Computers as teachers: learning from animations.

The effectiveness of an interactive multimedia computer program, the "Electronic Textbook in Human Physiology," in improving the knowledge of students studying cardiovascular physiology was determined from scores on tests given before and immediately after completion of a two-hour animation program on the Cardiac Cycle and Introduction to Electrocardiography and by comparison of performance on a final examination taken later with their unexposed (control) classmates. Unsigned comments on the use of the program were obtained from all participants and were universally laudatory. A marked and significant improvement in the immediate posttest compared with the pretest scores was found. More importantly, the students who had used the computer program achieved a significantly higher grade in the cardiovascular section of the final exam than their (control) classmates. Several possible explanations of the results are offered; the most likely one is that the use of the computer program facilitated learning. The implications of this, especially for curriculum planning, are discussed.

Meeting the urgency for document delivery in clinical medicine.

A Document Delivery library project was designed to improve delivery of information to health professionals in the Washington DC/Baltimore area. The project goals were to enhance delivery of full text documents and accelerate interlibrary loan services. The aim was to provide direct library services in the clinical arena by facilitating access to the articles needed by practitioners and clinical investigators. The objectives were to (1) design, develop and implement a comprehensive Document Delivery System (DDS) for the Library Information System (LIS) which included interlibrary loan, photocopy services and facsimile transmission capabilities; (2) establish a multi-university Library Knowledge Network for resource sharing; and (3) evaluate the project. The DDS and facsimile service are described and project data and outcomes are reported. Today, the participating libraries can use electronic means to share interlibrary loans. Georgetown users have responded favorably to the DDS and Fax services.

The impact of IAIMS at Georgetown: strategies and outcomes.

Integration of multiple information systems of a medical center will change the way physicians work and practice medicine in the future. Several major steps must be taken by an institution to make this a reality. Since 1983, Georgetown has been engaged in an Integrated Academic Information Management System (IAIMS) project to bring together multiple sources of information that reside on different computers and database systems. Georgetown is developing a Biotechnology and Biomedical Knowledge Network that includes informational and clinical databases, scholar workstations, instruction on computer use, a campuswide network with local area network nodes, and a modular approach to systems integration. The IAIMS project, spearheaded by the medical library, has enabled a broad spectrum of health professionals to benefit directly from new, dynamic information services. The network is heavily used; in 1991, more than 2,100 individual users conducted more than 148,500 computer functions and more than 104,000 searches. There is economy of scale in high-volume use. Overall, the average search cost is $1.57; for high use databases the cost is $0.38, and for low use, it is $9.41. As described in this paper, IAIMS offers a cost-effective means of enhancing patient care by improving information services to physicians. At Georgetown, IAIMS has advanced the concept of integration, accelerated use of computers in education, increased user acceptance of advanced technologies, and established cost factors for providing information resources. While progress made in improving the transfer of medical information is impressive, it is clear that IAIMS requires several more years of support to achieve full implementation.

Fulfilling the promise: implementing IAIMS at Georgetown University.

Predictions are that the integration of multiple information systems of a medical center will change the way doctors work and practice medicine in the future. Several major steps must be taken by an institution to make this a reality. The IAIMS program sponsored by the NLM is designed to achieve integration of resources in the medical center environment. The purpose of the IAIMS project at Georgetown is to develop a medical decision support system by bringing together multiple sources of information that reside on disparate computers and different database systems. This immense and complex task is described in this paper from an organizational, academic and technical perspective. Georgetown is developing a Biotechnology and Biomedical Knowledge Network which includes several informational and clinical databases, a variety of scholar workstations, instruction on use of computers, a campus-wide network with local area network nodes and a modular approach to systems integration. The IAIMS project is spearheaded by the medical library which has enabled a broad body of medical center users to benefit directly from new, dynamic services.

The MAClinical Workstation Project at Georgetown University.

The intent of the MAClinical Workstation Project is to develop computer workstations for medical students of the sort they will use in future medical practice. The idea is to instill information query habits in the daily clinical activities of these young physicians-in-training. The Georgetown University Medical Center Library spearheads the project in conjunction with the School of Medicine. The library handles technical support, including software development, user training, equipment maintenance, and network installations. The project began in 1988 with nine Macintosh computers; today thirty machines are distributed throughout the Georgetown University Hospital conference rooms, faculty and resident offices, and at four affliated hospitals. The Macintosh computers are connected to the medical center's local area network (LAN) with access to the Integrated Academic Information Management System (IAIMS) and Library Information System (LIS) databases. The MAClinical workstations serve multiple educational purposes in the clinical setting. Primarily, students gain experience in medical informatics by using a variety of software systems installed at the stations: the H&P Writer, a history and physical system written in the C programming language, can be used by students to prepare the admission record on patients they examine; also, students can keep patient records, check findings against a diagnostic system, look up drugs and treatment protocols, develop medical sketches, and find additional information when needed in the medical literature.

BioSYNTHESIS: access to a knowledge network of health sciences databases.

Users of the IAIMS Knowledge Network at the Georgetown University Medical Center have access to multiple in-house and external databases from a single point of entry through BioSYNTHESIS. The IAIMS project has developed a rich environment of biomedical information resources that represent a medical decision support system for campus physicians and students. The BioSYNTHESIS system is an information navigator that provides transparent access to a Knowledge Network of over a dozen databases. These multiple health sciences databases consist of bibliographic, informational, diagnostic, and research systems which reside on diverse computers such as DEC VAXs, SUN 490, AT&T 3B2s, Macintoshes, IBM PC/PS2s and the AT&T ISN and SYTEK network systems. Ethernet and TCP/IP protocols are used in the network architecture. BioSYNTHESIS also provides network links to the other campus libraries and to external institutions. As additional knowledge resources and technological advances have become available. BioSYNTHESIS has evolved from a two phase to a three phase program. Major components of the system including recent achievements and future plans are described.

Medical Facts File: a self service database of reference information.

The Dahlgren Memorial Library, Georgetown University Medical Center, will demonstrate Medical Facts File, a newly developed in-house database of general medical information. The file content emerged from the library's experience with commonly asked reference questions and the need to develop a database as an online source for users seeking quick answers to medical queries. Medical Facts File joins a growing family of over 18 databases which comprise Georgetown's IAIMS Knowledge Network. Use scenarios will demonstrate how an online search is initiated, either directly or as a prompt from one of the other online databases. The design of Medical Facts File at the Dahlgren Memorial Library began in late 1989 with a publishing section on instructions for authors planning to submit manuscripts to a variety of prominent medical journals. Since then, seven sections have been identified for the database. Three sections are highlighted for presentation, although work on the project is on-going. Medical Facts File is an easy-to-use, time saving system that facilitates tedious searching through a multitude of library sources. It provides users with a self-service, information look-up system.

First year's experience of the MAClinical Computer Workstations Project.

We have an installed base of MAClinical workstations available on hospital wards, which have been used for patient care, education, and research 24 hours a day for the past year. We began with eight machines in the hospital but now have distributed ten more machines to faculty. We have recently increased the programming staff so we can develop more software. The machines and their installation were costly, but have already proven useful for teaching and patient care. Plans for the second and third years of the MAClinical project include workstations for the faculty coordinators of clinical clerkships and expansion of workstations to affiliated hospitals where our students and residents rotate. Software will be expanded to include patient simulations and expert consultations. Medical practice, research, and teaching in the future will need to make more use of information technology. It is not yet clear exactly how and where computers will best serve clinical medicine, but the teaching hospital can be both a laboratory for developing applications and a school for training physicians to use them.