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PubMed2001

Information technology sophistication in health care: an instrument validation study among Canadian hospitals.

Several empirical studies have shown that the use of computer-based information systems could have positive impacts on organizational performance. Many agree to say that health care organizations are no exceptions. But if one wishes to identify the effects of information technology (IT) on the delivery of care, one must be able to characterize IT for operationalization purposes. The primary objective of this research project is to develop and validate a measurement instrument of IT sophistication in the hospital milieu. Such instrument should provide hospital managers with a diagnostic tool capable of indicating the profile of their respective institutions in regard to IT adoption and comparing this profile to those of other similar medical centers. Both qualitative and quantitative data were collected in order to assess the psychometric properties of the measurement instrument. Overall, findings suggest a high-moderate level of functional sophistication, a somewhat low level of technological sophistication, and an even lower level of integration sophistication in all of the sampled medical centers. Hence, future investments shall therefore be directed towards the integration of clinical and administrative applications and the acquisition of more advanced technological devices, more specifically those, which allow direct capture of clinical data at the bedside.

Computer Literacy↗
PubMedDate not supplied

Managing human resources in a changing health-care environment.

Managing human resources in this era of precipitous change poses one of the most difficult challenges and opportunities for leaders in the clinical laboratory. Shifts in health systems integration, cost control, patient-focused managed care, and provider changes have led to trends which fundamentally alter the way in which clinical laboratory services are organized, provided, and funded. To be successful change agents, laboratory managers must understand the cycle of human resource development and how people adopt change. They must embrace a systems thinking perspective and develop strategic leadership skills to share a vision of what the laboratory of the future will be. These new, advanced human resource management skills can be acquired through a variety of formal and informal learning experience.

Clinical Competence↗
PubMed2005

Bioinformatic insights from metagenomics through visualization.

Cutting-edge biological and bioinformatics research seeks a systems perspective through the analysis of multiple types of high-throughput and other experimental data for the same sample. Systems-level analysis requires the integration and fusion of such data, typically through advanced statistics and mathematics. Visualization is a complementary computational approach that supports integration and analysis of complex data or its derivatives. We present a bioinformatics visualization prototype, Juxter, which depicts categorical information derived from or assigned to these diverse data for the purpose of comparing patterns across categorizations. The visualization allows users to easily discern correlated and anomalous patterns in the data. These patterns, which might not be detected automatically by algorithms, may reveal valuable information leading to insight and discovery. We describe the visualization and interaction capabilities and demonstrate its utility in a new field, metagenomics, which combines molecular biology and genetics to identify and characterize genetic material from multi-species microbial samples.

Algorithms↗
PubMed2006

RAMEDIS: the rare metabolic diseases database.

UNLABELLED: The RAMEDIS system is a platform-independent, web-based information system for rare diseases based on individual case reports. It was developed in close cooperation with clinical partners and collects information on rare metabolic diseases in extensive detail (e.g. symptoms, laboratory findings, therapy and genetic data). This combination of clinical and genetic data enables the analysis of genotype-phenotype correlations. By using largely standardised medical terms and conditions, the contents of the database are easy to compare and analyse. In addition, a convenient graphical user interface is provided by every common web browser. RAMEDIS supports an extendable number of different genetic diseases and enables cooperative studies. Furthermore, use of RAMEDIS should lead to advances in epidemiology, integration of molecular and clinical data, and generation of rules for therapeutic intervention and identification of new diseases. AVAILABILITY: RAMEDIS is available from http://www.ramedis.de CONTACT: Thoralf Töpel (thoralf.toepel@uni-bielefeld.de).

Computational Biology↗
PubMed1995

Implementing network security guidelines in health care information systems.

A Health Care Establishment (HCE) is an establishment where medical services are rendered. These services are provided by the health care personnel. The infrastructure of a HCE may include Information Technology (IT) equipment that stores and processes HC information. The spread of distributed information technology in HCEs have necessitated the implementation of Network Security in Health Care Information System (HCISs), to assure confidentiality, integrity and availability of HC information being transmitted across HC networks. This paper presents a road map in implementing Network Security guidelines for the provision of Network Security in HCEs, work carried out within the Secure Environment for Information Systems in Medicine (SEISMED) project under the Advanced Informatics in Medicine (AIM) programme.

Computer Communication Networks↗
PubMed2006

eLearning in education and advanced training in neuroradiology: introduction of a web-based teaching and learning application.

INTRODUCTION: New information technologies offer the possibility of major improvements in the professional education and advanced training of physicians. The web-based, multimedia teaching and learning application Schoolbook has been created and utilized for neuroradiology. METHODS: Schoolbook is technically based as a content management system and is realized in a LAMP environment. The content is generated with the help of the developed system and stored in a database. The layout is defined by a PHP application, and the webpages are generated from the system. RESULTS: Schoolbook is realized as an authoring tool so that it can be integrated into daily practice. This enables the teacher to autonomously process the content into the web-based application which is used for lectures, seminars and self-study. A multimedia case library is the central building block of Schoolbook for neuroradiology, whereby the learner is provided with original diagnostic and therapeutic data from numerous individual cases. The user can put individual emphasis on key learning points as there are various ways to work with the case histories. Besides the case-based way of teaching and learning, a systematically structured way of dealing with the content is available. CONCLUSION: eLearning offers various opportunities for teaching and learning in academic and scientific as well as in economic contexts. Web-based applications such as Schoolbook may be beneficial not only for basic university education but also for the realization of international educational programmes such as the European Master of Medical Science with a major in neuroradiology.

Computer-Assisted Instruction↗
PubMed2006

Mouse Tumor Biology Database (MTB): status update and future directions.

The Mouse Tumor Biology (MTB) database provides access to data about endogenously arising tumors (both spontaneous and induced) in genetically defined mice (inbred, hybrid, mutant and genetically engineered mice). Data include information on the frequency and latency of mouse tumors, pathology reports and images, genomic changes occurring in the tumors, genetic (strain) background and literature or contributor citations. Data are curated from the primary literature or submitted directly from researchers. MTB is accessed via the Mouse Genome Informatics web site (http://www.informatics.jax.org). Integrated searches of MTB are enabled through use of multiple controlled vocabularies and by adherence to standardized nomenclature, when available. Recently MTB has been redesigned and its database infrastructure replaced with a robust relational database management system (RDMS). Web interface improvements include a new advanced query form and enhancements to already existing search capabilities. The Tumor Frequency Grid has been revised to enhance interactivity, providing an overview of reported tumor incidence across mouse strains and an entrée into the database. A new pathology data submission tool allows users to submit, edit and release data to the MTB system.

Animals↗
PubMed1995

[Application of patient card technology to health care].

The potential benefits of patient card technology in improving management and delivery of health services have been explored. Patient cards can be used for numerous applications and functions: as a means of identification, as a key for an insurance payment system, and as a communication medium. Advanced card technologies allow for the storage of data on the card, creating the possibility of a comprehensive and portable patient record. There are many types of patient cards: paper or plastic cards, microfilm cards, bar-code cards, magnetic-strip cards and integrated circuit smart-cards. Choosing the right card depends on the amount of information to be stored, the degree of security required and the cost of the cards and their supporting infrastructure. Problems with patient cards are related to storage capacity, backup and data consistency, access authorization and ownership and compatibility. We think it is worth evaluating the place of patient card technology in the delivery of health services in Israel.

Delivery of Health Care↗
PubMed2002

[Quality management and experiences with the "cancer center"].

BACKGROUND: The goal of quality management in oncology is to achieve the best possible therapeutic outcome. Improved diagnostic methods, more sophisticated therapies in various fields of specialisation and the increased implementation of multimodal therapies have led to considerable advances in the treatment of certain tumors in recent years. However, these advances depend on an interdisciplinary approach necessitating an increased division of labour. These in turn, because of the more complex organizational requirements within hospitals, make greater demands on quality management. METHODS: In October 1999 first steps were taken in the Klinikum rechts der Isar der TU München to organisationally integrate the various institutions involved in the treatment of patients with gastro-intestinal tumors. All the oncologic competence available was bundled in a Cancer Center thus creating the structural prerequisites for interdisciplinary quality management. A daily multidisciplinary Tumor Board, a computer-supported interdisciplinary information and communications system, an interdisciplinary Disease Management Team, an outpatients department and a study centre were all called into life. RESULTS: By the time the outpatients department went into service in November 2001 all the other structural innovations underlying interdisciplinary quality management had already been implemented. Since October 1999 2438 patients had been presented to the Tumor Board, 74% of them with primarily curative intent. CONCLUSIONS: The disease-oriented structure of the Cancer Center has proved worthwhile. The impact of the structure on the quality of processes and results, however, has yet to be evaluated.

Ambulatory Care↗
PubMed2004

[Classification of epileptic seizures and syndromes: new proposals].

In the decade of 1980 the International League Against Epilepsy (ILAE) developed a classification system of epileptic seizures and syndromes. These classifications were established progressively and are presently used in all the world. In the following years, video-EEG monitoring became widely available and provided direct information about seizure semiology and ictal EEG that had not been so well understood during the development of the ILAE classifications. This new information demonstrated certain limitations of the old classification of epileptic seizures. In addition, improvements in brain imaging techniques and research in genetics added further information on the pathophysiology of epilepsies and epileptic syndromes. In order to integrate these advances into the practical management of epilepsies, new classification proposals have been developed. This article reviews the clinical implications of these new classifications.

Humans↗
PubMed1991

Beyond water activity: recent advances based on an alternative approach to the assessment of food quality and safety.

Water, the most abundant constituent of natural foods, is a ubiquitous plasticizer of most natural and fabricated food ingredients and products. Many of the new concepts and developments in modern food science and technology revolve around the role of water, and its manipulation, in food manufacturing, processing, and preservation. This article reviews the effects of water, as a near-universal solvent and plasticizer, on the behavior of polymeric (as well as oligomeric and monomeric) food materials and systems, with emphasis on the impact of water content (in terms of increasing system mobility and eventual water "availability") on food quality, safety, stability, and technological performance. This review describes a new perspective on moisture management, an old and established discipline now evolving to a theoretical basis of fundamental structure-property principles from the field of synthetic polymer science, including the innovative concepts of "water dynamics" and "glass dynamics". These integrated concepts focus on the non-equilibrium nature of all "real world" food products and processes, and stress the importance to successful moisture management of the maintenance of food systems in kinetically metastable, dynamically constrained glassy states rather than equilibrium thermodynamic phases. The understanding derived from this "food polymer science" approach to water relationships in foods has led to new insights and advances beyond the limited applicability of traditional concepts involving water activity. This article is neither a conventional nor comprehensive review of water activity, but rather a critical overview that presents and discusses current, usable information on moisture management theory, research, and practice applicable to food systems covering the broadest ranges of moisture content and processing/storage temperature conditions.

Carbohydrates↗
PubMed2004

Organizing safety: conditions for successful information assurance programs.

Organizations must continuously seek safety. When considering computerized health information systems, "safety" includes protecting the integrity, confidentiality, and availability of information assets such as patient information, key components of the technical information system, and critical personnel. "High Reliability Theory" (HRT) argues that organizations with strong leadership support, continuous training, redundant safety mechanisms, and "cultures of high reliability" can deploy and safely manage complex, risky technologies such as nuclear weapons systems or computerized health information systems. In preparation for the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the Office of the Assistant Secretary of Defense (Health Affairs), the Offices of the Surgeons General of the United States Army, Navy and Air Force, and the Telemedicine and Advanced Technology Research Center (TATRC), US Army Medical Research and Materiel Command sponsored organizational, doctrinal, and technical projects that individually and collectively promote conditions for a "culture of information assurance." These efforts include sponsoring the "P3 Working Group" (P3WG), an interdisciplinary, tri-service taskforce that reviewed all relevant Department of Defense (DoD), Miliary Health System (MHS), Army, Navy and Air Force policies for compliance with the HIPAA medical privacy and data security regulations; supporting development, training, and deployment of OCTAVE(sm), a self-directed information security risk assessment process; and sponsoring development of the Risk Information Management Resource (RIMR), a Web-enabled enterprise portal about health information assurance.

Communication↗
PubMed2006

Advancing health system integration through supply chain improvement.

Collaboration is a key element to success in the provision of sustainable and integrated healthcare services. Among the many initiatives undertaken to improve service quality and reduce costs, collaboration among hospitals in Ontario has been difficult to achieve; however, voluntary collaboration is vital to achieving transformation of the magnitude envisioned by system leaders.

Cooperative Behavior↗
PubMed1989

Health care technology assessment and adoption: a case study.

Today's progressive hospital and health care system managers look to new ways to retain or augment their market share and to position themselves in their service areas. Since diffusion of new technologies into health care is market driven, informed decisions on the adoption of certain emerging patient care technologies can place a health care organization in a favorable financial position. There is a compelling need for hospital management and the governing board to collaborate with their medical staff on the development of an acceptable process to quickly identify and implement appropriate new technologies into the patient care environment. This joint effort is vital to ensure the integration of sound clinical values and objectives with planned institutional business strategies. Mount Carmel Health, a multifaceted health care corporation in central Ohio, has met the challenge of managing patient needs, physician interests, and limited hospital resources by forming a unique entity within the organization for the effective assessment and adoption of the latest medical technology. The division, which is called the Advanced Treatment and Bionics Institute (ATBI), is charged with assessing the latest clinical technologies and managing a hospital's adoption of the most appropriate ones. It serves to organize and streamline the identification, acquisition, adoption, and implementation of innovative treatment technologies at Mount Carmel hospitals.

Academies and Institutes↗
PubMed1998

Vision of an 'automated' hospital information system.

This paper tries to describe a coherent vision of a possible next generation of HIS that rethinks how and what for computing is used in hospitals. Current systems, organized mainly around the 'database' and the 'communication' paradigm help the data processing to a great extent. At the same time they cannot be accepted as 'automated' systems, as handling of information is done mostly by end-users, i.e. by human actors. Emerging methods enabling automated information handling are the following: integrated handling of different media, seamless communication among different systems, alternative input-output devices, tools for pro-active information handling. These technologies should be grouped to two main branches: technical advances in data handling and theoretical advances in knowledge handling. The advances in knowledge handling are really important: tools based on that can take over routine information handling tasks from human end users. To discuss automation in HIS it is useful to understand the process of information handling in general within the hospital. A suggested multidimensional information space, where information objects are gathered mainly along two axes, the 'patient axis' and the 'management' axis might be of help. Combinations of selected dimensions resulted in a space of an estimated 2,294,082 possible information handling situation types in an earlier publication. Automation of information handling tasks can be derived from this model. The authors suggest to automate certain tasks done usually by active actors of the information handling situation space. Software agents working 'on their own' are known entities in HIS systems. Two components are needed for automation: an organized data base where its content can be 'understood' and interpreted by an algorithm, with other words a knowledge base an algorithm, that covers a certain routine information handling task. Data bases of HIS should be re-thought in a way that enables automated processing to a greater extent. The development of data base technologies clearly point to this direction. If most of the data bases of a HIS will be like that, new generation of applications might be launched to use them. E.g. a software agent called 'patient assistant' could collect data from different sources and build a coherent and updated patient file. The results of a knowledge based, agent operated HIS should be the following: significantly less direct human involvement significantly less paper to be produced enhanced speed of data flow in general enhanced reliability by widespread watchdog functions

Algorithms↗
PubMed2003

A life scientist's gateway to distributed data management and computing: the PathPort/ToolBus framework.

The emergent needs of the bioinformatics community challenge current information systems. The pace of biological data generation far outstrips Moore's Law. Therefore, a gap continues to widen between the capabilities to produce biological (molecular and cell) data sets and the capability to manage and analyze these data sets. As a result, Federal investments in large data set generation produces diminishing returns in terms of the community's capabilities of understanding biology and leveraging that understanding to make scientific and technological advances that improve society. We are building an open framework to address various data management issues including data and tool interoperability, nomenclature and data communication standardization, and database integration. PathPort, short for Pathogen Portal, employs a generic, web-services based framework to deal with some of the problems identified by the bioinformatics community. The motivating research goal of a scalable system to provide data management and analysis for key pathosystems, especially relating to molecular data, has resulted in a generic framework using two major components. On the server-side, we employ web-services. On the client-side, a Java application called ToolBus acts as a client-side "bus" for contacting data and tools and viewing results through a single, consistent user interface.

Biological Science Disciplines↗
PubMed2000

[Aspects of developing a unified information system of space crew medical support based on networking technologies].

Computerization of national and international space research projects, real-time data management, improvement of the quality of medical support to space crew through more extensive use of video, audio and telemetric information put in the forefront the necessity to integrate individual experts and agencies in a single network. Described is the structure of the operative network mounted at the Russian Federation State Research Center--Institute of Biomedical Problems. The authors discuss issues related to networking participants in medical support of manned missions, and a biomedical data exchange format. Developed was a prototype of an on-line Web-server. Prospect for advancement of the informational network is outlined.

Aerospace Medicine↗
PubMed1989

Robotics in biomedical chromatography and electrophoresis.

The ideal laboratory robot can be viewed as "an indefatigable assistant capable of working continuously for 24 h a day with constant efficiency". The development of a system approaching that promise requires considerable skill and time commitment, a thorough understanding of the capabilities and limitations of the robot and its specialized modules and an intimate knowledge of the functions to be automated. The robot need not emulate every manual step. Effective substitutes for difficult steps must be devised. The future of laboratory robots depends not only on technological advances in other fields, but also on the skill and creativity of chromatographers and other scientists. The robot has been applied to automate numerous biomedical chromatography and electrophoresis methods. The quality of its data can approach, and in some cases exceed, that of manual methods. Maintaining high data quality during continuous operation requires frequent maintenance and validation. Well designed robotic systems can yield substantial increase in the laboratory productivity without a corresponding increase in manpower. They can free skilled personnel from mundane tasks and can enhance the safety of the laboratory environment. The integration of robotics, chromatography systems and laboratory information management systems permits full automation and affords opportunities for unattended method development and for future incorporation of artificial intelligence techniques and the evolution of expert systems. Finally, humanoid attributes aside, robotic utilization in the laboratory should not be an end in itself. The robot is a useful tool that should be utilized only when it is prudent and cost-effective to do so.

Chemistry, Clinical↗