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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).

Computer Communication Networks↗

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.

Computer Security↗

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.

Computer Communication Networks↗

Confidentiality.

Explore the source record for details and available documents.

Computer Security↗

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.

Community Health Nursing↗

Visual programming languages.

Visual programming languages enable physicians and other computer users with little knowledge of programming to develop computer software. The physician uses a visual paradigm to "draw" the computer interface and then attaches short segments of computer code to buttons, menus, and list boxes. The programs can be written for DOS or Windows and can be used with various printers and input devices (a keyboard, mouse, or pen). This article describes the development of an example of a medical program, which calculates the treadmill score.

Decision Support Techniques↗

Part II--clinical information systems: the nursing interface.

Given the fact that nurses generate over 50 percent of patient information, usable, automated nursing systems are essential. Neglecting the issues of usability of computer systems in healthcare results in poorly designed user interfaces, leaving nurses battling against extremely difficult and hostile systems. Two state-of-the-art technologies and nursing interfaces needed to develop mission-critical Clinical Information Systems are explored.

Computers↗

Portable data acquisition and control apparatus for implanted drug infusion pump interrogation.

Now that implantable drug infusion pumps are well established clinically, methods for diagnosing suspected pump failures are needed. The authors previously constructed a benchtop data acquisition and control apparatus to assist our work in developing new pump technology. Although this device is technically capable of in vivo pump monitoring, it is cumbersome. Thus, they recently created a portable interrogation unit with more limited features. This portable pump interrogation apparatus consists of a 32 bit MS-DOS labtop computer, data acquisition software, an analog/ASCII interface, a pressure transducer, and appropriate fluid conduits. Communication between the device and the implanted pump is via a percutaneous needle puncture of the drug reservoir refill septum. This procedure is identical to that employed in a standard pump refill. Pump performance is evaluated by incrementally filling the pump reservoir while simultaneously measuring reservoir pressure. The resulting data are presented on the computer screen as a plot of pressure versus volume that quickly and simply either eliminates or confirms the reservoir pressure source as a failure mode. Diagnostic runs are saved on file for archival purposes. Their benchtop apparatus has been a valuable and reliable tool over many years of use. The authors believe that their portable apparatus will be equally beneficial.

Data Collection↗

Description and initial applications of the Staggers & Parks Nurse-Computer Interaction Framework.

The authors developed a nurse-computer interaction framework by integrating concepts from human-computer interaction, nursing informatics, and developmental psychology. In this framework, nurses and computers interact in a system of mutual influences, with information being the medium of exchange between them. Nurse behaviors and computer interface actions occur according to their respective characteristics. In turn, the nurse-computer dyad is embedded within a nursing context and moves along a nursing informatics developmental trajectory. A sample of findings from empirical studies is placed in the framework, and framework uses are described.

Computer Simulation↗

Guidelines for creating a simple database.

The advantage of using a simple flat file program is its simplicity and flexibility. The user has control over screen and report design; creating a database that meets the specific needs of a single department is easy and inexpensive. On the other hand, flat file programs have limitations. The main problem with Q&A is the need to duplicate data in two or more files. Other limitations are a result of the menu-oriented system, which requires compromises in report formatting and other areas. Database management systems are improving rapidly. Relational databases are becoming easier to use and can overcome many of the limitations of a flat file system. Flat file systems are becoming more enhanced and are beginning to look relational. Developing a system using a simple flat file approach allows the novice to identify and use information without conceptualizing a relational structure. Information can be entered and used quickly, with a better understanding of how everything works. Fewer things can go wrong and need fixing. Keeping your systems simple and following our other guidelines will allow you to use the computer as a tool to increase productivity.

Database Management Systems↗

User evaluation of an integrated medical workstation for clinical data analysis.

Results are presented of the user evaluation of an integrated medical workstation for support of clinical research. Twenty-seven users were recruited from medical and scientific staff of the University Hospital Dijkzigt, the Faculty of Medicine of the Erasmus University Rotterdam, and from other Dutch medical institutions; and all were given a written, self-contained tutorial. Subsequently, an experiment was done in which six clinical data analysis problems had to be solved and an evaluation form was filled out. The aim of this user evaluation was to obtain insight in the benefits of integration for support of clinical data analysis for clinicians and biomedical researchers. The problems were divided into two sets, with gradually more complex problems. In the first set users were guided in a stepwise fashion to solve the problems. In the second set each stepwise problem had an open counterpart. During the evaluation, the workstation continuously recorded the user's actions. From these results significant differences became apparent between clinicians and non-clinicians for the correctness (means 54% and 81%, respectively, p = 0.04), completeness (means 64% and 88%, respectively, p = 0.01), and number of problems solved (means 67% and 90%, respectively, p = 0.02). These differences were absent for the stepwise problems. Physicians tend to skip more problems than biomedical researchers. No statistically significant differences were found between users with and without clinical data analysis experience, for correctness (means 74% and 72%, respectively, p = 0.95), and completeness (means 82% and 79%, respectively, p = 0.40).(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Systems↗

The development and practical use of information systems in the pharmaceutical industry.

To provide information on the efficacy, safety, and quality of medicine promptly and accurately, we have developed two databases: a literature database with numerical data, and a Drug Information database. By an easy-to-use, company-wide information network system, over 1,000 medical representatives in more than 80 offices throughout Japan can retrieve information. Information derived from the system is displayed on the terminal and the original documents are automatically output through a facsimile.

Databases, Bibliographic↗

Virtual reality in medicine.

Virtual reality (VR), as part of computer science, allows computer-based models of the real world to be generated, and provides humans with a means to interact with these models through new human-computer interfaces and, thus, to nearly realistically experience these models. This contribution explores the technical requirements for VR, describes technological advances and deficits, and analyzes the framework for future technological research and development. Although some non-medical applications are discussed, this contribution focuses primarily on medical applications of VR and outlines future prospects of medical VR applications. Finally, possible hazards arising from the use of VR are discussed. The authors recommend an interdisciplinary approach to technology assessment of VR.

Computer Graphics↗