Biomedical subjects
Publications and source records attributed to R A Korpman.
Historically, home health care has been carried out by independent organizations that provide limited-scope services in a home-only setting. But as capitation takes hold throughout the country, the concept that home care is often the most beneficial way to deliver major portions of patient care finally is becoming clear to health care providers, payers, and patients.
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The provision of medications to patients is not a departmental task managed by the pharmacy. Rather, it is an enterprise-wide task with management shared by physicians, pharmacists, and nurses. Only automation approaches that integrate all three axes in real time will be able to effectively support the desired goal: the optimal provision of the proper medication to the proper patient at the proper time.
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Interfaces between computer systems are reviewed. An interface establishes a physical connection between two computer systems, a conversational syntax, a format for logical messages passed between the systems, and a data-encoding structure understood by both systems. Interfaces are usually implemented as software modules and consist of three "layers." The physical layer contains the actual physical connection and the hardware, firmware, and software that make the connection work. The protocol layer ensures that the bits of data sent across the interface by the sending system are received intact and in the correct sequence. The logical layer organizes the data to be sent into a form that can be read by the other system. Interfaces can be described by whether they operate in batch or real time, whether they are unidirectional or bidirectional, and the medium used to establish the physical connection (e.g., the exchange of a floppy disk or with an RS-232 serial connection). The real challenge to producing an interface lies in ensuring that the transactions between the two systems are meaningful. An interface engine allows one computer system to interface with several others through a single connection. A good interface has invisibility, reliability, timeliness, flexibility, terseness, and utilities. In planning an interface, goals and the proposed exchanges of data should be clearly defined. The interface should be the simplest one that meets a pharmacy's needs. When the specifications for the interface are completed, the pharmacy should thoroughly test the interface.(ABSTRACT TRUNCATED AT 250 WORDS)
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Over the last few years, health care providers have increasingly recognized that health care is an information business. In fact, the restructuring now being contemplated by many in the context of reform cannot be done without proper information management support. The unfortunate concentration of the health care industry over the last 20 years on administrative and financial data capture has obscured the fact that the important focus should be on patient care and health care operations information. Information on patient care has, unfortunately, largely been relegated to the paper chart and other ad hoc pieces of paper. New systems should focus on health care operations optimization, with specific design features to address failings in the paper system. To be successful, such systems must be integrated and patient centered. This is especially clear in the new enterprise-based world of health care delivery, where patients are the only common factor among venues. Health record professionals, the primary caretakers of patient care information, should be deeply involved in helping institutions move to this new world.
Today's emphasis on cost containment and quality of care is leading hospitals to widen their automation focus from assisting financial departments to improving operations. Because acute nursing care accounts for a substantial portion of a hospital's personnel and services, developing an information system that places computer terminals at patient bedsides may lead to greater efficiency, among other benefits. Bedside access to information systems can mean that data is more accurately recorded and that nurses' time is more effectively spent on clinical care rather than clerical duties.
In today's cost-constrained health care delivery environment, hospitals are recognizing the need to optimize their care operations to improve the efficiency, efficacy, and service quality of primary health care providers, particularly the medical staff and nursing services, which comprise about 50% of the hospital's total personnel. Because health care institutions are in the business of caring for patients (not for accounts or departments), and because health care delivery largely is a personnel-intensive information industry, operations optimization is supported best by information systems that fully integrate all information concerning the patient. The goal of this is to simplify the job duties of direct care providers. The benefits of an integrated, patient-centered approach include demonstrable improvements in over-all patient care quality and staff satisfaction as well as a significant reduction in costs.
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To maximize the potential benefits from automation in the nursing department, you must fully understand the work flow. With this understanding, and a concomitant understanding of automation strategies, the best fit of an information system into nursing practice can be developed.
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The net effect of these features in an integrated system is that the pharmacist spends time more productively managing patient drug therapy, not the computer system. The patient's location and demographics, once entered, are immediately available in a clinically useful form. Information about medications, the patient's responses to them and all other clinical parameters is available in the pharmacy without leaving the pharmacy application, making the pharmacist more effective and efficient. Physicians' orders are qualified by the system as they are entered, minimizing the number of nonproductive encounters between the pharmacist and the physician. Medication orders arrive at the pharmacy in a more timely manner and with fewer problems. The pharmacy can, in turn, be more responsive, helping the patient receive medication that is timely, accurate and clinically appropriate. These benefits arise primarily as a by-product of the pharmacy being integrated into an information system environment in which data is easily and directly accessed and shared. The more closely the pharmacy and its information requirements are examined, the more important the integration component appears. Many of the above benefits are not achievable with a dedicated stand-alone pharmacy computer system; some are achievable with an interface to a stand-alone nursing-station based HIS. In the pharmacy, is to increase and flourish in its role as an important and integral part of the healthcare delivery team, then access by the pharmacist to all patient information, and access by other providers to information contributed by the pharmacy is a necessary requisite. Improvement inpatient care can be the only result of such enhanced interchange.
Integrated approaches to the delivery of patient care have the potential to do several things to alleviate potential problems resulting from the five changes discussed earlier. They bring physicians into a more active role with the largest group of employees in the hospital (nurses); giving them the opportunity to acquire a better appreciation of the objectives, goals, and constraints of other providers and of the institution as a whole. When nurses and other employees begin to appreciate the constraints placed on physicians by federal regulations and competition, mutual understandings are fostered. They lay a more solid foundation for good professional relationships between hospitals and IPAs and between hospital-based physicians and independent practitioners. They encourage the focus of all providers on quality patient care (at a price the community is willing to afford). They discourage the overlap of expensive services between providers and encourage planned growth for the community. They encourage collaborative practice at the bedside, at committee and board meetings, and throughout the community that can lead to the development of a new model of "health" care as opposed to "disease" care. Finally, they promote human understanding that encourages providers to recognize the appropriate professional (considering all the variables) for each role. Without such efforts, it appears that patient care quality will be the most likely aspect of health care to suffer in the future--a result against which all health care professionals should stridently guard.