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PubMed2003

The development of variable MLM editor and TSQL translator based on Arden Syntax in Taiwan.

The Arden Syntax standard has been utilized in the medical informatics community in several countries during the past decade. It is never used in nursing in Taiwan. We try to develop a system that acquire medical expert knowledge in Chinese and translates data and logic slot into TSQL Language. The system implements TSQL translator interpreting database queries referred to in the knowledge modules. The decision-support systems in medicine are data driven system where TSQL triggers as inference engine can be used to facilitate linking to a database.

Artificial Intelligence↗

PubMed2003

Educational programs in US medical schools, 2002-2003.

CONTEXT: To better provide medical students with the knowledge, skills, attitudes, and values they will need as physicians, US medical schools continue to make ongoing changes to their staffing and curricula. OBJECTIVE: To review the status of US medical education in the 2002-2003 academic year, compared with 1997-1998. DATA SOURCES: The Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire, the Association of American Medical Colleges (AAMC) Databook, and the AAMC Data Warehouse: Applicant Matriculant File. Data evaluated included those on medical school faculty, applicants, and students; curriculum hours devoted to new multidisciplinary or nontraditional subject areas (eg, cultural diversity, evidence-based medicine, medical ethics, medical informatics); and methods used to evaluate student learning. DATA SYNTHESIS: The number of full-time faculty members in the 126 LCME-accredited medical schools increased from 96 773 in 1997-1998 to 109 526 in 2002-2003 (+13.2%). The number of applicants entering decreased from 43 016 in 1997-1998 to 33 625 in 2002-2003 (-21.8%). The number of enrollees remained virtually unchanged from 1997-1998 (66 748) to 2002-2003 (66 677). Most medical schools have incorporated new subject areas into their curricula, although time devoted to these areas varies across schools. Schools typically use written examinations (National Board of Medical Examiners subject tests and/or internally prepared examinations) to assess factual knowledge, and observations by faculty members and residents to assess clinical skills. Use of standardized methods (eg, an objective structured clinical examination [OSCE]) to assess clinical skills is variable; 82 schools use a final third- or fourth-year comprehensive OSCE; 53 require a passing OSCE score for graduation. CONCLUSIONS: While the number of applicants to US medical schools has continued to decline, student numbers are constant. The number of full-time faculty members has increased. Schools are incorporating new subject areas into their curricula, and the use of standardized methods of assessing clinical skills, while variable, is generally increasing.

Adult↗

PubMed1995

Testing the knowledge of postgraduate trainees in medicine: a multimedia software package.

1. TASK OF THE PROGRAM. The task of the program is to test the knowledge of applicants at the examination for specialists degrees. The applicants must answer a series of multiple choice test questions, 40% of them are connected to a medical diagnostic image of different modalities e.g., x-ray, 2D gray scale ultrasound, CT, MRI, and endoscopy images. The answer may need simple measurements and finding target areas on the image. The program manages to: test 20 applicants simultaneously in a network, handle a database of questions and images, and document and print out exam results. 2. ORGANIZATIONAL ENVIRONMENT OF THE PROGRAM. The program was developed at the Medical Informatics Department of "Haynal Imre" University of Health Sciences, Budapest (MID-HIETE) according to the needs and intentions of the National Board of Medical Postgraduate Training. The program was sponsored by the OMFB/National Committee of Technical Development, a government agency, and by one of the commercial banks. 3. TECHNICAL ENVIRONMENT OF THE PROGRAM. 4. SCIENTIFIC BASIS. The data bank was developed according to a previous study of medical images in clinical practice. The study describes the information content of different medical images and their role in medical practice. The image data bank originates from the developer's own medical image library and from internationally acknowledged medical textbooks (respecting copyright issues). Knowledge base of questions was drawn from basic international textbooks. 5. SUMMARY. Within a period of two years, the MID-HIETE staff succeeded in developing a modular multimedia software package that tests and screens the knowledge of postgraduate trainees. This screening method is offered as an entrance exam for the specialist degree. Currently, this exam is administered as an oral test; the knowledge of the applicants may therefore not be tested thoroughly.

Education, Medical↗

PubMed1995

Naming notes: transitions from free text to structured entry.

To practice medicine in the near future, health care providers in the USA need an information infrastructure they do not yet have. We offer a contribution from social science research to discussions of current medical records practices and how health care activity systems may be transformed by the advent of electronic health records. The goal of the paper is to set forth a framework that connects over-arching questions concerning medical informatics systems development with the practical, cultural and conceptual issues involved in transitions from handwritten and other free text documentation to structured entry of medical records to build patient profiles. The research is broadly framed by an interest in how reciprocal modifications of the design and use of an electronic health record are negotiated in an iterative prototyping project. It is conducted as part of a complex multi-disciplinary research and development effort to create an electronic health record prototype for use in the integrated health care delivery environment of the Southern California Kaiser Permanente Medical Care Program.

Ambulatory Care↗

PubMed2004

Evidence-based medicine, medical decision analysis, and pathology.

Recent advances in molecular pathology and other technologies such as proteomics present pathologists with the challenge of integrating the new information generated with high-throughput methods with current diagnostic models based mostly on histopathology and clinicopathologic correlations. Parallel developments in the field of medical informatics and bioinformatics provide the technical and mathematical methods to approach these problems in a rational manner. However, it remains unclear whether pathologists or other medical specialists will become primarily responsible for the development and maintenance of these multivariate and multidisciplinary diagnostic and prognostic models that are hoped to provide more accurate, individualized patient-based information. Evidence-based medicine (EBM) and medical decision analysis (MDA) are relatively new disciplines that use quantitative methods to assess the value of information, differentiate fact from myth, and integrate so-called best evidence into multivariate models for the assessment of prognosis, response to therapy, selection of laboratory tests, and other complex problems that influence individual patient care. We review from an epistemological viewpoint the current approach to information in pathology and describe some of the concepts developed by the practitioners of EBM and MDA.

Computational Biology↗

PubMed1994

Physicians in health care management: 6. Physician bytes computer.

Revolutionary advancements in information technology are improving access to medical information, operational efficiency and clinical effectiveness. Health care facilities and agencies are planning to acquire information systems that will affect clinical and administrative functions. Federal and provincial agencies are beginning to define and collect diverse health care data and integrate them in a national database. As the demand for and access to information grows physicians will be key providers and users. They will have increasing access to critical patient data through clinical information systems; however, their practice patterns, clinical outcomes and resource utilization will also be subject to increasing scrutiny. To ensure appropriate use of technology and information systems, careful planning, selection, implementation and management will be needed. Physicians will require training to use the information and systems effectively. They must also recognize the increasing importance of such systems in delivering and managing health care; they must play a pivotal role in resolving management, information and systems issues and in promoting sound information and management strategies; and they must encourage research and education in medical informatics.

Attitude to Computers↗

PubMed1996

Pseudonyms for cancer registries.

In order to conform to the rigid German legislation on data privacy and security we developed a new concept of data flow and data storage for population-based cancer registries. A special trusted office generates a pseudonym for each case by a cryptographic procedure. This office also handles the notification of cases and communicates with the reporting physicians. It passes pseudonymous records to the registration office for permanent storage. The registration office links the records according to the pseudonyms. Starting from a requirements analysis we show how to construct the pseudonyms; we then show that they meet the requirements. We discuss how the pseudonyms have to be protected by cryptographic and organizational means. A pilot study showed that the proposed procedure gives acceptable synonym and homonym error rates. The methods described are not restricted to cancer registration and may serve as a model for comparable applications in medical informatics.

Anonyms and Pseudonyms↗

PubMed2006

Developing a medical image content repository for e-learning.

The integration of medical informatics and e-learning systems could provide many advanced applications including training, knowledge management, telemedicine, etc. Currently, both the domains of e-learning and medical image have sophisticated specifications and standards. It is a great challenge to bring about integration. In this paper, we describe the development of a Web interface for searching and viewing medical images that are stored in standard medical image servers. With the creation of a Web solution, we have reduced the overheads of integration. We have packaged Digital Imaging and Communications in Medicine (DICOM) network services as a component that can be used via a Web server. The Web server constitutes a content repository for searching, editing, and storing Web-based medical image content. This is a simple method by which the use of Picture Archiving and Communication System (PACS) can be extended. We show that the content repository can easily interact and integrate with a learning system. With the integration, the user can easily generate and assign medical image content for e-learning. A Web solution might be the simplest way for system integration. The demonstration in this paper should be useful as a method of expanding the usage of medical information. The construction of a Web-based repository and integrated with a learning system may be also applicable to other domains.

Computer Security↗

PubMed2003

Challenges to physicians' use of a wireless alert pager.

Pagers, personal data assistants (PDAs) and other devices that have wireless connectivity are becoming a popular method for delivering patient related information to medical decision makers. Although medical informatics research has emphasized the design, and implementation of pagers as event notification mechanisms, researchers have not paid as much attention to how this technology impacts medical work. We present a case study of physicians in a Surgical Intensive Care Unit (SICU) using wireless alert pagers. The pagers provide a variety of alphanumeric clinical alert messages and are widely used by SICU physicians. However, the use of the pagers has created unanticipated challenges to the physicians' traditional work practices. These challenges include: (1) flattening of hierarchical workflows, (2) coping with information overload and missing context, and (3) lack of feedback. These challenges are tied to both the specific technical design of the system and the traditional structure of medical work.

Attitude of Health Personnel↗

PubMedDate not supplied

Electronic health record meets digital library: a new environment for achieving an old goal.

Linking the electronic health record to the digital library is a Web-era reformulation of the long-standing informatics goal of seamless integration of automated clinical data and relevant knowledge-based information to support informed decisions. The spread of the Internet, the development of the World Wide Web, and converging format standards for electronic health data and digital publications make effective linking increasingly feasible. Some existing systems link electronic health data and knowledge-based information in limited settings or limited ways. Yet many challenging informatics research problems remain to be solved before flexible and seamless linking becomes a reality and before systems become capable of delivering the specific piece of information needed at the time and place a decision must be made. Connecting the electronic health record to the digital library also requires positive resolution of important policy issues, including health data privacy, government encouragement of high-speed communications, electronic intellectual property rights, and standards for health data and for digital libraries. Both the research problems and the policy issues should be important priorities for the field of medical informatics.

Internet↗

PubMed2006

Cutaneous manifestations of Hodgkin's disease.

BACKGROUND: Cutaneous manifestations associated with Hodgkin's Disease (HD) have not been well described. Most existing studies of the cutaneous manifestations of HD are individual case reports or literature reviews. The goal of this study was to define the spectrum of cutaneous manifestations of HD, as observed by the consulting dermatologist at a cancer center. METHODS: The tumor registry database maintained by the Department of Medical Informatics and the M.D. Anderson Visits database over a 5-year period was searched to identify patients with a diagnosis of HD and an appointment with Dermatology. The medical records were reviewed to determine frequency and presentation of cutaneous findings in HD. RESULTS: The search identified a total of 1049 registered patients with HD, of which 88 were seen at the Dermatology Clinic. Of these 88 patients evaluated by dermatology, 47 patients had either paraneoplastic cutaneous manifestations associated with HD (n = 45) or cutaneous HD (n = 3). The most common paraneoplastic skin manifestations were eczema (n = 18) and pruritus (n = 17), mycosis fungoides (n = 11), and erythema nodosum (n = 3). Mycosis fungoides, observed in 1% of the patients with HD at MDACC, was more than 290 times more common in patients with HD than in the general population. CONCLUSION: Although pruritus is the most commonly recognized presenting symptom of Hodgkin's lymphoma, new onset of eczema should also be considered as a possible warning sign deserving further investigation. Patients with adult-onset pruritus or eczema should be evaluated for possible HD with full lymph-node exam, CBC with differential, and chest X-ray. Erythema nodosum and mycosis fungoides should also be considered as cutaneous manifestations of HD.

Adolescent↗

PubMedDate not supplied

Informed decision making: the new paradigm.

Health care cannot survive in its present form. It is becoming unaffordable for a large share of the country's population. Its quality and effectiveness inexplicably vary between communities and across time. With all these problems, the process of health care can be understood. All that are needed are good, basic data; its access, management, and analysis; and then presentation of facts and observations. Together, these functions describe the translation of data into information--the field of medical informatics. Information about such management concerns as clinical efficiency (which largely is related to appropriateness and cost-effectiveness) and about the realities of day-to-day medical practice can be used to improve the value of health care. Informed decision making is based solely on confidence that, given the right information and understanding, we can all make the right decisions. The right decisions mean better patient acceptance and satisfaction, a sense of value enhancement by payers, and support of the Hippocratic tradition.

Decision Making, Organizational↗

PubMed1999

Medical libraries, bioinformatics, and networked information: a coming convergence?

Libraries will be changed by technological and social developments that are fueled by information technology, bioinformatics, and networked information. Libraries in highly focused settings such as the health sciences are at a pivotal point in their development as the synthesis of historically diverse and independent information sources transforms health care institutions. Boundaries are breaking down between published literature and research data, between research databases and clinical patient data, and between consumer health information and professional literature. This paper focuses on the dynamics that are occurring with networked information sources and the roles that libraries will need to play in the world of medical informatics in the early twenty-first century.

Databases, Factual↗

PubMed1998

Proposal of a new Internet standard for DICOM: DICOM-QR URL.

This paper proposes a new Internet standard that is combination of two standards in different domain, Internet and medical informatics. The both standards are described briefly in this paper. We describe how to combine them into a Internet standard. With a new standard, there are several advantages for medical information systems. The standard should be established by the following way of the Internet standards.

Internet↗

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↗

PubMed2000

Return on investment (ROI) analysis in the face of uncertainty

Calculation of return on investment should be as easy as knowing the cost and the benefit and doing the math. Unfortunately in medical informatics rarely do we know the benefit with absolute certainty. Often the benefit is a combination of "fuzzy" ill defined concepts. In order to support the ROI analysis for medical information systems we developed a probabilistic time varying model that allows each of the fuzzy concepts of savings to be expressed as a likelihood distribution rather than a fixed value. The model and an interactive simulator were created using the graphical programming language G (National Instruments, Dallas,TX). This tools allows rapid prototyping and drag and drop ease of customizing the model to the particular clinical setting. The resulting ROI is expressed in terms of likelihoods, potential risk and confidence intervals providing a unique view of the financial analysis not typically available. In this paper an example is illustrated for perioperative information systems.

Journal Article↗

PubMed2006

[Extensive educational program for high performance medical technologists].

The education system for medical technologists has recently been revolutionized, their educational periods vary from 2 to 9 years, and some already have doctoral degrees. In such a new situation, our faculty thinks that the most important point for new medical technologists is the ability to have a broad view of the clinical fields, especially the view of patients. Special training in bed-side education and a stint in several divisions, such as the surgical operation room, rehabilitation. radiological examination room, pharmacy, central storage room of medical records, and medical informatics, and so on, of the hospital is a powerful tool to obtain a broad view of the various clinical fields and can be essential for developing high performance medical technologists. As nine years have passed since starting this education, we evaluated this practice through systematic personal communication. As a result, it was found to be extremely effective for many reasons such as having a continuous image of the patient when they examine the blood sample in the hospital laboratory, showing advanced laboratory performance, and having no mental barrier to visiting the wards and so on. The abilities of our alumni are praised highly by many large scale hospitals around the country and 50% of them are working in the clinical laboratory division of these hospitals. About 40% are working in the division of research and development in various companies. We express sincere thanks to the director and all cooperative individuals for this course in the Osaka University Hospital.

Curriculum↗

PubMed1994

A Tcl/Tk based graphical interface to medical and administrative information.

FELIX is an front-end application processor, with an open systems back-end, that provides a uniform and intuitive interface to clinical and administrative information. It consists of an information browser, three clinical applications, and three management applications. FELIX was developed in a community hospital environment, but has conceptual and technical roots in medical informatics and the Internet.

Computer Graphics↗