Is My Current Computer Adequate?

Generally computers need to be replaced every three to four years. If your computer is four years old now you should consider purchasing a new laptop for medical school. The configuration below is a bare minimum that would be usable for a year or two. If your system does not meet these specifications you should consider a new laptop.

Bare Minimum Laptop: 3.0 GHz Pentium 4 or Pentium M, or 2.0 GHz G4, 2 GB RAM, 80 GB hard drive, 1024x768 resolution or higher monitor, CD-ROM, 801.11g WiFi, Ethernet, ink jet printer, VGA jack or adapter.

What Computer Should I Buy?
Recommended Solutions for Medical Students

The computer industry rolls out new models and features constantly. Choosing which computer and printer to buy is complicated, but to make it easier, we’ve listed some specifications and models at the end of this section for a "most portable" and a "larger screen" configuration.

Either Windows-compatible or Apple Macintosh computers are equally appropriate for use at the School of Medicine. There are a few rare types of software that will not run on the Macintosh, but we provide nearly all course resources on the Web, which is platform neutral. New Apple computers allow you to purchase and install Windows if you choose.

We recommend the use of a laptop computer, rather than a desktop. A laptop computer is a very handy for taking notes in class, carrying to the library or taking to a remote clerkship location.

Make sure any laptop you buy includes an Ethernet jack, and 802.11 b/g/n wireless connectivity. Students living in private housing can access all the University's network based services such as E-mail, Web, and reference systems remotely. Most medical students find using a high speed Cable Modem or DSL connection is a necessity, since multimedia files download much more quickly than with a modem. A DSL or Cable Modem connection will cost $25-$50 per month, but it can be used at the same time by several roommates.

If you buy the "Most Portable" model of either the Windows compatible or Macintosh system, you will get a computer that is small and easy to carry, and more than adequate for word processing, E-mail, Web browsing, and other common tasks. If you choose the "Large Screen" models you will get a little larger screen size, but with increased weight and size. We list Dell models below as examples of the Windows configurations. These are some of the best models available according to comparison reviews, and local sales and service is available at Cavalier Computers.

If you are buying a new computer, you will probably want to purchase a printer to make your work easier. Basic color inkjet printers are available for less than $100, and sometimes are bundled with new laptops.

Recommended Hardware Configurations:

Larger Screen PC: Dell Latitude E6500, Latitude E6400 Intel Core Duo 2.53 GHz; 4 GB RAM; 250 GB hard drive; DVD+/-RW drive; 802.11 b/g/n wireless; 10/100/1000 Ethernet; 14.1”-15.4" WXGA+ display; Integrated Speakers; VGA adapter; Carrying Case; 5-6 lbs; Price range: $1100-$1850.

Most Portable Netbook PC: Asus EeePC 1000HE: 10" screen, Intel Atom N280 1.6 GHz, 1 GB RAM, 160 GB hard drive, 10/100/1000 Ethernet, 802.11b/g/n wireless, VGA adapter. Weight about 5 lbs. 9 hour battery life. Price range: $390-$400.
Note: If you buy this small inexpensive netbook, consider getting a 20" display and external DVD drive for home use.

Larger Screen Mac: MacBook Pro: 15.4" widescreen display; 2.4 GHz Intel Core2 Duo; 2 GB RAM; 250 GB hard drive; FireWire 800 and USB 2.0 ports, Slot-loading double-layer SuperDrive (8x DVD+/-RW); AirPort Extreme (802.11b/g/n), and 10/100/1000 Ethernet; VGA adapter; Mac OS X Snow Leopard, Weight Weight: 5.5 lbs. Price range: from $1999.

Most Portable Mac: MacBook 13.3" widescreen display, 2.4 GHz Intel Core2 Duo; 2 GB RAM; 250 GB hard drive, USB 2.0 ports, Slot-loading double-layer Superdrive (8x DVD+/-RW), Airport Extreme (802.11b/g), 10/100/1000 Ethernet, VGA adapter, Mac OS X Snow Leopard, weight 5.0 lbs. Price range: from $1599.

Windows XP or Vista?
Many laptops can be purchased with either Windows XP or the newer Windows Vista. UVa supports both versions of Windows and either will do the job. We do not recommend upgrading a computer made before 2007 to Vista.

What about a Mobile Device?

All medical students buy a mobile devive while in medical school, but it is not a requirement until the core clerkship year. Typically students load their mobile unit with reference software that is helpful while seeing patients in the third and fourth years of medical school. Many students also find them useful for their calendar, contact management, to-do lists and note taking capabilities. We currently recommend that clerkship students buy iPod Touches or iPhones. If you are going to buy an iPod soon anyway, consider getting the Touch or an iPhone so you can load medical applications as needed. For more information see our PDA resource site or our PDA requirements page.

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Which software should I buy?

The following table highlights most of the standard, supported software usable in the UVA Health System Library. Many times new computers come packaged with all the software you will need. But if you need to purchase software we'll be able to help you better if you choose one of the packages below.

We require that all students install Symantec Antivirus, which is available at no charge from UVA. Windows users should also install Windows Defender to block spyware. Automatic updates for both products should be turned on.

Word Processing	Microsoft Word
Spreadsheet	Microsoft Excel
Presentation	Microsoft PowerPoint
Database	Microsoft Access (Win) Filemaker Pro (Mac)
Electronic Mail	Thunderbird1
Virus Protection	Symantec Antivirus1
Spyware Protection	Windows Defender1(Win)
Web Browser	Firefox1
Document Reader	Adobe Acrobat Reader1

¹Software is available free of charge to all UVA students, faculty, and staff. ITC's Software Download site.

Do I have to buy Microsoft Office?

No. Faculty many times distribute documents documents as Microsoft Word and PowerPoint files, so you will need a way to open or view these files. You can either purchase Microsoft Office for $10 at Cavalier Computers, or use free alternatives to MS Office.

The best free option for Windows is OpenOffice, a open source free Office suite alternative that works well. It includes a word processor, spreadsheet, presentation package, database, and drawing package, and it reads and writes Word and PowerPoint files with few problems.

NeoOffice for Mac is based on Open Office, and has been modified to work well with Mac OS X. It offers a word processor, spreadsheet, presentation package, database and drawing package, and reads and writes Word and PowerPoint files with few problems.

These applications are not officially supported, so you should be comfortable working with unique software should you like to avoid purchasing MS Office. If you do buy Microsoft Office, be sure to purchase it from Cavalier Computers for they offer it for only $10 to students, much less expensive that you can find elsewhere

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Where should I buy computer hardware and software?

There are many places to get good deals on computer equipment and software including mail order, direct from the manufacturers, computer "superstores," and local retail outlets. When checking prices, be sure to contact Cavalier Computers, a division of the University of Virginia Bookstore, which offers educational discounts that meet or beat many prices available elsewhere. Cavalier Computers is located on the University grounds and offers the added convenience of packages designed specifically for medical students, plus local service. You can contact Cavalier Computers' medical branch at (434) 924-4600 or visit their site at http://www.uvastudentcomputers.com to get information on their packages and order on-line.

Medical computer games

Thomas wrote a post yesterday on medical board games, which got me reminiscing about medical computer games. There is a long history of medical computer games, particularly within the simulation genre. Most noteworthy is the now extinct Bullfrog Productions’ wickedly funny Theme Hospital, which was published in 1997 by Electronic Arts. The game is a darkly humorous simulation, in which the player has to build a hospital, manage staff and attract patients. A similar game is the recently published Hospital Tycoon, published in 2007 by Codemasters.

Another sub-genre of medical games emerged from Japan with the succes of Trauma Centre: Under the Knife, released for the Nintendo DS in 2005. The game is a roleplaying game set in 2018, and features the struggle against a man-made disease called GUILT (Gangliated Utrophin Immuno Latency Toxin), which is distributed by a terrorist organization. The protagonist is a young surgeon, who learns he is a descendant of Asclepius, no less. The gameplay consists of a series of increasingly difficult operations (you can see what the gameplay looks like here), which the player has to complete to advance the story. The game has since spawned a number of follow-ups and clones.

Another series of games that deserve a special mention is the Life and Death-series, which dates back to the early years of DOS-gaming. Check out what a digitalised interactive brain surgery looked like in 1990 here.

There are a number of other medical games, but my personal favorite medically themed game (well, sort of medically themed) is the fantastic Psychonauts from 2005, in which the player has to delve into the psyches of a group of kids to stop a villain from tampering with their minds. A truly original and brilliant game, by any standards.

I have no doubt that we will see more medically themed games in the future, and particularly games along the lines of the protein-folding game Foldit (which has been mentioned on this blog before). Everyone, including scientists, are increasingly realising the co-creative potential of the participatory web, and there will no doubt be a rush to explore this potential.

Medical Robotics and Computer Assisted Surgery

The MRCAS Laboratory is the main laboratory of the Center for Medical Robotics and Computer Assisted Surgery. Our research involves both planning aspects of computer-assisted surgery, e.g., medical image computing and surgical simulation, and execution aspects, e.g., intraoperative sensing, registration, and actuation. Current projects include the HipNav system for total hip replacement surgery, the Image Overlay system for enhanced visualization of anatomical structures during surgery, projects simulating knee surgery and soft tissue properties, and the Intelligent Instrument project for enhanced manual accuracy in ophthalmologist microsurgery. Even when robotics technologies were relatively primitive, their potential role in boosting the productivity and competitiveness of the United States was foreseen in the evolving global marketplace. The Robotics Institute at Carnegie Mellon University was established in 1979 to conduct basic and applied research in robotics technologies relevant to industrial and societal tasks. Seeking to combine the practical and the theoretical, the Robotics Institute has diversified its efforts and approaches to robotics science while retaining its original goal of realizing the potential of the robotics field. Contact Us U.S.Mail The Robotics Institute 5000 Forbes Avenue Pittsburgh PA 15213-3890 1-412-268-3818 1-412-268-6436 (fax) Robotics Institute Director Matt Mason: matt.mason@cs.cmu.edu Robotics Institute Graduate Programs Admissions robotics.admissions@ri.cmu.edu Robotics Institute Administration Cheryl Wehrer: wehrer@cmu.edu Robotics Institute Public Relations & Press Releases Byron Spice: 1-412-268-9068, bspice@andrew.cmu.edu Robotics Institute General Questions robotics@ri.cmu.edu Robotics Institute Website Comments robotwebmaster@ri.cmu.edu

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What Medical Informatics Provides

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

Medical Informatics provides both a conceptual framework and a practical inspiration for this swiftly emerging scientific discipline. As a textbook for students of medical computer science, and a reference work for individual readers needing to understand the role computers can play in the provision of medical services, the book first explains basic concepts, then illustrates them with specific systems and technologies. For example, it describes computing systems for medical records, nursing, hospital information, pharmacy, radiology, patient monitoring, decision support, medical education, and office practice. The ultimate aim of the editors has been to focus on recurrent themes in medical informatics, medical computing applications, and future direction for research, as well as to clarify the definition, and to nurture the effectiveness, of healthcare computing.

Highlights: -Provides the conceptual base needed for understanding and implementing application in medical informatics -Presents sample of how computers assist in the delivery of health care -Includes pointers to additional literature, chapter summaries, and concise definition of recurring terms for self-study or classroom use.

New for the 2/e: -System Design and Engineering -Ethics of Health Informatics: Privacy, Confidentiality, Security and Legal Issues -System Evaluation and Technology Assessment -Public Health and Consumer Use of Health Information: Education, Research, Policy, Prevention and Quality Assurance -Healthcare Financing: Impact on Health Information Systems

Advantages of computer-based medical records

1. Simultaneous, remote access to patient data
   Multiple clinicians can access a patient's record simultaneously from many locations. With the recent advent of secure data transmission over the web, clinicians can now review and edit patient records from anywhere in the world.

2. Legibility of record
   Handwritten charts are notoriously difficult to read. On-screen or printed text is often far more legible than handwriting.

3. Safer data
   New users often fret over the potential for lost data due to system malfunctions. With a well designed and tested backup scheme and disaster recovery system, a computer-based record is much more reliable and less prone to data loss than conventional paper-based records.

4. Patient data confidentiality
   Record access can be restricted and monitored automatically; each user can have specific levels of access to various data types. Audit logs can be screened electronically to look for statistical abnormalities which may signal unauthorized record accesses.

5. Flexible data layout
   Users can have a separate data display and data entry screen, recall data in any order (e.g., chronologically or in reverse chronological order), and create disease or condition specific data review formats. Paper records suffer from temporal constraints in the sense that data are fixed in the exact sequence in which they were recorded.

6. Integration with other information resources
   Once in electronic form a patient's data can be linked to reference information stored and maintained locally or, via the internet, on a computer half-way around the world.

7. Incorporation of electronic data
   Physiologic data can be captured automatically from bedside monitors, laboratory analyzers, and imaging devices located throughout the healthcare enterprise. Such data capture is free from the uncertainties and unreliabilities of human data entry efforts.

8. Continuous data processing
   Provided that data are structured and coded in an unambiguous fashion, programs can continuously check and filter the data for errors, summarize and interpret data, and issue alerts and/or reminders to clinicians following the detection of potentially life-threatening events.

9. Assisted search
   In a small fraction of the time required using a manual system, computers can search free-text (or as Octo Barnett terms it "expensive text") as well as structured data to find a specific data value or to determine whether a particular item has ever been recorded. However, unstructured text must be searched with care since clinicians use many different words and phrases to express the same clinical concept.

10. Greater range of data output modalities
    Data can be presented to users via computer-generated voice, two-way pagers, or email, for example. In addition, instructions can be sent to external, computer-controlled devices like automatic pill dispensers, or infusion pumps which will then carry out the clinician's intended action. Patient-specific alarms can flash lights, ring bells, or buzz buzzers. Finally, multiple single plane images can be transformed back into a single 3-dimensional image and superimposed on the surgeon's field of view.

11. Tailored paper output
    Data can be printed using a variety of fonts, colors, and sizes to help focus the clinician's attention on the most important data. In addition, images can be combined with textual data to create a more complete "picture" of the patient's condition.

12. Always up to date
    If the electronic record is integrated, then all data is immediately available to all practitioners regardless of their physical location as soon as the data is entered into the computer. This eliminates the problems associated with several physicians, each keeping a small portion of a patient's medical record in their offices and transferring these paper-based records back and forth as they consult.

Health informatics

Health care informatics or medical informatics is the intersection of information science, computer science, and health care. It deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and bio-medicine. Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. It is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health and (bio)medical research.

Medical informatics began to take off in the US in the 1950s with the rise of the microchip and computers.

Early names for medical informatics included medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering, and medical computer technology.

Since the 1970s the coordinating body has been the International Medical Informatics Association (IMIA)

Medical informatics in the United States

The earliest use of computation for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley.^[3]

The next step in the mid 1950s were the development of expert systems such as MYCIN and INTERNIST-I. In 1965, the National Library of Medicine started to use MEDLINE and MEDLARS. At this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS (Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett's Laboratory of Computer Science ^[4] at Massachusetts General Hospital in Boston.^[5] In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS operating system was used to support MUMPS language specifications. As of 2004^[update], a descendent of this system is being used in the United States Veterans Affairs hospital system. The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA). A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 health care facilities.

In the 1970s a growing number of commercial vendors began to market practice management and electronic medical records systems. Although many products exist, only a small number of health practitioners use fully featured electronic health care records systems.

Homer R. Warner, one of the fathers of medical informatics,^[6] founded the Department of Medical Informatics at the University of Utah in 1968, and the American Medical Informatics Association (AMIA) has an award named after him on application of informatics to medicine.

Aspects of the field

• architectures for electronic medical records and other health information systems used for billing, scheduling, and research
• decision support systems in healthcare, including clinical decision support systems
• standards (e.g. DICOM, HL7) and integration profiles (e.g. Integrating the Healthcare Enterprise) to facilitate the exchange of information between healthcare information systems - these specifically define the means to exchange data, not the content
• controlled medical vocabularies (CMVs) such as the Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT), MEDCIN, Logical Observation Identifiers Names and Codes (LOINC), OpenGALEN Common Reference Model or the highly complex UMLS - used to allow a standard, accurate exchange of data content between systems and providers
• use of hand-held or portable devices to assist providers with data entry/retrieval or medical decision-making, sometimes called mHealth.
• The international standards on the subject are covered by ICS 35.240.80^[1] in which ISO 27799:2008 is one of the core components.^[2]
• Bioinformatics and medical informatics are expected to (partially) converge in the future