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PubMed1987

Introduction to hospital information systems.

The phrase, 'hospital information system', is frequently used in discussions about the flow of information throughout a hospital with the assumption that everybody has the same concept in mind. Closer examination shows that this is not necessarily the case. The author draws on his experience as the Chief Information Officer at University Hospital at Stony Brook to define a hospital information system in terms of the implementation at Stony Brook. The University Hospital Information System at University Hospital (UHIS), has received international acclaim and was recently selected by the IBM Quarterly of Australia as the world leader in hospital information systems. This paper answers four questions: What is a hospital information system? How does a hospital information system work? How do you implement a hospital information system? After the system is operational, where do you go, e.g., critical care data management, physician's office management? University Hospital at Stony Brook is located on eastern Long Island and is the tertiary care referral hospital for approximately 1.4 million people. Nothing in the hospital happens without computers. Doctors, nurses, administrators and staff at all levels rely on the system daily. The system operates 24 hours per day, seven days per week. Access to the system is through 300 terminals and 128 printers throughout the hospital. In addition to the UHIS terminals, the critical care management system which is called Patient Data Management System, (PDMS), is available at over 90 ICU beds and in the operating rooms.

Hospital Information Systems↗
PubMed1996

Experience and design recommendations for picture archiving and communication systems in the surgical setting.

An analysis of the efficacy of a picture archiving and communication system (PACS) in the surgical domain was undertaken at the Baltimore Veterans Affairs Medical Center. Interviews with surgeons and staff were conducted and supplemented by direct radiologist observation in the operating room (OR) and surgical outpatient clinic to determine patterns of routine clinical PACS use, levels of satisfaction both within and outside of the OR, and perceptions of the relative efficacy of the system in comparison to film. These data as well as suggestions from the surgical staff members were used to make recommendations for specific modifications in PACS design and operation to improve the current system and to help prescribe design improvements for future PAC systems. A high level of satisfaction with the system was found and the use of PACS was favored over film by a majority of surgeons and their staff. Findings of this study suggest that the design of a hospital-wide PAC system must have the flexibility to accommodate the specific requirements of a wide variety of end-users in their unique hospital environments.

Equipment Design↗
PubMed1988

Evolution of contemporary instrumentation for computer-assisted stereotactic surgery.

This article discusses the evolution of our stereotactic system which evolved from the commercially available Todd-Wells stereotactic instrument. The Todd-Wells frame was originally designed for radiographically based, functional neurosurgical procedures. We modified it for computed tomography compatibility and later devised localization systems for magnetic resonance imaging and digital angiography. Based on the limitations in the original design applying to our own set of requirements, including tumor stereotaxis, we totally redesigned the system around the arc-quadrant principle of the original Todd-Wells instrument. While this intermediate system was being used in our surgical practice, further limitations were noted and corrected in the system we presently use. The present stereotactic frame is completely interactive with an operating room computer system.

Brain Neoplasms↗
PubMed1998

Method to assist in the scheduling of add-on surgical cases--upper prediction bounds for surgical case durations based on the log-normal distribution.

BACKGROUND: A problem that operating room (OR) managers face in running an OR suite on the day of surgery is to identify "holes" in the OR schedule in which to assign "add-on" cases. This process necessitates knowing the typical and maximum amounts of time that the case is likely to require. The OR manager may know previous case durations for the particular surgeon performing a particular scheduled procedure. The "upper prediction bound" specifies with a certain probability that the duration of the surgeon's next case will be less than or equal to the bound. METHODS: Prediction bounds were calculated by using methods that (1) do not assume that case durations follow a specific statistical distribution or (2) assume that case durations follow a log-normal distribution. These bounds were tested using durations of 48,847 cases based on 15,574 combinations of scheduled surgeon and procedure. RESULTS: Despite having 3 yr of data, 80 or 90% prediction bounds would not be able to be calculated using the distribution-free method for 35 or 49% of future cases versus 22 or 22% for the log-normal method, respectively. Prediction bounds based on the log-normal distribution overestimated the desired value less often than did the distribution-free method. The chance that the duration of the next case would be less than or equal to its 90% bound based on the log-normal distribution was within 2% of the expected rate. CONCLUSIONS: Prediction bounds classified by scheduled surgeon and procedure can be accurately calculated using a method that assumes that case durations follow a log-normal distribution.

Algorithms↗
PubMedDate not supplied

Problems with telemetry monitoring systems.

The purchaser of telemetry monitoring systems for operating and recovery rooms has little information available on the practical aspects of ownership and usage. To explore this problem, we recorded 76 telemetry failures (both operator and machine failure) occurring over six months among 18 telemetry channels located in operating and recovery rooms. We experienced approximately one telemetry failure every three days or every 60 surgical procedures. Factory repairs were required on 29 transmitters and 19 receivers during a two-year period. We observed that 28% of the failures were attributable to lead and electrode problems, 25% to battery depletion, 22% to mechanical or electronic component failures, 12% to inappropriate control settings and frequency mismatching, and 13% to miscellaneous difficulties. The following problems were observed. Transmitters were dropped frequently and occasionally immersed in liquids. Thus, waterproofing is recommended for OR use, and lead-failure warning circuitry is mandatory. Inappropriate control settings and frequency mismatching led to a previously unrecognized hazard: that is, it is possible to receive and display ECG data from the wrong patient located in a distant room. (Stethoscopic monitoring can be used to confirm that the data being displayed are from the correct patient.) Battery failure can occur at inopportune times, e.g., during cardiac arrest. Transmitters are frequently "lost" because of their small size and high mobility. This study indicated to us that, in the operating room, telemetry is not desirable because of its high cost compared to hard wired systems, poor reliability, and the possible hazard of displaying data from the wrong patient if improperly used.

Biomedical Engineering↗
PubMed1991

NOTIS: an operating theatre information system.

Solutions to straightforward resource management problems need not always involve the use of complex, specialised and expensive software solutions. Commercially available 'off the shelf' packages have increased in flexibility and ease of use, and are usually an order of magnitude cheaper than their custom designed counterparts. In response to a request for a low cost database suitable to be used on a stand-alone microcomputer system, the widely available integrated software package Smart was used. The program specification required quantification and analysis of the workload in a medium sized operating theatre suite (at 6,000 cases/year) to be undertaken. In addition to providing Database, Spreadsheet and Wordprocessor modules, each with rapid and easy exchange of data from one module to another, Smart incorporates its own programming language. This may be used to build up complex series of instructions for data manipulation, to generate menus and create a naive user front end to the finished program. Although an adequate knowledge of database construction and basic programming are necessary, professional programming skills are not required. NOTIS, the Newham Operating Theatre Information System, is a menu driven program designed to be used by clerical staff, and accepting patient data derived from within the operating theatre. At the end of each month a set of predetermined reports are produced. These reports are designed to provide information on the workload, case type and medical personnel involvement applicable to theatre managers, anaesthetists and surgical staff.

Information Systems↗
PubMed1994

Toward a standardized language to describe perioperative nursing.

The Nursing Interventions Classification (NIC) is a standardized language that identifies all interventions performed by nurses. Each nursing intervention has a label name, a conceptual definition, and a set of defining activities. The NIC provides a standardized nomenclature for automated databases, describes and measures nursing's contribution to health care, facilitates nursing education, supports clinical decision making, plans resource allocation, and facilitates nursing research. Perioperative nurses can use the NIC to describe and document their contributions to surgical patients' outcomes.

Humans↗
PubMed1995

Patient data management systems in anaesthesia: an emerging technology.

The purpose of this review is to define the expectations of an on-line automatic patient data management system (PDMS) into anaesthesia work-stations in and around the operating room suite. These expectations are based on review of available information in the medical literature, and trials of several systems that are available commercially, three of them in a more detailed fashion (i.e. Informatics, Datex and North American Drager). The ideal PDMS should: -- communicate with and capture the information from different monitors, anaesthesia machines and electronic gadgets (e.g., infusion pumps) used in the operating room (OR), while presenting selected relevant values and trends on a screen. -- inform the anaesthetist of deviations from preselected limits of physiological and technical values. In the future, the system will hopefully be upgraded to include an algorithm-based decision support system. -- communicate with the hospital mainframe computer, and automatically transfer demographic data, laboratory and imaging results, and records obtained during preoperative consultations. -- at the end of each anaesthetic procedure, create an anaesthetic record with relevant data automatically collected by the system, as well as that which was entered manually by the physician during the procedure. A copy of this anaesthesia file must be kept on a computerized archive system. None of the systems so far evaluated fulfilled all our expectations. We have therefore adopted approach for the gradual introduction of such a system into our OR environment over the next two to five years, during which expected improvements may be incorporated to upgrade the system.

Anesthesiology↗
PubMed2003

Robotics and neurosurgery.

Ultimately, neurosurgery performed via a robotic interface will serve to improve the standard of a neurosurgeon's skills, thus making a good surgeon a better surgeon. In fact, computer and robotic instrumentation will become allies to the neurosurgeon through the use of these technologies in training, diagnostic, and surgical events. Nonetheless, these technologies are still in an early stage of development, and each device developed will entail its own set of challenges and limitations for use in clinical settings. The future operating room should be regarded as an integrated information system incorporating robotic surgical navigators and telecontrolled micromanipulators, with the capabilities of all principal neurosurgical concepts, sharing information, and under the control of a single person, the neurosurgeon. The eventual integration of robotic technology into mainstream clinical neurosurgery offers the promise of a future of safer, more accurate, and less invasive surgery that will result in improved patient outcome.

Clinical Competence↗