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Medical informatics: the substantive discipline behind health care computer systems.

The computer is rapidly becoming an interactive workstation for medical research and for clinical decision-making and it has become a preferred instrument for communication and documentation throughout health care. However, when the attempt is made to use the rigid conventions of information processing to impose order on the characteristically volatile and unpredictable phenomena encountered in the clinical setting, deep seated logical issues are uncovered. This challenge has generated the new field of Medical Informatics, one major goal of which is to formulate computer logics that can properly relate the idealized descriptions of disease, the rules for medical practice and the general guidelines for health care to the intricate diversities encountered in the care of individual patients. The Integrated Academic Information Management System (IAIMS) program of the National Library of Medicine provides the most ambitious environment for research in this new endeavor.

Expert Systems

Semantically assisted medical bibliographic retrieval: an experimental computer system.

An experimental computer-based bibliographic retrieval system has been implemented to explore how semantic (conceptual) relationships between MeSH terms might assist the retrieval process. To construct the experimental system's database, lists of abstracts were produced using MEDLINE. Each list contained papers discussing a specified pair of terms. Each abstract was then analyzed to determine the specific relationship(s) between the two terms discussed in that paper. The project then explored how these semantic relationships could be incorporated into the computer to enhance bibliographic retrieval.

Information Systems

A multicenter study of data collection and communication at primary health care centers.

Health care delivery is information intensive. As computer applications make information available to the decision maker with speed and accuracy, informatics applications will strengthen the infrastructure. This paper is the second part of a multicenter systems analysis study to design a common application software to support primary health care focused on information flow. We present the questionnaire analysis and observations from a field study of a district health site. Analyses using contingency tables revealed differences, some statistically significant. The field study confirmed that minor differences exist even within a district health site. Development of a common application software on the basis of information flow studies is feasible. However, to make optimum use of computer implementation, revision of the health information systems was recommended. It was suggested that application software be developed with the core data set required by the care providers to deliver and administrators to manage a vertical health program.

Communication

Ten years of medical informatics. Introduction.

The discussions of the Tenth Anniversary of the Symposium on Computer Applications in Medical Care (SCAMC) are summarized. Eight different subject areas are addressed: Medical informatics and medical education; Decision making, medical artificial intelligence, modelling and simulations; Image processing, 3-D graphics, and computer networks; Reimbursement policy, legal and regulatory issues; Encoding and representation of medical meaning; Ambulatory medical records systems; Hospital information systems; and Software environments for developing medical information systems. The activities of the 10th SCAMC consisted of Tutorials, Panel Discussions, a Plenary Session, Scientific Demonstrations, and an International Student Paper Competition in Medical Informatics.

Computer Communication Networks

Quality control methods for data entry in pathology using a computerized data management system based on an extended data dictionary.

In pathology, computerized data management systems have been used increasingly to facilitate a more efficient supply of information. Since data entry precedes data utilization, the reliability of the information stored strongly depends on the quality of data input. Despite its potential capability, most personal computer-based database software does not provide versatile and user-friendly data validation procedures. Therefore, we developed a data dictionary-driven data management system that enables the user to perform extensive validation routines without the need for hard programming. Using examples from an existing database for endometrial carcinomas, different types of data errors and their error traps are explained. It is pointed out that data type definitions, defaults, templates, or picture clauses are suitable means to avoid formal errors. Validations on data domains and ranges test whether data fall into a predefined scope. Relational checks control data validity within a context of different data items, whereas process routines provide automatic data computation, thereby circumventing user input. By exploiting the facilities of an extended data dictionary, a powerful tool is made available to secure various aspects of data integrity simultaneously with input. In this way, computerized data quality control can improve the efficiency and reliability of data management tasks in pathology.

Medical Informatics Computing

Informating, not automating, the medical record.

The author suggests that reference should be made in the future to the need to informate and not to automate the medical record. The reason for this recommended semantic change is first to avoid the mistaken notion that the computerization of medical records will reduce the number of personnel processing medical information. Instead, personnel will shift their attention from rote clerical activities to analytic activities made possible by the creation of new data bases by computers. These new data bases, a byproduct of informating the medical record, describe work processes and lend themselves to analytic activities which will enhance quality and efficiency in hospitals. The recent availability of report generators on commercial Laboratory Information Systems (LISs) mark their transition from automating to informating systems. One example of an ad hoc report used to enhance quality and efficiency in the clinical laboratories is the throughput report.

Clinical Laboratory Information Systems

[Evaluation of the control quality of arterial hypertension over a 10-year period at a hemodialysis center].

Using the "Diaphane" computed medical record system enables multicentric statistical studies to be conducted. With this system, the quality of arterial hypertension control (supine systolic and diastolic arterial pressure before and after dialysis) was evaluated over a 10-year period in chronic haemodialysis patients in comparison with a multicentric population. A continuous statistical study of the results showed a regular voluntary decrease in arterial pressure. The evaluation of the quality of medical care represented by this comparison contributes to a therapeutic improvement.

Adult

[Study of the utilization of health services in a rural region of southern Africa. Contribution of the computer].

Primary health care systems have to be regularly evaluated to ensure their proper management and plans to assess whether community health needs are satisfactorily met. Data required for such an evaluation are complex but an approach can be made through the indicators of health services utilisation. The processing of such informations can and should be computerised, regarding the constantly decreasing cost and the drastic help of this technic. The author presents his experience in a remote region of Southern Africa which has a regular and reliable record of services' utilisation. Three examples of the utility of such processed information are given.

Africa, Southern

Efficient storage of urodynamic signals by computer: application of FAN adaptive sampling.

Digital storage of urodynamic signals such as detrusor pressure and flowrate at a sufficiently high sampling rate (10 samples per second) to allow subsequent analysis requires considerable computer memory. A procedure for compressing these data by deleting redundant samples (the fan method of adaptive sampling) was tested. The method allows a flexible adaptation to specific hardware and a compromise between storage requirements and accuracy. In this study the number of samples required for adequate reconstruction of the detrusor pressure signal could be varied from 80% to 4% of the original number of samples by varying the average difference between reconstructed and original signal from 0.01 to 2 cm H2O. Fast components of the measurements (for example cough peaks) which were lost if a lower sampling rate or averaging was used to obtain equally low storage requirements were unaffected by this compression technique.

Algorithms

Automated analysis of medical text. II. Cognitive strategy.

In a previous paper, the authors described three paradigms applicable to automated medical text analysis. In this paper, the relative importance of the three paradigms is discussed, viz. the relative value of the linguistic word categorization, the semantic paradigm, and the medical fact delineation. The strategy adopted was to limit the linguistic disambiguation and apply probabilistic rules, in order to speed up the analytic process.

Algorithms

Querying medical databases in an environment offering logical data independence.

Medical information systems are becoming popular. Furthermore, their use is expected to be expanded in future. In order to easily extract information from the underlying databases, easy to use man-machine interfaces are required. This paper concerns the doctor interface of the ARPIA medical information system based on a relational database management system. The whole system is currently used inside the Outpatient Pediatric Clinic of the Catholic University of Rome, Italy. The interface provides logical data independence towards the underlying relational database. The paper contains some background about this kind of interfaces, and also, it sketches the software architecture of the implemented prototype.

Database Management Systems

Computer education of undergraduate medical students: a 2-year experience.

Computer literacy will become a necessity for doctors in the near future, as computer applications for clinical medicine are gradually developed and successfully implemented in the medical environment. Two years ago we began an optional course on computer systems for first-year medical students, as part of the biostatistics course at the University of Lisbon. The results of this experience show that computer education should be well adapted to the needs of students, and educators must continuously evaluate the students' reaction and anticipate the need for sudden changes in the course structure, which are often necessary to capture students' attention.

Education, Medical, Undergraduate