Large-scale Hospital Research Articles

System Replacement to a New HIS and Data Warehouse

Large-scale hospital information systems (HIS) generally consist of (i) online transaction processing (OLTP) and (ii) online analytical processing (OLAP) systems. Electronic medical records (EMR) are a major OLTP element. The data warehouse (DWH) assumes many important OLAP roles and maintains an institution’s medical care at a high level by providing EMR with the best practice cases available. This article focuses mainly on why OLTP and OLAP are needed and what roles the DWH plays, which means that the DWH has its own utilities and supplementary merits. The background of this discussion is closely related to the HIS at Nagasaki University Hospital introduced before the DWH is discussed.

Managing Disruptive Events: How To Create Interdepartmental Responses

This article describes new concepts and methods that have been successfully applied to manage disruptive events in a large scale hospital setting. Specifically it addresses problems with service quality that emerge from disruptive events and introduces the concept of wholism as a conceptual foundation for fostering interdepartmental responses. Finally, it presents an instructional method for teaching interdepartmental interdependency in corporate or university settings.

Exploring Nursing E-Learning Systems Success Based on Information System Success Model

E-learning is thought of as an innovative approach to enhance nurses' care service knowledge. Extensive research has provided rich information toward system development, courses design, and nurses' satisfaction with an e-learning system. However, a comprehensive view in understanding nursing e-learning system success is an important but less focused-on topic. The purpose of this research was to explore net benefits of nursing e-learning systems based on the updated DeLone and McLean's Information System Success Model. The study used a self-administered questionnaire to collected 208 valid nurses' responses from 21 of Taiwan's medium- and large-scale hospitals that have implemented nursing e-learning systems. The result confirms that the model is sufficient to explore the nurses' use of e-learning systems in terms of intention to use, user satisfaction, and net benefits. However, while the three exogenous quality factors (system quality, information quality, and service quality) were all found to be critical factors affecting user satisfaction, only information quality showed a direct effect on the intention to use. This study provides useful insights for evaluating nursing e-learning system qualities as well as an understanding of nurses' intentions and satisfaction related to performance benefits.

Correlation and Regression Analysis for Characterizations of a University Hospital

One of the most important issues in hospital management is how to determine the indicators for revenue of a large-scale hospital. Although it has been pointed out that the averaged value of length of stay in a hospital is an indicator of its revenue, quantitative evaluation has not been conducted. In this paper, we propose an analytic process based on methods for correlation and regression analysis to evaluate this indicator by using stored data in hospital information systems. We applied this method to data combined with discharge summaries and medical treatment fees, collected from 1997 to 2000 in Chiba University Hospital. The result shows that the length of stay can explain around 60-90% of the revenue during this period.

Clinical application on CT guiding interventional radiology technology

Objective The Computer Tomography (CT) guiding interventional radiology technology already became an extremely adequate technology in the large-scale general hospital, which was brought in since 2008-2009 in our hospital, and it has carried out dozens of cases, we improved it into a new kind of technology suitable for our hospital after summing up and studying it. This technology should be extended for popular use among the primary hospitals. Methods TOSHIBA Activion 16 screw CT scanner was used with the puncture needle Cook19G.After skin lung puncture biopsy 12 cases, after skin kidney puncture 25 cases, after skin liver puncture 7 cases. Results Among 12 cases of lung puncture biopsy, 9 cases are periphery the lung cancer, 2 cases are the pulmonary tuberculoses, 1 cases is pneumonia change in sexuality. 32 cases livers, the kidney puncture biopsy is a cyst, after extracts the pouch fluid to involve the hardened treatment, biggest cyst 11 cm, smallest cyst approximately 6cm, the short-term reexamination cyst obviously reduces approximately, after half year of reexaminations, the cyst disappeared basically or completely. No serious complication occurred. Conclusion The CT guiding interventional radiology technology belongs to the interventional radiology technology category, its application scope is broad, involving the whole body various systems, becoming one of the important methods of clinical diagnosis and treatment domain with characteristics of high security, minimally invasive surgery and less complication, etc. It' s worth to be extended popularly in primary hospitals. Key words: Puncture; Computer tomography (CT); Interventional radiology

RESEARCH ON ENERGY AND WATER CONSUMPTION AT LARGE-SCALE HOSPITAL

The maintenance records at a certain large-scale hospital, the total floor area 75,311m2 hospital building and 12,793m2 health checkup center, are investigated. The monthly and daily data of electricity, gas and water consumption are obtained. The paper presents the features of the hospital and the outline of the buildings at first, and then annual or monthly electricity and gas consumption, including CGS operation results, and water consumption are analyzed. Then, using the daily data, the correlation between the energy consumption and the enthalpy of outside air, the difference of the data on holidays, and the annual characteristics of energy and water consumption at weekdays are presented. The paper also shows the daily maximum electric power and the restraint kW-value for the electricity demand management.

An Application Research on the Workflow-based Large-scale Hospital Information System Integration

At present large-scale hospital information system has more than nodes, independent, extended strong and informative and so on, and it is difficult for the system to achieve a unified integration issues. In view of this, the article proposed a large-scale hospital information system integration solutions, which use the workflow-based mechanism for MIS development tools as the integration platform, customize and control the main line flow to achieve strong connection to the node and work independently as a loosely coupled business systems interface.

The equality of resource allocation in health care under the National Health Insurance System in Taiwan

An ideal resource allocation in health care should ensure most people to access equal health care services while needed. Not only social welfare economists but also health policy makers concern with rational distribution of health care resources. Taiwan implemented a National Health Insurance (NHI) program in 1995, to reduce financial barriers for all residents with a universal health care system. Horizontal equity, an explicit goal of the NHI system, is to guarantee equal opportunity of access to health care. Accordingly, this study, utilizing cross-sectional data, proposes a multi-criteria decision-making approach with grey incidence analysis to measure horizontal equity of health care resource allocation of the NHI in Taiwan. From the findings of this empirical study, most resources are allocated in North Taiwan resulting in geographical disparity due to unbalanced health care resource allocation. And the large-scale hospitals are mostly congregated only at metropolitan regions; therefore, the access to health care services for patients in rural areas is still limited. Finally, the NHI in Taiwan is a single-payer for all hospitals, in which payment for health care suppliers can be adopted as an efficient strategy to induce the disparity of resource allocation and to redistribute national health care resource.

H-64 大規模病院におけるエネルギーと水の消費量に関する調査研究 : (第1報)調査対象概要と年次・月次の消費特性

H-64 大規模病院におけるエネルギーと水の消費量に関する調査研究 : (第1報)調査対象概要と年次・月次の消費特性

H-65 大規模病院におけるエネルギーと水の消費量に関する調査研究 : (第2報)日々の消費データの分析

H-65 大規模病院におけるエネルギーと水の消費量に関する調査研究 : (第2報)日々の消費データの分析

Thinking of training for general practitioners and its preliminary practice

For the issues existed in training of general practitioners, with characteristics of community health-care service centers (CHS) and large-scale urban hospitals, a training model of exchange physicians between hospitals and CHSs was formulated. After three-month practice, a general practitioner-specialist technical cooperation group was established. The new model not only promoted construction of a two-way referral system, but also created environmental condition for training community physicians. Key words: Education, continuing; Professional competence

Virtualized Disaster Recovery Model for Large Scale Hospital and Healthcare Systems

Healthcare organizations face rising costs in effective management of hospital information systems. Adding to this burden is the Joint Commission’s mandate for disaster preparedness, which demands restoring access to information after unexpected catastrophes. Disaster recovery within healthcare organizations is essential because of its inherent critical nature and the possible losses’ impact on patients’ lives. This paper presents a virtualized disaster recovery model and presents steps for setting up the recovery environment and implementing the virtualized plan across multiple network systems. A large scale hospital and healthcare system in Minnesota participated in this study, and results indicate that the virtual model can provide acceptable performance when a limited number of client workstations are functioning. However, its performance is not as good as the traditional physical model, and its workload performance decays much quicker. Future research is suggested that tests more sophisticated models and incorporates finer granularity in the tabular distribution methodology.

Successfully Choosing Your EMR: 15 Crucial Decisions

ploying their first EMR as well as for those ready to replace their existing EMR with a new one, or an integrated EMR/ computer practice management (CMP) solution, or an EMR that also offers a patient-portal. Recently, the U.S. federal government has expressed its intent to enact widespread health reform. This book details how early adoption of EMR systems by hospitals and private physicians would assure successful implementation of health reform in the U.S. This book also serves as a practically invaluable guide to IT practice managers in hospitals in Korea. Earlier EMR adopters in Korea, such as tertiary and large-scale hospitals, would be leaders in e-hospital-based global healthcare. However, midand small-sized hospitals could also adopt EMR systems. The book includes useful contents, such as reasons of EMR adoption, methods for enhancing practice and effects of CPM system, structured data and report generation, interaction with EMR, interoperability, workflow enhancement/ EMR customization, documenting office workflow, evaluating vendor stability, lawyer proofing EMR, configuration and deployment, crisis planning and mitigation, protecting patient data, and negotiation of agreement with the vendor. The book also includes 15 crucial EMR decisions that must be made whenever you adopt, develop, and manage an EMR system. This book guides you through the factors that affect these decisions; it is both practical and fairly thorough. These 15 crucial decisions are the branches of a Decision Tree that must be navigated. The 15 EMR crucial decisions covered in the book are: 1. The most fundamental question concerning EMRs –Is now the right time to adopt? 2. What method will you use to build a staff consensus to adopt an EMR in your practice? 3. What level of EMR functionality will you deploy? 4. Will a freeform or structured clinical patient data apSuccessfully Choosing Your EMR: 15 Crucial Decisions

Using hospital administrative data to evaluate the knowledge‐to‐action gap in pressure ulcer preventive care

Issues of overuse, underuse and misuse are paramount and lead to avoidable morbidity and mortality. Although evidence-based practice is advocated, the widespread implementation of this kind of practice remains a challenge. This is also the case for evidence-based practice related to the prevention of pressure ulcers, which varies widely in process and outcome in Belgian hospital care. One major obstacle to bridging this knowledge-to-action gap is data availability. We propose using large-scale hospital administrative data combined with the latest evidence-based methods as part of the solution to this problem. To test our proposal, we applied this approach to pressure ulcer prevention, using an administrative dataset with regard to 6030 patients in 22 Belgian hospitals as a sample of nationally available data. Methods include a systematic review approach, evidence grading, recommendations formulation, algorithm construction, programming of the rule set and application on the database. We found that Belgian hospitals frequently failed to provide appropriate prevention care. Significant levels of underuse, up to 28.4% in pressure ulcer prevention education and 17.5% in the use of dynamic systems mattresses, were detected. Figures for overuse were mostly not significant. Misuse couldn't be assessed. These results demonstrate that this approach can indeed be successfully used to bridge the knowledge-to-action gap in medical practice, by implementing an innovative method to assess underuse and overuse in hospital care. The integrative use of administrative data and clinical applications should be replicated in other patient groups, other datasets and other countries.

Value of Medication Reconciliation in Reducing Medication Errors on Admission to Hospital

ABSTRACTAimTo review the literature and report on the prevalence of medication history taking errors occurring on admission to hospital when medications are prescribed or reordered, and the value of medication reconciliation in detecting these errors.MethodOvid Medline and PubMed databases were searched for articles published from 1966 to March 2008 that related to: medication errors on or during hospital admission; value of medication history taking and reconciliation on admission; and systems for reducing medication errors and adverse drug events. The Ovid Medline search identified 461 articles of which 20 were used. The PubMed search identified 119 articles, of these, 7 not found in the Ovid Medline search were used. References from the identified papers revealed a further 6 articles. Web sites of patient safety organisations were also searched and generated 8 articles. A total of 41 articles were used in the review.ResultsMedication history taking errors occur during transition points such as admission, transfer and discharge to hospital. The cited studies reviewing medication history errors are qualitative, study different population groups, use different methods to obtain medication history and do not always rate the clinical importance of the error. These limitations account for the range of medication history errors found in the cited studies (27–65%). Medication errors and subsequent adverse drug events are detected and reduced by a standardised process of reconciliation. Numerous large scale hospital initiatives in the US have outlined the implementation of a reconciliation process and the subsequent reduction in medication errors, adverse drug events and resultant economic benefits. Strategies for improving the medication reconciliation process include the use of a standardised form, improved communication, multidisciplinary approach, use of computerised physician or prescriber order entry with decision support and home medication lists.ConclusionObtaining a detailed medication history and performing medication reconciliation reduces the incidence of medication errors and subsequent adverse drug events.

Thinking about how to establish and perfect system of personnel training

The development of large-scale hospital depends on its comprehensive strength,and the scientific research is especially important of it.However.the potential of the scientific research is dependent on the discipline construction and personnel training.Selecting the outstanding person at home and abroad is the most important aspect of the scientific research field.Therefore,the system for cultivating and selecting talents must be established and perfected. Key words: Personnel training; Training management

Implementation of a large-scale hospital information infrastructure for multi-unit health-care services

With the increase in demand for high quality medical services, the need for an innovative hospital information system has become essential. An improved system has been implemented in all hospital units of the Yonsei University Health System. Interoperability between multi-units required appropriate hardware infrastructure and software architecture. This large-scale hospital information system encompassed PACS (Picture Archiving and Communications Systems), EMR (Electronic Medical Records) and ERP (Enterprise Resource Planning). It involved two tertiary hospitals and 50 community hospitals. The monthly data production rate by the integrated hospital information system is about 1.8 TByte and the total quantity of data produced so far is about 60 TByte. Large scale information exchange and sharing will be particularly useful for telemedicine applications.

Career stress and female managers' health in Taiwan's hospitals

This study investigates how perception-induced stress (barrier) and social capital (facilitator) affect the health of female managers. On the basis of the responses of 229 valid questionnaires of middle- and high-level female managers in large-scale hospitals, using a multilevel data analysis approach, this study investigates how perception-induced stress and social capital influence self-reported poor health of female managers. Analysis results indicate that all 3 perception-induced stresses (i.e., promotion-related procedural justice, promotion rate, and work-family conflict) and 2 social capital variables (i.e., mentor-assisted promotion and higher ranking mentor in other departments) are significantly associated with the health of female mangers. Factors involving the career success of women also affect their health. Health care organizations expecting to benefit from the long-term contribution of female elites must promote organizational equity and more heavily emphasize flexible work schedules, family-friendly policies, and perception management practices. In addition, adequately designed mentorship practices can greatly benefit female managers.

The Results of Gastric Cancer Surgery during the Early Stage of a Training Hospital

Konkuk University Hospital (KUH), which opened in September 2005, is currently categorized as a secondary hospital. Early on after its establishment, the surgical residents and nurses were relatively inexperienced in the treatment of stomach cancer. Therefore, the quality of surgery for stomach cancer at KUH may be different from that of the existing large-scale tertiary hospitals. The purpose of this study is first to investigate the clinicopathological characteristics of the gastric cancer patients at the KUH, and second to compare our morbidity & mortality rates with those of previous studies, and we also analyzed the risk factors of morbidity at the early stage of a training hospital. Materials and Methods: This study retrospectively collected the clinicopathological characteristics and the post-operative morbidity rates and mortality rates with using the electronic medical records of all the patients who went under a gastric cancer operation at KUH from September 2005 to April 2008. Results: The total number of gastric cancer patients who underwent operation was 201. The morbidity rate and death rate at KUH were 10.4% and 0.5%, respectively. The morbidity has increased with an older age. The other variables had no influence on morbidity. Conclusion: The morbidity rate, death rate and the clinicopathological characteristics of gastric cancer patients at KUH were similar to those of the previous reports. We found that age is the main factor affecting the morbidity rate after stomach cancer surgery. For further surgical qualification of stomach cancer surgery at KUH, it is necessary to collect the survival data of patients who undergo stomach cancer surgery.

Benchmarking psychiatric intensive care units (PICU) in a metropolitan area

Background With the deinstitutionalization of the last 30 years, psychiatric patients who where formerly housed and treated in large-scale mental hospitals in the country-side, were transferred to the cities and encouraged to rehabilitate and reintegrate in society, with the help of ambulatory psychiatric care and small-scale community admission units. In the same era, the number of compulsory admissions, and the turn-over on PICU's has steeply increased. The city of Amsterdam has six PICU's under the aegis of three distinct mental health care institutions. The nature and extent of differences in organizational structure, treatment policy and patient population between the units were largely unknown. The aim of this study was to evaluate the functioning of these units.