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Computer phobia.

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Humans

The findings--diagnosis continuum: implications for image descriptions and clinical databases.

As part of the Unified Medical Language System (UMLS) project, we have been exploring the use of semantic net representation to build a medical ontology that can adapt to the needs and perspective of differing kinds of users with varying purposes. A principal objective is to facilitate indexing and retrieval of objects in a variety of target databases, using their own source vocabularies, while maintaining the representation of concepts to which these source vocabularies refer in a single consistent form, so that retrievals that span resource types can be accommodated. In addition, a particular area of deficiency of the existing UMLS Metathesaurus is that of clinical findings, a part of the problem being the multiple alternative views and granularity levels at which clinical findings are described in different target databases. The problem is particularly obvious when one examines the way in which image findings are described, which may be at a purely perceptual level, or at varying levels of aggregation into higher level observations or interpretations. We have developed a recursive model for representing observations and interpretations in a semantic net along a continuum of degree of aggregation, that appears to lend itself well to adaptation to varying perspectives.

Diagnosis, Computer-Assisted

[The main objectives in using informatics in medicine].

The costly application of informatics in practical medicine should be associated with unequivocal clear motivation. Three important problems are presented whose solution is possible only by computer use: integration of health information on each citizen in the country with recording of this information in a modern carried which is possessed by each patient, wide availability of modern medical computerized medical documentation for research and statistical analysis, and computer-assisted rational economics of health care services.

Equipment Design

Medical informatics--an Australian perspective.

Computers, like the X-ray and stethoscope can be seen as clinical tools, that provide physicians with improved expertise in solving patient management problems. As tools they enable us to extend our clinical information base, and they also provide facilities that improve the delivery of the health care we provide. Automation (computerisation) in the health domain will cause the computer to become a more integral part of health care management and delivery before the start of the next century. To understand how the computer assists those who deliver and manage health care, it is important to be aware of its functional capabilities and how we can use them in medical practice. The rapid technological advances in computers over the last two decades has had both beneficial and counterproductive effects on the implementation of effective computer applications in the delivery of health care. For example, in the 1990s the computer hobbyist is able to make an investment of less than $10,000 on computer hardware that will match or exceed the technological capacities of machines of the 1960s. These rapid technological advances, which have produced a quantum leap in our ability to store and process information, have tended to make us overlook the need for effective computer programmes which will meet the needs of patient care. As the 1990s begin, those delivering health care (eg, physicians, nurses, pharmacists, administrators ...) need to become more involved in directing the effective implementation of computer applications that will provide the tools for improved information management, knowledge processing, and ultimately better patient care.

Australia

The organization engine: virtual data integration.

The Organization Engine is an early example of Virtual Data Integration--providing the appearance of integration at the desktop without modifying existing infrastructure. Starting with the Organization Engine, eight programming days were needed to provide uniform desktop access to a CODASYL-compliant hospital information system and to a MUMPS-based radiology information system (the technique is equally effective for relational and other data bases). The resulting tool provides a seamless integration of these two systems, image storage, pre-recorded audio, and document storage. In addition to providing uniform access, the tool allows healthcare providers to organize the data to suit their individual needs. The ease of this integration lies in two simple techniques: the transformation of data from all sources into a single, homogeneous representation, and the use of simple customization files to describe new object types and formats. The approach is sufficiently general to allow the integration of applications which present external interfaces of radically different forms. Two such forms are discussed here: data map publication and transactions.

Computer Communication Networks

[Medical informatics systems exemplified by the diagnosis of equilibrium disorders].

An interdisciplinary field, namely the differential diagnosis of balance disorders and vertigo, is used to describe how a medical expert system can be developed using modern computer analysis, medical expertise, and human pattern recognition techniques. The advantages, results, and unresolved issues of close cooperation between biomedical engineers and physicians are described. The aim of this cooperation was to ensure that complicated data were presented in simple graphic form and that large amounts of diagnostic data were optimally linked together for the generation of a recommended diagnosis. Similar techniques may usefully be employed in other areas of medicine.

Caloric Tests

From mainframe to micro: decentralization of perinatal epidemiology.

To evaluate the feasibility of analyzing large perinatal datasets on smaller computers, the 1980 National Natality Survey was downloaded first to a minicomputer and then to a microcomputer. Operating system utilities were used to minimize programming and storage requirements. Accuracy was confirmed by comparing descriptive statistics with published values derived on mainframes. Based on a typical analytic problem, implementation on the microcomputer compared favorably to implementation on the minicomputer. Our results suggest that the microcomputer may be a practical alternative to the mainframe for perinatal epidemiological analysis.

Computers

Design and implementation of a biomedical image database (BDIM).

We developed a biomedical image database (BDIM) which proposes a standardized representation of value arrays such as images and curves, and of their associated parameters, independently of their acquisition mode to make their transmission and processing easier. It includes three kinds of interactions, oriented to the users. The network concept was kept as a constraint to incorporate the BDIM in a distributed structure and we maintained compatibility with the ACR/NEMA communication protocol. The management of arrays and their associated parameters includes two distinct bases of objects, linked together via a gateway. The first one manages arrays according to their storage mode: long term storage on optionally on-line mass storage devices, and, for consultations, partial copies of long term stored arrays on hard disk. The second one manages the associated parameters and the gateway by means of the relational DBMS ORACLE. Parameters are grouped into relations. Some of them are in agreement with groups defined by the ACR/NEMA. The other relations describe objects resulting from processed initial objects. These new objects are not described by the ACR/NEMA but they can be inserted as shadow groups of ACR/NEMA description. The relations describing the storage and their pathname constitute the gateway. ORACLE distributed tools and the two-level storage technique will allow the integration of the BDIM into a distributed structure, Queries and array (alone or in sequences) retrieval module has access to the relations via a level in which a dictionary managed by ORACLE is included. This dictionary translates ACR/NEMA objects into objects that can be handled by the DBMS.(ABSTRACT TRUNCATED AT 250 WORDS)

Database Management Systems

Evaluation of clinical decision aids--more to think about.

Validation and clinical testing of medical decision aids is a hot topic at present. We state a few main points which, in our opinion, have not received the attention they deserve. Our main concerns have to do with the statistical design and analysis of field evaluation studies; with long-term effects; and with the interplay between medicine and the software industry. The points represent our reaction to a recent symposium on the topic, published in this special issue. We take the opportunity to supplement the papers at hand in various ways and, where we see a risk of misconceptions or poor practice becoming cemented, try to point out the proper course.

Decision Making, Computer-Assisted

Teaching medical informatics to biomedical engineering students: experiences over 15 years.

The Departments of Biomedical Engineering and Medical Informatics at Linköping University in Sweden were established in 1972-1973. The main purpose was to develop and offer courses in medicine, biomedical engineering and medical informatics to students in electrical engineering and computer science, for a specialization in biomedical engineering and medical informatics. The courses total about 400 hours of scheduled study in the subjects of basic cell biology, basic medicine (terminology, anatomy, physiology), biomedical engineering and medical informatics. Laboratory applications of medical computing are mainly taught in biomedical engineering courses, whereas clinical information systems, knowledge based decision support and computer science aspects are included within the medical informatics courses.

Biomedical Engineering

Structure characteristics of QMSOC and the relevant operators.

This article presents a further description on the background, significance, and structure characteristics of Quantitative Medicine Simulation and Operation by Computer (QMSOC). Also some basic operators were recommended for calculations of biomedical events such as estimation of substance concentrations, exploration of etiology, evaluation of biomedical effects, etc. At last some differences of QMSOC from other artificial intelligent systems in the medical field were discussed.

Computer Simulation

Teaching medical informatics: teaching on the seams of disciplines, cultures, traditions.

This paper reviews different concepts of medical informatics and identifies two families of approaches to education in it: a "specialist" approach, whereby medical informatics is taught as a specialization track for established disciplines like medicine, computer science, nursing, engineering, etc., and a "generalistic" approach, whereby it is taught as an integrated discipline incorporating essential traits of the aforementioned disciplines. The pros and cons of these approaches are outlined. The need to accommodate specific requirements of education is emphasized and these are identified, together with an outline of particular challenges that we are facing.

Attitude to Computers