Evaluation as a tool to increase knowledge in healthcare informatics.

The evaluation of information systems is an important topic in Clinical Informatics. It is argued that past evaluations have not been particularly informative in progressing the effective use of IT in healthcare due to their narrow focus. The different roles of evaluation in Clinical Informatics are examined, and the breadth and diversity of the available methodological tool kit highlighted.

The place of SGML and HTML in building electronic patient records.

The authors are concerned that, although popular, SGML (Standard Generalized Markup Language) is only one approach to capturing, storing, viewing and exchanging healthcare information and does not provide a suitable paradigm for solving most of the problems associated with paper based patient record systems. Although a discussion of the relative merits of SGML, HTML (HyperText Markup Language) may be interesting, we feel such a discussion is avoiding the real issues associated with the most appropriate way to model, represent, and store electronic patient information in order to solve healthcare problems, and therefore the medical informatics community should firstly concern itself with these issues. The paper substantiates this viewpoint and concludes with some suggestions of how progress can be made.

Telematics for clinical guidelines: a conceptual modelling approach.

PRESTIGE is a project for applying telematics to assist the dissemination and application of clinical practice guidelines and protocols. Previous publications have described PRESTIGE's technical approach, including the use of a generic model for representing the knowledge content of clinical guidelines. This approach offers the possibility of 'plug-and-play' electronic distribution of clinical guidelines produced by multiple authoring bodies for use on multiple healthcare clinical management software platforms.

Developing decision support systems: a change in emphasis.

Against a backdrop of many demonstrably proficient expert systems that are not routinely used, and a user community that is skeptical of the benefits of using such technology in healthcare, the AIM funded Dilemma project is attempting to introduce decision support technology into shared care environments within scenarios from the specialties of oncology and cardiology. This paper outlines the experiences of one work-package of the Dilemma project which is concerned with the development of applications with a decision support component for use in shared care of coronary artery disease patients. We suggest reasons why expert systems have failed to gain acceptance in the past, and conclude that a shift in emphasis from building expert systems to building clinically useful applications that have an expert system component may improve the chances of acceptance of this technology in the future.