Ebook: User Acceptance of Health Telematics Applications

The International Workshop on Acceptance of Telematics Applications by Healthcare Professionals, called “Education and Training in Health Telematics”, took place 11-12 December, 1998 in Thessaloniki, Greece, supported by the Information Society Programme of the European Commission and the European People's Party of the European Parliament.

This workshop is the second part of the series of workshop on Acceptance of Telematics Applications by Healthcare Professionals. The first has focused on the existing “Convincing cases” and the proceedings have been published in the IOS press series Studies in Health Technology and Informatics (#56). The next workshop of this series will be devoted to the user-friendliness of the health telematics systems and its role in improving the user acceptance.

This book contains the presentations of the participants of the 2^nd European Workshop on Acceptance of Telematics Applications by Healthcare Professionals, “Education and Training in Health Telematics”. The contributions describe on the current health telematics education programmes offered in universities, the continuing education programmes and the new ideas in training for the “just in time” learning.

We would like to acknowledge the excellent contributions of all the experts from Europe and North America that have presented current programmes in education and training in health telematics and the stimulating discussions on the importance and challenges of both continuous education and “just-in-time” training schemes for improvement of user acceptance. We would also like Dr. Ch. Safran and the Beth Israel Deaconess Medical Center of the Harvard Medical School for the teleconference and demonstration.

Finally, special thanks goes to the numerous students of health telematics classes offered in universities of 3 different cities of Greece, namely Thessaloniki, Athens and Patras. We believe that their participation was the “life” of the workshop and the most important element of the very successful meeting.

Antonios Trakatellis

Stavroula Maglavera

Ilias Iakovidis

Medical Informatics education is a complex task,, since it aims in educating inhomogeneous groups of people coming from different disciplines. In Greece, recently considerable advancements in the medical informatics education field are made. These advancements aim in bridging gaps in various areas of MI users interactions. In particular, an overview of the strategy of the Greek ministry of education shall be given, some examples of MI related educational programs shall be referred to, and finally the MI educational structure used in the Aristotelian University shall be presented in detail, laying out the strategy of this University for bridging various types of gaps.

In this contribution it is argued that it is difficult to talk of medical informatics education since the groups that need education in this field are not very homogeneous. Also these groups overlap. WG 1 of IMIA is in the process of producing recommendations for curricula in medical informatics. The target groups are defined by their career type, which is categorised using three axes: discipline, stage of career and level of expertise. An example is given of the knowledge requirements for medical students.

Based on recent advances in biomedical research and the developments of new equipment and techniques, the field of Biomedical Engineering and Health Care Telematics are currently undergoing a rapid evolution characterized by an increasing degree of specialization. This, in turns, imposes new requirements in advanced education, while the changing scene at European level, introduces a major challenge for harmonization and standardization of education with a focus on meeting the emerging needs. At the same time information technologies provide new means and tools supporting the educational and training activities. An initiative for the development of a multinational advanced course in Biomedical Engineering, is implemented in the University of Patras with extended collaboration of European Universities, providing a unique case for achievement of excellency. In order to take full advantage of this potential, a Quality Assurance system has been designed and implemented over the past four years, aiming to provide the appropriate framework for mutual recognition amongst the participating institutions. Additionally, the implementation of new telematic tools is scheduled for the near future, in order to provide the Course with teleconference facilities and allow a much larger number of students to remotely attend the lectures.

In computer science, the notion of a domain ontology - a formal specification of the concepts and of the relationships among concepts that characterize an application are a - has received considerable attention. In human-computer interaction, ontologies play a key role in defining the terms with which users and computer systems communicate. Such ontologies either implicitly or explicitly drive all dialogs between the computer and the user. In the construction of health-telematics applications, professionals need to understand how to design and apply domain ontologies to ensure effective communication with end-users. We currently are revising our training program in Medical Information Sciences at Stanford University to teach professional students in health telematics how to develop effective domain ontologies. Instruction concerning the construction and application of clinical domain ontologies should become an integral component of all health telematics curricula.

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 coordination 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.

The patient in a hospital bed is also a private individual that might access his or her own Electronic Patient Record (EPR) in association with additional tools that are able to show critical up-to-date knowledge about diagnoses, clinical investigations or treatments. The distributed EPRs are shown here in full production with the DOMED application of DIOGENE 2. Besides, in order to facilitate an easier understanding of the EPRs by the patient, the HON Web Site services are at his or her disposal in this respect at the same terminal.

MERMAID is a telemedicine project with global reach and a 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model is not limited to medical diagnostics but it encompasses all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications are considered while the full range of network choices is explored in terms of the cost/performance tradeoffs inherent to them and the developmental stage each of these options occupies in its life cycle. MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialty care best suited to each particular case. Finally, the development of programme modules for training and education of the seafarers in the use of the MERMAID medical communications system is given top priority as such modules constitute the firmest basis for the promotion of proper practice of telemedicine at sea.

The Life-long Learning concept is one which is appropriate for those who have (or create) the opportunities to develop their competencies once they are in an operational role. All models of healthcare delivery and management are VOLATILE and therefore the way of addressing new competencies cannot be prescriptive or stand still for too long, but the concepts do endure. Learning, in order to ‘keep up to date’ is very necessary - technology, new clinical practices and interventions, new drug interactions, increased patient demands $\ldots$ all add to the need to move with the times. This paper addresses some of the issues surrounding this challenge in the domain of informatics in support of healthcare delivery and management.

Just-in-time learning (JITL) methodology has been applied to many areas of knowledge acquisition and dissemination. The paradigm is a challenge to the traditional classroom course-oriented approach with the aim to shorten the learning time, increasing the efficiency of the learning process, improve availability and save money. The information technology tools and platforms have been heavily involved to develop and deliver JITL. This paper discusses the main characteristics of JITL with regard to its implementation to teaching Medical Informatics.

Train me, $\ldots$ but I have only 2 minutes!

This paper focuses on emerging Human Computer Interaction (HCI) challenges in the context of Health Telematics. Specifically, assumptions in traditional approaches to product and process quality are discussed, in order to unfold the reasons behind the loose and partial insight offered to the design of technology for the broadest possible end-user population. The premises of “Universal Design” are briefly discussed and the concept of “User Interfaces for All” is presented, as an articulation of Universal Design in the area of HCI. Following this, the paper discusses how such a perspective improves upon conventional methods and tools for HCI design and presents some of its relative merits in the context of Health Telematics.

In the emerging information society each hospital is supposed to become a node of a complex networked information system that has to be accessible to a variety of users. These include doctors, nurses, administrators and the patients themselves, whose role is briefly described. This asks for a new approach to the implementation of the interfaces of the information system, which are used to carry out different tasks by people with different interests and computer literacy. A new approach to the implementation of such interfaces, based on the concepts of User interfaces for All, is briefly outlined, describing the scientific and technical achievements in some projects partially funded by the European Commission and the activities of the International Scientific Forum “Towards an Information Society for All” set-up to discuss and promote the relevant scientific concepts and technical issues.

MEDICOM system is a world wide telematics application for electronic commerce of medical devices. It has been designed so as to provide the health care professionals with a central Internet access to up-to-date information about medical equipment from multiple manufacturers, in a particular easy and friendly way. Moreover, the Medicom system will serve the health care professionals’ requirements for high-quality information about specific products in a form of multimedia presentations and that of a secure communication channel with the community of manufacturers, especially for post marketing surveillance. The system will provide the medical staff (physicians and technicians) with demonstrations of the operation procedures and the functioning of high-tech equipment in a form of virtual models. Moreover, through the medicom system the end users of medical devices can have access to on line libraries and participate in special newsgroups. This paper discusses the architectural structure of the MEDICOM system with emphasis to its educational and training functionality.

MOMEDA is a two-years project supported by the European Commission (Telematics Applications Programme of DGXIII - Health Care Sector). The main objectives of the project are the development of a compact personal information terminal for hospital and home care environments that could be used by patients and a demonstrator that allows the consulting physician to access electronic patient record data from outside the hospital, using a hand held companion device connected to GSM network. Special attention is paid to a Personalized Medical Information System (PMIS) which will allow patients to access customized disease-specific information material that will enable them to fully understand in a simple and constructive form what their medical problem is, what the planned procedures are, what lifestyle they should follow during and after their hospitalization, thus becoming more qualified partners in the recovery process. Considering the fact that in most cases informed and educated patients are usually satisfied patients when the treatment is finished, patient satisfaction can be also accomplished. The design considerations for the PMIS system are presented and the implementation is discussed.