Implementation of a computerized physician medication order entry system at the Academic Medical Centre in Amsterdam

In the period 1997-2001 the Academic Medical Centre in Amsterdam implemented the computerized physician medication order entry (CPmOE) system Medicator. This article describes several important aspects of this program: technological architecture, features, implementation project, authentication and training, continuous support, human resource investments, route of prescription, logistics and administration. Furthermore important advantages and disadvantages of the CPmOE system are discussed. Advantages mainly concern patient safety and drug logistics, while disadvantages are related to access to a computer, user friendliness of the software and printer problems.

Implementing a mission-based reporting system at an academic health center: a method for mission enhancement

PURPOSE

To describe the utility of school-wide use of mission-based reporting (MBR) for medical school deans and department chairs.

METHOD

All faculty members in the University of California, Davis, School of Medicine reported their clinical, creative, teaching, and service activities for 2000-2001 to the MBR system. The authors report on school-wide and department MBR profiles, and profiles by rank and academic series. They validate MBR by comparing individual results with actual merit actions reviewed independently by the school's academic personnel committee.

RESULTS

A total of 419 faculty members (85%) completed their MBR reports. The average faculty member spent considerably more than 50 hours per week fulfilling the missions of the school, and full professors and faculty members in academic series supported by state funds were the most productive in investigative and creative work. The teaching load was shared equally by all the academic ranks, although the clinician-scholars taught more than did faculty members in the other series. There was an inverse relationship between clinical load and academic rank, with the majority of the clinical work performed by junior faculty members. MBR results compared favorably with the merit review process, although MBR is not expected to replace the traditional peer review system.

CONCLUSION

The creation of these graphic profiles and summaries is a valuable feature of MBR that would not have been possible without such quantitative data. The profiles allow monitoring to ensure that workload conforms to established objectives for individuals, departments, academic ranks and series. Finally, the authors discuss future directions for their MBR system.

The unilateral DNR order--one hospital's experience

Hospital or institutional policies that guide the activity of nurses in the care of their patients may, at times, be controversial. Nursing staffs often act as gatekeepers of patient care activities and the implementers of institutional policy. When nurses raise questions as to the appropriateness of a given policy statement, the institution should take serious notice and, perhaps, even study the policy outcomes that relate to the concerns expressed by the nursing staff. This article introduces a policy that originally prompted serious concerns by the nursing staff at one institution. The nursing staff voiced their concerns regarding a revision in the DNR policy that would allow physicians to write unilateral do-not-resuscitate (DNR) orders. Because of this, a review of this policy took place and the results were used to dispel unfounded concerns and also to improve the use of the policy. This article may help nursing administrators to understand better the importance of policy-related studies and it may also encourage nurses to question policy statements and guidelines that may present some concerns. Enhanced patient care will ultimately result by such teamwork and scholarly activity.

The success of emergency telemedicine at the State University of New York at Buffalo

The Telemedicine Program at the State University of New York at Buffalo, School of Medicine, and the Erie County Medical Center (UB/ECMC) represents a "quiet success story" for telemedicine development. Though a relatively young program starting in 1992, it demonstrates steady and consistent progress in the areas of clinical services, education and research as it continues to develop as a comprehensive university telemedicine program. The Emergency Telemedicine program provided 2,294 consultations in 2001. Other services included clinics in Gastroenterology, Infectious Disease (HIV/AIDS), Psychiatry, Orthopedic Hand Surgery, Dermatology, and Neurology. The UB/ECMC program has sponsored regular education activities with a focus on internet protocol (IP) videoconferencing for grand rounds in emergency medicine and traffic injury research, nursing education, distance precepting of nurse practitioner students on clinical rotations, Megaconference I and II presentations, and the continuing exploration of advanced tools for educational presentation over the internet. The program's research activities have focused on portable, roll-about telemedicine systems and virtual palpation using a data glove.

Decision making in acquiring medical technologies in Israeli medical centers: a preliminary study

OBJECTIVE

This preliminary study had two objectives: a) charting the considerations relevant to decisions about acquisition of new medical technology at the hospital level; and b) creating a basis for the development of a research tool that will examine the function of the Israeli health system in assessment of new medical technologies.

METHODS

A comprehensive literature review and in-depth interviews with decision makers at different levels allowed formulation of criteria considered by decision makers when they decide to purchase and use (or disallow the use) of new medical technology. The resulting questionnaire was sent to medical center directors, along with a letter explaining the goals of the study. The questionnaire included 31 possible considerations for decision making concerning the acquisition of new medical technology by medical centers. The interviewees were asked to indicate the relevance of each consideration in the decision-making process.

RESULTS

The most relevant criteria for the adoption of new technologies related to the need for a large capital investment, clinical efficacy of the technology as well as its influence on side effects and complication rates, and a formal approval by the Ministry of Health. Most interviewees stated that pressures exerted by the industry, by patients, or by senior physicians in the hospital are less relevant to decision making. Very small and usually not statistically significant differences in the ranking of hospital directors were found according to the hospitals' ownership, size, or location.

CONCLUSIONS

The present study is a basis for a future study that will map and describe the function of hospital decision makers within the area of new technology assessment and the decision-making process in the adoption of new healthcare technologies.

A mission-based reporting system applied to an academic pathology department

We report how data from the University of California (UC) Davis mission-based reporting system (MBR) can be used to define contributions for each division within a Department of Pathology based on faculty rank and series, and to evaluate whether these contributions are in alignment with the missions of the department and the goals of the school's leadership. MBR summary reports were generated for each division within the Department of Pathology; these reports illustrated the average contribution for each faculty rank and series in each of the following missions: investigative/creative work (research), teaching, clinical service, and administrative/community service. All divisions contributed equally to the teaching mission, averaging approximately 1/3 of a faculty member's time. Research was the primary mission for faculty in both the Research and the Clinical Pathology divisions, whereas clinical service was the primary mission for Anatomic Pathology. Both Anatomic Pathology and Clinical Pathology also played a large role in the administration/community service mission. These roles were appropriate based on the division's distribution of faculty in each of the faculty series. The average contribution to both the research and administrative/community service missions were larger for the Department of Pathology than it was for the school as a whole. The Department of Pathology's average contribution to both the teaching and clinical service missions was less than the school's average. We conclude that MBR data creates unique profiles for divisions and the department and enables interdepartmental comparisons that would not be possible by other means. Within the context of our school, the present analysis illustrates that the Department of Pathology is fulfilling the expectations of the school's leadership. In a more general sense, these profiles allow appropriate monitoring of the workforce, funds flow analysis, allocation of resources, and strategic planning in an academic medical center.

[An information system for the analysis of economic indices of the activity of a medical institution]

An information technology for analyzing the economic parameters of a medical institution is suggested in the article within the framework of the information system already functioning in the Republican foundation of compulsory medical insurance (Bashkortostan). The analysis of financing the therapeutic-and-prophylactic facilities is based on the graphic-and-analytic method and on extensive real statistics.

Opening of Hillman Cancer Center reaps generous media coverage. UPMC News Bureau enjoys results of ongoing efforts

The new Cancer Institute (UPCI), research facility of the UPMC (University of Pittsburgh Medical Center) Health System opened in October 2002. Named The Hillman Cancer Center after noted local philanthropists, it provides a natural opportunity for the UPMC Health System News Bureau to continue its educational goals. Extensive media coverage was valued at nearly $300,000.

Extending the hand of knowledge: promoting mobile technologies

The widespread use of handheld computers and other mobile devices in the healthcare environment and their potential for providing access to information has prompted health sciences librarians everywhere to learn more about this technology. Early in 2001, the Health Sciences Library (HSL) at the University of North Carolina at Chapel Hill began exploring ways to support mobile computing. This paper describes the four basic approaches taken by the librarians that helped establish the HSL as a leader in the area of mobile technologies.

Implementing PDA technology in a medical library: experiences in a hospital library and an academic medical center library

Personal digital assistants (PDAs) have grown from being a novelty in the late 1990s to an essential tool for healthcare professionals in the 2000s. This paper describes the experiences of a librarian who implemented PDA technology first in a hospital library, and then at an academic medical center library. It focuses on the role of the library in supporting PDA technology and resources. Included are programmatic issues such as training for library staff and clinicians, and technical issues such as Palm and Windows operating systems. This model could be used in either a hospital or academic health sciences library.

The benefits of library liaison programs for small libraries: an overview

Library liaison programs are commonly used and provide a successful framework for communication in academic libraries. Liaison programs, whereby librarians are formally designated as the primary contact between the library and one or more departmental or administrative units, are proven to improve the transfer of information between the library and users, to improve the quality of collections and services, and to enhance the library's image. Previously published literature on liaison programs is primarily devoted to large-scale liaison programs in academic settings, the market where this model is commonly employed. Small hospital and other smaller libraries are nearly absent in the literature, reflecting the low level of liaison use in the smaller library setting. This article invites hospital and other smaller libraries to explore the liaison model by presenting common liaison goals and activities that are not only pertinent to, but also scalable, adaptable, and adoptable by smaller and larger libraries alike.

Nurse leaders' perceptions of what compromises successful leadership in today's acute inpatient environment

The purpose of this study was to gain an understanding of nurse leaders' perceptions of both the value of their roles in today's health care setting and their beliefs about how power and gender interface with role worth. Support for the theoretical significance of this research stemmed from Kanter's Structural Theory of Organizational Behavior. Four leaders were recruited at the executive level and 12 at the director/managerial level. The results of the deductive analysis supported Kanter's theory. Eighty-three percent of the nurse leaders validated that access to power, opportunity, information, and resources created an empowered environment, producing a climate that fostered leadership success and enhanced levels of job satisfaction among nurses. This study provided groundwork on the kinds of leadership traits that foster nursing satisfaction and on whether or not gender influences leadership effectiveness. The findings of this study are both timely and relevant for nurse leaders faced with the effects of the current supply-and-demand nursing shortage and with fiscal restraints mandated by managed care and regulatory agencies.

Radical systems change. Innovative strategies to improve patient satisfaction

A project was initiated at Northwestern Memorial Hospital in Chicago focusing on patient satisfaction in the outpatient setting and how to improve it. Eight outpatient diagnostic areas were selected and a steering committee was formed. The team used patient satisfaction scores and patient and staff interviews to identify areas for improvement. Innovations were implemented in communications and information technology, staff role design, and process flow. Successes were realized in patient satisfaction above the 95th percentile, improved staff satisfaction, productivity, and internal and external recognition. The program serves as an organizationwide model supporting the hospital's Best Patient Experience strategic goal. This patient-focused model is being replicated in other areas of the hospital and can be replicated elsewhere.

A survey of academic departments of emergency medicine regarding operation and clinical practice: two years later

OBJECTIVES

To survey academic departments of emergency medicine (ADEMs) concerning their operation and clinical practice.

METHODS

A survey was mailed to the chairs of the 53 ADEMs in the United States established prior to 1999 (as listed on the Society for Academic Emergency Medicine website) requesting information on operations and clinical activity in budget year 1999-2000 compared with 1997-1998. These results were then compared with results of similar surveys conducted in the autumns of 1996 and 1998.

RESULTS

Forty-eight ADEMs (91%) responded. For 1999-2000, compared with 1997-1998, 38 ADEMs (79%) reported an increase in emergency department (ED) patient volume; five (10%) reported a decrease. Thirty-one (65%) ADEMs reported an increase in ED patient severity of illness, whereas only one (2%) reported a decrease. Thirty-two ADEMs (67%) reported an increase in net clinical revenue, and eight (17%) reported a decrease. Only five ADEMs (10%) said that other academic departments within their university/medical center aggressively directed patients away from the ED, compared with nine (22%) in the 1998 study. The percentage of ADEMs using mid-level providers remained essentially unchanged over the three studies-31 (66%) in 1996 versus 28 (68%) in 1998 and 31 (65%) in the present study. For all the studies, mid-level providers were most commonly used in a fast-track setting. The number of ADEMs with an observation unit has also remained relatively stable-18 (38%) in the current study versus 15 (31%) in the 1998 study. In the current study, only two (4%) ADEMs experienced a merger with another university system, compared with 12 (29%) in 1998. Eight (17%) ADEMs reported that their institution had merged with a private entity in the current study, compared with nine (22%) in 1998.

CONCLUSIONS

ADEMs continue to experience some very positive trends, namely, increases in ED patient volume, in severity of patient illness, and in net clinical revenue.

Relocating rheumatology patients to a new infusion center at Duke: a case study

This case study concerns relocating rheumatology patients at Duke University Medical Center to a new infusion center located in a physician based treatment setting. The case study follows the managerial decision-making process as it describes how the infusion center treatment site was chosen, how it was set up, how it functions, and what benefits to patient care it provides. A successful site-of-car relocation requires strong managers who are able to weigh objectively alternative courses of action. Moreover, the project champion must be able to distinguish key factors inside and outside the organization and chart the project's course accordingly.