A systematic review of the cost and cost-effectiveness of electronic discharge communications

BACKGROUND

The transition between acute care and community care can be a vulnerable period in a patients' treatment due to the potential for postdischarge adverse events. The vulnerability of this period has been attributed to factors related to the miscommunication between hospital-based and community-based physicians. Electronic discharge communication has been proposed as one solution to bridge this communication gap. Prior to widespread implementation of these tools, the costs and benefits should be considered.

OBJECTIVE

To establish the cost and cost-effectiveness of electronic discharge communications compared with traditional discharge systems for individuals who have completed care with one provider and are transitioning care to a new provider.

METHODS

We conducted a systematic review of the published literature, using best practices, to identify economic evaluations/cost analyses of electronic discharge communication tools. Inclusion criteria were: (1) economic analysis and (2) electronic discharge communication tool as the intervention. Quality of each article was assessed, and data were summarised using a component-based analysis.

RESULTS

One thousand unique abstracts were identified, and 57 full-text articles were assessed for eligibility. Four studies met final inclusion criteria. These studies varied in their primary objectives, methodology, costs reported and outcomes. All of the studies were of low to good quality. Three of the studies reported a cost-effectiveness measure ranging from an incremental daily cost of decreasing average discharge note completion by 1 day of $0.331 (2003 Canadian), a cost per page per discharge letter of €9.51 and a dynamic net present value of €31.1 million for a 5-year implementation of the intervention. None of the identified studies considered clinically meaningful patient or quality outcomes.

DISCUSSION

Economic analyses of electronic discharge communications are scarcely reported, and with inconsistent methodology and outcomes. Further studies are needed to understand the cost-effectiveness and value for patient care.

Fast Outlier Detection Using a Grid-Based Algorithm

As one of data mining techniques, outlier detection aims to discover outlying observations that deviate substantially from the reminder of the data. Recently, the Local Outlier Factor (LOF) algorithm has been successfully applied to outlier detection. However, due to the computational complexity of the LOF algorithm, its application to large data with high dimension has been limited. The aim of this paper is to propose grid-based algorithm that reduces the computation time required by the LOF algorithm to determine the k-nearest neighbors. The algorithm divides the data spaces in to a smaller number of regions, called as a “grid”, and calculates the LOF value of each grid. To examine the effectiveness of the proposed method, several experiments incorporating different parameters were conducted. The proposed method demonstrated a significant computation time reduction with predictable and acceptable trade-off errors. Then, the proposed methodology was successfully applied to real database transaction logs of Korea Atomic Energy Research Institute. As a result, we show that for a very large dataset, the grid-LOF can be considered as an acceptable approximation for the original LOF. Moreover, it can also be effectively used for real-time outlier detection.

Implementation and evaluation of a low-cost telemedicine station in the remote Ecuadorian rainforest

A clinical workstation was developed to provide basic telemedicine services in a medical clinic in rural Ecuador. The unit cost was less than $1000. The system provided videoconferencing and a Spanish language electronic medical record (EMR) for clinic consultations. All partners participated in the development of the EMR. Over a six-month period, almost all new patient encounters and ultrasound studies were entered into the EMR. Of 2387 patient encounters, 572 were recorded in electronic format and 80% were transmitted over the Internet for consultation. Four hundred and eight ultrasound studies were filed with the EMR and 90% were transmitted over the Internet for shared evaluation. During the six months of the study, there were no serious software or hardware problems. The doctor in Ecuador was initially trained at the laboratory in the USA. The two sites were in contact by email almost daily. Without such interaction, the performance of the software and hardware would probably have been worse. When a structured programme of instruction, protocols, EMR and technology support is in place, telemedicine can support remote rural practice.

"Real-Time" Monitoring of Under-Five Mortality: A Vision Tempered by Reality

Jennifer Bryce and the RMM Working Group describe the origin and rationale of the Real-Time Monitoring of Under-Five Mortality Collection.

A Simple, Low-Cost Platform for Real-Time Isothermal Nucleic Acid Amplification

Advances in microfluidics and the introduction of isothermal nucleic acid amplification assays have resulted in a range of solutions for nucleic acid amplification tests suited for point of care and field use. However, miniaturisation of instrumentation for such assays has not seen such rapid advances and fluorescence based assays still depend on complex, bulky and expensive optics such as fluorescence microscopes, photomultiplier tubes and sensitive lens assemblies. In this work we demonstrate a robust, low cost platform for isothermal nucleic acid amplification on a microfluidic device. Using easily obtainable materials and commercial off-the-shelf components, we show real time fluorescence detection using a low cost photodiode and operational amplifier without need for lenses. Temperature regulation on the device is achieved using a heater fabricated with standard printed circuit board fabrication methods. These facile construction methods allow fabrications at a cost compatible with widespread deployment to resource poor settings.

Computer glitch is a 'blow to morale'

Delays and spiralling costs of an IT upgrade for Scotland's NHS 24 helpline is a blow to nursing staff, the RCN says.

Costs of health IT: beginning to understand the financial impact of a dental school EHR

Health Information Technology (Health IT) constitutes an integral component of the operations of most academic dental institutions nowadays. However, the expenses associated with the acquisition and the ongoing maintenance of these complex systems have often been buried among costs for other electronic infrastructure systems, distributed across various cost centers including unmeasured central campus support, covered centrally and therefore difficult to quantify, and spread over years, denying school administrators a clear understanding of the resources that have been dedicated to Health IT. The aim of this study was to understand the financial impact of Health IT at four similar U.S. dental schools: two schools using a purchased Electronic Health Record (EHR), and two schools that developed their own EHR. For these schools, the costs of creating ($2.5 million) and sustaining ($174,000) custom EHR software were significantly higher than acquiring ($500,000) and sustaining ($121,000) purchased software. These results are based on historical data and should not be regarded as a gold standard for what a complete Health IT suite should cost. The presented data are intended to inform school administrators about the myriad of costs associated with Health IT and give them a point of reference when comparing costs or making estimates for implementation projects.

Radio Frequency Identification (RFID) and communication technologies for solid waste bin and truck monitoring system

This paper deals with a system of integration of Radio Frequency Identification (RFID) and communication technologies for solid waste bin and truck monitoring system. RFID, GPS, GPRS and GIS along with camera technologies have been integrated and developed the bin and truck intelligent monitoring system. A new kind of integrated theoretical framework, hardware architecture and interface algorithm has been introduced between the technologies for the successful implementation of the proposed system. In this system, bin and truck database have been developed such a way that the information of bin and truck ID, date and time of waste collection, bin status, amount of waste and bin and truck GPS coordinates etc. are complied and stored for monitoring and management activities. The results showed that the real-time image processing, histogram analysis, waste estimation and other bin information have been displayed in the GUI of the monitoring system. The real-time test and experimental results showed that the performance of the developed system was stable and satisfied the monitoring system with high practicability and validity.

Remote real-time monitoring of subsurface landfill gas migration

The cost of monitoring greenhouse gas emissions from landfill sites is of major concern for regulatory authorities. The current monitoring procedure is recognised as labour intensive, requiring agency inspectors to physically travel to perimeter borehole wells in rough terrain and manually measure gas concentration levels with expensive hand-held instrumentation. In this article we present a cost-effective and efficient system for remotely monitoring landfill subsurface migration of methane and carbon dioxide concentration levels. Based purely on an autonomous sensing architecture, the proposed sensing platform was capable of performing complex analytical measurements in situ and successfully communicating the data remotely to a cloud database. A web tool was developed to present the sensed data to relevant stakeholders. We report our experiences in deploying such an approach in the field over a period of approximately 16 months.

[Cost-effectiveness in the detection of influenza H1N1: clinical data versus rapid tests]

OBJECTIVE

Evaluate the performance of clinical data and the rapid influenza diagnostic test (RIDT) in diagnosing influenza H1N1, and analyze the cost-benefit of using this diagnostic tool.

METHODS

The RIDT was used for patients who came to four hospitals in Mexico City with an influenza-like illness (ILI) in October and November 2009. The diagnostic performance of the ILI clinical data and the RIDT was compared to that of the real-time reverse transcription polymerase chain reaction (rRT-PCR) test. The rRT-PCR test was conducted in a reference laboratory and blinded to the results of the RIDT. An economic evaluation also was conducted to estimate the budgetary impact of using the RIDT.

RESULTS

The study included 78 patients, 39 of whom tested positive for influenza H1N1 and 6 tested positive for seasonal influenza A, according to the results of the rRT-PCR. The ILI clinical data yielded a sensitivity of 96% and specificity of 21%; the RIDT yielded a sensitivity of 76% and specificity of 82%; and the ILI clinical data and RIDT together yielded a sensitivity of 96% and specificity of 100%. The positive likelihood quotient for ILI-headaches was 31.5 and that of ILI-odynophagia, 330. The use of RIDT yielded savings of US$12.6 per each suspected case.

CONCLUSIONS

Use of the RIDT to aid in the diagnosis of influenza H1N1 increases certainty and lowers the average cost per suspected and infected patient.

[Facing the challenges of ubiquitous computing in the health care sector]

The steady progress of microelectronics, communications and information technology will enable the realisation of the vision for "ubiquitous computing" where the Internet extends into the real world embracing everyday objects. The necessary technical basis is already in place. Due to their diminishing size, constantly falling price and declining energy consumption, processors, communications modules and sensors are being increasingly integrated into everyday objects today. This development is opening up huge opportunities for both the economy and individuals. In the present paper we discuss possible applications, but also technical, social and economic barriers to a wide-spread use of ubiquitous computing in the health care sector.

A practical approach for inexpensive searches of radiology report databases

RATIONALE AND OBJECTIVES

We present a method to perform full text searches of radiology reports for the large number of departments that do not have this ability as part of their radiology or hospital information system.

MATERIALS AND METHODS

A tool written in Microsoft Access (front-end) has been designed to search a server (back-end) containing the indexed backup weekly copy of the full relational database extracted from a radiology information system (RIS). This front end-/back-end approach has been implemented in a large academic radiology department, and is used for teaching, research and administrative purposes.

RESULTS

The weekly second backup of the 80 GB, 4 million record RIS database takes 2 hours. Further indexing of the exported radiology reports takes 6 hours. Individual searches of the indexed database typically take less than 1 minute on the indexed database and 30-60 minutes on the nonindexed database. Guidelines to properly address privacy and institutional review board issues are closely followed by all users.

CONCLUSIONS

This method has potential to improve teaching, research, and administrative programs within radiology departments that cannot afford more expensive technology.

Ten commonly asked computer questions ... and answers. Part 1

I hope that you have learned something from this article that will help you get through your next computer crisis. Remember that most computer problems are not your fault and they are not the end of the world. It stinks when your car breaks down, and it stinks when your PC crashes, but you will get through it. If your PC does crash, write down what you were doing when it crashed, any changes that were made, any software that was installed, and take a deep breath. You will be able to help get the problem solved quicker if you stay relaxed. Part 2 of this article, to be published in a future issue of Dentistry Today, will answer the next 5 commonly asked computer questions.

Detección de ADN de CMV en plasma mediante PCR en tiempo real utilizando SYBR-Green I como señal de amplificación

OBJECTIVE

The aim of this study is to assess a real-time PCR technique on the LightCycler 2.0 with SYBR-Green I detection as compared to another real-time PCR method based on detection with FRET (fluorescence resonance energy transfer) probes for the quantification of CMV DNA.

METHODS

The two real-time PCR methods were used to test plasma samples from immunocompromised patients with clinically suspected CMV disease, patients under follow-up without symptoms, and healthy adults. A standard curve for quantitative analysis by the SYBR-Green I method was performed with 10-fold diluted solutions of DNA from the CMV Towne strain (ATCC VR-977) cultured in MRC-5 monolayer. In addition, frozen samples from patients positive for CMV pp65 antigenemia were also analyzed and results compared using the two real time PCR methods.

RESULTS

The real-time PCR technique using SYBR-Green I on the LightCycler 2.0 was a highly specific, fast, simple and reliable test to quantify CMV; moreover, it was cost-effective.

CONCLUSION

Quantification of CMV DNA in plasma using this sensitive, fast, low-cost method was advantageous for the diagnosis and follow up of patients with opportunistic CMV infection, which are increasingly more frequent in our daily hospital clinical practice.

Perceptions and attitudes of Canadian dentists toward digital and electronic technologies

OBJECTIVES

To determine dentists" perceptions of the usefulness of digital technologies in improving dental practice and resolving practice issues; to determine dentists" willingness to use digital and electronic technologies; to determine perceived obstacles to the use of digital and electronic technologies in dental offices; and to determine dentists" attitudes toward Internet privacy issues.

METHODS

An anonymous, self-administered survey of Canadian dentists was conducted by mail. A potential mailing list of 14,052 active Canadian dentists was compiled from the 2003 records of provincial regulatory bodies. For each province, 7.8% of the dentists were randomly selected with the help of computer software. The surveys were mailed to this stratified random sample of 1,096 dentists.

RESULTS

The response rate was 28% (312/1,096). Of the 312 respondents, 4 (1%) were in full-time academic positions, 16 (5%) were not practising, and 9 (3%) provided incomplete data. Therefore, 283 survey responses were available for analysis. More than 60% of the dentists indicated that computer technology was quite capable or very capable of improving their current practice by increasing patient satisfaction, decreasing office expenses, increasing practice efficiency, increasing practice production, improving record quality and improving case diagnosis and treatment planning. More than 50% of respondents reported that digital photography and digital radiography were quite useful or very useful. About 70% of the dentists agreed or strongly agreed with using digital and electronic technologies to consult with dental specialists. Cost of equipment and lack of comfort with technology were regarded as significant or insurmountable obstacles by substantial proportions of respondents.

CONCLUSIONS

Respondents generally viewed digital and electronic technologies as useful to the profession. Increased office efficiency and production were perceived as positive effects of digital and electronic technologies. These technologies are more often used for consulting with colleagues rather than for consulting with patients. The major obstacles to the general use of these technologies were related to cost, lack of comfort with technology and differences in legislation between provinces and countries. Privacy issues were not perceived as a significant barrier.

Clinical information systems market - An insider’s view

Clinical information systems that provide electronic charting and documentation have been commercially available for over 15 years. These systems provide varying degrees of automation to flowsheets, forms, notes, worklists, care plans, and medication administration records. Although there are many benefits that an electronic system brings, such as accessibility, legibility, process adherence, and data mining, the market has been slow to adopt these systems. A variety of historical factors can explain the lack of widespread system implementations. Survey data of CEOs/CIOs from the Healthcare Information and Management Systems Society (HIMSS) shows promising data that clinically oriented applications will receive high prioritization in near term planning. Will this prioritization materialize in actual implementations? Market drivers appear to be in place to predict an increase in sales and implementations.