Showing papers in "Journal of Medical Systems in 2002"

Decision Trees: An Overview and Their Use in Medicine

Abstract: In medical decision making (classification, diagnosing, etc.) there are many situations where decision must be made effectively and reliably. Conceptual simple decision making models with the possibility of automatic learning are the most appropriate for performing such tasks. Decision trees are a reliable and effective decision making technique that provide high classification accuracy with a simple representation of gathered knowledge and they have been used in different areas of medical decision making. In the paper we present the basic characteristics of decision trees and the successful alternatives to the traditional induction approach with the emphasis on existing and possible future applications in medicine.

Comparison of Wavelet Transform and FFT Methods in the Analysis of EEG Signals

Abstract: In this study, whether the wavelet transform method is better for spectral analysis of the brain signals is investigated For this purpose, as a spectral analysis tool, wavelet transform is compared with fast Fourier transform (FFT) applied to the electroencephalograms (EEG), which have been used in the previous studies In addition, the time-domain characteristics of the wavelet transform are also detected The comparison results show that the wavelet transform method is better in detecting brain diseases

Exploring Hospitals' Adoption of Information Technology

Abstract: This study explores the adoption of information technology (IT) and the association between organizational and market factors, and IT adoption in hospitals. Results suggest that a wide range of amounts and types of IT are adopted. Hospitals with higher overall IT adoption adopt strategic IT most often. Hospitals with lower IT adoption adopt administrative IT most often. Results also show hospital IT adoption to be positively associated with hospital size, location, system membership, ownership, and market competition.

Measurement of Technical Efficiency of Public Hospitals in Kenya: Using Data Envelopment Analysis

Abstract: In Sub-Saharan Africa (SSA), there is a huge knowledge gap of health facilities performance. The objective of this study is to measure relative technical efficiencies of 54 public hospitals in Kenya using Data Envelopment Analysis (DEA) technique. 14 (26%) of the public hospitals were found to be technically inefficient. The study singled out the inefficient hospitals and provided the magnitudes of specific input reductions or output increases needed to attain technical efficiency.

Health Benefits and Risks of the Internet

Abstract: The linking of the Internet with health and medicine involves all levels of society, including individuals, health care providers, professional organizations, communities, and local and federal governments. A growing body of evidence suggests that despite the benefits of the Internet, this means of communication also figures into the creation of new forms of health risk for some users. This paper examines the effects of the Internet on the promotion of both health and illness. The discussion focuses on those factors of online communication that produce positive health outcomes and also the potential for health risk. Implications for health providers and for better serving patients are analyzed together with recommendations for improving services for those who go online to access health information.

Theory and Applications of Telemedicine

Abstract: In this study, telemedicine and the use of advanced telemedicine technologies are explained. Telemedicine is the use of modern telecommunications and information technologies for the provision of clinical care to individuals at a distance, and transmission of information to provide that care. Telemedicine can be used for decision making, remote sensing, and collaborative arrangements for the real-time management of patients at a distance. The use of telecommunications and information technologies in providing health services is determined. Telemedicine is described as combination of topics from the fields of telecommunication, medicine, and informatics. The medical systems infrastructure consisting of the equipment and processes used to acquire and present clinical information and to store and retrieve data are explained in details. The challenges existing in telemedicine development in different countries are given. Technological, political, and professional barriers in applications of telemedicine are defined. An investigation of telemedicine applications in various fields is presented, and enormous impact of telemedicine systems on the future of medicine is determined.

Integration Mechanisms and Hospital Efficiency in Integrated Health Care Delivery Systems

Abstract: This study analyzes integration mechanisms that affect system performances measured by indicators of efficiency in integrated delivery systems (IDSs) in the United States. The research question is, do integration mechanisms improve IDSs' efficiency in hospital care? American Hospital Association's Annual Survey (1998) and Dorenfest's Survey on Information Systems in Integrated Healthcare Delivery Systems (1998) were used to conduct the study, using IDS as the unit of analysis. A covariance structure equation model of the effects of system integration mechanisms on IDS performance was formulated and validated by an empirical examination of IDSs. The study sample includes 973 hospital-based integrated health care delivery systems operating in the United States, carried in the list of Dorenfest's Survey on Information Systems in Integrated Health care Delivery Systems. The measurement indicators of system integration mechanisms are categorized into six related domains: informatic integration, case management, hybrid physician–hospital integration, forward integration, backward integration, and high tech medical services. The multivariate analysis reveals that integration mechanisms in system operation are positively correlated and positively affect IDSs' efficiency. The six domains of integration mechanisms account for 58.9% of the total variance in hospital performance. The service differentiation strategy such as having more high tech medical services have much stronger influences on efficiency than other integration mechanisms do. The beneficial effects of integration mechanisms have been realized in IDS performance. High efficiency in hospital care can be achieved by employing proper integration strategies in operations.

Using DEA to Evaluate Efficiency and Formulate Policy Within a Greek National Primary Health Care Network

Abstract: The purpose of this paper is to critically evaluate the relative efficiency of primary health care centers of the principal Greek public insurance provider, the Social Security Institute (IKA). The source of the efficiency data was the Statistical Unit of IKA. Using Data Envelopment Analysis, we analyzed data from 133 centers nationwide. Input variables included the number of personnel, stratified in different categories, and the number of people covered by each health center. The number of pensioners enlisted to each health care facility was used as an index of aging and vulnerability of the covered population. According to the results of the study, centers with the technological infrastructure to perform laboratory and/or radiographic examinations exhibited higher efficiency scores. In addition, centers with eligible covered populations from 10,000 to 50,000 were found as the most efficient. Health sector reforms should be planned on the basis of such analyses. If the model is supplemented with valid demographic, socioeconomic, and epidemiological data, it may become the basis for the creation of a national health care chart, matching available resources to the population and its health care needs.

Adolescent Girls' Use of the Internet for Health Information: Issues Beyond Access

Abstract: Whilst the “digital divide” in access to Internet technology has rightly concerned commentators on health inequalities, there are issues beyond physical access that must be tackled if adolescents and adults are to optimize the benefits of this developing medium. Emerging themes from an exploratory qualitative study of adolescents' use of the Internet for information about health and medicines describe four major challenges. Access issues persist if there are insufficient school computers that are unable to cope with increasing Web site sophistication. Software on school-based machines preventing exposure to material that is deemed to be unsuitable may also prohibit access to educational sites about sexual health and drug misuse. Strategies to manage the volume of available information are needed. The interplay of active and passive information seeking challenges whether the Internet can be truly useful during acute illnessepisodes. This exploration with future health service users highlights important questions for further study.

Data Mining to Support Simulation Modeling of Patient Flow in Hospitals

Abstract: Spiraling health care costs in the United States are driving institutions to continually address the challenge of optimizing the use of scarce resources. One of the first steps towards optimizing resources is to utilize capacity effectively. For hospital capacity planning problems such as allocation of inpatient beds, computer simulation is often the method of choice. One of the more difficult aspects of using simulation models for such studies is the creation of a manageable set of patient types to include in the model. The objective of this paper is to demonstrate the potential of using data mining techniques, specifically clustering techniques such as K-means, to help guide the development of patient type definitions for purposes of building computer simulation or analytical models of patient flow in hospitals. Using data from a hospital in the Midwest this study brings forth several important issues that researchers need to address when applying clustering techniques in general and specifically to hospital data.

Theory and Applications of Biotelemetry

Abstract: In this study, biotelemetry and its evolution is explained in detail. Bioelectric and physiological variables could be measured by biotelemetry systems. The development of a biotelemetry system and its principal operation are presented. The components of a biotelemetry system are explained. Biomedical data has been telemetered through every medium between two sites by using a variety of modulated energy forms. Designing of the link between transmitter and receiver is described. Important factors in designing a backpack or implanted telemeter are explained. The main features of implanted biotelemetry units are determined. Single-channel and multichannel biotelemetry systems are defined. The types of telemetry, and a comparison thereof, are given. The power sources of biotelemetry systems and features of different power sources are explained. A survey of biotelemetry applications on humans and animals is presented and advantages of using biotelemetry systems are determined.

Clinical Process Analysis and Activity-Based Costing at a Heart Center

Abstract: Cost studies, productivity, efficiency, and quality of care measures, the links between resources and patient outcomes, are fundamental issues for hospital management today. This paper describes the implementation of a model for process analysis and activity-based costing (ABC)/management at a Heart Center in Sweden as a tool for administrative cost information, strategic decision-making, quality improvement, and cost reduction. A commercial software package (QPR®) containing two interrelated parts, “ProcessGuide and CostControl,” was used. All processes at the Heart Center were mapped and graphically outlined. Processes and activities such as health care procedures, research, and education were identified together with their causal relationship to costs and products/services. The construction of the ABC model in CostControl was time-consuming. However, after the ABC/management system was created, it opened the way for new possibilities including process and activity analysis, simulation, and price calculations. Cost analysis showed large variations in the cost obtained for individual patients undergoing coronary artery bypass grafting (CABG) surgery. We conclude that a process-based costing system is applicable and has the potential to be useful in hospital management.

Health Care Web Sites: Are They Reliable?

Abstract: Locating reliable health care information on the World Wide Web is difficult and confusing. Thus, Internet users must choose the appropriate resources to guide their health care decisions. This paper will describe the “typical” Internet user. Then, it will compare the three most “comprehensive” web site guidelines. Finally, it will summarize what criteria are necessary to create and maintain reliable health care web sites.

Clictate: A Computer-Based Documentation Tool for Guideline-Based Care

Abstract: The use of computer-based documentation tools confers many benefits to the delivery of evidence-based health care We developed Clictate, a structured reporting environment that utilized standard WindowsTM-based data entry constructs and natural language generation Clictate has been in use for over 3 years by pediatric providers in an ambulatory setting More than 50% of our providers use Clictate during the patient encounter This report describes our results to date, and suggests future opportunities for research and development in the area of computer-based documentation

Is the Turkish Health Care System Ready to Be a Part of the European Union

Abstract: Lately, Turkey is struggling to recover from the economic effects of the economic crisis so that the government officials are trying to impose budget cuts in health and education sectors After the United States, the country's national defense expenditures are the highest among the NATO countries Therefore, Turkey allocates only 3–4% of the gross domestic product for health care expenses Overall, the health status in Turkey is the lowest among the European Union countriess infant mortality rate is about 45 per 1000 live births, which is the highest on the European continent, and per capita health care expenditure is d120 Although 75% of the people are covered by some type of public insurance, 25% of the Turkish people do not have any insurance coverage The national system is funded by taxes (43%), out of pocket payments (32%), and social and private insurance premiums (25%) This study examines whether Turkey is ready to be a part of the European Union in terms of the health sector of its economy and health status of its people

Evolution in Medical Decision Making

Abstract: The classical approach to medical decision making can be limited by the underlying theories. The evolutionary computation is a different concept, which can find many different solutions of the problem. In medicine, this is useful because of different expectations the decision system must face. We implemented a tool for genetic induction of vector decision trees, which are a good choice for a medical decision model because of their simplicity and transparency. The vector decision tree gives multiple classifications in one single pass. Evolutionary development of such trees achieved good results when the results were statistically compared to those of other classical methods. For medical interpretation however a cooperation with doctors is needed to verify the model build.

A Structural Equation Modeling Approach to Examining the Predictive Power of Determinants of Individuals' Health Expenditures

Abstract: Understanding the determinants of health expenditures is essential for a fair and effective utilization profiling, particularly in the setting of capitation rates in risk-adjustment models. The objective of the study was to examine the relative importance of determinants in predicting future health expenditures, using structural equation modeling. Based on Andersen's behavioral system model, individual determinants along with prior utilization and measures of health status from 1994 are evaluated in a longitudinal design for their predictive power for health expenditures in 1995. A total of 4255 policyholders enrolled in three health plans at Trigon BlueCross/BlueShield of Virginia who responded to a mail survey were included for analysis. Person-level annual charges for health services utilization were used as the dependent variable. Five health scales were excerpted from Health Survey SF-36 to represent an individual's health status. Excluding prior utilization in 1994, health status (γ e −0.19, p < 0.001) and having diabetes (γ e 0.08, p < 0.001) are two statistically significant predictors of health expenditures in 1995. Including prior utilization, both health status (γ e −0.15, p < 0.001) and prior utilization (γ e 0.15, p < 0.001) are the most important predictors, followed by having diabetes (γ e 0.08, p < 0.001). Health status is a powerful predictor of future health expenditures, even when prior utilization is controlled.

Medical Information and the Internet: Do You Know What You Are Getting?

Abstract: Due to the Internet technology, hundreds of Web sites are accessible for medical information, and the retrieval of such information is quite rapid. Once you as a consumer obtain all of this information, how do you determine whether the information you are looking at is valid and current and even relevant to your needs? This article presents various criteria necessary to evaluate the information on a medical Web site; no standards currently are in place to mandate the validity of information published on the Internet.

Benchmarking Mechanical Ventilation Services in Teaching Hospitals

Abstract: The purpose of this investigation was to examine the technical efficiency of mechanical ventilation nonsurgery (DRG 475) among University Hospital Consortium (UHC) hospitals that consists of volunteer, teaching hospitals across the nation. The data for this study was retrieved from the 1997 UHC database that includes charge and discharge information for 69 hospitals. Data on 7961 patients classified with mechanical ventilation were aggregated to the hospital level. We retained data from a total of 62 hospitals, the other seven hospitals had missing data. The research questions were (1) Do UHC hospitals differ significantly in their efficiencies in the treatment of mechanically ventilated patients? (2) What inputs and outputs contribute most to the inefficiencies associated with mechanical ventilation? Of the 62 hospitals analyzed using data envelopment analysis technique, 10 were considered efficient and 52 were inefficient as compared to their benchmark peers. Efficient and inefficient hospitals did significantly differ between the transferred output variable and between the respiratory, laboratory, and radiology input variables. All inputs demonstrated excessive resource utilization among inefficient hospitals as compared to efficient hospitals. A total reduction of about d19 million dollars in ancillary services would need to occur for inefficient hospitals to approach the frontier of efficient hospitals. This study demonstrates that mechanical ventilation is costly, yet the specified ancillary services are capable of being reduced yielding technical efficiency as demonstrated by 10 efficient hospitals.

Mobile Computing in the Humanitarian Assistance Setting: An Introduction and Some First Steps

Abstract: We developed a Palm operating system-based handheld computer system for administering nutrition questionnaires and used it to gather nutritional information among the Burmese refugees in the Mae La refugee camp on the Thai–Burma border. Our experience demonstrated that such technology can be easily adapted for such an austere setting and used to great advantage. Further, the technology showed tremendous potential to reduce both time required and errors commonly encountered when field staff collect information in the humanitarian setting. We also identified several areas needing further development.

Technical Efficiency of Nursing Units in a Tertiary Care Hospital in Taiwan

Abstract: The variation in productivity and cost efficiency has been observed among 57 nursing units in a large tertiary care hospital. The inefficient units can achieve the same level of efficiency as the efficient units by altering their inputs (either nursing hours or patient costs). The optimization can be achieved through proper reallocations of nursing resources such as nursing hours or costs. However, the resource reallocation to achieve high efficiency should not be at the expense of quality of care. Future efficiency studies should incorporate the nursing sensitive measures of quality in the analysis.

Stochastic Trees and the StoTree Modeling Environment: Models and Software for Medical Decision Analysis

Abstract: In this paper we present a review of stochastic trees, a convenient modeling approach for medical treatment decision analyses. Stochastic trees are a generalization of decision trees that incorporate useful features from continuous-time Markov chains. We also discuss StoTree, a freely available software tool for the formulation and solution of stochastic trees, implemented in the Excel spreadsheet environment.

Regional Variation in Medical Systems Data: Influences on Upcoding

Abstract: Attempts to minimize over-reimbursement to health care providers have resulted in highly publicized prosecution of health care providers and provider organizations. Such prosecution has led many to propose that upcoding influences exerted upon health care information managers would largely disappear, both within and external to the provider organization. This study seeks to examine the degree of both intra- and extraorganizational influences on reimbursement optimizing practices through a national survey of accredited health information managers. Results suggest that significant upcoding influence continues to occur within organizations, despite the risk of severe counterfraud penalties designed to eliminate such practices. We examine variation in intra- and extraorganizational optimizing influences, finding such influence was found to exist both within and external to the provider organization. We also examine how optimization influences vary across demographic, practice setting, and market characteristics. We find significant variation in influence across practice settings and managed care markets. Ramifications for reimbursement assessment are discussed.

Negligible Electromagnetic Interaction Between Medical Electronic Equipment and 2.4 GHz Band Wireless LAN

Abstract: Wireless LANs using radio waves have recently gained popularity for installation in hospitals Because electromagnetic waves transmitted from mobile telephones have been shown to cause interference with medical electronic equipment, prudence would seem necessary when introducing radio wave communication devices into hospitals Therefore, we tested the effect of wireless LAN communication on medical electronic equipment and the effect of electronic equipment on wireless LAN communication We observed nine pieces of electronic equipment in the operating mode while transmitting radio waves from a wireless LAN Even when the access point was put very close to the medical electronic equipment surface and data was transmitted, no malfunction of the equipment was observed The medical electronic equipment caused little change in the effectiveness of the communication device, although radio waves emitted from electric knives and a remote patient monitor reduced the reception rate to about 60% The communication speed of the wireless LAN was temporarily reduced only when a microwave oven was located close to and facing the access point Because output in Japan is limited to a maximum of 10 mW, wireless LAN following the IEEE80211b standard should be able to be installed safely in Japanese hospitals However, wireless LAN access points should not be installed near microwave ovens

EPR Adoption and Dual Record Maintenance in the U.S.: Assessing Variation in Medical Systems Infrastructure

Abstract: The growing adoption of evidence-based medicine in the United States is acting to cause fundamental changes in the delivery of healthcare management services. With the increasing incorporation of electronic patient records (EPRs) into the day-to-day practice of medicine, it necessitates greater dependence on adequate functioning of such resources, as they become more frequently used as a clinical complement in the practice of medicine. Assessing the patterns of adoption of EPRs is likewise of increasing importance, with the recent imposition of uniform government data collection and management requirements. The medium of data storage and maintenance within many organizations is a critical factor in the ultimate delivery of service, with a like need for an integrated, designated medium for the management of data becoming paramount. This study examines, on a nationwide basis, variation in reported adoption of EPRs within U.S. healthcare organizations, and the related maintenance of dual electronic/paper record systems.

The Application of the Unified Modeling Language in Object-Oriented Analysis of Healthcare Information Systems

Abstract: This paper concerns itself with the beneficial effects of the Unified Modeling Language (UML), a nonproprietary object modeling standard, in specifying, visualizing, constructing, documenting, and communicating the model of a healthcare information system from the user's perspective. The author outlines the process of object-oriented analysis (OOA) using the UML and illustrates this with healthcare examples to demonstrate the practicality of application of the UML by healthcare personnel to real-world information system problems. The UML will accelerate advanced uses of object-orientation such as reuse technology, resulting in significantly higher software productivity. The UML is also applicable in the context of a component paradigm that promises to enhance the capabilities of healthcare information systems and simplify their management and maintenance.

Improving Information Access for Public Health Professionals

Abstract: Fundamental to our protection against biological weapons and the detection of disease outbreaks is the need to strengthen our surveillance systems. Improved electronic communications between local, state, and federal public health agencies provide a way for health officials to share information on unusual disease outbreaks and provide important health alert information. This article describes a model of a partnership between a regional medical library of the National Library of Medicine, a school of public health, and federally qualified community health centers. This project upgraded technology and provided public health professional training on Internet information and resources for local public health agencies.

A Practical Procedure to Prevent Electromagnetic Interference with Electronic Medical Equipment

Abstract: Problems involving electromagnetic interference (EMI) with electronic medical equipment are well-documented. However, no systematic investigation of EMI has been done. We have systematically investigated the causes of EMI. The factors involved in EMI were determined as follows: 1) Electric-field intensity induced by invasive radio waves from outside a hospital. 2) Residual magnetic-flux density at welding points in a building. 3) Electric-field intensity induced by conveyance systems with a linear motor. 4) The shielding capacity of hospital walls. 5) The shielding capacity of commercial shields against a wide range frequency radio waves. 6) The immunity of electronic medical equipment. 7) EMI by cellular telephone and personal handy-phone system handsets. From the results of our investigation, we developed a following practical procedure to prevent EMI. 1) Measurement of electric-field intensity induced by invasive radio waves from outside the hospital and industrial systems in the hospital. 2) Measurement of residual magnetic-flux density at electric welding points of hospital buildings with steel frame structures. 3) Control of the electromagnetic environment by utilizing the shielding capacity of walls. 4) Measurement of the immunity of electronic medical equipment. And 5) Installation of electronic gate equipment at the building entrance to screen for handsets.

On-Site Investigation of the Early Phase of Bhutan Health Telematics Project

Abstract: Telemedicine is valuable to many developing countries. International use of telemedicine is widespread. Telemedicine can improve health care in the developing countries by removing time and distance barrier, and optimize the use of limited health services in developing countries. The purpose of this paper is to investigate the current situation of healthcare services and telecommunications infrastructure in Bhutan. It summarizes the experience gained from a previous telemedicine pilot project initiated and implemented by the Telecommunication Development Bureau, International Telecommunication Union (BDT/ITU). It also introduces the priorities of telemedicine development set out by the local health authorities as well as the international organizations. By analyzing the common and most urgent problems in the country, which could be alleviated by using telemedicine, it formulates several recommendations concerning the future development strategy of telemedicine in Bhutan.

A Data Mining Approach to Characterizing Medical Code Usage Patterns

Abstract: This research describes a synthetic data mining approach to identifying diagnostic (ICD-9) and procedure (CPT) code usage patterns in two U.S. hospitals, with the goal of determining the adequacy and effectiveness of the current coding classification systems. We combine relative frequency measurements with measures of industry concentration borrowed from industrial economics in order to (1) ascertain the extent to which physicians utilize the available codes in classifying patients and (2) discover the factors that impinge on code usage. Our results partition the domain into areas for which the coding systems perform well and those areas for which the systems perform relatively poorly. The goal is to use this approach to understand how coding systems are used and to highlight areas for targeted improvement of the current coding systems.