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Establishing health informatics as a recognised and respected profession in the UK National Health Service.

The delivery of healthcare is an information dependent process. National government modernisation targets, and drives to improve the effectiveness and efficiency of care delivery systems and processes have the better use of information and IT at their heart. If we are to realise the benefits information and IT developments can bring, we have to ensure we have a suitable cadre of well educated, proactive professional specialists who understand the business of healthcare. The English NHS has an attrition rate of something like 43% amongst its ICT specialists, and there are recruitment and retention problems in a range of other informatics disciplines like medical records, project management and strategic management. A 1999-2000 survey indicated the reasons for recruitment and retention problems. One agreed solution has been to work towards establishing health informatics as a recognised and respected national profession. This is in addition to other national work to establish career pathways, make health informatics as a profession "mainstream", and to provide development opportunities at all levels. This paper sets out the background to the establishment of a profession in UK health services, outlines progress to date, and summarises other national development activity to support health informatics professionals.

Information Management↗

Development of competency-based on-line public health informatics tutorials: accessing and using on-line public health data and information.

In response to training and information needs of the public health workforce, the New York City Department of Health and Mental Hygiene, in collaboration with the Department of Biomedical Informatics, Columbia University and the New York Academy of Medicine, is developing a series of on-line, interactive tutorials in public health informatics. The goal is to teach public health practitioners how to locate, use, and disseminate data and information on the Internet, while imparting basic informatics principles. Course content is based on Public Health Informatics Competencies, and evaluation will be performed by measuring changes in self-efficacy and knowledge as well as determining user satisfaction.

Competency-Based Education↗

Continuous quality improvement and medical informatics: the convergent synergy.

Continuous quality improvement (CQI) and medical informatics specialists need to converge their efforts to create synergy for improving health care. Health care CQI needs medical informatics' expertise and technology to build the information systems needed to manage health care organizations according to quality improvement principles. Medical informatics needs CQI's philosophy and methods to build health care information systems that can evolve to meet the changing needs of clinicians and other stakeholders. This paper explores the philosophical basis for convergence of CQI and medical informatics efforts, and then examines a clinical computer workstation development project that is applying a combined approach.

Computer Security↗

Assessing informatics in Canadian schools of nursing.

The provision of informatics content in the basic education programs for Canadian nurses has been limited to date. In previous years, efforts to engage nurse educators in discussions regarding the significance of informatics for tomorrow's nurses had been met with limited interest and understanding. There was an obvious need to heighten the awareness and active participation of nurse leaders in the development of strategies to attend to the informatics education needs of Canadian nurses. This paper describes the findings of a national study to understand the current state of informatics integration within basic nursing curricula

Canada↗

Web impact factor: a bibliometric criterion applied to medical informatics societies' web sites.

Several methods are available to evaluate and compare medical journals. The most popular is the journal Impact Factor, derived from averaging counts of citations to articles. Ingwersen adapted this method to assess the attractiveness of Web sites, defining the external Web Impact Factor (WIF) to be the number of external pages containing a link to a given Web site. This paper applies the WIF to 43 medical informatics societies' Web sites using advanced search engine queries to obtain the necessary link counts. The WIF was compared to the number of publications available in the Medline bibliographic database in medical informatics in these 43 countries. Between these two metrics, the observed Pearson correlation was 0.952 (p < 0.01) and the Spearman rank correlation was 0.548 (p < 0.01) showing in both cases a positive and strong significant correlation. The WIF of medicalm informatics society's Web site is statistically related to national productivity and discrepancies can be used to indicate countries where there are either weak medical informatics associations, or ones that do not make optimal use of the Web.

Bibliometrics↗

Informatics in managed care: HIM adds value to data.

The third installment of the Journal of AHIMA's special series on managed care focuses on informatics--methods that add value to data, turning it into useful information. How do informatics and managed care fit together and what is HIM's role in this picture? The HIM professional's knowledge is critical to the health team responsible for the interpretation and use of statically valid information. For example, HIM professionals are well positioned in their understanding of the construct and application of coding classification systems (ICD-9-CM, CPT, etc.), and groupers (DRGs, APCs, ETGs, etc.). Their unique training positions them to understand the associated rules, principles, guidelines, and nuances associated with correct coding and grouping. And when codes or groupers change, HIM professionals work closely with the health team to ensure parity, validity and reliability of the appropriate data or data sets. Managed care organizations use value-added data, as you will see in this article, to evaluate contract pricing, develop contracts, evaluate existing services or detail benefit plans, process and in some instances pay claims, and report results to a number of interested parties. The previous article in this series ("Can You Manage Managed Care?" July/August 2001) focused on effective management of data, including data acquisition. This article takes us to the next level, where informatics creates value-added information, and discusses some important uses of this information within managed care. These articles build on two of the functional areas that form the HIM process within managed care organizations. Author Scott Stratton studied under the creators of DRGs and was involved in the development of their nursing home counterpart, RUGs. He also has worked with the creators of ETGs. As a result, he can present the perspective and context within which these systems were created and intended. and how they form the foundation for informatics as a functional area within managed care.

Diagnosis-Related Groups↗

Towards creating an informatics infrastructure in home health care.

Although information technology is utilized successfully in many industries, its use in health care-and home health care in particular--continues to lag. This column summarizes a recent article by Bakken and Hripcsak (2004) examining the potential for informatics to improve patient care quality in home health care by supporting evidence-based practices and patient safety. The authors provide definitions of the basic components of an informatics infrastructure e.g., data mining, digital sources of evidence, etc.--and recommend how to make an informatics infrastructure for the home health care industry a reality. Suggestions include: (1) integrating informatics into education and training; (2) creating public/private partnerships among government agencies, vendors, and industry associations; and (3) performing cost-effective analyses to determine the optimal uses of specific technologies.

Cooperative Behavior↗

The International Partnership for Health Informatics Education: lessons learned from six years of experience.

OBJECTIVES: To inform the medical and health informatics community on the rational, goals, and the achievements of the International Partnership for Health Informatics Education--IPHIE, (I phi E), that was established at six universities in 1999. METHODS: We elaborate on the overall goals of I phi E and describe the current state of affairs: the activities undertaken and faculty and student experience related to these activities. In addition we outline the lessons we have learned over these past six years and our plans for the future. RESULTS: I phi E members first started to collaborate by supporting and encouraging the exchange of talented students and faculty and by establishing joint master classes for honors students. Following the success of these activities, new initiatives were undertaken such as the organization of student workshops at medical informatics conferences and a joint course on strategic information management in hospitals in Europe. CONCLUSIONS: International partnerships such as I phi E take time to establish, and, if they are to be successful, maintaining leadership continuity is critically important. We are convinced that I phi E promotes professionalism of future medical informatics specialists. There will be a continuing growth of globalization in higher education. It will therefore become increasingly important to offer educational programs with international components.

Education↗

Basic medical science education must include medical informatics.

Medical Informatics is the science and art of processing medical information. In this age of "Information Explosion" choosing the useful one is rather difficult, and there lies the scope of electronic database management. However, still many outstanding personnel related to the healthcare sector take pride in being "computer illiterate". The onus of the best use lies on the end-user health care providers only. Another term tele-health encompasses all the e-health and telemedicine services. Computer aided or assisted learning (CAL) is a computer based tutorial method that uses the computer to pose questions, provide remedial information and chart a student through a course. Now the emphasis in medical education, is on problem based learning (PBL) and there CAL could be of utmost help if used judiciously. Basic Medical Education and Research lays the foundation for advancing and applying proper healthcare delivery systems. There is no doubt that deep knowledge of anatomy is mandatory for successful surgery. Also, comprehensive knowledge of physiology is essential for grasping the principles of pathology and pharmacology adequately, to avoid incorrect and inadequate practice of medicine. Similarly, medical informatics is not just a subject to be learnt and forgotten after the first professional MBBS examination. The final aim of every student should not only be to become a good user but also an expert for advancing medical knowledge base through medical informatics. In view of the fast changing world of medical informatics, it is of utmost necessity to formulate a flexible syllabus rather than a rigid one.

Education, Medical↗

Representation of medical informatics in the wikipedia and its perspectives.

A wiki is a technique for collaborative development of documents on the web. The Wikipedia is a comprehensive free online encyclopaedia based on this technique which has gained increasing popularity and quality. This paper's work explored the representation of Medical Informatics in the Wikipedia by a search of specific and less specific terms used in Medical Informatics and shows the potential uses of wikis and the Wikipedia for the specialty. Test entries into the Wikipedia showed that the practical use of the so-called WikiMedia software is convenient. Yet Medical Informatics is not represented sufficiently since a number of important topics is missing. The Medical Informatics communities should consider a more systematic use of these techniques for disseminating knowledge about the specialty for the public as well as for internal and educational purposes.

Cooperative Behavior↗

Knowledge for medicine and health care--laudation at the occasion of the honorary doctorate bestowed to Donald A. B. Lindberg by UMIT, University for Health Sciences, Medical Informatics and Technology in Innsbruck, Tyrol, Austria.

Dr. Donald A. B. Lindberg, Director of the U.S. National Library of Medicine, received an honorary doctorate from UMIT, the University for Health Sciences, Medical Informatics and Technology in Innsbruck, Tyrol. The celebration took place on September 28, 2004 at an academic event during a conference of the Austrian, German, and Swiss Societies of Medical Informatics, GMDS2004. Dr. Lindberg has been a pioneer in the field of computers in health care from the early 1960s onwards. In 1984 he became the Director of the National Library of Medicine in Bethesda, the world's largest fully computerized biomedical library. Dr. Lindberg has been involved in the early activities of the International Medical Informatics Association (IMIA), among others being the chair of the Organizing Committee for MEDINFO 86 in Washington D.C. He was elected the first president of the American Medical Informatics Association (AMIA), and served as an editor of Methods of Information in Medicine.

Austria↗

Medical informatics and health care organizations.

A dialogue between upper management and operational elements over an organization's informatics policies and procedures could take place in an environment in which both parties could succeed. Excellent patient care practices can exist in organizational settings where upper management is not concerned with the specifics of the medical care process. But as the medical care process itself becomes costly, complex, and part of the purview of upper management, solutions to ambiguous informatics policies and practices need to be found. As the discussion of cost determination suggests, a comprehensive "top-down" solution may not be feasible. Allowing patient care expertise to drive the design and implementation of clinical computing modules without unduly restrictive specifications from above is probably the best way to proceed. But if the organization needs to know the specifics of a treatment episode, then the informatics definitions specific to treatment episodes need to be unambiguous and consistently applied. As the discussion of Social Security numbers suggests, communication of information across various parts of the organization not only requires unambiguous data structure definitions, but also suggests that the communication process not be dependent on the content of the messages. Both ideas--consistent data structure definitions for essential data and open system communication architectures--are current in the medical informatician's vocabulary. The same ideas are relevant to the management and operation of large and diffuse health care enterprises. The lessons we are learning about informatics policy and practice controls in clinical computing need to be applied to the enterprise as a whole.

Costs and Cost Analysis↗

Informatics programs in the United States and abroad.

Health informatics continues to gain recognition as a discipline in the United States and abroad, and professional societies are encouraging medical educators to include informatics in their curricula. Other health professions are also developing courses and requirements in informatics. The University of Maryland is establishing a database of informatics programs in the United States and abroad, and readers are invited to contribute information to this database.

Curriculum↗

Education in medical informatics in The Netherlands: a nationwide policy and the Erasmus curriculum.

The curricula of all Medical Faculties still bear the characteristics of an era in which the physician was not educated in managing medical information systems, using communication networks, and processing knowledge. In attempting to formulate the prerequisites for developing and adjusting future curricula, we discuss the evolution of medical information technology during the past 25 years and give examples to illustrate that, by extrapolating current trends, future developments in information technology, medicine and education can be predicted. A plea is made for a strong interaction between scientific developments in medical informatics and academic education. In addition, a model based on our experience in medical informatics education of over 15 years, is pointed out. Furthermore, a nationwide policy on medical informatics in The Netherlands, is discussed. Our treatise is concluded by presenting the outline of the curriculum in medical informatics at the Erasmus University in Rotterdam. Educational recommendations conclude the paper.

Computers↗

Informatics in professional education.

The University of Maryland at Baltimore (UMAB) is a professional school campus, including schools of Dentistry, Law, Medicine, Nursing, Pharmacy, Graduate Studies, and Social Work and Community Planning. In late 1987, UMAB convened a Task Force on Informatics, intended to support the campus as it worked to become a Centre of Excellence for Informatics. The Task Force reviewed the current computing environment at UMAB and the individual schools. In assessing the state of the art in informatics, its work was supplemented by the formation of external advisory committees of national and international informaticians. Deliberations proceeded according to a methodology designed to develop factual databases and to generate consensus. The Task Force report, which is excerpted in the following paper, established a tiered taxonomy of competencies; defined the three levels; and set forth program models for the two higher levels. Special note was made of the programs in nursing and dental informatics newly established at UMAB. The report concluded with three recommendations, each with detailed action points identified.

Computers↗

The postgraduate medical informatics programme at the University of Cape Town.

The Medical Informatics education programme at the University of Cape Town was developed as part of the postgraduate education programme run by the Department of Biomedical Engineering. The aim of the programme is twofold: a) To give students a broad background in Medical Informatics, to enable them to participate in the development, planning and management of information systems to support health care in South Africa, and b) To enable them to do a research project in a specialised area, thus learning research techniques, and contributing to the development of Medical Informatics as a discipline. Students benefit from participating in a postgraduate programme in a multidisciplinary department, which is firmly linked to the health care environment. A more specialised Medical Informatics programme is planned, but the multidisciplinary nature of work in this field will continue to be emphasised.

Biomedical Engineering↗

Bringing nursing informatics into the undergraduate classroom.

Nursing informatics is not formally addressed in most undergraduate nursing education programs. Nurses usually rely on their employer and/or device vendors to provide this education. Few nurses are able to capitalize on the potential of computer technology because they have not been sufficiently exposed to nursing informatics during their nursing education. Biomedical computer technology/informatics needs to be brought into the classroom, away from the pressures of the work environment. Informatics training needs to be incorporated into undergraduate nursing education through an integrated systems approach, combining elements of nursing, systems analysis, and engineering. In this article, a university-based state-of-the-art classroom and education plan using an integrated approach to educate nurses in nursing informatics is described.

Curriculum↗

Curriculum for medical informatics at the University of Heidelberg/School of Technology Heilbronn.

The specialized university curriculum for medical informatics at the University of Heidelberg/School of Technology Heilbronn described in this paper is one of the oldest educational approaches in the field of medical informatics, and has been successful for more than 20 years with more than 600 graduates (Diplom-Informatiker der Medizin). It is based on the concept of medical informatics as an independent medical discipline, and covers the total spectrum ranging from health care economics, biosignal and medical image processing, model building in medicine, to information and knowledge processing in medicine. It is a program of 4.5 years duration with a strong emphasis on the methodological foundations of medical informatics and on practical education in a number of specific laboratories. Thirty-five students are admitted each semester, and in total about 390 students enrolled. The faculty consists of 17 full-time members and about 25 part-time lecturers.

Curriculum↗