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Concept of a PACS and imaging informatics-based server for radiation therapy.

Radiation Therapy (RT) is an image-based treatment. It requires images from projection X-rays, computed tomography, magnetic resonance, positron emission tomography, Linear Accelerator for tumor localization, treatment planning and verification of treatment plans. During the treatment process, patient's images are transmitted to every necessary station in the RT department. However, images of the same patient are generally scattered and there is no permanent home base for them due to the nature and traditional organization of the RT department. The advance in diagnostic picture archiving and communication system and the establishment of RT DICOM Standard provide an opportunity to define and design an RT server as a means to organize RT images and related data. This paper describes the RT workflow and the concept of the DICOM RT server. An example of RT treatment of nasopharyngeal carcinoma based on the RT server concept is given.

Diagnostic Imaging↗

[Medical informatics (hospital information systems) in neonatology: reality and insufficiencies].

The generalized implementation in France of hospital information systems (HIS) is often considered by the medical practitioners as a useless constraint. Nevertheless, they are now largely used by the administrative authorities for their economical evaluation of medical care. In neonatology HIS is applied to the hospitalized sick neonates as well as to the healthy newborn infants during their maternity hospital stay with their mother following birth. This paper focuses on the practical aspects and difficulties of the current French HIS in neonatology.

Diagnosis-Related Groups↗

A study of collaboration among medical informatics research laboratories.

The InterMed Collaboratory involves five medical institutions (Stanford University, Columbia University, Brigham and Women's Hospital, Massachusetts General Hospital, and McGill University) whose mandate has been to join in the development of shared infrastructural software, tools, and system components that will facilitate and support the development of diverse, institution-specific applications. Collaboration among geographically distributed organizations with different goals and cultures provides significant challenges. One experimental question, underlying all that InterMed has set out to achieve, is whether modern communication technologies can effectively bridge such cultural and geographical gaps, allowing the development of shared visions and cooperative activities so that the end results are greater than any one group could have accomplished on its own. In this paper we summarize the InterMed philosophy and mission, describe our progress over 3 years of collaborative activities, and present study results regarding the nature of the evolving collaborative processes, the perceptions of the participants regarding those processes, and the role that telephone conference calls have played in furthering project goals. Both informal introspection and more formal evaluative work, in which project participants became subjects of study by our evaluation experts from McGill, helped to shift our activities from relatively unfocused to more focused efforts while allowing us to understand the facilitating roles that communications technologies could play in our activities. Our experience and study results suggest that occasional face-to-face meetings are crucial precursors to the effective use of distance communications technologies; that conference calls play an important role in both task-related activities and executive (project management) activities, especially when clarifications are required; and that collaborative productivity is highly dependent upon the gradual development of a shared commitment to a well-defined task that leverages the varying expertise of both local and distant colleagues in the creation of tools of broad utility across the participating sites.

Computer Communication Networks↗

AI in medical education--another grand challenge for medical informatics.

The potential benefits of artificial intelligence in medicine (AIM) were never realized as anticipated. This paper addresses ways in which such potential can be achieved. Recent discussions of this topic have proposed a stronger integration between AIM applications and health information systems, and emphasize computer guidelines to support the new health care paradigms of evidence-based medicine and cost-effectiveness. These proposals, however, promote the initial definition of AIM applications as being AI systems that can perform or aid in diagnoses. We challenge this traditional philosophy of AIM and propose a new approach aiming at empowering health care workers to become independent self-sufficient problem solvers and decision makers. Our philosophy is based on findings from a review of empirical research that examines the relationship between the health care personnel's level of knowledge and skills, their job satisfaction, and the quality of the health care they provide. This review supports addressing the quality of health care by empowering health care workers to reach their full potential. As an aid in this empowerment process we argue for reviving a long forgotten AIM research area, namely, AI based applications for medical education and training. There is a growing body of research in artificial intelligence in education that demonstrates that the use of artificial intelligence can enhance learning in numerous domains. By examining the strengths of these educational applications and the results from previous AIM research we derive a framework for empowering medical personnel and consequently raising the quality of health care through the use of advanced AI based technology.

Artificial Intelligence↗

Informatics.

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Information Services↗

WHO views on perspectives in health informatics.

The wider use of telematics in public health and patient care will be a very important strategy for Member States, and one that can help bring expert knowledge to new areas and institutions in a cost-effective and rapid manner. However, such a strategy should take into account a number of elements that are given below. Health telematics systems and services should be dictated by health need s and by clinical and public health standards, not be technology-driven. The values and principles of Health for All (HFA), notably equity, sustainability, participation and accountability, should apply fully to the development of health telematics. Health telematics requires new skills from the relevant decision-makers , operators and users, calling for a mix of participatory education, skills training, continuing professional education and lifelong learning. Given the fast rate of technological obsolescence and changing price-performance ratios, countries will benefit from closer collaboration on the development of technological standards, compatibility, open architecture, competitive prices and pilot applications. Managing health information developments in an effective and rational way at the level of the European Region will require the major organizations active in this field to enter into more formal agreements of cooperation than is the case today; most importantly, this will involve World Health Organization (WHO), the European Commission and Organization for Economic Co-operation and Development (OECD).

Europe↗

Research needs and priorities in health informatics.

A Delphi study was accomplished on the topic "what is needed to implement the information society within healthcare? and which research topics should be given higher priority than other topics to achieve the desired evolution?", involving 29 international experts. The study comprised of four phases, (I) a brainstorming phase based on a open question; (II) an evaluation phase for mutual commenting; (III) a feedback phase allowing corrections/extensions; and (IV) a phase collecting the ratings of individual issues within a questionnaire synthesised from the previous phases. A total of 110 research items and 58 supplementary barriers were raised, divided into 14 topics grouped according to homogeneity. The emphasised research topics are business process re-engineering, the electronic patient record and connected inter-operating systems, (support for) evidence-based medicine and clinical guidelines, and education. Issues inherent to the healthcare domain often are the kernel of the research recommended. Similarly, methods and 'people'-issues are strongly emphasised among the research issues in general and among those for which the experts' joint opinion was rated as statistically significant. In contrast, only a minority of the research issues emphasised was related to technical issues.

Delphi Technique↗

Medical informatics: quo vadis?

In this contribution some comments are given regarding an article of Haux et al., which is published in the same issue. After discussing some general aspects of the paper, the comments focus on patient-centred care and genomics. Trends that are observed today are used to predict the situation with respect of the use of ICT in healthcare in the year 2013. It is postulated that a shared electronic patient record in which both healthcare provider and patient enter and retrieve data will be available. The role of the patient in the management of her disease will be much larger than it is now. The impact of new knowledge coming from the field of genomics will be large. It is not possible to predict the impact on functionality and the use of healthcare information systems in 2013.

Attitude of Health Personnel↗