Kyusuk Chung

Telemedicine in the USA: standardization through information management and technical applications

In this article, we describe the need for telemedicine standards and classify various standards of telemedicine. The emerging issues in telecommunications standards, the application of these standards in the health care industry, and future development directions of telemedicine standards are described. Especially, the telemedicine code standardization of drugs and health care providers, multimedia-conferencing-based ISO telemedicine standards, information security management, wireless technology advances for telemedicine using sensor networks, and future standardization issues and considerations are introduced and discussed in detail.

Introduction: Geographic Information Systems in Public Health and Medicine

Geographic information systems (GIS) are increasingly being used in public health and medicine. Advances in computer technology, the encouragement of its use by the federal government, and the wide availability of academic and commercial courses on GIS are responsible for its growth. Some view GIS as only a tool for spatial research and policy analysis, while others believe it is part of a larger emerging new science including geography, cartography, geodesy, and remote sensing. The specific advantages and problems of GIS are discussed. The greatest potential of GIS is its ability to clearly show the results of complex analyses through maps. Problems in using GIS include its costs, the need to adequately train staff, the use of appropriate spatial units, and the risk it poses to violating patient confidentiality. Lastly, the fourteen articles in this special issue devoted to GIS are introduced and briefly discussed.

Health and GIS: Toward Spatial Statistical Analyses

This study examined the extent to which health studies, mostly in public health and epidemiology, used geographical information systems (GIS). We identified a wide range of tools they used—ranging from geocoding through simple buffer/overlay functions to spatial query functions. However, studies tend to rely on tools outside of GIS for spatial statistical analyses. This may reflect a lack of spatial statistical tools that are suitable for health researchers whose data are rather geographically aggregated count data than continuous data. Implementation within GIS of spatial analytical tools suitable for aggregated data over a region will increase the use of GIS beyond simple GIS operations in health studies.

Toward Efficient Medication Error Reduction: Error-Reducing Information Management Systems

Hospitals and other health-care providers today are being pressed more than ever to use technologies for reducing medical errors. Particularly, medication errors are likely to increase fast as Americans age. This paper intends to provide a starting point for understanding information technologies and database systems supporting such technologies as Computerized Physician Order Entry (CPOE), Automated Dispensing System (ADS), and Bar Coding System designed to reduce medication errors in hospitals. Although vendors provide the necessary communication software and applications, actions involving governments, technology vendors, pharmaceutical companies, and clinical researchers are needed to put to actual use the applications with a massive potential to significantly reduce medication-related errors.

Current Issues in Health Care Informatics

Health care informatics has emerged as a diverse and important new field of study. The field can be very broadly defined as the science that addresses how best to use information to improve health care. The field includes the four areas of bioinformatics, medical informatics, public health informatics, and consumer health informatics. Health care informatics applications can be used to improve the quality of patient care, to increase productivity, and to provide access to knowledge. After providing an overview of the field, the 10 articles contained in this special issue are briefly discussed. The first six articles address a diverse set of topics such as the use of health care informatics to conduct research, clinical information systems used by the U.S. Air Force, electronic medical records and physician satisfaction in Oman, and a point of care documentation system used by hospice care providers. The last four articles discuss the complex issues raised by the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The American Hospital Association’s Annual Survey of Hospitals: a critical appraisal

Data from the American Hospital Association’s Annual Survey of Hospitals, which are used to produce the AHA Guide, Hospital Statistics, and other data products, are widely used by hospital administrators, academic researchers, and healthcare marketers. Although they are widely used, many who use data from the survey are unaware of their limitations and problems. Such problems include: inaccuracies and inconsistencies in reporting; low response rates to certain data items; biases in reporting; and a lack of publicly available technical documentation concerning the statistical methodology of the survey, particularly its estimation and imputation procedures for missing data. Failure to be sophisticated consumers of data products can misdirect the outcome of important planning and marketing efforts.

Overview of Administrative Simplification Provisions of HIPAA

The administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 are considered to have a considerable impact on the health care industry in the United States of America. The HIPAA-mandated electronic transactions using Electronic Data Interchange (henceforth EDI) methods have brought significant issues on privacy, confidentiality and security for individually identifiable information not to mention technical issues. The purpose of this paper is to facilitate the understanding of those issues surrounding the administrative simplification part of HIPAA. Toward this goal, the paper provides an overview of HIPAA through a systematic approach of understanding its evolution and its requirements.

A Point of Care Clinical Documentation System for Hospice Care Providers

This article identifies two areas of hospice care that may benefit the most from a point-of-care (POC) clinical documentation system: documentation for recertification and symptom/pain management. Applications as solutions for the hospice POC clinical documentation system need two documentation support tools: (1) knowledge-based external or internal reference data available to physicians or medical staff right at the bedside and (2) assisting medical staff in filling out electronic forms for clinical measurements by providing real-time prompts, clues, alerts, or other types of feedback, along with the common features such as pre-defined values in specific fields. Our study may encourage more software vendors to include clinical documentation support tools in their solutions.

The Effects of the Americans with Disabilities Act: A Longitudinal Model Analysis

Abstract The Americans with Disabilities Act (ADA) of 1990 intends to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities. By 1994 the ADA extended to all employers with 15 or more employees that were recommended to make reasonable accommodations for qualified workers with disabilities. This article provides statistically rigorous estimation of employment effects of the ADA on working-age (25–59) men with disabilities using the panel data of Survey of Income and Program Participation (SIPP). Previous studies failed to detect the beneficial effect of the ADA by failing to focus on the relevant subpopulation that the ADA intends to target—those who can participate in workforce. Our findings suggest that the implementation of the extended ADA regulations in 1994 had positive impact on the well-being of the disabled who are labor participants. This held true regardless of measures of disability used.

Disparities in Outcomes of Acute Myocardial Infarction across Health Insurance Statuses

The number of uninsured has increased during recent years. This study explores underlying factors associated with the insurance-status disparities in hospital care by examining 80,730 acute myocardial infarction discharges in the National Inpatient Sample. Compared to patients having private insurance, Medicaid patients’ higher mortality risk related to severity of illness while the higher mortality of uninsured patients related to interactive effects between insurance status and hospital characteristics. Primary care strategies are likely to improve the hospital care for Medicaid patients while ensuring access to high quality care for patients with limited financial means can improve outcomes for uninsured patients.