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PubMed1999

[Outline of Health Level Seven (HL7) standard].

Health Level Seven (HL7) is a standard for medical informatics exchange between healthcare providers. Its applicable area includes order entry of many kinds, test result reporting, prescriptions, Admit/Discharge/Transfer of patient, etc. It is one of the most successful medical standards. Merits of HL7 are 1) its richness of elements of details for laboratory test orders and results, 2) its protocol definitions for HIS-LIS data exchange, 3) its standard body's healthy management, and 4) its popularity makes related softwares more available and less expensive. Limitations of HL7 are 1) its difficulty of expression of clinical findings, signs, and symptoms, which comprise electronic medical records, all because of lack of adequate code of these items, and 2) its being a description of fixed timing of examination results, not being a sequence of episode of the patient. HL7 Japan have been founded in 1998, as the 7th international affiliate of HL7. Its secretariat facility is provided by JAHIS (Japan Association of Healthcare Information System vendors). Its activities comprise; 1) HL7 seminars held more than 3 times each year, 2) Japanese language publication of HL7 standards and related documents, and 3) submission of requirements from Japanese users to HL7 USA for coming versions.

Clinical Laboratory Information Systems↗
PubMed2005

Assessing the potential economic value of health information technology interventions in a community-based health network.

Health information professionals recognize the need to demonstrate that the benefits of health information technological (HIT) interventions outweigh their costs. However, such cost-benefit analyses are rarely conducted for HIT interventions, due in part to the lack of a standard methodology. In this study, we describe how the U.S. Public Health Service's guidelines for health economic analyses can be used to evaluate HIT interventions. This framework is described in the context of an economic analysis we are conducting for three HIT interventions to be implemented in a community-based health network caring for Medicaid beneficiaries in Durham County, North Carolina. At present, the 17,779 patients in our study cost Medicaid more than $5 million per month. In sensitivity analyses, we demonstrate that if our information intervention redirects just 10% of low-severity emergency room encounters to outpatient encounters, it will result in $12,523 of monthly savings to the local health system.

Biomedical Technology↗
PubMed2002

Transparency and selfhood: Utopia and the informed body.

One aspect of the development of a health-orientated consumer culture is the growth of self-screening and self-diagnosis among the lay public--e.g. over-the-counter diagnostic tests, computerized health assessments. DIY genetic tests. This trend is interpreted as the expression of a distinctively postmodern 'utopian' impulse. Postmodernity's inwardly directed gaze has replaced the communitarian vision of modernity. In the absence of overarching visions, the postmodern utopian telos becomes the attainment of a perfect. imperishable body. Somatopia is the collective expression of these privatized and personalized body projects. The accomplishment and authentication of these body projects necessitates the creation of a 'transparent body'. This 'transparent body' is enabled and constructed by developments in information and medical technologies. The political and health implications of the transparent, 'informed' body are explored.

Attitude to Health↗
PubMed2003

Patient demands and the development of EHR systems.

Patient demands to the development and implementation of electronic health care records (EHR) are rarely considered in professional health informatics societies. This project has investigated the citizens' opinion in Denmark by means of a newly developed methodology "development space". A group of citizens form a lay panel and are briefed on the fundamental issues in the development and strategies for EHR. They confront an expert panel with a number of questions and on the basis of the answers they write a report. The results show that the citizens in the lay panel demanded clear answers to strategic, technical and attitudinal questions. They demonstrated an ability to see through relatively complex relations and formulate multifaceted opinions, which can add valuable input to the development and implementation process of EHR in the professional environments.

Attitude to Computers↗
PubMed2006

What does it take to replace an old functioning information system with a new one? A case study.

PURPOSE: To investigate the case of a municipal wound care practice and the process of designing a specific computer documentation record system. In carrying out our kind of action research, creation of the system that integrate digital photos, was supposed to remake the old wound care documentation system and transform it into a more advanced and unified tool. METHODS: Ethnographic studies were conducted before and parallel to the design work. Nurse practitioners were involved in design and actively determining essentials of the computer artefact. Developmental Work Research (DWR) is the framework against which data from the work practice and system development where analyzed and interpreted. RESULTS: First, an old-fashioned information system (IS) within health care work will not successfully be replaced by a new one, unless the new is better "as a whole", that is, better supports work practices of a range of occupational and professional workers. Second, when designing information system for the public sector, system designers will almost always face dilemmas based on a contradiction between central, high level interest and a local level work-practice perspective. DISCUSSION: Our study reveals that the work practice of the municipal nurses is characterized by three distinctive features: High mobility, the need for face-to-face interaction in different locations, and a great variety of artefact usage. This implies that a new information system has to be "better as a whole" dealing with those characteristics.

Diffusion of Innovation↗
PubMed1995

Guided bone regeneration of bone defects associated with implants: an evidence-based outcome assessment.

Guided bone regeneration is a new technique that evolved following the guided tissue regeneration procedure for regeneration of lost periodontium. The objective of guided bone regeneration is to promote bone formation in osseous deformities either before or in conjunction with endosseous implant placement. Osseous defects consist mainly of extraction sites, dehiscences or fenestrations, and localized ridge deformities. In addition, bone defects may either provide natural spacemaking or be nonspacemaking. A plethora of publications indicate that the guided bone regeneration technique can be used successfully in all types of defects. Nonspacemaking defects usually require bone graft materials to assist in space maintenance and enhance bone formation. Fixation pins are also used, either with or without graft materials, in this regard. The scientific literature on guided bone regeneration was reviewed by a task force to determine techniques proven to increase predictability relative to successful patient outcomes and to develop specific evidence based diagnostic and treatment decision trees.

Alveolar Bone Loss↗
PubMed1998

Standardization and security for the EMR.

The Ministry of Health and Welfare of Japan announced 'Healthcare Information Strategy 21' in 1994. This report shows that the Healthcare Information System is the key to improving the quality and efficiency of healthcare. One of the elements for realizing the new Healthcare Information System is the Electronic Medical Record (EMR). Following the publication of this report, work began with the aim of discovering a way to recognize the EMR as formal documentation and four national projects of research and development have been started. The themes of these projects are: 'Interoperability of EMR', 'Standardization of EMR', 'Modeling of the Clinical Process' and 'Security for EMR'. The Japanese Association of the Healthcare Information Systems Industry (JAHIS) is in charge of 'Security for EMR'. There are many discussions in relation to the security for EMR. However, many of these discussions relate to information technology, while there are few discussions regarding definitions of security. Therefore, there are many different theories about security itself, which will be an obstacle to standardization. To design the security system for EMR, JAHIS has defined 'Security for EMR' as the first step. The present study was conducted with medical informatics and security specialists. It has designed 'Requirement Definitions', 'Goals of Security', 'Estimation of threats to security', 'Necessity conditions' and a 'Security Model'. This paper covers these definitions and our security design concept.

Computer Security↗
PubMed2006

[Impact of the Internet on communication flow of scientific health information].

Communication flow of scientific information has been restructured with the development of new technologies and the Internet and their impact on social relations worldwide. The production of scientific knowledge has also been influenced by these cultural, social and economic changes and has contributed to new patterns of scientific communication. The objective of the study was to present the traditional scientific communication model and its evolution to electronic scientific communication stimulated by the use of electronic media and Internet and networking. While the traditional model is based on printed publications, the new one focuses on electronic publishing and open unlimited access to published literature. The challenges faced are in using all the potential of electronic media for improving traditional communication flow of scientific information and defining policies to support the new model of scientific communication to ensure quality, preservation and dissemination of information as a common good.

Access to Information↗
PubMed2002

[Internet in medicine--development and perspectives].

Internet is one of information technologies marking the transition from the second to the third millennium. The present role and expansion of Internet in medicine and healthcare is reviewed together with the perspective of further development. The beginning and initial expansion of the use of Internet in medicine are described. The World Wide Web (WWW or Web) is recognized as a major reason for this expansion, reaching a state described as a Web-pandemic. The rapid increase of the number of papers dealing with Internet in medical literature is presented as well as the appearance of several journals dedicated to Internet in medicine. First specialized symposia, among them MEDNET world conferences, are noted. First uses of Internet in medicine comprised databases, discussion groups, electronic newsletters, software archives and online public access catalogues. The appearance of the Web has led to a significant improvement of the Internet use in medicine, which is reflected in an exponential increase in the number of publications. It is noted that Internet allows "to do old things in new ways", but also "to do new things". It has become clear that the information revolution evoked by the internet shall leave a deep trace in medicine, as health information has become accessible to the public and ceased to be in exclusive control of health professionals. New medical fields--telemedicine and cybermedicine--appeared as the result of the development and global expansion of information and communication technologies, with cybermedicine dealing more specifically with the use of Internet. The advantages and disadvantages of cybermedicine are discussed, and major problems related to the quality of health information are highlighted. Several systems for quality criteria of health related Web-sites are described, indicating that Websites have to conform with the quality criteria such as transparency and honesty, accountability, privacy and data protection, currency, accountability and accessibility. A review of the development of the use of Internet in medicine in Croatia is given. It is ever more recognized worldwide that the Internet is capable to create conditions for partnership between patients and clinicians. In concluding remarks, the reasons are given for a sooner access to the Internet and its daily use in healthcare activity.

Croatia↗
PubMed2004

A consensus action agenda for achieving the national health information infrastructure.

BACKGROUND: Improving the safety, quality, and efficiency of health care will require immediate and ubiquitous access to complete patient information and decision support provided through a National Health Information Infrastructure (NHII). METHODS: To help define the action steps needed to achieve an NHII, the U.S. Department of Health and Human Services sponsored a national consensus conference in July 2003. RESULTS: Attendees favored a public-private coordination group to guide NHII activities, provide education, share resources, and monitor relevant metrics to mark progress. They identified financial incentives, health information standards, and overcoming a few important legal obstacles as key NHII enablers. Community and regional implementation projects, including consumer access to a personal health record, were seen as necessary to demonstrate comprehensive functional systems that can serve as models for the entire nation. Finally, the participants identified the need for increased funding for research on the impact of health information technology on patient safety and quality of care. Individuals, organizations, and federal agencies are using these consensus recommendations to guide NHII efforts.

Health Policy↗
PubMed2006

[Deficient information in developing countries: Internet alone is no solution].

Health-care personnel in developing countries have poor access to information, partly because the books are out of date and journals and Internet access are lacking, and partly because the information that is available is not appropriate for the local situation. There is too little research aimed at the problems of the Third World. This is due to a lack of interest in Western countries and because local scientists have done too little research. Internet solves the problem of access to information for health-care personnel in large hospitals and institutes, but there is still a shortage of relevant information for them as well. The editorial boards of professional journals could make a contribution by facilitating the publication of relevant research. Health-care personnel in rural areas will remain dependent upon basic books. This basic component of the provision of information should continue to receive attention. For the time being, Internet will remain inaccessible for rural health-care personnel. One of the initiatives being undertaken in order to improve the provision of information to health-care personnel in developing countries is the distribution of the 'blue trunk library' of the WHO with a selection of more than 100 basic books in every trunk. A number of journals have also taken action: the BMJ Publishing Group offers access to its journals free of charge to the 118 poorest countries and the Canadian Medical Association Journal provides free copies to libraries in developing countries. Moreover, a number ofwebsites have been started with a view to enlarging the information for health-care personnel in the Third World.

Books↗
PubMedDate not supplied

Use of patient education and monitoring software in community pharmacies.

OBJECTIVE: To determine the level of use of health education and monitoring software programs in independent community pharmacies in rural locales. DESIGN: The use of seven software programs that deliver patient education and provide blood pressure monitoring was assessed at five sites of the Nebraska Drug Information Network (NDIN) for one month. Direct Access, a Windows-based software program, documented which programs were accessed and for what time period. RESULTS: During a one-month period, 326 accesses were logged representing 44 hours of computer time. Extrapolated to all 30 sites of NDIN, this represents 264 hours and 1,956 accesses monthly. On average, each pharmacy logged 8.8 hours within 65 accesses each month. Each access averaged 8 minutes. DynaPulse (167 accesses; 16.4 hours) was the most frequently used product, followed by Home Medical Advisor Pro (54 accesses; 8.9 hours) and Mayo Clinic The Family Pharmacist (35 accesses; 8.3 hours). The least amount of time was spent with BodyWorks (0.6 hours) but Wellness Checkpoint had fewest accesses (7 accesses). CONCLUSION: Applied medical informatics is assuming a larger role in daily clinical practice as pharmacy practitioners strive to better inform their patients. This is congruent with the finding that a better informed public can be a healthier public. This study demonstrates that computer systems are readily used by patients and pharmacists in rural communities.

Adult↗
PubMed2004

The future of general internal medicine. Report and recommendations from the Society of General Internal Medicine (SGIM) Task Force on the Domain of General Internal Medicine.

The Society of General Internal Medicine asked a task force to redefine the domain of general internal medicine. The task force believes that the chaos and dysfunction that characterize today's medical care, and the challenges facing general internal medicine, should spur innovation. These are our recommendations: while remaining true to its core values and competencies, general internal medicine should stay both broad and deep-ranging from uncomplicated primary care to continuous care of patients with multiple, complex, chronic diseases. Postgraduate and continuing education should develop mastery. Wherever they practice, general internists should be able to lead teams and be responsible for the care their teams give, embrace changes in information systems, and aim to provide most of the care their patients require. Current financing of physician services, especially fee-for-service, must be changed to recognize the value of services performed outside the traditional face-to-face visit and give practitioners incentives to improve quality and efficiency, and provide comprehensive, ongoing care. General internal medicine residency training should be reformed to provide both broad and deep medical knowledge, as well as mastery of informatics, management, and team leadership. General internal medicine residents should have options to tailor their final 1 to 2 years to fit their practice goals, often earning a certificate of added qualification (CAQ) in special generalist fields. Research will expand to include practice and operations management, developing more effective shared decision making and transparent medical records, and promoting the close personal connection that both doctors and patients want. We believe these changes constitute a paradigm shift that can benefit patients and the public and reenergize general internal medicine.

Career Choice↗
PubMed2005

The role of states in improving health and health care for young children.

States are uniquely positioned to make significant improvements in the quality of health and heath care for young children, due to their roles as administrators of Medicaid and the State Children's Health Insurance Program, as well as mental health, public health, and education programs. Quality improvement initiatives are often hampered, however, by lack of coordination among programs within a state, by the lack of adequate data and information technology, and the tendency of state officials to focus on short-term policy projects. Even in the face of these burdens and other difficult fiscal and administrative challenges, state officials are optimistic that improvements are possible. Potential solutions that state officials consider promising include developing specific child health quality measures, measuring and monitoring performance, making information on quality performance easily available, rewarding superior performance, and using performance measures in purchasing and program decisions.

Child↗
PubMed2003

Public key infrastructures for health.

Introducing the technological step into this new 3rd millennium, advanced communication means like global networks including the Internet become more and more important for a fast and convenient information exchange across regional and even national borders. Concerning the sector of public and private healthcare and welfare, new health information system, or citizens' information systems in general, are coming up to meet the needs of the whole information society. Thus, developing and implementing those systems is one of the most important aims of the present and the near future. Access to, and communication of, relevant patient-related administrative and medical information items always means a secure and trustworthy way of dealing with data. Concerning the main aspects of specific legal, social, ethical, technical, organisational, and even political requirements for secure access and secure communication of health data in terms of data protection, data security, privacy, safety and quality using unprotected networks as, e.g., the Internet, there is a strong and even growing need for the fundamental technology of Trusted Third Parties to meet the whole range of the security categories as integrity, confidentiality, availability, accountability, and access control.

Computer Security↗
PubMedDate not supplied

Roundtable on bioterrorism detection: information system-based surveillance.

During the 2001 AMIA Annual Symposium, the Anesthesia, Critical Care, and Emergency Medicine Working Group hosted the Roundtable on Bioterrorism Detection. Sixty-four people attended the roundtable discussion, during which several researchers discussed public health surveillance systems designed to enhance early detection of bioterrorism events. These systems make secondary use of existing clinical, laboratory, paramedical, and pharmacy data or facilitate electronic case reporting by clinicians. This paper combines case reports of six existing systems with discussion of some common techniques and approaches. The purpose of the roundtable discussion was to foster communication among researchers and promote progress by 1) sharing information about systems, including origins, current capabilities, stages of deployment, and architectures; 2) sharing lessons learned during the development and implementation of systems; and 3) exploring cooperation projects, including the sharing of software and data. A mailing list server for these ongoing efforts may be found at http://bt.cirg.washington.edu.

Bioterrorism↗
PubMed2006

Mapping the literature of nursing informatics.

OBJECTIVE: This study was part of the Medical Library Association's Nursing and Allied Health Resources Section's project to map the nursing literature. It identified core journals in nursing informatics and the journals referenced in them and analyzed coverage of those journals in selected indexes. METHOD: Five core journals were chosen and analyzed for 1996, 1997, and 1998. The references in the core journal articles were examined for type and number of formats cited during the selected time period. Bradford's Law of Scattering divided the journals into frequency zones. RESULTS: The time interval, 1990 to 1998, produced 71% of the references. Internet references could not be tracked by date before 1990. Twelve journals were the most productive, 119 journals were somewhat productive, and 897 journals were the least productive. Journal of the American Medical Informatics Association was the most prolific core journal. The 1998 journal references were compared in CINAHL, PubMed/MEDLINE, Science Citation Index, and OCLC Article First. PubMed/MEDLINE had the highest indexing score.

Abstracting and Indexing↗
PubMed2004

Informed consent to the secondary use of EHRs: informatic rights and their limitations.

It is frequently asserted that the secondary use of data contained in electronic health records (EHRs) requires the informed consent of the subjects of these records. This paper argues that while correct in principle, this has four important ethically based limitations: when it seriously threatens the equal and competing right of others, when it undermines the ability of health care providers to carry out their mandates, when it imperils the possibility of establishing and maintaining a health care system in the first place, and when it makes bona fide research impossible. Nevertheless, as a general rule, when consent can be had, it should be had. This paper provides a theoretical basis for these claims by looking at the nature and role of EHRs and provides some possible approaches for incorporating them into the health care delivery process.

Confidentiality↗