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PubMed1984

Using commercial application' software. Integrating clinic office practices.

Automation of clinic business office practices has often been accomplished by the use of the procedures obtained from the provider of automated services. With the availability of the microcomputer and the commercially available business application software, the desired automated procedures may be obtained by discretionary use of the products. By describing the integration and the operational use of business application software within a multiphysician specialty clinic, the author highlights both the problems encountered and the benefits achieved.

Ambulatory Care Facilities↗
PubMed1993

Automation of medical examiner offices.

General information and principles regarding the automation of medical examiner and coroner offices are presented. Topics discussed include the importance of using available resource groups, questions that should be answered to determine the need for automation, the importance of specifically defining office needs and goals prior to automation, the value of capturing data in multiple ways, the importance of maintaining some hardcopy files, the value of ensuring capability to modify and enlarge the computer system, the need to tailor systems to the needs of specific offices, possibilities for generating money or acquiring equipment at little or no cost, the use of personal computers and commercially available software, the value of having all operations inhouse, transition to new operating systems and environments, and the foreseeable use of emerging technologies.

Coroners and Medical Examiners↗
PubMed1999

EDI and imaging automate the business office.

By implementing electronic remittance posting and imaging in patient accounting, New York's Memorial Sloan-Kettering Cancer Center was able to eliminate 22 full-time equivalent supervisory and staff positions and save $365,000 in physical space, microfilm and media costs the first year the new system was operational. Memorial Sloan-Kettering currently is participating in a pilot program with its Medicare fiscal intermediary to determine how EDI can be used to manage claim-status information between payer and provider. By combining EDI, fax, and imaging technologies, Memorial Sloan-Kettering is making its patient accounting process more efficient and providing better service to its patients.

Cancer Care Facilities↗
PubMed1998

Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest.

OBJECTIVE: To determine the feasibility of police officers providing defibrillation with automated external defibrillators (AEDs) and to assess the effectiveness of this strategy in reducing time to defibrillation of victims of out-of-hospital sudden cardiac arrest. METHODS: This was a prospective, interventional cohort study with historical controls conducted in 7 suburban communities in which police usually arrived at the scene of medical emergencies before EMS personnel. All adult patients who suffered cardiac arrest before EMS arrival and on whom EMS personnel attempted resuscitation were enrolled. Police officers who were trained to use and equipped with AEDs during the intervention phase were dispatched simultaneously with EMS to medical emergencies. Police were instructed to use the AED immediately on determination of pulselessness. Outcome measures were the difference between control and intervention phases in interval from the time the call was received at dispatch to the time of first defibrillation and in rate of survival to hospital discharge for patients initially in ventricular fibrillation. RESULTS: EMS personnel attempted 183 resuscitations in the control phase and 283 during the intervention; of these, 80 (44%) and 127 (45%), respectively, involved patients with initial ventricular fibrillation rhythms. Mean time to defibrillation decreased from 11.8+/-4.7 minutes in the control phase to 8.7+/-3.7 minutes in the intervention phase (P<.0001). Survival to hospital discharge of patients in ventricular fibrillation did not differ between phases (6% control versus 14% intervention, P=.1). When police arrived before EMS personnel, shock administered by police compared with shock administered by EMS was associated with improved survival (26% [12/46] versus 3% [1/29], P=.01). Logistic regression analysis revealed AED use was an independent predictor of survival to hospital discharge. CONCLUSION: In 7 suburban communities, police use of AEDs decreased time to defibrillation and was an independent predictor of survival to hospital discharge.

Adult↗
PubMed2000

Model of data structure and flow in general practice: a guide to evaluation of practice management software.

Despite its benefits, the computerisation of Australian general medical practices has been delayed, partly due to user concerns about the format of data dictated by available software and the portability of such data. This article proposes certain essential criteria for practice management software, which may provide a framework for its evaluation by users. A set of simple guidelines for database maintenance is also proposed. The author believes that users should become familiar with basic software architecture and drive the market to develop packages that conform to these minimal criteria.

Family Practice↗
PubMed2003

Is there a digital divide among physicians? A geographic analysis of information technology in Southern California physician offices.

OBJECTIVE: The aim of this study was to determine whether physician offices located in high-minority and low-income neighborhoods have different levels of access to information technology than offices located in lower-minority and higher-income areas. DESIGN: A cross-sectional survey was conducted of pediatrics, family medicine, and general practice offices in Orange County, California. Survey data were linked with community demographic data from the 2000 Census using a geographical information system. RESULTS: Of 307 offices surveyed, 141 responded (46%). Offices located in high-minority and high-poverty areas were as likely to respond as other offices. Among responding offices, 94% had a computer, 77% had Web access, 29% had broadband Internet access, and 53% used computerized scheduling and billing systems. Offices located in minority and low-income communities had equivalent access to each technology. Offices in communities with larger proportions of Hispanics were less likely to have practice Web pages, but other uses of the Internet were not associated with practice location. Offices reported high levels of interest in online clinical systems but also high levels of concern about these systems' usability and confidentiality. Offices with Web access and those with practice management systems expressed greater interest in online clinical systems but also greater levels of concern about usability and confidentiality. These attitudes were equivalent among offices in different communities. CONCLUSION: Primary care offices located in poor and minority communities in a large, suburban county had high levels of access to and interest in Web-based systems. Physicians' offices may therefore provide a venue for online services aimed at improving health outcomes for poor and minority communities. Research is needed in other geographic regions to determine the generalizability of these findings.

Attitude to Computers↗
PubMed1996

Document management and scanning in the physician's office.

A popular PC magazine recently conducted a survey asking readers whether a paperless office or Santa Claus was more believable. Santa Claus won. Health care professionals would make that same choice. They come from an educational process that teaches, if it is not on paper, it never happened. However, the necessity for fast and easy access to medical documents, particularly in managed care networks, is causing the paperless office to rush forward at breakneck speed.

CD-ROM↗
PubMed1992

Variability of indirect methods used to determine blood pressure. Office vs mean 24-hour automated blood pressures.

Blood pressure is a cardiovascular measurement with dynamic characteristics that can be influenced by a number of internal and external factors. The preferred blood pressure determination method would be one that reduces variability between measurements and that reflects the true blood pressure level. In this article, we present the variability of, and agreement between, the blood pressures collected by two indirect methods on the same patients during a hypertensive research project. Data obtained on patients in a typical clinical setting are also provided. Twenty-four-hour diastolic pressures obtained by the automated method demonstrated no regression to a lower mean, while blood pressures obtained casually in the office exhibited such regression. The 95% confidence interval of repeated measures for casual office blood pressure on a patient in a research setting (35/17 mm Hg) or in typical clinic practice (26/19 mm Hg) were similar, while the range of the mean 24-hour automated blood pressure monitoring (21/11 mm Hg) was smaller and demonstrated less variability. The magnitudes of the differences in blood pressures obtained on separate occasions in the same subjects were significantly lower with automated vs casual blood pressure determination methods (7.9/4.6 vs 13.7/7.4 mm Hg for both systolic and diastolic pressures). The agreement (95% confidence interval) between blood pressures obtained by the two methods (19/12 mm Hg) was found to be similar to the repeatability of automated blood pressure monitoring alone, and superior to that for data recorded casually in the office (35/17 mm Hg). Thus, the variability in mean 24-hour automated blood pressures is less than that for casual office blood pressures. The clinician should understand that the variability of blood pressures measured on an individual may be much greater than that reported for populations of hypertensive patients, and must be considered when applying epidemiologic group data to a specific patient. Moreover, any methodology of indirect blood pressure measurement that may reduce the variability and improve repeatability of casual office blood pressures deserves further consideration.

Ambulatory Care↗