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PubMed1994

Twenty years medical informatics education at Heidelberg/Heilbronn: evolution of a specialized curriculum for medical informatics.

The medical informatics curriculum at University of Heidelberg/School of Technology Heilbronn started in 1972 as a specialized university curriculum. In this paper, we report on 20 years of experience and the evolution of this educational approach with respect to structure and content of the curriculum. We emphasize that this evolution parallels the development of medical informatics to a medical discipline in its own right, with distinct application domains and specific methodological approaches. Based on our experience and on recommendations from the national and international community, we describe and discuss the features of the curriculum.

Curriculum↗
PubMed2002

Evaluation: salvation or nemesis of medical informatics?

The currently prevailing paradigms of evaluation in medical/health informatics are reviewed. Some problems with application of the objectivist approach to the evaluation of real-rather than simulated-(health) information systems are identified. The rigorous application of the objectivist approach, which was developed for laboratory experiments, is difficult to adapt to the evaluation of information systems in a practical real-world environment because such systems tend to be complex, changing rapidly over time, and often existing in a variety of variants. Practical and epistemological reasons for the consequent shortcomings of the objectivist approach are detailed. It is argued that insistence on the application of the objectivist principles to real information systems may hamper rather than advance insights and progress because of this. Alternatives in the form of the subjectivist approach and extensions to both the objectivist and subjectivist approaches that circumvent the identified problems are summarized. The need to include systems engineering approaches in, and to further extend, the evaluation methodology is pointed out.

Evaluation Studies as Topic↗
PubMedDate not supplied

Top-down design of a picture archiving and communications system (PACS) by means of simulation.

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.

Archives↗
PubMedDate not supplied

AIDA and medical courseware.

For more than a decade the Department of Medical Informatics has offered one-week training courses on the subject of computer applications in medicine and health care. Since 1983 two courses are given at a rate of one course every two weeks. One course is on programming and problem solving and consists of three modules of increasing complexity in techniques and methods in programming and structured system development. This course focusses on only some aspects of medical informatics: the development of a medical information system, and the problems occurring in the process of automation. These aspects, however, are dealt with in detail. To this end the students are trained in using the programming system MUMPS and the fourth-generation software package AIDA. The second, introductory course is an intensive training on several distinct areas of man-machine interactions. It contains lessons in the fields of communication and recording; storage and retrieval and databases; computation and automation; recognition and diagnosis; and therapy and control. This paper describes the use of AIDA in developing and maintaining lessons for the latter course, and the assistance of AIDA for teaching purposes in the former course.

Computer User Training↗
PubMed1995

Effective access to distributed heterogeneous medical text databases.

INQUERY is an advanced text information retrieval system developed by the Information Retrieval Laboratory of the University of Massachusetts in Amherst. It is based on Bayesian inference networks, which are probabilistic models for reasoning with multiple sources of uncertain evidence. The evidence, in this case, is the presence or absence of words and/or phrases in a document. Evidence is combined into belief that a document is relevant. The INQUERY retrieval engine has been developed with the support of ARPA, NSF, and industrial funding. It has a number of unique features and has achieved excellent results in the TIPSTER and TREC evaluations. Informatics research and application development using INQUERY has recently begun in the medical domain, including a new ARPA initiative concerned with clinical text. The features that we will focus on in this demonstration are: Automatic processing of natural language queries, including the extraction of phrases and specific medical concepts such as drug doses; Document selection through automatic relevance feedback and routing techniques, including the construction of complex queries using the INQUERY query language; The integration of conventional database techniques with text analysis and retrieval; Automatic thesaurus generation and query expansion using the PhraseFinder system; Distributed database access, including automatic database selection and merging of local searches; this will be demonstrated using a collection of medical databases; Retrieval based on passages, rather than whole documents.

Bayes Theorem↗
PubMed2007

Selected eHealth applications in Cyprus from the training perspective.

OBJECTIVES: In this paper a review of selected eHealth applications in Cyprus is presented linked with their success or failure based on their training activities. METHODS: The eHealth systems presented and their training activities include an update of the health information system (HIS) in the public hospitals, a medical system for emergency telemedicine (AMBULANCE and EMERGENCY-112 projects), a home monitoring system for cancer patients (DITIS), a satellite-based network in healthcare applications (EMISPHER and HEALTHWARE projects), and the training activities of the Cyprus Society of Medical Informatics. Different methodologies for training were used ranging from classical approaches like train the trainers, using demo cases followed by personal training, group training, and workshops, to more recent methodologies based on eLearning sessions including teleconsultations. RESULTS: The training was carried out successfully in all cases. However, not all eHealth systems were put into practice successfully, mainly for reasons not related to training. CONCLUSIONS: It is anticipated that this paper will promote the importance of these applications and their training activities as well as help in the spin off of others thus enabling the offering of a better service to the citizen.

Computer Communication Networks↗
PubMed1993

Computerized management of respiratory care.

Respiratory care as an organized discipline is only about 45 years old, and the management of this dynamic allied health profession has usually been characterized by a demand-for-service mentality. As pressure continues to control costs, those departments that maximize quality patient care cost-effectively with thoroughly documented outcomes are in a better position to compete for future resources. The practice of respiratory care is changing as is the practice of medical care in general. Accountability for resource consumption and the quality of the product delivered are essential elements in the delivery of respiratory modalities. We have developed and implemented a comprehensive patient-data-based approach to the management of respiratory care. The essential elements of this approach are (1) relative-value-unit procedure base; (2) individual, shift, and department productivity that is attached to the annual performance review process; (3) management reporting on a 24-hour basis, with biweekly review at the management level; (4) development and implementation of a comprehensive patient-data-documentation system that permits automatic patient billing and 100% data review for quality-assurance documentation; (5) the development of a medical alerting system that alerts the Medical Director and Respiratory Care staff to potentially harmful events that, if untreated, may result in increased morbidity or mortality; and (6) the development of concurrent and retrospective tools for patient-outcomes research. These functions are supported by an active Medical Informatics Department that is nationally recognized in medical computing and logic application.

Cost-Benefit Analysis↗
PubMed1992

The European Community: standardization in medical informatics and imaging.

The use of informatics and telecommunications in health care and medicine has reached a stage where the application of standards is an absolute requirement. The AIM Programme of the CEC DGXIII stimulated the study of the subject, and has supported the set up of an official European platform for standardization in this field, the CEN TC251. The needs for standardization in one of the subareas, medical imaging, are described in detail. The future solutions of the problems concerned are regarded prerequisites for the general and practical use of PACS and IMACS.

European Union↗
PubMed1998

Medical informatics in the new millennium.

In a period of social transformation, we must reinvent health care. For guidance, we can look to the evolving discipline of medical informatics and to the patterns of investment in the practice arena. A top ranked application need, the computerized patient record (CPR) offers cost savings and supports clinical quality and ambulatory care. In the new millennium, we need to define our values with precision and use technology to achieve quality health care.

Forecasting↗
PubMed1994

Developing a medical informatics education program to support a statewide health information network.

The Florida Health Information Network (FHIN) was established in October 1989 to provide biomedical information services to the University of Florida Health Science Center (HSC) and to health professionals throughout the state--especially the northern thirty-nine counties of the state. FHIN services are available to all affiliates of the HSC and by annual subscription to nonaffiliates. At present, FHIN services include database access, circulation services, document delivery, and information services. Training network users has been an objective since the inception. Training has targeted both the HSC Library staff and HSC users and now is expanding to include remote users. Because many users have had insufficient experience with computers, the library has to teach the mechanics of access and network use and to instruct users regarding applications and database searching. This paper describes the development and implementation of the medical informatics education program. Topics include library staff training; educational offerings for HSC faculty, staff, and students; development and implementation of the remote training program; and organizational and budgetary implications for the construction of such a program.

Computer Communication Networks↗
PubMed1994

From HIS to IAIMS: expanding the scope of information processing applications in a German university hospital.

Since the mid eighties the department of medical informatics at the University Hospital of Giessen (Germany) has been engaged in the development of a comprehensive hospital information system. The installation of a campus wide network has set the basis to provide not only clinical patient-oriented information, but also general information resources for research, medical education and administrative purposes, thus creating an environment which in the U.S. became known as an integrated academic information management system (IAIMS). The underlying concept of the whole approach is to provide one-stop information shopping capabilities at the clinicians and administrators desktop in order to meet the increasing information needs of health professionals with the emerging reality of the potential benefits of computer and communication technologies. This paper describes the various steps performed to realize this concept at Giessen University Hospital and the evaluation results derived from analysis of the acceptance of these new technologies among our hospital staff.

Computer Systems↗
PubMed1999

[Information technology as a support in the area of education].

Decision Support Systems (DSS) are more and more used and developed, mainly within the management area. It is used at strategic level for global planning and managing the organization; at tactical level for short-term planning, process realization and control. Although many authors state that DSS are used only at global and tactical level, some of them--through practical applications--show that specific DSS can be created in order to support decision in other areas than classical management. Paper describes computer application that efficiently supports organisation of exams at The Department for Medical Informatics of Medical Faculty in Tuzla.

Decision Support Techniques↗
PubMed1997

An expert-guided decision tree construction strategy: an application in knowledge discovery with medical databases.

With the steady growth in electronic patient records and clinical medical informatics systems, the data collected for routine clinical use have been accumulating at a dramatic rate. Inter-disciplinary research provides a new generation of computation tools in knowledge discovery and data management is in great demand. In this study, an expert-guided decision tree construction strategy is proposed to offer an user-oriented knowledge discovery environment. The strategy allows experts, based on their expertise and/or preference, to override inductive decision tree construction process. Moreover, by reviewing decision paths, experts could focus on subsets of data that may be clues to new findings, or simply contaminated cases.

Algorithms↗
PubMed2000

Structural relationships within medical informatics.

This study seeks to increase our understanding of the structure of Medical Informatics. In particular, it focuses on the relationships between information science and information technology on the one hand, and biomedical research, clinical practice, and medical education on the other, that have defined "medical informatics." Using indexing terms and MeSH tree structures assigned to medical informatics literature covered by MEDLINE, co-occurrence analysis provides a "map" of the field. Major research and application focuses arrayed within the map elucidate a finer structure than reported previously. Dimensions "Techniques vs. Systems" and "Signs & Symptoms vs. Processes" form the two axes of the map and relate to the relationships underlying the indexing assignments given to the literature studied. Related studies underway using the INSPEC database will provide a complementary perspective on the structure of medical informatics as a field.

Bibliometrics↗
PubMed1997

An information infrastructure for long-term care.

Emerging trends promise to alter the way long-term care is practiced. These include: changing regulation of the nursing home industry with emphasis on outcome and assessment, a trend in medical informatics away from expert systems and toward on-line decision support and reminder systems, and the application of industrial statistical quality management techniques to the realm of human services. Emerging standards such as the Arden Syntax and Unified Medical Language Systems and technologies such as Rapid Application Development Tools will facilitate the use of modern computing to mold and implement these converging trends.

Abstracting and Indexing↗
PubMedDate not supplied

An informatics infrastructure is essential for evidence-based practice.

The contention of the author is that an informatics infrastructure is essential for evidenced-based practice. Five building blocks of an informatics infrastructure for evidence-based practice are proposed: 1) standardized terminologies and structures, 2) digital sources of evidence, 3) standards that facilitate health care data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and 5) informatics competencies. Selected examples illustrate how each of these building blocks supports the application of evidence to practice and the building of evidence from practice. Although a number of major challenges remain, medical informatics can provide solutions that have the potential to decrease unintended variation in practice and health care errors.

Evidence-Based Medicine↗