[Possible applications of the KAMEDIN teleradiology system with special reference to an economic analysis]

INTRODUCTION

Different concepts and applications of teleradiology systems have been realised. However, their cost-effectiveness is still questionable. Therefore, a cost-benefit analysis of three different scenarios of the new teleradiology system Kamedin (Kooperatives Arbeiten und rechnergestützte Medizinische Diagnostik auf innovativen Netzen der Deutschen Telekom) was performed.

METHODS

CT examinations were transmitted from an Advantage Windows (GE) workstation to a Kamedin workstation using DICOM 3 protocol. Afterwards a teleconference was established with a Kamedin workstation in the intensive care unit within the hospital via FDDI/Ethernet, with an external workstation in a radiology department 6 km away via ISDN and with a Kamedin PC located with radiologist on duty 22 km away via ISDN. On average, 36 CT slices per patient were transferred. A break-even analysis was performed with respect to costs of hardware, software, support, use of ISDN and staff, as well as benefits like the decrease in transportation or film documentation costs.

RESULTS

Owing to the different reductions in transportation costs, two applications (intensive care unit and external PC) showed a break-even of 1817 and 528 teleconferences/year, respectively. Further optimisation of cost-effectiveness is possible on condition that existing hardware can be used and an automatic data transfer without staff control is available. When all optimisation factors were combined, the break-even decreased to a minimum of 167 and 77 teleconferences/ year, respectively.

CONCLUSION

Teleconferences with high image quality can be set up between workstations and PCs using the Kamedin system. Depending on the possible decrease in transportation costs, teleconferencing is cost-effective under certain conditions. Teleradiology has additional advantages, such as the acceleration and optimisation of patient management.

[Advantages and cost-benefit analysis of various teleradiology scenarios]

With the increasing number of users and technical improvements, there are several application scenarios of teleradiology. To perform a cost-benefit analysis, an approach is presented, which focuses on both monetary and qualitative aspects. Process-related, qualitative and quantitative evaluations are described. The prestudy compares the radiological workflow before and after the introduction of a teleradiology system. A scoring model is part of the qualitative evaluation. The quantitative study focuses on costs and savings. Amortisation and a net present value of savings versus costs can be derived using dynamic investment methods. Savings can be achieved after a short time under ideal conditions, but there is no guarantee for a reimbursement for all systems.

Principals of design and evaluation of an information system for a department of respiratory medicine

OBJECTIVES

To evaluate a departmental computer system.

DESIGN

a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.

SETTING

Within a department of respiratory medicine serving a hospital of 1323 beds.

MAIN OUTCOME MEASURES

a. Time taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.

RESULTS

a. The computer system (CS) was significantly faster than the manual system (MS) for lung function evaluation (CS = 7.63 min/test, MS = 12.25 min/test), loan of equipment (CS = 0.40 min/loan, MS = 2.07 min/loan), and checking for overdue equipment (CS = 0.49 s/record, MS = 9 s/record). The production of correspondence was slightly slower with the computer (CS = 9.30 min/letter, MS = 8.54 min/letter). b. All outpatient episodes, but only 43 of 65 (66%) of in-patient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988-1990 were high (72,178 pounds). Only 1200 pounds to 1845 pounds per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice (4049-4765 pounds). After 10 years the projected deficit is 10,000 pounds per annum in running costs.

CONCLUSIONS

In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay.

Improving information access with an emergency department system

An emergency department (ED) clinical system was developed by in-house personnel, with ED physician, nursing, registration and clerical staff input. The utilization of existing hardware and customization of the hospital's mainframe hospital information system (HIS) facilitated the implementation of a cost-effective system that meets the information access needs of a busy, state-of-the-art academic ED. The transition to automation of the ED was facilitated through the use of a comprehensive training plan and change strategies.

Electronic clinical trial protocol distribution via the World-Wide Web: a prototype for reducing costs and errors, improving accrual, and saving trees

Clinical trials today typically are inefficient, paper-based operations. Poor community physician awareness of available trials and difficult referral mechanisms also contribute to poor accrual. The Physicians Research Network (PRN) web was developed for more efficient trial protocol distribution and eligibility inquiries. The Medical University of South Carolina's Hollings Cancer Center trials program and two community oncology practices served as a testbed. In 581 man-hours over 18 months, 147 protocols were loaded into PRN. The trials program eliminated all protocol hardcopies except the masters, reduced photocopier use 59%, and saved 1.0 full-time equivalents (FTE), but 1.0 FTE was needed to manage PRN. There were no known security breaches, downtime, or content-related problems. Therefore, PRN is a paperless, user-preferred, reliable, secure method for distributing protocols and reducing distribution errors and delays because only a single copy of each protocol is maintained. Furthermore, PRN is being extended to serve other aspects of trial operations.

To your computer, the world really will end soon

As the year 2000 approaches, we see it as a time filled with great promise. Our computer sees it as the year 1900. Systems will begin to fail as date-sensitive materials start to clog the works. Are existing lines of code being rewritten or is a new calculator-application being plugged into your computer system to handle the situation?

Supercomputing in cancer research

Human Genome Analysis and Image Processing are part of the 'Grand Challenges' in High Performance Computing. The traditional mainframe has become insufficient for these applications in Biocomputing. Scalable parallel processor systems have entered the marketplace with superior price/performance. The evaluation process of such a system by an application-oriented benchmark test suite is described. Meanwhile a large system is integrated in the client/server structure of the Deutsches Krebsforschungszentrum where the traditional mainframe is completely replaced by scalable systems.

Can computer-aided systems engineering tools enhance the development of health care information systems? A critical analysis

Computer-aided systems engineering (CASE) is a software technology that helps systems developers write complex application programs. CASE has been identified as having the potential to help health information systems developers complete large-scale projects such as the computer-based patient record or community health information network. The article evaluates the current use of CASE in health care and other settings through a review of the literature. There is no consensus on the value of CASE. Many experts believe that it is an emerging technology that will become widespread, whereas others see it as expensive and cumbersome to use.

What value do computers provide to NHS hospitals?

As the NHS spends around pond 220 million a year on information technology for use by acute hospitals that are hard pressed for resources, it is reasonable to ask what value is provided. A review of rigorous scientific evidence for the value of information technology to NHS hospitals found that published evidence is scarce and far from conclusive. Information technology in NHS hospitals needs further assessment so that future decisions on such necessary and important investments are based on clear, well documented experience and research.

Computerization: reengineering the lawyering process for the 21st century

Alvin and Heidi Toffler, describe the benefits of "informationware" and how one of the most tradition-bound organizations, the armed forces, has substantially changed its operations. According to the authors, mere knowledge is not sufficient to prevail; how one manages or uses knowledge separates winners from losers. Further, the authors say "...basically add new elements or create new combinations of old elements within an existing 'game.' A true revolution goes beyond that to change the game itself, including its rules, its equipment, the size and organization of the 'teams,' their training, doctrine, tactics, and just about everything else. Even more important, it changes the relationship of the game to society itself." Application of this theory to today's litigation is obvious and compelling. The ways in which clients and defense counsel obtain, analyze, and strategically apply evidence and legal principles must change to incorporate the informationware this society uses in other lines of business. This means more extensive and appropriate usage of computer hardware in a software environment that fully supports emerging client and defense counsel needs. The computer system must provide case direction, helpful suggestions, and direct, rapid access to data bases containing information presently available only through person-to-person networking.

Information technology financing options

Healthcare executives facing the challenges of delivering quality care and controlling costs must consider the role information technology systems can play in meeting those challenges. To make the best use of information system expenditures, organizations must carefully plan how to finance system acquisitions. Some options that should be considered are paying cash, financing, financing "soft" costs, leasing, credit warehousing and early acceptance financing, and tax-exempt and conduit financing.

High performance computing for the human genome project

Human Genome Analysis and Image Processing are part of the 'Grand Challenges' in High Performance Computing. The traditional mainframe has become insufficient for these applications in Biocomputing. New scalable parallel processor systems enter the marketplace with superior price/performance. The evaluation process of such a system by an application-oriented benchmark test suite is described. The system is integrated in the client/server structure of the Deutsches Krebsforschungszentrum where 'rightsizing' will eliminate the mainframe completely in the near future.

[Cost effectiveness and patient benefit of digital image management systems for radiology]

In many countries today, politicians are faced with the difficulty of having to reduce the overproportional increase in the cost of healthcare. In this context the contribution of medical technology to costs in the total spent are nearly always overestimated and its potential for savings underestimated. Based on international studies, investment and subsequent running costs for large, high-tech systems for diagnosis and therapy will be shown to account for only about 1% of the total cost of healthcare. Impressive examples of the application of computed tomography, magnetic resonance tomography and digital angiography deliver statistics regarding valid patient benefits and efficiency of modern diagnostic imaging systems. Studies about related therapeutic possibilities of angioplasty and extra-corporal lithotripsy demonstrate the overall economic advantages of modern medical technology. Arising from the positive results due to the use of such equipment, the additional cost savings potential to be expected by networking these digital modalities with one another, as well as with other information and communications technology systems, will be analysed. The results will be assessed and compared to experience gained from routine clinical operation of such integrated systems. 72% of the total turnover of the Medical Engineering Group of Siemens AG for diagnostic imaging modalities in 1991/1992 arose from digital imaging modalities, and this percentage is expected to continue to increase. This paper will concentrate on these modern digital methods.

Lessons learned while building an integrated ICU workstation

The project LUCY (Linked Ulm Care sYstem) is described. The goal of this project was to build a research workstation in an Intensive Care Unit which enables evaluation of data/information processing and presentation concepts. Also evaluation of new devices and functions considering not only one device but the workplace as an entirety was an aim of the project. We describe the complete process of building from the stage of design until its testing in clinical routine. LUCY includes a patient monitor, a ventilator, 4 infusion pumps and 8 syringe pumps. All devices are connected to a preprocessing computer via serial interfaces. A high performance graphic workstation is used for central display of physiological and therapeutic variables. A versatile user interface provides touch screen, keyboard and mouse interaction. For fluid administration a bar code based control and documentation facility was included. While our scheduled development efforts were below 4 man-years, the overall man-power needed until the first routine test amounts to 8 man-years. Costs of devices and software sum up to 160,000 US$. First experiences in clinical routine show good general acceptance of the workplace concept. Analysing the recorded data we found 90% of the items to be redundant: individual filtering algorithms are necessary for each of nowaday's devices. The flexibility of the system concerning the implementation of new features is far from our expectations. Technical maintenance of the system during clinical operation requires continuous effort which we cannot afford in the current situation.

The missing variable: ensuring a positive ROI (return on investment)

In summary, the business value of IS technology is a function of its role in the organization's business strategy. Value can be assigned to expected benefits from the technology. But, the validity of that determination depends on developing a plan to fully and appropriately use the technology, reengineer operations and embrace a new way of doing business. The need for IS technology in today's healthcare environment is unquestioned. Realizing the full business value of IS technology is the issue. Will it be treated as an expense to be minimized, or as a strategy for the future? A strategy embraced as part of the new evolving healthcare delivery system will result in your investment in IS technology truly being an investment in the future.

A computerized acquisition technique for the Wingate anaerobic test

This paper describes a computerized system for the administration of the Wingate anaerobic test. The rate of pedal revolutions on a cycle ergometer is measured automatically to determine the maximal anaerobic capacity, total energy output and decline of power output over time. The system is cost effective, provides high accuracy and is incorporated into a fitness-analysis system that allows the user to recall and print present and past test results for the monitoring of anaerobic performance.