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PubMed1998

Availability of health data: requirements and solutions.

There is an increasing recognition of the importance of the health data available for the corporate healthcare system model with the electronic patient record as the central unit of the healthcare information systems. There is also increasing recognition of the importance of developing simple international standards for record components, including clinical and administrative requirements. Aspects of security and confidentiality have to be reviewed in detail. The advantages of having health data available when and where it is required will modify healthcare delivery and support cost control with economies of scale and sharing of resources. The infrastructure necessary to make this model a reality is being developed through different international initiatives, which have to be integrated and co-ordinated to have common disaster planning strategies and better funding alternatives.

Computer Communication Networks↗
PubMed1993

Childhood blindness: a new form for recording causes of visual loss in children.

The new standardized form for recording the causes of visual loss in children is accompanied by coding instructions and by a database for statistical analysis. The aim is to record the causes of childhood visual loss, with an emphasis on preventable and treatable causes, so that appropriate control measures can be planned. With this standardized methodology, it will be possible to monitor the changing patterns of childhood blindness over a period of time in response to changes in health care services, specific interventions, and socioeconomic development.

Abstracting and Indexing↗
PubMed2005

The use of a structured form during urology out-patient consultations -- a randomised controlled trial.

OBJECTIVES: To compare the completeness of documentation in the medical record using a structured form (SF) versus a traditional medical record (TMR). METHODS: Randomised controlled trial comparing the use of SF and TMR in urology out-patient clinics for documentation of 15 items of clinical information, time taken to complete and acceptability to clinicians assessed by a self-completion questionnaire.in a teaching and district general hospitals. RESULTS: Four hundred new urology patient consultations, 11 clinicians. Completeness of information was compared between groups based on the medical record alone (SF vs. TMR), medical record plus letter to GP and letter alone. SFs were significantly (p<0.0001) more complete than TMRs for the majority of the items in all three groups. There was no significant difference in the time taken to document information using either type of record. The clinicians generally found the SF acceptable for routine use. CONCLUSIONS: Structured forms significantly improved the completeness of documentation for new out-patient consultations in urology.

Ambulatory Care↗
PubMed1995

Complaints management--in-depth review.

Introduces the Complaints Manager program from Health-TEC to address the problems involved in complaints management and control in the health service. Shows the main screens available for data input. Demonstrates the wide range of reports which can be generated. Suggests that the Complaints Manager program provides an efficient and low-cost means of keeping complaints under control.

Cost-Benefit Analysis↗
PubMedDate not supplied

A critical review of the infectious diseases surveillance system in the Gaza Strip.

The development and strengthening of national surveillance systems is a key part of communicable disease control. This review article describes and evaluates the Palestinian surveillance system and discusses the role of the epidemiology departments and other health providers in Gaza Strip in reporting infectious diseases, considers the use of the data collected, and makes recommendations for strengthening infectious diseases surveillance. Underreporting of infectious diseases remains a major problem in communicable diseases surveillance. Recommendations include the unification of the reporting forms between different health providers, increased involvement of health providers in reporting of infectious diseases, and complete separation of surveillance and clinical activities in epidemiology departments.

Bias↗
PubMed2000

[Meticulous handling of electronic patient records in general practice].

A 41-year-old woman visited her general practitioner because she wished to receive her medical records and those of her two children. She had decided to move pending divorce and wanted to transfer her medical information to another physician. The information was handed to her on a floppy disk. The next day her husband came and demanded that his own information be deleted from the records. Many Dutch physicians have electronic patient records, which will replace paper records presently. Patients may decide to have their medical information selectively transferred to another physician. This may interfere with adequate information of the treating physician. Electronic episode-related patient records may facilitate transfer of information and will have an important role in regulating physician-patient contact according to the Wet Bescherming Persoonsgegevens (Act on the protection of personal data), the Wet op de Geneeskundige Behandelingsovereenkomst (Act on agreement concerning medical treatment), and the Wet op de Beroepen in de Individuele Gezondheidszorg (Individual health care professionals act). Patients' rights to control the transfer of their information must be ensured.

Adult↗
PubMed2006

Unbundling the confusion about "unbundling" of charges.

Rejecting service codes on the basis that they have been unbundled has become a popular way for payers to reduce total billed charges. However, the contract between the hospital and the payer, and not Medicare or some hastily manufactured and inconsistent industry standard, controls the obligation to pay for healthcare services.

Economics, Hospital↗
PubMed2005

Screening of new entrants for tuberculosis: responses to port notifications.

BACKGROUND: Tuberculosis in England and Wales is associated with recently arrived immigrants. Screening new entrants for tuberculosis has received considerable attention recently. Despite several calls to reorganize screening processes for new entrants because of perceived ineffectiveness, some systems at ports have remained largely unchanged, including notification arrangements. METHODS: A postal questionnaire was sent to Consultants in Communicable Disease Control (CsCDC) who normally receive port health notification forms from London Heathrow Port Health Control Unit relating to new entrants who had either been screened and found to have a normal chest X-ray, not had an chest X-ray due to pregnancy or young age or whose examination was inconclusive (Port 101 and 102 forms). RESULTS: Almost half of the responding CsCDC attempted to follow-up all Port 101 and 102 referrals; of these CsCDC, 46 percent reported that they were actually able to follow-up under 50 percent. CsCDC had developed their own criteria to aid decisions as to which referrals to follow-up. CONCLUSION: The follow-up by CsCDC of new entrants passing through Heathrow Port Health Control Unit who have been screened and found to have a normal chest X-ray, not had an X-ray due to pregnancy or young age, or whose examination was inconclusive varies considerably and there is no consistent national practice. Substantial efforts are being expended on attempting to follow-up new entrants, many of whom may be at low risk of tuberculosis. The effectiveness (and efficiency) of this approach is probably low.

Algorithms↗
PubMed1990

Computerization of plateletpheresis quality control records with a commercially available spreadsheet program.

Many apheresis units lack the resources to acquire customized computer software for record keeping. We have adapted a commercially available "spreadsheet" program (Lotus 1-2-3) to aid in quality control activities for plateletpheresis. Data are entered in a grid pattern wherein each donation occupies one row and successive columns contain numerical data derived from the donation. The last two columns contain formulas that calculate yield and collection efficiency from values entered in preceding columns. The program runs on an IBM PC or equivalent with 512 K RAM; the combined cost of a computer and software is currently under $2,000.00. Data entry requires fewer keystrokes per record than computation of yield and efficiency with a calculator, and creates an inclusive permanent record for future analysis. Data sorting and statistical functions allow rapid identification of incomplete records, and derivation of average platelet yield and/or collection efficiency for any time period of interest. The program also facilitates determining the proportion of donations that fall below any chosen cutoff. Performance characteristics of a particular instrument or operator can be assessed easily by isolating the pertinent records and analyzing them separately. The system will thus accomplish a variety of quality control activities, including those mandated by licensing agencies. It can be implemented by apheresis personnel with limited "computer literacy" and is superior to manual tabulation of quality control data in both ease of data entry and facility of analysis.

Data Interpretation, Statistical↗
PubMed2000

Practical risk-adjusted quality control charts for infection control.

BACKGROUND: Control chart methodology has been widely touted for monitoring and improving quality in the health care setting. P charts and U charts are frequently recommended for rate and ratio statistics, but their practical value in infection control may be limited because they (1) are not risk-adjusted, and (2) perform poorly with small denominators. The Standardized Infection Ratio is a statistic that overcomes both these obstacles. It is risk-adjusted, and it effectively increases denominators by combining data from multiple risk strata into a single value. SETTING: The AICE National Database Initiative is a voluntary consortium of US hospitals ranging in size from 50 to 900 beds. The infection control professional submits monthly risk-stratified data for surgical site infections, ventilator-associated pneumonia, and central line-associated bacteremia. METHODS: Run charts were constructed for 51 hospitals submitting data between 1996 and 1998. Traditional hypothesis tests (P values <.05) flagged 128 suspicious points, and participating infection control professionals investigated and categorized each flag as a "real problem" or "background variation." This gold standard was used to compare the performance of 5 unadjusted and 11 risk-adjusted control charts. RESULTS: Unadjusted control charts (C, P, and U charts) performed poorly. Flags based on traditional 3-sigma limits suffered from sensitivity <50%, whereas 2-sigma limits suffered from specificity <50%. Risk-adjusted charts based on the Standardized Infection Ratio performed much better. The most consistent and useful control chart was the mXmR chart. Under optimal conditions, this chart achieved a sensitivity and specificity >80%, and a receiver operating characteristic area of 0. 84 (P <.00001). CONCLUSIONS: These findings suggest a specific statistic (the Standardized Infection Ratio) and specific techniques that could make control charts valuable and practical tools for infection control.

Bacteremia↗
PubMed1992

The final word. OSHA's final ruling offers firm deadlines for infection control.

Departments that have put off program development while waiting for the final ruling to be published have a lot of work to do. Many departments have been cited and fined by OSHA in the past year for failure to begin infection-control programs or provide hepatitis-B vaccines to personnel. Under the new budget, OSHA was granted permission to up its fine structure sevenfold--thus, a small fine is $7,000, and the highest fine for a single violation is $70,000. Fines can have a greater impact on a department's budget than implementation of the program over time. A key point to remember is that a strong infection-control program will reduce exposure follow-up costs and worker-compensation claims. Infection control is a win-win situation.

Blood↗
PubMed1993

Computer-aided administration of a radiology equipment insurance program.

The Medical College of Georgia's radiology department has developed computer software that helps the department manage its radiology equipment insurance program. By providing clear menus and choice boxes instead of manual typing wherever possible, the software minimizes the time spent on data entry and management functions. In addition, the software helps track vendor invoices and unreimbursed claims, and maintains a service call log. It also provides a bar-coded service ticket for use by in-house engineers. Completed tickets, which are copied and filed, have replaced ledger books. Furthermore, the software helps the department comply with JCAHO requirements, since service tickets link the documentation of quality control problems to their resolution.

Academic Medical Centers↗
PubMed1995

An assessment of data quality in the Vermont-Oxford Trials Network database.

The Vermont-Oxford Trials Network is a voluntary collaborative research group of neonatologists that maintains a database for very low birthweight infants (501-1500 g). The database (1) provides core data for randomized trials, (2) serves as a resource for outcomes research in neonatology, and (3) generates quality management reports for participating sites. To assess the reliability of this database and to determine the sources of error, we reviewed 635 medical records chosen at random from among the 4341 eligible infants born at 40 participating data generating sites during an 18-month period beginning January 1, 1990. The estimated frequencies of disagreement between the medical record and database for each of the 10 data items studied and the standard errors of the estimates (in parentheses) were: date of birth 1.3% (0.4), date of admission 2.5% (0.6), date of discharge 8.8% (1.0), birthweight (difference > 50 g) 2.9% (0.6), location of birth (inborn or outborn) 2.1% (0.5), multiple birth 2.2% (0.5), cesarean section 2.5% (0.6), gender 2.1% (0.5), status 28 days after birth 3.4% (0.6), final status 2.9% (0.6). The overall proportions and mean values for items in the database were close to the estimated values based on the random sample of records. There were a total of 247 disagreements between the database and the medical records in the sample. Twenty-three were due to data keying errors. Two hundred twenty-four were due to errors in transcription or interpretation. The rate of data keying errors decreased from over 50 errors per 10,000 fields to less than 15 errors per 10,000 fields when specific quality control procedures, including visual inspection, were instituted. Data keying errors accounted for 13.7% of all disagreements between the database and medical record before improved data entry methods were introduced, and only 3.7% of all errors after they were introduced. We concluded that the Vermont-Oxford Trials Network Database is reliable. Data keying errors have been reduced by the introduction of additional quality control measures. Further reductions in database errors will require measures aimed at minimizing transcription or interpretation errors by individuals completing the data forms.

Computer Communication Networks↗