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Biomedical subjects

B A Friedman

Publications and source records attributed to B A Friedman.

At least 19 recordsLinked to original sources
PubMed2001

The total laboratory solution: a new laboratory E-business model based on a vertical laboratory meta-network.

Major forces are now reshaping all businesses on a global basis, including the healthcare and clinical laboratory industries. One of the major forces at work is information technology (IT), which now provides the opportunity to create a new economic and business model for the clinical laboratory industry based on the creation of an integrated vertical meta-network, referred to here as the "total laboratory solution" (TLS). Participants at the most basic level of such a network would include a hospital-based laboratory, a reference laboratory, a laboratory information system/application service provider/laboratory portal vendor, an in vitro diagnostic manufacturer, and a pharmaceutical/biotechnology manufacturer. It is suggested that each of these participants would add value to the network primarily in its area of core competency. Subvariants of such a network have evolved over recent years, but a TLS comprising all or most of these participants does not exist at this time. Although the TLS, enabled by IT and closely akin to the various e-businesses that are now taking shape, offers many advantages from a theoretical perspective over the current laboratory business model, its success will depend largely on (a) market forces, (b) how the collaborative networks are organized and managed, and (c) whether the network can offer healthcare organizations higher quality testing services at lower cost. If the concept is successful, new demands will be placed on hospital-based laboratory professionals to shift the range of professional services that they offer toward clinical consulting, integration of laboratory information from multiple sources, and laboratory information management. These information management and integration tasks can only increase in complexity in the future as new genomic and proteomics testing modalities are developed and come on-line in clinical laboratories.

Chemistry, Clinical↗
PubMed1996

Using hub technology to facilitate information system integration in a health-care enterprise.

The deployment and maintenance of multiple point-to-point interfaces between a clinical information system, such as a laboratory information system, and other systems within a healthcare enterprise is expensive and time consuming. Moreover, the demand for such interfaces is increasing as hospitals consolidate and clinical laboratories participate in the development of regional laboratory networks and create host-to-host links with laboratory outreach clients. An interface engine, also called a hub, is an evolving technology that could replace multiple point-to-point interfaces from a laboratory information system with a single interface to the hub, preferably HL7 based. The hub then routes and translates laboratory information to other systems within the enterprise. Changes in application systems in an enterprise where a centralized interface engine has been implemented then amount to thorough analysis, an update of the enterprise's data dictionary, purchase of a single new vendor-supported interface, and table-based parameter changes on the hub. Two other features of an interface engine, support for structured query language and information store-and-forward, will facilitate the development of clinical data repositories and provide flexibility when interacting with other host systems. This article describes the advantages and disadvantages of an interface engine and lists some problems not solved by the technology. Finally, early developmental experience with an interface engine at the University of Michigan Medical Center and the benefits of the project on system integration efforts are described, not the least of which has been the enthusiastic adoption of the HL7 standard for all future interface projects.

Delivery of Health Care↗
PubMed1996

The challenge of managing laboratory information in a managed care environment.

This article considers some of the major changes that are occurring in pathology and pathology informatics in response to the shift to managed care in the United States. To better understand the relationship between information management in clinical laboratories and managed care, a typology of integrated delivery systems is presented. Following this is a discussion of the evolutionary trajectory for the computer networks that serve these large consolidated healthcare delivery organizations. The most complex of these computer networks is a community health information network. Participation in the planning and deployment of community health information networks will be important for pathologists because information management within pathology will be inexorably integrated into the larger effort by integrated delivery systems to share clinical, financial, and administrative data on a regional basis. Finally, four laboratory information management challenges under managed care are discussed, accompanied by possible approaches to each of them. The challenges presented are (1) organizational integration of departmental information systems such as the laboratory information system; (2) weakening of the best-of-breed approach to laboratory information system selection; (3) the shift away from the centralized laboratory paradigm; and (4) the development of rule-based systems to monitor and control laboratory utilization.

Community Networks↗
PubMed1994

Differentiating between marketing-driven and technology-driven vendors of medical information systems.

Buyers of medical information systems such as laboratory information systems need to recognize that the vendors of such systems may pursue corporate strategies emphasizing expenditures on marketing and client services, expenditures on technology and research and development (R&D), or a more balanced approach. The strategic goals and objectives of a vendor of an information system should align closely with those of a potential hospital client. A restless hospital client seeking cutting-edge technology will probably be dissatisfied with a system vendor who emphasizes slow ongoing incremental system development. Objective criteria for distinguishing between a marketing-driven vendor and a technology-driven vendor of medical information systems, and their variants, are presented based on the ratio of marketing expenditures to sales revenue compared with the ratio of research and development expenditures to sales revenue of the company. More subjective narrative criteria are also offered for making such distinctions.

Hospitals↗
PubMed1993

Fluconazole therapy for coccidioidal meningitis. The NIAID-Mycoses Study Group.

OBJECTIVE: To determine the efficacy and safety of fluconazole treatment of coccidioidal meningitis. DESIGN: Uncontrolled clinical trial. SETTING: Four university-based treatment centers in California, Arizona, and Texas. Most therapy was conducted without hospitalization. PATIENTS: Fifty consecutive patients with active coccidioidal meningitis, of which 47 (94%) were evaluable. Twenty-five patients had received no previous treatment for their meningitis, and nine had coinfection with human immunodeficiency virus (HIV). INTERVENTION: Fluconazole was administered in an oral dose of 400 mg once per day for up to 4 years (median, 37 months) in responding patients. Concurrent therapy with another antifungal agent was prohibited. MEASUREMENTS: Predefined assessment of infection-related abnormalities was done at the time of enrollment and was repeated at least every 4 months during treatment. Elimination of 40% or more of baseline abnormalities was considered a response. RESULTS: Thirty-seven of 47 (79%; 95% CI, 61% to 90%) evaluable patients responded to treatment. Response rates were similar for patients with and without previous therapy, for patients with and without concomitant HIV infection, and for patients with and without pre-existing hydrocephalus. Most improvement occurred within 4 to 8 months after starting treatment. Patient symptoms resolved more quickly than did cerebrospinal fluid abnormalities. In 15 of 20 responding patients followed for 20 months or more, residual low-level cerebrospinal fluid abnormalities remained throughout therapy. No patient discontinued therapy because of drug-related side effects, although confusion developed in two patients that resolved when the dose of fluconazole was reduced. CONCLUSION: Fluconazole therapy is often effective in suppressing coccidioidal meningitis.

AIDS-Related Opportunistic Infections↗
PubMed1993

Integrating information from decentralized laboratory testing sites. The creation of a value-added network.

The decentralization of laboratory testing provides distinct advantages for clinicians and patients, such as the reduction of test turnaround time, but also promotes the development of scattered caches of results. This problem could be ameliorated by the creation of an integrated laboratory data base. Such an approach would provide clinicians with a patient view of laboratory information in addition to the functional view of it that is offered currently. Impressive technologic advances are being made in the development of a distributed computer architecture in which processing tasks and information are shared across multiple hardware platforms attached to a network. Such architecture could be used to create a regional value-added laboratory network to integrate test information generated in decentralized testing sites. Independent reference laboratories and tertiary-care referral hospitals are the most likely candidates to create distributed value-added networks. Pathologists should view themselves as health-care professionals responsible for the processing, storage, and transmission of information, as well as for its generation. In time, the partition of information along hospital geopolitical boundaries will appear archaic and will be replaced by an emphasis on local and regional integration of medical information similar to that advocated here.

Clinical Laboratory Information Systems↗
PubMed1992

An analysis of the relationship between a pathology department and its laboratory information system vendor.

The ongoing collaborative relationship between a pathology department and the vendor of its laboratory information system is vitally important because of the strategic importance of the laboratory information system in managing the information product of the department. Laboratory information system vendors are value-added resellers in that they produce software and package it with hardware manufactured by another manufacturer. The success of laboratory information system value-added resellers in creating information systems that are highly functional depends on their forward vertical quasi-integration into pathology departments. Because of this relationship, laboratory information system value-added resellers exert a significant degree of control over departments, largely through the creation of switching costs. There are a number of strategies by which departments can exercise greater control over vendors, one of which is to serve as either an alpha- or beta-development site for the vendor's software. Such a strategy is not without risk, but it achieves the dual purpose of enhancing both the expertise of departmental personnel and the quality of the software product.

Clinical Laboratory Information Systems↗
PubMed1992

Client-server design provides model for 'coopetition' alliances.

As healthcare organizations move from isolated departments to integrated information sharing, who will pilot this change? Both the director and manager of pathology data systems at the University of Michigan Hospitals in Ann Arbor suggest vendors, system integrators and hospital administrators put aside competition and try a new concept--"coopetition"--to solve the problem.

Clinical Laboratory Information Systems↗
PubMed1992

Comparison of susceptibility to beta-lactam antimicrobial agents among bacteria isolated from intensive care units.

Evaluating microbial isolation and susceptibility patterns from institutional settings is a well-established component of ongoing infection control activities. At the University of Michigan Hospitals, susceptibility profiles for selected bacteria tested from 1984 to 1989 were analyzed for major changes in the percentage of organisms susceptible to beta-lactam antimicrobials. Data on bacteria isolated from respiratory specimens obtained from 1433 patients in intensive care units (ICUs) during a 10-month interval were compared with like data obtained from 750 non-ICU patients. Antimicrobial agents studied were chosen based on hospital formulary availability and prevailing usage in the institution. Susceptible and moderately susceptible categories were combined for purposes of reporting, since empiric therapeutic doses would cover strains having both susceptibility levels. Antimicrobic susceptibilities were compared and differences analyzed among the ICUs. Major shifts in susceptibility were noted during the 5-year period. The incidence and susceptibility profiles of the microorganisms varied considerably between ICU and non-ICU patients. Pseudomonas aeruginosa isolates from individual ICUs showed large variations in prevailing susceptibilities, with the burn unit harboring the most resistant strains. However, the neurological, surgical, and critical care medicine units also showed large numbers of antimicrobial-resistant pseudomonads. Among Enterobacter cloacae isolates, only imipenem showed a high level of activity against both ICU and total hospital isolates. When examined by individual ICU, however, imipenem resistance was seen in the general medicine and burn units. The burn and pediatric ICUs showed increased rates of recovery of beta-lactam-resistant E. cloacae isolates, although significantly high resistance rates were seen throughout all ICUs. The surgical ICU was noted to have an abnormally high incidence of lower respiratory infections caused by P. aeruginosa. The antibiogram indicated that one possible epidemic strain was involved. However, when the isolates were subjected to fatty-acid profiling by gas-liquid chromatography, it was found that cross-contamination with five discernible strains had occurred among the ten patients tested. These preliminary data suggest that resistant pseudomonads can be harbored and spread within an ICU, and that the ICU can act as a reservoir of resistance that is spread to a "step-down" unit.

Anti-Bacterial Agents↗
PubMed1991

Using the laboratory information system to achieve strategic advantage over the competitors of hospital-based clinical laboratories.

The competitors of hospital pathologists are commercial reference laboratories, hospital special function laboratories, pathology groups in neighboring hospitals, hospital mainframe computer personnel, and users of patient proximity testing systems. The laboratory information system can provide a strategic advantage over these competitors by matching, exceeding, or substituting for their capabilities and by creating switching costs for clinics, administrations, and patients. For example, the installation of microcomputers in clinicians' private offices provides them with ready access to the pathology data base, bonds them to the hospital, and capitalizes on the willingness of the hospital to invest in information technology.

Clinical Laboratory Information Systems↗
PubMed1990

Using the LIS as a strategic tool.

A major shift in emphasis is now occurring in pathology informatics, the subdiscipline within pathology that focuses on automated information management. This shift involves a much greater emphasis on both the strategic value of the pathology database and high-level applications running on the laboratory information system (LIS).

Clinical Laboratory Information Systems↗
PubMed1990

The potential role of physicians in the management of hospital information systems.

The centralized management of manual and automated information systems in hospitals, including the medical record, is usually delegated to administrators rather than to physicians. It is also likely that the importance of automated information systems will increase rapidly as the medical record is electronified. Many significant changes have occurred in recent years relating to the manner in which information systems are managed in hospitals. To address the challenge of this new information environment, hospital Chief Executive Officers (CEOs) have begun to create a new executive hospital position called the Chief Information Officer (CIO). CIOs are included in the hospital executive cabinet and commonly direct all hospital information systems, telecommunications, and management engineering. Although the model of the physician-director of an information system is common at the departmental level with the Laboratory Information System as one example, physicians rarely serve within the central hospital administration as information specialists such as the CIO. Although many physicians would be suitably qualified to serve in this capacity, another option for them would be the position of Chief Medical Information Officer (CMIO) with responsibility for utilization review, medical records, and quality assurance. The CMIO would serve centrally on a part-time basis, continuing to practice simultaneously in a medical specialty. The medical information specialist must not be insulated from the flow of clinical information and discourse with medical colleagues because of the increasing use of information systems for improving work efficiency and the pursuit of quality goals.

Administrative Personnel↗
PubMed1990

Informatics as a separate section within a department of pathology.

Departments of pathology should be reorganized to include a separate section of pathology informatics (PI) in addition to the traditional sections of clinical pathology and anatomic pathology. PI is the discipline of medical informatics as practiced within pathology and encompasses a rich mix of activities. The primary role of specialists working in clinical pathology and anatomic pathology would be to create information, whereas that of informaticians in a section of PI would be to add value to the created information by processing it and communicating it to users. The four major benefits associated with a PI section would be as follows: (1) enhanced productivity and efficiency in the development of alignment and impact applications; (2) better management of the information product of pathology and the informaticians themselves; (3) increased political power and influence for pathology; and (4) increased awareness and sophistication on the part of departmental leaders about information processing. Departmental benefits from the proposed organizational change would thus be calibrated in terms of the ability of the revamped department to harness and exploit new information technology.

Clinical Laboratory Information Systems↗
PubMed1990

Horizontal and vertical integration in hospital laboratories and the laboratory information system.

An understanding of horizontal and vertical integration and their quasi-integration variants is important for pathologists to formulate a competitive strategy for hospital clinical laboratories. These basic organizational concepts, in turn, are based on the need to establish control over critical laboratory inputs and outputs. The pathologist seeks greater control of mission-critical system inputs and outputs to increase the quality and efficiency of the laboratory operations. The LIS produces horizontal integration of the various hospital laboratories by integrating them vertically. Forward vertical quasi-integration of the laboratories is mediated primarily by the LIS through front-end valued-added features such as reporting of results and creating a long-term on-line test result archive. These features increase the value of the information product of pathology for clinicians and increase the cost of switching to another system. The LIS can also serve as a means for customizing the information product of the laboratories to appeal to new market segments such as hospital administrators.

Clinical Laboratory Information Systems↗