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As issues of security, accountability and access are resolved, the Internet will act as the central infrastructure for a global as well as a community health information network. It will help nurses extend their services to the community and to educate specific patient populations.
Information system planning for the ED is complex and new to emergency medicine, despite being used in other industries for many years. It has been estimated that less than 15% of EDs have comprehensive EDIS currently in place. The manner in which administration is approached in large part determines the success in obtaining appropriate institutional support for an EDIS. Active physician and nurse involvement is essential in the process if the new system is to be accepted at the user level. In the ED, large volumes of information are collected, collated,interpreted, and acted on immediately. Effective information management therefore is key to the successful operation of any ED. Although computerized information systems have tremendous potential for improving information management, such systems are often underused or implemented in such a way that they increase the workload on caregivers and staff. This is counter productive and should be avoided. In developing and implementing EDIS one should be careful not to automate poorly designed manual processes. Examples are ED tracking systems that require staff to manually relocate patients in the system. This task probably is completed only when the ED volume is low and "worked around" when the department is busy. Information from such a system is, therefore, flawed; at best useless and at worst counter productive. Alternatively, systems are available that can track patients automatically through the ED by way of infrared sensors similar to those used in baggage-tracking systems that have been in place in airports for years. In the automated (computerized) ED, we must have zero-fault-tolerant,enterprise-wide, hospital information networked systems that prevent unnecessary duplication of tasks, assist in tracking and entering data, and ultimately help analyze the information on a minute-to-minute basis. Such systems only reach their potential when they are fully integrated, including legacy systems, rather than stand alone proprietary EDIS. Further,a modular approach in which individual components are connected to a flexible computer backbone is ideal.Finally, good clinical content is key to virtually every aspect of the EDIS. Much of this content is yet to be developed and what is available still needs to be adapted to the EDIS environment. Daunting as it may be, an EDIS implementation properly accomplished results in better patient care, improved staff productivity, and a satisfying work environment (Box 3).
We numerically investigate the scale-free network model of Barabási and Albert [A. L. Barabási and R. Albert, Science 286, 509 (1999)] through the use of various path finding strategies. In real networks, global network information is not accessible to each vertex, and the actual path connecting two vertices can sometimes be much longer than the shortest one. A generalized diameter depending on the actual path finding strategy is introduced, and a simple strategy, which utilizes only local information on the connectivity, is suggested and shown to yield small-world behavior: the diameter D of the network increases logarithmically with the network size N, the same as is found with global strategy. If paths are sought at random, D is equivalent to N(0.5) is found.
Electronic information utilities in the health sciences such as MINET (Medical Information Network) are increasingly important as it becomes more convenient for end users to retrieve data and use various online information services such as electronic mail from personal computer workstations. MINET is examined in depth as the most fully developed end-user utility. Several other end-user utilities and full-text databases in the health sciences are listed and described.
The Telecommunications Information Network (TIN) was an applied research project that evaluated the ability of slow-scan television to provide medical information on demand to health-care professionals at hospitals far from any urban area. This paper reviews the TIN project, describes its use, and discusses system advantages and disadvantages. System evaluation encompasses (1) project benefits; (2) technical barriers to implementation and utilization; (3) the replication of services and the technology utilized; and (4) cost factors.
The INFORMM (Information Network for Online Retrieval & Medical Management) patient problem/nursing diagnosis form is a computer-generated, patient record document of information related to identified patient conditions and patient outcomes. These patient and nursing data, accessible online as well as in paper copy, enhance continuity of care by providing, to all authorized clinicians, a list and history of identified patient problems/nursing diagnoses and the patient's status in terms of the achievement of projected patient outcomes. This cumulative, patient-centered documentation facilitates patient care effectiveness and provides mechanisms to capture and retrieve patient and outcome data for quality improvement and research purposes.
OBJECTIVE: to describe the key concepts and elements used to implement a comprehensive access management system to a distributed, component-based healthcare information system. METHODS: the a priori access is based on an institution-wide policy for access rights coupled to proximity process for the granting of such rights. Access rights are explicit and externalized from the information systems components. A posteriori control is based on a centralized, exhaustive journal of accesses to all components coupled to a decentralized verification process for suspicious accesses. RESULTS: the system has been operational for three years, initially used for the access to the computerized patient record components, and now extending to all the components of the hospital information system. The same architecture will be used for the development of the trans-institutional community health information network.
The health professional multimedia workstation is the natural entry point to health and knowledge networks. It should allow an easy and transparent management of all the data necessary for patient management. Multimedia nature of processed information reflects evolution of medical techniques that involve more and more complex objects such as video sequences or digitized signals. Workstations can be considered from 3 points of view: the professional end-users, the developers and the decision makers. The long term goal for the end-user is to establish an easy access in a working environment, that gives him/her the feeling of a single comprehensive application running on a single computer when the information system relies on a set of heterogeneous and geographically distributed components. Development of a workstation requires the integration into the same environment of tools to localize, access, manipulate and communicate the required information within a health information network. Analysis of the 445 Medline-indexed publications for the January 1991 to December 1994 period, that included the word workstation either in their title or in their abstract, helps in refining objectives and challenges both for the health professionals and the decision makers.
Changing business practices, customers needs, and market dynamics have driven many organizations to implement interorganizational systems (IOSs). IOSs have been successfully implemented in the banking, cotton, airline, and consumer-goods industries, and recently attention has turned to the health care industry. This article describes an exploratory study of health care IOS implementations based on the voluntary community health information network (CHIN) model.
Recent issues on BSE(Bovine Spongiform Encephalopathy) and health hazards caused by adverse reactions of medical drugs, have strongly emphasized the necessity for safety measures to secure public health. These issues have been attributed to the delay to obtain overseas information on safety and regulation, and the lack of an adequate system for acquirement and assessment of such information. In order to develop a system where domestic and international safety information is collected, analyzed, assessed and presented both scientifically and systematically, the Division of Chem-Bio Informatics of the National Institute of Health Sciences was reorganized to the Division of Safety Information on Drug, Food and Chemicals in April, 2003. Collection and evaluation of safety information on medical drugs, food and chemical substances is now centralized at the Division, which consists of 5 sections, the first, second and third sections being newly established. The first section assesses information on medical drugs, the second section deals with food microorganisms, and the third section focuses on chemicals in food. The fourth and fifth sections retain their previous functions, namely, chemical safety information research and information network infrastructure support within the institute, respectively. The purpose of this paper is to describe how we will manage safety information on drug, food and chemicals, focusing on the role of the three new sections.
Information exchange, enabled by computable interoperability, is the key to many of the initiatives underway including the development of Regional Health Information Exchanges, Regional Health Information Organizations, and the National Health Information Network. These initiatives must include public health as a full partner in the emerging transformation of our nation's healthcare system through the adoption and use of information technology. An electronic health record - public health (EHR-PH)system prototype was developed to demonstrate the feasibility of electronic data transfer from a health care provider, i.e. hospital or ambulatory care settings, to multiple customized public health systems which include a Newborn Metabolic Screening Registry, a Newborn Hearing Screening Registry, an Immunization Registry and a Communicable Disease Registry, using HL7 messaging standards. Our EHR-PH system prototype can be considered a distributed EHR-based RHIE/RHIO model - a principal element for a potential technical architecture for a NHIN.
"This paper focuses on the role of information and communication in international migration by means of a survey which covers economic and broader perspectives, both at the micro and macro levels. The human capital model of migration is reviewed and the likely impact of recent and anticipated developments in telecommunications technology is noted. The job search model is reformulated in the context of international migration but extensive modification is required to describe the potential sampling of job offers and other informational needs of international migrants. It is argued that spatial selectivity is to a large extent influenced by migration networks in which information flows play a critical role. This is further elucidated by offering an analytical framework based on the systems approach to migration."
In recent years, the rapid expansion in Internet access and computer-mediated communication has fostered new opportunities for individuals with health-related concerns to participate in supportive communication within a network of individuals dealing with similar issues. The aim of this study was to examine the nature of socially supportive communication that took place within a computer-mediated support network for individuals affected by irritable bowel syndrome. Using deductive thematic analysis, 572 posted messages were examined with reference to five main categories of social support (i.e., emotional, esteem, information, network, and tangible assistance). The analysis suggests that the primary function of this group was the communication of informational support, notably within the areas of symptom interpretation, illness management, and interaction with health care professionals.
OBJECTIVES: As health care develops from an organization-centered via service-centered (disease management) towards a person-centered system (favored homecare, patient monitoring, body area networks), information systems involved have to be semantically interoperable, process-related, decision-supportive, context-sensitive, user-oriented, and trustworthy. METHODS: The aforementioned paradigm shift requires highly flexible solutions based on knowledge concepts, provided by a service-oriented and model-driven approach. RESULTS: Information systems' design, implementation and maintenance have to be realized based on formal grammar. This is true for all considered aspects and views of the system and its components, using metalanguages and reflecting all domains touched. CONCLUSIONS: For meeting the challenge, involvement of, and close collaboration between, experts from different domains as well as knowledge and tooling regarding formal modeling and model interchange are required.
The INFORMM (Information Network For Online Retrieval & Medical Management) patient discharge referral form is interdisciplinary in scope. The initial automated form, implemented on 41 general inpatient care units as of December, 1991, involved the collaboration of the departments of Nursing, Social Services, Medical Records, and Patient Registration. As development proceeds, it is expected that other clinical disciplines will contribute additional data and information to augment and complement the content of the patient discharge referral form.
In Finland, the shared record is a virtual electronic health record (EHR). It consists of health data generated, maintained and preserved by different health care service providers. Two different kinds of technologies for integrating regional EHR-systems are applied, but mainly by using a common middleware. Services provided by this middleware are EHR location services using a link repository and combining EHR-viewing services with security management services including consent management and identification services for health professionals. The Regional Health Information Organization (UUMA) approach is based on a stepwise implementation of integrated regional healthcare services to create a virtually borderless healthcare organization--a patient centered virtual workspace. In the virtual workspace multi-professional teams and patients collaborate and share information regardless of time and place. Presently the regional health information network (RHIN) is comprised of three integrated services between primary, secondary and tertiary care within the county of Uusimaa. The regional healthcare modules consist of an (1) eReferral network, (2) integrated EHR service between health care professionals and (3) PACS system. The eReferral between primary and secondary care not only speeds up the transfer, but also offers an option for communication in the form of eConsultation between general practitioners and hospital specialists. By sharing information and knowledge remote eConsultations create a new working environment for integrated delivery of eServices between the health care providers. Over 100,000 eReferral messages (40 %) were transferred between health care providers. Interactive eConsultations enable supervised care leading to the reduction of outpatient visits and more timely appointments. One third (10/31) of the municipal health centers are connected to the clinics in the Helsinki University Central Hospital by the eReferral system. The link directory service extends the dimensions of networking between organizations by combining legacy systems within regional primary and secondary care. The link directory is an interface to diverse patient information systems, like HUSpacs, containing links pointing to the actual patient data located in remote information systems. The original data including images can be viewed with a web browser, but data can be accessed only with the patient's informed consent. Currently the reference data base includes 9.5 million links from 1.4 million patients with over 2.000 daily users. We aim to create a new working environment for professionals by incorporation of innovative information and communication technology, new organization of work and re-engineering of workflows. In the near-future, the citizen will have an active role participating in decisions on his care, carrying out guided self-care and taking steps of pro-active prevention.
In France, the prevalence of End-Stage Renal Disease (ESRD) is not precisely known. The sources of information are scattered and not coordinated. Consequently, care is ill adapted to meet the demand. The Multi-Source Information System is the basis of the Renal Epidemiology and Information Network (REIN). It is dedicated to improve and organise our medical and epidemiological knowledge of ESRD and to aid public health decision-making in this area. The proposed approach is based on the datawarehouses. This model allows a unified vision of scattered data into distinct databases, for a better management, be it particular (patient follow-up) or global (regional follow-up), with a finality of aid in decision-making. Several categories of problems were considered: the global conception of the information system, the organisation of the datawarehouse, which offers different viewpoints of the data, the integration of heterogeneous data coming from different sources, data exchange and definition of a specific ontology.
Molecular Probe Data Base contains detailed information on synthetic oligonucleotides with a sequence of up to 100 nucleotides. This database prevalently contains information related to human oligonucleotides used in diagnostics. Molecular Probe Data Base has been made available on-line through the Internet by means of Network Information Retrieval (NIR) tools since 1993. Two years ago, a collaboration with EMBL Data Library was also set up, so that the Molecular Probe Data Base has been integrated with other molecular biology data banks in the sphere of the SRS WWW network browser. In this paper, the most recent enhancements and the current status of the Molecular Probe Data Base are briefly presented.