PACS Implementation Challenges in a Public Healthcare Institution: A South African Vendor Perspective / 대한의료정보학회지

OBJECTIVES: Conventional radiological processes have been replaced by digital images and information technology systems within South Africa and other developing countries. Picture Archiving and Communication Systems (PACS) technology offers many benefits to institutions, medical personnel and patients; however, the implementation of such systems can be a challenging task. It has been documented that South Africa has been using PACS for more than a decade in public hospitals with moderate success. The aim of this study was to identify and describe the PACS challenges endured by PACS vendors during implementation in the South African public healthcare sector. METHODS: This was achieved by engaging in a methodological approach that was qualitative in nature collecting data through semi structured interviews from 10 PACS experts/participants which were later analysed qualitatively. RESULTS: The findings show that PACS vendors have countless challenges, some of which include space, insufficient infrastructure, image storage capacity, system maturity and vendor related concerns. It was clear that the PACS experts readily offered contextually appropriate descriptions of their encounters during PACS implementations in South African public healthcare institutions. CONCLUSIONS: PACS vendors anticipate these challenges when facing a public healthcare institution and it is recommended that the hospital management and potential PACS stakeholders be made aware of these challenges to mitigate their effects and aid in a successful implementation.

QASF 2. 0 - Sistema de perguntas e respostas em doenças crônicas / QASF 2. 0 - Question-answering system on chronic diseases / QASF 2. 0 - Sistema de pregunta y respuesta en enfermedades crónicas

As doenças crônicas são um grave problema mundial de saúde pública. Elas são responsáveis por morbidez,mortalidade, incapacidade e baixa qualidade de vida. No Brasil, 72% das mortes são causadas por doenças crônicas, e no mundo esse valor é de 60%. Sabe-se que a atual produção científica mundial é vasta e as informações contidas nos artigos científicos podem ser úteis para o profissional da saúde. Porém, ler artigos científicos é uma tarefa que exige tempo e disposição. O objetivo deste artigo é apresentar a segunda versão do sistema de perguntas e respostas QASF para auxiliar os profissionais da saúde e outros usuários na busca rápida por informações, especificamente, em doenças crônicas. O processo de desenvolvimento do sistema baseou-se na construção de módulos de processamento de pergunta,de documentos e de resposta. Com o QASF, espera-se facilitar o acesso a informações.

Chronic diseases is a global public health problem. They are responsible for morbidity, mortality, disability andpoor quality of life. Chronic diseases cause 60% of deaths worldwide and 72% of deaths in Brazil. It is known that the current world scientific production is vast and the information contained in scientific papers can be useful for health professionals. However, the reading of scientific articles is a demanding and time-consuming task. This paper presents a question answering system to help health professionals quickly search for information about chronic diseases. The core of the question answering system includes the development of modules for processing questions, documents and answers. It is expected to support users that demand for quick information about chronic diseases. Precision rates between 50% and 60% were obtained.

Modelos de tomada de decisão em bioética clínica: apontamentos para a abordagem computacional / Models of decision making in clinical bioethics: notes for a computational approach

A bioética tem se tornado, nas últimas décadas, um tema de importância central para a prática clínica, por fornecer ferramentas teóricas para a tomada de decisão do profissional de saúde. A questão que se propõe diz respeito a como saber se a decisão é a mais apropriada, já que uma decisão na esfera clínica - quer se esteja atuando na atenção primária, secundária ou terciária - deve, necessariamente, ser acertada tanto do ponto de vista técnico, quanto do ponto de vista ético. A literatura tem apresentado diferentes modelos para a tomada de decisão no campo de análise da bioética clínica. Com base nessas ponderações, objetiva-se, no presente ensaio, apresentar apontamentos sobre (i) a tomada de decisão na área de bioética clínica e (ii) as possibilidades de abordagem computacional das decisões bioéticas...

Bioethics has become over the recent decades a central question to clinical practice, due to the fact that it provides theoretical tools for decision making in health care. The issue that arises concerns how to know whether the decision made is the most appropriate, considering that a clinic decision - whether working in primary, secondary, or tertiary care - must be accurate from both the technical and the ethical point of views. As a result, different models for decision making in clinical bioethics have been presented in the literature. Based on these considerations, the objective of this article is to point important issues about (i) decision making in the field of clinical bioethics and (ii) the possibilities of computational approaches to assist such decisions...

La bioética se ha convertido, en las últimas décadas, en un tema de gran importancia en la práctica clínica, proporcionando herramientas teóricas para la toma de decisiones de los profesionales de la salud. La pregunta que se plantea es cómo saber si la decisión es la más apropiada, puesto que una decisión en el ámbito clínico - si se está trabajando en la atención primaria, secundaria o terciaria - debe necesariamente ser correcta desde el punto de vista técnico, como el punto de vista ético. La literatura ha presentado diferentes modelos para la toma de decisiones en el ámbito del análisis de la bioética clínica. Sobre la base de estas consideraciones, el objetivo en el siguiente texto es presentar puntos sobre (i) la toma de decisiones en el ámbito de la bioética clínica y (ii) las posibilidades de un enfoque computacional de las decisiones bioéticas...

Aplicativos móveis desenvolvidos para a área da saúde no Brasil: revisão integrativa da literatura / Mobile applications developed for the health sector in Brazil: an integrative literature review / Aplicaciones móviles desarrolladas para el sector de la salud en Brasil: revisión integradora de la literatura

A popularização dos celulares inteligentes, os smartphones, tem sido considerada por muitos a revolução tecnológica de maior impacto nos últimos tempos. Considerado um computador de bolso e com acesso a milhões de aplicativos, sua principal característica é a quebra da limitação da mobilidade, acompanhando o seu usuário 24 horas por dia em qualquer lugar. Essa qualidade é fundamental para auxiliar a assistência em saúde, uma vez que esses profissionais deslocam-se constantemente dentro das instituições em que trabalham. Este estudo objetivou identificar quais as pesquisas envolvendo tecnologia móvel aplicada à saúde que estão sendo desenvolvidas no Brasil. A metodologia empregada é do tipo revisão integrativa da literatura. A amostra final contou com 27 trabalhos. A análise dos resultados trouxe que a temática mais abordada no desenvolvimento de aplicativos móveis para a área de saúde foi a de apoio ao profissional. Quando analisado o foco desses aplicativos, viu-se que a área mais beneficiada pela pesquisa em computação móvel tem sido a multiprofissional. Concluiu-se, com a revisão, que é de suma importância o desenvolvimento de aplicativos móveis vinculados à pesquisa científica em saúde, pois seu conteúdo será analisado e testado por profissionais que conhecem as reais necessidades dos usuários finais.

The popularization of smartphones has been considered by many the technological revolution of greatest impact in recent years. Considered a pocket computer with access to millions of applications, its main feature is the breaking of the limitations of mobility, following its user 24 hours a day, anywhere. This quality is essential to assisting in healthcare activities, since these professionals constantly move around within the institutions in which they work. This study aimed to identify prior research developed in Brazil which involved mobile technology applied to healthcare. The methodology used in this study was an integrative literature review. The final sample included 27 articles. Analysis of results showed that the most commonly addressed theme in the production of mobile applications for the healthcare field was support for healthcare professionals. Analyzing the focus of mobile applications, it could be found that the category of interdisciplinarity was the most benefited by research in mobile technology. The review concluded that it is of great importance to develop mobile applications linked to scientific research on healthcare, since their content will be analyzed and tested by professionals who know the final users' real needs.

La popularización de los teléfonos inteligentes (smartphones) ha sido considerada por muchos como la revolución tecnológica de mayor impacto de los últimos tiempos. Se trata de un ordenador de bolsillo con acceso a millones de aplicaciones cuya principal característica es que la ruptura con los limites de la movilidad: puede seguir al usuario durante las 24 horas desde cualquier lugar. Esta cualidad es esencial para apoyar al sector de la salud ya que los profesionales se desplazan constantemente dentro de las instituciones dónde trabajan. El presente estudio ha buscado identificar los estudios que se están llevando a cabo en Brasil con tecnologia móvil aplicada a la salud. La metodologia utilizada es tipo revisión integradora de la literatura. La muestra final incluyó 27 estudios. El análisis de los resultados indica que el tema que más se desarrolla es el de apoyo profesional. Al analizar el foco de estas aplicaciones se observa que la zona más favorecida por la investigación en informática móvil es la multiprofesional. El artículo concluyó que es de suma importancia desarrollar aplicaciones móviles relacionadas con la investigación científica en salud porque su contenido podrá ser analizado y probado por profesionales que conocen las necesidades reales de los usuarios finales.

Use of a gesture user interface as a touchless image navigation system in dental surgery: Case series report

PURPOSE: The purposes of this study were to develop a workstation computer that allowed intraoperative touchless control of diagnostic and surgical images by a surgeon, and to report the preliminary experience with the use of the system in a series of cases in which dental surgery was performed. MATERIALS AND METHODS: A custom workstation with a new motion sensing input device (Leap Motion) was set up in order to use a natural user interface (NUI) to manipulate the imaging software by hand gestures. The system allowed intraoperative touchless control of the surgical images. RESULTS: For the first time in the literature, an NUI system was used for a pilot study during 11 dental surgery procedures including tooth extractions, dental implant placements, and guided bone regeneration. No complications were reported. The system performed very well and was very useful. CONCLUSION: The proposed system fulfilled the objective of providing touchless access and control of the system of images and a three-dimensional surgical plan, thus allowing the maintenance of sterile conditions. The interaction between surgical staff, under sterile conditions, and computer equipment has been a key issue. The solution with an NUI with touchless control of the images seems to be closer to an ideal. The cost of the sensor system is quite low; this could facilitate its incorporation into the practice of routine dental surgery. This technology has enormous potential in dental surgery and other healthcare specialties.

Preparation of a Drug Information Database Application Using FileMaker Go® / 医薬品情報学

<b>Objective: </b>We aimed to develop software that could provide drug information off-line using a smart device.  Therefore, FileMaker Go® was examined and evaluated as a mobile drug information application.<br><b>Methods: </b>A mobile drug information database (Mobile DI-DB) application was created using FileMaker Go®.  The function, search performance, and characteristics of Mobile DI-DB were evaluated.  In addition, question and answer time with Mobile DI-DB was compared with that existing drug information database (existing DI-DB) of the Soka Municipal Hospital.<br><b>Results: </b>Mobile DI-DB can be viewed on an iPad®and iPhone®.  The software is full-text searchable, has good search performance, and is characterized by a small file size.  Furthermore, question and answer times were found to be shorter about 1/3 with Mobile DI-DB than with existing DI-DB.<br><b>Conclusion: </b>A mobile drug information database prepared with Filemaker Go® can now be viewed on a smart device, making drug information easier to access than ever before.  Although this study focused on increasing operational efficiency of pharmacists through the use of the Mobile DI-DB application, we believe that this application can benefit other users too.

Poronto: ferramenta para construção semiautomática de ontologias em português / Poronto: tool for semi-automatic ontology construction in portuguese / Poronto: herramienta para construcción semiautomática de ontologías en portugués

Objetivo: Apresentar uma ferramenta semiautomática para construção de ontologias a partir de textos em português na área da saúde. Método: Pesquisa aplicada com abordagem quantitativa, operacionalizada em seis etapas: identificação de ferramentas para aprendizagem de ontologia, identificação de ferramentas de anotação linguística, elaboração do protótipo, avaliação do protótipo, elaboração da versão final da ferramenta e avaliação dos resultados. Resultados: Foram realizados três experimentos em domínios diferentes. Os termos extraídos foram avaliados por especialistas nas respectivas áreas, sendo a ferramenta considerada relevante para auxiliar no processo de construção de ontologias. Conclusão: Foi comprovada a dificuldade em se construir ontologias semiautomaticamente devido à complexidade envolvida no processo de extração de termos, sendo muito importante a participação do especialista no pós-processamento. Dado que a avaliação do especialista é subjetiva, é preciso selecionar especialistas com critérios padronizados e em quantidade significativa para se ter uma avaliação menos sujeita a falhas.

Objetivo: Presentar una herramienta para construcción semiautomática de ontologías a partir de textos en portugués en el área de la salud. Método: Investigación aplicada con abordaje cuantitativo, operado en seis etapas: identificación de herramientas para aprendizaje de ontología, identificación de herramientas de anotación lingüística, elaboración del prototipo, evaluación del prototipo, elaboración de la versión final de la herramienta y evaluación de los resultados. Resultados: Fueron realizados tres experimentos en dominios diferentes. Los términos extraídos fueron evaluados por especialistas en las respectivas áreas, siendo la herramienta considerada relevante para auxiliar en el proceso de construcción de ontologías. Conclusión: Fue comprobada la dificultad en construir ontologías automáticamente debido a la complejidad involucrada en el proceso de extracción de términos, siendo muy importante la participación del especialista en el pos-procesamiento. Dado que la evaluación del especialista es subjetiva, es preciso seleccionar especialistas con criterios estandarizados y en cantidad significativa para tener una evaluación menos sujeta a fallas.

Objective: Present a tool for semi-automatic ontology construction from texts in Portuguese in the health area. Method: Applied research with a quantitative approach, operationalized in six steps: identification of tools for ontology learning, identification of linguistic annotation tools, prototype development, prototype evaluation, preparation of the final version of the tool, and results evaluation. Results: Three experiments were conducted in different domains. The extracted terms were evaluated by experts in their respective areas. The tool was considered relevant to support the ontology construction process. Conclusion: It was demonstrated the difficulty in constructing ontologies semi-automatically due to the complexity involved in the terms extraction process, being very important the participation of an expert in the post-processing. As the expert?s evaluation is subjective, it is necessary to select experts with standardized criteria and in a significant number to have an evaluation with fewer failures.

Medical informatics methods for the clinical evidence extraction

Clinical professionals gain new information to assist in patient care when they read the medical literature. Similarly, in clinical preventive medicine, medical science documents that have previously published can be searched and evaluated in order to confirm the scientific support for the clinical preventive medical service offered in order to prevent chronic disease. This paper introduces the medical informatics techniques for knowledge extraction that can become the basis for clinical practice. Particularly, it discusses the clinical document retrieval and knowledge discovery tools that can search for extracting the knowledge which the medical expert desires with data mining techniques. For example, Clinical medical personnel and medical researchers can locate the information from the latest literature rapidly or find and evaluate the scientific basis for the treatment and prevention of infection. This study can be used when they analyze the correlation between accumulated and different type of data and contributes to the detection of new knowledge. Recently, the concern about the visualization of massive data and information is high as the importance of big data has received greater attention. Contributions to this technique and decision support tools will increase gradually due to the way support for decision-making through scientific evidence for the pattern changing disease is evaluated or as one of the clinical practice guidelines is accepted.

Case Report Form for oral health assessments: methodological considerations

Information on the oral health condition of the target population is required to enable the development of policy strategies for oral health promotion. This information needs to be substantiated by reliable data obtained through regular oral health assessments. Countries around the world have set up oral health data-registration systems that monitor the oral health of the population. These systems are either integrated in the public oral health care service or in national surveys conducted on a regular basis. This paper describes the conception and development of a Case Report Form for oral health assessments and introduces a recently developed electronic data-registration system for data capture in oral health surveys. The conception and development of a Case Report Form poses a number of challenges to be overcome. In addition to ensuring the scientific quality of its contents, several requirements need to be met. In the framework of national oral health surveys, handwritten data capture has proven accurate, but entails an important workload related to the printing and transporting of the forms, data transfer and storage of the forms, as well as the time required to perform these tasks. On the other hand, electronic data capture enables time saving and better performance. However, the advantages of this system may not be fully acknowledged by general practitioners, and their motivation to employ information and communication technologies may need to be encouraged. In the long term, the inclusion of electronic data registration in university training is probably the best strategy to achieve this.

Construction Case with an Electronic Hospital Formulary to Be Able to Do Rapid Retrieval Using a Portable Terminal iPhone® / 医薬品情報学

<b>Objective: </b>The hospital is changing its formulary reference from paper-based to intranet.  There was concern that both paper-based and intranet versions of the formulary would be necessary.  Revising the paper-based hospital formulary each time package inserts are revised is difficult.  For your review we report on the creation of the iPhone® electronic formulary which enables rapid off-line formulary retrieval and easy updates while at the same time providing low cost service in a light device.<br><b>Methods: </b>The CSV (Comma Separated Value) of the hospital formulary dictionary was made using a standard personal computer.  The CSV data file was converted using JAMES2DIC into a HTML file format.  Next, the converted HTML file is transformed into the EPWING (Electronic Publishing WING) format using EBStudio.  Finally, we forward the EPWING dictionary file from the personal computer to the iPhone®.  The retrieval becomes possible by using EBPocket for iOS of EPWING/electronic book viewer software for the iPhone®.  The number of items was assumed to be 29 items thought for a lot of inquiries to exist.<br><b>Results: </b>We compared the paper-based formulary with the iPhone® electronic formulary.  As a result, the iPhone4® electronic formulary shortened the retrieval time, was smaller, lighter, and excellent at a lower price.<br><b>Conclusion: </b>The iPhone4® electronic formulary enables the user to perform complex full-text searches and retrieve information at a much higher speed than is possible with paper based formularies.  It has the additional advantage of seamless integration and deployment of formulary additions or reference material revisions.  We believe we have successfully created a practical electronic formulary.

Establishing the risk of neonatal mortality using a fuzzy predictive model / Modelo preditivo fuzzy para estabelecer o risco de morte neonatal

The objective of this study was to develop a fuzzy model to estimate the possibility of neonatal mortality. A computing model was built, based on the fuzziness of the following variables: newborn birth weight, gestational age at delivery, Apgar score, and previous report of stillbirth. The inference used was Mamdani's method and the output was the risk of neonatal death given as a percentage. 24 rules were created according to the inputs. The validation model used a real data file with records from a Brazilian city. The receiver operating characteristic (ROC) curve was used to estimate the accuracy of the model, while average risks were compared using the Student t test. MATLAB 6.5 software was used to build the model. The average risks were smaller in survivor newborn (p < 0.001). The accuracy of the model was 0.90. The higher accuracy occurred with risk below 25 percent, corresponding to 0.70 in respect to sensitivity, 0.98 specificity, 0.99 negative predictive value and 0.22 positive predictive value. The model showed a good accuracy, as well as a good negative predictive value and could be used in general hospitals.

O objetivo do artigo foi avaliar o uso da lógica fuzzy para estimar possibilidade de óbito neonatal. Desenvolveu-se um modelo computacional com base na teoria dos conjuntos fuzzy, tendo como variáveis peso ao nascer, idade gestacional, escore de Apgar e relato de natimorto. Empregou-se o método de inferência de Mamdani, e a variável de saída foi o risco de morte neonatal. Criaram-se 24 regras de acordo com as variáveis de entrada, e a validação do modelo utilizou um banco de dados real de uma cidade brasileira. A acurácia foi estimada pela curva ROC; os riscos foram comparados pelo teste t de Student. O programa MATLAB 6.5 foi usado para construir o modelo. Os riscos médios foram menores para os que sobreviveram (p < 0,001). A acurácia do modelo foi 0,90. A maior acurácia foi com possibilidade de risco igual ou menor que 25 por cento (sensibilidade = 0,70, especificidade = 0,98, valor preditivo negativo = 0,99 e valor preditivo positivo = 0,22). O modelo mostrou acurácia e valor preditivo negativo bons, podendo ser utilizado em hospitais gerais.

A Survey on Current Status of Computerization of Physician Office Practice in Korea / 대한의료정보학회지

The extent of utilization of computers at clinics (physicians'office) setting in Korea has not yet been studied. Lack of such information hinders developing effective strategic plans for implementing Information and Communication Technology(ICT) to physicians office practice. Therefore this study was conducted to elucidate current status of computer use in physicians office practice. A mail survey was carried out to randomly selected 2,000 members of Korean Medical Association and 26.3% responded. The results showed that percent of clinics currently using computers and internet for the clinical practice was 98.0% and 85.2%, respectively. With recent gain of popularity in using computers and internet in public, more than 50% of respondents thought that transmission of sensitive medical information through internet was acceptable. Ninety six percent of respondents utilized computerized health insurance claims and electronic medical record system. However, 36.3% of respondents was keeping paper form patients medical records in addition to the computerized records to meet regulatory requirements. Overall, this study seems to indicate that physicians in practice show a strong interest in computerization, although the adaption of ICT in the field of medicine is relatively slow. In conclusion, physicians office practice can be a potential area for future ICT application.

Nuevas tecnologías de la información y la comunicación en la enseñanza de las Ciencias Médicas

Se reporta que el objetivo fundamental del trabajo consistió en aplicar las nuevas tecnologías de la información y la comunicación (NTIC) en la actividad docente-investigativa de los estudiantes de medicina, con vistas a prepararlos para su futuro desempeño profesional. Para lograr esto, se convocó a una Jornada Científica Virtual, actividad sin precedentes en la enseñanza de las ciencias médicas en Cuba, donde se presentaron los trabajos en formato HTML, con el fin de facilitar su publicación en el Web y permitir el acceso de los interesados a ellos. Se realizó la discusión virtual de los trabajos en un canal del Internet Relay Chat (IRC). Se lograron la aplicación de las NTIC en la actividad académica y la profundización en los contenidos de Psicología Médica. Los estudiantes crearon sus propias páginas Web, desarrollaron la habilidad para establecer la comunicación a través del IRC y se aumentó la integración entre las asignaturas de Informática y Psicología Médicas.

The main objective of this paper was to apply the new informational and communication technologies to the teaching-research activity of the medical students with a view to preparing them for their future professional performance. To this end, a Virtual Scientific Event was organized, an unprecedented activity in the teaching of medical sciences in Cuba, in which papers in HTML format were submitted so as to facilitate their publication in Web sites and access by those who are interested. The virtual discussion of these papers was carried out in an Internet Relay Chat(IRC) channel. The objectives of implementing the NICT in the academic work and deepening into the contents of medical psychology were fulfilled. The students created their own Web pages and learned how to establish communication through IRC, besides, Medical Informatics and Psychology were more related.

Laboratorio virtual en anestesiología

El desarrollo de la informática ha permitido la creación de laboratorios automatizados (virtuales) que apoyan el aprendizaje y la investigación de técnicos y profesionales en el campo de las ciencias médicas, como parte del proceso educativo-docente que se desarrolla en nuestras instituciones de salud. Se propone, como parte de la educación a distancia, la utilización de técnicas de digitalización y procesamiento de imágenes con herramientas confeccionadas por nuestro grupo de trabajo. Se desarrolló un trabajo sobre anestesiología aplicada a la especialidad de cirugía oral y maxilofacial que contribuye al conocimiento y aprendizaje de alumnos, técnicos y profesionales a través de un software que permite clasificar imágenes captadas y procesadas en diferentes equipos (scanner, cámara digital, etc.). En las imágenes clasificadas se describen aspectos de utilidad para el entrenamiento del personal en formación en las diferentes técnicas de anestesia locorregional. La utilización de este medio de enseñanza en soporte electrónico ofrece la posibilidad de actualizar, adecuar, describir, procesar, representar y modificar, gráficos, textos e imágenes de forma rápida y ahorrando cuantiosos recursos.

The development of the computer science has led to the creation of automated (virtual) labs that support the learning process and research work of technicians and professionals in the medical field as part of the teaching-educational process that is being developed in our health institutions. As part of the distance learning, we propose he use of image digitalization and processing techniques with tools designed by our working group. A research work on anesthesiology applied to oral and maxillofacial surgery was developed, which contributes to increase knowledge and encourage learning in students, technicians and professionals by means of a software enabling to classify images that have been taken and processed by different scanner equipment, digital camera, etc. Classified images describe helpful aspects for training personnel in the various locoregional anesthesia techniques. This teaching aid in electronic support provides the possibility of updating, adapting, describing, processing. Representing and changing graphs, texts and images in a quicker way, thus saving a lot of resource.

The role of computers in medical education

Changes in health care delivery and styles of learning in medical education have forced a need to use and critically evaluate a variety of new teaching tools, including the computer. While the computer is unlikely to ever replace the patient as the primary focus of learning, it does have the ability to reproduce a highly interactive environment and can mimic many situations in Medicine. Apart from virtual reality and simulation, which is still in its infancy in medical education, the computer and appropriate software can be used to generate extremely effective case scenarios. Increasingly large amounts of material are being delivered in electronic format and medical schools place greater emphasis on computer-based instruction in their curricula. This has potential benefit for speed and ease of access of up-to-date information and the material can be used by individuals and organisations off-campus. It is possible that suitably prepared computer-based materials will be used to replace traditional styles of teaching and learning, namely, the lecture, tutorial and practical class. There is evidence in the literature that such computer material can be at least as effective in terms of short-term knowledge gain and problem-solving abilities, but the place of this resource as an aid to understanding and long-term learning has yet to be defined. Computer-based instruction is expensive and to make effective, efficient and appropriate use of this resource in medical education will require considerable and careful thought(AU)

Los cambios en la atención médica y los estilos de aprendizaje en la educación médica han llevado a la necesidad de usar y de evaluar críticamente una variedad de nuevas herramientas de enseñanza, incluyendo la computadora. Aun cuando la computadora difícilmente nunca podrá reemplazar al paciente como foco primario del aprendizaje, sí tiene la capacidad de reproducir un medio altamente interactivo y puede mimetizar muchas situaciones médicas. Aparte de la realidad virtual y la simulación, que aún están en su infancia dentro de la educación médica, la computadora y un software apropiado pueden ser usados para generar escenarios clínicos extremadamente efectivos. Se ha ido incrementando la elaboración de una gran cantidad de material en formato electrónico y las escuelas médicas dan mayor énfasis, en sus curricula, a la instrucción basada en la computación. Esto tiene un beneficio potencial para la velocidad y facilidad de acceso a la información actualizada y el material puede ser empleado por individuos y organizaciones fuera del recinto universitario. Es posible que materiales basados en la computación, adecuadamente preparados, puedan emplearse para reemplazar estilos tradicionales de enseñanza-aprendizaje, entre ellos las conferencias, los tutoriales y las clases prácticas. En la literatura existen evidencia de que tales materiales computacionales pueden ser al menos efectivos en términos de mejoría del aprendizaje a corto plazo y de las habilidades de solución de problemas, pero el lugar de estos recursos como una ayuda para la comprensión y el aprendizaje a largo plazo aún no ha sido definido. La instrucción basada en la computación es cara y para el uso apropiado, efectivo y eficiente de este recurso en la educación médica requerirá un análisis considerable y cuidadoso(AU)