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.     

Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part I. Views of surviving spouse on effects of the service on the patient.

The surviving spouses of 34 patients who died of cancer at St Christopher''s Hospice have been interviewed about 13 months after the patient''s death. The information given is compared with that obtained from 34 spouses of patients dying from cancer in other hospitals and matched with the St Christopher''s group. Patients at St Christopher''s were less often thought to have suffered severe pain and other distress than at other hospitals, but pain relief was not bought at the cost of drug-induced confusion and patients at St Christopher''s remained more mobile than at other hospitals. Hospice patients were more aware of chapel services and prayers than at other hospitals. None was said to have been upset by these and 66% were glad of them. Despite the frequency of deaths in the Hospice, patients at St Christopher''s were no more likely to be thought to have been ''upset'' by such events than patients elsewhere or to have found their interactions with other patients anything but helpful.     

Comparison of Computing Capability and Information System Abilities of State Hospitals Owned by Ministry of Labor and Social Security and Ministry of Health

The main purpose of this study is to give an idea to the readers about how big and important the computing and information problems that hospital managers as well as policy makers will face with after collecting the Ministry of Labor and Social Security (MoLSS) and Ministry of Health (MoH) hospitals under single structure in Turkey by comparing the current level of computing capability of hospitals owned by two ministries. The data used in this study were obtained from 729 hospitals that belong to both ministries by using a data collection tool.The results indicate that there have been considerable differences among the hospitals owned by the two ministries in terms of human resources and information systems. The hospital managers and decision makers making their decisions based on the data produced by current hospital information system (HIS) would more likely face very important difficulties after merging MoH and MoLSS hospitals in Turkey. It is also possible to claim that the level and adequacy of computing abilities and devices do not allow the managers of public hospitals to use computer technology effectively in their information management practices. Lack of technical information, undeveloped information culture, inappropriate management styles, and being inexperienced are the main reasons of why HIS does not run properly and effectively in Turkish hospitals.     

Advanced Nurse-Patient Communication System

Effective communication is the most important part of any healthcare organization. For many years, hospital nurse call solutions had been stand-alone systems with occasional integration to pocket paging for outputting patient call alerts to mobile staff. In the late 1990’s, technology enabled in-building wireless phones to supplement or replace paging systems as a means of not only sending alerts, but also enabling voice communication between mobile staff and patients. Today’s nurse call market requires integration of additional information from location and ADT (admit, discharge, transfer) systems into what have traditionally been nurse call applications. This system information is required not only at the nursing station, pagers, and phones, but also at PC’s placed on each patient care floor in hallways, nurse stations, and offices, and at areas away from the patients, including administrator and clinical engineering offices. It is crucial that nurses have the latest patient information in their hand wherever they go in the hospital. In this paper, MatchMaker.NET has been developed to integrate all these technologies into the hospital’s LAN to improve nurse-patient communication.     

Defining the application portfolio for an integrated hospital information system: A tutorial

Although many successful applications in the hospital environment have been introduced and implemented, hospital information systems have had little impact upon the daily operation of hospitals. Furthermore, integrated hospital information systems, although vital to the hospitals' functioning, have proved to be more complicated to develop and difficult to harness than expected. This paper discusses the need for an integrated hospital information system and provides a framework for the development of its application portfolio. The scope of such a system is the integration of the medical, administrative and fiscal information elements of the hospital into a unified systems environment.     

Clinical Information System Availability and Use in Urban and Rural Hospitals

Clinical information systems (CIS) capture clinical data to support more efficient and effective decision making and clinical care delivery. Only a few estimates of CIS availability and use in hospitals are available nationally. The purpose of the current research is to examine differences in CIS availability and use between urban and rural hospitals. A survey addressing this purpose was completed by 74 (63.7%) of Iowa hospitals. Rural hospitals lag behind urban hospitals in terms of many CIS applications. More than 80% of the urban hospitals, but only between 30 and 40% of the rural hospitals, reported using computers to collect basic clinical information for potential use in an electronic medical record (EMR) and computerized provider order entry (CPOE) system. Comparison of CIS within one state’s urban and rural hospitals sheds light on variation in clinical support applications, decision support, and electronic medical record “readiness” in these settings.     

大数据时代医院图书馆的角色转换与读者需求

大数据时代医院读者群体获取知识的途径与方式发生很大变化,对实体图书馆文献资源和馆员的依赖度大为降低,致使医院图书馆角色发生转变,医院图书馆只有加强医学文献资源体系研究,分析读者需求,结合医院发展实际,调整定位,转换角色,才能提供更好的信息服务,提出现阶段医院图书馆满足读者信息需求的具体策略。     

城市公立医院综合改革背景下公立医院发展战略研究——基于SWOT分析方法

目的 明确在改革背景下城市公立医院的发展战略。方法 利用SWOT分析城市公立医院在城市公立医院综合改革背景下的发展优势、劣势、机遇和威胁。结果 城市公立医院的优势体现在人才、技术上,劣势是管理体制和运行机制不完善,面临的发展机遇是国家大力推动公立医院改革以及城镇化、疾病谱的改变,威胁是分级诊疗和社会办医的影响。结论 城市公立医院应推动管理体制和运行机制改革,并继续发挥在人才、技术上的优势,将服务定位于危急重症和疑难杂症等高层次医疗服务需求上。     

在中国的国情下医院信息部门应有的角色与作用

我国近几年在大规模的进行医院信息化建设，甚至很多走在信息化前列的医院已经开始了信息系统全面改造过程中。但事实上中国目前还处于医院信息化建设的初级阶段，由于和国外的医疗制度和医疗体系大相径庭又很难将国外信息化建设成熟经验完全的照搬照套，在整个建设当中充当主要执行作用的信息部门必须在医院信息化建设中找准角色充分发挥其作用，有力的推动医院的信息化建设。     

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 Keyword Search System for Medical Doctors to Introduce Their Patients to Specialists

We developed an online keyword search system on a WWW server to help medical doctors to introduce their patients to specialists. The system stores special knowledge and advanced techniques of 287 medical specialists in Kyushu University Hospital. The data set was presented by the medical specialists themselves. Specialists can rewrite their data set using the browser anytime to keep their data set up to date. In addition, the specialists are reminded to keep their data set up to date by direct mail once a year. The system does not use any database management systems. We used only two text files and the “grep” command, one of the basic commands of the UNIX system. Then, it takes less than 1 sec to search one medical specialist's data set from 200 specialists' data sets. The system is useful not only inside the hospital but also for practitioners in the local area.     

Decision trees based on automatic learning and their use in cardiology

Computerized information systems, especially decision support systems, have become an increasingly important role in medical applications, particularly in those where important decision must be made effectively and reliably. But the possibility of using computers in medical decision making is limited by many difficulties, including the complexity of conventional computer languages, methodologies and tools. Thus a conceptual simple decision making model with the possibility of automating learning should be used. In this paper we introduce a cardiological knowledge-based system based on the decision tree approach supporting the mitral valve prolapse determination. Prolapse is defined as the displacement of a bodily part from its normal position. The term mitral valve prolaps (PMV), therefore, implies that the mitral leaflets are displaced relative to some structure, generally taken to be the mitral annulus. The implications of the PMV are the following: disturbed normal laminar blood flow, turbulence of the blood flow, injury of the chordae tendinae, the possibility of thrombus's composition, bacterial endocarditis, and finally hemodynamic changes defined as mitral insufficiency and mitral regurgitation. Uncertainty persists about how it should be diagnosed and about its clinical importance. It is our deep belief that the echocardiography enables properly trained experts armed with proper criteria to evaluate PMV almost 100%. But unfortunately, there are some problems concerned with the use of echocardiography. In that manner we have decided to start a research project aimed at finding new criteria and enabling the general practitioner to evaluate PMV using conventional methods and to select potential patients from the general population. To empower one to perform needed activities we have developed a computer tool called ROSE (computeRised prOlaps Syndrom dEtermination) based on algorithms of automatic learning. This tool supports the definition of new criteria and the selection of potential PMV-patients.     

Induction for senior house officers. Part I: The hospital programme

The study was set up to examine how an induction programme can be designed to meet the needs and expectations of senior house officers (SHOs) beginning a new post in a hospital. A total of 63 SHOs, in five hospitals in the Anglia region, participated in standardised structured interviews up to 3 months after starting their post, by sorting a list of 38 possible induction topics in order of priority. Trainees'' early induction needs were found to centre on day-one service activities, ie, information that enables them to undertake their service work efficiently and effectively, is particularly valued and required early. Information related to clinical education and training is also valued, but many trainees prefer it to be provided after they have been in post for a week or two. Much induction information can also be effectively conveyed in writing, with little or no need for additional formal presentation. We conclude that first-day induction programmes which strive to satisfy the range of trainee needs in one session fail to take account of the different priorities that trainees attach to induction information. Trainees do not want all information at once. Information of prime concern to clinical tutors, namely education, training and generic skills, is generally favoured after a week or two. To ensure that trainees'' hospital induction needs are met in an efficient and effective way, programmes must be flexible and timely, and supported by comprehensive written information.


     

Trade names or approved names. Part II. Points of view. The hospital pharmacist

In hospitals, the use of approved names for prescribing and labelling is an essential requirement for precision and safety in giving medicines. Substitution is an unavoidable consequence of using approved names which brings benefits, but creates problems that demand more widespread recognition and urgent attention. In particular, dangerous variations in response following brand changes can occur in patients stabilized on certain products. The Licensing Authority and the Pharmaceutical Industry have a responsibility to eliminate brand bio-availability differences. But there is an immediate need; firstly, to identify the small number of products where brand changes in patients stabilized on them can result in potentially dangerous variations in response; and secondly, to safeguard patients being treated with these products, by avoiding substitution and preventing inadvertent brand changes by including brand or manufacturer''s names on labels and in all communications between hospital doctors and general practitioners. The complete elimination of substitution is not feasible and the indiscriminate use of brand names in hospitals causes confusion and increases risks of error in giving medicines.     

全院PACS系统远程备份与容灾技术的研究应用

随着现代医院信息化程度的提高，各种业务系统中所产生的数据量越来越大。各种自然灾害或人为误操作，系统故障等意外情况造成的数据丢失和业务中断，都会给医院带来损害。医学影像存档和通信系统（Picture Archivingand Communication Systems，PACS）作为一个庞杂且集成度高的系统，必须保持其稳定性和连续性。为此不仅要考虑系统数据的备份问题，还要考虑系统在发生故障时如何保证医院日常业务的连续性和数据存储的完整性。主要探讨了中山市人民医院在实施全院PACS系统升级时，在PACS系统数据远程备份和容灾方面应用的一些最新技术，同时剖析了容灾的发展趋势。     

互联网医院与实体医院信息交互及业务流程管理研究

互联网医院是今后医院发展的重要方向,但其并非一个可以独立运行的个体,而必须依托于实体医院,两者优势互补,资源共享。但两者必须实现信息交互及业务往来,才能更好地优化资源,实现优质医疗服务的交叉融合。互联网医院与实体医院信息及业务的互联互通,由于互联网医院突破了地域和时间限制,业务也将不仅以疾病治疗为主,而是从关注疾病本身到关注人健康本身的转变,从一体化到人性化服务的转变,从关注病案到关注患者就医体验的转变,更好地提高医院服务质量,提高患者就诊效率及就医满意度。     

Making the transition from information systems of the 1970s to medical information systems of the 1990s: The role of the Physician's Workstation

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these systems are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development of a Physician's Workstation which integrates information from multiple existing information systems and discuss how the workstation makes it possible to move from the departmental systems of the present to the computer-based medical record system of the future.     

Developing IT Infrastructure for Rural Hospitals: A Case Study of Benefits and Challenges of Hospital-to-Hospital Partnerships

This article presents a study identifying benefits and challenges of a novel hospital-to-hospital information technology (IT) outsourcing partnership (HHP). The partnership is an innovative response to the problem that many smaller, rural hospitals face: to modernize their IT infrastructure in spite of a severe shortage of resources. The investigators studied three rural hospitals that outsourced their IT infrastructure, through an HHP, to a larger, more technologically advanced hospital in the region. The study design was based on purposive sampling and interviews of senior managers from the four hospitals. The results highlight the HHP''s benefits and challenges from both the rural hospitals'' and vendor hospital''s perspectives. The HHP was considered a success: a key outcome was that it has improved the rural hospitals'' IT infrastructure at an affordable cost. The investigators discuss key elements for creating a successful HHP and offer preliminary answers to the question of what it takes for an HHP to be successful.     

北京市医院区域信息系统建设和应用现状分析

分析北京市区域信息系统建设和应用现状,为政府部门精准决策提供科学依据.采用分层随机抽样方法,对北京地区二级及以上医院的区域信息化建设和应用情况进行问卷调查,并进行统计分析.研究结果显示,北京市二级及以上医院远程会诊诊断、远程影像、双向转诊系统及医联体平台的建设率分别为38.8％、41.4％、33.6％及28.4％,以上...     

同级医院信息共享行为的博弈分析

目的：对同级医院信息共享过程中的“囚徒困境”进行破解，为政府推进区域卫生信息化建设的政策制定提供理论依据。方法：构建不同条件下医院信息共享的博弈模型并进行分析。结果：激励机制、惩罚机制和被许可的合作试错是破解同级医院信息共享“囚徒困境”的有效措施。结论：政府通过建立激励机制和惩罚机制及合作进入退出机制等措施可促进同级医院间的信息共享行为。