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Healthcare standards in the US are produced by six standard developers organizations: ACR/NEMA, ASC X12N, ASTM, HL7, IEEE, and NCPDP. The activities of these groups are coordinated through the ANSI HISPP. While considerable progress has been made in the area of data interchange standards, little progress has been made in the area of vocabulary standards.
Looking to the next generation of hospital information systems (HIS), the paper first provides an overview of enterprise systems, including the concept, current developments, hospital perspectives, critical issues and requirements, and future value-added enhancements. The paper then focuses on efforts drawing upon existing expertise in these critical areas, including infrastructure, workstations, standards, computerized patient records, and security. It concludes by stressing the importance of collaborative efforts in the creating of the next generation of HIS, health information systems or HIS.
This is the first in a series of tutorials concerning the simulation of micropopulation models for use in epidemiological research. The series emphasizes the techniques that are in use at the National Micropopulation Simulation Resource at the University of Minnesota. This initial series of tutorials uses chronic disease models, specifically coronary heart disease models, to illustrate the principles and methodologies employed. The series is intended for persons having some familiarity with electronic, digital computation and desiring to know more about a specific class of simulations, namely those that apply Monte Carlo techniques in the simulation of micropopulation models as a part of biomedical research. It is the author's hope that these tutorials will be particularly useful for students in medical informatics; they could also be of interest to professionals in both the computational and the biomedical sciences.
The CENTRASYS system for the Hospital Pharmacy, developed as part of a research project of the Department of Medical Informatics is described. The role of AIDA, a fourth-generation software package, as a prototyping tool is discussed. It is concluded that AIDA facilitates prototyping and is also very suitable as a vehicle for systems in operation. It is further concluded that prototyping is of great help in the developmental phase of a project, but that great care has to be taken during evaluation of the prototypes: minimize the number of test sites and try to avoid that users become dependent on the system, because every prototype needs further tuning before it really becomes an operational system.
A Medical Information System for the Fertility Department has been built (VERGYNIA) using the 4th generation software package AIDA to make the medical data accessible for research and teaching on the one hand and to assist the management of the department in the daily routine of patient care on the other. The system has been implemented on a PDP 11/23 computer with a 20 Mbyte hard disk, a 10 Mbyte removable disk and 128 Kbyte central memory. Three visual display terminals and a small printer are connected to the system. A dedicated line connection between this system and the computer facilities of the Department of Medical Informatics allows easy transfer of data for analysis by statistical packages and the transfer of new programs to the computer of the Fertility Department. The PDP 11/23 contains a production system, a developmental system, and a separate environment for research which can all three run simultaneously on the same computer without interfering with each other. VERGYNIA was predominantly constructed with AIDA; only parts of the output programs have been programmed in MUMPS, due to the fact that the required AIDA tools were not yet available at the time of development. The original version of VERGYNIA was already in operation in 1982 and was built with the tools that form the basis of the current AIDA release. Due to many ad hoc modifications and additions, the system needed a total redesign in order to make it compatible with the new enhancements of the current AIDA release. This redesign was carried out during 1985.
The development of picture archiving and communications systems (PACS) for medical applications can be regarded as a challenging field in medical informatics. Since 1982, several projects have been started into this direction worldwide. The Dutch IMAGIS (Image Information System) project, started in 1984, is one of them. Within this project, a top-down design strategy is chosen, with the following first steps: (1) A thorough information analysis for a Radiology Department, in which both qualitative and quantitative aspects are included. Such an analysis can be used to estimate the workload on a future PACS system. (2) The construction of a flexible performance prediction tool, based on discrete even simulation. Such a tool can be used to predict the performance of a certain computer system configuration under a certain workload. Based on the information analysis, and using the performance prediction tool, a PACS system is drafted for the thorax section of the Diagnostic Radiology Department of the Leiden University Hospital. In this first design attempt, the assumption was made that current working procedures concerning images will be maintained as much as possible.
KNET is an environment for constructing probabilistic, knowledge-intensive systems within the axiomatic framework of decision theory. The KNET architecture defines a complete separation between the hypermedia user interface on the one hand, and the representation and management of expert opinion on the other. KNET offers a choice of algorithms for probabilistic inference. We and our coworkers have used KNET to build consultation systems for lymph-node pathology, bone-marrow transplantation therapy, clinical epidemiology, and alarm management in the intensive-care unit. Most important, KNET contains a randomized approximation scheme (RAS) for the difficult and almost certainly intractable problem of Bayesian inference. Our algorithm can, in many circumstances, perform efficient approximate inference in large and richly interconnected models of medical diagnosis. In this article, we describe the architecture of KNET, construct a randomized algorithm for probabilistic inference, and analyze the algorithm's performance. Finally, we characterize our algorithms' empiric behavior and explore its potential for parallel speedups. From design to implementation, then, KNET demonstrates the crucial interaction between theoretical computer science and medical informatics.
The methodology of RECursive Partition and AMalgamation (RECPAM) previously presented in Parts I and II (A. Ciampi et al., Computer. Methods Progr. Biomed. 26 (1988) 239-256 and 30 (1989) 283-296) pursues its development with an application to predict long-term effects of a disease given a set of clinical information measured at the time of illness. This paper illustrates how RECPAM deals with a situation typical in Medical Informatics applied to data on Haemophilus influenzae type b meningitis.
Magnetoencephalography (MEG) non-invasively infers the distribution of electric currents in the brain by measuring the magnetic fields they induce. Its superb spatial and temporal resolution provides a solid basis for the 'functional imaging' of the brain provided it is integrated with other brain imaging techniques. MAGNOBRAIN is an applied research project that developed tools to integrate MEG with MRI and EEG. These include: (1) software for MEG oriented MRI feature extraction; (2) the Brain Data Base (BDB) which is a reference library of information on the brain used for more realistic and biologically meaningful functional localisations through MEG and EEG; and (3) a database of normative data (age and sex matched) for the interpretation of MEG. It is expected that these tools will evolve into a medical informatics environment that will aid the planning of neurosurgical operations as well as contribute to the exploration of mental function including the study of perception and cognition.
The IREP Project is based on the concept of 'rehabilitation programme' (LLP--Life Long Programme). It consists in a global vision of the patient's therapeutic-rehabilitative path, that is realised by the description, selection, adaptation and evaluation of generalised protocols. This paper discusses the issues arising in the definition of multidisciplinary rehabilitation programmes involving the co-operation of independent teams. A methodology to formalise and collect descriptions of programmes is presented. A programme is considered as a set of interconnected activities, represented as a graph of Activity Modules, organised in Context Trees; the resulting structured representation is the framework to implement timely and effective communication services in a global information system on rehabilitation. Based on this experience, a set of possible requirements for software tools to formalise and manage programmes have been suggested; it was the basis for the realisation of a first prototype under field test in a rehabilitation environment by other partners of the IREP Project.
Generally, health services are not covered by the treaties of the European Community. However, to an increasing extent the EC has and will have an influence on national health systems. In particular the effects of regulations made for other sectors have repercussions for health. For example the free movement of labour and the harmonization initiatives have direct effects on the educational curricula for health professions and may, in time increase professional migration within the community. Within the EC research programmes health related topics have been included to an increasing extent. This goes in particular for medical informatics, standardization, quality assurance systems and pharmaceuticals. Indirect effects of the single market will probably appear within the area of insurance, public purchasing and building and other types of construction works. Other areas that probably will be influenced are record security and occupational health benefits.
Artificial intelligence in medicine (AIM) has reached a period of adolescence in which interactions with the outside world are not only natural but mandatory. Although the basic research topics in AIM may be those of artificial intelligence, the applied issues touch more generally on the broad field of medical informatics. To the extent that AIM research is driven by performance goals for biomedicine, AIM is simply one component within a wide range of research and development activities. Furthermore, an adequate appraisal of AIM research requires an understanding of the research motivations, the complexity of the problems, and a suitable definition of the criteria for judging the field's success. Effective fielding of AIM systems will be dependent on the development of integrated environments for communication and computing that allow merging of knowledge-based tools with other patient data-management and information-retrieval applications. The creation of this kind of infrastructure will require vision and resources from leaders who realize that the practice of medicine is inherently an information-management task and that biomedicine must make the same kind of coordinated commitment to computing technologies as have other segments of our society in which the importance of information management is well understood.
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Heart failure can be the final stage of almost any type of cardiovascular diseases. Such diseases are the leading cause of recurrent hospital stay and mortality in developed countries, and an increasingly important cause of morbidity and mortality in developing countries. In consideration of the growing incidence of this syndrome, the Province of Trento (Northern Italy) supports a research project called e-Heart Failure. The aims of this project include the implementation of a web-based patient record management system which must allow all the professionals involved in the care process to provide a shared and continuous care. This paper emphasizes the role of ontologies in supporting the continuity of care. In a complex scenario where multiple agents co-operate in order to allow continuity of care, ontologies are the essential glue to ensure semantic consistency to data and knowledge shared by the different actors involved in the process, including patients and their families.
OBJECTIVES: The use of IT in health care has merged advanced knowledge and skills for health care professionals. Former studies indicate that basic skills in computer use are no more than comprehensive competencies to manage electronically stored information in health care. The purpose of this paper is to review the literature focusing on the concept information literacy in the field of health, nursing and medical informatics. The target is to find out how information literacy is defined, in what kind of context it is presented and who are the focus of interest. METHODS: An automated literature search was performed on-line to Medline and by using the EndNote Bibliographic Software. All together the number of papers analyzed was 97 or 78% of the total literature search result. RESULTS: The survey indicates that the concept information literacy does not exist as such in the literature, but it can be found as a synonym to 'computer literacy' or even more obscure concepts such as 'informatics awareness' or 'computer experience'. The definitions of these concepts varied considerably. A variety of descriptions of educational programs were also found, none were based on the IMIA recommendations. CONCLUSIONS: In international cooperation such as that of IMIA WG1, a wide range of efforts still needs to be carried out to compile educational programmes in health informatics to enhance knowledge and skills in computer use among health care professionals.
Since clinical management of patients and clinical research are essentially time-oriented endeavours, reasoning about time has become a hot topic in medical informatics. Here we present a method for prognosis of temporal courses, which combines temporal abstractions with case-based reasoning. It is useful for application domains where neither well-known standards, nor known periodicity, nor a complete domain theory exist. We have used our method in two prognostic applications. The first one deals with prognosis of the kidney function for intensive care patients. The idea is to elicit impairments on time, especially to warn against threatening kidney failures. Our second application deals with a completely different domain, namely geographical medicine. Its intention is to compute early warnings against approaching infectious diseases, which are characterised by irregular cyclic occurrences. So far, we have applied our program on influenza and bronchitis. In this paper, we focus on influenza forecast and show first experimental results.