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PubMed2005

Effects of using a computer in a doctor's office on patient attitudes toward using computerized prompts in routine care.

BACKGROUND: We undertook this investigation to understand the effect of using a computer in a primary care setting on attitudes toward using computers to improve health services delivery. METHODS: In this analysis, we compared the acceptability data from the group of primary care patients from 10 community-based practices who did not use a computer program, and answered the questions hypothetically, with data from a group of patients who actually used a program such as one proposed in the survey taken by the first group of patients. Attitudes toward three uses of the program, screening, counseling and changing treatments were measured, as well as attitudes toward specific aspects of the program, such as security. RESULTS: The great majority of patients who used the program believed that the program was not too long (80.1%), was easy to use (82.3%) and that the questions were not hard to answer (75.7%). Also, on average only 20% of patients had concerns about the privacy and confidentiality of using the program. Patients who had used the computer program were significantly less likely to favor its use for screening [odds ratio (OR)=0.09, 95% confidence interval (CI)=0.04-0.19], counseling [OR=0.13 (95% CI=0.05-0.31)] and changing treatments for chronic conditions, such as hypertension [OR=0.12 (95% CI=0.07-0.23)]. Patients who felt that the computer took too long to use were less likely to favor its use for each of the three uses. CONCLUSIONS: Despite acceptability ratings that were high and consistent with ratings observed in other studies, exposure to the program significantly diminished support for using it in routine care. These findings highlight the need for measuring overall program acceptability in the context of a realistic use scenario and for correlating overall acceptability with acceptability of individual program components and attitudes, as a means for identifying opportunities for program improvement.

Adult↗
PubMed2005

Databases for knowledge discovery. Examples from biomedicine and health care.

Examples are given of the use of large research databases for knowledge discovery. Such databases are not only increasingly used for research in the 'hard' mathematics-based disciplines such as physics and engineering but also in more 'soft' disciplines, such as sociology, psychology and, in general, the humanities. In between the 'hard' and the 'soft' disciplines lie disciplines such as biomedicine and health care, from which we have selected our illustrations. This latter area can be subdivided into: (1) fundamental biomedical research, related to the 'hard' scientific approach; (2) clinical research, using both 'hard' and 'soft' data and (3) population-based research, which can be subdivided into prospective and retrospective research. The examples that we shall offer are representative for using computers in scientific research in general, but in medical and health informatics in particular.

Biomedical Research↗
PubMed2006

Context awareness in health care: a review.

BACKGROUND: Health care systems will integrate new computing paradigms in the coming years. Context-awareness computing is a research field which often refers to health care as an interesting and rich area of application. AIM: Through a survey of the research literature, we intended to derive an objective view of the actual dynamism of context awareness in health care, and to identify strengths and weaknesses in this field. METHODS: After discussing definitions of context, we proposed a simple framework to analyse and characterize the use of context through three main axes. We then focused on context-awareness computing and reported on the main teams working in this area. We described some of the context-awareness projects in health care. A deeper analysis of the hospital-based projects demonstrated the gap between recommendations expressed for modelling context awareness and the actual use in a prototype. Finally, we identified pitfalls encountered in this area of research. RESULTS: A number of opportunities remain for this evolving field of research. We found relatively few groups with such a specific focus. As yet there is no consensus as to the most appropriate models or attributes to include in context awareness. We conclude that a greater understanding of which aspects of context are important in a health care setting is required; the inherent sociotechnical nature of context-aware applications in health care; and the need to draw on a number of disciplines to conduct this research.

Biomedical Technology↗
PubMed2006

An e-consent-based shared EHR system architecture for integrated healthcare networks.

OBJECTIVES: Virtual integration of distributed patient data promises advantages over a consolidated health record, but raises questions mainly about practicability and authorization concepts. Our work aims on specification and development of a virtual shared health record architecture using a patient-centred integration and authorization model. METHODS: A literature survey summarizes considerations of current architectural approaches. Complemented by a methodical analysis in two regional settings, a formal architecture model was specified and implemented. RESULTS: Results presented in this paper are a survey of architectural approaches for shared health records and an architecture model for a virtual shared EHR, which combines a patient-centred integration policy with provider-oriented document management. An electronic consent system assures, that access to the shared record remains under control of the patient. A corresponding system prototype has been developed and is currently being introduced and evaluated in a regional setting. CONCLUSION: The proposed architecture is capable of partly replacing message-based communications. Operating highly available provider repositories for the virtual shared EHR requires advanced technology and probably means additional costs for care providers. Acceptance of the proposed architecture depends on transparently embedding document validation and digital signature into the work processes. The paradigm shift from paper-based messaging to a "pull model" needs further evaluation.

Computer Communication Networks↗
PubMed2002

Improving system quality through software evaluation.

The role of evaluation is examined with respect to quality of software in healthcare. Of particular note is the failure of the Therac-25 radiation therapy machine. This example provides evidence of several types of defect which could have been detected and corrected using appropriate evaluation procedures. The field of software engineering has developed metrics and guidelines to assist in software evaluation but this example indicates that software evaluation must be extended beyond the formally defined interfaces of the software to its real-life operating context.

Evaluation Studies as Topic↗
PubMed1986

Cardiology office computer use: primer, pointers, pitfalls.

An office computer is a utility, like an automobile, with benefits and costs that are both direct and hidden and potential for disaster. For the cardiologist or cardiovascular surgeon, the increasing power and decreasing costs of computer hardware and the availability of software make use of an office computer system an increasingly attractive possibility. Management of office business functions is common; handling and scientific analysis of practice medical information are less common. The cardiologist can also access national medical information systems for literature searches and for interactive further education. Selection and testing of programs and the entire computer system before purchase of computer hardware will reduce the chances of disappointment or serious problems. Personnel pretraining and planning for office information flow and medical information security are necessary. Some cardiologists design their own office systems, buy hardware and software as needed, write programs for themselves and carry out the implementation themselves. For most cardiologists, the better course will be to take advantage of the professional experience of expert advisors. This article provides a starting point from which the practicing cardiologist can approach considering, specifying or implementing an office computer system for business functions and for scientific analysis of practice results.

Cardiology↗
PubMedDate not supplied

How can usability measurement affect the re-engineering process of clinical software procedures?

As a consequence of the dramatic improvements achieved in information technology standards in terms of single hardware and software components, efforts in the evaluation processes have been focused on the assessment of critical human factors, such as work-flow organisation, man-machine interaction and, in general, quality of use, or usability. This trend is particularly valid when applied to medical informatics, since the human component is the basis of the information processing system in health care context. With the aim to establish an action-research project on the evaluation and assessment of clinical software procedures which constitute an integrated hospital information system, the authors adopted this strategy and considered the measurement of perceived usability as one of the main goals of the project itself: the paper reports the results of this experience.

Evaluation Studies as Topic↗
PubMed1999

The General Practice computer system project: a doctor's desktop for Australia.

The Australian Department of Health and Family Services engaged the IBM consulting practice to develop a functional specification and technical architecture for a General Practice computer system (GPCS) in January, 1997. The project was completed in September, 1997. This paper describes the rationale for development of the specification, the process that was undertaken and provides an overview of the completed specification and architecture. The paper also explores a number of issues related to computing in general practice which were raised during the consultative process, and considers factors which were found to be important in obtaining adoption and use of computer technology on the doctor's desk.

Australia↗
PubMedDate not supplied

A variance-based measure of inter-rater agreement in medical databases.

The increasing use of encoded medical data requires flexible tools for data quality assessment. Existing methods are not always adequate, and this paper proposes a new metric for inter-rater agreement of aggregated diagnostic data. The metric, which is applicable in prospective as well as retrospective coding studies, quantifies the variability in the coding scheme, and the variation can be differentiated in categories and in coders. Five alternative definitions were compared in a set of simulated coding situations and in the context of mortality statistics. Two of them were more effective, and the choice between them must be made according to the situation. The metric is more powerful for larger numbers of coded cases, and Type I errors are frequent when coding situations include different numbers of cases. We also show that it is difficult to interpret the meaning of variation when the structures of the compared coding schemes differ.

Computer Simulation↗
PubMed2002

Does size really matter--using a decision tree approach for comparison of three different databases from the medical field of acute appendicitis.

Decision trees have been successfully used for years in many medical decision making applications. Transparent representation of acquired knowledge and fast algorithms made decision trees one of the most often used symbolic machine learning approaches. This paper concentrates on the problem of separating acute appendicitis, which is a special problem of acute abdominal pain, from other diseases that cause acute abdominal pain by use of an decision tree approach. Early and accurate diagnosing of acute appendicitis is still a difficult and challenging problem in everyday clinical routine. An important factor in the error rate is poor discrimination between acute appendicitis and other diseases that cause acute abdominal pain. This error rate is still high, despite considerable improvements in history-taking and clinical examination, computer-aided decision-support, and special investigation such as ultrasound. We investigated three databases of different size with cases of acute abdominal pain to complete this task as successful as possible. The results show that the size of the database does not necessary directly influence the success of the decision tree built on it. Surprisingly we got the best results from the decision trees built on the smallest and the biggest database, where the database with medium size (relative to the other two) was not so successful. Despite this we were able to produce decision tree classifiers that were capable of producing correct decisions on test data sets with accuracy up to 84%, sensitivity to acute appendicitis up to 90%, and specificity up to 80% on the same test set.

Acute Disease↗
PubMed2003

The impact of medical technology on office workflow.

Digital technologies are gaining wider acceptance within the medical and dental professions. The lure of increased productivity and improved quality entice practices to adapt. These systems are beginning to have a profound impact on the workflows within the practice, as well as putting new demands on existing resources. To successfully implement a new technology within your practice, you must look beyond advertising and discover the real requirements of the system. Vendors rarely try to help beyond the sale and installation of their equipment, nor do they consider how their product might require you to modify the way you and your staff work. Acquiring the necessary knowledge through self-education, a consultant, or (preferably) a combination of the two is the best way to integrate a new technology with your practice.

Computer Systems↗
PubMedDate not supplied

The end of print: digitization and its consequence--revolutionary changes in scholarly and social communication and in scientific research.

The transformation from print to digital media for scientific communication, driven in part by the growth of the Internet and the tremendous explosion in the amount of information now available to everybody, is creating fundamental changes in institutions such as publishers, libraries, and universities that primarily exist for the creation, management, and distribution of information and knowledge. Scientific, technological, and medical journals are the first publications to be completely transformed from print to digital format but monographs are beginning to appear in digital format as well and soon all communication and publishing of scientific information will be entirely electronic. In fact, this change is affecting all components of the scientific enterprise, from personal correspondence and laboratory methods to peer reviewing and the quality assessment of scientific research. Along with these radical and rapid changes in information presentation and distribution are coincident changes in the expectations of both the public and other scientists, with both groups demanding ever more rapid, open, and global access to scientific information than has been available in the past. The consequence of this revolution in the mechanics of communications technology is threatening the very existence of a number of highly regarded institutions such as intellectual property, commercial publishers, scientific societies, and academic libraries and might soon begin to threaten even the traditional university.

Communication↗
PubMed1997

Applying object-oriented technologies in modeling and querying temporally oriented clinical databases dealing with temporal granularity and indeterminacy.

The need of managing temporal information given at different levels of granularity or with indeterminacy is common to many application areas. Among them, we focus on clinical data management. Different time granularities and indeterminacy are also needed in querying temporal databases. In this paper, we describe GCH-OSQL (Granular Clinical History-Object Structured Query Language), an object-oriented temporally-oriented extension of SQL. GCH-OSQL is based on an object-oriented temporal data model, GCH-OODM. GCH-OODM allows storage of clinical information at different and mixed granularities or with temporal indeterminacy. GCH-OSQL deals with the valid time of clinical information. The temporal extension of the SELECT construct includes the addition of the TIME-SLICE and MOVING WINDOW clauses, and the capability to reference the temporal dimension of objects in the WHERE and SELECT clauses. Using object-oriented technologies, a system prototype for GCH-OSQL and GCH-OODM has been implemented and applied to data management of follow-up patients after coronary angioplasty intervention.

Computer Simulation↗
PubMed1992

In search of a perfect partnership.

There's no question that our partnership is a natural, given the technological emphasis in modern medicine. My comments are not intended as criticism, but offered in the spirit of broadening our mutual understanding. I believe that open communication will enhance our continued collaboration in this interdisciplinary effort and yield significant advances in medical science.

Algorithms↗