Can we solve current problems with nursing information systems?

Dutch nurses are confronted with health care information systems quite often. However, they do not take full advantage of electronic support for their care activities and professional development. The nursing process is often considered the core of nursing care delivery and guides the documentation of care. Currently, this process can be supported electronically. However, the actual use of nursing information systems (NISs) in the Netherlands is limited to a few sites. Therefore, it is timely to analyse the problems that exist in the development and use of NISs and to look for solutions to solve them. This paper proposes both the nursing information reference model (NIRM), and structured discussions for a proper course of action in the development and use of NISs.

PROforma: a general technology for clinical decision support systems

The need for flexible and well understood knowledge representations which are capable of capturing clinical guidelines and protocols for decision support systems is widely recognised. The PROforma method for specifying clinical guidelines and protocols comprises a graphical notation for their design, and a formal knowledge representation language to enable them to be executed by a computer to support the management of medical procedures and clinical decision making. PROforma technology consists of a graphical knowledge editor for the creation of guidelines, and an enactment engine for testing and executing them. This paper provides an overview of the motivation and structure of PROforma, and illustrates its use in the development of clinical applications.

An asynchronous co-operative model for co-ordinating medical unit activities

CSCW is devoted to the analysis of interactions among human beings when performing their work together (Ellis et al., Commun. ACM 1 (34) (1991) 38-58). The main fields of application are work organisation, healthcare, education and training. Our main goal is to study the co-operative models allowing task co-ordination and conflict management between actors within a distributed environment, particularly in medical units. We do not aim to produce a practical system suitable for near-term deployment in the intensive care units (ICU), but rather an experimental system that performs and co-ordinates a range of intelligent planning tasks in ICU activities. The emphasis will be put especially on asynchronous co-operation. We apply the Workflow approach to ICU organisation through the analysis and the proposal of a co-operative model.

DIAS--the diabetes advisory system: an outline of the system and the evaluation results obtained so far

The present paper gives a description of the Diabetes Advisory System (DIAS), and the evaluation results obtained so far. DIAS is a decision support system for the management of insulin dependent diabetes. The core of the system is a compartment model of the human carbohydrate metabolism implemented as a causal probabilistic network (CPN or Bayesian network), which gives it the ability to handle the uncertainty, for example, in blood glucose measurements or physiological variations in glucose metabolism. The evaluation results suggest that, at least in our hands, DIAS can generate advice that is safe and of a quality that is at least comparable to what is available from experienced clinicians.

Using a supply usage relational database to reduce costs

Relational database applications are valuable tools for tracking supply utilization patterns. This information can be used to standardize supplies and reduce utilization, thereby reducing costs and improving consistency. A supply usage database can generate comprehensive reports in a fraction of the time required to produce similar reports by other means. The reports can provide data sorted by patient, surgeon, procedure, product, or any other data field the user specifies, and the comprehensive data are a persuasive means for suggesting changes to supply utilization patterns to physicians.

Health services, coordination and the Internet

The on-going specialization of medical services requires socioeconomic coordination of different health services. The GP is the key to improve this primary coordination. To qualify referral decisions by the GP an Internet-like information system (VisInfo) has been implemented in Denmark. This VisInfo contains information on (1) alternative periods of waiting, (2) medical guidelines for specific treatments (3) clinical home pages, and (4) links to non-medical providers of health services (NGOs). VisInfo was originally implemented in the Counties of Funen, Northern Jutland and Vejle in 1993-1995. A number of other counties are implementing similar information systems whereof the County of Frederiksborg, recently has implemented the first real Internet-system. Provisional experiences with the VisInfo strategy is presented on (1) the general user interest, (2) elaborations of the strategy, and (3) organization. Based on the BlackSeaDiab Action Plan and the BlackSea TeleDiab project, the potential for dissemination of medical informatics in the Black Sea Region through an adaption of the VisInfo strategy is discussed.

Establishing need for and designing information systems supporting decentralized services for the elderly: the case of Allegheny County, Pennsylvania

Leaders of senior social services in Allegheny County, Pennsylvania, have reevaluated home-delivered meals (HDM) for the elderly in light of demographic and economic changes. A recommendation was the establishment of an integrated information system aiding policy and provider-level users in coordinating and planning numerous services, including HDM. The first step is the establishment of computerized geographic information and decision support systems. Further integration of a unified client database would enhance the capabilities of this information system in coordinating services for seniors. These possibilities, along with value-based and administrative challenges to constructing a countywide information system, are discussed.

Computer assisted process management for health care: the IBIS tool

IBIS is a broad range informatics tool, which can provide essential assistance to users during quality development projects in the health care environment. It can be used to set up a preliminary process model and specify variable and their interrelationships; the system propagates various quality related effects through the process structure, in a bottom up fashion, by linking quality indices to outcomes, repetitively, until arriving at the final outcome, at the top. An incorporated interactive browser is used to simulate the running process, to test and evaluate it, though a cause--effect interaction on intermediate or final outcomes. The tool provides guided support throughout the quality development procedure and during the continuous improvement process. At the same time, it constitutes an effective training tool on the principles of quality work. Additionally, IBIS can be used for the quality system's documentation, by means of a multimedia presentation, incorporating descriptive text, images and graphical displays, video sequences and sound.

[Optimization of radiation protection in the agrosphere: methods of optimization and computer systems for decision support with respect to management of protective measures]

Principles and methods of radiation protection optimisation for countermeasure implementation on areas subjected to radioactive contamination are discussed. Methodological aspects of the protective measures analysis in agrosphere are presented. Methods of estimation of intervention levels, examples of assessment and comparison of countermeasure effectiveness with the use of various criteria are considered. The brief review of up-to-date decision support systems is submitted along with the description of computer system PRANA DSS for estimation of the consequences and countermeasures management in agrosphere in the long-term period of liquidating the consequences of a nuclear accident.

Merging high tech with quality care

Concerns about preserving quality care and services for managed care members continues to grow with the ongoing development of information technologies. In this article, Mitchell Curtis highlights some of the latest innovations that can improve healthcare access and services for everyone.

Trendstar at Flinders Medical Centre

Trendstar provides Flinders Medical Centre with a reliable management tool that facilitates appropriate resource allocation and ensures that those resources are utilised efficiently. The system supports our aim to provide high quality, cost effective care for our clients.

A process model basis for evolving hospital information systems

Hospitals often invest significant resources in the development of large and complex information systems that must be modified and extended to respond to changing requirements and to exploit the capabilities offered by modern technologies. A disciplined approach of managing the evolution of hospital information systems is then required so that to meet the increasing demands for effective and efficient use of scarce resources. This paper takes a process oriented view of the hospital and presents an approach based on hospital process modeling which aims at assessing the current status of computer support within a hospital and at identifying new opportunities for automation. The approach is illustrated by an example taken from a major Greek hospital.

Information theoretical approach to constitution and reduction of medical data

In medical decision problems it is very important to use the most relevant piece of information for decision making. We focus on a special case of diagnostic decision making when we can measure many symptoms and signs and we have to make diagnostic conclusions. We can state the problem as follows. We can measure symptoms and signs of a patient, denoted by s1, s2, ..., sk, and we have to decide about a possible diagnosis d. We know that the symptoms and signs have different costs w1, w2, ... wk when they are examined. Of course, each symptom, sign or their combination has a different predictive value for the diagnosis. Our task is to find out the combination of symptoms from given data with a sufficient informative value for diagnostic decision making. However, simultaneously we look for a combination of symptoms and signs with minimal costs among those carrying sufficient information. For that reason we will describe approaches based on information measures of statistical dependence and to show the idea of the program CORE (constitution and reduction of data) prepared for practical applications in medicine.

A human resource planning model for hospital/medical technologists: an analytic hierarchy process approach

This paper deals with the development of a human resource planning (HRP) model for hospital laboratory personnel. External and organizational factors impacting the demand and supply of clinical laboratory personnel in an urban academic health center are identified by a Delphi process. These factors are structured into a hierarchy for the application of the Analytic Hierarchy Process (AHP). Computer software, Expert Choice, was used in model hierarchy development and judgmental elicitation process. The model result can be applicable to eliciting the perceptions, insights, and understanding of health-care decision-makers for strategic human resource planning.

Computer supported decision making in therapy of arterial hypertension

Therapy of hypertension is still more or less empirical. Several classes of antihypertensive medications are known, the effect of which is based on different mechanisms. The efficacy of the treatment is not always a reliable indication of the appropriate selection as a good therapeutical response can sometimes be achieved at the expense of humoral simulation. This can lead to harmful increased synthesis of trophic hormones. The program for PC called HYPERTENZE supports decision making in therapy of arterial hypertension. It gives a sequence of decisions based on clinical experience using a series of parameters. The program is using the Microsoft Access language of the Access database system and due to the Access Developers Toolkit it does not require Access to be installed on the user's computer. The program HYPERTENZE offers the user essential information and explanation of the decisions in a graded form. The price list of equivalent medications can be updated by the user himself. It seems that this program might be very useful for Czech general practitioners.

The use of clinical guidelines to improve medical practice: main issues in the United States

The use of clinical guidelines has become a key issue in the US health care system. In contrast to European systems, where such initiatives usually are controlled by one administrative agency, in the US there is a pluralistic approach and many kinds of guidelines coexist, initiated by health professions, managed care organizations, state or federal agencies, hospitals, and insurers. This paper reviews the main trends, indicating that guidelines will play an increasingly prominent role: use of institution-based guidelines vs national, professional, or state-based guidelines; use of more decision-support systems made possible by computerization and changes in cost containment strategies. Combining quality of care objectives with the business objectives of institutions increases the likelihood of a wider adoption by physicians. Several issues, such as the legal implications or the conflict of objectives, illustrate limits in the use of such standards to judge individual cases; however, most recent developments tend to reconcile individual decisions and what is known from probabilities on representative samples. By bringing such information into the decision process between physician and patient, the use of guidelines challenges the traditional asymmetry of information between professionals and patients. In a context of increasing health care costs, clinical guidelines represent a very useful tool for debating rationing issues and standard benefit packages, in order to make the system more equitable. Evaluations of the effectiveness of clinical guidelines on performance are contradictory, but when rigorous evaluations exist, clinical guidelines are found to be effective. The amount of improvement, however, may vary considerably.

Decision support at the crossroads

Quality, like beauty, is in the eye of the beholder--patients, physicians and payors all have their own perspective, If everyone is pleased with the outcome--the patient is cured, the physician managed the condition before it worsened and the payor saved money because the patient didn't need surgery--then isn't that quality care? Clinical decision support systems can help improve the quality of care by providing relevant information right at the time it's needed most--at the clinician's fingertips. Armed with the right information, physicians can diagnose more effectively and make better decisions about care and treatment, say some industry experts. But, caution others, clinical decision support systems are not intended to take the place of a physician's good judgement.