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PubMed2001

Power to the PDA.

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Computer Communication Networks↗
PubMed2001

The role of clinical informatics in the Agency for Healthcare Research and Quality's efforts to improve patient safety.

In 1998, the Institute of Medicine (IOM) issued a report on medical errors, which estimated that up to 98,000 people die in U.S. hospitals each year from errors. This report raised concerns that medical errors have become a national public health problem that should be addressed in the same manner as other epidemics such as heart disease, diabetes, and obesity. In 2001, the IOM released a follow-up report encompassing a broader range of quality issues. They concluded that the U.S. healthcare system is outmoded and incapable of providing consistent, high-quality care. They outlined a strategy for redesigning U.S. healthcare delivery to achieve safe, dependable, high-quality care, which emphasizes information technology as an integral part of the solution. AHRQ's fiscal year 2001 appropriation included an increase of $50 million dollars for initiatives to reduce medical errors and improve patient safety. AHRQ responded to this mandate by developing a series of research solicitations that form an integrated set of activities to design and test best practices for reducing errors in multiple health care settings. This paper discusses the components of this program and the central role of medical informatics research in the Agency's efforts to improve the safety of medical care in America.

Decision Support Systems, Clinical↗
PubMed2002

Creating knowledge repositories from biomedical reports: the MEDSYNDIKATE text mining system.

MEDSYNDIKATE is a natural language processor for automatically acquiring knowledge from medical finding reports. The content of these documents is transferred to formal representation structures which constitute a corresponding text knowledge base. The system architecture integrates requirements from the analysis of single sentences, as well as those of referentially linked sentences forming cohesive texts. The strong demands MEDSYNDIKATE poses to the availability of expressive knowledge sources are accounted for by two alternative approaches to (semi)automatic ontology engineering. We also present data for the knowledge extraction performance of MEDSYNDIKATE for three major syntactic patterns in medical documents.

Confidence Intervals↗
PubMed2002

Medical informatics: searching for underlying components.

OBJECTIVE: To discuss unifying principles that can provide a theory for the diverse aspects of work in medical informatics. If medical informatics is to have academic credibility, it must articulate a clear theory that is distinct from that of computer science or of other related areas of study. RESULTS: The notions of reusable domain antologies and problem-solving methods provide the foundation for current work on second-generation knowledge-based systems. These abstractions are also attractive for defining the core contributions of basic research in informatics. We can understand many central activities within informatics in terms defining, refining, applying, and evaluating domain ontologies and problem-solving methods. CONCLUSION: Construing work in medical informatics in terms of actions involving ontologies and problem-solving methods may move us closer to a theoretical basis for our field.

Information Science↗
PubMed2002

Medical informatics as a discipline at the beginning of the 21st century.

OBJECTIVES: To analyse the present situation of the discipline medical informatics and to propose actions for change. METHODS: Evaluation of the current situation mainly based on anecdotal evidence. RESULTS: The difference between the scientific and the engineering aspects of medical informatics get blurred. Because of the requirements of European funding medical informatics focuses more on engineering than on science. Too many manuscripts are submitted that describe engineered artefacts without a scientific purpose. Some of the subjects (like security issues) that are studied in medical informatics are not considered important by medical faculties thus impeding support. CONCLUSIONS: The methodological underpinnings of our research should be strengthened, impact studies should be more frequently performed; the quality of results reporting should be increased.

Forecasting↗
PubMed2002

Quality enhancing conceptual tools for medical decision making.

The scientific and the medical communities are among the first asked both to advance highly specialized knowledge and to make it available to a wider community of users, accessing specialized knowledge and searching for single pieces of information for a whole variety of purposes that require diverse information needs and demands. Health advisors may want to update progress in research in a certain field of medicine, to ask experts the right kinds of questions and, even more fundamentally, to be able to describe those health problems they may encounter in their patients' community with words and expressions that can be both understandable and accurate. Researchers, physicians and nurses all face the need to share information that comes out of stabilized, or established, research, meaning research that has been accurately tested as opposed to new and untested assumptions, and to thus establish a common code. A common code may be used by experts in the field to communicate, exchange and compare results and to translate some of the results into common sense-based explanations that can be made widely available. In order to circulate new discoveries and highly specialized knowledge in medicine and to disseminate it to a larger community, accurate planning of consistent metaphors and analogies are of crucial help. Accurate metaphors and analogies come as a result of a skilled art and science; no metaphor or analogy can represent a specific topic within a highly specialized knowledge domain without having first undergone major processes of redefinition. This is precisely what will be explored in this chapter, the added value of both powerful and reliable conceptual tools in the medical field, such as metaphors and analogies, and a commonly shared code to make qualitative reasoning about medical information possible. To improve progress in research and medical care, everyone needs to establish a common language to work with and from. In terms of medical advice documentation, the use of a visual system, CTML, would be instrumental in providing and documenting information. This system can be understood by and thus connect researchers, health care professionals, and patients.

Decision Support Systems, Clinical↗
PubMed2002

Two-phase study to assess the number of cases based on claims databases: characteristics of the validation data set.

OBJECTIVE: In a two-phase study design, the characteristics of an external data set were studied for precision and bias of the number of incident or prevalent cases of a disease obtained from claims databases. METHODS: In the study population (first phase), incident or prevalent cases were counted whereas external data (second phase) provided sensitivity and specificity estimates to count cases in a claims database. Influence of potential differences in sensitivity and specificity between the two phases were evaluated. This was illustrated for 50-90% sensitivity and 99-99.99% specificity ranges. RESULTS AND CONCLUSIONS: The impact of differences in sensitivity and specificity depends on the odds of disease in the study population. We provide advice on the choice of adequate data sets to correct claims database estimates.

Bias↗
PubMed2002

Rapid deployment of an electronic disease surveillance system in the state of Utah for the 2002 Olympic Winter Games.

The key to minimizing the effects of an intentionally caused disease outbreak is early detection of the attack and rapid identification of the affected individuals. The Bush administration's leadership in advocating for biosurveillance systems capable of monitoring for bioterrorism attacks suggests that we should move quickly to establish a nationwide early warning biosurveillance system as a defense against this threat. The spirit of collaboration and unity inspired by the events of 9-11 and the 2002 Olympic Winter Games in Salt Lake City provided the opportunity to demonstrate how a prototypic biosurveillance system could be rapidly deployed. In seven weeks we were able to implement an automated, real-time disease outbreak detection system in the State of Utah and monitored 80,684 acute care visits occurring during a 28-day period spanning the Olympics. No trends of immediate public health concern were identified.

Bioterrorism↗