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Medical informatics. Computer applications in health care
Int .I Biomed Comput,
31 (1992)
251-259
257
Elsevier Scientific Publishers Ireland Ltd.
BOOK REVIEW
Medical Informatics. Computer Applications in Health Care, E.H. Shortliffe,
L.E.
Perreault, G. Wiederhold and L.M. Fagan. 715 pp. The book contains three parts: (i) Recurrent themes in medical informatics, (ii) Medical computing applications and (iii) Medical informatics in the years ahead. Each chapter within these parts ends with suggested readings and questions for discussion. In addition a glossary and an extensive list of references is provided at the end of the book. Firstly, in Chapter 1 a scenario is presented describing how in the future the information management for a typical practicing physician may look like. This strategy is based on the assumption that integrated information management is available. Several concepts like LAN, connectivity, etc. are introduced and their potential uses described. Then, the terminology concerning biomedical applications of computers is discussed. Several terms that describe the discipline are presented. Finally, the term medical informatics is chosen as the preferred term although the term medical computer science is used in this book for those situations where specifically computers and their use within medical-informatics activities are discussed. A definition of medical informatics is not provided. The authors are of the opinion that the nature of the discipline is better illustrated by examples than via a formal definition. A historical perspective of the use of computers in medicine is given. Then, the relationship of medical informatics to medical science and practice, to biomedical engineering and to computer science is discussed. A separate paragraph is devoted to the nature of medical information. Chapter 2 discusses the acquisition, storage and use of medical data. The strong points and the weaknesses of the traditional medical record systems are reviewed. The importance of standardization from the point of view’ of standard care is emphasized. Then, the issue of the selection of medical data and the generation of hypotheses is discussed. The hypothetico-deductive approach - the method by which humans are supposed to arrive at a diagnosis - is explained. Subsequently, the relationship between data and hypotheses is discussed. Concepts like sensitivity, specificity and predictive value are introduced. The third chapter deals with the process of medical decision making under uncertainty. Methods to assess pretest probability of a disease are presented. Then, the operating characteristics of diagnostic tests are explained. Subsequently, Bayes theorem is introduced. Also, concepts like expected value of the outcome of decisions, utility and decision trees are presented and a decision analysis example is given. In Chapter 4 the essential concepts for medical computing are presented. An overview of computer hardware and software is given. Also database management systems are discussed. One paragraph is devoted to signal processing. The last paragraph discusses data communication.
258
Book review
Chapter 5 starts with a discussion of the functions that computer systems in medicine provide. Then the methodology for developing systems is presented. An illustrative case is presented emphasizing the importance of careful design, of responsiveness to the needs as they are perceived by the intended users and the importance of an awareness of different users’ varying perspectives. The last paragraph discusses the topic of the evaluation of systems. The second part of the book deals with medical applications. Chapter 6 discusses medical record systems. The advantages and disadvantages of computer-stored medical record systems are discussed. Examples are given of four automated ambulatory medical record systems (COSTAR, the Regenstrief Medical Record System, The Medical Record (TMR) and Summary Time Oriented Record (STOR)). It is noted that computer stored medical record systems are used in relatively few institutions. The reasons are stated and trends for the future indicated. In Chapter 7 hospital information systems are discussed. Firstly, the functions of hospital information systems are presented. Then three alternative architectures for hospital information systems are discussed: the central, modular and distributed approach. Also a comparison is made of three hospital information systems (TMIS, HELP and PROMIS). The chapter ends with a look into the future. Chapter 8 deals with nursing information systems. Nursing as a professional health care discipline is described. Attention is given to clinical practice, to nursing administration and to nursing research and development. The lack of standardized taxonomies and of systematic methods of recording is acknowledged. The development of computer systems for nursing is described from a historical perspective. It is concluded that computer applications for nursing practice have developed more readily outside the hospital setting. For the area of nursing administration it is concluded that computer systems do not estimate staffing needs more accurately than the head nurse. In this chapter also fundamental issues concerning nursing information systems are presented. Again the issue of the lack of taxonomies of nursing phenomena is discussed. Chapter 9 discusses laboratory information systems. Firstly, the organization of and the information flow in the laboratory is described. Then, the historical development of laboratory information systems is given. The functions these systems perform are described next. Two laboratory information systems are presented. In addition two systems designed to support data interpretation and diagnosis in the clinical laboratories are described. Chapter 10 is devoted to pharmacy systems. The functions of such systems are explained. Attention is paid to drug-related decision support and drug information services. Radiology systems are discussed in Chapter 11. Image generation, image analysis, image management and information management topics are reviewed and current applications of computers in radiology are reported. Chapter 12 focuses on patient monitoring. The development of computer based monitoring is sketched, examples of applications are given and current issues in patient monitoring are discussed. In Chapter 13 information management in physician’s offices in the USA is analyzed. Attention is paid to medical information, scientific information, accounting and administrative information and financial management and practice-planning information. Then a number of systems is presented.
Book review
259
Chapter 14 describes extensively bibliographic retrieval systems and issues affecting them. Clinical decision support systems are discussed in Chapter 15. The nature of clinical decision making is explained. Two early systems (MYCIN and the abdominal pain program of De Dombal) are reviewed. A structure for characterizing clinical decision support systems is suggested. The chapter proceeds with scientific issues. Then Internist, Oncocyn and HELP are discussed. The chapter ends with issues for future research. Clinical research systems is the topic of Chapter 16. The clinical research process and fundamental issues of data collection and analysis are described. Then a number of clinical research systems are presented. Chapter 17 reviews the use of computers in medical education. The role that the computer can play is discussed and some examples of recently developed CAl systems are given. In the end the factors that limit the use of CA1 at the moment are presented. Chapter 18 is devoted to health-assessment systems. The concept of healthassessment systems is explained. The value of information systems for healthassessment systems is presented. The effects of offering health assessment in terms of mortality reduction and financial savings are discussed. The third part of the book is devoted to the future of medical informatics. Since the success of the introduction of new technology in health care depends on the economic realities Chapter 19 pays attention to the way healthcare institutions in the United States are reimbursed for the services they provide. Moreover the issue of how managers of hospitals and other health care institutions need to think about costs, technology assessment and capital investment is discussed. The impact on medical informatics is explained. In the last chapter two scenarios from the future are discussed. The assumptions underlying the scenarios are presented. One important assumption is that of the availability of standardization. Standardization facilitates integration of systems. Standardization of hardware and software protocols used by medical instruments is discussed. Also the Unified Medical Language System is presented that can provide a common terminology for medical record systems, etc. In medical centers integration of information is necessary to support patient care, education, research and administration. The concept of integrated academic information management systems is introduced. The last section deals with forces that affect the future of medical computing. Not all subjects that can be expected in a book on medical informatics are treated. The use of computers in radiotherapy is not covered, for example. Also EKG and EEG analysis is hardly discussed. The book is written with the American community in mind. Hardly any discussions of work performed in other parts of the world will be found. The book is well written and discusses most of the material that should be covered by a book on medical informatics. The book can therefore be recommended to anyone who is interested in obtaining a good overview of computer applications in medicine. Also the book can be used successfully in curricula in medical informatics. A. Hasman
31 (1992)
251-259
257
Elsevier Scientific Publishers Ireland Ltd.
BOOK REVIEW
Medical Informatics. Computer Applications in Health Care, E.H. Shortliffe,
L.E.
Perreault, G. Wiederhold and L.M. Fagan. 715 pp. The book contains three parts: (i) Recurrent themes in medical informatics, (ii) Medical computing applications and (iii) Medical informatics in the years ahead. Each chapter within these parts ends with suggested readings and questions for discussion. In addition a glossary and an extensive list of references is provided at the end of the book. Firstly, in Chapter 1 a scenario is presented describing how in the future the information management for a typical practicing physician may look like. This strategy is based on the assumption that integrated information management is available. Several concepts like LAN, connectivity, etc. are introduced and their potential uses described. Then, the terminology concerning biomedical applications of computers is discussed. Several terms that describe the discipline are presented. Finally, the term medical informatics is chosen as the preferred term although the term medical computer science is used in this book for those situations where specifically computers and their use within medical-informatics activities are discussed. A definition of medical informatics is not provided. The authors are of the opinion that the nature of the discipline is better illustrated by examples than via a formal definition. A historical perspective of the use of computers in medicine is given. Then, the relationship of medical informatics to medical science and practice, to biomedical engineering and to computer science is discussed. A separate paragraph is devoted to the nature of medical information. Chapter 2 discusses the acquisition, storage and use of medical data. The strong points and the weaknesses of the traditional medical record systems are reviewed. The importance of standardization from the point of view’ of standard care is emphasized. Then, the issue of the selection of medical data and the generation of hypotheses is discussed. The hypothetico-deductive approach - the method by which humans are supposed to arrive at a diagnosis - is explained. Subsequently, the relationship between data and hypotheses is discussed. Concepts like sensitivity, specificity and predictive value are introduced. The third chapter deals with the process of medical decision making under uncertainty. Methods to assess pretest probability of a disease are presented. Then, the operating characteristics of diagnostic tests are explained. Subsequently, Bayes theorem is introduced. Also, concepts like expected value of the outcome of decisions, utility and decision trees are presented and a decision analysis example is given. In Chapter 4 the essential concepts for medical computing are presented. An overview of computer hardware and software is given. Also database management systems are discussed. One paragraph is devoted to signal processing. The last paragraph discusses data communication.
258
Book review
Chapter 5 starts with a discussion of the functions that computer systems in medicine provide. Then the methodology for developing systems is presented. An illustrative case is presented emphasizing the importance of careful design, of responsiveness to the needs as they are perceived by the intended users and the importance of an awareness of different users’ varying perspectives. The last paragraph discusses the topic of the evaluation of systems. The second part of the book deals with medical applications. Chapter 6 discusses medical record systems. The advantages and disadvantages of computer-stored medical record systems are discussed. Examples are given of four automated ambulatory medical record systems (COSTAR, the Regenstrief Medical Record System, The Medical Record (TMR) and Summary Time Oriented Record (STOR)). It is noted that computer stored medical record systems are used in relatively few institutions. The reasons are stated and trends for the future indicated. In Chapter 7 hospital information systems are discussed. Firstly, the functions of hospital information systems are presented. Then three alternative architectures for hospital information systems are discussed: the central, modular and distributed approach. Also a comparison is made of three hospital information systems (TMIS, HELP and PROMIS). The chapter ends with a look into the future. Chapter 8 deals with nursing information systems. Nursing as a professional health care discipline is described. Attention is given to clinical practice, to nursing administration and to nursing research and development. The lack of standardized taxonomies and of systematic methods of recording is acknowledged. The development of computer systems for nursing is described from a historical perspective. It is concluded that computer applications for nursing practice have developed more readily outside the hospital setting. For the area of nursing administration it is concluded that computer systems do not estimate staffing needs more accurately than the head nurse. In this chapter also fundamental issues concerning nursing information systems are presented. Again the issue of the lack of taxonomies of nursing phenomena is discussed. Chapter 9 discusses laboratory information systems. Firstly, the organization of and the information flow in the laboratory is described. Then, the historical development of laboratory information systems is given. The functions these systems perform are described next. Two laboratory information systems are presented. In addition two systems designed to support data interpretation and diagnosis in the clinical laboratories are described. Chapter 10 is devoted to pharmacy systems. The functions of such systems are explained. Attention is paid to drug-related decision support and drug information services. Radiology systems are discussed in Chapter 11. Image generation, image analysis, image management and information management topics are reviewed and current applications of computers in radiology are reported. Chapter 12 focuses on patient monitoring. The development of computer based monitoring is sketched, examples of applications are given and current issues in patient monitoring are discussed. In Chapter 13 information management in physician’s offices in the USA is analyzed. Attention is paid to medical information, scientific information, accounting and administrative information and financial management and practice-planning information. Then a number of systems is presented.
Book review
259
Chapter 14 describes extensively bibliographic retrieval systems and issues affecting them. Clinical decision support systems are discussed in Chapter 15. The nature of clinical decision making is explained. Two early systems (MYCIN and the abdominal pain program of De Dombal) are reviewed. A structure for characterizing clinical decision support systems is suggested. The chapter proceeds with scientific issues. Then Internist, Oncocyn and HELP are discussed. The chapter ends with issues for future research. Clinical research systems is the topic of Chapter 16. The clinical research process and fundamental issues of data collection and analysis are described. Then a number of clinical research systems are presented. Chapter 17 reviews the use of computers in medical education. The role that the computer can play is discussed and some examples of recently developed CAl systems are given. In the end the factors that limit the use of CA1 at the moment are presented. Chapter 18 is devoted to health-assessment systems. The concept of healthassessment systems is explained. The value of information systems for healthassessment systems is presented. The effects of offering health assessment in terms of mortality reduction and financial savings are discussed. The third part of the book is devoted to the future of medical informatics. Since the success of the introduction of new technology in health care depends on the economic realities Chapter 19 pays attention to the way healthcare institutions in the United States are reimbursed for the services they provide. Moreover the issue of how managers of hospitals and other health care institutions need to think about costs, technology assessment and capital investment is discussed. The impact on medical informatics is explained. In the last chapter two scenarios from the future are discussed. The assumptions underlying the scenarios are presented. One important assumption is that of the availability of standardization. Standardization facilitates integration of systems. Standardization of hardware and software protocols used by medical instruments is discussed. Also the Unified Medical Language System is presented that can provide a common terminology for medical record systems, etc. In medical centers integration of information is necessary to support patient care, education, research and administration. The concept of integrated academic information management systems is introduced. The last section deals with forces that affect the future of medical computing. Not all subjects that can be expected in a book on medical informatics are treated. The use of computers in radiotherapy is not covered, for example. Also EKG and EEG analysis is hardly discussed. The book is written with the American community in mind. Hardly any discussions of work performed in other parts of the world will be found. The book is well written and discusses most of the material that should be covered by a book on medical informatics. The book can therefore be recommended to anyone who is interested in obtaining a good overview of computer applications in medicine. Also the book can be used successfully in curricula in medical informatics. A. Hasman