January 31, 2004
Epocrates Online
During the Month of February 2004, the online version of ePocrates is having an open house. There are no restrictions, no fees, no obligations. This is an opportunity to evaluate the web-based version which includes patient education information, pill pictures, medical equations, and clinical guidelines.
For free!
January 24, 2004
Free Trial - Sage Journals Online
Sage Publications is offering a free access trial period for their journals from Jan to March 2004. They have a fairly extensive collection of journals including a number in Psychiatry, Technology and related fields.
Give them a try!
Here is a listing of the topic categories and most categories have many journals:
Ageing and Gerontology
Anthropology
Childhood Studies
Communication & Media Studies
Counselling & Psychotherapy
Criminology
Cultural Studies
Development Studies
Economics
Education
Engineering
Evaluation & Methodology
History
Information Science
Linguistics
Literature
Management & Organization Studies
Marketing
Materials Science
Nursing & Health Research
Peace Studies
Philosophy
Political Science & International Affairs
Psychology & Psychiatry
Public Administration
Race & Ethnic Studies
Science, Technology & Medicine
Social Policy
Social Work
Sociology
Tourism Studies
Urban Studies & Planning
Women's & Gender Studies
January 19, 2004
The Effectiveness of Telepsychiatry
An article in the Canadian Psychiatric Association Bulletin by Donald Hilty,MD and colleagues at the University of California, Davis assessed the effectiveness of telepsychiatry for clinicians, clinical educators and clinical researchers. In a comprehensive review of the telepsychiatry literature from 1965 to June 2003, a number of factors were identified as potential indicators for evaluating effectivess of the technology. These include: access to care, quality of care, reliability, comparison with in-person care, patient and provider satisfaction, cost, education and empowerment.
Dr Hilty points out that although additional research is needed, telepsychiatry appears effective, based on the preliminary data on access to care, quality of care (that is, outcomes, diagnosis and ability for users to communicate), satisfaction and education. It also empowers patients, providers and communities. While it is too early to determine if telepsychiatry is cost-effective, the delination of all of the elements that make this technology work is an important beginning for future clinicians and researchers.
January 14, 2004
Proposed National Information Technology Infrastructure
This week, Sen. Hillary Rodham Clinton (D-N.Y.) proposed legislation that would create a national information technology infrastructure. Such a system would modernize the sharing of medical information nationwide and allow health providers to share electronic health records, research, prescriptions and other information.
The new legislation would also provide research on the quality and effectiveness of care, and provide the public with a standardized reporting system that would allow patients to compare performance on hospitals and other providers.
The goal is to use technology to help coordinate and integrate our healthcare system. By establishing voluntary "interoperability standards", this will ensure that different hospital and physician systems can talk to each other, exchange electronic health records, and reduce paperwork. Another important aspect of the legislation is to give providers the latest research, clinical guidelines, reminders, and information, right at their fingertips through hand-held computers and other tools, and giving patients access to their health record as well as personal health tools to involve them more in their own health care.
"Americans need a new, modern, 21st-century version of health care delivery, based on the premise of information in the hands of the right people at the right time," Sen. Clinton said.
Related Information
Description of the proposed legislation
National Health Information Infrastructure Act of 2003 introduced last year
Recent AATP Weblog posting about the Online Health Record in Canada
January 10, 2004
Technology and the Medieval Manuscript
Technology in Psychiatry can take many forms and variations. It can include the impact of handheld computers in a clinical environment, the ability of an EMR to provide proper medication alerts, the computer-human interface, an automated diagnostic program and many other interesting and exciting aspects. Technology does not always mean computer, although the boundaries are certainly blurring as we become more digital. Can it help make a differential diagnosis between the fanciful writings of a medieval manic vs a brilliant scientific codex?
A fascinating story in The Economist describes how the latest technology has been applied to solve the history and translation of a very unusual document - the Voynich manuscript.
In 1912, the antiquarian book dealer Wilfrid M. Voynich bought a number of mediaeval manuscripts from an undisclosed location in Europe. Among these was a lavishly illustrated manuscript codex of 234 pages, written in an unknown script with unusual illustrations. According to the manuscript's history, no one has been able to decipher the manuscript and many have tried from the 1600's to today. Eminent cryptographers and cryptanalysts have attempted but it still remains a mystery.
The manuscirpt is written in an elegant, but otherwise unknown script and almost all pages contain illustrations. It is about 1.5 inches thick and has a blank limp vellum cover that does not contain any indication of age, authorship or origin. The manuscript would appear to be a scientific book. 
The illustrations are mostly herbal with other sections that are astronomical and so-called cosmological drawings and also some odd, perhaps anatomical, drawings including pipes and tubes resembling blood vessels, together with human figures, mostly nude females, similar to ones in the astrological section.
Some suggest that the book is an elaborate hoax, or undecipherable scribblings of a madman.There have been suggestions that Voynichese is a modified form of Chinese. Others think it may be Ukrainian with the vowels taken out. But Voynichese words do not resemble those of any known language. 
Nor is the text a simple transliteration into fanciful symbols: the internal structure of Voynichese words, and how they fit together in sentences, is unlike patterns seen in other languages. One scholar even suggests that it may have been written by an 8 year old Leonardo daVinci.
In a paper published in the January issue of Cryptologia, Gordon Rugg, a computer scientist at Keele University, in England, thinks he may be one step closer to an explanation of how the text might have been created. He used a grid of 40 rows and 39 columns to create a table which he filled in with Voynichese syllables. He then placed a grille, a piece of cardboard with three squares cut out in a diagonal pattern,on top of the table, and started forming words by reading off the syllables as he moved the grille across columns and down rows. The result was words with the same internal patterns as Voynichese. Dr Rugg and his team are now writing software to create dozens of tables and grilles in an attempt to reproduce other linguistic patterns in the manuscript. If their findings hold up, it would mean that the regularity of Voynichese is no longer an argument against the manuscript being an elaborate hoax. There is hope that this research will result in a new style of computer programming with powerful possibilities.
As the Economist article suggests, "most people expect to find a work of modest historical interest, rather than the secret of life. As with most puzzles, the thrill of solution lies in the process, rather than the product."
The manuscript currently resides at the Beinecke Rare Book Library at Yale.
January 07, 2004
Online Consultation Now Billable
This week the AMA has made a temporary Current Procedural Terminology, or CPT, code for online consultations available. The code, 0074T will be used for reimbursement of appropriate online patient-physician consultations. Although the code will only become official in July, it is being released now to give providers and payers time to program it into their information systems. Currently, only a small number of payers currently reimburse for online consultations and generally through pilots or selected programs.
According to an article in Health Data Management,"an online medical evaluation is a type of Evaluation & Management service provided by a physician or qualified health care professional, to a patient using Internet resources, in response to the patient’s online inquiry. Reportable services involve the physician’s personal timely response to the patient’s inquiry and must involve permanent storage (electronic or hard copy) of the encounter. This service should not be reported for patient contacts (e.g., telephone calls) considered to be pre-service or post-service work for other E&M or non-E&M services. A reportable service would encompass the sum of communication (e.g., related telephone calls, prescription provision, laboratory orders) pertaining to the online patient encounter or problem(s)."
January 04, 2004
Sentient Beings in a Digital Landscape
Recently film enthusiasts have flocked to movie theaters to enjoy the climax of the Lord of the Rings Trilogy - The Return of the King. A major scene in the film is the ultimate battle that wages humanity against the monstrous forces that would dominate Middle Earth, the Ringwraiths.
The battle represents a milestone in computer-generated filmmaking. Combat scenes have traditionally been one of the most challenging because of the complexity. There is a mix of chaos and purposeful action that plays out when soldiers clash in large numbers. 
If you increase the number of characters to the thousands and make each fighter appear autonomous onscreen, the level of programming intricacy increases dramatically. Needless to say, new technology was required.
According to Karl Sims, a former MIT researcher whose 1994 paper, "Evolving Virtual Creatures,"human (and humanoid) forms represent the highest order of computer graphic simulation because audiences are trained since birth to track human movement in all its complexity. So far, Sims says, filmmakers have done better with smaller creatures: "Even swarms of insects are easier to simulate than humans."
Previous simulations of digitally created physical interactions in crowds were relatively simple. Using basic rules governing attraction and repulsion, designers aimed single points called particles at each other. Each particle represents a different individual, and when a satisfactory mix is achieved to portray the movements of a group or crowd, animation is added: The particle is rendered as a digital human or creature. The result is not always natural-looking movement in two-dimensional space. The movement of real people, especially in battle over rough terrain, is a hugely more complex challenge for the programmer.
New Zealander, Stephen Regelous, wrote a software program called Massive. It generates crowds whose interaction is based not on particle dynamics but on unique and unpredictable choices made by individual characters within a scene. Rather than concentrating on duplicating mechanical actions, Massive endows each character with a digital brain and gives it the power to act completely on its own. In an AI sense, the characters fighting in Helm's Deep are actually fighting. 
Massive characters, or "agents," function as complex beings subject to physical forces, with specific body attributes that range from the biological (short, good eyesight, dark skin) to the behavioral (aggressive). These features govern a Massive character's ability to generate credible motion. Each character is assigned a host of potential actions, as many as 350, each about a second long (sword up, sword down, step forward, step back). How these actions play out is determined by the character's brain, a tangled web of anywhere from 100 to 8,000 behavioral logic nodes, which provide the rules that allow each character to perceive, interpret and respond to what's happening around it: to make decisions and act. These nodes group into rule collections which control aggression, fighting style, movement across varied terrain, and a dozen other factors.
Fuzzy logic is needed to support the random and variable events that introduce the element of the unpredictable into digital scenes and make the result much more human. A Massive archer doesn't just hit or miss his target. He adjusts his aim as each arrow follows a slightly different and random trajectory. Success or failure is based on many complex and sometimes interrelated factors, including the skill level he's been programmed with, the weather, and even his mood at the time; but, as in the real world, there's no way to know whether any single shot will be on the mark.
And behavior changes. Massive-generated characters are convincing in part because their inputs come from the digital landscape around them; each has eyes and ears on which it must rely to navigate through battle.
Once created, Massive characters are inserted into unpopulated scenes. The characters are then left to do what they've been created to do, and a battle scene assembles itself. This can take minutes, or overnight, depending on the size and complexity of the scene. Beyond general tendencies, the filmmaker does not know precisely what a character will do, since each is an autonomous and, within the confines of the digital landscape, sentient being.
Adapted from Popular Science, Dec 2003
Digital Horses Quicktime Video