"All Quiet on the Western Front" - Clinical Information Systems Research in the Year 2021.

OBJECTIVES: In this synopsis, we give an overview of recent research and propose a selection of best papers published in 2021 in the field of Clinical Information Systems (CIS). METHOD: As CIS section editors, we annually apply a systematic process to retrieve articles for the IMIA Yearbook of Medical Informatics. For eight years now, we use the same query to find relevant publications in the CIS field. Each year we retrieve more than 2,400 papers which we categorize in a multi-pass review to distill a preselection of up to 15 candidate papers. External reviewers and yearbook editors then assess the selected candidate papers. Based on the review results, the IMIA Yearbook editorial board chooses up to four best publications for the section at a selection meeting. To get a comprehensive overview of the content of the retrieved articles, we use text mining and term co-occurrence mapping techniques. RESULTS: We carried out the query in mid-January 2022 and retrieved a deduplicated result set of 2,688 articles from 1,062 different journals. This year, we nominated ten papers as candidates and finally selected two of them as the best papers in the CIS section. As in the previous years, the content analysis of the articles revealed the broad spectrum of topics covered by CIS research, but - on the other side - no real innovations or new upcoming research trends. However, the significant impact of COVID-19 on CIS research was observable also this year. CONCLUSIONS: The trends in CIS research, as seen in recent years, continue to be observable. The content analysis revealed nothing really new in the CIS domain. What was very visible was the impact of the COVID-19 pandemic, which still effects our lives and also CIS.

Data Exchange Standards in Teleophthalmology: Current and Future Developments.

BACKGROUND: Teleophthalmology services are considered capable of supporting screening, early diagnosis, and monitoring of leading causes of blindness on a global scale. Therefore, standards and best practices are needed to seamlessly exchange medical ocular images and related data among relevant stakeholders with maximum interoperability. OBJECTIVES: This paper provides an overview of current standards in the field of store-and-forward teleophthalmology data exchange and further developments in this area. METHODS: A literature review was conducted for healthcare standards with a focus on data exchange in ophthalmology. RESULTS: IHE, HL7 FHIR, DICOM, and clinical terminologies are considered the most important standards, providing distinct concepts, solutions, and guidelines for ophthalmology. CONCLUSION: Available standards provide the necessary base for teleophthalmology on technical and semantic interoperability, but practical use is limited due to missing process interoperability resulting in proprietary interfaces of vendors and rejection by ophthalmologists. Further investigations should analyze processual needs on ophthalmology data exchange standards.

Real-Time & Autonomous Data Transmission for Vital-Sign Telemonitoring: Requirements & Conceptualization.

The alpine space is challenging for mobile care organizations as rural homes of patients are often characterized through long way distances or might be sometimes even isolated due to weather conditions. Real-time monitoring features for supporting mobile care require the easy conduction of self-measurements on vital signs for patients. Therefore, a vital sign telemonitoring system got conceptualized, utilizing the potential of Information and Communication Technology (ICT). The aim of this work was to gather technical and user-related requirements for a patient-centered telemonitoring system. Therefore, a mixed approach was followed comprising a comprehensive technical review, a literature review and interviews with stakeholders. Suitable use cases were derived from the gathered technical and user-related requirements. The results yielded to a concept for a seamless integrated, unobtrusive home monitoring system for elderly people with real-time data synchronization and communication features to support the mobile nurse organization, which got implemented and evaluated in the field. The concept overcomes known barriers of usability on telemonitoring systems like complex interaction which might lead to more efficiency and effectiveness in mobile nursing. The developed concept got further implemented as a prototype and validated within a 3-month test period.

Managing Complexity. From Documentation to Knowledge Integration and Informed Decision Findings from the Clinical Information Systems Perspective for 2018.

OBJECTIVE: To summarize recent research and to propose a selection of best papers published in 2018 in the field of Clinical Information Systems (CIS). METHOD: Each year a systematic process is carried out to retrieve articles for the CIS section of the IMIA Yearbook of Medical Informatics and to select a set of pest papers for the section. The same query as in the last five years was used. The retrieved articles were categorized in a multi-pass review carried out by the two section editors. The final selection of candidate papers was then peer-reviewed by Yearbook editors and external reviewers. Based on the review results the best papers were then chosen at the selection meeting with the IMIA Yearbook editorial board. Text mining, and term co-occurrence mapping techniques were again used to get an overview of the content of the retrieved articles. RESULTS: The query was carried out in mid-January 2019, yielding a consolidated, deduplicated result set of 2,264 articles which had been published in 957 different journals. This year, we nominated twelve papers as candidates and three of them were finally selected as best papers in the CIS section. Again, the content analysis of the articles revealed the broad spectrum of topics which is covered by CIS research. CONCLUSIONS: We could observe ongoing trends from our 2017 analysis. The patient increasingly moves in the focus of the research activities and trans-institutional aggregation of data is still an important field of work. The move to use patient and other clinical data directly for the patient and to support data driven process management, the move away from clinical documentation to patient-focused knowledge generation and support of informed decision, is gaining momentum by the application of new or already known but, due to technological advances, now applicable methodological approaches.

Effects of Adult Patient Portals on Patient Empowerment and Health-Related Outcomes: A Systematic Review.

Patient portals are offered by health care organizations to facilitate health information sharing and patient empowerment and support patient-centered care. The aim of this systematic review is to assess the effect of patient portals on patient empowerment and health-related outcomes. After a systematic literature search, ten randomized controlled trials (RCTs) were included in this review. Of these, seven RCTs were conducted in the United States., two in Canada, and one in Japan. Study characteristics, risk of bias, and outcomes were extracted. varied in terms of intervention, included patients, and outcome. Most studies found no or only a small, clinically non-relevant effect of patient portals. The review showed that future research should develop a taxonomy to describe patient portal functionalities to facilitate the aggregation of evidence.

Impact of Students' Presence and Course Participation on Learning Outcome in Co-Operative Online-based Courses.

Socio-constructive instructional designs for online-based learning focus on interaction and communication of students to allow in-depth learning. The objective of this study is to analyze whether increased interaction of students in online-based learning settings may contribute to better outcome. We developed indicators for presence, participation, and interactivity of students. We extracted log data from the learning management system for 31 students in 10 online courses (n=123 course attendances). We correlated indicators to final grades and also applied a decision tree based machine learning approach. We found only weak to moderate correlations between the indicators and final grades, but acceptable results concerning prediction of students' success based on the indicators. Our results support the theory that student presence and participation in online-based courses is related to learning outcome.

On the Way to Close the Loop in Information Logistics: Data from the Patient - Value for the Patient.

OBJECTIVE: To summarize recent research and to propose a selection of best papers published in 2017 in the field of Clinical Information Systems (CIS). METHOD: Each year a systematic process is carried out to retrieve articles and to select a set of best papers for the CIS section of the International Medical Informatics Association (IMIA) Yearbook of Medical Informatics. The query aiming at identifying relevant publications in the field of CIS was refined by the section editors during the last years. For three years now, the query is stable. It comprises search terms from the Medical Subject Headings (MeSH) thesaurus as well as additional free text search terms from PubMed and Web of Science®. The retrieved articles were categorized in a multi-pass review carried out by the two section editors. The final selection of candidate papers was then peer-reviewed by Yearbook editors and external reviewers. Based on the review results, the best papers were then selected by the IMIA Yearbook editorial board. Text mining, and term co-occurrence mapping techniques were used to get an overview on the content of the retrieved articles. RESULTS: The query was carried out in mid-January 2018, yielding a consolidated result set of 2,255 articles which had been published in 939 different journals. Out of them, 15 papers were nominated as candidate best papers and four of them were finally selected as best papers in the CIS section. Again, the content analysis of the articles revealed the broad spectrum of topics which is covered by CIS research. CONCLUSIONS: Modern clinical information systems serve as backbone for a very complex, trans-institutional information logistics process. Data that is produced by, documented in, shared via, organized in, presented by, and stored within clinical information systems is more and more reused for multiple purposes. We found a lot of examples showing the benefits of such data reuse with various novel approaches implemented to tackle the challenges of this process. We also found that the patient moves in the focus of interest of CIS research. So the loop of information logistics begins to close: data from the patients is used to produce value for the patients.

Developing and Evaluating Collaborative Online-Based Instructional Designs in Health Information Management.

The number of students enrolled in online courses is increasing steadily. Distance education offers many advantages, but also has inherent challenges. Successful distance education needs a thoughtfully designed instructional strategy where students are supported to actively create knowledge. We present the design and evaluation of three online-based courses in health informatics. The courses were based on a collaborative instructional strategy. The evaluation comprised workload analysis, student evaluation, student interviews and student reflections. Students expressed high satisfaction with online learning, despite a high workload, and high perceived learning outcomes. Using the Community of Inquiry framework as reference, we found very high levels of teaching presence, social presence and cognitive presence. Summarizing, we found that the chosen instructional strategy supported student-centered, collaborative learning. We conclude by presenting lesson learned for online-based instructional design.

An Approach for the Support of Semantic Workflows in Electronic Health Records.

With the unprecedented increase of healthcare data, technologies need to be both, highly efficient for the meaningful utilization of accessible data and flexible to adapt to future challenges and individual preferences. The OntoHealth system makes use of semantic technologies to enable flexible and individual interaction with Electronic Health Records (EHR) for physicians. This is achieved by the execution of formally modelled clinical workflows and the composition of Semantic Web Services (SWS). Several seamless components provide a service-oriented structure defined by individual designed EHR-workflows. This work gives an overview of the planned architecture and its main components. The architecture constitutes the basis for the prototype implementation of all components. With its highly dynamic structure based on SWS, the architecture will be able to cope with both, the individual users' needs as well as the quick evolving healthcare domain.

Building a Semantic Model to Enhance the User's Perceived Functionality of the EHR.

In order to facilitate and increase the usability of Electronic Health Records (EHRs) for healthcare professional's daily work, we have designed a system that enables functional and flexible EHR access, based on the execution of clinical workflows and the composition of Semantic Web Services (SWS). The backbone of this system is based on an ontology. In this paper we present the strategy that we have followed for its design, and an overview of the resulting model. The designed ontology enables to model patient-centred clinical EHR workflows, the involved sequence of tasks and its associated functionality and managed clinical data. This semantic model constitutes also the main pillar for enabling dynamic service selection in our system.

Dynamic User Interfaces for Service Oriented Architectures in Healthcare.

Electronic Health Records (EHRs) play a crucial role in healthcare today. Considering a data-centric view, EHRs are very advanced as they provide and share healthcare data in a cross-institutional and patient-centered way adhering to high syntactic and semantic interoperability. However, the EHR functionalities available for the end users are rare and hence often limited to basic document query functions. Future EHR use necessitates the ability to let the users define their needed data according to a certain situation and how this data should be processed. Workflow and semantic modelling approaches as well as Web services provide means to fulfil such a goal. This thesis develops concepts for dynamic interfaces between EHR end users and a service oriented eHealth infrastructure, which allow the users to design their flexible EHR needs, modeled in a dynamic and formal way. These are used to discover, compose and execute the right Semantic Web services.

Robotic Assistance in Medication Management: Development and Evaluation of a Prototype.

An increasing number of elderly people and the prevalence of multimorbid conditions often lead to age-related problems for patients in handling their common polypharmaceutical, domestic everyday medication. Ambient Assisted Living therefore provides means to support an elderly's everyday life. In the present paper we investigated the viability of using a commercial mass-produced humanoid robot system to support the domestic medication of an elderly person. A prototypical software application based on the NAO-robot platform was implemented to remind the patient for drug intakes, check for drug-drug-interactions, document the compliance and assist through the complete process of individual medication. A technical and functional evaluation of the system in a laboratory setting revealed versatile and viable results, though further investigations are needed to examine the practical use in an applied field.

Requirements for Workflow-Based EHR Systems - Results of a Qualitative Study.

BACKGROUND: Today's high quality healthcare delivery strongly relies on efficient electronic health records (EHR). These EHR systems or in general healthcare IT-systems are usually developed in a static manner according to a given workflow. Hence, they are not flexible enough to enable access to EHR data and to execute individual actions within a consultation. OBJECTIVES: This paper reports on requirements pointed by experts in the domain of diabetes mellitus to design a system for supporting dynamic workflows to serve personalization within a medical activity. METHODS: Requirements were collected by means of expert interviews. These interviews completed a conducted triangulation approach, aimed to gather requirements for workflow-based EHR interactions. The data from the interviews was analyzed through a qualitative approach resulting in a set of requirements enhancing EHR functionality from the user's perspective. RESULTS: Requirements were classified according to four different categorizations: (1) process-related requirements, (2) information needs, (3) required functions, (4) non-functional requirements. CONCLUSION: Workflow related requirements were identified which should be considered when developing and deploying EHR systems.

A software tool to analyze clinical workflows from direct observations.

Observational data of clinical processes need to be managed in a convenient way, so that process information is reliable, valid and viable for further analysis. However, existing tools for allocating observations fail in systematic data collection of specific workflow recordings. We present a software tool which was developed to facilitate the analysis of clinical process observations. The tool was successfully used in the project OntoHealth, to build, store and analyze observations of diabetes routine consultations.

A nationwide computerized patient medication history: evaluation of the Austrian pilot project "e-Medikation".

PURPOSE: To manage medication treatment and to assure medication safety, health care professionals need a complete overview of all drugs that have been prescribed or are taken by a patient. In 2009, Austria launched the pilot project "e-Medikation" in three pilot regions. E-Medikation gives access to a patient's nationwide medication list and includes medication safety checks. The objective of this paper is to report on the evaluation results and lessons learnt. METHODS: A formative evaluation study performed between July and December 2011 comprised a standardized survey of participating physicians, pharmacists, and patients, as well as an analysis of the e-Medikation log files. RESULTS: During the evaluation period, 18,310 prescriptions and 13,797 dispensings were documented, and 22,359 medication safety checks were performed. Overall, 61 physicians, 68 pharmacists, and 553 patients responded to a written survey. The results showed high acceptance of the idea of e-Medikation among pharmacists and patients and mixed acceptance among physicians. The satisfaction with the quality of the software used in the pilot project was low. CONCLUSIONS: The overall aim to increase medication safety seems achievable through e-Medikation, but several limitations of the pilot project need to be solved before a national rollout. Based on the evaluation results and after redesign of e-Medikation, Austria is now planning a nationwide introduction of e-Medikation starting in 2015.

The impact of electronic patient portals on patient care: a systematic review of controlled trials.

BACKGROUND: Modern information technology is changing and provides new challenges to health care. The emergence of the Internet and the electronic health record (EHR) has brought new opportunities for patients to play a more active role in his/her care. Although in many countries patients have the right to access their clinical information, access to clinical records electronically is not common. Patient portals consist of provider-tethered applications that allow patients to electronically access health information that are documented and managed by a health care institution. Although patient portals are already being implemented, it is still unclear in which ways these technologies can influence patient care. OBJECTIVE: To systematically review the available evidence on the impact of electronic patient portals on patient care. METHODS: A systematic search was conducted using PubMed and other sources to identify controlled experimental or quasi-experimental studies on the impact of patient portals that were published between 1990 and 2011. A total of 1,306 references from all the publication hits were screened, and 13 papers were retrieved for full text analysis. RESULTS: We identified 5 papers presenting 4 distinct studies. There were no statistically significant changes between intervention and control group in the 2 randomized controlled trials investigating the effect of patient portals on health outcomes. Significant changes in the patient portal group, compared to a control group, could be observed for the following parameters: quicker decrease in office visit rates and slower increase in telephone contacts; increase in number of messages sent; changes of the medication regimen; and better adherence to treatment. CONCLUSIONS: The number of available controlled studies with regard to patient portals is low. Even when patient portals are often discussed as a way to empower patients and improve quality of care, there is insufficient evidence to support this assumption.

Physicians' perceptions on the usefulness of contextual information for prioritizing and presenting alerts in Computerized Physician Order Entry systems.

BACKGROUND: One possible approach towards avoiding alert overload and alert fatigue in Computerized Physician Order Entry (CPOE) systems is to tailor their drug safety alerts to the context of the clinical situation. Our objective was to identify the perceptions of physicians on the usefulness of clinical context information for prioritizing and presenting drug safety alerts. METHODS: We performed a questionnaire survey, inquiring CPOE-using physicians from four hospitals in four European countries to estimate the usefulness of 20 possible context factors. RESULTS: The 223 participants identified the 'severity of the effect' and the 'clinical status of the patient' as the most useful context factors. Further important factors are the 'complexity of the case' and the 'risk factors of the patient'. CONCLUSIONS: Our findings confirm the results of a prior, comparable survey inquiring CPOE researchers. Further research should focus on implementing these context factors in CPOE systems and on subsequently evaluating their impact.

The status of IT service management in health care - ITIL® in selected European countries.

BACKGROUND: Due to the strained financial situation in the healthcare sector, hospitals and other healthcare providers are facing an increasing pressure to improve their efficiency and to reduce costs. These trends challenge health care organizations to introduce innovative information technology (IT) based supportive processes. To guarantee that IT supports the clinical processes perfectly, IT must be managed proactively. However, until now, there is only very few research on IT service management especially on ITIL® implementations in the health care context. METHODS: The current study aims at exploring knowledge about and acceptance of IT service management (especially ITIL®) in hospitals in Austria and its neighboring regions Bavaria (Germany), Slovakia, South Tyrol (Italy) and Switzerland. Therefore highly standardized interviews with the respective head of information technology (CIO, IT manager) were conducted for selected hospitals from the different regions. In total 75 hospitals were interviewed. Data gathered was analyzed using descriptive statistics and where necessary methods of qualitative content analysis. RESULTS: In most regions, two-thirds or more of the participating IT managers claim to be familiar with the concepts of IT service management and of ITIL®. IT managers expect from ITIL® mostly better IT services, followed by an increased productivity and a reduction of IT cost. But only five hospitals said to have implemented at least parts of ITIL®, and eight hospitals stated to be planning to do this in the next two years. When it comes to ITIL®, Switzerland and Bavaria seem to be ahead of the other countries. There, the highest levels of knowledge, the highest number of implementations or plans of an implementation as well as the highest number of ITIL® certified staff members were observed. CONCLUSION: The results collected through this study indicate that the idea of IT services and IT service management is still not widely recognized in hospitals in the countries and regions of the study. It is also indicated that hospitals need further assistance in order to be able to successfully implement ITIL®. Overall, research on IT service management and ITIL® in health care is rare.

Patient empowerment by electronic health records: first results of a systematic review on the benefit of patient portals.

Patient portals provide patients with access to a provide-managed electronic health record (EHR). They may provide an interesting approach to increase patient empowerment. The objective of this paper is to provide a first overview of the state-of-the-art and the impact of patient portals. Based on a systematic literature search, we identified five evaluation studies on patient portals. These studies demonstrate only little effect of patient portals on patient empowerment.

SeReM2--a meta-model for the structured definition of quality requirements for electronic health record services.

Quality assurance is a major task with regard to Electronic Health Records (EHR). Currently there are only a few approaches explicitly dealing with the quality of EHR services as a whole. The objective of this paper is to introduce a new Meta-Model to structure and describe quality requirements of EHRs. This approach should support the transnational quality certification of EHR services. The Model was developed based on interviews with 24 experts and a systematic literature search and comprises a service and requirements model. The service model represents the structure of a service whereas the requirements model can be used to assign specific predefined aims and requirements to a service. The new model differs from existing approaches as it accounts for modern software architectures and the special attributes of EHRs.