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PubMed2006

Informatics and public health at CDC.

Since CDC acquired its first mainframe computer in 1964, the use of information technology in public health practice has grown steadily and, during the past 2 decades, dramatically. Public health informatics (PHI) arrived on the scene during the 1990s after medical informatics (intersecting information technology, medicine, and health care) and bioinformatics (intersecting mathematics, statistics, computer science, and molecular biology). Similarly, PHI merged the disciplines of information science and computer science to public health practice, research, and learning. Using strategies and standards, practitioners employ PHI tools and training to maximize health impacts at local, state, and national levels. They develop and deploy information technology solutions that provide accurate, timely, and secure information to guide public health action.

Centers for Disease Control and Prevention, U.S.↗
PubMed2002

Development of universal electronic health record in cardiology.

In the paper we discuss the vision and experiences in development of electronic health record based on universal structure of collectable data, multimedia objects, all equipped by supporting systems for data verification and medical guidelines connection. This development is based on existing European and international standards in the field of medical informatics.

Cardiology↗
PubMed1990

Improving the quality of ambulatory health care with enhanced medical information systems: using the computer to diagnose faulty clinical processes.

The lack of consistency in the performance of the processes which implement clinical decisions is an important problem in ambulatory care. Since delayed or neglected actions in patient care may have serious consequences, we studied the use of industrial quality management techniques to determine where three clinical processes could be improved. These quantitative and graphical tools were useful in showing that in some processes, the failure rate could be as high as 33%. However, lack of readily available process data prevented a full analysis of the extent of the failures, so specific suggestions for improvement could not be made. Medical informatics and management specialists have an important role in designing enhanced medical information systems with which to examine and improve patient care processes. This new generation of MIS's should include order entry systems with flags for selected transactions, audit trails for all automated processes, functional integration of the separate departmental information systems, and enhanced communications features.

Ambulatory Care↗
PubMed2005

Skill needs for nurses in their role as health informatics professionals: a survey in the context of global health informatics education.

In the process of developing global health informatics education, a common understanding of educational outcomes is required. Therefore, an educational framework for health informatics professionals is desirable to support student mobility, trans-national and borderless education. Nurses form a significant part of the health workforce and need to be properly educated for their roles in health informatics. To ascertain their perceptions of needs and priorities, we developed a web-based questionnaire and surveyed Australian nurses on the preferred knowledge/skills set for health informatics professionals. Among others, the questionnaire is based on the International Medical Informatics Association's (IMIA) set of recommendations on education and IMIA's scientific map. Benner's five levels of competencies were applied to measure the degree of competency required for each skill/knowledge. Altogether, 82 Australian nurses completed the questionnaire. The nurses' perceived degree of competency required for a total of 74 specific skills and knowledge in five skill categories is presented in this paper as well as the overall results for each of the five categories. Further, significant differences between the nurses' primary roles and primary interest in health informatics are discussed. The development of a comprehensive health informatics education framework needs to take into account nurses as well as other health professionals. Repeating the survey in other countries and for various professions is essential to develop an international educational framework.

Adult↗
PubMed1998

Design should help use of patients' data.

Checklists and other tools help doctors to use published evidence in clinical practice. Two other important sources of evidence, however, are the patient and his or her medical record. This series aims to advance the practice of evidence-based medicine by helping in redesign of medical records, drawing on insights from psychology, information design, and medical informatics; and by promoting changes analogous to those occurring in the medical literature. The four papers look at: the uses of medical records and importance of organising them so doctors can use the data they contain; different methods doctors use to search for data and how design of records can help or hinder these approaches; how we interpret data once found, and how record formatting assists this process; and the issues raised by computerisation of records.

Evidence-Based Medicine↗
PubMed1996

Extraction and anonymity protocol of medical file.

To carry out the epidemiological study of patients suffering from a given cancer, the Department of Medical Informatics (DIM) has to link information coming from different hospitals and medical laboratories in the Burgundy region. Demands from the French department for computerized information security (Commission Nationale de l'Informatique et des Libertés: CNIL), in regard to abiding by the law of January 6, 1978, completed by the law of July 1st, 1994 on nominal data processing in the framework of medical research have to be taken into account. Notably, the CNIL advised to render anonymous patient identities before the extraction of each establishment file. This paper describes a recently implemented protocol, registered with the French department for computerized information security (Service Central de la Sécurité des Systèmes d'information : SCSSI) whose purpose is to render anonymous medical files in view of their extraction. Once rendered anonymous, these files will be exportable so as to be merged with other files and used in a framework of epidemiological studies. Therefore, this protocol uses the Standard Hash Algorithm (SHA) which allows the replacement of identities by their imprints while ensuring a minimal collision rate in order to allow a correct linkage of the different information concerning the same patient. A first evaluation of the extraction and anonymity software with regard to the purpose of an epidemiological survey is described here. In this paper, we also show how it would be possible to implement this system by means of the Internet communication network.

Computer Communication Networks↗
PubMed1997

Compositional and enumerative designs for medical language representation.

Medical language is in essence highly compositional, allowing complex information to be expressed from more elementary pieces. Embedding the expressive power of medical language into formal systems of representation is recognized in the medical informatics community as a key step towards sharing such information among medical record, decision support, and information retrieval systems. Accordingly, such representation requires managing both the expressiveness of the formalism and its computational tractability, while coping with the level of detail expected by clinical applications. These desiderata can be supported by enumerative as well as compositional approaches, as argued in this paper. These principles have been applied in recasting a frame-based system for general medical findings developed during the 1980s. The new system captures the precise meaning of a subset of over 1500 medical terms for general internal medicine identified from the Quick Medical Reference (QMR) lexicon. In order to evaluate the adequacy of this formal structure in reflecting the deep meaning of the QMR findings, a validation process was implemented. It consists of automatically rebuilding the semantic representation of the QMR findings by analyzing them through the RECIT natural language analyzer, whose semantic components have been adjusted to this frame-based model for the understanding task.

Internal Medicine↗
PubMed1986

The teaching of medical records and informatics in West Germany and the Netherlands.

A report of the study sponsored by Allan Brooking NHS Travel Fellowship which was carried out in October 1982 is presented. The author's findings for the visit, discussion and conclusion are given. The visit to West Germany was centred on a full-time school at the University of Ulm. The University course accepts 35 students per year and lasts for three years. The syllabus is broadly similar to that used in the UK, there was, however, considerable bias towards computing and statistics. In addition to extensive theory, emphasis was placed on practical work in the University and in the field. The course has a formal structure of examinations and final assessment on a student dissertation. After graduation 60% of the students were employed in the private sector, 25% worked in hospitals and 15% in research work.

Curriculum↗
PubMedDate not supplied

Application of the RealAudio package to computerized medical lectures.

We created a multimedia system to computerize past lectures using RealAudio software. Physicians, medical researchers and students can browse the contents of lecture slides and handouts with synchronous audio using the Internet. The audience can easily review the most interesting parts of lectures and medical students can listen to complete medical lectures from remote sites with narration and slide depiction, whenever convenient. We have created three multimedia programs; the memorial lecture of a professor's retirement, a new method of hand washing for surgical procedures and a lecture on medical informatics. The cost of this system and the results of the evaluation by medical students are described. The ease of using this application makes it a potentially valuable tool for clinicians and researchers.

Computer-Assisted Instruction↗
PubMed1990

Reference standards for software evaluation.

The field of automated ECG analysis was one of the earliest topics in Medical Informatics and may be regarded as a model both for computer-assisted medical diagnosis and for evaluating medical diagnostic programs. The CSE project has set reference standards of two kinds: In a broad sense, a standard how to perform a comprehensive evaluation study, in a narrow sense, standards as specific references for evaluating computer ECG programs. The evaluation methodology used within the CSE project is described as a basis for presentation of results which are published elsewhere in this issue.

Diagnosis, Computer-Assisted↗
PubMed2005

Moderately differentiated neuroendocrine carcinoma (atypical carcinoid) of the larynx: a clinically aggressive tumor.

OBJECTIVES: To evaluate the presentation, treatment, and outcome of a small series of patients with moderately differentiated neuroendocrine carcinoma (MDNC) of the larynx seen at one institution and to provide information on this uncommon laryngeal malignancy for therapeutic decision making. STUDY DESIGN: Retrospective analysis of medical records. Cases were identified from databases maintained by the medical informatics and pathology departments. METHODS: Patient, tumor, treatment, and outcome data were collected from medical records. Main outcome measures were recurrence, overall and disease-specific survival, and cause of death. RESULTS: Eleven patients (6 males; 5 females) seen between 1990 and 2003 had sufficient documentation for further evaluation. Patients presented with dysphagia, throat pain, or hoarseness, and all tumors arose in the supraglottis. Eight of 11 patients gave a history of cigarette use. Of the 10 patients treated with curative intent, 7 who recurred all died with disease. The average disease-free interval was 54 months, with a range of 2 to 101 months. The overall and disease-specific survival was 64 and 54 months, respectively. Nine patients were alive 3 years after diagnosis. No correlations with age, stage at presentation, or initial treatment modality and outcome (recurrence or survival) were found. CONCLUSIONS: Laryngeal MDNC is an aggressive malignancy with frequent regional and distant metastases. Although surgical resection is usually recommended, patients did respond to radiation and chemotherapy, suggesting a combined approach may be indicated. Aggressive initial therapy is needed because development of recurrence portends a poor outcome.

Adult↗
PubMedDate not supplied

Benefits of an object-oriented database representation for controlled medical terminologies.

OBJECTIVE: Controlled medical terminologies (CMTs) have been recognized as important tools in a variety of medical informatics applications, ranging from patient-record systems to decision-support systems. Controlled medical terminologies are typically organized in semantic network structures consisting of tens to hundreds of thousands of concepts. This overwhelming size and complexity can be a serious barrier to their maintenance and widespread utilization. The authors propose the use of object-oriented databases to address the problems posed by the extensive scope and high complexity of most CMTs for maintenance personnel and general users alike. DESIGN: The authors present a methodology that allows an existing CMT, modeled as a semantic network, to be represented as an equivalent object-oriented database. Such a representation is called an object-oriented health care terminology repository (OOHTR). RESULTS: The major benefit of an OOHTR is its schema, which provides an important layer of structural abstraction. Using the high-level view of a CMT afforded by the schema, one can gain insight into the CMT's overarching organization and begin to better comprehend it. The authors' methodology is applied to the Medical Entities Dictionary (MED), a large CMT developed at Columbia-Presbyterian Medical Center. Examples of how the OOHTR schema facilitated updating, correcting, and improving the design of the MED are presented. CONCLUSION: The OOHTR schema can serve as an important abstraction mechanism for enhancing comprehension of a large CMT, and thus promotes its usability.

Classification↗
PubMed1998

A concept model for the automatic maintenance of controlled medical vocabularies.

A controlled medical vocabulary is a fundamental requirement in a range of medical informatics applications. Large vocabularies development and maintenance is labor intensive and costly. Maintainers of medical vocabularies need appropriate tools to do their work correctly. In this paper, we describe our concept model for a controlled medical vocabulary. We present how this model can check vocabulary consistency. We propose a set of tools in a distributed environment, which permits edition, visualization and maintenance of medical terminologies.

Humans↗
PubMed1999

The RITHME inter-mediation platform for data exchanges between healthcare professionals.

Data Exchanges between Healthcare Professionals are always limited to paper. For letters, reports, results, the physicians and hospitals are yet using the classical post-office mailing system. With the growing development of Medical Informatics within the Hospital Information Systems and the GPs offices, the way to exchange medical data will be more and more oriented towards the Telematics procedures. If Tele-consultation, video-conferencing applications appear as routine procedures, a safe, protected, and rapid transmission of medical data and records through electronic mailing systems is not yet really available. The Rithme Intermediation Platform is an experimental product, tested in the town of Armentières (in the City of Lille) in the North of France to allow a better, safer, more rapid electronic communication between all the professionals of a geographical sector. One of the mail component of this platform is the "Events Server" which collects and displays all the available information concerning a dedicated patient to the medical authorized correspondents. To realise this task the Rithme Platform takes charge of 4 main functions: formatting the messages, assuring the security, managing the directories, notifying emergencies. Currently experienced with success in the City of Lille, this Platform will be soon customised and commercialized.

Computer Communication Networks↗
PubMed2000

A modelization of the task allocation problem for prescribing activity in an ICU.

The improvement of coordination between Health Care Professionals belonging different specialities and who are extremely mobile, is a crucial problem in Medicine. A workflow System is one example of the new informatics tools which facilitate the transfer of information and responsibility between health care providers. Medical informatics systems in particular should be reactive enough to cope with the flexibility of real work situations: in this paper, we present the task allocation problem. We distinguish between the workflow control process and the notifying process, which concerns the sharing out of the tasks between the actors concerned. We focus on the impact of strategies of notification on the progress of coordinated work. We propose a simulator to model and study the different ways of sharing tasks between actors in an Intensive Care Unit's activity of prescription.

Computer Simulation↗
PubMed1995

Generalism in medical education: the next steps.

The Association of American Medical Colleges accepted in full the strategies recommended by its Generalist Task Force in 1992, in particular the central goal that a majority of graduating medical students be committed to careers in generalist specialties and that medical schools make appropriate efforts to reach this goal as quickly as possible. Both generalists and specialists need a revised education. For example, they will have to master intellectually challenging analytic sciences fundamental to general practice, such as clinical epidemiology, decision analysis, health care economics, and medical informatics. Also, they must be educated in ambulatory care settings, which are most like generalist medical practice. Also, the medical faculty must contain large numbers of generalists, who will serve on important institutional committees and be involved in health services research and decision analysis. To educate generalist physicians, academic medicine must tackle many challenges effectively. It will, because medical education has a fundamental responsibility to produce a physician workforce that meets the needs of the American people.

Education, Medical↗
PubMedDate not supplied

MUMPS as an education tool.

The department of Medical Informatics at the Free University is, in addition to research, responsible for the education of medical students in medical-information processing. The Department has a PDP 11/70 running part-time under MUMPS-11 V4B, and since 1978 has had a PDP 11/60. A set of medical education programs has been developed consisting of: (a) A simple introduction to MUMPS. (b) A patient-census module. (c) A neonatal module. (d) A dental data-base. In this paper the educational programs are outlined and examples of their use are given.

Bile Ducts↗
PubMed2003

Computational integrative physiology: at the convergence of the life and computational sciences.

OBJECTIVE: In this paper we outline how Computational Integrative Physiology (CIP) can help unravel the mechanisms of normal and pathological biological processes. Our objective is to illustrate how CIP is firmly grounded on the life and computational sciences. METHOD: After describing a general theoretical frame-work for CIP, we will center our discussion on cardiac rhythmic disorders with a particular focus on the Long QT syndrome that will serve as a case example. Within this context, we will describe multi-scale processes in biological, medical and in general mathematical terms, starting from the control of gene expression to the electrical activity of the entire heart. We will therefore proceed from the smaller microscopic scales to the larger macroscopic ones. In doing so, we will illustrate, at least in a qualitative sense, how CIP can be accomplished by showing some of the relations that can exist between mathematical variables characterizing models of different space-scales. CONCLUSION: We will conclude by putting forth how CIP and the related fields of bioinformatics and medical informatics are necessary to derive meaningful knowledge from the huge and exponentially growing biological and medical data.

Biological Science Disciplines↗