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PubMed1993

Evaluating consensus among physicians in medical knowledge base construction.

This study evaluates inter-author variability in knowledge base construction. Seven board-certified internists independently profiled "acute perinephric abscess", using as reference material a set of 109 peer-reviewed articles. Each participant created a list of findings associated with the disease, estimated the predictive value and sensitivity of each finding, and assessed the pertinence of each article for making each judgment. Agreement in finding selection was significantly different from chance: seven, six, and five participants selected the same finding 78.6, 9.8, and 1.6 times more often than predicted by chance. Findings with the highest sensitivity were most likely to be included by all participants. The selection of supporting evidence from the medical literature was significantly related to each physician's agreement with the majority. The study shows that, with appropriate guidance, physicians can reproducibly extract information from the medical literature, and thus established a foundation for multi-author knowledge base construction.

Abscess↗
PubMed1993

Repeated multiphasic screening examinations: evaluating the process.

There are sound clinical and epidemiological reasons to promote and emphasize early detection efforts and disease prevention services. A large body of scientific literature supports the notion that detection and intervention early in the course of many diseases is beneficial both to the afflicted individual and to society at large. Several publications deal with the evaluation of multiphasic screening examinations (MSE) as a tool for simultaneous early detection and prevention of multiple risk factors and various diseases. Usually, this technology is evaluated based on data from a single (cross-sectional) comprehensive screening study. However, frequently MSE are performed periodically, resulting in repeated test results of the same individuals. The health impact of such repeated (longitudinal) MSE has not been studied extensively. Similarly, many of the unique theoretical, technical, and epidemiological features characteristic of consecutive (periodical) comprehensive screening examinations are not well-documented. The purpose of this study was to compare the test results of two MSE, performed 3.5 years apart, in order to demonstrate certain characteristics of multiphasic health testing (MHT) technology related to repeated (longitudinal) multiphasic examination of the same individuals.

Humans↗
PubMed1993

Probability graphics support for medical reasoning.

Graphic displays of data from clinical observations and laboratory testing provide important support to the health practitioner in managing an increasing amount of complex information. A graphic display program is described that preserves much of the context of data that is important to their evaluation, and that maintains a sense of the strength of the signal when aberrant data are encountered.

Artificial Intelligence↗
PubMed1997

Informatics: a physician's view.

From bedside to boardroom, physicians are coming on-line to use automated information systems. Physicians are increasingly able to scroll through computer screens to scan images and lab summaries. But they will obtain their most critical data by listening to, observing, and examining patients. Practitioners will be driven in two diagnostic realms by informatics: acute care and chronic care. Training of both internists and surgeons will be enhanced. Nurses will be able to take on more of doctors' work. Telemedicine may eventually reduce patient visits to the office and doctors' trips to the emergency department. Health care system management is strengthened and network message traffic smoothed by informatics, but lack of trust will slow acceptance.

Acute Disease↗
PubMed1998

Tailoring communications for primary care settings.

In more and more medical settings, physicians have less and less time to be effective communicators. To be effective, they need accurate, current information about their patients. Tailored health communications can facilitate positive patient-provider communications and foster behavioral changes conducive to health. Tailored communications (TCs) are produced for an individual based on information about that person. The focus of this report is on tailored print communications (TPCs). TPCs also enhance the process of evaluation, because they require a database and the collection of patient-specific information. We present a Tailoring Model for Primary Care that describes the steps involved in creating TPCs. We also provide examples from three ongoing studies in which TPCs are being used in order to illustrate the kinds of variables used for tailoring the products that are developed and how evaluation is conducted. TPCs offer opportunities to expand the reach of health professionals and to give personalized, individualized massages in an era of shrinking professional contact time.

Decision Making, Organizational↗
PubMed1998

Computer assisted orthopaedic surgery. Image guided and robotic assistive technologies.

Technologies are emerging that will influence the way in which orthopaedic surgery is planned, simulated, and performed. Recent advances in the fields of medical imaging, computer vision, and robotics have provided the enabling technologies to permit computer aided surgery to become an established area which can address clinical needs. Although these technologies have been applied in industry for more than 20 years, the field of computer assisted orthopaedic surgery is still in its infancy. Image guided and surgical navigation systems, robotic assistive devices, and surgical simulators have begun to emerge from the laboratory and hold the potential to improve current surgical practice and patients' outcomes. The goals of these new clinically focused technologies are to develop interactive, patient specific preoperative planners to optimize the performance of surgery and the postoperative biologic response, and develop more precise and less invasive interactive smart tools and sensors to assist in the accurate and precise performance of surgery. The medical community is beginning to see the benefit of these enabling technologies which can be realized only through the collaboration and combined expertise of engineers, roboticists, computer scientists, and surgeons.

Biomedical Engineering↗
PubMedDate not supplied

Learning to think like a user: using cognitive task analysis to meet today's health care design challenges.

The growing role of information technology in our society has changed the very nature of many of the tasks that workers are called on to perform. Technology has resulted in a dramatic reduction in the number of proceduralized, rote tasks that workers must face. The impact of technology on many tasks and functions has been to greatly increase demands on the cognitive skills of workers. More procedural or predictable tasks are now handled by smart machines, while workers are responsible for tasks that require inference, diagnosis, judgment, and decision making. The increase in the cognitive demands placed on workers and the redistribution of tasks have created a need for a better understanding of the cognitive components of many tasks. This need has been recognized by many in the health care domain, including the U.S. Food and Drug Administration (FDA). Recent FDA regulations encourage the use of human factors in the development of medical devices, instruments, and systems. One promising set of methods for filling this need is cognitive task analysis.

Biomedical Engineering↗
PubMed1998

Information retrieval at the millenium.

Information retrieval systems were among the first medical informatics applications, yet their use has changed substantially in this decade with the growth of end-user computers and the Internet. While early challenges revolved around how to increase the amount of information available in electronic form, more recent challenges center on how to manage the growing volume. Traditional information retrieval issues--such as how to organize and index information to make it more retrievable as well as how to evaluate the effectiveness of systems--are still as pertinent as ever.

Abstracting and Indexing↗
PubMed1998

HCFA documentation guidelines and the need for discrete data: a golden opportunity for applied health informatics.

BACKGROUND: The medical community is shocked by the complexity of the documentation now required to support the Medicare billing codes. This situation represents an opportunity for Electronic Medical Records that use discrete data to become a central factor at the point of care by fulfilling these stringent documentation specifications. METHODS: This empirical study explores whether a discrete data EMR has the ability to generate automatically a report describing what billing code is consistent with the documentation recorded. We tested this hypothesis on HBOC Pathways SMR by attempting to create algorithms that reflected the HCFA guidelines. We validated this process using historical records from the Cleveland Clinic. RESULTS: All the data elements required by HCFA were available as discrete data. Using algorithms, the billing code consistent with the documentation of the health care encounter could be automatically generated. CONCLUSIONS: EMRs using discrete data can substantially reduce the burden placed on health care providers by HCFA's new documentation guidelines. This benefit creates a window of opportunity for health informatics to become an integral tool in the provision of health care. Using EMRs for billing purposes can help achieve the loftier goal of using EMRs for quality improvement.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2003

Craniofacial imaging informatics and technology development.

PURPOSE: 'Craniofacial imaging informatics' refers to image and related scientific data from the dentomaxillofacial complex, and application of 'informatics techniques' (derived from disciplines such as applied mathematics, computer science and statistics) to understand and organize the information associated with the data. METHOD: Major trends in information technology determine the progress made in craniofacial imaging and informatics. These trends include industry consolidation, disruptive technologies, Moore's law, electronic atlases and on-line databases. Each of these trends is explained and documented, relative to their influence on craniofacial imaging. RESULTS: Craniofacial imaging is influenced by major trends that affect all medical imaging and related informatics applications. The introduction of cone beam craniofacial computed tomography scanners is an example of a disruptive technology entering the field. An important opportunity lies in the integration of biologic knowledge repositories with craniofacial images. CONCLUSION: The progress of craniofacial imaging will continue subject to limitations imposed by the underlying technologies, especially imaging informatics. Disruptive technologies will play a major role in the evolution of this field.

Databases as Topic↗
PubMed2000

Agent-oriented captology for medical informatics.

Considering that neither captology nor agent-orientation, are applied in medical informatics, as they could be, the paper presents a broad-spectrum generic architectural framework to support developing adaptive medical applications, based on synergistic correlation between persuasive interfaces and intelligent agents. Their main features are adapted for medical informatics. Lying on this groundwork, the design space for agent-oriented persuasive applications is defined and several guidelines for its main dimensions are given. The approach is instantiated through an agent-based test-bench application, having the purpose to persuade to quit smoking.

Artificial Intelligence↗
PubMed1989

Teaching medical informatics to biomedical engineering students: experiences over 15 years.

The Departments of Biomedical Engineering and Medical Informatics at Linköping University in Sweden were established in 1972-1973. The main purpose was to develop and offer courses in medicine, biomedical engineering and medical informatics to students in electrical engineering and computer science, for a specialization in biomedical engineering and medical informatics. The courses total about 400 hours of scheduled study in the subjects of basic cell biology, basic medicine (terminology, anatomy, physiology), biomedical engineering and medical informatics. Laboratory applications of medical computing are mainly taught in biomedical engineering courses, whereas clinical information systems, knowledge based decision support and computer science aspects are included within the medical informatics courses.

Biomedical Engineering↗
PubMed2003

Hypertension and medical informatics.

BACKGROUND: Only about 27% of Americans with hypertension have their disease under control. Hypertension in the African-American population has a higher prevalence (32%) and is less likely to be treated or controlled compared with that in the caucasian population. Hypertension places a significant burden on patients and health care systems. Applications of medical informatics can facilitate the management of hypertension. Examples that illustrate the utility, status, and future potential of medical informatics applications in the treatment of hypertension are presented. METHODS: Relevant studies and review articles were accessed through a PubMed search of the English-language literature and for current Internet-based information for the time period of 1993-2002. Search terms included, but were not limited to, hypertension, medical informatics, medical information science, electronic medical records, Internet, and managed care. RESULTS: There is evidence that medical informatics has a favorable impact on health care issues as it relates to patients and physicians. Although the use of computers to assist in managing hypertension is in its infancy, there are examples where informatics applications have a demonstrated clinical value. CONCLUSIONS: Management of hypertension needs much improvement. The use of computers and the Internet in health care is expanding and expected to have a positive impact on the management of chronic diseases, such as hypertension.

Black People↗
PubMed1998

Design of a virtual reality laboratory for interdisciplinary medical application.

The Department of Medical Informatics of the University of Goettingen sets up a medical interdisciplinary Virtual Reality (VR) laboratory. The interdisciplinary approach for the design of the laboratory is based on a systematic, technical and application-orientated analysis. Its result led to the decision for a CAVE-like multi wall stereo projection (MWSP) system with networked workstation hardware. Within the boundary of an exemplary evaluation of the laboratory, its technical specifications and the validity in neuropsychological tests are supposed to be improved. Both techniques, Head Mounted Display (HMD) as well as multi wall stereo projection (MWSP) systems have a high degree of immersion. MWSP systems have a lower ratio of simulator sickness and a good visual fidelity. They can also be used as a multi-user environment. Networked workstations and high-end-computers are compared in view of their costs and possible expansibility.

Computer Simulation↗