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PubMed1991

Using the laboratory information system to achieve strategic advantage over the competitors of hospital-based clinical laboratories.

The competitors of hospital pathologists are commercial reference laboratories, hospital special function laboratories, pathology groups in neighboring hospitals, hospital mainframe computer personnel, and users of patient proximity testing systems. The laboratory information system can provide a strategic advantage over these competitors by matching, exceeding, or substituting for their capabilities and by creating switching costs for clinics, administrations, and patients. For example, the installation of microcomputers in clinicians' private offices provides them with ready access to the pathology data base, bonds them to the hospital, and capitalizes on the willingness of the hospital to invest in information technology.

Clinical Laboratory Information Systems↗
PubMed1997

The role of communication servers in the architecture of healthcare information systems.

Communication between departmental subsystems within a hospital information system (HIS) is more and more supported by dedicated communication servers (CS). One of the main advantages is a centralized and standardized flow of information. Beside this "classic" approach a communication server may be embedded on at least two other hierarchical levels in the architecture of healthcare information systems: in an organizational unit within a hospital (subsystem) but also in large scale healthcare information systems covering aspects of communication between the involved external healthcare providers.

Hospital Information Systems↗
PubMed2001

Ethical problems in health information systems.

OBJECTIVES: To introduce term and concept of infoethics and to argue on its importance for health information systems. METHODS: To argue about our viewpoint of the dominance of the human component, which has been discussed at an IMIA working conference held in Helsinki, Finland (February 1998) devoted to the evaluation of health information systems. RESULTS AND CONCLUSIONS: Any technology sets a relationship between human beings and their environment, both physical and human. No technology can be seen as merely instrumental. This is especially relevant when dealing with large automatic information systems, developed to contribute to the management and integration of large organizations, such as hospitals. In such a context, the environment is mainly made up of humans. In evaluating such information systems, human factors preside over merely technical factors. Even if satisfying the latter is mandatory, they are never really sufficient. A perfect hard- and software system can be an absolute failure in everyday use. In any information system, the human factor is, of course, human-computer interaction, which always occurs when one person interacts with the machinery. However, in a simultaneous multi-user context, human-human interaction is the main question to tackle. The evaluation of large information systems, such as those found in hospitals, is founded in the whole concept of inter-human relationships which underlie the design and use of the system. Indeed, such an information system predominately appears as a social system, with its psychological, sociological and ethical features.

Ethics↗
PubMed1995

The deployment of a World Wide Web (W3) based medical information system.

The development of Web technologies has revolutionized information dissemination on the Internet. The University of Minnesota Hospital and Clinic's Web Clinical Information System (CIS) demonstrates the use of the Web as an infrastructure for deploying a medical information system at a fraction of the developmental cost of more traditional client server systems. This Web CIS has been deployed since December 1994. It makes available laboratory results, including a radically improved clinical microbiology reporting system, ad hoc laboratory order entry, and an embedded expert system protocol laboratory ordering system. It provides these services to any physician or patient care area with TCP (or SLIP/PPP) connection to our hospital network backbone, whether the client computer is running MS Windows, the Macintosh OS, or X-Windows. A formal evaluation of one of this systems subcomponents, the display of clinical microbiology information, demonstrated a significant savings in clinician time (43% p < .001) and substantial reduction in interpretive errors (0 vs 15 p < .01).

Clinical Laboratory Information Systems↗
PubMed2003

Development and implementation of a multi-centre information system for paediatric and infant critical care.

BACKGROUND: With no UK collective information system, a need existed to establish an integrated information system for public and private sector hospitals providing paediatric and infant critical care services. A lack of information in the past made it difficult for those procuring, providing and monitoring services to make informed, evidence-based decisions using reliable integrated data. OBJECTIVES: To develop and implement a collective multi-purpose information system for paediatric and infant critical care that was easily adaptable to any UK infant or paediatric critical care setting. Information outputs had to fulfil policy requirements and meet the needs of stakeholders. METHOD: Two minimum datasets, corresponding data definitions, survey forms and a user database were developed through a process of consultation by utilising an information partnership. Design, content, development and implementation issues were identified, discussed and resolved through a co-ordinated collaborative process. RESULTS: Data collection was implemented in all London and Brighton National Health Service (NHS) general and cardio-thoracic paediatric intensive care (PIC) units, several private PIC units and one NHS tertiary referral neonatal unit (NNU) 24 months from project start. CONCLUSIONS: The development of universal integrated information systems for defined settings of care is achievable within reasonable timeframes; however, successful development and implementation requires working within an information partnership to maximise co-ordination, co-operation and collaboration. Those collecting and using data must be identified and involved in all aspects of development from project start. Financial and manpower resources must be well planned. Datasets should be as small as possible in order to make the collection of complete and valid data realistically achievable. When considering service-based information needs, considerable thought should be given to a multi-purpose; multi-use approach based on the most refined minimum dataset possible.

Child↗
PubMed1996

Mapping clinical scenarios to functional requirements: a tool for evaluating clinical information systems.

We developed a tool for evaluating clinical information systems (CIS) by mapping a set of detailed functional requirements to specific elements of clinical scenarios. A team of primary care physicians, specialists, medical records professionals, and information systems staff defined detailed requirements for a new CIS at Harvard Pilgrim Health Care. The requirements were mapped to elements of clinical scenarios, which were provided to vendors for use in demonstrating their systems. Systems were rated as to how well they met the functional requirements in their demonstrations. This method of evaluating information systems provides an incremental advantage over use of requirements or scenarios by themselves.

Ambulatory Care Information Systems↗
PubMed1995

Assessment of effects and costs of information systems.

Insight into the effects and costs of information systems is becoming increasingly important. A key problem is to provide evidence which is transportable among sites. Transportability demands agreement on how to carry out assessment of information systems. In the VISTA study, three Dutch hospitals developed together an evaluation protocol for the assessment of the effects and costs of the nursing information system VISION. This protocol is based on a quasy-experimental study design allowing filtering for non-VISION influences. The protocol also included a uniform cost model. Based on a cost calculation for the three hospitals, the costs for hospital-wide implementation of VISION in a 445- and 800-bed hospital were extrapolated. VISTA is considered as a trial for application of one evaluation protocol at various sites. It is recommended to extend this national trial to a multi-national one, for instance by applying the cost model more broadly.

Computer Systems↗
PubMedDate not supplied

Recent developments of care information systems in Germany.

The authors describe recent developments in the German health care system. A taking stock of the current state of hospital information system implementations in Germany leads to the conclusion that up to now no integrated hospital information system can be found, but that the awareness for the necessity of such a system is growing. Anticipated challenges and risks of care information systems are examined on grounds of an exemplification by the German care information system PIK (Pflegedienst im Krankenhaus--Nursing service in hospital). With regard to the shift from functional to holistic nursing in Germany it is argued that the consequences of the implementation of a care information system are intertwined closely with the nursing model.

Computer Communication Networks↗
PubMed1994

National health information systems in the Pacific islands: in search of a future.

Health information is essential for proper management and deployment of limited resources in the health services of the Pacific Islands. There have been numerous efforts to establish and strengthen sustainable information systems but the common feature of these attempts has been the very limited achievement. Subsequently, the use of information as a management tool has been abandoned in favour of 'gut feeling', hearsay and adhocry. In the last decade health planning and primary health care activities have necessitated the re-emphasis of monitoring and surveillance of health and health service indicators. Therefore a revival of interest in health information systems is taking place. A review of national health information systems in the Pacific showed that routinely collected data remained largely untouched by human thought. The contributing factors to the current inertia are examined with suggestions on how to elevate health information from its current lowly status to its rightful place as an essential tool for management. The special problems of small island states, like limited resources, geographical isolation, natural barriers to technology, and diverse cultural milieu, will be examined in relation to an appropriate health information system for Pacific Island countries in the twenty-first century.

Information Systems↗
PubMed1997

[International standardization of laboratory information systems].

The standardization of clinical laboratory information systems is one of the most difficult but important subjects for clinical laboratory community and laboratorians. International Standard Organization (ISO) has the projects in this field (JTC1/SC7) which is the part of approach to the international laboratory standardization (ISO/TC 212). US NCCLS and European CEN/TC 251 are working under ISO/TC 212. In the United States, the National Academy for Clinical Biochemistry (NACB) and the American Association for Clinical Chemistry (AACC) had started recently to organize the international collaboration program on the subject. The Japan Society of Clinical Pathology (JSCP)'s Council of Laboratory Informatics had joined this program in 1995. NACB/AACC's Ad Hoc Committee which was organized in 1996 is now trying to collect the general opinions ("what and how") through their internet home page. The current status of the works on the standardization of clinical laboratory information systems in the U.S., Europe, and Japan is reviewed briefly in this article. HL7 electronic data exchange specification and clinical testing coding systems such as LOINC coding project and JSCP's coding project are also reviewed.

Clinical Laboratory Information Systems↗
PubMed1996

Selecting managed care information systems.

A decade ago, a handful of managed care information systems occupied a relatively minor niche in the healthcare information system industry. Today, dozens of small software development firms are experiencing explosive expansion and are being courted by larger vendors for partnership or acquisition. When selecting an information system capable of meeting the demands of managed care providers, financial managers should consider carefully the types of systems that are available, their price ranges, their modules, and the type of vendor selling the systems.

Clinical Medicine↗
PubMed2006

[Critical evaluation of the Primary Care Information System (SIAB) and its implementation in Ribeirão Preto, São Paulo, Brazil].

As the health information system used by the Family Health Program teams, the Primary Care Information System (SIAB) is a potential tool for follow-up of registered families and local planning, thus motivating the present study. Semi-structured interviews were held with key individuals in this health information system chain, among Family Health Teams in the municipality of Ribeirão Preto and surrounding region, São Paulo State, Brazil, with the objective of analyzing certain characteristics in the system, including: knowledge and having received training to handle it and utilization for local planning and social control. The study concluded that the SIAB is an easy system to handle, but that it presents some limitations already found in other health information systems, such as: difficulty in identifying individuals in the program, limited number of diseases reported, and limited utilization to back planning and decision-making at the local level. Therefore, the analysis of the SIAB was highly important for improving this health information system and can contribute to future improvements and adaptations in the program.

Ambulatory Care Information Systems↗
PubMed1980

A statewide decentralized public drug information system.

A statewide drug information system designed to assist consumers and health professionals is described, with emphasis on the training of pharmacists in the system's satellites. The development of the system was initially funded by a 10-month, $12,500 grant from the Chemical Dependency Division of the State of Minnesota Department of Public Welfare. Twenty-one satellite drug information centers in community or hospital pharmacies are linked by a WATS telephone line to the library of the University of Minnesota College of Pharmacy. Consumers' questions are handled through the satellites with the pharmacists there referring to the central information source as needed. All the pharmacists in the system are trained in a one and one-half day program that covers (1) consultation skills, (2) communication skills, (3) drug information retrieval and distribution, (4) practical applications, (5) promotion, and (6) resources and referrals. The average amount of time devoted to the service for all pharmacy sites is 15-20 minutes per day. Percentage of time that specific resources are used include one's own knowledge and experience, 64.8%; a fellow pharmacist, 5.7%; another resource individual, 5.1%; a standard pharmacy reference book, 13.4%; the central clearinghouse at the college, 6.2%; and another resource facility, 4.8%. The authors believe that their system can be easily adapted to other areas.

Community Pharmacy Services↗
PubMed1991

Geographic information systems: their application in animal disease control.

Geographic information systems (GIS) are computerised information systems that allow for the capture, storage, manipulation, analysis, display and reporting of geographically referenced data. They have been used in recent years for a wide variety of purposes, including town planning and environmental resource management. The technology has many features which make it ideal for use in animal disease control, including the ability to store information relating to demographic and causal factors and disease incidence on a geographical background, and a variety of spatial analysis functions. A number of possible veterinary applications are suggested, and three examples of the use of GIS in New Zealand are discussed.

Animal Diseases↗
PubMed2004

[Information system of the Federal Health Monitoring System. An online database offering a wide range of health information].

The information system of the Federal Health Monitoring System (http://www.gbe-bund.de) offers as an online database a wide range of coordinated health information in words and figures. High-performance software tools allow the information to be researched, analyzed flexibly, and downloaded onto the user's own PC for subsequent processing. At present, the core of the information system represents more than 650 million data from more than 100 data sources, combined in sensible indicators. Clearly arranged diagrams, easy-to-understand texts, and precise definitions complete the offer. Documentations contain additional information on more than 200 data sources, features of surveys, methodological questions of surveys, and contact persons.

Databases as Topic↗
PubMed2005

Health information systems - past, present, future.

In 1984, Peter Reichertz gave a lecture on the past, present and future of hospital information systems. In the meantime, there has been a tremendous progress in medicine as well as in informatics. One important benefit of this progress is that our life expectancy is nowadays significantly higher than it would have been even some few decades ago. This progress, leading to aging societies, is of influence to the organization of health care and to the future development of its information systems. Twenty years later, referring to Peter Reichertz' lecture, but now considering health information systems (HIS), two questions are discussed: which were lines of development in health information systems from the past until today? What are consequences for health information systems in the future? The following lines of development for HIS were considered as important: (1) the shift from paper-based to computer-based processing and storage, as well as the increase of data in health care settings; (2) the shift from institution-centered departmental and, later, hospital information systems towards regional and global HIS; (3) the inclusion of patients and health consumers as HIS users, besides health care professionals and administrators; (4) the use of HIS data not only for patient care and administrative purposes, but also for health care planning as well as clinical and epidemiological research; (5) the shift from focusing mainly on technical HIS problems to those of change management as well as of strategic information management; (6) the shift from mainly alpha-numeric data in HIS to images and now also to data on the molecular level; (7) the steady increase of new technologies to be included, now starting to include ubiquitous computing environments and sensor-based technologies for health monitoring. As consequences for HIS in the future, first the need for institutional and (inter-) national HIS-strategies is seen, second the need to explore new (transinstitutional) HIS architectural styles, third the need for education in health informatics and/or biomedical informatics, including appropriate knowledge and skills on HIS. As these new HIS are urgently needed for reorganizing health care in an aging society, as last consequence the need for research around HIS is seen. Research should include the development and investigation of appropriate transinstitutional information system architectures, of adequate methods for strategic information management, of methods for modeling and evaluating HIS, the development and investigation of comprehensive electronic patient records, providing appropriate access for health care professionals as well as for patients, in the broad sense as described here, e.g. including home care and health monitoring facilities. Comparing the world in 1984 and in 2004, we have to recognize that we imperceptibly, stepwise arrived at a new world. HIS have become one of the most challenging and promising fields of research, education and practice for medical informatics, with significant benefits to medicine and health care in general.

Computer Systems↗