A national agenda for public health informatics.

The American Medical Informatics Association 2001 Spring Congress brought together the public health and informatics communities to develop a national agenda for public health informatics. Discussions on funding and governance; architecture and infrastructure; standards and vocabulary; research, evaluation, and best practices; privacy, confidentiality, and security; and training and workforce resulted in 74 recommendations with two key themes: (1) all stakeholders need to be engaged in coordinated activities related to public health information architecture, standards, confidentiality, best practices, and research and (2) informatics training is needed throughout the public health workforce. Implementation of this consensus agenda will help promote progress in the application of information technology to improve public health.

HUBNET: Wide Area Network utilization of Local Area Network medical reference and communication resources.

The State University of New York at Buffalo School of Medicine and Biomedical Sciences and its associated teaching sites have developed and partially implemented a regional Wide Area Network (WAN) in Buffalo and Western New York. The school wishes to use this WAN to deliver reference and communication resources to students, residents and faculty. The richest pool of easy to use reference and communication resources are PC software programs that are intended for individual workstations or at best, client-server, Local Area Network (LAN) implementation. HUBNET (Hospitals and University at Buffalo Library Resource Network), a project of the School of Medicine and the Library Consortium of Health Institutions in Buffalo offers integrated presentation of many such LAN resources over this regional WAN. The system crosses many institutional boundaries and reaches physically remote sites in a complex mix of information systems environments with few issues related to performance. The system design provides a level of ease of use that has brought many new users into active computer use while addressing integration into diverse information systems settings and networking environments.

Digital patient records and the medical desktop: an integrated physician workstation for medical informatics training.

The Institute of Medicine and others have advocated a shift from a paper-based to an electronic medical record and many authorities have advanced the concept of a physician workstation that can provide access to a wide variety of both clinically and reference oriented medical information. We have developed a working model of an integrated physician workstation based on a graphically oriented "Medical Desktop," for personal computers. This system gives the user access to much of the information necessary for the practice of medicine, by integrating an electronic medical record (notes, orders, consults, lab values, and radiological studies, organized both independently and in a "Visual Chart") with tools such as drug references, clinical manuals, textbooks of medicine, literature searching, expert system decision support, and electronic communication. It contains an on-line help system that facilitates use and allows access to all the systems' capabilities. This system has been used to teach students and physicians the methods and potential of computer-based medical information management to prepare them for the impact of computers in their practices and educate them concerning the imperative for the involvement of all health care providers in implementing these changes.

Implementing the Medical Desktop: tools for the integration of independent information resources.

The increasing availability of medical information resources has moved the "Medical Desktop" from a theoretical construct to a practical necessity. Many micro-computers are becoming available in clinical and academic settings that can access several medical information applications. These computers are usually not powerful workstations that are part of a clinically oriented information support system, but are personal computers with varied capabilities. The applications on these computers come from different sources, are accessed through different user interfaces and do not share data well. The de facto "Medical Desktop" this situation presents will discourage most end-users because the combination of applications is complex, the applications are poorly integrated, and individual applications are inconsistent. At the State University of New York at Buffalo School of Medicine and Biomedical Sciences we have developed several Microsoft Windows-based tools that accept a systems level diversity of resources, but work toward the construction of a coherent "Medical Desktop." These tools include a lexical term linker, a resource database, and a context sensitive help system that is tailored to locally available resources.