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Wireless networking can be a very complex science, requiring an understanding of physics and the electromagnetic spectrum. While the radio theory behind the technology can be challenging, a basic understanding of wireless networking can be sufficient for small-scale deployment. Numerous security mechanisms are available to wireless technologies, making it practical, scalable, and affordable for healthcare organizations. The decision on the selected security model should take into account the needs for additional server hardware and administrative costs. Where wide area network connections exist between cooperative organizations, deployment of a distributed security model can be considered to reduce administrative overhead. The wireless approach chosen should be dynamic and concentrate on the organization's specific environmental needs. Aspects of organizational mission, operations, service level, and budget allotment as well as an organization's risk tolerance are all part of the balance in the decision to deploy wireless technology.

German hospitals and surgical clinics/departments are facing far-reaching changes. One triggering factor is the imminent reorganization of hospital financing to a system of compensation, which is universally based on diagnosis-related groups (DRGs) and entails a market-economy orientation in the hospital sector. Digital technologies, which facilitate making the necessary adjustments to clinic structures to meet forthcoming challenges, represent another element. The "digital transformation" of the hospital of the future takes place on three levels. The restructuring of the surgical realm runs rather a traditional course by increasing use of information technology, mostly to optimize documentation and existing procedures or to reduce costs. The second sphere reaches substantially further, encompassing reorganization of disease-oriented cooperation between the different medical specialties and enabling the establishment of suitably structured disease-oriented medical centers. This is followed by the third phase, which involves networking clinics or medical centers with private practitioners, aftercare and rehabilitation services, and other disease-oriented care providers.

HIPAA's administrative simplification rule was introduced to reduce the costs of handling provider-payer transactions by standardizing them. The transaction rules are predicted to save billions of dollars. To get the biggest payoff, providers will need to overhaul their business processes as part of electronic transaction processing. By eliminating redundant and inefficient administrative processes, staff time can be focused on processes that improve financial performance and customer satisfaction. If your organization needs to have an extension beyond the original compliance date, you must file a plan before Oct. 16 to show how you'll come into compliance by Oct. 16, 2003. Check the roadmap and timetable for HIPAA compliance and see where your organization is and where it needs to be.

Along with tight reimbursement and confounding regulations, any list of big headaches for health care leaders includes information technology. We've been promised so much from IT for so long, and have been disappointed so many times, who can blame us for being skeptical, if not downright cynical? When is the last time an investment in information technology actually improved your bottom line? But we know we can't dismiss IT altogether. At the end of the rainbow there really is efficiency, security and better care for patients. So how close are we? In this issue, H&HN takes a hard look at technology--what it can do for us today and tomorrow. We look at return on investment, examining whether hospitals are measuring what they get back against what they put in; a budding effort to bring a common platform to health care IT; handheld computers; electronic medical records; and computerized physician order entry. The technology is out there, but it's fair to ask: is it really clicking yet?

Unlabelled: Mount Clemens General Hospsital, Mount Clemens, Mich., Problem: performance anomalies due to multiple interfaces with separate systems., Solution: implementation of an interface engine., Results: improved management of data exchange among disparate systems., Keys to Success: up-front studies of vendor offerings, potential problems, and long-term needs.

Five years into a manic pace of consolidation, hospital-based health delivery systems across the country are feeling the pressure to establish computer networks to unite all sites and services. In the campaign to lift healthcare out of an era of paper and pencil, organizations have spent freely on healthcare software applications. But computer pros say that's not enough.

A computerized system for radioisotope management and real time inventory coordinated across a large organization is reported. It handles hundreds of individual users and their separate inventory records. Use of highly efficient computer network and database technologies makes it possible to accept, maintain, and furnish all records related to receipt, usage, and disposal of the radioactive materials for the users separately and collectively. The system's central processor is an HP-9000/800 G60 RISC server and users from across the organization use their personal computers to login to this server using the TCP/IP networking protocol, which makes distributed use of the system possible. Radioisotope decay is automatically calculated by the program, so that it can make the up-to-date radioisotope inventory data of an entire institution available immediately. The system is specifically designed to allow use by large numbers of users (about 300) and accommodates high volumes of data input and retrieval without compromising simplicity and accuracy. Overall, it is an example of a true multi-user, on-line, relational database information system that makes the functioning of a radiation safety department efficient.

The Washington Heights-Inwood Community Health Management Information System (WHICHIS) at the Columbia-Presbyterian Medical Center (CPMC) provides 15 community physician practices with seamless networking to the CPMC Wide-Area Network. The costs and benefits of the project were evaluated. Installation costs, including hardware, office management software, cabling, network routers, ISDN connection and personnel time, averaged $22,902 per office. Maintenance and support costs averaged $6,293 per office per year. These costs represent a "best-case" scenario after a several year learning curve. Participating physicians were interviewed to assess the impact of the project. Access to the CPMC Clinical Information System (CIS) was used by 87%. Other resource usage was: non-CPMC Web-based resources, 80%; computer billing, 73%; Medline and drug information databases, 67%; and, electronic mail, 60%. The most valued feature of the system was access to the CPMC CIS. The second most important was the automatic connection provided by routed ISDN. Frequency of access to the CIS averaged 6.67 days/month. Physicians reported that the system had significantly improved their practice of medicine. We are currently exploring less expensive options to provide this functionality.

Once you have a vision and strategy for the future, an information system will probably be your biggest and most important investment. Information systems that can track clinical data are critical to providing employers with the data they're demanding and doctors with the data they need. See how and why Sentara Health System developed the Sentara Physician Information System (SPIN).

The common situation in a hospital with multiple departments is a heterogeneous set of subsystems, one or more for each department. Today, we have a rising number of requests for an information interchange between these independent systems. The exchange of patients data has a technical and a conceptional part. Establishing a connection between more than two subsystems requires links from one system to all the others, each of them with its own code translation, interface and message transfer. A communication server is an important tool for significantly reducing the amount of work for the technical realisation. It reduces the number of interfaces, facilitates the definition, maintenance and documentation of the message structure and translation tables and helps to keep control on the message pipelines. Existing interfaces can be adapted for similar purposes. Anyway, a communication server needs a lot of configuration and it is necessary to know about low-level internetworking on different hard- and software to take advantage of its features. The code for writing files on a remote system and for process communication via TCP/IP sockets or similar techniques has to be written specifically for each communication task. There are first experiences in the university school of medicine in Mainz setting up a communication server to connect different departments. We also made a checklist for the selection of such a product.

Six Iowa hospitals that don't have a common owner are banding together to form a health information network using a software system that they couldn't have afforded individually. The network will provide easy access to electronic records throughout a broad, rural area.

At any node on the network implementation timeline, whether in the first planning stages or after the bottom-line benefits are stacking up, networking is a compelling idea. So compelling, with flexibility, cost-cutting results and strengthened community resources, that it extends its influence into the future of the organizations it serves. Two institutions, University Hospital in Denver and the Medical Center of Delaware in Wilmington, Del., illustrate networking's tempting benefits. University Hospital disabled its mainframe, switching to an Ungermann-Bass Access One smart hub in January of this year. Their systems are added to the network one-at-a-time, with plans for complete integration once everything is working online. In contrast, the Medical Center of Delaware shifted to networking in 1987, following a five-year implementation plan. The completed, integrated network is now a strategic tool for containing costs an MCD.

Innovative methods of providing workplace education for health care professionals may be a key to the survival of rural hospitals in America. Such methods must overcome time, distance, cost and organizational constraints, and take into account the structure of the learning experience. The Texas Hospital Education and Research Foundation has recently been involved in two programs that tested new approaches to worker education using distance-learning strategies. The projects--resource sharing among rural directors of nursing and training for cancer tumor registrars--used computer-conferencing technology. A new model using existing satellite, audio-conferencing, and computer-based instruction augmented by computer conferencing is proposed. The Computer-Related Assisted Distance Learning Enhancement (CRADLE) model integrates existing technologies to provide education to health care workers at their desktop. The Cancer Learning Center (CLC) tested peer collaboration, the primary component of the model. The ultimate goal is to have the system available to all tumor registrars in Texas, and to secure funding to implement rural nursing and rural high-school health occupations education projects. Current projects from set-up through results are presented.

In this paper the results of the standardization efforts and an evaluation study concerning electronic data interchange (EDI) performed by the 31 (Inter Institutional Information exchange)-project are described. In an earlier paper the results of a preliminary study were reported. EDI concerns communication between autonomous information systems and therefore needs standardization of the messages to be exchanged. In the 31-project ten different types of standard messages have been defined. The use of these messages for exchanging information between hospitals, GPs and pharmacies is described. It is concluded that relatively large time savings can be obtained when communicating electronically. It is also concluded that the electronic data interchange between hospitals and GPs can be performed without additional costs. The electronic communication of prescriptions between GPs and pharmacies does raise the costs of communication at the moment. The impact of EDI on the functioning of people in the organizations involved varies widely.

The Regional Medical Center at Memphis--the oldest hospital in Tennessee--acknowledged that information technology is a critical key to the pursuit of medical and managerial excellence. By outsourcing much of the center's computing and telecommunications needs, the MED's CEO, Lucy Shaw, feels she has maximized information technology benefits to her institution with maximum cost control.