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The author recounts his experience using the Colorado Medical Information Network, an online system linking physicians with hospitals, pharmacies, labs and HMOs. Through the system--without any previous computer experience--the author has greatly enhanced his practice management capability.
The Internet is rapidly evolving from a resource used primarily by the research community to a true global information network offering a wide range of databases and services. This evolution presents many opportunities for improved access to biomedical information, but Internet-based resources have often been difficult for the non-expert to develop and use. The World Wide Web (WWW) supports an inexpensive, easy-to-use, cross-platform, graphic interface to the Internet that may radically alter the way we retrieve and disseminate medical data. This paper summarizes the Internet and hypertext origins of the WWW, reviews WWW-specific technologies, and describes current and future applications of this technology in medicine and medical informatics. The paper also includes an appendix of useful biomedical WWW servers.
BACKGROUND: EUROETHICS is a database covering European literature on ethics in medicine. It is produced within Eurethnet, a European information network on ethics in medicine and biotechnology. OBJECTIVES: The aim of Euroethics is to disseminate information on European bioethical literature that may otherwise be difficult to find. METHODS: A collaboration model for pooling data from different centres was developed. The policy was to accomplish data uniformity, while still allowing for local differences in terms of software, indexing practices and resources. Records contributed to the database follow common standards in terms of data fields and indexing terms. The indexing terms derive from two thesauri, Thesaurus Ethics in the Life Sciences (TELS) and Medical Subject Headings (MeSH). Combining elements from search tools developed previously, the developers sought to find a technical solution optimized for this data model. An approach relying on a thesaurus database that is loaded along with the bibliographic database is described. RESULTS AND CONCLUSIONS: The present case study offers examples of possible approaches to several tasks often encountered in database development, such as: merging data from diverse sources, getting the most out of indexing terms used in a database, and handling more than one thesaurus in the same system.
In the emerging information society each hospital is supposed to become a node of a complex networked information system that has to be accessible to a variety of users. These include doctors, nurses, administrators and the patients themselves, whose role is briefly described. This asks for a new approach to the implementation of the interfaces of the information system, which are used to carry out different tasks by people with different interests and computer literacy. A new approach to the implementation of such interfaces, based on the concepts of User interfaces for All, is briefly outlined, describing the scientific and technical achievements in some projects partially funded by the European Commission and the activities of the International Scientific Forum "Towards an Information Society for All" set-up to discuss and promote the relevant scientific concepts and technical issues.
Evidence exists that support services for community elders vary with need. However, few controlled longitudinal analyses have been carried out regarding descriptive profiles of elders experiencing differential change in service levels -- the focus of analysis here. Using a multivariate profile procedure (PC-Group), 1,730 elders followed over an 18-month period were first classified according to change in functional status groupings that predicted change in hours of service over this period, and each group was subsequently subdivided. Five of nine profiles identified (82% of the sample) were relatively stable functionally. In general, changes in service levels reflected change in functional status; profiles reflected differential change in service level depending upon whether functional status declined; the network provided an unusually high level of service (overextended) at baseline; or the informal network consisted exclusively of children.
The DERMatology INFOrmation NETwork (DERM/INFONET) of the American Academy of Dermatology has become a reality. DERM/INFONET consists of a number of data bases providing information and educational programs for the dermatologist. Currently the components are: DERM/MLS (Medical Literature Search), DERM/RX (dermatologic therapy), DERM/USP (United States Pharmacopeia data base), DERM/ALLERGENS (Food and Drug Administration and Environmental Protection Agency Listings of allergens); Melanoma Prognosis Model; Electronic Mail; Bulletin Board; Meetings Calendar; ICD/CPT (International Classification of Diseases/Current Procedural Terminology) codes; AAD Membership/Committee Directories; and Dermatology Quiz. Additional data bases are planned. As audiovisual and alphanumeric communication systems evolve, newer opportunities for enhancing the DERM/INFONET Biomedical Communication Network will undoubtedly provide even greater opportunities for aiding the dermatologist in delivering state-of-the art management for their patients.
The molecular probe data base (MPDB) contains detailed information on synthetic oligonucleotides, including their identification, target genes, applications and bibliographic references. It is available on-line through Internet and can be searched by using Network Information Retrieval tools. In this article the most recent enhancements of MPDB, both in terms of data contents and new ways of access, are described. These include a recently established collaboration with EMBL Data Library, in the sphere of SRSWWW network browser, in view of a better integration of MPDB with other molecular biology databases.
The nine hospitals that belong to the Hospital Consortium of Greater Rochester have a long history of working together to control health care costs in this upstate New York community. Now they're focusing on creating an electronic health information network. The project has the support of major local employers, which want to keep unnecessary care to a minimum to reduce costs. Electronic networking also will support longstanding efforts in Rochester to ensure that hospitals don't needlessly duplicate services. And the network will allow providers to more easily draw on a treasure trove of information already stored in clinical data bases.
A local area communications network (LACN) has been implemented successfully at the University of California, San Francisco (UCSF) Hospital. This technology, developed by the Applied Physics Laboratory of the Johns Hopkins University, facilitates communication among systems previously considered "incompatible". The implication of this experiment is that a modular, evolutionary approach to medical systems will soon be a viable alternative to the "total" single-vendor approach now commonly used. Substantial preparation by a medical center, however, will be required in order to use an LACN properly. This will probably be done in many cases with the assistance of a new type of medical systems vendor, i.e., one having no systems of its own to sell.
As dependence upon interorganizational and international health care informatics becomes absolute, and with increased vulnerability of information networks and applications and the cunning sophistication of computer criminals, it becomes imperative to implement tight information systems security to ward off any possible threat to these vital life-dependent information systems. In a rapidly decentralizing environment, the author proposes centralized security control, implemented in a Security Audit Center under the direct supervision of an Information Systems Security Manager who is a high-ranking organization staff member. Of the various components of the Security Audit Center, the most significant is the security audit expert systems which analyze audit data files according to security rules and present a precise status of systems security and realtime suspicion alert of the various breaches and intrusions.
This article has examined the impact that telecommunications technologies may have on the way in which health care services are delivered. A number of scenarios of how that might occur were discussed. Some of these scenarios are already being realized. Telemedicine, for instance, is being used in certain geographic regions of the United States. Various community health information networks are in the developmental stages or at varying degrees of operability. Two such networks in Colorado and Wisconsin were offered as examples. The impact of these developments on confidentiality and security of patient information, issues central to the responsibilities of health information managers, has been discussed. These technological advancements will have consequences for health information managers in other ways, too. The types of tasks that are performed and how those tasks are performed related to storing and retrieving information will be different in the future. In the transition period, blurring of job functions may occur as different types of practitioners strive to carve their niche in the electronic environment. For instance, as electronic patient records are linked to bibliographic databases of medical literature, where do the responsibilities of health information managers end and medical librarians begin? The best way to ensure a position on the health care team of the future is to recognize the opportunities provided by this dynamic period in health care.
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.
Electronic information access is an imperative skill for the modern health professional. Mead Data Central's MEDIS overcomes the limitations of "abstract-only" information networks and provides rapid access to a large collection of full-text medical information. With its proprietary communications software, Mead can display citations in a paged format with on-screen highlighting (in "reverse video") of search terms as they appear in documents. Users can move through the electronic pages as easily as they would thumb through a journal or book. A practice section on MEDIS is billed only for connect charges for using, and a unique on-line tutorial, which, while not specific for MEDIS, introduces users to searching the Mead system. Training is available to subscribers in several major cities and training software is available. MEDIS is a unique resource to access medical literature in full-text quickly and efficiently.
The Arizona Health Information Network (AZHIN) is a statewide member-driven organization committed to improving access to information for health sciences students and practitioners. Members include several hospitals and hospital systems, an academic health sciences center, and other diverse health care organizations. AZHIN offers its members unlimited Web access to ten well-known health sciences databases. This paper explores the impact that AZHIN has had on its member institutions. A survey asked members to reflect on AZHIN and its possible effects on the visibility of the librarian within the institution, relative dollars spent on AZHIN and range of resources available, Internet connectivity within their institution, access to AZHIN and other Internet resources, teaching, and benefits of collaboration. Results indicated that AZHIN members have access to a wider range of resources than they would otherwise. There are financial savings for some. Internet connectivity and AZHIN membership can provide the librarian with a broadened role and increased visibility. The availability of MEDLINE and other AZHIN resources encouraged some institutions to install Internet connectivity more quickly. Teaching library users has increased. Overall, AZHIN members recognized many benefits of their collaboration.
The development of a Faculty of Medical Sciences (FMS) and an academic health sciences library for the University of the West Indies (UWI) has proven to be a polemical and political issue due to the depressed economy of the country. Although FMS is still shrouded in politics and controversy after its inaugural year, the Medical Sciences Library (MSL) has expanded its dimensions and is actively developing a biomedical information network within the country. This will result in better dissemination and control of biomedical information. The library now participates in joint projects with other health sciences libraries in the country with the goal of joint automated listings of holdings and shared cataloging projects. This paper examines the development of the library and explains the difficulties experienced in its developmental stages due to politics, the delay in appointment of a medical sciences librarian, and the financial decline in the local economy.
Sophisticated integration of medical information about cancer and other chronic diseases has become increasingly important in diagnosis, treatment, care of patients and clinical research. Cancer control strategy could not be planned without such precise information. Information on cancer prevention is divided into primary, secondary and tertiary levels. The current situation in Japan at each level is reviewed, and effective systems proposed. We need an integrated system for collecting and analyzing information, and for distributing it efficiently to the public, health professionals and health planners, and this can be achieved by building a cancer information center within the National Cancer Center. Some examples of information networks in the U.S.A. set up to achieve the purposes set out above are given, and recent attempts to build a similar network in Japan are introduced. International collaborative work should advance more effectively through such information systems.
The development of healthcare information systems as tools to facilitate business success traditionally has focused on a single profit center. The cataclysmic changes that are reshaping American healthcare have accelerated the affiliation of provider entities to form systems that have broader geographic coverage, deliver a larger portion of the provider continuum of care, and are more attractive partners for purchasers of healthcare services. Integrated and/or standardized information system technologies can provide great benefit in containing costs and optimizing quality among partners resulting from healthcare mergers and acquisitions as the new entity positions itself to increase market share and enhance its bottom line. Graduate Health System (GHS) in the Philadelphia area has demonstrated the efficacy of its investment to build a system-wide information network that delivers multiple standardized, integrated systems for both the financial and operational advantage of all component institutions. Building on its patient information system as the centerpiece of its information strategy, GHS has deployed a variety of tools across its network infrastructure that have brought new capabilities and savings to its member hospitals. In light of some of GHS's successes, other hospitals and healthcare systems may be able to re-create similar savings and efficiencies by applying like strategies in cooperation with their affiliated partners.
A community health information network (CHIN) is a group of health care providers and others interested in health care in a community who share computerized patient information and medical records to provide comprehensive quality care at a lower cost. To protect confidential patient data, all CHIN members should sign a confidentiality agreement describing how and for what purposes health information may be used and incorporating adequate indemnification provisions for unauthorized disclosure. Further, CHIN members should implement practical security passwords which are periodically changed, and the rapid deactivation of the user identification of terminated employees. To ensure data integrity, clear policies should be established for recording, amending and destroying information stored in patient records. To preserve the availability of the network's essential software, CHIN members also should enter into software license agreements which will allow for uninterrupted use of the network software following the addition of a new member or the departure on an existing member. Medical groups participating in CHINs can utilize these strategies to minimize their liability exposure from patient data confidentiality lapses and to promote proper data management and software availability for the smooth functioning of the network.