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Recent advances in natural language processing for biomedical applications.

We survey a set a recent advances in natural language processing applied to biomedical applications, which were presented in Geneva, Switzerland, in 2004 at an international workshop. While text mining applied to molecular biology and biomedical literature can report several interesting achievements, we observe that studies applied to clinical contents are still rare. In general, we argue that clinical corpora, including electronic patient records, must be made available to fill the gap between bioinformatics and medical informatics.

Abstracting and Indexing↗

Teaching life-long learning skills in a fourth-year medical curriculum.

For more than twenty years, the Ruth Lilly Medical Library has been a traditional part of the Indiana University School of Medicine curriculum. Recently, following changes to the curriculum, the Library's role has evolved to include responsibility for developing and teaching a Medical Informatics rotation as part of the senior year clerkships. Heavy emphasis is placed on acquiring life-long learning skills, especially on locating and critically appraising the best clinical evidence in the medical literature. In its first four months, the rotation has been quite favorably received by both students and faculty, but will continue changing to keep pace with future curriculum alterations and new technology.

Clinical Clerkship↗

Nursing informatics. Issues for critical care medicine.

The demands of today's health care arena have forced the issue of automation and computerization. Nursing, as the major stakeholder in the collecting, managing, processing, transforming, and communicating of information regarding the patient, has developed a new approach to these tasks. Nursing informatics, which is the application of computer science and information science, is being used to manage and process the data, information, and knowledge necessary in the discipline. Although still in its infancy, nursing informatics has started to have a major effect on health care information gathering and clinical practice despite the multiple barriers to its advancement. Critical care is a data-rich environmental that can benefit from better management and processing of the data derived from the critically ill patient. Nursing and medical informatics joining together to organize the data, coupled with the introduction of good DSS and the addition of information retrieval systems at the bedside and the on-line medical record, will have a positive effect on the critical care environment and on the critical care patient outcomes.

Critical Care↗

Education in informatics in medicine and the health sciences--the need for relevance.

At the University of Newcastle, the 5-year undergraduate programme in Medicine has been developed as a problem-based, self-directed, fully integrated curriculum. Curricular integration involves not only the basic and clinical sciences, but also population medicine, critical reasoning and the development of a broad range of professional skills. Medical informatics has been seen as an increasingly important professional skill and the integrated nature of the curriculum has provided an appropriate setting for the introduction and continuing development of this component of the curriculum. Over the last 3 years this component has been developed to be incorporated into the curriculum for the health sciences within the faculty, becoming health informatics. Informatics for undergraduate students in medicine and allied health professions must be developed as a relevant and useful component of the curriculum.

Allied Health Personnel↗

Health care providers on the World Wide Web: quality of presentations of surgical departments in Germany.

It is becoming increasingly common for health care providers to present information on the World Wide Web (WWW). Patients, as well as health care professionals, do not really know what they can expect today. Many quality criteria are proposed for the assessment of medical Internet sites focusing mainly on structure and content management. The objective of this study was to assess the quality of presentations by health care providers on the WWW and to detect strengths and weaknesses with regard to potential target groups, patients, colleagues, and students. A sample of 171 presentations was randomly selected in March 2000 from a collection of 469 surgical departments in Germany. Medical doctors undergoing a full-time training in medical informatics rated the presentations. A previously evaluated questionnaire was used to assess the presentations with regard to 12 criteria about content and technical features. For each criterion the categories 'very good', 'sufficient', and 'insufficient' could be used. Twenty medical doctors assessed 168 presentations with one to seven valuations per presentation. Three presentations could not be accessed at the time of evaluation. Sixty-eight per cent of the median values of each criterion were rated as insufficient. The only criteria rated sufficient or better in at least 50% were: employees/map, survey of offered medical services, navigation, and layout. University hospitals and heart centres achieved significantly better results than regional hospitals. In conclusion, the quality of provider information on the W WW is unsatisfactory. Most surgical departments do not provide information that could help patients to choose their physicians. The criteria set developed here could be a useful tool for a target-group-oriented self-assessment of provider presentations on the World Wide Web.

Attitude of Health Personnel↗

Modelling for natural language understanding.

Natural Language Understanding (NLU) is a rapidly growing field in medical informatics. Its potential for tomorrow's applications is important. However, it is limited by its ability to ground its components on a solid model of the domain. This opens the way for the emergence of the discipline of medical domain modelling, as part of the vast field of Knowledge Base (KB) engineering. This article aims at describing the current development of a multilingual natural language system, strongly oriented towards the semantics of the domain. Special emphasis is presently given to the task of building a domain model, and to establish direct links with the language platform. The result is a model-driven NLU system. Numerous benefits are expected in the long term.

Artificial Intelligence↗

Knowledge management: evaluating the organizational requirements and culture for an emerging technology.

The purpose of this paper is to explore the application of knowledge management concepts to an information systems (IS) knowledge base, as opposed to a clinical one. The field of Medical Informatics is committed to helping others manage medical information and knowledge through the application of information technology. At Partners HealthCare, a wide variety of clinical information management systems have been built and implemented in complex environments, creating an extensive applied informatics knowledge base. How should healthcare IS departments manage this intellectual capital? That's the question that Partners HealthCare is asking its senior and middle IS managers. This paper reports on an internal survey addressing Knowledge Management (KM) requirements, the potential application of this technology in our organization, and discusses where we are today and where to go from here.

Data Collection↗

International training in health informatics: a Brazilian experience.

Technology is transforming not only the practice of health-care but also professional training and educational models. Developing countries, such as Brazil, are increasingly suffering from a severe shortage of health informatics specialists. Training of professionals in this field is expensive, and there is a limited supply of high-quality teaching resources available. We envision that training in health informatics can be better achieved if cultural and technological barriers are anticipated and the training program is prepared accordingly. We describe our four-year experience of a Brazil/USA training program and discuss lessons learned during its implementation. Eleven onsite courses, one seminar, and two conferences were developed under this unique initiative, which made possible the collaboration among different countries and distinguished leaders in the field of medical informatics.

Brazil↗

European standardization efforts: an important framework for medical imaging.

For several years now, users have been waiting for standards allowing medical images to be exchanged, managed, stored and manipulated. Standards are prerequisites for the development of PACS and IMACS systems. It is because of the lack of standards that PACS have not yet widely been implemented. The ACR-NEMA committee (American College of Radiology--National Electronical Manufactures Association) are developing an image communication standard: DICOM 3.0. This should allow interconnection of different imaging modalities and other PACS nodes. Part of the DICOM 3.0 work will be demonstrated at RSNA 93 with involvement of Europe. In the European Standardization Committee (CEN), the technical committee responsible for the standardization activities in Medical Informatics (CEN TC 251), has agreed upon the directions and the scopes to be followed in this field. They are described in the directory of the European standardization requirements for health care informatics and programme for the development of standard adopted on 28 February 1991 by CEN TC 251. Top-down objectives describe the common framework and items like terminology, security, while the more bottom-up oriented items describe fields like medical imaging and multi-media. Since CEN TC 251 started working, an important coordination took place between Europe and the US and Japan, resulting in a common future approach. CEN TC 251 is setting the scene for a more technologically independent standard on a mid term basis. This standard will first have to be proto-typed before it can be published, because it must be possible to implement the standard, too much complexity will not be accepted by the industry. The European imaging standardization work based on the ISO/IPI standard, will be briefly explained; as well as the general framework model and object oriented model; the interworking aspects, and the relation to ISO standards. One should realize be realised that a standard is needed, which is not too ambitious. Because DICOM 3.0 will be ready soon, Europe has decided to support these activities and will concentrate on the next step to be taken.

Computer Communication Networks↗

Building health informatics skills for health professionals: results from the Australian Health Informatics Skill Needs Survey.

OBJECTIVE: To ascertain health professionals' perceptions of health informatics skills required in their roles. DESIGN: A paper-based survey with a stratified random sample of Australian health professionals and a web-based survey open to all Australian health professionals were conducted. MEASUREMENT: A questionnaire on the health professionals' perceived degree of competency required for a total of 69 specific skills in five skill categories based on the International Medical Informatics Association's (IMIA) set of recommendations on education and IMIA's scientific map. RESULTS: 462 health professionals responded to the paper-based questionnaire, and 167 respondents to the Internet questionnaire. Internet respondents reported higher required degrees of competency for specific health informatics and information technology skills than paper respondents, while paper respondents valued clinical skills higher than the Internet respondents. CONCLUSION: Health professionals increasingly use information technology (IT), and some also deploy, research or develop health care IT. Consequently, they need to be adequately educated for their specific roles in health informatics. Our results inform developers of educational programs while acknowledging the diversity of roles in health informatics and the diversity of pathways towards a professional health informatics qualification.

Adult↗

The J. Otto Lottes Health Sciences Library and the Microcomputer Learning Laboratory.

Opened in 1985, the J. Otto Lottes Health Sciences Library at the University of Missouri-Columbia has adapted to changes in information technology by installing a fiber optic backbone, establishing local area networks and file servers with databases and software programs, establishing a microcomputer learning laboratory, and responding to the needs of a problem-based learning curriculum. The library works cooperatively with the Medical Informatics Group, which is housed in the library and runs the micro laboratory, to support student and faculty computing.

CD-ROM↗

Neural computation in medicine.

During the last decade there has been a great revival of interest in neural modelling. Powerful new computational methods have resulted from work in this area and are being applied to an increasing range of medical problems. This paper briefly explains the nature of a neural model and then reviews work in neural computation involving problems in medical informatics (e.g. expert systems) and modelling of psychiatric and neurological phenomena. The state of the art is assessed, and speculation about future developments is given.

Medical Informatics↗

Triangulation applied to Jan H. van Bemmel.

OBJECTIVE: To describe the person of Jan H. van Bemmel from different points of view. METHOD: Triangulation. RESULTS AND CONCLUSIONS: Jan H. van Bemmel successfully contributed to research and education in medical informatics. He inspired a lot of people in The Netherlands and internationally.

Biomedical Research↗

Computers in healthcare: overview and bibliography.

OBJECTIVE: The objective of this article is to provide an overview of computer technology and an associated bibliography, emphasizing institutional-based healthcare applications and pharmacoinformatics. DATA SOURCES: References were selected from the authors' files and from a computerized search over the last five years on computers in healthcare/medical informatics and in pharmacy. STUDY SELECTION: Articles selected for review and discussion were considered to be important contributions to the respective areas listed in the bibliography and representative of advancements in computer applications in healthcare and pharmacy. DATA SYNTHESIS: The computer has become an important support tool for healthcare professionals. Medical informatics and the discipline related to pharmacy, called pharmacoinformatics, have evolved from the cognitive underpinnings of medicine, pharmacy, and computer science. Recent developments in computer technology have resulted in computers that are fast, increasingly portable, and user friendly. Hospital information systems employ computers in various ways to deal with the vast amount of information used by various departments. Standards for electronic data exchange are being developed to increase the integration potential of these systems. Hospital pharmacists have used computers for drug distribution, financial analysis and inventory control, drug interaction detection, pharmacokinetic dosing, drug information, and drug therapy monitoring. Expert systems are being developed in several areas of drug therapy. Pharmacy educators have developed interactive courseware to help students learn problem-solving skills in the areas of calculations, therapeutics, and drug information. CONCLUSIONS: Pharmacists need to become more involved with applications of technology to pharmacy. Properly implemented, computers can provide more time for pharmacists to use their cognitive skills in the delivery of pharmaceutical care.

Clinical Pharmacy Information Systems↗

Future directions in evaluation research: people, organizational, and social issues.

OBJECTIVE: To review evaluation literature concerning people, organizational, and social issues and provide recommendations for future research. METHOD: Analyze this research and make recommendations. RESULTS AND CONCLUSIONS: Evaluation research is key in identifying how people, organizational, and social issues - all crucial to system design, development, implementation, and use - interplay with informatics projects. Building on a long history of contributions and using a variety of methods, researchers continue developing evaluation theories and methods while producing significant interesting studies. We recommend that future research: 1) Address concerns of the many individuals involved in or affected by informatics applications. 2) Conduct studies in different type and size sites, and with different scopes of systems and different groups of users. Do multi-site or multi-system comparative studies. 3) Incorporate evaluation into all phases of a project. 4) Study failures, partial successes, and changes in project definition or outcome. 5) Employ evaluation approaches that take account of the shifting nature of health care and project environments, and do formative evaluations. 6) Incorporate people, social, organizational, cultural, and concomitant ethical issues into the mainstream of medical informatics. 7) Diversify research approaches and continue to develop new approaches. 8) Conduct investigations at different levels of analysis. 9) Integrate findings from different applications and contextual settings, different areas of health care, studies in other disciplines, and also work that is not published in traditional research outlets. 10) Develop and test theory to inform both further evaluation research and informatics practice.

Canada↗

A study on home health care support information system for health evaluation.

The need for home health care has been increasing in Japan and the application of various techniques such as medical informatics are desired to support home health care services. Therefore, we developed an information system for health evaluation of the elderly including patients at home by applying multifunctional telephone set and an IC memory card, by which complaints, symptoms, and conditions by them can be collected, recorded, and transmitted to medical facilities. We also conducted an experiment for trial use of the system with the cooperation of elderly female volunteers. It was recognized that the elderly volunteers could operate the system with the help of public health nurses and their health information could be collected by the system. Although the developed system has some problems, it was suggested that the system would be useful for the support of health evaluation of elderly at home.

Aged↗

Standardization in the field of medical image management: the contribution of the MIMOSA model.

This paper deals with the development of standards in the field of medical imaging and picture archiving and communication systems (PACS's), and notably concerning the interworking between PACS's and hospital information systems (HIS). It explains, in detail, how a conceptual model of the management of medical images, such as the medical image management in an open system architecture (MIMOSA) model, can contribute to the development of standards for medical image management and PACS's. This contribution is twofold: 1) Since the model lists and structures the concepts and resources involved to make the images available to the users when and where they are required, and describes the interactions between PACS components and HIS, the MIMOSA work helps by defining a reference architecture which includes an external description of the various components of a PACS, and a logical structure for assembling them. 2) The model and the implementation of a demonstrator based on this model allow the relevance of the Digital Imaging and Communications in Medicine (DICOM) standard with respect to image management issues to be assessed, highlighting some current limitations of this standard and proposing extensions. Such a twofold action is necessary in order both to bring solutions, even partial, in the short term, and to allow for the convergence, in the long term, of the standards developed by independent standardization groups in medical informatics (e.g., those within Technical Committee 251 of CEN: Comité Européen de Normalisation).

Diagnostic Imaging↗