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PubMed2005

Medicare program; durable medical equipment regional carrier service areas and related matters. Final rule.

This final rule provides a mechanism for us to expeditiously make changes to the durable medical equipment regional carrier (DMERC) service area boundaries without notice and comment rulemaking. Through this mechanism, we can change the geographical boundaries served by the regional contractors that process durable medical equipment claims through issuance of a Federal Register notice and make other minor changes in the contract administration of the DMERCs. The mechanism provides a method for increasing or decreasing the number of DMERCs, changing the boundaries of DMERCs based on criteria other than the boundaries of the Common Working File sectors, and awarding new contractors to perform statistical analysis or maintain the national supplier clearinghouse. We will publish these changes and their justifications in a Federal Register notice, rather than through notice and comment rulemaking. Although we may change the number and configuration of regional carriers, we are not altering the criteria and factors that we use in awarding contracts. Through this final rule, we are improving the contracting process so that we can swiftly meet the challenges of the changing healthcare industry and address the changing needs of beneficiaries, suppliers, and the Medicare program.

Catchment Area, Health↗
PubMed1998

Fellowship training in infectious diseases: a report from the regional and national meetings of infectious diseases division chiefs and program directors.

During the 2-year period April 1995 to April 1997, six regional meetings and one national meeting of division chiefs and program directors of adult infectious diseases programs in the United States were held to review fellowship training. Herein, we report data on job availability and job selection for recently graduated fellows. We summarize discussions on decreasing the number of fellows in training, and we outline suggested components of a core clinical curriculum and of three training tracks--clinician track, clinical investigator track, and basic investigator track.

Adult↗
PubMedDate not supplied

Internet patient records: new techniques.

BACKGROUND: The ease by which the Internet is able to distribute information to geographically-distant users on a wide variety of computers makes it an obvious candidate for a technological solution for electronic patient record systems. Indeed, second-generation Internet technologies such as the ones described in this article--XML (eXtensible Markup Language), XSL (eXtensible Style Language), DOM (Document Object Model), CSS (Cascading Style Sheet), JavaScript, and JavaBeans--may significantly reduce the complexity of the development of distributed healthcare systems. OBJECTIVE: The demonstration of an experimental Electronic Patient Record (EPR) system built from those technologies that can support viewing of medical imaging exams and graphically-rich clinical reporting tools, while conforming to the newly emerging XML standard for digital documents. In particular, we aim to promote rapid prototyping of new reports by clinical specialists. METHODS: We have built a prototype EPR client, InfoDOM, that runs in both the popular web browsers. In this second version it receives each EPR as an XML record served via the secure SSL (Secure Socket Layer) protocol. JavaBean software components manipulate the XML to store it and then to transform it into a variety of useful clinical views. First a web page summary for the patient is produced. From that web page other JavaBeans can be launched. In particular, we have developed a medical imaging exam Viewer and a clinical Reporter bean parameterized appropriately for the particular patient and exam in question. Both present particular views of the XML data. The Viewer reads image sequences from a patient-specified network URL on a PACS (Picture Archiving and Communications System) server and presents them in a user-controllable animated sequence, while the Reporter provides a configurable anatomical map of the site of the pathology, from which individual "reportlets" can be launched. The specification of these reportlets is achieved using standard HTML forms and thus may conceivably be authored by clinical specialists. A generic JavaScript library has been written that allows the seamless incorporation of such contributions into the InfoDOM client. In conjunction with another JavaBean, that library renders graphically-enhanced reporting tools that read and write content to and from the XML data-structure, ready for resubmission to the EPR server. RESULTS: We demonstrate the InfoDOM experimental EPR system that is currently being adapted for test-bed use in three hospitals in Cagliari, Italy. For this we are working with specialists in neurology, radiology, and epilepsy. CONCLUSIONS: Early indications are that the rapid prototyping of reports afforded by our EPR system can assist communication between clinical specialists and our system developers. We are now experimenting with new technologies that may provide services to the kind of XML EPR client described here.

Internet↗
PubMed1999

'Telemedical' neurosurgical network saves lives, prevents unnecessary patient transfers.

Telemedicine improves patient care and saves money, too. An emergency telemedicine network for neurosurgeons in northern California is helping hospitals near San Francisco reduce unnecessary transportation costs. Find out how the network is ensuring that neurosurgical emergencies are identified faster, so patients get the right level of care at the right time.

California↗
PubMedDate not supplied

Building a dream: creating an oncology day/evening hospital.

The demand for inpatient beds has reached and often exceeds capacity producing waiting lists for cancer care. There is a need to explore alternative approaches to oncology treatment. The Oncology Day/Evening Hospital (ODEH), originally envisioned in 1995 as a joint project between an ambulatory cancer centre and a large teaching hospital, is an important cancer treatment initiative offering extended hours of ambulatory oncology treatment on days, evenings, weekends and statutory holidays. A review of current inpatient treatment modalities revealed that many patients receiving inpatient therapy could be safely and effectively managed in the ambulatory setting if treatment regimens were modified and if ambulatory hours of operation were extended. Healthcare improvements expected were: appropriate movement of inpatient activity to the ambulatory setting; more opportunities for patient choice in treatment time thereby allowing for maintenance of normal living; better quality of life for patients through prevention of hospitalization; decrease in treatment waiting times; consolidation of patients into an ambulatory oncology treatment setting as opposed to utilization of adult medicine units; and more rational inpatient bed utilization with reduction of admissions and intra-treatment transfers. This article describes our experience in building a dream, the challenges and lessons learned in implementing a better way to deliver oncology care in an environment of rapid change and staff shortages.

Ambulatory Care↗
PubMed1998

Organizational responses to managed care: issues for academic health centers and implications for pediatric programs.

The health care market dynamics that supported and directed the growth and development of Academic Health Centers (AHCs) have changed dramatically in the last 10 years. AHCs are struggling to adapt to new reimbursement mechanisms and to compete effectively for limited dollars, but are constrained by administrative and governance structures that are slow to evolve. Their multiple missions, including education, research, and care for complex patients and underserved populations, are at risk. Although most recognize the need for substantive reorganization, available resources and market specifics vary dramatically from one AHC to another. The current approaches to adaptation by four AHCs are described, along with some of the unique challenges confronted by academic pediatric programs.

Academic Medical Centers↗
PubMed2001

Using the eXtensible Markup Language (XML) in a regional electronic patient record for patients with malignant diseases.

Communication between different institutions which are responsible for the treatment of the same patient is of outstanding significance, especially in the field of tumor diseases. Regional electronic patient records could support the co-operation of different institutions by providing ac-cess to all necessary information whether it belongs to the own institution or to a partner. The Department of Medical Informatics, University of Heidelberg is performing a project in co-operation with the Thoraxclinic-Heidelberg and the Department of Clinical Radiology, University of Heidelberg with the goal: to define an architectural concept for interlinking the electronic patient record of the two clinical institutions to build a common virtual electronic patient record and carry out an exemplary implementation, to examine composition, structure and content of medical documents for tumor patients with the aim of defining an XML-based markup language allowing summarizing overviews and suitable granularities, and to integrate clinical practice guidelines and other external knowledge with the electronic patient record using XML-technologies to support the physician in the daily decision process. This paper will show, how a regional electronic patient record could be built on an architectural level and describe elementary steps towards a on content-oriented structuring of medical records.

Computer Security↗
PubMed1969

NERMLS: The first year.

The Countway Library, Boston, was the nation's first Regional Medical Library under the Regional Medical Library Program of the NLM. New England Regional Medical Library Service (NERMLS) began in October 1967 and is the outgrowth of traditional extramural services of the Harvard and Boston Medical Libraries (constituents of the Countway). During the first year over 27,000 requests were received of which 84 percent were filled. Some problems of document delivery (and their solution) are recounted. Other activities were: a limited amount of reference work; distribution of a Serials List; and planning for a region-wide medical library service. Proposals call for consultation and education, regional reference service, and improved document delivery service. Emphasis is placed on the role of the Community Hospital as a center for continuing education and the need to strengthen and assist hospital medical libraries. With the Postgraduate Medical Institute, Boston, NERMLS assisted in the compilation of a small physician-selected medical Core Collection which would serve as a minimum standard collection for community hospital libraries.

Information Services↗
PubMed2006

Education to improve the triage of mental health patients in general hospital emergency departments.

General hospital emergency departments (EDs) are obvious places for individuals in distress or in a mental health crisis to seek assistance. However, triage nurses admit to a lack of expertise and confidence in psychiatric assessment which can result in less accurate assessments than for medical or trauma presentations. The objectives of a collaborative project between an Adult Mental Health Program and an Adult Emergency Program in a Canadian regional health authority were to: provide education and training to triage nurses regarding mental health and illness; monitor the transit of mental health patients through the ED; monitor wait times; and determine the adequacy of the Canadian Triage Acuity and Assessment Scale in the triage of psychiatric presentations. Although the percentages of patients triaged as "emergent" did not change as a result of the education, the percentage of patients who were triaged as "not urgent" but required hospitalization was significantly reduced. Although average lengths of stay in the ED were also reduced after the education, this may or may not have been related to the educational sessions. The project was successful in increasing collaboration between the two departments and has resulted in enhanced, on-going mental health education for ED nurses.

Attitude of Health Personnel↗
PubMed1992

The hospital-physician computer communications network: an alternative application.

For more than five years hospitals have been developing computer communications networks as a physician bonding strategy because of their success in promoting hospital admissions and additional referrals to the sponsoring hospitals' specialists. An alternative, nonproprietary network may also be worthy of consideration because of the services and benefits it delivers to the total health care delivery system and to society as a whole--in addition to the advantages it offers the sponsoring hospital. An example of such a network is offered as an illustration.

Colorado↗
PubMed2006

The Alberta Ambassador Program: delivering Health Technology Assessment results to rural practitioners.

BACKGROUND: The purpose of Health Technology Assessment (HTA) is to make the best possible summary of the evidence regarding specific health interventions in order to influence health care and policy decisions. The need for decision makers to find relevant HTA data when it is needed is a barrier to its usefulness. These barriers are highest in rural areas and amongst isolated practitioners. METHODS: A multidisciplinary team developed an interactive case-based instructional strategy on the topic of chronic non-cancer pain (CNCP) management using clinical evidence derived by HTA. The evidence for each of 18 CNCP interventions was distilled into single-sheet summaries. Clinicians and HTA specialists ('Ambassadors') conducted 11 two-hour interactive sessions on CNCP in eight of Alberta's nine health regions. Pre- and post-session evaluations were conducted. RESULTS: The sessions were attended by 130 individuals representing 14 health and administrative disciplines. The ambassador model was well received. The use of content experts as ambassadors was highly rated. The educational strategy was judged to be effective. Awareness of the best evidence in CNCP management was increased. Although some participants reported practice changes as a result of the workshops, the program was not designed to measure changes in patient outcome. CONCLUSION: The ambassador program was successful in increasing awareness of the best evidence in CNCP management, and positively influenced treatment decisions. Its teaching methods were felt to be unique and innovative by participants. Its methods could be applied to other clinical content areas in order to increase the uptake of the results of HTA.

Alberta↗
PubMed2004

The Pacific Island Health Care Project: easing the cancer burden in the United States associated Pacific Islands.

Cancer is a serious and ever increasing problem in the United States Associated Pacific Islands (USAPIs). Nearly 30% of all consultations and referrals are for cancer. Depending on the type of cancer, the prognosis for long-term survival is often poor and the cost of caring for such patients is considerable. Tripler Army Medical Center (TAMC) provides tertiary medical care to patients from the USAPIs in support of Graduate Medical Education (GME) at no cost to the patient or jurisdiction. Continuing its tradition of leading telemedicine initiatives in the Pacific, TAMC has developed a web-based electronic consultation and referral network, the Pacific Island Health Care Project (PIHCP). Ten sites in Micronesia and one in American Samoa were provided with computer equipment. Local clinicians request consultation from TAMC specialists through the internet, attaching supporting imagery. The consults are posted on a secure web page, where they are viewed, evaluated, forwarded, and commented on by the consultants. Experience with more than 2,100 cases indicates that the Internet can be easily used as a store-and-forward consultation format and offers a cost effective means for distance consultation, referral, and learning. This format has provided for a more rational evaluation of all patients but especially patients with cancer. Patients who are terminally ill, have widely metastasized disease, and/or have inoperable tumors or recurrences are excluded so that limited resources can be used for those most likely to benefit. There has been overwhelming enthusiasm for such Internet consultations between referring physicians and consultants. Many Pacific Islander patients have received state-of-the-art medical care through this program. At the same time, the training of TAMC physicians and residents has been enhanced by their opportunity to care for these remarkable and deserving patients from the Pacific.

Education, Medical, Continuing↗
PubMed1989

The effect of urban trauma system hospital bypass on prehospital transport times and Level 1 trauma patient survival.

We studied the influence of hospital bypass on prehospital times and Level 1 trauma patient survival. During the nine-month study period, 251 Level 1 trauma patients were transported to the Cook County Hospital trauma unit by Chicago Fire Department (CFD) paramedics. The prehospital times and survival rates in the 203 (81%) patients who arrived with vital signs were analyzed. In this group, 64 (32%) had a hospital Trauma Score (TS) of 12 or less, 74 (39%) had at least one Abbreviated Injury Score (AIS) of 4 or more, and 58 (30%) had an Injury Severity Score (ISS) of more than 20. There were 66 (32%) directly transported patients and 137 (68%) patients who required hospital bypass. The time from CFD contact (by 911) to trauma center arrival (total run time) was on the average three minutes longer in the bypass group than in the direct group (36 +/- 11 vs 33 +/- 10 minutes, P less than .05). The travel time from the scene to the hospital (transport time) also was three minutes longer in the bypass group (7 +/- 3 vs 4 +/- 2 minutes, P less than .005). The need for bypass did not significantly influence survival. Survival was 86% in the bypass group and 85% in the direct group. The elapsed time between the injury and CFD contact (delay time) averaged 27 +/- 26 minutes and contributed 43% to the 63-minute mean overall time from the injury event to arrival at the trauma center. Total run time in directly transported patients accounted for 52% of the mean overall prehospital time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗