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The potential role of physicians in the management of hospital information systems.

The centralized management of manual and automated information systems in hospitals, including the medical record, is usually delegated to administrators rather than to physicians. It is also likely that the importance of automated information systems will increase rapidly as the medical record is electronified. Many significant changes have occurred in recent years relating to the manner in which information systems are managed in hospitals. To address the challenge of this new information environment, hospital Chief Executive Officers (CEOs) have begun to create a new executive hospital position called the Chief Information Officer (CIO). CIOs are included in the hospital executive cabinet and commonly direct all hospital information systems, telecommunications, and management engineering. Although the model of the physician-director of an information system is common at the departmental level with the Laboratory Information System as one example, physicians rarely serve within the central hospital administration as information specialists such as the CIO. Although many physicians would be suitably qualified to serve in this capacity, another option for them would be the position of Chief Medical Information Officer (CMIO) with responsibility for utilization review, medical records, and quality assurance. The CMIO would serve centrally on a part-time basis, continuing to practice simultaneously in a medical specialty. The medical information specialist must not be insulated from the flow of clinical information and discourse with medical colleagues because of the increasing use of information systems for improving work efficiency and the pursuit of quality goals.

Administrative Personnel↗

Groups vie for lucrative managed care accreditation business.

The race is on to determine which organization will become the accreditation agency of choice for the managed care industry. At stake is enormous clout at the state and national levels--and a lot of money. Squaring off against the traditional accreditation leader, the Joint Commission on Accreditation of Healthcare Organizations, are: the National Committee for Quality Assurance, the American Association of Preferred Provider Organizations, and the Utilization Review Accreditation Commission.

Accreditation↗

The evolution of an operative registry--a commentary.

The Operative Registry, also known as DA Form 4108, constitutes the basic, geographically focused, sequential log of operative activities for any given Army Medical Treatment Facility. The information provided for the Registry, with specific refinements, constitutes an essential data base for quality assurance and utilization review. The experience at Madigan Army Medical Center in developing the structure and function of this computerized data base is summarized.

Hospitals, Military↗

An assessment of the anticompetitive effects of preferred provider organizations.

Although preferred provider organizations (PPOs) sponsored by third parties are likely to offer benefits to society through increased competition, those sponsored by providers may generate a risk of anticompetitive collusion. Such cartellike collusion could result in price fixing, less aggressive utilization review, and restrictions on entry and innovation in the market. In this article, we provide guidance on the potential risks posed by provider-sponsored PPOs. We suggest that public policy should generally promote PPOs and remove regulatory barriers to their growth because of their cost containment potential. Policy design should, however, reflect an awareness of the potential anticompetitive outcomes of provider-sponsored PPOs and should promote antitrust oversight of their activities.

Economic Competition↗

Service line management. New opportunities for nursing executives.

The benefits of service line management are crucial to hospitals' survival in today's changing health care environment. Nursing executives can direct activities affecting every aspect of health care delivery in the role of service line manager. These activities include such important components as standards of care, utilization review, program development, physician relations, and quality practice issues.

Administrative Personnel↗

The impact of reimbursement changes on doctors' office testing.

Most of the recent changes that have revolutionized the way health care is financed include powerful pecuniary incentives to move care out of the hospital and into such outpatient settings as doctors' offices. However, many of these changes also include aggressive utilization reviews with stiff penalties for noncompliance. Thus, although doctors' office testing will continue to expand, this growth may bring more external oversight into doctors' offices.

Ambulatory Care↗

Cost-effective tertiary care.

We have highlighted several key points: There is a discrete subgroup of psychiatric patients who benefit from tertiary care. This treatment demands extraordinary intensity of staffing within the context of a facility whose leadership (and ownership) is committed to that level of care. Treatment should optimally occur within small residential units with clinically homogeneous populations of defined age range. mechanisms of quality control, including extensive programs of orientation, inservice, and utilization review, are paramount in achievement of success. Financial feasibility is dependent on maintenance of a high rate of occupancy, which in turn is reflective of the facility's effectiveness in fulfillment of its clinical mandate. Financial feasibility is dependent on a low relapse rate. Integration of biologic, psychologic antisocial aspects of treatment is the key to effectiveness. An intensively staffed and well-integrated unit is essential.

Adolescent↗

Evaluating HMO/IPA contracts for family physicians: one group's experiences.

This article reports the experience of a 15-person primary care group with two health maintenance organization/independent practice association (HMO/IPA) contracts. In 1986 the group received over $1.5 million in capitated payments from the plan to cover medical care of approximately 4,000 patients. The expenses exceeded the income for one plan. Analysis of primary care, specialty care, and ancillary services provides insight into factors that must be considered in evaluating HMO/IPA contracts. Eleven questions that should be asked before signing contracts and guidelines for utilization review and quality assurance are reviewed.

California↗

Assessing illness severity and outcome in critically ill patients.

Severity of illness scores have great potential to improve use of scarce resources and to help monitor quality of care. Injury severity scores can reliably separate trauma patients into high- and low-mortality groups, but have limitations when applied in triage decision making. Specific predictive models for chest pain patients have improved admitting practices in some emergency departments. Univariate predictors of survival include age, severity of illness, and presence of chronic illnesses, especially cancer. General multivariate models for intensive care patients have correctly categorized hospital outcome in approximately 85 per cent of cases when applied in a retrospective fashion. These models are insufficiently precise for application to individual patients; but they may be helpful in assessing quality of care in the intensive care unit, in assessing efficacy of new technologies, and in utilization review audits.

Age Factors↗

Mental health care utilization and costs in a corporate setting.

This article presents the mental health care utilization and costs among 14,162 employees and their families, covered under a major medical policy of a large multinational corporation for the 1984 policy year. Mental health care costs comprise a substantial portion of the total health care dollars expended (8.1%) for a relatively small fraction of the total number of claims (2.8%). The average hospital stay for mental disorders (20 days for employees; 15 days for spouses; 43 days for dependents) was significantly longer than for other illnesses (6.1 days for employees; 6.2 days for spouses; 4.4 days for dependents). Although the average daily hospital cost for mental disorders was less than that for non-mental conditions, total expenditures per admission were approximately three times higher due to the long lengths of stay. Case management, peer utilization review, and day treatment are recommended to reduce these costs.

Adult↗

Computerized discharge summaries.

A computerized, English text discharge summary system is described that is exclusively used for all patients discharged from a 150-bed rehabilitation hospital. The system covers all diagnostic categories. Cumulative statistics and other statistical routines are provided for clinical research, utilization review and administrative purposes.

Computers↗

Computer assisted patient evaluation (CAPE): a multi-purpose computer system for an anesthesia service.

We have designed and built a database management system, the computer assisted patient evaluation (CAPE) system, for use in patient management, research, and administration in our anesthesia practice. An important part of the system is the use of specially designed forms on which anesthesiologists record patient histories and management information during the course of patient care. The forms provide means for convenient and complete record keeping, as well as for direct computerization. We demonstrate the flexibility and utility of the CAPE system by presenting a series of examples of its use. These include development and implementation of a preoperative screening program to identify patients at high risk of postoperative respiratory complications; a study of anesthesia technique and outcome; auditing for quality of care; and utilization review of respiratory therapy.

Anesthesia Department, Hospital↗

Utilization of mental health services by the aging.

A descriptive study of persons 55 years of age and older who were newly admitted (60 cases) or in ongoing treatment (30 cases) in a mental health center was done as an outgrowth of a utilization review study. The total population of 461 was studied from July 1, 1977, to June 30, 1978. A chart review of 90 cases was performed. The newly admitted subsample was married, was diagnosed as depressed, and had a broad range of dispositions into various treatment modalities. The chronic subsample was single, diagnosed as schizophrenic, and in treatment in a single community-support unit. These differences were statistically significant at the P<.01, P<.001, and P<.001 levels, respectively. Although the newly admitted subsample had no previous contact with psychiatric services, 44 of the 60 patients (73 percent) were on psychoactive medication prescribed by nonpsychiatric physicians. Implications for the training of general medical practitioners and mental health center staff, and the need for ongoing assessment of patients in community support units are discussed, as well as the significant risk to patients from potentially harmful drug interactions.

Aged↗