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PubMed1999

Building a hospital information system: design considerations based on results from a Europe-wide vendor selection process.

A number of research and development projects in the U.S. and in Europe have shown that novel technologies can open significant perspectives for hospital information systems (HIS). The selection of software products for a HIS, however, is still nontrivial. Generalist vendors promise a broad scope of functionality and integration, while specialist vendors promise elaborated and highly adapted functionality. In 1997, the university hospital Marburg, a 1,250 bed teaching hospital, decided to introduce a new large-scale HIS. The objectives of the project included support of clinical workflows, cost effectiveness and a maximum standard of medical care. In 1997/98 a formal Europe-wide vendor contest was performed. 15 vendors, including several from the U.S., participated. Systems were checked against the hospital's objectives, functionality, and technological criteria. One of the results of both technology and market assessment was the identification of fundamental technological and design aspects strongly influencing functionality and flexibility.

Commerce↗

PubMed1999

New paradigms for medical decision support and education: the Stanford Health Information Network for Education.

The information needs of physicians are complex and ever increasing in a world of rapidly expanding medical knowledge and a practice environment where physicians are required to know and do more with shrinking resources. Current strategies for providing clinical decision support and continuing medical education have failed, in part, because they have not provided timely, easy access to information that is current, integrated with other information and the physician's workflow, and relevant to specific questions that occur during the patient encounter. Meeting these challenges involves understanding the nature of medical knowledge, the different information needs of physicians, the clinical decision-making process, and the constraints of the physicians work environment, as well as the traditional barriers to physician education. We explore the nature of some of these challenges and propose one solution in the form of a highly integrated web-based technology--The Stanford Health Information Network for Education.

Academic Medical Centers↗

PubMed1999

Clinical information systems: strategic imperatives driving IDNs forward.

Reviewing the "state of the art" of clinical information systems in healthcare, one can't help but be struck by how many promises remain unfulfilled. Yes, there have been advances in electronic medical information systems in the past three decades, but in many ways, the same problems exist today that have existed all along. Implementation of clinical information systems (CIS) still requires major changes in workflow. And those core problems continue to dog the progress of integrated healthcare delivery systems, which are struggling to demonstrate value to purchasers, payers, providers, and consumers as they aggregate vertically and horizontally across the continuum. At the same time, mastering the "people" issues, those that revolve around how technology is integrated into the clinical practice of medicine, continues to be the key success factor for producing a usable solution, even with all the advances in hardware and software.

Computer Communication Networks↗

PubMed1999

Hospital information systems: chances and obstacles on the way to integration.

Today, most large hospital information systems (HIS) comprise many heterogeneous application systems, loosely coupled via interfaces. Integration could offer many advantages, like the support of interdepartmental workflows or a consistent patient record. This cannot be achieved, however, by simply interfacing originally unrelated component systems. In this paper, we present relevant concepts of integration, the autonomy/consistency tradeoff, and technical alternatives in some detail. Based on our recent experiences in analyzing an existing HIS and selecting adequate vendors for the needs of our 1250-bed hospital, we then discuss strategies and tradeoffs on the way to a HIS that utilizes state-of-the-art technology to fill the users' needs.

Hospital Information Systems↗

PubMed1999

A system for the description of healthcare guidelines.

Contained costs and quality of treatment are two elements which have to be considered when planning and controlling both clinical and managerial activities of healthcare structures (HCSs). Each structure has to be marked by a high level of quality of treatment and by specific professional competencies and skills of its operators. It is therefore fundamental to provide a system which supports the management of processes and of guidelines which characterise an healthcare structure. In this paper we present a system able to describe processes of an HCS and in particular clinical guidelines. This system is based on a workflow conceptual model, able to represent clinical and managerial activities carried out in HCSs (the Atreus model).

Computer Simulation↗

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↗

PubMedDate not supplied

Project planning, training, measurement and sustainment: the successful implementation of voice recognition.

Computerized voice recognition systems (VR) can reduce costs and enhance service. The capital outlay required for conversion to a VR system is significant; therefore, it is incumbent on radiology departments to provide cost and service justifications to administrators. Massachusetts General Hospital (MGH) in Boston implemented VR over a two-year period and achieved annual savings of $530,000 and a 50% decrease in report throughput. Those accomplishments required solid planning and implementation strategies, training and sustainment programs. This article walks through the process, step by step, in the hope of providing a tool set for future implementations. Because VR has dramatic implications for workflow, a solid operational plan is needed when assessing vendors and planning for implementation. The goals for implementation should be to minimize operational disruptions and capitalize on efficiencies of the technology. Senior leadership--the department chair or vice-chair--must select the goals to be accomplished and oversee, manage and direct the VR initiative. The importance of this point cannot be overstated, since implementation will require behavior changes from radiologists and others who may not perceive any personal benefits. Training is the pivotal factor affecting the success of voice recognition, and practice is the only way for radiologists to enhance their skills. Through practice, radiologists will discover shortcuts, and their speed and comfort will improve. Measurement and data analysis are critical to changing and improving the voice recognition application and are vital to decision-making. Some of the issues about which valuable date can be collected are technical and educational problems, VR penetration, report turnaround time and annual cost savings. Sustained effort is indispensable to the maintenance of voice recognition. Finally, all efforts made and gains achieved may prove to be futile without ongoing sustainment of the system through retraining, education and technical support.

Certification↗

PubMed2000

[Selection of a hospital information system--experiences and critical aspects].

Due to typical problems (heterogeneity, lack of clinical functionality, Y2K problems) the board of directors of the university hospital of Marburg decided in 1997 to replace major components of the existing system by commercially available software. The products available on the market were analyzed, and, under participation of different user groups, a comprehensive functional specification was generated. This was the basis for a Europe-wide vendor selection process. In this context, several key aspects were identified, which are critically important for realizing a HIS that fulfills the specified functional requirements. Among these key aspects are the integration of heterogeneous system components, the support of cross-departmental workflow, and flexibility as well as adaptability to specific clinical requirements. As a result, we found that with today's commercially available products and standards there is no single solution that fully meets all requirements. However, some "generalist" vendors are offering integrated systems with acceptable clinical functionality. Tools are emerging which enable the clinical user to generate forms for data input and data flow. Still, a hospital information system will consist of separate components that have to be integrated, but the role of integrated, component-based approaches is becoming more important.

Computer Systems↗

PubMed2000

Electronic commerce: beyond the euphoria.

As the center of considerable media attention, case study articles, vendor research, and development efforts, electronic commerce technology is entering healthcare and having a profound effect. The simple truth, however, is that after the drama and excitement begins to wear off, completing a successful e-commerce implementation remains good old-fashioned hard, sometimes monotonous work. To be successful, e-commerce technologies must be planned and implemented with rigorous project standards, and incorporated with significant process and workflow reengineering to actually return significant value to the organization. This article briefs readers on the organizational issues they must consider in evaluating e-commerce readiness--cultural, executive and technological factors that either support or inhibit project and technology success. Readers will be left with the tools to conduct an electronic commerce "readiness assessment" to evaluate the immediate, mid- and long-term potential of electronic commerce; practical remediation strategies for better preparing the organization for the changes inherent in moving to an e-commerce-enabled business model; and comments from the field--advice from organizations that have successfully implemented e-commerce technologies into their ongoing operations.

Commerce↗

PubMedDate not supplied

The diffusion of decision support systems in healthcare: are we there yet?

Clinical decision support (CDS) systems, with the potential to minimize practice variation and improve patient care, have begun to surface throughout the healthcare industry. This study reviews historic patterns of information technology (IT) in healthcare, analyzes barriers and enabling factors, and draws three lessons. First, the widespread adoption of clinical IT, including CDS systems, depends on having the right organizational and individual financial incentives in place. Second, although CDS systems and clinical IT in general are powerful tools that can be used to support the practice of medicine, they alone cannot redefine the workflow or processes within the profession. Healthcare managers counting on technology to restructure or monitor clinicians' work patterns are likely to encounter substantial resistance to CDS systems, even those that generate valuable information. Third, while the pace of implementing IT systems in healthcare has lagged behind that of other industries, many of the obstacles are gradually diminishing. However, several factors continue to inhibit their widespread diffusion, including the organizational turmoil created by large numbers of mergers and acquisitions, and the lack of uniform data standards.

Attitude to Computers↗

PubMed2000

Requirements of a Web-based experiment management system.

Recent advances in tools for scientific data acquisition, visualization, and analysis have lead to growing information management problems for medical research laboratories. An exponential increase in the volume of data, combined with a proliferation of heterogeneous formats and autonomous systems, has driven the need for flexible and powerful Experiment Management Systems (EMS). This paper provides a detailed analysis of the informatics requirements of an EMS, and proposes a new type of middleware called an EMS-Building Environment (EMSBE), which enables the rapid development of web-based systems for managing laboratory data and workflow. We describe the Web-Interfacing Respository Manager (WIRM), an open-source application server for building customizable experiment management systems. WIRM is being used to manage several ongoing experiments, including a natural language processor of radiological findings, and an interdisciplinary project for studying brain function.

Clinical Laboratory Information Systems↗

PubMed2000

Weaving the Web into legacy information systems.

For many years, client-server systems were developed as the backbone of clinical computing in leading hospitals around the country. Beth Israel Deaconess Medical Center now faces the challenge of bridging the technology gap between such systems and the Internet. While developing Web interfaces to legacy clinical systems gives a taste of the future, it is clear that complete institutional migration to the Web is not imminent. Asking clinicians to utilize two different systems, Web-based and legacy, in the interim phase is just one of the difficulties in such transition. This paper describes "Mbridge", a solution that allows legacy system users to exploit the benefits of the Internet in a fashion that does not interfere with their workflow and is both simple and affordable to implement. The service allows clinicians to work on the legacy platform while context-sensitive clinical content is streamed to the browser without their intervention. Using the system, we can gradually expose clinicians to new Web-based applications and resources without forcing them to operate two computing environments simultaneously. The service achieves these goals by means of linkage and coordination rather than by code-translation, data exchange or replication.

Computer Systems↗

PubMed2000

ActiveGuidelines: integrating Web-based guidelines with computer-based patient records.

Use of the World Wide Web provides an efficient means to disseminate guidelines, but integrating them into the workflow at the point of care remains elusive. We developed a method, ActiveGuidelines (AGL), of integrating web-based guidelines with computer-based patient record (CPR) systems. An ActiveGuideline is an HTML document containing special tags that are interpreted by a CPR as actions (e.g., medication order, test order, referral, patient instructions). In our usage scenario, the CPR automatically displays ActiveGuidelines relevant to the current patient context. After reviewing the guideline, the user selects recommended orders directly from the ActiveGuideline. The selected orders are automatically transmitted to the CPR and executed as regular orders. An ActiveGuideline editor facilitates easy conversion of existing HTML-formatted guidelines into ActiveGuidelines. We believe that integrating patient-specific ActiveGuidelines within a CPR system will improve utilization of clinical guidelines in routine patient care.

Computer Systems↗

PubMed2000

Executing clinical guidelines: temporal issues.

In our previous work, we proposed a domain-independent language to describe clinical guidelines and a graphical tool to acquire them. In this paper, we describe an approach to execute clinical guidelines. We propose a flexible execution engine that can be used in clinical decision support applications, and also for medical education, or for integrating guidelines into the clinical workflow. We also focus our attention on temporal issues in the execution of guidelines, including the treatment of composite, concurrent and/or cyclic actions.

Databases as Topic↗

PubMed2000

The Internet as cure for inefficient office business processes.

Application service providers (ASPs) offer medical groups unprecedented efficiency in practice management via the Internet at low subscription rates. With online, real-time access to registration, scheduling, eligibility verification, claims processing and collection functions, medical groups can streamline workflow and better care for patients, while optimizing their reimbursement potential.

Contract Services↗

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↗

PubMed2000

Distributed information system architecture for Primary Health Care.

We present a distributed architectural framework for Primary Health Care (PHC) Centres. Distribution is handled through the introduction of the Roaming Electronic Health Care Record (R-EHCR) and the use of local caching and incremental update of a global index. The proposed architecture is designed to accommodate a specific PHC workflow model. Finally, we discuss a pilot implementation in progress, which is based on CORBA and web-based user interfaces. However, the conceptual architecture is generic and open to other middleware approaches like the DHE or HL7.

Computer Communication Networks↗

PubMed2000

A regional health network supported by organisational change. Cross sectorial electronic referral and confirmation of booking.

The goal of the Funen Health Care Network is to ensure a fast correct communication between the Health Care professionals. Since 1993 electronic links have been established from all clinical hospital departments, radiology departments, laboratories, the clinical microbiology department and the pathology department to the general practitioners. Recently, the electronic referral and a confirmation of the booking has been implemented, and this will be followed by structured clinical e-mail service. Due to directed organisational changes, the introduction of electronic referral has resulted in a faster and more logical workflow in the hospitals when dealing with referrals. The primary sector is kept updated on the patient throughout the period of care.

Appointments and Schedules↗