The Netherlands Institute for Accreditation of Hospitals.
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Academies and Institutes↗
Biomedical subjects
E M van Gennip
Publications and source records attributed to E M van Gennip.
[Towards an accreditation system for the Dutch hospitals].
The development of the Netherlands system for accreditation of hospitals started in 1989 in the Pilotproject Accreditation (PACE). This resulted in the establishment of the Netherlands Institute for Accreditation of Hospitals (NAIH) early 1999, by the Dutch Association of Hospitals, the Dutch Association of University Hospitals, the Dutch Organisation of Medical Specialists and the PACE foundation. Dutch hospitals may request (voluntary) for an accredition for their whole organisation or for parts of it, independent of the used quality system. An accreditation assesses whether organizational requirements are available for quality assurance. Accreditation is not primarily aimed to account for organizational quality, but rather to find points for improvement. The survey is carried out by peers: experts from other Dutch hospitals. The frame of reference used in accreditation is composed of 35 departmentwise standards and a hospitalwide standard 'Quality system'. All standards are developed by people in Dutch hospitals. NIAH can accept certificates for parts of the hospital (e.g. laboratoria) issues by organisations. The system is complementary to the 'visitities' which are organized by the medical specialist societies in the Netherlands. From 1996-1998 trial accreditations were carried out in 19 Dutch hospitals. These showed that the accreditation system has an added value for Dutch hospitals.
Accreditation↗
Results of discussions at the IMIA WG 13 and 15 working conference.
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Congresses as Topic↗
IMIA Working Group 15: technology assessment and quality development in health informatics.
The working group on technology assessment and quality development in health informatics was established as a follow-up to the recommendations made at the IMIA-ISTAHC working conference in 1990. The working group was approved by the IMIA General Assembly at Kyoto, September, 1993. The working group aims to further develop the field of technology assessment and quality development in health informatics, by: promoting consensus development on methodological issues; promoting comprehensive assessment of health care information technologies, for instance by providing expertise; demonstrating the value and importance of assessment of health care information technologies, to health care decision makers, health care providers and developers of information technologies.
Medical Informatics↗
Guidelines for cost-effective implementation of Picture Archiving and Communication Systems. An approach building on practical experiences in three European hospitals.
This paper describes a comprehensive approach for the assessment of the impact of (partial) Picture Archiving and Communication Systems (PACS). The approach is developed, based on actual clinical experience in three European hospitals and tested in these environments. The approach departs from a thorough analysis of the working procedures and information flows before implementation, both descriptive and quantitative. On the basis of this analysis, quantitative (and hence testable) objectives of the implementation are defined. The implementation strategy is defined after comparison of various scenarios, taking costs and effects for both the final and the transition phases into account. The approach is supported by a comprehensive evaluation protocol and a software package (PACER). The approach is demonstrated in this paper by applying it on a hypothetical PACS implementation for CT, ultrasound and for the part of the radiology department serving ICU. The objectives of this PACS are: (1)--to shorten the turn around time between the radiology department and ICU from 4 h to 30 min, (2)--to save 2000 m2 of film per year and (3)--to save personnel time. In this case the PACS is introduced in three phases and completed after three years. The cost analysis shows that, if started in 1995, a financial break even point is reached after 6 years, when comparing costs for the film-based system with those of the PACS. Experiences in the three sites show that the approach helps to harvest potential benefits, allowing a cost-effective implementation of PACS.
Cost-Benefit Analysis↗
Assessment of effects and costs of information systems.
Insight into the effects and costs of information systems is becoming increasingly important. A key problem is to provide evidence which is transportable among sites. Transportability demands agreement on how to carry out assessment of information systems. In the VISTA study, three Dutch hospitals developed together an evaluation protocol for the assessment of the effects and costs of the nursing information system VISION. This protocol is based on a quasy-experimental study design allowing filtering for non-VISION influences. The protocol also included a uniform cost model. Based on a cost calculation for the three hospitals, the costs for hospital-wide implementation of VISION in a 445- and 800-bed hospital were extrapolated. VISTA is considered as a trial for application of one evaluation protocol at various sites. It is recommended to extend this national trial to a multi-national one, for instance by applying the cost model more broadly.
Computer Systems↗
Effects measured in the evaluation of automated information systems.
The results of a literature search show that most of the evaluation studies of automated information systems are dealing with structure measures. Only 15 of 91 studies investigated effects on the outcome of the care process. Probably one of the reasons for this lack of investigated "outcome" measures is the fact that many of the evaluated systems were not in routine use at the moment of evaluation. It is, however, possible to obtain indicators of outcome measures by investigating the relationship between process measures and outcome measures. In the context of many developments, such as the trend of increasing attention to the evaluation of outcomes of the care process and the increasing costs of health care, the effect of automated information systems on the outcome of the health care process becomes more and more important. In the attempts to develop guidelines for the evaluation of automated information systems, it is therefore important to pay attention to the relationship between process and outcome.
Computer Systems↗
Costs and effects of a nursing information system in three Dutch hospitals.
VISION is an integrated nursing information system developed in the Netherlands. In mid-1992, a technology assessment of this system was started: the VISTA project. Its aim is to assess the costs and effects of VISION in three different types of hospitals: a University Hospital, a General Hospital, and a Psychiatric Hospital. The study was financially supported by the Dutch Ministry of Welfare, Health, and Culture. Each hospital selected an experimental ward at which VISION parts were installed (VISION was not yet complete during the study). Also, control wards were selected at which no VISION parts were installed. A series of two measurements were carried out at the experimental and control wards. The first experiences show that VISION can be used in various applications, in different environments. Although the second measurements were done just a few weeks after the installation of VISION parts, first effects could already be demonstrated. Nurses were enthusiastic and the quality of coordination of care increased. Time savings have not yet been demonstrated, but are expected after a longer, more extensive use of the system. Extrapolation of costs for hospital-wide implementation revealed that the costs of VISION are low compared to similar systems in the US. After reviewing the first results, each hospital decided to continue the implementation of VISION parts. More measurements are planned.
Analysis of Variance↗
ATIM, accompanying measure on the assessment of information technology in medicine.
ATIM is an Accompanying Measure under the AIM programme which aims at developing consensus on methods and criteria for assessment of Information Technologies applied in health care and at the application of these methods in two AIM project lines: (a) Knowledge Based and Decision Support Systems and (b) Medical Multimedia Workstations and Images. ATIM builds on, and coordinates assessments and evaluations which are planned in current AIM projects. It consists of workshops, meetings and the coordination of assessments in the two project lines. Networking is an essential element. The main goal of ATIM is to demonstrate the value of assessment to the various actors in this field. One of the end-products of ATIM will be a handbook on how to assess information technologies in medicine, with practical examples from AIM projects.
Artificial Intelligence↗
A view of the workshop.
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Costs and Cost Analysis↗
Workshop aims, outline of the program.
This workshop on the Technology Assessment of PACS has been organized as a rounding off of the Technology Assessment activities which were initiated within the Dutch PACS Project (1986-1989). It is made possible by a funding from the Dutch Ministry of Health Care (WVC). We hope it will be not only a rounding off, but will contribute to more intensive cooperations in this area. In the scope of the Dutch PACS project, the software package CAPACITY for cost analyses of PACS has been developed, to stimulate the dialogue and exchange of data. During the workshop, the data which were collected with CAPACITY are used as a framework for discussions. This paper presents the outline of the workshop, its background, its aims and the program.
Cost-Benefit Analysis↗
Overview of CAPACITY data.
This paper presents an overview of the data from 15 cases collected with the CAPACITY software for cost analysis of PACS. The data suggest that both hospital wide and partial PACS implementations do not pay back yet. Only Nuclear Medicine PACS systems may be introduced cost-neutral in the near future. Because of the assumed price drop of hardware components of 5-25% per year, hospital wide and partial PACS may allow cost savings within the next 10-20 years. There are major differences in viewpoints concerning the required PACS configurations and their costs. The experiences with the CAPACITY software suggest the need for the establishment of key rules, for designing a PACS configuration and for estimating PACS costs.
Computer Systems↗
Evaluation of personnel savings through PACS: a modelling approach.
The ability to improve the efficiency of the use of medical image information is often believed to be one of the most important potentials of PACS. The organization within hospitals is however complex, which makes it difficult to predict the impact of the system. This paper addresses several methods for the analysis of the organizational impact and proposes a modelling method.
Costs and Cost Analysis↗
Do the benefits outweigh the costs of PACS? The results of an International Workshop on Technology Assessment of PACS.
On May 26-27, 1991, an International Workshop on the Technology Assessment of PACS was held at Enkhuizen, The Netherlands. During this workshop 35 experts in the field, from 13 different countries, discussed amongst others the required functionality of PACS, diagnostic aspects and the quality of care and organizational aspects. The key question was whether, when and how PACS is feasible, both from a financial and a clinical point of view. Data which were collected with the aid of the software tool CAPACITY formed the starting point of this meeting. This paper gives an outline of the discussions during this workshop. The main conclusion is that more clinical research is needed, to get a better insight into the costs and the clinical benefits of PACS. Because of the high costs of the PACS technology, international cooperation in this field is requested. It is recommended that the CAPACITY project, which is set up to stimulate the international dialogue and data exchange on PACS, is continued.
Cost-Benefit Analysis↗
Evaluation of automated information systems in health care: an approach to classifying evaluative studies.
In this paper we discuss an approach to classifying evaluative studies of automated information systems in health care. Selected literature (76 studies) is classified according to the type of automated information system (based on relationship to the care process), the study design used, the data collection methods used, the effect(s) measured and the type of evaluation (e.g. cost-benefit analysis). First results show that certain types of automated information systems have not been evaluated much, going by the number of studies selected. Furthermore, it is observed that certain study designs (time-series design), data collection methods (modelling and simulation) and effect measures (job satisfaction) are hardly to be found in the literature. Only 10 of 76 selected studies used a type of evaluation for which both consequences and costs are considered. Detailed investigation of the literature may provide information for the development of a general framework for the evaluation of different types of automated information systems.
Classification↗
An analysis of the costs of a hospital-wide Picture Archiving and Communication System with the software package CAPACITY.
Within the scope of the Dutch PACS project, the costs of a hospital wide PACS in the Utrecht University Hospital were estimated, with the help of the software package CAPACITY. The cost analysis was based on the most recent specifications of the costs of the equipment, on extrapolations, and on the experience acquired with a PACS prototype in the Utrecht University Hospital. Savings due to a possible reduction in the length of stay, or due to logistic improvements were not taken into account. The results indicate that the extra costs of a hospital wide PACS would amount to 3.2% of the total hospital budget. By taking into account the expected price movements, it is predicted that a hospital wide PACS may allow enough savings to pay itself back, when installed near the turn of the century. The result of this cost analysis depends on a large number of assumptions. Therefore two sensitivity analyses are carried out, i.e., concerning the number of workstations required and concerning the organizational impact of PACS.
Computer Systems↗
PACER: a software tool for PACS decision makers.
This paper describes the development of the software package PACER as it evolved from a cost model to a software package for PACS decision making. PACER was developed as part of the TEASS topic from the EurIPACS project. EurIPACS is an EU subsidized project covering a wide area of PACS related research. The TEASS topic concerns the evaluation of prototype PACSystems in three European hospitals. PACER allows the user to evaluate costs of various PACS implementation scenarios and compare them to the costs of the current film based situation. Its cost calculation is based on a straight forward description of costs of a film based radiology department and of PACS. The PACER cost analysis can consider stepwise introduction of PACS and a corresponding stepwise disappearance of the film environment. This analysis includes effects of price developments. PACER calculates costs and expenses for a number of years in succession. The calculated results can be analysed using graphs, tables and sensitivity analysis tools. Preliminary tests in three hospitals indicate that PACER can indeed be a useful tool in the decision process concerning PACS.
Costs and Cost Analysis↗