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Summary: Objectives: In Austria, the general practitioner (GP) is the first point of contact for persons with health problems. Depending on the severity of the person''s medical condition, a GP may refer her or him to a secondary care hospital consultant, who reports findings back to the GP in form of a paper-based discharge letter. Researchers report that paper-based communication of medical documents between different health care providers is insufficient in quality, error prone and too slow in many cases. Our aim was to develop and to realise a strategy for a stepwise replacement of the paper-based transmission of medical documents with a distributed, shared medical record. Methods: In the first step of a three-steps strategy for development of a consistent, comprehensive and secure regional health care network, an electronic communication of discharge letters and diagnostic results between existing information systems of different health care providers in Tyrol, Austria, has been established: in the form of cryptographically signed S/MIME e-mail messages and, additionally, via a secure web portal system. In two further steps, an extension of the system by a bi-directional communication and by improvements of the web portal system is planned, leading to a comprehensive electronic patient record for shared care. Results: After realisation of step 1, in October 2004, about 3500 electronic discharge letters were sent out from the Innsbruck University Hospital (IUH), which represents about 8% of the total number of discharge letters of the IUH. In addition, a lot of feedback was received and legal, organisational, financial and methodical difficulties were overcome. Discussion: The stepwise approach to replace paper-based with electronic communication in the first step was helpful, since knowledge has been gained and cooperations were formed. For the realisation of a distributed, shared medical record (steps 2 and 3), it will not be sufficient only to replace paper-based transmission of medical documents with electronic communication technologies, but in the further steps, organisational changes will become necessary. As well, legal ambiguities must be resolved before a distributed medical record for cooperative care, used by several institutions as well as by patients, could be established. [Copyright &y& Elsevier]

Objectives: Emergency medical services have been established in many countries all over the world. Good first care improves the outcome of patients in terms of hospital stay duration, chances of full recovery and of treatment costs. In this paper, we present an integrated approach combining spatial information and integer optimization for emergency medical service location planning. The research is motivated by a recent call for bids to restructure the location of emergency medical services in the Austrian federal state of Lower Austria by the local state government.Methods: Our framework allows for constraints on the places where an emergency care physician is stationed, accounting for the fact that - for economical reasons - it might not be feasible to arbitrarily place emergency care physicians. We use maximum coverage linear programs to get accurate solutions for the problem instances (depending on the maximum allowed number of emergency care physicians and the constraints of their placement). We optimize for the maximum number of covered residents given certain parameters. The travelling distances are calculated by means of a digital road graph. Moreover we analyze the coverage of the day population as there are significant shifts in the number of persons present at daytime. For every problem instance we have calculated the ten best solutions and examined the variance among them. For the demand point aggregation we have used a cell grid.Results: Using our method we can show that with less emergency care physicians more residents can be covered. This is highly applicable to low populated areas where the coverage becomes better. There is little variance from the best to the second best solution: There are only small changes (usually only one cell is shifted) between the best and the second best solution. The coverage of the day population - except for a few problem instances - is always better than the coverage of the residents (reflecting the fact that many residents commute to more densely populated areas).Conclusions: In our study, we show that our solutions provide better coverage of residents with fewer emergency care physicians than the current status quo. [ABSTRACT FROM AUTHOR]

Abstract: Background: Acceptance by citizens seems to be crucial for the future success of an electronic health record (EHR) in Germany and Austria. We analyzed citizens’ knowledge and expectations about the concept and contents of an EHR. We also addressed possible fears and barriers, and we investigated desired EHR functionalities relevant to citizens in the Austrian and German population. Methods: Standardized interviews of a convenience sample of 203 Austrian and 293 German citizens recruited in two metropolises. Results: Up to three-quarter of the interviewed citizens already collect and store medical documents at home, mostly in paper-based form. No respondents had already used an Internet-based personal health record. Between 80% and 90% of respondents were supportive of the idea of an electronic exchange of health-related data between health care providers as core functionality of an EHR. However, many respondents formulated concerns with regard to data protection and data security within an EHR. The EHR functionalities most supported by respondents included the electronic vaccination record, online information on doctors and hospitals, and the administration of appointments and reminders. Conclusion: The results indicate a generally positive attitude towards the EHR. However, the study shows that data protection is an issue for many citizens, and that despite strong media discussion, there are information deficits with regard to the national EHR initiatives. [Copyright &y& Elsevier]

Objectives: Hospital information systems (HIS) are a substantial quality and cost factor for hospitals. Systematic monitoring of HIS quality is an important task; however, this task is often seen to be insufficiently supported. To support systematic HIS monitoring, we developed HIS-Monitor, comprising about 107 questions, focusing on how a hospital information system does efficiently support clinical and administrative tasks., Methods: The structure of HIS-Monitor consists of a matrix, crossing HIS quality criteria on one axis with a list of process steps within patient care on the other axis. HIS-Monitor was developed based on several pretests and was now tested in a larger feasibility study with 102 participants., Results: HIS-Monitor intends to describe strengths and weaknesses of information processing in a hospital. Results of the feasibility study show that HIS-Monitor was able to highlight certain HIS problems such as insufficiently supported cross-departmental communication, legibility of drug orders and other paper-based documents, and overall time needed for documentation. We discuss feasibility of HIS-Monitor and the reliability and validity of the results., Conclusions: Further refinement and more formal validation of HIS-Monitor are planned.

The Steiermärkische Krankenanstaltenges. m.b.H (KAGes) is a company, owned by the province of Styria in Austria, which operates 21 hospitals with about 8000 beds and 14000 employees, serving a population of ca. 1.2 million people. KAGes has purchased a new hospital information system (HIS) for its hospitals. Within the strategic IT plan and the 'system structure new' (SSN) project, a methodology was developed for making an effective HIS purchase. Several steps of this project are described in the paper, request for product information, evaluation of vendor proposals, product presentations, test site evaluation, reference site visits and selection of vendor finalists. The authors present the internal project management methodology, including the structure of the project team, project information management through intranet, criteria for different steps of the evaluation and evaluation site organization. Four major HIS vendors with leading HIS products qualified for this stage of the project (evaluation site). About 60 teams with 400 members (end users and IT-experts) have assessed all the products installed, during one or more, repeated test sessions. The decision on which new HIS to purchase were based on the recommendations derived from this evaluation. After completing SSN-project with the suggestion to KAGes-top-management for negotiations with two vendor finalists, the new project named MEDOCS was started mid-1999. Two pilot installations (one general hospital and one teaching hospital department) are nowadays in the pilot implementation and subsequent roll-out (including substitution of the legacy system) is scheduled until the year 2003.