month study period from April to June 2007. In 67.93% of patient visits, the physicians read patient NHI-IC cards, and in 16.76% of the reads, the NHI-IC card contained at least one prescribed medication that was taken by the patient. Among the prescriptions issued by physicians, on average, there were 2.36% prescriptions containing at least one medication that might be duplicative to the prior prescriptions stored in NHI-IC cards. The rate of potential duplicate medication alerts for the Pediatric Department was higher than that for the Urology Department (2.78% versus 1.67%). However, the rate of revisions to prescriptions was higher in the Urology Department than the Pediatric Department. Overall, the rate of physicians reviewing and revising their prescriptions was 29.25%; the rate of physicians reviewing without revising their prescriptions was 43.62%; the rate of physicians turning off the alert screens right after the screens popped up (overridden) was 27.13%. Thus, physicians accepted alerts to review their prescriptions with patients in most situations (72.87%). Moreover, over the study period, the rate of total revisions made to prescriptions increased and the "overridden" rate decreased. Our approach enhances the capability of CPOE systems using NHI-IC cards as a nationwide infrastructure to provide more complete patient health information and medication history sharing among hospitals in Taiwan. Thus, our system can provide a better prescribing tool to help physicians detect potential duplicate medications for frequent doctor-shopping patients and hence enhance patient safety across hospital boundaries. However, the effectiveness of detecting duplicate medications with our approach is very much dependent on the completeness of NHI-IC cards, which in turn primarily depends on physician use of the cards when prescribing. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Clinician preferences for verbal communication compared to EHR documentation in the ICU

PubMed Central

Collins, S.A.; Bakken, S.; Vawdrey, D.K.; Coiera, E.; Currie, L

2011-01-01

Background Effective communication is essential to safe and efficient patient care. Additionally, many health information technology (HIT) developments, innovations, and standards aim to implement processes to improve data quality and integrity of electronic health records (EHR) for the purpose of clinical information exchange and communication. Objective We aimed to understand the current patterns and perceptions of communication of common goals in the ICU using the distributed cognition and clinical communication space theoretical frameworks. Methods We conducted a focus group and 5 interviews with ICU clinicians and observed 59.5 hours of interdisciplinary ICU morning rounds. Results Clinicians used an EHR system, which included electronic documentation and computerized provider order entry (CPOE), and paper artifacts for documentation; yet, preferred the verbal communication space as a method of information exchange because they perceived that the documentation was often not updated or efficient for information retrieval. These perceptions that the EHR is a “shift behind” may lead to a further reliance on verbal information exchange, which is a valuable clinical communication activity, yet, is subject to information loss. Conclusions Electronic documentation tools that, in real time, capture information that is currently verbally communicated may increase the effectiveness of communication. PMID:23616870

Using Cellulose Nanofibers and Its Palm Oil Pickering Emulsion as Fat Substitutes in Emulsified Sausage.

PubMed

Wang, Yanan; Wang, Wenhang; Jia, Hongjiao; Gao, Guixian; Wang, Xiao; Zhang, Xiaowei; Wang, Yabin

2018-06-01

Nano cellulose is attracting great interest in food and nutraceutical fields and also provides a potential additive to develop functional meat products such as low fat sausage. Here, we compared 1 wt% aqueous dispersion of cellulose nanofiber (CNF) and its palm oil Pickering emulsion (CPOE) at the ratio of 1:1 (water: oil, v:v) for being fat alternatives replacing 30% and 50% of the original fat of the emulsified sausage. Replacing fat by CPOE and CNF resulted in lower fat content, lower cooking loss and higher moisture content and higher lightness values (P ≤ 0.05) at both fat levels. Textural analysis indicated that the products formulated with CPOE showed higher hardness, springiness, chewiness and the texture was enhanced by the addition of CNF, especially when 30% fat was substituted. Compared with the full-fat control, the sausages formulated with CPOE became more elastic and compact, especially by the incorporation of CNF according to the rheology and scanning electron microscope results. The reformulated products with CPOE and CNF at the 30% level showed higher sensory scores (P ≤ 0.05) while at the 50% level produced comparable quality to the control, but no significant differences were found in the overall acceptability. In summary, CNF and its Pickering emulsion provide the potential as potential fat alternatives for developing low fat meat products. Cellulose nanofibers present a variety of distinguishing properties, such as large surface area, great stability and high strength. The ability to stabilize emulsions and good biocompatibility enlarge its application in food. In this study, we attempted to use cellulose nanofibers and its palm oil Pickering emulsion as fat substitutes to partly replace the original fat of pork emulsified sausages, hoping to provide some basic information for using cellulose nanofibers and its Pickering emulsion as fat substitute to high fiber, low fat meat products. © 2018 Institute of Food Technologists®.

Factors influencing the adoption of health information technologies: a systematic review

PubMed Central

Garavand, Ali; Mohseni, Mohammah; Asadi, Heshmatollah; Etemadi, Manal; Moradi-Joo, Mohammad; Moosavi, Ahmad

2016-01-01

Introduction The successful implementation of health information technologies requires investigating the factors affecting the acceptance and use of them. The aim of this study was to determine the most important factors affecting the adoption of health information technologies by doing a systematic review on the factors affecting the acceptance of health information technology. Methods This systematic review was conducted by searching the major databases, such as Google Scholar, Emerald, Science Direct, Web of Science, Pubmed, and Scopus. We used various keywords, such as adoption, use, acceptance of IT in medicine, hospitals, and IT theories in health services, and we also searched on the basis of several important technologies, such as Electronic Health Records (HER), Electronic Patient Records (EPR), Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), Hospital Information System (HIS), Picture Archiving and Communication System (PACS), and others in the 2004–2014 period. Results The technology acceptance model (TAM) is the most important model used to identify the factors influencing the adoption of information technologies in the health system; also, the unified theory of acceptance and use of technology (UTAUT) model has had a lot of applications in recent years in the health system. Ease of use, usefulness, social impact, facilitating conditions, attitudes and behavior of users are effective in the adoption of health information technologies. Conclusion By considering various factors, including ease of use, usefulness, and social impact, the rate of the adoption of health information technology can be increased. PMID:27757179

Factors influencing the adoption of health information technologies: a systematic review.

PubMed

Garavand, Ali; Mohseni, Mohammah; Asadi, Heshmatollah; Etemadi, Manal; Moradi-Joo, Mohammad; Moosavi, Ahmad

2016-08-01

The successful implementation of health information technologies requires investigating the factors affecting the acceptance and use of them. The aim of this study was to determine the most important factors affecting the adoption of health information technologies by doing a systematic review on the factors affecting the acceptance of health information technology. This systematic review was conducted by searching the major databases, such as Google Scholar, Emerald, Science Direct, Web of Science, Pubmed, and Scopus. We used various keywords, such as adoption, use, acceptance of IT in medicine, hospitals, and IT theories in health services, and we also searched on the basis of several important technologies, such as Electronic Health Records (HER), Electronic Patient Records (EPR), Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), Hospital Information System (HIS), Picture Archiving and Communication System (PACS), and others in the 2004-2014 period. The technology acceptance model (TAM) is the most important model used to identify the factors influencing the adoption of information technologies in the health system; also, the unified theory of acceptance and use of technology (UTAUT) model has had a lot of applications in recent years in the health system. Ease of use, usefulness, social impact, facilitating conditions, attitudes and behavior of users are effective in the adoption of health information technologies. By considering various factors, including ease of use, usefulness, and social impact, the rate of the adoption of health information technology can be increased.

An electronic safety screening process during inpatient computerized physician order entry improves the efficiency of magnetic resonance imaging exams.

PubMed

Schneider, Erika; Ruggieri, Paul; Fromwiller, Lauren; Underwood, Reginald; Gurland, Brooke; Yurkschatt, Cynthia; Kubiak, Kevin; Obuchowski, Nancy A

2013-12-01

Delays between order and magnetic resonance (MR) exam often result when using the conventional paper-based MR safety screening process. The impact of an electronic MR safety screening process imbedded in a computerized physician order entry (CPOE) system was evaluated. Retrospective chart review of 4 months of inpatient MR exam orders and reports was performed before and after implementation of electronic MR safety documentation. Time from order to MR exam completion, time from MR exam completion to final radiology report, and time from first order to final report were analyzed by exam anatomy. Length of stay (LOS) and date of service within the admission were also analyzed. We evaluated 1947 individual MR orders in 1549 patients under an institutional review board exemption and a waiver of informed consent. Implementation of the electronic safety screening process resulted in a significant decrease of 1.1 hours (95% confidence interval 1.0-1.3 hours) in the mean time between first order to final report and a nonsignificant decrease of 0.8 hour in the median time from first order to exam end. There was a 1-day reduction (P = .697) in the time from admission to the MR exam compared to the paper process. No significant change in LOS was found except in neurological intensive care patients imaged within the first 24 hours of their admission, where a mean 0.9-day decrease was found. Benefits of an electronic process for MR safety screening include enabling inpatients to have decreased time to MR exams, thus enabling earlier diagnosis and treatment and reduced LOS. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

Computerized pharmacy surveillance and alert system for drug-related problems.

PubMed

Ferrández, O; Urbina, O; Grau, S; Mateu-de-Antonio, J; Marin-Casino, M; Portabella, J; Mojal, S; Riu, M; Salas, E

2017-04-01

Because of the impact of drug-related problems (DRPs) on morbidity and mortality, there is a need for computerized strategies to increase drug safety. The detection and identification of the causes of potential DRPs can be facilitated by the incorporation of a pharmacy warning system (PWS) in the computerized prescriber order entry (CPOE) and its application in the routine validation of inpatient drug therapy. A limited number of studies have evaluated a clinical decision support system to monitor drug treatment. Most of these applications have utilized a small range of drugs with alerts and/or types of alert. The objective of this study was to describe the implementation of a PWS integrated in the electronic medical record (EMR). The PWS was developed in 2003-2004. Pharmacological information to generate drug alerts was entered on demographic data, drug dosage, laboratory tests related to the prescribed drug and drug combinations (interactions, duplications and necessary combinations). The PWS was applied in the prescription reviews conducted in patients admitted to the hospital in 2012. Information on 83% of the drugs included in the pharmacopeia was introduced into the PWS, allowing detection of 2808 potential DRPs, representing 79·1% of all potential DRPs detected during the study period. Twenty per cent of PWS DRPs were clinically relevant, requiring pharmacist intervention. The PWS detected most potential DRPs, thus increasing inpatient safety. The detection ability of the PWS was higher than that reported for other tools described in the literature. © 2017 John Wiley & Sons Ltd.

Development of an Instrument for Measuring Clinicians’ Power Perceptions in the Workplace

PubMed Central

Bartos, Christa E.; Fridsma, Douglas B.; Butler, Brian S.; Penrod, Louis E.; Becich, Michael J.; Crowley, Rebecca S.

2008-01-01

We report on the development of an instrument to measure clinicians’ perceptions of their personal power in the workplace in relation to resistance to computerized physician order entry (CPOE). The instrument is based on French and Raven’s six bases of social power and uses a semantic differential methodology. A measurement study was conducted to determine the reliability and validity of the survey. The survey was administered online and distributed via a URL by email to 19 physicians, nurses, and health unit coordinators from a university hospital. Acceptable reliability was achieved by removing or moving some semantic differential word pairs used to represent the six power bases (alpha range from 0.76–0.89). The Semantic Differential Power Perception (SDPP) survey validity was tested against an already validated instrument and found to be acceptable (correlation range from 0.51–0.81). The SDPP survey instrument was determined to be both reliable and valid. PMID:18375189

Factors associated with adoption of health information technology: a conceptual model based on a systematic review.

PubMed

Kruse, Clemens Scott; DeShazo, Jonathan; Kim, Forest; Fulton, Lawrence

2014-05-23

The Health Information Technology for Economic and Clinical Health Act (HITECH) allocated $19.2 billion to incentivize adoption of the electronic health record (EHR). Since 2009, Meaningful Use Criteria have dominated information technology (IT) strategy. Health care organizations have struggled to meet expectations and avoid penalties to reimbursements from the Center for Medicare and Medicaid Services (CMS). Organizational theories attempt to explain factors that influence organizational change, and many theories address changes in organizational strategy. However, due to the complexities of the health care industry, existing organizational theories fall short of demonstrating association with significant health care IT implementations. There is no organizational theory for health care that identifies, groups, and analyzes both internal and external factors of influence for large health care IT implementations like adoption of the EHR. The purpose of this systematic review is to identify a full-spectrum of both internal organizational and external environmental factors associated with the adoption of health information technology (HIT), specifically the EHR. The result is a conceptual model that is commensurate with the complexity of with the health care sector. We performed a systematic literature search in PubMed (restricted to English), EBSCO Host, and Google Scholar for both empirical studies and theory-based writing from 1993-2013 that demonstrated association between influential factors and three modes of HIT: EHR, electronic medical record (EMR), and computerized provider order entry (CPOE). We also looked at published books on organizational theories. We made notes and noted trends on adoption factors. These factors were grouped as adoption factors associated with various versions of EHR adoption. The resulting conceptual model summarizes the diversity of independent variables (IVs) and dependent variables (DVs) used in articles, editorials, books, as well as quantitative and qualitative studies (n=83). As of 2009, only 16.30% (815/4999) of nonfederal, acute-care hospitals had adopted a fully interoperable EHR. From the 83 articles reviewed in this study, 16/83 (19%) identified internal organizational factors and 9/83 (11%) identified external environmental factors associated with adoption of the EHR, EMR, or CPOE. The conceptual model for EHR adoption associates each variable with the work that identified it. Commonalities exist in the literature for internal organizational and external environmental factors associated with the adoption of the EHR and/or CPOE. The conceptual model for EHR adoption associates internal and external factors, specific to the health care industry, associated with adoption of the EHR. It becomes apparent that these factors have some level of association, but the association is not consistently calculated individually or in combination. To better understand effective adoption strategies, empirical studies should be performed from this conceptual model to quantify the positive or negative effect of each factor.

Hospital pharmacy practice in Saudi Arabia: Prescribing and transcribing in the Riyadh region

PubMed Central

Alsultan, Mohammed S.; Khurshid, Fowad; Salamah, Heba J.; Mayet, Ahmed Y.; Al-jedai, Ahmed H.

2011-01-01

Purpose The purpose of this survey is to outline pharmacy services in hospitals on a regional level in the Kingdom of Saudi Arabia. Methods A modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire as pertinent to Saudi Arabia was used to conduct a national survey. After discussing with the pharmacy directors of 48 hospitals in the Riyadh region over the phone on the survey’s purpose, the questionnaires were personally delivered and collected upon completion. The hospital lists were drawn from the Ministry of Health hospital database. Results Twenty-nine hospitals participated in the survey giving a response rate of 60.4%. Approximately 60% of the hospitals which participated in the survey required prior approval for the use of non-formulary medications. About 83.3% of hospitals reviewed compliance with clinical practice guidelines and 72.7% hospitals reported that pharmacists are also actively involved in these activities. Pharmacists in more than 95% of hospitals provided consultations on drug information. A staff pharmacist routinely answering questions was the most frequently cited (74.1%) method by which objective drug information was provided to prescribers. Electronic drug information resources were available in 77.7% of hospitals, although internet use is not widely available to hospital pharmacists, with only 58.6% of hospitals providing pharmacist access to the internet. About, 34.5% of hospitals had computerized prescriber order entry (CPOE) systems with clinical decision-support systems (CDSSs) and 51.9% of the hospitals had electronic medical record (EMR) system. Conclusion Hospital pharmacists are increasingly using electronic technologies to improve prescribing and transcribing of medications in Saudi Arabia. PMID:23960794

Enabling medication management through health information technology (Health IT).

PubMed

McKibbon, K Ann; Lokker, Cynthia; Handler, Steve M; Dolovich, Lisa R; Holbrook, Anne M; O'Reilly, Daria; Tamblyn, Robyn; J Hemens, Brian; Basu, Runki; Troyan, Sue; Roshanov, Pavel S; Archer, Norman P; Raina, Parminder

2011-04-01

The objective of the report was to review the evidence on the impact of health information technology (IT) on all phases of the medication management process (prescribing and ordering, order communication, dispensing, administration and monitoring as well as education and reconciliation), to identify the gaps in the literature and to make recommendations for future research. We searched peer-reviewed electronic databases, grey literature, and performed hand searches. Databases searched included MEDLINE®, Embase, CINAHL (Cumulated Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts, Compendex, Inspec (which includes IEEE Xplore), Library and Information Science Abstracts, E-Prints in Library and Information Science, PsycINFO, Sociological Abstracts, and Business Source Complete. Grey literature searching involved Internet searching, reviewing relevant Web sites, and searching electronic databases of grey literatures. AHRQ also provided all references in their e-Prescribing, bar coding, and CPOE knowledge libraries. Paired reviewers looked at citations to identify studies on a range of health IT used to assist in the medication management process (MMIT) during multiple levels of screening (titles and abstracts, full text and final review for assignment of questions and data abstrction). Randomized controlled trials and cohort, case-control, and case series studies were independently assessed for quality. All data were abstracted by one reviewer and examined by one of two different reviewers with content and methods expertise. 40,582 articles were retrieved. After duplicates were removed, 32,785 articles were screened at the title and abstract phase. 4,578 full text articles were assessed and 789 articles were included in the final report. Of these, 361 met only content criteria and were listed without further abstraction. The final report included data from 428 articles across the seven key questions. Study quality varied according to phase of medication management. Substantially more studies, and studies with stronger comparative methods, evaluated prescribing and monitoring. Clinical decision support systems (CDSS) and computerized provider order entry (CPOE) systems were studied more than any other application of MMIT. Physicians were more often the subject of evaluation than other participants. Other health care professionals, patients, and families are important but not studied as thoroughly as physicians. These nonphysicians groups often value different aspects of MMIT, have diverse needs, and use systems differently. Hospitals and ambulatory clinics were well-represented in the literature with less emphasis placed on long-term care facilities, communities, homes, and nonhospital pharmacies. Most studies evaluated changes in process and outcomes of use, usability, and knowledge, skills, and attitudes. Most showed moderate to substantial improvement with implementation of MMIT. Economics studies and those with clinical outcomes were less frequently studied. Those articles that did address economics and clinical outcomes often showed equivocal findings on the effectiveness and cost-effectiveness of MMIT systems. Qualitative studies provided evidence of strong perceptions, both positive and negative, of the effects of MMIT and unintended consequences. We found little data on the effects of forms of medications, conformity, standards, and open source status. Much descriptive literature discusses implementation issues but little strong evidence exists. Interest is strong in MMIT and more groups and institutions will implement systems in the next decades, especially with the Federal Government's push toward more health IT to support better and more cost-effective health care. MMIT is well-studied, although on closer examination of the literature the evidence is not uniform across phases of medication management, groups of people involved, or types of MMIT. MMIT holds the promise of improved processes; clinical and economics studies and the understanding of sustainability issues are lacking.

Incidence of potential drug interactions in a transplant centre setting and relevance of electronic alerts for clinical practice support.

PubMed

Polidori, Piera; Di Giorgio, Concetta; Provenzani, Alessio

2012-01-01

Adverse drug events may occur as a result of drug-drug interactions (DDIs). Information technology (IT) systems can be an important decision-making tool for healthcare workers to identify DDIs. The aim of the study is to analyse drug prescriptions in our main hospital units, in order to measure the incidence and severity of potential DDIs. The utility of clinical decision-support systems (CDSSs) and computerised physician order entry (CPOE) in term of alerts adherence was also assessed. DDIs were assessed using a Micromedex® healthcare series database. The system, adopted by the hospital, generates alerts for prescriptions with negative interactions and thanks to an 'acknowledgement function' it is possible to verify physician adherence to alerts. This function, although used previously, became mandatory from September 2010. Physician adherence to alerts and mean monthly incidence of potential DDIs in analysed units, before and after the mandatory 'acknowledgement function', were calculated. The intensive care unit (ICU) registered the greatest incidence of potential DDIs (49.0%), followed by the abdominal surgery unit and dialysis (43.4 and 42.0%, respectively). The cardiothoracic surgery unit (41.6%), step-down unit (38.3%) and post-anaesthesia care unit (30.0%) were comparable. The operating theatre and endoscopy registered the fewest potential DDIs (28.2 and 22.7%, respectively). Adherence to alerts after the 'acknowledgement function' increased by 25.0% in the ICU, 54.0% in the cardiothoracic surgery unit, 52.5% in the abdominal surgery unit, 58.0% in the stepdown unit, 67.0% in dialysis, 51.0% in endoscopy and 48.0% in the post-anaesthesia care unit. In the operating theatre, adherence to alerts decreased from 34.0 to 30.0%. The incidence of potential DDIs after mandatory use of the 'acknowledgement function' decreased slightly in endoscopy (-2.9%), the abdominal surgery unit (-2.7%), dialysis (-1.9%) and the step-down unit (-1.4%). Improving DDI alerts will improved patient safety by more appropriately alerting clinicians.

Renal Drug Dosing

PubMed Central

Vogel, Erin A.; Billups, Sarah J.; Herner, Sheryl J.

2016-01-01

Summary Objective The purpose of this study was to compare the effectiveness of an outpatient renal dose adjustment alert via a computerized provider order entry (CPOE) clinical decision support system (CDSS) versus a CDSS with alerts made to dispensing pharmacists. Methods This was a retrospective analysis of patients with renal impairment and 30 medications that are contraindicated or require dose-adjustment in such patients. The primary outcome was the rate of renal dosing errors for study medications that were dispensed between August and December 2013, when a pharmacist-based CDSS was in place, versus August through December 2014, when a prescriber-based CDSS was in place. A dosing error was defined as a prescription for one of the study medications dispensed to a patient where the medication was contraindicated or improperly dosed based on the patient’s renal function. The denominator was all prescriptions for the study medications dispensed during each respective study period. Results During the pharmacist- and prescriber-based CDSS study periods, 49,054 and 50,678 prescriptions, respectively, were dispensed for one of the included medications. Of these, 878 (1.8%) and 758 (1.5%) prescriptions were dispensed to patients with renal impairment in the respective study periods. Patients in each group were similar with respect to age, sex, and renal function stage. Overall, the five-month error rate was 0.38%. Error rates were similar between the two groups: 0.36% and 0.40% in the pharmacist- and prescriber-based CDSS, respectively (p=0.523). The medication with the highest error rate was dofetilide (0.51% overall) while the medications with the lowest error rate were dabigatran, fondaparinux, and spironolactone (0.00% overall). Conclusions Prescriber- and pharmacist-based CDSS provided comparable, low rates of potential medication errors. Future studies should be undertaken to examine patient benefits of the prescriber-based CDSS. PMID:27466041

The impact of electronic medical record systems on outpatient workflows: a longitudinal evaluation of its workflow effects.

PubMed

Vishwanath, Arun; Singh, Sandeep Rajan; Winkelstein, Peter

2010-11-01

The promise of the electronic medical record (EMR) lies in its ability to reduce the costs of health care delivery and improve the overall quality of care--a promise that is realized through major changes in workflows within the health care organization. Yet little systematic information exists about the workflow effects of EMRs. Moreover, some of the research to-date points to reduced satisfaction among physicians after implementation of the EMR and increased time, i.e., negative workflow effects. A better understanding of the impact of the EMR on workflows is, hence, vital to understanding what the technology really does offer that is new and unique. (i) To empirically develop a physician centric conceptual model of the workflow effects of EMRs; (ii) To use the model to understand the antecedents to the physicians' workflow expectation from the new EMR; (iii) To track physicians' satisfaction overtime, 3 months and 20 months after implementation of the EMR; (iv) To explore the impact of technology learning curves on physicians' reported satisfaction levels. The current research uses the mixed-method technique of concept mapping to empirically develop the conceptual model of an EMR's workflow effects. The model is then used within a controlled study to track physician expectations from a new EMR system as well as their assessments of the EMR's performance 3 months and 20 months after implementation. The research tracks the actual implementation of a new EMR within the outpatient clinics of a large northeastern research hospital. The pre-implementation survey netted 20 physician responses; post-implementation Time 1 survey netted 22 responses, and Time 2 survey netted 26 physician responses. The implementation of the actual EMR served as the intervention. Since the study was conducted within the same setting and tracked a homogenous group of respondents, the overall study design ensured against extraneous influences on the results. Outcome measures were derived empirically from the conceptual model. They included 85 items that measured physician perceptions of the EMR's workflow effect on the following eight issues: (1) administration, (2) efficiency in patient processing, (3) basic clinical processes, (4) documentation of patient encounter, (5) economic challenges and reimbursement, (6) technical issues, (7) patient safety and care, and (8) communication and confidentiality. The items were used to track expectations prior to implementation and they served as retrospective measures of satisfaction with the EMR in post-implementation Time 1 and Time 2. The findings suggest that physicians conceptualize EMRs as an incremental extension of older computerized provider order entries (CPOEs) rather than as a new innovation. The EMRs major functional advantages are seen to be very similar to, if not the same as, those of CPOEs. Technology learning curves play a statistically significant though minor role in shaping physician perceptions. The physicians' expectations from the EMR are based on their prior beliefs rather than on a rational evaluation of the EMR's fit, functionality, or performance. Their decision regarding the usefulness of the EMR is made very early, within the first few months of use of the EMR. These early perceptions then remain stable and become the lens through which subsequent experience with the EMR is interpreted. The findings suggest a need for communication based interventions aimed at explaining the value, fit, and usefulness of EMRs to physicians early in the pre- and immediate post-EMR implementation stages. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

A Computer Prescribing Order Entry-Clinical Decision Support system designed for neonatal care: results of the 'preselected prescription' concept at the bedside.

PubMed

Gouyon, B; Iacobelli, S; Saliba, E; Quantin, C; Pignolet, A; Jacqz-Aigrain, E; Gouyon, J B

2017-02-01

The neonatal intensive care units (NICUs) are at the highest risk of drug dose error of all hospital wards. NICUs also have the most complicated prescription modalities. The computerization of the prescription process is currently recommended to decrease the risk of preventable adverse drug effects (pADEs) in NICUs. However, Computer Prescribing Order Entry-Clinical Decision Support (C.P.O.E./C.D.S.) systems have been poorly studied in NICUs, and their technical compatibility with neonatal specificities has been limited. We set up a performance study of the preselected prescription of drugs for neonates, which limited the role of the prescriber to choosing the drugs and their indications. A single 29 bed neonatal ward used this neonatal C.P.O.E./C.D.S. system for all prescriptions of all hospitalized newborns over an 18-month period. The preselected prescription of drugs was based on the indication, gestational age, body weight and post-natal age. The therapeutic protocols were provided by a formulary reference (330 drugs) that had been specifically designed for newborns. The preselected prescription also gave complete information about preparation and administration of drugs by nurses. The prescriber was allowed to modify the preselected prescription but alarms provided warning when the prescription was outside the recommended range. The main clinical characteristics and all items of each line of prescription were stored in a data warehouse, thus enabling this study to take place. Seven hundred and sixty successive newborns (from 24 to 42 weeks' gestation) were prescribed 52 392 lines of prescription corresponding to 65 drugs; About 30·4% of neonates had at least one out of licensed prescription; A prescription out of the recommended range for daily dose was recorded for 1·0% of all drug prescriptions. WHAT IS NEW?: The C.P.O.E./C.D.S. systems can currently provide a complete preselected prescription in NICUs according to dose rules, which are specific to newborns and also comply with local specificities (therapeutic protocols and formulation of drugs). The role of the prescriber is limited to the choice of drugs and their indications. The prescriber still retains the possibility of modifying each item of the prescription, with all other prescription items being calculated by the C.P.O.E. system. In these conditions, the prescribers rarely modified the preselected prescription and the rate of out of range prescription was low. A multicentric study is required to confirm and extend these observations. This study showed the feasibility of preselected prescription in NICUs and a low rate of out of range prescriptions. The preselected prescription could play a key role in lowering the dose error rate in NICUs. © 2016 John Wiley & Sons Ltd.

Gaming against medical errors: methods and results from a design game on CPOE.

PubMed

Kanstrup, Anne Marie; Nøhr, Christian

2009-01-01

The paper presents design game as a technique for participatory design for a Computerized Decision Support System (CDSS) for minimizing medical errors. Design game is used as a technique for working with the skills of users, the complexity of the use practice and the negotiation of design here within the challenging domain of medication. The paper presents a developed design game based on game inspiration from a computer game, theoretical inspiration on electronic decision support, and empirical grounding in scenarios of medical errors. The game has been played in a two-hour workshop with six clinicians. The result is presented as a list of central themes for design of CDSS and derived design principles from these themes. These principles are currently under further exploration in follow up prototype based activities.

Oil-return characteristics of refrigerant oils in split heat pump system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sundaresan, S.G.; Radermacher, R.

1996-08-01

Currently, HFC substitute refrigerants for R-22 are being evaluated in air-conditioning and heat pump applications. The oil return characteristics and heat transfer effects of the lubricants are being studied again. Based on commercial refrigeration experience POEs are the lubricants of choice for HFC refrigerants. POEs have two major drawbacks: hygroscopicity and high cost. Thus the question is raised to what extent is it possible to replace POEs with a lower cost, but immiscible, oil such as mineral oil. It is the purpose of this study to experimentally investigate the oil return behavior of R-407C with mineral oil in a splitmore » three-ton heat pump in comparison to R407C/POE and R-22/Mineral Oil.« less

24 CFR 350.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Security) maintained in the Book-entry System, as set forth in Federal Reserve Bank Operating Circulars. (b...: Book-entry Ginnie Mae Security. A Ginnie Mae Security issued or maintained in the Book-entry System... Reserve Banks. Book-entry System. The automated book-entry system operated by the Federal Reserve Banks...

EMR Database Upgrade from MUMPS to CACHE: Lessons Learned.

PubMed

Alotaibi, Abduallah; Emshary, Mshary; Househ, Mowafa

2014-01-01

Over the past few years, Saudi hospitals have been implementing and upgrading Electronic Medical Record Systems (EMRs) to ensure secure data transfer and exchange between EMRs.This paper focuses on the process and lessons learned in upgrading the MUMPS database to a the newer Caché database to ensure the integrity of electronic data transfer within a local Saudi hospital. This paper examines the steps taken by the departments concerned, their action plans and how the change process was managed. Results show that user satisfaction was achieved after the upgrade was completed. The system was stable and offered better healthcare quality to patients as a result of the data exchange. Hardware infrastructure upgrades improved scalability and software upgrades to Caché improved stability. The overall performance was enhanced and new functions were added (CPOE) during the upgrades. The essons learned were: 1) Involve higher management; 2) Research multiple solutions available in the market; 3) Plan for a variety of implementation scenarios.

31 CFR 357.0 - Book-entry systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... General Information § 357.0 Book-entry systems. (a) Treasury securities. Treasury securities are...-entry system is the book-entry system in which Treasury securities are held in a tiered system through securities intermediaries such as financial institutions or brokerage firms. A Treasury security is...

31 CFR 357.0 - Book-entry systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... General Information § 357.0 Book-entry systems. (a) Treasury securities. Treasury securities are...-entry system is the book-entry system in which Treasury securities are held in a tiered system through securities intermediaries such as financial institutions or brokerage firms. A Treasury security is...

31 CFR 357.0 - Book-entry systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... General Information § 357.0 Book-entry systems. (a) Treasury securities. Treasury securities are...-entry system is the book-entry system in which Treasury securities are held in a tiered system through securities intermediaries such as financial institutions or brokerage firms. A Treasury security is...

31 CFR 357.0 - Book-entry systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... General Information § 357.0 Book-entry systems. (a) Treasury securities. Treasury securities are...-entry system is the book-entry system in which Treasury securities are held in a tiered system through securities intermediaries such as financial institutions or brokerage firms. A Treasury security is...

31 CFR 306.23 - Securities eligible to be held in the Legacy Treasury Direct® Book-entry Securities System.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Legacy Treasury Direct® Book-entry Securities System. 306.23 Section 306.23 Money and Finance: Treasury... Securities eligible to be held in the Legacy Treasury Direct® Book-entry Securities System. (a) Eligible... book-entry securities system. (b) Conversion of Registered Security to book-entry form to be held in...

Study of advanced atmospheric entry systems for Mars

NASA Technical Reports Server (NTRS)

1978-01-01

Entry system designs are described for various advanced Mars missions including sample return, hard lander, and Mars airplane. The Mars exploration systems for sample return and the hard lander require decleration from direct approach entry velocities of about 6 km/s to terminal velocities consistent with surface landing requirements. The Mars airplane entry system is decelerated from orbit at 4.6 km/s to deployment near the surface. Mass performance characteristics of major elements of the Mass performance characteristics are estimated for the major elements of the required entry systems using Viking technology or logical extensions of technology in order to provide a common basis of comparison for the three entry modes mission mode approaches. The entry systems, although not optimized, are based on Viking designs and reflect current hardware performance capability and realistic mass relationships.

31 CFR 306.23 - Securities eligible to be held in the TREASURY DIRECT Book-entry Securities System.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TREASURY DIRECT Book-entry Securities System. 306.23 Section 306.23 Money and Finance: Treasury Regulations... Securities eligible to be held in the TREASURY DIRECT Book-entry Securities System. (a) Eligible issues. The... conversion to the TREASURY DIRECT Book-entry Securities System. The notice shall specify the period during...

31 CFR 357.0 - Book-entry systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Book-entry systems. 357.0 Section 357..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING BOOK-ENTRY TREASURY BONDS, NOTES AND BILLS HELD IN LEGACY TREASURY DIRECT General Information § 357.0 Book-entry systems. (a) Treasury...

Mars Pathfinder flight system integration and test.

NASA Astrophysics Data System (ADS)

Muirhead, B. K.

This paper describes the system integration and test experiences, problems and lessons learned during the assembly, test and launch operations (ATLO) phase of the Mars Pathfinder flight system scheduled to land on the surface of Mars on July 4, 1997. The Mars Pathfinder spacecraft consists of three spacecraft systems: cruise stage, entry vehicle and lander. The cruise stage carries the entry and lander vehicles to Mars and is jettisoned prior to entry. The entry vehicle, including aeroshell, parachute and deceleration rockets, protects the lander during the direct entry and reduces its velocity from 7.6 to 0 km/s in stages during the 5 min entry sequence. The lander's touchdown is softened by airbags which are retracted once stopped on the surface. The lander then uprights itself, opens up fully and begins surface operations including deploying its camera and rover. This paper overviews the system design and the results of the system integration and test activities, including the entry, descent and landing subsystem elements. System test experiences including science instruments, the microrover, Sojourner, and software are discussed. The final qualification of the entry, descent and landing subsystems during this period is also discussed.

24 CFR 350.11 - Notice of Attachment for Ginnie Mae Securities in Book-entry System.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Securities in Book-entry System. 350.11 Section 350.11 Housing and Urban Development Regulations Relating to... AND URBAN DEVELOPMENT BOOK-ENTRY PROCEDURES § 350.11 Notice of Attachment for Ginnie Mae Securities in Book-entry System. The interest of a debtor in a Security Entitlement may be reached by a creditor only...

24 CFR 350.11 - Notice of Attachment for Ginnie Mae Securities in Book-entry System.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Securities in Book-entry System. 350.11 Section 350.11 Housing and Urban Development Regulations Relating to... AND URBAN DEVELOPMENT BOOK-ENTRY PROCEDURES § 350.11 Notice of Attachment for Ginnie Mae Securities in Book-entry System. The interest of a debtor in a Security Entitlement may be reached by a creditor only...

24 CFR 350.11 - Notice of Attachment for Ginnie Mae Securities in Book-entry System.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Securities in Book-entry System. 350.11 Section 350.11 Housing and Urban Development Regulations Relating to... AND URBAN DEVELOPMENT BOOK-ENTRY PROCEDURES § 350.11 Notice of Attachment for Ginnie Mae Securities in Book-entry System. The interest of a debtor in a Security Entitlement may be reached by a creditor only...

47 CFR 11.14 - Primary Entry Point (PEP) System.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Primary Entry Point (PEP) System. 11.14 Section 11.14 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL EMERGENCY ALERT SYSTEM (EAS) General § 11.14 Primary Entry Point (PEP) System. The PEP system is a nationwide network of broadcast...

47 CFR 11.14 - Primary Entry Point (PEP) System.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Primary Entry Point (PEP) System. 11.14 Section 11.14 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL EMERGENCY ALERT SYSTEM (EAS) General § 11.14 Primary Entry Point (PEP) System. The PEP system is a nationwide network of broadcast...

31 CFR 357.22 - Transfers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AND BILLS HELD IN LEGACY TREASURY DIRECT Legacy Treasury Direct Book-Entry Securities System (Legacy...-entry system, and TreasuryDirect ®. A security may also be transferred between accounts in Legacy... system. A transfer of a security from Legacy Treasury Direct to the commercial book-entry system is...

12 CFR 615.5450 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND OPERATIONS, AND FUNDING OPERATIONS Book-Entry Procedures for Farm Credit Securities § 615.5450... the claimant for another person to hold, transfer, or deal with the security. (b) Book-entry security means a Farm Credit security issued or maintained in the Book-entry System. (c) Book-entry System means...

78 FR 66803 - Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... Transfer of U.S. Treasury Book-Entry Securities Held on the National Book-Entry System AGENCY: Bureau of... (Treasury) is announcing a new fee schedule applicable to transfers of U.S. Treasury book-entry securities maintained on the National Book-Entry System (NBES) that occur on or after January 2, 2014. DATES: Effective...

31 CFR 356.4 - What are the book-entry systems in which auctioned Treasury securities may be issued or maintained?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false What are the book-entry systems in... BUREAU OF THE PUBLIC DEBT SALE AND ISSUE OF MARKETABLE BOOK-ENTRY TREASURY BILLS, NOTES, AND BONDS... book-entry systems in which auctioned Treasury securities may be issued or maintained? There are three...

12 CFR 615.5560 - Book-entry Procedure for Farm Credit System Financial Assistance Corporation Securities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OPERATIONS Farm Credit System Financial Assistance Corporation Securities § 615.5560 Book-entry Procedure for Farm Credit System Financial Assistance Corporation Securities. (a) The Farm Credit System Financial... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Book-entry Procedure for Farm Credit System...

78 FR 14290 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-05

... Fitness File (June 11, 1997, 62 FR 31793). * * * * * Changes: System ID: Delete entry and replace with ``F036 AF A1 I.'' System Name: Delete entry and replace with ``Air Force Fitness Program.'' System location: Delete entry and replace with ``Air Force Fitness Management System (AFFMS) is located at Defense...

Overview of the Phoenix Entry, Descent and Landing System

NASA Technical Reports Server (NTRS)

Grover, Rob

2005-01-01

A viewgraph presentation on the entry, descent and landing system of Phoenix is shown. The topics include: 1) Phoenix Mission Goals; 2) Payload; 3) Aeroshell/Entry Comparison; 4) Entry Trajectory Comparison; 5) Phoenix EDL Timeline; 6) Hypersonic Phase; 7) Parachute Phase; 8) Terminal Descent Phase; and 9) EDL Communications.

Orion Entry Display Feeder and Interactions with the Entry Monitor System

NASA Technical Reports Server (NTRS)

Baird, Darren; Bernatovich, Mike; Gillespie, Ellen; Kadwa, Binaifer; Matthews, Dave; Penny, Wes; Zak, Tim; Grant, Mike; Bihari, Brian

2010-01-01

The Orion spacecraft is designed to return astronauts to a landing within 10 km of the intended landing target from low Earth orbit, lunar direct-entry, and lunar skip-entry trajectories. Al pile the landing is nominally controlled autonomously, the crew can fly precision entries manually in the event of an anomaly. The onboard entry displays will be used by the crew to monitor and manually fly the entry, descent, and landing, while the Entry Monitor System (EMS) will be used to monitor the health and status of the onboard guidance and the trajectory. The entry displays are driven by the entry display feeder, part of the Entry Monitor System (EMS). The entry re-targeting module, also part of the EMS, provides all the data required to generate the capability footprint of the vehicle at any point in the trajectory, which is shown on the Primary Flight Display (PFD). It also provides caution and warning data and recommends the safest possible re-designated landing site when the nominal landing site is no longer within the capability of the vehicle. The PFD and the EMS allow the crew to manually fly an entry trajectory profile from entry interface until parachute deploy having the flexibility to manually steer the vehicle to a selected landing site that best satisfies the priorities of the crew. The entry display feeder provides data from the ENIS and other components of the GNC flight software to the displays at the proper rate and in the proper units. It also performs calculations that are specific to the entry displays and which are not made in any other component of the flight software. In some instances, it performs calculations identical to those performed by the onboard primary guidance algorithm to protect against a guidance system failure. These functions and the interactions between the entry display feeder and the other components of the EMS are described.

Health systems: changes in hospital efficiency and profitability.

PubMed

Büchner, Vera Antonia; Hinz, Vera; Schreyögg, Jonas

2016-06-01

This study investigates potential changes in hospital performance after health system entry, while differentiating between hospital technical and cost efficiency and hospital profitability. In the first stage we obtained (bootstrapped) data envelopment analysis (DEA) efficiency scores. Then, genetic matching is used as a novel matching procedure in this context along with a difference-in-difference approach within a panel regression framework. With the genetic matching procedure, independent and health system hospitals are matched along a number of environmental and organizational characteristics. The results show that health system entry increases hospital technical and cost efficiency by between 0.6 and 3.4 % in four alternative post-entry periods, indicating that health system entry has not a transitory but rather a permanent effect on hospital efficiency. Regarding hospital profitability, the results reveal an increase in hospital profitability only 1 year after health system entry, and the estimations suggest that this effect is a transitional phenomenon. Overall, health system entry may serve as an appropriate management instrument for decision makers to increase hospital performance.

What systems participants know about access and service entry and why managers should listen.

PubMed

Duncombe, Rohena

2017-08-01

Objective The present study looked at the views of people directly involved in the entry process for community health counselling using the frame of the health access literature. The concurrence of system participants' views with the access literature highlights access issues, particularly for people who are vulnerable or disadvantaged. The paper privileges the voices of the system participants, inviting local health services to consider using participatory design to improve access at the entry point. Methods People involved in the entry process for community health counselling explored the question, 'What, for you, are the features of a good intake system?' They also commented on themes identified during pilot interviews. These were thematically analysed for each participant group by the researcher to develop a voice for each stakeholder group. Results People accessing the service could be vulnerable and the entry process failed to take that into account. People directly involved in the counselling service entry system, system participants, consisted of: professionals referring in, people seeking services and reception staff taking first enquiries. They shared substantially the same concerns as each other. The responses from these system participants are consistent with the international literature on access and entry into health services. Conclusion Participatory service design could improve primary healthcare service entry at the local level. Canvassing the experiences of system participants is important for delivering services to those who have the least access and, in that way, could contribute to health equity. What is known about the topic? People with the highest health needs receive the fewest services. Health inequality is increasing. What does this paper add? System participants can provide advice consistent with the academic research literature that is useful for improving service entry at the local level. What are the implications for practitioners? Participatory design can inform policy makers and service providers. Entry systems could acknowledge the potential vulnerability or disadvantage of people approaching the service.

Shuttle launched flight tests - Supporting technology for planetary entry missions

NASA Technical Reports Server (NTRS)

Vetter, H. C.; Mcneilly, W. R.; Siemers, P. M., III; Nachtsheim, P. R.

1975-01-01

The feasibility of conducting Space Shuttle-launched earth entry flight tests to enhance the technology base for second generation planetary entry missions is examined. Outer planet entry environments are reviewed, translated into earth entry requirements and used to establish entry test system design and cost characteristics. Entry speeds up to those needed to simulate radiative heating levels of more than 30 kW/sq cm are shown to be possible. A standardized recoverable test bed concept is described that is capable of accommodating a wide range of entry technology experiments. The economic advantage of shared Shuttle launches are shown to be achievable through a test system configured to the volume constraints of a single Spacelab pallet using existing propulsion components.

Application of the FADS system on the Re-entry Module

NASA Astrophysics Data System (ADS)

Zhen, Huang

2016-07-01

The aerodynamic model for Flush Air Data Sensing System (FADS) is built based on the surface pressure distribution obtained through the pressure orifices laid on specific positions of the surface,and the flight parameters,such as angle of attack,angle of side-slip,Mach number,free-stream static pressure and dynamic pressure are inferred from the aerodynamic model.The flush air data sensing system (FADS) has been used on several flight tests of aircraft and re-entry vehicle,such as,X-15,space shuttle,F-14,X-33,X-43A and so on. This paper discusses the application of the FADS on the re-entry module with blunt body to obtain high-precision aerodynamic parameters.First of all,a basic theory and operating principle of the FADS is shown.Then,the applications of the FADS on typical aircrafts and re-entry vehicles are described.Thirdly,the application mode on the re-entry module with blunt body is discussed in detail,including aerodynamic simulation,pressure distribution,trajectory reconstruction and the hardware shoule be used,such as flush air data sensing system(FADS),inertial navigation system (INS),data acquisition system,data storage system.Finally,ablunt module re-entry flight test from low earth orbit (LEO) is planned to obtain aerodynamic parameters and amend the aerodynamic model with this FADS system data.The results show that FADS system can be applied widely in re-entry module with blunt bodies.

31 CFR 356.4 - What are the book-entry systems in which auctioned Treasury securities may be issued?

Code of Federal Regulations, 2010 CFR

2010-07-01

... in which auctioned Treasury securities may be issued? There are three book-entry securities systems... marketable Treasury securities. We maintain and transfer securities in these three book-entry systems at... inflation. Securities may be transferred from one system to the other, unless the securities are not...

18 CFR 1314.2 - Definition of terms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PROCEDURES FOR TVA POWER SECURITIES ISSUED THROUGH THE FEDERAL RESERVE BANKS § 1314.2 Definition of terms... applicable. (a) Book-entry System means the automated book-entry system operated by the Reserve Banks acting... issued or maintained in the Book-entry System of the Reserve Banks. (c) CUSIP Number is a unique...

An assessment of the impact of transition on advanced winged entry vehicle thermal protection system mass

NASA Technical Reports Server (NTRS)

Wurster, K. E.

1981-01-01

This study examines the impact of turbulent heating on thermal protection system (TPS) mass for advanced winged entry vehicles. Four basic systems are considered: insulative, metallic hot structures, metallic standoff, and hybrid systems. TPS sizings are performed using entry trajectories tailored specifically to the characteristics of each TPS concept under consideration. Comparisons are made between systems previously sized under the assumption of all laminar heating and those sized using a baseline estimate of transition and turbulent heating. The relative effect of different transition criteria on TPS mass requirements is also examined. Also investigated are entry trajectories tailored to alleviate turbulent heating. Results indicate the significant impact of turbulent heating on TPS mass and demonstrate the importance of both accurate transition criteria and entry trajectory tailoring.

Ames Infusion Stories for NASA Annual Technology Report: Nano Entry System for CubeSat-Class Payloads

NASA Technical Reports Server (NTRS)

Smith, Brandon; Jan, Darrell Leslie; Venkatapathy, Etiraj

2015-01-01

The Nano Entry System for CubeSat-Class Payloads led to the development of the Nano-Adaptable Deployable Entry and Placement Technology ("Nano-ADEPT"). Nano-ADEPT is a mechanically deployed entry, descent, and landing (EDL) system that stows during launch and cruise (like an umbrella) and serves as both heat shield and primary structure during EDL. It is especially designed for small spacecraft where volume is a limiting constraint.

Enabling Venus In-Situ Science - Deployable Entry System Technology, Adaptive Deployable Entry and Placement Technology (ADEPT): A Technology Development Project funded by Game Changing Development Program of the Space Technology Program

NASA Technical Reports Server (NTRS)

Wercinski, Paul F.; Venkatapathy, Ethiraj; Gage, Peter J.; Yount, Bryan C.; Prabhu, Dinesh K.; Smith, Brandon; Arnold, James O.; Makino, alberto; Peterson, Keith Hoppe; Chinnapongse, Ronald I.

2012-01-01

Venus is one of the important planetary destinations for scientific exploration, but: The combination of extreme entry environment coupled with extreme surface conditions have made mission planning and proposal efforts very challenging. We present an alternate, game-changing approach (ADEPT) where a novel entry system architecture enables more benign entry conditions and this allows for greater flexibility and lower risk in mission design

Adjustable Bracket For Entry Of Welding Wire

NASA Technical Reports Server (NTRS)

Gilbert, Jeffrey L.; Gutow, David A.

1993-01-01

Wire-entry bracket on welding torch in robotic welding system provides for adjustment of angle of entry of welding wire over range of plus or minus 30 degrees from nominal entry angle. Wire positioned so it does not hide weld joint in view of through-the-torch computer-vision system part of robot-controlling and -monitoring system. Swiveling bracket also used on nonvision torch on which wire-feed-through tube interferes with workpiece. Angle simply changed to one giving sufficient clearance.

Optimizing TLB entries for mixed page size storage in contiguous memory

DOEpatents

Chen, Dong; Gara, Alan; Giampapa, Mark E.; Heidelberger, Philip; Kriegel, Jon K.; Ohmacht, Martin; Steinmacher-Burow, Burkhard

2013-04-30

A system and method for accessing memory are provided. The system comprises a lookup buffer for storing one or more page table entries, wherein each of the one or more page table entries comprises at least a virtual page number and a physical page number; a logic circuit for receiving a virtual address from said processor, said logic circuit for matching the virtual address to the virtual page number in one of the page table entries to select the physical page number in the same page table entry, said page table entry having one or more bits set to exclude a memory range from a page.

Optimizing the user interface of a data entry module for an electronic patient record for cardiac rehabilitation: A mixed method usability approach.

PubMed

van Engen-Verheul, Mariëtte M; Peute, Linda W P; de Keizer, Nicolette F; Peek, Niels; Jaspers, Monique W M

2016-03-01

Cumbersome electronic patient record (EPR) interfaces may complicate data-entry in clinical practice. Completeness of data entered in the EPR determines, among other things, the value of computerized clinical decision support (CCDS). Quantitative usability evaluations can provide insight into mismatches between the system design model of data entry and users' data entry behavior, but not into the underlying causes for these mismatches. Mixed method usability evaluation studies may provide these insights, and thus support generating redesign recommendations for improving an EPR system's data entry interface. To improve the usability of the data entry interface of an EPR system with CCDS in the field of cardiac rehabilitation (CR), and additionally, to assess the value of a mixed method usability approach in this context. Seven CR professionals performed a think-aloud usability evaluation both before (beta-version) and after the redesign of the system. Observed usability problems from both evaluations were analyzed and categorized using Zhang et al.'s heuristic principles of good interface design. We combined the think-aloud usability evaluation of the system's beta-version with the measurement of a new usability construct: users' deviations in action sequence from the system's predefined data entry order sequence. Recommendations for redesign were implemented. We assessed whether the redesign improved CR professionals' (1) task efficacy (with respect to the completeness of data they collected), and (2) task efficiency (with respect to the average number of mouse clicks they needed to complete data entry subtasks). With the system's beta version, 40% of health care professionals' navigation actions through the system deviated from the predefined next system action. The causes for these deviations as revealed by the think-aloud method mostly concerned mismatches between the system design model for data entry action sequences and users expectations of these action sequences, based on their paper-based daily routines. This caused non completion of data entry tasks (31% of main tasks completed), and more navigation actions than minimally required (146% of the minimum required). In the redesigned system the data entry navigational structure was organized in a flexible way around an overview screen to better mimic users' paper-based daily routines of collecting patient data. This redesign resulted in an increased number of completed main tasks (70%) and a decrease in navigation actions (133% of the minimum required). The think-aloud usability evaluation of the redesigned system showed that remaining problems concerned flexibility (e.g., lack of customization options) and consistency (mainly with layout and position of items on the screen). The mixed method usability evaluation was supportive in revealing the magnitude and causes of mismatches between the system design model of data-entry with users' data entry behavior. However, as both task efficacy and efficiency were still not optimal with the redesigned EPR, we advise to perform a cognitive analysis on end users' mental processes and behavior patterns in daily work processes specifically during the requirements analysis phase of development of interactive healthcare information systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Entry, Descent, and Landing With Propulsive Deceleration

NASA Technical Reports Server (NTRS)

Palaszewski, Bryan

2012-01-01

The future exploration of the Solar System will require innovations in transportation and the use of entry, descent, and landing (EDL) systems at many planetary landing sites. The cost of space missions has always been prohibitive, and using the natural planetary and planet s moons atmospheres for entry, descent, and landing can reduce the cost, mass, and complexity of these missions. This paper will describe some of the EDL ideas for planetary entry and survey the overall technologies for EDL that may be attractive for future Solar System missions.

8 CFR 235.7 - Automated inspection services.

Code of Federal Regulations, 2012 CFR

2012-01-01

...—(i) Port Passenger Accelerated Service System (PORTPASS). A system in which certain ports-of-entry... application for entry by the alien program participants on the date PORTPASS is used. United States citizens... Service. Non-United States citizens must meet all applicable documentary and entry eligibility...

75 FR 5579 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-03

... with re-entry controlled by passwords. The DLA Enterprise Hotline Program Database is also password...: * * * * * System location: Delete entry and replace with ``Director, DLA Accountability Office (DA), Headquarters....'' * * * * * Retention and disposal: Delete entry and replace with ``Records are destroyed/deleted 10 years after...

8 CFR 235.7 - Automated inspection services.

Code of Federal Regulations, 2013 CFR

2013-01-01

...—(i) Port Passenger Accelerated Service System (PORTPASS). A system in which certain ports-of-entry... application for entry by the alien program participants on the date PORTPASS is used. United States citizens... Service. Non-United States citizens must meet all applicable documentary and entry eligibility...

8 CFR 235.7 - Automated inspection services.

Code of Federal Regulations, 2011 CFR

2011-01-01

...—(i) Port Passenger Accelerated Service System (PORTPASS). A system in which certain ports-of-entry... application for entry by the alien program participants on the date PORTPASS is used. United States citizens... Service. Non-United States citizens must meet all applicable documentary and entry eligibility...

8 CFR 235.7 - Automated inspection services.

Code of Federal Regulations, 2014 CFR

2014-01-01

...—(i) Port Passenger Accelerated Service System (PORTPASS). A system in which certain ports-of-entry... application for entry by the alien program participants on the date PORTPASS is used. United States citizens... Service. Non-United States citizens must meet all applicable documentary and entry eligibility...

Mars Science Laboratory Entry, Descent and Landing System Overview

NASA Technical Reports Server (NTRS)

Steltzner, Adam D.; San Martin, A. Miguel; Rivellini, Tomasso P.; Chen, Allen

2013-01-01

The Mars Science Laboratory project recently places the Curiosity rove on the surface of Mars. With the success of the landing system, the performance envelope of entry, descent and landing capabilities has been extended over the previous state of the art. This paper will present an overview to the MSL entry, descent and landing system design and preliminary flight performance results.

Generic aerocapture atmospheric entry study, volume 1

NASA Technical Reports Server (NTRS)

1980-01-01

An atmospheric entry study to fine a generic aerocapture vehicle capable of missions to Mars, Saturn, and Uranus is reported. A single external geometry was developed through atmospheric entry simulations. Aerocapture is a system design concept which uses an aerodynamically controlled atmospheric entry to provide the necessary velocity depletion to capture payloads into planetary orbit. Design concepts are presented which provide the control accuracy required while giving thermal protection for the mission payload. The system design concepts consist of the following elements: (1) an extendable biconic aerodynamic configuration with lift to drag ratio between 1.0 and 2.0; (2) roll control system concepts to control aerodynamic lift and disturbance torques; (3) aeroshell design concepts capable of meeting dynamic pressure loads during aerocapture; and (4) entry thermal protection system design concepts to meet thermodynamic loads during aerocapture.

27. View of entry door to vestibule to MWOC entry ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

27. View of entry door to vestibule to MWOC entry door in transmitter building no. 102 (note coded key pad to left and intercom phone on left) and door to the central systems monitor room (CSMR) to right (out of sight). - Clear Air Force Station, Ballistic Missile Early Warning System Site II, One mile west of mile marker 293.5 on Parks Highway, 5 miles southwest of Anderson, Anderson, Denali Borough, AK

Mars Science Laboratory (MSL) Entry, Descent, and Landing Instrumentation (MEDLI): Complete Flight Data Set

NASA Technical Reports Server (NTRS)

Cheatwood, F. McNeil; Bose, Deepak; Karlgaard, Christopher D.; Kuhl, Christopher A.; Santos, Jose A.; Wright, Michael J.

2014-01-01

The Mars Science Laboratory (MSL) entry vehicle (EV) successfully entered the Mars atmosphere and landed the Curiosity rover safely on the surface of the planet in Gale crater on August 6, 2012. MSL carried the MSL Entry, Descent, and Landing (EDL) Instrumentation (MEDLI). MEDLI delivered the first in-depth understanding of the Mars entry environments and the response of the entry vehicle to those environments. MEDLI was comprised of three major subsystems: the Mars Entry Atmospheric Data System (MEADS), the MEDLI Integrated Sensor Plugs (MISP), and the Sensor Support Electronics (SSE). Ultimately, the entire MEDLI sensor suite consisting of both MEADS and MISP provided measurements that were used for trajectory reconstruction and engineering validation of aerodynamic, atmospheric, and thermal protection system (TPS) models in addition to Earth-based systems testing procedures. This report contains in-depth hardware descriptions, performance evaluation, and data information of the three MEDLI subsystems.

Mission Sizing and Trade Studies for Low Ballistic Coefficient Entry Systems to Venus

NASA Technical Reports Server (NTRS)

Dutta, Soumyo; Smith, Brandon; Prabhu, Dinesh; Venkatapathy, Ethiraj

2012-01-01

The U.S and the U.S.S.R. have sent seventeen successful atmospheric entry missions to Venus. Past missions to Venus have utilized rigid aeroshell systems for entry. This rigid aeroshell paradigm sets performance limitations since the size of the entry vehicle is constrained by the fairing diameter of the launch vehicle. This has limited ballistic coefficients (beta) to well above 100 kg/m2 for the entry vehicles. In order to maximize the science payload and minimize the Thermal Protection System (TPS) mass, these missions have entered at very steep entry flight path angles (gamma). Due to Venus thick atmosphere and the steep-gamma, high- conditions, these entry vehicles have been exposed to very high heat flux, very high pressures and extreme decelerations (upwards of 100 g's). Deployable aeroshells avoid the launch vehicle fairing diameter constraint by expanding to a larger diameter after the launch. Due to the potentially larger wetted area, deployable aeroshells achieve lower ballistic coefficients (well below 100 kg/m2), and if they are flown at shallower flight path angles, the entry vehicle can access trajectories with far lower decelerations (50-60 g's), peak heat fluxes (400 W/cm2) and peak pressures. The structural and TPS mass of the shallow-gamma, low-beta deployables are lower than their steep-gamma, high-beta rigid aeroshell counterparts at larger diameters, contributing to lower areal densities and potentially higher payload mass fractions. For example, at large diameters, deployables may attain aeroshell areal densities of 10 kg/m2 as opposed to 50 kg/m2 for rigid aeroshells. However, the low-beta, shallow-gamma paradigm also raises issues, such as the possibility of skip-out during entry. The shallow-gamma could also increase the landing footprint of the vehicle. Furthermore, the deployable entry systems may be flexible, so there could be fluid-structure interaction, especially in the high altitude, low-density regimes. The need for precision in guidance, navigation and control during entry also has to be better understood. This paper investigates some of the challenges facing the design of a shallow-gamma, low-beta entry system.

Development of Thermal Protection Materials for Future Mars Entry, Descent and Landing Systems

NASA Technical Reports Server (NTRS)

Cassell, Alan M.; Beck, Robin A. S.; Arnold, James O.; Hwang, Helen; Wright, Michael J.; Szalai, Christine E.; Blosser, Max; Poteet, Carl C.

2010-01-01

Entry Systems will play a crucial role as NASA develops the technologies required for Human Mars Exploration. The Exploration Technology Development Program Office established the Entry, Descent and Landing (EDL) Technology Development Project to develop Thermal Protection System (TPS) materials for insertion into future Mars Entry Systems. An assessment of current entry system technologies identified significant opportunity to improve the current state of the art in thermal protection materials in order to enable landing of heavy mass (40 mT) payloads. To accomplish this goal, the EDL Project has outlined a framework to define, develop and model the thermal protection system material concepts required to allow for the human exploration of Mars via aerocapture followed by entry. Two primary classes of ablative materials are being developed: rigid and flexible. The rigid ablatives will be applied to the acreage of a 10x30 m rigid mid L/D Aeroshell to endure the dual pulse heating (peak approx.500 W/sq cm). Likewise, flexible ablative materials are being developed for 20-30 m diameter deployable aerodynamic decelerator entry systems that could endure dual pulse heating (peak aprrox.120 W/sq cm). A technology Roadmap is presented that will be used for facilitating the maturation of both the rigid and flexible ablative materials through application of decision metrics (requirements, key performance parameters, TRL definitions, and evaluation criteria) used to assess and advance the various candidate TPS material technologies.

41 CFR 101-30.304 - Application of item entry control.

Code of Federal Regulations, 2012 CFR

2012-07-01

... entry control. 101-30.304 Section 101-30.304 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 30-FEDERAL CATALOG SYSTEM 30.3-Cataloging Items of Supply § 101-30.304 Application of item entry control. In addition...

33 CFR 161.18 - Reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... call. H HOTEL Date, time and point of entry system Entry time expressed as in (B) and into the entry... KILO Date, time and point of exit from system Exit time expressed as in (B) and exit position expressed....; for a dredge or floating plant: configuration of pipeline, mooring configuration, number of assist...

Mars Entry Atmospheric Data System Trajectory Reconstruction Algorithms and Flight Results

NASA Technical Reports Server (NTRS)

Karlgaard, Christopher D.; Kutty, Prasad; Schoenenberger, Mark; Shidner, Jeremy; Munk, Michelle

2013-01-01

The Mars Entry Atmospheric Data System is a part of the Mars Science Laboratory, Entry, Descent, and Landing Instrumentation project. These sensors are a system of seven pressure transducers linked to ports on the entry vehicle forebody to record the pressure distribution during atmospheric entry. These measured surface pressures are used to generate estimates of atmospheric quantities based on modeled surface pressure distributions. Specifically, angle of attack, angle of sideslip, dynamic pressure, Mach number, and freestream atmospheric properties are reconstructed from the measured pressures. Such data allows for the aerodynamics to become decoupled from the assumed atmospheric properties, allowing for enhanced trajectory reconstruction and performance analysis as well as an aerodynamic reconstruction, which has not been possible in past Mars entry reconstructions. This paper provides details of the data processing algorithms that are utilized for this purpose. The data processing algorithms include two approaches that have commonly been utilized in past planetary entry trajectory reconstruction, and a new approach for this application that makes use of the pressure measurements. The paper describes assessments of data quality and preprocessing, and results of the flight data reduction from atmospheric entry, which occurred on August 5th, 2012.

76 FR 18062 - U.S. Securities; Sale and Issue of Marketable Book-Entry Treasury Bills, Notes, and Bonds; Book...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

...; Sale and Issue of Marketable Book-Entry Treasury Bills, Notes, and Bonds; Book-Entry Treasury Bonds... longer be opened and transfers of securities from other book-entry systems will no longer be [email protected] . SUPPLEMENTARY INFORMATION: Legacy Treasury Direct [supreg] is a book- entry, non...

Using System Architecture, Review Entry Criteria, and Standard Work Package Data to Enable Rapid Development of Integrated Master Schedules

DTIC Science & Technology

2016-03-01

ENTRY CRITERIA, AND STANDARD WORK PACKAGE DATA TO ENABLE RAPID DEVELOPMENT OF INTEGRATED MASTER SCHEDULES by Burton W. Porter Jr. March 2016...2. REPORT DATE March 2016 3. REPORT TYPE AND DATES COVERED Master’s Thesis 4. TITLE AND SUBTITLE USING SYSTEM ARCHITECTURE, REVIEW ENTRY ... ENTRY CRITERIA, AND STANDARD WORK PACKAGE DATA TO ENABLE RAPID DEVELOPMENT OF INTEGRATED MASTER SCHEDULES Burton W. Porter Jr. Civilian

The PEN&PAD data entry system: from prototype to practical system.

PubMed Central

Kirby, J.; Rector, A. L.

1996-01-01

This paper describes some of the issues addressed in the transition of the PEN&PAD from prototype clinical workstation to practical data entry system for use by general practitioners in the UK. Background and motivation of the PEN&PAD and GALEN projects are presented before the operation of the PEN&PAD user interface is described. A number of issues which have arisen in the development of the PEN&PAD Data Entry System are discussed. PMID:8947757

Adaptable Holders for Arc-Jet Screening Candidate Thermal Protection System Repair Materials

NASA Technical Reports Server (NTRS)

Riccio, Joe; Milhoan, Jim D.

2010-01-01

Reusable holders have been devised for evaluating high-temperature, plasma-resistant re-entry materials, especially fabrics. Typical material samples tested support thermal-protection-system damage repair requiring evaluation prior to re-entry into terrestrial atmosphere. These tests allow evaluation of each material to withstand the most severe predicted re-entry conditions.

Report of the Defense Science Board Task Force on Future Strategic Strike Skills

DTIC Science & Technology

2006-03-01

25 Figure 11: Re - entry Systems – Critical Skills...SKILLS___________________________________________________25 Figure 9: Guidance – Critical Skills Figure 10: Re - entry Systems – Critical Skills ICBMS/BASING...ability to survive intercontinental ballistic missile re - entry and then to operate effectively thereafter, is another area where current skills are

40 CFR 142.34 - Entry and inspection of public water systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 23 2014-07-01 2014-07-01 false Entry and inspection of public water systems. 142.34 Section 142.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS IMPLEMENTATION Federal Enforcement § 142.34 Entry and inspection of public...

Stakeholder identification of advanced technology opportunities at international ports of entry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Parker, S.K.; Icerman, L.

As part of the Advanced Technologies for International and Intermodal Ports of Entry (ATIPE) Project, a diverse group of stakeholders was engaged to help identify problems experienced at inland international border crossings, particularly those at the US-Mexican border. The fundamental issue at international ports of entry is reducing transit time through the required documentation and inspection processes. Examples of other issues or problems, typically manifested as time delays at border crossings, repeatedly mentioned by stakeholders include: (1) lack of document standardization; (2) failure to standardize inspection processes; (3) inadequate information and communications systems; (4) manual fee and tariff collection; (5)more » inconsistency of processes and procedures; and (6) suboptimal cooperation among governmental agencies. Most of these issues can be addressed to some extent by the development of advanced technologies with the objective of allowing ports of entry to become more efficient while being more effective. Three categories of technologies were unambiguously of high priority to port of entry stakeholders: (1) automated documentation; (2) systems integration; and (3) vehicle and cargo tracking. Together, these technologies represent many of the technical components necessary for pre-clearance of freight approaching international ports of entry. Integration of vehicle and cargo tracking systems with port of entry information and communications systems, as well as existing industry legacy systems, should further enable border crossings to be accomplished consistently with optimal processing times.« less

Trajectory and Aeroheating Environment Development and Sensitivity Analysis for Capsule-shaped Vehicles

NASA Technical Reports Server (NTRS)

Robinson, Jeffrey S.; Wurster, Kathryn E.

2006-01-01

Recently, NASA's Exploration Systems Research and Technology Project funded several tasks that endeavored to develop and evaluate various thermal protection systems and high temperature material concepts for potential use on the crew exploration vehicle. In support of these tasks, NASA Langley's Vehicle Analysis Branch generated trajectory information and associated aeroheating environments for more than 60 unique entry cases. Using the Apollo Command Module as the baseline entry system because of its relevance to the favored crew exploration vehicle design, trajectories for a range of lunar and Mars return, direct and aerocapture Earth-entry scenarios were developed. For direct entry, a matrix of cases was created that reflects reasonably expected minimum and maximum values of vehicle ballistic coefficient, inertial velocity at entry interface, and inertial flight path angle at entry interface. For aerocapture, trajectories were generated for a range of values of initial velocity and ballistic coefficient that, when combined with proper initial flight path angles, resulted in achieving a low Earth orbit either by employing a full lift vector up or full lift vector down attitude. For each trajectory generated, aeroheating environments were generated which were intended to bound the thermal protection system requirements for likely crew exploration vehicle concepts. The trades examined clearly pointed to a range of missions / concepts that will require ablative systems as well as a range for which reusable systems may be feasible. In addition, the results clearly indicated those entry conditions and modes suitable for manned flight, considering vehicle deceleration levels experienced during entry. This paper presents an overview of the analysis performed, including the assumptions, methods, and general approach used, as well as a summary of the trajectory and aerothermal environment information that was generated.

Entry at Venus

NASA Technical Reports Server (NTRS)

Venkatapathy, Ethiraj; Smith, Brandon

2016-01-01

This is lecture to be given at the IPPW 2016, as part of the 2 day course on Short Course on Destination Venus: Science, Technology and Mission Architectures. The attached presentation material is intended to be introduction to entry aspects of Venus in-situ robotic missions. The presentation introduces the audience to the aerodynamic and aerothermodynamic aspects as well as the loads, both aero and thermal, generated during entry. The course touches upon the system design aspects such as TPS design and both high and low ballistic coefficient entry system concepts that allow the science payload to be protected from the extreme entry environment and yet meet the mission objectives.

NASA CEV Reference Entry GN&C System and Analysis

NASA Technical Reports Server (NTRS)

Munday, S.; Madsen, C.; Broome, J.; Gay, R.; Tigges, M.; Strahan, A.

2007-01-01

As part of its overall objectives, the Orion spacecraft will be required to perform entry and Earth landing functions for Low Earth Orbit (LEO) and Lunar missions. Both of these entry scenarios will begin with separation of the Service Module (SM), making them unique from other Orion mission phases in that only the Command Module (CM) portion of the Crew Exploration Vehicle (CEV) will be involved, requiring a CM specific Guidance, Navigation and Control (GN&C) system. Also common to these mission scenarios will be the need for GN&C to safely return crew (or cargo) to earth within the dynamic thermal and structural constraints of entry and within acceptable accelerations on the crew, utilizing the limited aerodynamic performance of the CM capsule. The lunar return mission could additionally require an initial atmospheric entry designed to support a precision skip and second entry, all to maximize downrange performance and ensure landing in the United States. This paper describes the Entry GN&C reference design, developed by the NASA-led team, that supports these entry scenarios and that was used to validate the Orion System requirements. Description of the reference design will include an overview of the GN&C functions, avionics, and effectors and will relate these to the specific design drivers of the entry scenarios, as well as the desire for commonality in vehicle systems to support the different missions. The discussion will also include the requirement for an Emergency Entry capability beyond that of the nominal performance of the multi-string GNC system, intended to return the crew to the earth in a survivable but unguided manner. Finally, various analyses will be discussed, including those completed to support validation efforts of the current CEV requirements, along with those on-going and planned with the intention to further refine the requirements and to support design development work in conjunction with the prime contractor. Some of these ongoing analyses will include work to size effectors (jets) and fuel budgets, to refine skip entry concepts, to characterize navigation performance and uncertainties, to provide for SM disposal offshore and to identify requirements to support target site selection.

Remote Monitoring Systems for Chronic Patients on Home Hemodialysis: Field Test of a Copresence-Enhanced Design

PubMed Central

Liu, Na; Jung, Younhyun; Arisy, Adani; Nicdao, Mary Ann; Mikaheal, Mary; Baldacchino, Tanya; Khadra, Mohamed; Sud, Kamal

2017-01-01

Background Patients undertaking long-term and chronic home hemodialysis (HHD) are subject to feelings of isolation and anxiety due to the absence of physical contact with their health care professionals and lack of feedback in regards to their dialysis treatments. Therefore, it is important for these patients to feel the “presence” of the health care professionals remotely while on hemodialysis at home for better compliance with the dialysis regime and to feel connected with health care professionals. Objective This study presents an HHD system design for hemodialysis patients with features to enhance patient’s perceived “copresence” with their health care professionals. Various mechanisms to enhance this perception were designed and implemented, including digital logbooks, emotion sharing, and feedback tools. The mechanism in our HHD system aims to address the limitations associated with existing self-monitoring tools for HHD patients. Methods A field trial involving 3 nurses and 74 patients was conducted to test the pilot implementation of the copresence design in our HHD system. Mixed method research was conducted to evaluate the system, including surveys, interviews, and analysis of system data. Results Patients created 2757 entries of dialysis cases during the period of study. Altogether there were 492 entries submitted with “Very Happy” as the emotional status, 2167 entries with a “Happy” status, 56 entries with a “Neutral” status, 18 entries with an “Unhappy” status, and 24 entries with a “Very unhappy” status. Patients felt assured to share their emotions with health care professionals. Health care professionals were able to prioritize the review of the entries based on the emotional status and also felt assured to see patients’ change in mood. There were 989 entries sent with short notes. Entries with negative emotions had a higher percentage of supplementary notes entered compared to the entries with positive and neutral emotions. The qualitative data further showed that the HHD system was able to improve patients’ feelings of being connected with their health care professionals and thus enhance their self-care on HHD. The health care professionals felt better assured with patients’ status with the use of the system and reported improved productivity and satisfaction with the copresence enhancement mechanism. The survey on the system usability indicated a high level of satisfaction among patients and nurses. Conclusions The copresence enhancement design complements the conventional use of a digitized HHD logbook and will further benefit the design of future telehealth systems. PMID:28851680

The relative effects of entry parameters on thermal protection system weight. [space shuttle orbiters

NASA Technical Reports Server (NTRS)

Hirasaki, P. N.

1971-01-01

Shielding a spacecraft from the severe thermal environment of an atmospheric entry requires a sophisticated thermal protection system (TPS). Thermal computer program models were developed for two such TPS designs proposed for the space shuttle orbiter. The multilayer systems, a reusable surface insulation TPS, and a re-radiative metallic skin TPS, were sized for a cross-section of trajectories in the entry corridor. This analysis indicates the relative influence of the entry parameters on the weight of each TPS concept. The results are summarized graphically. The trajectory variables considered were down-range, cross-range, orbit inclination, entry interface velocity and flight path angle, maximum heating rate level, angle of attack, and ballistic coefficient. Variations in cross-range and flight path angle over the ranges considered had virtually no effect on the required entry TPS weight. The TPS weight was significantly more sensitive to variations in angle of attack than to dispersions in the other trajectory considered.

Rapid Nipah virus entry into the central nervous system of hamsters via the olfactory route

PubMed Central

Munster, Vincent J.; Prescott, Joseph B.; Bushmaker, Trenton; Long, Dan; Rosenke, Rebecca; Thomas, Tina; Scott, Dana; Fischer, Elizabeth R.; Feldmann, Heinz; de Wit, Emmie

2012-01-01

Encephalitis is a hallmark of Nipah virus (NiV) infection in humans. The exact route of entry of NiV into the central nervous system (CNS) is unknown. Here, we performed a spatio-temporal analysis of NiV entry into the CNS of hamsters. NiV initially predominantly targeted the olfactory epithelium in the nasal turbinates. From there, NiV infected neurons were visible extending through the cribriform plate into the olfactory bulb, providing direct evidence of rapid CNS entry. Subsequently, NiV disseminated to the olfactory tubercle and throughout the ventral cortex. Transmission electron microscopy on brain tissue showed extravasation of plasma cells, neuronal degeneration and nucleocapsid inclusions in affected tissue and axons, providing further evidence for axonal transport of NiV. NiV entry into the CNS coincided with the occurrence of respiratory disease, suggesting that the initial entry of NiV into the CNS occurs simultaneously with, rather than as a result of, systemic virus replication. PMID:23071900

Development Of A Combined Sensor System For Atmospheric Entry Missions

NASA Astrophysics Data System (ADS)

Preci, A.; Eswein, N.; Herdrich, G.; Fasoulas, S.; Roser, H.-P.; Auweter-Kurtz, M.

2011-05-01

The payload COMPARE is developed at the Institute of Space Systems for various entry scenarios. It was previously laid out for a Mars entry mission and afterwards redesigned for the German Aerospace Centre suborbital re-entry mission SHEFEX II, which had its successful roll-out in July 2010 and is due to be launched in September 2011. The sensor system aims to simultaneously measure the temperature of the thermal protection shield, the radiation from the plasma and the pressure. The most recent development of COMPARE is a combined sensor system for ablative thermal protection systems enabling a separation of the radiative heat flux from the total heat flux. Furthermore, it enables also the detection of specific species in the plasma by measuring the radiative heat flux at a defined wavelength range. In the frame of an ESA funded project a breadboard has been build and tested in a plasma wind tunnel in order to prove the feasibility of such a sensor system for upcoming entry missions. Results of these measurements are presented in this work.

Return on Investment Point of Service Computerized Provider Charge Entry

PubMed Central

Kiepek, Wendy; FitzHenry, Fern; Shultz, Edward K

2003-01-01

Provider charge entry systems offer many benefits to users and organizations. At Vanderbilt University Medical Center, a web-based provider charge entry system promises to deliver benefits in reducing days in accounts receivable, reducing labor required for claims and edit processing, and implementing business rules that deliver both strategic and financial benefits. PMID:14728396

31 CFR 354.1 - Definitions of terms.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING BOOK-ENTRY SECURITIES OF THE... the claimant for another Person to hold, transfer, or deal with the Security. (b) Book-entry Sallie Mae Security means a Sallie Mae Security issued or maintained in the Book-entry System. (c) Book-entry...

31 CFR 337.6 - Conversions to book-entry.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Conversions to book-entry. 337.6... FEDERAL HOUSING ADMINISTRATION DEBENTURES Certificated Debentures § 337.6 Conversions to book-entry. Upon implementation of the book-entry debenture system, to be announced in advance by separate public notice, all new...

31 CFR 337.6 - Conversions to book-entry.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Conversions to book-entry. 337.6... HOUSING ADMINISTRATION DEBENTURES Certificated Debentures § 337.6 Conversions to book-entry. Upon implementation of the book-entry debenture system, to be announced in advance by separate public notice, all new...

31 CFR 337.6 - Conversions to book-entry.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Conversions to book-entry. 337.6... HOUSING ADMINISTRATION DEBENTURES Certificated Debentures § 337.6 Conversions to book-entry. Upon implementation of the book-entry debenture system, to be announced in advance by separate public notice, all new...

31 CFR 337.6 - Conversions to book-entry.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Conversions to book-entry. 337.6... HOUSING ADMINISTRATION DEBENTURES Certificated Debentures § 337.6 Conversions to book-entry. Upon implementation of the book-entry debenture system, to be announced in advance by separate public notice, all new...

31 CFR 337.6 - Conversions to book-entry.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Conversions to book-entry. 337.6... HOUSING ADMINISTRATION DEBENTURES Certificated Debentures § 337.6 Conversions to book-entry. Upon implementation of the book-entry debenture system, to be announced in advance by separate public notice, all new...

Mars Entry Atmospheric Data System Modeling, Calibration, and Error Analysis

NASA Technical Reports Server (NTRS)

Karlgaard, Christopher D.; VanNorman, John; Siemers, Paul M.; Schoenenberger, Mark; Munk, Michelle M.

2014-01-01

The Mars Science Laboratory (MSL) Entry, Descent, and Landing Instrumentation (MEDLI)/Mars Entry Atmospheric Data System (MEADS) project installed seven pressure ports through the MSL Phenolic Impregnated Carbon Ablator (PICA) heatshield to measure heatshield surface pressures during entry. These measured surface pressures are used to generate estimates of atmospheric quantities based on modeled surface pressure distributions. In particular, the quantities to be estimated from the MEADS pressure measurements include the dynamic pressure, angle of attack, and angle of sideslip. This report describes the calibration of the pressure transducers utilized to reconstruct the atmospheric data and associated uncertainty models, pressure modeling and uncertainty analysis, and system performance results. The results indicate that the MEADS pressure measurement system hardware meets the project requirements.

Midwives and the Computerization of Perinatal Data Entry: The Theory of Beneficial Engagement.

PubMed

Craswell, Alison; Moxham, Lorna; Broadbent, Marc

2016-10-01

Theory building in nursing and midwifery both to explain and inform practice is important to advance these professions via provision of a theoretical foundation. This research explored the process of perinatal data entry undertaken by midwives to explore the impact of the movement from paper to computer collection of data. Use of grounded theory methodology enabled theory building, leading to a theoretical understanding of the phenomenon and development of the Theory of Beneficial Engagement grounded in the data. Methods involved in-depth semistructured interviews with 15 users of perinatal data systems. Participants were recruited from 12 different healthcare locations and were utilizing three different electronic systems for data entry. The research question that guided the study focused on examining the influences of using the computer for perinatal data entry. Findings indicated that qualities particular to some midwives denoted engagement with perinatal data entry, suggesting a strong desire to enter complete, timely, and accurate data. The Theory of Beneficial Engagement provides a model of user engagement with systems for perinatal data entry consistent with other theories of engagement. The theory developed describes this phenomenon in a simple, elegant manner that can be applied to other areas where mandatory data entry is undertaken.

Genesis Sample Return Capsule Overview

NASA Technical Reports Server (NTRS)

Willcockson, Bill

2005-01-01

I. Simple Entry Capsule Concept: a) Spin-Stabilized/No Active Control Systems; b) Ballistic Entry for 11.04 km/sec Velocity; c) No Heatshield Separation During Entry; d) Parachute Deploy via g-Switch + Timer. II. Stardust Design Inheritance a) Forebody Shape; b) Seal Concepts; c) Parachute Deploy Control; d) Utah Landing Site (UTTR). III. TPS Systems a) Heatshield - Carbon-Carbon - First Planetary Entry; b) Backshell - SLA-561V - Flight Heritage from Pathfinder, MER; d) Forebody Structural Penetrations Aerothermal and TPS Design Process has the Same Methodology as Used for Pathfinder, MER Flight Vehicles.

Predictive Modeling for NASA Entry, Descent and Landing Missions

NASA Technical Reports Server (NTRS)

Wright, Michael

2016-01-01

Entry, Descent and Landing (EDL) Modeling and Simulation (MS) is an enabling capability for complex NASA entry missions such as MSL and Orion. MS is used in every mission phase to define mission concepts, select appropriate architectures, design EDL systems, quantify margin and risk, ensure correct system operation, and analyze data returned from the entry. In an environment where it is impossible to fully test EDL concepts on the ground prior to use, accurate MS capability is required to extrapolate ground test results to expected flight performance.

Port-of-entry advanced sorting system (PASS) operational test

DOT National Transportation Integrated Search

1998-12-01

In 1992 the Oregon Department of Transportation undertook an operational test of the Port-of-Entry Advanced Sorting System (PASS), which uses a two-way communication automatic vehicle identification system, integrated with weigh-in-motion, automatic ...

Multi-Mission System Analysis for Planetary Entry (M-SAPE) Version 1

NASA Technical Reports Server (NTRS)

Samareh, Jamshid; Glaab, Louis; Winski, Richard G.; Maddock, Robert W.; Emmett, Anjie L.; Munk, Michelle M.; Agrawal, Parul; Sepka, Steve; Aliaga, Jose; Zarchi, Kerry;

MAPS: The Organization of a Spatial Database System Using Imagery, Terrain, and Map Data

DTIC Science & Technology

1983-06-01

segments which share the same pixel position. Finally, in any largo system, a logical partitioning of the database must be performed in order to avoid...34theodore roosevelt memoria entry 0; entry 1: Virginia ’northwest Washington* 2 en 11" ies for "crossover" for ’theodore roosevelt memor i entry 0

30 CFR 75.326 - Mean entry air velocity.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Mean entry air velocity. 75.326 Section 75.326... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.326 Mean entry air velocity. In exhausting face ventilation systems, the mean entry air velocity shall be at least 60 feet per minute...

30 CFR 75.326 - Mean entry air velocity.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Mean entry air velocity. 75.326 Section 75.326... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.326 Mean entry air velocity. In exhausting face ventilation systems, the mean entry air velocity shall be at least 60 feet per minute...

Considerations for setting up an order entry system for nuclear medicine tests.

PubMed

Hara, Narihiro; Onoguchi, Masahisa; Nishida, Toshihiko; Honda, Minoru; Houjou, Osamu; Yuhi, Masaru; Takayama, Teruhiko; Ueda, Jun

2007-12-01

Integrating the Healthcare Enterprise-Japan (IHE-J) was established in Japan in 2001 and has been working to standardize health information and make it accessible on the basis of the fundamental Integrating Healthcare Enterprise (IHE) specifications. However, because specialized operations are used in nuclear medicine tests, online sharing of patient information and test order information from the order entry system as shown by the scheduled workflow (SWF) is difficult, making information inconsistent throughout the facility and uniform management of patient information impossible. Therefore, we examined the basic design (subsystem design) for order entry systems, which are considered an important aspect of information management for nuclear medicine tests and needs to be consistent with the system used throughout the rest of the facility. There are many items that are required by the subsystem when setting up an order entry system for nuclear medicine tests. Among these items, those that are the most important in the order entry system are constructed using exclusion settings, because of differences in the conditions for using radiopharmaceuticals and contrast agents and appointment frame settings for differences in the imaging method and test items. To establish uniform management of patient information for nuclear medicine tests throughout the facility, it is necessary to develop an order entry system with exclusion settings and appointment frames as standard features. Thereby, integration of health information with the Radiology Information System (RIS) or Picture Archiving Communication System (PACS) based on Digital Imaging Communications in Medicine (DICOM) standards and real-time health care assistance can be attained, achieving the IHE agenda of improving health care service and efficiently sharing information.

The ubiquitin-proteasome system is essential for the productive entry of Japanese encephalitis virus.

PubMed

Wang, Shaobo; Liu, Haibin; Zu, Xiangyang; Liu, Yang; Chen, Liman; Zhu, Xueqin; Zhang, Leike; Zhou, Zheng; Xiao, Gengfu; Wang, Wei

2016-11-01

The host-virus interaction during the cellular entry of Japanese encephalitis virus (JEV) is poorly characterized. The ubiquitin-proteasome system (UPS), the major intracellular proteolytic pathway, mediates diverse cellular processes, including endocytosis and signal transduction, which may be involved in the entry of virus. Here, we showed that the proteasome inhibitors, MG132 and lactacystin, impaired the productive entry of JEV by effectively interfering with viral intracellular trafficking at the stage between crossing cell membrane and the initial translation of the viral genome after uncoating. Using confocal microscopy, it was demonstrated that a proportion of the internalized virions were misdirected to lysosomes following treatment with MG132, resulting in non-productive entry. In addition, using specific siRNAs targeting ubiquitin, we verified that protein ubiquitination was involved in the entry of JEV. Overall, our study demonstrated the UPS is essential for the productive entry of JEV and might represent a potential antiviral target for JEV infection. Copyright © 2016 Elsevier Inc. All rights reserved.

Method and system for entering data within a flight plan entry field

NASA Technical Reports Server (NTRS)

Gibbs, Michael J. (Inventor); Van Omen, Debi (Inventor); Adams, Michael B. (Inventor); Chase, Karl L. (Inventor); Lewis, Daniel E. (Inventor); McCrobie, Daniel E. (Inventor)

2005-01-01

The present invention provides systems, apparatus and methods for entering data into a flight plan entry field which facilitates the display and editing of aircraft flight-plan data. In one embodiment, the present invention provides a method for entering multiple waypoint and procedure identifiers at once within a single a flight plan entry field. In another embodiment, the present invention provides for the partial entry of any waypoint or procedure identifiers, and thereafter relating the identifiers with an aircraft's flight management system to anticipate the complete text entry for display. In yet another embodiment, the present invention discloses a method to automatically provide the aircraft operator with selectable prioritized arrival and approach routing identifiers by a single manual selection. In another embodiment, the present invention is a method for providing the aircraft operator with selectable alternate patterns to a new runway.

Aerocapture Inflatable Decelerator for Planetary Entry

NASA Technical Reports Server (NTRS)

Reza, Sajjad; Hund, Richard; Kustas, Frank; Willcockson, William; Songer, Jarvis; Brown, Glen

2007-01-01

Forward Attached Inflatable Decelerators, more commonly known as inflatable aeroshells, provide an effective, cost efficient means of decelerating spacecrafts by using atmospheric drag for aerocapture or planetary entry instead of conventional liquid propulsion deceleration systems. Entry into planetary atmospheres results in significant heating and aerodynamic pressures which stress aeroshell systems to their useful limits. Incorporation of lightweight inflatable decelerator surfaces with increased surface-area footprints provides the opportunity to reduce heat flux and induced temperatures, while increasing the payload mass fraction. Furthermore, inflatable aeroshell decelerators provide the needed deceleration at considerably higher altitudes and Mach numbers when compared with conventional rigid aeroshell entry systems. Inflatable aeroshells also provide for stowage in a compact space, with subsequent deployment of a large-area, lightweight heatshield to survive entry heating. Use of a deployable heatshield decelerator enables an increase in the spacecraft payload mass fraction and may eliminate the need for a spacecraft backshell.

SCOPE in Cataloguing.

ERIC Educational Resources Information Center

Tom, Ellen; Reed, Sue

This report describes the Systematic Computerized Processing in Cataloguing system (SCOPE), an automated system for the catalog department of a university library. The system produces spine labels, pocket labels, book cards for the circulation system, catalog cards including shelf list, main entry, subject and added entry cards, statistics, an…

A bundle with a preformatted medical order sheet and an introductory course to reduce prescription errors in neonates.

PubMed

Palmero, David; Di Paolo, Ermindo R; Beauport, Lydie; Pannatier, André; Tolsa, Jean-François

2016-01-01

The objective of this study was to assess whether the introduction of a new preformatted medical order sheet coupled with an introductory course affected prescription quality and the frequency of errors during the prescription stage in a neonatal intensive care unit (NICU). Two-phase observational study consisting of two consecutive 4-month phases: pre-intervention (phase 0) and post-intervention (phase I) conducted in an 11-bed NICU in a Swiss university hospital. Interventions consisted of the introduction of a new preformatted medical order sheet with explicit information supplied, coupled with a staff introductory course on appropriate prescription and medication errors. The main outcomes measured were formal aspects of prescription and frequency and nature of prescription errors. Eighty-three and 81 patients were included in phase 0 and phase I, respectively. A total of 505 handwritten prescriptions in phase 0 and 525 in phase I were analysed. The rate of prescription errors decreased significantly from 28.9% in phase 0 to 13.5% in phase I (p < 0.05). Compared with phase 0, dose errors, name confusion and errors in frequency and rate of drug administration decreased in phase I, from 5.4 to 2.7% (p < 0.05), 5.9 to 0.2% (p < 0.05), 3.6 to 0.2% (p < 0.05), and 4.7 to 2.1% (p < 0.05), respectively. The rate of incomplete and ambiguous prescriptions decreased from 44.2 to 25.7 and 8.5 to 3.2% (p < 0.05), respectively. Inexpensive and simple interventions can improve the intelligibility of prescriptions and reduce medication errors. Medication errors are frequent in NICUs and prescription is one of the most critical steps. CPOE reduce prescription errors, but their implementation is not available everywhere. Preformatted medical order sheet coupled with an introductory course decrease medication errors in a NICU. Preformatted medical order sheet is an inexpensive and readily implemented alternative to CPOE.

Port-of-entry Advanced Sorting System (PASS) operational test : final report

DOT National Transportation Integrated Search

1998-12-01

In 1992 the Oregon Department of Transportation undertook an operational test of the Port-of-Entry Advanced Sorting System (PASS), which uses a two-way communication automatic vehicle identification system, integrated with weigh-in-motion, automatic ...

Remote Monitoring Systems for Chronic Patients on Home Hemodialysis: Field Test of a Copresence-Enhanced Design.

PubMed

Liu, Na; Kim, Jinman; Jung, Younhyun; Arisy, Adani; Nicdao, Mary Ann; Mikaheal, Mary; Baldacchino, Tanya; Khadra, Mohamed; Sud, Kamal

2017-08-29

Patients undertaking long-term and chronic home hemodialysis (HHD) are subject to feelings of isolation and anxiety due to the absence of physical contact with their health care professionals and lack of feedback in regards to their dialysis treatments. Therefore, it is important for these patients to feel the "presence" of the health care professionals remotely while on hemodialysis at home for better compliance with the dialysis regime and to feel connected with health care professionals. This study presents an HHD system design for hemodialysis patients with features to enhance patient's perceived "copresence" with their health care professionals. Various mechanisms to enhance this perception were designed and implemented, including digital logbooks, emotion sharing, and feedback tools. The mechanism in our HHD system aims to address the limitations associated with existing self-monitoring tools for HHD patients. A field trial involving 3 nurses and 74 patients was conducted to test the pilot implementation of the copresence design in our HHD system. Mixed method research was conducted to evaluate the system, including surveys, interviews, and analysis of system data. Patients created 2757 entries of dialysis cases during the period of study. Altogether there were 492 entries submitted with "Very Happy" as the emotional status, 2167 entries with a "Happy" status, 56 entries with a "Neutral" status, 18 entries with an "Unhappy" status, and 24 entries with a "Very unhappy" status. Patients felt assured to share their emotions with health care professionals. Health care professionals were able to prioritize the review of the entries based on the emotional status and also felt assured to see patients' change in mood. There were 989 entries sent with short notes. Entries with negative emotions had a higher percentage of supplementary notes entered compared to the entries with positive and neutral emotions. The qualitative data further showed that the HHD system was able to improve patients' feelings of being connected with their health care professionals and thus enhance their self-care on HHD. The health care professionals felt better assured with patients' status with the use of the system and reported improved productivity and satisfaction with the copresence enhancement mechanism. The survey on the system usability indicated a high level of satisfaction among patients and nurses. The copresence enhancement design complements the conventional use of a digitized HHD logbook and will further benefit the design of future telehealth systems. ©Na Liu, Jinman Kim, Younhyun Jung, Adani Arisy, Mary Ann Nicdao, Mary Mikaheal, Tanya Baldacchino, Mohamed Khadra, Kamal Sud. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 29.08.2017.

Mars Science Laboratory Entry, Descent and Landing System Development Challenges and Preliminary Flight Performance

NASA Technical Reports Server (NTRS)

Steltzner, Adam D.; San Martin, A. Miguel; Rivellini, Tommaso P.

2013-01-01

The Mars Science Laboratory project recently landed the Curiosity rover on the surface of Mars. With the success of the landing system, the performance envelope of entry, descent, and landing capabilities has been extended over the previous state of the art. This paper will present an overview of the MSL entry, descent, and landing system, a discussion of a subset of its development challenges, and include a discussion of preliminary results of the flight reconstruction effort.

Overview of the MEDLI Project

NASA Technical Reports Server (NTRS)

Gazarik, Michael J.; Hwang, Helen; Little, Alan; Cheatwood, Neil; Wright, Michael; Herath, Jeff

2007-01-01

The Mars Science Laboratory Entry, Descent, and Landing Instrumentation (MEDLI) Project's objectives are to measure aerothermal environments, sub-surface heatshield material response, vehicle orientation, and atmospheric density for the atmospheric entry and descent phases of the Mars Science Laboratory (MSL) entry vehicle. The flight science objectives of MEDLI directly address the largest uncertainties in the ability to design and validate a robust Mars entry system, including aerothermal, aerodynamic and atmosphere models, and thermal protection system (TPS) design. The instrumentation suite will be installed in the heatshield of the MSL entry vehicle. The acquired data will support future Mars entry and aerocapture missions by providing measured atmospheric data to validate Mars atmosphere models and clarify the design margins for future Mars missions. MEDLI thermocouple and recession sensor data will significantly improve the understanding of aeroheating and TPS performance uncertainties for future missions. MEDLI pressure data will permit more accurate trajectory reconstruction, as well as separation of aerodynamic and atmospheric uncertainties in the hypersonic and supersonic regimes. This paper provides an overview of the project including the instrumentation design, system architecture, and expected measurement response.

Overview of the MEDLI Project

NASA Technical Reports Server (NTRS)

Gazarik, Michael J.; Little, Alan; Cheatwood, F. Neil; Wright, Michael J.; Herath, Jeff A.; Martinez, Edward R.; Munk, Michelle; Novak, Frank J.; Wright, Henry S.

2008-01-01

The Mars Science Laboratory Entry, Descent, and Landing Instrumentation (MEDLI) Project s objectives are to measure aerothermal environments, sub-surface heatshield material response, vehicle orientation, and atmospheric density for the atmospheric entry and descent phases of the Mars Science Laboratory (MSL) entry vehicle. The flight science objectives of MEDLI directly address the largest uncertainties in the ability to design and validate a robust Mars entry system, including aerothermal, aerodynamic and atmosphere models, and thermal protection system (TPS) design. The instrumentation suite will be installed in the heatshield of the MSL entry vehicle. The acquired data will support future Mars entry and aerocapture missions by providing measured atmospheric data to validate Mars atmosphere models and clarify the design margins for future Mars missions. MEDLI thermocouple and recession sensor data will significantly improve the understanding of aeroheating and TPS performance uncertainties for future missions. MEDLI pressure data will permit more accurate trajectory reconstruction, as well as separation of aerodynamic and atmospheric uncertainties in the hypersonic and supersonic regimes. This paper provides an overview of the project including the instrumentation design, system architecture, and expected measurement response.

A combination HIV reporter virus system for measuring post-entry event efficiency and viral outcome in primary CD4+ T cell subsets.

PubMed

Tilton, Carisa A; Tabler, Caroline O; Lucera, Mark B; Marek, Samantha L; Haqqani, Aiman A; Tilton, John C

2014-01-01

Fusion between the viral membrane of human immunodeficiency virus (HIV) and the host cell marks the end of the HIV entry process and the beginning of a series of post-entry events including uncoating, reverse transcription, integration, and viral gene expression. The efficiency of post-entry events can be modulated by cellular factors including viral restriction factors and can lead to several distinct outcomes: productive, latent, or abortive infection. Understanding host and viral proteins impacting post-entry event efficiency and viral outcome is critical for strategies to reduce HIV infectivity and to optimize transduction of HIV-based gene therapy vectors. Here, we report a combination reporter virus system measuring both membrane fusion and viral promoter-driven gene expression. This system enables precise determination of unstimulated primary CD4+ T cell subsets targeted by HIV, the efficiency of post-entry viral events, and viral outcome and is compatible with high-throughput screening and cell-sorting methods. Copyright © 2013 Elsevier B.V. All rights reserved.

The Influence of China's Entry into the WTO on Its Education System

ERIC Educational Resources Information Center

Ding, Xiaohao; Yue, Changjun; Sun, Yuze

2009-01-01

The entry of China in the World Trade Organization (WTO) in 2001 holds a number of promises for educational services. The purpose of this article is to explore both the direct and the indirect influence of China's entry into WTO on its education system. The direct influence mainly refers to the increase in the demand for education overseas and in…

31 CFR 315.3 - Converting definitive savings bonds to book-entry bonds in New Treasury Direct.

Code of Federal Regulations, 2011 CFR

2011-07-01

... book-entry bonds in New Treasury Direct. 315.3 Section 315.3 Money and Finance: Treasury Regulations.... SAVINGS NOTES General Information § 315.3 Converting definitive savings bonds to book-entry bonds in New... book-entry bonds through New Treasury Direct, an online system for holding Treasury securities. The Web...

31 CFR 315.3 - Converting definitive savings bonds to book-entry bonds in New Treasury Direct.

Code of Federal Regulations, 2010 CFR

2010-07-01

... to book-entry bonds in New Treasury Direct. 315.3 Section 315.3 Money and Finance: Treasury.... SAVINGS NOTES General Information § 315.3 Converting definitive savings bonds to book-entry bonds in New... book-entry bonds through New Treasury Direct, an online system for holding Treasury securities. The Web...

Entry Vehicle Control System Design for the Mars Smart Lander

NASA Technical Reports Server (NTRS)

Calhoun, Philip C.; Queen, Eric M.

2002-01-01

The NASA Langley Research Center, in cooperation with the Jet Propulsion Laboratory, participated in a preliminary design study of the Entry, Descent and Landing phase for the Mars Smart Lander Project. This concept utilizes advances in Guidance, Navigation and Control technology to significantly reduce uncertainty in the vehicle landed location on the Mars surface. A candidate entry vehicle controller based on the Reaction Control System controller for the Apollo Lunar Excursion Module digital autopilot is proposed for use in the entry vehicle attitude control. A slight modification to the phase plane controller is used to reduce jet-firing chattering while maintaining good control response for the Martian entry probe application. The controller performance is demonstrated in a six-degree-of-freedom simulation with representative aerodynamics.

Computer retrieval of bibliographies using an editing program

USGS Publications Warehouse

Brethauer, G.E.; Brokaw, V.L.

1979-01-01

A simple program permits use of the text .editor 'qedx,' part of many computer systems, to input bibliographic entries and to retrieve specific entries which contain keywords of interest. Multiple keywords may be used sequentially to find specific entries.

SAKURA-viewer: intelligent order history viewer based on two-viewpoint architecture.

PubMed

Toyoda, Shuichi; Niki, Noboru; Nishitani, Hiromu

2007-03-01

We propose a new intelligent order history viewer applied to consolidating and visualizing data. SAKURA-viewer is a highly effective tool, as: 1) it visualizes both the semantic viewpoint and the temporal viewpoint of patient records simultaneously; 2) it promotes awareness of contextual information among the daily data; and 3) it implements patient-centric data entry methods. This viewer contributes to decrease the user's workload in an order entry system. This viewer is now incorporated into an order entry system being run on an experimental basis. We describe the evaluation of this system using results of a user satisfaction survey, analysis of information consolidation within the database, and analysis of the frequency of use of data entry methods.

INVESTIGATION OF DRY-WEATHER POLLUTANT ENTRIES INTO STORM-DRAINAGE SYSTEMS

EPA Science Inventory

This article describes the results of a series of research tasks to develop a procedure to investigate non-stormwater (dry-weather) entries into storm drainage systems. Dry-weather flows discharging from storm drainage systems can contribute significant pollutant loadings to rece...

Research and development for Onboard Navigation (ONAV) ground based expert/trainer system: ONAV entry knowledge requirements specification update

NASA Technical Reports Server (NTRS)

Bochsler, Daniel C.

1988-01-01

A revised version of expert knowledge for the onboard navigation (ONAV) entry system is given. Included is some brief background information together with information describing the knowledge that the system does contain.

77 FR 67062 - Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-08

... DEPARTMENT OF THE TREASURY Fiscal Service Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book-Entry System AGENCY: Bureau of the Public Debt, Fiscal... fee schedule applicable to transfers of U.S. Treasury book-entry securities maintained on the National...

75 FR 67807 - Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-03

... DEPARTMENT OF THE TREASURY Fiscal Service Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book-Entry System Authority: 31 CFR 357.45. AGENCY: Bureau of the...) is announcing a new fee schedule applicable to transfers of U.S. Treasury book-entry securities...

76 FR 68523 - Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-04

... DEPARTMENT OF THE TREASURY Fiscal Service Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book-Entry System AGENCY: Bureau of the Public Debt, Fiscal... fee schedule applicable to transfers of U.S. Treasury book-entry securities maintained on the National...

Designing Computerized Provider Order Entry Software in Iran: The Nurses' and Physicians' Viewpoints.

PubMed

Khammarnia, Mohammad; Sharifian, Roxana; Zand, Farid; Keshtkaran, Ali; Barati, Omid

2016-09-01

This study aimed to identify the functional requirements of computerized provider order entry software and design this software in Iran. This study was conducted using review documentation, interview, and focus group discussions in Shiraz University of Medical Sciences, as the medical pole in Iran, in 2013-2015. The study sample consisted of physicians (n = 12) and nurses (n = 2) in the largest hospital in the southern part of Iran and information technology experts (n = 5) in Shiraz University of Medical Sciences. Functional requirements of the computerized provider order entry system were examined in three phases. Finally, the functional requirements were distributed in four levels, and accordingly, the computerized provider order entry software was designed. The software had seven main dimensions: (1) data entry, (2) drug interaction management system, (3) warning system, (4) treatment services, (5) ability to write in software, (6) reporting from all sections of the software, and (7) technical capabilities of the software. The nurses and physicians emphasized quick access to the computerized provider order entry software, order prescription section, and applicability of the software. The software had some items that had not been mentioned in other studies. Ultimately, the software was designed by a company specializing in hospital information systems in Iran. This study was the first specific investigation of computerized provider order entry software design in Iran. Based on the results, it is suggested that this software be implemented in hospitals.

Comprehensive analysis of a Radiology Operations Management computer system.

PubMed

Arenson, R L; London, J W

1979-11-01

The Radiology Operations Management computer system at the Hospital of the University of Pennsylvania is discussed. The scheduling and file room modules are based on the system at Massachusetts General Hospital. Patient delays are indicated by the patient tracking module. A reporting module allows CRT/keyboard entry by transcriptionists, entry of standard reports by radiologists using bar code labels, and entry by radiologists using a specialty designed diagnostic reporting terminal. Time-flow analyses demonstrate a significant improvement in scheduling, patient waiting, retrieval of radiographs, and report delivery. Recovery of previously lost billing contributes to the proved cost effectiveness of this system.

Planetary/DOD entry technology flight experiments. Volume 2: Planetary entry flight experiments

NASA Technical Reports Server (NTRS)

Christensen, H. E.; Krieger, R. J.; Mcneilly, W. R.; Vetter, H. C.

1976-01-01

The technical feasibility of launching a high speed, earth entry vehicle from the space shuttle to advance technology for the exploration of the outer planets' atmospheres was established. Disciplines of thermodynamics, orbital mechanics, aerodynamics propulsion, structures, design, electronics and system integration focused on the goal of producing outer planet environments on a probe shaped vehicle during an earth entry. Major aspects of analysis and vehicle design studied include: planetary environments, earth entry environment capability, mission maneuvers, capabilities of shuttle upper stages, a comparison of earth entry planetary environments, experiment design and vehicle design.

48 CFR 552.270-9 - Inspection-Right of Entry.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for asbestos fibers; (2) Inspecting the heating, ventilation and air conditioning system, maintenance... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Inspection-Right of Entry. 552.270-9 Section 552.270-9 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION...

8. LONG VIEW OF CONCRETE FORBAY/SANDBOX FROM ENTRY POINT OF ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. LONG VIEW OF CONCRETE FORBAY/SANDBOX FROM ENTRY POINT OF WATER CONVEYANCE SYSTEM. VIEW TO WEST. - Tule River Hydroelectric Project, Water Conveyance System, Middle Fork Tule River, Springville, Tulare County, CA

78 FR 35607 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-13

..., Camp H.M. Smith, HI 96861-4028.'' * * * * * Categories of records in the system: Delete entry and.... Box 64028, Camp H.M. Smith, HI 96861-4028.'' Notification procedure: Delete entry and replace with...

Structures and Mechanisms Design Concepts for Adaptive Deployable Entry Placement Technology

NASA Technical Reports Server (NTRS)

Yount, Bryan C.; Arnold, James O.; Gage, Peter J.; Mockelman, Jeffrey; Venkatapathy, Ethiraj

2012-01-01

System studies have shown that large deployable aerodynamic decelerators such as the Adaptive Deployable Entry and Placement Technology (ADEPT) concept can revolutionize future robotic and human exploration missions involving atmospheric entry, descent and landing by significantly reducing the maximum heating rate, total heat load, and deceleration loads experienced by the spacecraft during entry [1-3]. ADEPT and the Hypersonic Inflatable Aerodynamic Decelerator (HIAD) [4] share the approach of stowing the entry system in the shroud of the launch vehicle and deploying it to a much larger diameter prior to entry. The ADEPT concept provides a low ballistic coefficient for planetary entry by employing an umbrella-like deployable structure consisting of ribs, struts and a fabric cover that form an aerodynamic decelerator capable of undergoing hypersonic flight. The ADEPT "skin" is a 3-D woven carbon cloth that serves as a thermal protection system (TPS) and as a structural surface that transfers aerodynamic forces to the underlying ribs [5]. This paper focuses on design activities associated with integrating ADEPT components (cloth, ribs, struts and mechanisms) into a system that can function across all configurations and environments of a typical mission concept: stowed during launch, in-space deployment, entry, descent, parachute deployment and separation from the landing payload. The baseline structures and mechanisms were selected via trade studies conducted during the summer and fall of 2012. They are now being incorporated into the design of a ground test article (GTA) that will be fabricated in 2013. It will be used to evaluate retention of the stowed configuration in a launch environment, mechanism operation for release, deployment and locking, and static strength of the deployed decelerator. Of particular interest are the carbon cloth interfaces, underlying hot structure, (Advanced Carbon- Carbon ribs) and other structural components (nose cap, struts, and main body) designed to withstand the pressure and extremely high heating experienced during planetary entry.

Technology Investments in the NASA Entry Systems Modeling Project

NASA Technical Reports Server (NTRS)

Barnhardt, Michael; Wright, Michael; Hughes, Monica

2017-01-01

The Entry Systems Modeling (ESM) technology development project, initiated in 2012 under NASAs Game Changing Development (GCD) Program, is engaged in maturation of fundamental research developing aerosciences, materials, and integrated systems products for entry, descent, and landing(EDL)technologies [1]. To date, the ESM project has published over 200 papers in these areas, comprising the bulk of NASAs research program for EDL modeling. This presentation will provide an overview of the projects successes and challenges, and an assessment of future investments in EDL modeling and simulation relevant to NASAs mission

75 FR 20850 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-21

... in the efforts to make system changes. Grantees will complete systems web-based data entry on goals... grantee and key staff-partner interview 249 2 1.60 797 guide EBHV grantee systems web-based data entry... prevent child maltreatment. An evaluation study will address four domains: (1) Systems change to develop...

RADON MITIGATION IN SCHOOLS: HVAC SYSTEMS IN SCHOOLS TEND TO HAVE A GREATER IMPACT ON RADON LEVELS THAN HVAC SYSTEMS IN HOMES

EPA Science Inventory

The first part of this two-part paper discusses radon entry into schools, radon mitigation approaches for schools, and school characteristics (e.g., heating, ventilation, and air conditioing -- HVAC-- system design and operationg) that influence radon entry and mitigation system ...

Mars Entry Atmospheric Data System Modelling and Algorithm Development

NASA Technical Reports Server (NTRS)

Karlgaard, Christopher D.; Beck, Roger E.; OKeefe, Stephen A.; Siemers, Paul; White, Brady; Engelund, Walter C.; Munk, Michelle M.

2009-01-01

The Mars Entry Atmospheric Data System (MEADS) is being developed as part of the Mars Science Laboratory (MSL), Entry, Descent, and Landing Instrumentation (MEDLI) project. The MEADS project involves installing an array of seven pressure transducers linked to ports on the MSL forebody to record the surface pressure distribution during atmospheric entry. These measured surface pressures are used to generate estimates of atmospheric quantities based on modeled surface pressure distributions. In particular, the quantities to be estimated from the MEADS pressure measurements include the total pressure, dynamic pressure, Mach number, angle of attack, and angle of sideslip. Secondary objectives are to estimate atmospheric winds by coupling the pressure measurements with the on-board Inertial Measurement Unit (IMU) data. This paper provides details of the algorithm development, MEADS system performance based on calibration, and uncertainty analysis for the aerodynamic and atmospheric quantities of interest. The work presented here is part of the MEDLI performance pre-flight validation and will culminate with processing flight data after Mars entry in 2012.

Preliminary assessment of the Mars Science Laboratory entry, descent, and landing simulation

NASA Astrophysics Data System (ADS)

Way, David W.

On August 5, 2012, the Mars Science Laboratory rover, Curiosity, successfully landed inside Gale Crater. This landing was the seventh successful landing and fourth rover to be delivered to Mars. Weighing nearly one metric ton, Curiosity is the largest and most complex rover ever sent to investigate another planet. Safely landing such a large payload required an innovative Entry, Descent, and Landing system, which included the first guided entry at Mars, the largest supersonic parachute ever flown at Mars, and the novel Sky Crane landing system. A complete, end-to-end, six degree-of-freedom, multi-body computer simulation of the Mars Science Laboratory Entry, Descent, and Landing sequence was developed at the NASA Langley Research Center. In-flight data gathered during the successful landing is compared to pre-flight statistical distributions, predicted by the simulation. These comparisons provide insight into both the accuracy of the simulation and the overall performance of the Entry, Descent, and Landing system.

Woven Thermal Protection System (WTPS) a Novel Approach to Meet NASA's Most Demanding Reentry Missions

NASA Technical Reports Server (NTRS)

Stackpoole, Mairead

2014-01-01

NASA's future robotic missions to Venus and outer planets, namely, Saturn, Uranus, Neptune, result in extremely high entry conditions that exceed the capabilities of current mid-density ablators (PICA or Avcoat). Therefore mission planners assume the use of a fully dense carbon phenolic heat shield similar to what was flown on Pioneer Venus and Galileo. Carbon phenolic (CP) is a robust Thermal Protection System (TPS) however its high density and thermal conductivity constrain mission planners to steep entries, high heat fluxes, pressures and short entry durations, in order for CP to be feasible from a mass perspective. The high entry conditions pose certification challenges in existing ground based test facilities. In 2012 the Game Changing Development Program in NASA's Space Technology Mission Directorate funded NASA ARC to investigate the feasibility of a Woven Thermal Protection System (WTPS) to meet the needs of NASA's most challenging entry missions. This presentation will summarize maturation of the WTPS project.

8. INTERIOR OF FRONT SCREENEDIN PORCH SHOWING PORCH ENTRY DOOR ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. INTERIOR OF FRONT SCREENED-IN PORCH SHOWING PORCH ENTRY DOOR AT PHOTO CENTER AND FRONT ENTRY DOOR TO LIVING ROOM AT PHOTO LEFT. VIEW TO NORTHWEST. - Bishop Creek Hydroelectric System, Plant 4, Worker Cottage, Bishop Creek, Bishop, Inyo County, CA

40 CFR 141.100 - Criteria and procedures for public water systems using point-of-entry devices.

Code of Federal Regulations, 2011 CFR

2011-07-01

... include physical measurements and observations such as total flow treated and mechanical condition of the... engineering design review of the point-of-entry devices. (2) The design and application of the point-of-entry...

40 CFR 141.100 - Criteria and procedures for public water systems using point-of-entry devices.

Code of Federal Regulations, 2013 CFR

2013-07-01

... include physical measurements and observations such as total flow treated and mechanical condition of the... engineering design review of the point-of-entry devices. (2) The design and application of the point-of-entry...

40 CFR 141.100 - Criteria and procedures for public water systems using point-of-entry devices.

Code of Federal Regulations, 2012 CFR

2012-07-01

... include physical measurements and observations such as total flow treated and mechanical condition of the... engineering design review of the point-of-entry devices. (2) The design and application of the point-of-entry...

Apollo experience report: Guidance and control systems: Command and service module entry monitor subsystem

NASA Technical Reports Server (NTRS)

Reina, B., Jr.; Patterson, H. G.

1975-01-01

The conceptual aspects of the command and service module entry monitor subsystem, together with an interpretation of the displays and their associated relationship to entry trajectory control, are presented. The entry monitor subsystem is described, and the problems encountered during the developmental phase and the first five manned Apollo flights are discussed in conjunction with the design improvements implemented.

Inhibitors of SARS-CoV Entry - Identification using an Internally-Controlled Dual Envelope Pseudovirion Assay

PubMed Central

Zhou, Yanchen; Agudelo, Juliet; Lu, Kai; Goetz, David H.; Hansell, Elizabeth; Chen, Yen Ting; Roush, William R.; McKerrow, James; Craik, Charles S.; Amberg, Sean M.; Simmons, Graham

2011-01-01

Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) emerged as the causal agent of an endemic atypical pneumonia, infecting thousands of people worldwide. Although a number of promising potential vaccines and therapeutic agents for SARS-CoV have been described, no effective antiviral drug against SARS-CoV is currently available. The intricate, sequential nature of the viral entry process provides multiple valid targets for drug development. Here, we describe a rapid and safe cell-based high-throughput screening system, Dual Envelope Pseudovirion (DEP) Assay, for specifically screening inhibitors of viral entry. The assay system employs a novel dual envelope strategy, using lentiviral pseudovirions as targets whose entry is driven by the SARS-CoV Spike glycoprotein. A second, unrelated viral envelope is used as an internal control to reduce the number of false positives. As an example of the power of this assay a class of inhibitors is reported with the potential to inhibit SARS-CoV at two steps of the replication cycle, viral entry and particle assembly. This assay system can be easily adapted to screen entry inhibitors against other viruses with the careful selection of matching partner virus envelopes. PMID:21820471

9. INTERIOR OF LIVING ROOM SHOWING OPEN 6LIGHT FRONT ENTRY ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

9. INTERIOR OF LIVING ROOM SHOWING OPEN 6-LIGHT FRONT ENTRY DOOR AND TWO 6-LIGHT OVER 1-LIGHT SASH WINDOWS OVERLOOKING FRONT ENTRY STEPS. VIEW TO NORTHEAST. - Rush Creek Hydroelectric System, Clubhouse Cottage, Rush Creek, June Lake, Mono County, CA

INVESTIGATION OF INAPPROPRIATE POLLUTANTS ENTRIES INTO STORM DRAINAGE SYSTEMS: A USER'S GUIDE

EPA Science Inventory

This User's Guide is the result of a series of EPA sponsored research tasks to develop a procedure to investigate non-stormwater entries into storm drainage systems. A number of past projects have found that dry-weather flows discharging from storm drainage systems can contribu...

Anesthesia Recordkeeping: Accuracy of Recall with Computerized and Manual Entry Recordkeeping

ERIC Educational Resources Information Center

Davis, Thomas Corey

2011-01-01

Introduction: Anesthesia information management systems are rapidly gaining widespread acceptance. Aggressively promoted as an improvement to manual-entry recordkeeping systems in the areas of accuracy, quality improvement, billing and vigilance, these systems record all patient vital signs and parameters, providing a legible hard copy and…

RADON MITIGATION IN SCHOOLS: CASE STUDIES OF RADON MITIGATION SYSTEMS INSTALLED BY EPA IN FOUR MARYLAND SCHOOLS ARE PRESENTED

EPA Science Inventory

The first part of this two-part paper discusses radon entry into schools, radon mitigation approaches for schools, and school characteristics (e.g., heating, ventilation, and air-conditioning -- HVAC-- system design and operation) that influence radon entry and mitigation system ...

Entry, Descent, and Landing with Propulsive Deceleration: Supersonic Retropropulsion Wind Tunnel Testing and Shock Phenomena

NASA Technical Reports Server (NTRS)

Palaszewski, Bryan

2014-01-01

The future exploration of the Solar System will require innovations in transportation and the use of entry, descent, and landing (EDL) systems at many planetary landing sites. The cost of space missions has always been prohibitive, and using the natural planetary and planet's moon atmospheres for entry, and descent can reduce the cost, mass, and complexity of these missions. This paper will describe some of the EDL ideas for planetary entry and survey the overall technologies for EDL that may be attractive for future Solar System missions. Future EDL systems may include an inflatable decelerator for the initial atmospheric entry and an additional supersonic retropropulsion (SRP) rocket system for the final soft landing. A three engine retropropulsion configuration with a 2.5 in. diameter sphere-cone aeroshell model was tested in the NASA Glenn Research Center's 1- by 1-ft (1×1) Supersonic Wind Tunnel (SWT). The testing was conducted to identify potential blockage issues in the tunnel, and visualize the rocket flow and shock interactions during supersonic and hypersonic entry conditions. Earlier experimental testing of a 70deg Viking-like (sphere-cone) aeroshell was conducted as a baseline for testing of a SRP system. This baseline testing defined the flow field around the aeroshell and from this comparative baseline data, retropropulsion options will be assessed. Images and analyses from the SWT testing with 300- and 500-psia rocket engine chamber pressures are presented here. In addition, special topics of electromagnetic interference with retropropulsion induced shock waves and retropropulsion for Earth launched booster recovery are also addressed.

Entry, Descent, and Landing with Propulsive Deceleration: Supersonic Retropropulsion Wind Tunnel Testing and Shock Phenomena

NASA Technical Reports Server (NTRS)

Palaszewski, Bryan

2013-01-01

The future exploration of the Solar System will require innovations in transportation and the use of entry, descent, and landing (EDL) systems at many planetary landing sites. The cost of space missions has always been prohibitive, and using the natural planetary and planet's moon atmospheres for entry, and descent can reduce the cost, mass, and complexity of these missions. This paper will describe some of the EDL ideas for planetary entry and survey the overall technologies for EDL that may be attractive for future Solar System missions. Future EDL systems may include an inflatable decelerator for the initial atmospheric entry and an additional supersonic retro-propulsion (SRP) rocket system for the final soft landing. A three engine retro-propulsion configuration with a 2.5 inch diameter sphere-cone aeroshell model was tested in the NASA Glenn 1x1 Supersonic Wind Tunnel (SWT). The testing was conducted to identify potential blockage issues in the tunnel, and visualize the rocket flow and shock interactions during supersonic and hypersonic entry conditions. Earlier experimental testing of a 70 degree Viking-like (sphere-cone) aeroshell was conducted as a baseline for testing of a supersonic retro-propulsion system. This baseline testing defined the flow field around the aeroshell and from this comparative baseline data, retro-propulsion options will be assessed. Images and analyses from the SWT testing with 300- and 500-psia rocket engine chamber pressures are presented here. In addition, special topics of electromagnetic interference with retro-propulsion induced shock waves and retro-propulsion for Earth launched booster recovery are also addressed.

Venus In Situ Explorer Mission design using a mechanically deployed aerodynamic decelerator

NASA Astrophysics Data System (ADS)

Smith, B.; Venkatapathy, E.; Wercinski, P.; Yount, B.; Prabhu, D.; Gage, P.; Glaze, L.; Baker, C.

The Venus In Situ Explorer (VISE) Mission addresses the highest priority science questions within the Venus community outlined in the National Research Council's Decadal Survey. The heritage Venus atmospheric entry system architecture, a 45° sphere-cone rigid aeroshell with a carbon phenolic thermal protection system, may no longer be the preferred entry system architecture compared to other viable alternatives being explored at NASA. A mechanically-deployed aerodynamic decelerator, known as the Adaptive Deployable Entry and Placement Technology (ADEPT), is an entry system alternative that can provide key operational benefits and risk reduction compared to a rigid aeroshell. This paper describes a mission feasibility study performed with the objectives of identifying potential adverse interactions with other mission elements and establishing requirements on decelerator performance. Feasibility is assessed through a launch-to-landing mission design study where the Venus Intrepid Tessera Lander (VITaL), a VISE science payload designed to inform the Decadal Survey results, is repackaged from a rigid aeroshell into the ADEPT decelerator. It is shown that ADEPT reduces the deceleration load on VITaL by an order of magnitude relative to a rigid aeroshell. The more benign entry environment opens up the VISE mission design environment for increased science return, reduced risk, and reduced cost. The ADEPT-VITAL mission concept of operations is presented and details of the entry vehicle structures and mechanisms are given. Finally, entry aerothermal analysis is presented that defines the operational requirements for a revolutionary structural-TPS material employed by ADEPT: three-dimensionally woven carbon cloth. Ongoing work to mitigate key risks identified in this feasibility study is presented.

NREL Validated Google's Little Box Challenge Entries | Energy Systems

Science.gov Websites

inverter with a power density greater than 50 watts per cubic inch. To help determine the winner, NREL validated the entries at the Energy Systems Integration Facility. Text version A smaller inverter that is

Atmospheric Risk Assessment for the Mars Science Laboratory Entry, Descent, and Landing System

NASA Technical Reports Server (NTRS)

Chen, Allen; Vasavada, Ashwin; Cianciolo, Alicia; Barnes, Jeff; Tyler, Dan; Hinson, David; Lewis, Stephen

2010-01-01

In 2012, the Mars Science Laboratory (MSL) mission will pioneer the next generation of robotic Entry, Descent, and Landing (EDL) systems, by delivering the largest and most capable rover to date to the surface of Mars. As with previous Mars landers, atmospheric conditions during entry, descent, and landing directly impact the performance of MSL's EDL system. While the vehicle's novel guided entry system allows it to "fly out" a range of atmospheric uncertainties, its trajectory through the atmosphere creates a variety of atmospheric sensitivities not present on previous Mars entry systems and landers. Given the mission's stringent landing capability requirements, understanding the atmosphere state and spacecraft sensitivities takes on heightened importance. MSL's guided entry trajectory differs significantly from recent Mars landers and includes events that generate different atmospheric sensitivities than past missions. The existence of these sensitivities and general advancement in the state of Mars atmospheric knowledge has led the MSL team to employ new atmosphere modeling techniques in addition to past practices. A joint EDL engineering and Mars atmosphere science and modeling team has been created to identify the key system sensitivities, gather available atmospheric data sets, develop relevant atmosphere models, and formulate methods to integrate atmosphere information into EDL performance assessments. The team consists of EDL engineers, project science staff, and Mars atmospheric scientists from a variety of institutions. This paper provides an overview of the system performance sensitivities that have driven the atmosphere modeling approach, discusses the atmosphere data sets and models employed by the team as a result of the identified sensitivities, and introduces the tools used to translate atmospheric knowledge into quantitative EDL performance assessments.

Aerodynamic and Aerothermal TPS Instrumentation Reference Guide

NASA Technical Reports Server (NTRS)

Woollard, Bryce A.; Braun, Robert D.; Bose, Deepack

2016-01-01

The hypersonic regime of planetary entry combines the most severe environments that an entry vehicle will encounter with the greatest amount of uncertainty as to the events unfolding during that time period. This combination generally leads to conservatism in the design of an entry vehicle, specifically that of the thermal protection system (TPS). Each planetary entry provides a valuable aerodynamic and aerothermal testing opportunity; the utilization of this opportunity is paramount in better understanding how a specific entry vehicle responds to the demands of the hypersonic entry environment. Previous efforts have been made to instrument entry vehicles in order to collect data during the entry period and reconstruct the corresponding vehicle response. The purpose of this paper is to cumulatively document past TPS instrumentation designs for applicable planetary missions, as well as to list pertinent results and any explainable shortcomings.

Attitude determination with three-axis accelerometer for emergency atmospheric entry

NASA Technical Reports Server (NTRS)

Garcia-Llama, Eduardo (Inventor)

2012-01-01

Two algorithms are disclosed that, with the use of a 3-axis accelerometer, will be able to determine the angles of attack, sideslip and roll of a capsule-type spacecraft prior to entry (at very high altitudes, where the atmospheric density is still very low) and during entry. The invention relates to emergency situations in which no reliable attitude and attitude rate are available. Provided that the spacecraft would not attempt a guided entry without reliable attitude information, the objective of the entry system in such case would be to attempt a safe ballistic entry. A ballistic entry requires three controlled phases to be executed in sequence: First, cancel initial rates in case the spacecraft is tumbling; second, maneuver the capsule to a heat-shield-forward attitude, preferably to the trim attitude, to counteract the heat rate and heat load build up; and third, impart a ballistic bank or roll rate to null the average lift vector in order to prevent prolonged lift down situations. Being able to know the attitude, hence the attitude rate, will allow the control system (nominal or backup, automatic or manual) to cancel any initial angular rates. Also, since a heat-shield forward attitude and the trim attitude can be specified in terms of the angles of attack and sideslip, being able to determine the current attitude in terms of these angles will allow the control system to maneuver the vehicle to the desired attitude. Finally, being able to determine the roll angle will allow for the control of the roll ballistic rate during entry.

26. EXCAVATION OF EAST (FRONT) BASEMENT WELL AND DRAINAGE SYSTEM, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

26. EXCAVATION OF EAST (FRONT) BASEMENT WELL AND DRAINAGE SYSTEM, WITH ARCHED ENTRY INTO BASEMENT UNDER FRONT ENTRY IN BACKGROUND, LOOKING NORTH (NOTE GALLETING IN BRICK FOUNDATION) - Belair, Tulip Grove Drive, Belair-at-Bowie, Bowie, Prince George's County, MD

31 CFR 357.14 - What authority does a Federal Reserve Bank have?

Code of Federal Regulations, 2010 CFR

2010-07-01

...-ENTRY TREASURY BONDS, NOTES AND BILLS HELD IN LEGACY TREASURY DIRECT Treasury/Reserve Automated Debt Entry System (TRADES) § 357.14 What authority does a Federal Reserve Bank have? (a) Each Federal Reserve... system under this part. ...

Space Shuttle third flight /STS-3/ entry RCS analysis. [Reaction Control System

NASA Technical Reports Server (NTRS)

Scallion, W. I.; Compton, H. R.; Suit, W. T.; Powell, R. W.; Blackstock, T. A.; Bates, B. L.

1983-01-01

Flight data obtained from three Space Transportation System orbiter entries (STS-1, 2, and 3) are processed and analyzed to determine the roll interactions caused by the firing of the entry reaction control system (RCS). Comparisons between the flight-derived parameters and the predicted derivatives without interaction effects are made. The flight-derived RCS Plume flow-field interaction effects are independently deduced by direct integration of the incremental changes in the wing upper surface pressures induced by RCS side thruster firings. The separately obtained interaction effects are compared to the predicted values and the differences are discussed.

Address entry while driving: speech recognition versus a touch-screen keyboard.

PubMed

Tsimhoni, Omer; Smith, Daniel; Green, Paul

2004-01-01

A driving simulator experiment was conducted to determine the effects of entering addresses into a navigation system during driving. Participants drove on roads of varying visual demand while entering addresses. Three address entry methods were explored: word-based speech recognition, character-based speech recognition, and typing on a touch-screen keyboard. For each method, vehicle control and task measures, glance timing, and subjective ratings were examined. During driving, word-based speech recognition yielded the shortest total task time (15.3 s), followed by character-based speech recognition (41.0 s) and touch-screen keyboard (86.0 s). The standard deviation of lateral position when performing keyboard entry (0.21 m) was 60% higher than that for all other address entry methods (0.13 m). Degradation of vehicle control associated with address entry using a touch screen suggests that the use of speech recognition is favorable. Speech recognition systems with visual feedback, however, even with excellent accuracy, are not without performance consequences. Applications of this research include the design of in-vehicle navigation systems as well as other systems requiring significant driver input, such as E-mail, the Internet, and text messaging.

The X-38 V-201 Flap Actuator Mechanism

NASA Technical Reports Server (NTRS)

Hagen, Jeff; Moore, Landon; Estes, Jay; Layer, Chris

2004-01-01

The X-38 Crew Rescue Vehicle V-201 space flight test article was designed to achieve an aerodynamically controlled re-entry from orbit in part through the use of two body mounted flaps on the lower rear side. These flaps are actuated by an electromechanical system that is partially exposed to the re-entry environment. These actuators are of a novel configuration and are unique in their requirement to function while exposed to re-entry conditions. The authors are not aware of any other vehicle in which a major actuator system was required to function throughout the complete re-entry profile while parts of the actuator were directly exposed to the ambient environment.

Assessment of Competencies for Computer Information Systems Curricula.

ERIC Educational Resources Information Center

Womble, Myra N.

1993-01-01

In a survey of 80 managerial and 130 entry-level computer professionals, most entry workers believed they possessed competencies identified in Association for Computing Machinery (ACM) curricula; most managers did not agree. Most managers rated 28% of ACM competencies moderately to not important; 63% were so rated by entry workers. (SK)

Locking Nut with Stress-Distributing Insert

NASA Technical Reports Server (NTRS)

Daniels, Christopher C.

2010-01-01

Reusable holders have been devised for evaluating high-temperature, plasma-resistant re-entry materials, especially fabrics. Typical material samples tested support thermal-protection-system damage repair requiring evaluation prior to re-entry into terrestrial atmosphere. These tests allow evaluation of each material to withstand the most severe predicted re-entry conditions.

76 FR 11199 - Application(s) for Duty-Free Entry of Scientific Instruments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-01

... of the central nervous systems of freshwater prawns. Justification for Duty-Free Entry: There are no... 120 kV accelerating voltage, and an electron gun assembly with Cool Beam Illumination System--LaB6..., flexibility of software for signal acquisition and image processing, overall system stability, and ease of use...

RADON MITIGATION IN SCHOOLS: HVAC SYTEMS IN SCHOOLS TEND TO HAVE A GREATER IMPACT ON RADON LEVELS THAN HVAC SYSTEMS IN HOMES

EPA Science Inventory

The first part of this two-part paper discusses radon entry into schools, radon mitigation approaches for schools, and school characteristics (e.g., heating, ventilation, and air conditioing -- HVAC-- system design and operationg) that influence radon entry and mitigation system ...

Intelligent Visual Input: A Graphical Method for Rapid Entry of Patient-Specific Data

PubMed Central

Bergeron, Bryan P.; Greenes, Robert A.

1987-01-01

Intelligent Visual Input (IVI) provides a rapid, graphical method of data entry for both expert system interaction and medical record keeping purposes. Key components of IVI include: a high-resolution graphic display; an interface supportive of rapid selection, i.e., one utilizing a mouse or light pen; algorithm simplification modules; and intelligent graphic algorithm expansion modules. A prototype IVI system, designed to facilitate entry of physical exam findings, is used to illustrates the potential advantages of this approach.

Guidance and Control Architecture Design and Demonstration for Low Ballistic Coefficient Atmospheric Entry

NASA Technical Reports Server (NTRS)

Swei, Sean

2014-01-01

We propose to develop a robust guidance and control system for the ADEPT (Adaptable Deployable Entry and Placement Technology) entry vehicle. A control-centric model of ADEPT will be developed to quantify the performance of candidate guidance and control architectures for both aerocapture and precision landing missions. The evaluation will be based on recent breakthroughs in constrained controllability/reachability analysis of control systems and constrained-based energy-minimum trajectory optimization for guidance development operating in complex environments.

Shuttle program. MCC Level C formulation requirements: Entry guidance and entry autopilot

NASA Technical Reports Server (NTRS)

Harpold, J. C.; Hill, O.

1980-01-01

A set of preliminary entry guidance and autopilot software formulations is presented for use in the Mission Control Center (MCC) entry processor. These software formulations meet all level B requirements. Revision 2 incorporates the modifications required to functionally simulate optimal TAEM targeting capability (OTT). Implementation of this logic in the MCC must be coordinated with flight software OTT implementation and MCC TAEM guidance OTT. The entry guidance logic is based on the Orbiter avionics entry guidance software. This MCC requirements document contains a definition of coordinate systems, a list of parameter definitions for the software formulations, a description of the entry guidance detailed formulation requirements, a description of the detailed autopilot formulation requirements, a description of the targeting routine, and a set of formulation flow charts.

Supersonic Retropropulsion Technology Development in NASA's Entry, Descent, and Landing Project

NASA Technical Reports Server (NTRS)

Edquist, Karl T.; Berry, Scott A.; Rhode, Matthew N.; Kelb, Bil; Korzun, Ashley; Dyakonov, Artem A.; Zarchi, Kerry A.; Schauerhamer, Daniel G.; Post, Ethan A.

2012-01-01

NASA's Entry, Descent, and Landing (EDL) space technology roadmap calls for new technologies to achieve human exploration of Mars in the coming decades [1]. One of those technologies, termed Supersonic Retropropulsion (SRP), involves initiation of propulsive deceleration at supersonic Mach numbers. The potential benefits afforded by SRP to improve payload mass and landing precision make the technology attractive for future EDL missions. NASA's EDL project spent two years advancing the technological maturity of SRP for Mars exploration [2-15]. This paper summarizes the technical accomplishments from the project and highlights challenges and recommendations for future SRP technology development programs. These challenges include: developing sufficiently large SRP engines for use on human-scale entry systems; testing and computationally modelling complex and unsteady SRP fluid dynamics; understanding the effects of SRP on entry vehicle stability and controllability; and demonstrating sub-scale SRP entry systems in Earth's atmosphere.

Woven Thermal Protection System (WTPS) a Novel Approach to Meet Nasa's Most Demanding Reentry Missions

NASA Technical Reports Server (NTRS)

Stackpoole, Margaret M.; Ellerby, Donald T.; Gasch, Matt; Ventkatapathy, Ethiraj; Beerman, Adam; Boghozian, Tane; Gonzales, Gregory; Feldman, Jay; Peterson, Keith; Prabhu, Dinesh

2014-01-01

NASA's future robotic missions to Venus and other planets, namely, Saturn, Uranus, Neptune, result in extremely high entry conditions that exceed the capabilities of current mid density ablators (PICA or Avcoat). Therefore mission planners assume the use of a fully dense carbon phenolic heatshield similar to what was flown on Pioneer Venus and Galileo. Carbon phenolic is a robust TPS, however, its high density and thermal conductivity constrain mission planners to steep entries, high fluxes, pressures and short entry durations, in order for CP to be feasible from a mass perspective. The high entry conditions pose certification challenges in existing ground based test facilities. In 2012 the Game Changing Development Program in NASA's Space Technology Mission Directorate funded NASA ARC to investigate the feasibility of a Woven Thermal Protection System to meet the needs of NASA's most challenging entry missions. This presentation will summarize the maturation of the WTPS project.

Storage of sparse files using parallel log-structured file system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bent, John M.; Faibish, Sorin; Grider, Gary

A sparse file is stored without holes by storing a data portion of the sparse file using a parallel log-structured file system; and generating an index entry for the data portion, the index entry comprising a logical offset, physical offset and length of the data portion. The holes can be restored to the sparse file upon a reading of the sparse file. The data portion can be stored at a logical end of the sparse file. Additional storage efficiency can optionally be achieved by (i) detecting a write pattern for a plurality of the data portions and generating a singlemore » patterned index entry for the plurality of the patterned data portions; and/or (ii) storing the patterned index entries for a plurality of the sparse files in a single directory, wherein each entry in the single directory comprises an identifier of a corresponding sparse file.« less

Development of FIAT-Based Parametric Thermal Protection System Mass Estimating Relationships for NASA's Multi-Mission Earth Entry Concept

NASA Technical Reports Server (NTRS)

Sepka, Steven A.; Zarchi, Kerry; Maddock, Robert W.; Samareh, Jamshid A.

2013-01-01

Part of NASAs In-Space Propulsion Technology (ISPT) program is the development of the tradespace to support the design of a family of multi-mission Earth Entry Vehicles (MMEEV) to meet a wide range of mission requirements. An integrated tool called the Multi Mission System Analysis for Planetary Entry Descent and Landing or M-SAPE tool is being developed as part of Entry Vehicle Technology project under In-Space Technology program. The analysis and design of an Earth Entry Vehicle (EEV) is multidisciplinary in nature, requiring the application many disciplines. Part of M-SAPE's application required the development of parametric mass estimating relationships (MERs) to determine the vehicle's required Thermal Protection System (TPS) for safe Earth entry. For this analysis, the heat shield was assumed to be made of a constant thickness TPS. This resulting MERs will then e used to determine the pre-flight mass of the TPS. Two Mers have been developed for the vehicle forebaody. One MER was developed for PICA and the other consisting of Carbon Phenolic atop an Advanced Carbon-Carbon composition. For the the backshell, MERs have been developed for SIRCA, Acusil II, and LI-900. How these MERs were developed, the resulting equations, model limitations, and model accuracy are discussed in this poster.

Predictors of re-entry into the child protection system in Singapore: a cumulative ecological-transactional risk model.

PubMed

Li, Dongdong; Chu, Chi Meng; Ng, Wei Chern; Leong, Wai

2014-11-01

This study examines the risk factors of re-entry for 1,750 child protection cases in Singapore using a cumulative ecological-transactional risk model. Using administrative data, the present study found that the overall percentage of Child Protection Service (CPS) re-entry in Singapore is 10.5% based on 1,750 cases, with a range from 3.9% (within 1 year) to 16.5% (within 8 years after case closure). One quarter of the re-entry cases were observed to occur within 9 months from case closure. Seventeen risk factors, as identified from the extant literature, were tested for their utility to predict CPS re-entry in this study using a series of Cox regression analyses. A final list of seven risk factors (i.e., children's age at entry, case type, case closure result, duration of case, household income, family size, and mother's employment status) was used to create a cumulative risk score. The results supported the cumulative risk model in that higher risk score is related to higher risk of CPS re-entry. Understanding the prevalence of CPS re-entry and the risk factors associated with re-entry is the key to informing practice and policy in a culturally relevant way. The results from this study could then be used to facilitate critical case management decisions in order to enhance positive outcomes of families and children in Singapore's care system. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mechanism of supporting sub-communicator collectives with O(64) counters as opposed to one counter for each sub-communicator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kumar, Sameer; Mamidala, Amith R.; Ratterman, Joseph D.

A system and method for enhancing barrier collective synchronization on a computer system comprises a computer system including a data storage device. The computer system includes a program stored in the data storage device and steps of the program being executed by a processor. The system includes providing a plurality of communicators for storing state information for a bather algorithm. Each communicator designates a master core in a multi-processor environment of the computer system. The system allocates or designates one counter for each of a plurality of threads. The system configures a table with a number of entries equal tomore » the maximum number of threads. The system sets a table entry with an ID associated with a communicator when a process thread initiates a collective. The system determines an allocated or designated counter by searching entries in the table.« less

Mechanism of supporting sub-communicator collectives with o(64) counters as opposed to one counter for each sub-communicator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blocksome, Michael; Kumar, Sameer; Mamidala, Amith R.

A system and method for enhancing barrier collective synchronization on a computer system comprises a computer system including a data storage device. The computer system includes a program stored in the data storage device and steps of the program being executed by a processor. The system includes providing a plurality of communicators for storing state information for a barrier algorithm. Each communicator designates a master core in a multi-processor environment of the computer system. The system allocates or designates one counter for each of a plurality of threads. The system configures a table with a number of entries equal tomore » the maximum number of threads. The system sets a table entry with an ID associated with a communicator when a process thread initiates a collective. The system determines an allocated or designated counter by searching entries in the table.« less

Mechanism of supporting sub-communicator collectives with O(64) counters as opposed to one counter for each sub-communicator

DOEpatents

Kumar, Sameer; Mamidala, Amith R.; Ratterman, Joseph D.; Blocksome, Michael; Miller, Douglas

2013-09-03

A system and method for enhancing barrier collective synchronization on a computer system comprises a computer system including a data storage device. The computer system includes a program stored in the data storage device and steps of the program being executed by a processor. The system includes providing a plurality of communicators for storing state information for a bather algorithm. Each communicator designates a master core in a multi-processor environment of the computer system. The system allocates or designates one counter for each of a plurality of threads. The system configures a table with a number of entries equal to the maximum number of threads. The system sets a table entry with an ID associated with a communicator when a process thread initiates a collective. The system determines an allocated or designated counter by searching entries in the table.

Entry, Descent, and Landing With Propulsive Deceleration: Supersonic Retropropulsion Wind Tunnel Testing

NASA Technical Reports Server (NTRS)

Palaszewski, Bryan

2012-01-01

The future exploration of the Solar System will require innovations in transportation and the use of entry, descent, and landing (EDL) systems at many planetary landing sites. The cost of space missions has always been prohibitive, and using the natural planetary and planet s moons atmosphere for entry, descent, and landing can reduce the cost, mass, and complexity of these missions. This paper will describe some of the EDL ideas for planetary entry and survey the overall technologies for EDL that may be attractive for future Solar System missions. Future EDL systems may include an inflatable decelerator for the initial atmospheric entry and an additional supersonic retro-propulsion (SRP) rocket system for the final soft landing. As part of those efforts, NASA began to conduct experiments to gather the experimental data to make informed decisions on the "best" EDL options. A model of a three engine retro-propulsion configuration with a 2.5 in. diameter sphere-cone aeroshell model was tested in the NASA Glenn 1- by 1-Foot Supersonic Wind Tunnel (SWT). The testing was conducted to identify potential blockage issues in the tunnel, and visualize the rocket flow and shock interactions during supersonic and hypersonic entry conditions. Earlier experimental testing of a 70 Viking-like (sphere-cone) aeroshell was conducted as a baseline for testing of a supersonic retro-propulsion system. This baseline testing defined the flow field around the aeroshell and from this comparative baseline data, retro-propulsion options will be assessed. Images and analyses from the SWT testing with 300- and 500-psia rocket engine chamber pressures are presented here. The rocket engine flow was simulated with a non-combusting flow of air.

A successful retrograde re-entry at aorta using the Outback LTD catheter for a bilateral common iliac artery occlusion.

PubMed

Kim, Tae-Hoon; Ahn, Ji-Hun; Kim, Do-Hoi

2013-05-01

The Outback LTD re-entry catheter system has become a valuable tool for peripheral intervention and it has been widely used for variable peripheral chronic total occlusion (CTO). However, its use in the setting of the aorta was restricted because of concerns of bleeding risks resulting from re-entry puncture or ballooning. This report presents a case of successful re-entry using the Outback LTD Re-Entry Catheter (Cordis, Bridgewater, New Jersy) at the aorta in a patient with bilateral common iliac artery occlusion. Copyright © 2012 Wiley Periodicals, Inc.

Analytic Development of a Reference Profile for the First Entry in a Skip Atmospheric Entry

NASA Technical Reports Server (NTRS)

Garcia-Llama, Eduardo

2010-01-01

This note shows that a feasible reference drag profile for the first entry portion of a skip entry can be generated as a polynomial expression of the velocity. The coefficients of that polynomial are found through the resolution of a system composed of m + 1 equations, where m is the degree of the drag polynomial. It has been shown that a minimum of five equations (m = 4) are required to establish the range and the initial and final conditions on velocity and flight path angle. It has been shown that at least one constraint on the trajectory can be imposed through the addition of one extra equation in the system, which must be accompanied by the increase in the degree of the drag polynomial. In order to simplify the resolution of the system of equations, the drag was considered as being a probability density function of the velocity, with the velocity as a distribution function of the drag. Combining this notion with the introduction of empirically derived constants, it has been shown that the system of equations required to generate the drag profile can be successfully reduced to a system of linear algebraic equations. For completeness, the resulting drag profiles have been flown using the feedback linearization method of differential geometric control as a guidance law with the error dynamics of a second order homogeneous equation in the form of a damped oscillator. Satisfactory results were achieved when the gains in the error dynamics were changed at a certain point along the trajectory that is dependent on the velocity and the curvature of the drag as a function of the velocity. Future work should study the capacity to update the drag profile in flight when dispersions are introduced. Also, future studies should attempt to link the first entry, as presented and controlled in this note, with a more standard control concept for the second entry, such as the Apollo entry guidance, to try to assess the overall skip entry performance. A guidance law that includes an integral feedback term, as is the case in the actual Space Shuttle entry guidance and as is proposed in Ref 29, could be tried in future studies to assess whether its use results in an improvement of the tracking performance, and to evaluate the design needs when determining the control gains.

Development of FIAT-Based Parametric Thermal Protection System Mass Estimating Relationships for NASA's Multi-Mission Earth Entry Concept

NASA Astrophysics Data System (ADS)

Sepka, S. A.; Samareh, J. A.

2014-06-01

Mass estimating relationships have been formulated to determine a vehicle's Thermal Protection System material and required thickness for safe Earth entry. We focus on developing MERs, the resulting equations, model limitations, and model accuracy.

ADEPT - A Mechanically Deployable Entry System Technology in Development at NASA

NASA Technical Reports Server (NTRS)

Venkatapathy, Ethiraj; Wercinski, Paul; Cassell, Alan; Smith, Brandon; Yount, Bryan

2016-01-01

The proposed presentation will give an overview of a mechanically deployable entry system concept development with a comprehensive summary of the ground tests and design development completed to-date, and current plans for a small-scale flight test in the near future.

Woven Thermal Protection System Based Heat-shield for Extreme Entry Environments Technology (HEEET)

NASA Technical Reports Server (NTRS)

Ellerby, Donald; Venkatapathy, Ethiraj; Stackpoole, Margaret; Chinnapongse, Ronald; Munk, Michelle; Dillman, Robert; Feldman, Jay; Prabhu, Dinesh; Beerman, Adam

2013-01-01

NASA's future robotic missions utilizing an entry system into Venus and the outer planets, namely, Saturn, Uranus, Neptune, result in extremely high entry conditions that exceed the capabilities of state of the art low to mid density ablators such as PICA or Avcoat. Therefore mission planners typically assume the use of a fully dense carbon phenolic heat shield similar to what was flown on Pioneer Venus and Galileo. Carbon phenolic is a robust TPS material however its high density and relatively high thermal conductivity constrain mission planners to steep entries, with high heat fluxes and pressures and short entry durations, in order for CP to be feasible from a mass perspective. The high entry conditions pose challenges for certification in existing ground based test facilities and the longer-term sustainability of CP will continue to pose challenges. In 2012 the Game Changing Development Program (GCDP) in NASA's Space Technology Mission Directorate funded NASA ARC to investigate the feasibility of a Woven Thermal Protection System (WTPS) to meet the needs of NASA's most challenging entry missions. This project was highly successful demonstrating that a Woven TPS solution compares favorably to CP in performance in simulated reentry environments and provides the opportunity to manufacture graded materials that should result in overall reduced mass solutions and enable a much broader set of missions than does CP. Building off the success of the WTPS project GCDP has funded a follow on project to further mature and scale up the WTPS concept for insertion into future NASA robotic missions. The matured WTPS will address the CP concerns associated with ground based test limitations and sustainability. This presentation will briefly discuss results from the WTPS Project and the plans for WTPS maturation into a heat-shield for extreme entry environment.

Woven Thermal Protection System Based Heat-shield for Extreme Entry Environments Technology (HEEET)

NASA Technical Reports Server (NTRS)

Chinnapongse, Ronald; Ellerbe, Donald; Stackpoole, Maragaret; Venkatapathy, Ethiraj; Beerman, Adam; Feldman, Jay; Peterson Keith; Prabhu, Dinesh; Dillman, Robert; Munk, Michelle

2013-01-01

NASA's future robotic missions utilizing an entry system into Venus and the outer planets, namely, Saturn, Uranus, Neptune, result in extremely severe entry conditions that exceed the capabilities of state of the art low to mid density ablators such as PICA or Avcoat. Therefore mission planners typically assume the use of a fully dense carbon phenolic heat shield similar to what was flown on Pioneer Venus and Galileo. Carbon phenolic (CP) is a robust TPS material however its high density and relatively high thermal conductivity constrain mission planners to steep entries, with high heat fluxes and pressures and short entry durations, in order for CP to be feasible from a mass perspective. The high entry conditions pose challenges for certification in existing ground based test facilities and the longer-­-term sustainability of CP will continue to pose challenges. In 2012 the Game Changing Development Program (GCDP) in NASA's Space Technology Mission Directorate funded NASA ARC to investigate the feasibility of a Woven Thermal Protection System (WTPS) to meet the needs of NASA's most challenging entry missions. This project was highly successful demonstrating that a Woven TPS solution compares favorably to CP in performance in simulated reentry environments and provides the opportunity to manufacture graded materials that should result in overall reduced mass solutions and enable a much broader set of missions than does CP. Building off the success of the WTPS project GCDP has funded a follow on project to further mature and scale up the WTPS concept for insertion into future NASA robotic missions. The matured WTPS will address the CP concerns associated with ground based test limitations and sustainability. This presentation will briefly discuss results from the WTPS Project and the plans for WTPS maturation into a heat-­-shield for extreme entry environment.

Radiation Modeling in Shock-Tubes and Entry Flows

DTIC Science & Technology

2009-09-01

the MSRO surface , the local spherical coordinate system with a normal n is entered. Radiation Modeling in Shock-Tubes and Entry Flows 10 - 30 RTO...for each simulated photon group. Radiation Modeling in Shock-Tubes and Entry Flows 10 - 52 RTO-EN-AVT-162 There are two algorithms. In the first...Tubes and Entry Flows RTO-EN-AVT-162 10 - 57 all surfaces of the spatial finite-difference mesh should be calculated. This is illustrated in Figure

Navigation and EDL for the Mars Exploration Rovers

NASA Technical Reports Server (NTRS)

Watkins, Michael M.; Han, Dongsuk

2006-01-01

A viewgraph presentation on Deep Space Navigation, and Entry, Decent, and Landing (EDL) for Mars Exploration Rovers is shown. The contents include: 1) JPL Spacecraft Operating across the Solar System; 2) 2003 - 2004: The Busiest Period in JPL's History; 3) Deep Space Navigation Will Enable Many of the New NASA Missions; 4) What Exactly is Navigation vs. GNC for Deep Space?; 5) Cruise and Approach: Why is Deep Space Navigation So Difficult?; 6) Project Importance of GNC: Landing Site Selection; 7) Planetary Communications and Tracking; 8) Tracking Data Types; 9) Delta Differential One-Way Range (deltaDOR); 10) All Solutions Leading up to TCM-4 Design; 11) Entry Flight Path Sensitivities; 12) MER Navigation Results; 13) Atmospheric Entry Targeting and Delivery; 14) Landing Ellipse Orientation; 15) MER Landing Site Trade Example; 16) Entry, Descent and Landing: Entry Guidance or What Things Do We NOT do for MER Landings (but we will later...); 17) Entering Martian Space 8:29 p.m. PST (ERT); 18) Entry, Descent and Landing; 19) Entry, Descent and Landing: Terminal Guidance; 20) The Challenge Going from 12,000 mph to Zero in Less Than Six Minutes; 21) Spirit Landing Location; 22) Entry, Descent and Landing: The Future; 23) Powered Descent Time-Line; and 24) Updated Sky Crane Maneuver Description. A short summary is also given on planetary guidance, navigation and control as it pertains to EDL systems

Enveloping Aerodynamic Decelerator

NASA Technical Reports Server (NTRS)

Nock, Kerry T. (Inventor); Aaron, Kim M. (Inventor); McRonald, Angus D. (Inventor); Gates, Kristin L. (Inventor)

2018-01-01

An inflatable aerodynamic deceleration method and system is provided for use with an atmospheric entry payload. The inflatable aerodynamic decelerator includes an inflatable envelope and an inflatant, wherein the inflatant is configured to fill the inflatable envelope to an inflated state such that the inflatable envelope surrounds the atmospheric entry payload, causing aerodynamic forces to decelerate the atmospheric entry payload.

GUIDANCE FOR IMPLEMENTING A POINT-OF-USE (POU) OR POINT-OF-ENTRY (POE) TREATMENT STRATEGY FOR COMPLIANCE WITH SDWA

EPA Science Inventory

The challenges facing small drinking water systems were a major focus of the 1996 Amendments to the Safe Drinking Water Act (SDWA). One way Congress sought to help systems meet these challenges was by explicitly allowing systems to install point-of-use (POU) and point-of-entry (P...

Key Attributes of a Successful Physician Order Entry System Implementation in a Multi-hospital Environment

PubMed Central

Ahmad, Asif; Teater, Phyllis; Bentley, Thomas D.; Kuehn, Lynn; Kumar, Rajee R.; Thomas, Andrew; Mekhjian, Hagop S.

2002-01-01

The benefits of computerized physician order entry have been widely recognized, although few institutions have successfully installed these systems. Obstacles to successful implementation are organizational as well as technical. In the spring of 2000, following a 4-year period of planning and customization, a 9-month pilot project, and a 14-month hiatus for year 2000, the Ohio State University Health System extensively implemented physician order entry across inpatient units. Implementation for specialty and community services is targeted for completion in 2002. On implemented units, all orders are processed through the system, with 80 percent being entered by physicians and the rest by nursing or other licensed care providers. The system is deployable across diverse clinical environments, focused on physicians as the primary users, and accepted by clinicians. These are the three criteria by which the authors measured the success of their implementation. They believe that the availability of specialty-specific order sets, the engagement of physician leadership, and a large-scale system implementation were key strategic factors that enabled physician-users to accept a physician order entry system despite significant changes in workflow. PMID:11751800

IXV re-entry demonstrator: Mission overview, system challenges and flight reward

NASA Astrophysics Data System (ADS)

Angelini, Roberto; Denaro, Angelo

2016-07-01

The Intermediate eXperimental Vehicle (IXV) is an advanced re-entry demonstrator vehicle aimed to perform in-flight experimentation of atmospheric re-entry enabling systems and technologies. The IXV integrates key technologies at the system level, with significant advancements on Europe's previous flying test-beds. The project builds on previous achievements at system and technology levels, and provides a unique and concrete way of establishing and consolidating Europe's autonomous position in the strategic field of atmospheric re-entry. The IXV mission and system objectives are the design, development, manufacturing, assembling and on-ground to in-flight verification of an autonomous European lifting and aerodynamically controlled reentry system, integrating critical re-entry technologies at system level. Among such critical technologies of interest, special attention is paid to aerodynamic and aerothermodynamics experimentation, including advanced instrumentation for aerothermodynamics phenomena investigations, thermal protections and hot-structures, guidance, navigation and flight control through combined jets and aerodynamic surfaces (i.e. flaps), in particular focusing on the technologies integration at system level for flight. Following the extensive detailed design, manufacturing, qualification, integration and testing of the flight segment and ground segment elements, IXV has performed a full successful flight on February 11th 2015. After the launch with the VEGA launcher form the CSG spaceport in French Guyana, IXV has performed a full nominal mission ending with a successful splashdown in the Pacific Ocean. During Flight Phase, the IXV space and ground segments worked perfectly, implementing the whole flight program in line with the commanded maneuvers and trajectory prediction, performing an overall flight of 34.400 km including 7.600 km with hot atmospheric re-entry in automatic guidance, concluding with successful precision landing at a distance of ~1 km from the target, including the wind drift acting on the parachute from an altitude of 4.5 km.

An Approximate Ablative Thermal Protection System Sizing Tool for Entry System Design

NASA Technical Reports Server (NTRS)

Dec, John A.; Braun, Robert D.

2005-01-01

A computer tool to perform entry vehicle ablative thermal protection systems sizing has been developed. Two options for calculating the thermal response are incorporated into the tool. One, an industry-standard, high-fidelity ablation and thermal response program was integrated into the tool, making use of simulated trajectory data to calculate its boundary conditions at the ablating surface. Second, an approximate method that uses heat of ablation data to estimate heat shield recession during entry has been coupled to a one-dimensional finite-difference calculation that calculates the in-depth thermal response. The in-depth solution accounts for material decomposition, but does not account for pyrolysis gas energy absorption through the material. Engineering correlations are used to estimate stagnation point convective and radiative heating as a function of time. The sizing tool calculates recovery enthalpy, wall enthalpy, surface pressure, and heat transfer coefficient. Verification of this tool is performed by comparison to past thermal protection system sizings for the Mars Pathfinder and Stardust entry systems and calculations are performed for an Apollo capsule entering the atmosphere at lunar and Mars return speeds.

An Approximate Ablative Thermal Protection System Sizing Tool for Entry System Design

NASA Technical Reports Server (NTRS)

Dec, John A.; Braun, Robert D.

2006-01-01

A computer tool to perform entry vehicle ablative thermal protection systems sizing has been developed. Two options for calculating the thermal response are incorporated into the tool. One, an industry-standard, high-fidelity ablation and thermal response program was integrated into the tool, making use of simulated trajectory data to calculate its boundary conditions at the ablating surface. Second, an approximate method that uses heat of ablation data to estimate heat shield recession during entry has been coupled to a one-dimensional finite-difference calculation that calculates the in-depth thermal response. The in-depth solution accounts for material decomposition, but does not account for pyrolysis gas energy absorption through the material. Engineering correlations are used to estimate stagnation point convective and radiative heating as a function of time. The sizing tool calculates recovery enthalpy, wall enthalpy, surface pressure, and heat transfer coefficient. Verification of this tool is performed by comparison to past thermal protection system sizings for the Mars Pathfinder and Stardust entry systems and calculations are performed for an Apollo capsule entering the atmosphere at lunar and Mars return speeds.

10 CFR 73.45 - Performance capabilities for fixed site physical protection systems.

Code of Federal Regulations, 2010 CFR

2010-01-01

... authorization schedules and entry criteria before permitting entry and to initiate response measures to deny... movement of strategic special nuclear material within material access areas. To achieve this capability the physical protection system shall: (1) Detect unauthorized placement and movement of strategic special...

Linking medical records to an expert system

NASA Technical Reports Server (NTRS)

Naeymi-Rad, Frank; Trace, David; Desouzaalmeida, Fabio

1991-01-01

This presentation will be done using the IMR-Entry (Intelligent Medical Record Entry) system. IMR-Entry is a software program developed as a front-end to our diagnostic consultant software MEDAS (Medical Emergency Decision Assistance System). MEDAS (the Medical Emergency Diagnostic Assistance System) is a diagnostic consultant system using a multimembership Bayesian design for its inference engine and relational database technology for its knowledge base maintenance. Research on MEDAS began at the University of Southern California and the Institute of Critical Care in the mid 1970's with support from NASA and NSF. The MEDAS project moved to Chicago in 1982; its current progress is due to collaboration between Illinois Institute of Technology, The Chicago Medical School, Lake Forest College and NASA at KSC. Since the purpose of an expert system is to derive a hypothesis, its communication vocabulary is limited to features used by its knowledge base. The development of a comprehensive problem based medical record entry system which could handshake with an expert system while creating an electronic medical record at the same time was studied. IMR-E is a computer based patient record that serves as a front end to the expert system MEDAS. IMR-E is a graphically oriented comprehensive medical record. The programs major components are demonstrated.

Development and Test Plans for the MSR EEV

NASA Technical Reports Server (NTRS)

Dillman, Robert; Laub, Bernard; Kellas, Sotiris; Schoenenberger, Mark

2005-01-01

The goal of the proposed Mars Sample Return mission is to bring samples from the surface of Mars back to Earth for thorough examination and analysis. The Earth Entry Vehicle is the passive entry body designed to protect the sample container from entry heating and deceleration loads during descent through the Earth s atmosphere to a recoverable location on the surface. This paper summarizes the entry vehicle design and outlines the subsystem development and testing currently planned in preparation for an entry vehicle flight test in 2010 and mission launch in 2013. Planned efforts are discussed for the areas of the thermal protection system, vehicle trajectory, aerodynamics and aerothermodynamics, impact energy absorption, structure and mechanisms, and the entry vehicle flight test.

Computerized physician order entry from a chief information officer perspective.

PubMed

Cotter, Carole M

2004-12-01

Designing and implementing a computerized physician order entry system in the critical care units of a large urban hospital system is an enormous undertaking. With their significant potential to improve health care and significantly reduce errors, the time for computerized physician order entry or physician order management systems is past due. Careful integrated planning is the key to success, requiring multidisciplinary teams at all levels of clinical and administrative management to work together. Articulated from the viewpoint of the Chief Information Officer of Lifespan, a not-for-profit hospital system in Rhode Island, the vision and strategy preceding the information technology plan, understanding the system's current state, the gap analysis between current and future state, and finally, building and implementing the information technology plan are described.

Evaluation of manhole inserts as structural barriers to mosquito entry into belowground stormwater systems using a simulated treatment device.

PubMed

Harbison, Justin E; Metzger, Marco E; Allen, Vaikko; Hu, Renjie

2009-09-01

Belowground proprietary stormwater treatment devices can produce mosquitoes, including vectors of West Nile virus. Elimination of vertical entry points such as pick holes in manhole covers may reduce the number of mosquitoes entering and reproducing in these structures. Plastic manhole dish inserts were evaluated as structural barriers against mosquito entry through pick holes in a simulated stormwater treatment device. Inserts were 100% effective at preventing mosquito entry through covers when no other openings existed. In devices configured with an open lateral conveyance pipe, the addition of an insert under the cover reduced mosquito oviposition significantly. Subsequent trials to further elucidate mosquito entry through manhole covers found a significant positive correlation between increasing number of pick holes and mosquito oviposition. Results of the study suggest the potential for manhole dish inserts to decrease the number of mosquitoes entering belowground structures. The different available stormwater treatment systems and site-specific installations may, however, provide a much greater variety of possible alternate entry points for mosquitoes than was addressed in the current study. Further work is needed in field installations to quantify the significance of pick holes to mosquito entry and determine under what conditions, if any, manhole dish inserts would be most effective and appropriate.

A Model for Effective Systems Engineering Workforce Development at Space and Naval Warfare Systems Center (SSC) Atlantic

DTIC Science & Technology

2013-09-01

Entry  Activity  17.0 CONFIGURAT ION  MANAGEMEN T   Knowledge and basic abilities associated  to perform configuration management  activities  Entry...Activity  17.0 CONFIGURAT ION  MANAGEMEN T   Aware of configuration change control  Entry  Activity  18.0 REQUIREMEN TS MANAGEMENT  Participate in (for...Washington headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202

Preliminary Study Using Forward Reaction Control System Jets During Space Shuttle Entry

NASA Technical Reports Server (NTRS)

Restrepo, Carolina; Valasek, John

2006-01-01

Failure or degradation of the flight control system, or hull damage, can lead to loss of vehicle control during entry. Possible failure scenarios are debris impact and wing damage that could result in a large aerodynamic asymmetry which cannot be trimmed out without additional yaw control. Currently the space shuttle uses aerodynamic control surfaces and Reaction Control System jets to control attitude. The forward jets are used for orbital maneuvering only, while the aft jets are used for yaw control during entry. This paper develops a controller for using the forward reaction control system jets as an additional control during entry, and assesses its value and feasibility during failure situations. Forward-aft jet blending logic is created, and implemented on a simplified model of the space shuttle entry flight control system. The model is validated and verified on the nonlinear, six degree-of-freedom Shuttle Engineering Simulator. A rudimentary human factors study was undertaken using the forward cockpit simulator at Johnson Space Center, to assess flying qualities of the new system and pilot workload. Results presented in the paper show that the combination of forward and aft jets provides useful additional yaw control, in addition to potential fuel savings and the ability to balance the use of the fuel in the forward and aft tanks to meet availability constraints of both forward and aft fuel tanks. Piloted simulation studies indicated that using both sets of jets while flying a damaged space shuttle reduces pilot workload, and makes the vehicle more responsive.

76 FR 20953 - Application(s) for Duty-Free Entry of Scientific Instruments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-14

...., 9700 South Cass Ave., Lemont, IL 60439. Instrument: Mythen 1K Detector System. Manufacturer: Dectris... (RIXS) to study the electronic structure of highly correlated systems. This instrument is unique in that... dynamic range; and a small, lightweight and compact design. Justification for Duty-Free Entry: There are...

41 CFR 101-30.304 - Application of item entry control.

Code of Federal Regulations, 2011 CFR

2011-07-01

... control. 101-30.304 Section 101-30.304 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 30-FEDERAL CATALOG SYSTEM 30.3-Cataloging Items of Supply § 101-30.304 Application of item entry control. In addition...

41 CFR 101-30.304 - Application of item entry control.

Code of Federal Regulations, 2014 CFR

2014-07-01

... control. 101-30.304 Section 101-30.304 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 30-FEDERAL CATALOG SYSTEM 30.3-Cataloging Items of Supply § 101-30.304 Application of item entry control. In addition...

41 CFR 101-30.304 - Application of item entry control.

Code of Federal Regulations, 2013 CFR

2013-07-01

... control. 101-30.304 Section 101-30.304 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 30-FEDERAL CATALOG SYSTEM 30.3-Cataloging Items of Supply § 101-30.304 Application of item entry control. In addition...

41 CFR 101-30.304 - Application of item entry control.

Code of Federal Regulations, 2010 CFR

2010-07-01

... control. 101-30.304 Section 101-30.304 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 30-FEDERAL CATALOG SYSTEM 30.3-Cataloging Items of Supply § 101-30.304 Application of item entry control. In addition...

INVESTIGATION OF INAPPROPRIATE POLLUTANT ENTRIES INTO STORM DRAINAGE SYSTEMS: A USER'S GUIDE

EPA Science Inventory

This User's Guide, summarized here, is the result of a series of research tasks (sponsored by the U.S. Environmental Protection Agency) to develop a procedure to investigate non-stormwater entries into storm drainage systems. Past projects have found that dry-weather flows disc...

40 CFR 141.100 - Criteria and procedures for public water systems using point-of-entry devices.

Code of Federal Regulations, 2010 CFR

2010-07-01

... water systems using point-of-entry devices. 141.100 Section 141.100 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER... meet all national primary drinking water regulations and would be of acceptable quality similar to...

31 CFR 337.12 - Applicability of TREASURY DIRECT regulations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... DIRECT regulations. The regulations governing the TREASURY DIRECT Book-Entry Securities System (TREASURY... following exceptions: (a) Securities account. (See § 357.20 of this chapter.) An account in the book-entry debenture system may be established by the Department of the Treasury upon receipt of the request that a new...

Current Investments in the NASA Entry Systems Modeling Project

NASA Technical Reports Server (NTRS)

Wright, Michael; Barnhardt, Michael; Hughes, Monica

2017-01-01

This talk will provide an overview of investments in the Entry Systems Modeling project, along with some context of where the effort sits in the overall Space Technology EDL Portfolio. Technical highlights, particularly with referent to work on Ablation Modeling, will be given. Future directions will be discussed.

5. Exterior view, enclosure at walkin entry level between Test ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

5. Exterior view, enclosure at walk-in entry level between Test Cell 6 (right) and Test Cell 7 (left), Systems Integration Laboratory Building (T-28), looking southwest. High pressure gas tank and generator test firings are conducted in the enclosure. - Air Force Plant PJKS, Systems Integration Laboratory, Systems Integration Laboratory Building, Waterton Canyon Road & Colorado Highway 121, Lakewood, Jefferson County, CO

A hypersonic vehicle approach to planetary exploration

NASA Technical Reports Server (NTRS)

Murbach, Marcus S.

1993-01-01

An enhanced Mars network class mission using a lifting hypersonic entry vehicle is proposed. The basic vehicle, derived from a mature hypersonic flight system called SWERVE, offers several advantages over more conventional low L/D or ballistic entry systems. The proposed vehicle has greatly improved lateral and cross range capability (e.g., it is capable of reaching the polar regions during less than optimal mission opportunities), is not limited to surface target areas of low elevation, and is less susceptible to problems caused by Martian dust storms. Further, the integrated vehicle has attractive deployment features and allows for a much improved evolutionary path to larger vehicles with greater science capability. Analysis of the vehicle is aided by the development of a Mars Hypersonic Flight Simulator from which flight trajectories are obtained. Atmospheric entry performance of the baseline vehicle is improved by a deceleration skirt and transpiration cooling system which significantly reduce TPS (Thermal Protection System) and flight battery mass. The use of the vehicle is also attractive in that the maturity of the flight systems make it cost-competitive with the development of a conventional low L/D entry system. Finally, the potential application of similar vehicles to other planetary missions is discussed.

Arcjet Testing of Woven Carbon Cloth for Use on Adaptive Deployable Entry Placement Technology

NASA Technical Reports Server (NTRS)

Arnold, James O.; laub, Bernard; Chen, Yih-Kang; Prabhu, Dinesh K.; Bittner, M. E.; Venkatapathy, Ethiraj

2013-01-01

This paper describes arcjet testing and analysis that has successfully demonstrated the viability of three dimensional woven carbon cloth for dual use in the Adaptive Deployable Entry Placement Technology (ADEPT). ADEPT is an umbrella-like entry system that is folded for stowage in the launch vehicle s shroud and deployed in space prior to reaching the atmospheric interface. A key feature of the ADEPT concept is its lower ballistic coefficient for delivery of a given payload than those for conventional, rigid body entry systems. The benefits that accrue from the lower ballistic coefficient include factor of ten reductions of deceleration forces and entry heating. The former enables consideration of new classes of scientific instruments for solar system exploration while the latter enables the design of a more efficient thermal protection system. The carbon cloth now base lined for ADEPT has a dual use in that it serves as ADEPT s thermal protection system and as the "skin" that transfers aerodynamic deceleration loads to its umbrella-like substructure. The arcjet testing described in this paper was conducted for some of the higher heating conditions for a future Venus mission using the ADEPT concept, thereby showing that the carbon cloth can perform in a relevant entry environment. The ADEPT project considered the carbon cloth to be mission enabling and was carrying it as a major risk during Fiscal Year 2012. The testing and analysis reported here played a major role in retiring that risk and is highly significant to the success and possible adoption of ADEPT for future NASA missions. Finally, this paper also describes a preliminary engineering level code, based on the arcjet data, that can be used to estimate cloth thickness for future missions using ADEPT and to predict carbon cloth performance in future arcjet tests.

Viability of 3 D Woven Carbon Cloth and Advanced Carbon-Carbon Ribs for Adaptive Deployable Entry Placement Technology (ADEPT) for Future NASA Missions

NASA Technical Reports Server (NTRS)

Venkatapathy, Ethiraj; Arnold, James O.; Peterson, K. H.; Blosser, M. L.

2013-01-01

This paper describes aerothermodynamic and thermal structural testing that demonstrate the viability of three dimensional woven carbon cloth and advanced carbon-carbon (ACC) ribs for use in the Adaptive Deployable Entry Placement Technology (ADEPT). ADEPT is an umbrella-like entry system that is folded for stowage in the launch vehicle's shroud and deployed prior to reaching the atmeopheric interface. A key feature of the ADEPT concept is a lower ballistic coefficient for delivery of a given payload than seen with conventional, rigid body entry systems. The benefits that accrue from the lower ballistic coefficient incllude factor-of-ten reductions of deceleration forces and entry heating. The former enables consideration of new classes of scientific instruments for solar system exploration while the latter enables the design of a more efficient thermal protection system. The carbon cloth base lined for ADEPT has a dual use in that it serves as the thermal protection system and as the "skin" that transfers aerdynamic deceleration loads to its umbrella-like substructure. Arcjet testing described in this paper was conducted for some of the higher heating conditions for a future Venus mission using the ADEPT concept, thereby showing that the carbon cloth can perform in a relevant entry environment. Recently completed the thermal structural testing of the cloth attached to a representative ACC rib design is also described. Finally, this paper describes a preliminary engineering level code, based on the arcjet data, that can be used to estimate cloth thickness for future ADEPT missions and to predict carbon cloth performance in future arcjet tests.

A Method for Semi-quantitative Assessment of Exposure to Pesticides of Applicators and Re-entry Workers: An Application in Three Farming Systems in Ethiopia.

PubMed

Negatu, Beyene; Vermeulen, Roel; Mekonnen, Yalemtshay; Kromhout, Hans

2016-07-01

To develop an inexpensive and easily adaptable semi-quantitative exposure assessment method to characterize exposure to pesticide in applicators and re-entry farmers and farm workers in Ethiopia. Two specific semi-quantitative exposure algorithms for pesticides applicators and re-entry workers were developed and applied to 601 farm workers employed in 3 distinctly different farming systems [small-scale irrigated, large-scale greenhouses (LSGH), and large-scale open (LSO)] in Ethiopia. The algorithm for applicators was based on exposure-modifying factors including application methods, farm layout (open or closed), pesticide mixing conditions, cleaning of spraying equipment, intensity of pesticide application per day, utilization of personal protective equipment (PPE), personal hygienic behavior, annual frequency of application, and duration of employment at the farm. The algorithm for re-entry work was based on an expert-based re-entry exposure intensity score, utilization of PPE, personal hygienic behavior, annual frequency of re-entry work, and duration of employment at the farm. The algorithms allowed estimation of daily, annual and cumulative lifetime exposure for applicators, and re-entry workers by farming system, by gender, and by age group. For all metrics, highest exposures occurred in LSGH for both applicators and female re-entry workers. For male re-entry workers, highest cumulative exposure occurred in LSO farms. Female re-entry workers appeared to be higher exposed on a daily or annual basis than male re-entry workers, but their cumulative exposures were similar due to the fact that on average males had longer tenure. Factors related to intensity of exposure (like application method and farm layout) were indicated as the main driving factors for estimated potential exposure. Use of personal protection, hygienic behavior, and duration of employment in surveyed farm workers contributed less to the contrast in exposure estimates. This study indicated that farmers' and farm workers' exposure to pesticides can be inexpensively characterized, ranked, and classified. Our method could be extended to assess exposure to specific active ingredients provided that detailed information on pesticides used is available. The resulting exposure estimates will consequently be used in occupational epidemiology studies in Ethiopia and other similar countries with few resources. © The Author 2016. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Preventing re-entry to foster care.

PubMed

Carnochan, Sarah; Rizik-Baer, Daniel; Austin, Michael J

2013-01-01

Re-entry to foster care generally refers to circumstances in which children who have been discharged from foster care to be reunified with their family of origin, adopted, or provided kinship guardianship are returned to foster care. In the context of the federal performance measurement system, re-entry refers specifically to a return to foster care following an unsuccessful reunification. The federal Children and Family Services Review measures re-entry to foster care with a single indicator, called the permanency of reunification indicator, one of four indicators comprising the reunification composite measure. This review focuses on research related to the re-entry indicator, including the characteristics of children, caregivers and families, as well as case and child welfare services that are associated with a higher or lower risk of re-entry to foster care. Promising post-reunification services designed to prevent re-entry to foster care are described.

Definition ofthe Design Trajectory and Entry Flight Corridor for the NASA Orion Exploration Mission 1 Entry Trajectory Using an Integrated Approach and Optimization

NASA Technical Reports Server (NTRS)

McNamara, Luke W.; Braun, Robert D.

2014-01-01

One of the key design objectives of NASA's Orion Exploration Mission 1 (EM- 1) is to execute a guided entry trajectory demonstrating GN&C capability. The focus of this paper is defining the flyable entry corridor for EM-1 taking into account multiple subsystem constraints such as complex aerothermal heating constraints, aerothermal heating objectives, landing accuracy constraints, structural load limits, Human-System-Integration-Requirements, Service Module debris disposal limits and other flight test objectives. During the EM-1 Design Analysis Cycle 1 design challenges came up that made defining the flyable entry corridor for the EM-1 mission critical to mission success. This document details the optimization techniques that were explored to use with the 6-DOF ANTARES simulation to assist in defining the design entry interface state and entry corridor with respect to key flight test constraints and objectives.

Characterization of the receptor-binding domain of Ebola glycoprotein in viral entry.

PubMed

Wang, Jizhen; Manicassamy, Balaji; Caffrey, Michael; Rong, Lijun

2011-06-01

Ebola virus infection causes severe hemorrhagic fever in human and non-human primates with high mortality. Viral entry/infection is initiated by binding of glycoprotein GP protein on Ebola virion to host cells, followed by fusion of virus-cell membrane also mediated by GP. Using an human immunodeficiency virus (HIV)-based pseudotyping system, the roles of 41 Ebola GP1 residues in the receptor-binding domain in viral entry were studied by alanine scanning substitutions. We identified that four residues appear to be involved in protein folding/structure and four residues are important for viral entry. An improved entry interference assay was developed and used to study the role of these residues that are important for viral entry. It was found that R64 and K95 are involved in receptor binding. In contrast, some residues such as I170 are important for viral entry, but do not play a major role in receptor binding as indicated by entry interference assay and/or protein binding data, suggesting that these residues are involved in post-binding steps of viral entry. Furthermore, our results also suggested that Ebola and Marburg viruses share a common cellular molecule for entry.

Angle of Attack Modulation for Mars Entry Terminal State Optimization

NASA Technical Reports Server (NTRS)

Lafleur, Jarret M.; Cerimele, Christopher J.

2009-01-01

From the perspective of atmospheric entry, descent, and landing (EDL), one of the most foreboding destinations in the solar system is Mars due in part to its exceedingly thin atmosphere. To benchmark best possible scenarios for evaluation of potential Mars EDL system designs, a study is conducted to optimize the entry-to-terminal-state portion of EDL for a variety of entry velocities and vehicle masses, focusing on the identification of potential benefits of enabling angle of attack modulation. The terminal state is envisioned as one appropriate for the initiation of terminal descent via parachute or other means. A particle swarm optimizer varies entry flight path angle, ten bank profile points, and ten angle of attack profile points to find maximum-final-altitude trajectories for a 10 30 m ellipsled at 180 different combinations of values for entry mass, entry velocity, terminal Mach number, and minimum allowable altitude. Parametric plots of maximum achievable altitude are shown, as are examples of optimized trajectories. It is shown that appreciable terminal state altitude gains (2.5-4.0 km) over pure bank angle control may be possible if angle of attack modulation is enabled for Mars entry vehicles. Gains of this magnitude could prove to be enabling for missions requiring high-altitude landing sites. Conclusions are also drawn regarding trends in the bank and angle of attack profiles that produce the optimal trajectories in this study, and directions for future work are identified.

Intersections of Family Homelessness, CPS Involvement, and Race in Alameda County, California

PubMed Central

Shinn, Marybeth

2016-01-01

The homelessness and child protective services (CPS) systems are closely linked. This study examines the patterns and sequence of families’ involvement with homeless shelters and CPS, as well as whether involvement in each system predicts involvement in the other using linked administrative records for 258 families recruited in emergency shelters in Alameda County, California. More than half of families were reported to CPS at some point, but less than one fifth ever had a report substantiated. Reports that were uninvestigated or unfounded increased in the months leading up to shelter entry and spiked immediately afterward, but substantiations and child removals increased only later. Shelter use before study entry was associated with CPS referrals and investigations after study entry, although not with substantiated cases or child removals. However, CPS involvement before study entry was not associated with returns to shelter after study entry. These results imply that an unsubstantiated report of neglect or abuse may serve as an early warning signal for homelessness and that preventive strategies aiming to affect both homeless and child protective systems should focus on reducing homelessness. CPS workers should evaluate families’ housing needs and attempt to link families to appropriate resources. Black families were disproportionately referred to CPS after shelter entry after controlling for other family characteristics, but race was not associated with substantiations of neglect or abuse or with child removals. Findings lend modest support to human decision-making and institutional explanations of racial disproportionalities in CPS involvement, especially for reporters outside of the CPS system. PMID:27318034

Passive cooling system for top entry liquid metal cooled nuclear reactors

DOEpatents

Boardman, Charles E.; Hunsbedt, Anstein; Hui, Marvin M.

1992-01-01

A liquid metal cooled nuclear fission reactor plant having a top entry loop joined satellite assembly with a passive auxiliary safety cooling system for removing residual heat resulting from fuel decay during shutdown, or heat produced during a mishap. This satellite type reactor plant is enhanced by a backup or secondary passive safety cooling system which augments the primary passive auxiliary cooling system when in operation, and replaces the primary cooling system when rendered inoperative.

Prediction of aerodynamic heating and pressures on Shuttle Entry Air Data System (SEADS) nose cap and comparison with STS-61C flight data

NASA Technical Reports Server (NTRS)

Ting, Paul C.; Rochelle, William C.; Curry, Donald M.

1988-01-01

Results are presented from predictions of aerothermodynamic heating rates, temperatures, and pressures on the surface of the Shuttle Entry Air Data System (SEADS) nosecap during Orbiter reentry. These results are compared with data obtained by the first actual flight of the SEADS system aboard STS-61C. The data also used to predict heating rates and surface temperatures for a hypothetical Transatlantic Abort Landing entry trajectory, whose analysis involved ascertaining the increases in heating rate as the airstream flowed across regions of the lower surface catalycity carbon/carbon composite to the higher surface catalycity columbium pressure ports.

12 CFR 615.5452 - Law governing rights and obligations of Federal Reserve Banks, Farm Credit banks, and Funding...

Code of Federal Regulations, 2010 CFR

2010-01-01

... FUNDING OPERATIONS Book-Entry Procedures for Farm Credit Securities § 615.5452 Law governing rights and... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Law governing rights and obligations of Federal...: (i) A book-entry security or security entitlement, and (ii) The operation of the Book-entry System as...

State Policies Affecting the "Adult Re-Entry Pipeline" in Postsecondary Education: Results of a Fifty-State Inventory

ERIC Educational Resources Information Center

Boeke, Marianne; Zis, Stacey; Ewell, Peter

2011-01-01

With support from the Bill and Melinda Gates Foundation, the National Center for Higher Education Management Systems (NCHEMS) is engaged in a two year project centered on state policies that foster student progression and success in the "adult re-entry pipeline." The adult re-entry pipeline consists of the many alternative pathways to…

A System Description of the Heroin Trade

DTIC Science & Technology

1994-01-01

19 3.3. Estimated Distribution of Heroin Smuggling by U.S. Entry Region ............................................. 20 4.1...14. Distribution of Incoming Heroin Among U.S. Entry Regions (Cells A351 to R418) .................................... 84 C-15. Distribution of...Transportation Modes into U.S. Entry Regions (Cells A419 to P472) .................................... 86 C.16. Seizures of Heroin (Cells A473 to P498

Entry Risk into the Juvenile Justice System: African American, American Indian, Asian American, European American, and Hispanic Children and Adolescents

ERIC Educational Resources Information Center

Vazsonyi, Alexander T.; Chen, Pan

2010-01-01

Background: Findings on disproportionate minority contact remain mixed. Few empirical studies have examined to what extent entry risk into juvenile justice varies across ethnic/racial groups, and to what extent childhood aggressive behaviors foretell later deviance and entry risk. In the current study, we sought to address these shortcomings by…

A multicenter study of outcome in systemic lupus erythematosus. I. Entry variables as predictors of prognosis.

PubMed

Ginzler, E M; Diamond, H S; Weiner, M; Schlesinger, M; Fries, J F; Wasner, C; Medsger, T A; Ziegler, G; Klippel, J H; Hadler, N M; Albert, D A; Hess, E V; Spencer-Green, G; Grayzel, A; Worth, D; Hahn, B H; Barnett, E V

1982-06-01

A retrospective study of factors influencing survival in 1,103 patients with systemic lupus erythematosus (SLE) was carried out at 9 university centers diverse in geographic, socioeconomic, and racial characteristics. The mortality and disease characteristics of the patients at study entry varied widely among centers. The survival rates from the time patients with a diagnosis of SLE were first evaluated at the participating center was 90% at 1 year, 77% at 5 years, and 71% at 10 years. Patients with a serum creatinine greater than 3 mg/dl at study entry had the lowest survival rates: 48%, 29%, and 12% at 1, 5, and 10 years, respectively. Survival rate also correlated independently with the entry hematocrit, degree of proteinuria, number of preliminary American Rheumatism Association criteria for SLE satisfied, and source of funding of medical care. When data were corrected for socioeconomic status, race/ethnic origin did not significantly influence survival. Survival rates varied widely at different participating institutions, generally due to differences in disease severity. Place of treatment was independently associated with survival only in the second year after study entry. Disease duration before study entry did not account for the differences in disease severity.

Overview of the Phoenix Entry, Descent and Landing System Architecture

NASA Technical Reports Server (NTRS)

Grover, Myron R., III; Cichy, Benjamin D.; Desai, Prasun N.

2008-01-01

NASA s Phoenix Mars Lander began its journey to Mars from Cape Canaveral, Florida in August 2007, but its journey to the launch pad began many years earlier in 1997 as NASA s Mars Surveyor Program 2001 Lander. In the intervening years, the entry, descent and landing (EDL) system architecture went through a series of changes, resulting in the system flown to the surface of Mars on May 25th, 2008. Some changes, such as entry velocity and landing site elevation, were the result of differences in mission design. Other changes, including the removal of hypersonic guidance, the reformulation of the parachute deployment algorithm, and the addition of the backshell avoidance maneuver, were driven by constant efforts to augment system robustness. An overview of the Phoenix EDL system architecture is presented along with rationales driving these architectural changes.

31 CFR 356.4 - What are the book-entry systems in which auctioned Treasury securities may be issued or maintained?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false What are the book-entry systems in... system) at their par amount. Par amounts of Treasury inflation-protected securities do not include... Circular, Public Debt Series No. 2-86, as amended (part 357 of this chapter) and part 363 of this chapter...

31 CFR 356.4 - What are the book-entry systems in which auctioned Treasury securities may be issued or maintained?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false What are the book-entry systems in... system) at their par amount. Par amounts of Treasury inflation-protected securities do not include... Circular, Fiscal Service Series No. 2-86, as amended (part 357 of this chapter) and part 363 of this...

Modern Advances in Ablative TPS

NASA Technical Reports Server (NTRS)

Venkatapathy, Ethiraj

2013-01-01

Topics covered include: Physics of Hypersonic Flow and TPS Considerations. Destinations, Missions and Requirements. State of the Art Thermal Protection Systems Capabilities. Modern Advances in Ablative TPS. Entry Systems Concepts. Flexible TPS for Hypersonic Inflatable Aerodynamic Decelerators. Conformal TPS for Rigid Aeroshell. 3-D Woven TPS for Extreme Entry Environment. Multi-functional Carbon Fabric for Mechanically Deployable.

Integrated Design System (IDS) Tools for the Spacecraft Aeroassist/Entry Vehicle Design Process

NASA Technical Reports Server (NTRS)

Olynick, David; Braun, Robert; Langhoff, Steven R. (Technical Monitor)

1997-01-01

The definition of the Integrated Design System technology focus area as presented in the NASA Information Technology center of excellence strategic plan is described. The need for IDS tools in the aeroassist/entry vehicle design process is illustrated. Initial and future plans for spacecraft IDS tool development are discussed.

Web-Based Time Entry Systems: Providing Greater Automation and Compliance

ERIC Educational Resources Information Center

Williams, Tracy

2005-01-01

Time and resources are becoming increasingly scarce in most higher education institutions today. As a result, colleges and universities are looking to streamline and simplify many costly, labor-intensive administrative processes. In this article, Tracy Williams examines how Web-based time-entry systems can help institutions save valuable time and…

The IXV experience, from the mission conception to the flight results

NASA Astrophysics Data System (ADS)

Tumino, G.; Mancuso, S.; Gallego, J.-M.; Dussy, S.; Preaud, J.-P.; Di Vita, G.; Brunner, P.

2016-07-01

The atmospheric re-entry domain is a cornerstone of a wide range of space applications, ranging from reusable launcher stages developments, robotic planetary exploration, human space flight, to innovative applications such as reusable research platforms for in orbit validation of multiple space applications technologies. The Intermediate experimental Vehicle (IXV) is an advanced demonstrator which has performed in-flight experimentation of atmospheric re-entry enabling systems and technologies aspects, with significant advancements on Europe's previous flight experiences, consolidating Europe's autonomous position in the strategic field of atmospheric re-entry. The IXV mission objectives were the design, development, manufacturing, assembling and on-ground to in-flight verification of an autonomous European lifting and aerodynamically controlled reentry system, integrating critical re-entry technologies at system level. Among such critical technologies of interest, special attention was paid to aerodynamic and aerothermodynamics experimentation, including advanced instrumentation for aerothermodynamics phenomena investigations, thermal protections and hot-structures, guidance, navigation and flight control through combined jets and aerodynamic surfaces (i.e. flaps), in particular focusing on the technologies integration at system level for flight, successfully performed on February 11th, 2015.

FLPP IXV Re-Entry Vehicle, Supersonic Charectisation Based on DNW SST Wind Tunnel Tests and CFD

NASA Astrophysics Data System (ADS)

Kapteijn, C.; Maseland, H.; Chiarelli, C.; Mareschi, V.; Tribot, J.-P.; Binetti, P.; Walloscheck, T.

2009-01-01

The European Space Agency ESA, has engaged in 2004, the IXV project (Intermediate eXperimental Vehicle) which is part of the FLPP (Future Launcher Preparatory Programme) aiming at answering to critical technological issues for controlled re-entry, while supporting the future generation launchers and to improve in general European capabilities in the strategic field of atmospheric re-entry for future space transportation, exploration and scientific applications. The IXV key mission and system objectives are the design, development, manufacturing, assembling and on- ground to in-flight verification of an autonomous European lifting and aerodynamically controlled re- entry system, integrating the critical re- entry technologies at the system level. In particular, the IXV shall demonstrate system integrated key technologies such as lifting flight control by means of aerodynamic surfaces that are one of the main primary objectives of the experimental investigation. Lifting and aerodynamic controlled re-entry represents a significant capability advancement with respect to the ballistic re-entry of capsules like the ARD. Since hypersonic aerodynamics is essentially different from supersonic aerodynamics, the current mission is to perform an atmospheric re-entry in combination with a safe recovery the in supersonic flight regime. However, mission extension to trimmed transonic flight is under consideration based on a preliminary analysis of the aerodynamic characteristics of the IXV configuration. Since the beginning of the IXV project, an aerodynamic data base (AEDB) has been built up and continuously updated integrating the additional information mainly provided by means of CFD (ie: Euler and Navier-Stokes) and lately also by means of WTTs. This AEDB serves for flying qualities analysis and for re-entry simulations. During the development phase B2/C1, the effectiveness of the control surfaces and their impact on te vehicle's aerodynamic forces in the supersonic regime is measured for a number of discrete deflection settings in the Super-Sonic wind Tunnel (SST) of DNW. Enabling an improved understanding of the measured aerodynamic characteristics, complementary computations were performed by Thales Alenia Space. The complete set of data was analyzed and compared enabling a consolidation of the nominal aerodynamic and aerodynamic uncertainties as well. The paper presents the main objectives of the supersonic characterisation of IXV including WTTs, and the main outcomes of the current data comparisons.

Assisted entry mitigates text messaging-based driving detriment.

PubMed

Sawyer, Benjamin D; Hancock, Peter A

2012-01-01

Previous research using cell phones indicates that manual manipulation is not a principal component of text messaging relating driving detriment. This paper suggests that manipulation of a phone in conjunction with the cognitive need to compose the message itself co-act to contribute to driving degradation. This being so, drivers sending text messages might experience reduced interference to the driving task if the text messaging itself were assisted through the predictive T9 system. We evaluated undergraduate drivers in a simulator who drove and texted using either Assisted Text entry, via Nokia's T9 system, or unassisted entry via the multitap interface. Results supported the superiority of the T9 system over the multitap system implying that specific assistive technologies can modulate the degradation of capacity which texting tragically induces.

Radiative and convective heating during Venus entry.

NASA Technical Reports Server (NTRS)

Page, W. A.; Woodward, H. T.

1972-01-01

Determination of the stagnation region heating of probes entering the Venusian atmosphere. Both convective and radiative heat-transfer rates are predicted, and account is taken of the important effects of radiative transport in the vehicle shock layer. A nongray radiative transport model is utilized which parallels a four-band treatment previously developed for air (Page et al., 1969), but includes two additional bands to account for the important CO(4+) molecular band system. Some comparisons are made between results for Venus entry and results for earth entry obtained using a viscous earth entry program.

STS-26 launch and entry crew equipment demonstration at Naval Weapons Center

NASA Technical Reports Server (NTRS)

1988-01-01

STS-26 launch and entry crew equipment demonstration is conducted by JSC Crew and Thermal Systems Division's (CTSD's) employee James O. Schlosser at the Naval Weapons Center, China Lake, California. Schlosser (left) gives a briefing on the new crew equipment baselined for STS-26 as Astronaut James P. Bagian models the new gear. Included in the package are navy blue launch and entry suit (LES), launch and entry helmet (LEH), parachute, life raft, and survival gear. A mission specialist seat is visible in background between the two men.

Entry, Descent and Landing Systems Analysis: Exploration Class Simulation Overview and Results

NASA Technical Reports Server (NTRS)

DwyerCianciolo, Alicia M.; Davis, Jody L.; Shidner, Jeremy D.; Powell, Richard W.

2010-01-01

NASA senior management commissioned the Entry, Descent and Landing Systems Analysis (EDL-SA) Study in 2008 to identify and roadmap the Entry, Descent and Landing (EDL) technology investments that the agency needed to make in order to successfully land large payloads at Mars for both robotic and exploration or human-scale missions. The year one exploration class mission activity considered technologies capable of delivering a 40-mt payload. This paper provides an overview of the exploration class mission study, including technologies considered, models developed and initial simulation results from the EDL-SA year one effort.

Electronic Chemotherapy Order Entry: A Major Cancer Center's Implementation

PubMed Central

Sklarin, Nancy T.; Granovsky, Svetlana; O'Reilly, Eileen M.; Zelenetz, Andrew D.

2011-01-01

Implementation of a computerized provider order entry system for complex chemotherapy regimens at a large cancer center required intense effort from a multidisciplinary team of clinical and systems experts with experience in all facets of the chemotherapy process. The online tools had to resemble the paper forms used at the time and parallel the successful established process as well as add new functionality. Close collaboration between the institution and the vendor was necessary. This article summarizes the institutional efforts, challenges, and collaborative processes that facilitated universal chemotherapy computerized electronic order entry across multiple sites during a period of several years. PMID:22043182

Electronic Chemotherapy Order Entry: A Major Cancer Center's Implementation.

PubMed

Sklarin, Nancy T; Granovsky, Svetlana; O'Reilly, Eileen M; Zelenetz, Andrew D

2011-07-01

Implementation of a computerized provider order entry system for complex chemotherapy regimens at a large cancer center required intense effort from a multidisciplinary team of clinical and systems experts with experience in all facets of the chemotherapy process. The online tools had to resemble the paper forms used at the time and parallel the successful established process as well as add new functionality. Close collaboration between the institution and the vendor was necessary. This article summarizes the institutional efforts, challenges, and collaborative processes that facilitated universal chemotherapy computerized electronic order entry across multiple sites during a period of several years.

Aerocapture Inflatable Decelerator (AID)

NASA Technical Reports Server (NTRS)

Reza, Sajjad

2007-01-01

Forward Attached Inflatable Decelerators, more commonly known as inflatable aeroshells, provide an effective, cost efficient means of decelerating spacecrafts by using atmospheric drag for aerocapture or planetary entry instead of conventional liquid propulsion deceleration systems. Entry into planetary atmospheres results in significant heating and aerodynamic pressures which stress aeroshell systems to their useful limits. Incorporation of lightweight inflatable decelerator surfaces with increased surface-area footprints provides the opportunity to reduce heat flux and induced temperatures, while increasing the payload mass fraction. Furthermore, inflatable aeroshell decelerators provide the needed deceleration at considerably higher altitudes and Mach numbers when compared with conventional rigid aeroshell entry systems. Inflatable aeroshells also provide for stowage in a compact space, with subsequent deployment of a large-area, lightweight heatshield to survive entry heating. Use of a deployable heatshield decelerator not only enables an increase in the spacecraft payload mass fraction and but may also eliminate the need for a spacecraft backshell and cruise stage. This document is the viewgraph slides for the paper's presentation.

Arcjet Testing of Micro-Meteoroid Impacted Thermal Protection Materials

NASA Technical Reports Server (NTRS)

Agrawal, Parul; Munk, Michelle M.; Glaab, Louis J.

2013-01-01

There are several harsh space environments that could affect thermal protection systems and in turn pose risks to the atmospheric entry vehicles. These environments include micrometeoroid impact, extreme cold temperatures, and ionizing radiation during deep space cruise, all followed by atmospheric entry heating. To mitigate these risks, different thermal protection material samples were subjected to multiple tests, including hyper velocity impact, cold soak, irradiation, and arcjet testing, at various NASA facilities that simulated these environments. The materials included a variety of honeycomb packed ablative materials as well as carbon-based non-ablative thermal protection systems. The present paper describes the results of the multiple test campaign with a focus on arcjet testing of thermal protection materials. The tests showed promising results for ablative materials. However, the carbon-based non-ablative system presented some concerns regarding the potential risks to an entry vehicle. This study provides valuable information regarding the capability of various thermal protection materials to withstand harsh space environments, which is critical to sample return and planetary entry missions.

Thermal Vacuum Facility for Testing Thermal Protection Systems

NASA Technical Reports Server (NTRS)

Daryabeigi, Kamran; Knutson, Jeffrey R.; Sikora, Joseph G.

2002-01-01

A thermal vacuum facility for testing launch vehicle thermal protection systems by subjecting them to transient thermal conditions simulating re-entry aerodynamic heating is described. Re-entry heating is simulated by controlling the test specimen surface temperature and the environmental pressure in the chamber. Design requirements for simulating re-entry conditions are briefly described. A description of the thermal vacuum facility, the quartz lamp array and the control system is provided. The facility was evaluated by subjecting an 18 by 36 in. Inconel honeycomb panel to a typical re-entry pressure and surface temperature profile. For most of the test duration, the average difference between the measured and desired pressures was 1.6% of reading with a standard deviation of +/- 7.4%, while the average difference between measured and desired temperatures was 7.6% of reading with a standard deviation of +/- 6.5%. The temperature non-uniformity across the panel was 12% during the initial heating phase (t less than 500 sec.), and less than 2% during the remainder of the test.

Centralized Data Management in a Multicountry, Multisite Population-based Study.

PubMed

Rahman, Qazi Sadeq-ur; Islam, Mohammad Shahidul; Hossain, Belal; Hossain, Tanvir; Connor, Nicholas E; Jaman, Md Jahiduj; Rahman, Md Mahmudur; Ahmed, A S M Nawshad Uddin; Ahmed, Imran; Ali, Murtaza; Moin, Syed Mamun Ibne; Mullany, Luke; Saha, Samir K; El Arifeen, Shams

2016-05-01

A centralized data management system was developed for data collection and processing for the Aetiology of Neonatal Infection in South Asia (ANISA) study. ANISA is a longitudinal cohort study involving neonatal infection surveillance and etiology detection in multiple sites in South Asia. The primary goal of designing such a system was to collect and store data from different sites in a standardized way to pool the data for analysis. We designed the data management system centrally and implemented it to enable data entry at individual sites. This system uses validation rules and audit that reduce errors. The study sites employ a dual data entry method to minimize keystroke errors. They upload collected data weekly to a central server via internet to create a pooled central database. Any inconsistent data identified in the central database are flagged and corrected after discussion with the relevant site. The ANISA Data Coordination Centre in Dhaka provides technical support for operations, maintenance and updating the data management system centrally. Password-protected login identifications and audit trails are maintained for the management system to ensure the integrity and safety of stored data. Centralized management of the ANISA database helps to use common data capture forms (DCFs), adapted to site-specific contextual requirements. DCFs and data entry interfaces allow on-site data entry. This reduces the workload as DCFs do not need to be shipped to a single location for entry. It also improves data quality as all collected data from ANISA goes through the same quality check and cleaning process.

A Study on Re-entry Predictions of Uncontrolled Space Objects for Space Situational Awareness

NASA Astrophysics Data System (ADS)

Choi, Eun-Jung; Cho, Sungki; Lee, Deok-Jin; Kim, Siwoo; Jo, Jung Hyun

2017-12-01

The key risk analysis technologies for the re-entry of space objects into Earth’s atmosphere are divided into four categories: cataloguing and databases of the re-entry of space objects, lifetime and re-entry trajectory predictions, break-up models after re-entry and multiple debris distribution predictions, and ground impact probability models. In this study, we focused on re- entry prediction, including orbital lifetime assessments, for space situational awareness systems. Re-entry predictions are very difficult and are affected by various sources of uncertainty. In particular, during uncontrolled re-entry, large spacecraft may break into several pieces of debris, and the surviving fragments can be a significant hazard for persons and properties on the ground. In recent years, specific methods and procedures have been developed to provide clear information for predicting and analyzing the re-entry of space objects and for ground-risk assessments. Representative tools include object reentry survival analysis tool (ORSAT) and debris assessment software (DAS) developed by National Aeronautics and Space Administration (NASA), spacecraft atmospheric re-entry and aerothermal break-up (SCARAB) and debris risk assessment and mitigation analysis (DRAMA) developed by European Space Agency (ESA), and semi-analytic tool for end of life analysis (STELA) developed by Centre National d’Etudes Spatiales (CNES). In this study, various surveys of existing re-entry space objects are reviewed, and an efficient re-entry prediction technique is suggested based on STELA, the life-cycle analysis tool for satellites, and DRAMA, a re-entry analysis tool. To verify the proposed method, the re-entry of the Tiangong-1 Space Lab, which is expected to re-enter Earth’s atmosphere shortly, was simulated. Eventually, these results will provide a basis for space situational awareness risk analyses of the re-entry of space objects.

8. EXTERIOR DETAIL OF FRONT ENTRY PORCH SHOWING ORIGINAL ARTS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. EXTERIOR DETAIL OF FRONT ENTRY PORCH SHOWING ORIGINAL ARTS AND CRAFTS STYLE ELECTRICAL LANTERN. VIEW TO SOUTH. - Rush Creek Hydroelectric System, Clubhouse Cottage, Rush Creek, June Lake, Mono County, CA

STS-114: Discovery Day 13 Mission Status Briefing

NASA Technical Reports Server (NTRS)

2005-01-01

LeRoy Cain, STS-114 Ascent/Entry Flight Director, takes a solo stand with the Press in this briefing. He reports that the vehicle is in good shape, consumable status is excellent, and the shuttle crew is in high spirits and preparing for de-orbit and landing. LeRoy and his team have completed the entry system check up, flight control check up, reactor control system check up, and noted that all are at nominal performance; weather forecast is very good, the Entry team is ready and looking forward to de-orbit and landing at the Kennedy Space Center on Monday, August 8th. Re-entry, personal feelings, Columbia accident, data gathering, consumable situation, back up sites, weather, communication block out, night and day landing, and Commander Collin's piloting skills during night flight are some of the topics covered with the News media.

The Design Process of Physical Security as Applied to a U.S. Border Port of Entry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wagner, G.G.

1999-02-22

This paper details the application of a standard physical security system design process to a US Border Port of Entry (PoE) for vehicle entry/exit. The physical security design methodology is described as well as the physical security similarities to facilities currently at a US Border PoE for vehicles. The physical security design process description includes the various elements that make up the methodologies well as the considerations that must be taken into account when dealing with system integration of those elements. The distinctions between preventing unlawful entry/exit of illegal contraband and personnel are described. The potential to enhance the functionsmore » of drug/contraband detection in the Pre-Primary Inspection area through the application of emerging technologies are also addressed.« less

Automation of Command and Data Entry in a Glovebox Work Volume: An Evaluation of Data Entry Devices

NASA Technical Reports Server (NTRS)

Steele, Marianne K.; Nakamura, Gail; Havens, Cindy; LeMay, Moira

1996-01-01

The present study was designed to examine the human-computer interface for data entry while performing experimental procedures within a glovebox work volume in order to make a recommendation to the Space Station Biological Research Project for a data entry system to be used within the Life Sciences Glovebox. Test subjects entered data using either a manual keypad, similar to a standard computer numerical keypad located within the glovebox work volume, or a voice input system using a speech recognition program with a microphone headset. Numerical input and commands were programmed in an identical manner between the two systems. With both electronic systems, a small trackball was available within the work volume for cursor control. Data, such as sample vial identification numbers, sample tissue weights, and health check parameters of the specimen, were entered directly into procedures that were electronically displayed on a video monitor within the glovebox. A pen and paper system with a 'flip-chart' format for procedure display, similar to that currently in use on the Space Shuttle, was used as a baseline data entry condition. Procedures were performed by a single operator; eight test subjects were used in the study. The electronic systems were tested under both a 'nominal' or 'anomalous' condition. The anomalous condition was introduced into the experimental procedure to increase the probability of finding limitations or problems with human interactions with the electronic systems. Each subject performed five test runs during a test day: two procedures each with voice and keypad, one with and one without anomalies, and one pen and paper procedure. The data collected were both quantitative (times, errors) and qualitative (subjective ratings of the subjects).

A LISP-Ada connection

NASA Technical Reports Server (NTRS)

Jaworski, Allan; Lavallee, David; Zoch, David

1987-01-01

The prototype demonstrates the feasibility of using Ada for expert systems and the implementation of an expert-friendly interface which supports knowledge entry. In the Ford LISP-Ada Connection (FLAC) system LISP and Ada are used in ways which complement their respective capabilities. Future investigation will concentrate on the enhancement of the expert knowledge entry/debugging interface and on the issues associated with multitasking and real-time expert systems implementation in Ada.

Aerodynamic Challenges for the Mars Science Laboratory Entry, Descent and Landing

NASA Technical Reports Server (NTRS)

Schoenenberger, Mark; Dyakonov, Artem; Buning, Pieter; Scallion, William; Norman, John Van

2009-01-01

An overview of several important aerodynamics challenges new to the Mars Science Laboratory (MSL) entry vehicle are presented. The MSL entry capsule is a 70 degree sphere cone-based on the original Mars Viking entry capsule. Due to payload and landing accuracy requirements, MSL will be flying at the highest lift-to-drag ratio of any capsule sent to Mars (L/D = 0.24). The capsule will also be flying a guided entry, performing bank maneuvers, a first for Mars entry. The system's mechanical design and increased performance requirements require an expansion of the MSL flight envelope beyond those of historical missions. In certain areas, the experience gained by Viking and other recent Mars missions can no longer be claimed as heritage information. New analysis and testing is re1quired to ensure the safe flight of the MSL entry vehicle. The challenge topics include: hypersonic gas chemistry and laminar-versus-turbulent flow effects on trim angle, a general risk assessment of flying at greater angles-of-attack than Viking, quantifying the aerodynamic interactions induced by a new reaction control system and a risk assessment of recontact of a series of masses jettisoned prior to parachute deploy. An overview of the analysis and tests being conducted to understand and reduce risk in each of these areas is presented. The need for proper modeling and implementation of uncertainties for use in trajectory simulation has resulted in a revision of prior models and additional analysis for the MSL entry vehicle. The six degree-of-freedom uncertainty model and new analysis to quantify roll torque dispersions are presented.

40 CFR 141.100 - Criteria and procedures for public water systems using point-of-entry devices.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 23 2014-07-01 2014-07-01 false Criteria and procedures for public water systems using point-of-entry devices. 141.100 Section 141.100 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Use of Non-Centralized Treatment Devices §...

78 FR 14295 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-05

.... SUPPLEMENTARY INFORMATION: The Department of the Air Force's notices for systems of records subject to the...: Delete entry and replace with ``10 U.S.C., 8013, Secretary of the Air Force; 10 U.S.C. Sections 885... E.O. 9397 (SSN), as amended.'' Purpose(s): Delete entry and replace with ``To support the Air Force...

Radio/FADS/IMU integrated navigation for Mars entry

NASA Astrophysics Data System (ADS)

Jiang, Xiuqiang; Li, Shuang; Huang, Xiangyu

2018-03-01

Supposing future orbiting and landing collaborative exploration mission as the potential project background, this paper addresses the issue of Mars entry integrated navigation using radio beacon, flush air data sensing system (FADS), and inertial measurement unit (IMU). The range and Doppler information sensed from an orbiting radio beacon, the dynamic pressure and heating data sensed from flush air data sensing system, and acceleration and attitude angular rate outputs from an inertial measurement unit are integrated in an unscented Kalman filter to perform state estimation and suppress the system and measurement noise. Computer simulations show that the proposed integrated navigation scheme can enhance the navigation accuracy, which enables precise entry guidance for the given Mars orbiting and landing collaborative exploration mission.

Development Of Metallic Thermal Protection System For The Expert Re-Entry Vehicle: Design Verification

NASA Astrophysics Data System (ADS)

Fatemi, Javad

2011-05-01

The thermal protection system of the EXPERT re-entry vehicle is subjected to accelerations, vibrations, acoustic and shock loads during launch and aero-heating loads and aerodynamic forces during re-entry. To fully understand the structural and thermomechanical performances of the TPS, heat transfer analysis, thermal stress analysis, and thermal buckling analysis must be performed. This requires complex three-dimensional thermal and structural models of the entire TPS including the insulation and sensors. Finite element (FE) methods are employed to assess the thermal and structural response of the TPS to the mechanical and aerothermal loads. The FE analyses results are used for the design verification and design improvement of the EXPERT thermal protection system.

Beale Air Force Base, Perimeter Acquisition Vehicle Entry PhasedArray Warning ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Beale Air Force Base, Perimeter Acquisition Vehicle Entry Phased-Array Warning System, Satellite Communications Terminal, End of Spencer Paul Road, north of Warren Shingle Road (14th Street), Marysville, Yuba County, CA

7 CFR 1260.302 - Organic exemption.

Code of Federal Regulations, 2014 CFR

2014-01-01

... National Organic Program (NOP) (7 CFR part 205) system plan; only produces products that re eligible to be... classification should be entered by the importer on the Customs entry documentation. Any line item entry of 100...

7 CFR 1260.302 - Organic exemption.

Code of Federal Regulations, 2011 CFR

2011-01-01

... National Organic Program (NOP) (7 CFR part 205) system plan; only produces products that re eligible to be... classification should be entered by the importer on the Customs entry documentation. Any line item entry of 100...

7 CFR 1260.302 - Organic exemption.

Code of Federal Regulations, 2012 CFR

2012-01-01

... National Organic Program (NOP) (7 CFR part 205) system plan; only produces products that re eligible to be... classification should be entered by the importer on the Customs entry documentation. Any line item entry of 100...

7 CFR 1260.302 - Organic exemption.

Code of Federal Regulations, 2013 CFR

2013-01-01

... National Organic Program (NOP) (7 CFR part 205) system plan; only produces products that re eligible to be... classification should be entered by the importer on the Customs entry documentation. Any line item entry of 100...

Beale Air Force Base, Perimeter Acquisition Vehicle Entry PhasedArray Warning ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Beale Air Force Base, Perimeter Acquisition Vehicle Entry Phased-Array Warning System, Electric Substation, End of Spencer Paul Road, north of Warren Shingle Road (14th Street), Marysville, Yuba County, CA

47 CFR 73.1820 - Station log.

Code of Federal Regulations, 2010 CFR

2010-10-01

... part. (iii) An entry of each test and activation of the Emergency Alert System (EAS) pursuant to the... functions may be utilized to record entries in the station log Provided: (1) The recording devices do not...

Beale Air Force Base, Perimeter Acquisition Vehicle Entry PhasedArray Warning ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Beale Air Force Base, Perimeter Acquisition Vehicle Entry Phased-Array Warning System, Microwave Equipment Building, End of Spencer Paul Road, north of Warren Shingle Road (14th Street), Marysville, Yuba County, CA

The status of online Mendelian inheritance in man (OMIM) medio 1994.

PubMed Central

Pearson, P; Francomano, C; Foster, P; Bocchini, C; Li, P; McKusick, V

1994-01-01

During the last year many changes have been introduced into the system of maintaining OMIM. There are three major components of the reorganization. First, a distributed editorial system was introduced which provides a three-tiered editorial board with senior editors, science writers and subject editors. Second, MIM entries have been restructured to provide separate gene and phenotype information and to organize them into separate catalogs. The restructuring also establishes clearly defined sections for entering new information, converts old entries to the new structure, and establishes a file maintenance and editorial system in SGML format. Third, the entry numbering and naming system has been modified. In addition, the information has been made available through a variety of output media, including books, CD-ROM and online access based on the IRx, WAIS, Gopher and WWW formats. PMID:7937048

Dynamic graph system for a semantic database

DOEpatents

Mizell, David

2016-04-12

A method and system in a computer system for dynamically providing a graphical representation of a data store of entries via a matrix interface is disclosed. A dynamic graph system provides a matrix interface that exposes to an application program a graphical representation of data stored in a data store such as a semantic database storing triples. To the application program, the matrix interface represents the graph as a sparse adjacency matrix that is stored in compressed form. Each entry of the data store is considered to represent a link between nodes of the graph. Each entry has a first field and a second field identifying the nodes connected by the link and a third field with a value for the link that connects the identified nodes. The first, second, and third fields represent the rows, column, and elements of the adjacency matrix.

Dynamic graph system for a semantic database

DOEpatents

Mizell, David

2015-01-27

A method and system in a computer system for dynamically providing a graphical representation of a data store of entries via a matrix interface is disclosed. A dynamic graph system provides a matrix interface that exposes to an application program a graphical representation of data stored in a data store such as a semantic database storing triples. To the application program, the matrix interface represents the graph as a sparse adjacency matrix that is stored in compressed form. Each entry of the data store is considered to represent a link between nodes of the graph. Each entry has a first field and a second field identifying the nodes connected by the link and a third field with a value for the link that connects the identified nodes. The first, second, and third fields represent the rows, column, and elements of the adjacency matrix.

Computer-based physician order entry: the state of the art.

PubMed Central

Sittig, D F; Stead, W W

1994-01-01

Direct computer-based physician order entry has been the subject of debate for over 20 years. Many sites have implemented systems successfully. Others have failed outright or flirted with disaster, incurring substantial delays, cost overruns, and threatened work actions. The rationale for physician order entry includes process improvement, support of cost-conscious decision making, clinical decision support, and optimization of physicians' time. Barriers to physician order entry result from the changes required in practice patterns, roles within the care team, teaching patterns, and institutional policies. Key ingredients for successful implementation include: the system must be fast and easy to use, the user interface must behave consistently in all situations, the institution must have broad and committed involvement and direction by clinicians prior to implementation, the top leadership of the organization must be committed to the project, and a group of problem solvers and users must meet regularly to work out procedural issues. This article reviews the peer-reviewed scientific literature to present the current state of the art of computer-based physician order entry. PMID:7719793

Entry Atmospheric Flight Control Authority Impacts on GN and C and Trajectory Performance for Orion Exploration Flight Test 1

NASA Technical Reports Server (NTRS)

McNamara, Luke W.

2012-01-01

One of the key design objectives of NASA's Orion Exploration Flight Test 1 (EFT-1) is to execute a guided entry trajectory demonstrating GN&C capability. The focus of this paper is the ight control authority of the vehicle throughout the atmospheric entry ight to the target landing site and its impacts on GN&C, parachute deployment, and integrated performance. The vehicle's attitude control authority is obtained from thrusting 12 Re- action Control System (RCS) engines, with four engines to control yaw, four engines to control pitch, and four engines to control roll. The static and dynamic stability derivatives of the vehicle are determined to assess the inherent aerodynamic stability. The aerodynamic moments at various locations in the entry trajectory are calculated and compared to the available torque provided by the RCS system. Interaction between the vehicle's RCS engine plumes and the aerodynamic conditions are considered to assess thruster effectiveness. This document presents an assessment of Orion's ight control authority and its effectiveness in controlling the vehicle during critical events in the atmospheric entry trajectory.

Defining the Role of BTLA in Breast Cancer Immunosurveillance and Selective Targeting of the BTLA-HVEM-LIGHT Costimulatory System

DTIC Science & Technology

2010-05-01

receptor superfamily, member 14 ( herpesvirus entry mediator) (Tnfrsf14), mRNA. 1 atggaacctc tcccaggatg ggggtcggca ccctggagcc...reverse disease, suggesting its mechanism occurs early after aHSCT. Anti-BTLA treatment prevented GVHD independently of herpesvirus entry mediator...2663-2674 (2007). 29. Nelson, C. A. et al., Structural determinants of herpesvirus entry mediator recognition by murine B and T lymphocyte

Record completeness and data concordance in an anesthesia information management system using context-sensitive mandatory data-entry fields.

PubMed

Avidan, Alexander; Weissman, Charles

2012-03-01

Use of an anesthesia information management system (AIMS) does not insure record completeness and data accuracy. Mandatory data-entry fields can be used to assure data completeness. However, they are not suited for data that is mandatory depending on the clinical situation (context sensitive). For example, information on equal breath sounds should be mandatory with tracheal intubation, but not with mask ventilation. It was hypothesized that employing context-sensitive mandatory data-entry fields can insure high data-completeness and accuracy while maintaining usability. A commercial off-the-shelf AIMS was enhanced using its built-in VBScript programming tool to build event-driven forms with context-sensitive mandatory data-entry fields. One year after introduction of the system, all anesthesia records were reviewed for data completeness. Data concordance, used as a proxy for accuracy, was evaluated using verifiable age-related data. Additionally, an anonymous satisfaction survey on general acceptance and usability of the AIMS was performed. During the initial 12 months of AIMS use, 12,241 (99.6%) of 12,290 anesthesia records had complete data. Concordances of entered data (weight, size of tracheal tubes, laryngoscopy blades and intravenous catheters) with patients' ages were 98.7-99.9%. The AIMS implementation was deemed successful by 98% of the anesthesiologists. Users rated the AIMS usability in general as very good and the data-entry forms in particular as comfortable. Due to the complexity and the high costs of implementation of an anesthesia information management system it was not possible to compare various system designs (for example with or without context-sensitive mandatory data entry-fields). Therefore, it is possible that a different or simpler design would have yielded the same or even better results. This refers also to the evaluation of usability, since users did not have the opportunity to work with different design approaches or even different computer programs. Using context-sensitive mandatory fields in an anesthesia information management system was associated with high record completeness rate and data concordance. In addition, the system's usability was rated as very good by its users. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Development of a Parachute System for Deceleration of Flying Vehicles in Supersonic Regimes

NASA Astrophysics Data System (ADS)

Pilyugin, N. N.; Khlebnikov, V. S.

2010-09-01

Aerodynamic problems arising during design and development of braking systems for re-entry vehicles are analyzed. Aerodynamic phenomena and laws valid in a supersonic flow around a pair of bodies having different shapes are studied. Results of this research can be used in solving application problems (arrangement and optimization of experiments; design and development of various braking systems for re-entry vehicles moving with supersonic speeds in the atmosphere).

Atmospheric entry probes for outer planet exploration. Outer planet entry probe technical summary

NASA Technical Reports Server (NTRS)

1974-01-01

The use of unmanned space probes for investigating the conditions existing on and around the outer planets of the solar system is discussed. The subjects included in the report are: (1) the design of a common entry probe for outer planet missions, (2) the significant trades related to the development of a common probe design, (3) the impact of bus selection on probe design, (4) the impact of probe requirements on bus modifications, and (5) the key technology elements recommended for advanced development. Drawings and illustrations of typical probes are included to show the components and systems used in the space probes.

The Mars Exploration Rovers Entry Descent and Landing and the Use of Aerodynamic Decelerators

NASA Technical Reports Server (NTRS)

Steltzner, Adam; Desai, Prasun; Lee, Wayne; Bruno, Robin

2003-01-01

The Mars Exploration Rovers (MER) project, the next United States mission to the surface of Mars, uses aerodynamic decelerators in during its entry, descent and landing (EDL) phase. These two identical missions (MER-A and MER-B), which deliver NASA s largest mobile science suite to date to the surface of Mars, employ hypersonic entry with an ablative energy dissipating aeroshell, a supersonic/subsonic disk-gap-band parachute and an airbag landing system within EDL. This paper gives an overview of the MER EDL system and speaks to some of the challenges faced by the various aerodynamic decelerators.

Method and system for efficiently searching an encoded vector index

DOEpatents

Bui, Thuan Quang; Egan, Randy Lynn; Kathmann, Kevin James

2001-09-04

Method and system aspects for efficiently searching an encoded vector index are provided. The aspects include the translation of a search query into a candidate bitmap, and the mapping of data from the candidate bitmap into a search result bitmap according to entry values in the encoded vector index. Further, the translation includes the setting of a bit in the candidate bitmap for each entry in a symbol table that corresponds to candidate of the search query. Also included in the mapping is the identification of a bit value in the candidate bitmap pointed to by an entry in an encoded vector.

Entry, Descent and Landing Systems Analysis Study: Phase 1 Report

NASA Technical Reports Server (NTRS)

DwyerCianciolo, Alicia M.; Davis, Jody L.; Komar, David R.; Munk, Michelle M.; Samareh, Jamshid A.; Powell, Richard W.; Shidner, Jeremy D.; Stanley, Douglas O.; Wilhite, Alan W.; Kinney, David J.;

An Efficient User Interface Design for Nursing Information System Based on Integrated Patient Order Information.

PubMed

Chu, Chia-Hui; Kuo, Ming-Chuan; Weng, Shu-Hui; Lee, Ting-Ting

2016-01-01

A user friendly interface can enhance the efficiency of data entry, which is crucial for building a complete database. In this study, two user interfaces (traditional pull-down menu vs. check boxes) are proposed and evaluated based on medical records with fever medication orders by measuring the time for data entry, steps for each data entry record, and the complete rate of each medical record. The result revealed that the time for data entry is reduced from 22.8 sec/record to 3.2 sec/record. The data entry procedures also have reduced from 9 steps in the traditional one to 3 steps in the new one. In addition, the completeness of medical records is increased from 20.2% to 98%. All these results indicate that the new user interface provides a more user friendly and efficient approach for data entry than the traditional interface.

Using a Scripted Data Entry Process to Transfer Legacy Immunization Data While Transitioning Between Electronic Medical Record Systems

PubMed Central

Michel, J.; Hsiao, A.; Fenick, A.

2014-01-01

Summary Background Transitioning between Electronic Medical Records (EMR) can result in patient data being stranded in legacy systems with subsequent failure to provide appropriate patient care. Manual chart abstraction is labor intensive, error-prone, and difficult to institute for immunizations on a systems level in a timely fashion. Objectives We sought to transfer immunization data from two of our health system’s soon to be replaced EMRs to the future EMR using a single process instead of separate interfaces for each facility. Methods We used scripted data entry, a process where a computer automates manual data entry, to insert data into the future EMR. Using the Center for Disease Control’s CVX immunization codes we developed a bridge between immunization identifiers within our system’s EMRs. We performed a two-step process evaluation of the data transfer using automated data comparison and manual chart review. Results We completed the data migration from two facilities in 16.8 hours with no data loss or corruption. We successfully populated the future EMR with 99.16% of our legacy immunization data – 500,906 records – just prior to our EMR transition date. A subset of immunizations, first recognized during clinical care, had not originally been extracted from the legacy systems. Once identified, this data – 1,695 records – was migrated using the same process with minimal additional effort. Conclusions Scripted data entry for immunizations is more accurate than published estimates for manual data entry and we completed our data transfer in 1.2% of the total time we predicted for manual data entry. Performing this process before EMR conversion helped identify obstacles to data migration. Drawing upon this work, we will reuse this process for other healthcare facilities in our health system as they transition to the future EMR. PMID:24734139

Changes, disruption and innovation: An investigation of the introduction of new health information technology in a microbiology laboratory.

PubMed

Toouli, George; Georgiou, Andrew; Westbrook, Johanna

2012-01-01

It is expected that health information technology (HIT) will deliver a safer, more efficient and effective health care system. The aim of this study was to undertake a qualitative and video-ethnographic examination of the impact of information technologies on work processes in the reception area of a Microbiology Department, to ascertain what changed, how it changed and the impact of the change. The setting for this study was the microbiology laboratory of a large tertiary hospital in Sydney. The study consisted of qualitative (interview and focus group) data and observation sessions for the period August 2005 to October 2006 along with video footage shot in three sessions covering the original system and the two stages of the Cerner implementation. Data analysis was assisted by NVivo software and process maps were produced from the video footage. There were two laboratory information systems observed in the video footage with computerized provider order entry introduced four months later. Process maps highlighted the large number of pre data entry steps with the original system whilst the newer system incorporated many of these steps in to the data entry stage. However, any time saved with the new system was offset by the requirement to complete some data entry of patient information not previously required. Other changes noted included the change of responsibilities for the reception staff and the physical changes required to accommodate the increased activity around the data entry area. Implementing a new HIT is always an exciting time for any environment but ensuring that the implementation goes smoothly and with minimal trouble requires the administrator and their team to plan well in advance for staff training, physical layout and possible staff resource reallocation.

Beale Air Force Base, Perimeter Acquisition Vehicle Entry PhasedArray Warning ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Beale Air Force Base, Perimeter Acquisition Vehicle Entry Phased-Array Warning System, Civil Engineering Storage Building, End of Spencer Paul Road, north of Warren Shingle Road (14th Street), Marysville, Yuba County, CA

31 CFR 315.3 - Converting definitive savings bonds to book-entry bonds in New Treasury Direct.

Code of Federal Regulations, 2013 CFR

2013-07-01

... book-entry bonds through New Treasury Direct, an online system for holding Treasury securities. The Web... definitive savings bonds should follow online instructions for conversion. Regulations governing converted...

31 CFR 315.3 - Converting definitive savings bonds to book-entry bonds in New Treasury Direct.

Code of Federal Regulations, 2012 CFR

2012-07-01

... book-entry bonds through New Treasury Direct, an online system for holding Treasury securities. The Web... definitive savings bonds should follow online instructions for conversion. Regulations governing converted...

31 CFR 315.3 - Converting definitive savings bonds to book-entry bonds in New Treasury Direct.

Code of Federal Regulations, 2014 CFR

2014-07-01

... book-entry bonds through New Treasury Direct, an online system for holding Treasury securities. The Web... definitive savings bonds should follow online instructions for conversion. Regulations governing converted...

31 CFR 363.206 - How can I transfer my marketable Treasury security into my TreasuryDirect ® account from another...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Treasury security into my TreasuryDirect ® account from another book-entry system? 363.206 Section 363.206... transfer your marketable Treasury security from the commercial book-entry system by contacting the..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING SECURITIES HELD IN TREASURYDIRECT...

Integrated Thermal Response Tool for Earth Entry Vehicles

NASA Technical Reports Server (NTRS)

Chen, Y.-K.; Milos, F. S.; Partridge, Harry (Technical Monitor)

2001-01-01

A system is presented for multi-dimensional, fully-coupled thermal response modeling of hypersonic entry vehicles. The system consists of a two-dimensional implicit thermal response, pyrolysis and ablation program (TITAN), a commercial finite-element thermal and mechanical analysis code (MARC), and a high fidelity Navier-Stokes equation solver (GIANTS). The simulations performed by this integrated system include hypersonic flow-field, fluid and solid interaction, ablation, shape change, pyrolysis gas generation and flow, and thermal response of heatshield and structure. The thermal response of the ablating and charring heatshield material is simulated using TITAN, and that of the underlying structural is simulated using MARC. The ablating heatshield is treated as an outer boundary condition of the structure, and continuity conditions of temperature and heat flux are imposed at the interface between TITAN and MARC. Aerothermal environments with fluid and solid interaction are predicted by coupling TITAN and GIANTS through surface energy balance equations. With this integrated system, the aerothermal environments for an entry vehicle and the thermal response of both the heatshield and the structure can be obtained simultaneously. Representative computations for a proposed blunt body earth entry vehicle are presented and discussed in detail.

Improving a health information system for real-time data entries: An action research project using socio-technical systems theory.

PubMed

Adaba, Godfried Bakiyem; Kebebew, Yohannes

2018-03-01

This paper presents the findings of an action research (AR) project to improve a health information system (HIS) at the Operating Theater Department (OTD) of a National Health Service (NHS) hospital in South East England, the UK. Informed by socio-technical systems (STS) theory, AR was used to design an intervention to enhance an existing patient administration system (PAS) to enable data entries in real time while contributing to the literature. The study analyzed qualitative data collected through interviews, participant observations, and document reviews. The study found that the design of the PAS was unsuitable to the work of the three units of the OTD. Based on the diagnoses and STS theory, the project developed and implemented a successful intervention to enhance the legacy system for data entries in real time. The study demonstrates the value of AR from a socio-technical perspective for improving existing systems in healthcare settings. The steps adopted in this study could be applied to improve similar systems. A follow-up study will be essential to assess the sustainability of the improved system.

Mid-Lift-to-Drag Ratio Rigid Vehicle Control System Design and Simulation for Human Mars Entry

NASA Technical Reports Server (NTRS)

Johnson, Breanna J.; Cerimele, Christopher J.; Stachowiak, Susan J.; Sostaric, Ronald R.; Matz, Daniel A.; Lu, Ping

2018-01-01

The Mid-Lift-to-Drag Ratio Rigid Vehicle (MRV) is a proposed candidate in the NASA Evolvable Mars Campaign's (EMC) Pathfinder Entry, Descent, and Landing (EDL) architecture study. The purpose of the study is to design a mission and vehicle capable of transporting a 20mt payload to the surface of Mars. The MRV is unique in its rigid, asymmetrical lifting-body shape which enables a higher lift-to-drag ratio (L/D) than the typical robotic Mars entry capsule vehicles that carry much less mass. This paper presents the formulation and six-degree-of-freedom (6DOF) performance of the MRV's control system, which uses both aerosurfaces and a propulsive reaction control system (RCS) to affect longitudinal and lateral directional behavior.

A Comparison of Two Skip Entry Guidance Algorithms

NASA Technical Reports Server (NTRS)

Rea, Jeremy R.; Putnam, Zachary R.

2007-01-01

The Orion capsule vehicle will have a Lift-to-Drag ratio (L/D) of 0.3-0.35. For an Apollo-like direct entry into the Earth's atmosphere from a lunar return trajectory, this L/D will give the vehicle a maximum range of about 2500 nm and a maximum crossrange of 216 nm. In order to y longer ranges, the vehicle lift must be used to loft the trajectory such that the aerodynamic forces are decreased. A Skip-Trajectory results if the vehicle leaves the sensible atmosphere and a second entry occurs downrange of the atmospheric exit point. The Orion capsule is required to have landing site access (either on land or in water) inside the Continental United States (CONUS) for lunar returns anytime during the lunar month. This requirement means the vehicle must be capable of flying ranges of at least 5500 nm. For the L/D of the vehicle, this is only possible with the use of a guided Skip-Trajectory. A skip entry guidance algorithm is necessary to achieve this requirement. Two skip entry guidance algorithms have been developed: the Numerical Skip Entry Guidance (NSEG) algorithm was developed at NASA/JSC and PredGuid was developed at Draper Laboratory. A comparison of these two algorithms will be presented in this paper. Each algorithm has been implemented in a high-fidelity, 6 degree-of-freedom simulation called the Advanced NASA Technology Architecture for Exploration Studies (ANTARES). NASA and Draper engineers have completed several monte carlo analyses in order to compare the performance of each algorithm in various stress states. Each algorithm has been tested for entry-to-target ranges to include direct entries and skip entries of varying length. Dispersions have been included on the initial entry interface state, vehicle mass properties, vehicle aerodynamics, atmosphere, and Reaction Control System (RCS). Performance criteria include miss distance to the target, RCS fuel usage, maximum g-loads and heat rates for the first and second entry, total heat load, and control system saturation. The comparison of the performance criteria has led to a down select and guidance merger that will take the best ideas from each algorithm to create one skip entry guidance algorithm for the Orion vehicle.

Automated identification of drug and food allergies entered using non-standard terminology.

PubMed

Epstein, Richard H; St Jacques, Paul; Stockin, Michael; Rothman, Brian; Ehrenfeld, Jesse M; Denny, Joshua C

2013-01-01

An accurate computable representation of food and drug allergy is essential for safe healthcare. Our goal was to develop a high-performance, easily maintained algorithm to identify medication and food allergies and sensitivities from unstructured allergy entries in electronic health record (EHR) systems. An algorithm was developed in Transact-SQL to identify ingredients to which patients had allergies in a perioperative information management system. The algorithm used RxNorm and natural language processing techniques developed on a training set of 24 599 entries from 9445 records. Accuracy, specificity, precision, recall, and F-measure were determined for the training dataset and repeated for the testing dataset (24 857 entries from 9430 records). Accuracy, precision, recall, and F-measure for medication allergy matches were all above 98% in the training dataset and above 97% in the testing dataset for all allergy entries. Corresponding values for food allergy matches were above 97% and above 93%, respectively. Specificities of the algorithm were 90.3% and 85.0% for drug matches and 100% and 88.9% for food matches in the training and testing datasets, respectively. The algorithm had high performance for identification of medication and food allergies. Maintenance is practical, as updates are managed through upload of new RxNorm versions and additions to companion database tables. However, direct entry of codified allergy information by providers (through autocompleters or drop lists) is still preferred to post-hoc encoding of the data. Data tables used in the algorithm are available for download. A high performing, easily maintained algorithm can successfully identify medication and food allergies from free text entries in EHR systems.

Mars Science Laboratory Navigation Results

NASA Technical Reports Server (NTRS)

Martin-Mur, Tomas J.; Kruizingas, Gerhard L.; Burkhart, P. Daniel; Wong, Mau C.; Abilleira, Fernando

2012-01-01

The Mars Science Laboratory (MSL), carrying the Curiosity rover to Mars, was launched on November 26, 2011, from Cape Canaveral, Florida. The target for MSL was selected to be Gale Crater, near the equator of Mars, with an arrival date in early August 2012. The two main interplanetary navigation tasks for the mission were to deliver the spacecraft to an entry interface point that would allow the rover to safely reach the landing area, and to tell the spacecraft where it entered the atmosphere of Mars, so it could guide itself accurately to close proximity of the landing target. MSL used entry guidance as it slowed down from the entry speed to a speed low enough to allow for a successful parachute deployment, and this guidance allowed shrinking the landing ellipse to a 99% conservative estimate of 7 by 20 kilometers. Since there is no global positioning system in Mars, achieving this accuracy was predicated on flying a trajectory that closely matched the reference trajectory used to design the guidance algorithm, and on initializing the guidance system with an accurate Mars-relative entry state that could be used as the starting point to integrate the inertial measurement unit data during entry and descent. The pre-launch entry flight path angle (EFPA) delivery requirement was +/- 0.20 deg, but after launch a smaller threshold of +/- 0.05 deg was used as the criteria for late trajectory correction maneuver (TCM) decisions. The pre-launch requirement for entry state knowledge was 2.8 kilometers in position error and 2 meters per second in velocity error, but also smaller thresholds were defined after launch to evaluate entry state update opportunities. The biggest challenge for the navigation team was to accurately predict the trajectory of the spacecraft, so the estimates of the entry conditions could be stable, and late trajectory correction maneuvers or entry parameter updates could be waved off. As a matter of fact, the prediction accuracy was such that the last TCM performed was a small burn executed eight days before landing, and the entry state that was calculated just 36 hours after that TCM, and that was uploaded to the spacecraft the same day, did not need to be updated. The final EFPA was 0.013 deg shallower than the -15.5 deg target, and the on-board entry state was just 200 meters in position and 0.11 meters per second in velocity from the post-landing reconstructed entry state. Overall the entry delivery and knowledge requirements were fulfilled with a margin of more than 90% with respect to the pre-launch thresholds. This excellent accuracy contributed to a very successful and accurate entry, descent, and landing, and surface mission.

Rapid Assembly of Customized TALENs into Multiple Delivery Systems

PubMed Central

Zhang, Zhengxing; Zhang, Siliang; Huang, Xin; Orwig, Kyle E.; Sheng, Yi

2013-01-01

Transcriptional activator-like effector nucleases (TALENs) have become a powerful tool for genome editing. Here we present an efficient TALEN assembly approach in which TALENs are assembled by direct Golden Gate ligation into Gateway® Entry vectors from a repeat variable di-residue (RVD) plasmid array. We constructed TALEN pairs targeted to mouse Ddx3 subfamily genes, and demonstrated that our modified TALEN assembly approach efficiently generates accurate TALEN moieties that effectively introduce mutations into target genes. We generated “user friendly” TALEN Entry vectors containing TALEN expression cassettes with fluorescent reporter genes that can be efficiently transferred via Gateway (LR) recombination into different delivery systems. We demonstrated that the TALEN Entry vectors can be easily transferred to an adenoviral delivery system to expand application to cells that are difficult to transfect. Since TALENs work in pairs, we also generated a TALEN Entry vector set that combines a TALEN pair into one PiggyBac transposon-based destination vector. The approach described here can also be modified for construction of TALE transcriptional activators, repressors or other functional domains. PMID:24244669

19 CFR 149.5 - Eligibility to file an Importer Security Filing, authorized agents.

Code of Federal Regulations, 2010 CFR

2010-04-01

... data interchange system. If the Importer Security Filing and entry or entry summary are provided via a... must retain powers of attorney in English until revoked. Revoked powers of attorney and letters of...

Newly designed launch and entry suit (LES) modeled by technician

NASA Image and Video Library

1988-11-14

Space shuttle orange launch and entry suit (LES), a partial pressure suit, is modeled by a technician. LES was designed for STS-26, the return to flight mission, and subsequent missions. Included in the crew escape system (CES) package are launch and entry helmet (LEH) with communications carrier (COMM CAP), parachute pack and harness, life raft, life preserver unit (LPU), LES gloves, suit oxygen manifold and valves, boots, and survival gear.

Mars Sample Return Using Commercial Capabilities: Propulsive Entry, Descent, and Landing of a Capsule Form Vehicle

NASA Technical Reports Server (NTRS)

Gonzales, Andrew A.; Lemke, Lawrence G.; Huynh, Loc C.

2014-01-01

This paper describes a critical portion of the work that has been done at NASA, Ames Research Center regarding the use of the commercially developed Dragon capsule as a delivery vehicle for the elements of a high priority Mars Sample Return mission. The objective of the investigation was to determine entry and landed mass capabilities that cover anticipated mission conditions. The "Red Dragon", Mars configuration, uses supersonic retro-propulsion, with no required parachute system, to perform Entry, Descent, and Landing (EDL) maneuvers. The propulsive system proposed for use is the same system that will perform an abort, if necessary, for a human rated version of the Dragon capsule. Standard trajectory analysis tools are applied to publically available information about Dragon and other legacy capsule forms in order to perform the investigation. Trajectory simulation parameters include entry velocity, flight path angle, lift to drag Ratio (L/D), landing site elevation, atmosphere density, and total entry mass, in addition engineering assumptions for the performance of the propulsion system are stated. Mass estimates for major elements of the overall proposed architecture are coupled to this EDL analysis to close the overall architecture. Three synodic launch opportunities, beginning with the 2022 opportunity, define the arrival conditions. Results state the relations between the analysis parameters as well as sensitivities to those parameters. The EDL performance envelope includes landing altitudes between 0 and -4 km referenced to the Mars Orbiter Laser Altimeter datum as well as minimum and maximum atmosphere density. Total entry masses between 7 and 10 mt are considered with architecture closure occurring between 9.0 and 10 mt. Propellant mass fractions for each major phase of the EDL - Entry, Terminal Descent, and Hazard Avoidance - have been derived. An assessment of the effect of the entry conditions on the Thermal Protection System (TPS) currently in use for Dragon missions shows no significant stressors. A useful payload mass of 2.0 mt is provided and includes mass and grow allowance for a Mars Ascent Vehicle (MAV), Earth Return Vehicle (ERV), and mission unique equipment. The useful payload supports an architecture that receives a sample from another surface asset and sends it directly back to Earth for recovery in a high Earth orbit. The work shows that emerging commercial capabilities as well as previously studied EDL methodologies can be used to efficiently support an important planetary science objective. The work also has applications for human exploration missions that will also use propulsive EDL techniques

RPMIS: The Roswell Park Management Information System

PubMed Central

Priore, R.L.; Lane, W.W.; Edgerton, F.T.; Naeher, C.H.; Reese, P.A.

1978-01-01

This paper presents a generalized approach to data entry and editing utilizing formatted video computer terminals. The purpose of the system developed is to facilitate the creation of many small data bases, with a minimum of implementation time, while maintaining extensive editing capability and preserving ease of use by data entry personnel. RPMIS has demonstrated its utility in shortening the time between research activities and clinical application of results. The system allows entry and retrieval of overlapping subsets of the patient's record in an order and format most appropriate to the individual application. It is used for production of synoptic presentations of information from the labs, the ward and the clinic. RPMIS was designed for the clinical trials setting and has been well received and implemented for numerous such studies. Additional uses have included several registries, screening clinics, retrospective studies, and epidemiologic investigations. The system has found fortuitous use in maintaining curriculum vitae, publications lists and continuing medical education credits.

Tactile Data Entry for Extravehicular Activity

NASA Technical Reports Server (NTRS)

Adams, Richard J.; Olowin, Aaron B.; Hannaford, Blake; Sands, O Scott

2012-01-01

In the task-saturated environment of extravehicular activity (EVA), an astronaut's ability to leverage suit-integrated information systems is limited by a lack of options for data entry. In particular, bulky gloves inhibit the ability to interact with standard computing interfaces such as a mouse or keyboard. This paper presents the results of a preliminary investigation into a system that permits the space suit gloves themselves to be used as data entry devices. Hand motion tracking is combined with simple finger gesture recognition to enable use of a virtual keyboard, while tactile feedback provides touch-based context to the graphical user interface (GUI) and positive confirmation of keystroke events. In human subject trials, conducted with twenty participants using a prototype system, participants entered text significantly faster with tactile feedback than without (p = 0.02). The results support incorporation of vibrotactile information in a future system that will enable full touch typing and general mouse interactions using instrumented EVA gloves.

Entry, Descent and Landing Systems Analysis Study: Phase 2 Report on Exploration Feed-Forward Systems

NASA Technical Reports Server (NTRS)

Dwyer Ciancolo, Alicia M.; Davis, Jody L.; Engelund, Walter C.; Komar, D. R.; Queen, Eric M.; Samareh, Jamshid A.; Way, David W.; Zang, Thomas A.; Murch, Jeff G.; Krizan, Shawn A.;

Improvements Could Be Made in Reconciling Other Defense Organizations Civilian Pay to the General Ledger

DTIC Science & Technology

2016-03-25

could not record a journal entry to this account. DFAS Indianapolis provided us with a System Change Proposal dated April 17, 2014, which proposed a...system change to DAI to permit journal entries to USSGL 2213 that was implemented in October 2015. However, DFAS Indianapolis should not have allowed...properly accrued civilian pay for the 12 ODOs that used the Defense Agencies Initiative or the Defense Business Management System general ledgers

Analytic Guidance for the First Entry in a Skip Atmospheric Entry

NASA Technical Reports Server (NTRS)

Garcia-Llama, Eduardo

2007-01-01

This paper presents an analytic method to generate a reference drag trajectory for the first entry portion of a skip atmospheric entry. The drag reference, expressed as a polynomial function of the velocity, will meet the conditions necessary to fit the requirements of the complete entry phase. The generic method proposed to generate the drag reference profile is further simplified by thinking of the drag and the velocity as density and cumulative distribution functions respectively. With this notion it will be shown that the reference drag profile can be obtained by solving a linear algebraic system of equations. The resulting drag profile is flown using the feedback linearization method of differential geometric control as guidance law with the error dynamics of a second order homogeneous equation in the form of a damped oscillator. This approach was first proposed as a revisited version of the Space Shuttle Orbiter entry guidance. However, this paper will show that it can be used to fly the first entry in a skip entry trajectory. In doing so, the gains in the error dynamics will be changed at a certain point along the trajectory to improve the tracking performance.

[Is the ICU staff satisfied with the computerized physician order entry? A cross-sectional survey study].

PubMed

Fumis, Renata Rego Lins; Costa, Eduardo Leite Vieira; Martins, Paulo Sergio; Pizzo, Vladimir; Souza, Ivens Augusto; Schettino, Guilherme de Paula Pinto

2014-01-01

To evaluate the satisfaction of the intensive care unit staff with a computerized physician order entry and to compare the concept of the computerized physician order entry relevance among intensive care unit healthcare workers. We performed a cross-sectional survey to assess the satisfaction of the intensive care unit staff with the computerized physician order entry in a 30-bed medical/surgical adult intensive care unit using a self-administered questionnaire. The questions used for grading satisfaction levels were answered according to a numerical scale that ranged from 1 point (low satisfaction) to 10 points (high satisfaction). The majority of the respondents (n=250) were female (66%) between the ages of 30 and 35 years of age (69%). The overall satisfaction with the computerized physician order entry scored 5.74±2.14 points. The satisfaction was lower among physicians (n=42) than among nurses, nurse technicians, respiratory therapists, clinical pharmacists and diet specialists (4.62±1.79 versus 5.97±2.14, p<0.001); satisfaction decreased with age (p<0.001). Physicians scored lower concerning the potential of the computerized physician order entry for improving patient safety (5.45±2.20 versus 8.09±2.21, p<0.001) and the ease of using the computerized physician order entry (3.83±1.88 versus 6.44±2.31, p<0.001). The characteristics independently associated with satisfaction were the system's user-friendliness, accuracy, capacity to provide clear information, and fast response time. Six months after its implementation, healthcare workers were satisfied, albeit not entirely, with the computerized physician order entry. The overall users' satisfaction with computerized physician order entry was lower among physicians compared to other healthcare professionals. The factors associated with satisfaction included the belief that digitalization decreased the workload and contributed to the intensive care unit quality with a user-friendly and accurate system and that digitalization provided concise information within a reasonable time frame.

EPIRUS-NET: A Wireless Health Telematics Network in Greece

DTIC Science & Technology

2001-10-25

has also to be made. The system is represented of three basic layers: the database layer, the middleware and the Hospital Daily Progress Anamnesis ... Anamnesis . The Encounter entry is uniquely identified by the incremental ID, IID, attribute. Each encounter entry is associated with a clinical...the main entities of the system (Hospital, Patient, Anamnesis , Encounter, Clinical Examination, Daily Progress, Examination, Release Ticket), along

Hypersonic and Supersonic Static Aerodynamics of Mars Science Laboratory Entry Vehicle

NASA Technical Reports Server (NTRS)

Dyakonov, Artem A.; Schoenenberger, Mark; Vannorman, John W.

2012-01-01

This paper describes the analysis of continuum static aerodynamics of Mars Science Laboratory (MSL) entry vehicle (EV). The method is derived from earlier work for Mars Exploration Rover (MER) and Mars Path Finder (MPF) and the appropriate additions are made in the areas where physics are different from what the prior entry systems would encounter. These additions include the considerations for the high angle of attack of MSL EV, ablation of the heatshield during entry, turbulent boundary layer, and other aspects relevant to the flight performance of MSL. Details of the work, the supporting data and conclusions of the investigation are presented.

Cubesat Application for Planetary Entry (CAPE) Missions: Micro-Reentry Capsule (MIRCA)

NASA Technical Reports Server (NTRS)

Esper, Jaime

2014-01-01

The Cubesat Application for Planetary Entry Missions (CAPE) concept describes a high-performing Cubesat system which includes a propulsion module and miniaturized technologies capable of surviving atmospheric entry heating, while reliably transmitting scientific and engineering data. The Micro Return Capsule (MIRCA) is CAPEs first planetary entry probe flight prototype. Within this context, this paper briefly describes CAPEs configuration and typical operational scenario, and summarizes ongoing work on the design and basic aerodynamic characteristics of the prototype MIRCA vehicle. CAPE not only opens the door to new planetary mission capabilities, it also offers relatively low-cost opportunities especially suitable to university participation.

Truck transportation through border ports of entry : analysis of coordination systems.

DOT National Transportation Integrated Search

2002-11-01

This report identifies shortcomings in coordination at U.S. Mexico border ports-of-entry and recommends alternatives that would improve operations and reduce congestion and delay. Based on the review of numerous previous reports and more than 100...

33 CFR 105.260 - Security measures for restricted areas.

Code of Federal Regulations, 2010 CFR

2010-07-01

...; (7) Control the entry, parking, loading and unloading of vehicles; (8) Control the movement and...) Using security personnel, automatic intrusion detection devices, surveillance equipment, or surveillance systems to detect unauthorized entry or movement within restricted areas; (7) Directing the parking...

33 CFR 105.260 - Security measures for restricted areas.

Code of Federal Regulations, 2011 CFR

2011-07-01

...; (7) Control the entry, parking, loading and unloading of vehicles; (8) Control the movement and...) Using security personnel, automatic intrusion detection devices, surveillance equipment, or surveillance systems to detect unauthorized entry or movement within restricted areas; (7) Directing the parking...

ENTRYSAT: A 3U Cubesat to Study the Re-Entry Atmospheric Environment

NASA Astrophysics Data System (ADS)

Garcia, R. F.; Chaix, J.; Mimoun, D.; EntrySat student Team

2014-04-01

The EntrySat is a 3U CubeSat designed to study the uncontrolled atmospheric re-entry. The project, developed by ISAE in collaboration with ONERA, is funded by CNES and is intended to be launched in January 2016, in the context of the QB50 network. The scientific goal is to relate the kinematics of the satellite with the aerothermodynamic environment during re-entry. In particular, data will be compared with the computations of MUSIC/FAST, a new 6-degree of freedom code developed by ONERA to predict the trajectory of space debris. According to these requirements, the satellite will measure the temperature, pressure, heat flux, and drag force during re-entry, as well as the trajectory and attitude of the satellite. One of the major technological challenges is the retrieval of data during the re-entry phase, which will be based on the Iridium satellite network. The system design is based on the use of commercial COTS components, and is mostly developed by students from ISAE. As such, the EntrySat has an important educational value in the formation of young engineers.

Data capture by digital pen in clinical trials: a qualitative and quantitative study.

PubMed

Estellat, Candice; Tubach, Florence; Costa, Yolande; Hoffmann, Isabelle; Mantz, Jean; Ravaud, Philippe

2008-05-01

To investigate the use of the digital pen (DP) system to collect data in a clinical trial. To assess the accuracy of the system in this setting. Qualitative study based on semistructured interviews and a focus group. Quantitative study comparing the DP system and a double manual data-entry system in accuracy of acquiring data by variable type (tick boxes, dates, numbers, letters). An ongoing randomised multicentric clinical trial in tertiary care in France. 27 investigators involved in the trial (anaesthetists) who did or did not include patients, 4 study monitors and the study coordinator. Six key findings emerged: 1) the DP system was easy to use; its utilisation was intuitive, even for investigators inexperienced in informatics; 2) despite its portability, the DP was not always used in front of patients; 3) the DP system did not affect patient recruitment; 4) most of the technical problems of the system occurred during setup (compatibility, password access, antivirus software); 5) the main advantage was quickness of data availability for the study coordination staff and the main hindrance was the extra time required for online verification; and 6) all investigators were ready to use the system again. The investigators had to check 16% of data obtained by the DP system during the verification step. There is no relevant difference between the number of errors for the DP and the double manual data-entry systems: 8/5022 versus 6/5022 data entries. 5 out of 8 DP-system failures were due to the intelligent character recognition system. The DP system has a good acceptability among all investigators in a clinical setting, whether they are experienced with computers or not, and a good accuracy, as compared with double manual data entry.

Mass Spectrometry for Planetary Probes: Past, Present and Future

NASA Technical Reports Server (NTRS)

Niemann, Hasso B.; Harpold, Dan N.; Jamieson, Brian G.; Mahaffy, Paul R.

2005-01-01

Atmospheric entry probes present a unique opportunity for performing quantitative analysis of extra-terrestrial atmospheres in cases where remote sensing alone may not be sufficient and measurements with balloons or aircraft is not practical. An entry probe can provide a complete vertical profile of atmospheric parameters including chemical composition, which cannot be obtained with most other techniques. There are, however, unique challenges associated with building instruments for an entry probe, as compared to orbiters, landers, or rovers. Conditions during atmospheric entry are extreme, there are inherent time constraints due to the short duration of the experiment, and the instrument experiences rapid environmental changes in temperature and pressure as it descends. In addition, there are resource limitations, i.e. mass, power, size and bandwidth. Finally, the demands on the instrument design are determined in large part by conditions (pressure, temperature, composition) unique to the particular body under study, and as a result there is no one-size-fits-all instrument for an atmospheric probe. Many of these requirements can be more easily met by miniaturizing the probe instrument. Our experience building mass spectrometers for atmospheric entry probes leads us to believe that the time is right for a fundamental change in the way spaceflight mass spectrometers are built. The emergence over the past twenty years of Micro-electro- mechanical Systems (MEMS), utilizing lithographic semiconductor fabrication techniques to produce instrument systems in miniature, holds great promise for application to spaceflight mass spectrometry. A highly miniaturized, high performance and low-power mass spectrometer would be an enormous benefit to future entry probe missions, allowing, for example, parallel measurements (e.g., multiple simultaneous gas chromatographic analyses and direct atmospheric leaks.) Such an instrument would also enable mass spectrometry on board small multiple entry probes. In the development of a MEMS Mass Spectrometer, the challenge facing us is to move beyond the proof-of-concept, where research dollars tend to focus, and carry out the detailed work of developing a high performance mass spectrometer system on a chip which meets the unique technical requirements for an atmospheric entry probe described above.

Nano Entry System for CubeSat-Class Payloads Project (Nano-ADEPT)

NASA Technical Reports Server (NTRS)

Smith, Brandon Patrick

2014-01-01

This project is developing a mechanically deployed system through a mission application study, deployment/ejection testing, and wind tunnel testing. Adaptable Deployable Entry and Placement Technology (ADEPT) has been under development at NASA since 2011. Nano-ADEPT is the application of this revolutionary entry technology for small spacecraft. The unique capability of ADEPT for small science payloads comes from its ability to stow within a slender volume and deploy passively to achieve a mass-efficient drag surface with a high heat rate capability. Near-term applications for this technology include return of small science payloads or CubeSat technology from Low Earth Orbit (LEO) and delivery of secondary payloads to the surface of Mars.

Performance analysis of different database in new internet mapping system

NASA Astrophysics Data System (ADS)

Yao, Xing; Su, Wei; Gao, Shuai

2017-03-01

In the Mapping System of New Internet, Massive mapping entries between AID and RID need to be stored, added, updated, and deleted. In order to better deal with the problem when facing a large number of mapping entries update and query request, the Mapping System of New Internet must use high-performance database. In this paper, we focus on the performance of Redis, SQLite, and MySQL these three typical databases, and the results show that the Mapping System based on different databases can adapt to different needs according to the actual situation.

Kaizen newspaper

NASA Technical Reports Server (NTRS)

Shearer, Scott C. (Inventor); Proferes, John Nicholas (Inventor); Baker, Sr., Mitchell D. (Inventor); Reilly, Kenneth B. (Inventor); Tiwari, Vijai K. (Inventor)

2013-01-01

Systems, computer program products, and methods are disclosed for tracking an improvement event. An embodiment includes an event interface configured to receive a plurality of entries related to each of a plurality of improvement events. The plurality of entries includes a project identifier for the improvement event, a creation date, an objective, an action related to reaching the objective, and a first deadline related to the improvement event. A database interface is configured to store the plurality of entries in an event database.

Heatshield for Extreme Entry Environment Technology (HEEET) Enabling Missions Beyond Heritage Carbon Phenolic

NASA Technical Reports Server (NTRS)

Stackpoole, M.; Boghozian, T.; Chavez-Garcia, J.; Ellerby, D.; Fowler, M.; Gage, P.; Gasch, M.; Gonzales, G.; Kazemba, C.; Kellermann, C.;

Ongoing Capabilities and Developments of Re-Entry Plasma Ground Tests at EADS-ASTRIUM

NASA Technical Reports Server (NTRS)

Jullien, Pierre

2008-01-01

During re-entry, spacecrafts are subjected to extreme thermal loads. On mars, they may go through dust storms. These external heat loads are leading the design of re-entry vehicles or are affecting it for spacecraft facing solid propellant jet stream. Sizing the Thermal Protection System require a good knowledge of such solicitations and means to model and reproduce them on earth. Through its work on European projects, ASTRIUM has developed the full range of competences to deal with such issues. For instance, we have designed and tested the heat-shield of the Huygens probe which landed on Titan. In particular, our plasma generators aim to reproduce a wide variety of re-entry conditions. Heat loads are generated by the huge speed of the probes. Such conditions cannot be fully reproduced. Ground tests focus on reproducing local aerothermal loads by using slower but hotter flows. Our inductive plasma torch enables to test little samples at low TRL. Amongst the arc-jets, one was design to test architecture design of ISS crew return system and others fit more severe re-entry such as sample returns or Venus re-entry. The last developments aimed in testing samples in seeded flows. First step was to design and test the seeding device. Special diagnostics characterizing the resulting flow enabled us to fit it to the requirements.

Implementation of a dynamic data entry system for the PHENIX gas system

NASA Astrophysics Data System (ADS)

Hagiwara, Masako

2003-10-01

The PHENIX detector at the BNL RHIC facility uses multiple detector technologies that require a precise gas delivery system, including flammable gases that require additional monitoring. During operation of the detector, it is crucial to maintain stable and safe operating conditions by carefully monitoring flows, pressures, and various other gas properties. These systems are monitored during running periods on a continuous basis. For the most part, these records were kept by hand, filling out a paper logsheet every four hours. A dynamic data entry system was needed to replace the paper logsheets. The solution created was to use a PDA or laptop computer with a wireless connection to enter the data directly into a MySQL database. The system uses PHP to dynamically create and update the data entry pages. The data entered can be viewed in graphs as well as tables. As a result, the data recorded will be easily accessible during PHENIX's next running period. It also allows for long term archiving, making the data available during the analysis phase, providing knowledge of the operating conditions of the gas system.

Grants Document-Generation System

NASA Technical Reports Server (NTRS)

Hairell, Terri; Kreymer, Lev; Martin, Greg; Sheridan, Patrick

2008-01-01

The Grants Document-Generation System (GDGS) software allows the generation of official grants documents for distribution to the appropriate parties. The documents are created after the selection and entry of specific data elements and clauses. GDGS is written in Cold Fusion that resides on an SQL2000 database and is housed on-site at Goddard Space Flight Center. It includes access security written around GSFC's (Goddard Space Flight Center's) LIST system, and allows for the entry of Procurement Request information necessary for the generation of the resulting Grant Award.

A Multifunctional Hot Structure Heatshield Concept for Planetary Entry

NASA Technical Reports Server (NTRS)

Walker, Sandra P.; Daryabeigi, Kamran; Samareh, Jamshid A.; Wagner, Robert; Waters, Allen

2015-01-01

A multifunctional hot structure heatshield concept is being developed to provide technology enhancements with significant benefits compared to the current state-of-the-art heatshield technology. These benefits can potentially enable future planetary missions. The concept is unique in integrating the function of the thermal protection system with the primary load carrying structural component. An advanced carbon-carbon material system has been evaluated for the load carrying structure, which will be utilized on the outer surface of the heatshield, and thus will operate as a hot structure exposed to the severe aerodynamic heating associated with planetary entry. Flexible, highly efficient blanket insulation is sized for use underneath the hot structure to maintain required operational internal temperatures. The approach followed includes developing preliminary designs to demonstrate feasibility of the concept and benefits over a traditional, baseline design. Where prior work focused on a concept for an Earth entry vehicle, the current efforts presented here are focused on developing a generic heatshield model and performing a trade study for a Mars entry application. This trade study includes both structural and thermal evaluation. The results indicate that a hot structure concept is a feasible alternative to traditional heatshields and may offer advantages that can enable future entry missions.

Human Mars Entry, Descent and Landing Architectures Study Overview

NASA Technical Reports Server (NTRS)

Polsgrove, Tara T.; Dwyer Cianciolo, Alicia

2016-01-01

Landing humans on Mars will require entry, descent and landing (EDL) capability beyond the current state of the art. Nearly twenty times more delivered payload and an order of magnitude improvement in precision landing capability will be necessary. Several EDL technologies capable of meeting the human class payload delivery requirements are being considered. The EDL technologies considered include low lift-to-drag vehicles like Hypersonic Inflatable Aerodynamic Decelerators (HIAD), Adaptable Deployable Entry and Placement Technology (ADEPT), and mid range lift-to-drag vehicles like rigid aeroshell configurations. To better assess EDL technology options and sensitivities to future human mission design variations, a series of design studies has been conducted. The design studies incorporate EDL technologies with conceptual payload arrangements defined by the Evolvable Mars Campaign to evaluate the integrated system with higher fidelity than have been performed to date. This paper describes the results of the design studies for a lander design using the HIAD, ADEPT and rigid shell entry technologies and includes system and subsystem design details including mass and power estimates. This paper will review the point design for three entry configurations capable of delivering a 20 t human class payload to the surface of Mars.

SHEFEX - the vehicle and sub-systems for a hypersonic re-entry flight experiment

NASA Astrophysics Data System (ADS)

Turner, John; Hörschgen, Marcus; Turner, Peter; Ettl, Josef; Jung, Wolfgang; Stamminger, Andreas

2005-08-01

The purpose of the Sharp Edge Flight Experiment (SHEFEX) is to investigate the aerodynamic behaviour and thermal problems of an unconventional shape for re-entry vehicles, comprising multi-facetted surfaces with sharp edges. The main object of this experiment is the correlation of numerical analysis with real flight data in terms of the aerodynamic effects and structural concept for the thermal protection system (TPS). The Mobile Rocket Base of the German Aerospace Center (DLR) is responsible for the test flight of SHEFEX on a two stage unguided solid propellant sounding rocket which is required to provide a velocity of the order of March 7 for more than 30 seconds during atmospheric re-entry. This paper discusses the problems associated with the mission requirements and the solutions developed for the vehicle and sub-systems.

Mission and Design Sensitivities for Human Mars Landers Using Hypersonic Inflatable Aerodynamic Decelerators

NASA Technical Reports Server (NTRS)

Polsgrove, Tara; Thomas, Herbert D.; Dwyer Cianciolo, Alicia; Collins, Tim; Samareh, Jamshid

2017-01-01

This paper explores the impact of human Mars mission architecture decisions on the design and performance of a lander using the HIAD entry system: (a) Earth departure options, (b) Mars arrival options, (c) Entry Descent and Landing options.

Evaluation of emergency medical text processor, a system for cleaning chief complaint text data.

PubMed

Travers, Debbie A; Haas, Stephanie W

2004-11-01

Emergency Medical Text Processor (EMT-P) version 1, a natural language processing system that cleans emergency department text (e.g., chst pn, chest pai), was developed to maximize extraction of standard terms (e.g., chest pain). The authors compared the number of standard terms extracted from raw chief complaint (CC) data with that for CC data cleaned with EMT-P and evaluated the accuracy of EMT-P. This cross-sectional observation study included CC text entries for all emergency department visits to three tertiary care centers in 2001. Terms were extracted from CC entries before and after cleaning with EMT-P. Descriptive statistics included number and percentage of all entries (tokens) and all unique entries (types) that matched a standard term from the Unified Medical Language System (UMLS). An expert panel rated the accuracy of the CC-UMLS term matches; inter-rater reliability was measured with kappa. The authors collected 203,509 CC entry tokens, of which 63,946 were unique entry types. For the raw data, 89,337 tokens (44%) and 5,081 types (8%) matched a standard term. After EMT-P cleaning, 168,050 tokens (83%) and 44,430 types (69%) matched a standard term. The expert panel reached consensus on 201 of the 222 CC-UMLS term matches reviewed (kappa=0.69-0.72). Ninety-six percent of the 201 matches were rated equivalent or related. Thirty-eight percent of the nonmatches were found to match UMLS concepts. EMT-P version 1 is relatively accurate, and cleaning with EMT-P improved the CC-UMLS term match rate over raw data. The authors identified areas for improvement in future EMT-P versions and issues to be resolved in developing a standard CC terminology.

Flexible Ablators: Applications and Arcjet Testing

NASA Technical Reports Server (NTRS)

Arnold, James O.; Venkatapathy, Ethiraj; Beck, Robin A S.; Mcguire, Kathy; Prabhu, Dinesh K.; Gorbunov, Sergey

2011-01-01

Flexible ablators were conceived in 2009 to meet the technology pull for large, human Mars Exploration Class, 23 m diameter hypersonic inflatable aerodynamic decelerators. As described elsewhere, they have been recently undergoing initial technical readiness (TRL) advancement by NASA. The performance limits of flexible ablators in terms of maximum heat rates, pressure and shear remain to be defined. Further, it is hoped that this emerging technology will vastly expand the capability of future NASA missions involving atmospheric entry systems. This paper considers four topics of relevance to flexible ablators: (1) Their potential applications to near/far term human and robotic missions (2) Brief consideration of the balance between heat shield diameter, flexible ablator performance limits, entry vehicle controllability and aft-body shear layer impingement of interest to designers of very large entry vehicles, (3) The approach for developing bonding processes of flexible ablators for use on rigid entry bodies and (4) Design of large arcjet test articles that will enable the testing of flexible ablators in flight-like, combined environments (heat flux, pressure, shear and structural tensile loading). Based on a review of thermal protection system performance requirements for future entry vehicles, it is concluded that flexible ablators have broad applications to conventional, rigid entry body systems and are enabling to large deployable (both inflatable and mechanical) heat shields. Because of the game-changing nature of flexible ablators, it appears that NASA's Office of the Chief Technologist (OCT) will fund a focused, 3-year TRL advancement of the new materials capable of performance in heat fluxes in the range of 200-600 W/sq. cm. This support will enable the manufacture and use of the large-scale arcjet test designs that will be a key element of this OCT funded activity.

Mars2020 Entry, Descent, and Landing Instrumentation (MEDLI2): Science Objectives and Instrument Requirements

NASA Technical Reports Server (NTRS)

Bose, Deepak; White, Todd; Schoenenberger, Mark; Karlgaard, Chris; Wright, Henry

2015-01-01

NASAs exploration and technology roadmaps call for capability advancements in Mars entry, descent, and landing (EDL) systems to enable increased landed mass, a higher landing precision, and a wider planetary access. It is also recognized that these ambitious EDL performance goals must be met while maintaining a low mission risk in order to pave the way for future human missions. As NASA is engaged in developing new EDL systems and technologies via testing at Earth, instrumentation of existing Mars missions is providing valuable engineering data for performance improvement, risk reduction, and an improved definition of entry loads and environment. The most notable recent example is the Mars Entry, Descent and Landing Instrument (MEDLI) suite hosted by Mars Science Laboratory for its entry in Aug 2012. The MEDLI suite provided a comprehensive dataset for Mars entry aerodynamics, aerothermodynamics and thermal protection system (TPS) performance. MEDLI data has since been used for unprecedented reconstruction of aerodynamic drag, vehicle attitude, in-situ atmospheric density, aerothermal heating, and transition to turbulence, in-depth TPS performance and TPS ablation. [1,2] In addition to validating predictive models, MEDLI data has demonstrated extra margin available in the MSL forebody TPS, which can potentially be used to reduce vehicle parasitic mass. The presentation will introduce a follow-on MEDLI instrumentation suite (called MEDLI2) that is being developed for Mars-2020 mission. MEDLI2 has an enhanced scope that includes backshell instrumentation, a wider forebody coverage, and instruments that specifically target supersonic aerodynamics. Similar to MEDLI, MEDLI2 uses thermal plugs with embedded thermocouples and ports through the TPS to measure surface pressure. MEDLI2, however, also includes heat flux sensors in the backshell and a low range pressure transducer to measure afterbody pressure.

Simulation-Based Analysis of Reentry Dynamics for the Sharp Atmospheric Entry Vehicle

NASA Technical Reports Server (NTRS)

Tillier, Clemens Emmanuel

1998-01-01

This thesis describes the analysis of the reentry dynamics of a high-performance lifting atmospheric entry vehicle through numerical simulation tools. The vehicle, named SHARP, is currently being developed by the Thermal Protection Materials and Systems branch of NASA Ames Research Center, Moffett Field, California. The goal of this project is to provide insight into trajectory tradeoffs and vehicle dynamics using simulation tools that are powerful, flexible, user-friendly and inexpensive. Implemented Using MATLAB and SIMULINK, these tools are developed with an eye towards further use in the conceptual design of the SHARP vehicle's trajectory and flight control systems. A trajectory simulator is used to quantify the entry capabilities of the vehicle subject to various operational constraints. Using an aerodynamic database computed by NASA and a model of the earth, the simulator generates the vehicle trajectory in three-dimensional space based on aerodynamic angle inputs. Requirements for entry along the SHARP aerothermal performance constraint are evaluated for different control strategies. Effect of vehicle mass on entry parameters is investigated, and the cross range capability of the vehicle is evaluated. Trajectory results are presented and interpreted. A six degree of freedom simulator builds on the trajectory simulator and provides attitude simulation for future entry controls development. A Newtonian aerodynamic model including control surfaces and a mass model are developed. A visualization tool for interpreting simulation results is described. Control surfaces are roughly sized. A simple controller is developed to fly the vehicle along its aerothermal performance constraint using aerodynamic flaps for control. This end-to-end demonstration proves the suitability of the 6-DOF simulator for future flight control system development. Finally, issues surrounding real-time simulation with hardware in the loop are discussed.

FLPP IXV Re-entry Vehicle, Transonic Characterisation Based on FOI T1500 Wind Tunnel Tests and CFD

NASA Astrophysics Data System (ADS)

Torngren, L.; Chiarelli, C.; Mareschi, V.; Tribot, J.-P.; Binetti, P.; Walloschek, T.

2009-01-01

The European Space Agency ESA, has engaged in 2004, the IXV project (Intermediate eXperimental Vehicle) which is part of the FLPP (Future Launcher Preparatory Programme) aiming at answering to critical technological issues, while supporting the future generation launchers and to improve in general European capabilities in the strategic field of atmospheric re-entry for space transportation, exploration and scientific applications. The IXV key mission and system objectives are the design, development, manufacturing, assembling and on-ground to in-flight verification of an autonomous European lifting and aerodynamically controlled re-entry system, integrating the critical re-entry technologies at the system level. The current IXV vehicle is a slender body type exhibiting rounded shape, thick body controlled by means of two control surfaces. The current mission is to perform an atmospheric re- entry ended by a safe recovery in supersonic regime. A potential extension of the flight domain down to the transonic regime was proposed to be analyzed. The objectives were to study the capability of the IXV for flying autonomously enabling a recovery of the vehicle by means of a subsonic parachute based DRS. The vehicle designed for the hypersonic speeds integrating a large base with only two control surfaces located close to the plane of symmetry is definitively not tuned for transonic ones. CFD done by Thales Alenia Space and wind tunnel activities involving FOI T1500 facility contributed to built up an Aerodynamic Data Base (AEDB) to be used as inputs for flying qualities analysis and re-entry simulations. The paper presents the main objectives of the transonic activities with emphasis on CFD and WTT including a description of the different prediction tools and discussing the main outcomes of the current data comparisons.

Orion Entry Monitor

NASA Technical Reports Server (NTRS)

Smith, Kelly M.

2016-01-01

NASA is scheduled to launch the Orion spacecraft atop the Space Launch System on Exploration Mission 1 in late 2018. When Orion returns from its lunar sortie, it will encounter Earth's atmosphere with speeds in excess of 11 kilometers per second, and Orion will attempt its first precision-guided skip entry. A suite of flight software algorithms collectively called the Entry Monitor has been developed in order to enhance crew situational awareness and enable high levels of onboard autonomy. The Entry Monitor determines the vehicle capability footprint in real-time, provides manual piloting cues, evaluates landing target feasibility, predicts the ballistic instantaneous impact point, and provides intelligent recommendations for alternative landing sites if the primary landing site is not achievable. The primary engineering challenges of the Entry Monitor is in the algorithmic implementation in making a highly reliable, efficient set of algorithms suitable for onboard applications.

27. EXCAVATION OF EAST (FRONT) BASEMENT WELL AND DRAINAGE SYSTEM, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

27. EXCAVATION OF EAST (FRONT) BASEMENT WELL AND DRAINAGE SYSTEM, WITH ARCHED ENTRY INTO BASEMENT UNDER FRONT ENTRY IN BACKGROUND, LOOKING NORTH (NOTE GALLETING IN BRICK FOUNDATION) BUT CLOSER RANGE SHOWING BRICK STRUCTURE WHICH CARRIED WATER FROM THE GUTTER DRAIN PIPE INTO THE BRICK DRAIN ALONG THE GROUND AND AWAY FROM THE FOUNDATION OF THE HOUSE - Belair, Tulip Grove Drive, Belair-at-Bowie, Bowie, Prince George's County, MD

Multi-Mission Earth Vehicle Subsonic Dynamic Stability Testing and Analyses

NASA Technical Reports Server (NTRS)

Glaab, Louis J.; Fremaux, C. Michael

2013-01-01

Multi-Mission Earth Entry Vehicles (MMEEVs) are blunt-body vehicles designed with the purpose of transporting payloads from outer space to the surface of the Earth. To achieve high-reliability and minimum weight, MMEEVs avoid use of limited-reliability systems, such as parachutes, retro-rockets, and reaction control systems and rely on the natural aerodynamic stability of the vehicle throughout the Entry, Descent, and Landing (EDL) phase of flight. The Multi-Mission Systems Analysis for Planetary Entry (M-SAPE) parametric design tool is used to facilitate the design of MMEEVs for an array of missions and develop and visualize the trade space. Testing in NASA Langley?s Vertical Spin Tunnel (VST) was conducted to significantly improve M-SAPE?s subsonic aerodynamic models. Vehicle size and shape can be driven by entry flight path angle and speed, thermal protection system performance, terminal velocity limitations, payload mass and density, among other design parameters. The objectives of the VST testing were to define usable subsonic center of gravity limits, and aerodynamic parameters for 6-degree-of-freedom (6-DOF) simulations, for a range of MMEEV designs. The range of MMEEVs tested was from 1.8m down to 1.2m diameter. A backshell extender provided the ability to test a design with a much larger payload for the 1.2m MMEEV.

An Automated Medical Information Management System (OpScan-MIMS) in a Clinical Setting

PubMed Central

Margolis, S.; Baker, T.G.; Ritchey, M.G.; Alterescu, S.; Friedman, C.

1981-01-01

This paper describes an automated medical information management system within a clinic setting. The system includes an optically scanned data entry system (OpScan), a generalized, interactive retrieval and storage software system(Medical Information Management System, MIMS) and the use of time-sharing. The system has the advantages of minimal hardware purchase and maintenance, rapid data entry and retrieval, user-created programs, no need for user knowledge of computer language or technology and is cost effective. The OpScan-MIMS system has been operational for approximately 16 months in a sexually transmitted disease clinic. The system's application to medical audit, quality assurance, clinic management and clinical training are demonstrated.

Regenstrief Institute's Medical Gopher: a next-generation homegrown electronic medical record system.

PubMed

Duke, Jon D; Morea, Justin; Mamlin, Burke; Martin, Douglas K; Simonaitis, Linas; Takesue, Blaine Y; Dixon, Brian E; Dexter, Paul R

2014-03-01

Regenstrief Institute developed one of the seminal computerized order entry systems, the Medical Gopher, for implementation at Wishard Hospital nearly three decades ago. Wishard Hospital and Regenstrief remain committed to homegrown software development, and over the past 4 years we have fully rebuilt Gopher with an emphasis on usability, safety, leveraging open source technologies, and the advancement of biomedical informatics research. Our objective in this paper is to summarize the functionality of this new system and highlight its novel features. Applying a user-centered design process, the new Gopher was built upon a rich-internet application framework using an agile development process. The system incorporates order entry, clinical documentation, result viewing, decision support, and clinical workflow. We have customized its use for the outpatient, inpatient, and emergency department settings. The new Gopher is now in use by over 1100 users a day, including an average of 433 physicians caring for over 3600 patients daily. The system includes a wizard-like clinical workflow, dynamic multimedia alerts, and a familiar 'e-commerce'-based interface for order entry. Clinical documentation is enhanced by real-time natural language processing and data review is supported by a rapid chart search feature. As one of the few remaining academically developed order entry systems, the Gopher has been designed both to improve patient care and to support next-generation informatics research. It has achieved rapid adoption within our health system and suggests continued viability for homegrown systems in settings of close collaboration between developers and providers. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Effects of Control Hysteresis on the Space Shuttle Orbiter's Entry. M.S. Thesis - George Washington Univ.

NASA Technical Reports Server (NTRS)

Powell, R. W.

1975-01-01

There are six degree-of-freedom simulations of the space shuttle orbiter entry with aerodynamic control hysteresis conducted on the NASA Langley Research Center interactive simulator known as the Automatic Reentry Flight Dynamics Simulator. These were performed to determine if the presence of aerodynamic control hysteresis would endanger the mission, either by making the vehicle unable to maintain proper attitude for a safe entry, or by increasing the amount of the reaction control system's fuel consumption beyond that carried.

Directory interchange format manual, version 3.0

NASA Technical Reports Server (NTRS)

1990-01-01

The Directory Interchange Format (DIF) is a data structure used to exchange directory level information about data sets among information systems. The format consists of a number of fields that describe the attributes of a directory entry and text blocks that contain a descriptive summary of and references for the directory entry. All fields and the summary are preceded by labels identifying their contents. All values are ASCII character strings. The structure is intended to be flexible, allowing for future changes in the contents of directory entries.

Labeled line drawing of launch and entry suit identifies various components

NASA Technical Reports Server (NTRS)

1988-01-01

Line drawings illustrate the front and back of the space shuttle launch and entry suit (LES) and labels identify various components. LES was designed for STS-26, the return to flight mission, and subsequent missions. Included in the crew escape system (CES) package are launch and entry helmet (LEH) with communications carrier (COMM CAP), parachute pack and harness, life preserver unit (LPU), life raft unit (LRU), LES gloves, suit oxygen manifold and valves, boots, and survival gear. Details of larger components are also identified.

Heatshield for Extreme Entry Environment Technology (HEEET) for Missions to Saturn and Beyond

NASA Technical Reports Server (NTRS)

Ellerby, D.; Blosser, M.; Chinnapongse, R.; Fowler, M.; Gasch, M.; Hamm, K.; Kazemba, C.; Ma, J.; Milos, F.; Nishioka, O.;

Heatshield for Extreme Entry Environment Technology (HEEET) - Enabling Missions Beyond Heritage Carbon Phenolic

NASA Technical Reports Server (NTRS)

Ellerby, D.; Beerman, A.; Blosser, M.; Boghozian, T.; Chavez-Garcia, J.; Chinnapongse, R.; Fowler, M.; Gage, P.; Gasch, M.; Gonzales, G.;

Heatshield for Extreme Entry Environment Technology (HEEET) Enabling Missions Beyond Heritage Carbon Phenolic

NASA Technical Reports Server (NTRS)

Ellerby, D.; Beerman, A.; Blosser, M.; Boghozian, T.; Chavez-Garcia, J.; Chinnapongse, R.; Fowler, M.; Gage, P.; Gasch, M.; Gonzaes, G.;

Heatshield for Extreme Entry Environment Technology (HEEET) Development and Maturation Status for NF Missions

NASA Technical Reports Server (NTRS)

Ellerby, D.; Blosser, M.; Boghozian, T.; Chavez-Garcia, J.; Chinnapongse, R.; Fowler, M.; Gage, P.; Gasch, M.; Gonzales, G.; Hamm, K.;

An Automated Temperature Controller for the Advanced Hall Effect Experimental Data Acquisition System.

DTIC Science & Technology

1982-03-01

ENTRY: ACCA CONTAINS THE CHARACTER EXIT: ACCA CONTAINS THE CHARACTER DISPLAY TAilLE UPDATKD DISPLAY POINTER INCREMENTED VOLATILE RECISTERS: B...OUTPUTS THE RIC11T HALF-BYTE OF THE HEX NUMBER CON- TAINED IN ACCA TO THE DISPLAY. ENTRY: ACCA CONTAINS THE HEX NUMBER EXIT: ACCA CONTAINS THE HEX...OUTPUTS THE LEFT HALF-BYTE OF THE HEX NUMBER CON- TAINED IN ACCA TO THE DISPLAY. ENTRY: ACCA CONTAINS THE HEX NUMBER EXIT: ACCA CONTAINS THE HEX

Labeled line drawing of launch and entry suit identifies various components

NASA Image and Video Library

1988-09-22

Line drawings illustrate the front and back of the space shuttle launch and entry suit (LES) and labels identify various components. LES was designed for STS-26, the return to flight mission, and subsequent missions. Included in the crew escape system (CES) package are launch and entry helmet (LEH) with communications carrier (COMM CAP), parachute pack and harness, life preserver unit (LPU), life raft unit (LRU), LES gloves, suit oxygen manifold and valves, boots, and survival gear. Details of larger components are also identified.

Aviation Warrant Officer Program and Enlisted Aviator Study

DTIC Science & Technology

1977-11-01

MOS. No direct appointment into this MOS. (b) 961A (ATTACHE TECHNICIAN) Entry and advanced MOS. (c) 221B ( NIKE MISSILE ASSEMBLY TECHNICIAN) Entry MOS...Advanced level is MOS, 251B (Air Defense Missile System Repair Technician, NIKE ) (d) 963A (INTERROGATION TECHNICIAN) Entry and advanced MOS, but...30 SEP 77 021A - Club Manager 9 2 222B - AD MSL Fire Tech, Nike 13 39 *Authorization equals 10.0% of the assigned strength for FY 77. 18 To make a

Heatshield for Extreme Entry Environment Technology (HEEET) Development and Maturation Status

NASA Technical Reports Server (NTRS)

Ellerby, D.; Boghozian, T.; Driver, D.; Chavez-Garcia, J.; Fowler, M.; Gage, P.; Gasch, M.; Gonzales, G.; Kazemba, C.; Kellermann, C.;

Design Guidelines for the User Interface to Computer-Based Information Systems

DTIC Science & Technology

1983-03-01

Marshall and Alderman, 1981. See also: Section 3.1.3. -22 Single Keying for Alphabetic Data -22 When alphabetic data entry is required, the user should be...distinction between single and multiple blanks in data entry; in particular, the user should not have to count blanks. Comment: People cannot be relied upon...logically related items should be accomplished by a single , explicit action at the end, rather than by separate entry of each item. Comment: This practice

31 CFR 357.31 - Certifying individuals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... SERVICE, DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING BOOK-ENTRY TREASURY... DIRECT Legacy Treasury Direct Book-Entry Securities System (Legacy Treasury Direct) § 357.31 Certifying... has placed an endorsement on the form reading substantially as follows: “Absence of signature by owner...

12 CFR 615.5456 - Authority of Federal Reserve Banks.

Code of Federal Regulations, 2010 CFR

2010-01-01

... banks and the Funding Corporation; (3) To effect transfer of book-entry securities between participants... Section 615.5456 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM FUNDING AND FISCAL AFFAIRS, LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Book-Entry Procedures for Farm Credit...

12 CFR 615.5456 - Authority of Federal Reserve Banks.

Code of Federal Regulations, 2014 CFR

2014-01-01

... banks and the Funding Corporation; (3) To effect transfer of book-entry securities between participants... Section 615.5456 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM FUNDING AND FISCAL AFFAIRS, LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Book-Entry Procedures for Farm Credit...

12 CFR 615.5456 - Authority of Federal Reserve Banks.

Code of Federal Regulations, 2013 CFR

2013-01-01

... banks and the Funding Corporation; (3) To effect transfer of book-entry securities between participants... Section 615.5456 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM FUNDING AND FISCAL AFFAIRS, LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Book-Entry Procedures for Farm Credit...

12 CFR 615.5456 - Authority of Federal Reserve Banks.

Code of Federal Regulations, 2012 CFR

2012-01-01

... banks and the Funding Corporation; (3) To effect transfer of book-entry securities between participants... Section 615.5456 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM FUNDING AND FISCAL AFFAIRS, LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Book-Entry Procedures for Farm Credit...

12 CFR 615.5456 - Authority of Federal Reserve Banks.

Code of Federal Regulations, 2011 CFR

2011-01-01

... banks and the Funding Corporation; (3) To effect transfer of book-entry securities between participants... Section 615.5456 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM FUNDING AND FISCAL AFFAIRS, LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Book-Entry Procedures for Farm Credit...

24 CFR 350.7 - Authority of Federal Reserve Banks as Depositories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... applies, in accordance with the Securities Documentation, Federal Reserve Bank Operating Circulars, this..., Security Entitlements, and the operation of the book-entry system under this part. ...) Each Federal Reserve Bank is hereby authorized as Depository for Book-entry Ginnie Mae Securities to...

3. EXTERIOR OF FRONT ENTRY SHOWING GABLE OVER RECESSED PORCH ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

3. EXTERIOR OF FRONT ENTRY SHOWING GABLE OVER RECESSED PORCH WITH RUSTIC STYLE DECORATIVE TREATMENT. WELDED STEEL PORCH RAILING ADDED IN 1972 IS VISIBLE AT PHOTO CENTER. VIEW TO SOUTHWEST. - Rush Creek Hydroelectric System, Worker Cottage, Rush Creek, June Lake, Mono County, CA

Assessment of the Mars Science Laboratory Entry, Descent, and Landing Simulation

NASA Technical Reports Server (NTRS)

Way, David W.; Davis, J. L.; Shidner, Jeremy D.

2013-01-01

On August 5, 2012, the Mars Science Laboratory rover, Curiosity, successfully landed inside Gale Crater. This landing was only the seventh successful landing and fourth rover to be delivered to Mars. Weighing nearly one metric ton, Curiosity is the largest and most complex rover ever sent to investigate another planet. Safely landing such a large payload required an innovative Entry, Descent, and Landing system, which included the first guided entry at Mars, the largest supersonic parachute ever flown at Mars, and a novel and untested Sky Crane landing system. A complete, end-to-end, six degree-of-freedom, multi-body computer simulation of the Mars Science Laboratory Entry, Descent, and Landing sequence was developed at the NASA Langley Research Center. In-flight data gathered during the successful landing is compared to pre-flight statistical distributions, predicted by the simulation. These comparisons provide insight into both the accuracy of the simulation and the overall performance of the vehicle.