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PubMedDate not supplied

MedDigital trends and tactics to lead into the future.

Physician executives need to harness appropriate digital technology by understanding key trends and implementing best tactics. Being and doing MedDigital means taking back control and improving care--and, at the same time, improving efficiencies and the bottom line. This article presents seven e-trends that are shaping health care: (1) Consumers and patients are pushing doctors to go digital; (2) from Web health information to MedDigital decision support; (3) beyond managed care to custom health; (4) wireless is the way of the new world; (5) Passive web portals yield to digital destinations; (6) e-commerce means lower transaction cost; and (7) develop e-health care ROI methodologies and track results. The authors provide myriad examples of new technology that will revolutionize health care and provide both physicians and consumers with valuable interactive tools to enhance health, treatment, and decision-making.

Ambulatory Care Information Systems↗
PubMed1998

Radiology information systems, picture archiving and communication systems, teleradiology--overview and design criteria.

Information technology (IT), long taken for granted in commercial settings, is now being utilized for health-care applications. Medical imaging has lagged comparatively due to the extremely vast data content of each frame; thus, the requirement for expensive high-end components. Further, IT in radiology has evolved from two distinctly separate camps--information systems, known as RIS (radiology information systems) and PACS (picture archiving and communications systems). Both RIS and PACS applications have migrated to the PC environment, enabling cost-effective implementation, but from two backgrounds: RIS from vendors using conventional information systems platforms and products, and PACS from radiographic film and modality vendors. The radiology department at Texas Tech University has assembled a seamlessly integrated, enterprise-wide RIS/PACS/teleradiology intranet. The design criteria include user-friendliness, flexibility to respond to changing needs, and open modular architecture to assure interoperability, cost-effectiveness, and future-proofing of investment. Since no single venor could provide an integrated system meeting our specifications, we decided to assume the burden of constructing our own system. As the system integrator, we embrace open architecture, thus enabling the incorporation of industry-standard-compliant, COTS (commercially off the shelf) products as modules. Microsoft Windows NT operating system, Visual C++ programming language, TCP/IP (transmission control protocol/internetworking protocol), relational SQL (structured query language) database, ODBC (open database connectivity), HL-7 (health level seven) and DICOM (digital imaging and communications in medicine) interfaces are utilized. The usage of COTS components reduces the cost to very affordable levels. With this approach, any module in our system can be replaced when outmoded, without affecting other modules in our system, making it truly future-proof. Construction and evolution of our system (TECHRAD) is reviewed.

Computer Systems↗
PubMed1999

Information systems integration in radiology.

Advances in information systems and technology in conjunction with outside forces requiring improved reporting are driving sweeping changes in the practice of radiology. In most academic radiology departments, there can be at least five separate information systems in daily use, a clinical picture archiving and communication system (PACS), a hospital information system (HIS), a radiology information system (RIS), a voice-recognition dictation system, and an electronic teaching/research file system. A PACS will have incomplete, incorrect, and inconsistent data if manual data entry is used. Correct routing of studies for diagnostic reporting and clinical review requires accurate information about the study type and the referring physician or service, often not easily entered manually. An HIS is a hospital-wide information system used to access patient information, reports from various services, and billing information. The RIS is typically a system specifically designed to place radiology orders, to receive interpretations, and to prepare bills for patients. Voice-recognition systems automatically transcribe the radiologist's dictation, eliminating transcription delays. Another system that is needed in a teaching hospital holds images and data for research and education. Integration of diverse systems must be performed to provide the functionality required by an electronic radiology department and the services it supports. Health Level 7 (HL7) and Digital Imaging and Communications in Medicine (DICOM) have enabled sharing of data among systems and can be used as the building blocks for truly integrated systems, but the user community and manufacturers need to specify the types of functionality needed to build clinically useful systems. Although technology development has produced the tools for interoperability for clinical and research/educational use, more work needs to be done to define the types of interaction that needs to be performed to realize the potential of these systems.

Computer Communication Networks↗
PubMed2003

Characterization of prediagnostic symptoms among primary epithelial ovarian cancer cases and controls.

OBJECTIVE: The goal of this study was to characterize types, frequency, combinations, and relative onset of symptoms among ovarian cancer cases and controls. METHODS: Participants were from an ongoing, population-based, case-control study of primary epithelial ovarian cancer in a 48-country region of North Carolina. Incident cases (N = 267), aged 20-74, were identified by area hospitals on a rapid case ascertainment basis between April 1999 and March 2001. Population-based controls, with at least one intact ovary, frequency matched on age and race, were identified using random-digit dialing (N = 287) and Health Care Financing Administration (HCFA) phone lists (N = 30). Trained nurse-interviewers, using a standardized questionnaire, asked participants about specific symptoms experienced for at least 2 weeks in the year prior to diagnosis (cases)/interview (controls). RESULTS: More than 90% of cases reported at least one symptom and symptoms were most often the reason for the doctor visit leading to diagnosis (74%), followed by routine examination (12%). Among invasive cases, symptoms with onsets longer before diagnosis (median 5-7 months) included gas/nausea/indigestion; urinary frequency/urgency; bowel irregularity; abnormal menstrual/vaginal bleeding or discharge; pain during intercourse; and ongoing fatigue. Symptoms with onsets closer to diagnosis (median of 2-4 months) included distended/hard abdomen; bloating/feeling of fullness; unexplained weight gain/loss; pelvic/abdominal discomfort; chest pain/respiratory difficulties; and "other" symptoms. Controls reported fewer symptoms than cases (median 1 vs 5 or 6). Control symptoms were of longer duration and much less likely to occur in combination. CONCLUSION: Earlier diagnosis of ovarian cancer may be possible if women and physicians recognize the importance of combinations of seemingly unrelated symptoms, especially those identified as occurring longer before diagnosis.

Adult↗
PubMed2000

Image analysis for discrimination of cervical neoplasia.

Colposcopy involves visual imaging of the cervix for patients who have exhibited some prior indication of abnormality, and the major goals are to visually inspect for any malignancies and to guide biopsy sampling. Currently colposcopy equipment is being upgraded in many health care centers to incorporate digital image acquisition and archiving. These permanent images can be analyzed for characteristic features and color patterns which may enhance the specificity and objectivity of the routine exam. In this study a series of images from patients with biopsy confirmed cervical intraepithelia neoplasia stage 2/3 are compared with images from patients with biopsy confirmed immature squamous metaplasia, with the goal of determining optimal criteria for automated discrimination between them. All images were separated into their red, green, and blue channels, and comparisons were made between relative intensity, intensity variation, spatial frequencies, fractal dimension, and Euler number. This study indicates that computer-based processing of cervical images can provide some discrimination of the type of tissue features which are important for clinical evaluation, with the Euler number being the most clinically useful feature to discriminate metaplasia from neoplasia. Also there was a strong indication that morphology observed in the blue channel of the image provided more information about epithelial cell changes. Further research in this field can lead to advances in computer-aided diagnosis as well as the potential for online image enhancement in digital colposcopy.

Adolescent↗
PubMed2005

Removing hidden patient data from digital images in PowerPoint.

OBJECTIVE: The purpose of this article is to discuss the potential issue of exposing patient information from digital images used in PowerPoint presentations. CONCLUSION: Current methods for safeguarding patient information in PowerPoint presentations still contain the potential for risk. In radiology, many digital images used in PowerPoint contain hidden patient identification information. Although cautious use of cropping and masking techniques has been adequate for presentation, the hidden information is still available as part of the digital image and may pose Health Insurance Portability and Account-ability Act (HIPAA) risks. This article will discuss the origin of this issue and describe simple solutions for permanently removing patient information using built-in PowerPoint functions.

Humans↗
PubMed2006

Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City men.

BACKGROUND: Persons reporting sexual identity that is discordant with their sexual behavior may engage in riskier sexual behaviors than those with concordant identity and behavior. The former group could play an important role in the spread of sexually transmitted diseases. OBJECTIVE: To describe discordance between self-described sexual identity and behavior among men who have sex with men and associations between identity-behavior and risk behaviors. DESIGN: Cross-sectional, random digit-dialed telephone survey of health status and risk behaviors. SETTING: New York City. PARTICIPANTS: Population-based sample of 4193 men. MEASUREMENTS: Concurrent measures of sexual identity and sexual behaviors, including number and sex of sex partners, condom use during last sexual encounter, and recent testing for HIV infection. Sex partner information was ascertained in a separate section from sexual identity; all participants were asked about the number of male sex partners and then were asked about the number of female sex partners in the past year. RESULTS: Of New York City men reporting a sexual identity, 12% reported sex with other men. Men who had sex with men exclusively but self-identified as heterosexual were more likely than their gay-identified counterparts to belong to minority racial or ethnic groups, be foreign-born, have lower education and income levels, and be married. These men were more likely than gay-identified men who have sex with men to report having only 1 sexual partner in the previous year. However, they were less likely to have been tested for HIV infection during that time (adjusted prevalence ratio, 0.6 [95% CI, 0.4 to 0.9]) and less likely to have used condoms during their last sexual encounter (adjusted prevalence ratio, 0.5 [CI, 0.3 to 1.0]). LIMITATIONS: The survey did not sample groups that cannot be reached by using residential telephone services. CONCLUSIONS: Many New York City men who have sex with men do not identify as gay. Medical providers cannot rely on patients' self-reported identities to appropriately assess risk for HIV infection and sexually transmitted diseases; they must inquire about behavior. Public health prevention messages should target risky sexual activities rather than a person's sexual identity.

Adolescent↗
PubMed2003

[Aspects of the Moscow fluorographic services status and possible approaches to its reorganization].

Due to the fact that modern digital fluorographic plants have been introduced into medical practice, it is necessary to elaborate new organizational and technological forms of work during fluorographic survey. For this, 1-2 Moscow okrugs completely equipped with digital fluorographic plants should be used to examine their actual capacities and on this basis to develop guidelines for detection of chest diseases by applying this new technological equipment. While organizing mass surveys by using digital fluorographs, it is necessary to take into account the definite conditions: health care facilities must be equipped with a uniform digital fluorograph; for continuity in work and information exchange, the software of all fluorographs must be unified within the city; a personified electronic fluographic card catalogue must be provided by identifying decreed contingents and tuberculosis risk groups; digital fluorographs must be fitted with the programmes that permit one to keep records and accounts in accordance with the approved official statistical forms; the database must be compatible in all users for prompt exchange of information on modem communication and for transmission of the results of a survey on diskette carriers; a fluorographic center wherein the fluorograms of individuals with suspected tuberculosis should be collected and deciphered (by modem communication or on diskette information carriers) must be set up on the basis of one of the tuberculosis dispensaries.

Adult↗
PubMed1997

Setting health priorities: community boards accurately reflect the preferences of the community's residents.

Setting priorities remains an important part of healthcare planning and program management. Local community input is often sought in government or publicly sponsored programs. Community policy/advisory boards are a common vehicle to represent the community's interests in program decisions and direction. Questions remain whether community boards accurately represent their communities' views. As part of a planning effort within Chicago and Cook County, Illinois, local District Health Councils (DHCs) have been created to provide assistance and leadership in systemization and improvement of the healthcare in communities with the poorest health status in the region. We sought to discover how closely the perceptions of health priorities of DHC members agreed with those of community members. A structured five-point Likert scale questionnaire of 22 of the most common diseases and conditions known to impact health were used for a random digit dialing telephone interview with a sample of 286 households from three under-served communities. The same interview was repeated with all DHC members (n = 80) representing those communities. Sociodemographic profiles and health-related behaviors were also collected. The results of this interview indicate a close and substantial agreement in priorities between community members and DHC members. Psychosocial conditions such as violence and substance abuse were ranked as the highest priorities by both groups. In contrast, sociodemographics and healthcare behavior differed significantly between DHC members and community's residents. This study demonstrates that these community policy/advisory boards can closely reflect the views of the communities they represent. Attention to their differences in sociodemographics and healthcare experiences with the community may strengthen their role even more.

Adult↗
PubMed2003

The role and importance of farriery in equine veterinary practice.

There is a lot of room for us to become the central source of medical information regarding shoeing and lameness in our own practice area. This takes a good bit of effort and a real "outreach" to client and farrier. It can be done with the one tool we are best at--the acquisition and careful dispensing of information that we can put together regarding the health of the foot. Such information includes the following: 1. Radiographically guided hoof trimming and shoeing. 2. Ultrasonography. 3. Digital radiography. 4. Thermography. 5. Nutritional and health counseling. Become the "local" expert in hoof health and farrier science. Publish a newsletter on the subject, and speak to small groups clients. Participate in farrier education at both the national and local level. Attend and/or speak at farrier symposiums. Do not be intimidated by the Internet. We have more "gurus" than they do. Tap into the stream of educational materials available, such as journals, videotapes, and colleague recommendations. Realize that you do not have to convince a national audience of your knowledge; the one client in front of you at the time is plenty. Take time to talk to farriers; discuss your ideas based on fact or clinical experience rather than dictating your thoughts, and do not lecture them unless you have a tray full of slides. Give them a goal rather than a prescription engraved on a stone tablet (ie, "we'd like to see this horse grow a little more heel"). Let them "choose" how to accomplish your goal. It is a good idea to be respectful in all discussions with people who carry hammers and bend iron for a living. All of us need to realize that there are probably more horses in the world today that spend their entire working lives unshod and without the benefit of our combined expertise. There is little doubt that they would be better off with our help in many instances, but the fact remains that many lead long productive lives unshod. This fact can lead to some confusion among many clients who suddenly ask for a "'mustang" trim or others who advocate a return to "natural" trims, not ever realizing that we have changed all the natural patterns of their horses' lives and physiology by introducing confinement, artificial bedding, weight bearing, and artificial diets, altering hoof growth in the process. Shoeing, hoof care, and hoof repair become necessary in many situations of domestication. We need to be skilled in assessing the appropriateness and quality of the shoes and technology used and thus help in the adaptation to demands placed on our equine patients. Conversely, we can use the principles of the natural trim and apply them to the foot as shown in Figs. 1 and 2 (Fig. 6). One must be aware of the latest in shoeing "fads" and realize that although certain shoes are suddenly popular because they solve one type of lameness, they are not always a substitute for tried and true methods (Fig. 7). Become familiar with the options, and work within the confines of your knowledge and with the assistance of a competent farrier.

Animal Husbandry↗
PubMed1998

Comparison of two methods for radiometric evaluation of resin-based restorative materials.

OBJECTIVES: To compare radiographic densitometry with indirect digital image analysis for evaluating the radiopacity of nine different resin-based restorative materials. METHODS: Discs of amalgam and nine different resin-based restorative material, 10 mm in diameter and 2 mm thick, were radiographed together with 2 mm thick discs of intact and carious human teeth and an aluminium stepwedge. Density was evaluated by digital transmission densitometry and with the histogram function of an image analysis programme (Image Tool 1.27, University of Texas Health Sciences Center, Texas, USA) following the digitization of the radiographs with a drum scanner. RESULTS: The two methods produced essentially similar results. With both methods, Dyract (Dentsply De Trey, Konstanz, Germany) had the highest radiodensity and Estilux Hybrid (Kulzer, Werheim, Germany) the lowest. CONCLUSION: Digital image analysis is a suitable alternative to transmission densitometry for evaluation of the radiopacity of restorative materials.

Absorptiometry, Photon↗
PubMedDate not supplied

Geographic information systems (GIS): new perspectives in understanding human health and environmental relationships.

Geographic information systems (GIS) and digital computer technology will advance the mission of the Centers for Disease Control and Prevention (CDC) and Agency for Toxic Substances and Disease Registry (ATSDR) to protect public health. Geographic positioning, topology, and planar and surface measurements are basic GIS properties which enable highly precise locational referencing of spatial phenomena. The growing uses of remotely sensed imagery and satellite facilitated global positioning systems are contributing to unprecedented surveillance of the environment and greater understanding of known and suspected environmental disease associations with human and animal health. Earth science and public health monitoring GIS databases offer new analytic opportunities for disease assessment and prevention.

CD-ROM↗
PubMed2005

Digital divide and stability of access in African American women visiting urban public health centers.

This exploratory study examines access to communication technologies, its association with health-related variables and study attrition, and its stability over time in a study of lower income African American women visiting urban public health centers. Participants (n = 1,227) provided information about cancer-related behaviors in a baseline questionnaire that also assessed their e-mail and cell phone/pager access. Interviews conducted at 1-, 6-, and 18-month follow up determined attrition, and an e-mail message sent to participants at 6-month follow up determined stability of access. Fewer than 10% of women reported e-mail access; 26% reported cell/phone pager access. At 6-month follow up, 45% of e-mail accounts were inactive; accounts from pay access providers were more likely to be inactive than work- or school-based accounts (58% versus 25%). Cell phone/pager access was positively associated with mammography knowledge. Attrition rates were lower among women with access than among those without access. Priorities for future research based on these preliminary findings are discussed.

Adolescent↗
PubMed2001

Time to learn: the outlook for renewal of patient-centred education in the digital age.

BACKGROUND: Major forces in society and within health systems are fragmenting patient care and clinical learning. The distancing of physician and trainee from the patient undermines learning about the patient-doctor relationship. The disconnection of care and learning from one successive venue to another impedes the ability of trainees to learn about illness longitudinally. METHODS: As a conceptual piece, our methods have been those of witnessing the experiences of patients, practitioners, and students over time and observing the impact of fragmented systems and changing expectations on care and learning. We have reflected on the opportunities created by digital information systems and interactive telemedicine to help renew essential relationships. RESULTS: Although there is, as yet, little in the literature on educational or health outcomes of this kind of technological enablement, we anticipate opportunities for a renewed focus on the patient in that patient's own space and time. Multimedia applications can achieve not only real-time connections, but can help construct a "virtual patient" as a platform for supervision and assessment, permitting preceptors to evaluate trainee-patient interactions, utilization of Web-based data and human resources, and on-line professionalism. CONCLUSIONS: Just as diverse elements in society are capitalizing upon digital technology to create advantageous relationships, all of the elements in the complex systems of health care and medical training can be better connected, so as to put the patient back in the centre of care and the trainee's ongoing relationship to the patient back in the centre of education.

Clinical Competence↗
PubMed2005

The visible human and digital anatomy learning initiative.

A collaborative initiative is starting within the Internet2 Health Science community to explore the development of a framework for providing access to digital anatomical teaching resources over Internet2. This is a cross-cutting initiative with broad applicability and will require the involvement of a diverse collection of communities. It will seize an opportunity created by a convergence of needs and technical capabilities to identify the technologies and standards needed to support a sophisticated collection of tools for teaching anatomy.

Anatomy↗
PubMed2004

The benefit of health insurance coverage of contraceptives in a population-based sample.

This study estimated the value of contraceptives, through a random-digit-dialed survey of willingness to pay for health insurance coverage of contraceptives among 659 Washington State adults. People valued contraceptives at 5 times the actuarial cost; in general, women and reproductive-aged persons were willing to pay more, but low-income men highly valued contraceptives. Most respondents (85%) said that contraceptives should be covered by health insurance plans. The full benefit of contraceptives exceeds their cost.

Actuarial Analysis↗