Information resources assessment of a healthcare integrated delivery system. (1/9)

While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations.  (+info)

Protein classification artificial neural system. (2/9)

A neural network classification method is developed as an alternative approach to the large database search/organization problem. The system, termed Protein Classification Artificial Neural System (ProCANS), has been implemented on a Cray supercomputer for rapid superfamily classification of unknown proteins based on the information content of the neural interconnections. The system employs an n-gram hashing function that is similar to the k-tuple method for sequence encoding. A collection of modular back-propagation networks is used to store the large amount of sequence patterns. The system has been trained and tested with the first 2,148 of the 8,309 entries of the annotated Protein Identification Resource protein sequence database (release 29). The entries included the electron transfer proteins and the six enzyme groups (oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases), with a total of 620 superfamilies. After a total training time of seven Cray central processing unit (CPU) hours, the system has reached a predictive accuracy of 90%. The classification is fast (i.e., 0.1 Cray CPU second per sequence), as it only involves a forward-feeding through the networks. The classification time on a full-scale system embedded with all known superfamilies is estimated to be within 1 CPU second. Although the training time will grow linearly with the number of entries, the classification time is expected to remain low even if there is a 10-100-fold increase of sequence entries. The neural database, which consists of a set of weight matrices of the networks, together with the ProCANS software, can be ported to other computers and made available to the genome community. The rapid and accurate superfamily classification would be valuable to the organization of protein sequence databases and to the gene recognition in large sequencing projects.  (+info)

Understanding implementation: the case of a computerized physician order entry system in a large Dutch university medical center. (3/9)

Most studies of the impact of information systems in organizations tend to see the implementation process as a "rollout" of technology, as a technical matter removed from organizational dynamics. There is substantial agreement that the success of implementing information systems is determined by organizational factors. However, it is less clear what these factors are. The authors propose to characterize the introduction of an information system as a process of mutual shaping. As a result, both the technology and the practice supported by the technology are transformed, and specific technical and social outcomes gradually emerge. The authors suggest that insights from social studies of science and technology can help to understand an implementation process. Focusing on three theoretical aspects, the authors argue first that the implementation process should be understood as a thoroughly social process in which both technology and practice are transformed. Second, following Orlikowski's concept of "emergent change," they suggest that implementing a system is, by its very nature, unpredictable. Third, they argue that success and failure are not dichotomous and static categories, but socially negotiated judgments. Using these insights, the authors have analyzed the implementation of a computerized physician order entry (CPOE) system in a large Dutch university medical center. During the course of this study, the full implementation of CPOE was halted, but the aborted implementation exposed issues on which the authors did not initially focus.  (+info)

Post marketing surveillance of captopril (for hypertension): a preliminary report. (4/9)

1 The methodology and interim results of a post marketing surveillance of captopril, the first orally active angiotensin converting enzyme inhibitor are presented. 2 Utilising viewdata technology, details of hypertensive patients were entered directly into a mainframe computer. This allowed day to day monitoring of events; a facility not available with paper-based methods. 3 The design of the study allowed analysis of results including some details of efficacy, concomitant therapy, any disease symptoms and reasons for withdrawal. These factors could be categorised according to sex and age. 4 This preliminary report is based on the first 13,295 patients entered from July 1983 with follow-up until January 1985. The results of the study confirm the safety of captopril in the patients studied.  (+info)

Accessing the Columbia Clinical Repository. (5/9)

The Columbia Clinical Repository is the foundation of the Clinical Information System at the Columbia Presbyterian Medical Center (CPMC). The Repository is implemented as a relational database on an IBM mainframe, using a generic design that employs a small number of tables. Client applications on remote platforms send and receive data through Database Access Modules (DAMs), which support the HL7 protocol, while applications on the mainframe manipulate data through DAMs supporting a locally defined "query template". Implementation using static (compiled) SQL is compared to dynamic (ad hoc) SQL in terms of efficiency and flexibility.  (+info)

An automated Computerized Severity Index. (6/9)

The Computerized Severity Index (CSI) is a commercially available scoring system for hospital inpatients. Trained abstractors review the patient's paper medical record and enter the diagnoses and relevant physiological attributes. The HELP (Health Evaluation through Logical Processing) System at LDS Hospital stores patient data in discrete codes. This paper describes the development of an automatic interface between the standalone, personal-computer-based severity system and the mainframe-based hospital information system. The interface scores patient severity without the need for manual chart review. Severity scores from the automated and manual methods were identical for 70% of 222 general medical patients scored retrospectively. An evaluation of the causes for differing scores between the two methods is presented.  (+info)

Evolution of a legacy system to a Web patient record server: leveraging investment while opening the system. (7/9)

A layered system is under development to enhance our legacy system as a backend in a WEB-enabled system. Each layer of the system has defined functionality, leverages the investment in the layer below, and follows the strategy of reducing support requirements for workstations. The mainframe system provides administrative integration of sub-systems, security, and the central data repository for most information. The second layer is a graphical user interface (GUI) to the system for Windows platforms. Support needs are limited by relying chiefly on X-terminals and application servers. The "Intranet" layer is a WEB Server building upon the second layer gateways to provide platform-independent access to selected information and images. The fourth layer, under evaluation, will extend access to the central data repository for Internet users of web browsers that support private-key/public-key encryption.  (+info)

A new approach to the implementation of direct care-provider order entry. (8/9)

Successful implementation of direct computer-based care-provider order entry traditionally relies on one of two different approaches development from scratch or installation of a commercial product. The former requires extensive resources; the latter, by its proprietary nature, limits extension of the system beyond capabilities supplied by the vendor. This paper describes an intermediate approach using the association of a locally-developed and controlled set of distributed microcomputer based applications and a commercial, mainframe-based order entry application used as an order transaction processing system. This combination provides both an intuitive user interface and a platform for implementing clinical decision-support tools.  (+info)

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