A serial interface design to integrate bedside devices into patient monitoring systems.

While substantial progress has been made toward the development of the Medical Information Bus (MIB), there is a pressing need, today, to integrate bedside devices into patient monitoring systems. To help meet this need, SpaceLabs Inc. has developed serial interfaces that integrate various stand-alone devices into a patient monitoring system. The company makes available a Universal Flexport Protocol to manufacturers who wish to make their devices compatible with the SpaceLabs patient monitoring systems. This paper describes the design of the Flexport serial interfaces and the Universal Flexport Protocol.

UNIX and healthcare systems: a good marriage.

Powerful and versatile, UNIX makes open systems affordable in today's complex healthcare marketplace. As more emphasis is placed on combining the best systems for the least money, UNIX plays an important role. How many hospitals are using it already?

Software life cycle demands reform, calls for open networks.

Healthcare organizations can no longer accommodate the four-to-eight-year cycle for information software development. The senior VP of a large teaching hospital in Houston offers solid ways to shorten the cycle and be prepared to incorporate more rapid changes in technology.

Transcription technology today.

A fascination with telecommunications and technology has enabled this author and her corporate information systems department to achieve system integration and simple functionality in a comprehensive and diverse medical transcription unit.

Bringing social worlds together: computers as catalysts for new interactions in health care organizations.

In this case study, computer systems are explored as catalysts for new interactions between departments in health care organizations. Hypotheses investigated changes in the extent to which members of different departments (1) exchange information and (2) understand each other's work following implementation of an integrated medical information system. Analyses showed that communication-based forms of involvement in implementation (communicating with systems personnel and trainers, communicating about new ways to use the system, and receiving support from supervisors for doing so) were overwhelmingly more important than either general participation or computer use in predicting increases in interdepartmental interaction. Changes in tasks and roles also led to new, informal, face-to-face contacts to support computer system use, as well as greater administrative control over the organization as a whole. In addition, results of interviews and observations over the two-year study period illustrate the importance of work group identification in predicting changes accompanying computerization.

The management of medical records.

An optical disk filing system is an efficient approach to storing medical records; however, this system has not yet been put to practical use because it is usually a "stand-alone" type indirectly connected to a hospital information system. We have developed a medical record management system with an optical disk filing system connected to the host computer in the hospital information system. We can retrieve and display the medical records through the CRT (Cathode Ray Tube) terminals of the hospital information system at every ward and outpatient clinic. The patient's clinical information can be sent to several areas in the hospital using the hospital information system.

Development of a hospital management system to analyze nursing information using a microcomputer.

We have developed a hospital management system to analyze the large amount of the nursing information using a microcomputer system. In this system, we have combined the information from the patient database and the nursing database in order to evaluate the quality of medical care in the hospital. The utilization of a microcomputer is useful for filing and analyzing it and presenting the results in a variety of formats, including graphic representations.

Techniques for dataset design: a utilization management system model.

Designing a clinical information system offers a sense of accomplishment similar to that of a dramatic performance. The development of the data dictionary and proposed system description requires the same attention to detail as stage directions in a script. The people involved in daily system operation are of key importance in developing a clear understanding of how things actually happen in the information flow and decision process. Once the business rules are defined and edits and conditions are developed to ensure data integrity, it is time to step back and let the performance begin. The real power of the user-designed system, like that of a performance before a live audience, comes with the ability to query the data for answers to issues and problems decision makers did not face at the time of the initial system design.

A system to manage records for credentialed providers.

There has been a rapid growth in and evolution of information management to assure appropriate and timely awarding of privileges for credentialed providers. Proprietary software might not meet the needs of a particular facility. In this article, Jackie Walker and William F. Perry describe how, using commercially available database management software, information management can be tailored to the needs of an individual institution and altered as necessary.

Computers in the ICU: panacea or plague?

The introduction of the intensive care unit (ICU) in the 1960s with its demands for management of large volumes of patient data drove the initial introduction of computers into the ICU. Since the mid-1960s computer systems for the ICU have evolved into the highly sophisticated bedside workstations commercially available today. Despite all of the technologic advances in computers, their application in ICUs in the United States continues to spread very slowly. One of the largest problems is justifying the cost of systems primarily designed to automate data charting and generation of care plans. Although the existing commercial systems do an excellent job, few conclusive studies prove that these systems have a favorable cost-to-benefit ratio. Research systems have demonstrated that if one extends these systems to incorporate a fully integrated database, decision-support tools, automation of data acquisition, and more sophisticated display and user-interface technology, then these ICU computer systems can have a significant impact on improving the quality and reducing the costs of patient care. For computers to be embraced in the ICU environment, commercial systems of the future must move beyond merely gathering and displaying information. They must help the clinician at the bedside assimilate the vast array of ICU data and help him to make more effective decisions.

Looking back: evaluating the use of bar coding in medical record processing.

It is great to be able to say, if we had it to do over again, we would still do it.... But hindsight tells us we could have done some things better. We should have sinned bravely, and forged ahead with chart tracking in the main file room. The truth is, our inexperience with the technology made us overly cautious. We were, however, absolutely correct about the use of bar coding. Swift collection of accurate data is a treasure to be sought, bar coding is insurance of that treasure.

Impact of a multidisciplinary, collaborative approach to implement and enforce an automatic stop order policy.

Although an automatic stop order (ASO) policy is mandated by the Joint Commission on Accreditation of Healthcare Organizations, the policy remains unenforced or exists only "on paper" in some hospitals. Strict enforcement of an ASO can lead to improvement of patient care by requiring physicians and other healthcare professionals to periodically review a patient's drug regimen. Following the approval of an ASO policy by our facility's pharmacy and therapeutics (P&T) committee, an audit of 160 orders of controlled substances revealed that 75 orders (47 percent) were continued for more than one dose without a physician's renewal order. This problem was then brought to the attention of the P&T committee where a decision was made to resolve the situation using a multidisciplinary, collaborative approach. With the help of all of the healthcare professionals involved in this issue, as well as our computer network, a system for strict enforcement of the ASO policy was subsequently implemented and has proven to be successful.