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Biomedical subjects

Reinhold Haux

Publications and source records attributed to Reinhold Haux.

18 recordsLinked to original sources
PubMed2006

Systematic planning of patient records for cooperative care and multicenter research.

PURPOSE: The purpose of this paper is to introduce a method for systematically planning patient records for structured data entry that can be used in cooperative environments (e.g. cooperative care, multicenter trials) in a way that enables multipurpose use and shared data entry. METHODS: Design research, formal logic. RESULTS: The method suggests five steps: analyze the prevailing documentation infrastructure, provide terminology management system (TMS), provide documentation management system (DMS), plan the logical architecture, provide all necessary tools. CONCLUSIONS: The era of eHealth enables cooperative care and collaborative documentation. This can only be efficient if a multiple use and shared entry of data is realized. The task of the medical informatics community is to plan these environments systematically especially in complex environments which are enabled by emerging technologies.

Biomedical Research↗
PubMed2006

An e-consent-based shared EHR system architecture for integrated healthcare networks.

OBJECTIVES: Virtual integration of distributed patient data promises advantages over a consolidated health record, but raises questions mainly about practicability and authorization concepts. Our work aims on specification and development of a virtual shared health record architecture using a patient-centred integration and authorization model. METHODS: A literature survey summarizes considerations of current architectural approaches. Complemented by a methodical analysis in two regional settings, a formal architecture model was specified and implemented. RESULTS: Results presented in this paper are a survey of architectural approaches for shared health records and an architecture model for a virtual shared EHR, which combines a patient-centred integration policy with provider-oriented document management. An electronic consent system assures, that access to the shared record remains under control of the patient. A corresponding system prototype has been developed and is currently being introduced and evaluated in a regional setting. CONCLUSION: The proposed architecture is capable of partly replacing message-based communications. Operating highly available provider repositories for the virtual shared EHR requires advanced technology and probably means additional costs for care providers. Acceptance of the proposed architecture depends on transparently embedding document validation and digital signature into the work processes. The paradigm shift from paper-based messaging to a "pull model" needs further evaluation.

Computer Communication Networks↗
PubMed2006

Individualization, globalization and health--about sustainable information technologies and the aim of medical informatics.

This paper discusses aspects of information technologies for health care, in particular on transinstitutional health information systems (HIS) and on health-enabling technologies, with some consequences for the aim of medical informatics. It is argued that with the extended range of health information systems and the perspective of having adequate transinstitutional HIS architectures, a substantial contribution can be made to better patient-centered care, with possibilities ranging from regional, national to even global care. It is also argued that in applying health-enabling technologies, using ubiquitous, pervasive computing environments and ambient intelligence approaches, we can expect that in addition care will become more specific and tailored for the individual, and that we can achieve better personalized care. In developing health care systems towards transinstitutional HIS and health-enabling technologies, the aim of medical informatics, to contribute to the progress of the sciences and to high-quality, efficient, and affordable health care that does justice to the individual and to society, may be extended to also contributing to self-determined and self-sufficient (autonomous) life. Reference is made and examples are given from the Yearbook of Medical Informatics of the International Medical Informatics Association (IMIA) and from the work of Professor Jochen Moehr.

Decision Trees↗
PubMed2006

On feasibility and benefits of patient care summaries based on claims data.

BACKGROUND: Electronic availability of health care claims data maintained by health insurance companies today is higher than the availability of clinical patient record data. OBJECTIVE: To explore feasibility of automatically generated patient care summaries based on claims data and its benefit for health care professionals (HCP), when no shared electronic health record is available. METHODS: Based on an existing claims data model for German health insurance companies, a transformation and presentation algorithm was developed. To determine the utility of the resulting summaries, a focus group session comprising HCP and insurance representatives was arranged. Properties of an information system architecture capable of providing summaries to HCP were specified. RESULTS: A set of valuable healthcare information, in particular clinical pathways, medication, and anamnesis, can be derived from claims data that fits into the ASTM specification of a Continuity of Care Record. The focus group assessed the potential benefit of the summaries as high. Major issues are partial incompleteness and a lack of timeliness due to delayed reimbursement procedures as well as privacy-preserving and practicable access methods. The specified system architecture uses web services and a web interface to provide the summaries in HL7 CDA format. An important insight was that only a timely electronic reimbursement process will lead to precise, current, and reliable claims-based summaries. CONCLUSION: Generating patient care summaries based on claims data is feasible and produces valuable information for HCP, provided that the reimbursement process is conducted timely. Integration into a national health telematics platform will facilitate access to the summaries. Evaluation of algorithm and prototype system is underway to prove the benefit in clinical practice.

Algorithms↗
PubMed2005

Health information systems - past, present, future.

In 1984, Peter Reichertz gave a lecture on the past, present and future of hospital information systems. In the meantime, there has been a tremendous progress in medicine as well as in informatics. One important benefit of this progress is that our life expectancy is nowadays significantly higher than it would have been even some few decades ago. This progress, leading to aging societies, is of influence to the organization of health care and to the future development of its information systems. Twenty years later, referring to Peter Reichertz' lecture, but now considering health information systems (HIS), two questions are discussed: which were lines of development in health information systems from the past until today? What are consequences for health information systems in the future? The following lines of development for HIS were considered as important: (1) the shift from paper-based to computer-based processing and storage, as well as the increase of data in health care settings; (2) the shift from institution-centered departmental and, later, hospital information systems towards regional and global HIS; (3) the inclusion of patients and health consumers as HIS users, besides health care professionals and administrators; (4) the use of HIS data not only for patient care and administrative purposes, but also for health care planning as well as clinical and epidemiological research; (5) the shift from focusing mainly on technical HIS problems to those of change management as well as of strategic information management; (6) the shift from mainly alpha-numeric data in HIS to images and now also to data on the molecular level; (7) the steady increase of new technologies to be included, now starting to include ubiquitous computing environments and sensor-based technologies for health monitoring. As consequences for HIS in the future, first the need for institutional and (inter-) national HIS-strategies is seen, second the need to explore new (transinstitutional) HIS architectural styles, third the need for education in health informatics and/or biomedical informatics, including appropriate knowledge and skills on HIS. As these new HIS are urgently needed for reorganizing health care in an aging society, as last consequence the need for research around HIS is seen. Research should include the development and investigation of appropriate transinstitutional information system architectures, of adequate methods for strategic information management, of methods for modeling and evaluating HIS, the development and investigation of comprehensive electronic patient records, providing appropriate access for health care professionals as well as for patients, in the broad sense as described here, e.g. including home care and health monitoring facilities. Comparing the world in 1984 and in 2004, we have to recognize that we imperceptibly, stepwise arrived at a new world. HIS have become one of the most challenging and promising fields of research, education and practice for medical informatics, with significant benefits to medicine and health care in general.

Computer Systems↗
PubMed2005

From a paper-based transmission of discharge summaries to electronic communication in health care regions.

OBJECTIVES: In Austria, the general practitioner (GP) is the first point of contact for persons with health problems. Depending on the severity of the person's medical condition, a GP may refer her or him to a secondary care hospital consultant, who reports findings back to the GP in form of a paper-based discharge letter. Researchers report that paper-based communication of medical documents between different health care providers is insufficient in quality, error prone and too slow in many cases. Our aim was to develop and to realise a strategy for a stepwise replacement of the paper-based transmission of medical documents with a distributed, shared medical record. METHODS: In the first step of a three-steps strategy for development of a consistent, comprehensive and secure regional health care network, an electronic communication of discharge letters and diagnostic results between existing information systems of different health care providers in Tyrol, Austria, has been established: in the form of cryptographically signed S/MIME e-mail messages and, additionally, via a secure web portal system. In two further steps, an extension of the system by a bi-directional communication and by improvements of the web portal system is planned, leading to a comprehensive electronic patient record for shared care. RESULTS: After realisation of step 1, in October 2004, about 3500 electronic discharge letters were sent out from the Innsbruck University Hospital (IUH), which represents about 8% of the total number of discharge letters of the IUH. In addition, a lot of feedback was received and legal, organisational, financial and methodical difficulties were overcome. DISCUSSION: The stepwise approach to replace paper-based with electronic communication in the first step was helpful, since knowledge has been gained and cooperations were formed. For the realisation of a distributed, shared medical record (steps 2 and 3), it will not be sufficient only to replace paper-based transmission of medical documents with electronic communication technologies, but in the further steps, organisational changes will become necessary. As well, legal ambiguities must be resolved before a distributed medical record for cooperative care, used by several institutions as well as by patients, could be established.

Austria↗
PubMed2005

Towards shared patient records: an architecture for using routine data for nationwide research.

Ubiquitous information is currently one of the most challenging slogans in medical informatics research. An adequate architecture for shared electronic patient records is needed which can use data for multiple purposes and which is extensible for new research questions. We introduce eardap as architecture for using routine data for nationwide clinical research in a multihospital environment. eardap can be characterized as terminology-based. Main advantage of our approach is the extensibility by new items and new research questions. Once the definition of items for a research question is finished, a consistent, corresponding database can be created without any informatics skills. Our experiences in pediatric oncology in Germany have shown the applicability of eardap. The functions of our core system were in routine clinical use in several hospitals. We validated the terminology management system (TMS) and the module generation tool with the basic data set of pediatric oncology. The multiple usability depends mainly on the quality of item planning in the TMS. High quality harmonization will lead to a higher amount of multiply used data. When using eardap, special emphasis is to be placed on interfaces to local hospital information systems and data security issues.

Biomedical Research↗
PubMed2005

Preparing the Electronic Patient Record for Collaborative Environments and eHealth.

In the era of eHealth the electronic patient record is increasingly regarded as part of a collaborative environment. To efficiently support the documentary tasks and analyses a cooperative documentation infrastructure which allows multiple use and shared entry of data is necessary. The objective of this paper is to introduce a method for systematically planning such a cooperative documentation environment. It consists of the steps: analyse the prevailing documentation infrastructure, provide terminology, provide documentation management, plan the logical architecture and provide all necessary tools. The steps can be formally specified so that parameters can be automatically controlled and the environment can be updated more easily.

Cooperative Behavior↗
PubMed2005

Architectural quality criteria for hospital information systems.

An important part of hospital information systems (HIS) evaluation is the quality assessment of its architecture, i.e. the structure of its IT infrastructure. Therefore, quantitative architectural quality criteria are needed. On the basis of relevant architectural components of a HIS defined by 3LGM2, the following quality criteria were defined: functional redundancy, functional under-saturation, functional correspondence, informational redundancy, degree of heterogeneity and degree of computer-support. These quality criteria were implemented as part of the 3LGM2 tool, a modelling tool to create 3LGM2 conformant HIS models. For every 3LGM2 model and its components the relevant quality criteria are automatically calculated and presented. The defined quality criteria can be used for several information management purposes. Nevertheless they are not intended to make absolute statements about the HIS quality. To ensure their expressiveness, complete and consistent underlying 3LGM2 models are needed.

Computer Systems↗
PubMed2004

Approaches towards a regional, shared electronic patient record for health care facilities of different health care organizations--IT-strategy and first results.

Today, information processing in healthcare facilities is usually primarily directed towards the information needs of the respective institution. This stands in apparent contradiction to the fact that patients may not be solely treated in one general practice or hospital. More information processing towards patient-centered, shared care would better support high quality as well as efficient health care. We developed a stepwise approach transforming trans-institutional information system architectures (TISAs) from an inefficient state caused by redundancy and media cracks towards a state which better supports patient centered, shared care. In a total of three steps we want to establish electronic communication between existing information systems of different healthcare facilities for transmission of discharge summaries and diagnostic results. In further stages we plan to expand this communication solution to a regional comprehensive and consistent electronic patient record for multiple hospitals and general practices in Tyrol, Austria. In addition, two related approaches towards supporting shared care have been compared with our approach. The aim of this paper is to report on our approach and first experiences.

Ambulatory Care Information Systems↗
PubMed2004

Curricula in medical informatics.

Education in medical informatics is needed not only for those who want to become specialist in this area but also for health professionals. Since students, depending on the program they are enlisted in, require different types of knowledge and skills in medical informatics, curricula should be adapted to those needs. The curriculum structure also depends on the expert level the students want to attain. This contribution presents the knowledge and skills levels for different groups of students and presents two examples of curricula.

Curriculum↗
PubMed2003

Developing and evaluating criteria to help reviewers of biomedical informatics manuscripts.

Peer-reviewed publication of scientific research results represents the most important means of their communication. The authors have annually reviewed a large heterogeneous set of papers to produce the International Medical Informatics Association (IMIA) Yearbook of Medical Informatics. To support an objective and high-quality review process, the authors attempted to provide reviewers with a set of refined quality criteria, comprised of 80 general criteria and an additional 60 criteria for specific types of manuscripts. Authors conducted a randomized controlled trial, with 18 reviewers, to evaluate application of the refined criteria on review outcomes. Whereas the trial found that reviewers applying the criteria graded papers more strictly (lower overall scores), and that junior reviewers appreciated the availability of the criteria, there was no overall change in the interrater variability in reviewing the manuscripts. The authors describe their experience as a "case report" and provide a reference to the refined quality review criteria without claiming that the criteria represent a validated instrument for quantitative quality measurement.

Humans↗
PubMed2003

IMIA Working Conference on Health Information Systems 2002 in Heidelberg--practical HIS experiences.

OBJECTIVES: To give an overview of the scope of commercial Health Information Systems installed in academic centers. METHODS: Six systems presented during the working conference on Health Information Systems of IMIA, the International Medical Informatics Association, are described in a special issue of Methods of Information in Medicine. These contributions shortly summarize the systems' installed base, their functionality, their architecture, as well as site-specific deployment experiences. Specific highlights have been elaborated. CONCLUSION: The role of industrial solutions for Health Information Systems is of increasing importance. Companies have invested in clinical functionality, and significant progress in supporting clinical workflow has been made. Interfaces to connect subsystems are commonly used. Real interoperability, however, is still a challenge. Socio-technical issues are of central importance, and systems still need improved flexibility and adaptability to work practice in health care.

Academic Medical Centers↗
PubMed2002

Health care in the information society. A prognosis for the year 2013.

Our society is increasingly influenced by modern information and communication technology (ICT). Health care has profited greatly by this development. How could health care provision look in the near future, in 10 years, or more precisely, in the year 2013? What measures must be undertaken by political and self-governing health institutions, and by medical informatics research, to ensure an efficient, medically advanced and yet affordable future health care system? Three factors will greatly influence the further development of information processing in health care within the near future: the development of the population, medical advances, and advances in informatics. These factors have motivated us to set up 30 theses for health care provision in the year 2013. The theses cover areas of health care, such as its people, its information systems, and its ICT tools. Three major goals requiring achievement have been identified: patient-centered recording and use of medical data for cooperative care, process-integrated decision support through current medical knowledge, comprehensive use of patient data for research and health care reporting. In consequence, political institutions should provide a framework for networked, patient-centered health care. They are called on to regulate the storage and exchange of health care data and of appropriate information system architectures. Finally, the health care institutions themselves must emphasize professional information management more strongly. Relevant research topics in medical informatics are: comprehensive electronic patient records, modern health information system architectures, architectures for medical knowledge centers, specific data processing methods ('medical data mining'), and multi-functional, mobile ICT tools.

Adolescent↗
PubMed2002

Efficiency and safety of chemotherapy plans for children: CATIPO--a nationwide approach.

Chemotherapy is an important component of childhood cancer treatment. Due to the intensity of this therapy, an error in calculating the dosage of the cytostatic drugs would have severe consequences. Therefore, a computer-aided therapy planning system in pediatric oncology (CATIPO) was introduced into routine use in approximately 20 clinics across Germany. The system consists of a knowledge acquisition module for acquiring knowledge about chemotherapy protocols and a decision support module for producing a patient-specific therapy plan. The main benefits of the system are the reduction of errors and saving time during the development of a particular therapy plan. CATIPO's success is based on the enormous demand for this kind of decision support and its development in tight cooperation with future users.

Adolescent↗
PubMed2002

Master of science program in health information management at Heidelberg/Heilbronn: a health care oriented approach to medical informatics.

In the year 2000 the University of Heidelberg and the University of Applied Sciences Heilbronn established a second educational program in medical informatics, leading to a Master of Science (MSc) degree. In addition to their 4.5 year medical informatics program as an informatics-based approach to medical informatics, a postgraduate program in 'health information management' (Informationsmanagement in der Medizin) was set up as a complementary health care oriented approach to this field. The aim of the MSc program is to qualify physicians and other health care professionals to work as medical informaticians, particularly in the area of health information management. We admit 15 new students into the program each year. The intended program length is 15 months, comprising two study semesters (14 weeks per semester) and three months for the Master's thesis. The graduates are awarded the title 'Master of Science' by the Medical Faculty of the University of Heidelberg. The program is part of the International Partnership in Health Informatics Education of the Universities of Amsterdam, Heidelberg/Heilbronn, Minnesota and Utah. We report on this new program and on our experience with our very first students. The curriculum is compared with the related MSc programs.

Curriculum↗