The United States National Library of Medicine.
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Biomedical subjects
Publications and source records attributed to H M Schoolman.
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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.
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Evidence derived from several simple searchers of the literature suggests that one interested in identifying papers which discuss the methodologies of clinical trials will have reasonable success. However, the retrieval of a meaningful methodologic duscussion of any actual trial is unlikely because very little of this information has been published. Some suggestions to remedy this deficiency are given.
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Computers are used to influence diagnostic and therapeutic decisions. The computer's information-handling capabilities allow it to serve as a reliable extension of the physician's memory and expander of the physician's information and synthesized knowledge resources. Computers have been used to facilitate decisions through organization of patient data, improved classification of patients, decision analysis in clinical settings, and simulation of expert clinical reasoning. Computer programs are more successful in narrow, constrained, single arenas of medicine with much underlying pathophysiologic understanding and where decisions are based largely on hard laboratory data. New models of synthetic reasoning that simulate expert clinical behavior show promise of supporting complicated decisions concerning problems of multiple diseases. All systems are confronted by problems of consensus and authority of the underlying information used.
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Builders of expert systems have generally accepted the principle that computer software should not be subject to government regulation if health care practitioners can be expected to interpret and apply the systems intelligently. The purpose of this paper is to identify the information that builders must make available to permit health care practitioners to exercise their clinical judgment in interpreting and applying the output of computing systems.