Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics: Second Revision

BACKGROUND

The purpose of educational recommendations is to assist in establishing courses and programs in a discipline, to further develop existing educational activities in the various nations, and to support international initiatives for collaboration and sharing of courseware. The International Medical Informatics Association (IMIA) has published two versions of its international recommendations in biomedical and health informatics (BMHI) education, initially in 2000 and revised in 2010. Given the recent changes to the science, technology, the needs of the healthcare systems, and the workforce of BMHI, a revision of the recommendations is necessary.

OBJECTIVE

The aim of these updated recommendations is to support educators in developing BMHI curricula at different education levels, to identify essential skills and competencies for certification of healthcare professionals and those working in the field of BMHI, to provide a tool for evaluators of academic BMHI programs to compare and accredit the quality of delivered programs, and to motivate universities, organizations, and health authorities to recognize the need for establishing and further developing BMHI educational programs.

METHOD

An IMIA taskforce, established in 2017, updated the recommendations. The taskforce included representatives from all IMIA regions, with several having been involved in the development of the previous version. Workshops were held at different IMIA conferences, and an international Delphi study was performed to collect expert input on new and revised competencies.

RESULTS

Recommendations are provided for courses/course tracks in BMHI as part of educational programs in biomedical and health sciences, health information management, and informatics/computer science, as well as for dedicated programs in BMHI (leading to bachelor's, master's, or doctoral degree). The educational needs are described for the roles of BMHI user, BMHI generalist, and BMHI specialist across six domain areas - BMHI core principles; health sciences and services; computer, data and information sciences; social and behavioral sciences; management science; and BMHI specialization. Furthermore, recommendations are provided for dedicated educational programs in BMHI at the level of bachelor's, master's, and doctoral degrees. These are the mainstream academic programs in BMHI. In addition, recommendations for continuing education, certification, and accreditation procedures are provided.

CONCLUSION

The IMIA recommendations reflect societal changes related to globalization, digitalization, and digital transformation in general and in healthcare specifically, and center on educational needs for the healthcare workforce, computer scientists, and decision makers to acquire BMHI knowledge and skills at various levels. To support education in BMHI, IMIA offers accreditation of quality BMHI education programs. It supports information exchange on programs and courses in BMHI through its Working Group on Health and Medical Informatics Education.

My Journey Through the Field of Medical Informatics

In this contribution some achievements and milestones in the field of medical informatics, especially concerning decision support, as perceived by the author, are presented. The author focuses on those topics with respect to decision support that during his career in medical informatics impressed him and triggered him to convince his PhD students to start research on related topics. Both some of these achievements and the related research of some of his PhD students will be presented. The contribution starts with signal classification. Both ECG classification and sleep EEG classification are discussed. Then the use of Bayes' theorem for diagnostic purposes is discussed and some early applications pass review, among which the AAPHelp system developed by de Dombal and colleagues. Attention is subsequently paid to the advent of expert systems and other knowledge-based systems such as MYCIN and INTERNIST and to guideline-based decision support systems. Finally, the author presents his ideas about challenges for the field.

Nurses' experiences and viewpoints about the benefits of adopting information technology in health care: a qualitative study in Iran

Background

Information technology (IT) plays an important role in nursing practice. Hence, nurses’ experiences and viewpoints about IT integration into healthcare help improve nurses’ adoption of IT. This study aimed to explore the nurses’ experiences and viewpoints about the benefits of IT integration and adoption in healthcare.

Methods

This study was conducted with a qualitative research approach. Participants included 14 nurses from four hospitals affiliated to a large medical university in Iran, who were selected using a purposive sampling method. Data were collected through semi-structured interviews and analyzed using the conventional content analysis of Lundman and Graneheim.

Results

Six categories in the study reflected the nurses’ experiences and viewpoints about the benefits of integrating IT into health care. These categories included improving the quality and efficiency of medical services and care, facilitating the communication management in the technological environment, improving information documentation, management, and monitoring, improving resource management, improving management performance and policymaking, and facilitating pathways of organizational and professional growth.

Conclusions

Lessons learned in this study can help overcoming the barriers of IT adoption, and developing appropriate strategies to familiarize nurses with the benefits of IT in healthcare settings. Healthcare managers are recommended to investigate the experiences of nurses with IT in their hospitals and organize courses to orient hesitant nurses toward adopting IT.

Education in Biomedical and Health Informatics: A European Perspective

In higher education, programs in specialization in Health Informatics, Medical Informatics, Health Engineering are continuously growing. In this research, almost 1800 universities and colleges were checked in order to find related educational programs at all academic levels. Approximately 1000 academic leading degree programs in those domains have already been identified. The detailed records of the related educational programs will help to understand the current educational needs and priorities. Although, the growth of the related educational programs is not the same in each country.

Computerization of the Patient History -Patient Answers Compared with Medical Records

Computerized medical history taking, in which patients answer questions by using a terminal, is compared with the written medical record for a group of 99 patients in internal medicine. Patient complaints were analysed with respect to their frequency of occurrence for all important tracts, such as the respiratory, the gastro-intestinal and the uro-genital tracts. About 36% of over 3,200 patient answers were identical in the patient record and the written record, but a considerable percentage of complaints (56%), that were present in the patient record, were missing in the written record; the reverse was true for 4.5%. A computerized patient record appears to contain more extensive information about patient complaints, still to be interpreted by the experienced physician.

Automatic Coding of Diagnostic Reports

A method is presented for assigning classification codes to pathology reports by searching similar reports from an archive collection. The key for searching is textual similarity, which estimates the true, semantic similarity. This method does not require explicit modeling, and can be applied to any language or any application domain that uses natural language reporting. A number of simulation experiments was run to assess the accuracy of the method and to indicate the role of size of the archive and the transfer of document collections across laboratories. In at least 63% of the simulation trials, the most similar archive text offered a suitable classification on organ, origin and diagnosis. In 85 to 90% ofthe trials, the archive's best solution was found within the first five similar reports. The results indicate that the method is suitable for its purpose: suggesting potentially correct classifications to the reporting diagnostician.

Recommendations for Medical Informatics Training in The Netherlands

In this contribution recommendations for education and training in Medical Informatics as they have been formulated end 1987 by the Subcommittee Medical Informatics of the Royal Netherlands Academy of Arts and Sciences are described. The current situation of education and training is presented and compared with the recommendations. It is concluded that not all recommendations have yet been followed up.

Quality of Health Care: Informatics Foundations

Objective: To discuss in what ways computer systems can contribute to the quality of healthcare and on which principles of informatics successful systems are based.

Methods: Part of the information was obtained via a literature search and part is based on the knowledge of the authors.

Results: The results of the literature search are reported. The answers to the questions whether decision support is useful and which factors determine its success, the foundations of computerized guidelines systems and applications of physician order entry and medical risk management are presented. Conclusions: Despite many publications concerning diagnostic support systems their use in clinical practice is limited. Reminder systems do appear to have an impact on health outcomes. Standards for guideline models are being developed for effective sharing of guidelines across systems. Electronic patient records and physician order entry systems are useful aids in medical risk management.

Evaluation of a Method that Supports Pathology Report Coding

Objectives: The paper focuses on the problem of adequately coding pathology reports using SNOMED. Both the agreement between pathologists in coding and the quality of a system that supports pathologists in coding pathology reports were evaluated.

Methods: Six sets of three pathologists each received a different set of 40 pathology reports. Five different SNOMED code lines accompanied each pathology report. Three pathologists evaluated the correctness of each of these code lines. Kappa values and values for the reliability coefficients were determined to gain insight in the variance observed when coding pathology reports. The system that is evaluated compares a newly entered report, represented as a multi-dimensional word vector, with reports in a library, represented in the same way. The reports in the library are already coded. The system presents the code lines belonging to the five library reports most similar to the newly entered one to the pathologist in this way supporting the pathologist in determining the correct codes. A high similarity between two reports is indicated by a large value of the inproduct of the vector of the newly entered report and the vector of a report in the library.

Results: Agreement between pathologists in coding was fair (average kappa of 0.44). The reliability coefficient varied from 0.81 to 0.89 for the six sets of pathology reports. The system gave correct suggestions in 50% of the reports. In another 30% it was helpful for the pathologists.

Conclusions: On the basis of the level of the reliability coefficients it could be concluded that three pathologists are indeed sufficient for obtaining a gold standard for evaluating the system. The method used for comparing reports is not strong enough to allow fully automatic coding. It could be shown that the system induces a more uniform coding by pathologists. An evaluation of the incorrect suggestions of the system indicates that the performance of the system can still be improved.

Two Patient Care Information Systems in the Same Hospital: Beyond Technical Aspects

Objectives: To compare two clinical workstations in one hospital with respect to technical, organizational, cultural and human factors. One clinical workstation was a GUI to the HIS. The other was an electronic patient record for stroke.

Methods: Data were collected by means of in-depth interviews with end-users of both clinical workstations. The interviews were audio taped and transcribed for analysis.

Results: End users assessed both clinical workstations as user friendly. Coordination between health care workers was perceived to be enhanced. However, in both situations poor communication between management, implementers and users resulted in uncertainty and skepticism about future perspectives. Furthermore, it appeared that inpatient and outpatient settings needed clinical workstations with different requirements for an optimal fit between work practices and information system.

Conclusions: Regardless of the domain and content of a workstation, it can support coordination between disciplines. The communication concerning the information technology strategy deserves much attention. Finally, the requirements for inpatient and outpatient workstations differ.

A Rational Request Behavior: The Development of Prediction Instruments regarding Thyroid Function Tests in Primary Care

A prospective study was performed to encourage a rational thyroid-stimulating hormone (TSH) test request behavior of physicians, using prediction instruments. The latter give direct feedback about request adequacy on the basis of pretest probabilities of hyperthyroidism using patients’ signs and symptoms. For instrument design, stepwise logistic regression was used on diagnostic data acquired through questionnaires, answered by 80 physicians and 668 patients for whom physicians requested a TSH test. Instruments were designed for clinical and subclinical hyperthyroidism and for clinical hyperthyroidism alone. Use of the instrument for clinical or subclinical hyperthyroidism on the selected group, at a 5% probability threshold, can result in a 37% reduction of unnecessary TSH test requests. With the instrument for clinical hyperthyroidism at a 5% probability threshold, the number of unnecessary test requests can be reduced by 57%. Therefore, it can be concluded that the instruments can determine TSH test request adequacy and encourage a rational TSH test request behavior of physicians at low pretest probability thresholds.

Modeling in Biomedical Informatics – An Exploratory Analysis (Part 1)

Objectives: Modeling is a significant part of research, education and practice in biomedical and health informatics. Our objective was to explore, which types of models of processes are used in current biomedical/ health informatics research, as reflected in publications of scientific journals in this field. Also the implications for medical informatics curricula were investigated.

Methods: Retrospective, prolective observational study on recent publications of the two official journals of the International Medical Informatics Association (IMIA), the International Journal of Medical Informatics (IJMI) and Methods of Information in Medicine (MIM).

Results: 384 publications have been analyzed, 190 of IJMI and 194 of MIM. In regular papers (69 in IJMI, 62 in MIM), analyzed here in part 1, all of these model types could be found. In many publications we observed a mixture of models, being used to solve the ‘core’ research questions and also to systematically evaluate the research done. Knowledge of (and models for) software engineering and project management are also often needed. IJMI seems to have a closer focus on research concerning health information systems and electronic patient records, with a strong emphasis on evaluation. MIM seems to have a broader range of research approaches, including also statistical modeling and computational intensive approaches. The aim to provide solutions for problems related to data, information and knowledge processing and to study the general principles of processing data, information and knowledge in medicine and health care in order to contribute to improve the quality of health care, and of research and education in medicine and the health sciences was given in all publications.

Conclusions: Modeling continues to be a major task in research, education and practice in biomedical and health informatics. Knowledge and skills concerning a broad range of model types is needed.

Medical Informatics as a Discipline at the Beginning of the 21st Century

Objectives: To analyse the present situation of the discipline medical informatics and to propose actions for change.

Methods: Evaluation of the current situation mainly based on anecdotal evidence.

Results: The difference between the scientific and the engineering aspects of medical informatics get blurred. Because of the requirements of European funding medical informatics focuses more on engineering than on science. Too many manuscripts are submitted that describe engineered artefacts without a scientific purpose. Some of the subjects (like security issues) that are studied in medical informatics are not considered important by medical faculties thus impeding support.

Conclusions: The methodological underpinnings of our research should be strengthened, impact studies should be more frequently performed; the quality of results reporting should be increased.

Medical Informatics and Problem-based Learning

Problem-based learning (PBL) is an educational method that can be considered as an alternative to the traditional, discipline-based, approach to teaching. In this paper the characteristics of both approaches are discussed and compared. Some background knowledge concerning the principles that determine the success of instructional methods is presented. Finally, it is discussed how medical informatics can be taught in a PBL environment.

A Generic Model of Clinical Practice

Objectives: Many shared-care projects feel the need for electronic patient-record (EPR) systems. In absence of practical experiences from paper record keeping, a theoretical model is the only reference for the design of these systems. In this article, we review existing models of individual clinical practice and integrate their useful elements. We then present a generic model of clinical practice that is applicable to both individual and collaborative clinical practice.

Methods: We followed the principles of the conversation-for-action theory and the DEMO method. According to these principles, information can only be generated by a conversation between two actors. An actor is a role that can be played by one or more human subjects, so the model does not distinguish between inter-individual and intra-individual conversations.

Results: Clinical practice has been divided into four actors: service provider, problem solver, coordinator, and worker. Each actor represents a level of clinical responsibility. Any information in the patient record is the result of a conversation between two of these actors. Connecting different conversations to one another can create a process view with meta-information about the rationale of clinical practice. Such process view can be implemented as an extension to the EPR.

Conclusions: The model has the potential to cover all professional activities, but needs to be further validated. The model can serve as a theoretical basis for the design of EPR-systems for shared care, but a successful EPR-system needs more than just a theoretical model.

On Exemplary Scientific Conduct Regarding Submission of Manuscripts to Biomedical Informatics Journals

As the Editors of leading international biomedical informatics journals, the authors report on a recent pattern of improper manuscript submissions to journals in our field. As a guide for future authors, we describe ethical and pragmatic issues related to submitting work for peer-reviewed journal publication. We propose a coordinated approach to the problem that our respective journals will follow. This Editorial is being jointly published in the following journals represented by the authors: Computer Methods and Programs in Biomedicine, International Journal of Medical Informatics, Journal of Biomedical Informatics, Journal of the American Medical Informatics Association, and Methods of Information in Medicine.

An Approach to Knowledge Base Construction Based on Expert Opinions

Objectives: To describe, validate and demonstrate an approach for knowledge base construction based on expert opinions.

Methods: A knowledge base containing the frequency of occurrence of manifestations in epileptic seizures is constructed based on information provided by neurologists/epileptologists. The reliability of the responses is determined with the inter-rater intraclass correlation coefficient (ICC). If the ICC is not large enough the Spearman-Brown prophecy formula can be used to predict the number of additional experts. We propose a method to assess whether an additional expert provides information consistent with the already acquired data as well as a method to detect experts with deviating opinions. The power of the first method was determined.

Results: Data were collected for five seizure types. The ICCs determined from the responses for the various seizure types after inclusion of the additional experts was in all cases almost equal to 0.9, the target value. Yet one expert with diverging opinions concerning the frequency of occurrence of manifestations for different seizure types could be identified. Excluding this participant improved the reliability of the data. The power of the methods was good (≥ 0.75).

Conclusions: It is shown that human experts can provide reliable information about the frequency of occurrence of manifestations in epileptic seizures. In addition, the described approach correctly identified neurologists/epileptologists with both consistent and diverging opinions about the frequency of occurrence of manifestations in a number of seizure types.

Appropriateness of ICD-coded Diagnostic Inpatient Hospital Discharge Data for Medical Practice Assessment

Objectives: We performed a systematic review to investigate the quality of diagnostic hospital discharge data (DHDD) in order to gain insight in the usefulness of these data for medical practice assessment. We investigated the methods used to evaluate data quality, factors that determine data quality and its consequences for medical practice assessment.

Methods: We selected studies in which both completeness (or sensitivity: SENS) and correctness (or positive predictive value: PPV) were measured. We used the random-effects model to calculate mean SENS and PPV and to explore the effect of a number of covariates.

Results: The 101 included studies were very heterogeneous. We distinguished six typical study designs. We found a mean SENS of 0.67 (95%CI: 0.62– 0.73) and PPV of 0.76 (95%CI: 0.73– 0.79); SENS was significantly lower for comorbidity and complication studies than for some single disease studies. PPV was significantly higher for Scandinavian countries than for other countries. Recoding compared to re-abstracting of the medical record as a gold standard gave a significantly lower PPV. Diagnostic data were considered appropriate by the authors of the studies for quality of care purposes when both SENS and PPV were at least 0.85. Only 13% of the studies fulfilled this criterion.

Conclusions: Variability in quality of care between settings can easily be overshadowed by variability in data quality. However, the use of DHDD by physicians to evaluate their own medical practice may be useful. But only if physicians are willing to critically interpret the meaning of the information for their medical practice assessment.

Discussion of “Biomedical Infor -matics: We Are What We Publish”

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Biomedical Informatics: We Are What We Publish", written by Peter L. Elkin, Steven H. Brown, and Graham Wright. It is introduced by an editorial. This article contains the combined commenta -ries invited to independently comment on the Elkin et al. paper. In subsequent issues the discussion can continue through letters to the editor.

Long-term Impact of Physician Encoding on Detail and Number of Recorded Diagnoses

Objectives: To improve the recording of diagnostic discharge data, pediatricians encoded diagnostic information as part of discharge letter writing supported by a pediatric list of ICD-9-CM-based codes. We evaluated the effect of this new policy on level of detail and number of recorded diagnoses.

Methods: We compared proportions of specific principal diagnoses and numbers of secondary diagnoses of the four years before with the eight years after introduction.

Results: Immediately after introduction, half of the diagnoses for which both generic and specific codes existed was coded specific. In later years this proportion remained stable at 0.35 (p < 0.05). Diagnoses that fall under the pediatrician’s own subspecialty had more often a specific code than diagnoses that do not. The mean number of secondary diagnoses per admission increased from 0.7 before introduction to 1.4 in the third year after introduction (p < 0.05) but gradually fell back to 0.7. This increase and decrease was mainly due to diagnoses that did not fall under the pediatrician’s own subspecialty. The extra codes in individual discharge summaries had added informational value.

Conclusions: Discharge letter-linked encoding by pediatricians supported by a pediatric list of diseases leads initially to increased detail and number of diagnoses with added informational value. When attention diminishes, especially the level of detail and number of secondary diagnoses that do not fall under one’s own subspecialty decrease. The level of detail of principal diagnoses remains stable because of the advantage for pediatricians of having specific diagnostic codes falling under their own subspecialty.

Intention-based Expressions in GASTINE

Objectives: 1) To evaluate the design of the framework for computerized intention-based clinical practice guidelines; 2) to implement runtime features such as plan recognition and backtracking.

Method: To evaluate the design, we implemented the heart failure guideline into GASTINE, a tool for representing and executing intention-based clinical guidelines.

Result: Description of the current implementation of intention-based expressions in GASTINE and analysis of some generic shortcomings. Explanation of how these shortcomings are addressed. Presentation of how plan recognition and backtracking work and how they improve the system.

Conclusion: The improved guideline system is rather flexible, i.e., it allows deviations from the guideline as long as they are in the spirit of the guideline. The recognition of actions as intended by the users facilitates a flexible decision support system. The intentions are used to explain why certain actions were suggested. Therefore it is assumed that showing the intention behind suggested actions provides a better insight into why these actions are advised.

IMIA Accreditation of Biomedical and Health Informatics Education: Current State and Future Directions

Objectives: The educational activities initiated by the International Medical Informatics Association (IMIA) have had global impacts and influenced national societies and local academic programs in the field of Biomedical and Health Informatics (BMHI). After the successful publication and dissemination of its educational recommendations, IMIA launched an accreditation procedure for educational programs in BMHI. The accreditation procedure was pilot tested by several BMHI academic programs in different countries and continents to obtain a global perspective. Methods: This paper presents an overview of IMIA quality assurance and accreditation procedures along with feedback on issues and problems which emerged during the pilot. Results: It appears that IMIA quality assurance and procedures worked quite well in different countries of Europe, the Middle East, South America, and Asia. These first experiences provided adequate information for adapting, modifying, and optimizing the procedures and finally for the planning of future activities. Conclusions: IMIA accreditation framework comprises a single set of standards that apply at various levels to both academic and professional BMHI programs. The pilot phase confirmed the robustness and generalizability of quality assurance standards and associated procedures on which IMIA accreditation is based at an international level.

IMIA Educational Recommendations and Nursing Informatics

The updated version of the IMIA educational recommendations has given an adequate guidelines platform for developing educational programs in Biomedical and Health Informatics at all levels of education, vocational training, and distance learning. This chapter will provide a brief introduction of the recommendations pinpointing aspects for developing and assessing educational programs. We will provide a review of the existing feedback we have acquired during the IMIA site visits of accrediting educational programs at a worldwide level and discuss implementations issues. A brief overview of existing academic programs in Europe, North America and in other regions, especially for programs related to Nursing and to Nursing Informatics is provided. Finally, we will draw conclusions as how the IMIA recommendations may be required to be fitted into the specific needs of the Nursing Informatics and the needs of the Nursing professionals when they apply the recommendations to their academic and/or hospital/professional environments.

An Introduction to Structural Equation Modeling

In this contribution the principles behind Structural Equation Modeling (SEM) are presented. SEM is used for assessing the quality of models that are proposed on the basis of theory and experience. This contribution has an introductory level.

Commentaries on the IMIA Award of Excellence Lecture by Reinhold Haux

The IMIA Yearbook editorial team asked five internationally renowned biomedical informaticians to respond to Prof. Haux's editorial. This paper summarizes their thoughts and responses. Contributions are ordered alphabetically by the contributor's last name. All authors provided an equal contribution to this manuscript.

An abridged history of medical informatics education in europe

This contribution presents the development of medical informatics education in Europe. It does not discuss all developments that took place. Rather it discerns several themes that indicate the progress in the field, starting from the initiation phase to the final quality control phase.

History of medical informatics in europe - a short review by different approach

The panel intended to collect data, opinions and views for a systematic and multiaxial approach for a comprehensive presentation of “History of Medical Informatics”, treating both general (global) characteristics, but emphasizing the particular features for Europe. The topic was not only a subject of large interest but also of great importance in preparing a detailed material for celebration of forty years of medical informatics in Europe. The panel comprised a list of topics, trying to cover all major aspects to be discussed. Proposals of staging the major periods of medical informatics history were also discussed.

How to measure technology assessment: an introduction

This contribution introduces the Technology Acceptance model. Since information systems are still underutilized, application of models of user acceptance can provide important clues about what can be done to increase system usage.

IMIA Accreditation of Health Informatics Programs

OBJECTIVES

Health informatics programs usually are evaluated by national accreditation committees. Not always are the members of these committees well informed about the international level of (education in) health informatics. Therefore, when a program is accredited by a national accreditation committee, this does not always mean that the program is of an international level. The International Medical Informatics Association (IMIA) has expertise in the field of education. The IMIA Recommendations on Education in Biomedical and Health Informatics guide curricula development. The goal of this article is to show that IMIA can also play the role of accreditation agency and to present the IMIA accreditation protocol and experiences obtained with it.

METHODS

The accreditation procedure used in the Netherlands and Belgium was taken as a template for the design of the IMIA accreditation protocol. In a trial period of one and a half year the protocol is tested out on six health informatics programs.

RESULTS

An accreditation protocol was designed. For judging the curriculum of a program the IMIA Recommendations are used. The institution has to write a self-assessment report and a site visit committee visits the program and judges its quality, supported by the self-assessment report and discussions with all stakeholders of the program.

CONCLUSIONS

After having visited three programs it appears that the IMIA accreditation procedure works well. Only a few changes had to be introduced. Writing the self-assessment report already appears to be beneficial for the management of the program to obtain a better insight in the quality of their program.

Assessment of the IMIA educational accreditation process

The International Medical Informatics Association (IMIA) biomedical informatics educational recommendations of 2010 provided an excellent guide for institutions across the world in updating their curricula or establishing new programs. IMIA subsequently decided to offer an accreditation process, guided by the earlier recommendations, to assess existing educational programs in the field of biomedical informatics. This paper presents an overview and SWOT analysis of the accreditation process based on a two-year trial period at three sites across continents. Because other sites are now requesting similar accreditation visits by IMIA, the lessons learned by the committee that performed the assessments during trial period will provide useful guidance for both IMIA and those educational institutions.

Discussion of "Biomedical informatics: we are what we publish"

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Biomedical Informatics: We Are What We Publish", written by Peter L. Elkin, Steven H. Brown, and Graham Wright. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Elkin et al. paper. In subsequent issues the discussion can continue through letters to the editor.

Computer-interpretable guidelines

In this contribution the concept of computer-interpretable guidelines is discussed. Several guideline formalisms are presented and the GASTON and GASTINE formalisms are given as examples. Finally the problems associated with the integration of CIGs with EPR systems are mentioned.

Information technology for medication administration: assessing bedside readiness among nurses in Lebanon

Medication errors continue to be of great concern to hospitals. The use of Information technology (IT) for medication administration was recommended to assist nurses to administer medications safely, decrease the chance of medication errors, and contribute to patient safety. Such IT will be operational soon in some Lebanese hospitals. Users' readiness and acceptance to use such an IT application is crucial as it is a prerequisite for successful system implementation. This descriptive study used the Technology Acceptance Model to determine the level of nurses' readiness to use IT for medication administration in Lebanon. The sample included nurses working in three different major hospitals in Beirut. Data were collected on nurses' demographics, attitudes, perceived usefulness and ease of use of IT for medication administration. During the first 2 weeks of July, 2007, nurses manually or electronically were asked to voluntarily complete the questionnaire. Results showed that the users' attitude towards the use of the proposed IT is correlated with their perceptions on system usefulness and ease of use. Many showed a positive attitude towards system use and scored high on both perceptions. Yet around 20% of the nurses in the sample showed a negative attitude towards the use of the proposed system.

IMIA Accreditation of Health Informatics Programs

To develop a procedure for accrediting health informatics programs.

Development of a procedure for accreditation. Test of the accreditation procedure via a trial including four or five health informatics programs. A site visit committee consisting of three members evaluates the program based on a self-assessment report written by the program and the experiences and observations of the site visit committee during the site visit.

A procedure for accreditation has been developed. The instructions for health informatics programs have been written and a checklist for the site visit committee members is available. In total six subjects are considered, each one consisting of one or more facets. Each facet is judged using its corresponding criterion. Five health informatics programs volunteered. One health informatics program in Finland has already been visited and a report has been produced by the site visit committee. The next site visits are in June and July 2012. The site visit in Finland showed that English summaries of master theses are not enough to get a first impression of the methods used in the thesis. A table of contents is also needed. This information then can be used to select theses written in a language other than English for discussion.

The accreditation procedure document with instructions about writing the self-assessment report was very well structured and the instructions were clear according to the Finnish program. The site visit team could work well with the checklist. Self-assessment report model was very well structured and the instructions were clear.

Biomedical informatics--a confluence of disciplines?

BACKGROUND

Biomedical informatics is a broad discipline that borrows many methods and techniques from other disciplines.

OBJECTIVE

To reflect a) on the character of biomedical informatics and to determine whether it is multi-disciplinary or inter-disciplinary; b) on the question whether biomedical informatics is more than the sum of its supporting disciplines and c) on the position of biomedical informatics with respect to related disciplines.

METHOD

Inviting an international group of experts in biomedical informatics and related disciplines on the occasion of the 50th anniversary of Methods of Information in Medicine to present their viewpoints.

RESULTS AND CONCLUSIONS

This paper contains the reflections of a number of the invited experts on the character of biomedical informatics. Most of the authors agree that biomedical informatics is an interdisciplinary field of study where researchers with different scientific backgrounds alone or in combination carry out research. Biomedical informatics is a very broad scientific field and still expanding, yet comprised of a constructive aspect (designing and building systems). One author expressed that the essence of biomedical informatics, as opposed to related disciplines, lies in the modelling of the biomedical content. Interdisciplinarity also has consequences for education. Maintaining rigid disciplinary structures does not allow for sufficient adaptability to capitalize on important trends nor to leverage the influences these trends may have on biomedical informatics. It is therefore important for students to become aware of research findings in related disciplines. In this respect, it was also noted that the fact that many scientific fields use different languages and that the research findings are stored in separate bibliographic databases makes it possible that potentially connected findings will never be linked, despite the fact that these findings were published. Bridges between the sciences are needed for the success of biomedical informatics.

IMIA accreditation of health informatics programs

Health informatics programs usually are evaluated by national accreditation committees. Not always are the members of these committees well informed about the international level of (education in) health informatics. Therefore, when a program is accredited by a national accreditation committee, this does not always mean that the program is of an international level. Institutions may invite international experts to assess their educational programs. IMIA can serve as an intermediary for organizing the peer review. IMIA can play the role of accreditation committee and together with the institution assign an independent site visit committee to carry out the peer review. This contribution describes the IMIA accreditation procedure.

IMIA Accreditation of Health Informatics Programs

OBJECTIVE

To develop a procedure for accrediting health informatics programs.

METHODS

Development of a procedure for accreditation. Test of the accreditation procedure via a trial including four or five health informatics programs. A site visit committee consisting of three members evaluates the program based on a self-assessment report written by the program and the experiences and observations of the site visit committee during the site visit.

RESULTS

A procedure for accreditation has been developed. The instructions for health informatics programs have been written and a checklist for the site visit committee members is available. In total six subjects are considered, each one consisting of one or more facets. Each facet is judged using its corresponding criterion. Five health informatics programs volunteered. One health informatics program in Finland has already been visited and a report has been produced by the site visit committee. The next site visits are in June and July 2012. The site visit in Finland showed that English summaries of master theses are not enough to get a first impression of the methods used in the thesis. A table of contents is also needed. This information then can be used to select theses written in a language other than English for discussion.

CONCLUSIONS

The accreditation procedure document with instructions about writing the self-assessment report was very well structured and the instructions were clear according to the Finnish program. The site visit team could work well with the checklist. Self-assessment report model was very well structured and the instructions were clear.