This book is written as a text so that it can be used in formal courses, but authors 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 computing 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.chapters overview:
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 1 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 medical practice and biological research. Broad issues regarding the nature of data, information, and knowledge pervade all areas of application, as do concepts related to optimal decision making.
Chapters 2 and 3 focus on these topics but mention computers only in passing. They serve as the foundation for all that follows. A new Chapter 4 on cognitive science issues enhances the discussions in Chapters 2 and 3, pointing out that decision making and behavior are deeply rooted in the ways in which information is processed by the human mind. Key concepts underlying system design, human–computer interaction, educational technology, and decision making are introduced in this chapter.
Chapters 5 and 6 introduce the central notions of computer hardware and software that are important for understanding the applications described later. Also included is a discussion of computer-system design, with explanations of important issues to consider when reading about specific applications and systems throughout the remainder of the book.
Chapter 7 summarizes the issues of standards development, focusing in particular on data exchange and issues related to sharing of clinical data. This important and rapidly evolving topic warrants inclusion given the evolution of the national health information infrastructure and the increasingly central role of standards in enabling clinical systems to have their desired influence on healthcare practices. Chapter 8 is a new chapter that addresses a topic of increasing practical relevance in both the clinical and biological worlds: natural language understanding and the processing of biomedical texts. The importance of these methods is clear when one considers the amount of information contained in free-text dictated notes or in the published biomedical literature. Even with efforts to encourage structured data entry in clinical systems, there will likely always be an important role for techniques that allow computer systems to extract meaning from natural language documents.
Chapter 9 is another new chapter, this one developed in response to the growing complexity and size of the radiology systems chapters that had appeared in the first two editions. In this volume, we divide the former material into two chapters, one on Imaging and Structural Informatics (Chapter 9 in the Methods section of the book) and the other on Imaging Systems in Radiology (Chapter 18). This division has allowed us to separate the conceptual underpinnings, as represented in methods and imaging techniques, from the applications issues, highlighted in the world of radiological imaging and image management (e.g., in picture archiving and communication systems).
Chapter 10 addresses the key legal and ethical issues that have arisen when health information systems are considered. Then, in Chapter 11, the challenges associated with technology assessment and the evaluation of clinical information systems are introduced. Chapters 12 through 22 survey many of the key biomedical areas in which computers are being used. Each chapter explains the conceptual and organizational issues in building that type of system, reviews the pertinent history, and examines the barriers to successful implementations.
Chapter 23 provides a historical perspective on changes in the way society pays for health care. It discusses alternative methods for evaluating the costs and the benefits of health care, and suggests ways in which financial considerations affect medical computing.
The book concludes in Chapter 24 with a look to the future—a vision of how informatics concepts, computers, and advanced communication devices one day may pervade every aspect of biomedical research and clinical practice.
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