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PubMed1999

An architecture for bridging between research and practical use in health informatics.

Health informatics is a true interdisciplinary research discipline combining computer engineering, health science and fields dealing with organisation and communication issues. Much of the research published within the area has a common goal: to develop optimal information systems for better access to relevant data, information, and knowledge in the health care sector. As a respond to existing discontinuity between research and practical use, we present an architecture for an interdisciplinary virtual organisation promoting synergy across health informatics environments including research, industry, clinical, and educational settings. A set of key lessons learned from a practical implementation of the architecture are reported.

Computer Communication Networks↗
PubMed1999

Hospital information systems: chances and obstacles on the way to integration.

Today, most large hospital information systems (HIS) comprise many heterogeneous application systems, loosely coupled via interfaces. Integration could offer many advantages, like the support of interdepartmental workflows or a consistent patient record. This cannot be achieved, however, by simply interfacing originally unrelated component systems. In this paper, we present relevant concepts of integration, the autonomy/consistency tradeoff, and technical alternatives in some detail. Based on our recent experiences in analyzing an existing HIS and selecting adequate vendors for the needs of our 1250-bed hospital, we then discuss strategies and tradeoffs on the way to a HIS that utilizes state-of-the-art technology to fill the users' needs.

Hospital Information Systems↗
PubMed2000

Implementing an ICU-CIS integrated to a HIS in Latin America.

The hospital has been the main target for Medical Informatics since the beginning of its development. Ancillary and clinical systems entered into the scene first when the financial issues were covered. From those kind of applications the Intensive Care Unit (ICU) represents perhaps the most important challenge to achieve where there is a representative subset of the organization with most variables under control to show the performance of the institution. At the ICU, information technology defines many of the tasks which are performed and enable the professionals to process and interpret the great quantities of data that is generated about the patients and the system in which they receive their treatment and quality assurance (QA) is now almost completely dependent upon information technology in pretty much facets of medical care. In this paper, a clinical information system developed for the ICU is presented where the use of validated severity illness scoring systems and standardized definitions for events and outcomes the care delivered can be analysed comparing clinical outcomes and resource utilization. Cost containment can be also applied and observations simultaneously with quality improvement standards can be undergone. Clinical research regarding medical and nursing practice is also very helpful.

Hospital Information Systems↗
PubMed1992

Fulfilling the promise: implementing IAIMS at Georgetown University.

Predictions are that the integration of multiple information systems of a medical center will change the way doctors work and practice medicine in the future. Several major steps must be taken by an institution to make this a reality. The IAIMS program sponsored by the NLM is designed to achieve integration of resources in the medical center environment. The purpose of the IAIMS project at Georgetown is to develop a medical decision support system by bringing together multiple sources of information that reside on disparate computers and different database systems. This immense and complex task is described in this paper from an organizational, academic and technical perspective. Georgetown is developing a Biotechnology and Biomedical Knowledge Network which includes several informational and clinical databases, a variety of scholar workstations, instruction on use of computers, a campus-wide network with local area network nodes and a modular approach to systems integration. The IAIMS project is spearheaded by the medical library which has enabled a broad body of medical center users to benefit directly from new, dynamic services.

Academic Medical Centers↗
PubMed1993

Integrating Hospital Information Systems. The challenges and advantages of (re-)starting now.

With the new technologies available today, more complex and useful Hospital Information Systems (HIS) can be designed and implemented. These new technologies have allowed that information from different sources and nature such as documents, images and signals be integrated within a single environment. Open standards, reliable networks, powerful hardware and software and lower prices are among the issues that make all this possible. One of the main issues is what to do with old systems that do not adhere to this new HIS concept. At the Heart Institute (InCor), a decision was made towards starting developing a new system called I3S. This paper gives a brief description of that system.

Brazil↗
PubMed1996

Providing location-independent access to patient clinical narratives using Web browsers and a tiered server approach.

Health care today depends upon timely access to patient medical data and the latest medical knowledge. As we make the transition from a hospital-based organization to an integrated health care delivery system, patient care information must move throughout the organization quickly and efficiently over increasing distances. The emergence of widely-dispersed referral networks demands novel solutions to the problems of delivering patient care information to providers. We have developed a mechanism to provide location-independent access to clinical narrative reports using a multi-tiered server model and World Wide Web technologies for delivery. To successfully deploy such a system to sites separated by large distances, it is important to reduce complexity at the client site. Using a "thin client", such as a web browser, in our design facilitates deployment and support while reducing cost per user. This architecture allows the application to be updated without modification to the end-user software and eases maintenance over long distances.

Computer Communication Networks↗
PubMed1999

The Brigham integrated computing system (BICS): advanced clinical systems in an academic hospital environment.

The Brigham integrated computing system (BICS) provides nearly all clinical, administrative, and financial computing services to Brigham and Women's Hospital, an academic tertiary-care hospital in Boston. The BICS clinical information system includes a very wide range of data and applications, including results review, longitudinal medical records, provider order entry, critical pathway management, operating-room dynamic scheduling, critical-event detection and altering, dynamic coverage lists, automated inpatient summaries, and an online reference library. BICS design emphasizes direct physician interaction and extensive clinical decision support. Impact studies have demonstrated significant value of the system in preventing adverse events and in saving costs, particularly for medications.

Computer Security↗
PubMed1999

Translating national childhood immunization guidelines to a computer-based reminder recall system within an immunization registry.

To translate national childhood immunization guidelines to a computer-based reminder recall system, hierarchical system architecture design and combined approach of tabular and procedural knowledge representation are taken. Nested branches with hierarchical combinations of single antecedent variables are used to avoid logical incompleteness, redundancy and inconsistency. Mapping to the local electronic medical vocabulary is implemented to facilitate the integration with the local information system architecture. 26 second-level modules with 195 original branches and 121 final branches after pruning are encoded. 99.67% of the reminders are confirmed to be correct by SQL query.

Child↗
PubMed1994

Workstations as enabling technologies for the computer-based patient record (CPR): point of care approaches across the patient care continuum-nursing's perspective.

Patient care delivery has undergone major changes that significantly impact the definition of functional requirements for the professional workstation. To become an enabler for the computer-based patient record (CPR), the workstation must be used in the hospital, home and community environments, managing information for at least the length of treatment everywhere and every time it is needed by clinicians. The CPR is a vision, a strategy that may encompass many application systems, infrastructures, technologies and tools to support care delivery. Workstations are a fundamental tool for clinicians; appropriate devices must be adapted for the environment where care is being delivered.

Computer Communication Networks↗
PubMed1994

From HIS to IAIMS: expanding the scope of information processing applications in a German university hospital.

Since the mid eighties the department of medical informatics at the University Hospital of Giessen (Germany) has been engaged in the development of a comprehensive hospital information system. The installation of a campus wide network has set the basis to provide not only clinical patient-oriented information, but also general information resources for research, medical education and administrative purposes, thus creating an environment which in the U.S. became known as an integrated academic information management system (IAIMS). The underlying concept of the whole approach is to provide one-stop information shopping capabilities at the clinicians and administrators desktop in order to meet the increasing information needs of health professionals with the emerging reality of the potential benefits of computer and communication technologies. This paper describes the various steps performed to realize this concept at Giessen University Hospital and the evaluation results derived from analysis of the acceptance of these new technologies among our hospital staff.

Computer Systems↗
PubMed1994

Towards a meta-syntax for medical edi.

Assessment of the current medical edi (electronic data interchange) environment shows that 'old' syntaxes are used to specify interchange formats of messages containing highly complex information of a quickly evolving nature. After translation of message requirements towards message interchange format specifications in accordance with underlying syntax rules, system developers use modern technologies to implement the sending and receiving of edi message instances towards the distorted view imposed by these message interchange formats. The coexistence of several syntaxes and the urgent need for more standardised message types, require a new type of techniques and tools. The new mechanism should support a non-distorted message type development and provide the framework for data-driven conversion of message instances, from one interchange format to another.

Artificial Intelligence↗
PubMed1994

Automated metrics for user interface design and evaluation.

Automated metrics will allow user interfaces to be partially evaluated early in the development process. They allow potential problems to be identified and corrected prior to user testing, saving both time and money. As a result, improved interfaces can be developed without additional costs. Both task-independent and task-sensitive automated metrics appear promising. Task-independent metrics should prove most useful for predicting user preferences and somewhat useful for predicting user performance. Task-sensitive metrics should prove useful for predicting both user preferences and performance. Several metrics are introduced and research directions are discussed.

Computer Systems↗
PubMed1994

HERMES: a health care workstation integration architecture.

An architecture is described that facilitates integration of existing databases and applications without modifying them. By means of this architecture, data from different sources dispersed in a network can be combined and directly used in existing applications or applications that have been developed specially for integration. This feature of combining data from different sources into one workstation is viewed as the enabling technology on which computer-based patient records can be built. The abstraction of computer-, network- and application-specific details is completely dealt with by the integration architecture. This integration architecture has been developed with extendibility and flexibility in mind, and allows for a growth-path towards application of the open system paradigm in medicine.

Computer Communication Networks↗
PubMed1998

A new twist in US health care data standards development: adoption of electronic health care transactions standards for administrative simplification.

To reduce the costs of common administrative transactions, health plans, payers and providers encouraged the US Congress to legislate administrative simplification of specific electronic health data transactions. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 created incentives for a public-private partnership to develop and implement standards for the uniformity of health care data used in electronic administrative health transactions and standards for the privacy and security of individually identifiable health information. The standards' requirements of HIPAA and how they have been met by the US government hold promise for accelerating the uniform adoption of standards developed by accredited standards developing organizations. The transactions designated by Congress, the process of choosing the standards in the Department of Health and Human Services, the principles that guided these choices, and the actual choices, are presented here. A successful partnership for administrative health data standards can pave the way for success in clinical health data standards and their application in computer-based patient record systems.

Computer Security↗
PubMed1999

AIDMAN--advanced informatics distributed medical access network.

We describe AIDMAN, a pilot project in which health clinics in remote areas of Greece are connected with mainland hospitals, to provide routine clinical service for both chronic health care and accident and emergency. Clinical practice is supported through the use of the Virtual Consultation Workstation that is being developed and evaluated specifically for the project and which is based on readily available commercial products and international standards. The communication infrastructure remains a major obstacle to any telemedicine project, and for this reason, satellite communication is used in the AIDMAN project to overcome the current lack of digital links and bandwidth. The proposed system will provide real time video, high definition image, shared applications and data over a link running at 128 kbps. In this paper we discuss the design of the AIDMAN system, the Virtual Consultation Workstation and the communication channel.

Computer Communication Networks↗
PubMed1993

NetMenu: experience in the implementation of an institutional menu of information sources.

NetMenu is a program, developed at Yale, which enables straightforward access to online information systems. NetMenu has been deployed in several diverse settings within our medical center. In the hospital, NetMenu is functioning as a front-end for our clinical workstation providing access to the hospital information system, the clinical laboratory computer, a drug database and several bibliographic databases. The medical libraries are utilizing NetMenu for both medical education workstations and for scholarly information workstations. This paper describes our initial experience in the implementation, support, and maintenance of NetMenu as an institutional menu of information sources.

Academic Medical Centers↗
PubMed1994

A software engineering approach for medical workstations development.

Multimedia medical workstations represent the natural tool for accessing the hospital information system environment. They are complex medical systems that have to gather, in a single framework, a large collection of components dealing with multimedia medical objects. To remain current with both medical practice and with advances in the computer science field, they have to allow the iterative addition of new functions to the set of existing ones. In this paper, after a survey of commonly required medical workstation functional components, we shall try to discuss how a software engineering approach can streamline the development of a medical workstation. Different software engineering tools needed to build the functional components of a workstation are described. Their integration in a single dedicated environment is considered through four perspectives: data, presentation, communication and control. Benefits and limitations of an object-oriented approach are discussed.

Computer Communication Networks↗