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Health care professional workstations: where are we now? ... where should we be tomorrow?

This article looks back over four years during which major changes have occurred in healthcare informatics, both technically and from a policy perspective. A remarkable portion of what medical-informatics professionals were proposing in 1989 has subsequently come to pass. Thus, one lesson from reflections on the recent past is that now is the time for us to devise realistic expectations of what we will see happen in the next four years. Possible scenarios for the future are outlined, as are suggestions for how the informatics community might best prepare for what lies ahead.

Computer Communication Networks↗

Searching for molecules with similar biological activity: analysis by fingerprint profiling.

We have recently developed a mini-fingerprint (MFP) representation for small molecules that performs well in database searches for compounds with similar biological activity. The MFP consists of only 54 bit positions that account for numerical ranges of three two-dimensional (2D) descriptors or the presence or absence of defined structural fragments. Here we present an analysis method, termed fingerprint profiling, to systematically compare bit patterns of compounds belonging to different biological activity classes. Some but not all bit positions were variably occupied in seven different activity classes and responsible for the detection of structure-activity differences. The analysis has made it possible to rank bit positions and encoded molecular descriptors according to their importance for our similarity search calculations. Fingerprint profiling can be applied to any keyed bit string representation and should be helpful, for example, to analyze descriptor distributions in large compound databases.

Computer-Aided Design↗

[Current and future perspectives of medical information network systems for community health using personal computers and IC cards].

Recent developments in computer and communication technology were studied in relation to medical information network systems, using computers and IC cards, to solve problems in community health. Trial use of personal computer network systems among physicians and IC card systems for personal health data management are already in existence in some parts of Japan. These trials were studied and analyzed based on a questionnaire survey of physicians and patients. Results of the study produced some useful points that should be considered when introducing these systems. These included: 1) details on expectations and specifications for these systems by physicians and patients, 2) easy access to valuable information is a key point for active network systems among physicians, 3) plausibility of improvement of communication between physicians and patients by using these systems, 4) recognition that an important problem concerns patient information privacy and must be considered before introducing these systems. A study of practical merits of these systems and methodology for realization indicates that participation by active and attractive providers of information can be expected to stimulate frequent use of the network system. The cost of introducing these systems can be partially borne by eliminating the large investment now allocated for processing requests for reimbursement of medical services. Investigation into the introduction of medical information systems provides a good opportunity to elucidate problems in the present medical systems.

Computer Communication Networks↗

Using a WWW-based mail user agent for secure electronic mail service for health care users.

WWW-based user interface is presented for secure electronic mail service for healthcare users. Using this method, communications between an electronic mail (WWW) server and users (WWW browsers) can be performed securely using Secure Socket Layer protocol-based Hypertext Transfer Protocol (SSL-HTTP). The mail can be encrypted, signed, and sent to the recipients and vice versa on the remote WWW server. The merit of this method is that many healthcare users can use a secure electronic mail system easily and immediately, because SSL-compatible WWW browsers are widely used and this system can be made available simply by installing a WWW-based mail user agent on a mail server. We implemented a WWW-based mail user agent which is compatible with PEM-based secure mail and made it available to about 16,000 healthcare users. We believe this approach is effective in facilitating secure network-based information exchange among medical professionals.

Computer Communication Networks↗

A survey of fuzzy logic monitoring and control utilisation in medicine.

Intelligent systems have appeared in many technical areas, such as consumer electronics, robotics and industrial control systems. Many of these intelligent systems are based on fuzzy control strategies which describe complex systems mathematical models in terms of linguistic rules. Since the 1980s new techniques have appeared from which fuzzy logic has been applied extensively in medical systems. The justification for such intelligent systems driven solutions is that biological systems are so complex that the development of computerised systems within such environments is not always a straightforward exercise. In practice, a precise model may not exist for biological systems or it may be too difficult to model. In most cases fuzzy logic is considered to be an ideal tool as human minds work from approximate data, extract meaningful information and produce crisp solutions. This paper surveys the utilisation of fuzzy logic control and monitoring in medical sciences with an analysis of its possible future penetration.

Artificial Intelligence↗

Organizing medical networked information (OMNI).

The Internet has become a major source of biomedical information over the last 5 years. Several projects have recently been established to help users find respectable information sources quickly. OMNI (Organizing Medical Networked Information) is one such filtering and indexing project. OMNI has focused on the quality of information and the application to Internet resources of standard tools for organizing information such as the National Library of Medicine's Medical Subject Headings and the Dublin Core metadata format. Now two years old, the OMNI project fulfils a valuable role for the UK biomedical community, through its gateway service (http:@omni.ac.uk), its printed resource guides and its training workshop programme. OMNI is also a focus for biomedical metadata activities in the UK. The gateway continues to grow in size and further work on information quality issues and integration is planned.

Abstracting and Indexing↗

The use of the Balanced ScoreCard (BSC) in the model for investment and evaluation of medical information systems.

This paper describes the use of the Balanced ScoreCard (BSC) in the MIEMIS meso-model (Model for Investment and Evaluation of Medical Information Systems). The scope of the MIEMIS model is to integrate the evaluation process into the whole lifecycle of an information system using both a prospective and a retrospective approach. We conclude, that the MIEMIS-model has benefited from implementing the BSC into the model due to the fact, that the BSC can support the project management work. This approach helps ensuring, that the new information systems are fulfilled according to the plan and with a balance between the four perspectives (financial, customer/user, internal, and innovation/learning perspective) to avoid that the financial aspect is the driving force in developing and implementing a new information system, for example.

Computer Simulation↗

Modelling health care processes for eliciting user requirements: a way to link a quality paradigm and clinical information system design.

Hospital information systems have to support quality improvement objectives. The design issues of health care information system can be classified into three categories: 1) time-oriented and event-labelled storage of patient data; 2) contextual support of decision-making; 3) capabilities for modular upgrading. The elicitation of the requirements has to meet users' needs in relation to both the quality (efficacy, safety) and the monitoring of all health care activities (traceability). Information analysts need methods to conceptualize clinical information systems that provide actors with individual benefits and guide behavioural changes. A methodology is proposed to elicit and structure users' requirements using a process-oriented analysis, and it is applied to the field of blood transfusion. An object-oriented data model of a process has been defined in order to identify its main components: activity, sub-process, resources, constrains, guidelines, parameters and indicators. Although some aspects of activity, such as "where", "what else", and "why" are poorly represented by the data model alone, this method of requirement elicitation fits the dynamic of data input for the process to be traced. A hierarchical representation of hospital activities has to be found for this approach to be generalised within the organisation, for the processes to be interrelated, and for their characteristics to be shared.

Blood Transfusion↗

Navigating the Internet.

Navigating any complex set of information resources requires tools for both browsing and searching. A number of tools are available today for using Internet resources, and more are being developed. This article reviews existing navigational tools, including two developed at the Yale University School of Medicine, and points out their strengths and weaknesses. A major shortcoming of the present Internet navigation methods is the lack of controlled descriptions of the available resources. As a result, navigating the Internet is very difficult.

Computer Communication Networks↗

Computers in rheumatology.

The results of a nationwide survey of the use of computers in rheumatology departments in the UK is presented. The survey revealed a widespread interest in the various possible uses of computer hardware and software in the specialty, and highlighted the difference between the experience of those who use computers and the aspirations of those who hope to.

Medical Informatics Computing↗

Chem-tox informatics: data mining using a medicinal chemistry building block approach.

Relating chemical structure to biological activity is not a new endeavor, however, the ability to do this on large datasets is just emerging. To cope with the enormous amounts of data being generated, an assortment of computational methods has been developed in the fields of chemoinformatics and computational toxicology. Many of the molecular descriptors used in these approaches are abstract, theoretical constructs that are difficult to understand and visualize. Having easily recognized chemical features, such as those in several new programs, will allow chemists to use toxicological information (or any biological information) when designing new libraries. These improved chem-tox informatics systems will have an impact on library design, hit and lead optimization, development candidate testing and regulatory review.

Animals↗