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PubMed2005

New frontiers for nursing and health care informatics.

Health care and health information have been around since the time of Hippocrates or even before. Through the historical evolution, it is observed that the knowledge and information that were simple and easy to learn and retain by that time, became much more complex. This paper presents a brief reviewing on the evolution of MEDINFO conferences, and how nursing informatics grew up and made itself visible during all these years of IMIA conferences.

Brazil↗
PubMed2005

Learning outcomes in medical informatics: comparison of a WebCT course with ordinary web site learning material.

OBJECTIVE: The purpose of this study is to compare whether students' learning outcomes would be better in a designed learning environment (WebCT) than in a conventional web site (WWW) with similar course material but without special learning tools. CONTEXT: Third-year medical students in an introductory course on medical informatics at the University of Helsinki, Finland. METHODS: Students were randomly assigned to a WebCT group (n=39) and a WWW group (n=46). The students in the WebCT group utilized the course material in general discussion groups, special discussions about lectures, quizzes and students' own notes. The WWW group had access only to the course material. The learning outcome was assessed by administering an on-line examination and the learning experience of the students was assessed by an on-line quiz. RESULTS: The course grade was significantly higher in the WebCT group as compared to the WWW group. This finding was more prominent among females. The students of the WebCT group also experienced significantly more improvement in collaboration with the use of computers than the students in the WWW group. CONCLUSIONS: Based on our results, web-based learning seems to be more effective when students are provided with specially designed learning tools.

Education, Distance↗
PubMed2005

Problem-based learning in medical informatics for undergraduate medical students: an experiment in two medical schools.

PURPOSE: The objective of this work was to assess problem-based learning (PBL) as a method for teaching information and communication technology in medical informatics (MI) courses. A study was conducted in the Schools of Medicine of Rennes and Rouen (France) with third-year medical students. METHODS: The "PBL-in-MI" sessions included a first tutorial group meeting, then personal work, followed by a second tutorial group meeting. A problem that simulated practice and was focused on information technology was discussed. In Rouen, the students were familiar with PBL, and they enrolled on a voluntary basis, while in Rennes, the students were first-ever participants in PBL courses, and the program was mandatory. One hundred and seventy-seven students participated in the PBL-in-MI sessions and were given a questionnaire in order to evaluate qualitatively the sessions. RESULTS AND DISCUSSION: The response rate was 92.1%. The overall opinion of the students was good. 69.8% responded positively to the program. In Rouen, where the students participated in PBL-in-MI sessions on a voluntary basis, the students were significantly more enthusiastic about PBL-in-MI. Moreover, attitudes and opinions of students are plausibly related to differences in previous PBL skills. The fact that the naïve group had two tutors, one trained and one naïve as the students, has been investigated. Teacher naivety was an explanatory factor for the differences between Rennes and Rouen.

Consumer Behavior↗
PubMed2007

Expanding multi-disciplinary approaches to healthcare information technologies: what does information systems offer medical informatics?

The effective use of information technology (IT) is a crucial component for the delivery of effective services in health care. Current approaches to medical informatics (MI) research have significantly contributed to the success of IT use in health care but important challenges remain to be addressed. We believe that expanding the multi-disciplinary basis for MI research is important to meeting these research challenges. In this paper, we outline theories and methods used in information systems (IS) research that we believe can inform our understanding of health care IT applications and outcomes. To do so, we discuss some general differences in the focus and methods of MI and IS research to identify broad opportunities. We then review conceptual and methodological approaches in IS that have been applied in health care IT research. These include: technology-use mediation, collaborative work, genre theory, interpretive research, action research, and modeling. Examples of these theories and methods in healthcare IS research are illustrated.

Cooperative Behavior↗
PubMed2005

The use of receiver operating characteristic curves in biomedical informatics.

Receiver operating characteristic (ROC) curves are frequently used in biomedical informatics research to evaluate classification and prediction models for decision support, diagnosis, and prognosis. ROC analysis investigates the accuracy of a model's ability to separate positive from negative cases (such as predicting the presence or absence of disease), and the results are independent of the prevalence of positive cases in the study population. It is especially useful in evaluating predictive models or other tests that produce output values over a continuous range, since it captures the trade-off between sensitivity and specificity over that range. There are many ways to conduct an ROC analysis. The best approach depends on the experiment; an inappropriate approach can easily lead to incorrect conclusions. In this article, we review the basic concepts of ROC analysis, illustrate their use with sample calculations, make recommendations drawn from the literature, and list readily available software.

Biomedical Engineering↗
PubMed2002

Evaluation: salvation or nemesis of medical informatics?

The currently prevailing paradigms of evaluation in medical/health informatics are reviewed. Some problems with application of the objectivist approach to the evaluation of real-rather than simulated-(health) information systems are identified. The rigorous application of the objectivist approach, which was developed for laboratory experiments, is difficult to adapt to the evaluation of information systems in a practical real-world environment because such systems tend to be complex, changing rapidly over time, and often existing in a variety of variants. Practical and epistemological reasons for the consequent shortcomings of the objectivist approach are detailed. It is argued that insistence on the application of the objectivist principles to real information systems may hamper rather than advance insights and progress because of this. Alternatives in the form of the subjectivist approach and extensions to both the objectivist and subjectivist approaches that circumvent the identified problems are summarized. The need to include systems engineering approaches in, and to further extend, the evaluation methodology is pointed out.

Evaluation Studies as Topic↗
PubMed2002

Evaluation in health informatics: computer simulation.

The evaluation of complex medical informatics applications involves not only the information system, but also its impact on the organizational environment in which it is implemented. In instances where these applications cannot be evaluated with traditional experimental methods, computer simulation provides a flexible approach to evaluation. The construction of a computer simulation model involves the development of a model that represents important aspects of the system under evaluation. Once validated, the model can be used to study the effects of variation in system inputs, differences in initial conditions and changes in the structure of the system. Three examples are discussed, namely, a wide-area health care network, physician order entry into a hospital information system, and the use of an information system designed to prevent medical errors that lead to adverse drug events in hospitals.

Computer Simulation↗
PubMed2006

New models of population management for patients with diabetes--using informatics tools to support primary care.

Diabetes management continues to fall short of evidence-based goals of care. Population management represents a new approach to diabetes care for large numbers of patients with diabetes cared for within a single clinical system. This method is information intensive and generally requires an advanced informatics infrastructure. While Information Processing is a critical first step in population management, to have a significant impact on disease control population-based intervention must also employ potent Clinical Action tools that lower barriers to effective care. In this review we present two recent population management interventions within our health system that illustrate the principles of Information Processing and Clinical Action in diabetes care.

Cholesterol↗
PubMed1998

Nursing informatics in nursing education: a challenge to nurse teachers.

The use of computers in education has become commonplace. In this study with 162 nurse teachers, we found that although most nursing colleges in Finland have the necessary hardware for teaching informatics, teachers are not familiar with the software that is available for nursing education purposes. Teachers also lack confidence in their own abilities to cope with computer-assisted education. The information systems used in practical nursing are often inaccessible to nurse teachers. The teachers themselves say they would regularly need further training in their own computer skills.

Attitude of Health Personnel↗
PubMed2001

Medical informatics: reasoning methods.

The progress of medical informatics has been characterized by the development of a wide range of reasoning methods. These reasoning methods are based on organizing principles that make use of the various relations existing in medical domains: associations, probabilities, causality, functional relationships, temporal relations, locality, similarity, and clinical practice. Some, such as those based on associations and probabilities have been developed to the point where there are off-the-shelf tools available for the researcher to develop new decision support tools. Others such as temporal relations require more effort to use effectively. Even so, we have learned the importance of a separate explicit representation of the domain knowledge and have considerable experience and an impressive armamentarium with which to face the new milieu provided by the Internet.

Artificial Intelligence↗
PubMed2002

Bio- and chemo-informatics beyond data management: crucial challenges and future opportunities.

Bio- and chemo-informatics are now thought to be crucial to the success and integration of biotechnology and drug discovery. Research in this area has expanded to go beyond data- and information-management. Here, we review exemplary areas, such as target identification and validation, virtual screening, and prediction of downstream characteristics of leads, where further research will play a key role in progressing the field.

Biotechnology↗
PubMed2005

Transforming the work of early-stage drug discovery through bioprocess informatics.

Drug discovery has historically advanced by synergy and chance. These are proving insufficient to meet the needs of the marketplace and the demands of modern medicine. We describe our strategic approaches to building and employing flexible informatics tools to transform and improve the workflows and efficiencies of the early-stages of target development in drug discovery. We contrast our approach to strategies that have recently evolved at startup biotechnology companies who use similar technological approaches to drug development but who are less encumbered by precedent and history.

Drug Design↗
PubMed2002

On fortune telling for health informatics.

This paper examines the paper of Haux et al. in this issue of this journal. It gives some background on specifics of the German health care system, which underlie the theses and prognoses proposed by Haux et al. In analogy to a forecast of the future of health informatics, which is now 10 years old, I then suggest that these attempts meet two types of challenges:that of overestimating the positive effects of recent advances, which later are found not to scale up; and that of blind spots with respect to unforeseen significant advances. The attempt to find indications of such in the projections of Haux et al. leads, among other, to the conclusion that the projections of direct linkages between patients and care providers may be overoptimistic. As to whether the deviating opinions matter in the end, it is concluded that the technology advances may require less attention that the restructuring of the health care system required to take advantage of the advances of technology.

Caregivers↗
PubMed2002

CHESS: 10 years of research and development in consumer health informatics for broad populations, including the underserved.

This paper reviews the research and development around a consumer health informatics system CHESS (The Comprehensive Health Enhancement Support System) developed and tested by the Center for Health Systems Research and Analysis at the University of Wisconsin. The review places particular emphasis on what has been found with regard to the acceptance and use of such systems by high risk and underserved groups.

Aged↗
PubMed2003

Is medical informatics a mature science? A review of measurement practice in outcome studies of clinical systems.

OBJECTIVE: To determine the extent of explicit attention to formal issues of 'measurement' in studies examining outcomes of the deployment of clinical information systems. METHODS: A structured literature review identified 27 published studies reporting quantitative outcomes including attitudes, clinician behavior, quality of care, and cost of care. These studies were analyzed for types of outcome reported, evidence of 'reuse' of measurement methodology, and evidence of formal study of the reliability and validity of these measures. RESULTS: The 27 studies meeting the inclusion criteria were published between 1976 and 2002. Several of the studies addressed multiple outcome types. Nine examined clinician attitudes; 22 examined health care behaviors; 15 examined patient health status/quality of care; and four examined economic indicators. There were eight examples of reuse of measurement methods, five of which represented reuse within a single research group. Reliability indices were reported in three studies. There were no reported validity indices. CONCLUSION: Based on this sample of studies, specific attention to issues of measurement is sparse in outcome studies of deployed clinical information systems. As such, medical informatics does not appear to be on a par with more mature sciences in its approaches to measurement of key outcome variables.

Hospital Information Systems↗
PubMed1997

Education and training in health informatics: guidelines for European curricula.

Guidelines are suggested for European curricula in Health Informatics that apply to both healthcare professionals and health administrative staff. These guidelines are the results of in-depth discussions and thoughts of the EU-EDUCTRA concerted action. Emphasis is placed on the way information is generated in the health domain. The guidelines also consider the various actors, their position and role in the healthcare structure. Characteristics of and operations on health information are discussed. Data quality control, ethical issues, benefits and potential caveats related to health information are also outlined. The article concludes with a list of possible applications.

Administrative Personnel↗
PubMed1998

What is done, what is needed and what is realistic to expect from medical informatics standards.

Medical informatic experts have made considerable progress in the development of standards for orders and clinical results (CEN, HL7, ASTM), EKG tracings (CEN), diagnostic images (DICOM), claims processing (X12 and EDIFAC) and in vocabulary and codes (SNOMED, Read Codes, the MED, LOINC). Considerable work still remains to be carried out. Abstract models of health care information have to be created, to cover the necessary domain, and yet be simple enough to assimilate, implement, and manage. This requires a high degree of abstraction. Enormous amounts to develop standardized vocabulary are still required to complement such a model, and to define the subsets that apply to given contexts.

Computer Communication Networks↗
PubMed1998

Medical informatics education by medical professors within their discipline.

A system for medical informatics education for medical students has been developed in the medical school. This paper describes the concept underlying the development of this system and its progressive outcomes over 8 years. In order to stimulate students to acquire computer-related knowledge and skills, this subject has been integrated into the course works of various medical subjects such as physiology. In addition, acquired knowledge and skills are evaluated within each subject by the production of reports for example, using computers. This provides a concrete example for students of the relevance of the information sciences to the solving of medical problems. A well equipped computer facility for the study of medicine also plays a significant role in inspiring student incentive. A computer room equipped with Macintosh computers was opened adjacent to the main medical library and is used in the same manner as the library, with books replaced by computers. In addition, all new students acquire their own Macintosh PowerBook. These various initiations have facilitated concept that the computer may be applied to medical problem solving at any time or place and may become as commonplace as a pen in daily medical practice.

Computers↗