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PubMed2000

Exploring information technology adoption by family physicians: survey instrument valuation.

As the information needs of family physicians become more complex, there will be a greater need to successfully implement the technologies needed to manage that information. The ability to stratify primary care physicians can enable the implementation process to be more efficient. This research tested a new instrument on 101 family physicians, and was able to stratify physicians into high, intermediate, and low information technology (IT) usage groups. It is expected that this stratification would allow managers of IT implementation to target specific adoption strategies for each group. The instrument is available from ddixon@julian.uwo.ca.

Analysis of Variance↗
PubMed2000

GALEN's model of parts and wholes: experience and comparisons.

Part-whole relations play a critical role in the OpenGALEN Common Reference Model. We describe how particular characteristics of the underlying formalism have influenced GALEN's view on partonomy, and in more detail discuss how specific modelling issues have driven development of an extended set of partitive semantic links.

Medical Informatics Applications↗
PubMed2000

The use of information technology in improving medical performance. Part III. Patient-support tools.

Despite the proliferation of computer-based resources for patients, usefulness has been limited to date. Already, 17,000 biomedical Internet sites exist, and patients are increasingly finding support and knowledge on the Internet, but the accuracy of the information found is highly variable and difficult for patients to assess. Patients have also found value in electronic communication with physicians, although relatively few physicians routinely use email to communicate with patients on a regular basis. Nonetheless, patient-focused information technologies potentially will have profound effects on medical care. With advancing sophistication of technology, patients will increasingly be able to compare and choose doctors using the Internet and to access information that allows them to monitor and regulate the quality of their own care. Further, technologies will likely be developed to allow patients to increasingly manage their own care -- whether they are patients with chronic illnesses such as diabetes or congestive heart failure who use customized software to adjust drug dosages and other treatments or patients with such common illnesses as headache or gastrointestinal infection who access self-management programs that may even write prescriptions for them. Thoughtful analysis and policy development will be critical for ensuring that the benefits are maximized and potential harm minimized. Specific areas include assessing the effects on outcomes and the characteristics of patients and technologies that succeed with self-management, and developing policies regarding liability for Web-based medical transactions and the privacy of information provided to physicians by email and via interactive Web sites.

Biomedical Technology↗
PubMed2000

The use of information technology in improving medical performance. Part II. Physician-support tools.

Increasing data from a few sites demonstrate that information technologies can improve physician decision making and clinical effectiveness. For example, computer-based physician order entry systems, automated laboratory alert systems, and artificial neural networks have demonstrated significant reductions in medical errors. In addition, Internet services to disseminate new knowledge and safety alerts to physicians more rationally and effectively are rapidly developing, and telemedicine to improve rural access to specialty services is undergoing substantial growth. However, even technologies demonstrated to yield beneficial effects have not yet achieved widespread adoption, though the pace of change appears to be increasing as the Internet takes hold. Scientific evaluation of many technologies is also lacking, and the dangers of some of these technologies may be underappreciated. Research on the effects of specific technologies should be a priority. Policies should be developed to press information technology companies, such as pharmaceutical and medical device manufacturers, to recognize the importance of clinical evaluation. Research could also analyze the characteristics of effective technologies and of physicians and organizations who implement these technologies effectively.

Biomedical Technology↗
PubMed2000

The use of information technology in improving medical performance. Part I. Information systems for medical transactions.

Investment in medical information technologies reached $15 billion in 1996. However, these technologies have not had the wide impact predicted in streamlining bureaucracy, improving communications, and raising the effectiveness of care. In this series, we identify how such technologies are being used to improve quality and performance, the future directions for advancement, and the policy and research developments required to maximize public benefit from these technologies. Each of these articles focuses on a different type of information technology: (1) information systems to manage medical transactions; (2) physician-support technologies to improve medical practice; and (3) patient-focused technologies designed to change how people manage their own care. This first article of a 3-part series examines the successes of and opportunities for using advanced information systems that track and manage medical transactions for large populations to improve performance. Examples of such systems include: HEDIS, which gathers standardized data from health plans on quality of care; the USQA Health Services Research Program, which tracks treatment patterns and outcomes for 14 million insurance members; Ford's program to collect medical data for over 600,000 employees; and Harvard Pilgrim Health Care's system of computerized laboratory, pharmacy, ambulatory, and hospital admission records for its 1.5 million members. Data from these systems have led to modest improvements in knowledge and practice patterns for some diseases. Significant barriers are slowing efforts to add outcomes data to these databases and broaden the databases to cover larger populations. Nonetheless, existing data in currently evolving systems could be used to greater benefit in tracking public health and in identifying more effective treatments and causes of diseases.

Biomedical Technology↗