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In July 2002, the British Computer Society (BCS) Health Informatics Committee convened a meeting of 100 interested parties to facilitate dialogue on ways in which recent new National Health Service (NHS) strategies should be directed and how money is spent on informatics to support patient care, and the results that constitute success. Called the Radical Steps initiative, the project compiled a wide range of concerns expressed by attendees and sought ways to address these issues to realize maximum benefit for patient care, healthcare management, policy development, and health maintenance.


In November 2002, the BCS announced publication of an 8-page paper outlining recommendations for the future implementation of NHS healthcare informatics strategies. Covering topics such as Information Governance, Confidentiality, Transitioning and Coordinating Change, Partnerships with Industry, Standards, Procurement, Implementation Management, and Capacity and Capability, the document establishes recommendations for the patient, staff, the organization, and the process in each of these areas, emphasizing continued communication between the public and private sector, clinicians and patients, and vendors and users.


Key messages of the project include putting the patient first; changing the healthcare culture so that information technology is recognized as a tool for patient care, not just organizational needs; standardization as a requirement across the domain; and collecting and learning from experience to develop current best practices while emphasizing clinician awareness of informatics and providing ongoing training.


The project seeks to provide clear markers for moving informatics implementations forward through partnerships between internal and external parties, rather than "inflicting" it on clinicians by governmental decree, and has attempted to produce a model applicable to any situation of transition to an increased healthcare informatics presence.


The BCS invites participation in these ongoing discussions at its Web site,




OPENCLINICAL ANNOUNCES EXPANDED PUBLICATIONS, a Web site established in 2001 to respond to the "knowledge crisis" in medical care, has announced the publication of a "Green Paper,"Quality and Safety of Clinical Decision Support Systems. The paper reviews the quality, safety, ethical, and legal liability issues surrounding clinical decision support systems (CDSSs), which are usually geared to efficacy (measurable improvements in healthcare outcomes) rather than safety (potential for hazardous side effects). The authors identify a range of quality and safety assurance methods that may need to be adopted before clinical decision support gains the trust of clinicians and patients and becomes a routine part of healthcare.


The authors also raise the issue of CDSS accountability: "... if a decision support system gives bad advice, who will be held responsible? The software designers? The providers of medical knowledge used by the system? Or the end-users-the healthcare professionals who are responsible for the final clinical decision?" So far, they say, there is no case law establishing relevant precedents, but developers must still anticipate possible liabilities, and the paper discusses options for establishing quality methodologies, considers circumstances in which liability issues might arise, and furnishes recommendations for dealing with "legal exposure" should patients be harmed.


The document is open to members for discussion, and comments may be incorporated in an amendments list that will be appended to the end of the document and updated regularly. The publication precedes a planned expansion of material on decision support systems in healthcare at the site.


Also expanded and revised is the archive of Artificial Intelligence (AI) Systems in Clinical Practice ( Along with a discussion of AI Systems in Clinical Practice, reproduced from Guide to Medical Informatics, the Internet and Telemedicine by Enrico Coiera, the listing covers acute care, decision support, educational, laboratory, medical imaging, and quality assurance and administration systems. Each entry is live-linked to a document that gives location, rationale, developer, references, and contact information.


In addition, a new project, the Knowledge Publishing Collaboratory, has been announced. This effort aims to research the quality, safety, methodological, and technical issues involved in building, maintaining, and disseminating clinical knowledge applications for the Internet. invites contributions to this project and individual contributions from members. The site aims to provide a substantial and growing set of resources for technologists, clinicians, healthcare providers, and suppliers; to build a community of users, researchers, and suppliers; and to disseminate development tools and techniques for building healthcare applications that comply with the highest possible quality, safety, and ethical standards.


Visit OpenClinical at





The U.S. Federal Trade Commission (FTC) and 12 federal, state, and local law enforcement and consumer protection agencies have announced a 4-part initiative launched to fight deceptive spam and Internet scams. The centerpiece of the initiative is a group of more than 30 law enforcement actions, including 3 FTC complaints and 4 settlements with spammers caught in an FTC sting. In addition, 10 of the law enforcers signed letters to approximately 100 spammers warning them that their spam appeared to be illegal and that law enforcers could take action against them if they continued their fraudulent scams. Ten agencies participated in the FTC's "Spam Harvest," an initiative designed to test which actions consumers take online that put them most at risk for receiving spam. The operation also developed consumer education material, including a publication, "E-mail Address Harvesting: How Spammers Reap What You Sow," that uses the lessons learned from the Spam Harvest to provide tips to consumers who want to minimize their risk of receiving spam.


In an effort to determine what online activities place consumers at risk for receiving spam, Northeast Netforce investigators "seeded" 175 different locations on the Internet with 250 new, undercover e-mail addresses and monitored the addresses for 6 weeks. The sites included chat rooms, newsgroups, Web pages, free personal Web-page services, message boards, and e-mail service directories. One hundred percent of the e-mail addresses posted in chat rooms received spam; the first received spam only 8 minutes after the address was posted. Eighty-six percent of the e-mail addresses posted at newsgroups and Web pages received spam, as did 50% of addresses at free personal Web-page services, 27% from message board postings, and 9% of e-mail service directories.


Spam Harvest partners also found that the type of spam received was not related to the sites where the e-mail addresses were posted. For example, e-mail addresses posted to children's newsgroups received a large amount of adult content and work-at-home spam.


Results of the harvest indicated that spammers use different methods, as well as different sources, to seize consumers' e-mail addresses. Consumers who receive large amounts of objectionable spam may want to change e-mail addresses and follow some safer surfing tips suggested in the previously mentioned FTC publication, available online at Some of the tips are:


* Consider "masking" your e-mail address; for example,"[email protected]" could be masked as "[email protected]."


* Use a separate screen name for online chatting.


* Set up disposable e-mail addresses for discrete projects.


* Use two e-mail accounts-one for public posting, one for personal messages.


* Use a unique e-mail address, containing both letters and numbers.



Actions filed by the FTC included charges that one defendant used deceptive spam, including unauthorized use of logos of well-known financial institutions including Radian Bank, Prudential, and Fannie Mae, to induce victims to disclose sensitive financial information such as income, mortgage balances, and home values. The spammers purported to offer consumers competitive financing and refinancing loans. The defendants also allegedly forged e-mail headers (a technique known as "spoofing") so that any undeliverable messages went to e-mail addresses unaffiliated with the defendants. One unaffiliated third party was swamped with more than 30,000 bounce-back and angry "do not spam me" e-mails intended for the defendants. The FTC also alleged that the defendants deceptively claimed that consumers who received their solicitations could opt out of future offers. The FTC charged the defendants with unfair and deceptive practices, violations of the FTC Act, and with "pretexting," posing as an entity it was not in order to get sensitive financial information, which is a violation of the Gramm-Leach-Bliley Act. The matter was filed under seal and the information is not yet available publicly.


The FTC alleged that NetSource One and James R. Haddaway, operating as WorldRemove, used spam and the Internet to sell a service they claimed would reduce or eliminate spam from consumers' e-mail. The claims were false. In fact, using an undercover account to test the claims, the FTC found it received more spam after signing up for the service. The agency charged the defendants with violations of the FTC Act.


Brian Silverman, doing business as BES Systems, Electro Depot, Dallas Tech Surplus, and New York Tech Surplus offered laptop computers for sale via Internet auction houses, including eBay. The FTC alleges that Silverman accepted only cash, checks, or money orders for payment from winning bidders. In many instances he failed to provide the computers or provide refunds to his victims, the agency alleged. The FTC charged him with violating the FTC Act and the Mail or Telephone Order Merchandise Rule.


Four individuals who used spam to promote chain e-mail schemes have settled FTC charges that their schemes were illegal. In February 2002, the FTC sent warning letters to more than 2000 spammers whose chain-letter spam also contained deceptive claims that the FTC's Director of Marketing Practices could vouch for the illegal pyramid's legality. The agency used its spam database, which contains more than 20 million unsolicited commercial e-mails, to identify individuals who had received warnings and who continued to send the messages. Undercover investigators sent money to Jessica Drees, Heidi Freitas, Rosaline Leahy, and Nancy Merrill, who accepted the payments. Settlements will bar their participation in illegal chain-letter schemes in the future. Ten NetForce partners signed letters that were sent to 100 spammers who send similar chain-letter or pyramid scheme e-mails that warned the spammers that their activities are illegal and may prompt law enforcement actions.


In addition to the FTC, members of the Northeast Netforce include: The Connecticut Attorney General, the Maine Attorney General, the Massachusetts Attorney General, the New Hampshire Department of Justice, the New Jersey Division of Consumer Affairs, the New York City Department of Consumer Affairs, the New York State Attorney General, the New York State Consumer Protection Board, the Rhode Island Attorney General, the United States Attorney for the District of Massachusetts, the United States Postal Inspection Service, and the Vermont Attorney General. The Commission votes to file the complaints and accept the consent settlements were 5-0.





Marion J. Ball, EdD, vice president of clinical informatics strategies for Houston-based Healthlink Incorporated, was awarded the Morris R. Collen Award of Excellence at the American Medical Informatics Association's (AMIA) 2002 Annual Symposium. The Morris R. Collen Award of Excellence is presented to an individual who has shown leadership and made significant contributions to medical informatics over his or her career.


Dr. Ball was nominated unanimously by the AMIA Awards Committee. She is the first female recipient of the award. She is an adjunct professor at Johns Hopkins University School of Nursing, an affiliate faculty member of the University of Maryland Baltimore County, and an adjunct professor at the Uniformed Services University of the Health Sciences. She also spends time lecturing on various aspects of healthcare information technology; her most recent talks center on the role of enabling technologies in promoting patient safety. She has authored or edited 13 books, the latest of which is Cancer Informatics: Essential Technologies for Clinical Trials.


Dr. Ball joined Healthlink, a private company dedicated to the healthcare information technology industry, in 2001. A two-time recipient of the President's Award from AMIA, she has also received the Distinguished Service Award from the American Health Information Management Association (AHIMA), honorary lifetime membership in the Medical Library Association, and the Pioneer Award for Computers in Healthcare. She is a member of the Institute of Medicine, a consultant to the Board of Regents of the National Library of Medicine, and serves on the board for Health on the Net (HON).





The eHealth Institute has announced the winners of the 2002 Award for Application Excellence in Online Continuing Medical Education. The award was presented by the eHealth Institute ( and provided by the Health Communications Research Institute (


A total of 48 entries were received. A scoring instrument was developed and used to rate each entry according to content quality, usability, and use of multimedia and interactivity. Each course was initially reviewed by 2 judges. Eight semifinalists were chosen. Then each of the 6 judges plus the Summit conference organizer (a total of 7 judges) evaluated each semifinalist. After a group discussion, the judges selected a top place winner and 2 honorable mention winners.


The winner of the Best Online CME Course Award is "Treatment and Management of Type 2 Diabetes" (, developed by John Wiecha, MD, and Stefanie Curry, MEd, of the Department of Family Medicine, Boston University School of Medicine. To view "Treatment and Management of Type 2 Diabetes," contact Stefanie Curry at [email protected].


The honorable mention winners are "" (, sponsored by the University of Virginia and developed by Larry Gimple, MD; Ralph Buckley, MD; Jann Balmer, PhD, RN; and Jane Fruchtnicht, MSN, RN, from the University of Virginia School of Medicine; and Debra McMahon, PhD, CardioConcepts, Inc.; and "Ankle Injuries in Athletes" (, sponsored by the American Academy of Orthopaedic Surgeons, and developed by Richard Ferkel, MD and Robin Facer, Academy of Orthopaedic Surgeons.


To view "," register and log on to the site. To view "Ankle Injuries in Athletes," contact Howard Mevis at [email protected].





Concurrent with the discontinuation of PubScience, the U.S. government's attempt at a PubMed for scientific information, both the Office of Science and Technical Information (OSTI) ( and the National Technical Information Service (NTIS) ( are making efforts to fill the gap.


The NTIS recently announced that its Web site has been revamped and offers physicians, scientists, and healthcare administrators information on a wide variety of topics. NTIS maintains and disseminates the nation's largest collection of scientific, technical, engineering, and related information produced by or for hundreds of U.S. government agencies (including NIH) and worldwide sources. The site contains information on smallpox, breast cancer, and a wide variety of other diseases; research reports on a vast array of scientific and medical topics; and Federal guidelines for healthcare administrators. The total NTIS collection contains nearly 3 million documents spanning more than 350 subject areas. Approximately 1000 new items are added each week and many are available only through NTIS. All records are abstracted, indexed, and cataloged in the NTIS database. Users can execute free database searches from 1990 to the present, link to the full text of Web documents and download up to 20 pages free (21 pages and up costs $8.95), and access an array of multimedia and computer products from the National Audiovisual Center.


Scientific and technical information is available at Specific links to private information retrieval engines such as Scirus and Infotrieve, to which the government now defers, are available for journal literature at


NTIS is an agency of the Technology Administration of the Department of Commerce and has been collecting and disseminating scientific, business, and technical information for more than 50 years. OSTI is part of the Department of Energy (DOE), and specializes in physical and other sciences specifically of interest to the DOE.