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PubMed1997

Medical informatics training in pathology residency programs.

Computers and information technology are increasingly used by pathologists, necessitating training in such technology in pathology residency programs. We surveyed 176 programs in the United States and Canada to assess informatics training in terms of instructional methods used, computer availability, and type of training offered. Eighty-four programs replied, for a response rate of 48%. Ninety percent of programs reported offering formal informatics training, but only 68% of programs required it. A rotation dedicated to teaching informatics was provided in 24% of the programs; in 44% of programs, informatics was integrated with other rotations. The most common instructional methods used were hands-on experience with microcomputers and the use of tutors. In 94% of programs, computers were available for resident use; in 60%, residents had individual computers assigned to them. Five programs offered a dedicated informatics rotation but did not provide residents with individual computers, and 22 programs required informatics training but did not provide residents with individual computers. Comparison of these data with data from 1993 shows an increase in programs offering (90% vs 84%) or requiring (68% vs 59%) informatics. Fewer programs offer a dedicated rotation (24% vs 31%) or integrate informatics training with other rotations (44% vs 69%). These data suggest that although informatics training is considered important by most training programs, inadequate resources and lack of formal, structured programs may limit training.

Canada↗
PubMed1992

The European Community: standardization in medical informatics and imaging.

The use of informatics and telecommunications in health care and medicine has reached a stage where the application of standards is an absolute requirement. The AIM Programme of the CEC DGXIII stimulated the study of the subject, and has supported the set up of an official European platform for standardization in this field, the CEN TC251. The needs for standardization in one of the subareas, medical imaging, are described in detail. The future solutions of the problems concerned are regarded prerequisites for the general and practical use of PACS and IMACS.

European Union↗
PubMed1994

The application of future technologies to medical informatics.

Physician: "Condyloma, Toxoplasmosis, Blepharoplasty, and Fibroadenoma." Technoguru: "Pardon?" Physician (referring to "PCDR, Physician's Computer Desk Reference): "Carrier Sense Multiple Access, Spread Spectrum, Application Programming Interface, and Clustered Indexes." Technoguru: "Oh, now you're talking! How many do you want?" Until such time as computer scientists holding degrees in medicine become de rigueur, there will inevitably be conversations such as these. A pediatrician friend once told me that he could teach me in 30 days what I would need to know to handle 95 percent of the cases he sees. To handle the other 5 percent would still require 8 years of postgraduate medical education. The corollary for the application of technology is that I can teach you how to use a personal computer, and even to do a little programming, but to build a robust, mission-critical system for a production health care environment, well, back to school you go.

Computer Systems↗
PubMed1991

Medical informatics--an Australian perspective.

Computers, like the X-ray and stethoscope can be seen as clinical tools, that provide physicians with improved expertise in solving patient management problems. As tools they enable us to extend our clinical information base, and they also provide facilities that improve the delivery of the health care we provide. Automation (computerisation) in the health domain will cause the computer to become a more integral part of health care management and delivery before the start of the next century. To understand how the computer assists those who deliver and manage health care, it is important to be aware of its functional capabilities and how we can use them in medical practice. The rapid technological advances in computers over the last two decades has had both beneficial and counterproductive effects on the implementation of effective computer applications in the delivery of health care. For example, in the 1990s the computer hobbyist is able to make an investment of less than $10,000 on computer hardware that will match or exceed the technological capacities of machines of the 1960s. These rapid technological advances, which have produced a quantum leap in our ability to store and process information, have tended to make us overlook the need for effective computer programmes which will meet the needs of patient care. As the 1990s begin, those delivering health care (eg, physicians, nurses, pharmacists, administrators ...) need to become more involved in directing the effective implementation of computer applications that will provide the tools for improved information management, knowledge processing, and ultimately better patient care.

Australia↗
PubMedDate not supplied

Use of medical informatics for management of multiple sclerosis using a chronic-care model.

The mission of the Multiple Sclerosis Centers of Excellence (MSCoEs) is to optimize the services veterans with multiple sclerosis (MS) receive across the U.S. Veterans Health Administration. To accomplish this mission, the MSCoE West has adopted a collaborative chronic-disease management strategy along the lines of the model described by Wagner and colleagues. This model describes an organized, integrated, proactive, and population-based approach to patient care that includes healthcare delivery system change and patient-based self-management. While Wagner's model is described independent of information technology, the majority of actions called for in that model benefit tremendously from the application of a powerful and well-integrated informatics infrastructure designed to serve and support populations with chronic disease. Key elements such as goals and actions encourage high-quality care for those with chronic illnesses.

Chronic Disease↗
PubMed2002

Activity theory and medical informatics: usability, utility, and copability.

Working with health care today also means working with IT-systems. 'Human Factors' or 'user-friendly design' has been renowned as key factors for the development of safe and successful systems in many industries, not least in the IT-business. Likewise in the computerization of health care, the concepts of 'usefulness' and 'usability' will become key issues in the daily life (and death) in health care context at hospitals, at the GP's office, and in the home of the patient. Though it is a pressing problem, the literature is still very scarce on how to meet this challenge. Inspired by activity theory, this paper sets out to coin a term for an important way to ask questions when determining the usefulness of a medical IT-system. We normally ask two types of questions: 'How usable is the system?' (usability), and 'How functional is the system?' (utility). But most important, we will also have to ask: 'How well does the user cope with the new situation?' As a concept for the latter way of asking questions, we will suggest the term 'copability'.

Delivery of Health Care↗
PubMed1992

Tools for medical informatics.

Informatics uses words, terms and expressions of various scientific disciplines. The proposed tools, hermeneutics and phenomenology, generate a basis for quality control by establishing the authenticity and validity of such expressions. Without such tools there is the danger that poorly defined expressions obscure true meaning and prevent progress. The method is demonstrated on "objects" as used in "object oriented programming" and on "open systems" as used in the International Standards Organization model for "open system interconnection."

Medical Informatics↗
PubMedDate not supplied

[Medical informatics: historical roots and development since the 60's].

From the start, the development of the industrialized countries required observations in order to get informations on the demographic, administrative and health situation. In the course of centuries, methods of collecting and evaluating data improved. On the other hand, there was a stepwise development of auxiliary technical devices which allow to keep proven components and compose them with new ones under higher angles. Individual pioneers contributed to develop computers of high calculating capacity. The semi-conductor technique, its ongoing improvement and use in microelectronic industry gave rise to a revolution of information engineering. There was a tremendous development since the early sixties with an expanded use of computers in medicine. In a first phase, they helped overtaking auxiliary functions in clinical administration and measuring equipment in laboratories. Then, patient oriented systems with large data bases were created. In recent years, electronic telecommunication connecting hospital information systems (e.g. in university hospitals), but also other information centres on a national and international level, is of growing importance. The development of information techniques with broadened fields of application--e.g. medical image processing, handling of linguistic problems--is a challenge for medicine. Medical thinking has to channel information techniques properly with the aim of getting useful results, conserving privacy and avoiding irrelevant decision making.

History, 15th Century↗
PubMed1998

AI in medical education--another grand challenge for medical informatics.

The potential benefits of artificial intelligence in medicine (AIM) were never realized as anticipated. This paper addresses ways in which such potential can be achieved. Recent discussions of this topic have proposed a stronger integration between AIM applications and health information systems, and emphasize computer guidelines to support the new health care paradigms of evidence-based medicine and cost-effectiveness. These proposals, however, promote the initial definition of AIM applications as being AI systems that can perform or aid in diagnoses. We challenge this traditional philosophy of AIM and propose a new approach aiming at empowering health care workers to become independent self-sufficient problem solvers and decision makers. Our philosophy is based on findings from a review of empirical research that examines the relationship between the health care personnel's level of knowledge and skills, their job satisfaction, and the quality of the health care they provide. This review supports addressing the quality of health care by empowering health care workers to reach their full potential. As an aid in this empowerment process we argue for reviving a long forgotten AIM research area, namely, AI based applications for medical education and training. There is a growing body of research in artificial intelligence in education that demonstrates that the use of artificial intelligence can enhance learning in numerous domains. By examining the strengths of these educational applications and the results from previous AIM research we derive a framework for empowering medical personnel and consequently raising the quality of health care through the use of advanced AI based technology.

Artificial Intelligence↗
PubMed2002

The role of XML in medical informatics in Hungary.

Reforms in healthcare means frequent changes. The author focusing on flexible information systems and data structures in healthcare, that gives the chance to avoid costly deadlocks, incompatibilities and data chaos--keeping the financial and administrative burden of provider and reimbursement information systems at low level. He describes data and document exchange among health care providers (hospitals, GPs etc.) and the reimbursing insurance institute introducing XML (eXtensible Markup Language) technology and it's multimedia extension called SMIL (Synchronized Multimedia Integration Language) that well supports large textual and multimedia nature of data in healthcare. He presents the most frequent XML datasets for reimbursement in Hungary, the validation schemas (Data Type Definitions) and procedures, comparing the new and old data file sizes with different compressions. The comparison includes different schema file sizes, and validation times.

Humans↗
PubMedDate not supplied

Challenges and opportunities for technology assessment in medical informatics. Case study: PACS.

In this paper the basic steps of cost-effectiveness analysis (CEA) are applied in the evaluation of picture archiving and communication systems (PACS). The exercise demonstrates that evaluations of PACS have been technology-orientated, rather than problem-orientated. Moreover, many of the potential benefits of the system have been insufficiently investigated. Assessment based on the analysis of the bottlenecks in the film-based system alone appears to be quite inaccurate, as shown by the diverging outcomes of early assessment results. The development of PACS has reached a state in which the first clinical experiences are being collected. This provides an opportunity to test postulated costs and benefits. Moreover it may provide a better insight into the future potential of the technology. Experimenting with PACS is expensive. Hence, we should work together in evaluation, in order to benefit as much as possible from each other's experiences.

Cost-Benefit Analysis↗
PubMed2002

Measuring agreement in medical informatics reliability studies.

Agreement measures are used frequently in reliability studies that involve categorical data. Simple measures like observed agreement and specific agreement can reveal a good deal about the sample. Chance-corrected agreement in the form of the kappa statistic is used frequently based on its correspondence to an intraclass correlation coefficient and the ease of calculating it, but its magnitude depends on the tasks and categories in the experiment. It is helpful to separate the components of disagreement when the goal is to improve the reliability of an instrument or of the raters. Approaches based on modeling the decision making process can be helpful here, including tetrachoric correlation, polychoric correlation, latent trait models, and latent class models. Decision making models can also be used to better understand the behavior of different agreement metrics. For example, if the observed prevalence of responses in one of two available categories is low, then there is insufficient information in the sample to judge raters' ability to discriminate cases, and kappa may underestimate the true agreement and observed agreement may overestimate it.

Decision Making↗
PubMed2002

Evaluation: salvation or nemesis of medical informatics?

The currently prevailing paradigms of evaluation in medical/health informatics are reviewed. Some problems with application of the objectivist approach to the evaluation of real-rather than simulated-(health) information systems are identified. The rigorous application of the objectivist approach, which was developed for laboratory experiments, is difficult to adapt to the evaluation of information systems in a practical real-world environment because such systems tend to be complex, changing rapidly over time, and often existing in a variety of variants. Practical and epistemological reasons for the consequent shortcomings of the objectivist approach are detailed. It is argued that insistence on the application of the objectivist principles to real information systems may hamper rather than advance insights and progress because of this. Alternatives in the form of the subjectivist approach and extensions to both the objectivist and subjectivist approaches that circumvent the identified problems are summarized. The need to include systems engineering approaches in, and to further extend, the evaluation methodology is pointed out.

Evaluation Studies as Topic↗
PubMed1994

[Military medicine from the aspect of medical informatics].

The aggression and the war that has been imposed on Bosnia and Herzegovina is an excellent confirmation for the necessity of information as a resource of today. To be more specific, the information became a resource more important than the material or the energy, since it was exactly through the freedom of the information system and communications that the aggressor has managed to maximally engage and use all the other resources, and to considerably block our own and put it out of function. The health system, as the most important social system after the Defence Forces and the state authorities, had to create its own information system immediately at the beginning of the war and put it into function of health protection of the population in general, and at the disposal of the BH Army soldiers. On the other hand the indicators of the aggression level and all of its negative attributes (killed soldiers, murdered or injured civilians, mode, character and the level of brutality during injuring the victims and the like) are significantly repercussioned towards ours, the aggressors' and the foreign media and the structures from which depends further outcome of the war. And, finally, all the actions within the system of health activities, from offering healts protection, through the application of methods, techniques, technologies, resources, medicaments etc, also have its educative quality and value, furthermore, since the war which still lasts on these grounds, according to its character and specificity, has been so far unregistered in human history of the world.(ABSTRACT TRUNCATED AT 250 WORDS)

Bosnia and Herzegovina↗
PubMed1980

Medical informatics: developments in West Germany and South Africa.

Comparisons are made between medical information systems in West Germany and South Africa. In both countries the costs and importance of medical information systems dictate that a methodological approach is essential in order to obtain a solution for a particular environment. The special implications for South Africa are (i) to work from user requirements to computer system, rather than the reverse; (ii) to institute training programmes for the professionals required to organize and staff such systems; and (iii) to prepare the groundwork for medical information systems by scrutinizing the existing types, amounts, flows and uses of medical information.

Computers↗
PubMed1999

American Academy of Pediatrics. Pediatric Practice Action Group and Task Force on Medical Informatics. Privacy protection and health information: patient rights and pediatrician responsibilities.

Pediatricians and pediatric medical and surgical subspecialists should know their legal responsibilities to protect the privacy of identifiable patient health information. Although paper and electronic medical records have the same privacy standards, health data that are stored or transmitted electronically are vulnerable to unique security breaches. This statement describes the privacy and confidentiality needs and rights of pediatric patients and suggests appropriate security strategies to deter unauthorized access and inappropriate use of patient data. Limitations to physician liability are discussed for transferred data. Any new standards for patient privacy and confidentiality must balance the health needs of the community and the rights of the patient without compromising the ability of pediatricians to provide quality care.

Computer Security↗