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PubMed2001

Intranet meets hospital information systems: the solution to the integration problem?

Based on the results of an extensive market analysis and technology assessment, this paper summarizes the state of the art in web technology and compares it with the needs of integration in hospital information systems. Web technology and intranet have evolved to a core technology for distributed computing and distributed information systems. The advantage of platform independent distribution of information has led to euphoric visions of future integrated systems. However, true integration takes more than transparent access to heterogeneous information sources. To overcome the essential problems related to integration of autonomous systems it is important to find a common ontological basis for future component based systems.

Computer Communication Networks↗
PubMed2001

Validation of an instrument to measure dental students' use of, knowledge about, and attitudes towards computers.

Currently, no validated survey instrument exists to measure dental students' use of, knowledge about, and attitudes towards computers. Several studies have surveyed students about their knowledge and opinions regarding computers, but none of them has established the reliability and validity of the instrument(s) used. A measurement study to validate a preliminary survey for dental students was conducted. The preliminary instrument contained five scales: computer use, information resource use, computer knowledge, capabilities of computer systems, and effects of computers on dental practice. Selected variables were summarized descriptively, and a factor analysis for each scale was performed. In addition, construct validity was assessed through correlational analyses among several variables. Three hundred seventy surveys distributed to students at nine dental schools generated 156 responses (42 percent response rate). Sixty-four percent of respondents were male, 36 percent female. Respondents used computers an average approximately four hours per week, and most had begun using computers in 1991. All survey scales except computer use were unidimensional. Computer use required a two-factor solution that distinguished between clinical and nonclinical uses of computers. The instrument can be used for a demonstration study, but should be continuously refined and validated.

Analysis of Variance↗
PubMed2001

Information and communication technologies and health in low income countries: the potential and the constraints.

This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential. The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services. These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced. Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people. However, the basic difficulties encountered in using ICTs for such purposes are: an inadequate physical infrastructure; insufficient access by the majority of the population to the hardware; and a lack of the requisite skills for using them. We highlight the substantial cost involved in providing wider access, and the problem of resource allocation in poor countries where basic infrastructure for health and education is still lacking. Educating health professionals in the possible uses of ICTs, and providing them with access and "connectivity", would in turn spread the benefits to a much wider set of final beneficiaries and might help reduce the digital divide.

Delivery of Health Care↗
PubMed2001

Using cognitive work analysis to design clinical displays.

In today's ICUs clinicians routinely integrate huge numbers of discrete data points to arrive at a coherent picture of their patients' status. Often the clinician must obtain those data elements from many devices, which makes the problem more difficult. Because presenting data visually amplifies cognition by capitalizing on well-known human perceptual capabilities, it is not surprising that a growing body of research is directed at the effective presentation of visual information in clinical displays. However, developing clinical displays that effectively support clinicians' integration and understanding of many discrete data elements in complex, high technology work domains such as ICUs remains elusive. It may be that traditional analysis and design methods simply are inadequate for this kind of complex environment. Vicente has described a new methodology, called "cognitive work analysis" (CWA), which is targeted at the analysis of complex work domains. The analysis differs from traditional analytic methods in significant ways, particularly in its primary focus on analysis of the work domain, but also in its prescription for explicitly collecting information at five levels (the work domain, diagnostic and treatment tasks, diagnostic strategies, socio-organizational, and clinician skills) that place constraints on the ultimate display design. In this model, the order of data collection is also crucial. Because the work domain constraints tend to be the most permanent, they are likely to have the most impact on design, and so analysis starts there. As the analysis proceeds through the subsequent levels, additional design constraints are identified. We recently used CWA to analyze the information needs for interactive graphical displays that will integrate and represent data in structures that help clinicians visualize a patient's physiological status. We found that the analysis was an effective way to identify information needs at multiple levels. Based on our experience, CWA is a generic methodology that is highly applicable to medical informatics.

Algorithms↗
PubMed2001

An informatics system to support knowledge management in the health sector--the South African National Health Knowledge Network.

This paper discusses the planning and development of a South African national health knowledge network. The methodology is in essence based on the principles of knowledge management and the drivers of a system of innovation. The knowledge network, SA HealthInfo, aims to provide a one-stop interactive forum/resource, for quality-controlled and evidence-based health research information, to a wide spectrum of users, at various levels of aggregation, with the necessary security arrangements and facilities for interaction among users to promote explicit (codified) and tacit knowledge flow. It will therefore stimulate the process of innovation within the South African health system.

Computer Security↗
PubMed2001

Improving dialysis services through information technology: from telemedicine to data mining.

This paper discusses the issues related to use of Information Technology (IT) solutions in dialysis, and describes the implementation of some of them in a medium size dialysis center. First, starting from the analysis of the organization of public-health nephrology services, the potential role of IT is highlighted. Second, the main directions for IT exploitation in dialysis, namely telemedicine and automated monitoring of dialysis sessions are discussed. Third, the on-field implementation of these services is described, together with some preliminary results. The work here presented shows how IT may improve dialysis services by ameliorating quality and reducing costs.

Ambulatory Care Facilities↗
PubMed2001

Anamnesis via the internet--prospects and pilot results.

A comprehensive computerized questionnaire was developed to obtain the anamnesis of patients seeking contact with a physician for any type of new problem. The purpose of this pilot study was to investigate if a structured questionnaire filled out by the patient and complementing an interview at the physician's office would contribute to a better quality of the total anamnesis and/or lead to savings in time at the visit. The results encourage further developments in this direction. The potential uses proposed are, in addition to being used to improve a visit, the correct assessment of the history for prioritization and scheduling of visits and in some situations, the anamnesis obtained over the net may be the basis for medical advice without a visit. This study emphasizes the great improvement of information captured by this type of questionnaire based on medical knowledge about associated symptoms and relevant questions depending on the problem presented compared to the results obtained by a simple open question used in many e-health services today.

Female↗
PubMed2001

A framework for improving the quality of health information on the world-wide-web and bettering public (e-)health: the MedCERTAIN approach.

There has been considerable debate about the variable quality of health information on the world-wide-web and its impact on public health. While central authorities to regulate, control, censor, or centrally approve information, in-formation providers or websites are neither realistic nor desirable, public health professionals are interested in making systems available that direct patient streams to the best available information sources. National governments and medical societies have also recognized their responsibility to help users to identify "good quality" information sources. But what constitutes good quality, and how can such a system be implemented in a decentralized and democratic manner? This paper presents a model which combines aspects of consumer education, encouragement of best practices among information providers, self-labeling and external evaluations. The model is currently being implemented and evaluated in the MedCERTAIN project, funded by the European Union under the Action Plan for Safer Use of the Internet. The aim is to develop a technical and organisational infrastructure for a pilot system that allows consumers to access metainformation about web-sites and health information providers, including disclosure information from health providers and opinions of external evaluators. The paper explains the general conceptual framework of the model and presents preliminary experiences including results from an expert consensus meeting, where the framework was discussed.

Databases as Topic↗