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[Information systems for health and social care planning. Information basis and information channels in the municipalities].

The Norwegian Government has started to develop a new system for a better exchange of information between the central and the local authorities when planning health and social services. The plan is to base the system on nationwide collection and delivery of standardized indicators which will signal trends and enable comparisons. Several conclusions from an interview survey indicate that the new information system will not be particularly useful. Local authorities believe that their information is good enough already, and have little confidence in statistics prepared by the central authorities. On the other hand many of them called for more statistics that would enable comparisons between neighbouring municipalities, and several had themselves taken the initiative to collect data on various local needs and activities.

Health Planning

A biomedical information source: the National Clearinghouse for Alcohol Information.

The National Clearinghouse for Alcohol Information (NCALI) is an information resource developed by the National Institute on Alcohol Abuse and Alcoholism of the U.S. Department of Health, Education, and Welfare. It provides numerous alcohol-related information services to professionals in a wide spectrum of biomedical and other disciplines, services that are designed to aid information users in the discrimination and selection of useful literature from the volumes of available information. One such service will provide the biomedical professional, working in an alcohol-related field, with announcements of recent information in categories that he selects from 110 possible fields of interest. Another information service is the quality evaluation of technical documents. The quality evaluation system, which is under continuing development and refinement, serves the literature user by providing a literature quality prescreening process designed to aid users in their literature review and monitoring activities. Additional information services provided by the clearinghouse include Grouped Interest Guides, Subject Area Bibliographies, a quarterly magazine and a periodic general interest information service, and a wide range of special publications. Reference services provide a suitable depth of response to information requests through services that range from assemblages of standard information materials, such as pamphlets and similar publications, to automated data base searches for more technically oriented information requests.

Alcoholism

Community, hospital and clinical pharmacists and drug information centers as physician drug information sources.

The use of drug information centers and clinical, hospital and community pharmacists by university and community practice physicians in North Carolina was examined. Questionnaires were sent to 674 nonfederal physicians with a response rate of 203 (35.5%). Approximately half of the sample were staff members of a university hospital. The questionnaire covered eight types of drug information. Significant results were reported at the p = 0.05 level. Physicians sought specific drug information approximately one to four times a month. University hospital-affiliated physicians rated clinical and hospital pharmacists significantly higher than community pharmacists for six subject areas, and they also ranked clinical pharmacists over hospital pharmacists on four subject areas and considered them more reliable than other pharmacy drug information sources. Physicians associated with community hospitals ranked hospital pharmacists over community pharmacists as sources of information for four areas and rated them more reliable than other pharmacy drug information sources; this group preferred to use community pharmacists for information on product availability. It appears that clinical pharmacists are used by university-associated physicians as drug information sources. Use in community hospitals of the hospital pharmacist as a drug information source is better than the literature might suggest.

Attitude of Health Personnel

Information flow in the hospital: a comparative study of the Hungarian and the Dutch situation using a two axes model of hospital information flow.

This study compares the organization and structure of information flow in a Dutch and in a Hungarian hospital. The study was carried out as a field orientation part of a Health Care Management project of the Hogeschool van Amsterdam. The host of the field orientation was the BAZIS Foundation, the Central Development and Support Group Hospital Information System, Leiden. The visited hospitals were equipped with the BAZIS Hospital Information System. The method of study consisted of series of formalized interviews with all-level actors of a hospital; the interpretation of data was enhanced by a two axes (patient and management) model of information flow defined by the authors. In summary, Dutch hospitals show a more elaborate information flow system, with more information flow channels sideways among equal levels, less bureaucracy in organization of information flow, and significantly more benefits of automation, compared to the Hungarian situation.

Computer Systems

A specialized information center. The clinical neurology information center.

The history, philosophy, and methodology of a unique specialized medical information center are reported. The Clinical Neurology Information Center is an educational information service (giving its audience information which can be the basis for formulating their own questions) rather than an instructional information service (giving information in reply to questions). Clinical, as well as basic neuroscience, information is culled by professional neurologists from 855 medical periodicals. The essence of each article is summarized in a single sentence ("terse conclusions") or a bibliographic reference only is given; this material is published every two weeks in the Concise Clinical Neurology Review (CCNR). The format of the CCNR is such that the reader should be able to scan a very large amount of current literature by investing only twenty to thirty minutes every two weeks. The values of this system as well as some of its problems are discussed.

Abstracting and Indexing

Inform: conceptual modelling of intensive care information systems.

Intensive care of a patient requires heavy monitoring and versatile therapeutic actions. These produce a huge amount of patient information. A problem exists in managing this data and other information from all supporting activities creating a need for an automated information management system. To have a sound basis for future automated information systems in intensive care unit (ICU), a conceptual model is created to cover both the clinical and other activities of the ICU. The conceptual model consists of data flow diagrams and entity-relationship diagrams with underlying common data dictionary. A modern CASE tool is utilized to build the model. The work forms a part of AIM-INFORM project, which has a purpose to develop information management and decision support systems for high dependency environment.

Computer Simulation

Comparison of different information content models by using two strategies: development of the best information algorithm for Iliad.

Iliad is a diagnostic expert system for internal medicine. Iliad's "best information" mode is used to determine the most cost-effective findings to pursue next at any stage of a work-up. The "best information" algorithm combines an information content calculation together with a cost factor. The calculations then provide a rank-ordering of the alternative patient findings according to cost-effectiveness. The authors evaluated five information content models under two different strategies. The first, the single-frame strategy, considers findings only within the context of each individual disease frame. The second, the across-frame strategy, considers the information that a single finding could provide across several diseases. The study found that (1) a version of Shannon's information model performed the best under both strategies---this finding confirms the result of a previous independent study, (2) the across-frame strategy was preferred over the single-frame strategy.

Algorithms

The rabies information system--a model for a common information system in human and veterinary medicine.

An information system is described in the field of rabies, which realizes the integration of information streams from human medicine as well as from veterinary medicine by help of computers. This rabies information system is based on a homogeneous and coordinated system of surveillance in connection with prophylaxis and control of rabies. It includes a modification of the case record, suggested by the WHO-Expert-Committee on Rabies. The aims of this rabies information system are: to make obvious the epizootiological situation with formation and change of foci, to show the epidemiological importance of special animals and to recognize the epidemiological situation. All this has to be fulfilled in an integrated system. Furthermore optimal treatment is guaranteed by express diagnostics and earliest possible special treatment of high-risk groups by the co-operation of human and veterinary medicine. The rabies information system was generally introduced in the GDR in 1970. It has proved to be practicable and effective especially by standardization of diagnostics, recording exposure of the patient, his treatment and partly automated evaluations of situation records and documentation of efficiency.

Animals

Information seeking vs information utilization in children's induction from incomplete pictures.

By removing small squares which completely covered simple silhouette pictures, 4-,6-,8-, and 10-yr.-old children gradually exposed information until they were able to induce, or identify, the whole picture. This method allowed differentiation between the development of information-seeking behavior (accuracy of removing only those squares which exposed the silhouette) and utilization of information (accuracy of identifying partially exposed silhouettes). Results indicated a monotonic development in information seeking but a plateau between ages 6 and 8 yr. in utilization of information.

Age Factors

Information processing limits: the effects of information load and age.

As a test of the effects of age and information load Ss performed a visual and auditory discrimination task under conditions requiring division of attention. Amount of stimulus information was determined by the number of stimulus alternatives which could occur in a set of trials. Performance by 12 Ss over age 40 was impaired in comparison to 12Ss under age 40. Performance for all Ss was a function of amount of information, but there was no Age X Information Load interaction. It has been reported in the literature that age-related performance decrements are correlated with task complexity. These data indicate that amount of information is not a critical dimension of task complexity as it contributes to age-related performance deficits.

Adult

Oral contraceptive patient information. A questionnaire study of attitudes, knowledge, and preferred information sources.

A questionnaire was designed to assess attitudes, knowledge, and views and sources of drug information on oral contraceptives, with particular attention to the role of the patient-oriented package insert. An analysis of 828 completed questionnaires shows that many women are apprehensive about the safety of oral contraceptives. The impact of the patient-oriented oral contraceptive insert on the women surveyed appears to be positive. The present labeling is read and found useful by most oral-contraceptive users. Patients were variably informed about the correct use and side effects discussed in current labeling, suggesting a need for improved transmission of important drug information. Patients preferred information from health professionals and printed sources over media sources. Balanced label information about risks of oral contraceptives should be made available to improve the likelihood of sound risk-benefit judgments.

Adolescent

Development of a model of information security requirements for enterprise-wide medical information systems.

Information security methods developed within the narrow frameworks of operating system design, specific database models, and military security methods all concentrate on representation of the objects of access control, rather than on the information needs of the subjects. This approach does not adequately support the needs of the varied users of medical information systems, who must have access to information in support of multiple organizational roles. A new conceptual approach to access control in medical settings based on user requirements is discussed.

Computer Security

Information processing immunogenetic analysis. IV. Information amount and predictive power of different immunogenetic models.

Principles of information theory are imposed on immunogenetic information processing, whereby the 'information amount', simplicity, 'redundancy' and 'predicatability' of different encodings, models, theories or mappings can be objectively compared. As an example, the experimental observables emanating from the Rh system at its 10 reagent-8 haplotype level is shown to obtain an information amount of 140,120 and 78 bits when interpreted (encoded according to a simple-complex, complex-simple and complex-complex theory, model or program, respectively. The 'predictive' or 'accomodating' power of the simple-complex and complex-simple theories is shown to be 134, respectively 366 bits for a given set of experimental observables emanating from a S3 universe.

Computers

Information system, data bases, and on-line services of the Japan Information Center of Science and Technology (JICST).

The JICST information processing system consists of the data-base production system, authority file management system, bibliographic retrieval system, and printed issue compiling system. The bibliographic retrieval service based on the JICST On-line Information System (JOIS-I) has been available through leased line since 1976 and now also through dial-up line, which covers five data bases: the JICST bibliographic and on-going research information files, CA Condensates, MEDLARS, and TOXLINE files. The on-line output in Japanese kanji is also available. The newly revised JOIS-II system is now being developed.

Forecasting

Network information security in a phase III Integrated Academic Information Management System (IAIMS).

The developing Integrated Academic Information System (IAIMS) at Columbia-Presbyterian Medical Center provides data sharing links between two separate corporate entities, namely Columbia University Medical School and The Presbyterian Hospital, using a network-based architecture. Multiple database servers with heterogeneous user authentication protocols are linked to this network. "One-stop information shopping" implies one log-on procedure per session, not separate log-on and log-off procedures for each server or application used during a session. These circumstances provide challenges at the policy and technical levels to data security at the network level and insuring smooth information access for end users of these network-based services. Five activities being conducted as part of our security project are described: (1) policy development; (2) an authentication server for the network; (3) Kerberos as a tool for providing mutual authentication, encryption, and time stamping of authentication messages; (4) a prototype interface using Kerberos services to authenticate users accessing a network database server; and (5) a Kerberized electronic signature.

Computer Communication Networks

Ongoing development of the Critical Care Information System: the collaborative approach to automating information management in an intensive care unit.

Point-of-care (bedside) clinical information systems can fulfill a variety of functions. Included in these functions are: becoming receptacles for patient data and allowing data to be manipulated into formats that facilitate clinical decision making; functioning as sources for billing and auditing processes; interfacing to other hospital systems and bringing distant data to the bedside; and being a repository for information used in the development of hierarchical and/or relational databases. The initial and ongoing development of these systems in a dynamic clinical environment requires the construction of processes and work pathways to ensure that the needs and requirements of myriad personnel, departments and agencies within the health center milieu are addressed.

Administrative Personnel