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PubMed1999

The "mediator service", a component to ease the integration of medical applications in the SynEx framework.

Interoperability is a key issue and a long-term domain of research for distributed healthcare information systems. The European project SynEx provides an open and standard integration platform for both new and legacy medical applications. It allows the collaboration of distributed and heterogeneous healthcare records and services. It aims to provide access to Hospital Information Services, to remote sources of medical data and to medical knowledge, in a seamless way, hiding the distribution aspects and the heterogeneity of systems. In this project, the Medical Informatics Department of the Broussais University Hospital is responsible for the development of the "Mediator Service". It is a software component of the SynEx platform which is used as a "glue" mechanism to provide a flexible way to facilitate the interchange between any pair of systems, with different nomenclatures and data structures. The Mediator Service uses a generic model of mediators to create, through specialization, specific mediators for practical cases. Based on this model, it offers a C++ library to be used as the tool case by the programmers, to reduce the development effort. The use of XML as a powerful data interchange format and as a data structure descriptor is proposed and evaluated.

Computer Communication Networks↗
PubMed2001

Presence and chromosomal subtyping of Legionella species in potable water systems in 20 hospitals of Catalonia, Spain.

OBJECTIVE: To investigate the presence and clonal distribution of Legionella species in the water supply of 20 hospitals in Catalonia, Spain. SETTING: 20 hospitals in Catalonia, an area of 32,000 km2, located in northeast Spain. METHODS: Environmental cultures of 186 points of potable water supply and 10 cooling towers were performed for the presence of Legionella species. Following filtration and acid treatment, the samples were seeded in selective MWY (modified Wadowsky Yee)-buffered charcoal yeast extract-alpha agar. All isolates obtained were characterized microbiologically and genotyped by SfiI pulsed-field gel electrophoresis (PFGE). RESULTS: 73 of 196 water samples, representing 17 of the 20 hospitals included in the study, were positive for Legionella pneumophila (serogroups 1, 2-14, or both). The degree of contamination ranged from 200 to 74,250 colony-forming units/L. Twenty-five chromosomal DNA subtypes were detected by PFGE. A single DNA subtype was identified in 10 hospitals, 2 DNA subtypes were observed in 6 hospitals, and 1 hospital exhibited 3 different DNA subtypes. Each hospital had its own Legionella DNA subtype, which was not shared with any other hospitals. CONCLUSIONS: Legionella was present in the water of most of the hospitals studied; each such hospital had a unique, dominant chromosomal DNA subtype. The verification of several genomic DNA restriction profiles in such a small geographic area demonstrates the great genetic diversity of Legionella in the aquatic environment.

Bacterial Typing Techniques↗
PubMed1989

Piecing together a distributed system at Albany Medical Center.

When, after decades of debate, Albany Medical Center Hospital and Albany Medical College joined under an umbrella corporation in 1982, AMC started down the path toward an integrated clinical information system. What makes the AMC HIS--parts of which are still in prototype--notable, is its use of leading edge, if relatively new, systems.

Academic Medical Centers↗
PubMed2004

Communicable diseases monitored by disease surveillance in Kottayam district, Kerala state, India.

BACKGROUND & OBJECTIVES: A disease surveillance model developed in the North Arcot district, Tamil Nadu, was found to be practical, efficient, inexpensive and useful for public health action to monitor the success of ongoing interventions and to detect and intercept outbreaks. It was centred in the private (voluntary) sector with full co-operation and participation by the government sector. As Kerala state wanted to replicate this model in all districts, one district was chosen to pilot test it centred within the existing district public health system, soliciting participation from the private sector. A two-year (1999-2001) performance of this model is presented. METHODS: After elaborate preparations including the selection of 14 diseases to be reported and training of doctors in the private sector health care institutions and doctors and paramedical staff in all government health centres and hospitals, printed post cards were widely distributed. The business reply system was used so as to avoid handling postage stamps. Cards were received by the nodal officer in the district public health office and checked on a daily basis to detect disease prevalence and evidence of clustering in time and space. Swift action was taken on detecting case clustering. A monthly bulletin containing disease summaries and other useful information was freely distributed to all reporting centres. RESULTS: On an average, just over 100 disease reports were received every month. The most frequently reported diseases were, in the descending order, leptospirosis, acute dysentery, typhoid fever and acute hepatitis. Among vaccine-preventable childhood diseases, only measles was reported, but no diphtheria, tetanus or whooping cough. Several outbreaks were detected early and interventions applied to intercept them. The most striking example was that of cholera, the occurrence of which was detected swiftly for instituting highly successful control measures. INTERPRETATION & CONCLUSION: The district level disease surveillance system centred in the government public health system has been highly successful. Disease surveillance was responsible for the government to obtain information on the prevalence of leptospirosis in the district. The reports enabled the public health officers to detect disease-clustering as the early signals of outbreaks and to take quick remedial measures.

Cluster Analysis↗
PubMed2005

Influence of computerised medication charts on medication errors in a hospital.

INTRODUCTION: In hospitals where computerised physician order entry systems will not be available in the near future, there is a need to explore other ways of reducing medication errors that occur in the drug ordering and delivery system. One of these ways is the use of a computerised medication chart that is updated daily. The aim of this study was to evaluate the frequency, types and potential clinical significance of drug prescription and administration errors by comparing a traditional medication distribution system (where the transcription of handwritten into printed medication orders takes 3-5 days and the transfer of medication orders was not complete) with the use of a computerised medication chart (which was updated daily by pharmacy assistants on the ward). METHODS: Data were collected during two 3-week periods, from a 32-bed internal medicine unit, before and after the introduction of the computerised medication charts. Prescribing errors were observed by evaluation of all new and changed medication orders and administration errors were detected by using the disguised-observation technique. RESULTS: For prescribing errors, a total of 611 prescriptions before and 598 prescriptions after the intervention were evaluated. The total prescription error rate (of medication orders with >or=1 error) was found to be significantly higher with the computerised charts when compared with the old system (50.0% [299 of 598] vs 20.3% [124 of 611], odds ratio [OR] 3.80 [95% CI 2.94, 4.90]). This increase was caused by an increase in administrative prescription errors with a low potential clinical significance (mainly omission of the prescriber's name and the prescription date). The error rate for errors with a potential clinical significance was found to be significantly lower because the prescription error 'duplicate therapy' was eliminated (3.4% with the traditional medication chart vs 0% with the computerised chart). For administration errors, a total of 1122 drugs before the intervention and 1175 drugs after the intervention was observed to be administered. The total administration error rate was found to be significantly lower after the intervention (6.1% [72 of 1175] vs 10.5% [118 of 1122], OR 0.61 [95% CI 0.45, 0.84]), as was the error rate with a potential clinical significance. The contribution of handwritten medication orders to the total amount of medication orders was significantly decreased after the intervention (12.8% vs 20.6% [95% CI 4.6, 11.0]) and the administration of a drug ordered by a handwritten medication order resulted in a significantly higher administration rate than with administration of a drug ordered by a printed medication order (before the intervention 20.7% vs 8.0%, OR 2.99 [95% CI 1.96, 4.56], after the intervention 11.4% vs 5.6%, OR 2.18 [95% CI 1.16, 4.11]). CONCLUSION: This observational study shows a significant reduction in clinically relevant, administration and (therapeutic) prescription error rates when applying a system using computerised and daily updated medication charts compared with a system using traditional medication charts. Therefore, the use of computerised and daily updated medication charts has the potential to improve the quality of the medication distribution process in hospitals waiting for the implementation of a computerised physician order entry system.

Aged↗
PubMedDate not supplied

[Cost-benefit analysis of a semi-automated process in the preparation of unit-doses by the Pharmacy Department].

OBJECTIVE: To determine in monetary terms the effect of implementing a semi-automated procedure for preparation of drugs for unit dose distribution. METHODS: The current net value was estimated for three different flows involved in the evaluation of semi-automated drug storage and retrieval systems used in the unit dose distribution area in a hospital: capital investment, staff costs and structural costs related to physical space occupied. RESULTS: Implantation of the new work procedure produced an annual saving of 32,390 euro in staff costs and 5,645 euro in structural costs. Global cash flow has been estimated in -96,565 euro for a five year amortization period, with a benefit/cost ratio of 2.19. CONCLUSION: Replacement of traditional unit dose cart filling systems by a semi automated procedure presents a positive benefit/cost ratio and initial investment is paid off in 44 months.

Automation↗
PubMed1996

The NUCLEUS integrated electronic patient dossier breakthrough and concepts of an open solution.

This paper addresses the requirements of healthcare providers and hospital managers vis-à-vis electronic patient records that can be integrated. It starts from some critical failure factors, found with previous attempts to standardise the electronic health record. Standardisation appears to be the key issue: the subject of standardisation requires delicate positioning. Technology must provide us with the means to obtain the standardised foundation for an integrated health record concept, which can be completely configured and customised to meet the requirements of health professionals and institutions involved. NUCLEUS, project A2025 in the AIM programme, has taken on this endeavour, and with good success. This paper summarises the benefits of this approach for various categories of people interested in using electronic patient records. Moreover, it illustrates NUCLEUS' contribution to achieving seamless integration of care. Furthermore, this paper explains the conceptual innovations that have been achieved in the NUCLEUS project. It consolidates the main concept of Act Management, structuring the professional primary process as well as the interprofessional communication. These concepts are subsequently expanded to include the key elements of the NUCLEUS integrated electronic patient record. Next, the paper reflects on what has appeared to be one of the critical success factors of the electronic patient record: its configuration and customisation facilities. These facilities make it possible to access the patient record at various intuitive aggregation levels and to make the integrated patient record 'look like' the individually specialised record of the respective healthcare professionals. Finally, the paper addresses various topics required to facilitate the successful implementation and operation of the NUCLEUS integrated electronic patient record like security, integrity, message communication, distribution, heterogeneity and the context of the hospital information system.

Communication↗
PubMed2005

Role of air distribution in SARS transmission during the largest nosocomial outbreak in Hong Kong.

UNLABELLED: Severe acute respiratory syndrome (SARS) is primarily transmitted by bio-aerosol droplets or direct personal contacts. This paper presents a detailed study of environmental evidence of possible airborne transmission in a hospital ward during the largest nosocomial SARS outbreak in Hong Kong in March 2003. Retrospective on-site inspections and measurements of the ventilation design and air distribution system were carried out on July 17, 2003. Limited on-site measurements of bio-aerosol dispersion were also carried out on July 22. Computational fluid dynamics simulations were performed to analyze the bio-aerosol dispersion in the hospital ward. We attempted to predict the air distribution during the time of measurement in July 2003 and the time of exposure in March 2003. The predicted bio-aerosol concentration distribution in the ward seemed to agree fairly well with the spatial infection pattern of SARS cases. Possible improvement to air distribution in the hospital ward was also considered. PRACTICAL IMPLICATIONS: Our study revealed the need for the development of improved ventilation and air-conditioning systems in an isolation ward or a general hospital ward for infectious respiratory diseases. The outbreak in Ward 8A, which was in a general hospital and could house nearly 40 patients, demonstrated the cross-infection risks of respiratory infectious diseases in hospitals if a potential highly infectious patient was not identified and isolated. Our example simulation, which extended the SARS Busters' design for an isolation room to Ward 8A, demonstrated that there was room for improvement to minimize cross-infection in large general hospital wards.

Aerosols↗
PubMed1987

Distribution of ceftriaxone in the tissues of the female genital system.

Twenty-nine patients, hospitalized in order to undergo gynaecological surgery involving organ removal, were treated with a single intramuscular administration of 1 g ceftriaxone before surgery. The tissue levels of the drug determined in the organs considered: uterus, ovary, fallopian tubes, vagina, proved to be comparable and to guarantee its satisfactory and uniform penetration into the tissues of the female genital system at a slowly decreasing rate. The high levels observed 12 h and 24 h after administration (2.24 +/- 0.74 mcg/g; 3.58 +/- 0.60 mcg/g; 0.70 +/- 0.45 mcg/g; 1.20 +/- 0.57 mcg/g in the ovaries and myometrium respectively) suggest a possible application of ceftriaxone in presurgical prophylaxis also in cases of female genital surgery.

Adolescent↗
PubMed1998

Smoking habits and cessation programme in an Australian teaching hospital.

BACKGROUND: Data on prevalence of cigarette smoking by hospital employees are limited in Australia, but anecdotal evidence suggests that many health sector employees continue to smoke despite abundant evidence regarding the harmful effects of this habit. Nicotine is an addictive drug and arguably this should be known better in the health industry than in any other industry. Despite having this knowledge at their disposal, health sector employers rarely provide assistance to employees, relying instead on restrictive policies to reduce smoking in the workplace. METHODS: To assist employees to quit smoking, we instituted a medium intensity Stop Smoking Programme, run by a clinical pharmacist offering nicotine patches and support on a weekly basis. A principal aim of the service was to redress the imbalance between the availability of cigarettes and the most effective nicotine replacement therapy, the trandermal nicotine patch. Following 18 months operation of this service, we surveyed hospital employees to ascertain smoking rates and views on smoking cessation in this South Australian teaching hospital. RESULTS: In the first 18 months of operation, 111 staff members availed themselves of the service. At the first follow up period (three months), 21 were not contactable, 29 were successful in not smoking and 61 were still smoking. Six of the 29 who were not smoking at three months resumed smoking by six months, and a further four resumed smoking by 12 months. At the time of this report, 12 of the remaining 19 non smokers had completed two years since quitting and a further three of these had resumed regular smoking by this time. The cost of providing the service was modest at approximately $180.00 per known successful quitter. Results from the survey showed that 12.4% of hospital employees were regular smokers. Smoking prevalence was not equally distributed with female employees being twice as likely to smoke as their male counterparts and employees in the catering department having the highest smoking prevalence (23.8%). CONCLUSIONS: Although the prevalence of cigarette smoking by employees of this teaching hospital is lower than for the general community, health sector employers can reduce smoking prevalence further by providing assistance to their employees to quit smoking. The Stop Smoking Programme we describe is effective and could be replicated by other hospitals and similar organisations.

Australia↗
PubMed1999

[Progress of the laboratory supporting system of the ordering system].

University hospitals and large public hospitals introduced a first-generation ordering system, which mainly involved an integrated system developed by each institution. This type of system considerably improved the efficiency of hospital jobs, but clinically increased the burden of data-input handling of hospital staffs because the software used was unique to the respective unit. Later, the development of both network technology and package software for the ordering system allowed construction of an easy, low-cost and high-performance ordering system. Most of the recent ordering systems are a type of distributed system which is referred to as a client-server system. In this system the terminal was replaced by personal computer loaded with widely distributed Windows OS, resulting in better performance of multi-tasks. In February 1998, our hospital information system was changed from an intensive host-type to a client-server system, in which the laboratory ordering system was also reconstructed. The laboratory ordering system mainly utilizes EG Main for Windows, package software by Fujitsu Co. Ltd., and has reduced the handling of laboratory ordering jobs with Graphical User Interface and better construction of screen images. In addition to extra-laboratory tests, ordering into this system allowed the database of all the laboratory tests ordered in our hospital to be unified. The previous laboratory ordering system supported laboratory data, especially those of laboratory tests and samples conducted within the last 10 years, and the new system will also provide this function. The new laboratory ordering system is further expected to support reference image-data from physiological tests as well as to allow consultation concerning laboratory test data. These clinical job-supporting systems will likely lead to further progress of the total laboratory system.

Clinical Laboratory Information Systems↗
PubMed1996

The implications for information system design of how health care costs are determined.

As the costs of health care assume increasing importance in national health policy, information systems will be required to supply better information about how costs are generated and how resources are distributed. Costs, as determined by accounting systems, often are inadequate for policy analysis because they represent resources consumed (expenditures) to produce given outputs but do not measure forgone alternative uses of the resources (opportunity costs). To accommodate cost studies at the program level and the system level, relational information systems must be developed that allow costs to be summed across individuals to determine an organization's costs, across providers to determine an individual patient's costs, and across both to determine system and population costs. Program level studies require that cost variables be grouped into variable costs that are tied to changes in volume of output and fixed costs that are allocated rationally. Data sources for program-level analyses are organizational financial statements, cost center accounting records, Medicare cost reports, American Hospital Association surveys, and the Department of Veterans Affairs (VA) cost distribution files. System-level studies are performed to predict future costs and to compare costs of alternative modes of treatment. System-level analyses aggregate all costs associated with individuals to produce population-based costs. Data sources for system-level analyses include insurance claims;n Medicare files; hospital billing records; and VA inpatient, outpatient, and management databases. Future cost studies will require the assessment of costs from all providers, regardless of organizational membership status, for all individuals in defined populations.

Accounting↗
PubMedDate not supplied

A system for efficient scheduling of patient tests in hospitals.

Patient tests in hospital environments involve a significant percentage of hospital resources. The patient must occupy some of his/her time, personnel and equipment have to be allocated, co-operation between hospital laboratories and departments must be ensured, tests should be performed within rigid time limits and the results should be ready before due times imposed by doctors, nurses or other medical personnel. From the patient's point of view there must be almost no distress, while hospital management wants as much equipment utilization as possible. In the present paper we propose a system for efficient scheduling of patient tests, while obeying all temporal and managerial limitations as well as observing all medical procedures. This system, which we call HOSTESS, uses a new approach, the dynamic distributed scheduling for managing the patient test requests in large hospitals, with many laboratories that perform a multitude of tests. The system is designed as a modular expandable application, in order to perform efficiently under heavy loads. Doctors, nurses, laboratory technicians and other personnel enter their requests and HOSTESS creates consistent schedules for every equipment needed in the required tests.

Algorithms↗
PubMed1991

PC development gives Baptist Medical Center mainframe power.

Sophisticated distributed applications are easier to develop and maintain when prototyped using personal computer (PC) technology. Baptist Medical System, the largest hospital system in Arkansas, is using PC technology to prototype and then develop mainframe-based applications that augment mission-critical, distributed systems.

Arkansas↗
PubMed2005

[Pediatric medication errors and their prevention].

Two investigations, one carried out throughout France (PediAD) and the other exclusively in Robert Debré pediatric hospital (PediEM), focus on the difficulties encountered by nursing staff when administering drugs to children, and the risk of medication errors. Medication errors can arise from dysfunctions at all stages of the drugs circuit, and may involve doctors, pharmacists or nursing staff. In pediatric hospitals they are mainly related to the lack of commercial products specifically designed Jor children. In Robert Debré Hospital, only one-third of commercial products in stock are authorized for pediatric use with no age limit. Thus, even in a hospital where drug distribution is entirely computerized (PCS Patient Care System software), where dispensing is based on the DIP system (daily, individual, and personal) but is not con trolled, and where almost all requirements for sterile and non sterile preparations are met but where validation is only partial, the system is far from being error-free. Two major improvements are planned. First, dispensing will be automated in 2006. With the current shortage of pharmacy technicians, this will securitize drug dispensing and provide for therapeutic and economic traceability. Second, integration of a pharmacist within each medical team is being compared with validation of prescriptions by a pharmacist in the hospital pharmacy.

Automation↗
PubMed2000

[System design and implementation of a distributed PACS].

It is inevitable for our country to take the concept of informationized hospital in order to improve diagnosis quality and reduce administrative overhead. However we can not follow the way that has been taken in developed countries because of the national conditions of China. So we have to take some effective strategies to implement our high performance PACS. Based on our concrete experience gained from the development of a PACS in Shanghai, this paper presents a distributed architecture of PACS and describes the design detail of several PACS core components.

Computer Communication Networks↗
PubMed1994

[Profile of microbiological analyses needed for hospitalized clients at the Maisonneuve-Rosemont hospital].

During five consecutive administrative periods, a computer data bank was set up from informations written on laboratory forms requesting tests in microbiology. A total of 13,260 forms were received and 11,591 were included in our study. 7,010 tests (60%) were requested from medical specialties; 40% of these tests were from patients admitted on hematology and on pediatrics wards. Of the 4,581 remaining tests, 36% were ordered for patients admitted on general surgery and on ophthalmology wards. Medical patients had three times as much blood cultures requested than surgical patients. The numbers of urine cultures done for medical and surgical patients were however similar (1,832 and 1,699 respectively). The average cost for microbiology cultures was twice as much in medical than in surgical patients. Such analysis of prescribing profile for laboratory tests provides useful information for the diagnosis related groups (DRG) system and can allow for a more efficient distribution of hospital resources.

Databases, Factual↗
PubMed1999

Has DRG payment influenced the technical efficiency and productivity of diagnostic technologies in Portuguese public hospitals? An empirical analysis using parametric and non-parametric methods.

The use of Diagnosis Related Groups (DRG) as a mechanism for hospital financing is a currently debated topic in Portugal. The DRG system was scheduled to be initiated by the Health Ministry of Portugal on January 1, 1990 as an instrument for the allocation of public hospital budgets funded by the National Health Service (NHS), and as a method of payment for other third party payers (e.g., Public Employees (ADSE), private insurers, etc.). Based on experience from other countries such as the United States, it was expected that implementation of this system would result in more efficient hospital resource utilisation and a more equitable distribution of hospital budgets. However, in order to minimise the potentially adverse financial impact on hospitals, the Portuguese Health Ministry decided to gradually phase in the use of the DRG system for budget allocation by using blended hospital-specific and national DRG case-mix rates. Since implementation in 1990, the percentage of each hospital's budget based on hospital specific costs was to decrease, while the percentage based on DRG case-mix was to increase. This was scheduled to continue until 1995 when the plan called for allocating yearly budgets on a 50% national and 50% hospital-specific cost basis. While all other non-NHS third party payers are currently paying based on DRGs, the adoption of DRG case-mix as a National Health Service budget setting tool has been slower than anticipated. There is now some argument in both the political and academic communities as to the appropriateness of DRGs as a budget setting criterion as well as to their impact on hospital efficiency in Portugal. This paper uses a two-stage procedure to assess the impact of actual DRG payment on the productivity (through its components, i.e., technological change and technical efficiency change) of diagnostic technology in Portuguese hospitals during the years 1992-1994, using both parametric and non-parametric frontier models. We find evidence that the DRG payment system does appear to have had a positive impact on productivity and technical efficiency of some commonly employed diagnostic technologies in Portugal during this time span.

Diagnosis-Related Groups↗