基于三层架构的医院信息系统监控平台设计

针对越来越复杂的医院信息化管理问题,本文提出了一种基于三层架构的信息系统监控平台的设计思想,通过整合包括计算机主机、网络设备、操作系统、应用系统在内的所有可监控资源和对象,建立起一个集中统一的信息监控中心,使整个医院信息系统成为一个可控制、可预测的IT环境。     

医院门诊收费系统集成的实现

目的：实现医院门诊各收费系统的集成。方法使用Web Service技术解决方案实现医院门诊收费各系统的集成。结果医院门诊收费系统的集成使得所有收费操作都集中在一个系统窗口,使收费更加方便与快捷,有利于提高工作效率。结论此方案对医院信息系统集成提供了一种新的思路。     

Variables related to selection of conventional, cook-chill, and cook-freeze systems

This article reports the use of various foodservice systems in hospitals of 300 beds or more and explores the relationship of system choice to hospital, city, and county size. The conventional system, which involves the production of food close to time of service, has been the traditional method of hospital foodservice for centuries. The technology of the 1960s initiated the use of alternative systems, such as cook-chill and cook-freeze. Data from a survey of 807 hospital foodservice directors indicate that the conventional system remains the primary choice for hospital foodservice, although an increasing number of hospitals are converting to the cook-chill system. Choice of foodservice system appears to be dependent on the size of the hospital, city, and county but did not differ by region across the United States. In general, the smaller the hospital, city, and county, the more likely the use of the conventional system. As size increases, so does the occurrence of alternative systems, with cook-chill systems being the primary alternative chosen. Additional information is needed on the comparative costs and cash flows of the various foodservice systems.     

Knowledge management in health care

It is a long-term, sustainable commitment to changing the culture of health care to become more collaborative, more transparent, and more proactive. Knowledge management, implemented well, will transform the health care delivery system over the next few decades, into a more cost-effective, error-averse, and accountable public resource. For the sake of simplicity, this article will limit the application of knowledge management principles to the context of hospitals, hospital systems or associations, or other groupings of hospitals based on a common interest or focus. The field of knowledge management has tremendous application and value to the health care industry, particularly for hospitals and hospital systems. For many who have invested in a knowledge management infrastructure, it has become the measure of value of belonging to a hospital system or membership organization.     

Hospital staffing adjustments under global budgeting

The U.S. Department of Veterans Affairs operates a hospital system that distributes a national global budget to 159 hospital units. Over recent years, cost containment and downward budgetary pressures have affected hospital performance and the quality of care delivered in unknown ways. This article examines hospital staffing levels as potential performance measures. We first develop a regression model to estimate the number and types of clinical staff required to meet current inpatient workloads at VA medical centers. We are able to improve on previous analyses by employing better data on physicians and by evaluating the behavior of hospitals in consecutive years. Our findings provide managers of hospital systems with promising new approaches for comparing hospital production processes and more information on the effects of global budgeting on individual hospital staffing within systems.     

A decision support system for hospital bed assignment

This article presents the use of a computer-based decision support system for hospital bed assignment. The specific computer application discussed involves the development of an expert system, which mimics the decision-making process typically used by experts in a field. Expert systems are useful as consultants for problems that are best approached from the perspective of an expert. The prototype expert system presented in this article can be used to efficiently assign hospital beds to specific patients at the time of hospital admission or during the hospital stay. This assignment is based on a matching process by the expert system of patient needs and hospital bed characteristics. Data needed for this assignment are routinely collected at admission and updated during the patient's stay in the hospital. Use of this computer-based decision support system in conjunction with existing hospital information systems will result in more effective management of physical and human resources. As may be expected, any improvement in efficiency of use of resources will have an associated reduction in cost. Implications of using expert systems for future practice are also discussed.     

Dealing with problem number one--budget cuts: can you do more with less?

To cope with current budget restraints and cutbacks, hospital security departments are increasingly integrating their manpower with technology in the form of access control, CCTV cameras, and alarm systems to supplement their services as well as becoming more dependent on computerized information technology systems and IT departments to track hospital activities and incidents. Security directors contacted for this report also emphasize that they are doing more with less by providing value-added services both to expand activities and to demonstrate the importance of their departments to top management.     

The ability of hospital ventilation systems to filter Aspergillus and other fungi following a building implosion.

OBJECTIVES: To assess the ability of hospital air handling systems to filter Aspergillus, other fungi, and particles following the implosion of an adjacent building; to measure the quantity and persistence of airborne fungi and particles at varying distances during a building implosion; and to determine whether manipulating air systems based on the movement of the dust cloud would be an effective strategy for managing the impact of the implosion. DESIGN: Air sampling study. SETTING: A 976-bed teaching hospital in Baltimore, Maryland. METHODS: Single-stage impactors and particle counters were placed at outdoor sites 100, 200, and 400 m from the implosion and in five locations in the hospital: two oncology floors, the human immunodeficiency virus unit, the cardiac surgical intensive care unit, and the ophthalmology unit. Air handling systems would operate normally unless the cloud approached the hospital. RESULTS: Wind carried the bulk of the cloud away from the hospital. Aspergillus counts rose more than tenfold at outdoor locations up to 200 m from the implosion, but did not increase at 400 m. Total fungal counts rose more than sixfold at 100 and 200 m and twofold at 400 m. Similar to Aspergillus, particle counts rose several-fold following the implosion at 100 and 200 m, but did not rise at 400 m. No increases in any fungi or particles were measured at indoor locations. CONCLUSION: Reacting to the movement of the cloud was effective, because normal operation of the hospital air handling systems was able to accommodate the modest increase in Aspergillus, other fungi, and particles generated by the implosion. Aspergillus measurements were paralleled by particle counts.     

The effects of multi-hospital systems on hospital prices

US hospital prices are rising again after years of limited growth. We analyze trends in hospital prices during a period of significant price growth (1999-2003) to assess whether hospitals that are part of multi-hospital systems were able to increase their prices faster than non-system hospitals. We find hospitals that were members of multi-hospital systems were able to increase their prices substantially more than comparable non-systems hospitals (34% for large systems and 17% for small systems). Further, we find that the systems effect is not confined to hospitals that have other system member hospitals in their local markets. One possible explanation is that hospitals belonging to non-local multi-hospital systems have improved their bargaining position vis-à-vis health plans.     

医院设备的系统优化管理

医院设备管理是医院管理系统的一个重要分支，该文以系统论的观点简要论述如何对医院设备进行系统优化管理，以使医院的医疗卫生活动创造出更大的技术效益和经济效益。     

医疗数据集成平台总体架构设计

随着现代医院数字化建设的进一步发展，各种信息系统将越来越多的被投入使用。不同信息系统的构架设计、实现手段和开发环境都有差异，一般而言这些系统之间无法直接进行数据交互。医院需要建立一个提供各个子系统之间高效数据交互的集成平台，结合业务流程实现业务的跨系统整合。文章从医院数据集成平台的设想和构建实际出发，提出了数据集成平台设计理念、构架模块方面的理论设想，并将在实际建设中加以进一步验证和落实。     

Hospital volunteer's role and accident-prevention systems: a nationwide survey of Japanese hospitals.

This study aimed to examine the scope of activities performed by hospital volunteers. A survey was conducted on 3055 hospitals, randomly selected throughout Japan. Attention was also paid to the accident-prevention systems instituted by those facilities. Almost one-third (36.5%) of all hospitals had some hospital volunteers. About 60% (59.9%) of hospitals conducted volunteer activities more than once a week. Recreation (50.1%) was the most common role of the volunteers. The other activities in decreasing order were: conversation partners (45.8%), music and entertainment (43.7%), wheelchair pushing (41.8%) and helping administration (36.3%). Both direct and indirect contact between volunteers and patients was prevalent. Less than half of the hospitals had accident-prevention systems, such as guidelines for volunteer activities (except for Volunteer Insurance). Hospitals that had a volunteer coordinator tended to have significantly more accident-prevention systems. It is, therefore, important to establish volunteer coordinators in order to prevent accidents during hospital volunteer activities.     

Factors influencing health information system adoption in American hospitals

OBJECTIVES: To study the number of health information systems (HISs), applicable to administrative, clinical, and executive decision support functionalities, adopted by acute care hospitals and to examine how hospital market, organizational, and financial factors influence HIS adoption. METHODS: A cross-sectional analysis was performed with 1441 hospitals selected from metropolitan statistical areas in the United States. Multiple data sources were merged. Six hypotheses were empirically tested by multiple regression analysis. RESULTS: HIS adoption was influenced by the hospital market, organizational, and financial factors. Larger, system-affiliated, and for-profit hospitals with more preferred provider organization contracts are more likely to adopt managerial information systems than their counterparts. Operating revenue is positively associated with HIS adoption. CONCLUSION: The study concludes that hospital organizational and financial factors influence on hospitals' strategic adoption of clinical, administrative, and managerial information systems.     

影响科室绩效的灰色关联度分析

目的 探讨影响临床医务人员绩效的主要因素,为医院进行绩效核算提供参考.方法 对2008～2009年不同季度人均绩效及影响因素进行灰色关联度分析.结果 内科系统与绩效关联度最大的前5位因素是实际占用床日数、出院人数、门诊量、一级护理量及病床使用率.外科系统与绩效关联度最大的前5位是一级护理量、出院人数、病床使用率、实际占用床日数及手术量.结论 医院绩效核算体现了以工作量为主、多劳多得的原则,但若风险、技术因素考虑不充分,将难以调动起医务人员应用新技术和新方法的积极性.     

Unscheduled care. Traffic duty

Capacity management systems mean that although crews may have to travel further to a quieter hospital, patients may get treated more quickly. The systems can reduce the reliance on crews' and referring GPs' local knowledge, which may not be up to date. Not all systems are computerrised greater manchester and birmingham both use manual systems.     

Technical support for biomedical equipment decision making

Biomedical equipment in a hospital is diagnostic, therapeutic, monitoring, communication, and recordkeeping equipment that is directly or indirectly connected to the patient. This equipment continues to proliferate as developments in microcircuitry allow it to be smaller, more flexible, and thus more adaptable. One result of the equipment's increased flexibility is the ability to integrate individual equipment, clinician-users, patients, and hospital facilities into complex systems that enable the hospital to enhance patient care. Therefore, decision making regarding the acquisition and use of new equipment in the hospital must take into account the potential impact of the equipment on all the other elements of the system, including clinical and support staffs.     

Impact of network and system use on hospital X-inefficiency

A significant part of the restructuring in the health care industry has involved hospitals joining health networks and health systems. While the proclaimed purpose of this strategy has been to improve hospital performance, studies have found that not all member hospitals reap the desired outcomes. Variations in performance have been linked to, among other things, service provision at the network/system level versus individual hospital level. This study examined the impact of network and system use to provide services on hospital X-inefficiency (i.e., the difference between actual and optimal costs) in a national sample (n = 1,368) of U.S. urban, general, hospitals. Stochastic frontier analysis (SFA) revealed a mean hospital X-inefficiency of 14.85%. Results suggest that hospitals providing a moderate to high proportion of services at the network or system level were more efficient than hospitals that did not use networks or systems for service provision. Low users of networks or systems and nonusers had comparable levels of efficiency.     

Canadian federalism and the Canadian health care program: a comparison of Ontario and Quebec

The Quebec and Ontario health insurance and health service delivery systems, developed within the parameters of federal regulations and national financial subsidies, provide generally universal and comprehensive basic hospital and medical benefits and increasingly provide for the delivery of long-term care services. Within a framework of cooperative federalism, the health care systems of Ontario and Quebec have developed uniquely. In terms of vital statistics, the health of Ontario and Quebec residents generally is comparable. In viewing expenditures, Quebec has a more clearly articulated plan for providing accessible services to low-income persons and for integrating health and social services, although it has faced some difficulties in seeking to achieve the latter goal. Its plans for decentralized services are counter-balanced by a strong provincial role in health policy decision-making. Quebec's political culture also allows the province to play a stronger role in hospital planning and in the regulation of physician income than one finds in Ontario. These political dynamics allow Quebec an advantage in control of costs. In Ontario, in spite of some recent setbacks, physician interests and hospital sector interests play a more active role in health system bargaining and are usually able to influence remuneration and resource allocation decisions more than physician interests and hospital sector interests in Quebec.