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As we have advanced in medical informatics and created many impressive innovations, we also have learned that technologic developments are not sufficient to bring the value of computer and information technologies to health care systems. This paper proposes a model for improving how we develop and deploy information technology. The authors focus on trends in people, organizational, and social issues (POI/OSI), which are becoming more complex as both health care [...]

The purpose of the study is twofold: 1) to explore the applicability of combinatorial terminologies as the basis for building enumerated classifications, and 2) to investigate the usefulness of formal terminological systems for performing such classification and for assisting in the refinement of both combinatorial terminologies and enumerated classifications.

The contention of the author is that an informatics infrastructure is essential for evidenced-based practice. Five building blocks of an informatics infrastructure for evidence-based practice are proposed: 1) standardized terminologies and structures, 2) digital sources of evidence, 3) standards that facilitate health care data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and 5) informatics competencies. Selected examples [...]

The authors compare alternative methods of cost estimation for a patient multimedia education (PME) program, using a computerized weight-reduction PME project as an example. Data from the project planning and budgeting process and actual costs of the completed project are analyzed retrospectively to calculate three different estimates-pre-work, post-work, and actual work. Three traditional methods of estimating the cost of computer programs (the lines-of-code, function point, and task ratio analyses) underestimate [...]

To explore the use of an observational, cognitive-based approach for differentiating between successful, suboptimal, and failed entry of coded data by clinicians in actual practice, and to detect whether causes for unsuccessful attempts to capture true intended meaning were due to terminology content, terminology representation, or user interface problems.

The paper describes T/Gen, a prototype computer-based tool designed to help maintain the knowledge in a computer-based clinical practice guideline that provides patient-specific recommendations. T/Gen takes as input a set of clinical conditions to which a guideline must react, and allows the user to specify domain-specific constraints as to which combinations of conditions do not make sense or do not need to be exhaustively tested against one another. T/Gen automatically [...]

To analyze whether computer-generated reminders about infections could influence clinicians' practice patterns and consequently improve the detection and management of nosocomial infections.

The purpose of this report is to describe the author's experience using computerized dictation during routine outpatient medical practice. During a six-month period, patients seen by the author in the Pediatric Gastroenterology Clinic at the University of Virginia were assigned to human or computer-based transcription. Of 1,129 notes, 580 were completed by a transcriptionist and 549 by computer. The total time spent dictating and editing notes was approximately one minute [...]