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PubMedDate not supplied

The new informatics of national healthcare reform.

The President's Health Security Act has succeeded in attracting America's attention. Several of its initiatives have been well-publicized and hotly debated in Congress. The act also includes a number of implications for healthcare informatics, and devotes an entire chapter to this subject, although this area has not received as much publicity. Every behavioral healthcare provider's information system would be significantly affected by enactment of the Health Security Act. Selected forms and data elements for the management and delivery of behavioral healthcare services would need to be standardized. Organizations of behavioral healthcare providers, managed care companies and purchasers would increasingly share selected patient and subscriber information in aggregated form, for a variety of purposes. As a result, tougher laws to protect patient data privacy will likely be forthcoming. The following article gives an overview of the informatics needs of the soon-to-be reformed American healthcare system, into which behavioral healthcare will be integrated. As part of the larger system, behavioral healthcare services and information systems will need to comply with the same guidelines and requirements, outlined below, as other healthcare providers. Preparation to meet the information demands of the evolving healthcare system will require adaptation of existing computerized information systems, utilization of new technology, consultation with the system's major shareholders and attention to continuous quality improvement processes.

Computer Communication Networks↗
PubMed1996

English-only work rules: balancing fair employment considerations in a multicultural and multilingual healthcare workforce.

Most healthcare organizations are currently or will shortly be composed of a multicultural and multilingual workforce. In attempting to manage such diverse workforces. English-only work rules may be necessary to ensure effective communication among workers. However, care must be taken to insure that the employees' rights to free speech and a harassment-free workplace are not infringed by utilizing English-only work rules. This article attempts to assist the healthcare manager in dealing with the legal aspects of English-only work rules. Specifically, an examination of two legal cases is provided to illustrate the various legal aspects of such work rules. Also, suggestions are offered as to how and when, or when not, to implement English-only work rule in order to avoid possible liability.

Cultural Diversity↗
PubMed1997

Bridging the gap between managed care and academic medicine: an innovative fellowship.

Numerous challenges face academic medicine in the era of managed care. This environment is stimulating the development of innovative educational programs that can adapt to changes in the healthcare system. The U.S. Quality Algorithms Managed Care Fellowship at Jefferson Medical College is one response to these challenges. Two postresidency physicians are chosen as fellows each year. The 1-year curriculum is organized into four 3-month modules covering such subjects as biostatistics and epidemiology, medical informatics, the theory and practice of managed care, managed care finance, integrated healthcare systems, quality assessment and improvement, clinical parameters and guidelines, utilization management, and risk management. The fellowship may serve as a possible prototype for future post-graduate education.

Algorithms↗
PubMed1999

Promoting safe and effective genetic tests in the United States: work of the task force on genetic testing.

The Task Force on Genetic Testing was created to review genetic testing in the United States and, when necessary, to make recommendations to ensure the development of safe and effective genetic tests. A survey to explore the state of genetic testing was undertaken for the Task Force and completed in early 1995. The survey, as well as literature reports and other information collected for the Task Force, showed problems affecting safety and effectiveness, as defined by the Task Force: validity and utility of predictive tests, laboratory quality, and appropriate use by healthcare providers and consumers. On the basis of these findings, the Task Force made several recommendations to ensure safe and effective genetic testing. The Secretary of Health and Human Services followed up one recommendation by creating the Secretary's Advisory Committee on Genetic Testing. One of its functions will be to implement other recommendations of the Task Force.

Genetic Techniques↗
PubMed1987

Megatrends in hospital information systems.

The "megatrends" identified for hospital information system in this article require an innovative shift in hospital management perspective. Hospital chief executive officers and decision-makers must adopt a new model for planning and utilizing hospital information systems resources. Because of changes in the healthcare environment, prospective payment strategies for using information are very different from former retrospective reimbursement methods. The purpose of this article has been to identify emerging "megatrends" for structuring future hospital information systems. The primary causes of these significantly different demands is the prospective payment system. Medicare DRGs will probably expand into an all-encompassing payment plan which will alter the essence of hospital information systems. This article has reviewed the challenges of these "megatrends," and provided some preliminary management strategies for addressing these new demands on healthcare professionals.

Hospital Administration↗
PubMed1999

Rebuilding a clinical workstation with spider's silk of the Web.

The Yale-New Haven Hospital (YNHH) clinical workstation came into existence in 1993 to provide a simple menu-driven interface to high use information systems that would be easily accessible on the wards and in the intensive care units. Direct Internet access, advances in Web-based software, and greater cooperation between Yale-New Haven Hospital and Yale School of Medicine network technology groups have enabled the clinical workstations to become an integral tool for providing clinical care. The workstation provides bedside access to an expanding array of internal and external resources to support patient care and has the potential to become the basis for an interface that will be utilized throughout the multi-location Yale-New Haven Healthcare System.

Academic Medical Centers↗
PubMed2003

Medical rationing: the implicit result of Leadership by Example.

The Institute of Medicine (IOM) has released the latest publication in its campaign to curtail medical error: Leadership by Example: Coordinating Government Roles in Improving Health Care Quality. In this publication, the IOM recommends that the government utilize its position as the country's largest purchaser of healthcare to institute unified performance standards, create appropriate incentives to improve quality of care, and develop a system to disseminate provider-specific quality information to the public. The author examines these recommendations and the contents of IOM's prior publications and concludes that necessary predicates of IOM's vision are rationing of care and a two-tiered system of healthcare. Thus, if the IOM's recommendations are carried out, the author envisions a healthcare system in which truly state-of-the-art care can only be purchased out of pocket. He concludes that, although Leadership by Example is a rational plan to address escalating healthcare costs, it is unclear both whether the American public would support it if the IOM were explicit about its ultimate impact, and whether the recommendations, in the long run, will prove to be a good thing.

Delivery of Health Care↗
PubMed2004

E-health in the Scandinavian countries.

For more than 10 years the Scandinavian countries have been focusing on utilizing information technology to increase efficiency in the delivery of healthcare services. Over the last 3 years all three countries have built closed secure IP-based healthcare networks that cover nearly all aspects of the national healthcare sector. The next step is to connect the national networks and integrate them into one large Scandinavian healthcare network. This paper describes the history of e-health in the Scandinavian Countries, the challenges and emerging trends.

Computer Security↗
PubMedDate not supplied

The perils of healthcare workforce forecasting: a case study of the Philadelphia metropolitan area.

In 1996, a widely circulated and influential forecast for the Philadelphia Metropolitan Area stated that a decline in hospital and healthcare employment in the region would occur over the next five years. It also suggested that this decline would exacerbate the problem of an oversupply of nurses seeking hospital employment. The forecast reflected a regional leadership and expert consensus on the impact of the managed care transformation on workforce needs and was supported by short-term statistical trends in regional utilization and employment. Confounding these predictions was the fact that hospital and healthcare employment actually grew. By the end of 2001, hospitals in the region were experiencing problems in recruiting sufficient numbers of nurses, pharmacists, and technicians. The forecast failed to anticipate the impact of a strong regional economy on supply and underestimated the resilience of underlying forces that have driven the long-term growth in healthcare workforce demand. More effective ongoing monitoring can help moderate the fluctuation of workforce shortages and surpluses.

Adult↗
PubMed2005

Cross-district utilization of general hospital care in Nova Scotia: policy and service delivery implications for rural districts.

Acute care regionalization has been pursued in health systems throughout the industrial world as a means of achieving better patient outcomes for specialized services. The evidence in support of this policy direction is compelling, but is primarily based on highly specialized care, such as coronary and cancer treatments. There exists another, largely unintended, form of regionalization that involves the flow of patients from smaller urban and rural settings to major urban centres to obtain routine procedures. Using data from the Nova Scotia Discharge Abstract Database, this paper presents an analysis of cross-district utilization of secondary level acute care. In particular, we examine spatial, demographic and individual healthcare seeking characteristics of those residents who obtained relatively routine hospital care in a different district in 2000/2001, even though an equivalent level of service was available within their home district. Implications of cross-district utilization for the viability of medical service provision in smaller centres in the province and elsewhere are discussed.

Adolescent↗
PubMed2000

Internet resources for dentistry: government and medical sites for the dental professional.

As society transitions deeper into the Information Age, Information Technology has become a critical tool that supports all facets of the global economy. The Internet, via the World-Wide Web (WWW), has become a major component of business operations for corporate and educational organizational entities. An estimated 10,000 or more health-related websites are providing information for both consumers and healthcare professionals. In addition to private and state-supported institutions being present on the Internet, the federal government has moved rapidly toward disseminating information electronically, with significant utilization of the WWW as the technological vehicle. All branches of the US Government and federal-related agencies are now represented on the Internet in an effort to deliver content to their end users, primarily the public. The intent of this article is to complement the previous publication, "Internet Resources for Dentistry: Utilization of the Internet to Support Professional Growth, Decision Making, and Patient Care," by presenting dental healthcare professionals with information on additional governmental and medical "Internet" sites. In addition, healthcare professionals must arm themselves with more than just access itself, but also the ability to critically judge the quality of information retrieved from the WWW.

Commerce↗
PubMed2005

Facilitating applied information technology research.

Most healthcare organizations need to develop an understanding of the role, maturity, and utility of new information technologies. Performing this research can present a series of challenges. For example, IT staff may not know how to obtain resources; the research may show promising results but fail to be implemented; and organizations may not develop a thoughtful portfolio of research projects. To minimize these problems, applied information technology research must be managed. This paper describes the information technology research process at Partners HealthCare. The research process is a management process designed to identify important research topics, solicit IT staff proposals to investigate topics, prioritize and fund research projects, and communicate and disseminate research results. Sample research topics include the role of RFID, the impact of Internet-based e-visits, and approaches for integrating speech and direct input for clinical information systems. The paper describes the goals and activities of the research process and the role of the research council. The research proposal review process is discussed, and an inventory of approved research projects is reviewed. The paper discusses several challenges involved in creating and managing the research process.

Decision Making, Organizational↗
PubMed1999

A managed care curriculum: developing a managed care curriculum for primary care residents.

INTRODUCTION: Managed care in its numerous forms is continuing to change the face of the healthcare system in the United States. IMPACT OF MANAGED CARE ON MEDICAL EDUCATION: As managed care continues to invade the market, it has a substantial influence in shaping the parameters of graduate medical education. Various surveys have shown that residents are under-trained in managed care principles and practice. There is a clear need for a residency curriculum that fully prepares students to keep pace with modern markets. EDUCATIONAL METHODOLOGY: This manuscript describes a curriculum which emphasizes the role of the primary care physician, cost-effective practice, multidisciplinary practice and evidenced-based strategies. Educational methods and concepts presented here are based on the recommendations of healthcare educators, extensive literature searches and United States advisory panels. After the curriculum is completed, the resident will: 1. Practice cost-effectively under 100% capitation and learn proper risk management. 2. Utilize epidemiological thinking and community-oriented primary care. 3. Function as a part of healthcare team and understand how to achieve cost-effective care for patients. 4. Practice the principles of continuous quality improvement and assess patient satisfaction. 5. Practice and adopt evidence-based medicine and guidelines. 6. Become skilled with computers including facility with literature searches, databases and the internet. 7. Practice a full spectrum of primary care emphasizing patient education and psychosocial health. 8. Understand the ethical issues pertinent to managed care practices. EVALUATION: The residency curriculum committee will evaluate the managed care curricular elements on an on-going basis. CONCLUSION: This comprehensive curriculum for primary care residents can help ensure success in the new healthcare marketplace.

Curriculum↗
PubMedDate not supplied

A reassessment of spinal stabilization in severe cerebral palsy.

A homogenous population of 37 institutionalized patients with scoliosis and severe cerebral palsy was evaluated to assess the impact of spinal stabilization on comfort, function, health, and ease of nursing care. Through a prospective care-burden study, a 34-month retrospective analysis, and a healthcare worker questionnaire, 17 fused patients with a mean current scoliosis of 35 degrees were compared with 20 nonfused patients with a mean scoliosis of 76 degrees. No clinically significant differences were noted in pain or pulmonary medication utilization or therapy, decubiti, function, or time for daily care. Nevertheless, the majority of healthcare workers believed that the fused patients were more comfortable.

Activities of Daily Living↗
PubMed2000

Expanding the range of interventions to reduce HIV among adolescents.

OBJECTIVE: Structural interventions are identified to reduce adolescents' HIV risk. METHOD: The goals, strategies, approaches, and delivery sites of adolescent HIV prevention programs are reviewed. RESULTS: In addition to reducing sexual activity and substance use, HIV prevention programs may also reduce adolescents' HIV risk by: decreasing poverty; ensuring access to HIV testing, healthcare, general social skills training, and employment opportunities; and requiring community service for students. Adolescent HIV prevention programs do not currently utilize diverse modalities (computers, videotapes, television, telephone groups, computerized telephones) or sites (parents' workplaces, religious organizations, self-help networks, primary healthcare clinics) for delivering interventions. Diversifying current approaches to HIV prevention include: economic development programs; mandating delivery of programs at key developmental milestones (e.g. childbirth, marriage) and settings (school-based clinics, condom availability programs); securing changes in legislative and funding policies through ballot initiatives or lawsuits; and privatizing prevention activities. CONCLUSIONS: To implement structural HIV interventions for adolescents requires researchers to shift their community norms regarding the value of innovation, adopt designs other than randomized controlled trials, expand their theoretical models, and adopt strategies used by lawyers, private enterprise, and lobbyists.

Adolescent↗
PubMed2003

Day medicine: an urgent internal medicine clinic and medical procedures suite.

During Saskatchewan's healthcare reform of the 1990s, the number of acute hospital beds in Saskatoon District Health was cut in half. The emergency room and outpatient facilities were not able to accommodate an increasing number of patients needing urgent assessments and medical procedures. In this article, we describe the development, implementation and utilization of a day medicine program. This description may be useful to others planning healthcare delivery to medical patients, especially in a setting of resource constraint.

Day Care, Medical↗
PubMed2005

IGIV: contents, properties, and methods of industrial production--evolving closer to a more physiologic product.

Is the process the product? Immune globulin intravenous (IGIV) is not manufactured, but is purified (fractionated) from human plasma. Machines can only damage what Mother Nature makes; they cannot improve it. Therefore, fractionators of biologic molecules must strive to ensure what is taken from a human body is exactly the same when it is returned to the human body for optimal tolerability and safety. The processes of purification have the potential to adversely affect the product. Four primary purification processes exist for commercial IGIV. The Cohn-Oncley process is 1940s technology, which has been modified through the decades, but the basic process remains unchanged. The Kistler-Nitschmann process was developed in the 1950s by the Central Laboratory of the Swiss Red Cross (ZLB, today known as ZLB-Behring, a subsidiary of CSL Limited). Various attempts have been made to utilize chromatography as the sole separation technology without much success. Most recently, Bayer HealthCare (Talecris Biotherapeutics acquired the contributed assets of the worldwide plasma business of Bayer Biological Products and became operational April 1, 2005; all plasma-based products, including Gamunex, Prolastin, the hyperimmune line (Fraction II), Plasbumin (Bayer Albumin), Koate DVI, and Thrombate III were included) introduced a new product into the United States and Canada that utilizes caprylate and chromatography for high purity, better yields, and integration of safety and efficacy. This is the first new IGIV purification technology in over 20 years.

Drug Industry↗
PubMed1997

An introduction to using computer simulation in healthcare: patient wait case study.

As healthcare continues to become more competitive, the ability to assess tradeoffs between resource utilization, service, and operating costs grows in importance, such as with respect to appointment access, waiting room delays, and telephone service. This paper discusses the use of simulation analysis for studying and improving these and other health systems. A case study concerning pediatric waiting times illustrates typical steps involved in a simulation study, possible types of analyses, and resources required. Other healthcare uses of stimulation, pitfalls to avoid, and software selection also are discussed briefly.

Algorithms↗