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IAIMS at Columbia-Presbyterian Medical Center: accomplishments and challenges.

The concept of "one-stop information shopping" is becoming a reality at Columbia-Presbyterian Medical Center. Our goal is to provide access from a single workstation to clinical, research, and library resources; university and hospital administrative systems; and utility functions such as word processing and mail. We have created new organizational units and installed a network of workstations that can access a variety of resources and systems on any of seventy-two different host computers/servers. In November 1991, 2,600 different individuals used the clinical information system, 700 different individuals used the library resources, and 900 different individuals used hospital administrative systems via the network. Over the past four years, our efforts have cost the equivalent of $23 million or approximately 0.5% of the total medical center budget. Even small improvements in productivity and in the quality of work of individuals who use the system could justify these expenditures. The challenges we still face include the provision of additional easy-to-use applications and development of equitable methods for financial support.

Academic Medical Centers

The impact of IAIMS at Georgetown: strategies and outcomes.

Integration of multiple information systems of a medical center will change the way physicians work and practice medicine in the future. Several major steps must be taken by an institution to make this a reality. Since 1983, Georgetown has been engaged in an Integrated Academic Information Management System (IAIMS) project to bring together multiple sources of information that reside on different computers and database systems. Georgetown is developing a Biotechnology and Biomedical Knowledge Network that includes informational and clinical databases, scholar workstations, instruction on computer use, a campuswide network with local area network nodes, and a modular approach to systems integration. The IAIMS project, spearheaded by the medical library, has enabled a broad spectrum of health professionals to benefit directly from new, dynamic information services. The network is heavily used; in 1991, more than 2,100 individual users conducted more than 148,500 computer functions and more than 104,000 searches. There is economy of scale in high-volume use. Overall, the average search cost is $1.57; for high use databases the cost is $0.38, and for low use, it is $9.41. As described in this paper, IAIMS offers a cost-effective means of enhancing patient care by improving information services to physicians. At Georgetown, IAIMS has advanced the concept of integration, accelerated use of computers in education, increased user acceptance of advanced technologies, and established cost factors for providing information resources. While progress made in improving the transfer of medical information is impressive, it is clear that IAIMS requires several more years of support to achieve full implementation.

Academic Medical Centers

ACOGQUEST: the model phase of the IAIMS project of the American College of Obstetricians and Gynecologists.

In 1990, the American College of Obstetricians and Gynecologists (ACOG) became the first national organization to receive a model phase Integrated Academic Information Management System (IAIMS) grant from the National Library of Medicine. The goal of the ACOG model phase project is to develop and test a prototype for an integrated system that will meet the needs of ACOG and NAACOG members in patient care, research, education, and administrative information. The model phase goal will be accomplished primarily through ACOGQUEST, an integrated approach to providing accurate, current, quality-filtered information to ACOG and NAACOG members in a variety of formats. Another method of information dissemination now being tested is a heuristic-based patient management database, which will include a concise, interactive display of ACOG-reviewed information that can be incorporated into patient records.

Computer Communication Networks

[Hygienic evaluation of the work of technical school students on the video display terminals].

Psychologic and hygienic examination of students working on display calculating complexes (DCC) DCC-2 and DCC-3 during the extra study time revealed the features of their functional status caused by the DCC design and work schedule. Positive role of eye exercises during the work was stressed. 6-hours duration of students' work was considered as unfavourable. The duration of work must be reduced to 3 hours, prophylactic measures (eye and physical exercises) are to be added.

Adult

Attitudes of nurses toward computerization: a replication.

To assess the attitudes of nurses toward computerization, Stronge and Brodt's questionnaire, Assessment of Nurses' Attitudes Toward Computerization was used to survey head nurses, staff registered nurses, and licensed practical nurses in a 500-bed hospital. Nurses' attitudes were generally favorable toward computers and there were no significant differences in attitudes by nurses' job title, level of education, age, or years of nursing experience. Previous experience with computers was the only variable significantly related to total mean score with those nurses who had previously used computers having significantly (p less than 0.001) more favorable attitudes toward computers than those who reported no previous computer use. A factor analysis was obtained; five factors emerged. Although the factors are similar to the categories identified by Stronge and Brodt, results of the factor analysis suggest response bias.

Adult

Computer graphics and developmental theory: a powerful partnership.

Educating student nurses to successfully use computer technology involves conscientious planning from nursing faculty responsible for curriculum integration. Many computer elements may be considered such as computer literacy, word processing, and computer assisted instruction. Database programs, spreadsheet applications, and statistical packages are also often incorporated into curriculum integration efforts. Computer graphics and desk-top publishing can also be used as an effective teaching strategy. The following describes an attempt to combine a creative teaching approach for developmental theory within a course on human development while expanding on students' computer skills in the field of computer graphics.

Computer Graphics

Making it work.

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Computer User Training

Systems failures.

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Attitude of Health Personnel

Use of two online services as drug information sources for health professionals.

The utility of the online computer services BRS Colleague and Dialog Medical Connection, when used primarily as drug information sources by physicians, nurses, and pharmacists and attitudes toward their use, are described. Study sites included office-based medical practices, a university clinic family medicine group, and a university clinical pharmacy department. Participants had access to either of the computer services during two 9 1/2-month periods. All searches were automatically recorded and analyzed. A total of 1,112 search sessions were conducted (78% by pharmacists, 16% by nurses, 6% by physicians) by 38 of 65 participants. Information which completely answered questions was found for slightly less than one-third of searches. Errors occurred in about 81% of searches which retrieved incomplete information. Lack of time was a major factor which limited use of the services, and infrequent users felt that the services did not fit in well with their daily work routine.

Attitude to Computers

Theory-based approach to computer skill development in nursing administration.

The authors describe a theory-based approach to computer skill development in nursing administration that is a strategy for preparing nurse administrators to meet the challenge for effective decision making in the rapidly changing health care environment. A framework is presented using theories of decision making and information processing to integrate the development of knowledge and skills for decision making with knowledge and skills associated with computer decision support. Computerized support is available to help managers be effective at each stage of the decision-making process. Focusing on five stages of the decision-making process, the authors discuss how computers can facilitate decision-making. Computer applications introduced throughout a three-semester program in nursing administration include bibliographic databases, thought and word processing, database programs, decision analysis programs, spreadsheets, and project management programs. The curriculum and course activities are described.

Computer User Training