Association between Health Information Technology and Case Mix Index / 대한의료정보학회지

OBJECTIVES: Health information technology (IT) can assist healthcare providers in ordering medication and adhering to guidelines while improving communication among providers and the quality of care. However, the relationship between health IT and Case Mix Index (CMI) has not been thoroughly investigated; therefore, this study aimed to clarify this relationship. METHODS: To examine the effect of health IT on CMI, a generalized estimation equation (GEE) was applied to two years of California hospital data. RESULTS: We found that IT was positively associated with CMI, indicating that increased IT adoption could lead to a higher CMI or billing though DRG up-coding. This implies that hospitals' revenue could increase around $40,000 by increasing IT investment by 10%. CONCLUSIONS: The positive association between IT and CMI implies that IT adoption itself could lead to higher patient billings. Generally, a higher CMI in a hospital indicates that the hospital provides expensive services with higher coding and therefore receives more money from patients. Therefore, measures to prevent upcoding through IT systems should be implemented.

Association of EMR Adoption with Minority Health Care Outcome Disparities in US Hospitals / 대한의료정보학회지

OBJECTIVES: Disparities in healthcare among minority groups can result in disparate treatments for similar severities of symptoms, unequal access to medical care, and a wide deviation in health outcomes. Such racial disparities may be reduced via use of an Electronic Medical Record (EMR) system. However, there has been little research investigating the impact of EMR systems on the disparities in health outcomes among minority groups. METHODS: This study examined the impact of EMR systems on the following four outcomes of black patients: length of stay, inpatient mortality rate, 30-day mortality rate, and 30-day readmission rate, using patient and hospital data from the Medicare Provider Analysis and Review and the Healthcare Information and Management Systems Society between 2000 and 2007. The difference-in-difference research method was employed with a generalized linear model to examine the association of EMR adoption on health outcomes for minority patients while controlling for patient and hospital characteristics. RESULTS: We examined the association between EMR adoption and the outcomes of minority patients, specifically black patients. However, after controlling for patient and hospital characteristics we could not find any significant changes in the four health outcomes of minority patients before and after EMR implementation. CONCLUSIONS: EMR systems have been reported to support better coordinated care, thus encouraging appropriate treatment for minority patients by removing potential sources of bias from providers. Also, EMR systems may improve the quality of care provided to patients via increased responsiveness to care processes that are required to be more time-sensitive and through improved communication. However, we did not find any significant benefit for minority groups after EMR adoption.

Association of EMR Adoption with Minority Health Care Outcome Disparities in US Hospitals / 대한의료정보학회지

OBJECTIVES: Disparities in healthcare among minority groups can result in disparate treatments for similar severities of symptoms, unequal access to medical care, and a wide deviation in health outcomes. Such racial disparities may be reduced via use of an Electronic Medical Record (EMR) system. However, there has been little research investigating the impact of EMR systems on the disparities in health outcomes among minority groups. METHODS: This study examined the impact of EMR systems on the following four outcomes of black patients: length of stay, inpatient mortality rate, 30-day mortality rate, and 30-day readmission rate, using patient and hospital data from the Medicare Provider Analysis and Review and the Healthcare Information and Management Systems Society between 2000 and 2007. The difference-in-difference research method was employed with a generalized linear model to examine the association of EMR adoption on health outcomes for minority patients while controlling for patient and hospital characteristics. RESULTS: We examined the association between EMR adoption and the outcomes of minority patients, specifically black patients. However, after controlling for patient and hospital characteristics we could not find any significant changes in the four health outcomes of minority patients before and after EMR implementation. CONCLUSIONS: EMR systems have been reported to support better coordinated care, thus encouraging appropriate treatment for minority patients by removing potential sources of bias from providers. Also, EMR systems may improve the quality of care provided to patients via increased responsiveness to care processes that are required to be more time-sensitive and through improved communication. However, we did not find any significant benefit for minority groups after EMR adoption.

Effects of Health Information Technology on Malpractice Insurance Premiums / 대한의료정보학회지

OBJECTIVES: The widespread adoption of health information technology (IT) will help contain health care costs by decreasing inefficiencies in healthcare delivery. Theoretically, health IT could lower hospitals' malpractice insurance premiums (MIPs) and improve the quality of care by reducing the number and size of malpractice. This study examines the relationship between health IT investment and MIP using California hospital data from 2006 to 2007. METHODS: To examine the effect of hospital IT on malpractice insurance expense, a generalized estimating equation (GEE) was employed. RESULTS: It was found that health IT investment was not negatively associated with MIP. Health IT was reported to reduce medical error and improve efficiency. Thus, it may reduce malpractice claims from patients, which will reduce malpractice insurance expenses for hospitals. However, health IT adoption could lead to increases in MIPs. For example, we expect increases in MIPs of about 1.2% and 1.5%, respectively, when health IT and labor increase by 10%. CONCLUSIONS: This study examined the effect of health IT investment on MIPs controlling other hospital and market, and volume characteristics. Against our expectation, we found that health IT investment was not negatively associated with MIP. There may be some possible reasons that the real effect of health IT on MIPs was not observed; barriers including communication problems among health ITs, shorter sample period, lower IT investment, and lack of a quality of care measure as a moderating variable.

Correction: Effects of Health Information Technology on Malpractice Insurance Premiums / 대한의료정보학회지

The authors and their respective affiliations should be corrected.

Factors Affecting Electronic Medical Record System Adoption in Small Korean Hospitals / 대한의료정보학회지

OBJECTIVES: The objective of this paper is to investigate the factors affecting adoption of an Electronic Medical Record (EMR) system in small Korean hospitals. METHODS: This study used survey data on adoption of EMR systems; data included that from various hospital organizational structures. The survey was conducted from April 10 to August 3, 2009. The response rate was 33.5% and the total number of small general hospitals was 144. Data were analyzed using the generalized estimating equation method to adjust for environmental clustering effects. RESULTS: The adoption rate of EMR systems was 40.2% for all responding small hospitals. The study results indicate that IT infrastructure (OR, 1.48; 95% CI, 1.23 to 1.80) and organic hospital structure (OR, 1.86; 95% CI, 1.07 to 3.23) rather than mechanistic hospital structure or the number of hospitals within a county (OR, 1.08; 95% CI, 1.01 to 1.17) were critical factors for EMR adoption after controlling for various hospital covariates. CONCLUSIONS: This study found that several managerial features of hospitals and one environmental factor were related to the adoption of EMR systems in small Korean hospitals. Considering that health information technology produces many positive health outcomes and that an 'adoption gap' regarding information technology exists in small clinical settings, healthcare policy makers should understand which organizational and environmental factors affect adoption of EMR systems and take action to financially support small hospitals during this transition.

Measure of Clinical Information Technology Adoption / 대한의료정보학회지

OBJECTIVES: The objective of this study was to create a new measure for clinical information technology (IT) adoption as a proxy variable of clinical IT use. METHODS: Healthcare Information and Management Systems Society (HIMSS) data for 2004 were used. The 18 clinical IT applications were analyzed across 3,637 acute care hospitals in the United States. After factor analysis was conducted, the clinical IT adoption score was created and evaluated. RESULTS: Basic clinical IT systems, such as laboratory, order communication/results, pharmacy, radiology, and surgery information systems had different adoption patterns from advanced IT systems, such as cardiology, radio picture archiving, and communication, as well as computerized practitioner order-entry. This clinical IT score varied across hospital characteristics. CONCLUSIONS: Different IT applications have different adoption patterns. In creating a measure of IT use among various IT components in hospitals, the characteristics of each type of system should be reflected. Aggregated IT adoption should be used to explain technology acquisition and utilization in hospitals.

Effect of Health Information Technology Expenditure on Patient Level Cost / 대한의료정보학회지

OBJECTIVES: This study investigate the effect of health information technology (IT) expenditure on individual patient-level cost using California Office of Statewide Health Planning and Development (OSHPD) data obtained from 2000 to 2007. METHODS: We used a traditional cost function and applied hospital fixed effect and clustered error within hospitals. RESULTS: We found that a quadratic function of IT expenditure best fit the data. The quadratic function in IT expenditure predicts a decrease in cost of up to US$1,550 of IT labor per bed, US$27,909 of IT capital per bed, and US$28,695 of all IT expenditure per bed. Moreover, we found that IT expenditure reduced costs more quickly in medical conditions than surgical diseases. CONCLUSIONS: Interest in health IT is increasing more than ever before. Many studies examined the effect of health IT on hospital level cost. However, there have been few studies to examine the relationship between health IT expenditure and individual patient-level cost. We found that IT expenditure was associated with patient cost. In particular, we found a quadratic relationship between IT expenditure and patient-level cost. In other word, patient-level cost is non-linearly (or a polynomial of second-order degree) related to IT expenditure.

The Impact of Height, Weight and Body Mass Index(BMI) in Young Men with Varicoceles / 대한남성과학회지

PURPOSE: To assess the impact of physical characteristics on the incidence of varicoceles. Although previous reports have alluded to the fact that taller individuals may have a higher incidence of varicoceles, this has not been systematically studied. We hypothesized that physical characteristics such as height and weight could have a significant impact on the incidence of varicoceles. MATERIALS AND METHODS: We retrospectively reviewed charts of 145 patients who presented for evaluation of varicocele between 2000~2005. Each patients' age, symptoms, height, weight and body mass index (BMI) were recorded. Independent t-tests were performed to determine whether a correlation existed between presence of a varicocele and height, weight, or BMI. Moreover, we selected 90 patients whose varicocele was detected by pain and performed the same analysis in order to exclude selection bias. Additionally, we compared varicocele grade with height, weight and BMI by one-way ANOVA test. RESULTS: Our analysis showed that there was no association between height and the presence of a varicocele. However, the weight of the patient and the incidence of varicocele approached significance with greater weight associated with a lower incidence of varicoceles. There was also an association between BMI and the presence of varicoceles but the correlation did not depended on varicocele grade. CONCLUSIONS: Although previous reports have alluded to a higher incidence of varicoceles in taller patients, the current study found no correlation between height and the presence of a varicocele. Increased weight, however, was associated with a significantly lower incidence of varicoceles. Varicocele grade was not correlated with any factor. This study demonstrates that height is not a consideration when evaluating the infertile male, whereas weight may affect the ability to diagnose the varicocele.

IRIS-Transobturator Tape Procedure for the Treatment of Women with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: We wanted to evaluate the clinical efficacy, safety and satisfaction of patients with IRIS-transobturator tape (TOT) operation for the women suffering with stress urinary incontinence. MATERIALS AND METHODS: 53 women with stress urinary incontinence who underwent the TOT procedure between February 2004 and June 2005 were included in this study. Preoperatively, the patients were evaluated with history taking, a physical examination, a voiding diary, a one-hour pad test, uroflowmetry and the post voided residual urine. The procedure was carried out using a previously established method under local anesthesia for 37 patients and under spinal anesthesia for 16 patients. The post-operative symptoms and patient satisfaction were assessed by questionnaire. RESULTS: The patients' mean age was 49.6 years (average age: 35-73 years). The mean follow-up was 10.9 months (average follow-up: 3-20 months). The mean operation time was 30.2 minutes (average time: 20-50 minutes). The mean duration of the post operative indwelling catheter was 1 hour for local anesthesia and 18 hours (range: 14-20 hours) for spinal anesthesia. Of the 53 patients, 49 (92.4%) of the patients were cured and 4 (7.6%) were significantly improved. The postoperative complications were urinary retention in 4 patients, and tape exposure by vaginal erosion in 1 patient. De novo urgency occurred in 1 patient and de novo urge incontinence occurred in 1 patient. CONCLUSIONS: Despite the short term follow-up period, the IRIS-TOT procedure is simple, effective and less invasive for the treatment of stress urinary incontinence in terms of the high success rate and the low complication rates.

Development of Problem-based medical education program using the Internet / 대한의료정보학회지

Medicine in the twenty-first century will be different from the medicine of today. Recent changes in medical environment, such as changes in disease and mortality pattern and rapid increase in medical knowledge, require change and adaptation of medical education. The task of medical education is to help people entering medicine to prepare to meet their professional obligations in this new context. So we tried to join Problem-base learning(PBL), which challenges students to be more actively involved in defining what they learn and how they learn, and Computer-assisted learning(CAL), which uses multimedia and medical informatics as learning tools. Finally we developed Problem-oriented medical education program using the Internet. First, using simulated patient cases, we built clinical database with patients' history, physical examinations, and various laboratory findings. To provide PBL program through the Internet, we constructed client-server system using IJS(Internet Information Server) on Windows-NT settings, and made user-friendly dynamic interface with HTML, JAVA, JAVA Script and so on. PBL on the Web will make students learn effectively and actively, and offer vivid multimedia environment for medical education. We expect this PBL program to be used as an effective learning tool for residents or doctors as well as for medical students in the near future. The Internet

Patterns of Tumor Recurrence after Nephron Sparing Surgery for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: We evaluated patterns of tumor recurrence after nephron sparing surgery for sporadic renal cell carcinoma MATERIALS AND METHODS: From December 1992 to October 1997, 20 patients(21 renal units) underwent nephron sparing surgery(partial nephrectomy, wedge resection, enucleation) for sporadic renal cell carcinoma at our department. Mean postoperative followup period was 25.4+/-0.3 months. All patients were evaluated with a medical history, physical examination, blood chemistry, chest x-ray, abdominal CT every 6 months. The clinical course and outcome for patients who had recurrence after nephron sparing surgery were reviewed retrospectively. We also reviewed 122 patients who underwent radical nephrectomy at the same period for patterns of tumor recurrence. RESULTS: Renal cell carcinoma were recurred after nephron sparing surgery in 3 patients (15%, 3/21 renal units:14.2%). Local tumor recurrence with(1) or without(1) metastatic disease developed in 2 patients(10%). Metastatic disease without local tumor recurrence developed in 1 patient(5%). One patient with only local recurrence had positive resection margin. Initial pathological tumor stage and period to tumor recurrence were T3a and 4 months for patient with local recurrence, T2 and 10 months for patient with local recurrence and brain metastasis, T2 and 12 months for patient with lung metastasis without local recurrence. Renal cell carcinoma recurred after radical nephrectomy in 8 patients(6.6%). Local recurrence was none and all recurrent tumors were distant metastasis. CONCLUSIONS: The incidence of metastatic disease after nephron sparing surgery for renal cell carcinoma was not different from that occurring after radical nephrectomy but the incidence of local tumor recurrence after nephron sparing surgery was greater than that occurring after radical nephrectomy. Nephron sparing surgery must be done with enough negative resection margin.

Trimix Intracavernosal Injection Therapy in Patients with Erectile Dysfunction: Long-term Follow-up Result / 대한비뇨기과학회지

PURPOSE: Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. The synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy for erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. We evaluated the treatment outcome of intracavernosal injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). MATERIALS AND METHOD: From July 1993 to June 1997, 1000 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine 4.8mg, phentolamine 0.2mg and prostaglandin E1 1.8 microgram in 0.2ml). Underlying diseases were diabetes mellitus (33.1%), hypertension(7.5%) and others(12.3%). 471(47.1%) patients had no underlying disease. The volume of drug used ranged from 0.03 to 0.6ml(average: 0.18ml). RESULTS: After a mean follow-up of 10.9 months(3-44 months), 524 patients stayed on the home injection program. The drop-out rate was 47.6% with most of the cases during early home phase. The reasons for drop-out were inadequate response to medication, failure of injection, return of spontaneous erection, switch to other treatments, priapism, fear of needle or injection, loss of interest and economic reason. 88.3% of patients and 85.3% of the partners were satisfied wilts the result of home injection program. Priapism(3.9%), pain or discomfort(2.4%) and granuloma on injection site(1.5%) were noticeable complications, but corporal fibrosis and systemic side effect were not noticed. CONCLUSIONS: Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and most of all, very effective method for the treatment of the patients with erectile dysfunction.

Age-specific Reference Ranges for Prostate-specific Antigen from a Community-based Study / 대한비뇨기과학회지

PURPOSE: To analyze the relationship of age to serum prostate-specific antigen (PSA) levels among Koreans without clinically evident prostate cancer in a community-based study. MATERIALS AND METHOD: A total of 375 healthy men aged 50 to 79, residing in the small farming villages of Jeong-Eup county, Korea were examined with serum PSA(Hybritech Tandem-R) and digital rectal examination. One case of patient with prostate cancer was excluded. RESULTS: The serum PSA concentration is correlated with patient age(In PSA=-1.56+0.0257 x Age, r=0.32, p-value<0.0001). The recommended age-specific reference ranges of serum PSA(95th percentile) for men aged 50-59 years is 0-2.80ng/m1; for 60-69 years,0-3.56ng/m1; and for 70-79 years, 0-4.57ng/m1. CONCLUSIONS: The serum PSA concentration is correlated with patient age in Korean men and the age-specific PSA reference ranges for Korean are lower than those for Caucasian.

Change of the Upper Urinary Tracts and Occurrence of Metabolic Acidosis after Three Different Orthotopic Bladder Substitutions / 대한비뇨기과학회지

PURPOSE: Orthotopic neobladder following radical cystectomy are currently preferred to the other urinary diversions. We have compared three different ureteroenteric anastomoses regarding change of the upper urinary tracts and evaluated correlation between the length of bowel used for bladder reconstruction and metabolic acidosis. MATERIALS AND METHODS: Between Sep. 92 and Jul. 97, 37 patient(range 34-69 yrs) with bladder cancer underwent an orthotopic Mainz pouch with antireflux submucosal tunnel(n=10), an ileal low-pressure bladder substitute with direct ureteroileal anastomosis(Stuffier, n=15) and an ileal W-neobladder with serouslined ertramural tunnel(Ghoneim, n=12) following radical cystectomy Mean follow up was 22 months(7-64 twos). IVP and VCUG were performed at 6, 12 months postoperatively and annually thereafter. The measurement of serum electrolyte and/or arterial blood gas analysis were carried out every 3-6 months. RESULTS: The vesicoureteral reflux occurred in 37%(11/30 renal unit) with Stuffier pouch, 10%(2/20) with Mainz pouch, and none with Ghoneim(p=0.01). Moderate to severe hydronephrosis resulting from reflux was noted in 4 renal units with Stuffier pouch, while an atrophic kidney due to obstruction at ureteroenteric anastomosis was noted with each Mainz pouch and Ghoneim. Metabolic acidosis was identified in 5 patients(33%) with an Stuffier pouch whereas it was noted in less than 10% with Mainz pouch and Ghoneim(p=0.07). Two patients with deteriorated renal function need bicarbonate replacement therapy for correction of metabolic acidosis. CONCLUSIONS: Although most patients with direct ureteroileal anastomosis preserved renal function, antireflux ureteroenteric anastomosis using submucosal tunnel or serous-lined extramural tunnel is better in terms of occurrence of hydronephrosis and vesicoureteral reflux. The length of bowel less than 45cm used for bladder reconstruction may avoid metabolic acidosis