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Biomedical subjects

Marc Berg

Publications and source records attributed to Marc Berg.

At least 19 recordsLinked to original sources
PubMed2006

OZIS and the politics of safety: using ICT to create a regionally accessible patient medication record.

In studies on success and failure of ICT applications in health care, the 'context' is often used to explain the failure of a system and seldom to explain the success of a system. Science and Technology Studies (STS) have showed that for understanding success and failure of phenomena, one has to take a symmetrical approach and thus use the same concept for analyzing success and failure. In this article we analyze the success of OZIS, a communication protocol that makes it possible for pharmacists to exchange medication data by sharing a regionally accessible electronic medication record. Though OZIS serves a common goal - reducing medication errors - the stakeholders that are involved also have other, competing, interests. By focussing on the context and more specifically the interests of the stakeholders, we will show how the success of OZIS can be explained. By doing this, we will also show that this context is highly dynamic and that continuously changing incentives and constraints within the context lead to both facilitating and threatening the success of OZIS.

Access to Information↗
PubMed2006

Extending the understanding of computerized physician order entry: implications for professional collaboration, workflow and quality of care.

OBJECTIVE: To describe the perceived effect of computerized physician order entry (CPOE) on professional collaboration, workflow and quality of care. DESIGN: Semi-structured interviews with experts involved in the design, implementation and evaluation of computerized physician order systems in the United States. MEASUREMENTS: The interview transcripts were analyzed using six key concepts that identify context, professional collaboration, workflow and quality of care. RESULTS: The interviews reveal the complexity of CPOE. Although providers enter the orders, others collaborate in the decision-making process. There is a profound impact on workflow beyond that of the provider. While quality of care is the main impetus for implementation, it remains terribly difficult to measure the impact on quality. CONCLUSIONS: A proper understanding of CPOE as a collaborative effort and the transformation of the health care activities into integrated care programs requires an understanding of how orders are created and processed, how CPOE as part of an integrated system can support the workflow, and how risks affecting patient care can be identified and reduced, especially during hand-offs in the workflow.

Cooperative Behavior↗
PubMed2006

Implementing Six Sigma in The Netherlands.

BACKGROUND: Six Sigma, a process-focused strategy and methodology for business improvement, can be used to improve care processes, eliminate waste, reduce costs, and enhance patient satisfaction. EXPERIENCE WITH SIX SIGMA IN THE NETHERLANDS: Six Sigma was introduced in 2001 at the 384-bed Red Cross Hospital (Beverwijk). During the Green Belt training, every participant was required to participate in at least one Six Sigma project. The hospital's total savings in 2004 amounted to 1.4 million dollars, for an average savings of 67,000 dollars for each of the completed 21 projects. THREE EXAMPLES OF SUCCESSFUL PROJECTS: In one project, the team designed a new admission process for the operating rooms, resulting in an average starting time nine minutes earlier. This relatively minor improvement made it possible to operate on an additional 400 patients a year and to achieve a net savings of >273,000 dollars. A second project reduced the number of patients receiving intravenous (IV) antibiotics by switching to oral administration, yielding annual savings, based on medication costs alone, of >75,000 dollars. A third project reduced the length of stay in the delivery room from 11.9 to 3.4 hours, yielding an annual savings of 68,000 dollars. The "Ultimate Cure?": Six Sigma, which entails involvement of health care workers; use of improvement tools (from industry); creation of trained project teams to tackle complex, often cross-departmental processes; data analyses; and investment in quality improvement may prove the "ultimate cure" to the current cost, quality, and safety issues that challenge health care.

Anti-Bacterial Agents↗
PubMed2006

Bridging information gaps between primary and secondary healthcare.

Medication errors are harmful and costly for healthcare systems. Recent studies show that a major part of these errors are due to the problems in transferring the patient current medication-data between primary and secondary healthcare. Recent ICT development promises to improve the communication between primary and secondary healthcare. In order to find out the constraints that may hamper a communication project's productivity, an IT configuration for building a medication-data communication network between primary and secondary healthcare in the Netherlands was followed applying qualitative methods. We analysed some important problems that project faced and conclude that problems with the data integration and saving the data integrity are important challenges for the project to maintain its objectives.

Communication↗
PubMed2005

Overriding of drug safety alerts in computerized physician order entry.

Many computerized physician order entry (CPOE) systems have integrated drug safety alerts. The authors reviewed the literature on physician response to drug safety alerts and interpreted the results using Reason's framework of accident causation. In total, 17 papers met the inclusion criteria. Drug safety alerts are overridden by clinicians in 49% to 96% of cases. Alert overriding may often be justified and adverse drug events due to overridden alerts are not always preventable. A distinction between appropriate and useful alerts should be made. The alerting system may contain error-producing conditions like low specificity, low sensitivity, unclear information content, unnecessary workflow disruptions, and unsafe and inefficient handling. These may result in active failures of the physician, like ignoring alerts, misinterpretation, and incorrect handling. Efforts to improve patient safety by increasing correct handling of drug safety alerts should focus on the error-producing conditions in software and organization. Studies on cognitive processes playing a role in overriding drug safety alerts are lacking.

Drug Therapy, Computer-Assisted↗
PubMed2005

Factors that predicted change in health-related quality of life were identified in a cohort of diabetes mellitus type 1 patients.

OBJECTIVE: The aim of this study was to investigate whether sociodemographic and diabetes-specific characteristics can predict the rate of change in health-related quality of life (HRQOL) over time in patients with diabetes mellitus type I (DMT1). STUDY DESIGN AND SETTING: A Dutch cohort of 234 patients with DMT1 was followed for 6 years (1995-2001). HRQOL (RAND-36 and EuroQol) and several demographic and clinical patient characteristics were recorded annually during the study period. Baseline characteristics associated with rate of change in HRQOL were identified using an individual linear growth model. RESULTS: Patients showed a statistically significant decrease over time in most HRQOL scales. Higher baseline diastolic blood pressure was predictive of a faster decrease in RAND-36 PCS score (-0.025, P = .02). Patients with nephropathy showed a faster decrease in PCS (-0.749, P = .003), and those with intermittent claudication a faster decrease in EQ-5D (-0.049, P = .008). CONCLUSION: In this cohort of patients with DMT1, it was possible to identify factors predicting change in HRQOL. Late complications and risk factors for the development and progression of these complications are predictive of a lower HRQOL in the coming years.

Diabetes Mellitus, Type 1↗
PubMed2005

Looking for answers, constructing reliability: an exploration into how Dutch patients check web-based medical information.

INTRODUCTION: In the discussion about helping lay end users find reliable health-related information on the web, lay assessment practices of the reliability of information are often dismissed as insufficient. It is suggested that patients do not check important background information (authors, dates) for the medical content on websites. However, little effort has been made to understand how lay practices enable patients to assess information reliability in respect to their specific health situations. OBJECTIVE: This paper draws upon ethnographic research among Dutch patients to understand lay assessment practices. METHODS: We conducted qualitative interviews and observed patient search practices. Patients were asked to describe and then repeat the last searches they had conducted. They were also given standardized questions for searching for information. RESULTS: Patients did not utilize special user tools (checklists, seals, portals) to assist in searching for and evaluating information. However, we saw explicit strategies for checking information within their established patterns of searching, such as on and offline triangulation of information and checking information provider information and dates. CONCLUSION: Although patients do not follow standardized checklists, this is not to say that they are not assessing information. Their assessment processes are more extensive than current literature suggests.

Adult↗
PubMed2005

Change in perceived health and functioning over time in patients with type I diabetes mellitus.

OBJECTIVE: The objective of this study was to investigate perceived health and functioning (PHF) of patients with type I diabetes mellitus (DMT1) over time and to compare change in perceived PHF with that of a sample of the general population. METHODS: In a Dutch cohort of 234 patients with DMT1 we assessed PHF over time with two generic instruments: RAND-36 and EuroQol. We applied multilevel modelling to estimate change in PHF over the years 1995--2001. We compared change in PHF with change estimated from a comparably aged sample from the general population using a one-sample t-test. RESULTS: Patients reported a significant decrease in PHF for most RAND-36 subscales. Mean changes in RAND-36 scores ranged from -0.09 (mental health) to -1.18 per year (bodily pain). EQ scores decreased significantly as well. Patients in the cohort had a faster decrease in three RAND-36 subscales and EQ-VAS over time than the estimated decrease in the general population. CONCLUSION: This study showed that patients with DMT1 have a faster decrease in PHF over time than comparably aged persons from the general population. The generic instruments used in our study were sensitive enough to measure changes in PHF over time in an adult diabetes population.

Adult↗
PubMed2005

Quality based social insurance coverage and payment of the application of a high cost medical therapy: the case of spinal cord stimulation for chronic non-oncologic pain in The Netherlands.

This article describes a project in which a national continuous quality improvement system and a payment scheme were explicitly linked, while introducing an expensive treatment (Spinal Cord Stimulation (SCS)) in the social health insurance benefit package, in The Netherlands. By linking a national CQI system and a payment scheme in a conditional financing policy a steering instrument for future control of the quality of neuromodulation treatment through SCS is created.

Electric Stimulation Therapy↗
PubMed2005

Feasibility first: developing public performance indicators on patient safety and clinical effectiveness for Dutch hospitals.

This paper describes the development and implementation of the first national, public and obligatory set of hospital performance indicators in the Netherlands. Focusing on effectiveness and safety, the set was developed by the Dutch Health Care Inspectorate to improve the effectiveness and efficiency of their task: monitoring the quality of the care delivered by providers. In addition, the set would enhance the transparency of the hospital sector, and stimulate individual hospitals to improve their scores. Bridging some of the classic distinctions between 'internal' and 'external' indicators, the Inspectorate's vision was to rapidly produce a feasible set of indicators that would fulfill these aims, while maximally preventing 'side effects' such as misinterpretations, defensive or perverse reactions. Explicitly avoiding the trap of searching for exhaustive validity of the indicators, the inspectorate's motto was 'feasability first'. This paper describes how this simultaneously philosophical, political and pragmatic strategy played out successfully, and how the indicator set was ultimately embraced by all parties involved.

Benchmarking↗
PubMed2005

Bridging the quality chasm: integrating professional and organizational approaches to quality.

Current Western health care practices face the challenge to improve their quality on multiple dimensions simultaneously. This requires new ways to think about how to deliver health care services. A careful and 'flexible' standardization of care into 'care programs', we argue, is central. Yet such standardization is powerless without the application of four additional design principles: a thorough restructuring and delegation of tasks, the application of integrated planning, the use of indicators about the functioning of the care programs, and implementing process-supporting information technology. Vice versa, these additional principles can only function properly when integrated with care programs. We will only be able to improve the safety, effectiveness, patient-centeredness, and timeliness of health care, while reducing costs and improving equity, by integrating professional and organizational approaches to quality. This paper describes a series of interrelated design principles that together depict how future health care delivery could be organized.

Delivery of Health Care↗
PubMed2005

An ISO 9001 quality management system in a hospital: bureaucracy or just benefits?

PURPOSE: To describe how The Red Cross Hospital in Beverwijk, The Netherlands implemented an ISO 9000 quality management system throughout the entire organisation, obtained an ISO 9002:1994 and subsequently an ISO 9001:2000 certificate. DESIGN/METHODOLOGY/APPROACH: First, a global implementation plan was written concerning the process obtaining in each department. Once improved, each process was subjected to a procedure, and specific protocols effected. On completion the Quality Manual was put together. Quality management was completed by implementing an internal audit system involving 50 co-workers. FINDINGS: A number of advantages are found from using ISO. The focus on patients has been re-established. All processes are identified and subject to continuous improvement. Performance measurements were introduced and give an integrated picture of results. Measurements subsequently lead to improvement of quality of care and to quality system improvements. The documentation system serves the organization's needs without leading to bureaucracy. Positive effects on patient safety could be demonstrated compared with ten other hospitals. ORIGINALITY/VALUE: Given the need for adequate quality management tools in health care and the need for demonstrating quality, the positive effects reported in this article show how ISO is expected to become more prevalent in health-care organisations.

Accreditation↗
PubMed2004

Theory and practice of waiting time data as a performance indicator in health care. A case study from The Netherlands.

In this article we investigate the use of waiting time data as a performance indicator in health care in The Netherlands. We explain why the current publication of waiting time data fails to achieve one of the main goals: to have consumers and general practitioners act upon this information. The reason, we claim, is that even seemingly clear-cut, easily measurable and objective numbers such as waiting times need interpretation to become meaningful. Discussing four themes - the patient behind the number, the treatment behind the number, the strategy behind the number, and the specificity of the number - we will discuss just how deeply this need for interpretation affects the usability of 'waiting times' for purposes such as informing consumers. We will argue that this problem is due to not making a clear distinction between performance indicators for internal use and for external use. We conclude that the usefulness of the publication of waiting time data for consumers strongly increases when waiting times are guaranteed and related to treatment options like booking possibilities and other performance indicators such as patient satisfaction.

Data Collection↗
PubMed2004

Understanding implementation: the case of a computerized physician order entry system in a large Dutch university medical center.

Most studies of the impact of information systems in organizations tend to see the implementation process as a "rollout" of technology, as a technical matter removed from organizational dynamics. There is substantial agreement that the success of implementing information systems is determined by organizational factors. However, it is less clear what these factors are. The authors propose to characterize the introduction of an information system as a process of mutual shaping. As a result, both the technology and the practice supported by the technology are transformed, and specific technical and social outcomes gradually emerge. The authors suggest that insights from social studies of science and technology can help to understand an implementation process. Focusing on three theoretical aspects, the authors argue first that the implementation process should be understood as a thoroughly social process in which both technology and practice are transformed. Second, following Orlikowski's concept of "emergent change," they suggest that implementing a system is, by its very nature, unpredictable. Third, they argue that success and failure are not dichotomous and static categories, but socially negotiated judgments. Using these insights, the authors have analyzed the implementation of a computerized physician order entry (CPOE) system in a large Dutch university medical center. During the course of this study, the full implementation of CPOE was halted, but the aborted implementation exposed issues on which the authors did not initially focus.

Academic Medical Centers↗
PubMed2004

Clinical information systems: CareSuite from Picis.

In this article, we discuss the implementation of the CareSuite system (Picis, Wakefield, MA) in 5 intensive care units of the Erasmus Medical Center, Rotterdam, the Netherlands. We give a description of the implementation process, and the system as it is currently being used. We also confront the lessons learned during the implementation of this clinical information systems with insights from the research field of implementation, and thereby show the value of a socio-technical approach to clinical information systems implementation.

Computer Communication Networks↗
PubMed2004

Using information technology for patient education: realizing surplus value?

Computer-based patient information systems are introduced to replace traditional forms of patient education like brochures, leaflets, videotapes and, to a certain extent, face-to-face communication. In this paper, we claim that though computer-based patient information systems potentially have many advantages compared to traditional means, the surplus value of these systems is much harder to realize than often expected. By reporting on two computer-based patient information systems, both found to be unsuccessful, we will show that building computer-based patient information systems for patient education requires a thorough analysis of the advantages and limitations of IT compared to traditional forms of patient education. When this condition is fulfilled, however, these systems have the potential to improve health status and to be a valuable supplement to (rather than a substitute for) traditional means of patient education.

Adult↗