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PubMed2006

Current issues in health care informatics.

Health care informatics has emerged as a diverse and important new field of study. The field can be very broadly defined as the science that addresses how best to use information to improve health care. The field includes the four areas of bioinformatics, medical informatics, public health informatics, and consumer health informatics. Health care informatics applications can be used to improve the quality of patient care, to increase productivity, and to provide access to knowledge. After providing an overview of the field, the 10 articles contained in this special issue are briefly discussed. The first six articles address a diverse set of topics such as the use of health care informatics to conduct research, clinical information systems used by the U.S. Air Force, electronic medical records and physician satisfaction in Oman, and a point of care documentation system used by hospice care providers. The last four articles discuss the complex issues raised by the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Delivery of Health Care↗
PubMed1989

Development of a central division of general internal medicine.

A division of general internal medicine was, by design, developed to be central to many of the activities of the department of medicine. Since 1979 the division has grown from five faculty members to 29 members and has the potential for substantial additional growth. The division provides approximately 70% of all inpatient teaching by attending physicians, provides all of the general medicine outpatient teaching, and has substantial impact on medical student training programs. The division is responsible for more than $1.5 million of clinical services and approximately 10% of hospital admissions, and it is responsible for approximately 40% of all patients on the general medicine service. Research activities are divided into several distinct modules, including medical informatics, clinical epidemiology, occupational medicine, geriatrics, medical competency testing, and ethics. The division receives approximately $1.2 million from external sources, including the federal government and foundations, for its research activities. Because of its success, it may serve as a potential model for similar divisions in other departments of medicine.

Academic Medical Centers↗
PubMedDate not supplied

Access patterns of a clinic-based health information web site for international travelers.

A large national telephone survey conducted in 2000 by the Pew Internet & American Life Project estimated that 52 million American adults used the Internet to acquire health information. Based on population estimates, these users comprised 25% of all adults. The growth of online health information coupled with increasing Internet access has led to the emergence of consumer informatics as an outbranching from traditional medical informatics. The ease of international communications afforded by the Internet holds great promise for consumers in the realm of travel medicine. For example, an early study found that a Web site hosted by an international travel medicine clinic was accessed by client computers in more than 100 countries. Nevertheless, relatively little research has been conducted on consumer informatics in travel medicine. An important aspect of consumer informatics involves studying consumers' needs for health information. The purpose of this study was to perform a descriptive analysis of overall use and content-specific access patterns for health information provided on a clinic-based Web site for international travelers.

Ambulatory Care Facilities↗
PubMed2003

Personal digital assistants herald new approaches to teaching and evaluation in medical education.

Since its arrival in 1994, the personal digital assistant (PDA) has made significant inroads in the handheld industry, with 50% of physicians anticipated as users by 2005 due to its functionality as a point-of-care medical informatics tool. However, its use in medical education is less well documented. Since 1998, PDAs have been used at Medical College of Wisconsin (MCW) as both a teaching and an evaluation tool for medical student and resident education. This article highlights the use of the PDA in medical education and describes current applications for monitoring clinical experiences of students/residents, and teaching resources for hypertension, cardiac auscultation, and community health. MCW's experiences with the PDA as a real time teaching and data collection tool serves as a model for other medical schools and for our students who are educated in the importance of self-monitoring one's clinical experiences and the need for continuous improvement as future physicians.

Attitude to Computers↗
PubMed2003

Development of an indexing search engine for the UMVF: proposal for an indexing method based on Dublin Core and XML.

The UMVF (French Virtual Medical University) has many heterogeneous resources hosted by the servers of university partners of the project. One of its objectives is to develop an efficient tool to perform a single search on these resources. We first defined a standardized and interoperable indexing method. For each document, an XML file containing information on the fifteen elements of Dublin Core was created. We checked its structure and content with a DTD. If the XML file was valid, its data were then integrated into a central database from which the engine carried out a search. We tested our tool successfully with the resources hosted by the Rennes Laboratory of Medical Informatics in cooperation with the Radiology Medical Campus [1]. Our method allows the standardization of the production of information by the various servers and it conforms to the constraints of the semantic Web owing to the technologies chosen.

Abstracting and Indexing↗
PubMed2004

Establishing an international reference image database for research and development in medical image processing.

INTRODUCTION: The lack of comparability of evaluation results is one of the major obstacles of research and development in Medical Image Processing (MIP). The main reason for that is the usage of different image datasets with different quality, size and Gold standard. OBJECTIVES: Therefore, one of the goals of the Working Group on Medical Image Processing of the European Federation for Medical Informatics (EFMI WG MIP) is to develop first parts of a Reference Image Database. METHODS: Kernel of the concept is to identify highly relevant medical problems with significant potential for improvement by MIP, and then to provide respective reference datasets. The EFMI WG MIP has primarily the role of a specifying group and an information broker, while the provider user relationships are defined by bilateral co-operation or license agreements. RESULTS: An explorative database prototype has been implemented using the MySQL database software on the Web. Templates for provider user agreements have been worked out and already applied for own 'pre-RID-MIP' co-operations of the authors. DISCUSSION AND CONCLUSION: First steps towards a comprehensive reference image database have been done. Issues like funding, motivation, management, provision of Gold standards and evaluation guidelines are to be solved. Due to the interest from research groups and industry the efforts will be continued.

Databases as Topic↗
PubMed1998

HMI education for HIMs.

This paper analyses the curricula of the four Australian university programs for health information managers (HIMs) in relation to their coverage of health and medical informatics (HMI). The overlap between HIMs and HMIs should be increased through exchange of information at conferences such as this as well as communication and co-operation between the Schools of HIM and those offering health informatics related training at other Australian universities.

Administrative Personnel↗
PubMed1998

The next generation Internet and health care: a civics lesson for the informatics community.

The Internet provides one of the most compelling examples of the way in which government research investments can, in time, lead to innovations of broad social and economic impact. This paper reviews the history of the Internet's evolution, emphasizing in particular its relationship to medical informatics and to the nation's health-care system. Current national research programs are summarized and the need for more involvement by the informatics community and by federal health-care agencies is emphasized.

Computing Methodologies↗
PubMedDate not supplied

An informatics infrastructure is essential for evidence-based practice.

The contention of the author is that an informatics infrastructure is essential for evidenced-based practice. Five building blocks of an informatics infrastructure for evidence-based practice are proposed: 1) standardized terminologies and structures, 2) digital sources of evidence, 3) standards that facilitate health care data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and 5) informatics competencies. Selected examples illustrate how each of these building blocks supports the application of evidence to practice and the building of evidence from practice. Although a number of major challenges remain, medical informatics can provide solutions that have the potential to decrease unintended variation in practice and health care errors.

Evidence-Based Medicine↗
PubMed2005

Who are the informaticians? What we know and should know.

The beginning of the 21st century has seen a surge in interest and enthusiasm for health care information technology based on its ability to demonstrate improvements in the quality, safety, and cost-efficiency of health care. One question, however, for which we have fewer answers is "who will be the individuals that develop, implement, and evaluate these systems?" In particular, while most attention has been paid to the exemplar leaders in health information technology, less has been focused on the issue of the workforce necessary to sustain the systems to achieve their vision. The discipline of medical informatics must pay sufficient attention to the professional workforce that will deploy systems outside the informatics research setting so their benefits may more widely accrue.

Health Occupations↗
PubMed2004

A health informatics educational framework.

There is a need to be able to define a Health Informatician by their graduate attributes. Futhermore global health informatics education that facilitates student mobility requires a common understanding of educational outcomes. An internationally agreed health informatics education framework will facilitate us to meet these needs. This chapter provides an overview of a considerable amount of work undertaken in a number of countries and by IMIA's health and medical informatics education working group. We need to make good use of these foundations as they clarify the various health informatics roles and functions together with their associated health informatics competency requirements. We are now in a good position to progress this work by developing a health informatics qualifications and educational framework. This is expected to assist educational providers with curriculum development.

Computer User Training↗
PubMed1999

Human aspects of medical computer application.

Most of the research activities in the field of medical informatics are directed toward technological-technical problems. Human factors of computer use are often a neglected topic. Even the application of the tiniest microcomputer embedded in a medical diagnostic equipment may pose user acceptance and motivation problems but to mention larger scale hospital information systems. In this paper the author presents some aspects of the human-computer interaction problems in a medicinal computer application setting.

Attitude to Computers↗
PubMed1995

Clinical results using informatics to evaluate hereditary cancer risk.

A 12-year medical informatics project is described whose goal was to create a distributable computer-based service to support the identification of hereditary cancer patterns and recommend concomitant protocols of patient care surveillance. Key elements of the successful implementation strategy are described as the service has been successfully utilized at more than a dozen other cancer centers. Multi-year clinical results are presented from the implementation of this service.

Adult↗
PubMed2006

The practical impact of ontologies on biomedical informatics.

OBJECTIVES: To examine recent research work in the development and evaluation of controlled biomedical terminologies - especially, the representation of structured, controlled definitional knowledge about the terms themselves; such terminologies are often referred to as 'ontologies'. METHODS: A review of the published literature using PubMed, as well as full-text searches of recent Medinfo and American Medical Informatics Association (AMIA) Symposia proceedings, searching for the terms 'ontology' and 'ontologies' and for articles discussing specific, prominent ontological work. RESULTS: We summaries the ontologic aspects of twelve current terminology projects: Galen, the Unified Medical Language System (UMLS), the Medical Entities Dictionary (MED), SNOMED-CT, LOINC, the Foundational Model of Anatomy (FMA), the Gene Ontology (GO), ISO Reference Terminology Model for Nursing Diagnosis, NDF-RT, RxNorm, the NCI Thesaurus, and DOLCE+. We discuss the origins, domain, and ontologic representation of each of these and attempt to summarize the impact that each has had on terminologic work and biomedical applications. We also note the contributions of the Protégé tool to many of these efforts. CONCLUSION: Terminologic research and development have advanced significantly in the past 20 years, especially since the recent orientation toward controlled biomedical ontologies. This work has had significant impact on the development of terminologies themselves, their acceptance and dissemination as standards, and their use in supporting biomedical information systems.

Knowledge Bases↗
PubMed1988

The information age in concept and practice at the National Library of Medicine.

The evolution of today's information age is mirrored in the growth of the National Library of Medicine's bibliographic services: from the pioneering work of the Library in the last century to develop Index Medicus, to developing the innovative computerized MEDLARS system in the early 1960s, to the easily searchable on-line data bases now available to health professionals. The evolution has not come about without controversy, however, as tension developed between the public sector, where the information was viewed as a social benefit, and the private sector, where it was viewed as a source of profit. The Library has fostered research and development in biomedical communications in the laboratories of its Lister Hill Center and through grants to assist in establishing the field of medical informatics. The future of biomedical communications will be profoundly affected by work now being carried out by the Library: in fields such as biotechnology, through integrative methodologies such as the Unified Medical Language System now under development, and by a grant program to improve the infrastructure for information within academic health science centers.

Diffusion of Innovation↗
PubMed2002

BioDAQ--a simple biosignal acquisition system for didactic use.

A simple non expensive device for biosignal acquisition is presented. It mainly meets the requirements for didactic purposes specific in medical informatics laboratory classes. The system has two main types of devices: 'student unit'--the simplest one, used during lessons on real signals and 'demo unit', which can be also used in medical practice or for collecting biological signals. It is able to record: optical pulse, sphygmogram, ECG (1-4 leads) EEG or EMG (1-4 channels). For didactical purposes it has a large scale of recording options: variable sampling rate, gain and filtering. It can also be used in tele-acquisition via Internet.

Education, Medical↗
PubMed2002

Evidence-based practice for mere mortals: the role of informatics and health services research.

The poor translation of evidence into practice is a well-known problem. Hopes are high that information technology can help make evidence-based practice feasible for mere mortal physicians. In this paper, we draw upon the methods and perspectives of clinical practice, medical informatics, and health services research to analyze the gap between evidence and action, and to argue that computing systems for bridging this gap should incorporate both informatics and health services research expertise. We discuss 2 illustrative systems--trial banks and a web-based system to develop and disseminate evidence-based guidelines (alchemist)--and conclude with a research and training agenda.

Evidence-Based Medicine↗