Computers in hospital management and improvements in patients care--new trends in the United States

Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States

This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, usersatisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.

Tutorial on technology transfer and survey design and data collection for measuring Internet and Intranet existence, usage, and impact (survey-2000) in acute care hospitals in the United States

This paper provides a tutorial of technology transfer for management information systems in health care. Additionally it describes the process for a national survey of acute care hospitals using a random sample of 813 hospitals. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business to business and with customers. The relationships with systems approaches, user involvement, user satisfaction and decision-making will be studied. Changes with results of a prior survey conducted in 1997 can be studied and enabling and inhabiting factors identified. This information will provide benchmarks for hospitals to plan their network technology position and to set goals.

Impact of information systems on acute care hospitals: results from a survey in the United States

These results are from a survey of acute care hospitals in the United States. A random sample of 813 hospitals was selected with 115 responding and 33 incorrect addresses resulting in a 15% response rate. The purpose of the study was to measure the impact and future potential of information systems integration in the financial, medical, and administrative systems of the hospitals. Impact of Information Systems is measured in many ways. Questions about employee moral, reductions in employees, goals being met and overall satisfaction with the systems are asked and results analyzed. This information will provide a benchmark for hospitals to determine their information systems position and technology transfer planning. These analyses will lead to setting goals.

Survey of acute care hospitals in the United States relative to technology usage and technology transfer

This is a national survey of acute care hospitals. A random sample of 813 hospitals was selected. The purpose of the study was to measure the extent of information systems integration in the financial, medical, and administrative systems of the hospitals. The response rate is expected to be approximately 30%. This information will provide a benchmark for hospitals to determine their technology transfer position and to set goals.

An ECG storage and retrieval system embedded in client server HIS utilizing object-oriented DB

In the University of Tokyo Hospital, the improved client server HIS has been applied to clinical practice and physicians can order prescription, laboratory examination, ECG examination and radiographic examination, etc. directly by themselves and read results of these examinations, except medical signal waves, schema and image, on UNIX workstations. Recently, we designed and developed an ECG storage and retrieval system embedded in the client server HIS utilizing object-oriented database to take the first step in dealing with digitized signal, schema and image data and show waves, graphics, and images directly to physicians by the client server HIS. The system was developed based on object-oriented analysis and design, and implemented with object-oriented database management system (OODMS) and C++ programming language. In this paper, we describe the ECG data model, functions of the storage and retrieval system, features of user interface and the result of its implementation in the HIS.

Design of effective health decision support systems: towards automating the health administrators's decision processes

There has been very little evidence to suggest the effective use of, and demand for, computer-based systems by health care administrators to support their increasingly complex decision-making activities. This is so, despite a considerable amount of research attention paid to examining the efficiency and power of mathematical models, and the application of increasingly sophisticated Management Science Techniques to problems encountered within the health care system over the last several years. In recent times, advancing computer technology: 1) promises to close the gap between theory and practice, 2) creates a new perspective for computerized decision support in health care organisations, and 3) points to the need for new directions in research. This paper highlights the factors that are critical to the success of interfacing between health managerial decision-makers and effective computerized decision aids.

A generalizable framework for information systems for physician recruitment/referral

Hospital information systems have evolved from data processing systems for patient billing and payroll to decision-support systems which support decision making at the middle and upper management levels. With the advancements in the areas of database management, expert systems and networks, important hospital functions such as physician recruitment and referral which historically were performed using traditional procedures, are now performed using these computer-based technologies. Develops a generalizable framework for information systems for physician recruitment and referral using technologies of database management, expert systems and networks. This GIS-PRR system may be used by hospitals and other health-care providers to improve the efficiency and effectiveness of the physician recruitment/referral process.

Voting and priorities in health care decision making, portrayed through a group decision support system, using analytic hierarchy process

Within the health care industry many decision making approaches and tools are used. This paper explores a new tool, the Analytic Hierarchy Process (AHP), which permits both subjective and objective information to be considered in a decision. AHP has tremendous potential to solve both traditional and non-traditional health care problems. Its strength as a decision-making tool is its ability to combine both subjective and objective data. Application of AHP is discussed within the context of a Group Decision Support System (GDSS) model developed by Hatcher. The model is reviewed in limited detail, and readers are referred to the original article that defined and discussed the uniqueness and level of sophistication of GDSS applications in the health care industry. Health and medical delivery problems are discussed to highlight AHP requirements and the complexity of AHP applications. Health care applications are unique in that they lend themselves ideally to the use of computer data, image, voice, text, and multimedia concepts.

PC-based application programs in large health care systems

Public health care agencies lack the infrastructure to meet the increasing operational demands on them, but there is little comparative data on alternative operational structures and systems from which to formulate remedies. Improved information management systems could help address both the workload and the gathering of critically needed data. PC-based database and application programs (PC-APs) that communicate with the mainframe are proposed as a methodology for filling the information-processing gap between mainframe computing and manual information systems. We also propose a model for systematic study of information management systems in clinical settings which can be used to evaluate other aspects of clinical program operations as well. A pilot study demonstrating these methodologies suggests that this is a fruitful approach to assessing ambulatory care operations and that PC-APs can improve administrative and clinical functions and enhance FTE productivity at lower overall cost.

The potential for medical informatics in the Eastern Mediterranean Region

This article assesses the potential value of an integrated medical/ hospital information system (IMIS) for the members of the Eastern Mediterranean Region of the World Health Organization, and describes the preliminary results of a feasibility study questionnaire done in December 1989 at Salmaniya Medical Center (SMC) in the state of Bahrain.

Computer Rx: more harm than good?

Clinical information systems (CIS) are health care technologies that can assist clinicians and clinical managers to improve the performance of health care organizations. However, failure to consider scientific evidence of efficacy, effectiveness, and efficiency when selecting CISs is one factor explaining the adoption of systems that do not improve either the quality or efficiency of patient care. This paper discusses a technology assessment framework that can assist decision-makers to evaluate alternative CISs. Existing methodologies developed to evaluate diagnostic and therapeutic technologies can be used by researchers to provide evidence needed by decision-makers at each step of the framework. The rigorous evaluation of CISs prior to their implementation can help decision-makers to avoid adopting "white elephants."

Uniqueness of Group Decision Support Systems (GDSS) in medical and health applications

Group Decision Support Systems (GDSS) are defined and discussed. A GDSS model developed by the author is reviewed in depth for communication of the concepts of GDSS. The model's components are related to health care applications. Questions about unique requirements and level of sophistication in health care applications are explored. What are the differences? What is needed in GDSS software? How do implementation strategies differ? The purpose of this paper is to define and discuss the uniqueness and level of sophistication of GDSS applications in health care. The information requirements and level of information abstraction are the major forces considered in the design of specific medical GDSSs. Data for the GDSS and queries originate both internally and externally to the system. Raw data may be in image form and require extensive analysis by the decision makers for information to be extracted from the raw data. Efforts also are made to relate financial and medical data for better business decisions. This integration often has limited success. Additionally, financial data represent multiple sources and present concerns of validity and reliability. In medical diagnoses the knowledge bases are large and contain thousands of rules. Treatment planning and progress reporting rely on medical records that contain thousands of information items and that often require interpretation by an expert. These information attributes go beyond qualitative versus quantitative definitions and are the author's basis for the analysis presented in this paper.