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PubMedDate not supplied

Health-care quality promotion through infection prevention: beyond 2000.

Health-care value purchasing, complex health-care systems, and information technology are the three most important change drivers influencing the interrelated themes of the 4th decennial conference: accountability, quality promotion through infection prevention across the health-care delivery system, and medical informatics. Among the change drivers influencing themes of future conferences may be a societal mandate for health promotion and health-care access for all.

Delivery of Health Care↗
PubMed1993

Quality evaluation of controlled clinical information service trials.

Randomized controlled clinical trials are increasingly accepted as tools of computer technology assessment and, therefore, quality evaluation of trials has great theoretical and practical significance. The purpose of this study was to assist the design of evaluation studies and synthesis of published results by developing and validating an easy-to-use quality scoring method. The development of the new scoring system was based on the available quality evaluation methods and the analysis of 19 trial reports registered in the Columbia Registry of Controlled Clinical Information Service Trials. First critical aspects and afterwards the levels of quality were defined. In spite of the fact that all quality requirements were met by some trials, the average overall quality score was 52.6 (+/- 8.7) per cent. The minimum score was 37 and the maximum was 72 per cent. Data collection and site/sample definition were better in the good quality trials, but improvement in statistical analysis was erratic. The quality scoring method was validated by using another sample of 20 registered trials. While the number of published controlled clinical trials is increasing in medical informatics, the analysis was unable to demonstrate a significant positive correlation between the quality and year of publication.

Evaluation Studies as Topic↗
PubMed2005

UMLF: a unified medical lexicon for French.

Medical Informatics has a constant need for basic medical language processing tasks, e.g. for coding into controlled vocabularies, free text indexing and information retrieval. Most of these tasks involve term matching and rely on lexical resources: lists of words with attached information, including inflected forms and derived words, etc. Such resources are publicly available for the English language with the UMLS Specialist Lexicon, but not in other languages. For the French language, several teams have worked on the subject and built local lexical resources. The goal of the present work is to pool and unify these resources and to add extensively to them by exploiting medical terminologies and corpora, resulting in a unified medical lexicon for French (UMLF). This paper exposes the issues raised by such an objective, describes the methods on which the project relies and illustrates them with experimental results.

Abstracting and Indexing↗
PubMed2003

Suggested guidelines for e-mail communication in psychiatric practice.

BACKGROUND: Physicians and patients are increasingly communicating with one another by e-mail concerning administrative issues, medications, and other aspects of care. The objective of this article is to review existing guidelines for general physicians communicating with patients by e-mail as the basis for developing more specific guidelines for psychiatric practice. METHOD: We review e-mail guidelines previously developed by the American Medical Informatics Association, subsequently promulgated by the American Medical Association, and consider each suggestion for clinical and administrative practice from the perspective of psychiatric practice. Case vignettes illustrate several of these issues. RESULTS: We suggest expansion and/or modification of existing guidelines to address more directly issues of specific concern in psychiatric practice. CONCLUSION: Existing general guidelines concerning the use of e-mail in medical practice are useful starting points for psychiatric practice. Psychiatrists must pay particular attention to issues of confidentiality, communicative tone, and professional boundaries. With cautious application, e-mail may provide a useful tool for enhancing communication and treatment options for psychiatrists and their patients.

Adult↗
PubMed1993

Computerized management of respiratory care.

Respiratory care as an organized discipline is only about 45 years old, and the management of this dynamic allied health profession has usually been characterized by a demand-for-service mentality. As pressure continues to control costs, those departments that maximize quality patient care cost-effectively with thoroughly documented outcomes are in a better position to compete for future resources. The practice of respiratory care is changing as is the practice of medical care in general. Accountability for resource consumption and the quality of the product delivered are essential elements in the delivery of respiratory modalities. We have developed and implemented a comprehensive patient-data-based approach to the management of respiratory care. The essential elements of this approach are (1) relative-value-unit procedure base; (2) individual, shift, and department productivity that is attached to the annual performance review process; (3) management reporting on a 24-hour basis, with biweekly review at the management level; (4) development and implementation of a comprehensive patient-data-documentation system that permits automatic patient billing and 100% data review for quality-assurance documentation; (5) the development of a medical alerting system that alerts the Medical Director and Respiratory Care staff to potentially harmful events that, if untreated, may result in increased morbidity or mortality; and (6) the development of concurrent and retrospective tools for patient-outcomes research. These functions are supported by an active Medical Informatics Department that is nationally recognized in medical computing and logic application.

Cost-Benefit Analysis↗
PubMedDate not supplied

[An experience in teaching pharmacology on the internet].

Internet and Intranet are omnipresent in the University world. We developed an easy-access website (www.med.univ-rennes1.fr/etud/pharmaco) devoted to teaching pharmacology and report here our experience after 4 years of use. Our objective was to determine the value of this new teaching tool in the medical coursus. The site is entirely free and presents approximately 50 topics and diaporamas discussing various themes: the cell, the receptor, general pharmacology, clinical research, population research, drug classes, etc. Harbored by the Medical Informatics Laboratory of the University of Rennes Medical School, this site serves as a reference for medical students and others. More than 100 visits are recorded daily, approximately half from visitors outside France. The advantages of this new teaching tool, which operates within the framework of a Virtual Medical University project, are evident for students and professors alike. Its impact on the quality of drug therapy by future doctors remains to be determined.

Curriculum↗
PubMed2003

Towards a unified medical lexicon for French.

Medical Informatics has a constant need for basic Medical Language Processing tasks, e.g., for coding into controlled vocabularies, free text indexing and information retrieval. Most of these tasks involve term matching and rely on lexical resources: lists of words with attached information, including inflected forms and derived words, etc. Such resources are publicly available for the English language with the UMLS Specialist Lexicon, but not in other languages. For the French language, several teams have worked on the subject and built local lexical resources. The goal of the present work is to pool and unify these resources and to add extensively to them by exploiting medical terminologies and corpora, resulting in a unified medical lexicon for French (UMLF). This paper exposes the issues raised by such an objective, describes the methods on which the project relies and illustrates them with experimental results.

Algorithms↗
PubMed2004

Competencies and credentialing: nursing informatics.

This paper provides an overview and description of the processes that address the competencies and credentialing of nurses in the field of nursing informatics (NI). It provides the highlights of the informatics competencies that were proposed as the NI field advanced. It also provides an overview of the ANCC nursing informatics credentialing process. It will also present the credentialing process of the HIMSS organization which offers several different certifications. And finally it will address the new process for the international certification entitled Nursing Informatics Competency Recognition Certificate. The Nursing Informatics Special Interest Group of the International Medical Informatics Association (IMIA/NI-SIG) approved this certificate at the general assembly meeting during NI'2003 in Rio de Janeiro, Brazil. The certification is based on a professional portfolio that demonstrates expertise in this field for nurses outside the USA and Canada.

Credentialing↗
PubMed1997

[Expert systems for medicine--functions and developments].

Medical knowledge doubles every five years. Electronic media are necessary to manage these volumes. "Multimedia" and "information highway" are buzz-words and also concern medicine. Medical informatics tries to build a bridge between medical research which generates knowledge and daily practice in hospitals, ambulatory care and public services. Knowledge is used in different representations for multiple purposes and functions. Expert systems are mostly designed to fulfil certain functions and to support routine clinical practice. This paper tries to point out some important functions and to explain the capabilities by means of two example systems which can be used in several medical units. The main problem in using expert systems is, besides the quality of knowledge, the availability of patient data. For this reason the existence of an electronic patient record is another area which will be described in this paper. Expert systems are specialised medical information systems and have to fulfil the same success criteria as all the other systems, e.g. the integration into the daily routine as a trusted tool.

Adult↗
PubMed2002

Integrating genomics into health information systems.

OBJECTIVE: To outline the main issues related to the impact of the data generated by the Human Genome Project on health information systems. A major challenge for medical informatics is identified, consisting of adapting traditional systems to new genetic-based diagnostic and therapeutic tools. METHODS: Reviewing and analysing the different health information levels from an organisational complexity point of view. A model is proposed to explain the interactions between health informatics, bioinformatics and molecular medicine. RESULTS: We suggest a new framework that integrates genetic data into health information systems. Using this model, new topics for future research and development are identified. CONCLUSIONS: We are witnessing the birth of a new era (post-genomics). In this era technological advancements in genomics offer new opportunities for clinical applications. Medical informaticians should play an important role in this new endeavour.

Databases, Genetic↗
PubMed2007

The quality of evidence in health informatics: how did the quality of healthcare IT evaluation publications develop from 1982 to 2005?

OBJECTIVE: To obtain an overview of study designs and study methods used in research evaluating IT in health care, to present a list of quality criteria by which all kinds of reported evaluation studies on IT systems in health care can be assessed, and to assess the quality of reported evaluation studies on IT in health care and its development over time (1982-2005). METHODS: A generic 10-item list of quality indicators was developed based on existing literature on quality of medical and medical informatics publications. It is applicable to all kind of IT evaluation papers and not restricted to randomized controlled trials. One hundred and twenty explanatory papers evaluating the effects of an IT system in health care published between 1982 and 2005 were randomly selected from PubMed, the study designs and study methods were extracted, and the quality indicators were used to assess the quality of each paper by two independent raters. RESULTS: The inter-rater variability of scoring the 10 quality indicators as assessed by a pre-test with nine papers was good (K=0.87). There was a trend towards more multi-centre studies and authors coming more frequently from various departments. About 70% of the studies used a design other than a randomized controlled trial (RCT). Forty percent of the studies combined at least two different data acquisition methods. The quality of IT evaluation papers, as defined by the quality indicators, was only slightly improving in time (Spearman correlation coefficient [rs]=0.19). The quality of RCTs publications was significantly higher than the quality of non-RCT studies (p<0.001). CONCLUSION: The continuous and dominant number of non-RCT studies reflects the various approaches applicable to evaluate IT systems in health care. Despite the increasing discussion on evidence-based health informatics, the quality of published evaluation studies on IT interventions in health care is still insufficient in some aspects. Journal editors and referees should take care that reports of evaluation on IT systems contain all aspects needed for a sufficient understanding and reproducibility of a paper. Publication guidelines should be developed to support more complete and better publications of IT evaluation papers.

Europe↗
PubMed1998

Medical information processing: an interactive course for the Internet.

Medical students in Germany have to study the basics of medical information processing within a special curriculum which is part of the ecological course. This curriculum offers an introduction to principles of medical informatics. Starting with a conventional textbook, a computer-based training (CBT) program has been developed using the technologies of the internet and the World Wide Web (WWW). Features of the program include a well structured presentation of the information within the software and a high degree of interactivity. Early experiences suggest that this program enhances the learning in the domain of medical information processing. The program may be viewed via the URL: htfp.//www.med-rz.uni-sb.de/med_fak/imbei/pro jekt.

Education, Medical↗
PubMed2004

[Relevance of research networks in internal medicine].

Coming from a short international review reasons for networking of scientific research in Germany are given. Success and challenges of medical competence networks are listed, and it is argued how important it is to bridge networks in health care and medical research networks. Some examples from internal medicine are given. The prominent central role of patients is emphasized. Finally it is stated that Germany so far has not established the prerequisites to implement sustainable collaborative infrastructures. Specifically financial, legal, and political support is missing. In addition, it becomes clear that -- in contrast to the USA -- Germany lacks sufficient medical informatics specialists as well as health managers trained to manage IT or networked research. The planned introduction of a telematics infrastructure for health in Germany is perceived as a big chance for improvement.

Computer Communication Networks↗
PubMed1997

Health services, coordination and the Internet.

The on-going specialization of medical services requires socioeconomic coordination of different health services. The GP is the key to improve this primary coordination. To qualify referral decisions by the GP an Internet-like information system (VisInfo) has been implemented in Denmark. This VisInfo contains information on (1) alternative periods of waiting, (2) medical guidelines for specific treatments (3) clinical home pages, and (4) links to non-medical providers of health services (NGOs). VisInfo was originally implemented in the Counties of Funen, Northern Jutland and Vejle in 1993-1995. A number of other counties are implementing similar information systems whereof the County of Frederiksborg, recently has implemented the first real Internet-system. Provisional experiences with the VisInfo strategy is presented on (1) the general user interest, (2) elaborations of the strategy, and (3) organization. Based on the BlackSeaDiab Action Plan and the BlackSea TeleDiab project, the potential for dissemination of medical informatics in the Black Sea Region through an adaption of the VisInfo strategy is discussed.

Caregivers↗
PubMed1997

Software quality assessment for health care systems.

The problem of defining a quality model to be used in the evaluation of the software components of a Health Care System (HCS) is addressed. The model, based on the ISO/IEC 9126 standard, has been interpreted to fit the requirements of some classes of applications representative of Health Care Systems, on the basis of the experience gained both in the field of medical Informatics and assessment of software products. The values resulting from weighing the quality characteristics according to their criticality outline a set of quality profiles that can be used both for evaluation and certification.

Delivery of Health Care↗
PubMed2002

Health care, ethics, and information technologies.

This essay explores how ethics, computing, and health care intersect in medical informatics. It discusses the power technology places in the hands of health care professionals and the ethical problems they may encounter as a result of that power.

Decision Making↗
PubMed1993

The CIO and the medical informaticist: alliance for progress.

To achieve the full potential of information technology, health care institutions must overcome organizational and political barriers that often overshadow scientific and technical barriers. The time has come for an alliance between the Chief Information Officer (CIO) and medical informatics specialists, or informaticists. Organizations that successfully accomplish this alliance will position themselves to take advantage of the enormous potential of information technology to manage today's cost-quality pressures. This article first reviews some of the recent developments in the way health care organizations manage information technology. It then describes the traditional, perhaps the natural state of affairs, in which there may be tension and conflict between medical informaticists and line managers of information systems (IS). Finally, the article makes a case for closer collaboration and cooperation between these groups, and provides a case study that illustrates one example of such an alliance.

Academic Medical Centers↗
PubMed2005

[Smoking as potential confounder in german epidemiological studies: standardization of assessment, quantification, and analysis].

Tobacco smoking is one of the most frequently examined risk factors in epidemiological studies due to the high frequency of smoking in the population and its high risk potential. This paper discusses the issue of standardization of the assessment of tobacco exposure in German epidemiological studies based on a suggestion of the working group "Epidemiological methods" of the German Society of Epidemiology (DGEpi), the German Society of Social Medicine and Prevention (DGSMP), and German Society of Medical Informatics, Biometry and Epidemiology (GMDS) together with the working group "Epidemiology in the workplace" of the DGEpi and the German Society of Occupational and Environmental Medicine (DGAUM). The main element is a short questionnaire for German adults for the assessment of tobacco smoking in epidemiological studies where smoking is a potential confounder. In addition, information on the consideration of intermittent periods of non-smoking, a very short questionnaire for medical examinations in the workplace or non-responder interviews as well as the quantification and statistical modelling of smoking are presented. A brief discussion of scientific problems and questionnaires related to the exposure to environmental tobacco smoke is given.

Bias↗