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Results for “Integrated Advanced Information Management Systems”

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PubMed1998

Selecting office management computer equipment.

Even though you will never find a dental management system that will do exactly what you want, there are a tremendous variety of systems out there with some incredibly powerful features. Look for a system that can handle most of the tasks you need. Keep your eye on other technologies that you may want in your practice. The system you purchase now should be able to handle whatever technologies you decide to add on in the next 3 to 4 years. Once you have made the decision to purchase, the transition to automated management begins. It will be necessary to train you and your staff on how to use the system. Depending on the system chosen, it may be necessary to adjust your management strategies in a number of areas to take advantage of the system's features. This may cause a few adjustment problems at first, but things will work out with a little time and effort. In the next few years, advances in technology integration will allow you to seamlessly blend practice management, voice charting, intraoral cameras, CAD/CAM, lasers, EDI, video imaging, etc., into a single potent system for complete clinical and practice management. A dental practice management system is the first step to realizing that future. Shop wisely and invest your time in learning the terminology and techniques of automated information management.

Computers↗

PubMedDate not supplied

Radiology Information Systems: DREAM. patient management.

Until recently Radiology Information Systems (RISs) were considered a set of separate, often heterogeneous applications at the functional, technological and architectural level. In last years, the need for an integrated methodological approach and an engineering vision of the system design has become the most important aspect in the implementation of RISs. Based on this approach, the fundamental organizational, operational and clinical objectives of an advanced RIS together with the major critical factors of success, are presented. Such objectives and requirements have constituted the starting basis for the implementation of the DREAM (Distributed radiological environment advanced and multimedia) system, the result of the collaboration of the "Università Cattolica del S. Cuore, Policlinico A. Gemelli" of Rome and "GESI-Gestione Sistemi per l'Informatica". An overview of the main functional characteristics, the most qualifying aspects of the system and the methodological approach followed in its implementation, are reported.

Radiology Information Systems↗

PubMed2026

Management of Soft Tissue and Visceral Leiomyosarcomas.

IMPORTANCE: Leiomyosarcoma is a rare and heterogeneous malignant mesenchymal neoplasm associated with substantial morbidity and mortality. Given recent advances in biologic understanding and the complexity of leiomyosarcoma, a consensus-driven approach is needed to harmonize management and address remaining clinical and research gaps. OBJECTIVE: To provide an evidence-based synthesis of current diagnostic and therapeutic approaches for leiomyosarcoma by an international panel of physicians, researchers, and patient advocates, focusing on site-specific management, systemic therapy strategies, and key areas of clinical uncertainty, while identifying unmet needs and research priorities. EVIDENCE REVIEW: This review is based on a comprehensive evaluation of the literature, including clinical trials, observational studies, and international consensus guidelines. Sources were identified through MEDLINE (via PubMed) and Embase database searches and reference screening, then supplemented by multidisciplinary expert consensus. Emphasis was placed on studies informing diagnosis, surgical management, radiotherapy, and systemic therapy in leiomyosarcoma. FINDINGS: The rarity and heterogeneity of leiomyosarcoma poses substantial challenges in its management. In localized disease, complete surgical resection remains the cornerstone of treatment, with evidence supporting the use of site-specific perioperative treatment strategies. Prospective data supporting neoadjuvant or adjuvant chemotherapy are lacking, and the role of radiotherapy differs across anatomic disease sites and institutions. In advanced disease, multiple systemic therapies demonstrate activity, including anthracycline-based and gemcitabine-based combinations, trabectedin, and tyrosine kinase inhibitors, although optimal sequencing after first-line therapy remains undefined. Emerging data suggest potential benefit from treatment continuation strategies and selected use of local therapies in oligometastatic settings. Molecular heterogeneity is increasingly recognized but has not yet translated into routine clinical implementation, and integration of molecular profiling into diagnostic pathways for predictive and therapeutic insights remains an unmet need. CONCLUSIONS AND RELEVANCE: This international consensus addresses the diagnosis and management of leiomyosarcoma. Management requires a multidisciplinary, site-specific approach informed by limited but evolving evidence. Key uncertainties persist, particularly regarding perioperative therapy, optimal sequencing and combination of systemic treatments, and integration of molecular data. Continued international collaboration and leiomyosarcoma-specific clinical trials are needed to refine treatment strategies and improve patient outcomes.

Journal Article↗

PubMed2004

Communication of medical product risk: how effective is effective enough?

Ever-increasing attention is being paid worldwide to the safety of medical products, and the risks associated with their use. The integral role of risk communication in overall risk management is demonstrated by several recent market withdrawals of drugs, in which a perceived incapability of healthcare systems to manage well-characterised, avoidable risks was a significant factor. With advances in clinical pharmacology, pharmacogenomics and pharmacoepidemiology expanding our knowledge of medical products, effective delivery of the latest safety-related information to health professionals and consumers becomes even more imperative. In this regard, it is important to evaluate whether current modes of risk communication lead to desired changes in relevant behaviours such as prescribing or drug monitoring, particularly in context with which achieved level of effectiveness is deemed acceptable. This is crucial, as there have been product-specific risk communication efforts that achieved a fair degree of success, yet were not seen as effective enough to prevent market withdrawal of the medical product in question. In the service of improving public health through enhanced risk communication, it is essential to critically assess current methods, both as to results achieved (or not), and whether each method is applicable to the various types of risks associated with medical product use. Furthermore, just as combining methods may well improve overall risk communication, there are societal and psychological factors that must be considered in attempting to maximise effectiveness. However, in assessing risk communication effectiveness, the particular benefit- risk relationship of any individual medical product must also be part of the evaluative process.

Communication↗

PubMedDate not supplied

The National Alzheimer's Coordinating Center (NACC) Database: an Alzheimer disease database.

The National Alzheimer's Coordinating Center (NACC) is responsible for developing and maintaining a database of patient information collected from the 29 Alzheimer disease centers (ADCs) funded by the National Institute on Aging. Each of the centers collects center-determined data elements on patients enrolled into its center and transmits a minimum dataset to NACC. Data are managed differently at each center depending on that center's research needs. The centers' data systems vary from a single personal computer running spreadsheet software to a network of servers running an advanced data management system such as Oracle. The challenge for NACC is to expand and adjust previously collected data elements into an integrated database that could be used for administrative as well as research purposes. In addition, NACC sought to allow the centers to have the flexibility they needed for data submission. To accomplish this task, NACC designed a database that contained separate specific datasets each with individual data elements. NACC also designed a data management system to easily collect and manage these data. The NACC web site (www.alz.washington.edu) was created to allow access to the data.

Alzheimer Disease↗

PubMed1991

SISCOPE: a multiuser information system for gastrointestinal endoscopy.

SISCOPE is an integrated data management system for use in gastrointestinal endoscopy units which operates in the multiuser mode on UNIX minicomputers or MS-DOS personal computers and can be used for patient bookings, endoscopic data entry and retrieval, and automatic report generation in upper gastrointestinal endoscopy, proctologic examinations, colonoscopy and peritoneoscopy. The description of endoscopic findings is remarkably detailed and data entry very rapid due to an advanced design of input screens that incorporates several recent concepts, including windows, menu bars and pull-down menus; typing is eliminated as data is entered with a mouse by pointing at options within menus. Endoscopic findings can be described under eight headings: morphology, topography, qualifiers, modifiers, signs of bleeding, endoscopic diagnosis, pathological diagnosis and etiology. Terminology is based strictly 3on the OMED system. SISCOPE also allows recording of details on endoscopic procedures, indications for the examination, preparation, premedication, complications and late entry of pathology reports. After entering all data, a report in natural language is produced automatically, the entire process taking one minute on average. Data retrieval programs give on-line access to previous examinations of a given patient and automatically generate activity reports. A formal language allows direct queries to the database and transfer of data for statistical analysis or other data processing. The system is simple to learn and use because operation is intuitive and all endoscopic techniques share the same basic menu structure and screen design.

Computer Systems↗

PubMed2001

From data to evidence: evaluative methods in evidence-based medicine.

The amount of published information is increasing exponentially, and recent technologic advances have created systems whereby mass distribution of this information can occur at an infinite rate. This is particularly true in the broad field of medicine, as the absolute volume of data available to the practicing clinician is creating new challenges in the management of relevant information flow. Evidence-based medicine (EBM) is an information management and learning strategy that seeks to integrate clinical expertise with the best evidence available in order to make effective clinical decisions that will ultimately improve patient care. The systematic approach underlying EBM encourages the clinician to formulate specific and relevant questions, which are answered in an iterative manner through accessing the best available published evidence. The arguments against EBM stem from the idea that there are inherent weaknesses in research methodologies and that emphasis placed on published research may ignore clinical skills and individual patient needs. Despite these arguments, EBM is gaining momentum and is consistently used as a method of learning and improving health care delivery. However, if EBM is to be effective, the clinician needs to have a critical understanding of research methodology in order to judge the value and level of a particular data source. Without critical analysis of research methodology, there is an inherent risk of drawing incorrect conclusions that may affect clinical decision-making. Currently, there is a trend toward using secondary pre-appraised data rather than primary sources as best evidence. We review the qualitative and quantitative methodology commonly used in EBM and argue that it is necessary for the clinician to preferentially use primary rather than secondary sources in making clinically relevant decisions.

Evidence-Based Medicine↗

PubMed2006

A new way for multidimensional medical data management: volume of interest (VOI)-based retrieval of medical images with visual and functional features.

The advances in digital medical imaging and storage in integrated databases are resulting in growing demands for efficient image retrieval and management. Content-based image retrieval (CBIR) refers to the retrieval of images from a database, using the visual features derived from the information in the image, and has become an attractive approach to managing large medical image archives. In conventional CBIR systems for medical images, images are often segmented into regions which are used to derive two-dimensional visual features for region-based queries. Although such approach has the advantage of including only relevant regions in the formulation of a query, medical images that are inherently multidimensional can potentially benefit from the multidimensional feature extraction which could open up new opportunities in visual feature extraction and retrieval. In this study, we present a volume of interest (VOI) based content-based retrieval of four-dimensional (three spatial and one temporal) dynamic PET images. By segmenting the images into VOIs consisting of functionally similar voxels (e.g., a tumor structure), multidimensional visual and functional features were extracted and used as region-based query features. A prototype VOI-based functional image retrieval system (VOI-FIRS) has been designed to demonstrate the proposed multidimensional feature extraction and retrieval. Experimental results show that the proposed system allows for the retrieval of related images that constitute similar visual and functional VOI features, and can find potential applications in medical data management, such as to aid in education, diagnosis, and statistical analysis.

Algorithms↗

PubMed1997

Transition to capitation. Aligning incentives for success.

Horror stories abound about providers that have failed to modify their incentive systems and have exhausted their annual capitation budget in the first six months of the plan year. Aligning the business strategy and financial incentives in advance is the best way to ensure that your integrated delivery system's transition to capitation is a success story. Rarely are physicians or hospitals with experience limited to the fee-for-service arena prepared to jump into a managed care or capitated compensation system. The transition can be eased by implementing a "shadow" capitation or similar arrangement that will test physician performance under a risk arrangement in advance. The information can be used to restructure the compensation system to ensure that the behaviors being encouraged will promote successful care and fiscal management.

Capitation Fee↗

PubMed2001

The telematic network of referee hospital "V. Monaldi" in Naples: state of the art and perspectives.

The new advances in I.T. both in Hardware (wideband network) and in Software are rapidly changing the Health Information Systems scenario. In many hospitals of Campania Region this leads in many case to rebuild, starting from zero, both infrastructure and applications. Ericsson Enterprise has recently developed for the A.O. Monaldi and Integrated information System which consists of an advanced LAN (Local Area Network), a number of software infrastructures and some application systems as WEB site, Dicom PACS, E-mail server, Streaming Video from Operating Theatres, Internal TV Network. This integrated system represents the starting point for modern health information systems, which is compliant with new standards. The start-up of such systems represents always a problem for the organization and management point of view, therefore a number of problems concerning: training, education, security, privacy, operative procedures, co-ordination with existing applications, system management at the start-up and after. This paper deals with the technical aspects of this information system and discusses the problem met in introducing these IT products in a big and important hospital of Campania Region in Italy, in order to suggest a model, useful for other similar experiences.

Computer Systems↗

PubMed2000

The strategic use of outcome information.

BACKGROUND: Most health care executives see outcome measurement as a technical or tactical matter rather than as a strategic tool. Accordingly, provider investment in outcome measurement and management is relatively small. Nevertheless, outcome information can be key to achieving an organization's strategic objectives. Advances in risk adjustment and improvements in technology for data collection and analysis have made outcome measurement a practical tool for individual hospital use. CASE STUDIES: Strategically integrated outcome measurement efforts can give providers a competitive advantage over organizations that only use outcomes tactically. One of the best examples of an acute care provider that has used outcome information for strategic advantage is Intermountain Health Care (IHC; Salt Lake City). In 1997 IHC made clinical quality and outcomes the primary focus of its five-year strategic plan. To support the new strategy IHC's board of trustees approved the development of an outcome information system that generated data along clinical processes of care and the creation of a new management structure to use these data to hold professionals accountable and to set and achieve clinical improvement goals. From 1996 to 1999, IHC's share of the commercial health care market in Utah increased from roughly 50% to about 62% of the market, with the result that it has stopped actively marketing its services. DISCUSSION: Health care executives will not willingly invest in outcomes until they believe that they have business value. Therefore, making the business case for outcomes can help improve the quality of health care and the lives of individuals.

APACHE↗

PubMed1997

Comparing middleware concepts for advanced healthcare system architectures.

Different approaches to middleware, supporting systems integration in healthcare, are described and evaluated, regarding concepts, architectural framework, and relevance for healthcare enterprises. This evaluation includes CORBA, DHE, and HL7. CORBA, promoted in the healthcare area through the efforts of CORBAmed, is a strictly object-oriented approach, whereas DHE is based on process-related concepts. The earlier HL7 approach, without any modelling and with proprietary communication management, is changing to a harmonised information interchange concept in healthcare, taking into account also other protocols and medical domains with orientation to an electronic patient record. The opening also includes the separation of message definition and message exchange format, enabling the migration of different EDI standards. HL7 will also support the integration of standardised platforms as 'networking mediator applications'. Finally, some recommendations for future developments are given.

Computer Communication Networks↗

PubMed2003

The impact of the Internet on pediatric medicine.

The Internet has affected pediatricians and the families they serve in many ways by empowering users to manage information, and to communicate faster and more effectively. The Internet allows practitioners to store, retrieve, and manipulate patient-specific and general medical information within increasingly sophisticated integrated systems, allowing 'just-in-time' information at the point of care. Related technologies allow asynchronous, real-time, and mobile communication with colleagues, patients, and health organizations. These same technologies have empowered patients to seek health information independently from online libraries, support groups, and second opinions not previously available, creating knowledgeable and value-conscious healthcare consumers, thus evolving the nature of the physician-patient relationship. Because of these technology advances and their present and future effects on practice and patients, it is increasingly important for the general pediatrician to be aware of the potentials, practicalities, and pitfalls of the Internet with regard to general pediatrics.

Access to Information↗

PubMed1997

New tools for laboratory design and management.

The clinical laboratory is changing from a place of activity based on sample analysis to an in vitro diagnostic network. To convince our team, partners, and administrators, we need new comprehensive tools to define a strategy with limited risk of failure or conflicts. Specific quality goals should be established before choosing automated tools for sample handling, analytical systems, laboratory information systems, communication systems, or advanced technologies. A system approach maps and simplifies the process, based more on a functional study than on classical disciplines. A customer-supplier approach establishes the requirements between partners either inside or outside the laboratory. The quality system must be a management tool, linking samples, tasks, information, and documents. Quantitative simulation modeling explores different automation alternatives and their impact on laboratory workflow. Finally, integration of results in interactive semirealistic simulation tools for laboratory design or reengineering can be used as communications tools to involve laboratory professionals in the change of their practice.

Chemistry, Clinical↗

PubMed2003

Design, methods, and evaluation directions of a multi-access service for the management of diabetes mellitus patients.

Recent advances in information and communication technology allow the design and testing of new models of diabetes management, which are able to provide assistance to patients regardless of their distance from the health care providers. The M2DM project, funded by the European Commission, has the specific aim to investigate the potential of novel telemedicine services in diabetes management. A multi-access system based on the integration of Web access, telephone access through interactive voice response systems, and the use of palmtops and smart modems for data downloading has been implemented. The system is based on a technological platform that allows a tight integration between the access modalities through a middle layer called the multi-access organizer. Particular attention has been devoted to the design of the evaluation scheme for the system: A randomized controlled study has been defined, with clinical, organizational, economic, usability, and users' satisfaction outcomes. The evaluation of the system started in January 2002. The system is currently used by 67 patients and seven health care providers in five medical centers across Europe. After 6 months of usage of the system no major technical problems have been encountered, and the majority of patients are using the Web and data downloading modalities with a satisfactory frequency. From a clinical viewpoint, the hemoglobin A1c (HbA1c) of both active patients and controls decreased, and the variance of HbA1c in active patients is significantly lower than the control ones. The M2DM system allows for the implementation of an easy-to-use, user-tailored telemedicine system for diabetes management. The first clinical results are encouraging and seem to substantiate the hypothesis of its clinical effectiveness.

Diabetes Mellitus↗

PubMed1999

Choosing the right computer system.

We are living in a world where virtually any information you desire can be acquired in a matter of moments with the click of a mouse. The computer is a ubiquitous fixture in elementary schools, universities, small companies, large companies, and homes. Many dental offices have incorporated computers as an integral part of their management systems. However, the role of the computer is expanding in the dental office as new hardware and software advancements emerge. The growing popularity of digital radiography and photography is making the possibility of a completely digital patient record more desirable. The trend for expanding the role of dental office computer systems is reflected in the increased number of companies that offer computer packages. The purchase of one of these new systems represents a significant commitment on the part of the dentist and staff. Not only do the systems have a substantial price tag, but they require a great deal of time and effort to become fully integrated into the daily office routine. To help the reader gain some clarity on the blur of new hardware and software available, I have enlisted the help of three recognized authorities on the subject of office organization and computer systems. This article is not intended to provide a ranking of features and shortcomings of specific products that are available, but rather to present a process by which the reader might be able to make better choices when selecting or upgrading a computer system.

Appointments and Schedules↗

PubMed2002

Comparing concepts for electronic health record architectures.

Keeping all relevant information directly or indirectly related to patient's care, electronic health records (EHR) systems are supposed to be kernel application for any kind of health information systems. For facilitating shared care, managed care, or disease management, such EHR systems have to be scalable, portable, distributed, and interoperable which has to be enabled by a proper architecture supporting informational and functional needs as well. Advanced EHR architectures are based on object-oriented or component-oriented paradigms and use modern tooling to design, specify, implement and maintain EHR solutions. They reflect not only medical information but also underlying concepts and integrate an extended vocabulary. The most advanced EHR architecture approaches CEN ENV 13606, G-CPR, HL7 RIM and derived models, and finally the Australian GEHR project are shortly characterised. For comparing the solutions, the ISO RM - ODP, the Generic Component Model and the CORBA 3 methodology have been used. The HARP methodology for enhancing the current harmonisation of openEHR is shortly discussed.

Computer Systems↗

PubMed1980

Computer-generated fiscal reports for food cost accounting.

To optimize resource utilization for the provision of health-care services, well designed food cost accounting systems should facilitate effective decision-making. Fiscal reports reflecting the financial status of an organization at a given time must be current and representative so that managers have adequate data for planning and controlling. The computer-assisted food cost accounting discussed in this article can be integrated with other sub-systems and operations management techniques to provide the information needed to make decisions regarding revenues and expenses. Management information systems must be routinely evaluated and updated to meet the current needs of administrators. Further improvements in the food cost accounting system will be desirable whenever substantial changes occur within the foodservice operation at the University of Missouri-Columbia Medical Center or when advancements in computer technology provide more efficient methods for manipulating data and generating reports. Development of new systems and better applications of present systems could contribute significantly to the efficiency of operations in both health care and commercial foodservices. The computer-assisted food cost accounting system reported here might serve s a prototype for other management cost information systems.

Accounting↗