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PubMed2004

Precentral gyrus discrepancy in electronic versions of the Talairach atlas.

Electronic versions of the atlas of Talairach and Tournoux, including the Talairach Daemon and the official versions published by Thieme, contain a discrepant region of the precentral gyrus on axial slice +35 mm that extends far forward into the frontal lobe. This area is anatomically incorrect and internally inconsistent within the digital atlas software applications using their multiplanar cross-referencing tools. By cross-referencing the axial, sagittal, and coronal plates from the original printed atlas, we demonstrate that the discrepant area should be labeled middle frontal gyrus. The mislabeled portion encompasses a 3 x 1.5-cm region in the axial plane and has significant implications for sensorimotor studies that rely on the digital atlases for anatomic labeling.

Brain Mapping↗
PubMed1998

Computer assisted orthopaedic surgery. Image guided and robotic assistive technologies.

Technologies are emerging that will influence the way in which orthopaedic surgery is planned, simulated, and performed. Recent advances in the fields of medical imaging, computer vision, and robotics have provided the enabling technologies to permit computer aided surgery to become an established area which can address clinical needs. Although these technologies have been applied in industry for more than 20 years, the field of computer assisted orthopaedic surgery is still in its infancy. Image guided and surgical navigation systems, robotic assistive devices, and surgical simulators have begun to emerge from the laboratory and hold the potential to improve current surgical practice and patients' outcomes. The goals of these new clinically focused technologies are to develop interactive, patient specific preoperative planners to optimize the performance of surgery and the postoperative biologic response, and develop more precise and less invasive interactive smart tools and sensors to assist in the accurate and precise performance of surgery. The medical community is beginning to see the benefit of these enabling technologies which can be realized only through the collaboration and combined expertise of engineers, roboticists, computer scientists, and surgeons.

Biomedical Engineering↗
PubMed2006

ICT and OTs: a model of information and communication technology acceptance and utilisation by occupational therapists.

There is evidence to suggest that health professionals are reluctant to accept and utilise information and communication technologies (ICT) and concern is growing within health informatics research that this is contributing to the lag in adoption and utilisation of ICT across the health sector. Technology acceptance research within the field of information systems has been limited in its application to health and there is a concurrent need to develop and gain empirical support for models of technology acceptance within health and to examine acceptance and utilisation issues amongst health professionals to improve the success of information system implementation in this arena. This paper outlines a project that examines ICT acceptance and utilisation by Australian occupational therapists. It describes the theoretical basis behind the development of a research model and the methodology being employed to empirically validate the model using substantial quantitative, qualitative and longitudinal data. Preliminary results from Phase II of the study are presented. The theoretical significance of this work is that it uses a thoroughly constructed research model, with potentially the largest sample size ever tested, to extend technology acceptance research into the health sector.

Adult↗
PubMed1992

Involvement in medical informatics may enable pharmacists to expand their consultation potential and improve the quality of healthcare.

The outlook for pharmacy-related services foretells more involvement of both computers and information systems. Expert therapeutic systems and databases will enable pharmacists to expand their consultation potential through networks and improve the quality of healthcare that they provide. Therapeutic information management could be the largest pharmacy specialty of the future. As knowledge-based systems and networks become commonplace, there will be an increasing need for new components, system monitoring, and quality assurance. This is an opportunity for pharmacy to bring medical computing, as it relates to therapeutics, into the mainstream of the profession as a new discipline.

Clinical Pharmacy Information Systems↗
PubMed2000

Comparison of mailed vs. Internet applications of the Delphi technique in clinical informatics research.

The Delphi technique provides a means of assessing the judgments of groups of experts without the necessity of having these experts meet together. The technique has been used in health care since the mid-1970s, and has just recently become more common in clinical informatics research. As informatics develops as a specialty, it is logical to consider information technology solutions to research as well as clinical practice problems. The overall purpose of this methodology presentation is to compare a mailed vs. Internet application of the Delphi technique for clinical informatics research. Specifically, this presentation will provide: 1) an overview of the Delphi technique, and 2) a methodological comparison of two research applications of the Delphi technique. Results of the studies will be presented elsewhere.

Computer Communication Networks↗
PubMed1987

A vocabulary for medical informatics.

The terminology in medical informatics is evolving rapidly. The organizers of MEDINFO and SCAMC have used different sets of keywords to index their documents. Recognizing the limitations of this approach, members of those organizations joined with the National Library of Medicine in the creation of a better terminology for medical informatics. A hierarchical structure was placed on the terms to produce a thesaurus typical of the sort often used in the indexing and retrieving of documents. The building of this thesaurus began with an automatic merging of the thesaurus used by the Association of Computing Machinery and the Information Sciences component of the "Medical Subject Headings." This product was pruned by eliminating terms not related to those in the MEDINFO keyword list or not in the medical informatics literature. Further refinement of the thesaurus resulted from extensive discussions among the authors of this paper. The first major application of this terminology has been to the indexing of the articles in "MEDINFO-86 Proceedings." Major components of this medical informatics thesaurus also have been incorporated into the "Medical Subject Headings." This paper describes the process of preparing the thesaurus and presents an evaluation of its coverage of the "MEDINFO-86 Proceedings."

Abstracting and Indexing↗
PubMedDate not supplied

An integrated architecture for deploying a virtual private medical network over the web.

In this paper we describe a pilot architecture aiming at protecting Web-based medical applications through the development of a virtual private medical network. The basic technology, which is utilized by this integrated architecture, is the Trusted Third Party (TTP). In specific, a TTP is used to generate, distribute, and revoke digital certificates to/from medical practitioners and healthcare organizations wishing to communicate in a secure way. Digital certificates and digital signatures are, in particular, used to provide peer and data origin authentication and access control functionalities. We also propose a logical Public Key Infrastructure (PKI) architecture, which is robust, scalable, and based on standards. This architecture aims at supporting large-scale healthcare applications. It supports openness, scalability, flexibility and extensibility, and can be integrated with existing TTP schemes and infrastructures offering transparency and adequate security. Finally, it is demonstrated that the proposed architecture enjoys all desirable usability characteristics, and meets the set of criteria, which constitutes an applicable framework for the development of trusted medical services over the Web.

Certification↗
PubMed2000

Continuing educational needs in computers and informatics. McGill survey of family physicians.

OBJECTIVE: To describe family physicians' perceived educational needs in computers and informatics. DESIGN: Mailed survey. SETTING: General or family practices in Canada. PARTICIPANTS: Physicians (489 responded to a mailing sent to 2,500 physicians) who might attend sessions at the McGill Centre for CME. Two duplicate questionnaires were excluded from the analysis. METHOD: Four domains were addressed: practice profile, clinical CME needs, professional CME needs, and preferred learning formats. Data were entered on dBASE IV; analyses were performed on SPSS. MAIN FINDINGS: In the 487 questionnaires retained for analysis, "informatics and computers" was mentioned more than any other clinical diagnostic area, any other professional area, and all but three patient groups and service areas as a topic where improvement in knowledge and skills was needed in the coming year. Most physicians had no access to computer support for practice (62.6%); physicians caring for neonates, toddlers, or hospital inpatients were more likely to report some type of computer support. CONCLUSIONS: Family physicians selected knowledge and skills for computers and informatics as an area for improvement in the coming year more frequently than they selected most traditional clinical CME topics. This educational need is particularly great in small towns and in settings where some computerized hospital data are already available.

Adult↗
PubMed1995

An overview of the CERC ARTEMIS project.

The basic premise of this effort is that health care can be made more effective and affordable by applying modern computer technology to improve collaboration among diverse and distributed health care providers. Information sharing, communication, and coordination are basic elements of any collaborative endeavor. In the health care domain, collaboration is characterized by cooperative activities by health care providers to deliver total and real-time care for their patients. Communication between providers and managed access to distributed patient records should enable health care providers to make informed decisions about their patients in a timely manner. With an effective medical information infrastructure in place, a patient will be able to visit any health care provider with access to the network, and the provider will be able to use relevant information from even the last episode of care in the patient record. Such a patient-centered perspective is in keeping with the real mission of health care providers. Today, an easy-to-use, integrated health care network is not in place in any community, even though current technology makes such a network possible. Large health care systems have deployed partial and disparate systems that address different elements of collaboration. But these islands of automation have not been integrated to facilitate cooperation among health care providers in large communities or nationally. CERC and its team members at Valley Health Systems, Inc., St. Marys Hospital and Cabell Huntington Hospital form a consortium committed to improving collaboration among the diverse and distributed providers in the health care arena. As the first contract recipient of the multi-agency High Performance Computing and Communications (HPCC) Initiative, this team of computer system developers, practicing rural physicians, community care groups, health care researchers, and tertiary care providers are using research prototypes and commercial off-the-shelf technologies to develop an open collaboration environment for the health care domain. This environment is called ARTEMIS--Advanced Research TEstbed for Medical InformaticS.

Computer Communication Networks↗
PubMed2005

Rapid application design of an electronic clinical skills portfolio for undergraduate medical students.

The aim was to find how to use information and communication technology to present the clinical skills content of an undergraduate medical curriculum. Rapid application design was used to develop the product, and technical action research was used to evaluate the development process. A clinician-educator, two medical students, two computing science masters students, two other project workers, and a hospital education informatics lead, formed a design team. A sample of stakeholders took part in requirements planning workshops and continued to advise the team throughout the project. A university hospital had many features that favoured fast, inexpensive, and successful system development: a clearly defined and readily accessible user group; location of the development process close to end-users; fast, informal communication; leadership by highly motivated and senior end-users; devolved authority and lack of any rigidly imposed management structure; cooperation of clinicians because the project drew on their clinical expertise to achieve scholastic goals; a culture of learning and involvement of highly motivated students. A detailed specification was developed through storyboarding, use case diagramming, and evolutionary prototyping. A very usable working product was developed within weeks. "SkillsBase" is a database web application using Microsoft Active Server Pages, served from a Microsoft Windows 2000 Server operating system running Internet Information Server 5.0. Graphing functionality is provided by the KavaChart applet. It presents the skills curriculum, provides a password-protected portfolio function, and offers training materials. The curriculum can be presented in several different ways to help students reflect on their objectives and progress towards achieving them. The reflective portfolio function is entirely private to each student user and allows them to document their progress in attaining skills, as judged by self, peer and tutor assessment, and examinations. Training materials include web links and materials developed locally using pedagogic principles developed by the SkillsBase team. Although the usability of SkillsBase has been proven, uptake of software that has arisen 'bottom-up' from within the curriculum has proved slow. We plan to incorporate the SkillsBase services into a more comprehensive virtual managed learning environment, anticipating that presenting the functionality in an environment that is routinely used by students and teachers will increase uptake and use.

Clinical Competence↗
PubMedDate not supplied

Use of patient education and monitoring software in community pharmacies.

OBJECTIVE: To determine the level of use of health education and monitoring software programs in independent community pharmacies in rural locales. DESIGN: The use of seven software programs that deliver patient education and provide blood pressure monitoring was assessed at five sites of the Nebraska Drug Information Network (NDIN) for one month. Direct Access, a Windows-based software program, documented which programs were accessed and for what time period. RESULTS: During a one-month period, 326 accesses were logged representing 44 hours of computer time. Extrapolated to all 30 sites of NDIN, this represents 264 hours and 1,956 accesses monthly. On average, each pharmacy logged 8.8 hours within 65 accesses each month. Each access averaged 8 minutes. DynaPulse (167 accesses; 16.4 hours) was the most frequently used product, followed by Home Medical Advisor Pro (54 accesses; 8.9 hours) and Mayo Clinic The Family Pharmacist (35 accesses; 8.3 hours). The least amount of time was spent with BodyWorks (0.6 hours) but Wellness Checkpoint had fewest accesses (7 accesses). CONCLUSION: Applied medical informatics is assuming a larger role in daily clinical practice as pharmacy practitioners strive to better inform their patients. This is congruent with the finding that a better informed public can be a healthier public. This study demonstrates that computer systems are readily used by patients and pharmacists in rural communities.

Adult↗
PubMed2002

Ethical issues in public health informatics: implications for system design when sharing geographic information.

Public health programs today constitute a multi-professional inter-organizational environment, where both health service and other organizations are involved. Developing information systems, including the IT security measures needed to suit this complex context, is a challenge. To ensure that all involved organizations work together towards a common goal, i.e., promotion of health, an intuitive strategy would be to share information freely in these programs. However, in practice it is seldom possible to realize this ideal scenario. One reason may be that ethical issues are often ignored in the system development process. This investigation uses case study methods to explore ethical obstacles originating in the shared use of geographic health information in public health programs and how this affects the design of information systems. Concerns involving confidentiality caused by geographically referenced health information and influences of professional and organizational codes are discussed. The experience presented shows that disregard of ethical issues can result in a prolonged development process for public health information systems. Finally, a theoretical model of design issues based on the case study results is presented.

Computer Security↗
PubMed1995

Integrating medical informatics into an undergraduate medical curriculum.

his paper outlines a rationale for medical schools to integrate medical informatics into their curricula. The approach used in the problem-based undergraduate curriculum at Dalhousie University School of Medicine is presented in three areas: organizational structure, implementation, and curriculum development. Seven goal areas defined to guide the curriculum development process are described.

Computer Literacy↗
PubMed1998

An international health and nursing informatics module for distance education.

This paper describes why a module about health and nursing informatics is a necessary component for nursing education. Several developments in society and health care force health providers to manage the large amount of health data adequately. A module about health and nursing informatics was developed in international cooperation by three schools of nursing from Germany, The Netherlands and the UK. The content and learning activities of the realized example module for distance learning are described. Future plans include making this course material available in different languages on the World Wide Web.

Computer-Assisted Instruction↗
PubMed2005

Using feedback to raise the quality of primary care computer data: a literature review.

BACKGROUND: Primary care is recognised as a medical specialty and its unique information needs justify the existence of its own health informatics sub-specialty: primary care informatics (PCI). A challenge for PCI is how to raise the standard of computerised medical records so that meaningful conclusions can be drawn from them. In the UK the Primary Care Data Quality (PCDQ) programme has eight years experience of using feedback in an educational context to improve data quality. OBJECTIVE: This literature review set out to define the characteristics of a feedback process most likely to achieve change; the principles of which could be applied to PCDQ or to other data quality initiatives. METHOD: A literature review of the major medical bibliographical databases, and the websites and working groups of the international medical informatics associations. RESULTS: There are generalisable lessons for primary care derived from the literature about implementing best evidence, feedback and the theory of diffusion of innovation. The principles identified are: (1) Engage and support local innovators - i.e. those most likely to adopt change, demonstrate the evidence-base for the intervention and the form of feedback most acceptable to them (2) Model the clinical context in which quality improvement is required; (3) Develop an understanding of the health system, its culture and management system; and, (4) Identify and address technical issues relating to computer use and coding. CONCLUSIONS: Feedback is most effective when: clinically relevant, educationally orientated, given by peers, and sensitive to the socio-technical context.

Feedback↗
PubMedDate not supplied

Automated computer interviews to elicit utilities: potential applications in the treatment of deep venous thrombosis.

OBJECTIVE: To assess the practicality of an automated computer interview as a method to assess preferences for use in decision making. To assess preferences for outcomes of deep vein thrombosis (DVT) and its treatment. STUDY DESIGN: A multimedia program was developed to train subjects in the use of different preference assessment methods, presented descriptions of mild post-thrombotic syndrome (PTS), severe PTS and stroke and elicited subject preferences for these health states. This instrument was used to measure preferences in 30 community volunteers and 30 internal medicine physicians. We then assessed the validity of subject responses and calculated the number of quality-adjusted life years (QALYs) for each individual for each alternative. RESULTS: All subjects completed the computerized survey instrument without assistance. Subjects generally responded positively to the program, with volunteers and physicians reporting similar preferences. Approximately 26.5% of volunteers and physicians had preferences that would be consistent with the use of thrombolysis. Individualization of therapy would lead to the most QALYs. CONCLUSIONS: Utilization of computerized survey instruments to elicit patient preferences appears to be a practical and valid approach to individualize therapy. Application of this method suggests that there may be many patients with DVT for whom treatment with a thrombolytic drug would be optimal.

Adult↗