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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↗
PubMed1999

Macroscopic cryosectioning: a simple new method for producing digital, three-dimensional databases in veterinary anatomy.

Using a new method derived from the 'visible human project' (Spitzer et al., 1996, Journal of the American Medical Informatics Association, 3, 118-130), we were able to establish a simple and low-cost tool which produces high-quality cryosections of macroscopic specimens down to 1-mm slice thickness, based on a milling process. For the first time, a macroscopic cryotome is available to veterinary anatomists, which can be used on cutting faces up to 25 cm high and 50 cm wide and with a minimal slice thickness of 1 mm without any gap. The method employs a modified wood circular saw. Recording of the cutting faces is carried out 'online' by a high-resolution digital camera. The process has been tested extensively and produces high-quality sections of very hard material (teeth) as well as of very soft tissues (brain). It is now possible in veterinary medicine to provide three-dimensional anatomical databases of high resolution and of tissue-specific colour as an additional tool for high-quality two- and three-dimensional anatomical reconstructions for use in science and education.

Anatomy↗
PubMed2002

Verification of temporal scheduling constraints in clinical practice guidelines.

The computerization of clinical practice guidelines is a significant scientific challenge for the medical informatics community. One frequently reported factor hindering this objective is the existence of deficiencies within guideline knowledge. In this paper, we focus on the detection of flaws within temporal scheduling constraints. Temporal scheduling constraints are important elements of therapy management, and are frequently incorporated in clinical practice guidelines. We present a suitable verification method that is based on calculating the minimal network of temporal constraints on the execution of guideline activities. Our method serves three purposes: (1) it checks whether temporal scheduling constraints are consistent with scheduling constraints implied by control flow operators and the hierarchical structuring of a guideline; (2) it yields suggestions for an equivalent, yet more explicit representation of non-minimal constraints; (3) it can be used by the guideline interpreter to assemble feasible time intervals for the execution of each guideline activity. We evaluate our approach by applying it to a guideline specified in the Asbru language. For this purpose, we implemented a prototype verifier. Although we concentrate on the guideline representation language Asbru as the demonstration medium of our method within this paper, our approach can be reused to verify several alternative guideline representation formats.

Humans↗
PubMed2005

[HL7 standard--features, principles, and methodology].

The mission of HL7 Inc. non-profit organization is to provide standards for the exchange, management and integration of data that support clinical patient care, and the management, delivery and evaluation of healthcare services. As the standards developed by HL7 Inc. represent the world's most influential standardization efforts in the field of medical informatics, the HL7 family of standards has been recognized by the technical and scientific community as the foundation for the next generation healthcare information systems. Versions 1 and 2 of HL7 standard have solved many issues, but also demonstrated the size and complexity of health information sharing problem. As the solution complete new methodology has been adopted that is encompassed in the HL7 Version 3 recommendations. This approach standardizes Reference Information Model (RIM), which is the source of all derived domain models and message structures. Message design is now defined in detail, enabling interoperability between loosely coupled systems that are.designed by different vendors and deployed in various environments. At the start of the Primary Healthcare Information System project in the Republic of Croatia in 2002, the decision was to go directly to Version 3. The target scope of work includes clinical, financial and administrative data management in the domain of healthcare processes. By using HL7v3 standardized methodology we were able to completely map the Croatian primary healthcare domain to HL7v3 artefacts. Further refinement processes that are planned for the future will provide semantic interoperability and detailed description of all elements in HL7 messages. Our HL7 Business Component is in constant process of studying different legacy applications, making solid foundation for their integration to HL7-enabled communication environment.

Ambulatory Care Information Systems↗
PubMed2005

Health information systems: failure, success and improvisation.

BACKGROUND AND PURPOSE: The generalised assumption of health information systems (HIS) success is questioned by a few commentators in the medical informatics field. They point to widespread HIS failure. The purpose of this paper was therefore to develop a better conceptual foundation for, and practical guidance on, health information systems failure (and success). METHODS: Literature and case analysis plus pilot testing of developed model. RESULTS: Defining HIS failure and success is complex, and the current evidence base on HIS success and failure rates was found to be weak. Nonetheless, the best current estimate is that HIS failure is an important problem. The paper therefore derives and explains the "design-reality gap" conceptual model. This is shown to be robust in explaining multiple cases of HIS success and failure, yet provides a contingency that encompasses the differences which exist in different HIS contexts. The design-reality gap model is piloted to demonstrate its value as a tool for risk assessment and mitigation on HIS projects. It also throws into question traditional, structured development methodologies, highlighting the importance of emergent change and improvisation in HIS. CONCLUSIONS: The design-reality gap model can be used to address the problem of HIS failure, both as a post hoc evaluative tool and as a pre hoc risk assessment and mitigation tool. It also validates a set of methods, techniques, roles and competencies needed to support the dynamic improvisations that are found to underpin cases of HIS success.

Information Systems↗
PubMed1998

Diagnostic informativeness of compressed digital epiluminescence microscopy images of pigmented skin lesions compared with photographs.

Epiluminescence microscopy (ELM) is a useful method for improved diagnostic accuracy in early cutaneous melanoma. Conventional photographs of ELM images are commonly used for clinical research and documentation. Electronic images have advantages compared with photographs and are essential for medical informatics, computerized learning and telemedicine. Compression of electronic images allows a reduction in volume of data, but significant image deterioration may occur at high compression rates. We sought to study the diagnostic informativeness of compressed digital ELM images compared with conventional photographs. Fifty photographs of pigmented skin lesions, including 23 melanomas, were presented to eight dermatologists as photographic slides and as digital images with 30:1 Joint Photographic Experts Group (JPEG) compression. The diagnostic performance of the media and the readers was described in terms of sensitivity, specificity and areas under receiver operating characteristic curves (AUC). Agreement between the readings of the two types of media regarding the presence or absence of ELM criteria was assessed using kappa (kappa) statistics. The mean AUC was 0.81 (95% confidence interval [CI] = 0.73-0.90) for slides and 0.81 (95% CI = 0.72-0.90; P = 0.89) for digital images. Agreement between the readings of the two types of media regarding the presence or absence of ELM criteria ranged from kappa = 0.55 (95% CI = 0.22-0.88) for grey-blue area to kappa = 0.89 (95% CI = 0.74-1.00) for radial streaming. In conclusion, digital ELM images with 30:1 JPEG compression appear to be as informative as photographic slides when used to differentiate between melanoma and non-melanoma.

Area Under Curve↗
PubMedDate not supplied

The use of Data Mining in the categorization of patients with Azoospermia.

OBJECTIVE: Data Mining is a relatively new field of Medical Informatics. The aim of this study was to compare Data Mining diagnosis with clinical diagnosis by applying a Data Miner (DM) to a clinical dataset of infertile men with azoospermia. DESIGN: One hundred and forty-seven azoospermic men were clinically classified into four groups: a) obstructive azoospermia (n=63), b) non-obstructive azoospermia (n=71), c) hypergonadotropic hypogonadism (n=2), and d) hypogonadotropic hypogonadism (n=11). The DM (IBM's DB2/Intelligent Miner for Data 6.1) was asked to reproduce a four-cluster model. RESULTS: DM formed four groups of patients: a) eugonadal men with normal testicular volume and normal FSH levels (n=86), b) eugonadal men with significantly reduced testicular volume (median 6.5 cm3) and very high FSH levels (n=29), c) eugonadal men with moderately reduced testicular volume (median 14.5 cm3) and raised FSH levels (n=20), and d) hypogonadal men (n=12). Overall DM concordance rate in hypogonadal men was 92%, in obstructive azoospermia 73%, and in non-obstructive azoospermia 69%. CONCLUSIONS: Data Mining produces clinically meaningful results but different from those of the clinical diagnosis. It is possible that the use of large sets of structured and formalised data and continuous evaluation of DM results will generate a useful methodology for the Clinician.

Cohort Studies↗
PubMed1998

How well do physicians use electronic information retrieval systems? A framework for investigation and systematic review.

OBJECTIVE: Despite the proliferation of electronic information retrieval (IR) systems for physicians, their effectiveness has not been well assessed. The purpose of this review is to provide a conceptual framework and to apply the results of previous studies to this framework. DATA SOURCES: All sources of medical informatics and information science literature, including MEDLINE, along with bibliographies of textbooks in these areas, were searched from 1966 to January 1998. STUDY SELECTION: All articles presenting either classifications of evaluation studies or their results, with an emphasis on those studying use by physicians. DATA EXTRACTION: A framework for evaluation was developed, consisting of frequency of use, purpose of use, user satisfaction, searching utility, search failure, and outcomes. All studies were then assessed based on the framework. DATA SYNTHESIS: Due to the heterogeneity and simplistic study designs, no meta-analysis of studies could be done. General conclusions were drawn from data where appropriate. A total of 47 articles were found to include an evaluation component and were used to develop the framework. Of these, 21 articles met the inclusion criteria for 1 or more of the categories in the framework. Most use of IR systems by physicians still occurs with bibliographic rather than full-text databases. Overall use of IR systems occurs just 0.3 to 9 times per physician per month, whereas physicians have 2 unanswered questions for every 3 patients. CONCLUSIONS: Studies comparing IR systems with different searching features have not shown that advanced searching methods are significantly more effective than simple text word methods. Most searches retrieve only one fourth to one half of the relevant articles on a given topic and, once retrieved, little is known about how these articles are interpreted or applied. These studies imply that further research and development are needed to improve system utility and performance.

Evaluation Studies as Topic↗
PubMed2004

Cognitive and usability engineering methods for the evaluation of clinical information systems.

Increasingly healthcare policy and decision makers are demanding evidence to justify investments in health information systems. This demand requires an adequate evaluation of these systems. A wide variety of approaches and methodologies have been applied in assessing the impact of information systems in health care, ranging from controlled clinical trials to use of questionnaires and interviews with users. In this paper we describe methodological approaches which we have applied and refined for the past 10 years for the evaluation of health information systems. The approaches are strongly rooted in theories and methods from cognitive science and the emerging field of usability engineering. The focus is on assessing human computer interaction and in particular, the usability of computer systems in both laboratory and naturalistic settings. The methods described can be a part of the formative evaluation of systems during their iterative development, and can also complement more traditional assessment methods used in summative system evaluation of completed systems. The paper provides a review of the general area of systems evaluation with the motivation and rationale for methodological approaches underlying usability engineering and cognitive task analysis as applied to health information systems. This is followed by a detailed description of the methods we have applied in a variety of settings in conducting usability testing and usability inspection of systems such as computer-based patient records. Emerging trends in the evaluation of complex information systems are discussed.

Biomedical Engineering↗
PubMed1997

The future is no longer what it used to be. Managing health telematics projects.

Future used to mean global progress and convergence of science and technology and society. Today, we observe the decoupling of the two poles of knowledge formation and application (i.e. science and technology, and culture and society, respectively) and also fierce confrontation between them. The key issue to reconcile the two poles is to re-invent the link between them. The new future lies in the development of mental and technical capacities for change and the creation of new forms of solidarity. We propose, as a general attitude, to reactivate and develop the four principles of efficacy-effectiveness-efficiency, hospitality, responsibility and pertinence. Translated into driving forces for the development of health care telematic projects, they amount to the acceptance of and capacity for enterprise-wide solutions, hospitality and capacity to acquire outside knowledge, self-managed, multi-functional team work spirit, reengineering mentality to achieve pertinent technico-cultural solutions.

Attitude↗
PubMed1997

"Just-in-time" clinical information.

The just-in-time (JIT) model originated in the manufacturing industry as a way to manage parts inventories process so that specific components could be made available at the appropriate times (that is, "just in time"). This JIT model can be applied to the management of clinical information inventories, so that clinicians can have more immediate access to the most current and relevant information at the time they most need it--when making clinical care decisions. The authors discuss traditional modes of managing clinical information, and then describe how a new, JIT model may be developed and implemented. They describe three modes of clinician-information interactions that a JIT model might employ, the scope of information that may be made available in a JIT model (global information or local, case-specific information), and the challenges posed by the implementation of such an information-access model. Finally, they discuss how JIT information access may change how physicians practice medicine, various ways JIT information may be delivered, and concerns about the trustworthiness of electronically published and accessed information resources.

Clinical Competence↗
PubMed2004

Semantics and the medical web: a review of barriers and breakthroughs in effective healthcare query.

This paper provides an overview of the research into current medical vocabularies and their impact on searching the Web for health information. The Web provides growing opportunities for laypersons to gain knowledge about specific health conditions, though research to date has been incomplete. Many studies have examined aspects of controlled medical vocabularies. Other studies have examined aspects of medical Web searching vocabularies. In this context, there is a growing need to examine more closely laypersons' Web queries using controlled medical vocabularies that were designed to serve the needs of medical professionals. It may be the case that the average consumer of Web health services is not able to use correct medical terminology, and may not be able to choose analogous or synonymous terms from a search result list. Our review suggests a growing need for studies to examine the current applicability of controlled medical vocabularies as well as alternatives to semantic query by Web search engine users.

Humans↗