Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
J Am Med Inform Assoc. 2011 Nov-Dec;18(6):842-52. doi: 10.1136/amiajnl-2011-000229. Epub 2011 Jun 27.
There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD).
WIISARD combined advanced networking technology with electronic triage tags that reported victims' position and recorded medical information, with wireless pulse-oximeters that monitored patient vital signs, and a wireless electronic medical record (EMR) for disaster care. The EMR system included WiFi handheld devices with barcode scanners (used by front-line responders) and computer tablets with role-tailored software (used by managers of the triage, treatment, transport and medical communications teams). An additional software system provided situational awareness for the incident commander. The WIISARD system was evaluated in a large-scale simulation exercise designed for training first responders. A randomized trial was overlaid on this exercise with 100 simulated victims, 50 in a control pathway (paper-based), and 50 in completely electronic WIISARD pathway. All patients in the electronic pathway were cared for within the WIISARD system without paper-based workarounds.
WIISARD reduced the rate of the missing and/or duplicated patient identifiers (0% vs 47%, p<0.001). The total time of the field was nearly identical (38:20 vs 38:23, IQR 26:53-1:05:32 vs 18:55-57:22).
Overall, the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy, and likely to improve the quality of information available for the delivery of care during disasters.
人们越来越关注利用技术来增强灾难环境中可用于患者的临床信息的跟踪和质量。本文介绍了用于灾难医疗响应的无线因特网信息系统（WIISARD）的设计和评估。
WIISARD 将先进的网络技术与电子分诊标签相结合，该标签报告受害者的位置并记录医疗信息，还与无线脉搏血氧计相结合，用于监测患者生命体征，并与无线电子病历（EMR）一起用于灾难护理。EMR 系统包括具有条形码扫描仪的 WiFi 手持设备（供一线响应人员使用）和具有定制软件的平板电脑（供分诊、治疗、转运和医疗通信团队的管理人员使用）。一个额外的软件系统为事故指挥官提供态势感知。WIISARD 系统在为培训一线响应人员而设计的大规模模拟演习中进行了评估。该演习中叠加了一项随机试验，有 100 名模拟患者，50 名在对照组（纸质），50 名在完全电子化的 WIISARD 组。电子组中的所有患者均在 WIISARD 系统中接受治疗，而无需使用纸质工作流程。
WIISARD 降低了缺失和/或重复患者标识符的比例（0%对 47%，p<0.001）。现场总时间几乎相同（38:20 对 38:23，IQR 26:53-1:05:32 对 18:55-57:22）。
总体而言，WIISARD 的结果表明，用于灾难中受害者护理的无线 EMR 系统虽然开发复杂，但具有潜在的可行性，并且可能会改善灾难期间提供护理的信息质量。
