Today's or tomorrow's computer systems?

The computer technology of behavioral healthcare information systems must meet at least twelve requirements to effectively support clinical and management operations. Existing, antiquated "legacy" computer systems often fail to meet these requirements, due to high cost, slow turnaround, inconsistent data definitions, duplication, inflexibility and the lack of data integrity. There are five major transitions that an organization's information system undergoes to realize the full potential of new technology: from monolithic to parallel architectures; from procedural to object-oriented programming; from structural to relational databases; from legacy to "leap-frog" systems; and from fragmented systems to multimedia.

Influences on the use of capital by public hospitals

This paper examines key influences on the volume of capital employed by public hospitals. Empirical models are constructed and analysed separately for total capital employed and for plant and equipment only, using data from 68 Victorian hospitals. Such data provide an empirical base to guide government decisions on funding capital expenditure in hospitals. The analysis finds that the proportion of hospital expenditure devoted to outpatients and teaching, and the proportion of funding derived from government all influence the level of capital utilised per inpatient. The model provided a reasonable fit for plant and equipment, but much improved data coverage and consistent valuation of land and buildings are required to adequately explain influences on total capital.

Contemporary issues in HIM. Costs of ownership

Cost of ownership includes (among others) initial cost, cost of operation, cost of maintenance, and cost of training. Two important components of initial cost are the cost of design and the cost of manufacturing. In this article, we have looked at how factors other than initial cost affect the total cost of ownership of a product. We also discussed how trade-offs can affect performance and cost. Before making any decision on purchasing a complicated new system, the user needs to evaluate the total cost of ownership to determine which product to buy. Unfortunately, it is not always easy to find all the information needed to make these decisions.

The big-bang-for-your-buck theory

Do it right, and your investment in information technology can have all sorts of strategic payoffs. Do it wrong, and you'll be paying, dearly, for nothing. Here's a guide to evaluating IT and measuring its impact.

Optimizing computer-based system use in health professions' education programs

The use of computer-based systems to support training in health profession education programs has been discussed and analyzed for more than 10 years. The literature is rich with examples of how using these systems can benefit programs by more effectively distributing human resources, by making the delivery of instruction more individual and more flexible, by expanding the professional and technical competence of trainees, and by improving the monitoring of trainee performance. Obstacles to and conventional recommendations for the broadened use of computer-based systems are discussed, and an additional set of system design characteristics are described that health care educators can use in their preview and specifications for procurement of more effective computer-based systems in their training settings.

Product overview. Hot list: critical care/emergency room

June's HotList features emergency room and critical care products. All data have been provided by individual vendors who responded to our survey questions. Computers in Healthcare has made an effort to contact all vendors within this market. See the 1993 Computers in Healthcare Market Directory, for complete listings.

Will architecture win the technology wars?

Success today flows to the company that establishes proprietary architectural control over a broad, fast-moving, competitive space, Charles R. Morris and Charles H. Ferguson claim in "How Architecture Wins Technology Wars" (March-April 1993). No single vendor can keep pace with the outpouring of cheap, powerful, mass-produced components, so customers have been stitching together their own local systems solutions. Architectures impose order on the system and make interconnections possible. An architectural controller has power over the standard by which the entire information package is assembled. Because of the popularity of Microsoft's Windows, for example, companies like Lotus must conform their software to its parameters to be able to compete for market share. Proprietary architectural control has broader implications for organizational structure too: architectural competition is giving rise to a new form of business organization.

The '93 budget imperative: do more with less

Faced with another year of belt tightening, CIOs hope that by doling out the IS dollars more wisely in 1993--to training, maintenance, and client/server solutions--they'll be able to breathe a little easier.

How architecture wins technology wars

Signs of revolutionary transformation in the global computer industry are everywhere. A roll call of the major industry players reads like a waiting list in the emergency room. The usual explanations for the industry's turmoil are at best inadequate. Scale, friendly government policies, manufacturing capabilities, a strong position in desktop markets, excellent software, top design skills--none of these is sufficient, either by itself or in combination, to ensure competitive success in information technology. A new paradigm is required to explain patterns of success and failure. Simply stated, success flows to the company that manages to establish proprietary architectural control over a broad, fast-moving, competitive space. Architectural strategies have become crucial to information technology because of the astonishing rate of improvement in microprocessors and other semiconductor components. Since no single vendor can keep pace with the outpouring of cheap, powerful, mass-produced components, customers insist on stitching together their own local systems solutions. Architectures impose order on the system and make the interconnections possible. The architectural controller is the company that controls the standard by which the entire information package is assembled. Microsoft's Windows is an excellent example of this. Because of the popularity of Windows, companies like Lotus must conform their software to its parameters in order to compete for market share. In the 1990s, proprietary architectural control is not only possible but indispensable to competitive success. What's more, it has broader implications for organizational structure: architectural competition is giving rise to a new form of business organization.

An investigation into the use of a voice operated data input system

The aim of this study was to evaluate a voice operated data collection system intended for use in epidemiological surveys. Three groups of 45 adolescents, with similar caries experience, were examined by one examiner in schools. The caries data resulting from these examinations were collected in three ways; keyboard activated input to a portable computer, paper chart recording followed by manual input on return to base and examiner voice activated input direct to the computer. Maximum levels of accuracy were found with all three methods. The quickest method of collection in the field was by paper chart with a mean collection time per subject of 2.59 min, followed by 3.15 min for the manual keyboard method and 4.07 min for the voice activated method. When all the factors affecting time were taken into consideration it was found that overall the manual keyboard method was significantly faster than both the paper chart method and the voice activated method.

Countering advanced HIS marketing tactics

An explosion of technological advances and system developments in the information systems industry pushes the envelope in both hardware and software design. Equipment breakthroughs--reduced instruction set computing chips, or RISC, and DEC's 64-bit Alpha chip--herald an exciting new era in price-performance computing. And object-oriented programming systems, or OOPS, and computer-assisted software engineering, or CASE tools, both promise a golden age in programming productivity. At the same time however, marketing mavens at healthcare information system, or HIS, vendors keep pace with their cohorts in Research and Development by blazing new trails in the science of sales and marketing. To help healthcare executives keep pace with new developments in selling, let's review a few infamous breakthroughs in marketing. They put a new twist on the old saw: "caveat emptor." Following each marketing "advance" are counters to new marketing tricks, each recommended to keep savvy CIOs a step ahead.

Contract dangers lurk in turnkey implementations

Turnkey systems may seem the simple solution to automating a hospital. But too often, poorly negotiated and vaguely worded agreements turn such purchases into an implementation nightmare.

How Continental Bank outsourced its "crown jewels."

No industry relies more on information than banking does, yet Continental, one of America's largest banks, outsources its information technology. Why? Because that's the best way to service the customers that form the core of the bank's business, says vice chairman Dick Huber. In the late 1970s and early 1980s, Continental participated heavily with Penn Square Bank in energy investments. When falling energy prices burst Penn Square's bubble in 1982, Continental was stuck with more than $1 billion in bad loans. Eight years later when Dick Huber came on board, Continental was working hard to restore its once solid reputation. Executives had made many tough decisions already, altering the bank's focus from retail to business banking and laying off thousands of employees. Yet management still needed to cut costs and improve services to stay afloat. Regulators, investors, and analysts were watching every step. Continental executives, eager to focus on the bank's core mission of serving business customers, decided to outsource one after another in-house service--from cafeteria services to information technology. While conventional wisdom holds that banks must retain complete internal control of IT, Continental bucked this argument when it entered into a ten-year, multimillion-dollar contract with Integrated Systems Solutions Corporation. Continental is already reaping benefits from outsourcing IT. Most important, Continental staffers today focus on their true core competencies: intimate knowledge of customers' needs and relationships with customers.

Improving the efficiency of patient recruitment with an automated telephone screening system in a client-server environment

An automated telephone screening system was implemented at the Baltimore VA Hospital on a Local Area Network (LAN) to evaluate older adults for the GRECC research program. Using the system for decision support, a registered nurse (RN) placed 117 phone calls to older adults in the Baltimore community over a 3 month period. The modular design of the system allowed tracking of inclusion and exclusion criteria which was shared by clinicians and researchers. The design goal of the telephone screening system was to reduce time and personnel costs and increase the effectiveness of screening for recruitment for a major research project. Effectiveness is defined as avoiding under--or over--screening. Using the telephone system, it is estimated the research team saved over $6,000.00 in unnecessary medical evaluation in a 3 months period. As the system develops, the process by which older adults are assessed for research programs in the Geriatrics Service at the Baltimore VAMC will provide additional cost efficiencies.

Computer applications in quality assurance

The computer is rapidly becoming an essential tool for the physician. Proper use of computers in practice will help physicians achieve both higher levels of quality and greater consistency in patient care. Only with computers can physicians rapidly access and process all the data now needed to best address the needs of their patients. As computer use in practice becomes the standard, the inability to use these tools will be incompatible with quality care. The computer is rapidly becoming essential to modern medical management strategies that demand efficiency, accuracy, and cost effectiveness in response to patient demands for assurance that quality care is being delivered.

The case for fan and pump motor speed control

For many years buildings were designed to use standard plant and provide good operational conditions, without consideration of the efficient use of energy. This might have been acceptable when energy was cheap, but with rising energy costs, and recent government instruction to reduce consumption levels, it is necessary to actively consider plant running costs.

Personal computer equipment for dental digital subtraction radiography vs. industrial computer equipment and conventional radiography

A "low-cost" personal computer (PC) system used to digitize dental radiographs was tested by assessing the accuracy of its subtraction images versus those of "high-cost" industrial equipment and conventional radiography. Subtraction images were made of artificial lesions in human femur bone and subsequently evaluated by students and teachers. The observations were analyzed in terms of true positive and false positive reports. "Low-cost" and "high-cost" subtraction images revealed only small differences in diagnostic accuracy. Compared to conventional radiography, the diagnostic accuracy of the subtraction images with the "low-cost" PC system was significantly higher for all observers. The interexaminer variance was similar for the subtraction and the conventional images for both students and teachers, except for a significantly reduced interexaminer variance for the teachers concerning the true positive reports with the "low-cost" PC subtraction technique.