Application of a hybrid analysis method for a Web-enabled information system: a case study

A successful developmental effort frequently is defined as one that produces a deliverable that is satisfactory to the client, on time, within budget, and has had no adverse impact on ongoing business operations. This article describes through a case study approach the activities that one project used to ensure a successful development effort. The author advocates a hybrid methodological approach to systems analysis and design that is tailored for the specific project. The article also describes the project and people management practices used to support the developmental effort.     

Developing a health information network within an integrated delivery system: a case study

Changes in the health care environment, such as the growth of integrated delivery systems and the proliferation of managed care, are having a profound impact on the way in which health care organizations manage both clinical and financial information. Health information networks (HINs) are emerging to support the goals and internal needs of integrated delivery systems. In this environment, health care managers must assume a leadership role in planning for the development of HINs. The article provides an overview of the principal issues that should be addressed in an organization's information systems plan when a HIN is being developed and includes a case study that illustrates the key points discussed.     

Federal health information policy: a case of arrested development

Computerized patient records (CPRs) have reached a state of technical maturity that makes them an essential component of modern patient care. However, because uniform technical standards do not exist, CPRs constructed by different vendors do not convey clinical information easily from provider to provider. Moreover, unequal access to capital may mean a two-tier clinical information environment in the future. HIPAA, while important, did not anticipate the CPR revolution. New federal activism is required to assure not only interoperability of clinical data systems, but also that providers who lack capital and technical resources can make the needed digital conversion.     

Surveillance for quality assessment: IV. Surveillance using a hospital information system

Hospital surveillance for infection control purposes is a well-accepted method of following nosocomial infections in U.S. hospitals. However, hospital surveillance is being increasingly performed for nosocomial events in noninfectious areas, such as quality assurance and other areas of outcomes research. For the continued development of hospital surveillance in all these areas, dramatic growth in the amount of information collected will occur. To accommodate this growth and to validate new approaches in these areas, large amounts of data collection will be necessary. Collection of these data will be quite difficult without the creation of clinical hospital data bases in which large amounts of information are collected as a routine part of patient care, not as an elaborate addition to patient care. Automated hospital information systems, such as the HELP system, can facilitate the conduct of ongoing hospital surveillance not only in infection control but also in a broad range of areas, such as quality improvement outcomes research and cost-containment areas.     

The evaluation of the introduction of a quality management system: a process-oriented case study in a large rehabilitation hospital

OBJECTIVES: So far, there is limited proof concerning the effects of the introduction of quality management systems (QMS) on organisational level. This study concerns the introduction of a QMS in a large rehabilitation hospital. METHODS: Using an observational framework, a process-analysis is performed. The effects were analysed with repeated analyses using the Dutch version of the EFQM-model. RESULTS: The introduction of a QMS can be seen as a change process; the pre-change diagnosis proved to be essential. Although many change-related aspects are vital, training and communication, in particular, seemed to be underestimated. Outcomes are a positive correlation between participation in quality activities and work satisfaction and a repeatedly favourable EFQM-score (compared to national levels). CONCLUSIONS: Through a process-analysis, information could be generated to guide organisations in introducing a QMS. An outcome analysis revealed positive effects both in the EFQM-score and the staff's work satisfaction.     

Customer information and the quality improvement process: developing a customer information system

As growing numbers of health care organizations institute quality improvement programs, the demand within these organizations for reliable information about customers increases. By establishing a customer information system (CIS)--a model for collecting, archiving, and accessing customer information--health care organizations can eliminate the duplication of research, ensure that customer information is properly collected and interpreted, and provide decision makers access to better, more reliable customer information. Customer-supplier relationships are defined, guidelines for determining information needs are provided, and ways to set up and manage a CIS are suggested.     

The Washington state workers' compensation system: a case study

Washington State workers' compensation has researched applying managed care in workers' compensation through a series of research projects. In 1995 and 1996, the managed care project evaluated the impact of managed care on medical outcomes, patient satisfaction, and the cost control of medical care and disability. The managed care project also evaluated the long-term outcome of the cases by reviewing the participants 2 years after the injury. Finally,the managed care project evaluated the satisfaction of the employer with managed care. The Department of Labor and Industries Centers of Occupational Health and Education project currently is evaluating the impact of an occupational medicine-directed,education-oriented, protocol-guided pilot project.     

Developing a clinical information system: an interpretive case analysis within a UK hospital.

This paper seeks to adopt an interpretive case analysis for the study of the development of a clinical information system within a UK hospital. An initial literature review is outlined, which draws attention to the distinction between formal-rational and interpretive perspectives on information technology impacts. A case study is presented where a number of issues are identified which suggest that formal systems analysis techniques do not reflect the organizational realities within the hospital. The paper concludes with a brief discussion of the concerns for systems development, and notes the value of an interpretive perspective in this respect.     

Contradictions in the development of new hospices: a case study.

Despite a decade of concern about the 'mushrooming' of new hospice developments within the British Isles, we remain remarkably ignorant about the processes which lead to the initiation of new hospice projects and the factors which affect their progress. Three inter-related issues appear important: (1) policy and resource implications; (2) changing models of hospice care; (3) 'community' factors. This paper explores the interconnections between these, using a case study approach and describes in detail the efforts of a single local voluntary group to establish a programme of community care for dying people. It shows that: (1) local 'communities' are likely to make continued demands for hospice type care, despite official scepticism about proliferation; but also that these communities should not be seen as homogeneous in their aspirations and demands; (2) new models of community care will interact with wider policy changes in the NHS and Social Services to raise questions about how terminal care services can be further developed; (3) shifts away from traditional in-patient models of care are likely to high-light divisions between 'lay' and 'professional' groups in their perceptions of how services can be delivered.     

信息化是建设更是管理

医院信息化建设发展迅速，成为我国IT事业的一大热点，医院管理部门、医疗机构、HIS厂商非常关注医院信息化建设过程中的IT技术。本文总结了信息化建设过程困扰信息化部门的问题，提出在关注技术的同时，更要主要信息化建设工作的管理，并提出了几项切实可行的管理措施，包括引进项目管理思想，重视HIS厂商的维护作用，重视HIS的应用实效，重视沟通和培训，重视信息化人才的培养等。     

The quality and use of knowledge in health policy-making: a case study

A decision-making process about a healthcare programme is examined. The main objective of the programme was to reduce the high levels of risk factors for diseases such as coronary heart disease in individuals that conventional medical care could not handle well. The programme was ended after 10 years of operation. Why was this programme stopped and not another? Was the decision to end based on unsatisfactory performance of the programme and/or that there were better alternative uses of the resources? To answer the questions three models of decision-making will be applied to the process; special attention will be paid to the nature of knowledge on which the decision was based as well as to the logic of the process itself. The knowledge component of the process was deficient in a number of ways; nevertheless no other information was asked for by the participants. The role of the main body of the politicians in the decision-making process was extremely small. There were no traces of political ideology or a rational policy-making framework informing the decision; in fact the process was governed more by the enigmatic views of the political leadership and/or of the administrative leadership. To conclude, there is discussion of the implications of the results, especially whether the standard of knowledge, as well as the want of a systemic approach to health policy, was an aberration or reflected more common decision-making practices.     

Health system reform in Mexico: a critical review.

Last year Lancet published a series of articles on Mexico's 2004 health system reform. This article reviews the reform and its presentation in the Lancet series. The author sees the 2004 reform as a continuation of those initiated in 1995 at the largest public social security institute and in 1996 at the Ministry of Health, following the same conceptual design: "managed competition". The cornerstone of the 2004 reform-the voluntary Popular Health Insurance (PHI)--will not resolve the problems of the public health care system. The author assesses the robustness and validity of the evidence on which the 2004 reform is based, noting some inconsistencies and methodological errors in the data analysis and in the construction of the "effective coverage" index. Finally, some predictions about the future of PHI are outlined, given its intrinsic weaknesses. The next two or three years are critical for the viability of PHI: both families and states will face increasing difficulties in paying the insurance premium; health infrastructure and staff are insufficient to guarantee the health package services; and the private service contracting will further strain state health ministries' ability to strengthen service supply. Moreover, redistribution of federal health expenditure favoring PHI at the cost of the Social Security Institute will further endanger public health care delivery.     

Adopting Deming's quality improvement ideas: a case study

Much has been written about quality guru W. Edward Deming's quality improvement ideas. But how can his concepts be applied to a health care setting? Michael Pugh, CEO of Parkview Episcopal Medical Center, Pueblo, CO, and key members of his staff talked with Hospitals about what happened when they applied Deming's ideas at their hospital.