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The ability to successfully manage information technology-driven transformations of work processes into value--which has always been a critical requirement yet often a huge disappointment--is now becoming a main ingredient of success in all industries, including healthcare. This article prescribes management dimensions that healthcare leaders should focus on to improve their ability to manage and derive value from the re-invented work flow, especially the highly visible opportunities offered by e-commerce and the consumer movement.

The information technology revolution has transformed work from modest-paced serial processes to complex, fast-paced networked ones that depend not only on the technology but also on skilled and effective users of the technology. This evolution has woven a complex quilt of interdependencies among new information technologies, new users of those technologies, new skills required, new information management policies and procedures, and new opportunities. We must impose a new structure for managing the learning and work of new users, their tolerance of complexity and continuous learning, value-added usability, minimization of human error, and new support services for deployment, administration, and help.

The rate of diffusion of information technology varies among industries, as does its resultant added value. The different paces of work transformation are determined by the opportunities of the differing work processes, efficiency of exchange of workplace ideas, and relationships among constituencies. The differences raise the question of why the maturation process is accelerated (or restrained) in different industries, how the health care industry fares in comparison, and how information technology may be more effectively used as health care evolves toward new forms of work interaction, control mechanisms, and information technology management paradigms and as information processing moves toward higher levels of complexity.

Information is a dynamic, potentially high-value resource that institutions can use to achieve superior performance. The myriad of advanced information technology projects, however, delivers to the institution's clinical and business processes unpredictable deluges of information objects, both paper and electronic, that may add little value to the processes. Also, because the information arrival is often a trigger for work steps, its illogical arrival may actually dilute productivity and quality. The article describes an information distribution engine in use at a large hospital in the southwestern United States that allows remotely located recipients to define individualized rules for controlling the subset of diverse information that they receive, select its transmission and display media, and choreograph the sequence and timing of its arrival at their desktops.

As we providers of health care use information technology more comprehensively in the information-intensive and labor-intensive work of health care, we are finding that the quality of daily, on-the-spot support for use of that technology has become a critical success factor. And, since we use a great range of vendor products, the quality of vendor support is especially critical. This article describes our practical application of CQI indicators of vendor responsiveness and quality, and the vendor responses to this new strategy.

This article describes a CQI-driven effort to reengineer the tracking procedures for both inpatients and outpatients, refined to the extent that they have been identified as "best practices." The goal was to shift the work paradigm from a departmental focus to one that accepts work as a network of processes, but also to prepare for the new era of the electronic medical record, moving computer record keeping far closer to the point of care, requiring more precise recording of patient location.

Healthcare organizations can no longer accommodate the four-to-eight-year cycle for information software development. The senior VP of a large teaching hospital in Houston offers solid ways to shorten the cycle and be prepared to incorporate more rapid changes in technology.

This article describes practical applications of the Continuous Quality Improvement (CQI) concept applied to management of the Information Services Departments of a health care institution. The article is valuable for two reasons: (1) it is valuable as a successful application of CQI in an award-winning information services division of an award-winning health care institution, and (2) since the work of the information services function is so complex, has major interdependencies with many other functions throughout the entire organization, and is driven by fast-paced change, successful use in that function can be a model for other major functions of the hospital.

Constraints placed on the healthcare industry throughout the 1980s make long-term planning for information systems needs difficult and, at the same time, vital to an organization's survival. One hospital's model for information systems planning balances strong executive leadership with participation from groups inside and outside the hospital and incorporates an analysis of the information systems environment into the facility's annual planning cycle. The hospital's experience highlights several issues to be considered in an information systems plan.

Intrinsic tissue peroxidase activity can be more or less successfully destroyed by methanol-H2O2 treatment. It has been found, however, in our laboratory that horseradish peroxidase (HRP) coupled to antibody will bind to some tissue components on a nonspecific basis and remain to take part in the histochemical stain. This contributes considerably to the background. This difficulty can be largely overcome if the tissues are pretreated with a solution of horseradish peroxidase which binds with nonspecific tissue sites. The adsorbed enzyme, along with the intrinsic peroxidase, can then be successfully inactivated by methanol-H2O2 treatment. By this method of blocking, there is considerable reduction in background staining.

Horseradish peroxidase labeled antisera supplied commercially was used to evaluate B lymphocytes in peripheral blood. This technique not only gave comparable results to the conventional fluorescein method, but also proved to be more advantageous.

We describe the application of immunofixation staining of agarose-gel electrophoretograms in areas where its use in the clinical laboratory is appropriate. Immunofixation electrophoresis consists of an electrophoretic phase followed by a fixation phase in which antiserum is used to precipitate the protein. As long as the antibody is in slight excess or near equivalency, the antigen/antibody complex remains insoluble. The reaction can be detected by visual inspection in indirect light, by protein staining, or by use of antibodies labeled with fluorescein, enzyme, or isotope. In the method described here we primarily have used protein staining (Coomassie Blue) to accentuate the proteins fixed by antisera. All unreacted proteins are removed by pressing with filter paper and saline washing. In the clinical laboratory, this method expedites immunochemical evaluation of samples and may also supplement immunoelectrophoresis. It has been applied successfully in identifying small obscure monoclonal proteins in the serum and cerebrospinal fluid of patients with multiple sclerosis, subacute sclerosing panencephalitis, biclonal gammopathies, serum monoclonal light chains, and mobility shifts of certain proteins, particularly of the complement series. Immunofixation demonstrates that the protein bands present in spinal fluid from multiple sclerosis and subacute sclerosing panencephalitis patients are of the IgG class of immunoglobulins; and non-IgG protein, such as beta and gamma trace proteins, are not detected. We also comment on reverse immunofixation with labeled antigen as a branch of the procedure that allows detection of function of the immunoglobulins separated by electrophoresis.

Information systems are becoming of such strategic importance that planning for them must not be left to weak selection processes that executives are tempted to avoid diplomatically because of the difficulty and the internal friction that determined management might cause. Presented here is a methodology for planning the evolution of information systems.

As health care executives create and mold visions for the future of their institutions, they are discovering that one critical factor is that the vast potential power of information technology be skillfully implemented and managed. Past methods of managing what was at one time called data processing will no longer serve well in this new era. At The Methodist Hospital, innovative management methods have allowed us to bridge the gap from the information systems and management methods of the past. An excellent set of new management techniques has been used to engage project teams in the management of change. Information systems projects have been used successfully as catalysts for dramatic institutional growth and constructive change.

Opsoclonus-myoclonus (OM) is a neurological disorder usually occurring in infancy, clinically manifested by various involuntary movements. The pathogenesis of OM is unknown, but since the disease often is associated with viral infection or with neuroblastoma, an immunologic basis for OM has been postulated. We have studied two children with OM whose serum contained antibodies directed against the 210 kDa neurofilament protein; these antibodies were not seen in the serum of 21 children with other neurological disorders. Neurofilament proteins, which are found only in neurons, may be of prime importance in neuronal function, especially during development of the nervous system. Our findings suggest that generation of antibodies to the neurofilament proteins can occur in patients with opsoclonus-myoclonus; the role of the anti-NF210K antibodies in the pathogenesis of OM, however, is uncertain.