Showing papers in "Journal of Medical Systems in 1997"
TL;DR: Under and overutilization of operating suites are high, they are attractive potential targets for cost minimization and the magnitude of the potential savings are such that attempts to measure and eliminate this inefficiency could be financially rewarding.
Abstract: In this paper, we are concerned with cost reduction, operating suite utilization, and capacity planning in surgical services. We studied 58,251 computerized surgical records from a teaching hospital to determine a model for measuring operating suite utilization, analyzing the quality of surgical schedules, and allocating surgical suite budgets (capacity planning). The classical definition of operating suite (OR) utilization, encountered in the literature is the ratio of the total OR time used to the total OR time allocated or budgeted. To create a better measure of utilization, we measured underutilization and overutilization providing a more complete description of the overall use of resources. Because the costs of under and overutilization of operating suites are high, they are attractive potential targets for cost minimization and the magnitude of the potential savings are such that attempts to measure and eliminate this inefficiency could be financially rewarding.
149 citations
TL;DR: It is illustrated that less than ten percent of Turkish acute general hospitals operate efficiently compared to their counterparts, and that the validity of DEA is illustrated by comparing it to the ratio analysis method; no discernible differences are found.
Abstract: This study uses Data Envelopment Analysis to examine the technical efficiencies of 573 Turkish acute general hospitals. Inputs of number of beds, number of primary care physicians, and number of specialists, and how they are used to produce outputs of inpatient discharges, outpatient visits, and surgical operations, are examined. Results illustrate that less than ten percent of Turkish acute general hospitals operate efficiently compared to their counterparts. Inefficient, compared to efficient hospitals, on average utilize 32% more specialists, 47% more primary care physicians, and have 119% more staffed bed capacity. They also produce on average less output. Particularly, 13% less outpatient visits, 16% inpatient hospitalization, and 57% less surgical procedures. Additionally, the validity of DEA is illustrated by comparing it to the ratio analysis methods no discernible differences in the results are found.
126 citations
TL;DR: The hospital discharge registry showed relatively few misclassifications and the Danish National Registry of Patients (NRP), which is based on the regional registries, may provide a unique study base for future research.
Abstract: We estimated the validity, i.e., whether the diagnostic criteria were fulfilled for the patients registered with the diagnosis of liver cirrhosis in a Danish hospital discharge registry, and the completeness, i.e., whether all patients with liver cirrhosis were included in the registry. Information in the regional hospital discharge registry in the Country of Aarhus, Denmark was compared with hospital records and information in a pathology registry. 85.4% of the patients registered with a diagnosis of liver cirrhosis fulfilled the diagnostic criteria for the diagnosis (validity). 93.2% of the patients registered with biopsy proven liver cirrhosis in the pathology registry were found in the discharge registry (completeness) with a diagnosis of liver cirrhosis. The hospital discharge registry showed relatively few misclassifications and the Danish National Registry of Patients (NRP), which is based on the regional registries, may provide a unique study base for future research.
93 citations
TL;DR: The purpose of this study is to assign the personnel to the proper shift hours that enable management to meet the objective of minimizing the total payroll costs while patients are satisfied.
Abstract: This paper presents the development of a goal programming (GP) model as an aid to strategic planning and allocation for limited human resources in a health-care organization. The purpose of this study is to assign the personnel to the proper shift hours that enable management to meet the objective of minimizing the total payroll costs while patients are satisfied. A GP model is illustrated using the data provided by a health-care organization in the midwest area. The goals are identified and prioritized. The model result is examined and a sensitivity analysis is performed to improve the model applicability. The GP model application adds insight to the planning functions of resource allocation in the health-care organizations. The proposed model is easily applicable to other human resource planning process.
71 citations
TL;DR: This paper takes a process oriented view of the hospital and presents an approach based on hospital process modeling which aims at assessing the current status of computer support within a hospital and at identifying new opportunities for automation.
Abstract: Hospitals often invest significant resources in the development of large and complex information systems that must be modified and extended to respond to changing requirements and to exploit the capabilities offered by modern technologies. A disciplined approach of managing the evolution of hospital information systems is then required so that to meet the increasing demands for effective and efficient use of scarce resources. This paper takes a process oriented view of the hospital and presents an approach based on hospital process modeling which aims at assessing the current status of computer support within a hospital and at identifying new opportunities for automation. The approach is illustrated by an example taken from a major Greek hospital.
33 citations
TL;DR: It is demonstrated that logic-based algorithms can be used as a valid and efficient method of identifying large numbers of new breast cancer cases from claims data and provides a powerful tool to perform health care analysis and research for women with newly diagnosed carcinoma of the breast.
Abstract: Although claims data are increasingly being used to measure and manage the cost and quality of health care, few studies have evaluated algorithms developed for such analyses Therefore, the present study was performed to evaluate prospectively a previously published algorithm used to identify women with the new diagnosis of carcinoma of the breast This algorithm had been developed from the patterns of claims that suggested common clinical presentations of carcinoma of the breast In the present study, this algorithm was used to identify 177 potential cases of women with newly diagnosed carcinoma of the breast from the claims database of a large health maintenance organization (HMO) The algorithm's positive predictive value for cases identified in the present study was 83% (147/177) To attempt to improve upon the positive predictive value, multiple modifications of the algorithm were performed The previously defined best modification of the initial algorithm yielded a positive predictive value of 84% (147/174) in the present study with the loss of none of the true positive cases These results demonstrate that logic-based algorithms can be used as a valid and efficient method of identifying large numbers of new breast cancer cases from claims data This algorithm provides a powerful tool to perform health care analysis and research for women with newly diagnosed carcinoma of the breast
25 citations
TL;DR: The results of this study indicate that information needs for health care quality improvement cannot be met by simple literature searches and Clinicians and physician executives gaining direct access to bibliographic database could probably be better served by structured indexing of critical aspects of randomized controlled clinical trials.
Abstract: The purpose of this study was to measure the efficiency of simple searches in retrieving controlled evidence about specific primary health care quality improvement interventions and their effects. Searches were conducted to retrieve evidence on seven interventions and seven effect variables. Specific words and the closest Medical Subject Headings (MeSH) recommended by professional librarians were used to search the MEDLINE database. Searches were restricted to the MeSH publication type “randomized controlled trial.” Two reviewers independently judged retrieved citations for relevancy to the selected interventions and effects. In selecting MeSH terms, the average agreement among librarians was 64.3% (±26.1) for interventions and 57.1% (±19.9) for effects. Analysis of the 755 retrieved reports showed that MeSH term searches had an overall recall rate of 58% while the same rate for textword searches was significantly lower (11%, p < .001). The difference in overall precision rates was nonsignificant (26% versus 33%, p e .15). In the group of MeSH searches, overall precision and recall was significantly lower for effects than for interventions (12% versus 52%, p < .001 and 41% versus 69%, p < .001). Two textwords appeared in more than 25% of the benchmark collection: reminder (25.7%) and cost (25.0%). The results of this study indicate that information needs for health care quality improvement cannot be met by simple literature searches. Certain MeSH terms and combinations of textwords yield moderately efficient recall and precision in literature searches for health care quality improvement. Clinicians and physician executives gaining direct access to bibliographic database could probably be better served by structured indexing of critical aspects of randomized controlled clinical trials: design, sample, interventions, and effects.
24 citations
TL;DR: This project focuses on three major blood cell types, namely, erythrocytes, leukocytes and platelets, which are found in human blood and to classify them based upon their morphological features using neural networks.
Abstract: The objective of this project is to propose a method of identifying cells found in human blood and to classify them based upon their morphological features using neural networks. The project focuses on three major blood cell types, namely, erythrocytes, leukocytes and platelets. The data are collected using peripheral blood smears from clinical patients. The image acquisition requires 100× magnification on all the blood smears, the preprocessing involves the use of median and edge enhance filterss the feature extraction is done by performing the wavelet transform on the images. Finally classification of the blood cell types is done using ALOPEX and Back Propagation trained neural networks. The efficacy of both networks is then compared by comparing their outputs and number of iterations required to reach the final result.
23 citations
TL;DR: A neural network model in classifying both the well and not-well health status of HIV/AIDS patients is developed and evaluated in terms of validity and reliability of the test.
Abstract: This paper presents an application of neural networks to classify and to predict the health status of HIV/AIDS patients A neural network model in classifying both the well and not-well health status of HIV/AIDS patients is developed and evaluated in terms of validity and reliability of the test Several different neural network topologies are applied to AIDS Cost and Utilization Survey (ACSUS) datasets in order to demonstrate the neural network's capability
23 citations
TL;DR: The model result can be applicable to eliciting the perceptions, insights, and understanding of health-care decision-makers for strategic human resource planning.
Abstract: This paper deals with the development of a human resource planning (HRP) model for hospital laboratory personnel. External and organizational factors impacting the demand and supply of clinical laboratory personnel in an urban academic health center are identified by a Delphi process. These factors are structured into a hierarchy for the application of the Analytic Hierarchy Process (AHP). Computer software, Expert Choice, was used in model hierarchy development and judgmental elicitation process. The model result can be applicable to eliciting the perceptions, insights, and understanding of health-care decision-makers for strategic human resource planning.
23 citations
TL;DR: The medical record system DocuLive EPR was installed at a “typical” ward at the Central Hospital of Akershus and modules for laboratory order entry and reporting of results were evaluated prospectively using several information sources.
Abstract: The medical record system DocuLive EPR was installed at a “typical” ward at the Central Hospital of Akershus. Modules for laboratory order entry and reporting of results were evaluated prospectively using several information sources (hospital information systems, telephone records, user survey, semi-structured interviews with key informants). The main findings are discussed, and the lessons learned from the evaluation project are presented.
TL;DR: It is found that a community intervention trial against osteoporosis is both motivated and feasible and evidence is provided on these crucial issues of logics and logistics.
Abstract: Under designations like small areas action research and intervention, directed ‘ground-up’ health promotion and prevention in the population form an important part of the ongoing medical systems development. There is recent evidence of the success of community intervention against cardiovascular disease. In osteoporosis, however, there is still a lack of conclusive data on both the logics and logistics of such an approach. Since 1988, a county health policy program has been formulated and implemented in Ostergotland, Sweden, following the principles and guidelines of the WHO HFA 2000 declaration. Vadstena (n ≈ 7,600) was chosen for a local and generalizable osteoporosis prevention project mediated by the primary care organization by means of health promotion and education in the community. In the present report we emphasize that community intervention is an important new advancement of the medical systems, where the basic research questions include operational and management aspects as equally vital and measurable requisites and results as other performance and outcome variables. We found that a community intervention trial against osteoporosis is both motivated and feasible and in this report wish to provide evidence on these crucial issues of logics and logistics.
TL;DR: The framework that is being developed by the World Health Organization for addressing environmental health indicators is presented, the findings of a series of five regional workshops held in 1995–96 are reported on, and how human health has been addressed in a prominent EA conduct in northern Saskatchewan is presented.
Abstract: Environmental assessment (EA) is required in Canadian federal and provincial jurisdictions as part of the process for decision-making on the acceptability of development projects. With increasing recognition of the relationship between environment and health, assessing “health” impact has growing importance. This paper presents the framework that is being developed by the World Health Organization (WHO) for addressing environmental health indicators, reports on the findings of a series of five regional workshops held in 1995–96 to examine the role of health professionals in environmental assessment in Canada, and presents a case study illustrating how human health has been addressed in a prominent EA conduct in northern Saskatchewan. Opportunities for future development of environmental health indicators are considered, with special reference to the potential use of medical data to address these challenges.
TL;DR: A measure of explained variation of survival times for a given regression model used in survival analysis quantifies the predictive power of a set of prognostic factors in the model, and therefore provides useful information for more precise prediction of patient prognosis, and for designing randomized clinical trials with the capability of determining treatment effects.
Abstract: This paper describes a measure of explained variation (MEV) of survival times for a given regression model used in survival analysis. It quantifies the predictive power of a set of prognostic factors in the model, and therefore provides useful information for more precise prediction of patient prognosis, and for designing randomized clinical trials with the capability of determining treatment effects. The MEV defined in this article is asymptotically derived from the squared product-moment correlations it can be interpreted as an adaptation of the multiple correlation coefficient for the normal linear model to the survival time regression model. Monte-Carlo simulations are performed to investigate the statistical behavior of the proposed MEV. The MEV is applied to estimate the predictive power of several sets of prognostic factors for gastric cancer in Japan using data from a large clinical trial.
TL;DR: A deeper understanding of how clinical information systems are being implemented is provided by emphasizing research efforts on the dynamic nature of the process, that is, the “how” and “why” of what happened.
Abstract: The rapid movement of information technologies into health care organizations has raised managerial concern regarding the capability of today's institutions to satisfactorily manage their introduction. Indeed, several health care institutions have consumed huge amounts of money and frustrated countless people in wasted information systems implementation efforts. Unfortunately, there are no easy answers as to why so many health informatics projects are not more successful. In this light, the aim of this study is to provide a deeper understanding of how clinical information systems are being implemented by emphasizing research efforts on the dynamic nature of the process, that is, the “how” and “why” of what happened. Using a case study methodology, we examined the implementation of a patient charting system in the Burn Center of a large, not-for-profit, teaching hospital. Based on an in-depth examination of this implementation, several insights are offered to those who have responsibility for managing complex and risky clinical information system implementation projects.
TL;DR: The extent of information systems integration in the financial, medical, and administrative systems of the hospitals is measured to provide a benchmark for hospitals to determine their technology transfer position and to set goals.
Abstract: 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.
TL;DR: A graphical three-dimensional method that facilitates image registration and fusion, and provides quantitative geometric and volume information, enhances the use of functional imaging (SPECT, PET) which, though a powerful clinical tool, has the disadvantage of low spatial resolution and ill-defined boundaries.
Abstract: We present a graphical three-dimensional method that facilitates image registration and fusion, and provides quantitative geometric and volume information. In particular it enhances the use of functional (radiopharmaceutical) imaging (SPECT, PET) which, though a powerful clinical tool, has the disadvantage of low spatial resolution and ill-defined boundaries. Registration between functional images and structural images (MRI, CT) can augment the anatomical context of these functional images.
TL;DR: This paper outlines Kyushu University's university SOHO connection system and discusses the merits and demerits of using telephone line connections.
Abstract: SOHO (Small Office/Home Office) has recently become popular, as it makes working at home possible. Computers or Local Area Networks(LAN) connected to the office network from home are necessary for the implementation of this concept. Kyushu University has begun a service connecting home computers to the campus LAN for researchers, staff and students of the Faculty of Medicine. We have two different telephone connection methods. One connects the campus LAN and the home computer LAN using routers through the Integrated Services Digital Network (ISDN). The other connects computers at home to the workstation in the university, using modems and the PPP (Point to Point Protocol) through a public telephone analog line. This paper outlines our university SOHO connection system and discusses the merits and demerits of using telephone line connections.
TL;DR: There are 10 minimum EMR design criteria contained in this article that are recommended for implementation based upon 16 years of medical malpractice experience and loss prevention input, and this article will explore the best information published from this currently silent sector of the industry.
Abstract: Over the past few years, the traditional paper-based medical record system has come under close scrutiny by every participant in the healthcare industry. Some groups, especially federal agencies such as Medicare and Medicaid, HMOs, and other third party payors, have begun to demand changes in medical record documentation, and have become very assertive as to what goals and objectives will be met. In contrast, the medical liability insurance industry has remained almost invisible during this period of transition. At a recent electronic medical records (EMR) conference participants attending a software development workshop were asked if they had their systems reviewed from a medicolegal standpoint by a malpractice insurance carrier. In response to this inquiry, not one software vendor raised their hand to indicate this had been accomplished, or was even contemplated. In the author's opinion, the key missing factor in the current quest for a paperless medical office system rests in the domain of those who represent the medical liability industry. All of these gate-keepers of medical loss and risk prevention will eventually be called upon, either by choice or necessity, to validate every working EMR system that is used in medical practices in the future. This article will explore the best information published from this currently silent sector of the industry, and proposes an active involvement by the medical liability industry in the current EMR design and development processes taking place. In addition, there are 10 minimum EMR design criteria contained in this article that are recommended for implementation based upon 16 years of medical malpractice experience and loss prevention input.
TL;DR: From analysis, it was shown that the phase spectrum of a VEP has a certain periodicity in the 0- to 40-Hz region and this was used to determine the range of the period that characterizes normal and abnormal populations and to establish an experimental method for objectively examining any kind of VEP waveforms.
Abstract: The Visual Evoked Potential (VEP) is an electrophysiological commonly used test in investigating various neurophysiological disorders. Through the years many methods have been developed, but there are not many objective criteria in distinguishing a normal VEP waveform from an abnormal. In this communication we use the phase characteristics of the power spectrum as a criterion of distinguishing normals and abnormals. From our analysis, it was shown that the phase spectrum of a VEP has a certain periodicity in the 0- to 40-Hz region. By studying these periodicities we were able to determine the range of the period that characterizes normal and abnormal populations and to establish an experimental method for objectively examining any kind of VEP waveforms.
TL;DR: The experience using telephone conference calls to conduct support groups for chemically-dependent women suggests that teleconferencing may not be the most effective method for providing support services to chemically- dependent women.
Abstract: This paper describes our experience using telephone conference calls to conduct support groups for chemically-dependent women. Forty-seven women agreed to participate in regular, weekly support groups that were conducted by two chemical dependency counselors. Counselors attempted to conduct 59 support groups via a telephone conferencing system. Our data indicated that attendance at these sessions was poor. Seventeen sessions had no participants. No group sessions were attended by 4 or more women, and only 3 sessions (7.1%) included 3 participants. Very few clients made regular use of the support groups. Only 4 clients (8.5%) participated in more than 3 group sessions. Our findings suggest that teleconferencing may not be the most effective method for providing support services to chemically-dependent women.
TL;DR: The benefits and challenges of electronic communications are discussed and on a successful case of physician use of a hospital communication system (information systems, technology, physicians, health care).
Abstract: Information systems are increasingly being adopted by both community- and hospital-based providers of health care services. A gap is in linkages between carers both within a hospital and between hospitals and community providers. A range of technologies is available to improve communication of patient clinical data and other information. This paper discusses the benefits and challenges of electronic communications and reports on a successful case of physician use of a hospital communication system (information systems, technology, physicians, health care).
TL;DR: A model for allocating nursing staff duties using a Patient Dependency System was developed using a time motion study conducted in a leading hospital and results show significant increase in the efficiency of utilization of resources and improvement in the quality of the care.
Abstract: Hospitals are striving for funds and at the same time are required to improve the delivery and quality health care to patients. Naturally this strains hospital resources and requires sophistication in planning and in resource utilization. Nursing staff time remains one of the most important resources that require careful planning. Scheduling the time and duties of the nursing staff on the basis of patients' needs could improve the quality of care and ultimately leads to efficient utilization of hospital resources. This paper presents a model for allocating nursing staff duties using a Patient Dependency System. The model was developed using a time motion study conducted in a leading hospital. Resource utilization indexes were compared before and after the model was implemented. Results show significant increase in the efficiency of utilization of resources and improvement in the quality of the care. The model presented as a set of decision making rules suitable for use in a Patient Dependency Knowledge Based System.
TL;DR: Uncertainties such as changes in the population size served by the managed health care organization, new developments in health care delivery technologies and changing attitudes of the population regarding healthier lifestyles are considered in this model.
Abstract: Described is a simulation model for forecasting the appropriate mix of physicians needed to meet health service demands of patients in managed health care organizations The model can be used by executives of managed health care organizations to plan for physician staffing levels by specialty Uncertainties such as changes in the population size served by the managed health care organization, new developments in health care delivery technologies and changing attitudes of the population regarding healthier lifestyles are considered in this model Use of the model is illustrated in an example
TL;DR: By assuming ideal sound and velocity fields, it is shown that the Doppler angle can be obtained from the statistics of the reflected ultrasonic signals in time domain correlation ultrasonic flowmeter.
Abstract: Calculation of the Doppler angle from the correlation coefficient of two aligned windowed data sets of two echoes in the time domain correlation method has been demonstrated. By assuming ideal sound and velocity fields, it is shown that the Doppler angle can be obtained from the statistics of the reflected ultrasonic signals in time domain correlation ultrasonic flowmeter. The resolution cell is chosen to be much longer than the impulse response of the system in order that the signals reflected from the scatterers preceding and following the resolution cell will be sufficiently small that they do not contribute to the resolution cell. Hence, the truncation effects of the resolution cell on the nearby scatterers may be ignored. The mathematical derivation of correlation coefficient is presented clearly. The measurement method of Doppler angle is given from the position of two aligned resolution cells.
TL;DR: A query and analysis system for normal growth measurement of Japanese children on the authors' WWW server using CGI that will save doctors and nurses the difficulty of looking up a child's data, then having to make the calculation.
Abstract: We developed a query and analysis system for normal growth measurement of Japanese children on our WWW server using CGI. It has two subsystems. The first shows standard height and standard weight calculated by height. This subsystem can calculate the difference between measured height and the standard along with deviation and the ratio of measured weight to the standard weight. The second shows standard height, weight, head circumference, and chest circumference. This subsystem can calculate differences between the measurements and the standard as well as deviation. Because of the low amount of output required, very short turn-around time was required. This system also allows use of the same interface no matter which brand terminal is used and has wide reusability. This system will save doctors and nurses the difficulty of looking up a child's data, then having to make the calculation. We also compare the merits of CGI and Java.
TL;DR: The effect of errors associated with A/D conversion process on the accuracy of the velocity estimate is discussed and effects of interpolating the correlation function rather than determining the complete function were presented.
Abstract: The implementation of Time Domain Correlation Method for blood flow velocity estimation requires the conversion of the reflected ultrasonic signals into digital format in order that the computer can be utilized to investigate the technique. A number of quantization errors, namely, that the A/D has a finite bit resolution, only a limited number of samples of the waveform may be taken per wavelength and correlation function only exits at discrete points, have an effect on the velocity estimate. This paper discusses the effect of errors associated with A/D conversion process on the accuracy of the velocity estimate. A computer simulation was performed to achieve this goal. A band passed white Gaussian noise segment was used to simulate the reflected ultrasonic signal. The jitters of the velocity estimates corresponding various A/D resolutions were calculated and plotted. Effects of interpolating the correlation function rather than determining the complete function were presented.