Evans R S, Pestotnik S L
LDS Hospital, Salt Lake City, Utah.
Adv Exp Med Biol. 1994;349:87-96. doi: 10.1007/978-1-4757-9206-5_8.
The Infectious Disease Society of America is concerned about the excessive and inappropriate use of antibiotics in U.S. hospitals. Applications of Medical Informatics can help improve the use of antibiotics and help improve patient care by monitoring and managing enormous amounts of patient information. Monitoring the duration of every antibiotic ordered in the hospital or keeping tract of the antibiotic susceptibilities for five years are examples of tasks better performed by computers. The impact of computers in medicine is seen by some as disappointing. The computer revolution has not had the impact in medicine experienced by other areas. The acceptance and use of computers by medicine will be evolutionary rather than revolutionary. In 1979, the MYCIN project demonstrated that the computer could aid physicians in the selection of antibiotics. However, MYCIN was never clinically used because physicians were require to enter all patient information into the computer. The development of computerized medical records is an essential step to further the development and implementation of computer-aided decision support. The science of Medical Informatics is still relatively new but is emerging as a distinct academic field. A few hospitals are now installing information systems and have determined that these systems will play an essential role in their ability to survive into the next century. The telephone and the automobile have been recognized as two of the most important tools for improving medical care during the past 100 years. People could more readily get medical care and the time to transmit medical information was greatly reduced through physician use of the telephone and automobile. The computer is a tool that can be used to help physicians manage the great amount of medical information being generated every day. The computer can also alert the physician of patient conditions that need attention. However, it is the physician who must use and apply the computer provided information. Thus, the computer will assist but not replace physicians in providing medical care.
美国传染病学会对美国医院抗生素的过度及不当使用表示担忧。医学信息学的应用有助于改善抗生素的使用,并通过监测和管理大量患者信息来提高患者护理质量。监测医院中每种抗生素的使用时长或追踪五年内的抗生素药敏情况等任务,由计算机来执行会更出色。一些人认为计算机在医学领域的影响令人失望。计算机革命在医学领域并未产生像在其他领域那样的影响。医学对计算机的接受和使用将是渐进式的,而非革命性的。1979年,“迈肯系统”项目表明计算机可协助医生选择抗生素。然而,“迈肯系统”从未在临床中使用,因为医生需要将所有患者信息输入计算机。计算机化病历的发展是推动计算机辅助决策支持进一步发展和应用的关键一步。医学信息学这门科学仍相对较新,但正逐渐成为一个独特的学术领域。一些医院目前正在安装信息系统,并认定这些系统将对它们在下个世纪的生存能力发挥至关重要的作用。在过去的100年里,电话和汽车被公认为是改善医疗护理的两个最重要工具。通过医生使用电话和汽车,人们能更便捷地获得医疗护理,且传递医疗信息的时间大幅减少。计算机是一种工具,可用于帮助医生管理每天产生的大量医疗信息。计算机还能提醒医生注意患者需要关注的状况。然而,必须由医生来使用和应用计算机提供的信息。因此,在提供医疗护理方面,计算机将起到辅助作用,而非取代医生。