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Biomedical subjects

F H Roger

Publications and source records attributed to F H Roger.

18 recordsLinked to original sources

DRGs and documentation: the information problem.

Diagnosis Related Groups (DRGs) are becoming a new "information standard" for hospital comparisons in Europe. The availability of countrywide uniform medical record abstracts increased largely between 1982 and 1987 among EEC countries, following the definition of the European Minimum Basic Data Set. Diagnoses could easily be compared with reference to the ICD-9-CM code, while procedures have required mapping because the national coding schemes and because of the lack of an appropriate WHO classification for procedures. Financial data remain another area that should benefit from international comparisons. Data reliability depends largely on information uses and feedback to users. The AIM program of the EEC provides a good opportunity to initiate hospital data comparisons and to begin international research on indexes of severity, intensity and quality of care. The European scale is needed to compare hospital costs and outcomes with results from the U.S.A.

Abstracting and Indexing↗

Hospital statistics that contribute to epidemiology.

Can a hospital population be used as a set of reference to a general population? The purpose of the present paper is to underline several conditions for which hospital statistics might be used for epidemiological inference, e.g. to map-out the pattern and the frequency of diseases in a general population. In several countries the population base for hospital in-patients is known and well-documented. Under this assumption, the frequency of diseases that require hospitalization, such as meningitis or some birth defects might be estimated in relation to the general population. In other instances, the population base remains unknown, all hospitals from a given region not being able to provide uniform statistics. There might be false associations called Berkson's bias. However, a study of the frequency of some diseases estimated from a large population of in-patients gave surprisingly similar results to those obtained from well defined populations. It is concluded that, even when the population base is unknown, hospital statistics might already contribute largely to epidemiology under two conditions: (1) the hospital sample must be large enough (above 10 000 patients) and include a case mix from several specialties (e.g., all cases from the departments of internal medicine and surgery), (2) discharge abstracts should be available, reliable and comparable for all inpatients and include all diagnoses relevant to each case. The importance of accuracy and uniformity in registration is stressed as well as the need to develop more widely population-based hospital statistics.

Diagnosis-Related Groups↗

[Uniform autopsy record summaries].

Clinico-pathological comparisons are a mean to evaluate medical care that remains still rarely automated. They are confronted to obstacles linked to the automation of medical records. There are problems of volume, comparability and availability of informations as well as difficulties to generate diagnostic hypotheses from a mass of raw data. In order to solve these problems, it is proposed to use a uniform autopsy record summary with standardized methods for data selection, coding systems and evaluation of care.

Autopsy↗

[Not Available].

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Belgium↗

A survey of medical informatics in Belgium.

The Belgian Society for Medical Informatics (MIM) organized a survey in 1986 in order to assess the present state of development of medical informatics in Belgium. Questionnaires were sent to hospitals, laboratories, private practitioners and pharmacists, as well as to social security organizations and software industries. The response rate was higher in hospitals (93%) than in any other category. Results showed a large number of computerized hospitals (93% of general acute care hospitals and 91% of psychiatric hospitals). There has been a sharp increase (+ 15%) in computerization of the admission, accounting and billing procedures since 1985, most likely in relation with administrative rules issued by the Belgian Government. The same trend (+ 20%) has been observed for computer applications in clinical laboratories, between 1984 and 1985. There is almost one computer terminal for ten beds in the hospitals with more than 200 beds in 1986. This figure exemplifies the present trend to on-line access to data. Computerized instrumental aids to medicine such as text processing, imaging or computerized interpretation of signals have known a rapid extension during recent years, although less comprehensive than administrative applications in hospitals and in social security organizations. The present state of other applications in medicine (general practice, pharmacy, etc.) was more difficult to assess as those information systems remain more pinpointed. In all medical fields, there appears to be a new rise in computer programs offered by software companies.

Belgium↗

Security threats and trends in society.

This paper is concerned with what can go wrong in health information systems and focuses attention on new trends in computer technology that might generate a vulnerable structure of opportunities for committing unlawful or unethical acts that could threaten our society. Malicious threats are distinguished from accidental threats. Several of the many threats to security in a health environment are reviewed, as well as new trends in technology and in society that might have an effect on health data security. Particular attention is given to microcomputers, unauthorized access to networks and databases, 'viruses', as well as encryption, memory cards and 'information standards'. Some reasons are given to explain why crimes can be committed in the health care environment.

Confidentiality↗

[Computers and medico-surgical ethics].

The confidence of physicians and surgeons in computerized medical systems is highly related to data reliability, while the confidence of the public depends on the protection of medical information in automated systems. In order to assure to patients medical data privacy, the MIM is of opinion that deontological and legal rules concerning access to identifiable medical data in automated information systems shall be the same as those that are applicable to conventional medical records. The access to medical data banks should be exclusively reserved to physicians responsible for patient care and to the personnel mandated by them.

Belgium↗