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PubMed1991

The Physician's Workstation: an example of end user integration of information systems.

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these system are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development using rapid prototyping object-oriented programming tools of a Physician's Workstation which integrates information from five different applications running on three separate computer systems.

Computer Communication Networks↗
PubMedDate not supplied

An integrated hospital information system in The Netherlands.

The development of an experimental integrated hospital information system (HIS) at Leiden University Hospital was initiated by the Dutch government in 1972. As a result of this experiment, a sophisticated HIS is now used by 45 hospitals in the Netherlands, which together have more than 35% (22,000) of the acute care hospital beds in the country. Further development and maintenance of the system are in the hands of a nonprofit organization called BAZIS. This article describes the characteristics of the system and its functions. Special attention is given to technical issues, use of the system, costs, and the organizational structure overseeing multi-hospital participation.

Computer Systems↗
PubMed1993

Understanding the combination of memory variables: a re-examination.

This study was a direct prolongation of a study by Wellman, Collins, and Glieberman (1981), which showed that, provided a sufficiently sensitive methodology is used, it is possible to demonstrate experimentally that even 5-year-old children are capable of integrating two types of information--effort and difficulty of task--in their judgment of performance (number of items recalled). We prolonged this study by adopting Anderson's information integration methodology in order to provide evidence concerning the type of combinatorial rule describing subjects' use of both pieces of information and to refine analysis to the individual level. In terms of group results, it was possible to describe the algebraic aspects of the information integration process by an additive model in children and adolescents, and by a multiplicative model in adults. Conclusions changed considerably, however, when individual results were studied. In the 5- and 8-year-old children, the dominant rule was clearly unifactorial, involving effort. Only in the adult group was true integration seen in all subjects.

Adolescent↗
PubMedDate not supplied

Online support functions of prescription order system and prescription audit in an integrated hospital information system.

The role of the online prescription support functions of a prescription order entry system was analysed and the results of the prescription audit by pharmacists were examined. In the Kochi Medical School Hospital, an online prescription order system has been developed as part of an integrated hospital information system named IMIS (the Integrated Medical Information System), in which all the physicians enter their prescription orders into online display terminals. The prescription order entry system is provided with prescription support functions, which check the entered prescription data, issue warnings, and offer information about drugs or patients. The prescription order system reduces the incidence of simple prescription mistakes and greatly decreases the cases of inquiries by pharmacists. However, results of the analysis show that such functions as warnings of double order and repeated prescription of a drug do not work as well as expected. The system would thus require some kind of intelligence like that of the auditing pharmacists or that of the physicians with accurate knowledge of clinical pharmacology.

Drug Prescriptions↗
PubMed2006

Health Outcomes for Better Information and Care (HOBIC): integrating patient outcome information into nursing undergraduate curricula.

Nursing-sensitive outcomes provide common information across sectors, thus eliminating duplication that frequently occurs as individuals move across settings. These outcomes also facilitate increased trust among colleagues and support common understandings of patient care needs, thus enhancing continuity of care. Outcomes-oriented information is also likely to increase patient safety and improve overall quality of care. Shared standards and data support consistent decision-making, as nursing decisions can be tracked back over time to assess patient care outcomes. Consequently, nurses will have the means to determine the impact of their interventions on patient outcomes. At the same time, adoption of common approaches to patient assessment leads to greater professional accountability and moves nursing care from a task orientation to an outcomes focus. For administrators, such improvements in monitoring and evaluating patient outcomes translate into improvements in efficiencies and effectiveness, thus providing a return on investment in implementing these outcomes within their agency. For nurses, integration and utilization of outcomes information increases the visibility and significance of their decision-making and patient care. Together with patients, nurses can utilize the outcomes information to make evidence-based decisions and advocate for appropriate care. At an aggregate level, the use of outcomes information creates a continuous feedback loop that is essential to ensuring evidence-based care and the best possible patient outcomes, not only for individuals, but also for families, communities and populations. Outcomes-oriented care provides a gateway for transforming the way we care for patients; puts safe, ethical, high-quality care for patients first; embodies the principles of evidence-based practice; ensures that the value of nursing is clearly understood within the larger system; and ensures that the requirements for measurability and accountability can be achieved. This journey is continuous and is being expanded to engage all other health disciplines in understanding and documenting their contributions to patient care, both as individual practitioners and as members of a healthcare team. Preparing nursing students in an outcomes approach will facilitate systemwide adoption of HOBIC patient outcomes over time and provide a means to determine the impact of nursing care on our patients.

Computer User Training↗
PubMed1997

Evaluation of an expert system on lymph node pathology.

BACKGROUND: Pathfinder is an Expert System that assists pathologists in making accurate diagnoses in the domain of lymph-node pathology. Pathfinder provides a differential diagnosis based on the initial histological feature(s) observed by the pathologist, and suggests to the user additional histological features for observation that are likely to narrow the differential diagnosis. PURPOSE: To evaluate the diagnostic accuracy of pathologists with and without the Pathfinder. METHODS: Thirty H&E stained slides from 30 lymph node biopsy specimens on which a Consensus diagnosis was made by two experts were reviewed by 19 pathologists to evaluate Pathfinder. After a period of training, 10 pathologists using Pathfinder (Interactive Computer Method) and 9 pathologists using the Routine Method (diagnosis without computer) determined a differential diagnosis for 15 slides (Test 1). Pathologists were then crossed over, trained, and evaluated the remaining 15 slides (Test 2). For each test, the proportion of "correct" diagnoses was compared between methods. In addition, the information integration attributes (making logical diagnosis given a set of specific histologic features) of Pathfinder and pathologists were compared. Finally, feature identification and quantification skills of pathologists were determined and correlated with the percent correct diagnosis. RESULTS: The diagnostic accuracy using Pathfinder was greater than that using the Routine Method (40% v 32%, P = .02). Diagnostic accuracy for the group of pathologists who made diagnosis using the Routine Method in Test 1 increased when they made diagnosis using Pathfinder in Test 2 (27% to 44%, P < .0001). The proportion of correct diagnosis for the group of pathologists who used Pathfinder in Test 1 remained virtually unchanged when they gave up Pathfinder in Test 2 (35% to 37%). The percentage of incompatible feature identification ("atypical proliferation" diagnosis) was significantly lower after using Pathfinder (P < .0001). In addition, information integration attributes of Pathfinder were significantly superior than that of the pathologists (P < .0001). CONCLUSIONS: Pathfinder is a valuable tool that assists pathologists in making accurate diagnosis because it has superior attributes than pathologists to integrate information and to screen for observations incompatible with any specific disease.

Biopsy↗
PubMed2004

Indianapolis I3: the third generation Integrated Advanced Information Management Systems.

In 2001, the Regenstrief Institute for Health Care and the Indiana University School of Medicine (IUSM) began an IAIMS planning effort to create a vision and a tactical plan for the first Integrated Advanced Information Management Systems (IAIMS) implementation to cross a large area and include unaffiliated institutions. A number of elements made this planning effort unique. Among these elements were the existence of a network infrastructure that supported the Indianapolis Network for Patient Care, the existence of a mature medical informatics program at the Regenstrief Institute, and the existence of a wide-area knowledge network fostered by the IUSM libraries. However, the leadership for a strong information technology role in the IUSM that could promote collaboration in support of education and research across the diverse Indianapolis hospital systems had been lacking. By bringing together various groups, each with a commitment to improve health care quality and public health across the Indianapolis metropolitan area, regardless of individual institutional affiliation, the strategic directions for I3-Indianapolis IAIMS Initiative have been defined and the foundations for a third generation IAIMS construct have been laid in Indianapolis, Indiana.

Academic Medical Centers↗
PubMed1990

Models of integration given multiple sources of information.

Several models of information integration are developed and analyzed within the context of a proto-typical pattern-recognition task. The central concerns are whether the models prescribe maximally efficient (optimal) integration and to what extent the models are psychologically valid. Evaluation, integration, and decision processes are specified for each model. Important features are whether evaluation is noisy, whether integration follows Bayes's theorem, and whether decision consists of a criterion rule or a relative goodness rule. Simulations of the models and predictions of the results by the same models are carried out to provide a measure of identifiability or the extent to which the models can be distinguished from one another. The models are also contrasted against empirical results from tasks with 2 and 4 response alternatives and with graded responses.

Arousal↗
PubMed2004

Using protein expressions to predict survival in clear cell renal carcinoma.

PURPOSE: An accurate system for predicting survival for patients with solid tumors will allow for better patient selection for both established and novel therapies. We propose a staging system for clear cell variants of renal cell carcinoma (RCC) that includes molecular predictors and standard clinical predictors such as tumor-node-metastasis (TNM) stage, histological grade, and performance status (PS). EXPERIMENTAL DESIGN: A custom tissue array was constructed using clear cell RCC from 318 patients, representing all stages of localized and metastatic RCC, and immunohistochemically stained for molecular markers Ki67, p53, gelsolin, CA9, CA12, PTEN, EpCAM, and vimentin. We present a strategy for evaluating individual candidate markers for prognostic information and integrating informative markers into a multivariate prognostic system. RESULTS: The overall median follow-up and the median follow-up for surviving patients were 28 and 55 months, respectively. A prognostic model based primarily on molecular markers included metastasis status, p53, CA9, gelsolin, and vimentin as predictors and had high discriminatory power: its statistically validated concordance index (C-index) was found to be 0.75. A prognostic model based on a combination of clinical and molecular predictors included metastasis status, T stage, Eastern Cooperative Oncology Group PS, p53, CA9, and vimentin as predictors and had a C-index of 0.79, which was significantly higher (P < 0.05) than that of prognostic models based on grade alone (C = 0.65), TNM stage alone (C = 0.73), or the University of California Los Angeles integrated staging system (C = 0.76). CONCLUSIONS: Protein expressions obtained using widely available technology can complement standard clinical predictors such as TNM stage, histological grade, and PS.

Adenocarcinoma, Clear Cell↗
PubMed1999

Averaging expectancies and perceptual experiences in the assessment of quality.

This study examines whether people integrate expectancy information with perceptual experiences when evaluating the quality of consumer products. In particular, we investigate the following three questions: (1) Are expectancy effects observed in the evaluation of consumer products? (2) Can these effects be viewed in cognitive processing terms? (3) Can a mathematical model based on the averaging of attribute information describe the effects? Participants in two experiments blindly evaluated (with the product names removed) consumer products from six sensory modalities: vision (computer printer output), tactile (paper towels), olfaction (men's cologne), taste (corn chips), auditory (audio cassette tapes), and tactile/medicinal (hand lotion). Participants in both experiments were asked to: (1) rate the overall quality of the product given arbitrary quality labels (High Quality, Medium Quality, or Low Quality); (2) rate the overall quality of the product without the labels, and (3) estimate the scale values for the quality labels alone. Group results revealed main effects of the quality labels in all product categories. The pattern of results could be described by an averaging model based on Information Integration Theory. These results have implications for placebo effects in consumer behavior and decision making.

Attitude↗
PubMed2002

Publishing large proteome datasets: scientific policy meets emerging technologies.

Currently, there are various approaches to proteomic analyses based on either 2D gel or HPLC separation platforms, generating data of different formats, structures and types. Identification of these separated proteins or peptide fragments is typically achieved by mass spectrometry (MS) measurements that use either accurate mass measurements or fragmentation (MS-MS) information. Integrating the information generated from these different platforms is essential if proteomics is to succeed. A further challenge lies in generating standards that can accept the hundreds-of-thousands of mass spectra produced per analysis based on threshold or probability measurements. Finally, peer review and electronic publication processes will be crucial to the dissemination and use of proteomic information. Merging the policy requirements of data-intensive research with information technology will enable scientists to gain real value from global proteomics information.

Chromatography, Liquid↗
PubMed2002

Common principles of sensory encoding in spinal reflex modules and cerebellar climbing fibres.

An important step towards understanding the function of olivo-cerebellar climbing fibres must be to clarify what they signal. We suggest that climbing fibres projecting to paravermal cerebellum mediate highly integrated sensorimotor information derived from activity in spinal withdrawal reflex modules acting on single forelimb muscles. To test this hypothesis, cutaneous nociceptive receptive fields of spinal reflex modules were mapped and compared to those of climbing fibres. Quantitative methods were used both for mapping and for comparing receptive fields. The organization of muscle afferent input converging on individual climbing fibres was analysed in the light of results from receptive field comparisons. Individual cutaneous receptive fields in the two systems were readily matched. Matched pairs were highly similar with regard to detailed distributions of sensitivity: correlation coefficient r = 0.85; overlap of receptive field foci 72 % (average values). The olivary targets of muscle afferents from a given muscle were mainly climbing fibres with cutaneous receptive fields similar to that of the muscle itself, but to a lesser extent also other climbing fibres. In conclusion, paravermal climbing fibres apparently convey information integrating (i) cutaneous input to an individual spinal withdrawal reflex module, (ii) muscle afferent input from the output muscle of that module and (iii) muscle afferent input from muscles that constitute the output of functionally related modules. This suggests that an individual climbing fibre signals cutaneous sensory events reflecting activity of a single muscle conditional upon the functional state of the muscle itself and that of functionally related muscles.

Afferent Pathways↗
PubMed2005

Location perception: the X-Files parable.

Three aspects of visual object location were investigated: (1) how the visual system integrates information for locating objects, (2) how attention operates to affect location perception, and (3) how the visual system deals with locating an object when multiple objects are present. The theories were described in terms of a parable (the X-Files parable). Then, computer simulations were developed. Finally, predictions derived from the simulations were tested. In the scenario described in the parable, we ask how a system of detectors might locate an alien spaceship, how attention might be implemented in such a spaceship detection system, and how the presence of one spaceship might influence the location perception of another alien spaceship. Experiment 1 demonstrated that location information is integrated with a spatial average rule. In Experiment 2, this rule was applied to a more-samples theory of attention. Experiment 3 demonstrated how the integration rule could account for various visual illusions.

Adult↗
PubMed1998

Implications of new organizational relationships and fiscal incentives on health information managers.

Whether the health field in the United States should be dominated by more competition or by more government regulation is now at the center of the public policy debate. After examining the market-driven and regulatory models to constrain cost, improve quality, and enhance access to care, the article argues that our current centrist political philosophy can be expected to continue on Capitol Hill and among the state legislatures. As a result, this will force health information managers to labor within a blended approach that is partially market driven and partially governed by regulations. How such a hybrid system will affect the future role of health information professionals, integrated information systems, and other related topics is also discussed.

Benchmarking↗
PubMed1994

Primary and secondary care integration.

Integration of primary and secondary health care is a goal of the 1993 New Zealand health reforms. Focus groups were selected to raise options and stimulate improved integration between primary and secondary care in the Auckland metropolitan and rural areas. Cooperation, communication, coordination, were considered relevant. Several detailed recommendations were produced. They fell into six groups; (1) liaison committees or meetings, (2) communication, (3) referral admission discharge, (4) joint ventures, (5) horizontal integration and (6) general. A key recommendation was that regional health authorities should fund liaison committees or functions to promote inter provider integration. The findings of the focus groups are placed in context of the wider requirements for integration. These are integrated funding, integrated information systems, integrated purchasing and utilisation management.

Communication↗
PubMed2005

Putting things into perspective: individual differences in working-memory span and the integration of information.

An important function of working memory is the integration of incoming information into an appropriate model of the contextual situation. We hypothesized that individual variability in working-memory function (estimated using Engle's operation-span measure) may lead to differential reactivity to a changing context. We recorded event-related brain potentials (ERPs) and reaction-time measures to stimuli embedded in long stimulus series (two auditory discrimination tasks), and examined the participants' responses in relation to how the current stimuli fit with the context generated by the previous stimuli. In both tasks, participants with low working-memory span scores showed larger brain responses as a function of variations in the local stimulus sequence than participants with high span scores. These data suggest that the low working-memory span group is more affected by the local stimulus sequence than the high span group, possibly because they are more easily swayed by ongoing changes and are therefore less capable of maintaining their attention on the overall sequence.

Adolescent↗
PubMedDate not supplied

IAIMS: an interview with Dick West. Integrated Advanced Information Management Systems. Interview by Joan S Ash and Frances E Johnson.

Richard T. West, IAIMS (Integrated Advanced Information Management Systems) Program Officer at the National Library of Medicine for 13 years, reflects on the origin, development, effectiveness, and future of IAIMS efforts. He dwells on the changes that have taken place as the concept of IAIMS has evolved from a technology-based to an organization-based level of integration. The role of IAIMS in patient care, education, and research is discussed, along with the role of the librarian in the implementation of IAIMS programs. He sees a need for training for librarians, informaticians, and others in preparation for these efforts and for the development of academic reward systems that encourage them. He expresses a desire for those working in information technology in hospitals to gain a clearer understanding of IAIMS, because the concept fits hospitals as well as academic health science centers. He exhorts informaticians to bring to reality the futuristic fantasies of a new information world.

Computer-Assisted Instruction↗