Disaster recovery planning by HMOs: theoretical insights.

HMOs are becoming increasingly reliant on health management information systems (HMISs) for their effective functioning, competitive viability, and survival. Because of this critical dependence, HMOs must use disaster recovery planning (DRP) to safeguard their HMIS assets from natural as well as man-made disasters. This article purposes a theoretical framework, based on the theory of organizational innovation, to explain the factors involved in the adoption of DRP by HMOs.

Ethical analysis of organ recovery denials by medical examiners, coroners, and justices of the peace.

CONTEXT: Despite its pivotal nature, until the early 1990s the role of medical examiners, coroners, and justices of the peace was largely ignored in discussions of the critical shortage of organs for transplantation in the United States. These officials have the right to determine, from a medico-legal perspective, whether a deceased person can be an organ donor. Thus, they play an important role in the donation process. Using a principles-based ethical framework, this article examines the problem of nonrecovery of life-saving organs for transplantation in the United States because a medical examiner or other official denies recovery. OBJECTIVE: The goals of organ donation and the collection of forensic evidence are not mutually exclusive. An analysis of the ethical principles and obligations of beneficence, respect for autonomy, and justice reveals that medical examiners and other officials could probably, after appropriate review, release all cases under their jurisdiction for organ donation. CONCLUSION: Medical examiners, coroners, and justices of the peace could assume a leadership role, working together on public policy with medical, social, and legal groups, spearheading efforts to stop the loss of organs due to official denials, up to and including state and federal regulation and legislation. Beyond their professional obligations, as agents of a social institution, medical examiners and other officials have the more general ethical responsibility of promoting the public health and welfare and of reinforcing societal consensus that transplantation is a social good which should be optimized through formal and informal activities.

Impact of medical examiner/coroner practices on organ recovery in the United States.

OBJECTIVE: The object of this research is to determine the nature and extent of the loss of donor organs during a 3-year period that are otherwise medically suitable for organ transplantation owing to nonrelease by a local medical examiner or coroner. DESIGN AND DATA SOURCES: In a retrospective study of the effects of medical examiner/coroner donor release practices, a detailed survey was mailed to every organ procurement organization (OPO) in the United States. This survey collected specific data (eg, number of cases denied per year), as well as descriptive information. RESULTS: Of the 2670 organ donors reported by 39 OPO respondents in 1990, 62.1% were medical examiner cases, and 129 (7.2%) of these cases were denied recovery by the local medical examiner/coroner. The number of denials increased to 181 (9.6% of medical examiner cases) in 1991 and to 251 (11.4% of medical examiner cases) in 1992. It is estimated that the population of medical examiner/coroner denials from 1990 through 1992 may be as many as 884. Twenty percent of the OPO respondents reported that no cases were denied recovery by a local medical examiner/coroner. A comparative analysis reveals that the proportion of total reported potential medical examiner/coroner cases that were denied increased by 65% from 1990 to 1992, while medical examiner/coroner cases released declined slightly. CONCLUSIONS: Since an average of 3.37 organs were recovered per donor in 1992, it is possible that as many as 2979 people may have been denied transplants from 1990 through 1992 owing to medical examiners'/coroners' denials. There were no donor denials in 10 geographical areas of the United States, nor was there any instance of violation of case law or any documentation of flawed autopsies or collection of forensic evidence in donor cases released. These two factors suggest that the loss of human life from denials is not needed to protect the judicial process. Increased cooperation between medical examiner offices and OPOs could significantly increase the availability of transplantable organs.

The data base management system alternative for computing in the human services.

The traditional incremental approach to computerization presents substantial problems as systems develop and grow. The Data Base Management System approach to computerization was developed to overcome the problems resulting from implementing computer applications one at a time. The authors describe the applications approach and the alternative Data Base Management System (DBMS) approach through their developmental history, discuss the technology of DBMS components, and consider the implications of choosing the DBMS alternative. Human service managers need an understanding of the DBMS alternative and its applicability to their agency data processing needs. The basis for a conscious selection of computing alternatives is outlined.

Computers helping caseworkers: decision support systems.

The development of an effective computer-based decision support system depends on a major caseworker effort to provide the information needed for the computer bank.