Ebook: Health and Medical Informatics Education in Europe

The present volume titled ‘Health and medical informatics education in Europe” is the third volume in the series of the Conferences named as “Health Telematics Education”. In the previous two volumes “Health Telematics Education” and “Advances in Health Telematics Education - A NIGHTINGALE perspective” the emphasis was first in a global presentation of the needs and methods leading to coordinating efforts in educating healthcare professionals mainly in health telematics, and secondly in focusing in the field of nursing informatics taken up educational issues and special requirements of this particular area.

In this volume a presentation of Health Informatics and Medical Informatics courses that have been implemented in certain countries are presented, then certain applications and experiences are documented.

The European Commission has foreseen the need of education and training in the field of health informatics and has funded a number of activities and projects. A number of projects having this objective as a common denominator are presented also in this volume.

The editor wishes to thank all the authors for their excellent presentations and preparations of the papers as well as those that helped us to compile this book. This volume is also dedicated to all the ‘unknown’ educators trying to enhance the field of health informatics either in medical schools or in nursing institutions located in universities and hospitals across Europe and other countries having few resources but a wish to pursue the idea of health and medical informatics. From our point of view we will do everything possible to amplify this ideal and supply them with all necessary resources and educational material to succeed in their kind scope.

The Editor

Professor John Mantas

Health informatics education has evolved since the 1960s with a strong research foundation primarily in medical schools across the USA and Europe. By 1989 health informatics education was provided in some form by at least 20 countries representing five continents. This continues to progress, in Europe with the help of a number of special projects, via the integration of informatics into pre registration health professional courses, undergraduate and post graduate course work and research degree programs. Each program is unique in terms or content and structure reflecting the many foundation disciplines which contribute or are incorporated in the health informatics discipline. Nursing informatics education is not as widespread. Indeed the evidence suggests a poor uptake of informatics by this profession. Advances in computer based educational technologies are making innovative modes of educational delivery possible and are facilitating a shift towards learner centred, flexible and life long learning. Greater cooperation between Universities is recommended.

In this contribution the traditional approach to education is presented and compared with the problem-based approach. Trends in the healthcare system indicate that education in health informatics and training in ICT becomes mandatory for students and healthcare professionals. These trends are presented. In addition the role of ICT in education and training is discussed. Finally some educational programs are presented.

We report about new developments in the 5th version of the medical informatics program at the University of Heidelberg / School of Technology Heilbronn, reflect our approaches for the revision and discuss our current curriculum in relationship to other curricula in health informatics and medical informatics.

The specialised university curriculum for medical informatics at the University of Heidelberg / School of Technology Heilbronn is one of the oldest educational approaches in the field of medical informatics. During more than 25 years approx. 1000 students graduated.

The program belongs to the category of dedicated master programs for medical informatics and is based on the concept of medical informatics as a medical discipline of its own. It covers the total spectrum of medical informatics ranging from information systems in health care, biosignal and medical image processing, medical documentation, to information and knowledge processing in medicine. It is a 4.5 years program with a strong emphasis on the methodological foundations of medical informatics and on practical education in a number of specific laboratories.

For the 5 th version of the Heidelberg/Heilbronn curriculum on medical informatics, having started at winter semester 1997/98, we hope to have reflected the evolution of medical informatics as a separate discipline, moving one step further towards educating medical informatics, and not ‘Just’ medicine and informatics.

Health informatics is a recently established and important multi-disciplinary and inter-disciplinary field that not only involves informatics but also medicine, nursing, engineering, biology and other- related subjects. A co-ordination of this field at a postgraduate level becomes important now in Europe where other European Community programs such as the Telematics for Health Care will require at the Fourth Framework Programme (1994-1999) and the Fifth Framework Programme (2000-2006) adequate human resources of higher potential and knowledge. A European M.Sc. course met all the above objectives. The curriculum was developed according to previous experiences in similar programmes. Recently the course has been organised on the basis of an Inter-University nature with the participation of 5 Greek Universities. The paper aims at providing a description of the new academic programme and a brief evaluation of the implementation phase.

Swiss Society for Medical Informatics (SSMI) started to build a postgraduate curriculum in medical informatics a year ago. The aim is to build a curriculum with different modules allowing the healthcare professionals to follow individual path in order to fulfill their objectives. The professionals who could benefit from the curriculum are physicians, nurses, medical assistants, computer specialists in the healthcare domain. Different levels of certificates or diplomas will be given depending on the number of modules taken and the professional background. Modules can be taken in different ways: universities, hospitals, distance learning$\ldots$

The kickoff meeting for the leading group of this curriculum chaired by Dr Denz from Zurich was held on June 5 and 6 1998 was Swiss Nursing informatics group is active in this field.

Working Group 5 (WG5) “Nursing Informatics in Europe” is supporting countries efforts in building nursing informatics curriculum. Promoting links between specialists in this domain in different countries. Selecting relevant Websites to be used. Disseminating information to country members of WG5.

From the beginning a coherent approach to health informatics education has been aimed for in our project to develop learning materials. The features are the thematic approach of the contents, the interrelationship of the modules and the didactical approach embedded in the learning materials. Following results have been achieved. Learning materials have been developed for the following themes: healthcare policy and management, delivery of professional care (specific for nursing and allied health), more generic themes such as electronic patient record, clinical decision making, classification and coding of healthcare data and knowledge based systems.

Software made available by private companies has been selected for use in the learning modules. In specific cases the available software products did not match the criteria to support the learning materials. In these cases model applications have been developed that can be considered as forerunners for systems in practical use. Already some companies have expressed interest to adapt our home grown products for use in clinical practice.

The modules are based on a model curriculum that has been developed by Aarts et al in 1995. New developments in healthcare have prompted modification of the contents of a few modules. For example, a module has been redefined to cover the important issue of logistics in healthcare. The module on patient education has been adapted to take into account the resources available on the Internet. Also, new insights in the effectiveness of computer-based patient education have been taken into account. The module on informatics for disabled persons has been focussed on computer-based aids and is being linked to the EU-project “Impact” aimed at increasing knowledge about assistive technology. However, the model curriculum has proved to be reasonable robust as a base for our project to develop learning materials for health informatics.

It is widely acknowledged that the education and training of nurses in information management and technology is problematic. Drawing from recent research this paper presents a theoretical framework within which the nature of the problems faced by nurses in the use of information may be analysed. This framework, based on the critical social theory of Habermas, also provides a model for the informatics curriculum. The advantages of problem based learning and multi-media web-based technologies for the delivery of learning materials within this area are also discussed.

The SIP-project is a developmental project initiated by the deans of the Danish Nursing Schools on introducing and implementing the use and learning of Nursing Informatics in Danish nursing education. SIP is the acronym of SYGEPLEJE(Nursing) INFORMATIK (Informatics) and Psdagogik (Learning). This paper presents the background, structure, goals, expected and actual outcomes of the project and actual problems within the project.The SIP-project is a developmental project initiated by the deans of the Danish Nursing Schools on introducing and implementing the use and learning of Nursing Informatics in Danish nursing education. SIP is the acronym of SYGEPLEJE (Nursing) INFORMATIK (Informatics) and Psedagogik (Learning). This paper presents the background, structure, goals, expected and actual outcomes of the project and actual problems within the project.

The NIVEMES project creates an international network of Health Service providers which offer Telemedicine-Teleconsultation services to Remote, Isolated places and to ship vessels for both routine and emergency situations. The base of the system is the powerful Multimedia Health Record, with the ability to manage conventional data, images, videos and biosignals, acquired directly from the medical device. National and international medical codification schemata are employed such as ICD-X and WHO standards.

Telemedicine and Computing in Health Care are rapidly covering a pending gap, not fulfilled by current bureaucratic and telematic procedures. However even from the first test fields conducted during the past year, it is obvious that a variety of new training needs has arisen. The users of such systems need to be instructed new ways of conducting their business, of taking advantage of the services, even a new way of perceiving health care provision.

The user interface of the software is kept simple, thus getting acquainted with it requires minimum effort; however there are other issues on which training is required to best exploit the advantages the system offers. The telemedical networks spawned in each country must be co-ordinated, and the user needs to know where and how he/she will acquire the necessary support. Home-cared patients will have to operate medical devices and telemedical software, a task which although made easy from today's technology, it still requires some basic training, specially as far as elderly users are concerned.

The NIVEMES system uncovers a set of new training needs, but it offers at the same time a vehicle for educating the professional health-carers. The Health Record comprises a multimedia, explicit account of the patient history, which can be used for detailed and integrated study from trainee health carers of all levels (as well as from officers on board, people taking care of home-confined patients and others), on real data or in a simulated environment. At the same time the telemedicine facilities may increase the effectiveness of junior doctors working in remote areas and enhance the confidence residents have about their local health centres.

Systems like NIVEMES prove that new user needs arise nowadays and employment of modern tools requires training in modern methods and in a new way of thinking.

The purpose of this paper is to describe the design and the process of Cardiological Nursing Care Plans proposed to be used within an electronic patient record that can fulfill both nursing science and experience. The project is focused on the development of a clinical database capable of analysis to link control of nursing process with clinical outcome.

Students studying for different professions within the field of health care need to practice both multiprofessional collaboration and use of HIS and EPR software. The MuPSi concept utilizes computer-mediated communication to provide students access to a EPR software to enable the students to act collaboratively as members of a virtual health care team. The students are given a fictive patient case and use the EPR software to plan and document the care they provide. In order to achieve a higher grade of authenticity the case is presented as segments - the teachers direct the simulation by recording events that change the situation into the patient record.

It is a fact that elderly peoples’ life is characterised by problems such as deteriorating health and physical condition, feelings of loneliness, isolation, and of being dependent on others, in many aspects of their everyday lives. The objective of the RISE project is to provide an efficient vehicle for Heath Care Professionals for improving Health Care, quality of life and integration of the elderly and disabled people with society by implementing Information technology applications. In particular, RISE project aims in developing a distributed network of service providers across the European Union, which will provide integrated types of sennces to the elderly and disabled population. The purpose of this paper is to present the impact of this project concerning the Health Informatics sector. It will describe the issues regarding, the needs for education and training of the professionals that arise by the introduction of this concept, and, the possible ways that such a concept forms an efficient vehicle for Health Professionals in assisting these particular groups of users. The longer perspective seeks to redefine and reshape the Health Care services’ larger purpose, ie to make those comport with elementary individual needs of the elderly and disabled by introducing new methods of efficient health service provision. To achieve this there is an increased need for the training of the professionals. The outcome of RISE will be a set of specialised software components, tools and training methodologies designed to assist the Health Professionals achieving the aforementioned tasks.

The concepts expressed in this paper concerns the activities to be developed within HEALTHLINE, a European project under the Telematics Application programme. HEALTHLINE is an umbrella project which takes initiatives and provides links to other international projects on health telematics. The projects involved are NIVEMES and RISE; they represent the starting point from which a common approach will be developed.

The experience gained from these projects has highlighted two emerging requirements: information dissemination and training. To fulfil the needs of information, an Internet corner will be set up; it will allow citizens and health professionals to find and exchange information as well as to discuss themes concerning health care.

Due to the most advanced technologies recently introduced, the Health care sector has had to modify its traditional ways of working to aid professionals in exploiting new training techniques and Health Care provision methods.

HEALTHLINE will focus on training and on the development of the use of new tools and services. Furthermore, the project will exploit the training methodologies based on multimedia technology for developing training-on-the-job modules.

The entire system, in its final stage, will consist of a network for co-operating training and information dissemination; European sites in the project will share information, training material and provide education and information on tele-health, medical and health-care issues to health care providers, beneficiaries and the general public.

This paper will present a brief review of the use of simulations in clinical reasoning research and education, followed by a case-study describing the development of a research tool which attempted to elicit the decision-making strategies of novice and competent hospital nurses. The central feature of this simulation was the degree of flexibility and control it gave to the nurse participants over their information seeking strategies. The ability of this interactive multimedia simulation to mimic a real ward environment has a great potential in the teaching of clinical reasoning skills to health professionals.

In the Health field, there is an increasing need to give the Health professional the opportunity to experiment on real situations without necessarily having to be in contact with the patient. In order for this to be achieved, there must be a virtual reality representation via a safe and user friendly system, such as a computer. This means that by using Simulation and modelling techniques new models have to be constructed which will portray the reality. The scope of this paper is to present a Simulation Model and Practical for Educating the General Public for the AIDS Epidemic. The model and the practical were developed by using the tools and applications created under the COAST project.

GALEN-IN-USE is a European project that aims to promote greater European harmonisation and to overcome the problems encountered in using traditional coding and classification systems. This paper presents the work done by the Greek Centre of Medical Informatics and Terminology, as a collaborating centre of GALEN-IN-USE(GIU), in order to apply GIU's tools to Greek Health Care System as well as the affect of this application in education.