Costar - A Computer-Based Medical Information System for Ambulatory Care

Barnett, G. Octo; Justice, Norma; Somand, Michael E.; Adams, Jody; Greenlie, J.K.; Beaman, Peter D.; Penchas, S; Parent, M.S.

doi:10.1109/scamc.1978.679955

Cited by 37 publications

(41 citation statements)

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“…The automated medical records systems at HVMA/HPHC captured data from all ambulatory and inpatient encounters between plan members and providers in a combination of coded and narrative fields. 16,17 Coded data also included all laboratory tests and results (eg, HbA 1c ), diagnoses, procedures, and therapies. Members received prescription drug coverage through the in-house pharmacy system that generally provided 1 month's supply of medicine for a small copayment.…”

Section: Study Setting and Data Sourcesmentioning

confidence: 99%

Effects of Health Maintenance Organization Coverage of Self-monitoring Devices on Diabetes Self-care and Glycemic Control

Soumerai

Mah²,

Zhang³

et al. 2004

Arch Intern Med

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Section: Study Setting and Data Sourcesmentioning

confidence: 99%

Effects of Health Maintenance Organization Coverage of Self-monitoring Devices on Diabetes Self-care and Glycemic Control

Soumerai

Mah²,

Zhang³

et al. 2004

Arch Intern Med

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“…Ambulatory clinical information was obtained from an automated medical record system used for all clinical encounters, described in detail elsewhere. 18,19 Providers document encounters on a paper form that is subsequently input by medical records staff. The form allows selection of multiple diagnoses for each visit and entry of free text for history and physical examination findings.…”

Section: Data Sourcesmentioning

confidence: 99%

Comparing Asthma Care for Medicaid and Non-Medicaid Children in a Health Maintenance Organization

Finkelstein¹,

Barton²,

Donahue³

et al. 2000

Arch Pediatr Adolesc Med

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Objective: To compare ambulatory visit patterns, rates of medication use, and emergency department and hospital utilization for children with asthma covered under Medicaid and commercial payers within the same health maintenance organization (HMO).Design: Retrospective cohort study.Setting: Eleven staff-model pediatric departments of an HMO.Patients: A total of 1928 Medicaid and 11 007 nonMedicaid children aged 2 to 18 years with at least 1 encounter with a diagnosis of asthma between October 1, 1991, and September 30, 1996. Methods:We linked patient-level data from the HMO's automated medical record system for ambulatory encounters, a claims system for emergency department and hospital care, and an automated pharmacy dispensing database. Medicaid and non-Medicaid patients were compared for all encounter types and for prescribing and dispensing of ␤-agonist and controller medications (inhaled corticosteroids and cromolyn sodium). Incidence rate ratios were calculated from Poisson regression models to control for age, sex, and, when appropriate, ␤-agonist dispensing rate. The number of refills authorized on each prescription and the fraction of medications dispensed as refills compared with new prescriptions were compared for Medicaid and non-Medicaid patients.Results: Medicaid-insured children in the HMO were 1.4 times (95% confidence interval, 1.2-1.5) more likely to receive care in emergency departments and 1.3 times (95% confidence interval, 1.1-1.5) more likely to be hospitalized for their asthma compared with non-Medicaid members. Medicaid and non-Medicaid enrollees had similar yearly rates of nonurgent (1.32 vs 1.17) and urgent (0.38 vs 0.31) ambulatory visits. ␤-Agonists were dispensed roughly equally to Medicaid and non-Medicaid members. Although Medicaid patients were less likely to have controller medications dispensed (relative risk, 0.72; 95% confidence interval, 0.69-0.74), they were equally likely to have them prescribed.Conclusions: Differences in ambulatory contact for Medicaid members do not explain the higher rates of emergency department visits and hospitalization in this population. Reasons for lower rates of dispensing of controller medications should continue to be investigated as one cause of increased morbidity for low-income children with asthma.

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“…Barnett [ 11 ] wrote that in its design and implementation, a central objective of COSTAR was to provide information-processing support for communication of laboratory, x-ray, and electrocardiogram reports. By the late 1970s COSTAR had gone through four revisions in its system design at the HCHP [ 16 ]. By the end of the 1980s, the COSTAR system was widely disseminated in the United States, and was being used in more than 120 sites [ 9 ].…”

Section: Examples Of Early Csis and Integration With Mismentioning

confidence: 99%

Clinical Support Information Systems (CSISs)

Collen¹,

Silva²

2015

Health Informatics

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Operating within a larger medical information system (MIS), clinical support information systems (CSISs) process the specialized subsystem information used in support of the direct care of patients. Most of these CSISs were developed as stand-alone systems. This chapter highlights the early efforts to combine data from disparate departmental data systems into more "integrated ones" that support the full spectrum of data management needs of multi-hospital and ambulatory health systems. In the 1960s and 1970s, institutions incorporated clinical laboratory and medication subsystems into their MISs; more subsystems were added (pathology, imaging, etc.); and systems with integrated CSIS were developed for ambulatory care settings. Despite all the progress made over the past 40 years, two key challenges remain unsolved: fi rst is the lack of data interoperability among myriad systems; second is the lack of a useful point of care system. Both threaten to make the clinician's work harder; overcoming them is key to transforming the health care system. Keywords Clinical support information system s • Integrated CSIS • Interoperability • Point of care system s • Clinical subsystem s • Dietary information system sTaking care of a patient in 1950 or 2010 usually involved a physician seeing the patient in a medical offi ce or in a hospital. To evaluate the patient's health status, the physician took a history of the patient's medical problems (symptoms), performed a physical examination to discover any physical abnormalities (signs), and combined the symptoms and signs to see if they fi tted any syndrome. He then recorded the patient's history and examination fi ndings and any preliminary impressions of any syndromes in the patient's medical record, which was usually a paper-based chart. The physician often referred the patient for tests and procedures that involved clinical laboratory, radiology, and other clinical support services. Upon reviewing the results from these services, the physician could make a preliminary diagnosis

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Costar - A Computer-Based Medical Information System for Ambulatory Care

Cited by 37 publications

References 0 publications

Effects of Health Maintenance Organization Coverage of Self-monitoring Devices on Diabetes Self-care and Glycemic Control

Effects of Health Maintenance Organization Coverage of Self-monitoring Devices on Diabetes Self-care and Glycemic Control

Comparing Asthma Care for Medicaid and Non-Medicaid Children in a Health Maintenance Organization

Clinical Support Information Systems (CSISs)

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