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Clinical practice should reflect clinical science.

The Cochrane Collaboration was set up in 1992 as a world-wide network for creating and disseminating systematic reviews of randomised controlled trials (RCTs) in healthcare. Systematic reviewing of RCTs is an essential stage, prior to the creation and dissemination of clinical guidelines, in the practice of evidence-based medicine. This paper is intended to provide the health telematics community with an introduction to the motives, aims and activities of the Cochrane Collaboration.

Computer Communication Networks↗

Guideline based care: the challenge for knowledge based decision support.

The EPISTOL action was included in the accompanying measures of AIM '91-'94 as a strategic study, aimed at clarifying the impact in the near future of knowledge based systems and techniques for the health sector, and provide recommendations with respect to the research and development work required within this period. In all the EPISTOL events, namely the Munich and Brussels workshops, the topic of clinical guidelines and protocol and based care raised considerable interest. This paper summarises these discussions, focussing on the KBS support for clinical guidelines.

Artificial Intelligence↗

Prescription guidelines in OPADE: what are they, how are they used?

Many computerised drug prescription systems have been developed, but they are rarely used in clinical practice; among the reasons are their lack of integration with the functioning of medical institutions and the lack of consideration of general and local clinical practice rules. We present in this paper how OPADE, a computerised drug prescription system does answer this shortcoming by introducing prescription guidelines called Prescribing Principles. We argue that introduction of these Prescribing Principles will not only allow for integration of the computer in medical practice but will also introduce a positive feed back loop in the prescribing process.

Artificial Intelligence↗

Computerised guidelines in primary health care: reflections and implications.

This chapter introduces the role of clinical guidelines in improving the quality of care in Primary Health Care. It goes on to describe the literature with respect to the development, dissemination and implementation of clinical guidelines while attempting to highlight factors liable to impede their use. It concludes with a discussion of the role of informatics in ensuring the difficulties described are avoided.

Decision Support Techniques↗

Knowledge engineering for drug prescribing guidelines.

Prescribing drugs for the treatment of medical conditions is a very common activity for a doctor. Prescribing has enormous economic importance. Costs are rising quickly and there is an urgent need for doctors to have easy assess to advice about the cheapest, most effective therapy. On average 80% of GPs in the UK use a computer for their medical work and the figure is rising rapidly. Currently available systems provide only very simple checks and reminders. More sophisticated advice is provided by our prototype program. The program uses logic engineering to give advice, based on simple protocols for prescribing, tailored both to the condition being treated and the individual patient. The essential logical elements of the prescribing decision are discussed. These simple prescribing protocols may be the final common pathway for prescribing advice from many, more complex protocols for recommendations for drug treatment.

Cost Control↗

Health care security and privacy, quality and safety.

Working group 6 of CEN/TC251 is concerned with the broad field of Security and Privacy, Quality and Safety in Health Care. In line with the priorities given by SOGITS, the first areas to be looked into, are those concerned with Data Protection in Health Care Information Systems. In order to successfully work on standardisation in this field, one has to take into account the generally low awareness for these problems, and the necessity to avoid increasing the gap between theory and practice. Work of WG6 will build to a large extent on the results of a related AIM-project (SEISMED). A sketch is given of ongoing work on this subject. Briefly, also other work items for WG6 are reviewed.

Computer Security↗

Developments in health informatics within the standards associations of Australia and New Zealand.

Activities to support the development and adoption of Standards in health informatics are now well started. The Standards Association of Australia formed a committee (IT/14) on Medical Informatics which met for the first time in February 1991: early in 1992 it changed its name to reflect a broader concern with "Health Informatics" rather than the rather narrower interpretation that many had chosen to place on the term "Medical Informatics". The Standards Association of New Zealand held the inaugural meeting of persons interested in constituting committee SC606 on Health Informatics in August of this year. A growing program of active collaboration between Australia and New Zealand was formalised in July of this year, whereby standards will for the most part be jointly developed and adopted regionally, and whereby the separate committees will be merged wherever practicable to form a single head Joint Technical Committee (JTC) for each domain of involvement. The focus in Australia and New Zealand is at present very much on the need for standards to implement national health information networks. The progressive definition of network standards is prompting increased interest in the standards implemented within the systems and installations that must connect to the networks. The initial implementation of a national health information system in New Zealand is scheduled for 1st July 1993: detailed plans for an Australian health communications network are well advanced although no date for its implementation has been proposed. This paper outlines the general structure of the standards committees in the Antipodes, and of their various sub-committees. It will also outline broad terms of reference of these groups, and the major areas of current interests, activity and developments.

Australia↗

Recommendations for an object oriented healthcare information model.

The need for a healthcare information model as a component in a framework of standards for healthcare data interchange is identified. Key requirements for a method to support development of a healthcare information model are defined and recommendations for development of an Object Oriented Healthcare Information Model are presented.

Computer Communication Networks↗

The battle between Unix and Windows NT.

For more than a decade, Unix has been the dominant back-end operating system in health care. But that prominent position is being challenged by Windows NT, touted by its developer, Microsoft Corp., as the operating system of the future. CIOs and others are attempting to figure out which system is the best choice in the long run.

Administrative Personnel↗

Case-based quality management system for surgery, a bottom up approach.

Quality control has become a familiar concept in health care in The Netherlands in the last ten years, as it has elsewhere in the Western world. To achieve the goals of total quality, medical audit plays a central role in the process. An important issue for medical audit is to collect consistent and coherent data on the medical performance. As no widespread tradition exists to do this routinely using common widely accepted protocols and information technology, examples of routine quality control of medical services are scarce. In this paper a report is given of the process of collecting routine data on the surgical treatments and its complications in a Dutch general hospital. Based on the results of this and other local initiatives to control and improve the quality of surgical procedures the Dutch Association of Surgeons has recently adopted a policy document, which promotes to enhance quality Management. This paper presents also the increasing need among health care professionals to compare the results of treatment of similar patients. The role of Information Technology to achieve these goals is growing at an impressive pace. A more complete documentation of the care process will increasingly support a case based approach, which will be essential for a comprehensive analysis and Management of the care provided to patients. The paper supports a systematic collection of data documenting structure, process and outcome.

Data Collection↗

New challenges for nursing informatics.

Long a leader in health informatics, nursing faces new challenges. The full and effective use of technology requires an understanding of cognitive processes and organizational behavior. Nursing can play a key role in addressing aims supportive of a new vision of health informatics. The evolving paradigm for knowledge transfer will give rise to new educational models and new institutional entities which will nurture learning and relearning.

Education, Nursing↗