State of the art in clinical informatics: evidence and examples.

OBJECTIVE: The field of clinical informatics has expanded substantially in the six decades since its inception. Early research focused on simple demonstrations that health information technology (HIT) such as electronic health records (EHRs), computerized provider order entry (CPOE), and clinical decision support (CDS) systems were feasible and potentially beneficial in clinical practice. METHODS: In this review, we present recent evidence on clinical informatics in the United States covering three themes: 1) clinical informatics systems and interventions for providers, including EHRs, CPOE, CDS, and health information exchange; 2) consumer health informatics systems, including personal health records and web-based and mobile HIT; and 3) methods and governance for clinical informatics, including EHR usability; data mining, text mining, natural language processing, privacy, and security. RESULTS: Substantial progress has been made in demonstrating that various clinical informatics methodologies and applications improve the structure, process, and outcomes of various facets of the healthcare system. CONCLUSION: Over the coming years, much more will be expected from the field. As we move past the "early adopters" in Rogers' diffusion of innovations' curve through the "early majority" and into the "late majority," there will be a crucial need for new research methodologies and clinical applications that have been rigorously demonstrated to work (i.e., to improve health outcomes) in multiple settings with different types of patients and clinicians.

Experience in the use of social media in medical and health education. Contribution of the IMIA Social Media Working Group.

OBJECTIVES: Social media are online tools that allow collaboration and community building. Succinctly, they can be described as applications where "users add value". This paper aims to show how five educators have used social media tools in medical and health education to attempt to add value to the education they provide. METHODS: We conducted a review of the literature about the use of social media tools in medical and health education. Each of the authors reported on their use of social media in their educational projects and collaborated on a discussion of the advantages and disadvantages of this approach to delivering educational projects. RESULTS: We found little empirical evidence to support the use of social media tools in medical and health education. Social media are, however, a rapidly evolving range of tools, websites and online experiences and it is likely that the topic is too broad to draw definitive conclusions from any particular study. As practitioners in the use of social media, we have recognised how difficult it is to create evidence of effectiveness and have therefore presented only our anecdotal opinions based on our personal experiences of using social media in our educational projects. CONCLUSION: The authors feel confident in recommending that other educators use social media in their educational projects. Social media appear to have unique advantages over non-social educational tools. The learning experience appears to be enhanced by the ability of students to virtually build connections, make friends and find mentors. Creating a scientific analysis of why these connections enhance learning is difficult, but anecdotal and preliminary survey evidence appears to be positive and our experience reflects the hypothesis that learning is, at heart, a social activity.

The role of social media for patients and consumer health. Contribution of the IMIA Consumer Health Informatics Working Group.

OBJECTIVES: : To provide an overview on social media for consumers and patients in areas of health behaviours and outcomes. METHODS: A directed review of recent literature. RESULTS: : We discuss the limitations and challenges of social media, ranging from social network sites (SNSs), computer games, mobile applications, to online videos. An overview of current users of social media (Generation Y), and potential users (such as low socioeconomic status and the chronically ill populations) is also presented. Future directions in social media research are also discussed. CONCLUSIONS: : We encourage the health informatics community to consider the socioeconomic class, age, culture, and literacy level of their populations, and select an appropriate medium and platform when designing social networked interventions for health. Little is known about the impact of second-hand experiences faciliated by social media, nor the quality and safety of social networks on health. Methodologies and theories from human computer interaction, human factors engineering and psychology may help guide the challenges in designing and evaluating social networked interventions for health. Further, by analysing how people search and navigate social media for health purposes, infodemiology and infoveillance are promising areas of research that should provide valuable insights on present and emergening health behaviours on a population scale.

Evaluating the impact of hybrid electronic-paper environments upon novice nurse information seeking.

OBJECTIVE: The purpose of this study was to investigate the effects of hybrid environments (i.e. where part of the patient record is paper-based and part of it is electronic) upon aspects of novice nurse information seeking (i.e. amount of information accessed, choice of key information sources, type of information and use of information seeking tactics). METHODS: A within group, laboratory, experimental study was conducted using two simulated environments (i.e. a paper environment and a hybrid environment). Thirty-five novice nurses participated in the study. RESULTS: Findings revealed significant differences between the paper and hybrid environments in terms of their effects upon aspects of novice nurse information seeking. Subjects accessed: 1) less information in the hybrid environment than the paper environment, 2) more non-electronic sources of information were accessed by novice nurses in the hybrid environment, and 3) novice nurses used more passive information seeking tactics in the hybrid environment than the paper environment. Qualitative findings from the cued recall data revealed subjects experienced increased cognitive load in the hybrid environment. CONCLUSIONS: Hybrid environments may affect aspects of novice nurse information seeking. Future research should explore the effects of hybrid environments upon the information seeking of other types of health professionals (e.g. physicians, physiotherapists) with differing levels of expertise (i.e. novice, intermediate and expert).

MedCIRCLE: collaboration for Internet rating, certification, labelling and evaluation of health information on the World-Wide-Web.

We describe MedCIRCLE, an EU-funded semantic web project to implement the first steps towards a global, collaborative rating and guidance system for health information proposed in the MedCERTAIN project. In MedCIRCLE, three European gateway sites for consumer health information will implement the metadata vocabulary HIDDEL (Health Information Disclosure, Description and Evaluation Language). HIDDEL allows portals and gateways to make the results of their evaluations accessible as XML/RDF. The three participating national portals are: AQUMED (Agency for Quality in Medicine) patienten-information, de, COMB (Official Medical College of Barcelona) and CISMeF, a quality-controlled health gateway developed at Rouen University Hospital. Other health subject gateways, accreditation, or rating services are invited to join the collaboration simply by implementing HIDDEL on their gateways. Widespread implementation HIDDEL will allow intelligent agents or client-side software to harvest statements and opinions about the trustworthiness of other websites, assisting users in selecting trustworthy websites. The MedCIRCLE project builds on, expands and continues work on rating health information on the Internet piloted within the MedCERTAIN project. While MedCERTAIN provided the core technologies and software for rating and "trustmarking" health information, MedCIRCLE is built around these technologies and involves a wider medical community to assess health information, demonstrating the power of collaborative and interoperable evaluations in a semantic web environment. MedCIRCLE is a project with the overall objective to develop and promote technologies able to guide consumers to trustworthy health information on the Internet, to establish a global web of trust for networked health information, and to empower consumers to positively select high quality health information on the web. Other aims include refinement and expansion of HIDDEL, to become a standard vocabulary and interchange format for self- and third-party ratings of health information.

What is the prevalence of health-related searches on the World Wide Web? Qualitative and quantitative analysis of search engine queries on the internet.

While health information is often said to be the most sought after information on the web, empirical data on the actual frequency of health-related searches on the web are missing. In the present study we aimed to determine the prevalence of health-related searches on the web by analyzing search terms entered by people into popular search engines. We also made some preliminary attempts in qualitatively describing and classifying these searches. Occasional difficulties in determining what constitutes a "health-related" search led us to propose and validate a simple method to automatically classify a search string as "health-related". This method is based on determining the proportion of pages on the web containing the search string and the word "health", as a proportion of the total number of pages with the search string alone. Using human codings as gold standard we plotted a ROC curve and determined empirically that if this "co-occurance rate" is larger than 35%, the search string can be said to be health-related (sensitivity: 85.2%, specificity 80.4%). The results of our "human" codings of search queries determined that about 4.5% of all searches are "health-related". We estimate that globally a minimum of 6.75 Million health-related searches are being conducted on the web every day, which is roughly the same number of searches that have been conducted on the NLM Medlars system in 1996 in a full year.

[The internet. Chances, risks and prospects for the surgical patient]. / Das Internet. Chancen, Risiken und Perspektiven für den chirurgischen Patienten.

The World Wide Web (WWW) serves consumers with an abundance of health information and services. This factor sets new accents in the health care system. The Internet can help to create an informed patient, who is actively involved in clinical decision-making processes ("shared decision making"). This has effects on the physician patient relationship. An informed patient demands better performance. The increased transparency and comparability of provider performance in patient care leads to an enhanced competition between providers. On the other hand, the Internet also bears certain risks: The quality of health information on the Internet is frequently described as unsatisfactory and patients rarely pay attention to quality markers of the information provided. It is necessary to encourage an active quality management for health information and services on the web. The Internet is not only a passive information resource but, above, all, an interaction medium. It can be harnessed to facilitate quality management. Intelligent technologies will gain increasing significance in the future, when the WWW develops towards a "semantic web". In particular, consumers will use intelligent computer programs, so-called "agents", to gather information or to evaluate the trustworthiness of health information providers.

Evaluation of the usefulness of Internet searches to identify unpublished clinical trials for systematic reviews.

PRIMARY OBJECTIVE: To avoid selection and publication bias, systematic reviewers should employ a broad range of search techniques and make efforts to locate unpublished studies. We tried to establish whether searches on the World Wide Web (WWW) are useful to identify additional unpublished and ongoing clinical trials. RESEARCH DESIGN: Search strategies seven Cochrane systematic reviews were retrospectively adapted for the WWW in an attempt to find additional randomized controlled trials. METHODS AND PROCEDURES: A search strategy with the general pattern 'study methodology NEAR intervention NEAR condition' for the Internet search engine AltaVista was evaluated by measuring search time, recall of Internet searches for published studies; precision (proportion of webpages containing hints to relevant published and unpublished randomized clinical trials); number of additional unpublished or ongoing studies found on the Internet. MAIN OUTCOMES AND RESULTS: We reviewed 429 webpages in 21 hours and found hints to 14 unpublished, ongoing or recently finished trials, at least 9 were considered relevant for 4 systematic reviews. The recall of Internet searches to find references to published studies ranged between 0% and 43.6%, the precision for hints to published or unpublished studies range between 0% and 20.2%. CONCLUSIONS: Information on unpublished and particularly ongoing trials can be found on the Internet. A potential problem is the appraisal of non-peer reviewed electronic publications with questionable quality. More powerful search tools are needed. An 'Open Trial Initiative' is proposed to define a syntax for publishing trials on the web and to ensure interoperability of trial registers, so that special search engines can harvest information on ongoing and complete clinical trials.

Evidence-based patient choice and consumer health informatics in the Internet age.

In this paper we explore current access to and barriers to health information for consumers. We discuss how computers and other developments in information technology are ushering in the era of consumer health informatics, and the potential that lies ahead. It is clear that we witness a period in which the public will have unprecedented ability to access information and to participate actively in evidence-based health care. We propose that consumer health informatics be regarded as a whole new academic discipline, one that should be devoted to the exploration of the new possibilities that informatics is creating for consumers in relation to health and health care issues.

A framework for improving the quality of health information on the world-wide-web and bettering public (e-)health: the MedCERTAIN approach.

There has been considerable debate about the variable quality of health information on the world-wide-web and its impact on public health. While central authorities to regulate, control, censor, or centrally approve information, in-formation providers or websites are neither realistic nor desirable, public health professionals are interested in making systems available that direct patient streams to the best available information sources. National governments and medical societies have also recognized their responsibility to help users to identify "good quality" information sources. But what constitutes good quality, and how can such a system be implemented in a decentralized and democratic manner? This paper presents a model which combines aspects of consumer education, encouragement of best practices among information providers, self-labeling and external evaluations. The model is currently being implemented and evaluated in the MedCERTAIN project, funded by the European Union under the Action Plan for Safer Use of the Internet. The aim is to develop a technical and organisational infrastructure for a pilot system that allows consumers to access metainformation about web-sites and health information providers, including disclosure information from health providers and opinions of external evaluators. The paper explains the general conceptual framework of the model and presents preliminary experiences including results from an expert consensus meeting, where the framework was discussed.

A metadata vocabulary for self- and third-party labeling of health web-sites: Health Information Disclosure, Description and Evaluation Language (HIDDEL).

We describe HIDDEL (Health Information Disclosure, Description and Evaluation Language), formerly known as medPICS (platform for Internet content selection in medicine), a metadata vocabulary designed to enhance transparency, trust and quality of health information on the web. The vocabulary may be used (1) by webmasters to self-describe their contents and policies; (2) by infomediaries (e.g. Healthfinder, NHS Direct/NeLH), e.g. third party evaluators, rating or portal services, to annotate other websites; (3) and by users, to describe their preferences. As an XML application it conforms to the W3C's RDF Specification. The metadata vocabulary is primarily intended to enable descriptions of whole health websites or health information providers. The vocabulary is designed to provide a computer-readable electronic "label" of a health website, telling users who is behind the website, how the website is sponsored, what the con-tent, aim and target audience is, how the information was compiled, what risks the service bears, or what people say about the resource. Client-software can "read" this label automatically, compare it to the user s own set of preferences and needs, and alert and advise users.

An ontology of quality initiatives and a model for decentralized, collaborative quality management on the (semantic) World-Wide-Web.

This editorial provides a model of how quality initiatives concerned with health information on the World Wide Web may in the future interact with each other. This vision fits into the evolving "Semantic Web" architecture - ie, the prospective that the World Wide Web may evolve from a mess of unstructured, human-readable information sources into a global knowledge base with an additional layer providing richer and more meaningful relationships between resources. One first prerequisite for forming such a "Semantic Web" or "web of trust" among the players active in quality management of health information is that these initiatives make statements about themselves and about each other in a machine-processable language. I present a concrete model on how this collaboration could look, and provide some recommendations on what the role of the World Health Organization (WHO) and other policy makers in this framework could be.