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At least 865 records · Page 48Linked to original sources
PubMed1983

The impact of a private group practice of converting to an automated medical information system.

As hardware and software developments make medical information systems increasingly available to physicians office practices and outpatients facilities, there is a need to focus on systems installation and conversion issues. In addition to the detailed step-by-step implementation plan, the overall impact of the new system should be anticipated. The purchasers should consider such issues as new information flow and user communication patterns between patient care and ancillary and support departments; restructuring of fundamental approaches to work allocation for either batch or real-time systems; and new emphasis on any departments vital to problem-spotting and solving. At California Primary Physicians (CPP), an awareness of these changes did not develop until well after the official "live" data had passed and the staff had been successfully using the system for several months. This paper explains how the above issues have emerged and the impact they have had on CPP, and provides a framework for anticipating such matters in any system installation.

California↗
PubMed1984

Carry-over of medical information system influence to control patients.

Evaluations of medical information systems (MIS) often compare one or more dependent variables between experimental patients having the MIS available and control patients. Typically, physicians who are exposed to and therefore are potentially influenced by the MIS during visits with experimental patients also see control patients, thus possibly weakening the internal validity of subsequent comparisons between the MIS and the control conditions. The present study examines the possible bias due to carry-over of MIS influence to control patients in the context of a prospective, randomized design.

Diagnostic Tests, Routine↗
PubMedDate not supplied

Health reform and the VA medical care system.

Although the Department of Veterans Affairs medical care system is literally the largest health care system in the free world, it's value has been largely overlooked in the debate on national health care reform. VA performs essential functions and provides special services that must not be lost in the process of reform. Restructuring the U.S. health care delivery and financing systems will certainly affect VA, therefore any serious plan for reform should specify the VA's role and responsibilities in tomorrow's national health care system.

Decision Making, Organizational↗
PubMed1994

Air medical transport systems as a health-care integrator. Association of Air Medical Services.

Air medical transport services are an essential, cost-effective component of health-care delivery in the United States. Air medical transport services provide rapid access to high-quality, sophisticated medical technologies over large geographic areas. They reduce the cost of duplicating resources by obviating the need to provide similar levels of access and service at multiple locals in the region. The sophistication and quality of care maintained during transport provides a level of services not available with traditional ground transport services, particularly in rural areas. Air medical transport services also facilitate linkages between primary, secondary and tertiary-care facilities, allowing integration of programs and services to create regionalized systems of healthcare. While numerous strategies are necessary to reduce health-care costs in the United States without reducing quality and access, air medical transport systems are uniquely positioned to support the efficient integration of regional healthcare services, while maintaining the highest standards of care for patients.

Air Ambulances↗
PubMed1989

Opportunistic research in general practice using a low cost microcomputer based medical record system as a tool.

A low cost microcomputer-based medical record system was used to facilitate opportunistic research projects in the teaching clinic of the Chinese University of Hong Kong. An example of an actual clinical trial comparing the effectiveness of three methods of teaching breast self-examination to clinic patients was used and the process of setting up the research protocol, the sampling of patients, and the analysis of early results after one and a half years were described. It was found that the sampling bias in opportunistic research was that subjects selected were more likely to be older with more problems, and have a higher attendance rate at the clinic. The bias could be corrected during the analysis of data by stratifying the selected sample into groups of different attendance rates. Another potential sampling bias was due to non-compliance of both the patients and the clinical staff. However, it was found to be possible to obtain useful results from opportunistic research. It was easy to implement this type of research with the help of a computerized medical record system.

Adult↗
PubMed2000

[Future direction of medical care system for patients with infectious disease and the new infectious diseases control law in Japan--centering around a category 1 hospital].

As of April 1, 1999, the new Infectious Diseases Control Law became effective in Japan. Under the new law, there are three types of category for medical care systems such as "Specified Infectious Disease Medical Hospital", "Category 1 Infectious Disease (Ebola virus hemorrhagic fever, Marburg disease, Lassa fever, Crimean-Congo hemorrhagic fever and plague) Designated Hospital" and "Category 2 Infectious Disease (Cholera, Sigellosis, Typhoid fever, Paratyphoid fever, Poliomyelitis and Diphtheria) Designated Hospital". In these categories, "Category 1 Infectious Disease Designated Hospital" should be designated by prefectural governments, one hospital per prefecture. Recently some papers indicated that (1) whether each government should arrange a category 1 hospital, (2) whether strict isolation with precautions against airborne spread including negative air pressure with anterior-room should be required, (3) plague is not a dangerous disease and the patient with plague is not required of Category 1 hospital but Category 2 hospital for medical care and infection control. The purpose of this article is, including a counterargument for these opinion, to summarize the point of view for the new medical care system under the new law and to search for the future medical care system in Japan. First of all, medical care for patients with infectious diseases should not be a special one but the extension of the general one. Second, we understand that one of the purposes for Category 1 hospital is the core hospital concerning the therapy, pre/post education and research for infectious diseases in each prefectures. Third, the constructive standard for Category 1 hospital should be a strict one including negative air pressure rooms with an anterior-room and an outside hall, and the air should not be recirculated. Under the big chance of enforcement of this new Infectious Diseases Control Law in Japan, we should try to restruct about medical care system for patients with infectious diseases in a long-range plan.

Hospital Design and Construction↗
PubMed2003

Kaiser Permanente gets ready to roll out automated medical records system nationwide.

Use of automated medical records (AMRs) got a boost last month when Kaiser Permanente, the nation's largest integrated health management organization, announced that all its regions will begin moving to an AMR system this year. While the system has the obvious advantages of making healthcare records more up-to-date and complete when a patient visits, it also has numerous quality-of-care advantages--both for providers and Kaiser Permanente's 8.5 million members, officials say.

Delivery of Health Care, Integrated↗
PubMed1998

The medical care system and prevention: the need for a new paradigm.

The American medical care system falls to provide effective prevention services even though some prevention services are among the most cost-effective medical procedures available. Many prevention services are routinely delivered in inefficient or ineffective ways, and new technologies may be widely and aggressively implemented despite serious doubts about their efficacy and cost-effectiveness. The barriers to effective prevention services result from conceptual limitations in our model of medical care systems, particularly the lack of a population-based perspective. A change in paradigm is needed before reforms in our health care system can improve health without bankrupting the nation.

Cholesterol↗
PubMedDate not supplied

Software reuse reference model approach in developing an automated medical information system (AMIS) for improving health care practice.

OBJECTIVE: To evaluate patient acceptance of an automated medical information system specific to headache. BACKGROUND: Studies suggest that automated tools may help health care delivery systems to be efficient and effective, but patient satisfaction remains a major concern. METHODS: We adapted our software reuse reference model and Unified Modeling Language to apply the domain model to the headache population. Patients with headache were tested both to validate the system and to evaluate patient satisfaction and headache management with an automated system. RESULTS: The mean age of all study participants was 44 years. Over 95% of the participants were satisfied or strongly satisfied with the Automated Medical Information System. CONCLUSIONS: The results strongly suggest that patients are willing and able to use nontraditional sources, such as the Automated Medical Information System, to learn about their illnesses.

Adult↗
PubMedDate not supplied

Medicated intrauterine systems for treatment of endometriosis-associated pain.

Medicated intrauterine systems (IUSs) are intrauterine devices that act by means of the local release of a medication. The levonorgestrel (LNG)-IUS is a T-shaped device that releases the progestogen LNG directly into the uterine cavity. The LNG-IUS can be used with noncontraceptive, therapeutic intent for idiopathic menorrhagia, hormonal replacement therapy in conjunction with oral or transdermal estrogens, and endometriosis or adenomyosis-associated pain. For this last indication, however, the use of the LNG-IUS is still under clinical investigation.

Contraceptive Agents, Female↗
PubMed2002

Medical care system for NASA-Mir spaceflights.

A fundamental goal of space medicine is to maintain the health and fitness of spacecrews. Meeting this goal requires reliable, effective, up-to-date medical support systems for use in microgravity. This article describes some of the factors considered in the design and assembly of Russian and U.S. in-flight medical care systems. The successful mutual use of U.S. and Russian medications and medical equipment under the NASA-Mir program conclusively demonstrated the importance and advantages of cooperation among participating space agencies. Continued progress toward the integration of U.S. and Russian flight medical systems will further increase the effectiveness of the medical support of joint missions aboard the International Space Station.

Emergency Medical Services↗
PubMed1993

Emergency vehicle intervals versus collapse-to-CPR and collapse-to-defibrillation intervals: monitoring emergency medical services system performance in sudden cardiac arrest.

STUDY OBJECTIVE: To compare emergency vehicle response intervals with collapse-to-intervention intervals to determine which of these system data better correlated with survival after prehospital sudden cardiac arrest. STUDY DESIGN: A 22-month case series, collected prospectively, of out-of-hospital cardiac arrests. Times of collapse, dispatch, scene arrival, CPR, and initial defibrillation were determined from dispatch records, recordings of arrest events, interviews with bystanders, and hospital records. SETTING: Southwestern city (population, 400,000; area, 390 km2) with a two-tiered basic life support-advanced life support emergency medical services system. Emergency medical technician-firefighters without electrical defibrillation capability comprised the first response tier; firefighter-paramedics were the second tier. PATIENTS: One hundred eighteen cases of witnessed, out-of-hospital cardiac arrest in adults with initial ventricular fibrillation. MAIN OUTCOME MEASURES: Survival was defined as a patient who was discharged alive from the hospital. RESULTS: Eighteen of 118 patients (15%) survived. Survivors did not differ significantly from nonsurvivors in age, sex, or basic life support or advanced life support response intervals. Survivors had significantly (P < .05) shorter intervals from collapse to CPR (1.7 versus 5.2 minutes) and to defibrillation (7.4 versus 9.5 minutes). CONCLUSION: Collapse-to-intervention intervals, not emergency vehicle response intervals, should be used to characterize emergency medical services system performance in the treatment of sudden cardiac death.

Aged↗
PubMed1998

Design and development of an interactive medical teleconsultation system over the World Wide Web.

The objective of the medical teleconsultation system presented in this paper is to demonstrate the use of the World Wide Web (WWW) for telemedicine and interactive medical information exchange. The system, which is developed based on Java, could provide several basic Java tools to fulfill the requirements of medical applications, including a file manager, data tool, bulletin board, and digital audio tool. The digital audio tool uses point-to-point structure to enable two physicians to communicate directly through voice. The others use multipoint structure. The file manager manages the medical images stored in the WWW information server, which come from a hospital database. The data tool supports cooperative operations on the medical data between the participating physicians. The bulletin board enables the users to discuss special cases by writing text on the board, send their personal or group diagnostic reports on the cases, and reorganize the reports and store them in its report file for later use. The system provides a hardware-independent platform for physicians to interact with one another as well as to access medical information over the WWW.

Internet↗
PubMed2007

Increasing the number of gray shades in medical display systems--how much is enough?

Medical images produced by x-ray detectors, computed tomography (CT) scanners, and other modalities typically contain between 12-16 bits/pixel, which corresponds to 4,096-65,536 shades of gray. On the other hand, we see that these images are visualized by means of medical displays that have much lower available number of gray shades. For a long time medical LCDs only supported 8 bits or 256 shades of gray per pixel. With the introduction of medical displays optimized for mammography, the available number of gray scales increased to 1,024. Recently, several manufacturers announced new display systems with higher bit depth. Because higher bit depth often directly results in higher display cost, it is a logical question to ask if this is required or even useful at all. This paper will give an answer by investigating several aspects such as limitations of the human visual system, digital imaging and communication in medicine grayscale standard display function calibration, and characteristics of medical LCDs.

Calibration↗
PubMed2005

[Efficient use and problems associated with "home remote medical support system"--utilization of videophones for homecare patients].

"Home Remote Medical Support System" (the support system) is an interactive real time communication system, consisting of a vital health measuring device and a near-television quality home digital videophone installed at a residence, to connect a primary medical care institution and a homecare patient by information communication lines. Exclusive use of a telephone, vital health measuring device, TV monitor and camera are installed as home devices to communicate with a primary personal computer at the medical institution to manage patient's data and to have video phone health consultations. We employed and conducted the support system with a help from "the remote medical assistant task" operated by the local government since April 2004. Two patients actually used the support system in the first year although we initially planned to have three. In conclusion, the support system appears to have been useful for the health management of patients with stable conditions. Meanwhile, we have to reassess the application of the support system and to balance its accountability among the user efficiency, the content of the support provider and user expenses.

Home Care Services↗
PubMed2002

The evolution and current status of emergency medical services for children.

Emergency physicians have come to believe that comprehensive pediatric emergency care should be integrated into an overall medical system and organized regionally to address the special needs of children. Since our emergency medical systems have evolved in the care of adult trauma victims, we must look to that development for the origin of our present emergency medical services for children. Not until the 1970s did it became obvious that children, just as adults, should be included in an comprehensive emergency medical system for the care of their life threatening injuries. Since there is considerable overlap in the basic principles of trauma resuscitation and management of shock in children and adults, most children's regional trauma program developed as a part of an overall emergency medical system. The sharing of trauma facilities made it possible to utilize the special expertise of a very small number of pediatric surgeons who had trauma experience and to incorporate their skills into the broader concept of comprehensive regional trauma centers for children and adults. With further experience we soon realized that such emergency medical services for children's systems should include the following components: A two way communication system, a transport system with special equipment for the management of small children, a training program for first responders at the trauma site, a designated pediatric trauma center, a pediatric intensive care unit at the regional trauma center, a neurology/neurosurgery intermediate care unit at the regional center, a pediatric trauma rehabilitation unit and finally a pediatric trauma longterm rehabilitation and management unit for those with residual disabilities. With the further development of this concept of trauma units for children, pediatric surgeons, general surgeons involved in trauma care and pediatric emergency physicians have offered leadership to expand the emergency medical system for children to include life-threatening illness, as well as injuries. Thus, the organization of regional emergency medical services for children permits the highest quality management of children with life-threatening injuries and illness. This then is the final product: an inclusive, comprehensive emergency medical system for children for all life threatening conditions, both trauma and serious illness.

Child↗
PubMed2005

CLAIM (CLinical Accounting InforMation)--an XML-based data exchange standard for connecting electronic medical record systems to patient accounting systems.

With the evolving and diverse electronic medical record (EMR) systems, there appears to be an ever greater need to link EMR systems and patient accounting systems with a standardized data exchange format. To this end, the CLinical Accounting InforMation (CLAIM) data exchange standard was developed. CLAIM is subordinate to the Medical Markup Language (MML) standard, which allows the exchange of medical data among different medical institutions. CLAIM uses eXtensible Markup Language (XML) as a meta-language. The current version, 2.1, inherited the basic structure of MML 2.x and contains two modules including information related to registration, appointment, procedure and charging. CLAIM 2.1 was implemented successfully in Japan in 2001. Consequently, it was confirmed that CLAIM could be used as an effective data exchange format between EMR systems and patient accounting systems.

Accounts Payable and Receivable↗
PubMed2003

[Time for professionalising the system of medical ethics review in the Netherlands].

In two recent papers, a radical change of the review system for medical ethics review committees was proposed. The current systems in Great Britain and Australia were described and it was suggested that the extended roles and responsibilities of the medical ethics review committees could not be fulfilled by the present committees. It was proposed that professional medical ethics committees be established with full time members who would receive an appropriate honorarium. The Netherlands has a decentralised system of medical ethics review, which is based on peer review. A radical change of the current system of medical ethics review is not warranted. There is however a need for further improvements to the current peer-review system. An important aspect of this improvement is an honorarium for the members as well as a budget for training and for the adequate scientific and administrative support of the committee by a secretariat. The fees levied for reviewing each protocol could in part finance the committee and its secretariat. However, these fees will probably not meet all of the costs. Therefore the centres involved in medical research should consider supporting their committees. It is in their interest to demonstrate their wish to protect those persons who consent to participate as research subjects. This will maintain the confidence of both the public and future participants in clinical trials. Furthermore, an efficient and adequate system of ethical review will support a balanced view towards medical research with human subjects and will also contribute to a positive image of the centre also as an attractive environment for medical professionals.

Ethics Committees↗