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The objective of this paper is to identify trends and new technological developments that appear due to an ageing society and to relate them to current research in the field of medical informatics. A survey of the current literature reveals that recent technological advances have been made in the fields of "telecare and home-monitoring", "smart homes and robotics" and "health information systems and knowledge management". Innovative technologies such as wearable devices, bio- and environmental sensors and mobile, humanoid robots do already exist and ambient assistant living environments are being created for an ageing society. However, those technologies have to be adapted to older people's self-care processes and coping strategies, and to support new ways of healthcare delivery. Medical informatics can support this process by providing the necessary information infrastructure, contribute to standardisation, interoperability and security issues and provide modelling and simulation techniques for educational purposes. Research fields of increasing importance with regard to an ageing society are, moreover, the fields of knowledge management, ubiquitous computing and human-computer interaction.
The phenomenon of publication bias has probably existed since results of scientific research are being published. Positive and/or statistically significant results seem more likely to be published than negative and/or insignificant results. However, it is unclear if there is a remarkable impact of publication bias in medical informatics evaluation literature and how aware researchers are of its effect. We conducted a small-scale study in order to find out what the ratio of papers describing positive results vs. negative results is, tried to find enough studies to a certain subject to carry out a meta-analysis and assess publication bias by statistical methods, and finally examined reviews and meta-analyses for their results and their quality. A random sample of 86 studies showed a remarkably high percentage of descriptions of positive results (69.8%). 19 (36.6%) of the analyzed 54 reviews and meta-analyses came to a positive conclusion with regard to the overall effect of the analyzed system, 32 (62.5%) were inconclusive, and only one review came to a negative conclusion. Quantitative assessment of publication bias for health informatics studies was found difficult due to the low number of comparable studies. Although there is no clear evidence for a great impact of publication bias in medical informatics evaluation literature, further research should carried out.
In 2001, the revised course Software Engineering has been implemented in the Medical Informatics curriculum at the Academic Medical Center, Amsterdam. This 13 weeks, full-time course consists of three parts: internship, theory and project. All parts are provided in problem-oriented manner with special attention for relevant skills such as project management, documentation and presentation. During the internship, students observe how health care professionals at several hospital wards work and how information supply is organized. In the theory part, students study concepts and methods of software engineering by means of case descriptions and self-directed learning. During the project, they apply their acquired knowledge to an observed, clinical information problem and complete several stages of the software engineering process. Evaluation by inquiry showed that, compared to other courses, students spent more time, and distributed their time more evenly, during the whole period of the course. In conjunction with theory, a combination of internship and project in a hospital seems to provide a surplus value compared to a practical in a computer laboratory. The integration of software theory, clinical practice and problem-based approach, contributed to the enthusiastic, intensive and realistic way students learned in this important topic that might be chosen as a future profession.
This glossary defines terms used in the comparatively young science of medical informatics. It is hoped that it will be of interest to both novices and professionals in the field.
Integrated delivery systems (IDSs) recently have invested substantial financial resources in information technology (IT) initiatives. But the return on that investment for many IDSs in terms of improved productivity and reduced costs has been less than anticipated. Therefore, to improve or enhance the success of IT initiatives, some IDSs have sought to encourage more physician support of such efforts by creating a new executive position--director of medical informatics--designed to be filled by physician leaders who have knowledge and skill in managing information systems. The director of medical informatics, who typically reports to the CEO or CIO, coordinates IT initiatives that address physician concerns and promotes physician buy-in.
OBJECTIVES: Key bioinformatics and medical informatics research areas need to be identified to advance knowledge and understanding of disease risk factors and molecular disease pathology in the 21 st century toward new diagnoses, prognoses, and treatments. METHODS: Three high-impact informatics areas are identified: predictive medicine (to identify significant correlations within clinical data using statistical and artificial intelligence methods), along with pathway informatics and cellular simulations (that combine biological knowledge with advanced informatics to elucidate molecular disease pathology). RESULTS: Initial predictive models have been developed for a pilot study in Huntington's disease. An initial bioinformatics platform has been developed for the reconstruction and analysis of pathways, and work has begun on pathway simulation. CONCLUSIONS: A bioinformatics research program has been established at GE Global Research Center as an important technology toward next generation medical diagnostics. We anticipate that 21 st century medical research will be a combination of informatics tools with traditional biology wet lab research, and that this will translate to increased use of informatics techniques in the clinic.
The Infectious Disease Society of America is concerned about the excessive and inappropriate use of antibiotics in U.S. hospitals. Applications of Medical Informatics can help improve the use of antibiotics and help improve patient care by monitoring and managing enormous amounts of patient information. Monitoring the duration of every antibiotic ordered in the hospital or keeping tract of the antibiotic susceptibilities for five years are examples of tasks better performed by computers. The impact of computers in medicine is seen by some as disappointing. The computer revolution has not had the impact in medicine experienced by other areas. The acceptance and use of computers by medicine will be evolutionary rather than revolutionary. In 1979, the MYCIN project demonstrated that the computer could aid physicians in the selection of antibiotics. However, MYCIN was never clinically used because physicians were require to enter all patient information into the computer. The development of computerized medical records is an essential step to further the development and implementation of computer-aided decision support. The science of Medical Informatics is still relatively new but is emerging as a distinct academic field. A few hospitals are now installing information systems and have determined that these systems will play an essential role in their ability to survive into the next century. The telephone and the automobile have been recognized as two of the most important tools for improving medical care during the past 100 years. People could more readily get medical care and the time to transmit medical information was greatly reduced through physician use of the telephone and automobile. The computer is a tool that can be used to help physicians manage the great amount of medical information being generated every day. The computer can also alert the physician of patient conditions that need attention. However, it is the physician who must use and apply the computer provided information. Thus, the computer will assist but not replace physicians in providing medical care.
Over the last few years, there has been a major effort devoted to formalizing standards for healthcare. It is vital that such standards are fully "open," whether developed by formal standards bodies or otherwise. This paper discusses the various standards developed and in the process of being developed, including information on the standards process with particular reference to medical informatics. It also discusses a recent initiative in the United Kingdom National Health Service to ensure that formal standards are specified in procurements.
In a period of social transformation, we must reinvent health care. For guidance, we can look to the evolving discipline of medical informatics and to the patterns of investment in the practice arena. A top ranked application need, the computerized patient record (CPR) offers cost savings and supports clinical quality and ambulatory care. In the new millennium, we need to define our values with precision and use technology to achieve quality health care.
We describe a new methodology for development of a medical informatics curriculum for practicing clinicians. The curriculum is based on a biaxial framework in which information is categorized by type of application and role of the learner in relation to the application. The curriculum development process incorporates feedback from practicing clinicians on an ongoing basis.
Research and training programs in Medical Informatics and Telemedicine offered at the Politecnico di Milano are summarized. The educational pathways refer to the programs of the 5-years based Laurea Degree, the 3-years based Diploma Universitario Degree, of the post-Laurea 3-years-based Doctoral Degree and of the 1-year based Master Degree, as well as of the Continuing Education Program. The Research programs focus on databases and extend to the optimisation of the "Visible Human Dataset--Milano Mirror Site" services. Additional activities relate to standardization at both Italian and European levels and to cooperations with hospitals and manufacturers.
'Open Source' is a 20-40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market--probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General's COSTAR and the Veterans Administration's VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model.
The 2001 debate of the American College of Medical Informatics focused on the proposition that national regulatory mandate of computer-based provider order entry (CPOE), to take effect by the end of 2005, portends greater benefit than risk for health care delivery. Both sides accepted that provider order entry offers potential benefit. Those supporting the proposition emphasized public safety, noting that payers have little economic incentive to pay for quality and that a mandate would force vendors to improve the usability and value of their systems. They argued that the mandate would align the economic incentives to finally allow CPOE to be widely adopted. Those opposing the proposition emphasized the risks resulting from a mandate, including the direct implementation costs, the logistic issues of implementation, and the cost of failed implementations. They also noted the potential for errors introduced by the systems themselves and the fact that the safety and utility of commercially available CPOE products have yet to be proved.
The present paper is the result of a study investigating the legal issues, problems and obstacles which have arisen as a result of the R&D projects financed by the AIM Program 1991-94. Two parallel lines of investigation were adopted in this study. First of all, a questionnaire was sent to all project partners listed in the AIM 93 Report, with the objective of collecting information on the legal questions with which the individual projects were confronted in the course of their R&D work. This allowed for an initial mapping out of the legal aspects relevant in the field of medical informatics. Secondly, the actual projects were studied as to their legal content and in particular those which included a legal workpackage. This allowed for an assessment of further legal questions, some of which had as yet perhaps not been perceived as such. The present paper deals with five key aspects, describing the nature of the issues and the relevant law and case law or legal vacuum as it may be. It must be emphasised that, as pointed out in the title, this study offers an overview of the legal issues debate in medical informatics and is somewhat exploratory in nature. It is not intended to offer a critical analysis of existing picces of legislation or case law. This would call for more fundamental legal research. Instead the study restricts itself to a general description of existing legal principles and their relevance in the health care sector. As the reader will gather from this paper, legally speaking information technology is still a relatively new entity in the health care sector, which means that legal research and any resulting recommendations may have a real impact on the future course of the law in this field.
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PURPOSE: We are witnessing a paradigm shift in higher education as a result of technological advances, adoption of on-line learning and a greater participation in e-commerce by higher education providers. Given the dearth of academics with high-level expertise in health informatics in many countries, we need to explore how best to use our scarce resources to have the greatest possible impact regarding the preparation of health professionals such that they can make the best possible use of available informatics technologies to support health service delivery. METHODS: The International Medical Informatics Association's (IMIA) education working group together with its institutional (academic members) is exploring how best to provide global and collaborative health informatics education and research. Central Queensland University (CQU), one of these members, is also working with the Health Level Seven (HL7) organisation to provide specific standards education internationally using flexible delivery methods. RESULTS: A number of issues requiring further exploration and resolutions have been identified. An overview of these is provided.
This paper provides an introduction to the present basis for the Traditional Chinese Medical Informatics (TCMI). It also analyzes the contents, the characteristics of the information classification of Traditional Chinese Medicine (TCM) and prospects for TCMI.