Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Medical Informatics”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,081 records · Page 60Linked to original sources
PubMed1995

Network-based informatics support of research collaborations in the Human Genome Project and the Human Brain Project.

Sophisticated network-based informatics support will increasingly be required for collaborating biomedical laboratories located in different geographic locations, both to accommodate the massive amount of data being generated in certain fields, and to allow different types of data produced at different laboratories to be analyzed in an integrated fashion. The paper describes the experience of the Yale Center for Medical Informatics in providing informatics support for collaborative projects in gene mapping (as part of the national Human Genome Project) and neuroscience (as part of the national Human Brain Project). The paper describes the informatics needs of the two projects and the solutions being developed, describes certain lessons learned, and discusses certain broader issues that arise.

Brain Mapping↗
PubMed1998

Design and development of a multimedia database for emergency telemedicine.

Recent studies conclude that early and specialised pre-hospital patient management contributes to emergency cases survival. Recent developments in telecommunication and medical informatics by means of telemedicine can be extremely useful to accomplish such tasks in a cost-effective manner. Along that direction, we have designed a portable device for emergency telemedicine. This device is able to telematically "bring" the expert doctor at the emergency site, have him perform an accurate diagnosis, and subsequently direct the Emergency Medical Technicians on how to treat the patient until he arrives to the hospital. The need for storing and archiving all data being interchanged during the telemedicine sessions is very crucial for clinical, legal and administrative purposes. For this, we have developed a multimedia database able to store and manage the data collected by the AMBULANCE system. The database was equipped with a user-friendly graphical interface to enable use from computer naive users. Furthermore, the database has the possibility to display, in an standard way, ECG's, X-ray, CT and MRI images. The application is password protected with a three-level hierarchy access for users with different privileges. The scope of this application is to enhance the capabilities of the doctor on duty for a more precise and prompt diagnosis. The application has the ability to store audio files related to each emergency case and still images of the scene. Finally, this database can become a useful multimedia tool which will work together with the AMBULANCE portable device, the HIS and the PACS of the hospital. The system has been validated in selected non-critical cases and proved to be functional and successful in enhancing the ability of the doctor's on duty for prompt and accurate diagnosis and specialised pre-hospital treatment.

Ambulances↗
PubMed2004

Visions and strategies to improve evaluation of health information systems. Reflections and lessons based on the HIS-EVAL workshop in Innsbruck.

BACKGROUND: Health care is entering the Information Society. It is evident that the use of modern information and communication technology offers tremendous opportunities to improve health care. However, there are also hazards associated with information technology in health care. Evaluation is a means to assess the quality, value, effects and impacts of information technology and applications in the health care environment, to improve health information applications and to enable the emergence of an evidence-based health informatics profession and practice. OBJECTIVE: In order to identify and address the frequent problems of getting evaluation understood and recognised, to promote transdisciplinary exchange within evaluation research, and to promote European cooperation, the Exploratory Workshop on "New Approaches to the Systematic Evaluation of Health Information Systems" (HIS-EVAL) was organized by the University for Health Sciences, Medical Informatics and Technology (UMIT), Innsbruck, Austria, in April 2003 with sponsorship from the European Science Foundation (ESF). METHODS: The overall program was structured in three main parts: (a). discussion of problems and barriers to evaluation; (b). defining our visions and strategies with regard to evaluation of health information systems; and (c). organizing short-term and long-term activities to reach those visions and strategies. RESULTS: The workshop participants agreed on the Declaration of Innsbruck (see ), comprising four observations and 12 recommendations with regard to evaluation of health information systems. Future activities comprise European networking as well as the development of guidelines and standards for evaluation studies. CONCLUSION: The HIS-EVAL workshop was intended to be the starting point for setting up a network of European scientists working on evaluation of health information systems, to obtain synergy effects by combining the research traditions from different evaluation fields, leading to a new dimension and collaboration on further research on information systems' evaluation.

Education↗
PubMed2001

Learning to consult with computers.

OBJECTIVE: To develop and evaluate a strategy to teach skills and issues associated with computers in the consultation. INTERVENTION: An overview lecture plus a workshop before and a workshop after practice placements, during the 10-week general practice (GP) term in the 5th year of the University of Melbourne medical course. DESIGN: Pre- and post-intervention study using a mix of qualitative and quantitative methods within a strategic evaluation framework. OUTCOME MEASURES: Self-reported attitudes and skills with clinical applications before, during and after the intervention. RESULTS: Most students had significant general computer experience but little in the medical area. They found the workshops relevant, interesting and easy to follow. The role-play approach facilitated students' learning of relevant communication and consulting skills and an appreciation of issues associated with using the information technology tools in simulated clinical situations to augment and complement their consulting skills. The workshops and exposure to GP systems were associated with an increase in the use of clinical software, more realistic expectations of existing clinical and medical record software and an understanding of the barriers to the use of computers in the consultation. CONCLUSIONS: The educational intervention assisted students to develop and express an understanding of the importance of consulting and communication skills in teaching and learning about medical informatics tools, hardware and software design, workplace issues and the impact of clinical computer systems on the consultation and patient care.

Attitude to Computers↗
PubMed2000

Telemedicine at the top of the world: the 1998 and 1999 Everest extreme expeditions.

The National Aeronautics and Space Administration (NASA) initially established a Commercial Space Center (CSC) in the Department of Surgery at Yale University School of Medicine to further develop and evaluate technologies in information systems, telecommunications applied to medicine, and physiologic sensors. The CSC is known as the Medical Informatics and Technology Applications Consortium (MITAC). The overall purpose for this NASA program is to leverage technology, innovation, and resources from industry and academia through collaborative partnerships. The Yale-NASA CSC/MITAC organized the Everest Extreme Expeditions (E3) for the spring Himalayan climbing seasons in the years 1998 and 1999. The primary mission was to deliver advanced medical support with global telemedicine capabilities to one of the world's most remote and hostile settings--Mount Everest. The purpose was both humanitarian (providing medical support) and scientific (conducting medical and technology research). The Yale team provided medical care for the Everest Base Camp community; conducted validation experiments for several types of advanced medical technologies in this remote, hostile environment; and performed real-time monitoring of selected climbers, while also assessing the basic science of altitude physiology. Additionally, the teams conducted outreach medical care to the citizens of Nepal and provided several educational forums for a variety of medical and nonmedical personnel--including school-age children. As part of the project's mission, the E3 medical teams at both Nepal and New Haven were on a 24-hour emergency call system to deliver medical care in the event of a crisis. Unlike most of the teams at Everest, the mission of E3 was not to climb the 29,028-foot mountain the Nepalese call Sagarmatha ("Sky Head"). The mountain served as an extreme testing ground for telemedicine. The lessons learned from this testbed are reviewed here and further clarify the abilities to provide better health care in remote and extreme environments--which for some may even be their home environment during/after a medical illness.

Altitude Sickness↗
PubMed2001

A methodology for web-enabling a computer-based patient record with contributions from cognitive science.

Cognitive science is a rich source of insight for creative use of new Web technologies by medical informatics workers. I outline a project to Web-enable an existing computer-based patient record (CPR) in the context of ideas from philosophy, linguistics, artificial intelligence, and cognitive psychology. Web prototypes play an important role (a) because Web technology lends itself to rapid prototype development, and (b) because prototypes help team members bridge among disparate medical, computing, and business ontologies. Six Web-enabled CPR prototypes were created and ranked. User scenarios were generated using a user communication matrix. Resulting prototypes were compared according to the degree to which they satisfied medical, computing, and business constraints. In a different organization, or at different time, candidate prototypes and their ranking might have been different. However, prototype generation and comparison are fundamentally influenced by factors usefully understood in a cognitive science framework.

Cognitive Science↗
PubMed2004

Knowledge and process management in health care organizations.

OBJECTIVE: Medical knowledge management and care process management have become to be considered as valuable strategic assets that can lead to sustained increase in Health Care Organization (HCO) performance. Thus, it is essential to investigate which are the enablers for promoting knowledge-based organizations (people, organization, process, and system perspectives). Although they are essential for a HCO to manage knowledge effectively, it is still unclear how to employ them in more principled fashion. This requires innovative management strategies to determine effective ways of utilizing knowledge resources and capabilities available both within and outside the organization. METHOD: This paper reviews knowledge and process management theories, methods, and technologies that are potentially effective in building high performance HCOs. They come from a variety of fields behind computer science and medical informatics, e.g. from business and organization sciences to psychological and cognitive sciences, from epistemology to sociology. However, the success in developing future Health Information Systems (HIS) requires their incorporation into a new conceptual framework after recognizing how peculiar are the characteristics of HCOs with respect to other organizations. Investigating the nature of knowledge, in general, and of medical knowledge, in particular, is essential to define which services the future HIS should provide to foster collaboration between patients and health professionals. The knowledge creation process is then described in order to emphasize its dynamic and social characteristics. The potential of workflow technology for building innovative HISs is analyzed together with several basic research issues which are very challenging for researchers in the field. RESULT: A framework for augmenting the conceptual analysis of theories, methods, tools and effects of knowledge management in building high performance HCOs.

Health Facility Administration↗
PubMed2000

Learning tumor diagnostics and medical image processing via the WWW--the case-based radiological textbook ODITEB.

New Internet technologies offer excellent chances to build high-quality on-line learning media for the education in medicine. Especially, the teaching of diagnostics with medical imaging as well as medical image processing can be supported by the excellent visualization and interaction capabilities. In cooperation with three radiological departments at German universities in Munich, Erlangen and Würzburg, the case-based open distributed Internet text book (ODITEB) for tumor diagnosis of the GI-tract, liver, pancreas and thorax has been developed at the Institut für Medizinische Statistik und Epidemiologie (IMSE) of the Technische Universität München. It offers a big collection of clinical tumor cases located on servers at the provider sites Munich, Erlangen and Würzburg, visualization and interaction similar to a real CT or MRI console, original DICOM data, X-rays and endoscopic and endosonographic videos, and expert-guided tours through the cases. In a first evaluation in summer 1998, 32 medical students graded the application with 1.9 ('good') on a scale from 1 ('very good') to 5 ('very bad'). The textbook supports German language, an English version is in preparation. In a second part, it contains lessons in medical image processing for students of medical informatics. An ODITEB release 2 with several improvements will be finished until February 2000. The use of the textbook is free of cost.

Computer-Assisted Instruction↗
PubMed1991

The MAClinical Workstation Project at Georgetown University.

The intent of the MAClinical Workstation Project is to develop computer workstations for medical students of the sort they will use in future medical practice. The idea is to instill information query habits in the daily clinical activities of these young physicians-in-training. The Georgetown University Medical Center Library spearheads the project in conjunction with the School of Medicine. The library handles technical support, including software development, user training, equipment maintenance, and network installations. The project began in 1988 with nine Macintosh computers; today thirty machines are distributed throughout the Georgetown University Hospital conference rooms, faculty and resident offices, and at four affliated hospitals. The Macintosh computers are connected to the medical center's local area network (LAN) with access to the Integrated Academic Information Management System (IAIMS) and Library Information System (LIS) databases. The MAClinical workstations serve multiple educational purposes in the clinical setting. Primarily, students gain experience in medical informatics by using a variety of software systems installed at the stations: the H&P Writer, a history and physical system written in the C programming language, can be used by students to prepare the admission record on patients they examine; also, students can keep patient records, check findings against a diagnostic system, look up drugs and treatment protocols, develop medical sketches, and find additional information when needed in the medical literature.

Computer Systems↗
PubMed1990

Knowledge bases in medicine: a review.

Efforts to represent knowledge effectively have been central to progress in various aspects of medical informatics. These efforts range from relatively simple "electronic textbooks" to fairly sophisticated knowledge-based systems, which function as well as, or even better than, human experts faced with similar problems. Knowledge bases have been developed in many fields, but the relatively limited domains and structured language of medicine, as well as the importance of information in the provision of good medical care, have made research in medical knowledge representation an area of intense activity. This paper reviews representative knowledge bases and knowledge-based systems in medicine: electronic textbooks such as PDQ and the Hepatitis Knowledge Base (HKB), rule-based systems such as MYCIN, causal models (e.g., CASNET), and hypothesis- or frame-based systems, exemplified by PIP and INTERNIST-1. The paper describes the relationships among divergent approaches and provides a sense of current and future trends. It examines problems in knowledge-based systems, particularly in knowledge representation and acquisition, and the responses to these challenges. The latter include the use of domain-independent software shells for constructing knowledge bases, the adaptation and use of previously existing knowledge bases, and multiple uses of the same knowledge base for different purposes.

Artificial Intelligence↗
PubMed1995

Computerized patient records in primary care. Their role in mediating guideline-driven physician behavior change.

Implementation of practice guidelines remains problematic in spite of enormous efforts to develop and disseminate them, to establish their credibility, and to create incentives for physicians to adopt them. These strategies have failed to systematically change physician behavior because they do not address the involuntary time and mental processing constraints that have been clearly demonstrated to hamper physicians' ability to comply with guidelines. Computerized patient record systems directly address these constraints, and evidence is mounting that they are effective tools for changing physician behavior. A properly configured computerized patient record system provides decision support, facilitates work flow, and enables the routine collection of data for performance feedback. A synthesis of relevant research from the domains of practice guidelines and medical informatics strongly suggests that the operational support provided by computerized patient record systems will have a major impact on physician compliance with practice guidelines.

Ambulatory Care Information Systems↗
PubMedDate not supplied

How the past teaches the future: ACMI distinguished lecture.

More than 30 years of experience in developing a computer-based patient record system, The Medical Record (TMR), in multiple settings, in multiple specialty groups, and at multiple sites has taught us many lessons. Lessons related to computer-based patient records include the importance of a data model in which input, storage, and planned use are independent; separation of patient-specific data from metadata; a modular design to localize the program code that deals with a set of data; redundant storage to optimize tasks and response time; and integration of decision support into work process. Lessons related to medical informatics include the importance of a clinical-technical partnership, control of tools at the leading edge, and rapid prototyping in the real world. Finally, changes in technology move the challenges but do not eliminate them.

History, 20th Century↗
PubMedDate not supplied

Challenges and opportunities for computerizing the anesthesia record.

Most observers would agree that the goal of computerizing the anesthesia record is a worthy one. Despite the fact that several academic groups and vendors have attempted to develop and provide computerized anesthesia charting, the practice is not widespread. In this review article, we attempt to outline the reasons for this reluctance to use computers for anesthesia charting. Where there are problems to be solved, there also are opportunities. We discuss the development of strategies to solve these problems and thus present opportunities for medical informatics professionals and anesthesiologists to work toward joint solutions. Solving these problems includes the development of consensus standards and working out technical, social, and educational difficulties. Details of the approaches recommended are outlined.

Anesthesia↗
PubMed1998

Standardization and security for the EMR.

The Ministry of Health and Welfare of Japan announced 'Healthcare Information Strategy 21' in 1994. This report shows that the Healthcare Information System is the key to improving the quality and efficiency of healthcare. One of the elements for realizing the new Healthcare Information System is the Electronic Medical Record (EMR). Following the publication of this report, work began with the aim of discovering a way to recognize the EMR as formal documentation and four national projects of research and development have been started. The themes of these projects are: 'Interoperability of EMR', 'Standardization of EMR', 'Modeling of the Clinical Process' and 'Security for EMR'. The Japanese Association of the Healthcare Information Systems Industry (JAHIS) is in charge of 'Security for EMR'. There are many discussions in relation to the security for EMR. However, many of these discussions relate to information technology, while there are few discussions regarding definitions of security. Therefore, there are many different theories about security itself, which will be an obstacle to standardization. To design the security system for EMR, JAHIS has defined 'Security for EMR' as the first step. The present study was conducted with medical informatics and security specialists. It has designed 'Requirement Definitions', 'Goals of Security', 'Estimation of threats to security', 'Necessity conditions' and a 'Security Model'. This paper covers these definitions and our security design concept.

Computer Security↗
PubMedDate not supplied

The barriers to electronic medical record systems and how to overcome them.

Institutions all want electronic medical record (EMR) systems. They want them to solve their record movement problems, to improve the quality and coherence of the care process, to automate guidelines and care pathways to assist clinical research, outcomes management, and process improvement. EMRs are very difficult to construct because the existing electronic data sources, e.g., laboratory systems, pharmacy systems, and physician dictation systems, reside on many isolated islands with differing structures, differing levels of granularity, and different code systems. To accelerate EMR deployment we need to focus on the interfaces instead of the EMR system. We have the interface solutions in the form of standards: IP, HL7/ASTM, DICOM, LOINC, SNOMED, and others developed by the medical informatics community. We just have to embrace them. One remaining problem is the efficient capture of physician information in a coded form. Research is still needed to solve this last problem.

Continuity of Patient Care↗
PubMed2001

Using the eXtensible Markup Language (XML) in a regional electronic patient record for patients with malignant diseases.

Communication between different institutions which are responsible for the treatment of the same patient is of outstanding significance, especially in the field of tumor diseases. Regional electronic patient records could support the co-operation of different institutions by providing ac-cess to all necessary information whether it belongs to the own institution or to a partner. The Department of Medical Informatics, University of Heidelberg is performing a project in co-operation with the Thoraxclinic-Heidelberg and the Department of Clinical Radiology, University of Heidelberg with the goal: to define an architectural concept for interlinking the electronic patient record of the two clinical institutions to build a common virtual electronic patient record and carry out an exemplary implementation, to examine composition, structure and content of medical documents for tumor patients with the aim of defining an XML-based markup language allowing summarizing overviews and suitable granularities, and to integrate clinical practice guidelines and other external knowledge with the electronic patient record using XML-technologies to support the physician in the daily decision process. This paper will show, how a regional electronic patient record could be built on an architectural level and describe elementary steps towards a on content-oriented structuring of medical records.

Computer Security↗
PubMed1994

Digital archives and communication highways in health care require a second look at the legal framework of the seventies.

The present state of the art and the state of practice regarding legal aspects of medical informatics are reported. Examples are taken from networking, archiving, and virtual reality. It is derived that the data protection concepts of the seventies are covering only some legal aspects of the application scene today and in the future. Thus a far wider legal approach is necessary. It can only be mastered if engineers and lawyers discuss future trends and derive together a new legal framework for medical computer systems in the late nineties. As computers will be everywhere from childhood to death the key issue is not to just protect an individual but to positively frame an information society.

Computer Communication Networks↗
PubMed2000

GALEN-IN-USE: application in Greek and influences on education.

GALEN-IN-USE is a European project that aims to promote greater European harmonization and to overcome the problems encountered in using traditional coding and classification systems. This paper presents the work done by the Greek Centre of Medical Informatics and Terminology, as a collaborating centre of GALEN-IN-USE(GIU), in order to apply GIU's tools to Greek Health Care System as well as the affect of this application in education.

Classification↗