Biomedical subjects

Elske Ammenwerth

Publications and source records attributed to Elske Ammenwerth.

At least 19 recordsLinked to original sources

PubMed2006

HIS-Monitor: an approach to assess the quality of information processing in hospitals.

OBJECTIVES: Hospital information systems (HIS) are a substantial quality and cost factor for hospitals. Systematic monitoring of HIS quality is an important task; however, this task is often seen to be insufficiently supported. To support systematic HIS monitoring, we developed HIS-Monitor, comprising about 107 questions, focusing on how a hospital information system does efficiently support clinical and administrative tasks. METHODS: The structure of HIS-Monitor consists of a matrix, crossing HIS quality criteria on one axis with a list of process steps within patient care on the other axis. HIS-Monitor was developed based on several pretests and was now tested in a larger feasibility study with 102 participants. RESULTS: HIS-Monitor intends to describe strengths and weaknesses of information processing in a hospital. Results of the feasibility study show that HIS-Monitor was able to highlight certain HIS problems such as insufficiently supported cross-departmental communication, legibility of drug orders and other paper-based documents, and overall time needed for documentation. We discuss feasibility of HIS-Monitor and the reliability and validity of the results. CONCLUSIONS: Further refinement and more formal validation of HIS-Monitor are planned.

Austria↗

PubMed2006

IT-adoption and the interaction of task, technology and individuals: a fit framework and a case study.

BACKGROUND: Factors of IT adoption have largely been discussed in the literature. However, existing frameworks (such as TAM or TTF) are failing to include one important aspect, the interaction between user and task. METHOD: Based on a literature study and a case study, we developed the FITT framework to help analyse the socio-organisational-technical factors that influence IT adoption in a health care setting. RESULTS: Our FITT framework ("Fit between Individuals, Task and Technology") is based on the idea that IT adoption in a clinical environment depends on the fit between the attributes of the individual users (e.g. computer anxiety, motivation), attributes of the technology (e.g. usability, functionality, performance), and attributes of the clinical tasks and processes (e.g. organisation, task complexity). We used this framework in the retrospective analysis of a three-year case study, describing the adoption of a nursing documentation system in various departments in a German University Hospital. We will show how the FITT framework helped analyzing the process of IT adoption during an IT implementation: we were able to describe every found IT adoption problem with regard to the three fit dimensions, and any intervention on the fit can be described with regard to the three objects of the FITT framework (individual, task, technology). We also derive facilitators and barriers to IT adoption of clinical information systems. CONCLUSION: This work should support a better understanding of the reasons for IT adoption failures and therefore enable better prepared and more successful IT introduction projects. We will discuss, however, that from a more epistemological point of view, it may be difficult or even impossible to analyse the complex and interacting factors that predict success or failure of IT projects in a socio-technical environment.

Anxiety↗

PubMed2006

HIS-monitor: quality of information processing in hospitals.

Systematic monitoring of HIS quality is an important task; however, this task is often seen to be insufficiently supported. To support systematic HIS monitoring, we developed the HIS-Monitor questionnaire, focusing on how a hospital information system (HIS) does efficiently support clinical and administrative tasks. HIS-Monitor was applied in a feasibility study with 102 nursing participants. Results point to strengths and weaknesses of information processing in the participating departments. Based on the experiences of the feasibility study, HIS-Monitor is now further being optimized.

Austria↗

PubMed2006

Medical Data GRIDs as approach towards secure cross enterprise document sharing (based on IHE XDS).

Quality and efficiency of health care services is expected to be improved by the electronic processing and trans-institutional availability of medical data. A prototype architecture based on the IHE-XDS profile is currently being developed. Due to legal and organizational requirements specific adaptations to the IHE-XDS profile have been made. In this work the services of the health@net reference architecture are described in details, which have been developed with focus on compliance to both, the IHE-XDS profile and the legal situation in Austria. We expect to gain knowledge about the development of a shared electronic health record using Medical Data Grids as an Open Source reference implementation and how proprietary Hospital Information systems can be integrated in this environment.

Austria↗

PubMed2006

E-health approach to link-up actors in the health care system of Austria.

"Electronic health services are important" the EU commission stated in the E-Health action plan. By these means access to health care can be improved and the quality and effect of the offered medical services can be increased. By introducing the e-card in Austria, an overall link-up of nearly all health service providers of the external sector (e.g. family doctors) was achieved. In 2005 the Austrian E-Health Initiative (EHI) of the Austrian Federal Ministry for Health and Women mapped out a strategy to organise the development of the health system towards an integrated patient-centred. Hereby the electronic health record (EHR) plays a decisive role. The aim of this study is to analyse requirements for a virtual, cross-institutional and patient-centred electronic health record from the point of view of the exemplary main actors (Doctor and Patient), to define conditions, and then to evaluate the thus derived, specific concept of implementation. Aside from the two main actors regarding medical acts, namely the institution treating a patient (e.g. doctor, paramedic or nurse) and the patient receiving treatment, a row of other actors could be identified. Group assessment techniques with representatives of these actors resulted in an overview of required functions of an EHR. As a proof-of-concept an information system architecture conformable to the IHE XDS architecture for cross enterprise document sharing is currently being constructed and evaluated in the course of a pilot-project. If the core architecture fulfils the expectations, then a further extension to other hospitals and resident doctors, and subsequently also to the other actors of the health system, is planned. Since both legal and socio-technical requirements are presently not yet entirely met, and since there are also deficits from a methodical viewpoint, a complete implementation and widespread introduction will be a long term goal.

Austria↗

PubMed2006

Publication bias in medical informatics evaluation research: is it an issue or not?

The phenomenon of publication bias has probably existed since results of scientific research are being published. Positive and/or statistically significant results seem more likely to be published than negative and/or insignificant results. However, it is unclear if there is a remarkable impact of publication bias in medical informatics evaluation literature and how aware researchers are of its effect. We conducted a small-scale study in order to find out what the ratio of papers describing positive results vs. negative results is, tried to find enough studies to a certain subject to carry out a meta-analysis and assess publication bias by statistical methods, and finally examined reviews and meta-analyses for their results and their quality. A random sample of 86 studies showed a remarkably high percentage of descriptions of positive results (69.8%). 19 (36.6%) of the analyzed 54 reviews and meta-analyses came to a positive conclusion with regard to the overall effect of the analyzed system, 32 (62.5%) were inconclusive, and only one review came to a negative conclusion. Quantitative assessment of publication bias for health informatics studies was found difficult due to the low number of comparable studies. Although there is no clear evidence for a great impact of publication bias in medical informatics evaluation literature, further research should carried out.

Evaluation Studies as Topic↗

PubMed2005

From a paper-based transmission of discharge summaries to electronic communication in health care regions.

OBJECTIVES: In Austria, the general practitioner (GP) is the first point of contact for persons with health problems. Depending on the severity of the person's medical condition, a GP may refer her or him to a secondary care hospital consultant, who reports findings back to the GP in form of a paper-based discharge letter. Researchers report that paper-based communication of medical documents between different health care providers is insufficient in quality, error prone and too slow in many cases. Our aim was to develop and to realise a strategy for a stepwise replacement of the paper-based transmission of medical documents with a distributed, shared medical record. METHODS: In the first step of a three-steps strategy for development of a consistent, comprehensive and secure regional health care network, an electronic communication of discharge letters and diagnostic results between existing information systems of different health care providers in Tyrol, Austria, has been established: in the form of cryptographically signed S/MIME e-mail messages and, additionally, via a secure web portal system. In two further steps, an extension of the system by a bi-directional communication and by improvements of the web portal system is planned, leading to a comprehensive electronic patient record for shared care. RESULTS: After realisation of step 1, in October 2004, about 3500 electronic discharge letters were sent out from the Innsbruck University Hospital (IUH), which represents about 8% of the total number of discharge letters of the IUH. In addition, a lot of feedback was received and legal, organisational, financial and methodical difficulties were overcome. DISCUSSION: The stepwise approach to replace paper-based with electronic communication in the first step was helpful, since knowledge has been gained and cooperations were formed. For the realisation of a distributed, shared medical record (steps 2 and 3), it will not be sufficient only to replace paper-based transmission of medical documents with electronic communication technologies, but in the further steps, organisational changes will become necessary. As well, legal ambiguities must be resolved before a distributed medical record for cooperative care, used by several institutions as well as by patients, could be established.

Austria↗

PubMed2005

Specification of a reference model for the domain layer of a hospital information system.

OBJECTIVES: One of the tasks of information management is systematic planning of a Hospital Information System (HIS). However, the description and the analysis of the current state of a HIS typically create high costs and are not well supported. The aim of this paper is therefore to report about the specification of a reference model for the domain layer of a Hospital Information System. METHODS: We developed a reference model for the domain layer of a Hospital Information System based on the requirements index for information processing in hospitals for describing the enterprise functions, and based on the object types from the Health Level 7 Reference Information Model (HL7-RIM) for describing the entity types. RESULT: The developed reference model is a comprehensive hierarchic model of the enterprise functions of hospital information systems. The central enterprise function "patient treatment" for example is described with 35 enterprise functions and 38 entity types on a three-level hierarchy. DISCUSSION: Reference models provide a kind of modelling patterns that can easily be used and adapted to a respective Information System. The availability of reference models should therefore provide a highly valuable contribution to keep the costs for modelling Hospital Information Systems low. We will start to evaluate the reference model by using it in the description of the information systems of a University Clinic of the Tiroler Landeskrankenanstalten GmbH (TILAK), Austria. If this pre-test is positive, it is planned to extend the use of the reference model to the overall Hospital Information System of the TILAK.

Hospital Information Systems↗

PubMed2005

MedFlow - Improving Modelling and Assessment of Clinical Processes.

INTRODUCTION: Clinical processes are meant to restore the patient's health but often show weaknesses regarding their efficiency (e.g. ineffective task distribution for clinicians, long waiting times for patients). In order to improve these processes an assessment of their quality is needed. This assessment is based on adequate process models and proper systematic assessment procedures. Both seem not sufficiently present in the Activity Diagrams of the Unified Modeling Language (UML) or ARIS Event-driven Process Chains (EPC). OBJECTIVES: The aim of this paper is to develop and test a process modelling method which explicitly includes all details of clinical processes necessary for a systematic and even semiautomatic quality assessment. METHODS: We propose a model which is separated into process model, tool model, organisation model and information model. Its visualisation is based on the extended UML Activity Diagrams. RESULTS: After being defined formally the graphical elements of the proposed model were implemented into a commonly used modelling software. As a first validation step, various versions of the process of ordering a radiological examination were modelled. DISCUSSION: The advantage of our modelling approach is the combination of different aspects (i.e. description of processes, used tools, information objects and actor roles) into an integrated model so that details important for a systematic process assessment are now more explicitly included than in Activity Diagrams or EPC. Further evaluations will help to improve the model and to develop strategies for the semi-automatic analysis.

Humans↗

PubMed2005

Design and development of a monitoring system to assess the quality of hospital information systems: concept and structure.

Hospital information systems (HIS) are a substantial quality and cost factor in health care. Systematic monitoring of HIS quality is an important task for information management; however, this task is often seen to be insufficiently supported by available methods and tools. The aim of this research project is to develop a comprehensive monitoring system to assess the quality of hospital information systems, taking into account both computer-based and paper-based information processing.The structure of the developed monitoring system consists of a matrix, crossing HIS quality criteria on one axis (e.g., accessibility of information, or correctness and completeness of information) with a list of process steps within patient care on the other axis (e.g., patient admission, order entry, or clinical documentation). Relevant fields in this matrix, being defined by one quality criterion and one process step, contain detailed questions, that access the HIS quality with regard to the given criterion in a given process step.Based on the matrix, a questionnaire with around 140 questions has been developed, consisting of specific questions for physicians, nurses and other professional groups. The ongoing international evaluation will verify completeness, reliability, validity, and feasibility of this HIS quality monitoring system. First evaluation steps point to a high acceptance of this approach among IT staff and clinical staff.

Computers↗

PubMed2005

Trends in Evaluation Research 1982 - 2002: A Study on how the Quality of IT Evaluation Studies Develop.

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. The inventory is based on a systematic literature search in PubMed.In the first step of our inventory, we concentrated on describing long-term developments in questions, approaches, setting, methods and criteria of IT evaluation studies as described in the abstracts of the identified 1.035 publications. We found some signs of a maturation of evaluation research in medical informatics. However, these findings are only based on study abstracts that do not give sufficient information to assess the quality of studies in more detail.In a second step of our inventory, we are now looking at the quality of IT evaluation studies in health care, describing in more detail study design and assessing 10 quality indicators. For this second step, we analyse a randomized sample of 105 evaluation full papers in more detail. Besides more descriptive details on study design, the results will show whether IT evaluation studies are credible, and how their quality changed in the last 20 years. An interim analysis of the first 64 papers shows a stable quality of IT evaluation studies over the last 20 years.

Delivery of Health Care↗

PubMed2005

The effects and quality of IT evaluation studies: Trends in 1982 - 2002.

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. In a first step of our inventory, we concentrated on describing long-term developments e.g. in study questions and methods used of IT evaluation studies as described in the abstracts of the identified 1.035 publications. In the second step of our inventory, we now analysed 64 randomly selected full papers on evaluation studies, in order to answer two questions: Did IT evaluation studies show a positive effect of IT on quality of processes or outcome quality of patient care, and how did the quality of evaluation studies themselves develop in the last 20 years. Appropriateness of the care process was the most common and mostly positively evaluated aspect. There was a trend towards more multi-centre studies. The quality of the studies remained stable over time. Randomized controlled trials had significantly higher quality than non-RCT studies.

Evaluation Studies as Topic↗

PubMed2004

Visions and strategies to improve evaluation of health information systems. Reflections and lessons based on the HIS-EVAL workshop in Innsbruck.

BACKGROUND: Health care is entering the Information Society. It is evident that the use of modern information and communication technology offers tremendous opportunities to improve health care. However, there are also hazards associated with information technology in health care. Evaluation is a means to assess the quality, value, effects and impacts of information technology and applications in the health care environment, to improve health information applications and to enable the emergence of an evidence-based health informatics profession and practice. OBJECTIVE: In order to identify and address the frequent problems of getting evaluation understood and recognised, to promote transdisciplinary exchange within evaluation research, and to promote European cooperation, the Exploratory Workshop on "New Approaches to the Systematic Evaluation of Health Information Systems" (HIS-EVAL) was organized by the University for Health Sciences, Medical Informatics and Technology (UMIT), Innsbruck, Austria, in April 2003 with sponsorship from the European Science Foundation (ESF). METHODS: The overall program was structured in three main parts: (a). discussion of problems and barriers to evaluation; (b). defining our visions and strategies with regard to evaluation of health information systems; and (c). organizing short-term and long-term activities to reach those visions and strategies. RESULTS: The workshop participants agreed on the Declaration of Innsbruck (see ), comprising four observations and 12 recommendations with regard to evaluation of health information systems. Future activities comprise European networking as well as the development of guidelines and standards for evaluation studies. CONCLUSION: The HIS-EVAL workshop was intended to be the starting point for setting up a network of European scientists working on evaluation of health information systems, to obtain synergy effects by combining the research traditions from different evaluation fields, leading to a new dimension and collaboration on further research on information systems' evaluation.

Education↗

PubMed2004

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

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 the historical context of evaluation research, we conducted a systematic overview on trends in evaluation research of information technology in health care 1982-2002. The inventory is based on a systematic literature search in PubMed. Each of the found 1.035 papers from 1982-2002 was indexed based on a taxonomy coding type of information system, clinical domain, research strategy, evaluation methods, setting and evaluation aspects. We found interesting developments in evaluation research in the last 20 years. For example, their has been a strong shift from medical journals to medical informatics journals. With regard to methods, explanative research and quantitative methods have dominated evaluation studies in the last 20 years. From 1982 to today, the number of lab studies and technical evaluation aspects has declined, while studies focusing on process quality or outcome quality of patient care have increased. Based on our results, we are inclined to talk of a kind of maturation of evaluation studies in medical informatics research.

Bibliometrics↗

PubMed2004

"The declaration of Innsbruck": some reflections.

In 2003 a workshop was held in Innsbruck, Austria, on the topic of evaluation of ICT applications in Health Care. A result of that workshop was the "Declaration of Innsbruck". In the current paper we will further elaborate on this declaration and discuss some of the activities that are currently undertaken as supportive measures to enable the realization of the vision expressed in the declaration.

Austria↗

PubMed2003

Developing and evaluating criteria to help reviewers of biomedical informatics manuscripts.

Peer-reviewed publication of scientific research results represents the most important means of their communication. The authors have annually reviewed a large heterogeneous set of papers to produce the International Medical Informatics Association (IMIA) Yearbook of Medical Informatics. To support an objective and high-quality review process, the authors attempted to provide reviewers with a set of refined quality criteria, comprised of 80 general criteria and an additional 60 criteria for specific types of manuscripts. Authors conducted a randomized controlled trial, with 18 reviewers, to evaluate application of the refined criteria on review outcomes. Whereas the trial found that reviewers applying the criteria graded papers more strictly (lower overall scores), and that junior reviewers appreciated the availability of the criteria, there was no overall change in the interrater variability in reviewing the manuscripts. The authors describe their experience as a "case report" and provide a reference to the refined quality review criteria without claiming that the criteria represent a validated instrument for quantitative quality measurement.

Humans↗

PubMed2003

Can evaluation studies benefit from triangulation? A case study.

BACKGROUND: Information and communication technologies (ICTs) are increasingly being used in health care. Rigorous evaluations of ICT applications during both introduction and routine use are of great importance for decision makers and users. Within evaluation research, two main (and often rather distinct) traditions can be found: the objectivistic and the subjectivistic tradition. METHODS: The theory of triangulation deals with the integration of methods and approaches as to conduct better evaluation studies. In evaluation research, triangulation in general means the multiple employment of various sources of data, observers, methods, and/or theories in investigations of the same phenomenon. We applied triangulation aspects in the analysis of the effects of a computer-based nursing documentation system. RESULTS: We discuss, based on this case study, what benefits can be obtained from applying triangulation in an evaluation study. We show how both the validation of results and the completeness of results can be supported by triangulation. DISCUSSION: The decision whether triangulation may be useful for a given research question, and how it may be correctly applied, requires-like other evaluation methods-intensive training and methodological experience. Medical informatics evaluation research may profit from this well-established theory.

Documentation↗

PubMed2003

Evaluation of health information systems-problems and challenges.

OBJECTIVES: Information technology (IT) is emerging in health care. A rigorous evaluation of this technology is recommended and of high importance for decision makers and users. However, many authors report problems during the evaluation of information technology in health care. In this paper, we discuss some of these problems, and propose possible solutions for these problems. METHODS: Based on own experience and backed up by a literature review, some important problems during IT evaluation in health care together with their reasons, consequences and possible solutions are presented and structured. RESULTS AND CONCLUSIONS: We define three main problem areas-the complexity of the evaluation object, the complexity of an evaluation project, and the motivation for evaluation. Many evaluation problems can be subsumed under those three problem areas. A broadly accepted framework for evaluation of IT in healthcare seems desirable to address those problems. Such a framework should help to formulate relevant questions, to find adequate methods and tools, and to apply them in a sensible way.

Attitude to Computers↗