PubMed · 1625981
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K Dean. Trusting to technology.. https://pubmed.ncbi.nlm.nih.gov/1625981/
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OBJECTIVE: To investigate the effectiveness of computer based and manual district and unit information systems for identifying hospital deaths eligible for reporting to the National Confidential Enquiry into Perioperative Deaths (NCEPOD). DESIGN: Prospective six to 10 week study of hospital (death register, immediate coding of medical records) and district information systems followed by six month assessment after modification to entry of data. SETTING: Acute units within Lewisham and North Southwark Health District. PATIENTS: All 290 patients dying in hospital during the six weeks, for whom the medical records were obtainable in 231. MAIN OUTCOME MEASURES: Sensitivity and specificity of the information systems in ascertaining eligible surgical deaths (patients dying in hospital who had during 30 days previously had a surgical procedure while under the care of a consultant in a surgical specialty) tested against validated list of screened medical records. RESULTS: Of 231 medical records, 30 (12 from Lewisham, 18 from North Southwark) met the national inquiry's criteria. The computer based systems of both units detected less than 60% of eligible deaths (sensitivity 53%, specificity 83%); the death register detected about 60% (sensitivity 61%, specificity 89%); manual systems detected all eligible deaths. Subsequent modification to ensure immediate coding of records into the computerised systems during follow up failed to show any improvement. IMPLICATIONS: Routine hospital information systems may miss up to half the deaths eligible for NCEPOD.
Iowa Methodist Medical Center (IMMC) was one of the nation's early developers of a "hospital/physician" system, entering the arena during October 1985, under the direction of Ginny Wagner. Their "MOLI-Link" system now serves over 150 physicians in 50 locations, and is currently undergoing significant enhancement. MOLI-Link was originally developed using Annson Systems (IBAX) products, and has recently migrated to Wallace Computer Services (Wal-Link) software. Over the past 4 years, IMMC has investigated wide-area medical information networking, and is now actively investigating development of the Iowa Medical Information Network. It is envisioned that IMIN would provide clinical, administrative, and educational information services throughout the IMMC 37 county referral area.
Traditionally, Sisters of Mercy Health System (SMHS)-St Louis hospitals have had difficulty integrating quality information from external sources into their own monitoring and evaluation activities. This difficulty became apparent at the 14 hospitals of the SMHS when the system headquarters began providing its hospitals with comparative clinical outcome information. Although the hospitals found value in the comparative studies, the information was not fully used in individual hospitals' quality improvement efforts. As a result, SMHS developed a model for integrating external quality information into the local hospitals' ten-step monitoring and evaluation process. This article explains the integration model and shows how it has worked in several clinical scenarios.