[Comment on the contribution: Adlassnig, K.-P.: Medical informatics in research, education and patient management].
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To study the value of historical clinical information, which we defined as data more than one year old, we measured the frequency and patterns of use of historical laboratory data among 87 providers in a multispecialty group practice delivering ambulatory care. During a one-month observation period, 38% of the providers requested historical data for use in clinical decision making. The requests were made for 19% of the patients, and represent 4% of the provider-initiated transactions on the computing system (328 per month). A survey also indicated that historical data are beneficial in clinical decision making.
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Although a number of experiments have demonstrated the importance of spatial ability as a predictor of computer-based performance, there is little evidence relating to the mechanics of this association or the implications for interface design. Two experiments on the relative importance of spatial and nonspatial semantic information within the context of computerized information retrieval are described. The first experiment indicated that spatial ability did not interact with the spatial information content of the computer interface. The second experiment indicated that the effects of spatial ability are attenuated when additional nonspatial semantic information is provided.
BACKGROUND AND OBJECTIVES: A number of medical educators have called for an increased emphasis on medical informatics training, but few family practice residency programs have provided more than cursory teaching efforts in this area. This paper provides an overview of approaches to medical informatics education that have been implemented with some success by "pioneer" programs. A comprehensive review of the literature reveals many promising teaching applications of informatics tools, such as palmtop computing devices, e-mail, decision support software, and videoconferencing. However, barriers to the advancement of informatics training in residency remain, including low rates of computer ownership and use among residents, a lack of information regarding faculty computer skills, and lack of collaboration among programs teaching informatics. Based on the literature review and tempered by expert recommendations, an eight-step process for developing or refining a family medicine informatics curriculum is proposed: 1) conduct a needs assessment 2) review expert recommendations, 3) enlist faculty and local institutional support, 4) espouse a human-centered approach, 5) integrate informatics training into the larger curriculum, 6) provide easy access to computers, 7) provide practical training, and 8) measure and report educational outcomes.
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BACKGROUND: Computer technology is now a well established resource in medicine and medical sciences. Surgery in developed countries has taken great advantage of this resource. This review is intended to highlight important aspects of computers in surgery and also encourages surgeons in Nigeria to acquaint themselves with its influences. METHODS: Publications from local and international journals as well as standard surgical texts were reviewed. RESULTS: The role of computers in surgery spans the areas of patient care, training, research, communication as well as surgical administration. Though a compliment to the surgeon, it has its problems including overwhelming information requiring careful scrutiny; computer fraud, hacking and viruses; copyright laws; the 'threat' of a well-informed patient population; and the risk of over dependence. Surgery in Nigeria and most of African is yet to maximize its benefits. CONCLUSION: The application of computers in surgery will in the near future make surgical knowledge and practice become more simplified and less time with increased productivity will be required even for highly technical procedures.
Flexibility is an important design criterion for user interfaces of interactive computer systems. Flexibility should allow an adaptation of the system to inter- and intra-individual differences in users. Flexible design requires to know how users base their decisions when they select one of the various options for interaction offered by the system. This problem has been studied in a psychophysiological experiment. In the experiment subjects were required to create graphics on a screen. Independent variables were: experience of the subjects (varied by training sessions), dialogue technique (menues vs. command language) and tasks. Tasks were constructed and analyzed by Cognitive Complexity Theory in order to have tasks suited for either menue or command techniques. Mental effort was registered by P300-amplitude of evoked potentials in the preparation stage of interaction and by 0.10 Hz-component of heart rate variability during the execution stage. It was possible to identify decision strategies based on anticipations of cognitive effort by considering the technique preferences shown in the training sessions and the time subjects spent on the task analysis.
The use of computers has become an integral part of a clinician's work. A departmental or home computer linked to a modem allows the maxillofacial surgeon to access the wealth of clinical information and resources of the Internet. This article unravels some of the technology involved and acts as a guide for further exploration.
The Internet is the fastest growing new information service, but it is still an unknown territory to many production and inventory control (PIC) managers. It should not be, and by reading this article they can get a rough idea what it is, how to use it, why it should be used, and where to start.
This paper describes an Awareness Programme delivered throughout Ireland which aims to increase the level of understanding of healthcare professionals as to the benefits of Information and Communications Technology (ICT) and of emerging trends in Health Informatics in Europe. The programme examines the use of ICT across the whole health sector--primary, secondary and tertiary. It has been delivered at over 30 centres to more than 1500 health professionals.
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African Americans with low incomes and low literacy levels disproportionately suffer poor health outcomes from many preventable diseases. Low functional literacy and low health literacy impede millions of Americans from successfully accessing health information. These problems are compounded for African Americans by cultural insensitivity in health materials. The Internet could become a useful tool for providing accessible health information to low-literacy and low-income African Americans. Optimal health Web sites should include text written at low reading levels and appropriate cultural references. More research is needed to determine how African Americans with low literacy skills access, evaluate, prioritize, and value health information on the Internet.
Kaiser Permanente Mid-Atlantic States has developed a fully integrated outpatient information system which currently runs on an IBM ES9000 on a VM platform written in MUMPS. The applications include Lab, Radiology, Transcription, Appointments. Pharmacy, Encounter tracking, Hospitalizations, Referrals, Phone Advice, Pap tracking, Problem list, Immunization tracking, and Patient demographics. They are department specific and require input and output from a dumb terminal. We have developed a physician's work station to access this information using PC compatible computers running Microsoft Windows and a custom Microsoft Visual Basic 2.0 environment which draws from these 14 applications giving the physician a comprehensive view of all electronic medical records. Through rapid prototyping, voluntary participation, formal training and gradual implementation we have created an enthusiastic response. 95% of our physician PC users access the system each month. The use ranges from 0.2 to 3.0 screens of data viewed per patient visit. This response continues to drive the process toward still greater user acceptance and further practice enhancement.
Electronic health tools provide little value if the intended users lack the skills to effectively engage them. With nearly half the adult population in the United States and Canada having literacy levels below what is needed to fully engage in an information-rich society, the implications for using information technology to promote health and aid in health care, or for eHealth, are considerable. Engaging with eHealth requires a skill set, or literacy, of its own. The concept of eHealth literacy is introduced and defined as the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. In this paper, a model of eHealth literacy is introduced, comprised of multiple literacy types, including an outline of a set of fundamental skills consumers require to derive direct benefits from eHealth. A profile of each literacy type with examples of the problems patient-clients might present is provided along with a resource list to aid health practitioners in supporting literacy improvement with their patient-clients across each domain. Facets of the model are illustrated through a set of clinical cases to demonstrate how health practitioners can address eHealth literacy issues in clinical or public health practice. Potential future applications of the model are discussed.
This paper reports on the role users played in the design and development of an electronic patient record. Two key users participated in the project team. All future users received questionnaires and a selection of them was interviewed. Before starting the development of the EPR, the attitude of users towards electronic record keeping, their satisfaction with the paper clinical records, their knowledge of computers, and their needs and expectations of computer applications in health care were measured by means of a questionnaire. The results of the questionnaire were supplemented with in-depth interviews. Users had a neutral attitude towards electronic record keeping. They were more positive about data entry of the paper records than data retrieval. During the development phase, but prior to the implementation of the EPR, a second questionnaire measured satisfaction with the paper records. Satisfaction appeared to be related to self-rated computer experience. Inexperienced computer users tended to be more positive about the paper records. In general, respondents did not have many expectations about electronic record keeping. A second series of interviews zoomed in on the expectations users had. Except for more concise reporting no beneficial effects of electronic record keeping were expected.
Human-computer interaction (HCI) is a multidisciplinary field in which psychology and other social sciences unite with computer science and related technical fields with the goal of making computing systems that are both useful and usable. It is a blend of applied and basic research, both drawing from psychological research and contributing new ideas to it. New technologies continuously challenge HCI researchers with new options, as do the demands of new audiences and uses. A variety of usability methods have been developed that draw upon psychological principles. HCI research has expanded beyond its roots in the cognitive processes of individual users to include social and organizational processes involved in computer usage in real environments as well as the use of computers in collaboration. HCI researchers need to be mindful of the longer-term changes brought about by the use of computing in a variety of venues.
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