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PubMed2002

Teaching the teachers: helping faculty in a family practice residency improve their informatics skills.

Faculty members in family practice residencies are increasingly being asked to help residents develop skills in the use of informatics and evidence-based medicine (EBM). In order to do this successfully the teachers themselves must be skilled in the use of these tools. Recognizing the need for such training, the Maine Medical Center Family Practice Residency Program designed a faculty development project to increase knowledge and skills in the use of information technology. This project, which was carried out in 1999-2001, utilized a multifaceted approach that included improving the residency's technology infrastructure, conducting two instructional workshops, and offering EBM mentoring for preceptors. Faculty members also designed and carried out independent informatics projects. Pre- and post-project assessments of faculty members demonstrated a significant improvement in computer and EBM skills, and informal feedback from residents indicates that these skills have been successfully applied to the faculty members' teaching of residents and their practice of family medicine. This project had a positive impact on the faculty members in the residency program, increasing both their ability to employ information technology in individual and group teaching sessions and their use of EBM in clinical practice. Also, the culture within the residency program has been changed to one of utilizing computers and the Internet as principal resources for up-to-date information.

Curriculum↗
PubMedDate not supplied

RN, CIO: an executive informatics career.

The Chief Information Officer (CIO) position is a viable new career track for clinical informaticists. Nurses, especially informatics nurses, are uniquely positioned for the CIO role because of their operational knowledge of clinical processes, communication skills, systems thinking abilities, and knowledge about information structures and processes. This article describes essential knowledge and skills for the CIO executive position. Competencies not typical to nurses can be learned and developed, particularly strategic visioning and organizational finesse. This article concludes by describing career development steps toward the CIO position: leadership and management; healthcare operations; organizational finesse; and informatics knowledge, processes, methods, and structures.

Career Choice↗
PubMed1993

Introducing medical students to medical informatics.

Medical informatics (MI) has been introduced to medical students in several countries. Before outlining a course plan it was necessary to conduct a survey on students' computer literacy. A questionnaire was designed for students, focusing on knowledge and previous computer experience. The questions reproduced a similar questionnaire submitted to medical students from North Carolina University in Chapel Hill (NCU). From the results it is clear that although almost 80% of students used computers, less than 30% used general purpose applications, and utilization of computer-aided search of databases or use in the laboratory was exceptional. Men reported more computer experience than women in each area investigated by our questionnaire but this did not appear to be related to academic performance, age or course. Our main objectives when planning an MI course were to give students a general overview of the medical applications of computers and instruct them in the use of computers in future medical practice. As our medical school uses both Apple Macintosh and IBM compatibles, we decided to provide students with basic knowledge of both. The programme was structured with a mix of theoretico-practical lectures and personalized practical sessions in the computer laboratory. As well as providing a basic overview of medical informatics, the course and computer laboratory were intended to encourage other areas of medicine to incorporate the computer into their teaching programmes.

Computer Literacy↗
PubMed1995

Integrating informatics into the graduate community health nursing curriculum.

Advanced practice of community health nursing is enhanced if the nurse is able to identify, create, and use databases to support nursing assessments of communities and to manage and evaluate community health programs. The College of Nursing, Rutgers, The State University of New Jersey, has revised its curriculum for community health nursing graduate students to include a strong focus on nursing informatics. This paper summarizes the integration of theoretical content and practice exercises into a pre-course workshop and four-course sequence. A focal point of this effort has been the "Healthy People 2000 Nursing Informatics Project," in which students develop an automated community-assessment tool and database related to the Year 2000 objectives. The use of this database and related national, state, and local databases to document community needs is emphasized. Students also evaluate nursing information systems and use information technologies to design and evaluate community health grant proposals. Curriculum development, evaluation, and modification are detailed in relation to student learning needs, faculty preparation, and equipment and consultation requirements.

Community Health Nursing↗
PubMed1994

Sketching the future: trends influencing nursing informatics.

Technologies emerging in the fields of telecommunications, video and digital imaging, and microprocessing are shaping the future of nursing practice. To measure up to the future needs of nursing, nurses of today must have the vision and desire to become computer aware and technologically literate. Hypothetical future situations pose challenges related to current nursing informatics and artificial intelligence issues. Discussion includes technology issues related to the lifetime clinical health record. Areas that the Center for Nursing Research considers priorities for informatics suggest directions for nursing technology efforts. This article calls on all nurses to become active in designing and molding future clinical practice systems.

Computer Literacy↗
PubMedDate not supplied

An informatics infrastructure for patient safety and evidence-based practice in home healthcare.

The informatics infrastructure for patient safety and evidence-based practice (EBP) in home healthcare comprises data acquisition methods, healthcare standards including standardized terminologies, data repositories and clinical event monitors, data-mining techniques, digital sources of evidence, and communication technologies. Although the components of an informatics infrastructure are available and applications that bring these components together to promote patient safety and enable EBP have demonstrated positive or promising results in the acute care setting, a number of challenges hinder implementation in home healthcare. Resolution of these challenges requires commitment and collaboration among key stakeholders.

Benchmarking↗
PubMedDate not supplied

Standards for medical identifiers, codes, and messages needed to create an efficient computer-stored medical record. American Medical Informatics Association.

A major obstacle to establishing a computer-stored medical record is the lack of "standards" that would permit government, care providers, insurance companies, and medical computer system developers to share patient data easily. In this position paper, the Board of Directors of the American Medical Informatics Association recommends specific approaches to standardization in the areas of patient, provider, and site of care identifiers; computerized health care message exchange; medical record content and structure, and medical codes and terminologies. The key concept developed in this position paper is that developers and users of computer-stored medical records must embrace existing and tested approaches, despite their imperfections, to progress quickly. This approach to standardization is being coordinated with the American National Standards Institute's Health Informatics Standards Planning Panel. The development of standards is a long-term process involving continued refinement. The proposed standards are an important step toward the goal of better and more efficient health care.

Association↗
PubMedDate not supplied

Things to come: postmodern digital knowledge management and medical informatics.

The overarching informatics grand challenge facing society is the creation of knowledge management systems that can acquire, conserve, organize, retrieve, display, and distribute what is known today in a manner that informs and educates, facilitates the discovery and creation of new knowledge, and contributes to the health and welfare of the planet. At one time the private, national, and university libraries of the world collectively constituted the memory of society's intellectual history. In the future, these new digital knowledge management systems will constitute human memory in its entirety. The current model of multiple local collections of duplicated resources will give way to specialized sole-source servers. In this new environment all scholarly scientific knowledge should be public domain knowledge: managed by scientists, organized for the advancement of knowledge, and readily available to all. Over the next decade, the challenge for the field of medical informatics and for the libraries that serve as the continuous memory for the biomedical sciences will be to come together to form a new organization that will lead to the development of postmodern digital knowledge management systems for medicine. These systems will form a portion of the evolving world brain of the 21st century.

Artificial Intelligence↗
PubMedDate not supplied

Audacious goals for health and biomedical informatics in the new millennium.

The 1998 Scientific Symposium of the American College of Medical Informatics (ACMI) was devoted to developing visions for the future of health care and biomedicine and a strategic agenda for health and biomedical informatics in support of those visions. This symposium focus was prompted by the many major changes currently underway in health care delivery, education, and research, as well as in our health and biomedical enterprises, and by the constantly increasing role of information technology in both shaping and enabling these changes. The three audacious goals developed for 2008 are a virtual health care databank, a national health care knowledge base, and a personal clinical health record.

Artificial Intelligence↗
PubMedDate not supplied

Medical informatics and the science of cognition.

Recent developments in medical informatics research have afforded possibilities for great advances in health care delivery. These exciting opportunities also present formidable challenges to the implementation and integration of technologies in the workplace. As in most domains, there is a gulf between technologic artifacts and end users. Since medical practice is a human endeavor, there is a need for bridging disciplines to enable clinicians to benefit from rapid technologic advances. This is turn necessitates a broadening of disciplinary boundaries to consider cognitive and social factors pertaining to the design and use of technology. The authors argue for a place of prominence for cognitive science. Cognitive science provides a framework for the analysis and modeling of complex human performance and has considerable applicability to a range of issues in informatics. Its methods have been employed to illuminate different facets of design and implementation. This approach has also yielded insights into the mechanisms and processes involved in collaborative design. Cognitive scientific methods and theories are illustrated in the context of two examples that examine human-computer interaction in medical contexts and computer-mediated collaborative processes. The framework outlined in this paper can be used to refine the process of iterative design, end-user training, and productive practice.

Cognitive Science↗
PubMedDate not supplied

A primer on aspects of cognition for medical informatics.

As a multidisciplinary field, medical informatics draws on a range of disciplines, such as computer science, information science, and the social and cognitive sciences. The cognitive sciences can provide important insights into the nature of the processes involved in human- computer interaction and help improve the design of medical information systems by providing insight into the roles that knowledge, memory, and strategies play in a variety of cognitive activities. In this paper, the authors survey literature on aspects of medical cognition and provide a set of claims that they consider to be important in medical informatics.

Cognition↗
PubMedDate not supplied

Postdoctoral training in medical informatics: a survey of National Library of Medicine-supported fellows.

The National Library of Medicine (NLM) funds training programs in medical informatics and plans to significantly increase the number of program sites in the future. The authors surveyed all NLM-funded trainees at the nine sites supported in the spring of 1988 to determine their backgrounds, current research interests, and career plans. Forty-three fellows were identified, of whom 39 returned a mailed questionnaire. All but four were physicians (89.7%), 82.1% had at least one year of postdoctoral clinical training, and 61.5% had completed a residency. Seventy-one percent of those completing residency had done so in internal medicine. The most common areas of current research were decision support/decision analysis, knowledge representation, and artificial intelligence. The overwhelming majority of the fellows planned to seek positions in a medical school on completion of their fellowships, and most preferred affiliation with a department of medical informatics or medicine.

Education, Continuing↗
PubMed2003

Data mining: qualitative analysis with health informatics data.

The new computational algorithms emerging in the data mining literature--in particular, the self-organizing map (SOM) and decision tree analysis (DTA)--offer qualitative researchers a unique set of tools for analyzing health informatics data. The uniqueness of these tools is that although they can be used to find meaningful patterns in large, complex quantitative databases, they are qualitative in orientation. To illustrate the utility of these tools, the authors review the two most popular: the SOM and DTA. They provide a basic definition of health informatics, focusing on how data mining assists this field, and apply the SOM and DTA to a hypothetical example to demonstrate what these tools are and how qualitative researchers can use them.

Algorithms↗
PubMed2003

Medical informatics--a catalyst for operating room transformation.

For many years, computers have supported complex clinical ancillary functions such as the laboratory, radiology, endoscopy, and others. Digital computers have been successfully incorporated into specialized clinical instruments to offer advanced digital devices such as fetal monitors, heart monitors, and imaging equipment. But these devices are often not fully integrated with clinical management and operational systems. Beyond ancillary department applications, the result of almost 30 years of trying to automate the clinical processes in healthcare is large investments in both computer systems and paper medical records that have resulted in paper-based, computer-assisted processes of care. This expensive combination of partial clinical automation and archaic paper-based support processes is a major obstacle to improvements in care delivery and management. The need to use software, informatics, and standards to help manage the operating room and perioperative processes of care is significant. The potential to reduce adverse events, cost of care, and to enhance the quality of care are real and worth attaining. This paper focuses on what medical informatics improvements are needed to support improvements in surgical care and to assist in the management of the highly complex operating room and perioperative care process, and proposes research priorities in these areas.

Humans↗
PubMed2003

Grand challenges in dental informatics.

When truly significant scientific challenges are overcome, it profoundly changes the daily activities, as well as the future research activities, of everyone involved in the related field. By identifying and describing the grand challenges facing a scientific field, we can help funding agencies identify and prioritize projects for support, stimulate and encourage new investigators to work on these intellectual and technological challenges, and help define the field itself. In this article, we present an informatics-oriented, future-patient-care scenario, then describe a series of applications and the related informatics grand challenges facing the dental field today. New techniques and technologies to help us overcome these challenges would facilitate the development of truly monumental applications, such as a comprehensive electronic oral health record, an automated dental treatment planning system for all diagnoses, or a system to profile patient risk for chronic oral diseases.

Databases, Factual↗
PubMed2003

Issues and strategies for faculty development in technology and biomedical informatics.

Biomedical informatics and technology are becoming important components of dental education. The tools and techniques now available have the potential for significant impact on teaching and research by improving the way information is acquired, stored, retrieved, and managed. However, a gap exists between those who create, introduce, or implement the technology applications and the faculty in dental schools faced with the challenge of using it. For technology and informatics to thrive in the areas of didactic teaching, clinical teaching, and clinical practice, more than a select few must understand the potential applications. This paper provides an overview of the issues and strategies involved with faculty development for the use of technology in the educational setting. The discussion covers important reasons for developing faculty competence in technology applications, significant barriers to faculty development in this area, and several strategies designed to overcome these barriers.

Adaptation, Psychological↗
PubMed2003

Informatics challenges in tissue engineering and biomaterials.

Both tissue engineering and biomaterials have made tremendous strides recently, yet major questions remain unanswered. Tissue-engineered products have come to the market; others are in development. A fundamental issue that informatics could address for tissue engineering is to describe and to predict the cascade of biochemical and cellular reactions that occur as a function of time and implant material: surface texture, microporosity; pore size, density, and connectivity; and three-dimensional configuration. Behavior of ceramics, a subset of tissue-engineering scaffold materials and a mainstay of dental restorations, has been studied extensively for very thin layers and for thicknesses greater than 2 mm. Until recently, little has been known about dentally relevant thickness of 1-2 mm. Results have been surprising and are continuing to develop. Still, at least one fundamental question remains that could be addressed by informatics techniques: Where, along the spectrum of flat-polished material to 10-year clinical in vivo study, can we test to predict clinical performance of all-ceramic crowns accurately?

Biocompatible Materials↗
PubMed2003

The role of information technology and informatics research in the dentist-patient relationship.

A high-value doctor-patient relationship is based on a set of parameters which include the interpersonal relationship between the patient and the doctor. Based on the Primary Care Assessment Survey model, measures of the interpersonal relationship are associated with communication, interpersonal care, contextual knowledge of the patient, and trust. Despite the proven value of the doctor-patient relationship, current trends indicate that the quality of these relationships is on the decline. The advent of communication and information technologies has greatly affected the way in which health care is delivered and the relationship between doctors and patients. The convergence of communication and information technology with biomedical informatics offers an opportunity to affect the character of the doctor-patient relationship positively. This paper examines the intersection of the key features of the doctor-patient relationship and a variety of Internet-based, clinical, and administrative applications used in dental practice. This paper discusses the role of dental informatics research vis-à-vis the doctor-patient relationship and explores how it may inform the next generation of information technologies used in dental practice.

Communication↗