Biomedical subjects
Publications and source records attributed to R A Korpman.
Historically, home health care has been carried out by independent organizations that provide limited-scope services in a home-only setting. But as capitation takes hold throughout the country, the concept that home care is often the most beneficial way to deliver major portions of patient care finally is becoming clear to health care providers, payers, and patients.
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Interfaces between computer systems are reviewed. An interface establishes a physical connection between two computer systems, a conversational syntax, a format for logical messages passed between the systems, and a data-encoding structure understood by both systems. Interfaces are usually implemented as software modules and consist of three "layers." The physical layer contains the actual physical connection and the hardware, firmware, and software that make the connection work. The protocol layer ensures that the bits of data sent across the interface by the sending system are received intact and in the correct sequence. The logical layer organizes the data to be sent into a form that can be read by the other system. Interfaces can be described by whether they operate in batch or real time, whether they are unidirectional or bidirectional, and the medium used to establish the physical connection (e.g., the exchange of a floppy disk or with an RS-232 serial connection). The real challenge to producing an interface lies in ensuring that the transactions between the two systems are meaningful. An interface engine allows one computer system to interface with several others through a single connection. A good interface has invisibility, reliability, timeliness, flexibility, terseness, and utilities. In planning an interface, goals and the proposed exchanges of data should be clearly defined. The interface should be the simplest one that meets a pharmacy's needs. When the specifications for the interface are completed, the pharmacy should thoroughly test the interface.(ABSTRACT TRUNCATED AT 250 WORDS)
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In today's cost-constrained health care delivery environment, hospitals are recognizing the need to optimize their care operations to improve the efficiency, efficacy, and service quality of primary health care providers, particularly the medical staff and nursing services, which comprise about 50% of the hospital's total personnel. Because health care institutions are in the business of caring for patients (not for accounts or departments), and because health care delivery largely is a personnel-intensive information industry, operations optimization is supported best by information systems that fully integrate all information concerning the patient. The goal of this is to simplify the job duties of direct care providers. The benefits of an integrated, patient-centered approach include demonstrable improvements in over-all patient care quality and staff satisfaction as well as a significant reduction in costs.
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Integrated approaches to the delivery of patient care have the potential to do several things to alleviate potential problems resulting from the five changes discussed earlier. They bring physicians into a more active role with the largest group of employees in the hospital (nurses); giving them the opportunity to acquire a better appreciation of the objectives, goals, and constraints of other providers and of the institution as a whole. When nurses and other employees begin to appreciate the constraints placed on physicians by federal regulations and competition, mutual understandings are fostered. They lay a more solid foundation for good professional relationships between hospitals and IPAs and between hospital-based physicians and independent practitioners. They encourage the focus of all providers on quality patient care (at a price the community is willing to afford). They discourage the overlap of expensive services between providers and encourage planned growth for the community. They encourage collaborative practice at the bedside, at committee and board meetings, and throughout the community that can lead to the development of a new model of "health" care as opposed to "disease" care. Finally, they promote human understanding that encourages providers to recognize the appropriate professional (considering all the variables) for each role. Without such efforts, it appears that patient care quality will be the most likely aspect of health care to suffer in the future--a result against which all health care professionals should stridently guard.
The demands for information retrieval, processing, and synthesis placed on all providers of health care have increased dramatically in the last several decades. Although systems have been developed to capture charge-related data in support of cost reimbursement, there has been a conspicuous lack of attention paid to information tools to directly enhance the delivery of patient care. The termination of cost reimbursement, together with an increasing recognition of the problems inherent in current manual record-keeping systems, is creating a significant new focus on medical information. This change in focus requires a shift in systems orientation away from financial and departmentally centered systems and toward patient-centered approaches. There is thus increasing recognition of the need for a physician-level medical information specialist to serve as an institution's chief information officer, assuming responsibility for the collection, manipulation, and availability of all patient care-related data. By virtue of training, typical experience, hospital presence, and a noncompetitive position with the hospital's medical staff, the pathologist is uniquely suited for this position. To effectively perform this role, a variety of new specialized data management tools are becoming available. Integrated information systems, patient care management by exception, decision support tools, and, in the future, "artificial intelligence" assists can all be expected to become staples of pathology practice, especially impacting those pathologists who choose to be responsive to the new practice milieu of medical information science.
The thickness of the red cell membrane skeleton was deduced from measurements of the isthmus zones of intact cells that were maximally narrowed by one of two independent methods. The first method involved application of viscous drag to red cells entrapped between spider web fibers. The second method utilized cellular dehydration followed by spectrin denaturation at 49.5 degrees C. Measurements on thin sections showed that the isthmus is narrowed to approximately 120 nm by either method, suggesting that the membrane skeleton occupies a zone beneath the lipid bilayer that is up to 60 nm in thickness. The tertiary and quarternary structure of band 3, a major integral membrane protein that anchors the membrane skeleton to the lipid bilayers may be a critical determinant of the location of the membrane skeleton within the red cell.
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The clinical laboratory is examined as a microcosm of the entire health care delivery system. The introduction of computers into the clinical laboratory raises issues that are difficult to resolve by the methods of information science or medical science applied in isolation. The melding of these two disciplines, together with the contributions of other disciplines, has created a new field of study called medical information science. The emergence of this new discipline and some specific problem-solving approaches used in its application in the clinical laboratory are examined.
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Most efforts to automate the WBC differential have involved the use of devices to identify and enumerate WBC types, the underlying assumption being that the cell type percentages constitute the important end results. A different assumption exists. It is that the clinical usefulness of this procedure derives primarily from the fact that a trained morphologist has conducted a detailed examination of the slide. Based on this second assumption, a different approach to automation was investigated. This involved the use of a computer system to augment the morphologist in the slide examination process. This augmentation was accomplished by: 1. Determination of linked abnormalities on 117,000 WBC counts and presentation of linkages to the morphologist when a particular abnormality was identified on the hemogram or the slide. 2. Information feedback which compared each technologist with others in the laboratory performing similar tasks. 3. Varying the number of cells examined per slide, based on the apparent abnormality of the slide. The linkage patterns found, their clinical usefulness, and the impact on technologist performance and test quality are discussed.