Medical Informatics and the Quality of Health: New Approaches to Support Patient Care

Surgical Workflow Management Schemata for Cataract Procedures

Objective: Workflow guidance of surgical activities is a challenging task. Because of variations in patient properties and applied surgical techniques, surgical processes have a high variability. The objective of this study was the design and implementation of a surgical workflow management system (SWFMS) that can provide a robust guidance for surgical activities. We investigated how many surgical process models are needed to develop a SWFMS that can guide cataract surgeries robustly.

Methods: We used 100 cases of cataract surgeries and acquired patient-individual surgical process models (iSPMs) from them. Of these, randomized subsets iSPMs were selected as learning sets to create a generic surgical process model (gSPM). These gSPMs were mapped onto workflow nets as work-flow schemata to define the behavior of the SWFMS. Finally, 10 iSPMs from the disjoint set were simulated to validate the workflow schema for the surgical processes. The measurement was the successful guidance of an iSPM.

Results: We demonstrated that a SWFMS with a workflow schema that was generated from a subset of 10 iSPMs is sufficient to guide approximately 65% of all surgical processes in the total set, and that a subset of 50 iSPMs is sufficient to guide approx. 80% of all processes.

Conclusion: We designed a SWFMS that is able to guide surgical activities on a detailed level. The study demonstrated that the high inter-patient variability of surgical processes can be considered by our approach.

Toward a formalization of the process to select IMIA Yearbook best papers

BACKGROUND

Each year, the International Medical Informatics Association Yearbook recognizes significant scientific papers, labelled as "best papers", published the previous year in the subfields of biomedical informatics that correspond to the different section topics of the journal. For each section, about fifteen pre-selected "candidate" best papers are externally peer-reviewed to select the actual best papers. Although based on the available literature, little is known about the pre-selection process.

OBJECTIVE

To move toward an explicit formalization of the candidate best papers selection process to reduce variability in the literature search across sections and over years.

METHODS

A methodological framework is proposed to build for each section topic specific queries tailored to PubMed and Web of Science citation databases. The two sets of returned papers are merged and reviewed by two independent section editors and citations are tagged as "discarded", "pending", and "kept". A protocolized consolidation step is then jointly conducted to resolve conflicts. A bibliographic software tool, BibReview, was developed to support the whole process.

RESULTS

The proposed search strategy was fully applied to the Decision Support section of the 2013 edition of the Yearbook. For this section, 1124 references were returned (689 PubMed-specific, 254 WoS-specific, 181 common to both databases) among which the 15 candidate best papers were selected.

CONCLUSIONS

The search strategy for determining candidate best papers for an IMIA Yearbook's section is now explicitly specified and allows for reproducibility. However, some aspects of the whole process remain reviewer-dependent, mostly because there is no characterization of a "best paper".

The impact of accelerating electronic prescribing on hospitals' productivity levels: can health information technology bend the curve?

This paper examines how different strategies for implementing computerized prescriber order entry (CPOE) impact hospitals' productivity. We used the American Hospital Association's Annual Survey to construct hospital-level measures for 1,812 facilities and analyzed the productivity indices against CPOE use rates. The relationship between CPOE use rates and indices for "technical efficiency change" and "total factor productivity" was significant. Hospitals introducing CPOE facilitywide in a one-year period (where usage went from zero to more than 50%) experienced declines in both productivity indices. One implication is that hospitals achieving the goals of the "meaningful use" program promoted by the Centers for Medicare and Medicaid Services may do so at the expense of productivity.

Problem-based learning in medical informatics for undergraduate medical students: an experiment in two medical schools

PURPOSE

The objective of this work was to assess problem-based learning (PBL) as a method for teaching information and communication technology in medical informatics (MI) courses. A study was conducted in the Schools of Medicine of Rennes and Rouen (France) with third-year medical students.

METHODS

The "PBL-in-MI" sessions included a first tutorial group meeting, then personal work, followed by a second tutorial group meeting. A problem that simulated practice and was focused on information technology was discussed. In Rouen, the students were familiar with PBL, and they enrolled on a voluntary basis, while in Rennes, the students were first-ever participants in PBL courses, and the program was mandatory. One hundred and seventy-seven students participated in the PBL-in-MI sessions and were given a questionnaire in order to evaluate qualitatively the sessions.

RESULTS AND DISCUSSION

The response rate was 92.1%. The overall opinion of the students was good. 69.8% responded positively to the program. In Rouen, where the students participated in PBL-in-MI sessions on a voluntary basis, the students were significantly more enthusiastic about PBL-in-MI. Moreover, attitudes and opinions of students are plausibly related to differences in previous PBL skills. The fact that the naïve group had two tutors, one trained and one naïve as the students, has been investigated. Teacher naivety was an explanatory factor for the differences between Rennes and Rouen.