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The nation's largest health information management trade show took place in late February. For the second year in a row, health care management and information technology consultant Peter Wenzlick reports on the state of the art.
PURPOSE: To identify self-perceived problems in managing science information needs of U.S. primary practitioners and their opinion leaders. SAMPLE: A two-stage random sample of the American Medical Association's "Masterlist of Physicians" to identify 625 office-based physicians, including general practice, family practice, internal medicine, obstetrics and gynecology, and pediatrics, and 100 physician opinion leaders. DATA COLLECTION: A formal telephone survey was completed for 79% of practitioners and 90% of opinion leaders sampled, using a pretested instrument applied by trained telephone surveyors. RESULTS OF DATA ANALYSIS: Both practitioners and opinion leaders claimed that published reviews were the most useful means of identifying their information needs. When asked about use of six recent clinical advances, that is, "markers," for example, hemoglobin-A1C for diabetic control, as many as one fifth to one half were not using or were not aware of such an advance. Less than 1 in 3 practitioners personally searched the literature when information was needed; 2 in 3 claimed literature volume was unmanageable; 9 of 10 practitioners and opinion leaders assessed the scientific value of literature obtained, primarily from their own experience, with less than 1 in 10 contacting research methods specialists. Respondents suggested various innovations to better manage their science information needs in the future. CONCLUSIONS: Primary practitioners require substantial help in meeting current science information needs. Increase in such resources as "validated reviews" or "expert networks" might help meet these needs.
OBJECTIVE: To develop a conceptual model of a management information system for process-oriented health care organizations. METHODS: Qualitative data was collected from two case studies in process-oriented health care settings. The first study addressed the information requirements of health care managers and the second study focused on organizational activities and clinical practice. From these data, preliminary models were iteratively developed, interpreted, and further revised. SETTING: A county hospital in southern Sweden with 30 clinics and 3,200 employees. RESULTS: A conceptual model of a management information system for process-oriented health care organizations was developed in two parts: one part that describes the organizational interface of the model and the other part that describes the architecture of the model. CONCLUSION: A conceptual model has been developed for local-level integration of management information systems and organizational procedures in process-oriented health care organizations
An approach to reduce the complexity of information management is to distinguish it into strategic, tactical and operational management with each of the levels using its own software tools. In practice, the management levels are tightly connected and interact closely. The most evident information that has to be interchanged between the management levels is the information about finished, cancelled, running and planned activities or projects, respectively. We claim that the levels of information management should share information about the work done, and propose their integration by means of a network of so-called process frame instances. Process frame instances hold information about the activities of different information management levels in a structured and reusable way.
This article describes the development of a decision support system called CLASSICA, which assists nurse managers in financial management, resource allocation, activity planning, and quality control. CLASSICA integrates information about patient flow and activity, staffing, and the cost of nursing care at the nursing-unit level. The system provides assistance in planning activities, balancing the budget, and identifying barriers to unsatisfactory resource management. In addition, CLASSICA contains forecasting and simulation options to analyze the influence of factors that affect nursing costs. This article describes the system's development process steps to tailor it to the needs of nurse managers and their existing work practices. Nurse managers actively participated in defining their tasks and responsibilities; identified barriers and difficulties in managing these tasks; defined information needs, data input, and output and interface requirements; and identified expected benefits. Clear communication of project goals, strong user involvement, and purposeful benefit planning was used to achieve the goals for CLASSICA: (1) to provide essential information and decision support for effective financial management, resource allocation, activity planning, and staffing; (2) to improve nurse managers' competence in financial management and decision making; (3) to improve cost containment; and (4) to provide a helpful and easy to use tool for decision support.
MOTIVATION: As biomedical researchers are amassing a plethora of information in a variety of forms resulting from the advancements in biomedical research, there is a critical need for innovative information management and knowledge discovery tools to sift through these vast volumes of heterogeneous data and analysis tools. In this paper we present a general model for an information management system that is adaptable and scalable, followed by a detailed design and implementation of one component of the model. The prototype, called BioSifter, was applied to problems in the bioinformatics area. RESULTS: BioSifter was tested using 500 documents obtained from PubMed database on two biological problems related to genetic polymorphism and extracorporal shockwave lithotripsy. The results indicate that BioSifter is a powerful tool for biological researchers to automatically retrieve relevant text documents from biological literature based on their interest profile. The results also indicate that the first stage of information management process, i.e. data to information transformation, significantly reduces the size of the information space. The filtered data obtained through BioSifter is relevant as well as much smaller in dimension compared to all the retrieved data. This would in turn significantly reduce the complexity associated with the next level transformation, i.e. information to knowledge.
OBJECTIVES: Systematic information management in hospitals demands for a strategic information management plan (SIM plan). As preparing a SIM plan is a considerable challenge we provide a practical guideline that is directly applicable when a SIM plan is going to be prepared. METHODS: The guideline recommends a detailed structure of a SIM plan and gives advice about its content and the preparation process. It may be used as template, which can be adapted to the individual demands of any hospital. RESULTS: The guideline was used in several hospitals preparing a SIM plan. Experiences showed that the SIM plans could be prepared very efficiently and timely using the guideline, that the proposed SIM plan structure suited well, that the guideline offers enough flexibility to meet the requirements of the individual hospitals and that the specific recommendations of the guideline were very helpful. CONCLUSIONS: Nevertheless, we must strive for a more comprehensive theory of strategic information management planning which -- in the sense of enterprise architecture planning -- represents the intrinsic correlations of the different parts of a SIM plan to a greater extent.
OBJECTIVE: Contemporary health care places enormous health information management demands on laypeople. Insights into their skills and habits complements current developments in consumer health innovations, including personal health records. Using a five-element human factors model of work, health information management in the household (HIMH) is characterized by the tasks completed by individuals within household organizations, using certain tools and technologies in a given physical environment. DESIGN: We conducted a descriptive-exploratory study of the work of HIMH, involving 49 community-dwelling volunteers from a rural Midwestern community. MEASUREMENTS: During in-person interviews, we collected data using semistructured questionnaires and photographs of artifacts used for HIMH. RESULTS: The work of HIMH is largely the responsibility of a single individual, primarily engaged in the tasks of acquiring, managing, and organizing a diverse set of health information. Paper-based tools are most common, and residents develop strategies for storing information in the household environment aligned with anticipated use. Affiliative relationships, e.g., parent-child or spousal, within the household serve as the organization that gives rise to health information management practices. Synthesis of these findings led to identification of several storage strategies employed in HIMH. These strategies are labeled "just-in-time," "just-because," "just-in-case," and "just-at-hand," reflecting location of the artifacts of health information and anticipated urgency in the need to retrieve it. CONCLUSION: Laypeople develop and employ robust, complex strategies for managing health information in the home. Capitalizing on these strategies will complement and extend current consumer health innovations to provide functional support to people who face increasing demands to manage personal health information.
Employing Goffman's [(1959). The presentation of self in everyday life. New York: Doubleday and Company] notion of impression management, adolescents' conveyance of information about their whereabouts and activities to parents was assessed employing two methodologies. First, a two-wave panel design with a sample of 121 adolescents was used to test a model of information management incorporating two forms of information regulation (lying and willingness to disclose), adolescents' perception of their parents' knowledge about their activities, and adolescent misconduct. Path analysis was used to examine the model for two forms of misconduct as outcomes: substance use and antisocial behaviours. Fit indices indicate the path models were all good fits to the data. Second, 96 participants' responses to semi-structured questions were analyzed using a qualitative analytic technique. Findings reveal adolescents withhold or divulge information in coordination with their parents, employ impression management techniques, and try to balance safety issues with preservation of the parent-adolescent relationship.
Developing a good information management plan is a major project, but it can be accomplished by taking small incremental steps and making sure your team stays focused. Several good things will be produced as a result of your hard work. Your patients will ultimately receive better care due to the availability of more timely information. The hospital will gain cost effectiveness when the information is integrated. Society as a whole will benefit from the sharing of unidentifiable patient information through research.
This paper provides an overview of health information management practices in Singapore, based on personal observation and interviews with health information managers in five Singaporean hospitals. In Singapore borrowing a medical record often requires a formal request and a permanent tracer is maintained for each record. Medical officers generally have more responsibility than in Australia for coding, which is completed within three days of discharge. A Singapore-wide centralised patient database has been developed which is an important source of information about patient drug allergies. Record design and assembly, release of information and centralised registries are also described.
This article investigates the relationship between quality assurance (QA) and perceptions of the importance of information technology (IT) for information management in the health care industry. This issue is important because effective information management is recognized as a necessary condition for quality management. The unit of analysis of the article is the health care functional department. Data from 34 health care departments were collected and used for the analysis. Four specific hypotheses were proposed and tested. Our results suggest that end-user perceptions of the importance of IT for information management depends on formalization of QA, perceived importance of QA, time since QA was embraced, and number of people in the QA function.
A computer-assisted management information system was created to facilitate effective management of clinical nutrition services and labor resources in a 330-bed teaching and research hospital. Standards were developed for the quality and quantity of nutrition care, time required to provide nutrition care, and utilization of dietitians' time. Computer software was developed to report the volume of services provided, the need for services, and the utilization of labor hours. Data were evaluated to determine whether services were consistent with standards and to calculate a recommended number of clinical dietitian full-time equivalents for the hospital. Furthermore, the management information system was instrumental in developing a fee-for-service structure, for evenly distributing work loads among dietitians, and for monitoring adherence to standards of care.
UNLABELLED: Operating room (OR) scheduling information systems can decrease perioperative labor costs. Material management information systems can decrease perioperative inventory costs. We used computer simulation to investigate whether using the OR schedule to trigger purchasing of perioperative supplies is likely to further decrease perioperative inventory costs, as compared with using sophisticated, stand-alone material management inventory control. Although we designed the simulations to favor financially linking the information systems, we found that this strategy would be expected to decrease inventory costs substantively only for items of high price ($1000 each) and volume (>1000 used each year). Because expensive items typically have different models and sizes, each of which is used by a hospital less often than this, for almost all items there will be no benefit to making daily adjustments to the order volume based on booked cases. We conclude that, in a hospital with a sophisticated material management information system, OR managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the OR information system with the hospital's material management information system to achieve just-in-time inventory control. IMPLICATIONS: In a hospital with a sophisticated material management information system, operating room managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the operating room information system with the hospital's material management information system to achieve just-in-time inventory control.
In Romania a Health Management Information System (HMIS) project is in progress. The project covers the main activities of the Ministry of Health (MoH), of the 42 District Health Authorities and more than 250 other health care units. The first applications will be implemented at the middle of 1999. The paper shows the context of the HMIS among other Health Information Systems in Romania, its main parts and some organizational issues of the HMIS project, achievements and difficulties encountered.
This article describes the development of a Tuberculosis Informations Management in Kanagawa Prefecture. Although the informations management was very complicated and troublesome, it saves labor thanks to computerised management of data, and allows the preparation of various documents. This system uses tuberculosis surveillance informations developed by the Ministry of Health, Labour and Welfare. By using this system, it has become possible not only to improve the work efficiency, but we also to deliver timely and appropriate followup care to patients and their contacts. Moreover, access to necessary data and statistical informations, in the form of Excel spreadsheets, was possible in this system. Besides saving labor power, the system provides various informations needed for the evaluation of the tuberculosis situation in jurisdictional area. Thus, this system has become an essential informational tool in the planning of tuberculosis control strategy.
In this paper we describe the development of the Mental Health-Patient Information Management System (MH-PIMS), which is an information management system designed for use in a modern, primarily community-based, mental health service. MH-PIMS is a computerised database which was designed by clinicians and is supported by a case management system and complementary patient record set-together called the Assessment and Care Evaluation (ACE) system. The paper also describes the ACE system. MH-PIMS can generate patient reports of use to case managers and teams in managing their caseloads and is of use to senior clinicians and service managers for audit and strategic planning purposes.
The article describes the professional development program in health information management offered at the University of Sheffield. The program leads to the award of either the Diploma or the Master of Science in Health Information Management. The aims and objectives of the program are presented, along with the overall program structure, entry, registration, and attendance requirements. The available modes of study are described, along with the assessment methods employed. An outline of the modules offered by the program is provided. Finally, the current status of the program and proposed future developments are discussed.