bluuebunny/crossref_metadata_2025 huggingface dataset:
Question the Assumptions
Authors: Coiera Enrico
Published: February 2025

The lack of demonstrable success of computer based decision support technologies in health care requires a re-examination of the assumptions that support initiatives into these technologies. There are many ways in which one could explain away this lack of success, for example lack of technological maturity, lack of appropriate computer record infrastructures, or indeed professional resistance to novel technologies. However, one can also look at the fundamental assumptions that are taken as given when designing decision support systems. These assumptions about the problems that decision support systems should assist with, and the way that assistance should be provided are open to question. Much of the current work in decision support system research and development is based upon outdated views of the clinical workplace, and it is likely that the failure of the technology is in large part due to this. What is required is a principled re-examination of clinical practice, aimed at identifying the ways in which clinical workers should really be assisted. Until this is done, decision support technology will continue to be mismatched to the needs of health care workers.
Promoting Routine Use of Medical Knowledge Systems: Lessons from Computerised ECG Interpreters
Authors: Wyatt Jeremy
Published: February 2025

Medical knowledge systems are computer systems which contain medical knowledge and use it to reason about patients. Although the first was described over three decades ago, few have passed into routine use, compared to the large numbers of laboratory databases, CT scanners or computerised electrocardiogram (ECG) interpreters, which now process over 50 million ECGs per annum. This paper considers the lessons that we can learn from computerised ECG interpreters, and discusses six major issues: establishing closer dialogue between system developers and users, evaluating the impact of systems on users and their problems, integration with patient record systems, assembly of public, validated medical knowledge bases, reducing the emphasis on novel reasoning methods and considering the legal, regulatory and educational implications of this technology. Specific research topics are proposed under each of these headings.
Techniques for Studying Short-Term Changes in Cardio-Respiratory. Data, II
Authors: KITNEY R.I.  , DARVISH N.
Published: February 2025

The aim of the chapter is to review aspects of the analysis of cardio-respiratory interaction using spectral estimation methods. The first section of the paper provides background on nonlinear physiological oscillation, entrainment phenomena and computer modelling. Entrainment phenomena are described in some detail including: frequency pulling and nonlinear modulation. These phenomena are illustrated using the examples of respiratory sinus arrhythmia and the baro-receptor reflex. ARMA and AR techniques are reviewed and compared to the FFT. Experimental results on the interaction of heart rate, blood pressure and respiration are presented; it was shown that ARMA techniques provided evidence of short term independent physiological mechanisms whereby respiration affects heart rate and blood pressure. In the second section of the chapter time-frequency representations are introduced and the Short-Term Fourier Transform (STET), Wigner–Ville Distribution (WVD) and wavelet transforms are compared on a theoretical basis and applied to heart rate and respiration data, as well as test data, to highlight their differences. The first section of this part of the chapter points out a number of apparently complex phenomena in blood pressure, respiration and heart rate waveforms. These phenomena were shown to be more clearly understood by the application of nonlinear dynamic theory, coupled to computer modelling. In the second section the main advantages of the time-frequency methods were highlighted. These are their robustness and the fact that these methods do not require the data being analyzed to be stationary and as such represent an important development in the beat-to-beat study of cardio-respiratory control.
Development of Standards and Data Quality Control
Authors: Baert E.  , Beguin C.  , De Moor G.  , Roger France F.H.
Published: February 2025

Health care expenses represent 6 to 10% of the Gross National Product in most European countries. This budget exceeds by far those devoted to Defence or Education. The rising cost of health care concerns all governments. In each country of the European Community, measures were and will further be taken in order to increase efficiency in the delivery of health care. Recent advances in information technology offer new opportunities to collect, process and exchange data to document health practices. In Belgium the Ministry of Public Health collects uniform medical summaries for all acute care hospital inpatients, while detailed health care activities are documented for each patient through a very precise billing system. The use of Minimal Clinical Data and Minimal Nursing Data Sets in hospitals became mandatory four years ago. The fundaments for any datacollection is reliability, no matter what the preconceived aim was.
Coupling Mechanisms in the Scoliotic Spine
Authors: FARAFIPOUR Nader  , ALLARD Paul  , LABELLE Hubert  , RIVARD Charles-Hilaire  , DUHAIME Morris
Published: February 2025

This paper documents a novel technique to estimate the inter-vertebral motion and related coupling in five patients with idiopathic scoliosis and five control subjects. Triads were put over the spinous processes of the subjects. An eight 60-200Hz video camera Motion Analysis Expert Vision System was used to track these markers for right lateral bend trials. The markers’ 3-D coordinates were reconstructed by means of the Direct Linear Transformation technique after camera calibration. Rotations between any two triads were estimated by the Euler angles in the following sequence: bending, rotation and flexion. For a right bend, there is a left rotation of the thoracic spine and a compensatory right rotation of the lumbar spine in both the scoliotic spine and control subjects. Though, peak values were smaller for the scoliotic group but not significantly different, individual ratios involving the thoracic spine were significantly smaller for the scoliotic group denoting spinal rigidity.
Quantification of Spinal Mobility in Normal and Scoliotic Subjects During a Standing to Sitting Movement
Authors: DIMNET J.  , ROUSSOULY P.  , ROY C.
Published: February 2025

This paper presents a feasibility study for a project whose goal is to investigate how biomechanical factors, and in particular limitations in spinal mobility, contribute to the development of lower back pain. To quantify the mobility of each motion segment, each patient performed the same task, sitting down in a chair from an initial standing position. Vertebral axes were calculated from radiographs by the use of a D.L.T. procedure. Spinal mobility was determined by computing the change in the angle defined by the two vertebral axes of each motion segment between the initial standing position and the final seated position. The spinal mobility data support the concept of a reduced degree-of-freedom biomechanical model of the spine.
Estimation of 3-D Scoliotic Deformity from Back Shape Asymmetry
Authors: HIERHOLZER E.  , DRERUP B.
Published: February 2025

An improved method for a model-based estimation of the 3-dimensional shape of the scoliotic spine from back shape data is presented. The model is mathematically defined by a frequency-modulated sine curve. From this curve a 4-parameter model for the symmetry line is derived. By parameter variation the curve is fitted to the back surface, minimizing lateral asymmetry. As a result, a smooth and realistic curve is obtained which is superior to the conventional symmetry line. Results figuring the improvement of the vertebral curves (compared with radiographs) and examples are presented.
Act Management and Clinical Guidelines
Authors: Nicklin Peter  , Frandji Bruno
Published: February 2025

Clinical activity has always demanded close co-operation and co-ordination between clinicians and specialities. This applies especially in hospitals and in the future it will apply equally in primary and community care. Co-operation and co-ordination require two things: access to guidelines to control shared, distributed clinical activity, and common access to the patient record. Act management facilitates this by managing the process of care as it passes from one performer to another, enabling each to know at what point in the process (or cycle) they stand, what is expected of them, what is expected of others, and enabling them to access the information that they require. This paper describes act management with reference to guidelines and it is a contribution to the process, presently under way, that is intended to bring the leading examples of act management from the AIM NUCLEUS project and guideline support from the AIM DILEMMA project into close interworking in the same system.
A model for the structured description of healthcare activities and related data
Authors: Rossi Mori A.  , De Simone M.  , Lalle C.  , Ricci F.L.
Published: February 2025

Rehabilitation involves long-term, interdisciplinary processes. A model was developed, for the structured description of typical healthcare activities. Telematic services based on this model can support accurate data acquisition and communication among healthcare teams. Presentation of data within their context and according to the specific user's view is envisaged, based on deviations from the typical behaviours. Benefits are also expected in better understanding of the care processes themselves, easier comparison of different approaches, and diffusion of consensus-based knowledge.
Approaches to Experimental Design
Authors: Van Gennip Elisabeth M.S.J.
Published: February 2025

In case a working prototype exists, or even a product, effects of the information technology can be assessed “in real life”. Such an assessment in “real life” can be done with an experiment. This contribution describes how to design an experiment and how to prevent pitfalls, introduced by various causes of bias. In this respect internal validity and external validity are distinguished. It is concluded that the best study design depends on the focus and the boundary conditions in each individual setting. As a general rule it is recommended to consider all possible causes for bias, to eliminate or minimize bias where possible for example using specific study designs and statistics, or to take bias into account in interpreting results.
Evaluation of Automatic Health Information Systems What and How?
Authors: Grémy F.  , Bonnin M.
Published: February 2025

This chapter tries to look into the reasons for delusion about efficiency and quality of results of Medical Informatics Technology. Our thesis is that it is not a technology like the other medical technologies, and that “to assess medical informatics” implies to assess not only the machinery (hard and soft), but above all to assess what medical informatics really do for people. One can hardly speak of medical informatics without having in mind questions related to human concerns, thus without referring to human sciences.
Virtual Reality Meets Medical Education
Authors: Hoffman Helene M.
Published: February 2025

The University of California at San Diego (UCSD), School of Medicine is undertaking a multi-year project to create an educational computing environment which integrates elements of Virtual Reality, Multimedia, and communications technologies. The goal of this endeavor, named the Virtual Reality-Multimedia Synthesis project, is to create next-generation educational tools which extend the flexibility and effectiveness of medical teaching, promote the development of lifelong learning, and gain acceptance within the mainstream academic community. The initial phase, a feasibility study which is now complete, resulted in the production of a mock-up and video which communicated this vision and enabled feedback from potential endusers. Phase 2, now underway, involves the development and evaluation of a prototype system. Over the next three to four years, a working version is expected to be available for expanded testing in venues beyond UCSD.
Virtual Surgery for Fracture of the Mandible
Authors: Kobayashi Masahiro  , Fujino Toyomi  , Kaneko Tsuyoshi  , Chiyokura Hiroaki  , Enomoto Kanehisa  , Shiohata Kimihiko  , Momose Yuichi  , Kanbe Katsuyuki  , Shinozaki Katsuhiko  , Fuku Naohito
Published: February 2025

We report on a clinical application of virtual surgery system for fracture of the mandible. The equipment used consists of Silicon Graphics IRIS VGX-T with 60-inch display, wired liquid crystal shutter glasses, a pair of data gloves and Polhemus sensor. This system is useful in simulation surgery, education, and informed consent to the patients and their family. This system is produced for TEPIA 7th Exhibition (Machinery and Information Industries Promotion Foundation).
A Fully Immersive Cholecystectomy Simulation
Authors: Lasko-Harvill Ann  , Blanchard Chuck  , Lanier Jaron  , McGrew Dale
Published: February 2025

A fully immersive virtual reality simulation of an open abdomen cholecystectomy is described. Abdomen, biliary system and multiple surgical instruments are modeled in a virtual operating room environment. State machine interaction programming allows the user to perform an entire sequence of surgical tasks based on a task analysis of the operation.
Laser-Based 3D Volumetric Display System
Authors: Soltan Parviz  , Trias John  , Dahlke Weldon  , Lasher Mark  , McDonald Malvyn
Published: February 2025

Today, converting the 2-D data of conventional medical images into useful 3-D clinical information requires mentally integrating the data into a 3-D image. The transformation, however, is frequently difficult even for experienced radiologists. Even with the Magnetic Resonance Imaging (MRI) device, and its remarkably sophisticated imaging, the end product image is only a 2-D presentation of 3-D. The same can be said for all ultrasound imaging devices employed throughout hospitals and in clinical laboratories; they give the illusion of 3-D, using computed 2-D (flat) images.
TELEPRIM: Telematic Services for Primary Care
Authors: Piera Fernando
Published: February 2025

TELEPRIM is an acronym for Telematic Services in Primary Care.
Chip Cards in Public Managed Health Care
Authors: Hofmann Gerd-Guido
Published: February 2025

The Kassenärztliche Vereinigung (KV) is currently evaluating the feedback from the first quarterly billing periods after the introduction of an insurance chip card in Germany. Following initial anxiety concerning misuse of their data, patients show an overall acceptance of the chip cards. Physicians received special chip card readers and printers to transfer the data from the chip card to all forms used in the German health care system. The clearly overriding advantage of the chip cards lies in the easy and sure acquisition of patient data. Current trends show the onset of a number of projects with chip cards based on a variety of diverse technology containing medical data. It is the objective of the KV to standardize and certify these new technologies.
MENELAS: Coding and Information Retrieval from Natural Language Patient Discharge Summaries
Authors: Zweigenbaum P.
Published: February 2025

The overall goal of Menelas is to provide better access to the information contained in natural language patient discharge summaries, through the design and implementation of a pilot system able to analyse medical texts. This paper summarises the developments performed for this purpose during the project. It stresses the fundamental issue of the normalisation of medical information into a common, language-independent representation. The project has resulted in a collection of components, knowledge bases and systems for processing natural language patient discharge summaries. It has also produced methodological results on the design of a normalised representation of medical information and its construction from textual input. Further developments and applications have already started in the context of two other European Union projects.
A Framework Curriculum of Health Informatics for Higher Professional Education in Nursing and Allied Health
Authors: AARTS J.E.C.M.  , van der KOOIJ W.  , ROOSENBOOM P.G.M.
Published: February 2025

The authors describe a framework curriculum of health informatics for higher professional education in nursing and allied health in The Netherlands (the so-called VIT/HGZO project). The curriculum consists of 16 modules emphasizing the use of information and information technology in healthcare. It also stresses the use of formal methods to support decision making and the effect of healthcare policies and patient care on the development of information technology. For each module, the subjects, study and workload, prerequisites and learning outcomes are presented in detail.
A Systematic View On Health Informatics
Authors: HASMAN A.  , ALBERT A.
Published: February 2025

In this contribution the discipline of health informatics is described in a systematic way. It is recognized that health informatics deals with modelling of various processes and structures existing in the healthcare domain. Different processes are distinguished and their underlying computational and informational mechanisms are described. The chapter ends with an overview of the structure of applications as suggested by van Bemmel.
Creating an Infrastructure of Trusted Third Parties for Issuing of Cryptographic Cards for Signatures and User Identification
Authors: Klein G.O.
Published: February 2025

Smart cards with asymmetric encryption can be important tools for the information security of almost all health care information systems. The main functions are for user authentication, digital signatures and exchange of session keys for confidentiality protection but in addition they can be used as a proof of professional registration and as an access control device to patient data cards. This concept requires an infrastructure of Trusted Third Parties, trustworthy organisations that provide cards to professionals and issues signed certificates that links the identity of a user to a cryptographic key. Various aspects of the operation of such bodies are described in this paper and the attempts to create a European network of such bodies with the TrustHealth project under the European Commission sponsored Telematics for health programme is presented.
Health Card in France: New Rules Regarding Medical Data
Authors: Chabert-Peltat C.
Published: February 2025

The project SESAM/VITALE has been selected and will be put to use in France in 1995. Its aim is to replace the social security card, and to become a portable medical file. The health card is a card like others. This card is nothing more than the immerged part of a complexe information system, which is going to allow the exchange of information by means of computer and telematic networks, set up in each beneficiary of the health system (doctor, laboratory, hospital, pharmacy, health insurance company). A few questions which have been asked about the health care card have already been asked for other cards and computer systems data transmission: relations beetwen operators, contract for a card holder, the rights of the card holder, data property, card property. Most of the contracts of bearers of payment cards (bankcards, credit cards...) stipulate that the card remains the property of the issuer that reserves the right to withdraw it from the bearer in the case where he would not uphold his part of the contract. Regarding the health card, the problem of its restitution becomes more delicate. Taking the nature of registrated information into account, the health card isn’t an ordinary card. It will contain information relating to health, which revealed to a bad intentions third person could have serious repercussions for the patient. Special dispositions have been taken in order to protect the safety of these information:
Troubles about Privacy Protection as Security Issues of the Personal Health Data Management in Japan and some of Solution Proposals
Authors: Ishikawa K.  , Miyaji M.  , Nakamura Y.  , Nishi S.  , Sasaki T.  , Tsuji K.  , Yamamoto K.  , Watanabe R.
Published: February 2025

Japanese society needs the comprehensive medical services on the basis of various medical information and their management network. We discuss feasible rules and regulations of Personal Health Data (PHD) management based on surveys concerning the situation among facilities, social consciousness, and through experimental study of a model community health care in Japan. Surveys were conducted in 1994 among citizens and medical specialists on their consciousness to data protection as they have to consider how they manage their facilities and whether to have certain rules or regulations. We also discuss points of view on definite data management based on privacy protection; for instance investigated experimental study of the community model health care system. During such a process, we propose the classifications of PHD to use them from two view points as follows;
Multifunctional Card Terminals (MCTs) for the German Health Care
Authors: Struif B.M.
Published: February 2025

The functionality of the first generation of card terminals in German health care has been dedicated to the interworking with the nationwide introduced health insurance card. More than 80 million cards have been issued and more than 150 thousand card terminals of the first generation have been installed in doctor’s practices. In the meantime a second generation with enhanced functionality is required: the Multifunctional CardTerminals (MCTs). MCTs are open for any type of application and support processor cards with the transmission protocols T=0 and T=1. MCTs support also intelligent memory cards with the serial data access protocol SDAP (I2C-Bus), the 3-wire bus protocol 3WBP and the 2-wire bus protocol 2WBP. MCTs may have more than one interface for ICCs with contacts (e.g. for a professional card and a patient card) and functional units such as display and keyboard. Of special importance is the CT-API-library to be provided by MCT-manufacturers: this library allows easy integration of chip card technology in existing or new software systems by supporting an application independent CardTerminal Application Programming Interface.
A National Network of General Practitioners for Epidemiologic Surveillance and a Local Network Experimenting the Health Card as a Communication Tool between G.P.s and Local Health Structures
Authors: Panfilo M.  , Palombi L.  , Mariotti S.  , Lucchetti G.  , Corsetti E.  , Dario C.  , Carlini A.  , Tessarin M.  , Leone I.  , Fusiello S.
Published: February 2025

So far in Italy very little has been done to explore the possibility of querying personal files of doctors who have already started to computerize their medical files, to check the quality of information collected, or to attempt data standardization for epidemiologic purposes (1-3). The project here described tries to fill this gap, as data collected by general practitioners on their patients and on the diseases they encounter in the course of their activity are a valuable source of information, which is difficult to make use of because of lack of common protocols.
Health Administration System Using an Optical Memory Card in a Rural Community
Authors: Ozasa K.  , Hayashi K.  , Higashi A.  , Watanabe Y.  , Kawai K.  , Saito A.  , Tofukuji I.  , Kamachi S.
Published: February 2025

Use of a card system for accessing health information has been attempted in a rural town in Japan. Individual longitudinal data from health checkups and screenings were stored in an optical memory card. The data can be referenced at the next checkup or in a clinic during medical consultations for chronic diseases and provide background data for diagnoses. The system was administered through the town office and available to all three clinics in the town. Utilization of the card is currently limited, and we investigated the reason as well as ways to improve the system.
Introduction of Medical Cards to Improve Communication
Authors: Brenner G.  , Schaefer O.P.
Published: February 2025

At the beginning of 1995, the introduction of the statutory Health Insurance Card in Germany has been successfully completed. Its electronic memory chip permits the storage of the personal identification data of the about 73 Mio insured persons in Germany. Personal identification data are name, address, date of birth, health insurance number and insurance status. The offices of the about 110.000 German ambulatory physicians have at the same time been equipped with card reading devices and printers that permit the reading and processing of administrative data. In the meantime, the presentation of the health insurance card at each consultation has become mandatory and thus replaced the obligatory submission of claims forms. The health insurance card entitles the patient to receive medical services. The identification data stored on the memory chip are transferred to all forms used in practices (such as reimbursement forms, prescriptions, disability forms and referrals to hospitals).
Coordinated Care
Authors: Spillane J.
Published: February 2025

With drugs costs rising as fast as any other segment of health care, it is no wonder more and more employers view managed prescription care as a necessity, not as an option. In the early 1980’s carving out, or separating, prescription drug benefits from the traditional indemnity major medical plan was a major innovation in benefit plan design. The carving out the prescription drug benefit enabled providers and sponsors to track, report, review and control drug benefit costs so they were not buried in general major medical claims. Stand alone plans also gave sponsors the flexibility to modify the structure of their prescription benefits. But now plan sponsors realize they have created a powerful information base that can be used to control not just drug costs but other medical expenditures as well. Moreover, corporate benefit managers have discovered that pharmacy claims are often the only data readily available on their indemnity covered employee population. The prescription claim data in itself can identify some medical conditions. Conversely, medical claims data, if available, is often to general to pinpoint medical cost drivers. Combining the pharmaceutical and medical information can provide a more comprehensive picture. The current health care system in the United States is an uncordinated system, one in which a patient is cared for by multiple physicians and Pharmacists. In addition there is inadaquate feedback to pharmaceutical companies and payors due to uncoordinated/disconnected information flows. Pharmacists and physicians must be encouraged to communicate and collaborate in order to make rational, cost conscious prescribing decisions. Health care providers must learn to evaluate value and encourage appropriate utilization to meet cost-effective clinical objectives. Not having direct contact with physicians makes changing poor prescribing habits difficult. The next generation of pharmayceutical care management will go beyond pharmaceuticals and focus on what is best clinically, communicating protocolls on-line at the point of care. Engaging the patients and pharmacists in the optimal care loop will boost quality and save money.
Interoperability of Card Systems in Germany: - Assumptions and Minimal Requirements
Authors: Schaefer O.P.
Published: February 2025

Interoperability remains the key factor for a widespread acceptance of health cards and for further investment in technical infrastructure. To achieve interoperability, it is inevitable to find a consensus on certain technical, structural, ethical, and legal standards. European and G7 efforts on global harmonisation of card systems give an example for the ultimate goal, which should be taken into account right from the outset.
Open Information Systems and Data Security in Medicine
Authors: Blobel Bernd
Published: February 2025

The realization of the German law for a new structure of health care delivery by the ensurance of efficient structures and processes in hospitals calls for an optimal design of informational processes. To realize applications near to the users and just in time as well as to build up the complex functional relationships between departments and subsystems in big hospitals, a new design for Hospital Information Systems (HIS) is necessary. The features of modern HIS outlined in the paper can only be established by open systems, which guarantee portability, scalability and interoperability. This is also true in regionally distributed systems like the tumour register at Cancer Centres. In the paper the necessity and possibilities of open systems and different levels of application integration are discussed. The general statements are illustrated by practical realizations in the HIS of the Magdeburg University Hospital as well as in the tumour register at the Cancer Centre of Magdeburg/Sachsen-Anhalt. The creation of integrated structures for communications makes great demands on the ensurance of data security and data protection, especially for the inclusion of external partners from the region. In the context of high sensitive data of cancer patients data protection is of top priority. The legal problems of data collection, data storage and exchange in medicine are discussed first. The paper presents some aspects of the concept for data security and data protection in the Magdeburg University HIS and of the related concept for data protection in the tumour register of the Cancer Centre Magdeburg/Sachsen-Anhalt. Appropriate steps of realization are demonstrated. The application of hardware based modem access control systems with integrated encryption of data follows. The statements are extended to the planned installation of hardware based network access control systems with integrated encryption of data in the LAN.
Guidelines For Secure System Development And Secure Implementation
Authors: Bakker Albert R.  , Van Dorp Henk  , Van Veenen Gieneke
Published: February 2025

In this paper the present state of development of the guidelines for both secure system development and secure implementation, as being drafted within the scope of the SEISMED project, are briefly described. For system development there is a lot of literature how to cope with security requirements. For secure implementation of systems within an organization hardly any literature was found. By consequence there is a significant difference in maturity of the two sets of guidelines.
The EDITH Approach: The Management Of Authorisations And Security In Healthcare Information Systems
Authors: Ferrara Fabrizio Massimo
Published: February 2025

This paper provides a summary of the approach adopted by EDITH for the definition and management of the security aspects within a generic healthcare information system, organised according to a common architecture based on characteristics of modularity, openness and federation of the individual healthcare organisations and healthcare information systems. The specification and actual development of the Authorisation Server, shortly described in this paper, is the result of the joining of the activities carried out by GESI in the frame of the NUCLEUS (AIM 2025) and EDITH-Italy (ESPRIT 7058) projects.
Recommendations for European Health Data Protection Legislation
Authors: Callens Stefaan  , Nys Herman
Published: February 2025

In year 1 of the SEISMED project, the Katholieke Universiteit Leuven coordinated the inventory and analysis of medical personal data protection legislation in Europe. A report on legal issues of medical data protection legislation in Europe was written by the Vrije Universiteit Amsterdam, the Centre National pour la Recherche Scientifique (Paris) and the University College Dublin. This report served as a basis for a second important legal deliverable, i.e. the Health Informatics Deontology Code. In this third and final report, we take into account the results of the other two legal reports and we formulate recommendations for the national and European legislator. This report analyses critically the upcoming privacy directive. We propose several recommendations which should be taken into account by the European and national legislator. We focused quite extensively on the use of medical data for research purposes. We had several reasons to do this. One of them is the fact that the use of medical data for research purposes is very popular, in particular now the health care sector is becoming more and more ‘standardized’ by using computers, networksystems and telematics. Legislation is therefore needed. Moreover, the use of medical data for research purposes involves the transfer of data from one Member State to another. Therefore, a harmonized legislation is really needed. We hope that the recommendations we propose, will be taken into consideration by the European legislator.
Virtual Echography
Authors: Henry Delphine  , Troccaz Jocelyne  , Bosson Jean-Luc
Published: February 2025

We present a Virtual Echographic System. Because this examination is particulary difficult, developping a simulator is very useful to give students some common databases of pathological samples on which they could experiment image acquisition and evaluate their understanding of clinical cases. We have applied our method to the simulation of thigh ultrasonographic examination for thrombosis diagnosis. A preliminary system, focusing on image generation, has been developped. Virtual echographic slices are generated using a particular interpolation technique and a deformation model of significant structures. Resulting images have a visual quality similar to usual ones.
Introduction of New Technologies to the Medical Undergraduate Curriculum
Authors: Gupta Subhas C.  , Klein Scott A.  , Mehl David C.  , Verdi Marco G.  , Anderson Gary .L.
Published: February 2025

The rate at which new educational technologies are introduced is growing at a tremendous pace. This is in large part due to the recommendations of the AAMC Steering Committee on the Evaluation of Medical Education which strongly supported the use of Medical Informatics technologies for education. Some institutions have attempted to implement these technologies; however, a scientific study has not yet been conducted to document their potential benefit. Our attempts to conduct such a study were met with obstacles of resistance from faculty, administration, and students. To overcome these obstacles we have developed a solution which addresses all of the resistance that we encountered. This solution is based upon three premises: 1) adjunct introduction, 2) multicenter studies, and 3) scientific educational benefit analyses.
Telemedicine and Security
Authors: Jennett P.  , Watanabe M.  , Igras E.  , Premkumar K.  , Hall W.
Published: February 2025

The health care system is undergoing major reform, characterized by organized delivery systems (regionalization, decentralization, devolution, etc.); shifts in care delivery sites; changing health provider roles; increasing consumer responsibilities; and accountability. Rapid advances in information technology and telecommunications have led to a new type of information infrastructure which can play a major role in this reform. Compatible health information systems are now being integrated and connected across institutional, regional, and sectorial boundaries. In the near future, these information systems will readily be accessed and shared by health providers, researchers, policy makers, health consumers, and the public.
Virtual Reality Volumetric Display Techniques for Three-Dimensional Medical Ultrasound
Authors: Littlefield Richard J.  , Heiland Randy W.  , Macedonia Christian R.
Published: February 2025

Ultrasound imaging offers a safe, inexpensive method for obtaining medical data. It is also desirable in that data can be acquired at real-time rates and the necessary hardware can be compact and portable. The work presented here documents our attempts at providing interactive 3-D visualization of ultrasound data. We have found two volume rendering visualization packages to be quite useful and have extended one to perform stereographic volume visualization. Using a relatively inexpensive pair of commercial stereo glasses, we believe we have found a combination of tools that offers a viable system for enhancing 3-D ultrasound visualization.
3-D REPRESENTATION AND VISUALISATION OF THE HUMAN FACE AND APPLICATIONS TO SURGERY, MORPHOLOGY, ANTHROPOMETRICS AND FORENSIC SCIENCE
Authors: Goodwin Patricia M.  , Linney Alfred D.
Published: February 2025

A short historical review of facial measurements and computer graphics leading to visualisation systems is given. The use of a computer graphics workstation developed at University College London for the simulation and planning of maxillofacial and cranial surgery is described. This creates a display of anatomical surfaces from three dimensional (3-D) datasets generated by Computerised Tomography, Magnetic Resonance, Ultrasound medical imaging systems and by a purpose built optical body scanner. The workstation offers a wide variety of facilities allowing the operator to interact with and interrogate these three dimensional datasets via the displayed images. The manner in which the software allows the operator to plan surgical procedures and to produce surgical models for rehearsal and prosthesis manufacture is discussed and illustrated with case material. The use of the system for studying facial form, growth and change is discussed, and clinical, morphological and forensic applications are described.
Guidelines for Secure System Implementation for Health Care Management
Authors: van Veenen G.
Published: February 2025

During the process of bringing developed software into operational use, the implementation process, many activities have to be performed, which can have influence on the security of the information system of a health care environment.
Guidelines on IT Security Risk Analysis For Health Care Management
Authors: Davey J.  , King S.
Published: February 2025

The information systems under your control may be exposed to unauthorised access, fraud, other abuse or misuse or even major disaster.
E L C A N O: European and Latin-American Countries Associated for a Networked database of Outstanding guidelines in unusual clinical cases
Authors: Sancho JJ  , Oliveri NC  , Faba G.  , Campos M  , Sanz F  , De Dombal FT
Published: February 2025

The morbidity and mortality of unusual clinical cases ranges from five to sixfold times those of usual clinical cases. Noneless, there is an acute lack of structured information sources on the best managing practices for those cases. The general objective of ELCANO is to build and exploit a multilingual Virtual Library of outstanding clinical guidelines to manage unusual cases. This Virtual Library will be distributed across The Internet from the partners servers and accessed by specialists and specialists in training. Gastroenterology will be the initial area of the clinical practice to be addressed. The unique and innovative aspects of ELCANO are its orientation toward unusual cases, the framework embracing countries from Europe and Latin-America, the structured pre-validation of the cases and its multilingual contents as well as their indexing and codification using internationally accepted standards. An immediate benefit from ELCANO will be the availability of critical clinical information in places where there is a lack of experience coming from places where this experience is commonplace. ELCANO is to be regarded as a exploratory measure, to test the implementation of North-South and South-North collaboration in telecommunication of clinical information. When successful, a broader range of medical specialities and more countries in both regions as well as new regions are foreseen to be involved.
Regional Coordination of Referrals by Electronic Information Systems
Authors: Larsen Torben  , Lehrmann Tove
Published: February 2025

The on-going specialization of medical services requires an economic coordination of the different health services. The GP is the key to improve this primary coordination. To qualify referral decisions by the GP an Internet-like information system with minimal technical requirements at the level of the GP has been implemented in 3 Danish counties comprising 1/4 of the population. This Vislnfo contains information on 1) Alternative periods of waiting, 2) Medical guidelines for specific treatments, 3) Clinical Home Pages and 4) Links to non-medical providers of health services (NGO's). The initial achievement of Vislnfo according to an external evaluation was a coverage of 45% of referrral information required by the GP. Since the contents has been expanded and refined. A renewed test of actual coverage is scheduled for the autumn of 1996.
Medico-Economic Patient Encoding in the University Hospital of Geneva
Authors: Lovis Christian  , Michel Pierre-André  , Borst François  , Baud Robert  , Griesser Vincent  , Scherrer Jean-Raoul
Published: February 2025

The recent changes in the Swiss Healthcare financing system as well as the final phase of migration from a mainframe-based to a distributed UNIX-based HIS, has lead to the development of a new encoding system for diagnosis and interventions in our hospital. The goals fixed in the design of the new system could been achieved and the new system is used since July 1995. It is based on an semi-automatic encoder with natural language entry and an interface for managing the patient history running under Windows. Data are stored on a UNIX Ingres relational database. Since studies conducted in our Hospital as well as literature review has shown an overall bad quality of databases used for reimbursement claims, one of the main aspects that has directed the new concept of encoding was to increase the quality and the exhaustivity of the encoding. This has been achieved by associating the coding activity with the patient summary browser and the automatic production of discharge summaries.
Medical Language Processing and Resources Reusability: a case study applied to Dutch
Authors: Spyns Peter
Published: February 2025

In this paper, a case study is presented of how existing resources for medical language processing can be optimally reused. In particular, it will be shown how an existing morphosyntactical analyser for Dutch is coupled to the language independent components of other medical language understanding systems, namely the Ménélas (an Access System for Medical Records using Natural Language) and the LSP-MLP (Linguistic String Project -Medical Language Processor) systems.
Towards a new generation of terminologies and coding systems
Authors: Rossi Mori Angelo
Published: February 2025

The features of a new generation of terminological systems are introduced: they are computer-based, multihierarchical, extensible, mappable. This performance is achieved by a compositional approach: each phrase is systematically represented by predefined descriptors, according to a “categorial structure” (a model of semantic categories and their relations). A terminological system is therefore made of four interrelate components: categorial structure, system of descriptors, system of phrases and their systematic representations. The role of the European standardization body (CEN) to support the development of such terminological systems is outlined.
Ten commandments for implementation of Regional Health Care Networks. A case story from a large scale implementation
Authors: Johansen Ib  , Lehrmann Tove  , Jensen Henrik Bjerregaard  , Bernstein Knut
Published: February 2025

A successful implementation of a health care data network is dependent of a number of different - non technical - factors. The implementations of one of the largest Regional HC Network in Europe, FynCom, have been very fruitful. The experience obtained within this field has led to a set of 10 commandments. The main focus has been the collaboration among the different partners and the role of human aspects in the development, implementation and dissemination of the project.
Cognitive Evaluation for the Assessment of Information Technology in Healthcare
Authors: Beuscart-Zephir Marie-Catherine  , Brender Jytte  , Souf Nathalie  , Menager-Depriester Isabelle
Published: February 2025

The adoption of information technology has increased, and so have the demands that these systems adapt to the physicians' and nurses' work activities. Employment of quality management techniques during the development of ITbased solutions is necessary to ensure that they satisfy the users' requirements.
Evaluation of a Regional Electronic Health Care Network
Authors: Jørgensen Torben  , Bernstein Knut  , Danneskiold-Samsøe Bent  , Lehrmann Tove
Published: February 2025

A technology assessment of the regional health care network, FYNCOM showed a.o. a time saving for an average general practice of 50 minutes per day, and a better service to patients as compared to traditional mail communication. A significant part of the time saving was rather due to less clerical work and to organizational changes than to reduction of the transmission time per se. There was no clear evidence for a better clinical outcome due to the electronic network.
Monitoring the Quality of Care by Quality Indicators
Authors: Nicolosi E.  , Molino F.  , Pandolfo G.  , Molino G.
Published: February 2025

This paper defines what quality indicators are and proposes a classification to be used in a quality control program. The clinical record we refer to in the paper is supposed to be computerized and structured in a problemoriented manner. There are as many quality indicators as the number of different types of quality controls someone wants to make. There are general quality indicators reflecting the hospital organization and more specific ones measuring the quality of the methodological strategies applied by doctors during a patientmanagement process.
A Framework for Assessment of Information Technology and Telecommunications
Authors: Koukoumas Nicholas  , Papadourakis George  , Erimakis George-Marios
Published: February 2025

Health Care Systems confront among other challenges the one of effective and efficient development, implementation and use of Information Technology and Telecommunications (IT&T). The expected impact of IT&T at micro and macro levels of health care systems makes necessary a comprehensive approach for planning and decision making. Such a framework has been elaborated in order to provide a consistent tool for evaluation and assessment of IT&T applications.
Electronic Patient Record SCIRH
Authors: Tinggaard Nielsen Kim  , Agersten Jan  , Biering-Sørensen Fin
Published: February 2025

An electronic patient record system is being implemented at the Centre for Spinal Cord Injured in Copenhagen. Of importance is the use of standardised questionnaires / check-lists. Parts of the standardised recordings can be used for quality insurance including clinical databases. With this system double-registration is avoided. Because of the graphical user interface the system will be easy to use. The technical solution is based on a client / server setup with DOS / WINDOWS clients, Novell Netware servers and a mainframe equipped with IBM DB2 database system. The used development programming tool is POWERBUILDER.