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PubMed2005

Design of an integrated system for Milwaukee children with developmental disabilities.

Currently, data on children with developmental delays are collected on an as-needed basis and in general are created and maintained locally. In this paper, a comprehensive, user-friendly integrated system design for children age birth to three years with disabilities in Milwaukee County is proposed. After the prototype system is developed and tested as a "proof-of-concept" the product system will be migrated into the Wisconsin Public Health Information Network (WI-PHIN) as a Program Area Module (PAM).

Child, Preschool↗
PubMed1997

Recycling pool provides innovative financing for an integrated system.

Not-for-profit integrated delivery systems require innovative financing mechanisms to compete effectively with expanding for-profit systems. The Massachusetts Health and Educational Facilities Authority (Mass HEFA), in collaboration with Partners HealthCare Systems, Inc., Boston, Massachusetts, developed such a mechanism--a capital asset recycling pool funded through a $150 million bond issue. The recycling pool gives Partners flexible access to tax-exempt capital to fund routine capital expenses across the system and has enabled the system to centralize control of capital resources. Over the pool's 30-year life-span, Partners will be able to issue tax-exempt loans from the pool to any of its affiliates or, with Mass HEFA and insurer approval, transfer the funds to outside organizations. When the loans are repaid, the funds remain available and can be recycled at no additional cost to fund further capital projects. Creation of the pool was made possible by Partners' outstanding credit, strong market position, expanding primary care network, and substantial unrestricted net assets.

Boston↗
PubMedDate not supplied

System integration--the need in future anesthesia delivery systems.

Although current anesthesia delivery systems possess the virtues of familiarity, ruggedness, reliability, and longevity, problems inherent in their design require remedy. These systems consist of discrete subsystems that are unrelated physically, functionally, or by communications. Production of derived values, as opposed to raw data, is almost unheard of, although transformed data may be much more useful in the clinical environment. Future anesthesia delivery systems will use microprocessors to integrate data from multiple sensors with calculation, display, and control functions--without removing the anesthesiologist from the control loop. New ergonomic data will promote design of equipment that can be optimally manufactured, marketed, and used in clinical care. The proliferation of new equipment with advanced design and application features creates challenges for a society conscious of rising health-care costs. Creative alternatives to conventional financing, ownership, and early obsolescence of anesthesia systems must be sought in order to ensure that the quality of and capability for anesthetic care will continue to advance.

Anesthesia↗
PubMedDate not supplied

Polarity management: the key challenge for integrated health systems.

Integrated health systems are confronted with numerous dilemmas that must be managed. Many of these dilemmas are an inherent part of the system's structure, given that multiple competing hospitals, medical groups, and (sometimes) health plans are often under one organizational roof. This article presents an analysis of these dilemmas--referred to in the management literature as polarities--as they are found in six integrated health systems in Illinois. The nine polarities that must be managed include (1) hospital systems that want to be organizations of physicians; (2) system expansion by growing the physician component; (3) system centralization and physician decentralization; (4) centripetal and centrifugal forces involving physicians; (5) system objectives and physician interests; (6) system centralization and hospital decentralization; (7) primary care physicians and specialists; (8) physician autonomy via collectivization; and (9) vertical and virtual integration. The article identifies some of the solutions to the polarities that have been enacted by systems. In general, executives and physicians in integrated health systems must attend to the processes of integration as much as or more than the structures of integration.

Cooperative Behavior↗
PubMed1995

New governance for a new era: issues and challenges for integrating systems.

In this second part of a two-part column, Dr. Ruffin provides greater detail on seven key factors that he believes will govern the operations of integrated systems. Successful systems, he says, will be those that attract and retain physicians, have disciplined governance, integrate care through sharing of information among system elements, conserve capital, ensure strategic growth, control costs, and are proficient at processing information. It is important to understand, he says, that, in the movement from a fee-for-service payment mechanism, in which the various elements of the health care field bill for their services independently and according to rules designed for their benefit, to an integrated system, in which such independence can only lead to chaos, very substantial changes will be required in the governance of our health care institutions and organizations.

Cost Control↗
PubMed1987

Systems integration: tying it all together.

Healthcare organizations' changing priorities have created needs for new information systems, as well as a demand for better integration of existing systems. Ten years ago, data processing concentrated on general and patient accounting, payroll, and accounts payable. Today, automated systems have to be able to gather data from several different systems to help in the added areas of patient care, cost management, and marketing. Making the transition from a manual to a truly integrated system is a gradual process, but will realize long-term benefits such as increased system efficiency, improved patient care, and better strategic business support. Before taking this step, healthcare executives need to know the typical problems that may occur with integration and what factors to consider before developing an integrated system.

Capital Expenditures↗
PubMed1992

[Development of an integrated system of family medicine--pathologic anatomy service to start epidemiologic studies on tumors occurring in an area of southern Italy. First results].

In Italy there are eight tumor Population-Based Registries (PBRs) that publish incidence data, and only one of them (Ragusa) provides data for Southern Italy. Usually, PBRs are based on data collection from Pathologists and medical records. Our integrated system differentiates from traditional PBRs because the information comes from the General Practitioners (GPs) and is completed with the diagnosis provided by the Pathologists (Ps). During two years we have registered 1,057 new cancers on a middle period population of 212,644. GPs and Ps signed 395 and 879 incident cases, respectively. GPs alone provided 16.8%, Ps alone 62.6%, and either source 20.6% of total cases. After excluding non melanotic skin cancers and bladder carcinoma, the GPs-Ps integrated system counted 828 new cases in two years. These incidence data are the first in our region (Puglia). The 178 cases signed by GPs alone should have been lost if the informations of our PBR had been based only on local Ps' records. Moreover, 94 of GPs cases (11% of total cancers registered) were subjects who moved outside the area for diagnosis and treatment. Even if this article evaluates the effect of under-registration attributable to Ps or GPs, the cancer incidence data and the active involvement of GPs indicate that they could be usefully involved in the registration of cancer data.

Epidemiologic Methods↗
PubMed2005

A criticality-based framework for task composition in multi-agent bioinformatics integration systems.

MOTIVATION: During task composition, such as can be found in distributed query processing, workflow systems and AI planning, decisions have to be made by the system and possibly by users with respect to how a given problem should be solved. Although there is often more than one correct way of solving a given problem, these multiple solutions do not necessarily lead to the same result. Some researchers are addressing this problem by providing data provenance information. Others use expert advice encoded in a supporting knowledge-base. In this paper, we propose an approach that assesses the importance of such decisions with respect to the overall result. We present a way of measuring decision criticality and describe its potential use. RESULTS: A multi-agent bioinformatics integration system is used as the basis of a framework that facilitates such functionality. We propose an agent architecture, and a concrete bioinformatics example (prototype) is used to show how certain decisions may not be critical in the context of more complex tasks.

Algorithms↗
PubMed1996

Supporting the "clinic without walls" with an event-directed messaging system integrated into an electronic medical record.

To facilitate the communication of ideas, orders and treatment plans among providers practicing in a multidisciplinary ambulatory care setting, we have created an event-directed messaging system integrated into our larger Ambulatory Care Information System (ACIS). ACIS has been operational since 1992 and currently supports an average of 350 patient visits per day. The new messaging system permits a provider to send a message to the next provider who will be caring for a patient. The messages can be sent to any provider offering care in the future, or they can be directed to future visits with a particular clinical service. In contrast to traditional electronic mail systems, messages are not directed to specific providers or groups of provider. Messages are instead directed to a specific clinical event, namely a patient's visit to an appropriate clinic. Messages are displayed when a patient returns for a designated visit, both as part of a pre-printed progress note upon which a provider documents the visit and as part of a hypertext-based general information display in an electronic medical record. The messaging system helps providers ensure that subsequent providers caring for their patients will be alerted to pertinent aspects of a patient's care. It also similarly helps providers quickly gain familiarity with those issues prior providers had felt were important to highlight or did not want to risk being overlooked.

Ambulatory Care Information Systems↗
PubMed1997

System integrational and migrational concepts and methods within healthcare.

In this paper an overview and comparison of the basic concepts and methods behind different system integrational implementations is given, including the DHE, which is based on the coming Healthcare Information Systems Architecture pre-standard HISA, developed by CEN TC251. This standard and the DHE (Distributed Healthcare Environment) not only provides highly relevant standards, but also provides an efficient and well structured platform for Healthcare IT Systems.

Computer Communication Networks↗
PubMed2006

Respiratory control at exercise onset: an integrated systems perspective.

The near-immediate increase in breathing that accompanies the onset of constant load, dynamic exercise has remained a topic of interest to respiratory physiologists for the better part of a century. During this time, several theories have been proposed and tested in an attempt to explain what has been called the phase I response of exercise hyperpnoea, or the fast neural drive to breathe, and much controversy still remains as to what mediates this response. 'Central motor command' and 'afferent feedback' mechanisms, as described in animal models, have been centre stage in the debate, with much supportive evidence for their involvement. This review presents three relatively recent and controversial mechanisms and examines the increasing evidence for their involvement in the initial phase of exercise hyperpnoea: (1) the vascular distension hypothesis, (2) the vestibular feedback hypothesis and (3) the behavioral state hypothesis. Some outstanding fundamental questions and directions for future research are presented throughout, always with a focus on mechanistic efficacy in the integrated system response.

Exercise↗
PubMed2001

Functional analysis of the type III effectors AvrRpt2 and AvrRpm1 of Pseudomonas syringae with the use of a single-copy genomic integration system.

Gram-negative phytopathogenic bacteria require a type III secretion apparatus for pathogenesis, presumably to deliver Avr effector proteins directly into plant cells. To extend previous studies of Avr effectors that employed plasmids encoding Avr proteins, we developed a system that permits the integration of any gene into the Pseudomonas syringae genome in single copy. With this system, we confirmed earlier findings showing that P. syringae pv. maculicola strain PsmES4326 expressing the AvrRpt2 effector induces a resistance response in plants with the cognate R gene, RPS2. Chromosomally located avrRpt2, however, provoked a stronger resistance response than that observed with plasmid-expressed AvrRpt2 in RPS2+ plants. Additionally, chromosomal expression of AvrRpt2 conferred a fitness advantage on P. syringae grown in rps2- plants, aiding in growth within leaves and escape to leaf surfaces that was difficult to detect with plasmid-borne avrRpt2. Finally, with the use of the genomic integration system, we found that a chimeric protein composed of the N terminus of the heterologous AvrRpml effector and the C-terminal effector region of AvrRpt2 was delivered to plant cells. Because the C terminus of AvrRpt2 cannot translocate into plant cells on its own, this indicates that the N-terminal region can direct secretion and translocation during an infection, which supports the view that Avr proteins have a modular design. This work establishes a readily manipulatable system to study type III effectors in a biologically realistic context.

Arabidopsis↗
PubMed1996

Using hub technology to facilitate information system integration in a health-care enterprise.

The deployment and maintenance of multiple point-to-point interfaces between a clinical information system, such as a laboratory information system, and other systems within a healthcare enterprise is expensive and time consuming. Moreover, the demand for such interfaces is increasing as hospitals consolidate and clinical laboratories participate in the development of regional laboratory networks and create host-to-host links with laboratory outreach clients. An interface engine, also called a hub, is an evolving technology that could replace multiple point-to-point interfaces from a laboratory information system with a single interface to the hub, preferably HL7 based. The hub then routes and translates laboratory information to other systems within the enterprise. Changes in application systems in an enterprise where a centralized interface engine has been implemented then amount to thorough analysis, an update of the enterprise's data dictionary, purchase of a single new vendor-supported interface, and table-based parameter changes on the hub. Two other features of an interface engine, support for structured query language and information store-and-forward, will facilitate the development of clinical data repositories and provide flexibility when interacting with other host systems. This article describes the advantages and disadvantages of an interface engine and lists some problems not solved by the technology. Finally, early developmental experience with an interface engine at the University of Michigan Medical Center and the benefits of the project on system integration efforts are described, not the least of which has been the enthusiastic adoption of the HL7 standard for all future interface projects.

Delivery of Health Care↗
PubMed2004

ThyA as a selection marker in construction of food-grade host-vector and integration systems for Streptococcus thermophilus.

We constructed food-grade host-vector and integration systems for Streptococcus thermophilus by using a thymidylate synthase gene (thyA) as the selection marker. Two thyA genes, thyA(St) and thyA(Lb), were cloned from S. thermophilus and Lactobacillus delbrueckii subsp. bulgaricus, respectively. Thymidine-requiring mutants of S. thermophilus were obtained after successive cultures in the presence of trimethoprim, and one of them, TM1-1, was used as the host. Food-grade vectors were constructed by using either thyA(St) or thyA(Lb) as the selection marker. Transformants of TM1-1 created by using these vectors were selected for thymidine autotrophy as efficiently as for erythromycin resistance. By using the host-vector system developed in this way, a foreign amylase gene (amyA) was expressed in TM1-1 and was also integrated into the chromosome by use of a temperature-sensitive integration vector constructed with thyA(Lb) as the selection marker via a double-crossover event. The results obtained show that thyA is an efficient and safe selection marker for S. thermophilus that is suitable for food applications.

Base Sequence↗
PubMed1999

Primary care and primary health care for an integrated system.

The article by Rosser and Kasperski, "Organizing Primary Care for an Integrated System," provides an important stimulus for examining issues surrounding healthcare reform in Canada. As the "Guidelines for Commentary" of HealthcarePapers indicate, healthy debate can foster "constructive change. " The Canadian Nurses Association welcomes the opportunity to engage in such a debate and it is within this spirit that we offer a number of challenges, both at a theoretical/conceptual as well as a factual level, to the ideas presented by Rosser and Kasperski. Although there are a number of points in the article that warrant attention, this commentary will address only a selected few.

Canada↗
PubMed2000

Integrated system for rapid PCR-based DNA analysis in microfluidic devices.

An integrated system for rapid PCR-based analysis on a microchip has been demonstrated. The system couples a compact thermal cycling assembly based on dual Peltier thermoelectric elements with a microchip gel electrophoresis platform. This configuration allows fast (approximately 1 min/ cycle) and efficient DNA amplification on-chip followed by electrophoretic sizing and detection on the same chip. An on-chip DNA concentration technique has been incorporated into the system to further reduce analysis time by decreasing the number of thermal cycles required. The concentration injection scheme enables detection of PCR products after performing as few as 10 thermal cycles, with a total analysis time of less than 20 min. The starting template copy number was less than 15 per injection volume.

DNA↗
PubMed1995

Technology assessment at the Institute for Clinical Systems Integration and HealthPartners.

The Technology Assessment Committee of the Institute for Clinical Systems Integration (ICSI) draws upon the resources of many different groups and in turn, keeps the groups informed about new medical treatments, devices, and procedures. This new Minneapolis-based technology assessment committee uses a collaborative effort to serve the information needs of many employer groups, patients, providers, and health care organizations in the area. This committee serves as the principal mechanism by which new medical and surgical procedures, devices, and treatments, as well as new applications of old but unproved or doubtful applications of existing technologies are reviewed for medical appropriateness at ICSI (a nonprofit quality improvement organization) and at HealthPartners (a combined staff and group model HMO in Minnesota).

Academies and Institutes↗