"This report is about developing a common vision of our opportunities in genomic medicine, health IT and evidence-based care.

"The report takes stock of the tasks ahead for bringing Personalized Health Care to fruition. It identifies the “pathways” we need to pursue. And it provides an inventory of HHS-supported activities that are important for achieving Personalized Health Care. [...]

"We have the technology now to make health care much more personal and much more efficient. We just need to apply it to the tasks at hand —

• "To develop evidence-based standards for measuring and improving quality of care.
• "To build systems of health information technology to make the patient records available when and where they are needed.
• "To use those same systems to gather medical evidence from the day-to-day practice of medicine so that clinicians can make the best decisions for each patient.
• "And ultimately, to use our personal genetic information to tailor treatments more effectively to each patient. "

eHealth for Safety is an EU 6th Framework project which aims to carry out:

• "A structure and model of the (eHealth) patient safety and risk management domain
• "A literature review of ... ICT-based patient safety and risk management approaches and tools
• [Example] "good practice cases from around the world
• [An RTD roadmap for] "improving patient safety and risk management in healthcare with the support of ICT tools and services."

Clinical Decision Making - The Road Ahead. Robert A. Greenes (editor), Elsevier, November 2006

This new book on computer-based clinical decision support (CDS) begins by reviewing the motivation for CDS, the many ways in which it can be provided, the difficulties in implementing and supporting it, the methodologies involved, and successes and failures. The fundamental issue then considered is why, despite its promised benefits, adoption of CDS has been so limited and the pace of dissemination so slow without signs of significant acceleration. Organizational, business, and regulatory/legal issues and the role of standards are examined.

The issue of managing the underlying knowledge is then explored, and a number of approaches to tackling this are described, focusing on three primary lifecycle processes that must be supported:

1. Knowledge discovery: determining the knowledge needs for clinical care (and for particular enterprises), collecting the data and analyzing them to generate and validate knowledge;
2. Knowledge asset management: curating, and organizing knowledge to resolve inconsistencies, deal with overlaps, identify gaps, support formal knowledge representation, knowledge dissemination and update;
3. Knowledge application: determining the best ways to integrate knowledge into CDS applications, and facilitating replication of those experiences.

Finally, the book assesses the prospects for communal action to facilitate development of approaches to foster increased CDS use. The material complements the 2006 AMIA White Paper (supported by ONCHIT and AHRQ): "A Roadmap for National Action on Clinical Decision Support", and provides more detail about possible actions. The ideas presented are meant to facilitate discussions about how to align our collective efforts. Research agendas are identified and recommendations are given for initial steps to foster widespread adoption.

Several chapters of the book are written by its editor, Robert A. Greenes of Harvard University and Brigham and Women's Hospital, Boston, Massachusetts, USA. Other chapter authors include David Bates, Clem McDonald, Marc Overhage, Ted Shortliffe, Vimla Patel, Randy Miller, Robert Jenders, Mor Peleg and Stan Huff. For a complete author list and chapter headings, see links above right.

The book is aimed at health care professionals, medical informatics researchers, policy makers, IT development managers and clinical investigators. It can serve as a textbook or as additional reading in courses addressing electronic medical records, health information systems and clinical decision support.

A free sample chapter written by Robert A. Greenes is available from Elsevier (see links).

Legally eHealth is a European Commission project which aims to try to clarify the regulatory and legal framework for using many types of new eHealth technologies. The lack of such a framework is not confined to the EU.

The main aims of the project, which reports in 2007, are to:

• "An analysis of the existing EU level legal framework pertaining to the use of eHealth tools,systems and services
• "The development of an accessible knowledge base on legal and regulatory aspects of eHealth covering all pertinent EU level legislation and case law.
• "The development of a series of case studies to explore and elucidate the practical implications of the identified legislative issues in the use of eHealth tools, systems and services.
• To make "recommendations [to] meet any legislative and regulatory needs that may be found to exist."

"Healthcare practitioners and managers increasingly find themselves in clinical situations where they have to think fast and process myriad diagnostic test results, medications and past treatment responses in order to make decisions. Effective problem solving in the clinical environment or classroom simulated lab depends on a healthcare professional's immediate access to fresh information. Unable to consult a library for information, the healthcare practitioner must learn to effectively manage knowledge while thinking on their toes.

"Knowledge Management (KM) holds the key to this dilemma in the healthcare environment. KM places value on the tacit knowledge that individuals hold within an institution and often makes use of IT to free up the collective wisdom of individuals within an organization. Healthcare Knowledge Management: Issues, Advances and Successes will explore the nature of KM within contemporary healthcare institutions and associated organizations. It will provide readers with an understanding of approaches to the critical nature and use of knowledge by investigating healthcare-based KM systems. Designed to demystify the KM process and demonstrate its applicability in healthcare, this text offers contemporary and clinically-relevant lessons for future organizational implementations.

"The editors of this book have assembled a group of international contributors that reflects the diversity of KM applications in the healthcare sector. While many KM texts suffer from pitching theoretical issues at too technical a level, Healthcare Knowledge Management approaches the topic from the more versatile "twin" perspectives of both academia and commerce. This unique text is integrative in nature – a practical guide to managing and developing KM that is underpinned by theory and research.

Written for: "practicing professionals and students in medical informatics, hospital administration, and Knowledge Management."

Table of Contents:

The book sets out "action agendas detailing the measures needed to improve the safety of medication use [in the USA] in both the short- and long-term" in an effort to deal with "medication errors [which] injure 1.5 million people and cost billions of dollars annually".

"New computerized systems for prescribing drugs and other applications of information technology show promise for reducing the number of drug-related mistakes, the report says. Studies indicate that paper-based prescribing is associated with high error rates. Electronic prescribing is safer because it eliminates problems with handwriting legibility and, when combined with decision-support tools, automatically alerts prescribers to possible interactions, allergies, and other potential problems, the committee found. While it acknowledged that significant regulatory issues and problems with automated alerts still need to be worked out, the committee said that by 2008 all health care providers should have plans in place to write prescriptions electronically. By 2010 all providers should be using e-prescribing systems and all pharmacies should be able to receive prescriptions electronically. The Agency for Healthcare Research and Quality (AHRQ) should take the lead in fostering improvements in IT systems used in ordering, administering, and monitoring drugs." [Press Release]

Biomedical Informatics: Computer Applications in Health Care and Biomedicine by Edward H. Shortliffe and James J. Cimino (editors). Springer (3rd edition) May 2006.

"The practice of modern medicine requires sophisticated information technologies with which to manage patient information, plan diagnostic procedures, interpret laboratory results, and conduct research. This book, inspired by a Stanford University training program developed to introduce health professionals to computer applications in modern medical care, fills the need for a high quality text in computers and medicine, and meets the growing demand by practitioners, researchers, and students for a comprehensive introduction to key topics in the field. The work is designed for a broad audience interested in the intersection of computer science and medicine.

"Completely revised and expanded, the Third Edition (previously titled "Medical Informatics") includes several new chapters filled with brand new material. This book will provide both a conceptual framework and a practical approach for the implementation and management of IT used to improve the delivery of health care. Designed for use by professors and students of medical informatics and for practicing professionals, this book will focus on the role of computers in the provision of medical services. Biomedial Informatics, Third Edition, provides the conceptual base needed to comprehend and utilize medical informatics through easy to understand examples that demonstrate how computers assist in the delivery of health care. This text also includes pointers to additional literature, chapter summaries, and concise definition of recurring terms for self-study or classroom use."

New chapters in this 3rd edition cover Cognitive Science and Biomedical Informatics, Natural Language and Text Processing in Biomedicine, Imaging and Structural Informatics, Consumer Health Informatics and Telehealth, Public Health Informatics and the Health Information Infrastructure and Imaging Systems in Radiology

The book is in three parts. "The first consists of an introductory chapter and three further chapters each of which deals with one of [the Health Informatics] 'Grand Challenges'... The second part deals with various techniques used in Health Informatics and the theory behind some of them. A key element of this is the question of how we can represent clinical concepts in computer programs such as electronic health care records or decision support systems... The final part of the book explores attempts to apply health informatics in practice. "

13. 'Tele-informatics' II: An Information Renaissance in Healthcare
12. 'Tele-informatics' I: Using Technology to Traverse Space at the Speed of Care
11. Patient Relationship Management: Streamlined Approaches for Defragmenting Healthcare
10. How business intelligence is making healthcare smarter
9. Informing the Future with Emerging Clinical Information Technologies
8. Clinical Information Technology for Better Health
7. How the introduction of web-based Personal Health Records (PHR) hails an emerging era in healthcare which will revolutionise communication between patients and clinicians
6. The benefits of computer technology can only be realised when systems of work are changed
5. The application of computer technology in GP surgeries is beginning to have positive effects on chronic disease management
4. The benefits of a single 'national' health record have been demonstrated
3. How the value of computers in healthcare can be about improving decision making
2. How the use of computers in health care can reduce errors, improve patient safety and enhance the quality of care
1. A historical perspective on the value of investing in computer technology as an investment in infrastructure

The UK National Audit Office report reviews progress made by the NHS in reducing unintentional harm to patients in hospitals.

"A retrospective study of patient records in two English hospitals found that just over 10 per cent of patients experienced an ‘adverse event’. Around half of these (5.2 per cent) were judged to have been preventable. Responses to the NAO survey showed that, in 2004-05, trusts recorded some 2,081 deaths as a result of patient safety incidents, but it is widely acknowledged that there is significant under-reporting of deaths and serious incidents. Other estimates of deaths range from 840 to 34,000 but, in reality, the NHS simply does not know."

Garg AX, Adhikari NK, McDonald H et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005 Mar 9;293(10):1223-38.

The paper updates Hunt et al, 1998 and Johnston et al, 1994 (see links right) and looks again at some studies undertaken during the periods covered by these two papers.

   "Overall, 64% of 97 studies taken principally from a 6 year period to 1994 showed that DSS led to improved clinical practice, and 14% to improved outcomes (which was only measured in 52 studies)    4 of 10 studies on diagnostic DSS were positive (cf. 1/5 in Hunt et al, 1998); for preventive care, disease and drug management, figures ranged from 62-80%    A DSS study was 3 times as likely to be positive if it was evaluated by the developer rather than an independent evaluator    A DSS was 50% more likely to improve practice if it prompted the user rather than the user needed to consult it    [Only English language studies were included.] 70% of studies were from the US, 14% from the UK; only 16% of studies were commercially funded    Only 30% of systems got the data they needed from an EPR and only 15% had a GUI; research staff entered data in 21% of studies    Output was printed and put in notes in 45%, on screen in 40%    7 of the 13 studies in which impact on clinical time was measured showed that the DSS slowed doctors down    There was not enough data on cost effectiveness to comment".

"The intended audience of these guidelines are novices at evaluation of EDSS, rather than experts. The aim of the guidelines is to raise the understanding of topic areas, with pointers to useful journal references, books and web sites for those seeking more information. They are not intended to cover every aspect of each topic, but to stimulate thinking around key techniques and to foster an appreciation of the importance of evaluation."

This report is a result of the third phase of the IOM’s Quality Initiative started in 1996 ... [more]

The book is almost double the length of the first edition, written in 1996. A major new component (Part 2) looks at clinical informatics skills. This section is designed to "establish to clinicians why the study of health informatics is the foundation of all other clinical activities". There are also new chapters on areas (including bioterrorism and bioinformatics) where there has been a significant surge in research and development activity since the first edition.

Click on the links for more details, including sample chapters.

Quoted from the Preface to the Report: