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Integrating information for community-based health care.

Healthcare providers are increasingly faced with the need to develop comprehensive, clinically-oriented, community-focused information systems in order to remain financially viable and meet the information demands of healthcare consumers. Some providers interface and integrate their disparate information systems on their own. Others form integrated delivery systems that take advantage of economies of scale from an enterprise approach to information technology management. Still others form health information networks that allow them to pool information technology resources while pursuing independent business goals.

Community Networks↗

Implementation of a clinical information system in nurse-managed care.

The Penn Nursing Network Information System Project is a collaborative effort of practitioners, academic researchers, and a health-care software developer. The Penn Nursing Network, a group of nurse-managed practices owned and operated by the University of Pennsylvania School of Nursing, has taken a leadership role in the project. PNN is developing an information system specific to the needs of nurse-managed care and creating a data warehouse for nursing centres in the Philadelphia region. Important components of this project include the identification of key data elements to represent the problems treated, interventions performed, and outcomes sensitive to the nursing care provided. The Omaha System provided a useful framework for capturing the necessary data elements. However, additional data were needed. In addition, attention was paid to the development of a software program that would complement the workflow of the practitioner while capturing data efficiently. The main goal of the project is development of a longitudinal database reflective of clinical practice, to be used for both research and evaluation.

Clinical Nursing Research↗

Reports from the Eighth Annual Conference on Retroviruses and Opportunistic Infections. Chicago, February 4-8, 2001.

The Conference on Retroviruses and Opportunistic Infections is a research meeting created to provide a forum for basic and clinical science investigators to present, discuss, and critique developments in the field of human retrovirology and related opportunistic complications. The subjects highlighted are: virology, immunology, vaccines, pathogenesis, disease mechanisms in humans and animal models, primary/acute infection, host-virus interactions, antiretroviral therapy (preclinical, clinical, and complications), clinical pharmacology, opportunistic infections, epidemiology and infection control, microbicides, pediatric/maternal-fetal/women's health, and diagnostics. Following are digests of major reports from the conference, as compiled by the National Prevention Information Network (NPIN) of the Centers for Disease Control and Prevention (CDC).

AIDS-Related Opportunistic Infections↗

A tale of three cities--where RHIOS meet the NHIN.

Regional health information exchanges in California, Indiana, and Massachusetts have been collaborating on a prototype for a nationwide health information network, first under the auspices of the Markle Foundation's Connecting for Health program and now under contract to the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology. Since mid-2004, this collaboration has evolved from a collection of regional efforts to a standards-driven cooperative and now to one of four prototype national networks fostered by federal efforts. This development reflects a maturing market for interoperability and integration in healthcare information technology, starting with RHIOs, and suggests one response to the industry's need for the type of plug-and-play information exchange available in other industries. The authors share their experiences and their views of how RHIOs and a Nationwide Health Information Network will further develop to make interoperable electronic health records a reality in coming years. The content of this article is solely the responsibility of the authors and does not necessarily represent the official view of the Office of the National Coordinator for Health Information Technology.

Boston↗

Disulfide connectivity prediction using recursive neural networks and evolutionary information.

MOTIVATION: We focus on the prediction of disulfide bridges in proteins starting from their amino acid sequence and from the knowledge of the disulfide bonding state of each cysteine. The location of disulfide bridges is a structural feature that conveys important information about the protein main chain conformation and can therefore help towards the solution of the folding problem. Existing approaches based on weighted graph matching algorithms do not take advantage of evolutionary information. Recursive neural networks (RNN), on the other hand, can handle in a natural way complex data structures such as graphs whose vertices are labeled by real vectors, allowing us to incorporate multiple alignment profiles in the graphical representation of disulfide connectivity patterns. RESULTS: The core of the method is the use of machine learning tools to rank alternative disulfide connectivity patterns. We develop an ad-hoc RNN architecture for scoring labeled undirected graphs that represent connectivity patterns. In order to compare our algorithm with previous methods, we report experimental results on the SWISS-PROT 39 dataset. We find that using multiple alignment profiles allows us to obtain significant prediction accuracy improvements, clearly demonstrating the important role played by evolutionary information. AVAILABILITY: The Web interface of the predictor is available at http://neural.dsi.unifi.it/cysteines

Algorithms↗

Community health information and its management system: a new form for the next century.

The development of community health service brings a new branch of Medical Informatics, Community health care informatics and a new management system, Community Health Care Information System in the beginning of nest century. The paper first advance and explore this new concept. It states the focus of Community health care informatics as the promotion of health for the whole community. It not only gives treatment to individual patients through ways of disease management and information network, but also improves health condition of the whole community by "diagnosis of community health" and "prescription for community health". The paper also introduces the community health information system and its formation, technology, function and practical use, pointing out the crucial point of its research work to be precisely discovering the "information origin" and "three-in-one" working group.

China↗

Design and implementation of the Indianapolis Network for Patient Care and Research.

We are creating a health care information network that will link a large community medical record system to three hospital emergency departments, fifty community pharmacies, ten clinics, four health-maintenance organization (HMO) offices, and twelve homeless care sites in Indianapolis, Indiana. This project will test the feasibility of linking care providers across organizational boundaries and measure the benefits of such a network. The network will supply three kinds of information services: a "mini-medical library," patient medical record information, and a citywide prescription database incorporating a computer-based prescription-writing system. The use of medical resources, the cost of care, provider time spent giving care, and providers' opinions of the services will be used as outcomes in randomized clinical trials. Through this project, we hope to expand the information base available to the target care sites; reduce unnecessary testing and increase the efficiency of care in emergency departments; improve emergency department, office, and clinic prescribing patterns; enlarge the consortium of health care providers connected by the network; and develop strategies for successfully implementing a comprehensive city medical record resource.

Ambulatory Care Facilities↗

Developing a Public Key Infrastructure for a secure regional e-Health environment.

OBJECTIVES: Internet technologies provide an attractive infrastructure for efficient and low cost communications in regional health information networks. The advantages provided by the Internet come however with a significantly greater element of risk to the confidentiality and integrity of information. This is because the Internet has been designed primarily to optimize information sharing and interoperability, not security. The main objective of this paper is to propose the exploitation of public-key cryptography techniques to provide adequate security to enable secure healthcare Internet applications. METHODS: Public-key cryptography techniques can provide the needed security infrastructure in regional health networks. In the regional health-care security framework presented in this paper, we propose the use of state-of-art Public Key Infrastructure (PKI) technology. Such on e-Health PKI consists of regional certification authorities that are implemented within the central hospitals of each region and provide their services to the rest of the healthcare establishments of the same region. RESULTS: Significant experience in this area has been gained from the implementation of the PKI@AUTH project. CONCLUSIONS: The developed PKI infrastructure already successfully provides its security services to the AHEPA university hospital. The same infrastructure is designed to easily support a number of hospitals participating in a regional health information network.

Computer Security↗

Synapse Health Resources Online.

The University of Nebraska Medical Center maintains the Synapse Health Information Network to provide timely clinical and library resource information to health professionals across Nebraska and surrounding regions. The system is in over 115 sites across Nebraska and surrounding regions and maintains over 320 network users.

Health Education↗

The interplay between social and cultural context and perceptions of cardiovascular disease.

This paper seeks to explore the impact of social and cultural factors upon perceptions of the patients' cardiovascular risk and intended lifestyle changes. Qualitative and quantitative research approaches were used. The sample was purposeful; matched groups of 10 first time post myocardial infarction (MI) patients, 10 informal (spouse, blood relative or partner) and 10 formal carers (nursing staff) were selected on a convenience basis. Personal interviews were conducted with participants, during which a semistructured questionnaire was completed. A combination of descriptive statistics and qualitative analysis of these data revealed that social and cultural factors formed the basis of patients' and informal carers' perceptions of cardiovascular risks and social information networks provided the main source of information about cardiovascular risk. For the staff, known risk factors based on epidemiological evidence (lack of exercise and diet) formed the basis of their perceptions of the patients' cardiovascular risk factors. However, for all the participant groups (i.e. patients, informal carers and staff) the risk factors - diet and exercise were indicated as being the patients' intended lifestyle changes., The results illustrate potential interplay between 'social' and 'cultural' context and perceptions of cardiovascular risk and incongruency between perceptions of risk and perceptions of the patients' intended lifestyle change. These results may assist nurses in giving effective advice to patients and relatives about lifestyle change following myocardial infarction and inform future policy for cardiac rehabilitation.

Adult↗

NHIN, RHIOs, and Public Health.

Public health plays a critical role in forming the building blocks for community or regional health-information sharing, which is essential to the long-term viability of a Nationwide Health Information Network (NHIN) and the Regional Health Information Organizations (RHIOs). By contributing to its visions, policies, processes, standards, and needs/requirements, public health will close the loop within an NHIN and the RHIOs environment. In this article we illustrate public health's essential role in an NHIN and the RHIOs by examining the mutual benefits to healthcare and public health.

Humans↗

Information systems' key role in healthcare change.

Crisis in the US healthcare system, resulting from escalating costs and a large number of uninsured citizens, has caused industry-wide change. Joint ventures and alliances are being forged, and Integrated Healthcare Delivery Systems (IHDS) and Community Health Information Networks (CHINs) are forming. The evolving healthcare delivery system requires shifts in information systems, technology, and resources. New demands on information systems and networking infrastructures to support data exchange between multiple entities will be critical for survival and success.

Community Health Planning↗

Implementation of standardized nursing languages (NIC, NOC) in on-line care planning and documentation.

At the University of Iowa Hospitals and Clinics (UIHC), the Standardized Nursing Languages (SNLs) of Nursing Interventions Classification (NIC) and Nursing-sensitive Outcomes Classification (NOC) are being implemented in on-line care planning and documentation. NIC and NOC are being integrated in the INFORMM NIS (Information Network For Retrieval & Medical Management Nursing Information System). The implementation process for SNLs includes six components: objectives, programming, database content, education, utilization, and evaluation. This process has been used successfully in NIC implementation and will be applied in NOC field testing.

Humans↗

The neuroendocrine system: organization and homeostatic role.

The neuroendocrine system (NES) of Vertebrates can be defined as a set of cells organized in single organs and diffuse elements, sharing co-production of amine hormone/transmitters, peptide hormone/transmitters and specific markers of neural determination. In this perspective, the hypothalamic-pituitary-target organ axis (H-P axis), the autonomic nervous system (ANS) and the diffuse neuroendocrine or APUD system contribute to the NES. However, in Mammals and man virtually any compartment of the body harbors elements, often with different embryologic origin, having at least some of the NES features. Thus, all anatomical structures may be part of a wide functional circuitry, based on "internal secretions", that supersedes the current view of the NES. Historically, metaphysical antecedents of this concept can be found in the biomedical tradition dealing with the idea of the so called "vital energy". Currently, the "internal secretions" circuitry can be envisaged as an informational supersystem encompassing the H-P axis, ANS, APUD, immune and any other body system performing autocrine, paracrine and/or endocrine regulations, that superintends the homeostatic balance. Evolutionary evidence shows that diffuse autocrine/paracrine/endocrine, peptidergic secretions would be the oldest and hierachically simplest signals, with respect to the later and hierarchically more complex ANS and H-P axis outputs, to regulate body homeostasis. Therefore, the new acronym "Triune Information Network" (TIN) is proposed for the informational supersystem of internal secretions acting in Mammals and man via progressively higher levels of control (diffuse autocrine/paracrine/endocrine secretions, ANS and H-P axis) on a common energetic substrate: the internal body milieu.

History, Ancient↗

Preparing for the information age.

Educators need to prepare their students to meet the challenges of the information age. This article discusses the effects of the information age upon the field of biomedical communications, specifically the application of computer information networks to the dissemination of medical information. Emphasis is placed upon preparing our students for careers utilizing communications technology.

Communication↗

Implications of planning for regional libraries: our underlying philosophy.

The National Library of Medicine Extramural Program in administering the Medical Library Assistance Act of 1965 has developed the following specific program objectives: provide financial assistance for improving biomedical libraries; encourage and assist the establishment and functioning of a responsive national biomedical information network by strengthening present biomedical libraries and their interlibrary relationships; and assure that the biomedical library network is linked to related science information systems. The ultimate goal is to develop the role of the library as a full learning resource center for education, research, and service. The regional library program aims to augment present capability of existing medical libraries so that information can be made available more extensively and more rapidly. Comprehensive and thorough advanced planning is a basic element in the development of regional medical libraries.

Libraries, Medical↗

[Optimal exchange of resources and the administration of bibliographical services].

It is pointed out in this paper that an optimal exchange of resources requires a maximum availability of materials and services at minimum cost. The author is of the view that each activity of the biomedical information network will have to be subjected to critical scrutiny including a calculation of its costs. The overall plan will determine whether current activities can be maintained or expanded and new activities launched. The primary given to access to materials rather than to their possession is a step toward user-oriented networks, and therefore means that future development will be assessed in relation to the customer. The author is convinced that the recording and analysis of the use actually made of services by the user will generate many of the criteria that will govern some of the most important decisions to be taken in the future in connection with the network.

Information Services↗

Network support critical in choosing a lab system.

When providers acquire laboratory information systems, they're looking beyond improving their lab operations to determine how the software will provide data to build computerized patient records throughout an integrated delivery system. Vendors are beginning to differentiate themselves based on how effectively their systems support the formation of enterprisewide information networks.

Clinical Laboratory Information Systems↗