International Journal of Medical Informatics RSS feed: Current Issue. The Journal provides an international medium for dissemination of original results and interpretative reviews concerning the field of medical informatics. The Journal emphasizes the evaluation of systems in healthcare settings. The scope of the journal covers: • Information systems, including national or international registration systems, hospital information systems, departmental and/or physician's office systems, document handling systems, electronic medical record systems, standardization, systems integration etc.; • Computer-aided medical decision support systems using heuristic, algorithmic and/or statistical methods as exemplified in decision theory, protocol development, artificial intelligence, etc. • Educational computer based programs pertaining to medical informatics or medicine in general. • Organizational, economic, social, clinical impact, ethical and cost-benefit aspects of IT applications in health care. Short technical communications concerning (solved) problems in implementing or using existing information systems are welcome. Review articles concerning subjects falling in the scope of the journal are also invited.http://www.ijmijournal.com/?rss=yesElsevier Inc.en © 2010 Elsevier Ireland Ltd. All rights reserved. International Journal of Medical Informatics1386-5056794April 2010 © 2010 Elsevier Ireland Ltd. All rights reserved. healthpermissions@elsevier.comhttp://www.ijmijournal.com/article/PIIS1386505610000237/abstract?rss=yesThis issue contains a compendium of scientifically rigorous articles addressing specific usability issues in mobile health and CPOE. The papers contained in this special issue are the output of an IMIA Working Group (WG) on Human Factors Engineering in Health Informatics Symposium held in Lille, France. This topic and the papers from this special issue are important methods necessary to create safe and usable clinical decision support systems.Human factors engineering for healthcare IT clinical applicationsMarie-Catherine Beuscart-Zéphir, Jos Aarts, Peter Elkin10.1016/j.ijmedinf.2010.01.010International Journal of Medical Informatics 79, 4 (2010)2010-02-19International Journal of Medical Informatics2010-02-19794S1386-5056(10)X0004-1Editorial223224http://www.ijmijournal.com/article/PIIS138650561000002X/abstract?rss=yesAbstract: Objectives: Choosing and justifying the right amount of investment in healthcare information technologies (HITECH or HIT) in hospitals is an ever increasing challenge. Our objectives are to assess the financial impact of HIT on hospital outcome, and propose decision-helping tools that could be used to rationalize the distribution of hospital finances.Design: We used a production function and microeconomic tools on data of 21 Paris university hospitals recorded from 1998 to 2006 to compute the elasticity coefficients of HIT versus non-HIT capital and labor as regards to hospital financial outcome and optimize the distribution of investments according to the productivity associated with each input.Results: HIT inputs and non-HIT inputs both have a positive and significant impact on hospital production (elasticity coefficients respectively of 0.106 and 0.893; R2 of 0.92). We forecast 2006 results from the 1998 to 2005 dataset with an accuracy of +0.61%. With the model used, the best proportion of HIT investments was estimated to be 10.6% of total input and this was predicted to lead to a total saving of 388 million Euros for the 2006 dataset.Conclusion: Considering HIT investment from the point of view of a global portfolio and applying econometric and microeconomic tools allow the required confidence level to be attained for choosing the right amount of HIT investments. It could also allow hospitals using these tools to make substantial savings, and help them forecast their choices for the following year for better HITECH governance in the current stimulation context.Choosing the right amount of healthcare information technologies investmentsRodolphe Meyer, Patrice Degoulet10.1016/j.ijmedinf.2010.01.001International Journal of Medical Informatics 79, 4 (2010)2010-02-01International Journal of Medical Informatics2010-02-01794S1386-5056(10)X0004-1Regular papers225231http://www.ijmijournal.com/article/PIIS1386505610000171/abstract?rss=yesAbstract: Introduction: Inappropriate medication among elderly people increases the risk of adverse drug–drug interactions, drug-related falls and hospital admissions. In order to prevent these effects it is necessary to obtain a profile of the patients’ medication. A personal digital assistant (PDA) can be used as a medical decision support system (MDSS) to obtain a profile of the patients’ medication and to check for inappropriate drugs and drug combinations, and to reduce medication errors.Aim: The aim of the present study was to evaluate nurses’ experiences of using a MDSS in a PDA with a barcode reader, in order to obtain profiles of the patients’ medication, regarding drug–drug interactions, therapeutic duplications, and warnings for drugs unsuitable for elderly in home care.Methods: The LIFe-reader® is a MDSS in a PDA with a barcode reader. By scanning the drug packages in the patients’ home, the LIFe-reader® obtained profiles of the patients’ medication and checked for drug–drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly people. The LIFe-reader® also contained, e.g. drug information and medical reference works. Nurses (n=15) used the LIFe-reader® for five weeks during their nursing home care practice assignment. The nurses answered questionnaires about the content and functions of the LIFe-reader® before, during and after the nursing home care practice assignment, and were interviewed in focus groups. Descriptive statistics were used and content analysis was applied for qualitative data.Results: By using the LIFe-reader®, the majority of the nurses found it easy to obtain profiles of the patients’ medication and check for drug–drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly people. Most nurses regarded the LIFe-reader® to reduce drug-related risks of falling, and some thought it could reduce the drug-related admissions to hospitals. The scanning function was described as easy and time saving, although not always possible to use. The LIFe-reader® was regarded as a useful and user-friendly MDSS, but more content and functions were requested.Conclusions: We found that the LIFe-reader® has the potential to be a useful and user-friendly MDSS for nurses in home care when obtaining profiles of the patients’ medication regarding drug–drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly. A regular scanning of the patients’ drugs in their home might support nurses and general practitioners (GPs) in reducing the inappropriate use of drugs. If the LIFe-reader® should be used in a larger scale among nurses, more content and functions are necessary.Personal digital assistant with a barcode reader—A medical decision support system for nurses in home carePauline E. Johansson, Göran I. Petersson, Gunilla C. Nilsson10.1016/j.ijmedinf.2010.01.004International Journal of Medical Informatics 79, 4 (2010)2010-02-08International Journal of Medical Informatics2010-02-08794S1386-5056(10)X0004-1Regular papers232242http://www.ijmijournal.com/article/PIIS1386505610000183/abstract?rss=yesAbstract: Purpose: To evaluate the functionality of drug safety alerting in hospital computerized physician order entry (CPOE) systems by a newly developed comprehensive test.Methods: Comparative evaluation of drug safety alerting quality in 6 different CPOEs used in Dutch hospitals, by means of 29 test items for sensitivity and 19 for specificity in offices of CPOE system vendors. Sensitivity and specificity were calculated for the complete test, and for the categories “within-order checks”, “patient-specific checks”, and “checks related to laboratory data and new patient conditions”. Qualitative interviews with 16 hospital pharmacists evaluating missing functionality and corresponding pharmacy checks.Results: Sensitivity ranged from 0.38 to 0.79 and specificity from 0.11 to 0.84. The systems achieved the same ranking for sensitivity as for specificity. Within-order checks and patient-specific checks were present in all systems; alert generation or suppression due to laboratory data and new patient conditions was largely absent. Hospital pharmacists unanimously rated checks on contra-indications (absent in 2 CPOEs) and dose regimens less than once a day (absent in 4 CPOEs) as important. Pharmacists’ opinions were more divergent for other test items. A variety of pharmacy checks were used, and clinical rules developed, to address missing functionality.Conclusions: Our test revealed widely varying functionality and appeared to be highly discriminative. Basic clinical decision support was partly absent in two CPOEs. Hospital pharmacists did not rate all test items as important and tried to accommodate the lacking functionality by performing additional checks and developing clinical rules.Functionality test for drug safety alerting in computerized physician order entry systemsHeleen van der Sijs, Rachida Bouamar, Teun van Gelder, Jos Aarts, Marc Berg, Arnold Vulto10.1016/j.ijmedinf.2010.01.005International Journal of Medical Informatics 79, 4 (2010)2010-02-10International Journal of Medical Informatics2010-02-10794S1386-5056(10)X0004-1Regular papers243251http://www.ijmijournal.com/article/PIIS1386505609001932/abstract?rss=yesAbstract: Objective: Health information technology has been shown to influence the communication patterns of healthcare providers. The goal of this study was to learn more about how healthcare providers communicate and exchange patient clinical information during patient handoffs (transfers) between units in an acute care setting.Methods: Convenience sampling was used to select five patient handoffs. Questionnaires were distributed to providers identified through observation and snowball sampling. Social network analysis methodology was used to develop sociograms of the emergent communication patterns and identify the role of individual providers in the handoff process based on the number of contacts with other providers and incoming and outgoing communication activity. Individual handoff network size ranged from 11 to 20 providers. Participants were asked to describe the method of communication they used to access or share clinical information with other providers, their preferred method of communication; their satisfaction with the available options; and their suggestions for how the process could be improved.Results: The network patterns that emerged uncovered the overlapping use of synchronous and asynchronous communication methods (verbally via phone or in person; or written via paper charts and/or an electronic records). No particular professional group dominated or coordinated information flow; instead each handoff network exhibited unique communication patterns and information coordination by two or more influential providers from nursing, medicine, or pharmacy. Most (84%) participants preferred verbal communication. Overall satisfaction with the current communication process varied by unit: 82% of emergency department providers and 54% of the providers working in the admitting units stated they were satisfied or very satisfied. Recommendations for improvement included converting all units to the electronic health record, electronic handoff communication modules and asynchronous multi-professional communication logs.Conclusions: The results of this exploratory study provide a foundation for future research examining how network structure and communication principles can be used to design health information technology that compliments the non-linear information gathering and dissemination behaviors of providers from multiple professions.Multi-professional patterns and methods of communication during patient handoffsMarge M. Benham-Hutchins, Judith A. Effken10.1016/j.ijmedinf.2009.12.005International Journal of Medical Informatics 79, 4 (2010)2010-01-15International Journal of Medical Informatics2010-01-15794S1386-5056(10)X0004-1Regular papers252267http://www.ijmijournal.com/article/PIIS1386505610000225/abstract?rss=yesAbstract: Purpose: The objective of this paper is to show that grounded theory (GT), together with mixed methods, can be used to involve healthcare professionals in the design and enhancement of access control policies to Electronic Medical Record (EMR) systems.Methods: The mixed methods applied for this research included, in this sequence, focus groups (main qualitative method that used grounded theory for the data analysis) and structured questionnaires (secondary quantitative method).Results: Results showed that the presented methodology can be used to involve healthcare professionals in the definition of access control policies to EMR systems and explore these issues in a diversified and integrated way. The methodology allowed for the generation of great amounts of data in the beginning of the study and in a short time span. Results from the applied methodology revealed a first glimpse of the theories to be generated and integrated, with future research, into access control policies.Conclusions: The methodological research described in this paper is very rarely, if ever, applied in developing security tools such as access control. Nevertheless, it can be an effective way of involving healthcare professionals in the definition and enhancement of access control policies and in making information security more grounded into their workflows and daily practices.Grounding information security in healthcareAna Ferreira, Luis Antunes, David Chadwick, Ricardo Correia10.1016/j.ijmedinf.2010.01.009International Journal of Medical Informatics 79, 4 (2010)2010-02-15International Journal of Medical Informatics2010-02-15794S1386-5056(10)X0004-1Regular papers268283http://www.ijmijournal.com/article/PIIS1386505610000274/abstract?rss=yesAbstract: Purpose: The emergence and re-emergence of disease outbreaks of international concern in the last several years has raised the importance of health surveillance systems that exploit the open media for their timely and precise detection of events. However, one of the key barriers faced by current event-based health surveillance systems is in identifying fine-grained terms for an outbreak's geographical location. In this article, we present a method to tackle this problem by associating each reported event with the most specific spatial information available in a news report. This would be useful not only for health surveillance systems, but also for other event-centered processing systems.Methods: To develop an automated spatial attribute annotation system, we first created a gold standard corpus for training a machine learning model. Since the qualitative analysis on data suggested that the event class might have an impact on the spatial attribute annotation, we also developed an event classification system to incorporate event class information into the spatial attribute annotation model. To automatically recognize the spatial attribute of events, several approaches, ranging from a simple heuristic technique to a more sophisticated approach based on a state-of-the-art Conditional Random Fields (CRFs) model were explored. Different feature sets were incorporated into the model and compared.Results: The evaluations were conducted on 100 outbreak news articles. Spatial attribute recognition performance was evaluated based on three metrics; precision, recall and the harmonic mean of precision and recall (F-score). Among three strategies proposed in this article, the CRF model appeared to be the most promising for spatial attribute recognition with a best performance of 85.5% F-score (86.3% precision and 84.7% recall).Conclusion: We presented a methodology for associating each event in media outbreak reports with their spatial attribute at the finest level of granularity. Our goal has been to provide a means for enhancing the spatial understanding of outbreak-related events. Evaluation studies showed promising results for automatic spatial attribute annotation. In the future, we plan to explore more features, such as semantic correlation between words, that maybe useful for the spatial attribute annotation task.A methodology to enhance spatial understanding of disease outbreak events reported in news articlesHutchatai Chanlekha, Nigel Collier10.1016/j.ijmedinf.2010.01.014International Journal of Medical Informatics 79, 4 (2010)2010-02-15International Journal of Medical Informatics2010-02-15794S1386-5056(10)X0004-1Regular papers284296http://www.ijmijournal.com/article/PIIS1386505610000201/abstract?rss=yesAbstract: Objectives: In PubMed search forms, the publication date refers to both the date of electronic and printed publication. This fact is documented in PubMed, but difficult to anticipate by the users and can provoke misinterpretations of search results. The Technical Note aims at systematically investing the effect (referred to as the publication echo), clarifying onset and extent of the publication echo, and comments on its impact.Methods: Papers with ambiguous publication dates are systematically retrieved and a trend analysis with seasonal decomposition on monthly publication data is performed.Results: First doubled search results were found for 1999, their number since then rapidly increasing. Up to 17.6% of all articles of a year are found to be published electronically and in print, which can be before or afterwards. Maximum delay between the two dates is three years, except for one singular publication, where it is five years. Publication trends are exponential and linear when considering echoed and echo-cleaned data, respectively.Conclusions: As a conclusion, we suggest using a query formulation that unambiguously retrieves literature from PubMed by the date of publication.The publication echo: Effects of retrieving literature in PubMed by year of publicationCord Spreckelsen, Thomas M. Deserno, Klaus Spitzer10.1016/j.ijmedinf.2010.01.007International Journal of Medical Informatics 79, 4 (2010)2010-02-15International Journal of Medical Informatics2010-02-15794S1386-5056(10)X0004-1Regular papers297303http://www.ijmijournal.com/article/PIIS1386505608001822/abstract?rss=yesAbstract: This paper discusses some crucial issues associated with the exploitation of data and information about health care for the improvement of patient safety. In particular, the issues of human factors and safety management are analysed in relation to exploitation of reports about non-conformity events and field observations. A methodology for integrating field observation and theoretical approaches for safety studies is described.Two sample cases are discussed in detail: the first one makes reference to the use of data collected in the aviation domain and shows how these can be utilised to define hazard and risk; the second one concerns a typical ethnographic study in a large hospital structure for the identification of most relevant areas of intervention.The results show that, if national authorities find a way to harmonise and formalise critical aspects, such as the severity of standard events, it is possible to estimate risk and define auditing needs, well before the occurrence of serious incidents, and to indicate practical ways forward for improving safety standards.Human factors engineering in healthcare systems: The problem of human error and accident managementP.C. Cacciabue, G. Vella10.1016/j.ijmedinf.2008.10.005International Journal of Medical Informatics 79, 4 (2010)2009-01-30International Journal of Medical Informatics2009-01-30794S1386-5056(10)X0004-1Special Issue paperse1e17http://www.ijmijournal.com/article/PIIS1386505608002098/abstract?rss=yesAbstract: The aim of this paper is to review some work conducted in the field of user testing that aims at specifying or clarifying the test procedures and at defining and developing tools to help conduct user tests. The topics that have been selected were considered relevant for evaluating applications in the field of medical and health care informatics. These topics are: the number of participants that should take part in a user test, the test procedure, remote usability evaluation, usability testing tools, and evaluating mobile applications.Usability testing: a review of some methodological and technical aspects of the methodJ.M. Christian Bastien10.1016/j.ijmedinf.2008.12.004International Journal of Medical Informatics 79, 4 (2010)2009-04-03International Journal of Medical Informatics2009-04-03794S1386-5056(10)X0004-1Special Issue paperse18e23http://www.ijmijournal.com/article/PIIS138650560800110X/abstract?rss=yesAbstract: Background: While much is known about how to do usability testing of stationary Electronic Patient Record (EPR) systems, less is known about how to do usability testing of mobile ICT systems intended for use in clinical settings.Aim: Our aim is to provide a set of empirically based recommendations for usability testing of mobile ICT for clinical work.Method: We have conducted usability tests of two mobile EPR systems. Both tests have been done in full-scale models of hospital settings, and with multiple users simultaneously. We report here on the methodological aspects of these tests.Results: We found that the usability of the mobile EPR systems to a large extent were determined by factors that went beyond that of the graphical user interface. These factors include ergonomic aspects such as the ability to have both hands free, and social aspects such as to what extent the systems disturbs the face-to-face interaction between the health worker and the patient.Conclusions: To be able to measure usability issues that go beyond what can be found by a traditional stationary user interface evaluation, it is necessary to conduct usability tests of mobile EPR systems in physical environments that simulate the conditions of the work situation at a high level of realism. It is further in most cases necessary to test with a number of test subjects simultaneously.Usability testing of mobile ICT for clinical settings: Methodological and practical challengesDag Svanæs, Ole Andreas Alsos, Yngve Dahl10.1016/j.ijmedinf.2008.06.014International Journal of Medical Informatics 79, 4 (2010)2009-01-30International Journal of Medical Informatics2009-01-30794S1386-5056(10)X0004-1Special Issue paperse24e34http://www.ijmijournal.com/article/PIIS1386505608000671/abstract?rss=yesAbstract: Objectives: The integration of Human Factors is still insufficient in the design and implementation phases of complex interactive systems such as Computerized Physician Order Entry (CPOE) systems. One of the problems is that human factors specialists have difficulties to communicate their data and to have them properly understood by the computer scientists in the design and implementation phases. This paper presents a solution to this problem based on the creation of common documentation supports using Software Engineering (SE) and Human–Computer Interaction (HCI) methods.Method: The integration of SE and HCI methods and models is an interesting means for modelling an organization's activities, with software applications being part of these activities. Integrating these SE and HCI methods and models allows case studies to be seen from the technical, organizational and ergonomic perspectives, and also makes it easier to compare current and future work situations.Results: The exploitation of these techniques allows the creation of common work supports that can be easily understandable by computer scientists and relevant for re-engineering or design. In this paper, the basic principles behind such communication supports are described and illustrated by a real case study.Integrating the SE and HCI models in the human factors engineering cycle for re-engineering Computerized Physician Order Entry systems for medications: Basic principles illustrated by a case studyStéphanie Bernonville, Christophe Kolski, Nicolas Leroy, Marie-Catherine Beuscart-Zéphir10.1016/j.ijmedinf.2008.04.003International Journal of Medical Informatics 79, 4 (2010)2009-01-30International Journal of Medical Informatics2009-01-30794S1386-5056(10)X0004-1Special Issue paperse35e42http://www.ijmijournal.com/article/PIIS1386505609001142/abstract?rss=yesAbstract: Objective: The objectives of this paper are:In this approach, the implementation of such a complex IT solution is considered a major redesign of the work system. The paper describes the Human Factor (HF) tasks embedded in the project lifecycle: (1) analysis and modelling of the current work system and usability assessment of the medication CPOE solution; (2) HF recommendations for work re-design and usability recommendations for IT system re-engineering both aiming at a safer and more efficient work situation.Methods: Standard ethnographic methods were used to support the analysis of the current work system and work situations, coupled with cognitive task analysis methods and documents review. Usability inspection (heuristic evaluation) and both in-lab (simulated tasks) and on-site (real tasks) usability tests were performed for the evaluation of the CPOE candidate. Adapted software engineering models were used in combination with usual textual descriptions, tasks models and mock-ups to support the recommendations for work and product re-design.Results: The analysis of the work situations identified different work organisations and procedures across the hospital's departments. The most important differences concerned the doctor–nurse communications and cooperation modes and the procedures for preparing and administering the medications. The assessment of the medication CPOE functions uncovered a number of usability problems including severe ones leading to impossible to detect or to catch errors.Models of the actual and possible distribution of tasks and roles were used to support decision making in the work design process. The results of the usability assessment were translated into requirements to support the necessary re-engineering of the IT application.Conclusion: The HFE approach to medication CPOE efficiently identifies and distinguishes currently unsafe or uncomfortable work situations that could obviously benefit from an IT solution from other work situations incorporating efficient work procedures that might be impaired by the implementation of the CPOE. In this context, a careful redesign of the work situation and of the entire work system is necessary to actually benefit from the installation of the product in terms of patient safety and human performances. In parallel, a usability assessment of the product to be implemented is mandatory to identify potentially dangerous usability flaws and to fix them before the installation.Example of a Human Factors Engineering approach to a medication administration work system: Potential impact on patient safetyMarie-Catherine Beuscart-Zéphir, Sylvia Pelayo, Stéphanie Bernonville10.1016/j.ijmedinf.2009.07.002International Journal of Medical Informatics 79, 4 (2010)2009-09-10International Journal of Medical Informatics2009-09-10794S1386-5056(10)X0004-1Special Issue paperse43e57http://www.ijmijournal.com/article/PIIS1386505609001038/abstract?rss=yesAbstract: Objective: To investigate the human, social and organizational issues surrounding a Computerized Physician Order Entry system for Laboratory ordering (CPOE-L) implementation process and to analyze their interrelated effects on the system implementation failure in an academic medical setting. Second, to provide lessons learned and recommendations on to how to manage challenges of human, social and organizational nature surrounding CPOE-L implementations.Methods: The themes surrounding CPOE introduction were identified by a heuristic analysis of literature on CPOE implementations. The resulting set of themes was applied as a reference model for 20 semi-structured interviews conducted during the CPOE-L implementation process with 11 persons involved in the CPOE-L project and in reviewing all CPOE-L related project documentation. Data was additionally gathered by user questionnaires, by user discussion rounds and through an ethnographical study performed at the involved clinical and laboratory departments. In analyzing the interview transcripts, project documentation and data from user questionnaires and discussion rounds a grounded theory approach was applied by the evaluation team to identify problem areas or issues deserving further analysis.Results: Outlined central problem areas concerning the CPOE-L implementation and their mutual relations were depicted in a conceptual interpretative model. Understanding of clinical workflow was identified as a key theme pressured by organizational, human and social issues ultimately influencing the entire implementation process in a negative way. Vast delays in CPOE introduction, system immaturity and under-functionality could all be directly attributed to a superficial understanding of workflow. Consequently, final CPOE integration into clinical and laboratory workflows was inhibited by both end-users as well as department managers and withdrawal of the CPOE-L system became inevitable.Conclusion: This case study demonstrates which human, social and organizational issues relevant to CPOE implementation cumulatively led to a failure outcome of the CPOE-L pilot introduction. The experiences and considerations described in this paper show important issues for CPOE systems to be successfully introduced and to be taken into account in future CPOE implementations. Understanding and consideration of (clinical) workflow aspects by project managers and the involved clinical organization is of extreme importance from the very start of a CPOE implementation process.Anatomy of a failure: A sociotechnical evaluation of a laboratory physician order entry system implementationLinda W. Peute, Jos Aarts, Piet J.M. Bakker, Monique W.M. Jaspers10.1016/j.ijmedinf.2009.06.008International Journal of Medical Informatics 79, 4 (2010)2009-07-29International Journal of Medical Informatics2009-07-29794S1386-5056(10)X0004-1Special Issue paperse58e70http://www.ijmijournal.com/article/PIIS1386505608001275/abstract?rss=yesAbstract: In this manuscript we report an evaluation of the reliability of clinical research rules creation by multiple clinicians using the Health Archetype Language (HAL-42) and user interface. HAL-42 is a language which allows real time epidemiological inquiry using automatically derived clinical encodings with any health Ontology. This evaluation used SNOMED CT as the underlying Ontology. The inquiries were performed on a population of 17,731 patients whose 50,000 clinical records have all been fully encoded in SNOMED CT. Four subject matter experts (SMEs) were asked independently to encode and run 10 rules/studies. The inter-rater agreement was 74.8% (p=0.6526) with a Kappa statistic of 0.49217 (p=0.5722). The ten rules were divided into three easy rules, four moderate and three complex rules. There was no significant difference in the SME’s agreement when representing easy and complex rules (p=0.6243). We conclude that although the usability of the HAL-42 language is usable enough to achieve reasonable inter-rater reliability, some training will be necessary to reach high levels of reliability for ad hoc queries. We also conclude that SMEs are just as competent to perform complex queries as easy queries of ontologically indexed clinical data.The Health Archetype Language (HAL-42): Interface considerationsPeter L. Elkin, David Froehling, Dietlind Wahner-Roedler, Brett Trusko, Gail Welsh, S. Trent Rosenbloom, Theodore Speroff, Steven H. Brown10.1016/j.ijmedinf.2008.07.009International Journal of Medical Informatics 79, 4 (2010)2009-01-30International Journal of Medical Informatics2009-01-30794S1386-5056(10)X0004-1Special Issue paperse71e75http://www.ijmijournal.com/article/PIIS138650560900104X/abstract?rss=yesAbstract: Companies developing and commercializing Healthcare IT applications may decide to involve the users in the software development lifecycle in order to better understand the users’ needs and to optimize their products. Unfortunately direct developers–users dialogues are not sufficient to ensure a proper understanding of the users’ needs. It is also necessary to involve human factors specialists to analyze the users’ expression of their needs and to properly formalize the requirements for design purposes. The objective of this paper is to present a case study reporting the collaborative work between HF experts and a company developing and commercializing a CPOE. This study shows how this collaboration helps resolve the limits of direct users involvement and usual problems pertaining to users’ needs description and understanding.Method: The company participating in the study has implemented a procedure to convene regular meetings allowing direct exchanges between the development team and users’ representatives. Those meetings aim at getting users’ feedbacks on the existing products and at validating further developments. In parallel with usual HF methods supporting the analysis of the work system (onsite observations followed by debriefing interviews) and the usability evaluation of the application (usability inspection and usability tests), HF experts took the opportunity of the meetings organized by the company to collect, re-interpret and re-formulate the needs expressed by the users.Results: The developers perceive the physicians’ requirements concerning the display of the patient's list of medication as contradictory. In a previous meeting round the users had required a detailed view of the medication list against the synthesized existing one. Once this requirement satisfied, the users participating in the current meeting round require a synthesized view against the existing detailed one. The development team is unable to understand what they perceive as a reverse claim. Relying on a cognitive analysis of the physicians’ decision making concerning the patient's treatment, the HF experts help re-formulate the physicians’ cognitive needs in terms of synthesized/detailed display of the medication list depending on the stage of the decision making process. This led to an astute re-engineering of the application allowing the physicians to easily navigate back and forth between the synthesized and detailed views depending on the progress of their decision making.Conclusion: This study demonstrates that the integration of users’ representatives in the software lifecycle is a good point for the end users. But it remains insufficient to resolve the complex usability problems of the system. Such solutions require the integration of HF expertise. Moreover, such an involvement of HF experts may generate benefits in terms of reduction of (i) the number of iterative developments and (ii) the users’ training costs.From users involvement to users’ needs understanding: A case studyJulie Niès, Sylvia Pelayo10.1016/j.ijmedinf.2009.06.007International Journal of Medical Informatics 79, 4 (2010)2009-08-06International Journal of Medical Informatics2009-08-06794S1386-5056(10)X0004-1Special Issue paperse76e82http://www.ijmijournal.com/article/PIIS1386505608001858/abstract?rss=yesAbstract: Objective: To discuss, taking the example of a meta-analysis on computerized physician order entry (CPOE) systems, the special challenges of Evidence-Based Health Informatics, defined as the conscientious, explicit and judicious use of current best evidence when making decisions about introduction and operation of information technology in a given health care setting.Methods: We conducted a case study by performing a systematic review and meta-analysis of CPOE studies. We collected and discussed the challenges we addressed and how they could be overcome.Results: Challenges comprise the correct identification of published health informatics evaluation studies, the low reporting and study quality of studies, the problem of combining evidence from heterogeneous studies, and the problem of publication bias in health informatics.Conclusion: Based on our experiences while conducting the CPOE meta-analysis, we argue that we are still at the beginning of Evidence-Based Health Informatics. To overcome the discussed challenges, health informatics should strive for harmonized terminology, a study registry, reporting standards, financial or legal incentives for conducting studies, methods to combine evidence from quantitative and qualitative studies, and guidelines for conducting and publishing evaluation studies.Vision and challenges of Evidence-Based Health Informatics: A case study of a CPOE meta-analysisElske Ammenwerth, Petra Schnell-Inderst, Uwe Siebert10.1016/j.ijmedinf.2008.11.003International Journal of Medical Informatics 79, 4 (2010)2009-01-30International Journal of Medical Informatics2009-01-30794S1386-5056(10)X0004-1Special Issue paperse83e88