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PubMed1980

Oral syringe use survey.

Use of oral syringes at children's and ASHP-accredited residency hospitals in the United States was surveyed. Questionnaires were mailed to 131 hospitals; 117 (89.3%) were returned. Of the responding hospitals, 54.5% of children's hospitals and 67.1% of residency hospitals used oral syringes. There was no definite preference for a particular brand or type (glass vs. plastic) of syringe. Patients who often required liquid dosage forms, including pediatric and geriatric patients and patients with nasogastric tubes, were most frequently included in oral syringe distribution systems. Twenty-six of the 73 hospitals utilizing oral syringes used them for most unit dose liquids in all drug distribution systems. The remainder reported use for specific medications or circumstances. Expiration dating policies varied from 24 hours to one year to the manufacturer's expiration dating. The survey indicates widespread use of oral syringes and identifies a need for evaluation of medication stability in these devices.

Aged↗
PubMed1978

Characteristics of hospital pharmacy practice in Indiana.

Hospital pharmacy practice in Indiana was surveyed to determine drug distribution services, additional services, staffing and salaries. Questionnaires were mailed to the directors of the 113 licensed hospital pharmacies in the state; 63% responded. Unit dose drug distribution systems were used by 19% of the hospitals for all beds; by 16% for some of their beds. Intravenous admixture services were provided by 43% of the respondents. Drug use review, patient education and inservice education were all provided by more than 10 of the respondents; in general, clinical services were not well developed. Salaries for directors were related more to hospital bed size than to years of experience as a pharmacist. Howeever, salaries for staff pharmacists were related more to years of experience than to hospital bed size. It appeared that staff pharmacists who want to earn more income must consider an administrative position.

Indiana↗
PubMed2000

Implementing a Java-based image and report distribution system in a non-picture archiving and communication system environment.

The benefits and pitfalls of implementing a Java-based system to distribute results and images to referring physicians are addressed. The basic requirements for and barriers to implementing this system in a non-picture archiving and communication system (PACS) environment will also be discussed. The majority of radiology information systems (RIS) and hospital information systems (HIS) currently only distribute the text data for radiology examinations. This is generally adequate for low-acuity exams in a relatively healthy patient; however, many clinicians prefer to review images so they can correlate the reported findings with the image data, as well as review the exam themselves. A web-based solution eliminates the need for specialized review software and/or hardware at each review site. In addition, there is no need for support personnel to travel to each site to set up and upgrade software.

Data Display↗
PubMed1984

Consultant evaluation of a hospital medication system: synthesis of a new system.

Recommendations of consultants for the implementation of a new medication system at a large teaching hospital are described. Based on a previous analysis of the hospital's existing drug distribution and control system that revealed problems in reliability and response time, an interdisciplinary consultant group offered 14 recommendations, which included implementation of a computerized unit dose delivery system and selected clinical pharmacy services. Functions identified for which computerization would produce the greatest benefits included maintenance of patient census data, medication order entry and retrieval, and preparation of a medication administration record for nursing. Recommendations for improving the unit dose system in the hospital consisted of increasing the number of medications packaged in true unit dose form, increasing the frequency of daily deliveries of scheduled medications, sending p.r.n. medications on an on-call basis, decreasing the lead time for preparation of i.v. solutions, and using a pharmacist-manned portable medication cart to reduce workload on the central pharmacy during peak workload periods. Clinical pharmacy services identified as having the greatest cost-benefit ratio were discharge consults, drug therapy monitoring, and drug-use review. Using information from published studies and cost data from the hospital, a net annual savings of over +152,000 was projected with implementation of these services. Improvements in the unit dose system and implementation of clinical pharmacy services were expected to result in substantial cost savings in the study hospital.

Computers↗
PubMed1976

Comprehensive pharmacy services in an 85-bed hospital.

The development of a unit dose drug distribution system, centralized intravenous admixture program and clinical pharmacy services in a small hospital is discussed. The steps taken to implement and justify the programs and an outline of procedures followed is included.

Costs and Cost Analysis↗
PubMed2004

Integrating context-aware public displays into a mobile hospital information system.

Hospitals are convenient settings for deployment of ubiquitous computing technology. Not only are they technology-rich environments, but their workers experience a high level of mobility resulting in information infrastructures with artifacts distributed throughout the premises. Hospital information systems (HISs) that provide access to electronic patient records are a step in the direction of providing accurate and timely information to hospital staff in support of adequate decision-making. This has motivated the introduction of mobile computing technology in hospitals based on designs which respond to their particular conditions and demands. Among those conditions is the fact that worker mobility does not exclude the need for having shared information artifacts particular locations. In this paper, we extend a handheld-based mobile HIS with ubiquitous computing technology and describe how public displays are integrated with handheld and the services offered by these devices. Public displays become aware of the presence of physicians and nurses in their vicinity and adapt to provide users with personalized, relevant information. An agent-based architecture allows the integration of proactive components that offer information relevant to the case at hand, either from medical guidelines or previous similar cases.

Artificial Intelligence↗
PubMed1989

[The design and implementation of a hospital management information system at Peking Union Medical College hospital].

This paper analyses the environment, necessity, possibility and specificity of the development of a Hospital Information System (HIS) in the People's Republic of China. The overall design and step-by-step implementation of a Hospital Management Information System (HMIS) in Peking Union Medical Collage (PUMC) Hospital are described in great detail. An experimental HMIS consisting of 40 microcomputers and a minicomputer (VAX-730) with a mixed network has been developed and is running perfectly well in PUMC Hospital. It is a distributed data management system. Each department uses microcomputers (work stations) to handle its own work directly facing the end-users to meet the local requirements. The global data concerning the whole system will be stored in network to be shared with all the subsystems. The communication between two subsystems is through 3+ network. As a background support of the distributed data processing, the centralized data bases in VAX-730 could be used to analyse and evaluate activities of the whole hospital.

China↗
PubMed1982

Adjusting planning guidelines for cardiac-care units.

The principal concern of this paper is the development of procedures for adjusting the criteria currently being used for federally-legislated health planning activities. These procedures would enable the planner to account for the demographic, geographic and health-system conditions which cause variations in the need for health-care services in local communities. A case-mix method, hospital chart abstract data and demographic, geographic and health-system data from New Jersey were used to: create a list of diagnoses eligible for treatment in a Cardiac-Care Unit (CCU): select a sample of hospitals for study, and conduct a step-wise regression analysis of CCU utilization in these hospitals. It was concluded that CCU utilization was affected by factors such as the in-hospital availability of CCu beds, the type of hospital, CCU-patients' clinical severity, and the availability of ambulances and mobile intensive care units. Procedure for adjusting planning criteria to account for local conditions have yet to be developed. However, a method for using the types of results presented in this paper to develop such adjustment procedures was presented and illustrated. It is recommended that this method be used to create such adjustment procedures for the planning criteria for all hospital services and hence to assist Health Systems Agencies in rationalizing the distribution of our hospital care.

Coronary Care Units↗
PubMed1995

Experience with an automated point-of-use unit-dose drug distribution system.

Two years' experience with an automated, point-of-use unit-dose system at the University of California, San Diego Medical Center (UCSDMC) is described. Growing concerns about the efficiency and cost-effectiveness of the traditional unit-dose drug distribution system at UCSDMC, and the corresponding diversion of professional staff time from pharmaceutical care responsibilities, led us to investigate alternative systems. Criteria for a new system were developed and used in evaluating alternatives. Consideration was given to three possibilities: 1) improving the existing system, 2) automating the unit-dose cassette fill process, or 3) automating the final step in medication delivery at the nursing station. Based on the realization that our traditional unit-dose system was largely inefficient in today's hospital environment, it was concluded that the drug distribution system needed to be re-engineered in a way that simplified delivery and reduced waiting time. The Medstation Rx system marketed by the Pyxis Corporation (San Diego, CA) seemed to meet the need. During a 2-year period a Medstation Rx system was implemented in most of the hospital (in all but three specialty units) and evaluated. This system has resulted in several benefits, including a net savings in labor costs, a significant reduction in waiting time for first doses, and a reduction in dispensing errors. In the process, it was possible to minimize the disruption of pharmacists engaged in the direct provision of pharmaceutical care, thereby increasing their efficiency.

Automation↗
PubMed2001

Sharing patient care records over the World Wide Web.

In order to obtain appropriate medical care, patients can be referred or transported from one hospital to another based on the capacity, capability and quality of medical care provided by hospitals. Therefore, enabling patient care records to be shared among hospitals is essential not only in delivering the quality of medical care services but also in saving medical expenses. Currently, most patient care records are paper-based and not well organized. Hence, they are usually incomplete and can hardly be accessed in time. The authors in this paper present methods to structure and represent patient care records, design mechanisms for interpreting and integrating the XML-based patient care records into the existing hospital information systems. More importantly, in our approach, each significant piece of medical record is associated with a tag based on the syntax and semantics of the XML. The XML-based medical records enable a computer to capture the meaning and structure of the document on the web. The authors have developed a unified referral information system in which patient care records can be shared among hospitals over the Internet. It can not only facilitate the referral process but also maintain the integrity of a patient's medical record from distributed hospitals. The workflow of the system basically follows the existing manual system and can easily be adapted. The working group on integration of municipal hospital information systems, Department of Health, Taipei City Government, has decided to adapt this system for referral practice among the municipal hospitals.

Hospital Information Systems↗
PubMed1996

The doctor's view on education and training aspects of secure communication.

Using two examples of installed applications that are widely spread in a large teaching hospital, the awareness of secure communication is highlighted. Teaching to the rotating medical staff is organised on a regular basis. The physicians learn the responsibility they accept when entering the hospital information system (HIS). In a distributed environment, the confidentiality aspects change with the technology when the users perform with on-line helps and graphical interfaces.

Attitude of Health Personnel↗
PubMed1978

Distributed laboratory computing. Integration of a laboratory computer into a hospital information system.

The University of Iowa Hospitals and Clinics, a large teaching hospital and tertiary care referral center, has implemented a vendor-supplied laboratory computer package operating on a dedicated minicomputer. A high-speed communications link allows the laboratory computer to share patient administrative, census, and test result data with the central hospital information system on an interactive basis. Operational characteristics of the system are discussed, and special attention is given to the critical problems and advantages of interfacing two computers.

Computers↗
PubMed1987

Survey of small hospitals.

The CSHP Saskatchewan Branch created the position of Small Hospital Representative on their Executive Committee. This appointed person's major function was to improve representation on the Executive Committee for hospitals outside of Saskatoon and Regina. The representative sent a survey to these hospitals to establish the status of pharmacy practice in these hospitals and how to best serve them. There were 90 of 128 (70.3%) surveys completed. Survey results were separated into hospitals which employed pharmacists and those which did not. Elements of practice reported by hospitals with a pharmacist, which showed some degree of deficiency, included drug distribution systems, medication profiles and clinical pharmacy programs. Hospitals which did not employ a pharmacist obtained their pharmacy services from either a larger hospital or a local retail pharmacist. There were 11 hospitals which had no access to a pharmacist, depending on the Director of Nursing for medication-related activities. The Small Hospital Representative of CSHP Saskatchewan Branch, in co-operation with the professional associations used this study as a starting point in attempts to improve pharmacy practice in Saskatchewan in hospitals outside of Saskatoon and Regina.

Data Collection↗
PubMed1998

A hospital information system based on Common Object Request Broker Architecture (CORBA) for exchanging distributed medical objects--an approach to future environment of sharing healthcare information.

Tightly related subsystems in a HIS have to exchange medical data flexibly by the data object rather than by the battery of the data. We developed a CPR subsystem based on Common Object Request Broker Architecture (CORBA) that retrieves and stores clinical information in the object-oriented database via Internet Intra-ORB Protocol (IIOP). The system is hybridized with the legacy HIS applications on the client terminals. We believe that our solution and the experiences will contribute to the future CORBA-based environment in which computerized patient information is shared among hospitals, clinics, and tightly related systems.

Computer Communication Networks↗
PubMed2001

Doctors' use of electronic medical records systems in hospitals: cross sectional survey.

OBJECTIVES: To compare the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks. DESIGN: Cross sectional questionnaire survey. Semistructured telephone interviews with key staff in information technology in each hospital for details of local implementation of the systems. SETTING: 32 hospital units in 19 Norwegian hospitals with electronic medical records systems. PARTICIPANTS: 227 (72%) of 314 hospital doctors responded, equally distributed between the three electronic medical records systems. MAIN OUTCOME MEASURES: Proportion of respondents who used the electronic system, calculated for each of 23 tasks; difference in proportions of users of different systems when functionality of systems was similar. RESULTS: Most tasks listed in the questionnaire (15/23) were generally covered with implemented functions in the electronic medical records systems. However, the systems were used for only 2-7 of the tasks, mainly associated with reading patient data. Respondents showed significant differences in frequency of use of the different systems for four tasks for which the systems offered equivalent functionality. The respondents scored highly in computer literacy (72.2/100), and computer use showed no correlation with respondents' age, sex, or work position. User satisfaction scores were generally positive (67.2/100), with some difference between the systems. CONCLUSIONS: Doctors used electronic medical records systems for far fewer tasks than the systems supported.

Cross-Sectional Studies↗
PubMed1987

Routine culturing for Legionella in the hospital environment may be a good idea: a three-hospital prospective study.

The source for nosocomial Legionnaires' disease is the water distribution system. However, the implications for legionella contamination in a hospital without known Legionnaires' disease is unclear. Therefore, culturing for Legionella pneumophila in the environment has not been routinely recommended. The authors conducted a prospective pneumonia study in three hospitals, none of which was known to have a major problem with endemic legionellosis. The water system of Hospital 1 was colonized with L. pneumophila, serogroup 1; Hospital 2 was colonized by L. pneumophila, serogroup 5 (which is rarely associated with disease); Hospital 3 was essentially free of L. pneumophila. Sputum culture on selective legionella media, direct fluorescent antibody testing, and serology were performed for all nosocomial pneumonias regardless of clinical impression. At the end of the study the incidence of nosocomial legionnaires' disease was found to be 9%, 0%, and 0% in Hospitals 1, 2, and found to be 9%, 0%, and 0% in Hospitals 1, 2, and 3, respectively. In Hospital 1, monoclonal antibody subtyping confirmed that the patient isolates were identical to the environmental isolates. The authors conclude that environmental culturing, despite the absence of known Legionnaires' disease, is useful. Positive cultures from the hospital water supply would mandate the introduction of legionella testing into the laboratory and stimulate physicians to consider Legionnaires' disease when encountering nosocomial pneumonias.

Cross Infection↗