A Filmless Radiology Department in a Full Digital Regional Hospital: Quantitative Evaluation of the Increased Quality and Efficiency

Reggio Emilia hospital installed Picture Archiving and Communications Systems (PACS) as the final step towards a completely digital clinical environment completing the HIS/EMR and 1,400 web/terminals for patient information access. Financial benefits throughout the hospital were assessed upfront and measured periodically. Key indicators (radiology exam turnaround time, number of radiology procedures performed, inpatients length of stay before and after the PACS implementation, etc.) were analyzed and values were statistically tested to assess workflow and productivity improvements. The hospital went “filmless” in 28 weeks. Between the half of 2004 and the respective period in 2003, overall Radiology Department productivity increased by 12%, TAT improved by more than 60%. Timelier patient care resulted in decreased lengths of stay. Neurology alone experienced a 12% improvement in average patient stay. To quantify the impact of PACS on the average hospital stays and the expected productivity benefits to inpatient productivity were used a “high level” and a “detailed” business model. Annual financial upsides have exceeded $1.9 millions/year. A well-planned PACS deployment simplifies imaging workflow and improves patient care throughout the hospital while delivering substantial financial benefits. Staff buy-in was the key in this process and on-going training and process monitoring are a must

Reducing attendances and waits in emergency departments : a systematic review of present innovations

Reducing the waits in emergency departments is important for patients and is a government priority. In order to reduce waits the whole system must be considered. The flow of patients before arrival at the emergency department determines the workload of the department. The staffing, resources and systems within the emergency department are key to providing high quality timely care. The flow of patients after leaving the emergency department until their return home will determine whether they can be discharged from the department in a timely manner. Despite the present focus on emergency care in the NHS there have been no reviews of the literature to inform the present changes to reduce waits

Supply chain thinking in healthcare: lessons and outlooks

Problem definition: The lessons learned over decades of supply chain management provide an opportunity for stakeholders in complex systems, such as healthcare, to understand, evaluate, and improve their complicated and often inefficient ecosystems. Methodology: We provide a primer on supply chain thinking in healthcare, with a focus on healthcare delivery, by following a framework that is customer-focused, systems-based, and strategically orientated, and that simultaneously considers clinical, operational, and financial dimensions. Our goal is to offer an understanding of how concepts and strategies in supply chain management can be applied and tailored to healthcare by considering the sector's unique challenges and opportunities. Results: After identifying key healthcare stakeholders and their interactions, we discuss the main challenges facing healthcare services from a supply chain perspective and provide examples of how various supply chain strategies are being and can be used in healthcare. Academic/practical relevance: The complexity in managing healthcare supply chains offers opportunities for important and impactful research avenues in key supply chain management areas such as coordination and integration (e.g., new care models), mass customization (e.g., the rise in precision medicine), and incentives (e.g., emerging reimbursement schemes), which might, in turn, provide insights relevant to traditional supply chains. We also put forward new perspectives for practice and possible research directions for the supply chain management community. Managerial implications: By using supply chain thinking, healthcare organizations can decrease costs and improve the quality of care by uncovering, quantifying, and addressing inefficiencies

3rd EGEE User Forum

We have organized this book in a sequence of chapters, each chapter associated with an application or technical theme introduced by an overview of the contents, and a summary of the main conclusions coming from the Forum for the chapter topic. The first chapter gathers all the plenary session keynote addresses, and following this there is a sequence of chapters covering the application flavoured sessions. These are followed by chapters with the flavour of Computer Science and Grid Technology. The final chapter covers the important number of practical demonstrations and posters exhibited at the Forum. Much of the work presented has a direct link to specific areas of Science, and so we have created a Science Index, presented below. In addition, at the end of this book, we provide a complete list of the institutes and countries involved in the User Forum

The acceptance of telemedicine technology among medical doctors in Finland

Historically, healthcare has been seen as a slow adopter of new technology. Telemedicine services and its related technologies currently face significant changes and rapid expansion, partly due to the Covid-19 pandemic. It is generally accepted that the success of any new technology relies to a great extent on users’ satisfaction and satisfied medical doctors are therefore one of the key objectives of telemedicine service success. This quantitative study aims to determine which factors predict the adoption of telemedicine technology among medical doctors in Finland. It applies the telemedicine service acceptance model (TSA) which is based on the technology acceptance model (TAM) and has been previously validated in South Korea. In addition, this study evaluates the effects of Covid-19 pandemic on the medical doctors’ attitude towards telemedicine services. To test the hypotheses of the TSA model, an online survey was distributed to medical doctors in Finland. Non-probabilistic “snowballing” sampling technique was used and resulted in 185 responses. Structural equation modeling was applied to evaluate the causal relationships within the model. The results confirm the original TAM constructs: perceived ease of use & perceived usefulness are strong predictors of medical doctors’ behavioral intention to adopt telemedicine technology, and perceived ease of use is a predictor of perceived usefulness. Of the new predictive constructs in the TSA model, self-efficacy and accessibility of medical records were predictors of perceived ease of use, whereas accessibility of patients was a predictor of perceived usefulness. Perceived incentives were not found to be important concerning the intention to use telemedicine technology. Also, having had experience with telemedicine either before or during the Covid-19 pandemic and if the attitude towards telemedicine services had improved during the Covid-19 pandemic, they both predicted a higher behavioral intention to use telemedicine services in the future. This study contributes to the theoretical knowledge of technology acceptance by identifying important factors increasing the medical doctors’ acceptance of telemedicine technology. The results also indicate that the adoption of telemedicine services is likely to further accelerate due to the Covid-19 pandemic.Historiallisesti terveydenhuoltoalaa on pidetty hitaana uuden teknologian omaksujana. Etälääketieteen palvelut ja siihen liittyvä teknologia kokevat tällä hetkellä paljon muutoksia ja nopeaa kasvua, osittain Covid-19-pandemiasta johtuen. On yleisesti tunnustettu, että minkä tahansa uuden teknologian menestys riippuu paljolti käyttäjien tyytyväisyydestä ja tyytyväiset lääkärit ovatkin etälääketieteen palveluiden onnistumisen kannalta avainasemassa. Tässä kvantitatiivisessa tutkimuksessa määritetään, mitkä tekijät ennakoivat etälääketieteen teknologian omaksumista lääkäreiden keskuudessa Suomessa. Tutkimuksessa käytetään etälääketieteen palveluiden omaksumismallia (TSA; telemedicine service acceptance), joka perustuu teknologian omaksumismalliin (TAM; technology acceptance model) ja on aikaisemmin validoitu Etelä-Koreassa. Lisäki tässä tutkimuksessa tarkastellaa Covid-19-pandemian vaikutuksia lääkäreiden asenteisiin etälääketieteen palveluita kohtaan. Etälääketieteen palveuiden omaksumismallin hypoteesien testaamista varten verkkopohjaista kyselyä jaettiin lääkäreille Suomessa. Ei todennäköisyysotantaan perustuvaa ”lumipallotekniikkaa” käytettiin vastausten keräämisessä, jonka seurauksena kyselyyn kertyi 185 vastausta. Rakenneyhtälömallia käytettiin tarkasteltaessa syy-yhetyksiä. Tulokset vahvistavat alkuperäisen teknologian omaksumismallin käsitteitä: koettu käyttöhelppous & koettu hyödyllisyys ennakoivat vahvasti lääkäreiden käyttöaikeita omaksua etälääketieteen teknologiaa sekä koettu käyttöhelppous ennakoi koettua hyödyllisyyttä. Etälääketieteen palveluiden omaksumismallin uusista ennakoivista käsitteistä minäpystyvyys ja pääsy potilasasiakirjoihin ennakoivat koettua käyttöhelppoutta, kun taas potilaiden saavutettavuus ennakoi koettua hyödyllisyyttä. Koettujen kannusteiden ei todeta olevan tärkeä tekijä ennakoimassa etälääketieteen teknologian käyttöä. Lisäksi aikaisempi kokemus etälääketieteestä joko ennen Covid-19-pandemiaa tai sen aikana sekä jos asenne etälääketiedettä kohtaan Covid-19-pandemian aikana oli parantunut ennakoivat molemmat korkeampaa etälääketieteen teknologian käyttöaikeita tulevaisuudessa. Tämä tutkimus edesauttaa teknologian käyttöönoton teoreettista ymmärryspohjaa tunnistamalla niitä tärkeitä tekijöitä, jotka lisäävät etälääketieteen teknologian omaksumista lääkäreiden keskuudessa. Tulokset osoittavat myös, että etälääketieteen palveluiden omaksuminen todennäköisesti kiihtyy entisestään Covid-19-pandemian johdosta

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

Quantifying, Understanding and Predicting Differences Between Planned and Delivered Dose to Organs at Risk in Head & Neck Cancer Patients Undergoing Radical Radiotherapy to Promote Intelligently Targeted Adaptive Radiotherapy

Introduction: Radical radiotherapy (RT) is an effective but toxic treatment for head and neck cancer (HNC). Contemporary radiotherapy techniques sculpt dose to target disease and avoid organs at risk (OARs), but anatomical change during treatment mean that the radiation dose delivered to the patient – delivered dose (DA), is different to that anticipated at planning – planned dose (DP). Modifying the RT plan during treatment – Adaptive Radiotherapy (ART) – could mitigate these risks by reducing dose to OARs. However, clinical data to guide patient selection for, and timing of ART, are for lacking. Methods: 337 patients with HNC were recruited to the Cancer Research UK VoxTox study. Demographic, disease and treatment data were collated, and both DP and DA to organs at risk (OARs) were computed from daily megavoltage CT image guidance scans, using an open-source deformable image registration package (Elastix). Toxicity data were prospectively collected. Relationships between DP, DA and late toxicities were investigated with univariate, and logistic regression normal tissue complication probability (NTCP) modelling approaches. A sub-study of VoxTox recruited 18 patients who had MRI scans before RT fractions 1, 6, 16, and 26. Changes in salivary gland volumes and relative apparent diffusion coefficient (ADC) values were measured and related to toxicity events. Results: Spinal cord dose differences were small, and not predicted by weight loss or shape change. Mean DA to all other OARs was higher than DP; factors predicting higher DA included primary disease site, concomitant therapy, shape change and advanced neck disease. Nine patients (3.7%) saw DA>DP by 2Gy to more than half of the OARs assessed. These patients all had received bilateral neck RT for N-stage 2b oropharyngeal cancer. Strong uni- and multivariate relationships between OAR dose and toxicity were seen. Differences between DA and DP-based dose-toxicity models were minimal, and not statistically significant. On MRI, both parotid and submandibular glands shrank during treatment, whilst relative ADC rose. Relationships with toxicity were inconclusive. Conclusions: Small differences between OAR DP and DA mean that DA-based toxicity prediction models confer negligible additional benefit at the population level. Factors such as primary disease sub-site, concomitant systemic therapy, staging and shape change may help to select the patients that do develop clinically significant dose differences, and would benefit most from ART for toxicity reduction