Ethics and health informatics: focus on Latin America and the Caribbean / Ética e informática en salud: enfoque sobre Latinoamérica y el Caribe / Ética e informática em saúde: enfoque sobra a América Latina e o Caribe

Expanding use of computers in medicine continues to raise interesting and important ethical issues. After a brief review of the history of work in ethics in medical informatics, this introduction to this special issue of Acta Bioethica makes the case that this work must be applied in a Latin American and Caribbean context. From the use of intelligent machines to the evolution of the World Wide Web, the region presents vital -and under addressed- challenges to clinicians and policy makers. Sustained and regional debates, curriculum development and empirical and conceptual scholarship are among the means to ensure ethically optimized applications of health information technology in the region.

El creciente empleo de computadores en el área médica continúa planteando interesantes e importantes temas de salud. Después de una breve revisión de la historia de trabajos en ética de la informática en medicina, esta introducción al número especial de Acta Bioethica señala que este trabajo debe realizarse en un contexto latinoamericano y del Caribe. A partir del empleo de máquinas inteligentes hasta la evolución de la World Wide Web (WWW), la región presenta desafíos vitales -pero de muy poca atención- para los médicos y encargados de políticas públicas. Debates regionales continuos, desarrollo curricular y estudios empíricos y conceptuales figuran entre los medios que asegurarán en la región el uso éticamente óptimo de la tecnología de la información en salud.

O crescente emprego de computadores na área médica continua levantando interessantes e importantes temas de saúde. Após uma breve revisão da história de trabalhos em ética da informática em medicina, esta introdução ao número especial de Acta Bioethica, assinala que este trabalho deve realizar- se num contexto latino americano e do Caribe. A partir do emprego de máquinas inteligentes até a evolução da World Wide Web (WWW), a região apresenta desafios vitais, porem de muito pouca atenção, para os médicos e encarregados de políticas públicas. Debates regionais contínuos, desenvolvimento curricular e estudos empíricos e conceptuais figuram entre os médicos que asseguram na região uma utilização ótima, eticamente falando da tecnologia da informação em saúde.

Consumer health informatics: ethics, evaluation and standards / Cosumidor de salud informática: ética, evaluación y estándares / O consumidor de saúde informática: ética, avaliação e modelos

This article discusses the ethical issues involved in consumer health informatics -specifically those issues surrounding the provision of medical information for patients on the World Wide Web. The discussion includes concerns and suggestions relating to: quality control and error avoidance, Internet governance and Web site responsibility, and intellectual property and control. These issues are argued to be of exceptional importance in the developing world, including Latin America and the Caribbean.

Este artículo discute los temas éticos involucrados en la información en salud, específicamente aquéllos en torno a la entrega de información médica a los pacientes que ingresen a la World Wide Web. La discusión abarca preocupaciones y sugerencias en relación con el control de calidad, evitar los errores, el gobierno de Internet, la responsabilidad del sitio Web y el registro de la propiedad intelectual. Se argumenta que estos temas tienen gran importancia en el mundo en desarrollo, incluyendo a Latinoamérica y el Caribe.

Este artigo discute os temas éticos envolvidos na informação em saúde, especificamente no fornecimento de informação médica aos pacientes que ingressam na World Wide Web. A discussão envolve preocupações e sugestões em relação ao controle de qualidade, evitar os erros, o governo de Internet, a responsabilidade do site Web e o registro da propriedade intelectual. Argumenta-se sobre questões e temas de grande importância no mundo em desenvolvimento, incluindo a América Latina e o Caribe.

Development and Evaluation of a Web-based Support Program for the Maternal Role of Primiparas / 간호학회지

PURPOSE: This study was conducted to develop and evaluate a Web-based program for the maternal role of primiparas who use the internet. METHOD: The study process was a systems requirements analysis, design and development of a program, program testing by experts, program implementation, and program evaluation by users. A nonequivalent control group non-synchronized design was used. The data was collected from October 5th, 2002 to February 24th, 2003. RESULT: 1. Based on inquiries into mothers' needs, a Web-based support program was developed. The program was then modified from feedback received from experts. 2. In a sub-scale analysis of mothers' perception of a baby, amenability and persistence was significantly higher in the intervention group. The differences in the mean score of maternal self-confidence and maternal satisfaction were significant. 3. Cyber counseling was done for a total of 73 cases and the most frequent problems for counseling were feeding and nutrition (28.8%), followed by baby care, and health problems. CONCLUSION: It was proven that a Web-based support program provided appropriate support to primiparas and was effective in promoting their maternal role. Therefore, this study suggests that a Web-based support program for primiparas can become a powerful nursing intervention on virtually all mother and infant health concerns.

Development and Evaluation of a Web-based Ostomy Self-care Education Program / 대한의료정보학회지

OBJECTIVE: The purpose of this study was to develop a Web-based ostomy self-care education program and to evaluate its effects on ostomates' self-care knowledge and self-care behavior. METHODS: Based on the needs assessment and literature review, a Web-based ostomy self-care education program was developed and modified incorporating feedbacks from nurse experts panel. The experimental group received the ostomy self-care using the Web-based program and the control group received the traditional education. The level of self-care knowledge and self-care behavior were measured and were compared between the experimental and the control groups. RESULTS: The levels of self-care knowledge and self-care behavior in the experimental group were significantly higher than those of the control group. CONCLUSION: This study implies that a Web-based education program for the ostomates can be used to improve ostomy self-care.

Web-based Data Collection System for Patterns of Care Study of Radiation Oncology / 대한의료정보학회지

Data collection is a major problem in large scale clinical studies, especially muticenter and international trials. Data collection by mailing is too slow and expensive. Furthermore, difficulty in understanding handwritten notes from many investigators could result in potential errors in data entry. We developed web-based data collection system for patterns of care study of radiation oncology to collect data nation-widely and efficiently. We introduced drop-down box, check box, and radio button in data entry form for rapid, convenient and correct data entry. Our system also checks blank item, logical errors and other validity of data in real time. For security, we committed the server to the care of Korea Internet Data Center, implemented secure socket layer for communication between web server and clients, and established two remote backup systems. Participating investigators are satisfied with this system and we are collecting data efficiently. We think that web-based data collection system should be considered in any large scale clinical studies.

E-health and Internet in Medicine-A Strategic Perspective

The Internet is becoming increasingly important and essential in medicine. The number of health-related web sites and medical portal sites is rising exponentially in recent years. Now, ensuring that the Internet becomes a suitable and comfortable medium for supporting medical applications is a challenging task. Internet in medicine has changed the health and illness behavior of e-health consumers and the traditional doctor-patient relationship. The patients now can get more health information online and take more responsibilities for their own care (consumer empowerment). E-communication using e-mails between doctors and patients has become popular, but this kind of practice needs a proper standard guideline. Implementation of point-of-care(telemedicine), e-consultation and Internet prescription evokes ethical, medicolegal, and social issues and threatens the treaditional medical practice. It is highly recommended that the Korean doctors be familiar with the e-health and e-medicine.

Telemedicine in Dermatology / 대한피부과학회지

BACKGROUND: Telemedicine can be useful in dermatology in which there is a physical barrier between the dermatologist and patient or primary care giver. OBJECTIVE: Our purpose of this study is to examine a usefulness of teledermatology system in Korean situation. METHODS: We made store-and forward teledermatology system on world wide web for it's usefulness. We examined the difference of diagnostic accuracy, level of certainty, and quality of images of photographs and still digital images. RESULTS: The merits of our teledermatology system are summarized as follows1. It has more diagnostic accuracy than classic store-and forward system. 2. The real-time additional history taking and request of laboratory examinations are possible by chatting system between dermatologist and primary care giver. 3. Patient follow-up is easier than store-and forward system. The difference of diagnostic accuracy, level of certainty, and quality of images of photographs and still digital images are summarized as follows. 1. There is no difference of diagnostic accuracy between photographic readers and digital image readers. 2. There is no difference of level of certainty between photographic readers and digital image readers. 3. In assesment of quality of photographs, no difference was founded between photographic readers and digital image readers 4. The satisfaction of quality of photographs is very high in all groups. The average is 97.5%. CONCLUSION: This study provides evidence that our teledermatology system is useful in korean situation and still digital image can substitute historic photographs in teledermatology.

The analysis of the present status of the medical internet sites in Korea

BACKGROUND: After the World-Wide-Web(www) appeared, history has abruptly fallen in the new era of the Internet. In Korea, after the first medical internet site appeared, there was a major development in the WWW. But the quality and quantity of the web-page remains in infancy. Therefore, through the analysis of the Korean medical internet sites on present status, directions for development of Korean medical internet sites can be made. METHODS: From April 1st, 1999 to June 30th, 1999 in the Korean web sites, we visited 1044 sites. They included "Medmark Korea" representing medical search engine, "Eulji medical library" in the Eulji Medical College Hospital, and the medical sites of the "Yahoo Korea", "naver.com", and "simmani.com". Through this internet search, the information about locations, first publication year, classification by characteristics of homepage, speciality, web service form was obtained. Among these sites, acquireing from insufficient source further, questions were sent to the webmasters of 143 websites by e-mail. The questions included 7 items on the characteristic of webmasters, 8 items on the general characteristics of internet sites, 8 items on the contents, and their own comments. RESULTS: The occupation of webmasters was as follows: were physicians 94.4%, were male. According to age distribution, those in their thirties was 48.2%, and forties, 33.3%. Amone the 521 websites confirmed, there were 44 sites in 199 151 in 1996, 237 in 1997, and 79 in 1999. According to the distribution of location, metropolitan areas including Seoul, Inchon, Kyonggi occupied 68.9% among total. The main portion of the intentional visitors was ordinary people comprising 39.2%, members 9.8%, and physicians 7.7%. Concerning the purposes of publication, 38.7% of websites intended for health education to citizens, 31.0% for publicity of hospital or organizations, and 15.5% for exchange of information between members. For the most significant contents, 26.6% focused on the common-sense health issues, 35.7% on exchange of special medical information, 8.4% on education data for medical students, and 13.3% on publicity of hospitals. For the update interval, 22.0% renewed their sites within 1 week, 22.7% in 1 month, 23.4% in 3 months, and 20.6% in 6 months. For the effectiveness of homepage, the rate of `good' and `very good' response was 52.8%. CONCLUSION: Our investigation, showed that medical internet sites are lead by those in their thirties and forties. Web sites was concentrated to metropolitan areas where informational infrastructure was well developed. It is emphasized that efforts to informationalization by are needed by, governmental medical database systems should be established, and that the guidelines which enables validity of medical information should be set forth.

Design the Medical Related Web Database through Constructing Soonchunhyang University Hospital Homepage / 대한의료정보학회지

Thesedays, the computer network has become the most popular means of communicating and sharing of information. With the rapid growing of Internet usage, various kinds of medical-related Internet sites are appearing. Due to the popularity of World Wide Web, many hospitals and medical centers establish their own homepage. In Korea, the number of home pages about medicine and medical institutes is increasing. Although many medical-related sites in Korea are providing Internet services on WWW, the quality is still far behind from foreign countries. For constructing the homepage for each department in Soonchunhyang University Hospital Homepage, this paper first investigates the University Hospital's Internet Homepage. After rewiewing the homepage, the new homepage of Soonchunhyang University Hospital has een implemented. From the experience in implementing the homepage for Soonchunhyang University Hospital, this paper suggests the method to build and manage a homepage for other medical related sites.