Jerome H. Grossman

A simple programming system (“driver”) for the creation and execution of an automated medical history☆

Abstract A simple and yet versatile method for automating medical history has been designed. The system uses a “driver” which is a program designed for the execution of a repetitive task that is entirely data independent. The driver not only directs the on-line interview, but is also capable of generating a narrative summary of the interview. The system also contains numerous utility functions which allow the user to manipulate his data base. The system has been used in various projects concerned with automated medical histories and other on-line interview-based projects. This driver has played a major role in the successful utilization of these forms of interactive computer applications.

A Managerial Perspective on Information Systems in Medical Care Organizations

Publisher Summary There are a number of reasons why the promise—a new age of computer-assisted medical care—has not been realized. The process to reach that state was political and social, much more than it was technological. Also, the medical care process is still as much an art as a science, with many variables impacting almost every decision and with little, if any, agreement on the nature of the process. Therefore, computers did not have the ability to quantify and check clinical diagnoses. Most importantly, it turned out that at the operational level, medicine was a human process: the interaction between two human beings. The computer was not going to serve as an acceptable substitute in most cases to the physician, although patient reaction has been more favorable. Nevertheless, the goals of improving the quality of care and medical efficiency that were stated a few years ago for computer systems are still valid. These objectives are now more widely embraced, not only by some technologists and government agencies sponsoring their development but also by all of the principal constituents of the health care delivery system—consumers, providers, and insurers.

Information systems for ambulatory care

Until recently, most medical information systems were developed for use in hospitals, despite the fact that the majority of health care is given in clinics and physicians offices. There are several reasons for this situation, including the following: (1) the nature of acute care implies a more urgent need for communication of information among health professionals; (2) there is a greater volume of data collected on inpatients than on outpatients; (3) there are larger sums of money per encounter involved, tending to make information systems more economical.

Productivity research and healthcare delivery innovation

If a healthcare delivery system is to achieve quality and efficiency, participants must be able to measure quality and efficiency. Yet no healthcare system in the world — and certainly not the current US system, our main focus — measures, reports and acts on such a measure of productivity. This article describes the conventional methodology for measuring healthcare productivity and the more recent focus on episodes of illness and priority conditions. Specific clinical examples of productivity improvement and the many uses of such research — for private industry as well as public policy — illustrate why productivity research could be considered the ‘genome’ of healthcare delivery innovation.