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This paper describes a flexible, relational database management system designed explicitly with the needs and realities of social work in health care settings in mind. A variety of broad-based applications as well as organizational factors influencing implementation of automated information system are also discussed.
BACKGROUND: Somatization is a common, costly problem with great morbidity, but there has been no effective screening method to identify these patients and target them for treatment. OBJECTIVES: We tested a hypothesis that we could identify high utilizing somatizing patients from a management information system (MIS) by total number of visits and what we termed "somatization potential," the percentage of visits for which ICD-9 primary diagnosis codes represented disorders in the musculoskeletal, nervous, or gastrointestinal systems or ill-defined complaints. METHODS: We identified 883 high users from the MIS of a large staff model HMO as those having six or more visits during the year studied (65th percentile). A physician rater, without knowledge of hypotheses and predictors, then reviewed the medical records of these patients and identified somatizing patients (n = 122) and nonsomatizing patients (n = 761). In two-thirds of the population (the derivation set), we used logistic regression to refine our hypothesis and identify predictors of somatization available from the MIS: demographic data, all medical encounters, and primary diagnoses made by usual care physicians (ICD-9 codes). We then tested our prediction model in the remaining one-third of the population (the validation set) to validate its usefulness. RESULTS: The derivation set contained the following significant correlates of somatization: gender, total number of visits, and percent of visits with somatization potential. The c-statistic, equivalent to the area under the ROC curve, was 0.90. In the validation set, the explanatory power was less with a still impressive c-statistic of 0.78. A predicted probability of 0.04 identified almost all somatizers, whereas a predicted probability of 0.40 identified about half of all somatizers but produced few false positives. CONCLUSIONS: We have developed and validated a prediction model from the MIS that helps to distinguish chronic somatizing patients from other high utilizing patients. Our method requires corroboration but carries the promise of providing clinicians and health plan directors with an inexpensive, simple approach for identifying the common somatizing patient and, in turn, targeting them for treatment. The screener does not require clinicians' time.
Information system can be useful to effective and flexible decision making of nursing resource administration. A Nurse Resources Management Information Model and a Nurse Resources Management Information System (NRMIS) were developed in this study. The NRMIS consisted of a nursing staff scheduling system (NRS), a patient classification system (PCS), and an optimal nursing manpower estimating system (ONMES). The patient classification system was developed according to nursing intensity. The system was evaluated through user interface satisfaction and usefulness in the clinical settings. The main challenge is how we realize this information model to support evidence-based nursing resource administration.
This paper analyses the environment, necessity, possibility and specificity of the development of a Hospital Information System (HIS) in the People's Republic of China. The overall design and step-by-step implementation of a Hospital Management Information System (HMIS) in Peking Union Medical Collage (PUMC) Hospital are described in great detail. An experimental HMIS consisting of 40 microcomputers and a minicomputer (VAX-730) with a mixed network has been developed and is running perfectly well in PUMC Hospital. It is a distributed data management system. Each department uses microcomputers (work stations) to handle its own work directly facing the end-users to meet the local requirements. The global data concerning the whole system will be stored in network to be shared with all the subsystems. The communication between two subsystems is through 3+ network. As a background support of the distributed data processing, the centralized data bases in VAX-730 could be used to analyse and evaluate activities of the whole hospital.
The case management process is a critical management and operational component in the delivery of customer services across the patient care continuum. Case management has transcended time and will continue to be a viable infrastructure process for successful organizations in the future. A key component of the case management infrastructure is information systems and technology support. Case management challenges include effective deployment and use of systems and technology. As more sophisticated, integrated systems are made available, case managers can use these tools to continue to expand effectively beyond the patient's episodic event to provide greater levels of cradle-to-grave management of healthcare. This article explores methods for defining case management system needs and identifying automation options available to the case manager.
An important aspect in the effective management of an emergency medical services system is the ability to monitor system performance. To provide this information on a timely basis, a comprehensive data collection system is required. We describe the design, implementation, use, and effect of a comprehensive, computerized data retrieval system within an urban fire department. Building on a data collection system already in place, it was possible to minimize the cost and accelerate the training process. A comparison is included between the different type of systems available for use with prehospital providers. Use of prehospital data collection systems results in more in-depth understanding of system operations and the status of prehospital medical care provided to the community.
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Institutional and market changes seem to force hospitals across the Western world to revitalize their corporate strategies towards more cost efficiency on the one hand, and more flexibility towards customer demands on the other hand. Hospitals, however, apparently differ in the extent to which they are able to implement such strategies effectively. This paper explores whether these different levels of effectiveness depend on how hospitals' top managers' use of the available management information systems (MIS). Based on data obtained from the 218 CEOs of public hospitals in Spain, we analyze how CEOs' professional and educational backgrounds affect their use of MIS, and how the use of the MIS subsequently supports or inhibits the implementation of these strategic goals. The results indicate that CEOs with a predominant clinical background focus more on non-financial information for decision-making and prefer an interactive style of using MIS, which together support flexibility strategies. CEOs with a predominant administrative background seem more effective in establishing cost-reduction strategies, through their larger inclination to emphasize financial information in combination with a diagnostic use of the MIS. Implications for the strategic management of hospitals are outlined.
OBJECTIVES: In our department, we have been using an Anesthesia Information Management System (AIMS) for five years. In this study, we tested to what extent data extracted from the AIMS could be suitable for the supervision and time-management of operating rooms. METHODS: From 1995 to 1999, all relevant data from 103,264 anesthetic procedures were routinely recorded online with the automatic anesthesia record keeping system NarkoData. The program is designed to record patient related time data, such as the beginning of anesthesia or surgical procedure, on a graphical anesthesia record sheet. The total number of minutes of surgery and anesthesia for each surgical subspecialty per hour/day and day of the year was calculated for each of the more than 40 ORs, amounting to a total of 112 workstations. RESULTS: It was possible to analyze the usage and the utilization of ORs at the hospital for each day of the year since 1997. In addition, annual and monthly evaluations are made available. It is possible to scrutinize data of OR usage from different points of view: queries on the usage of an individual OR, the usage of ORs on certain days or the usage of ORs by a certain surgical subspecialty may be formulated. These data has been used repeatedly in our hospital for decision making in OR management and planning. CONCLUSIONS: In assessing the results of our study, it should be considered that the system used is not a specialized OR management tool. Despite these restrictions, the system contains data which can be used for an exact and relevant presentation of OR utilization.
The design of each new hospital site is typically preceded by decisions on the most appropriate level of biomedical equipment which significantly influences the layout of the hospital departments which are under construction. The most appropriate biomedical equipment should ideally be decided upon considering a series of demographic and social parameters of the hospital and international regulations and standards. This information should ultimately be distilled to proper technical specifications. This paper proposes a streamlined management process related to the procurement of biomedical equipment for new hospital sites or for those under expansion. The new management process aims to increase the efficiency of the experts involved in the definition of the most appropriate level of equipment and its technical specifications. It also addresses all aspects of the biomedical equipment-selection cycle, including the evaluation of the bids submitted by the equipment suppliers. The proposed process is assisted by a management information system, which integrates all related data-handling operations. It provides extensive decision-support facilities to the expert and a platform for the support of knowledge re-use in the field of biomedical-equipment selection.
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This paper investigates the problem of how an emergency case is taken care of from its location until the time the case reaches an emergency medical center or a hospital. The result of this investigation is an on-line Emergency Medical Services Management Information System (ESMIS). ESMIS is implemented using the TOTAL database management system. Part 1 outlines, in general, the steps of the ESMIS design procedure and concentrates on one step, namely the specification of ESMIS outputs.
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The task of managing laboratory data is not a new one. Over the past two decades, the use of Laboratory Information Management Systems (LIMS) has revolutionized how laboratories manage their data. A LIMS is more than software; it has become the workhorse of the laboratory, encompassing laboratory work-flow combined with user input, data collection, instrument integration, data analysis, user notification, and delivery of information and reporting. Types of organizations that utilize LIMS vary greatly from research laboratories to manufacturing laboratories to environmental testing laboratories. Commercially-available LIMS have been around since the 1980s. In addition, many laboratories have designed, implemented, and maintained in-house LIMS. The heart of any LIMS is the software. Like other laboratory systems, the LIMS software is subject to quality control and quality assurance checks. In regulatory environments this associated QA/QC is referred to as "system validation." The primary purpose of system validation is to ensure that the software is performing in a manner for which it was designed. For example, the system acceptance criteria should be established and tested against quantifiable tasks to determine if the desired outcome has been achieved. LIMS features, such as autoreporting, reproducibility, throughput, and accuracy must be quantifiable and verifiable. System validation ensures that the entire system has been properly tested, incorporates required controls, and maintains and will continue to maintain data integrity. Laboratories must establish protocols and standards for the validation process and associated documentation. Although vendors of commercial LIMS perform initial internal system validations, the system must be revalidated whenever the end user, vendor or third party adds modifications or customizations to the LIMS. Currently, detailed guidance regarding system validation of LIMS is not available to the user. The issue is addressed in Good Automated Laboratory Practices (GALP) and National Environmental Laboratory Accreditation Conference (NELAC) documents which indicate specific requirements or recommendations for operational checks and periodic testing; however, it is up to the laboratory to determine suitable methods to accomplish these tasks. Proper validation of a LIMS will allow a laboratory to comply with regulations and also provide comprehensive documentation on the system that is necessary to troubleshoot future problems.
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A project team from a nurse-managed health care center designed and used a microcomputer-based information management system to document the activities of their clinic. Commercial software, dBase III Plus, was used to program the system, called Nurse Education Link to Aged Center (NELAC). NELAC reflects the center's philosophy of helping clients attain maximum satisfaction of their health care needs through self care. NELAC's specific purposes include 1) matching student nurses with potential clients for clinical experiences; 2) providing an efficient reminder system to improve follow-up care for clients; 3) maintaining longitudinal client records; 4) producing reports of services and activities of the center; and 5) providing aggregate data for research.
For efficient monitoring of multidrug therapy programmes for leprosy both at microlevel (individual patient monitoring) as well as microlevel (programme monitoring), DANIDA decided to develop an alternative, simple and quick information system using a computer. A patient data base system was designed using dBase III Plus package. The field workers of the National Leprosy Eradication Programme were trained in transcribing data on to coded data sheets. The data of 1750 patients of six leprosy control units from the 4 MDT districts were processed and feedback reports were sent to paramedical workers and programme managers. The initial experience in the field over the past year has shown that a computerized management information system is feasible and well accepted by the field staff for the purpose of improving monitoring.
The National Cancer Institute-Cairo University (NCI) is a leading cancer center in the Middle East and Africa. It serves more than 15,000 new cases and more than 250,000 patient visit every year. The implementation of its Hospital Management Information System was completed and the system was operational in 1992. Although different modules were added to the HMIS, the core of the system has never been changed or updated. NCI evaluated its current system. NCI also evaluated the modern tools in databases and programming. NCI came to the conclusion that a new HMIS need to be installed. The needs of NCI staff were analyzed with consideration to budget issues and the limitations of a developing country. Different hardware, networking and software issues had to be considered in the updating. Arabization and customization were main factors in decision making.