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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↗
PubMedDate not supplied

Duration of pain condition and physical pathology as determinants of nurses' assessments of patients in pain.

This article is based on an experiment that examined features distinguishing chronic from acute pain syndromes, and their influence on nurses' estimates of patient suffering, pain relief actions, and attitudes toward patients. Two hundred sixty-eight nurses received one-paragraph descriptions of patients complaining of severe pain. Descriptions varied on the dimensions of duration (acute vs. chronic), signs of physical pathology (positive vs. negative), signs of depression (positive vs. negative), and diagnostic category (low back vs. headache vs. joint pain). Subjects estimated the intensity of the hypothetical patient's suffering, indicated priorities for specific pain relief actions, and rated the patient on a series of trait dimensions. Subjects attributed less intense pain when the patient had no signs of pathology and when duration was long-termed and chronic. They also assigned lower priorities to medication-related nursing actions when signs of pathology were negative. Finally, more negative personality and behavioral traits were attributed to the patient when signs of pathology were negative. The results reflect a dichotomous, organic versus psychogenic model of pain on the part of health care staff. Since the data indicate the chronic pain sufferer is negatively stereotyped by staff, a need exists to develop and disseminate more integrative models of the pain experience.

Adult↗
PubMed1998

US EPA's IRIS pilot program: establishing IRIS as a centralized, peer-reviewed data base with agency consensus. Integrated Risk Information System.

The US EPA's Integrated Risk Information System (IRIS) contains Agency consensus scientific positions and quantitative values on cancer and noncancer health effects that may result from lifetime oral or inhalation exposure to specific chemical substances in the environment. Combined with specific exposure assessment information, the summary health information in IRIS may be used as a source in evaluating potential public health risks from environmental contaminants. IRIS is available to the public via EPA's Internet server at http://www.epa.gov/iris. Originally developed for internal EPA use, IRIS usage has broadened since being made publicly available in 1988 to include the private and public sectors nationally and internationally. Up to 1995, IRIS summaries were generated from within various EPA Offices and Regions and reviewed by Agency Workgroups, one for cancer and one for noncancer endpoints, before entry onto IRIS. In response to the increasing usage and recognition of IRIS and suggestions for improvement, an IRIS Pilot program was initiated in 1995. The purpose of the Pilot was 3-fold: To improve efficiency in getting information on to IRIS; to improve documentation for the positions reported in IRIS summaries, including applying new methodologies and guidance; and to improve opportunity for public input including external peer review. A new infrastructure was put in place, consisting of a cross-Agency team of 'Chemical Managers', a Pilot Program Manager, and a set of Agency 'Consensus Reviewers'. Cancer and noncancer assessments were prepared in an integrated fashion for Pilot chemical substances, documented in 'Toxicological Reviews' and derivative IRIS summaries. Public input was emphasized via an initial data call and rigorous external peer review. A final step was Agency-wide consensus review by senior staff scientists representing EPA's Offices and Regions. EPA's experience with the Pilot is forming the basis for designing operational aspects of the long-term IRIS program.

Benchmarking↗
PubMed2000

Key elements for implementing comprehensive health care models for persons with HIV: a stakeholder analysis.

A semistructured interview was conducted with 69 stakeholders in three university-based health care projects that were funded to provide an integrated continuum of care for persons living with HIV/AIDS. Data from the key informant interviews yielded composite indicators of familiarity with the service model, the importance of the elements in the service model, and the perceived quality of services provided by these innovative HIV service demonstration projects. Ratings of service quality were related to ratings of the respondent's knowledge of the service demonstration project, the importance of the various elements in the service continuum, and several indicators of stakeholder characteristics using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). The groups of stakeholders most likely to give the highest quality or success ratings for these projects are identified. The implications of these findings for developing collaborative and comprehensive service models for persons with HIV/AIDS are discussed.

Comprehensive Health Care↗
PubMed1988

Glucose intolerance as contributor to noncommunicable disease morbidity and mortality. WHO integrated program for community health in noncommunicable diseases.

The World Health Organization (WHO) has considerable evidence that several interrelated factors (e.g., smoking, hypertension, cholesterol, and obesity) contribute to total mortality. Data are presented documenting that glucose intolerance is also a risk factor for total mortality, as well as for cancer and cardiovascular morality. The Kaunas-Rotterdam Intervention Study, which documented glucose tolerance and mortality in a cohort of men, shows a linear increase in total mortality with increasing blood glucose levels. By use of multiple logistic regressions, glucose was shown to be a significant risk factor (c = .2534, t = 4.0) for total mortality. A paradigm is presented in which diabetes is placed as a disease and glucose intolerance as a risk factor within the total scheme for the development of noncommunicable diseases. The WHO action plan for integrated programs in noncommunicable diseases is discussed. The program expands on the experience gained by WHO investigators in community programs and proposes a cooperative effort globally in community-based programming.

Blood Glucose↗
PubMed2005

Engaging in the audit of acupuncture practice.

OBJECTIVES: A pilot study was undertaken to examine the feasibility of auditing and developing a national database of acupuncture practice in the United Kingdom. METHODS: One hundred forty-five (145) practitioners, members of the British Acupuncture Council, were invited to participate in the study. Those who accepted were given training and then asked to record demographic and treatment outcomes data on new patients attending their practices over a 3-month period. Two questionnaires, the Measure Your Own Medical Outcomes Profile and the College of Integrated Chinese Medicine outcome questionnaire, were compared. Baseline health status was assessed and repeated patient feedback questionnaires employed. RESULTS: Of the 31 (21%) of practitioners who responded, only 9 (6%) eventually contributed data. A total of 69 patients participated in the study: 43 (68%) of the patients were female, and 46 (73%) were aged between 30 and 59. More than half (52%) had had their presenting problem for over 5 years and most (78%) were affected daily by it. Nineteen (30%) had had prior acupuncture treatment for their condition. The main categories of complaints reported were musculoskeletal and psychologic. Thirty-two (32) out of 41 (78%) patients with completed final outcomes data recorded moderate or major benefit in their main complaint, with no reports of deterioration. CONCLUSIONS: Although willing to be involved, practitioners found the research process time-consuming and were concerned how it could be balanced against the demands of a busy practice and the interests of patients. For a national audit study to succeed, the process would have to be simplified and practitioners encouraged to engage; collection of such information could then help to provide much-needed data on acupuncture treatment in the United Kingdom.

Acupuncture Therapy↗
PubMed2000

An evaluation of patient access to their electronic medical records via the World Wide Web.

This paper describes initial experience with the Web-based Patient Clinical Information System (PatCIS). The system was designed to serve as a framework for the integration of applications that help patients access their electronic medical record, add data to their record, review on-line health information, and apply their own clinical data (automatically) to guideline programs that offer health advice. The architecture supports security functions and records user activities, relieving application developers from concerns about safe information practices and the evaluation process. PatCIS is being used to study the social and cognitive impact of allowing patients to have access to their health records via the Web. To date, PatCIS has grown to include 15 clinical functions and 4 dynamic links to literature (called infobuttons). Eleven patients have been enrolled since April, 1999; five have been active users. Experience shows that the PatCIS architecture supports application integration while providing adequate security and evaluation functions. Initial caution with the patient enrollment process has limited recruitment and, consequently, usage. However, experience thus far suggests that PatCIS has good usability and utility. No adverse events, including undesirable impact on doctor-patient interactions, have been reported. There do not appear to be any technical impediments to scaling up the enrollment to continue to observe patient usage.

Computer Security↗
PubMedDate not supplied

[Role of the INAIL].

This report has to describe the activity of INAIL for improve information and training in the field of occupational health and safety. The discussion start from accident and professional illness data and gives evidence about social and economic cost of this phenomenon. INAIL want work together with other institution, social body, professional association for promote the integration of occupational health and safety in businesses management. The principal target are SMEs - Small and Medium size Enterprises. Information and training must follow this approach and sustain it. Information and training have to develop knowledge, competence and awareness like value for the organisations. This report describe models and tools for information and training which INAIL's improving even for the building sector.

Academies and Institutes↗
PubMed1992

Integrating Radiology and Hospital Information Systems: the advantage of shared data.

Information management is central to modern patient care. Computerization of information management has resulted in both departmental systems which serve information needs in locations such as the Radiology Department and in hospital-wide information systems which seek to integrate management of clinical data from many departments. For each of these systems to achieve the goal of maximizing both the effectiveness of health care workers and the quality of patient care, they need to share the data that they capture. Below we discuss a variety of applications, both currently available and in the realm of research protocols, that depend on a high level of communication between Radiology Information Systems and Hospital Information Systems. These examples suggest the benefits of integrating the medically relevant data collected by all of the computer-based information systems in the hospital setting.

Decision Making, Computer-Assisted↗
PubMed2026

Conference report: the third Bacterial Genome Sequencing Pan-European Network conference.

The third Bacterial Genome Sequencing Pan-European Network conference, held in Engelberg, Switzerland (12-15 January 2026), brought together experts from six European countries to discuss the implementation of bacterial genome sequencing in clinical microbiology and public health. Key themes included regulatory frameworks (In Vitro Diagnostic Regulation, General Data Protection Regulation), standardization, quality control, data sharing, economic evaluation, and the integration of artificial intelligence and long-read sequencing into diagnostic workflows. Across presentations, panel discussions, and workshops, participants emphasized that successful implementation of genome sequencing requires more than technical capacity: it depends on robust validation, sustainable funding, interoperable data standards, ethical governance, and interdisciplinary collaboration. The meeting highlighted that sequencing should remain question-driven and clinically meaningful, balancing cost, turnaround time, and public health impact. Overall, the conference reinforced the need for coordinated European efforts to advance responsible, standardized, and sustainable genomic surveillance and diagnostics.

bacterial genome sequencing↗
PubMed2000

Methylmercury and the health of indigenous peoples: a risk management challenge for physical and social sciences and for public health policy.

Methylmercury in aquatic ecosystems and bio-accumulated in aquatic biota, especially fish, is a major public health concern internationally. Precautionary efforts are currently underway internationally to reduce the anthropogenic release of mercury, which in turn, over time, will reduce human exposure. However, at the present time, it is important to address the issue of management of the risks of exposure as they exist now. Of particular concern are the impacts of methylmercury on indigenous populations which depend on fish as a subsistence food source, both in remote areas of developed countries, such as Canada, and in developing countries such as Brazil. Research into these impacts over the past two or three decades has shown that, other than in very severe pollution situations such as occurred in Minamata, Japan, the direct impacts on human health are difficult to prove. On the other hand, the indirect negative effects of methylmercury on health, mediated through the disruption of lifestyle and eating patterns and the associated socio-cultural and socio-economic consequences among the affected native populations, have, in many cases, been significant. These social factors have raised serious challenges in determining practical public health policies on the issue. Policy development relating to environmental contaminants has been presented, with the problem of assessing the role of the various factors which contribute to the impact on health as a result of socio-cultural disruption. These factors include changes in diet and lifestyle due to methylmercury in the environment and its real or perceived risk. The standard physical sciences risk assessment process, based on the lowest observed adverse effects level (LOAEL) or no observed adverse effects level (NOAEL) used in defining health policies may be seen as over-simplistic theoretical extrapolations when viewed in the context of the concerns of the social sciences. Both approaches, however, have relevance to health policies that address the risks posed by environmental methylmercury. Therefore, the standard physical sciences approach of the past three decades now needs to be linked with the social sciences approach, with its focus on the indirect impacts of exposure to methylmercury, to provide a comprehensive approach to public health policy development. With this objective in mind, this paper reviews methylmercury-related data from both physical and social sciences. It attempts to draw on the findings in both disciplines to provide suggestions for an integrated approach in policy development relating to human health and human exposure to methylmercury, especially among indigenous peoples in remote areas and in developing countries. An integrated approach such as this may help to limit adverse health effects in the indigenous communities affected.

Canada↗
PubMed1997

Health-related outcomes management: moving forward standing still.

In response to increasing economic and political pressures, administrators and other health-care professionals have become increasingly concerned with health-related outcomes management. The categories of outcomes in health care have been identified within administrative, economic, and clinical realms. Great emphasis has been placed in the literature on the importance of measuring and using outcome data for decision making. Despite this emphasis, little progress has been made in either the science or the art of outcomes management. Furthermore, integrating the art and science into systematic processes for outcomes management has been done with limited success. This paper focuses on the state of outcome concepts, measurement, collection, and evaluation. Strategies will be offered to move the conceptualization and operationalization of outcomes management forward.

Data Collection↗
PubMed1998

Quality improvement measures adopted by the Italian National Health Service.

The reform process underway within the Italian National Health System is aimed at making decision makers responsible for appropriate and efficient resource utilisation and at ensuring quality of care, eliminating conflict between fairness, quality and cost control. The risk for the quality of the services provided entailed by resource rationalisation is avoidable and controllable. This article explains how the Italian NHS has managed the reform process assuring quality improvement, and describes the policy and the tools adopted. As well as involving all players and the system as a whole in constant improvement, the Italian NHS's policy in pursuing quality of care is based on the adoption of a wide range of measures: measurement of health care and of clinical outcomes, systematic data collection, team work and protocols. The tools adopted, currently under implementation, to support quality control are: an integrated system of indicators for measuring efficiency and quality of NHS structures (demand and accessibility indicators, resource related indicators, activity indicators and result indicators); compulsory accreditation as a prerequisite for health care providers; a system to monitor and control the effects of the new prospective payment system; clinical guidelines (each related to a specific clinical problem); a menu of services (Carta dei Servizi) released by all NHS accredited service providers with full information and warranties regarding the services provided and their quality.

Health Care Reform↗
PubMed1995

Dynamic patient data bases: the foundation of an integrated approach to outcome measures for the healthcare professionals.

In recent years there has been a tremendous need among healthcare professionals to assess the effectiveness, efficiency, and appropriateness of the patient care services being provided through criteria-based outcome and program evaluation. Although the need for a tool which could evaluate the effectiveness of patient care is widely recognized, such an undertaking has been severely limited due to the lack of any automated means to collect and analyze patient data on a routine, continuous basis within a clinical setting. We have developed and implemented at Mineral Springs Hospital, Banff, Alberta an integrated and automated hospital information system that not only continuously collects administrative, financial, and patient data, but also contains an intelligent component for automated outcome measure and program evaluation. The system collects various non-duplicated data elements from each routine work process within the facility on a continuous basis. Through the creation of a dynamic patient database, data is transformed into information--a powerful decision support tool. The system provides flexible user-defined reports in patient-specific resource utilization, direct and/or indirect specific financial costs, result reporting of each intervention, service provided and user-defined criteria-based outcome, and program evaluation. The system design incorporates expert rules, dynamic data entry forms, quantitative models, and user-defined access control. Using information derived from the dynamic common database, managers and front-line clinicians can easily evaluate and modify management decisions or careplans on a macro or micro level. An external review is planned to evaluate whether the system has helped the assessment of effectiveness, efficiency and appropriateness of healthcare services being provided at the hospital. The fundamental concept behind the system design is that the patient is the center of activity for data collection. The system provides the answers to the 5 W's (who, what, where, when, and why) together with intervention and service result reports. A dynamic common patient database is the center of the system and is accessible to all with proper authorization. Common data elements are collected from routine work flow without extra data entry and this information is subsequently shared. Data collection is a continuous process. We believe that every process is the outcome of another sub-process or event. The design of the dynamic patient database incorporates patient-specific costing and outcome evaluation, user-defined flexible data entry forms, user-defined access control, outcome evaluation rules and information semantic rules. Such a patient database would provide the flexibility needed to accommodate diverse methodologies to evaluate outcomes whether it they be medical, cost, access and/or other combination of measures. The system was developed on a PC-based Network technology, using FOXPRO (XBase) as the database development tool incorporating advanced technology such as distributed processing and fault tolerant computing. We chose PC-based technology because it is economical, having relatively low maintenance costs and requires no major dependency on vendors. The developed system produces patient-specific reports with many dimensions. The reports are user-defined. The system reports general data, CMG, RGN, LOS, Expected LOS, and other user-defined demographic data. Resource utilization, financial costs, and result reportings are produced together with rule-based outcome assessments of any type of measures, including, but not limited to, pre-set functional/health goals, user satisfaction, clinicianUs text or codified comments etc. It provides the framework for continually capturing data at a practical, work-flow level. The incorporation of a dynamic patient database as the driving forece of an integrated, rule-based administration, financial and patient data system will provdie the tools for healthcar

Databases, Factual↗