Blood pressure variability and cognitive function in older hypertensives.

Several studies have shown that cerebrovascular organ damage can related not only to average blood pressure (BP) levels, but also to BP variability. The aim of this study was to investigate the relationship between 24 hr BP variability and cognitive function in older hypertensives. Forty older, never treated hypertensives were submitted to 24 hr ambulatory BP monitoring (ABPM) and subdivided, according to the variability of the systolic BP (SBP), in two groups: 23 with higher (> PV) and 17 with lower (< PV) SBP variability, defined as the standard deviation (SD) of the mean 24 hr SBP values and as coefficient of variation (CV). They underwent a cognitive assessment by mini mental state examination (MMSE) and a recording of the brain event-related potentials (ERPs). ERPs record neuronal electric activity when the patients are submitted to frequent and rare acoustic stimuli and must recognize and count rare (target) stimuli. The two groups with statistically different 24 hr SBP variability, did not show significant differences in MMSE scores or in N2 and P300 ERP latencies, thus indicating a lack of difference in the cognitive ability between the two groups. Our results show that cognitive function is not related to 24 hr SBP variability in older hypertensives.

Circadian blood pressure pattern and cognitive function in newly diagnosed older hypertensives.

Hypertensive subjects can be subdivided in two groups, dippers and non-dippers, according to the presence or the lack of a nocturnal fall of blood pressure (BP) of over 10%. Several studies have investigated cardiovascular and cerebrovascular organ damage in the two groups with discordant results, but fewer of them analysed the relationship between circadian BP pattern and cognitive function, and none in the early phases of hypertension. To this purpose, we selected 40 older hypertensives, 23 dippers and 17 non-dippers, with newly diagnosed hypertension, never treated, who underwent to 24-h ambulatory BP monitoring (ABPM), Mini-Mental State Examination (MMSE) and recording of event-related potentials (ERPs). No significant differences between dippers and non-dippers were found in the MMSE scores and P300 latency values, as we expected, and not even in N2 wave latency values, showing that the non-dipping pattern is not associated with lower cognitive function in the early phases of hypertension.

Avoiding HIPAA hype: preparing for HIPAA affordably.

In the scramble to prepare their organizations for HIPAA compliance, healthcare financial managers may believe they must commit significant funds to overhauling information systems and hiring consulting firms. But security and confidentiality policies required by HIPAA cannot be implemented solely by upgrading computer systems. HIPAA compliance requires a wholesale change in staff attitudes and behavior regarding patient security and confidentiality. Healthcare organizations can prepare to comply with HIPAA regulations practically and affordably by combining in-house expertise with limited assistance from outside consulting firms. An added benefit of emphasizing the use of in-house resources to prepare the organization for HIPAA compliance is that the organization can develop and retain its own experts on HIPAA.

Event-related potentials in the elderly with new mild hypertension.

Hypertension is a risk factor for cerebrovascular diseases (CVD) and cognitive impairment and the relative risk of CVD at every level of blood pressure (BP) is greater among the elderly. We submitted 20 elderly affected by new mild hypertension and 10 elderly normotensives to 24-hour ambulatory BP monitoring (ABPM), to evaluate their cognitive state using the Mini-Mental-State-Examination and to the recording of related acoustic evoked potentials (P300 and N2). We did not find significant differences for P300 latency between hypertensives and normotensives, while N2 latency recording showed a statistically significant protracted value in elderly hypertensives. In these patients we found a significant correlation between the N2 latency and systolic blood pressure values recorded by ABPM. These results demonstrated early functional alterations of cognitive state in elderly hypertensives, that are related to systolic blood pressure and future data might point to an earlier use of therapy.

Information technology: doing more, spending less.

Few hospitals use their increasingly limited financial resources to successfully realize all the benefits of information technology (IT). Part of the problem in achieving success is that hospitals waste funds by, for example, allowing "temporary" consultants to become long-term, full-time fixtures in the IT department. Or the organizations create conditions for failure by overstaffing or understaffing their IT departments or opting to invest in pilot or beta technology of unproven worth. Healthcare finance executives need to scrutinize the IT expenditure requests they receive and evaluate the realistic return on investment. They also need to conduct audits of their IT contracts and invoices to ensure they are not paying unnecessary or invalid fees.

Year 2000 compliance starts in 1999 for financial systems.

Preparing for the potential year 2000 computer date problem should have begun long ago. Healthcare organizations should be well along in testing their information systems to ensure that both financial and clinical applications are year 2000 compliant. Some organizations may have started to experience problems, particularly with their financial systems. A noncompliant financial system that generates incorrect data without creating error messages or rejecting transactions poses particularly serious problems for providers.

Pitfalls to avoid when merging information systems.

When healthcare organizations merge, their goal often is to improve operational efficiencies, with information systems (IS) a common target for cost reduction. These cost reductions usually are achieved by reducing staff, consolidating data centers, establishing standardized systems, and sharing resources throughout the system. During this process, however, several common pitfalls can cause merging organizations to stumble. By carefully evaluating their options, merging organizations can avoid these potential traps and reduce their IS costs.

Is your healthcare information system physician friendly?

An organization's healthcare information system (HIS) can be used as a tool to improve relationships with its physicians by facilitating physician work processes and research. An effective HIS should provide census reports tailored to individual physician needs, allow physicians access to information via dedicated personal computers (PCs) or terminals, and should have features, such as screen design and graphical interfaces that are easy to understand and use. In addition, the HIS should provide comprehensive reports, have online ordering capability, and respond quickly to the needs of busy physicians. A good HIS also supports physician-related activities occurring outside the hospital. For example, physician office managers should be able to access billing information, such as patient demographics and procedure codes, contained in the HIS. And, physicians should be able to retrieve archived information from their offices or homes. Critical to physicians' successful use of an organization's HIS is administration's attitude and support. An organization that places a priority on physician issues and needs can make even a basic HIS an effective tool for its physicians, while a sophisticated HIS that does not address physician needs will not maximize return on the investment.

Selecting practice management information systems.

Despite enormous advances in information systems, the process by which most medical practices select them has remained virtually unchanged for decades: the request for proposal (RFP). Unfortunately, vendors have learned ways to minimize the value of RFP checklists to where purchasers now learn little about the system functionality. The authors describe a selection methodology that replaces the RFP with scored demos, reviews of vendor user manuals and mathematically structured reference checking. In a recent selection process at a major medical center, these techniques yielded greater user buy-in and favorable contract terms as well.

Selecting managed care information systems.

A decade ago, a handful of managed care information systems occupied a relatively minor niche in the healthcare information system industry. Today, dozens of small software development firms are experiencing explosive expansion and are being courted by larger vendors for partnership or acquisition. When selecting an information system capable of meeting the demands of managed care providers, financial managers should consider carefully the types of systems that are available, their price ranges, their modules, and the type of vendor selling the systems.

Applying TQM/CQI principles to information system selection.

Faced with the challenge of selecting a new information system, senior management at North Valley Hospital in Whitefish, Montana, decided to employ principles of total quality management and continuous quality improvement to help ensure an efficient process that involved and empowered those who would use the new system. Senior managers set a vision for the process, then assigned responsibility for system selection to a task force representing departments and disciplines that would be most affected by the system. The task force established a systematic process for identifying information system needs, evaluating existing products, and selecting among those products.

It's a jungle out there: strategies for controlling information systems costs.

This article discusses four major areas where healthcare financial managers can reconcile the conflicting goals their healthcare organizations face: keeping up with the latest in technology while at the same time constantly striving to reduce healthcare information systems costs.

Experts debate the future of healthcare computing--discussion.

Healthcare Financial Management engaged four healthcare information systems experts in a discussion about the future of computing and technology in the healthcare industry. The four experts agree that as the healthcare industry consolidates, managed care advances, and healthcare reform legislation continues to be debated, demands for increased connectivity and new applications will be met by new healthcare information systems products based on new technology.

HIS (healthcare information systems) consultants: when are they necessary, and why?

The rapid escalation of consulting fees for the installation of healthcare information systems and the potential abuses associated with consulting relationships has prompted some to question the need to hire consultants for systems installation. Consulting arrangements were considered cost effective when information systems were first being automated, but the rising cost of consulting services along with the increasing sophistication of hospital personnel regarding computerization suggest that the use of consultants receive close scrutiny. Following some simple guidelines may limit potential abuses and allow hospitals to obtain maximum service for their investment.

Countering advanced HIS marketing tactics.

An explosion of technological advances and system developments in the information systems industry pushes the envelope in both hardware and software design. Equipment breakthroughs--reduced instruction set computing chips, or RISC, and DEC's 64-bit Alpha chip--herald an exciting new era in price-performance computing. And object-oriented programming systems, or OOPS, and computer-assisted software engineering, or CASE tools, both promise a golden age in programming productivity. At the same time however, marketing mavens at healthcare information system, or HIS, vendors keep pace with their cohorts in Research and Development by blazing new trails in the science of sales and marketing. To help healthcare executives keep pace with new developments in selling, let's review a few infamous breakthroughs in marketing. They put a new twist on the old saw: "caveat emptor." Following each marketing "advance" are counters to new marketing tricks, each recommended to keep savvy CIOs a step ahead.