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As information & communication technologies have advanced, interest in mobile health care systems has grown. In order to obtain information seamlessly from distributed and fragmented clinical data from heterogeneous institutions, we need solutions that integrate data. In this article, we introduce a method for information integration based on real-time message communication using trigger and advanced database technologies. Messages were devised to conform to HL7, a standard for electronic data exchange in healthcare environments. The HL7 based system provides us with an integrated environment in which we are able to manage the complexities of medical data. We developed this message communication interface to generate and parse HL7 messages automatically from the database point of view. We discuss how easily real time data exchange is performed in the clinical information system, given the requirement for minimum loading of the database system.
We present a comprehensive review of anthropological, sociological, and psychological theory and data on the structure, content, and function of health-related schemas. Health psychology's need to integrate specific variables and principles from the other disciplines is highlighted. Suggestions for future research are offered, and the importance of cultural factors in health beliefs is emphasized.
The basics of a particular Integrated Electronic Health Record (I-EHR) implementation are presented, as realised by the Patient Clinical Data Directory (PCDD) system. PCDD operates within the context of HYGEIAnet, the Integrated Healthcare Telematics Network of Crete. PCDD is based on a federation of autonomous information systems and provides to its authorized users alternative views of the health record as well as access and retrieval services to its geographically distributed segments. The data model of the PCDD is based on the Subjective Objective Assessment Plan (SOAP) model that originates from the primary healthcare domain. Access to detailed information on particular patients healthcare encounters is delivered via role-based authorization privileges and controls. The administration of the national healthcare organizations' business rules, for different user-groups, is made via a specially tailored and developed rule-editor.
BACKGROUND: The purpose of this study was to explore the use of storytelling as a method to teach breast health information to older African American women. METHODS: A qualitative design utilizing the focus-group method. RESULTS: Six story types (categories) emerged from the focus-group data and were integrated into the breast health education class. Categories were: 1) loss, 2) pain, 3) suffering, 4) fear and worry/stress, 5) death, and 6) faith in God and prayer. Three major outcomes resulted from the storytelling format: 1) peer teaching enhanced learning, 2) incorrect information was identified and clarified, and 3) personal experiences were validated. CONCLUSIONS: Integration of African American women's self-identified issues and concerns with breast health messages through storytelling resulted in a meaningful teaching-learning experience.
OBJECTIVE: To describe the reasons for encounter (RFE) at the casualty department of a small rural hospital and to highlight the value of the hospital to the community, and to health care workers, medical educators, and policy makers. SETTING: A small South Australian rural town with a population of about 4500 served by a 50-bed hospital that provides a 24 hour casualty service manned by the local three-person general practice on a fee-for-service basis. METHODS: Using an integrated computerised health information management system, data on all the RFE at the casualty department were accumulated over 9 months, coded with ICHPPC-2-Defined, analysed and transferred to a spreadsheet for presentation. RESULTS: There were sex variations in the various age groups with males presenting more commonly with accidents and injuries. The main reasons for encounter were injuries (35%), respiratory system problems (13%), ear problems (10%), infections (5%), ill-defined problems (5%), supplementary classification (5%). CONCLUSIONS: There is sufficient 'clinical material' for undergraduate and graduate training in the management of trauma and orthopaedic problems but insufficient for obstetric and abdominal surgical emergencies in small rural hospitals. Small rural hospitals must be supported and used effectively by educators and policy-makers to help rural doctors meet the needs of the 30% of the Australian population who do not live on the coastal fringe.
According to health politicians at present, the modernisation of the health care system is a continuous task of the health policy of governments. The core of this modernisation: to have information about the needs of the population and the patients, to ensure immaterial and material conditions of health care, to organise and direct the process of health care in the interests of the favourable results of the outcome of care activities. The fundamental conditions of the modernisation to update the health information systems are harmonised on an international level. The main goal of the bilateral program is: to develop and introduce health informatics telemedicine systems for transmission and integration of information systems and health data between structures in Hungary and Italy. The program contemplates doing problem-oriented electronic patients record structures with a flexible, interactive and high operation-speed knowledge basis network for health institutes of both countries.
Assessment of human health risks of environmental agents has often been limited to consideration of the potential for the agent to cause cancer or general systemic toxicity after long-term exposure. The U.S. Environmental Protection Agency (U.S. EPA) is increasingly moving toward the development of integrated assessments, which consider all potential health end points including developmental toxicity, neurotoxicity, immunotoxicity, reproductive effects, and germ cell mutagenicity. The U.S. EPA has a responsibility to assess risks to nonhuman species or ecosystems when appropriate data are available. An example of a recent integrated human health and ecological risk assessment can be found in the U.S. EPA Mercury Study Report to Congress. This report covers the following topics in separate volumes: an inventory of anthropogenic mercury emissions in the United States; an exposure assessment using measured and predicted values and including indirect dietary exposure; an evaluation of human health risks; an assessment of ecologic risk wherein water criteria are presented for several wildlife species; an overall integrated characterization of human and nonhuman risk; and a discussion of risk management considerations. In the evaluation of human health risk, genetic toxicology data were considered for three forms of mercury: elemental, inorganic (divalent), and methylmercury. These data were used in judgments of two types of potential health effects (carcinogenicity and germ cell mutagenicity). In assessment of potential carcinogenicity of inorganic and methylmercury, genetic toxicity data were key. Data for clastogenicity in the absence of mutagenicity supported the characterization of inorganic and methylmercury as materials that produce carcinogenic effects only at high, toxic doses. The evidence for clastogenicity, coupled with information on metabolism and distribution, resulted in a judgment of a moderate degree of concern (or weight of evidence) that inorganic mercury can act as a human germ cell mutagen. For methylmercury, the degree of concern for germ cell mutagenicity is high.
This article draws upon data from a unique, 11-country study of young people's health behaviour, facilitated by the WHO Regional Office for Europe. Analyses of the data available on individual health behaviours cluster into two groups: (i) health enhancing behaviours; and (ii) health-compromising behaviours. The results were analysed to identify the strength and consistency of these lifestyles across countries. A relatively modest proportion of the variance of the original variables was explained by these two lifestyle factors, but a consistent pattern emerged between countries. This consistency indicates that the health-related lifestyles of young people may not vary greatly between the countries in the study, a finding which might be used as an encouragement for greater international cooperation in the development and use of health education materials for young people, which may be easily transferable between countries. The data also support a more integrated approach to health education based on the promotion of healthy lifestyles, rather than a focus on individual health behaviours.
The results of a 2001 national survey of the ambulatory care responsibilities of pharmacists in managed care organizations (MCOs) and integrated health systems are reported and compared with the results of similar surveys conducted in 1997 and 1999. Three hundred and seventy-six MCOs and integrated health systems participated in the telephone survey. The surveyelicited data about organizational structure and pharmacist functions in the ambulatory care environment. Survey respondents were asked about 24 specific ambulatory care pharmacist functions. The performance of functions was related to five "enabling" factors: pharmacists on interdisciplinary care teams, automated dispensing systems, integrated electronic medical records, very supportive medical staff, and very supportive senior management. Twenty previously measured functions decreased since 1999. Decreases were greatest in negotiating pharmaceutical contracts (-28%), administering immunizations (-27%), and immunization screening (-24%). Enabling factors supported continued expansion. Two clusters of functions, patient-related and population-related activities, were identified and supported differentially by enabling factors. Group-model and staff-model HMOs had the most enabling factors and the broadest scope of pharmacist functions. Independent practice associations had fewer enabling factors and a different mix of functions, with an emphasis on population-focused functions. Ambulatory care functions of pharmacists have expanded to new areas and have decreased in more traditional areas, perhaps because of the current pharmacist shortage and the increase in the number of prescriptions and patients.
OBJECTIVE: The study examined changes in the use of shelters in New York City by mentally ill persons with a history of homelessness who received housing placements through the New York-New York (NY/NY) housing initiative between 1990 and 1999 and the impact of the initiative on the overall demand for shelter beds in the city. METHODS: Computerized service records on housing, shelter use, and health care services were linked to create an integrated data set for 3,167 persons who received NY/NY housing placements, which provided mental health services, and for a matched control group of persons with mental illness who used shelters but did not receive housing placements. Regression analyses were used to assess the relationships between shelter use and receipt of a placement. Differences in postplacement shelter use between NY/NY housing recipients and the matched control group were then examined at an individual level and a population level. RESULTS: Heavy users of the shelter system were more likely to be placed in NY/NY housing. In the two-year postplacement period, persons who received a NY/NY housing placement used, on average, 128.2 fewer shelter days than those in the control group. In 1996, the NY/NY housing initiative reduced the average nightly census in New York City shelters by an estimated 4.6 percent. CONCLUSIONS: Providing housing combined with mental health services is an effective approach to reducing shelter use among mentally ill persons who have a history of homelessness.
In September 2000, the Agency for Healthcare Quality and Research and the American Academy of Pediatrics Center for Child Health Research sponsored a meeting of experts and knowledgeable stakeholders to identify 1) the special information needs of pediatric care and 2) health service research questions related to the use of information technology in children's health care. Technologies that support the care of children must address issues related to growth and development, children's changing physiology, and the unique diseases of children and interventions of pediatric care. Connectivity and data integration are particular concerns for child health care workers. Consumer health information needs for this population extend beyond the needs of one individual to the needs of the family. Recommendations of the attendees include rapid implementation of features in electronic health information systems that support pediatric care and involvement of child health experts in policy making, standards setting, education, and advocacy. A proposed research agenda should address both effectiveness and costs of information technology, with special consideration for the needs of children, the development and evaluation of clinical decision support in pediatric settings, understanding of the epidemiology of iatrogenic injury in childhood, supplementation of vocabulary standards with pediatrics-specific terminology, and improvement in health care access for children, using telemedicine.
This article begins with a summary of the trend toward a person-based health record, and the need to integrate data from a variety of sources to achieve this. A project is described that demonstrated problems with the structure of nursing care plans. These problems affected the ability to integrate care plan data into a clinical database capable of analysis to link control of process with clinical outcome. A second project is described that focused on the development of data sets holding higher-level descriptions suitable for the maintenance of a person-based record, but at a summarized level and with no clinical detail. Finally, a prototype care planning system is described that, while maintaining the data required by the Nursing Process, was more flexibly structured to support analysis and hierarchical levels of description.
Among the characteristics of the present time, we meet the ranking of information among the key resources of effective management of business systems. Up to date, integral and accurate information have gained precedence over conventional economic resources. This applies particularly in the case of large and complex business systems, including the national health care and health insurance systems. High quality and unified databases form the foundation for rational and quality procedures ranging from the operative level to the national strategy level. The goal of this paper is to demonstrate, on the example of Slovene experience, the importance of keeping quality databases for the purposes of health care and health insurance system management. The paper reviews the achieved level and the plans of further development of unified databases in this sector in Slovenia. The key emphasis in the development of an integrated system has been laid upon establishing uniform primary databases and providing appropriate integration in the area of data interchange among the actors of the health care and health insurance systems and other national systems.
PURPOSE: The value of genetic information for improving the performance of clinical risk prediction models has yielded variable conclusions. Many methodological decisions have the potential to contribute to differential results. We performed multiple modeling experiments integrating clinical and demographic data from electronic health records with genetic data to understand which decisions may affect performance. METHODS: Clinical data in the form of structured diagnostic codes, medications, procedural codes, and demographics were extracted from 2 large independent health systems, and polygenic risk scores (PRS) were generated across all patients of European ancestry with genetic data in the corresponding biobanks. Crohn's disease was studied based on its substantial genetic component, established electronic health records-based definition, and sufficient prevalence for training and testing. We investigated the impact of choices regarding the PRS integration method, training sample, model complexity, and performance metrics. RESULTS: Overall, our results showed that including PRS resulted in higher performance, but this gain was only robust in situations with limited clinical information. We found consistent performance increases from more compute-intensive models, such as random forest, but the impact of other decisions varied by site. CONCLUSION: This work highlights the importance of considering methodological decision points in interpreting the impact of PRS on prediction performance in clinical models.
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As health care reform and components of managed competition begin to infiltrate the health care system, health care providers will be facing significant challenges over the next several years in responding to priorities that mandate the delivery of appropriate, comprehensive, cost-efficient high quality care. Changes in financial risk, increasing accountability, performance documentation, and outcome measurements will hold providers more responsible for the input and output of services provided. In an effort to respond to these challenges, health care providers will have to rely on integrated data systems to identify opportunities for improvement in an effort to more effectively manage and measure the impact of health care delivery as patients move through the health care system.
BACKGROUND: Monitoring and researching clinical care calls for comprehensive clinical databases. In mental health care these need to cover all aspects of the care of each patient and to accommodate the complexity of care which may last from weeks to years. This paper describes the pilot work for a mental health clinical database intended to be implemented throughout the English National Health Service. METHODS: In collaboration with three pilot sites, a set of data extracts was defined which could reasonably easily be produced, mostly using existing statistical data collection systems. Software was designed to integrate these extracts into patient-based records describing overall spells of mental health care. These data were extracted from their systems for a 6-month pilot period. RESULTS: Two of the three sites produced data sets, which appeared to give a reasonably complete account of the work undertaken in the pilot period. Known differences in service design and clinical perspective between the two sites were clearly reflected. CONCLUSIONS: The approach to extracting and collating the data is workable within existing resources and produces illuminating data for clinical audit, management and planning. Completeness and accuracy of data is likely to be a continuing problem, as for any routine data capture exercise. However, the process of integrating data from several channels assists this, as inconsistencies become apparent and can be tackled. The approach is now being implemented throughout England.