Microsystems in health care: Part 2. Creating a rich information environment.
BACKGROUND
A rich information environment supports the functioning of the small, functional, frontline units--the microsystems--that provide most health care to most people. Three settings represent case examples of how clinical microsystems use data in everyday practice to provide high-quality and cost-effective care.


METHODS
At The Spine Center at Dartmouth, Lebanon, New Hampshire, a patient value compass, a one-page health status report, is used to determine if the provided care and services are meeting the patient's needs. In Summit, New Jersey, Overlook Hospital's emergency department (ED) uses uses real-time process monitoring on patient care cycle times, quality and productivity indicator tracking, and patient and customer satisfaction tracking. These data streams create an information pool that is actively used in this ED icrosystem--minute by minute, hourly, daily, weekly, and annually--to analyze performance patterns and spot flaws that require action. The Shock Trauma Intensive Care Unit (STRICU), Intermountain Health Care, Salt Lake City, uses a data system to monitor the "wired" patient remotely and share information at any time in real time. Staff can complete shift reports in 10 minutes.


CONCLUSIONS
Information exchange is the interface that connects staff to patients and staff to staff within the microsystem; microsystem to microsystem; and microsystem to macro-organization.
Nelson
Eugene C
EC
Dartmouth-Hitchcock Medical Center (DHMC), Lebanon, New Hampshire, USA.
Batalden
Paul B
PB
Homa
Karen
K
Godfrey
Marjorie M
MM
Campbell
Christine
C
Headrick
Linda A
LA
Huber
Thomas P
TP
Mohr
Julie J
JJ
Wasson
John H
JH
D003628:Database Management Systems; D004636:Emergency Service, Hospital / Q000592:standards; D006751:Hospital Information Systems; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D007857:Leadership; D009513:New Hampshire; D009515:New Jersey; D019982:Organizational Case Studies; D015279:Organizational Culture; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D013122:Spinal Diseases / Q000628:therapy; D013597:Systems Analysis; D015912:Thrombolytic Therapy; D017749:Total Quality Management / Q000379:methods / Q000458:organization & administration*; D014589:Utah; D014947:Wounds and Injuries / Q000628:therapy