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Medical Informatics Europe 78
First Congress of the European Federation for Medical Informatics Proceedings, Cambridge, England September 4 – 8, 1978
Häftad, Engelska, 1978
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These proceedings reflect the major scientific contribution by the First International Congress of the European Federation for Medical Informatics. The European Federation for Medical Informatics is a co-operative venture between the National Informatics Societies of Europe. It is sponsoring this first inter national meeting organised by the Medical Specialist Groups of the British Society under the guidance of a European Scientific Programme Committee. The challenge of medical informatics has been well taken and the scientific papers by its members cover a wide range of topics dealing with medical records, laboratory investigation, indexing and administrative systems, nursing records, planning and administration modelling, data bases, text processing, transferability, user education, privacy, etc. Not published in this volume are presentations by industry about hardware and software. Also at the meeting there will-be teaching sessions for doctors, nurses, scientists and administrators who are just entering this field which are also not published. Medical informatics has established itself as an important area of medical activity and its growing application, as this conference illustrates, suggests a very rich potential for the future. Aids to medical decision making and modelling are newer areas of activity, where significant progress has been made. Sociological changes have taken place to meet this challenge and developments in the issues of privacy and confidentiality are important, as also are user education, and the teaching of medical informatics to medical students and to doctors.
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The writing of this text arose through the opportunity of one author (D.F.) to spend a sabbatical leave studying the developments within the Stockholm County health operations. The computerization project that had started virtually 10 years previously. focussed on the Danderyd hospital. had received continuing attention in the world scene. It therefore seemed an appropriate site for study for one charged with responsibility for developing computerized hospital information systems. An intent to assemble a private report became an attempt to write a public monograph when it was discovered that the leaders of the Stockholm project had aspired for some time to put their work more cohesively in the public domain. Since any such publication would be in English and oriented to an international market. the involvement of one extraneous author representative of that market obviously had its appropriateness - in language. interest and detachment. The resulting book is unusual. if not unique. because of its lengthy and detailed description of one system • Starting from an introduction to Sweden and the local health care system. it proceeds through to detailed descriptions of user procedures. terminal displays. and computer files. Undoubtedly some readers will question the merit in having such detail. particularly as it relates to outmoded equipment and a locally developed programming language. Yet some of those same readers might well be among those many people who ask elsewhere why we should repeatedly "re-invent the wheel" in the computer industry.
Long-Term Studies on Side-Effects of Contraception — State and Planning
Symposium of the Study Group ‘Side-Effects of Oral Contraceptives — Pilot Phase’ Munich, September 27–29, 1977
Häftad, Engelska, 1978
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Conference reports of scientific meetings do not automatically justi fy publication. Our decision to publish the Proceedings of this Sym posium was based on a number of reasons. The subject of more or less grave adverse side-effects of oral contra ception is of major importance for all women. If the research insti tutions of Gynecology make fundamental mistakes in this subject, then the trust in them will diminish substantially. National institutions will have to shoulder a part of that burden, too, if they do not suc ceed in timely prevention of grave and widespread health risks and damages. Adverse side-effects of oral contraception become only apparent in later life and probably only after a latent interval of at least 10 years. The German female population will be fully exposed to that situation during the next decade. Up to now about 40 % of the women aged 35 years or older have no experience with the pill. Ten years later nearly all of them shall have used the pill for a short period at least. If serious long-term side-effects exist, we have to build up our research strategy now to detect these health hazards in time. Large-scale studies cannot be generated just out of nothing, the development and review of ideas in a pilot phase is necessary. The pilot phase of a German long-term study began three years ago. We shall report our experiences of that pilot phase, because this might be of value for other projects of this kind.
Clinical Trials in ‘Early’ Breast Cancer
Methodological and Clinical Aspects of Treatment Comparisons Proceedings of a Symposium, Heidelberg, Germany, 4th to 8th December, 1978
Häftad, Engelska, 1979
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Medical Informatics Berlin 1979
International Conference on Medical Computing Berlin, September 17–20, 1979 Proceedings
Häftad, Engelska, 1979
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The HIB 79 Congress is the second one organized by the European Federation for l-iedical Informatics (EFMI). The host society is the "Deutsche Gesellschaft fur l-ledizinische Dokurnentation, Informatik und Statistik (GMDS) who are holding their 24th annual meeting at this time. The program of MIB 79 covers every aspect of the application of information science to medicine and public health, and as such respresents the state of the art. Medical Informatics (M. I. ) is now at a turning pOint. To date, despite the efforts made by specialists in many countries, the balance sheet of M. I. remains rather poor. One of the reasons for this situation is the fact that the computers of yesterday were the prerogative of an elite of users. They were expensive, difficult to use, remot. e from the users, and mainly in the hands of a sacerdotal caste of data processing speciali sts • In the future, data processing facilities will be cheap, easy to handle, and immediately accessible. Data processing will have a chance of becoming truly democratic thanks to two important and complementary trends in computer technology: 1. a network due to computer communication partnership; 2. miniaturization due to the dramatic expansion of micro-processor and computer technology. IV The combination of these two main hardware achievements for which some neologisms have been invented - "compunication" \ in the USA and "telEnnatique" in France - will lead to a completely new way of processing data which may be called "distributed informatics.
Technology and Health: Man and His World
A SALUTIS UNITAS Contribution to an International Conference on Medical Informatics, Riva del Garda, Italy, April 21–25, 1978
Häftad, Engelska, 1980
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SALUTIS UNITAS, Unity for Health, an organization 'Uniting physicians of the world to foster better health for all people through international exchange of technological information', was officially founded in 1972 after preceding years of preparation. One of its main objectives is the scientific communication, be it by meeting or by publications. So several scientific meetings could be held, mostly together with other scientific organizations, and resulted in the publication of the respective proceedinqs 1. Studies were commissioned 2 to investigate trends in health care delivery and their socio-economic consequences, which also provided the basis for further investigations 3. So also in 1978 an international congress was organized by SALUTIS UNITAS and sponsored by the international Menarini Foundation under its directorship of Dr. Gorini. This volume is based on the contributions of SALUTIS UNITAS mewbers of this meeting 'Man and his World, Technology and Health', supplemented by further studies and materials. The main objective was to look at various recipients of health care delivery: the individual, the community, the region and the nation. Emphasis was placed on systems analysis, simulation techniques and evaluation. According to the composition of the SALUTIS UNITAS membership, conceptual and interdisciplinary aspects prevail over descriptions of in-depth methodology,thus providing a broad access to the problems investigated. For the Editors Amonqst others see: Mas~, E., Collen, ~.F., Gorini, S. (Eds): The Computer in Health Care Systems in Some European Countries and in the United States (Piccin, Padua 1976).
Mathematical Aspects of Computerized Tomography
Proceedings, Oberwolfach, February 10–16, 1980
Häftad, Engelska, 1981
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G. T. Herman F. Natterer Universitat des Saarlandes Medical Image Processing Group Department of Computer Science Angewandte Mathematik und State University of New York at Informatik 66 Saarbrucken Buffalo Germany 4226 Ridge Lea Road Amherst, N. Y. 14226 USA In August 1978 we have attended a working conference on Computer Aided Tomography and Ultrasonics in Medicine which was held in Haifa, Israel under the auspices of the International Federation for Information Pro- cessing [1]. That meeting, in common with other meetings relating to computerized tomography, concentrated on the physical, engineering and clinical aspects of the topic, with little attention paid to the under- lying mathematics, and no attention paid to recent developments in ma- thematics inspired by computerized tomography (although not necessarily) useful for computerized tomography). We both felt that it would be worthwhile to organize a meeting of mathematicians which would concen- trate on the mathematical aspects of computerized tomography. This vol- ume (and the meeting on which it is based) is the outcome of our decision in August 1978 to attempt to bring together such a meeting.In the meantime much has been published on the topic of computerized to- mography.
Computers and Mathematical Models in Medicine
Medical Sessions of the First Conference on Mathematics at the Service of Man Barcelona, July 11–16, 1977
Häftad, Engelska, 1981
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The papers gathered in this volume were presented at the medical sessions of the First Conference on Mathematics at the Service of Man held in Barcelona, Spain, July 11-16, 1977. Papers presented at the medical sessions were more numerous than those pre sented in any other single area of specialization covered in the conference. Because pf this, the Publications Committee resolved that papers presented at medical sessions be published separately from the proceedings of the conference. The proceedings of the conference have been published by the Esco1a Tecnica Superior d'Arquitectura de 1a Universitat Po1itecnica of Barcelona. The papers contained in this volume were selected on the basis of current interest and willingness of the authors to publish. They are organized not accord ing to the sequence in which they were presented at the conference, but, to the extent that this was possible, in topic areas. As its name indicates, the principal purpose of the conference was to under score the fact that mathematics is a science whose applications are relevant to many aspects of human activity. In the opinion of the editors of this volume, the conference met its objective with success, both in terms of the broad variety of topics covered as well as by the number of nations that were represented at the conference in spite of the special circumstances prevailing in Spain at that time.
Applications of Operations Research to Health Care Delivery Systems
A Complete Review of Periodical Literature
Häftad, Engelska, 1981
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Medical Informatics Europe 81
Third Congress of the European Federation of Medical Informatics Proceedings, Toulouse, France March 9–13, 1981
Häftad, Engelska, 1981
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The European Federation for Medical Informatics has established itself as a regional body coordinating activity in medical informatics. The Congress in Toulouse, MIE-81, from 9 - 13 March 1981, is the third congress in the ser ies following MIE-78 in Cambr idge, and MIB-79 in Berlin with a gap during 1980 for the world congress MEDINFO-80 in Tokyo. The rationale behind all these congresses is the scientific need to share results and ideas and the educational need to train a wide variety of professional staff in the potential of health care and medical informatics. All the caring professions are involved, doctors, scientists, nurses, para-medical staff, administrators, health care planners, community physicians, epidemiologists, statisticians, operations analysts together with specialists from the computing profession dealing with system analysis, hardware, software, languages, data-bases and the marketing of systems. Medical Informatics is a very wide subject with ramifications throughout the health care and preventive services; it offers a key to the monitoring and improvement of patient care and to the provision of a healthier environment. The collection and evaluation of relevant data improves our understanding of the ways in which health care is provided while the availability of cheaper computer hardware and more versatile software enables us to design and implement more revealing and intelligent medical systems. Even though typical systems take a substantial amount of time to design, implement and evaluate, there is the continuing need for informaticians to assess the current state of developmen.
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Computer and Blood Banking
(EDP Applications in Transfusion Medicine) GMDS Spring Conference Tübingen, April 9–11, 1981 Proceedings
Häftad, Engelska, 1981
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In the autumn of 1980, the decision was made by the responsible bodies of the German Society for Medical Documentation, Informatics and Statistics (Deutsche Gesellschaft fUr Medlzinische Dokumentation, Informatik und Statistik e.V.) to make the application of computers in blood banking and blood transfusion one of the topics to be treated at the 8th spring conference of this Society, which was then arranged to take place in TUbingen from April 9-11, 1981. The goal of the con- ference was to unite application specialists and methodologists in order to assess current achievements and identify fields needing further improvement. We were fortunate to obtain the interest of the German Society for Blood Transfusion and Immunohaemat6logy D~. Roos, the head of the EDP Work study group of the Section 1 of this. Society did substantially influence the programme. Many of the papers actually reflect accomplish- ments of his research and of the work study group. We also consider ourselves fortunate to win Prof. C. Mueller-Eckhardt, current president of this Society, to give an introductory address.
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In diagnostic medicine a large part of information about the patient is drawn from data, which, more or less, are represented in an opti calor pictorial form. There is a very wide range of such data as e.g. the patients appearance, the various kinds of radiological images, or cytological imagery. In conventional diagnostics the data, as it comes from the acquisition device, is perceived by the physician and is interpreted with the help of a large amount of "a priori" knowledge to give a diagnostic finding. During the last 15 years a steadily rising number of attempts have been made to support these processes by the application of com puters. The attempts mainly concentrate on three objectives: 1. Support of the perception process by the production of better or new types of images, e.g. by Computer tomography or Computer angio graphy (image processing) . 2. Automation of the interpretation process, e.g. for bloodcell dif ferentiation (pattern recognition) . 3. Management of the steeply rising amount of medical image data in the hospital (image data bases) . Although the early applications of digital methods aimed at the second . . objective, in the last years much more success has been a achieved in the support of the perception process by methods of image process ing. The reason for this is obvious - in the case of automatic interpre tation the a priori knowledge of the physician has to be formalized.
Medical Informatics Europe 82
Fourth Congress of the European Federation of Medical Informatics Proceedings, Dublin, Ireland, March 21–25, 1982
Häftad, Engelska, 1982
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The European Federation for Medical Informatics is a regional coordinat- ing body. The Congress in Dublin. MIE 82. from 21st to 25th March 1982. is the fourth in the series following MIE 78 in Cambridge. MIE 79 in Berlin. There was a break in 1980 for the World Congress - MEDINFO 8- in Tokyo. This was followed by MIE 81 in Toulouse. The rationale behind these congresses is the scientific need to share results and ideas. and the educational need to train a wide variety of professional staff in the potential of Medical Informatics in health care delivery. All the caring professions are involved. doctors. scientists. nurses. pharma- cists. paramedical staff. administrators. health care planners. commu- nity physicj-US'I,!Dedical educationalists. epidemiologists. statisti- cians. o. pe-~atio'ns 'analysts. together with specialists from the comput- ing profession dealin~ with systems analysis. hardware. software. lan- guages. data ba,s~s and marketing of systems. The pre-publi~~tion of'conference proceedings from a multi-stream con- ference is partic~l~t~y valuable in a rapidly expanding multidisciplin- ary field su~h as'M~dical Informatics.It enables participants to fol- low work presented at sessions that they are unable to attend. More im- portantly. is also provides a permanent record with relevant bibliogra- phy for other workers to assess which groups are active and in which areas. All the papers have been refereed and the referees' suggestions incorporated in the final texts. Rapid publication. using camera-ready copy. reduces the time available for editing and indexing.
Biomedical Images and Computers
Selected Papers Presented at the United States-France Seminar on Biomedical Image Processing, St. Pierre de Chartreuse, France, May 27–31, 1980
Häftad, Engelska, 1982
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The technology of automatic pattern recognition and digital image processing, after over two decades of basic research, is now appearing in important applications in biology and medicine as weIl as industrial, military and aerospace systems. In response to a suggestion from Mr. Norman Caplan, ·the Program Director for Automation, Bioengineering and Sensing at the United States National Science Foundation, the authors of this book organized the first Uni ted States-France Seminar on Biomedical Image Processing. The seminar met at the Hotel Beau Site, St. Pierre de Chartreuse, France on May 27-31, 1980. This book contains most of the papers presented at this seminar, as weIl as two papers (by Bisconte et al. and by Ploem ~ al.) discussed at the seminar but not appearing on the program. We view the subject matter of this seminar as a confluence amon~ three broad scientific and engineering disciplines: 1) biology and medicine, 2) imaging and optics, and 3) computer science and computer engineering. The seminar had three objectives: 1) to discuss the state of the art of biomedical image processing with emphasis on four themes: microscopic image analysis, radiological image analysis, tomography, and image processing technology; 2) to place values on directions for future research so as to give guidance to agencies supporting such research; and 3) to explore and encourage various areas of cooperative research between French and Uni ted States scientists within the field of Biomedical Image Processing.
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Nuclear ftedicine is not and has not been a purely imaging discipline. It is function analysis that has always been the focal pOint. This fact has become particularly obvious in the last few years through the employment of nev short-lived radionuclides, new technical procedures and data processing. The disadvantage of function analysis in Inclear ftedicine through the use of radioactively labeled compounds is that more and more complicated and expensive equipment his to be used. A further characteristic is that these machines are stationary, and that the patients cannot be examined under physiological conditions. For technical reasons the x-camera is developing in the direction of mea suring mainly the so-ca~led 'soft' I-emitters at the present time. On the other hand, positron emitters are the radionuclides which are of interest for metabolic functions. At present, positron cameras are even more e~pensive and complicated machines, the use of which is very demanding. In this book Priv. -Doz. Dr. med. Dipl. -Ing. D. Peter pretschner has described a new system which contains his ideas and his technical developments. He describes a solution to the urgent questions and dif ficulties in the employment of radioactive substances for diagnosis. It does not demand large resources and can be used under the appropri ate individual physiological conditions. Here he was helped by his training as a natural scientist and engineer, as well as by his being an experienced clinician.
Discovery and Representation of Causal Relationships from a Large Time-Oriented Clinical Database: The RX Project
The RX Project
Häftad, Engelska, 1982
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As a hospital physician it is impossible to escape the notion that the difficult medical problems one encounters are also being confronted by other' physicians throughout the world. It is equally apparent that without special effort one's own patient observations will not be shared with others. Without the medical literature there would be almost no meaningful shadng of experience. Medical textbooks and journals contain reports of the latest tests and treatments. from university hospitals and research centers. There are, however, definite limitations to the medical literature. First. the literature records only a miniscule and highly select portion of medical experience. Second, because of this selectivity, it may be difficult to apply the findings and recommendations in the literature to one's own patients. One serious consequence of these characteristics of the medical literature is that patients are largely overtreated. Tests and treatments are over-prescribed, and adverse effe
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The German edition of this manual appeared in 1979. Its main objective then was to extend help to those engaged in multiaentric therapeutic studies, especially with respect to the "Federal Government's Program on Promoting Research and Development in the Service of Health". Experience with therapeutic studies in the Federal Republic of Germany showed that considerable problems as to methods and implementation of such studies exist. The manual was an attempt to present current metho dological knowledge and the experience obtained from completed studies in the light of the international literature. No radically new methodo logy was produced; however, the information representing the state-of the art, which is widely scattered up to now, has been compiled. For the American edition of this manual a few changes have been made. These concern especially the literature where references to German un published manuscripts were omitted. The authors wish to thank Dr. Andreas Jaffe for the translation, and Evelyn Birke who typewrited the lecture-notes manuscrip~ • . GUnzburg and Munich Sibylle Biefang November 1981 Wolfgang Kopcke Martin A. Schreiber Contents Page Foreword 1. Methods of Therapeutic Studies 2 1. 1. Terminology 4 1. 2. Experimental Design 11 1. 3. Types of Studies 20 1. 4. Steps in Drug Testing 2. Checklist for the Planning, Implementation and Evaluation 22 of Therapeutic Studies 22 2. 1. Planning of Experiments 29 2. 2. Documentation 36 2. 3. Organization 41 2. 4. Statistical Analysis 44 2. 5.
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The worldwide economic recession of the last years - sometimes described as an outright depression similar to the one of the early thirties - has led many health policy analysts and even policy makers to revive the old question of whether, and in what respect, there is a close relationship between economic development and health. In tackling this question, to day's health services research looks rather helpless: even if a truth has the appearance of a truism, it will not necessarily be aCknowledged in practice. While it is an established fact that social as well as (macro)economic conditions or events have an important influence on the health of people, this subject has been rarely pursued by medical or epidemiological research and rather has been treated - in industrial countries at least - as a quantit~ n~gligeable. Yet, this ahistoric and even parochial attitude must be questioned on methodological as well as political grounds. - As to methodological aspects, further investigation into the relation ship between health and the economy is essential in order to identify the real relevance, i. e. opportunity costs, of medical care; even more important, it might also direct attention to the interfaces - fairly neglected by our over-specialized system of sciences - between biome tries and econometrics, medicine and epidemiology, epidemiology and socio-economics. It is, hence,an area of research from which methodo l09iCa-l development can receive' major stimuli.
Objective Medical Decision-making; Systems Approach in Acute Disease
Eindhoven, The Netherlands, 19–22 April 1983 Proceedings
Häftad, Engelska, 1983
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Objective medical decision~making has shown itself to be an emerging discipline which is sufficiently robust to promote its further development. This book identifies many important areas for applications in the field of acute patient care. The different approaches require testing, evaluation and mutual co~parisons to ensure that the right method is used to solve the existing problem. Medical sciences and patient care are increasingly supported by system sciences, resulting in growing multi- and interdisciplinary research and development areas. In this context, system sciences involve the methods, techniques, concepts and approaches obtained f~om disciplines such as mathematics, statistics, stochastic signal theory, fuzzy set theory, systems and control theory, signal analysis, pattern recogni tion, simulation, computer languages, structured programming, data base management and computer sciences. This book contains the papers of a workshop "Objective Medical Decision making f Systems approach in acute disease" which was initia ted and supported by the SWG/COMAC on Biomedical Engineering, Evaluation of Technology, Transfer and Standardization of CRM/CREST of the European Community. In setting up the original programme we have been assisted by a group of experts and for their cooperation we are very gratef.ul to S. Dawids, Copenhagen E. Epple, Tlibingen ; J. Jones, Harrow; L. Lambotte, Brussels C. Marchesi, Pisa and D. Robert, Lyon. The papers have been arranged in four groups, each followed by a brief synopsis. The four groups are : diagnosis, monitoring, therapy and control, and evaluation of criteria and procedures.
Medical Informatics Europe 84
Proceedings, Brussels, Belgium, September 10–13, 1984
Häftad, Engelska, 1984
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Medical Informatics Europe 85
Proceedings, Helsinki, Finland August 25–29, 1985
Häftad, Engelska, 1985
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The European Federation for Medical Informatics (EFMI) is a regional coordinating body for the National Informatics Societies of Europe. EFMI has organized a number of congresses. The Congresses in Cambridge 1978, Berlin 1979, Toulouse 1981, Dublin 1982 and Brussels 1984 were all successful in providing the wide variety of people in the caring and specialists in the computing profession with up-to-date inform ation from the expanding multidisciplinary field of medical inform atics. We hope that the sixth European Congress on Medical Informatics, MIE-85 in Helsinki will be equally successful. You have in your hand the pre-publication of papers to be presented at MIE-85 as well as the short abstracts of the posters. The proceed ings enable the participants to follow work presented at sessions that they are unable to attend. It also provides a permanent record with relevant bibliography for workers in the field of medical com puting. All the papers have been refereed and the referees' suggest ions incorporated in the final text. Rapid publication, using camera ready paper, reduces the time required for editing and indexing. The editorial board has worked hard to improve the standard of the communications and to reduce the number of errors. Very few papers did not arrive in time to be included in the proceedings: these are marked with * in the table of contents.
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The symposium held at Freiburg on September 10th, 1983 had been con- cerned with methodical problems in early detection. chiefly of can- cer. The first lectures dealt with mathematical models. They were followed by contributions to the possibilities of obtaining the pa- rameters required by the models and for the assessment of the me- thods. The two final lectures outlined a monitoring system for rare diseases and some problems in early detecting heart and circulation diseases. The meeting had been organized by the Deutsche Gesellschaft fUr Me- dizinische Dokumentation. Informatik und Statistik (GMDS). Thus the programme committee was set up by the heads of the GMDS Arbeitsgrup- pen affected by the respective topics. namely Dr. Keil (epidemiology}. Prof *. Dr. NeiS (statistical methods). PD Dr. Schwartz (systematic preventive checkup and early detection). PD Dr. Trampisch (methods of prognosis and decision making) and the signer. This is a welcome opportunity to put on record my thanks to various people and organizations. The lecturers had elaborated their manus- cripts and some have revised them. The individual discussions had been conducted by Prof. Dr. Dietz. Prof. Dr.Michaelis. Prof. Dr.
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Psychoanalysis and information science are two disciplines that twenty years ago hardly anyone would have considered closely related with re gard either to persons or subject matter. The cooperation between the two fields was made possible, on the one hand, by the development of information science from a technological discipline to a theoretically founded scientific discipline, and on the other, by the development of psychoanalysis from a hermetically closed special discipline to an open and empirical science. This study reports the successful inclusion of information science as an instrument of research on the psychoanalytic process. This direction of work was initiated by Donald Spence and Hartvig Dahl from the Re search Institute of Mental Health, New York, at the end of the 1960s. H. Thom~, H. K~che1e, and their research group in Ulm must be credited with having adopted Spence's programs as early as 1974; at that time the programs even had to be implemented far away on the IBM computer at the University of Heidelberg. The efforts to expand computer-aided con tent analysis to a method for process research led in 1975 to the ac quisition of the Hamburg program for Electronic Verbal Analysis (EVA). In the following years the author of this study revised, extended, and supplemented the EVA to create the U1m version. This book now describes another step in the integration of information technology in fundamen tal research in psychoanalysis.
Objective Medical Decision-Making Systems Approach in Disease
Workshop, Crete, Greece, April 30–May 5, 1985 Proceedings
Häftad, Engelska, 1986
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System Analysis of Ambulatory Care in Selected Countries
With Special Concern for Computer Support
Häftad, Engelska, 1986
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The Working Group 5 of the International Medical Informatics Associa tion (IMIA) is dedicated to information systems in primary care with special emphasis on computer systems in the doctor's office. Accord ingly, a conference was held in Hannover in 1980 where the first ap proaches were described and experiences in system analysis, system construction and evaluation were discussed (Rienhoff, O. and Abrams, M.E. (eds.): The Computer in the Doctor's Office, North-Holland, Amsterdam: 1980). Computer hardware and software development has been rapid over the last years. Thus the prerequisites for a successful support of the work of the physician in his office have improved. But system con struction still lags behind and the actual penetration of systems is lower than 2 % of the doctors' offices in most countries. This applies to industrialized countries. However, attempts are made everywhere to improve primary care by means of modern information technology. Information systems depend upon the real environment into which they are placed: administrative procedures govern priorities and procedures in doctor's office computers, possibilities to defray cost upon the various carriers or the patients have a great influence on the propagation of systems. Furthermore, various procedures of accounting or re-imbursement may lead to a facilitation or to a delay of the in troduction of systems. The 'art of medical practice' has reached a comparable standard within at least the industrialized countries.
Del 31 - Lecture Notes in Medical Informatics
Operations Research for Health Planning and Administration
Häftad, Engelska, 1987
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Operations research aims to assist managers faced with problems of coordinating activities; improving the quality of care of services delivered; making optimal resource allocation decisions and generally, managing services and institutions. Operations research (or O.R.) was originally developed in response to the problems of the second World War. It was characterised then by a unifying and clear objective; clear problems that had to be solved and the use of inter-disciplinary teams to analyse and solve identified problems. This analysis often drew on mathematical techniques. After the war, operations research moved in two separate but related directions. In England, the emphasis on inter-disciplinary approaches and problem solving teams remained. The operations researcher still used mathematical techniques but these were not systematised into a volume of standard formulae. The emphasis of operations research was on the approach not the tools used (see, for example, Luckman & Stringer, 1974; also Luck, Luckman, Smith & Stringer 1971; and McLachlan, 1975). In the United States, the emphasis was placed on the use of mathematical techniques. Operations research became a mathematically based science relying on standardised models (e. g. queuing, allocation) and formulae. This approach was facilitated by the availability of computers.
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The Working Group 5 of the International Medical Informatics Associ ation (IMIA) dedicates its work to information systems in primary and ambulatory care. The first conference of this Working Group in Hanno ver in 1980 produced a review of the state of the art of that time and gave perspectives for future development (Rienhoff, O. and Abrams, M.E. (eds.): The Computer in the Doctor's Office, Horth Holland, Amsterdam: 1980). In the meantime, a rapid development has taken place. Therefore it seemed appropriate to hold another working conference which was con ducted in Munich, December 2-6, 1985. The goal of this working conference was to review the developments in this field and to critically evaluate the progress achieved so far. The conference addressed general principles in system development and prerequisists for their successful introduction into routine use. Furthermore, the topics of expert systems and new technologies were discussed in the context of their usefulness and usability in ambula tory care systems. As before, it became very clear that actual computer systems to sup port ambulatory and/or primary care have to meet the conditions of the health care delivery systems, into which they are to be placed.
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As research on expert systems has moved well into its second decade, it has become popular to cite the limitations of the phenomenologic or associational approach to knowledge representation that was typical of first generation systems. For example, the Internist-1 knowledge base represents explicitly over 600 diseases, encoding associated disease manifestations (signs, symptoms, physical findings, and lab abnormalities) but failing to deal with the reasons that those findings may be present in the disease [Miller, R. A. 82]. In recent years Pople has sought to add detailed causal models to the knowledge base in a revised version of the program known as CADUCEUS [Pople 82]. Similarly, a typical production rule in the MYCIN system states inferences that may be drawn when specific conditions are found to be true [Buchanan 84], but the underlying explanations for such relationships are not encoded. Clancey has argued that MYCIN needs such "supporting knowledge" represented, especially if its knowledge base is to be used for teaching purposes [Clancey 83]. By the late 1970s, artificial intelligence researchers were beginning to experiment with reasoning systems that used detailed mechanistic or causal niodels of the object being analyzed. Among the best early examples were a program to teach students how to analyze electronic circuits [Brown 82] and a system for diagnosing problems with mechanical devices [Rieger 76].
AIME 87
European Conference on Artificial Intelligence in Medicine Marseilles, August 31st – September 3rd 1987 Proceedings
Häftad, Engelska, 1987
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The current scarcity of expert systems where the reasoning is based on Bayesian probability theory may be due to misconceptions about probabilities found in the literature.