Informatics for Health and Social Care

Published by Informa Healthcare
Online ISSN: 1753-8165
Print ISSN: 1753-8157
The Internet has become one of the main drivers of e-health. Whilst its impact and potential is being analysed, the Web 2.0 phenomenon has reached the health field and has emerged as a buzzword that people use to describe a wide range of online activities and applications. The aims of this article are: to explore the opportunities and challenges of the Web 2.0 within the health care system and to identify the gap between the potential of these online activities and applications and the empirical data. The analysis is based on: online surveys to physicians, nurses, pharmacist and patient support groups; static web shot analysis of 1240 web pages and exploration of the most popular Web 2.0 initiatives. The empirical results contrast with the Web 2.0 trends identified. Whereas the main characteristic of the Web 2.0 is the opportunity for social interaction, the health care system at large could currently be characterised by: a lack of interactive communication technologies available on the Internet; a lack of professional production of health care information on the Internet, and a lack of interaction between these professionals and patients on the Internet. These results reveal a scenario away from 2.0 trends.
In the general population, social disparities in Internet practices have been less described than disparities in health information access. Aim is to determine whether there are differences in the frequency of Internet use for health information among health seekers. We conducted an Internet-based survey from November 2006 to March 2007. We considered the 3720 residents of France who had searched for health information during the previous 12 months. This study reveals different uses of the Internet for health information seeking (HIS) between men and women and between the general population and people who work in the health sector. Health status, taking care of somebody who is sick, and active Internet use were associated with higher frequencies of online HIS to varying degrees. The effects of age and level of education were not clear or were not significant. Greater health concerns and some issues in the physician-patient relationship were associated with higher frequencies of Internet use for HIS in the general population. Considering that this increasing use of online tools for HIS is consistent with current public health policies that promote the development of the 'informed patient', one should remain cautious about these social disparities in online HIS practices.
To investigate the medical informatics scientific output in 33 European countries. Medical Subject Heading term "medical informatics" was used to identify all relevant articles published in 1998-2007 and indexed in the Medline database. The number of articles was adjusted to the population size of each included country in order to obtain the rates per million inhabitants. A total of 28,604 articles were identified. The highest number per million inhabitants was found for Switzerland and the lowest for Albania. Overall, European Union member states had higher output than non-member states, gross domestic product was strongly associated with the scientific output in the field of medical informatics (r = 0.88, p < 0.001). While most countries had significant increase in the scientific output during the observed period, an adjustment to the European average output trend suggested that Lithuania, Portugal, Serbia and Spain had a greater increase than the rest of Europe. The results suggest large disparities across Europe. Further development of medical informatics as a profession and a clear recognition of the discipline are needed to reduce these disparities and propel further increase in research productivity.
Use of Internet versions of questionnaires may have several advantages in clinical and epidemiological research, but we know little about if Internet versions differ with respect to validity and reliability. We aimed to compare Internet- and pen-and-paper versions of short form-36 (SF-36) with respect to test-retest reliability and internal consistency. Women referred to mammography (n = 782) were randomised to receive either a paper version with a prepaid return envelope or a guideline on how to fill in the Internet version. A subgroup was asked to answer the questionnaire once again in the alternative version. Test-retest reliability was assessed by the intra-class correlation coefficient. Internal consistency was calculated as Cronbach's alpha. The between-version test-retest reliability for the eight subscales were between 0.63 and 0.92. Cronbach's alpha for the two versions were all between 0.75 and 0.93 with minor differences between the Internet- and the pen-and-paper version. We found little or no evidence of a difference in test-retest reliability and internal consistency when we compared an Internet- and a pen-and-paper version of SF-36.
Falls have various causes and are often associated with mobility impairments. Preventive steps to avoid falls may be initiated, if an increasing fall risk could be detected in time. The objective of this article is to identify an automated sensor-based method to determine fall risk of patients based on objectively measured gait parameters. One hundred fifty-one healthy subjects and 90 subjects at risk of falling were measured during a Timed 'Up & Go' test with a single triaxial acceleration sensor worn on a waist belt. The fall risk was assessed using the STRATIFY score. A decision tree induction algorithm was used to distinguish between subjects with high and low risk using the determined gait parameters. The results of the risk classification produce an overall accuracy of 90.4% in relation to STRATIFY score. The sensitivity amount to 89.4%, the specificity to 91.0% and the reliability parameter kappa equals 0.79. The method presented is able to distinguish between subjects with high and low fall risk. It is unobtrusive and therefore may be applied over extended time periods. A subsequent study is needed to confirm the model's suitability for data recorded in patients' everyday lives.
The development of ongoing assessment tools to monitor older adult health and wellness can support improved quality of life and independence. These technologies have often been employed within private residences. Our work describes a telehealth kiosk system implemented within a community setting, which reduces the costs of installing and maintaining individual systems. Though user acceptance of telehealth systems has been studied within the context of home residences, this has yet to be addressed for community-based systems. Older adults in a retirement community were recruited to use a telehealth system including assessment of vital signs and cognitive performance. With a series of focus groups (N = 12, average age 79.3 years), we examined user perceptions of the telehealth kiosk, addressing issues of usability, effectiveness and privacy. Older adults were favorable towards the collection of health monitoring information, recognizing the utility of these data sources. There were issues of usability, especially regarding ergonomics of the telehealth kiosk. We found no concerns over privacy, with some participants expressing increased preference for the social interactions afforded through the community setting. Understanding the social, technical and human factors involved with a community-based telehealth system can inform the design of cost-effective health monitoring systems.
To assess the applicability of the Technology Acceptance Model (TAM) constructs in explaining HIV case managers' behavioural intention to use a continuity of care record (CCR) with context-specific links designed to meet their information needs. Data were collected from 94 case managers who provide care to persons living with HIV (PLWH) using an online survey comprising three components: (1) demographic information: age, gender, ethnicity, race, Internet usage and computer experience; (2) mock-up of CCR with context-specific links; and items related to TAM constructs. Data analysis included: principal components factor analysis (PCA), assessment of internal consistency reliability and univariate and multivariate analysis. PCA extracted three factors (Perceived Ease of Use, Perceived Usefulness and Perceived Barriers to Use), explained variance = 84.9%, Cronbach's ά = 0.69-0.91. In a linear regression model, Perceived Ease of Use, Perceived Usefulness and Perceived Barriers to Use explained 43.6% (p < 0.001) of the variance in Behavioural Intention to use a CCR with context-specific links. Our study contributes to the evidence base regarding TAM in health care through expanding the type of professional surveyed, study setting and Health Information Technology assessed.
Today's registration of newborns with congenital cytomegalovirus (cCMV) infection is still performed on paper-based forms in Flanders, Belgium. This process has a large administrative impact. It is important that all screening tests are registered to have a complete idea of the impact of cCMV. Although these registrations are usable in computerised data analysis, these data are not available in a format to perform electronic processing. An online Neonatal Registry (NEOREG) System was designed and developed to access, follow and analyse the data of newborns remotely. It allows remote access and monitoring by the physician. The Java Enterprise layered application provides patients' diagnostic registration and treatment follow-up through a web interface and uses document forms in Portable Document Format (PDF), which incorporate all the elements from the existing forms. Forms are automatically processed to structured EHRs. Modules are included to perform statistical analysis. The design was driven by extendibility, security and usability requirements. The website load time, throughput and execution time of data analysis were evaluated in detail. The NEOREG system is able to replace the existing paper-based CMV records.
In recent years, the rise in total student intake of medical schools across England has not been met by an increase in medical teachers. Computer aided learning (CAL) has the potential to address this disequilibrium. We conducted a survey of clinical medical students at our institution to ascertain the level of access to media devices capable of delivering vision and/or audio. The aim was to establish a baseline to assist CAL providers plan for appropriate modes of content delivery. A questionnaire was emailed to all clinical medical students at UCL. To validate the email survey, an identical paper questionnaire was distributed to a compulsory class for third year clinical medical students. The e-questionnaire and validation questionnaire response rate was 46 and 100% respectively. Eighty-six percent of students had home access to broadband Internet, and 85% of home computers were suitable for a full multimedia experience. Seventy-four percent of students indicated that their primary place of access was at home. Sixty-three percent of students had portable MP3 devices and over 50% owned an iPod. The hardware environment appears favourable for the introduction of complex multimedia teaching programs to medical students, but access is not universal. In addition to personal computers, inexpensive portable multimedia players might offer the opportunity to deliver 'on demand' learning. Medical schools planning for delivery of CAL should consider student access to desktop and portable media devices when designing an e-learning curriculum.
A personally controlled health records (PCHR) system allows a patient user to share his/her health records with trusted physicians by manually granting them the access privilege to his/her online records. However, it presents the problem of emergency access in situations where the user is physically unable to grant the access and the access is required by an Emergency Room (ER) physician who does not have the privilege at that moment. To deal with such a problem, we introduce an online polling system to provide the emergency access control to PCHR systems. For each emergency access request, the access privilege is controlled according to the combined opinions of the patient's preset emergency contacts and other online registered physicians. Because our system is based on the demographic number of the physician community nationwide, it provides a stable emergency access control at all times.
A challenge when groups from different disciplines work together in implementing health information technology (HIT) in a health-care context is that words often have different meanings depending upon work practices, and definition of situations. Accessibility is a word commonly associated with HIT implementation. This study aimed to investigate different meanings of accessibility when implementing HIT in everyday work practice in a health-care context. It focused on the perspective of nurses to highlight another view of the complex relationship between HIT and information in a health-care context. This is a qualitative study influenced by institutional ethnographic. District nurses and student nurses were interviewed. The results indicate that when implementing HIT accessibility depends on working routines, social structures and patient relationship. The findings of the study suggest that interaction needs to take on a more important role when implementing HIT because people act upon words from the interpreted meaning of them. Symbolic interactionism is proposed as a way to set a mutual stage to facilitate an overall understanding of the importance of the meaning of words. There is a need for making place and space for negotiation of the meaning of words when implementing HIT in everyday work practice.
Health websites are used frequently, but there are many concerns about their value as information sources. Additionally, there are numerous personal barriers that prevent individuals from wholly benefitting from them. In order to assess the quality of health websites and their accessibility to users, we created tools based on previous research that examine design aspects, information validity, motivational health content and literacy content. To test these tools, we examined 155 breast cancer websites and created scores for each assessment tool to describe the percent of constructs on the average website. Results demonstrated that websites performed best on the design tool followed by the information validity, motivational health content and literacy assessment tools. The average website contained the majority of the design and information validity constructs, but only about a third of the motivational health or literacy constructs. Multiple items from the motivational health content and literacy assessment tools were not found on any of the websites, and many were only represented on a handful of sites. Overall, the assessment tools were useful in evaluating the quality of websites, and could serve as valuable resources for health website developers in the future.
Online databases have been increasingly used as a key resource in the search for health information. The current study aims to compare the use patterns of online databases between physicians and nurses. A structured questionnaire was mailed to physicians and nurses of randomly selected regional hospitals in Taiwan. Valid questionnaires with complete answers were collected from 544 physicians and 1,573 nurses from November 2008 to February 2009. In general, physicians made more use of online databases than nurses (p  <  0.001). They more often accessed English-language online databases (p  <  0.001), including MEDLINE, MD Consult, UpToDate, Cochrane Library and ProQuest. On the other hand, nurses accessed Chinese-language online databases more frequently than physicians (p  <  0.001). Using a multivariate logistic regression model to adjust the personal characteristics, we found that nurses more often accessed Chinese-language online databases than physicians. Physicians used online databases to locate health information the most for clinical practice (76.6%), followed by instruction preparation (63.3%), and research (57.0%). Nevertheless, nurses used such databases more often for class assignments (66.4%) and clinical practice (55.8%). In conclusion, the behavior and motivation of access to online databases varied between physicians and nurses. Our findings provide evidence in the strategies to enhance the accessing of online databases.
Study recruitment and sample disposition. 
Temporal profile of survey responses as percentages of total sample frame (* n refers to total number of valid e-mails). 
To report the implementation of an open source web survey application and a case study of its first utilisation, particularly as to aspects of logistics and response behaviour, in a survey of Brazilian university students' conceptions about injury causing events. We developed an original application capable of recruiting respondents, sending personal e-mail invitations, storing responses and exporting data. Students of medical, law, communication and education schools were asked about personal attributes and conceptions of the term accident, as to associations and preventability. The response rate was 34.5%. Half of the subjects responded by the second day, 66.3% during the first week. Subjects around 4.2% (95% CI 3.3-5.4) refused to disclose religious persuasion, and 19.2% (95% CI 17.2-21.3) refused to disclose political persuasion, whereas only 2.8% (95% CI 2.1-3.8), on average, refused to answer questions on conceptions and attitudes. There was no significant difference between early and late respondents in respect to selected attributes and conceptions of accident (P-value varied from 0.145 to 0.971). The word accident evoked the notion of preventability to 85.1% (95% CI 83.2 to 87.0) of the subjects, foreseeability to 50.3% (95% CI 47.7-53.0), fatality to 15.1% (95% CI 13.3-17.1) and intentionality to 2.3% (95% CI 1.6-3.2). Web surveying university students' conceptions about injuries is feasible in a middle-income country setting, yielding response rates similar to those found in the literature.
Flow chart of the evaluation of the quality and accuracy of nutrition information on cancer prevention.
This study aimed to assess the quality and accuracy of nutrition information about cancer prevention available on the Web. The keywords 'nutrition  +  diet  +  cancer  +  prevention' were submitted to the Google search engine. Out of 400 websites evaluated, 100 met the inclusion and exclusion criteria and were selected as the sample for the assessment of quality and accuracy. Overall, 54% of the studied websites had low quality, 48 and 57% had no author's name or information, respectively, 100% were not updated within 1 month during the study period and 86% did not have the Health on the Net seal. When the websites were assessed for readability using the Flesch Reading Ease test, nearly 44% of the websites were categorised as 'quite difficult'. With regard to accuracy, 91% of the websites did not precisely follow the latest WCRF/AICR 2007 recommendation. The quality scores correlated significantly with the accuracy scores (r  =  0.250, p  <  0.05). Professional websites (n  =  22) had the highest mean quality scores, whereas government websites (n  =  2) had the highest mean accuracy scores. The quality of the websites selected in this study was not satisfactory, and there is great concern about the accuracy of the information being disseminated.
The objective of this study was to determine whether peer recommendations made in response to user queries about non-insulin dependent type II diabetes in an online health forum for retired persons were in agreement with diabetes clinical practice guidelines. A content analysis was conducted on type II diabetes conversations occurring in an online health forum for Canadian retired persons from 1 January to 31 December 2006. Recommendations responding to posted questions about diabetes were compared with published Canadian diabetes clinical practice guidelines. Seven diabetes-related questions generated 17 responses and 35 recommendations. Comparison of recommendations with evidence-based sources indicated that 91% (32/35) were in agreement with the best practice clinical guidelines for type II diabetes. Discussion themes included diabetic signs and symptoms, glycemic control, neuropathy, retinopathy, diet and physical activity recommendations and interactions of prednisone with glucose control. Concerns about the accuracy of online peer recommendations about type II diabetes care and management have not supported these results. This forum presents information sharing among a group of knowledgeable older adults with high interactive health literacy skills. Future research is needed to determine whether deviations from 'accurate' online information are truly harmful or represent lay expert adaptations to self-care routines.
Knowledge-based system.  
Distributed data mining framework.  
The use of data mining techniques to improve the diagnostic system accuracy is investigated in this paper. The data mining algorithms aim to discover patterns and extract useful knowledge from facts recorded in databases. Generally, the expert systems are constructed for automating diagnostic procedures. The learning component uses the data mining algorithms to extract the expert system rules from the database automatically. Learning algorithms can assist the clinicians in extracting knowledge automatically. As the number and variety of data sources is dramatically increasing, another way to acquire knowledge from databases is to apply various data mining algorithms that extract knowledge from data. As data sets are inherently distributed, the distributed system uses agents to transport the trained classifiers and uses meta learning to combine the knowledge. Commonsense reasoning is also used in association with distributed data mining to obtain better results. Combining human expert knowledge and data mining knowledge improves the performance of the diagnostic system. This work suggests a framework of combining the human knowledge and knowledge gained by better data mining algorithms on a renal and gallstone data set.
Primary objective: Electronic patient portals give patients access to personal medical data, potentially creating opportunities to improve knowledge, self-efficacy, and engagement in healthcare. The combination of knowledge, self-efficacy, and engagement has been termed activation. Our objective was to assess the relationship between patient activation and outpatient use of a patient portal. Research design: Survey. Methods and procedures: A telephone survey was conducted with 180 patients who had been given access to a portal, 113 of whom used it and 67 of whom did not. The validated patient activation measure (PAM) was administered along with questions about demographics and behaviors. Results: Portal users were no different from nonusers in patient activation. Portal users did have higher education level and more frequent Internet use, and were more likely to have precisely 2 prescription medications than to have more or fewer. Conclusion: Patients who chose to use an electronic patient portal were not more highly activated than nonusers, although they were more educated and more likely to be Internet users.
Different studies have analysed a wide range of use cases and scenarios for using IT-based services in homecare settings for elderly people. In most instances, the impact of such services has been studied using a one-dimensional approach, either focusing on the benefits for the patient or health service provider. The objective of this contribution is to explore a model for identifying and understanding outcomes of IT-based homecare services from a multi-actor perspective. In order to better understand the state of the art in homecare informatics, we conducted a literature review. We use experiences from previous research in the area of informatics to develop the proposed model. The proposed model consists of four core activities 'identify involved actors', 'understand consequences', 'clarify contingencies', 'take corrective actions', and one additional activity 'brainstorming IT use'. The primary goal of innovating organisations, processes and services in homecare informatics today, is to offer continued care, better decision support both to practitioners and patients, as well as effective distribution of resources. A multi-actor analysis perspective is needed to understand utility determination for the involved stakeholders.
Background characteristics. 
Objectives: To describe the association of team climate with attitudes toward information and communication technology among nursing staff working on acute psychiatric wards. Background: Implementation of ICT applications in nursing practice brings new operating models to work environments, which may affect experienced team climate on hospital wards. Method: Descriptive survey was used as a study design. Team climate was measured by the Finnish modification of the Team Climate Inventory, and attitudes toward ICT by Burkes' questionnaire. The nursing staff (N = 181, n = 146) on nine acute psychiatric wards participated in the study. Results: It is not self-evident that experienced team climate associates with attitudes toward ICT, but there are some positive relationships between perceived team climate and ICT attitudes. The study showed that nurses' motivation to use ICT had statistically significant connections with experienced team climate, participative safety (p = 0.021), support for innovation (p = 0.042) and task orientation (p = 0.042). Conclusion: The results suggest that asserting team climate and supporting innovative operations may lead to more positive attitudes toward ICT. It is, in particular, possible to influence nurses' motivation to use ICT. More attention should be paid to psychosocial factors such as group education and co-operation at work when ICT applications are implemented in nursing.
Background: Assessing and evaluating health care is important, and an abundance of instruments are developed in different languages. Translating existing, validated instruments is demanding and calls for adherence to protocol. Purpose: The purpose of this study was to translate and culturally adapt the FAMCARE-2 scale for use in Sweden. Methods: Traditional back-translation and the decentering stance were utilized and assessed. Experts in palliative care clinic and research were involved; the FAMCARE-2 instrument was discussed with family caregivers and content validity was assessed by experienced health professionals. Results: Significant discrepancies were not revealed by back-translation. Using the decentering stance gave reliable structure and opportunities for reflection throughout the translation process. Discussion: Translating an existing instrument into a second language requires interpretation and adaptation more than a naive translation. The back-translation process may be enhanced if the decentering stance is adopted.
The Contextual Activity Sampling System (CASS) is a novel methodology designed for collecting data of on-going learning experiences through frequent sampling by using mobile phones. This paper describes how it for the first time has been introduced to clinical learning environments. The purposes of this study were to cross-culturally adapt the CASS tool and questionnaire for use in clinical learning environments, investigate whether the methodology is suitable for collecting data and how it is experienced by students. A study was carried out with 51 students who reported about their activities and experiences five times a day during a 2-week course on an interprofessional training ward. Interviews were conducted after the course. The study showed that CASS provided a range of detailed and interesting qualitative and quantitative data, which we would not have been able to collect using traditional methods such as post-course questionnaires or interviews. Moreover, the participants reported that CASS worked well, was easy to use, helped them structure their days and reflect on their learning activities. This methodology proved to be a fruitful way of collecting information about experiences, which could be useful for not only researchers but also students, teachers and course designers.
National register systems include detailed individual-level information. In the Nordic countries, these data sources include personal identification number, which can be used for linkages between registers. A case study on the effects of possible hazardous waste on the former and current residents of Myllypuro in Helsinki, Finland, is presented to assess if the utilisation of pre-collected official health register information is feasible in environmental health research. National register information was used as the primary data source, since large-scale health examination studies are seldom feasible and the use of surveys may result in biased information. The exposure data were based on residence information from the Central Population Register and the outcome data came from three national population and health registers. No evidence of health problems was found. The use of administrative register data was feasible, since the main prerequisites of epidemiological studies - the enumeration of exposed population without selection bias, the tracking of exposed population without loss to follow-up and the formation of different exposure measures - were reached. The small size of study sample and the rarity of several outcome measures impeded the analysis and the evaluation of clinical and public health aspects of the main findings.
The aim of this explorative study was to describe nurses' opportunities to integrate computer and Internet-based programmes in psychiatric out-patient care among adolescents with depression. Therefore, nurses' daily computer use and possible problems related to it were investigated. The data were collected by conducting focus group interviews with Finnish registered nurses (n  =  12) working at the out-patient clinics of two university central hospitals. The data were analysed using inductive content analysis. The analysis showed that nurses used the computer and Internet in their daily work for data transmission and informal interaction with adolescents. Findings revealed that nurses have good computer skills, a positive attitude towards using the computer and Internet and were motivated to make use of both on a daily basis. Problems faced in daily computer use were a lack of instructions and education, and lack of help and support. We can conclude that nurses have good opportunities to implement computer and Internet-based programmes in adolescent out-patient care. These results are encouraging keeping in mind that adolescents are the most active Internet users in society.
Characterization of the respondents. 
The exploratory investigation described in this paper tried to identify and acknowledge the added value created by the adoption of nursing practice standards. It did so using a case study in a large Portuguese hospital. Following a literature review, five assumptions were proposed. Subsequently, a survey was developed and administered to a sample of nursing staff at the hospital in question. Our results confirmed all but our final assumption, leading to the conclusion that the adoption of standards is beneficial to nursing practice.
Factors influencing physician adoption of e-detailing.
E-detailing means using digital technology: internet, video conferencing and interactive voice response. There are two types of e-detailing: interactive (virtual) and video. Currently, little is known about what factors influence physicians' adoption of e-detailing. The objectives of this study were to test a model of physicians' adoption of e-detailing and to describe physicians using e-detailing. A mail survey was sent to a random sample of 2000 physicians practicing in Iowa. Binomial logistic regression was used to test the model of influences on physician adoption of e-detailing. On the basis of Rogers' model of adoption, the independent variables included relative advantage, compatibility, complexity, peer influence, attitudes, years in practice, presence of restrictive access to traditional detailing, type of specialty, academic affiliation, type of practice setting and control variables. A total of 671 responses were received giving a response rate of 34.7%. A total of 141 physicians (21.0%) reported using of e-detailing. The overall adoption model for using either type of e-detailing was found to be significant. Relative advantage, peer influence, attitudes, type of specialty, presence of restrictive access and years of practice had significant influences on physician adoption of e-detailing. The model of adoption of innovation is useful to explain physicians' adoption of e-detailing.
A decline of cognitive abilities is a part of normal human ageing. However, recent research has demonstrated that an enriched environment can have a beneficial impact on cognitive function in old age. Accordingly, mentally and socially active lifestyles are associated with less cognitive decline in old age. Specific interventions such as computerized cognitive training programs for older adults are also known to have a positive effect on the level of cognitive functioning. Therefore, online platforms combining cognitive training with web 2.0 features may yield multiple benefits for older users. However, to date only little research exists on technological acceptance and media use in this age-group especially for cognitively-impaired seniors. Therefore, in order to assess specific preferences and potential barriers of older adults regarding a web-based platform for cognitive training, we conducted qualitative interviews with 12 older adults. Half of the participants were diagnosed with mild cognitive impairment (MCI). Most importantly, our results show that cognitive exercises should incorporate themes and topics older adults are interested in. Additional communication features could serve as ideal methods for increasing user motivation. Furthermore, we derived eight critical requirements of older adults concerning daily use of a web-based cognitive training platform. Implications for future research and development are discussed.
Introduction: Older adults with multiple chronic conditions face the complex task of medication management involving multiple medications of varying doses at different times. Advances in telehealth technologies have resulted in home-based devices for medication management and health monitoring of older adults. We examined older adults' perceptions of a telehealth medication dispensing device as part of a clinical trial involving home healthcare clients, nurse coordination and use of the medication dispensing device. Methods: Ninety-six frail older adult participants who used the medication dispensing device for 12 months completed a satisfaction survey related to perceived usefulness and reliability. Results were analyzed and grouped by themes in the following areas: Ease of Use, Reliability, Medication Management Assistance, Routine Task Performance and Acceptability. Results: Nearly all participants perceived the medication dispensing device as very easy to use, very reliable and helpful in the management of their medications. Eighty-four percent of participants expressed a desire to use the machine in the future. Conclusion: The technology-enhanced medication management device in this study is an acceptable tool for older adults to manage medication in collaboration with home care nurses. Improved usability and cost models for medication dispensers are areas for future research.
Objective: To examine older adults' attitudes toward multifunctional technology tools and specific preferences and expectations that would maximize their utility and usability. Methods: We held three focus groups sessions for this pilot study to determine perceptions of older adults toward multifunctional wellness tools, including usefulness and barriers to use. Areas discussed included features that would be wanted or unwanted, form factor and context of use. Recordings were transcribed and qualitative content analysis was performed. Results: Fourteen older adults participated in the focus group sessions. Participants viewed potential uses for wellness tools with regard to their health and health information positively, as they felt currently available tools were lacking. In addition, participants felt that a single-user, smaller, portable device would be more useful than a non-portable multi-user device. Concerns were expressed toward technologies that were difficult to use with aging-related changes, privacy and perceptions of technology. Conclusions: Participants felt generally positively toward a multifunctional wellness tool and would be willing to use one if it were portable, intuitive and had reliable health-related information on the device.
Competency in health numeracy is essential in understanding risk about disease susceptibility and the consequences of disease treatment. Both health literacy and skill in using the Internet to obtain health information are lower among older compared with younger adults. Presentation format of health information has been shown to influence comprehension. The objective of this study was to determine the influence of information formatting (text and graphic) on older adults' comprehension of Internet-based numeric cancer risk information. This cross-sectional study involved a convenience sample of adults, aged 50 years and older from diverse ethnic and educational backgrounds. Cancer risk information, obtained from a Canadian Cancer Society web page, was presented as text, graphics or as a combination of text and graphics formats. Comprehension of the information was assessed by six questions focused on basic numeracy skill and ability to perform simple calculations and operations. A three-item general context numeracy and an eight-item health context numeracy instrument were used to describe health numeracy skills of participants. The six-item Newest Vital Sign (NVS) test was used to assess prose and numeric health literacy. There was no statistically significant effect of presentation format on participants' comprehension of the cancer information. Participants' comprehension of basic health numeracy information was positively correlated with education (p < or = 0.05) and income (p < or = 0.01) whereas comprehension of information that assessed calculation and operations numeracy skill was positively correlated only with income (p < or = 0.05). Health literacy skill and income explained a significant proportion of the variance in overall comprehension of Internet-based cancer risk information (R(2) = 0.414, p < or = 0.01) in this sample of older adults. Format of numeric risk information was not a significant factor in the comprehension of cancer risk information in this group of ethnically diverse, older adults. However, comprehension of the information was related to health literacy skill and income.
Aim: To determine the one-month prevalence of the seeking of web-based health information in the general adult population and to identify the symptoms associated with more frequent searching for information online. Methods: This was an observational cross-sectional study in a representative sample of 1,002 randomly selected Slovenian inhabitants. We used the method of computer-assisted telephone interviews. The questionnaire consisted of demographic questions, questions about the prevalence and duration of pre-selected symptoms in the past month, questions on the presence of chronic disease and a question about using the Internet for seeking health advice in the past month. Results: Among 774 respondents who reported having had symptoms in the past month, 25.8% of them reported seeking health information on the Internet. The factors found to be independently associated with the seeking of health information on the Internet were a younger age, a higher education level and the presence of constipation, irritability, fatigue, memory impairment and excessive sweating in the past month. Conclusions: The study showed that the Internet was a common source of health information in the general adult population, particularly used for symptoms which are common but not well defined and not associated with a particular disease.
In recent years, Internet-delivered treatments have been largely used for pain monitoring, offering healthcare professionals and patients the ability to interact anywhere and at any time. Electronic diaries have been increasingly adopted as the preferred methodology to collect data related to pain intensity and symptoms, replacing traditional pen-and-paper diaries. This article presents a multisensor data fusion methodology based on the capabilities provided by aerospace systems to evaluate the effects of electronic and pen-and-paper diaries on pain. We examined English-language studies of randomized controlled trials that use computerized systems and the Internet to collect data about chronic pain complaints. These studies were obtained from three data sources: BioMed Central, PubMed Central and ScienceDirect from the year 2000 until 30 June 2012. Based on comparisons of the reported pain intensity collected during pre- and post-treatment in both the control and intervention groups, the proposed multisensor data fusion model revealed that the benefits of technology and pen-and-paper are qualitatively equivalent [Formula: see text]. We conclude that the proposed model is suitable, intelligible, easy to implement, time efficient and resource efficient.
The development of information and communication technologies for design of environments for ageing is of great importance considering demographic trends in the future. There is a realistic hope for the preservation of self-determination and independence in the long term. However, some risks like a gradual loss of privacy should not be underestimated. The article discusses some ethical problems within this context. At the same time, the article demonstrates that the development and implementation of these technologies might be discussed for instance under some ethical assumptions of personal self-responsibility as well as social responsibility for the widest independence in advanced age.
During the last decade, the challenges of an ageing society became focus for extensive scientific, public and political discussions. From discussions in scientific fora within each discipline, there is now a shift towards cross-disciplinary scientific approaches. The aim of this article is therefore, to collect and describe different scientific viewpoints in this regard and to point out research gaps to be addressed in the future. The article is based on a number of review articles and keynote lectures given by the author, and complemented with informal interviews of experts from different scientific fields engaged in the field of technology and ageing. Results show that research has emerged from being technology-focussed to scenario-based taking different scientific perspectives into account. However, the biggest challenge still is to accommodate the need for a holistic integrated service which means to provide personalised services and adapt technology and content to individual needs of different stakeholders. Further, cross-disciplinary research is needed that relates informatics and technology to different stages of the aging process and that evaluates the effects of proposed technical solutions.
GAL's approach: the 'double circle' (adapted from [5], p. 86 and [7], p. 34). 
Institutions participating in GAL and their relationships to scenarios and cross-sectional topics. 
AAL labs at TU Braunschweig / PLRI and OFFIS. 
Worldwide, ageing societies are bringing challenges for independent living and healthcare. Health-enabling technologies for pervasive healthcare and sensor-enhanced health information systems offer new opportunities for care. In order to identify, implement and assess such new information and communication technologies (ICT) the 'Lower Saxony Research Network Design of Environments for Ageing' (GAL) has been launched in 2008 as interdisciplinary research project. In this publication, we inform about the goals and structure of GAL, including first outcomes, as well as to discuss the potentials and possible barriers of such highly interdisciplinary research projects in the field of health-enabling technologies for pervasive healthcare. Although GAL's high interdisciplinarity at the beginning slowed down the speed of research progress, we can now work on problems, which can hardly be solved by one or few disciplines alone. Interdisciplinary research projects on ICT in ageing societies are needed and recommended.
Computerised log files are important for analysing user behaviour in health informatics to gain insight into processes that lead to suboptimal user patterns. This is important for software training programmes or for changes to improve usability. Technical user behaviour regarding decision aids has not so far been thoroughly investigated with log files. The aim of our study was to examine more detailed user interactions of primary-care physicians and their patients with arriba-lib, our multimodular electronic library of decision aids used during consultations, on the basis of log data. We analysed 184 consultation log files from 28 primary-care physicians. The average consultation time of our modules was about 8 min. Two-thirds of the consultation time were spent in the history information part of the programme. In this part, mainly bar charts were used to display risk information. Our electronic library of decision aids does not generate specific user behaviour based on physician characteristics such as age, gender, years in practice, or prior experience with decision aids. This supports the widespread use of our e-library in the primary-care sector and probably beyond.
Clear separation among ontology, knowledge and information layers.  
Schematic description of ABCD application in the TM-based system.  
The user uploads a new image and the system returns ABCD values.  
The user retrieves information.
The design and implementation of a web-based diagnostic support tool for melanoma dermatological images and related diagnostic data is presented. The proposed system is semantic web-based and is driven by exploiting the combination of AJAX framework and topic map technology. A novel client/server architecture was developed that enables several clients to interact online with the topic map-based system. Users have the ability to access the system anywhere and anytime via a simple Internet browser. Additionally, an ABCD application has been developed for automated calculation of ABCD parameters and consequently embedded in the proposed TM-based system.
The combination of ambient intelligence (AmI) and domotics has the potential to respond to elderly people's desire to live independent from extensive forms of care. Their slow adoption of technological aids shows reluctance, though. This article investigates their motivations to adopt ambient intelligent domotics, and proposes design principles specifically based on their preferences and experiences. Respondents appeared to be more acceptive of tangible problems they expected with AmI domotics than intangible ones. In addition, their opinions seemed to be profoundly influenced by the way they perceived their psychological quality of life, while their physical conditions did not seem to have noticeable impacts.
In this study, a software tool was developed to analyse the medical data collected from laryngeal cancer operations by using two data mining techniques. The software, run on real-world medical data, is a tool that enables medical decisions to be reached by analysing past records from patients. The k-means algorithm, which is a clustering algorithm in data mining, was used to point out the intensities in the data set and to display two dimensions on the charts. The data of three screens that were named as selective clustering, different pre- and post-operation stages and clustering operations based on pre-operation T values, were processed using clustering with the k-means algorithm and one screen, which named relapse and survival percentages, was processed through classifying. It helps the future decision-making process by considering false estimates of pre-operation stages of the cases and by using the information gathered from past cases concerning tumour relapse and the survival percentage for prognostication. The characteristics of laryngeal cancer operations data, that involve causal links, were exposed by using two data mining techniques in this application.
List of rules.
Developing legally compliant systems is a challenging software engineering problem, especially in systems that are governed by law, such as healthcare information systems. This challenge comes from the ambiguities and domain-specific definitions that are found in governmental rules. Therefore, there is a significant business need to automatically analyze privacy texts, extract rules and subsequently enforce them throughout the supply chain. The existing works that analyze health regulations use the US Health Insurance Portability and Accountability Act as a case study. In this article, we applied the Breaux and Antón approach to the text of the Saudi Arabian healthcare privacy regulations; in Saudi Arabia, privacy is among the top dilemmas for public and private healthcare practitioners. As a result, we extracted and analyzed 2 rights, 4 obligations, 22 constraints and 6 rules. Our analysis can assist requirements engineers, standards organizations, compliance officers and stakeholders by ensuring that their systems conform to Saudi policy. In addition, this article discusses the threats to the study validity and suggests open problems for future research.
Overuse of antibiotics is a critical problem in intensive care today. The situation is further complicated by the extremely data-intensive environment with clinical data presented in distributed, often stand-alone information systems. To access and interpret all data is a complex and time-consuming technical and cognitive challenge. We propose a holistic integrated visualization in the form of a patient overview to support physicians in decision making for use of antibiotics at intensive care units. Special emphasis is put on analysis of work processes to identify information needs, the development of a visualization tool based on an integrated data model, and usability testing of the tool in combination with an eye-tracking technology. The visualization tool was highly rated in terms of user performance and preferences, and the analysis of users' visual patterns showed that different types of data visualization may benefit specialist and resident intensive care physicians depending on the task to be performed. A highly interactive tool for integrated information visualization could potentially increase the understanding of a patient's infection status and ultimately enhance decision making for the use of antibiotics.
The current Turkish healthcare management system has a structure that is extremely inordinate, cumbersome and inflexible. Furthermore, this structure has no common point of view and thus has no interoperability and responds slowly to innovations. The purpose of this study is to show that using which methods can the Turkish healthcare management system provide a structure that could be more modern, more flexible and more quick to respond to innovations and changes taking advantage of the benefits given by a service-oriented architecture (SOA). In this paper, the Turkish healthcare management system is chosen to be examined since Turkey is considered as one of the Third World countries and the information architecture of the existing healthcare management system of Turkey has not yet been configured with SOA, which is a contemporary innovative approach and should provide the base architecture of the new solution. The innovation of this study is the symbiosis of two main integration approaches, SOA and Health Level 7 (HL7), for integrating divergent healthcare information systems. A model is developed which is based on SOA and enables obtaining a healthcare management system having the SSF standards (HSSP Service Specification Framework) developed by the framework of the HSSP (Healthcare Services Specification Project) under the leadership of HL7 and the Object Management Group.
Emergency healthcare is one of the emerging application domains for information services, which requires highly multimodal information services. The time of consuming pre-hospital emergency process is critical. Therefore, the minimization of required time for providing primary care and consultation to patients is one of the crucial factors when trying to improve the healthcare delivery in emergency situations. In this sense, dynamic location of medical entities is a complex process that needs time and it can be critical when a person requires medical attention. This work presents a multimodal location-based system for locating and assigning medical entities called ITOHealth. ITOHealth provides a multimodal middleware-oriented integrated architecture using a service-oriented architecture in order to provide information of medical entities in mobile devices and web browsers with enriched interfaces providing multimodality support. ITOHealth's multimodality is based on the use of Microsoft Agent Characters, the integration of natural language voice to the characters, and multi-language and multi-characters support providing an advantage for users with visual impairments.
Progress in information and communication technologies (ICT) is providing new opportunities for pervasive health care services in aging societies. To identify starting points of health-enabling technologies for pervasive health care. To describe typical services of and contemporary ICT architecture paradigms for pervasive health care. Summarizing outcomes of literature analyses and results from own research projects in this field. Basic functions for pervasive health care with respect to home care comprise emergency detection and alarm, disease management, as well as health status feedback and advice. These functions are complemented by optional (non-health care) functions. Four major paradigms for contemporary ICT architectures are person-centered ICT architectures, home-centered ICT architectures, telehealth service-centered ICT architectures and health care institution-centered ICT architectures. Health-enabling technologies may lead to both new ways of living and new ways of health care. Both ways are interwoven. This has to be considered for appropriate ICT architectures of sensor-enhanced health information systems. IMIA, the International Medical Informatics Association, may be an appropriate forum for interdisciplinary research exchange on health-enabling technologies for pervasive health care.
Home telehealth services for elderly people promise to contribute to a more efficient health care in the future. Though isolated services at a patient's home might make sense for some applications, the full potential of home telehealth only arises through its integration into existing health information systems (HIS) and care processes. We know about traditional HIS architectures. However, so far no models exist, helping us to understand and describe the upcoming sensor-enhanced transinstitutional information system architectures for home telehealth services. To develop a nomenclature for sensor-enhanced transinstitutional health information system architectures. We conducted two systematic literature reviews, assessing typical services and users of home telehealth and key characteristics of transinstitutional health information system architectures. The information retrieved from both reviews was integrated to build the nomenclature sought after. We present a nomenclature of information and communication technology (ICT) architectures for home telehealth services. The developed dimensions provide an overview on typical users, services, operating organisations, information flow, geographical reach and architectural paradigms of sensor-enhanced transinstitutional health information systems. The developed nomenclature helps us to better understand the upcoming ICT architectures. However, we are still in need of further experiences with their application.
-Duration of the test.  
Duration of the test.
-Types of averages calculated on glucometers.  
This review evaluated the level of informatics in glucometers through an assessment of the quantity and types of information and advice provided to users. Manufacturer websites were investigated and the characteristics of glucometers were examined. One hundred glucometers from 27 manufacturers were analysed. Many glucometers contained simple informatics features and five also contained on-device graphing features for users to monitor trends. Some manufacturers have extended informatics via external software. A small number of glucometers provided knowledge for the user by, for example, simple embedded decision support protocols. However, it is suggested that glucometers could better serve as primary care devices through the incorporation of more decision support directly on the device.
Implementation of eHealth is one of the key long-term goals of the Slovenian public sector. The main objective of eHealth is the construction of a comprehensive health information system (IS) and the connection of a widespread network of stakeholders within the healthcare sector. The article presents a review of the eHealth project in Slovenia and provides a comparative analysis of eHealth development in Slovenia, Austria and Denmark. Focusing on the situation in Slovenia, the article identifies the main deficiencies in the current state of eHealth implementation, maps a set of general success factors in the field and suggests guidelines for the effective development and implementation of eHealth projects.
The Internet has made it possible for patients and their families to access vast quantities of information that previously would have been difficult for anyone but a physician or librarian to obtain. Health information websites, however, are recognised to differ widely in quality and reliability of their content. This has led to the development of various codes of conduct or quality rating tools to assess the quality of health websites. However, the validity and reliability of these quality tools and their applicability to different health websites also varies. In principle, rating tools should be available to consumers, require a limited number of elements to be assessed, be assessable in all elements, be readable and be able to gauge the readability and consistency of information provided from a patient's view point. This article reviews the literature on the trends of the Internet use for health and analyses various codes of conduct/ethics or 'quality tools' available to monitor the quality of health websites from a patient perspective.
In this research, we apply a large-scale logistic regression analysis to assess the patient missed opportunity risks at a complex VA (US Department of Veterans Affairs) hospital in three categories, namely, no-show alone, no-show combined with late patient cancellation and no-show combined with late patient and clinic cancellations. The analysis includes unique explanatory variables related to VA patients for predicting missed opportunity risks. Furthermore, we develop two aggregated weather indices by combining many weather measures and include them as explanatory variables. The results indicate that most of the explanatory variables considered are significant factors for predicting the missed opportunity risks. Patients with afternoon appointment, higher percentage service connected, and insurance, married patients, shorter lead time and appointments with longer appointment length are consistently related to lower risks of missed opportunity. Furthermore, the VA patient-related factors and the two proposed weather indices are useful predictors for the risks of no-show and patient cancellation. More importantly, this research presents an effective procedure for VA hospitals and clinics to analyze the missed opportunity risks within the complex VA information technology system, and help them to develop proper interventions to mitigate the adverse effects caused by the missed opportunities.
Top-cited authors
Markus Meis
  • Cochlear Germany
Matthias Gietzelt
  • Hannover Medical School
George Demiris
  • University of Pennsylvania
Michael Marschollek
  • Hannover Medical School
Jared Reyes
  • Envision Research Institute