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PubMedDate not supplied

Three decades of research on computer applications in health care: medical informatics support at the Agency for Healthcare Research and Quality.

The Agency for Healthcare Research and Quality and its predecessor organizations-collectively referred to here as AHRQ-have a productive history of funding research and development in the field of medical informatics, with grant investments since 1968 totaling $107 million. Many computerized interventions that are commonplace today, such as drug interaction alerts, had their genesis in early AHRQ initiatives. This review provides a historical perspective on AHRQ investment in medical informatics research. It shows that grants provided by AHRQ resulted in achievements that include advancing automation in the clinical laboratory and radiology, assisting in technology development (computer languages, software, and hardware), evaluating the effectiveness of computer-based medical information systems, facilitating the evolution of computer-aided decision making, promoting computer-initiated quality assurance programs, backing the formation and application of comprehensive data banks, enhancing the management of specific conditions such as HIV infection, and supporting health data coding and standards initiatives. Other federal agencies and private organizations have also supported research in medical informatics, some earlier and to a greater degree than AHRQ. The results and relative roles of these related efforts are beyond the scope of this review.

Databases, Factual↗
PubMed1994

Health service production in the view of medical informatics.

Medical informatics aims to improve the process and the result of health care delivery, both in its theoretical and practical aspects through the application of formal methods and concepts of informatics and the utilization of up-to-date information and communication technology. As part of a theoretical framework this paper deals with the factors of production, the constitutive criteria and the formal aspects of health service production in the view of medical informatics.

Delivery of Health Care↗
PubMed1995

American College of Physicians (ACP) medical informatics and telemedicine.

The American College of Physicians (ACP) is the largest speciality society in the United States with over 83,000 Internal Medicine physician members. ACP seeks to be the foremost comprehensive education and information resource for all internists in support of its mission "to enhance the quality and effectiveness of health care." Medical Informatics and telemedicine is an integral part of the American College of Physicians' strategy to achieve its goals. ACP Medical Informatics Subcommittee and staff develop ACP policies and programs to improve clinical care and medical education through the use of Information Systems and new technologies for managing and integrating medical information and knowledge. This paper describes present and planned ACP informatics and telemedicine programs and projects focussing particularly on strategies to meet physicians' information needs incident to their patient care activities.

Forecasting↗
PubMed1995

The role of medical informatics in telemedicine.

The role of medical informatics in telemedicine is dependent on using the power of the computerized database to not only feed patient specific information to the health care providers, but to use the epidemiological and statistical information in the data base to improve decision making and ultimately care. The computer is also a powerful tool to facilitate standardizing and monitoring of care and when applied in continuous quality improvement methodology it can enhance the improvement process well beyond what can be done by hand. The coupling of medical informatics with telemedicine allows sophisticated medical informatics systems to be applied in low population density and remote areas.

Databases, Factual↗
PubMed2006

Leading knowledge producers within the biomedical informatics community.

OBJECTIVES: To present findings on academic leadership within the biomedical informatics community based upon the number of research articles produced by authors, institutions, and countries within five biomedical informatics journals. METHODS: Five biomedical informatics journals were analyzed for the most producing author, institution, and country for two time periods: 1995-1999 and 2000-2004. RESULTS: Results show that an overall trend exists whereby the academic leadership for author, institution, and country is the U.S. The results exist for both time periods of 1995-1999 and 2000-2004. CONCLUSIONS: Even though individual institutional and author rankings may have fluctuated within the two time periods (1995-1999 and 2000-2004), U.S. dominance at the institutional and author level remains significant within the five biomedical journals selected for this study.

Internationality↗
PubMed2006

Interrogating the druggable genome with structural informatics.

Structural genomics projects are producing protein structure data at an unprecedented rate. In this paper, we present the Target Informatics Platform (TIP), a novel structural informatics approach for amplifying the rapidly expanding body of experimental protein structure information to enhance the discovery and optimization of small molecule protein modulators on a genomic scale. In TIP, existing experimental structure information is augmented using a homology modeling approach, and binding sites across multiple target families are compared using a clique detection algorithm. We report here a detailed analysis of the structural coverage for the set of druggable human targets, highlighting drug target families where the level of structural knowledge is currently quite high, as well as those areas where structural knowledge is sparse. Furthermore, we demonstrate the utility of TIP's intra- and inter-family binding site similarity analysis using a series of retrospective case studies. Our analysis underscores the utility of a structural informatics infrastructure for extracting drug discovery-relevant information from structural data, aiding researchers in the identification of lead discovery and optimization opportunities as well as potential "off-target" liabilities.

Databases, Factual↗
PubMed2006

Informatics tools to improve clinical research study implementation.

BACKGROUND: There are numerous potential sources of problems when performing complex clinical research trials. These issues are compounded when studies are multi-site and multiple personnel from different sites are responsible for varying actions from case report form design to primary data collection and data entry. METHODS: We describe an approach that emphasizes the use of a variety of informatics tools that can facilitate study coordination, training, data checks and early identification and correction of faulty procedures and data problems. The paper focuses on informatics tools that can help in case report form design, procedures and training and data management. CONCLUSION: Informatics tools can be used to facilitate study coordination and implementation of clinical research trials.

Clinical Trials as Topic↗
PubMed2004

Promoting patient safety through informatics-based nursing education.

The Institute of Medicine (IOM) Committee on Quality of Health Care in America identified the critical role of information technology in designing safe and effective health care. In addition to technical aspects such as regional or national health information infrastructures, to achieve this goal, healthcare professionals must receive the requisite training during basic and advanced educational programs. In this article, we describe a two-pronged strategy to promote patient safety through an informatics-based approach to nursing education at the Columbia University School of Nursing: (1) use of a personal digital assistant (PDA) to document clinical encounters and to retrieve patient safety-related information at the point of care, and (2) enhancement of informatics competencies of students and faculty. These approaches may be useful to others wishing to promote patient safety through using informatics methods and technologies in healthcare curricula.

Curriculum↗
PubMed2005

Evaluation frameworks for nursing informatics.

Rigorous evaluation of informatics applications in healthcare is important so that the impact of such systems can be understood. Although many quantitative methods have been employed to evaluate informatics systems, there is a growing trend to utilized qualitative methods during both the formative and summative phases of research. Several evaluation frameworks that have been proposed highlight the need for both qualitative and quantitative evaluation methods in the development and post-implementation phases of informatics systems development. Recommendations regarding the timing, type and use of qualitative methods differ for each of these frameworks. This paper examines the strengths and weaknesses of the published evaluation frameworks and enumerates the qualitative research methods in use in each of these frameworks.

Nursing Informatics↗
PubMed2004

Synergy between medical informatics and bioinformatics: facilitating genomic medicine for future health care.

In this paper, we review the results of BIOINFOMED, a study funded by the European Commission (EC) with the purpose to analyse the different issues and challenges in the area where Medical Informatics and Bioinformatics meet. Traditionally, Medical Informatics has been focused on the intersection between computer science and clinical medicine, whereas Bioinformatics have been predominantly centered on the intersection between computer science and biological research. Although researchers from both areas have occasionally collaborated, their training, objectives and interests have been quite different. The results of the Human Genome and related projects have attracted the interest of many professionals, and introduced new challenges that will transform biomedical research and health care. A characteristic of the 'post genomic' era will be to correlate essential genotypic information with expressed phenotypic information. In this context, Biomedical Informatics (BMI) has emerged to describe the technology that brings both disciplines (BI and MI) together to support genomic medicine. In recognition of the dynamic nature of BMI, institutions such as the EC have launched several initiatives in support of a research agenda, including the BIOINFOMED study.

Biotechnology↗
PubMedDate not supplied

Nursing and the informatics revolution.

The Institute of Medicine's quality initiatives have collectively emphasized the importance of information technology to the transformation of health care. Not coincidentally, federal initiatives in 2004 have signaled the start of "the decade of health information technology." Building on those reports, this article describes the informatics revolution in process, and nursing's readiness to move in that direction. The promise of informatics in reshaping practice is sketched out in terms of seven aims for improvement, followed by a listing of some of the issues that must be addressed for nursing to realize those possibilities. In similar fashion, changes in academia are discussed both in terms of the promise of informatics applications and the barriers to achieving that preferred future. The article ends with some policy recommendations and reflections on opportunities at hand, particularly the growing emphasis on patient self-management support.

Informatics↗
PubMed2000

The echocardiography laboratory in the informatic era.

This article overviews the latest progress in echocardiography in this informatic era. We will present new, different techniques available in clinical settings for qualitative and quantitative evaluation of global and regional left ventricular function, showing their helpfulness in clinical work. We will also report our personal experiences with 3-dimensional (3-D) echocardiography in quantification of left ventricular total mass and left-ventricular dysfunctional mass, and in evaluation of left-ventricular parietal stress. Finally, we will show how the organization of a modern echocardiography laboratory is changing after informatic progress: we will report our personal experiences about transmission of echocardiography data between 2 work stations, located in different places; in this way we can realize an informatic web, which can go out from the single echocardiography laboratories and move toward intradepartment and interdepartment services.

Echocardiography, Three-Dimensional↗
PubMed1998

The importance of developing an informatics framework for mental health.

Though mental health services are important in human terms, and account for a tenth of health expenditure, they are not well served in informatics developments. There are no specific mental health components in the European Union's health telematics programmes, and there is similar under-representation in national programmes. Yet telematics has much to offer mental health services and their management, and can address directly current service anxieties. Telematics concepts which could benefit mental health include integrated, multi-disciplinary records, real-time multi-site record access, and structured programmes to plan, schedule, and monitor care delivery. The power of information systems to sort data, and to represent them graphically, can sift like data items from complex records, and can present them in displays which highlight their significance. Above all, quality of care can be enhanced by monitoring, and by improved outcome measurement. However, a planned programme of research and development is needed, to relate and adjust current health informatics techniques to the special attributes of mental health. The World Health Organisation has identified the potential of such a programme, but greater vision and commitment is needed at policy level if mental health services and patients are to receive the benefits from health informatics which are available to the physically ill.

Abstracting and Indexing↗
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↗
PubMed2002

Discovery informatics: its evolving role in drug discovery.

Drug discovery and development is a highly complex process requiring the generation of very large amounts of data and information. Currently this is a largely unmet informatics challenge. The current approaches to building information and knowledge from large amounts of data has been addressed in cases where the types of data are largely homogeneous or at the very least well-defined. However, we are on the verge of an exciting new era of drug discovery informatics in which methods and approaches dealing with creating knowledge from information and information from data are undergoing a paradigm shift. The needs of this industry are clear: Large amounts of data are generated using a variety of innovative technologies and the limiting step is accessing, searching and integrating this data. Moreover, the tendency is to move crucial development decisions earlier in the discovery process. It is crucial to address these issues with all of the data at hand, not only from current projects but also from previous attempts at drug development. What is the future of drug discovery informatics? Inevitably, the integration of heterogeneous, distributed data are required. Mining and integration of domain specific information such as chemical and genomic data will continue to develop. Management and searching of textual, graphical and undefined data that are currently difficult, will become an integral part of data searching and an essential component of building information- and knowledge-bases.

Artificial Intelligence↗
PubMed2003

Open Source software in medical informatics--why, how and what.

'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.

Database Management Systems↗
PubMed1998

Assessing the progress of the M.Sc. course in health informatics under the ERASMUS programme.

Health informatics is an emerging and important multi-disciplinary field that involves, informatics but also medicine, nursing, engineering, biology and other-related subjects. A co-ordination of this field at a postgraduate level becomes important now in Europe where other European Community programs such as the 'Telematics for Health Care' will require at the Fourth Framework Programme (94-99) adequate human resources of higher potential and knowledge. This European M.Sc. course meets all the above objectives. The Curriculum was developed according to the results of the ERASMUS Workshop, which was held in Athens on 13-15 September 1990 under the ERASMUS Contract number ICP-90-G-0009/12. The implementation now runs under the contract ICP-95-G-1038/12. The 6-year evaluation of the course based both on staff and student evaluation proved that the M.Sc. course in health informatics has been successful.

Curriculum↗
PubMed1998

Teaching the fundamentals of information systems management in health care. Lecture and practical training for students of medical informatics.

For the management of information systems in health care, it is important that projects are systematically planned and carried out. This is a major task for medical informatics professionals which should be taught in a medical informatics curriculum. In the respective lecture in the Heidelberg/Heilbronn medical informatics curriculum, we teach fundamentals of the management of information systems and of projects. The examples of the lecture are taken from hospital information systems. Furthermore, we have developed a 5-step method for the systematic, goal-oriented planning of projects. The lecture is complemented by a comprehensive practical training, so that the methods taught can be applied to a particular, relevant problem of the Heidelberg University Hospital.

Curriculum↗