Board certified physicians in health informatics a European precedent for professional recognition.

OBJECTIVE: To document the official recognition of a new specialty in health informatics in one European country, because a similar legal process may lead to professional equivalence for physicians in all member countries of the European Union and elsewhere. METHOD: In Belgium, a Ministerial Decree in 2001 established criteria for the certification of Physician Specialist in Health Data Management. Such recognition of a new competence is a natural complement to a University Master's degree and can have a major influence on the salary scale and on professional recognition and development in public and private sectors. RESULTS: Teaching and training programmes in Belgium were adapted according to the Decree. Ninety-seven physicians were certified in the French community and 72 in the Flemish community between 2002 and 2009, with a prerequisite of this title for engagement in several official and private positions, and a salary increase. DISCUSSION: In other countries, recognition of a specific competence in health informatics remains, at best, a voluntary registration process and University programs vary widely. The implications of this Decree, with recognition of Physician Specialist in Health Data Management as a special competence, rather than a medical specialty, are discussed. The extension of such recognition to health professions other than physicians is not yet envisaged. CONCLUSION: Although the title "Physician Specialist in Health Data Management" may appear rather old fashioned, recognition of this competence in a European Union country is a first step to help its diffusion to other countries.

Health data quality improvement by comparing administrative medical data and billing data.

OBJECTIVE: The increasing use of medical administrative databases in hospital financing means more attention is being paid to their quality. The object of this study is to compare diagnoses found in the medical database to treatments mentioned in the billing database and to identify hospital stays with discrepancies. METHOD: The analysis is performed for the diagnoses of heart failure, hypertension, and pneumonia. Data were extracted from the 2000 National Medical Minimum Basic Data Set (MBDS) database and from the 2000 National bill summary database. The in-hospital stays were split into four analysis groups: patients with the selected disease and a corresponding treatment, patients with the selected disease but without a corresponding treatment, patients with a treatment, without the selected disease, but with another pathology requiring the same treatment, and patients with a treatment, without the selected disease and without any other pathology requiring the same treatment. RESULTS: The proportion of in-hospital stays with the disease in the medical database but without a corresponding treatment mentioned in the billing database was 1.1% for heart failure, 12.0% for hypertension, and 5.1% for pneumonia. Under-reporting (patient with a treatment but without any corresponding disease) concerned a high proportion of stays for heart failure and for hypertension (29.6% and 26.8%, respectively). CONCLUSIONS: This database comparison identified hospital stays with discrepancies between the medical database and the billing database. This method allows a better focus on the medical MBDS to be reviewed but must be completed by a thorough analysis of the medical chart. An extension of this methodology to other pathology would be useful to assess the quality of administrative data.

[The advancement, progress and challenges in medical informatics in Belgium]. / Etat d'avancement, progrès et défis de l'informatique médicale en Belgique.

The development of medical informatics has been as quick in Belgium as in neighbouring countries. It followed the worldwide diffusion of new information technologies, mainly in hospitals, in laboratories, for medical imaging and, more recently, for the EPR (electronic patient record), the e-prescription and bioinformatics. Today, 78 % of general practitioners have access to an EPR and 100 % of acute care hospitals use computers. The Federal Government developed a policy in order to obtain more coherence in information systems and an economy of scale in the (nineteen) eighties, by introducing a reform of health care financing based on diagnoses documented by hospital inpatients record summaries, exhaustive since 1990. During the last years, software quality criteria, called labels, have been introduced in general practice, and "BeHealth", a Federal health network with a secure access platform and authentified medical data, has been developed as a pilot project. Challenges of health telematics in Belgium are related to a profound change in doctor-patient relationship. a shift in organizing medical practice and risks linked to socio-economic interests. These cannot have a primacy over patient interests. Informatics and medicine are not incompatible. The human character of doctor-patient relationship has to be preserved.

Electronic signature and certification models in health care.

Recently, Belgian legislation has enabled the practical use of electronic signatures. Several implementation options are still open and different models for deployment on a wide scale are possible. This document describes two models that can be applied to the healthcare domain and summarises the recommendations as issued by the Belgian Health Telematics Standards Committee

A systematic approach for analysis and design of secure health information systems.

A toolset using object-oriented techniques including the nowadays popular unified modelling language (UML) approach has been developed to facilitate the different users' views for security analysis and design of health care information systems. Paradigm and concepts used are based on the component architecture of information systems and on a general layered security model. The toolset was developed in 1996/1997 within the ISHTAR project funded by the European Commission as well as through international standardisation activities. Analysing and systematising real health care scenarios, only six and nine use case types could be found in the health and the security-related view, respectively. By combining these use case types, the analysis and design of any thinkable system architecture can be simplified significantly. Based on generic schemes, the environment needed for both communication and application security can be established by appropriate sets of security services and mechanisms. Because of the importance and the basic character of electronic health care record (EHCR) systems, the understanding of the approach is facilitated by (incomplete) examples for this application.

WHO views on perspectives in health informatics.

The wider use of telematics in public health and patient care will be a very important strategy for Member States, and one that can help bring expert knowledge to new areas and institutions in a cost-effective and rapid manner. However, such a strategy should take into account a number of elements that are given below. Health telematics systems and services should be dictated by health need s and by clinical and public health standards, not be technology-driven. The values and principles of Health for All (HFA), notably equity, sustainability, participation and accountability, should apply fully to the development of health telematics. Health telematics requires new skills from the relevant decision-makers , operators and users, calling for a mix of participatory education, skills training, continuing professional education and lifelong learning. Given the fast rate of technological obsolescence and changing price-performance ratios, countries will benefit from closer collaboration on the development of technological standards, compatibility, open architecture, competitive prices and pilot applications. Managing health information developments in an effective and rational way at the level of the European Region will require the major organizations active in this field to enter into more formal agreements of cooperation than is the case today; most importantly, this will involve World Health Organization (WHO), the European Commission and Organization for Economic Co-operation and Development (OECD).

Control and use of health information: a doctor's perspective.

The electronic health record offers all advantages of computer based memories. It is accessible over networks, highly structured and allows exchange of information both within the institution and across its borders. However, it has potential disadvantages among which a great risk for confidentiality, integrity and availability of information about identifiable patients exists. The present paper discusses advantages and disadvantages of the electronic health record as well as methods in order to control and use appropriately identifiable patient data. Personal data protection requires a legislation, a code of conduct, information contracts, an organisation under the responsibility of a physician, technical tools for health security, risk analysis methods, standards for development and implementation of computer systems as well as training and teaching sessions.

Security of the electronic health care record--professional and ethical implications.

Many challenges face developers of secure computerised clinical systems but the technical problems are overshadowed by procedural, professional and ethical issues. The development and use of computerised systems must be controlled through compliance with standards and procedures for information security, enforced through national legislation and professional codes of conduct, if serious abuse of the data is to be avoided. Health care professionals cannot be expected to acquire working knowledge of how information systems are made secure since this is a technical and highly complex subject. However, it is essential that health care professionals understand why it is important to maintain a secure environment for the records they keep about patients and their care and how this can be organised. This is best achieved through a well structured educational programme involving all trainee and qualified health care staff, a task which should be coordinated by the national professional bodies. A management structure is needed within health care facilities that recognises the responsibility of health care professionals to keep the health care data relating to their patients secure. An arrangement is proposed that gives the most senior clinician in a health care facility the ultimate responsibility for security of health care data held in the organisation. Where appropriate, this would be delegated to a senior clinician with training and experience in information systems and their security. This 'information doctor' would, with the assistance of computer experts and health care managers, implement and monitor the organisation's information security strategy. Contracts should be developed between health care facilities and their patients, defining the limits to the use and disclosure of personal health data. Similar contracts with external agencies should also stipulate the minimum level of security to be applied to health records shared between the organisations.