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PubMed2003

The role of the academic medical center library in training public librarians.

PURPOSE: This project enhanced access to and awareness of health information resources on the part of public libraries in western Pennsylvania. SETTING/PARTICIPANTS/RESOURCES: The Health Sciences Library System (HSLS), University of Pittsburgh, conducted a needs assessment and offered a series of workshops to 298 public librarians. BRIEF DESCRIPTION: The National Library of Medicine-funded project "Access to Electronic Health Information" at the HSLS, University of Pittsburgh, provided Internet health information training to public libraries and librarians in sixteen counties in western Pennsylvania. Through this project, this academic medical center library identified the challenges for public librarians in providing health-related reference service, developed a training program to address those challenges, and evaluated the impact of this training on public librarians' ability to provide health information. RESULTS/OUTCOME: The HSLS experience indicates academic medical center libraries can have a positive impact on their communities by providing health information instruction to public librarians. The success of this project--demonstrated by the number of participants, positive course evaluations, increased comfort level with health-related reference questions, and increased use of MEDLINEplus and other quality information resources--has been a catalyst for continuation of this programming, not only for public librarians but also for the public in general. EVALUATION METHOD: A training needs assessment, course evaluation, and impact training survey were used in developing the curriculum and evaluating the impact of this training on public librarians' professional activities.

Academic Medical Centers↗
PubMed1995

Survey of global telemedicine.

The number and scope of telemedicine projects and applications world-wide are growing rapidly along with exponential expansions in national and international information infrastructures and computer capabilities to support them. To track these rapid changes, the Center for Public Service Communications (CPSC) of Arlington, VA, developed the Telemedicine and Information Technologies in Health Care: Project Tracking Document for the National Aeronautics and Space Administration (NASA). This document is maintained by CPSC and frequently updated. It tracks the following areas in telemedicine and health care informatics: (1) major existing Federal grant and other assistance programs and activities; (2) legislation effecting policy in these areas; (3) projects using various technologies throughout the US; and (4) telemedicine projects/interests in other nations. This paper is a survey of international (global) telemedicine activities that are outlined in that document.

Australia↗
PubMed2006

Purposes of health identification cards and role of a secure access platform (Be-Health) in Belgium.

Although other alternatives may exist, identification cards have been chosen as an acceptable and adequate tool to be used to identify patients and health professionals. It is planned to use these for digital signature and for access to electronic health records: for searching various databases as well as for health information exchange. Local applications might exist independently, but the Belgian federal state has now developed Be-Health, a platform for health professionals, social security personnel and the general public, designed to facilitate a secure common uniform access to certain health data.

Access to Information↗
PubMed2003

The Cancer Genetics Network: recruitment results and pilot studies.

OBJECTIVE: The National Cancer Institute established the Cancer Genetics Network (CGN) to support collaborative investigations into the genetic basis of cancer susceptibility, explore mechanisms to integrate this new knowledge into medical practice, and identify ways of addressing the associated psychosocial, ethical, legal, and public health issues. SUBJECTS AND METHODS: The CGN has developed the complex infrastructure required to support the projects, including the establishment of guidelines and policies, uniform methods, standard questionnaires to be used by all of the centers, and a standard format for submission of data to the Informatics Center. Cancer patients and their family members have been invited to enroll and be included in a pool of potential study participants. The Information Technology Group is responsible for support of the design, implementation, and maintenance of the multicenter Network-wide research protocols. RESULTS: As of January 2004, the CGN contained data on 23,995 probands (participants) and 425,798 family members. As a resource for cancer genetic studies, the CGN has a large number of probands and first-degree relatives with and without cancer and with multiple ethnicities. Different study designs can be used including case-control, case-case, and family studies. CONCLUSIONS: The unique resources of the CGN are available for studies on cancer genetic susceptibility, translational research, and behavioral research. The CGN is now at a point where approved collaborators may have access to enrolled patients and their families for special studies, as well as to the clinical, environmental and family cancer history data banked in the Informatics Center.

Female↗
PubMed2003

[Safety information project on drug, food and chemicals. Division of Safety Information on Drug, Food and Chemicals. National Institute of Health Sciences].

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.

Consumer Product Safety↗
PubMed2006

The computerized patient record: where do we stand ?

OBJECTIVES: To provide an overview of trends in research, developments and implementations of the computerized patient record (CPR) of the last two years. METHODS: We surveyed the medical informatics literature, spanning the years 2004-2005, focusing on publications on CPRs. RESULTS: The main trends revealed were: 1) the development of technologies to realize privacy and security goals or remote data entry and access to CPRs; 2) investigations into how to enhance the quality and reuse of CPR data; 3) the development and evaluation of decision support functions to be integrated with CPRs; 4) evaluations of the impact of CPRs on clinicians, patients, clinical work settings and patient outcomes; and 5) the further development and use of standards to move towards shared electronic health records (EHRs). CONCLUSION: The CPR is playing a growing part in medical informatics research and evaluation studies, but the goal of establishing a comprehensive lifelong EHR is still a long way off. In moving forward to EHRs, convergence of EHR standards seems required to realize true interoperability of health care applications. User acceptance of present-day CPRs (for all categories of users) and compatibility with work patterns has not been achieved yet, and can only be realized by giving these goals high priority. This will require substantial resources for in-depth work flow analysis, development and evaluation of CPRs. Besides this, the implementation of effective CPRs asks for health care organizations that are willing to invest in new developments and to contribute to evaluation studies, to further improve CPRs' functionalities and enhance their use in practice.

Confidentiality↗
PubMed1995

Rotterdam general practitioners report (ROHAPRO): a computerised network of general practices in Rotterdam, The Netherlands. Rotterdam's HuisArtsen Project.

STUDY OBJECTIVE: Dutch public health services are charged with collective preventive care for the population--care that should, by law, be based on epidemiological data. General practices potentially offer important data for this purpose, particularly since more and more use a computer. This study aimed to assess whether it is possible to obtain useful epidemiological data from this source. DESIGN: In 1990, the Rotterdam Municipal Health Service, in collaboration with the Erasmus University Rotterdam, started a computerised sentinel practice network. The main features of this and a specific small investigation are described. SETTING: The following institutions cooperate in the network: Municipal Health Service Rotterdam Area; Departments of General Practice and of Medical Informatics, Erasmus University Rotterdam; Rotterdam District Association of General Practitioners. PATIENTS: Data are currently collected from 20 general practitioners and > 40,000 patients. In a specific project, the distribution of cardiovascular risk factors in different ethnic groups was compared. MAIN RESULTS: It was possible to build up a regional epidemiological registration system in this manner. In the cardiovascular project we found striking differences between ethnic groups. The risk profile for Turkish men, in particular, was less favourable. The health service also uses the system to improve cooperation between public health and primary health care (for example, in cervical screening, influenza vaccination). CONCLUSION: Computerised general practices offer great possibilities for research and for preventive activities in which public health care and general practitioners can cooperate.

Adult↗
PubMedDate not supplied

Does national regulatory mandate of provider order entry portend greater benefit than risk for health care delivery? The 2001 ACMI debate. The American College of Medical Informatics.

The 2001 debate of the American College of Medical Informatics focused on the proposition that national regulatory mandate of computer-based provider order entry (CPOE), to take effect by the end of 2005, portends greater benefit than risk for health care delivery. Both sides accepted that provider order entry offers potential benefit. Those supporting the proposition emphasized public safety, noting that payers have little economic incentive to pay for quality and that a mandate would force vendors to improve the usability and value of their systems. They argued that the mandate would align the economic incentives to finally allow CPOE to be widely adopted. Those opposing the proposition emphasized the risks resulting from a mandate, including the direct implementation costs, the logistic issues of implementation, and the cost of failed implementations. They also noted the potential for errors introduced by the systems themselves and the fact that the safety and utility of commercially available CPOE products have yet to be proved.

Delivery of Health Care↗
PubMed2004

Medical activities and statistics.

The evaluation of the medical activity is a major concern for hospitals and public health services. With the introduction of coding (IDC-10 and CHOP classifications) hospitals are now able to analyze their medical activity. A way to improve physicians' acceptance in analyzing their work is to give them valuable feedback information. Building statistics tools is costly and time consuming. Therefore introducing data warehouse tools is helpful. Nice Code is an easy-to-use software that helps medical encoding while immediately offering understandable statistics. In Switzerland, physicians demand real feedback based on the data transmitted at the "cantonal" or federal levels and more transparency in third payer's decisions. In this respect, several cantons decided to equip public health services and hospitals with this tool. The goal is to give, physicians and economists, powerful tools for analyzing the medical activity.

Hospital Information Systems↗
PubMed2001

Digital signature technology for health care applications.

BACKGROUND: The personal computer and the Internet have provided many useful services to both health care professionals and the general public. However, security remains a key factor that could limit their further growth potential. METHODS: We reviewed and assessed the potential use of the cryptographic technique to resolve security issues. We also analyzed services available in the current market environment and determined their viability in supporting health care applications. RESULTS: While the cryptographic application has a great potential in protecting security of health care information transmitted over the Internet, a nationwide security infrastructure is needed to support deployment of the technology. Although desirable, it could be cost prohibitive to build a national system to be dedicated for the health care purpose. CONCLUSIONS: A hybrid approach that involves the government's development of a dedicated security infrastructure for health care providers and the use of commercial off-the-shelf products and services by the general public offers the most cost-effective and viable approach.

Computer Security↗
PubMed1986

Origins of medical informatics.

Medical informatics is a new knowledge domain of computer and information science, engineering and technology in all fields of health and medicine, including research, education and practice. Medical informatics has evolved over the past 30 years as medicine learned to exploit the extraordinary capabilities of the electronic digital computer to better meet its complex information needs. The first articles on this subject appeared in the 1950s, the number of publications rapidly increased in the 1960s and medical informatics was identified as a new specialty in the 1970s.

History, 20th Century↗
PubMed2005

The effects and quality of IT evaluation studies: Trends in 1982 - 2002.

During the last years the significance of evaluation studies as well as the interest in adequate methods and approaches for evaluation has grown in medical informatics. In order to put this discussion into historical perspective of evaluation research, we conducted a systematic review on trends in evaluation research of information technology in health care from 1982 to 2002. In a first step of our inventory, we concentrated on describing long-term developments e.g. in study questions and methods used of IT evaluation studies as described in the abstracts of the identified 1.035 publications. In the second step of our inventory, we now analysed 64 randomly selected full papers on evaluation studies, in order to answer two questions: Did IT evaluation studies show a positive effect of IT on quality of processes or outcome quality of patient care, and how did the quality of evaluation studies themselves develop in the last 20 years. Appropriateness of the care process was the most common and mostly positively evaluated aspect. There was a trend towards more multi-centre studies. The quality of the studies remained stable over time. Randomized controlled trials had significantly higher quality than non-RCT studies.

Evaluation Studies as Topic↗
PubMedDate not supplied

Rating the raters: legal exposure of trustmark authorities in the context of consumer health informatics.

There are three areas of potential legal exposure for an organization such as a trustmark authority involved in e-health quality rating. First, an e-health provider may make a complaint about negative or impliedly negative ratings rendered by the ratings body (false negative). Typically, a negative ratings complaint would rely on defamation or product disparagement causes of action. In some cases such complaints could be defended on the basis of absence of malice (US). Second, the rating body might render a positive rating on e-health data that a third party allegedly relied upon and suffered injury (false positive). While the primary cause of action would be against the e-health data provider, questions may arise as to the possible liability of the trustmark authority. For example, some US liability exposure is possible based on cases involving the potential liability of product warrantors, trade associations, and certifiers or endorsers. Third, a ratings body may face public law liability for its own web misfeasance. Several risk management approaches are possible and would not necessarily be mutually exclusive. These approaches will require careful investigation to assess their risk reduction potential and, in some cases, the introduction of legislation.

Consumer Behavior↗
PubMedDate not supplied

Things to come: postmodern digital knowledge management and medical informatics.

The overarching informatics grand challenge facing society is the creation of knowledge management systems that can acquire, conserve, organize, retrieve, display, and distribute what is known today in a manner that informs and educates, facilitates the discovery and creation of new knowledge, and contributes to the health and welfare of the planet. At one time the private, national, and university libraries of the world collectively constituted the memory of society's intellectual history. In the future, these new digital knowledge management systems will constitute human memory in its entirety. The current model of multiple local collections of duplicated resources will give way to specialized sole-source servers. In this new environment all scholarly scientific knowledge should be public domain knowledge: managed by scientists, organized for the advancement of knowledge, and readily available to all. Over the next decade, the challenge for the field of medical informatics and for the libraries that serve as the continuous memory for the biomedical sciences will be to come together to form a new organization that will lead to the development of postmodern digital knowledge management systems for medicine. These systems will form a portion of the evolving world brain of the 21st century.

Artificial Intelligence↗
PubMed2006

Lest formalisms impede insight and success: evaluation in health informatics--a case study.

OBJECTIVES: To illustrate the advantages of an open-ended formative evaluation approach using a project-specific selection of methods over the controlled trial approach in the evaluation of health information systems. To illustrate factors leading to success and others impeding it in a telehealth project. METHODS: The methods and results of an evaluation of the BC Telehealth Program are summarized. RESULTS: The evaluation gave a comprehensive picture of the project, including assessment of the effects of an array of telehealth applications, and their economic impact. Factors leading to success and others preventing it are identified from the level of overall program management to the project specifics. The results include unanticipated effects and explanations for their reasons of occurrence. Neither the comprehensiveness of information nor the timeliness was achieved in a related project using a controlled trial approach. CONCLUSIONS: Not all types of health information system projects can be evaluated using the controlled trial approach. This approach may impede important insights. It is also usually much less efficient. Funding agencies and journal editors have to take this into account when selecting projects for funding and submissions for publication.

British Columbia↗
PubMed2006

Comparing approaches for advanced e-health security infrastructures.

OBJECTIVES: The healthcare systems of all developed countries face the challenge for improving quality, efficiency and safety of patients' care. For meeting this challenge, health is moving from being organisation-centred to process-based care. This process will continue in the future turning health towards person-centred architectures. This system transformation is combined with extended and advanced communication and collaboration supported and enabled by appropriate information and communication technologies (ICT), also called e-health. The resulting solutions have to be trustworthy. METHODS: There is a set of security services needed for realising trustworthy e-health solutions. Those security services must be comprehensively integrated in the e-health application. Furthermore, a set of infrastructure services has to be specified and implemented. For keeping the solutions future-proof, they have to comply with architectural principles and paradigms. RESULTS: After shortly introducing meanwhile internationally acknowledged architectural paradigms for applications, means and infrastructures providing security services, existing, or specified advanced solutions are described and compared. In that context, the Electronic Health Record as e-health core application has been especially considered. Based on published work as well as on explored solutions, the security services needed are summarised and evaluated. The pros and cons of investigated examples are collected and interpreted. In that context, especially the German health telematics framework architecture and security infrastructure and the corresponding implementable solutions on the one hand and the USA Veterans Health Administration approach to security have been carefully considered. CONCLUSION: Processes and systems are determined by policies, which define and distinguish constraints for communication and collaboration. Therefore, formally modelling policies and performing policy bridging are the main challenges to be met. As result of investigations, recommendations have been derived for establishing the trustworthiness required for any e-health solution at different level from regional to national, European, and even global scale, which are included in the conference summary.

Computer Security↗
PubMed2004

Demography of French anaesthesiologists. Results of a national survey by the French College of Anaesthesiologists (CFAR) and the French National Society of Anaesthesia and Intensive Care (SFAR), supported by the National Institute for Demographic Studies (INED).

BACKGROUND AND OBJECTIVE: The perception of a looming manpower shortage led the French College of Anaesthesiologists (CFAR) and the French Society of Anaesthesia and Intensive Care (SFAR), with assistance from the National Institute for Demographic Studies (INED), to conduct a national survey of French anaesthesiologists in order to determine precise physician characteristics data, analyse professional practices and project future service provision. METHODS: The survey was based on self-administered individual questionnaires, approved by the National Committee on Informatics and Freedom (CNIL). The survey was carried out at the end of 1998 among 1484 hospitals (590 public and 894 private), under the supervision of local referees and regional co-ordinators. RESULTS: Of 9741 anaesthesiologists' posts, 5694 (58%) are in public hospitals, 3569 (37%) in private practice and 478 (5%) in private hospitals within the National Health Service, i.e. the participant au service public hospitalier (PSPH). Complex validation of the results was necessary to account for the missing responses and multiple sites of activity. The survey identified 8876 specialists practising anaesthesia and intensive care in France at the beginning of 1999, including 216 in French overseas territories. This figure is consistent with that published by the Medical Council (Ordre des Médecins) on 1 January 1999, identifying 8950 anaesthesiologists in France, including 234 in the overseas territories. Annual growth in the anaesthesiologist population has fallen from 9% pre-1989 to 0% in 1999. Male anaesthesiologists outnumber females (35.7%). The average age has risen from 42.8 yr in 1989 to 45.9yr in 1999. The age distribution of anaesthesiologists has become bell shaped, reflecting reduced numbers of younger practitioners. There are currently 14.75 anaesthesiologists per 100 000 people (compared to 12.9 in 1989), a figure slightly above the European average, but there is considerable geographical inequality between the north and south of France, with increased concentrations in large cities that contain university hospitals. CONCLUSIONS: Future service provision must take account of falling numbers of new anaesthesiologists and an increase in retirements, but must also include changes in working practices, such as the European Working Time Directive. If anaesthesia manpower shortages are to be avoided, there must be a restructuring of the work-place, a redefinition of tasks and improved management of working time.

Age Distribution↗