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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↗
PubMed2001

Health informatics.

Health informatics is the development and assessment of methods and systems for the acquisition, processing and interpretation of patient data with the help of knowledge from scientific research. This definition implies that health informatics is not tied to the application of computers but more generally to the entire management of information in healthcare. The focus is the patient and the process of care. The apparent information overload and the imperfection of medical decision making motivate the use of information systems for medical decision support. Health informatics provides tools to control processes in healthcare, acquire medical knowledge and communicate information between all people and organisations involved with healthcare. Although the development of medical information systems may often lag behind the available possibilities, the technological state of the current medical information systems is better than it is generally held to be. Health informatics should help healthcare professionals to provide better and more cost-effective care and enable healthcare systems to be more efficient and to adapt better to our patients' needs. Health informatics may reshape the way we deliver care to meet the demands of the future.

Artificial Intelligence↗
PubMedDate not supplied

Trends and pitfalls with nomenclatures and classifications in medicine.

This paper reflects some of the main points in the history and the trends of classifications, nomenclatures and knowledge representation models in medicine. The relations with philosophical background are briefly related. The contributions in this field during the Medical Informatics Europe (MIE) conference in 1997 are presented. International collaborations in the field of lexico-semantic resources and inter-disciplinary partnership in natural language processing technologies are necessary steps to achieve definitive results that will lead to applications in the daily medical practice.

Algorithms↗
PubMed1995

[Informatics in medical schools and postgraduate education centers for health professionals. Survey on the situation in Spain].

BACKGROUND: Informatics is acquiring an increasing relevance in the medical profession. METHODS: During the year 1993, a survey was carried out at the medical schools (MS) and postgraduate education centres (PEC) in Epidemiology, Public Health and Health Administration of Spain, on the available computer infrastructure and the teaching activities. The percentages of respondents were 81 at the MS and 100 at the PEC. RESULTS: 81% of the MS and 100% of the PEC had a computer laboratory, mainly equipped with personal computers with MS-DOS operating system. The use of general purpose applications was predominant. The number of students using the computer laboratory was very variable (5-300 per day). 48% of the MS organized courses on microcomputer applications. 66% of the MS included subjects related with informatics in the new curricula. CONCLUSIONS: Use of computers in the Spanish MS is heterogeneous. Compared with the Nord-American MS, they do not usually use applications of computer-assisted-instruction. The use of the computers at the PEC is much more generalized.

Curriculum↗
PubMed1988

Medical informatics: an introduction to computer technology in medicine.

Access and effective management of medical information have become increasingly important in the practice of medicine today. Computer technology is developing to achieve this goal. This had led to the emergence of a new specialty, medical informatics, the basic science of the use of computers in medicine. Areas of patient care to which medical informatics has been applied include history taking, medical records, medical data base information retrieval, test performance, test result retrieval, decision support, patient monitoring, medical education, quality assurance and utilization review, medical research, and medical office and financial management. It is important that these applications become integrated with existing medical information systems and that physicians take a leading role in developing and maintaining these systems.

Computers↗
PubMed1998

Standardisation in medical image management.

A medical image without the relevant associated data is of no value. What is relevant depends on the use which is to be made of the image. The associated data may be divided into groups associated with the patient, the image data (array size, data type), the image itself (e.g. acquisition method), the requested imaging procedure to which it belongs, graphical, numerical and time information associated with the images, relevant results of other medical procedures, etc. Images, digital images and the associated data must be managed in an efficient manner in order to deliver appropriate patient care. In order to realise fully the potential of digital imaging, digital image data must be transmitted from acquisition units and stored in such a way as to allow appropriate access to health care practitioners in the imaging department, hospital and community. Standards exist for the formatting and transmission of image and related data (Digital Imaging and Communications in Medicine (DICOM). NEMA PS 3.1-PS3.12, The National Electrical Manufacturers Association, Rosslyn, VA, 1992, 1993, 1995; Health Level Seven, An Application Protocol for Electronic Data Exchange In Healthcare Environment, version 2.2, Health Level Seven Inc., Ann Arbor, MI, 1994; Comite European de Normalisation, Technical Committee 251: Medical Informatics) although further work is required in order to improve interoperability. There is some overlap in current standards, thus an important area is the agreement on the scope of the work to be done by different bodies. Standards are lacking in the areas of image management and presentation. Strategies for the efficient use of a memory hierarchy to achieve satisfactory archiving and access must be developed and this depends on the existence of appropriate descriptive data fields. Specific issues exist regarding security of image data. Key areas requiring immediate work are the profiling of descriptive data elements according to different clinical application needs in order to improve interoperability and the development of strategies for evolution from legacy systems to modern networked systems. The best way forward is to consolidate and refine existing specifications.

Data Display↗
PubMed1994

Digital archives and communication highways in health care require a second look at the legal framework of the seventies.

The present state of the art and the state of practice regarding legal aspects of medical informatics are reported. Examples are taken from networking, archiving, and virtual reality. It is derived that the data protection concepts of the seventies are covering only some legal aspects of the application scene today and in the future. Thus a far wider legal approach is necessary. It can only be mastered if engineers and lawyers discuss future trends and derive together a new legal framework for medical computer systems in the late nineties. As computers will be everywhere from childhood to death the key issue is not to just protect an individual but to positively frame an information society.

Computer Communication Networks↗
PubMed2000

Implementing an ICU-CIS integrated to a HIS in Latin America.

The hospital has been the main target for Medical Informatics since the beginning of its development. Ancillary and clinical systems entered into the scene first when the financial issues were covered. From those kind of applications the Intensive Care Unit (ICU) represents perhaps the most important challenge to achieve where there is a representative subset of the organization with most variables under control to show the performance of the institution. At the ICU, information technology defines many of the tasks which are performed and enable the professionals to process and interpret the great quantities of data that is generated about the patients and the system in which they receive their treatment and quality assurance (QA) is now almost completely dependent upon information technology in pretty much facets of medical care. In this paper, a clinical information system developed for the ICU is presented where the use of validated severity illness scoring systems and standardized definitions for events and outcomes the care delivered can be analysed comparing clinical outcomes and resource utilization. Cost containment can be also applied and observations simultaneously with quality improvement standards can be undergone. Clinical research regarding medical and nursing practice is also very helpful.

Hospital Information Systems↗
PubMed1987

Medical applications of computers: an overview.

In this review computer applications in medicine are discussed from the point of view of the levels of information processing as suggested by van Bemmel. Applications are presented and research directions indicated. The purpose of this review article is to give an overview of the field of medical informatics. A structural approach is followed in discussing the subjects of communication, databases, complex calculations (including signal analysis and image analysis techniques), pattern recognition and expert systems. The role the computer system plays in relation to the physician is discussed. It is stressed that computers cannot replace the physician, because computer systems use programs, that are of a scientific nature. This means that only certain aspects are taken into account and that one abstracts from individuality. Therefore, computers are unable to give advice about individual patients regarding their future.

Database Management Systems↗
PubMed1992

A survey of videodisc and interactive videodisc projects in North America: Part I.

Selected videodisc (VD) and interactive videodisc (IVD) programs, projects and topics are presented in two articles in this and a subsequent issue of the journal. Part I reviews the impact of Information Science developments on image management. The American Society of Hematology Slide Bank and other specific applications in urology, paediatric neurology, obstetrical nursing, medical decision making, dental diagnosis and treatment (DDT), and paediatric cardiology, are reviewed as educational and informatics research projects. This is followed by a section on three-dimensional reconstructions of the brain which stresses digital images. Multi-purposing and repurposing are reviewed in two prototype programs. A discussion of the multidisciplinary Slice of Life projects completes this first article.

Computer Graphics↗
PubMed2000

Prospects for progress in diagnostic imaging.

New fast-imaging MRI systems designed specifically for cardiac magnetic resonance enable new applications of noninvasive vascular imaging. The use of functional MRI and diffusion tensor imaging to map brain function and structure offers a new dimension to an understanding of the human condition. Clinical applications of functional MRI will influence many specialties including surgery, education, and rehabilitation. Functional imaging has the potential to visualize the regional concentration of specific proteins. This imaging at the level of molecules may be possible by use of a contrast material whose signal is changed by local enzymatic activity. The three-dimensional digital data collected in modern imaging techniques allow for virtual endoscopy in the respiratory, alimentary, and cardiovascular systems. Virtual endoscopy may replace many of the more invasive diagnostic methods in the near future. The measurement of clinical decision-making through observer performance studies better informs both the physician and the patient on how to improve upon the quality of clinical practice. These prospects for progress reinforce diagnostic imaging as a cornerstone in medical informatics. The history of creating images used in medicine reveals the invention of diagnostic tools which may provide new information but premature use can result in improper application of a poorly understood technology. Research into the use of new technology may be as important as the technology itself in improving the human condition.

Diagnostic Imaging↗
PubMed1998

Clinical informatics in medical education: yesterday, today, tomorrow. Experiences at the first Faculty of Medicine, Charles University.

The subject known as clinical informatics started to develop in the 60's in medical education of clinical disciplines and was mainly concerned with structuring information for instruction and examinations. This application contributed substantially to the development of the discipline of medical education that started to be considered as a legitimate new field that could become a clinical sub-specialty in its own right. Due to uneven access to computer hardware the area developed differently in the West and East. We elaborated our projects for application of didactic games in internal medicine for the paper and pencil system. On turn of the 90's the use of PCs brought new possibilities for the application of computer programme support in the analysis of the effectiveness of the system of instruction in internal medicine we were concerned with. We carried out two longitudinal studies in clinical memory of the 4th and 6th year students of the same study cycle. In a non-anonymous questionnaire, more than 1000 respondents described their experience in observation/examination of 70 recommended disorders important for internal practice. We offer some unpublished results showing how the clinical memory of the students is formed during the four-year study and how few possibilities there are for some students to see some manifestations of various clinical disorders. Thinking about the future we are preparing a series of integrated medical and language programmes for the use of the multi-medial approach.

Computer-Assisted Instruction↗
PubMed2002

How to find out burning problem of telemedicine?

Sample of 177 cited papers from Current Contents in year 2001 containing word 'telemedicine' as a keyword, and/or in title and/or in abstract. Most of papers were coming from Journal of Telemedicine & Telecare, International Journal of Medical Informatics and Telemedicine Journal & E-Health. Titles and abstracts were analysed statistically by using Sphinx Lexica as a tool and lexical statistics and lexical analysis as methods. Environment/neighbourhood of words potentially reflecting evaluation in telemedicine, enabled to make synthesis: evaluation or similar words were mentioned in connections with programs and plans of telemedicine application in the whole, with economic issue (minimizing, low-cost, reducing cost), with ICT evaluation, quality, and scarcely with methodology and criteria for evaluation.

Medical Informatics↗
PubMed1995

Curriculum of medical informatics and medical technology in the medical faculty.

1. CURRICULUM DESCRIPTION. Twenty years ago, our faculty organized several lessons in a physiology course to inform students about computers. Recently, new courses in informatics were established. In their first year, students take a compulsory course (15 hours=h) of basic computer science (computers databases, networking, and basic non-medical computer software). A special elective course in medical informatics (30h) can be taken in the 4th year (about 20% of students pass tis course). This course includes the following lessons: computers in medicine (2h), scientific information (4h), classification in medicine (2h- including ICD, SNOMED etc.), computer support of clinical decision (2h-calculation principles with demonstration), artificial intelligence (2h), statistical software (2h), hospital information systems (2h), software for practitioners (2h), biosignal and image analysis (4th), computers in pharmacology (2h), computer simulation (2h), support of metabolic care (2h-consultations, risk calculations), and laboratory information systems (2h). The same course, though slightly differences, is used for paramedical students (occupational therapy, health education, and nursing). Medical technology was established in a three year curriculum courses in the 1st year include common courses in electronic devices (60 h), computers and programming (120 h), biophysics (90 h), biomechanics (30 h), and different medical courses (500 h). For the 2nd and 3rd year, 75% of the courses (700 h per year) are technical e.g., medical devices, information systems, signal and picture analysis, laboratory technique, and data protection. 2. CONCLUSION AND PERSPECTIVES. Students of medicine, and some paramedical studies, are able to use computer in their profession after having taken these courses. Bachelors of medical technology find application in biomedical research, hospitals, and medical technology firms.

Curriculum↗
PubMed2004

Promoting patient safety and enabling evidence-based practice through informatics.

OBJECTIVES: The purposes of this article are to highlight the role of informatics in promoting patient safety and enabling evidence-based practice (EBP), 2 significant aspects for assuring healthcare quality; to delineate some challenges for the future; and to provide key recommendations for education, practice, policy, and research. METHODS: First, we describe the components of an informatics infrastructure for patient safety and evidence-based practice. Second, we address the role of informatics in 4 areas: 1) information access; 2) automated surveillance for real-time error detection and prevention; 3) communication among members of the healthcare team; and 4) standardization of practice patterns. Last, we delineate some future challenges for nursing and for informatics and provide key recommendations for education, practice, policy, and research. RESULTS: The components of an informatics infrastructure are available and applications that bring together these components to promote patient safety and enable EBP have demonstrated positive or promising results. CONCLUSIONS: Challenges must be addressed so that an informatics infrastructure and related applications that promote patient safety and enable EBP can be realized.

Equipment Safety↗
PubMed1986

The National Library of Medicine and medical informatics.

Medical informatics attempts to provide the theoretic and scientific basis for the use of automated information systems in biomedicine. Even though a new field, its roots are in the 19th century. The National Library of Medicine (NLM) began classifying the medical literature and publishing the Index Medicus in 1897; in the early 1960s, the growth of the index gave rise to MEDLARS, the first successful, large-scale, computerized bibliographic system. In 1971, about the time MEDLARS evolved into a nationwide on-line retrieval system known as MEDLINE, a committee of the Association of American Medical Colleges published a report calling for the NLM to exert strong leadership in developing computer applications for information transfer in medicine. The NLM has sponsored several training and research programs in this area and is now developing the concept of "centers of excellence" in medical informatics. In addition, there are a number of current research and development activities within the NLM internal and extramural programs that may influence the progress of medical informatics.

History, 19th Century↗