[Preparing dermatological discharge reports within an electronic clinical information systems. A pilot investigation regarding medical and economical aspects]. / Arztbriefschreibung in der Dermatologie im Rahmen eines elektronischen Patientendatenmanagements. Pilotuntersuchung unter medizinisch-ökonomischen Gesichtspunkten.

The insertion of all patient details in one clinical information system (CIS) provides an enormous potential to rationalize and accelerate the administrative procedures in primary patient care. A successful data management system has to record not only the entire spectrum of the patient's medical data, but also the patient's personal data like name, address, date of birth, as well as names and addresses of other involved physicians. In addition, all aspects of the database gathered from varying sources must be compatible. The program has to be user-friendly enough that many different workers with varying backgrounds can effectively employ it. We investigated the effective saving of time in preparing a patient's discharge report based on conventional dictation using the clinical information system (Soarian) compared to a conventional, isolated word-processing program (Word). Existing potentials and limitations concerning the use of the CIS are presented. The objective analysis of measured processing times demonstrated a reduction for the typist, but no benefit for the physician dictating the discharge report. In the subjective perception of all users, the processing time appeared to have increased due to awkward editing and navigation functions. Improvements are required to increase the acceptance of the program by the users.

[Diagnosis-related groups. Safeguarding and distribution of revenues from the perspective of anaesthesiology]. / Diagnosis Related Groups. Sicherung und Aufteilung von Erlösen aus anästhesiologischer Perspektive.

After 30 years of belt-tightening in the health care system and the mandatory implementation of the German diagnosis-related groups (DRG) system in 2004, the cost pressure on German hospitals has increased again. Cases break even only if prime costs fall below DRG revenues. On the one hand it is required from hospitals that prime costs are evaluated in terms of effectiveness, but on the other hand they have to allow for generation of adequate revenues and performance-oriented distribution of profits. This article first presents the political background of the German DRG system and then systematically assesses the different types of reimbursement. Aspects in the field of anaesthesia which are relevant to the generation of adequate revenues are: documentation of intraoperatively occurring diagnoses, documentation of intraoperative procedures, the grouper function "complicating procedure", the demographic attribute "hours on mechanical ventilation" and the issue of supplemental revenues. Following comments on the generation of adequate revenues, the alternative means of internal budgeting, the German DRG case-costing and the percentage of sales method, are discussed. The present contribution is intended to assist readers in the prevailing discussion about economic awareness of the health care market.

[Computer-assisted process simulation: a suitable instrument for process optimization in hospitals]. / Computerunterstützte Prozesssimulation: Ein Beitrag zur Prozessoptimierung im OP.

The increasing financial pressure on hospitals resulting from changes in the health system demands detailed knowledge about the cost and earnings situation in the hospital. An essential part of strategic controlling now entails establishing structured cost-unit accounting. This can then be used for example through process optimization to ascertain savings potential and rationalization measures. This paper illustrates a possibility of using computer-assisted process simulation to find ways for prozess optimization. The simulation has been based on the treatment process "operative procedure" of a clinical pathway "CABG" developed in our hospital. The starting points for simulation possible prozess optimization consisted in the elimination of existing waiting times, respectively the parallel organization of certain partial processes. The software used for the simulation was Coral iGrafix Process 2003. The results of 1000 simulation processes reveal a clear reduction in the whole lead-time for the patient, both in avoiding waiting times and also in parallel process organization. In contrast to the initial situation (triangular distribution), the overall duration of the treatment section can be described approximately with normal distribution and a clear cluster of minimum overall durations. Computer-assisted process simulation is a suitable instrument for revealing and establishing possibilities for process optimization in hospitals, and therefore makes a valuable contribution to strategic controlling.

Cost unit accounting based on a clinical pathway: a practical tool for DRG implementation.

Setting up a reliable cost unit accounting system in a hospital is a fundamental necessity for economic survival, given the current general conditions in the healthcare system. Definition of a suitable cost unit is a crucial factor for success. We present here the development and use of a clinical pathway as a cost unit as an alternative to the DRG. Elective coronary artery bypass grafting was selected as an example. Development of the clinical pathway was conducted according to a modular concept that mirrored all the treatment processes across various levels and modules. Using service records and analyses the process algorithms of the clinical pathway were developed and visualized with CorelTM iGrafix Process 2003. A detailed process cost record constituted the basis of the pathway costing, in which financial evaluation of the treatment processes was performed. The result of this study was a structured clinical pathway for coronary artery bypass grafting together with a cost calculation in the form of cost unit accounting. The use of a clinical pathway as a cost unit offers considerable advantages compared to the DRG or clinical case. The variance in the diagnoses and procedures within a pathway is minimal, so the consumption of resources is homogeneous. This leads to a considerable improvement in the value of cost unit accounting as a strategic control instrument in hospitals.

Simulation methods for the online extraction of ECG parameters under Matlab/Simulink.

The classification of cardiac pathologies in the human ECG greatly depends on the reliable extraction of characteristic features. This work presents a complete simulation environment for testing ECG classification algorithms under Matlab/Simulink. Evaluation of algorithm performance is undertaken in full compliance with the ANSI/AAMI standards EC38 and EC57, and ranges from beat-to-beat analysis to the comparison of episode markers (e.g., for VT/VF detection algorithms). For testing the quality of waveform boundary detection, our own testing methods have been implemented in compliance with existing literature.

Parameter extraction of ECG signals in real-time.

In order for a mobile ECG recorder to be able to classify a heart rhythm online, the significant parameters must be extracted. The relevant parameters are the beginning, peak and end of the QRS-complex, the P- and T-waves, the ST-segment and other significant intervals, such as the RR-interval. The aim of the development was, firstly, stable, real-time-capable QRS detection, which finally achieved values for sensitivity of 98.9% and a positive predictivity of 99.9% on standard ECG databases. Also, a filter-based detection of P- and T-waves was implemented, which can also be performed in real-time on a microcontroller platform.

Is age-related stability of subjective well-being a paradox? Cross-sectional and longitudinal evidence from the Berlin Aging Study.

Subjective well-being is thought to remain relatively stable into old age despite health-related losses. Age and functional health constraints were examined as predictors of individual differences and intraindividual change in subjective well-being, as indicated by positive and negative affect, using cross-sectional (N = 516) and longitudinal (N = 203) samples from the Berlin Aging Study (age range 70-103 years). In cross-sectional and longitudinal analyses, age and functional health constraints were negatively related to positive affect but unrelated to negative affect. Cross-sectionally, controlling for functional health constraints reversed the direction of the relationship between age and positive affect and produced a negative association between age and negative affect. Findings suggest two qualifications to the average stability of overall subjective well-being: Only some dimensions of subjective well-being remain stable, while others decline; age per se is not a cause of decline in subjective well-being but health constraints are.