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Cultural aspects of information technology implementation.

Culture sets our values and norms. It is a way of thinking that determines our behaviours, decisions, actions and knowledge. Technology transfer and integration are basically the exchange of the knowledge, know-how and skills through which technology was created and on which its use depends. Culture is deeply rooted in ourselves. We are usually unaware of its influence on our professional activity. Cultures are diverse, and their encounter through technology exchange triggers conflicts that are expressed in objective terms. We need to detect and resolve those conflicts at the right level, i.e. at the cultural level instead of only focusing on the visible 'obstacles' to the deployment of telematics applications. This paper summarises the basic concepts on which we ground a practical approach to detecting and resolving culture-based conflicts in technology transfer and integration. It investigates the relation between cultural preferences and actions. Culture is translated and reduced to a seven dimensions framework. Cultural preferences influence the decision-making process that leads to tangible actions. The structure and dynamics of that process are described as a Change Governance Framework. It considers the control aspects of decision making that are sensitive to cultural preferences, i.e. the way decisions are taken, why, by whom.

Cultural Diversity↗

Supporting clinical practice at the bedside using wireless technology.

OBJECTIVES: Despite studies that show improvements in both standards of care and outcomes with the judicious application of clinical practice guidelines (CPGs), their clinical utilization remains low. This randomized controlled trial examined the use of a wirelessly networked mobile computer (MC) by physicians at the bedside with access to an emergency department information system, decision support tools (DSTs), and other software options. METHODS: Each of ten volunteer emergency physicians was randomized using a matched-pair design to work five shifts in standard fashion (desktop computer [DC] access) and five shifts with a wirelessly networked MC. Work pattern issues and electronic CPG/DST use were compared using end-of-shift satisfaction questionnaires and review of a CPG/DST database. Repeated-measures analysis of variance was used to examine between-shift differences. RESULTS: A total of 100 eight-hour shifts were evaluated; 99% compliance with postshift questionnaires was achieved. Using a seven-point Likert scale (MC values first), MCs were rated as being as fast (5.04 vs. 4.54; p=0.13) and convenient (5.08 vs. 4.14; p=0.07) as DCs. Overall, physicians rated MCs to be less efficient (3.18 vs. 4.30; p=0.02) but encouraged more frequent use of DSTs (4.10 vs. 3.47; p=0.03) without impacting doctor-patient communication (2.78 vs. 2.96; p=0.51). During the study period, physician use of an intranet Web application (eCPG) was more frequent during shifts assigned to the MC when compared with the DC (eCPG uses/shift, 3.6 vs. 2.0; p=0.033). CONCLUSIONS: The MC technology permitted physicians to access information at the bedside and increased the use of CPG/DST tools. According to physicians, patients appeared to accept their use of information technology to assist in decision making. Development of improved computer technology may address the major limitation of MC portability.

Computers↗

The Healthgrid White Paper.

Over the last four years, a community of researchers working on Grid and High Performance Computing technologies started discussing the barriers and opportunities that grid technologies must face and exploit for the development of health-related applications. This interest lead to the first Healthgrid conference, held in Lyon, France, on January 16th-17th, 2003, with the focus of creating increased awareness about the possibilities and advantages linked to the deployment of grid technologies in health, ultimately targeting the creation of a European/international grid infrastructure for health. The topics of this conference converged with the position of the eHealth division of the European Commission, whose mandate from the Lisbon Meeting was "To develop an intelligent environment that enables ubiquitous management of citizens' health status, and to assist health professionals in coping with some major challenges, risk management and the integration into clinical practice of advances in health knowledge." In this context "Health" involves not only clinical procedures but covers the whole range of information from molecular level (genetic and proteomic information) over cells and tissues, to the individual and finally the population level (social healthcare). Grid technology offers the opportunity to create a common working backbone for all different members of this large "health family" and will hopefully lead to an increased awareness and interoperability among disciplines. The first HealthGrid conference led to the creation of the Healthgrid association, a non-profit research association legally incorporated in France but formed from the broad community of European researchers and institutions sharing expertise in health grids. After the second Healthgrid conference, held in Clermont-Ferrand on January 29th-30th, 2004, the need for a "white paper" on the current status and prospective of health grids was raised. Over fifty experts from different areas of grid technologies, eHealth applications and the medical world were invited to contribute to the preparation of this document.

Computer Communication Networks↗

Distributed user interfaces for clinical ubiquitous computing applications.

OBJECTIVES: Ubiquitous computing with multiple interaction devices requires new interface models that support user-specific modifications to applications and facilitate the fast development of active workspaces. METHODS: We have developed NOSTOS, a computer-augmented work environment for clinical personnel to explore new user interface paradigms for ubiquitous computing. NOSTOS uses several devices such as digital pens, an active desk, and walk-up displays that allow the system to track documents and activities in the workplace. RESULTS: We present the distributed user interface (DUI) model that allows standalone applications to distribute their user interface components to several devices dynamically at run-time. This mechanism permit clinicians to develop their own user interfaces and forms to clinical information systems to match their specific needs. We discuss the underlying technical concepts of DUIs and show how service discovery, component distribution, events and layout management are dealt with in the NOSTOS system. CONCLUSION: Our results suggest that DUIs--and similar network-based user interfaces--will be a prerequisite of future mobile user interfaces and essential to develop clinical multi-device environments.

Computer Communication Networks↗

Scalable methodologies for distributed development of logic-based convergent medical terminology.

As the size and complexity of medical terminologies increase, terminology modelers are increasingly hampered by lack of tools and methods to manage the development process. This paper presents our use and ongoing evaluation of a description-logic classifier to support cognitive scalability of the underlying terminology and our enhancements to that classifier to support concurrent development utilizing semantics-based concurrency control methods. Our enhancements, collectively referred to as the Gálapagos, consist of several applications that take locally-developed terminology enhancements from multiple sites, identify conflicting design decisions, support the modelers' reconciliation of the conflicting designs, and efficiently disseminate updates tailored for locally enhanced terminologies. We have tested our ideas through concurrent evolutionary enhancement of SNOMED International at three Kaiser Permanente regions and the Mayo Clinic. We have found that the underlying environment has met our design objectives, and supports semantic-based concurrency control, and identification and resolution of conflicting design decisions.

Artificial Intelligence↗

Computer applications in dermatology.

Advances in computer technology both in hardwares and softwares has stimulated the proliferation of the use of computers in dermatology. The computers enable the voluminous medical literature and records to be compiled and accessed readily. Information technology enables dermatologists to conduct literature searches efficiently and helps in the management of patients. The information compiled in the computers as databases together with its capability to handle complex statistical analysis also enables dermatologists and computer scientists to develop expert systems to assist the dermatologist in the diagnosis and prognostication of diseases and to predict disease trends. Computers have also allowed dermatologists to assess visual images objectively, making it possible to study treatment response more accurately.

Artificial Intelligence↗

The need to ensure that the globalization of information and telematics does not destabilize health-care worldwide.

Modern telecommunication transcends institutional, organizational and cultural boundaries. In the context of health-care, this means that information, enquiries, demands and service provision can be routed anywhere, free of institutional or natural control. The Internet makes information available to anyone regardless of its quality, source or intention. Organizationally initiated applications such as telemedicine are usually intended to reinforce local systems, but their very design and intention indicate a potential rapidly to transcend inherited but electronically ineffectual boundaries. The consequences of such uncontrolled globalization of health-care activities will range from beneficial empowerment and quality improvement, to detrimental effects such as overloading of experts, and undermining of stable health-care systems. The major unplanned societal re-engineering effects in a paper-based culture are likely to be significant and global institutions need to respond by creating positive global frameworks and policies.

Clinical Competence↗

Machine learning in bioinformatics: a brief survey and recommendations for practitioners.

Machine learning is used in a large number of bioinformatics applications and studies. The application of machine learning techniques in other areas such as pattern recognition has resulted in accumulated experience as to correct and principled approaches for their use. The aim of this paper is to give an account of issues affecting the application of machine learning tools, focusing primarily on general aspects of feature and model parameter selection, rather than any single specific algorithm. These aspects are discussed in the context of published bioinformatics studies in leading journals over the last 5 years. We assess to what degree the experience gained by the pattern recognition research community pervades these bioinformatics studies. We finally discuss various critical issues relating to bioinformatic data sets and make a number of recommendations on the proper use of machine learning techniques for bioinformatics research based upon previously published research on machine learning.

Algorithms↗

Comparing alternative methods for composing community peer groups: a data warehouse application.

A method for assessing the health status of communities has been under development for a decade at the University of South Florida. Known as CATCH (Comprehensive Assessment for Tracking Community Health), the method utilizes health status indicators from multiple data sources. With federal grant support, a unique data warehouse has been created to automate CATCH assessments and to enhance online analytical processing for efficient data browsing, knowledge discovery, and model testing. A comparison of two peer grouping methods (population size versus predicted age-adjusted mortality) is reviewed to demonstrate the warehouse capabilities.

Community Health Planning↗

Symbolic anatomic knowledge representation in the Read Codes version 3: structure and application.

The Read Thesaurus (Version 3 of the Read Codes) is a controlled medical vocabulary produced during the Clinical Terms Projects with the involvement of over 2,000 health care professionals from all United Kingdom specialties. In addition to allowing the transfer of clinical information in a meaningful way, it supports analysis of this information and provides a basis for the development of shareable medical knowledge bases. The thesaurus includes a comprehensive, dynamic set of over 7,000 gross anatomic concepts richly linked in a network with over 16,000 operative procedures and 40,000 disorders. The representation of anatomic concepts aims to balance the requirements for expressivity, clearness, and simplicity. The underlying directed acyclic graph hierarchy is independent of the alphanumeric code and enables continued refinement and expansion. A template table allows semantic definition, qualification, and linkage of concepts.

Anatomy↗

Guidelines for the effective use of entity-attribute-value modeling for biomedical databases.

PURPOSE: To introduce the goals of EAV database modeling, to describe the situations where entity-attribute-value (EAV) modeling is a useful alternative to conventional relational methods of database modeling, and to describe the fine points of implementation in production systems. METHODS: We analyze the following circumstances: (1) data are sparse and have a large number of applicable attributes, but only a small fraction will apply to a given entity; (2) numerous classes of data need to be represented, each class has a limited number of attributes, but the number of instances of each class is very small. We also consider situations calling for a mixed approach where both conventional and EAV design are used for appropriate data classes. RESULTS AND CONCLUSIONS: In robust production systems, EAV-modeled databases trade a modest data sub-schema for a complex metadata sub-schema. The need to design the metadata effectively makes EAV design potentially more challenging than conventional design.

Database Management Systems↗

Realtime textured 3D-models for medical applications.

Realistic visualisation becomes more and more important in medicine. Whenever a patient individual 3D-model was generated the aim is to visualise the model as realistic as possible. We use 3D-models in our diagnostic and therapeutic tools for intraoperative visualisation of e.g. CT-scans. Most medical tools uses surface-rendering or volume-rendering for virtual visualisation. The coloration of a visualised model is normally done by using a convenient colour for each surface resp. volume. Our approach for 3D-models generated from motion in image series (e.g. videoendoscopes) is to add textures to the 3D-model. The main problem is, to handle the huge amount of videoimage-data (20Mb/sec.) and render the model in realtime.

Computer Simulation↗

European security framework for healthcare.

eHealth and telemedicine services are promising business areas in Europe. It is clear that eHealth products and services will be sold and ordered from a distance and over national borderlines in the future. However, there are many barriers to overcome. For both national and pan-European eHealth and telemedicine applications a common security framework is needed. These frameworks set security requirements needed for cross-border eHealth services. The next step is to build a security infrastructure which is independent of technical platforms. Most of the European eHealth platforms are regional or territorial. Some countries are looking for a Public Key Infrastructure, but no large scale solutions do exist in healthcare. There is no clear candidate solution for European-wide interoperable eHealth platform. Gross-platform integration seems to be the most practical integration method at a European level in the short run. The use of Internet as a European integration platform is a promising solution in the long run.

Computer Security↗

Microdissection, microchip arrays, and molecular analysis of tumor cells (primary and metastases).

Advances in biotechnology and bioinformatics are offering promise for new breakthroughs in gene discovery and elucidation of gene function. At present, many candidate genes related to cancer pathogenesis have been identified in several types of human cancer, yet frequently their function remains elusive. This is particularly true as it relates to the progression of human cancer. This landscape could change dramatically, however, as technological innovations and improvements continue to revolutionize these fields. High-throughput molecular approaches are emerging, which may become accurate, automated, and cost-effective. For example, DNA arrays on microchips are under development with numerous applications, including the ability to screen genes rapidly for mutations and to study patterns of gene expression on a large scale. Automated systems for microdissection and sequencing are also in their implementation stages. Commensurate with their integration and evolution, these information and technological tools have the potential to offer a more comprehensive understanding of multiple genetic and cellular alterations occurring during cancer initiation, development, and progression. Ultimately, this fundamental knowledge can provide strategies for intervention, prevention, and early diagnosis. This is a US government work. There are no restrictions on its use.

Base Sequence↗

VATAM: developing consensus in validation of health telematics applications.

VATAM (Validation of Telematics Applications in Medicine) is an EU supported project in the Health care sector of the Telematics Application Programme. Its objective is to assist other health telematics projects by providing a platform for discussion on validation, eventually resulting in 'guidelines for validation of telematics applications in medicine'. The VATAM work can be subdivided into three phases: the inventory phase (1996) in which information is collected on validation approaches in the Telematics Application Programme, previous efforts and expertise. The dissemination phase (1997) will be used to extend and adapt the framework developed in the inventory phase, through cooperation with other projects The experiences phase (1998) in which the projects are actually applying validation, will be used by VATAM to validate the VATAM methodology. VATAM has finished the inventory phase successfully and is now working on the dissemination phase by--among others--establishing contacts with other projects, and providing information on the inventory through the World Wide Web (URL: http:(/)/www-vatam.unimaas.nl). This paper discusses the approach adopted and the proposed VATAM framework to structure the large variety of validation approaches.

Computer Communication Networks↗

MEDUSA: a fuzzy expert system for medical diagnosis of acute abdominal pain.

Even today, the diagnosis of acute abdominal pain represents a serious clinical problem. The medical knowledge in this field is characterized by uncertainty, imprecision and vagueness. This situation lends itself especially to be solved by the application of fuzzy logic. A fuzzy logic-based expert system for diagnostic decision support is presented (MEDUSA). The representation and application of uncertain and imprecise knowledge is realized by fuzzy sets and fuzzy relations. The hybrid concept of the system enables the integration of rule-based, heuristic and case-based reasoning on the basis of imprecise information. The central idea of the integration is to use case-based reasoning for the management of special cases, and rule-based reasoning for the representation of normal cases. The heuristic principle is ideally suited for making uncertain, hypothetical inferences on the basis of fuzzy data and fuzzy relations.

Abdomen, Acute↗

IRMA--content-based image retrieval in medical applications.

The impact of content-based access to medical images is frequently reported but existing systems are designed for only a particular modality or context of diagnosis. Contrarily, our concept of image retrieval in medical applications (IRMA) aims at a general structure for semantic content analysis that is suitable for numerous applications in case-based reasoning or evidence-based medicine. Within IRMA, stepwise processing results in six layers of information modeling (raw data layer, registered data layer, feature layer, scheme layer, object layer, knowledge layer) incorporating medical expert knowledge. At the scheme layer, medical images are represented by a hierarchical structure of ellipses (blobs) describing image regions. Hence, image retrieval transforms to graph matching. The multilayer processing is implemented using a distributed system designed with only three core elements. The central database holds program sources, process-ing schemes, images, features, and blob trees; the scheduler balances distributed computing by addressing daemons running on all connected workstations; and the web server provides graphical user interfaces for data entry and retrieval..

Computer Graphics↗

Translating clinical outcomes to patient value: an evidence-based treatment approach.

This is a summary report from An Evidence-Based Treatment Approach: Successful Regenerative Outcomes, Task Force 4, Translating Clinical Outcomes to Patient Value. It represents recommendations for translating the clinical benefits of regenerative therapies to value that the patient can understand and accept. A review of the evidence on translating clinical outcomes to patient value was presented to the task force for discussion. Then outcome criteria established by other task forces on clinical applications of regenerative therapy were used to evaluate the evidence. Published literature related to many different areas, such as clinician-patient communication, patient behavior, the role of other dental professionals, and organization of the practice and its processes, was included in this review. Outcomes charts and decision-making trees were developed to provide a framework for the recommendations of the task force. The ultimate objectives of this task force were to help the practitioner to clearly perceive the benefits that regeneration can provide to patients and to help the clinician to present the facts in a manner that will increase patients' acceptance of the recommended treatment.

Bibliographies as Topic↗