Computerized electrocardiography - an adjunct to the physician

Article Abstract:

Each year more than 50 million electrocardiograms (ECGs) in the US are read by computers. The electronic data recording is useful in enhancing, storing, and retrieving the ECGs. The use of computer programs to actually interpret the ECG and suggest a diagnosis has lagged behind the use of the computer simply to manage the quantity of data. However, in the December 19, 1991 issue of The New England Journal of Medicine researchers conducted a study in which the ECGs of both healthy subjects and patients with heart disease were analyzed by nine computer programs and a panel of eight cardiologists. There are some weaknesses in this study. It is well established that many people without clinical symptoms have heart disease, and therefore the control group is immediately suspect. In the Journal study, the decisions made by the programs and physicians were compared with the diagnoses made on the basis of clinical symptoms, a diagnosis that was assumed to be correct, which may not have been the case. Nevertheless, interesting observations arose from this study. The computer programs performed well, but were inferior to the performance of the cardiologists. The best program was only as good as the average cardiologist in identifying healthy patients, but was inferior to the average cardiologist in identifying various disease categories. Cardiologists make decisions according to a strict set of rules, based on both research and experience. There is no reason why these rules cannot be incorporated into the next generation of more sophisticated ECG analysis programs. Such programs will be useful for teaching, for stimulating new ideas, and for organizing ECG data. It is not likely, however, that any computer program for the analysis of ECGs will be able to stand on its own in the near future. If the programs are convenient and easy-to-learn, they are likely to be very helpful to physicians. However, they can only be used as an adjunct to interpretation by a competently trained physician. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Computer-aided medical diagnosis, Computer aided medical diagnosis, Electrocardiography

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The computer-based patient record and confidentiality

Article Abstract:

The establishment of a computer network containing all medical information on all patients in the US would pose a serious threat to patient confidentiality. Patient confidentiality is already threatened as more parties, including insurers, employers, and detectives, claim the right to access medical records. A growing number of employees of health care facilities have access to computerized patient records and these people may be paid by outside parties to disclose information. Disclosure of such information can lead to discrimination by businesses, employers, schools, and families. Some argue that a national medical data network would foster research that could benefit public health and such benefits are more important than individual privacy. However, the loss of privacy could cause people to not seek care or alter what they say to doctors. Congressional bills that establish a national data network should make provisions to protect patient confidentiality.

Column, Confidential communications, Physician-patient privilege

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Sacred secrets -- the privacy of medical records

Article Abstract:

Congress should pass federal legislation forbidding the revelation of any information in a person's medical record without their consent. Medical records that are used for other purposes should be stripped of any identifiable information.

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