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PubMed1993

[Analysis of parameters used for the evaluation of the Relative Complexity Index beta].

The Relative Complexity Index beta (RCI beta) has been devised as an indicator of the relative complexity and cost of anaesthesia. It takes into account the type of anaesthesia, the duration, the type of surgery and the patients' ASA status. This study analyses the relative weight of each component of RCI by a multiple regression analysis. The results show the pre-eminence of the surgical procedure in the formula. The weight of surgical procedure is responsible of 80 p. cent of the model's variance. In these conditions, the RCI beta cannot be accepted as an accurate complexity index of anaesthesia.

Anesthesia, General↗
PubMed1993

[Is the Relative Complexity Index beta an accurate indicator of the cost of anesthesia?].

In order to assess the medical activity and the related costs, the French Ministry of Health has designed a relative value scale for medical procedures, the Relative Complexity Index (RCI). The RCI for anaesthesiology, called BETA, is the result of the combination of four subindexes: T for the type of anaesthesia, D for the duration, C for the related surgical procedure, and EG for the patient's status according to the ASA scale. The goal of this study has been to test whether the BETA index was actually an acceptable indicator of the direct cost of an anaesthetic. We have determined the cost of 248 procedures in a teaching hospital and achieved a statistical analysis of the relationship between costs, RCI and the various subindexes. The mean cost of an anaesthetic was 1,205 FF (SD = 1,325), 61.4% of which being for salaries. The cost of a general anaesthetic was 2.5 times higher than the cost of a local/regional anaesthesia procedure. Mean cost was around 700 FF for ENT, urology, gynaecology and obstetrics, 1,200 FF for orthopaedia and visceral surgery, and 5,130 FF for cardiac surgery (not including the equipment for extracorporeal circulation). A strong positive relation was found between the BETA and cost (r = 0.90, p < 10(-4)). The best predictive model of cost was log-linear, using only the duration, the type of anaesthetic and the related surgical procedure. The patient's status was not a significant factor, nevertheless in our sample, ASA 4 patients had a significantly higher cost than others (p = 0.0004, Mann & Whitney test).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

The development of MML (Medical Markup Language) version 3.0 as a medical document exchange format for HL7 messages.

Medical Markup Language (MML), as a set of standards, has been developed over the last 8 years to allow the exchange of medical data between different medical information providers. MML Version 2.21 used XML as a metalanguage and was announced in 1999. In 2001, MML was updated to Version 2.3, which contained 12 modules. The latest version--Version 3.0--is based on the HL7 Clinical Document Architecture (CDA). During the development of this new version, the structure of MML Version 2.3 was analyzed, subdivided into several categories, and redefined so the information defined in MML could be described in HL7 CDA Level One. As a result of this development, it has become possible to exchange MML Version 3.0 medical documents via HL7 messages.

Medical Informatics Applications↗
PubMed2004

Creation of a master table for checking indication and contraindication of medicine from a knowledge base linked with a thesaurus.

To develop a system for checking indication and contraindication of medicines in prescription order entry system, a master table consisting of the disease names corresponding to the medicines adopted in a hospital is needed. The creation of this table requires a considerable manpower. We developed a Web-based system for constructing a medicine/disease thesaurus and a knowledge base. By authority management of users, this system enables many specialists to create the thesaurus collaboratively without confusion. It supports the creation of a knowledge base using concept names by referring to the thesaurus, which is automatically converted to the check master table. When a disease name or medicine name was added to the thesaurus, the check table was automatically updated. We constructed a thesaurus and a knowledge base in the field of circulatory system disease. The knowledge base linked with the thesaurus proved to be efficient for making the check master table for indication/contraindication of medicines.

Artificial Intelligence↗
PubMedDate not supplied

[The internet presentation of medical departments: an example of a pediatric surgical department].

INTRODUCTION: In times of easy world wide information transfer and reduced economic resources of the community, the presentation of medical departments in the internet becomes more and more important. But realisation is often insufficient. METHOD: The welcome page is the most important element. It should be appealing and easy to understand. Menues should lead to further information like "employees", "premises", "approach" and "medical information". Quick loading times are neccesary to make surfing more comfortable. DISCUSSION: The internet presentation becomes more and more essential in our days. Legal restrictions, although being reduced in the last years, have to be observed.

Child↗
PubMedDate not supplied

[Diagnosis--therapy and documentation].

The procedures of documentation of diagnostic findings are well established--but different in their graphical and structural appearance of patients histories. Out of multiple findings a retrieval with valid informations is very clumsy. In order to increase quality a complete and reliable registration of clinical data base is necessary. For this purpose the use of electronic media is profitable if the requirements of the data-base are well defined. A nationwide agreement on one key-system--including the transformation of textual structures--is proposed. Only this way leads to comparable results in therapeutic procedures.

Data Collection↗
PubMed2005

Hospital rules-based system: the next generation of medical informatics for patient safety.

PURPOSE: The hospital rules-based system (HRBS) and its subsystems at a major medical center are described. SUMMARY: The HRBS was implemented at the Mayo Clinic to rapidly identify and communicate crucial information to the clinician in order to optimize patient care. The system also enhances workload efficiency and improves documentation and communication. The system is used by the infectious-diseases division, pharmacy services, nutritional support services, infection control, and the nursing department. The six HRBS subsystems are Web-based programs that share a common structural design and integrate computerized information from multiple institutional databases. The integrated data are presented in a user-friendly format that improves the efficiency of data retrieval. Information, such as monitoring notes and intervention information, can be entered for specific patients. The subsystems use rules designed to detect suboptimal therapy or monitoring and identify opportunities for cost savings in a timely manner. CONCLUSION: The HRBS enhances the identification of drug-related problems while optimizing patient care and improving communication and efficiency at a major medical center.

Hospital Information Systems↗
PubMed1999

Discordance between physicians and coders in assignment of diagnoses.

OBJECTIVE: To measure concordance between physicians and medical record coders in their assignment of diagnoses. DESIGN: Prospective cohort series. SETTING: Five hundred and fifty-bed, tertiary-care, university teaching hospital. Study participants. In-patients who were discharged from either the Cardiac Sciences Program (n=125), the Renal Program (n=43), or the HIV-AIDS Program (n=25) during the period May 18-July 1, 1995. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Physicians and coders assigned diagnoses for individual in-patients based on their independent interpretations of the patient chart and discharge summary sheet. All assigned diagnoses were coded using the ICD-9-CM classification system. Concordance was measured for the most responsible diagnosis and for all assigned diagnoses. Difference in calculated resource intensity weights based on physicians' and coders' assignment of diagnoses was also calculated. RESULTS: Concordance rates for the most responsible diagnosis in each program were: Cardiac Sciences [27%; 95% confidence interval (CI)=20-36%], Renal Program (35%; 95% CI=21-53%), and HIV-AIDS Program (20%; 95% CI, 6-41%). Concordance rates for all diagnoses per chart were similar: Cardiac Sciences (20%; 95% CI, 14-25%), Renal Program (25%; 95% CI, 20-33%), and HIV-AIDS Program (29%; 95% CI, 25-44%). Resource intensity weights assigned by coders for the Cardiac Sciences and HIV-AIDS Program were significantly higher than those assigned by the physicians.

Abstracting and Indexing↗
PubMed1988

PRUFILE: a clinical and laboratory database for the genetics centre.

The growing complexity and volume of workload in a Clinical Genetics Centre can rapidly swamp the available clerical facilities. The multiuser database described gives facilities not only for administrative control and documentation but also for the production of data for clinical and scientific analysis. The close link between clinical and laboratory databases gives great versatility and easy expansion as new tests and disciplines are applied to clinical genetic problems.

Clinical Laboratory Information Systems↗
PubMed2005

Information governance standards for managing e-health information.

Integrity of patient information, from both a quality and a security perspective, is critical to patient care. In the UK, the information governance initiative of the National Health Service (NHS) provides a framework to monitor and control the management of confidential patient data. Information governance standards grew out of the Data Accreditation Programme, first proposed in the 1998 NHS document Information for Health. The Data Accreditation Programme was based on a three-stage assessment of data quality in acute hospitals. Stage one required internal review of policy and procedures for data input into computerized patient administration systems. Stage two involved an external audit to verify compliance with the standards. Stage three mandated audits of data outputs, focusing on clinical coding quality. Before stage three of the programme was fully implemented, the standards were incorporated into the information governance initiative, in which standards were expanded to include primary care and other health-care settings. These standards address many information management issues, including security and data quality, which are key concerns in telemedicine and e-health applications. Compliance is essential for the successful implementation of the NHS Care Records Service, which will allow sharing of electronically stored patient information across the UK.

Confidentiality↗
PubMed2005

The implementation of electronic services: planned or organic growth?

The literature on innovation suggests that projects are successful when rigorous project management is mixed judiciously with 'organic' development. This paper argues that organic growth can play a substantial role in the implementation of electronic services in healthcare settings. Evidence for organic growth is presented, based on a study of email use. Methods are presented for investigating email use in health service settings in the National Health Service (NHS) in Bradford, England. Geographical information systems (GIS) outputs and social network analyses are presented. The results demonstrate a fivefold increase in the use of email over a 13-month period, which is shown to be largely independent of the growth in the number of organisations using the network. They also demonstrate a marked increase in the complexity of the patterns of email use over the period.

Data Collection↗
PubMed1997

Primary care informatics: Bhorugram, India: revisited.

A Primary Health Care Informatics project was initiated in 1990 at Bhorugram, Rajasthan, India. It was reported in MIE91 with initial, encouraging results. The evaluation of the information system has been successful in all operational terms, and the Fully Immunised Child (FIC) could be used as a local cardinal index to monitor and evaluate the quality of care, cost-effectiveness and community participation. Health Systems and Health Economy Research alike have long searched for apt quality and performance markers that in themselves could embrace and express a number of aspects and factors. The FIC index is shown to well meet the criteria of such a cardinal measure in the MCHC services. We, also, demonstrate an implementation strategy for establishing Information Systems in Primary Health Care Centres in Developing countries.

Child↗
PubMedDate not supplied

Transforming the cancer center in the 21st century.

Academic cancer centers will be hit, simultaneously, by all three of the technology tidal waves outlined above within the next five years. In preparing for this impact one should note the central role that Internet technologies will play in providing solutions in all three areas. In addition, as the volume and size of data objects increases dramatically, having an adequate networking infrastructure in place will be crucial. So what do we do now to prepare for the future? The following five steps are suggested: (1) Establish an oncology informatics group within the cancer center to provide the necessary expertise and begin the planning process. (2) Begin implementing a secure intranet based on standard Internet technologies. (3) Work with the host medical center and external agencies to determine who will pay for and implement a high-bandwidth networking infrastructure. (4) Recruit a bioinformatician who can help implement technologies to take advantage of the genomics data wave when it hits. (5) Ensure that the cancer center's EMR system can support cancer protocol data and facilitate the retrieval and delivery of the complex digital imaging data that are in our future.

Cancer Care Facilities↗