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PubMed1996

Computers and medical information: an elective for fourth-year medical students.

The Computers and Medical Information elective is a collaborative effort to expose students to a variety of computer applications for medical information management. The course has a modular format so that students can work with a variety of people who are enthusiastic users of computer-based information systems. The elective emphasizes learning by doing. Faculty introduce concepts and systems and serve as guides in the use of systems. Students have rated the course positively and, after four years as an elective, some of the course's content has been integrated into the required curriculum.

Computer Communication Networks↗
PubMed1998

An educational program in the medical uses of computers for rural physicians.

The Medical College of Ohio and three rural hospitals co-sponsored three educational programs in the medical applications of computers for rural physicians in Northwest Ohio. The College's Outreach Librarian played a major role in the programs. These programs were significant and possibly unique because of the comprehensiveness of the material presented and their focus on training rural physicians. Topics covered in the programs included: basic computer skills; online catalogs; online databases; CD-ROMs; the World Wide Web; and e-mail.

Area Health Education Centers↗
PubMed2003

Three steps to data quality.

BACKGROUND: The quality of data in general practice clinical information systems varies enormously. This variability jeopardizes the proposed national strategy for an integrated care records service and the capacity of primary care organisations to respond coherently to the demands of clinical governance and the proposed quality-based general practice contract. This is apparent in the difficulty in automating the audit process and in comparing aggregated data from different practices. In an attempt to provide data of adequate quality to support such operational needs, increasing emphasis is being placed on the standardisation of data recording. OBJECTIVE: To develop a conceptual framework to facilitate the recording of standardised data within primary care. METHOD: A multiprofessional group of primary care members from the South Thames Research Network examined leading guidelines for best practice. Using the nominal group technique the group prioritized the information needs of primary care organisations for managing coronary heart disease according to current evidence. RESULTS: Information needs identified were prioritized and stratified into a functional framework. CONCLUSION: It has been possible within the context of a primary care research network to produce a framework for standardising data collection. Motivation of front-line clinicians was achieved through the incorporation of their views into the synthesis of the dataset.

Comorbidity↗
PubMed2006

Primary care computing in England and Scotland: a comparison with Denmark.

This paper compares the status of primary care computing in England and Scotland with that of Denmark. The rate of utilisation by Danish GPs is among the highest in the world and the MedCom national health network handles over 90% of the country's primary sector clinical communications. A high proportion of English and Scottish GPs also use computers in their clinical practices, and like their Danish colleagues, they benefit from more accurate and streamlined medications management, particularly in terms of repeat prescriptions. The historical forces and factors which influenced the development of primary care computing are identified and discussed.

Attitude to Computers↗
PubMed2006

Is primary care ready to embrace e-health? A qualitative study of staff in a London primary care trust.

OBJECTIVES: e-Health refers to the organisation and delivery of health services and information using the internet and related technologies. We investigated the perceptions of primary care staff towards e-health initiatives in the NHS Connecting for Health programme and whether front-line staff are ready to implement such changes. DESIGN: Twenty participants from different professional groups were purposively selected for interview, based on their current computer usage. The same practice staff were subsequently observed in order to gain an insight into how they use computers. SUBJECTS: Practice staff (doctors, nurses, practice managers and receptionists) who will be expected to use new information technology and primary care trust (PCT) staff who are involved in its implementation were selected to participate in this study. SETTING: A north London PCT with 62 general practices. Four practices were selected for the study. RESULTS: Analysis of the interviews and the observational data yielded six recurrent themes that have a bearing on readiness to use information and communication systems to support clinical care: perceptions of technology and NHS Connecting for Health; issues relating to resources; patient choice; matters relating to confidentiality and security; political pressures; and how information technology is currently used within primary care. CONCLUSIONS: At the time of the study the systems that form part of NHS Connecting for Health, apart from the Quality Management and Analysis System (QMAS), were not implemented across the PCT. All the practices in the study acknowledged the benefits new technology would bring to the workplace, but there were also some common concerns, which suggest that staff working in primary care practices are not ready for e-health. Successful implementation of the NHS Connecting for Health programme rests on identifying, acknowledging and overcoming these concerns. A different approach might be required for those practices that have made very little progress in using email or moving towards an electronic patient record. This study suggests that a mistrust of technology and fears as to the heavy initial workload involved in becoming fully computerised have dissuaded some practices from embracing e-health. If NHS Connecting for Health is to be a success, implementation teams might need to focus initially on practices that have been reluctant to use technology to support both clinical care and the day-to-day work of the practice.

Attitude to Computers↗
PubMed2004

Information technology for detecting medication errors and adverse drug events.

It is estimated that over three-quarters of a million people are injured or die in hospitals each year from adverse drug events (ADEs). The majority of medical errors result from poorly designed healthcare systems rather than from negligence on the part of healthcare providers. In general, healthcare systems rely on voluntary reporting, which seriously underestimates the number of medication errors and ADEs by as much as 90%. This paper reviews the causes and impact of medication errors and ADEs. It also reports studies that have used information technology (IT) to detect and prevent medication errors and ADEs. Significant reduction of medication errors and ADEs requires systemic implementation of IT, improvements in the reporting of errors, and integration of the components of the healthcare systems' information systems. At the present time, most healthcare systems should be able to use IT to detect and prevent ADEs.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Diagnosis and management of bronchiolitis.

Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm. The American Academy of Pediatrics convened a committee composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics. The committee partnered with the Agency for Healthcare Research and Quality and the RTI International-University of North Carolina Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to the diagnosis, management, and prevention of bronchiolitis. The resulting evidence report and other sources of data were used to formulate clinical practice guideline recommendations. This guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen. Recommendations are made for prevention of respiratory syncytial virus infection with palivizumab and the control of nosocomial spread of infection. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent comprehensive peer review before it was approved by the American Academy of Pediatrics. This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis.

Acute Disease↗
PubMed2002

Information management driven by diagnostic patient data: right information for the right patient.

Existing and future diagnostic technologies are providing a huge amount of data about the patient, which are to be sensibly managed by the treating physician. More than that, the sheer complexity of the interrelation between these data are calling for a radically new approach in the handling of medical data and information. The physician--representing the pivot between the diagnostic knowledge about the patient's condition and the globally available medical information--is to be supported in his decision-making by automated systems that provide the appropriate information in a timeframe and with a degree of detail that is adjusted to the actual needs of the decision process. To find the right drug for the right patient the doctor needs the right information for the right patient. In this article, requirements for a future Medical Data Web are discussed and possible routes to solutions are indicated.

Forecasting↗
PubMed2005

Biomedical data integration: using XML to link clinical and research data sets.

Data integration occurs when a query proceeds through multiple data sets, thereby relating diverse data extracted from different data sources. Data integration is particularly important to biomedical researchers since data obtained from experiments on human tissue specimens have little applied value unless they can be combined with medical data (i.e., pathologic and clinical information). In the past, research data were correlated with medical data by manually retrieving, reading, assembling and abstracting patient charts, pathology reports, radiology reports and the results of special tests and procedures. Manual annotation of research data is impractical when experiments involve hundreds or thousands of tissue specimens resulting in large, complex data collections. The purpose of this paper is to review how XML (eXtensible Markup Language) provides the fundamental tools that support biomedical data integration. The article also discusses some of the most important challenges that block the widespread availability of annotated biomedical data sets.

Data Collection↗
PubMed2026

Enterocutaneous Fistula-Associated Sepsis and Mortality: Development and Validation of a Multimodal Artificial Intelligence Prediction Model.

BACKGROUND: Predicting enterocutaneous fistula (ECF)-associated sepsis and mortality poses significant challenges in digital health care due to the disease's complexity and heterogeneous clinical manifestations. Current approaches that rely on single-modal data or traditional scoring systems often fail to capture the intricate immune-inflammatory dynamics and multisystem involvement in patients with ECF. OBJECTIVE: This study aims to develop an artificial intelligence (AI)-driven multimodal fusion model integrating clinical, imaging, and transcriptomic data for early prediction of ECF-associated sepsis and 28-day mortality, addressing the limitations of conventional single-dimensional models. METHODS: This study leveraged publicly available datasets (Medical Information Mart for Intensive Care III [MIMIC-III], electronic Intensive Care Unit [eICU], and The Cancer Genome Atlas) to construct a multimodal framework. Clinical parameters were processed using Extreme Gradient Boosting, abdominal imaging features were extracted via convolutional neural networks, and transcriptomic profiles were analyzed with variational autoencoders. A Transformer-based fusion network was employed for joint prediction and validated through cross-validation and external testing. Key features were identified using Shapley Additive Explanations and Local Interpretable Model-Agnostic Explanations interpretability algorithms, while immune regulatory mechanisms were explored via weighted gene co-expression network analysis. RESULTS: The multimodal model achieved an area under the curve (AUC) of 0.89 for predicting sepsis and 28-day mortality, outperforming unimodal models (clinical-only model, AUC 0.72, and imaging-only model, AUC 0.78). Critical predictors included Sequential Organ Failure Assessment score, lactate levels, intra-abdominal free fluid on imaging, and immunoregulatory genes (programmed death-ligand 1 [PD-L1] and indoleamine 2,3-dioxygenase 1 [IDO1]). Mechanistic analysis revealed distinct immune reprogramming in patients with sepsis, characterized by increased regulatory T cells and M2 macrophages, along with downregulated cluster of differentiation 8+ (CD8+) T cells. CONCLUSIONS: This multimodal AI model offers an innovative digital solution in medical informatics, enabling precise early risk stratification for ECF-associated sepsis. By integrating multisource data and providing interpretable insights into immune-inflammatory pathways, the model enhances health care quality for patients with ECF and paves the way for personalized intervention strategies.

Humans↗
PubMed2003

[Computing in medical practice].

OBJECTIVES: Currently, information technology is part of several aspects of our daily life. The objective of this paper is to analyze and discuss the use of information technology in both medical education and/or medical practice. SOURCES: Information was gathered through non-systematic bibliographic review, including articles, official regulations, book chapters and annals. Direct search and search of electronic databanks in Medline and Lilacs databases were also performed. SUMMARY OF THE FINDINGS: This paper was structured in topics. First, there is a discussion on the electronic medical record. The following aspects are presented: history, functions, costs, benefits, ethical and legal issues, and positive and negative characteristics. Medical decision-support systems are also evaluated in view of the huge amount of information produced every year regarding healthcare. The impact of the Internet on the production and diffusion of knowledge is also analyzed. Telemedicine is assessed, since it presents new challenges to medical practice, and raises important ethical issues such as "virtual medical consultation." Finally, a practical experience of modernization of a pediatric outpatient center by the introduction of computers and telecommunication tools is described. CONCLUSIONS: Medical computing offers tools and instruments that support the administrative organization of medical visits, gather, store and process patient's data, generate diagnoses, provide therapeutical advice and access to information in order to improve medical knowledge and to make it available whenever and wherever adequate decision-making is required.

Decision Support Systems, Clinical↗
PubMedDate not supplied

PACS cost justification: an industry perspective.

Picture archiving and communication systems (PACS) are seen as an expensive application of computer technology in diagnostic medicine. They are, admittedly, an important expansion of medical informatics into the management of images, but the cost of such systems is not easily justified. Analysis of published data shows that high technology equipment has not significantly contributed to the alarming increase in health care cost in the United States. Furthermore, within the new reimbursement scheme for Medicare procedures radiology costs amount only to less than 5%. The paper gives an analysis of where high cost in PACS is concentrated and suggests ways of justifying the expense of a PAC system.

Cost-Benefit Analysis↗
PubMedDate not supplied

An essay on power of expert systems versus human expertise.

In connection with several recent studies of medical informatics, the usefulness and use of expert systems have been both criticized and defended. We have examined the issue of the inference power of expert systems compared to that of human experts. At an abstract level we have shown that there is no doubt that expert systems could successfully complement human experts within strictly limited and well-defined specialties, and actually be of reasonable aid in diagnosis, provided that the expert systems have been correctly and effectively elaborated. Also practical experiments were conducted with our recently implemented expert system.

Brain Diseases↗
PubMedDate not supplied

Information technology and cancer prevention.

Information technology is rapidly advancing and making its way into many primary care settings. The technology may provide the means to increase the delivery of cancer preventive services. The aim of this systematic review is to examine the literature on information technology impacts on the delivery of cancer preventive services in primary care offices. Thirty studies met our selection criteria. Technology interventions studied to date have been limited to some type of reminder to either patients or providers. Patient reminders have been mailed before appointments, mailed unrelated to an appointment, mailed after a missed appointment, or given at the time of an appointment. Telephone call interventions have not used technology to automate the calls. Provider interventions have been primarily computer-generated reminders at the time of an appointment. However, there has been limited use of computer-generated audits, feedback, or report cards. The effectiveness of information technology on increasing cancer screening was modest at best. The full potential of information technology to unload the provider-patient face-to-face encounter has not been examined. There is critical need to study these new technologic approaches to understand the impact and acceptance by providers and patients.

Humans↗
PubMed1990

The CIO and IRM (information resources management) alliance: maneuvering for the competitive edge in hospital information management.

In 1986, Johns noted that "The hospital industry was caught unprepared for the external demands and information needs required in a case-mix reimbursement environment." Lack of a data-processing philosophy and inattention to external forces were cited as having hampered technology upgrade and integration of financial and clinical databases. The intervening years have witnessed a growth of information dissemination in the health care industry concerning information value and resource management. The frequency of appearance of articles on information management in the professional literature and the number of workshops and professional meetings addressing the topic attest to the current visibility of the information resource. Despite this flurry of interest, the industry has not developed its own models of information resources management nor validated its information evolution with accepted management information systems models. While interest in health care information resource management exists, understanding of the complex issues in this area has not developed as one would expect. While there are a myriad of reasons for this, a contributing factor is the lack of a research foundation for development and application of theory and models. Even though various graduate programs exist in medical informatics and biomedical computing, few concentrate on the study of health information resource management from an organizational perspective. Because of this, academic research in the area has been minimal. The scarcity of graduate-level programs has also meant that few individuals have been educated to deal with the challenges of managing the many disparate functional activities associated with health care information resource management. Due to a variety of internal and external forces, extreme demands were placed on the hospital information resource during the past decade.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital Administrators↗