A taxonomy: Hospital information systems evaluation methodologies

During the past decade, computers and information systems and their resultant products have pervaded hospitals. Not only have the number of and investments in computers and their associated systems increased, but the types of hospital systems and affected functions have also multiplied. Unfortunately, methodologies to measure impacts of these systems have not evolved at the same pace. There have been few developments of new techniques. Existing techniques have not been adapted for use in hospitals. As a result, evaluations are not performed or are based upon generalizations, often with users minimally involved, if at all. Most techniques emphasize the cost-benefit approach, but this should not be the only tool used. This paper presents a taxonomy of methodologies for the evaluation of hospital information systems. The analyses of methodologies and systems are accomplished from user's perspectives. Effectiveness of system products is emphasized. Users are provided with an additional tool to plan, organize, control, and direct the information resources and achieve the hospital's goals and objectives.     

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.     

Hospital information systems and the development of a national health information system

Hospitals require information to support medical quality assurance, cost containment, productivity improvement, utilization analysis, program planning and evaluation, research, and education. Although hospitals could benefit from participation in a national health information system, many would be reluctant to participate particularly if participation were federally mandated. Incentives to participation should include funding of developmental costs, standardized computer software, guarantees of system stability, and prompt reporting back to participating hospitals.     

Computer-based information systems models

A synthesis of theories from the management information systems (MIS) field provided the conceptual framework to describe how to design and develop effective computer-based information systems. An analysis of activities and interviews with nurse managers in a tertiary care medical center provided the basis for describing five major nursing department functions and the information requirements arising from those functions. The MIS framework was applied to the nursing department information requirements in order to derive MNIS, a normative model of a nursing information system, which was then used to “bench mark” the current status of commercially available nursing information systems. The researchers compared the MNIS with 28 nursing information systems that vendors are currently developing or marketing. The comparison revealed large gaps between nursing department needs and vendor-provided solutions.     

网络舆情视域下公众对负面医疗信息的评价分析

目的:分析网络舆情视域下公众对负面医疗信息的评价。方法:使用自行编制的问卷调查公众对负面医疗信息的评价,共回收有效问卷1174份。使用均值、标准差、频数等进行描述性分析。不同组数据之间的比较分析采用独立样本t检验。结果:新闻媒体、医院是公众获取医疗信息的主要来源。公众对负面医疗信息的评价在负面医疗信息给医患关系、个体情绪带来的影响方面得分较高。有医学背景的公众更能认识到负面医疗信息给医患关系、医疗行业、个体情绪带来的不利影响。结论:为了减少负面医疗信息在网络舆情的传播机制下带来的不利影响,应该从政府、医院、新闻媒体、公众等多方视角采取综合措施。     

Chinese translation of English textbooks on internal medicine from the 1850s to the 1940s

During the 100 years from 1850 to 1949, six English textbooks on internal medicine were translated into Chinese and published. Publication of these books was a response to the increased demand for Chinese textbooks after the opening of several Western-style hospitals and medical schools in China where the instruction was in Chinese. Throughout this period, textbooks translated from English were regarded as symbols of mainstream and authority within medical communities in China. There was a shift of translators from British and American medical missionaries to Chinese medical elites. Publishers also changed from missionary hospitals or missionary organizations to the Chinese Medical Association, which was led by ethnic Chinese. After the 1950s, translation activity continued in Taiwan, but it was halted in China until after the Cultural Revolution. This paper provides bibliographic information about these books. The transition of medical authority in China during this 100-year period is also reviewed through the successive publication of translated textbooks on internal medicine.     

提高医院新时期下新会计制度改革的会计信息质量

传统的会计信息质量,毋庸置疑将被新经济时期所要求的高质量的会计信息质量所替代,本文全方位地探讨了在信息化迅猛发展的新形势下,通过一些实际的案例阐述了医院如何设立内部和新的外部的监督机构管理模式——医院理事会内的会计师事务所对医院会计内部控制制度审计和改进,探讨了医院如何在内外监管的新的管理模式下,并在医院的新会计制度改革后,多方促进了医院内部会计内部控制制度工作的改进,并促使得医院的会计信息的质量大大地提高。     

Maximizing the benefits of health care information systems

Information systems can improve cost control, increase the timeliness and accuracy of patient care and administration information, increase service capacity, reduce personnel costs and inventory levels, and improve the quality of patient care. However, experience shows that most of these benefits will not occur automatically following system implementation. Operational problems may exist that diminish information timeliness, accessibility, and accuracy; policies and procedures may not have been sufficiently tailored to reflect the realities and intents of the systems; and personnel tasks may not have been adequately restructured. In order to realize the full potential of information systems, health care organizations must plan for and implement strategies that are designed to maximize such benefits. This paper describes a method for developing benefits maximization strategies. The processes used to define strategies and their outcomes are presented.     

Pharmaco-economic evaluation of antibiotic therapy strategies in DRG-based healthcare systems - a new approach

The cost of treatments especially in conditions where multiresistant bacteria are involved are a major issue in times where in most developed countries in the world payment systems based on diagnoses-related-groups (DRG) are in place. There is great evidence that especially the length of stay in hospital (LOS), the time in the intensive care unit (ICU-days) and the hours of mechanical ventilation (HMV) are major cost drivers. - While established methods of pharmacoeconomical analyses focus on the efficiency of drugs from healthcare system perspective, these data are often not sufficient for improving treatment strategies in a given hospital context. - We developed a system that allows the analysis of patients with severe infections on the basis of routine data that is also used for reimbursement. These data contain a lot of information concerning the clinical conditions. By using the ICD-coding we developed an algorithm which allows the detection of patients with infections and gives information on the potential financial outcome of these patients. By using the analysis it is possible to identify subsets of infections and the patient records that had a potentially negative DRG-result, i.e. the costs are higher than the reimbursement. When identified the patient records undergo a peer review, where the clinical situation and the antibiotic therapy are reviewed by medical experts. In case simulations it is possible to find out if a different therapeutic approach, e.g. by different choices in initial (empirical) antibiotic treatment would have caused other outcomes. - Data driven analyses together with peer reviews of patient records are a useful tool to examine antibiotic treatment strategies and to establish changes that again can be reviewed on a regular basis. Doing this a continous improvement process can be established in hospitals which can lead to a better balance of clinical and economical outcomes in patients with severe infections. Moreover these analyses are helpful in assessing the literature on economical benefits of new therapies.     

The Effectiveness of the Installation of a Mobile Voice Communication System in a University Hospital

In large hospitals, collaborative clinical practice is currently emphasized, with members of various departments expected to work as a team. The importance of accurate communication among the team members is of utmost importance. To improve such communication, the introduction of mobile voice communication systems has received much attention in Japan. Shimane University Hospital also introduced a Personal Handy-phone System (PHS) for doctors. In the traditional setting, much time was wasted searching for doctors through multiple calls on fixed-line telephones. In order to measure the effectiveness of our system, the change in the number of calls made on fixed-line telephones before and after PHS installation was compared. The total number of calls was reduced by more than 35%, and the number of calls to the wards on weekdays was reduced by half. Mobile telecommunication systems with small output power, such as PHS, are known to cause little interference with medical devices which makes it possible to use mobile voice communication safely in hospitals. The improvement in communication by this systems resulted in an improvement in labor efficiency.     

医院管理信息系统与检验信息系统的无缝连接探讨

随着接口技术的不断发展,HIS与LIS系统的无缝连接在各医院中得到了更加广泛的应用。为了更加深入的探讨医院HIS与LIS的无缝连接的效果,本次研究采用了不同的接口方式对医院信息化建设中各应用系统信息的无缝连接,共享做数据做接口。并根据系统无缝连接的特点以及医院的实际情况,提出了各种连接方法的不同点,促进了医院信息系统的有效整合,提高其在医院中的实用性。     

The case for randomized controlled trials to assess the impact of clinical information systems

There is a persistent view of a significant minority in the medical informatics community that the randomized controlled trial (RCT) has a limited role to play in evaluating clinical information systems. A common reason voiced by skeptics is that these systems are fundamentally different from drug interventions, so the RCT is irrelevant. There is an urgent need to promote the use of RCTs, given the shift to evidence-based policy and the need to demonstrate cost-effectiveness of these systems. The authors suggest returning to first principles and argue that what is required is clarity about how to match methods to evaluation questions. The authors address common concerns about RCTs, and the extent to which they are fallacious, and also discuss the challenges of conducting RCTs in informatics and alternative study designs when randomized trials are infeasible. While neither a perfect nor universal evaluation method, RCTs form an important part of an evaluator's toolkit.     

A preliminary conceptual framework for the design,development, and use of client-oriented information systems in health

Client-oriented information systems (COIS) in the health care arena are defined and discussed. The antecedents of these systems, as well as current examples of the systems, are described. Prior studies in this area suggest content for COIS but demonstrate the lack of a conceptual framework to guide the design, development, adoption, and use of these systems. The purpose of the paper is to suggest a preliminary conceptual framework for future study of COIS that draws upon concepts from the field of management information systems.     

依托医院局域网 拓展医学信息服务空间

"军字一号"工程为医院的网络医学信息服务提供了技术平台,使医学信息资源得到了最佳配置和高度共享,医学信息服务的能力和水平明显提高.     

医疗信息化集成平台在医院的建设与思考

以新华医院医疗集成平台为案例,探讨在现有异源异构信息系统的基础上,基于面向服务(SOA)的开放架构和国际标准,构建以临床数据仓库(CDR)为核心的大型医院统一集成平台,实现来自不同厂商的HIS、LIS、RIS、护理信息系统等的数据整合、信息共享、流程协同,并同步推进临床信息化建设,通过电子病历浏览器和医生门户实现全流程患者信息实时同步共享。结论:为新华医院信息化建设搭建起一个高可靠性,高扩展性、高安全性的基础平台架构,为医院集成平台建设提供了参考[1]。     

Privacy, confidentiality and automated health information systems.

Professor Vuori's paper, first presented at the fourth Medico-legal Conference in Prague in the spring of this year, deals with the problem of the maintenance of confidentiality in computerized health records. Although more and more information is required, the hardware of the computer systems is so sophisticated that it would be very expensive indeed to 'break in' and steal from a modern data bank. Those concerned with programming computers are becoming more aware of their responsibilities concerning confidentiality and privacy, to the extent that a legal code of ethics for programmers is being formulated. They are also aware that the most sensitive of all relationships--the doctor-patient relationship--could be in danger if they failed to maintain high standards of integrity. An area of danger is where administrative boundaries between systems must be crossed--say between those of health and employment. Protection of privacy must be ensured by releasing full information about the type of data being stored, and by maintaining democratic control over the establishment of information systems.     

大型城市医疗信息共享服务研究概述

通过调研上海医院信息系统的基础情况,以及文献检索借鉴国内外的相关经验,专家咨询、专题小组讨论等方法制定医疗信息系统方案。明确了医疗信息共享的业务需求,完成了系统设计,在国内首先对医疗信息共享中的法律问题进行了研究,率先在23所市级医院进行了应用示范,建立了跨医院临床信息系统。     

The physician as a locus of authority,responsibility, and operational control of medical systems

Physicians are commonly being excluded from meaningful participation in the planning, implementation, and operation of automated medical systems in hospitals. The authors advocate a rapid shift toward greater physician involvement in such systems, arguing that such a shift is desirable, feasible, and also inevitable. After reviewing the organization of information systems in hospitals, the authors describe the manner in which physician control of medical systems adds to the worth of such systems by enhancing the quality and efficiency of health care delivery. The proposed information system management role of physicians is characterized in terms of authority, responsibility, and operational control. Finally, advice is offered from an organizational perspective for establishing a physician as the hospital Medical Information Director.     

An evaluation methodology for office practice information systems

This paper presents an evaluation methodology for assessing information systems in office practice. The premise is that a meaningful evaluation of information systems in office practice should be a threefold process: First, assess the internal performance of the information system; second, analyze the communication between the users and the information system; and third, evaluate how well practice managers utilize information prepared by the system in managing the practice. The paper approaches the topic from a systems perspective and develops the research method through the presentation of criteria for each of the three evaluation components.     

网络信息分类体系的优化

结合网络信息分类体系的特点,对传统分类法在网络环境中应用的局限性和网站自编分类体系目前存在的主要问题进行了分析,从对传统分类法的改造、分类主题一体化和网络信息分类的标准化建设等方面提出了优化网络信息分类体系的具体措施。