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Computer interview for screening blood donors for risk of HIV transmission.
To test the ability of a computer-based interview to detect factors related to the risk of the human immunodeficiency virus (HIV) among potential blood donors, and to determine donor reactions to the use of the computer, we compared the rate of detection of HIV-related factors elicited by the computer interview with the rate elicited by standard American Red Cross procedures (written questionnaires and face-to-face interviews) for assessment of donor suitability. The study was performed at a Red Cross blood donor center and a hospital. A consecutive sample of 294 male and female blood donors 18 to 75 years of age participated in a randomized crossover trial in which the order of the two methods was reversed. Among 272 prospective donors who provided complete data, the computer identified 12 who reported either behavior associated with a risk of acquiring HIV or symptoms compatible with AIDS. None of these 12 was so identified by face-to-face interviews or written questionnaires. Only one used the confidential unit exclusion procedure to prevent use of his donated blood. Tests for antibody to HIV were negative in blood from all 272 subjects. The subjects enjoyed the computer interview and judged it to be more private than the standard method for donor assessment.
Transfer of laboratory data from a mainframe to a microcomputer: an interim approach.
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Expert systems as computer assisted instruction systems for nursing education and training.
The ever-increasing specialization of nursing care may require nursing professionals to provide nursing care outside of their specialty. Nurses will have to familiarize themselves with a new specialization area at short notice. Fortunately, expert-systems technology can prove particularly helpful in achieving this familiarity. As such, this technology can prove a valuable tool for education and training of nursing professionals and students. This article describes the unique edge that expert systems technology provides in this context. Using VP-Expert, an expert system shell, the authors present two examples to illustrate the development of a computer aided instruction system and the unique benefits such a system offers.
Rehabilitation technology: exploitation of R&D and current technologies.
This paper summarizes the contributions made by all of the authors in Session (1) of the 1st TIDE Congress and highlights the potentialities for exploitation of research and developments in areas of technology relevant to aspects of interfaces relating to visual perception, facilitation of human communication, prosthetics and orthotics, robotics and signal processing. Means by which promising technological developments can be expedited for more widespread availability are discussed together with aspects of consumer involvement and teamwork through consortia of relevant expertise.
A system for integrated ECG analysis.
A system for combined analysis of resting, rhythm and exercise electrocardiograms has been developed. Also an "expert" module for rule-based processing with backward chaining for reasoning has been implemented. The system can be used for routine ECG analysis as well as for research and teaching in electrocardiography.
Nurse-computer interaction: staff performance outcomes.
The purpose of this study was to examine the relationship of nurses' cognitive and demographic characteristics to their information retrieval speed, accuracy, and subjective screen satisfaction during on-line interactions with three different computer screens. One hundred ten randomly selected female clinical nurses interacted with computer screens of varying information densities. Age, spatial memory, and spatial visualization were significant predictors for nurses' practiced and overall performance speeds. Age was an important variable across screens; the cognitive variables, however, differed according to screen types. Age was a predictor of nurses' practiced accuracy, while both age and spatial visualization predicted overall accuracy scores. Perceptual speed was not a significant predictor in any equations, and none of the nurse characteristics predicted subjective screen satisfaction.
The technical conditions for an open architecture.
The development of Open Systems Architecture and the extensive networked interconnection of Health and Hospital Information Systems (HIS) offer great opportunities for improved care, but simultaneously these facilities pose a great danger to the overall security of the information held. The Geneva University Hospital which has built up it centralized informatics system over the last twenty years must now bring about the conditions for a migration towards open system, for although during the last ten years there have been declarations of intent, this architecture is still a long way from final implementation. Like others, the DIOGENE system (the Geneva HIS) has had to face difficult choices especially due to its own successful situation at the end of the eighties. This paper gives a brief explanation of the technical conditions needed in order to fully migrate towards an open system. The first choices towards obtaining optimum communication standards, operating systems and database management systems were the easiest. The real difficulties occurred when deciding on the choice for management tools in this open environment.
Security Audit Center--a suggested model for effective audit strategies in health care informatics.
As dependence upon interorganizational and international health care informatics becomes absolute, and with increased vulnerability of information networks and applications and the cunning sophistication of computer criminals, it becomes imperative to implement tight information systems security to ward off any possible threat to these vital life-dependent information systems. In a rapidly decentralizing environment, the author proposes centralized security control, implemented in a Security Audit Center under the direct supervision of an Information Systems Security Manager who is a high-ranking organization staff member. Of the various components of the Security Audit Center, the most significant is the security audit expert systems which analyze audit data files according to security rules and present a precise status of systems security and realtime suspicion alert of the various breaches and intrusions.
An accountability server for health care information systems.
The paper starts off by first briefly discussing the necessary ethical, legal and administrative/management controls that are required before the mechanisms of accountability controls can be implemented in automated clinical patient record systems. After these social aspects are discussed the technical aspects of the ALS are outlined. The security concepts of the ECMA framework are reviewed and used to explain the technical design of the ALS. A walk-through of the server in a typical patient record transaction is used to explain the operations of the server. The paper concludes with a general discussion of the usefulness of accountability mechanisms in making security in health care information work in practice.
Security for decentralized health information systems.
Health care information systems must reflect at least two basic characteristics of the health care community: the increasing mobility of patients and the personal liability of everyone giving medical treatment. Open distributed information systems bear the potential to reflect these requirements. But the market for open information systems and operating systems hardly provides secure products today. This 'missing link' is approached by the prototype SECURE Talk that provides secure transmission and archiving of files on top of an existing operating system. Its services may be utilized by existing medical applications. SECURE Talk demonstrates secure communication utilizing only standard hardware. Its message is that cryptography (and in particular asymmetric cryptography) is practical for many medical applications even if implemented in software. All mechanisms are software implemented in order to be executable on standard-hardware. One can investigate more or less decentralized forms of public key management and the performance of many different cryptographic mechanisms. That of, e.g. hybrid encryption and decryption (RSA+DES-PCBC) is about 300 kbit/s. That of signing and verifying is approximately the same using RSA with a DES hash function. The internal speed, without disk accesses etc., is about 1.1 Mbit/s. (Apple Quadra 950 (MC 68040, 33 MHz, RAM: 20 MB, 80 ns. Length of RSA modulus is 512 bit).
Developing health information systems using safety management procedures and formal development methods.
This paper reports on the MORSE project that aims to produce a coherent approach to the development of reusable software for safety critical systems. Within the project there are three case studies, each using RAISE, a formal language and formal development method. The case study dealing with the redevelopment of a clinical laboratory system is used for illustration.
The AIM SEISMED guidelines for system development and design.
Discussion of the process of drafting guidelines that provide managers within the Health Care Establishments with guidance on how to ensure that safety, security and soundness aspects are taken care of in the development and design of new systems to be used within their establishments. The resulting guidelines focus on requirements for organisations which are involved in the development and design of (secure) information systems to be used in a health care environment, where confidentiality, integrity and availability of the stored data is of the utmost importance. Because of the importance of one European direction in constructing and maintaining secure environments we took the ITSEC criteria as the main guide.
Security requirements for electronic patients records: the Norwegian view.
Information security, including secrecy, privacy and data integrity, quality and availability, are fundamental issues when electronic patient records are introduced and used. In this paper we outline the results of a project that KITH carried out on an assignment from the Norwegian Ministry of Health. We describe the general and detailed requirements set up in the project for electronic patient records, and to the hospitals that take such into use. We believe that these requirements are the minimum necessary to give a positive answer to the question of whether electronic patient records can meet all the security-related requirements and intentions given by current regulations. In our work we have focused on secrecy, privacy and data integrity, but also on elaborating requirements that allow a user friendly and suitable implementation of electronic patient record systems.
Epidemiology for community health nursing: an interactive computer assisted instruction program.
Epidemiology and its application to community health nursing is an essential concept for baccalaureate nursing students. To facilitate student learning, nursing faculty chose to use computer assisted instruction (CAI) as an adjunct teaching-learning strategy. An interdisciplinary team, including nursing content specialists and a computer programmer, produced an interactive CAI that integrated epidemiologic content, community health nursing practice, and learning-theory principles. Contents of the program modules are described, and program strategies used to enhance learning are delineated. Evaluation of the program indicated students (N = 106) believed the content was clearly explained and preferred learning epidemiology through combining classroom learning with CAI rather than through textbook reading assignments.
Computer networks as a medical resource. Accessing and using the Internet.
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EquipTeach: a computer-aided instruction to teach users how to operate specific medical equipment.
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