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PubMed1994

Physicians in health care management: 6. Physician *bytes* computer.

Revolutionary advancements in information technology are improving access to medical information, operational efficiency and clinical effectiveness. Health care facilities and agencies are planning to acquire information systems that will affect clinical and administrative functions. Federal and provincial agencies are beginning to define and collect diverse health care data and integrate them in a national database. As the demand for and access to information grows physicians will be key providers and users. They will have increasing access to critical patient data through clinical information systems; however, their practice patterns, clinical outcomes and resource utilization will also be subject to increasing scrutiny. To ensure appropriate use of technology and information systems, careful planning, selection, implementation and management will be needed. Physicians will require training to use the information and systems effectively. They must also recognize the increasing importance of such systems in delivering and managing health care; they must play a pivotal role in resolving management, information and systems issues and in promoting sound information and management strategies; and they must encourage research and education in medical informatics.

Attitude to Computers↗
PubMed1999

Actual problems in medical informatics.

Medical informatics has been the first science that connects all traditional medical disciplines, thanking to common information needs and requirements of these disciplines. Its goal is incorporating of information technology into medical praxis, getting medical professionals in touch with capabilities of computer technology and preparing the professionals for the future that belongs to more and more powerful computer technologies. Information as a "crucial" component of medicine is in the focus of each investigation. There are many problems that have to be solved through fundamental investigation: knowledge databases; knowledge structuring problems; joining the different kinds of knowledge; knowledge and representation of decision making process; medical concepts; integration and information and knowledge exchange; education of medical staff; structure and organisation. What kinds of management are the best for application in the field of medical informatics? What are the changes in organisation and structure when computer are used? How to connect education processes in clinical centres, libraries, clinical functions and investigations? In this article author discuss about the theoretical and practical part of the education process on biomedical faculties in Bosnia and Herzegovina, according to new curriculum.

Medical Informatics↗
PubMedDate not supplied

The interactions between clinical informatics and bioinformatics: a case study.

For the past decade, Stanford Medical Informatics has combined clinical informatics and bioinformatics research and training in an explicit way. The interest in applying informatics techniques to both clinical problems and problems in basic science can be traced to the Dendral project in the 1960s. Having bioinformatics and clinical informatics in the same academic unit is still somewhat unusual and can lead to clashes of clinical and basic science cultures. Nevertheless, the benefits of this organization have recently become clear, as the landscape of academic medicine in the next decades has begun to emerge. The author provides examples of technology transfer between clinical informatics and bioinformatics that illustrate how they complement each other.

Academic Medical Centers↗
PubMed1998

Measuring the quality of diagnostic hypothesis sets for studies of decision support.

Within medical informatics there is widespread interest in computer-based decision support and the evaluation of its impact. It is widely recognized that the measurement of dependent variables, or outcomes, represents the most challenging aspect of this work. This paper describes and reports the reliability and validity of an outcome metric for studies of diagnostic decision support. The results of this study will guide the analytic methods used in our ongoing multi-site study of the effects of decision support on diagnostic reasoning. Our measurement approach conceptualizes the quality of a diagnostic hypothesis set as having two components summed to generate a composite index: a Plausibility Component derived from ratings of each hypothesis in the set, whether correct or incorrect; and a Location Component derived from the location of the correct diagnosis if it appears in the set. The reliability of this metric is determined by the extent of interrater agreement on the plausibility of diagnostic hypotheses. Validity is determined by the extent to which the index generates scores that make sense on inspection (face validity), as well as the extent to which the component scores are non-redundant and discriminate the performance of novices and experts (construct validity). Using data from the pilot and main phases of our ongoing study (n = 124 subjects working 1116 cases), the reliability of our diagnostic quality metric was found to be 0.85-0.88. The metric was found to generate, on inspection, no clearly counterintuitive scores. Using data from the pilot phase of our study (n = 12 subjects working 108 cases), the component scores were moderately correlated (r = 0.68). The composite index, computed by equally weighting both components, was found to discriminate the hypotheses of medical students and attending physicians by 0.97 standard deviation units. Based on these findings, we have adopted this metric for use in our further research exploring the impact of decision support systems on diagnostic reasoning and will make it available to the informatics research community.

Decision Support Systems, Clinical↗
PubMed1998

Rating health information on the Internet: navigating to knowledge or to Babel?

CONTEXT: The rapid growth of the Internet has triggered an information revolution of unprecedented magnitude. Despite its obvious benefits, the increase in the availability of information could also result in many potentially harmful effects on both consumers and health professionals who do not use it appropriately. OBJECTIVES: To identify instruments used to rate Web sites providing health information on the Internet, rate criteria used by them, establish the degree of validation of the instruments, and provide future directions for research in this area. DATA SOURCES: MEDLINE (1966-1997), CINAHL (1982-1997), HEALTH (1975-1997), Information Science Abstracts (1966 to September 1995), Library and Information Science Abstracts (1969-1995), and Library Literature (1984-1996); the search engines Lycos, Excite, Open Text, Yahoo, HotBot, Infoseek, and Magellan; Internet discussion lists; meeting proceedings; multiple Web pages; and reference lists. INSTRUMENT SELECTION: Instruments used at least once to rate the quality of Web sites providing health information with their rating criteria available on the Internet. DATA EXTRACTION: The name of the developing organization, Internet address, rating criteria, information on the development of the instrument, number and background of people generating the assessments, and data on the validity and reliability of the measurements. DATA SYNTHESIS: A total of 47 rating instruments were identified. Fourteen provided a description of the criteria used to produce the ratings, and 5 of these provided instructions for their use. None of the instruments identified provided information on the interobserver reliability and construct validity of the measurements. CONCLUSIONS: Many incompletely developed instruments to evaluate health information exist on the Internet. It is unclear, however, whether they should exist in the first place, whether they measure what they claim to measure, or whether they lead to more good than harm.

Computer Communication Networks↗
PubMed2000

Use of a secure Internet Web site for collaborative medical research.

Researchers who collaborate on clinical research studies from diffuse locations need a convenient, inexpensive, secure way to record and manage data. The Internet, with its World Wide Web, provides a vast network that enables researchers with diverse types of computers and operating systems anywhere in the world to log data through a common interface. Development of a Web site for scientific data collection can be organized into 10 steps, including planning the scientific database, choosing a database management software system, setting up database tables for each collaborator's variables, developing the Web site's screen layout, choosing a middleware software system to tie the database software to the Web site interface, embedding data editing and calculation routines, setting up the database on the central server computer, obtaining a unique Internet address and name for the Web site, applying security measures to the site, and training staff who enter data. Ensuring the security of an Internet database requires limiting the number of people who have access to the server, setting up the server on a stand-alone computer, requiring user-name and password authentication for server and Web site access, installing a firewall computer to prevent break-ins and block bogus information from reaching the server, verifying the identity of the server and client computers with certification from a certificate authority, encrypting information sent between server and client computers to avoid eavesdropping, establishing audit trails to record all accesses into the Web site, and educating Web site users about security techniques. When these measures are carefully undertaken, in our experience, information for scientific studies can be collected and maintained on Internet databases more efficiently and securely than through conventional systems of paper records protected by filing cabinets and locked doors. JAMA. 2000;284:1843-1849.

Computer Security↗
PubMed1999

[Computed assisted voice recognition. A dream or reality in the pathologist's routine work?].

During the last 30 years the analysis of human speech with powerful computers has taken great strides; therefore, cost-effective, comfortable solutions are now available for use in professional routine work. The advantages of using voice recognition are the creation of new documentation or archives, reduced personnel costs and, last but not least, independence in cases of unforeseen notification of illness or owing to annual leave. For voice recognition systems to be used easily, a considerable amount of time must be invested for the first 3 months. Younger colleagues in particular will be more motivated to dictate more precisely and more detailed because of the introduction of voice recognition. The effects on other sectors of medical training, quality control, histology report preparation, and transmission can only be speculated.

Artificial Intelligence↗
PubMed2006

Perceptual structure of the desired functionality of internet-based health information systems.

With the emergence of the Internet, new health information systems are being designed and implemented that focus on coordination between providers, patients, payors and other constituents. While the importance of end user input in identifying the desired functionality of systems has long been recognized, very little work focuses on how users perceive the desired functionalities of these new systems to group together, and the implications of these groupings for the organization of functionalities into program modules and associated user interfaces. In this paper, we advance the construct, user based perceptual structure of desired functionality, in the context of these new coordination-intensive health information systems. Perceptual structure depicts how users perceive different desired system functions to group together. A conceptual framework is advanced which links perceptual structure to two broad categories of components, external coordination and internal coordination, which are related to prospective beliefs about system value. The framework is tested empirically via two field studies conducted by a hospital chain focusing on two major user groups, physicians and office administrators. The setting involves a proposed Internet-based health information system that links various constituencies in the service delivery chain. The empirically generated perceptual structure is found to be largely supportive of its conceptual counterpart. Implications for the design and development of this new class of systems, and public policy implications of such new systems are presented.

Consumer Behavior↗
PubMed2006

Bioinformatics: The philosophical and ethical issues at stake in a new modality of research practices.

This article deals with the integration of ethical reflection into the research practices of the project at the Lille Nord-Pas-de-Calais genopole: "Multifactorial genetic pathologies and therapeutic innovations". The general hypothesis of this text is that changes in research practices in biology (mainly through the use of bioinformatics) imply changes in medical practices, which require critical reflection. This hypothesis could be broken down into three sub-hypotheses: (1) Research in biology is undergoing a complete transformation; (2) Research in biology is a cultural practice, which cannot be reduced to a simple cognitive action; (3) Research in biology is a techno-scientific practice. As for the method, the aim of our research at the Medical Ethics Centre is to elucidate the philosophical and ethical range of biomedical practices. This work entails a double task for reflection. On the one hand, from the revelation of ethical tensions present in these practices, we have to think about what is at stake in these practices, and more broadly in society. On the other hand, we have to analyse the conditions enabling the actors to assume the significance of ethical reflection in their practices. The method set up to undertake this double task could be qualified as "narrative hermeneutics", as its aim is to attempt to interpret the stakes in practices from proximity with these practices and from what their actors have to say about them. The text then goes on to analyse more specifically the emergence and place of bioinformatics in present-day biomedical research.

Biomedical Research↗
PubMed1991

Computer graphics representation of a statistical model used with computer-aided diagnosis.

A description of computer graphics of a multidimensional model that is used with computer-aided diagnosis or prognosis is presented. The model is discussed and computer graphics of the model are developed. The computer graphics are suitable as visual supplements for presenting the computer-aided diagnostic model to individuals who may be inexperienced in multivariate statistics.

Animals↗