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At least 1,261 records · Page 70Linked to original sources
PubMed2002

Safe, controllable technology?

In a discussion starting from Haux et al. it is asked, if a safe and controllable technology to implement the patient centered health record is available and which measures must be taken to insure the safety of the record-these include legislation, education, technical measures etc. In addition to the goals set forward in the support for patient empowerment is proposed as another major goal for IT-systems in medicine for the next decade. Finally the role of IT with respect to physicians and patients is discussed: IT systems have the capability to perform tasks that are considered the tasks of physicians and it is likely, that these capabilities will be implemented.

Computer Systems↗
PubMed2002

Information and communication technology in health care: do we need feedback?

Applying information and communication technology (ICT) to a given medical domain is not merely adding a new technique. When applied to a medical domain, ICT has the potential to radically change processes in that domain. In their paper 'Health care in the information society: a prognosis for the year 2013' Haux and co-workers provide us with a set of predictions based on progress in three main areas: (1). patient-centred recording and use of medical data for collaborative care; (2). process-integrated decision support; and (3). comprehensive use of patient data for research and health care reporting. We complement their theses by predicting some of the feedback mechanisms that will develop as ICT is shaping health care. Feedback is return to the input of a part of the output of a mechanism; this part of the input constituting information that reports discrepancies between intended and actual operation and leads to a self-correcting action that can be utilised. We discuss feedback in the areas Haux identifies: the patient record, decision support, and the use of data for research and health care reporting. For each of these domains, we will discuss the output that serves as input, the discrepancies discovered, and the self-correction that will or should follow.

Cooperative Behavior↗
PubMed2002

Commentary on 'health care in the information society. A prognosis for the year 2013'.

The paper, entitled 'Health care in the information society-a prognosis for the year 2013' is in this commentary compared with previous relevant documents. In the paper quantitative prognoses are presented for each of 30 theses. Some developments such as the influence of genomic medicine on health care were not covered by the theses. ICT measures as suggested in the paper are quite acceptable but the paper does not mention side effects of ICT on health care and is therefore a bit unbalanced. As a reference, the Japanese grand design for information-oriented health care is also introduced.

Aged↗
PubMed2002

MEDSYNDIKATE--a natural language system for the extraction of medical information from findings reports.

MEDSYNDIKATE is a natural language processor, which automatically acquires medical information from findings reports. In the course of text analysis their contents is transferred to conceptual representation structures, which constitute a corresponding text knowledge base. MEDSYNDIKATE is particularly adapted to deal properly with text structures, such as various forms of anaphoric reference relations spanning several sentences. The strong demands MEDSYNDIKATE poses on the availability of expressive knowledge sources are accounted for by two alternative approaches to acquire medical domain knowledge (semi)automatically. We also present data for the information extraction performance of MEDSYNDIKATE in terms of the semantic interpretation of three major syntactic patterns in medical documents.

Confidence Intervals↗
PubMed2003

Standards for detailed clinical models as the basis for medical data exchange and decision support.

INTRODUCTION: Detailed clinical models are necessary to exchange medical data between heterogeneous computer systems and to maintain consistency in a longitudinal electronic medical record system. At Intermountain Health Care (IHC), we have a history of designing detailed clinical models. The purpose of this paper is to share our experience and the lessons we have learned over the last 5 years. DESIGN: IHC's newest model is implemented using eXtensible Markup Language (XML) Schema as the formalism, and conforms to the Health Level Seven (HL7) version 3 data types. The centerpiece of the new strategy is the Clinical Event Model, which is a flexible name-value pair data structure that is tightly linked to a coded terminology. DISCUSSION: We describe IHC's third-generation strategy for representing and implementing detailed clinical models, and discuss the reasons for this design.

Decision Support Systems, Clinical↗
PubMed2003

VistA--U.S. Department of Veterans Affairs national-scale HIS.

The Veterans Health Administration of the U.S. Department of Veterans Affairs has a long, successful, and interesting history of using information technology to meet its mission. Each medical center is computerized to a degree that surprises the uninitiated. For example, medical documentation and ordering are computerized at every facility. A sophisticated national infrastructure has been developed to replicate, support, and evolve single-center successes. With advances in inter-facility networking, data sharing, and specialized central support and technical tools, VistA is becoming a single, highly scalable national health information system (HIS) solution. In this paper, we present an historical overview of VistA's development, describe its current functionality, and discuss its emergence as a national-scale hospital information system.

Forms and Records Control↗
PubMed2003

Design and implementation of a web-based HL7 message generation and validation system.

Health level 7 (HL7) is the standard of electronic data interchange in the health domain. We have developed a web-based message generation and validation system for testing the message format of the data exchange among hospitals and health organizations. Compared with other existing ones, this system has incorporated several novel functions that optimize medical data exchange and helps medical students in learning HL7 messages. When receiving HL7 message from another system with the hypertext transmission protocol or accepting an uploaded HL7 message file, the system shows the validation result through a web browser. In this platform, users may input and edit medical data on-line to test and generate standard HL7 messages. The system supports various data formats and is capable of transforming HL7 messages between the standard delimiter format and the extensible markup language format. This system has been successfully passed our system evaluation among 139 student users for HL7 training. Most of the users agreed that the system is helpful for medical data exchange.

Computer Systems↗
PubMed1998

Standardisation in medical image management.

A medical image without the relevant associated data is of no value. What is relevant depends on the use which is to be made of the image. The associated data may be divided into groups associated with the patient, the image data (array size, data type), the image itself (e.g. acquisition method), the requested imaging procedure to which it belongs, graphical, numerical and time information associated with the images, relevant results of other medical procedures, etc. Images, digital images and the associated data must be managed in an efficient manner in order to deliver appropriate patient care. In order to realise fully the potential of digital imaging, digital image data must be transmitted from acquisition units and stored in such a way as to allow appropriate access to health care practitioners in the imaging department, hospital and community. Standards exist for the formatting and transmission of image and related data (Digital Imaging and Communications in Medicine (DICOM). NEMA PS 3.1-PS3.12, The National Electrical Manufacturers Association, Rosslyn, VA, 1992, 1993, 1995; Health Level Seven, An Application Protocol for Electronic Data Exchange In Healthcare Environment, version 2.2, Health Level Seven Inc., Ann Arbor, MI, 1994; Comite European de Normalisation, Technical Committee 251: Medical Informatics) although further work is required in order to improve interoperability. There is some overlap in current standards, thus an important area is the agreement on the scope of the work to be done by different bodies. Standards are lacking in the areas of image management and presentation. Strategies for the efficient use of a memory hierarchy to achieve satisfactory archiving and access must be developed and this depends on the existence of appropriate descriptive data fields. Specific issues exist regarding security of image data. Key areas requiring immediate work are the profiling of descriptive data elements according to different clinical application needs in order to improve interoperability and the development of strategies for evolution from legacy systems to modern networked systems. The best way forward is to consolidate and refine existing specifications.

Data Display↗
PubMed1998

MERIT-9: a patient information exchange guideline using MML, HL7 and DICOM.

To realize clinical data exchange between healthcare providers, there must be many standards in many layers. Terms and codes should be standardized, syntax to wrap the data must be mutually parsable, then transfer protocol or exchange media should be agreed. Among many standards for the syntax, HL7 and DICOM are most successful. However, everything could not be handled by HL7 solely. DICOM is good for radiology images, but, other clinical images are already handled by other 'lighter' data formats like JPEG, TIFF. So, it is not realistic to use only one standard for every area of clinical information. For description of medical records, especially for narrative information, an standard generalized mark-up language, document type definition (SGML DTD) for medical information, called MML (medical markup language) had been created in Japan. It is already implemented in more than ten healthcare providers. However, it is again not realistic to use MML solely for clinical information in various level of detail. Therefore, we proposed a guideline for use of available medical standards to facilitate clinical information exchange between healthcare providers. It is called MERIT-9 (Medical Records, Images, Texts, -Information Exchange). A typical use is HL7 messages, DICOM files, referred from an MML file in a patient record, as external entities. Both MML and MERIT-9 have been research projects of Japanese Ministry of Health and Welfare and the purpose is to facilitate clinical data exchanges. They are becoming to be used in technical specifications for new hospital information systems in Japan.

Community Networks↗
PubMed1999

Development of a cross-thesaurus with Internet-based refinement supported by UMLS.

Combinatorial terminological systems are appearing, to solve the issues related to flexibility and precision of representation requested by modern healthcare information systems and in particular by messaging standards. The development of a robust system of descriptors ('cross-thesaurus') is a crucial activity in the production of combinatorial terminological systems. We developed a tool (I-BROWSE) to produce a cross-thesaurus by analysing existing terminological corpora. To facilitate the work of experts and to produce re-usable results, our application interacts via the Internet with the UMLS Knowledge Sources Server. We applied our tool on 6372 dissections on surgical procedures produced in the project GALEN-IN-USE, as a part of the internal Quality Assurance Program. Support from UMLS seems mostly promising about descriptors on , , and . Additional assistance can be given to domain experts on less frequent descriptors on pervasive modifiers. We plan to apply our tool also to production of terminological standards in CEN, as a part of a world-wide process of gradual convergence and transformation of coding systems into second-generation systems and terminological services.

Databases as Topic↗
PubMedDate not supplied

Protocols and guides, tools.

The author describes in the first part of the review the definitions and relations of the occurring concepts. In the second part a short history of the topic is overviewed. The third part is dealing with the electronic patient record based development of guidelines in addition what are the relations among guidelines, protocols, tools, knowledge-based systems, diagnosis supporting systems, expert systems, outcome analysis and artificial intelligence. A short review of what was presented in the MIE '97 in this area is finally described and the Session Chairman's conclusion.

Computer Communication Networks↗
PubMed1999

Questions on validity of International Classification of Diseases-coded diagnoses.

International Classification of Diseases (ICD) codes are used for indexing medical diagnoses for various purposes and in various contexts. According to the literature and our personal experience, the validity of the coded information is unsatisfactory in general, however the 'correctness' is purpose and environment dependent. For detecting potential error sources, this paper gives a general framework of the coding process. The key elements of this framework are: (1) the formulation of the established diagnoses in medical language; (2) the induction from diagnoses to diseases; (3) indexing the diseases to ICD categories; (4) labelling of the coded entries (e.g. principal disease, complications, etc.). Each step is a potential source of errors. The most typical types of error are: (1) overlooking of diagnoses; (2) incorrect or skipped induction; (3) indexing errors; (4) violation of ICD rules and external regulations. The main reasons of the errors are the physician's errors in the primary documentation, the insufficient knowledge of the encoders (different steps of the coding process require different kind of knowledge), the internal inconsistency of the ICD, and some psychological factors. Computer systems can facilitate the coding process, but attention has to be paid to the entire coding process, not only to the indexing phase.

Abstracting and Indexing↗
PubMed1998

Introducing information technology in the clinical setting. Lessons learned in a trauma center.

Using a case study methodology, we examined the implementation of a nursing flow sheet system in the trauma center of a large, not-for-profit, teaching hospital. Findings add new insights to the existing body of knowledge in the information technology and medical informatics fields. First, results reveal that the success of clinical information systems requires a proactive stance where key actors anticipate and address the challenges ahead and capitalize on opportunities. Second, empirical evidence indicates that project outcomes ultimately depend on how the implementation process is managed and what the organization and its members do with the system once it is introduced. Finally, the case at hand shows that the nature and overall quality of the implementation strategy can be largely predicted by the key actors involved in the project, given their own background, skills, interest, and level of motivation.

Developed Countries↗