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PubMed2002

The diffusion of innovation: factors influencing the uptake of telehealth.

The actual use of telehealth, particularly for clinical consultations, has in many cases been less than anticipated. The literature identifies a number of factors or barriers. These include legal issues, technical difficulties, time and convenience, cost and training/familiarity with the equipment. No single factor has been identified as being consistently present. Rogers' diffusion of innovation theory suggests that organizational structures and cultures will affect health professionals' perceptions of telehealth. The introduction of telehealth services affects existing work practices and workflows. We believe that it is necessary to develop strategies for the introduction of telehealth applications which take into account the idiosyncrasies of the health service sector, and the particular structures and cultures of individual organizations within that sector.

Diffusion of Innovation↗

PubMed2004

Making the business case for hospital information systems--a Kaiser Permanente investment decision.

Further evidence in favor of the clinical IT business case is set forth in Kaiser Permanente's cost/benefit analysis for an electronic hospital information system. This article reviews the business case for an inpatient electronic medical record system, including 36 categories of quantifiable benefits that contribute to a positive cumulative net cash flow within an 8.5 year period. However, the business case hinges on several contingent success factors: leadership commitment, timely implementation, partnership with labor, coding compliance, and workflow redesign. The issues and constraints that impact the potential transferability of this business case across delivery systems raise questions that merit further attention.

Capital Expenditures↗

PubMed2003

[Anaesthesia tomorrow. Looking to the future].

As in past and present times anaesthesiology will remain the central and original part in the spectrum of anaesthesiology, emergency, pain and intensive-care medicine also in the future. Nevertheless, profound changes will take place within the next few years promoting the anaesthesiologist to the manager of the perioperative workflow. Soft and hard skills like qualification in organisation, team-leading, costing and overall quality management will be mandatory. On the other hand, medical and scientific visions should also remain in scope. Improvements in selectivity of pharmacology and monitoring in anaesthesiology and reduction of perioperative morbidity should also be actively promoted. To provide independence from commercial goals of industrial companies and to enable developments from basic research up to evidence-based clinical applications, concentration of knowledge and financial resources in centres of excellence will be imperative.

Analgesics↗

PubMed2002

Creating a culture of medication administration safety: laying the foundation for computerized provider order entry.

BACKGROUND: Computerized provider order entry (CPOE) systems are recognized as an effective tool for reducing preventable adverse drug events; however, implementation is a complex process that involves much more than installing new software. The literature addresses the use of these systems in large tertiary care hospitals and university settings; yet there is little information on their implementation and use in smaller hospitals. Beaver Dam Community Hospital, a small, rural hospital, set about laying the foundation for implementing CPOE. Actions were taken in terms of context (the culture and attitude, acceptance, and importance regarding the change), process (roles, workflow, and policies relating to the change), and content (how-to, such as procedural steps and rules). USE OF THE RAPID-CYCLE IMPROVEMENT PROCESS: The team elected to use the rapid-cycle improvement process for implementation to allow it to move ahead quickly, adjusting changes as necessary for maximum success. Each change was considered an individual Plan-Do-Check-Act cycle, with its own action plan and measurement for successful implementation. PLANNING ACTUAL IMPLEMENTATION: The Patient Safety Committee has begun the planning of actual implementation--Phase II. Issues addressed include how to phase in the system--in which units to bring up first, how to structure the transitional period, how to redesign workflow, and how to plan role changes. SUMMARY: The changes already implemented contribute to medication safety and are important from that perspective alone, without the use of CPOE. The addition of an electronic system will enhance the organization's ability to provide safe, accurate medication administration.

Clinical Pharmacy Information Systems↗

PubMed2003

Actual aspects of image-guided surgery.

Use of surgical navigation systems is becoming an increasingly important part of both planning and performing intracranial and spinal surgery. Numerous clinical reports have described neuronavigation as a useful adjunct to surgery that allows neurosurgery to be less invasive and more effective. Although the method of image-guided surgery was introduced more than a decade ago, new technologies have changed and refined the procedure substantially. This chapter summarizes the recent developments of advanced image-guided surgery. For most operations, microscope navigation has replaced pointer navigation. Using the microscope as the localizing device, the workflow is not interrupted and microsurgical procedure can be continued as usual. New chip technology allows integration of magnetic resonance images, angiography findings, endoscopic view, or other pictures in the eyepiece of the microscope. A new method of patient registration is laser scanning and surface matching. When using high-quality images, this new method can be used without additionally acquired images, may reduce costs, simplify the pre-registration procedure, and increase application accuracy compared to skin-fiducial registration. Moreover, integration of other imaging modalities is becoming an increasingly used feature and provides useful information during surgery.

Brain Mapping↗

PubMedDate not supplied

A task-targeted automation system: a case study.

Kaiser Permanente's Northern California Regional Laboratory recently achieved an important milestone in its continuous quality improvement project by automating time-consuming and labor-intensive tasks involved in preanalytical and postanalytical sample processing. The new task-targeted automation system, the most sophisticated of its kind in the world, consists of three key components: the Roche Diagnostics PSD 1 primary sample decapper/sorter/archiver, the Roche Diagnostics VS 250 aliquoter, and a data manager/process controller developed by Data Innovations. The system was placed into service in April 1998, culminating more than a year of planning and implementation. Within months after the system went into operation, the laboratory observed significant improvements in workflow and efficiency, as well as a reduction in work-related injuries. The purpose of this article is to provide management teams in other laboratories with a description of the planning and implementation process and offer suggestions for those contemplating a similar program.

Automation↗

PubMed2004

[Automatic milking systems--quality assurance of milk for drinking].

German consumers trust the safety and the quality of milk and milk products. Compared with other animal products, e. g. meat and meat products, their confidence is justified in so far as milk and milk products cause only few foodborne diseases in Germany, although 80 percent of all German cows develop at least one case of mastitis per lactation. Due to financial reasons, more and more German dairy farmers are forced to initiate a time-saving rationalization of their workflow. Therefore, automatic milking systems (AMS) are used increasingly, even though the costs of purchase result in a slow pick-up in sales. Moreover, AMS do not comply with legal requirements. Thus, an additional regular, the so called "catalogue of measures", had to be enacted to ensure the hygienic harmlessness of milk produced by AMS. This is the first time, that udder health at individual cow level was related to milk quality beyond merely clinical signs. Together with technical innovations for an improved health monitoring at cow and herd level as well as the implementation of quality assurance programs based on prevention, this improvement offers good prospects to produce not only a hygienically harmless, but also a physiologically composed milk and therefore a qualitatively high-grade milk from healthy cows. Being the vehicle of the most recent improvements in technology, AMS do have the potential to make a crucial contribution to this development.

Animal Husbandry↗

PubMed1999

The strategic and operational characteristics of a distributed phased archive for a multivendor incremental implementation of picture archiving and communications systems.

The long-term (10 years) multimodality distributed phased archive for the Medical Information, Communication and Archive System (MICAS) is being implemented in three phases. The selection process took approximately 10 months. Based on the mandatory archive attributes and desirable features, Cemax-Icon (Fremont, CA) was selected as the vendor. The archive provides for an open-solution allowing incorporation of leading edge, "best of breed" hardware and software and provides maximum flexibility and automation of workflow both within and outside of radiology. The solution selected is media-independent, provides expandable storage capacity, and will provide redundancy and fault tolerance in phase II at minimum cost. Other attributes of the archive include scalable archive strategy, virtual image database with global query, and an object-oriented database. The archive is seamlessly integrated with the radiology information system (RIS) and provides automated fetching and routing, automated study reconciliation using modality worklist manager, clinical reports available at any Digital Imaging and Communications in Medicine (DICOM) workstation, and studies available for interpretation whether validated or not. Within 24 hours after a new study is acquired, four copies will reside within different components of the archive including a copy that can be stored off-site. Phase II of the archive will be installed during 1999 and will include a second Cemax-Icon archive and database using archive manager (AM) Version 4.0 in a second computer room.

Computer Communication Networks↗

PubMed2005

Internet-based radiology order-entry, reporting, and workflow management system for coordinating urgent study requests during off-hours.

OBJECTIVE: Our aim was to develop a simple, low-cost, Internet-based application for radiology order-entry, reporting, and workflow management during off-hours. CONCLUSION: The system was quickly accepted by users both within and outside the radiology department, and it required very modest resources to develop, deploy, and support. In a busy on-call setting at a high-volume academic institution, the system described was effective in obtaining more thorough patient histories from referring physicians, reducing the number of telephone calls required, and documenting more rigorously the communication between radiologists and clinical services. These benefits allow the generation of more informative and timely radiology reports.

Emergencies↗

PubMed2003

Experiences with a generator tool for building clinical application modules.

OBJECTIVES: To elaborate main system characteristics and relevant deployment experiences for the health information system (HIS) Orbis/OpenMed, which is in widespread use in Germany, Austria, and Switzerland. METHODS: In a deployment phase of 3 years in a 1.200 bed university hospital, where the system underwent significant improvements, the system's functionality and its software design have been analyzed in detail. We focus on an integrated CASE tool for generating embedded clinical applications and for incremental system evolution. We present a participatory and iterative software engineering process developed for efficient utilization of such a tool. RESULTS: The system's functionality is comparable to other commercial products' functionality; its components are embedded in a vendor-specific application framework, and standard interfaces are being used for connecting subsystems. The integrated generator tool is a remarkable feature; it became a key factor of our project. Tool generated applications are workflow enabled and embedded into the overall data base schema. Rapid prototyping and iterative refinement are supported, so application modules can be adapted to the users' work practice. CONCLUSIONS: We consider tools supporting an iterative and participatory software engineering process highly relevant for health information system architects. The potential of a system to continuously evolve and to be effectively adapted to changing needs may be more important than sophisticated but hard-coded HIS functionality. More work will focus on HIS software design and on software engineering. Methods and tools are needed for quick and robust adaptation of systems to health care processes and changing requirements.

Computer Systems↗

PubMed2004

[Digital knowledge in the coat pocket -- hand-held personal digital assistants in radiology].

The personal digital assistant (PDA) enables the independent access to large data in a pocket-sized format. The applications for hand-held computers are growing steadily and can support almost any kind of problem. An overview of the available hardware and software is provided and evaluated. Furthermore, the use of the PDA in the clinical daily routine is described. In view of the numerous software programs available in radiology, the range of software solutions for radiologists is presented. Despite the high acquisition cost, the PDA has already become the digital assistant for the radiologist. After a short time of getting used to the PDA, nobody wants to miss it at work or at home. New technical features and available software programs will continuously increase the integration of the PDA into the medical workflow in the near future.

Computers↗

PubMed2004

Overcoming information overload: an information system for the primary care physician.

Primary Care Office InSite (PCOI) is a Web-based intranet application that provides ready access to a collection of information useful in primary care. The PCOI Web site was developed by, and is widely used within, the Massachusetts General Hospital (MGH) and its affiliated community practices. Over 1600 users logged 60,000 separate sessions in the past year. The site contains clinical practice guidelines, patient educational material, drug prescription and cost information and referral information, all designed for use during routine patient care activity. A continuing and dynamic collaboration between the users and developers of the system, just-in-time access and a "one-stop portal" to a variety of resources have resulted in a very high approval rating by the users. This paper discusses the important characteristics of the Web site, specific functions that improve the workflow of the practicing clinician, and limitations of the present implementation.

Ambulatory Care Information Systems↗

PubMed2006

The IMRT information process-mastering the degrees of freedom in external beam therapy.

The techniques and procedures for intensity-modulated radiation therapy (IMRT) are reviewed in the context of the information process central to treatment planning and delivery of IMRT. A presentation is given of the evolution of the information based radiotherapy workflow and dose delivery techniques, as well as the volume and planning concepts for relating the dose information to image based patient representations. The formulation of the dose shaping process as an optimization problem is described. The different steps in the calculation flow for determination of machine parameters for dose delivery are described starting from the formulation of optimization objectives over dose calculation to optimization procedures. Finally, the main elements of the quality assurance procedure necessary for implementing IMRT clinically are reviewed.

Animals↗

PubMed2000

Integrating knowledge based functionality in commercial hospital information systems.

Successful integration of knowledge-based functions in the electronic patient record depends on direct and context-sensitive accessibility and availability to clinicians and must suit their workflow. In this paper we describe an exemplary integration of an existing standalone scoring system for acute abdominal pain into two different commercial hospital information systems using Java/Corba technolgy.

Abdomen, Acute↗

PubMed2026

Cost-Effectiveness of Electronic Patient-Reported Outcome Measure Interventions in Cancer: Systematic Review and Parameter Extraction for Economic Modeling.

BACKGROUND: Complex digital interventions that integrate electronic patient-reported outcome measures (ePROM) into clinical practice in cancer have the potential to improve quality of life, increase survival, and reduce health resource use and costs. Such systems can help patients with cancer self-manage chemotherapy symptoms, reduce clinicians' workloads through automated decision support, and resolve problems earlier. However, more research on the cost-effectiveness of ePROM monitoring is needed. OBJECTIVE: This paper comprises two complementary components: (1) a systematic literature review summarizing and evaluating the quantitative and qualitative evidence related to the cost-effectiveness of ePROM monitoring and (2) a health economic model parameter extraction. We also conducted supplementary targeted searches and scoping to provide context to our findings. METHODS: We searched Ovid (including MEDLINE and Embase), Scopus, and the International Health Technology Assessment Database for original English-language papers published on or before March 2025 using search strings that combined terms related to ePROMs, health economics, and cancer/oncology. We included papers reporting health economic-related outcomes for ePROM interventions designed for adult cancer populations and excluded screening tools and conference abstracts. RESULTS: We included 34 publications from 27 unique studies and identified and analyzed 26 ePROM-integrated interventions within these. Most (23/26) of the included interventions explicitly described some form of alert handling and automated decision support based on remote ePROM monitoring. Of the 34 publications, 5 presented full cost-effectiveness analysis results, of which 3 were highly uncertain and lacked clear differences in costs and health outcomes between ePROMs and standard care; conversely, 2 presented strong evidence of cost-effectiveness due to quality-of-life improvements, reduced hospitalizations, and potentially more autonomy in health-related travel (eg, ePROM-monitored patients can drive or walk to the hospital instead of using taxis or ambulances). A further 5 publications reported partial health economic results (eg, cost-consequence and budget impact), of which 1 detected no difference in strategies; in contrast, 4 reported lower health resource use and costs of ePROMs, mainly due to hospitalization reductions. Overall, 12 of the 27 studies included a qualitative component but mostly focused on user experience and design-related themes; only 2 of these addressed economic-specific themes (eg, changes in workflow and resource use due to ePROM implementation and integration), indicating some potential for time saving due to ePROM monitoring. CONCLUSIONS: Some ePROM-integrated interventions demonstrated cost-effectiveness in cancer care, but the evidence base remains limited. Where evidence does exist, cost-effectiveness appears driven by reduced hospitalization and improved quality of life. Qualitative research within the included studies rarely addressed economic questions. We provide a detailed parameter extraction for use in future economic modeling and recommend research priorities, including quantitative mapping of ePROM symptom data onto health resource use patterns, and qualitative work exploring how ePROM implementation affects clinical workloads and patient-perspective costs.

Humans↗

PubMed2004

Dyslipidemia in patients with angiographically confirmed coronary artery disease--an opportunity for improvement.

BACKGROUND: There are few data about lipid profiles in unselected patients with angiographically confirmed coronary artery disease (CAD). HYPOTHESIS: The study was undertaken to investigate the demographics, clinical characteristics, angiographic findings, and baseline lipid status of 1,000 consecutive unselected patients with angiographically confirmed CAD. METHODS: Between April 2001 and July 2002, we obtained informed consent and prospectively collected clinical characteristics, fasting lipid profiles, and angiographic results from 1,000 sequential patients with CAD confirmed by angiography. RESULTS: In these patients with confirmed CAD, 78% had history of hyperlipidemia. Although 62% were receiving lipid-lowering therapy, only 46% had a low-density lipoprotein target of < 100 mg/dl, and only 20% had achieved all four National Cholesterol Education Program-recommended lipid targets. CONCLUSIONS: Better strategies to ensure optimal lipid levels are required. One such method using computerized workflow is being evaluated in this population.

Aged↗

PubMed2007

Power matters in closing the phenotyping gap.

Much of our understanding of physiology and metabolism is derived from investigating mouse mutants and transgenic mice, and open-access platforms for standardized mouse phenotyping such as the German Mouse Clinic (GMC) are currently viewed as one powerful tool for identifying novel gene-function relationships. Phenotyping or phenotypic screening involves the comparison of wild-type control mice with their mutant or transgenic littermates. In our study, we explored the extent to which standardized phenotyping will succeed in detecting biologically relevant phenotypic differences in mice generated and provided by different collaborators. We analyzed quantitative metabolic data (body mass, energy intake, and energy metabolized) collected at the GMC under the current workflow, and used them for statistical power considerations. Our results demonstrate that there is substantial variability in these parameters among lines of wild-type C57BL/6 (B6) mice from different sources. Given this variable background noise in mice that serve as controls, subtle phenotypes in mutant or transgenic littermates may be overlooked. Furthermore, a phenotype observed in one cohort of a mutant line may not be reproducible (to the same extent) in mice coming from a different environment or supplier. In the light of these constraints, we encourage researchers to incorporate information on intrastrain variability into future study planning, or to perform advanced hierarchical analyses. Both will ultimately improve the detectability of novel phenotypes by phenotypic screening.

Animals↗

PubMed2002

Accelerating drug discovery by integrative implementation of laboratory automation in the work flow.

Acceleration of the drug discovery process in pre-clinical pharmaceutical research is a highly desirable goal and combinatorial chemistry united with automation technology promised to accomplish this task. Through the accumulation of experience with automated devices over time it became evident that only by harmonisation and streamlining of work-flow procedures the efficiency of the overall process can be improved. An open architecture of efficient data management and appropriate utilisation of automated laboratory protocols provides the opportunity to react in a flexible and advisable way. Only an integrative workflow concept promotes the enhancement of the overall performance. However, the foundation of any efforts towards the accelerated synthesis of new and desired compound arrays lies in the development of reliable chemistry protocols amenable to solid- and solution phase chemistry.

Automation↗