On Teaching International Courses on Health Information Systems. Lessons Learned during 16 Years of Frank - van Swieten Lectures on Strategic Information Management in Health Information Systems.

BACKGROUND: Health information systems (HIS) are one of the most important areas for biomedical and health informatics. In order to professionally deal with HIS well-educated informaticians are needed. Because of these reasons, in 2001 an international course has been established: The Frank - van Swieten Lectures on Strategic Information Management of Health Information Systems. OBJECTIVES: Reporting about the Frank - van Swieten Lectures and about our students' feedback on this course during the last 16 years. Summarizing our lessons learned and making recommendations for such international courses on HIS. METHODS: The basic concept of the Frank - van Swieten lectures is to teach the theoretical background in local lectures, to organize practical exercises on modelling sub-information systems of the respective local HIS and finally to conduct Joint Three Days as an international meeting were the resulting models are introduced and compared. RESULTS: During the last 16 years, the Universities of Amsterdam, Braunschweig, Heidelberg/Heilbronn, Leipzig as well as UMIT were involved in running this course. Overall, 517 students from these universities participated. Our students' feedback was clearly positive. The Joint Three Days of the Frank - van Swieten Lectures, where at the end of the course all students can meet, turned out to be an important component of this course. Based on the last 16 years, we recommend common teaching materials, agreement on equivalent clinical areas for the exercises, support of group building of international student groups, motivation of using a collaboration platform, ensuring quality management of the course, addressing different levels of knowledge of the students, and ensuring sufficient funding for joint activities. CONCLUSIONS: Although associated with considerable additional efforts, we can clearly recommend establishing such international courses on HIS, such as the Frank - van Swieten Lectures.

Archetype based search in an IHE XDS environment.

To prevent information overload of physicians when accessing EHRs we introduce a method to extend the IHE XDS profile metadata-based search towards a content-based search. Detailed queries are created based on predefined information needs mapped to ISO/EN 13606 Archetypes. They are aggregated to a metadata-based query to retrieve all relevant documents, which are then analyzed for the desired contents. The results are presented in a tabular form. The content-based search in IHE-XDS could be implemented efficiently and was found helpful by the evaluating physicians.

Clinical situations and information needs of physicians during treatment of diabetes mellitus patients: a triangulation study.

Physicians should have access to the information they need to provide the most effective health care. Medical knowledge and patient-oriented information is dynamic and expanding rapidly so there is a rising risk of information overload. We investigated the information needs of physicians during treatment of Diabetes mellitus patients, using a combination of interviews, observations, literature research and analysis of recorded medical information in hospitals as part of a methodical triangulation. 446 information items were identified, structured in a set of 9 main categories each, as well as 6 time windows, 10 clinical situations and 68 brief queries. The physician's information needs as identified in this study will now be used to develop sophisticated query tools to efficiently support finding of information in an electronic health record.

The Archetype-enabled EHR system ZK-ARCHE - integrating the ISO/EN 13606 standard and IHE XDS profile.

The EHR system ZK-ARCHE automatically generates forms from ISO/EN 13606 archetypes. For this purpose the archetypes are augmented with components of the reference model to achieve so-called "comprehensive archetypes". Data collected via the forms are stored in a list which associates each value with the path of the corresponding comprehensive archetype node coded as W3C XPath. From this list archetype-conformant EHR extracts can be created. The system is embedded with the IHE XDS profile to allow direct data exchange in an environment of distributed data storage.

Creating ISO/EN 13606 archetypes based on clinical information needs.

Archetypes model individual EHR contents and build the basis of the dual-model approach used in the ISO/EN 13606 EHR architecture. We present an approach to create archetypes using an iterative development process. It includes automated generation of electronic case report forms from archetypes. We evaluated our approach by developing 128 archetypes which represent 446 clinical information items from the diabetes domain.

Specification of a reference model for the domain layer of a hospital information system.

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.

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.