Clinical decision support capabilities of commercially-available clinical information systems.

BACKGROUND: The most effective decision support systems are integrated with clinical information systems, such as inpatient and outpatient electronic health records (EHRs) and computerized provider order entry (CPOE) systems. Purpose The goal of this project was to describe and quantify the results of a study of decision support capabilities in Certification Commission for Health Information Technology (CCHIT) certified electronic health record systems. METHODS: The authors conducted a series of interviews with representatives of nine commercially available clinical information systems, evaluating their capabilities against 42 different clinical decision support features. RESULTS: Six of the nine reviewed systems offered all the applicable event-driven, action-oriented, real-time clinical decision support triggers required for initiating clinical decision support interventions. Five of the nine systems could access all the patient-specific data items identified as necessary. Six of the nine systems supported all the intervention types identified as necessary to allow clinical information systems to tailor their interventions based on the severity of the clinical situation and the user's workflow. Only one system supported all the offered choices identified as key to allowing physicians to take action directly from within the alert. Discussion The principal finding relates to system-by-system variability. The best system in our analysis had only a single missing feature (from 42 total) while the worst had eighteen.This dramatic variability in CDS capability among commercially available systems was unexpected and is a cause for concern. CONCLUSIONS: These findings have implications for four distinct constituencies: purchasers of clinical information systems, developers of clinical decision support, vendors of clinical information systems and certification bodies.

Book Review: Regulating Code : Good Governance and Better Regulation in the Information Age

Digital technologies have profoundly changed not only the ways we create, distribute, access, use and re-use information but also many of the governance structures we had in place. Overall, "older" institutions at all governance levels have grappled and often failed to master the multi-faceted and multi-directional issues of the Internet. Regulatory entrepreneurs have yet to discover and fully mobilize the potential of digital technologies as an influential factor impacting upon the regulability of the environment and as a potential regulatory tool in themselves. At the same time, we have seen a deterioration of some public spaces and lower prioritization of public objectives, when strong private commercial interests are at play, such as most tellingly in the field of copyright. Less tangibly, private ordering has taken hold and captured through contracts spaces, previously regulated by public law. Code embedded in technology often replaces law. Non-state action has in general proliferated and put serious pressure upon conventional state-centered, command-and-control models. Under the conditions of this "messy" governance, the provision of key public goods, such as freedom of information, has been made difficult or is indeed jeopardized.The grand question is how can we navigate this complex multi-actor, multi-issue space and secure the attainment of fundamental public interest objectives. This is also the question that Ian Brown and Chris Marsden seek to answer with their book, Regulating Code, as recently published under the "Information Revolution and Global Politics" series of MIT Press. This book review critically assesses the bold effort by Brown and Marsden.

Achieving effective biosurveillance with the Nationwide Health Information Network

The federal government is currently developing the Nationwide Health Information Network (NHIN). Described as a “network of networks,” the NHIN seeks to provide a nationwide, interoperable health information infrastructure that will securely connect consumers with those involved in health care. As part of the national health information technology (HIT) agenda, the NHIN aims to improve individual and population health by enabling health information to follow the consumer, be available for clinical decision-making, and support important public health measures such as biosurveillance. While the NHIN promises to improve clinical care to individuals and to reduce U.S. health care system costs overall, this electronic environment presents novel challenges for protecting individually identifiable health information. A major barrier to achieving public trust in the NHIN is the development of, and adherence to, a consistent and coordinated approach to privacy and security of health information. This paper will analyze the policy framework for electronic health information exchange with the NHIN. This exercise will demonstrate that the current policy is an effective framework for achieving effective biosurveillance with the NHIN. ^

Assessing the impact of electronic health record technology adoption on hospital labor efficiency

Information technology (IT) in the hospital organization is fast becoming a key asset, particularly in light of recent reform legislation in the United States calling for expanding the role of IT in our health care system. Future payment reductions to hospitals included in current health reform are based on expected improvements in hospital operating efficiency. Since over half of hospital expenses are for labor, improved efficiency in use of labor resources can be critical in meeting this challenge. Policy makers have touted the value of IT investments to improve efficiency in response to payment reductions. ^ This study was the first to directly examine the relationship between electronic health record (EHR) technology and staffing efficiency in hospitals. As the hospital has a myriad of outputs for inpatient and outpatient care, efficiency was measured using an industry standard performance metric – full time equivalent employees per adjusted occupied bed (FTE/AOB). Three hypotheses were tested in this study.^ To operationalize EHR technology adoption, we developed three constructs to model adoption, each of which was tested by separate hypotheses. The first hypothesis that a larger number of EHR applications used by a hospital would be associated with greater staffing efficiency (or lower values of FTE/AOB) was not accepted. Association between staffing efficiency and specific EHR applications was the second hypothesis tested and accepted with some applications showing significant impacts on observed values for FTE/AOB. Finally, the hypothesis that the longer an EHR application was used in a hospital would be associated with greater labor efficiency was not accepted as the model showed few statistically significant relationships to FTE/AOB performance. Generally, there does not appear a strong relationship between EHR usage and improved labor efficiency in hospitals.^ While returns on investment from EHR usage may not come from labor efficiencies, they may be better sought using measures of quality, contribution to an efficient and effective local health care system, and improved customer satisfaction through greater patient throughput.^

Efficiency from pharmacy inventory technology: A means to improving quality in non-profit hospitals

Hospitals, like all organizations, have both a mission and a finite supply of resources with which to accomplish that mission. Because the inventory of therapeutic drugs is among the more expensive resources needed by a hospital to achieve its mission, a conceptual model of structure plus process equals outcome posits that adequate emphasis should be placed on optimization of the organization's investment in this important structural resource to provide highest quality outcomes. Therefore emphasis should be placed on the optimization of pharmacy inventory because lowering the financial investment in drug inventory and associated costs increases productive efficiency, a key element of quality. ^ In this study, a post-intervention analysis of a hospital pharmacy inventory management technology implementation at The University of Texas M.D. Anderson Cancer Center was conducted to determine if an intervention which reduced a hospital's financial investment in pharmaceutical inventory provided an opportunity to incrementally optimize the organization's mix of structural resources thereby improving quality of care. The results suggest that hospital pharmacies currently lacking technology to support automated purchasing logistics and perpetual, real-time inventory management for drugs may achieve measurable benefits from the careful implementation of such technology, enabling the hospital to lower its investment in on-hand inventory and, potentially, to reduce overall purchasing expenditures. ^ The importance of these savings to the hospital and potentially to the patient should not be underestimated for their ability to generate funding for previously unfunded public health programs or in their ability to provide financial relief to patients in the form of lower drug costs given the current climate of escalating healthcare costs and tightening reimbursements.^

Technology Choice, Change of Trade Structure, and A Case of Hungarian Economy

In the IT industry, there has been a remarkable increase in the demand for system LSI. A system LSI must be tailor-designed for each electrical appliance, and then produced. It is said that in recent years, this production method has made the IC cycle ambiguous. It can be sought that the choice of whether the economy pursues a development path centering on technology which is tradable or technology which is embodied in labor, depends on the historical background. In this paper, the economic background is explained in order to analyze and capture movements in the IT industry and technology. Then, an econometric model for Hungary has been constructed to estimate the effect of technological progress on the economy.

Technology Choice in the IT Industry and Changes of the Trade Structure

In the IT industry, there has been a remarkable increase in the demand for system LSI. A system LSI must be produced, tailor-designed for each electrical appliance. It is said that this production method has made the IC cycle ambiguous in recent years. It can be sought that the choice of whether the economy pursues a development path centering on technology which is tradable or technology which is embodied in labor, depends on the historical background. The relationship between these two types of technologies is changing rapidly every one or two years. In this background, the analysis is focused on the new trend of technology. In the section 2, the newest trend of technology in the field of system LSI is explained. Then, which kind of technology will be developed and how it will have an affect in the near future, is considered.

Information systems offshore outsourcing: managerial conclusions from academic research

In the light of the growing interest raised by Information Systems Offshore Outsourcing both in the managerial world and in the academic arena, the present work carries out a revision of the research in this area. We have analysed 89 research articles on this topic published in 17 prestigious journals. The analysis deals with aspects such as research methodologies, level of analysis in the studies, data perspective, economic theories used or location of vendors and clients of these services; and it additionally identifies the most frequent topics in this field as well as the most prolific authors and countries. Although other reviews about the research in this area have been published, the present paper achieves a greater level of detail than previous works. The review of the literature in the area could have interesting implications not only for academics but also for business practice.

The Determinants of Investment in Information and Communication Technologies. Bruges European Economic Research (BEER) Papers 16/March 2010

In this paper we investigate the determinants of ICT investment at the macro level for a panel of ten countries over the period 1992-2005. We argue that, since ICT is a General Purpose Technology, its diffusion can be understood only considering the interaction with institutional and structural factors. The empirical results are in line with this view: facilitating factors such as changes in regulation, human capital and the sectoral composition of the economy are relevant determinants for increasing ICT investment.

Offshoring of Information-intensive Services: Structural Breaks in Industry Life Cycles. ACES Working Papers, August 2010

The emergence of widespread offshoring of information-intensive services is arguably one of the more impactful phenomena to transform business in the last ten years. A growing body of research has examined the firm-level drivers andlocation factors (i.e., the why's and where's) of services offshoring. However, little empirical research has examined the maturation sequencing (or when's) of services offshoring. Adopting industry life cycle theory as a framework, the key research questions examined in the paper are: when do different categories of offshoring services provision change from being emergent sectors to more mature ones, and how does the timing of this sequence relate to the type of service offshored. Using a database of 1420 offshore services FDI projects, we find that the value-add as well as the information sensitivity of the service category are related to when the service categories progress through the industry life cycle. Implications for future waves of service offshoring are discussed.

Optical Technology Division.

Mode of access: Internet.

Public information in the national information infrastructure : report to the Regulatory Information Service Center, General Services Administration, and to the administrator of the Office of Information and Regulatory Affairs, Office of Management and Budget /

Mode of access: Internet.

Measures to address the impact of computer technology on lesser developed countries [microform] : hearings before the Subcommittee on Investigations and Oversight and the Subcommittee on Science, Research and Technology of the Committee on Science and Technology, U.S. House of Representatives, Ninety-seventh Congress, second session, May 19, July 15, 1982.

"No. 137."

Expert survey on priorities for the information society in the Caribbean

An on-line survey of experts was conducted to solicit their views on policy priorities in the area of information and communication technologies (ICT) in the Caribbean. The experts considered the goal to “promote teacher training in the use of ICTs in the classroom” to be the highest priority, followed by goals to “reduce the cost of broadband services” and “promote the use of ICT in emergency and disaster prevention, preparedness and response.” Goals in the areas of cybercrime, e-commerce, egovernment, universal service funds, consumer protection, and on-line privacy rounded out the top 10. Some of the lowest ranked goals were those related to coordinating the management of infrastructure changes. These included the switchover for digital terrestrial television (DTT) and digital FM radio, cloud computing for government ICT, the introduction of satellite-based internet services, and the installation of content distribution networks (CDNs). Initiatives aimed at using ICT to promote specific industries, or specific means of promoting the digital economy, tended toward the centre of the rankings. Thus, a general pattern emerged which elevated the importance of focusing on how ICT is integrated into the broader society, with economic issues a lower priority, and concerns about coordination on infrastructure issues lower still.