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PubMed2000

Leveraging technology for success.

Many new information systems, technologies, and inventions promise significant benefit and value. Balancing the ever-increasing technology demands and their related expense with provision of high quality cost-effective patient care is one of today's significant organizational challenges. When appropriately deployed, Information Technology can support organizations in achieving their competitive leverage, market position, quality patient care, and efficient operations. This article presents an overview of the impact of new and emerging technologies, and suggests ways organizations can successfully leverage information systems and technology.

Community Participation↗
PubMed1995

Procurement of information systems effectively (POISE): using the new UK guidelines to purchase an integrated clinical laboratory system.

Open tendering for medical informatics systems in the UK has traditionally been lengthy and, therefore, expensive on resources for vendor and purchaser alike. Events in the United Kingdom (UK) and European Community (EC) have led to new Government guidance being published on procuring information systems for the public sector: Procurement of Information Systems Effectively (POISE). This innovative procurement process, launched in 1993, has the support of the Computing Services Association (CSA) and the Federation of the Electronics Industry (FEI). This paper gives an overview of these new UK guidelines on healthcare information system purchasing in the context of a recent procurement project with an NHS Trust Hospital. The aim of the project was to replace three aging, separate, and different laboratory computer systems with a new, integrated turnkey system offering all department modules, an Open modern computer environment, and on-line electronic links to key departmental systems, both within and external to the Trust by the end of 1994. The new system had to complement the Trust's strategy for providing a modern clinical laboratory service to the local population and meet a tight budget.

Clinical Laboratory Information Systems↗
PubMed1998

Payoff in the pacific.

Asia Pacific economies are struggling to cope with the past year's series of financial catastrophies and regain the market stature and confidence they once enjoyed. Despite the turmoil, all industries including healthcare continue to demonstrate their commitment toward privatization and modernization through technology. Advances in healthcare IT in the Asia Pacific region are narrowing the differences in healthcare between East and West. Is the information age speeding healthcare toward a global standard?

Asia↗
PubMed2002

Through a glass darkly: what should public health observatories be observing?

BACKGROUND: Eight regional public health observatories were launched in England in February 2000, to strengthen the availability and use of health information and to support efforts to tackle health inequalities at local level. This qualitative study was carried out by the Merseyside and Cheshire Zone of the North West Public Health Observatory to assess the needs of local users and producers of public health information. METHODS: Semi-structured in-depth interviews were carried out with 42 representatives of three major groups in Merseyside and Cheshire: community groups, public-health-related professionals in the local statutory and academic sectors, and information specialists within the National Health Service. RESULTS: Different groups of users and producers encountered different problems in accessing health information. Community groups had significant problems accessing and interpreting health information and were concerned about tokenism and the failure of professionals to recognize lay knowledge. Professionals experienced difficulties in accessing local information from outside their agency and had concerns over partnerships failing to work together to share information. The health information specialists stressed the danger of providing information without supporting intelligence, the difficulty of keeping track of the many local sources, and the importance of having access to local authority data sources. All three groups relied on their own networks in their search for information, and these should not be overlooked in any dissemination strategy. CONCLUSION: Information requires skilled interpretation to become policy-relevant public health intelligence. This research identified major problems in the communication of lay health knowledge and in the accessibility of public health intelligence.

Access to Information↗
PubMed2006

Health Outcomes for Better Information and Care (HOBIC): integrating patient outcome information into nursing undergraduate curricula.

Nursing-sensitive outcomes provide common information across sectors, thus eliminating duplication that frequently occurs as individuals move across settings. These outcomes also facilitate increased trust among colleagues and support common understandings of patient care needs, thus enhancing continuity of care. Outcomes-oriented information is also likely to increase patient safety and improve overall quality of care. Shared standards and data support consistent decision-making, as nursing decisions can be tracked back over time to assess patient care outcomes. Consequently, nurses will have the means to determine the impact of their interventions on patient outcomes. At the same time, adoption of common approaches to patient assessment leads to greater professional accountability and moves nursing care from a task orientation to an outcomes focus. For administrators, such improvements in monitoring and evaluating patient outcomes translate into improvements in efficiencies and effectiveness, thus providing a return on investment in implementing these outcomes within their agency. For nurses, integration and utilization of outcomes information increases the visibility and significance of their decision-making and patient care. Together with patients, nurses can utilize the outcomes information to make evidence-based decisions and advocate for appropriate care. At an aggregate level, the use of outcomes information creates a continuous feedback loop that is essential to ensuring evidence-based care and the best possible patient outcomes, not only for individuals, but also for families, communities and populations. Outcomes-oriented care provides a gateway for transforming the way we care for patients; puts safe, ethical, high-quality care for patients first; embodies the principles of evidence-based practice; ensures that the value of nursing is clearly understood within the larger system; and ensures that the requirements for measurability and accountability can be achieved. This journey is continuous and is being expanded to engage all other health disciplines in understanding and documenting their contributions to patient care, both as individual practitioners and as members of a healthcare team. Preparing nursing students in an outcomes approach will facilitate systemwide adoption of HOBIC patient outcomes over time and provide a means to determine the impact of nursing care on our patients.

Computer User Training↗
PubMed1999

Factors that cause industries to lead or lag in use of information technology: does health care lag?

The rate of diffusion of information technology varies among industries, as does its resultant added value. The different paces of work transformation are determined by the opportunities of the differing work processes, efficiency of exchange of workplace ideas, and relationships among constituencies. The differences raise the question of why the maturation process is accelerated (or restrained) in different industries, how the health care industry fares in comparison, and how information technology may be more effectively used as health care evolves toward new forms of work interaction, control mechanisms, and information technology management paradigms and as information processing moves toward higher levels of complexity.

Attitude to Computers↗
PubMed2005

The quality of sulphadoxine-pyrimethamine and amodiaquine products in the Kenyan retail sector.

BACKGROUND AND OBJECTIVE: Malaria is a disease of major public health importance in Kenya killing 26,000 children under 5 years of age annually. This paper seeks to assess the quality of sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) products available over-the-counter to communities in Kenya as most malaria fevers are self-medicated using drugs from the informal retail sector. METHODS: A retail audit of 880 retail outlets was carried in 2002 in four districts in Kenya, in which antimalarial drug stocks and their primary wholesale sources were noted. In addition, the expiry dates on audited products and the basic storage conditions were recorded on a proforma. The most commonly stocked SP and AQ products were then sampled from the top 10 wholesalers in each district and samples subjected to standard United States Pharmacopoeia (USP) tests of content and dissolution. RESULTS AND DISCUSSION: SP and AQ were the most frequently stocked antimalarial drugs, accounting for approximately 75% of all the antimalarial drugs stocked in the four districts. Of 116 SP and AQ samples analysed, 47 (40.5%) did not meet the USP specifications for content and/or dissolution. Overall, approximately 45.3% of SP and 33.0% of AQ samples were found to be sub-standard. Of the sub-standard SP products, 55.2% were suspensions while 61.1% of the substandard AQ products were tablets. Most SP failures were because of the pyrimethamine component. CONCLUSION: There is a need to strengthen post-marketing surveillance systems to protect patients from being treated with sub-standard and counterfeit antimalarial drugs in Kenya.

Amodiaquine↗
PubMed2002

Development and pilot testing of an Organizational Information Technology/Systems Innovation Readiness Scale (OITIRS).

Empirical evidence indicates that healthcare organizational readiness for new information technology/systems (IT/S) is crucial to successful innovation. Despite this evidence, limited research has been done to define innovation readiness, and develop and test metrics to measure it. This presentation reports on the third phase in a multi-phased research program focused on healthcare organizational change related to IT/S innovation. In the initial two phases, the concept of IT/S innovation readiness was explored and its sub-dimensions identified and validated. In the third phase, findings from the first two phases were used to develop and pilot test an Organizational Information Technology/Systems Innovation Readiness Scale (OITIRS) for use in healthcare settings. The specific aims of this presentation are to 1) provide background information on the development of the OITIRS, and 2) report pilot testing results that support use of the OITIRS in healthcare informatics research.

Health Care Sector↗
PubMed2003

Methods to estimate and compare VA expenditures for assistive devices to Medicare payments.

OBJECTIVE: To describe the methods used to estimate and compare Veterans Health Administration (VA) annual expenditures for assistive devices and their repair at six VA hospitals with payments for those same devices in the private sector. METHODS: Information about dispensed assistive devices and their costs was extracted from (1) the VA's National Prosthetic Patient Database, (2) each site's listing of the VA's Denver Distribution Center cost center in the Cost Distribution Jurisdictional Report, and (3) review of invoices for implanted prosthetics at each study site. We estimated private sector payments by applying Medicare geographically adjusted rates for purchases or rentals, where rates existed, or by inflating VA costs by 30%. RESULTS: The VA spent a total of $30.6 million for prosthetics at the six sites in fiscal year 1999, of which $14.2 million was for items captured in the National Prosthetic Patient Database, $3.4 million for the Denver Distribution Center, and more than $8.1 million for implants. Indirect VA costs were estimated at $4.8 million. Hypothetical private sector payments were estimated at $49.8 million. CONCLUSIONS: Unlike Medicare, VA both contracts to provide assistive devices (through a competitive bidding process) and dispenses devices it has purchased. This approach results in significantly lower expenditures, consistent with other reports. Generalizing these cost savings to other private or federal programs covering assistive devices requires further study.

Data Interpretation, Statistical↗
PubMed1998

Utilisation of specialist medical manpower in Malaysia.

One hundred and twenty specialists from the Ministry of Health, the Universities and the private sector provided information on 4,802 patients seen over a total of two hundred and forty working days. This information was used to classify the patients into four categories based on a disease complexity classification. Each specialist's perception on the appropriateness of utilisation of his expertise was obtained. Complex cases requiring specialist expertise in management made up 69.8%, 73.5% and 19.1% of the cases of the Ministry of Health, University and private sector specialists respectively. Underutilisation was most marked with paediatricians and obstetricians in the private sector. The Specialist Register, the Programme for Accreditation of Hospitals and a National Health Financing Plan can be used to influence positively the case-mix of specialists.

Health Services↗
PubMedDate not supplied

Design and implementation of a portal for the medical equipment market: MEDICOM.

BACKGROUND: The MEDICOM (Medical Products Electronic Commerce) Portal provides the electronic means for medical-equipment manufacturers to communicate online with their customers while supporting the Purchasing Process and Post Market Surveillance. The Portal offers a powerful Internet-based search tool for finding medical products and manufacturers. Its main advantage is the fast, reliable and up-to-date retrieval of information while eliminating all unrelated content that a general-purpose search engine would retrieve. The Universal Medical Device Nomenclature System (UMDNS) registers all products. The Portal accepts end-user requests and generates a list of results containing text descriptions of devices, UMDNS attribute values, and links to manufacturer Web pages and online catalogues for access to more-detailed information. Device short descriptions are provided by the corresponding manufacturer. The Portal offers technical support for integration of the manufacturers Web sites with itself. The network of the Portal and the connected manufacturers sites is called the MEDICOM system. OBJECTIVES: To establish an environment hosting all the interactions of consumers (health care organizations and professionals) and providers (manufacturers, distributors, and resellers of medical devices). METHODS: The Portal provides the end-user interface, implements system management, and supports database compatibility. The Portal hosts information about the whole MEDICOM system (Common Database) and summarized descriptions of medical devices (Short Description Database); the manufacturers servers present extended descriptions. The Portal provides end-user profiling and registration, an efficient product-searching mechanism, bulletin boards, links to on-line libraries and standards, on-line information for the MEDICOM system, and special messages or advertisements from manufacturers. Platform independence and interoperability characterize the system design. Relational Database Management Systems are used for the system s databases. The end-user interface is implemented using HTML, Javascript, Java applets, and XML documents. Communication between the Portal and the manufacturers servers is implemented using a CORBA interface. Remote administration of the Portal is enabled by dynamically-generated HTML interfaces based on XML documents. A representative group of users evaluated the system. The aim of the evaluation was validation of the usability of all of MEDICOM s functionality. The evaluation procedure was based on ISO/IEC 9126 Information technology - Software product evaluation - Quality characteristics and guidelines for their use. RESULTS: The overall user evaluation of the MEDICOM system was very positive. The MEDICOM system was characterized as an innovative concept that brings significant added value to medical-equipment commerce. CONCLUSIONS: The eventual benefits of the MEDICOM system are (a) establishment of a worldwide-accessible marketplace between manufacturers and health care professionals that provides up-to-date and high-quality product information in an easy and friendly way and (b) enhancement of the efficiency of marketing procedures and after-sales support.

Advertising↗
PubMed2005

From the emergency department to home.

AIM: The purpose of this study was to explore dimensions of the management of the older person following care in an emergency department in preparation for discharge home by identifying perceptions and attitudes of staff in both emergency department and primary care sectors. BACKGROUND: It is recognized that older people discharged home directly from the emergency department are a vulnerable group. Effective communication and liaison are seen to be keys to the provision of high quality care for older people in the emergency department and in ensuring a seamless care between sectors. DESIGN: A purposeful sample was collected that comprised the total population (n = 222) of all grades of medical and nursing staff in both the emergency department and all nursing (Public Health Nurses & Practice nurses) and medical staff (General Practitioners) in the primary care area. METHODS: Methodology used was that of a survey approach of nursing and medical staff in both the emergency department and primary care services. Standardized questionnaires were employed which comprised both open and closed questioning style. Raw statistical data were analysed using SPSS for Windows while the qualitative data arising from the open-ended questions were content analysed for themes. RESULTS: Many staff in the primary care area reported the level of communication between the emergency department and the primary care area as unsatisfactory with confusion regarding follow-up care and a lack of support for older people on discharge. Hospital staff reported the level of communication to be much greater than that perceived by their colleagues in primary care. There was agreement of staff in both sectors in relation to the perceived usefulness of a discharge liaison nurse in the emergency department. CONCLUSIONS: Previous research highlights communication difficulties when patients are discharged from hospital. Findings from this study indicate that this problem can also be applied to the emergency department. RELEVANCE TO CLINICAL PRACTICE: Implications for practice include a need for a multidisciplinary approach to developing referral guidelines, staff training and a comprehensive dissemination of information between sectors ultimately to improve quality and continuity of care for the older person.

Aftercare↗
PubMed2000

Digital health care: where health care, information technology, and the Internet converge.

The digital health care industry applies information technologies to facilitate communications, commerce, transactions, business problem solving, and enhanced decision making for one or more groups that supply, consume, or finance health care services and products. The variation among companies is significant, but each one attempts to leverage information technology to drive sustainable evolutionary change. In an overview of the industry, a framework is provided to understand the maze of business plans.

Computer Security↗
PubMedDate not supplied

Nontraditional work factors in farmworker adolescent populations: implications for health research and interventions.

Agriculture has been documented to be one of the most hazardous work environments for both adults and children. Adolescents may be especially vulnerable to adverse health effects from agricultural exposures due to the rapid growth and development experienced during those years. Separating the occupational, economic, and social issues in this population is difficult. Weak regulatory protection, lack of compliance with existing regulations, and gaps in service provision characterize the working conditions of adolescent farmworkers. Although there is increasing research on the impact of work organization on mental and physical health in adult working populations, there is a scarcity of research focused on this concept in young workers--and it remains virtually unaddressed in young farmworkers. Work characteristics of the informal work sector, better delineated in international literature, should be considered when planning research or interventions in this at-risk population. Further, the population of adolescent farmworkers is diverse, and research strategies and interventions need to be targeted and tailored to the heterogeneous groups. This article addresses some of the nontraditional work factors associated with the less-than-formal work organization and environments in the farmworker adolescent population and how these factors may inform the planning of research and interventions. Specifically, mobility, cultural patterns and social networks, alternative sampling strategies, alternative delivery of health care and education, and involvement of a wide range of players in the work environment of adolescent farmworkers should all be considered when conducting research or planning programs for this population.

Adolescent↗