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PubMed2003

Practical applications approach to design, development and implementation of an integrated management system.

The introduction of quality, risk, safety, health and environmental management philosophies has significantly changed industry's view of company organization and controlling processes. Quality, risk, safety, health and environmental programs and systems, such as ISO 9000, ISO 14000, process safety, and risk management are impacting the way industry will meet the challenges of safety and environmental risks and the needs of the customer in the future.A wealth of knowledge has been extracted from practical application case studies, which would otherwise be unobtainable without years of experience related to management systems design, development, implementation and control. This paper discusses a practical applications approach to design, develop and implement an integrated management system encompassing quality (ISO 9000), process safety management (CFR 29 1910.119), risk management programs (CFR 40 part 68), environmental management (ISO 14000), and safety and health. This paper includes a discussion of management systems integration and an overview of management systems standards that apply to the petrochemical and chemical manufacturers industries. The paper also provides an overview on integrating management systems, including issues related to the following topics: Establishing a management system team and objectives. Assessing and knowing your organization. Designing the management system to meet site objectives. Developing system documentation. Implementing effective management systems. Measuring program performance. Continuous improvement.

Carcinogens↗
PubMed1994

Costs and benefits of integrated healthcare systems.

Although forming an integrated healthcare system can be extremely expensive, many hospitals and physician groups are discovering that by doing so, they can reap significant benefits, including increased market share, more secure physician income, and better physician "quality of life," a financially stronger organization, and an enhanced ability to adapt to the changing healthcare environment. In most cases, the return on the investment required to reorganize the physician, hospital, and healthcare plan relationship is likely to be substantial.

Capital Financing↗
PubMed2002

Development of a risk-based TMDL assessment approach using the integrated modeling system GIBSI.

Using the integrated modeling system GIB SI and a case study, this paper presents the development of a risk-based TMDL assessment approach that links wet (nonpoint/diffuse) and dry weather (point) sources to a probability of exceeding water quality standards (WQS) governing wateruses. The case study focused on determining whether WQS defining recreational uses of water requiring direct and prolonged contact were attainable if the waste water effluent of a small town was treated using aerated lagoons and if the agricultural nonpoint source (NPS) loads were reduced using different fertilization rates. Dry weather sources were assumed to solely contribute to bacteriological impairment of the studied river reach. Meanwhile, both wet and dry weather sources were assumed to contribute to aesthetic impairment. Simulation results showed that treating the waste water effluent while reducing the agricultural NPS loads by 27% allowed on average over a four-year study period for attainment of the bacteriological WQS 100% of the summer time while lowering the probability of exceeding the aesthetic WQS from 0.32 to 0.19 (30 to 18 days). The results of this study showed this risk-based assessment approach was well suited to establish TMDL. These probabilities should be evaluated using long meteorological series.

Forecasting↗
PubMed1983

Integrated library systems.

The development of integrated library systems is discussed. The four major discussion points are (1) initial efforts; (2) network resources; (3) minicomputer-based systems; and (4) beyond library automation. Four existing systems are cited as examples of current systems.

Computers↗
PubMed2001

Evaluation of an integrated membrane system for water repurification.

An integrated membrane system was evaluated for water repurification. Performance evaluation of the membrane system was based on three criteria: flux and fouling, disinfection capability, and rejection of pollutants. Minimal membrane fouling was observed for all of the membranes employed in the study. Significant contaminant rejection was also achieved by the membrane system purifying the reclaimed water to meet and exceed drinking water standards. Wide range of virus rejection was observed for the membranes, which was dependent on the membrane type, manufacturer, and the fouling status. Overall, the results of this study demonstrated that the integrated membrane system is a very effective and reliable process for water repurification.

Biotechnology↗
PubMed1994

Implementation of a PC-based integrated control system for children.

Children with severe physical disabilities often require a range of technological devices to aid them with the fundamental tasks carried out in everyday life. These tasks areas may include mobility, communication, environment control and computer access for education. The most efficient, and often the most cost-effective, way of providing for these requirements is by the provision of a single, integrated system tailored to the individual's needs and abilities. BASIS, the Barnsley And Sheffield Integrated System, is an integrated control system based on a wheelchair-mounted personal computer (PC) and currently implements the following modules: wheelchair control; a spoken communication package; control of home equipment via infra-red; and a facility to run third-party software. The system presents a consistent and uniform environment to the user for selection and activation of these modules and can be controlled by one to four switches (scanning or directed access), a touch screen, a head pointer or a mouse. Safety considerations have played a central part in the design of the system. BASIS can be tailored to the user's requirements by editing a text file in software and by connecting the appropriate hardware modules to the serial and parallel ports. The graphical user interface has been designed for use by children and employs pictorial representation (icons) of available functions on a colour screen. These icons can be chosen from clip-art or drawn on computer drawing package. It is also possible to scan in and utilize drawings or photographs.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed2006

Integrated testing strategies for use in the EU REACH system.

Integrated testing strategies have been proposed to facilitate the process of chemicals risk assessment to fulfil the requirements of the proposed EU REACH system. Here, we present individual, decision-tree style, strategies for the eleven major toxicity endpoints of the REACH system, including human health effects and ecotoxicity. These strategies make maximum use of non-animal approaches to hazard identification, before resorting to traditional animal test methods. Each scheme: a) comprises a mixture of validated and non-validated assays (distinguished in the schemes); and b) decision points at key stages to allow the cessation of further testing, should it be possible to use the available information to classify and label and/or undertake risk assessment. The rationale and scientific justification for each of the schemes, with respect to the validation status of the tests involved and their individual advantages and limitations, will be discussed in detail in a series of future publications.

Animal Testing Alternatives↗
PubMed1990

DataVoice: a microcomputer-based general purpose voice-controlled data-collection system.

An integrated system of hardware and software has been developed to combine the input of coordinate data from a digitizing pad with voice input for object identification or classification. The menu and voice-controlled software generates a sequential ASCII file which contains an object identification section and a data section. Rules for data entry and analysis programs have been developed for several applications. These are being tested and include general stereological analyses, bone, kidney and skin histomorphometry, boundary analyses, neuron classification and malignancy grading.

Artificial Intelligence↗
PubMed2005

Improvement of pollutant drift forecast system applied to the Prestige oil spills in Galicia Coast (NW of Spain): development of an operational system.

An integrated system named METEOMOHID, developed by MeteoGalicia in the first stage of the Prestige accident in November 2002 was used successfully in an operational form to support decision making and assist in recovering tasks. Afterwards, METEOMOHID has been enhanced with the aim of developing an operational oceanography system to be used in the NW of the Iberian Peninsula. The METEOMOHID system includes local area hydrodynamic coastal ocean modelling (MOHID), real time atmospheric forcing from a local meteorological model (ARPS). Using the available data from the Prestige crisis, a set of simulations were designed in order to reproduce the oil spill drift. The implementation of a detailed vertical resolution in the model has allowed obtaining a detailed surface dynamic, improving our knowledge of the behaviour of tarballs into the water column. Thus, the wind-driven Eckman drift, the direct dragging of the wind were detached, and the possible existence of subsurface oil was assessed. In addition, the present work evaluates the effects of introducing climatologic large scale currents in the METEOMOHID system.

Atlantic Ocean↗
PubMed2002

The determinants of hospital and HMO vertically integrated delivery systems in a competitive health care sector.

As a response to increased competition in the U.S. health care system, there have been a number of structural changes such as substantial increases in the number of hospital closings, horizontal mergers, and vertical combinations. This paper uses logistic regression and ordinary least squares models to attempt to understand why short-term, non-federal hospitals have created vertically integrated systems with HMOs in urban and rural markets during the 1993-1997 period. During this period, 1,917 integrated systems were formed while 1,466 dissolved. The empirical results indicate that the relative buying power of hospitals is a significant determinant of why hospitals would create vertically integrated systems with HMOs. Other variables also have significant effects upon the creation of vertical affiliations both at the individual hospital level and at the market level.

Bed Occupancy↗
PubMed2006

Building integrated information systems for chronic care: the California experience.

For over three decades, chronic-care services have been described as fragmented, complex, difficult to access, overlapping, and duplicative in function. Although a number of remedies have been implemented to improve service delivery, little has been written about the potential of integrated information systems (IIS) to serve as a remedy to fragmentation. We begin to address this gap by comparing and contrasting three unique models of chronic-care IIS developed in California to improve service delivery. To analyze the current status of each IIS, we apply six design criteria: (1) the information on programs and services is comprehensive, (2) the system has the capacity to serve the needs of diverse users, (3) the system integrates multiple layers and levels of information, (4) information from multiple sources is standardized and uniform, (5) information can be accessed in a timely manner, and (6) provisions are adequate to meet all requirements for privacy and confidentiality. Although much work remains to be done, there is reason to be optimistic that innovative IIS can contribute to the development of more effective chronic-care delivery systems.

California↗
PubMed1991

Design and testing of the Baxter Integrated Disconnect Systems (IDS).

This paper describes the result of a miltidisciplinary approach to the design and evaluation of a new CAPD disconnect system: the Baxter Integrated Disconnect System (IDS). This system consists of a bag full of fresh Dianeal, an empty bag for the drainage of spent dialysate and tubings connecting the 2 in a Y fashion. With this system, the patient makes only one connection. The system is disposable. The major property that makes this unique is that all components are preassembled, and the whole system is steam-sterilized as 1 unit. In general, similar systems use different sterilization methods for the various components of the system. Those components are then assembled, under clean conditions by the manufacturer, without final sterilization of the unit. Assembly of the components is sometimes left to the patient. The concept of IDS, therefore, is unique and warrants lower rates of contamination. This system has been tested on patients for a total observation period of 765 patient months, and has proven to be simple, safe and effective. It yields a 63% probability of peritonitis-free patients at 24 months.

Dialysis Solutions↗
PubMed1997

Personal privacy in the health care system: employer-sponsored insurance, managed care, and integrated delivery systems.

Widespread collection and use of identifiable information can promote social goods while, at the same time, infringing on personal privacy. Information systems are developing within the context of a fundamental transformation in the organization, delivery, and financing of health care. Changes in the health care system include rapid development of employer-sponsored health coverage, managed care organizations, and integrated delivery systems. These complex, multifaceted arrangements for delivering and paying for health care require ever-more-sophisticated information systems that facilitate extensive sharing of personal data. Systemic flows of sensitive health information occur both vertically and horizontally among employers, hospitals, insurers, laboratories, and suppliers. Beyond this complex web of vertical and horizontal sharing are the multiple demands for information management, quality assurance, research, governmental regulation, and public health. Theoretical problems exist with the law and ethics of informational privacy. The traditional method of exercising control over personal health information is through informed consent. Informed consent, however, within a modern health information infrastructure becomes highly complex. In this kind of environment, the doctrine of informed consent is flawed and does not provide sufficient control over personal information to assure adequate protection of privacy.

Biomedical Research↗
PubMed2006

A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial.

BACKGROUND: Care for elderly persons with disabilities is usually characterized by fragmentation, often leading to more intrusive and expensive forms of care such as hospitalization and institutionalization. There has been increasing interest in the ability of integrated models to improve health, satisfaction, and service utilization outcomes. METHODS: A program of integrated care for vulnerable community-dwelling elderly persons (SIPA [French acronym for System of Integrated Care for Older Persons]) was compared to usual care with a randomized control trial. SIPA offered community-based care with local agencies responsible for the full range and coordination of community and institutional (acute and long-term) health and social services. Primary outcomes were utilization and public costs of institutional and community care. Secondary outcomes included health status, satisfaction with care, caregiver burden, and out-of-pocket expenses. RESULTS: Accessibility was increased for health and social home care with increased intensification of home health care. There was a 50% reduction in hospital alternate level inpatient stays ("bed blockers") but no significant differences in utilization and costs of emergency department, hospital acute inpatient, and nursing home stays. For all study participants, average community costs per person were C dollar 3390 higher in the SIPA group but institutional costs were C dollar 3770 lower with, as hypothesized, no difference in total overall costs per person in the two groups. Satisfaction was increased for SIPA caregivers with no increase in caregiver burden or out-of-pocket costs. As expected, there was no difference in health outcomes. CONCLUSIONS: Integrated systems appear to be feasible and have the potential to reduce hospital and nursing home utilization without increasing costs.

Aged↗
PubMed1997

Creating integrated service systems for homeless persons with mental illness: the ACCESS Program. Access to Community Care and Effective Services and Supports.

The Access to Community Care and Effective Services and Supports (ACCESS) demonstration program was initiated in 1993 by the U.S. Department of Health and Human Services as part of a national agenda to end homelessness among persons with serious mental illness. Demonstration projects have been established in nine states to develop integrated systems of care for this population. This paper provides an overview of the ACCESS program and presents definitions of services integration and systems integration. Evaluating the effectiveness of integration strategies is a critical aspect of the program. The authors describe the evaluation design and the integration strategies being evaluated and summarize findings from a formative evaluation of the project's first two years. The evaluation revealed several problems that were addressed by providing technical assistance to the states. States were helped to articulate a broader mission of addressing system-level barriers, develop an expanded plan, strengthen the authority of interagency councils, involve leaders at the state and agency levels, and develop joint funding strategies.

Adult↗
PubMed1996

Formularies in integrated health systems: Fallon Healthcare System.

Formulary management implications in a Massachusetts integrated health system consisting of a physician group practice clinic, an HMO, a hospital, a long-term care facility, a physician-hospital organization, a home care agency, and a clinical laboratory are described. Two formularies govern drug therapy for most patients in the system. The formulary of the group practice (Fallon Clinic) is used for 180,000 patients covered by the HMO. The formulary of Saint Vincent Hospital influences drug use in the hospital and the system's long-term care facility. Both formularies require formal review before a drug is added and have structured processes for nonformulary requests. Entities in the health system are still being integrated at the operational level. The system does not have a formal position on integration of the formularies, but information exchange and collaboration occur because of overlap in the membership of the committees that approve the two formularies. Formulary decision-making has been coordinated to account for systemwide needs (for example, enoxaparin was not added to the hospital's formulary because of concerns about continuity of drug therapy after discharge, and the hospital's formulary includes the oral agents on the clinic's formulary). The systems uses one group-purchasing organization and one wholesaler; one person negotiates separate contracts for the hospital and the clinic. System coordination of formulary management has had little effect on daily activities of the pharmacy staff. Drug use among ambulatory patients in this integrated health system is influenced by the clinic's formulary, and drug use among patients in the hospital and subacute care beds is influenced by the hospital's formulary.

Cost Savings↗
PubMed1995

Second-generation legal issues in integrated delivery systems.

The formation and operation of integrated healthcare delivery systems raise significant legal issues. Some of these issues, such as antitrust, tax-exempt status, and fraud and abuse, have been discussed extensively. However, other legal issues, such as those involving management of business risk, use of systemwide information management, and securing of tax-exempt financing, have not received much attention.

Antitrust Laws↗
PubMed1994

The antitrust risks of management services organizations, medical foundations, and integrated delivery systems.

This chapter focuses on the antitrust implications of forming a fully integrated delivery system. The danger lies in a challenge by the federal government or private parties, if the proposed system threatens the development of competing systems or excludes individuals or entities. By explaining the risks facing less integrated arrangements involving medical foundations and management services organizations, why forming an integrated system may resolve some of those risks, and the advantages and disadvantages of other options, this chapter also points out one of the primary benefits of forming an integrated system: reducing the antitrust risks. Finally, general suggestions are posed to minimize the antitrust risks when planning and developing any collaborative effort among providers.

Antitrust Laws↗