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PubMed2004

[Integrated delivery systems in California--success and failure determining factors for the first 10 years and impetus for Germany].

Since the coming into effect of the Health Care Modernization Act (Gesundheitsmodernisierungsgesetz) the conditions for integrated health care delivery are favourable in Germany. However, comprehensive approaches are a long time in coming. In contrast, integrated health care delivery as an integral part of the spreading of managed care entered a further stage of development, which enables health care decision makers to draw conclusions regarding the further development of integrated health care delivery in Germany. Based on case studies integrated delivery systems in the San Francisco Bay Area have been analyzed with the objective to evaluate pitfalls and successful strategies for integrated health care delivery. The major pitfalls refer to an insufficient local focus, a lack of actual integration and the application of per capita reimbursement (which is a key subject on the political agenda in Germany as well) within integrated delivery systems. On the contrary, successful strategies include achieving a dynamic tension between centralized and decentralized coordination, internal and external relationship management, well organised human resource management including a well-defined corporate policy and a comprehensive implementation of information technology. Based on US experiences with integrated delivery systems implications for the design of integrated health care delivery in Germany are discussed.

California↗
PubMed1989

Integration vs. interface.

To conclude, system interfaces and system integration have specific uses based on the individual hospital's assessment of current and future needs. For the short-term, interfaces can provide a level of increased functionality without the upheaval of current operations. On the long-term considerations, the cost may factor negatively against the hospital's long-term information requirements and its inability to move and adapt quickly as the healthcare environment changes. Integrated systems, while requiring conversion from current interfaced systems, provide the functions and flexibility that serve a hospital's immediate and long-term information needs and enable it to survive in an increasingly-volatile healthcare environment.

Cost-Benefit Analysis↗
PubMed2003

Building integrated health systems in central and eastern Europe: an analysis of WHO and World Bank views and their relevance to health systems in transition.

BACKGROUND: Two questions are addressed. i) What are the views on health and health systems as expressed in the World Development Report 2000/2001 of the WB and the World Health Report 2000 and Health 21 of the World Health Organization, and how compatible are those views? ii) To what extent will compliance of CEEC and NIS with the WHO and WB recommendations result in health systems that produce maximum health for all by adequately addressing the needs of their populations? METHOD: The reports prepared by the World Bank and the World Health Organization were assessed against the theoretical framework of a needs-based public health approach. RESULTS: It is observed that the WHO and WB approaches are currently converging, although there remain differences in their respective focuses. The main merit of the WHO approach is its focus on performance and the systems approach towards health (care). The merit of the WB view is the integrated approach to health, education and poverty. It is argued that CEEC and NIS need to anticipate an ageing population and growing numbers of chronically ill. This calls for integrated health care systems and more integrated funding and payment systems. CONCLUSION: The recommendations provided in the WHR and the WDR with regard to integrated care and integrated financing remain rather abstract. Advisors of CEEC and NIS on health care reform and Western assistance projects should focus more on future needs, in order to avoid building health systems that consistently lag behind the needs of their populations.

Delivery of Health Care, Integrated↗
PubMed1991

Traditional and modern medicine working in tandem.

Because of the many problems relating to health care delivery in Africa, it is becoming apparent that neither the exclusive/monopolistic nor the tolerant legislative systems should be tolerated any longer. Especially since the Alma Ata Conference held by the WHO/UNICEF there has been growing impetus towards either inclusive/parallel (the beneficial co-existence of traditional and modern medical systems), or integrated systems. Although the idea of making traditional and modern medicine work in tandem in a united treatment context has its merits, it is also plagued by issues such as the nature of the products of an integrated training, resistance by stubborn protagonists of either of the two systems, or that only lip-service is paid to the idea of co-operation. Nevertheless, it is believed that all interest groups--the authorities responsible for health care delivery, the Western-trained health care workers, the traditional healers and the users of these services--stand to gain from such liaison.

Delivery of Health Care↗
PubMed2000

Assessment: the first step in creating a more integrated system-wide approach to nursing practice.

As complex healthcare systems are created, professional nurses in these systems must address the integration of nursing practice. To facilitate the transition to a more common system-wide approach to professional practice, leaders at one health system began by conducting an assessment of their current reality of nursing practice. The authors describe the assessment process, including the staff survey questionnaire and recommendations to strengthen nursing practice and make the transition to a more common system-wide approach to professional practice.

Delivery of Health Care, Integrated↗
PubMed2004

Bioinformatics integration and agent technology.

Vast amounts of life sciences data are scattered around the world in the form of a variety of heterogeneous data sources. The need to be able to co-relate relevant information is fundamental to increase the overall knowledge and understanding of a specific subject. Bioinformaticians aspire to find ways to integrate biological data sources for this purpose and system integration is a very important research topic. The purpose of this paper is to provide an overview of important integration issues that should be considered when designing a bioinformatics integration system. The currently prevailing approach for integration is presented with examples of bioinformatics information systems together with their main characteristics. Here, we introduce agent technology and we argue why it provides an appropriate solution for designing bioinformatics integration systems.

Algorithms↗
PubMed2005

High sensitivity for tuberculosis in a national integrated surveillance system in Finland.

Little is known about the sensitivity of surveillance for tuberculosis after integration of formerly dedicated tuberculosis surveillance and control into the general health care system, an integration which took place in Finland in 1987. We compared routine laboratory notifications to the National Infectious Disease Register (NIDR) for Mycobacterium tuberculosis from January 1, 1995, to December 31, 1996, with data collected independently from all laboratories offering M. tuberculosis culture, and with data from patient records. 1059 culture-positive cases were found. The overall sensitivity of the NIDR was 93 % (984/1059). The positive predictive value of a culture-positive case in the NIDR to be a true culture-confirmed case was 99%. For the culture-confirmed cases in the NIDR, one or more physician notification forms had been submitted for 89%. A highly sensitive notification system for culture-positive tuberculosis can be achieved in an integrated national infectious disease surveillance system based on laboratory notification.

Clinical Laboratory Information Systems↗
PubMed2002

An integrated vector system for cellular studies of phage display-derived peptides.

Peptide phage display is a method by which large numbers of diverse peptides can be screened for binding to a target of interest. Even when successful, the rate-limiting step is usually validation of peptide bioactivity using living cells. In this paper, we describe an integrated system of vectors that expedites both the screening and the characterization processes. Library construction and screening is performed using an optimized type 3 phage display vector, mJ(1), which is shown to accept peptide libraries of at least 23 amino acids in length. Peptide coding sequences are shuttled from mJ(1) into one of three families of mammalian expression vectors for cell physiological studies. The vector pAL(1) expresses phage display-derived peptides as Gal4 DNA binding domain fusion proteins for transcriptional activation studies. The vectors pG(1), pG(1)N, and pG(1)C express phage display-derived peptides as green fluorescent protein fusions targeted to the entire cell, nucleus, or cytoplasm, respectively. The vector pAP(1) expresses phage display-derived peptides as fusions to secreted placental alkaline phosphatase. Such enzyme fusions can be used as highly sensitive affinity reagents for high-throughput assays and for cloning of peptide-binding cell surface receptors. Taken together, this system of vectors should facilitate the development of phage display-derived peptides into useful biomolecules.

Alkaline Phosphatase↗
PubMed1992

CAPD bag changing with integrated disconnect system gives lower incidence of peritonitis than with UV-box system.

UNLABELLED: The use of a UV-box disconnect system reduces the incidence of peritonitis as compared with manual exchanges. An integrated disconnect system (IDS) also gives good results. See Figure 1. From 1988-1991, we prospectively compared two groups of patients using either a UV-box disconnect system (Baxter, n = 18, mean age 64, range 28-75 yrs) or an IDS (Baxter, n = 25, mean age 53, range 30-78). The Tenckhoff catheter had been inserted by the same technique in all patients, and the training program and nursing care were also identical. Since many younger patients preferred IDS and refused randomization, age was significantly lower in the IDS group. All peritonitis episodes (PER) were registered. Excluded from calculations of PER were episodes most probably not due to failure in connective device: PER after incidental penetration of the dialysis bags, deep penetrating tunnel infections and in the direct course of abdominal surgery. RESULTS: There were significantly fewer months with PER (one month = 1 PER; Chi-2 = 6.45, p < 0.05) in patients using the IDS (3 PER/269 months) compared with those using the UV-box system (15 PER/355 months). The IDS was requested mainly by younger patients, while some older patients found it to be too complicated. CONCLUSION: The integrated disconnect system is especially acceptable by younger patients, and patients using the IDS show a low incidence of peritonitis.

Adult↗
PubMed1996

An integrated care system for musculoskeletal disorders in a managed care setting.

Practice guidelines, education, consensus building, and extensive communication were the tools used in developing a musculoskeletal care system. Primary care physicians directed patient care using practice guidelines for common musculoskeletal conditions. Patient education and empowerment were emphasized. Specialist consultations were made available by telephone/voicemail to advise primary care physicians regarding treatment plans and the need for specialty referrals. Significant reductions in medical service utilization for this patient population were achieved while high levels of patient satisfaction were maintained. Such integrated systems are likely to work well within other MCOs.

Case Management↗
PubMed1992

Implementing an integrated financial system.

Faced with four redundant date entry software systems and a staff that relied heavily on manual systems, agency administrators searched for a fully integrated automation system. The author describes the agency's success with and staff's acceptance of the chosen system.

Financial Management, Hospital↗
PubMed2006

The Gaggle: an open-source software system for integrating bioinformatics software and data sources.

BACKGROUND: Systems biologists work with many kinds of data, from many different sources, using a variety of software tools. Each of these tools typically excels at one type of analysis, such as of microarrays, of metabolic networks and of predicted protein structure. A crucial challenge is to combine the capabilities of these (and other forthcoming) data resources and tools to create a data exploration and analysis environment that does justice to the variety and complexity of systems biology data sets. A solution to this problem should recognize that data types, formats and software in this high throughput age of biology are constantly changing. RESULTS: In this paper we describe the Gaggle -a simple, open-source Java software environment that helps to solve the problem of software and database integration. Guided by the classic software engineering strategy of separation of concerns and a policy of semantic flexibility, it integrates existing popular programs and web resources into a user-friendly, easily-extended environment. We demonstrate that four simple data types (names, matrices, networks, and associative arrays) are sufficient to bring together diverse databases and software. We highlight some capabilities of the Gaggle with an exploration of Helicobacter pylori pathogenesis genes, in which we identify a putative ricin-like protein -a discovery made possible by simultaneous data exploration using a wide range of publicly available data and a variety of popular bioinformatics software tools. CONCLUSION: We have integrated diverse databases (for example, KEGG, BioCyc, String) and software (Cytoscape, DataMatrixViewer, R statistical environment, and TIGR Microarray Expression Viewer). Through this loose coupling of diverse software and databases the Gaggle enables simultaneous exploration of experimental data (mRNA and protein abundance, protein-protein and protein-DNA interactions), functional associations (operon, chromosomal proximity, phylogenetic pattern), metabolic pathways (KEGG) and Pubmed abstracts (STRING web resource), creating an exploratory environment useful to 'web browser and spreadsheet biologists', to statistically savvy computational biologists, and those in between. The Gaggle uses Java RMI and Java Web Start technologies and can be found at http://gaggle.systemsbiology.net.

Computational Biology↗
PubMedDate not supplied

Integrating information systems in medicine: a reference model for middleware.

This paper addresses the problem of integrating healthcare information systems, from a technological viewpoint. We propose to take the concept of an ¿integration service' as an elementary concept in discussing the problem of integration. We then propose a taxonomy for grouping integration services according to their functionality and their domain specificity. The use of this taxonomy for decomposing an integration problem into (less complex) sub-problems is demonstrated. Finally, a sequence of steps to be taken in solving an integration problem is discussed.

Computing Methodologies↗
PubMed1999

Sophisticated hospital information system/radiology information system/picture archiving and communications system (PACS) integration in a large-scale traumatology PACS.

Picture archiving and communications system (PACS) in the context of an outpatient trauma care center asks for a high level of interaction between information systems to guarantee rapid image acquisition and distribution to the surgeon. During installation of the Innsbruck PACS, special aspects of traumatology had to be realized, such as imaging of unconscious patients without identification, and transferred to the electronic environment. Even with up-to-date PACS hardware and software, special solutions had to be developed in-house to tailor the PACS/hospital information system (HIS)/radiology information system (RIS) interface to the needs of radiologic and clinical users. An ongoing workflow evaluation is needed to realize the needs of radiologists and clinicians. These needs have to be realized within a commercially available PACS, whereby full integration of information systems may sometimes only be achieved by special in-house solutions.

Ambulatory Care Facilities↗
PubMed2005

Effect of illumination in an integral imaging system with large depth of focus.

We present the characteristics of integral imaging systems with large depth of focus (DOF) by use of two kinds of illumination: plane illumination and diffusing illumination. For each system, we perform ray analysis based on ray optics. To check the visual quality through optical experiments, we use an average image of observed images picked up at various positions within a large DOF. The synthesized elemental images for a three-dimensional (3-D) object with two character patterns were displayed in an optical system and its reconstruction experiments are performed. Experimental results show that use of diffusing illumination can improve visual quality of reconstruction 3-D images in depth-priority integral imaging.

Journal Article↗
PubMedDate not supplied

Integrated health systems: building the perfect IT beast.

The evolution of managed care, from strictly paying for to actually providing care, has shifted the focus of information technology in this industry as well. Today, the perfect managed care information system requires functionality beyond claims processing and back-end HMO operations. The IT goal for integrated health system (IHS) executives should be a hybrid of both payor- and provider-based functionalities.

Delivery of Health Care, Integrated↗
PubMed1980

CNS control over gill reflex behaviors in Aplysia: satiation causes an increase in the suppressive control in older but not young animals.

The CNS and PNS interact and form an integrated system which mediates adaptive gill withdrawal reflex behaviors evoked by tactile stimulation of the siphon. The CNS exerts suppressive and facilitatory control over the PNS in the mediation of these behaviors. It was found that in Aplysia the CNS's supressive control over the PNS was significantly greater than in nonsatiated control animals. In the controls, the evoked gill reflex met a mimimal response amplitute criterion with the CNS and PNS present, while in the satiated group the reflex did not meet this criterion. In the control group, the relflex amplitute and the subsequent habituation were the same following removal of the CNS, while in satiated animals the reflex amplitude was larger and the rate of habituation slower with only the PNS intact. Satiation had no effect on young Aplysia since CNS control was not yet operable. It is thus of prime importance to take the "state" of the preparation into consideration in the analysis of the neural mechanisms that underlie adaptive gill reflex behaviors. The gill withdrawal reflex and its subsequent habituation evoked by repeated tactile stimulation of the siphon in Aplysia has been studied extensively in an attempt to gain an understanding of the neuronal mechanisms that underlie adaptive behavior (Jacklet and Lukowiak, 1975; Kandel, 1976). It has been found that the central (CNS) and peripheral(PNS) nervous systems in Aplysia interact and form an integrated system which normally mediates both the reflex and its subsequent habituation (Peretz, Jacklet, and Lukowaik, 1976; Lukowiak and Peretz, 1977). Further, it was found that in the integrated system the CNS exerted both suppressive and facilitatory control over the PNS in the mediation of gills reflex behaviors (Lukowiak, 1977a). Removal of only the CNS's suppressive control over the PNS, while leaving intact its facilitatory influence, resulted in a significant reduction in reflex latency, a significant increase in reflex amplitude, and a reflex that is resistant to habituation with repeated stimulation (Lukowiak, 1977a). In addition, it was found that an identifiable neuron, Ld9, could modulate the ability of the reflex to habituate (Lukowiak, 1979a). With induced tonic low-level activity in L9 the reflex evoked by repeated siphon stimulation did not habituate even though the synaptic decremental process which occurs in gill motor neurons such as L7 and accompanies gill reflex habituation (Castellucci et al., 1970) continued to occur. The neurons in abdominal ganglion, which by their activity exert control over the PNS and thus the reflex, have not yet been identified but it is known that these same neutrons apparently exert control over the synaptic input received by gill motor neurons such as L7 from the central sensory neurons (Byrne, Castellucci, and Kandel, 1974) as a result of siphon stimulation (Peretz and Lukowiak, 1975; Lukowiak and Peretz, 1980).

Adaptation, Physiological↗