[Health systems and information systems].
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An information system is described in the field of rabies, which realizes the integration of information streams from human medicine as well as from veterinary medicine by help of computers. This rabies information system is based on a homogeneous and coordinated system of surveillance in connection with prophylaxis and control of rabies. It includes a modification of the case record, suggested by the WHO-Expert-Committee on Rabies. The aims of this rabies information system are: to make obvious the epizootiological situation with formation and change of foci, to show the epidemiological importance of special animals and to recognize the epidemiological situation. All this has to be fulfilled in an integrated system. Furthermore optimal treatment is guaranteed by express diagnostics and earliest possible special treatment of high-risk groups by the co-operation of human and veterinary medicine. The rabies information system was generally introduced in the GDR in 1970. It has proved to be practicable and effective especially by standardization of diagnostics, recording exposure of the patient, his treatment and partly automated evaluations of situation records and documentation of efficiency.
The microbiological information system ISM gives the possibility to collect data of patients and findings on punch strips, to transmit the findings to the senders and to store and evaluate the data according to medical points of view and for the purpose of performance statistics. The essential elements of the system are demonstrated and the basic principles of the data processing apparatus type R300 are described. Here the author particularly enters the calculator-internal testing processes for elimination of codation and punching errors. Finally the further development of the information system provided is briefly sketched. The advantages of the use of electronic data processing result from 1. the simplificstion and unification of the information relations, 2. the reduction of writing work, 3. the centralised transmission of findings, 4. the increased security of data and 5. the possibility of mathematico-statistical evaluations of the stored data material. According to its basic conception the information system ISM may be used universally and it is possible to enlarge it.
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The Experiment Information System (EIS) is a computerized data collection, maintenance, and reporting system for specified information values collected during the lifespan of animals assigned to toxicologic investigations at NCTR. The system records and/or controls experimental variables, which might ultimately affect the results, through the operation and integration of the Diet Preparation Subsystem (DPS), the Environmental Monitoring Subsystem (EMS), the Microbiology Subsystem (MBS), and the Chemistry Data Subsystem (CDS). The fifth component of the EIS, the Experimental Data Collection Subsystem (EDCS), is responsible for handling all data generated by, or attributed to, the animals from assignment until death or removal. Through integration of these five subsystems, the history of an animal while on study is recorded and stored for later recall. In addition, "routine" and "special" reports are made available through the system software which enables stringent control of the experiment by the Principal Investigator, Animal Husbandry, and NCTR Management.
The Breeding Information System (BIS) facilitates management control of the breeding colony operation at the National Center for Toxicological Research (NCTR). Although this automated data handling system was initially intended to support Animal Husbandry the system's basic design, flexibility or reporting, data manipulation capabilities, and integration with other NCTR data collection systems provides BIS with capabilities that have application to other groups including the Plans and Programs and most scientific areas. This description of the System is in terms of its potential value to these diverse user groups.
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The Vienna General Medical Information System is applied at the university clinics of the medical faculty of Vienna. The system consists of several components: 1. Program complex for the support of daily routine work, 2. documentation system, 3. Vienna laboratory system, 4. differential diagnosis and screening system, 5. medical information system, 6. medical evaluation system. The central part of the system is the patient-orientated data bank.
The MEDINFO (MEDical INFOrmation) system is a general purpose computer-based information storage, retrieval, and analysis system. It is designed for a time sharing, on-line computer system for the rapid and easy creation, maintenance, and analysis of general data files. A wide variety of types of information may be used. These include numeric, categoric, text, date, and multiple-response. The file structure allows several sets of data, including date-orientated data, to be used. MEDINFO permits a study to be created, a description of the data made, data to be entered and updated into records, and for the data to be displayed or analyzed by the investigator without programmer intervention.
The Post-Experiment Information System (PEIS) is an automated data collection and reporting system composed of three specialized subsystems: Pathology, Chemistry and Microbiology. These subsystems function either independently or collectively to construct and maintain a comprehensive data base of all experimental values derived from, or associated with, an animal carcass. All data are retrievable by the unique Carcass Identification (CID) number assigned at death, which is the correlative of the Unique Identification Number (UIN) assigned to the animal at birth and used throughout its lifespan. Elements processed under the PEIS include gross and microscopic pathological observations, organ weights, hematologic data, chemical data, and microbiological analyses. The ability of the system to integrate the post-experiment data with the information collected on an animal from birth (BIS) and during the experiment (EIS) provides a complete animal history to the Principal Investigator or other requestor.
This paper describes the development of a system for recording encounter data in family practice. The system has been developed by the Department of Family Medicine, University of Western Ontario, and came about as a natural addition to a previously reported method for describing and defining a practice population. The system gathers information on each encounter and includes data concerning the patient, the provider, the location, and certain other details concerning the encounter, including all problems dealt with on that occasion. The storage and analysis of these data are carried out by a computer. The uses of such data are many, and some of them will be dealt with in the fourth and last paper in this series.
An automated radiology department information system, serving the diagnostic radiology and nuclear medicine divisions, has been developed. Radiology applications are part of a centralized data processing operation which incorporates clinical, administrative, research, and teaching subsets. The radiology subset includes remote on-line ordering/reporting, automated examination census and statistics, an on-line audit trail/workload control program, and financial reports. The software is linked to other hospital applications. This system improved report turn-around times, decreased clerical loads, and provided better financial management.
A method for evaluating drug information systems is described. The method measures both qualitative and quantitative performance. For the categories, "Basic Therapeutic Information", and "Commercial and Investigational Product Information," specific data that should be present are identified; evaluated systems are searched for these data related to a standard sample of 122 drugs. Systems are also searched for the presence of any information relating to these drugs in the categories, "Applied Clinical Research Information" and "Nonclinical Laboratory Research Information". In addition, systems are searched for the presence of 215 drug-drug interactions and 244 drug-laboratory test interferences. Using relative weights that have been assigned to the content statistics, an aggregate measure of system's content is determined. The method also measures annual cost of operating a system. The application of the method to two drug information systems is discussed briefly.
The Multi-State Information System for Psychiatric Patients (MSIS) is a computer based, clinical and administrative management information system used by numerous mental health programs and facilities for patient and program management. Structured forms are used for the collection of core information on patients, on services rendered, on affiliated agencies, and on fiscal and administrative processes. A variety of output reports and general retrieval techniques are being used to help administer and evaluate patient care programs, monitor clinical and program management functions, refer clients to other service agencies, and review individual cases, as well as for administrative functions such as cost finding, rate setting, billing, and inventory control. MSIS is currently field testing an automated problem-oriented psychiatric record, and a goal-oriented record to be used with the mentally retarded is under development.
This article has attempted to demonstrate that decision making and evaluation can be carried out in a systematic fashion only if agencies make a commitment to do so, and only if adequate systems are established. The management information system is the most expensive and most sophisticated component of the integrated model presented here. Its existence, in some fashion, is essential to the operation of the model. Contrary to what many managers may believe and practice, the management information system is not in itself the final solution to evaluation. Neither is the evaluation a panacea for all program ills. Evaluation can provide the information required to meet the ever increasing demands for agency or program accountability evaluation can also provide insights for future decisions to change or alter the allocation of resources. Such evaluation must be carefully planned and implemented; and, at the state level, can be successful only if executed in a systematic manner as suggested here. Regardless of the degree of sophistication of any system, it will work only when supported by users in the local treatment centers. If the model employed does little to serve them, it is not a model worth considering. It is with these needs in mind that this model was developed.
A computer-based medical information system (COSTAR) has been used to support a quality assurance program where the data collection is an integral part of the patient care recording activity and, therefore, does not require a separate abstracting or encoding process. This program utilizes concurrent audit to detect deficiencies in patient care, and automatic rapid feedback to the responsible provider in time to allow the provider to correct the deficiency. This system has been demonstrated to improve follow-up of throat cultures, positive for Group A Beta hemolytic streptococcus. It is well accepted by the medical staff whose practice is being audited. Because the data are collected as part of the routine operation of COSTAR, the computer monitoring and feedback have only a small incremental cost.