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We commonly think of telemedicine as a video link between a primary care physician and a specialist. By the author's definition, it is remote communication of information to facilitate clinical care and includes voice, images, elements of a medical record, and commands to a surgical robot. While telemedicine deals with communication, medical informatics focuses on the use of information. Dr Coiera, an MD and a computer scientist, is a well-known authority in Europe and Australia. His present work offers physicians with self-taught and fragmentary knowledge in computer skills a comprehensive view of medical computing, laying a solid basis for this new discipline. The book, however, is not an easy, undemanding manual or a source of medically interesting Web sites, newsgroups, or mailing lists. It is a standard textbook and an introduction to a medical specialty. As such, it fulfills the expectations of the serious student. The volume has 21 chapters in seven major parts. Part 1 gives an intriguing theoretical view of informatics in general, which in later chapters helps in understanding computer models and their limitations. The other parts deal with information systems in healthcare, protocol-based systems, language, coding and classification, communications systems, the Internet, and intelligent clinical decision support. Each chapter ends with an excellent summary. References are numerous and interesting, and a glossary of computer terminology gives special attention to medical computing. The index could have been a bit more comprehensive. Contrary to the introduction, this book is probably somewhat demanding to read for physicians new to the field, which is to be expected with a standard text in a new specialty. To take full advantage, the reader should have some computer literacy. Each part begins with thoughtful, usually historical quotes pertaining to the subject matter. The text is sprinkled with interesting references and analogies to general medicine, genetics, and even psychology and philosophy. Especially insightful and novel is the comparison of DNA to a computer's memory, a sort of an encrypted database: "The symbolic language of DNA, and thus the ability to interpret DNA, resides in the surrounding cellular structures. Without these molecules, there would be no way that we could decode the symbolic meaning of DNA—the data stored in the DNA would be uninterpretable." After reading this book, one should feel comfortable understanding and discussing medical informatics and telemedicine and will have insight into the work of computer scientists and program designers and the limitations and potentials of medical computing. Such a text should be required reading for every physician intending to enter a fellowship program in medical informatics, and it is also highly recommended to every doctor and medical student interested in this emerging medical specialty.
JAMA – American Medical Association
Published: Oct 21, 1998
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