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PubMedDate not supplied

The Virtual Hospital: an IAIMS integrating continuing education into the work flow.

Researchers at the University of Iowa are developing an integrated academic information management system (IAIMS) for use on the World Wide Web. The focus is on integrating continuing medical education (CME) into the clinicians' daily work and incorporating consumer health information into patients' life styles. Phase I of the project consists of loosely integrating patients' data, printed library information, and digital library information. Phase II consists of more tightly integrating the three types of information, and Phase III consists of awarding CME credits for reviewing educational, material at the point of patient care, when it has the most potential for improving outcomes. This IAIMS serves a statewide population. Its design and evolution have been heavily influenced by user-centered evaluation.

Attitude to Computers↗
PubMed2005

The Kaiser Permanente IT transformation.

Kaiser Permanente's major health IT initiative, KP Health-Connect, will integrate all patient information in a single system linking medical information with billing, scheduling, and registration data throughout the organization. Healthcare financial leaders whose organizations want to undertake a similar initiative should: Ensure dedicated financial leadership on the team, Maintain a collaborative relationship with other team members, Champion the project, Plan for contingencies, Develop new processes, Provide financial oversight for every phase of the project.

Financial Management↗
PubMedDate not supplied

Measuring outcomes in care of the elderly.

This observational study was designed to assess whether routine measurement of outcomes using standard instruments is possible as part of clinical routine in care of the elderly, and to establish if such instruments are responsive to clinical change. Indices of functional status, cognitive function and subjective health status were collected routinely on admission and discharge in 540 inpatients and 340 patients attending a day hospital. Data collection became integrated into clinical routine. Response rates were generally good and yielded acceptably complete data. For inpatients, outcome was reflected by measurement of survival, physical function (Barthel index) and social status, each of these indicators showing significant change between admission and discharge. For day hospital patients, neither these, nor the Nottingham ADL scale, nor a health status indicator proved sufficiently responsive to clinical change to merit recommendation as outcome indicators for routine use in older patients. In ambulatory care in older patients, such as those attending a day hospital, new approaches are needed to measure clinical outcomes.

Activities of Daily Living↗
PubMed2006

Integrating radiology information systems with healthcare delivery environments using DICOM and HL7 standards.

Integration based on open standards, in order to achieve communication and information interoperability, is one of the key aspects of modern health care information systems. Interoperability presents data and communication layer interchange. In this context we identified the HL7 standard as the world's leading medical Information and communication technology (ICT) standard for the business layer in healthcare information systems and we tried to explore the ability to exchange clinical documents with minimal integrated healthcare information systems (IHCIS) change. We explored HL7 Clinical Document Architecture (CDA) abilities to achieve radiology information system integration (DICOM) to IHCIS (HL7). We introduced the use of WADO service interconnection to IHCIS and finally CDA rendering in widely used Internet explorers.

Croatia↗
PubMed2001

Multimodal cranial neuronavigation: direct integration of functional magnetic resonance imaging and positron emission tomography data: technical note.

OBJECTIVE: This is the first report of the direct integration of functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) data into cranial neuronavigation. METHODS: In a patient with a left precentral oligodendroglioma (World Health Organization Grade III), the Zeiss MKM system (Carl Zeiss Co., Oberkochen, Germany) was used for navigation based on thin-slice, T1-weighted, contrast-enhanced magnetic resonance imaging (MRI) scans. fMRI and methionine PET data were integrated by landmark matching, with reference to skin fiducials. RESULTS: The inaccuracy of the image fusion between fMRI and T1-weighted MRI data was 1.7 mm, that between PET and T1-weighted MRI data was 4.3 mm, and that for the subsequent registration of the navigation was 1.2 mm. The correct fMRI localization of the precentral gyrus was intraoperatively verified by cortical somatosensory evoked potential (phase-reversal) monitoring. Although the tumor was not clearly defined in the MRI scans, [11C]methionine PET demonstrated a clear tumor border, enabling us to achieve gross total tumor removal without postoperative functional deficits. CONCLUSION: Functional neuronavigation permits observation and preservation of relevant brain areas. Other functional areas (such as short-term memory areas) that can be detected only by fMRI might also warrant future monitoring. The simultaneous integration of fMRI and PET data adds a new dimension to cranial neuronavigation, enabling the observation of tumors in relation to functional cortical areas (in our case, the motor strip).

Brain↗
PubMed1998

Implications of new organizational relationships and fiscal incentives on health information managers.

Whether the health field in the United States should be dominated by more competition or by more government regulation is now at the center of the public policy debate. After examining the market-driven and regulatory models to constrain cost, improve quality, and enhance access to care, the article argues that our current centrist political philosophy can be expected to continue on Capitol Hill and among the state legislatures. As a result, this will force health information managers to labor within a blended approach that is partially market driven and partially governed by regulations. How such a hybrid system will affect the future role of health information professionals, integrated information systems, and other related topics is also discussed.

Benchmarking↗
PubMed2005

Privacy protection for HealthGrid applications.

OBJECTIVES: This contribution aims at introducing the problem of privacy protection in e-Health and at describing a number of existing privacy enhancing techniques (PETs). The recognition that privacy constitutes a fundamental right is gradually entering public awareness. Because healthcare-related data are susceptible to being abused for many obvious reasons, public apprehension about privacy has focused on medical data. Public authorities have become convinced of the need to enforce privacy protection and make considerable efforts for promoting through privacy protection legislation the deployment of PETs. METHODS: Based on the study of the specific features of Grid technology, ways in which PET services could be integrated in the HealthGrid are being analyzed. Grid technology aims at removing barriers between local and remote resources. The privacy and legal issues raised by the HealthGrid are caused by the transparent interchange and processing of sensitive medical information. PET technology has already proven its usefulness for privacy protection in health-related marketing and research data collection. RESULTS: While this paper does not describe market-ready solutions for privacy protection in the HealthGrid, it puts forward several cases in which the Grid may benefit from PETs. CONCLUSION: Early integration of privacy protection services into the HealthGrid can lead to a synergy that is beneficial for the development of the HealthGrid itself.

Access to Information↗
PubMedDate not supplied

Trauma registrar training: integrating registry functions into the trauma program--Part 2.

Effective health-information management is heavily reliant upon the data-collection process of the health care program. This is also true in trauma-care systems, where healthcare providers have come to rely on timely access to complete and accurate information to support many critical functions of a trauma program. The process by which data are collected and analyzed deserves constant attention and reassessment. Data obtained in reports and analyses are only as accurate as the data abstraction and validation processes allow. The University of Pennsylvania Health System Trauma Network recognizes this, and as a result, developed this training and orientation guideline. This guideline supports the importance of the registry role in the overall trauma program, but most importantly, it fosters and supports a team approach to data collection, which in our experience has allowed us to develop and maintain trauma registry databases which provides valid, useful and current information for all.

Curriculum↗
PubMed1998

The lived experience of patient prudence in health care.

The purpose of this phenomenological study was to describe the lived experience of patient prudence in health care. Prudence has previously been defined as good judgement in setting realistic personal goals and using personal resources to achieve those goals. Audiotaped interviews were conducted with 10 hospitalized adults for whom health care providers had previously recommended life style changes for health reasons. Data were analysed using Colaizzi's method. Seventy-seven significant statements were identified and, from their formulated meanings, seven themes emerged that were integrated into a description of the fundamental structure of prudence. From the patient perspective, prudence in health care is a dynamic phenomenon that involves achieving well-being and self-perpetuation within the context of the patient's world of competing values and is experienced with emotions that range from harmony to fear and depression.

Adult↗
PubMed1994

Lessons from a child health system on opportunities and threats to quality from networked record systems.

The British Child Health System has been designed and widely implemented to support equity of access to preventive child health services, using case-based integrated records. Lately, telematics has been increasingly applied to improve the timeliness of data entry. A special project has been established to monitor overall quality of the system's use and of the resultant preventive services. The telematics application has been found to be a potential threat to quality in a way which would apply to all remote networked patient-based systems. The demonstration will show the methodology and interim results.

Child↗
PubMed1985

Employment status, employment characteristics, and women's health.

This study looked at characteristics of employment which are related to positive health among women. Aspects of employment which may account for health status differences between employed women and those not in the labor force were also studied. The subjects were 1140 adult females, aged 18 through 64. Medical record data covering seven years of inpatient and outpatient services were linked with survey data of the respondents. For all ages, women employed in jobs with a higher degree of social support and integration had better health than women in jobs with little social support and integration through work. The findings suggest that the social support and integration gained through work is a salient aspect of employment which contributes to health status differences between employed women and those not participating in the labor force.

Adolescent↗
PubMed1988

Integrated Academic Information Management Systems (IAIMS). Part II. Planning and implementing integrated information services. Integration and outreach: Integrated Academic Information Management Systems (IAIMS) at Maryland.

The University of Maryland Campus for the Professions is now realizing the first benefits of integrated academic information management systems (IAIMS). With the support of the National Library of Medicine, the information Resources Management Division has joined with the Health Sciences Library to plan and to implement change. Within the information utility concept, networked data communications and end-user computing function as the means to integration. Plans call for new 370-based software to extend system capabilities. Mechanisms for outreach ensure that the potential of integration is realized. These mechanisms include technology assisted learning centers, informatics program development, special programs (geriatrics, hypertension pilot), and new applications (conferencing system, voice mail, videodisc development, interinstitutional resource sharing).

Academic Medical Centers↗
PubMed2006

Mink as a sentinel species in environmental health.

The concept of "sentinel species" is important in the environmental health sciences because sentinel species can provide integrated and relevant information on the types, amounts, availability, and effects of environmental contaminants. Here we discuss the use of mink (Mustela vison) as a sentinel organism by reviewing the pertinent literature from exposure- and effects-based studies. The review focuses on mercury (Hg) and polychlorinated biphenyls (PCBs), as they are persistent, ubiquitous, and bioaccumulative contaminants of concern to both humans and wildlife. Mink are widely distributed, abundant, and regularly trapped in temperate, aquatic ecosystems, and this makes them an excellent model to address issues in environmental pollution on both temporal and spatial scales. As a high-trophic-level, piscivorous mammal, mink can bioaccumulate appreciable concentrations of certain pollutants and have been shown to be sensitive to their toxic effects. The husbandry and life history of mink are well understood, and this has permitted controlled dosing experiments to be conducted using animals reared in captivity. These manipulative studies have yielded important quantitative information on exposure-response relationships and benchmarks of adverse health effects, and have also allowed the cellular mechanisms underlying toxic effects to be explored. Furthermore, the data accrued from the laboratory continue to validate observations made in the field. Research derived from mink can bridge and integrate multiple disciplines, and the information collected from this species has allowed environmental health scientists to better understand and characterize pollution effects on ecosystems.

Animals↗
PubMed1998

Nursing informatics: a universal nursing language.

Knowledge is necessary to use information to make decisions in nursing situations. Nursing data must be grouped in a logical way so the interrelationship between the classification systems and specific concrete phenomena in individual nursing situations is useful. The processing and management of information for decision making is the focus in nursing and health care. The development and use of language that represents the domain of nursing is an essential dimension in an integrated and coordinated health care delivery system. The design and acceptance of a universal nursing language system is critical to collect appropriate data to document nursing's role, functions, and effectiveness in health care by the year 2000. This is an urgent message for nurses to be involved in the technology and nursing care documentation to demonstrate quality care that is cost effective. In the next century, nurses must speak a common nursing language that has the same meaning for all nurses.

Humans↗
PubMed2002

How to produce EDMS requirements and cost-benefit data.

Electronic document management systems (EDMS) have a profound impact on administrative operations of health care provider organizations. Thorough yet conservative system requirements and cost-benefit data can prove the necessity and priority of the EDMS. This case study-based article provides a methodology for all EDMS implementations, including the preparation of the vision and scope, business analysis, cost-benefit analysis, and system specification and project plan. These are illustrated with EDMS examples. To successfully minimize project risk, the article reviews the importance of phasing, standards, and integration, and it provides six detailed examples of this methodology.

Cost-Benefit Analysis↗
PubMed2001

Strategies for integrating primary health services in middle- and low-income countries: effects on performance, costs and patient outcomes.

BACKGROUND: Integration of primary health care is change to bring together inputs, organisation, management and delivery of particular service functions. Integration has been promoted in the health sector to improve the efficiency of health care delivery. The need for integration arose from perceptions that services were fragmented when delivered through separate vertical programmes. Integration is relevant to the health system at various levels, and this review is concerned with integration at the point of delivery. OBJECTIVES: To assess the effects of strategies to integrate primary health care services on producing a more coherent product and improving health care delivery and health status, in relation to service cost, outputs, impact and user acceptability. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register (August 2000), MEDLINE (1966 to September 2000), EMBASE (1988 to September 2000), Socio Files (1974 to September 2000), Popline (1970 to September 2000), HealthStar (1975 to September 2000), Cinahl (1982 to September 2000); Cab Health (1972 to 1999), International Bibliography of the Social Sciences (1970 to 1999), and reference lists of articles. We also searched the Internet and World Health Organization (WHO) library database, hand searched relevant WHO publications and contacted experts in the field. SELECTION CRITERIA: Randomised trials, controlled before and after studies, and interrupted time series analyses of integration strategies in primary health care services. Health services in high-income countries were excluded. The primary outcomes were service outputs: productivity and coverage, impact, user acceptability and unit cost. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Four studies were included. There was no consistent pattern of benefit. Integration had a clear positive effect on the outputs in only one study; in another it had similar effects to vertical programme delivery but greater effect than the control group. In the other two studies integration resulted in negative outputs in comparison with vertical programmes, although in one of these integration performed better than the control group. REVIEWER'S CONCLUSIONS: Few studies of good quality, large and with rigorous study design have been carried out to investigate the evidence to support integration as a style of service delivery. In fact, some studies found greater effects for vertical health care delivery. Policy makers and planners considering integration could introduce strategies, using rigorous study design, to allow further evaluation and increase the base of studies from which to draw evidence.

Clinical Trials as Topic↗