Medical Informatic

Resumo -Este artigo descreve a importância da prescrição de terapia nutricional em um serviço hospitalar e relata sobre a padronização ocorrida em um sistema de prescrição eletrônica de um hospital universitário terciário. Através desta padronização a Divisão de Nutrição e Dietética obtêm diversos benefícios.

Information systems Medical informatics Collaborative work Genre theory Interpretive methods a b s t r a c t The effective use of information technology (IT) is a crucial component for the delivery of effective services in health care. Current approaches to medical informatics (MI) research

Objective: The International Medical Informatics Association (IMIA) agreed on revising the existing international recommendations in health informatics/medical informatics education. These should help to establish courses, course tracks or even complete programs in this field, to further develop existing educational activities in the various nations and to support international initiatives concerning education in biomedical and health informatics (BMHI), particularly international activities in educating BMHI specialists and the sharing of courseware. Method: An IMIA task force, nominated in 2006, worked on updating the recommendations' first version. These updates have been broadly discussed and refined by members of IMIA's National Member Societies, IMIA's Academic Institutional Members and by members of IMIA's Working Group on Health and Medical Informatics Education. Results and Conclusions: The IMIA recommendations center on educational needs for health care...

The Ministry of Health and Welfare of Japan announced 'Healthcare Information Strategy 21' in 1994. This report shows that the Healthcare Information System is the key to improving the quality and efficiency of healthcare. One of the elements for realizing the new Healthcare Information System is the Electronic Medical Record (EMR). Following the publication of this report, work began with the aim of discovering a way to recognize the EMR as formal documentation and four national projects of research and development have been started. The themes of these projects are: 'Interoperability of EMR', 'Standardization of EMR', 'Modeling of the Clinical Process' and 'Security for EMR'. The Japanese Association of the Healthcare Information Systems Industry (JAHIS) is in charge of 'Security for EMR'. There are many discussions in relation to the security for EMR. However, many of these discussions relate to information technology, while there are few discussions regarding definitions of security. Therefore, there are many different theories about security itself, which will be an obstacle to standardization. To design the security system for EMR, JAHIS has defined 'Security for EMR' as the first step. The present study was conducted with medical informatics and security specialists. It has designed 'Requirement Definitions', 'Goals of Security', 'Estimation of threats to security', 'Necessity conditions' and a 'Security Model'. This paper covers these definitions and our security design concept.

Interactive health communication using Internet technologies is expanding the range and flexibility of intervention and teaching options available in preventive medicine and the health sciences. Advantages of interactive health communication include the enhanced convenience, novelty, and appeal of computer-mediated communication; its flexibility and interactivity; and automated processing. We outline some of these fundamental aspects of computer-mediated communication as it applies to preventive medicine. Further, a number of key pathways of information technology evolution are creating new opportunities for the delivery of professional education in preventive medicine and other health domains, as well as for delivering automated, self-instructional health behavior-change programs through the Internet. We briefly describe several of these key evolutionary pathways. We describe some examples from work we have done in Australia. These demonstrate how we have creatively responded to the challenges of these new "information environments," and how they may be pursued in the education of preventive medicine and other health care practitioners and in the development and delivery of health behaviorchange programs through the Internet. Innovative and thoughtful applications of this new technology can increase the consistency, reliability, and quality of information delivered.

Although information technology (IT)-based applications in healthcare have existed for more than three decades, methods to evaluate outputs and outcomes of the use of IT-based systems in medical informatics is still a challenge for decision makers, as well as to those who want to measure the effects of ICT in healthcare settings. The aim of this paper is to review published articles in the area evaluations of IT-based systems in order to gain knowledge about methodologies used and findings obtained from the evaluation of IT-based systems applied in healthcare settings. The literature review includes studies of IT-based systems between 2003 and 2005. The findings show that economic and organizational aspects dominate evaluation studies in this area. However, the results focus mostly on positive outputs such as user satisfaction, financial benefits and improved organizational work. This review shows that there is no standard framework for evaluation effects and outputs of implementation and use of IT in the healthcare setting and that until today no studies explore the impact of IT on the healthcare system' productivity and effectiveness.

The International Classification of Primary Care (ICPC) has become a standard all over the world. It became a standard tool to classify the important elements in the Electronic Patient Record (EPR) of the GP: reasons for encounter (RFE) reflecting the patient's view, process of care (decision, action, intervention or plans) reflecting the care process, and the assessment (diagnosis or health issue) reflecting the doctor's view. ICPC-2 is fully compatible with structuring data in the episode of care model and it's reflecting the essential elements of each patient/provider encounter. To implement ICPC-2 in the EPR a Thesaurus has been developed in Belgium with double encoded clinical labels. The implementation is now mandatory for labeled EPR systems in Belgium. The use of ICPC 2 may improve the accessibility and use of on-line Expert systems and Guidelines.

Summary Objective: The International Medical Informatics Association (IMIA) agreed on revising the existing international recommendations in health informatics / medical informatics education. These should help to establish courses, course tracks or even complete programs in this field, to further develop existing educational activities in the various nations and to support international initiatives concerning education in biomedical and health informatics (BMHI),

The development of Information and Communication Technologies (ICT) shall have a high impact on health care and patient management. Some of the factors underlying this development as well as the recommendations made for optimum use of those technologies are discussed in this article. #

Background: Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable.

The model selection strategy is an important determinant of the performance and acceptance of a medical diagnostic decision support system based on supervised learning algorithms. This research investigates the potential of various selection strategies from a population of 24 classification models to form ensembles in order to increase the accuracy of decision support systems for the early detection and diagnosis of breast cancer. Our results suggest that ensembles formed from a diverse collection of models are generally more accurate than either pure-bagging ensembles (formed from a single model) or the selection of a ''single best model.'' We find that effective ensembles are formed from a small and selective subset of the population of available models with potential candidates identified by a multicriteria process that considers the properties of model generalization error, model instability, and the independence of model decisions relative to other ensemble members.

Objectives: We present KNAVE-II, an intelligent interface to a distributed architecture specific to the tasks of query, knowledge-based interpretation, summarization, visualization, interactive exploration of large numbers of distributed time-oriented clinical data, and dynamic sensitivity analysis of these data. KNAVE-II main contributions to the fields of temporal reasoning and intelligent user interfaces are: (1) the capability for interactive computation and visualization of domain specific temporal abstractions, supported by ALMA -a computational engine that applies the domain knowledge base to the clinical time-oriented database. (2) Semantic (ontology-based) navigation and exploration of the data, knowledge, and temporal abstractions, supported by the IDAN mediator, a distributed architecture that enables runtime access to domain-specific knowledge bases that are maintained by expert physicians. Methods and materials: KNAVE-II was designed according to 12 requirements that were defined through iterative cycles of design and user-centered evaluation. The complete architecture has been implemented and evaluated in a cross-over study design that compared the KNAVE-II module versus two existing methods: paper charts and an Excel electronic spreadsheet. A small group of clinicians answered the same queries, using the domain of oncology and a set of 1000 patients followed after bonemarrow transplantation. Results: The results show that users are able to perform medium to hard difficulty level queries faster and more accurately by using KNAVE-II than paper charts and Excel. Moreover, KNAVE-II was ranked first in preference by all users, along all usability dimensions.

i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 8 ( 2 0 0 9 ) 711-720 Africa for the past three years and is attracting successively larger numbers of participants with almost 200 implementers and developers attending the 2008 meeting in Durban, South Africa. Six African developers are presently registered on the first intake of the OpenMRS Internship program. Successful collaborations have been started with several African developer groups and projects initiated to develop interoperability between OpenMRS and various applications. The South African OpenMRS Implementer group successfully configured, installed and maintained an integrated HIV/TB OpenMRS application without significant programming support. Since then, this model has been replicated in several other African sites. The OpenMRS Implementers Network has contributed substantially to the growth and sustainability of OpenMRS in Africa and has become a useful way of including Africans in the development and implementation of OpenMRS in developing countries. The Network provides valuable support and enables a basic OpenMRS application to be implemented in the absence of onsite programmers.

Medical informatics Computer systems evaluation Questionnaires Task performance User-computer interface Electronic health record Patient care a b s t r a c t Objective: In the health informatics field, usability studies typically focus on evaluating a single information system and involve a rather small group of end-users. However, little is known about the usability of clinical information and communication technology (ICT) environment in which healthcare professionals work daily. This paper aims at contributing to usability research and user-oriented development of healthcare technologies with three objectives: inform researchers and practitioners about the current state of usability of clinical ICT systems, increase the understanding of usability aspects specific for clinical context, and encourage a more holistic approach on studying usability issues in health informatics field. Methods: A national web questionnaire study was conducted in Finland in spring 2010 with 3929 physicians actively working in patient care. For the purposes of the study, we described three dimensions of clinical ICT system usability that reflect the physicians' viewpoint on system usage: (1) compatibility between clinical ICT systems and physicians' tasks, (2) ICT support for information exchange, communication and collaboration in clinical work, and (3) interoperability and reliability. The dimensions derive from the definitions of usability and clinical context of use analysis, and reflect the ability of ICT systems to have a positive impact on patient care by supporting physicians in achieving their goals with a pleasant user experience. The research data incorporated 32 statements with a five-point Likert-scale on physicians' experiences on usability of their currently used ICT systems and a summative question about school grade given to electronic health record (EHR) systems.

In this chapter we provide a broad overview of selected knowledge management, data mining, and text mining techniques and their use in various emerging biomedical applications. It aims to set the context for subsequent chapters. We first introduce five major paradigms for machine learning and data analysis including: probabilistic and statistical models, symbolic learning and rule induction, neural networks, evolution-based algorithms, and analytic learning and fuzzy logic. We also discuss their relevance and potential for biomedical research. Example applications of relevant knowledge management, data mining, and text mining research are then reviewed in order including: ontologies; knowledge management for health care, biomedical literature, heterogeneous databases, information visualization, and multimedia databases; and data and text mining for health care, literature, and biological data. We conclude the paper with discussions of privacy and confidentiality issues of relevance to biomedical data mining.

The International Classification of Primary Care (ICPC) has become a standard all over the world. It became a standard tool to classify the important elements in the Electronic Patient Record (EPR) of the GP: reasons for encounter (RFE) reflecting the patient's view, process of care (decision, action, intervention or plans) reflecting the care process, and the assessment (diagnosis or health issue) reflecting the doctor's view. ICPC-2 is fully compatible with structuring data in the episode of care model and it's reflecting the essential elements of each patient/provider encounter. To implement ICPC-2 in the EPR a Thesaurus has been developed in Belgium with double encoded clinical labels. The implementation is now mandatory for labeled EPR systems in Belgium. The use of ICPC 2 ay improve the accessibility and use of on-line Expert systems and Guidelines.

The School of Medicine at the University of Rennes has moved to problem-based learning (PBL) in medical curriculum and has exploited a WWW based system for the development, delivery, and management of electronic resources for medical students . The electronic environment has provided new opportunities for educational staff to help prepare future physicians. Several services are used: virtual patient applications for training (Cardiolab is an example of such a computer system that associates basic science and clinical cases), information available on the Internet and knowledge bases for medical decision support. Emphasis is placed on acquiring life-long learning skills. A new course for undergraduate medical students has been based on those principles 2 Contexte La Faculté de Médecine de Rennes a mis en place depuis plusieurs années une démarche pédagogique du type approche par problèmes (APP)/apprentissage du raisonnement clinique (ARC).

We present BITOLA, an interactive literature-based biomedical discovery support system. The goal of this system is to discover new, potentially meaningful relations between a given starting concept of interest and other concepts, by mining the bibliographic database MEDLINE ® . To make the system more suitable for disease candidate gene discovery and to decrease the number of candidate relations, we integrate background knowledge about the chromosomal location of the starting disease as well as the chromosomal location of the candidate genes from resources such as LocusLink and Human Genome Organization (HUGO). BITOLA can also be used as an alternative way of searching the MEDLINE database. The system is available at

Resumo -Este artigo apresenta o estado atual do projeto de integração do sistema SIGA Saúde, em uso na Secretaria Municipal de Saúde de São Paulo, aos Laboratórios de Análises Clínicas que realizam os exames laboratoriais da rede. Apresenta-se a experiência inicial no uso do padrão LOINC (Logical Observations Identifiers, Names, Codes) para identificar os exames. A forma como foi implementado o padrão HL7 v3 para estabelecer a comunicação entre os sistemas é também apresentada. Finaliza-se com as lições aprendidas, e desafios.

In this chapter we provide a broad overview of selected knowledge management, data mining, and text mining techniques and their use in various emerging biomedical applications. It aims to set the context for subsequent chapters. We first introduce five major paradigms for machine learning and data analysis including: probabilistic and statistical models, symbolic learning and rule induction, neural networks, evolution-based algorithms, and analytic learning and fuzzy logic. We also discuss their relevance and potential for biomedical research. Example applications of relevant knowledge management, data mining, and text mining research are then reviewed in order including: ontologies; knowledge management for health care, biomedical literature, heterogeneous databases, information visualization, and multimedia databases; and data and text mining for health care, literature, and biological data. We conclude the paper with discussions of privacy and confidentiality issues of relevance to biomedical data mining.

General Ontological Language (GOL) is a formal framework for representing and building ontologies. The purpose of GOL is to provide a library of top-level ontologies which can be used as a framework for building more specific ontologies. This report is a living document of the GOL-project of the University of Leipzig. GOL is part of the work of the Research Group Ontologies in Medicine (Onto-Med) which is based on the collaborative work of the Institute of Medical Informatics, Statistics and Epidemiology (IMISE) and the Institute for Informatics (IfI). It represents work in progress toward a proposal for an integrated family of top-level ontologies and will be applied to several fields of medicine, in particular to the field of Clinical Trials.

Resumen -Con el creciente aumento de la aplicación de la tecnología de la información en el campo de la salud, existe una necesidad y un creciente interés por que exista recurso humano formado en informática médica (IM). La educación a distancia es una metodología que ha sido utilizada a nivel internacional en idioma inglés para la capacitación en IM. El objetivo de este trabajo es relatar la experiencia en la implementación de un programa de educación a distancia en IM en Latinoamérica. Se realizó la adaptación regional del curso que dicta el a través del programa 10x10, creado por la American Medical Informatics Association para la formación del recurso humano en IM. El curso tuvo 10 semanas de duración, contó con 152 inscriptos, habiendo completado la totalidad del curso el 93%, la mayoría de los alumnos provienen del área de la salud y el 84% son de Argentina. Los alumnos evaluaron en forma positiva los contenidos del curso. La experiencia inicial obtenida en la formación en IM en Latinoamérica puede extenderse a toda la región, para capacitar recurso humano en una disciplina que está en creciente desarrollo.

Physical inactivity is a recognized independent risk factor for the development of cardiovascular disease. However, a large proportion of the U.S. population does not participate in regular physical activity, and research has shown that without intervention, most people remain sedentary. Thus, an urgent need exists for developing effective interventions to promote physical-activity adoption and maintenance. Additionally, it is important that these interventions can be disseminated to the large population of sedentary individuals. To be disseminable, physical-activity interventions must move beyond reliance on strictly face-to-face modes and begin to more fully use newer technologies, such as the Internet. This article summarizes the progress made in promoting physical activity with interactive communications. We also delineate areas for future research.

Health care and health information have been around since the time of Hippocrates or even before. Through the historical evolution, it is observed that the knowledge and information that were simple and easy to learn and retain by that time, became much more complex. This paper presents a brief reviewing on the evolution of MEDINFO conferences, and how nursing informatics grew up and made itself visible during all these years of IMIA conferences.

Recently, it has been demonstrated that subclinical inflammation and the con-centration of inflammatory markers, such as cytokines, correlate strongly to cardiovascular mortality and morbidity in both healthy subjects and in those with known coronary artery disease (CAD) . Furthermore, vascular inflammation plays a critical role in the initiation, evolution and rupture of atherosclerotic plaque .

To examine the impact of design aspects of computerized physician order entry (CPOE) systems for medication ordering on usability, physicians' workflow and on medication orders. Methods: We systematically searched Pub -Med, EMBASE and Ovid MEDLINE for articles published from 1986 to 2007. We also evaluated reference lists of reviews and relevant articles captured by our search strategy, and the web-based inventory of evaluation studies in medical informatics 1982-2005. Data about design aspects were extracted from the relevant articles. Identified design aspects were categorized in groups derived from principles for computer screen and dialogue design and user guidance from the International Stan-dard Organization, and if CPOE-specific, from the collected data. Results: A total of 19 papers met our inclusion criteria. Sixteen studies used qualitative evaluation methods and the rest both qualitative and quantitative. In total 42 CPOE design aspects were identified and categorized in seven groups: 1) documentation and data entry components, 2) alerting, 3) visual clues and icons, 4) drop-down lists and menus, 5) safeguards, 6) screen displays, and 7) auxiliary functions. Conclusions: Beside the range of functionalities provided by a CPOE system, their subtle design is important to increase physicians' adoption and to reduce medication errors. This requires continuous evaluations to investigate whether interfaces of CPOE systems follow normal flow of actions in the ordering process and if they are cognitively easy to understand and use for physicians. This paper provides general recommendations for CPOE (re)design based on the characteristics of CPOE design aspects found.

Este trabalho tem por objetivo descrever a concepção, modelagem e implementação de um Data Warehouse (DW) com informações do Sistema Único de Saúde (SUS), utilizando informações do Sistema de Autorização de Internação Hospitalar (AIH), e buscando retratar o quadro de internação pública na Região Sudeste dos anos 2001 a 2006. A criação do DW seguiu as etapas do Processo de KDD: seleção dos dados; pré-processamento; transformação; data mining; interpretação e análise. Abstract -This work show the construction of a Data Warehouse (DW) with information from the Unified Health System (SUS), using information from the system Inpatient Hospital Authorization (AIH), seeking to portray the situation of public hospital inpatients of the Southeast region of Brazil between 2001 and 2006. The DW construction followed the steps of KDD process: Data Selection; Pre-Processing, Processing, Data Mining, Interpretation and Analysis .

Medical informatic experts have made considerable progress in the development of standards for orders and clinical results (CEN, HL7, ASTM), EKG tracings (CEN), diagnostic images (DICOM), claims processing (X12 and EDIFAC) and in vocabulary and codes (SNOMED, Read Codes, the MED, LOINC). Considerable work still remains to be carried out. Abstract models of health care information have to be created, to cover the necessary domain, and yet be simple enough to assimilate, implement, and manage. This requires a high degree of abstraction. Enormous amounts to develop standardized vocabulary are still required to complement such a model, and to define the subsets that apply to given contexts.

Background: The present study describes a computerized registry of cardiovascular disease patients in a large health maintenance organization in Israel. The registry is aimed to be used by health professionals to identify cardiovascular disease patients and to follow the courses of their illnesses and risk factors. Methods: In 1998, the registry was initiated using advanced information technology that integrated personal computerized community and hospital records, data from laboratory tests, dispensed medications, physiological signals, radiological images, and reports from investigations and procedures. Results: Between 1998 and 2007, the number of patients with cardiovascular diseases that were identified by the registry has increased from 34,144 to 80,339. During this period, the age-adjusted prevalence rates have risen from 3.7% to 5.1% and from 1.9% to 2.6%, among men and women, respectively. The percentage of ischemic heart disease patients who reached target LDL was doubled, from 21% in 2000 to 50% in 2006. The average stay in hospital declined from 11.7 to 8.6 days. Primary myocardial infarction rates declined 33% and 54% in men aged 54-65 and women aged 65-74 years, respectively. Conclusions: The present study provides, for the first time in Israel, data on selected quality of care and clinical outcomes using a large, population-based registry of cardiovascular disease patients. It demonstrates a significant improvement in the adherence with LDL tests and achieving target LDL levels and a subsequent decline in incidence of myocardial infarction within ten years since its establishment.

In the past decade medical applications of virtual reality (VR) and telemedicine have been rapidly developing, and the technology has changed from a research curiosity to a commercially and clinically important area of medical informatics technology. The chapter details the characteristics of the Experiential Cognitive Therapy (ECT), an integrated in-patient/out-patient (4 weeks) and telemedicine approach (24 weeks), that tries to enhance the cognitive-behavioral therapy used in the treatment of eating disorders by means of VR sessions and telemedicine support in the follow-up stage. In particular, using VR and telemedicine, ECT is able to address body experience disturbances, interpersonal relationships, self efficacy and motivation to change, key issues for the development and maintenance of eating disorders that are somehow neglected by actual clinical guidelines. This approach will be highlighted by the presentation of the clinical rationale, its different phases and by systematic analysis of the results obtained in different preliminary studies.

Resumo -O estudo e uso das terminologias vêm se tornando cada vez mais essenciais ao desenvolvimento de diversas áreas de pesquisa, incluindo informática em saúde, ciências da informação, inteligência artificial e lingüística computacional. Terminologias tais como vocabulários controlados, cabeçalhos de assunto e tesauros são usados como instrumento para indexação, classificação, busca e recuperação de informação, sendo o tesauro o tipo mais sofisticado e utilizado. O MeSH representa um cabeçalho de assunto das ciências da saúde, publicado e mantido pela National Library of Medicine (NLM), EUA, amplamente utilizado para tratamento de informação em saúde e em ferramentas de aplicação da informática em saúde. O objetivo deste trabalho é apresentar um método de conversão do cabeçalho MeSH em um tesauro para otimizar operações complexas efetuadas com o MeSH em pesquisas científicas. Para exemplificar foi utilizada uma pesquisa sobre a epistemologia da informática em saúde, que visa compreender se a informática em saúde se caracteriza mais como ciência, tecnologia ou uma mistura de ambos, a partir da literatura científica, do uso do MeSH e de métodos e ferramentas computacionais.

Over the past several years, there has been an increase in interest in translating human factors knowledge and methods, primarily used in complex, event-driven, sociotechnical settings such as aviation, to health care. In this article, we overview the primary concepts in cognitive systems engineering that may aid in formulating interventions in a variety of diverse medical settings to reduce the likelihood of patient harm. To improve resilience in medication delivery, we propose immediately incorporating 3 key levers: (1) scenario-based design and evaluation of interventions, (2) advanced information visualization techniques to reduce data overload in the electronic medical record, and (3) explicit consideration and documentation of asynchronous, interdisciplinary teamwork support during software requirements analysis, including a workload shifting analysis. For long-term progress, we recommend investing in research to better understand technical work in health care, specifically task requirements in work domains and the trade-offs and strategies that workers use to meet these demands. FIGURE 1. Cognitive system triad. Patterson et al

Open Source' is a 20 Á/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. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General's COSTAR and the Veterans Administration's VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. 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. #

This paper presents an infrastructure project for Telehealth and Telemedicine coupled to a proposal of interiorization of medical education deployed by the Federal University of Ceara (UFC), with the creation of the Colleges of Medicine of Barbalha and Sobral, in the south and north regions of the State, responsible for the health and medical assistance of a large portion of

Purpose: Information Technologies and Knowledge-based Systems can significantly improve the management of complex distributed health systems, where supporting multidisciplinarity is crucial and communication and synchronization between the different professionals and tasks becomes essential. This work proposes the use of the ontological paradigm to describe the organizational knowledge of such complex healthcare institutions as a basis to support their management. The ontology engineering process is detailed, as well as the way to maintain the ontology updated in front of changes. The paper also analyzes how such an ontology can be exploited in a real healthcare application and the role of the ontology in the customization of the system. The particular case of senior Home Care assistance is addressed, as this is a highly distributed field as well as a strategic goal in an ageing Europe.

Purpose: The agent-oriented paradigm has emerged as a viable approach for the development of autonomic systems in the healthcare domain. This paper reviews representative works in this area in order to identify the main research lines and study their level of applicability.

The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decision support. Last, we suggest actionable recommendations for delivering effective clinical decision support using alerts. A review of studies from the medical informatics literature suggests that many basic human factors principles are not followed, possibly contributing to the lack of acceptance of alerts in clinical information systems. We evaluate the limitations of current alerting philosophies and provide recommendations for improving acceptance of alerts by incorporating human factors principles in their design.

Most of current Information and Knowledge Based Systems manage impressive amounts of information, ranging from local databases to resources imported from the web. In addition to widely pointed-out integration and maintenance difficulties, other common problem is overwhelming of users with much more information than the strictly necessary for fulfilling a task, forcing them to dig in a list of results to find valuable answers. This issue is especially critical in mobile decision support systems, since neither the capabilities of the handheld devices nor the users' situation are likely to ease or even permit carrying out this manual post-processing.

Continuous developments in information and communication technologies (ICT) have resulted in an increasing use of these technologies in the practice of medicine and in the provision of medical care. This paper presents a series of perspectives from different areas of expertise on some of the ways in which ICT has changed the social picture in respect of the practice of medicine. The aim of the paper is to provide a context for further debate, in the form of a Panel Session, where the issue of Human Choice and Computing can be discussed with reference to a set of specific scenarios. The authors of this paper represent a wide variety of disciplines including law, ethics, medicine, philosophy and computer science, thus bringing a broad perspective to begin the discussions. The aim of the session is to provoke further discussion, encouraging input from other disciplines respresented by the participants, with a view to identifying the level of human choice in a social arena which has at its heart a vulnerable community. In this environment, and in this era, the "social" in social informatics has never been more important.

Medical Informatics has a constant need for basic Medical Language Processing tasks, e.g., for coding into controlled vocabularies, free text indexing and information retrieval. Most of these tasks involve term matching and rely on lexical resources: lists of words with attached information, including inflected forms and derived words, etc. Such resources are publicly available for the English language with the UMLS Specialist Lexicon, but not in other languages. For the French language, several teams have worked on the subject and built local lexical resources. The goal of the present work is to pool and unify these resources and to add extensively to them by exploiting medical terminologies and corpora, resulting in a unified medical lexicon for French (UMLF). This paper exposes the issues raised by such an objective, describes the methods on which the project relies and illustrates them with experimental results.