Malaria control in Brazil has been improved by the development of a micro-computer-based image inform-ation system according to an article in IDRC Reports, April 1993, 17-19.
SIG-MALARIA, the software developed by the Federal University of Rio de Janeiro's bio-medical engineering depart-ment with extra funding from the International Development Research Centre, uses information provided by SUCAM, the division of the Ministry of Health responsible for malaria surveillance and control. The system displays municipal data and produces information for decision-making in the prevention and control of malaria, a disease which is currently spreading too quickly for effective control.
The software also helps planners by speeding the flow of information from regional workers. `The main idea of this project is to develop an instrument that can be used locally in the field - one that is user friendly and will provide the people working there with immediate answers about their data'. Municipalities will have a microcomputer so that SUCAM can enter data as it comes from the field and immediately access and display that data.
Future refinements will provide sequential monthly maps to estimate flareups and show movement patterns. This will help warn of possible epidemics and allow for more timely control measures. Later Brazilian and Sri Lan-kan researchers will collaborate on implemen-ting the system in Sri Lanka. `We plan to use geographical information systems to study the spreading of diseases here and in other countries'.
Costing of Library Operations and Services: An Automated Modelling System
This report of a presentation by Dr. Robert Hayes, Emeritus Professor and Former Dean, Library School, University of California, Los Angeles, 10 June 1993 at the University of Central Queensland was prepared by Prof. Amy Zelmer, Health Science, UCQ.
Much of the current rhetoric about the 'access' to information held in other libraries seems to assume that there is no cost to the acquisition of such information. On the other hand Dr Hayes maintains that access to such information is very expensive and that there is the potential for serious disruption of library services if such access requests rise much above the present levels. To address this situation, Dr Hayes has developed a model of library use which mirrors actual library use. The model has provision for a number of variables:
Mathematical formulae have been developed which permit the exploration of alternative resource allocations. A set of spreadsheets have been developed, based on this model, for use by library administrators.
The model has been tested in a number of situations in the USA and Dr Hayes' purpose in coming to Australia at this time was to test the validity of the model in the Australian situation. (Although his visit to Rockhampton was early in his trip, he indicated that so far the model seemed to be applicable to the Australian lib-raries' situation, although some of the variables required some variation to fit the situation here; for example, a different salary structure for library staff and much less use of student labour in academic libraries in Australia than in the USA.) According to Dr Hayes, the major element missing in the model at this point is a recognition of the effects of library access allo-cation upon the user; the impact of access on use, response times and on costs to the user.
Although this model was developed within the context of academic libraries, it may have some considerable relevance to hospital and medical records librarians who must also make decis-ions on resource allocations in the `access or acquisition' context.
Aga Khan University Information System
The January 1993 issue of The Aga Khan Health Services International Newsletter carried a re-port on the information system at the Aga Khan University Medical Centre (AKUMC). According to the report,
`The Systems at AKUMC have clearly demonstrated that it is quite practical to put advanced Information Technology to work sensibly in a developing milieu, thereby providing health care systems whose quality and effectiveness are of the highest standard.'
The AKUMC system includes Medical Records where similar sounding names are retrieved through `soundex' techniques; Laboratory Res-ults with many lab instruments directly con-nected to the computer system and hospital-wide reporting; Pharmacy for the issuing of all drugs and a `drug-to-drug' interaction warning; and Financial Systems tightly coupled to the Clinical and Administrative Systems to capture charges for Laboratory, Radiology, and Pharm-acy. Medical research is supplemented by the coding and analysis of patients and disease cat-egories. Some 240 terminals distribute AKUMC information system services to a broad range of users across the hospital campus. Future plans include a Nurse Information System, a Patient Care Inquiry System, and an on-line Medical Records System.
Ethical Issues in Software Demonstrations and Research
I have been present at three demonstrations over the last year where presenters have used what appeared to be live patient data to illustr-ate the use of their software or hardware sys-tem. On one occasion, the screen even con-tained full details of a patient with a notation about HIV test results.
We are all very busy people, and it does take extra time to prepare dummy data for a presen-tation, however there can be little excuse for ignoring patient's rights in this manner. If nothing else, presenters should have a better sense of self-preservation, for sooner or later someone will make a formal complaint. For the rest of use, we need to be aware at all times of the need to protect the right to privacy that every patient/client must be able to expect from trusted health practitioners.
I've recently received a useful book on a rela-ted topic, that of planning ethically responsible research. The book is based on US practice and is directed towards the social sciences, but its discussion of research protocols, general ethi-cal principles, voluntary consent, confident-iality, and risk assessment is equally relevant to health practitioners. The `bottom line' is that all research, even when not directly involving human subjects, does have ethical implications that should be discussed before beginning the research project.
Sieber, Joan E. (1992). Planning Ethically Responsible Research: A guide for students and internal review boards, Applied Social Science Methods Series, Volume 31, Sage, Newbury Park, CA.
The Education Working Group of the American Medical Informatics Association is attempting to compile a database of reviews of and comm-ents on computer-based learning materials in the health sciences. The reviews will initially be made available on a gopher server at the University of Pittsburgh.
Reviews can be short and discuss a single aspect of a package. Staff at a resource centre, for example, can best evaluate a package by whether it gets used and if it is easy to install and maintain. Students can describe how a particular package was helpful to them (for ex-ample, because it explained a complex pro-cess, or presented review questions faster than a book). Instructional designers and developers can address issues of user interface. Content can be evaluated by faculty or students.
A single paragraph highlighting the strong points of a package from your particular point of view can be extremely valuable. In addition to the comments, the database needs to know unambiguously what the package is, who you are, and something about the experience on which the review is based. Submissions should be in plain ASCII text; for convenience, keep line-length to 70 characters or less. If you would like more detailed guidelines, send mail to cra@med.pitt.edu. Send contributed reviews to Caroline Arms at cra@med.pitt.edu.
Lynn Zelmer is a Lecturer in 'end user' computing, with particular interests in health informatics, change and technology, problem-based learning, and the use of simulations, multimedia, and hypermedia in computer assisted learning.
Send submissions for this column to him at the Department of Mathematics and Computing, University of Central Queensland,
ROCKHAMPTON, QLD 4702.
FAX: (079) 309 729.
AARN: L.Zelmer@UCQ.Edu.AU