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PubMed1999

Information resources assessment of a healthcare integrated delivery system.

While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations.

Computer Communication Networks↗
PubMed1991

A simple approach for the distribution of computationally intense tasks in an heterogeneous environment: distribution of the MDPP image-processing package.

A method has been developed to link the display ability of a high-resolution graphics workstation with the computational power of a local mainframe or a remote supercomputer via an electronic data network. The method allows this link to be established in a manner largely transparent to the user. The application of the method is illustrated by our successful distribution of the computationally intensive portions of an imaging program (MDPP) from a small VAX workstation to a VAX mainframe and Cray Y-MP8/832 using a simple message-passing technique. This technique can be applied to almost any configuration of networked machines.

Algorithms↗
PubMed1989

[The aging heart and its pathology. An epidemiological study of 229 cases based on a clinical and radiological classification].

The paper studies epidemiological distribution of the aging heart and its pathology in a sample of 229 subjects (101 male and 128 female) on the basis of a clinical and radiological classification into cardiological phenotypes. This study involved the use of mathematical statistical procedures following a standard method using SIR database (Scientific Information Retrieval) software implemented on the CDC Cyber 170/730 mainframe in the Trieste University Computing Center that is connected with the Chair of Geriatric Pathology. Using this software it was possible to assess the epidemiological significance of the usual clinical parameters, and show that the most representative cardiopathy is the 3rd type, i.e. the hypertrophic-ischemic cardiopathy belonging to the large aortic heart. Its natural pathogenesis is independent of risk factors and relates to the aging of muscular and connective tissues in which the coronary circulation is involved in the deterioration of the cardiovascular system and is therefore different from the primary ischemias of adults.

Aged↗
PubMedDate not supplied

Failed appointments in residency practices: who misses them and what providers are most affected?

BACKGROUND: Missed appointments can affect patient health, disrupt schedules, and result in poor utilization of resources, increased workload for staff and physicians, and lost learning opportunities for residents in training programs. METHODS: The setting was an established community-hospital-based family practice residency practice averaging 25,000 outpatient visits per year in a small northern New England town. Data from a computer-scheduling system and hospital mainframe, as well as demographic and other information contained in billing records and patient schedules, were abstracted for patients who scheduled 3962 appointments on 36 sampled days during 1995. RESULTS: The missed appointment rate during the study period was 6.7 percent. Characteristics associated with missed appointments were younger patient age (17 to 30 years), Medicaid coverage or lack of health insurance, and appointments scheduled with first-year residents or medical students. CONCLUSIONS: Attention should be given to those patients most likely to miss appointments and, in training programs, to patients seeing first-year residents and medical students. It is possible that our relatively low missed appointment rate overall resulted from the nature of the practice and its environment.

Adolescent↗
PubMed1998

Data dictionaries at Giessen University Hospital: past--present--future.

The concept of maintaining a medical data dictionary as a HIS core component was fundamental for all HIS development phases since the mid eighties at Giessen University Hospital. Being influenced by an early experimental installation of the HELP hospital information system and its PTXT data dictionary, we kept this approach through a number of development cycles of our own hospital information system. While our first data dictionary implementation (GMDD) was still very close to the PTXT structure (polyhierarchical design with an eight level hierarchy), the second generation dictionary (MDD-GIPHARM) has already been designed using a more flexible semantic network model. GMDD was a mainframe development (realized on Tandem Computers) based on the Tandem Nonstop SQL RDBMS. The major clinical applications established on top of the GMDD were laboratory results review, diagnosis documentation and physician discharge summaries. The MDD-GIPHARM development was initiated on PC-basis as the core of a rheumatology departmental system using MS-Access and then further enhanced within a research project to build knowledge-based functions for drug therapy. A first set of such functions based on MDD-GIPHARM is in routine use since 1996. Our current focus is to enhance MDD-GIPHARM towards an application independent vocabulary server (GDDS), which may be used for a variety of applications with the intranet of Giessen University Hospital. In this paper the evolutionary development of those data dictionary concepts at Giessen University Hospital is illustrated and compared with international activities in the last decade.

Hospital Information Systems↗
PubMed1991

Going online with outsiders.

Whether it's hiring expertise to straighten out a problem-plagued computer system, using a firm to smooth the transition to a new system, or saying goodbye to the mainframe altogether, a growing number of hospitals are handing over the management of all or part of their data processing operations to outsiders. "Outsourcing" can offer a variety of advantages, including helping control costs, making more effective use of capital and relieving staffing shortages.

Computers, Mainframe↗
PubMed1993

A national survey to assess current use of computerised information systems in obstetrics.

OBJECTIVE: To ascertain the number and type of obstetric computer systems (OCS) in Great Britain, and to ascertain user satisfaction with these systems. DESIGN: A postal questionnaire was circulated to every consultant obstetrician in Great Britain at the beginning of 1992. MAIN OUTCOME MEASURES: Information was sought on the hardware, software and uses of obstetric computer systems. Satisfaction with, benefits and problems of the system were also assessed. RESULTS: There was an 87.5% response rate. Of the 264 units questioned, 100 units reported that they had a computer system. Sixty-five units used terminals connected to a mainframe or minicomputer and 17 used stand-alone personal computers (PCs). Local area networks (LANs) were used in 19 units and wide area network (WANs) in 22 units. Software varied from commercial turnkey systems to in-house systems. The quoted annual running cost ranged from 50 pounds to 48,000 pounds. Most units were satisfied with their system. Problems included slow operating times, unreliability, user unfriendliness, deficiencies in training and inadequate customer support services. CONCLUSIONS: Obstetric computer systems are now coming into widespread use. Despite problems, the use of such systems is likely to increase. This survey establishes a database for those units who are considering acquiring or changing their computer system for the purpose of audit or research.

Attitude to Computers↗
PubMed1986

Survey results: radiology information systems and personal computing.

The AHRA statistical Resource Committee reports on the prevalence of radiology information systems and personal computers, the major applications run in radiology departments, the use of mainframe versus standalone systems, and other important findings from its recent computer survey.

Computers↗
PubMed1985

Maximizing the efficiency of a study on alcohol-related birth defects by means of data collection and analytic strategy dissociation.

Application of the terms "prospective" and "retrospective" to quasi/experimental research designs used in clinical investigations is often ambiguous; they often lack specification as to whether they apply to data acquisition, analytic strategy, or both. Data may be collected prospectively by preplanned protocol or retrospectively by chart review. In addition, the direction of analysis may be prospective--comparing differential outcomes for at-risk and not at-risk (exposed/not exposed) groups--or retrospective--comparing differential preceding risks for affected and nonaffected groups. Prospective data collection is advantageous in assuring the availability of crucial variables for an entire sample, but prospective analytic strategies may be inefficient, underestimating effect sizes, particularly when the outcome of interest is rare or the effect, even if large, is seen in only a small proportion of cases. In a prospective multilinear regression model of risks for lowered birthweight for gestational age, 2% of the variance was explained by alcohol variables after adjustment for confounding. In comparison, a similar multilinear regression of case-control sample, in which the frequency of the abnormal outcome is raised, showed 18% of the variance explained by alcohol variables. Data collection and analytic strategies may be dissociated. Although some statistical power may be lost because of reduced sample size, synthetic case-control analysis is efficient in examining small effects. It also has the advantage of decreasing the size of the database to be managed and the time required for analysis. Using this approach, it is feasible to perform virtually any analysis that can be done on a mainframe on medium-sized departmental computer system.

Birth Weight↗
PubMed1996

A new approach to the implementation of direct care-provider order entry.

Successful implementation of direct computer-based care-provider order entry traditionally relies on one of two different approaches development from scratch or installation of a commercial product. The former requires extensive resources; the latter, by its proprietary nature, limits extension of the system beyond capabilities supplied by the vendor. This paper describes an intermediate approach using the association of a locally-developed and controlled set of distributed microcomputer based applications and a commercial, mainframe-based order entry application used as an order transaction processing system. This combination provides both an intuitive user interface and a platform for implementing clinical decision-support tools.

Computer Communication Networks↗
PubMedDate not supplied

[The use of the computer in the neonatal intensive therapy unit: the current and prospective aspects].

The Authors assert that computer can give an adjunctive value to our abilities, improve the punctuality of own service, lighten the duties of routine (leaving free time for own-self or for adjournment). We have noticed a gradual but continuous increase of the use of the computer in the last years in hospital particularly in the Neonatology department and in the NICU, even because in these departments the data to compare are numerous. In the Brindisi's NICU since 1/7/1986 there has been a process of progressive increase of the use of the computer, based on three directions: filing data of the patients, computer-assisted management of the treatment of RDS, computer-assisted follow-up of the risk-baby, and management of the resources. Moreover are reported possibilities of future applications, as records of diagnosis and helped therapy, interface with medical equipment, linking with databank and with the hospital's mainframe.

Computer Systems↗
PubMed1988

How changes in computer technology are revolutionizing the practice of chemistry.

During the early 1980s, two major developments in computer technology changed the way chemists approached their science. The advent of the micropressor and then the PC changed experimental chemistry, while the availability of two classes of computer, the superminicomputer and supercomputer, greatly influenced computational chemistry. In the past two years, graphics workstation computers have begun to affect the practice of chemistry by combining fast, high-resolution, multiwindow graphics with superminicomputer power. In 1988, the advent of a new class of computer--the graphics supercomputer--offers extraordinary promise to both theoretician and experimentalist. In these systems, near-Cray compute power is combined with ultrahigh-speed 3-dimensional graphics for unparalleled visualization of molecular processes and other complex events. This is made practical not just by computing and graphics power but by use of ultrahigh internal bandwidths inside the graphics supercomputers. Another major development in scientific computing is the evolving concept of the laboratory computer network. Current network designs include hierarchical configurations incorporating various levels of computers--through supercomputers--either locally or via national or regional networks. New software methods are also having impact on chemical research, allowing, for example, the scientist to better abstract information from noisy or incomplete experimental data. Use of parallelism (multiple CPUs) in new design workstation computers will extend their power, by the early 1990s, past that of current supercomputer mainframes. Within five years the chemist will have $10 million of 1985 computer power on his desk, for considerably less than $100,000, along with visualization tools and software only dreamed of in 1985.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemical Phenomena↗
PubMed1991

[A survey of the best bibliographic searching system in occupational medicine and discussion of its implementation].

When occupational health personnel, especially occupational physicians search bibliographies, they usually have to search bibliographies by themselves. Also, if a library is not available because of the location of their work place, they might have to rely on online databases. Although there are many commercial databases in the world, people who seldom use them, will have problems with on-line searching, such as user-computer interface, keywords, and so on. The present study surveyed the best bibliographic searching system in the field of occupational medicine by questionnaire through the use of DIALOG OnDisc MEDLINE as a commercial database. In order to ascertain the problems involved in determining the best bibliographic searching system, a prototype bibliographic searching system was constructed and then evaluated. Finally, solutions for the problems were discussed. These led to the following conclusions: to construct the best bibliographic searching system at the present time, 1) a concept of micro-to-mainframe links (MML) is needed for the computer hardware network; 2) multi-lingual font standards and an excellent common user-computer interface are needed for the computer software; 3) a short course and education of database management systems, and support of personal information processing for retrieved data are necessary for the practical use of the system.

Computers↗
PubMed1986

Personal access to sequence databases on personal computers.

A comprehensive package of software has been developed to access nucleic acid and protein sequence databases on stand-alone IBM personal computers. The software combines keyword search on the annotation fields of the data with pattern matching algorithms on the biological sequences. Sequences containing complex sites like promoters or kink sites can be identified as well as sequences that are similar to a query sequence. Protein sequences with particular patterns of amino acids such as hydrophobic regions can be identified as well. Considering the relatively inexpensive hard disks now available, personal computers have become a cost-effective alternative to mainframe processing for sequence databases.

Amino Acid Sequence↗
PubMed1993

Office-based interventions to improve delivery of cancer prevention services by primary care physicians.

Physician forgetfulness, patient refusal, and practice logistical difficulties are among the major reasons that physicians perform cancer prevention activities less frequently than recommended by established guidelines. To improve delivery of prevention services, office system interventions of several types have been developed and tested. These include approaches aimed at patients during the medical encounter (in-reach) and outside the medical setting (outreach). In-reach interventions include medical record checklists and flow sheets, stickers and alerts, audit with feedback, nurse-initiated reminders, and computer-generated reminders, including ones generated by mainframe and microcomputer systems. In-reach interventions are directed at patients alone, at physicians alone, at patients and physicians simultaneously, or at office staff. Outreach reminder interventions include reminder postcards, letters, telephone calls, and questionnaires. Outreach reminders are directed at patients alone. The authors review the literature supporting the efficacy of such office systems. The analysis suggests that office systems are effective strategies in promoting cancer prevention activities.

Counseling↗
PubMed1991

An assessment of variable thickness and fiber orientation of the skeletal muscle layer on electrocardiographic calculations.

This paper assesses the effectiveness of including variable thickness and fiber orientation characteristics of the skeletal muscle layer in calculations relating epicardial and torso potentials. A realistic model of a canine torso which includes extensive detail about skeletal muscle layer thickness and fiber orientation is compared with two other uniformly anisotropic models: one of constant thickness and the other of variable thickness. First, transfer coefficients are calculated from the model data. Then torso potentials for each model are calculated from the transfer coefficients and measured epicardial potentials. The comparison of calculated and observed torso potentials indicates that a simple model consisting of a uniformly anisotropic skeletal muscle layer of 1.0-1.5 cm constant thickness significantly improves the model. However, if photographic slices of the canine torso are used to introduce more detailed data about the variation in skeletal muscle thickness and fiber orientation into the model, the agreement and between calculated and measured torso potentials decreased, although a finite element mesh of over 5000 nodes was used to describe the skeletal muscle in the more detailed model. One source of error increase was considered to be due to numerical discretization and could be reduced with a much finer mesh or by utilizing higher order polynomials to represent the potential distribution within each finite element. However, the results presented in this paper show that high precision computation (64-bit word length) on the mainframe IBM 3081 with an attached FPS-164 gives a slow rate of improvement with reduced discretization intervals and that utilizing higher order polynomials within each finite element gives an even slower rate of improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗