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PubMed2006

Comparing approaches for advanced e-health security infrastructures.

OBJECTIVES: The healthcare systems of all developed countries face the challenge for improving quality, efficiency and safety of patients' care. For meeting this challenge, health is moving from being organisation-centred to process-based care. This process will continue in the future turning health towards person-centred architectures. This system transformation is combined with extended and advanced communication and collaboration supported and enabled by appropriate information and communication technologies (ICT), also called e-health. The resulting solutions have to be trustworthy. METHODS: There is a set of security services needed for realising trustworthy e-health solutions. Those security services must be comprehensively integrated in the e-health application. Furthermore, a set of infrastructure services has to be specified and implemented. For keeping the solutions future-proof, they have to comply with architectural principles and paradigms. RESULTS: After shortly introducing meanwhile internationally acknowledged architectural paradigms for applications, means and infrastructures providing security services, existing, or specified advanced solutions are described and compared. In that context, the Electronic Health Record as e-health core application has been especially considered. Based on published work as well as on explored solutions, the security services needed are summarised and evaluated. The pros and cons of investigated examples are collected and interpreted. In that context, especially the German health telematics framework architecture and security infrastructure and the corresponding implementable solutions on the one hand and the USA Veterans Health Administration approach to security have been carefully considered. CONCLUSION: Processes and systems are determined by policies, which define and distinguish constraints for communication and collaboration. Therefore, formally modelling policies and performing policy bridging are the main challenges to be met. As result of investigations, recommendations have been derived for establishing the trustworthiness required for any e-health solution at different level from regional to national, European, and even global scale, which are included in the conference summary.

Computer Security↗
PubMed2004

Demography of French anaesthesiologists. Results of a national survey by the French College of Anaesthesiologists (CFAR) and the French National Society of Anaesthesia and Intensive Care (SFAR), supported by the National Institute for Demographic Studies (INED).

BACKGROUND AND OBJECTIVE: The perception of a looming manpower shortage led the French College of Anaesthesiologists (CFAR) and the French Society of Anaesthesia and Intensive Care (SFAR), with assistance from the National Institute for Demographic Studies (INED), to conduct a national survey of French anaesthesiologists in order to determine precise physician characteristics data, analyse professional practices and project future service provision. METHODS: The survey was based on self-administered individual questionnaires, approved by the National Committee on Informatics and Freedom (CNIL). The survey was carried out at the end of 1998 among 1484 hospitals (590 public and 894 private), under the supervision of local referees and regional co-ordinators. RESULTS: Of 9741 anaesthesiologists' posts, 5694 (58%) are in public hospitals, 3569 (37%) in private practice and 478 (5%) in private hospitals within the National Health Service, i.e. the participant au service public hospitalier (PSPH). Complex validation of the results was necessary to account for the missing responses and multiple sites of activity. The survey identified 8876 specialists practising anaesthesia and intensive care in France at the beginning of 1999, including 216 in French overseas territories. This figure is consistent with that published by the Medical Council (Ordre des Médecins) on 1 January 1999, identifying 8950 anaesthesiologists in France, including 234 in the overseas territories. Annual growth in the anaesthesiologist population has fallen from 9% pre-1989 to 0% in 1999. Male anaesthesiologists outnumber females (35.7%). The average age has risen from 42.8 yr in 1989 to 45.9yr in 1999. The age distribution of anaesthesiologists has become bell shaped, reflecting reduced numbers of younger practitioners. There are currently 14.75 anaesthesiologists per 100 000 people (compared to 12.9 in 1989), a figure slightly above the European average, but there is considerable geographical inequality between the north and south of France, with increased concentrations in large cities that contain university hospitals. CONCLUSIONS: Future service provision must take account of falling numbers of new anaesthesiologists and an increase in retirements, but must also include changes in working practices, such as the European Working Time Directive. If anaesthesia manpower shortages are to be avoided, there must be a restructuring of the work-place, a redefinition of tasks and improved management of working time.

Age Distribution↗
PubMed2006

ENN-ICS--implementation and evaluation of a multilingual learning management system for sleep medicine in Europe.

A new web based network aims at the improvement of health care in Europe by integrating advanced e-learning and e-publishing technologies for the training of medical doctors, nurses, and students. The field of application is sleep physiology and sleep medicine. Based on a multilingual, multimedia communication system, ENN-ICS Centre offers direct access to medical information for users, i.e healthcare professionals and citizens, in Europe and worldwide. The use of XML supports the development of media independent contents for multiple target groups. Editorial and distributive processes are supported by customized central editorial, content management and learning management systems (CMS, LMS). ENN-ICS e-health services are evaluated by selected user groups in North, Middle and Southern Europe using reliable and scientifically accepted validation instruments. The compliance with essential quality requirements and criteria is tested and verified by using online questionnaires based on the DISCERN questionnaire for evaluating patient information, the HON principles for health-related websites and the GMDS catalogue of quality criteria for electronic publications in medicine. The system architecture and its exemplary applications can be used as a model for future e-health services dealing with neurological and other medical topics.

Europe↗
PubMed1991

[Qualitative and quantitative evaluation of the information flow regarding the "medical insurance" problems].

The presented qualimetric evaluation of documentary information flow permitted one to identify some of its characteristics, single out a group of nuclear and perinuclear journals containing about 70 percent of the entire documentary flow publications on the given problem and provide recommendations on the organization and retrieval search in the reference-information fund of our country.

Insurance, Health↗
PubMed1994

Case-based telematic systems towards equity in health care. Introduction to the symposium.

The theme of this International Symposium, co-sponsored by EFMI (the European Federation for Medical Informatics) and WHO-Eur (the European Office of the World Health Organisation) is made of four components: (1) an ethical principle: equity in health care, that aims to social justice; (2) measurements of equity that should be case-based/population related; (3) communication of this information at a wide scale, using telematics, e.g. integrated computer systems at distance; (4) actions to improve health care and equity in its delivery by using resource management tools and developing quality of care. The combination of these four elements is recommended as a coherent scheme for future actions of public authorities in health care. They were therefore associated in the somewhat complex title of the symposium. A special attention is given to the present degree of availability of a large number of case based/population related data sources in Europe, as well as on the need to develop generic models in telematics, rather than too strict standards at the user level. These information systems can be made easily accessible to clinicians and epidemiologists as an aid to their decision making in the European region.

Computer Communication Networks↗
PubMed2000

Information subsystem of the difference between anions sum and hardness of water and its influence on human health.

Underground and surface waters in Dalmatia (Southern Croatia) have relatively preserved their natural characteristics since the greatest agglomeration of population and industry is located along the coast. The danger of pollution with fecal microorganism and products of biological decomposition is the most immediate problem but can be efficiently eliminated by water chlorination. The ecological need to sum up the work on water quality examination and estimation of future water quality trends resulted in water quality monitoring, i.e. in human health monitoring. It is necessary for large number of analytical and ecological health data to organize them from the informatical aspect into databases, the relational database for chemical analysis studying (the difference between anions sum and hardness) as methodological base for studying the ecological factors that influence human health defined in this paper. Results used for the prototype implementation subsystem of the chemical water analysis control are based on the investigations of Water Examination Department of the Public Health Institute of the Split-Dalmatian County (Croatia). Over 3400 data are comprised what is the sufficient examination sample. The software used included Win '95, Mo '97, and Paradox 4,5, while the hardware used included Pentium II 300 MHz, floppy, 128 MB RAM HDD 4,3 GB, CD x 24, HP DeskJet 710C.

Anions↗
PubMed2001

Use of innovative technologies in the evaluation of Nashville's REACH 2010 community action plan: reducing disparities in cardiovascular disease and diabetes in the African American community.

Ethnic minorities in the United States suffer disproportionately from chronic diseases such as cancer, heart disease, AIDS, and diabetes. A nationally-funded initiative known as Racial and Ethnic Approaches to Community Health (REACH) has designated 26 communities to implement demonstration projects to reduce health disparities in targeted minority populations. This article presents two methods of integrating innovative technologies into the program's evaluation plan: (1) a Web-based data entry system for recording project activity and (2) geographic information systems (GISs) for developing visual maps of project targets. These technologies can assist other programs in managing and measuring community-based public health initiatives.

Black or African American↗
PubMed2005

Internet use by a referral gastroenterology clinic population and their medical information preferences.

BACKGROUND: Internet use is growing rapidly in Iran. However, little is known about the rate of Internet access and Internet use habits of gastroenterology patients and their health information preferences in the country. METHODS: A two-part questionnaire was presented to a convenience sample of 401 consecutive outpatients (mean age: 43.7 years) of a referral gastroenterology clinic in Tehran from February 21 to March 13, 2004. RESULTS: Of all literate patients (92%), 62% self-estimated their disease-related knowledge as nothing to little. The most common sources of information were media (62%) and printed materials (58%). Printed material (57%) and media (35%) were the most preferred means of receiving health information; the Internet was the most preferred means among Internet users and almost all of them were interested in getting online medical services. The cause (65%) and treatment (56%) of disease were the most favorite knowledge topics. Of all patients 28% could use Internet. Males, more educated and younger subjects were more likely to use the Internet. Of the Internet users, 37% had already performed at least one search for medical information. CONCLUSION: Though Internet is not yet a popular means of patient education in Iran, considering the speedy growth of Internet use and its undeniable advantages and prospects in a young country like Iran, it seems wise for private and public health sectors to start more vigorous planning to develop web-based patient education systems run by trusted bodies and encourage and cultivate its use among patients.

Adult↗
PubMed1998

Communication technologies and applications in a medical environment.

As we move into the next millennium, we anticipate a rapid introduction of Information and Communication Technologies (ICTs) into the medical environment. In applying these technologies in Health Care Environments, the basic goals are to improve: (a) the collaboration between the different partners in the health sector, (b) the access to care and (c) the medical education, and to enhance overall quality (by increasing the availability of some applications, improve the quality of others and facilitate some completely new ones), and all these at affordable cost. This requires close interaction between health care practitioners and information technologists to ensure that the proposed technologies satisfy current user's needs, and anticipate future. The public awareness and the acceptance of the new medical environments by the users are key factors for successful implementations.

Computer Communication Networks↗
PubMed2002

[Anesthesiologists in France. First results of the national survey conducted in 1999 by the French College of Anesthesiologist, The French National Society of Anesthesia and Intensive Care with the scientific support of the National Institute for Demographic Studies].

OBJECTIVES: Fears related to the future of anaesthesia manpower in France have led the French College of Anaesthesiologists (Cfar) and the French Society of Anaesthesia and Intensive Care (Sfar), in scientific partnership with the National Institute for Demographic Studies (Ined), to set-up a national survey among French anaesthetists (MAR) practicing in France, to describe their demographic evolution and to analyse their professional activities. METHODS: The survey was based on a personal questionnaire, filled by each individual, approved by the National Commission on Informatics and Freedoms (CNIL). The survey was conducted in November 1998, in the 1484 hospitals, public (590) and private (894) where anaesthetics are performed, under the control of local and regional referents. RESULTS: The anaesthesiologists positions count gave a total of 9741 positions shared between 5694 in public practice (58%), 3569 in private practice (37%) and 478 in private hospitals taking part to the national health service-PSPH (5%). The evaluation of the number of anaesthesiologists from the number of positions has made necessary a methodology of rectification of the survey to take in account the lack of response and the multiple sites of activity. The survey allows an evaluation of around 8876 physicians practising anaesthesia and intensive care in France at the beginning of 1999, among them 216 overseas. This census is in concordance with the count made by the Medical Council--Ordre des médecins--which published a number of 8716 anaesthesiologists in France, and 234 overseas, at the 1st January 1999, corresponding to a total of 8950. The annual demographic growth has felt from 9% per year, before 1989, to reach the level zero, in 1999. The masculinisation of the speciality is growing with a proportion of 35.7% of females, as well as ageing, the overage of age increasing from 42.8 in 1989 to 45.9 years in 1999. The pyramid of ages does not correspond to a growing population but to ageing people due to a decrease of the youngest classes. The medical density of 14.75 anaesthesiologists for 100,000 inhabitants in 1999, compared to 12.9 in 1989, is slightly above the European average, but the geographic distribution is very unequal between north and south, the large cities, centre of a university hospital, and the smaller one even if a reduction of differences is observed. The study and the analysis of professional activities bring important data to take in account side of demographic evolution. CONCLUSION: The demographic evolution must integrate non-only the reduction of the entries in the speciality, of the retirements, but also the sociological evolutions linked to the working time reduction. The solutions face to the promised shortcut of manpower consist of a reorganisation of the structures, a new definition of tasks and managements, without the possibility to avoid and adjustment of the anaesthesiologists population.

Adult↗
PubMed2000

[Which health information systems for the evaluation of health actions?].

The evaluation of health actions requires large amounts of information allowing an assessment of relevance, coherence, efficacy, efficiency and impact of these interventions. Information systems should support evaluation processes by helping to obtain pertinent indicators, tracers and standard operating procedures. To reach this objective, specific functions need to be implemented, including traceability, documentation, investigation and scientific awareness. But this supposes that health information systems respect quality criteria that this article defines. The following criteria are considered: simplicity, validity, acceptability, informative value, representativeness, continuity, reactivity, fluidity, flexibility of the system, and also confidentiality of information. The historical developments of medical informatics have induced the creation of independent information systems, answering to specific objectives. This lack of integration is an obstacle to the evaluation of health actions because of the difficulty to view transversally and longitudinally the sequence of actions for a same patient. Thus integrated health information systems, organised around patient care episodes, are necessary to support evaluation and to contribute effectively to decision making in public health, because the evaluation of health actions implies the availability of information about the individuals who are the targets of these actions.

Decision Making↗
PubMed2006

Education and training of health information systems--a literature review.

This review concerned the content of education and training in health information systems targeted for healthcare professionals. The publications selected for the review were explored as to their educational content, theoretical approaches, available options, learning outcomes and the respective impact on organisational learning. A total of 1772 abstracts were screened and up to 423 abstracts studied in more detail. Two reviewers independently assessed the extracted data and decided to include 21 articles for the final review. The studies were analysed in relation to health informatics competence level, previous knowledge of information system usage, learning environment, teaching methods, pedagogical approaches, goals of training and assessment of learning. The review revealed that any level of competence in health informatics contributes to the learning process. The review suggested that more attention should be paid to setting up goals for training and measuring the preferable competence level of learning. It also clearly indicated the need for further research on teaching health informatics to healthcare professionals.

Curriculum↗
PubMed2003

Time series modeling for syndromic surveillance.

BACKGROUND: Emergency department (ED) based syndromic surveillance systems identify abnormally high visit rates that may be an early signal of a bioterrorist attack. For example, an anthrax outbreak might first be detectable as an unusual increase in the number of patients reporting to the ED with respiratory symptoms. Reliably identifying these abnormal visit patterns requires a good understanding of the normal patterns of healthcare usage. Unfortunately, systematic methods for determining the expected number of (ED) visits on a particular day have not yet been well established. We present here a generalized methodology for developing models of expected ED visit rates. METHODS: Using time-series methods, we developed robust models of ED utilization for the purpose of defining expected visit rates. The models were based on nearly a decade of historical data at a major metropolitan academic, tertiary care pediatric emergency department. The historical data were fit using trimmed-mean seasonal models, and additional models were fit with autoregressive integrated moving average (ARIMA) residuals to account for recent trends in the data. The detection capabilities of the model were tested with simulated outbreaks. RESULTS: Models were built both for overall visits and for respiratory-related visits, classified according to the chief complaint recorded at the beginning of each visit. The mean absolute percentage error of the ARIMA models was 9.37% for overall visits and 27.54% for respiratory visits. A simple detection system based on the ARIMA model of overall visits was able to detect 7-day-long simulated outbreaks of 30 visits per day with 100% sensitivity and 97% specificity. Sensitivity decreased with outbreak size, dropping to 94% for outbreaks of 20 visits per day, and 57% for 10 visits per day, all while maintaining a 97% benchmark specificity. CONCLUSIONS: Time series methods applied to historical ED utilization data are an important tool for syndromic surveillance. Accurate forecasting of emergency department total utilization as well as the rates of particular syndromes is possible. The multiple models in the system account for both long-term and recent trends, and an integrated alarms strategy combining these two perspectives may provide a more complete picture to public health authorities. The systematic methodology described here can be generalized to other healthcare settings to develop automated surveillance systems capable of detecting anomalies in disease patterns and healthcare utilization.

Bioterrorism↗
PubMed2001

Integrated patient data for optimal patient management: the value of laboratory data in quality improvement.

Managed care organizations are shifting from traditional utilization management programs to focus on initiatives that improve the health of an insured population. This strategy requires sophisticated data integration to identify at-risk individuals and track outcomes. Laboratory data are becoming increasingly valuable tools for managed care organizations and healthcare providers. The HEDIS Effectiveness of Care measures have incorporated laboratory data into several key performance indicators. By building a comprehensive repository of laboratory data that includes both procedure codes and laboratory values, managed care organizations can realize substantial savings by avoiding the costly medical record reviews required when administrative data are incomplete. In addition to tracking clinical outcomes, laboratory data provide the ability to risk-stratify a population to target high-risk individuals for case management and disease management interventions. Healthcare organizations face several challenges in the integration of laboratory data into medical databases and practice management software. Confidentiality is a key consideration in view of recent healthcare regulations. Providers of laboratory services should work collaboratively with organizations setting standards for healthcare informatics to facilitate the pooling of data for quality improvement and outcomes research. Health Level Seven, Inc. (HL7), Logical Observation Identifier Names and Codes (LOINC), and Systematized Nomenclature of Medicine (SNOMED) will likely play a key role in this process.

Clinical Laboratory Techniques↗
PubMed2005

Instruments to assess the quality of health information on the World Wide Web: what can our patients actually use?

OBJECTIVE: To find and assess quality-rating instruments that can be used by health care consumers to assess websites displaying health information. DATA SOURCES: Searches of PubMed, the World Wide Web (using five different search engines), reference tracing from identified articles, and a review of the of the American Medical Informatics Association's annual symposium proceedings. REVIEW METHODS: Sources were examined for availability, number of elements, objectivity, and readability. RESULTS: A total of 273 distinct instruments were found and analyzed. Of these, 80 (29%) made evaluation criteria publicly available and 24 (8.7%) had 10 or fewer elements (items that a user has to assess to evaluate a website). Seven instruments consisted of elements that could all be evaluated objectively. Of these seven, one instrument consisted entirely of criteria with acceptable interobserver reliability (kappa> or =0.6); another instrument met readability standards. CONCLUSIONS: There are many quality-rating instruments, but few are likely to be practically usable by the intended audience.

Humans↗
PubMed1999

Information subsystem of the chemical coefficients K1 and K2 as the base for the study of the ecological factors that influence human health.

With regard to the relatively limited water supply in the area of Dalmatia (Southern Croatia), water supply system and health care institutions are especially interested in observing and monitoring the waters, as well as preserving their quality. The ecological need to sum up the work on water quality investigations led us to monitor the environment. Because it is necessary, from the informatical aspect, to organize mass ecological health data into databases, the relational database for the research of chemical analyses (coefficients K1 and K2) as the methodological foundation for the study of the ecological factors that influence human health is defined in this paper. Results used for the prototype implementation subsystem of the chemical water analysis control are based on the investigations of the Water Examination Department of the Public Health Institute of the Split-Dalmatian County (Croatia). Over 2500 data comprised the examination sample. The software used included Win'95, MO'97, and Paradox 4.5, while the hardware used included Pentium II 200 MHz, floppy, 64 MB RAM, HDD 2.1 GB, CD x 24, HP Ljet 4L.

Alkalies↗
PubMedDate not supplied

Future directions for research in laboratory medicine: the findings of a Delphi survey of stakeholders.

In July 1995, we asked 101 experts to anticipate future areas for research in clinical laboratory medicine using a modified Delphi survey approach. The panel included academicians, clinical laboratory professionals, laboratory managers, practicing physicians public health officials, hospital administrators, and representatives of manufacturing industries, managed care organizations, commercial laboratories, and government health agencies. The participants predicted fewer laboratories, more automation, and fewer skilled staff needed in the future. The consensus was that laboratory quality assurance will focus on patient outcomes and be benchmarked against peer groups. They agreed that quality assurance routinely will be integrated into testing kits. Measures derived from medical informatics, such as outcomes analysis and utilization statistics, will become a standard feature of health care. A major area of concern was the effect that reorganizing health care and striving for cost containment will have on laboratory services. These views were consistent with those expressed by participants at a CDC conference on the frontiers of laboratory medicine research held shortly after the study was completed. These topics by now are familiar to most laboratory professionals, and we urge them to explore the many research issues raised with their colleagues in their clinical laboratories, health-care organizations, and industry.

Attitude to Health↗
PubMed2004

Indianapolis I3: the third generation Integrated Advanced Information Management Systems.

In 2001, the Regenstrief Institute for Health Care and the Indiana University School of Medicine (IUSM) began an IAIMS planning effort to create a vision and a tactical plan for the first Integrated Advanced Information Management Systems (IAIMS) implementation to cross a large area and include unaffiliated institutions. A number of elements made this planning effort unique. Among these elements were the existence of a network infrastructure that supported the Indianapolis Network for Patient Care, the existence of a mature medical informatics program at the Regenstrief Institute, and the existence of a wide-area knowledge network fostered by the IUSM libraries. However, the leadership for a strong information technology role in the IUSM that could promote collaboration in support of education and research across the diverse Indianapolis hospital systems had been lacking. By bringing together various groups, each with a commitment to improve health care quality and public health across the Indianapolis metropolitan area, regardless of individual institutional affiliation, the strategic directions for I3-Indianapolis IAIMS Initiative have been defined and the foundations for a third generation IAIMS construct have been laid in Indianapolis, Indiana.

Academic Medical Centers↗