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PubMed2005

An incremental pharmacy informatics model for use in a rural hospital.

We present an implementation model for pharmaceutical computerized decision support (CDS) that enables a hospital to incrementally target specific "high value" projects as needs are identified and support is secured. Our model, which we are currently implementing in a rural medical center, allows the hospital and its staff to quickly reap some benefits from CDS in spite of resource limitations.

Clinical Pharmacy Information Systems↗
PubMedDate not supplied

Health Level Seven (HL7): standard for healthcare electronic data transmissions.

The nursing profession needs computer-formatted data that can be exchanged within and between agencies. The exchange of electronic data, both in the United States and in the international community, requires agreement on the format of the data elements to be exchanged. The Health Level Seven (HL7) standard is a proposed voluntary standard for healthcare applications that addresses the way information is exchanged electronically. This brief article will provide background information regarding the development and status of HL7 and its implications for nursing. From the clinical perspective, nurses follow standards of care developed by professional organizations. These standards facilitate clear communication among nurses, consumers, and members of other disciplines. Similarly, the electronic transmission and exchange of clinical information must have a standard to ensure that messages arrive and are decoded correctly. Many standards for electronic data already exist; financial transactions such as banking are familiar examples. The theme of the 1990 Symposium on Computer Applications in Medical Care (SCAMC), was Standards in Medical Informatics. Many pertinent papers and workshops were presented. However, references to electronic data standards are found primarily in conference proceedings and technical manuals. Thus, although activity is widespread, and events are rapidly moving in the healthcare industry, most of the information is not yet widely available. It seems timely, therefore, to provide background material to nurses in order for them to participate in the process.

Computer Communication Networks↗
PubMed2003

Integr8: enhanced inter-operability of European molecular biology databases.

OBJECTIVES: The increasing production of molecular biology data in the post-genomic era, and the proliferation of databases that store it, require the development of an integrative layer in database services to facilitate the synthesis of related information. The solution of this problem is made more difficult by the absence of universal identifiers for biological entities, and the breadth and variety of available data. METHODS: Integr8 was modelled using UML (Universal Modelling Language). Integr8 is being implemented as an n-tier system using a modern object-oriented programming language (Java). An object-relational mapping tool, OJB, is being used to specify the interface between the upper layers and an underlying relational database. RESULTS: The European Bioinformatics Institute is launching the Integr8 project. Integr8 will be an automatically populated database in which we will maintain stable identifiers for biological entities, describe their relationships with each other (in accordance with the central dogma of biology), and store equivalences between identified entities in the source databases. Only core data will be stored in Integr8, with web links to the source databases providing further information. CONCLUSIONS: Integr8 will provide the integrative layer of the next generation of bioinformatics services from the EBI. Web-based interfaces will be developed to offer gene-centric views of the integrated data, presenting (where known) the links between genome, proteome and phenotype.

Computational Biology↗
PubMed1995

Medicine in virtual environments.

Virtual Environments allow a human to interact with a (computer) system in such a way that a high level of presence in a computer-synthesised world is experienced. In principle, all human senses are involved with the interaction. Many applications may benefit from this type of human-machine interfacing, however, few have emerged so far for medicine. In this paper we elaborate on some realistic potential applications of Virtual Environment technology in the field of medicine. These applications can be found in education/training, therapy, surgery, rehabilitation, diagnosis, telemedicine and biomechanics. The value to be added to these applications by VE technology lies in the fact that patient data or patient models may be moderated to the physician in a more intuitive and natural manner. Despite these potentials, the short-term feasibility of these applications can be put into question for various reasons. Firstly, the current generation of display devices have a resolution that may show to be too low to achieve a sufficiently high degree of realism for medical applications. Secondly, there are no commercially-available actuators for tactile and force feedback which the physician desperately need for the simulation of the contact with the (virtual) patient. Thirdly, the enormous computing power required for these applications (still) needs a considerable investment. With these limitations in mind, we believe that we are at the cradle of a whole new generation of VE applications in medicine.

Computer Simulation↗
PubMed2004

[Medical informatics education at the Medical School in Tuzla].

Medical informatics is a specific and interdisciplinary science which involves many participants of the health system like: patients, physicians, nurses, managers, administrators, computer experts, students, with the different level of education and understanding, different approaches and expectations. Education of medical informatics requests organization solutions of high quality and necessary equipment for its realization. Educational programs are also limited by student's basic knowledge of informatics from secondary schools. For assessment of this knowledge we have conducted special designed questionnaire at the first year of undergraduate study which results confirm our thesis that great number of students entered the faculty with the lack of basic knowledge from informatics area. In this paper was presented level of organization and education of medical informatics at the Medical faculty and University Clinical Center of Tuzla, with its characteristics through which this system has been passed since 1990.

Bosnia and Herzegovina↗
PubMedDate not supplied

Medical informatics in the intensive care unit: state of the art 1991.

Intensive care medicine requires timely, accurate, and integrated patient records to provide the highest quality patient care. Computerized patient records offer the best method to achieve these needs. The expectations of society for medical progress through increased use of computers is growing. For optimal use of computers in the ICU there must be a harmonious collaboration between medical informaticists, physicians, nurses, therapists, and administrators. The future use of computers in ICU care will be evolutionary rather than revolutionary. We are on the frontier of some exciting times in the next decade as computers become commonplace in the clinical care process rather than an unusual event. This paper discusses the progress and challenges of computers in the ICU.

Clinical Protocols↗
PubMed2004

A semantic approach to segmentation of overlapping objects.

OBJECTIVES: This paper aims at introducing a novel approach for segmentation of overlapping objects and at demonstrating its applicability to medical images. METHODS: This work details a novel approach enhancing the known theory of full-segmentation of an image into regions by lifting it to a semantic segmentation into objects. Our theory allows the formal description of partitioning an image into regions on the first level and allowing the occurrence of overlaps and occlusions of objects on a second, semantic level. Possible applications for the use of this 'semantical segmentation' are the analysis of radiographs and micrographs. We demonstrate our approach by the example of segmentation and separation of overlapping cervical cells and cell clusters on a set of 787 image pairs of registered PAP- and DAPI-stained micrographs. The semantical cell segmentation yielding areas of cell plasmas and nuclei are compared to a manual segmentation of the same images, where 2212 cells have been labeled. A direct comparison of over and under-segmentation between the two segmentation sets yields a mean difference value of 10.15% for the nuclei and 10.80% for the plasma. RESULTS: Using the proposed theory of semantical segmentation of images in combination with adequate models of the image contents, our approach allows identifying, separating and distinguishing several overlapping, occluding objects in medical images. Applying the proposed theory to the application of cervical cell segmentation from overlapping cell clusters and aggregates, it can be seen that it is possible to formally describe the complex image contents. CONCLUSIONS: The proposed method of semantical segmentation is a mighty tool and under the assumption of the subtractive transparency model can be used in different medical image processing applications such as radiology and microscopy. By using alternative models to solve the ambiguities attached to overlaps and occlusions, further fields of application can be addressed.

Algorithms↗
PubMed1990

Computer applications in orthopaedics.

With the rapid developments in microprocessors, the widespread availability of computers has brought about broad applications in the field of orthopaedics. The present technology enables large quantities of data to be logically processed in a very short span of time. This has led to the development of information management database systems where relevant medical information may be retrieved very quickly and effectively. The analytical power of the computer has also been utilised in expert systems to assist in clinical-decision making process. Computer graphics have revolutionised the visualisation of physical features of internal and external body parts, providing new and improved modalities of diagnosis. In some centres, surgical planning and rehearsals are already being carried out at the computer terminal with the use of animation and computer graphics. Computer technology has also played an active role in the field of prosthetics and rehabilitation. Intelligent robotic systems and microprocessor with functional neuromuscular stimulation have been applied to benefit, and in some cases restore some motor functions to the physically disabled. With more collaboration between engineers, scientists and the medical community, several prototypes of computer-controlled prostheses and prosthesis designed and manufactured by Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) technology are available today to assist the amputees in their daily living and ambulatory activities.

Computer Graphics↗
PubMed2006

Medical informatics in medical research - the Severe Malaria in African Children (SMAC) Network's experience.

OBJECTIVES: Computers are widely used for data management in clinical trials in the developed countries, unlike in developing countries. Dependable systems are vital for data management, and medical decision making in clinical research. Monitoring and evaluation of data management is critical. In this paper we describe database structures and procedures of systems used to implement, coordinate, and sustain data management in Africa. We outline major lessons, challenges and successes achieved, and recommendations to improve medical informatics application in biomedical research in sub-Saharan Africa. METHODS: A consortium of experienced research units at five sites in Africa in studying children with disease formed a new clinical trials network, Severe Malaria in African Children. In December 2000, the network introduced an observational study involving these hospital-based sites. After prototyping, relational database management systems were implemented for data entry and verification, data submission and quality assurance monitoring. RESULTS: Between 2000 and 2005, 25,858 patients were enrolled. Failure to meet data submission deadline and data entry errors correlated positively (correlation coefficient, r = 0.82), with more errors occurring when data was submitted late. Data submission lateness correlated inversely with hospital admissions (r = -0.62). CONCLUSIONS: Developing and sustaining dependable DBMS, ongoing modifications to optimize data management is crucial for clinical studies. Monitoring and communication systems are vital in multi-center networks for good data management. Data timeliness is associated with data quality and hospital admissions.

Acute Disease↗
PubMed2004

Medical informatics at Heidelberg/Heilbronn: status-evaluation-new challenges in a specialised curriculum for medical informatics after thirty years of evolution.

After reporting on characteristics, structure and contents of the specialised informatics-based curriculum for medical informatics (MI) at the University of Heidelberg/University of Applied Sciences Heilbronn, the paper describes the development during the last 5 years, and in particular a complementary health care oriented postgraduate program in 'Health Information Management' (IM). Furthermore, it outlines results of a study among the MI graduates, which aims to assess their job situation and to evaluate the curriculum from their viewpoint and so establishes a summary of 30 years of experience with the program. Finally, the paper discusses new challenges of the program, considering the results of the study, perspectives of health care provision in the next decade, content changes to be focused on and the growing competition in the field of programs for medical informatics.

Computer-Assisted Instruction↗
PubMed1992

The European Community: standardization in medical informatics and imaging.

The use of informatics and telecommunications in health care and medicine has reached a stage where the application of standards is an absolute requirement. The AIM Programme of the CEC DGXIII stimulated the study of the subject, and has supported the set up of an official European platform for standardization in this field, the CEN TC251. The needs for standardization in one of the subareas, medical imaging, are described in detail. The future solutions of the problems concerned are regarded prerequisites for the general and practical use of PACS and IMACS.

European Union↗
PubMed1999

Medical practice and informatics tools: a vignette.

In this article the authors recreate an improvisational vignette originally presented at the Third Annual Information Connection in Burlington, Vermont, in January 1998. The vignette illustrates various state-of-the-art decision-support systems for clinical care and their promises and problems in real-world medical practice. The characters are Dr. Alex Grant, a rural physician in solo practice; Anna Everett, a patient suffering from chronic headaches; Bob, a hospital librarian; and Sarah, Dr. Grant's nurse. The short play centers on Dr. Grant's attempt to diagnose the cause of Anna's headaches (which he and she believe to be sinus-related) and the roles information technologies--Medline searching, Anna's own Internet searches, the use of MDConsult, which provides Internet access to standard medical texts, journals, etc., and a desktop decision-support tool called Problem Knowledge Couplers--play in this process. The vignette concludes with the realization that while computer technologies can be of great help in medicine "there is still a need for a good doctor to pull it all together."

Diagnosis, Computer-Assisted↗
PubMed1991

Preparing doctors for tomorrow: information management as a theme in undergraduate medical education.

The evolving nature of medical knowledge and technology requires that the practitioners of tomorrow be able to develop practice management and computer skills in order to enhance quality patient care, ongoing education, and research. The paper describes how the discipline of medical informatics can be integrated into an undergraduate medical curriculum, not as a course or series of courses but as a repeated theme throughout the 3-year system-based curriculum. Recommendations specific to integrating medical informatics into an undergraduate curriculum are outlined with respect to: (1) content; (2) content organization; (3) management; and (4) evaluation. Six areas of information and computer management applications are discussed. These are computer-assisted learning, retrieving and organizing information from computerised databases, the application of medical informatics tools to the critical appraisal of literature and associated statistical software packages, hospital- and office-based information systems, and electronic communications. Medical education has a history of resistance to change. Reference to guidelines and experiences of others who have negotiated information management and medical informatics changes into medical school environments can therefore be helpful. It is in this context that this paper is presented.

Alberta↗
PubMed1992

[Medical informatics as a complementary method in medical education].

The practice of the decision making at the bed side especially highlights the place to be devoted to medical informatics both at the pre- and post-graduate levels. Still in a relatively recent past, say the 50s-60s, most of the medical educational efforts were delivered when watching and then imitating the medical behaviour of an older physician. The medical educators were aware that besides the formal lessons related to selected chapters of medical textbooks, there were an obvious need for better training in the ability to make sound clinical judgements. If this ability has been considered only as an artful and intuitive process neither subjected to theoretical analysis nor to be captured in a formal quantitative model, now things have changed to such an extent that it becomes broadly shared that a science of medical decision making can be reasonably founded and this threefold: 1) Upon a formulated logic, 2) The probability theory, and 3) A value theory. The first gives the hand to artificial intelligence (AI) technics, the third to medical information data bases dealing either with patients (like in hospital information systems) or with literature like MEDLINE or electronic "cookbooks". Basically the probabilistic theory is based here upon a priori probabilities related to patients informations and data and opens the way to bayesian decision making. After this little summary it is stressed that educational informatics in medicine would appear either very central or very marginal, if not optional.

Computer-Assisted Instruction↗