Smart Manufacturing.

Historic manufacturing enterprises based on vertically optimized companies, practices, market share, and competitiveness are giving way to enterprises that are responsive across an entire value chain to demand dynamic markets and customized product value adds; increased expectations for environmental sustainability, reduced energy usage, and zero incidents; and faster technology and product adoption. Agile innovation and manufacturing combined with radically increased productivity become engines for competitiveness and reinvestment, not simply for decreased cost. A focus on agility, productivity, energy, and environmental sustainability produces opportunities that are far beyond reducing market volatility. Agility directly impacts innovation, time-to-market, and faster, broader exploration of the trade space. These changes, the forces driving them, and new network-based information technologies offering unprecedented insights and analysis are motivating the advent of smart manufacturing and new information technology infrastructure for manufacturing.

Costs of health IT: beginning to understand the financial impact of a dental school EHR.

Health Information Technology (Health IT) constitutes an integral component of the operations of most academic dental institutions nowadays. However, the expenses associated with the acquisition and the ongoing maintenance of these complex systems have often been buried among costs for other electronic infrastructure systems, distributed across various cost centers including unmeasured central campus support, covered centrally and therefore difficult to quantify, and spread over years, denying school administrators a clear understanding of the resources that have been dedicated to Health IT. The aim of this study was to understand the financial impact of Health IT at four similar U.S. dental schools: two schools using a purchased Electronic Health Record (EHR), and two schools that developed their own EHR. For these schools, the costs of creating ($2.5 million) and sustaining ($174,000) custom EHR software were significantly higher than acquiring ($500,000) and sustaining ($121,000) purchased software. These results are based on historical data and should not be regarded as a gold standard for what a complete Health IT suite should cost. The presented data are intended to inform school administrators about the myriad of costs associated with Health IT and give them a point of reference when comparing costs or making estimates for implementation projects.

The value of all-payer claims databases to states.

All-payer claims databases are being developed in states across the nation to fill gaps in information about the health care system. The value of such databases is becoming more apparent as these databases mature and are used more frequently to help states better understand their health care utilization and costs.

Burden on university hospitals of handling portable data for imaging (PDI) media.

BACKGROUND: Portable Data for Imaging (PDI) is regularly used as a guideline for sharing medical imaging data between hospitals and other medical institutions. When a patient is referred to another location, the patient almost always brings PDI media on a CD or DVD. However, problems often occur when trying to view images on PDI discs inserted into computer terminals, and it is more efficient to view images on the hospitals' own picture archiving and communication system (PACS). On the request of doctors, it has become a routine practice to import PDI data to the PACS of the referred hospital. OBJECTIVE: The aim of this study was to analyze the increase in PDI image importing and investigate methods for reducing the burden caused by importing images. METHODS: We compiled representative data on image importing over time and analyzed the test modalities, number of images, volume of data, and referring hospital or medical clinic from which the data originated. RESULTS: The amount of PDI images imported to the PACS has risen despite no large increase in the number of patients. Currently, images imported from PDI media make up 22.8% of the total number of images stored in the PACS. The images come from a diverse array of hospitals (184 hospitals) and 82% are essential for medical care. The total annual expenditure associated with PDI data management is estimated to be 98,300 USD. CONCLUSION: The spreading use of the PDI guideline has led to a dramatic increase in data image sharing in the field of healthcare. While this has great benefits for patients and doctors, it is also associated with a greater cost and an overall burden for hospitals. These results indicate the need for a system to enable many hospitals and clinics to participate in image sharing at a cheaper cost.

[Implementation of a patient data management system. Effects on intensive care documentation]. / Einführung eines Patientendatenmanagementsystems. Auswirkungen auf die intensivmedizinische Dokumentation.

BACKGROUND: Patient data management systems (PDMS) enable digital documentation on intensive care units (ICU). A commercial PDMS was implemented in a 25-bed ICU replacing paper-based patient charting. The ICU electronic patient record is completely managed inside the PDMS. It compiles data from vital signs monitors, ventilators and further medical devices and facilitates some drug dose and fluid balance calculations as well as data reuse for administrative purposes. Ventilation time and patient severity scoring as well as coding of diagnoses and procedures is supported. Billing data transferred via interface to the central billing system of the hospital. Such benefits should show in measurable parameters, such as documented ventilator time, number of coded diagnoses and procedures and others. These parameters influence reimbursement in the German DRG system. Therefore, measurable changes in cost and reimbursement data of the ICU were expected. MATERIAL AND METHODS: A retrospective analysis of documentation quality parameters, cost data and mortality rate of a 25-bed surgical ICU within a German university hospital 3 years before (2004-2006) and 5 years after (2007-2011) PDMS implementation. Selected parameters were documented electronically, consistently and reproducibly for the complete time span of 8 years including those years where no electronic patient recording was available. The following parameters were included: number of cleared DRG, cleared ventilator time, case mix (CM), case mix index (CMI), length of stay, number of coded diagnoses and procedures, detailed overview of a specific procedure code based on daily Apache II and TISS Core 10 scores, mortality, total ICU costs and revenues and partial profits for specific ICU procedures, such as renal replacement therapy and blood products. RESULTS: Systematic shifts were detected over the study period, such as increasing case numbers and decreasing length of stay as well as annual fluctuations in severity of disease seen in the CM and CMI. After PDMS introduction, the total number of coded diagnoses increased but the proportion of DRG relevant diagnoses dropped significantly. The number of procedures increased (not significantly) and the number of procedures per case did not rise significantly. The procedure 8-980 showed a significant increase after PDMS introduction whereas the DRG-relevant proportion of those procedures dropped insignificantly. The number of ventilator-associated DRG cases as well as the total ventilator time increased but not significantly. Costs and revenues increased slightly but profit varied considerably from year to year in the 5 years after system implementation. A small increase was observed per case, per nursing day and per case mix point. Additional revenues for specific ICU procedures increased in the years before and dropped after PDMS implementation. There was an insignificant increase in ICU mortality rate from 7.4 % in the year 2006 (before) to 8.5 % in 2007 (after PDMS implementation). In the following years mortality dropped below the base level. CONCLUSION: The implementation of the PDMS showed only small effects on documentation of reimbursement-relevant parameters which were too small to set off against the total investment. The method itself, a long-term follow-up of different parameters proved successful and can be adapted by other organizations. The quality of results depends on the availability of long-term parameters in good quality. No significant influence of PDMS on mortality was found.

Does introduction of a Patient Data Management System (PDMS) improve the financial situation of an intensive care unit?

BACKGROUND: Patient Data Management Systems (PDMS) support clinical documentation at the bedside and have demonstrated effects on completeness of patient charting and the time spent on documentation. These systems are costly and raise the question if such a major investment pays off. We tried to answer the following questions: How do costs and revenues of an intensive care unit develop before and after introduction of a PDMS? Can higher revenues be obtained with improved PDMS documentation? Can we present cost savings attributable to the PDMS? METHODS: Retrospective analysis of cost and reimbursement data of a 25 bed Intensive Care Unit at a German University Hospital, three years before (2004-2006) and three years after (2007-2009) PDMS implementation. RESULTS: Costs and revenues increased continuously over the years. The profit of the investigated ICU was fluctuating over the years and seemingly depending on other factors as well. We found a small increase in profit in the year after the introduction of the PDMS, but not in the following years. Profit per case peaked at 1039 € in 2007, but dropped subsequently to 639 € per case. We found no clear evidence for cost savings after the PDMS introduction. Our cautious calculation did not consider additional labour costs for IT staff needed for system maintenance. CONCLUSIONS: The introduction of a PDMS has probably minimal or no effect on reimbursement. In our case the observed increase in profit was too small to amortize the total investment for PDMS implementation.This may add some counterweight to the literature, where expectations for tools such as the PDMS can be quite unreasonable.

Exploiting parallel R in the cloud with SPRINT.

BACKGROUND: Advances in DNA Microarray devices and next-generation massively parallel DNA sequencing platforms have led to an exponential growth in data availability but the arising opportunities require adequate computing resources. High Performance Computing (HPC) in the Cloud offers an affordable way of meeting this need. OBJECTIVES: Bioconductor, a popular tool for high-throughput genomic data analysis, is distributed as add-on modules for the R statistical programming language but R has no native capabilities for exploiting multi-processor architectures. SPRINT is an R package that enables easy access to HPC for genomics researchers. This paper investigates: setting up and running SPRINT-enabled genomic analyses on Amazon's Elastic Compute Cloud (EC2), the advantages of submitting applications to EC2 from different parts of the world and, if resource underutilization can improve application performance. METHODS: The SPRINT parallel implementations of correlation, permutation testing, partitioning around medoids and the multi-purpose papply have been benchmarked on data sets of various size on Amazon EC2. Jobs have been submitted from both the UK and Thailand to investigate monetary differences. RESULTS: It is possible to obtain good, scalable performance but the level of improvement is dependent upon the nature of the algorithm. Resource underutilization can further improve the time to result. End-user's location impacts on costs due to factors such as local taxation. CONCLUSIONS: Although not designed to satisfy HPC requirements, Amazon EC2 and cloud computing in general provides an interesting alternative and provides new possibilities for smaller organisations with limited funds.

Costs of cloud computing for a biometry department. A case study.

BACKGROUND: "Cloud" computing providers, such as the Amazon Web Services (AWS), offer stable and scalable computational resources based on hardware virtualization, with short, usually hourly, billing periods. The idea of pay-as-you-use seems appealing for biometry research units which have only limited access to university or corporate data center resources or grids. OBJECTIVES: This case study compares the costs of an existing heterogeneous on-site hardware pool in a Medical Biometry and Statistics department to a comparable AWS offer. METHODS: The "total cost of ownership", including all direct costs, is determined for the on-site hardware, and hourly prices are derived, based on actual system utilization during the year 2011. Indirect costs, which are difficult to quantify are not included in this comparison, but nevertheless some rough guidance from our experience is given. To indicate the scale of costs for a methodological research project, a simulation study of a permutation-based statistical approach is performed using AWS and on-site hardware. RESULTS: In the presented case, with a system utilization of 25-30 percent and 3-5-year amortization, on-site hardware can result in smaller costs, compared to hourly rental in the cloud dependent on the instance chosen. Renting cloud instances with sufficient main memory is a deciding factor in this comparison. CONCLUSIONS: Costs for on-site hardware may vary, depending on the specific infrastructure at a research unit, but have only moderate impact on the overall comparison and subsequent decision for obtaining affordable scientific computing resources. Overall utilization has a much stronger impact as it determines the actual computing hours needed per year. Taking this into ac count, cloud computing might still be a viable option for projects with limited maturity, or as a supplement for short peaks in demand.

MyMolDB: a micromolecular database solution with open source and free components.

BACKGROUND: To manage chemical structures in small laboratories is one of the important daily tasks. Few solutions are available on the internet, and most of them are closed source applications. The open-source applications typically have limited capability and basic cheminformatics functionalities. In this article, we describe an open-source solution to manage chemicals in research groups based on open source and free components. It has a user-friendly interface with the functions of chemical handling and intensive searching. RESULTS: MyMolDB is a micromolecular database solution that supports exact, substructure, similarity, and combined searching. This solution is mainly implemented using scripting language Python with a web-based interface for compound management and searching. Almost all the searches are in essence done with pure SQL on the database by using the high performance of the database engine. Thus, impressive searching speed has been archived in large data sets for no external Central Processing Unit (CPU) consuming languages were involved in the key procedure of the searching. AVAILABILITY: MyMolDB is an open-source software and can be modified and/or redistributed under GNU General Public License version 3 published by the Free Software Foundation (Free Software Foundation Inc. The GNU General Public License, Version 3, 2007. Available at: http://www.gnu.org/licenses/gpl.html). The software itself can be found at http://code.google.com/p/mymoldb/.

Comparison of patient assistance program software.

PURPOSE: The capabilities of available software programs for the management of applications to patient assistance programs (PAPs) and associated administrative tasks are reported. SUMMARY: Fifteen PAP software programs available at the time of data collection (July-September 2010) were identified through an Internet search and from e-mailed responses to a listserv request. To supplement and confirm the information obtained online, the software makers were contacted; additional data were collected through follow-up correspondence. The survey was restricted to standalone programs; all manufacturer-provided information was assumed to be accurate, and the products were not tested. The 15 software products evaluated (11 Web-based and 4 Windows-based programs) offered a wide range of capabilities to streamline the PAP application process, such as storage of patient and physician profiles, automatic completion of forms with stored data, application status tracking, and customized report generation. The Web-based programs offered some advantages over the Windows-based programs, including greater user accessibility and automatic updates. Product pricing varied widely, depending on the specific licensing terms. Some manufacturers offered discounts to health care organizations participating in the 340B Prime Vendor Program; some offered volume discounts. In addition, grant support may be available to help pay software licensing costs. CONCLUSION: There are at least 15 software programs for streamlining and enhancing the process of PAP application management. No single program can meet the needs of every organization; selecting the right product demands a close look at the needs of an organization and the features and logistics of each program.

Cost optimization of a real-time GIS-based management system for hazardous waste transportation.

In this paper, the design and cost analysis of a real-time, geographical information system (GIS) based management system for hazardous waste transportation are described. The implementation of such a system can effectively prevent illegal dumping and perform emergency responses during the transportation of hazardous wastes. A case study was conducted in Guangzhou, China to build a small-scale, real-time management system for waste transportation. Two alternatives were evaluated in terms of system capability and cost structure. Alternative I was the building of a complete real-time monitoring and management system in a governing agency; whereas alternative II was the combination of the existing management framework with a commercial Telematics service to achieve the desired level of monitoring and management. The technological framework under consideration included locating transportation vehicles using a global positioning system (GPS), exchanging vehicle location data via the Internet and Intranet, managing hazardous waste transportation using a government management system and responding to emergencies during transportation. Analysis of the cost structure showed that alternative II lowered the capital and operation cost by 38 and 56% in comparison with alternative I. It is demonstrated that efficient management can be achieved through integration of the existing technological components with additional cost benefits being achieved by streamlined software interfacing.

How to implement information technology in the operating room and the intensive care unit.

The number of operating rooms and intensive care units looking for a data management system to perform their increasingly complex tasks is rising. Although at this time only a minority is computerized, within the next few years many centres will start implementing information technology. The transition towards a computerized system is a major venture, which will have a major impact on workflow. This chapter reviews the present literature. Published papers on this subject are predominantly single- or multi-centre implementation reports. The general principles that should guide such a process are described. For healthcare institutions or individual practitioners that plan to undertake this venture, the implementation process is described in a practical, nine-step overview.

The price is now right. UnitedHealth Group's settlement on benchmarking databases could make out-of-network care costs more transparent, equal, some say.

Disagreement surrounds the discussion of whether the demise of two Ingenix price databases will aid the provider-payer relationship. Karen Ignagni, AHIP's CEO, questions the objective, wondering why in some cases "billings so exceed reimbursement." However, AMA President Nancy Nielsen, left, retorts, "This is an attempt to divert attention from what was clearly a rigged scheme".

The economic characteristics of registries and their policy implications.

BACKGROUND: The discipline of economics supplies principles that may contribute to the discourse about investments in trauma registries and the role of the public sector, as well as the optimal use of the datasets those investments create. METHODS: Principles from production economics, information economics, and public economics are employed to explore the reasons that trauma registries may be prone to underfunding, relative to their value, and to describe a threat to value maximization. The typical production activities and cost structures of registries are analyzed, along with the way registries generate social benefits. Assuming that the purpose of a trauma registry is to maximize the value or social good it creates, a number of investment, governance, and pricing principles are then proposed. RESULTS: Trauma registries are multiproduct enterprises. They are generally characterized by large and indivisible fixed, joint costs, and relatively low marginal costs. This implies that registries are subject to strong economies of scale and scope. Additionally, because registry data are not depleted by use, the registry's output is, technically, nonrival in consumption. The value created by registries may be maximized when a marginal-cost pricing policy is adopted. This means that the optimal price schedule for access to trauma registry data are likely to be zero, or close to zero, for some users. DISCUSSION: The economic principles presented here complement the contributions from other disciplines in discussions about the establishment of new registries or about improving some aspects of existing registries.

Image-based crystal detection: a machine-learning approach.

The ability of computers to learn from and annotate large databases of crystallization-trial images provides not only the ability to reduce the workload of crystallization studies, but also an opportunity to annotate crystallization trials as part of a framework for improving screening methods. Here, a system is presented that scores sets of images based on the likelihood of containing crystalline material as perceived by a machine-learning algorithm. The system can be incorporated into existing crystallization-analysis pipelines, whereby specialists examine images as they normally would with the exception that the images appear in rank order according to a simple real-valued score. Promising results are shown for 319 112 images associated with 150 structures solved by the Joint Center for Structural Genomics pipeline during the 2006-2007 year. Overall, the algorithm achieves a mean receiver operating characteristic score of 0.919 and a 78% reduction in human effort per set when considering an absolute score cutoff for screening images, while incurring a loss of five out of 150 structures.

Reducing HIE costs through real-time data feed visualizations.

Reliable and cost-effective health information exchanges require real-time monitoring of data sources, especially during implementation and deployment. MidSouth eHealth Alliance developers created a tool for real-time visualization of data feed logs which summarizes activity over multiple time windows and across different components, sources, and event types. This representation allows maintainers to differentiate between expected patterns and events that require rapid intervention to ensure reliable data handling, supporting efficient monitoring of and response to anomalous activity.