Use of RSS Feeds for the Implementation of Clinical Reminder

Abstract

A computer-based reminder system can help physicians get right information and make right decisions in daily clinical work in time. This study presents a RSS-based Clinical Reminding System (RCRS) designed for reminding clinicians to deal with their varied unfinished clinical works. The RCRS was implemented in a hospital to automatically generate messages for every clinician on the basis of clinical information gathered from the hospital information system (HIS) and send them by RSS feed. In order to allow all physicians to participate in the project, the RCRS was integrated with the Computerized Physician Order Entry (COPE) system to provide messages whenever a clinician logs in the HIS; the connection on screen lets the clinician easily make some response. The system can help clinicians focus on patient care without keeping track of the schedule of clinical chores stored in various systems. Two physicians, also directors from Clinical Informatics Research & Development Center (CIRD) who were appointed as project leaders of the RCRS project who went through the entire development process were chosen as interviewees to obtain a preliminary evaluation of the system. The results show the "Information Content" of this system was suggested to be modified, and "Information Accuracy", "Formats", "Ease of use" and "Timeliness" of the system were appropriate to meet the system design purposes.[PUBLICATION ABSTRACT]

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J Med Syst (2012) 36:20292036 DOI 10.1007/s10916-011-9665-6

ORIGINAL PAPER

Use of RSS Feeds for the Implementation of Clinical Reminder

Wen-Chou Chi & Chia-Hsien Wen & Chih-Yu Lin &

Sek-Kwong Poon & Shih-Che Huang

Received: 11 November 2010 /Accepted: 11 February 2011 /Published online: 12 March 2011 # Springer Science+Business Media, LLC 2011

Abstract A computer-based reminder system can help physicians get right information and make right decisions in daily clinical work in time. This study presents a RSS-based Clinical Reminding System (RCRS) designed for reminding clinicians to deal with their varied unfinished clinical works. The RCRS was implemented in a hospital to automatically generate messages for every clinician on the basis of clinical information gathered from the hospital information system (HIS) and send them by RSS feed. In order to allow all physicians to participate in the project, the RCRS was integrated with the Computerized Physician Order Entry (COPE) system to provide messages whenever a clinician logs in the HIS; the connection on screen lets the clinician easily make some response. The system can help clinicians focus on patient care without keeping track of the schedule of clinical chores stored in various systems. Two physicians, also directors from Clinical Informatics Research & Development Center (CIRD) who were appointed as project leaders of the RCRS project who went through the entire development process were chosen as interviewees to obtain a preliminary evaluation of the system. The results show the Information Content of this system was suggested to be modified, and

Information Accuracy, Formats, Ease of use and Timeliness of the system were appropriate to meet the system design purposes.

Keywords RSS . CPR . XML . Information systems

Introduction

Several information storage and retrieval systems have been applied in medical services for a while. There are two important contributions of computer-based service systems: they help reduce medical errors and increase service efficiency [1]. Because of the huge databases created by input clinical orders and Electronic Medical Records (EMRs), there is a great deal of useful information in the system which helps make appropriate and critical decisions in clinical services through Clinical Decision Support System (CDSS). According to requests of the clinical staff, CDSS uses data from EMR and appropriate algorithms of the model (model base) to provide recommendations to the staff.

Computerized reminder is one of the important CDSSs used in hospitals. Physicians can get important information from the computer reminder system and use the information to make decisions [2]. There are two important functions of an efficient reminder system. The first is providing the right information to increase accuracy of decision-making. Electronic medical record systems and computer-based reminder systems have enhanced adherence to preventive care guidelines, which follow evidence-based guidelines [3]. The second is delivering the right information at the right time. Point of care computer and mobile phone text message systems are common in hospitals. Savel et al. suggested use of the Podcasting technology to deliver the media content in iCritical care for communication. Podcast-

W.-C. Chi : C.-Y. LinDepartment of Information Management, National Chung Cheng University,Chiayi County, Taiwan

C.-H. Wen (*)

Department of Computer Science and Information Management, Providence University,Taichung, Taiwane-mail: [email protected]

S.-K. Poon : S.-C. HuangTaichung Veterans General Hospital, Taichung, Taiwan

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ing comprises of an iPod and iTunes. The podcasting software checks new audio content delivered by RSS feeds [4]. Vashitz et al. used statistical measures to estimate responses of compliance, reliance, spillover and reactance and demonstrated them with data from a large-scale clinical reminder system for secondary prevention of cardiovascular diseases, and found that CDSS can close the treatment gap and improve physicians adherence to guidelines [2]. In our study, we adopt the RSS mechanism to collect new clinical information from HIS.

The effectiveness of computer reminders is debatable. Some studies conclude that computer reminders produce much smaller improvements than those generally expected from implementation of computerized order entry and EMRs [57]. Some others have reached opposite conclusions [58]. Lobach, D.F. suggested that a useful reminder has some characteristics that can make reminders successful, such as automatic prompts to use the system, integration with charting or order entry system and response required [9].

However, most reminder systems are individual systems that can provide only one single event alert [5]. Recently, some reminder systems have been used in disease management or to prevent disease, which means these systems start to provide a series of alerts, rather than a single alert [6]. Since most reminder systems now support evidence-based guidelines and have their own delivery systems, in the daily clinical work, physicians still need to collect a lot of information from different subsystems of the HIS; every subsystem has its own alert, which puts a burden on physicians to check through each subsystem. Integration of information is a critical issue for a reminder system. Integration of text messaging and electronic patient records (EPRs) or databases are still at early stages. These systems usually have no provision for response required [10], which decreases the effectiveness of the reminder system [9]. Collecting all information, not information about just one event or one disease, and providing physicians a comprehensive to do list, can help prevent errors and increase service quality.

RSS (Really Simple Syndication), or Rich Site Summary or Resource Description Framework (RDF) Site Summary,i.e. a data exchange protocol for sharing web content, may fit the requirements of a clinical reminder system. It may simplify and speed users access to the latest updated information published by a web site. The publisher of the web site creates an RSS file, also known as RSS feed or RSS channel, in which the content to be published is transformed into an XML-based format. Any user can read the RSS feed at different sites at the same time by using an RSS aggregator (RSS reader), an application that allows the user to read the content of a RSS file [1113]. In general, there are three common types of RSS

aggregators: (1) The Desktop RSS aggregator is the standalone program. Users download this program to their computers from Internet and use it to collect the feeds and refresh items when a feed is updated; (2) The web-based aggregator is an online web service. Users can use it to collect the feeds and browse messages on the Internet; and(3) The Plug-in aggregator that allows users to view RSS feeds with an existing program such as Microsoft Outlook [13]. RSS is generally used in real-time news reading and publication information management [1416]. There are some RSS-based applications used in health care but no one has applied it in hospital based medical care [4, 17, 18].

The proposed RSS-based clinical information reminder system (RCRS) is currently implemented at the case hospital in Taiwan. The reminder is integrated with the HIS. It periodically collects clinical information required by clinicians from HIS and transforms it into RSS messages automatically. The clinicians receive RSS messages whenever they log on HIS. The reminder is also associated with the Lightweight Directory Access Protocol (LDAP) server of HIS for user authentication to protect privacy of patients.

RSS is an effective tool to integrate and disseminate information internally among clinicians. The main functional component of a computer-based patient-record (CPR) system is integrated communication support. A patient-oriented medical record is the communication tool for team members who take care of the patient. Traditional CPR systems generally provide passive pull-type communication because each team member has to scan through the record to find others opinions. By including RSS mechanism in a CPR system, each team members opinion automatically reaches other members of the team.

System design

We have built the RSS-based clinical information reminder system in such a way that it not only ensure smooth operation but is also more effective and efficient. Two modes for users operations in our system were designed and built: one is the standalone system installed in the PCs of the clinic and the workstations; the other one is the web-based module which integrates with the COPE system. The system architecture (Fig. 1) uses the following components and sources of clinical information.

Standalone mode

In standalone mode, PCs and Workstations are installed in the standalone system for front-end of the reminder system and used by healthcare workers to log in the reminder system through the intranet. The LDAP server receives the

J Med Syst (2012) 36:20292036 2031

Fig. 1 The system architecture and its operation flowof RSS-based clinical information reminder

users login request and identifies the users identity and authority. In RSS reminder, the system allows only the related healthcare workers to access the information. HIS stores the clinical information and translates it into XML-formatted files. The RSS Server includes the RSS aggregator and the database server of the reminder system. The reminder system works by coupling itself with the HIS of the hospital. The RSS server periodically collects XML-formatted clinical information from HIS and saves it into the RSS database as RSS clinical messages. RSS feeds are created concurrently.

Web-based mode

In this mode, we develop a RSS web service module and integrate it with the CPOE system because the clinicians are familiar with CPOE in the hospital. When a clinician uses the RSS service in the CPOE, the RSS web service sends the clinician ID and patients ID to the RSS server through the delivered web address. The RSS server receives the address and interprets it, and then returns the patients clinical information to the RSS web service. An example of the web addresses: http://xxx.xxx.xxx./?doctor_id=Y123009&patient_id=A123008772

Web End =http://xxx.xxx.xxx./? http://xxx.xxx.xxx./?doctor_id=Y123009&patient_id=A123008772

Web End =doctor_id=Y123009&patient_id=A123008772 .

Data structure of the reminder

Figure 2 shows an example of RSS clinical messages stored in the clinical information reminder system. The data structure of the reminder system consists of an index-file and a large number of data-files.

The index-file is the RSS feed that lists some important attributes, such as patient ID, data-file name, and physician ID of all data-files. A data-file records detailed data of a

clinical information of a patient. Both index-file and data-files are in XML format conforming to RSS 2.0. A <channel> element of the RSS feed represents a class of RSS clinical messages. There are n <item> elements in a channel, if there are n RSS clinical messages in the class. The patient ID, data-file name, and physician ID of a RSS clinical message are correspondingly stated in <title> element, <link> element, and <description> element of an item. Since a physician does not always have a specific client, the RSS aggregator of the reminder is designed as a web-based (the second type) aggregator. The RSS server performs event-driven RSS syndication because only messages that match a clinicians ID are retrieved and displayed to the user [13, 19]. Whenever a physician logs in HIS, the LDAP server pass the address of the RSS aggregator and the relevant cipher data to the RSS server to initiate the reminder after authentication. The aggregator gets the RSS feed and picks items whose doctors ID in <description> element match the information obtained from the LDAP server. A matched item is represented by a sound message. Then the aggregator passes the list of sound messages to the RSS server and requests it to retrieve the sound messages from RSS database. All sound messages are displayed for further usage by the clinician.

System implementation

The reminder is developed using the VB.net and ASP.net programming language and Microsoft SQL Server 2000. In our system, four classes of RSS clinical messages are processed for the reminder:Abnormal laboratory results notification, abnormal examination results notification, discharge note notification, and consultation notice notification.

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Data-file

( ALRN_960223153701_00132412B.xml )

Index-file

<?xml version="1.0" encoding="Big5" ?><rss version="2.0"><channel><title>Abnormal Laboratory Results Notification</title> <item><title>Patient's ID :001312412B</title> <link>ALRN_960223153701_001312412B.xml</link> <description>Doctor's Id :1305B</description> </item></channel><channel>

<title>Abnormal Examination Results Notification</title> <item><title>Patient's ID :001312412B</title> <link>AERN_960223153701_001312412B.xml</link> <description>Doctor's Id :1305B</description></item></channel><channel>

<title>Consultation Notice Notification</title> <item><title>Patient's ID :001312412B</title> <link>CNN_960223153701_001312412B.xml</link> <description>Doctor's Id :1305B</description> </item></channel><channel>

<title> Discharge Note Notification</title><item><title>Patient's ID :001312412B</title> <link>DNN_960223153701_001312412B.xml</link> <description>Doctor's Id :1305B</description> </item></channel></rss>

<?xml version="1.0" encoding="Big5" ?> <danger_value> <doctor_id>1305B</doctor_id> <patient_name>NICK</patient_name> <patient_id>001312412B</patient_id> <value>HGB:7</value> <log_code>02035</log_code> <extn>18158</extn> </danger_value>

<?xml version="1.0" encoding="Big5" ?><AER><apply_id>78947844</apply_id> <patient_id>001312412B</patient_id> <patient_name>NICK</patient_name> <Examination_item>SONO, BREAST</Examination_item> <Cdoctor_name>David</Cdoctor_name> <source>hospitalization</source> <Examination_date>960629</Examination_date> <Fdoctor_name>Smith</Fdoctor_name> <Sdoctor_name>Jacky</Sdoctor_name> <Cdoctor_id>1305B</Cdoctor_id></AER>

<?xml version="1.0" encoding="Big5" ?> <discharge> <prof_doctor_id>1305B</prof_doctor_id> <stay_doctor_id>1236A</stay_doctor_id> <leave_day>960128</leave_day> <patient_id>001312412B</patient_id> <sickbed>W86-031</sickbed> <dayline>960201</dayline> <fine_day>960204</fine_day> <patient_name>NICK</patient_name> </discharge>

Data-file

( CNN_960223153701_00132412B.xml )

( AERN_960223153701_00132412B.xml )

( DNN_960223153701_00132412B.xml )

Fig. 2 An example of clinical messages stored in the clinical information reminder

Clinical Reminder System - Dr. Lin 97/1/22 15:39

Function (F) Help (H)

Abnormal Lab. Results Abnormal Exa. Results Discharge Note Consulation Notice

History

- Abnormal Lab. Results Abnormal Exa. Results Discharge Note Consulation Notice

S |

Y 03214567 Danny

HGB: 11 970122

Y 09872236 Tom

Y 02674311 Sam

HGB: 11 970122

HGB: 12 970122

HGB: 11 970122

Link to the appopriate application

Patient -Name : Grace Wang Value : HGB: 11Code: 15102Ext : 18163

Ordering by Clicking Title

Fig. 3 An example screen about abnormal laboratory results notification

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Clinical Reminder System - Dr. Lin 97/1/22 15:39

Function (F) Help (H)

Abnormal Lab. Results Abnormal Exa. Results Discharge Note Consulation Notice

- History

Select All ( A ) Cancel ( C ) Move ( M )

Patient No. : 00515123 Patient - Name: Tomas Lin Order : Dr. ChenSource: EmergencyItem: CHEST PA VIEW Date of Exam : 970121 First: Dr. WenSeconde : Dr.Lin

Fig. 4 An example of transforming an abnormal examination results notification message into an archived one

An abnormal laboratory results notification message is sent to inform the physician that the result of a laboratory test he/she ordered is abnormal and critical. If a test result is verified to be abnormal and out of the acceptable range, relative information about the abnormal laboratory result, such as patients name, the laboratory result, and the order date-time are immediately sent to the physician who ordered the tests. Figure 3 shows an example screen about abnormal laboratory results notification in the standalone mode.

The left part of the screen is a list of different classes of RSS clinical messages. Archived messages are also shown. Archived messages are shown when the archived messages item in the class list is clicked. The upper right hand part of the screen lists laboratory results notification messages that the clinician has received. If one of the messages in the list is clicked, detailed information of the message will be shown on the lower right hand part of the screen. The physician may access the laboratory information system by clicking the asterisk in the link field of the message.

Clinical Reminder System - Dr. Lin 97/1/22 15:39

Function (F) Help (H)

Abnormal Lab. Results Abnormal Exa. Results Discharge Note Consulation Notice

History

- Abnormal Lab. Results Abnormal Exa. Results Discharge Note Consulation Notice

S |

R | ! | Patient No. | Patient Name

| Bed No. | Fine | Link Y 01221155 Grace Wang W105-01 970122

Patient -Name : Grace Wang Discharge Date : 97.1.24 Due Date: 97.1.27Fine : 97.1.30Resident No. : 1206A Specialist No. : 1305B

Fig. 5 An example screen about discharge note notification message

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Clinical Reminder System - Dr. Lin 97/1/22 15:39

Function (F) Help (H)

Abnormal Lab. Results Abnormal Exa. Results Discharge Note Consulation Notice

History

- Abnormal Lab. Results Abnormal Exa. Results Discharge Note Consulation Notice

Patient Name

Patient No. : 01221155 Patient - Name: Grace Wang Location: W105Bed No. W105-01Tune : 99.1.22 pm 15:00 Due Date: 99.1.23 pm 17:00

Simple Records

*Dear doctor*This is a case of AF, right rental *Arterv stenosis ( thrombus). CRF

Patient No.

Fig. 6 An example screen about consultation notice notification

Figure 4 shows an example screen about abnormal examination results notifications. Similar to the structure of the abnormal laboratory results notification, it is used to notify a physician that the result of an imaging examination or a pathology examination he/she ordered is abnormal.

Discharge note notification is used to notify the clinician that one of his/her patient is ready to be discharged and he/ she has to prepare the discharge note before deadline. Figure 5 shows RSS clinical messages about a clinicians discharge note notification.

A consultation notice message notifies a clinician that there is a consultation he/she has to hold. A sample screen for the consultation notice notification is shown in Fig. 6.

Evaluation

The case hospital is a medical center in central Taiwan. At present, the case hospital has more than 500 physicians and 1,500 beds. Team members of this project are from the CIRD; two directors from CIRD who are also physicians and user of the RCRS are appointed as project leaders. The major functions of CIRD are (1) conduct and develop prototype applications to demonstrate advanced clinical computing techniques or concepts; and (2) establish the vision of enterprise clinical systems and articulate the vision throughout the entire hospital. Therefore, at the design stage of RCRS, both project leaders were responsible for discussing RCRS functions with physicians in their group meetings periodically. After RCRS was implemented, they were responsible for training and collecting feedback from the users to further improve the RCRS.

In order to allow all physicians to participate in this project, the RCRS was integrated with the CPOE system to provide feedback. After the system was stable, the superintendent then established policies of using RCRS. The project leaders who went through the entire development process were chosen as our interviewees to obtain a preliminary evaluation of RCRS. The interview results were recorded using the taxonomy developed by Doll, W.J., & TorKzadeh G. in The Measure of End-User Computing Satisfaction [20]. They are very important indexes of information system success [21].

The interviewees summarized that most users suggested that the content of the system needs to be screened in order to avoid information overload. Because information provided by the system is not created from the system, but collected from other systems, users believe information provided by the system is accurate. Regarding Ease of use and Timeliness of the system, most users were satisfied but had two recommendations. First, they suggested that end users need to be provided greater authority in order to be able to manipulate the information they want because some events may be meaningful for some users but not for others. Second, although the information can be provided immediately, it shows up at the computer screen and, therefore, users can not have access to information when theyre away from the computer.

Discussion

One of advantages of RCRS over the transitional reminder system designed for one patient or one disease is that the

J Med Syst (2012) 36:20292036 2035

system can integrate all information from different systems and provide it to the point-of-care computer. The physician does not have to collect information from different systems in the hospital, which can increase efficiency of service. Another benefit of this system is that it requires the user to respond to the information, i.e. the users have to see the information coming from this system. The system is embedded in HIS, and provides information from EMR to the point-of-care computer. Physicians see and respond to information provided by RSS feed each time when they log in to HIS. This design can decrease the error of omission [8] and fit the characteristics of a useful reminder system, and the response required [9]. Forcing the user to see the message may also increase compliance of the physician to follow evidence-based guidelines [8].

Providing too much information can cause the physician information overload [22] but the amount of information that will cause overload is difficult to determine. About the information content, users may only know what is not adequate and have no idea about what it should be. As aforementioned, multi-disciplinary cares usually involve different information from different users, Sprague suggests that the information should be screened at the first time they use it, but the control is hard to define [23]. In other words, too much control by users makes it difficult to follow, and too little control limits the compliance of users. In order to prevent loss of essential information, RCRS does not allow users to determine the type of information provided by the program but provides standardized information for all professionals involved in the patients care.

There are at least three directions for future research: a broadcasting system mechanism, information screen mechanism, and integration of more subsystems feeds. In order to reduce the amount of errors in patient care, getting correct information on time is important. Although the RCRS is able to provide information on time, medical professionals need to use the point-of-care computers to access the information. Medical professionals rarely stay in front of a computer during work. Therefore, it is important to develop a broadcast system that is capable of sending real-time information to medical professionals via wireless devices such as mobile phones, which can make communication more efficient [10].

According to our interviews, physicians may be over-burdened if provided too much information which may not be relevant. If this system can screen information and verify important information would be helpful and increase the users acceptance of this system.

During this implementation, we collected information only from the laboratory information system and the admission system. It will be more powerful when the system is connected to other subsystems like emergency medical system, medicine system and prescription system.

Conclusion

RSS allows acquisition of up-to-date information quickly from the Internet. This paper presents the design and implementation of an RSS-based clinical information reminder system. Most hospital information systems in Taiwan are heterogeneous systems. We offer a rapid and inexpensive method to integrate these systems. RSS is generally used in real-time news reading and publication information management [1416]. Some RSS-based applications used in health care but no one has applied it in hospital based medical care [17, 18]. This study points out that what comprises a good reminder system and the lag between an ideal system and real world system to show the value of this study and contributes to close the gap in the related literature.

Although the pioneer system only includes four classes of clinical messages, it is proved that the reminder helps clinicians manage their clinical chores. According to the evaluation by project leaders, this RSS-base reminder system is useful and effective and suggested to the superintendent not only to expand the RCRS to include all kinds of messages needed by the physicians but also put this idea into the design of the next generation Hospital Information System. As Tierney et al. concluded from their study, the poor outcome of using a reminder system may be because of physicians poor compliance to the reminder system [8]. A longitudinal assessment is, therefore, needed to further explore the benefits and usage of the RCRS.

Acknowledgments This paper is based upon work supported by National Science Council (NSC), Taiwan under grants no. NSC98-Z410-H-126-010-MY2, NSC96-2221-E-126-006, NSC96-2221-E-126-004-MY3 and NSC95-2218-E-007-025. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the NSC.

References

1. Aspden, P., Wolcott, J. A., Bootman, J. L., and Cronenwett, L. R., Committee on Identifying and Preventing Medication Errors. Preventing medication errors: quality chasm series. The National Academies Press, Washington (DC), 2006.

2. Vashitz, G., Meyer, J., and Pamet, R., Defining and measuring physicians responses to clinical reminders. J. Biomed. Inform. 42:317326, 2009.

3. McDonald, C. J., Hui, S. L., Smith, D. M., Cohen, S. J., Weinberger, M. and McCabe, G. P., Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann. Intern. Med. 100:1308, 1984.

4. Savel, R. H., Goldsten, E. B., and Perencenich, E. N., The iCritical care podcast: a novel medium for critical care communication and education. J. Am. Med. Inform. Assoc. 14:9499, 2007.

5. Hunt, D. L., Haynes, R. B., Hanna, S. E., and Smith, K., Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA 280(15):13391346, 1998.

2036 J Med Syst (2012) 36:20292036

6. Garg, A. X., Adhikari, N. K., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., Sam, J., and Haynes, R. B., Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 293(10):12231238, 2005.7. Shojania, K. G., Jennings, A., Mayhew, A., Ramsay, C., Eccles, M., and Grimshaw, J., Effect of point-of-care computer reminders on physician behaviour: a systematic review. CMAJ 182(5):E216225, 2010.

8. Tierney, W. M., Overhage, J. M., and Murray, M. D., Effects of computerized guidelines for managing heart disease in primary care. J. Gen. Intern. Med. 18:967976, 2003.

9. Kawamoto, K., Houlihan, C. A., Balas, E. A., and Lobach, D. F., Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 330(7494):765773, 2005.

10. Makela, K., Paavola, T., and Stenman, M., Development of short message service application for patient-provider communication in clinical psychiatry. Telemed J E Health. 16(7):827829, 2010.

11. Cadenhead, R., Curry, A., and Zellers, S., RSS at Harward Law. RSS Advisory Board, 2005a, last visited 2005-02-18, http://blogs.law.harvard.edu/tech/rss#whatIsRss

Web End =http://blogs. http://blogs.law.harvard.edu/tech/rss#whatIsRss

Web End =law.harvard.edu/tech/rss#whatIsRss .

12. Bray, T., Paoli, J., Sperberg-McQueen, C. M., Maler, E., and Yergeau, F., Extensible Markup Language (XML) 1.0 (Third Edition) W3C Recommendation 04 February 2004, The World Wide Web Consortium, 2004, last visited 2005-02-18, http://www.w3.org/TR/2004/REC-xml-20040204/

Web End =http://www. http://www.w3.org/TR/2004/REC-xml-20040204/

Web End =w3.org/TR/2004/REC-xml-20040204/ .

13. Ola, A., and Niclas, L., RSSThe future of internal communication? Reports from MSI, ISSN 16502647, 2005.

14. Hu, Y. H., Lim, S., and Rizos, C., Delivering GNSS Data Over the Internet Using RSS for Post-processing Applications. International Symposium on GPS/GNSS 2005.

15. Klein, M., Mika, P., and Serban, R., Semantics-based Publication Management using RSS and FOAF. SemanticDesktop.org. Proceedings of the 1st Workshop on the Semantic Desktop (SD 2005), 4th International Semantic Web Conference, Galway, Ireland.

16. elikba, Z., What is RSS and how can it serve libraries? Learning for the Future: e-Learning, pp. 277292, stanbul (Turkey), 2004.

17. Phillippi, J. C., and Buxton, M., Web 2.0: easy tools for busy clinicians. J. Midwifery Womens Health 55(5):472476, 2010.

18. Ku, H. H., and Huang, C. M., Web2OHS: A Web2.0-Based Omnibearing Homecare System. IEEE Trans. Inf. Technol. Biomed. 14(2), 224233, 2010.

19. Coile, R. C. Jr., The Paperless Hospital, Healthcare in a Digital Age. Foundation of the American College of the Healthcare Executives, 2002.

20. Doll, W. J., and TorKzadeh, G., The measure of end-user computing satisfaction. Manage. Inf. Syst. Q. 12(2):259274, 1988.

21. DeLone, W. H., and McLean, E. R., The DeLone and McLean model of information systems success: a ten-year update. J. Manage. Inf. Syst. 19(4):930, 2003.

22. Rebitzer, J. B., Rege, M., and Shepard, C., Influence, information overload, and information technology in health care. Adv. Health Econ. Health Serv. Res. 19:4369, 2008.

23. Sprague, R. H., Jr., A framework for the development of decision support systems. Manage. Inf. Syst. Q. 4(4):126, 1980.

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Use of RSS Feeds for the Implementation of Clinical Reminder

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