Table Of ContentHealth Informatics
Kathryn J. Hannah Marion J. Ball
Series Editors
Springer Science+Business Media, LLC
Health Informatics Series
(formerly Computers in Health Care)
Series Editors
Kathryn J. Hannah Marion J. Ball
Dental Informatics
Integrating Technology into the Dental Environment
L.M. Abbey and J. Zimmerman
Aspects of the Computer-based Patient Record
M.J. Ball and M.F. Collen
Performance Improvement Through Information Management
Health Care 's Bridge to Success
MJ. Ball and J.V. Douglas
Strategies and Technologies for Healthcare Information
Theory into Practice
MJ. Ball, J.V. Douglas, and D.E. Garets
Nursing Informatics
lWlere Caring and Technology Meet, Third Edition
M.J. Ball, K.J. Hannah, S.K. Newbold, and J.V. Douglas
Healthcare Information Management Systems
A Practical Guide, Second Edition
MJ. Ball, D.W. Simborg, J.W. Albright, and J.V. Douglas
Clinical Decision Support Systems
Theory and Practice
E.S. Berner
Strategy and Architecture of Health Care Information Systems
M.K. Bourke
Information Networks for Community Health
P.F. Brennan, S.J. Schneider, and E. Tornquist
Introduction to Clinical Informatics
P. Degoulet and M. Fieschi
Patient Care Information Systems
Successful Design and Implementation
E.L. Drazen, J.B. Metzger, J.L. Ritter, and M.K. Schneider
Introduction to Nursing Informatics, Second Edition
KJ. Hannah, MJ. Ball, and M.J.A. Edwards
Information Technology for the Practicing Physician
J.M. Kiel
Computerizing Large Integrated Health Networks
The VA Success
R.M. Kolodner
(continued after Index)
Peter Ramsaroop Marion J. Ball
David Beaulieu ludith V. Douglas
Editors
Advancing Federal
Sector Health Care
A Model for Technology
Transfer
With 100 Illustrations
Springer
Peter Ramsaroop, MBA Marion 1. Ball, EdD David Beaulieu
Chairman and Founder Adjunct Professor Vice President
HealthCPR.com lohns Hopkins University Managing Director of the
6313 Fox Hunt Road School of Nursing Government Practice
Alexandria, VA 22307, USA Baltimore, MD 21205, USA First Consulting Group
forrnerly forrnerly Avon, CT 06001, USA
Consultant Vice President
First Consulting Group First Consulting Group
Baltimore, MD 21210, USA Baltimore, MD 21210, USA
ludith V. Douglas, MA, MHS Series Editors:
Adjunct Lecturer Kathryn 1. Hannah, PhD, RN Marion 1. Ball, EdD
lohns Hopkins University Professor, Department of Adjunct Professor
School of Nursing Community Health Science lohns Hopkins University
Baltimore, MD 21205, USA Faculty of Medicine School of Nursing
forrnerly The University of Calgary forrnerly
Associate Calgary, Alberta, Canada Vice President
First Consulting Group First Consulting Group
Baltimore, MD 21210, USA Baltimore, MD 21210, USA
Library of Congress Cataloging-in-Publication Data
Advancing federal sector health care: a model for technology transfer 1 editors, Peter Ramsaroop ...
[et a!.l.
p. cm.-(Health informatics series)
Includes bibliographical references and index.
(alk. paper)
1. Medicine, Military-Technological innovations-United States. 2. Medical innovations-United
States. 3. Medical informatics-United States. 4. Medical care-United States--Cost contro!.
5. Medical care-United States-Quality contro!. I. Ramsaroop, Peter. 11. Health informatics
[DNLM: 1. Delivery of Health Care-United States. 2. Medical Informatics Applications-United
States. 3. Biomedical Technology-United States. 4. Govemment Programs--United States.
5. Hospitals, Federal-organization & administration-United States. 6. Military Medicine-United
States. W 26.5 A2447 2001]
RC971 .A28 2001
362.1"0973-dc21 00-059476
Printed on acid-free paper.
The following chapters were produced in whole or in part by officers or employees of the United States Govemment as
part of their official duties, and as such, the text is in the public domain: Chapters 4, 6, 8, 9, 10, 12, 13, 14, 15, 16, 17,
18, 19,20,22, and 23.
© 2001 Springer Science+Business Media New York
ISBN 978-1-4419-2877-1 ISBN 978-1-4757-3439-3 (eBook)
DOI 10.1007/978-1-4757-3439-3
Originally published by Springer-Verlag New York,lnc.in 2001
Softcover reprint ofthe hardcover Ist edition 2001
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mission of the publisher ( Springer Seience+Business Media, LLC ),
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of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed is forbidden.
The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former
are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks
and Merchandise Marks Act, may accordingly be used freely by anyone.
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press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors
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SPIN 10774685
A Dedication to
Donald Allan Bror Lindberg, MD
It is unlikely that any one person in the federal government has contributed
more to medical informatics than Donald AB. Lindberg, the current Direc
tor of the National Library of Medicine. Lindberg's stature in the field and
his contributions to medical informatics and to the National Library of
Medicine have already been compared to those of lohn Shaw Billings. From
1865 to 1895, Billings, an Army medical officer, was the Director of the
Army Surgeon General's Library, the forerunner of the National Library
of Medicine created by congressional legislation signed by President
Dwight Eisenhower in 1956.
Donald AB. Lindberg received his AB. Magna cum Laude in 1954 from
Amherst College and his M.n. degree from Columbia University in 1958.
After completing his training in pathology at the University of Missouri
School of Medicine, he stayed on to become Professor of Pathology, Pro
fessor and Chairman of the Department of Information Science, Director
of the Health Services Research Center and Health Care Technology
Center, and Direetor of the Information Scienee Group.
In 1984, Donald Lindberg became the Director of the National Library
of Medieine, a role he still plays with vision and strength. From 1992 to 1995,
he took on an added task, serving as the first Direetor of the National Coor
dination Office for High Performance Computing and Communications, in
the Office of Science and Technology Poliey. Since 1996, he has been the
United States Coordinator for the G-7 Global Healthcare Applications
Project for the Global Information Infrastructure Initiative.
Through the years, Lindberg has served on many professional eom
mittees and boards of medical professional organizations. The recipient
of dozens of honors and awards, including several honorary doctoral
degrees, he was the first delegate from the American Medical Informatics
Association to the International Medical Informatics Association. In
addition to giving hundreds of invited lectures and talks throughout
the world, he has published four books on medical informatics along
with more than 200 scientific papers, technical reports, and book
chapters.
v
vi A Dedication to Donald Allan Bror Lindberg, MD
The National Library of Medicine has made important contributions to
medical informatics under Donald Lindberg's leadership. In the 1970s, the
library initiated MEDLINE and began to offer extramural funding for
medical informatics training programs. In 1980s, Lindberg launched two
transformational efforts. The Integrated Academic Information Manage
ment System (IAIMS) program encouraged the use of computers and com
munication networks within healthcare institutions. The United Medical
Language System (UMLS) project focused on access to machine-readable
information located in a variety of sourees, including the scientific litera
ture, factual databanks, knowledge-based expert systems, and computer
based patient records. In the 1990s, the library supported projects in
telemedicine, the human genome program, and the Visible Human project.
With such outstanding leaders as Donald A.B. Lindberg, the federal
government has made substantial contributions to the domain of medical
informatics that are improving health care for all.
Foreword I
As a result of severe wounds received in World War II, I have spent many
months in military hospitals, including 20 months in an Army hospital
immediately after the war. I continue to use the Military Health System, as
do many of my colleagues in Congress, because I firmly believe the quality
of health care delivered in military and veterans hospitals is second to none.
The largest system of its type in the world, the U.S. military healthcare
system is undergoing changes as dramatic as those experienced by the
entire country. During Desert Storm, we saw new technologies, such as
telemedicine, at work in the field. Since then, military medicine has contin
ued to imprave and develop innovations that often focus on healthcare
issues of concern to society as a whole.
We already have seen technology transfer at work. Things we use in our
everyday lives, from sunscreen to the Internet, have come to us directly
from innovations developed by federal researchers. The private sector,
working with the public agencies, has creatively adapted federal research.
For example, the hemopump is used successfully by heart surgeons world
wide to save heart patients. This device, developed by Richard Wampler,
was based on satellite technology information that was declassified in the
early 1980s.
The chapters in this book focus on current federal sector efforts to shape
health care and technology transfer. Many of the initiatives described
involve some degree of partnering between the public and private sectors.
Other initiatives aim to deliver top-quality care to populations that are
microcosms of our society at large. These efforts strive to improve perfor
mance while containing costs. The solutions offered include redesigning
processes and using technologies to do so.
The contributors to this book share their experiences fram the federal
sector health systems. The authors demonstrate successful technology pro
grams that, in their opinion, have improved health care. They suggest ways
to meet the demands of consumers who grow increasingly sophisticated and
knowledgeable, and they offer valuable insights into the challenges of
population-based health.
vii
viii Foreword I
Both the private and public sectors can benefit from the collaborative
wisdom of this book's editors and contributors. For policy makers and deci
sion makers, this book provides a fresh look at technology transfer and
innovation in health care-an area that is of profound concern to each and
every one of uso
Alaha.
Daniel K. Inauye
Senior Senator (Democrat) from Hawaii
Ranking Minority Member
Defense Subcommittee of the Senate Appropriations Committee
Foreword 11
As a long-time advocate of increased partnership between the Veterans
Health Administration and the Military Health System, I strongly urge all
healthcare professionals and every individual involved in the highest levels
of policy making to read this most informative and timely book.
VA Medical Centers have long partnered with leading academic institu
tions throughout the country. Together, they have been responsible for
cutting edge research and innovative clinical applications. Since 1984, the
VA and DoD have had statutory authority to work together (VAlDoD
Sharing Act). Although many projects, mostly local, have resulted, much
more could be done to maximize the buying power and healthcare deliv
ery capabilities of both organizations.
In my role as Chairman of the Congressional Commission on Service
members and Veterans Transition Assistance, I reported to Congress our
recommendations to establish a joint VA/DoD healthcare policy office and
create joint procurement activities. This experience, along with my other
work in the federal sector, convinced me that partnering is critical.
Federal agencies and the private sector must expand and extend their
collaborative efforts. Only then can technology and information transfer be
maximized for the benefit of all Americans.
Anthony J Principi
President, QTC Medical Services Inc.
Formerly Deputy Secretary of Veterans Affairs
Acting Secretary of Veterans Affairs
Und er President George Bush
IX
