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Integrated delivery systems. Evolving oligopolies.

The proliferation of Integrated Delivery Systems (IDSs) in regional health care markets has resulted in the movement of these markets from a monopolistic competitive model of behavior to an oligopoly. An oligopoly is synonymous with competition among the few, as a small number of firms supply a dominant share of an industry's total output. The basic characteristics of a market with competition among the few are: (1) A mutual interdependence among the actions and behaviors of competing firms; (2) competition tends to rely on the differentiation of products; (3) significant barriers to entering the market exist; (4) the demand curve for services may be kinked; and (5) firms can benefit from economies of scale. An understanding of these characteristics is essential to the survival of IDSs as regional managed care markets mature.

Costs and Cost Analysis↗

ARCHIMED: a Network of Integrated Information Systems.

ARCHIMED is a Network of Integrated Information Systems (NIIS). This novel concept of hospital information system has a major advantage over the currently used distributed systems. The normalized representation structure of its databases enable its Navigators to reach simultaneously not only the data coming from different hospital departments, laboratories, and other hospital facilities, but also the data from different hospitals associated in the network.

Computer Communication Networks↗

[Integrated model system for environmental policy analysis].

An integrated model system for environmental policy analysis is built up with a Computable General Equilibrium (CGE) model as a core model, which is linked with an environmental model, air dispersion model, and health effect model (exposure-response functions) in an explicit way, therefore the model system is capable of evaluating the effects of policies on environment, health and economy and their interactions comprehensively. This method is used to analyze the effects of Beijing presumptive (energy) taxes on air quality, health, welfare and economic growth, and the conclusion is that sole presumptive taxes may slow down the economic growth, but the presumptive taxes with green tax reform can promote Beijing sustainable development.

Environment↗

[Reliability and completeness of an integrated epidemiologic system of acute viral hepatitis].

An integrated epidemiological system for the surveillance of acute viral hepatitis (Seiva) has been performed in Italy. Aim of the present work is to evaluate diagnostic completeness and reliability of the surveillance system in the Piedmont Region. Results show that 15% of Acute Viral Hepatitis are not reported by the system and that the potential diagnostic errors are 7.3% of the cases.

Acute Disease↗

Influences of carotenoid supplementation on the integrated antioxidant system of a free living endangered passerine, the hihi (Notiomystis cincta).

The integrated antioxidant system is recognised as an essential component of an organisms self maintenance. Our knowledge of this system, however, is largely restricted to species of economic importance. The health and productivity benefits these dietary based compounds provide make them increasingly relevant for study in wildlife ecology. The aim of this research was to identify numerous components of this integrated system in a free living and endangered passerine bird, the hihi. In addition experimental supplementation with carotenoids was used to investigate the modulatory interactions with other members of the antioxidant system. Our results identified lutein and zeaxanthin as the carotenoids utilised by hihi (82% and 17% of total carotenoids respectively in control samples of egg yolk, 84% and 16% of total carotenoids respectively in control samples of nestling plasma), and that vitamin E was represented by both alpha- and gamma-tocopherol. Retinol was also present, as was selenium in surprisingly high concentrations (599.64, 91.76, 377.72 ng/g fresh weight Se in control samples of yolk, albumin and plasma, respectively). Supplementation of lutein and zeaxanthin not only increased their presence in egg yolk (F(1,10)=14.285, P=0.005 and F(1,10)=9.606, P=0.015, respectively) and nestling plasma (F(1,19)=35.126, P<0.001 and F(1,19)=28.597, P<0001, respectively) but also led to increased selenium concentration in egg yolk (F(1,10)=7.213, P=0.028), increased retinol concentration in nestling plasma (F(1,19)=4.272, P=0.054) and decreased alpha-tocopherol concentration in nestling plasma (F(1,19)=5.122, P=0.037). These results provide detail of the antioxidant system in novel taxa and importantly highlight interaction between these various compounds. Given their increased application in productivity and health in agriculture and human medicine we highlight the potential application of this knowledge in wildlife ecology and conservation.

Animals↗

[A research on healthcare integrating model of medical information system].

System integration is inevitable since there are lots of heterogeneous medical information systems in the complicated medical environment. The current medical communication standards often focus on one aspect of the integration and do not provide a general scheme. Based on the analysis of the application of medical integration, the medical integration model HIM (Healthcare integrating model) is put forward, and the dataflow integration framework, function integration framework and interface integration framework in the HIM are designed subsequently. HIM provides a 3-D scheme for the integration of medical information systems, which not only contains the three aspects of integration application vertically, but covers the whole medical area horizontally.

Database Management Systems↗

The Brigham integrated computing system (BICS): advanced clinical systems in an academic hospital environment.

The Brigham integrated computing system (BICS) provides nearly all clinical, administrative, and financial computing services to Brigham and Women's Hospital, an academic tertiary-care hospital in Boston. The BICS clinical information system includes a very wide range of data and applications, including results review, longitudinal medical records, provider order entry, critical pathway management, operating-room dynamic scheduling, critical-event detection and altering, dynamic coverage lists, automated inpatient summaries, and an online reference library. BICS design emphasizes direct physician interaction and extensive clinical decision support. Impact studies have demonstrated significant value of the system in preventing adverse events and in saving costs, particularly for medications.

Computer Security↗

A system for integrated ECG analysis.

A system for combined analysis of resting, rhythm and exercise electrocardiograms has been developed. Also an "expert" module for rule-based processing with backward chaining for reasoning has been implemented. The system can be used for routine ECG analysis as well as for research and teaching in electrocardiography.

Electrocardiography↗

[Building a SAN and NAS integrated storage system in hospitals].

We have recentely built a cluster and backup system based on a SAN + NAS integrated storage system at a low price. The integration of SAN + NAS provides a storage system of fine quality, high reliability and high stability for hospitals. The article mainly introduces the choice of the project, the design of SAN + NAS integration and its implementation.

Computer Storage Devices↗

Problems with integrating legacy systems.

The economic and organizational impact of imposing state-of-the-art technology to the large number of proprietary legacy systems operational in most hospitals requires integrated clinical professional workstations to provide flexible encapsulation mechanisms for these systems rather than reengineering these systems to this new technology. In this paper the implications of different input/output and translation models of legacy systems for their integration into a clinical workstation is described. Examples of legacy systems that have been integrated in the HERMES clinical workstation are presented as examples of the range of difficulties one might encounter. The features that an integrated workstation should offer for integrating a broad range of legacy systems are also addressed in this paper.

Computer Systems↗

Effects of mental health centre staff turnover on HIV/AIDS service delivery integration.

This study examined the effects of mental health service provider turnover rates on system integration. System integration was defined as appropriate referrals and the freeflow exchange of information among three components: mental health care, primary health care, and dedicated HIV care coordination services. From a sample of 17 mental health centres across a midwestern state, higher staff turnover rates did not negatively impact integration, with the exception of within-centre services. Mental health service providers are aware of who other network providers are, but integration breaks down at a level of implementation in terms of contacts, exchange of information and referrals. Integrative efforts focused on care coordination with little to no evidence of bidirectionality.

Acquired Immunodeficiency Syndrome↗

[Integrated computer system for regulating eukaryotic gene expression].

The review describes several modules of the GeneExpress integrated computer system concerning the regulation of gene expression in eukaryotes. Approaches to the presentation of experimental data in databases are considered. The employment of GeneExpress in computer analysis and modeling of the organization and function of genetic systems is illustrated with examples. GeneExpress is available at http://wwwmgs.bionet.nsc.ru/mgs/gnw/.

Animals↗

Passively driven integrated microfluidic system for separation of motile sperm.

This paper describes a self-contained integrated microfluidic system that can separate motile sperm from small samples that are difficult to handle using conventional sperm-sorting techniques. The device isolates motile sperm from nonmotile sperm and other cellular debris, based on the ability of motile sperm to cross streamlines in a laminar fluid stream. The device is small, simple, and disposable yet is an integrated system complete with sample inlets, outlets, sorting channel, and a novel passively driven pumping system that provides a steady flow of liquid; it requires no external power source or controls. The device fulfills a need in clinical settings where small amounts of sperm need to be sorted. It also opens the way for convenient bioassays based on sperm motility including at-home motile sperm tests.

Cell Separation↗

Implementation of a patient-centred and physician-oriented healthcare information system.

Integration of information has enabled expeditious operation in air transfer, banking, shopping, and stock brokerage, but not in healthcare. Existing health information systems (HIS) are concerned too much with departmental performance and charge billing, and neglect the end users--the patients and the physicians. The resultant HIS then has divergent operation to antagonize the physicians, and has fragmented data to the disadvantage of patients. Recognizing the problems and the trend of HIS, this study proposed and implemented a patient-centred and physician-oriented HIS in a Urology clinic. The proposed HIS had patient care as its core, and accurately coded the patient's diagnoses and therapy information. It also offered a friendly environment and complete function for the physician to administrate medical records and to provide healthcare services. The HIS had client/server structure and an open system to protect the hardware investment and the software implementation. It will be the key to success in complete hospital environments.

Hospital Information Systems↗

Formularies in integrated health systems: Integris health.

Formulary management implications are described for an Oklahoma integrated health system that consists of 14 acute care facilities, numerous owned medical practices, and a fledgling HMO and has loose alliances with other rural facilities. A systemwide pharmacy director has yet to be appointed; however, the position of pharmacy operations manager for the Oklahoma City area has been created. A physician group has been formed that is expected to address systemwide pharmacy and therapeutics (P&T) committees and formulary strategies. Currently, P&T committee activities take place at the individual hospital level. The hospitals do not have restrictive formularies. An overall formulary system would likely be patterned after the largest hospital's system, which includes a formal approval process in which a P&T subcommittee reviews drug use outside established guidelines and the P&T committee asks the appropriate medical department to address the problem. For ambulatory care, the HMO has contracted with a pharmacy benefit manager (PBM), and there is no coordination of formulary efforts between the PBM and health system entities. Although this and other problems remain to be resolved, some standardization of drug use has begun. Also, all entities in the system use the same purchasing group and plan to use the same information systems. Drug use among hospitalized patients in this integrated health system is influenced by the usage guidelines established at the largest hospital, and drug use among ambulatory managed care patients is influenced by an external PBM.

Cost Savings↗

The Andover Working Group--accelerating the implementation of standards.

The Andover Working Group was formed with the objective to accelerate and broadly deliver standards-based solutions for healthcare which feature plug and play interoperability across the continuum of care. In this paper, organization and processes used by the Andover Working Group are discussed. A description of how multilateral message profiles, combined with object-oriented component middleware supporting application developments, systems integration and systems operation remove many of the barriers to deployment of systems of standards based applications is also given.

Diffusion of Innovation↗

Overview of the ACCESS Program. Access to Community Care and Effective Services and Supports.

The authors provide an overview of the ACCESS program (Access to Community Care and Effective Services and Supports), which evaluated the integration of service systems and its impact on outcomes for homeless persons with severe mental illness. The ACCESS program provided funds and technical assistance to nine community sites to implement strategies for system change that would promote systems integration. These experimental sites, along with nine comparison sites, also received funds to support outreach and assertive community treatment for 100 clients a year for four years at each site. Data on the implementation of system change strategies were collected from 1994 to 1998 during annual visits to the sites. Data on changes in systems integration were obtained from interviews with key informants from relevant organizations in each community. Client outcome data were obtained at program entry and three and 12 months later from 7,055 program participants across the four annual client cohorts at all sites. Detailed findings from the ACCESS evaluation are presented in two accompanying articles, and overall conclusions are offered in a fourth article.

Community Mental Health Services↗