Human aspects of medical computer application.

Most of the research activities in the field of medical informatics are directed toward technological-technical problems. Human factors of computer use are often a neglected topic. Even the application of the tiniest microcomputer embedded in a medical diagnostic equipment may pose user acceptance and motivation problems but to mention larger scale hospital information systems. In this paper the author presents some aspects of the human-computer interaction problems in a medicinal computer application setting.

Vision of an 'automated' hospital information system.

This paper tries to describe a coherent vision of a possible next generation of HIS that rethinks how and what for computing is used in hospitals. Current systems, organized mainly around the 'database' and the 'communication' paradigm help the data processing to a great extent. At the same time they cannot be accepted as 'automated' systems, as handling of information is done mostly by end-users, i.e. by human actors. Emerging methods enabling automated information handling are the following: integrated handling of different media, seamless communication among different systems, alternative input-output devices, tools for pro-active information handling. These technologies should be grouped to two main branches: technical advances in data handling and theoretical advances in knowledge handling. The advances in knowledge handling are really important: tools based on that can take over routine information handling tasks from human end users. To discuss automation in HIS it is useful to understand the process of information handling in general within the hospital. A suggested multidimensional information space, where information objects are gathered mainly along two axes, the 'patient axis' and the 'management' axis might be of help. Combinations of selected dimensions resulted in a space of an estimated 2,294,082 possible information handling situation types in an earlier publication. Automation of information handling tasks can be derived from this model. The authors suggest to automate certain tasks done usually by active actors of the information handling situation space. Software agents working 'on their own' are known entities in HIS systems. Two components are needed for automation: an organized data base where its content can be 'understood' and interpreted by an algorithm, with other words a knowledge base an algorithm, that covers a certain routine information handling task. Data bases of HIS should be re-thought in a way that enables automated processing to a greater extent. The development of data base technologies clearly point to this direction. If most of the data bases of a HIS will be like that, new generation of applications might be launched to use them. E.g. a software agent called 'patient assistant' could collect data from different sources and build a coherent and updated patient file. The results of a knowledge based, agent operated HIS should be the following: significantly less direct human involvement significantly less paper to be produced enhanced speed of data flow in general enhanced reliability by widespread watchdog functions

[Reproducibility of malignancy grading in prostatic cancers using the Gleason-Böckling system]. / A kórszövettani malignitási fokozat Gleason és Böcking-osztályozásának reprodukálhatósága prostatarákokban.

Histologic slides from 50 cases of prostatic adenocarcinoma were evaluated by 5 pathologists, in order to test the reproducibility of grading in two systems. Twenty-five needle core biopsies and 25 surgical (adenomectomy) specimens were graded in two sessions, according to the histomorphologic criteria of Gleason and Böcking. The results were analyzed by the kappa statistics. In surgical specimens, there were no significant differences in the interobserver reproducibility of microscopically assessed categories. In needle biopsies, however, Gleason's primary pattern (62%, kappa = 0.42), and Böcking's histological pattern (63%, kappa = 0.37) showed the highest level of agreement. Among the computed (derivated) classification terms, those consisting of only 3 groups (Gleason grouping, kappa = 0.39; Böcking grade, kappa = 0.39) proved to be better reproducible than the corresponding score values (p < 0.05). When compressing both systems into two grades (high and "non-high"), reproducibility was improved (kappa = 0.52). For a substantial improvement of grading results, more accurate grade definitions, continuing training and regular consultation of pathologists are necessary. Based on the results obtained by intraobserver analysis we conclude that kappa statistics is of limited value when analyzing the role of individual experience at grading reproducibility.

Evolution of a regional health-care information system--the design phase.

In 1996 a program of the Soros Foundation was launched to study a regional health care inodel Main stake holders of health care financing and providing in three counties in South-Western Hungary found the idea appealing and the Soros Model Region Program was started. This paper outlines the activity of the second sub-project of the model region program: the development of a regional health care information system. The build-up of a data and knowledge base serving the differing needs of mentioned goals is based on international standards. Availability and user involvement is based on different media for presenting the information as printed publications, CD-ROM data bases and World Wide Web availability. A congruency and coherency principle is maintained by a unified data model used for different purposes and a planned unified communication protocol among all participants in the model region program. Studies regarding health care status, economics and financing on regional level show that a better fitting health care services profile and a more flexible resource management might be achieved based on the mentioned regionality principle.

Quality of healthcare related software applications--setting up an accreditation system in Hungary.

Meeting expectations of high quality health care, the safe and secure operation of medical information systems is a "must". However for healthcare software nationwide quality control systems are not widely used. A quality control project of health care applications in Hungary has been launched in 1996 by the Hungarian Society of Healthcare Informatics (MEIT) and Medico-Biological Section of Johann Neumann Society of Computing (NJSZT) by establishing a joint Healthcare Informatics Applications Accreditation Board (Board ESAB). The Board developed an evaluation methodology and a legal procedure to test health care software application modules. The evaluation method is based on international standards as ISO-9126 and on emerging European standards of CEN/TC 251. First rounds of accreditation already proved that there is a need among providers and users for the accreditation process. The authors hope that establishing an accreditation system will lead to a more balanced health care software market where users have an opportunity to inform themselves by the opinion of independent experts on the product they intend to purchase.

High aortoiliac occlusion: treatment with thoracic aorta to femoral arterial bypass.

Bifurcation bypass grafting from the thoracic aorta to femoral arteries provides excellent revascularization in the presence of high aortoiliac occlusive disease. Two such cases are described. There were no postoperative complications and the follow-up aortograms showed well-functioning grafts.

Right aortic arch with contralateral congenital subclavian steal syndrome.

Three cases of right aortic arch associated with contralateral congenital subclavian steal syndrome are presented. Diagnosis may be made if special attention is given to the blood pressures and amplitude of pulses in both arms. Retrograde aortography is necessary to establish a definitive diagnosis. If symptoms are present in the adolescent, a bypass graft procedure should be performed.