Making health informatics competencies useful: an applied health informatics competency self-assessment system.

Years ago we undertook to define Health Informatics (HI) competencies. This effort resulted in the creation of a document that articulated HI roles, the challenges faced by HI professionals, the high-level tasks that they needed to undertake to address these challenges and the competencies (skills, knowledge, and experience) they needed to complete these tasks. Unfortunately, in so doing we created what is arguably the most boring book in history, shoes contents are very difficult to extract, use, maintain and improve. We report here the completion of a pilot of a system that we believe corrects this situation. It is a webbased tool that incorporates all of the material, from roles to detailed competencies, enabling them to be accessed and used for a variety of purposes, the most notable of which is professional self-assessment.

WebSAT: a web-based competency self-assessment system linking to educational resources.

We describe a web-based system that enables an individual to assess him/her self against the set of competencies required for a variety of roles in the area of Applied Health Informatics (AHI). The competencies themselves were developed by a multi-disciplinary team under the auspices of the Canadian Institute for Health Research (CIHR), and include the knowledge, skills, and experience necessary to fulfill specific roles as an applied health informatician. Both textual and graphical information is presented to the user and potential mechanisms for correcting competency gaps are presented in this online interactive system.

Authoring and generation of individualized patient education materials.

Although the pre-surgical patient-surgeon encounter is the opportunity to educate the patient, it is essential that the patient be given educational materials to complement the face-to-face exchange. This is virtu-ally impossible to do well with brochures, because many combinations of procedures are possible, dif-ferent patients have different concerns, and patients have varying levels of literacy and knowledge. In the extreme, a patient would either be given a set of bro-chures selected from 100s of variants, or all patients would be given the same set of brochures without regard for differing needs. We have been developing an information brochure generator that customizes material for every individual patient regardless of the complexity of the surgical intervention.

The development of model curricula for Health Informatics.

We have developed model Health Informatics (HI) curricula for the education of three categories of professionals: Applied Health Informaticians, the professionals that deploy information technologies, Research and Development Health Informaticians those that develop new concepts, techniques, and solutions, and what we have called Clinician Health Informaticians, providers who use HI capabilities to support their professional work. The curricula specify the competencies that each type of professional must acquire.

A framework for best practices in the deployment of departmental information systems.

In previous work, we conceptualized a departmental information system as embodying a flexible, but limited, model for the operation of a department, such as a laboratory or diagnostic imaging service. We further recognized these systems as tools that enable data-driven departmental management and function as feeder systems to enterprise management decision-support systems, and also embody a departmental and components of an enterprise management model. Finally, for systems that interact with professionals related to decision support, we note that such systems embody partial cognitive models that must be congruent with the professionals cognitive processes (or professionals cognitive behaviors must alternatively be congruent with the systems cognitive model), if these systems are to be supportive of the professionals thinking and decision making. In this paper, we review this thinking and use it to derive proposed "best practices" in IS management, and system planning, procurement, implementation, and use.

The development of a model curriculum for applied health informatics.

Applied Health Informaticians (AHIs) are professionals that deploy information technologies in support of health system processes. AHIs require both a well-developed knowledge base that encompasses the health system, computer science, and health information systems-related topics (what is known as the "Body of Knowledge"), as well as a set of intellectual and procedural skills (what we call the "Body of Skills") and preparatory experiences. The availability of skilled and knowledgeable AHIs has become a critical issue in today's health system.

The need for a skills-focussed applied healthcare informatics curriculum.

Experience with Information Systems (IS) staff, interactions with healthcare senior management, and discussions with faculty and students have led us to the conclusions that few healthcare organizations have conceptualized and articulated an optimal organizational role for IS (particularly for IS leadership). In this paper we will describe the multi-polar, often conflicting "expectations" faced by many of today's healthcare IS departments, and define a set of useful and sustainable institutional model roles for IS. Then, we will formulate the set of challenges which IS professionals in these roles must be prepared to address. We will use this to propose a challenge-oriented, skills-based, methodology-focussed curriculum in Applied Healthcare Informatics, and delivery mechanisms that suit potential candidates.

A new architecture for enterprise information systems.

Irresistible economic and technical forces are forcing healthcare institutions to develop regionalized services such as consolidated or virtual laboratories. Technical realities, such as the lack of an enabling enterprise-level information technology (IT) integration infrastructure, the existence of legacy systems, and non-existent or embryonic enterprise-level IT services organizations, are delaying or frustrating the achievement of the desired configuration of shared services. On attempting to address this matter, we discover that the state-of-the-art in integration technology is not wholly adequate, and itself becomes a barrier to the full realization of shared healthcare services. In this paper we report new work from the field of Co-operative Information Systems that proposes a new architecture of systems that are intrinsically cooperation-enabled, and we extend this architecture to both the regional and national scales.

The challenges and opportunities of laboratory regionalization.

These are some of the major historical trends and rationale for the sea change in laboratory medicine today. The creation of cooperative regional networks and consolidated regional laboratories potentially can: 1) Pool the technologic strengths of individual laboratories across a region; 2) Create economies of scale by combining capacities for certain procedures; 3) Lower unit costs by increasing volumes of business from nonpatients; 4) Span all of the traditional testing venues along the new expanding continuum of care. The authors in this monograph will take the saga forward in time, outlining critical organizational, technologic, and strategic aspects of the newly evolving laboratory of the 21st century.

IT capabilities for the realization of the laboratory without walls.

This article presents the factors that are driving the restructuring of laboratory services and the information technology capabilities that are necessary to support the regionalized laboratory services organization. The overall need is for a trans-entity laboratory information system with point of care ordering and results reporting and enterprise-wide specimen transportation and tracking, that is interfaced with other information resources required for clinical decision-making, and patient care, operational, and financial management.

A primer for beginning sports injury study researchers.

In this paper, I offer a set of important dimensions against which research projects can be analyzed. If one can image that each dimension has a range of from 0 to 100 percent, the objective in doing good research is to make our work in each dimension a 100 percent proposition. To ensure this, it would seem wise for the researcher to have checklists like those that pilots use before take off and landing. Before "take off," the researcher would make sure that the hypothesis is valid and well-stated; that the research project is well designed; that all approvals are obtained; and that the operational aspects have been planned and all preparations are in place. During the research project, the researcher will take care that the proper processes have been established and are executed and monitored; and that staff with the proper training and attitudes are doing their jobs. At the end of the study, when it comes to "land" the project, the researcher will make sure that the results are analyzed properly and that they are presented in a meaningful way. If all these steps are taken then arrival at the "destination"--a successful study--will be far more likely. There are resources available to assist the researcher in each dimension. Database systems assist in collecting data; statistical packages assist in analysing data; clinical trial modeling programs assist in designing a clinical trial. Any of the tools requires a skilled craftsperson to use them properly, but the skills can be learned. However, nothing yet exists to assist the researcher in having good ideas and formulating clear hypotheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Randomised controlled trial of computer assisted management of hypertension in primary care.

The hypothesis that general practitioners would obtain better outcomes for patients with hypertension using a computer than doctors not using a computer was tested. Sixty family physicians were randomised to two treatment strategies. "Test" physicians completed a data collection form after each visit from a patient with hypertension and mailed the forms to the test centre for processing. Computer feedback on management was mailed to the doctors. This encouraged doctors to apply the "stepped care" protocol, supplied charts of diastolic blood pressure v time, and ranked patients' diastolic blood pressures by percentile. Letters were mailed to patients to remind them of appointments. "Control" doctors filled out the same data collection forms as test physicians, but neither doctors nor patients received computer feedback. Physicians who used the computer saw more patients per practice than control doctors (test 50 patients, control 40). For all patients the length of follow up was significantly longer in test practices (test 199 days, control 167), and a smaller percentage dropped out of active treatment in test practices (test 37.5%, control 42.1%). For patients with "moderate" hypertension of a baseline diastolic pressure of greater than 104 mm Hg the mean score of the last recorded pressure was below the goal of 90 mm Hg in test practices (88.5 mm Hg), but it failed to reach this goal in control practices (93.3 mm Hg). A greater average reduction of diastolic pressure was achieved in test practices (test 21.7 mm Hg, control 16.7 mm Hg). Though patients with "moderate" hypertension were better controlled in test practices than in control practices, the patients in test practices visited their doctors less often (test 13.3 visits per patient-year, control 17.4 visits). Among patients with newly detected hypertension test practices achieved a greater reduction in diastolic pressure than control practices (test 15.1 mm Hg v control 11.3 mm Hg) and more sustained control of hypertension (test 323 days per patient-year with a diastolic pressure of 90 mm Hg or less v control 259 days).

Alternatives in the handling, processing and storage of electrocardiograms.

Physicians and administrators are becoming aware that computer technology can play a significant role in the electrocardiology department. Problems related to the large number of requests for electrocardiograms, the production and communication of electrocardiographic tracings and reports, the access to stored tracings and the overall cost of providing effective services have led administrators to look for assistance through automation. Before expensive equipment and new procedures are introduced, a survey of the electrocardiology department's functions and procedures can lead to important insights. Automation can be achieved in stages, and problems can be solved by separate steps. Options range from basic word-processing support to completely automated electrocardiographic interpretation and computerized storage of records. Choosing the appropriate equipment and programs requires knowledge of the present system, awareness of the options and analysis of the costs and savings.

Computer-assisted reporting system for the follow-up patients with cardiac pacemakers.

The implantation of large numbers of permanent cardiac pacemakers carries with it the responsibility for continual reassessment of all aspects of patient management. Experience with more than 4,000 pacemaker implants and replacements since 1963 has led to the development of a comprehensive computer-assisted data collection, management, and reporting system for the follow-up of patients with cardiac pacemakers. Over a seven-year period, data forms have been developed for the detailed documentation of pre-operative, intraoperative and follow-up information. These were designed in the form of checklists suitable for direct computer entry using mark-sense document readers. Special emphasis has been placed on pre-operative indications, selection of appropriate pacing systems, reliable follow-up methodology, and monitoring the performance of various pulse-generators. This system makes possible the rapid computer production of hospital records and reports to involved physicians and can be used to schedule follow-up assessments as required. The information also can be used for hospital statistics, billing, research, and pacemaker registration at the provincial, state of federal level. Experience has shown that a computer-assisted methodology is the only practical means of providing adequate follow-up for a large group of patients. In addition, direct access to relevant information helps to create an environment in which essential research can be carried out in the face of demanding clinical practice.