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PubMed1995

Managed care and health information networks.

Communication and data exchange among existing health information systems is becoming increasingly important in the health care industry. In a managed care environment, the focus is on delivering value by providing consumers access to high-quality health care at reasonable cost. This article explains how the use of a health information network in the managed care system, which links all related entities, improves the quality of health care by allowing access to critical data on demand and decreases the cost of delivery by enhancing communication among managed care providers.

Computer Communication Networks↗
PubMed1993

Advanced computer applications in radiology: clinical applications.

Computers play a major role in bridging the gap between image generation and patient care by providing enhanced images that better meet the needs of referring physicians. Spiral computed tomography allows generation of three-dimensional images that are not affected by motion artifact. Volume rendering, a three-dimensional reconstruction algorithm, yields images free of computer-generated artifacts and superior in quality. Currently, technologic computer advances play an important role in three clinical areas: orthopedic applications, oncologic applications, and prosthetic design. Three-dimensional imaging is especially valuable in fracture assessment because it allows exploration of image data to define the location of fracture fragments, the integrity of the joint space, and any possible displacement. With three-dimensional imaging, the extent of tumor spread into adjacent soft tissue or involvement of blood vessels can be determined, even in difficult anatomic areas. Volume rendering and increased computer speed allow greatly improved treatment planning for radiation therapy and custom design of orthopedic prostheses. Through the mutual understanding of goals between physicians and computer scientists, the computer can reach its full potential in medicine, resulting in improved patient care.

Diagnostic Imaging↗
PubMed1999

[The role of the biostatistician in biomedical research].

Medical research projects that involve any aspect of the collection, summarization, analysis and/or interpretation of clinical quantitative information require statistical support. This input may be provided by the clinicians themselves if properly trained, but is most appropriately and commonly achieved by a relationship with a biostatistician. The biostatistician can be an assistant, a consultant, or a colleague co-investigator. The role of the biostatistician in the research endeavor is one that is partially dictated by the nature of this relationship, but also is one that has evolved considerably in the recent past. This paper reviews the role of the biostatistician in terms of the potential contribution to the research, with special attention to the evolution of this role in light of the fast changes in computation and in statistical methodology. Finally, a method for biostatistical critical appraisal of the biomedical literature is proposed.

Biometry↗
PubMed1994

Computers: getting started.

Because there is not much written about computer application in the emergency department you will frequently find yourself reading about applications in other areas. It is up to you to apply this information in the emergency setting. This makes you pioneers, in search of a new and better tomorrow. Our future is not yet written. It is waiting on you and your creative ideas to keep the wagon rolling. Don't let the new territory of informatics, hardware hardships, and foreign computer languages get you down. Accept informatics as just another challenge, like the many we have faced successfully in the past. Use these resources and your expertise in emergency nursing to create innovative informatic systems.

Emergency Nursing↗
PubMed1987

Computer-aided quality assurance. A critical appraisal.

Computerized information systems hold the promise of overcoming problems in the management of clinical information Many of the claims of the creators and promoters of these systems, however, are not based on sound clinical studies. To determine the ability of computer information systems to improve the quality of medical care, we applied methodologic criteria to published articles in the field. Only 30 (22%) of 135 articles reported preplanned investigations, and only half of these met minimal criteria for scientific investigations. Fourteen studies were well designed and executed. All studies reported improvements in the process of care. However, patient outcomes were not measured, not affected, or only minimally influenced. While computer information systems show increasing potential, more work is required to enhance their effect on the quality of care and thus on patient outcomes.

Evaluation Studies as Topic↗
PubMed1999

Laparoscopy in the new century.

Minimally invasive surgery already has established itself as a useful tool in the management of trauma. The future holds exciting possibilities for this field, borne and fostered by innovative developments in imaging, computer technology, and artificial intelligence. The next millennium may witness the disappearance of trauma surgery as it is known today.

Artificial Intelligence↗
PubMed1998

Computer-facilitated collaboration: experiences building SNOMED-RT.

Collaborative development involving both individuals and groups is often less efficient than independent development because of communication overhead and integration costs. Despite the decreased development efficiency, collaborations promise more general-purpose products because of the opportunity for integration, with negotiation and reconciliation of diverse perspectives. Collaborations are also perhaps less costly when considered in contexts where there is significant duplication of effort. Computer-facilitated collaboration can reduce the communication and integration burden such that the increased effort required to manage a successful collaboration focuses primarily on the development of shared conceptual model among the developers by requiring that the work product be independently reproducible. This reproducibility requirement incorporates formal quality assurance processes into the development process. In this paper, we describe our initial experiences developing SNOMED-RT using such a computer-facilitated collaborative process. We quantify the extra costs incurred to achieve consistency in our efforts and reproducibility of our results.

Cooperative Behavior↗
PubMed1991

A multicenter study of data collection and communication at primary health care centers.

Health care delivery is information intensive. As computer applications make information available to the decision maker with speed and accuracy, informatics applications will strengthen the infrastructure. This paper is the second part of a multicenter systems analysis study to design a common application software to support primary health care focused on information flow. We present the questionnaire analysis and observations from a field study of a district health site. Analyses using contingency tables revealed differences, some statistically significant. The field study confirmed that minor differences exist even within a district health site. Development of a common application software on the basis of information flow studies is feasible. However, to make optimum use of computer implementation, revision of the health information systems was recommended. It was suggested that application software be developed with the core data set required by the care providers to deliver and administrators to manage a vertical health program.

Communication↗
PubMed2001

An elementary introduction to Bayesian computing using WinBUGS.

Bayesian statistics provides effective techniques for analyzing data and translating the results to inform decision making. This paper provides an elementary tutorial overview of the WinBUGS software for performing Bayesian statistical analysis. Background information on the computational methods used by the software is provided. Two examples drawn from the field of medical decision making are presented to illustrate the features and functionality of the software.

Bayes Theorem↗
PubMed1996

Computers, communication and confidentiality: tales of Baron Munchausen.

The aim was to examine the use of computer and paper based systems in accident and emergency (A&E) departments in the management of patients who are frequent attenders. More than half of the A&E consultants in the Thames regions who were sent a questionnaire responded (44 of the 80). 82% of the respondents use such systems predominantly to monitor violent patients, those with Munchausen syndrome, and children on the "at risk" register. Systems currently in use fail to fulfil many of the functions that would be required of an ideal system. When using computers to store and communicate clinical data, several ethical problems were identified but these appeared to be outweighed by the practical need and were also present with paper based systems. Safeguards could also be built into computer based systems to reduce some of the ethical problems. Computer systems should be deliberately chosen and implemented in response to a specific management problem. The potential benefits should be weighed against possible damaging side effects, such as a breach of confidentiality.

Confidentiality↗
PubMed2001

Gene expression profiles for monitoring radiation exposure.

Previous demonstrations that the dose, dose rate, radiation quality, and elapsed time since ionising radiation exposure result in variations in the response of stress genes suggest that gene expression signatures may be informative markers of radiation exposure. Defining sets of genes that ate specific for different outcomes of interest will be key to such an approach. A generalised post-exposure prolile may identify exposed individuals within a population, while more specific fingerprints may reveal details of a radiation exposure. Changes in gene expression in human cell lines occur after as little as 0.02 Gy rays, and in peripheral blood lymphocytes alter as little as 0.2 Gy. Diverse genes are also elevated in vivo in mice 24 h after 0.2 Gy irradiation. Ongoing microarray analyses meanwhile continue to identify large numbers of potential biomarkers from varied irradiation protocols. Development of computation-intensive informatics analysis methods will be needed for management of the complex gene expression profiles resulting from such experiments. Although the preliminary data are encouraging, significant work remains before meaningful correlations with risk or practical assessment of exposure can be made by gene expression profiling.

Gene Expression↗
PubMed1999

Nursing informatics. Issues for critical care medicine.

The demands of today's health care arena have forced the issue of automation and computerization. Nursing, as the major stakeholder in the collecting, managing, processing, transforming, and communicating of information regarding the patient, has developed a new approach to these tasks. Nursing informatics, which is the application of computer science and information science, is being used to manage and process the data, information, and knowledge necessary in the discipline. Although still in its infancy, nursing informatics has started to have a major effect on health care information gathering and clinical practice despite the multiple barriers to its advancement. Critical care is a data-rich environmental that can benefit from better management and processing of the data derived from the critically ill patient. Nursing and medical informatics joining together to organize the data, coupled with the introduction of good DSS and the addition of information retrieval systems at the bedside and the on-line medical record, will have a positive effect on the critical care environment and on the critical care patient outcomes.

Critical Care↗
PubMed1999

Toward a framework for computer-mediated collaborative design in medical informatics.

The development and implementation of enabling tools and methods that provide ready access to knowledge and information are among the central goals of medical informatics. The need for multi-institutional collaboration in the development of such tools and methods is increasingly being recognized. Collaboration involves communication, which typically involves individuals who work together at the same location. With the evolution of electronic modalities for communication, we seek to understand the role that such technologies can play in supporting collaboration, especially when the participants are geographically separated. Using the InterMed Collaboratory as a subject of study, we have analyzed their activities as an exercise in computer- and network-mediated collaborative design. We report on the cognitive, sociocultural, and logistical issues encountered when scientists from diverse organizations and backgrounds use communications technologies while designing and implementing shared products. Results demonstrate that it is important to match carefully the content with the mode of communication, identifying, for example, suitable uses of E-mail, conference calls, and face-to-face meetings. The special role of leaders in guiding and facilitating the group activities can also be seen, regardless of the communication setting in which the interactions occur. Most important is the proper use of technology to support the evolution of a shared vision of group goals and methods, an element that is clearly necessary before successful collaborative designs can proceed.

Communication↗
PubMedDate not supplied

Accuracy of on-site data entry in a rural primary care research network.

OBJECTIVE: This study examined how accurately research data can be entered into a database by rural research network members with little computer training and no data-entry experience. METHODS: A rural primary care research network in the Upper Peninsula of Michigan collected data from a study, and each practice entered its data on a standard database. The data were then sent electronically to the main research center where they were downloaded and analyzed. Accuracy of data entry was evaluated by comparing data received at the center with data on the original questionnaire. RESULTS: Accuracy of the data, entered by practice coordinators (nurses) with little or no computer experience, was completed with an error rate of one error per 220 keystrokes or .22 errors per 1,000 keystrokes. CONCLUSIONS: Results indicate that remote data entry in research networks can be accomplished accurately and reliably with little training.

Electronic Data Processing↗
PubMedDate not supplied

The Australian Medicines Handbook and its controlling vocabularies.

The Australian Medicines Handbook is intended to serve as an independent peer-reviewed knowledge resource for health care providers. A printed handbook is planned first, followed by electronic products. Information about medication will be dissected and entered into a detailed database, whose elemental nature should make it "computer understandable." The terms used in the database will be cross-referenced to preferred terms. Thus, the vocabulary will be controlled. The handbook will be printed directly from the database with use of database publishing techniques.

Australia↗
PubMed1997

Surveillance of antimicrobial resistance: the WHONET program.

Genes expressing resistance to each antimicrobial agent emerged after each agent became widely used. More than a hundred such genes now spread selectively through global networks of populations of bacteria in humans or animals treated with those agents. Information to monitor and manage this spread exists in the susceptibility test results of tens of thousands of laboratories around the world. The comparability of those results is uncertain, however, and their storage in paper files or in computer files with diverse codes and formats has made them inaccessible for analysis. The WHONET program puts each laboratory's data into a common code and file format at that laboratory, either by serving as or by translating from its own computer reporting system. It then enables each medical center to analyze its files in ways that help it monitor and manage resistance locally and to merge them with files of other centers for collaborative national or global surveillance of resistance.

Bacteria↗