Information Knowledge Systems Management - Volume 8, issue 1-4

Article Type: Other

DOI: 10.3233/IKS-2009-0153

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 1-2, 2009

Authors: Rouse, William B. | Cortese, Denis A.

Article Type: Other

DOI: 10.3233/IKS-2009-0157

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 3-14, 2009

Authors: Berwick, Donald M. | Luo, Eva

Article Type: Research Article

Abstract: Kim, aged 3 years, lies asleep, waiting for a miracle. Outside herroom, the nurses on the night shift pad softly through the half-lightedcorridors, stopping to count breaths, take pulses, or check the intravenouspumps. In the morning, Kim will have her heart fixed. She will be medicatedand wheeled into the operating suite. Machines will take on the functionsof her body: breathing and circulating blood. The surgeons will place asmall patch over a hole within her heart, closing …off a shunt between herventricles that would, if left open, slowly kill her. Kim will be fine if the decision to operate on her was correct; if the surgeon is competent; if that competent surgeon happens to be trained to deal with the particular anatomic wrinkle that is hidden inside Kim's heart; if the blood bank cross-matched her blood accurately and delivered it to the right place; if the blood gas analysis machine works properly and on time; if the suture does not snap; if the plastic tubing of the heart-lung machine does not suddenly spring loose; if the recovery room nurses know that she is allergic to penicillin; if the "oxygen" and "nitrogen" lines in the anesthesia machine have not been reversed by mistake; if the sterilizer temperature gauge is calibrated so that the instruments are in fact sterile; if the pharmacy does not mix up two labels; and if when the surgeon says urgently, "Clamp, right now", there is a clamp on the tray. If all goes well, if ten thousand "ifs" go well, then Kim may sing her grandchildren to sleep some day. If not, she will be dead by noon tomorrow. If Kim were an astronaut, strapped into her seat at the top of some throbbing rocket, the crowd assembled would hold their breath in the morning Florida sun. "How can it possibly work?" they would whisper. "How many parts are there in that machine? A million? What if one fails? My toaster fails. Please let it all work right." The machine would bellow smoke, the gantry fall away, and slowly the monster would rise, Kim on top. If it worked, they would cheer. "A miracle," they would shout, in awe that the millions of tiny lines of effort, the millions of tiny lines of cause and effect, from job shops in Ohio and laboratories in Pasadena, criss-crossing through time and space, could converge so magnificently in a massive, gleaming rocket launched exactly right. Perfect. If it failed, they would cry. So would the rocket's makers, who had done their very best. No one wanted it to end this way. Poor Kim. What was the trouble? What went wrong? Why? The lines of cause will converge around Kim in the morning as she wheels toward the operating room. Thousands upon thousands of elements weaving a basket to hold her safely, all hope. No crowd holds its breath tonight; but wouldn't they if they knew? From: Berwick DM. Controlling variation in health care: a consultation from Walter Shewhart. Medical Care 1991; 29: 1212–1225. Show more

DOI: 10.3233/IKS-2009-0131

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 17-21, 2009

Authors: Carayon, Pascale | Wood, Kenneth E.

Article Type: Research Article

Abstract: Patient safety is a global challenge that requires knowledge and skills in multiple areas, including human factors and systems engineering. In this chapter, numerous conceptual approaches and methods for analyzing, preventing and mitigating medical errors are described. Given the complexity of healthcare work systems and processes, we emphasize the need for increasing partnerships between the health sciences and human factors and systems engineering to improve patient safety. Those partnerships will be able to …develop and implement the system redesigns that are necessary to improve healthcare work systems and processes for patient safety. Show more

DOI: 10.3233/IKS-2009-0134

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 23-46, 2009

Authors: Cassel, Christine K. | Johnston-Fleece, Michelle | Reddy, Siddharta

Article Type: Research Article

Abstract: The role of systems in addressing the needs of elderly and chronically ill populations remains a far from universal way of thinking, much less practice, in health care. Re-engineering the current fragmented system to align providers, patients and payment models to facilitate proactive management of conditions associated with advanced age and/or one or more chronic diseases – rather than responding to costly consequences of a health care system optimized for acute care conditions – will be …a major challenge for all stakeholders. There are, however, promising success stories that are taking place in the United States today that may provide a model for improvement. The authors define the issues faced by the health care providers and payers that arise when providing care for the elderly and those with chronic conditions – issues that threaten to overwhelm the financial and human health care resources that exist to serve these populations. They define innovative ways of thinking about systems of care, and provide examples of unique systems that have applied theory into practice. These successful leaders may offer lessons in proactively managing complex health conditions, overcoming communication barriers and using technology to complement the necessary human touch that is essential to health care delivery. Show more

DOI: 10.3233/IKS-2009-0135

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 47-69, 2009

Authors: Stroebel, Robert | Moynihan, Timothy

Article Type: Research Article

Abstract: Health care provided in the final year of life is typically costly and often delivers unintended outcomes. High value can be defined for end of life care. High value clinical practices exist for end of life care and a common set of high value processes can be identified. The current system structure of healthcare delivery does not consistently support those high value processes. An improved organizational schema could foster sustained delivery of high value delivery operations. …The healthcare ecosystem needs to evolve to provide appropriate incentives and support for an appropriately designed care system. Show more

DOI: 10.3233/IKS-2009-0136

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 71-86, 2009

Authors: Darling, Helen

Article Type: Research Article

Abstract: This chapter provides an overview of health care costs in the United States, including trends, sources and uses of funds, employers' role, and factors driving costs. It also reviews what analysts believe are cost drivers especially compared to other countries that have significantly lower health care costs and, often, better health outcomes. Within the US, there are also important differences by geography, further demonstrating that higher US costs do not reflect higher quality and greater patient …and physician satisfaction. In fact, the opposite is often the case. Show more

DOI: 10.3233/IKS-2009-0137

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 87-104, 2009

Authors: Detmer, Don E.

Article Type: Research Article

Abstract: Information technology in health care (HIT) is getting a major boost in the United States through the passage of the American Recovery and Reinvestment Act (ARRA) of 2009. The portion of the Act that relates to health information technology (HITECH) seeks to achieve widespread implementation of electronic health records (EHRs) across the land and assure that these EHRs achieve sufficient levels of `meaningful use' to improve care, reduce costs, and result in better outcomes. This chapter …sets the stage for the other chapters that follow in this section. The chapter will review current thinking about how HIT will facilitate collection, dissemination, and evaluation of information throughout the system. Further, it will discuss the role and potential for HIT to support a learning organization [7,8]. Finally, it will outline the current widely identified barriers to progress, e.g., standards development, lack of interoperability and connectivity, and limited decision support that uses evidence-based guidelines created and maintained explicitly to be actionable through computer-based records and systems. Further, with the passage of HITECH, there is a continued attention given to privacy policy at the expense of access to person-specific health information for legitimate social purposes including research and community health. More will be said about this near the end of the chapter. Finally, the chapter will end with a discussion of the difference between information and communication and it will advocate for greater attention to the use of technology as a tool for improve communications and not simply storage and transmission of information. Show more

DOI: 10.3233/IKS-2009-0138

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 107-118, 2009

Authors: Stead, William W.

Article Type: Research Article

Abstract: A radical change in technical approach is needed to achieve electronic health records suitable to support an engineered system of healthcare. This chapter suggests a redefinition of interoperable health information. It provides examples of how to break the electronic health record challenge into component parts to match computational technique to the scale of the problem handled by a component.

DOI: 10.3233/IKS-2009-0140

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 119-143, 2009

Authors: McGinnis, J. Michael

Article Type: Research Article

Abstract: Whether for the generation or application of evidence to guide healthcare decisions, the success of evidence-based medicine is grounded in principles common to engineering. In the Learning Healthcare System envisioned by the Institute of Medicine's (IOM) Roundtable on Evidence-Based Medicine, evidence emerges as a natural by-product of care delivery, which is thoroughly documented, pooled for continuous monitoring and analysis, integrated with insights from related studies, and fed back seamlessly to improve the …consistency and appropriateness of care decisions by clinicians and their patients. Drawing from lessons shared at the IOM/NAE symposium, Engineering a Learning Healthcare System, this paper provides an overview of the state-of-play in health care today, some of its key challenges, the vision and features of a learning healthcare system, applicable commonalties and principles from engineering, and potential collaborative opportunities moving forward to the benefit of both fields. Show more

DOI: 10.3233/IKS-2009-0156

Citation: Information Knowledge Systems Management, vol. 8, no. 1-4, pp. 145-157, 2009