Forward Outlook: The Need for Evidence and for Action in Health Informatics.

Evidence-based health informatics (EBHI) is a key concept in the development and deployment of IT systems and applications in an ethical, efficient and effective health system. There is an ever growing body of knowledge to guide IT-related decision making, but further growth of this body of knowledge is required as the health IT domain and technologies are continuously evolving, leading to new functionalities and applications. However, EBHI should not wait until retrospective evidence is available - increasingly policy makers should draw on available prior and external evidence to influence design and development processes so as to ensure that health IT is devised in response to a delivery process need and not as an IT driven goal.

A comparative review of patient safety initiatives for national health information technology.

Objective: To collect and critically review patient safety initiatives for health information technology (HIT).

Method: Publicly promulgated set of advisories, recommendations, guidelines, or standards potentially addressing safe system design, build, implementation or use were identified by searching the websites of regional and national agencies and programmes in a non-exhaustive set of exemplar countries including England, Denmark, the Netherlands, the USA, Canada and Australia. Initiatives were categorised by type and software systems covered.

Applying GEP-HI for the planning of an evaluation study: a case study walkthrough (workshop).

A Good evaluation practice in Health Informatics (GEP-HI) Evaluation Practice guideline has been developed through a consensus making process. The guideline lists a set of 60 issues that are relevant for planning, implementation and execution of an evaluation study in the health informatics domain. These issues cover the phases of an evaluation study: Study exploration, first study design, operationalization of methods, detailed study design, execution and finalization of an evaluation study.

Guideline for good evaluation practice in health informatics (GEP-HI).

Objective: Development of a good practice guideline to plan and perform scientifically robust evaluation studies in health informatics.

Methods: Issues to be addressed in evaluation studies were identified and guidance drafted based on the evaluation literature and on experiences by key players. Successive drafts of the guideline were discussed in several rounds by an increasing number of experts during conferences and by e-mail.

Next steps in evaluation and evidence - from generic to context-related.

Introduction: E-health systems are increasingly important and widespread, but their selection and implementation are still frequently based on belief, rather than scientific evidence, and adverse effects are not systematically addressed. Progress is being made in promoting generic evaluation methodologies as a source of scientific evidence, but effort is now needed to consider methods for special situations.

Method: Review of five evaluation contexts - national e-health plans, telemedicine, Health Informatics 3.

Mini Stare-HI: guidelines for reporting health informatics evaluations in conference papers.

Background: To improve the quality of reports of health informatics evaluations we recently devised and published a guideline named STARE-HI, now formally endorsed by IMIA.

Objective: To develop a prioritization framework of ranked items (a mini-STARE-HI) to assist authors when reporting health informatics evaluation studies in a restricted space conference paper.

Method: We invited 111 editors of health informatics conference proceedings and reviewers and authors of health informatics evaluation studies to score 106 reporting items on a scale ranging from "0 - not necessary" through to "10 - essential" by a web-based survey.

Introducing guidelines for good evaluation practice in health informatics.

Good evaluation practice guidelines have been developed through a consensus making process by a core team and the health informatics community. A set of 60 issues has been identified that is relevant for planning, implementation and execution of an evaluation study in the health informatics domain. These issues cover all phases of an evaluation study: Study exploration, first study design, operationalization of methods, detailed study design, execution and finalization of an evaluation study.

Linking informaticians and end users - using the STARE-HI evaluation reporting framework as a unifying design approach.

There is understandable concern about low uptake and sub-optimal use of health informatics systems, which is often caused by a lack of shared objectives and values by the different stakeholders. Moreover, all parties work to different ethical codes. For future success, all need to work to the same values and objectives, measured by agreed outcomes data, creating robust evidence.

Generic screen representations for future-proof systems, is it possible? There is more to a GUI than meets the eye.

Background: Future-proof EHR systems must be capable of interpreting information structures for medical concepts that were not available at the build-time of the system. The two-model approach of CEN 13606/openEHR using archetypes achieves this by separating generic clinical knowledge from domain-related knowledge. The presentation of this information can either itself be generic, or require design time awareness of the domain knowledge being employed.

Improving the quality of the evidence base of health informatics.

Evaluation of health informatics technology has had attention from quite a few researchers in health informatics in the last few decades. In the early nineties of the past century several working groups and research projects have discussed evaluation methods and methodologies. Despite these activities, evaluation of health informatics has not received the recognition it deserves.

Writing for publication in biomedical informatics.

Writing for publication can be a rewarding activity for researchers at all levels of experience. However, many students and researchers are less familiar with the various aspects of the publication process. The purpose of this workshop is to provide participants with the knowledge, skills, and practical advice that can lead to successful scientific publications.

STARE-HI--Statement on reporting of evaluation studies in Health Informatics.

Objective: Development of guidelines for publication of evaluation studies of Health Informatics applications.

Methods: An initial list of issues to be addressed in reports on evaluation studies was drafted based on experiences as editors and reviewers of journals in Health Informatics and as authors of systematic reviews of Health Informatics studies, taking into account guidelines for reporting of medical research. This list has been discussed in several rounds by an increasing number of experts in Health Informatics evaluation during conferences and by using e-mail and has been put up for comments on the web.

Inter-organizational future proof EHR systems. A review of the security and privacy related issues.

Objectives: Identification and analysis of privacy and security related issues that occur when health information is exchanged between health care organizations.

Methods: Based on a generic scenario questions were formulated to reveal the occurring issues. Possible answers were verified in literature.

PSI: The Dutch Academic Infrastructure for shared biobanks for translational research.

Translational research requires large patient populations. A single research institute is not able to build up such a population in a short period of time. The String of Pearls Initiative (in Dutch "Parelsnoer Initiatief", PSI) is a joint effort by the eight academic medical centers in the Netherlands to built an infrastructure for joint biobanking as to meet this challenge of establishing large collections of data and samples in relevant medical domains.

Generic screen representations for future proof systems--is it possible? Two-model approach to a generic GUI.

Semantic interoperability should not only cover system interpretation of incoming information, but should be extended to include screen representation. This article describes a two-model approach to generate a screen representation for archetype-based information, which is inspired by the two-model approach used by openEHR for their archetypes. It provides a separation between software-related display knowledge and domain-related display knowledge and is designed with reuse of components in mind.

The quality of reporting of health informatics evaluation studies: a pilot study.

The quality of reporting of evaluations in Health Informatics is considered to be open for improvement. STARE-HI provides guidance for improved reporting. This study aims at establishing the quality of reporting prior to dissemination of STARE-HI.

With good intentions.

Objective: To develop a framework for clinical practice guidelines that not only allows the representation of best practices, but also facilitates reasoning about acceptable alternatives for those best practices.

Method: Design of an explicit representation formalism of intentions of guidelines and guideline steps. Implementation of this representation and reasoning mechanisms in GASTON, a tool for representing and executing computerized clinical guidelines.

With good Intentions.

The use of intentions in computer-based guidelines may help to make them more flexible, easier to adapt to local standards, easier to evaluate and to improve. We see possibilities of using intentions in several areas: as a generator of actions which could be performed and then compared with the decision of the physician, as a method for pruning proposed actions based on current and previous patient data. In this contribution we present our approach to intention-based guidelines.

Towards a Generic Connection of EHR and DSS.

Decision Support Systems (DSS) are typically integrated in Electronic Health Record systems (EHR). By removing this integration full reuse of a DSS system is possible. The connection between the EHR and the DSS system should be standards-based and generic.

"The declaration of Innsbruck": some reflections.

In 2003 a workshop was held in Innsbruck, Austria, on the topic of evaluation of ICT applications in Health Care. A result of that workshop was the "Declaration of Innsbruck". In the current paper we will further elaborate on this declaration and discuss some of the activities that are currently undertaken as supportive measures to enable the realization of the vision expressed in the declaration.

PropeR and archetypes.

Unlabelled: The PropeR project studies a genric combination of an electronic health record (EHR) and decision support software (DSS). This study comprises different medical domains.

Goal: Develop a distributed EHR system that is flexible enough to be used in different domains without major modifications.

PropeR revisited.

Introduction: The PropeR EHR system (PropeRWeb) is a multidisciplinary electronic health record (EHR) system for multidisciplinary use in extramural patient care for stroke patients.

Design: The system is built using existing open source components and is based on open standards. It is implemented as a web application using servlets and Java Server Pages (JSP's) with a CORBA connection to the database servers, which are based on the OMG HDTF specifications.

Towards a PropeR combination of patient records and protocols.

The combination of a computer-based patient record system with a decision support system may give physicians the decisive push they need to accept such systems. In the PropeR-project we determine the requirements for a generic interface between both such systems and measure its potential impact on patient care. In this overview we describe the objectives, the experimental approach, and the current state of the PropeR-project.