virtX - evaluation of a computer-based training system for mobile C-arm systems in trauma and orthopedic surgery.

OBJECTIVES: Operating room personnel (ORP) operating mobile image intensifier systems (C-arms) need training to produce high quality radiographs with a minimum of time and X-ray exposure. Our study aims at evaluating acceptance, usability and learning effect of the CBT system virtX that simulates C-arm based X-ray imaging in the context of surgical case scenarios. METHODS: Prospective, interventional study conducted during an ORP course with three groups: intervention group 1 (training on a PC using virtX), and 2 (virtX with a C-arm as input device), and a control group (training without virtX) - IV1, IV2 and CG. All participants finished training with the same exercise. Time needed to produce an image of sufficient quality was recorded and analyzed using One-Way-ANOVA and Dunnett post hoc test (alpha = .05). Acceptance and usability of virtX have been evaluated using a questionnaire. RESULTS: CG members (n = 21) needed more time for the exercise than those of IV2 (n = 20): 133 +/- 55 vs. 101 +/- 37 sec. (p = .03). IV1 (n = 12) also performed better than CG (128 +/- 48 sec.), but this was not statistically significant. Seventy-nine participants returned a questionnaire (81% female, age 34 +/- 9 years, professional experience 8.3 +/- 7.6 years; 77% regularly used a C-arm). 83% considered virtX a useful addition to conventional C-arm training. 91% assessed virtual radiography as helpful for understanding C-arm operation. CONCLUSIONS: Trainees experienced virtX as substantial enhancement of C-arm training. Training with virtX can reduce the time needed to perform an imaging task.

Simplifying the exploration of volumetric images: development of a 3D user interface for the radiologist's workplace.

Volumetric imaging (computed tomography and magnetic resonance imaging) provides increased diagnostic detail but is associated with the problem of navigation through large amounts of data. In an attempt to overcome this problem, a novel 3D navigation tool has been designed and developed that is based on an alternative input device. A 3D mouse allows for simultaneous definition of position and orientation of orthogonal or oblique multiplanar reformatted images or slabs, which are presented within a virtual 3D scene together with the volume-rendered data set and additionally as 2D images. Slabs are visualized with maximum intensity projection, average intensity projection, or standard volume rendering technique. A prototype has been implemented based on PC technology that has been tested by several radiologists. It has shown to be easily understandable and usable after a very short learning phase. Our solution may help to fully exploit the diagnostic potential of volumetric imaging by allowing for a more efficient reading process compared to currently deployed solutions based on conventional mouse and keyboard.

Towards new scopes: sensor-enhanced regional health information systems - part 1: architectural challenges.

OBJECTIVES: To analyze utilization of sensor technology in telemonitoring and home care and to discuss concepts and challenges of sensor-enhanced regional health information systems (rHIS). METHODS: The study is based upon experience in sensor-based telemedicine and rHIS projects, and on an analysis of HIS-related journal publications from 2003 to 2005 conducted in the context of publishing the IMIA Yearbook of Medical Informatics. RESULTS: Health-related parameters that are subject to sensor-based measurement in home care and telemonitoring are identified. Publications related to telemonitoring, home care and smart houses are analyzed concerning scope and utilization of sensor technology. Current approaches for integrating sensor technology in rHIS based on a corresponding eHealth infrastructure are identified. Based on a coarse architecture of home care and telemonitoring systems ten challenges for sensor-enhanced rHIS are identified and discussed: integration of home and health telematic platforms towards a sensor-enhanced telematic platform, transmission rate guarantees, ad hoc connectivity, cascading data analysis, remote configuration, message and alert logistic, sophisticated user interfaces, unobtrusiveness, data safety and security, and electronic health record integration. CONCLUSIONS: Utilization of sensor technology in health care is an active field of research. Currently few research projects and standardization initiatives focus on general architectural considerations towards suitable telematic platforms for establishing sensor-enhanced rHIS. Further research finalized by corresponding standardization is needed. Part 2 of this paper will present experiences with a research prototype for a sensor-enhanced rHIS telematic platform.

Health information systems--technology and acceptance. Findings from the section on health information systems.

OBJECTIVES: To summarize current outstanding research in the field of health information systems (HIS). METHOD: Synopsis of the articles selected for the IMIA Yearbook 2007. RESULTS: Five articles from three international peer reviewed journals were selected for the HIS section of the IMIA Yearbook 2007. They represent outstanding research on new user interfaces for mobile data entry, smart card based approaches for national eHealth projects, generic system architectures for telemedicine services, new approaches for electronic prescriptions based on ubiquitous computing, and telemedical systems for chronic care in COPD. CONCLUSIONS: In the field of health information systems, evaluation and general architectural aspects of telemedical platforms respectively eHealth infrastructures currently is an important research topic as well as establishing acceptance of new technologies from the users and the organizations point of view.

Expanding the scope of health information systems. Challenges and developments.

OBJECTIVES: To identify current challenges and developments in health information systems. METHODS: Reports on HIS, eHealth and process support were analyzed, core problems and challenges were identified. RESULTS AND CONCLUSION: Health information systems are extending their scope towards regional networks and health IT infrastructures. Integration, interoperability and interaction design are still today's core problems. Additional problems arise through the integration of genetic information into the health care process. There are noticeable trends towards solutions for these problems.

Health information systems: between shared care and body area networks. Findings from the Section on health Information Systems.

OBJECTIVES: To summarize current excellent research in the field of health information systems (HIS). METHODS: Synopsis of the articles selected for the IMIA Yearbook 2006. RESULTS: Current research in the field of HIS is focused on supporting transinstitutional health care processes including health record systems, integration of new data types and knowledge based decision support, patient empowerment, the utilization of new technologies like wearable systems or ubiquitous computing in home and personal care, and methods and tools for the analysis, development, management, and evaluation of HIS. CONCLUSIONS: The best paper selection of articles on HIS comprises examples of excellent research on integration of HIS based on standards for electronic health records, methods and tools for HIS oriented change management, the use of wearable systems for telemedical surveillance of chronically ill patients, technology driven home care concepts for the elderly and physically disabled, and data privacy issues arising from the emergence of new clinical data types in the context of biomedicine. Besides successful research concerning important aspects of HIS, achieving interoperability and integration of health information subsystems and technology remains an important field of work.

Pre-operative dynamic interactive exploration of complex articular fractures using a novel 3D navigation tool.

OBJECTIVES: Trauma surgeons possess specific anticipative pathoanatomical and procedural domain knowledge that can be used for information extraction from original CT image data. This knowledge so far remains unused in clinical workflow and surgeons do not take an active part in the process of image generation and processing. The objectives of our work are to propose and employ a strategy to directly involve surgeons in a dynamic image exploration process and to exemplarily assess the clinical use of this approach for pre-operative diagnosis of complex articular fractures. METHODS: We used an interactive 3D navigation tool with a novel human-computer interface for the exploration of articular fractures of two selected anatomical structures. The system offers dynamic interaction with a virtual 3D reconstruction model and the possibility to create on-the-fly oblique multiplanar reformations by tracking hand movements. Three expert surgeons performed exemplary explorations and rated the use of the method for preoperative diagnosis in informal interviews. RESULTS: The approach and the system were well received by the three surgeons. The dynamic interaction was rated to be helpful in understanding fracture morphology. Two examples--a radius and a calcaneal fracture--are presented. CONCLUSIONS: Surgeons with their specific domain knowledge should be involved in the process of image processing. The benefit of using oblique multiplanar reformations for pre-operative planning in articular fractures appears to be substantial and they should therefore be included in radiological and surgical textbooks. Further evaluation is necessary to assess the use of interactive exploration systems in routine diagnosis.

Analysis and Specification of Telemedical Systems Using Modelling and Simulation: the MOSAIK-M Approach.

BACKGROUND AND MOTIVATION: INCA (Intelligent Control Assistant for Diabetes) is a project funded by the EU with the objective to improve diabetes therapy by creating a personal control loop interacting with telemedical remote control. Development of telemedical systems generally is a complex task especially in international projects where engineering and user groups with different social and cultural background have to be included into the system development process. OBJECTIVES: To explore if and how sophisticated information system modelling and simulation techniques can improve the development of telemedical systems. METHODS: For system analysis and design the MOSAIK-M approach was chosen. MOSAIK-M means "Modelling, simulation, and animation of information and communication systems in medicine". It includes a generic process scheme, a meta model and a tool environment. The generic process scheme guides modelling projects to produce models of high quality in terms of correctness, completeness and validity. The meta model defines the modelling language.In INCA MOSAIK-M is used for analysis of the problem domain, specification of the telemedical system and cost/benefit-analysis. RESULTS: The MOSAIK-M approach was used to create two models: an "As Is"-model of the problem domain and a "To Be"-model of the INCA system. The "As Is"-model of conventional insulin pump based diabetes care comprises submodels of diabetes management, ambulatory and clinical care. The "To Be"-model describes a patient's diabetes management using a smart phone that controls an insulin pump based on continuously measured interstitial glucose. It also describes telemedical care of a patient by diabetologists and a call centre. Both models can be simulated enhanced by visualisation capabilities to explore specific cases or scenarios. This feature proved valuable for the evaluation of both models through domain experts. The "To Be" model is used to guide the implementation of the system. Both models are being augmented by cost structures to support cost/benefit-analysis. CONCLUSIONS: Even a complex telemedical system like the INCA system can be successfully specified using sophisticated modelling and simulation based approaches like MOSAIK-M. The resulting specification is a result of its own and ensures a lasting effect of the definitions and specifications produced during the project. International cooperation and evaluation of the system design prior to its implementation profit from simulation and visualisation capabilities of MOSAIK-M.

The challenge of ubiquitous computing in health care: technology, concepts and solutions. Findings from the IMIA Yearbook of Medical Informatics 2005.

OBJECTIVES: To review recent research efforts in the field of ubiquitous computing in health care. To identify current research trends and further challenges for medical informatics. METHODS: Analysis of the contents of the Yearbook on Medical Informatics 2005 of the International Medical Informatics Association (IMIA). RESULTS: The Yearbook of Medical Informatics 2005 includes 34 original papers selected from 22 peer-reviewed scientific journals related to several distinct research areas: health and clinical management, patient records, health information systems, medical signal processing and biomedical imaging, decision support, knowledge representation and management, education and consumer informatics as well as bioinformatics. A special section on ubiquitous health care systems is devoted to recent developments in the application of ubiquitous computing in health care. Besides additional synoptical reviews of each of the sections the Yearbook includes invited reviews concerning E-Health strategies, primary care informatics and wearable healthcare. CONCLUSIONS: Several publications demonstrate the potential of ubiquitous computing to enhance effectiveness of health services delivery and organization. But ubiquitous computing is also a societal challenge, caused by the surrounding but unobtrusive character of this technology. Contributions from nearly all of the established sub-disciplines of medical informatics are demanded to turn the visions of this promising new research field into reality.

Strategic information management plans: the basis for systematic information management in hospitals.

Information management in hospitals is a complex task. In order to reduce complexity, we distinguish strategic, tactical, and operational information management. This is essential, because each of these information management levels views hospital information systems from different perspectives, and therefore uses other methods and tools. Since all these management activities deal only in part with computers, but mainly with human beings and their social behavior, we define a hospital information system as a sociotechnical subsystem of a hospital. Without proper strategic planning it would be a matter of chance, if a hospital information system would fulfil the information strategies goals. In order to support strategic planning and to reduce efforts for creating strategic plans, we propose a practicable structure.

Specification of a computer-based information system for ophthalmology using modeling and simulation techniques.

A model of an information system for ophthalmologic practices has been constructed using an object-oriented development environment. This model allows us to dynamically visualize the proceedings in a medical environment by graphical means. The model includes an object-oriented basis data model for ophthalmologic applications and tools for the medical staff e.g., a patient record browser. Special (sub)systems can be integrated into the basis model. Some aspects of the development process will be discussed.