ABSTRACT
A linking program used by Connecticut Healthcare Information Management and Exchange to maintain the Master Person Index for its large, state-wide patient data repository is being stretched beyond its limits by the growing size and complexity of the database. This paper presents the early work into developing a second-generation linking program. Like the original program, the new linker will use a unique multi-step process to allow effective linking of data from a large number of dissimilar data sources. The new linker will use parallel multi-processing to allow improved performance and scalability. These changes will also make possible more sophisticated statistical methods of defining link confidence. The system is implemented using a scalable collection of inexpensive, PC based systems running the Linux operating system, a freely available database engine, and the Java programming language.
Subject(s)
Abstracting and Indexing , Medical Record Linkage/methods , Medical Records Systems, Computerized/organization & administration , Connecticut , Databases as Topic , HumansABSTRACT
Efforts to utilize Uniform Hospital Discharge Data Sets (UHDDS) for epidemiological studies have been hampered by the limitations of those databases. The purpose of this paper is to illustrate that linking to external databases can provide the verification necessary to overcome many of those limitations. This method has dramatically altered study design at the Connecticut Hospital Research and Education Foundation and has provided an efficient method for specifying data collection weaknesses within the resident databases.
Subject(s)
Databases, Factual , Medical Record Linkage , Patient Discharge/statistics & numerical data , Cause of Death , Cesarean Section/statistics & numerical data , Connecticut/epidemiology , Data Collection/standards , Data Interpretation, Statistical , Diagnosis-Related Groups , Epidemiologic Methods , Female , Hospital Information Systems , Hospital Mortality , Humans , Male , Patient Transfer/statistics & numerical data , Pregnancy , Registries , Reproducibility of Results , Suicide/statistics & numerical dataABSTRACT
CHIME-Net is a state-wide community health information network project which uses a frame-relay approach to interfacility and internet connectivity. This is a collaborative effort among competitive institutions, which embraces technologies new to the health care industry. The experiences of implementation of the CHIME-Net pilot project are presented as a first milestone for the state-wide effort.
Subject(s)
Community Networks , Computer Communication Networks , Computer Communication Networks/standards , Computer Security , Connecticut , Hospital Information Systems , Information Systems , Pilot ProjectsABSTRACT
An approach for a frame-relay implementation is described which is intended to establish connectivity between the health care providers in the state of Connecticut with a gateway to the internet. While other health care networking efforts have based the interconnectivity efforts on direct connections to the internet for each institution, our design takes a more cost effective approach by establishing a private health care network with a single entry point to the internet. This will not only provide the advantages of internet connections to all participating providers, but it will also isolate intrastate patient care traffic from the internet, reserving internet traffic for those information needs not available within the statewide network. In addition to the network solution, an extensive user support infrastructure is also presented.
Subject(s)
Computer Communication Networks , Information Systems , Connecticut , Medical Records Systems, Computerized , TelemedicineABSTRACT
BACKGROUND: The "Toward Excellence in Care" program was launched by Connecticut hospitals and physicians in 1988 to develop and use quality-of-care indicators for use in quality improvement. METHODOLOGY: Data came primarily from the Connecticut Health Information Management and Exchange (CHIME) database, which contains discharge abstract information, UB (uniform billing)-82 information, and additional data elements, for all of Connecticut's 34 acute care hospitals. Linkages also occur with the state mortality database, the trauma registry, and with admission/discharge data within and across Connecticut hospitals. The "Toward Excellence in Care" program staff help the hospital use the data on indicator reports for quality improvement. EXAMPLE: On receiving a report on care for patients with acute myocardial infarction (AMI) a program representative summarized opportunities for improvement. The data were then disseminated to both the cardiology and the hospitalwide quality improvement staffs. Cardiologists conducted chart review on 100% of patients included in the last time-frame on the report (for example, fiscal year 1991). The quality improvement professional documented the system of care for an AMI patient. Recommended actions included adoption of a policy for emergency department administration of thrombolytic therapy before a cardiology consultation, and modification of the postcoronary care program. CONCLUSIONS: Progress in addressing four challenges-easing the burden of data collection on the hospitals, maximizing acceptance of information by hospitals and physicians, risk adjusting data to permit comparison of outcomes, and facilitating understanding of reports--is reflected in expanding use of the "Toward Excellence in Care" program.
