Training synergies between medical informatics and health services research: successes and challenges

[Educational Programmes in Health Services Research in Germany: Current State and Future Perspectives]

Ziel der Studie Ziel dieser Untersuchung war es, die derzeit akkreditierten Versorgungsforschungsstudiengänge in Deutschland im Hinblick auf ihre Strukturdaten und Inhalte zu analysieren.

Methodik Im Rahmen eines deskriptiven qualitativen Designs wurden die aktuellen Studienverlaufspläne, die Modulhandbücher und die Steckbriefe akkreditierter Masterstudiengänge der Versorgungsforschung inhaltsanalytisch ausgewertet.

Ergebnisse Die 6 analysierten Studiengänge zeigen sich hinsichtlich ihrer strukturellen Merkmale und lehr-lerninhaltlichen Ausrichtung in den wesentlichen Punkten als homogen. Ziel aller Studiengänge ist es, fach- und disziplinübergreifende personale und soziale Kompetenzen zu fördern, um Versorgungsbedarfe im Gesundheitswesen zu identifizieren, Innovationen der Versorgung zu entwickeln, zu initiieren, zu evaluieren und kritisch zu reflektieren.

Schlussfolgerungen Trotz ähnlicher Lehr-Lerninhalte bestehen spezifische Ausrichtungen, für die sich die Studierenden vor dem Hintergrund ihrer individuellen Präferenzen entscheiden können. Diese Ergebnisse könnten unter Berücksichtigung aktueller Diskurse und weiterer Erkenntnisse als Grundlage für Empfehlungen zur Entwicklung eines Kerncurriculums dienen.

Biomedical and Health Informatics Education - the IMIA Years

OBJECTIVE

This paper presents the development of medical informatics education during the years from the establishment of the International Medical Informatics Association (IMIA) until today.

METHOD

A search in the literature was performed using search engines and appropriate keywords as well as a manual selection of papers. The search covered English language papers and was limited to search on papers title and abstract only.

RESULTS

The aggregated papers were analyzed on the basis of the subject area, origin, time span, and curriculum development, and conclusions were drawn.

CONCLUSIONS

From the results, it is evident that IMIA has played a major role in comparing and integrating the Biomedical and Health Informatics educational efforts across the different levels of education and the regional distribution of educators and institutions. A large selection of references is presented facilitating future work on the field of education in biomedical and health informatics.

Cancer informatics for the clinician: an interaction database for chemotherapy regimens and antiepileptic drugs

BACKGROUND

Cancer patients are at high risks of manifesting drug-drug interactions (DDIs) which can potentiate serious negative outcomes. It is important for clinicians to make accurate, timely, safe and effective decisions with regards to drug use in the patient.

OBJECTIVE

To provide clinicians with an oncology-specific drug interaction database that is relevant to their daily practice. This database focuses on DDIs with anticancer drugs (ACDs), single- and multiple-agent chemotherapy regimens.

METHODS

Drug-related and interaction-related information between anticancer and antiepileptic drugs were compiled from drug information handbooks and databases, package inserts, and published literature from PubMed. Web documents were served from a modified web server with a database engine and programming interface constructed using Adobe software and various programming scripts.

RESULTS

OncoRx is an oncology-specific database whose structure is designed around chemotherapy regimens and generic drug names used in anticancer treatment. OncoRx currently comprises of 117 ACDs and 256 single-agent and combination chemotherapy regimens. It covers all the major classes of ACDs and their frequently prescribed chemotherapy regimens, and can detect up to over 2000 interactions with 24 antiepileptic drugs. Data provided to clinicians include pharmacokinetic parameters of the drugs, information regarding the chemotherapy regimens and the detected DDIs.

CONCLUSION

OncoRx is able to identify DDIs between ACDs and adjuvant drug therapy. This is the first database of its kind to be able to detect interactions for combination chemotherapy regimens. This tool will assist clinicians in improving clinical response and reducing adverse effects based on the therapeutic and toxicity profiles of the drugs.

Design and evaluation in eHealth: challenges and implications for an interdisciplinary field

Much has been written about insufficient user involvement in the design of eHealth applications, the lack of evidence demonstrating impact, and the difficulties these bring for adoption. Part of the problem lies in the differing languages, cultures, motives, and operational constraints of producers and evaluators of eHealth systems and services. This paper reflects on the benefits of and barriers to interdisciplinary collaboration in eHealth, focusing particularly on the relationship between software developers and health services researchers. It argues that the common pattern of silo or parallel working may be ameliorated by developing mutual awareness and respect for each others’ methods, epistemologies, and contextual drivers and by recognizing and harnessing potential synergies. Similarities and differences between models and techniques used in both communities are highlighted in order to illustrate the potential for integrated approaches and the strengths of unique paradigms. By sharing information about our research approaches and seeking to actively collaborate in the process of design and evaluation, the aim of achieving technologies that are truly user-informed, fit for context, high quality, and of demonstrated value is more likely to be realized. This may involve embracing new ways of working jointly that are unfamiliar to the stakeholders involved and that challenge disciplinary conventions. It also has policy implications for agencies commissioning research and development in this area.

Internet infrastructures and health care systems: a qualitative comparative analysis on networks and markets in the British National Health Service and Kaiser Permanente

BACKGROUND

The Internet and emergent telecommunications infrastructures are transforming the future of health care management. The costs of health care delivery systems, products, and services continue to rise everywhere, but performance of health care delivery is associated with institutional and ideological considerations as well as availability of financial and technological resources.

OBJECTIVE

to identify the effects of ideological differences on health care market infrastructures including the Internet and telecommunications technologies by a comparative case analysis of two large health care organizations: the British National Health Service and the California-based Kaiser Permanente health maintenance organization.

METHODS

A qualitative comparative analysis focusing on the British National Health Service and the Kaiser Permanente health maintenance organization to show how system infrastructures vary according to market dynamics dominated by health care institutions ("push") or by consumer demand ("pull"). System control mechanisms may be technologically embedded, institutional, or behavioral.

RESULTS

The analysis suggests that telecommunications technologies and the Internet may contribute significantly to health care system performance in a context of ideological diversity.

CONCLUSIONS

The study offers evidence to validate alternative models of health care governance: the national constitution model, and the enterprise business contract model. This evidence also suggests important questions for health care policy makers as well as researchers in telecommunications, organizational theory, and health care management.

Basic concepts in medical informatics

This glossary defines terms used in the comparatively young science of medical informatics. It is hoped that it will be of interest to both novices and professionals in the field.

Integrating medical informatics and health services research: the need for dual training at the clinical health systems and policy levels

Reams of data pertaining directly to the core health services research mission are accumulating in large-scale organizational and clinical information systems. Health services researchers who grasp the structure of information systems and databases and the function of software applications can use existing data more effectively, assist in establishing new databases, and develop new tools to survey populations and collect data. At the same time, informaticians are needed who can structure databases that serve the needs of health service research and who can design and evaluate applications that effectively improve health care delivery. As long as health services researchers and informaticians work in separate spheres, however, opportunities to use data from health care encounters to improve care, expand knowledge, and develop more effective policies will be missed. This paper provides a brief exploration of 1) existing successful collaborations between health services researchers and informaticians and 2) needs and opportunities for additional joint work in several core research areas.

Bridging the gap in medical informatics and health services research: workshop results and next steps

In January 2000, the Agency for Healthcare Research and Quality (AHRQ) and the National Library of Medicine (NLM) cosponsored an invitational workshop entitled "Medical Informatics and Health Services Research: Bridging the Gap." Planned by a small committee of representatives from NLM and AHRQ institutional training centers, the workshop was designed to address the need for education of researchers interested in working at the intersection of the fields of medical informatics and health services research. More than 100 educators and researchers from AHRQ- and NLM-sponsored training programs in medical informatics and health services research participated in the workshop. Through a series of plenary presentations and breakout sessions, the workshop addressed ways of increasing the pool of persons interested, trained, and experienced in addressing specific areas of synergy between the two fields. This paper reports on the results of the workshop.