MULTILAYER FEEDFORWARD NETWORKS WITH NON-POLYNOMIAL ACTIVATION FUNCTIONS CAN APPROXIMATE ANY FUNCTION

Several researchers characterized the activation functions under which multilayer feedforward networks can act as universal approximators. We show that all the characterizations that were reported thus far in the literature ark special cases of the following general result: a standard multilayer feedforward network can approximate any continuous function to any degree of accuracy if and only if the network's activation functions are not polynomial. We also emphasize the important role of the threshold, asserting that without it the last theorem doesn't hold.Information Systems Working Papers Serie

ROI Assessment on Using Information Technology in the Course of Admission Decisions in Myocardial Infarction Diagnosis

The healthcare sector has been investing heavily in health information technologies (HIT), with the aim of improvingdecision-making through improved medical processes, reduced costs and integration of medical data. However, the overallcontribution of HIT to the medical field is not obvious, especially, in high-stress environments such as the emergencydepartment (ED). The objective of this research is to explore whether investing in HIT in an ED is rewarding in evaluatingacute myocardial infarction diagnosis in EDs.We evaluated the overall profitability of certain integrative medical IS in a cost-effectiveness analysis using an experimentalstudy in the course of diagnosing an acute myocardial infarction. The results in the paper show that our specific medicalcases received a clear cost-effective reading since the results (ΔCosts/ΔQuality) were lower than the range of all commonthreshold values. Furthermore, the use of HIT in the ED also improved the quality of the medical care

A RETURN ON INVESTMENT ANALYSIS OF USING HEALTH INFORMATION TECHNOLOGY IN THE COURSE OF ADMISSION DECISIONS

In light of the ever-growing importance and usability of medical information systems (IS), the healthcare sector has been investing heavily in these technologies in recent years, with the aim of improving decision-making through improved medical processes, reduced costs and integration of medical data. However, these systems are extremely costly. In addition, the overall contribution of these technologies to the medical field is not obvious, especially, in high-stress environments such as emergency departments (EDs). The objective of this research is to explore whether investing in health information technology (HIT) in an ED is financially rewarding in general, and specifically the circumstances under which such an investment is more rewarding and vice versa. A cost-effectiveness analysis served as the selected tool for return on investment (ROI) estimations of certain integrative medical IS that serves seven main hospitals in Israel. We evaluated the overall profitability of this medical IS, by balancing the quality gained from information (retrieved from medical IS) against the costs of providing this information. The results of the cost-effectiveness analysis show that our specific medical cases of chest pain received a clear cost-effective reading since the results (ΔQuality/ΔCosts) were lower than the range of all common threshold values. Furthermore, the use of HIT in the ED improved the quality units per patient for each chosen admission decisions The findings of this study may also contribute to policy makers in the healthcare sector regarding the advisability of investing in such systems

Normative Value of Information for Decision-Making in the Healthcare Environment

With their ever-growing importance and usability, the healthcare sector has been investing heavily in medical information systems (IS) in recent years, as part of the effort to improve medical decision-making and increase its efficiency. This research aims to evaluate the contribution of information technology (IT) to improving the medical decision-making processes and to evaluate the degree to which IT investments are worthwhile. The method included the assessment of normative value of information. A decision tree model was developed. The calculated tree results were summarized in a cost-effectiveness analysis and a return on investment (ROI) analysis. This research aim to contribute: Researchers - by providing insights regarding decision theory, value of information and medical informatics; Practitioners - by promoting the design of medical IS; Physicians - by enhancing efficient use of information resources; Patients - by improving healthcare services; Policy decision-makers - regarding the advisability of investing and managing medical IS

The Contribution of Information Technology to Emergency Medicine

Information systems have been adopted in many fields including the healthcare industry. Indeed, keeping abreast of theadvances of the technological age, many medical organizations have invested heavily in information technologies (IT),aiming at improving medical decision-making and increasing its efficiency. Despite their advantages, information systems donot always provide the vital medical information required for medical decision-making, and the decisions may result in adecreased level of quality of care and unnecessary costs.The objective of this research is to evaluate the contribution of IT to decision-makers (physicians) at the point of care ofemergency departments (EDs). We evaluate the contribution of the medical information to medical decisions by using twomethods: the track log-file analysis and an experimental study. Our results lead to the major conclusion that using ITcontributes to increasing the proportion of correct admission decisions

THE IMPACT OF INFORMATION TECHNOLOGY ON ADMISSION DECISIONS

Information systems have been adopted in many fields, no less so in the health industry. Indeed, keeping abreast of the advances of the technological age, many medical organizations have invested heavily in information technologies (IT), aiming at improving medical decision-making and increasing its efficiency. Despite their obvious advantages, the systems do not always immediately provide the vital medical information required for critical decision-making, and the decisions that are based on this partial information may result in a decreased level of quality of care and unnecessary costs. The objective of this research is to evaluate the contribution of IT to decision-makers (physicians) at the point of care of emergency departments (EDs) by investigating whether the information systems (IS) have improved the medical outcomes, in the complex and highly stressful environment of the ED, with time constraints and overcrowding. We evaluated the contribution of the medical information to admission decisions by using two research methods: the track log-file analysis (with statistical tools) and an experimental study. The results were obtained using a unique database containing 3,219,910 referrals to the ED on seven main hospitals in Israel. Our results lead to the major conclusion that viewing medical history contributes to many clinical and admission decisions and clearly reduces the number of avoidable admissions

ADOPTION OF ELECTRONIC HEALTH RECORDS SYSTEM: DIFFERENTIATING MAIN ASSOCIATIONS

Health organizations are implementing health information technologies such as electronic health records (EHR), information systems (IS), and health information exchange (HIE) networks to improve decision-making. However, over the years, the healthcare environment has demonstrated numerous unsuccessful implementations of such technologies. One of the reasons is that physicians tend not to make use of these technologies in the healthcare environment. The various explanations put forward typically refer to patient, physician, and/or work environment-related factors. \ \ This study evaluated the factors associated with the EHR use among physicians in the complex environment of emergency departments. \ \ We used log-files retrieved from an integrative and interoperable EHR that serves Israeli hospitals. We found that EHR was primarily consulted for patients presenting with internal diagnoses, patients of older age, and it was used more by internists than by surgical specialists. Furthermore, EHR usage was larger for admitted patients than for those discharged. \ \ The findings show factors associated with EHR use and suggest that it is mostly related to case-specific features and to physician specialty. The findings strongly suggest that when planning assimilation projects for EHR systems and HIE networks, attention should be paid to those factors associated with system usage. Specifically, in order to increase the efficiency of the system, and enhance its use in the ED environment, physicians´ preferences and practice-related needs need to be taken into account. Furthermore, well-thought IT design and implementation are necessary to generate an increase in meaningful use of HIT, which can serve both physicians´ and patients´ needs

The Influence of EHR Components on Admission Decisions

Medical organizations are implementing electronic health record (EHR) systems in order to improve medical decision-making. The goal of this study was to characterize the specific data components that improve the process of medical decision-making in an emergency department (ED). The outcome measures were the decision to admit/discharge a patient, and differences in single-day admission rates with/without EHR IS. A database containing 3.2 million ED referrals from seven main Israeli hospitals was subjected to log file analysis. We found that viewing medical history via the EHR IS significantly affects admission decisions. The data show a reduction in the number of avoidable single-day admissions but an increase in the rate of prolonged admissions. Previous admissions, laboratory tests, imaging and previous surgeries were the most influential information components

Improving Medical Decision-Making Using Electronic Health Record Systems

This paper evaluates the contribution of an electronic health records (EHR) system to efficient decision-making by physicians, and investigates whether these systems lead to more efficient medical care in emergency departments (ED). Log-files of patient visits and admissions were retrieved from an integrative EHR system that serves seven main hospitals owned by a large health maintenance organization (HMO). This study focused on readmissions within seven days and single-day admissions, problems that concern hospitals around the world. The findings indicate that using an EHR system in the EDs correlates with a decreased number of readmissions within seven days as well as with a reduced number of single-day admissions. The results provide evidence that using EHR system may contribute to efficiency in an ED by assisting decision-making. We believe this is the first data set that investigates the impact of an EHR on hospital efficiency at the scale of HMO

Gram-Negative Bacteremia upon Hospital Admission: When Should Pseudomonas aeruginosa Be Suspected?

Background. Pseudomonas aeruginosa is an uncommon cause of community-acquired bacteremia among patients without severe immunodeficiency. Because tension exists between the need to limit unnecessary use of anti-pseudomonal agents and the need to avoid a delay in appropriate therapy, clinicians require better guidance regarding when to cover empirically for P. aeruginosa. We sought to determine the occurrence of and construct a model to predict P. aeruginosa bacteremia upon hospital admission. Methods. A retrospective study was conducted in 4 tertiary care hospitals. Microbiology databases were searched to find all episodes of bacteremia caused by gram-negative rods (GNRs) ⩽48 h after hospital admission. Patient data were extracted from the medical records of 151 patients with P. aeruginosa bacteremia and of 152 randomly selected patients with bacteremia due to Enterobacteriaceae. Discriminative parameters were identified using logistic regression, and the probabilities of having P. aeruginosa bacteremia were calculated. Results. P. aeruginosa caused 6.8% of 4114 unique patient episodes of GNR bacteremia upon hospital admission (incidence ratio, 5 cases per 10,000 hospital admissions). Independent predictors of P. aeruginosa bacteremia were severe immunodeficiency, age >90 years, receipt of antimicrobial therapy within past 30 days, and presence of a central venous catheter or a urinary device. Among 250 patients without severe immunodeficiency, if no predictor variables existed, the likelihood of having P. aeruginosa bacteremia was 1:42. If ⩾2 predictors existed, the risk increased to nearly 1:3. Conclusions. P. aeruginosa bacteremia upon hospital admission in patients without severe immunodeficiency is rare. Among immunocompetent patients with suspected GNR bacteremia who have ⩾2 predictors, empirical anti-pseudomonal treatment is warrante