Topics in health information management最新文献

Breast screening requires radiologists to exercise keen perceptual skills to find what may be faint, small features, and sophisticated interpretative skills to classify them correctly. Understandably, radiologists sometimes make errors, and evidence suggests that employing a computer prompting aid can reduce them. To investigate prompting aid requirements, we have studied both current reading practices and radiologists reading with prompts. These studies have enabled us to understand better how radiologists manage errors in current practice, and how they deal with prompting aid errors. They also show that such aids may get used in ways quite different from those originally envisaged.

Neonatal intensive care involves continuous monitoring of highly unstable patients in order to plan and deliver effective care and treatment. Making care and treatment decisions depends upon using information obtained in many different ways. Analysis of care and treatment tasks shows how much staff need to rely on one another for crucial information. This problem becomes more acute as personnel change shifts, yet are still obliged to maintain continuity of care. Effective sharing of information is done through the medium of shared records, shift handovers, ward rounds, and informal verbal exchanges. This article describes strategies for understanding the tasks involved in neonatal intensive care, considers issues of task fragmentation, identifies the communication systems designed to minimize the effects of this fragmentation, and reviews problems associated with those systems that give rise to the potential for human error.

The effectiveness of a procedure is increasingly guided by the evaluation of patient outcomes. Outcomes data is used to develop clinical pathways of care and to define appropriate resource-use levels without sacrificing quality of care. Integration of the economic implications of medical services into an outcome-based guideline allows for the development of disease-management strategies. In cardiovascular medicine, risk reduction is associated with high cost due to the "pay-back" of new technologies and therapies. A major challenge is to define a balance between "high tech" care and cost. This paper devises an outpatient evidence-based guideline using clinical and economic outcomes data for the diagnosis of coronary disease.

The need for a patient-centered approach to health care services delivery is well recognized. Health care has become more specialized, with increasing numbers of disciplines and subdisciplines. In addition, both providers and community are increasingly mobile. As a consequence, patients see more providers, which has led to increasing fragmentation of patient-centered care and in particular of patients' personal health records. Clinicians and patients alike recognize the need to ensure that care information is patient-centered, continuous, and integrated in order to optimize the effectiveness of proactive and reactive care. Current arrangements, however, including the architecture of medical record and information management systems, are mainly provider- and service-centered and may not readily support the sharing of data to this end.

The ability of case managers to rely on the traditional intuitive appreciation for the value of case management is declining. Case managers must accept the challenge of identifying, measuring, and reporting their outcomes, and clearly link outcomes with accountability. Practicing case managers must be as familiar with outcomes measurement and selecting relevant measures as their managers. The Case Management Society of America (CMSA) sponsored the development of the Council for Case Management Accountability (CCMA) to provide leadership in the development of outcomes. The work and mission of CCMA includes the creation of the "Spectrum of Accountability" and sponsoring three "State of the Science" papers addressing key case management outcomes areas.

The complexity of the health care environment will increase in the next millennium. Organizations must adopt an approach of selecting outcomes management solutions that are focused on data capture, analysis, and comparative reviews and reporting. They must decisively and creatively implement, in a phased approach, integrated solutions from existing robust systems, while considering future systems targeted for implementation. Outcomes management solutions must be integrated with the organization's information systems strategic plan. The successful organization must be able to turn business-critical data into information that supports both business and clinical decision-making activities. In short, health care organizations will have to become information-driven.

Readmissions are a key measurement tool in today's outcomes-focused health care environment. Monitoring the volume of readmissions is a straightforward process in light of the database resources available to care providers. Examining and reporting on the actual reasons for readmissions provides opportunities for improvement specific to the needs of a patient population. The readmission coding tool used at the Medical University of South Carolina demonstrates both the ability to assess the causes for patients returning to our institution within thirty days of discharge and the opportunity to correct problems in specific service areas with regard to discharge planning.

The solution to the crisis in U.S. health care lies not in longing for the good old days or lobbying for higher reimbursements, but rather in taking a lesson from industry and producing a higher quality product more efficiently. The way to accomplish such a tall order is through collecting better information and applying it to improve care. The tools required are available: computers to gather and analyze data, the Internet to communicate information, research to advance the practice of medicine. The enduring health care organizations will be those that understand and embrace the coming changes, and change themselves.

As the practice of medicine grows in complexity and the public calls for demonstrated value at decreased cost, the need for increasing effectiveness of both providing care and evaluating patient outcomes becomes paramount. This paper will demonstrate the success of utilizing a standardized taxonomy within an automated patient record to provide cues to clinicians regarding individual, patient-focused outcomes as well as timely evaluation of aggregated patient outcomes data. A case study will be used to illustrate dynamic evaluation of clinical outcomes following cardiac surgery.

To prepare to enter the Last Great Race, the Iditarod, you need a great team with experience, dedication, training, sponsorship, and the ability to work towards the desired goal. Planning a cross-continuum care management system is equally challenging. In this article, we present a real-life example of how a community-based hospital system has begun to integrate existing case management and care coordination efforts into a unified approach to care management. This scenario challenges organizations developing, refining, and evaluating care management efforts to think about what is being done, how, and why.