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Health On the Net automated database of health and medical information.

With the number of World Wide Web sites growing every day, the problem is not just to find information, but to locate the right piece of information. Current World Wide Web search engines have not resolved this problem as they most often return a long list of documents. The search result is then unusable because of the large number of answers from different domains and topics. Only complex queries may, in a given situation, produce a limited number of potentially relevant documents. To make searches more efficient and usable by common users, we now need intelligent and specialised search engines on the Net [1,2]. Health On the Net Foundation and the Molecular Imaging and Bioinformatics Laboratory at Geneva University Hospital have developed Multi-Agent Retrieval Vagabond on Information Networks (MARVIN), a robot that searches sites and documents specifically related to a given specialised field. One such robot has already been implemented and used for the medical and the 2D electrophoresis domains. Health On the Net Foundation has implemented the corresponding search engines, MedHunt (http://www.hon.ch/cgi-bin/find) for the medical field and 2DHunt (http://www.hon.ch/cgi-bin/2DHunt/find) for the 2D electrophoresis field.

Computer Communication Networks↗

Assessing informatics students' satisfaction with a web-based courseware system.

This study assessed health informatics student satisfaction with two subsequent versions of Prometheus, a web-based courseware system. Prometheus versions 4 and 5 were assessed to gauge the effect of modifications to improve the usability of the system. The Questionnaire for User Interaction Satisfaction (QUIS, version 7.0) was administered at the end of fall semester 2001 (in which Prometheus version 4 was used) and again at the end of Spring 2002 (in which Prometheus version 5 was used). QUIS contains measures of user satisfaction of the overall system and 11 specific dimensions, including screen, terminology and system information, learning, system capabilities, manuals and online help, multimedia, and teleconferencing. In general, students had favorable judgments of Prometheus, and their satisfaction level remained relatively stable across the two versions. However, usability enhancements incorporated into version 5 produced no significant differences in student satisfaction ratings. The results of this study provide a benchmark for comparing the relative usability of alternative courseware systems and demonstrate the utility of user satisfaction surveys for assessing and improving courseware systems. With increases in the need for compliance education and the education of clinicians with 'just in time knowledge', courseware systems will become an integral part of the clinical information systems, increasing the importance of usability studies such as this one.

Adult↗

Medical informatics and the concept of disease.

This paper attempts to address the general question whether information technologies, as applied in the area of medicine and health care, have or are likely to change fundamental concepts regarding disease and health. After a short excursion into the domain of medical informatics I provide a brief overview of some of the current theories of what a disease is from a more philosophical perspective, i.e. the "value free" and "value laden" view of disease. Next, I consider at some length, whether health care informatics is currently modifying fundamental concepts of disease. To this question I will answer largely in the negative, and I will provide the sketch of some arguments from current research programs in medical informatics why I think this is the case. This argumentation is supported by a detailed account of how the disease profile for beriberi heart disease, used in one of the major medical informatics diagnostic programs, QMR (and its ancestor INTERNIST-1), was developed, and why at least this program essentially follows received views of traditional medicine. The one main exception to the conformity of this program to "received" views of a disease occurs when the program's designers need to fine-tune a disease definition. This fine-tuning is to comport with the expert's perspective on the disease, including his or her epistemic values, as well as the program's other resources for diagnosing components of a disease.

Beriberi↗

Graphical knowledge presentation in a MUMPS-based decision-support system.

Conventional knowledge-based medical expert systems present information and elicit responses in the form of text. PHOENIX, a decision-support system designed to help non-radiologist physicians select diagnostic imaging procedures, offers a graphical user interface. The system constructs and displays algorithms, or flowcharts, from the rules in its knowledge base. Users can view the flowcharts and move through them by answering questions at branch points. The system provides detailed textual explanations of the rules and descriptions of the imaging procedures. The system is written in MUMPS, a common programming language for biomedical information systems, and is easily incorporated into clinical computer systems.

Algorithms↗

An approach for access differentiation design in medical distributed applications built on databases.

A formalized "top to bottom" design approach was described in [1] for distributed applications built on databases, which were considered as a medium between virtual and real user environments for a specific medical application. Merging different components within a unified distributed application posits new essential problems for software. Particularly protection tools, which are sufficient separately, become deficient during the integration due to specific additional links and relationships not considered formerly. E.g., it is impossible to protect a shared object in the virtual operating room using only DBMS protection tools, if the object is stored as a record in DB tables. The solution of the problem should be found only within the more general application framework. Appropriate tools are absent or unavailable. The present paper suggests a detailed outline of a design and testing toolset for access differentiation systems (ADS) in distributed medical applications which use databases. The appropriate formal model as well as tools for its mapping to a DMBS are suggested. Remote users connected via global networks are considered too.

Computer Communication Networks↗

Electronic patient records and the impact of the Internet.

The term electronic patient record (EPR) means the electronic collection of clinical narrative and diagnostic reports specific to an individual patient. A true EPR should allow physicians and nurses to practice in a paperless fashion. The wide adoption of Internet technologies should allow truly distributed sharing of patient data across traditional organizational barriers. Hence, the meaning of an EPR, as a representation of documents, should be transformed into a collaborative environment that supports workflow, enables new care models and allows secure access to distributed health data. This paper reviews the current realization of EPRs in the context of paper-based medical records. The Internet architecture that Boston-based medical informatics researchers refer to as W3-EMRS is described in the context of a successful implementation of CareWeb at the Beth Israel Deaconess Medical center. Finally, we describe how this Internet-based approach can be extended beyond the boundaries of traditional care settings to help evolve new collaborative models of eHealth.

Computer Security↗

On the foundation and structure of medical informatics.

The authors from China and the United States take medical informatics from theory to practice by improving its research, application, and dissemination and by expanding its educational potential. We built a theoretical model and discussed its definition, approach, foundation, principles, and structure. Medical informatics is the interdisciplinary study of information science applied to medicine and health care. Its developing approach is transplantation. The foundation of medical informatics has "building blocks" of knowledge. They are: information procedure models; information classification principles; information processing methodologies; and functional hierarchical principles of information systems. The structure of medical informatics includes the main knowledge branches and their logical relations. There are four big branches: computer tools and systems methods; engineering equipment and methods; medical fields information systems; and health care management systems. Based on the investigation of the professional status (its theory and application, and its forms and the contents) of medical informatics, it can be seen that this new discipline is becoming mature.

China↗

The Finnish informatics nurse, her job and education against a background of international development.

This paper presents a small survey made to Finnish "adp-nurses" working at adp-departments or as contact persons and informants at the wards. Their positions, job descriptions and informal education is discussed in relation to recent international development in the field. Finally the necessity of starting formal education for the European informatics nurse is stressed.

Computer Literacy↗

AIM: a personal view of where I have been and where we might be going.

My own career in medical informatics and AI in medicine has oscillated between concerns with medical records and concerns with knowledge representation with decision support as a pivotal integrating issue. It has focused on using AI to organise information and reduce 'muddle' and improve the user interfaces to produce 'useful and usable systems' to help doctors with a 'humanly impossible task'. Increasingly knowledge representation and ontologies have become the fulcrum for orchestrating re-use of information and integration of systems. Encouragingly, the dilemma between computational tractability and expressiveness is lessening, and ontologies and description logics are joining the mainstream both in AI in Medicine and in Intelligent Information Management generally. It has been shown possible to scale up ontologies to meet medical needs, and increasingly ontologies are playing a key role in meeting the requirements to scale up the complexity of clinical systems to meet the ever increasing demands brought about by new emphasis on reduction of errors, clinical accountability, and the explosion of knowledge on the Web.

Artificial Intelligence↗

Security of medical data transfer and storage in Internet. Cryptography, antiviral security and electronic signature problems, which must be solved in nearest future in practical context.

The informatical revolution in computer age, which gives significant benefit in transfer of medical information requests to pay still more attention for aspect of network security. All known advantages of network technologies--first of all simplicity of copying, multiplication and sending information to many individuals can be also dangerous, if illegal, not permitted persons get access to medical data bases. Internet is assumed to be as especially "anarchic" medium, therefore in order to use it in professional work any security principles should be bewared. In our presentation we will try to find the optimal security solution in organisational and technological aspects for any medical network. In our opinion the harmonious co-operation between users, medical authorities and network administrators is core of the success.

Computer Security↗

Informatics in medical practice: billing systems survey by the Hawaii Medical Association.

The Information Age has arrived! Our offices are quickly integrating information machines for the business part of our profession, just as the stethoscope and scalpel are requisites for the practice of medicine and surgery. The mission of the HMA Computer Committee is to provide guidance in the direction of medical informatics for its members. We hope to assist the membership in the selection, evaluation and use of the products relating to the processing of information in the modern practice of medicine.

Accounting↗

Computers in medicine.

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Medical Informatics↗

Combat medical informatics: present and future.

In this paper, we describe a U.S. Army concept to monitor soldier physiologic status and provide computer-based medical support to increase the likelihood of soldier survival on the battlefield. Supported by an underlying platform of complex wearable computerized systems, the "Warfighter Physiological Status Monitoring" (WPSM) concept consists of an array of biosensors embedded in the soldier's uniform integrated with a database management system and a decision support system that will provide assistance in casualty prevention and casualty management. We discuss the main components of the WPSM, its present status, key requirements and outstanding challenges, and near- and far-term research directions.

Biosensing Techniques↗

XML-based synchronization of mobile medical devices.

Today, mobile computing provides enough resources to be used in medical applications. Patient treatment is a process that involves multiple partners. All those partners need access to common patient-data and need to make changes to the patients' health record. Therefore, data that the partners collect and change with mobile devices has to be synchronized on a central server to form the master patient record. Data conflicts resulting from the synchronization have to be solved automatically. Our project describes a solution for XML-based data replication and synchronization for mobile health applications.

Computers, Handheld↗