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What is eHealth (3): a systematic review of published definitions.

CONTEXT: The term eHealth is widely used by many individuals, academic institutions, professional bodies, and funding organizations. It has become an accepted neologism despite the lack of an agreed-upon clear or precise definition. We believe that communication among the many individuals and organizations that use the term could be improved by comprehensive data about the range of meanings encompassed by the term. OBJECTIVE: To report the results of a systematic review of published, suggested, or proposed definitions of eHealth. DATA SOURCES: Using the search query string "eHealth" OR "e-Health" OR "electronic health", we searched the following databases: Medline and Premedline (1966-June 2004), EMBASE (1980-May 2004), International Pharmaceutical Abstracts (1970-May 2004), Web of Science (all years), Information Sciences Abstracts (1966-May 2004), Library Information Sciences Abstracts (1969-May 2004), and Wilson Business Abstracts (1982-March 2004). In addition, we searched dictionaries and an Internet search engine. STUDY SELECTION: We included any source published in either print format or on the Internet, available in English, and containing text that defines or attempts to define eHealth in explicit terms. Two of us independently reviewed titles and abstracts of citations identified in the bibliographic databases and Internet search, reaching consensus on relevance by discussion. DATA EXTRACTION: We retrieved relevant reports, articles, references, letters, and websites containing definitions of eHealth. Two of us qualitatively analyzed the definitions and coded them for content, emerging themes, patterns, and novel ideas. DATA SYNTHESIS: The 51 unique definitions that we retrieved showed a wide range of themes, but no clear consensus about the meaning of the term eHealth. We identified 2 universal themes (health and technology) and 6 less general (commerce, activities, stakeholders, outcomes, place, and perspectives). CONCLUSIONS: The widespread use of the term eHealth suggests that it is an important concept, and that there is a tacit understanding of its meaning. This compendium of proposed definitions may improve communication among the many individuals and organizations that use the term.

Delivery of Health Care↗

Structural relationships within medical informatics.

This study seeks to increase our understanding of the structure of Medical Informatics. In particular, it focuses on the relationships between information science and information technology on the one hand, and biomedical research, clinical practice, and medical education on the other, that have defined "medical informatics." Using indexing terms and MeSH tree structures assigned to medical informatics literature covered by MEDLINE, co-occurrence analysis provides a "map" of the field. Major research and application focuses arrayed within the map elucidate a finer structure than reported previously. Dimensions "Techniques vs. Systems" and "Signs & Symptoms vs. Processes" form the two axes of the map and relate to the relationships underlying the indexing assignments given to the literature studied. Related studies underway using the INSPEC database will provide a complementary perspective on the structure of medical informatics as a field.

Bibliometrics↗

What is eHealth?: a systematic review of published definitions.

CONTEXT: The term eHealth is widely used by many individuals, academic institutions, professional bodies and funding organisations. It has become an accepted neologism despite the lack of an agreed-upon clear or precise definition. We believe that communication among the many individuals and organisations that use the term could be improved by comprehensive data about the range of meanings encompassed by the term. OBJECTIVE: To report the results of a systematic review of published, suggested or proposed definitions of eHealth. DATA SOURCES: Using hte search query string 'eHealth' OR 'e-Health' OR 'electronic health', we searched the following databases: Medline and Premedline (1996-June 2004), EMBASE (1980-May 2004), International Pharmaceutical Abstracts (1970-May 2004), Web of Science (all years), Information Sciences Abstracts (1996-May 2004), Library Information Sciences Abstracts (1969-May 2004), and Wilson Business Abstracts (1982-March 2004), In addition, we searched dictionaries and an Internet search engine. STUDY SELECTION: We included any source published in either print format or on the Internet, available in English, and containing text that defines or attempts to define eHealth in explicit terms. Two of us independently reviewed titles and abstracts of citations identified in the bibliographic databases and Internet search, reaching consensus on relevance by discussion. DATA EXTRACTION: We retrieved relevant reports, articles, references, letters and websites containing definitions of eHealth. Two of us qualitatively analysed the definitions and coded them for content, emerging themes, patterns and novel ideas. DATA SYNTHESIS: The 51 unique definitions that we retrieved showed a wide range of themes, but no clear consensus about the meaning of the term eHealth. We identified two universal themes (health and technology) and six less general (commerce, activities, stakeholders, outcomes, place, and perspectives). CONCLUSIONS: The widespread use of the term eHealth suggests that it is an important concept, and that there is a tacit understanding of its meaning. This compendium of proposed definitions may improve communication among the many individuals and organisations that use the term.

Journal Article↗

Health and medical informatics education.

Health and medical informatics education has meanwhile gained considerable importance for medicine and for health care. Specialized programs in health/medical informatics have therefore been established within the last decades. This special issue of Methods of Information in Medicine contains papers on health and medical informatics education. It is mainly based on selected papers from the 5th Working Conference on Health/Medical Informatics Education of the International Medical Informatics Association (IMIA), which was held in September 1992 at the University of Heidelberg/Technical School Heilbronn, Germany, as part of the 20 years' celebration of medical informatics education at Heidelberg/Heilbronn. Some papers were presented on the occasion of the 10th anniversary of the health information science program of the School of Health Information Science at the University of Victoria, British Columbia, Canada. Within this issue, programs in health/medical informatics are presented and analyzed: the medical informatics program at the University of Utah, the medical informatics program of the University of Heidelberg/School of Technology Heilbronn, the health information science program at the University of Victoria, the health informatics program at the University of Minnesota, the health informatics management program at the University of Manchester, and the health information management program at the University of Alabama. They all have in common that they are dedicated curricula in health/medical informatics which are university-based, leading to an academic degree in this field. In addition, views and recommendations for health/medical informatics education are presented. Finally, the question is discussed, whether health and medical informatics can be regarded as a separate discipline with the necessity for specialized curricula in this field.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical Informatics↗

Leeds Undergraduate Medical Education Conference, 7-8 July 1995.

The Leeds Undergraduate Medical Education Conference (LUMEC) was held on 7-8 July 1995. This conference, devoted entirely to undergraduate medical education, was unique in that it was organized entirely by four medical students. It attracted a wide and enthusiastic audience and excellent speakers. Professor Charles George (Chairman, Education Committee, General Medical Council) spoke about Tomorrow's Doctors, Dr Mark Bailey (Part-chairman, Medical Students' Committee of the British Medical Association) responded with 'Today's Students on Tomorrow's Doctors', and Dr Fleur Fisher (Ethics, Science and Information Division, British Medical Association) focused on the central place of ethics and communication skills in medicine. Professor Sam Leinster (Director of Medical Studies, Liverpool University) and Professor Tim de Dombal (Director, Clinical Information Science Unit, Leeds University) debated the need for new technology and radical change in the curriculum. Finally, Dr Stella Lowry (International Division, British Medical Association) considered the assessment of staff and Mrs Joy Crosby (Curriculum Facilitator, Dundee Medical School) discussed the assessment of students. Discussions focused on a variety of areas, including the need for change, the control of the money available for teaching and the problems of assessment.

Education, Medical, Undergraduate↗

Toward a model for nursing informatics.

PURPOSE: To propose a new model for the development of nursing informatics based on historical precedent. SIGNIFICANCE: Nursing informatics is expanding rapidly. The proposed model aids in understanding the areas of research, relating them to each other, and it shows areas where work is missing or should be extended. ORGANIZING FRAMEWORK: Nursing informatics as the interaction of cognitive science, computer science, and information science resting on a base of nursing science. IMPLICATIONS: As this model is tested, it can act as an organizing framework to understand and relate studies of nursing informatics and give organization for future research, education, and development.

Computer Communication Networks↗

A new approach to the concept of "relevance" in information retrieval (IR).

The concept of "relevance" is the fundamental concept of information science in general and information retrieval, in particular. Although "relevance" is extensively used in evaluation of information retrieval, there are considerable problems associated with reaching an agreement on its definition, meaning, evaluation, and application in information retrieval. There are a number of different views on "relevance" and its use for evaluation. Based on a review of the literature the main problems associated with the concept of "relevance" in information retrieval are identified. The authors argue that the proposal for the solution of the problems can be based on the conceptual IR framework built using a systems analytic approach to IR. Using this framework different kinds of "relevance" relationships in the IR process are identified, and a methodology for evaluation of "relevance" based on methods of semantics capturing and comparison is proposed.

Evaluation Studies as Topic↗

Establishing a nursing informatics program.

Nursing informatics is the synthesis of nursing science, information management science, and computer science to enhance the input, retrieval, manipulation, and/or distribution of nursing data. The literature abounds with articles stressing the unmet computer needs of nurses. Nurses must go beyond knowing computer terms and following basic program commands; they must be informatics competent. This article proposes five courses in nursing informatics to enhance all areas of nursing: practice, administration, education, and research.

Certification↗

Reasoning strategies and the use of biomedical knowledge by medical students.

This paper reports one of a series of studies conducted to investigate the role of biomedical knowledge in clinical reasoning. It was motivated by findings from our earlier studies that demonstrate that when specific basic science information is provided to medical students prior to solving a clinical case, they are unable to use this information in explaining the patient problem. An experiment was designed to investigate the use of biomedical information in the explanation of a clinical problem without any basic science information (spontaneous explanation) and where basic science information was provided after the clinical case (biomedically primed explanation). The results are discussed in the context of a two-stage model of diagnostic reasoning. The first stage is referred to as data-driven reasoning, and is characterized by the triggering of inferences from observations in the data to hypotheses. The second stage is designated as predictive reasoning, and is characterized by the generation of inferences driven by hypotheses. The results show that, with the exception of final-year medical students, the use of biomedical information interfered with the data-driven reasoning process. However, it did facilitate the process of predictive reasoning by the students. It is proposed that a sound disease classification scheme is necessary before biomedical knowledge can facilitate both data-driven and predictive reasoning during clinical problem-solving.

Clinical Competence↗

Laboratory medicine in the age of information.

Information systems in laboratory medicine reflect and respond to the major changes now taking place in health care. This fruitful and practical area for medical information science encompasses problems in medical information science, shop floor control and issues in clinical behavior.

Clinical Laboratory Information Systems↗

Observations on health information in developing countries.

Based on personal experiences, observations are offered on health information in developing countries, ways in which information systems can be strengthened, and opportunities for health-information science graduates. Although data collection consumes a significant portion of the health worker's day, information systems are often a low priority in developing countries. Health-information systems can be strengthened by focusing on local solutions, by building skills in health workers, by utilizing appropriate technology, and by integrating information systems into health programs. Health-information science graduates can assist in improving systems in developing countries, but this will require a broad and flexible definition of health information science, which is much more than computing technology; it is supporting health workers to define, manage, and apply the information they need.

Developing Countries↗

Impact of information technology on the role of health sciences librarians.

Information technology is transforming the nature of health sciences information and its management, thereby altering the traditional responsibilities of health sciences librarians. As a result, the traditional educational preparation for librarianship is no longer entirely relevant, and there is a real possibility that information management will be taken over by individuals with different educational backgrounds and skills. This paper explores four topics relevant to this issue: the emergence of new forms of health sciences information, the impact of technology on the practice of health sciences librarianship, the interaction of technology and the practice of health sciences librarianship, and the relationship among these three topics and the educational preparation of health sciences librarians.

Curriculum↗

"Bridging the information gap" for Virginia public health nurses.

This project was designed to increase the public health nurse's knowledge and use of health science information resources available from the National Library of Medicine's databases through the use of the Grateful Med software program. In 1994, the Tompkins-McCaw Library located on the Medical College of Virginia Campus (MCV) of Virginia Commonwealth University (VCU) was awarded a Nursing Information Access Grant from the Southeastern/Atlantic Region of the National Network of Libraries of Medicine (NN/LM). This project was a collaboration of the Tompkins McCaw Library, the VCU School of Nursing, and The Virginia Department of Health. Sixty public health nurses received Grateful Med training. Session evaluations were conducted and indicate that although public health nurses received training and had access to health science information resources through Grateful Med, subsequent use of the resources was very limited. Similar to reports on information-seeking behaviors of physicians, public health nurses seek information from colleagues, personal collections, and other resources locally available. Reasons for the project's limited success in changing the health science information seeking and utilization practices of public health nurses are discussed, and potential solutions are proposed.

Grateful Med↗

Racquet sports. The future.

The future of sports medicine and the affiliated sciences is extremely promising within the world of tennis. Players and coaches have recognized the important role of science in supporting tennis training and development. The USTA has established the sport sciences as a basis for all programs and policies. The challenges for the future appear clear: 1. To promote tennis specific research that specifically addresses the training, development, and competitive needs of coaches and athletes. 2. To access sport science information generated in other countries or by other sports that maybe useful to tennis in the United States. 3. To disseminate sport science information in user-friendly language to the widest possible audience. 4. To support all classifications of tennis players with sport science information relevant to their group including all ages and skill levels. Much has been accomplished in the past 10 years to support athlete development, but the promise of the future is exciting and will require teamwork within the tennis and scientific communities by people who love tennis.

Humans↗

Rating health information on the Internet: navigating to knowledge or to Babel?

CONTEXT: The rapid growth of the Internet has triggered an information revolution of unprecedented magnitude. Despite its obvious benefits, the increase in the availability of information could also result in many potentially harmful effects on both consumers and health professionals who do not use it appropriately. OBJECTIVES: To identify instruments used to rate Web sites providing health information on the Internet, rate criteria used by them, establish the degree of validation of the instruments, and provide future directions for research in this area. DATA SOURCES: MEDLINE (1966-1997), CINAHL (1982-1997), HEALTH (1975-1997), Information Science Abstracts (1966 to September 1995), Library and Information Science Abstracts (1969-1995), and Library Literature (1984-1996); the search engines Lycos, Excite, Open Text, Yahoo, HotBot, Infoseek, and Magellan; Internet discussion lists; meeting proceedings; multiple Web pages; and reference lists. INSTRUMENT SELECTION: Instruments used at least once to rate the quality of Web sites providing health information with their rating criteria available on the Internet. DATA EXTRACTION: The name of the developing organization, Internet address, rating criteria, information on the development of the instrument, number and background of people generating the assessments, and data on the validity and reliability of the measurements. DATA SYNTHESIS: A total of 47 rating instruments were identified. Fourteen provided a description of the criteria used to produce the ratings, and 5 of these provided instructions for their use. None of the instruments identified provided information on the interobserver reliability and construct validity of the measurements. CONCLUSIONS: Many incompletely developed instruments to evaluate health information exist on the Internet. It is unclear, however, whether they should exist in the first place, whether they measure what they claim to measure, or whether they lead to more good than harm.

Computer Communication Networks↗

Collaboration in a continuum of learning: developing the next generation of leadership.

A project to create a lifelong learning community among health sciences library and information professionals by demonstrating the potential for using complementary technologies to provide access to a full range of educational experiences as recommended in Platform for Change, the Medical Library Association's educational policy statement, is described. The cooperative project brings together the rich continuing education tradition of the Medical Library Association, the experience of the University of South Carolina in distance education, and the Library and Information Science Distance Education Consortium to create a virtual campus through which health sciences library professionals may engage in lifelong learning.

Cooperative Behavior↗

How complexity science can inform a reflective process for improvement in primary care practices.

BACKGROUND: Quality improvement processes have sometimes met with limited success in small, independent primary care settings. The theoretical framework for these processes uses an implied understanding of organizations as predictable with potentially controllable components. However, most organizations are not accurately described using this framework. Complexity science provides a better fit for understanding small primary care practices. METHODS: The Multimethod Assessment Process (MAP)/Reflective Adaptive Process (RAP) is informed by complexity science. This process was developed in a series of studies designed to understand and improve primary care practice. A case example illustrates the application and impact of the MAP/RAP process. RESULTS: Guiding principles for a reflective change process include the following: an understanding of practices' vision and mission is useful in guiding change, learning and reflection helps organizations adapt to and plan change, tension and discomfort are essential and normal during change, and diverse perspectives foster adaptability and new insights for positive change. DISCUSSION: A reflective change process that treats organizations as complex adaptive systems may help practices make sustainable improvements.

Organizational Case Studies↗