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Dental informatics. A cornerstone of dental practice.

BACKGROUND: Dental informatics is a relatively new field that has significant potential for supporting clinical care. Most dentists are unaware of what dental informatics is, what its goals are, what it has achieved and how they can get involved in it. METHODS: The authors conducted a literature review and several round-table discussions with dental informatics experts to discuss the preceding issues surrounding dental informatics. RESULTS: Dental informatics is the application of computer and information sciences to improve dental practice, research, education and management. Numerous applications that support clinical care, education and research have been developed. Dental informatics is beginning to exhibit the characteristics of a discipline: core literature, trained specialists and educational programs. CONCLUSIONS: Dental informatics presents possible solutions to many long-standing problems in dentistry, but it also faces significant obstacles and challenges. Its maturation will depend as much on the efforts of people as on the collective efforts of the profession. PRACTICE IMPLICATIONS: Dental informatics will produce an increasing number of applications and tools for clinical practice. Dentists must keep up with these developments to make informed choices.

Delivery of Health Care↗

Towards shared patient records: an architecture for using routine data for nationwide research.

Ubiquitous information is currently one of the most challenging slogans in medical informatics research. An adequate architecture for shared electronic patient records is needed which can use data for multiple purposes and which is extensible for new research questions. We introduce eardap as architecture for using routine data for nationwide clinical research in a multihospital environment. eardap can be characterized as terminology-based. Main advantage of our approach is the extensibility by new items and new research questions. Once the definition of items for a research question is finished, a consistent, corresponding database can be created without any informatics skills. Our experiences in pediatric oncology in Germany have shown the applicability of eardap. The functions of our core system were in routine clinical use in several hospitals. We validated the terminology management system (TMS) and the module generation tool with the basic data set of pediatric oncology. The multiple usability depends mainly on the quality of item planning in the TMS. High quality harmonization will lead to a higher amount of multiply used data. When using eardap, special emphasis is to be placed on interfaces to local hospital information systems and data security issues.

Biomedical Research↗

A data-gathering broker as a future-orientated approach to supporting EPR users.

With the continued expansion of electronic patient record systems ahead of comprehensive evidence, metrics, or future-proofing, health informatics in Europe and beyond is embarking on a faith-driven adventure that also risks data swamping of end-users. An alternative approach is an information broker system, drawing from departmental data sources. A 3-year study in health and social care has produced a first demonstrator which can search for specified information in heterogeneous distributed data stores, with source-specific permission can copy it, and then merge the search results into one integrated picture in a real-time process which is also captured in an audit system. The research project has addressed a number of issues during the study, including updating the concepts of role-based access, semantic interoperability, and harnessing web-based services bound at the time of need. A demonstrator now exists, and provides a platform for further application and development research. This paper summarises how this opens up a viable alternative approach for the next generation of health record systems, enabling record searching and integration as and when it is needed for specific patient-related purposes, whilst being independent of organisations, diagnostic approaches, or service delivery structures, and reducing the risks of data swamping.

Access to Information↗

Bridging the digital divide: reaching vulnerable populations.

The AMIA 2003 Spring Congress entitled "Bridging the Digital Divide: Informatics and Vulnerable Populations" convened 178 experts including medical informaticians, health care professionals, government leaders, policy makers, researchers, health care industry leaders, consumer advocates, and others specializing in health care provision to underserved populations. The primary objective of this working congress was to develop a framework for a national agenda in information and communication technology to enhance the health and health care of underserved populations. Discussions during four tracks addressed issues and trends in information and communication technologies for underserved populations, strategies learned from successful programs, evaluation methodologies for measuring the impact of informatics, and dissemination of information for replication of successful programs. Each track addressed current status, ideal state, barriers, strategies, and recommendations. Recommendations of the breakout sessions were summarized under the overarching themes of Policy, Funding, Research, and Education and Training. The general recommendations emphasized four key themes: revision in payment and reimbursement policies, integration of health care standards, partnerships as the key to success, and broad dissemination of findings including specific feedback to target populations and other key stakeholders.

Financing, Organized↗

Communities' readiness for health information exchange: the National Landscape in 2004.

BACKGROUND: The Secretary of Health and Human Services recently released a report calling for the nation to create a national health information network (NHIN) that would interconnect Regional Health Information Organizations (RHIOs). These RHIOs, which others have called Local or Regional Health Information Infrastructures (LHII), would in turn interconnect local as well as national health information resources. Little data exist about the activities taking place in communities to create LHIIs. APPROACH: The authors analyzed data that communities submitted in response to a request for capabilities issued by the Foundation for eHealth as part of their Connecting Communities for Better Health program using descriptive statistics and subjective evaluation. IMPRESSION: The authors analyzed data from 134 responses from communities in 42 states and the District of Columbia. Communities are enthusiastic about moving forward with health information exchange to create LHIIs to improve the efficiency, quality, and safety of care. They have identified significant local sources of investment and plan to use some clinical data standards but not as broadly as was expected. The communities have not yet developed the specific technical approaches or the sustainable business models that will be required. Many communities are interested in creating an LHII and are developing the leadership commitment needed to translate that interest into an operational reality. Clinical information standards can be incorporated into a community's plans as often as they need to be. Communities have to overcome funding issues, develop deeper understanding of the technical and organizational issues, and aggressively share their learning to succeed within their community and to help other communities succeed.

Community Networks↗

Enhancing the Metathesaurus with clinically relevant concepts: anatomic representations.

To create a comprehensive taxonomy for medical concepts it is necessary to identify gaps and reconcile differences that exist between clinical, bibliographic, and other source vocabularies. As part of the Unified Medical Language System project, we have proposed enhancements to the Metathesaurus by the inclusion of terms from two source vocabularies with different unique perspectives or views. This process has disclosed a number of issues that arise as complexity increases. These issues must be resolved if the resultant Metathesaurus is to support the variety of uses for which it is intended.

Abstracting and Indexing↗

Integrating medical informatics into an undergraduate medical curriculum.

his paper outlines a rationale for medical schools to integrate medical informatics into their curricula. The approach used in the problem-based undergraduate curriculum at Dalhousie University School of Medicine is presented in three areas: organizational structure, implementation, and curriculum development. Seven goal areas defined to guide the curriculum development process are described.

Computer Literacy↗

Representation of clinical data using SNOMED III and conceptual graphs.

None of the coding schemes currently contained within the Unified Medical Language System (UMLS) is sufficiently expressive to represent medical progress notes adequately. Some coding schemes suffer from domain incompleteness, others suffer from the inability to represent modifiers and time references, and some suffer from both problems. The recently released version of the Systematized Nomenclature of Medicine (SNOMED III) is a potential solution to the data-representation problem because it is relatively domain complete, and because it uses a generative coding scheme that will allow the construction of codes that contain modifiers and time references. SNOMED III does have an important weakness, however. SNOMED III lacks a formalized system for using its codes; thus, it fails to ensure consistency in its use across different institutions. Application of conceptual-graph formalisms to SNOMED III can ensure such consistency of use. Conceptual-graph formalisms will also allow mapping of the resulting SNOMED III codes onto relational data models and onto other formal systems, such as first-order predicate calculus.

Medical Informatics Applications↗

Issues and opportunities in public health informatics: a panel discussion.

A panel was convened at the American Medical Informatics Association Spring Congress to discuss issues and opportunities that arise when informatics methods, theories, and applications are applied to public health functions. Panelists provided examples of applications that connect efforts between public health and clinical care, emphasizing the need for integration of clinical data with public health data and the analysis of those data to support surveillance and informed decision making. Benefits to be gained by both medical informatics and public health at the interface were evident; both encounter the same major issues including privacy, systems integration, standards, and many more.

Congresses as Topic↗

An end user evaluation of query formulation and results review tools in three medical meta-search engines.

PURPOSE: Retrieving sufficient relevant information online is difficult for many people because they use too few keywords to search and search engines do not provide many support tools. To further complicate the search, users often ignore support tools when available. Our goal is to evaluate in a realistic setting when users use support tools and how they perceive these tools. METHODS: We compared three medical search engines with support tools that require more or less effort from users to form a query and evaluate results. We carried out an end user study with 23 users who were asked to find information, i.e., subtopics and supporting abstracts, for a given theme. We used a balanced within-subjects design and report on the effectiveness, efficiency and usability of the support tools from the end user perspective. CONCLUSIONS: We found significant differences in efficiency but did not find significant differences in effectiveness between the three search engines. Dynamic user support tools requiring less effort led to higher efficiency. Fewer searches were needed and more documents were found per search when both query reformulation and result review tools dynamically adjust to the user query. The query reformulation tool that provided a long list of keywords, dynamically adjusted to the user query, was used most often and led to more subtopics. As hypothesized, the dynamic result review tools were used more often and led to more subtopics than static ones. These results were corroborated by the usability questionnaires, which showed that support tools that dynamically optimize output were preferred.

Consumer Behavior↗