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What has come to be known as the "Woods Hole course", Biomedical Informatics, is a week-long course sponsored by the National Library of Medicine which has been offered since 1992. Its participants include librarians, clinicians, educators, and administrators. This article discusses the content of the course and its applicability to medical librarians.
BACKGROUND: As genomics becomes increasingly relevant to medicine, medical informatics and bioinformatics are gradually converging into a larger field that we call computational biomedicine. OBJECTIVES: Developing a computational framework that is common to the different disciplines that compose computational biomedicine will be a major enabler of the further development and integration of this research domain. METHODS: Probabilistic graphical models such as Hidden Markov Models, belief networks, and missing-data models together with computational methods such as dynamic programming, Expectation-Maximization, data-augmentation Gibbs sampling, and the Metropolis-Hastings algorithm provide the tools for an integrated probabilistic approach to computational biomedicine. RESULTS AND CONCLUSIONS: We show how graphical models have already found a broad application in different fields composing computational biomedicine. We also indicate several challenges that lie at the interface between medical informatics, statistical genomics, and bioinformatics. We also argue that graphical models offer a unified framework making it possible to integrate in a statistically meaningful way multiple models ranging from the molecular level to cellular and to clinical levels. Because of their versatility and firm statistical underpinning, we assert that probabilistic graphical models can serve as the lingua franca for many computationally intensive approaches to biology and medicine. As such, graphical models should be a foundation of the curriculum of students in these fields. From such a foundation, students could then build towards specific computational methods in medical informatics, medical image analysis, statistical genetics, or bioinformatics while keeping the communication open between these areas.
Interest in decision-support programs for clinical medicine soared in the 1970s. Since that time, workers in medical informatics have been particularly attracted to rule-based systems as a means of providing clinical decision support. Although developers have built many successful applications using production rules, they also have discovered that creation and maintenance of large rule bases is quite problematic. In the 1980s, several groups of investigators began to explore alternative programming abstractions that can be used to build decision-support systems. As a result, the notions of "generic tasks" and of reusable problem-solving methods became extremely influential. By the 1990s, academic centers were experimenting with architectures for intelligent systems based on two classes of reusable components: (1) problem-solving methods--domain-independent algorithms for automating stereotypical tasks--and (2) domain ontologies that captured the essential concepts (and relationships among those concepts) in particular application areas. This paper highlights how developers can construct large, maintainable decision-support systems using these kinds of building blocks. The creation of domain ontologies and problem-solving methods is the fundamental end product of basic research in medical informatics. Consequently, these concepts need more attention by our scientific community.
This article presents a description and case study of CiteSpace II, a Java application which supports visual exploration with knowledge discovery in bibliographic databases. Highly cited and pivotal documents, areas of specialization within a knowledge domain, and emergence of research topics are visually mapped through a progressive knowledge domain visualization approach to detecting and visualizing trends and patterns in scientific literature. The test case in this study is progressive knowledge domain visualization of the field of medical informatics. Datasets based on publications from twelve journals in the medical informatics field covering the time period from 1964-2004 were extracted from PubMed and Web of Science (WOS) and developed as testbeds for evaluation of the CiteSpace system. Two resulting document-term co-citation and MeSH term co-occurrence visualizations are qualitatively evaluated for identification of pivotal documents, areas of specialization, and research trends. Practical applications in bio-medical research settings are discussed.
Barely more than 15 years have passed since electronic memory cards appeared, their popularity has grown rapidly (first of all as a cash-saving device and later for other purposes, as well). This is due also to the growing interest towards development of the intelligence of information systems for the follow-up of patients' health condition and medical care in countries with a highly developed health and insurance system (need for the creation of data bases divided for individuals) and also to their commitment towards a better control of the quality and costs of health care. We can come to the conclusion that the aim of research, development and the creation of systems in health informatics is to prevent illness and to give a direct informatic support to medical and nursing activity carried out in the patients' interests. The smart card and the surrounding application systems are certainly the appropriate means for the achievement of these aims.
CONTEXT: To better provide medical students with the knowledge, skills, attitudes, and values they will need as physicians, US medical schools continue to make ongoing changes to their staffing and curricula. OBJECTIVE: To review the status of US medical education in the 2002-2003 academic year, compared with 1997-1998. DATA SOURCES: The Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire, the Association of American Medical Colleges (AAMC) Databook, and the AAMC Data Warehouse: Applicant Matriculant File. Data evaluated included those on medical school faculty, applicants, and students; curriculum hours devoted to new multidisciplinary or nontraditional subject areas (eg, cultural diversity, evidence-based medicine, medical ethics, medical informatics); and methods used to evaluate student learning. DATA SYNTHESIS: The number of full-time faculty members in the 126 LCME-accredited medical schools increased from 96 773 in 1997-1998 to 109 526 in 2002-2003 (+13.2%). The number of applicants entering decreased from 43 016 in 1997-1998 to 33 625 in 2002-2003 (-21.8%). The number of enrollees remained virtually unchanged from 1997-1998 (66 748) to 2002-2003 (66 677). Most medical schools have incorporated new subject areas into their curricula, although time devoted to these areas varies across schools. Schools typically use written examinations (National Board of Medical Examiners subject tests and/or internally prepared examinations) to assess factual knowledge, and observations by faculty members and residents to assess clinical skills. Use of standardized methods (eg, an objective structured clinical examination [OSCE]) to assess clinical skills is variable; 82 schools use a final third- or fourth-year comprehensive OSCE; 53 require a passing OSCE score for graduation. CONCLUSIONS: While the number of applicants to US medical schools has continued to decline, student numbers are constant. The number of full-time faculty members has increased. Schools are incorporating new subject areas into their curricula, and the use of standardized methods of assessing clinical skills, while variable, is generally increasing.
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.
The Canon Group is an informal organization of medical informatics researchers who are working on the problem of developing a "deeper" representation formalism for use in exchanging data and developing applications. Individuals in the group represent experts in such areas as knowledge representation and computational linguistics, as well as in a variety of medical subdisciplines. All share the view that current mechanisms for the characterization of medical phenomena are either inadequate (limited or rigid) or idiosyncratic (useful for a specific application but incapable of being generalized or extended). The Group proposes to focus on the design of a general schema for medical-language representation including the specification of the resources and associated procedures required to map language (including standard terminologies) into representations that make all implicit relations "visible," reveal "hidden attributes," and generally resolve ambiguous or vague references. The Group is proceeding by examining large numbers of texts (records) in medical sub-domains to identify candidate "concepts" and by attempting to develop general rules and representations for elements such as attributes and values so that all concepts may be expressed uniformly.
Communication makes up a very important part of the daily practice of health professionals. Current trends in health care indicate that this will even increase. However, the explicit application of Information and Communication Technologies (ICT) in order to support communication is relatively rare. This leaves a great potential of ICT in health care unused. The clinical informatics group at the Leiden University Medical Centre has established a research program which aims at eliciting, analysing, and specifying requirements for communication supporting ICT-applications in health care. Several research projects are part of this program already. Two of these, that focus on supporting a specific kind of health professional/client communication, are discussed in this paper against the background of the research program.
OBJECTIVE: This article highlights technology innovations in psychiatric and medical education, including applications from other fields. METHOD: The authors review the literature and poll educators and informatics faculty for novel programs relevant to psychiatric education. RESULTS: The introduction of new technologies requires skill at implementation and evaluation to assess the pros and cons. There is a significant body of literature regarding virtual reality and simulation, including assessment of outcomes, but other innovations are not well studied. CONCLUSIONS: Innovations, like other uses of technology, require collaboration between parties and integration within the educational framework of an institution.
OBJECTIVE: The development of tailor-made domain-specific modeling languages is sometimes desirable in medical informatics. Naturally, the development of such languages should be guided. The purpose of this article is to introduce a set of requirements for such languages and show their application in analyzing and comparing existing modeling languages. DESIGN: The requirements arise from the practical experience of the authors and others in the development of modeling languages in both general informatics and medical informatics. The requirements initially emerged from the analysis of information modeling techniques. The requirements are designed to be orthogonal, i.e., one requirement can be violated without violation of the others. RESULTS: The proposed requirements for any modeling language are that it be "formal" with regard to syntax and semantics, "conceptual," "expressive," "comprehensible," "suitable," and "executable." The requirements are illustrated using both the medical logic modules of the Arden Syntax as a running example and selected examples from other modeling languages. CONCLUSION: Activity diagrams of the Unified Modeling Language, task structures for work flows, and Petri nets are discussed with regard to the list of requirements, and various tradeoffs are thus made explicit. It is concluded that this set of requirements has the potential to play a vital role in both the evaluation of existing domain-specific languages and the development of new ones.
Ontology is no longer a mere research topic, but its relevance has been recognized in several practical fields. Current applications areas include natural language translation, e-commerce, geographic information systems, legal information systems and biology and medicine. It is the backbone of solid and effective applications in health care and can help to build more powerful and more interoperable medical information systems. The design and implementation of ontologies in medicine is mainly focused on the re-organization of medical terminologies. This is obviously a difficult task and requires a deep analysis of the structure and the concepts of such terminologies, in order to define domain ontologies able to provide both flexibility and consistency to medical information systems. The aim of this special issue of Computers in Biology and Medicine is to report the current evolution of research in biomedical ontologies, presenting both papers devoted to methodological issues and works with a more applicative emphasis.
The chief aspects of this paper are the condition of the birth of life informatics and its tasks, basic concepts, principles, and structure. There are three phases of combining informatics with medicine: product, technological, and theoretic application of which the goals are respectively the informatization of numerical and word processing, data of medical treatment, and the knowledge of medicine. While reached the third phase we have dealt with two types of biological information, physical and nonphysical, i.e., body information (i.e., the information about body's components and structure), and life information (i.e., the information about life codes and life programs). Life informatics is a main branch of bioinformatics. It is a new member of the medical informatics family, and as such is younger than health informatics, nursing informatics, and dental informatics. It's task is to assist biologists and medical doctors to recognize and interfere the human life information procedure just as they are doing well with human body's matter and energy system. Its basic concepts are life information, life information medicine, and life information therapy. Its most important principles are information materialism, general informatics, and information determinism. Its main branches are biomolecule, cellular, organic, individual, and social informatics. In the third millennium, the life informatics will be a leading discipline in biology, medicine and informatics, which will gradually influence modern philosophy and other humanities.
We propose a modular formal ontology of the biomedical domain with two components, one for biological objects, corresponding broadly to anatomy, and one for biological processes, corresponding broadly to physiology. The result constitutes what might be described as a joint venture between two perspectives--of so-called three-dimensionalism and four-dimensionalism--which are normally regarded as incompatible. We outline an approach which allows them to be combined together, and provide examples of its application in biomedicine.
The authors discuss basic problems of analogue - digital transmission focused on practical questions with regard to the application of medical technique in combination with a computer. They discuss the different parts of the digital-measurement chain, different methods of signal transmission and finally also practical applications.
The advances of health informatics over the last 50 years are briefly sketched to reveal the pervasiveness of their applications in health and health care. The relations to research in health informatics and health are pointed out. From this perspective it is argued that the evolution of consumer health informatics in the last decade has had a profound impact on the practice of medicine, on patient-physician relations and, hence, on the requirements for medical education. The different access to information and how it is used in educational environments will also dramatically affect how curricula are structured both at undergraduate and postgraduate levels. The impact of health informatics on medical education is further elaborated, and the requirements on infrastructure in support of this education are detailed. This infrastructure goes beyond instructional laboratories and includes academic units for medical informatics and, most importantly perhaps, funding resources and adjudication capacity for health informatics research and their integration into the Canadian research organization and the new Canadian Institutes of Health Research.
Medical informatics aims to improve the process and the result of health care delivery, both in its theoretical and practical aspects through the application of formal methods and concepts of informatics and the utilization of up-to-date information and communication technology. As part of a theoretical framework this paper deals with the factors of production, the constitutive criteria and the formal aspects of health service production in the view of medical informatics.
Disaster response to mass-casualty incidents represents one of the greatest challenges to a community's emergency response system. Rescuers, field medical personnel, and regional emergency departments and hospitals must often provide care to large numbers of casualties in a setting of limited resources, inadequate communication, misinformation, damaged infrastructure, and great personal risk. Emergency care providers and incident managers attempt to procure and coordinate resources and personnel, often with inaccurate data regarding the true nature of the incident, needs, and ongoing response. In this chaotic environment, new technologies in communications, the Internet, computer miniaturization, and advanced "smart devices" have the potential to vastly improve the emergency medical response to such mass-casualty incident disasters. In particular, next-generation wireless Internet and geopositioning technologies may have the greatest impact on improving communications, information management, and overall disaster response and emergency medical care. These technologies have applications in terms of enhancing mass-casualty field care, provider safety, field incident command, resource management, informatics support, and regional emergency department and hospital care of disaster victims.