Analysis, modelling and simulation of information systems as part of the medical informatics program at Heidelberg/Heilbronn.
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Telemedicine systems that provide health delivery services to rural clinics and hospitals are being demonstrated in clinical settings. This paper summarizes the research and consortia projects at the University of Arizona Medical Center. The paper describes the Rural and Global Picture Archiving and Communications (PACS) environment developed under a National Science Foundation grant. The Rural and Global PACS environment includes many workstations, database, and networking components and is treated as a large distributed system. These components are described in this paper. The multimedia services for radiology provided by the Rural and Global PACS are described and their performance is measured. Finally, the current research work using the Open Software Foundation's distributed computing environment (OSF DCE) services is described. An OSF DCE testbed for the Rural and Global PACS is described and the rationale of using OSF DCE in the project is presented.
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In response to curricular changes, many academic health sciences librarians have participated in curriculum planning and/or developed informatics course requirements for students enrolled at health sciences universities. This article describes the use of clinical vignette assignments, student journal club activities, and vignette-type multiple choice questions to teach and assess skills related to managing biomedical information, communicating effectively, basic computing, and life-long learning.
Intensive care medicine requires timely, accurate, and integrated patient records to provide the highest quality patient care. Computerized patient records offer the best method to achieve these needs. The expectations of society for medical progress through increased use of computers is growing. For optimal use of computers in the ICU there must be a harmonious collaboration between medical informaticists, physicians, nurses, therapists, and administrators. The future use of computers in ICU care will be evolutionary rather than revolutionary. We are on the frontier of some exciting times in the next decade as computers become commonplace in the clinical care process rather than an unusual event. This paper discusses the progress and challenges of computers in the ICU.
A major reorganization of healthcare services is occurring in the United States. It has evolved from the solo- and group-practice models of the 1940s with fee-for-service and insurer-indemnification financing that used paper-based information systems to support preventive medical services. In the 1990s there emerged nation-wide, managed-care plans employing enhanced computer-based information systems with online preventive medical practice guidelines and Internet-supported home-care telemedicine. It is helpful to review how this major reengineering of medicine has come about.
The Health Management Information System (HMIS) project initiated by the Ministry of Health as a component of the healthcare reform is aiming to ensure the technical, functional and operative support for: i) a better overview of the population health status, of the medical care needs and of the Health System performances; ii) the improvement of the resource allocation and consumption; iii) reform support. This system is supposed to assure a better information flow from the lower to the upper levels of the healthcare network by help of a modern IT support. In the first development stage the system is planned to link the Ministry of Health with the 41 District Health Authorities (DHAs) and with more than 200 pilot health units. The implementation of such a large system raises serious problems of acceptability and a thorough training programme for both technical staff and end users must be considered in order to face this challenge.
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The Health Management Information System (HMIS) project initiated by the Romanian Ministry of Health as a component of the healthcare reform is aiming to ensure the technical, functional and operative support for: (i) a better overview of the population health status, of the medical care needs and of the Health System performances; (ii) the improvement of the resource allocation and consumption; and (iii) reform support. This system is supposed to assure a better information flow from the lower to the upper levels of the healthcare network by help of a modern IT support. In the first development stage the system is planned to link the Ministry of Health with the 41 District Health Authorities (DHAs) and with more than 200 pilot health units. The implementation of such a large system raises serious problems of acceptability and a thorough training programme for both technical staff and end users must be considered in order to face this challenge.
The classic function of health sciences libraries is to build and maintain a knowledge base and to provide timely access to that collective memory for the purpose of learning, teaching, caring for patients, conducting research or managing an organization. The formats and representation of that knowledge base are changing rapidly, as are the methods and techniques for gaining access to information. Medical libraries have long used computers for cataloging and controlling records but are now shifting to acquiring, managing and distributing bibliographic and full-text information to local library "networks."
Positive outcomes come to health care organizations that are doing the right things well, that is, their organizational strategies are aligned with their environments and they are executing those strategies well. Likewise, the informatics strategies must also be aligned with the organization's strategies. Without this congruence, informatics does not have the potential to have a substantial positive impact on the overall organizational outcomes. The execution of the informatics strategies must also be exemplary; however, the change processes required for achieving the desired informatics and organizational outcome goals are demanding and complicated. Implementing them in extremely complex organizations that operate on a 7-day by 24 hour basis is not easy. However, we are constantly learning more about complex change processes and the ways we can better manage them to improve our needed informatics outcomes. The challenge is to build upon the existing research base to more us even further ahead.
The world's major economic powers, the G7, have initiated a collaborative International research and demonstration program to exploit the benefits of information and communications technology for society. The Global Healthcare Applications Project (GHAP) is investigating a variety of informatics applications in disease specific domains, telemedicine, and multilingual textual and image database systems. This paper summarizes the nine GHAP sub-projects undertaken to date, with emphasis on those in which the U.S. is a participant. The growing use of smart card technology, especially in Europe, is adding new impetus for similar medical and health experiments in the U.S. A pilot project now underway in several Western states is described.