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PubMed1997

The integration of two health systems: social stratification, work and health in East and West Germany.

This is an analysis of system integration, social stratification and work for health status and health care in East and West Germany. It is based on aggregate data and representative survey data of random samples of 2554 adults in both subsystems. Findings show that there were marked differences in life-expectancy prior to unification. The integration of the two systems, which occurred almost totally with regard to terms of West German health care organization, shows adjustment problems in the East for the public Health-Care-Funds and few if any for ambulatory care. The work situation has an impact on health, but there are no significant differences for East versus West. Social stratification variables show an influence on subjective health status for education (East) and for income, social status (West), while physician utilization (despite a preference of specialists by those with higher status) is not significantly determined by stratification variables in either East or West Germany. Beyond the central focus on work and stratification determinants a major finding pertains to a comparatively worse health situation for the aged and for women in what was the former East Germany. System models of Capitalism versus Socialism fit the results and recent history of the two systems to only a limited degree, as the West German corporate health system shows clear limits in following free market principles. The East German system, regardless of its centralized organization and move towards a socialist system, never fully abandoned the traditional model of German health care. Unlike the East German health system, that of West Germany, with its general expansion to 92% of the population, shows an increasing effect for social redistribution. The latter may be a reason why standard indicators of social stratification show less of an impact on health and health care than expected, while conditions at work clearly determine the health of people-the latter being the case in both the former East and West Germany.

Adult↗
PubMed1992

VA's Integrated Imaging System on three platforms.

The DHCP Integrated Imaging System provides users with integrated patient data including text, image and graphics data. This system has been transferred from its original two screen DOS-based MUMPS platform to an X window workstation and a Microsoft Windows-based workstation. There are differences between these various platforms that impact on software design and on software development strategy. Data structures and conventions were used to isolate hardware, operating system, imaging software, and user-interface differences between platforms in the implementation of functionality for text and image display and interaction. The use of an object-oriented approach greatly increased system portability.

Computer Graphics↗
PubMed1997

Managing clinical integration in integrated delivery systems: a framework for action.

An integrated delivery system (IDS) in healthcare must coordinate patient care across multiple functions, activities, and operating units. To achieve this clinical integration, senior management confronts many challenges. This paper uses a cross-functional-process (CFP) framework to discuss these challenges. There are ten CFPs that fall into three categories: planning processes (strategy formulation, program adaptation, budget formulation), organizational processes (authority and influence, client management, conflict resolution, motivation, and cultural maintenance), and measurement and reporting processes (financial and programmatic). Each process typically spans several functional units. Senior management must consider how to improve both the functioning of each CFP, as well as its "fit" with the other nine. The result can be greater clinical integration, improved cost management, and more coordinated care for enrollees.

Budgets↗
PubMedDate not supplied

How do integrated delivery systems adopt and implement clinical information systems?

We examined how five integrated delivery systems make decisions about and implement clinical information systems. Using case study methods, we identified general themes and explored how organizational context factors and information technology characteristics affect adoption and implementation processes.

Administrative Personnel↗
PubMed2002

HOWDY: an integrated database system for human genome research.

HOWDY is an integrated database system for accessing and analyzing human genomic information (http://www-alis.tokyo.jst.go.jp/HOWDY/). HOWDY stores information about relationships between genetic objects and the data extracted from a number of databases. HOWDY consists of an Internet accessible user interface that allows thorough searching of the human genomic databases using the gene symbols and their aliases. It also permits flexible editing of the sequence data. The database can be searched using simple words and the search can be restricted to a specific cytogenetic location. Linear maps displaying markers and genes on contig sequences are available, from which an object can be chosen. Any search starting point identifies all the information matching the query. HOWDY provides a convenient search environment of human genomic data for scientists unsure which database is most appropriate for their search.

Chromosome Mapping↗
PubMed1989

[An integrated control system for radioisotope facilities].

The authors developed an integrated system for managing the safe use of radioisotope laboratory facilities, users' access to controlled areas, and the control of air-conditioners. This system consisted of a personal computer, an access controller, an eye retinal verifier, magnetic card readers, hand foot cloth monitors, video tape recorders and a fire alarm system. The access controller was set as the central unit to operate the whole system including 13 gates and air-conditioners. Under this program, only registered persons were permitted to enter the laboratories; the exact records on access were easily obtained; and electricity and fuel expenses were largely reduced. We expect that the system would facilitate the safe use of radioisotopes and the utilization of laboratory facilities.

Facility Design and Construction↗
PubMed1996

Integrated delivery systems: the Edsel of health care.

Integrated delivery systems (IDSs) describe the various pieces of the provider world that have been pulled together contractually under one corporate roof, forming a single, relatively complete local delivery system to assume risk. Technically, the earliest examples of an IDS are HMOs themselves, be they IPA, staff, or group models. However, an HMO was not called an IDS then, because it was the risk-bearing entity. Integrated delivery systems really emerged over the last few years as HMOs changed from being the risk-bearing entity, to contracting with separate risk-bearing entities.

Capitation Fee↗
PubMed1991

Development of an integrated filing system for endoscopic images.

A new integrated filing system for endoscopic images has been developed, comprising a main image filing system and subsystems located at different stations. A hybrid filing system made up of both digital and analog filing devices was introduced to construct this system that combines the merits of the two filing methods. Each subsystem provided with a video processor, is equipped with a digital filing device, and routine images were recorded in the analog image filing device of the main system. The use of a multi-input adapter enabled simultaneous input of analog images from up to 8 video processors. Recorded magneto-optical disks make it possible to recall the digital images at any station in the hospital; the disks are copied without image degradation and also utilised for image processing. This system promises reliable storage and integrated, efficient management of endoscopic information. It also costs less to install than the so-called PACS (picture archiving and communication system), which connects all the stations of the hospital using optical fiber cables.

Analog-Digital Conversion↗
PubMed1996

Milestones for developing integrated delivery systems.

A number of elements driving development of integrated delivery systems are examined in this article. Some key factors influencing, possibly impeding, the development of community integrated delivery systems are identified. Three scenarios depicting how these new systems of care will develop in the coming five years are put forth.

Delivery of Health Care, Integrated↗
PubMed1994

Tax exemption and integrated delivery systems.

This chapter discusses tax exemption of integrated delivery systems, including the requirements for exemption, the charitable purposes test, the private inurement and private benefit tests, and an application to integrated delivery systems. It also discusses the structure of the Friendly Hills and Facey Nonprofit Medical Foundations, including the analysis of the Internal Revenue Service. Finally, it discusses the process for obtaining tax exemption.

Charities↗
PubMed2002

Managing the measurement: a model of data support in an integrated delivery system.

There are many functions in an integrated delivery system charged with focused, clinical excellence and process improvement based on data. Information system complexity, enhanced technology and software, and increased demand for data have created the need for one healthcare organization to look at an alternative system for data support of these key functions. This article describes a clinical data department model that has been implemented successfully in an integrated delivery system. It describes the structure and function of this department and its relationship in supporting the areas where clinical data is needed.

Data Collection↗
PubMed1997

Supporting infobuttons with terminological knowledge.

We have developed several prototype applications which integrate clinical systems with on-line information resources by using patient data to drive queries in response to user information needs. We refer to these collectively as infobuttons because they are evoked with a minimum of keyboard entry. We make use of knowledge in our terminology, the Medical Entities Dictionary (MED) to assist with the selection of appropriate queries and resources, as well as the translation of patient data to forms recognized by the resources. This paper describes the kinds of knowledge in the MED, including literal attributes, hierarchical links and other semantic links, and how this knowledge is used in system integration.

Information Storage and Retrieval↗
PubMedDate not supplied

Measuring primary care practice performance within an integrated delivery system: a case study.

This article examines the use of an integrated performance measurement system to plan and control primary care service delivery within an integrated delivery system. We review a growing body of literature that focuses on the development and implementation of management reporting systems among healthcare providers. Our study extends the existing literature by examining the use of performance information generated by an integrated performance measurement system within a healthcare organization. We conduct our examination through a case study of the WMG Primary Care Medicine Group, the primary care medical group practice of WellSpan Health System. WellSpan Health System is an integrated delivery system that serves south central Pennsylvania and northern Maryland. Our study examines the linkage between WellSpan Health's strategic objectives and its primary care medicine group's integrated performance measurement system. The conceptual design of this integrated performance measurement system combines financial metrics with practice management and clinical operating metrics to provide a more complete picture of medical group performance. Our findings demonstrate that WellSpan Health was able to achieve superior financial results despite a weak linkage between its integrated performance measurement system and its strategic objectives. WellSpan Health achieved this objective for its primary care medicine group by linking clinical performance information to physician compensation and reporting practice management performance through the use of statistical process charts. They found that the combined mechanisms of integrated performance measurement and statistical process control charts improved organizational learning and communications between organizational stakeholders.

Delivery of Health Care, Integrated↗
PubMed1999

ASHP survey of ambulatory care responsibilities of pharmacists in managed care and integrated health systems--1999.

The results of a 1999 national survey of the ambulatory care responsibilities of pharmacists in managed care organizations (MCOs) and integrated health systems are reported and compared with the results of a similar survey conducted in 1997. Four hundred MCOs and integrated health systems participated in the telephone survey. The survey elicited data about organizational structure and pharmacist functions in the ambulatory care environment. Survey recipients were asked about 24 specific ambulatory pharmacist functions. The performance of functions was related to five "enabling" factors: pharmacists on interdisciplinary teams, automated dispensing systems, integrated electronic medical records, and "very supportive" medical staff and senior management. Thirteen functions were reported to be routine activities for more than 50% of the respondents, compared with nine functions in 1997. The top four functions-using pharmacoeconomic data to make formulary decisions, conducting medication management programs, tracking adverse drug reactions, and providing written information with each new prescription-were performed in 75% or more of organizations. Some 15-18% of respondents indicated they would add specialized pharmacy-managed clinics, services to determine patient use of herbal products and dietary supplements, and Internet prescription services within 12 months, suggesting this expansion is likely to continue. Enabling factors supported expansion. Two clusters of functions were identified that related to either population-focused or patient-focused activities, and these were supported differentially by enabling factors. Group-model and staff-model HMOs had the most enabling factors and the greatest scope of pharmacist functions. Independent practice associations had fewer enabling factors and a different mix of pharmacist functions, with an emphasis on population-focused functions, suggesting that a second model of ambulatory care pharmacist activity may be emerging. Ambulatory care functions of pharmacists in integrated health-system settings have expanded broadly since 1997.

Ambulatory Care↗
PubMed1986

Lymphatics, lymph and lymphoid cells: an integrated immune system.

Lymphatics, lymph and lymphoid cells are still considered to be different entities and not parts of one integrated system. Surgeons working on the problems of lymphedema study lymph flow kinetics but neglect lymph humoral and cellular constituents. Immunologists study the problems of lymph cells but neglect lymph transport and chemical composition. This article describes the author's own views on the function of the lymphatics, lymph proteins and cells as one integrated immunoregulatory system. Data from own studies on the peripheral lymphatic system performed mostly in man are quoted.

B-Lymphocytes↗
PubMed1998

DBGET/LinkDB: an integrated database retrieval system.

The integrated database retrieval system DBGET/LinkDB is the backbone of the Japanese GenomeNet service. DBGET is used to search and extract entries from a wide range of molecular biology databases, while LinkDB is used to search and compute links between entries in different databases. DBGET/LinkDB is designed to be a network distributed database system with an open architecture, which is suitable for incorporating local databases or establishing a specialized server environment. It also has an advantage of simple architecture allowing rapid daily updates of all the major databases. The WWW version of DBGET/LinkDB at GenomeNet is integrated with other search tools, such as BLAST, FASTA and MOTIF, and with local helper applications, such as RasMol. In addition to factual links between database entries, LinkDB is being extended to included similarity links and biological links toward computerization of logical reasoning processes.

Databases, Factual↗