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UNIT-I BIOMEDICAL INFORMATION TECHNOLOGY
PART A
1. What is medical Informatics?
Health care informatics (or) Medical informatics is the intersection of Information
Science, Computer Science and Health Science. Its deals with resources, devices and
method to optimize the acquisition, storage, retrieval and use of information in health and
bioscience.
2. What is healthcare?
It refers to the treatment and management of illness, and the preservation of health
through service offered by the medical, dental, pharmaceutical and nursing
Healthcare embraces all the goods and service designed to promote health
including preventive, curative and palliative intervention.
3. Name the seven technical divisions in BUREAU
• Training
• Media
• Editorial
• Health education centre and services
• Research and evaluation
• Field study and demonstration centre
• School health education division.
4. What is the Mission of WHO?
WHO- World Health Organization is established on 7th April 1948.it is
specialized United Nations Agency Which acts as a coordinator for public health around
the world.
Mission:
Attainment by all people of the highest possible level of health
1
5. Define Hospital Information System (HIS).
A HIS is also called clinical information system. HIS is a comprehensive,
integrated information system designed to manage the administrative, financial, and
clinical aspects of a hospital. This encompasses paper-based information as well as data
processing machines.
6. What are the two types of databases used in Medicine?
• Bibliographic Databases
• Non-bibliographic database.
7. What is meant by Bibliographic databases?
These are composed of citation to journal articles or other forms of printed
information, while others are purely factual and contain such data as statistics or adverse
effects of certain chemicals or drugs.
Eg:
MEDLINE
PREMED LINE
BIOSIS
POPLINE, etc.
8. What is meant by Non-bibliographic databases?
Full- text databases in the form of encyclopedias, textbooks, reference
publications, and growing number of medical periodicals are common.
Eg;
CANCERPROS
CLINPROT.
2
9. What is Multimedia?
Multimedia is any Combination of text, graphs, art, sound, animation, and video
delivered by computer or other electronic means.
10. Where to use Multimedia?
Multimedia used in e-learning, telemedicine, video conference, film, advertising,
video games, railway station, shopping malls, museums and grocery stores.
11. What are stages of a project?
• Planning
• Designing
• Producing
• Testing
• Delivering
12. What are all requirements to make a multimedia project?
• Hardware
• Software
• Creativity
• Organization
13. Define Virtual Reality.
Convergence of technology and create invention in multimedia is virtual reality.
In virtual reality, our cyberspace is made up of many thousands of geomentric objects
plotted in three-dimensional space.
The more objects and the more points that describe the object, the higher
resolution and the more realistic view.
3
14. Define Testing.
Test multimedia programs to make sure that they meet the objectives of projects,
work properly on the intended platforms, and meet the needs of client or end user.
15. What is multimedia hardware?
Two most significant platforms for producing and delivering multimedia projects.
These are
• Macintosh OS from Apple and
• PC clone running Microsoft Windows.
Hardware peripherals are monitors, disk drives and scanners.
16. What are the two types of platform?
1. Macintosh
2. Windows
17. What is Macintosh platform?
All Macintoshes can play sound. Most Macintoshes, 8-bit and 16-bit graphics
capability is available. AV series of Macintoshes can digitize video as well as sound. The
Macintosh computer is needed for developing a project’s delivery requirements, its
content and the tools are needed for production.
18. What are the three multimedia PC standards?
1. MPC level 1
2. MPC level 2
3. MPC level 3
19. What are the two types of Connections?
1. Small Computer System interface[SCSI]
2. Media Control Interface[MCI]
4
20. What are the storage devices?
1. Floppy disks
2. hard disks
3. syquest drives
4. optical storage devices
5. DVD
6. CD-ROM Players
7. CD-ROM recorders
8. Video disc Players.
21. What are the input devices?
Keyboard, mouse, track ball, touch screens, magnetic card encoders, and readers,
graphic tablets, scanners, OCR devices voice recognition systems and digital
cameras.
22. What are the output devices?
1. audio devices
2. amplifiers
3. speakers
4. video devices
5. Projectors.
23. What are the communication devices?
1. modems
2. IDSN
3. cable modems
4. Networks.
5
24. Define ISDN
For high transmission speeds, we will need to use Integrated Services Digital
Network (ISDN),SWITCHED-56, T12, T3, and ATM. ISDN lines are important for
Internet access, networking, and audio and video conferencing.
25. Explain about MIDI.
• MIDI-Musical Instrument Digital Interface
• It is communication standard developed in the early 1980s for electronic musical
instrument and computers.
• It allows music and sound synthesizers from different manufactures to
communicate with each other by sending messages along cables connected to the
devices.
• MIDI provides a protocol for passing detailed descriptions of a musical score,
such as the notes, sequences of notes.
26. What are the advantages of MIDI over Digital Audio?
1. MIDI files are much more compact than digital audio files, and the size of a
MIDI file is completely independent of play back quality.
2. MIDI files will be 200 to 1,000 times smaller than CD- quality Digital Audio
files.
3. MIDI files may sound better than digital audio files.
4. We can change the length of a MIDI file without changing the pitch of the
music.
27. What is the Information Retrieval tools used in Medicine?
Archie:
Archie is a searchable database of the location of files that are available for the
public to download.
Gophers:
6
Gophers organize information in different computers into a menu and, with the
help of Veronica, can lead you to relevant resources.
28. What is PHR?
Personal Health Records (PHR) PHR is an electronic repository in which a
person can store his or her health-related information securely and privately and also
share that information with multiple health care providers or others are the patient's
discretion.
29. What is meant by Telemedicine?
Telemedicine is distance consultation among health professionals or between
health professionals and patients by use of telecommunications technology such as
real-time audio or visual systems, most notably video conferencing.
The potential advantages are obvious in dispersed communities (rural areas)
where expertise is thinly spread, and when traveling is difficult or inconvenient for
doctor or patient.
30. What is meant by Internet? list its advantages
The Internet is a means to improve health and health care delivery, its full
utilization is not clear. Nevertheless, an increasing proportion of the public is using the
Internet for health information.
The advantages of the Internet as a source of health information include:
• convenient access to a massive volume of information,
• ease of updating information, and
• the potential for interactive formats that promote understanding and
retention of information.
7
Health information on the Internet may make patients better informed, leading to
better health outcomes, more appropriate use of health service resources, and a
stronger physician-patient relationship.
PART-B
1. Explain the health Education in India?
Health Education in India:
Introduction:
India is the largest country in south Asia with the second population in the world.
Only 60% of the population is literature. Health education in India has along history
however its formal integration on into health services is less than 50 years old.
In the government, Central Health Education BUREAU (CHEB) is the apex
institution for health education in India. The Bureau was set-up in 1956. It has seven
technical divisions, namely
• Training
• Media
• Editorial
• Health education centre and services
• Research and evaluation
• Field study and demonstration centre
• School health education division
The Bureau conducts a one year postgraduate diploma in health education (DHE).
Training:
The training division conducts in-service training to various categories of
personnel in health and related fields. The trainees include medical and non-medical
personnel deputed to the bureau for training in health education.
8
Media:
• The media division organizes exhibitions on various health topics and
celebrations of important days such as World Health day, No Tobacco Day, and
World AIDS Day.
• Its also organize exhibitions on various occasions at the request of the Ministry of
Health & family Welfare.
• Voluntary organizations and other government departments such as Central
Reverse Police Force.
• It also participates in international fairs at pragti Maidan, New Delhi.
Editorial Divisions:
The editorial division brings out periodicals namely Swasth Hind (English
Monthly), Arogya Sandesh (Hindi Monthly), and Swasthya ShiKsha Samachar (Hindi
quarterly) to disseminate health education information.
The health education division:
• The health education division provides technical guidance to state health
education bureaus and strengthens their activities.
• It also assists in developing health education programs and materials for the
government and non-governmental agencies in promotion of health education.
Research and evaluation Division:
• It conducts behavioral studies on various aspects of health.
• It has also developed and conducts asocial science research methods course.
Field study and demonstration centre Division:
• It serves as a field laboratory to test methods and media of health education which
can be adopted elsewhere.
• It provides opportunities for various divisions to undertake field trail, conduct
research, test, and developing methods, media and train personnel in actual field
situations.
9
School health education division:
• It promotes health education in the school systems of education in the country.
• It has developed & revised curricula from primary to higher secondary level
including health education materials.
• It coordinates With National Council of Educational Research and Training
(NCERT) & Central Board of Secondary (CBSE) for inclusion of health
education subjects in formal and non formal education.
2. Explain the healthcare system?
Introduction:
• India is the most privatized health market in the world.
• Public support for healthcare has been historically low in India, averaging less
than 1 percent of the GDP.
• In the last decade public health investment and expenditure has seen a secular
declining trend.
• During the same period the private health sector grew rapidly, from being about 3
percent of GDP in the beginning of 1990s to over 5 percent today.
• In fact, the health sector has been growing at the rate of 1.4 times that of the GDP.
• This also means that the burden out-of-pocket on households is also increasing
rapidly and more so for the poorest sections, especially since the public health
expenditure are declining.
• What is the worse is that the poor have to increasingly resort to taking debt or
selling assets to meet costs of hospital care.
• It is estimated that 20 million people each year fall below the poverty line because
of indebtedness due to healthcare.
The healthcare system:
• Public health facilities are allocated on the basis of population-based norms
and/or on basis of specific geographic units.
10
• Thus for primary care, there are dispensaries and health centre which provide
largely ambulatory care.
• Rural areas have mostly health centers like primary health centre (PHC) and sub
centre through which preventive and promotive care is provided, largely through
paramedics.
• Taluka and other small towns and cities have only dispensaries and a hospital.
• The district towns and larger towns and cities have dispensaries and one or more
secondary level hospitals depending on the their population size and these may be
owned by either state and/or local government, some of them may even have a
teaching hospital and/or special hospital.
• Compared to rural area the urban areas are much better endowed with public
health facilities.
• Another special feature of public health services is that there are mass health care
programmes, family planning and maternal and child health programs.
• The public health system caters to 20 percent of ambulatory care, 45 percent of
hospitalizations, 50 percent of institutional deliveries, 65 percent of antennal care,
80 percent of immunization, and 90 percent of family welfare planning services.
• Private health care is much larger and widespread than public health services.
• Individual practitioners in their clinics provide ambulatory care, which may often
be within their residences.
• The number of registered practitioners in estimated to be about 13 lakhs across
the country with the large concentrations in states like Maharastra, Gujarat, and
the southern states, and about 80 percent are in private sector.
• The allopathic doctors constitute about 45 percent of total registered practitioners
and are located mostly in urban areas, where as non-allopath are mostly located in
the smaller towns and rural areas.
• With regard to private hospitals the data gaps are similar,
• There is no proper registration process for private hospitals and hence the data
available is a gross underestimate, as revealed by surveys in Maharastra, and
Andra Pradesh.
11
• The latest estimate reveals that nearly that nearly 70 percent of all hospitals and
40 percent of all hospital beds in the country are in the private sector with over 80
percent of them being urban areas.
• A peculiar characteristic of private health services is that, unlike the public health
sector, they provide almost entirely only curative care.
• Further, the private health sector is fully commodified and totally unregulated
with complete absences of ethics.
3. Explain the prospects of health insurance?
• The current political economy of health care in India makes India the most
privatized health sector in the world.
• Out of pocket expenditures are the main mechanism of financing healthcare and
in the context of large large-scale poverty in India this not only contributes to
widespread inequities but is also unsustainable.
• Public investments and expenditure on healthcare have been declining since India
acquiesced to ASP.
• The limited social insurance coverage, which exists mostly for the middle classes
in India, is witnessing declining trends and also experiencing privatization.
• World Bank and other multilateral and bilateral agencies are promoting private
insurance as an option for classes who can afford to pay premiums and
community finance strategies for the poor-they are advocating for a declining role
of the state in public health finance.
• This is a contradictory to global experience which shows that universal access
with equity can only be achieved with financing mechanisms which are largely of
a public nature like social insurance, tax revenues, payroll deductions or some
such combinations.
• The phenomenal growth of the private health sector has also coincided with the
decline and collapse of the public health sector during the same period.
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• This is partly due do the worsening fiscal crises. In India Tax: GDP rations are
down to a mere 12percent as against more developed countries where such ratios
are close to 30 percent.
• With current fiscal polices directed at further reductions in tax revenues, the
states’ resources pool will shrink further ad social expenditure like healthcare are
the first to come under pressure.
• What is worse that the private health sector is fully commodified and totally
unregulated with complete absences of ethics and no standards of care are
followed.
• In such an environment health insurance does not stand a chance and it is
precisely this factor that has prevented health insurance of any kind from playing
any significant role in financing health care in country.
• Hence the little health insurance that exits in India, whether social or private, is
restricted to classes who have the capacity anyway to buy the best healthcare from
the market.
• And the poor and subsistence level populations who actually need the protection
of insurance are burdened without of pocket expenditure given the fact that public
health services are not adequately accessible.
• For health insurance to become a reality public health finance has to take a
dominant position for financing healthcare.
• For this to be made possible to entire healthcare system in the country, public and
private, needs to be organized into a defined system which functions according to
rules and regulations, uses standardized for protocol for care and treatment, is
subject to price regulation an is financed through pooling of all available
resources under an independent and autonomous authority which is public
monopoly and accountable to all stakeholder.
• To facilitate and organized and publicly financed healthcare system, a very large
proportion of the work force will have to be included under a contributory scheme
through the social health insurance route.
• About half of the country’s population has the potential to be a part of social
insurance mechanism.
13
• The other half of the population can be supported through tax revenues and other
publicly raised revenues, like sin taxes on alcohol, tobacco, paan masalas, private
vehicles, etc.
• The enhanced social insurance mechanism has the potential to raise an additional
2 percent of the GDP for the public health sector.
• This is highly feasible in India but will need the appropriate political will to make
it a reality.
• To give a health insurance and related financing mechanisms a chance appropriate
legislation and a constitutional mandate, which brings healthcare into the social
security ambit from a rights framework, will be necessary.
• For this to be happen political will has to be generated and for the latter civil
society has to be activated to demand health care as a rights.
4. Explain the sources of information with emphasis on electronic
resources?
Introduction:
Information, an invaluable resource is being disseminated, transformed and
Communicated in a variety of environments. They are now mostly available in e-media.
Librarians cannot afford to ignore this development and they must prepare themselves to
handle e-sources. Move towards electronic handling of information will be cost-effective
and users will be in a position to get pinpointed information with the help of powerful
search engines.
1. INFORMATION SOCIETY
Information is a most predominant element in the present society and much of the
labour force is working in information related sectors, in this society. Sometimes, this
society is also referred to as information conscious society, particularly in less developed
countries. In most advanced countries, this society is referred to as information society. In
information conscious society (1):
i) People realize the importance of access to information
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ii) People do not necessarily have the information they need
iii) Information structure to access information hardly organized and exists.
Information, a predominant element, pervades and dominates in the day-to-day
activities, in the information society. In such a society, quick delivery of needed
information, most economically is the ordinary state of affairs. An information conscious
society is however, a necessary prelude to an information society. Important features of
an information society are (1):
i) Information, a self-regenerative resource:
It is a key economic element. It is a Socio-economic product. Its organized
generation and its use are helpful in promoting socio-economic activities. Planners,
policy-makers, R & D personnel, Academicians, etc. realize that it is an important
resource for their day-to-day activities and further they do realize that decisions are based
on reliable, valid and timely information. It is
a) An instrument of social change;
b) A non-depleting resource;
c) A commodity subject to economic analysis.
ii) Intensive use of information technologies
The amount of information in any discipline doubles once in every seven to ten
years. In this sense, we can conjecture that 'information grows at an exponential rate'.
Further, it is very difficult to collect, process, store and retrieve information in
interdisciplinary areas. It is in these two contexts, role of information technologies is
considerable and their intensive use is a necessity. The tremendous potentialities of
information technologies resulting from the integration of communication technologies
and computer technologies and their impact on business & industry, on government,
education & health services etc.
ii) Increased awareness of the importance of life-long learning;
iv) Boundaries between work, leisure and education are getting blurred;
15
v) Process of decision-making aims at the future requirements; as a result, environment
protection is given equal importance.
vi) Considerable rise in the number of white collar workers.
In information society, countries are further grouped as information rich and
information poor. The information rich nations tend also to be materially-rich with high
Gross National Product; they have the potential advantage for becoming richer.
The information poor nations tend also to be poor in most other material aspects
with low Gross National Product.
The basic steps in the process involved in information handling are information
generation, collection, storage, processing and dissemination, utilization and feedback.
2. INFORMATION SOURCES: Origin
The beginning of information sources may be traced to man's earliest attempts to record
Thoughts, concepts, ideas, and events. Sir Karl Popper in his book "Objective
Knowledge", recognized a world of objective knowledge which is the totality of all
human thought embodied in human artifacts, as in documents and also in music, the arts,
the technologies. He called this a third world. According to Popper's ontological scheme
(2).
• world 1 is the physical world -- earth
• world 2 is the world of subjective knowledge or "mental states"
• world 3 is the world of objective knowledge
-- are important sources of information.
3. INFORMATION SOURCES: Different Types
Different sources of information may broadly be grouped as documentary and
nondocumentary sources. Invention of printing machine by Johannes Gutenberg in 1452
has contributed immensely to "printing industry". Since then, information has been
recorded in printed form -- in documents.
Documents enable us to transfer information from one generation to another; also
from one place to another.
16
Printed documents are published in a variety of forms; documents are further
grouped into
• Primary,
• Secondary and
• Tertiary documents.
Primary documents contain new or original idea or new interpretations of known
facts.
Secondary documents are those derived from primary sources.
Tertiary documents are those that are based on the primary and secondary sources
of information. The information presented in the tertiary sources is highly condensed and
the aim is to provide relevant information in minimum number of expressions primarly
the aids to search primary and secondary sources.
Table 1 below gives the list of primary, secondary and tertiary sources of
information (4).
Table-1: Different Types of Documents
Primary Documents Secondary Documents Tertiary DocumentsPeriodicals
Research/Technical reports
Conference Proceedings
Patents
Standards
Theses & dissertations
Research reports
Trade Literature
Laboratory Notebooks
Official Publications
Correspondence, Personal
files etc.
Bibliographies
Indexing &
Abstracting Services
Reviews; State-of the-
art reports
Monographs
Reference Books
-- Dictionaries
-- Encyclopedias
-- Handbooks
-- Tables
-- Formulae
Yearbooks
Directories
Bibliography of
bibliographies
List of research in
progress
Guides to libraries,
organizations
literature, etc.
Periodicals
17
Periodicals include journals, bulletins, transactions, proceedings or similar works
which appear at regular period in numbered sequence. However, newspapers, annuals,
magazines are generally excluded under this category.
The most of the primary sources of literature appears in the form of periodicals. The
articles in periodicals report the results of recent research works and they are the main
means of research communication for the exchange of scientific information
Examples of periodicals are:
i) Nature (weekly), 1899+, London, Macmillan Press
ii) Physics of fluids (monthly), 1958+, Newyork, American Institute of Physics
Technical Reports
A report is an account or a text describing in detail an event situation or the like,
usually as a result of observation, inquiry, experiment, etc.
Technical reports generally give the results of R & D experiments/projects; they
are primitive in the sense that they are published as and when research activities progress
often, these are considered as primary sources of information, especially in the area of
aeronautics, and applied atomic energy. These are generally unpublished or semi-
published literature. Examples of reports are
i) Scientific & Technical Reports, National Aeronautics and Space Administration
(NASA) (USA)
ii) National Technical Information Centre Reports (NTIS)
Patents
It is an official document conferring an exclusive right, granted by a government to an
inventor to manufacture, use or seek an invention for a certain numbers of years; the list
of such patents usually appear in the Government gazette; also one can refer for its details
in World Patent Index (weekly), 1975+, London, Derwent Publications.
Standards
They are the publications issued by certain authorities such as International
Standards Organization, Bureau of Indian Standards, British Standards Institutions, etc.
18
It is something considered by an authority or by general consent as a basis of
comparison. Standards ensure reliability; for manufacturing units and for design
engineers, standards are an important source of information.
Pamphlets
It is a short treatise or essay, generally a controversial tract on some subject of
Contemporary interest.
ELECTRONIC SOURCES OF INFORMATION
Electronic publishing has become a major topic in the world literature in recent
years, particularly because of the developments in information technologies. Electronic
publications -- all those publications which are in electronic or digital media -- are
usually known as electronic sources of information.
Most of the electronic sources were available on magnetic tapes and some were
online. Mostly secondary sources (-- bibliographical databases).
Today, electronic sources are available on CD-ROMs or on the Net.
In the present day context, sources which are available on the Net are often
referred to as online sources. These sources consist of reference documents (dictionaries,
encyclopedia, directories, handbook, atlas, etc), data, research publications, journals etc.
These developments have a great impact on libraries, changing user expectations;
They force librarians to re-think:
i) The collection they have to develop
ii) The services that they provide
iii) The electronic sources that they have to acquire/subscribe
Electronic media:
The electronic media offer unique advantage for information transfer; e.g.
flexibility rapid delivery, low cost, compact storage and interactivity. It may even
displace print as a major media of dissemination in foreseeable future.
19
In recent years, two other 'media' have emerged in this context -- multi-media and
hypertext media.
Multi-media:
The multi-media refer to the integration of data, text, image and sound within a single
digital information environment. It is effectively being utilized in applications in
education and training, business, health sciences, publishing, entertainment, etc.
Hypermedia
The hypermedia, popularly known as hypertext, is generally used to refer to
information containing higher proportion of graphics and images and is almost always
includes video sequence or any form of animated information.
In hypermedia, information is organized in nonsequential manner -- generally
consists of nodes/chunks of information, may alter the way in which we read, write and
organize information. Hypertext is an access mechanism. Links are used in hypertext to
direct the readers to additional or related information (like the footnotes, glossaries, in
printed media.)
Information on CD-ROMs:
The CD-ROMs, one type of electronic sources (media), are increasingly
becoming popular; its growth is increasing at an exponential rate.
In the field of computer science, contain one or two CD-ROMs. Its organization is
troublesome.
CD-ROM on Ayurveda
The Dabur Research foundation has launched a CR-ROM on the ancient Indian
medicine system of Ayurveda titled Ayurveda Authentica.
The CD-ROM was jointly developed by DRF and Tata interactive system - a
division of Tata Industries Ltd. This CD includes more than 800 pages of text, video clips
on yoga, Ayurvedic therapies, comprehensives psychosomatic analysis and an exhaustive
glossary cum pronunciation guide of Sanskrit words.
20
The CD is an important electronic source of information for any Ayurveda expert.
Three CD-ROM title from the Medical Economics Company
Recently, three new titles on CD-ROM have been announced by the Medical
Economics company. One of them is the PDR Electronic library. It containing 9,000
pages of the most popular medical references.
Information includes chemical structures, and illustrations and full color full
images. It is updated three times, in a year. The PDR Nurses handbook provides complete
description of drugs including contents, side effects, overdose symptoms and treatment.
WINMDR Medical Device Register is the third CD.
It is a fully interactive computer programme for windows. The product enables
swift access to more than 3,000 pages of detailed medical device listing on products and
manufactures.
Medical Meta Map on Asthma
The Institute for Scientific Information has recently released a filtered clinical
data set in its new Meta Maps product line. Asthma Meta map, a decision making tool for
drug development team, is intended to guide clinical and marketing programs, and to
improve research strategies and clinical study design.
The information is delivered on a Y2K - compliant CD-ROM via Microsoft
Access 97 software, and users can browse, filter, and sort the data.
The number of CD-ROMs were increased from 2900 in 1992 to 13, 000 in 1998.
The actual figures are:
E-journals
A journal contains scholarly articles. It disseminates current information on
research and development in a particular subject field. It is being published periodically
(-- with continuity).
Until recently, journals were available only in printed media; for sometime, they were
also popular in the form of microfiche /microfilm. Now they are even available in
electronic media.
21
They are being processed and published (-- receiving, refereeing, editorial work,
etc) through electronic media. Such journals in electronic media are often known as
virtual sources, paperless journals, online journals, and most popularly known as e-
journals.
An e-journal, like any other serial is produced, published and distributed all over
globe via electronic network. E-journals for all practical purposes may thus be defined as
those journals which are available in electronic media; some may be available on CD-
ROM; a few may be available only on online; some may be available both in electronic
media and in print.
McMillan defines E-journals as "any serials, produced, published, and distributed
nationally and internationally via electronic networks.
Growth of E-journals and Newsletter
July
'91
March
'92
April
'93
May
'94
May
'95
May
'96
Dec.
'97Electronic Journal
Electronic
Newsletters
27
83
36
97
45
195
181
262
306
369
306
369
2459
955
Total 110 113 240 443 675 1689 3414
Electronic sources are volatile and they exist in a dynamic environment in which
librarians are compelled to reassess assumptions and roles periodically.
Merits and Demerits of E-Journals:
Merits:
i) Subscription Cost
22
The subscription cost of the printed journals is almost increasing every year; if
one opts for E-journals (if available, for a given title), there may be a potential
saving to the order of at least 20 to 30%, over a period of time
The cost of the E-journals are likely to be cheaper since there are no distribution
and production cost.
ii) Multimedia and Hypermedia Capabilities
Electronic journals can take advantage of the multimedia capabilities --
integrating text, video and sound.
Hypermedia enable linkages among sections within an article as well as
among articles in journals and other electronic resources
.
iii) Accessibility
A large collection of journals can be shared in real time
iv) Selective Dissemination of Information Service
Users may be alerted as and when a new articles of their interest is accepted
and published in electronic media
v) Speed of distribution and production
Printing & mailing processes may totally be eliminated
During the review process, and all other communications, articles may be
transferred in digital media -- since much of the text is created in digital form by the
users/authors themselves, publishers require little time/cost to review, editing and perhaps
the final electronic page.
Can be distributed electronically
Increases portability -- a simple CD-ROM can hold thousands of articles with
complete indexing
Establishes network communication among authors, editors and references.
Demerits:
23
There are certain disadvantages; such as:
i) Economic Barriers
It requires high-tech; it costs -- purchasing, maintenance, upgrading of both h/w
and s/w
ii) Socio-cultural barriers
It may be difficult for users to adjust and develop habits to handle e-journals
iii) Technological barriers
Lack of proper infrastructure to handle e-journals
Examples of E-journals and their cost:
SPIE (the International Society for Optical Engineering) produces world-class
scholarly journals in the field of optics. The important E-journals in this area are:
1. Optical Engineering
2. Journal of Biomedical Optics
3. Journal of Electronic Imaging
SPIE Journals are available in print, online and CR-ROM formats. Tables of
contents and abstracts for these three journals are available in two ways:
1. In ASCII format via the home page for each journals are available in three ways:
Optical Engineering (1992-present)
Journal of Electronic Imaging (1992-present)
Journal of Biomedical Optics (1996-present)
2. In html format via AIP's Online Journals Publishing Services (1998-presents)
SPIE Journals Online is accessible in PDF format via AIP's Online Journals
Publishing Services.
24
Full Text access to SPIE Journals is available by subscription or institutional site
license. SPIE Journals on CD-ROM are available for 1996-97 and 98.
Each CD-ROM contains PDF pages of the complete years for all three journals
and is Macintosh, PC Windows (486 or higher), and Unix compatible.
Secondary sources available in Internet
i) http://www.oed.com/
The Oxford English Dictionary went to print in 1928, the electronic version was
created in 1992.It is also available in CD-ROM formats. Published by Oxford University
Press. email: [email protected]
Oxford English Dictionary (Second Edition) on CD-ROM Version 2.0 (0-19-268788-3 )
Oxford English Dictionary (online edition) will be available from March 2000
ii) http://www.graylab.ac.uk/omd/index.html
Online Medical Dictionary (OMD)
OMD is a searchable dictionary created by Dr Graham Dark and contains terms
relating to biochemistry, cell biology, chemistry, medicine, molecular biology, physics,
plant biology, radiobiology, science and technology.
iii). http://cns-web.bu.edu/pub/laliden/WWW/Visionary/Visionary.html
Visionary:
A dictionary for terminology used in the study of human and animal vision.
Written and maintained by:
Lars Liden o ([email protected])
Dept. of Cognitive and Neural Systems
25
Boston University
iv. Encarta online
Encarta Online Deluxe - Price $49.95.
Encarta Reference Suite 2000 — (CD-ROM and DVD-ROM) Rebate Offer
$35.00 U.S./$50
v. http://www.encyclopedia.com/
Brought out by Infonautics Corporation 1999 – free for more information about
Encyclopedia.com
Send email to [email protected]
Other Electronic Resources
There are various kinds of electronic resources in the Net. New resources/sites are
added almost every day.
1. The iworld (www.iworld.com):
An Internet resource is an online magazine.
It basically gives Internet news.
It also offers a searchable list of Internet service providers.
2. CNET:-
The computers network (www.cnet.com),
web review (www.webreview.com), Hotwired (www.hotwired.com).
CNET gives information about Internet and its technologies; it offers reviews and
tips for using some of the new software products.
The web review features articles, tutorials and demos; also assists us in learning
the latest web authoring techniques and tools -- graphic design, animation, information
architecture, audio, video, etc.
One of the most important electronic sources is amazon.com. In this site, one can
browse list of newly published books, place an order for books; one can even browse the
site for music, video, auctions, electronics, toys & games, etc.
26
Today, the "amazon.com" is a place to find and discover anything we want to buy
online. More than 10 million people in more than 160 countries have used this site for
shopping in the last few years. It offers a variety of services. For instance:
• Search for books, music, videos, and more -- in a snap.
• Browse the virtual aisles in hundreds of products categories -- everything form
audio books, jazz, and video documentaries to coins and stamps up for auction.
• Instant personalized recommendations; (it is based on our earlier purchases )
• Sign up for Delivers, e-mail subscription services, to provide the latest reviews
of exceptional new titles in categories that we are interested-in.
• To search over a million UK-published titles and local content at Amazon.co.uk
and German-published title at Amazon.de.
• Provision to become an Amazon.com Associate and earn money by selling
books, CDs, DVDs, videos, and many other products on our Web site.
5. Explain the financing healthcare system?
Financing healthcare:
• The total value of the health sector in India today is over Rs 1,500 billion or US$
34 billion.
• This work out of 434 per capita which is 6 percent of GDP, of this 15 percent is
publicly financed, 4 percent is from, social insurance, 1percent private insurance
and the remaining 80 percent being out of pocket as user-fees(85 percent of which
goes to the private sector)
• Two third of the users are purely out-of-pocket users and 90 percent of them are
from the poorest sections.
• The traged7y is that in India, as elsewhere, those who have the capacity to buy
health care from the market most often get healthcare without having to pay for it
directly, and those who are below the poverty line or living it subsistence levels
27
are forced to make direct payments, often with the heavy burden of Debt, to
access healthcare from the market.
• National data reveals that 50 percent of the bottom quintile sold assets or took
loans to access hospital care.
• Hence loans and sale of assets are estimated to contribute substantially to
financing healthcare.
• This makes the need for insurance and social security even more imminent.
• Public financing of healthcare comes largely from state government budgets,
above 80 percents, and the balance from the union government (12 percent) and
the local government (8 percent).
• Of the total public health budget today, about 10 percent is externally financed in
contrast to about 1 percent prior to the structural adjustment loan from the World
Bank and loans from other agencies.
• Private financing is mostly out-of-pocket with a large position, especially for
hospitalization, coming not from current incomes but for savings, debt and sale of
assets.
• Insurance contributions, whether for social insurance schemes or as private
insurance premiums, constitute a very small proportion.
Social health insurance:
• The total employment in India today is estimated at 400 million but of this only
28 million is in what is called the organized sector, which is covered by
comprehensive social security legislation, including social health insurance.
• The largest of this is the ESIS which covers 8 million employees, and including
family members provides health security to 33 million persons.
• In 2002-03, the ESIS Corporation spent Rs 12 billion on healthcare for its
member beneficiaries averaging Rs 365 per beneficiary.
• The effective covers a mere 3.2 percent of the population.
• Another about half percent of the population is covered through the CGHS. In the
same year the CGHS spent Rs 2 billion averaging Rs 450 per beneficiary.
28
• While these social insurance plans have been around for along time, their
credibility is at stake and large scale out-sourcing to the private sector is taking
place.
• ESIS has private panel doctors in large cities that provide ambulatory care to
those covered under ESIS whereas their own doctors in dispensaries and hospitals
run by ESIS are increasingly idling.
• Similarly under CGHS, those are covered being given ‘choice’ to access private
healthcare by being given reimbursements which for instance for a by-pass-
surgery could go up to Rs 150,000 for a senior bureaucrat.
• Further, other government employees like the railways, defence services and the
P&T department have significant healthcare services and/or reimbursements for
their employees which amounts to a significant Rs 16 billion per annum and this
is averaged a whopping Rs1,150 per beneficiary.
• Also, Welfare funds have been created by Acts of parliament for the specific
occupational groups, including those in selected unorganized sector group, like
beedi workers, plantation workers, mine workers, building/construction workers,
head load workers to meet social security benefits like healthcare, education,
recreation, water supply, hosing etc.,
• In 2002-03, these funds expended Rs 350 million on healthcare, which was about
half of the expenditure of the welfare funds.
• From rest of the organized sector, largely the middle and upper middle classes,
about 30 million persons are provided healthcare protection from employees
through reimbursements and/or employer provision.
• This is estimated about Rs 24 Billion per year, averaging Rs 3000 per annum.
• Thus about 10 percent of the counter’s population has some form of social
insurance cover for health through their employment.
• From time to time, the government has also introduced social security schemes,
including health cover for various group of population.
• Especially the poor or below poverty line groups, in the unorganized sector, like
the Krishi Shramik Samajik Sanatha Yojana, National maternity benefits scheme,
29
Handloom workers thrift, health and group insurance, agricultural workers and
central schemes, National illness assistance fund and state illness funds, etc.,
• But these schemes are not run on a regular basis that is if a person gets a benefit
once there is no guarantee that the same person continues to get access to that
scheme on a regular basis.
• No firm figures of their coverage are available because most such schemes, like
the latest community health insurance scheme in the 2003-2004 budgets, are
populist announcements to lend social credibility to the budget and when the next
budget comes the scheme gets quietly archived.
Private health insurance:
• Private or what is often also called “voluntary” insurance is a recent phenomena
starting in an organized way some time in the mid-eighties through the public
sector insurance companies.
• Prior to that these insurance companies did have group insurance schemes for
their special clients (read big general insurance clients) but that covered an
insignificant no. of employees and their families.
• From mid ‘80s, the mediclaim scheme which is an individual hospitalization
policy and does not cover comprehensive healthcare was started.
• This picked up momentum gradually and entered the growth phase around 1998
but even today covers pr one percent of the population.
• The public sector insurance companies gross annual premiums of Rs 10 billion for
mediclaim policies from 10 million insured lives.
• In the last few years, some private insurance companies have also entered the fray
but they are as yet very small players having less than 10 percent of the market
share.
• Insurance persons predicts that mediclaim is slated to touch 50 million persons in
the next two years with the rapidly escalating cost of private healthcare as also
extension of user fees in public hospitals
• The private insurance companies are also slated to capture an increased market
share in this business.
30
6. Explain the Evolution of Healthcare Management in India?
Historical Background of Healthcare Management:
1. Introduction:
The history of medical record parallels the history of medicine. Primitive
medical records carved in wood and chipped in stone date back to approximately
25000 B.C. In subsequent centuries, hieroglyphics found on parchments recorded
scientific progress. Although, these chronicles preserve medical achievement of those
eras for later generations.
2. Flourishing of medical practice in India:
Ample evidence exists to substantiate the flourishing of medical practice in
India many centuries before the birth of Christ. Art forms such as the icons, friezes,
and frescoes in the caves and temples of Ajanta and Ellore and on the Buddhist Stupas
of Amaravathi and Nagarjuna Konda portray medical concepts.
There are innumerable references to the science of medicine and surgery in
Indian epics like Mahabharata and Ramayana. The earliest documentation of medical
practice in India is found in Athervaveda. The first Indian textbook of medicine
Atreya Samhita was written by the sage Atreya during the Sutra period following the
Vedic ages; this book united previously scattered medical care details into a
comprehensive compendium. Agnivesa Samhita also documents the art of healing in a
textbook containing about twelve thousand verses.
3. First Indian Textbook of Surgery:
Charka Samhita represents the view of points of numerous scholars through
many centuries, beginning with practices during the period of Agnivesa and ending
with those propounded by Dridhabala fifteen centuries later. This Samhita excellently
records a glorious period of creative Indian medicine.
31
Susruta Samhita became the first Indian textbook of surgery, describing twenty
sharp and one-hundred-and-one blunt surgical instruments, methods of preparation for
major surgery, and native methods for anesthesia administration.
Ashtanga Hridaya by Vegabhatta described surgical procedures and discussed
innovative drugs for medical care. The translation of this work form Sanskrit to
Persian by Ali Mohammed Ben Ali Ismail Asavali Asseli as Tibb Shifa Mohammed
Sahi is considered an outstanding masterpiece.
4. Unani Tibba System of Medicine:
Unani Tibba System of Medicine with origins tracing to ancient Greek
medicine, was introduced into India by Muslim rulers by the Thirteenth Century A.D.,
this system of medicine was firmly entrenched in places like Delhi, Aligarh, Lucknow
and Hyderabad. The Hakims who practiced this system quite willingly also utilized the
effective drugs of the Ayurveda system and included them in their Pharmacopoeia.
5. Decline in the indigenous system of medicine:
The successive invasions of India and eventual British Colonial Rule of India
evoked a decline in the indigenous system of medicine. Allopathic medical
missionaries arrived form other countries to establish hospitals and dispensaries.
Modern medicine was introduced into India by the Portuguese in the Sixteenth
Century. In 1510, Albuquerque founded the first Indian hospital, the Royal Hospital in
Goa. This hospital highly touted as one of the finest worldwide, was transferred to
Jesuit control in 1591. Rudimentary medical teaching began there in 1703 and by 1842
a complete school of medicine and surgery was extant. The Ecole de Pondicherry was
a school of medicine established in India by the French government in 1823.
The Medical Department of the East India Company was created in 1740. This
unit was comprised of British military surgeons and their local assistants. A committee
appointed by Lord William Bent nick drafted the principles of a medical curriculum in
32
1833. This effort culminated with the establishment of Madras Military Medical
School in 1835. A medical college was opened in Calcutta in January 1836, and the
Grant Medical College in Bombay was opened in November 1845 under the auspices
of Sir Robert Grant, the then Governor of Bombay. Homeopathy, which Samuel
Heinemann (1755-1843) of Germany propounded, gained a foothold in India between
1819 and 1839. This system of pharmacodynamics is based on natural laws of cure.
Homeopathy is practiced in numerous countries worldwide, but India claims to have
the largest number of practitioners of this system.
Prior to Independence:
The struggle for independence went on for decades coupled with the First and
Second World War, there was a great vacuum in the development of medical and
medical record system; although it is well-known, medicine and medical records go
together, due to unknown reasons the status of medical records in India prior to fifties
was deplorable.
There was only a vague concept of the value of medical records among the e
professional staff. Establishing or ensuring the proper functioning of the medical
records departments in hospitals and health institutions was absent. Many hospitals
had no medical record departments; records were bundled and kept in wards, store
rooms only for a short duration.
The basic forms required for a complete record and vital laboratory, x-ray and
other tests necessary for establishing a correct diagnoses, were absent. The
International Classification of Diseases was not known to many medical people. As
for statistics, there was no insight as to what type of statistics were important and why,
and need for standardized procedures on collecting, compiling and reporting was also
absent.
1. Primary Health Care Center:
33
Earlier during the sixties and seventies the medical record system in PHCs was
very poor, majority of the health centers i.e. 90 to 95% of them depended much upon
the registers maintained for administrative and other purposes and patient information
was disintegrated. Very few teaching hospitals especially mission hospitals had special
record forms. Majority of the population in India sought healthcare mainly through
primary healthcare centers or sub-centers specially people living in rural areas.
2. Outpatient Record System:
The people in urban and cities used primarily, the outpatient services and the
medical record systems utilized in these outpatient services can be broadly classified
into two categories namely the:
(i) Outpatient slip/chit system
(ii) Departmental record system
(i) Outpatient Slip/Chit System:
More than 90 -95% both large and small hospitals in India employed Outpatient
slip/chit system. Although a simple, economical, and time saving procedure, the
slip/chit system is inadequate from the stand point of comprehensive patient care
Clinicians, administrators, and even patients were convinced of the deficiencies
of this method. The outpatient chit supplies the patient with an identity card and also
served as a treatment chart. Frequently, patients lose or misplace the outpatient slip and
then register as a new case on subsequent episode of care.
(ii) Departmental Record System:
Although superior to the outpatient slip system, this departmental record system
used in outpatient of hospitals also lacked effectiveness. The system consists of
departmental outpatient cards designed to meet the needs of each clinical specialty
(cardiology, neurology, obstetrics, psychiatry and so forth...)
34
The unit record is not achieved with this system because each specialty
department registered patients directly and maintained its own record system. Patients
do not have custody of their records. If a patient visits four separate clinical
departments for treatment, that patient will have four separate health records. Records
from a particular department are generally not available to other clinical departments;
as a result, a composition health history of an individual patient is not readily
available.
3. Inpatient Record System:
The inpatient record system was greatly organized and records were of book
type with sheets measuring thirteen inches by eight inches.
With each facility standard forms are utilized for the history and physical
examination report, the report of diagnostic investigations, operative report, treatment
and progress notes, intake and output record, authorization for release and records of
linen, room rent collection, messages to police, and so on…
The majority of hospitals in India had an admission office for admitting
patients. The inpatient chart originates with the admission office and is sent to the
ward along with the patient. The ward nurse was responsible for this record until the
patient was discharged from the hospital.
Certain hospitals returned discharged patients charts to the admission office on a
weekly basis where the admission clerk enters statistical data into admission/accession
register.
Post Independence:
India attained independence in the year 1947 and became Sovereign Republic in
the year 1950, since then the Government of India has been making all efforts to
develop simultaneously many national programs such as agriculture, industry,
communication and healthcare service for its large population.
35
1. Establishment of Central Bureau of Health Intelligence (CBHI):
In 1958, on the recommendation of Douglas Burdick, Health Division of
Planning Commission to improve the teaching hospital records.
Then the Government of India (GOI) established the Central Bureau of Health
Intelligence (CBHI) in the year 1961 to function as the National Nodal Institute of the
Director General of Health Services (Dte. GHS), Ministry of Health and Family
Welfare (MOHFW), GOI. Its objectives include providing ready information on
National Health Profile of India envisaging demography, healthcare, morbidity and
mortality indicators, as well as medical/paramedical education and infrastructure in the
country.
2. Appointment of A. L. Mudaliar's Committee:
The Government appointed "A. L. Mudaliar's Committee" in the year 1964,
which recommended "Provision made in the 4th 5 year plan to establish MRDs in
Teaching Hospitals". In accordance with the committee's proposal, the Central Council
of Health in its Srinagar Session in October 1964 passed the following resolutions:
"The Central Council of Health Recognizing the important role played by Medical
Records in efficient hospital care and Teaching and Research recommend that the
available training facilities in medical records may be fully utilized and adequate
provision made in the 4th Five year plan for proper medical records department
(MRD) in all teaching and major hospitals in the country".
3. Establishing of MRD to improve healthcare in all the Teaching and Major
Hospitals:
The Government of India as a follow up action sanctioned 50% of grants for
those who establish the medical record department (MRD) in their hospitals. This
facility was availed by many and many teaching and major hospitals have established
MRDs. The Christian Medical College Hospital (CMCH) and Jawaharlal Postgraduate
Medical Education and Research hospitals (JIPMER) were the only two institutes had
36
comprehensive medical records system at par with international standards that were
able to meet excellent patient care, medical education and research programs.
Hospital Information Systems as an International Perspective:
1. Hospital Information System:
Since the early beginning in the 1960s, hospital information system (HISs) has
been developed to cover both administrative and medical functions. However, it must
be recognized that the first systems often focused on the billing and are reimbursement
aspects of hospital activities.
These systems were designed to provide a money-oriented return on investment
and streamline patient admissions. The system included managed appointments and
provided (stand-alone) ancillary services for hospital laboratories, the pharmacy and
radiology departments to support existing manual procedures without adding value,
and they functioned as a bonding element among the many disparate systems inside
and outside the hospital.
The 1980s saw the implementation of two nearly worldwide changes with a
significant impact on the way computer applications were used in hospitals. On one
hand, reimbursement systems gradually evolved from a free-for-service basis to a
fixed budget system where figures on resource consumption played a central role. On
the other hand, medical systems initially developed to simply automate existing
processes became systems supporting physicians, nurses, and other healthcare
providers in their daily patient care activities. The aim was to attempt to guarantee
standards of care and lead to improved levels of decision making.
Health care data are the source of healthcare information, so it stands to reason
that a health care organization cannot have high quality healthcare information without
first establishing that it has high-quality healthcare data.
37
Data quality must be established at the most granular level. Much healthcare
information is gathered through patient care documentation by clinical providers and
administrative staff. In the new millennium, information technology will catalyze
dramatic change in many aspects of medicine, including patient records. Good medical
care requires accurate records of greater detail than in the past. Malpractice protection
mandates more organized and complete records.
Third party payers are requiring more justification for the expenses generated by
physicians' actions. Today's economics require more efficient and cost-effective
methods of keeping the patient's clinical records.
2. Telemedicine:
Telemedicine is distance consultation among health professionals or between
health professionals and patients by use of telecommunications technology such as
real-time audio or visual systems, most notably video conferencing.
The potential advantages are obvious in dispersed communities (rural areas)
where expertise is thinly spread, and when traveling is difficult or inconvenient for
doctor or patient.
Uses are wide and varied and include direct interview and history taking,
observation of physical signs, and distance reporting of imaging procedures. The
location of consultation varies from hospital inpatient and outpatient settings, to
broader residential and home settings, and even outer space.
3. Internet and Web-based Medical Communication:
The Internet is a means to improve health and health care delivery, its full
utilization is not clear. Nevertheless, an increasing proportion of the public is using the
Internet for health information.
The advantages of the Internet as a source of health information include
convenient access to a massive volume of information, ease of updating information,
38
and the potential for interactive formats that promote understanding and retention of
information. Health information on the Internet may make patients better informed,
leading to better health outcomes, more appropriate use of health service resources,
and a stronger physician-patient relationship.
The Healthcare Delivery System in India:
1. Primary Health Care:
India is one the few countries in the world that have well established primary
healthcare delivery and health information system interlinking with all different types
of centers.
The current health information system by and large was paper based on the
MOHFW had already launched the integrated Disease Surveillance Project (IDSP) in
the country with weekly health information flow through computerized and satellite-
based system from each district up to the national level. The following figures of two
distinct periods show the progress made by India.
39
2. Information and Communication Technology (ICTs):
ICT has a significant role to play in health care delivery to reach nook and
corner of the rural India. More than 70% of population is living in most peripheral and
difficult terrain with least access to certain basic health facilities.
The MOHFW in collaboration with the Ministry of Information,
Communication and Technology, the National Rural Health Mission (NRHM) of
MOHFW is working out to strengthening the infrastructure, services to utilizing the
ICTs for utmost benefit of needy to the optimum. The CBHI is using ICT for public
health and welfare include:
(a) Electronic health information flow from the periphery upwards under primary
healthcare delivery system in India.
40
(b) Road safety profile of India as prepared by CBHI/Dte.GHS in collaboration with
various stakeholders in the country,
(c) Road traffic injury surveillance while linking more than 140 Trauma Centers being
developed in the Dte.GHS/MOHFW. (d) The disaster management and related
surveillance mechanism. The MOHFW/GOI in this course, include computerized and
satellite based health information and surveillance systems (viz. IDSP), web based on-
line health data inputs and reports generation, video-conference, reviews, training,
education and telemedicine linking peripheral, secondary and tertiary hospitals in
India..
Hospital Information Systems as an Indian Perspective
1. Computerized Patient Records: Health care industry is one of the most
information intensive and technologically advanced in our society. Thus, the
information should be accessible easily, timely, complete, accurate, reliable and
relevant information in making important strategic or patient care decisions.
The end objective of medical informatics is the integration of data, knowledge,
and tools necessary to apply that data and knowledge in the decision-making process
associated with patient care.
2. Though India has transformed its healthcare delivery system dramatically during
last one decade.
As being large country with huge population and budgetary limitations, majority
of government hospitals have not fully implemented the electronic health record
systems.
However, some major corporate hospitals have been using the computerized
systems, mainly for administrative and financial purposes and with limited clinical
aspects.
41
Those who claim to have fully computerized also lack interoperability.
Therefore, there is a dire need to establish uniform computerized system in all the
health institutions by observing certain norms as recommended by international
organizations for implementation of hospital information systems.
It is foreseen that by 2015 many countries would have automated all their health
institutions by paperless records. India cannot afford to lag behind.
3. Transformation from manual to electronic system:
To be more precise, the entire hospital system that is being practiced with the
manual or hybrid system has to be completely transformed into electronic by using the
latest information technology for example; HIS which contains the domain
functionality; flowcharts, screens, database that are developed, tested and produced as
application software for implementation in order to convert a hospital into a
computerized format.
Application Domain: The application layer to include: Patient management, Medical
care, Nursing, Medical support, Administrative, Ancillary services. The information
Bus deals with services.
The middleware layer should include: Authorization component, Patient
component, Activity component, Resource component, and Healthcare record and
Knowledge component. The persistent layer related to Images, Bio-signals,
alphanumeric data, Web pages.
While developing the electronic hospital information system, in order to achieve
interoperability, portability and data exchange health care information system must
apply standards. Some of the standards are as follows:
ISO; HL7;HIPAA; ICD; PACS'; DICOM;ASTM;SNOMED;CPT, etc
42
Clinical alerts reminding system.
Drug - Drug; Drug -- Laboratory; Drug - Pregnancy;
Drug - Condition; Drug - pediatric; Drug – Duplication
Signal processing (EEG, EMG, ECG): Computers are useful devices for processing
electrical signals from various sources, such as ECG for detection of heart
dysrhythmias and EEG for analysis and detection of spike and sharp waves that can
sometimes be missed by the neurologist.
Image Processing: Image processing (radiography, US, CT scanning,
MRI/MRA, SPECT/PET scanning, cerebral angiography) 3.6 Decision Support
System: Decision support systems are real-time computerized algorithms that help
physicians in their clinical practice. -specific information.
43
Provider Order Entry Systems: Computer -based provider order entry (CPOE)
systems are potential benefits in terms of a improving the quality of patient care and
reducing the costs.
Requirements for the Implementation of EHR Systems:
The transition from handwritten paper medical records to electronic health
records is essentially linked to the following challenging issues.
The development of a (standard) healthcare record structure within healthcare
organization Merging the EHR component with other health information system
components A common medical terminology; to avoid incompatibilities and to
guarantee the consistency, reusability, and sharability of the different components of a
larger system.
The increased availability of communication facilities to internal and external
healthcare providers (e.g., GPs, other healthcare organizations). An adequate
formalization of medical knowledge to accommodate users with more intelligent
features.
The availability of an audit train to facilitate the detection of data alteration and
to address potential security violations Scalability: Multidisciplinary institutions
require an HER system that can readily scale as the institution grows while
maintaining local ownership of data.
The automatic availability of a central comprehensive information responsibility
for healthcare policymakers (providers, hospital managers) to define future policies by
analyzing the past on several levels.
Future of Health Records:
The future of the Health Records is said to be the Personal Health Records
(PHR) PHR is an electronic repository in which a person can store his or her health-
44
related information securely and privately and also share that information with
multiple health care providers or others are the patient's discretion.
PHRs will give patients access to tools for managing this information, some of
which patients will enter themselves and some which will come from their clinical
care provider, pharmacy, a public heath authority, or other sources.
Information related to population health and even climate and environment
conditions, will be stores and integrated in a way that prompts patients to take
appropriate action. The information will be accessible whenever and wherever an
authorized user needs it. PHR from Public Health point of view: have an easily
accessible and navigable. This would enable public health experts to spot health trends
early, which is critical for detecting viral outbreaks like avian flue.
Recommendations:
1 The GOI has to integrate all the health institutions of the country stating from
primary, secondary and tertiary care hospitals by electronic health records with
interoperability to maintain a single unique record with unique number for each
patient; (i.e. the concept of one-patient one- number-one- and-one -record to maintain
continuity from birth to death. 2 The GOI with MCI and other organizations have to
develop Accreditation standards for healthcare delivery at par with international
standards to maintain certain level of health quality.
45
FIGURE: THE HUB OF CLINICAL INFORMATION SYSTEMS
46
7. Explain the role of internet in medicine?
Introduction:
• The internet is the global network of computers and online services providing
worldwide communication.
• ARPANET (Advanced Research Project Agency) began in1969 as an experiment
in resource sharing and provided survivable high bandwidth communication link
between major existing computational resources, and computer in education
industrial and govt. research laboratories.
• It served acts as a test for the development of advanced network protocols
including Transmission control Protocols (TCP) and Internet Protocol (IP) which
introduced the idea of inter-working, allowing networks of different technology
and connection protocols to be linked together while providing a unified internet
work addressing scheme and a common set of transport and application protocol.
Connecting to the internet:
• The computers that connect to the internet via telephone lines need a kind of
interpreter called SLIP (Serial line Internet Protocol) or PPP (Point-to-Point
Protocol).
Internet Services –overview:
Three primary internet applications are
• File Transfer Protocol (FTP)
• Telnet.
Electronic mail:
• It allows you to send message from your computer to another, either as a personal
message, or to a group of people via mailing list or news group.
47
File Transfer Protocol:
• It allows to upload or download files.
Telnet:
• Lets you log in remotely to other computers and uses them as if you were
physically present at a terminal in the same location.
Information Retrieval Tools:
The most important secondary applications are information retrieval tools. There are
• Archie
• Gophers
• WAIS
• WWW
Archie:
• It is searchable database of the location of the files that are available for the public
to download.
Gophers:
• It organize information in different computers into a menu and , with the help of
Veronica, can lead to relevant resources.
WAIS:
• It goes further than Archie and can search content of files lookink for a match to
your query.
WWW:
• Gopher and WWW link together as sorted elements so seamlessly that their
element applications are known as Browsers for Accessing resources.
Searching the medical web:
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• There are several large multi-subjected catalogues of internet resources that cover
medical topics, often dividing resources by clinical specialty or general health and
medical subject headings.
• Directories characteristically lend themselves to causal browsing.
• The biggest advantage of manually created directories is their ability to include an
annotation describing the resources when present.
EX:
OMNI (Organizing Medical networked information):
• It is founded by the joint Information System Committee (JISC) of the UK and
operated by a consortium including the British Medical Research Council, the
British Medical Association Library, the Welcome Centre for Medical Science
and others.
• It is a searchable subject-based catalogue of the UK and Global medical education
and research resources, providing a description of each resources.
• URL:http://omni.ac.Uk/
Medweb:
• From the Emory University of health Science Centre Library is a popular and
well-supported North American Resources
URL:http//www.emory.edu/WHSCL/medweb.html
Cliniweb:
• From the Oregon health Science University is a browsable index of clinically
relevant information at the level of individual www pages, using the MeSH
disease tree.
• Searches are mapped to the closest available MeSH term
<URL:http://www.arcade:uniowa.edu/hardin_www/md.html
Use of internet in Medicine:
• Various groups are developing medicine-related internet resources that utilize e-
mail, FTP, Gopher, WAIS and WWW to make online text, graphics, and
multimedia medical content available.
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• In September 1995, the European society for internet in medicine was established
for promoting the use of the internet in medical sciences.
• In October 1996, the society hosted MEDNET 96, the first European congress of
the internet in medicine.
• For both individuals as well as healthcare organizations, the internet provides vast
resources including electronic journals and books; access to medical database
such as cancer net –a collection of documents relating to cancer diagnosis and
management, telemedicine protocols, computer assisted learning, etc.
8. EXPLAIN THE COMPONENTS OF MULTIMEDIA?
TEXT REPRESENTATION
ASCII:
The most commonly used character encoding is ASCII (American Standard Code
for Information Interchange), a 7-bit encoding developed by the American
National Standards body.
ASCII codes are usually stored in 8-bit bytes, but a byte can represent 256 values,
twice as many as the 128 needed for ASCII
ISO CHARACTER SETS:
The main shortcoming of ASCII is its lack of support for non-English text.
ISO Encoding are becoming widely used, appearing, e.g.In The X Window
System, post script, and international versions of Software packages.
MARKED – UP TEXT:
Printed text has both from and content. While content may be represented by a
sequence of characters, the form of a document, its visual presentation structure,
remain an elusive quantity.
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For a clear content it does not specify presentation structure and additional
information which is needed.
STRUCTURED TEXT:
When tags are used, structural information is dispersed throughout the text.
Document editors must scan and parse the text in order to extract this information
and build representations that can be processed more efficiently.
HYPER TEXT
Although text has a hierarchical structure from the perspective of Lay out and
logical organization.
Hyper Text or nonlinear text has instead a graph – like structure.
TEXT OPERATIONS:
Character Operations
The simplest operations on text deal with individual characters and are the
building blocks for more complicated text processing.
Many programming languages support a character data type
STRING OPERATIONS:
Characters are often grouped into strings
Data structures containing sequences of characters
EDITING:
Editing operations are used to modify the form and content of documents
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The simplest editing operations are the familiar inserts / delete and Cut / copy /
paste
FORMATTING:
Formatting is the process of applying lay out specification to text
Text formatting is either interactive or non interactive
In the first case, the formatter operates in parallel with an editor
PATTERN MATCHING AND SEARCHING:
Most editors provide a search and replace command based on the ability to
recognize a pattern within the text
A wide range of patterns can be formally represented by regular expressions
SORTING:
Computer scientists have exhaustively studied sorting algorithms and their time
and space requirements are well known
ENCRYPTION:
Text encryption is increasing in use with a spread of electronic mail and other
network services.
One commonly used method is DES (Data Encryption Standard)
LANGUAGE – SPECIFIC OPERATIONS:
The operations described above are language independent. They can be applied to
text containing English, French, or any other language for which a character
encoding exists
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There are other operations, which make use of knowledge about specific
languages
These operations include spell – check, parsing, and the statistical analysis of
writing style
SOUND:
It is the most sensuous element of multimedia
MULTIMEDIA SYSTEM SOUNDS:
We can use sound right off the bat on both the Macintosh and on a multimedia PC
running Windows because system beeps and warnings are as soon as we install
the operating system
On the Macintosh, we can choose one of several sounds for the system beep, to
indicate an error or warning
MIDI VERSUS DIGITAL AUDIO:
MIDI (MUSICAL INSTRUMENT DIGITAL INTERFACE)
It is a communications standard developed in the early 1980s for electronic
musical instruments and computers
It allows music and sound synthesizers from different manufactures to
communicate with each other by sending messages along cables connected to the
devices
DIGITAL AUDIO:
We can digitize sound from a microphone, a synthesizer, and existing taper
recordings, live radio and television broadcasts, popular CDs and our favorite
long – playing records
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Digitized sound is sample sound. In each and every fraction, a sample of sound is
taken and stored as digital information in bits and bytes
MAKING MIDI AUDIO:
Composing our own original score can be one of the most creative and rewording
aspects of building a multimedia project, and MIDI is the quickest, easiest, and
most flexible tool for this task
To make MIDI scores, we need sequencer software, and a sound synthesizer
A MIDI keyboard is useful to simplify the creation of musical scores
AUDO FILE FORMATS:
A sound files format is simply a recognized methodology for organizing the
digitize sound’s data bits and bytes into a data file
The structure of the file must be known, of course, before the data can be saved or
later loaded into a computer to be edited or played as sound
On the Macintosh, Digitized sounds may be stored as data files or they may be
Stored as resources in the resource fork of the system or Application as SNDs
ADDING SOUND TO OUR MULTIMEDIA PROJECT:
Decide what kind of sound is needed. Decide where audio events will occur in
the flow of our project. Fit the sound cues into our storyboard, or makeup a cue
sheet
Decide where and when to use either digital or MIDI Data
Acquire source material by creating it from scratch or Purchasing it
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Edit the sounds to fit out project
Test the sounds to be sure they are times properly with the Project’s images.
IMAGES:
MAKING STILL IMAGES
Still images may be small or large, or even full screen
They may be colored, placed at random on the screen, evenly geometric or oddly
shaped
BITMAPS:
A bitmap is a simple information matrix describing the individual dots that are the
smallest elements of resolution on a computer screen or other display or printing
device.
A one-dimensional matrix is required for monochrome, greater depth is required
to describe the more that 16 million colors.
The picture elements can be either on or off, or can represent varying shades of
color.
CLIP ART:
If we do not want to make our own, we can get bitmaps from suppliers of clip art,
and from photograph suppliers who have already digitized the images for us
Clip are is available on floppy disks, on CD-ROMs, and through online services
BITMAP SOFTWARE:
Most multimedia authoring tools bitmap – editing features
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Director includes a powerful image editor that provides advanced tools such as
onion skinning and image filtering using common plug – ins from photo shop and
other third – party designers
3-D MODELING:
Creating objects in the dimensions on a computer screen can be difficult for
designers used for drawing squares, circles, and other width and height geo
metrics on a two-dimensional monitor screen
For 3-D, the depth of cubes and spheres must be calculated and displayed in the
perspective of the rendered object seems correct to the eye
COLOR:
Color is a vital component of multimedia
UNDERSTANDING NATURAL LIGHT AND COLOR:
Light comes from an atom when an electron passes from a higher to a lower
energy level
Each atom produces uniquely specific colors. This explanation of light, known as
the quantum theory
Color is the frequency of a light wave within the narrow band of the
electromagnetic spectrum to which the human eye responds
COMPUTERIZED COLOR:
MONITORS AND COLOR:
Most multimedia is presented on color monitors that display a matrix of 640
pixels across and 480 pixels down. Each pixel may be one of 256 colors
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The 640* 480, 250-color setup is called VGA (Video graphics Array) and it is the
default configuration for most Windows and Macintosh multimedia systems
COMPUTER COLOR MODELS:
The color of a pixel on our computer monitor is expressed as an amount of red,
green and blue.
It takes more computer memory and processing speed to Digitally manage and
display the greater combinations of red, Green and blue values that make more
shades of color visible to the eye
Models use to specify colors in computer terms are RGB, HSB, HSC, CMYK,
CIE and others
COLOR PALETTES:
Palettes are mathematical tables that define the color of a pixel displayed on the
screen
On the on the Macintosh, tables are called color lookup tables
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