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Variations research is one important strategy in the quality management movement designed to improve the quality of health care and to control costs. Information systems are being utilized in variations research to provide an array of potential variables, to provide measures of the variability inherent in these variables, and to assist with the study of the linkages of patient and provider characteristics with interventions and outcomes. This article presents a [...]

In recent decades there have been major advances in the creation and implementation of information technologies and in the development of measures of health care quality. The premise of this article is that informatics provides essential infrastructure for quality assessment and improvement in nursing. In this context, the term quality assessment and improvement comprises both short-term processes such as continuous quality improvement (CQI) and long-term outcomes management. This premise is [...]

Evaluators must develop methods to characterize the use of the rapidly proliferating electronic networks that link patients with health services. In this article the 4-S framework is proposed for characterizing the use of health services delivered via computer networks. The utility of the 4-S framework is illustrated using data derived from a completed, randomized field experiment in which 47 caregivers of persons who had Alzheimer's disease accessed ComputerLink, a special [...]

The High-Performance Computing and Communications (HPCC) program is a multiagency federal effort to advance the state of computing and communications and to provide the technologic platform on which the National Information Infrastructure (NII) can be built. The HPCC program supports the development of high-speed computers, high-speed telecommunications, related software and algorithms, education and training, and information infrastructure technology and applications. The vision of the NII is to extend access to [...]

Health care delivery systems and organizations around the world are undergoing reorganization and reengineering. Rational decision making about such activities must be based on information. Much of the presently available data is inadequate for this task, and therefore needs to be transformed. One such experience in the province of Alberta, Canada, is discussed. The development of a comprehensive information strategy, the need to apply information management principles, the organizational implications [...]

This article describes the implementation of a suite of computer programs to manage and provide access to a database containing the electronic documents that constitute the NIH-Guide that is distributed by the NIH on a weekly basis. The software consists of a management program that reads, processes, and stores the incoming documents and performs erratum updates on existing documents; an alerting program that sends selected information to users who have [...]

Conceptual models for diagnostic reasoning proposed in the medical literature are presented to stimulate discussion about the issue of the appropriateness of probabilistic knowledge-based systems for medical diagnosis. Evidence is presented to corroborate the authors' view that diagnosis is a problem-solving task, rather than a decision-making task. In the authors' opinion, probabilistic reasoning is better suited to situations dealing with choices for clinical intervention, rather than to those dealing with [...]

From my viewpoint as a patient, 1. Medical knowledge has expanded to the point that individuals cannot adequately improve quality without the assistance of computer programs. 2. The medical profession must concentrate on why and how computer program projects must be used, not on why they cannot be used. 3. The successful application of computer programs to clinical medicine is dependent mainly on the efforts of individual institutions and people [...]

The overarching informatics grand challenge facing society is the creation of knowledge management systems that can acquire, conserve, organize, retrieve, display, and distribute what is known today in a manner that informs and educates, facilitates the discovery and creation of new knowledge, and contributes to the health and welfare of the planet. At one time the private, national, and university libraries of the world collectively constituted the memory of society's [...]