International Journal of Medical Informatics RSS feed: Articles in Press. 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//inpress?rss=yesElsevier Inc.en © 2010 Elsevier Ireland Ltd. All rights reserved. International Journal of Medical Informatics1386-50562010-07-26 © 2010 Elsevier Ireland Ltd. All rights reserved. healthpermissions@elsevier.comhttp://www.ijmijournal.com/article/PIIS1386505610001243/abstract?rss=yesAbstract: Purpose: In 2005, an innovative system of hospital-community on-line medical records (OFEK) was implemented at Clalit Health Services (CHS). The goals of the study were to examine the extent of OFEK's use and its impact on quality indicators and medical-service utilization in Internal Medicine and General Surgery wards of CHS hospitals.Methods: Examining the frequency of OFEK's use with its own track-log data; comparing, “before” and “after”, quality indicators and service utilization data in experimental (CHS patients) versus control groups (other patients).Results: OFEK's use increased by tens of percentages each year, Internal Medicine wards showed a significant decrease in the number of laboratory tests and 3 CT tests performed compared with the control group. Wards using OFEK extensively showed a greater decrease in CT tests, in one imaging test, and in the average number of ambulatory hospitalizations. No similar changes were found in General Surgery wards.Conclusions: The study helps evaluate the extent to which OFEK's targets were achieved and contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of Health Information Technology (HIT) systems.The impact of an integrated hospital-community medical information system on quality and service utilization in hospital departments - Corrected ProofNurit Nirel, Bruce Rosen, Assaf Sharon, Orna Blondheim, Michael Sherf, Hadar Samuel, Arnon D. Cohen10.1016/j.ijmedinf.2010.06.005International Journal of Medical Informatics (2010)2010-07-26International Journal of Medical Informatics2010-07-26http://www.ijmijournal.com/article/PIIS1386505610001139/abstract?rss=yesAbstract: Background: In 2000 the Korean government initiated efforts to secure healthcare accessibility and efficiency anytime and anywhere via the nationwide healthcare information system by the end of 2010. According to the master plan, electronic health record (EHR) research and development projects were designed in 2005. One subproject was the design and implementation of standards-based interoperable clinical decision support (CDS) capabilities in the context of the EHR system.Objective: The purpose of this study was to describe the challenges, process, and outcomes of defining and implementing a national CDS architecture to stimulate and motivate the widespread adoption of CDS services in Korea.Methods: CDS requirements and design principles were established by conducting a selective literature review and a survey of clinicians, managers, and hospital and industrial health information technology engineers regarding issues related to CDS architectures. The previous relevant works of the American Medical Informatics Association, the Healthcare Information and Management Systems Society, and Health Level Seven were used to validate the scope and themes of the service architecture. The Arden Syntax, Standards-Based Sharable Active Guideline Environment, First DataBank, and SEBASTIAN approaches were used to assess the coverage of the application architecture thus defined. A CDS prototype of an outpatient hypertension management system was implemented and assessed in a simulated experimental setting to evaluate the feasibility of the proposed architecture.Results: Four CDS service features were identified: knowledge application, knowledge management, audit and evaluation, and CDS and knowledge governance. Five core components of CDS application architecture were also identified: knowledge-execution component, knowledge-authoring component, data-interface component, knowledge repository, and service-interface component. The coverage and characteristics of the architecture identified herein were found to be comparable with those described previously. Two scenarios of deployment architecture were identified in the context of Korean healthcare. The preliminary feasibility test revealed that the architecture exhibited good performance and made it easy to integrate patient data.Conclusion: We have described the efforts that have been made to realize CDS service features, core components, application, and deployment architectures in the context of the Korean EHR. These outcomes showed the potential to contribute to the adoption of CDS at the national level.Design and implementation of a standards-based interoperable clinical decision support architecture in the context of the Korean EHR - Corrected ProofInSook Cho, JeongAh Kim, Ji Hyun Kim, Hyun Young Kim, Yoon Kim10.1016/j.ijmedinf.2010.06.002International Journal of Medical Informatics (2010)2010-07-12International Journal of Medical Informatics2010-07-12http://www.ijmijournal.com/article/PIIS1386505610001152/abstract?rss=yesAbstract: Background and purpose: There are several cost–benefit evaluations of introducing new technology for administrative purposes in the health care sector. Whereas some of these recognise the importance of adapting the working procedures to the new technology, very few look into the consequences of delays in adaptation to the new technology. In this paper, we focus on the consequences of keeping old working procedures, although new technology is implemented.Methods: Based on on-site observations we have estimated the economic gains of implementing electronic message exchange in the health care sector depending on which working procedures are applied. Then we continue by using a dynamic cost–benefit analysis (CBA) in order to take into account that conversion to new working procedures takes place over time, and we demonstrate the loss in potential gains due to such a delay.Results: Keeping working procedures fit to old technology when new technology is implemented may imply that only between 40 and 50% of the potential time savings (benefits) are realised. In a dynamic perspective, the keeping of double procedures for 10 years and more will jeopardise the economic gains for surgeries, whereas hospitals still may have an economic gain. The delay in conversion to new working procedures implies that only 50% of the dynamic net present value of the gains is realised. The longer it takes before the old procedures are abandoned the lower is the dynamic net present value of the gains. This is due to the discounting of future gains.Conclusions: These are all arguments for emphasising and putting resources into training and motivation programs for employees when new technology is being implemented.Limitations of the study: We have only considered quantifiable effects of electronic message exchange in the health care sector, and only for hospitals and surgeries.Economic gains from electronic message exchange: The importance of working procedures - Corrected ProofMargrethe Aanesen, Mikko Moilanen, Frank Olsen10.1016/j.ijmedinf.2010.06.004International Journal of Medical Informatics (2010)2010-07-12International Journal of Medical Informatics2010-07-12http://www.ijmijournal.com/article/PIIS1386505610001140/abstract?rss=yesAbstract: Objective: To reflect about medical informatics as a discipline. To suggest significant future research directions with the purpose of stimulating further discussion.Methods: Exploring and discussing important developments in medical informatics from the past and in the present by way of examples. Reflecting on the role of IMIA, the International Medical Informatics Association, in influencing the discipline.Results: Medical informatics as a discipline is still young. Today, as a cross-sectional discipline, it forms one of the bases for medicine and health care. As a consequence considerable responsibility rests on medical informatics for improving the health of people, through its contributions to high-quality, efficient health care and to innovative research in biomedicine and related health and computer sciences. Current major research fields can be grouped according to the organization, application, and evaluation of health information systems, to medical knowledge representation, and to the underlying signal and data analyses and interpretations. Yet, given the fluid nature of many of the driving forces behind progress in information processing methods and their technologies, progress in medicine and health care, and the rapidly changing needs, requirements and expectations of human societies, we can expect many changes in future medical informatics research. Future research fields might range from seamless interactivity with automated data capture and storage, via informatics diagnostics and therapeutics, to living labs with data analysis methodology, involving sensor-enhanced ambient environments. The role of IMIA, the International Medical Informatics Association, for building a cooperative, strongly connected, and research-driven medical informatics community worldwide can hardly be underestimated.Conclusions: Health care continuously changes as the underlying science and practice of health are in continuous transformation. Medical informatics as a discipline is strongly affected by these changes and is in a position to be a key, active contributor in these changes.Medical informatics: Past, present, future - Corrected ProofReinhold Haux10.1016/j.ijmedinf.2010.06.003International Journal of Medical Informatics (2010)2010-07-08International Journal of Medical Informatics2010-07-08http://www.ijmijournal.com/article/PIIS1386505610001127/abstract?rss=yesAbstract: Background: A locum practitioner is an out-of-hours general practitioner who needs access to the electronic health record of visiting patients. The electronic locum record is a summary of the electronic health record available to the locum practitioner and includes the most significant health problems, the most recent records of the patient's visits to the practice, current medication data and information on allergies and intolerances. The locum practitioner returns a locum medical note to the electronic health record at the general practitioner with his or her diagnosis, treatment or referral of the visiting patient. A pilot project of the electronic locum record was implemented in the Twente region of the Netherlands.Objective: To obtain policy information for the nationwide implementation of the electronic locum record as a first component of the electronic health record in the Netherlands.Methods: First, evaluation aspects were collected from parties involved in the pilot implementation process. Aspects were taken from the work flow to operationalise the electronic health record. Secondly, indicator questions were formulated and normative levels agreed for each indicator by a panel with experts from the medical and information technology domain. Third, the actual values were rated either by measurement (technical indicators) or by structured interviews (process indicators) with the general practitioners who joined the pilot study. Finally, a cross case analysis was performed by checking for (in-)consistencies among the respondents.Results: Eight out of the 15 key indicators scored positive, three failed and four remained inconclusive. The indicators that failed the norms related to the guideline for electronic registration of patient information, the process of acquiring the healthcare professional identification card and card-related services. Indicators that remained inconclusive referred to storing and archiving of identification cards and codes, the use of the identification repository at the general practice post and the usefulness and ease-of-use of the electronic locum record.Conclusions: The study demonstrates that many processes, systems, services and practices for nation-wide implementation of the electronic locum record for general practitioners in the Netherlands are in place. However, significant improvements are required on a number of aspects. For example general practitioners need to be trained more in applying the guideline for electronic registration of patient data. Also the process for general practitioners to acquire their unique healthcare professional identification cards should require less effort. We also recommend that a strong regional information technology support group should be in operation during roll-out.The electronic locum record for general practitioners: Outcome of an evaluation study in the Netherlands - Corrected ProofAdrie C.M. Dumay, Timber I. Haaker10.1016/j.ijmedinf.2010.06.001International Journal of Medical Informatics (2010)2010-07-07International Journal of Medical Informatics2010-07-07http://www.ijmijournal.com/article/PIIS1386505610001103/abstract?rss=yesAbstract: Objectives: This study aims to explore the issues and challenges involved in designing and organizing pilot implementations of health information systems (HIS). Pilot implementations are a widely used approach for identifying design flaws and implementation issues before full-scale deployment of new HIS. However, it is not uncommon for pilot implementations to fail in the sense that little can be learned from them.Method: We employed an interpretive case study approach in attempting to throw light on the reasons why pilot implementations sometimes fail. We studied the (failed) pilot implementation of an electronic Pregnancy Record (ePR) in Denmark. Our primary data collection methods comprised participant observations, semi-structured interviews and document analyses.Results: Based on a comprehensive evaluation of the implementation process, we identify three major challenges that complicated the pilot project and eventually led to its failure, namely difficulties in (1) defining an appropriate scope for the pilot implementation, (2) coping with unanticipated technical and practical problems, and (3) ensuring commitment from test users and their managers.Conclusion: Pilot implementations are a very useful technique for developing HIS, but also one that is very difficult to do successfully. It is sometimes assumed that pilot implementations are less complicated and risky than regular, full-scale implementations. However, pilot implementations are not just small-scale versions of conventional implementations; they are fundamentally different and they have their own complications and issues to deal with that make them hard to design and manage.Pilot implementation of health information systems: Issues and challenges - Corrected ProofJørgen P. Bansler, Erling Havn10.1016/j.ijmedinf.2010.05.004International Journal of Medical Informatics (2010)2010-06-24International Journal of Medical Informatics2010-06-24