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PubMed2003

Representation of relationships between data in healthcare documents.

In healthcare data are to a large extent represented in narrative textual documents. The analysis of narrative text has not been solved successfully up to now. The results of natural language processing or fully indexing systems have not been completely satisfying. It is in particular difficult to detect and describe reliably relationships between data items in narrative text. The eXtensible Markup Language XML has opened new and very promising perspectives in this environment which could improve the storage, processing and analysis of narrative textual documents in particular in healthcare.

Germany↗
PubMed2004

Managing change in health informatics--lessons learned from a third of a century of change. Introduction.

This short paper describes strategies and tactics that have been used for introducing Health Informatics projects in Scotland, UK during the last almost 40 years. This is a country of only 5 million population. It has a scattered geography with isolated islands and moorland and hilly areas along with a populous former industrial heartland. It has a unified National Health Service, free at each point of contact. By many measurements it is not a healthy population with traditions of unhealthy life-styles.

Hospital Information Systems↗
PubMed2004

Integrating clinical information in NHS Scotland: the role of Scottish Care Information Store.

A key plank in NHS Scotland's information management and technology (IM&T) eHealth Strategy is the web-based system known as Scottish Care Information (SCI) Store, which gives primary and secondary care clinicians access to core clinical information. There is one SCI Store in each of the 15 NHS Board areas. At present all GP practices in 11 of these areas have access to SCI Stores for test results. Work is underway to augment the Stores with clinical letters and GP summary data. Strategically, SCI Store is seen as the ubiquitous element in our eHealth Strategy which will allow information to be shared across Scotland in a secure and reliable way.

Computer Communication Networks↗
PubMed2004

Implementing evidence-based practice in undergraduate teaching clinics: a systematic review and recommendations.

The objective of this project was to identify an effective methodology of approaching and implementing evidence-based principles in undergraduate teaching clinics to promote evidence-based dentistry in future clinical practice. A systematic review was undertaken to examine evidence-based clinical teaching and faculty continuing education. Research published from 1996 to 2002 was retrieved by searching several databases and the Internet, along with conducting hand searches and reviewing bibliographies maintained by faculty experts. Qualitative checklists for different types of studies were created to evaluate the literature. Relevant studies were selected if they met all four predetermined essential criteria and a minimum of two out of three desirable criteria. Systematic reviews were chosen if they met all five essential criteria. Data from selected articles were extracted, and study quality was assessed. We found that three systematic reviews and nine original research articles were deemed methodologically acceptable. Problem-based learning and evidence-based health care interventions increased student knowledge of medical topics and their ability to search, evaluate, and appraise medical literature. Dental students in a problem-based learning curriculum, emphasizing evidence-based practices, scored higher on the NDB I (National Dentistry Boards, Part I) than students in traditional curricula. While effective modules in implementing theoretical evidence-based principles exist, very few high-quality studies are available that examine these principles in dental undergraduate teaching clinics. No methodologically appropriate studies on the education of faculty in the implementation of evidence-based principles are available. Some studies promote promising theories and methodologies of teaching evidence-based care; based on these theories, a comprehensive model is proposed in this article. Considering the strength of evidence in the reviewed literature, we concluded that an evidence-based approach to clinical care is effective.

Curriculum↗
PubMed2004

The NLM Gateway: a metasearch engine for disparate resources.

The U.S. National Library of Medicine (NLM) has created a metasearch engine called the NLM Gateway at the URL "gateway.nlm.nih.gov". The Gateway allows the user to issue one search that takes place on multiple NLM retrieval engines. A composite result set is presented in several categories of information: journal citations; books, serials and audiovisuals; consumer health; meeting abstracts; and other collections.

Databases as Topic↗
PubMed2004

Automated clinical annotation of tissue bank specimens.

Modern, molecular bio-medicine is driving a growing demand for extensively annotated tissue bank specimens. With careful clinical, pathologic and outcomes annotation, samples can be better matched to the research question at hand and experimental results better understood and verified. However, the difficulty and expense of detailed specimen annotation is well beyond the capability of most banks and has made access to well documented tissue a major limitation in medical re-search. In this context, we have implemented automated annotation of banked tissue by integrating data from three clinical systems--the cancer registry, the pathology LIS and the tissue bank inventory system--through a classical data warehouse environment. The project required modification of clinical systems, development of methods to identify patients between and map data elements across systems and the creation of de-identified data in data marts for use by researchers. The result has been much more extensive and accurate initial tissue annotation with less effort in the tissue bank, as well as dynamic ongoing annotation as the cancer registry follows patients over time.

Clinical Laboratory Information Systems↗
PubMed2004

Computer interviewing in a primary care office: the patients are ready.

UNLABELLED: Computer patient interviewing has been used since 1968 and must be acceptable to a majority of patients for wide spread use to occur. Computer interviewing is still not used widely in the United States. Potential barriers have not been identified in the literature. METHODS: 150 of 164 (91.5%) eligible patients at a family medicine ambulatory practice were enrolled in a study to evaluate computer interview of cough and sore throat complaints. Subjects were given the choice to have the interview in the waiting or examination room. Telephone interviews were conducted 2-4 weeks later with 143/150 patients (95.3%). RESULTS: 102/150 (68%) of subjects chose the wait-ing room and 48/150 (32%) chose the examination room for the computer interview. 127/143 (88.8%) were willing to use the computer interview for evaluation of cough or sore throat again in the future. 116/143 (81.1%) were willing to use the computer interview for other medical complaints in the future. CONCLUSIONS: Patients are willing to use computer interview-ing and some interviews may be conducted in the waiting room.

Adolescent↗
PubMed2004

The RODS Open Source Project: removing a barrier to syndromic surveillance.

The goal of the Real-time Outbreak and Disease Surveillance (RODS) Open Source Project is to accelerate deployment of computer-based syndromic surveillance. To this end, the project has released the RODS software under the GNU General Public License and created an organizational structure to catalyze its development. This paper describes the design of the software, requested extensions, and the structure of the development effort.

Algorithms↗
PubMed2004

Evaluating the impact of information communication technologies on complex organizational systems: a multi-disciplinary, multi-method framework.

The health informatics research community has been undertaking work at the organization-technology intersection for some time now. However there is no one place in the literature which presents a rigorously-defined evaluation framework for use by practitioners and researchers seeking to assess the impact of information and communication technologies on organizational processes and outcomes. There are two main challenges. One is to conceptualize the design features of such an evaluation framework. The second is to specify what data will be gathered and how. This paper aims to address each of these problems.

Academic Medical Centers↗
PubMed2002

Information architecture for a federated health record server.

This paper describes the information models that have been used to implement a federated health record server and to deploy it in a live clinical setting. The authors, working at the Centre for Health Informatics and Multiprofessional Education (University College London), have built up over a decade of experience within Europe on the requirements and information models that are needed to underpin comprehensive multi-professional electronic health records. This work has involved collaboration with a wide range of health care and informatics organisations and partners in the healthcare computing industry across Europe though the EU Health Telematics projects GEHR, Synapses, EHCR-SupA, SynEx and Medicate. The resulting architecture models have fed into recent European standardisation work in this area, such as CEN TC/251 ENV 13606. UCL has implemented a federated health record server based on these models which is now running in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. The information models described in this paper reflect a refinement based on this implementation experience.

Computer Communication Networks↗
PubMed2004

Advances in biomedical image analysis--past, present and future challenges.

Starting from raw data files coding eight bits of gray values per image pixel and identified with no more than eight characters to refer to the patient, the study, and technical parameters of the imaging modality, biomedical imaging has undergone manifold and rapid developments. Today, rather complex protocols such as Digital Imaging and Communications in Medicine (DICOM) are used to handle medical images. Most restrictions to image formation, visualization, storage and transfer have basically been solved and image interpretation now sets the focus of research. Currently, a method-driven modeling approach dominates the field of biomedical image processing, as algorithms for registration, segmentation, classification and measurements are developed on a methodological level. However, a further metamorphosis of paradigms has already started. The future of medical image processing is seen in task-oriented solutions integrated into diagnosis, intervention planning, therapy and follow-up studies. This alteration of paradigms is also reflected in the literature. As German activities are strongly tied to the international research, this change of paradigm is demonstrated by selected papers from the German annual workshop on medical image processing collected in this special issue.

Electronic Data Processing↗