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PubMed2000

DI2ADEM: an adaptive hypermedia designed to improve access to relevant medical information.

The World Wide Web (web) provides the same type of information to widely different users and these users must then find the information suitable for their use in the package offered. The authors present the DI2ADEM project designed to take the user into account and intended to provide this user with appropriate medical information. To do that, DI2ADEM is suggesting an adaptive hypermedia based on the management of a meta-knowledge of the user and a knowledge of the information that can be circulated. An adaptive hypermedia prototype devoted to paediatric oncology was implemented on the intranet network of a university hospital.

Diffusion of Innovation↗
PubMed2000

Speech recognition propels transcription revolution.

Speech recognition technology continues to develop. Now, with additional enhancements, the latest models offer solutions for entire enterprises. The author rounds up the latest developments.

Forms and Records Control↗
PubMed2000

The development of a new information model for a pediatric cancer registry on late treatment sequelae in The Netherlands.

Worldwide, the need is felt for life time follow up of survivors of childhood cancer and for the establishment of registries of the late effects of pediatric oncology treatments. There is however little consensus about how this all should take place. For example, agreement on the nature of this follow up and the type of data to be collected in view of the earlier diagnosis and treatment of the patient is lacking. In a close collaboration between the 'Late Effects Study Group' (consisting of the Pediatric Oncology department of the Emma Children's Hospital and the department of Medical Oncology at the Academic Medical Center), the Netherlands Cancer institute/Antoni van Leeuwenhoek Hospital, and the department of Medical Informatics of the University of Amsterdam, consensus was reached on a new dataset on adverse late effects of pediatric oncology treatment. This dataset was used in developing an information model for the design of a computerized documentation system, PLEKsys. PLEKsys covers both standardized documentation of all relevant data items for evaluating late effects and review facilities on individual patient basis and on patient cohorts. We will install PLEKsys at all Dutch pediatric oncology centers and use the information model as a starting point in developing a National Pediatric Oncology Follow up Registry. A national programme encompassing all Dutch pediatric oncology centers has already been set up to co-ordinate the construction of this national registry.

Child↗
PubMed2001

On the necessity of systematically planning clinical tumor documentation.

Tumor documentation is an important task for both clinical research and patient care. Documentation systems for these purposes have to be planned systematically and should be goal oriented. We applied the method of a so-called 'standardized documentation protocol' for systematically planning two documentation systems in oncology: one for the tumor center Heidelberg/Mannheim and the other for a nationwide project in the field of documentation and therapy planning in pediatric oncology. The method proved to be helpful in both cases even though the resulting documentation protocols are completely different and although they served different objectives. Therefore, the aim of the paper is to motivate and help medical informatics professionals to systematically plan other documentation systems using this method.

Child↗
PubMed2001

Proofs of the necessity of medical informatics for the physicians in Bulgaria.

It is obvious that medical practice needs to sustain a radical quality change due the fast penetration of information technologies in medicine and healthcare. One of the major problems of this change is the adequate education of the medical specialists to use these information and communication technologies, including Hospital information systems and electronic medical records. A study has been carried out among the physicians in Bulgaria. The aim of the study was to check weather the Bulgarian physicians are ready to face the challenges of modern information technologies in their daily medical practice. The results show that although 97.5% of the Bulgarian physicians have a positive attitude to information technologies and 86.7% recognise the need of using computers in medicine, 84.1% of them do not have the necessary skills and knowledge to use computers in their daily medical practice. They are absolutely unaware what the electronic medical record might contribute to their practice. Their knowledge of the subject, principles and methods of medical informatics tends to nil. The study was the first of the kind carried out in Bulgaria. It proved our initial hypothesis that Bulgarian physicians need to be educated not only how to use computers, they are in badly need of education in medical informatics. The study proved that the adequate education in medical informatics is one of the most important parameters for the implementation of information technologies, especially electronic medical records in medical practice. Its result may form the background for the preparation of the strategy of teaching medical informatics in Bulgaria. The first step of the implementation of this strategy is to include medical informatics in the regular curriculum of students of medicine.

Attitude to Computers↗
PubMed2001

Reinventing patient-centered computing for the twenty-first century.

Despite evidence over the past decade that patients like and will use patient-centered computing systems in managing their health, patients have remained forgotten stakeholders in advances in clinical computing systems. We present a framework for patient empowerment and the technical realization of that framework in an architecture called CareLink. In an evaluation of the initial deployment of CareLink in the support of neonatal intensive care, we have demonstrated a reduction in the length of stay for very-low birthweight infants, and an improvement in family satisfaction with care delivery. With the ubiquitous adoption of the Internet into the general culture, patient-centered computing provides the opportunity to mend broken health care relationships and reconnect patients to the care delivery process. CareLink itself provides functionality to support both clinical care and research, and provides a living laboratory for the further study of patient-centered computing.

Humans↗
PubMed2001

CHESS: ten years of research and development in consumer health informatics for broad populations, including the underserved.

This paper reviews the research and development around a consumer health informatics system CHESS (The Comprehensive Health Enhancement Support System) developed and tested by the Center for Health Systems Research and Analysis at the University of Wisconsin. The review will place particular emphasis on what has been found with regard to the acceptance and use of such systems by high risk and underserved groups.

Aged↗
PubMed2001

Common medical terminology comes of age, Part Two: Current code and terminology sets--strengths and weaknesses.

A number of clinical coding and vocabulary schemes are in use in healthcare enterprises today. Most of them are weak in light of the qualities that characterize adequate controlled medical terminologies, as outlined in Part One of this review. Here we look at the major code and terminology sets with a critical eye, as well as suggest practical steps to enable health industry information system purchasers and users to move forward with their effort to use common terminology to improve the quality, service, and knowledge in their enterprise.

Abstracting and Indexing↗
PubMed2002

The scope and direction of health informatics.

Health Informatics (HI) is a dynamic discipline based on the medical sciences, information sciences, and cognitive sciences. Its domain can broadly be defined as medical information management. The purpose of this paper is to provide an overview of this domain, discuss the current "state of the art," and indicate the likely growth areas for health informatics. The sources of information used in this paper are selected publications from the literature of Health Informatics, HI 5300: Introduction to Health Informatics, which is a course from the Department of Health Informatics at the University of Texas Houston Health Sciences Center, and the author's personal experience in practicing telemedicine and implementing an electronic medical record at the NASA-Johnson Space Center. The conclusion is that the direction of Health Informatics is in the direction of data management, transfer, and representation via electronic medical records and the Internet.

Forecasting↗
PubMed2002

[IT systems for clinical databases--status and perspectives].

Generally, the use of clinical databases for quality development in the hospital sector has not been satisfactory. A substantial problem attaches to the IT systems used hitherto. This article describes a number of requirements which the National Indicator Project has specified for a forthcoming second generation of clinical database system. Besides, the second generation system Clinical Performance Measurements which is used in the Copenhagen Hospital Corporation for several disease areas and for The Danish Vascular Registry is described. This experience emphasizes the need for central management of development initiatives within clinical quality databases. The management must allow for coordination, rational management and experience-based further development of IT systems for the clinical databases and integration with present and forthcoming systems including electronic patient record systems. The management should also allow for the decisive interaction between clinical quality development and medical informatics.

Data Collection↗
PubMed2002

Development of a time-oriented data warehouse based on a medical information event model.

We designed a new medical information event model and developed a time-oriented data warehouse based on the model. Here, the medical information event in a basic data unit is handled by a medical information system. The timing of decision making and treatment for a patient in the processing of his medical information is sometimes very critical. The time-oriented data warehouse was developed, to provide a search feature on the time axis. Our medical information event model has a unique simple data structure. PC-ORDERING2000 developed by NEC, which used Oracle, had about 600 pages of tables. However, we reduced these 600 complicated data structures to one unique and simple event model. By means of shifting clinical data from the old type order entry system into the new order entry system of the medical information event model, we produced a simple and flexible system, and the easy secondary use of clinical data of patients was realized. Evaluation of our system revealed heightened data retrieval efficiency and shortened response time 1:600 at a terminal, owing to the 1:600 reduction of the number of tables as mentioned above.

Databases, Factual↗
PubMed2003

Pervasive self-care solutions in telecardiology. Typical use cases from the EPI-MEDICS project.

In western countries, heart disease is the main cause of premature death. Most of cardiac deaths occur out of hospital. Because of a continuously growing elderly population, the number of heart attacks is steadily increasing. Symptoms are often interpreted incorrectly. Victims do not survive long enough to benefit from inhospital treatments. To reduce the time before treatment, the only useful diagnostic tool to assess the presence of a cardiac event is the electrocardiogram (ECG). Event and transtelephonic ECG recorders are used to improve decision-making but require setting up new infrastructures. The pervasive solution proposed by the European EPI-MEDICS project is an intelligent Personal ECG Monitor for the early detection of cardiac events. It includes part of the patient electronic health record (EHR), embeds a web server and decision-making techniques, generates different alarm levels and forwards alarm messages to the relevant care providers by means of new generation wireless communication. It is cost saving, involving care providers only if necessary, without requiring to set-up specific infrastructures. Healthcare becomes personalized, wearable and ubiquitous.

Arrhythmias, Cardiac↗