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PubMed2005

An inventory of evaluation studies of information technology in health care trends in evaluation research 1982-2002.

OBJECTIVES: During the last years the significance of evaluation studies as well as the interest in adequate methods and approaches for evaluation has grown in medical informatics. In order to put this discussion into historical perspective of evaluation research, we conducted a systematic review on trends in evaluation research of information technology in health care from 1982 to 2002. METHODS: The inventory is based on a systematic literature search in PubMed. Abstracts were included when they described an evaluation study of a computer-based component in health care. We identified 1035 papers from 1982 to 2002 and indexed them based on a multi-axial classification describing type of information system, study location, evaluation strategy, evaluation methods, evaluation setting, and evaluation focus. RESULTS AND CONCLUSIONS: We found interesting developments in evaluation research in the last 20 years. For example, there has been a strong shift from medical journals to medical informatics journals. With regard to methods, explanatory research and quantitative methods have dominated evaluation studies in the last 20 years. Since 1982, the number of lab studies and technical evaluation studies has declined, while the number of studies focusing on the influence of information technology on quality of care processes or outcome of patient care has increased. We interpret this shift as a sign of maturation of evaluation research in medical informatics.

Evaluation Studies as Topic↗
PubMed1995

Teleform scannable data entry: an efficient method to update a community-based medical record? Community care coordination network Database Group.

Community-based multi-disciplinary care of chronically ill individuals frequently requires the efforts of several agencies and organizations. The Community Care Coordination Network (CCCN) is an effort to establish a community-based clinical database and electronic communication system to facilitate the exchange of pertinent patient data among primary care, community-based and hospital-based providers. In developing a primary care based electronic record, a method is needed to update records from the field or remote sites and agencies and yet maintain data quality. Scannable data entry with fixed fields, optical character recognition and verification was compared to traditional keyboard data entry to determine the relative efficiency of each method in updating the CCCN database.

Chronic Disease↗
PubMed2006

HDLalert - a healthcare DL alerting system: from user needs to implementation.

In the health domain, there are many circumstances where clinicians (i.e. doctors, nurses, allied health professionals) and patients wish to track changes in medical knowledge. However, existing 'news' or 'alert' services provide relatively limited means for selecting which information to receive. The result is that clinicians and patients often receive information that is inappropriate, irrelevant or simply too much. In this paper, we detail alert-relevant findings from several international user studies (e.g. UK, Germany and New Zealand) incorporating both clinical staff (across several hospitals) and patients' perceptions. These findings demonstrate the importance of context, in terms of both the user's task and immediate environment. We introduce a novel alerting architecture that can provide a finely tailored stream of alerts to the user, and provides further support to assist the interpretation of received material.

Consumer Behavior↗
PubMed2000

Digital photography in the dental practice--an overview (II).

The advantage of digital cameras is the instant, digitalized availability of photos. The image quality has reached that of conventionally taken photographs, and for most applications, the digital origin of the photo is no longer discernable. Thus, digital photos are suited for immediate data transmission, for instance to the lab or a colleague. Similarly, they can also be instantly integrated into the practice's software and stored there. If one expects the same quality of digital photo documentation as from conventional photo documentation, then there is no alternative to the still-expensive professional digital reflex cameras, which are in the same price range as intraoral videosystems. These systems can be considered technically mature and suitable for routine practice applications. However, the advantages of digital photos can only be had at greater technical (regarding cameras and peripheral devices) expense. Amateur-class digital viewfinder cameras and reflex cameras without zoom lenses have only limited applications in terms of documentation, where they may supplement conventional photography. Before acquiring a digital camera, it makes good sense to draw up a cost-benefit list and consider alternatives. As dental practices become more and more computerized, digital photo documentation will also be a standard procedure of the future. In any case, it is worthwhile to start looking closely at these media now.

Equipment Design↗
PubMed1997

Disasters and the information technology revolution.

This paper, the second in a series of state-of-the art reviews, examines the evolution and possible medium-term future of information technology (IT) in disaster management. Until the end of the 1970s, civilian application of IT to disaster management was confined to a few specialised departments of universities, large companies and government. Between the late 1970s and mid-1980s, microprocessor-based devices brought limited, though rapidly improving, computing capacity to a wider range of organisations and individuals. Operational applications included real-time emergency information, management decision support and programme and project planning. Extensive innovation occurred, though operational implementation was often long delayed or limited in scope. During the late 1980s, desktop systems became more powerful, more networked, more portable and generally more mature, with a range of practical emergency-related tools emerging. Computer communications emerged as a practical technology for linking emergency professionals on a global basis. From the early 1990s onwards, powerful and inter-connectable computer equipment has evolved to become an indispensable component of disaster operations worldwide. There are presently major changes under way in emergency-related global information access and networking--the implications of which have yet to be played out. The last part of the paper highlights a set of key technologies which seems likely to shape disaster planning, management and research over the next 10 years, and draws out some operational and organisational implications.

Computer Communication Networks↗
PubMed1993

[Collecting, publishing and searching scientific and research information].

Time of information in which we live resulted in the increase of the amount of the information exponential growth of the new kind of knowledge, flourishing of the familiar ones, and the appearance of the new sciences. Medical (health) informatics occupies the central place in all the segments of modern medicine in the past thirty years--in practical work, education and scientific research. In all that, computers have taken over the most important role and are used intensively for the development of the health information systems. Following activities develop intensively within the area of health informatics: health- documentation, health-statistics, health-informatics and biomedical scientific and professional information. Starting with the fact that in this century and especially after the World War II, great advancement in bio-medical sciences is visible, in Bosnia and Herzegovina, it is clear that as a result of the above increase in scientific research, in the number of scientists, and funds invested in scientific institutions, equipment and documentation, is visible. Innovations and developments in science demand analytic-synthetic processing of scientific information and their utilisation research. This can be realised by collecting sources (documents) for reading, noting, editing, discovering-which is the integral part of scientific developmental research. Scholarly journals as well as the publications that follow the latest events in the world of science, and inform their users in the area of bio-medicine quickly and efficiently, play an important role in the professional literature.

Information Storage and Retrieval↗
PubMed2001

Why some physicians envy dentists: the applications service provider.

To summarize, here's what I get from my ASP. My staff and I can access our schedules, patient information, etc, any time and from anywhere--not just from the office PC. All I need is a standard Internet browser and a connection to the Internet. Only authorized personnel have access to my data. My online practice management system is password protected and operates with Verisign SSL--the highest level of Internet security. All information is stored in my secure database, which my ASP backs up and replicates continuously. Dental. PackOnline even operates dual servers. In case one server has a problem, they just switch to the other server, so I never have to worry about "down-time." I can give patients access to their own information online-treatment plans, patient education material, balances, etc, in a highly private and confidential manner. I can share patient information, x-rays, and other materials online with colleagues, specialists, and labs, again in a highly confidential manner. I send out billing, recalls, claims, and more automatically because my ASP has real-time connections to service providers. No more time spent printing, folding, stamping cards, billing, or processing claims. This is a tremendous cost and time saver!

Computer Security↗
PubMed1998

GPCRDB: an information system for G protein-coupled receptors.

The GPCRDB is a G protein-coupled receptor (GPCR) database system aimed at the collection and dissemination of GPCR related data. It holds sequences, mutant data and ligand binding constants as primary (experimental) data. Computationally derived data such as multiple sequence alignments, three dimensional models, phylogenetic trees and two dimensional visualization tools are added to enhance the database's usefulness. The GPCRDB is an EU sponsored project aimed at building a generic molecular class specific database capable of dealing with highly heterogeneous data. GPCRs were chosen as test molecules because of their enormous importance for medical sciences and due to the availability of so much highly heterogeneous data. The GPCRDB is available via the WWW at http://www.gpcr.org/7tm

Computer Communication Networks↗
PubMed1997

The modern CIO: forging a new role in the managed care era.

The advent of managed care has helped forge new roles for healthcare professionals. Competitive pressures, the profile of the member community, and provider network design drive healthcare delivery via the managed care model. Careful analysis and design of the managed care model charts the success or failure of the health care delivery system--usually an integrated delivery system (IDS). Therefore, those healthcare organizations that have chosen to get on the managed care bandwagon must re-invent themselves, both culturally and technologically. The chief information officer (CIO) leads this technological revolution. To work effectively, the technological infrastructure of the IDS must be closely in line with enterprise goals and objectives. In the managed care environment the old information system (IS) approach of supporting the operational needs of individual departments simply will not work. The CIO's new role will be to master the concept of managed care to ensure that enterprise-wide needs for operational, clinical, and financial information are met, and that IS and enterprise goals are aligned. CIOs who have an intuitive grasp of the managed care environment--although their numbers are growing as managed care mushrooms--make up a minority group. They are a special breed with clearly definable qualities such as business savvy and an affinity for big-picture thinking. To an IDS, a CIO with these qualities is a rare gem indeed. This article introduces Don Winschel, the associate administrator and CIO of Johnson City Medical Center (Johnson City, TN) as an example of one such modern CIO.

Administrative Personnel↗
PubMed2001

A multilingual medical thesaurus browser for patients and medical content managers.

This paper introduces a user-friendly browser interface which integrates multilingual search and browsing functionalities within medical thesauri via the internet. The tool is being developed as part of the GIN Austria Patient Information System and is based on an adapted datamodel of the MeSH thesaurus. A prototype offers the possibility to build up queries and export lists of MeSH main headings collected during browsing the relevant MeSH trees. The thesaurus browser can be used both by patients and citizens to build queries based on a controlled vocabulary to match them with existing documents within GIN and by medical information managers to find out appropriate keywords for interactive tagging or indexing of medical contents. A key component of this tool is the flexible choice of different languages of the MeSH datasource as well as of the user interface. Both can be changed independently at any point during a session. Another central aspect is the use of the UMLS Metathesaurus in combination with localized Thesaurus versions due to existing international character set problems.

Abstracting and Indexing↗
PubMed1999

Public health and the Air Management Information System (AMIS).

This paper discusses the importance of public health studies with respect to risk assessment and risk management in the framework of air quality management. This is performed with respect to the Air Management Information System (AMIS), which was set up recently by the World Health Organization. The Air Management Information System is an information-exchange system in the scheme of the Global Air Quality Partnership providing information on all issues of air quality management between its participants: municipalities, countries' environmental protection agencies, international organizations, World Bank and international development banks, and nongovernmental organizations. Public health studies of air pollution-induced health effects are an important ingredient for decisions with respect to the management of air quality. First, they are to be used to derive air quality standards from air quality guidelines. Secondly, they serve to assess the causal link between observed health effects in the population and the causative agents in the air. Thirdly, they can be used to estimate ideal (in the sense of not being expressed in monetary terms) or economic damage functions that are necessary to assess the magnitude of the ideal or economic damages to human health. The latter are necessary for a sensible cost-benefit analysis in which the costs of control measures to reduce air pollution are compared with the costs of health effects.

Air Pollution↗
PubMed2005

IMGT-Choreography for immunogenetics and immunoinformatics.

IMGT, the international ImMunoGeneTics information system (http://imgt.cines.fr), was created in 1989 at Montpellier, France. IMGT is a high quality integrated knowledge resource specialized in immunoglobulins (IG), T cell receptors (TR), major histocompatibility complex (MHC) of human and other vertebrates, and related proteins of the immune system (RPI) which belong to the immunoglobulin superfamily (IgSF) and MHC superfamily (MhcSF). IMGT provides a common access to standardized data from genome, proteome, genetics and three-dimensional structures. The accuracy and the consistency of IMGT data are based on IMGT-ONTOLOGY, a semantic specification of terms to be used in immunogenetics and immunoinformatics. IMGT-ONTOLOGY has been formalized using XML Schema (IMGT-ML) for interoperability with other information systems. We are developing Web services to automatically query IMGT databases and tools. This is the first step towards IMGT-Choreography which will trigger and coordinate dynamic interactions between IMGT Web services to process complex significant biological and clinical requests. IMGT-Choreography will further increase the IMGT leadership in immunogenetics and immunoinformatics for medical research (repertoire analysis of the IG antibody sites and of the TR recognition sites in autoimmune and infectious diseases, AIDS, leukemias, lymphomas, myelomas), veterinary research (IG and TR repertoires in farm and wild life species), genome diversity and genome evolution studies of the adaptive immune responses, biotechnology related to antibody engineering (single chain Fragment variable (scFv), phage displays, combinatorial libraries, chimeric, humanized and human antibodies), diagnostics (detection and follow up of residual diseases) and therapeutical approaches (grafts, immunotherapy, vaccinology). IMGT is freely available at http://imgt.cines.fr.

Alleles↗
PubMed1994

The need for security--a clinical view.

Systems which process patient health data of any kind are considered to be medical information systems. Some data can be categorized as non-personal, non-identifiable, or non-patient-based such as knowledge bases. Others are considered as highly sensitive because of the 'need to know' to deliver health care to patient. Access is not only justifiable for doctors and nurses, but, for specific purposes to administrative personnel and public health organisations. Of special concern are registers on sexually transmitted diseases, mental health and genetic diseases. In future, patients might gain more autonomy and also have access to some parts of their own record. Telematics allows them to update a data base and to consult a knowledge base. Clearly, physicians in charge of the cases have a responsibility that has been recognised by law in all Western countries. Access to patient's data should take into account this responsibility. Although most health professionals would still believe that confidentiality is the main issue, it appears that data integrity and availability are as important in the context of the 'paperless' electronic record. Information should be complete and correct, to be only accessed by authorized persons. The health care environment is characterised by an open nature of clinics that leaves them vulnerable to theft, damage and unauthorized access. Disclosure of information may affect the patient's social standing as well as their general health. The health professions lack sufficiently well-defined organisational structure, culture and perceptions to support security.

Computer Communication Networks↗
PubMed1992

Was the Dalkon Shield a safe and effective intrauterine device? The conflict between case-control and clinical trial study findings.

OBJECTIVE: To compare the findings of the case-control and cohort studies used to indict the Dalkon Shield (A.H. Robins Company, Inc., Richmond, VA) with the findings of the Dalkon Shield clinical trials. DATA IDENTIFICATION: All published reports on the Dalkon Shield were identified through MEDLARS system (United States National Library of Medicine) searches and by cross checking all references in these reports. The same approach was used to identify all case-control and cohort studies of the purported relationship between intrauterine devices (IUDs) and pelvic inflammatory disease (PID). STUDY SELECTION: Only studies of interval patients that included 50 or more women and 6 or more months of follow up that computed standard IUD event rates (rates of pregnancy and expulsion and removal for pain and bleeding) were selected for this study. All case-control and cohort studies identified were included except two case-control studies that included women with sterile chronic salpingitis. RESULTS: The 16 case-control and 2 cohort studies found or suggested that the Dalkon Shield increased the risk of PID. The 71 clinical trials of the Dalkon Shield show that when this device is inserted by an experienced clinician it is a safe and effective contraceptive method, comparable with other IUDs used at the time. There was no evidence of an increased risk of PID found in these clinical trials. CONCLUSIONS: This study offers convincing evidence that the indictment of the Dalkon Shield was a mistake. Additionally, this study shows that physician skill and experience is far more important to successful IUD insertion than previously recognized, a finding with considerable implications for IUD study designs and for marketing strategies.

Case-Control Studies↗
PubMed2007

Nurses are increasingly involved in pharmacovigilance in Sweden.

INTRODUCTION: In Sweden, voluntary adverse drug reaction (ADR) reporting started over 40 years ago to detect rare, serious, unexpected adverse, mainly type B, reactions. During the period 1965-2004, 92,000 reports were assessed. Since certain nurses are licensed to prescribe a limited number of drugs, nurses also form part of the reporting team. AIM: To analyse the ADR reporting by nurses in Sweden. METHODS: All reports by nurses and other health-care personnel entered into the Swedish ADRs database SWEDIS (Swedish Drug Information System) were retrieved for the 10-year period 1995-2004 (Swedish population: 9 million). The intention was to analyse the nurses' reports from a quantitative and qualitative point of view. RESULTS: The total number of ADR reports has gradually increased during the past 10 years from 3000 to over 4000 in 2004 (465 per million inhabitants), an increase by 28%. All ADR reports originate from health care personnel. The nurses' contribution to the ADR reporting increased from 2-3% in the mid-90s to 12% in 2004. The most common drugs involved in the nurses' reporting were various kinds of vaccines. Skin reactions dominated among the nurses' ADR reports. The ADRs reported by nurses were, as a consequence of many vaccine reports, compared to all reports, not so often classified as serious, but were on the other hand more often assessed with a causal relationship. CONCLUSIONS: Nurses, in their position as drug administrators who record signs and symptoms of the patients, play an increasingly important role for detection of suspected ADRs and are now contributing to a significant amount of the ADR reporting in Sweden.

Adverse Drug Reaction Reporting Systems↗
PubMed1993

Perusing the literature via citation links.

While MEDLINE searching is recognized as the single most effective means to identify relevant items to solve clinical and research problems, the clinician should also consider the complementary strategy to search for relevant items citing a known key paper. This study reports on the usefulness of citation searching based on the analysis of 89 searches. For each topic, the citations linked to an average of 24% additional relevant materials. At least one relevant item was added to 85% of the searches. The additional effort of scanning another printout is minimal since citation searching for 42% of the searches produced less than 7 additional items, half of which were judged to be useful. Duplicate retrievals were mostly of definite relevance. This alternate strategy appeared to be effective in interdisciplinary topics. Furthermore, the online version of the citation index is known for short turn-around time in processing, a feature important for many rapidly developing specialties.

Costs and Cost Analysis↗