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PubMed1999

The management and policy challenges of the globalisation effect of informatics and telemedicine.

Managers and policy makers face new and as yet unrecognised challenges--particularly loss of control--through the application of new information technologies in healthcare. Whilst informatics and telemedicine are important developments, the potential for adverse organisational and societal effects should be recognised and anticipated. Health organisations are frequently seen as circumscribed networks, and these in turn form local alliances with related organisations. Information technologies are frequently construed as relating to operational systems within organisations, not least electronic patient record systems and diagnostic systems. These can then be linked to new generation health business systems, to provide accurate management information at low additional cost. However, this pair of assumptions is now seriously flawed, due to the effects of the latest developments in health informatics and telemedicine. In particular, telecommunications and Internet technologies render ineffectual previous external barriers of distance and national boundaries, whilst within the organisation the combination of knowledge bases with information technologies creates tendencies towards internal autonomy. Organisational and national policy control of health care face direct and radical challenges through perverse effects of otherwise beneficial developments, and early action is needed.

Database Management Systems↗
PubMed1998

Informatics and end-stage renal disease.

Medical informatics is an interdisciplinary field that deals with the intellectual activities; information management; and communication tasks of medical practice, basic science and clinical research, and medical education. By projecting the future of medical informatics as it specifically relates to applications in end-stage renal disease, this report focuses on some technical innovations, application of existing technology in novel ways, and program applications useful for practitioners caring for renal patients.

Guidelines as Topic↗
PubMed2001

Modeling a medical environment: an ontology for integrated medical informatics design.

Modern medical environments have seen an increase in technological complexity and pressures of handling more patients with fewer resources, resulting in higher demands on medical practitioners. Medical informatics designers will have to focus on the problem of organizing medical information more effectively to enable practitioners to cope with these challenges. This article addresses this research problem for the particular area of medical problem solving in patient care. First, we describe a traditional modeling approach for medical reasoning used as a basis for developing some decision support systems. We argue these models may be faithful to what is known about biomedical knowledge, but they have limitations for human problem solving, especially in unanticipated situations. Second, we present an ontological framework, known as the abstraction hierarchy (Rasmussen, IEEE Trans. Man. Cybernetics 15 (1985) 234-243), for integrating patient representations that are faithful to existing biomedical knowledge and that are consistent with what is known about human problem solving. Through an example of a critical event in the operating room, we reveal how this framework can support medical problem solving in unanticipated situations. Third, we show how to use these representations as a frame of reference for mapping medical roles, responsibilities, sensors, and controls in an operating room context. Finally, we provide some insight for medical informatics designers in using this framework to design novel training programs and human-computer displays.

Decision Support Techniques↗
PubMed2001

Evaluating informatics applications--clinical decision support systems literature review.

This paper reviews clinical decision support systems (CDSS) literature, with a focus on evaluation. The literature indicates a general consensus that clinical decision support systems are thought to have the potential to improve care. Evidence is more equivocal for guidelines and for systems to aid physicians with diagnosis. There also is general consensus that a variety of systems are little used despite demonstrated or potential benefits. In the evaluation literature, the main emphasis is on how clinical performance changes. Most studies use an experimental or randomized controlled clinical trials design (RCT) to assess system performance or to focus on changes in clinical performance that could affect patient care. Few studies involve field tests of a CDSS and almost none use a naturalistic design in routine clinical settings with real patients. In addition, there is little theoretical discussion, although papers are permeated by a rationalist perspective that excludes contextual issues related to how and why systems are used. The studies mostly concern physicians rather than other clinicians. Further, CDSS evaluation studies appear to be insulated from evaluations of other informatics applications. Consequently, there is a lack of information useful for understanding why CDSSs may or may not be effective, resulting in making less informed decisions about these technologies and, by extension, other medical informatics applications.

Decision Support Systems, Clinical↗
PubMed2001

Side effects and responsibility of medical informatics.

Medical informatics systems have the ultimate goal to improve the quality of health care. However, these systems have also the potential to compromise the quality of health care if they are misused, intrinsically faulty or entail unexpected side effects. The purpose of the paper is to discuss examples from the experience of the author, where well-intended medical informatic applications proved to have potentially harmful effects or side effects. It is argued that medical informaticians (MI) have an extended professional responsibility, which covers not only the state of the art technical planning, an implementation of information processing systems in medicine, but also the final result for the patient. In order to discuss professional duties of medical informaticians, a modification of the Software Engineering Code of Ethics and Professional Practice developed by ACM/IEEE is proposed as a guideline. For several examples, these guidelines are used to analyze possible actions and professional responsibility.

Delivery of Health Care↗
PubMed1997

Education and training in medical informatics, statistics and epidemiology in EuroMISE.

The paper gives information on education and training covered by the Joint European Project (JEP) entitled 'Education in the Methodology Field of Health Care, EuroMISE (European Education in Medical Informatics, Statistics and Epidemiology)', that has been running for 3 years (1993-1995) under the umbrella of the European TEMPUS-PHARE programme. Training and education in EuroMISE consists of three overlapping methodological branches: Medical informatics (MI), medical statistics (MS) and epidemiology (E). The teaching scheme has been developed in cooperation between 11 universities in the European Union and Charles University in Prague (four medical faculties, the Faculty of Mathematics and Physics and the Faculty Hospital) together with the Academy of Sciences of the Czech Republic (Institute of Computer Science). The paper shows EuroMISE targets, structure of EuroMISE courses and conferences and gives further views to the future in this field of education.

Congresses as Topic↗
PubMed1998

How to create awareness and ensure broad dissemination of health informatics standards.

There is a range of organisations with responsibility for information standards development within Australia. These include Standards Australia, which is formally linked to the International Organisation for Standards (ISO), the National Health Information Management Group, which deals with the government sector and several statutory organisations such as the Australian Institute of Health and Welfare and the National Centre for Classification in Health. The different constituencies involved with each of these organisations, the scope of healthcare informatics and the rate of organisational and technological change in the industry present a significant challenge in ensuring that the standard setting process is highly visible, responsive and capable of demonstrating its value through effective implementation. Creating awareness and ensuring broad dissemination of healthcare informatics standards is a key component in meeting this challenge. This can operate at a number of levels from strategic to operational. At the strategic level, it requires active engagement and commitment of the key decision-makers, both political and professional. This may require directly lobbying and promoting the benefits of standardisation to those decision-makers but can be achieved even more effectively by creating industry awareness and demand through carefully targeted presentations on the impact of standards to broader health industry forums. At the tactical level, the standards development medium itself can be used to engage and gain commitment from government, professionals, vendors and the health industry by operating as an inclusive, open and effective process. At the operational level, there is the opportunity for much more efficient use of technology to create awareness of both these processes and their outcomes. The establishment in Australia of a web enabled National Health Information Knowledge base built around ISO standards is one example of the type of development which will assist in the acceleration of awareness of standards and standardisation, which is needed to cope with the increasing demand.

Australia↗
PubMed1998

From a time standard for medical informatics to a controlled language for health.

CEN ENV 12381 is a European Prestandard focusing on formal representation and explicit reference of temporal information in healthcare informatics and telematics. One of its merits is not just the possibility to represent natural language expressions containing time-related information in a structured way, but also to give some mechanisms on how clinical language itself can be used to convey meaning unambiguously. As such, CEN ENV 12381 introduces the notion of 'controlled language use' in the domain of healthcare. In this paper the principles behind controlled language design and use are explained. Through a detailed study of the inconsistencies and ambiguities that arise when interpreting Snomed procedure terms in the framework of the Galen-In-Use project, it is shown that most of them can be explained as a violation of sound term-formation principles. A proposal is made to develop a controlled language for health and to use it in subsequent versions of coding and classification systems. It is expected that such an endeavour will lead to a more effective application of linguistic engineering in areas such as automatic knowledge acquisition, automatic translation, and terminology validation in the domain of healthcare informatics.

Artificial Intelligence↗
PubMed1998

Integrated medical informatics with small group teaching in medical education.

National Taiwan University College of Medicine (NTUCM) introduced small groups of teaching and basic-clinical integrated courses for medical students in 1992. By using computer network and multimedia techniques, this study tried to overcome barriers to learning in small group teaching. The Department of Medical Informatics of NTUCM established campus networking and computer classrooms and provided Internet and intranet network services including mail, netnews, bulletin board systems (BBS), world wide web (WWW), gopher, ftp and local file servers. To implement an interactive learning environment, the authors first tried mail lists, newsgroups and BBS. Next an integrated learning system prototype on the WWW was developed to provide functions including online syllabus, discussion boards simulated to BBS, online talk, interactive case studies, virtual classroom with video on demand (VOD) and Internet medical resources. The results showed that after the medical students completed the required course of medical informatics and had good network access using a network to communicate with each other became a daily practice. In the future, the system will extend to the tutoring of clinical practice and continuing medical education. The authors expect a national medical education network and more international cooperation and exchange.

Curriculum↗
PubMed1998

Integrating learning contexts in a medical informatics program--preparing for the introduction of PACS.

This paper analyzes the possibilities to extend learning contexts within a one-year medical informatics educational program (MIP) at a Radiology Department in Sweden. The MIP was carried out within a theoretical framework based upon the integration of four learning contexts, which were inspired by Nonaka's theory of organizational knowledge creation. A summary of organizational knowledge creation theory and the ideas behind the learning contexts are presented. The main objective of the study was to investigate what would be the major benefits from the use of various learning contexts in a one-year medical informatics program? The MIP was found to form a basis for better learning conditions by increasing the flexibility, accommodating greater numbers of students as well as offering better possibilities for continuous learning. Evaluation of the MIP revealed that 98% of radiology department staff as compared to 39% of the intensive care unit staff, who had followed the hospital routine program, felt competent enough to independently use the functions of a new medical system. Although there are good reason to believe that the superior confidence for information technology (IT) is due to the integration of learning contexts, it can not be excluded that it may be due to other reasons also.

Education, Medical, Continuing↗
PubMed1998

An international health and nursing informatics module for distance education.

This paper describes why a module about health and nursing informatics is a necessary component for nursing education. Several developments in society and health care force health providers to manage the large amount of health data adequately. A module about health and nursing informatics was developed in international cooperation by three schools of nursing from Germany, The Netherlands and the UK. The content and learning activities of the realized example module for distance learning are described. Future plans include making this course material available in different languages on the World Wide Web.

Computer-Assisted Instruction↗
PubMed1998

On development of medical informatics education via European cooperation.

In this paper, we show different activities of the European Center for Medical Informatics, Statistics and Epidemiology (EuroMISE Center) of Charles University and Academy of Sciences in the field of medical informatics, statistics and epidemiology education and training. The development of these activities started within the TEMPUS-PHARE project in 1993 and they are continuing with the support of another project, particularly the IT EDUCTRA (Information Technologies Education and Training) (Fourth Framework Programme) project. New approaches using the Internet as well as newly developed programmes are described.

Czech Republic↗
PubMed1999

IMIA Working Group 15: technology assessment and quality development in health informatics.

The working group on technology assessment and quality development in health informatics was established as a follow-up to the recommendations made at the IMIA-ISTAHC working conference in 1990. The working group was approved by the IMIA General Assembly at Kyoto, September, 1993. The working group aims to further develop the field of technology assessment and quality development in health informatics, by: promoting consensus development on methodological issues; promoting comprehensive assessment of health care information technologies, for instance by providing expertise; demonstrating the value and importance of assessment of health care information technologies, to health care decision makers, health care providers and developers of information technologies.

Medical Informatics↗
PubMed2002

Evidence-based practice for mere mortals: the role of informatics and health services research.

The poor translation of evidence into practice is a well-known problem. Hopes are high that information technology can help make evidence-based practice feasible for mere mortal physicians. In this paper, we draw upon the methods and perspectives of clinical practice, medical informatics, and health services research to analyze the gap between evidence and action, and to argue that computing systems for bridging this gap should incorporate both informatics and health services research expertise. We discuss 2 illustrative systems--trial banks and a web-based system to develop and disseminate evidence-based guidelines (alchemist)--and conclude with a research and training agenda.

Evidence-Based Medicine↗
PubMed2003

Medical informatics in the intensive care unit: overview of technology assessment.

Effective patient care in the intensive care unit (ICU) depends on the ability of clinicians to process large amounts of clinical and laboratory data. Recently, medical informatics applications have been developed to store and display patient information and assist clinical decision making. Despite the proliferation of these systems and their potential to improve patient care, there are no comprehensive health technology assessments incorporating considerations of safety, functionality, technical performance, clinical effectiveness, economics, and organizational implications. The objectives and methods of informatics evaluations depend on the type of application and the stage of development. Qualitative and quantitative nonrandomized evaluations of comprehensive information management systems like electronic medical records and picture archiving and communications systems should concentrate on technical and functional issues. Specific applications like clinical decision support systems and computerized patient care systems are designed to improve patient outcomes and clinical performance; randomized controlled trials (RCTs) to assess clinical effectiveness are important in their assessment. Although studies of these applications in the ICU setting are increasing, there are currently very few published randomized trials.

Decision Support Systems, Clinical↗
PubMed2001

Hickam 2000: the maturation of, and linkages between, medical informatics and bioinformatics.

I have always been infatuated with computers and convinced of their potential for solving problems in biologic research and clinical care. In the 1960s I thought we could use the computer to predict the shape of macromolecules from their chemical formulas and fundamental physical chemical principles. However, with the computers of the 1960s that was a fantasy. So I focused on the use of computers to manage medical record content and to assist with clinical care. The Electronic Medical Record (EMR) we began developing in 1972 with 33 diabetes patients now carries nearly 300 million separate results for more than 3 million patients. The data include lab and other diagnostic studies, dictated notes, orders, encounter records, radiology images, electrocardiograph tracings, and motion cardiac echoes, and the care provider at Indiana University and Wishard Hospital is accessed 10 million times per year. We have also agitated for standards to make the collection of these data easier. This work has become part of a field called medical informatics. In the meantime, the application of computers to biology has rapidly matured into a field called bioinformatics, and researchers in this field now provide annotated databases for many categories of molecules, programs for "matching" newly discovered genomic sequences with previously studied sequences, and systems for storing and processing massive amounts of genomic and molemic data. They have developed sophisticated methods for predicting the shape of biologic macromolecules and other important insights about biology and evolution. Medical informatics and bioinformatics intersect at many points. The most important intersection is between electronic medical records and the human specimen databases that can link genotype to the phenotype, as needed, to unravel polygenetic disease causality. The National Cancer Institute is embarking on an intriguing effort to use EMRs (phenotype) to link to paraffin blocks (genotype) in pathology laboratories where opportunities for cancer genomic discovery are open. We will participate in this effort and look forward to bending the EMR we developed for clinical use to bioinformatics uses as well.

Clinical Medicine↗
PubMed2003

Future history: medical informatics in geriatrics.

With deference to Isaac Asimov's The Foundation, which is the inspiration for this series, we briefly describe the "present history" of medical informatics (the application of information technology in medicine) in geriatrics, and then project a "future history" of this same endeavor. The older patient often has multiple acute and chronic problems that require management by a variety of medical professionals in a variety of settings. Proper care necessitates efficient gathering, integration, and management of information by each professional in each setting. As medical informatics evolves, we project that barriers to information exchange (both between providers and between providers and patients) will continue to decrease while the quality and relevance of exchanged information will continue to increase. The nexus of care will be the electronic medical record (EMR), which will shed its current paper chart metaphor and adopt an industrial process metaphor based on tasks and tolerances or goals. The multidisciplinary management of geriatric patients will strike a new balance: doctors, nurses, allied health professionals, family, and patients will all participate in the management of the patient's care. The EMR will coordinate data from a variety of novel sources, including wearable sensors monitoring physiologic parameters, falls, diet, ambulation, and medication compliance. The highly organized data in the EMR will allow explicit decision support for computer-facilitated, evidence-based care; will empower midlevel providers and patients with an increased role in the care plan; and will promote the realignment of care from hospitals/clinics to the patient's home.

Aged↗
PubMed1989

A review of medical education and medical informatics.

Physicians have considerable difficulty collecting and interpreting information from patients, dealing with the uncertainties associated with diagnosing and treating their patients, communicating precisely with one another, keeping up to date, and applying recommended procedures when indicated. Some of the advances in information technology may help physicians to manage information more effectively through more accessible, validated clinical indexes, data bases of diagnostic test characteristics, computerized audits of clinical activities with feedback, expert systems, on-line access to the medical literature, and other tools of medical informatics. Medical educators can catalyze this process by facilitating the introduction of information technology into academic clinical settings so that students can learn its use first-hand and by promoting the evolution of this and other aspects of medical informatics, a new discipline dedicated to the solution of information problems in health care. The potential roles for computer-aided instruction and centralized computer laboratories in medical schools are much less clear.

Canada↗