Showing papers in "Journal of Medical Systems in 1986"

The computerized severity index: a new tool for case-mix management

Abstract: We describe the new Computerized Severity Index (CSI) that is obtained from an expanded discharge abstract data set, based on a 6th-digit severity addition to the ICD-9-CM coding system. The new 6-digit code book (called ICD-9-CMSA) is used to label existence and severity of each principal and secondary diagnosis. It can be used to produce an overall severity of illness level for each hospital inpatient. The impact of severity-adjusted DRGs on prospective payment and uses of the CSI for assessing quality of care, efficiency, physician practice profiles, and prediction of posthospital resource needs are discussed.

Problems in establishing the medical expert systems CADIAG-1 and CADIAG-2 in rheumatology

Abstract: CAD1AG-] and CADIAG-2 are medical expert systems with applications in rheumatology, gastroenterology, and hepatology. CADIAG-1 is based on a symbolic logic representation of medical relationships between symptoms, signs, or findings and diseases. Definite relationships (obligatory occurrence, confirming, and excluding) as well as uncertain relationships O~aculta tire occurrence and not confirming) are applied to confirm or exclude diagnoses and to establish diagnostic hypotheses. CADIAG-2 employs fuzzy set theory and fuzzy logic to formalize medical entities and relationships. The medical concept of confirming or excluding diagnoses is identical to that of CADIAG-1, but diagnostic hypotheses are generated differently. Here, a documentation of medical relationships allowing gradual transitions from "always" to "never" for the frequencies of occurrence of symptoms with and from "strong" to "weak"for their strengths of confirmation for diseases leads to strongly or weakly supported diagnostic hypotheses in the actual case. Tests with 322 real patient cases from a rheumatological hospital, each including between 500 and 700 symptoms, signs, and findings, were carried out. The percentage of cases diagnosed correctly is about 80%. Problems and pio~alls that became apparent in the evaluation of the cases are shown and discussed.

Maximizing the benefits of health care information systems

Abstract: Information systems can improve cost control, increase the timeliness and accuracy of patient care and administration information, increase service capacity, reduce personnel costs and inventory levels, and improve the quality of patient care. However, experience shows that most of these benefits will not occur automatically following system implementation. Operational problems may exist that diminish information timeliness, accessibility, and accuracy; policies and procedures may not have been sufficiently tailored to reflect the realities and intents of the systems; and personnel tasks may not have been adequately restructured. In order to realize the full potential of information systems, health care organizations must plan for and implement strategies that are designed to maximize such benefits. This paper describes a method for developing benefits maximization strategies. The processes used to define strategies and their outcomes are presented.

Design of a management support system for hospital strategic planning

Abstract: Recent changes in the health care industry that foster competition are drastically affecting hospital planning and marketing activities. Increased price competition, the development of less costly alternative health care delivery systems and providers, and the shift to prospective average-cost reimbursement for Medicare beneficiaries are major factors promoting a new emphasis on strategic hospital planning. Hospital information systems do not currently support the sophisticated data-collection and analysis requirements that will be needed to implement strategic planning activities. New data must be collected and old data must be analyzed and stored in new ways. New hospital information systems designs are needed to cope with the change in the economic structure of the health care industry and its effects on hospital information needs. This paper proposes a system design for a management support system that will assist hospital administrators and planners in analyzing internal organizational data and external industry data to develop strategic planning objectives, strategies, and business plans. Analysis of the structure and process of hospital strategic planning was performed to identify the information needs of hospital planners. A prototype system is currently being implemented at the University of Arizona. The system provides an integrating framework for data base management systems, executive information systems, model management systems, and dialogue management systems. Objective analytical models and subjective strategic planning models are available to assist with idea structuring and decision processing.

Overview of an architectural approach to the development of the Johns Hopkins Hospital distributed clinical information system

Abstract: The Johns Hopkins Hospital has initiated an ambitious program to apply modern technologies to the development of a new, comprehensive clinical information system. Since many components of a system exist and since the JHH management is decentralized, a distributed, networked system is being built. To properly accomplish this task an architectural basis for strategic systems planning was developed. This paper reviews briefly the layered architectural approach.

Local network and distributed processiing issues in the Johns Hopkins Hospital

Abstract: The Johns Hopkins Hospital has initiated an ambitious program to apply modern technologies to the development of a new, comprehensive clinical information system. One component of this system is a networking technology for supporting the integration of diverse and functionally distinct information systems. This paper discusses the selection of the networking technology implemented at JHH, issues and problems, networking concepts, protocols, and reliability.

Hospital information systems—friend or foe? a management perspective

Abstract: Hospital Information System—Friend or Foe? It is hoped that after reading this paper it is apparent that an HIS can be either. The executive sponsoring the project controls its fate. The system can be a friend, enhancing the success of the executive and his/her organization, or it can be an expensive disaster. If an organization initiates a system implementation haphazardly, without the commitment of the executive and a definite set of objectives to be achieved, it is risking disaster. Alternatively, if the techniques presented in this paper are adhered to, the organization can expect to reap the benefits provided by a successful integrated hospital information system. Friend or Foe—the decision is yours.

Interactive videodisc to teach combat trauma life support

Abstract: Training military physicians in trauma management is a dilemma in peacetime, since there are few opportunities to gain clinical experience within the military care system. This program provides experience in clinical decision making through case simulation. Five cases, of increasing difficulty, are presented in a single videodisc side. The program is implemented on a system based on the IBM PC, and is written in the C programming language. The program emphasizes clinical realism by providing many clinical options at each decision point, and by audiovisually depicting combat clinical care in very realistic ways. The user interface is flexible and, though complex, is easy to use; it is supported by a narrated, on-line tutorial.

Computer-assisted instruction: an overview

Abstract: The development of computer-assisted instruction (CAI) is discussed and definition of major concepts is presented. The three major types of CAI (drill and practice, tutorials, and simulations) are defined and examples given for each. The impact of CAI in nursing is discussed and several CAI systems are described.

The request for proposal (RFP): the key document in successful systems acquisition

Abstract: The health care industry is complex and changing. Management in this environment requires significant quantities of acurate timely data for administrators and clinicians alike. In response to this demand, health care facilities have sought to upgrade or replace their computer systems with ones that have greater ability to enhance decision making in real time. The standard development process dictates a requirements analysis, with a Request for Proposal (RFP) as a likely product. This document, which delineates the institution's needs and provides a guide for appropriate vendor responses, has been given scant attention in the literature, particularly in the health care environment. This paper attempts to provide insight into what the goals and objectives of the RFP should be and explicates those elements that are necessary to produce an effective instrument. It details what information should be included about the institution, basic hardware and software issues that should be addressed, and proposes guidelines for response and evaluation. It is suggested that the proper development of an RFP will be a key factor in the successful acquisition of an appropriate health care information system.

Cost-benefit of laboratory computer systems

Abstract: The benefits and costs of a computer laboratory information system have been evaluated in three military hospitals, using a pre- and postimplementation comparison of time spent by laboratory and medical staff on information-handling activities, turnaround time for laboratory results, and staff perceptions of performance. The evaluation indicates that the laboratory information system is very cost-effective. A major benefit is the reduction in nursing staff time required to obtain laboratory test status and results.

An inexpensive and portable talking-tactile terminal for the visually handicapped

Abstract: The visually handicapped computer user or programmer is faced with a very difficult task in interfacing with computing hardware. The types of equipment currently available for this purpose fall into one of several general categories: expensive, nonportable, and domain-specific. In the current paper, we describe a new terminal device designed specifically for the visually handicapped that answers all of the problems mentioned above. The work is already under way, with a prototype model is currently in use by a visually handicapped programmer on the development team. In the remainder of this paper we will present a report on the current status of our project as well as plans and milestones for future work.

A method linking statistics and knowledge engineering for making medical consulting systems: a medical consulting system for electric response audiometry through auditory slow vertex response

Abstract: There are two methods of making medical consulting systems: the statistical method and the knowledge engineering method. Since both of these methods seem to be very different from each other, they have been recognized and applied separately. We contend, however, that a combination of statistics and knowledge engineering is a more effective and suitable way to create a medical consulting system than is the use of either method alone. In order to justify this contention, we created a medical consulting system, AUTSVR-V1.1, which detects auditory slow vertex responses (SVR) through observing and identifying background activities of the electroencephalogram (EEG) automatically during measurement of SVRs for the purpose of objective electric response audiometry (ERA), and compared it with AUTSVR-V1.0, which depends on statistics only.

Standardizing the Raster display for medical images using a fixed set of frame buffer primitives

Abstract: Two major difficulties associated with medical image processing are the diverse image formats that must be dealt with because of the differences in image sources and the number of incompatible display systems available for viewing images both before and after processing. We describe a very small set of primitives that need to be defined to utilize any raster display. When these primitives have been implemented for a particular device, then a standard set of image display programs can be compiled and images and the results of image processing can be displayed. The main purpose of this paper is to describe what a raster display looks like from the point of view of the programmer and to define the specific hardware and software data about the raster display that must be known in order to implement the small set of primitives.

National survey of hospital data processing -1985

Abstract: The National Survey of Hospital Data Processing contains a great wealth of information that the hospitals have contributed in respect to the trends and changes that are now occurring within our hospital data-processing environment. 2-5 We wish to thank all of those hospitals that have participated in this study and have been willing to provide the kind of information that is so essential in tabulating these results. It is our hope that this report will provide some measure of return on your investment and that it will supply some answers to you as you face the difficult questions of planning and projecting for the future. A great deal more information is contained within the study, but it cannot be presented because of the sheer volume of information that remains. For this reason, the survey has been structured as an on-line database rather than a report. We ask that those who have interests in seeking more in-depth information from these files contact our publishing office so that we can advise you of ways that this information can be conveniently made available to you for your special project. There will be a follow-up report for 1986 when that database is complete. For those who wish to do longitudinal studies, a parallel volume was published in August 1985 that should provide a 4-year perspective on the field of hospital data processing.

Impact of computerization on laboratory staffing

Abstract: On the basis of state-wide longitudinal data from 80% of the hospitals in Kentucky, regression manpower models were developed. The results indicate that computers in hospital laboratories do not necessarily cut down on manpower needs but rather increase the number of higher-level manpower positions, those of medical technologists.

Dissemination of COSTAR: promises and realities

Abstract: COmputer-STored Ambulatory Record (COSTAR) is an automated medical record, fiscal management and reporting system, developed in the mid-1970s for use in ambulatory care settings. Its flexibility, full functionality, low cost, and transportability held great promise for wide system dissemination in the 1980s. Reportedly, over 150 health organizations have installed COSTAR worldwide. In reality, this number represents a small fraction of the potential market. Several factors are listed below as contributing to the slower than expected dissemination. Of major importance may be that COSTAR--written in the MUMPS language--could not be installed on IBM hardware. Recently, however, third-party software houses announced MUMPS operating systems that allow COSTAR to run in a multiuser environment on the IBM PC/AT. Developments in the microcomputer field that may impact on the dissemination of COSTAR are described in this paper in addition to early experiences at MITRE with COSTAR on the IBM PC/AT.

Keyboards for the handicapped: a new concept

Abstract: A keyboard has been designed and constructed for persons restricted to using a head or mouth stick. The keyboard is not a modification of existing keyboard technology but involves a completely new concept. The keyboard, called a 2DOF keyboard, requires only two degrees of freedom motion for actuation. The problems of simultaneous key requirements, accidental key strikes, and multiple strikes of the same key have been solved. The keyboard is transparent to the personal computer to which it is connected, allowing use of any available software.

Preparing faculty to use and develop computer-based instructional materials in nursing

Abstract: This paper identifies the need for more specific guidelines in preparing faculty to use and develop computer-based instructional materials. Cory's model for faculty development is described and planning considerations are outlined. Finally, components of this multifaceted approach to faculty development--identifying available resources, emphasizing the current uses of computers, providing computer literacy/faculty awareness sessions, focusing on the instructional use of microcomputers, collaboration, and communication--are discussed.

Design of an integral computer-based wheelchair controller/linear synchronous motor system

Abstract: The purpose of this paper is to illustrate the advantages of designing computer-based motor controllers together with innnovative motors, such that maximum controller/motor system benefits are obtained. Specifically, this paper describes how a computer-based controller/drive system for powered wheelchairs has been designed and is being built and tested. This type of integral controller/drive system has been possible to build into a wheelchair only with the advent of the microprocessor-based feedback motor controller. The type of motor chosen for this project was a linear synchronous motor (LSM), which is highly efficient (90%+) and could easily be made an integral part of a wheelchair wheel, providing a “no-moving-parts” drive system. However, an LSM cannot be variable-speed-controlled without knowledge of, and controlled adjustment to, the absolute rotor versus stator position at each point in time. Microprocessor-based feedback motor controllers make precise, efficient control of LSMs possible at a reasonable cost. In addition, this combination of controller and motor provides a very flexible wheelchair controlldrive system that may be easily programmed to suit the needs and necessities of the wide variety of over 200,000 persons now using powered wheelchairs.

The POSCH data processing experience: the problem of metadata

Abstract: Metadata, the term, may be new but metadata, the concept, is not new. For purposes of this paper, the term metadata is defined as the data used to define, store, retrieve, combine, analyze, and present the data values (the “real” data, so to speak). As clinical research studies get larger, it becomes desirable to use automated managers of the metadata. The Program on the Surgical Control of the Hyperlipidemias (POSCH), a national multiclinic clinical trial, manages most of its metadata manually but has been experimenting with ways to more fully automate them. Its Information Management System (IMS) is described with special emphasis on how it manages the metadata. The case is presented for further automation and standardization of metadata in large clinical research studies so that costs can be contained and smaller increments of “progress” can be measured. The concept of a Metadatabase Management System (MDBMS) is developed and illustrated using POSCH.

Portable and desktop microcomputers for patient care charting

Abstract: Microcomputers are perfectly suited for the input, storage, display, and printing of medical information. The most efficient method of data input and verification is by health professionals themselves, at the bedside or in the exam room. Battery-powered microcomputers are now available with all the power and function of desktops. One patient-care software package [Smart-Chart(tm)] allows entry of clinical data into battery-powered computers such as the Epson Geneva or Data General One, and two-way communication of such data with IBM-PC compatibles. This system inexpensively places a complete computer system in the hands of health professionals in all locations of practice (even at home for use during telephone calls). A dozen or so floppy disks can allow primary physicians to have immediate access to current information on all patients in their practice. Medical notation by computer may now achieve its full potential for clarifying medical records, improving patient care, and diminishing the frustration of medical practice.

An information theoretic method for classifying patients according to the risk of adverse hospital incidents

Abstract: The measure of Mutual Information is used to select, out of a large number of possibly interrelated qualitative patient variables, those that are most related to the probability of occurrence of adverse incidents. The subpopulations defined by the variables selected are grouped according to risk levels while minimizing the loss of information. Results of the application of the method to predict the occurrence of three types of incidents in four hospitals are reported.

Developing computer simulations for staff nurse education

Abstract: Computer-assisted instruction holds promise for individualizing continuing education programs. This article describes how staff nurse educators are taught how to use the principles of instructional design to write clinical nursing simulations. At the conclusion of a 15-hour workshop participants have written, programmed, and begun the process of field testing their simulation.

The impact of microcomputers on program excellence

Abstract: The following criteria were used to document program enhancement after the implementation of a microcomputer laboratory: faculty and student attitudes toward computer-assisted instruction (CAI); student anxiety scores toward state board examinations; increased visibility of the college (number of authored CAI modules, CAI grants, computer committee memberships, faculty attendance at computer courses); and relationship involving learning style, attitude, and student learning. Ninety-two of 112 students and 39 of 55 faculty responded to the request for data collection. Postimplementation, both faculty and students showed mean increases in their attitude toward CAI, although not statistically significant. Senior students had significantly decreased anxiety scores toward the state RN licensure examination after using Mosby's NURSESTAR for review (p<.001). Increased visibility was also documented, but data collection continues regarding the relationship involving learning style, attitude, and student learning. It was concluded that the innovation of computers in an established nursing curriculum served to enhance program excellence.

A detecting method for the fetal QRS complex with a small amplitude

Abstract: It is often impossible to determine the presence of the fetal QRS waves from leads on the maternal abdomen because the amplitude is small or noise interferes. Yet, clinically, confirmation is highly necessary. Clinicians face a great difficulty when the fetal QRS waves are not identifiable: when, for example, they are not apparent owing either to the fetal death or to the poor recording system. We therefore developed the fetal QRS complex detecting system for computer use. This system was developed through the use of two procedures. First, possible fetal QRS waves were detected by computing slopes of moving regression lines. Second, the location of the fetal QRS waves was determined from possible fetal QRS waves by using the weighted period-gram method. We recognized that this system can detect fetal QRS complex from fetal ECGs that are affected by mixture noises in the fetal ECGs accompanying both cephalic and breech presentations.

Medical diagnostic support for spacecraft: the NASA project

Abstract: In today's fast paced high-tech world, the idea of space travel and space stations is not an uncommon topic of discussion. Only 20 to 30 years ago, the Saturday afternoon matinee showed spellbound youngsters a vision of spaceships, laser beams, and a host of odd-shaped objects traveling at the speed of light. Since the advent of the space shuttle and the economic possibilities of industrial parks in space, we now can begin to plan in earnest about human life in space and extended trips for planetary exploration. Although space offers many opportunities, it also carries with it the same risks that exist on planet earth. Man, as the predominant resource in making this transition possible, will definitely be involved in future space travel and was originally planned to be part of the long space-probe missions that went to Mars and Saturn. It was out of that era that this diagnostic support project was born some 6 to 7 years ago when it was felt that humans would be needed for mission support on board space vehicles. Although extended manned missions have never been undertaken by the United States, we anticipate that there will be such programs in the near future and that humans will be sent to other planets just as early explorers came across the ocean in sailing craft.

Does your hospital need a robot or a management trainer? On advising the health care executive who is interested in innovation, but uncommitted to it

Abstract: Executives of small hospitals and home health services have heard that this is the Age of Computers, Telecommunications, Robotics, and Gene Engineering, and they wonder if their organizations might benefit from the high technology and advanced management tools employed by big corporations and “leading edge” hospitals. But they are too tired and busy to greatly expand their technical/managerial expertise, especially since there are so many choices among possible innovations, ranging from robotics to management training, each choice demanding different new expertise, and each requiring an investment of time and energy. We helped several health care executives to identify their options for innovation. We offered a scoring scheme to sort out the innovation options (a simple but effective way to decide what innovation would be “right” for their organization), and a simple, “back of the envelope” tutorial on robotics in health care. The principle is to allow the administrators to make a quick evaluation of the paths they might wish to travel. Our point here is that for every “natural-born” innovator, there must be dozens of interested but uncommitted persons who need some gentle, simple help. To the extent that the diffusion of medical systems depends on a mass market, these fence-sitters must receive help and guidance.

Market model addresses hospitals' need for decision support

Abstract: A Decision Support System should be approached, not as “starting over,” but as a natural extension of the design and development of a hospital's current HIS. Integrated, real-time HISs generate reams of information that, when combined with relevant external data, provide the essential information base for a hospital DDS. The Travenol Market Model is discussed as an example of a DSS specific to hospital needs.

Human factors design of a video monitor emulator and display (VMED) for visuallyimpaired computer users

Abstract: This paper describes research conducted by the Atlanta VA Medical Center in the area of visual impairment and computer usage—in particular, work on the design of a device that reformats computer video output for use by persons with limited usable vision. The objective of the current project is to design, build, and test a video/video control interface that can be connected to and will reformat the video data of any general-purpose computer/word processor. The objectives of this work are (1) to complete a human factors analysis of types of tasks performed on computers/word processors, and (2) to design and build a universal interface that implements the results of the aforementioned study.