Ebook: MEDINFO 2010

The theme for the International Medical Informatics Association's (IMIA) 13th World Congress on Medical and Health Informatics, Medinfo 2010 is Partnerships for effective e-Health solutions. It is well recognised that information and communication technologies have enormous potential for improving the health and lives of individuals. Innovative and effective change using such technologies is reliant upon people working together in partnerships to create innovative and effective solutions to problems with particular regard to contextual and environmental factors.

Medinfo 2010 brings together the health informatics community from across the globe with a focus on how we can work together and share our experiences and knowledge to promote sustainable solutions to the challenges presenting to us all. This will be an historical event as Medinfo 2010 is hosted in Africa for the first time.

The Scientific Program Committee (SPC) was presented with a strong field of 905 submissions meeting the call of the congress challenge. This included 603 papers, 203 posters, 41 workshops/tutorials, 37 panels and 21 scientific demonstration applications. The final paper acceptance rate was 43%. All papers were assigned to two or three reviewers who scored each of the papers and provided feedback to authors. All submissions were categorised into one of four major themes (Hospital information systems, Consumer-health informatics, Knowledge management, National and International Health IT) and submissions within each of these theme areas were re-reviewed by assigned members of the SPC.

The final program covers all aspects of modern health informatics, ranging from traditional topics, such as hospital information systems, patient registries, nursing informatics, data integration, standards, interoperability issues and decision support, to new topics such as translational bioinformatics, text mining, intelligent data analysis, emerging technologies, quality, social networking, workflow and organizational issues. The papers have been selected with the guiding principle of including in the program both high quality methodological research and high impact applications of health informatics. In some cases, the authors achieved both goals.

A distinguishing feature of Medinfo 2010 program is the presence of several sessions on public health and national and international initiatives to promote health IT. The scientific challenges to implement large-scale initiatives are strongly related to the conference theme, as they rely on effective partnerships between all actors involved in health care informatics. The scientific rigor of the congress papers can be seen both as a consequence and reflection of IMIA's strategic decision to see its role as a promoter of science and health IT throughout the world. Health Informatics researchers internationally are rising to the challenge of providing robust evidence of the transformational effects of effective health information exchange.

The Scientific Program Committee thanks all those who made submissions to Medinfo. Special thanks also go to the worldwide team who reviewed these submissions and provided feedback. For the first time the SPC organised a mentor scheme which provided the opportunity for researchers seeking to submit papers to Medinfo to have their work reviewed by an international expert prior to the Congress submission closing date. 42 papers were reviewed as part of this process. We thank the team of mentors who generously gave their time to support their colleagues as part of this scheme.

Riccardo Bellazzi, PhD, University of Pavia, Pavia, Italy

Johanna Westbrook, PhD, The University of Sydney, Lidcombe, New South Wales, Australia

Recent consumer health informatics initiatives advocate individual access and management of personal medical records. However, little is known regarding the impact of personal access of health information on clinical practice. This paper introduces a field study investigating the usage patterns of personal health records in medical consultations. The self-managed records provide patients with a strong sense of ownership and control over their own health information. Personal medical records have been used primarily for transiting information among different providers. This behavior changed patient-provider communication into a records sharing. Doing so effectively eliminated the potential errors in the verbal reporting process. This study indicates that patients can be effective contributors to their own health and suggest the design of health information systems to rethink the role of patients in the healthcare process and shift the responsibility of healthcare to the patients' side.

In this paper we discuss the fact that more and more patients are treated in their homes by a set of organizations, sometimes with different ownership, and how this fact places new and severe demands on health care and home service staff to communicate and collaborate. We point to the need for managers in different organizations to agree on ways of communicating and collaborating on the operational level and how this aspect needs to be considered during procurement of home care services. Most importantly, by reasoning around a set of problematic areas, we derive a set of related problems and suggest solutions for dealing with them. The solutions are a mix of organizational/administrative measures and IT support for communication and coordination.

It is commonly accepted that public engagement with eHealth is beneficial. However, engagement is also variable. This article presents the findings of a review of published evaluation studies around eHealth services. A targeted search of MEDLINE, CINAHL and EMBASE returned 2622 unique abstracts. 50 articles met the inclusion criteria and were subjected to further analysis. 6 review articles were used for post hoc validation. Four main types of eHealth service or resource were identified: health information on the Internet; custom-built online health information; online support; and telehealth. 5 key themes emerged in terms of facilitators or barriers to engagement: characteristics of users; technological issues; characteristics of eHealth services; content issues; social aspects of use; and eHealth services in use. Recommendations arising from the review include: targeting efforts to engage those underserved by eHealth; maximizing exposure to eHealth across all sections of society; improving access to computers and the internet; appropriate design and delivery; ensuring content is relevant to different audiences; capitalizing on the interest in social computing; and clarifying the role of health workers in the delivery of eHealth.

While healthcare information plays an essential role in the process of disease management, previous studies have shown that many patients may be unaware of the availability of certain healthcare information, thus leading to the progression of their diseases and deterioration of their health. This study explores the information seeking behaviors among patients with type-2 diabetes and explores the barriers that hinder effective healthcare information usages. 19 semi-structured interviews were carried out with patients and caregivers in various stages of diabetes disease management. Data analysis identified five major barriers for seeking health information: lack of motivation, passiveness, inconsistency of information, generality of information and loss of information. These findings call for the designing of active and personalized information delivery mechanisms.

This research paper examines the challenges in the development and adoption of an electronic patient diary within the Pathways Home for Respiratory Illness Project. This project supported community-based patients suffering from chronic obstructive pulmonary disease (COPD) to achieve increased levels of self-management and self-efficacy using electronic-monitoring techniques and mentoring by community health nurses. Participants had the option of voluntarily adopting an electronic patient diary to support their self-monitoring, which provided patients, nurses and clinicians with access to symptom and psycho-social data. This aimed to improve the identification, comprehension and initiation of early action in relation to alterations in their conditions. The paper presents data on technology adoption, electronic diary usage and, self-reported data quality, as well as examining the impact of the technology on hospitalisations (frequency and duration). The participants who chose to use the online patient diary continued their involvement with the project for the entire trial period (85% vs 54% completion). Participants were more likely to maintain use of the online patient diary than the paper diary. Both the groups experienced a positive improvement in their self-efficacy to self-manage their condition scores. The data highlight the problems implicit in some of the assumptions underpinning existing information systems models, especially in evaluating impact and the end-points presumed to be relevant in systems development life cycles.

Web-based interventions can be effective in changing behaviour of people faced with health problems. However, it is unclear whether they are effective in preventing health problems like overweight. The aim of this study was to investigate usage and effectiveness of the Healthy Weight Assistant (HWA), a web-based application to increase healthy behaviour in adults with a healthy weight or slight overweight, by means of a Randomised Controlled Trial (RCT). 297 respondents were randomly assigned to the intervention (n=147) or the waiting list group (n=150). The intervention group received access to the intervention for 12 weeks. At pre- and post-test we measured dietary and physical activity behaviour (primary outcomes) and BMI, knowledge, attitude, self-efficacy, subjective behaviour and insight in behaviour (secondary outcomes). All participants, regardless of group, show improvement in healthy behaviour and subjective assessment of healthy behaviour. People who are older, score higher on dietary behaviour and under-estimate their dietary behaviour are more likely to use the HWA. Using the HWA leads to improvement in physical activity behaviour and insight in physical activity behaviour.

This paper presents an online prospective study investigating whether the strength of social feedback, i.e. the proportion of persons who concur or do not concur with one's own answer to a question, influences the way one answers health-related questions. Two hundred and twenty-seven undergraduate students were recruited to use an online search engine to answer six health-related questions. Subjects recorded their pre- and post-search answers to each question and their level of confidence in these answers. After answering each question post-search, subjects were presented with a summary of post-search answers provided by previous subjects and were asked to answer the question again. There was a statistically significant relationship between the absolute number of others with a different answer (the crowd's opinion volume) and the likelihood of an individual changing an answer (P < .0001). Subjects' likelihood of changing answer increased as the percentage of others with a different answer (the crowd's opinion density) increased (P = 0.047). Overall, 98.3% of subjects did not change their answer when it concurred with the majority (i.e. > 50%) of subjects. When subjects had a post-search answer that did not concur with the majority, they were 24% more likely to change answer than those with answers that concurred (P < .0001). This study provides empirical evidence that strength of social feedback influences the way healthcare consumers answer health-related questions.

The arrival of the Internet contributes to the growth of new areas for patient empowerment. In the presence of a challenge such as this, we nevertheless note that the adequacy and characteristics of the web strategies of healthcare providers have, up to the present, not been subjected to thoroughgoing critical analysis. The aim of this paper is to: (a) provide an analysis of the key factors of an efficient web strategy for healthcare organizations with regard to the issue of patient empowerment (b) build a concise indicator for measuring the degree of empowerment potential of healthcare providers' web sites (Patient Web Empowerment Index -PWEI-). PWEI was calculated in order to assess the web sites of 340 Italian National Health Service healthcare organizations, the aim being the appraisal of the current degree of maturity of their web strategies in relation to potentials for an effective increase in patient empowerment.

This paper describes the development and implementation of a web based electronic health record for the Homecare Service program in the Hospital Italiano de Buenos Aires. It reviews the process of the integration of the new electronic health record to the hospital information system, allowing physicians to access the clinical data repository from their Pc's at home and with the capability of consulting past and present history of the patient health care, order, tests, and referrals with others professionals trough the new Electronic Health Record. We also discuss how workflow processes were changed and improved for the physicians, nurses, and administrative personnel of the Homecare Services and the educational methods used to improve acceptance and adoption of these new technologies. We also briefly describe the validation of physicians and their field work with electronic signatures.

Population ageing needs health-enabling technologies for delivering pervasive health care. Home care plays an import role in pervasive health care. In this paper, we aim to construct a home-centered health information system architecture which can efficiently manage multi sensors, actuators and decision support systems. Open Services Gateway initiative (OSGI) was used for constructing the service oriented architecture. HL 7 Arden Syntax for medical logic module (MLM) was used to describe the medical knowledge; An Arden compiler was used to interpret the MLMs. The Arden compiler was packed in an OSGI bundle. All of the knowledge bases can share the compiler within the OSGI platform. System within the OSGI-based architecture can change their behaviors during runtime. The proposed prototype architecture was deployed in a case study.

Home based health care (HBHC) is advocated by the WHO “to ensure better accessibility to effective and efficient health care in community and home-settings to improve health and well-being, and contribute to morbidity and mortality reduction”. In South Africa the government and many other role players see an increasingly important role for HBHC. Many researchers believe that the evolution of HBHC will follow the socio-technical network evolution. There can be no doubt that the focus is on using information and communication technologies (ICT) to implement HBHC solutions. The objective of this paper is to provide a rich picture of the current situation and needs for improvement in HBHC in South Africa today through descriptive research in one specific case. The longer-term purpose is to identify pain-points that require socio-technical solutions, including but not exclusively ICT-supported solutions.

Our research work is towards a service that can support senior citizens towards their independent living and active ageing. As it is suggested, physical and cognitive exercise training can contribute to a significant prolongation of personal autonomy and participation in society across prevailing age-related impairments such as cognitive decline. In the current paper, the approach of combination of both physical and cognitive training – adopted by LLM project – is discussed related to other similar projects that have taken place in the area of elderly home care and training. The aim of this work is to describe the technical design details of the integration process of the LLM service, which is based on a Web service architecture and to discuss alternative interface elements to be included in the LLM platform in terms of enabling user accessibility and acceptance.

This paper illustrates a platform based on a general architecture for implementing home care services for chronic patients composed of a Remote Care Unit located at a patient's home and a Health Care Center Unit located at the treating center. The Remote Care Unit may be deployed on multiple platforms including PCs, mobile phones and even embedded devices not equipped with monitor, and may be configured to support many interoperability issues occurring among the parties involved in a health care delivery process. The platform may be tailored to match the specific issues of any chronic disease supporting either data acquisition as well as customized reminders and notifications from the center. Remote Care Unit platforms are also able to exploit multiple channels for acquiring data, including wireless links with medical devices, speech interaction and graphical user interaction. In this paper a couple of applications addressing the needs of diabetic and nephropatic patients developed on top of that platform are also introduced.

The demographic change will lead to an increase in the incidence of falls in the elderly. Technological progress allows for unobtrusive physical activity measurement with miniature sensors, e.g. accelerometers. Yet it is unclear which activities or activity patterns are associated with an increased fall risk. The aim of the research for this paper is to identify daily physical activities associated with a high fall risk. A one-year follow-up study was conducted with n=50 geriatric patients who took part in a telephone interview to assess fall events, their consequences and a set of daily physical activities. Descriptive analysis of the data shows that there are marked differences between fallers (n=21) and non-fallers (n=29) in the overall activity level, the amount of shopping activity and associated locomotion, and in the intensity of light household work. The results confirm that there are differences in typical daily activities between fallers and non-fallers that may be used as parameters to enhance fall prediction models.

With the development of electronic personal health records, more patients are gaining access to their own medical records. However, comprehension of medical record content remains difficult for many patients. Because each record is unique, it is also prohibitively costly to employ human translators to solve this problem. In this study, we investigated whether multilingual machine translation could help make medical record content more comprehensible to patients who lack proficiency in the language of the records. We used a popular general-purpose machine translation tool called Babel Fish to translate 213 medical record sentences from English into Spanish, Chinese, Russian and Korean. We evaluated the comprehensibility and accuracy of the translation. The text characteristics of the incorrectly translated sentences were also analyzed. In each language, the majority of the translations were incomprehensible (76% to 92%) and/or incorrect (77% to 89%). The main causes of the translation are vocabulary difficulty and syntactical complexity. A general-purpose machine translation tool like the Babel Fish is not adequate for the translation of medical records; however, a machine translation tool can potentially be improved significantly, if it is trained to target certain narrow domains in medicine.

For the past decade, adoption of electronic health records (EHRs) has been proposed as one of the most viable approaches to improving the United States health care system [1]. Although there is evidence that EHR adoption is slowly progressing, current methods of assessing adoption have yielded significant variance in estimates of EHR utilization. We conducted an environmental scan consisting of a review of the literature as well as a series of discussions with health center and health center network representatives and experts in the field to understand the current state of EHR adoption and use in the United States and assess the feasibility of developing a systematic approach to tracking EHR usage.

Meaningful and efficient methods for measuring Electronic Health Record (EHR) adoption and functional usage patterns have recently become important for hospitals, clinics, and health care networks in the United State due to recent government initiatives to increase EHR use. To date, surveys have been the method of choice to measure EHR adoption. This paper describes another method for measuring EHR adoption which capitalizes on audit logs, which are often common components of modern EHRs. An Audit Data Mart is described which identified EHR functionality within 836 Departments, within 22 Hospitals and 170 clinics at Intermountain Healthcare, a large integrated delivery system. The Audit Data Mart successfully identified important and differing EHR functional usage patterns. These patterns were useful in strategic planning, tracking EHR implementations, and will likely be utilized to assist in documentation of “Meaningful Use” of EHR functionality.

Medical records must be kept over an extended period of time, meanwhile computer based medical records are renewed every 5–6 years. Readability of medical records must be assured even though the systems are renewed by different vendors. To achieve this, we proposed a method called DACS, in which a medical record is considered as an aggregation of documents. A Document generated by a system is transformed to a format read by free software such as PDF, which is transferred with the document meta-information and important data written on the XML to the Document Deliverer. It stores these data into the Document Archiver, the Document Sharing Server and the Data Warehouse (DWH). We developed the Matrix View which shows documents in chronological order, and the Tree View showing documents in class tree structure. By this method all the documents can be integrated and be viewed by a single viewer. This helps users figure out patient history and find a document being sought. In addition, documents' data can be shared among systems and analyzed by DWH. Most importantly DACS can assure the lifelong readability of medical records.

Due to the fact that health care professionals in Malawi are often overstretched, the use and quality of health data can be compromised. The Malawi Health Management Information System (HMIS) has streamlined data collection and reporting and increased the use of data to improve care. Obstacles remain, including incomplete reporting and low staff morale. With the Baobab Health Trust and the Malawi Ministry of Health, Partners In Health piloted an innovative point-of-care data system for primary care that functions alongside OpenMRS, an open source medical record platform. The system has given access to a patient-level primary care dataset in real time. Initial results highlight some of the benefits of a point-of-care system such as improved data quality, emphasize the importance of sharing data with clinical practitioners, and shed light on how this approach could strengthen HMIS.

The objective of this study was to determine the relative efficiency of novices compared to a prediction of skilled use when performing tasks using the touchscreen interface of an EMR developed in Malawi. We observed novice users performing touchscreen tasks and recorded timestamp data from their performances. Using a predictive human performance modeling tool, the authors predicted the skilled task performance time for each task. Efficiency and rates of error were evaluated with respect to user interface design. Nineteen participants performed 31 EMR tasks seven times for a total of 4,123 observed performances. We analyzed twelve representative tasks leaving 1,596 performances featuring six user interface designs. Mean novice performance time was significantly slower than mean predicted skilled performance time (p < 0.001). However, novices performed faster than the predicted skilled level in 208 (13%) of successful task performances. These findings suggest the user interface design supports a primary design goal of the EMR – to allow novice users to perform tasks efficiently and effectively.

Systematic methods to improve the effectiveness and efficiency of electronic health record-mediated processes will be key to EHRs playing an important role in the positive transformation of healthcare. Business process management (BPM) systematically optimizes process effectiveness, efficiency, and flexibility. Therefore BPM offers relevant ideas and technologies. We provide a conceptual model based on EHR productivity and negative feedback control that links EHR and BPM domains, describe two EHR BPM prototype modules, and close with the argument that typical EHRs must become more process-aware if they are to take full advantage of BPM ideas and technology. A prediction: Future extensible clinical groupware will coordinate delivery of EHR functionality to teams of users by combining modular components with executable process models whose usability (effectiveness, efficiency, and user satisfaction) will be systematically improved using business process management techniques.

This paper reports the results from a survey of 131medical practitioners in South Australian General Practice concerning adoption of a computerised system for storing and potentially amalgamating health information from several practices. Practitioners were primarily influenced by the positively perceived potential for such technology use to improve patient health and well-being outcomes and secondarily by the negatively perceived potential for unwanted change in the status, control and autonomy of their professional role. Practitioner attitude reflected how they resolved the competing influences. The data suggest that strategies for implementing such systems should address individual perceptions by increasing belief in the potential for patient improvement or by decreasing belief of the inevitability of unwanted role change.