This heavily revised open access edition provides a thorough overview of the technologies available to assemble, manage and assess the quality of health information systems. It details a variety of ...scenarios in the context of both health and heath care, including where prevention and wellness are related, such as the treatment of both acute and chronic diseases. Stakeholder requirements are also described to provide perspectives for describing the architectures and management techniques associated with health information systems, enabling the reader to develop a detailed holistic overview of the subject. Health Information Systems: Technological and Management Perspectives features a detailed overview of how information systems in health care can be managed and is a vital resource for medical informatics students seeking an up-to-date text on the topic.
Abstract Objective To reflect about medical informatics as a discipline. To suggest significant future research directions with the purpose of stimulating further discussion. Methods Exploring and ...discussing important developments in medical informatics from the past and in the present by way of examples. Reflecting on the role of IMIA, the International Medical Informatics Association, in influencing the discipline. Results Medical informatics as a discipline is still young. Today, as a cross-sectional discipline, it forms one of the bases for medicine and health care. As a consequence considerable responsibility rests on medical informatics for improving the health of people, through its contributions to high-quality, efficient health care and to innovative research in biomedicine and related health and computer sciences. Current major research fields can be grouped according to the organization, application, and evaluation of health information systems, to medical knowledge representation, and to the underlying signal and data analyses and interpretations. Yet, given the fluid nature of many of the driving forces behind progress in information processing methods and their technologies, progress in medicine and health care, and the rapidly changing needs, requirements and expectations of human societies, we can expect many changes in future medical informatics research. Future research fields might range from seamless interactivity with automated data capture and storage, via informatics diagnostics and therapeutics, to living labs with data analysis methodology, involving sensor-enhanced ambient environments. The role of IMIA, the International Medical Informatics Association, for building a cooperative, strongly connected, and research-driven medical informatics community worldwide can hardly be underestimated. Conclusions Health care continuously changes as the underlying science and practice of health are in continuous transformation. Medical informatics as a discipline is strongly affected by these changes and is in a position to be a key, active contributor in these changes.
IntroductionShoulder lesions rank among the top 15 diagnoses accounting for days of incapacity to work. Inpatient or full-day outpatient rehabilitation are some of the standard therapies. For ...sustainable rehabilitation, continuation of rehabilitation after discharge from a rehabilitation centre is vital. Besides medical exercise therapy (MET), home-based physical exercise programmes are used. To monitor exercise quantity and quality, AGT-Reha, a health-enabling technology for home rehabilitation, has been developed and evaluated in a pilot study for technical feasibility and acceptance. To integrate the digital therapeutic AGT-Reha into regular healthcare processes, an efficacy evaluation is required.Methods and analysisAGT-Reha-WK is a prospective, monocentric, non-randomised, unblinded non-inferiority trial. Primary objective is to investigate whether AGT-Reha enhanced home-based exercise training is non-inferior to MET as standard aftercare. Secondary objective is to compare the costs of both therapies. Efficacy as medical success (primary outcome) is examined with regard to ability to work, return to work and sustainability of training (secondary outcomes). The outcome measure for non-inferiority is shoulder function (pain and disability) assessed by the standardised Shoulder Pain and Disability Index (SPADI). The non-inferiority margin is set to 10 points on SPADI score using a 95% CI. Subjects will be recruited at the Rehabilitation Center Bad Pyrmont, Germany. The total number of subjects should be 84 (42 per group). Treatment takes 6 months per patient. Subjects will be assessed at four time points: pre-baseline (admission to rehabilitation centre), baseline (discharge from rehabilitation centre), post-therapy and follow-up (3 months post-therapy).Ethics and disseminationEthics approval was granted by the Ethics Committee of Hannover Medical School (ethics approval no: 7313). Results of the trial are planned to be published in a peer-reviewed journal.Trial registration numberGerman Clinical Trials Register DRKS00011596. Registered 2 June 2017. Recruitment started on 3 March 2017, and it is expected to continue until December 2020.Protocol versionV2.0, 23 May 2018, Amendment 01: improved risk analysis, clarification of exclusion criteria to increase reproducibility, additional documentation with OpenClinica; these changes have no effect on structural equality.
Adherence and motivation are key factors for successful treatment of patients with chronic diseases, especially in long-term care processes like rehabilitation. However, only a few patients achieve ...good treatment adherence. The causes are manifold. Adherence-influencing factors vary depending on indications, therapies, and individuals. Positive and negative effects are rarely confirmed or even contradictory. An ontology seems to be convenient to represent existing knowledge in this domain and to make it available for information retrieval.
First, a manual data extraction of current knowledge in the domain of treatment adherence in rehabilitation was conducted. Data was retrieved from various sources, including basic literature, scientific publications, and health behavior models. Second, all adherence and motivation factors identified were formalized according to the ontology development methodology METHONTOLOGY. This comprises the specification, conceptualization, formalization, and implementation of the ontology "Ontology for factors influencing therapy adherence to rehabilitation" (OnTARi) in Protégé. A taxonomy-oriented evaluation was conducted by two domain experts.
OnTARi includes 281 classes implemented in ontology web language, ten object properties, 22 data properties, 1440 logical axioms, 244 individuals, and 1023 annotations. Six higher-level classes are differentiated: (1) Adherence, (2) AdherenceFactors, (3) AdherenceFactorCategory, (4) Rehabilitation, (5) RehabilitationForm, and (6) RehabilitationType. By means of the class AdherenceFactors 227 adherence factors, thereof 49 hard factors, are represented. Each factor involves a proper description, synonyms, possibly existing acronyms, and a German translation. OnTARi illustrates links between adherence factors through 160 influences-relations. Description logic queries implemented in Protégé allow multiple targeted requests, e.g., for the extraction of adherence factors in a specific rehabilitation area.
With OnTARi, a generic reference model was built to represent potential adherence and motivation factors and their interrelations in rehabilitation of patients with chronic diseases. In terms of information retrieval, this formalization can serve as a basis for implementation and adaptation of conventional rehabilitative measures, taking into account (patient-specific) adherence factors. OnTARi also enables the development of medical assistance systems to increase motivation and adherence in rehabilitation processes.
Open Access (OA) is an evolving publication model that is heavily supported by politics and science organizations aiming to make scientific knowledge more accessible to a wider audience. Whether it ...will indeed alter scholarly communication, however, depends on researchers' underlying attitudes, motivations, and needs. Drawing on group discussions and interviews (n = 42), this study explores the perceptions, attitudes and behaviours of researchers towards OA publishing. We focus on researchers in the field of biomedical and health informatics located in different global regions and from different seniority levels. Overall, the results show that whilst most researchers support the idea of making scientific knowledge freely accessible to everyone, they are hesitant about actually living this practice by choosing OA journals to publish their own work. Article processing charges and quality issues are perceived as the main obstacles in this respect, revealing a two-sided evaluation of OA models, reflecting the different viewpoints of researchers as authors or readers. The results further highlight hitherto underexplored influencing factors regarding institutional frame conditions, located on the level of the scientific system, the publication service providers or the national/international OA policies.
One main challenge of health care systems in future will be the care and treatment of dementia patients. To their advanced age, dementia patients do not only have limitations in cognition, ...perception, and articulation, but also suffer from several other diseases (multimorbidity). These patients have sophisticated needs for assistance, care, and treatment relying on different health care sectors. Well-known communication and coordination deficits between sectors are intensified in the case of dementia, to the above described limitations. Coordination processes concerning the transition of patients from hospitals to inpatient or outpatient aftercare pose particularly difficult. To show a possible future direction for improving intersectoral care of dementia patients, we developed the web-based case management system CASEPLUS-SimPat as part of the project SimPat “Securing Integrated Care for Multi-morbid Patients with Dementia using an IT-based Service Concept”. CASEPLUS-SimPat allows health care professionals, hospital employees and general practitioners, to jointly access patient data and exchange information about the treatment of patients. The case management system was implemented in a three-tier architecture with a role-based authorization concept. A portal for relatives complements the system. By providing precise information and e-learning services, caring relatives are integrated into the care process. In a pilot test, CASEPLUS-SimPat shows a good usability. Adapting aspects, such as keywords used to structure entries will make it easier to find required information, and thus will increase usability. Next steps comprise integration of further health care professionals and care facilities as well as real-life testing in terms of feasibility and effectiveness.
In 1984, Peter Reichertz gave a lecture on the past, present and future of hospital information systems. In the meantime, there has been a tremendous progress in medicine as well as in informatics. ...One important benefit of this progress is that our life expectancy is nowadays significantly higher than it would have been even some few decades ago. This progress, leading to aging societies, is of influence to the organization of health care and to the future development of its information systems. Twenty years later, referring to Peter Reichertz’ lecture, but now considering health information systems (HIS), two questions are discussed: which were lines of development in health information systems from the past until today? What are consequences for health information systems in the future?
The following lines of development for HIS were considered as important: (1) the shift from paper-based to computer-based processing and storage, as well as the increase of data in health care settings; (2) the shift from institution-centered departmental and, later, hospital information systems towards regional and global HIS; (3) the inclusion of patients and health consumers as HIS users, besides health care professionals and administrators; (4) the use of HIS data not only for patient care and administrative purposes, but also for health care planning as well as clinical and epidemiological research; (5) the shift from focusing mainly on technical HIS problems to those of change management as well as of strategic information management; (6) the shift from mainly alpha-numeric data in HIS to images and now also to data on the molecular level; (7) the steady increase of new technologies to be included, now starting to include ubiquitous computing environments and sensor-based technologies for health monitoring.
As consequences for HIS in the future, first the need for institutional and (inter-) national HIS-strategies is seen, second the need to explore new (transinstitutional) HIS architectural styles, third the need for education in health informatics and/or biomedical informatics, including appropriate knowledge and skills on HIS. As these new HIS are urgently needed for reorganizing health care in an aging society, as last consequence the need for research around HIS is seen. Research should include the development and investigation of appropriate transinstitutional information system architectures, of adequate methods for strategic information management, of methods for modeling and evaluating HIS, the development and investigation of comprehensive electronic patient records, providing appropriate access for health care professionals as well as for patients, in the broad sense as described here, e.g. including home care and health monitoring facilities.
Comparing the world in 1984 and in 2004, we have to recognize that we imperceptibly, stepwise arrived at a new world. HIS have become one of the most challenging and promising fields of research, education and practice for medical informatics, with significant benefits to medicine and health care in general.
Objective: To provide guidance on the future development and role of medical informatics, or biomedical and health informatics, in form of reflections.
Method: To report on the author’s previous ...activities as a medical informatician, which spans almost half a century. It began in 1973 when he started to study medical informatics. In 1978, more than four decades ago, his professional work started. He retired at the end of summer semester 2021. This was the occasion to prepare this farewell lecture.
Results: In twenty reflections, thoughts are presented on professional careers (R1 – ‘places’), on medical informatics as discipline (R2 – ‘interdisciplinarity’, R3 – ‘focuses’, R4 – ‘affiliations’), on research (R5 – ‘duality’, R6 – ‘confluences’, R7 – ‘correlations’, R8 – ‘collaboration’), on education (R9 – ‘community’, R10 – ‘competencies’, R11 – ‘approaches’), on academic self-governance (R12 – ‘autonomy’), on engagement (R13 – ‘Sisyphos’, R14 – ‘professional societies’, R15 – ‘respect’, R16 – ‘tightrope walk’), and on good scientific practice (R17 – ‘time invariants’, R18 – ‘Zeitgeist’, R19 – ‘knowledge gain’, R20 – ‘exercising’).
Conclusions: It has been a pleasure for me to participate in medical informatics activities for almost fifty years. During that time, there have been significant advances, including in medicine and in informatics, and also in medical informatics itself. And now it is the turn of others. While keeping in mind that tradition is not preserving the ashes, but passing on the fire, this report with its reflections may be of some help.
The Heidelberg-Heilbronn medical informatics program, whose foundation and development during its first 50 years are reported here, was initially established in 1972 as a diploma program, then ...converted into a consecutive bachelor’s and master’s program starting in 2007. With approximately 2,000 graduates, it is probably not only the world’s oldest dedicated medical informatics program, but also the one with the most graduates. Important impulses have been set nationally and internationally by teachers as well as by graduates of the Heidelberg-Heilbronn medical informatics program. An important piece of history was written at Heidelberg University and Heilbronn University of Applied Sciences with this medical informatics program. In terms of its objectives, the field of medical informatics belongs to medicine. In terms of methods and tools, it can be largely assigned to computer science. To adequately map the synergies that can arise from this duality of medicine and informatics in a dedicated medical informatics curriculum was and remains an important as well as challenging task.
This is a commentary on Professor Giere’s essay ‘Verpasste Chancen. Nachdenken über Fehlentwicklungen der Medizinischen Informatik Missed opportunities. Reflections on misdevelopments in medical ...informatics’. The author addresses some of the issues discussed in the ‘missed opportunities’ and comments on them in six commentaries. In addition, he seeks to describe the period of the 1970s, a time when medical informatics was established as a new field, with Wolfgang Giere as one of its pioneers. After reading the ‘missed opportunities’, one may ask: Were there mainly misdevelopments during the time described, were there only ‘missed opportunities’? This impression would by no means be correct from the author’s point of view. It would have been desirable that further progress could have been made in the projects described by Wolfgang Giere – if this was realistically possible given the state of knowledge and the organizational and technical possibilities at that time. Though there was also important, successful work and considerable progress during that period.
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