Abstract: Healthcare and medical research in Germany are heading to more interconnected systems. New initiatives are funded by the German government to encourage the development of Integrated Research and Treatment Centers (IFB). Within an IFB new organizational structures and infrastructures for interdisciplinary, translational and trans-sectoral working relationship between existing rigid separated sectors are intended and needed. This paper describes how an IT-infrastructure of an IFB could look like, what major challenges have to be solved and what methods can be used to plan such a complex IT-infrastructure in the field of healthcare. By means of project management, system analyses, process models, 3LGM<sup>2</sup>-models and resource plans an appropriate concept with different views is created. This concept supports the information management in its enterprise architecture planning activities and implies a first step of implementing a connected healthcare and medical research platform.
Notes: Staubert, Sebastian xD;Winter, Alfred xD;Speer, Ronald xD;Loffler, Markus xD;Netherlands xD;Studies in health technology and informatics xD;Stud Health Technol Inform. 2010;160:1319-23.
Abstract: Zusammenfassung Die Medizin ist geprägt sowohl durch ihren besonderen unmittelbaren und existenziellen Bezug zu Menschen als auch durch ihre zunehmende ökonomische Bedeutung. Ein Medizinisches Informationssystem ist das umfassende System aller Informationsverarbeitung einer medizinischen Einrichtung oder Region. Während die Architekturprinzipien des rechnerbasierten Teils solcher Informationssysteme wenige Besonderheiten aufweist, bündelt das Management dieser Informationssysteme viele Herausforderungen und Probleme, die wegen der besonderen Bedeutung der Medizin besondere Priorität bei der Lösung haben müssen.
Abstract: OBJECTIVES: Translational medicine research needs a two-way information highway between 'bedside' and 'bench'. Unfortunately there are still weak links between successfully integrated information roads for bench, i.e. research networks, and bedside, i.e. regional or national health information systems. The question arises, what measures have to be taken to overcome the deficiencies. METHODS: It is examined how patient care-related costs of clinical research can be separated and shared by health insurances, whether quality of patient care data is sufficient for research, how patient identity can be maintained without conflict to privacy, how care and research records can be archived, and how information systems for care and research can be integrated. RESULTS: Since clinical trials improve quality of care, insurers share parts of the costs. Quality of care data has to be improved by introducing minimum basic data sets. Pseudonymization solves the conflict between needs for patient identity and privacy. Archiving patient care records and research records is similar and XML and CDISC can be used. Principles of networking infrastructures for care and research still differ. They have to be bridged first and harmonized later. CONCLUSIONS: To link information systems for care (bed) and for research (bench) needs technical infrastructures as well as economic and organizational regulations.
Abstract: OBJECTIVE: Both regional health information systems (rHIS) and hospital information systems (HIS) need systematic information management. Due to their complexity information management needs a thorough description or model of the managed information system. METHODS: The three layer graph-based meta-model (3LGM(2)) and the 3LGM(2) tool provide means for effectively describing and modeling HIS by hospital functions, application systems and physical data processing components. The 3LGM(2) tool has been used to model parts of the information system of the health care system of the German federal state Saxony and of the Leipzig University Medical Centre. RESULTS: Experiences showed, that 3LGM(2) is suitable for supporting information management even in rHIS. We explain some benefits for information management in regional as well as local settings. CONCLUSIONS: Acceptance of the 3LGM(2) depends strictly on its integration in management structures on the institutional, regional, and even national or European level.
Abstract: Objectives: For planning hospital information systems it is important to recognize the interrelation between business processes and the communication needs between supporting application systems. We therefore present an approach to model, visualize and analyze those interdependencies. Methods: The approach is based on the concepts defined in 3LGM(2), a meta-model to describe health information systems (HIS). An information process is defined as a sequence of functions using or updating information; a communication path as a sequence of communication links between interfaces belonging to application systems. The search for communication paths belonging to an information process is interpreted as an all-pairs shortest-paths problem. To solve this problem the Floyd-Warshall algorithm is applied. Results: The resulting algorithm has been implemented as function of the 3LGM(2) tool, a tool to create 3LGM(2) compliant models. With it, it is possible to interactively define information processes at the domain layer and to analyze step by step whether the infrastructure at the logical tool layer is sufficient to communicate necessary data between application systems. Conclusions: The presented approach enables the representation and analysis of dependencies between information processes and communication paths. With it, the HIS architecture is directly associated with the business needs. This is an important condition for the systematic planning of hospital information systems.
Abstract: OBJECTIVES: To report about the themes and about experiences with practicums in the management of information systems in health care settings (health information management) for medical informatics students. METHODS: We first summarize the topics of the health information management practicums/projects that the authors organized between 1990 and 2003 for the medical informatics programs at Heidelberg/Heilbronn, Germany, UMIT, Austria, as well as for the informatics program at the University of Leipzig, Germany. Experiences and lessons learned, obtained from the faculty that organized the practicums in the past 14 years, are reported. RESULTS: Thirty (of 32) health information management practicums focused on the analysis of health information systems. These took place inside university medical centers. Although the practicums were time-intensive and required intensively tutoring students with regard to health information management and project management, feedback from the students and graduates was mainly positive. DISCUSSION: It is clearly recommended that students specializing in medical informatics need to be confronted with real-world problems of health information systems during their studies.
Abstract: OBJECTIVES:: Systematic information management in hospitals demands for a strategic information management plan (SIM plan). As preparing a SIM plan is a considerable challenge we provide a practical guideline that is directly applicable when a SIM plan is going to be prepared. METHODS:: The guideline recommends a detailed structure of a SIM plan and gives advices about its content and the preparation process. It may be used as template, which can be adapted to the individual demands of any hospital. RESULTS:: The guideline was used in several hospitals preparing a SIM plan. Experiences showed that the SIM plans could be prepared very efficiently and timely using the guideline, that the proposed SIM plan structure suited well, that the guideline offers enough flexibility to meet the requirements of the individual hospitals and that the specific recommendations of the guideline were very helpful. CONCLUSIONS:: Nevertheless, we must strive for a more comprehensive theory of strategic information management planning which - in the sense of enterprise architecture planning - represents the intrinsic correlations of the different parts of a SIM plan to a greater extent.
Notes: TY - JOUR xD;2005-09-22: Liebe Birgit, xD;lieber Alfred, xD; xD;nur kurz: Unser Paper "Preparing strategic information management plans for hospitals: a xD;practical guideline - SIM plans for hospitals: a guideline" xD;ist unter den Top 10 der im 1. Halbjahr 2005 am häufigsten online heruntergeladenen Artikel (lt IJMI-Jahresbericht). xD;Gratulation! xD; xD;Lg, Elske
Abstract: Objectives: One of the tasks of information management is systematic planning of a Hospital Information System (HIS). However, the description and the analysis of the current state of a HIS typically create high costs and are not well supported. The aim of this paper is therefore to report about the specification of a reference model for the domain layer of a Hospital Information System. Methods: We developed a reference model for the domain layer of a Hospital Information System based on the requirements index for information processing in hospitals for describing the enterprise functions, and based on the object types from the Health Level 7 Reference Information Model (HL7-RIM) for describing the entity types. Result: The developed reference model is a comprehensive hierarchic model of the enterprise functions of hospital information systems. The central enterprise function "patient treatment" for example is described with 35 enterprise functions and 38 entity types on a three-level hierarchy. Discussion: Reference models provide a kind of modelling patterns that can easily be used and adapted to a respective Information System. The availability of reference models should therefore provide a highly valuable contribution to keep the costs for modelling Hospital Information Systems low. We will start to evaluate the reference model by using it in the description of the information systems of a University Clinic of the Tiroler Landeskrankenanstalten GmbH (TILAK), Austria. If this pre-test is positive, it is planned to extend the use of the reference model to the overall Hospital Information System of the TILAK.
Abstract: Both regional health information systems and hospital information systems need systematic information management. Due to their complexity information management needs a thorough description or model of the managed HIS. The three layer graph based meta model (3LGM(2)) and the 3LGM(2) tool provide means for effectively modeling HIS. The 3LGM(2) tool has been used to build a model of the health information system of the German federal state Saxony. The model is not only used to support the further development of the Saxonian health information system but also for supporting strategic information management planning in the medical center of Leipzig University. Acceptance of the method depends strictly on its integration in management structures on the institutional, regional, national or even European level.
Notes: The focus in healthcare is gradually shifting from isolated procedures in single healthcare institutions (e.g. a hospital) to patient-oriented care extending across institutional boundaries. xD;A main objective of this approach is to reduce healthcare costs by decreasing hospital stays and increasing community care. To achieve this objective in practice, all relevant treatment facts must be made available to different care providers at the point of care. This paper describes an approach by which information technology can support managed care by providing a communication solution that meets user requirements.
Abstract: To control the heterogeneity inherent to hospital information systems the information management needs appropriate hospital information systems modeling methods or techniques. This paper shows that, for several reasons, available modeling approaches are not able to answer relevant questions of information management. To overcome this major deficiency we offer an UML-based ontology for describing hospital information systems architectures. This ontology views at three layers: the domain layer, the logical tool layer, and the physical tool layer, and defines the relevant components. The relations between these components, especially between components of different layers make the answering of our information management questions possible.
Abstract: Information management in hospitals requires a strategic plan that gives directives for the construction and development of a hospital information system. The paper describes the purpose and a suggested structure for those strategic plans. This structure is a central component for a guideline that may be used for creating and updating strategic plans.
Abstract: Information management in hospitals requires a strategic plan that gives directives for the construction and development of a hospital information system. The paper describes the purpose and a suggested structure for those strategic plans. This structure is a central component for a guideline that may be used for creating and updating strategic plans.
Abstract: Computer-based clinical decision support systems (CDSSs) are still today not in widespread use, although there has been extensive research and development for several decades. We have, based on the literature of the last years, summarised some of the problems that may lead to low user acceptance and that should be addressed more extensive in future developments of CDSSs. We describe different aspects of the usefulness of CDSSs according to the elements (relevance, validity, and work) of a formula of usefulness of information, and, in a short section, refer to the discussion about clinical guidelines.
Abstract: Das Management eines Krankenhauses hat sich zu einem erheblichen Teil mit der Planung, Steue-rung und Überwachung der Informationsverarbeitung zu beschäftigen. Es ist erfor-derlich, die-ses Ma-nagement der Informationsverarbeitung systematisch zu betreiben. xD;Ziel dieser Arbeit ist es, die be-grifflichen Grundlagen zu schaffen, um vorhandene Methoden und Werkzeuge für das Management von Informationssyste-men auf ihre Brauch-barkeit für das Manage-ment von Krankenhausinformati-onssystemen prüfen und gegebe-nenfalls neue Methoden und Werk-zeuge zielge-richtet entwickeln zu können. xD;Das Management von Krankenhausinformationssystemen ist das Informati-onsma-nagement in Krankenhäusern. Es umfaßt das Management von Information, das Mana-gement von Anwendungssy-stemen und das Management von rechner- und nicht-rechnerunterstützter Informations- und Kommu-nikationstechnik. Es gibt keine strukturellen Besonderheiten bei dem Management von Krankenhaus-informations-systemen gegenüber dem Mana-gement anderer großer, verteilter und heterogener Infor-mations-systeme. Unterschiede er-geben sich allerdings aus den besonderen Aufgaben der Kranken-haus--informati-onssysteme in Patientenversorgung, Forschung und Lehre.
Abstract: Within the daily workload at a ward there is a considerable amount of information process ing. It is the task of a systematic management of hospital information systems to provide the health profes sionals the right information in the right place at the right time. The paper deals with the consequences for the management of hospital informa tion systems if health profes sional workstations are to be introduced as a means for this infor mation logistic and with the ex peri ences made in the Heidelberg University Hospi tal. xD;Health professional workstations are formally defined in the context of a three level graph based model of hospital information systems. It is derived, that health professional work stations do have communication needs not only on the physical level of computer systems in the hospital information system but also on the logical tool level, which is the level of application sys tems. On this level communication servers or brokers are of considerable importance. xD;In Heidelberg there are about 200 health professional workstations (MEDIAS) in routine use. xD;Keywords: communication servers, communication standards, hospital information systems, health professional workstations, integrated advanced medical information systems (IAIMS).
Abstract: The large number of inpatient and outpatient treatments in university hospitals leads to a high expense of medical documentation and consequently to an increasing number and size of medical documents. Due to legal regulations, these documents, which are mostly collected in patient-oriented folders (medical records), in general have to be stored for 30 years. This implies several spatial, organizational, and economical problems. Today, conventional archiving in hospitals often does not satisfy the medical needs to make available medical records for health care professionals in a systematic manner and in time. xD; xD;From 1989 to 1993 a prolective pilot study on 'digital optical archiving of medical records' was carried out at Heidelberg University Hospital. The study results have made evident the feasibility of digital optical archiving in hospitals. Assumed that at least 40 percent of medical documents are originally produced in a digital format and that application systems generating these documents can be linked on-line to application systems for digital optical archiving via a communication system, it can be expected that the costs and organizational efforts for digital optical archiving will not exceed those of conventional archiving. xD; xD;In 1995, Heidelberg University Hospital will establish the information procedure 'digital optical archiving of medical records'. The digital optical archive will first be filled up with the medical records of the clinic for neurosurgery, and the endoscopic and sonographic films and reports of the clinic for internal medicine. The authors expect, that this procedure stepwise will lead to an integrated functionality on health (*) care professional workstations, to a hospital-wide use of medical documents, and to media-independent document management systems. xD; xD;The authors focus on the potentials of digital optical archiving, regarding this information procedure as an integral part of hospital information systems, and requirements on the systematic management of hospital information systems with respect to digital optical archiving. xD; xD;Keywords: Hospital information systems, medical records, archives, digital optical archiving, computer-based patient records.
Abstract: Computer-based mobile information processing in hospitals is at a turning point of becoming a substantial and integral part of hospital information systems. Its necessity and potential require a comprehensive systematic approach to support the needs of health care professionals and thus to contribute to high quality patient care and medical research. From the authors' point of view, standardized digital documents could become an appropriate basis for distributed mobile information processing in hospitals. An architecture for the integrated co-operative use of conventional, stationary, and mobile information tools is a major research topic at Heidelberg University. The objective of this paper is to present a departmental prototype design to establish mobile information processing as an integral part of hospital information systems through the use of standardized digital documents.
Abstract: This paper presents formal approaches for assessing the integration of information system components. They were developed to support decisions in the strategic management of information systems. The fulfillment of integration requirements, the dependency of information system components on each other, and the heterogeneity of the integration infrastructure are the major assessment criteria.The meta-model 3LGM2A is the (semi-)formal base for methods introduced here. The fulfillment of integration requirements is checked by matching sets of application components that have specific requirements (requirements domains) with sets of application components that exchange data or call operations related to the requirements (communication domains). Requirements categories support the handling of the numerous specific requirements.For assessing the complexity of an information system or its subsystems the figures degree of informational dependence, degree of functional dependence, and degree of heterogeneity are defined.
Notes: Acceptance Rate 37% xD;"we can now confirm the status of AMIA Annual Symposium papers as fully peer-reviewed" xD; xD;Dear Birgit Brigl: xD; xD;I am pleased to inform you that the resubmission of your AMIA 2005 paper has been approved by the Scientific Program Committee. xD; xD;As you know, this year we implemented a somewhat new procedure for the papers accepted for the AMIA 2005 Annual Symposium. Authors were asked to address carefully the comments of the reviewers and the SPC, and to submit a revised version of their manuscript for publication in the Proceedings. xD; xD;We believe this additional step in the paper preparation process has improved enormously quality and scientific validity of papers, and that we can now confirm the status of AMIA Annual Symposium papers as fully peer-reviewed. xD; xD;Thank you xD; xD;Sincerely, xD; xD;Jeff Williamson on behalf of the AMIA 2005 Scientific Program Committee xD; xD;Dear Robert Baud: xD; xD;I am sending this message to all research paper submitters, first of all, to thank you for your interest in AMIA and, second, to explain a bit about how the review process was conducted. xD; xD;We had a record number of papers submitted this year (n = 479) and accepted 176 (37%) of these. We had initially planned for 156 papers to be accepted, but increased this in light of the volume of high quality submissions. As you may know, the format of the annual symposium was significantly revised in 2003 through creation of the "foundations" and "applications" tracks and through a complete overhaul of the review process. The revised review process implemented in 2003, and repeated with some small changes in 2005, entailed hand assignment by a member of the Scientific Program Committee (SPC) of four reviewers to each submitted paper. In each case, the SPC member making the reviewer assignments is a person with expertise on the topic of the paper, and someone who usually knows personally the reviewers he/she is assigning. After the reviews are returned, the SPC member synthesizes the reviewers' quantitative ratings and narrative comments into an overall recommendation to accept or not accept the paper. At a subsequent meeting, the SPC chair and the track chairs make the final decisions based on these recommendations. xD; xD;This year, 90% of the reviews were returned by the deadline, which meant that almost all papers received three or four reviews. The very small number of papers that received two reviews were looked at more carefully by the SPC before a final recommendation was made. The acceptance decisions are driven exclusively by scientific merit based on peer review, without regard to distributions of topics. The acceptance rates for foundational and applications papers were identical; overall 81 foundational and 95 applications papers were accepted. xD; xD;The competition for space on this year's program, even after we expanded it, required that papers be "better than good" to make it onto the program. Some authors of papers that were not accepted may have received comments from the reviewers that seemed paradoxically positive. Space limitations made us unable to accept some papers that, on the whole, were favorably reviewed--but not as favorably as others. We did, as noted above, expand the number of paper sessions, but this is a zero-sum game and the increased number of paper sessions comes at the expense of panels and other session types at the meeting that are of interest to many attendees. The poster session is not as space-limited and we were able to accept 80% of submitted posters this year. xD; xD;I hope that all of you will take a moment to browse through the accepted papers by accessing the online program on the AMIA website. If you are an author of a generally well-reviewed but still not accepted paper, I hope this letter has helped you understand the degree of care and attention that went into the review process as well as the numerical constraints under which we were working. xD; xD;Please feel free to contact me with any questions you might have, or any suggestions to improve our peer review system. xD; xD;Best regards, xD; xD;Chuck Friedman xD;SPC Chair, AMIA 2005 Annual Symposium
Abstract: To control the heterogeneity inherent to hospital information systems the information management needs appropriate hospital information systems modeling methods or techniques. This paper shows that, for several reasons, available modeling approaches are not able to answer relevant questions of information management. To overcome this major deficiency we offer an UML-based ontology for describing hospital information systems architectures. This ontology views at three layers: the domain layer, the logical tool layer, and the physical tool layer, and defines the relevant components. The relations between these components, especially between components of different layers make the answering of our information management questions possible.
Abstract: Health professionals at a ward need appropriate health professional work stations for being able to get all the information they need. It is the task of the man agement of a hospital information system (HIS) to provide access to the required in formation procedures in a uniform way. The paper gives a taxonomy of uniformity but makes clear, that uniform user interfaces are worthless, if there is no appropriate communication infrastructure at both the logical and the physical level of the corre sponding HIS. Experiences in the Heidelberg University Hospital show, that prag matic approaches can be successful.
Abstract: Computer-based mobile information processing in hospitals is on the turning point of becoming a substan tial and integral part of hospital information systems. Its necessity and potentials require a comprehensive sys tematic approach to support the needs of health care professionals and thus to contribute to high quality patient care and medical research. From the authors' point of view, standardized digital documents could become an appropriate basis for dis tributed mobile information processing in hospitals. An architecture for the integrated co-opera tive use of conventional, stationary, and mobile information tools is a major research topic at Heidelberg university. The objective of this paper is to present a departmental prototype design to estab lish mobile informa tion processing as an integral part of hospital information systems through the use of standardized digital docu ments
Abstract: Die Mobilität ärztlichen und pflegerischen Handelns in Krankenhäusern führt zu dem Bedarf einer ebenfalls mobi len Informationsunterstützung. Die Möglichkeit überall Informa tionen zu verarbeiten, z.B. durch die Ver fügbarkeit neuartiger 'mobiler Informationswerkzeuge', kann nach Meinung der Autoren die Grundbedürfnisse der Anwender befriedigen (z.B. durch Kommunikati onsfunktionen) und diese rechtzeitig am jeweiligen Arbeitsplatz bei patientenbe zogenen Verfahren unterstützen (z.B. durch aktuelle Laborbefunde). Bei der Einführung von mobilen Informations werkzeugen als integraler Bestandteil eines Krankenhausinformationssystems können sicherlich viele Vor arbei ten der herkömm lichen papier- und rechnerbasierten Informations verarbeitung wie derverwendet werden. Trotzdem sollte die Einführung dieser neuartigen mobilen Informations werkzeuge nach Mei nung der Autoren nicht als logische evolutio näre Weiterentwicklung angese hen werden. Es sollte die Chance ergriffen werden, durch Berück sichtung wei terer Anforderungen des mobilen Arbeitens die Qualität der Informationsverarbeitung in Krankenhäusern insgesamt zu stei gern. In diesem Übersichtsreferat werden mögliche Potentiale der Verwendung mobiler Informationswerk zeuge im Krankenhaus aufgezeigt und Anforderungen für deren Integration in ein Kranken haus informationssystem aufgestellt. Am Beispiel des Heidelberger Forschungsprojektes "Koope ratives Problemlösen" wird ein Modell für die Einführung mobiler Informationswerk zeuge vorgestellt.
Abstract: Die Mobilität ärztlichen und pflegerischen Handelns in Krankenhäusern führt zu dem Bedarf einer ebenfalls mobi len Informationsunterstützung. Die Möglichkeit überall Informa tionen zu verarbeiten, z.B. durch die Ver fügbarkeit neuartiger 'mobiler Informationswerkzeuge', kann nach Meinung der Autoren die Grundbedürfnisse der Anwender befriedigen (z.B. durch Kommunikati onsfunktionen) und diese rechtzeitig am jeweiligen Arbeitsplatz bei patientenbe zogenen Verfahren unterstützen (z.B. durch aktuelle Laborbefunde). Bei der Einführung von mobilen Informations werkzeugen als integraler Bestandteil eines Krankenhausinformationssystems können sicherlich viele Vor arbei ten der herkömm lichen papier- und rechnerbasierten Informations verarbeitung wie derverwendet werden. Trotzdem sollte die Einführung dieser neuartigen mobilen Informations werkzeuge nach Mei nung der Autoren nicht als logische evolutio näre Weiterentwicklung angese hen werden. Es sollte die Chance ergriffen werden, durch Berück sichtung wei terer Anforderungen des mobilen Arbeitens die Qualität der Informationsverarbeitung in Krankenhäusern insgesamt zu stei gern. In diesem Übersichtsreferat werden mögliche Potentiale der Verwendung mobiler Informationswerk zeuge im Krankenhaus aufgezeigt und Anforderungen für deren Integration in ein Kranken haus informationssystem aufgestellt. Am Beispiel des Heidelberger Forschungsprojektes "Koope ratives Problemlösen" wird ein Modell für die Einführung mobiler Informationswerk zeuge vorgestellt.
Abstract: Wir berichten über eine prolektive, prospektive Beobachtungsstudie über den Zugriff auf medizinisches Wissen durch Ärzte und andere Benutzer des Heidelberger Klinikuminformationssystems. Innerhalb dieses Informationssystems kann über klinische Arbeitsplatzsysteme auf einen medizinischen Wissensserver 24 Stunden am Tag, 7 Tage die Woche am Arbeitsplatz des Arztes, der Pflegekraft usw. zugegriffen werden. Das Wissen hatte zum Zeitpunkt der Studie einen Umfang von ca. 24 Gigabyte. Während der Studie beobachteten wir ca. 96 Zugriffe pro Arbeitstag. Bei den auf den Wissensserver zugreifenden Personen handelte es sich vor allem um Ärzte und Medizinstudenten. Vorwiegende Nutzungsgründe waren eine wissenschaftliche Arbeit (50%), ein eigener klinischer Fall (19%), eine allgemeine medizinische Frage (14%) oder eine aktuelle klinische Frage (13%). Zugegriffen wurde auf medizinische Wissensbanken wie MEDLINE (79%), Rote Liste (6%), aber auch auf elektronische Lehrbücher und auf wissensbasierte Systeme. 65% der Zugriffe auf medizinisches Wissen wurden als erfolgreich beurteilt. Nach unserer Ansicht kann der Zugriff auf medizinisches Wissen ein erster, vergleichsweise einfach zu realisierender Schritt zur wissensbasierten Diagnose- und Therapieunterstützung in Krankenhäusern sein. Konsequenzen für das Management von Krankenhausinformationssystemen, um die Voraussetzungen für einen solchen Wissenszugriff zu schaffen, werden aufgezeigt. xD;Schlüsselwörter: wissensbasierte Diagnose- und Therapieunterstützung, Krankenhausinformationssysteme, klinische Arbeitsplatzsysteme.
