Failure to provide clinicians useful IT systems: opportunities to leapfrog current technologies.

OBJECTIVE: To discuss why clinical information systems are failing. METHOD: Subjectively analyzing the development of clinical IT systems during the last decades. RESULTS AND CONCLUSIONS: The challenge is to anticipate what information clinicians need and then deliver it in a way that is tailored for their unique views. Clinicians need workstations that offer the highest level possible of user-determined flexibility and customization. We envision and outline a so-called point of care work station, automatically scaling to the display, hardware capacity, operating system, applications (local or distributed) the user needs and across diverse health IT systems.

Redefining and improving patient safety.

OBJECTIVES: The Institute of Medicine (IOM) has focused attention on patient safety in the United States. Other countries share these concerns. METHODS: Governmental agencies and professional organizations are redefining approaches to safety, calling upon the use of information and communication technology as an enabler and expanding the range of evidence admissible in documenting success. RESULTS: Efforts to understand medical errors have used retrospective chart review, incident reporting, and computerized surveillance; the result is an evolving picture of the number, nature, and cause of errors. Approaches used to prevent errors include computerized physician order entry, decision support tools, computerized monitoring, and evidence-based practice; varying levels of evidence document their success. CONCLUSIONS: Technology offers challenging capabilities, not simple solutions. New evidence and new tools demand new approaches and attention to human factors.

The Cancer Informatics Infrastructure (CII): an architecture for translating clinical research into patient care.

Today, the clinical trial process remains slow and paper-based. The creation of a Cancer Informatics Infrastructure (CII) can provide the architectural base across the continuum of cancer research and cancer care. Recommendations of a Long Range Planning Committee identified near-term activities for the Office of Informatics at the National Cancer Institute (NCI). These include participating in national standards development; fostering oncology-related terminology and standards, e.g., Common Data Elements (CDEs); and leveraging mainstream informatics and Internet technologies, using the successful Internet model that focuses on facilitating stakeholder participation, sponsoring the CII rather than subsidizing it, and providing a test bed as well as an infrastructure. Diffusion tactics include extending the CII concept beyond its "early adopters" to the wider community through recommendations for the near-term and development of a major document defining next-phase activities.

Health informatics: managing information to deliver value.

Can informatics improve health? This paper answers yes, exploring its components, benefits, and effect on a wide variety of health-related activities. We first examine how information technology enables health informatics, supporting information management and knowledge creation through its four cornerstones. Success factors in using informatics are covered next, including human factors, the role of trained health informaticians, and the importance of matching informatics initiatives with business goals and establishing and measuring value. We demonstrate the potential effect of the Internet on health services through such e-health applications as enterprise-wide patient records, state-of-the-art call centers, and data repositories. For current evidence that informatics is already improving health, we turn to such topics as disease management, telehealth, patient safety, and decision support. As more organizations move informatics from theory into practice and realize its value, they will transform inefficient processes and improve care for all.

Medical informatics in the new millennium.

In a period of social transformation, we must reinvent health care. For guidance, we can look to the evolving discipline of medical informatics and to the patterns of investment in the practice arena. A top ranked application need, the computerized patient record (CPR) offers cost savings and supports clinical quality and ambulatory care. In the new millennium, we need to define our values with precision and use technology to achieve quality health care.

Philosophy into practice: a health informatics course proposal.

International health informaticians acknowledge the critical importance of education and training to the successful implementation of information technology in the health-care setting. As access to the Internet grows, so does the richness of resources the Internet can supply. With the changes in health care brought by communication, telematics will become the successor to informatics. The authors present the philosophy of telematics training and propose a short training course designed to help health professionals in developing nations take advantage of telematics, providing conceptual understanding and hands-on training.

New challenges for nursing informatics.

Long a leader in health informatics, nursing faces new challenges. The full and effective use of technology requires an understanding of cognitive processes and organizational behavior. Nursing can play a key role in addressing aims supportive of a new vision of health informatics. The evolving paradigm for knowledge transfer will give rise to new educational models and new institutional entities which will nurture learning and relearning.

Health information networks.

Health information networks could link health care providers throughout the community. Development activities in the United States are varied and numerous. Collaboration is key to the ultimate "network of networks" and is actively fostered.

Ocular toxicity of mitomycin C and 5-fluorouracil in the rabbit.

We studied the histotoxic effects of mitomycin C and 5-fluorouracil (5-FU) in the eyes of New Zealand white rabbits using light microscopy. Twenty-four eyes of 24 rabbits received subconjunctival injections of mitomycin C (0.025, 0.05, 0.10, 0.20, 0.40 or 0.80 mg/mL) or 5-FU (10.0 mg/mL), either alone (0.25 mL) or in combination with anterior chamber injections (0.05 mL), once daily for 4 consecutive days. Two eyes of two rabbits received subconjunctival and anterior chamber injections of unpreserved sterile saline. The eyes were examined regularly for external signs of toxicity and were enucleated 4 weeks after the last injection. Mitomycin C produced considerable tissue damage in the anterior segment, the severity being related to both the concentration and the route of administration. Eyes that received both subconjunctival and anterior chamber injections showed more damage than those that received subconjunctival injections alone. At the highest concentration of mitomycin C the cornea was inflamed, with stromal necrosis and marked endothelial loss. Hemorrhagic iris necrosis was also seen. In contrast, the 5-FU-treated eyes showed no microscopic evidence of toxicity. We conclude that there is greater risk of toxic anterior segment effects when mitomycin C is used as adjunctive therapy following filtration or pterygium surgery.

Building the library/information center of the future.

Changes in the mission, roles, and infrastructure of academic health sciences libraries pose an enormous challenge to those designing and planning new library buildings. The library will be judged by its ability to respond to changing information dissemination patterns, changing missions, technologies not yet contemplated, and curricular trends, notably the rise of informatics and problem-based learning. Key questions are posed; the answers will shape library building now and in the future.

Can health/medical informatics be regarded as a separate discipline?

The participants of the panel on education and training in Medical Informatics, concurred that health/medical informatics is today thriving as a separate discipline, despite inevitable uncertainties regarding the future. Conferees discussed the distinctions between physician-built systems and those designed by medical informaticians, focusing on methodology as critical to medical informatics.

An international health/medical informatics programs database.

The University of Maryland at Baltimore has established a database of health/medical informatics programs worldwide. Since 1991, IMIA's Working Group on Education and Training in Medical Informatics has provided guidance on critical issues of policy and purpose. At the Heidelberg/Heilbronn Working Conference in 1992 on Health/Medical Informatics education, representatives to WG1 and participants made suggestions regarding database intent, structure, and attributes.

Preparing medical informaticians: a cross-disciplinary approach.

Information systems are a necessity in tomorrow's healthcare environment--but who will be trained to use them and use them well? A whole generation of practitioners is backing away from the challenge--how are they to become educated?