Monday, June 7, 2010

Wherever you live, you can now study online for a Masters degree from the University of Liverpool

Laureate Online Education, the University of Liverpool's exclusive worldwide e-learning partner, has developed a 100% online learning environment which enables you to fit a Masters degree into your life and acquire relevant, up to date knowledge to boost your career.
Our students come from more than 175 different countries worldwide. Many are busy professionals with extensive work experience.Studying online with the University of Liverpool puts them at the heart of a learning experience that has successfully delivered educational and career benefits to thousands of professionals across the world.


A Fruitful Partnership
The partnership between the University of Liverpool and Laureate Online Education brings together a unique combination of resources and capabilities.The University of Liverpool is responsible for the academic quality of our programmes and it awards the degrees. The online Masters programmes we offer originate in Liverpool's highly ranked Faculty of Medicine, School of Management, Department of Computer Science and Law School.
Laureate, as the University of Liverpool's exclusive worldwide e-learning partner, makes the

University's programmes available online, providing the e-learning environment and personal student support.Both partners are renowned for quality, innovation and continuous improvement in online teaching and learning. A Message From the Vice-Chancellor

"These online Masters programmes have led the way in online education in the 21st century. I am delighted that so many working professionals are engaged in learning on these programmes and that many hundreds have already graduated and are reaping the benefits of their studies in their careers.
“The University's traditions of excellence and dedication to quality are reflected in all of the online programmes we offer. We are committed not only to keeping pace with, but also staying ahead of, the constantly evolving and increasingly global demand for higher education and professional advancement.

"Vice-ChancellorProfessor Sir Howard Newby

www.uol.ohecampus.com
©2010 Laureate Online Education. All rights reserved

Study at the OU

Want to get a qualification that will help you develop or change your career? Learn a subject in depth? The Open University – voted top for student satisfaction for three years running – could provide the flexibility, the qualifications and the top-class teaching you’re after. For most courses you don't need any previous qualifications. And with our world-leading blend of supported open learning and innovative course materials, you’ll get an exceptional learning experience.

Explore the prospectus; Over 570 courses can count towards more than 200 qualifications. With specially designed introductory courses, you can gradually build towards your first university-level qualification, towards a degree and even beyond.


New to the OU? Answers to your questions about what it's like to study with the OU: our world-class distance learning method; help with fees; support for disabled students; studying while you’re overseas, or caring; how you get a qualification; getting credit for successful study elsewhere.


Support for your study; The OU will support you all the way: with financial help, with the study skills you need to succeed in higher education, or advice to help you develop or maybe change your career. And there is a wide range of services for disabled students.


The Open Programme: The Open Programme is a unique, flexible and highly respected programme of study that lets you build your qualification using courses from any of our undergraduate subject areas.

Government Accredited Training

Welcome to 21st century learning.

Cengage Education is a world leader in distance education. Since 1921, we have helped more than 700,000 Australians realise their earning and creative potential. We’ve set them off down exciting new career paths, seen them start businesses of their own and enriched their lives with fulfilling new ways to spend their leisure time.

Extremely flexible.
What makes Cengage Education stand out from other institutions is the ability for you to study anywhere. When you enrol in one of our courses, you’ll find no class or lecture schedules making demands on your time. You set your own timetable and conduct all your study at your own pace in a suitable, comfortable environment.

All of which makes Cengage Education the ideal solution for people looking to fit in their learning with work, parenthood, social life, or the demands of a busy family lifestyle.
In addition, many of our courses can be completed in less than a year – it’s up to you how fast you work your way through your course. Higher Education courses have a maximum limit of seven years for completion.

Simple and affordable.
We offer a variety of payment options for most courses, including up–front payment discounts and low deposit, interest–free monthly instalment plans (this does not apply to Higher Education courses). No hidden costs either – your course fee covers all your learning materials, delivered straight to you.

Nationally recognised.
Cengage Education is a dual sector Higher Education Institution (DET, NSW) and a Registered Training Organisation (VETAB, NSW), which means many of our courses are Nationally Recognised and Accredited. Many of our courses are Austudy/Abstudy approved. Many of our students will graduate with nationally recognised and industry endorsed qualifications. You may get credit towards an advanced course offered by Cengage Education, college or university.
Experienced and qualified tutors.

Our tutors are all experts in their field, with years of valuable experience. They assess your work, answer your questions and provide guidance and encouragement throughout your course. Our Student Services representatives are also on hand to offer support.

Range of support networks.
Supported by our fully qualified, industry experienced course tutors and our well– trained student services department are there to help students with any questions they may have. Our student mentoring program is available in certain courses to help keep our students motivated and focused on their study which could transform their life.In addition to all this, all our students have access to our online services, including:Student Forums where you can interact with other students enrolled in your course Assignment Submission to quickly and conveniently submit your assignments for grading Online Libraries with a wealth of searchable news, periodicals and articles Assessment Tips and Studying Tips to help you reach your potential
Regular Student Newsletters keeping you up to date with what’s happening at Cengage Education Tutor Enquiry allows students to ask questions of their tutor It just works!That’s enough from us. See what our graduates have to say about us in their testimonials.

Are you looking to make the next step in your career? When was the last time you did something for yourself?Cengage Education (formerly Thomson Education Direct) has enrolled more than 700,000 students since 1921! Offering a choice of more than 130 courses covering higher education, vocational education, leisure courses and more, we are one of the largest private educators in Australia.

Cengage Education offers a range of degree, diploma and certificate level courses that are government accredited and recognised by employers and industry groups Australia wide. Find out more about nationally recognised courses with Cengage Education.


Study for a rewarding career in child care with Cengage Education. Learn more about childcare...


Study online and enhance your career!
If you think education is an important part of getting ahead in your chosen career, you’re right!If it’s a successful career that you seek and you’re interested in learning new skills, Cengage Education can provide you with the training and qualifications you’ll need.Check out our courses.
Research online with the Gale Library

As a Cengage Education student, you’ll have access to Gale – one of the world’s largest online libraries. It contains millions of articles, covering everything from business and health care to technology and general interest subjects.You won’t have to go to the library to research assignments with so much reference material at your fingertips!

Mentors to keep you on track,If you’re worried about motivation, there’s no need! Our Student Support Mentor Program will provide that little extra push to keep on track with your studies.

CONTACT: Head office; Level One, 1 Waltham StreetArtarmon NSW 2064
Mail;Locked Bag 900Artarmon NSW 1570
Phone;1300 853 033 (inside Australia)+61 2 9433 3655 (outside Australia)
Fax;1300 853 014 (inside Australia)+61 2 9433 3666 (outside Australia)

Welcome to Learning at Home - Home Study, Distance Learning Courses.

"Providing independent & impartial advice, learning and service to students worldwide from our base in Suffolk since 1998"

Learning at Home at your own pace, independently or with the help of your tutor, is a flexible, cost-effective, way to improve your prospects, your career, and your income. Choosing and enrolling on your course with Learning at Home gives you independent, impartial advice, the widest choice of the best courses available on one easy to navigate website, and a simple and trouble free enrolment at the best possible price.

Unemployed? On Job Seekers Allowance or Income Support for 6+ Months?
We can offer funding advice!
Call us on 08456 123 823

Spread the cost of your course: Interest-Free Easy Payment Scheme.(UK Only)*No additional charge*Interest-free*Still benefit from special offers & discountsPlease note that we do not accept AmEx cards for this payment scheme.

Call us on 08456 123 823
Free UK Delivery *Courses delivered to you in one complete package (not unit by unit) so you can study at your own pace!*Most courses available in both paper or online versions!

Rediscover Education with InterActive

InterActive is an incredibly unique and innovative distance learning platform providing professional and postgraduate qualifications 100% online.
Regardless of your geographic location, regardless of the time of day, InterActive makes achieving your education goals easy and convenient. Using cutting-edge technology, InterActive brings the best in high quality UK education to your computer screen. Studio recorded lectures feautre our expert tutors and a dedicated support staff ensures that your studies proceed smoothly. InterActive allows you to get the most out of your educational experience by being completely flexible and customisable around your lifestyle. Find out more »

InterActive is a unique online learning platform enabling you to study for a range of Masters Degrees and Professional Qualifications anytime, anywhere.
No matter where you’re based, it has never been easier to fit study into your lifestyle. With InterActive you can complete your programme completely online whilst still benefiting from personal interaction with both other students and expert tutors.
In partnership with London School of Business & Finance (LSBF), InterActive provides you with the opportunity to pursue globally recognised Professional Qualifications and specially designed MBA and MSc programmes at your convenience.
Approach
Programmes
Partners
Team
See samples of our studio recorded lectures with expert tutors here.


Online Programmes
Through collaborations with London School of Business & Finance (LSBF), InterActive is pleased to provide you with the opportunity to obtain internationally renowned accounting professional qualifications and post-graduate degrees in business through our online portal.
Choose Your Programme
Study MBA Online expand

Master of Business Administration(MBA) is the global standard in management excellence. With the choice to study a general MBA or to choose one of 12 specialisations you can ensure that the degree programme prepares you for success in the area of business that interests you the most.Learn more »
Study MSc in Finance Online expand

The MSc in Finance is the degree of choice for those looking to excel in Finance. The ability to study a general degree or to specialise in one of 8 specialisations ensures that you will be prepared to excel in the financial field of your choice.Learn more »
Online Programmes expand

The MSc in Marketing degree will make you stand out in the excting field of Marketing. Either the general degree or one of 7 specialisations will accelerate your career.Learn more »
Study ACCA Online expand

ACCA (Association of Chartered Certified Accountants) is the globally recognized professional accounting designation. Through becoming an internationally recognized chartered accountant, ACCA will help you excel in Accounting and Finance. ACCA is also well recognzied in the fields of Corporate Management and Consulting.Learn more »

Study CIMA Online expand and visit: http://www.studyinteractive.org/contact/

Check out the top 20 online colleges right now.

Our educational experts investigated hundreds of online colleges and universities across the globe before choosing the top twenty (20). Some award only online degrees; others are traditional colleges and universities offering both campus-based and online education. All are fully accredited by agencies recognized by the United States Department of Education (not the “bogus” agencies listed on some websites).
Every one of our top twenty (20) distance education colleges offers financial aid to qualified students, and many offer scholarships and/or tuition installment plans. As you will see, almost everyone can afford the cost of online education.
Many offer accelerated degrees, credit for life experience, and/or credit by examination. In fact, we think you will be very pleasantly surprised by how quickly you can earn a fully accredited degree online, and by the variety of online degrees available.

Our experts have identified the best online degree programs.
Our rankings were determined by a team of experienced educators who investigated more than 200 online colleges and weighed factors which include overall academic quality, breadth of degree offerings, availability of academic and other student support services, willingness to consider life experience and/or military credit (DANTES), accelerated degree options, overall cost, scholarship availability, tuition installment and financial aid options, institutional stability, and overall reputation.

What is the best online college for you?
Only you can determine which online colleges and which online degrees can best meet your individual needs. Our goal is to save you some time by giving you a list of what we think are the twenty (20) best online colleges and universities. We are not suggesting that online college #1 will necessarily be a better choice for you than college #20. In fact, we advise and encourage you to request free information from any of the colleges below which interest you.
We also suggest that you add this site to your favorites list and visit weekly until you have made your final college choice as we plan regular updates and revisions as we learn more about the online colleges we have listed (and others which may take their places).

Choose the Best Online College for You:

Looking for a top-notch online education, but don’t know where to start? Fear no more. At bestcollegesonline.com, you are free to view our rankings of the best online colleges in the U.S. and find degree programs that meet your needs. All of our listed colleges are accredited institutions that offer reliable degree programs for a reasonable tuition rate.

There are tons of online schools that claim they have the most affordable tuition rate, fastest degree plans or the most programs, but the truth is many of them do not practice what they preach. The schools we rank have shown their success by the growing number of students who enroll every year.

With so many online colleges to choose from, it can be difficult to know which one is best for you. But, taking the time to review our school rankings and research each college will save you time and money. Choosing the right college is an important decision and one that we want to make easier for you.

Ashford University - Associate's, Bachelor's, & Master's Degrees. Ashford University provides working adults an excellent place to pursue a secondary or uncompleted degree. Ashford’s programs are affordable and flexible and an excellent place for students to learn at their own pace.

Kaplan University - Associate's, Bachelor's, & Master's Degrees. As one of the largest online universities with a widely recognized name, Kaplan University offers a myriad of campus and online programs for both full-time and part-time students looking to efficiently advance their career.

University of Phoenix - Associate's, Bachelor's, Master's & Doctoral Degrees. University of Phoenix is dedicated to providing high-quality education and is accredited by the Higher Learning Commission. University of Phoenix offers both on-campus and online learning programs that fit individual scheduling needs.

Capella University - Master's & Doctoral Degrees. Capella University is an accredited university that offers several career programs and degrees in Psychology, Business, Accounting, Finance, Education and Technology. Capella is dedicated to its vision of online education that offers flexible and interactive programs for lifelong learners.

American InterContinental University - Associate's, Bachelor's, & Master's Degrees. American InterContinental University has been educating students for over 35 years at campuses around the world. AIU is an accredited university that provides students with the skills needed to compete for today’s fastest-growing jobs and industries.

Colorado Technical University - Associate's, Bachelor's, Master's, & Doctoral Degrees. Colorado Technical University looks forward to educating full time professionals or first time college students. Colorado Tech is a well respected educational institution with a plethora of affordable degree plans.

Walden University - Master's & Doctoral Degrees. For over 35 years, Walden has been committed to making a positive social impact on the world. This accredited institution is ideal for students who want to make a difference and engage in real-world learning at the same time.

Liberty University - Associate's, Bachelor's, & Master's Degrees. Liberty University is the largest evangelical university and offers numerous online programs to assist students in reaching their career goals.

Accredited Online College Degrees

Discover the advantages of earning your degree online through top online colleges and universities. The Accredited Online Colleges website provides you with information on hundreds of online degrees through accredited colleges and universities. Get started today on the road to a brighter future with an accredited degree online.

You can earn an online Associate, Bachelor, Masters, PhD, or Doctorate degree through these top accredited universities. Click on the following links to receive complimentary information from each online college. Or, find out more about the online accredited degrees they offer by clicking on Online Degrees.

Advantages of Accredited Degrees from Online Colleges & Universities.There are many advantages to obtaining a college education through accredited online colleges and universities! Here are just a few:
You can earn an advanced degree that can lead to an increase in salary.
You save on child care costs since you don't have to leave home.
Online colleges require little or no commuting, saving time and money.
You can complete your course work when it is convenient for you.
Online colleges offer easy access to your teachers, other students, and the library since they are only a click away.

The Importance of Online Degrees from Accredited Online Colleges & Universities:

In the midst of today's "diploma mills" that offer you phony degrees in just 2 weeks, making sure that online degrees are accredited has become more important than ever. Accreditation is a process of school approval. In order to gain accreditation, online colleges and universities are reviewed thoroughly over the course of several years by an outside agency that holds the colleges and universities to a set of standards and then determines whether the colleges meet those standards. Because accreditation is such a difficult (and costly) process to go through, it's a good way to differentiate between legitimate colleges and universities versus fly-by-night colleges or "diploma mills".

Earning an accredited online degree from a top college or university will ensure that your hard work will be treated with respect by potential employers. Because a phony, non-accredited degree could be considered worthless in the working world, it is critical you are only researching online colleges and universities that have gained accreditation in your educational search.
Feeling confused? Relax. All of the degrees featured on our site are accredited. We have done the research for you!

Studies on Online Accredited Degrees: Numerous studies have proven that students obtaining online college degrees from accredited colleges and universities perform as well or better than their on-campus counterparts. The book "The No Significant Difference Phenomenon" by Thomas L. Russell cites 355 research reports, papers, and summaries dating back to 1928 that found no significant difference between an online college education and in-class learning. Where a difference was identified, it generally favored the student obtaining an online accredited education from an online college!

An extensive study conducted by the University of Phoenix comparing its own campus-based students to its online college education students came to the same conclusion. In addition, it identified the current online format as the most effective vehicle for distance education.

Monday, February 22, 2010

How a Computer Science Degree Prepares you for Medical School

Students are sometimes surprised to learn that a wide variety of undergraduate degrees can properly prepare them for applying to medical school. An undergraduate degree in Computer Science is good preparation for many reasons.

Computer Science is used in many aspects of Medicine

Here are just a few interesting areas where Computer Science is important in Medicine, both in research and in clinical settings.

A Computer Science degree teaches you to think logically and work cooperatively

Our Computer Science courses teach you to think logically and to strive to find new and elegant solutions. Many of our courses also include practical work with groups, so you also learn to work cooperatively. These are all skills that help make a good physician.

You will have plenty of room in our program for Medical School prerequisite courses

A BSc degree in Computer Science leaves plenty of room for elective courses if a student needs to complete a few prerequisite courses for Medical School. Most prerequisite Science courses will have already been completed in CEGEP (for Quebec students) or in the Science freshman year (for students entering McGill from outside of Quebec). Our programs also leave open the option of doing a minor in another field, for example, a minor in Biology, Chemistry, Psychology, or Social Studies of Medicine. A particularly interesting minor is the new Minor in Interdisciplinary Life Sciences. By combining your studies in Computer Science or Software Engineering with the Minor in Interdisciplinary Life Sciences you can prepare for many possible careers, including applying to Medicine.

Our Computer Science students can get to know their Professors

In Computer Science we have a large number of upper-year courses that are small and where you can get to know your Professors. We also encourage undergraduates to participate in our research. This means that you can forge good contacts with professors who will be able to write you meaningful recommendation letters for your applications to further studies, whether it is for Medical School or for further graduate studies.

A Computer Science degree gives you options

You will have many options at the end of your undergraduate studies. You will be prepared to apply to Medical School, but you will also have the options open of continuing to graduate school or to work in Computer Science and related medical fields.

Profiles of our students who have gone on to medical school or health science related graduate studies

Some of our Computer Science undergraduates go on to medical school or to graduate school in fields related to medicine. Click on the names of the following students to read about their experiences and how their undergraduate studies at McGill helped them realize their dreams.

  • Benjamin Azan
    Winner of the best undergraduate research project in Computer Science, 2005
    BSc (Major Computer Science, Minor Music Technology), McGill
    Student in the Johns Hopkins Post Baccalaureate Pre-Medical Program
  • Moses Mathur
    BSc, Major in Computer Science, McGill
    MSc, Computer Science, McGill
    Medical Student, Jefferson Medical College
  • Julian Wolfson
    BSc (Joint Honours Mathematics and Computer Science), McGill
    PhD candidate, Biostatistics, University of Washington

General Information

McGill University is the top research university in Canada (tied with U. of Toronto, based Macleans's 2005 rankings) and is the only Canadian university to rank among the top 12 universities in the world (based on Times 2007 rankings). The School of Computer Science currently stands second in Canada for its research funding. Our professors have received many distinguished awards for research and teaching, while our students, after also winning their share of awards, go on to become top-notch research and industry leaders. A graduate degree from SOCS is recognized in both the academic and industrial worlds as a proof of excellence.

Our department is currently strong of 34 faculty members, 60 Ph.D. students, and 100 Masters students. All of our Ph.D. students and most of our Masters students are funded through teaching assistantships or research assistantships. Approximately half our graduate students are Canadian and the other half are from abroad.

Location

McGill is an English language university located in the heart of Montreal, the second largest French-speaking city in the world. Montreal has a reputation for its cosmopolitan atmosphere, history, cultural and sport activities, and excellent restaurants. The cultural offerings of the city include a symphony orchestra, ballet, opera, several theaters and museums. For outdoor recreation, Mount Royal, a wooded mountain with a lake and parks located very close to the university, along with the St. Lawrence river, the many lakes and parks around the island of Montreal, provide opportunity for a wide variety of activities. Montreal consistently ranks among the most livable cities in the world, and the cost of living is among the lowest for cities of its size. The city is extremely safe and has an excellent public transportation system. Note that although speaking French is useful to fully enjoy your experience in Montreal, it is by no means necessary, as English is also spoken fluently by most of the population. More information can be found on the McGill Prospective Students web page, while information on Montreal is available from Montreal International.

The Academic Year

The academic year at McGill, as at most Canadian universities, has two terms (or semesters). These are the Fall term - early September to early December - and the Winter term - early January to mid-April.There is also a Summer term, although no graduate courses are offered during this session. It is used by students as a time for research or completing projects or theses.

Important Information for Foreign Students

All students who are not citizens or permanent residents of Canada are required to obtain the necessary Visa and/or Student Authorization documents prior to entering the country. Do NOT leave home without proper documentation! You CANNOT change your status from Visitor to Student when in Canada.

Student Authorization: Issued by Canada Immigration through a Canadian Embassy or Consulate. There is a processing fee of $125 on all applications for Student Authorizations. LINK

Certificate of Acceptance (CAQ): Issued by Quebec Immigration for a fee of $100. If there is no Quebec Immigration office in the country in which you are applying, you must fill out the application for a CAQ and send it to the Quebec Immigration Office in Montreal along with the $100 processing fee. Once CAQ is approved, Quebec Immigration will telex the Canadian Embassy you are dealing with. If there is a Quebec Immigration office in the country in which you are applying, you apply for the CAQ through them.

Health Insurance (Compulsory): Quebec requires all international students to participate in a recognized Health Insurance Plan. Cost is approximately $500 per year for a single person. Most students use one of the insurance plans offered by McGill.

Once accepted, all international students receive detailed instructions on immigration procedures. These instructions should be read very carefully to avoid unnecessary delays. Applicants are advised to begin procedures necessary to ensure admission to Canada and complete required medical papers for Canadian Immigration authorities as soon as possible after submitting an application for admission. For more information, see the McGill International Student Services.

Student Accommodation

Off-campus housing is the most popular among McGill graduate students, as it is usually affordable, convenient, and easy to find. The Off-Campus Housing Service keeps a computerized list of available housing within walking distance of McGill, or easily accessible by metro and bus lines. Most listings are checked to ensure minimum standards of cleanliness and state of repair. Rental rates vary according to accommodation desired, but are considered very reasonable in comparison with most North American cities.

The University maintains a limited number of apartment units in several nearby locations. Housing request forms can be obtained from the Graduate Housing office


CONTACT US:

Administrative Office

3480 University Street
McConnell Engineering Building, Room 318
Montreal, Quebec, Canada
H3A 2A7
Phone: (514) 398-7071
Fax: (514) 398-3883


Computer Science Advances Medicine From Firststop Online Degree

The medical field is benefiting from the implementation of computer science in technology. The daVinci Surgical Robotic System helps to reduce the invasiveness of surgery and the time needed for healing.

Computer Science Surgery

Many people suffer from cancer in the mouth and throat. Through conventional surgery, removal of a tumor can cause speech and swallowing dysfunction as well as external scarring. In May 2005, the University of Pennsylvania's School of Medicine completed two studies that suggest that the daVinci Surgical Robotic System will be an effective tool in these kinds of surgeries.

Instead of an almost ear-to-ear incision and the splitting of the jaw in half, the robot can enter through the mouth and voice box. The doctor views the surgery through a 3-D computer monitor and manipulates the arms from there. An added benefit is that the movements are more intuitive; if you want the robot to move right, then you move your hand right. In other robotic systems, to move the robot right, you had to move left.

Past Achievements

The daVinci Surgical Robotic System has already had success in prostate surgery, coronary artery bypass, and even gastric bypasses. With so many nerve endings involved in a prostate surgery, the robot allows for more precision to help reduce the occurrences of incontinence and impotence caused by the surgery. The robot can also repair heart valves without opening up the patient's rib cage.

The robot isn't perfect. A doctor needs to have between 20 and 50 operations to become proficient. Critics says that since the doctor never feels the tissue that he is cutting, he won't have as good a feel of how far cancer has spread in such surgeries. Nonetheless, the advances in computer technology make this robot an amazing step forward in science and medicine.

Computer Science Online

Computer science can do great things to advance healing technology, and the field offers you a great way to help heal people other than the traditional route of becoming a doctor. A computer science degree is important to build the right skill sets for this highly technical career.

An online college degree can help you get your computer science degree. Flexible to your own time schedule, an online college degree can start you down the path to creating the healing hands of the new millennium.

Sources



About the Author
James Tolles is the Managing Editor for HQ|Publications. He helped write and edit the successful application for Sparks, NV that earned the city honors as a 2004 All-America City Finalist-a title held by only 30 cities in the nation. He is also a freelance writer. He attended a four year liberal arts college and holds two B.A. degrees, one in Creative Writing and the other in History.


http://www.firststoponlinedegree.com/contact.php

How Computers are seen in Biology and Medicine

Computers in Biology and Medicine is a medium of international communication of the revolutionary advances being made in the application of the computer to the fields of bioscience and medicine. The Journal encourages the exchange of important research, instruction, ideas and information on all ...

Computers in Biology and Medicine is a medium of international communication of the revolutionary advances being made in the application of the computer to the fields of bioscience and medicine. The Journal encourages the exchange of important research, instruction, ideas and information on all aspects of the rapidly expanding area of computer usage in these fields.

The Journal will focus on such areas as
(1) Analysis of Biomedical Systems: Solutions of Equations;
(2) Synthesis of Biomedical Systems: Simulations;
(3) Special Medical Data Processing Methods;
(4) Special Purpose Computers and Clinical Data Processing for Real Time, Clinical and Experimental Use; and
(5) Medical Diagnosis and Medical Record Processing. Also included are the fields of
(6) Biomedical Engineering; and
(7) Medical Informatics as well as Bioinformatics. The journal is expanding to include
(8) Medical Applications of the Internet and World Wide Web;
(9) Human Genomics;
(10) Proteomics; and
(11) Functional Brain Studies.

The publication policy is to publish
(1) new, original articles that have been appropriately reviewed by competent scientific people, (2) surveys of developments in the fields,
(3) pedagogical papers covering specific areas of interest, and
(4) book reviews pertinent to the field.

Articles which examine the following topics of special interest are being featured in Computers in Biology and Medicine: computer aids to the analysis of biochemical systems, computer aids to biocontrol-systems engineering, neuronal simulation by digital-computer gating components, automatic computer analysis of pictures of biological and medical importance, use of computers by commercial pharmaceutical and chemical organizations, radiation-dosage computers, and accumulating and recalling individual medical records, real-time languages, interfaces to patient monitors, clinical chemistry equipment, data handling and display in nuclear medicine and therapy.

The applications of computers to biological and biomedical problem solving go back to the very beginnings of computer science, automata theory [1], and mathematical biology [2]. With the advent of more versatile and powerful computers, biological and biomedical applications of computers have proliferated so rapidly that it would be virtually impossible to compile a comprehensive review of all developments in this field. Limitations of computer simulations in biology have also come under close scrutiny, and claims have been made that biological systems have limited information processing power [3]. Such general conjectures do not, however, deter biologists and biomedical researchers from developing new computer applications in biology and medicine. Microprocessors are being widely employed in biological laboratories both for automatic data acquisition/processing and modeling; one particular area, which is of great biomedical interest, involves fast digital image processing and is already established for routine clinical examinations in radiological and nuclear medicine centers, Powerful techniques for biological research are routinely employing dedicated, on-line microprocessors or array processors; among such techniques are: Fourier-transform nuclear magnetic resonance (NMR), NMR imaging (or tomography), x-ray tomography, x-ray diffraction, high performance liquid chromatography, differential scanning calorimetry and mass spectrometry. Networking of laboratory microprocessors linked to a central, large memory computer is the next logical step in laboratory automation. Previously unapproachable problems, such as molecular dynamics of solutions, many-body interaction calculations and statistical mechanics of biological processes are all likely to benefit from the increasing access to the new generation of "supercomputers". In view of the large number, diversity and complexity of computer applications in biology and medicine, we could not review in any degree of detail all computer applications in these fields; instead, we shall be selective and focus our discussion on suggestive computer models of biological systems and those fundamental aspects of computer applications that are likely to continue to make an impact on biological and biomedical research. Thus, we shall consider unifying trends in mathematics, mathematical logics and computer science that are relevant to computer modeling of biological and biomedical systems. The latter are pitched at a more formal, abstract level than the applications and, therefore, encompass a number of concepts drawn from the abstract theory of sets and relations, network theory, automata theory, Boolean and n-valued logics, abstract algebra, topology and category theory. The present analysis of relational theories in biology and computer simulation has also inspired a number of new results which are presented here as "Conjectures" since their proofs are too lengthy and too technical to be included in this review. In order to maintain a self-contained presentation-the definitions of the main concepts are given, with the exception of a minimum of simple mathematical concepts.

Information Technology in Medicine

Information and communication technologies are about to make a massive move into medical practice, not only in selected areas of 'high-tech' medicine, but throughout the field. Research in information technologies is needed in the areas of medical imaging, telecooperation, education and training

Medical images are produced in such a number and richness of detail that they can only be analyzed with the help of the computer. Computers not only improve the quality of the images, but also help in reconstructing structures, detecting anomalies and measuring. In particular, computers help with an appropriate visualization to make the image contents understandable to the clinician. Three-dimensional images are used more and more. They have the inherent problem that it is extremely difficult to visualize images consisting of a cloud of material in different shades of grey. Mechanisms have to be found that render the interesting detail and hide other structures that are not relevant for a particular situation. The selection and composition of algorithms depend on the medical goals of a particular analysis and thus can only be determined together with medical experts.

Images are needed to plan and control microinvasive surgical procedures. It is therefore necessary to design systems that support the physician with appropriate visualizations throughout the whole process from image acquisition, diagnosis, treatment planning, surgery to final control.

As medical professionals become more specialized, diagnosis and treatment occur in cooperation between different physicians that may be distributed. They have to use computers to exchange their medical data, in particular images. However, data transfer alone is not sufficient. they must also be able to communicate about their patients, to talk freely about medical data and refer to that data during their discussion. Merging these two communication channels (verbal and data communication) is a challenge that needs to be addressed before teleconsultation can be reasonably efficient. And finally, medical knowledge increases at an amazing pace. Physicians are required to keep up with new knowledge for their whole life. To ensure the quality of diagnosis and treatment, special emphasis on continuous education is needed. Computer-based techniques can help with this task, in particular if they provide training on the job, assisting in the analysis of images and teleconsultation.

All these problems can be solved only in interdisciplinary teams. One needs physicians that are open-minded to think about new computer-based approaches. Computer scientists have to listen for the problems of their medical partners. Psychologists have to look at human-human and human-computer interaction. Engineers and administrators have to make things work. A single profession can no longer deal with all aspects of the complex problems. Furthermore, new systems have to be designed iteratively, with the user in mind. Systems must be addressed to real user problems. However, it is not possible to completely assess the value of a new development before it is taken into daily practice with real users. Developers must be ready to radically change their systems until these really meet the user needs. Users must be involved, but not in a naive fashion ("tell me what you need"). A constructive dialog between users and developers, involving a sequence of prototype systems, is needed to acquire the real user needs.

The following examples show that ERCIM members work together with medical partners on all these aspects. These interdisciplinary activities are needed to broaden the influence of computer science research in our society throughout Europe.

Please contact:
Thomas Berlage - GMD
Tel: +49 2241 2141
E-mail: berlage@gmd.de

Information technology–improving medicine

Computer technology in the workplace is becoming increasingly common. US medicine was initially slow in adoption of information technology, but acceptance has accelerated significantly over the past few years. There are four areas in which rapid advances have been made: computerised order entry; electronic medical records (EMRs); e-mail communication; and hand-held devices. These four technologies are destined to revolutionise the way medicine is practiced in the US.

Reducing medical errors has become a national priority in the US. Specifically adverse drug events are an important source of injuries in hospitalised patients. In response to the need to improve patient safety, computer physician order entry (CPOE) systems have become increasingly more common. In general, CPOE systems force physicians to write all orders online. These systems have the capacity to verify that written orders are correct, that is, based on a patient profile, they can automatically check the dose and contraindications of a specific drug. They have been shown to dramatically reduce serious medication errors. Unlike EMRs (see below), I believe that most hospitals in the US will have CPOEs within five years. From both a financial and publicity standpoint, hospitals will be unable to afford the consequences of a medical error that was preventable. Whether CPOEs are mandated by US hospital licensing bodies is less clear.

EMRs hold great promise in the clinical arena. The ability to care for patients with a record that is integrated with laboratory and pharmacy information, and provides point of service information regarding preventive services, diagnosis, treatment, and follow up represents a dramatic advance in patient care. Improving and measuring quality would be instantly improved if all clinicians used EMRs. For example, it would be easy to prompt clinicians that their patient with diabetes needs an eye examination or a haemoglobin A1c level. Drug prescribing patterns of individual clinicians could be carefully evaluated and compared to established standards. In fact, computer based clinical support as part of an EMR has been shown to improve physician performance and patient outcomes. Unfortunately, in the US, with its cottage industry approach to care and payment, it is not clear who will support this dramatic advance. Currently, a number of staff model health maintenance organisations and academic medical centres have EMRs. But most physicians that I speak with, who are in private practice or work at community health centres, cannot afford the change to EMRs. Not only are they concerned about the cost, but daily maintenance and upkeep is of concern. Of note, one approach that may speed the introduction of EMRs is the use of systems with specified functions. Hence EMRs would be introduced in a more gradual fashion. Nevertheless, I believe we are more than a decade away from a time when a substantial number of Americans will have the majority of their care provided by a clinician sitting at a computer terminal or holding a computer screen.

E-mail communication has been compared to the telephone—a new form of communication that will transform the practice of medicine. “You've got mail” is a common refrain heard by 32 million America Online subscribers around the world. The benefits of e-mail include: (1) communication that is dyssynchronous—that is, the two parties do not both need to be “home” to communicate; (2) it is inexpensive, convenient, and available in many places; (3) it can provide a permanent record of the transaction; (4) it affords a certain level of anonymity that is not available on the telephone; and (5) it may make practice far more efficient. There are many potential liabilities, including threats to confidentiality and privacy, inappropriate use, and the possible workload that it may create for clinicians. Nevertheless, many patients in the US are requesting e-mail communication with their physicians, and more importantly, the office of their physicians. Just like the telephone, e-mail communication should be established with an office, rather than an individual, so that requests can be appropriately categorised, distributed, and answered. I predict that e-mail communication between physician and patient will become more common, more quickly, than EMRs. We tend to be responsive to patients in the US, particularly since they are increasingly seen as consumers, and few patients are clamouring for an EMR, but many are requesting access to e-mail communication.

I have been impressed with the numerous software packages now available for hand-held devices. Growth charts, books, pharmacy databases, and other important patient related information is now available. The recently released US guidelines for management of cholesterol were available for hand-held devices soon after they were published. Hand-helds will soon have as much memory as desktop computers did 3–5 years ago. Where I practice, virtually every physician, and certainly every resident, has a hand-held and is making good use of it in the clinical arena. Combined with EMRs, and advances in e-mail communication, it is quite imaginable that every physician will be able to literally “carry” the medical record of every patient they care for and communicate with them instantaneously. The uses of hand-helds will continue to evolve, but I suspect that every physician in the US will be using them in the next few years.

Information technology is advancing rapidly. Translation by head sets, distant surgery by telecommunication, and consultation by video and computer, are examples that I have not discussed. However, unlike those advances, EMRs, e-mail communication, hand-held devices, and computer order entry are likely to touch the lives of everyone of us and our patients

Medicine + Technology + Telecommunications = Telemedicine

During the past decade, more and more people have been able to avoid physically going into work by telecommuting from their home computer. Medicine has taken a cue from this growing trend by combining telecommunications technology and medicine to create telemedicine and telehealthcare. While healthcare professionals have always communicated with one another over the telephone, telemedicine kicks things up a notch by utilizing sophisticated satellite technology to broadcast consultations between healthcare professionals who are oceans apart or only a few miles away. Videoconferencing equipment and robotic technology have helped to make doctor’s offices and medical facilities as close to one another as the nearest computer screen.

There are two popular types of technology used for telemedicine applications. The first of these is called “store and forward” which is used for transferring digital images from one location to another. A healthcare professional takes a picture of a subject or an area of concern with a digital camera. The information on the digital camera is “stored” and then “forwarded” by computer to another computer at a different location. This type of technology is utilized for non-emergent situations, when there’s time for a diagnosis or consultation to be made, usually within 24 to 48 hours, with the findings then sent back. The most common use of store and forward technology is with teleradiology, where x-rays, CT scans, and MRIs can be sent from within the same facility, between two buildings in the same city, or from one location to another anywhere in the world. There are hundreds of medical centers, clinics, and individual physicians who use some form of teleradiology. Many radiologists are even installing appropriate computer technology within their own homes, allowing them access to images sent directly to them for diagnosis, eliminating an unnecessary and possibly time-consuming trip back into to a hospital or clinic. Telepathology is also another common use of this type of technology, with images of pathology slides sent from one location to another for diagnostic consultation. Dermatology is one area that greatly benefits from the store and forward technology, with digital images of different skin conditions taken and sent to a dermatologist for diagnosis.

Utilized when a face-to-face consultation is necessary, the second most widely-used technology is two-way, interactive television (IATV). This is when the patient, along with their healthcare provider (a doctor or a nurse practitioner) and a telemedicine coordinator (or a combination of the three), gather at one site (the originating site), and a specialist is at another site (the referral site) which is usually at a large, metropolitan medical center. Videoconferencing equipment is placed at both locations allowing for a consultation to take place in “real-time”. Videoconferencing technology has decreased in price over the past few years, and many of the computer programs are no longer as complex as they once were, allowing for healthcare professionals to use nothing more than a simple desktop videoconferencing system. Almost all areas of medicine have been able to benefit from videoconferencing, including psychiatry, internal medicine, rehabilitation, cardiology, pediatrics, obstetrics, gynecology and neurology. Also, many different peripheral devices like otoscopes (which help doctors look inside the ear) and stethoscopes (which enable a doctor to listen to a person’s heartbeat) can be attached to computers, aiding with an interactive examination. Many healthcare professionals are becoming more creative with the technology that’s available to them in order to conduct telemedicine. For example, it's not unusual to use store-and-forward, interactive, audio, and video still images in a variety of combinations and applications. Use of the Web to transfer clinical information and data is also becoming more prevalent, and the use of wireless technology is being used to provide ambulances with mobile telemedicine services of all kinds.

Around the world, there are many programs being used in a variety of ways to provide technologically-advanced healthcare. Telemedicine can be used in the remotest parts of the world or in places as close as a correctional facility, helping to eliminate the dangers and costs associated with the transportation of prisoners to a medical center. Also on the horizon for telemedicine is the development of robotics equipment for telesurgery applications which would enable a surgeon in one location to remotely control a robotics arm for surgery in another location. The military has been at the forefront of development for this type of technology because of the obvious advantages it offers for use on the battlefield; however, some academic medical centers and research organizations are also testing and using telesurgery in order to continue the advancements in telemedicine.

As wonderful as the advent of telemedicine is, there are still drawbacks that people need to know about, like the fact that many states will not allow out-of-state physicians to practice medicine unless they are licensed in that particular state. The Centers for Medicare and Medicaid (CMS) have placed restrictions on the amount given in reimbursements for telemedicine procedures, and many private insurance companies will not reimburse at all for this technology, although states such as California and Kentucky have legislated that insurers must reimburse the same amount for a telemedicine procedure as they would for an actual face-to-face consultation. There are also underlying fears of malpractice suits for physicians engaged in telemedicine because there is a lack of hands-on interaction with patients. However, several studies show that most people who have experienced long-distance healthcare via telemedicine have been quite satisfied with the care they received. There are also the technological problems which can hamper the progress of telemedicine, like the fact that regular telephone lines tend to be inadequate in handling many of the telemedical applications. Also, many rural areas still don’t have the cable wiring or other kinds of high bandwidth telecommunications needed to access the equipment required for more sophisticated medical uses. One other obstacle stands in the way of progress, and that’s the issue of funding. During 2005, the Technology Opportunity Program (TOP) will not receive funds for telemedicine/telehealth, and the Office for the Advancement of Telehealth (OAT) will not be able to fund any new programs either. The good news is that some private corporations and telecommunications companies are trying to fill the financial void created by the lack of funding.

All in all, the advantages of telemedicine definitely outweigh its detractors, with it soon being just another way to see a healthcare professional. The future of telemedicine will not only be advantageous for those in rural communities, but will also offer people who are homebound within metropolitan areas with a way to access specialty care. Eventually, everyone could have a personal diagnosis system through their home computers, and it will monitor our health status on a daily basis, as well as have the ability to automatically notify a medical professional when we become ill. Telemedicine, telehealth, and e-health will continue to combine the best of medicine, technology, and telecommunications, which will help make our lives healthier and safer.

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Training, Other Qualifications, and Advancement of Clinical Laboratory

Clinical laboratory technologists generally require a bachelor's degree in medical technology or in one of the life sciences; clinical laboratory technicians usually need an associate degree or a certificate.

Education and training. The usual requirement for an entry-level position as a clinical laboratory technologist is a bachelor's degree with a major in medical technology or one of the life sciences; however, it is possible to qualify for some jobs with a combination of education and on-the-job and specialized training. Universities and hospitals offer medical technology programs.

Bachelor's degree programs in medical technology include courses in chemistry, biological sciences, microbiology, mathematics, and statistics, as well as specialized courses devoted to knowledge and skills used in the clinical laboratory. Many programs also offer or require courses in management, business, and computer applications. The Clinical Laboratory Improvement Act requires technologists who perform highly complex tests to have at least an associate degree.

Medical and clinical laboratory technicians generally have either an associate degree from a community or junior college or a certificate from a hospital, a vocational or technical school, or the Armed Forces. A few technicians learn their skills on the job.

The National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) fully accredits about 479 programs for medical and clinical laboratory technologists, medical and clinical laboratory technicians, histotechnologists and histotechnicians, cytogenetic technologists, and diagnostic molecular scientists. NAACLS also approves about 60 programs in phlebotomy and clinical assisting. Other nationally recognized agencies that accredit specific areas for clinical laboratory workers include the Commission on Accreditation of Allied Health Education Programs and the Accrediting Bureau of Health Education Schools.

Licensure. Some States require laboratory personnel to be licensed or registered. Licensure of technologists often requires a bachelor's degree and the passing of an exam, but requirements vary by State and specialty. Information on licensure is available from State departments of health or boards of occupational licensing.

Certification and other qualifications. Many employers prefer applicants who are certified by a recognized professional association. Associations offering certification include the Board of Registry of the American Society for Clinical Pathology, the American Medical Technologists, the National Credentialing Agency for Laboratory Personnel, and the Board of Registry of the American Association of Bioanalysts. These agencies have different requirements for certification and different organizational sponsors.

In addition to certification, employers seek clinical laboratory personnel with good analytical judgment and the ability to work under pressure. Technologists in particular are expected to be good at problem solving. Close attention to detail is also essential for laboratory personnel because small differences or changes in test substances or numerical readouts can be crucial to a diagnosis. Manual dexterity and normal color vision are highly desirable, and with the widespread use of automated laboratory equipment, computer skills are important.

Advancement. Technicians can advance and become technologists through additional education and experience. Technologists may advance to supervisory positions in laboratory work or may become chief medical or clinical laboratory technologists or laboratory managers in hospitals. Manufacturers of home diagnostic testing kits and laboratory equipment and supplies also seek experienced technologists to work in product development, marketing, and sales.

Professional certification and a graduate degree in medical technology, one of the biological sciences, chemistry, management, or education usually speeds advancement. A doctorate usually is needed to become a laboratory director. Federal regulation requires directors of moderately complex laboratories to have either a master's degree or a bachelor's degree, combined with the appropriate amount of training and experience.

Clinical Laboratory Technologists and Technicians

Clinical laboratory testing plays a crucial role in the detection, diagnosis, and treatment of disease. Clinical laboratory technologists, also referred to as clinical laboratory scientists or medical technologists, and clinical laboratory technicians, also known as medical technicians or medical laboratory technicians, perform most of these tests.

Clinical laboratory personnel examine and analyze body fluids, and cells. They look for bacteria, parasites, and other microorganisms; analyze the chemical content of fluids; match blood for transfusions; and test for drug levels in the blood that show how a patient is responding to treatment. Technologists also prepare specimens for examination, count cells, and look for abnormal cells in blood and body fluids. They use microscopes, cell counters, and other sophisticated laboratory equipment. They also use automated equipment and computerized instruments capable of performing a number of tests simultaneously. After testing and examining a specimen, they analyze the results and relay them to physicians.

With increasing automation and the use of computer technology, the work of technologists and technicians has become less hands-on and more analytical. The complexity of tests performed, the level of judgment needed, and the amount of responsibility workers assume depend largely on the amount of education and experience they have. Clinical laboratory technologists usually do more complex tasks than clinical laboratory technicians do.

Clinical laboratory technologists perform complex chemical, biological, hematological, immunologic, microscopic, and bacteriological tests. Technologists microscopically examine blood and other body fluids. They make cultures of body fluid and tissue samples, to determine the presence of bacteria, fungi, parasites, or other microorganisms. Technologists analyze samples for chemical content or a chemical reaction and determine concentrations of compounds such as blood glucose and cholesterol levels. They also type and cross match blood samples for transfusions.

Clinical laboratory technologists evaluate test results, develop and modify procedures, and establish and monitor programs, to ensure the accuracy of tests. Some technologists supervise clinical laboratory technicians.

Technologists in small laboratories perform many types of tests, whereas those in large laboratories generally specialize. Clinical chemistry technologists, for example, prepare specimens and analyze the chemical and hormonal contents of body fluids. Microbiology technologists examine and identify bacteria and other microorganisms. Blood bank technologists, or immunohematology technologists, collect, type, and prepare blood and its components for transfusions. Immunology technologists examine elements of the human immune system and its response to foreign bodies. Cytotechnologists prepare slides of body cells and examine these cells microscopically for abnormalities that may signal the beginning of a cancerous growth. Molecular biology technologists perform complex protein and nucleic acid testing on cell samples.

Clinical laboratory technicians perform less complex tests and laboratory procedures than technologists do. Technicians may prepare specimens and operate automated analyzers, for example, or they may perform manual tests in accordance with detailed instructions. They usually work under the supervision of medical and clinical laboratory technologists or laboratory managers. Like technologists, clinical laboratory technicians may work in several areas of the clinical laboratory or specialize in just one. Phlebotomists collect blood samples, for example, and histotechnicians cut and stain tissue specimens for microscopic examination by pathologists.

Work environment. Clinical laboratory personnel are trained to work with infectious specimens. When proper methods of infection control and sterilization are followed, few hazards exist. Protective masks, gloves, and goggles often are necessary to ensure the safety of laboratory personnel.

Working conditions vary with the size and type of employment setting. Laboratories usually are well lighted and clean; however, specimens, solutions, and reagents used in the laboratory sometimes produce fumes. Laboratory workers may spend a great deal of time on their feet.

Hours of clinical laboratory technologists and technicians vary with the size and type of employment setting. In large hospitals or in independent laboratories that operate continuously, personnel usually work the day, evening, or night shift and may work weekends and holidays. Laboratory personnel in small facilities may work on rotating shifts, rather than on a regular shift. In some facilities, laboratory personnel are on call several nights a week or on weekends, in case of an emergency



Evolution of Medical Technology

American Medical technologists

The American Medical Technologists (AMT) is a nonprofit certification agency and professional membership association representing over 45,000 individuals in allied health care. Established in 1939, AMT has been providing allied health professionals with professional certification services and membership programs to enhance their professional and personal growth. Upon certification, individuals automatically become members of AMT and start to receive valuable benefits.

Certifications are offered in the following categories: Medical Technologists, Medical Laboratory Technicians, Medical Lab Assistants, Medical Assistants, Medical Administrative Specialists, Phlebotomy Technicians, Dental Assistants, Allied Health Instructors, Clinical Laboratory Consultants

Founded in 1939, American Medical Technologists (AMT) is a nationally and internationally recognized certification agency and membership society for the following allied health professionals:

Medical and Dental Office

Medical Assistant

Medical Administrative Specialist

Dental Assistant

Laboratory

Medical Technologist

Medical Laboratory Technician

Medical Laboratory Assistant

Phlebotomist

Clinical Laboratory Consultant

Health Education

Allied Health Instructor

AMT certification examinations are developed, administered, and analyzed using industry standards and state-of-the-art methodologies. Each examination is developed by a committee of subject-matter experts. As the tests provide only one source of information regarding examinee competence, they are used in conjunction with other indicators of training and experience in the granting of certification. Once certification is granted, applicants automatically become members of AMT and have a host of member benefits at their disposal.

AMT is accredited by the National Commission for Certifying Agencies (NCCA). Not all healthcare certification organizations are NCCA accredited -- in fact, very few have received such recognition. Only organizations meeting rigorous NCCA Standards bear the NCCA seal of approval.

AMT Mission Statement

The mission of AMT is to manage, promote, expand upon and continuously improve our certification programs for allied health professionals who work in a variety of disciplines and settings, to administer certification examinations in accordance with the highest standards of accreditation, and to provide continuing education, information, advocacy services and other benefits to our AMT members.

AMT Vision Statement

Our vision is for American Medical Technologists to be acknowledged and recognized by the world as truly being THE premier certification and membership organization for allied health professionals, particularly those in the professions of medical technology, phlebotomy, medical assisting, dental assisting and medical office administration.

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Error and Injury in Computers & Medical Devices

Computers are playing an increasing role in everyday life, so it is not surprising that incidents involving computers have become a common matter of litigation. In a wide variety of technical, financial and other situations, people make decisions and perform responses based on the appearance of a computer screen. The increased reliance of computer controlled devices in medicine is particularly noteworthy because of the critical safety issues involved. As I will discuss below, this produces a conflict between the usual goal of interface design, intuitiveness and ease-of-use, and the safety of patients.

When error occurs, the question naturally arises as to how one can apportion responsibility between the human and the computer: was the computer poorly designed or was the human negligent?

In many cases, the critical component of the computer is its interface. Users/operators generally do not understand the computer's inner world of bits, bytes, files, ram, etc. Rather, they understand the computer through its interface, the text and images that appears on the screen. Hence, a popular saying in the computer world is that for the user:

"The Interface Is The System"

User/operator actions can only be evaluated in the context of the interface. As an analogy, suppose a driver fails to see a STOP sign, runs an intersection and hits another car. Is it the driver's fault? If the STOP were highly visible, the answer would likely be "yes." If the STOP sign were hidden by foliage, then the answer is likely "no" because the information were beyond human ability to perceive and to respond. Similarly, the actions of a computer user can only be evaluated in reference to the quality interface design.

In order to assess responsibility, it is important to understand how interfaces are designed. Below, I provide a brief outline of the methods which designers use in creating and evaluating computer and other man-machine interfaces.

Standard Practice in Interface Design

There are two principal issues which should be investigated when there is an accident involving computers. First, the computer interface should be evaluated for adequacy of design. Faulty design could be construed as negligence on the part of the designers. As discussed below, there are a number of standard criteria available for evaluating adequacy. Second, the interface design procedure should be closely examined. Just as there are standards for nursing practice and for medical care, there is standard practice for interface design. Although not formally codified, the standard practice is generally understood by interface professionals and is described in most design texts. Failure to follow the generally agreed practice is also a possible source of negligence.

Most interface design occurs in 4 overlapping phases. In addition, there is a 5th optional phase, which may or may not be performed.

1. Requirements gathering

The designer studies users and their tasks and attempts to develop a set of requirements, which state what the interface should do. This stage is critical, since misunderstanding the users (or user classes if there are different groups) will guarantee a flawed interface design.

2. Prototype development:

The next step is to develop a prototype with which to test users. In most cases, the initial prototypes are crude (sometimes even paper and pencil) and become more refined with user testing. (See next phase.)

3. Formative Usability Evaluation:

A good designer will continually test users in order to validate design and to test assumptions. Each design is really a guess until it has been tested and found adequate by a representative set of users (although there are other useful techniques - see below). The designer uses data obtained from each evaluation to refine and form (hence the name "formative") the design and prototype. The design is retested (looping the procedure back to phase 2), and the design further refined. In theory, testing stops when a predetermined set of benchmarks is reached and/or when the designer is simply satisfied. In reality, design typically ceases when time or money run out.

4. Conversion of Prototype to Final Software

Software engineers (programmers with little or no interface design experience in most cases) convert the prototype to a final form, usually in a faster and more efficient programming language. It is not uncommon for the design to change significantly in this process. Sometimes the software engineer makes what he/she considers small changes (which may, in fact, be major changes) in order to make programming easier and sometimes the efficient programming language simply cannot produce the design exactly.

5. Summative Usability Testing

Usability testers evaluate the final interface functionality. This may occur in-house, or the testers may go to customers in the field. Results are then used to improve the next software revision.

The scheme outlined here, with some variation, is standard practice by interface design and usability experts. However, this is not how all interfaces are designed. In many companies, people with little or no design, usability or human factors experience often create the interface. Some companies are run by techies who simply slap untested interfaces together as an afterthought, with software engineers performing interface "design." Graphic artists often design interfaces, especially on web sites, although they have no psychology or human factors training. Lastly, usability testing is expensive, so companies may skimp on this part of the project budget. Although the importance of human factors is becoming better understood in the technology world, inadequate design procedures are still common.

A properly conducted design procedure generates a series of standard documents. The most important are the "requirements document," "design specification" and the "change control" documents. The requirements document says what the interface ought to do. The design specification document describes the interface in detail. It is usually written by the designer(s) so that the people programming the production code know what the design should be. There is often a deviation between the design and final product for the reasons already described. Lastly, the change control document is a formal notation of all changes in the design, usually after the design specification is written. There are almost invariably some design changes made up until the last possible second. Usually, there are specific people who must "sign off" on each document.

Standard Evaluation of Interfaces

Usability testing of the prototype is a critical part of design. There are many techniques for testing, but they fall into two general classes:

  • Those that that involve actual users
  • Those that do not involve actual users.
The first method, which has many variations, has users sitting at a computer and working with a prototype. At early development stages, the user may be merely exploring the software - viewing screen, clicking buttons, entering numbers, etc. With more refined prototypes, the user may be solving a simulated task which resembles his/her real work. The tester may simply write qualitative observations or may record quantitative data, such as number of errors and time required for task completion, and perform statistical analysis. Videotaping of users is common.

The second method is sometimes used to supplement, and occasionally replace the first if users are hard to obtain. This occurs if the users' time is very valuable (physicians, lawyers, or very highly skilled technical employees, etc) or if the users are geographically remote. Moreover, it is sometimes difficult to know who the users will be, so it may be misleading to test with any particular group.

A common nonuser method is called "Heuristic Evaluation." A group of 3-5 usability experts and/or nonexperts judges the interface based on a set of specific criteria. Here are some criteria, which would be used to judge most interfaces:

  • Simplicity: make the interface easy to use:
  • Design For Error: assume that the user will make errors. Make errors easy to reverse and/or find a way to prevent them, e. g., ask for confirmation on important actions.
  • Make System State Visible: the user should know what is happening inside the computer from looking at the interface.
  • Speak the user's language: use concepts with which the user is familiar. If there are different classes of user (say, novices and experts in the work), then be sure that both groups understand the interface.
  • Minimize Human Memory Load: human memory is fallible and people are likely to make errors if they must remember information. Where possible have the critical information on the screen. Recognition and selection from a list are easier than memory recall.
  • Provide feedback to the user: when the user makes an action, provide feedback that something happened. At the most basic level, the feedback may simply be a beep to indicate that a button press was recorded. At a higher level, the feedback may be a message that describes the consequences off the action in detail.
  • Provide good error messages: When errors occur, provide the user with good information about the problem. Poor error messages can be disastrous, as in the Therac-25 case.
  • Be Consistent: Similar actions should produce similar results and objects, which are the same visually (colors, shapes), should be related in an important way. Conversely different objects should be indicated by different visual appearance.
These same criteria can be used to judge the responsibility of the interface design in an accident. From experience, I'd guess the most common problems are lack of consistency, hiding of the system state and failure to design for error. (Most interface designers have never head of a Failure Mode and Effects Analysis.)

Ease of Use vs. Safety: An Example of Medical Device Error

One problem in evaluating interface design is that safety and ease-of-use sometimes conflict. Interface designers are taught to make the interface "user friendly" and intuitive. Being intuitive, however, is a two-edged sword. The good news is that users learn the interface quickly and make fewer errors. In addition, an intuitive interface is more likely to be properly operated when the user is under stress, the time when people unconsciously fall back their innate and highly learned behavior.

The bad news is that very notion of "intuitive" means that the user/operator won't have to think too much. In safety critical situations, this is not always desirable. People have a tendency to minimize their workload by using more and more general cues. For example, instead of reading a red warning label, they may learn to simply respond when they see the red text - it is much easier and faster to recognize color than to read text. If there is an unusual or unexpected message in red, the user will not notice the change because the cue is color, not the actual text. Similarly, users learn to make their responses "automatic" when they occur with great frequency.

The classic example of ease-safety conflict is the Therac-25, which was a computer-controlled device for delivering measured bursts of radiation to cancer patients. Several patients being treated with the machine accidentally received fatal doses of radiation.

There were many problems with the Therac-25 (including poor error messages which failed to make the machine state visible), but I'll just comment on one aspect of the interface design. In the original version of the machine, the operator had to enter control parameters twice. First, they were typed into the computer and sent with by hitting the "enter" key. Second, the user entered the values into a control panel. This provided redundancy for a critical task. It seemed less likely that the operator would enter the same wrong values twice. Moreover, the computer could check to make sure that the values were the same.

From an ease-of-use standpoint, this was a clumsy design. The interface designers decided make the users life easier by removing the need to confirm values with the control board. As before, the user typed numbers and then hit the enter key to send the values. Instead of going to the control board, the values appeared again on the screen, and the user could confirm them by hitting the "enter" key a second time. This second confirmation was a replacement for the control board data entry. It was much a faster and more efficient interface design.

Users soon began entering the values and then simply hitting the "enter" key twice without looking at the screen. The new system was easier, but the redundant check on the values was gone.

This was highly predictable because of phenomena called "automaticity" and "response chaining." When a person repeatedly performs a task requiring a standard and unvarying series of responses, then the responses chain together and effectively become a single response. Once started, the chain of responses runs off automatically. For example, a pianist learning a new piece might have to think about every note before hitting the key. After practice, the pianist simply runs off the series of responses without thinking. This reliance on "muscle memory" is obviously much easier, but thinking is removed from the task. The Therac-25 case was a particular bad example because the enter and confirmation responses were identical, which facilitates response linking.

Such errors are common. In another case, a nurse, accidentally turned off the alarm on computerized equipment monitoring a critically ill patient. Normal operation required her to set the alarm to "on" and then to confirm the choice with several more responses on computer keyboard. She viewed a series of computer screens containing information about the alarm system. After each, she was to press the enter key again to confirm and to see the next screen. With experience, the responses chained and became automatic. She would set the alarm and begin merely hitting the enter key rapidly - tap, tap, tap - without really monitoring the screen information. She had done this many times before and the screens had never revealed any important information, so she began (unconsciously) conserving attention and increasing efficiency by ignoring the "irrelevant" information. On this one occasion, she missed the screen saying that the alarm was still off. The response chain, once started, had run off without supervision.

Summary

Since "The Interface is the system", an attorney investigating any accident involving a computer should examine the interface design. The first questions that should always be asked about an accident involving computers are:

  • Did the interface design meet the requirements of the task?
  • Did the interface meet standard evaluation criteria?
  • Was standard practice followed in the interface design?
  • Was testing adequate?
  • Were the test users appropriate?
  • Were the usability test results properly interpreted and incorporated in the design?
  • Were there "Change Control" and other formal documents on the design procedure?
  • Who designed the interface and what were his/her credentials?
  • If a safety critical situation, what was the tradeoff between ease-of-use and safety?
There are also secondary issues which should also be examined, such as "Was user training adequate?", "If the user/operator could customize the interface, did he/she reduce interface quality?," etc.

In this article, I have outlined the issues involved in determining responsibility in accidents involving computers. Computers and similar devices are truly "man-machine systems," where both components must function properly to avoid error. It is perhaps natural to examine only the user/operator actions, since they represent the visible "sharp end" of the system. In many cases, however, the major fault lies with the machine and/or the process used to develop the most important part, the user interface.