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With all the attention placed on the mechanical and technological aspects of office automation equipment, the human element can be overlooked. Office automation is not just equipment, but the process of integration of people, information, functions and procedures. This article explores attitudes ranging from dread to fascination, personnel issues, ergonomics and other "human" aspects of the automation process.
OBJECTIVE: To assess the knowledge and attitudes of law enforcement officers regarding treating out-of-hospital cardiac arrest (OHCA) and using automated external defibrillators (AEDs). METHODS: This was a survey conducted among officers serving Marion County, Indiana. RESULTS: Of 1,130 surveys distributed, 929 (82.2%) were returned. Among these officers, 603 (66.4%) were certified in cardiopulmonary resuscitation (CPR) and 103 (11.3%) had received AED training. Most officers had limited knowledge regarding OHCA. A 100-point knowledge score (mean +/- SD: 31.9 +/- 14.3) was higher in officers who had performed CPR while on duty [35.0, 95% confidence interval (95% CI) = 32.9 to 37.2, p = 0.005] and who were AED-trained (40.8, 95% CI = 38.0 to 43.6, p < 0.001). Of the respondents, 367 (40.1%) believed that AED usage by local law enforcement was needed, and 323 (35.6%) stated that they would feel comfortable using an AED if trained. A 100-point attitude score (mean +/- SD: 32.1 +/- 21.0) was higher in officers who had CPR certification (38.2, 95% CI = 35.6 to 40.8), who had performed CPR while on duty (40.6, 95% CI = 37.7 to 43.5), who were AED-trained (39.5, 95% CI = 35.6 to 43.4), and who had improved OHCA knowledge (+3.8 per 10 points knowledge score, 95% CI = 3.0 to 4.7), p < 0.001, all significant factors. CONCLUSIONS: Limited knowledge and negative attitudes of law enforcement officers regarding their involvement in treating OHCA and using AEDs are commonly present. These factors could result in barriers that negatively impact law enforcement AED programs.
The number of vascular exams for venous thromboembolic disease increases dramatically in the vascular medicine unit at the Grenoble University Hospital (France). In order to improve the efficiency and the homogeneity of all the medical staff involved, a computerized register has been created. It automatically provides a letter for the prescriber of the consultation. This database, working on a computer network, has three main functions: office automation (medical folder, report), education, and clinical research. The office automation evaluation is performed after a 6 month experience, comparing 100 medical reports about venous thrombosis assisted by the computer to 100 medical reports written before the installation of the system. The introduction of digitized register is real, still this evaluation has induced some modification in the system in order to be more efficient.
The maturing of technologies in computer capabilities, particularly direct digital signals, has provided an exciting variety of new communication and facility control opportunities. These include telecommunications, energy management systems, security systems, office automation systems, local area networks, and video conferencing. New applications are developing continuously. The so-called "intelligent" or "smart" building concept evolves from the development of this advanced technology in building environments. Automation has had a dramatic effect on facility planning. For decades, communications were limited to the telephone, the typewritten message, and copy machines. The office itself and its functions had been essentially unchanged for decades. Office automation systems began to surface during the energy crisis and, although their newer technology was timely, they were, for the most part, designed separately from other new building systems. For example, most mainframe computer systems were originally stand-alone, as were word processing installations. In the last five years, the advances in distributive systems, networking, and personal computer capabilities have provided opportunities to make such dramatic improvements in productivity that the Selectric typewriter has gone from being the most advanced piece of office equipment to nearly total obsolescence.
The evaluation and management of hypertension is based on indirect blood pressures obtained in the office (COBPs) using the mercury sphygmomanometer. The usefulness of COBPs is limited by factors such as observer bias, which confound the ability to discern the true blood pressure value. Automated portable monitors have been marketed, which also measure blood pressure (ABP) indirectly throughout 24 hours, but without human intervention. Acceptance of a new device that indirectly records blood pressure depends largely on its the agreement with the established method of blood pressure measurement. This review compares the variability of blood pressures collected indirectly by standard mercury sphygmomanometer and by an auscultatory automated portable blood pressure monitor. The results indicate that blood pressure, when measured indirectly in a hypertensive patient, is quite variable. Automated blood pressures were lower and demonstrated less within-subject variability during repeated measures than COBPs. The agreement between ABPs and COBPs was better than the agreement between COBPs alone on successive visits. In addition, the mean hourly blood pressure profiles recorded throughout 24 hours by automated and manual methods from ten hypertensive patients were nearly identical. These data suggest that blood pressures measured by auscultatory automated methods are similar to and representative of those obtained manually.
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There are many ways of automating medical examiner and coroner offices, one of which is to purchase commercial software products specifically designed for death investigation. We surveyed four companies that offer such products and requested information regarding each company and its hardware, software, operating systems, peripheral devices, applications, networking options, programming language, querying capability, coding systems, prices, customer support, and number and size of offices using the product. Although the four products (CME2, ForenCIS, InQuest, and Medical Examiner's Software System) are similar in many respects and each can be installed on personal computers, there are differences among the products with regard to cost, applications, and the other features. Death investigators interested in office automation should explore these products to determine the usefulness of each in comparison with the others and in comparison with general-purpose, off-the-shelf databases and software adaptable to death investigation needs.
Following a suggestion that the National Association of Medical Examiners (N.A.M.E.) develop a N.A.M.E. Information Center (NIC), N.A.M.E. conducted a survey to evaluate the current status of medical examiner office automation (computerization) in the United States. Responses were received from 80 unique reporting areas, including 75 medical examiner offices, which represent approximately 30% of the 258 medical examiner jurisdictions in the country. A total of 58 responders (65%) indicated that their office was automated. At least 38 states have one or more automated death investigation office, and electronic data exist for approximately 145,000 deaths per year, or approximately 30% of all deaths certified by medical examiners and coroners annually and approximately 6% of all deaths per year in the United States. Although computerized offices vary substantially in size and in their choice of hardware and software, a typical computerized medical examiner office (a) is in a single county with 1,000-6,000 death reports per year, (b) keeps electronic records on all cases reported, (c) uses an IBM or compatible personal computer (PC) or PC network with off-the-shelf software, (d) stores data on cause of death, manner of death, how injuries occur, and toxicology results, and (e) is interested in sharing its data. Considerable electronic death investigation data exist that can provide timely and valuable information for mortality and public health studies.
To measure the success of automating the business office with electronic billing and document management systems, the hospital's original goals were reviewed: Had the number of FTEs been maintained or reduced: Yes--claims volume is up 58% over 6 years with a 22% reduction in FTEs (see Exhibit 3). Was the cost of maintaining the paper filing system reduced? Yes--and the cost saving from the hospital's document imaging system will allow a 4.4 year payback. Is better customer service being provided? Yes--online access to patient demographic and financial information has improved response time. Having met all its goals, North Kansas City Hospital considers the installation of both systems to have been complete success. The facility expects to continue expansion of the document management system into accounts payable, payroll, home health, and other document-intensive areas to achieve further cost savings in the future.
Simultaneous ACCESS to and DISSEMINATION of electronically available PROFESSIONAL KNOWLEDGE, in a productive, Cost-of-Ownership effective, and affordable manner are now achievable. Emerging MANAGEMENT-OF-INFORMATION and SYSTEMS-INTEGRATION disciplines are essential contributing factors to devising and implementing NEW STRATEGIES for ONLINE REFERENCE LIBRARIES. Bringing integrated information closer to the ultimate user and RESHAPING the electronic databases and full-text management systems MARKETPLACE are the most significant outcomes. Key technology attributes are advancements in CD-ROM, Networking, and office automation. We have proven this concept by developing an INTERFACE between MEDLINE from COMPACT CAMBRIDGE and ALL-IN-1 from DIGITAL EQUIPMENT CORPORATION. Saved search results are automatically routed to the individual's ALL-IN-1 account where further DOCUMENT MANAGEMENT and electronic mail functions may be performed. A 486Ware system from Logicraft and a five-members VAX-Cluster (respectively), are linked in a DECNet environment that is the foundation of Children's Integrated Hospital Information System. In phase one of the project up to 8 SIMULTANEOUS USERS may access the 8 RECENT YEARS, from any one of 1500 ACCESS POINTS (local and remote), and utilize any one of 150 NETWORKED PRINTERS. Opportunities are now within reach to expand the electronic library services while utilizing progressive methods and taking advantage of the best available technologies.
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Careful initial evaluation of the options is vital to successful medical office automation. The many available software programs should be scrutinized to be certain the one chosen satisfies all one's listed needs. In addition to the usual functions expected of computers, the data gathered can be used to market the urologic practice. Word processing, spreadsheet, and database programs can enhance relations among the urologist's office, referring physicians, and patients.
Inspite of the inherent potential, the computer-based medical record is underutilized today, although the use of computers in medicine and psychiatry is widespread. Lack of information is one of the reasons why physicians have resisted the introduction of information systems in medical practice beyond auxiliary services. The author describes the functions of a clinical information system currently in use in a psychiatric inpatient hospital, offering an electronic medical record, office automation tools, knowledge databases and individual PC-programs. He discusses measures to preserve the confidentiality and integrity of the electronic data and shortterm experiences concerning benefits and risks of the system.
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Office automation in echocardiography is necessary linked to the need of speeding up the reporting which is generally done, to date, in a subsequent phase and it is time consuming With the present work we suggest a software made with the dBASE III Plus applied package, on a PS/2 IBM computer which makes it possible to quickly calculate the bodily surface and at the same time having instantaneous presentation of the normality ranges of the cardiac structures, of the myocardiac kinesis and the Doppler-color appraisal of valvular flows. The speed of reporting is greatly increased and all the data taken make up a database standardized for future statistical elaborations, besides providing an electronic file of echocardiographical reports.
As home care agencies become more automated they may find they have outgrown their personal computers. Multi-user computer systems offer lower costs, branch office automation, hardware independence, and have room for future expansion.
We used the Genetics Office Automation System (GOAS), a database management system designed to facilitate collection and analysis of medical genetic data, to evaluate the Missouri Genetics Disease Program (MGDP). From 1985 through 1995, patient data were collected at four tertiary care genetic centers. The number of genetic visits per 100,000 people more than doubled from 1985 through 1995. The results of subpopulation analyses indicate that the MGDP has facilitated improvements in: (1) services for newborns and infants, (2) rural outreach programs, and (3) evaluation of the incidence and impact of genetic disorders.