Milton P. Huang

An Informatics Curriculum for Psychiatry

Information technology is growing at a tremendous rate, becoming a part of all aspects of the practice of psychiatry. Medical informatics is the study of the use of information in medicine. As information management becomes a greater part of the definition of psychiatric practice, it becomes critical that an understanding of medical informatics principles as applied to psychiatric practice should be incorporated into psychiatric residency training. The authors outline the components and objectives of such a curriculum, focusing on basic tasks of patient care, communication, education, and practice management. The authors conclude with a discussion of issues affecting implementation, including assessment of resources and program planning.

Barriers to Telemedicine in Psychiatry

Telepsychiatry is the practice of psychiatry using a telecommunication link for the purpose of delivering clinical care. Telecommunications allow for access to care and consultation when a patient or other consultee are in a place other than the same location as the provider. Within the context of recent media attention given to telemedicine (TM), little attention has been shown to telepsychiatry. Instead, attention has been given to other medical applications, in particular cardiology, radiology, pathology, and emergency medicine. More broadly, issues concerning TM are being discussed as it becomes apparent that the implementation of TM is not progressing as rapidly or extensively as hoped (Sanders & Tedesco, 1993). These discussions do not attempt to deal with the specific and unique factors concerning the practice of psychiatry and the barriers that might exist in this field.

The CAVE™ System

The CAVE™ is a projective virtual reality system that represents the state of the art in virtual reality technology. Its construction solves many of the problems of traditional head-mounted devices. Now marketed by Pyramid Systems, it is reaching a wide audience and finding applications in academic research and industry. Researchers at the University of Michigan are now applying the CAVE™ in mental health applications, and these devices will permit further exploration of the phenomenology and structure of mental illness and mental function.

Tools for Developing Multimedia in Psychiatry

Multimedia refers to the use of graphics, sound, animation, and video in the transmission of information. By accessing several sensory modalities instead of only one, multimedia allows greater communication than simple text or simple speech. Creating a message with visual and auditory elements increases the density of information sent and permits greater impact. Furthermore, the term multimedia has also come to suggest a media that allows interactivity. Unlike a movie that must be seen from beginning to end in a fixed sequence, multimedia productions directly elicit information from the audience and alter themselves accordingly. Although present and utilized within medicine and psychiatry for over 20 years (Baskett, 1978; Miller, 1972), recent advances in computer technology have propelled multimedia to a new prominence. Increases in central processor speed and storage capacity have enabled the rise of digital media where text, music, and video are created and distributed with the use of computers. With the help of computer tools, the technical expertise required to develop media is more easily mastered and dispersed. Previously, artisans and artists spent their lives dedicated to a single realm such as printing, photography, etc. Now, anyone can produce professional results with the help of a desktop system. These effects are becoming evident in almost all areas of communication, entertainment, and education. The “digital revolution” is leading the way for what is thought of as the most significant advance since the development of the printing press.

Behavioral Health Consumerism and the Internet

One of the most significant consequences of Internet development has been in the area of consumer health care. Recent research found evidence of upward of 25 million adults in the United States searching for health information and potentially 15,000 health care sites.1 Never in the history of medicine have patients had such ready access to medical knowledge or such an ability to communicate with a broad range of similarly or identically ill patients, regardless of disease rarity.2 This is a new era in the development of medicine and mental health care. Nevertheless, there are potential downsides to this evolution. Issues of security and confidentiality are the concerns most frequently cited, but they are also the most obvious. This chapter discusses Web development in relationship to computer-human interfaces as well as managed care, the forces that have propelled patients into increasingly becoming healthcare consumers, the periods of Web development based on the prevailing technologies of the time and the associated functions, as they became available to consumers, and future trends in Internet development.

A Model for Developing Web Sites at Academic Medical Institutions

Web sites in healthcare-related areas extend from those created by patients to sites of major corporations within the healthcare industries. It is essential for academic medicine institutions to maintain their presence on the World Wide Web as patients and their families seek more information about healthcare via the Internet. Using a model of Web site creation, the authors describe these methods across the four phases in the life cycle of a Web site, which include design, development, implementation, and maintenance/update. This model consists of the individual/team-based method, an organization-based method, and the outsourcingbased method. The application of this model demonstrates that these methods vary in benefits and limitations across the four phases of the Web site life cycle depending on the needs and resources of the organization. The features selected for a Web site during its design are the best indicator for the method for the organization to develop and maintain its Web site. It is appropri...

The Zachman Framework: An Information System Architecture for DMS

A Disease Management System (DMS) promises patient centered care delivered throughout the course of a disease in an integrated healthcare delivery system. The DMS is a radical departure from traditional modes of care that primarily focus on the caregiver—caretaker relationship. The DMS is not meant to undermine this relationship, but add continuity and intelligence to the ongoing care of patients. Compared to the traditional relationship, a DMS requires more thought, consideration, and planning. An extensive data, information, and knowledge infrastructure is needed that facilitates the operation of the DMS. Yet, such an infrastructure requires a new paradigm for its creation, implementation, and maintenance. We propose the need for an information system architecture in this setting. Others have used the Zachman Framework for Information Systems Architecture (ZFISA) in different industries for this purpose. Whether the ZFISA is chosen is less significant than the need for comprehensive information system m...