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PubMedDate not supplied

Internet as clinical information system: application development using the World Wide Web.

Clinical computing application development at Columbia-Presbyterian Medical Center has been limited by the lack of a flexible programming environment that supports multiple client user platforms. The World Wide Web offers a potential solution, with its multifunction servers, multiplatform clients, and use of standard protocols for displaying information. The authors are now using the Web, coupled with their own local clinical data server and vocabulary server, to carry out rapid prototype development of clinical information systems. They have developed one such prototype system that can be run on most popular computing platforms from anywhere on the Internet. The Web paradigm allows easy integration of clinical information with other local and Internet-based information sources. The Web also simplifies many aspects of application design; for example, it includes facilities for the use of encryption to meet the authors' security and confidentiality requirements. The prototype currently runs on only the Web server in the Department of Medical Informatics at Columbia University, but it could be run on other Web servers that access the authors' clinical data and vocabulary servers. It could also be adapted to access clinical information from other systems with similar server capabilities. This approach may be adaptable for use in developing institution-independent standards for data and application sharing.

Computer Communication Networks↗
PubMed2002

A novel codification scheme based on the "VITAL" and "DICOM" Standards for telemedicine applications.

The field of interest discussed in this study is a novel codification scheme for (vital signs) medical device communication and patient monitoring data interchange, into the context of effective home care service provisioning. With medical technology having developed in isolation and major manufacturers developing their own proprietary communication protocols, which preclude connection to devices from different manufacturers, and with healthcare trends having evolved, pointing to primary care, telecare and home care monitoring, there is an increasing need for technical standardization in healthcare environments and the development of protocols that enable communication in a structured and open way. In this study, a novel codification scheme has been developed, based on two healthcare informatics standards, the VITAL and DICOM Sup. 30, in addressing the robust interchange of waveform and medical data for a home care application. Based on this scheme, we created a real-time facility, consisting of a base unit and a telemedicine (mobile) unit, that enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3-lead ECG, pulse rate, blood pressure and SpO2) of the patient. This paper presents an object-oriented design with unified modeling language (UML) of a class hierarchy for exchanging the acquired medical data and performing alert management, and investigates the applicability of the proposed scheme into a commercial patient-connected medical device, thus addressing service and functionality requirements with focus on home-care applications. The system has been validated for technical performance over several telecommunication means and for clinical validity via real patient-involved pilot trials.

Database Management Systems↗
PubMed2002

The micro-macro spectrum of medical informatics challenges: from molecular medicine to transforming health care in a globalizing society.

BACKGROUND: Medical informatics has always encompassed a very broad spectrum of techniques for clinical and biomedical research, education and practice. There has been a concomitant variety of depth of specialization, ranging from the routine application of information processing methods to cutting-edge research on fundamental problems of computer-based systems and their relations to cognition and perception in biomedicine. OBJECTIVES: Challenges for the field can be placed in perspective by considering the scale of each--from the highly detailed scientific problems in bioinformatics and emerging molecular medicine to the broad and complex social problems of introducing medical informatics into web-related global settings. METHODS: The scale of an informatics problem is not only determined by the inherent physical space in which it exists, but also by the conceptual complexity that it involves, reinforcing the need to investigate the semantic web within which medical informatics is defined. RESULTS AND CONCLUSION: Bioinformatics, biomedical imaging and language understanding provide examples that anchor research and practice in biomedical informatics at the detailed, scientific end of the spectrum. Traditional concerns of medical informatics in the clinical arena make up the broad mid-range of the spectrum, while novel social interaction models of competition and cooperation will be needed to understand the implications of distributed health information technology for individual and societal change in an increasingly interconnected world.

Databases, Factual↗
PubMed1999

Contribution of EFMI to development of medical informatics. European Federation for Medical Informatics.

The European Federation for Medical Informatics has been established in 1976. At the MIE 96 it has celebrated the 20th anniversary of its existence. During these 20 years the number of number of national societies who became a member has been increased from 10 to 26 and nowadays is 29 not mentioning 2-3 applicants. The objectives of EFMI are: a) to advance international co-operation and dissemination of information, b) to promote research and development, c) to promote high standards in the application, d) to encourage high standards in education in this field. The achieve these goals EFMI organizes yearly European Congresses the MIE-s. Through its working groups contributes very well to the scientific development of medical informatics. The Working Group Chairmen regularly organizes tutorials workshops and many of them participate in teaching medical informatics in their homeland as well as on international courses. EFMI publishes scientific papers from its congresses in the Medical Informatics and in the International Journal of Medical Informatics. The most important meeting, however is the regular Council Meeting--twice a year--where council members can exchange opinions, have opportunity to discuss problems of medical informatics and last but not lease recently medical Inform-ETHICS. This Council is operating as a HUMAN-NET counterbalancing the dysinformations coming from the Internet.

Europe↗
PubMed2005

Introduction to the special issue on advances in clinical and health-care knowledge management.

Clinical and health-care knowledge management (KM) as a discipline has attracted increasing worldwide attention in recent years. The approach encompasses a plethora of interrelated themes including aspects of clinical informatics, clinical governance, artificial intelligence, privacy and security, data mining, genomic mining, information management, and organizational behavior. This paper introduces key manuscripts which detail health-care and clinical KM cases and applications.

Confidentiality↗
PubMed2004

A new form of application service provider (ASP) in the development of data systems and data flow and management of data in (multiple campus) health care institutions.

There is a distinct lag in the way the informatics management is applied, implemented and used in health care institutions in comparison to other industries. Part of this is caused by strict regulations, but there also seems to be a defined trust and attitude problem from the medical corps towards dependency from automatisation. The only way to guarantee overall advance however is to apply technology implementations which enhance the performance capabilities of the medical corps, the way they already have in other fields. We propose a new model for implementing software applications and their communication on the scale of a multi campus health care institution.

Computer Communication Networks↗
PubMed1997

Software quality assessment for health care systems.

The problem of defining a quality model to be used in the evaluation of the software components of a Health Care System (HCS) is addressed. The model, based on the ISO/IEC 9126 standard, has been interpreted to fit the requirements of some classes of applications representative of Health Care Systems, on the basis of the experience gained both in the field of medical Informatics and assessment of software products. The values resulting from weighing the quality characteristics according to their criticality outline a set of quality profiles that can be used both for evaluation and certification.

Delivery of Health Care↗
PubMed2004

Electronic medical record systems in Israel's public hospitals.

BACKGROUND: Various medical centers in Israel have recently incorporated electronic medical record systems. Knowing the EMR systems' features and pattern of use is an essential step for developing locally and nationally integrated systems. OBJECTIVES: To evaluate the status of EMR systems in all major general hospitals in Israel in terms of the applications used and the patterns of use. METHODS: Structured questionnaires were sent to hospital directors and directors of medical informatics units of 26 general and pediatric hospitals serving the vast majority of the population in Israel. The questionnaire included questions pertaining to the EMR systems, their usage, and the attitude of the participants to data security issues. RESULTS: Of the 26 general hospitals 23 (88.4%) returned the questionnaires. Of these, 21 (91.3%) use EMR systems. Twenty-seven different types of systems are in use in Israeli hospitals, and generally more than one type is used in a hospital. Physicians work with EMR systems in over 98% of the departments. Also, the EMR systems are used for clinical admission and discharge in over 90% of the departments and for medical daily follow-up in about 45%. CONCLUSIONS: Most of the hospitals in Israel use EMR systems but there is no standard data model. Physicians are the main users but the amount of data entered is still limited. Adoption of standards is essential for the integration of electronic patient records across Israeli healthcare organizations.

Adolescent↗
PubMed1995

Comparison of the clinical informativeness of photographs and digital imaging media with multiple-choice receiver operating characteristic analysis.

BACKGROUND AND DESIGN: Electronic medical imaging is important for medical informatics, computerized learning, and especially for the growing field of telemedicine. The image resolution necessary for a clinical application can be determined by use of receiver operating characteristic (ROC) experiments. Completely profiling display systems is a tedious process, requiring multiple ROC experiments. We have developed a multiple-choice ROC analysis technique to compare the relative informativeness of digital image formats for a spectrum of cutaneous lesions simultaneously. The technique makes use of logical competitor sets (LCSs) of clinical conditions to redefine multiple-choice responses into the present/absent framework required for conventional ROC curve construction. The study divided 180 slides and digital images into three LCSs: pigmented lesions, flesh-colored papules, and papulosquamous conditions. Eight dermatologists diagnosed the lesions presented in two randomized viewing sessions. Accuracy profiles, independent of individual observer sensitivities, were derived from the responses. RESULTS: The informativeness of color slides and digital images was statistically similar, even when the conditions were stratified by difficulty of diagnosis. Results for nine specific skin conditions represented in the three LCSs were obtained simultaneously. CONCLUSIONS: Digital images appear to be as informative as slides for specific dermatologic diagnoses in the three LCSs tested. The use of LCSs allows stratification of results by diagnosis with greater efficiency than multiple repeated ROC experiments. Multiple-choice ROC analysis used in conjunction with logical competitor sets is the best currently available method for comparing imaging media for use in visual disciplines such as dermatology, radiology, pathology, and others.

Diagnosis, Computer-Assisted↗
PubMed2004

Pathology informatics questions and answers from the University of Pittsburgh pathology residency informatics rotation.

CONTEXT: Effective pathology practice increasingly requires familiarity with concepts in medical informatics that may cover a broad range of topics, for example, traditional clinical information systems, desktop and Internet computer applications, and effective protocols for computer security. To address this need, the University of Pittsburgh (Pittsburgh, Pa) includes a full-time, 3-week rotation in pathology informatics as a required component of pathology residency training. OBJECTIVE: To teach pathology residents general informatics concepts important in pathology practice. DESIGN: We assess the efficacy of the rotation in communicating these concepts using a short-answer examination administered at the end of the rotation. Because the increasing use of computers and the Internet in education and general communications prior to residency training has the potential to communicate key concepts that might not need additional coverage in the rotation, we have also evaluated incoming residents' informatics knowledge using a similar pretest. DATA SOURCES: This article lists 128 questions that cover a range of topics in pathology informatics at a level appropriate for residency training. These questions were used for pretests and posttests in the pathology informatics rotation in the Pathology Residency Program at the University of Pittsburgh for the years 2000 through 2002. With slight modification, the questions are organized here into 15 topic categories within pathology informatics. The answers provided are brief and are meant to orient the reader to the question and suggest the level of detail appropriate in an answer from a pathology resident. RESULTS: A previously published evaluation of the test results revealed that pretest scores did not increase during the 3-year evaluation period, and self-assessed computer skill level correlated with pretest scores, but all pretest scores were low. Posttest scores increased substantially, and posttest scores did not correlate with the self-assessed computer skill level recorded at pretest time. CONCLUSIONS: Even residents who rated themselves high in computer skills lacked many concepts important in pathology informatics, and posttest scores showed that residents with both high and low self-assessed skill levels learned pathology informatics concepts effectively.

Internship and Residency↗
PubMed2002

Medicine in the 21st century: global problems, global solutions.

OBJECTIVES: To discuss application areas of information technology in medicine and health care on the occasion of the opening of the Private Universität für Medizinische Informatik und Technik Tirol/University for Health Informatics and Technology Tyrol (UMIT) at Innsbruck, Tyrol, Austria. RESULTS AND CONCLUSIONS: Important application areas of information technology in medicine and health are appropriate individual access to medical knowledge, new engineering developments such as new radiant imaging methods and the implantable pacemaker/defibrillator devices, mathematical modeling for understanding the workings of the human body, the computer-based patient record, as well as new knowledge in molecular biology, human genetics, and biotechnology. Challenges and responsibilities for medical informatics research include medical data privacy and intellectual property rights inherent in the content of the information systems.

Confidentiality↗
PubMed1994

Medical informatics conference papers: a content analysis of research in a new discipline.

One of the hallmarks of a mature discipline is a varied and robust body of literature describing the research activities of the discipline. Medical informatics has rapidly become an accepted scientific discipline, having emerged from two long established disciplines (medical and computer science). This study looks at one form of scientific communication as a descriptive indicator of the maturity of medical informatics as a discipline. Conference proceedings were selected because they represent one of the first means of communication within a discipline in a semiformal format. Findings confirm that conference papers report research, development, and application projects across a wide range of topics; identify a possible trend toward increased funding; and show widespread use of empirical and quantitative research and analytical techniques. Deficiencies in the conference papers are also discussed.

Congresses as Topic↗
PubMed2002

Integrating genomics into health information systems.

OBJECTIVE: To outline the main issues related to the impact of the data generated by the Human Genome Project on health information systems. A major challenge for medical informatics is identified, consisting of adapting traditional systems to new genetic-based diagnostic and therapeutic tools. METHODS: Reviewing and analysing the different health information levels from an organisational complexity point of view. A model is proposed to explain the interactions between health informatics, bioinformatics and molecular medicine. RESULTS: We suggest a new framework that integrates genetic data into health information systems. Using this model, new topics for future research and development are identified. CONCLUSIONS: We are witnessing the birth of a new era (post-genomics). In this era technological advancements in genomics offer new opportunities for clinical applications. Medical informaticians should play an important role in this new endeavour.

Databases, Genetic↗
PubMed2003

Medical informatics--a catalyst for operating room transformation.

For many years, computers have supported complex clinical ancillary functions such as the laboratory, radiology, endoscopy, and others. Digital computers have been successfully incorporated into specialized clinical instruments to offer advanced digital devices such as fetal monitors, heart monitors, and imaging equipment. But these devices are often not fully integrated with clinical management and operational systems. Beyond ancillary department applications, the result of almost 30 years of trying to automate the clinical processes in healthcare is large investments in both computer systems and paper medical records that have resulted in paper-based, computer-assisted processes of care. This expensive combination of partial clinical automation and archaic paper-based support processes is a major obstacle to improvements in care delivery and management. The need to use software, informatics, and standards to help manage the operating room and perioperative processes of care is significant. The potential to reduce adverse events, cost of care, and to enhance the quality of care are real and worth attaining. This paper focuses on what medical informatics improvements are needed to support improvements in surgical care and to assist in the management of the highly complex operating room and perioperative care process, and proposes research priorities in these areas.

Humans↗
PubMed2002

Automatic diagnosis classification of patient discharge letters.

CAIRN (Computer Assisted Medical Information Resource Navigation) is a prototyping System that allows flexible medical data storage and retrieval supporting medical informatics research. In this paper methods that automate the selection of ICD-9 diagnosis (International Classification of Diseases and Diagnoses, 9th Revision) are investigated. We present the Text Data Mining module extension of CAIRN and its application in order to organize in a systematic way uncontrolled terms, to propose relationships between uncontrolled terms and finally aid the diagnosis classification.

Disease↗
PubMed2002

[The informatics process in health: subjects discussed in articles published from 1978 to 1998].

The principal themes are described approached in goods of indexed newspapers, in two bases of available data in Internet, in the period from 1978 to 1998. Consultations were accomplished BIREME, through Internet, being used the descriptors in several orders. A total of 54 goods was obtained that were codified and tabulated. It was ended that, in the studied sample, the thematic of the researches developed on computer science in health had a profile change that passed of theoretical studies for applications in the work atmosphere.

Medical Informatics↗
PubMed2005

[Possibilities of application of distance learning in medical curriculum].

Possibilities of introduction of distance learning in medical curriculum is the title of project which commenced in 2002 at Cathedra for Medical Informatics of the Medical faculty in Sarajevo. Project is approved by Federal and Cantonal ministries of science and education. The purpose of this project is to support improvement of the educational process at biomedical faculties using contemporary methods, methodologies and information technologies in accordance with strategies and objectives given by Bologna declaration. Pilot project is attained after three years, theoretical and practical part of subject Medical Informatics are adapted to modern concepts of education using world trends of distance learning. One group of students from Medical faculty was involved in this project, which was finalized by electronic registration of exam and electronic testing on June 20, 2005 in public, in Physiological amphitheatre of Medical faculty in Sarajevo. In this article we have given complete description of this project as well as its basic adventages and disadvantages.

Bosnia and Herzegovina↗
PubMed2005

[Legal aspects of health telematics].

Specific legal issues arise from the distance of the participants in health telematics. Substandard care not meeting the state of the art can yield malpractice litigation, especially if a diagnosis or therapy conveyed via telematics proves to be deficient. On the other hand, communication deficiencies may bring about a reversal of the burden of proof. If the patient's damage can not be attributed to the responsible person due to the division of labour, a joint liability is likely to be adjudicated. A specific legal risk analysis is required as a basis for a risk-adequate design of any application in health telematics.

Computer Communication Networks↗