SIMULACIÓN DEL TSUNAMI DE 1960 EN UN ESTUARIO DEL CENTRO-SUR DE CHILE Revista de Geografía Norte Grande, 33: 5-18 (2005) Simulación del tsunami de 1960 en un estuario del centro-sur de Chile1 MARCELO LAGOS2, DANTE GUTIÉRREZ3 Se modela el tsunami de 1960 en un estuario del centro-sur de Chile. Lareconstrucción del evento se realizó mediante la modelación del escenariosísmico tsunamigénico, utilizando una técnica de simulación numérica detsunamis de campo cercano, permitiendo caracterizar el proceso de gene-ración, propagación e inundación generada por las ondas en las áreascosteras bajas. Los resultados de la simulación del tsunami se validan conantecedentes y evidencias existentes del evento real.
Customer Name (MetaCondNormal-Roman 26pt/2 Managing clinical evidence at the speed of change Business overview
Based in Boston, Massachusetts, Partners HealthCare is an integrated health system
founded by Brigham and Women's Hospital and Massachusetts General Hospital in 1994.
Partners HealthCare is one of the nation's leading biomedical research organizations and
a principal teaching affiliate of Harvard Medical School. • Quick, easy access to comprehensive In addition to two academic medical centers, the Partners HealthCare system includes information boosts quality and community hospitals, specialty hospitals, community health centers, a physician network, accuracy of clinical decision home health and long-term care services, and other health-related entities. support content that drivespatient safety, quality, utilizationmanagement, and clinical research • Central repository for clinical Evidence-based medical practice—the technique of using the best, most current scientific decision support knowledge bases evidence to make decisions about the care of individual patients—has become a streamlines content review and cornerstone of patient care for large, progressive medical facilities such as Partners Healthcare. By definition, evidence-based practice demands quick, easy access tocomprehensive and current literature, data, and other information on specific medical • Online collaboration for making conditions and treatments. However, the sheer volume and complexity of this information design decisions on clinical has placed a strain on physicians and other caregivers who are hard-pressed to keep up decision support knowledge with the latest findings. At the same time, insurance providers and the public are exerting bases increases productivity growing pressure on practitioners to improve their quality, efficiency, and performance. and effectiveness of the clinicaldecision support update process At Partners, these business drivers were causing administrators to take a comprehensivelook at existing computer-based clinical decision support systems to identify silos, gaps,and other inefficiencies. "Our overriding objective is to provide decision support thatimproves both the quality of care for patients and the performance of clinicians," saidTonya Hongsermeier, Corporate Manager, Clinical Knowledge Management and DecisionSupport. "It was becoming more and more difficult to affordably develop, acquire, andmaintain the knowledge bases required to deliver meaningful decision support." More streamlined review and decision makingA specific area targeted for improvement was the process by which clinicians reviewedliterature and came to consensus on disease management approaches. The company's previous configuration for decision support did not provide adequate tools and personnelfor efficient vetting of information and updating of clinical decision support knowledge Partners Healthcare
bases. "There was a lack of transparency into the knowledge already in production, and System of hospitals, research there were too many bottlenecks when it came time for people to agree on content," said and teaching facilities, clinics, Hongsermeier. "We wanted to provide better support for the content vetting process and physicians in Boston, without requiring our busy physicians to have to attend committee meetings." Improving organizational effectiveness In evaluating potential solutions for a more comprehensive decision support system,Partners had several objectives. Most importantly, the new system would reduce the cost and increase the speed in which clinical innovations and evidence could be translated into Metropolitan Boston area clinical practice. "Through data-driven improvements in performance, we hoped toimprove Partners' effectiveness as a learning organization," said Hongsermeier. "And we needed to bring our knowledge assets into better alignment with business, regulatory, Collaboration and content safety, and quality requirements.
"Partners has a long and successful track record in applied clinical decision support; in EMC products
fact, we've created some of the best systems in production worldwide," she said. "Now, EMC Documentum content with the explosion in clinical information, it was time to go to the next level." management platform, EMCDocumentum eRoom EMC Documentum solution
Common repository for current
To meet these objectives, Partners Healthcare implemented an integrated knowledge and comprehensive clinical management system based on the EMC® Documentum® content management platform decision support content such as and EMC Documentum eRoom® collaboration software. Documentum provides a rules, order sets, documentation centralized repository for a library of clinical evidence that can be accessed across the templates, reports, and others; enterprise, and eRoom creates a collaborative workspace for clinicians to review literature portal for easy search and and make consensus-based decisions. Together, Documentum and eRoom create a access; online collaboration metadata environment for managing the lifecycle of content for the health system's and consensus by clinicians clinical decision support function.
when changes need to be madeto decision support content to Global control over critical information reflect the latest evidence-based Within the Documentum repository, documentation on the design of the content is standards of care organized and is made available to users via a searchable knowledge management portal.
Proprietary taxonomy and filters have been built so documents can be sorted by a varietyof perspectives, clinical disciplines, and other criteria such as application, site, venue,patient population, end user, and clinical care setting. Physicians, clinicians, quality improvement personnel, and knowledge engineeringteams can browse the portal by topic and access all pertinent documents in a specificcategory such as coronary artery disease management. The documents contain thedesign specifications and all the relevant information about that particular contentartifact including author, business owner, date of last update, and others. According toa set schedule, documents are periodically posted to eRoom so that Partners clinicianscan review them and determine whether the content needs to be updated in the decisionsupport system. "A large driver for this new system was our ability to manage changesand updates to knowledge," said Hongsermeier. "Once the decision has been madefor knowledge to change, it needs to happen rapidly and it requires the ability tochange rules, order sets, templates, and reports quickly and accurately. Documentumprovides the industrial-strength content management functionality to ensure effectivechange management." "The EMC Documentum solutions are playing a key role in our ability to continue enhancing and improving the quality of our clinical decision support knowledgeso that we can offer superior quality of care to patients and excellent ‘quality oflife' for our clinicians and other employees." Tonya Hongsermeier, MD, MBA, Corporate Manager,
Clinical Knowledge Management and Decision Support
Shortening and streamlining review and changeDocumentum eRoom has dramatically improved the processes by which reviewing clinicians collaborate and make decisions for standard dosage guidelines and othertreatment procedures. Before Documentum and eRoom, documents were maintainedin folders on file systems and were related by title and common location only. "It wasdifficult to know what information had changed from one version to the next or why,and when people moved on to new jobs, folders would get lost," said Cathyann Harris,Project Manager, Clinical Knowledge Management and Decision Support. "Since documents are now posted to eRooms by Documentum, we're able to maintain muchmore extensive ‘metaknowledge' on each—the who, what, when, where, and why ofeach piece of information." In one example, Partners has created an eRoom to support a database for medicationdosing of geriatric patients. The clinicians responsible for reviewing these dosingguidelines according to the latest medical information and literature are able to"meet" in the eRoom, hold on-line discussions, and reach consensus via the eRoom pollingfunctionality. In a typical scenario, a pharmacist proposes changing the frequency ofan ibuprofen dosage based on recommendations in updated literature. Once the clinicianshave agreed on the new dosage, the pharmacist can post supporting documentationto the eRoom and the system keeps an audit trail of each member's statements andactions. "eRoom has played a large role in helping us reduce the cost and increase thespeed of knowledge acquisition for our decision support systems," said Harris. "Thesystem has greatly shortened the cycle for making decisions and implementingchanges by enabling people to reach agreement online, rather than spending monthsparticipating in committees and attending meetings." Summary
At Partners Healthcare, the EMC Documentum content management platform and EMC
Documentum eRoom have brought new efficiencies to decision support processes and
greatly enhanced clinicians' ability to make evidence-based decisions on patient care.
The Documentum repository has brought new levels of control and streamlined access
to critical information, and eRoom has greatly enhanced clinicians' ability to propose,
discuss, and make decisions on changes to treatment guidelines. "The Documentum
solutions are playing a key role in our ability to continue enhancing and improving the
quality of our clinical decision support knowledge so that we can offer superior quality
of care to patients and excellent ‘quality of life' to our clinicians and other employees,"
EMC Corporation (NYSE:EMC) is the world leader in products, services, and solutions for
information storage and management. Through information lifecycle management (ILM)
strategies, EMC helps enterprises of all sizes manage their growing volumes of
information—from creation to disposal—according to its changing value. EMC information
infrastructure solutions are at the heart of this mission, helping organizations manage,
use, protect, and share their information assets more efficiently and cost-effectively. The
result? Information with greater business value and at lower management cost.
1-508-435-1000In North America 1-866-464-7381 EMC2, EMC, Documentum, eRoom, and whereinformation lives are registered trademarks ofEMC Corporation. All other trademarks used herein are the property of their respective owners.
Copyright 2007 EMC Corporation. All rights reserved. Published in the USA. 6/07 Customer ProfileS13080607V1 / H2857
de Diagnóstico y TratamientoPSIQUIATRÍA La calidad requiere guías que orienten y normas que regulen el proceso La salud. Un derecho para vivir bien Esta publicación es propiedad del Instituto Nacional de Seguros de Salud INASES, siendo autorizada su reproducción total o parcial a condición de citar fuente y propiedad.Departamento Técnico de SaludDeposito Legal: 4 - 1 - 449 - 12 - P.O.