Development of Fundamental Infrastructure for Nationwide EHR in Japan

The movement of create medical information systems that is now taking place involves both progress in EMR (Electronic Medical Records)—computerization of records at hospitals and clinics, and also in EHR (Electronic Health Records) in which information is shared with individual regions. However, the geographical coming and going of people in modern society is extremely active. Naturally the places these people move to are not necessarily within the same region. For this reason, even if the basic unit for the health care supply system is in practical terms limited to the local level, if services are restricted to only one region, many persons may be unable to receive the benefits of health care cooperation. In this study, we constructed a mechanism for a medical cooperation system which links the EHR systems of individual regions and is able to create a one-patient, one-record system on the national level. In this paper, we will provide a report of this mechanism and of the 4-year operational trial.     

Design of a management support system for hospital strategic planning

Recent changes in the health care industry that foster competition are drastically affecting hospital planning and marketing activities. Increased price competition, the development of less costly alternative health care delivery systems and providers, and the shift to prospective average-cost reimbursement for Medicare beneficiaries are major factors promoting a new emphasis on strategic hospital planning. Hospital information systems do not currently support the sophisticated data-collection and analysis requirements that will be needed to implement strategic planning activities. New data must be collected and old data must be analyzed and stored in new ways. New hospital information systems designs are needed to cope with the change in the economic structure of the health care industry and its effects on hospital information needs. This paper proposes a system design for a management support system that will assist hospital administrators and planners in analyzing internal organizational data and external industry data to develop strategic planning objectives, strategies, and business plans. Analysis of the structure and process of hospital strategic planning was performed to identify the information needs of hospital planners. A prototype system is currently being implemented at the University of Arizona. The system provides an integrating framework for data base management systems, executive information systems, model management systems, and dialogue management systems. Objective analytical models and subjective strategic planning models are available to assist with idea structuring and decision processing.     

Evolution of a computerized support system for health care capacity planning

This paper describes the evolution of a computerized support system for health care capacity planning within the Veterans Administration (VA) health care system. The VA's early attempts at computerization are described, along with the subsequent refinements made necessary by the deficiencies in those early attempts. The evolution of both the planning logic and the software configurations is set forth, along with some plans for future development.     

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.     

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.     

PC-based application programs in large health care systems

Public health care agencies lack the infrastructure to meet the increasing operational demands on them, but there is little comparative data on alternative operational structures and systems from which to formulate remedies. Improved information management systems could help address both the workload and the gathering of critically needed data. PC-based database and application programs (PC-APs) that communicate with the mainframe are proposed as a methodology for filling the information-processing gap between mainframe computing and manual information systems. We also propose a model for systematic study of information management systems in clinical settings which can be used to evaluate other aspects of clinical program operations as well. A pilot study demonstrating these methodologies suggests that this is a fruitful approach to assessing ambulatory care operations and that PC-APs can improve administrative and clinical functions and enhance FTE productivity at lower overall cost.     

Tutorial on Technology Transfer and Survey Design and Data Collection for Measuring Internet and Intranet Existence, Usage, and Impact (Survey-2000) in Acute Care Hospitals in the United States

This paper provides a tutorial of technology transfer for management information systems in health care. Additionally it describes the process for a national survey of acute care hospitals using a random sample of 813 hospitals. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business to business and with customers. The relationships with systems approaches, user involvement, user satisfaction and decision-making will be studied. Changes with results of a prior survey conducted in 1997 can be studied and enabling and inhabiting factors identified. This information will provide benchmarks for hospitals to plan their network technology position and to set goals.     

定点医院推行医保体系化管理初探

医疗机构是实施医疗保障制度改革中的重要方,医疗机构在医疗行为中加强管理,对构建和谐医、保、患关系有着重要的现实意义。对定点医院推行的医保体系化管理机制,医保沟通体系、医保质量体系、医保服务体系、医保信息体系、医保文化体系等5个子体系对医保体系化管理具有重要作用。5个子体系既是5个独立的单元,也是整个医保管理体系的有机构成部分,只有这5个体系相互配合、共同发展,才能保证医保事业的稳步前进。     

The Computer-Based Patient Record Challenges Towards Timeless and Spaceless Medical Practice

Although computerization is increasingly advocated as a means for hospitals to enhance quality of care and control costs, few studies have evaluated its impact on the day-to-day organization of medical work. This study investigated a large Computerized Patient Record (CPR) project ($50 million U.S.) aimed at allowing physicians to work in a completely electronic record environment. The present multiple-case study analyzed the implementation of this project conducted in four hospitals. Our results show the intricate complexity of introducing the CPR in medical work. Profound obstructions to the achievement of a tighter synchronization between the care and information processes were the main problems. The presence of multiple information systems in one (Communication, Decision Support, and Archival record keeping) was overlooked. It introduced several misconceptions in the meaning and codification of clinical information that were then torn apart between information richness to sustain clinical decisions and concision to sustain care coordination.     

Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States

This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, user satisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.     

Computerized Physician Order Entry: Helpful or Harmful?

Computerized physician order entry (CPOE) is touted as a major improvement in patient safety, primarily as a result of the Institute of Medicine''s 1999 report on medical errors and the subsequent formation of the “Leapfrog Group” of companies to preferentially direct their employees'' health care to those institutions that install such systems (as part of directives that “Leapfrog” feels will improve patient care). Although the literature suggests that such systems have the potential to improve patient outcomes through decrease of adverse drug events, actual improvements in medical outcomes have not been documented. Installation of such systems could actually increase the number of adverse drug events and result in higher overall medical costs, particularly in the first few years of their adoption.In the last five years, hospitals, including our own, have begun to use computerized systems that require physicians and other health care providers to electronically enter patient care orders.¹ Before this time, only a handful of hospitals used such systems. These computer programs contain algorithms that alert health care providers to potentially harmful therapeutic decisions before orders are processed. The installation of these systems is costly (millions of dollars) and requires major behavioral changes, not only by physicians, but also by the entire health care organization.² In January 2003, Cedars-Sinai Health System in Los Angeles removed its recently installed computerized physician order entry (CPOE) system from use after almost unanimous protest from the medical staff. Why are hospitals and other health care organizations pursuing this avenue at this time? Does the literature support the premise that these systems are beneficial for patient care? Do such systems decrease total health care costs? The answers to these questions are still evolving. In this forum, we address these questions and describe some of the pertinent medical literature on this subject.     

A Theory for Classification of Health Care Organizations in the New Economy

Most of the available studies into information technology (IT) have been limited to investigating specific issues, such as how IT can support decision makers distributing the information throughout health care organization, or how technology impacts organizational performance. In this study, for use in the planning of information system development projects, a theoretical model for the classification of health care organizations is proposed. We try to reflect the development in the contemporary digital economy by theoretically classifying health care organizations into three types, namely traditional, developing, and flexible. We describe traditional health care organizations as organizations with a centralized system for management and control. In developing health care organizations, IT is spread over the horizontal dimension and is used for coordinating the different parties throughout the organization. Finally, flexible health care organizations are those which work actively with the design of new health care organizational structure while they are designing the information system.     

A network collaboration implementing technology to improve medication dispensing and administration in critical access hospitals

We report how seven independent critical access hospitals collaborated with a rural referral hospital to standardize workflow policies and procedures while jointly implementing the same health information technologies (HITs) to enhance medication care processes. The study hospitals implemented the same electronic health record, computerized provider order entry, pharmacy information systems, automated dispensing cabinets (ADC), and barcode medication administration systems. We conducted interviews and examined project documents to explore factors underlying the successful implementation of ADC and barcode medication administration across the network hospitals. These included a shared culture of collaboration; strategic sequencing of HIT component implementation; interface among HIT components; strategic placement of ADCs; disciplined use and sharing of workflow analyses linked with HIT applications; planning for workflow efficiencies; acquisition of adequate supply of HIT-related devices; and establishing metrics to monitor HIT use and outcomes.     

区域医疗服务模式在医疗物联网中扮演的角色

目的：通过对医疗物联网的应用,认知其给区域卫生院的服务模式带来的变革,从而逐步转换职能,以治疗为中心的模式向预防为主服务模式转变。方法：区域卫生院以及居民家庭可以小规模应用医疗物联网设备、集成应用平台系统,检测、传送居民健康信息。结果：通过对其应用,增强社区医院以及卫生管理中心保健预防功能,以保健预防为主服务新模式。结论：通过探索行之有效的服务新模式,促进社区医院以及卫生管理中心职能转变,谋求自身发展。     

社区孕前保健网底建设探索研究

背景　我国是出生缺陷高发国家，出生缺陷日益成为突出的公共卫生和社会问题。为降低出生缺陷，相关权威部门颁布并更新了《孕前与孕期保健指南》，国家实行免费孕前优生健康检查。由于宣传力度不够等原因，国家免费政策遇冷。目前社区缺少孕前健康教育专业人员。目的　总结上海市宝山区淞南镇社区卫生服务中心（简称中心）在孕前保健网底建设探索中取得的经验。方法　2018年3-12月，中心利用卫生计生系统合二为一、统一管理的有效模式，将卫生服务、计生指导与管理整合后的社区孕产期保健管理网络为基础，创建社区孕前保健管理网络，培养社区孕前保健管理队伍，广泛宣传孕前优生知识和国家免费孕前优生健康检查政策，将分级诊疗、上下联动的医疗模式运用于孕前保健。于宣传前后，对社区孕前保健管理队伍成员开展孕前优生知识知晓情况的调查；对服务对象开展不良孕产史、国家免费政策知晓情况、孕前优生知识知晓情况、孕前保健知识需求情况、孕前优生健康检查情况的调查。结果　淞南镇共240对夫妇438例接受了孕前保健健康教育服务。宣教后，孕前保健管理队伍成员免费孕前检查服务内容、服用叶酸时间、服用叶酸原因、人工流产后适宜受孕时间知晓率均高于宣教前（P<0.05）。宣教后，438例（100.0%）服务对象均知晓国家免费政策，高于宣教前的359例（82.0%）（P<0.05）。宣教后，服务对象孕前健康准备时间、孕前不宜接触的毒害物、孕前健康准备内容、开始服用叶酸时间知晓情况均高于宣教前（P<0.05）。宣教后，96对（40.0%）夫妇已作或已预约孕前优生健康检查。2017年按照原来的工作模式，免费孕前优生健康检查数未完成目标任务，目标任务83对，实际完成76对；2018年按照新的孕前保健工作模式，免费孕前优生健康检查数超额完成目标任务，目标任务75对，实际完成95对。结论　新创建的社区孕前保健管理网络具有较强的管理能力和专业优势，又具有成熟的社会宣传和政策执行能力，通过分级诊疗、上下联动的医疗模式拓展了社区孕前保健服务内涵，此模式运用前景广阔；对育龄夫妇进行一级干预，符合我国当下的形势需求，其简单易行、操作性较强、经济成本低、作用范围广，值得推广。     

Impact of Information Systems on Acute Care Hospitals: Results from a Survey in the United States

These results are from a survey of acute care hospitals in the United States. A random sample of 813 hospitals was selected with 115 responding and 33 incorrect addresses resulting in a 15% response rate. The purpose of the study was to measure the impact and future potential of information systems integration in the financial, medical, and administrative systems of the hospitals. Impact of Information Systems is measured in many ways. Questions about employee moral, reductions in employees, goals being met and overall satisfaction with the systems are asked and results analyzed. This information will provide a benchmark for hospitals to determine their information systems position and technology transfer planning. These analyses will lead to setting goals.     

我国公立医院人力资源管理的思考

目的:伴随着我国医疗改革政策的逐步落实,我国的医疗市场将逐步呈现公立医院、民营医院及其他合资医院同时并存、相互竞争的状况。方法:就我国目前医疗市场的发展状况来看,医疗市场的竞争,从本质上来看,仍旧是人力资源的竞争,公立医院的内部人力资源能够最大限度的发挥其效能,关系到公立医院生存与发展。结果:因此本文着重指出目前公立医院人力资源管理中存在的问题及解决问题的对策。结论:以期能够对我国当前人力资源管理的加强提供一点借鉴。     

The diffusion of computer-based information technology into health institutions of Republic of Serbia (FR Yugoslavia)

The basic purpose of this study was to analyze the diffusion of computer-based information technology into the health care institutions of the Republic of Serbia in the year 1994, and to compare the results with a similar investigation in 1992 in order to determine the state and progress of its development. The instrument of investigation was a questionnaire with 24 questions, distributed to all the independent health institutions in Serbia (total 238). The overall response rate was 40.8%. Of the number of responding health institutions, 92.8% own computers which are in use, six PCs on average, and on average use two application softwares, obligatory one for accounting and billing. In conclusion, health care institutions in the Republic of Serbia are unsatisfactorily equipped with information technology and without the developed institutional information system, except on the level of the project. So, careful planning, selection, implementation and management with national coordination will be needed to ensure the appropriate use of technology and information systems in health care.     

数字化医院建设与数字医学的发展

数字化医院是我国卫生信息化发展纲要明确规定的建设目标。对于促进医疗卫生事业改革与发展具有深远意义。为此,对数字化医院基本概念、国内外数字化医院建设现状与进展进行全面阐述。简要概述数字化医院的六个主要特征：医疗设备数字化、医疗方式网络化、医院管理信息化、医疗服务数字化、辅助决策智能化和支持社区与家庭保健常态化。根据现代科学技术和信息技术的发展进程,从四个方面展望了数字化医院的发展趋势,探讨了数字化医院建设与数字医学发展的关系。     

Medical informatics. An emerging academic discipline and institutional priority

Information management constitutes a major activity of the health care professional. Currently, a number of forces are focusing attention on this function. After many years of development of information systems to support the infrastructure of medicine, greater focus on the needs of physicians and other health care managers and professionals is occurring--to support education, decision making, communication, and many other aspects of professional activity. Medical informatics is the field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including the information science and the technology to support these tasks. An intrinsically interdisciplinary field, medical informatics has a highly applied focus, but also addresses a number of fundamental research problems as well as planning and policy issues. Medical informatics is now emerging as a distinct academic entity. Health care institutions are considering, and a few are making, large-scale commitments to information systems and services that will affect every aspect of their organizations' function. While academic units of medical informatics are presently established at only a few medical institutions in the United States, increasing numbers of schools are considering this activity and many traditional departments are seeking and attracting individuals with medical informatics skills.