Showing papers in "Journal of Medical Systems in 1990"
TL;DR: The utility of DEA is analyzed by comparing this technique with other methods used to measure efficiency, by discussing the application of DEA in the health care industry and by assessing the validity of results from DEA studies.
Abstract: The rising cost of health care has created great interest in developing methods to increase the efficiency of health care organizations. Despite this interest most analyses of prospective payment and other programs designed to control expenditures have examined costs and not efficiency. This article examines a new technique—data envelopment analysis (DEA)—that facilitates the conduct of efficiency studies. The utility of DEA is analyzed by comparing this technique with other methods used to measure efficiency, by discussing the application of DEA in the health care industry and by assessing the validity of results from DEA studies. The article concludes with an assessment of the strengths and weaknesses of DEA and suggestions for refining this technique.
59 citations
TL;DR: The increasing importance of computer-stored databases for clinical research prompted a historical review of their evolution over the past three decades and the various types of clinical research registers and databases were described.
Abstract: The increasing importance of computer-stored databases for clinical research prompted a historical review of their evolution over the past three decades. The special problems associated with the computer processing of clinical research data were reviewed, and the various types of clinical research registers and databases were described.
41 citations
TL;DR: This paper applies Data Envelopment Analysis (DEA) to the assessment of the performance of Florida general hospitals.
Abstract: Unlike conventional methods for evaluating the performance of a not-for-profit entity, a recently developed mathematical programming technique called Data Envelopment Analysis (DEA) is able to handle multiple inputs and outputs simultaneously without assigning arbitrary weights and does not require the use of homogeneous measurement units nor a prespecified functional relationship between inputs and outputs. This technique can generate a summary scalar efficiency ratio for each decision-making unit and identify the individual amount of inefficiency for each input and/or output. This paper applies DEA to the assessment of the performance of Florida general hospitals.
19 citations
TL;DR: A group design study was carried out using regulated feedback to enhance functional recovery in stroke patients to make use of the sensory feedback to outperform the control group in each of the three tasks.
Abstract: A group design study was carried out using regulated feedback to enhance functional recovery in stroke patients. Patients trained on three computerized tasks aimed at improving guided limb motion in the hemiplegic arm. The therapeutic group was able to make use of the sensory feedback to outperform the control group in each of the three tasks. The therapeutic group also showed an adaptation of the improved performance on the three tasks. Further investigation is required to demonstrate that such sensory feedback training results in a corresponding improvement in activities of daily living skills.
13 citations
TL;DR: The need for an integrated hospital information system is discussed and a framework for the development of its application portfolio is provided and the scope is the integration of the medical, administrative and fiscal information elements of the hospital into a unified systems environment.
Abstract: Although many successful applications in the hospital environment have been introduced and implemented, hospital information systems have had little impact upon the daily operation of hospitals. Furthermore, integrated hospital information systems, although vital to the hospitals' functioning, have proved to be more complicated to develop and difficult to harness than expected. This paper discusses the need for an integrated hospital information system and provides a framework for the development of its application portfolio. The scope of such a system is the integration of the medical, administrative and fiscal information elements of the hospital into a unified systems environment.
11 citations
TL;DR: This paper provides a framework for evaluating healthcare software from a usability perspective, based on a review of both the healthcare software literature and the general literature on software usability and evaluation.
Abstract: This paper provides a framework for evaluating healthcare software from a usability perspective. The framework is based on a review of both the healthcare software literature and the general literature on software usability and evaluation. The need for such a framework arises from the proliferation of software packages in the healthcare field, and from an historical focus on the technical and functional aspects, rather than on the usability, of these packages. Healthcare managers are generally unfamiliar with usability concepts, even though usability differences among software can play a significant role in the acceptance and effectiveness of systems. Six major areas of usability are described, and specific criteria which can be used in the software evaluation process are also presented.
11 citations
TL;DR: The purpose of this paper is to define and discuss the uniqueness and level of sophistication of GDSS applications in health care and to review in depth the model developed by the author.
Abstract: 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.
10 citations
Journal Article•
6 citations
TL;DR: The results support the assumption of a relationship between hypertension and diabetes, although the question of causality between the two diagnoses remains unsolved.
Abstract: Clinical databases from automated medical records represent a growing resource for deriving new medical knowledge. In this study a large primary health care database was explored with respect to the association between hypertension and diabetes. Data collection was made with a query language, and data analysis performed with an interactive knowledge-based statistical tool, MAXITAB, employing a multivariate tabular analysis technique. In the study population of 6660 patients the prevalence of diabetes was almost three times higher for hypertensive patients than for those with no hypertension. Conversely, the prevalence of hypertension was 2.6 times higher for diabetic patients than for those with no diabetes. The results support the assumption of a relationship between hypertension and diabetes, although the question of causality between the two diagnoses remains unsolved. Knowledge-based statistical tools of this kind may be feasible for exploring large clinical databases and may result in new medical hypotheses, worthy of further investigation.
6 citations
TL;DR: Progress has been made in automated medical text processing, the topic of this paper, and computers must bridge the gap between the narrative text in the medical record and computer technology.
Abstract: Clinical practice of medicine is highly information-intensive. At the bedside, past experience is the primary justification of reasoning and decisions. This past medical experience is an amalgamation of textbook information and personal experience. During the last 2-3 decades, both of these major sources of clinical information have appeared less and less effective. The pace of progress, resulting in better diagnostic tools and new therapies, has undermined our personal experience, and for the same reason, the time lapse between drafting the manuscripts and distributing the textbooks has become a growing problem. Emphasis has shifted from textbooks to scientific journals with shorter publishing delays, and the role of daily newspapers and television programs seems to be growing. The traditional ways of gathering clinical knowledge and experience seem to fail more and more. In addition to textbooks and scientific journals, current clinical experience is described in millions of patient records, stored in hospitals and ambulatory care offices. However, we have no easy access to patient charts, and we are lacking a method for cost-effective merging of clinical case histories to make them suitable for much-needed statistical inferences. Computers could make a major contribution in this area, but first we must bridge the gap between the narrative text in the medical record and computer technology. Recently, much encouraging progress has been made in automated medical text processing, the topic of this paper.
6 citations
TL;DR: This paper presents Structured Spreadsheet Modeling as a possible solution, and shows that it is applicable in the MR/DM field on a concrete basis.
Abstract: The construction, evaluation, implementation, and use of models representing various algorithms, strategies, methods, theories etc. based on the analysis of great amounts of data are necessary in both Medical Research and Decision Making (MR/DM). Performing such tasks manually is not only time consuming and tedious, but also very error-prone. The appearance of a computer with its ability to store and process information has opened an opportunity to facilitate enormously and improve activities. However, the effective use of computers is limited by difficulties accompanying noncomputer specialists like doctors, nurses, and other medical staff in learning and using conventional programming languages, tools, and techniques. In this paper we present Structured Spreadsheet Modeling as a possible solution, and show that it is applicable in the MR/DM field on a concrete basis.
TL;DR: The following articles are abstracted from “Smart Card Monthly”, a special issue of this publication devoted to healthcare which provides detail about the growth of this concept in Europe.
Abstract: The following articles are abstracted from “Smart Card Monthly”. Stephan Seidman is the editor of this publication. One issue each year is devoted to a special topic, and this year the subject is healthcare. Since this technology has significant potential for medical systems, we have asked Mr. Seidman for his permission to reprint several of the key articles which provide detail about the growth of this concept in Europe. The Smart Card Monthly is available for an annual subscription price of $79 and can be ordered by calling 415-326-3325 or by writing to Mr. Seidman at 140 University Ave. Suite 42, Palo Alto, California 94301.
TL;DR: The admission problem list that NEONATE generates was compared to the admission problem lists of the current CETUS system for 30 patients and compared to a retrospectively constructed gold standard problem list.
Abstract: NEONATE is a prototype of an expert application for the HELP Hospital Information System. Its goal is to improve documentation in the Newborn Intensive Care Unit. The decision module of NEONATE is designed to produce an admission problem list. In this paper, the admission problem list that NEONATE generates was compared to the admission problem list of the current CETUS system for 30 patients. These were compared to a retrospectively constructed gold standard problem list. Of 101 problems in the gold standard list, 56 were on the current admission reports; 82 were found by NEONATE. NEONATE found 31 problems missed on the current admission reports; the current admission reports contained 5 problems missed by NEONATE. The current admission reports contained 9 false positives; whereas NEONATE's reports contained 27. Of the 27, 16 were caused by a single rule in NEONATE. We conclude that an expert system has great potential for improving the documentation of the patient problem list.
TL;DR: This pilot project has successfully demonstrated a clinical workstation (CWS) operating on an acute general neurology and neurosurgical inpatient nursing unit and a critical care unit at The Johns Hopkins Hospital.
Abstract: New computer tools for physicians, nurses, and the medical care team will become common in the 1990s. This paper describes a clinical workstation (CWS) development project that uses new technology that moves the technical support for medical decision making from the computer room to the nursing station. Collection, processing, and display of clinical information including patient identification, laboratory, and radiology results and current medications are carried out in the environment of a multi-windowed computer workstation. Easy access to automated medical literature databases from the workstation is also provided. This pilot project has successfully demonstrated a CWS operating on an acute general neurology and neurosurgical inpatient nursing unit and a critical care unit at The Johns Hopkins Hospital.
TL;DR: This work studied the use of industrial quality management techniques to determine where three clinical processes could be improved, and showed that in some processes, the failure rate could be as high as 33%.
Abstract: The lack of consistency in the performance of the processes which implement clinical decisions is an important problem in ambulatory care. Since delayed or neglected actions in patient care may have serious consequences, we studied the use of industrial quality management techniques to determine where three clinical processes could be improved. These quantitative and graphical tools were useful in showing that in some processes, the failure rate could be as high as 33%. However, lack of readily available process data prevented a full analysis of the extent of the failures, so specific suggestions for improvement could not be made. Medical informatics and management specialists have an important role in designing enhanced medical information systems with which to examine and improve patient care processes. This new generation of MIS's should include order entry systems with flags for selected transactions, audit trails for all automated processes, functional integration of the separate departmental information systems, and enhanced communications features.
TL;DR: A Maintenance Management Expert System (MMES) is developed that is suitable for hospitals as well as for manufacturing organizations and provides several reports that can be utilized for improving maintenance effectiveness.
Abstract: In this paper a Maintenance Management Expert System (MMES) is developed. This system is suitable for hospitals as well as for manufacturing organizations. This expert system consists of five sections. These are work order management, equipment management, craftsmen management, material and supply control, and monitoring of maintenance activities. In addition the MMES provides several reports that can be utilized for improving maintenance effectiveness.
TL;DR: The functionality and technical structure of Hospital of the Future, as well as the integration issues among disparate healthcare systems addressed in developing the display, are discussed.
Abstract: Technology is gaining increasing attention and competitive importance in the healthcare industry, but healthcare administrators need more than just talk to make effective technology investments. Andersen Consulting and the American College of Healthcare Executives have created Hospital of the FutureSM, in Dallas, Texas, as a dynamic, evolving research and demonstration forum that allows healthcare administrators and providers to see potential technology solutions in action—in healthcare settings specifically designed to look and feel like the real thing. This article discusses the functionality and technical structure of Hospital of the Future, as well as the integration issues among disparate healthcare systems addressed in developing the display.
TL;DR: A simulation model is developed as a tool to describe the behavior of the inpatient admission system in a hospital due to difficulties involved in the self-development or vendor approach to model such a complex system.
Abstract: In this paper a simulation model is developed as a tool to describe the behavior of the inpatient admission system in a hospital. Due to difficulties involved in the self-development or vendor approach to model such a complex system, the author uses SIMAN software to develop a simulation model for the inpatient admission system. To most hospitals, advantages are gained in terms of reduced purchasing and maintenance cost, and ease of use, as this software can run on any personal computer.
TL;DR: A proposal for a Medical Data Protection Deontology Code in Greece is presented, based on what holds internationally, particularly in the EC countries, on recent data acquired from Greek sources and on the experience resulting from what is acceptable in Greece.
Abstract: In this paper, a proposal for a Medical Data Protection Deontology Code in Greece is presented. Undoubtedly, this code should also be of interest to other countries. The whole effort for the composition of this code is based on what holds internationally, particularly in the EC countries, on recent data acquired from Greek sources and on the experience resulting from what is acceptable in Greece. Accordingly, policies and their influence on the protection of health data, as well as main problems related to that protection, have been considered.
TL;DR: A microcomputer based system that integrates image processing and computer graphics techniques to automate the data extraction and storage process in cephalometric analyses increases the consistency of measurements and improves the productivity of surgical and dental staff.
Abstract: This paper describes a microcomputer based system that integrates image processing and computer graphics techniques to automate the data extraction and storage process in cephalometric analyses. The system increases the consistency of measurements and improves the productivity of surgical and dental staff.
TL;DR: The design of this system and its heavy dependence upon computer resources provide an excellent model for looking forward into the earth based medical clinics of the future.
Abstract: The Health Maintenance Facility (HMF) is the code name for a space-based medical clinic. The HMF is an integral part of the U.S. sponsored space station program due to be launched in the late 1990s. Contained in this module will be equipment, facilities, and supplies that can be used to support space station crew health. The range of medical care will depend upon the skill of the crew, the tools available, and the support systems that can be used from earth. The design of this system and its heavy dependence upon computer resources provide an excellent model for looking forward into the earth based medical clinics of the future.
TL;DR: Results of this study indicate that a HIS is critical to the viability of a hospital's operation and the level of compromises made during the selection process have an impact upon the how satisfied the healthcare provider is with the HIS they select.
Abstract: This research study evaluates the selection process of a Hospital Information System (HIS), focusing on the level of compromise required by healthcare professionals during said process and the level of satisfaction achieved with the system selected. How other variables, such as job title, length of experience in the healthcare, data processing, and information systems fields affect these measured levels are also evaluated. Results of this study indicate that a HIS is critical to the viability of a hospital's operation and the level of compromises made during the selection process have an impact upon the how satisfied the healthcare provider is with the HIS they select.
TL;DR: The first portable electronic medical reference, a Pocket PDR, will be announced by Physicians' Desk Reference before the end of 1990 and will be available to physicians early next year, with verbatim information on dosage, administration, contraindications, and warnings for every prescription drug in PDR.
Abstract: The first portable electronic medical reference, a Pocket PDR ®, will be announced by Physicians' Desk Reference ® before the end of 1990 (Figure 1). The new product is small enough to fit easily into the pocket of a physician's lab coat or suit jacket and be at hand to check a patient's drug therapies during clinical rounds, in a hospital emergency room or virtually any place drug information is required. It will be available to physicians early next year, with verbatim information on dosage, administration, contraindications, and warnings for every prescription drug in PDR. In all, the device will contain 6.7 million characters of text, enough to fill a dozen paperback books. The text will be stored in compressed form in read-only memory (ROM) chips mounted in the unit. \"Now physicians will have a portable, reliable drug information system at hand for instant retrieval no matter where they are,\" says Edward R. Barnhart, PDR publisher and senior vice president of Medical Economics Data Company. To keep current, information will be updated periodically with ROM cartridges about half the width of a credit card. The Pocket PDR more than meets specifications by Ralph Grams, M.D., of the Medical Systems Group at the University of Florida's College of Medicine, for a vest pocket computer--\"a major innovation in the practice of medicine . . . a serious step forward in the delivery of knowledge to a wide variety of users who are limited in their current application of computer technology.\" PDR's pocket computer weighs only 10 ounces and closes into a compact 6I/8 '' × 3\" × 7/8\". It is priced at $249. In use, the Pocket PDR opens to reveal a screen large enough to show eight 40character-wide lines on a double nematic supertwist liquid crystal display. Its keyboard is a standard QWERTY typewriter layout, with number keys doubling as function keys. The unit is powered by four replaceable standard AAA alkaline batteries, with a lithium backup battery to keep the user's personal notes, bookmarks and settings from being lost when power batteries are replaced. There also is a plug for a DC power adaptor. A row of dedicated function keys across the top of the keyboard are labeled to make it easy for physicians to look up any prescription drug and have it on the display in seconds.
Journal Article•
TL;DR: The Systems Integration approach is discussed and it is suggested that it encourages user commitment, provides greater modularity, is cost effective, and supports solutions that offer greater functionality.
Abstract: The current health care environment is complex, with no single systems solution dominating the marketplace. A new approach utilizes Networked Systems Integration to link disparate systems together. This paper discusses the Systems Integration approach and suggests that it encourages user commitment, provides greater modularity, is cost effective, and supports solutions that offer greater functionality. However, it is noted that this approach is not without problems that can dramatically effect the realization of benefits.
TL;DR: This special editorial review in theJournal of Medical Systems is dedicated to the use and application of vest pocket computers (VPCs) and will review the current specifications for such equipment and also available application software that can be purchased.
Abstract: This special editorial review in theJournal of Medical Systems is dedicated to the use and application of vest pocket computers (VPCs). We will not be discussing PCs, mainframes, lap tops, or notebook-size processors. Our focus is on a light-weight, small, compact device that will comfortably fit in the vest pocket or purse of a health care worker. This new device, the VPC, is just now coming into the market with major manufacturer support. This issue will review the current specifications for such equipment and also available application software that can be purchased. The topics discussed in this review will follow a logical sequence of presentation. First, will be a justification of the VPC in light of the needs of the user community. The second section will discuss the available hardware on the market and present a direct comparison of prices and specifications. Our final overview will offer a projection for the future and a discussion of where this technology might lead in the coming months. Today, we are at the threshold of a major innovation in the practice of medicine. The VPC will be a serious step forward in the delivery of knowledge to a wide variety of users who are limited in their current application of computer technology. I hope that this introductory series will be the stimulus for a user group to develop and initiate a flood of activity that will generate great interest in this new technology.
TL;DR: The objective of this paper is to provide a methodology and evaluative framework in which available Medical Care Classification Systems can be assessed as to which one best meets the needs of the quality assurance programs within ambulatory care settings.
Abstract: An essential need of a Quality Assurance Program (QAP) in an ambulatory care setting is accurate and reliable information characterizing the encounter between patient and provider. This information includes identification of the patient's reason for visit, the provider's diagnostic impressions, and procedures performed. Such data can be used to maintain an informational index on the nature of patient care. Based upon this index, a wide variety of special studies in the assessment and assurance of the quality of care can be conducted. A primary consideration in the development of such an index is the choice of a Medical Care Classification System (MCCS) to be used to code encounter-related data.33 The objective of this paper is to provide a methodology and evaluative framework in which available Medical Care Classification Systems can be assessed as to which one best meets the needs of the quality assurance programs within ambulatory care settings.
Journal Article•
TL;DR: This paper describes the application of the thematic approach to the evaluation of a complex, community-oriented cancer research program.
Abstract: The evaluation of programs with multiple, and potentially conflicting, goals requires the integration of measures of goal achievement that often are not easily combined. One approach is the development of analytical themes which span the various goals of a particular program. The themes provide a mechanism by which the policy concerns of individuals with varying perspectives can be integrated into the evaluation framework. As well, the themes allow for flexibility in the development of new analysis as the program matures and environments change. This paper describes the application of the thematic approach to the evaluation of a complex, community-oriented cancer research program.
TL;DR: A radiotherapy treatment planning system has been installed on a personal computer and was developed to meet the clinical demands and budgetary constraints of any radiotherapy department.
Abstract: A radiotherapy treatment planning system has been installed on a personal computer and was developed to meet the clinical demands and budgetary constraints of any radiotherapy department The system consists of an IBM compatible PC-AT computer with a 16 bit microprocessor, 40 MB hard disk drive, and a 5-1/4″ floppy disk drive The computer is supplied with an analog to digital conversion card for communication with a back lit digitizer The CT-Interface computer with 16 color extended graphics display unit allows for the transfer of data on contours of the patient body, tumor, critical normal structures, and a density matrix (Housfield numbers) from the CT-Images taken from a CT-Scanner The system supports software for teletherapy, brachytherapy, combined therapy (tele + brachy) and cancer registry MS-DOS Version 321 is used as the operating system The programs are written in BASIC, C, and Assembly languages The system has high performance with speed and accuracy during dose calculations A dot-matrix printer/plotter is used to print the final dose distribution results in text or graphics for permanent records