Information Technology Solutions for Healthcare
Understanding how healthcare is being transformed by IT is key to the improvement of medical standards and reduction of cost. The synergy between computer technology and medical services allows fascinating new possibilities for benefit in areas such as co
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European Center for Medical Informatics, Statistics and Epidemiology Charles University and Academy of Sciences of the Czech Republic Institute of Computer Science AS CR, Pod Vodarenskou vezi 2, 182 07 Prague, Czech Republic
One of the greatest appeals of a career in medicine is the challenge to one’s intellect to solve an endless variety of problems. Medical care is often said to be the art of making decisions without adequate information. Physicians must frequently choose treatment long before they know which disease is present. Even when the illness is known, one must usually select from among several treatment options, and the consequences of each cannot be foretold with certainty. In medical decision-making it also means to collect data on patients in the framework of a diagnostic and therapeutic cycle (Figure 8-1). For each patient a diagnostic and therapeutic cycle can occur once (e.g. during the examination of a patient) or it may be repeated (e.g. in monitoring of a patient on the intensive care unit).
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plan Figure 8-1 Diagnostic and therapeutic cycle.
Information gathered in the diagnostic and therapeutic cycle about a patient from medical interviews, physical examinations and diagnostic tests usually does not reveal the patient’s true state. Patient’s signs, symptoms and diagnostic tests are usually representative of more than one disease, and there is no certain way to distinguish among these possibilities. Considering the basic features that are used in diagnostic processes (e.g. anatomic defects, specific etiological factors, genetic deviations, physiological and biochemical abnormalities, clinical signs), we can divide diseases into five classes according to the degree of certainty of diagnostic conclusions [8]. However, in diagnostic decision-making, diagnoses are often considered as convention symbols that only mark clinical states that are very similar. To the first class of diseases, diagnosed with the highest degree of certainty (sometimes with total certainty), belong diseases that are, under current medical knowledge, well defined, with known etiology and clear clinical manifestation that is not changed by the type of individual or external conditions. This class includes major anatomic deviations, some inherited diseases and injuries. The second class involves diseases with known and well-defined etiology, but with different clinical presentation in individuals and influenced by external conditions. This class includes malnutrition, microbiological infections, and allergic reactions to given substances and poisonings. In the third class are diseases of the descriptive type, where something is known about etiology or the general type of a pathologic reaction of the organism. The name of the diagnosis is derived from a description of the principal symptoms and signs, e.g. liver cirrhosis, essential hypertension. The fourth class includes diseases where the physical effects of the disease are apparent but the cause is unknown and the picture of the disease s
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