Current Challenge in Consumer Health Informatics: Bridging the Gap between Access to Information and Information Understanding.

The number of health-related websites has proliferated over the past few years. Health information consumers confront a myriad of health related resources on the internet that have varying levels of quality and are not always easy to comprehend. There is thus a need to help health information consumers to bridge the gap between access to information and information understanding-i.

Validity and responsiveness of the Rehabilitation Activities Profile (RAP) in patients with rheumatoid arthritis.

Objective: To investigate the internal consistency, validity and responsiveness of the Rehabilitation Activities Profile (RAP; a rehabilitation tool structuring the multidisciplinary team care process) in patients with rheumatoid arthritis.

Methods: In 85 rheumatoid arthritis patients admitted to a rheumatology clinic the RAP was applied at admission, at discharge, and six weeks thereafter. Additional assessments included measures of physical and psychological functioning, disease activity and quality of life.

Can contextualization increase understanding during man-machine communication? A theory-driven study.

The Internet offers unlimited possibilities for finding health information. However, the user is often faced with the problem of understanding it. Contextualization has a role to play in enhancing the user's comprehension.

The impact of introducing an ICF-based rehabilitation tool on staff satisfaction with multidisciplinary team care in rheumatology: an exploratory study.

Objective: To investigate the impact of introducing a rehabilitation tool on multidisciplinary team members' satisfaction with team functioning, team conferences and written information exchange.

Design: Pretest posttest design.

Setting: Day patient and inpatient wards of a rheumatology rehabilitation clinic.

Effectiveness of the introduction of an International Classification of Functioning, Disability and Health-based rehabilitation tool in multidisciplinary team care in patients with rheumatoid arthritis.

Objective: To investigate whether the use of an International Classification of Functioning, Disability and Health (ICF)-based instrument to structure multidisciplinary care improves clinical effectiveness and satisfaction in patients with rheumatoid arthritis (RA) admitted for multidisciplinary team care.

Methods: Consecutive patients with RA admitted to an inpatient or day patient multidisciplinary team care ward were included during a 12-month period before (period I) and after (period II) the introduction of an ICF-based rehabilitation tool (Rehabilitation Activities Profile [RAP]). Patients were assessed at admission, discharge, and 6 weeks thereafter.

Illness stories on the internet: what do breast cancer patients want at the end of treatment?

The study aims to elicit user requirements for internet-based applications disclosing fellow patients' illness stories for the benefit of breast cancer patients. Twenty-six breast cancer patients, recruited via the Dutch Patient Organization for Breast Cancer, were interviewed about their preferences with regards to content, appearance, and search options concerning fellow patients' illness stories online. The interviews were analysed quantitatively (SPSS) and qualitatively (NVivo).

The impact of the implementation of a rehabilitation tool on the contents of the communication during multidisciplinary team conferences in rheumatology.

Objective: Problems with multidisciplinary team conferences in health care include the exchange of too much (discipline-specific) information. The aim of this study was to investigate the effect of the implementation of a rehabilitation tool on the contents of communication during multidisciplinary team conferences in a rheumatology setting.

Methods: All initial and follow-up team conferences of 25 consecutive patients with rheumatoid arthritis admitted to a day patient care ward were videotaped during a period before (period I) and after (period II) the introduction of a rehabilitation tool.

Pilot study of the development of a theory-based instrument to evaluate the communication process during multidisciplinary team conferences in rheumatology.

Background: Coordinated teams with multidisciplinary team conferences are generally seen as a solution to the management of complex health conditions. However, problems regarding the process of communication during team conferences are reported, such as the absence of a common language or viewpoint and the exchange of irrelevant or repeated information. To determine the outcome of interventions aimed at improving communication during team conferences, a reliable and valid assessment method is needed.

The impact of structuring multidisciplinary team conferences mediated by ICT in the treatment of patients with rheumatic diseases.

Communication processes are pervasive in the daily practice of health professionals. Reorganizing these daily practices by introducing ICT, inevitably effects one or more communication processes. Understanding exactly what these effects are, is a major problem in designing and implementing ICT-applications.

The impact of ICT on communication in healthcare.

Communication processes are pervasive in the daily practice of health professionals. Reorganizing these daily practices by introducing ICT, inevitably effects one or more communication processes. Understanding exactly what these effects are, is a major problem in designing and implementing ICT-applications.

Communication support: a challenge for ICT in health care.

Communication makes up a very important part of the daily practice of health professionals. Current trends in health care indicate that this will even increase. However, the explicit application of Information and Communication Technologies (ICT) in order to support communication is relatively rare.

Improving the quality of communication in healthcare.

In this paper we present an assessment instrument for evaluating the quality of communication processes in health care. This instrument is based on communication theory, and does not only indicate the level of quality, but also explains it. This makes it also useful as a design tool in reorganising communication processes, in order to make them more effective.

Use cases and DEMO: aligning functional features of ICT-infrastructure to business processes.

Objectives: The proper alignment of functional features of the ICT-infrastructure to business processes is a major challenge in health care organisations. This alignment takes into account that the organisational structure not only shapes the ICT-infrastructure, but that the inverse also holds. To solve the alignment problem, relevant features of the ICT-infrastructure should be derived from the organisational structure and the influence of this envisaged ICT to the work practices should be pointed out.

Availability and usability of data for medical practice assessment.

Objective: We analyzed availability and usability of the electronic patient data required for assessment of medical practice for a specific patient group.

Design: Case study in which physicians defined performance indicators and additional exploratory information. Data availability in the hospital information system was determined.

Availability and accuracy of electronic patient data for medical practice assessment.

Unlabelled: We analyzed availability and accuracy of electronic patient data needed to assess medical practice. A case study was performed in which pediatricians formulated 14 performance indicators that cover aspects of care for children with suspected meningitis. Data items needed to quantify these indicators were listed.

A process view of medical practice by modeling communicative acts.

The need of an electronic patient record with a process view on medical care is widely acknowledged. Characteristics of DEMO (Dynamic Essential Modeling of Organizations) suggest that with this methodology an adequate process view of medical practice can be obtained. In applying DEMO to the care process of the emergency department at the University Medical Centre Utrecht, it was investigated if DEMO fulfilled our expectations.

Understanding terminological systems. I: Terminology and typology.

Terminological systems are an important research issue within the field of medical informatics. For precise understanding of existing terminological systems a referential framework is needed that provides a uniform terminology and typology of terminological systems themselves. In this article a uniform terminology is described by putting relevant fundamental notions and definitions used by standard organizations such as CEN and ISO into perspective, and interrelating them to arrive at a useful typology of terminological systems.

Effect of discharge letter-linked diagnosis registration on data quality.

Objective: Diagnostic data are essential for the assessment of medical practice: they are needed for retrieval of clinical cases and describing co-morbidity and complications. In most Western countries, diagnosis registration in hospital information systems is based mainly on completing forms after patient discharge. As this registration plays no role in patient care, data quality is usually unsatisfactory.

Analysis and design of an ontology for intensive care diagnoses.

Information about the patient's health status and about medical problems in general, play an important role in stratifying a patient population for quality assurance of intensive care. A terminological system which supports both the description of health problems for daily care practice and the aggregation of diagnostic information for evaluative research, is desirable for description of the patient population. This study describes the engineering of an ontology that facilitates a terminological system for intensive care diagnoses.

The graduate training in medical information sciences in the Academic Medical Centre at the University of Amsterdam.

Since its inception in 1987, the 4-year Medical Information Sciences (MIS) curriculum at the Academic Medical Centre (AMC), Amsterdam has gone through several major changes. The present curriculum started in 1994. The course takes 4 years, the first 3 years are programmed in integrated modules of 7 weeks in duration each.

Research design for the project information for analysis of clinical care in the Academic Medical Center, Amsterdam.

The medical staff at the Department of Pediatrics in the Academic Medical Center, Amsterdam, are strongly involved in the analysis of the effectiveness and efficiency of the clinical care provided. One method to increase effectiveness and efficiency is to provide clinicians with a comprehensive summary of their medical activities.

On the use of a hospital information system in evaluating clinical care: a case report.

In this paper we describe, as an example, how we obtained the information needed to evaluate a newly introduced protocol for ordering X-rays for ankle trauma patients. Extensive use was made of available data and facilities of the hospital information system (HIS). Procedures for collecting the required additional data, which were not recorded in the HIS but were needed to evaluate the protocol, were embedded in the current medical and administrative routine of the emergency room.

Decision analysis--a helpful tool for clinicians to establish diagnostic-therapeutic guidelines?

In this paper we focus on the question: Does decision analysis provide a framework to assess the value of diagnostic tests in clinical practice and how can it be used by clinicians in establishing diagnostic-therapeutic guidelines. To study this question we performed two analyses concerning the use of pelvic lymphadenectomy and pedal lymphography for staging prostate cancer. Both analyses yielded similar results as far as the preferred strategy was concerned, yet the approach and set up of the two analyses were different.

Increased risk of second cancers in managing Hodgkins disease: the 20-year Leiden experience.

Between January 1969 and December 1988, 482 patients were treated for Hodgkin's disease at the Leiden University Hospital. All cases were routinely recorded in the Hospital Information System, which has an active annual follow-up. Of all patients, 57% remained relapse free.

How to approach a hospital information system as sampling frame. Selection of patients with a percutaneous renal biopsy.

The paper describes the four steps that have to be taken in the process of using a hospital information system as sampling frame: step 1, description of the medical routine and registrations related to the study population; step 2, defining the design and criteria for selection; step 3, creating the datafile and step 4, validating the datafile. To illustrate these four steps a detailed description of the selection of patients with a percutaneous renal biopsy is given, using the central database of Leiden University Hospital. All registrations relating to patients undergoing a percutaneous renal biopsy in 1985 and 1986 were taken into account and combined in defining the design and criteria for selection.