Improving the safety and quality of nursing care through standardized operating procedures in Bosnia and Herzegovina.

AIM: We explored how selected 'positive deviant' healthcare facilities in Bosnia and Herzegovina approach the continuous development, adaptation, implementation, monitoring and evaluation of nursing-related standard operating procedures. BACKGROUND: Standardized nursing care is internationally recognized as a critical element of safe, high-quality health care; yet very little research has examined one of its key instruments: nursing-related standard operating procedures. INTRODUCTION: Despite variability in Bosnia and Herzegovina's healthcare and nursing care quality, we assumed that some healthcare facilities would have developed effective strategies to elevate nursing quality and safety through the use of standard operating procedures. METHODS: Guided by the 'positive deviance' approach, we used a multiple-case study design to examine a criterion sample of four facilities (two primary healthcare centres and two hospitals), collecting data via focus groups and individual interviews. FINDINGS: In each studied facility, certification/accreditation processes were crucial to the initiation of continuous development, adaptation, implementation, monitoring and evaluation of nursing-related SOPs. In one hospital and one primary healthcare centre, nurses working in advanced roles (i.e. quality coordinators) were responsible for developing and implementing nursing-related standard operating procedures. Across the four studied institutions, we identified a consistent approach to standard operating procedures-related processes. CONCLUSIONS: The certification/accreditation process is enabling necessary changes in institutions' organizational cultures, empowering nurses to take on advanced roles in improving the safety and quality of nursing care. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Standardizing nursing procedures is key to improve the safety and quality of nursing care. Nursing and Health Policy are needed in Bosnia and Herzegovina to establish a functioning institutional framework, including regulatory bodies, educational systems for developing nurses' capacities or the inclusion of nursing-related standard operating procedures in certification/accreditation standards.

Foreknowledge of the Fourth Semester Students about Medical Informatics at the Medical Faculty University of Sarajevo.

INTRODUCTION: High educational and teaching standards were the main reason why from the begging student satisfaction surveys and assessments of the students' knowledge, attitudes and opinions were paramount in the educational process at the Cathedra for Medical Informatics at the Medical Faculty University of Sarajevo. AIM: The aim of this study was to evaluate general knowledge of the fourth semester students about informatics and medical informatics and compare it with previous generations. METHODS: Students at the beginning of the fourth semester and before second planned lectures receive "Questionnaire for biomedical students about use and knowledge of information technologies". Collected data was retrospectively used for this study. The scientific study committee of the Cathedra for Medical Informatics reviewed and approved the database for using this study. At the beginning of the survey, all students were informed that their data could be tracked. Also, all students were informed and got lectures on surveys, development and use of questionnaires for the examination of the patient/student satisfactions and how results of the survey and analysis could help continuously improving quality of the teaching process. DISCUSSION AND CONCLUSION: Medical students come to the faculty with significant IT knowledge and skills. It can even be argued that students rank their knowledge in some way lower than we as teachers estimate based on their practical work. They organize groups on social networks where they exchange information about lectures and exams. It is common for each study year to have its own group. Through this group, information and presentations that teachers send to students are exchanged. One of the goals of teaching medical informatics is the method of searching for medical information on the Internet. The skills learned in medical informatics classes complement those learned earlier and provide a solid base for physicians who are able to supplement their knowledge using IT technologies when they need it.

Measures to Improve Integration of Healthcare in Federation of Bosnia and Herzegovina.

INTRODUCTION: In its annual report for 2008, the World Health Organization (WHO) states fragmentation is one of the five most common shortcomings experienced by health systems in health care provision, while an integrated healthcare model can significantly improve efficacy/efficiency, reduce visits to doctors, improve patient satisfaction, and ensure safe and quality healthcare. AIM: The aim of our study is to point out importance of the cooperation between healthcare professionals from different sectors, institutions and levels of care involved in patient treatment and care and to propose measures for integration including criteria for clinical review and audit. METHODS: In this paper, feedback and results from three workshops held in Tuzla on October 16th, 2007, Bihac on December 9th, 2013, and Sarajevo on November 24th, 2018, were analyzed. All three workshops used the same methodology: first they have had a lecture on the topic of "Interface theory and protection blocks in the health system" and the second part took the form of six working groups in accordance with participants' affinities and places of employment. RESULTS: The measures proposed to improve the interface are included: Development and adoption existing of clinical practice guidelines and pathways; Maintain joint working group meetings; Eliminate conflicts between PHC and hospital care and seek consensus through formal cooperation. Criteria for clinical audit of the PHC-hospital interface are: annual analysis of unnecessary or inadequate referrals as well as of any duplication of tests and prescriptions (failure to control costs); joint planning of preventive treatments (including the ministry and public health authorities); and clear responsibilities related to screening programs and patient path analysis. DISCUSSION: Standardized communication protocols should be used to improve communication between health professionals at different levels and to moderate integration processes and protect data. CONCLUSION: Regular communication between healthcare professionals across the various institutions and levels of health care is a prerequisite for organizational, functional, service and clinical integration.

Medical audit of diabetes mellitus in primary care setting in Bosnia and Herzegovina.

AIM: To assess the quality of diabetes care provided by family medicine teams in primary health centers in Bosnia and Herzegovina (BH) through a medical audit, addressing the extent to which clinical practice complied with pre-determined explicit criteria of long-term management. METHOD: Retrospective analysis included randomly selected medical records of patients with type 1 or 2 diabetes mellitus treated by 18 family medicine teams at 5 locations in BH, included in the Canadian International Development Agency/World Health Organization project "Strengthening health care systems in BH with focus on primary health care/family medicine model." Audit record form contained 24 questions on sex, age, diabetes type, body mass index (BMI), hypertension, family anamnesis, annual examinations (HbA1C, BMI, lipid profile or total cholesterol, blood creatinine, neurological examination, urinalysis for albuminuria, foot care, and examination of ocular fundus), smoking habits, alcohol consumption, patient education, prescribed insulin and other drugs, and patient's health care-seeking behavior. Standardized and record forms were returned anonymously with 99.3% response rate. RESULTS: Records of 536 patients with diabetes were analyzed (64% women and 87% patients with diabetes mellitus type 2). Family medicine teams showed poor compliance with established criteria for diabetes control. Metabolic control (69.5%) was acceptable, but the level of monitoring complications of diabetes (foot and ocular fundus examined in 53.4% and 53% of patients, respectively) was low. There were also considerable variations in diabetes management between different centers as well as between the teams in the same center. CONCLUSION: The audit revealed deficiencies in the quality of diabetes care and variations in care provision between primary care teams. Clinical guidelines and continuing education about acceptable diabetes care should be developed and implemented in BH.

How to assess and improve quality of medical education: lessons learned from Faculty of Medicine in Sarajevo.

There is no such science as medicine where half life is 7 years, what means that in 3-4 years 50% of current knowledge will be wrong. If doctors use old techniques and methods then they will cure patients wrongly. Very fast and rapid increase of biomedical sciences and medical information in certain way force medical professionals to continuity learning in order to stay update. In this project a quantitative method of examination has been used. For the purposes of the research a survey questionnaires were created consisted of 28, 35 and 18 questions for all three groups of examinees. Beside general characteristics (sex, age, faculty, and year of studies) the questionnaire included questions referring to the variables of structure, process and results in the system of education. Authors used Lickert five degree scale for the evaluation. Total of 521 students of the faculties of biomedical science in Sarajevo were surveyed; students of the Faculty of Medicine, Faculty of Dental Medicine (Stomatology), Faculty of Pharmacy, Nursing College, students of final year and postgraduate students from Faculty of Medicine, University of Sarajevo. On the basis of survey results authors concluded that the following should be done: The reform needs to be carried out in accordance with possibilities and needs, general faculty rules should include regulations that refer to insuring the quality of education, a continuous quality of studying needs to be insured - internal and external evaluation of the quality of work of respective education institution needs to be carried out, education standards need to be set, i.e. minimum knowledge and skills which a student needs to gain during studies is to be set, curriculums and programs need to be harmonized with countries in the region and Western Europe, Regular evaluation of lecturers needs to be done, Increase of size and content of the practical part of teaching needs to be encouraged as well as distance learning organized on Cathedra for Medical Informatics and Family Medicine at Faculty of Medicine in Sarajevo, increase of international and regional mobility of students needs to be encouraged, students need to be included in the faculty reform, panel discussions need to be organized where students will be informed on the reform progress, where students can talk about their problems, give suggestions and solutions to certain situations. Students are motivated to study further when their ideas are accepted, the number of books in libraries needs to increase in accordance with financial possibilities and audio/visual and electronic aids need to be purchased and in place. Concept of quality incorporates at least three dimensions and has three different meanings. Those are: - Comparative meaning in terms of the level of perfectionist, - Quantitative meaning in terms of the level accessed and - Appropriateness for certain purpose. Objective of this study is to begin process of improvement of educational process at biomedical faculties at University of Sarajevo, but ultimate goal of all involved in medical education should be large number of health professionals who will be able to work independently and cure patients in best manner in 21st century.

Medical education and role of medical informatics.

Bosnia and Herzegovina (BiH), as developing country in transition, has to shift from traditional ways of learning to the transformation of the university education in accordance with Bologna process and educational standards in European Union. In the light of these changes authors conducted research at bio-medical faculties in Sarajevo in order to address issues of the education of future physicians and especially role of medical informatics in their under and post graduate studies and continuous medical education. As per given results in this study, current quality of medical education at biomedical faculties, University of Sarajevo, is unsatisfactory due to several reasons and some among others are those traditionally seen as "computer literacy". Problems are determined and recommendations are given for decision makers to support transformation of BiH medical educational system to have physicians, dentists, pharmacists and nurses who possess the knowledge, skills and attitudes required to be competent in medical informatics if they wish to incorporate into their practices systematic approaches for promoting and maintaining the health of defined populations.

[Medical informatics education at medical schools in Bosnia and Herzegovina]. / Medicinska informatika na medicinskim fakultetima u bosni i hercegovini.

AIM: Standardization of education process and almost every aspect of life in EU moved the authors of this paper to evaluate medical informatics education at medical schools in Bosnia and Herzegovina. A very complex political structure and existence of two entities, one district and ten cantons in the Federation of Bosnia and Herzegovina caused great differences in the curricula, teaching methods and quality of acquired knowledge among medical schools in the country. Also, on the example of the teaching process at the Medical School, University of Sarajevo, the authors propose a future united and integrated system in the area. METHOD: Method of the study is descriptive, comparing education in medical informatics at five B&H medical schools. Over 500 students answered questionnaires designed at medical schools in Sarajevo and Tuzla. The questions tackled the contents of the subject of medical informatics, the possibility of acquiring knowledge from both practical and theoretic lessons, "good" and "bad" sides of the curricula as well as students' computer literacy. RESULTS: The subject of medical informatics is being taught in at least 3-4 different ways. Medical schools in Banja Luka and Foca/Srbinje are under a strong influence of the University of Belgrade, Serbia and Montenegro; the teaching staff in Mostar are from Croatia; the University of Tuzla has its own way; and Medical School in Sarajevo maintains high quality values and principles. Things and events that distinguish the Medical School, University of Sarajevo is the fact that it is the only medical school in Bosnia and Herzegovina which has a web site of of the Department of Medical Informatics, organized a number of events including a distance learning course, and has a highly competent teaching staff. Medical School in Sarajevo is the oldest medical school in Bosnia and Herzegovina established in 1944. As a required subject, medical informatics was introduced in the academic year 1992/1993, and it is the only medical school in Bosnia and Herzegovina where medical informatics is taught in two semesters, second and eleventh. DISCUSSION: Three important areas are discussed: the quality of education in secondary schools should be improved; the lack of multimedia equipment, good LAN, high-speed connection to Internet and well organized web design, and issues related to maintenance of equipment; and students should have free access to computer rooms to enable them to extend their knowledge in spare time; general information about health system should be available to students to allow them to require the role and importance of medical informatics in "real life". Naturally, we raise the question of unique and systematic medical informatics education in the whole country, irrespective of entities, nationality or religion of students. CONCLUSION: Medical informatics education at Medical School, University of Sarajevo, is based on the same concept as on prestigious universities all over the world and in accordance with recommendations of the working groups on education of EFMI and IMIA. Other medical schools in Bosnia and Herzegovina should employ the same methodology and system of work in order to have standardized education in medical informatics and to achieve high quality in education. To enable us to follow the European and global achievements in this area, the power of fact should predominate in the education system as well as in the health system.

Web based distance learning at Faculty of Medicine of Sarajevo University.

The time in which we live is defined by the significant influence of the information technologies on our lives, changes and development of society and the efficacy of all the organization systems. Increase and development of distance learning (DL) technologies over the past decade has exposed the potential and the efficiency of new technologies. Number of events has organized by teaching staff from Cathedrae for Medical Informatics in order to promote distance learning and web based education are very extensive: professional-scientific events, workshops and congresses, first tele-exam at the Medical Faculty, Introducing of Distance learning in curriculum at biomedical faculties, etc. At the University in Sarajevo in year 2003 was opened the e-learning center for the support to the faculties the distance studies by use of the information technology. At Medical Faculty of University of Sarajevo at Cathedrae for Medical Informatics since 2002 is in progress realization of the project named: "Possibilities of introducing distance learning in medical curriculum", approved by the Federal and the Cantonal ministry of science and education. Pilot project was realized during three past school years, theoretical and practical education of subject Medical informatics are adapted to the new concepts of education using world trends of education from the distance. One group of students was included in the project finalized by electronic exam registration and electronic exam on 20 June 2005, publicly, in the Physiology amphitheatre of the Medical Faculty in Sarajevo.

FIRST BH COCHRANE SYMPOSIUM HELD.

The first BH Cochrane Symposium was held on 12 October 2015 in Sarajevo, Bosnia and Herzegovina (BH), organized by the Agency for Quality and Accreditation in Healthcare in Federation of BH (AKAZ) and Medical Faculty University of Sarajevo. A group of ten national and international experts presented the Cochrane organization and systematic reviews, as well as the IMPACT Observatory, development of guidelines in BH, and the role of AKAZ. Examples of the development and use of Cochrane reviews in evidence informed decision making in health as well as research integrity were presented and discussed. Major BH decision makers and interested professionals from all over BH participated in a symposium and its lively discussion, especially from the perspective of Cochrane and its activities in BH, and the collaboration with the Croatian Cochrane. It can be expected that this symposium will inspire further growth of participation and use of Cochrane in BH and increase the awareness of various aspects of evidence informed medicine and research integrity.

Application of Agree II Instrument for Appraisal of Postpartum Hemorrhage Clinical Practice Guidelines in Bosnia and Herzegovina.

INTRODUCTION: Federal Minister of Health and Minister of Health and Social Welfare of the Republika Srpska as a Governmental health authorities in Federation of Bosnia and Herzegovina (FBiH) and the Republika Srpska nominated/appointed health professionals as their representatives to a multidisciplinary Guidelines Adaptation Group (GAG). This group started with its work in September 2015. The main purpose of the guidelines development exercise is to develop guidelines with worldwide recognized methodology for clinical guidelines development and adaptation. At the end of this consultancy, GAG would have develop a clinical practice guideline on Postpartum hemorrhage (PPH) through the adaptation method, starting from published international clinical guidelines and adapting it according to the country specific requirements. METHODOLOGY: During the process of identifying the best guideline for adaptation, the GAG had to pass several steps. One of the crucial steps was to identify the questions related to clinical practice and health policy for which answers are needed to be addressed by the guideline. These questions included relevant issues regarding the topic area such as diagnosis, prognosis, intervention, service delivery, and training. After that, six guidelines have been researched by the six members of the GAG to see if they answered the identified questions. Evaluating the methodological quality of the selected clinical guidelines was a second essential step before deciding which ones could best fit the needs and interests. AGREE II instrument has been chosen as methods for evaluating clinical guideline quality and appropriateness. Four appraisers conducted the assessment of each of the selected guidelines for PPH. All appraisers passed the training for the AGREE II instrument before conducting appraisals, as recommended by the AGREE collaboration. Each of the four guidelines was rated independently with the AGREE II tool by each appraiser. RESULTS: The highest score was obtained by the WHO recommendations for postpartum hemorrhage guidelines and each of four assessors recommended it to be adapted and further implemented. DISCUSSION: In spite of several serous attempts and two Agencies for quality improvement in BiH the whole process of guideline adaptation is still in the beginning and therefore the establishment of a strong connection with similar institutions and organizations from our region and the rest of the world is very important. Cooperation and collaboration across institutions and countries and key stakeholders have potential to significantly improve the validity and quality of the adapted guidelines and to positively influence implementation.

Ensuring patient safety.

Patient safety is key factor in the process of health care improvement. World Health Organization (WHO) as coordinating authority for health within the United Nations launched a World Alliance for Patient Safety dedicated to bringing significant benefits to patients. Patients for Patient Safety, one of ten action areas of the World Alliance, is designed to ensure that the perspective of patients and families, consumers and citizens, is a central reference point in shaping this important work. This action area is led by the patient safety consumer movement. In Bosnia and Herzegovina has not State Law to regulate patient safety, but Law on the System of Quality and Safety Improvement, and Accreditation in Healthcare in Federation of Bosnia and Herzegovina (FB&H) established Agency for Quality and Accreditation in the Health Care System of the FB&H as a competent entity in the field of improvement of quality and safety, and accreditation in healthcare. Beside the Agency, all service providers need to promote a culture of openness, fairness, accountability and transparency. Also, stakeholders involved in health care should recognize that patients can actively contribute to strengthening thuality and safety of health servicesthrough active participation and to insist on open dialogue, transparency and appropriate information on the potential risks that the health service incurs, as part of enhancing patient health literacy and involvement.

[Clinical audit as method of quality improvement of healthcare in patients with diabetes, stroke and in cesarean section]. / Klinicki audit kao metoda unapredenja kvaliteta zdravstvene usluge kod pacijenata sa dijabetesom, mozdanim udarom i kod carskog reza.

INTRODUCTION: Clinical audit is used as a term for any kind of audit leaded by professionals in health care, and should not be complicated or unpleasant job. AIM: The aim of this work is to demonstrate the variations in practice between doctors working in a health care organization and the institutions (health centers - DZ and hospitals). Variations in practical work show the difference in quality of work between the doctors and the institutions, as well as variations in the use of resources and expenditure costs. METHODS: Three different questionnaires had been developed for three different clinical entities: diabetes, cesarean section, and stroke. The questionnaires had been created in collaboration with experts from each of those medical entities and based on research of literature, and valorized by the questionnaire for creating audits and calculations of ACQ (Audit Criteria Questionnaire) score. RESULTS: Diabetes--The hugest disproportion is in not measuring (none evidencing) regular annual screenings for retina and foot, but albumin and creatinin are being controlled in very high percentage. Stroke: In hospital A in checked medical records side of cerebral lesion was evidenced regularly, what was different in hospital B, while in hospital B 100% of swallowing disorders were evidenced. Cesarean section: In hospital A the average period of preoperative length of stay is four days, while in hospital B it is 0.4 days, while the postoperative length of stay for both hospitals is 6 days. DISCUSSION: Clinical audit is a systematic analysis of quality of health care and as per the Accreditation standards for hospitals, published by the Federal Agency for Health Care Quality and Accreditation-AKAZ; it is mandatory to perform the clinical audit in 3-5 areas twice, in the year precedes the accreditation survey. CONCLUSION: Using small sample, authors proved big variations in practice among doctors and among health institutions as well. It has direct consequence on quality and costs and can be solved using AKAZ accreditation standards. It is very difficult to improve the quality of health care without regularly performed and documented clinical audits.

[Quality assesment of education at Faculty of Medicine University of Sarajevo]. / Ocjena kvaliteta edukacije na Medicinskom fakultetu Univerziteta u Sarajevu.

INTRODUCTION: Measurement of the quality of medical education and assessment of students' satisfaction in today world are necessary and it is of priceless importance. Students' requests are Increased and traditional way of education is insuffcient in the "era of information". New technologies change the way of our perception of the world, how we think, and communicate with others. METHODOLOGY: The survey was conducted on the sample of 48 students of the final year of the study of Medical faculty in Sarajevo in June 2006. Questionnaire has 24 process and outcome variables for the purpose of quality assessment of the education at the faculty. RESULTS: By measurement of the education quality for the students of final year of Medical faculty in Sarajevo with formatted questionnaires determined was average grade for the quality of lectures which is 3, quality of practical work is 2.9, and quality of the skills gained is 2.8. 77.5 % students attended lectures regularly, 80% are able to give injection in a vein, and 32.5% had training on models for reanimation, model for intubation or model for giving shots, since 92.5% of students have never worked independently ultra-sound examination. The most frequent objection for teachers were that they have not been trying to animate students and because that they do not use audio-visual equipment, assistants of professor very often have other duties during t he practice education and that they are not interested to transfer-their knowledge and experience to students. DISCUSSION AND CONCLUSION Majority of students consider having more practical work, more contacts with patients and that assistants of professor should point out some Interesting clinical cases. Answers on problems during learning and practical exercises majority o f students find on Internet, in not mandatory textbooks and just 7% of students got answers from professors of assistants of professor. Small number o f students in the process of learning use just mandatory textbooks, majority use other textbooks and Internet. Possibility to access professional literature is the largest over Internet. Majority of the student surveyed think that they have solid and good knowledge o fcomputer technology. More of 50 % of students assess that after the study that they will not be able to perform practice independently.

[Why B&H does not have law on health data protection?]. / Zasto BiH nema Zakon o zastiti medicinskih podataka?

Protection of private data is secured by number of laws in EU and in some aspects they consider clinical or medical data, or they are more common and therefore reflect on general data protection. Considering the fact that, there are no laws in Bosnia and Herzegovina on Data protection, neither Health Data protection, it could be concluded that, based on Law on free access to information in Bosnia and Herzegovina, patients cannot control dissemination of private and confidential information about their health and health status in general. The authors suggest creation of legislative in this area in Bosnia and Herzegovina in accordance with directive 95/46/EC of European Parliament and Council of Europe, which come into force in EU in 1997.

[Criteria how to choose adequate methodology and relevant variables for assessment of quality of primary healthcare]. / Kriteriji za izbor adekvatne metodologije i relevantnih varijabli za procjenu kvaliteta primarne zdravstvene zastite.

INTRODUCTION: Research of satisfaction of patients in the area of primary health care (PHC) and especially criteria how to choose best methodology and the relevant variables guided to the situation where activities were focused on description of the basic structure and processes of health care rather than on identification of needs for services and on result based assessment and satisfaction of patients with provided service. To give advantage to any of methodologies is inexplicable problem and depend of factors beyond of health service control. PURPOSE: Aim of this paper is to review existing measurements of healthcare for ones who intend to use measurements of quality of healthcare for clinical and research purposes and to recommend criteria how to choose adequate methodology and relevant variables for assessment of quality of primary healthcare. METHODOLOGY: For our study we used experience of the Cathedra for Medical Informatics, Medical faculty, University of Sarajevo with emphasis on research of quality of PHC. We selected over 3,000 users of PHC (patients-adults) in PHC units in ten cantons of Federation of Bosnia and Herzegovina. RESULTS: Statistically significant results we got when we crossed general attitude of patients about quality of healthcare with the following variables: place where patient receive healthcare, consultation with patients about patients' rights and life styles. We have not got statistically significant results when we crossed the following variables with general attitude of patients: distance from place of living to place where patients get healthcare, examination schedule in the units of PHC, continuity of healthcare, organization of field service and possibility to choose physician or nurse. CONCLUSION: Very often researchers create their own methods of measurement instead to carry out systematic review of existing ones to enable them to find appropriate one. In this paper we recommended guidelines for finding the most appropriate methods of health measurement using experience of the Cathedra for Medical Informatics, Medical faculty in Sarajevo.

[Possibilities of application of distance learning in medical curriculum]. / Mogucnosti uvodenja ucenja na daljinu u medicinski curriculum.

Possibilities of introduction of distance learning in medical curriculum is the title of project which commenced in 2002 at Cathedra for Medical Informatics of the Medical faculty in Sarajevo. Project is approved by Federal and Cantonal ministries of science and education. The purpose of this project is to support improvement of the educational process at biomedical faculties using contemporary methods, methodologies and information technologies in accordance with strategies and objectives given by Bologna declaration. Pilot project is attained after three years, theoretical and practical part of subject Medical Informatics are adapted to modern concepts of education using world trends of distance learning. One group of students from Medical faculty was involved in this project, which was finalized by electronic registration of exam and electronic testing on June 20, 2005 in public, in Physiological amphitheatre of Medical faculty in Sarajevo. In this article we have given complete description of this project as well as its basic adventages and disadvantages.

Distance learning at biomedical faculties in bosnia & herzegovina.

Increase and development of distance learning technologies over the past decade has exposed the potential and the efficiency of new technologies. Benefit and use of contemporary information technologies is the area where medical informatics got the most on understanding and importance. Definition of distance learning as "use of technologies based on health care delivered on distance" covers areas such as electronic health, tele-health (e-health), telematics, telemedicine, tele-education, etc. For the need of e-health, telemedicine, tele-education and distance learning there are various technologies and communication systems from standard telephone lines to the system of transmission digitalized signals with modem, optical fiber, satellite links, wireless technologies, etc. Tele-education represents health education on distance, using Information Communication Technologies(ICT), as well as continuous education of a health system beneficiaries and use of electronic libraries, data bases or electronic data with data bases of knowledge. In this paper authors described activities on introduction of distance learning in teaching process at Medical faculty, University of Sarajevo, Bosnia and Herzegovina. Internet was not really meant to be a means of human communication at first; but the clearly the Net become a main piece of human communication.

Education of medical informatics at Medical Faculty of Sarajevo.

The medical informatics as the separate medical discipline very quickly gets developed, both in Bosnia and Herzegovina. In our country, the medical informatics is a separate subject for the last ten years, regarding to the Medical curriculum at the biomedical faculties in Bosnia and Herzegovina is in accordance with the project of the education related to Bologna declaration and the project EURO MEDICINA. Last year the Chair of the Medical Informatics of the Medical Faculty in Sarajevo celebrates ten years of its existence. The research was performed using the separate questionnaire patterns data carriers with the defined characteristics for the quality assessment of the performed course. The total attitude of the assessed students speaks about dominantly expressed satisfaction with the majority of the parameters that are important for assessment of the quality and the tuition contents which were evaluated during the questionnaire. The education in the field of the medical informatics is based at the concept which is used in the developed countries of the world, and according the recommendations of the working groups of the European and world association of the medical informatics. The theoretical and practical teaching and training performance in the wholeness is performed by use of the computer equipment, and the final knowledge check of the students also is performed using the Data Base Management System MSAccess specifically designed to cover full teaching and training material by using questions set in the data base which encircled nearly 1500 questions combinations. In this paper author presents ten years of experience of medical informatics education at biomedical faculties in Bosnia and Herzegovina.

[Distance learning in medical education]. / Ucenje na daljinu u medicinskoj edukaciji.

Distance learning or learning from the distance represents the educative technique with occupies all more significant place in the actual medical education of the healthcare workers at the international plan, specuale in the domains of the postgraduated and continuous medical education. It represents the educative technique of the significant effectivness, wich has to have at the disposal both adequate technological infrastructure as well as the previous education of the lecturer and users, adapted teaching plans and evaluation mechanisms of knowledge. By use of the rich choice of technological models, in relation to the traditional method of learning, enables the simultaneous education to the great number of students of the various profiles, the approach to all the relevant data basis as well as the mechanism of the evaluation knowledge institutions and the lectures.

[Electronic data records in primary health care and aspects of their development in Bosnia and Herzegovina]. / Elektronski nosaci podataka u primarnoj zdravstvenoj zastiti i razvojne perspektive u BiH.

In Medical Informatics medical documentation and evidention are most probably the key areas. Also, in primary health care it is very important and part of daily activity of medical staff. Bosnia and Herzegovina is trying to be close to developed countries and to modernize and computerize current systems of documentation and to cross over from manual and semi manual methods to computerized medical data analysis. The most of European countries have developed standards and classification systems in primary health care for collecting, examination, analysis and interpretation of medical data assessed. One of possibilities as well as dilemma, which data carrier should be used for storage and manipulation of patient data in primary health care, is use of electronic medical record. Most of the South East European countries use chip or smart card and some of countries in neighborhood (Italy) choose laser card as patient data carrier. Both technologies have the advantages and disadvantages what was comprehensively colaborated by the authors in this paper, with intention to help experts who make decisions in this segment to create and to correctly influence on improvement of quality, correctness and accuracy of medical documentation in primary health care.