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PubMed2001

History and trends in clinical information systems in the United States.

PURPOSE: To provide a synopsis of issues about clinical information systems for nurses not schooled in nursing informatics. ORGANIZING CONSTRUCT: The past, present, and future of clinical computing, including major factors resulting in the early hospital information systems (HIS) and decision support systems (DSS) in the United States, current advances and issues in managing clinical information, and future trends and issues. METHODS: Literature review and analysis. FINDINGS AND CONCLUSIONS: The first HIS and DSS were used in the late 1960s and were focused on applications for acute care. The change from fee-for-service to managed care required a change in the design of clinical information systems toward more patient-centered systems that span the care continuum, such as the computer-based patient record (CPR). Current difficulties with CPR systems include lack of systems integration, data standardization, and implementation. Increased advances in information and technology integration and increased use of the Internet for health information will shape the future of clinical information systems.

Decision Making, Computer-Assisted↗

PubMedDate not supplied

Gaining links: health information networks arise--with integration challenges.

As chins gain favor and efficiency in several regions of the country, they are increasingly used to speed both financial and clinical data interchanges. Technologic advances in information management are shifting the laboratory from a passive entity generating data to an active medical support service.

Clinical Laboratory Information Systems↗

PubMedDate not supplied

Computational systems analysis of developmental toxicity: design, development and implementation of a Birth Defects Systems Manager (BDSM).

Birth defects and developmental disabilities remain an important public health issue worldwide. With the availability of genomic sequences from a growing number of human and model organisms and the rapid expansion of the public repositories holding large-scale gene expression datasets, a computational systems analysis of developmental toxicology can incorporate this vast digital information toward the realization of predictive models for complex disease. Here we describe the initial design, development and implementation of a Birth Defects Systems Manager (BDSM). The project was motivated by the need for a computational-bioinformatics infrastructure to manage vast digital information from functional genomics and for a new knowledge environment specifically engineered for the analysis of developmental processes and toxicities. Proof-of-concept tested BDSM using meta-analysis of gene expression data collected from different laboratories, technology platforms, and study models. The composite dataset incorporated 232 microarray comparisons of RNA samples by single or dual microarray platforms, cDNA or oligonucleotide based probes, and human or mouse sequence information. Preliminary results identified system-level features in the embryonic transcriptome as it reacted to various developmental-teratological stimuli. BDSM is open access through the worldwide web (http://systemsanalysis.louisville.edu/) and can be integrated with other bioinformatics tools and resources to advance the pace of discovery in birth defects research.

Animals↗

PubMedDate not supplied

Transforming care: medical practice design and information technology.

The transformation of the medical practice is possible today because of the advancement of system design knowledge coupled with innovations in information technology (IT). Examples of such transformed care are present today, and they are creating a roadmap for others. Those efforts are also elucidating critical issues in the use of IT to advance health care quality. Connectivity, electronic integration, and knowledge management are the key functionalities emerging as levers to promote this transformation.

Chronic Disease↗

PubMed2003

The interaction of domain knowledge and linguistic structure in natural language processing: interpreting hypernymic propositions in biomedical text.

Interpretation of semantic propositions in free-text documents such as MEDLINE citations would provide valuable support for biomedical applications, and several approaches to semantic interpretation are being pursued in the biomedical informatics community. In this paper, we describe a methodology for interpreting linguistic structures that encode hypernymic propositions, in which a more specific concept is in a taxonomic relationship with a more general concept. In order to effectively process these constructions, we exploit underspecified syntactic analysis and structured domain knowledge from the Unified Medical Language System (UMLS). After introducing the syntactic processing on which our system depends, we focus on the UMLS knowledge that supports interpretation of hypernymic propositions. We first use semantic groups from the Semantic Network to ensure that the two concepts involved are compatible; hierarchical information in the Metathesaurus then determines which concept is more general and which more specific. A preliminary evaluation of a sample based on the semantic group Chemicals and Drugs provides 83% precision. An error analysis was conducted and potential solutions to the problems encountered are presented. The research discussed here serves as a paradigm for investigating the interaction between domain knowledge and linguistic structure in natural language processing, and could also make a contribution to research on automatic processing of discourse structure. Additional implications of the system we present include its integration in advanced semantic interpretation processors for biomedical text and its use for information extraction in specific domains. The approach has the potential to support a range of applications, including information retrieval and ontology engineering.

Abstracting and Indexing↗

PubMed2001

Barriers to sustainable water-quality management.

Due to the pressures of increasing population and developing economy all over the world, the present situation of water-quality management is far from satisfactory. To enhance sustainability of water-quality-management systems, in-depth research of the related barriers and the relevant mitigation approaches is desired. In this paper, recent developments, advancements, challenges, and barriers associated with practices of water-quality management were analyzed. A number of related methodologies, applications, and policy considerations were examined. Issues of information support, technology development, system integration, and policy implementation were discussed. Perspectives of sustainable water-quality management in the twenty-first century were investigated, demonstrating many demanding areas for enhanced research efforts, including issues of data availability and reliability, concerns in system complexity and methodology validity, limitations of computer techniques, usefulness of research outputs, difficulties in policy implementation, and necessity of training programs.

Decision Support Techniques↗

PubMed2005

Grid requirements for the integration of biomedical information resources for health applications.

OBJECTIVES: The goal of this paper is to identify how Grid technology can be applied for the development and deployment of integration systems, bringing together distributed and heterogeneous biomedical information sources for medical applications. METHODS: The integration of new genetic and medical knowledge in clinical workflows requires the development of new paradigms for information management in which the ability to access and relate disparate data sources is essential. We adopt a requirements perspective based on the user needs we have identified in the development of the INFOGENMED system to assess current Grid technology against those requirements. RESULTS: The gap between Grid features and distributed biomedical information integration needs is characterized. Results from prospective studies are also reported. CONCLUSIONS: Grid infrastructures offer advanced features for the deployment of collaborative computational environments across virtual organizations. New Grid developments are in line with the problem of multiple site information integration. From the INFOGENMED point of view, Grid infrastructures need to evolve to implement structured data access services and semantic content description and discovery.

Computational Biology↗

PubMed2002

Operating room management and strategies in Switzerland: results of a survey.

BACKGROUND AND OBJECTIVE: Operating room management structures and interrelationships both within the operating suite and with other departments in the hospital can be very complex. Several different professional and support groups are represented that often have infrastructures of their own that may compete or conflict with the management hierarchy in the operating room. Today, there is often little actual management of the operating suite as an entity. We surveyed current operating room management in Switzerland. METHODS: A questionnaire was sent to the chief anaesthesiologists of all public hospitals in Switzerland. It asked for information about the structure, organization and management of operating rooms as well as respondents' opinions and expectations about management. Derived from both the literature and the results of the survey, a 'stages of excellence' model of best practice was developed. RESULTS: The overall response rate was 70%. Most anaesthesiologists were unsatisfied with current management policies and structures in their operating rooms. Of the hospitals questioned, 40% did not have an information system at all for the operating rooms. The remaining 60% had an information system that allowed rough scheduling in 71%, but only a few had more sophisticated systems that enabled dynamic scheduling (19%), user-defined conflict checking (5%), administration of a subsequent patient transfer station (postanaesthesia care units, intensive medical care, intensive care units) (10%) or other more advanced uses. All hospitals questioned offered some type of ambulatory surgery in a 'hospital-integrated' manner (i.e. use of the same operating room for both in- and outpatient surgery), but none had implemented a more efficient system where outpatient surgery was performed in separate facilities. CONCLUSIONS: Current management of the operating room in Switzerland is far from best-practice standards.

Anesthesiology↗

PubMed1989

Information technology and the future of health services delivery.

This article examines the dramatic ways that information technology will influence clinical care, strategic management, and organization of the health care delivery system in the years ahead. Advancements in microprocessors, telecommunications, mass storage of data and images, and input-output devices will be accompanied by increased use of health-related software packages. Standardized patient record formats and coding systems will facilitate system integration and networking of computers. Clinical decision support systems will assist physicians in medical diagnosis and treatment. Computer-enhanced medical imaging and other noninvasive procedures will reduce surgery, patient pain and discomfort, and lower costs. Automation will get closer to the patient. Management information and decision support systems will be central to effective management in a highly competitive environment. Information systems will support strategic planning, cost control, productivity enhancement, quality improvement, and evaluation of products and services.

Delivery of Health Care↗

PubMed2006

ENN-ICS--implementation and evaluation of a multilingual learning management system for sleep medicine in Europe.

A new web based network aims at the improvement of health care in Europe by integrating advanced e-learning and e-publishing technologies for the training of medical doctors, nurses, and students. The field of application is sleep physiology and sleep medicine. Based on a multilingual, multimedia communication system, ENN-ICS Centre offers direct access to medical information for users, i.e healthcare professionals and citizens, in Europe and worldwide. The use of XML supports the development of media independent contents for multiple target groups. Editorial and distributive processes are supported by customized central editorial, content management and learning management systems (CMS, LMS). ENN-ICS e-health services are evaluated by selected user groups in North, Middle and Southern Europe using reliable and scientifically accepted validation instruments. The compliance with essential quality requirements and criteria is tested and verified by using online questionnaires based on the DISCERN questionnaire for evaluating patient information, the HON principles for health-related websites and the GMDS catalogue of quality criteria for electronic publications in medicine. The system architecture and its exemplary applications can be used as a model for future e-health services dealing with neurological and other medical topics.

Europe↗

PubMed1994

Physicians in health care management: 6. Physician bytes computer.

Revolutionary advancements in information technology are improving access to medical information, operational efficiency and clinical effectiveness. Health care facilities and agencies are planning to acquire information systems that will affect clinical and administrative functions. Federal and provincial agencies are beginning to define and collect diverse health care data and integrate them in a national database. As the demand for and access to information grows physicians will be key providers and users. They will have increasing access to critical patient data through clinical information systems; however, their practice patterns, clinical outcomes and resource utilization will also be subject to increasing scrutiny. To ensure appropriate use of technology and information systems, careful planning, selection, implementation and management will be needed. Physicians will require training to use the information and systems effectively. They must also recognize the increasing importance of such systems in delivering and managing health care; they must play a pivotal role in resolving management, information and systems issues and in promoting sound information and management strategies; and they must encourage research and education in medical informatics.

Attitude to Computers↗

PubMed2005

Modelling privilege management and access control.

OBJECTIVES: For establishing trustworthiness in advanced architectures for future-proof health information systems being open, flexible, scaleable, portable, and semantically interoperable, security and privacy services needed must be designed as an inherent part of the architecture. Such architecture has to meet the paradigms of distribution, component orientation, formal modelling, separation of logical and technological aspects, etc. METHODS: In model-driven architectures components providing security and privacy services have to be specified using the same methodology of formal models with meta-languages as expression means, as deployed in computational, technical, or medical domains. The resulting approach must be based on the ISO Reference Model-Open Distributed Processing. RESULTS: Currently, standards developing organisation are defining emerging tasks and standards for semantic interoperability and trustworthy collaboration for advanced health information systems. Communication security issues have been specified and implemented, while application security challenges such as privilege management and access control are still under development. Therefore, a series of formal models have been developed by the authors covering, e.g. domains, service delegation, claims control, policies, roles, authorisations, and access control. The required models are introduced and interpreted in a generic way. The crucial concept of security policy and its relationship to the other concepts has been considered in detail. CONCLUSION: Based on formal models, security services can be integrated into advanced systems architectures enabling semantic interoperability in the context of trustworthiness of communication and co-operation.

Access to Information↗

PubMed1991

A distributed approach to integrated inquiry and display for radiology.

Picture archive and communications (PACS) systems should be flexible and modular in design so that new advances in storage, computation, and display technology can be introduced into the system without a significant redesign of existing software. The acquisition, storage, and management of radiologic images must be carefully integrated with a radiology information system. Our architecture is based on a four-level data model: (1) patient information, (2) examination information and reports, (3) image information, and (4) instances of images. The PACS being developed at the Mallinckrodt Institute of Radiology within the Electronic Radiology Laboratory consists of three primary components: application clients, database servers and image servers. One type of application client is an image-capable workstation that supports a radiology image viewing application. The application client queries the database server for information regarding patient and examination data in response to user-level requests. The database server responds to the request by retrieving the appropriate patient demographics and examination information, along with a pointer to the image/instance data from a central database. The client then uses the image data pointer to query the image server for the actual pixel data. The image server responds by transmitting the pixel data to the requesting application client or a designated auxiliary display device. Other clients act as image data acquisition nodes. Queries to the database servers are made via a library of callable subroutines. Software integrity is maintained throughout the system by dynamically loading software from a code-control database. Inquiry and display transactions, supported on a local-area network (Ethernet), have been measured and analyzed. Results and observations are presented.

Computer Communication Networks↗

PubMed1994

Applying the Australian Quality Awards criteria to a clinical chemistry department.

National quality award schemes can provide a detailed self-assessment process enabling an organization to assess its current position and to highlight opportunities for further improvement along the road to implementing best practice. This article describes how the Australian Quality Awards were used to guide the intermediate stages of implementation and to integrate some advanced stages of implementation of total quality management within a clinical chemistry department.

Australia↗

PubMed2001

Sensing pathogens and tuning immune responses.

The immune system is capable of making qualitatively distinct responses against different microbial infections, and recent advances are starting to reveal how it manages this complex task. An integral component of the immune system is a network of cells known as dendritic cells (DCs), which sense different microbial stimuli and convey this information to lymphocytes. A better understanding of DC biology has allowed a model to be constructed in which the type of immune response to an infection is viewed as a function of several determinants, including the subpopulation of DCs, the nature of the microbe, microbe recognition receptors, and the cytokine microenvironment.

Animals↗

PubMed2002

Integrating the lightweight authentication protocol (LAP) with access control mechanisms in wireless health care information systems.

Health information networks are expected to support information exchange that is authentic, accurate, private and available when, where and to whom is needed. With the increase of the shared medical information and resources in healthcare wireless information systems, unauthorized access to the information by illegal users also increases. The security of the transmitted information is a vital issue. In this paper, we report on the development of the Lightweight Authentication Protocol (LAP), which makes a mobile and distributed system more secure and flexible and we implement it in a Health Care Environment where the clinicians use mobile and wireless devices like PDAs. We also provide an indicative example of integrating the LAP with access control mechanisms. Context-based Team Access Control (C-TMAC) model is used in this example, since it provides great flexibility on user-permissions management in collaborative healthcare environments. LAP is indeed capable to support efficiently the advanced authorization procedures of such demanding active security models.

Computer Security↗

PubMed2003

Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system.

Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.

Artificial Intelligence↗

PubMed1998

The evolution of an integrated timeline for oncology patient healthcare.

The introduction of computers in the medical environment has contributed to the proliferation of medical data, often making it difficult to consolidate information on a single patient. In patients with complex medical problems, such as oncology patients, the lack of data integration can negatively impact on patient care. This paper presents an infrastructure for the creation of an integrated multimedia timeline that automatically combines patient information from distributed hospital information sources, and creates a visual summary of pertinent events in a patient's medical history. In this prototype, we focus on oncology patients under treatment for advanced cancers.

Database Management Systems↗