Systematic Planning of Clinical Documentation

All information obtained from a patient in the course of medical care is a potential part of clinical documentation. The documentation usually serves a number of different purposes. The task of a documentation system is to fulfil these purposes in a methodically correct manner and as economically as possible. This requires that the properties of the documentation system be planned systematically with a view to the goals pursued. To support systematic planning, a “documentation protocol” is proposed analogous to the “study protocol” used for controlled clinical trials. The individual sections of the proposed documentation protocol are described and the design options which exist in the corresponding planning phases are pointed out. Experience gained by the application of the documentation protocol is discussed.

Medical Informatics Heidelberg/Heilbronn: Graduates’ Experiences and Job Situation

On the occasion of the 20th anniversary of the curriculum of medical informatics at the University of Heidelberg/School of Technology Heilbronn, a written and anonymous inquiry was carried out in March 1992 among the entirety of graduates from the curriculum. The aim of the inquiry was to obtain from the graduates of the curriculum information about their current places of employment, their fields of work, the state of continuing education as well as about their professional position. It was, in addition, intended to obtain from the graduates’ point of view an assessment of the education received during their studies as well as an assessment of the job situation. A questionnaire was sent to all persons having completed their studies by that time (n = 567, as of 1.1.1992). 62.2% of the forms were returned duly filled in; 92.2% of the graduates are employed. 44.5% out of them are working within the field of medical informatics, 53.0% are working outside medical informatics but within the sector of informatics and 2.2% in other fields; 0.3% were without indication. As far as places of employment are concerned, enterprises concentrating on hardware and software development rank first, followed by hospitals and medical institutions affiliated to universities. As far as fields of work are concerned, information systems within the health care sector (especially hospital information systems) as well as medical documentation predominate in the group of those employed within medical informatics, whereas among those not working within medical informatics software engineering as well as database systems and information systems prevail. The judgement passed on the job situation was, in the main, positive. The gross annual income on the average comes to about DM 85,000, every tenth of the graduates draws an income of more than DM 120,000. The assessment of the curriculum on the whole is positive. 68% of the graduates would take up medical informatics again. Twenty-eight of altogether 346 graduates included into the inquiry obtained a doctor’s degree, 2 among them qualified for lecturing in medical informatics.

Medical Informatics Education Needs Information System Practicums in Health Care Settings

Objectives: To report about the themes and about experiences with practicums in the management of information systems in health care settings (health information management) for medical informatics students.

Methods: We first summarize the topics of the health information management practicums/projects that the authors organized between 1990 and 2003 for the medical informatics programs at Heidelberg/ Heilbronn, Germany, UMIT, Austria, as well as for the informatics program at the University of Leipzig, Germany. Experiences and lessons learned, obtained from the faculty that organized the practicums in the past 14 years, are reported.

Results: Thirty (of 32) health information management practicums focused on the analysis of health information systems. These took place inside university medical centers. Although the practicums were time-intensive and required intensively tutoring students with regard to health information management and project management, feedback from the students and graduates was mainly positive.

Discussion: It is clearly recommended that students specializing in medical informatics need to be confronted with real-world problems of health information systems during their studies.

On Educating about Medical Data Management

Objectives: To summarize background, challenges, objectives, and methods for the usability of patient data, in particular with respect to their multiple use, and to point out how to lecture medical data management.

Methods: Analyzing the literature, providing an example based on Simpson’s paradox and summarizing research and education in the field of medical data management, respectively health information management (in German: Medizinische Dokumentation).

Results: For the multiple use of patient data, three main categories of use can be identified: patientoriented (or casuistic) analysis, patient-group reporting, and analysis for clinical studies. A so-called documentation protocol, related to study plans in clinical trials, supports the multiple use of data from the electronic health record in order to obtain valid, interpretable results. Lectures on medical data management may contain modules on introduction, basic concepts of clinical data management and coding systems, important medical coding systems (e.g. ICD, SNOMED, TNM, UMLS), typical medical documentation systems (e.g. on patient records, clinical and epidemiological registers), utilization of clinical data management systems, planning of medical coding systems and of clinical data management systems, hospital information systems and the electronic patient record, and on data management in clinical studies.

Conclusion: Usability, the ultimate goal of recording and managing patient data, requires, besides technical considerations, in addition appropriate methodology on medical data management, especially if data is intended to be used for multiple purposes, e.g. for patient care and quality management and clinical research. Medical data management should be taught in health and biomedical informatics programs.

On educating about medical data management - the other side of the electronic health record

OBJECTIVES

To summarize background, challenges, objectives, and methods for the usability of patient data, in particular with respect to their multiple use, and to point out how to lecture medical data management.

METHODS

Analyzing the literature, providing an example based on Simpson's paradox and summarizing research and education in the field of medical data management, respectively health information management (in German: Medizinische Dokumentation).

RESULTS

For the multiple use of patient data, three main categories of use can be identified: patient-oriented (or casuistic) analysis, patient-group reporting, and analysis for clinical studies. A so-called documentation protocol, related to study plans in clinical trials, supports the multiple use of data from the electronic health record in order to obtain valid, interpretable results. Lectures on medical data management may contain modules on introduction, basic concepts of clinical data management and coding systems, important medical coding systems (e.g. ICD, SNOMED, TNM, UMLS), typical medical documentation systems (e.g. on patient records, clinical and epidemiological registers), utilization of clinical data management systems, planning of medical coding systems and of clinical data management systems, hospital information systems and the electronic patient record, and on data management in clinical studies.

CONCLUSION

Usability, the ultimate goal of recording and managing patient data, requires, besides technical considerations, in addition appropriate methodology on medical data management, especially if data is intended to be used for multiple purposes, e.g. for patient care and quality management and clinical research. Medical data management should be taught in health and biomedical informatics programs.

Medical informatics education needs information system practicums in health care settings--experiences and lessons learned from 32 practicums at four universities in two countries

OBJECTIVES

To report about the themes and about experiences with practicums in the management of information systems in health care settings (health information management) for medical informatics students.

METHODS

We first summarize the topics of the health information management practicums/projects that the authors organized between 1990 and 2003 for the medical informatics programs at Heidelberg/Heilbronn, Germany, UMIT, Austria, as well as for the informatics program at the University of Leipzig, Germany. Experiences and lessons learned, obtained from the faculty that organized the practicums in the past 14 years, are reported.

RESULTS

Thirty (of 32) health information management practicums focused on the analysis of health information systems. These took place inside university medical centers. Although the practicums were time-intensive and required intensively tutoring students with regard to health information management and project management, feedback from the students and graduates was mainly positive.

DISCUSSION

It is clearly recommended that students specializing in medical informatics need to be confronted with real-world problems of health information systems during their studies.

Recommendations on the design of hospital Intranets

Intranets are being widely introduced in hospitals like in many other organisations. Although their development is just like setting up any other information system in a hospital, there is a tendency to neglect well established principles of software engineering and information system design in that area. Starting from a functional definition of an intranet, we illustrate its potential importance for a hospital from different aspects. A systematic framework for an iterative design and maintenance process is suggested. Some important design principles are depicted.

Simulation of the initial concentration-time course after intravenous application of the drug

In this paper we present a widely applicable computational method for the description of the initial concentration-time-course after intravenous injection of a substance. The intravascular concentration-time course, r, is described as r = c0 + g x r, where the asterisk denotes the convolution operation, c0 is the concentration-time course during the first passage of the substance and g is the transport function of the body. If the body transport function is known, then the concentration-time course of a substance can be predicted. The site of interest can be chosen arbitrarily, i.e. the concentration-time course in the arterial circulation supplying any organ can be described. This might be of special interest for the optimal design of intravenous injections of contrast media, where initial concentrations at the region of interest determine the success of the diagnostic procedure.

Teaching the fundamentals of information systems management in health care. Lecture and practical training for students of medical informatics

For the management of information systems in health care, it is important that projects are systematically planned and carried out. This is a major task for medical informatics professionals which should be taught in a medical informatics curriculum. In the respective lecture in the Heidelberg/Heilbronn medical informatics curriculum, we teach fundamentals of the management of information systems and of projects. The examples of the lecture are taken from hospital information systems. Furthermore, we have developed a 5-step method for the systematic, goal-oriented planning of projects. The lecture is complemented by a comprehensive practical training, so that the methods taught can be applied to a particular, relevant problem of the Heidelberg University Hospital.

Systematic planning of clinical documentation

All information obtained from a patient in the course of medical care is a potential part of clinical documentation. The documentation usually serves a number of different purposes. The task of a documentation system is to fulfil these purposes in a methodically correct manner and as economically as possible. This requires that the properties of the documentation system be planned systematically with a view to the goals pursued. To support systematic planning, a "documentation protocol" is proposed analogous to the "study protocol" used for controlled clinical trials. The individual sections of the proposed documentation protocol are described and the design options which exist in the corresponding planning phases are pointed out. Experience gained by the application of the documentation protocol is discussed.

Medical informatics Heidelberg/Heilbronn: graduates' experiences and job situation. An inquiry among graduates having completed the curriculum of medical informatics at the University of Heidelberg/School of Technology Heilbronn

On the occasion of the 20th anniversary of the curriculum of medical informatics at the University of Heidelberg/School of Technology Heilbronn, a written and anonymous inquiry was carried out in March 1992 among the entirety of graduates from the curriculum. The aim of the inquiry was to obtain from the graduates of the curriculum information about their current places of employment, their fields of work, the state of continuing education as well as about their professional position. It was, in addition, intended to obtain from the graduates' point of view an assessment of the education received during their studies as well as an assessment of the job situation. A questionnaire was sent to all persons having completed their studies by that time (n = 567, as of 1.1.1992). 62.2% of the forms were returned duly filled in; 92.2% of the graduates are employed. 44.5% out of them are working within the field of medical informatics, 53.0% are working outside medical informatics but within the sector of informatics and 2.2% in other fields; 0.3% were without indication. As far as places of employment are concerned, enterprises concentrating on hardware and software development rank first, followed by hospitals and medical institutions affiliated to universities. As far as fields of work are concerned, information systems within the health care sector (especially hospital information systems) as well as medical documentation predominate in the group of those employed within medical informatics, whereas among those not working within medical informatics software engineering as well as database systems and information systems prevail.(ABSTRACT TRUNCATED AT 250 WORDS)

Summary of the General Discussion

Five breakout groups at the 1992 International Working Conference on Health/Medical Informatics Education in Heidelberg/Heilbronn compared six programs, located in the United States, Canada, Great Britain, and Germany. Acknowledging the difficulties in comparing programs in different countries and at different degree levels, the groups proposed four different schemata for distinguishing among programs. Despite widely varying approaches, there was consensus on the need for a robust model for health/medical informatics curricula. The viewpoint of the presented summaries is necessarily that of the authors.