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PubMed2004

The role of ethics in information technology decisions: a case-based approach to biomedical informatics education.

The purpose of this paper is to propose a case-based approach to instruction regarding ethical issues raised by the use of information technology (IT) in healthcare. These issues are rarely addressed in graduate degree and continuing professional education programs in health informatics. There are important reasons why ethical issues need to be addressed in informatics training. Ethical issues raised by the introduction of information technology affect practice and are ubiquitous. These issues are frequently among the most challenging to young practitioners who are ill prepared to deal with them in practice. First, the paper provides an overview of methods of moral reasoning that can be used to identify and analyze ethical problems in health informatics. Second, we provide a framework for defining cases that involve ethical issues and outline major issues raised by the use of information technology. Specific cases are used as examples of new dilemmas that are posed by the introduction of information technology in healthcare. These cases are used to illustrate how ethics can be integrated with the other elements of informatics training. The cases discussed here reflect day-to-day situations that arise in health settings that require decisions. Third, an approach that can be used to teach ethics in health informatics programs is outlined and illustrated.

Curriculum↗
PubMed2002

Rapid deployment of an electronic disease surveillance system in the state of Utah for the 2002 Olympic Winter Games.

The key to minimizing the effects of an intentionally caused disease outbreak is early detection of the attack and rapid identification of the affected individuals. The Bush administration's leadership in advocating for biosurveillance systems capable of monitoring for bioterrorism attacks suggests that we should move quickly to establish a nationwide early warning biosurveillance system as a defense against this threat. The spirit of collaboration and unity inspired by the events of 9-11 and the 2002 Olympic Winter Games in Salt Lake City provided the opportunity to demonstrate how a prototypic biosurveillance system could be rapidly deployed. In seven weeks we were able to implement an automated, real-time disease outbreak detection system in the State of Utah and monitored 80,684 acute care visits occurring during a 28-day period spanning the Olympics. No trends of immediate public health concern were identified.

Bioterrorism↗
PubMed2001

Information and communication technologies and health in low income countries: the potential and the constraints.

This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential. The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services. These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced. Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people. However, the basic difficulties encountered in using ICTs for such purposes are: an inadequate physical infrastructure; insufficient access by the majority of the population to the hardware; and a lack of the requisite skills for using them. We highlight the substantial cost involved in providing wider access, and the problem of resource allocation in poor countries where basic infrastructure for health and education is still lacking. Educating health professionals in the possible uses of ICTs, and providing them with access and "connectivity", would in turn spread the benefits to a much wider set of final beneficiaries and might help reduce the digital divide.

Delivery of Health Care↗
PubMed2003

Automated syndromic surveillance for the 2002 Winter Olympics.

The 2002 Olympic Winter Games were held in Utah from February 8 to March 16, 2002. Following the terrorist attacks on September 11, 2001, and the anthrax release in October 2001, the need for bioterrorism surveillance during the Games was paramount. A team of informaticists and public health specialists from Utah and Pittsburgh implemented the Real-time Outbreak and Disease Surveillance (RODS) system in Utah for the Games in just seven weeks. The strategies and challenges of implementing such a system in such a short time are discussed. The motivation and cooperation inspired by the 2002 Olympic Winter Games were a powerful driver in overcoming the organizational issues. Over 114,000 acute care encounters were monitored between February 8 and March 31, 2002. No outbreaks of public health significance were detected. The system was implemented successfully and operational for the 2002 Olympic Winter Games and remains operational today.

Algorithms↗
PubMedDate not supplied

The Surgeon General's Report and special-needs patients: a framework for action for children and their caregivers.

The Surgeon General's Report, Oral Health in America, is the first comprehensive assessment of oral, dental, and craniofacial health in the history of our nation. The intent of this first-ever Report is to alert Americans to the full meaning of oral health and its importance to general health and well-being across the lifespan. Moreover, the Report has been released at a time in human history of enormous changes as well as opportunities. The convergence of public health policies, "quality of life" expectations, global informatics, a new century of biotechnology, the completion of the Human Genome Project, changes in the management of health care, and the acknowledgment of enormous health disparities herald a call to action. These profound dynamics particularly affect children and their caregivers and the multitude of social, economic, and health issues associated with special patients and developmental disabilities. This paper will highlight the issues, provide recommendations, and suggest a call to action.

Adolescent↗
PubMed2001

Expanding the boundaries: enhancing dentistry's contribution to overall health and well-being of children.

The Surgeon General's Report, Oral Health in America, is the first comprehensive assessment of oral, dental, and craniofacial health in the history of our nation. The intent of this report is to alert all Americans to the full meaning of oral health and its importance to general health and well-being across the life span. Moreover, the report has been released at a time of enormous changes in human history as well as opportunities. The convergence of public health policies, "quality of life" expectations, global informatics, a new century of biotechnology, the advent of nanotechnology, the completion of the human genome project, changes in the management of health care, and the acknowledgment of enormous health disparities heralds a call to action. These changes affect children and their caregivers and the elderly. They also affect the social, economic, and health issues associated with special patients, including those with developmental disabilities. This paper highlights dentistry's future and how oral health is broadening the impact on patient and community health and dental practice, with a focus on children's oral health. The paper provides recommendations and suggests a call to action.

Adolescent↗
PubMed1999

A health information network for managing innercity tuberculosis: bridging clinical care, public health, and home care.

The purpose of this study was to use a health information network and innovative technology to coordinate tuberculosis care. An innercity medical center, a local health department, and a home care nurse service in northern Manhattan were used. The organizations were linked with computer networks. An automated decision support system with a natural language processor was used to detect tuberculosis cases and report them to the health department, and to select patients for respiratory isolation. Educational materials were placed on the World Wide Web and a Web-based kiosk. Home care nurses were outfitted with wireless pen-based computers, and data were relayed to the medical center. Automated tuberculosis case reporting resulted in time savings but not improved accuracy. Automated rules resulted in significant improvements in respiratory isolation. Kiosk educational materials were well-used. Wireless computing led to better access to information for both nurses and physicians, but not to reduction of workload. The key success element was recognition of critical priorities. It is concluded that innovative technology can facilitate the coordination of clinical care, public health, and home care.

Academic Medical Centers↗
PubMed1995

[Informatics in medical schools and postgraduate education centers for health professionals. Survey on the situation in Spain].

BACKGROUND: Informatics is acquiring an increasing relevance in the medical profession. METHODS: During the year 1993, a survey was carried out at the medical schools (MS) and postgraduate education centres (PEC) in Epidemiology, Public Health and Health Administration of Spain, on the available computer infrastructure and the teaching activities. The percentages of respondents were 81 at the MS and 100 at the PEC. RESULTS: 81% of the MS and 100% of the PEC had a computer laboratory, mainly equipped with personal computers with MS-DOS operating system. The use of general purpose applications was predominant. The number of students using the computer laboratory was very variable (5-300 per day). 48% of the MS organized courses on microcomputer applications. 66% of the MS included subjects related with informatics in the new curricula. CONCLUSIONS: Use of computers in the Spanish MS is heterogeneous. Compared with the Nord-American MS, they do not usually use applications of computer-assisted-instruction. The use of the computers at the PEC is much more generalized.

Curriculum↗
PubMedDate not supplied

Bridging the gap in medical informatics and health services research: workshop results and next steps.

In January 2000, the Agency for Healthcare Research and Quality (AHRQ) and the National Library of Medicine (NLM) cosponsored an invitational workshop entitled "Medical Informatics and Health Services Research: Bridging the Gap." Planned by a small committee of representatives from NLM and AHRQ institutional training centers, the workshop was designed to address the need for education of researchers interested in working at the intersection of the fields of medical informatics and health services research. More than 100 educators and researchers from AHRQ- and NLM-sponsored training programs in medical informatics and health services research participated in the workshop. Through a series of plenary presentations and breakout sessions, the workshop addressed ways of increasing the pool of persons interested, trained, and experienced in addressing specific areas of synergy between the two fields. This paper reports on the results of the workshop.

Curriculum↗
PubMed2006

Description of a method to support public health information management: organizational network analysis.

In this case study, we describe a method that has potential to provide systematic support for public health information management. Public health agencies depend on specialized information that travels throughout an organization via communication networks among employees. Interactions that occur within these networks are poorly understood and are generally unmanaged. We applied organizational network analysis, a method for studying communication networks, to assess the method's utility to support decision making for public health managers, and to determine what links existed between information use and agency processes. Data on communication links among a health department's staff was obtained via survey with a 93% response rate, and analyzed using Organizational Risk Analyzer (ORA) software. The findings described the structure of information flow in the department's communication networks. The analysis succeeded in providing insights into organizational processes which informed public health managers' strategies to address problems and to take advantage of network strengths.

Database Management Systems↗
PubMed2006

Using a portable wireless computer lab to provide outreach training to public health workers.

Librarians at Louisiana State University Health Sciences Center in Shreveport developed an outreach program for public health workers in north Louisiana. This program provided hands-on training on how to find health information resources on the Web. Several challenges arose during this project. Public health units in the region lacked suitable teaching labs and faced limited travel budgets and tight staffing requirements, which made it impractical for public health workers to travel. One solution to these problems is a portable wireless computer lab that can be set up at each site. The outreach program utilized this approach to present on-site training to public health workers in the region. The paper discusses operational and technical issues encountered in implementing this public health outreach project.

Community-Institutional Relations↗
PubMed2004

Wisconsin's environmental public health tracking network: information systems design for childhood cancer surveillance.

In this article we describe the development of an information system for environmental childhood cancer surveillance. The Wisconsin Cancer Registry annually receives more than 25,000 incident case reports. Approximately 269 cases per year involve children. Over time, there has been considerable community interest in understanding the role the environment plays as a cause of these cancer cases. Wisconsin's Public Health Information Network (WI-PHIN) is a robust web portal integrating both Health Alert Network and National Electronic Disease Surveillance System components. WI-PHIN is the information technology platform for all public health surveillance programs. Functions include the secure, automated exchange of cancer case data between public health-based and hospital-based cancer registrars; web-based supplemental data entry for environmental exposure confirmation and hypothesis testing; automated data analysis, visualization, and exposure-outcome record linkage; directories of public health and clinical personnel for role-based access control of sensitive surveillance information; public health information dissemination and alerting; and information technology security and critical infrastructure protection. For hypothesis generation, cancer case data are sent electronically to WI-PHIN and populate the integrated data repository. Environmental data are linked and the exposure-disease relationships are explored using statistical tools for ecologic exposure risk assessment. For hypothesis testing, case-control interviews collect exposure histories, including parental employment and residential histories. This information technology approach can thus serve as the basis for building a comprehensive system to assess environmental cancer etiology.

Automation↗