Physicians in health care management: 6. Physician *bytes* computer.

Revolutionary advancements in information technology are improving access to medical information, operational efficiency and clinical effectiveness. Health care facilities and agencies are planning to acquire information systems that will affect clinical and administrative functions. Federal and provincial agencies are beginning to define and collect diverse health care data and integrate them in a national database. As the demand for and access to information grows physicians will be key providers and users. They will have increasing access to critical patient data through clinical information systems; however, their practice patterns, clinical outcomes and resource utilization will also be subject to increasing scrutiny. To ensure appropriate use of technology and information systems, careful planning, selection, implementation and management will be needed. Physicians will require training to use the information and systems effectively. They must also recognize the increasing importance of such systems in delivering and managing health care; they must play a pivotal role in resolving management, information and systems issues and in promoting sound information and management strategies; and they must encourage research and education in medical informatics.     

A study on building data warehouse of hospital information system

Background  Existing hospital information systems with simple statistical functions cannot meet current management needs. It is well known that hospital resources are distributed with private property rights among hospitals, such as in the case of the regional coordination of medical services. In this study, to integrate and make full use of medical data effectively, we propose a data warehouse modeling method for the hospital information system. The method can also be employed for a distributed-hospital medical service system.

Methods  To ensure that hospital information supports the diverse needs of health care, the framework of the hospital information system has three layers: datacenter layer, system-function layer, and user-interface layer. This paper discusses the role of a data warehouse management system in handling hospital information from the establishment of the data theme to the design of a data model to the establishment of a data warehouse. Online analytical processing tools assist user-friendly multidimensional analysis from a number of different angles to extract the required data and information.

Results  Use of the data warehouse improves online analytical processing and mitigates deficiencies in the decision support system. The hospital information system based on a data warehouse effectively employs statistical analysis and data mining technology to handle massive quantities of historical data, and summarizes from clinical and hospital information for decision making.

Conclusions  This paper proposes the use of a data warehouse for a hospital information system, specifically a data warehouse for the theme of hospital information to determine latitude, modeling and so on. The processing of patient information is given as an example that demonstrates the usefulness of this method in the case of hospital information management. Data warehouse technology is an evolving technology, and more and more decision support information extracted by data mining and with decision-making technology is required for further research.

     

综合支付改革信息支持平台构建

介绍基于医院基础信息系统的综合支付改革信息支持平台构建思路。本系统从医院及政府部门的监管需要出发,可以用于异地异构医院信息系统的综合支付管理与监控。实现基层医疗机构诊疗服务过程的数据采集,从而对医疗服务的费用、质量和医务人员绩效进行精细化管理。     

医院信息平台构建与设计

随着医改和区域信息化的发展,传统医院信息化模式已经不能满足当前区域与医院内部信息的发展需求,怎样伞方位解决医院内部各信息系统的有效整合,解决当前区域信息化与数据共享、医疗卫生管理以及医疗体制改革与机制创新所面临的一系列问题,进一步促进医院的建设与发展,将是今后医院信息化发展方向。就这此问题的解决,针对医院信息平台的构建进行讨论。     

AMIA Advocates National Health Information System in Fight Against National Health Threats

To protect public health and national safety, AMIA recommends that the federal government dedicate technologic resources and medical informatics expertise to create a national health information infrastructure (NHII). An NHII provides the underlying information utility that connects local health providers and health officials through high-speed networks to national data systems necessary to detect and track global threats to public health. AMIA strongly recommends the accelerated development and wide-scale deployment of electronic public health surveillance systems, computer-based patient records, and disaster-response information technologies. Such efforts hold the greatest potential to protect our citizens from disaster and to deliver the best health care if disaster strikes.To protect public health and national safety, AMIA recommends that the federal government dedicate technologic resources and medical informatics expertise to create a national health information infrastructure (NHII). An NHII provides the underlying information utility that connects local health providers and health officials through high-speed networks to national data systems (e.g., Centers for Disease Control and Prevention) necessary to detect and track global threats to public health.In the short term, this means adapting existing information systems to facilitate public health surveillance and emergency response. To establish a permanent infrastructure, AMIA strongly recommends the accelerated development and wide-scale deployment of electronic public health surveillance systems, computer-based patient records, and disaster-response information technologies. Such efforts hold the greatest potential to protect our citizens from disaster, and to deliver the best health care if disaster strikes.While meeting the acute needs of today, this initiative will begin laying the groundwork for a NHII that will continue to serve the health needs of the nation—a lasting endowment for future generations. Establishing an NHII requires thoughtful strategic planning and strong inter-agency leadership. Work on key components of the NHII must begin immediately. These key components include:

• Strategic planning and coordination. There must be a central coordinating entity that can quickly inventory existing public- and personal-health initiatives and develop a strategy to fashion a national system to protect Americans against health threats of various types, including biological, chemical, nuclear, and physical. The short-term strategy must be part of a framework for a permanent infrastructure that serves public health, patient care, and research.
• Connectivity and communications. Local, regional, and national coordination cannot exist without efficient, instantaneous communication. Public health services must be linked using secure connections to the Internet as an immediate top priority. AMIA recommends federal government funding to guarantee high-speed, dedicated access to the Internet for all public and private health care facilities and related organizations. Minimum-level workstations should be required, and adequate tools and training should be provided.
• Standards. Effective communication among local, community, state, and federal facilities require the use of standards. Health care messaging standards should be used for data interchange. A common vocabulary standard and required data elements for public health surveillance databases are required to enable effective sharing of data. Without a common vocabulary, data from local systems cannot be analyzed to detect emerging health threats. Government coordination and support for consensus standardization and low-cost distribution of common vocabularies for health event detection, prevention, and intervention are a fundamental aspect of an NHII.
• Resource databases. An up-to-date, central, Internet-based health resources directory containing information about available resources—knowledge, physical, and human—is vital to providing the timely information needed to manage any public health crisis. The national health resource directory would include information about physical resources, such as health care organizations, safety facilities, and environmental agencies; human resources, including physicians, nurses, and public health and support personnel; organizational resources, such as emergency medical services, county and city law enforcement agencies, and other emergency-response groups; and knowledge resources ranging from clinical guidelines to extensive clinical decision support algorithms related to threat vectors. Local health authorities must be trained in use of the directory to effectively derive maximal benefit when responding to national health threats.
• Public health surveillance systems. Effective public health practice and decision making depend on timely information, much of which is not readily available. Information about patients with clinical conditions of public health importance, symptoms compatible with prodromes of serious infection or exposure, health behaviors, and environmental risk factors must be collected, transmitted, aggregated, analyzed, and utilized for prompt decision making. Whether the health threat is biological, chemical, or nuclear, early detection and rapid response are essential. Existing public health systems in place and under development should be adapted to meet the current needs. Implementation of public health system initiatives such as the National Electronic Disease Surveillance System and Health Alert Network must be accelerated to meet the acute threat posed by bioterrorism.
• National identifiers. National identifiers for providers, insurers, businesses, and individuals are required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The privacy provision of HIPAA that protects confidential health information has been finalized. In the face of the acute crisis, the work on identifiers should be accelerated so that effective epidemiologic data can be gathered and analyzed and appropriate health care services delivered where needed.

AMIA is an organization of professionals who operate at the interface between health care and computer and information science. Our leadership and members are capable and willing to contribute to solving the acute situation while laying the foundation for a lasting infrastructure to manage health information for the benefit of patients and the public.TANG, National Health Information System Proposal     

The case mix system

The Case Mix System (CMS) was developed as a broad-based decision support system for planning and managing effectiveness in the product line environment. CMS is proven in a range of hospital settings and provides the information needed to meet todays health care management challenges.     

Integrating Medical Informatics and Health Services Research: The Need for Dual Training at the Clinical Health Systems and Policy Levels

Reams of data pertaining directly to the core health services research mission are accumulating in large-scale organizational and clinical information systems. Health services researchers who grasp the structure of information systems and databases and the function of software applications can use existing data more effectively, assist in establishing new databases, and develop new tools to survey populations and collect data. At the same time, informaticians are needed who can structure databases that serve the needs of health service research and who can design and evaluate applications that effectively improve health care delivery. As long as health services researchers and informaticians work in separate spheres, however, opportunities to use data from health care encounters to improve care, expand knowledge, and develop more effective policies will be missed. This paper provides a brief exploration of 1) existing successful collaborations between health services researchers and informaticians and 2) needs and opportunities for additional joint work in several core research areas.In the 1970s, the health services researcher^* managed data on tapes, rented valuable and scarce CPU time on a mainframe computer, and often required the assistance of a programmer. By the early 1990s, the health services researcher had been freed, able to harness the power of desktop computers running database and statistical programs and, for nominal fees, having access to myriad publicly available secondary data sets on CDs, such as the National Health and Nutrition Examination Survey. Schools of public health and other training programs in clinical and health services research began to systematically teach the skills necessary to analyze these data.Today, reams of data pertaining directly to the core health services research mission are accumulating in large-scale organizational and clinical information systems. Health services researchers who grasp the structure of information systems and databases and the function of software applications can use existing data more effectively, assist in establishing new databases, and develop new tools to survey populations and collect data. At the same time, informaticians are needed who can structure databases that serve the needs of health service research and who can design and evaluate applications that effectively improve health care delivery. As long as health services researchers and informaticians work in separate spheres, however, opportunities to use data from health care encounters to improve care, expand knowledge, and develop more effective policies will be missed.     

高血压危险度评估软件系统的开发

运用健康危险度评估的理论、高血压危险因素研究数据和现代信息技术,参考医院业务开展流程和产品商业运作流程。开发一套适合医院使用和商业运作的设计高血压危险度评估软件系统。该软件功能较完善,包括：危险评估、资料管理、随访功能、关怀服务、后台维护、后台管理;在实现对使用者罹患高血压危险度评估的同时还提供了服务拓展功能,为使用者提供院外后续服务;另外,通过随访功能还可为高血压流行病学研究提供帮助,完全符合高血压防治、流行病学研究及临床防治信息化需要。     

医学信息学本体知识库系统手工构建研究

自2010年我国推行医改政策以来,医疗信息化行业发展迅速。传统的信息技术已不能充分满足医疗信息行业的发展需要。此时CDA技术、本体与语义技术逐渐引入医疗信息化行业的应用中来,涉及临床信息采集、处理、管理和使用等多方面。以由卫生部颁布的《卫生信息数据元目录》为基础,设计开发出基于标准数据元的医学信息学本体知识库,并构建以CDASchema技术为基础的数据采集引擎,致力于解决当前区域医疗中临床信息合理化采集和整合使用的问题。     

北京市某医院战略发展影响因素分析简

目的：探寻北京市某医院（以下简称A医院）战略规划的影响因素,为制定符合自身特点的战略规划提供科学依据和参考。方法：利用文献分析法广泛收集国内外相关文献资料,并经专家讨论法构建A医院战略规划影响因素评价指标;采用德尔菲法,给遴选的27名医院管理专家邮寄咨询表,确定指标权重。结果：构建A医院战略规划影响因素的评价指标和权重,A医院战略规划影响因素按重要程度排在前5位的依次是医疗服务、人力资源、学科建设、国家卫生政策方针、医院文化品牌。结论：A医院战略规划主要是由医院内部影响因素主导,同时受到国家卫生政策、方针的影响;A医院战略规划要充分考虑医院内部的优势和劣势,同时兼顾外部的机会及威胁。     

Meeting the challenge: Health information technology’s essential role in achieving precision medicine

Precision medicine can revolutionize health care by tailoring treatments to individual patient needs. Advancing precision medicine requires evidence development through research that combines needed data, including clinical data, at an unprecedented scale. Widespread adoption of health information technology (IT) has made digital clinical data broadly available. These data and information systems must evolve to support precision medicine research and delivery. Specifically, relevant health IT data, infrastructure, clinical integration, and policy needs must be addressed. This article outlines those needs and describes work the Office of the National Coordinator for Health Information Technology is leading to improve health IT through pilot projects and standards and policy development. The Office of the National Coordinator for Health Information Technology will build on these efforts and continue to coordinate with other key stakeholders to achieve the vision of precision medicine. Advancement of precision medicine will require ongoing, collaborative health IT policy and technical initiatives that advance discovery and transform healthcare delivery.     

医院信息管理系统的拓展及应用价值

目的:分析现有的医院信息管理系统,在实际工作中积极拓展医院信息管理系统应用途径,提高信息系统的应用价值.方法:通过对现有医院信息系统的评估,分析可应用的信息资源,多方拓展信息资源的应用价值.结果:可以通过信息系统双向交流拓展,获得更多有价值的资料,在公共卫生安全和传染病管理、职业病防治等领域广泛应用.结论:拓展医院信息管理系统应用渠道和领域、提高信息应用价值,在医疗改革、医疗管理中意义重大.     

多院区医院信息系统建设模式研究

目的针对多院区医院建设中一体化管理、同质医护质量控制和物流成本控制对医院信息化建设的需求,提出多院区医院信息系统建设模式。方法分析多院区医院管理的难点,并转化为对信息系统建设的需求,对照多院区医院医疗业务与单一院区的差异,结合医院信息互联互通的要求,找出现有医院信息系统在数据、功能和应用上的差距,提出以主数据管理和患者主索引管理为基础,临床数据中心、运营数据中心建设为重点,改造、重构单一院区医院信息系统成为多院区医院信息系统,建设药品物资配送系统和商务智能系统。结果将多院区医院信息系统建设模式应用于我院“一院四区”的信息建设中,信息系统支撑了新院区门诊和住院按时开业,满足医院一体化管理、同质医护质量控制和物流成本控制对信息系统的要求。结论多院区医院信息系统建设模式有效地支撑医院一体化同质管理,复用了原院区医院的患者医疗信息,集成了原院区医院的遗留系统,节约了成本。     

基于医务社会工作视角的出院计划在医养结合中的重要性及可行性研究

在“健康中国”和健康养老服务的大背景下,应积极应对人口老龄化,推进医养结合。出院计划是利用专业人员帮助患者及照护者在转换医疗照护机构时,能达到完整且持续性的照顾,以求得到最佳的健康状况及生活质量。医养结合为推行出院计划提供了客观条件,为老年人出院后得到连续性照护服务提供了可能。同时,出院计划能够将老年人住院期间的康复状况与出院后的照护联结起来,整合资源,为老年人继续康复提供保障。医务社会工作介入出院计划,对评估老年人整体需求、增强专业沟通合作、跟进出院后的康复状况有重要作用。结合我国医养结合现状,发展医务社会工作参与的,适合国情的出院计划是亟待开展的工作。本研究旨在探讨由医务社会工作介入的出院计划在医养结合中的重要性,并分析其可行性,为评估老年人整体需求、增强专业沟通合作、跟进出院后的康复状况提供重要参考。     

Future models of general practice training in Australia

Current proposals for significant primary health care reform in Australia create a timely opportunity to reflect on the education and training requirements of future general practitioners. Australian general practice will become increasingly team-based, with growing emphasis on coordinated care, chronic disease management, and disease prevention and self-management, while maintaining its focus on delivering high-quality, patient-centred care. This will require cost-effective application of new technologies and information management systems within new models of delivering health care. Future models of general practice training must respond to these new ways of working to ensure general practice remains an attractive career choice and training programs graduate doctors who are equipped to meet the health needs of Australians. This article discusses potential development of new general practice vocational training models in Australia. This includes hospital rotations that are more directly integrated with general practice placements and have greater emphasis on the needs of the future general practice workforce; and an extension of the training program to 4 years with a final year tailored to future career plans including development of expertise in practice management, specific clinical disciplines or academic skills.     

医院决策支持信息系统的建设与实践

目的：信息化是现代化医院运营、管理的必由之路,医院管理模式的创新和发展依然依靠医院管理和决策的信息化。方法：医院决策、管理支持系统必须在数据仓库框架下构建;必须具备长期的战略导向管理和日常精细化管理的核心内容,通过对“人、财、物”的全要素管理,对“院级、科级、员工”的多层级管理,多主体、多主题、多方位、多时空的评价体系和预警机制的建点。结果：实现医院决策和管理的科学化。结论：通过实践,认为医院决策、管理支持系统是推动医院管理创新和发展的有效工具,必将促进我国卫生管理事业更好更快的发展。     

Hospital ownership and psychiatric services

Dramatic increases have occurred in the proportion of for-profit hospitals in the general hospital sector; even more pronounced increases have occurred within the psychiatric sector. Concomitant with this changing mix of ownerships, revised reimbursement plans are being proposed for psychiatry. Thus, providers of acute psychiatric inpatient care, although loosely aggregated, constitute a service system that is experiencing dynamic revision. This article examines the implications of these changes for health policy analysts and planners in the design of hospital payment mechanisms and in planning for resources to meet the needs of the public. The state of California is viewed as a system, and data from the state are examined to test traditional assumptions of economic behavior when less costly substitute services are available. The availability of services such as outpatient clinics, emergency psychiatric services, and partial hospitalization are found to vary according to hospital ownership. Differences in availability of these services influence the access to inpatient care experienced by various populations within the defined system. Although these services may permit earlier discharge from the hospital, the poor insurance coverage of ambulatory psychiatric care relative to inpatient hospitalization^1–3 distorts this effect. The implications of these findings for public policy are discussed.     

Pathologic elements in the planning of information systems: The case of hospitals in Quebec

The existing usage of information technology for information systems in hospitals draws attention to the fact that: (a) health care units which operate sophisticated numerical instrumentation to support medical activities rarely employ computers for the management of their operations and (b) despite the availability of affordable information technologies (microcomputers, networks, etc.), few hospitals include such elements as health care unit management in the development of their information systems portfolio. Is this paradoxical situation a result of the planning methodologies or of factors affecting their use? Or can it be attributed to the failure of present planning methodologies to incorporate the diversity of computerization approaches of the various stakeholders involved? If this is the case, untapped potential computerization possibilities exist that could lead to the development of hospital services and increased organizational efficiency.     

Multidisciplinary care plans for diabetes: how are they used?

OBJECTIVE: To understand how multidisciplinary care plans are being used in the management of patients with diabetes, and to explore the role of collaboration in care planning. DESIGN: Grounded theory interview study. SETTING: Primary care, June 2005 to October 2006. PARTICIPANTS: Thirty-eight people from three New South Wales Divisions of General Practice: 19 general practitioners, eight diabetes-related allied health providers, two endocrinologists, and nine adults with type 2 diabetes. Sampling was purposeful then theoretical. RESULTS: GPs use care plans to organise clinical care and help patients access allied health providers. Written plans are used to educate patients about their care and to motivate change. GPs rarely discuss care plans with other providers, and providers are unlikely to change their approach to patients on the basis of care plans. Patients do not expect to participate in care planning. CONCLUSIONS: Care planning may increase evidence-based multidisciplinary care for patients with diabetes, but it rarely results in genuine collaboration between providers and patients. This suggests a difference may exist between Australian policymakers' and providers' definitions of patients with complex needs. Care plans could facilitate patient self-management by including more personalized information. Further research is needed to clarify which patients would benefit from a truly collaborative approach to their care.     

Toward health and wellbeing for indigenous Australians

The health of indigenous Australians remains well below that of non-indigenous Australians and indigenous peoples in Canada and New Zealand. Although recent planning has initiated many outstanding, culturally appropriate programmes with indigenous involvement, health statistics only reflect marginal improvement in recent years. It is crucial that positive programmes are sustained with appropriately directed funding. An approach that includes respect for the emotional and spiritual wellbeing of Australia's indigenous peoples will assist to redress some of the disadvantage caused by dispossession of country, language, and identity. It is clear from many programmes that are in place, that primary health care delivered locally through community controlled organisations, will minimise the impact of serious illnesses that currently threaten whole families and communities. Westernized health care systems are slow to learn from indigenous peoples in Australia and other places, that maintenance of wellness, not management of illness should be the goal.