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From the early 20th century, HIM professionals have been part of the turbulent story of healthcare in America. How has the profession, and AHIMA, evolved along with the industry? The author describes the environmental changes that have shaped the profession.
The evaluation of health actions requires large amounts of information allowing an assessment of relevance, coherence, efficacy, efficiency and impact of these interventions. Information systems should support evaluation processes by helping to obtain pertinent indicators, tracers and standard operating procedures. To reach this objective, specific functions need to be implemented, including traceability, documentation, investigation and scientific awareness. But this supposes that health information systems respect quality criteria that this article defines. The following criteria are considered: simplicity, validity, acceptability, informative value, representativeness, continuity, reactivity, fluidity, flexibility of the system, and also confidentiality of information. The historical developments of medical informatics have induced the creation of independent information systems, answering to specific objectives. This lack of integration is an obstacle to the evaluation of health actions because of the difficulty to view transversally and longitudinally the sequence of actions for a same patient. Thus integrated health information systems, organised around patient care episodes, are necessary to support evaluation and to contribute effectively to decision making in public health, because the evaluation of health actions implies the availability of information about the individuals who are the targets of these actions.
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A flood of new technologies is engulfing health care. Adopting them can be magical, or horrifically problematic. Yet few institutions have any real, routine process for thinking about them. There are four essential actions an organization must take to explore this fascinating, confusing world of high technology.
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Implementation of problem lists and their relation to standardized coding systems have been approached and analysed in different ways. Most evaluations concern quantitative aspects such as content coverage in a specific domain. In order to reveal the qualitative aspects of diagnostic coding, medical record texts from primary health care encounters were compared with terms from a coding system that was used for describing them statistically. The records were coded by six general practitioners, and in some cases, an applied diagnostic term was found within the text, while other record text-coding system relationships were categorized as synonyms, alternative terms, and interpretations. Thus, the categories roughly corresponded to a measure of semantic distance between the terms in the record text and the rubrics of the coding system, and there was a correlation between semantic distance and inter-rater agreement. The subcategories of this scheme corresponded fairly well to recently published desiderata for clinical terminology servers, including functionality such as word normalization and spelling correction. However, not all problems could have been automatically coded by means of lexical methods, which can be partly explained by the fact that diagnostic coding also relies on clinical knowledge. In addition, proper automation relies on context representation within the records.
In today's ICUs clinicians routinely integrate huge numbers of discrete data points to arrive at a coherent picture of their patients' status. Often the clinician must obtain those data elements from many devices, which makes the problem more difficult. Because presenting data visually amplifies cognition by capitalizing on well-known human perceptual capabilities, it is not surprising that a growing body of research is directed at the effective presentation of visual information in clinical displays. However, developing clinical displays that effectively support clinicians' integration and understanding of many discrete data elements in complex, high technology work domains such as ICUs remains elusive. It may be that traditional analysis and design methods simply are inadequate for this kind of complex environment. Vicente has described a new methodology, called "cognitive work analysis" (CWA), which is targeted at the analysis of complex work domains. The analysis differs from traditional analytic methods in significant ways, particularly in its primary focus on analysis of the work domain, but also in its prescription for explicitly collecting information at five levels (the work domain, diagnostic and treatment tasks, diagnostic strategies, socio-organizational, and clinician skills) that place constraints on the ultimate display design. In this model, the order of data collection is also crucial. Because the work domain constraints tend to be the most permanent, they are likely to have the most impact on design, and so analysis starts there. As the analysis proceeds through the subsequent levels, additional design constraints are identified. We recently used CWA to analyze the information needs for interactive graphical displays that will integrate and represent data in structures that help clinicians visualize a patient's physiological status. We found that the analysis was an effective way to identify information needs at multiple levels. Based on our experience, CWA is a generic methodology that is highly applicable to medical informatics.
The use of language for communication purposes introduces a semantic gap in data processing. We have developed a new tool called semantic distance to overcome this gap. A previous presentation of our tool was based on an empirical approach. Here, we examine the properties and theoretical foundation of semantic distance from a rationalistic perspective. We present an epistemological framework to explain the meaning of semantic distance. As a tool, the purpose of semantic distance is the exchange of data or knowledge based on linguistic expressions between software components. We propose a review of the relationship between language and its representation for data processing based on the underlying philosophical assumptions. Description logic is a new paradigm in the medical informatics community to express relations between terms in "is-a" hierarchies. The utility of semantic distance is compared to description logic for communication purposes in different use cases.
The Nursing Terminology Summit has used collaborative processes to bring about significant changes in the development of terminology standards for nursing. This paper draws on agendas, reports, notes, and other documents from the Summit, in addition to the authors' own experience as Organizer, Steering Committee, and participants, to provide a brief history of the Summit process. The analysis identifies factors that increased the risk of failure as well as factors that fostered success. The paper concludes with lessons learned that can be applied in other arenas to promote change in medical informatics.
The development of community health service brings a new branch of Medical Informatics, Community health care informatics and a new management system, Community Health Care Information System in the beginning of nest century. The paper first advance and explore this new concept. It states the focus of Community health care informatics as the promotion of health for the whole community. It not only gives treatment to individual patients through ways of disease management and information network, but also improves health condition of the whole community by "diagnosis of community health" and "prescription for community health". The paper also introduces the community health information system and its formation, technology, function and practical use, pointing out the crucial point of its research work to be precisely discovering the "information origin" and "three-in-one" working group.
The paper examines the issues of security and safety in Health Information Systems and focuses the need for the development of appropriate Guidelines for the effective use of IEC 61508 standard.
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The standard method of studying inherited disease is to observe its pattern of distribution in families, that is, its pattern in a pedigree. For clinical studies focused on inherited disease, a pedigree diagram is a valuable visual tool for the display of inheritance patterns. We describe the creation of a web-based pedigree display module for Trial/DB, a Web accessible database developed at the Yale Center for Medical Informatics (YCMI) to support clinical research studies. The pedigree diagram is generated dynamically from the database. The icons representing each subject in the pedigree are selectable hyperlinks that will display detailed clinical data collected on the subject. Microsoft Active Server Page and Scalable Vector Graphics (SVG) are used to create the interactive pedigree diagrams.
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OBJECTIVES: The aim of this paper is to build a theoretical framework for analysis of when decision-makers should use end-user participation as a form of insurance for unforeseen consequences of implementing information systems in healthcare organizations. METHOD: Data were collected in a case study of an information system development project in a small clinical setting. During the initial phase, the future end-users of the system were allowed to actively influence the system design and test every new tool that was considered for implementation. RESULTS: The results of the case study suggest that when time and effort are invested in allowing healthcare staff to participate in information system development processes, the benefits can well exceed the costs throughout the life cycle of the project. Risk-averse decision-makers fearing negative secondary consequences of a HIS, with regard to clinical work flow, will always adopt measures to prevent future failures, if they can find a possibility of shifting these risks. Therefore, they calculate the present discounted value of the effects accrued over time to the unit and predict the amount of resources they are willing to pay to acquire on insurance (such as design participation) that will protect the organization from future losses. CONCLUSIONS: End-user participation in the design process can be the key positive influence on the quality of the service and, thereby, organizational effectiveness. Investments in broad design participation can, consequently, be a productive activity that transforms potential current income into future benefits.
OBJECTIVE: To compare selected maternal, obstetric and newborn medical information on live birth certificates to medical record abstracted data. STUDY DESIGN: The Florida Department of Health provided a computer tape containing the Hillsborough County Florida live birth certificate data for July 1, 1992, through December 31, 1996. This information was compared to selected maternal, obstetric and newborn medical data abstracted from the hospital records of women who delivered in that county. RESULTS: Three hospitals provided care for 75% (44,654) of all deliveries in the county in the study period. There were no differences in age, race, gravidity or parity of patients between the data sets. There was no concurrence between the number of patients on the state-compiled birth certificate data and the medical record data in 8 maternal medical complications, 5 complications of labor and delivery, 3 obstetric procedures, 3 abnormal neonatal conditions or 7 congenital anomalies from any hospitals. There was no difference between the three hospitals in the incidence of mismatches. CONCLUSION: The medical information on the birth certificates from this county was discrepant from that abstracted directly from the patients' medical records. Caution is required in drawing conclusions from these data sets.