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PubMed2004

Integrating the New York citywide immunization registry and the childhood blood lead registry.

In February of 2004, the New York City Department of Health and Mental Hygiene completed the integration of its childhood immunization and blood lead test registry databases, each containing over 2 million children. A modular approach was used to build a separate integrated system, called Master Child Index, to include all children in both the immunization and lead test registries. The principal challenge of this integration was to properly align records so that a child represented in one database is matched with the same child in the other database. To accomplish this task as well as to identify internal duplicate records within each database, an artificial intelligence record linkage system was created. The preliminary results show high rates of accurate merging of records both within and between the two databases. The 4,610,585 records contained in both databases before Master Child Index implementation consolidated into 2,977,290 records in the integrated system. The matching system eliminated 523,720 duplicate records within the two databases and matched and merged 1,109,575 records between the two databases. The Department of Health and Mental Hygiene plans to further develop the Master Child Index and use it as the department-wide, record-matching system.

Artificial Intelligence↗
PubMed1993

The tricarboxylic acid cycle in Dictyostelium discoideum. Systemic effects of including protein turnover in the current model.

The current model for the tricarboxylic acid cycle in Dictyostelium discoideum is based on extensive experimental studies of enzyme kinetics in vitro and of metabolite fluxes measured in vivo. In the previous papers (Shiraishi, F., and Savageau, M. A. (1992) J. Biol. Chem. 267, 22912-22918; 22919-22925; 22926-22933; 22934-22943) of this series we have carried out extensive analyses of the current model within the framework of biochemical systems theory with a view toward understanding the behavior of the integrated system. The model was found to be ill determined with respect to at least three of its features. In this paper we propose a minimal modification in the model that is consistent with previous experimental data but also includes recycling of amino acids for protein synthesis, one of the neglected features identified as important in the previous analysis. We again perform an analysis within the framework of biochemical systems theory to determine the systemic consequences of this change. The results show that the robustness of the modified model, as determined by the parameter sensitivities, is improved by 2 orders of magnitude over that of the previous model. Analysis of the dynamics shows that the turnover times for the pools of alanine, glutamate, and aspartate are reduced by 2 orders of magnitude and made more physiologically realistic. The distribution of flux is no longer rigidly fixed, and problems previously centered on the metabolism of pyruvate have been partially alleviated. Continued discrepancies lead us to question the degree to which kinetic data obtained with purified enzymes in vitro faithfully reflect the kinetic behavior of the integrated enzyme system in vivo. We must continue to re-examine the manner in which the kinetics of reactions in vivo are represented and to reassess the physical conditions that prevail in vitro and in vivo. Results in this paper direct our attention toward specific aspects of the system where these efforts should be focused. Thus, a minimal modification of the previous model has led to several improvements that make it more representative of the tricarboxylic acid cycle in D. discoideum, and the analysis in this paper leads to further predictions for improving the model.

Animals↗
PubMed2005

Integrated airlift bioreactor system for on-site small wastewater treatment.

An integrated airlift bioreactor system was developed, which mainly consists of a multi-stage loop reactor and a gas-liquid-solid separation baffle and possesses dual functions as bioreactor and settler. This integrated system was used for on-site treatment of industrial glycol wastewater in lab-scale. The strategy of gradually increasing practical wastewater concentration while maintaining the co-substrate glucose wastewater concentration helped to accelerate the microbial acclimation process. Investigation of microbial acclimation, operation parameters evaluation and microbial observation has demonstrated the economical and technical feasibility of this integrated airlift bioreactor system for on-site small industrial wastewater treatment.

Bacteria↗
PubMedDate not supplied

Putting the enterprise into the enterprise system.

Enterprise systems present a new model of corporate computing. They allow companies to replace their existing information systems, which are often incompatible with one another, with a single, integrated system. By streamlining data flows throughout an organization, these commercial software packages, offered by vendors like SAP, promise dramatic gains in a company's efficiency and bottom line. It's no wonder that businesses are rushing to jump on the ES bandwagon. But while these systems offer tremendous rewards, the risks they carry are equally great. Not only are the systems expensive and difficult to implement, they can also tie the hands of managers. Unlike computer systems of the past, which were typically developed in-house with a company's specific requirements in mind, enterprise systems are off-the-shelf solutions. They impose their own logic on a company's strategy, culture, and organization, often forcing companies to change the way they do business. Managers would do well to heed the horror stories of failed implementations. FoxMeyer Drug, for example, claims that its system helped drive it into bankruptcy. Drawing on examples of both successful and unsuccessful ES projects, the author discusses the pros and cons of implementing an enterprise system, showing how a system can produce unintended and highly disruptive consequences. Because of an ES's profound business implications, he cautions against shifting responsibility for its adoption to technologists. Only a general manager will be able to mediate between the imperatives of the system and the imperatives of the business.

Accounting↗
PubMed1995

Participatory design of computer-supported organizational learning in health care: methods and experiences.

This paper outlines a Computer-Supported Co-operative Work (CSCW) system for primary care and presents from its participatory design process time consumption, costs, and experiences. The system integrates a hypermedia environment, a computerized patient record, and an electronicmessage system. It is developed to coordinate organizational learning in primary care from micro to macro levels by connecting strategic planning to monitoring of patient routines. Summing up design experiences, critical issues for making CSCW systems support cost-effectiveness of health care are discussed.

Community Health Centers↗
PubMed1979

Community Mental Health Care: new services from old systems.

An integrated service system for the mentally disabled must encompass federally supported community centers and state-supported mental hospitals. The vision, of course, has been elusive. Rational coordination and collaboration will be politically difficult but economically necessary to achieve a just--and sane--society.

Community Mental Health Services↗
PubMed2004

QIS: A framework for biomedical database federation.

Query Integrator System (QIS) is a database mediator framework intended to address robust data integration from continuously changing heterogeneous data sources in the biosciences. Currently in the advanced prototype stage, it is being used on a production basis to integrate data from neuroscience databases developed for the SenseLab project at Yale University with external neuroscience and genomics databases. The QIS framework uses standard technologies and is intended to be deployable by administrators with a moderate level of technological expertise: It comes with various tools, such as interfaces for the design of distributed queries. The QIS architecture is based on a set of distributed network-based servers, data source servers, integration servers, and ontology servers, that exchange metadata as well as mappings of both metadata and data elements to elements in an ontology. Metadata version difference determination coupled with decomposition of stored queries is used as the basis for partial query recovery when the schema of data sources alters.

Computer Communication Networks↗
PubMed2005

Enzyme-based amperometric biosensors for continuous and on-line monitoring of cerebral extracellular microdialysate.

Analytical systems integrating in vivo microdialysis sampling with enzyme-based electrochemical biosensor detection have been increasingly accepted to be a new technique for continuous and on-line monitoring of biologically important species. Extensive interests in such integrated on-line analytical systems have suggested that these systems are very useful for physiological and pathological investigations. This review mainly focuses on the principle, development and striking applications of the enzyme-based amperometric biosensors integrated with in vivo microdialysis for continuous and on-line monitoring of cerebral extracellular fluid in recent years.

Acetylcholine↗
PubMed2001

Capillary-based fully integrated and automated system for nanoliter polymerase chain reaction analysis directly from cheek cells.

A miniaturized, integrated and automated system based on capillary fluidics has been developed for nanoliter DNA analysis directly from cheek cells. All steps for DNA analysis, including injecting aqueous reagents and DNA samples, mixing the solutions together, thermal cell lysis, polymerase chain reaction (PCR), transfer and injection of PCR product, separation, sizing and detection of those products are performed in a capillary-based integrated system. A small amount of cheek cells collected by a plastic toothpick is directly dissolved in the PCR cocktail in a plastic vial or mixed on-line with a small volume of PCR cocktail (125 nl) in the capillary. After thermal cell lysis and PCR in a microthermal cycler, the DNA fragments are mixed with DNA size standards and transferred to a micro-cross for injection and separation by capillary gel electrophoresis. Programmable syringe pumps, switching valves, multiposition and freeze-thaw valves are used for microfluidic control in the entire system. This work establishes the feasibility of performing all the steps of DNA analysis from real samples in a capillary-based nanoliter integrated system.

Automation↗
PubMed2003

From computerized patient records to national resource.

To help curb constantly rising costs of medical services, healthcare providers in Israel have been busy incorporating computerized patient record systems (CPR) into their organizations since the early 1990s. Our CPR based integrated system solutions (named Clicks) now serve over 90% of primary and secondary medical care professionals throughout the country, covering over 90% of the population across medical fields with all healthcare providers. Online verification of member rights, embedded business rules and medical protocols as well as Preventive Medical Assistance (PMA) rules are incorporated into the system. These, coupled by bi-directional communication to facilitate implementation and enforcement at all points of service and to transmit administrative and focal medical information, have created a firm foundation for carrying out the organization's cost control and expense management strategies. The CPR systems based on these underlying concepts and on token driven data entry methodology have transformed traditional medical work areas into virtually paperless environments. The enterprise wide solutions use dedicated viewports to address the needs and requirements of any medical field, user population and a wide range of medical facilities. Extensive data collection and detailed documentation are maintained universally at all points of service, for the entire patient population. Current applications, based on a distributed approach and local databases with communication to central systems for bi-directional transfer of information, gradually give way to unified databases located on central systems. Two concepts are being implemented: (a) MDC (Medical Data Core), which contains patients' focal medical data as transmitted from the local database at the physician's workstation, and (b) a complete centrally located database, where continuous communication is required from the physician's workstation to the central system, through dumb terminals. This concept entails massive investment in communication capacity and hardware and requires high reliability of all communication transactions at all times. MDC information by contrast does not require open communication lines around the clock, is communicated bi-directionally at predefined points in time or in the workflow, alleviating load and congestion on communication lines. In addition, access, retrieval and display of MDC information is done using standard browsing techniques under known protocols and requires no extra investment for these capabilities.

Diffusion of Innovation↗
PubMed1994

Lining up their shots. Exclusive new Hay survey shows the impact of integration on MD compensation.

Managed care and systems integration are having a major impact on physician compensation, says a new survey by the Hay Group. The survey of physician compensation across hospital, group practice and managed care settings shows a slowing in pay growth, a shift in emphasis toward primary care, and increased emphasis on variable compensation strategies. At the same time, demand for physician executives is rising dramatically.

Data Collection↗
PubMed1989

A clinical database management system for improved integration of the Veterans Affairs Hospital Information System.

The Department of Veterans Affairs (VA) Decentralized Hospital Computer Program (DHCP) contains data modules derived from separate ancillary services (e.g., Lab, Pharmacy and Radiology). It is currently difficult to integrate information between the modules. A prototype is being developed aimed at integrating ancillary data by storing clinical data oriented to the patient so that there is easy interaction of data from multiple services. A set of program utilities provides for user-defined functions of decision support, queries, and reports. Information can be used to monitor quality of care by providing feedback in the form of reports, and reminders. Initial testing has indicated the prototype's design and implementation are feasible (in terms of space requirements, speed, and ease of use) in outpatient and inpatient settings. The design, development, and clinical use of this prototype are described.

Ancillary Services, Hospital↗
PubMed1998

US EPA's IRIS pilot program: establishing IRIS as a centralized, peer-reviewed data base with agency consensus. Integrated Risk Information System.

The US EPA's Integrated Risk Information System (IRIS) contains Agency consensus scientific positions and quantitative values on cancer and noncancer health effects that may result from lifetime oral or inhalation exposure to specific chemical substances in the environment. Combined with specific exposure assessment information, the summary health information in IRIS may be used as a source in evaluating potential public health risks from environmental contaminants. IRIS is available to the public via EPA's Internet server at http://www.epa.gov/iris. Originally developed for internal EPA use, IRIS usage has broadened since being made publicly available in 1988 to include the private and public sectors nationally and internationally. Up to 1995, IRIS summaries were generated from within various EPA Offices and Regions and reviewed by Agency Workgroups, one for cancer and one for noncancer endpoints, before entry onto IRIS. In response to the increasing usage and recognition of IRIS and suggestions for improvement, an IRIS Pilot program was initiated in 1995. The purpose of the Pilot was 3-fold: To improve efficiency in getting information on to IRIS; to improve documentation for the positions reported in IRIS summaries, including applying new methodologies and guidance; and to improve opportunity for public input including external peer review. A new infrastructure was put in place, consisting of a cross-Agency team of 'Chemical Managers', a Pilot Program Manager, and a set of Agency 'Consensus Reviewers'. Cancer and noncancer assessments were prepared in an integrated fashion for Pilot chemical substances, documented in 'Toxicological Reviews' and derivative IRIS summaries. Public input was emphasized via an initial data call and rigorous external peer review. A final step was Agency-wide consensus review by senior staff scientists representing EPA's Offices and Regions. EPA's experience with the Pilot is forming the basis for designing operational aspects of the long-term IRIS program.

Benchmarking↗
PubMed2006

Integrating asthma prevention and control: the roles of the coalition.

Activities addressing pediatric asthma are often fragmented. Allies coalitions promoted integration, the alignment of concurrent asthma control activities across and within sectors. Systems integration describes activities from an organizational perspective. Activities included developing a shared vision, promoting consistency in asthma education and self-management support, improving adherence to clinical guidelines, advocating jointly for policy change, and seeking funds collaboratively. Service integration describes activities focused on ensuring seamless, comprehensive services through coordination within and across organizations. Activities included use of community health workers (CHWs) and nurses for care coordination, program cross-referral, and clinical quality improvement. Integration is a sustainable role for coalitions as it requires fewer resources than service delivery and results in institutionalization of system changes. Organizations that seek integration of asthma control may benefit.

Asthma↗
PubMed1986

An integrated perinatal information system and telecommunications networking.

The integrated perinatal information system in Albany Medical Center has two significant features: that of a flexible user-definable database and ease of networking both locally and regionally. The unified perinatal record is structured in Ansi standard MUMPS and resides on the College Vax 750. A special set of program tools ensures effective multi-split screen display, moving pointers, and corresponding multiple choice entries. Because it is self contained, it has the ability to create complex data structures without programming. A powerful math/statistical library has been incorporated. In house, the use of existing PABX wire allows for simultaneous voice/data traffic. Linkage to the regional system is made by modem connection. The system is compatible with the demands of both clinical and regional management.

Computers↗
PubMed2002

Straight talk: new approaches in healthcare. The digital hospital comes of age.

When the Indiana Heart Hospital opens Feb. 17, 2003, it will operate a nearly paperless and filmless environment. The 88-bed hospital is a joint venture between Community Health Network, a four-hospital system in Indianapolis, and a group of cardiologists and cardiovascular surgeons. When Phoenix Children's Hospital opened its 300-bed facility May 24, 2002, it went live with its core information systems in place. The non-profit hospital plans to add, improve, and integrate systems over the next few years, eventually becoming a mostly digital environment as well. In the seventh installment of Straight Talk, we discuss the steps necessary to become a paperless facility. Modern Healthcare and PricewaterhouseCoopers present Straight Talk. The session on the Digital hospital was held on October 8, 2002 at Modern Healthcare's Chicago Headquarters. Charles S. Lauer, publisher of Modern Healthcare, was the moderator.

Arizona↗
PubMed1988

Integrated Academic Information Management Systems (IAIMS). Part II. Planning and implementing integrated information services. Integration and outreach: Integrated Academic Information Management Systems (IAIMS) at Maryland.

The University of Maryland Campus for the Professions is now realizing the first benefits of integrated academic information management systems (IAIMS). With the support of the National Library of Medicine, the information Resources Management Division has joined with the Health Sciences Library to plan and to implement change. Within the information utility concept, networked data communications and end-user computing function as the means to integration. Plans call for new 370-based software to extend system capabilities. Mechanisms for outreach ensure that the potential of integration is realized. These mechanisms include technology assisted learning centers, informatics program development, special programs (geriatrics, hypertension pilot), and new applications (conferencing system, voice mail, videodisc development, interinstitutional resource sharing).

Academic Medical Centers↗