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PubMed1995

An integrated secure design of a medical database system.

An integrated secure design methodology for the enhancement of database security in a hospital environment is presented in this paper. The proposed design methodology is based on both the discretionary and the mandatory database security policies. In this way, the advantages of both approaches are combined to enhance medical database security. The experimental implementation of the methodology in a major Greek hospital is also presented. The implementation has shown that the combined discretionary and mandatory security enforcement effectively limits unauthorized access to the medical database, without severely restricting the capabilities of the system.

Computer Security↗

PubMed2005

A pilot bridging data integration and analytics: BioMediator and R?

Biological research today involves aggregating and analyzing large amounts of data from disparate sources. Tools such as the University of Washington's BioMediator system integrate heterogeneous data. Analytic packages such as the R environment have a rich set of tools to analyze biomedical research data. Our pilot project bridged data integration and analytics in a general way by successfully incorporating the BioMediator system into the R platform for specific analyses on neurophysiologic research data.

Brain↗

PubMed1996

Web-based delivery and open-architecture database support in the ITreS Counselor Information System.

ITreS is a prototype information system for substance abuse counselors and clinicians. ITreS integrates client records, on-line screening and assessment instruments, and knowledge bases into a single integrated system. This paper discusses two aspects of the development of ITres: the use of the World Wide Web as a development and delivery environment and the use of an attributed translation-based data model to integrate data from various sources into a single client record.

Computer Communication Networks↗

PubMedDate not supplied

Modeling of parenteral container headspace pressure.

When containers and related closure systems holding fluids are heated, internal pressures are generated. Depending upon conditions, surprisingly high pressures can be developed. These pressures are often sufficient to break system integrity. Numerous factors combine to determine the pressure generated within the container and closure system. Each of these factors can vary during the manufacture and service life of the product. Prudent pharmaceutical design seeks to set and control all the factors in such a manner that container and related closure integrity are maintained from the time of assembly to the time of use. Answers can be obtained by pure experimentation ("cut, try, recut and retry until it comes out right") or by predicting performance with a good mathematical model and testing once to verify the model. Pure experimentation requires extensive prototype parts and testing thereof. The mathematical model approach is more exact and produces a better product quicker and at lower cost. This paper uses a simple tubing vial to demonstrate the two approaches to controlling internal pressures from assembly to use. A mathematical model with experimental verification produces high confidence that the system integrity will be maintained as desired. The model used to predict the headspace pressure of the tubing vial is of significance in estimating performance of similar containers and related closures. It can rapidly produce product with predictable behavior. As such, the model is an excellent tool for designers of pharmaceutical products.

Drug Packaging↗

PubMed1999

Get patient information anytime, anywhere.

In a hospital faced with rapidly changing community needs, system integration will unite data from beside monitors and ancillary equipment with the hospital's information system. The technology enables faster, easier, and fewer patient transfers, flexible monitor use, continuous monitoring, and remote access of patient information.

Humans↗

PubMedDate not supplied

Managing information resources: a study of ten healthcare organizations.

This article presents the results of information technology management audits conducted by senior executives at ten healthcare organizations. The audits evaluated how well the following seven information technology management responsibilities were carried out: (1) strategic information systems planning; (2) employment of a user focus in system development; (3) recruiting of competent personnel; (4) information systems integration; (5) protection of information security and confidentiality; (6) employment of effective project management in system development; and (7) post-implementation evaluation of information systems. The audit results suggest that most of these responsibilities are being met to a considerable extent by a majority of the organizations studied. However, substantial variation across organizations was noted. Executives participating in the study were able to define areas in which the management of information resources in their organizations was in need of attention. The audit process encourages senior management to provide the leadership required to ensure that information technology is used to maximum advantage.

Computer Security↗

PubMed1991

Integrated fluid handling system for biomolecular interaction analysis.

An integrated fluid handling system used for multichannel biomolecular interaction analysis is described. Reactions between biological molecules are monitored in real time by measuring changes in the angular position where surface plasmon resonance occurs at a biospecific active surface. The adsorption efficiency of the analyte onto the biospecific active surface is up to approximately 3%, due to the low channel height, 50 microns, in the flow cell. When a large part of the total biospecific active surface for surface plasmon resonance probing (approximately 0.15 mm2) is used, the sensitivity is high. Sample sizes in the order of 1-50 microL can be injected. The sample zone dispersion is minimized by the low dead volume in the system (approximately 0.4 microL) accomplished by using integrated sample loops and thin conduits. An asset of this integration is the low reagent consumption. The sensor chip with the biospecific active surface is reusable and easily exchanged. Experimental results obtained with a theophylline monoclonal antibody as the analyte are compared with a theoretical model. The standard deviation for the repeatability is approximately 5% typically with 50 microL of 250 pM analyte, and the assay time is 10 min. The detection limit is approximately 10 pg of the analyte on the probed spot of the surface. Possible improvements of the sensitivity and detection limit are discussed.

Antibodies, Monoclonal↗

PubMed1999

Performance improvement integration: a whole systems approach.

Performance improvement integration in health care organizations is a challenge for health care leaders. Required for accreditation by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission), performance improvement (PI) can be designed as a sustainable model for performance to survive in a turbulent period. Central Baptist Hospital developed a model for PI that focused on strategy established by the leadership team, delineated responsibility through the organizational structure of shared governance, and accountability for outcomes evidenced through the organization's profitability. Such an approach integrated into the culture of the organization can produce positive financial margins, positive customer satisfaction, and commendations from the Joint Commission.

Hospitals, Religious↗

PubMed1994

ISWAC: proposed system for the integrated assembly of chromosomes.

The generation of a physical map as an integral part of sequence project management is a problem that present computer systems do not address. Primarily, the analysis performed is based solely on the information available from a single knowledge level. Management systems that are currently available do not adequately model the multi-layer top down strategy that is most often utilized to manage large scale sequencing projects. Single layered approaches reflect an algorithmic inadequacy since interacting data sets are required to provide a good solution. The analysis tool that is currently under development termed ISWAC, the Integrated System for Wholistic Assembly of Chromosomes, overcomes these limitations by integrating information available from five layers of knowledge. These knowledge layers utilize information from the linkage map, physical map, restriction map, clone strategy map and the DNA sequence itself. The approach we are implementing, reviews current project status and continually refines the experimental strategy necessary to efficiently complete the sequencing task. To facilitate project completion the system is designed to interactively recommend strategies based on partial information. The utility of this tool is enhanced by implementing knowledge representation techniques that allow reasoning with approximate concepts characteristic of these data-sets. In addition, the raw physical data is maintained within an integrated map database to ease data verification. This paper presents the first discussion of the design specifications for a computer system to assimilate the various forms of data that are being generated as part of the human genome project. It was specifically written to stimulate discussion regarding data standardization, translation, analysis and most important, an understandable user-interphase for the molecular biologist. We would hope that interested readers would respond by assisting in the definition of a set of universal data standards and adopting them in their laboratories.

Algorithms↗

PubMed2005

Reaching for visual cues to depth: the brain combines depth cues differently for motor control and perception.

Vision provides a number of cues about the three-dimensional (3D) layout of objects in a scene that could be used for planning and controlling goal-directed behaviors such as pointing, grasping, and placing objects. An emerging consensus from the perceptual work is that the visual brain is a near-optimal Bayesian estimator of object properties, for example, by integrating cues in a way that accounts for differences in their reliability. We measured how the visuomotor system integrates binocular and monocular cues to 3D surface orientation to guide the placement of objects on a slanted surface. Subjects showed qualitatively similar results to those found in perceptual studies--they gave more weight to binocular cues at low slants and more weight to monocular cues like texture at high slants. We compared subjects' performance in the visuomotor task with their performance on matched perceptual tasks that required an observer to estimate the same 3D surface properties needed to control the motor behavior. The relative influence of binocular and monocular cues changed in qualitatively the same way across stimulus conditions in the two types of task; however, subjects gave significantly more weight to binocular cues for controlling hand movements than for making explicit perceptual judgments in these tasks. Thus, the brain changes how it integrates visual cues based not only on the information content of stimuli, but also on the task for which the information is used.

Brain↗

PubMed1996

Surveillance and the National Center for Prevention Services.

Five key surveillance issues faced by the National Center for Prevention Services for the next 10 years are: 1) developing surveillance for risk factors, 2) agreeing on and standardizing definitions, 3) integrating surveillance systems into general public health information systems, 4) integrating surveillance and public health information systems into patient care data systems, and 5) integrating health service and programmatic data into surveillance and public health information systems. Current technology and public health needs combine to make development of integrated, compatible surveillance and information systems essential, not just desirable.

Communicable Disease Control↗

PubMed2003

A unifying basis of auditory thresholds based on temporal summation.

Thresholds of auditory-nerve (AN) fibers and auditory neurons are commonly specified in terms of sound pressure only, implying that they are independent of time. At the perceptual level, however, the sound pressure required for detection decreases with increasing stimulus duration, suggesting that the auditory system integrates sound over time. The quantity commonly believed to be integrated is sound intensity, implying that the auditory system would have an energy threshold. However, leaky integrators of intensity with time constants of hundreds of milliseconds are required to fit the data. Such time constants are unknown in physiology and are also incompatible with the high temporal resolution of the auditory system, creating the resolution-integration paradox. Here we demonstrate that cortical and perceptual responses are based on integration of the pressure envelope of the sound, as we have previously shown for AN fibers, rather than on intensity. The functions relating the pressure envelope integration thresholds and time for AN fibers, cortical neurons, and perception in the same species (cat), as well as for perception in many different vertebrate species, are remarkably similar. They are well described by a power law that resolves the resolution-integration paradox. The data argue for the integrator to be located in the first synapse in the auditory pathway and we discuss its mode of operation.

Animals↗

PubMed1999

Information technology in primary health care.

Appropriate application of information technology in primary health care will extend traditional diagnosis and patient management beyond the doctor's clinic into the everyday living environment. We describe a model of information management in primary health care, and place special emphasis on the emerging areas of clinical decision support, computerised clinical measurements, patient education and network connectivity. Briefly discussed is the design of innovative home monitoring techniques and a telemedicine based communications infrastructure that should improve access to high quality primary health care for all citizens, irrespective of their distance from major urban centres. A preliminary design for a telemedicine-assisted primary health care network is presented, based on this model of information management. The premise is that improvements in health care services and reductions in health care costs can be effected by establishing a continuum of patient care from the patient's home, to the doctor's surgery, to speciality services in hospitals and to other service providers in the health care sector. While, the proposal focuses on new opportunities arising from the imminent introduction of broad band interactive fibre optic networks throughout Australia, the technology and projected data transfers could easily be handled in the short-term using modem access to the standard telephone network. A simple connectivity scheme for system integration is also presented.

Computer Systems↗

PubMed2006

Integrating radiology information systems with healthcare delivery environments using DICOM and HL7 standards.

Integration based on open standards, in order to achieve communication and information interoperability, is one of the key aspects of modern health care information systems. Interoperability presents data and communication layer interchange. In this context we identified the HL7 standard as the world's leading medical Information and communication technology (ICT) standard for the business layer in healthcare information systems and we tried to explore the ability to exchange clinical documents with minimal integrated healthcare information systems (IHCIS) change. We explored HL7 Clinical Document Architecture (CDA) abilities to achieve radiology information system integration (DICOM) to IHCIS (HL7). We introduced the use of WADO service interconnection to IHCIS and finally CDA rendering in widely used Internet explorers.

Croatia↗

PubMed2001

History and trends in clinical information systems in the United States.

PURPOSE: To provide a synopsis of issues about clinical information systems for nurses not schooled in nursing informatics. ORGANIZING CONSTRUCT: The past, present, and future of clinical computing, including major factors resulting in the early hospital information systems (HIS) and decision support systems (DSS) in the United States, current advances and issues in managing clinical information, and future trends and issues. METHODS: Literature review and analysis. FINDINGS AND CONCLUSIONS: The first HIS and DSS were used in the late 1960s and were focused on applications for acute care. The change from fee-for-service to managed care required a change in the design of clinical information systems toward more patient-centered systems that span the care continuum, such as the computer-based patient record (CPR). Current difficulties with CPR systems include lack of systems integration, data standardization, and implementation. Increased advances in information and technology integration and increased use of the Internet for health information will shape the future of clinical information systems.

Decision Making, Computer-Assisted↗

PubMed1990

Integration of formulary systems with centralized pharmaceutical procurement.

The integration of formularies with pharmaceutical group purchasing and supply systems for multiple hospitals and ambulatory health centers in the Indian Health Service of the US Public Health Service is described. Two models by which these systems have been integrated are presented. The approach of one group of facilities for maintaining high-quality therapeutics in a cost-effective manner was to maintain separate P & T Committees and formularies for each facility, with one centralized drug procurement center. The other group developed a central P & T Committee and formulary to serve all area facilities, as well as continued to maintain a separate P & T Committee at each facility that could act between meetings of the central committee. These models of centralized procurement have provided both decreased drug costs and increased information on drug use within the multifacility systems. In both models, staff have reached consensus on drugs that will provide quality therapeutics in a cost-conscious environment.

Arizona↗

PubMed1998

[Modelling of radiological services in the context of a hospital information system: does the DICOM standard meet the requirements?].

PROBLEM: The data model given in the DICOM standard is examined under the aspect of system integration. Semantic properties of the IODs (information object definitions) and their relationships are investigated. METHOD: Starting from the entities defined in Part 3 of the DICOM standard, we explored how the classes defined there can be integrated into a common data model of the electronic patient record implemented by the HIS (Hospital Information System). Based on the IODs we investigated the definitions and semantics of entities being relevant for structured recording of image data. RESULTS: Because semantic definitions are incomplete, a proposal is made for the core domain of structured radiologic service recording. Its definition of semantics goes beyond the application domain of radiologic imaging to avoid structural conflicts during HIS/RIS/PACS integration. Differentiation between treatment and billing provides an independent temporal mapping of services concerning medical and billing aspects. Two groups of radiologic services are distinguished: radiologic imaging and additional services. CONCLUSION: The incomplete definition of IOD semantics leads to potential conflicts during system integration. Complete covering of this topic is necessary for implementation of the electronic patient record.

Data Interpretation, Statistical↗

PubMed1999

Integrating healthcare for older populations.

The complex array of needs posed by older adults has frequently produced fragmentation of care in traditional fee-for-service systems. Integration of care components in newer health systems will maximize patient benefits and organizational efficiency. This article outlines the major issues involved in integration of care for older populations. A health system must integrate its care of older adults in many ways: among providers, both in primary care and specialty services; with community-based sources of care; and across sites of care (clinic, hospital, emergency department, and nursing home). Integrating reimbursement structures for various services will serve to create a client-oriented system, as opposed to a finance-centered system, thereby enhancing coordination of care. The extent to which two experimental comprehensive systems, PACE (Program of All-inclusive Care of the Elderly) and SHMO II (Social Health Maintenance Organization), have achieved clinical and financial integration are discussed in detail. Healthcare organizations are encouraged to create integrated models of care and to study the effects of integration on patient outcomes.

Aged↗