Reinhold Haux

Medical informatics: Past, present, future

OBJECTIVE To reflect about medical informatics as a discipline. To suggest significant future research directions with the purpose of stimulating further discussion. METHODS Exploring and discussing important developments in medical informatics from the past and in the present by way of examples. Reflecting on the role of IMIA, the International Medical Informatics Association, in influencing the discipline. RESULTS Medical informatics as a discipline is still young. Today, as a cross-sectional discipline, it forms one of the bases for medicine and health care. As a consequence considerable responsibility rests on medical informatics for improving the health of people, through its contributions to high-quality, efficient health care and to innovative research in biomedicine and related health and computer sciences. Current major research fields can be grouped according to the organization, application, and evaluation of health information systems, to medical knowledge representation, and to the underlying signal and data analyses and interpretations. Yet, given the fluid nature of many of the driving forces behind progress in information processing methods and their technologies, progress in medicine and health care, and the rapidly changing needs, requirements and expectations of human societies, we can expect many changes in future medical informatics research. Future research fields might range from seamless interactivity with automated data capture and storage, via informatics diagnostics and therapeutics, to living labs with data analysis methodology, involving sensor-enhanced ambient environments. The role of IMIA, the International Medical Informatics Association, for building a cooperative, strongly connected, and research-driven medical informatics community worldwide can hardly be underestimated. CONCLUSIONS Health care continuously changes as the underlying science and practice of health are in continuous transformation. Medical informatics as a discipline is strongly affected by these changes and is in a position to be a key, active contributor in these changes.

Individualization, globalization and health – about sustainable information technologies and the aim of medical informatics

This paper discusses aspects of information technologies for health care, in particular on transinstitutional health information systems (HIS) and on health-enabling technologies, with some consequences for the aim of medical informatics. It is argued that with the extended range of health information systems and the perspective of having adequate transinstitutional HIS architectures, a substantial contribution can be made to better patient-centered care, with possibilities ranging from regional, national to even global care. It is also argued that in applying health-enabling technologies, using ubiquitous, pervasive computing environments and ambient intelligence approaches, we can expect that in addition care will become more specific and tailored for the individual, and that we can achieve better personalized care. In developing health care systems towards transinstitutional HIS and health-enabling technologies, the aim of medical informatics, to contribute to the progress of the sciences and to high-quality, efficient, and affordable health care that does justice to the individual and to society, may be extended to also contributing to self-determined and self-sufficient (autonomous) life. Reference is made and examples are given from the Yearbook of Medical Informatics of the International Medical Informatics Association (IMIA) and from the work of Professor Jochen Moehr.

Strategic information management plans: the basis for systematic information management in hospitals

Information management in hospitals is a complex task. In order to reduce complexity, we distinguish strategic, tactical, and operational information management. This is essential, because each of these information management levels views hospital information systems from different perspectives, and therefore uses other methods and tools. Since all these management activities deal only in part with computers, but mainly with human beings and their social behavior, we define a hospital information system as a sociotechnical subsystem of a hospital. Without proper strategic planning it would be a matter of chance, if a hospital information system would fulfil the information strategies goals. In order to support strategic planning and to reduce efforts for creating strategic plans, we propose a practicable structure.

A systematic view on medical informatics.

Medical informatics is defined as the scientific discipline concerned with the systematic processing of data, information and knowledge in medicine and health care. The domain of medical informatics (including health informatics), its aim, methods and tools, and its relevance to other disciplines in medicine and health sciences are outlined. It is recognized that one of the major tasks of medical informatics is modelling processes. In this context, biological, communication, decision, engineering, educational, organizational and computational processes are distinguished and described.

On Health-enabling and Ambient-assistive Technologies

Objectives: To provide an introductory overview on selected areas of health-enabling and ambient-assistive technologies and to suggest relevant fields for future research. Methods: Summarizing the state of the art for 1) ambient environments and 2) health-related sensor technologies, 3) presenting relevant medical conditions and their relation to health-enabling technologies, and 4) illustrating the application of those technologies for lifestyle management with examples for activity monitoring and prevention of overweight. The suggestions for future research are based on own research projects in this field. Results: Health-enabling and ambient-assistive technologies are regarded to have the potential to significantly improve quality of life and efficiency of health care in aging societies. Research on health-enabling and ambient-assistive technologies is highly multidisciplinary. Conclusions: It still has, to a large extent, to be exploratory. An increasing amount of outcomes research through well-designed evaluation studies that explore technical solutions in a social context and in relation to individual needs will be crucial.

Health-enabling technologies for the elderly - An overview of services based on a literature review

BACKGROUND Services for the elderly based on health-enabling technologies promise to contribute significantly to the efficiency and effectiveness of future health care. Due to this promise, over the last years the scientific community has designed a complex variety of these valuable innovations. A systematic overview of the developed services would help to better understand their opportunities and limitations. OBJECTIVE To obtain a systematic overview of services for the elderly based on health-enabling technologies and to identify archetypical service categories. METHODS We conducted a literature review using PubMed and retrieved 1447 publications. We stepwise reduced this list to 27 key publications that describe typical service archetypes. RESULTS We present six archetypical service categories, namely handling adverse conditions, assessing state of health, consultation and education, motivation and feedback, service ordering and social inclusion and describe their implementation in current research projects.

Health-enabling technologies for pervasive health care: on services and ICT architecture paradigms

Background. Progress in information and communication technologies (ICT) is providing new opportunities for pervasive health care services in aging societies. Objectives. To identify starting points of health-enabling technologies for pervasive health care. To describe typical services of and contemporary ICT architecture paradigms for pervasive health care. Methods. Summarizing outcomes of literature analyses and results from own research projects in this field. Results. Basic functions for pervasive health care with respect to home care comprise emergency detection and alarm, disease management, as well as health status feedback and advice. These functions are complemented by optional (non-health care) functions. Four major paradigms for contemporary ICT architectures are person-centered ICT architectures, home-centered ICT architectures, telehealth service-centered ICT architectures and health care institution-centered ICT architectures. Conclusions. Health-enabling technologies may lead to both new ways of living and new ways of health care. Both ways are interwoven. This has to be considered for appropriate ICT architectures of sensor-enhanced health information systems. IMIA, the International Medical Informatics Association, may be an appropriate forum for interdisciplinary research exchange on health-enabling technologies for pervasive health care.

Assessing elderly persons' fall risk using spectral analysis on accelerometric data - a clinical evaluation study

Falls are among the leading causes for morbidity, mortality and lasting functional disability in the elderly population. Several studies have shown the applicability of accelerometry to detect persons with a high fall risk. Most of these studies have been conducted under laboratory settings and without clear definition of ‘fall risk’ reference measures. The aim of our work is to provide a simple unsupervised method to assess the fall risk of elderly persons as measured by reference clinical fall risk assessment scores. Our method uses parameters computed by spectral analysis on triaxial accelerometer data recorded in a clinical setting, and is evaluated using simple logistic regression classifier models with reference to three clinical reference scores. The overall prediction accuracy of the models ranges from 65.5–89.1%, with sensitivity and specificity between 78.5–99% and 15.4–60.4%, respectively. Our results show that our simple method can be used to detect persons with a high fall risk with a fair to good predictive accuracy when tested against common clinical reference scores. Our parameters are independent of specific test procedures and therefore are suited for use in an unsupervised setting. Our future research will include the evaluation of our method in a large prospective study.

Nursing process documentation systems in clinical routine—prerequisites and experiences

Documentation of the nursing process is an important, but often neglected part of clinical documentation. Paper-based systems have been introduced to support nursing process documentation. Frequently, however, problems, such as low quality and high writing efforts, are reported. However, it is still unclear if computer-based documentation systems can reduce these problems. At the Heidelberg University Medical Center, computer-based nursing process documentation projects began in 1998. A computer-based nursing documentation system has now been successfully introduced on four wards of three different departments, supporting all six phases of the nursing process. The introduction of the new documentation system was accompanied by systematic evaluations of prerequisites and consequences. In this paper, we present preliminary results of this evaluation, focusing on prerequisites of computer-based nursing process documentation. We will discuss in detail the creation and use of predefined nursing care plans as one important prerequisite for computer-based nursing documentation. We will also focus on acceptance issues and on organizational and technical issues.

ICT-based health information services for elderly people: Past experiences, current trends, and future strategies

Although health information is readily available on the Internet and has changed the way people deal with their health in many ways, the retrieval of relevant information remains problematic, especially for elderly people. With a focus on elderly people, this paper summarizes current trends in consumer health informatics, discusses past and present intiatives providing health-information services, and proposes a future strategy for the design of sustainable services. A systematic literature review and a review of past German and EU projects concerned with health information services for elderly people are given. Many publications focus on health information services for specific diseases and on their quality and semantic accessibility, yet few deal with presenting and customizing health information for elderly and disabled people. Past experiences from Germany suggest that very often the specific needs of this target group are not met, and therefore accessibility remains largely hypothetical. We propose a strategy with five key points for the design of sustainable health-information services for elderly people. More research is needed to customize web-based health information services to the needs of the user group that needs them most urgently—elderly and disabled people.