International journal of medical informatics
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Comparative Study
Diagnostic accuracy of chest X-rays acquired using a digital camera for low-cost teleradiology.
Store-and-forward telemedicine, using e-mail to send clinical data and digital images, offers a low-cost alternative for physicians in developing countries to obtain second opinions from specialists. To explore the potential usefulness of this technique, 91 chest X-ray images were photographed using a digital camera and a view box. Four independent readers (three radiologists and one pulmonologist) read two types of digital (JPEG and JPEG2000) and original film images and indicated their confidence in the presence of eight features known to be radiological indicators of tuberculosis (TB). ⋯ There was no statistical difference in the overall performance between the readings from the original films and both types of digital images. The size of JPEG2000 images was approximately 120KB, making this technique feasible for slow internet connections. Our preliminary results show the potential usefulness of this technique particularly for tuberculosis and lung disease, but further studies are required to refine its potential.
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Health care professionals need information delivery tools for accessing information at the point of patient care. Personal digital assistants (PDAs), or hand-held devices demonstrate great promise as point of care information devices. An earlier study [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678] on the use of PDAs at the point of care found that hardware constraints, such as memory capability limited their usefulness, however, they were used frequently for accessing medical references and drug information [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, 1995, 678]. ⋯ Concerns and drawbacks mentioned by these residents included physical size of the PDA and the potential for catastrophic data loss. Another issue raised by our results suggests that security and Health Information Portability and Accountability Act (HIPAA) compliance need to be addressed, in part by resident education about securing patient data on PDAs. Overall, PDAs may become even more widely used if two issues can be addressed: (a) providing secure clinical data for the current patients of a given resident, and (b) allaying concerns of catastrophic data loss from their PDAs (e.g. by educating residents about procedures to recover information from PDA backup files).
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In the emergency medical services (EMS) system, appropriate prehospital care can substantially decrease casualty mortality and morbidity. This study designed a simulation model, evaluated the existing EMS system, and suggested improvements. ⋯ The following alternatives provided the greatest combination of effectiveness, quality patient care, and cost-efficiency: (1) because of its unique location, increase Hospital 22's staffing level to two ALS teams. (2) Establish a specific rescue protocol for the two-tier system that preassigns two network hospitals to each of the 36 EMS subgroups along with a prearranged calling sequence. If implemented, this will improve EMS performance, streamline the system, reduce randomness, and enhance efficiency.
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The medical procedures at the patient bedside are out of the scope of current HIS/RIS systems, which means that patient record and image data access during the medical visit or the execution, recording and confirmation of the medicine prescriptions, still do not enjoy computerized support. As a consequence, the necessary inclusion of new data to the patient record, still needs to be carried out through notations on paper and later typed, causes delays on the availability of this information (Mobile computing in a hospital: the Ward-In-Hand project. ⋯ The server acts as a database for multimodal electronic patient record information, storing patient data from computerized tomography (CT), ultrasonography (US), magnetic resonance (MRI) images and also medical findings, observations and prescriptions coded as DICOM Structured Reports (Digital Image and Communications in Medicine). The prototype described in this article implements a medical images and structured reports server that makes the search and recovery of data stored in the DICOM standard possible.
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'Open Source' is a 20-40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market--probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. ⋯ In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model.