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At least 811 records · Page 45Linked to original sources
PubMed1997

Integrated delivery systems: the future for Canadian health care reform?

Influential health care leaders have recently said that it is a misnomer to refer to the current muddle of Canadian health care services and providers as a "system." Consequently, Canadian professionals and citizens have been exposed to increasing numbers of publications recommending that a move to fully and properly Integrated Delivery Systems (IDS) could rectify many of the difficulties with which our current non-system is faced. There is, however, a skepticism that the 'IDS movement' is just another in a series of fads that will come and go, without positively impacting the health care system. In this article, the authors provide arguments for why integration is critically required, an overview of types of integration, the qualities of a fully integrated system, and a discussion of the advantages and cautions to proceeding with IDS development. They conclude with the argument that--despite potential obstacles--the possible advantages of IDSs make it vital that we pursue integration.

Canada↗
PubMedDate not supplied

Hospitals in integrated delivery systems.

With inpatient use plummeting and HMOs demanding deep discounts, hospitals are restructuring themselves to run more efficiently and promote health as part of integrated delivery systems. This installment of HSL's continuing series discusses major strategies hospital directors can establish to support their institutions.

Cost Control↗
PubMed1998

Integrated health systems: they will set benchmarks for performance.

Nearly 600 health care delivery systems are in the process of integrating, and the number of highly integrated health systems based in rural areas jumped 72% in 1997. The primary reason for the integration trend is diminishing resources brought on by restricted reimbursement. Experts agree it will be difficult for freestanding hospitals to survive.

Benchmarking↗
PubMed1995

Network integration: the impact of integrated delivery systems. Roundtable discussion.

One of the hottest, most competitive segments of the healthcare IS industry encompasses integration tools and systems for linking divergent, best-of-breed systems. As firms such as Healthcare Communications, HUBLink, Oacis, Software Technologies Corp., Century Analysis and Eagle Innovations vie for new contracts, CIOs and IS directors wonder about the strategic advantages of single-vendor solutions vs. the best-of-breed approach. This dynamic has driven system acquisitions for several years. More recently, 33 percent of respondents to the 1995 HIMSS/HP Survey cited integration across separate facilities as their No. 1 priority for the next two years. Clearly the emergence of integrated delivery systems and providers of continuums of care--where the cost to replace the information technologies of acquired or partnered entities remains prohibitive--will cause the market for interface engines and other integration tools to continue expanding. Following are the perceptions of a few experts on the topic. They were asked to answer two questions: 1) What are the toughest challenges faced when integrating an integrated delivery system? and 2) What are the current best practices to solving this challenge?

Comprehensive Health Care↗
PubMed2003

Systems biology: integrating technology, biology, and computation.

The Human Genome Project has changed the worlds of biology and medicine-helping to catalyze two major paradigm changes: systems biology and predictive, preventive and personalized medicine. These two themes will dominate 21st century biology and medicine. I will discuss these changes and indicate how they may interface with with the process of aging.

Animals↗
PubMedDate not supplied

A database perspective of the transition from single-use (ancillary-based) systems to integrated models supporting clinical care and research in a MUMPS-based system.

The Composite Health Care System (CHCS), a MUMPS-based hospital information system (HIS), has evolved from the Decentralized Hospital Computer Program (DHCP) installed within VA Hospitals. The authors explore the evolution of an ancillary-based system toward an integrated model with a look at its current state and possible future. The history and relationships between orders of different types tie specific patient-related data into a logical and temporal model. Diagrams demonstrate how the database structure has evolved to support clinical needs for integration. It is suggested that a fully integrated model is capable of meeting traditional HIS needs.

Database Management Systems↗
PubMed2000

Immune system protects integrity of tissues.

The immune system neither discriminates between "Self" and "Nonself", nor it acts when confronting "Danger", rather, it reacts to disruption of tissue integrity allowing its renewal. The "integrity" hypothesis proposes three groups of signals that coordinate actions of dendritic cells and immunocytes during the initiation of the specific immune response, and suggests explanations for tolerance, memory formation, and repertoire selection, including differences with other theories.

Biological Evolution↗
PubMedDate not supplied

Integrating training systems for occupational health and safety, quality and environmental management.

Quality, occupational health and safety, and environmental issues are three key areas that, along with productivity and service, must be managed effectively. Organizations face the need to develop integrated systems for the management of these areas. As organizations increasingly need to seek efficiencies, one field in which such integration can bring considerable gains is training. The present paper examines how the requirements for training in different areas overlap and how an integrated training program may be developed.

Environmental Health↗
PubMedDate not supplied

The promise--and peril--of integrated cost systems.

Recent advances in managerial accounting have helped executives get the information they need to make good strategic decisions. But today's enterprise resource planning systems promise even greater benefits--the chance to integrate activity-based costing, operational-control, and financial reporting systems. But managers need to approach integration very thoughtfully, or they could end up with a system that drives decision making in the wrong direction. Operational-control and ABC systems have fundamentally different purposes. Their requirements for accuracy, timeliness, and aggregation are so different that no single, fully integrated approach can be adequate for both purposes. If an integrated system used real-time cost data instead of standard rates in its ABC subsystem, for example, the result would be dangerously distorted messages about individual product profitability--and that's precisely the problem ABC systems were originally designed to address. Proper linkage and feedback between the two systems is possible, however. Through activity-based budgeting, the ABC system is linked directly to operations control: managers can determine the supply and practical capacity of resources in forthcoming periods. Linking operational control to ABC is also possible. The activity-based portion of an operational control system collects information that, while it mustn't be fed directly into the activity-based strategic cost system, can be extremely useful once it's been properly analyzed. Finally, ABC and operational control can be linked to financial reporting to generate cost of goods sold and inventory valuations--but again, with precautions.

Budgets↗
PubMed1995

Integrated information systems: tools for affiliation.

The development of healthcare information systems as tools to facilitate business success traditionally has focused on a single profit center. The cataclysmic changes that are reshaping American healthcare have accelerated the affiliation of provider entities to form systems that have broader geographic coverage, deliver a larger portion of the provider continuum of care, and are more attractive partners for purchasers of healthcare services. Integrated and/or standardized information system technologies can provide great benefit in containing costs and optimizing quality among partners resulting from healthcare mergers and acquisitions as the new entity positions itself to increase market share and enhance its bottom line. Graduate Health System (GHS) in the Philadelphia area has demonstrated the efficacy of its investment to build a system-wide information network that delivers multiple standardized, integrated systems for both the financial and operational advantage of all component institutions. Building on its patient information system as the centerpiece of its information strategy, GHS has deployed a variety of tools across its network infrastructure that have brought new capabilities and savings to its member hospitals. In light of some of GHS's successes, other hospitals and healthcare systems may be able to re-create similar savings and efficiencies by applying like strategies in cooperation with their affiliated partners.

Cost-Benefit Analysis↗
PubMed1994

Special Medicare reimbursement and fraud and abuse considerations for management services organizations, medical foundations, and integrated delivery systems.

This chapter discusses certain Medicare reimbursement and fraud and abuse considerations for management services organizations (MSOs), medical foundations, and integrated delivery systems. It stresses the necessity of a business plan, the sources of capitalization that might be used in creating an integrated delivery system, and their effect on Medicare reimbursement. It also discusses related party principles and considerations and the Medicare "incident to" regulations. Furthermore, it discusses the application of certain Medicare safe harbor regulations on MSOs' structures and services, and those of medical foundations and integrated delivery systems.

Capital Financing↗
PubMed2001

Integration of information systems: assessing its quality.

Due to organizational and technological changes the need for integrating information systems within healthcare institutions, has increased enormously. Although the technical means for systems integration have definitely matured, integration methodologies are still in their infancy. Two important questions regarding systems integration are hardly ever addressed in a systematic way: how to derive integration requirements, and how to check whether the requirements are met in a given integrated system. These two questions must be answered if we want to assess or improve the quality of integration of a given set of systems. In this article we present a nine-step method for deriving integration requirements from a business process model, and we assess the quality of integration of a given integrated system against these requirements. The method is demonstrated by elaborating two case studies from the health care domain.

Computer Simulation↗
PubMed1997

Developing a health information network within an integrated delivery system: a case study.

Changes in the health care environment, such as the growth of integrated delivery systems and the proliferation of managed care, are having a profound impact on the way in which health care organizations manage both clinical and financial information. Health information networks (HINs) are emerging to support the goals and internal needs of integrated delivery systems. In this environment, health care managers must assume a leadership role in planning for the development of HINs. The article provides an overview of the principal issues that should be addressed in an organization's information systems plan when a HIN is being developed and includes a case study that illustrates the key points discussed.

Capital Financing↗
PubMedDate not supplied

Simulating an integrated critiquing system.

OBJECTIVE: To investigate factors that determine the feasibility and effectiveness of a critiquing system for asthma/COPD that will be integrated with a general practitioner's (GP's) information system. DESIGN: A simulation study. Four reviewers, playing the role of the computer, generated critiquing comments and requests for additional information on six electronic medical records of patients with asthma/COPD. Three GPs who treated the patients, playing users, assessed the comments and provided missing information when requested. The GPs were asked why requested missing information was unavailable. The reviewers reevaluated their comments after receiving requested missing information. MEASUREMENTS: Descriptions of the number and nature of critiquing comments and requests for missing information. Assessment by the GPs of the critiquing comments in terms of agreement with each comment and judgment of its relevance, both on a five-point scale. Analysis of causes for the (un-)availability of requested missing information. Assessment of the impact of missing information on the generation of critiquing comments. RESULTS: Four reviewers provided 74 critiquing comments on 87 visits in six medical records. Most were about prescriptions (n = 28) and the GPs' workplans (n = 27). The GPs valued comments about diagnostics the most. The correlation between the GPs' agreement and relevance scores was 0.65. However, the GPs' agreements with prescription comments (complete disagreement, 31.3%; disagreement, 20.0%; neutral, 13.8%; agreement, 17.5%; complete agreement, 17.5%) differed from their judgments of these comments' relevance (completely irrelevant, 9.0%; irrelevant, 24.4%; neutral, 24.4%; relevant, 32.1%; completely relevant, 10.3%). The GPs were able to provide answers to 64% of the 90 requests for missing information. Reasons available information had not been recorded were: the GPs had not recorded the information explicitly; they had assumed it to be common knowledge; it was available elsewhere in the record. Reasons information was unavailable were: the decision had been made by another; the GP had not recorded the information. The reviewers left 74% of the comments unchanged after receiving requested missing information. CONCLUSION: Human reviewers can generate comments based on information currently available in electronic medical records of patients with asthma/COPD. The GPs valued comments regarding the diagnostic process the most. Although they judged prescription comments relevant, they often strongly disagreed with them, a discrepancy that poses a challenge for the presentation of critiquing comments for the future critiquing system. Requested additional information that was provided by the GPs led to few changes. Therefore, as system developers faced with the decision to build an integrated, non-inquisitive or an inquisitive critiquing system, the authors choose the former.

Asthma↗
PubMed2007

Correlation of PET/CT standardized uptake value measurements between dedicated workstations and a PACS-integrated workstation system.

PURPOSE: This study was conducted to evaluate the clinical utility of a Positron Emission Tomography/Computed Tomography (PET/CT) analysis module of a picture archiving communication system (PACS) workstation in comparison to a dedicated PET/CT interpretation workstation. MATERIALS AND METHODS: The study included 32 consecutive patients referred for an [(18)F] Fluro-2-Deoxy-D: -Glucose ((18)F-FDG) PET/CT at our institution. Images were reviewed at dedicated PET/CT and at PACS-integrated workstations. Mean standardized uptake values (SUVs) were calculated for the liver and the lung. Maximum SUVs were recorded for the bladder and an index lesion with the highest FDG uptake. The time spent for SUV measurements was recorded. Correlation of the SUV measurements was calculated with the Pearson coefficient. RESULTS: Pearson coefficients between the workstations ranged from 0.96 to 0.99 for bladder and lesion maximum SUVs. For liver and lung average SUVs, the coefficients varied from 0.53 to 0.98. The mean time spent to perform the four SUV measurements was 122.6 s for the dedicated workstations and 134.6 s for the PACS-integrated system. CONCLUSION: The correlation of SUV measurements between dedicated PET/CT and PACS-integrated workstations is very good, especially for maximum SUVs. For routine reading of PET/CT scans, a PACS workstation with a PET/CT analysis module offers an excellent alternative to the use of a dedicated PET/CT workstation.

Fluorodeoxyglucose F18↗
PubMed1998

The role of home care in integrated delivery systems.

The health care field is moving rapidly toward integrated delivery systems (IDS). The role of home care in such system is unclear. This study seeks to describe the current status of home care in IDS and to examine health care administrators' perceptions about the importance of IDS components. A random sample of 1600 administrators was surveyed, 400 each from home care agencies, hospitals, nursing homes, and medical groups. Results reveal that hospitals lead integration, nursing homes are least involved, and home care agencies and medical groups fall in between. Administrator's opinions vary considerably about the importance of select services and integrating mechanisms.

Administrative Personnel↗
PubMed1998

Integrated data system means better maintenance.

The University of Texas M.D. Anderson Cancer Center has consolidated six databases into one integrated facilities management system. In the first year of implementation, the system has saved about $150,000 by cutting personel costs and reducing inventory by 27%. Keys to successful implementation include completely shutting off the old system before starting up the new one and testing the system in-house to work out glitches before it went on-line.

Academic Medical Centers↗
PubMed2005

DaVinci canvas: a telerobotic surgical system with integrated, robot-assisted, laparoscopic ultrasound capability.

We present daVinci Canvas: a telerobotic surgical system with integrated robot-assisted laparoscopic ultrasound capability. DaVinci Canvas consists of the integration of a rigid laparoscopic ultrasound probe with the daVinci robot, video tracking of ultrasound probe motions, endoscope and ultrasound calibration and registration, autonomous robot motions, and the display of registered 2D and 3D ultrasound images. Although we used laparoscopic liver cancer surgery as a focusing application, our broader aim was the development of a versatile system that would be useful for many procedures.

Computer Graphics↗