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An architecture for a health care provider's workstation.

This paper presents an architecture for a health care provider's workstation designed to assist health care providers in performing their daily activities. The design is based on the concept of a clinician's associate which acts as an intelligent intermediary between the provider and a diverse collection of clinical, administrative, and educational information sources. The architecture is designed to be hardware platform independent, to work across different I/O capabilities, and to be open, allowing specialized applications to be easily integrated with the system and their functionality delivered through a common user environment.

Computer Communication Networks↗

The role of the UMLS in 'storing' and 'sharing' across systems.

We will argue that 'sharing', 're-use', 're-purposing', and 'addition' of health care information is difficult, intrinsically; that the best way to overcome the difficulty is to start doing it, as soon as possible, and that the UMLS Knowledge Sources provide the best place to start. We recommend that the UMLS be used as a default source of biomedical concept names and relationships, as a comprehensive, data-based, 'reference model', and as an example of a large, ecumenical, evolving, continuously updated source of re-usable health care information.

Computer User Training↗

An open, component-based information infrastructure for integrated health information networks.

A fundamental requirement for achieving continuity of care is the seamless sharing of multimedia clinical information. Different technological approaches can be adopted for enabling the communication and sharing of health record segments. In the context of the emerging global information society, the creation of and access to the integrated electronic health record (I-EHR) of a citizen has been assigned high priority in many countries. This requirement is complementary to an overall requirement for the creation of a health information infrastructure (HII) to support the provision of a variety of health telematics and e-health services. In developing a regional or national HII, the components or building blocks that make up the overall information system ought to be defined and an appropriate component architecture specified. This paper discusses current international priorities and trends in developing the HII. It presents technological challenges and alternative approaches towards the creation of an I-EHR, being the aggregation of health data created during all interactions of an individual with the healthcare system. It also presents results from an ongoing Research and Development (R&D) effort towards the implementation of the HII in HYGEIAnet, the regional health information network of Crete, Greece, using a component-based software engineering approach. Critical design decisions and related trade-offs, involved in the process of component specification and development, are also discussed and the current state of development of an I-EHR service is presented. Finally, Human Computer Interaction (HCI) and security issues, which are important for the deployment and use of any I-EHR service, are considered.

Abstracting and Indexing↗

HL7 ontology and mobile agents for interoperability in heterogeneous medical information systems.

Modern medical information management is a knowledge intensive activity requiring a high degree of interoperability across various health management entities. Ontology-based multi-agent systems provide a framework for interactions in a distributed medical systems environment without the limitations of a more traditional client server approach. In this paper, we describe electronic Medical Agent System (eMAGS) a multi-agent system with an ontology based on an accepted public health message standard, Health Level Seven (HL7), to facilitate the flow of patient information across a whole healthcare organisation.

Computer Communication Networks↗

Disparate systems, disparate data: integration, interfaces, and standards in emergency medicine information technology.

As part of the broader informatics consensus initiative sponsored by Academic Emergency Medicine, this report addresses the issues of integration, interfaces, and data standards and how they are relevant to information management in emergency medicine. The purpose of this report, and the workgroup that contributed to its content, is to provide emergency physicians and other stakeholders in the emergency informatics community a sense of direction as they design, build, and/or choose systems. Problems are identified, strategies to address these problems are discussed, and consensus recommendations are provided.

Emergency Medicine↗

Computers in the ICU: panacea or plague?

The introduction of the intensive care unit (ICU) in the 1960s with its demands for management of large volumes of patient data drove the initial introduction of computers into the ICU. Since the mid-1960s computer systems for the ICU have evolved into the highly sophisticated bedside workstations commercially available today. Despite all of the technologic advances in computers, their application in ICUs in the United States continues to spread very slowly. One of the largest problems is justifying the cost of systems primarily designed to automate data charting and generation of care plans. Although the existing commercial systems do an excellent job, few conclusive studies prove that these systems have a favorable cost-to-benefit ratio. Research systems have demonstrated that if one extends these systems to incorporate a fully integrated database, decision-support tools, automation of data acquisition, and more sophisticated display and user-interface technology, then these ICU computer systems can have a significant impact on improving the quality and reducing the costs of patient care. For computers to be embraced in the ICU environment, commercial systems of the future must move beyond merely gathering and displaying information. They must help the clinician at the bedside assimilate the vast array of ICU data and help him to make more effective decisions.

Computer Systems↗

Health professional workstations and their integration in a hospital information system: the pragmatic approach MEDIAS.

Within the daily workload at a ward there is a considerable amount of information processing. It is the task of a systematic management of hospital information systems to provide health professionals with the right information in the right place at the right time. This paper deals with the consequences for the management of hospital information systems if health professional workstations are introduced as a means for this information logistic and with the experiences gained in the Heidelberg University Hospital. Health professional workstations are formally defined in the context of a three level graph-based model of hospital information systems. It is found that health professional workstations have communication needs not only on the physical level of computer systems in the hospital information system but also on the logical tool level, which is the level of application systems. On this level communication servers or brokers are of considerable importance. In Heidelberg there are about 200 health professional workstations (MEDIAS) in routine use.

Computer Communication Networks↗

Building a data foundation for tomorrow's healthcare information management systems.

Accurate, timely data are a necessary foundation for an effective healthcare information management system. Today's systems do not achieve their potential because they lack this essential ingredient. Technology can reduce the problem by making the data entry task easier, but a complete solution will require new strategies for system implementation and use. Functions must be implemented in a sequence that allows the initial functions to establish a data foundation for subsequent functions. Each atomic data item must be collected separately, with a consistent definition. Data capture strategies must permit data to be collected once, at the source. Finally, the data must be used, reused, and corrected by all members of the healthcare team.

Decision Making, Computer-Assisted↗

Integrated databases--the foundation for the information linking of the actors in the national health care and health insurance systems.

Among the characteristics of the present time, we meet the ranking of information among the key resources of effective management of business systems. Up to date, integral and accurate information have gained precedence over conventional economic resources. This applies particularly in the case of large and complex business systems, including the national health care and health insurance systems. High quality and unified databases form the foundation for rational and quality procedures ranging from the operative level to the national strategy level. The goal of this paper is to demonstrate, on the example of Slovene experience, the importance of keeping quality databases for the purposes of health care and health insurance system management. The paper reviews the achieved level and the plans of further development of unified databases in this sector in Slovenia. The key emphasis in the development of an integrated system has been laid upon establishing uniform primary databases and providing appropriate integration in the area of data interchange among the actors of the health care and health insurance systems and other national systems.

Data Collection↗

IAIMS and sharing.

The Integrated Academic Information Management System (IAIMS) concept is about sharing resources and information, and about improving the decision-making ability of health care professionals by integrating information. At Columbia-Presbyterian Medical Center, the IAIMS project has established an information architecture based on common, shared computing and networking resources. The institutional computing culture has been changed with increased sharing of information and, consequently, improved quality of information. Several classes of information in the areas of clinical, scholarly, administrative, basic research, and core resources have been identified for better understanding of information responsibility. Technical problems such as heterogeneity on workstation platforms and lack of universal syntactic and semantic standards for health care information exchange still impede inter-institutional sharing of information.

Artificial Intelligence↗

BioSYNTHESIS: access to a knowledge network of health sciences databases.

Users of the IAIMS Knowledge Network at the Georgetown University Medical Center have access to multiple in-house and external databases from a single point of entry through BioSYNTHESIS. The IAIMS project has developed a rich environment of biomedical information resources that represent a medical decision support system for campus physicians and students. The BioSYNTHESIS system is an information navigator that provides transparent access to a Knowledge Network of over a dozen databases. These multiple health sciences databases consist of bibliographic, informational, diagnostic, and research systems which reside on diverse computers such as DEC VAXs, SUN 490, AT&T 3B2s, Macintoshes, IBM PC/PS2s and the AT&T ISN and SYTEK network systems. Ethernet and TCP/IP protocols are used in the network architecture. BioSYNTHESIS also provides network links to the other campus libraries and to external institutions. As additional knowledge resources and technological advances have become available. BioSYNTHESIS has evolved from a two phase to a three phase program. Major components of the system including recent achievements and future plans are described.

Academic Medical Centers↗

Global information infrastructure.

The High Performance Computing and Communications Program (HPCC) is a multiagency federal initiative under the leadership of the White House Office of Science and Technology Policy, established by the High Performance Computing Act of 1991. It has been assigned a critical role in supporting the international collaboration essential to science and to health care. Goals of the HPCC are to extend USA leadership in high performance computing and networking technologies; to improve technology transfer for economic competitiveness, education, and national security; and to provide a key part of the foundation for the National Information Infrastructure. The first component of the National Institutes of Health to participate in the HPCC, the National Library of Medicine (NLM), recently issued a solicitation for proposals to address a range of issues, from privacy to 'testbed' networks, 'virtual reality,' and more. These efforts will build upon the NLM's extensive outreach program and other initiatives, including the Unified Medical Language System (UMLS), MEDLARS, and Grateful Med. New Internet search tools are emerging, such as Gopher and 'Knowbots'. Medicine will succeed in developing future intelligent agents to assist in utilizing computer networks. Our ability to serve patients is so often restricted by lack of information and knowledge at the time and place of medical decision-making. The new technologies, properly employed, will also greatly enhance our ability to serve the patient.

Computer Communication Networks↗

Health care professional workstations: where are we now? ... where should we be tomorrow?

This article looks back over four years during which major changes have occurred in healthcare informatics, both technically and from a policy perspective. A remarkable portion of what medical-informatics professionals were proposing in 1989 has subsequently come to pass. Thus, one lesson from reflections on the recent past is that now is the time for us to devise realistic expectations of what we will see happen in the next four years. Possible scenarios for the future are outlined, as are suggestions for how the informatics community might best prepare for what lies ahead.

Computer Communication Networks↗

In front of us.

The care of patients is an information-intensive activity in which a large number of decisions must be made. Through the support of more rapid, less expensive, and better decisions, workstations can contribute positively to the science, the art, and the economics of health-care. They have greatest potential value when they have access to a large amount of information relevant to the decisions which must be made jointly by patients and their care providers. Technological and psychological barriers to the acceptance of workstations are becoming increasingly surmountable. Workstations may increase patients' satisfaction with the care they are provided, reduce the total cost of care, and reduce the cost of clinical information to third parties, by economically enabling comprehensive, up-to-date, and accurate medical records from which information can be rapidly and cheaply extracted and made accessible to all who need to use it.

Computer Communication Networks↗

Workstations as enabling technologies for computer-based patient records.

Advances in computer-based technologies and cultural changes occurring in the workplace are changing the way we work and share information. Networked, distributed computing environments offer the promise of improving the quality of patient care and containing costs. Understanding and overcoming the cognitive and behavioral barriers of machine-man interactions will help us to fulfill that promise.

Computer Communication Networks↗

Development towards multimedia medical workstations.

In this paper, concepts and examples of medical workstations with multimedia and hypermedia capabilities will be presented. These workstations have special hardware and software requirements. Also described in the article are the developments in Europe (AIM project line) within this area.

Computer Communication Networks↗