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Showing papers in "Journal of Medical Systems in 1988"


Journal ArticleDOI
TL;DR: The computerized operating room scheduling and monitoring system is described in this article and an operational measure of scheduling accuracy is proposed and suggested for incorporating into planning and allocation decisions.
Abstract: As health care providers seek ways to reduce the cost of health care services, hospital operating rooms (ORs) have been identified as potential areas for cost reduction efforts. Cost containment efforts which have shifted significant portions of the inpatient population to ambulatory areas have resulted in an inpatient population which is sicker and more procedure-intensive. Efficient management of operating rooms has assumed even greater importance in this environment. Inefficient or inaccurate scheduling of OR time often results in delays of surgery or cancellations of procedures, which are costly to the patient and the hospital. Approaches to efficient use of ORs include computerized scheduling, utilization monitoring, and refinement of scheduling policies and procedures. In the absence of commercially avaiable software to meet operating room management information needs, Johns Hopkins developed its own system in 1983. This software provides detailed information for daily OR management and long-term planning. The computerized operating room scheduling and monitoring system is described in this article and an operational measure of scheduling accuracy is proposed. Suggestions are made for incorporating this measure into planning and allocation decisions.

99 citations


Journal ArticleDOI
TL;DR: A methodology to determine and maintain the schedule times used in a computer-based OR Scheduling System is presented and state-of-the-art equations to be used for different scheduling situations are presented.
Abstract: A methodology to determine and maintain the schedule times used in a computer-based OR Scheduling System is presented. State-of-the-art equations to be used for different scheduling situations are presented and discussed with the attendant data base reduction methodology to provide the scheduling parameters. An example is given of the data reduction methodology as well as suggestions for maintenance of the data base.

40 citations


Journal ArticleDOI
TL;DR: This article presents an expert system called MEDELEX (MEdicaidELigibilityEXpert) for determining Medicaid eligibility, written in Prolog and designed in such a way that it can be readily modified to take into account the state-to-state variability in eligibility requirements for AFDC Medicaid.
Abstract: The eligibility requirements for AFDC Medicaid are so extensive and complicated that most health care providers do not attempt to ascertain whether or not a particular patient is eligible for the program, even when no other source of payment is available. This results in lost revenue for health service providers nationwide amounting to hundreds of millions of dollars per year. Computer technology, in the form of expert systems, offers an opportunity to rationalize the Medicaid eligibility determination process and to do real-time assessment of patient eligibility. This article presents an expert system called MEDELEX (MEdicaidELigibilityEXpert) for determining Medicaid eligibility. The program (when run on an 8 MHz MS-DOS microcomputer with at least 640 KB of RAM) requires about 20 min for data entry and 5 sec for the actual eligibility determination. The expert system was written in Prolog and has been designed in such a way that it can be readily modified to take into account the state-to-state variability in eligibility requirements for AFDC Medicaid.

25 citations


Journal ArticleDOI
TL;DR: Using criteria such as reliability, clinical validity, homogeneity, number of categories, and data acquisition costs, the analysis suggests that while none of the hospital patient classification systems is perfect, great strides have been made in reflecting the multiproduct nature of thehospital.
Abstract: Concerns about inefficiency and excessive expenditures has stimulated interest in the measurement of the output of the hospital, an organization that produces a wide variety of products. Diagnosis Related Groups and a number of severity measures including Disease Staging, the Severity of Illness Index, and Patient Management Categories are described and evaluated. Using criteria such as reliability, clinical validity, homogeneity, number of categories, and data acquisition costs, the analysis suggests that while none of the hospital patient classification systems is perfect, great strides have been made in reflecting the multiproduct nature of the hospital.

22 citations


Journal ArticleDOI
TL;DR: The current state of informations systems in hospital management is discussed, including decision support systems for the management, administrative and patient care units of the hospital.
Abstract: This article discusses the current state of informations systems in hospital management. Decision Support Systems (DSS) for the management, administrative and patient care units of the hospital are described. These DSS's include market planning, nurse scheduling and blood screening systems. Trends for future uses of information systems in the hospital environment are addressed.

22 citations


Journal ArticleDOI
TL;DR: A primary care university clinic discovered major errors in its medical records after instituting a computerized medical records system and a quality assessment tool was devised to measure the error rate and provide clues to the sources of these errors.
Abstract: A primary care university clinic discovered major errors in its medical records after instituting a computerized medical records system. A quality assessment tool was devised to measure the error rate and provide clues to the sources of these errors. During the implementation of this tool a marked reduction in data entry errors occurred suggesting its use had a positive impact on our medical record quality.

19 citations


Journal ArticleDOI
TL;DR: Using his natural language medical text analyzing system, the author has computer-processed the discharge summary segment of the patient record and the output of the text analyzer is a list of medical facts.
Abstract: Using his natural language medical text analyzing system, the author has computer-processed the discharge summary segment of the patient record. The output of the text analyzer is a list of medical facts. The low-cost, high productivity process is eminently suited for screening the quality of clinical care provided in the hospital.

18 citations


Journal ArticleDOI
TL;DR: A case-based financial planning model is presented here for the purpose of assisting managerial decision making in the strategic areas of case mix planning and pricing, and testing the model with a hypothetical example of a hospital strategic planning problem demonstrates its potential as a decision-making aid.
Abstract: The institution of prospective payment systems by many health care insurers has drawn increased attention to case-based financial planning in hospitals. When hospital revenues are directly linked to patient diagnoses rather than to the types and quantities of services supplied to patients, managers must be aware of the financial implications of different case mixes and must be prepared to influence insurers' price structures. A case-based financial planning model is presented here for the purpose of assisting managerial decision making in the strategic areas of case mix planning and pricing. The computerized model characterizes hospitals as product manufacturers, the product being discharged patients. Diagnosis serves to differentiate the “products”; however, diagnoses are grouped by payor and similar treatment cost experiences to create a limited set of managerially meaningful case types. Diagnostic and treatment costs are also aggregated to facilitate the modeling of the hospital production process. The computerized model projects the number of patients of each case-type and total patient volume, based on estimated patient volume growth rates. The model also projects prices and contribution margins for each case-type, as well as total contribution to hospital overhead. Testing the model with a hypothetical example of a hospital strategic planning problem demonstrates the model's potential as a decision-making aid in case mix planning and case-type pricing. It also reveals several model shortcomings that require further developmental effort.

10 citations


Journal ArticleDOI
TL;DR: A modular, microcomputer and videodisc expert system, for patients with mechanical low back pain, that supports individual patient needs with a broad knowledge base, and analytical modelling techniques that connect flexible inference structures and user choices.
Abstract: This paper outlines a modular, microcomputer and videodisc expert system, for patients with mechanical low back pain. The system incorporate facts, rules, and methods to extract data, opinions, information, and user preferences. It supports individual patient needs with a broad knowledge base, and analytical modelling techniques that connect flexible inference structures and user choices. Videodisc based expert systems help break the bottleneck in relevant medical knowledge representation. The expert system program serves the user in the capacity of teacher, confidant, interpreter, diagnostician, and adviser.

8 citations


Journal ArticleDOI
TL;DR: ESA, a system forevaluatingserialangiograms, used a symbiotic approach between man and machine, where technologists provide the visual skills with an expert system imitating the conceptual skills of the expert, to produce a partially automated system that is more consistent and cost effective than one that is fully manual.
Abstract: Some candidate medical expert system applications have a significant visual component. Knowledge engineers usually dismiss such task domains as potential expert systems applications. Our success in developing ESCA, a system forevaluatingserialangiograms, shows that such task domains should not be dismissed so quickly. We used a symbiotic approach between man and machine, where technologists provide the visual skills with an expert system imitating the conceptual skills of the expert, to produce a partially automated system that is more consistent and cost effective than one that is fully manual. The agreement between the system's conclusions and that of a panel of experts is good. The expert system actually has a slightly higher agreement rate with the expert panel than the agreement rate between two expert panel teams evaluating the same film pair.

8 citations


Journal ArticleDOI
TL;DR: The manner in which physician control of medical systems adds to the worth of such systems by enhancing the quality and efficiency of health care delivery is described.
Abstract: Physicians are commonly being excluded from meaningful participation in the planning, implementation, and operation of automated medical systems in hospitals. The authors advocate a rapid shift toward greater physician involvement in such systems, arguing that such a shift is desirable, feasible, and also inevitable. After reviewing the organization of information systems in hospitals, the authors describe the manner in which physician control of medical systems adds to the worth of such systems by enhancing the quality and efficiency of health care delivery. The proposed information system management role of physicians is characterized in terms of authority, responsibility, and operational control. Finally, advice is offered from an organizational perspective for establishing a physician as the hospital Medical Information Director.

Journal ArticleDOI
TL;DR: The approach to the design of a new microbiology subsystem has been to maximize the functionality without requiring unusual input devices.
Abstract: Increased demands on technologists' time and the desire to have electronic storage of patient information have led to numerous computer-based efforts to manage microbiology data. Our approach to the design of a new microbiology subsystem has been to maximize the functionality without requiring unusual input devices. DEC VT100-compatible terminals are used for data entry and display. Data are displayed taking advantage of such features of these terminals as reverse video, highlighting, and scroll windowing. Numerous single-key instructions for invoking functions and changing cursor positions have been implemented to minimize keystrokes and to anticipate the entry sequences of the technologists. A program that allows the quick location and display of specimens and results is also included in the package.

Journal ArticleDOI
TL;DR: A new system for resident selection that uses a descriptive rating scale and a microcomputer to create a rank order list for the National Resident Matching Program showed correlation with both clinical performance of Pl-1 and Pl-2 pediatric residents and the American Board of Pediatrics In-training Examination.
Abstract: This paper describes a new system for resident selection that uses a descriptive rating scale and a microcomputer to create a rank order list for the National Resident Matching Program. The methods utilized to analyze the time efficiency, interrater reliability, and predictive validity of the system are reported. Interrater reliability was found to be high. The rank list was shown to correlate with both clinical performance of Pl-1 and Pl-2 pediatric residents and the American Board of Pediatrics In-training Examination. Correlations for the Pl-2 year were stronger than for the Pl-1 year.

Journal ArticleDOI
TL;DR: The computerized database system described was initially developed in 1986 to facilitate analysis of retrospective head and neck cancer data from the Royal Adelaide Hospital Department of Otolaryngology and has now been expanded to become an on-going patient information management system.
Abstract: The computerized database system described was initially developed in 1986 to facilitate analysis of retrospective head and neck cancer data from the Royal Adelaide Hospital Department of Otolaryngology. This has now been expanded to become an on-going patient information management system. It is based on the dBase-III-Plus database package and is implemented on an IBM XT compatible computer. The system was designed to be used by staff without specialist computer skills and is therefore largely “menu-driven.” The main functions include patient record creation, update, and retrieval, and the production of reports including graphical presentations. There is also a powerful but easy to use query facility. The system has already provided much useful epidemiological material but is now beginning to fulfill an even more important role in patient follow-up and in assisting evaluation of alternative treatment protocols.

Journal ArticleDOI
TL;DR: The major objective of this study was to evaluate the impact of various pricing, advertising, and service strategies on profitability and result is a pricing strategy which allows the center to reach their financial goal of breaking even while maintaining their service policies.
Abstract: This study represents the financial and qualitative evaluation of a Health Promotion Center of a private hospital located in a medium-sized town located in a predominantly agricultural area. The major objective of this study was to evaluate the impact of various pricing, advertising, and service strategies on profitability. The result is a pricing strategy which allows the center to reach their financial goal of breaking even while maintaining their service policies. The hospital, which serves a community of 500,000 people, recently developed a new concept called a “Health Promotion Center” (HPC). The HPC provides services such as fitness programs, nutrition awareness, rehabilitation and therapy, and child and adult care. For this purpose, a new building was constructed and the center became operational in June 1983. A variety of management options available to the center are described with evaluations of their usefulness. Evaluation methods include scenarios, stochastic simulations, and analyses of how the decision makers use these methods. The inclusion of risk management, model flexibility, and user involvement are stressed throughout the paper and are critical in the decision process.

Journal ArticleDOI
TL;DR: A regional IBD registry encompassing 18 hospitals and IBD specialists in east/northeast Pennsylvania was established to promote awareness of the clinical and epidemiological aspects of the disease.
Abstract: Inflammatory Bowel Disease is characterized by two major entities, Crohn's Disease and Ulcerative Colitis. These bowel diseases have associated problems involving the eyes, joints, skin, kidneys, immunological system, hepatobiliary system, and psychiatric disturbances. A regional IBD registry encompassing 18 hospitals and IBD specialists in east/northeast Pennsylvania was established to promote awareness of the clinical and epidemiological aspects of the disease. Results of this data collection effort will be shared with patients and physicians through the use of newsletters and symposia. A Basic History (HX) form, an Operative Data (OR) form, and an Annual Follow-up (FU) form was used to collect relevant data. Participation is voluntary and all information is confidential.

Journal ArticleDOI
TL;DR: TheLAB VALUES system, an expert system that diagnoses the likelihood of various diseases, given the results of routine blood tests, was found to perform well when compared to these published cases.
Abstract: LAB VALUES is an expert system that diagnoses the likelihood of various diseases, given the results of routine blood tests. Its knowledge structure employs bit maps. The similarity between a new case and a bit map in the knowledge base is calculated via a similarity score. The system was tested against published cases with definite diagnostic endpoints, and was found to perform well when compared to these published cases. System performance was not improved by incorporating disease frequency into the results.

Journal ArticleDOI
TL;DR: Although the code table implemented is designed for bit-mapped document images at one bit per pixel, an experiment has been undertaken to investigate its role in compressing multiple bit perpixel images such as radiographs.
Abstract: The recent availability of a special-purpose IC implementing the standard CCITT run length coder/decoder has made it possible for distortion free image compression to be done economically and quickly with a personal computer plug-in circuit card. Although the code table implemented is designed for bit-mapped document images at one bit per pixel, an experiment has been undertaken to investigate its role in compressing multiple bit per pixel images such as radiographs. Representative x-ray images of various body parts are processed; the average compression ratio and standard deviation is 2.37 and 0.28, respectively, for CCITT group 4 compression, and 2.21 and 0.29, for CCITT group 3 compression.

Journal ArticleDOI
TL;DR: Current trends in software design, current levels of responsibilities for the various parties involved in bringing automation to clinical medicine, why software development is so difficult to quality control, and certain characteristics of system development which contribute most to the construction of inaccurate models are presented.
Abstract: This paper presents some observations on a number of topics which affect the quality of computer software and includes: current trends in software design, current levels of responsibilities for the various parties involved in bringing automation to clinical medicine, why software development is so difficult to quality control, and certain characteristics of system development which contribute most to the construction of inaccurate models.

Journal ArticleDOI
TL;DR: While this system, currently adopted by the Yale Comprehensive Cancer Center, represents an effective approach to handling the data-management needs of a large, single-institution cancer research center, the design and programming methodology can be readily adapted to other research settings.
Abstract: A computerized system for the management of a clinical research database has been developed with several attractive features. This relational database management system allows for screen-driven data entry, data checking, system security, and report generation in a timely manner. In addition, the system is cost-effective in a number of ways: (1) development time is considerably reduced due to the inherent programming features of the software, (2) once developed the system can be maintained by nontechnical personnel thereby reducing personnel costs, (3) the system can be developed and maintained on a microcomputer system, and (4) the commercial software used in our system is periodically updated thereby assuring the user of state-of-the-art technology. Beyond the initial expenditures for hardware and software, no additional system costs are incurred. While this system, currently adopted by the Yale Comprehensive Cancer Center, represents an effective approach to handling the data-management needs of a large, single-institution cancer research center, the design and programming methodology can be readily adapted to other research settings.

Journal ArticleDOI
TL;DR: A multifacility EMS system resource allocation model is developed that enables its user to evaluate the equitability of resource allocation schemes and is appropriate for use in both prospective and retrospective EMS System resource allocation analyses.
Abstract: As instruments of public policy, Emergency Medical Service Systems must not only make effective use of the available resources but also ensure that those resources are shared equitably by the systems' facilities. This paper develops a multifacility EMS system resource allocation model that enables its user to evaluate the equitability of resource allocation schemes. Recognizing and objectively defining the relationships between the consumption of system resources and the provision of EMS System services, this model is appropriate for use in both prospective and retrospective EMS System resource allocation analyses.

Journal ArticleDOI
TL;DR: The VA's early attempts at computerization are described, along with the subsequent refinements made necessary by the deficiencies in those early attempts, as well as some plans for future development.
Abstract: This paper describes the evolution of a computerized support system for health care capacity planning within the Veterans Administration (VA) health care system. The VA's early attempts at computerization are described, along with the subsequent refinements made necessary by the deficiencies in those early attempts. The evolution of both the planning logic and the software configurations is set forth, along with some plans for future development.

Journal ArticleDOI
TL;DR: An adaptive control approach to the problem of the treatment of solid tumors through the use of a data base as part of an expert system that leads to stabilization of the system through the appearance on a computer display screen of a stable equilibrium point or a limit cycle.
Abstract: The paper describes an adaptive control approach to the problem of the treatment of solid tumors. The evolution with timet of the state of a tumor is modelled by a two-compartment system, governed by two differential equations forming an autonomous system under therapy control u, $$\begin{gathered} \frac{{dy_1 }}{{dt}} = f_1 (y_1 ,y_2 ;u) \hfill \\ \frac{{dy_2 }}{{dt}} = f_2 (y_1 ,y_2 ;u), \hfill \\\end{gathered}$$ wherey1 andy2 are the number of proliferating and nonproliferating cells, respectively. The output is analyzed in the phase planey1y2. The control problem is that of restricting the tumor state to a predetermined region of the plane by selecting a suitable change in therapy control u, e.g., modality and dosage, when the state solution intersects the boundary of this region and the ratioy1/y2 of proliferating to nonproliferating cells is displayed together with an elapsed time scale. Then, consequent selection of a suitable therapeutic sequence may be assisted by the use of a data base as part of an expert system. The process is repeated at each intersection of the prescribed boundary. Such sequences may lead to stabilization of the system through the appearance on a computer display screen of a stable equilibrium point or a limit cycle.

Journal ArticleDOI
TL;DR: The survey results indicate that the majority of health care institutions have responded by increasing their information resources, both in terms of hardware and software, and have moved to integrate the medical and financial data.
Abstract: The move from a retrospective payment system (value added) to a prospective payment system (diagnostic related) has not only influenced the health care business but also changed their information systems' requirements. The change in requirements can be attributed both to an increase in data processing tasks and also to an increase in the need for information to more effectively manage the organization. A survey was administered to capture the response of health care institutions, in the area of information systems, to the prospective payment system. The survey results indicate that the majority of health care institutions have responded by increasing their information resources, both in terms of hardware and software, and have moved to integrate the medical and financial data. In addition, the role of the information system has changed from a cost accounting system to one intended to provide a competitive edge in a highly competitive marketing environment.

Journal ArticleDOI
TL;DR: The intent of this paper is to understand the characteristics of those frame buffers currently used to display images, versus more ideal frame buffers for medical image display purposes.
Abstract: The intent of this paper is to understand the characteristics of those frame buffers currently used to display images, versus more ideal frame buffers for medical image display purposes. This study is based on current needs and what characteristics might be desirable. Two case examples are presented: (1) a system developed for high quality computer graphics and (2) a system developed for nuclear medicine and radiation therapy treatment planning. Our study considers: (1) defining a pixel depth sufficient to hold data, (2) the desirability of multiple color look-up tables, (3) how cine loops are managed, and (4) display memory size.

Journal ArticleDOI
TL;DR: The object data were obtained from patients with neurotic disorders who were diagnosed by several doctors for 10 years in a subagricultural areas in Japan and the weights attached for personal information depending upon the similarity between the information and the kinds of Neurotic disorders using the theory of fuzzy sets were calculated.
Abstract: Constructing and estimating a model to explain the mechanism of neurotic disorders is important and significant. The model helps the rearrangement or representation of knowledge obtained from professional physicians. However, it is a very difficult problem, because the objects requiring analysis are mental activities of human beings, and they originally include a comparatively large variance between individuals. The object data were obtained from patients with neurotic disorders who were diagnosed by several doctors for 10 years in a subagricultural areas in Japan. We analyzed the data and calculated the weights attached for personal information depending upon the similarity between the information and the kinds of neurotic disorders using the theory of fuzzy sets. From the results of our analysis, we constructed and estimated a model explaining the mechanism causing neurotic disorders as several linear equations. From data processing points of view, the estimation we attempted is placed in a kind of effective data compression with respect to discrete statistical data.

Journal ArticleDOI
TL;DR: Lack of familiarity with benefits to be attained through automation was proposed as responsible for observed decrements in receptivity among medical departments.
Abstract: Analyses were performed on the perceived automation needs and current medical department computerization status aboard ships of the U.S. Pacific Fleet to determine if present automation status had a bearing on receptivity to further automation. Current medical department automation status consisted of microcomputers and/or the Shipboard Nontactical ADP Program (SNAP). Measures of receptivity to department automation included perceived need for automation of reports and composite scores of perceived need for 12 automated medical capabilities. Those ships with the highest present levels of automation were the most receptive to medical department computerization. Lack of familiarity with benefits to be attained through automation was proposed as responsible for observed decrements in receptivity among medical departments.

Journal ArticleDOI
TL;DR: A semiautomated user driven method for document mapping is described in this paper and should decrease the amount of time required to validate the information content of a query.
Abstract: An information retrieval system should provide references to the set of documents the user must evaluate in order to satisfy his/her information requirements. A major concern in this evaluation process is whether or not a document meets the user's needs. In many document retrieval systems there is no relevant information regarding the content of the documents. This makes it very difficult to evaluate if a document is relevant to the user's initial query. This suggests the need for a method to compare the documents on a word by word basis. Fully automated methods are too complex and difficult to generalize upon. A semiautomated user driven method for document mapping is described in this paper. It should decrease the amount of time required to validate the information content of a query.

Journal ArticleDOI
TL;DR: Bureau Common Reporting requirements data tapes for Fiscal Year 1980 indicated that special projects that were either health department or public agency sponsored were more likely to have more non-medical patient encounters and more health education and social work staff for a given level of expenditures.
Abstract: Bureau Common Reporting Requirements (BCRR) data tapes for Fiscal Year 1980 were analyzed to determine whether the type of sponsoring agency influenced the productivity or indicators of care of Maternity and Infant Care and Children and Youth Projects. Sponsors were classified as either health department or non-health department, health department or major medical center, or public or private in three separate sets of analyses. Some of these analyses indicated that special projects that were either health department or public agency sponsored were more likely to have more non-medical patient encounters and more health education and social work staff for a given level of expenditures. Although publicly sponsored projects employed fewer physician equivalents than did the non-public projects, those physicians were more productive. Despite these differences in encounters, staffing, and utilization of physicians, there were no differences in available measures of the process of care between categories of projects in any of the analyses.