John S. Silva

Health Status of Air Force Veterans Occupationally Exposed to Herbicides in Vietnam: I. Physical Health

The Air Force Health Study is a 20-year comprehensive assessment of the health of Air Force veterans of Operation Ranch Hand, the unit responsible for aerial spraying of herbicides in Vietnam. The study compares the health and noncombat mortality of Ranch Hand veterans with a comparison group of Air Force veterans primarily involved with cargo missions in Southeast Asia but who were not exposed to herbicides. This report summarizes the health of these veterans as determined at the third in a series of physical examinations. Nine hundred ninety-five Ranch Hands and 1299 comparison subjects attended the second follow-up examination in 1987. The two groups were similar in reported health problems, diagnosed skin conditions, and hepatic, cardiovascular, and immune profiles. Ranch Hands have experienced significantly more basal cell carcinomas than comparison subjects. The two groups were not different with respect to melanoma and systemic cancer.

An architecture for a health care provider's workstation

This paper presents an architecture for a health care providers workstation designed to assist health care providers in performing their daily activities. The design is based on the concept of a clinicians associate which acts as an intelligent intermediary between the provider and a diverse collection of clinical, administrative, and educational information sources. The architecture is designed to be hardware platform independent, to work across different I/O capabilities, and to be open, allowing specialized applications to be easily integrated with the system and their functionality delivered through a common user environment.

The health care professional's workstation: its functional components and user impact

Our purpose in this chapter is to describe selected requirements for a health care professional’s workstation (PWS). We focus on the use of a PWS as an intelligent intermediary between a provider and an integrated hospital information system (HIS).

Prognosis for year 2013

New knowledge from biotechnology and new capabilities provided by the evolving global information infrastructure are already transforming health care. Three clusters of technologies hold particular promise: grid computing, intimate computing, and micro laboratory computing. The confluence of these technologies will change clinical laboratory equipment into portable devices, easing the administrative details involved in delivering care and ushering in a new age of monitoring clinical states. Two vignettes, an office visit and a clinical trial, are offered as prognosis for clinical care in 2013. New capabilities hold the power to transform health care, making it truly patient centered as the Institute of Medicine (IOM) has urged.

Disruptive Innovation: Point of Care

Authors’ note: It is important for the reader to understand that these essential elements of a PCMH were defined exclusively by physician organizations. The authors have used the term Medical Home to be more inclusive of all health practitioners. This fourth edition of Nursing Informatics is replete with examples of how information technology (IT) can help nurses work safer and provide “better” care. One section in this volume contains a detailed description of the TIGER initiative that lays out a set of core informatics competencies for nurses and a roadmap of how to infuse nursing with the capacity to use IT to its fullest extent. The vision of the TIGER initiative is to: “enable nurses to use informatics tools, principles, theories and practices… making information technology the stethoscope for the twenty-first century.” This TIGER initiative even recommends an “IT driver’s license” to certify that a nurse knows how to drive the IT systems he or she will use. No one would get a driver’s license, however, if driving a car was of little use in everyday life. In order for IT to become an integral part of the practice of nursing, it must be fundamentally useful.

Engineering the Next Generation of Health Systems

This chapter focuses on three changes that will dramatically affect the rapidly evolving health ecosystem. It highlights today’s high value/high usability computing paradigm, the explosion of information within the Web and the challenges for EHR systems as they try to face the data tsunami. The chapter proposes that a Complex Adaptive System (CAS) framework will be essential for an inclusive health ecosystem that meets the needs of clients, consumers and health workers. The authors suggest that a person-owned wellness-health record (POWR) will be required in the new ecosystem. It postulates that a Smart point of need system for all users should replace the current point of care systems that are limited to healthcare workers. The chapter concludes with a description of a community-based health ecosystem that adopts the behaviors of a CAS, incorporates continuous quality improvement and exploits new technologies to support decision-making for all individuals within the community.