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The role of the UMLS in 'storing' and 'sharing' across systems.

We will argue that 'sharing', 're-use', 're-purposing', and 'addition' of health care information is difficult, intrinsically; that the best way to overcome the difficulty is to start doing it, as soon as possible, and that the UMLS Knowledge Sources provide the best place to start. We recommend that the UMLS be used as a default source of biomedical concept names and relationships, as a comprehensive, data-based, 'reference model', and as an example of a large, ecumenical, evolving, continuously updated source of re-usable health care information.

Computer User Training↗

Integrating non-proprietary workstations into proprietary systems.

'Clinical workstations', increasingly described as pivotal components of information systems for patient care, can be characterized as providing several major functions: access to data, presentation of data, computation (including medical decision logic), entry of data, and combinations of the above, integrated appropriately for various clinical situations. Because workstation technology is developing rapidly on many fronts and the demands on health-care organizations are growing, it is increasingly unlikely that any single total-system solution can effectively meet the needs. This paper discusses some of the issues pertinent to the integration of non-proprietary workstations with proprietary hospital systems. The approach of a particular vendor, the role of a meta-database, user interface design standards, and some problems consequent to the new technologies are discussed.

Computer Security↗

An architecture for a health care provider's workstation.

This paper presents an architecture for a health care provider's workstation designed to assist health care providers in performing their daily activities. The design is based on the concept of a clinician's associate which acts as an intelligent intermediary between the provider and a diverse collection of clinical, administrative, and educational information sources. The architecture is designed to be hardware platform independent, to work across different I/O capabilities, and to be open, allowing specialized applications to be easily integrated with the system and their functionality delivered through a common user environment.

Computer Communication Networks↗

Health information systems - past, present, future.

In 1984, Peter Reichertz gave a lecture on the past, present and future of hospital information systems. In the meantime, there has been a tremendous progress in medicine as well as in informatics. One important benefit of this progress is that our life expectancy is nowadays significantly higher than it would have been even some few decades ago. This progress, leading to aging societies, is of influence to the organization of health care and to the future development of its information systems. Twenty years later, referring to Peter Reichertz' lecture, but now considering health information systems (HIS), two questions are discussed: which were lines of development in health information systems from the past until today? What are consequences for health information systems in the future? The following lines of development for HIS were considered as important: (1) the shift from paper-based to computer-based processing and storage, as well as the increase of data in health care settings; (2) the shift from institution-centered departmental and, later, hospital information systems towards regional and global HIS; (3) the inclusion of patients and health consumers as HIS users, besides health care professionals and administrators; (4) the use of HIS data not only for patient care and administrative purposes, but also for health care planning as well as clinical and epidemiological research; (5) the shift from focusing mainly on technical HIS problems to those of change management as well as of strategic information management; (6) the shift from mainly alpha-numeric data in HIS to images and now also to data on the molecular level; (7) the steady increase of new technologies to be included, now starting to include ubiquitous computing environments and sensor-based technologies for health monitoring. As consequences for HIS in the future, first the need for institutional and (inter-) national HIS-strategies is seen, second the need to explore new (transinstitutional) HIS architectural styles, third the need for education in health informatics and/or biomedical informatics, including appropriate knowledge and skills on HIS. As these new HIS are urgently needed for reorganizing health care in an aging society, as last consequence the need for research around HIS is seen. Research should include the development and investigation of appropriate transinstitutional information system architectures, of adequate methods for strategic information management, of methods for modeling and evaluating HIS, the development and investigation of comprehensive electronic patient records, providing appropriate access for health care professionals as well as for patients, in the broad sense as described here, e.g. including home care and health monitoring facilities. Comparing the world in 1984 and in 2004, we have to recognize that we imperceptibly, stepwise arrived at a new world. HIS have become one of the most challenging and promising fields of research, education and practice for medical informatics, with significant benefits to medicine and health care in general.

Computer Systems↗

Digital libraries--a quality concept.

The idea of digital libraries is not new, but recent developments have made the realisation of this idea more of a practical possibility than ever before. In particular, the availability of tools for easy access to information and for easy production of new information has encouraged traditional publishers to make their information available in digital networked form. but also made it possible for many individual authors to directly publish their own information on the Internet, bypassing traditional publishers and established bibliographic systems. Managing these new information resources is the task of Internet digital libraries such as OMNI. A key issue is the need to signpost the quality of information sources. A variety of ways of doing this are possible.

Computer Communication Networks↗

Use of large databases for resolving critical care problems.

Large databases allow for rapid access to large volumes of data. To convert raw data to information, large numbers of data points must be correlated into a descriptive pattern that can be interpreted by the user. Databases must be constructed so as to allow reliable extraction of the raw data into a format that supports analysis of events in a meaningful, objective, and reproducible manner. Databases must be responsive to a variety of users. They must not demand unrealistic amounts of effort on those responsible for data entry. Standard protocols in various stages of development will make databases easier to use and more reliable. Database management tools such as the Internet and the National Library of Medicine will become more integrated into the practice of critical care medicine at all levels, including administration, clinical care, and research. This article provides an overview of the capabilities and difficulties associated with large databases. The major areas of use of large databases in the hospital setting are administration, bibliographic, patient care, research, and education. Each of these areas has different requirements and is supported by different types of databases. The advantages and disadvantages of linear, relational, and object-oriented databases are discussed. Issues relating to methods of data entry and the accuracy and reliability of data are discussed. The challenges involving integration of various sources of data and the interfacing of devices are reviewed.

Critical Care↗

MRIDIR--a system for integrating research databases.

Lederle's Medical Research Integrated Database Information Retrieval (MRIDIR) system provides timely and facile access to a growing body of computerized, in-house data relating to pharmaceutical discovery and development. It was created in response to a proliferation of special-purpose programs, each dealing with a specific dataset and each with its own query syntax. Written in FORTRAN and interfacing to the System-1022 Database Management System, MRIDIR provides relational links between these datasets and, from the user's viewpoint, integrates them into a single database with a simple query language. A special dataset called the "data dictionary" describes these linkages, and alterations to the database structure (eg, addition of new datasets) are smoothly accomplished through changes to the data dictionary.

Drug Evaluation↗

Using views for retrieving data from extremely heterogeneous databanks.

Information in molecular biology or biology in general is contained in a multitude of different databanks each specializing in a certain area. This specialization is useful since it improves the maintainability of the data and the flexibility of the overall structure which until now manages to exist without almost any standards. However, information gathering from these extremely heterogeneous sources is difficult since the desired data may be scattered over many databanks. This paper presents the concept of views implemented in the retrieval system SRS that uses links between databanks and a sophisticated parsing engine for information extraction to provide a flexible way of searching and obtaining data across databank boundaries. The implementation provides homogeneous access to all databanks using two types of views: the list-view which displays selected data-fields in their original format and the table-view available for HTML and plain ASCII text which tries to represent the data in a format independent from that of the source databank.

Amino Acid Sequence↗

Online literature-retrieval systems: how to get started.

Basic information describing online literature-retrieval systems is presented; the power of online searching is also discussed. The equipment, expense involved, and training necessary to perform online searching efficiently is described. An individual searcher needs only a computer terminal and a telephone; by telephone, the searcher connects with an online vendor's computer at another location. The four major U.S. vendors (Dialog, Bibliographic Retrieval Services, Systems Development Corporation, and the National Library of Medicine) are compared. A step-by-step procedure of logging in and searching is presented. Using the International Pharmaceutical Abstracts database as an example, 17 access points to locating an article via an online system are compared with only two (the subject and author index entry) of a printed service. By searching online, one can search the published literature on a specific topic in a matter of minutes. An online search is very useful when limited information is available or the search question contains a term that is not in a printed index.

Drug Information Services↗

Genome Information Broker (GIB): data retrieval and comparative analysis system for completed microbial genomes and more.

Genome Information Broker (GIB) is a powerful tool for the study of comparative genomics. GIB allows users to retrieve and display partial and/or whole genome sequences together with the relevant biological annotation. GIB has accumulated all the completed microbial genome and has recently been expanded to include Arabidopsis thaliana genome data from DDBJ/EMBL/GenBank. In the near future, hundreds of genome sequences will be determined. In order to handle such huge data, we have enhanced the GIB architecture by using XML, CORBA and distributed RDBs. We introduce the new GIB here. GIB is freely accessible at http://gib.genes.nig.ac.jp/.

Arabidopsis↗

A one-step approach to data retrieval, analysis and documentation.

In this paper we propose a system architecture to support data retrieval from patient records, together with data analysis, and report generation. Moving from retrieval all the way to documentation should be done as in a pipeline, and computer support must minimize manual steps in this knowledge refinement scenario. A case study is drawn from urology for surgery on patients with lower urinary tract symptoms.

Computer Systems↗

[Use of an information-search diagnostic system for recognizing acute hereditary metabolic diseases with early lethal outcomes].

An information retrieval diagnostic system for hereditary metabolic diseases that are characterized by acute progression and early fatal outcome was developed. The system includes four databases: a list of nosological forms (n = 152), a list of clinical symptoms and characteristics (n = 1094), clinical portraits of every disease, and a list of biochemical characteristics (n = 1072). The system describes each disease as follows: clinical phenotype, etiology, genetics, pathogenesis, biochemical phenotype, paraclinical investigations, differential diagnosis, treatment, and prevention.

Acute Disease↗