Biomedical informatics computer applications in health care and biomedicine

Edward H Shortliffe James J Cimino Editors Biomedical Informatics Computer Applications in Health Care and Biomedicine Fourth Edition 123 Biomedical Informatics Edward H Shortliffe • James J Cimino Editors Biomedical Informatics Computer Applications in Health Care and Biomedicine Fourth Edition Editors Edward H Shortliffe, MD, PhD Departments of Biomedical Informatics at Columbia University and Arizona State University New York, NY USA James J Cimino, MD Bethesda, MD USA ISBN 978-1-4471-4473-1 ISBN 978-1-4471-4474-8 DOI 10.1007/978-1-4471-4474-8 Springer London Heidelberg New York Dordrecht (eBook) Library of Congress Control Number: 2013955588 © Springer-Verlag London 2014 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer Permissions for use may be obtained through RightsLink at the Copyright Clearance Center Violations are liable to prosecution under the respective Copyright Law The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made The publisher makes no warranty, express or implied, with respect to the material contained herein Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Dedicated to Homer R Warner, MD, PhD, FACMI A Principal Founder of the Field of Biomedical Informatics 1922–2012 The Fourth Edition of Biomedical Informatics: Computer Applications in Health Care and Biomedicine is dedicated to the memory and professional contributions of Homer R Warner Homer was not only a pioneer in biomedical informatics but a sustained contributor who is truly one of the founders of the field that mourned his loss in November of 2012 Homer’s publications on the use of computers in health care span 50 years, from 1963 to 2012, but he can claim an additional decade of informatics research that predated digital computer use, including the use of analog computers and mathematical models ranging from details of cardiac function all the way up to medical diagnosis.1 He is best known for his development of the Health Evaluation through Logical Processing (HELP) system, which was revolutionary in its own right as a hospital information system, but was truly visionary in its inclusion of the logical modules for generating alerts and reminders The HELP system, Warner, H R., Toronto, A F., Veasey, L G., & Stephenson, R 1961 A mathematical approach to medical diagnosis Application to congenital heart disease JAMA: The Journal of the American Medical Association, 177, 177–183 begun in 1968, is still running today at the LDS Hospital in Salt Lake City; innovations are continually added while commercial systems struggle to replicate functions that HELP has had for almost half a century Homer’s other contributions are far too numerous to recount here, but you will find them described in no less than six different chapters of this book Homer’s contributions go far beyond merely the scientific foundation of biomedical informatics He also provided extensive leadership to define informatics as a separate academic field He accomplished this in many settings; locally by founding the first degree-granting informatics department at the University of Utah, nationally as the President of the American College of Medical Informatics, and internationally as the founding editor of the well-known and influential journal Computers and Biomedical Research (now the Journal of Biomedical Informatics) But perhaps his greatest impact is the generations of researchers and trainees that he personally inspired who have gone on to mentor additional researchers and trainees who together are the life blood of biomedical informatics Homer’s true influence on the field is therefore incalculable Just consider the convenience sample of this book’s 60 chapter co-authors: the following diagram shows his lineage of professional influence on 52 of us.2 Both of us were privileged to have many professional and personal interactions with Homer and we were always struck by his enthusiasm, energy, humor, generosity, and integrity In 1994, Homer received the American College of Medical Informatics’ highest honor, the Morris F Collen Award of Excellence We are proud to have this opportunity to add to the recognition of Homer’s life and career with this dedication James J Cimino Edward H Shortliffe Homer R Warner Scott Narus Valerie Florance Stanley M Huff Clement J McDonald Randolph A Miller G Octo Barnett Charles P Friedman Scott Evans Reed M Gardner Terry Clemmer Paul D Clayton W Edward Hammond Peter Szolovits David Vawdrey Judy G Ozbolt Carol Friedman Roger B Mark Kenneth W Goodman James J Cimino Lynn Vogel Issac Kohane William A Yasnoff Robert A Greenes Kenneth Mandl George Hripcsak Vimla L Patel Edward H Shortliffe William Hersh Peter Embi David R Kaufman Adam Wilcox Noémie Elhadad David W Bates Justin B Starren Douglas K Owens Parvati Dev Robert Rudin Philip Payne Michael Chiang Paul C Tang Holly Jimison Kevin B Johnson Russ B Altman Blackford Middleton Mark A Musen James Brinkley Mark E Frisse Suzanne Bakken Jonathan Silverstein Jessica Tenenbaum Sean D Mooney Patricia Dykes Daniel L Rubin Nigam Shah Ian Foster Paul Clayton and Peter Szolovits provide important connections between Homer Warner and ten coauthors but, while they are informatics leaders in their own right, they are not contributors to this edition of this book Preface to the Fourth Edition The world of biomedical research and health care has changed remarkably in the 25 years since the first edition of this book was undertaken So too has the world of computing and communications and thus the underlying scientific issues that sit at the intersections among biomedical science, patient care, public health, and information technology It is no longer necessary to argue that it has become impossible to practice modern medicine, or to conduct modern biological research, without information technologies Since the initiation of the human genome project two decades ago, life scientists have been generating data at a rate that defies traditional methods for information management and data analysis Health professionals also are constantly reminded that a large percentage of their activities relates to information management—for example, obtaining and recording information about patients, consulting colleagues, reading and assessing the scientific literature, planning diagnostic procedures, devising strategies for patient care, interpreting results of laboratory and radiologic studies, or conducting case-based and population-based research It is complexity and uncertainty, plus society’s overriding concern for patient well-being, and the resulting need for optimal decision making, that set medicine and health apart from many other information-intensive fields Our desire to provide the best possible health and health care for our society gives a special significance to the effective organization and management of the huge bodies of data with which health professionals and biomedical researchers must deal It also suggests the need for specialized approaches and for skilled scientists who are knowledgeable about human biology, clinical care, information technologies, and the scientific issues that drive the effective use of such technologies in the biomedical context Information Management in Biomedicine The clinical and research influence of biomedical-computing systems is remarkably broad Clinical information systems, which provide communication and information-management functions, are now installed in essentially all healthcare institutions Physicians can search entire drug indexes in a few seconds, using the information provided by a computer program to anticipate harmful side effects or drug interactions Electrocardiograms (ECGs) are typically analyzed initially by computer programs, and similar techniques are being applied for interpretation of pulmonary-function tests and a variety of vii viii Preface to the Fourth Edition laboratory and radiologic abnormalities Devices with embedded processors routinely monitor patients and provide warnings in critical-care settings, such as the intensive-care unit (ICU) or the operating room Both biomedical researchers and clinicians regularly use computer programs to search the medical literature, and modern clinical research would be severely hampered without computer-based data-storage techniques and statistical analysis systems Advanced decision-support tools also are emerging from research laboratories, are being integrated with patient-care systems, and are beginning to have a profound effect on the way medicine is practiced Despite this extensive use of computers in healthcare settings and biomedical research, and a resulting expansion of interest in learning more about biomedical computing, many life scientists, health-science students, and professionals have found it difficult to obtain a comprehensive and rigorous, but nontechnical, overview of the field Both practitioners and basic scientists are recognizing that thorough preparation for their professional futures requires that they gain an understanding of the state of the art in biomedical computing, of the current and future capabilities and limitations of the technology, and of the way in which such developments fit within the scientific, social, and financial context of biomedicine and our healthcare system In turn, the future of the biomedical computing field will be largely determined by how well health professionals and biomedical scientists are prepared to guide and to capitalize upon the discipline’s development This book is intended to meet this growing need for such well-equipped professionals The first edition appeared in 1990 (published by Addison-Wesley) and was used extensively in courses on medical informatics throughout the world It was updated with a second edition (published by Springer) in 2000, responding to the remarkable changes that occurred during the 1990s, most notably the introduction of the World Wide Web and its impact on adoption and acceptance of the Internet The third edition (again published by Springer) appeared in 2006, reflecting the ongoing rapid evolution of both technology and health- and biomedically-related applications, plus the emerging government recognition of the key role that health information technology would need to play in promoting quality, safety, and efficiency in patient care With that edition the title of the book was changed from Medical Informatics to Biomedical Informatics, reflecting (as is discussed in Chap 1) both the increasing breadth of the basic discipline and the evolving new name for academic units, societies, research programs, and publications in the field Like the first three editions, this new version provides a conceptual framework for learning about the science that underlies applications of computing and communications technology in biomedicine and health care, for understanding the state of the art in computer applications in clinical care and biology, for critiquing existing systems, and for anticipating future directions that the field may take In many respects, this new edition is very different from its predecessors, however Most importantly, it reflects the remarkable changes in computing and communications that continue to occur, most notably in communications, networking, and health information technology policy, and the exploding interest in the role that information technology must play in systems integration and the melding of genomics with innovations in clinical practice and Preface to the Fourth Edition ix treatment In addition, new chapters have been introduced, one (healthcare financing) was eliminated, while others have been revamped We have introduced new chapters on the health information infrastructure, consumer health informatics, telemedicine, translational bioinformatics, clinical research informatics, and health information technology policy Most of the previous chapters have undergone extensive revisions Those readers who are familiar with the first three editions will find that the organization and philosophy are unchanged, but the content is either new or extensively updated.1 This book differs from other introductions to the field in its broad coverage and in its emphasis on the field’s conceptual underpinnings rather than on technical details Our book presumes no health- or computer-science background, but it does assume that you are interested in a comprehensive summary of the field that stresses the underlying concepts, and that introduces technical details only to the extent that they are necessary to meet the principal goal It thus differs from an impressive early text in the field (Ledley 1965) that emphasized technical details but did not dwell on the broader social and clinical context in which biomedical computing systems are developed and implemented Overview and Guide to Use of This book This book is written as a text so that it can be used in formal courses, but we have adopted a broad view of the population for whom it is intended Thus, it may be used not only by students of medicine and of the other health professions, but also as an introductory text by future biomedical informatics professionals, as well as for self-study and for reference by practitioners The book is probably too detailed for use in a 2- or 3-day continuing-education course, although it could be introduced as a reference for further independent study Our principal goal in writing this text is to teach concepts in biomedical informatics—the study of biomedical information and its use in decision making—and to illustrate them in the context of descriptions of representative systems that are in use today or that taught us lessons in the past As you will see, biomedical informatics is more than the study of computers in biomedicine, and we have organized the book to emphasize that point Chapter first sets the stage for the rest of the book by providing a glimpse of the future, defining important terms and concepts, describing the content of the field, explaining the connections between biomedical informatics and related disciplines, and discussing the forces that have influenced research in biomedical informatics and its integration into clinical practice and biological research As with the first three editions, this book has tended to draw both its examples and it contributors from North America There is excellent work in other parts of the world as well, although variations in healthcare systems, and especially financing, tend to change the way in which systems evolve from one country to the next The basic concepts are identical, however, so the book is intended to be useful in educational programs in other parts of the world as well Subject Index Genotype, 698 Geographic information systems (GIS), 503, 507 Georgetown Home Health Care Classification (HHCC), 232 Gestalt psychology, 141 Gigabytes, 153 GINA See Genetic Information Nondiscrimination Act (GINA) GIS See Geographic information systems (GIS) GLIF See GuideLine Interchange Format (GLIF) Global processing, 309 Globus Online, 174 GO See Gene Ontology (GO) Goals, Operators Methods and Selection Rules (GOMS), 130 Google, 630, 633, 807 Google Health, 498, 499, 534, 538 Google Scholar, 623 Gopher, 521 Governance, 432, 458, 513 Government roles, 13, 215, 506 GPU See Graphical processing unit (GPU) GPGPU See General purpose graphical processing unit (GPGPU) GRAIL See GALEN Representation and Integration Language (GRAIL) Grammar, 262 context-free, 263, 266 probabilistic, 262–4, 266 Grammar rule, 266 Grand challenges, 801ff Granularity, 630 Graphical processing unit (GPU), 150, 154 Graphical user interface, 169 Graphs, 735 Grid computing, 182 Group Health Cooperative, 492, 527 Growth charts, 49 GS1, 219 Guardian Angel Manifesto (Proposal), 526 Guideline Element Model (GEM), 668 GuideLine Interchange Format (GLIF), 668 Guidelines See Clinical guidelines Gulf of evaluation, 131 Gulf of execution, 131 H Hadoop, 181 Handovers, 577, 579 Haptic feedback, 154, 555, 595, 682 Harmonic mean, 276 Harrison’s Online, 623 Harvard Medical Practice Study, 134 Harvard University, 208, 747 HCFA (Health Care Financing Administration) former name for Centers for Medicare and Medicaid Services (CMS) HCI See Human-computer interaction (HCI) Head word, 262 951 Health Care Financing Administration (HCFA) former name for Centers for Medicare and Medicaid Services (CMS) Health Desk, 532 Health Evaluation Logical Processing system See HELP System Health Industry Business Communications Council (HIBCC), 247 Health informatics education, 685 Health information exchange (HIE), 207, 404, 425, 790, 801 Health information infrastructure (HII), 17, 404, 423ff, 503, 514, 523 Health Information Management Systems Society (HIMSS), 240 Health information and communications technology (HICT), 542 See also Health information technology Health information technology See EHRs, CPOE, departmental systems, HIE Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH), 17, 331, 341, 349, 405, 415, 427, 470, 478, 483, 534, 535, 647, 788ff, 800 Health information technology policy, 781ff Health Insurance Portability and Accountability Act of 1976 (HIPAA), 12, 245, 276, 338, 349, 392, 418, 428, 454, 486, 550, 610 Health Level (HL7), 12, 204, 216, 218–20, 235, 237, 241, 242, 396, 445, 575, 607, 656, 660, 722, 770 Clinical Document Architecture (CDA), 224, 277, 770 Clinical Genomics Workgroup, 726 Individual Case Safety Reports, 772 Reference Information Model (RIM), 224, 241, 243, 248, 251 Terminfo, 224 Health literacy, 111 Health maintenance organizations (HMOs), 213, 447 Health on the Net Foundation (HON), 522, 535, 618 HON Select, 620 Health promotion, 13 Health Record Banking Alliance (HRBA), 433, 435 Health record banks (HRBs), 434ff Health services research, 756 Health Wise, 532 Healthcare financing, 34 See also Insurance Healthcare informatics See Biomedical informatics Healthcare information systems (HCIS), 443ff Healthcare organizations (HCOs), 443ff Healthcare team, 43 Healthfinder, 620 HealthGate Data Corporation, 532 HealthVault See Microsoft HealthVault HELP (Health Evaluation Logical Processing) System, 304, 487, 563, 576, 578, 580ff, 649, 652ff, 660 Helpers, 174 Heritage Foundation, 435 Heuristic evaluation, 132, 137 Heuristics, 59 See also Cognitive heuristics 952 HGNC See HUGO Gene Nomenclature Committee (HGNC) HHCC See Home Health Care Classification (HHCC) HIBCC See Health Industry Business Communications Council (HIBCC) HICT See health information and communications technology (HICT) HIE See Health information exchange (HIE) Hierarchy, 624 Highwire Press, 616, 634 HII See Health information infrastructure (HII) HIMSS See Health Information Management Systems Society (HIMSS) Hindsight bias, 135 HIPAA See Health Insurance Portability and Accountability Act (HIPAA) HIS See Hospital information systems (HIS) Historical control, 758 HIT See Health information technology (HIT) HITECH See Health Information Technology for Economic and Clinical Health Act (HITECH) HL7 See Health Level (HL7) HMOs See Health maintenance organizations Home computing, 537 Home Health Care Classification (HHCC), 232 Home telehealth, 542, 551–3 monitoring, 558 Home telemedicine unit, 549, 551, 553 HON See Health on the Net Foundation (HON) Hopkins Teen Central, 521, 525 Hospital-acquired infections See Nosocomial infections Hospital information systems, 22, 189, 212, 216, 444 HTML (HyperText Markup Language), 173, 174, 267, 627 HTTP See HyperText Transfer Protocol (HTTP) HUGO Gene Nomenclature Committee (HGNC), 234 Human Brain Project, 306 Human Disease Network, 736 Human factors, 110, 133ff See also Usability Human Gene Mutation Database, 698 Human Genome Project, 55, 251, 696, 711, 723 Human-computer interaction, 110, 128ff See also Usability Hypertext, 174 HyperText Markup Language See HTML (HyperText Markup Language) HyperText Transfer Protocol (HTTP), 173, 206 Hypothesis generation, 60, 63, 256 Hypothesis-driven reasoning, 126 Hypothetico-deductive approach, 60, 70, 125 I I2b2 (Informatics for Integrating Bench and Bedside), 282, 770 IAIMS See Integrated Academic Information Management Systems (IAIMS) ICANN See Internet Corporation for Assigned Names and Numbers (ICANN) Subject Index ICD-10 See International Classification of Diseases, Tenth Revision (ICD-10) ICD-10-CM See International Classification of Diseases, Tenth Revision-Clinical Modifications (ICD-10-CM) ICD-9 See International Classification of Diseases, Ninth Revision ICD-9-CM See International Classification of Diseases, Ninth Revision-Clinical Modifications ICMP See Internet Control Message Protocol (ICMP) Icons ICNP See International Classification of Nursing Practice (ICNP) ICPC See International Classification of Primary Care (ICPC) ICHPPC See International Classification of Health Problems in Primary Care (ICHPPC) IDEATel See Informatics for Diabetes Education and Telemedicine (IDEATel) IDF See Inverse document frequency (IDF) IDF*TF weighting See TF*IDF weighting IDNs See Integrated delivery networks (IDNs) IEEE See Institute of Electrical and Electronics Engineers (IEEE) IHE See Integrating the Healthcare Enterprise (IHE) IHTSDO See International Health Terminology Standards Development Organization (IHTSDO) Image acquisition, 286ff, 600 biomolecular, 597 compression, 544 content representation, 297 database, 622 enhancement, 309 exchange, 609 interpretation, 286, 319ff, 599 link-based, 630 metadata, 299 patches, 311 quality, 295ff quantitation, 310, 321 registration, 317ff rendering, 309 retrieval, 319 segmentation, 313ff Image-guided procedures, 595 Image processing, 286, 307ff Imaging informatics, 28, 285ff, 593 Imaging systems, 593ff iMDSoft, 575 IMIA See International Medical Informatics Association (IMIA) Immersive simulated environments, 129, 682 Immunization registries, 510 informatics issues, 511ff information systems (IIS), 595 Implementation science, 759 IMS Global Learning Consortium, 689 Subject Index Incentive Programs for Electronic Health Records rule, 483, 484 Independent variables, 72, 369 Index, 259 Index Medicus, 614, 704 Indexing, 614, 624ff automated, 624, 628ff controlled terminologies, 624ff manual, 624, 626ff Indirect care, 479 Individualized medicine See Personalized medicine Infectious disease monitoring, 581 Inference, 320 Inflectional morphemes, 261 Influence diagrams, 101ff, 658 Infobutton, 400, 402, 481, 644, 656, 687 InfoPOEMS, 623 InfoRAD, 601 Informatics for Diabetes Education and Telemedicine (IDEATel), 140, 549, 552 Informatics for Integrating Bench and Bedside See i2b2 Information, 19, 58 extraction, 258, 638 management, 443ff model, 303 need, 615 nature of, 32ff needs, 646 requirements, 448 resources, 356 science, 19, 30 structure, 26 theory, 20 Information retrieval (IR), 110, 259, 613ff, 762 evaluation, 634 exact-match, 630, 631 partial-match, 631, 632 retrieval systems, 632ff Ink-jet printers, 155 Input devices, 154 Institute of Electrical and Electronics Engineers (IEEE), 213, 218, 219, 235, 245 Learning technology Standards Committee, 689 Institute of Medicine (IOM), 14, 419, 482, 483, 488, 504, 523, 524, 805 Institutional Review Boards (IRBs), 178, 339, 761 Insurance, 444 Blue Cross, 444 Blue Shield, 444 Medicaid, 444 Medicare, 444 Integrated Academic Information Management Systems (IAIMS), 489 Integrated circuits, 567 Integrated delivery networks (IDNs), 157, 338, 443ff, 484, 486 Integrated Services Digital Network (ISDN), 239, 550, 552 Integrating the Healthcare Enterprise (IHE), 219–21 Integration, 8, 450, 607, 695 953 Intelihealth, 622 Intellectual property, 350, 640 Intelligent tutoring systems, 683, 684 Intensive care unit (ICU), 561ff neonatal (NICU), 553, 561 surgical (SICU), 565 Interactions, 735 Interactive television, 518 Interactive video, 522 Interdisciplinary care, 478, 479 Interface Definition Language (IDL), 180 Interface engine, 445 Interface technology, 405 Intermediate effect, 123 Intermountain Healthcare, 398, 571, 576, 580, 581 Internal representations, 138 Internal Revenue Service, 214, 225 Internal validity, 761 International Classification of Diseases 56, 226, 249, 655, 769 Ninth Revision (ICD-9), 226–8, 734 Ninth Edition-Clinical Modification (ICD-9-CM), 226, 227, 277, 282, 464, 769, 771 Tenth Revision (ICD-10), 57, 226, 228 Tenth Edition-Clinical Modification (ICD-10-CM), 226, 228 International Classification of Health Problems in Primary Care (ICHPPC), 228 International Classification of Nursing Practice (ICNP), 232 International Classification of Primary Care (ICPC), 228 International Council of Nurses, 232 International Health Terminology Standards Development Organization (IHTSDO), 219, 221, 230, 491 International Medical Informatics Association (IMIA), 495 International Standards Organization (ISO), 212, 245, 627 Technical Committee 215 (Health Informatics) (TC215), 213, 218, 219 ISO/CEN 13606, 224 ISO Standard 1087, 225 Internet, 162, 239 addresses, 162 development of, 10 service providers (ISP), 163 support group (ISG), 522, 525 Internet Corporation for Assigned Names and Numbers (ICANN), 162 Internet Control Message Protocol (ICMP), 173 Interstate Nurse Licensure Compact, 557 Interoperability, 8, 250, 276, 472, 639, 640, 670, 764 Interpreter, 165 Intervention, 758 Interventional radiology, 598 Interviews, 377 Intravenous (IV) pump, 563, 583, 584 Intrinsic evaluation, 275 Inverse document frequency (IDF), 629 954 IOM See Institute of Medicine (IOM) iPhone, 529, 587 IPA See Individual practice associations iPad, 587 IR See Information retrieval (IR) ISDN See Integrated Services Digital Network (ISDN) ISG See Internet support group (ISG) ISO See International Standards Organization (ISO) ISP See Internet service provider (ISP) IV pump See Intravenous (IV) pump J JAMIA See Journal of the American Medical Informatics Association Java, 165 JavaScript, 165 JavaScript Object Notation (JSON), 180 JBI See Journal Biomedical Informatics JCAHO See Joint Commission, The JIC See Joint Initiative Council (JIC) Jobs, 168 See also Training Joint Commission, The (TJC; formerly, Joint Commission for Accreditation of Health Care Organizations; JCAHO), 250, 449, 485 Joint Initiative Council (JIC), 219 Johns Hopkins University, 690 Journal of Biomedical Informatics (JBI), 21, 29, 724, 774 Journal of Educational Research, 692 Journal of the American Medical Informatics Association, 724, 774 JSON See JavaScript Object Notation Judgment See Clinical judgment “Just in time” information model, 522, 531, 553, 687, 691 K Kaiser Health System, 23, 430, 520, 527, 532 KEGG See Kyoto Encyclopaedia of Genes and Genomes (KEGG) Kernel, 167, 169 Key fields, 170 Key performance indicators (KPIs), 606 Keyboards, 154 Keyword approach (natural language processing), 257 KF See Knowledge Finder (KF) Kilobytes, 153 Knowledge, 58 acquisition, 651 compilation, 120 discovery, 638 evidence-based, 19 organization of, 117 procedural, 119 representation, 298ff Knowledge base, 65, 659, 664, 717 conceptual, 119 reasoning, 322 Subject Index Knowledge based systems, 659 See also Expert systems Knowledge Finder (KF), 637 Kyoto Encyclopaedia of Genes and Genomes (KEGG) L Labor and delivery suites, 561 Laboratory information system (LIS), 190, 197 LANs See Local-area networks (LANs) Laser printers, 155 Latency, 142, 555 Latent conditions, 135 Latent failure, 135 Law of proximity, 141, 142 Law of symmetry, 141, 142 LCD See Liquid crystal display (LCD) LDS Hospital, 23, 394, 399, 576ff, 581, 652 LEAN, 458 Learning assessment, 687 Learning health system, 14, 17, 672, 773, 805 Learning through design, 681 Legal issues, 50, 347ff, 513 See also Regulation Library, 638 Licensure, 557 Leadership Leapfrog Group Learning center, 687, 688 LED See Light-emitting diode (LED) Leeds abdominal pain system, 649 Legacy systems, 488 Lexemes, 261 Lexical-statistical retrieval, 631 Lexicography Lexicon, 261, 262, 606 Liability under tort law, 347 Library of Congress, 640 Light-emitting diode (LED), 154 Likelihood ratios, 83 LingPipe, 283 Linguistic knowledge, 260 Linguistic String Project, 257 Linux, 208 Liquid crystal display (LCD), 154 LIS See Laboratory information system (LIS) LISP, 165 List servers, 173 Literature reference databases, 519, 619 Local-area networks, 4, 157ff, 239, 465, 601 protocols, 158 Lockheed Corporation, 23, 464 LOCKSS project (National Digital Information Infrastructure Preservation Program), 640 LocusLink, 282 Logan International Airport, 543 Logic-based semantics, 264 Logical Observations, Identifiers, Names, and Codes (LOINC), 232–4, 249, 282 Logical Record Architecture, 225 LOINC See Logical Observations, Identifiers, Names, and Codes (LOINC) Subject Index Long-term memory, 117 Long-term storage, 153, 154 Lossless compression, 602 Lossy compression, 602 Lots of Copies Keep Stuff Safe See LOCKSS project Low-level processes Low-resource environments, 558 LUNAR, 257 M M (computer language) See MUMPS Machine language, 164 Machine learning, 260, 584, 708, 709, 802 Machine translation, 260 Macros, 164 Magnetic media, 150 Magnetic-resonance imaging (MRI), 35, 289, 293, 595 Magnetic-resonance spectroscopy, 289 Magnetoencephalography, 290 Mainframe computers, 463 Malpractice, 348 Managed care, 34 Managed competition Management of uncertainty, 67ff Management science, 30 MAP See Mean average precision (MAP) MapReduce, 181 Markle Foundation, 527 Markov models, 96, 261 Marshfield Clinic, 550, 558 Massachusetts General Hospital (MGH), 23, 30, 492, 520, 543 Massachusetts General Hospital Utility Multiprogramming System See MUMPS Massachusetts Institute of Technology (MIT), 678 Massachusetts Medical Society (MMS), 240 Mayo Clinic, 393, 491, 577, 579, 584, 587 Mayo Health Advisor, 532 Master patient index (MPI), 459 McMaster University, 680 MDConsult, 621, 623, 627 Mean average precision (MAP), 635 Meaningful use (of electronic health records), 13, 17, 192, 200, 241, 396, 454, 509, 545, 646, 773, 782ff See also HITECH Means-ends analysis, 113 Measurement, 369 Medbiquitous standards, 686, 690 MedEd PORTAL, 685, 687 Mediators, 181 Medicaid See Centers for Medicaid and Medicare Services (CMS); Insurance Medical cognition, 110, 121ff Medical College of Wisconsin, 748 Medical computer science, 19 Medical Data Interchange Standards, 235 Medical devices, 31, 793 Medical Dictionary of Regulatory Affairs (MedRA), 249, 282, 770, 771 955 Medical entities dictionary, 469 Medical errors, 111 Medical expertise, 125 Medical informatics, 26 See also Biomedical informatics Medical Information Bus (MIB), 245, 571, 578, 587 Medical Knowledge Self-Assessment Program Medical library, 687 Medical Library Association, 350 Medical Literature Analysis and Retrieval System (MEDLARS), 614, 627 Medical logic modules (MLMs), 204, 240, 652, 660, 661 Medical home See Patient centered medical home Medical history taking, 520 Medical record committees, 339 Medical records See Electronic health records Medical Subject Headings (MeSH), 234, 282, 301, 614, 624, 625, 627, 739 Medicare See Centers for Medicaid and Medicare Services (CMS); Insurance MEDINET project, 23 MEDITECH, 467 MEDLARS See Medical Literature Analysis and Retrieval System (MEDLARS) MEDLARS Online See MEDLINE MedLEE, 257 MEDLINE, 282, 464, 480, 614, 619, 626ff, 631ff, 636, 637 MEDLINEplus, 400, 623, 687, 739, 807 Medscape, 687 MEDSYNDIKATE, 257 MedRA See Medical Dictionary of Regulatory Affairs (MedRA) MedWISE, 489 Megabits, 157 Megabytes, 153 Memorandum of understanding, 376 Memory (human), 116, 117 Memory sticks, 472 Mental images, 119 Mental models, 119 Mental representations, 115 Mentoring, 683, 684 Merck Medicus, 623 MERLOT, 689, 690 MeSH See Medical Subject Headings (MeSH) Messaging, 214, 245 Meta-analysis, 81 Meta-tools Metabolomics, 711, 727 Metadata, 170, 614, 726, 763 Metagenomics, 702, 752 Metathesaurus (UMLS), 234, 281, 6256 MetaVision, 575 MGH See Massachusetts General Hospital (MGH) MGH Utility Multi-Programming System See MUMPS mHealth See Mobile health MHS See Military Health System (MHS) MIAME See Minimum Information About a Microarray Experiment (MIAME) MiCare, 499 Subject Index 956 Microarray chips, 696 See also Gene expression data, MIAME Microcomputers, 24 Micromedex, 400, 480 Microprocessor, 24, 567 Microsimulation models, 103 Microsoft HealthVault, 431, 499, 529 Microsoft, Inc., 350, 431 Microsoft Bing, 630, 633 MIF See Model Interchange Format (MIF) Military Health System (MHS), 498 MIME See Multipurpose Internet Mail Extensions (MIME) MIMIC-II (Multiparameter Intelligent Monitoring in Intensive Care), 276, 584 Minicomputers, 444, 567 Minimum Information About a Microarray Experiment (MIAME), 711, 717 Misspellings, 277, 278 Mistakes, 135 MIT See Massachusetts Institute of Technology (MIT) Mixed-initiative dialog, 655 MKSAP See Medical Knowledge Self-Assessment Program (MKSAP) MLMs See Medical logic modules (MLMs) MMS See Massachusetts Medical Society Mobile phones, 558, 587 See also Smart phones Mock-ups, 193 Model Interchange Format (MIF), 224 Model organisms databases, 282, 624 Modifiers, 259 Molecular biology, 696 Molecular Biology Database Collection, 622 Molecular imaging, 294 Monotonicity, 123 Moore’s Law, 25, 417, 717 Morbidity and Mortality Weekly Report (MMWR), 507 Morphemes, 260, 261, 268 Morphological knowledge, 261, 265 Morphology, 260, 261, 630 Morphometrics, 597 Mosaic, 207 Motion artifacts, 544 Mouse, 154 Mouse Genome Informatics, 282, 624 MPI See Master patient index (MPI) MPLS See Multiprotocol label switching (MPLS) MRI See Magnetic resonance imaging (MRI) Multi-axial terminology, 230 Multidisciplinary Epidemiology and Translational Research in Intensive Care Data Mart, 584 Multimodal interfaces, 129 Multiparameter Intelligent Monitoring in Intensive Care database See MIMIC-II Multiphasic screening, 394 Multiprocessing, 168 Multiprogramming, 168 Multiprotocol label switching (MPLS), 544 Multipurpose Internet Mail Extensions (MIME), 173 Multiuser systems, 168 MUMPS, 165, 445, 464 MyChart, 526 MYCIN, 649ff, 659, 661 MyHealtheVet, 527 MyMediHealth, 533 N NAHIT See National Alliance for Health Information Technology (NAHIT) Naïve Bayes, 657 Name, 225 Name authority, 469 Name-servers, 162 Named entity normalization, 259 Named-entity recognition, 259 NANDA See North American Nursing Diagnosis Association (NANDA) NAR See Nucleic Acids Research (NAR) database NASA See National Aeronautics and Space Administration (NASA) Narrative data, 303 National Academy of Sciences, 482–3 National Aeronautics and Space Administration (NASA), 543 National Alliance for Health Information Technology National Cancer Institute (NCI), 621, 745, 767, 769, 770 National Center for Biomedical Computing, 770 National Center for Biomedical Ontology (NCBO), 732 National Center for Biotechnology Information (NCBI), 234, 619, 710, 713, 770 NCBI Bookshelf, 621 National Center for Microscopy and Imaging Research, 318 National Committee for Quality Assurance National Committee on Vital and Health Statistics (NCVHS), 426 National Council of State Boards of Nursing, 557 National Council for Prescription Drug Programs (NCPDP), 213, 219, 235, 245 National Digital Information Infrastructure Preservation Program (NDIIPP), 640 National Drug Codes (NDC), 234 National Electronic Disease Surveillance System National Guidelines Clearinghouse (NGC), 620 National Health and Nutrition Examination (NHANES), 508 National health goals, 783 National Health Information Infrastructure (NHII) See Health information infrastructure National Health Information Network (NHIN), 483, 486 NHIN Connect, 483 NHIN Direct, 483 National Health Service (UK) (NHS), 224, 230, 545 NHS Direct, 545 National Heart, Lung and Blood Institute, 522 National Human Genome Research Institute (NHGRI), 702, 745 National Information Standards Organization (NISO), 627 Subject Index National Institute for Standards and Technology (NIST), 181, 219, 635 National Institutes of Health (NIH), 24, 616, 623, 686, 687, 724, 756, 770, 774 NIH Reporter, 623 Pain Consortium, 769 National Library of Medicine (NLM), 24, 25, 233, 234, 282, 400, 411, 542, 614, 620, 621, 624, 628, 632, 634, 687, 731, 739, 772 NLM Gateway, 634 postdoctoral fellowship, 774 National Provider Identifier (NPI), 213 National Quality Forum (NQF), 220, 250 National Research Council, 338, 426, 482, 483, 489 National Science Foundation (NSF), 10, 538, 617 Nationwide Health Information Network (NwHIN), 404 Natural history study, 758, 759 Natural language, 251 Natural language processing (NLP), 251ff, 405, 656, 733 Natural language query, 631 Naturalistic studies, 375 NCBI See National Center for Biotechnology Information (NCBI) NCBO See National Center for Biomedical Ontology (NCBO) NCPDP See National Council for Prescription Drug Programs (NCPDP) NCI See National Cancer Institute (NCI) NCVHS See National Committee on Vital and Health Statistics (NCVHS) NDC See National Drug Codes (NDC) NDIIPP See National Digital Information Infrastructure Preservation Program (NDIIPP) Nebraska Psychiatric Institute, 543 NEDSS See National Electronic Disease Surveillance System (NEDSS) Needs assessment, 362, 689 Negation, 278 Negative dictionary, 629 Negative predictive value, 84 Negligence theory, 347 Nested structures, 263 Net reclassification improvement (NRI), 730 Netter Interactive 3D, 684 NetWellness, 622 Network access providers, 157, 158, 163 Network analysis, 735 Network Level, 172 Network operations center (NOC), 434 Network stack, 171, 172 Network topology, 172 Neuroinformatics, 287, 317 NeuroNames, 300 New York Presbyterian Hospital (NYPH), 393, 552 New York State Psychiatric Institute (NYSPI), 551 NGC See National Guidelines Clearinghouse (NGC) NHII See National Health Information Infrastructure (NHII) NHIN See National Health Information Network (NHIN) NHS See National Health Service (UK) 957 NIC See Nursing Interventions Classification (NIC) NICU See Neonatal intensive care unit (NICU) NISO See National Information Standards Organization (NISO) NIST See National Institute for Standards and Technology (NIST) NLP See Natural language processing (NLP) NLTK (Natural Language Tool Kit), 283 NOC See Nursing Outcomes Classification (NOC) Noise, 161 Nomenclature, 55, 222ff North American Nursing Diagnosis Association (NANDA), 232 Nosocomial infections, 563 NPI See National Provider Identifier (NPI) NSF See National Science Foundation (NSF) Nuclear magnetic resonance (NMR), 293 Nuclear medicine imaging, 293 Nucleic Acids Research (NAR) database, 622 Nursing care, 477 Nursing informatics, 26 Nursing terminologies, 232 Nursing Interventions Classification (NIC), 232 Nursing Outcomes Classification (NOC), 232 Nutritionist, 478 Nyquist frequency, 161 NYPH See New York Presbyterian Hospital (NYPH) NYSPI See New York State Psychiatric Institute (NYSPI) O Object Management Group (OMG), 668 Objectivist studies, 367 OBI See Ontology for Biomedical Investigations Object, 225 Observational cohort study, 759 Occupational therapist, 478 Odds, 82 Odds ratio, 82 Office of Civil Rights, 349 Office of the National Coordinator for Health Information Technology (ONC; formerly ONCHIT), 17, 192, 217, 404, 483, 671, 773, 782ff OLAP See On line analytic processing OLTP See On line transaction processing Omaha System, 232 omics data, 722 omics technologies, 707 Omnibus Budget Reconciliation Act 1981 Omnibus Budget Reconciliation Act 1989 On line analytic processing (OLAP), 171 On line transaction processing (OLTP), 171 ONC (formerly; ONCHIT) See Office of the National Coordinator for Health Information Technology Online Mendelian Inheritance in Man (OMIM) database, 621, 622, 715, 736, 738 Online Registry of Biomedical Informatics Tools (ORBIT), 283 958 Ontologies, 222ff, 272, 278, 323, 661, 730 Ontology for Biomedical Investigations (OBI), 769 Open access, 617 Open CL, 154 Open Course Ware movement, 678 Open data interface (ODI), 404 Open Directory, 620, 627, 628 Open standards development policy, 217 Open Standards Interconnect (OSI) protocol, 236, 237 Open source, 207, 419 OpenEHR Foundation, 220, 224, 491 OpenGALEN, 232 OpenMRS, 409 OpenNLP, 283 Operating characteristics (of tests), 75 Operating rooms, 561 Operating systems, 167ff Ophthalmologic imaging, 297 Optical character recognition, 410 Optical coherence tomography, 297 Optical disks, 150 ORBIT See Online Registry of Biomedical Informatics Tools (ORBIT) Order-entry systems See Computerized provider order entry (CPOE) Order sets, Organizational change, 16 Oscilloscope, 567 OSI See Open Standards Interconnect protocol (OSI) Osirix, 684 Outcome data, 342, 786 variables, 368 Outcomes research, 756 Output devices, 154–5 Overload, 190 OVID (formerly, CD Plus), 619, 621, 637, 686, 762 OWL (Web Ontology Language), 224, 323 Oximeter See Pulse oximeter P Packets, 158 PACS See Picture archiving and communications systems (PACS) PageRank algorithm, 630 Pages, 168 Palo Alto Research Center (PARC), 797 Paper records, 4ff, 50ff, 392ff PaperChase, 464 Parallel computing, 181 Parallel database management system, 181 Parallel processing, 151, 181 Parse tree, 269 Part of speech, 261, 263, 269 tagging, 270 Partial-match searching, 631 Partial parsing See Shallow parsing Partners Health Care, 401, 492, 494, 748 Participant recruitment, 764 Subject Index Participant registration, 766 Participant screening, 766 Pascal, 165 PatCIS See Patient Clinical Information System (PatCIS) Patents, 350 Pathognomonic tests, 62 Pathology Education Instruction Resource (PEIR), 622 Patient identifiers, 213, 214 engagement, 518 tracking, 460 triage, 463 Patient care information management, 475ff Patient care information systems, 480 Patient-centered care, 17, 476ff Patient-centered communication, 523 Patient centered systems, 14, 485, 495 Patient centered medical home, 478, 792 Patient Centered Outcomes Research Institute (PCORI), 774 Patient Clinical Information System (PatCIS), 526, 527 Patient Gateway, 492 Patient identifiers, 794 Patient monitoring, 561ff intensive care units, 561, 564 Patient portals, 517, 526ff, 545 Patient safety, 111, 133ff, 357, 793 Patient-care systems, 475ff Patient simulator, 682 Patient tracking, 460 Patients Like Me, 525 PatientSite, 526 Pattern recognition, 802 Pay for performance, 450, 457, 485, 486 PCAST See President’s Council of Advisors on Science and Technology (PCAST) PCHR See Personally controlled health record (PCHR) PCORI See Patient Centered Outomes Research Institute (PCORI) PCPs See Primary care physicians (PCPs) PDAs See Personal digital assistants (PDAs) PDF See Portable Document Format (PDF) PEM See Privacy-Enhanced Mail (PEM) Perimeter definition, 175 Performance indicators See Key performance indicators Perl, 165 Personal computers (PCs), 4, 24 Personal electronic communications, 545 Personal Genome Project (PGP), 698, 746 Personal health applications, 517 Personal health information (PHI), 803 Personal health records (PHR), 345, 417, 498, 499, 517ff, 526ff, 610, 784, 792, 805, 806 tethered, 492 Personalized medicine, 55, 647, 721, 724, 806 Personally controlled health record (PCHR), 529 PET scan See Positron emission tomography (PET) Petabyte, 153 Pharmacogenomics, 29, 737ff Subject Index Pharmacogenomics Knowledge Base (PharmGKB), 698, 739, 740 Pharmacovigilence, 256 Phenome-wide association scan (PheWAS), 734 Phenotype, 256, 610, 698 PHI See Personal health information (PHI) Phillips Corporation, 570 PHIN See Public Health Information Network (PHIN) PHRs See Personal health records (PHRs) Physical Transport Level, 172 Physical therapist, 478 Physicians’ Information and Education Resource (PIER), 623 Picture-archiving and communication systems (PACS), 197, 296, 308, 548, 601 PIER See Physicians’ Information and Education Resource (PIER) PITAC See President’s Information Technology Advisory Committee (PITAC) Pittsburgh Note Repository, 282 Pixels, 155, 298 PL/1, 165 Placebo, 758, 759 Placebo-controlled trial, 759 Planning, 325 Plug-ins, 174 PLoS See Public Library of Science (PLoS) Podcast, 678 Pointing devices, 154 Policy, 513, 808 See also HIT policy Polysemy, 280, 630 Portable Document Format (PDF), 630 Portico, 640 Positive predictive value, 84 Positron-emission tomography (PET), 289 Post-test probability, 71 Postcoordination, 223, 229 Postdoctoral fellowship See National Library of Medicine postdoctoral fellowship Postgenomic databases, 725 POTS (plain old telephone system) See Telephone PPO See Preferred provider organizations (PPO) Practice management systems, 445 Practice redesign, 792 Pragmatics, 260, 266 Precision, 276, 634 Precision medicine, 610 See also Personalized medicine Precoordination, 223, 229 Predicate calculus, 118 Predicate logic, 257, 271 Prediction of function, 707, 742 Predictive biomarkers See Biomarkers Predictive value, 63 negative, 84 positive, 63, 84 Preferred provider organizations, 213 President’s Council of Advisors on Science and Technology (PCAST), 427, 439, 806 President’s Information Technology Committee (PITAC), 426 959 Pretest probability, 70 Prevalence, 63 Prevention (of disease), 11, 13 Primal pictures, 684 Primary knowledge-based information, 615 Prior probability See Pretest probability Privacy, 8, 175, 198, 249, 276, 335, 349, 419, 427, 793, 809 Privacy-Enhanced Mail (PEM), 173 Private Management Domain (PRMD), 163 PRMD See Private Management Domain (PRMD) Probabilistic approach (natural language processing), 258 Probabilistic systems, 657 Probability, 64, 67ff subjective assessment, 71 threshold, 98 Problem-based learning, 675, 767, 679ff Problem solving, 645 See also Decision making Problem space, 113 Problem-Oriented Medical Information System (PROMIS), 487 Procedural knowledge, 119, 120 Process integration, 451 Process reengineering, 16, 457 Production rules, 120 Productivity, 455 Professional Standards Review Organizations (PSROs), 485 Professional-patient relationship, 334, 344 Prognostic scoring system, 341 Programming languages, 164ff Project HealthDesign Initiative, 345, 529, 533, 537 PROMIS See Problem-Oriented Medical Information System (PROMIS) PROSPECT See Prospective Outcome Systems using Patient-specific Electronic Data to Compare Tests and Therapies (PROSPECT) Prospective Outcome Systems using Patient-specific Electronic Data to Compare Tests and Therapies (PROSPECT), 484 Prospective studies, 53, 416 Protected memory, 168 Protégé system, 665 Protein Data Bank (PDB), 700, 704, 714 Proteomics, 696 Protocol (clinical), 7, 584, 585 Protocol analysis, 113 Protocol authoring, 765 Protocol management, 766 Provider communications, 46 Provider-profiling systems, 462 Pseudo-identifiers, 507 PSRO See Professional Standards Review Organizations (PSRO) Public health, 339, 504ff, 645 informatics, 28, 503ff Public Health Information Network (PHIN), 509, 515 Public-key cryptography, 177, 404 Public Library of Science (PLoS), 617 960 Public policy See Policy PubMed, 276, 400, 619, 621ff, 631ff, 704, 762, 799 PubMed Central (PMC), 276 Pulse oximeter, 570 Punctuation, 268 Python, 165 Q QALYs See Quality-adjusted life years (QALYs) QOS See Quality of service (QOS) QRS wave, 160 QSEN See Quality and Safety Education for Nurses (QSEN) Quality-adjusted life years, 91, 96 Quality and Safety Education for Nurses (QSEN), 489 Quality assurance, 666 control, 12 management, 455, 486 measurement, 785ff reporting, 415 Quality of service (QOS), 544 Quasi-experiement, 758, 759 Query, 614 Query and reporting tools, 766 Query language, 170 Query-response cycle, 433 Question answering, 259, 638 Question understanding, 256 R Radiology, 593ff Radiology systems, 593ff information systems, 603ff Radiology Society of North America (RSNA), 220, 234, 600 RadLex, 234, 301ff, 325, 606 RAM (random access memory), 153 Randomized clinical trials (RCTs), 50, 373, 758, 759 RCRIM See Regulated Clinical Research Information Management (RCRIM) RCTs See Randomized clinical trials (RCTs) RDF See Resource Description Framework (RDF) RSS See Really Simple Syndication (RSS) Read Clinical Codes, 57, 230, 231, 300 Read-only memory See ROM (read-only memory) Real-time data acquisition, 159 Real-time monitoring, 568, 569 Really Simple Syndication (RSS), 268, 620 Recall, 276, 634 Receiver, 235 Receiver-operating characteristic (ROC) curve, 78, 79, 81, 729 Records, 170 See also Medical records Reference Information Model See Health Level Seven Reference Information Model Reference resolution, 259 Reference standards, 275 Subject Index Referential expression, 267, 274, 275 Referral bias, 73, 80 Regenstrief Institute, 407, 413, 415, 654 Regenstrief Medical Record System (RMRS), 394, 487 Regional extension centers, 427 Regional Health Information Organizations (RHIOs), 427 Regional network, 162 Registers, 151, 153 Registries, 14 Regular expression, 261, 262, 265 Regulated Clinical Research Information Management (RCRIM), 768 Regulation, 341, 347ff, 750, 793 Relationships (natural language processing), 259 Relative recall, 634, 635 Relevance judgement, 635 Relevance ranking, 630 Reminders, 188, 190, 414, 654 Remote consultation See Teleconsultation Remote intensive care, 542, 554, 555 Remote interpretation, 545, 547 Remote monitoring, 472, 545–7, 559 Remote presence healthcare See Telemedicine Report generation, 170 Representation, 225 Representational state, 147 Representational State Transfer (REST), 180 Representativeness, 72 Research monitoring tools, 766 Research planning, 763 REST See Representational State Transfer (REST) Resource Description Framework (RDF), 627–8 Results reporting, 461 RESUME system Retrieval, 614, 630ff Retrospective chart review, 53 Retrospective research study, 50, 416, 758, 759 Return on investment (ROI), 648 Review of systems (ROS), 61 RFDS See Australian Royal Flying Doctor Service (RFDS) RHIO See Regional Health Information Organization (RHIO) Rich Site Summary See Really Simple Syndication Rich Text Format (RTF), 267 Risk attitude, 94 Risk-neutral, 94 RIM See Health Level Seven Reference Information Model (RIM) RNA, 698 Roadmap for Medical Research (NIH), 724 Robert Wood Johnson Foundation, 345, 486, 530, 537 Robotic surgery, 555 ROC curve See Receiver-operating characteristic (ROC) curve Role-limited access, 178 ROM (read-only memory), 153 Rounds report, 579, 580, 587 Routers, 158 external, 162 Subject Index RS-232, 571 RSNA See Radiology Society of North America (RSNA) RSS See Really Simple Syndication (RSS) RTF See Rich text Format (RTF) Rule-based approach (natural language processing), 258 Rule-based systems, 659 See also MYCIN RxNorm, 233, 234, 282, 396, 731, 734, 738 S Saccharomyces Database, 282 Safe, Timely, Effective, Efficient, Equitable, Patientcentered (STEEP) care, 524 Safety See Patient safety Sampling, 160, 370 Sandia National Laboratory, 659 Satellite, 11, 543, 558 Scenario-based learning, 679ff Schema, 118, 170 Science Citation Index (SCI), 622 Scientific American Medicine, 636 SCO See Standard Development Organizations Charter Committee (SCO) SCOPUS, 623 SCORM See Sharable Content Object Reference Model (SCORM) Screening tools, 765 SCRIPT, 245 Script, 166 SDLC See Software development lifecycle (SDLC) SDOs See Standards development organizations (SDOs) Search See Information retrieval Secondary knowledge-based information, 615 Secondary use of data See Data reuse Secret-key cryptography, 177 Secure FTP (SFTP), 174 Secure Shell (SSH), 173 Secure Sockets Layer (SSL), 174 Security, 8, 175, 198, 214, 419, 454, 766, 809 Self care, 518 Self-help, 520 Semantic analysis, 272 Semantic grammar, 265 Semantic Network (UMLS), 281, 626 Semantic patterns, 264 Semantic sense, 264 Semantic types, 264 Semantic web, 627 Semantics, 260, 264, 272ff Sender, 235 Sensitivity, 62, 67ff Sensitivity analysis, 95ff Sensors, 800 Sentences, 268 Sentiment analysis, 260 Sequence, 700 alignment, 705 databases, 712 961 Sequencing, 702, 703, 744 next generation, 702, 745 Service-oriented architecture (SOA), 205, 206, 243, 470, 668, 763 Set-based searching, 630 Set-top boxes, 11 Setting-specific factors (SSF), 669 SFTP See Secure FTP (SFTP) Shallow parsing, 270 Sharable Content Object Reference Model (SCORM), 690 SHARE models, 225 Shared decision making, 518 SHARP Program See Strategic Health IT Research Projects Shielding, 161 Short Message Service (SMS), 558 Short-term memory, 117 SHRDLU, 257 SICU See Intensive care unit, surgical Side effects, 743 Signal processing, 159ff Simple Mail Transport Protocol (SMTP), 173, 534 Simple Object Access Protocol (SOAP), 206 Simulated patients, 685 Simulation, 681ff, 691, 762 Simulation center, 685, 688 Single nucleotide polymorphisms, 697, 740, 741 Single photon emission computed tomography (SPECT), 294 Single-signon, 199 Single user systems, 168 Six Sigma, 458 Skype, 526 SlideShare, 678 SlideTutor, 684 Slips, 135 Slots, 272 Smalltalk, 165 SMArt (Substitutable Medial Applications, reusable technologies), 208, 225, 529, 530 Smart phones, 4, 45, 461, 558 Smith Waterman algorithm, 704, 706 SMK See Structured Meta Knowledge (SMK) SMS See Short Message Service (SMS) SMTP See Simple Mail Transport Protocol (SMTP) SNOMED-CT (Systematized Nomenclature of Medicine-Clinical Terms), 57, 221–3, 230, 232, 234, 249, 277, 282, 300, 301, 396, 464, 491, 655, 731, 734, 770, 771 SNOP (Standardized Nomenclature of Pathology), 57 SNP See Single nucleotide polymorphism (SNP) SOA See Service-oriented architecture (SOA) SOAP See Simple Object Access Protocol (SOAP) Social networking, 4, 517, 525 Social Science Citation Index (SSCI), 622 Societal change, 472 Software, 164ff, 186ff certification, 351 962 Software development, 191ff, 196, 197 analysis, 191, 192 evaluation, 195, 196 implementation phase, 194 integration, 202 lifecycle (SDLC), 191ff integration, 194 planning, 191, 192 testing, 193 Software oversight committees, 351 Software psychology, 130 Solid state drives, 150 Spamming, 173 Spatial resolution, 155, 156, 295 Specialist Lexicon (UMLS), 281, 626 Specificity, 63, 67ff SPECT See Single photon emission computed tomography (SPECT) Spectrum bias, 80 Speech recognition, 162, 406, 603 Spirometer, 547 SPRUS, 257 SQL See Structured Query Language (SQL) SSCI See Social Science Citation Index (SSCI) SSH See Secure Shell (SSH) SSL See Secure Sockets Layer (SSL) ST segment, 162 STEEP See Safe, Timely, Effective, Efficient, Equitable, Patient-centered (STEEP) care Standard of care, 334 Standard development organizations, 215, 218ff Standard Development Organizations Charter Committee (SCO), 220 Standard Guidelines for the Design of Educational Software, 689 Standard ML, 165 Standards, 8, 211ff, 418, 436, 670 data in clinical research, 764, 767ff data definitions, 12 data transmission and sharing, 12 development process, 215ff Standards and Certification Criteria for Electronic Health Records rule, 483 Standards development organizations (SDO), 214, 491 Stanford University, 23, 615, 739, 747 Stat! Ref, 621 Static simulation, 681 Stem cells, 744 Stemming, 629 Stimulus Bill See American Reinvestment and Recovery Act (ARRA) Stop words, 629 STOR, 394 Storage, 34 active, 153 archival, 153 long-term, 153, 1544 Store and forward, 544, 545, 549 Strategic Health IT Research Projects (SHARP program), 483, 491 Subject Index Stratified medicine See Genomic medicine Strict product liability, 347 Structural alignment, 705 Structural analysis, 703 Structural imaging, 288 Structural informatics, 28 See also Imaging informatics Structure validation, 363 Structured data entry, 656 Structured Meta Knowledge (SMK), 232 Structured Query Language (SQL), 170 Study arm, 758 Subdomains, 279 Subheadings, 625 Subjectivist studies, 374 Sublanguage, 262 Substitutable Medial Applications, reusable technologies See Substitutable Medial Applications, reusable technologies (SMArt) Summative evaluation, 689 Supervised learning, 658, 728 Support vector machine (SVM), 312, 709 See also Machine learning Surescripts, 397 Surgical intensive care unit See Intensive care unit, surgical Surveillance, 11, 191, 425, 505 syndromic, 337, 584 Sustainability, 513 Switches, 158 Symbolic-programming languages, 164 Synchronous communication, 544 Syndromic software integration, 256 Syndromic surveillance See Surveillance, syndromic Synonymy, 280, 624, 630 Syntactic knowledge, 262ff Syntactic parse, 269 Syntax, 260, 261, 269ff Systematic review, 618 System learnability, 110 Systematized Nomenclature of Medicine–Clinical Terms See Systematized Nomenclature of Medicine– Clinical Terms (SNOMED-CT) Systematized Nomenclature of Pathology See SNOP (Standardized Nomenclature of Pathology) Systems biology, 699, 703 Systems programs, 169 T Tablet computers, 45, 461 Tabulating machines, 23 Tactile feedback See Haptic feedback Tailored information, 799 Tales from the Heart, 680 TATRC See Telemedicine and Advanced Technology Resource Center (TATRC) TBI See Translational bioinformatics (TBI) TCP/IP See Transmission Control Protocol/Internet Protocol (TCP/IP) Technical Advisory Group, 220 Subject Index Technicon Data Systems (TDS), 23 Technicon Medical Information System, 464 Telecardiology, 547 Telecommunications, 11 Teleconsultation, 543, 550 Teledermatology, 547 Telegraphic language, 262 Telehealth, 535, 541ff, 784, 792 licensure and economics, 557 networks, 543 video-based, 550, 552 Telehome care See Home telehealth Tele-ICU, 554, 555, 585, 586 Telemedicine, 5, 15, 344, 541, 542 Telemedicine and Advanced Technology Resource Center (TATRC), 538 Teleophthalmology, 542, 547 Telepathology, 547, 548 Telephone, 545, 549ff cellular, 558 Telepresence, 344, 542, 544, 545, 555, 556, 595 Telepsychiatry, 542, 551 Teleradiology, 15, 542, 543, 547, 548, 557, 606 Telerobotics, 555, 556 Telestroke, 554 Telesurgery, 542, 555 Temporal resolution, 295 Terabyte, 153 Term, 225, 624 Term frequency Term weighting, 629 Terminals Terminologies, 8, 225, 226 for clinical research, 768ff Terminology authority, 469 Terminology services, 469 Test collection, 635 Test-interpretation, 62, 79ff Test-referral bias, 80 Tests See Diagnostic tests Text comprehension, 113 Text generation, 260 Text mining, 638, 742, 762 Text processing, 267 Text REtrieval Conference (TREC), 635 Text readability assessment, 260 Text simplification, 260 Text summarization, 260, 638 TF See Term frequency (TF) TF*IDF weighting, 629 The Medical Record (TMR), 394, 487 Therapeutic targeting, 728 Thesaurus, 624 Thick clients, 198 Thin clients, 198 Think-aloud protocols, 113 Thomson-Reuters, 623 Threads, 166 Three-dimensional environment, 691 Time-shared computers, 23 963 Time-sharing networks, 614 Tissue imaging, 296TJC See Joint Commission, The TMIS See Technicon Medical Information System (TMIS) TMR See The Medical Record (TMR) Tokens, 261, 268 Tokenization, 267, 268 Tolven, 224 Top down parsing, 271 Tooth Atlas, 679 Tort law, 347 Touchscreen, 154 Tower of Hanoi, 113, 114 Track pad, 154 Training, 15, 595, 750 Transaction sets, 235 Transcription, 406 Transducer, 569 Transition matrix, 270 Transition probabilities, 97 Translating Research into Practice (TRIP), 620 Translational bioinformatics, 717, 721ff Translational medicine, 721 See also CTSAs Translational research, 759 Transmission Control Protocol/Internet Protocol (TCP/ IP), 162, 172, 173, 239, 466, 600 Transport level, 172 Transport level security (TLS), 174, 410 TREC See Text REtrieval Conference (TREC) Tree See Decision tree Tri-Service Medical Information System (TRIMIS), 487 Triage, 463 Trigger event, 238, 583 TRIMIS See Tri-Service Medical Information (TRIMIS) TRIP See Translating Research into Practice (TRIP) True negatives, 76ff True positives, 76ff True-negative rate, 77ff True-positive rate, 77ff Twenty-three and Me (23andMe), 748, 751 Twisted-pair wires, 158 Type checking, 165 Type I errors, 709 Typographical errors, 277, 278 U Ubiquitous computing, 129 UCC See Uniform Code Council (UCC) UCUM, 396 UDP See User Datagram Protocol (UDP) Ultrasound, 292 UMIA, 283 UML See Unified Modeling Language (UML) UMLS See Unified Medical Language System (UMLS) Unicode, 152, 268 Unified Medical Language System (UMLS), 58, 234ff, 265, 281, 282, 301, 469, 625, 626, 731, 739 Unified Modeling Language UML), 224, 225, 272, 768 Uniform Code Council (UCC), 247 964 Uniform Resource Identifier (URI), 639 Uniform Resource Name (URN), 639 Unique health identifier (UHI), 794 Unintended consequences, 136ff, 493, 496 United Nations, 235 Universal Product Number Repository, 247 Uniform Resource Locator (URL), 174, 639 Universal System Bus (USB), 571 University Hospital of Giessen, 493 University of Colorado, 345 University of Columbia Missouri, 487 University of Leeds, 649 University of Michigan, 466 University of Pennsylvania, 289 University of Pittsburgh, 289 University of California Los Angeles, 306 University of California San Francisco, 465 University of California Santa Cruz University of Washington, 301, 306, 409 University of Wisconsin, 520 Up-To-Date, 400, 480, 623, 687 URAC (Utilization Reviewed Accredditation, Commission (518) URI See Uniform Resource Identifier (URI) URL See Universal Resource Locator (URL) URN See Uniform Resource Name (URN) Usability testing, 133, 363, 418, 493 USB See Universal System Bus (USB) User authentication, 198 User Datagram Protocol (UDP), 172 User interfaces, 128, 803 User-interface layer, 469 Utility, 89, 94, 658, 671 V Validation, 195 Validity, 761 Value theory, 89ff Vanderbilt University, 493, 494 Vector mathematics, 631 Vector-space model, 631 Vendors (of clinical systems), 340 Ventilator alarms, 581 Verification, 195 Vertical integration, 446 Veterans Health Administration, 208, 224, 232, 332, 392, 395, 430, 465, 527, 534, 548, 665 National Drug File (VANDF), 234 Veterinary informatics, 26 Video-based Telehealth, 548 Videoconferencing, 544, 545 Video display terminals (VDTs), 463 View(s), 170 View schemas, 170 Virginia Commonwealth University, 492 Virtual address, 169 Virtual Patient, 685 Virtual reality, 683 Subject Index Virtual memory, 168, 169 Virtual Private Networks (VPNs), 177, 609 Virtual reality, 129 Viruses, 176 Visible Body, 684 Visible Human Project, 622 VistA system, 208, 332, 395, 661, 665 Visual analog scales, 94 Visual diagnosis, 127 VisualDX, 622 Visualization, 605, 684, 762 Vital signs, 564, 565 Vocabulary, 55, 198, 225, 226, 624 Volatile memory, 153 Volume rendering, 310 Volunteer effect, 371 Von Neuman machines, 150, 151 Voxel, 289, 291, 317 Voxelman, 305 VPNs See Virtual Private Networks (VPNs) W WANs See Wide-area networks (WANs) Washington DC Principles for free access to science, 617 Washington Heights/Inwood Informatics Infrastructure for Comparative Effectiveness Research (WICER), 484 Waterfall software development model, 196, 197 Wearable computers, 798 Web-based Clinical Information System (WebCIS), 552 Web browsers, 174 Web catalog, 620 Web of Science, 622, 623 Web Ontology Language See OWL Web services, 180 Web Services Description Language (WSDL), 180, 206 WebCIS See Web-based Clinical Information System (WebCIS) Webinar, 678 Weblog See Blog WebMD, 687 WebPath, 622 WebTV, 525 WEDI See Workgroup for Electronic Data Interchange Weight Watchers Online, 531 White space, 268 WHO See World Health Organization (WHO) WHO Drug Dictionary WHO-ART See World Health Organization Adverse Reactions Terminology Whole slide digitization, 609 WICER See Washington Heights/Inwood Informatics Infrastructure for Comparative Effectiveness Research Wide-area networks (WAN), 157, 163, 238 WIPO See World Intellectual Property Organization (WIPO) Wireless networking, Subject Index WIRM See Web Interfacing Repository Manager (WIRM) Wishard Memorial Hospital, 394 WizOrder, 400 WONCA See World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Word(s), 153, 268 Word sense, 264, 272, 282 Word sense disambiguation (WSD), 272, 282 Workflow management, 606, 669 Workflow modelling, 492, 493, 764 Workforce training, 763 Workgroup for Electronic Data Interchange (WEDI), 220 Working memory See Short-term memory Workstations, 45 World Health Organization (WHO), 56, 226, 582 WHO Drug Dictionary, 232 World Intellectual Property Organization (WIPO), 640 World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA), 228 World Wide Web (WWW), 174, 175, 521, 614 965 Worm(s), 176 WormBase Database, 282 WSD See Word sense disambiguation WSDL See Web Services Description Language WWW See World Wide Web (WWW) X X.25, 239 X-rays Xerox PARC See Palo Alto Research Center XML (Extensible Mark-up Language), 175, 206, 216, 235, 240, 242, 267, 303, 471, 628, 666, 772 Y Y2K problem, 40 Yale University, 226 YouTube, 678 Z Z39.84, 639 Zynx, 623 ... biomedical research and clinical practice The Study of Computer Applications in Biomedicine The actual and potential uses of computers in health care and biomedicine form a remarkably broad and. .. health, and biomedical research in coming years? • What we mean by the terms biomedical informatics, medical computer science, medical computing, clinical informatics, nursing informatics, bioinformatics,... for Health Care and Biomedicine 149 Jonathan C Silverstein and Ian T Foster Software Engineering for Health Care and Biomedicine 185 Adam B Wilcox, Scott P Narus, and David K Vawdrey Standards