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Evolving community health information networks.

A community health information network (CHIN) provides technology-based information services to help maintain optimal health for all the residents of a community. Defining features of a CHIN are that its services are available to all stakeholders and that competitors collaborate to share information. The initial impetus for a CHIN is usually to facilitate paying for health care or to share clinical records. Complex legal, organizational, funding, and control issues confront CHIN initiators, and reliable models do not exist today. During development, issues of program focus and technology selection arise, followed by concerns about information privacy and the CHIN's role in quality of care. Once basic capabilities are implemented, a mature CHIN can offer extensive cost-recovering health-related services to providers, related agencies, and consumers. Developments are underway that eventually will allow a CHIN to support a fully integrated longitudinal health record. A national network of mature CHINs would offer health care professionals further collaborative possibilities that could change the shape of future health care.

Community Health Planning↗

Perfect DiViSy technology for video network in medicine (Moscow Information Network for Teleoncology).

A large telemedicine project is now under development in Moscow. The general task of the project is to link oncology research centres and hospitals meeting the project profile, and to provide on-line (using real-time video conferences) and off-line (via distributed database of medical information) information exchange. There was no existing technology available for use at the project's base which was ready to meet all requirements, so we are using specially created technology for video networks (DiViSy V.97). We suppose this technology to be more applicable for use in telemedicine networks than are business video conference technologies and classical Internet/Intranet technologies. We affirm in our conclusion that now is the time for developing special telemedicine standards, recommendations of compatibility, etc., and that we are ready to take part in this process.

Computer Communication Networks↗

Providing access to healthcare information resources using Internet Gopher technology as a part of a state-wide medical information network.

An Internet healthcare information resources Gopher server is described as a part of a state-wide medical information network. The development of the server and its design and operation are presented. The potential impact of this technology on the healthcare delivery process and issues associated with the use of public domain information resources are discussed.

Computer Communication Networks↗

Medical libraries, bioinformatics, and networked information: a coming convergence?

Libraries will be changed by technological and social developments that are fueled by information technology, bioinformatics, and networked information. Libraries in highly focused settings such as the health sciences are at a pivotal point in their development as the synthesis of historically diverse and independent information sources transforms health care institutions. Boundaries are breaking down between published literature and research data, between research databases and clinical patient data, and between consumer health information and professional literature. This paper focuses on the dynamics that are occurring with networked information sources and the roles that libraries will need to play in the world of medical informatics in the early twenty-first century.

Databases, Factual↗

Models for evolving community health information networks.

Community stakeholders, from hospital systems to independent physicians, from self-insured employers to managed health plans, from government agencies to consumers, require access to health information across the continuum of care. As the information highways for organizations and communities, health information networks and community health information networks have become the vehicles to address this growing health information imperative. Research identified more than 500 health information networks in all 50 states and most metropolitan markets. Health information networks vary widely in their definition, strategy, and operational status. Despite tumultuous change with both successes and failures, health information networks are indeed affecting health care delivery within enterprises and local communities, across regions, and on a national scale.

Community Networks↗

Lessons learned in building a global information network on chemicals (GINC).

The Global Information Network on Chemicals (GINC) was a project to construct a worldwide information network linking international, national, and other organizations working for the safe management of chemicals. Proposed in 1993, the project started the next year and lasted almost 10 years. It was begun as a joint project of World Health Organization (WHO), International Labor Organization (ILO), and United Nations Environment Program (UNEP), and later endorsed by the Intergovernmental Forum on Chemical Safety (IFCS). Asia, particularly East Asia and the Pacific islands, was chosen as the feasibility study region. The author's group then at the National Institute of Health Sciences (NIHS) of Japan led this initiative and hosted numerous meetings. At these meetings, tutorial sessions for communicating chemical safety expertise and emerging new information technologies relevant to the safe management of chemicals were offered. Our experience with this project, particularly the Web-based system and the tutorial sessions, may be of use to others involved with Web-based instruction and the training of chemical safety specialists from both developed and developing countries.

Chemical Phenomena↗

New paradigms for medical decision support and education: the Stanford Health Information Network for Education.

The information needs of physicians are complex and ever increasing in a world of rapidly expanding medical knowledge and a practice environment where physicians are required to know and do more with shrinking resources. Current strategies for providing clinical decision support and continuing medical education have failed, in part, because they have not provided timely, easy access to information that is current, integrated with other information and the physician's workflow, and relevant to specific questions that occur during the patient encounter. Meeting these challenges involves understanding the nature of medical knowledge, the different information needs of physicians, the clinical decision-making process, and the constraints of the physicians work environment, as well as the traditional barriers to physician education. We explore the nature of some of these challenges and propose one solution in the form of a highly integrated web-based technology--The Stanford Health Information Network for Education.

Academic Medical Centers↗

Using information networks as a decision-making tool.

Reforms in healthcare have made the industry more competitive than ever. With budgets being cut all across the country, many healthcare managers are being asked to do more with less, and to do it more quickly. This combination of dynamics creates the need for tools that can help healthcare decision makers make good strategic decisions quickly and confidently. One such tool available to hospitals are information networks. A healthcare information network is an organization that streamlines and expedites decision-making processes by providing healthcare facilities with information that is either too time consuming or impossible for the facility to gather on its own. The information networks conduct research, analyze and condense the findings, and forward relevant data to the member facilities. By outsourcing the tedious research, analysis, synthesis, and presentation of key decision-making data to the information networks, member hospitals free their limited resources to concentrate on the details of the day-to-day operations. In most cases, hospitals that use information networks can also receive the information back more quickly than if they had done the research themselves.

Computer Communication Networks↗

The costs of a national health information network.

BACKGROUND: The use of information technology may result in a safer and more efficient health care system. However, consensus does not exist about the structure or costs of a national health information network (NHIN). OBJECTIVES: To describe the potential structure and estimate the costs of an NHIN. DESIGN: Cost estimates of an NHIN model developed by an expert panel. SETTING: U.S. health care system. MEASUREMENTS: An expert panel estimated the existing and the expected prevalence in 5 years of critical information technology functionalities. They then developed a model of an achievable NHIN by defining key providers, functionalities, and interoperability functions. By using these data and published cost estimates, the authors determined the cost of achieving this model NHIN in 5 years given the current state of information technology infrastructure. RESULTS: To achieve an NHIN would cost 156 billion dollars in capital investment over 5 years and 48 billion dollars in annual operating costs. Approximately two thirds of the capital costs would be required for acquiring functionalities and one third for interoperability. Ongoing costs would be more evenly divided between functionality and interoperability. If the current trajectory continues, the health care system will spend 24 billion dollars on functionalities over the next 5 years or about one quarter of the cost for functionalities of a model NHIN. LIMITATIONS: Because of a lack of primary data, the authors relied on expert estimates. CONCLUSIONS: While an NHIN will be expensive, 156 billion dollars is equivalent to 2% of annual health care spending for 5 years. Assessments such as this one may assist policymakers in determining the level of investment that the United States should make in an NHIN.

Health Expenditures↗

Networked information and clinical decision making: the experience of Birmingham Heartlands and Solihull National Health Service Trust (Teaching).

OBJECTIVES: The paper presents the findings of the evaluation of a pilot project to introduce networked information resources into clinical settings in a large NHS Trust and describes the subsequent developments of networked information within the Trust. DESIGN: The main purpose of the evaluation was to ascertain whether access to electronic journals and other resources via a networked system offered real benefits to clinical effectiveness. SETTING: Birmingham Heartlands and Solihull NHS Trust (Teaching). SUBJECTS: Medical and administrative staff at Birmingham and Solihull NHS Trust. RESULTS: The main conclusions of the evaluation were that: (1) appropriate location of terminals close to clinical areas is vital to ensure that best use is made of networked information resources; (2) rapid access to networked information services saves staff time and allows educational opportunities to be realized; (3) networked information resources enhance rather than replace existing information sources; (4) training and support are essential to maximizing the benefits of networked information services, and (5) such a network can support clinical decision making. CONCLUSIONS: With the development of clinical governance, the clinical network has assumed even greater importance within the Trust. Timely and easy access to clinical and educational information is crucial to the practice of evidence-based medicine which underpins high quality clinical care. The evaluation led to a number of recommendations which have since been used to develop the clinical network at Birmingham Heartlands and Solihull NHS Trust.

Adult↗

Community readiness for a computer-based health information network.

The need for timely and accurate communication among healthcare providers has prompted the development of computer-based health information networks that allow patient and client information to be shared among agencies. This article reports the findings of a study to assess whether residents of an upstate New York community were ready for a computer-based health information network to facilitate delivery of long term care services. Focus group sessions, which involved both consumers and professionals, revealed that security of personal information was of concern to healthcare providers, attorneys, and consumers. Physicians were the most enthusiastic about the possibility of a computer-based health information network. Consumers and other healthcare professionals, including nurses, indicated that such a network would be helpful to them personally. Nurses and other healthcare professionals need to be knowledgeable about the use of computer-based health information networks and other electronic information systems as this trend continues to spread across the U.S.

Adult↗

[Development of perinatal management system using optical card and regional health information network].

In Kagawa Prefecture, a perinatal management system using the optical medical card and the information network has been introduced since October 1998. Four hospitals(Kagawa Medical University, Sakaide Municipal Hospital, Uchinomi Town Hospital and Tsuda Prefectural Hospital) are connected with each other through the health information network(Kagawa Health and Welfare Information Network) organized by Kagawa Prefecture. (http://www.hw.kagawa-swc.or.jp/net/) Patients' clinical data are described on the optical card based on the "standard format of the Japan Association of Obstetricians and Gynecologists(JAOG). (http://www.jaog.or.jp/JAPANESE/MEMBERS/JOUHOU/H10/index.htm). Clinical information including the fetal heart rate(FHR) and sonography (JPG) can be easily transmitted through this network(on line). Without the network, patient data can also be transmitted using the optical card(off line). There are still many technical and social problems to be solved in the future, research into the use of medical information network should be continued.

Computer Communication Networks↗

The Public Health Information Network (PHIN) Preparedness initiative.

The Public Health Information Network (PHIN) Preparedness initiative strives to implement, on an accelerated pace, a consistent national network of information systems that will support public health in being prepared for public health emergencies. Using the principles and practices of the broader PHIN initiative, PHIN Preparedness concentrates in the short term on ensuring that all public health jurisdictions have, or have access to, systems to accomplish known preparedness functions. The PHIN Preparedness initiative defines functional requirements, technical standards and specifications, and a process to achieve consistency and interconnectedness of preparedness systems across public health.

Bioterrorism↗

Education on medical informatics integrated in the campus information network system at Shimane Medical University.

An integrated campus information network system at Shimane Medical University has been developed to organize medical information generated from each section and provide information services useful for education, research, and clinical practice. This report outlines: the education-research system in connection with a campus information network system, the MUMPS programming self-directed learning software, and the curriculum of education on medical informatics.

Computer Systems↗

Functional gaps in attaining a national health information network.

We describe the health information technology (HIT) required for a model of a national health information network (NHIN). Specifically, we define the functional HIT capabilities of an attainable NHIN and determine the gap between the current state of HIT and its likely state in five years, given current trends of adoption. Administrative functionalities will be more prevalent than clinical functionalities in five years. Smaller stakeholders, such as home health care agencies, will lag in adoption. Policy changes, such as financial incentives to HIT end users or regulatory measures, may help accelerate the adoption of HIT for a model NHIN.

Diffusion of Innovation↗