Medical data management : a practical guide /

Medical data management : a practical guide /

Saved in:
Bibliographic Details
Uniform title:Medizinische Dokumentation. English.
Imprint:New York : Springer, 2003.
Description:xvi, 201 p. ; 26 cm.
Language:English
Series:Health informatics
Subject:
Medical records -- Data processing.
Database management.
Medicine -- Data processing.
Information storage and retrieval systems.
Medical Records.
Forms and Records Control -- methods.
Information Storage and Retrieval.
Information Systems.
Database management.
Information storage and retrieval systems.
Medical records -- Data processing.
Medicine -- Data processing.
Format: Print Book
URL for this record:http://pi.lib.uchicago.edu/1001/cat/bib/5700648
Hidden Bibliographic Details
Other authors / contributors:Leiner, F. (Florian)
ISBN:0387955941 (hardcover : alk. paper)
0387951598 (softcover : alk. paper)
Notes:"First English translation of the German third editon."
Includes bibliographical references and index.
Table of Contents:
  • Foreword to the First German Edition
  • Series Preface
  • Preface
  • 1. What Is Medical Documentation About?
  • 1.1. What It Is and What It Isn't
  • 1.2. Medical Documentation: Do We Really Need It?
  • 1.2.1. Problems and Motivation
  • 1.2.2. More Important Today Than Ever Before
  • 1.3. What Are the Objectives of Medical Documentation?
  • 1.3.1. General Objectives
  • 1.3.2. Objectives in Patient Care
  • 1.3.3. Objectives in Administration
  • 1.3.4. Objectives in Quality Management and Education
  • 1.3.5. Objectives in Clinical Research
  • 1.4. Multiple Use of Patient Data
  • 1.5. Medical Documentation: Child's Play?
  • 1.6. Computer-Supported Medical Documentation: A Panacea?
  • 1.7. Checklist: Objectives of Medical Documentation
  • 1.8. Exercises
  • 2. Basic Concepts of Clinical Data Management and Coding Systems
  • 2.1. The Documenting Institution
  • 2.1.1. The Physician's Office and the Outpatient Clinic
  • 2.1.2. The Hospital
  • 2.1.3. Other Relevant Institutions
  • 2.2. From Attributes to Data Management
  • 2.2.1. Objects and Attributes
  • 2.2.2. Definitions, Labels, and Terminology
  • 2.2.3. Data, Information, and Knowledge
  • 2.2.4. Documents
  • 2.2.5. Data Management Systems
  • 2.2.6. Exercises
  • 2.3. Clinical Data Management Systems
  • 2.3.1. Characteristics of Clinical Data Management Systems
  • 2.3.2. Exercises
  • 2.4. Medical Coding Systems
  • 2.4.1. Coding Systems: Why Do We Need Them?
  • 2.4.2. What Is a Coding System?
  • 2.4.3. Classifications and Nomenclatures
  • 2.4.4. A Few Additional Remarks
  • 2.4.5. Exercises
  • 3. Important Medical Coding Systems
  • 3.1. International Classification of Diseases (ICD)
  • 3.1.1. The 10th Revision (ICD-10)
  • 3.1.2. Extensions to the ICD
  • 3.2. Procedure Classifications
  • 3.2.1. International Classification of Procedures in Medicine (ICPM)
  • 3.2.2. ICD-10-Procedure Coding System (ICD-10-PCS)
  • 3.3. Systematized Nomenclature of Medicine (SNOMED)
  • 3.3.1. SNOMED Reference Terminology (SNOMED RT)
  • 3.3.2. SNOMED Clinical Terminology (SNOMED CT)
  • 3.4. The TNM Classification of Malignant Tumors
  • 3.4.1. Structure
  • 3.5. MeSH and UMLS
  • 3.6. Exercises
  • 4. Typical Medical Documentation
  • 4.1. The Patient Record
  • 4.2. Patient Record Archives
  • 4.3. Clinical Basic Data Set Documentation
  • 4.4. Clinical Findings Documentation
  • 4.5. Clinical Tumor Documentation
  • 4.6. Documentation for Quality Management
  • 4.7. Clinical and Epidemiological Registers
  • 4.8. Documentation in Clinical Studies
  • 4.9. Documentation in Hospital Information Systems
  • 4.10. Exercises
  • 5. Utilization of Clinical Data Management Systems
  • 5.1. Patient-Oriented Analysis
  • 5.2. Patient-Group Reporting
  • 5.3. Clinical Studies
  • 5.4. Quality Measures in Information Retrieval
  • 5.5. Exercises
  • 6. Clinical Data Management: Let's Make a Plan!
  • 6.1. Planning Medical Coding Systems
  • 6.1.1. General Principles
  • 6.1.2. Principles of Ordering Qualitative Data
  • 6.1.3. Principles of Ordering Quantitative Data
  • 6.2. Planning Clinical Data Management Systems
  • 6.2.1. Why Plan Them at All?
  • 6.2.2. The Documentation Protocol
  • 6.2.3. Prolective and Prospective Analyses
  • 6.2.4. Additional Remarks
  • 6.3. Example: A Tumor Documentation Protocol
  • 6.4. Exercises
  • 7. Documentation in Hospital Information Systems
  • 7.1. The Hospital Information System
  • 7.1.1. The Concept
  • 7.1.2. The Significance
  • 7.1.3. The Need for a Strategic Plan
  • 7.1.4. Important Hospital Functions
  • 7.1.5. Exercises
  • 7.2. Management and Operation of Hospital Information Systems
  • 7.2.1. The Strategic Plan
  • 7.3. The Electronic Patient Record
  • 7.3.1. What Is an Electronic Patient Record?
  • 7.3.2. Advantages and Disadvantages of the Electronic Patient Record
  • 7.3.3. Introducing the Electronic Patient Record
  • 7.4. Methodology of Medical Documentation
  • 8. Data Management in Clinical Studies
  • 8.1. Therapeutic Trials
  • 8.2. Good Clinical Practice (GCP)
  • 8.3. Study Protocol
  • 8.4. Case Report Forms (CRFs)
  • 8.5. Monitoring
  • 8.6. Auditing and Quality Assurance
  • 8.7. Processing of the Quality Assurance
  • 8.7.1. Checking and Correcting Data
  • 8.7.2. Classification of Nonstandardized Entries
  • 8.7.3. Secondary Data Acquisition
  • 8.7.4. Database Closure
  • 8.8. Analysis
  • 8.9. Archiving the Trial Master File
  • 8.10. Checklist: Data Management in Clinical Studies
  • 8.11. Exercise
  • 9. Concluding Remarks
  • 10. Suggested Further Information
  • 10.1. General References
  • 10.2. Standardization Bodies
  • 10.3. Education in Medical Documentation
  • 10.4. Professional and Other Relevant Organizations
  • 10.5. Information on Coding Systems
  • 10.6. Basic Literature on Medical Documentation
  • 11. Thesaurus of Medical Documentation
  • 11.1. Documentation Protocol of the Thesaurus
  • 11.2. Thesaurus Entries
  • 12. Index
The John Crerar Library bookplate

Similar Items