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PubMed2005

Privacy protection for HealthGrid applications.

OBJECTIVES: This contribution aims at introducing the problem of privacy protection in e-Health and at describing a number of existing privacy enhancing techniques (PETs). The recognition that privacy constitutes a fundamental right is gradually entering public awareness. Because healthcare-related data are susceptible to being abused for many obvious reasons, public apprehension about privacy has focused on medical data. Public authorities have become convinced of the need to enforce privacy protection and make considerable efforts for promoting through privacy protection legislation the deployment of PETs. METHODS: Based on the study of the specific features of Grid technology, ways in which PET services could be integrated in the HealthGrid are being analyzed. Grid technology aims at removing barriers between local and remote resources. The privacy and legal issues raised by the HealthGrid are caused by the transparent interchange and processing of sensitive medical information. PET technology has already proven its usefulness for privacy protection in health-related marketing and research data collection. RESULTS: While this paper does not describe market-ready solutions for privacy protection in the HealthGrid, it puts forward several cases in which the Grid may benefit from PETs. CONCLUSION: Early integration of privacy protection services into the HealthGrid can lead to a synergy that is beneficial for the development of the HealthGrid itself.

Access to Information↗
PubMed1998

An evidence-based approach to interactive health communication: a challenge to medicine in the information age. Science Panel on Interactive Communication and Health.

OBJECTIVE: To examine the current status of interactive health communication (IHC) and propose evidence-based approaches to improve the quality of such applications. PARTICIPANTS: The Science Panel on Interactive Communication and Health, a 14-member, nonfederal panel with expertise in clinical medicine and nursing, public health, media and instructional design, health systems engineering, decision sciences, computer and communication technologies, and health communication, convened by the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. EVIDENCE: Published studies, online resources, expert panel opinions, and opinions from outside experts in fields related to IHC. CONSENSUS PROCESS: The panel met 9 times during more than 2 years. Government agencies and private-sector experts provided review and feedback on the panel's work. CONCLUSIONS: Interactive health communication applications have great potential to improve health, but they may also cause harm. To date, few applications have been adequately evaluated. Physicians and other health professionals should promote and participate in an evidence-based approach to the development and diffusion of IHC applications and endorse efforts to rigorously evaluate the safety, quality, and utility of these resources. A standardized reporting template is proposed to help developers and evaluators of IHC applications conduct evaluations and disclose their results and to help clinicians, purchasers, and consumers judge the quality of IHC applications.

Evidence-Based Medicine↗
PubMed2003

The 34th Walter J. Zeiter lecture: creating the future of PM&R: building on our past.

The founders of the field of physical medicine and rehabilitation (PM&R) took advantage of a confluence of political, technical, and economic opportunities to launch our specialty. In the process, they expressed their values of belief in the importance of function, the team approach to health care, the utility of physical agents and modalities in the management of neuromuscular conditions, the impact of education for our patients and their families, the rights of persons with a disability (PWD), and the responsibility of our field to advocate for public policy issues concerned with the needs of PWD. Advances in the technology of health care delivery and biomedicine will shape our future. Specific trends and factors are addressed. Equally important will be the political dimension, including the aging of our global population, and the economic consequences of health insurance pressures. The field of PM&R should focus on activities that take advantage of emerging trends but are rooted in our traditional values. In particular, the field should look forward to the massive growth of populations in need of our services because of aging and longevity, the emerging global health community, and our increasing technical capacity to impact improvements in health and function. The field is charged to preserve awareness of our core values, to support the common good of research, to keep the use of new and emerging technology in check to serve the needs of our patients, to continue our advocacy for social justice for PWD, and to embrace the emerging global community.

Aging↗
PubMed2003

Systematic review of scope and quality of electronic patient record data in primary care.

OBJECTIVE: To systematically review measures of data quality in electronic patient records (EPRs) in primary care. DESIGN: Systematic review of English language publications, 1980-2001. DATA SOURCES: Bibliographic searches of medical databases, specialist medical informatics databases, conference proceedings, and institutional contacts. STUDY SELECTION: Studies selected according to a predefined framework for categorising review papers. DATA EXTRACTION: Reference standards and measurements used to judge quality. RESULTS: Bibliographic searches identified 4589 publications. After primary exclusions 174 articles were classified, 52 of which met the inclusion criteria for review. Selected studies were primarily descriptive surveys. Variability in methods prevented meta-analysis of results. Forty eight publications were concerned with diagnostic data, 37 studies measured data quality, and 15 scoped EPR quality. Reliability of data was assessed with rate comparison. Measures of sensitivity were highly dependent on the element of EPR data being investigated, while the positive predictive value was consistently high, indicating good validity. Prescribing data were generally of better quality than diagnostic or lifestyle data. CONCLUSION: The lack of standardised methods for assessment of quality of data in electronic patient records makes it difficult to compare results between studies. Studies should present data quality measures with clear numerators, denominators, and confidence intervals. Ambiguous terms such as "accuracy" should be avoided unless precisely defined.

Ambulatory Care Information Systems↗
PubMed2005

Towards a wireless patient: chronic illness, scarce care and technological innovation in the United Kingdom.

'Modernization' is a key health policy objective in the UK. It extends across a range of public service delivery and organizational contexts, and also means there are radical changes in perspective on professional behaviour and practice. New information and communications technologies have been seen as one of the key mechanisms by which these changes can be engendered. In particular, massive investment in information technologies promises the rapid distribution and deployment of patient-centred information across internal organizational boundaries. While the National Health Service (NHS) sits on the edge of a pound sterling 6 billion investment in electronic patient records, other technologies find their status as innovative vehicles for professional behaviour change and service delivery in question. In this paper, we consider the ways that telemedicine and telehealthcare systems have been constructed first as a field of technological innovation, and more recently, as management solutions to problems around the distribution of health care. We use NHS responses to chronic illness as a medium for understanding these shifts. In particular, we draw attention to the shifting definitions of 'innovation' and to the ways that these shifts define a move away from notions of technological advance towards management control.

Chronic Disease↗
PubMed2005

Modeling cancer registration processes with an enhanced activity diagram.

OBJECTIVES: Adequate instruments are needed to reflect the complexity of routine cancer registry operations properly in a business model. The activity diagram is a key instrument of the Unified Modeling Language (UML) for the modeling of business processes. The authors aim to improve descriptions of processes in cancer registration, as well as in other public health domains, through the enhancements of an activity diagram notation within the standard semantics of UML. METHODS: The authors introduced the practical approach to enhance a conventional UML activity diagram, complementing it with the following business process concepts: timeline, duration for individual activities, responsibilities for individual activities within swimlanes, and descriptive text. RESULTS: The authors used an enhanced activity diagram for modeling surveillance processes in the cancer registration domain. Specific example illustrates the use of an enhanced activity diagram to visualize a process of linking cancer registry records with external mortality files. CONCLUSIONS: Enhanced activity diagram allows for the addition of more business concepts to a single diagram and can improve descriptions of processes in cancer registration, as well as in other domains. Additional features of an enhanced activity diagram allow to advance the visualization of cancer registration processes. That, in turn, promotes the clarification of issues related to the process timeline, responsibilities for particular operations, and collaborations among process participants. Our first experiences in a cancer registry best practices development workshop setting support the usefulness of such an approach.

Computer Simulation↗
PubMed2003

Getting the big picture: the macro-politics of information system development (and failure) in a Canadian hospital.

OBJECTIVES: While recognized that global actors influence health information system design, studies of health informatics have largely focused on micro politics of technology design and implementation. Here a problematic patient care information system (PCIS) is discussed in relation to federal and provincial policies and corporate strategies to demonstrate that our understanding of health informatics can be enhanced by linking micro studies of health informatics to larger macro contexts. METHODS: Interviews and document study. RESULTS: Although the extent to which federal initiatives influenced (or failed to influence) provincial and hospital initiatives remains debateable, events initiated at one level (the hospital's decision to implement software, initiated at the organizational level) are influenced (perhaps indirectly) by developments in other contexts (federal/macro changes gave an initiative more weight; provincial initiatives such as the Labour Accord altered the industrial relations environment in which system development occurred). CONCLUSIONS: Micro-studies of work practice, invaluable in addressing interactions between technologies, users and work practices, often fail to account for the historic reach of global actors, although it is often these historic circumstances that contribute to present-day interactions between user, information system and organization, and that find expression - often indirectly - in daily work practices.

Canada↗
PubMed2001

Suggested principles of professional ethics for the online provision of mental health services.

The goal of this project was to suggest principles of professional ethics for the online provision of clinical mental health services that could guide both clinicians who provide and patients who receive such services. A joint committee of the International Society for Mental Health Online (ISMHO) and the Psychiatric Society for Informatics (PSI) was formed. Discussion and development of these principles took place online. A set of principles was produced and endorsed by ISMHO on January 9, 2000, and by PSI on May 13, 2000. The principles involve informed consent (about the process, the clinician, the potential risks and benefits, safeguards, and alternatives), standard operating procedure (competence, legal requirements, the structure of the services, evaluation, multiple treatment providers, confidentiality, records, and existing guidelines), and emergencies (procedures and local backup). This project demonstrates that traditional principles of professional ethics can be extended to online services, that comprehensive ethical principles can be developed by groups that cross disciplinary and national boundaries, and that productive collaboration can take place entirely online; and suggest that online clinicians have the potential to regulate themselves.

Clinical Competence↗
PubMedDate not supplied

David Brailer on a private-public health information technology infrastructure. Interview by Susan V. White.

David Brailer, MD PhD, was appointed the first National Health Information Technology Coordinator by the U.S. Department of Health and Human Services Secretary Tommy Thompson on May 6, 2004. As National Coordinator he is to execute President Bush's Executive Order of April 27, 2004, calling for widespread deployment of health information technology (HIT) within 10 years. Dr. Brailer is an authority on clinical data sharing, local health information exchanges, and the use of peer-to-peer technologies in healthcare. He is a leader in the strategy and financing of quality and efficiency in healthcare, with a particular emphasis on HIT and health systems management. Previously, Dr. Brailer was a Senior Fellow at the Health Technology Center in San Francisco, advising a variety of regional and national data-sharing projects and several major corporations about the role of IT in improving the quality of healthcare. Dr. Brailer recently completed 10 years as Chairman and CEO of CareScience, Inc., a provider of care management services and Internet-based solutions that help reduce medical errors and improve physician and hospital-based performance. Dr. Brailer holds doctoral degrees in both medicine and economics. While in medical school, he was a Charles A. Dana Scholar at the University of Pennsylvania School of Medicine and the first recipient of the National Library of Medicine Martin Epstein Award for his work in expert systems. Dr. Brailer was among the first medical students to serve on the Board of Trustees of the American Medical Association.

Diffusion of Innovation↗
PubMed2001

A framework for improving the quality of health information on the world-wide-web and bettering public (e-)health: the MedCERTAIN approach.

There has been considerable debate about the variable quality of health information on the world-wide-web and its impact on public health. While central authorities to regulate, control, censor, or centrally approve information, in-formation providers or websites are neither realistic nor desirable, public health professionals are interested in making systems available that direct patient streams to the best available information sources. National governments and medical societies have also recognized their responsibility to help users to identify "good quality" information sources. But what constitutes good quality, and how can such a system be implemented in a decentralized and democratic manner? This paper presents a model which combines aspects of consumer education, encouragement of best practices among information providers, self-labeling and external evaluations. The model is currently being implemented and evaluated in the MedCERTAIN project, funded by the European Union under the Action Plan for Safer Use of the Internet. The aim is to develop a technical and organisational infrastructure for a pilot system that allows consumers to access metainformation about web-sites and health information providers, including disclosure information from health providers and opinions of external evaluators. The paper explains the general conceptual framework of the model and presents preliminary experiences including results from an expert consensus meeting, where the framework was discussed.

Databases as Topic↗
PubMed2006

Neglected user perspectives in the design of an online hospital bed-state system: implications for the National Programme for IT in the NHS.

Technical aspects of the National Programme for IT in the National Health Service have run ahead of genuine engagement with front-line users. We have explored with front-line NHS staff the factors which limit their contribution to management information from operational systems. Staff place psychological distance between 'the real job' and the reporting of information. Even where accurate reporting is heavily incentivized, and operational control is shared between staff and shift leader, the reporting of information to the computer represents a division between caregiving and computer input, and between information openly declared and that waiting to be disclosed. The Programme needs to reconsider how clinicians are to be engaged. Equally, information systems designers, if they expect to obtain management information and want to understand the limitations of that process, need to be socialized into the fields where systems are to be deployed.

Disclosure↗
PubMed2003

Making the boundaries clearer: revisiting information systems with fading boundaries.

PURPOSE: To address issues of importance in 1994 and what has happened in those issues. METHODS: A number of questions and issues will be examined. Were we right in our focus at that time and what did we miss? What has happened that perhaps changed our perspectives and philosophies? Has the need changed? Is the model of fading boundaries a correct one, and how far have we gone in realizing a communication system in dealing with those boundaries? What progress have we made internationally on these issues? How are we working internationally to solve these problems? RESULTS: The fifth working conference relating to hospital information systems (HIS) was held in Durham, North Carolina in August 1994. The Institute of Medicine publication The Computer-based Patient Record: An Essential Technology for Health Care had been published in 1991 and had begun influencing thinking and direction for clinical information systems. The difference between and relationship of HIS and Computer-based Patients Records was the topic of much discussion and debate. The 1994 conference strongly recognized the need for standards specifically for data exchange, unique patient identifier, data definitions and common clinical data sets and for clinical terminology. Interconnectivity and interoperability were identified as separate but related problems to be solved. Technology was not considered to be a barrier, and projections for bandwidth to meet data dissemination requirements were favorable. In the 7 years after the Durham conference, many things have changed dramatically. Progress has been made in a number of areas, and some of the projections have been realized. However, it is surprising to note what areas still remain problems, particularly noting what problems have been worked on without success and what problems have not even been addressed. It is interesting to speculate that if the Durham conference was repeated today, would it be accepted as a current event?

Hospital Information Systems↗
PubMed2006

Key functional characteristics in designing and operating health information websites for user satisfaction: an application of the extended technology acceptance model.

OBJECTIVE: With growing demand for health information and rapid development of information technology, health information websites are emerging as the most effective media to meet the public's needs for health information. This article is intended to offer a technical view on the design and operations of health information websites. Along this line, employed here is the Technology Acceptance Model (TAM), which has been widely used to predict user acceptance based on Perceived Ease-of-Use (PEOU) and Perceived Usefulness (PU). METHODS: We extend the original TAM by including some exogenous variables since it is necessary to understand the role of the antecedents of acceptance constructs when designing an effective health information website for improving user satisfaction. This study focuses on identifying the core functional factors in designing and operating health information websites. Conducted are some multivariate statistical analyses based on data from an extensive survey. RESULTS: The results from the structural equation analysis suggest that functional characteristics should be categorized into three groups: one affecting PU and PEOU, another affecting only PEOU, and the other having no direct effect on either PU or PEOU. In particular, 'usage support' and 'customization' are two key functional characteristics in the extended TAM framework for health information websites. CONCLUSION: Contrary to expectations, however, the direct effect of PEOU on usage support is hardly observed, which differentiates health information websites from other commercial websites like online shopping malls. As a result, understanding the antecedents of PU takes on more significance.

Access to Information↗
PubMed2001

Suggested principles of professional ethics for the online provision of mental health services.

The goal of this project was to suggest principles of professional ethics for the online provision of clinical mental health services that could guide clinicians who provide and patients who receive such services. A joint committee of the International Society for Mental Health Online (ISMHO) and the Psychiatric Society for Informatics (PSI) was formed. Discussion and development of these principles took place online. A set of principles was produced and endorsed by ISMHO on January 9, 2000, and by PSI on May 13, 2000. The principles involve informed consent (about the process, the clinician, the potential risks and benefits, safeguards, and alternatives), standard operating procedure (competence, legal requirements, the structure of the services, evaluation, multiple treatment providers, confidentiality, records, and existing guidelines), and emergencies (procedures and local backup). This project demonstrates that traditional principles of professional ethics can be extended to online services, that comprehensive ethical principles can be developed by groups that cross disciplinary and national boundaries, and that productive collaboration can take place entirely online; and suggest that online clinicians have the potential to regulate themselves.

Clinical Competence↗
PubMed2005

Developing and validating a nursing website evaluation questionnaire.

AIM: The aim of this paper is to report on the development and validation of an evaluation questionnaire for nursing websites. BACKGROUND: Increasing numbers of the general public and health care professionals are using the Internet to access health and health care-related information. The quality of such websites, therefore, needs to be evaluated. METHODS: A total of 24 websites in the United States and Taiwan, including websites in 13 leading schools and 11 hospitals, were selected as test websites. A total of 120 participants with Master's degrees in either nursing or mechanical engineering were invited to examine the 24 websites using a nursing website evaluation questionnaire. A 32-item questionnaire was developed, covering overall impression, download and switch speed, accessibility and convenience, web page content, service function and compatibility with common browsers. Participants were requested to connect to the specific websites and browse the contents before filling in the questionnaire. The results were arranged into 12 different sequences and prepared on a CD using Macromedia Dreamweaver. Data were analysed using Cronbach's alpha, Guttman split-half reliability and factor analysis. FINDINGS: Internal consistency was good, with a Cronbach's alpha of 0.93 in Part I and a KR-20 (Kuder Richardson) of 0.85 in Part II. Four factors given in Part I were identified as content truth, accessibility and convenience, speed and connection, and overall impression. CONCLUSION: The nursing website evaluation questionnaire had good construct validity and internal consistency.

Adult↗
PubMed2006

Outbreak detection through automated surveillance: a review of the determinants of detection.

Public health agencies and other groups have invested considerable resources in automated surveillance systems over the last decade. These systems generally follow syndromes in pre-diagnostic data drawn from sources such as emergency department visits. A main goal of syndromic surveillance systems is to detect outbreaks rapidly and the number of studies evaluating outbreak detection has increased recently. This paper reviews these studies with the goal of identifying the determinants of outbreak detection in automated syndromic surveillance systems. The review identified 35 studies with 22 studies (63%) relying on naturally occurring outbreaks and 13 studies (37%) relying on simulated outbreaks. In general, the results from these studies suggest that syndromic surveillance systems are capable of detecting some types of disease outbreaks rapidly with high sensitivity. The determinants of detection included characteristics of the system and of the outbreak. Influential system characteristics included representativeness, the outbreak detection algorithm, and the specificity of the algorithm. Important outbreak characteristics included the magnitude and shape of the signal and the timing of the outbreak. Future evaluations should aim to address inconsistencies in the evidence noted in this review and to identify the potential influence of other factors on outbreak detection.

Diagnosis, Computer-Assisted↗
PubMed2003

E-oncology and health portals: instructions and standards for the evaluation, production organisation and use.

In 2002 the Italian Ministry of Health promoted the institution of a network and a web portal, E-oncology (2), for the seven NHS research institutions specialising in oncology (Istituti di Ricovero e Cura a Carattere Scientifico-IRCCS). One of the aims was to gather and provide information on tumoral pathologies to operators and the public. For an optimum organisation of a health web site it is necessary to comply with the standards internationally used. The World Wide Web Consortium (W3C) has developed guidelines for accessibility and usability of the sites, implemented in Italy through governmental issues. Many international organisations adopt rules and codes of conduct to validate biomedical information and have organised quality portals such as NLM, OMNI, MEDCIRCLE, HON etc. Some terminological standards, such as the MESH thesaurus and UMLS, have been produced by the libraries for a correct management and an effective information retrieval, and are currently used by the most important biomedical web sites. The Dublin Core, metadata standard for the integration of information deriving from heterogeneous archives, has also been developed by the libraries. The easy access to information dims the complex architecture necessary for the construction of a web site. The contribution of different professionals is necessary to guarantee the production of quality medical/health web sites, among them librarians have always been involved with the management of knowledge and their skills are extremely valuable. Furthermore, the libraries' network is essential in order to guarantee universal access to health information, mostly still against payment, and to contribute to overcoming the 'digital divide' and 'second-level digital divide'.

Evaluation Studies as Topic↗
PubMed2004

Electronic medical record systems in Israel's public hospitals.

BACKGROUND: Various medical centers in Israel have recently incorporated electronic medical record systems. Knowing the EMR systems' features and pattern of use is an essential step for developing locally and nationally integrated systems. OBJECTIVES: To evaluate the status of EMR systems in all major general hospitals in Israel in terms of the applications used and the patterns of use. METHODS: Structured questionnaires were sent to hospital directors and directors of medical informatics units of 26 general and pediatric hospitals serving the vast majority of the population in Israel. The questionnaire included questions pertaining to the EMR systems, their usage, and the attitude of the participants to data security issues. RESULTS: Of the 26 general hospitals 23 (88.4%) returned the questionnaires. Of these, 21 (91.3%) use EMR systems. Twenty-seven different types of systems are in use in Israeli hospitals, and generally more than one type is used in a hospital. Physicians work with EMR systems in over 98% of the departments. Also, the EMR systems are used for clinical admission and discharge in over 90% of the departments and for medical daily follow-up in about 45%. CONCLUSIONS: Most of the hospitals in Israel use EMR systems but there is no standard data model. Physicians are the main users but the amount of data entered is still limited. Adoption of standards is essential for the integration of electronic patient records across Israeli healthcare organizations.

Adolescent↗