Healthcare information technology and economics.

At the 2011 American College of Medical Informatics (ACMI) Winter Symposium we studied the overlap between health IT and economics and what leading healthcare delivery organizations are achieving today using IT that might offer paths for the nation to follow for using health IT in healthcare reform. We recognized that health IT by itself can improve health value, but its main contribution to health value may be that it can make possible new care delivery models to achieve much larger value. Health IT is a critically important enabler to fundamental healthcare system changes that may be a way out of our current, severe problem of rising costs and national deficit.

Model human behavior: don't constrain it!

Healthcare processes are complex and highly variable from day to day. Healthcare process execution can be affected by any participant in a process, including clinicians, the patient, and the patient's family, as well as environmental factors such as clinician, staff, facility and equipment availability, and patient clinical status. However, only a few solutions exist that enable computer support for a process to address the full complexity and variability of healthcare processes.

The National Student Forum and the emergence of Health Informatics Clubs.

Our greatest hope for the future of eHealth and the enabling of our health system is today's students. However, we face a challenge: few students are aware of careers in Health Informatics and other aspects of eHealth. This paper describes an initiative to engage our future workforce in HI.

Harmonizing the competency cacophony.

Many have addressed the challenge of defining Health Informatics (HI) competencies, and eleven efforts have produced detailed lists of competencies. Although there are commonalities among these lists, several aspects of this work frustrate our using it to define a consensus view of HI competencies. This project has involved the documentation and comparison of the competencies produced by key authors and an effort to suggest competency terminology that derives from and harmonizes these efforts, but does not emphasize any one contribution.

An innovative learning experience for entry to eHealth careers.

We describe an innovative educational program that provides an easily-accessible introduction to Applied Health Informatics (AHI) in an effort to attract new trainees to this discipline. We call this program the AHI Bootcamp. It includes an intense, interactive, but brief on-site program, with the majority of its content delivered in approximately 80 hours of on-line presentations.

Kick-starting health informatics careers--a Canadian approach.

We introduce the Applied Health Informatics Bootcamp. This is an intense, interactive on-site program, augmented by approximately 80 hours of on-line material. The Bootcamp is intended to introduce those with little or no knowledge of Health Informatics (HI) to the nature, key concepts, and applications of this discipline to addressing challenges in the health field.

Making health informatics competencies useful: an applied health informatics competency self-assessment system.

Years ago we undertook to define Health Informatics (HI) competencies. This effort resulted in the creation of a document that articulated HI roles, the challenges faced by HI professionals, the high-level tasks that they needed to undertake to address these challenges and the competencies (skills, knowledge, and experience) they needed to complete these tasks. Unfortunately, in so doing we created what is arguably the most boring book in history, shoes contents are very difficult to extract, use, maintain and improve.

A web-based communities of practice support system for caregivers.

CareNet is an interactive Web-based system intended to support informal caregivers (ordinary citizens who are engaged in providing residential healthcare to their families and friends). The design of CareNet uses concepts from a number of areas including: Communities of Practice, software engineering, content authoring, and knowledge management to create a supportive environment for the caregiver. The specific objectives of the CareNet project are: (1) To create a highly effective interactive environment that addresses the needs of caregivers to: (1a) obtain information and guidance, (1b) achieve efficient communication with professional healthcare workers with whom they collaborate and with other caregivers from whom they can gain advice, emotional support and solace, (1c) access other information and physical resources that are needed for proper care, and (1d) document their observations, interventions and insights that can in future become a knowledge resource for other caregivers; and (2) To demonstrate the beneficial impact of CareNet on caregivers who collaborate with professional care providers and on their interactions with professional care providers.

Authoring and generation of individualized patient education materials.

Although the pre-surgical patient-surgeon encounter is the opportunity to educate the patient, it is essential that the patient be given educational materials to complement the face-to-face exchange. This is virtu-ally impossible to do well with brochures, because many combinations of procedures are possible, dif-ferent patients have different concerns, and patients have varying levels of literacy and knowledge. In the extreme, a patient would either be given a set of bro-chures selected from 100s of variants, or all patients would be given the same set of brochures without regard for differing needs.

WebSAT: a web-based competency self-assessment system linking to educational resources.

We describe a web-based system that enables an individual to assess him/her self against the set of competencies required for a variety of roles in the area of Applied Health Informatics (AHI). The competencies themselves were developed by a multi-disciplinary team under the auspices of the Canadian Institute for Health Research (CIHR), and include the knowledge, skills, and experience necessary to fulfill specific roles as an applied health informatician. Both textual and graphical information is presented to the user and potential mechanisms for correcting competency gaps are presented in this online interactive system.

Achieving a "therapeutic dose" of IT.

Our health systems face a number of critical challenges over the next several decades, not the least of which is the aging of our baby boomers. Many have suggested that information technologies will be an essential tool, which will increase health system productivity and in so doing will help us manage our way through these challenging times. Unfortunately, little evidence exists supporting the hypothesis that IT creates productivity gains in any sector, let alone health.

A framework for best practices in the deployment of departmental information systems.

In previous work, we conceptualized a departmental information system as embodying a flexible, but limited, model for the operation of a department, such as a laboratory or diagnostic imaging service. We further recognized these systems as tools that enable data-driven departmental management and function as feeder systems to enterprise management decision-support systems, and also embody a departmental and components of an enterprise management model. Finally, for systems that interact with professionals related to decision support, we note that such systems embody partial cognitive models that must be congruent with the professionals cognitive processes (or professionals cognitive behaviors must alternatively be congruent with the systems cognitive model), if these systems are to be supportive of the professionals thinking and decision making.

The development of model curricula for Health Informatics.

We have developed model Health Informatics (HI) curricula for the education of three categories of professionals: Applied Health Informaticians, the professionals that deploy information technologies, Research and Development Health Informaticians those that develop new concepts, techniques, and solutions, and what we have called Clinician Health Informaticians, providers who use HI capabilities to support their professional work. The curricula specify the competencies that each type of professional must acquire.

The development of a model curriculum for applied health informatics.

Applied Health Informaticians (AHIs) are professionals that deploy information technologies in support of health system processes. AHIs require both a well-developed knowledge base that encompasses the health system, computer science, and health information systems-related topics (what is known as the "Body of Knowledge"), as well as a set of intellectual and procedural skills (what we call the "Body of Skills") and preparatory experiences. The availability of skilled and knowledgeable AHIs has become a critical issue in today's health system.

A new architecture for enterprise information systems.

Irresistible economic and technical forces are forcing healthcare institutions to develop regionalized services such as consolidated or virtual laboratories. Technical realities, such as the lack of an enabling enterprise-level information technology (IT) integration infrastructure, the existence of legacy systems, and non-existent or embryonic enterprise-level IT services organizations, are delaying or frustrating the achievement of the desired configuration of shared services. On attempting to address this matter, we discover that the state-of-the-art in integration technology is not wholly adequate, and itself becomes a barrier to the full realization of shared healthcare services.

The need for a skills-focussed applied healthcare informatics curriculum.

Experience with Information Systems (IS) staff, interactions with healthcare senior management, and discussions with faculty and students have led us to the conclusions that few healthcare organizations have conceptualized and articulated an optimal organizational role for IS (particularly for IS leadership). In this paper we will describe the multi-polar, often conflicting "expectations" faced by many of today's healthcare IS departments, and define a set of useful and sustainable institutional model roles for IS. Then, we will formulate the set of challenges which IS professionals in these roles must be prepared to address.

The challenges and opportunities of laboratory regionalization.

These are some of the major historical trends and rationale for the sea change in laboratory medicine today. The creation of cooperative regional networks and consolidated regional laboratories potentially can: 1) Pool the technologic strengths of individual laboratories across a region; 2) Create economies of scale by combining capacities for certain procedures; 3) Lower unit costs by increasing volumes of business from nonpatients; 4) Span all of the traditional testing venues along the new expanding continuum of care. The authors in this monograph will take the saga forward in time, outlining critical organizational, technologic, and strategic aspects of the newly evolving laboratory of the 21st century.

IT capabilities for the realization of the laboratory without walls.

This article presents the factors that are driving the restructuring of laboratory services and the information technology capabilities that are necessary to support the regionalized laboratory services organization. The overall need is for a trans-entity laboratory information system with point of care ordering and results reporting and enterprise-wide specimen transportation and tracking, that is interfaced with other information resources required for clinical decision-making, and patient care, operational, and financial management.

A primer for beginning sports injury study researchers.

In this paper, I offer a set of important dimensions against which research projects can be analyzed. If one can image that each dimension has a range of from 0 to 100 percent, the objective in doing good research is to make our work in each dimension a 100 percent proposition. To ensure this, it would seem wise for the researcher to have checklists like those that pilots use before take off and landing.

Randomised controlled trial of computer assisted management of hypertension in primary care.

The hypothesis that general practitioners would obtain better outcomes for patients with hypertension using a computer than doctors not using a computer was tested. Sixty family physicians were randomised to two treatment strategies. "Test" physicians completed a data collection form after each visit from a patient with hypertension and mailed the forms to the test centre for processing.

Alternatives in the handling, processing and storage of electrocardiograms.

Physicians and administrators are becoming aware that computer technology can play a significant role in the electrocardiology department. Problems related to the large number of requests for electrocardiograms, the production and communication of electrocardiographic tracings and reports, the access to stored tracings and the overall cost of providing effective services have led administrators to look for assistance through automation. Before expensive equipment and new procedures are introduced, a survey of the electrocardiology department's functions and procedures can lead to important insights.