Donald W. Simborg

A Controlled Experiment to Evaluate the Use of a Time-Oriented Summary Medical Record

A randomized single-blind experiment was done in a medical subspecialty clinic in order to determine whether a flow-sheet type of summary medical record could validly serve as a means to communicate clinical information in the absence of the traditional medical record. Two groups of outpatient physician-patient encounters were compared: In the 68 study encounters (Group S), physicians were given a flow-sheet summary record with the option to receive the standard medical record if they desired; in the 27 control encounters (Group C), physicians were given the standard medical record plus the flow-sheet summary record. Fifty-nine per cent of study-group physicians did not choose to receive the full medical record. The study group was found not to differ (p = 0.013) from controls significantly with regard to the follow-up of clinical information as measured by pre- and post-encounter chart review. Physician providers in the study group were unable to detect by retrospective chart review overlooked clinical information with greater frequency than control group providers. We conclude that a flow-sheet type of summary medical record can serve as the sole source of clinical information in a substantial number of outpatient follow-up encounters in a medical subspecialty clinic without deterioration in the communication of clinical information.

Local area networks and the hospital

Hospital information systems are characterized by their complexity of individual functions, heterogeneity of functions, and dependence upon integration. A distributed computerized information system is well suited to meeting the needs of hospitals. A local area communications network (LACN) removes a major impediment to the use of distributed systems. An advanced microprocessor-based LACN using fiberoptic communications has been developed by the Applied Physics Laboratory of The Johns Hopkins University and has been implemented at the University of California, San Francisco Hospital.

Classification of ambulatory care using patient-based, time-oriented indexes.

This paper presents a new approach to the classification of ambulatory care into isoresource consumption groups. In contrast to classification schemes based on visits, this case-mix approach creates an index based on resources used by diagnostic categories by a patient during a year. An application of this method to a primary care, group practice data base produced resource consumption groups with coefficients of variation in an acceptable range compared with the coefficients of variation of the diagnosis-related groups used to classify inpatient care.

Networking and medical information systems.

A local area communications network (LACN) has been implemented successfully at the University of California, San Francisco (UCSF) Hospital. This technology, developed by the Applied Physics Laboratory of the Johns Hopkins University, facilitates communication among systems previously considered “incompatible”. The implication of this experiment is that a modular, evolutionary approach to medical systems will soon be a viable alternative to the “total” singlevendor approach now commonly used. Substantial preparation by a medical center, however, will be required in order to use an LACN properly. This will probably be done in many cases with the assistance of a new type of medical systems vendor, i.e., one having no systems of its own to sell.

Technology in hospitals the effect of prospective reimbursement

The hypothesis is presented that prospective reimbursement will alter the adoption and dissemination of new technology in hospitals beginning immediately and extending into the indefinite future. During the past two decades the dramatic rise in health care costs has been paralleled by an equally dramatic adoption and proliferation of cost raising technologies. Both “big ticket” and “little ticket” technologies have contributed to the rising costs. Cost or cost-plus reimbursement mechanisms have fueled this phenomenon. Prospective reimbursement reverses the incentives for cost raising technology adoption and will select out cost saving technologies. Both the mechanism of prospective reimbursement and the psychological and political environment which accepts limitations in resources will make the stated hypothesis a reality.