OnTARi: an ontology for factors influencing therapy adherence to rehabilitation.

BACKGROUND: Adherence and motivation are key factors for successful treatment of patients with chronic diseases, especially in long-term care processes like rehabilitation. However, only a few patients achieve good treatment adherence. The causes are manifold. Adherence-influencing factors vary depending on indications, therapies, and individuals. Positive and negative effects are rarely confirmed or even contradictory. An ontology seems to be convenient to represent existing knowledge in this domain and to make it available for information retrieval. METHODS: First, a manual data extraction of current knowledge in the domain of treatment adherence in rehabilitation was conducted. Data was retrieved from various sources, including basic literature, scientific publications, and health behavior models. Second, all adherence and motivation factors identified were formalized according to the ontology development methodology METHONTOLOGY. This comprises the specification, conceptualization, formalization, and implementation of the ontology "Ontology for factors influencing therapy adherence to rehabilitation" (OnTARi) in Protégé. A taxonomy-oriented evaluation was conducted by two domain experts. RESULTS: OnTARi includes 281 classes implemented in ontology web language, ten object properties, 22 data properties, 1440 logical axioms, 244 individuals, and 1023 annotations. Six higher-level classes are differentiated: (1) Adherence, (2) AdherenceFactors, (3) AdherenceFactorCategory, (4) Rehabilitation, (5) RehabilitationForm, and (6) RehabilitationType. By means of the class AdherenceFactors 227 adherence factors, thereof 49 hard factors, are represented. Each factor involves a proper description, synonyms, possibly existing acronyms, and a German translation. OnTARi illustrates links between adherence factors through 160 influences-relations. Description logic queries implemented in Protégé allow multiple targeted requests, e.g., for the extraction of adherence factors in a specific rehabilitation area. CONCLUSIONS: With OnTARi, a generic reference model was built to represent potential adherence and motivation factors and their interrelations in rehabilitation of patients with chronic diseases. In terms of information retrieval, this formalization can serve as a basis for implementation and adaptation of conventional rehabilitative measures, taking into account (patient-specific) adherence factors. OnTARi also enables the development of medical assistance systems to increase motivation and adherence in rehabilitation processes.

A Metric for Evaluating a Transformation of Subscription-Based Journals into Open-Access Journals.

Open Access is an upcoming paradigm to communicate scientific knowledge. The Trans-O-MIM Project works on strategies, models, and evaluation metrics for the goal-oriented, stepwise, sustainable, and fair transformation of established subscription-based scientific journals into open-access-based journals. This research intends to present an evaluation metric and the associated identified appropriate parameters for such transformations. To develop the evaluation metric, it has been implemented in the context of a business management method for planning, steering and controlling action and corporate strategies. The central element was a 3-step procedure for developing the metric. In stage 1 necessary preconditions for a transformation were considered. Stage 2 is the actual elaboration of the evaluation metric by means of a scenario analysis and stage 3 comprises the exemplary testing at the journal Methods of Information in Medicine. The three methodological steps have primarily resulted in 5 scenarios with 9 different final states from the scenario analysis. Thus, the metric is now composed of these 5 scenarios, which can be used to evaluate the success or failure of a transformation. A list of 65 suitable parameters to measure changes in scenario were compiled. So, it is possible to evaluate the transformation and to find the current final state. Parameters like submissions, publications, and time as well as the scenario states could be applied to the transformation process of the Methods of Information in Medicine journal. The proposed evaluation metric can be used to evaluate the transformation processes of subscription-based journals into open-access-based journals.

CASEPLUS-SimPat: An Intersectoral Web-Based Case Management System for Multimorbid Dementia Patients.

One main challenge of health care systems in future will be the care and treatment of dementia patients. To their advanced age, dementia patients do not only have limitations in cognition, perception, and articulation, but also suffer from several other diseases (multimorbidity). These patients have sophisticated needs for assistance, care, and treatment relying on different health care sectors. Well-known communication and coordination deficits between sectors are intensified in the case of dementia, to the above described limitations. Coordination processes concerning the transition of patients from hospitals to inpatient or outpatient aftercare pose particularly difficult. To show a possible future direction for improving intersectoral care of dementia patients, we developed the web-based case management system CASEPLUS-SimPat as part of the project SimPat "Securing Integrated Care for Multi-morbid Patients with Dementia using an IT-based Service Concept". CASEPLUS-SimPat allows health care professionals, hospital employees and general practitioners, to jointly access patient data and exchange information about the treatment of patients. The case management system was implemented in a three-tier architecture with a role-based authorization concept. A portal for relatives complements the system. By providing precise information and e-learning services, caring relatives are integrated into the care process. In a pilot test, CASEPLUS-SimPat shows a good usability. Adapting aspects, such as keywords used to structure entries will make it easier to find required information, and thus will increase usability. Next steps comprise integration of further health care professionals and care facilities as well as real-life testing in terms of feasibility and effectiveness.

Analysing the Scientific Publications of Peter Reichertz: Reflections from the Perspective of Medical Informatics Knowledge Today.

Professor Peter L. Reichertz is one of the most significant pioneers in the field of medical informatics worldwide. In 1969, 50 years ago, he became Professor at the Hannover Medical School. On the occasion of this anniversary an attempt was made to report on the scientific work of Peter Reichertz and to reflect on this work in the light of medical informatics knowledge today. The aim of this study was to search publications listings in the Peter L. Reichertz Archive, in Pubmed/Medline, and in the Web of Science. As well as to analyse contents and communication approaches to help in classifying Peter Reichertz's scientific publications. Three comprehensive publication lists were identified: the Print Bibliography (384 publications), the Disc Bibliography (285 publications) and the Selected Publications Bibliography (111 publications). Based on the last bibliography, a classification was built along the semantic dimensions of (1) major topics, (2) fields of publication, and (3) publication languages. Major contents of Peter Reichertz's research in informatics were medical informatics as a field (including education), informatics applications in medicine and health care, and health information systems. Clear shifts over time were observed. To his research on informatics applications, in the 1970s health information systems was added as topic, which then became a major part of his research. While in the 1960s and earlier German was a major publication language, from the 1970s onwards this shifted to English as the major language. Peter Reichertz very early identified the potential of computers in medicine and health care. He did not just use information and communication technology and information processing methodology as if they were other technology, such as microscopes or ultrasonic devices, for improving diagnosis and therapy. He was visionary enough to very early see the revolutionary potential of informatics for biomedicine and health care, with consequential impact on research and education.

Should Degree Programs in Biomedical and Health Informatics be Dedicated or Integrated? : Reflections and Recommendations after more than 40 Years of Medical Informatics Education at TU Braunschweig, including 10 Years of B.Sc. and 15 Years of M.Sc. Integrated Degree Curricula.

Education in biomedical and health informatics (BMHI) has been established in many countries throughout the world. For degree programs in BMHI we can distinguish between those that are completely stand-alone or dedicated to the discipline vs. those that are integrated within another program. After running integrated degree medical informatics programs at TU Braunschweig for 10 years at the B.Sc. and for 15 years at the M.Sc level, we (1) report about this educational approach, (2) analyze recommendations on, implementations of, and experiences with degree educational programs in BMHI worldwide, (3) summarize our lessons learned with the integrated approach at TU Braunschweig, and (4) suggest an answer to the question, whether degree programs in biomedical and health informatics should be dedicated or integrated. According to our experience at TU Braunschweig and based on our analysis of publications, there is a clear dominance of dedicated degree programs in BMHI. The specialization in medical informatics within a computer science program, as offered at TU Braunschweig, may be a good way of implementing an integrated, informatics-based approach to medical informatics, in particular if a dual degree option can be chosen. The option of curricula leading to double degrees, i.e. in this case to two separate degrees in computer science and in medical informatics might, however, be a better solution.

Overview of recent trans-institutional health network projects in Japan and Germany.

Worldwide populations are aging and countries have to prepare for the effects of demographic change in health care. Health information exchange (HIE), which is the process of moving patient information across health care providers electronically, can help overcome health data fragmentation and open opportunities to improve patient care in terms of quality, economy and efficiency. Since Japan and Germany are among the first countries strongly impacted by demographic changes of aging populations, we report on current developments about health information systems carrying out HIE based on case studies in both countries. Four projects that address the improvement of HIE within a defined region have been selected and investigated: the German project of the Lower Saxony Bank of Health and the Japanese projects Chiba ITnet, Nagasaki AjisaiNet and the National Disaster and Backup System of Japan. The project descriptions are based on relevant English publications, on-site visits and interviews with developers and users. The projects are introduced in terms of their basic architecture and implementation, their present status and future objectives. The projects' developments are still in progress and all have to cope with significant challenges before they will be able to provide a fully working trans-institutional health network solution.

Feasibility study of a sensor-based autonomous load control exercise training system for COPD patients.

Decision support systems (DSSs) which are able to automatically supervise and control physical exercise training of patients affected by chronic obstructive pulmonary disease (COPD) are regarded as a novel method to promote rehabilitation. The objective of our research work for this paper was to evaluate the feasibility of a rule-based DSS for autonomous bicycle ergometer training of COPD patients. Load control is based on real-time analysis of sensor parameters oxygen saturation and heart rate. Ten COPD patients have participated in a study, performing altogether 18 training sessions. On average, 7.4 rules were fired in each training session. Four sessions had to be stopped for different reasons. The average ergometer training load ranged between 31 and 47 W. The average percentage of heart rate in or lower than the intended target zone was 45.9 and 41.6%, respectively. The average patient-perceived Borg value was 12.6±2.4. Patients reported a high satisfaction for the automatically controlled training. With the help of the DSS, patients may change their training place from a rehabilitation center to their own homes. More studies are needed to assess long-term clinical and motivational effects of the DSS in home environment.

Reflections on 'health care in the information society--a prognosis for the year 2013'.

In the year 2000 a talk was given and later published on how health care could look like in the year 2013. The aim was to "identify priorities in medical informatics research and necessary activities by policymakers in order to ensure an efficient, advanced, and yet affordable future health care system" (Haux R, Ammenwerth E, Herzog W, Knaup P. Health care in the information society. A prognosis for the year 2013. Int J Med Inform. 2002; 66: 3-21). In the year 2013 a workshop took place, critically reflecting on the prognoses and theses made for the year 2013. This editorial is reporting on the 2013-workshop and is introducing three papers, in which the workshop results have been summarized.

A collaboration tool based on SNOCAP-HET.

Health enabling technologies and ambient assisted living are important fields in biomedical informatics. In this context, a huge variety of analysis methods are applied. Neither is a suitable structuring of these methods available, nor is an aid known for selecting appropriate methods for a given set of data specifying a context and a problem. The goal of the present paper is to present a prototype of a semantic collaboration tool which is based on the Systematic Nomenclature for Contexts, Analysis Methods and Problems in Health-Enabling Technologies (SNOCAP-HET). This tool can be seen as a first step towards an assistance system for decision support within SNOCAP-HET. We present aspects of the selection and modeling process of our tool and discuss its benefits and appealing tasks for further research. Moreover we present a number of already planned and some unspecified upcoming steps which should optimize SNOCAP-HET in the future.

Assessing the prognoses on Health care in the information society 2013--thirteen years after.

Health care and information technology in health care is advancing at tremendous speed. We analysed whether the prognoses by Haux et al. - first presented in 2000 and published in 2002 - have been fulfilled in 2013 and which might be the reasons for match or mismatch. Twenty international experts in biomedical and health informatics met in May 2013 in a workshop to discuss match or mismatch of each of the 71 prognoses. After this meeting a web-based survey among workshop participants took place. Thirty-three prognoses were assessed matching; they reflect e.g. that there is good progress in storing patient data electronically in health care institutions. Twenty-three prognoses were assessed mismatching; they reflect e.g. that telemedicine and home monitoring as well as electronic exchange of patient data between institutions is not established as widespread as expected. Fifteen prognoses were assessed neither matching nor mismatching. ICT tools have considerably influenced health care in the last decade, but in many cases not as far as it was expected by Haux et al. in 2002. In most cases this is not a matter of the availability of technical solutions but of organizational and ethical issues. We need innovative and modern information system architectures which support multiple use of data for patient care as well as for research and reporting and which are able to integrate data from home monitoring into a patient centered health record. Since innovative technology is available the efficient and wide-spread use in health care has to be enabled by systematic information management.

Past and next 10 years of medical informatics.

More than 10 years ago Haux et al. tried to answer the question how health care provision will look like in the year 2013. A follow-up workshop was held in Braunschweig, Germany, for 2 days in May, 2013, with 20 invited international experts in biomedical and health informatics. Among other things it had the objectives to discuss the suggested goals and measures of 2002 and how priorities on MI research in this context should be set from the viewpoint of today. The goals from 2002 are now as up-to-date as they were then. The experts stated that the three goals: "patient-centred recording and use of medical data for cooperative care"; "process-integrated decision support through current medical knowledge" and "comprehensive use of patient data for research and health care reporting" have not been reached yet and are still relevant. A new goal for ICT in health care should be the support of patient centred personalized (individual) medicine. MI as an academic discipline carries out research concerning tools that support health care professionals in their work. This research should be carried out without the pressure that it should lead to systems that are immediately and directly accepted in practice.

Design and implementation of the standards-based personal intelligent self-management system (PICS).

Against the background of demographic change and a diminishing care workforce there is a growing need for personalized decision support. The aim of this paper is to describe the design and implementation of the standards-based personal intelligent care systems (PICS). PICS makes consistent use of internationally accepted standards such as the Health Level 7 (HL7) Arden syntax for the representation of the decision logic, HL7 Clinical Document Architecture for information representation and is based on a open-source service-oriented architecture framework and a business process management system. Its functionality is exemplified for the application scenario of a patient suffering from congestive heart failure. Several vital signs sensors provide data for the decision support system, and a number of flexible communication channels are available for interaction with patient or caregiver. PICS is a standards-based, open and flexible system enabling personalized decision support. Further development will include the implementation of components on small computers and sensor nodes.

Reflections Towards the Future of Medical Informatics.

OBJECTIVE: To provide guidance on the future development and role of medical informatics, or biomedical and health informatics, in form of reflections. METHOD: To report on the author's previous activities as a medical informatician, which spans almost half a century. It began in 1973 when he started to study medical informatics. In 1978, more than four decades ago, his professional work started. He retired at the end of summer semester 2021. This was the occasion to prepare this farewell lecture. RESULTS: In twenty reflections, thoughts are presented on professional careers (R1 - 'places'), on medical informatics as discipline (R2 - 'interdisciplinarity', R3 - 'focuses', R4 - 'affiliations'), on research (R5 - 'duality', R6 - 'confluences', R7 - 'correlations', R8 - 'collaboration'), on education (R9 - 'community', R10 - 'competencies', R11 - 'approaches'), on academic self-governance (R12 - 'autonomy'), on engagement (R13 - 'Sisyphos', R14 - 'professional societies', R15 - 'respect', R16 - 'tightrope walk'), and on good scientific practice (R17 - 'time invariants', R18 - 'Zeitgeist', R19 - 'knowledge gain', R20 - 'exercising'). CONCLUSIONS: It has been a pleasure for me to participate in medical informatics activities for almost fifty years. During that time, there have been significant advances, including in medicine and in informatics, and also in medical informatics itself. And now it is the turn of others. While keeping in mind that tradition is not preserving the ashes, but passing on the fire, this report with its reflections may be of some help.

Trans-O-MIM-An International Research Project on Open Access Transformation: Outcomes and Lessons Learned.

BACKGROUND: During the last decades, the Open Access paradigm has become an important approach for publishing new scientific knowledge. From 2015 to 2020, the Trans-O-MIM research project was undertaken with the intention to identify and to explore solutions in transforming subscription-based journals into Open Access journals. Trans-O-MIM stands for strategies, models, and evaluation metrics for the goal-oriented, stepwise, sustainable, and fair transformation of established subscription-based scientific journals into Open-Access-based journals with Methods of Information in Medicine as an example. OBJECTIVES: To present an overview of the outcomes of the Trans-O-MIM research project as a whole and to share our major lessons learned. METHODS: As an approach for transforming journals, a Tandem Model has been proposed and implemented for Methods of Information in Medicine. For developing a metric to observe and assess journal transformations, scenario analysis has been used. A qualitative and a two-tier quantitative study on drivers and obstacles of Open Access publishing for medical informatics researchers was designed and conducted. A project setup with a research team, a steering committee, and an international advisory board was established. Major international medical informatics events have been used for reporting and for receiving feedback. RESULTS: Based on the Tandem Model, the journal Methods of Information in Medicine has been transformed into a journal where, in addition to its subscription-based track, from 2017 onwards a Gold Open Access track has been successfully added. An evaluation metric, composed of 5 scenarios and 65 parameters, has been developed, which can assist respective decision makers in assessing such transformations. The studies on drivers and obstacles of Open Access publishing showed that, while most researchers support the idea of making scientific knowledge freely accessible to everyone, they are hesitant about actually living this practice by choosing Open Access journals to publish their own work. Article-processing charges and quality issues are perceived as the main obstacles in this respect, revealing a two-sided evaluation of Open Access models, reflecting the different viewpoints of researchers as authors or readers. Especially researchers from low-income countries benefit from a barrier-free communication mainly in their role as readers and much less in their role as authors of scientific information. This became also evident at the institutional level, as Open Access policies or financial support through funding bodies are most prevalent in Europe and North America. CONCLUSION: With Trans-O-MIM, an international research project was performed. An existing journal has been transformed. In addition, with the support of the International Medical Informatics Association, as well as of the European Federation for Medical Informatics and of the German Association for Medical Informatics, Biometry and Epidemiology as European and German medical informatics organizations, we did run an international experiment on Open Access incentives. Both together are, as far as the authors know, unique. We therefore expect that this research could add new knowledge on Open Access transformation.

A literature overview and comparison of driving impairing condition assessment approaches by health enabling technologies.

Due to demographic change, more elderly people have the need to preserve and support mobility by car despite age-related functional limitations. Since accidents by the elderly are primarily caused by age related limitations, and not by careless or irresponsible behavior, it may be beneficial to detect driving impairing conditions. The presented review gives an overview of technologies to detect driving impairing conditions like drowsiness and stress or excessive demand. A comparison of the approaches to detect these conditions suggests that a combination of approaches is the most feasible method. However, there are still few systems that focus on the elderly.

EFMI initiatives for inter-regional cooperation: the TrEHRT project.

The paper refers to EFMI's initiatives to develop an international cooperation with different regional groups of IMIA. More details are presented about the successful project "TrEHRT - Traveler's Electronic Health Record Template". Its potential applicability, compact structure and functional simplicity turned this product into a template capable to become an international standard, using mobile phones.

On Appropriate Evaluation Methodologies in the Context of Using Both Accident and Health Record Data.

Accident and emergency informatics has become a new approach to accident research in the era of digitization, where it has become realistic to integrate data recorded at accident sites with data in electronic health records of patients. This chapter deals with the question on whether the existing and well-established evaluation methodologies used in accident-centered research as well as in patient-centered research within clinical medicine are sufficient and should also be used for such integrated data or whether they have to be modified or extended. Based on the Gaus-Muche-Nomenclature on studies in clinical medicine, it will be outlined which types of studies are appropriate here. In addition to observational studies and registers, controlled trials using randomization are also be regarded as an important approach for gaining new knowledge. In order to appropriately access data from health records and from accidents, standards for representing and communicating data for such studies will be of importance. Another criterion is referential integrity. Here and with respect to accidents the International Standard Accident Number (ISAN) may be of importance.

Health Information Systems: Past, Present, Future - Revisited.

BACKGROUND: Health information systems (HIS) represent an essential part of the infrastructure for the delivery of good health care. OBJECTIVES: To present the author's personal views on HIS developments over the last decades and on the opportunities and priorities for future HIS developments. METHODS: Reflecting on his views, the author identified relevant semantic dimensions, which are denoted as development paths, and searched for appropriate periods to characterize HIS development leaps. RESULTS: HIS developments were divided into the periods past (1961-2016), present (2017-2022), and future (the next decades). Eight development paths for HIS were considered as being relevant to presenting the author's views: life situations related to health care, entities for health care, health care facilities, settings of health care, data to be processed, features for functions, architectures of HIS, and management of HIS. For each of these paths, the past and present states as well as challenges and opportunities for future HIS developments were outlined. DISCUSSION AND CONCLUSIONS: The presented views on HIS developments and the selected development paths and periods are by nature subjective 'avant la lettre'. The views were, however, formed over almost half a century during which the author has been engaged with HIS developments, and thus may be worth reporting and discussion. If past is prologue, the tremendous HIS developments in the past and in the present may predict a similar development intensity in the future. Present HIS are significantly better than HIS of the past, however they leave room for continued improvement with an end of HIS developments far from sight.

Applied Clinical Informatics Journal: A Brief History.

In 2009, Schattauer Verlag in Stuttgart, Germany first published the Applied Clinical Informatics (ACI) Journal. ACI has served since its inception as an official journal of the International Medical Informatics Association. Later, the American Medical Informatics Association and the European Federation for Medical Informatics named ACI as an official journal. This manuscript describes the history of the journal from its inception to present day including publication measures, challenges, and successes.

The International Academy of Health Sciences Informatics: 2021 Update.

OBJECTIVES: To summarize the activities of the International Academy of Health Sciences Informatics (IAHSI) in 2021 and welcome its 2021 Class of Fellows. METHODS: Report on governance, strategic directions, newly elected fellows, plenary meetings, and other activities of the Academy. RESULTS: As in 2020, all of the Academy's activities were carried out virtually due to the COVID-19 pandemic. In 2021, new Board members were elected. Strategic activities in data standards and interoperability and in mentorship moved forward. A new class of 26 Fellows was elected, bringing the total membership of the Academy to 204 Fellows from all regions of the world. In addition, a virtual plenary meeting was held. CONCLUSIONS: The Academy has continued to pursue its role as the honorific society globally for biomedical and health informatics. Expansion of strategic activities and membership will continue moving forward.