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PubMed1993

Fertility and infertility assessment by review of records.

The assessment of fertility and infertility in dairy herds requires accurate and complete data that are collected in a timely manner. The data must be entered in a record system that provides easy accessibility. An understanding of terminology and statistical calculations, along with knowledge of industry standards, reproductive physiology, and pathology is essential if problem solving is to occur. Problem solving begins by developing an understanding of the events influencing past reproductive performance. Progress is made by establishing a detailed reproductive management plan to monitor the current breeding herd and to identify potential problems before they occur. The introduction of microcomputers and on-farm record systems has greatly enhanced the veterinarian's ability to access and process data. For the first time in history, cowside health data collection systems integrated with production records are being used. This provides the opportunity to collect and summarize and analyze reproductive and production data as the events occur. Successful reproductive performance depends on effective and efficient management. For veterinarians to effectively and positively influence the reproductive performance of the herd, they must influence management. This requires working with dairy management to make changes in job assignments and description. Taking time to assess records with managers is an invaluable tool to convince dairy management of the necessity for change.

Animals↗
PubMedDate not supplied

First steps toward integration of divergent information systems.

Because of increased vertical and horizontal integration of health care businesses, integration of health care data is more crucial than ever. One hospital's first steps in this direction consisted of development of an online physician's office billing system through which users could access the hospital mainframe and data programs.

Computers↗
PubMed2003

Kaiser Permanente gets ready to roll out automated medical records system nationwide.

Use of automated medical records (AMRs) got a boost last month when Kaiser Permanente, the nation's largest integrated health management organization, announced that all its regions will begin moving to an AMR system this year. While the system has the obvious advantages of making healthcare records more up-to-date and complete when a patient visits, it also has numerous quality-of-care advantages--both for providers and Kaiser Permanente's 8.5 million members, officials say.

Delivery of Health Care, Integrated↗
PubMed2001

Issues and opportunities in public health informatics: a panel discussion.

A panel was convened at the American Medical Informatics Association Spring Congress to discuss issues and opportunities that arise when informatics methods, theories, and applications are applied to public health functions. Panelists provided examples of applications that connect efforts between public health and clinical care, emphasizing the need for integration of clinical data with public health data and the analysis of those data to support surveillance and informed decision making. Benefits to be gained by both medical informatics and public health at the interface were evident; both encounter the same major issues including privacy, systems integration, standards, and many more.

Congresses as Topic↗
PubMed2004

Information system architectures for syndromic surveillance.

INTRODUCTION: Public health agencies are developing the capacity to automatically acquire, integrate, and analyze clinical information for disease surveillance. The design of such surveillance systems might benefit from the incorporation of advanced architectures developed for biomedical data integration. Data integration is not unique to public health, and both information technology and academic research should influence development of these systems. OBJECTIVES: The goal of this paper is to describe the essential architectural components of a syndromic surveillance information system and discuss existing and potential architectural approaches to data integration. METHODS: This paper examines the role of data elements, vocabulary standards, data extraction, transport and security, transformation and normalization, and analysis data sets in developing disease-surveillance systems. It then discusses automated surveillance systems in the context of biomedical and computer science research in data integration, both to characterize existing systems and to indicate potential avenues of investigation to build systems that support public health practice. RESULTS: The Public Health Information Network (PHIN) identifies best practices for essential architectural components of a syndromic surveillance system. A schema for classifying biomedical data-integration software is useful for classifying present approaches to syndromic surveillance and for describing architectural variation. CONCLUSIONS: Public health informatics and computer science research in data-integration systems can supplement approaches recommended by PHIN and provide information for future public health surveillance systems.

Bioterrorism↗
PubMed2004

How the pediatric autopsy yields valuable information in a vertically integrated health care system.

CONTEXT: Although autopsy rates have declined significantly in recent decades, studies continue to validate the autopsy as an important source of clinically relevant information, a teaching tool, and a quality assurance measure. A recent review of autopsy series showed a decline in the number of serious errors likely to have affected clinical outcome detected at autopsy during the past 46 years, with a current major error rate of 8.4% to 24.4%. OBJECTIVE: Our hypothesis was that the pediatric autopsy would uncover a significant number of major unexpected findings at the high end of the spectrum predicted by a recent review. This study assesses the unexpected findings at a pediatric hospital whose autopsy service handles both in-house (tertiary care) and referral (mostly perinatal) cases for a vertically integrated health care system. DESIGN: Data were analyzed from an autopsy effectiveness report completed for all autopsies performed in 2000. The data from this series include concordance of premortem and postmortem diagnoses, with the autopsy considered the criterion standard. The autopsy effectiveness report also provided logistic information, such as problems with consents, medical records, specimen identification, and prosection. SETTING: Pediatric autopsies were performed by members of the Pediatric Pathology Division in a freestanding children's hospital in the Intermountain West of the United States with a large rural catchment area. This hospital is part of a large health maintenance organization serving the surrounding urban and rural areas. PATIENTS: A sample of all in-house and referral autopsies for the year 2000 was examined. MAIN OUTCOME MEASURE: The percentage of cases with a major or minor diagnostic discrepancy or unexpected pathologic finding using the autopsy as the criterion standard. RESULTS: The overall autopsy rate was 40% (39 hospital autopsies and 15 forensic autopsies per 135 total deaths) and was 32% excluding forensic cases. Twenty-two additional referral autopsies from outside institutions were performed. Of 61 autopsies, 12 (20%) revealed a major diagnostic discrepancy or unexpected pathologic finding, 17 (28%) had a minor unexpected finding or additional diagnosis, 41 (67%) clarified the differential diagnosis, 46 (75%) confirmed or verified a major diagnosis, and 21 (34%) provided information regarding treatment effects. Additionally, 3 (5%) had problems with identification, and 12 (20%) had problems with consent, all of which were resolved prior to initiation of the autopsy. CONCLUSIONS: These data confirm the value of the pediatric autopsy in a children's hospital and a vertically integrated health care system. It is an important medical and quality assurance procedure for assessing the accuracy of diagnoses, clarifying differential diagnoses, yielding unexpected findings, and providing feedback regarding therapeutic outcomes.

Autopsy↗
PubMed1997

The health care 100.

They are the giants of health care delivery: the top 100 integrated health systems. This exclusive ranking from St. Anthony Publishing includes revenue, physician and financial data on the nation;s largest integrated systems.

Catchment Area, Health↗
PubMed2025

Integrating explainable artificial intelligence with multiomics systems biology and electronic health record data mining for personalized drug repurposing in Alzheimer's disease.

Alzheimer's disease (AD) is characterized by region- and patient-specific molecular heterogeneity, which hinders therapeutic design. In this study, we introduce PRISM-ML (PRecision-medicine using Interpretable Systems and Multiomics with Machine Learning), an open-source integrated analysis pipeline that combines interpretable machine learning with systems biology and electronic health records data mining to elucidate the molecular diversity of AD and predict promising drug repurposing opportunities. First, we integrated and harmonized transcriptomic (bulk RNA-seq) and genomic (genome-wide association study) data from 2105 brain samples, each with matched data from the same individual (1363 AD patients, 742 controls; 9 tissues), sourced from three independent studies. Random forest classifiers with SHapley Additive exPlanations identified patient-specific biomarkers; unsupervised clustering resolved 36 molecularly distinct subtissues (defined as clusters of samples within a brain tissue that share a specific expression pattern); and gene-gene coexpression networks prioritized 262 high-centrality bottleneck genes as putative regulators of dysregulated pathways. Next, knowledge graph-based drug repurposing predicted six Food and Drug Administration (FDA)-approved drugs that simultaneously target multiple bottleneck genes and multiple AD-relevant pathways. Notably, in a large US de-identified insurance-claims database (n&#x2009;=&#x2009;364&#xa0;733), exposure to promethazine, one of the candidate drugs, was associated with a 57%-62% lower incidence of AD versus an active antihistamine comparator (adjusted hazard ratio 0.38; inverse-probability weighted 0.43; both P&#x2009;<&#x2009;.001), providing real-world support for its repurposing potential. In summary, PRISM-ML, as an explainable multiomics analysis pipeline, is readily transferable to other complex diseases, advancing precision medicine.

Alzheimer Disease↗
PubMed1996

Point-of-care systems, informatics, and health care delivery.

Evolving information technology has had profound effects on business operations and the marketplace. The health care services industry, particularly hospitals, clinics, and medical offices, has historically lagged behind other industries in the implementation of comprehensive, integrated, computerized data management tools. Health care reformers are looking to the promises of the information technology "revolution" as a means of improving systemic efficiency and health care quality. This study discusses the impact of informatics, or information technology, on the delivery of health care services. We present the evolution of informatics and the predicted future benefits of integrated computerized patient records and point-of-care systems.

Computer Security↗
PubMedDate not supplied

Integrating outcomes, quality and utilization data for profiling behavioral health providers.

Profiling the performance of mental health providers can be done on the basis of performance indicators derived from outcomes research, quality assurance and utilization review. By focusing on collaboration and data-driven accountability, the authors have attempted to use provider profiling to rebalance the relationship between payor, provider and managed care organization, while avoiding the perception of a punitive grading system. Outcomes data thus are directly tied into provider profiling, in addition to their more customary uses in assessing and improving the quality of treatment results.

California↗
PubMed2000

Health promotion in the curricula and teaching of two polytechnics in Finland.

The purpose of this study was to examine the manifestation of health promotion in two Finnish health care and nursing polytechnic curricula for students starting their studies in August 1997. Another goal was to explore students' and their teachers' perceptions of which modules contained health promotion, as well as to find out which modules contained integrated health promotion. In this study, data and investigator triangulation were used. The data consisted of the curricula of two polytechnics of health care and of interviews with 20 student nurses and their teachers. The data were analysed using content analysis. Health promotion studies were integrated with other studies in the curriculum of the first polytechnic, whereas the second polytechnic had two separate health promotion modules. While most students were in favour of separate health promotion modules, teachers supported integrated modules. Students also reported that their teachers integrated health promotion in modules which were not named as such, for example, in language modules. The results represent a major challenge concerning the content of health promotion in the curricula and, also, the methods for teaching health promotion. More cooperation between teachers during the process of planning curricula is recommended.

Curriculum↗
PubMed2003

Data integration and warehousing: coordination between newborn screening and related public health programs.

At birth, patient demographic and health information begin to accumulate in varied databases. There are often multiple sources of the same or similar data. New public health programs are often created without considering data linkages. Recently, newborn hearing screening (NHS) programs and immunization programs have virtually ignored the existence of newborn dried blood spot (DBS) newborn screening databases containing similar demographic data, creating data duplication in their 'new' systems. Some progressive public health departments are developing data warehouses of basic, recurrent patient information, and linking these databases to other health program databases where programs and services can benefit from such linkages. Demographic data warehousing saves time (and money) by eliminating duplicative data entry and reducing the chances of data errors. While newborn screening data are usually the first data available, they should not be the only data source considered for early data linkage or for populating a data warehouse. Birth certificate information should also be considered along with other data sources for infants that may not have received newborn screening or who may have been born outside of the jurisdiction and not have birth certificate information locally available. This newborn screening serial number provides a convenient identification number for use in the DBS program and for linking with other systems. As a minimum, data linkages should exist between newborn dried blood spot screening, newborn hearing screening, immunizations, birth certificates and birth defect registries.

Birth Certificates↗
PubMed1998

[Medical auditing: procedures assessment in the women's integral health care program in the Vila Municipal Health Clinic, Pelotas, Rio Grande do Sul, Brazil]

This study is based on a medical audit of the Vila Municipal Health Clinic, Pelotas, Rio Grande do Sul. We collected data from family medical records in 1992,1993, and 1994. The data concerned the Women's Integral Health Care Program. We collected information on age, visits for medical and non-medical reasons, blood pressure, breast examination, coverage of Pap smear testing, and contraceptive methods. On average, women visited the clinic 3.5 to 4 times a year; 53% of the women were between 20 and 39 years of age; 42.5% of the women had had a Pap smear in the previous three years; 19% of the women had had their breasts examined. Blood pressure measurement was the most common procedure recorded in this clinic. We believe quality of medical records is a factor in patient care. We expect a critique of the low-quality medical records found in this audit can serve as the basis for a discussion among the health care team, with a view towards improving medical care, thereby benefiting patients.

Journal Article↗
PubMed1975

The use of an information system for community health services planning and management.

The challenge of delivering health care on a more cost-effective and equitable basis has led to the formation of new kinds of organizations, which in turn require new kinds of management information systems. The system described in this article is used for planning resource allocation and monitoring the overall performance of Livingston Community Health Services, Inc., a rural community-owned health service designed to provide comprehensive care to a geographically defined target population. The Health Services Data System processes information on performance and productivity, effectiveness with respect to the target population, and billing and financial activities. Input consists of the results of a community census and two household surveys, patient registrations and patient services operating data, and financial data. Besides billing patients automatically, the system integrates financial, demographic, and health services utilization data to generate monthly summaries for the administrators, medical director, and community board. The article discusses several examples of these summaries, stratifying utilization by geographic location of residence, age, income, and race.

Accounting↗
PubMed2005

Validity of the EQ-5D as a generic health outcome instrument in a heroin-dependent population.

OBJECTIVE: To evaluate the validity of the EuroQol (EQ-5D) in a population of chronic, treatment-resistant heroin-dependent patients. METHODS: The EQ-5D is studied relative to the Maudsley Addiction Profile (MAP), the Symptom Checklist (SCL-90) and the European Addiction Severity Index (EuropASI) which were used to assess the participant's physical functioning, mental health and social integration, respectively. Data were gathered from 430 patients participating in the Dutch heroin trials with an intended 12-month treatment period. The EQ-5D was used as a separate health outcome measure. Statistical analyses were conducted using Spearman's and Pearson's correlations. RESULTS: The EQ-5D dimensions mobility, self-care and usual activities generally showed low correlations with relevant parameters of the MAP-HSS, SCL-90 and EuropASI (r=0.132-0.369). The EQ-5D dimension pain/discomfort showed low to moderate hypothesized correlations with all disease-specific measures (r=0.153-0.496). The EQ-5D dimension anxiety/depression showed moderate to high correlations with the SCL-90 (including the sum score) and some of the EuropASI parameters (r=0.133-0.615). The EQ-5D utility scores were moderately correlated with the MAP-HSS (r=-0.468) and the SCL-90 (r=-0.491) total score and with response to treatment at month 12. CONCLUSION: The majority of hypothesized associations between the EQ-5D and the disease or domain-specific measures could be confirmed. The validity of the EQ-5D-based utility score appears to be suitable in the evaluation of chronic, heroin-dependent populations.

Adult↗
PubMed2004

Conforming to HIPAA regulations and compilation of research data.

PURPOSE: A set of deidentified patient data compliant with the Health Information Portability and Accountability Act (HIPAA) was compiled, the data lost as a function of unique data elements (UDEs) were measured, and the deidentified data were tested for potential for reidentification. METHODS: After approval by the institutional review board of an integrated health system, a limited-data set was created by querying the health system's pharmacy, administrative, and financial files for patients discharged between January 1 and December 31, 2000. Using the HIPAA "safe-harbor" method, this limited-data set was converted into a deidentified-data table for future statistical analysis, and UDEs in both data sets were identified and quantified. Unique combinations of commonly available data were also identified. RESULTS: The limited-data set, representing 4,738 patient discharges, contained 810,456 UDEs in 322,657 records organized into four data tables (demographics, diagnoses, medication orders, and laboratory test results). The deidentified-data table, representing 4,722 discharges, contained 562,171 UDEs in 128 data-type columns in a single data table. About 31% of the data volume was lost. Much of the information lost was of the type that is of special interest to researchers (e.g., time between episodes of care, ages of >89 years). CONCLUSION: A study suggested that deidentified patient data with a reasonable degree of protection against reidentification were less complete than may be necessary for good research.

Guideline Adherence↗