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BMJ No 7109 Volume 315 Medicine and books Saturday 13 September 1997 Evaluation Methods in Medical InformaticsCharles P Friedman, Jeremy C Wyatt
Computers have not been kind to physicians. They enable monitoring and pestering everywhere. None the less, there have been generations of computer enthusiasts in health care, including many doctors. The appeal seems obvious: we forget easily, the computer never forgets; we are slow to do simple things, the computer is fast; we tire, the machine is tireless. Even 30 years ago it seemed a natural partnership. With the computer to leverage our strengths and ease our frailties, we could all be Oslers. Every clinician would become more skilful, assisted by an uncomplaining aide of unwavering alertness and unerring recollection. For decades the pioneers worked to make this vision real. From early efforts has come a discipline that borrows liberally from computer science and epidemiology, ethnography and cognitive science, sociology and management, economics and industrial engineering, library science and mathematics, epistemology and health services research. Add in all of the healthcare professions, and call it medical (or, better, health) informatics. It is a mÍelange that appeals to restless minds. Medical informatics deals with all the aspects of medical information, except its content. Not how best to manage asthma, but rather how information on asthma management might be stored, retrieved, and applied. The results of this work are information systems that are often challenging to understand, measure, evaluate, and improve. That challenge can now be met with the sturdy assistance of Friedman and Wyatt, two respected informaticians. They have produced a landmark book, which should have a place of honour in the library of anyone seeking a deeper understanding of clinical informatics in general and evaluation in particular. The authors focus on clinical information resources, which is a large subset of the wider field of medical informatics. With few wasted words in three short chapters, they provide the careful reader with a good understanding of large clinical computing systems. They do a similarly excellent job of outlining evaluation, though they perhaps overdo the "subjectivist" (intuitive, holistic, sociable) versus "objectivist" (rational, reductionist, no dates) dichotomy. The discussions on measurement, validity, and study design will feel familiar to students of epidemiology, but the perspective of information systems brings new value. The authors, mindful of the many disciplines they draw on, define and use terms with precision. The analysis and discussion of subjectivist methods will be new to many readers, and, philosophy aside, it is hard to improve on. This book will have future editions, where minor improvements could be made. The rich bibliography might make a better reference at the back of the book, or, best of all, in electronic form on the world wide web. With their academic foundations so well laid, the authors might further consider evaluation in the "quick and dirty" world of commercial software development. These minor quibbles, of course, only underscore what a fine book this is. John Faughnan,
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