Topics in health information management最新文献

The election of the Labour government in May 1997 has seen the continuation of advanced market reforms intended to modernize the UK National Health Service (NHS). The planning and implementation of information systems and technology (IS/IT) following these structural changes is both widespread and significant. An information strategy for the NHS, published recently, is intended to provide an initial seven-year program of life-long electronic health records for everyone in the United Kingdom. This article explores the potential role of these systems in the specific provision of the new primary health care groups. It argues that, if primary care physicians adopt appropriate delivery channels and service packages and are proactive in the use of IS/IT, then the outcome will produce more patient choice, less nonattendance, and consequently improved primary health care provision.

This article reports the results of a recent survey on usefulness of computer-based nursing information systems (NISs). To assess their usefulness, three research questions were asked: Are computer-based NISs useful to most nurses? What accounts for the nurses' assessment of NISs? What factors influence the usefulness of NISs? This framework can serve to guide empirical investigations into various aspects of information systems in hospitals. The findings lead to implications for nursing care management, as well as suggestions for nursing quality research opportunities.

Changes in health care delivery, reimbursement schemes, and organizational structure have required health organizations to manage the costs of providing patient care while maintaining high levels of clinical and patient satisfaction outcomes. Today, cost information, clinical outcomes, and patient satisfaction results must become more fully integrated if strategic competitiveness and benefits are to be realized in health management decision making, especially in multi-entity organizational settings. Unfortunately, traditional administrative and financial systems are not well equipped to cater to such information needs. This article presents a framework for the acquisition, generation, analysis, and reporting of cost information with clinical outcomes and patient satisfaction in the context of evolving health management and decision-support system technology. More specifically, the article focuses on an enhanced costing methodology for determining and producing improved, integrated cost-outcomes information. Implementation issues and areas for future research in cost-information management and decision-support domains are also discussed.

The general perception that the use of information technology (IT) in health care is ten to fifteen years behind IT in other industrial sectors such as banking, manufacturing, and airline is rapidly changing. Health care providers, faced with an unprecedented era of competition and managed care, are now exploring the opportunities for using IT to improve the quality while simultaneously reducing the cost of health care. A revolution is taking place in the health care industry, with IT playing an increasingly important role in its delivery. In recent years, for example, the industry spent approximately $12 billion to $14 billion a year on IT. Further exponential growth is expected as the health care industry implements electronic medical records, upgrades hospital information systems, sets up intranets for sharing information among key stakeholders, and uses public networks, such as the Internet, for distributing health-related information and for providing remote diagnostics. Along with these drastic changes and the new approach to health care, the field of health/medical informatics and telematics has also experienced significant growth in the last few years. This article identifies and surveys the critical information technologies that are being adopted to provide strategic benefits to the various health care constituencies including hospitals and health maintenance organizations (HMOs).

This article describes a system addressed to different health care professionals for building, using, and sharing decision support systems for resource allocation. The system deals with selected areas, namely the choice of diagnostic tests, the therapy planning, and the instrumentation purchase. Decision support is based on decision-analytic models, incorporating an explicit knowledge representation of both the medical domain knowledge and the economic evaluation theory. Application models are built on top of meta-models, that are used as guidelines for making explicit both the cost and effectiveness components. This approach improves the transparency and soundness of the collaborative decision-making process and facilitates the result interpretation.

One fundamental clinical role of radiologists is to provide attending physicians with interpretations of an individual patient's radiological images essential to a treatment plan or overall patient management. Interpreting images from a newly taken radiological examination often requires reference to prior images of the same patient to establish a baseline from which to confirm a suspected pathological process or injury or to evaluate the progression of one that has been identified. Such image references are crucial to the radiologist's examination reading and when inappropriately supported can result in prolonged reading time, decreased report quality, and frustration. To address the problem of inadequate image prefetching methods used by many health care organizations, we took a knowledge-based approach and developed Image Retrieval Expert System (IRES), which incorporates relevant medical/radiological knowledge and contains image retrieval heuristics commonly shared by radiologists. This article describes the design of IRES, highlights its preliminary evaluation results, and discusses issues important for managing this and similar technologies in a health care organization.

The failure of health care information systems is a topic of critical importance for information management professionals. Such failure is also important for the consumers of health services who rely on the informed activity of health care workers for their well-being. This article presents case studies of two information systems projects within the British National Health Service that are generally viewed as having failed. The article provides an analysis of these failures, and examines whether the British National Health Service is particularly prone to the phenomenon of information systems failure.

Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

The Organizational Behavior discipline suggests that there are various functions of management within organizations. The functions require that people make decisions as part of the ordinary operations of the organization. These decisions are dependent on timely, accurate, and reliable information. Because the functions of management vary, the information requirements to support those functions also vary. An information system that is designed on the basis of these varying information needs for different parts of the management structure thereby producing an information system that is integrated rather than fragmented, promotes the probability of better decisions and thus enhances the organization's competitive position in its environment.

Growth in managed care has resulted in an increased need for studies in health care planning. The article focuses on the estimated number of primary care beds needed in the state to provide quality services to all Oklahoma residents. Based on the 1996 population estimations for Oklahoma and its distribution to the 77 counties, a space-filling approach is used to determine 46 service areas, each of which will provide primary care service to its area population. Service areas are constructed such that residents of an area are within an acceptable distance to a primary care provider in the area. A simulation model is developed to determine the number of primary care beds needed in each service area. Statistical analysis on actual hospital data is used to determine the distributions of inpatient flow and length of stay. The simulation model is validated for acute care hospitals before application to the service areas. Sensitivity analysis on model input parameter values is performed to determine their effect on primary care bed calculations. The effect of age distribution on the bed requirement is also studied. The results of this study will assist the Oklahoma Health Care Authority in the development of sound health care policy decisions.