Decision Support Methods in Healthcare

Decision Support Methods in Healthcare Introduction Currently, healthcare practitioners are working hard to ensure that the safety of patients is guaranteed. They are also working toward averting expensive lawsuits that result from medical malpractices. Additionally, medical practitioners have devised mechanisms for the bar-coding of medicines, patients, and nurses to ensure that patients receive safe medicines and quality healthcare services (Tan, Sheps, 1998). Some healthcare systems are using decision support methods and relational database design to make effective decisions concerning patients care. In this paper, I will discuss the decision support systems and relational database design of Partners HealthCare System, Inc. Partners HealthCare System, Inc. uses complex medical intelligence systems to enable doctors and nurses make efficient decisions as pertains to patient care. Electronic Medical Administration Record (EMAR) is one of the database management systems that the healthcare system uses to make decisions and carry out its activities. Partners HealthCare System is a network that consists of various healthcare facilities. The network has medical centers, community hospitals, specialty healthcare services, and several basic healthcare specialists (Lighter, Fair, 2000). Partners HealthCare System, Inc. employs Oracle and SQL for the warehousing of its data. It also uses it for data mining and OLAP applications. Additionally, the organization makes wide use of CACHE, an Intersystem Corp based in MA, for various clinical purposes. The HealthCare System separates their mission to offer important healthcare for patients from other applications. Moreover, the System selected CACHE because of its highly availability, and high demands of effective patient care. CACHE forms a significant part of Partners relational database design and web application setting. It is particularly relevant to Partners mission in clinical applications because of the technologys use of algorithms and schemas that store data effectively. The performance of the database is enhanced by the sparse matrix storage method. The organization manages the application of CACHE over the web and this helps the Partners to have an advanced and substantial processing of transactions. CACHE has a distributed protocol, which effectively lessens network traffic (Shortliffe, Cimino, 2006). Consequently, there is increased processing of transactions. Additionally, it is easy to scale up the technology to serve several users without compromising its performance. CACHE technological innovation is a significant tool for the development of applications for patient care because it handles data in a more flexible way than other conventional relational database structures. The clinical department of Partners HealthCare System has complicated forms of data. Consequently, a lot of data cannot be classified effectively into two-dimensional systems. The advantage of CACHE is that it can consider data in two or more than two dimensional structure when necessary (Harrington, 2002). Partners HealthCare System Inc. has developed a modern wireless EMAR as an artificial intelligence for patient care. This development has particularly replaced all paper works carried out by nurses in recording medicine dispensation to patients. Moreover, EMAR technology uses advanced decision support systems and features that promote client safety. Through the technology, the medications in storage facilities, such as the pharmacy dispensing equipment, is bar-coded to enable nurses to scan the ID to verify that correct medications are supplied to the right clients. Additionally, the practitioner can scan his or her ID badge to create a completed inventory track of the medication course. Highest verification of medication procedures, as indicated by one of Partners nurses, takes place in the pharmacy. When the medical practitioner feeds information into the system concerning the prescription, the medication order is examined before it is made available for the nurse to deal with. Some artificial intelligences employed in the prescription are based on probability of medication reactions, likely patient reactions to the medications, and likelihood of overprescribing drugs to patients in relation to previous prescriptions. EMAR technology constitutes of several electronic reminders that help nurses in their daily medication prescriptions thereby enabling them to solve problems arising during patient care processes. For instance, the technology provides cues that remind nurses concerning such issues like prescription overdue, or recording of patients pain level to decide whether the administration of a particular medication is effective or not. However, nurses take into consideration that EMAR checking does not replace their role in evaluating situations to make decisions (Shortliffe, Cimino, 2006). The checks enable nurses to have confidence that the safety of patients is guaranteed. EMAR is compressed in wireless computers and laptops with readers of bar-codes, and this allows nurses to move closely to the patients with their computer system. By bringing the scanner to the patients bedside, risks and errors are eliminated. For instance, if a medical practitioner enters a wrong medication order after a drug prescription at the pharmacy, the nurse will receive an alerting message on his or her laptop screen, as he or she scans the patient prior to drug administration. Artificial intelligence innovation for decision support is employed by various medical practitioners to make the decision support systems more useful. CACHE technology serves an important role in enhancing workflow among healthcare systems and benefits contributors. Through CACHE applications, insurance organizations are connected with healthcare systems to deliver services to patients. CACHE applications promote the workflow between third-party companies and Partners HealthCare System. For instance, relational database design of a real-time query between the healthcare organization and insurance firms aids in determining eligibility for benefits. This affects the organizations capacity to collect finances for a medical situation while improving the workflow (Wager, Lee, Glaser, 2005). Applications have been developed to connect Partners system of order entry of medications to database of pharmaceutical organizations to ascertain whether particular medications are covered by particular payers. The incorporation of this element into the drug prescription process has resulted in improved workflow in drug prescription, and it ensures that Partners HealthCare System, Inc. is compensated for the medications prescribed. Partners HealthCare indicates that CACHE applications have benefits associated with their usage. This technological innovation employs open standards. Consequently, it enables interoperation among several platforms. Therefore, CACHE is crucial in the implementation of web services to link several systems. CACHE is also cheap because Partners achieve their mission for patient care from the product hardware without necessarily investing large amounts of funds in other technologies. Moreover, CACHE applications do not require complex management as compared to SQL and Oracle developments. CACHE is more accessible and easy to maintain whereby medical practitioners use computers directly in healthcare settings (Shortliffe, Cimino, 2006). The figure below represents an entity-relationship model used in Decision Support Methods in Healthcare and Relational Database Adopted from: http://www.andrew.cmu.edu/user/rpadman/Data%20management%20technologies-%20day%202%20slides.ppt Health and Human Services (HHS) department indicates that there is need for the advancement in the database systems of healthcare services to create a nationwide database that uses electronic medical recording to trail an individuals dealings with the healthcare system from birth till death. As a means of staying relevant to the HHS requirement, Partners HealthCare System has implemented an electronic health information management (e-HIM). This requires the healthcare organization to guarantee the accessibility of information to promote advanced healthcare provision and essential health matters required to make decisions for use in various environments and organizations. Nevertheless, these objectives will only be realized when there is efficient, accurate, reliable, and secure storage of information in efficiently designed automated databases (Wager, Lee, Glaser, 2005). Relational database is the most common kind of database employed in healthcare systems. It tracks patient care including various forms of treatment, results from the treatments, and significant indicators of states of patients such as pulse rate, level of blood pressure, and blood glucose. Moreover, relational database interlinks with several information structures in healthcare service systems such as Partners. For example, a relational database in the section of cardiac care is linked directly with the registration system of the healthcare facility. Once a patient is registered, information concerning him or her is relayed to the database through health level seven procedures (Shortliffe, Cimino, 2006). This allows cardiac care practitioners to focus on offering the best care to the patient because they do not need to register the patient again. Relational database reduces the need for paperwork in recording and transfer of information. It also improves efficiency in healthcare systems while acting as an accounting tool. For instance, patients suffering from diabetes, who exhibit fairly similar signs and symptoms such as overweight and high levels of blood glucose, can be closely examined to ascertain the manner in which various medications, like Glucovance, help in managing their symptoms. Moreover, relational database is essential as it determines patients at risk, for instance, individuals with aneurysms in family history. When these patients are recognized they undergo screening to avoid suffering from certain ailments (Wager, Lee, Glaser, 2005). Decision trees are used in Partners HealthCare System and other healthcare facilities to help in solving of clinical and healthcare problems. With the increase in the difficulty of clinical problems, there is an exponential increase in the probabilities and uncertainties, and this means that sophisticated solutions, rather than the simple ones, are required. Consequently, in these scenarios, decision trees become more suitable because they take into consideration weighted probabilities and anticipated outcomes (Harrington, 2002). Decision trees help in clinical situations because they present precisely and instructively the procedures with which the medical practitioner provides care to a patient as indicated by clinical and laboratory diagnostic results. The extensive procedures are routinely attained at basing on previous use of algorithms and decision trees in solving clinical problems. Medical practitioners use such procedures cautiously when practicing clinical medicine. When using decision trees, the physicians recognize that clinical decision models are different from mathematical representations. When protocols are employed to give directions, they prevent undesired or costly clinical processes (Tan, Sheps, 1998). Protocols are normally used to evaluate benefits of using a particular prescription or a new type of drugs. Accurate protocols allow for the collection of information from various healthcare facilities because patients are put under a stringently defined management process. Moreover, if the protocols are accurately defined and monitored, wise conclusions are reached at when drugs are used effectively. Protocols and other decision making techniques have various advantages. They enable clinical practitioners to efficiently learn on how to solve clinical problems. They enable medical practitioners to formulate some questions that enable them to define clinical problems at hand. They present precise scientific and systematic procedures for solving clinical problems. Moreover, they are efficient as regards to time, effort required, and cost. Decision trees and protocols form the foundation upon which significant knowledge of particular clinical problems is evaluated. Additionally, these decision making tools help medical practitioners to consult each other concerning particular clinical problems, and they form suitable means to evaluate clinical activities. Decision trees and protocols are also beneficial to patients because they increase the probability that the patient will receive high quality care, maximum effective results from medications, and more effective medical aid. Moreover, decision trees enable the avoidance of unnecessary prescriptions and medicines thereby assuring the client that only the necessary treatment is achieved. Furthermore, these tools ensure cost-effective and standardized treatment. Below is an example of a decision tree for appendicitis (Wager, Lee, Glaser, 2005) Perforated Operate inflamed Decide now Perforated Not operate inflamed Perforated Patient worse Inflamed Perforated Wait seven hours Patient same Inflamed Expert systems and decision making techniques entails the clinical decision support systems CDSSs, which are computer programs devised to offer expert support to healthcare practitioners in the making of clinical decisions. These expert systems employ integrated clinical information to enable doctors to evaluate data concerning patients thereby making relevant decisions as concerns to the diagnosis of diseases, their prevention and medication. Expert systems are available in various healthcare departments including pharmacy, dentistry, and medicine (Lighter, Fair, 2000). Many CDSSs constitute of four fundamental components. These are inference engine (IE), knowledge base (KB), working memory, and the explanation module. The inference engine is the major part of the system, and it uses the information stored in the system together with the information about the patient to make decisions concerning particular situations. Moreover, the IE manages the kind of activity that the system can initiate. For instance, it establishes the alert and reminder procedures in an alerting mechanism. Moreover, it determines the conclusions or decisions that can be displayed on the screen of the diagnostic system. The KB represents the information used by the IE. For instance, in a case of caries, the KB will present information concerning the risks for fresh lesions and their levels. Knowledge bases are created either by a domain expert or by a computerized procedure. The creation of knowledge by an engineer involves the assistance of a clinical domain specialist who ed its and manages the KB. On the other hand, in a computerized process, information is obtained from external sources that include journal articles, books, and database using a particular computer application (Harrington, 2002). Information collected concerning a patient is stored in the database or modified into a message. This forms the working memory. Patients information ranges from demographic features such as gender and date of birth, drugs in use, allergies, and previous medical problems, among other data. All CDSSs do not contain the explanation module. The explanation module serves the purpose of creating validations for the decisions made by the IE when using the information in KB against patient information within the working memory. CDSSs work in a synchronized manner in that they communicate directly with the medical practitioner who waits for the information from the system. An example of this application is one which examines interactions between drugs or likely allergies experienced by patients in response to particular prescribed medicine. When working in a synchronous approach, CDSSs carry out their rationalizations in an independent manner without the aid of any user (Gillies, 2002). For instance, the production of a reminder for a checkup or hygiene takes place independently. Clinical Decision Support Systems are categorized as either open or closed loop structures. In open-loop system, the CDSS makes decisions but it does not initiate an action on its own. Examples of open-loop systems are applications that produce alerts or reminders. The eventual decision concerning the activity to be performed is determined by the medical practitioner. On the other hand, in closed-loop systems, the system initiates the action without involving a medical practitioner. Other significant types of CDSSs include consultation systems, clinical guidelines, and event monitors. A consultation system entails situations where a medical practitioner enters information concerning a patient into the system. Information entered may include patient demographic characteristics, medical history, and physical diagnosis, among others. The system then lists the problems related with the situation and provides possible solutions. An event monitor, on the other hand, constitutes of software that collects all data copies accessible in electronic design within the healthcare facility and employs its knowledge base to relay alerts and reminders to medical practitioners when necessary (Lighter, Fair, 2000). Clinical instructions are integrated in the CDSSs, and they are invented by clinical experts and distributed by professional or state organizations. In this case, the clinical guidelines serve as official statements to recommend the most appropriate practices as pertains to particular clinical problems. Researchers in clinical field have invented standardized representations of information to promote the sharing of the guidelines. An example of standardized representation of information is the Guideline Interchange Format (GLIF) or Arden Syntax. Arden Syntax refers to an American National Standards Institutes (ANSI) standard used to represent quantifiable clinical information (Wager, Lee, Glaser, 2005). Arden Syntax presents decision rules known as medical logic model (MLM). Moreover, every MLM has adequate reasoning to enable it make a clinical decision. On the other hand, the Guideline Interchange Format (GLIF) constitutes of a format interpretable by the computer to enable representation of clinical practice directions invented by InterMed collaboration, which is a project carried out jointly at Stanford, McGraw, Harvard, and Columbia University laboratories (Gillies, 2002). This application serves as a language that can be used for general purposes to develop and implement clinical decision support systems, which are applied in various clinical spheres. Besides supplying recommendations for patient care, the application can be used to ensure quality and medical knowledge. Therefore, decision support systems help healthcare professionals to make relevant decisions when dealing with patient care to ensure maximum quality and safety for the patients.

Egocentrism: The Epicenter of Fuzzy Ethics Essay

Egocentrism is a trait that not the highest of the morally esteemed in society will evade. Ideally this is what Aratani is ascertaining. Formatively, take the much ascribed moral class, the clergy. This purported moral class is always and will always front for their faith to have the highest attendance. They will promise miracles, traversing bounds of wealth through to healing; yet they ultimately do not deliver to the very word. One will refrain from terming this as cheating, given the moral and the spiritual authority from which the confession comes from (Deremer, P A.; Gruen, G E). Thinking outside this bracket, expecting more morality from the sheep when the shepherd has not towed the line seems relatively protracted; the epicenter of this discourse. Aratani simply appears to be arguing for what Maslow’s hierarchy of needs is meant to ascertain. In deed, from one level of satisfaction humanity will always yearn to move to the next. As Aratani asserts, when the player wins any base ball match, the worst the player will yearn for is to remain in that position; win and win and win! Or at best, improve on the record (Hanson, K O). Worse still, kill to remain at the very helm. This is shear presentation of utter egocentrism. The attitude of winning presents a competitive scenario for the world, which ultimately translates into innovation. However, cheating to meet this end is simply extraverted negative egocentrism. The reason for this trend appears relatively similar under varying circumstances. Whatever the orientation, the ethical miscreant simply endears to remain the very best, not to be outwitted by any other person (Deremer, P A. et al). One will argue that this is ideally competition. But then it is not moral to use the two words interchangeably or as synonyms. Presumably, the ideals of competition are more positive while those of egocentrism are negative and subverting. In effect blaming the entire yearning for more by any perpetrator of such traits would equally be senseless. Take the case of Drogba, after winning the trophy for the category of the best boot; all commercials use him for advertising their brands. Every brand pays him a fortune, his wealth increases at the rate of ticking seconds. Definitely signs that this trend of cash and fame inflows will be guarded at all possible costs (Aratani, L. ). In earnest it is not the will of the perpetrator; the world creates all the precedence for such occurrences. According to Maslow, the apex of humanity is self actualization. However, there seems to be no such ideal case as self actualization. If such cases existed, probably the cases of cheating and conspiracy to achieve this anterior end would just be reduced. I feel it is the search for supremacy, due the lack of the actualization stage, stable state, which precipitates the incessant lies and anterior activities. Ideally capitalism has a hand, s invisible yet so invincible in orientation in all these undertakings. Earnestly, if the wealth created in this due process would be shared within the community, then not the least individual will yearn to amaze as much wealth (Hanson, K O). Vividly, humanity would only look for as much as can sustain them without going beyond ethical boundaries to access more. It is utterly impossible or near to impossible perceiving any change in attitude that would see the overall yearning for more and more changed. If indeed religion was any practicable ideal, it would offer a worth course, but then it is equally bedeviled by the relentless yearning for more; believers, offerings, miracles and even wealth, earthly and heavenly alike. On the backdrop of this assertion, the best way towards ethical morality is socialism. Within the principles of socialism, and yet still given the egocentric nature of humanity, but as a curtailment, no individual will want to simply amaze much only to be used by the masses. People will only yearn for moderation in fame and wealth (Aratani, L. ). The need for actualization will be universalized and the need for craving for more will be curtailed. Ultimately, the course for reduced egocentrism is as course; whichever the approach, the solution towards this end is utterly individual reevaluation and rethinks. References Aratani, L. Ethics Boundaries Still Appear Fuzzy; Teen Cheating Poll Results Reflect Pressure, Some Believe, Washington Post 19 November 2006: C03 Deremer, P A. ; Gruen, G E. Children’s moral judgments: the relationship between intentionality, social egocentrism and development Journal of Genetic Psychology, Jun79, Vol. 134 Iss. 2, p207 Hanson, K O. , Culture Suggests Cheaters Do Prosper, Markkula Center for Applied Ethics. 6 March 2005. 17 Apr. 2009.

April Greiman

â€Å"Great things are not done by impulse, but a series of small things brought together. â€Å"? Vincent Van Gogh April Greiman is by far one of the most influential female artists in the history of Design. She was born in New York in 1948 and was raised in a very family oriented environment, her creativity was greatly influenced by her mother, father and aunt who shared a passion for art, music and encouraged her to be an independent, curious, adventurous woman.After acknowledging her great interest in art, she applied to several art schools and was accepted into the Kansas City Art Institute where she received a BFA in Graphic Design. Later on, with the influence of the principles of Modernism and exploration of technology, she continued her education by enrolling in a graduate program at the Basel School of Design in Switzerland. The experience and skills she gained from her educational background allowed her to explore the aesthetics of a computerized world, the art of digita l design and visual communication.Around the mid-1970s, Greiman decided to explore a different environment from New York and moved to Los Angeles, California where she started her own design business known as â€Å"Made in Space, Inc. †. Greiman is recognized as a pioneer in computerized design, her style is based on the exploration of words, images and the usage of color in space by combining art with modern technology. She was highly inspired by the landscape of the Death Valley; A landscape that continues to inspire her work and change the way she analyzes dimensions, objects and color.Her style is often seen as American Postmodernism with an influence of Swiss design coming from her educational background. Because of her work and style, April Greiman has been recognized for her potential in utilizing computers as an innovative medium to transform the art world. Around 1980s, Greiman took a risk and decided to support and explore the initiative proposed by Macintosh of usi ng computer design. This new genre in art quickly confirmed Greiman’s position as the pioneer of visual communication and design.Her eagerness to learn and explore this new medium is what has gotten her the respect and appreciation for her work. Her ability to engage the audience and embrace spaces by providing a floating effect to her work, combining architecture and typographic forms allowed her to become one of the most prominent icons in the design world. In 1982, April Greiman was selected head of the design department at the California Institute of the Arts. Throughout her time in CalArts, she focused on her role as an educator and the importance of transforming design.Greiman was able to take advantage of the state of the art equipment that was provided by the institution and began to combine video and media images in her work. Her input in this field and her accomplishments successfully gave her the opportunity to make this department more focused in a variety of idea s other than design renaming this field as visual communication. The popularity and recognition April Greiman gained over the years is mostly because of of her creativity, experience working with graphics and implementation of visual communication with the use of technological devices.As an Artist and educator, she has been able to work in a number of posters and websites for her clientele, she is the author of several design books including Hybrid Imagery: The Fusion of Technology and Graphic Design and Something from Nothing. She is such a great inspiration for young artists and designers that her work has been exhibited in important institutions such as the Museum of Modern Art, the Walker Art Center, the School of Visual Arts, the Pasadena Museum of California Art,among others.In addition, Greiman has been awarded numerous honors that include: the American Institute of Graphic Arts’Gold Medal, a Chrysler Design Award and also Hallmark Corporation’s Hall Chair Fello wship. Greiman is well known for her work Does it make sense? a piece accepted by the Design Quarterly magazine from which she became the guest artist. This piece became a 3Ãâ€"6 poster that unfolded and was specifically done only in computer design. This piece contained the image of her nude self-portrait, containing various typographic effects and symbols throughout. This work completely pushed boundaries and forced artists to ethink the capacity for computers to make an impact in the art world and communication. In this sense, her work completely challenged the original and traditional notions of the magazine and of art by combining text with image, and expanding a new world of imagination and creativity for the upcoming generations following her steps. Hand holding a bowl of rice is an important addition to her work, it is a public art commission located in korea town, Los Angeles, CA. This piece was done in two walls of a building, the image is the screen shot of a video foota ge shot by Greiman, the image was later translated into oil paint.This piece clearly encompasses her style in dimension, usage of color and placement of objects. The art work was made to honor rice as an important symbol of abundance in the Asian culture. â€Å"I see everything as an object in space†¦when web design came into the realm of possibilities†¦I was already looking at it as spatial media† -AG In addition to the public art and other installations, Greiman is also known by her work with photography and her exhibition of Drive by Shooting strictly digital photography. This exhibition is made up of images that Greiman began to take over the years while driving her car.The exploration of this aspect of photography sparked the importance of nature and detail, the interaction of the lens with the moving environment, the experimentation of light, form, texture, and the ability to manipulate and create a spatial astonishing experience through digital work. April Gr eiman’s work continues to expand with her collaboration with architects in the design of spaces. Miracle Manor a well known spa located in California, is the perfect representation of her creativity and exploration of the design principles.After a long and successful career under her belt, Greiman continues her great vision of design with the interaction in a diversity of environments. As an important and well known designer, Greiman has the experience of working for important institutions such as the US Postal service, Aol/Time Warner in addition to Microsoft. The support and respect from such important companies and her development as a successful and more knowledgeable artist is what keeps her passion for design strong and strengthens her position as a pioneer in the graphic design world.

Was All The President s Men By Carl Bernstein And Bob...

The book I chose to do my book review on was All The President s Men by Carl Bernstein and Bob Woodward and throughout the report I will discuss the power that the press has. On June 17, 1972, the United States had changed for both journalism and politics. A common break in was failed as the downfall of President Richard Nixon was eminent, while two young journalists from the Washington Post Carl Bernstein and Bob Woodward had risen to their glory of the biggest reporting story of their careers. The Watergate Scandal was sought out as one of the biggest political scandals during the Presidency of Nixon. Nixon at the time was going up for reelection was paranoid and afraid of losing the race to Senator George McGovern, at the time Nixon had employed a group of men to commit an arrangement of illegal activities that would put the republican party ahead of the democrats in order to gain a second term as president. Everything was all fine and dandy until the botched attempt to break int o the Watergate building which housed the Democratic National Committee. Throughout these allegations and corruptness of the republican party Bob Woodward and Carl Bernstein had exposed the truth of forty three people that were tied to the actions of the Watergate scandal, which later had let to their arrest. While Woodward and Bernstein had uncovered the truth of this scandal some question the methods that they had to go through to come to a conclusion. Was what they have done ethical andShow MoreRelatedAll The President s Men By Bob Woodward And Carl Bernstein1003 Words   |  5 PagesAll The President s Men by Bob Woodward and Carl Bernstein tells the story behind the Watergate scandal. It all started with a burglary at the Democratic headquarters, but proved to be something much more complex. This story tells how two reporters worked with sources to uncover deceit in the highest levels of government. On June 17, 1972, Woodward was asked to cover a story for his job at the Washington Post. There had been a burglary at the Watergate hotel. When he arrived at the newsroom, heRead More All the Presidents Men Essay example854 Words   |  4 PagesAll the Presidents Men The movie â€Å"All the Presidents Men† (1976), is based on the work of Bob Woodward and Carl Bernstein two Washington Post newspaper writers, who uncovered the cover-up of the White Houses involvement in the Democratic Party National headquarters, Watergate, break-in. At first, Bob Woodward discovers what seems to be a minor break-in but is surprised to find that top lawyers were already on the defense case. He also discovers that names and addresses of Republican fundRead MoreAll The President s Men1140 Words   |  5 PagesAll the President s Men can be seen as an historical document describing journalism during the 70’s. Along with this, we learn how paranoia affects individuals and the publishing process. 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Vincent Canby, a reviewer for the New York Times called the movie, â€Å"an unequivocal smash-hit—the thinking man’s Jaws.† Because the film is written from the perspective of Bob Woodward and Carl Bernstein, the movie works as a blockbuster, and not just a documentary. The script was written in such a way