Biomedical subjects

E Ammenwerth

Publications and source records attributed to E Ammenwerth.

At least 19 recordsLinked to original sources

PubMed2007

The quality of evidence in health informatics: how did the quality of healthcare IT evaluation publications develop from 1982 to 2005?

OBJECTIVE: To obtain an overview of study designs and study methods used in research evaluating IT in health care, to present a list of quality criteria by which all kinds of reported evaluation studies on IT systems in health care can be assessed, and to assess the quality of reported evaluation studies on IT in health care and its development over time (1982-2005). METHODS: A generic 10-item list of quality indicators was developed based on existing literature on quality of medical and medical informatics publications. It is applicable to all kind of IT evaluation papers and not restricted to randomized controlled trials. One hundred and twenty explanatory papers evaluating the effects of an IT system in health care published between 1982 and 2005 were randomly selected from PubMed, the study designs and study methods were extracted, and the quality indicators were used to assess the quality of each paper by two independent raters. RESULTS: The inter-rater variability of scoring the 10 quality indicators as assessed by a pre-test with nine papers was good (K=0.87). There was a trend towards more multi-centre studies and authors coming more frequently from various departments. About 70% of the studies used a design other than a randomized controlled trial (RCT). Forty percent of the studies combined at least two different data acquisition methods. The quality of IT evaluation papers, as defined by the quality indicators, was only slightly improving in time (Spearman correlation coefficient [rs]=0.19). The quality of RCTs publications was significantly higher than the quality of non-RCT studies (p<0.001). CONCLUSION: The continuous and dominant number of non-RCT studies reflects the various approaches applicable to evaluate IT systems in health care. Despite the increasing discussion on evidence-based health informatics, the quality of published evaluation studies on IT interventions in health care is still insufficient in some aspects. Journal editors and referees should take care that reports of evaluation on IT systems contain all aspects needed for a sufficient understanding and reproducibility of a paper. Publication guidelines should be developed to support more complete and better publications of IT evaluation papers.

Europe↗

PubMed2006

Factors influencing success and failure of health informatics systems--a pilot Delphi study.

OBJECTIVES: The aim is to gain information on factors influencing success and failure for Health Informatics applications from a group of medical informaticians. METHODS: Based on the presentations at a special topic conference on success and failure in Health ICT and analysis of the proceedings, we conducted a Delphi study on success and failure aspects. RESULTS: A total of 110 success factors and 27 failure criteria were identified, distributed on categories like functional, organizational, behavioral, technical, managerial, political, cultural, legal, strategy, economy, education and user acceptance. These factors and criteria were rated for six different system types. Unanimously it was agreed that "collaboration and co-operation" and "setting goals and courses" are "essential for the success" of clinical systems, and "user acceptance" for educational systems. Similarly, the score "essential in order to avoid a failure" were given unanimously on clinical systems for "response rate and other performance measures" and on administrative systems for "not understanding the organizational context" with "not understanding or foreseeing the extent to which the new IT-system affects the organization, its structure and/or work procedures" as the highest scoring sub-item. CONCLUSIONS: All success factors and failure criteria were considered relevant by the Delphi expert panel. There is no small set of relevant factors or indicators, but success or failure of a Health ICT depends on a large set of issues. Further, clinical systems and decision support systems depend on more factors than other systems.

Delphi Technique↗

PubMed2006

Evaluation of the electronic transmission of medical findings from hospitals to practitioners by triangulation.

OBJECTIVES: The need for regional, cross-institutional electronic networks in health care is steadily growing to support seamless, cooperative health care. The aim of this study is to evaluate the impact of electronic transmission between hospitals and practitioners in a Tyrolean health care network, and to derive technical and organizational points for improvement. METHODS: Between March and August 2004 we carried out a triangulation-based cross-sectional study, combining a qualitative study based on semi-structured, problem-centric interviews with selected practitioners, with a quantitative study based on a standardized questionnaire survey of all the Tyrolean practitioners that receive electronic messages. The survey was designed to confirm the hypotheses which have been systematically derived from the interviews. RESULTS AND CONCLUSIONS: The results show high satisfaction and positive impact of electronic communication. The triangulation of quantitative and qualitative methods was found to be useful in order to make the definition and confirmation of the hypotheses more transparent.

Austria↗

PubMed2006

Medical informatics education needs information system practicums in health care settings--experiences and lessons learned from 32 practicums at four universities in two countries.

OBJECTIVES: To report about the themes and about experiences with practicums in the management of information systems in health care settings (health information management) for medical informatics students. METHODS: We first summarize the topics of the health information management practicums/projects that the authors organized between 1990 and 2003 for the medical informatics programs at Heidelberg/Heilbronn, Germany, UMIT, Austria, as well as for the informatics program at the University of Leipzig, Germany. Experiences and lessons learned, obtained from the faculty that organized the practicums in the past 14 years, are reported. RESULTS: Thirty (of 32) health information management practicums focused on the analysis of health information systems. These took place inside university medical centers. Although the practicums were time-intensive and required intensively tutoring students with regard to health information management and project management, feedback from the students and graduates was mainly positive. DISCUSSION: It is clearly recommended that students specializing in medical informatics need to be confronted with real-world problems of health information systems during their studies.

Austria↗

PubMed2006

Process potential screening - an instrument to improve business processes in hospitals.

OBJECTIVES: Hospitals are increasingly under pressure to optimize their processes. So far, an instrument to systematically identify the potentials for improvement of a given business process is missing. The aim of this project is to develop such an instrument. METHODS: Initially, central aspects of the quality of a hospital process were identified on the basis of a systematic literature review. Secondary to that, criteria to measure quality aspects were defined: More than 300 criteria from medical and business informatics, economics and quality management publications were gathered and systematically aggregated. RESULTS: As a result, the Process Potential Screening (PPS) instrument was developed. The PPS is a matrix containing two axes: Axis I comprises 30 quality aspects referring to results, execution and control of hospital processes. Axis II comprises 16 quality criteria (e.g., customer satisfaction, time). The PPS displays approximately 400 relevant combinations of those quality aspects and quality criteria that help to identify potentials for improvement of a given hospital process. It utilizes different methods for the measurement of the criteria and for application by way of individuals or groups. CONCLUSIONS: In using the PPS, relevant potentials for improvement were identified in ten typical hospital processes. The instrument's practicability must now be examined in further studies by the final target group (e.g., quality or project managers, and the staff responsible for processes).

Hospital Administration↗

PubMed2006

Health technology assessment. Findings from the Section on Assessing Information Technologies for Health.

OBJECTIVES: To summarize current excellent research in the field of health technology assessment. METHODS: Synopsis of the articles selected for the IMIA Yearbook 2006. RESULTS: Five excellent articles representing the research in four different nations were selected for the IMIA Yearbook 2006 from three international peer reviewed journals. CONCLUSIONS: The best paper selection for the Yearbook section 'Assessing Information Technologies for Health' presents papers evaluating the benefit and side-effects of information technology in various settings. They clearly indicate that benefit of IT in health care can be achieved when the systems are appropriately designed, implemented and operated. Besides the presented quantitative studies, also qualitative study designs are of value to find unintended effects of IT, or to better explain found effects. IT evaluation supports a reflective practice on how health informatics influences health care, enabling the emergence of an evidence-based health informatics.

Awards and Prizes↗

PubMed2006

Impact of CPOE on mortality rates--contradictory findings, important messages.

OBJECTIVE: To analyze the seemingly contradictory results of the Han study (Pediatrics 2005) and the Del Beccaro study (Pediatrics 2006), both analyzing the effect of CPOE systems on mortality rates in pediatric intensive care settings. METHODS: Seven CPOE system experts from the United States and Europe comment on these papers. RESULTS: The two studies are not contradictory, but almost non-comparable due to differences in design and implementation. They demonstrate the range of outcomes that can be obtained from introducing informatics applications in complex health care settings. Implementing informatics applications is a sociotechnical activity, which often depends more on the organizational context than on a specific technology. As health informaticians, we must not only learn from failures, but also avoid both uncritical scepticism that may arise from drawing overly general conclusions from one negative trial, as much as uncritical optimism from limited successful ones. CONCLUSION: The commentaries emphasize the need to promote systematic studies for assessing the socio-technical factors that influence the introduction of increasingly sophisticated informatics applications within complex organizations. The emergence of evidence-based health informatics will be based both on evaluation guidelines and implementation guidelines, both of which increase the chances of successful implementation. In addition, well-educated health informaticians are needed to manage and guide the implementation processes.

Europe↗

PubMed2005

Preparing strategic information management plans for hospitals: a practical guideline SIM plans for hospitals: a guideline.

OBJECTIVES: Systematic information management in hospitals demands for a strategic information management plan (SIM plan). As preparing a SIM plan is a considerable challenge we provide a practical guideline that is directly applicable when a SIM plan is going to be prepared. METHODS: The guideline recommends a detailed structure of a SIM plan and gives advice about its content and the preparation process. It may be used as template, which can be adapted to the individual demands of any hospital. RESULTS: The guideline was used in several hospitals preparing a SIM plan. Experiences showed that the SIM plans could be prepared very efficiently and timely using the guideline, that the proposed SIM plan structure suited well, that the guideline offers enough flexibility to meet the requirements of the individual hospitals and that the specific recommendations of the guideline were very helpful. CONCLUSIONS: Nevertheless, we must strive for a more comprehensive theory of strategic information management planning which -- in the sense of enterprise architecture planning -- represents the intrinsic correlations of the different parts of a SIM plan to a greater extent.

Hospital Information Systems↗

PubMed2005

Bad health informatics can kill--is evaluation the answer?

OBJECTIVE: Health care is entering the age of information society. It is evident that the use of modern information and communication technology (ICT) offers tremendous opportunities to improve health care. However, there are also hazards associated with ICT in health care. We want to present an overview of typical hazards associated with ICT in health care, and to discuss how ICT evaluation can be a solution. METHODS: We analyze examples of failures and problems associated with ICT in health care. This collection is also made available on a website. RESULTS AND CONCLUSION: Systematic, continuous evaluation of quality and effects of ICT during the whole life cycle of ICT components seems to be one important approach to detect and prevent possible ICT hazards and failures, supporting a higher quality of patient care. However, empirical studies proving this assumption are needed.

Internet↗

PubMed2005

An inventory of evaluation studies of information technology in health care trends in evaluation research 1982-2002.

OBJECTIVES: During the last years the significance of evaluation studies as well as the interest in adequate methods and approaches for evaluation has grown in medical informatics. In order to put this discussion into historical perspective of evaluation research, we conducted a systematic review on trends in evaluation research of information technology in health care from 1982 to 2002. METHODS: The inventory is based on a systematic literature search in PubMed. Abstracts were included when they described an evaluation study of a computer-based component in health care. We identified 1035 papers from 1982 to 2002 and indexed them based on a multi-axial classification describing type of information system, study location, evaluation strategy, evaluation methods, evaluation setting, and evaluation focus. RESULTS AND CONCLUSIONS: We found interesting developments in evaluation research in the last 20 years. For example, there has been a strong shift from medical journals to medical informatics journals. With regard to methods, explanatory research and quantitative methods have dominated evaluation studies in the last 20 years. Since 1982, the number of lab studies and technical evaluation studies has declined, while the number of studies focusing on the influence of information technology on quality of care processes or outcome of patient care has increased. We interpret this shift as a sign of maturation of evaluation research in medical informatics.

Evaluation Studies as Topic↗

PubMed2005

The challenge of ubiquitous computing in health care: technology, concepts and solutions. Findings from the IMIA Yearbook of Medical Informatics 2005.

OBJECTIVES: To review recent research efforts in the field of ubiquitous computing in health care. To identify current research trends and further challenges for medical informatics. METHODS: Analysis of the contents of the Yearbook on Medical Informatics 2005 of the International Medical Informatics Association (IMIA). RESULTS: The Yearbook of Medical Informatics 2005 includes 34 original papers selected from 22 peer-reviewed scientific journals related to several distinct research areas: health and clinical management, patient records, health information systems, medical signal processing and biomedical imaging, decision support, knowledge representation and management, education and consumer informatics as well as bioinformatics. A special section on ubiquitous health care systems is devoted to recent developments in the application of ubiquitous computing in health care. Besides additional synoptical reviews of each of the sections the Yearbook includes invited reviews concerning E-Health strategies, primary care informatics and wearable healthcare. CONCLUSIONS: Several publications demonstrate the potential of ubiquitous computing to enhance effectiveness of health services delivery and organization. But ubiquitous computing is also a societal challenge, caused by the surrounding but unobtrusive character of this technology. Contributions from nearly all of the established sub-disciplines of medical informatics are demanded to turn the visions of this promising new research field into reality.

Biomedical Technology↗

PubMed2004

An international course on strategic information management for medical informatics students: aim, content, structure, and experiences.

We report on a course for medical informatics students on hospital information systems, especially on its strategic information management. Starting as course at the Medical Informatics Program of the University of Heidelberg/University of Applied Sciences Heilbronn, it is now organized as international course in the framework of the International Partnership for Health Informatics Education (http:// www.iphie.org) jointly for medical information science students from the University of Amsterdam, medical informatics students, as well as health information management students from the Universities of Heidelberg/Heilbronn. In 2002, medical informatics students from the Master of Science program of the newly founded University for Health Informatics and Technology Tyrol (UMIT) at Innsbruck, Austria, joined. We report about the aim of this course, its audience, and the educational programs involved, about its content and structure, as well as about our experiences gained so far.

Curriculum↗

PubMed2004

An international course on strategic information management for medical informatics students: international perspectives and evaluation.

All over the world, countries more and more take part in the international society and economy. To meet the stringent requirements of this globalization asks for internationally oriented and well-educated graduates. A major challenge of academia thus lies in qualifying graduates for international positions in this new world. A crucial element in the training and education of tomorrow's medical informatics specialists is exposure to health care systems across national borders. In this contribution, we report on the international aspects of and experiences with an inter-university course for medical informatics students on hospital information systems, in particular on their strategic information management. From 2001 onwards, this course was offered jointly for students of the University of Amsterdam, the University of Heidelberg/University of Applied Sciences Heilbronn and the University of Health Informatics and Technology, Tyrol (UMIT). Based on our experiences, future establishment of international courses in the medical and health informatics field is recommended.

Austria↗

PubMed2004

Towards clinical bioinformatics: advancing genomic medicine with informatics methods and tools.

OBJECTIVES: To summarize the challenges facing clinical applications in the light of growing research results in genomic medicine and bioinformatics. METHODS: Analysis of the contents of the Yearbook of Medical Informatics 2004 of the International Medical Informatics Association (IMIA). RESULTS: The Yearbook of Medical Informatics 2004 includes 32 articles selected from 22 peer-reviewed scientific journals. A special section on clinical bioinformatics highlights recent developments in this field. Several guest editors review the promises and limitations of available methods and resources from biomedical informatics that are relevant to clinical medicine. Integrated data and knowledge resources are generally regarded to be central and key issues for clinical bioinformatics. Further review papers deal with public health implications of bioinformatics, knowledge management and trends in health care education. The Yearbook includes for the first time a section on the history of medical informatics, where the significant impact of the Reisensburg protocol 1973 on international health and medical informatics education is examined. CONCLUSIONS: Close collaboration between bioinformatics and medical informatics researchers can contribute to new insights in genomic medicine and contribute towards the more efficient and effective use of genomic data to advance clinical care.

Computational Biology↗

PubMed2003

Medical informatics and the quality of health: new approaches to support patient care - findings from the IMIA Yearbook of Medical Informatics 2003.

OBJECTIVES: The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of excellent papers on medical informatics research which have been recently published (http://www. yearbook.uni-hd.de). The 2003 Yearbook of Medical Informatics took as its theme the role of medical informatics for the quality of health care. In this paper, we will discuss challenges for health care, and the lessons learned from editing IMIA Yearbook 2003. RESULTS AND CONCLUSIONS: Modern information processing methodology and information and communication technology have strongly influenced our societies and health care. As a consequence of this, medical informatics as a discipline has taken a leading role in the further development of health care. This involves developing information systems that enhance opportunities for global access to health services and medical knowledge. Informatics methodology and technology will facilitate high quality of care in aging societies, and will decrease the possibilities of health care errors. It will also enable the dissemination of the latest medical and health information on the web to consumers and health care providers alike. The selected papers of the IMIA Yearbook 2003 present clear examples and future challenges, and they highlight how various sub-disciplines of medical informatics can contribute to this.

Delivery of Health Care↗

PubMed2002

Systems analysis in health care: framework and example.

OBJECTIVES: Due to the high complexity of structures and processes in health care, thorough systems analyses in health care run the risk of becoming very complex and difficult to handle. Therefore, we aimed to support systematic systems analysis in health care by developing a comprehensive framework that presents and describes potential areas of analysis. METHODS: A framework for systems analysis in health care was developed and applied in a health care setting. To provide a clear structure, the framework describes the potential views and levels of systems analyses in a health care environment. RESULTS: The framework comprises five views (roles and responsibilities, information processing and tools, communication, business processes, teams structure and cooperation) and five levels of analysis (overall organization, organizational unit, staff member, role, task). The framework was successfully applied in an analysis of the structures and processes of the Department of Child and Adolescent Psychiatry of the University Medical Center Heidelberg. CONCLUSIONS: The proposed comprehensive framework aims to structure the views and levels of systems analysis in the complex health care environment. Our first experiences support the usefulness of such a framework.

Communication↗

PubMed2002

Medical Imaging Informatics and Medical Informatics: opportunities and constraints. Findings from the IMIA yearbook of Medical Informatics 2002.

OBJECTIVES: The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of recent excellent papers on medical informatics research (http://www.yearbook.uni-hd.de). The 2002 Yearbook of Medical Informatics took as its theme the topic of Medical Imaging Informatics. In this paper, we will summarize the contributions of medical informatics researchers to the development of medical imaging informatics, discuss challenges and opportunities of imaging informatics, and present the lessons learned from the IMIA Yearbook 2002. RESULTS AND CONCLUSIONS: Medical informatics researchers have contributed to the development of medical imaging methods and systems since the inception of this field approximately 40 years ago. The Yearbook presents selected papers and reviews on this important topic. In addition, as usual, the Yearbook 2002 also contains a variety of papers and reviews on other subjects relevant to medical informatics, such as Bioinformatics, Computer-supported education, Health and clinical management, Health information systems, Knowledge processing and decision support, Patient records, and Signal processing.

Computer-Assisted Instruction↗

PubMed2002

A requirements index for information processing in hospitals.

OBJECTIVES: Reference models describing typical information processing requirements in hospitals do not currently exist. This leads to high hospital information system (HIS) management expenses, for example, during tender processes for the acquisition of software application programs. Our aim was, therefore, to develop a comprehensive, lasting, technology-independent, and sufficiently detailed index of requirements for information processing in hospitals in order to reduce respective expenses. METHODS: Two-dozen German experts established an index of requirements for information processing in university hospitals. This was done in a consensus-based, top-down, cyclic manner. Each functional requirement was derived from information processing functions and sub-functions of a hospital. RESULTS: The result is the first official German version of a requirements index, containing 233 functional requirements and 102 function-independent requirements, focusing on German needs. The functional requirements are structured according to the primary care process from admission to discharge and supplemented by requirements for handling patient records, work organization and resource planning, hospital management, research and education. Both the German version and its English translation are available in the Internet. CONCLUSIONS: The index of requirements contains general information processing requirements in hospitals which are formulated independent of information processing tools, or of HIS architectures. It aims at supporting HIS management, especially HIS strategic planning, HIS evaluation, and tender processes. The index can be regarded as a draft, which must, however, be refined according to the specific aims of a particular project. Although focused on German needs, we expect that it can also be useful in other countries. The high amount of interest shown for the index supports its usefulness.

Computer Systems↗