TDS informatics systems in US hospitales

IDS INFORMATICS IN  TWO NORTH AMERICAN HOSPITAL TDS AND SYMPOSIUM 1994 MIAMI  (22-24 April 1994)

André Fabre April 1994

TDS was born in 1971 to a company called Tecnicon data system to operate a prototype capsule hospital information system prototype by Lockheed Missiles and Space Co. The first achievement, was done in  El Camino Hospital in Mountain View, the California.

In 1990 TDS was acquired by Alltell major telecommunications company as SIS (Systematics Information Services) °

 The TDS 7000

 Following the TDS 4000 version 7000 version based on the notion of permanent medical record (PPR)  was launched in 1990 as a computer system integrating all hospital functions both in the care management.

The architecture and, most often, technical support, are in the pipeline. He also was a TDS product specifically designed to interface to the IBM application.

In fact, the TDS environment also uses the Microsoft Windows system and can ensure full compatibility with Macintosh workstation computers. websites

in Europe, the implementation is mainly located in the UK where there are 20 sites General Hospital in London. In Belgium, the University Hospital Brussels Brugman together several hospitals including St. Peter's Hospital was recently equipped with TDS. Two sites are planned in the Netherlands. In France, Toulon has to contract for the equipment of a capital support safety system relied on case supported on S. 7000 capital which the installation is in progress.

Most sites, more than 200 are located in North America: In addition to the most famous, El Camino, and the two hospitals and forced windows of the visit: the Daystate Hospital, Springfield, and  Washington Hospital, Pennsylvania

Others hospitals operating TDS system are : Saint Francis in Quebec, Beth Israel in New York, East General Hospital in Toronto, Anne Harbor Michigan hospital, Samaritan Hospital in Phoenix Arizona,.

 DAYSTATE, SPRINGFIELD, MASS.

It is a private non-profit hospital.

In total 1008 beds, 800 in the main hospital , 30,000 admissions per year with 207,000 hospital days and 147,000 consultations.

A TDS  5000system is in place managed by a unit of IBM 9121-260 kind of a full capacity of 14 GB

WASHINGTON HOSPITAL (WASHINGTON, PENNSYLVANIA)

Washington is a community hospital having wih a high level of competitiveness in the proximity of Pittsburgh.

The capacity of the hospital is of 362 beds, with 13,000 admissions per year, 39,000 and 233,000 emergency visits annually.

The hospital has a TDS 4000 type apparatus. At the equipment was done in 1989 and the conversion to type 7000 is underway.

 GENERAL  HOSPITAL TOULON

A comprehensive presentation was made by the Director General of Assistance Publique de Marseille, former director of Toulon Hospital.

It is an interactive communication system for all hospital areas: overall care and medical technology services across multiple geographies system working round the clock with a response time guaranteed by the manufacturer. Maintenance is also guaranteed for the manufacturer

The PPR (permanent patient record) system is the main axis of the 7000 TDS program which is the main features are as follows: single chart with permanent number, following  all successive episodes in all sites from birth to death. Included in the files: admissions had that census history especially allergies), requirements, conditions of the patient on admission, examination results, reports and summaries for hospitalizations and consultation ..

It is important to note that  the system assumes both for coding and grouping records in DRG

Modules of the TDS system Toulon are :

. Data Access

. Clinical computing on Graphics: resource management, planning and schedule appointments

. Open Hub Unix interfaces on multiple hardware and software

. Careminder applications

. DRG coding is grouping

. LIGHTPEN is a major component of TDS with  voice control in many applications, in particular reports of use and coding as well as several projects electronic slate and wireless networks

 PERSONAL COMMENTS

 Regarding quality of care we can only emphasize the high quality of all papers and presentations that were made during the symposium

Information departments of each hospital are under the responsibility of secretaries and chief manager. No physician is directly involved..

The system is permanently in use without any intervention of medical.

The average time for data recording  is 10 minutes per record but intensive care require a period of half an hour to enter. Note that in both hospitals visited, no problem seems to exist only on waiting for the response from the computer even in peak assignment and over 50 000 files.

Reluctance was expressed by several doctors alleging various causes:. Lack of availability, initiative managers separation, perhaps this brand famous medical individualism Medical participation is especially made residents while this specialist future specialists in family medicine that Washington Hospital. Note that among the 180 participants at the symposium called SA and there were only 32 doctors and medical director with him. Other clinicians often have the President of the Medical Commission setting a single physician is directly affected by the information system. The majority of participants in the symposium was, it must be stressed, manager.

Homogeneity and consistency at each level of system utilization. The question remains: is this state of mind he so teamwork but it is physical security in the first degree, the ethical aspects are clearly far behind the occupations of practical use. The implications of such a situation should not be underestimated: the willingness to participate fully in the operation of a network is a matter of mentality not to mention culture.

Unifying role of HIS: Unquestionably network operation federate partners hospital system with the same tasks and sharing the same goals. An important application for the Flemish connecting multiple locations in the same hospital group, for example, nursing home, long stay, psychiatry, cancer center.

HIS as economic control: requirements: the pressed key is a combination system that further tests medications medical and nursing procedures. This direct expression of the real economic power of medical decisions. One can not help but recall here the famous aphorism that modern medicine is no longer based on the diagnosis but the indications (the choice of additional tests and procedures)

Nursing Resources: Nurses work seems positively influenced by hi s: time spent looking for information about the past from 40% to 25% since the implementation of the TDS. network usage would also have favorable effects on the recruitment and retention of employment of nurses

Use of references: the protocol does not make a wider use of decision trees, improved convenience criterion guiding and a reduction in hours or transmission requirements. All hospital officials insist that judicial remedies are much less likely with the implementation of the application system

Length of stay: the alleged reduction of length of stay due to improved traffic conditions information

Readmission development of balance and preset patterns

Input acts "at source" an obvious interest cost accounting

Billing: several modules of hospital billing and accounting are available

Importance of standardized prescription: the importance of the economic and organizational standardized and probably underestimated in Europe prescription.

In the long term prospects appear poorly defined control standards and therefore not to say management requirements that may explain some of the reluctance of the medical profession

HIS IT

IT: an instrument of economic power? Anyone who has information has power is the one that was able to invest enough in the computer appears between dominant management. This is a key idea in the United States: IT is an effective tool for competitiveness.

HIS and health policy of the United States : traditional situation independent medical billing the patient according to procedures performed and considered appearing as eyes age. In the 80s and projective Medicare payment program (ppi (

Testing and projective payment program that generated the creation of DRGs : For a decade the principle of at least partial funding of hospitals was based on medical activity was based system. The enormous growth over the health led to seek other solutions in the most spectacular is the idea of a fixed budget (envelope-funded insurance companies budget since the overall budget

 Conclusions 

Years 90s were the era of capitation: adaptive response to this new situation and put in place a comprehensive control of supply and demand.

Where consolidation among city doctors, group practices and HMO, dirty relationship between the hospital and the city under various statutes (association, wage, foundation rental services)

Total cross borders without logic very different from the distinction in Europe between hospital and ambulatory medicine.

HIS: a means of adaptation to the new health care system?

Integrated computer systems can record each decision delay "medical black box" and always providing users the appropriate normative reference.

The principle of a permanent interactive communication between partners of the same system is irrespective of hospital services or even categories of medical care.

TDS could be considered primarily as an instrument to tailor, organize and control the hospital care and survive the budget constraints are fixed

the logic of the fixed budget is considered sclerotic Europe but actually appears generate many adaptive responses and competitiveness in the United States. It is too easy to evoke invoke cultural differences here. There is an example in which Europeans should think more

TDS provides an interesting solution to the three goals unattainable with conventional methods:

- Adaptation to specific needs of a hospital, a service, or to the individual user

- Instant communication between partners of the same hospital or between hospitals in the same group

- Maintaining permanent reference normative basis of an optimum streamlining medical decisions

Which perspectivesfor implementation in French hospitals?

This is a problem of adaptation more than a cost problem. Insist that the North American experience is initially focused on nursing care. Clearly the system is considered as an extension of an advanced level of training and organization.

The old saying still applies: "build solid but not in the desert or in the disorder."

 

a.fabre.fl@gmail.com

 

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