This too shall pass: a grounded theory study of Filipino cancer survivorship.

Considering the paucity of studies dealing with the holistic aspect of the cancer experience, this grounded theory study seeks to conceptualize the process of cancer survivorship among Filipinos. Twenty-seven Filipino cancer survivors were purposively selected, and a two-part instrument, specifically robotfoto and focus group interviews, was used to gather data. The Glaserian method of grounded theory analysis was used, and extended texts were analyzed inductively via a dendrogram. Member checking and correspondence were observed to validate the surfacing stages, leading to the conceptualization of a theoretical model termed as the Ribbon of Cancer Survivorship. The said model describes the trifling (living before), transfusing (accepting the reality), transforming (being strong), and transcending (living beyond) phases of cancer survivorship. Ten interesting substages were also identified, namely: tainting, desolating, disrupting, and embracing for the transfusing phase; tormenting, distressing, awakening, and transfiguring for the transforming phase, and trembling and enlivening for the transcending phase. The resulting theoretical model has clearly and successfully described the entire process of cancer survivorship among Filipinos. It is hoped that the model be used as a reference for future studies about cancer survivorship and as a guide for nurses in providing a more empathetic care among cancer patients.

Mergers in health care: avoiding divorce IDS style.

The recent flurry of merger activity in the healthcare industry has given rise to a significant number of integration efforts. Unfortunately, some of these "marriages" will end in "divorce." Reasons for failure can be found in four critical dimensions of integration: structural, operational, clinical, and informational. Each dimension has its associated pitfalls, and every merger confronts clearly identifiable risks. By taking steps to mitigate such risks, merging organizations can improve the chances the merger will succeed. If the merger does fail, measures taken prior to the merger, such as including an escape clause in the merger contract, can help avoid problems in dividing operational assets, physicians practices, and information assets.

The data debate. CIOs weigh issues, obstacles to information networks. Panel discussion.

CEOs are looking toward the development of provider networks in a post-reform environment, as envisioned in the AHA's proposal for Community Care Networks. But CIOs face conceptual and technical challenges on the path to true information networking. An exclusive Hospitals panel discussion.

Beyond cost benefit: an assessment approach for the '90s.

A new evaluation approach is needed to evaluate clinical and management applications of H.I.S.-- where the major benefits may not be related to labor savings. New evaluation approaches also need to reflect a "bottom line" business orientation. We will describe an evaluation approach which is based on TQM concepts and meets both these criteria and incorporates benefits realization into the evaluation process.

Survey of computer-assisted electrocardiography in the United States.

The purpose of this study was to update a 1976 study by Arthur D. Little, Inc., on the use of automatic ECG analysis systems. Thirteen vendors of computerized ECG systems received survey forms in 1987 and a follow-up telephone survey was completed in early 1988. The vendors surveyed included service bureaus and providers of computer-based data management and analysis systems and analysis carts. Analysis carts were subdivided into standard-sized and portable analysis carts. The technical specifications used by the respondents varied from 3 simultaneous leads to 14 simultaneous leads. The standards used were AHA, AAMI, and ANSI. Various compression techniques were used. The method of testing adult, pediatric, and serial comparison programs varied from the use of expert electrocardiographers to non-ECG data bases. Service bureau customers consisted mainly of general practitioners and primary care physicians' offices, with an estimated 1.2 million ECGs processed in 1987. Analysis and data management systems mainly serviced large hospitals, with an estimated 15 million ECGs processed in 1987. Standard-sized analysis carts used in hospitals and physicians' offices were estimated to process over 31 million ECGs in 1987. Portable analysis carts installed in hospitals, primary care, and general practitioners' offices and clinics processed almost 7 million ECGs in 1987. Computerized ECG analysis has been one of the most rapidly and widely adopted computer applications in medicine; its potential benefits in improving quality and consistency of interpretations has long been recognized. This study indicates that additional information on accuracy of current ECG software is needed to ensure that the technology is optimally applied in patient care.

Use of computerized information systems in U.S. health maintenance organizations and hospitals.

A comparison was made between the use of data processing in hospitals and Health Maintenance Organizations (HMOs). Findings indicate that the HMO and hospital data processing markets are currently quite distinct. As expected, the functions automated reflect the uses of the different care delivery systems. The hardware and software vendors to these markets are also different. A high percentage (50%) of HMOs are using software they developed in-house. In this respect, current HMO data processing is similar to the hospitals of a decade ago. The hospital market (for hardware and total systems) is highly concentrated. A few firms have a combined market share of over 50% and there are a large number of firms with very small shares. In the HMO market, there is a high concentration ratio for hardware but not for software or systems. HMOs and hospitals are almost uniformly satisfied with their hardware. Satisfaction with most applications is between 80 and 90% but there is a need, at least within HMOs, for improvements in support of the software supplied.

Maximizing the benefits of health care information systems.

Information systems can improve cost control, increase the timeliness and accuracy of patient care and administration information, increase service capacity, reduce personnel costs and inventory levels, and improve the quality of patient care. However, experience shows that most of these benefits will not occur automatically following system implementation. Operational problems may exist that diminish information timeliness, accessibility, and accuracy; policies and procedures may not have been sufficiently tailored to reflect the realities and intents of the systems; and personnel tasks may not have been adequately restructured. In order to realize the full potential of information systems, health care organizations must plan for and implement strategies that are designed to maximize such benefits. This paper describes a method for developing benefits maximization strategies. The processes used to define strategies and their outcomes are presented.