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 © 2012 Published by Elsevier Inc. All rights reserved. International Journal of Medical Informatics1386-5056816June 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.ijmijournal.com/article/PIIS1386505612000809/abstract?rss=yesEditorial Board10.1016/S1386-5056(12)00080-9International Journal of Medical Informatics 81, 6 (2012)2012-06-01International Journal of Medical Informatics2012-06-01816S1386-5056(12)X0006-6iihttp://www.ijmijournal.com/article/PIIS1386505611002644/abstract?rss=yesHighlights: ► This subject has never been studied in Saudi Arabia. ► The use of Internet to search for health related information has been growing rapidly in Saudi Arabia. ► Our research draws the attention of health authorities about this practice.Abstract: Background: The use of the Internet to search for health-related information (HRI) has become a common practice worldwide. Our literature review failed to find any evidence of previous studies on this topic from Saudi Arabia.Objective: To determine the public use of the Internet in Saudi Arabia to search for HRI and to evaluate patients’ perceptions of the quality of the information available on the Internet compared to that provided by their health care providers.Methods: A self-administered questionnaire about Internet use to search for HRI was distributed randomly to male and female outpatients and visitors attending a public University Hospital in Riyadh, Saudi Arabia from January to May 2010. A Chi-squared test was used to assess the association between different categorical variables. Multiple logistic regression was used to relate the use of the Internet to search for HRI with various socio-demographic variables.Results: The questionnaire response was 80.1%, with completion of 801 of the 1000 distributed questionnaires; 50% (400/801) of respondents were males. The mean age of respondents was 32±11 years. The majority of respondents used the Internet in general (87.8%), and 58.4% of them (363/622) used the Internet to search for HRI. The majority stated a doctor was their primary source of HRI (89.3%, 654/732). This practice was considered useful by 84.2%, and the main reason behind it was sheer curiosity (92.7%, 418/451). Other reasons included not getting enough information from their doctor (58.5%, 227/413) and not trusting the information given by their doctor (28.2%, 101/443). Forty-four percent (205/466) searched for HRI before coming to the clinic; 72.5% of those discussed the information with their doctors and 71.7% (119/166) of those who did so believed that this positively affected their relationship with their doctor. Searching the Internet for health information was observed more frequently among the 30–39 year age group (OR=2.0, 95% CI 1.1–3.7), females (OR=3.8, 95% CI 2.3–6.4), individuals with university or higher education (OR=1.7, 95% CI 1.1–2.8), employed individuals (OR=2.7, 95% CI 1.4–4.9) and high income groups (OR=2.8, 95% CI 1.5–5.1).Conclusions: A proportion of the public searches the Internet to obtain HRI for various reasons, which could have consequences on their health and relationship with their doctors. Therefore, doctors should be aware of the health information available online to help guide patients to reliable websites. Health authorities should also be aware of the issue to offer regulations and solutions.Internet use by the public to search for health-related informationKhalid M. AlGhamdi, Noura A. Moussa10.1016/j.ijmedinf.2011.12.004International Journal of Medical Informatics 81, 6 (2012)2012-01-05International Journal of Medical Informatics2012-01-05816S1386-5056(12)X0006-6363373http://www.ijmijournal.com/article/PIIS138650561100270X/abstract?rss=yesHighlights: ► Online informational needs of patients i.c. navigation and content should be met in a personalized way to avoid attrition and to encourage adherence. ► eHealth literacy scale (eHEALS) does not seem to cover all aspects of digital skills. ► Patient perspective is indispensable for usability research in consumer health informatics. ► Mixed social scientific techniques deliver useful results regarding usability improvement and information seeking behavior.Abstract: Background: To improve the information position of health care consumers and to facilitate decision-making behavior in health the Dutch ministry of Health commissioned the National Institute for Public Health and the Environment to develop, host and manage a public national health and care portal (www.kiesbeter.nl) on the Internet. The portal is used by over 4 million visitors in 2010. Among them, an increasing amount of patients that use the portal for information and decision making on medical issues, healthy living, health care providers and other topics.Objective: First objective is to examine what usability aspects of the portal kiesBeter.nl matter for chronic patients and their informal carers with regard to information seeking, self-management, decision making, on line health information and other variables. Second objective is to make evidence-based practical recommendations for usability improvement.Methods: An innovative combination of techniques (semi-structured interviews; eHealth Literacy scale; scenario-based study using think-aloud protocol and screen capture software; focus group) is used to study usability and on line information seeking behavior in a non random judgment sample of three groups of patients (N=21) with long-term medical conditions (arthritis, asthma and diabetes).Results: The search strategy mostly used (65%) by the relatively well-educated subjects is ‘orienteering’. Users with long-term conditions and their carers expect tailored support from a national health portal, to help them navigate, search and find the detailed information they need. They encounter serious problems with these usability issues some of which are disease-specific. Patients indicate a need for personalized information. They report low impact on self-management and decision making. Overall judgment of usability is rated 7 on a Likert type 0–10 scale. Based on the outcomes recommendations could be formulated. These have led to major adaptations to improve usability.Limitations: A non-representative composition of a small non random judgment sample does not permit generalization to other populations and cognitive bias cannot be quantified. However if mixed methods are applied valid conclusions can be drawn with regard to usability issues.Online usability and patients with long-term conditions: A mixed-methods approachHans C. Ossebaard, Erwin R. Seydel, Lisette van Gemert-Pijnen10.1016/j.ijmedinf.2011.12.010International Journal of Medical Informatics 81, 6 (2012)2012-01-20International Journal of Medical Informatics2012-01-20816S1386-5056(12)X0006-6374387http://www.ijmijournal.com/article/PIIS1386505611002711/abstract?rss=yesHighlights: ► The mobile phone and internet intervention improved waist circumference and body weight at 12 weeks in post-menopausal women. ► A significant mean decrease in blood pressure was observed for the intervention group. ► The web-based intervention using mobile phone and Internet decreased total cholesterol and low-density lipoprotein-cholesterol.Abstract: Purpose: The present study evaluated whether an intervention using a short message service (SMS) by personal cellular phone and Internet would reduce cardiovascular risk factors in post-menopausal women with abdominal obesity over 12 weeks.Methods: This is a quasi-experimental design with pre and post tests. Participants were recruited from the gynecology outpatient and family medicine departments of a tertiary care hospital located in an urban city of South Korea. Only 67 subjects completed the entire study, 34 in the intervention group and 33 controls. The goal of intervention was to reduce waist circumference (WC), body weight (BW) and blood pressure (BP) levels. Before the intervention, demographic variables, WC, BW, BP, fasting plasma glucose (FPG) and serum lipids were measured as pre-test data. The WC, BW, BP, FPG and serum lipids were measured again 12 weeks later. Patients in the intervention group were requested to record their WC, BW, BP, type and amount of diet and exercise in a weekly web-based diary through the Internet or by cellular phone. The researchers sent weekly recommendations on diet and exercise as an intervention to each patient, by both cellular phone and Internet. The intervention was applied for 12 weeks.Results: WC and BW significantly decreased by 3.0cm and 2.0kg, respectively, at 12 weeks compared with the baseline in the intervention group. However, the mean changes in the control group significantly increased by 0.9cm and 0.7kg. Systolic BP (SBP) and diastolic BP (DBP) significantly decreased by 6.5 and 4.6mmHg in the intervention group, respectively. The mean changes in the control group were not significant in either SBP or DBP. A significant mean decrease in total cholesterol (TC) was observed for the intervention group by 12.9mg/dl, while the control group showed a significant mean increase by 1.5mg/dl. Low-density lipoprotein-cholesterol (LDL-C) for the intervention group showed a significant mean decrease 11.3mg/dl. The mean change in the control group was, however, not significant.Conclusion: Web-based individual intervention using both SMS and Internet improved WC, BW, BP, TC, and LDL-C during 12 weeks in post-menopausal women with abdominal obesity.Evaluation of mobile phone and Internet intervention on waist circumference and blood pressure in post-menopausal women with abdominal obesityMin-Jeong Park, Hee-Seung Kim10.1016/j.ijmedinf.2011.12.011International Journal of Medical Informatics 81, 6 (2012)2012-01-24International Journal of Medical Informatics2012-01-24816S1386-5056(12)X0006-6388394http://www.ijmijournal.com/article/PIIS1386505611002346/abstract?rss=yesHighlights: ► A web-based cancer navigation tool was presented to clinic team members. ► A qualitative approach served to explore team members’ perceptions of the tool. ► Overall, participants’ views were positive about the OIN™. ► Findings highlighted potential barriers pertaining to OIN™ uptake. ► Exploring multiple stakeholders views of e-health can enhance implementation.Abstract: Objectives: The Internet has become an important source of health information for patients and health care providers (HCPs) alike. Whereas studies have begun to document the effects of the internet on health behaviors and outcomes, surprisingly few studies have explored HCPs’ perceptions of the internet as a key resource accessed by patients. However, as HCPs are seen as pivotal in guiding patients toward these resources, it is timely to study their perceptions. Therefore, the present inquiry explores HCPs’ views of a recently developed high quality virtual navigation tool called the Oncology Interactive Navigator™ (OIN).Design: Using a qualitative approach, in-depth interviews were conducted with 16 members of a multidisciplinary colorectal oncology team and volunteers at a large Cancer Centre in Montreal, Quebec, Canada.Results: Content analysis revealed emerging themes centering on key benefits including: perceptions of a highly accessible, comprehensive high quality repository of cancer information; a means to further enhance HCP-patient communication and trust; and a significant catalyst to patient–family communication and support. Perceived drawbacks included patient (e.g., socio-demographic profile) and system's (e.g., professional roles and time constraints) characteristics that may limit OIN™ full implementation and uptake.Conclusions: The findings underscore the relevance of virtual navigation tools to ensure optimal person-centred care in cancer. Findings also suggest how virtual tools such as the OIN™ can best be used in practice as well as they guide strategies to adopt to optimize implementation of similar innovations in health care.Oncology team members’ perceptions of a virtual navigation tool for cancer patientsKristen R. Haase, Carmen G. Loiselle10.1016/j.ijmedinf.2011.11.001International Journal of Medical Informatics 81, 6 (2012)2012-01-16International Journal of Medical Informatics2012-01-16816S1386-5056(12)X0006-6395403http://www.ijmijournal.com/article/PIIS1386505612000172/abstract?rss=yesHighlights: ► This paper presents a successful experience in the setting up of a telemedicine solution for remote video-EEG consultation. ► The system was technically and clinically viable and impact over patients was very positive. ► To the best of our knowledge, this is a pioneer experience in Spain. ► Provides a reference model with huge repercussion for a health system.Abstract: Purpose: The purpose of this paper is to report and discuss a successful experience in the setting up of a telemedicine solution for remote video-electroencephalography consultation (tele-EEG) in La Rioja, Spain. The setup has been implemented between a primary hospital situated in Calahorra (Calahorra Hospital Foundation, FHC) and a secondary hospital in Logroño (San Pedro Hospital, HSP), the capital city of the region of La Rioja.Methods: During the twelve first months of the setting-up a detailed evaluation study was performed. During this period we evaluated the technical aspects of the setup and also demonstrated the clinical viability of the system. The impact on hospital organization and the impact on patients regarding the improvement in their quality of life, as well as their financial savings, were also evaluated.Results: During these twelve months a total of 259 consultations were conducted through the telemedicine system. The clinical viability study was completely successful, and technical problems were detected only during the first months of setting-up. Regarding patients’ preferences (177 completed an opinion questionnaire), 99% expressed a high degree of satisfaction with the telemedicine service. They also remarked that they preferred the telemedicine service to previous methods for the EEG test, on the grounds that it provided a significant improvement in access to specialized medical care and important financial savings in terms of travel (around 30€ per visit) and of time (approximately 2h) invested in consultations.Conclusions: After one year of evaluation, we concluded that the tele-EEG system had been successfully introduced into the clinical routine. As a matter of fact, the success of the telemedicine system has led to its widespread use and it has now replaced the conventional EEG service for FHC patients almost completely.Setting up a telemedicine service for remote real-time video-EEG consultation in La Rioja (Spain)C. Campos, E. Caudevilla, A. Alesanco, N. Lasierra, O. Martinez, J. Fernández, J. García10.1016/j.ijmedinf.2012.01.006International Journal of Medical Informatics 81, 6 (2012)2012-02-13International Journal of Medical Informatics2012-02-13816S1386-5056(12)X0006-6404414http://www.ijmijournal.com/article/PIIS1386505611002449/abstract?rss=yesHighlights: ► The introduction of home telecare seems to lead to mixed results in practice. ► We investigate key factors influencing implementation success. ► The stability of the technical and financial environment is key. ► The alignment of goals and implementation strategy is also found to be crucial. ► A champion-wise roll-out seems imperative for initial implementation.Abstract: Rationale: The introduction of home telecare in healthcare organizations has shown mixed results in practice. The aim of this study is to arrive at a set of key factors that can be used in further implementation of video communication. We argue that key factors are mainly found in the organizational climate for home telecare implementation, the characteristics of the implementation strategy and the available technology.Methods: Interviews were conducted in three care organizations with 27 respondents of different levels within and outside the organization. Implementation determinants, based on earlier research, were used as a categorization framework for the interviews.Results: We found that most prominent factors influencing implementation outcomes relate to the stability of the technical and the external environment and the alignment of organization, goals and implementation strategy.Conclusion: Because of the experimental nature of implementing video communication, attention to telecare influencers has been inconsistent and disorganized but it is becoming increasingly important. According to the respondents, a champion-led roll-out is imperative for implementation in order to advance to the next stage in home telecare and to organize services for substitution of care.Key factors influencing the implementation success of a home telecare applicationT.R.F. Postema, J.M. Peeters, R.D. Friele10.1016/j.ijmedinf.2011.12.003International Journal of Medical Informatics 81, 6 (2012)2012-01-09International Journal of Medical Informatics2012-01-09816S1386-5056(12)X0006-6415423http://www.ijmijournal.com/article/PIIS1386505612000366/abstract?rss=yesHighlights: ► Information technology has the potential to offer hope of consistent treatment across settings and populations while nurses begin to utilize and integrate it into practice. ► Patient education is a key feature in addressing patients’ individual needs. ► Patient education sessions using information technology need to be planned in advance. ► Patients’ mental state ought to be considered and nurses need to be educated in the use of patient education using information technology.Abstract: Objective: To evaluate the use of web-based patient education sessions in the psychiatric inpatient care.Methods: The qualitative and quantitative data was collected from 93 patients’ evaluation reports in two psychiatric hospitals in Finland completed by 83 nurses.Results: The web-education included six patient education sessions which were used over a period lasting between 1 and 70 days and took 10–360min per patient. Out of 508 sessions, 464 had no interruptions or disturbances, 37 sessions had disturbances and seven sessions were interrupted. Three fourths of the sessions were used successfully. Factors associated with use were patients’ vocational education level, mental status, diagnoses, number of nurses involved and hospital.Conclusion: It is important to invest effort in web-based patient education during patients’ hospitalization and to use it even with patients suffering from serious mental health disorders. This is meant to provide more alternatives in nursing.Use of web-based patient education sessions on psychiatric wardsMinna Anttila, Maritta Välimäki, Heli Hätönen, Tiina Luukkaala, Minna Kaila10.1016/j.ijmedinf.2012.02.004International Journal of Medical Informatics 81, 6 (2012)2012-03-01International Journal of Medical Informatics2012-03-01816S1386-5056(12)X0006-6424433