Discussion of "Evidence-based health informatics:how do we know what we know?"

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Evidence-based Health Informatics: How Do We Know What We Know?" written by Elske Ammenwerth [1]. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Ammenwerth paper. In subsequent issues the discussion can continue through letters to the editor. With these comments on the paper "Evidence-based Health Informatics: How do we know what we know?", written by Elske Ammenwerth [1], the journal seeks to stimulate a broad discussion on the challenges of evaluating information processing and information technology in health care. An international group of experts has been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper.11 page(s

Health Informatics for Healthcare Quality Improvement: A Literature Review of Issues, Challenges and Findings

Healthcare providers in the United States are facing increasing pressures to provide high quality healthcare at affordable prices, while being compliant with a multitude of complex laws. Recent legal developments have highlighted the role of Information Technology and related systems in providing evidence based healthcare in an efficient manner. Health Informatics has become an integral part of the rapidly advancing healthcare technology scenario, and is emerging as a key resource for healthcare quality improvement in the United States. Considering the rapid pace at which the field of health informatics is advancing, it is important for researchers and the practitioners alike to stay abreast of current literature and developments in the field. This literature review paper captures and summarizes from research literature the most significant issues, challenges and findings pertaining to the field of health informatics with a focus on healthcare quality improvement

Learner’s satisfaction within a breast imaging eLearning course for radiographers

Background: An asynchronous eLearning system was developed for radiographers in order to promote a better knowledge about senology and mammography. Objectives: to assess the learners’ satisfaction. Methods: Target population included radiographers and radiogr aphy students, in order to assess eLearning satisfaction according to different experience levels in breast imaging. Satisfaction was measured through a questionnaire developed especially for eLearning systems, using a seven - point Likert scale. Main topics related are content, interface, personalization and learning community. Results: Overall, 85% of learners were satisfied with the course and 87,5% considered that the course is successful. Main areas that were evaluated by most learners in a positive way were interface and content (between six and seven - point); on the other hand, learning community presented a wider distribution of answers . Conclusions: The course provides an overall high degree of learner satisfaction, thus providing more effective knowle dge gain on breast imaging for radiographers

Development and Assessment of an E-Learning Course on Breast Imaging for Radiographers: A Stratified Randomized Controlled Trial

Background: Mammography is considered the best imaging technique for breast cancer screening, and the radiographer plays an important role in its performance. Therefore, continuing education is critical to improving the performance of these professionals and thus providing better health care services. Objective: Our goal was to develop an e-learning course on breast imaging for radiographers, assessing its efficacy , effectiveness, and user satisfaction. Methods: A stratified randomized controlled trial was performed with radiographers and radiology students who already had mammography training, using pre- and post-knowledge tests, and satisfaction questionnaires. The primary outcome was the improvement in test results (percentage of correct answers), using intention-to-treat and per-protocol analysis. Results: A total of 54 participants were assigned to the intervention (20 students plus 34 radiographers) with 53 controls (19+34). The intervention was completed by 40 participants (11+29), with 4 (2+2) discontinued interventions, and 10 (7+3) lost to follow-up. Differences in the primary outcome were found between intervention and control: 21 versus 4 percentage points (pp), P<.001. Stratified analysis showed effect in radiographers (23 pp vs 4 pp; P=.004) but was unclear in students (18 pp vs 5 pp; P=.098). Nonetheless, differences in students’ posttest results were found (88% vs 63%; P=.003), which were absent in pretest (63% vs 63%; P=.106). The per-protocol analysis showed a higher effect (26 pp vs 2 pp; P<.001), both in students (25 pp vs 3 pp; P=.004) and radiographers (27 pp vs 2 pp; P<.001). Overall, 85% were satisfied with the course, and 88% considered it successful. Conclusions: This e-learning course is effective, especially for radiographers, which highlights the need for continuing education

The use of computerised clinical decision support systems in emergency care : a substantive review of the literature

Objectives: This paper provides a substantive review of international literature evaluating the impact of computerised clinical decision support systems (CCDSS) on the care of emergency department (ED) patients. Material and Methods: A literature search was conducted using Medline, CINAHL, EMBASE electronic resources and grey literature. Studies were selected if they compared the use of a CCDSS with usual care in a face-to-face clinical interaction in an ED. Results: Of the 23 studies included approximately half demonstrated a statistically significant positive impact on aspects of clinical care with the use of CCDSSs. The remaining studies showed small improvements, mainly around documentation. However, the methodological quality of the studies was poor with few or no controls to mitigate against confounding variables. The risk of bias was high in all but six studies. Discussion: The ED environment is complex and does not lend itself to robust quantitative designs such as Randomised Controlled Trials. The quality of the research in approximately 75% of the studies was poor and therefore conclusions cannot be drawn from these results. However the studies with a more robust design show evidence of the positive impact of CCDSSs on ED patient care. Conclusion This is the first review to consider the role of CCDSSs in emergency care and expose the research in this area. The role of CCDSSs in Emergency Care may provide some solutions to the current challenges in EDs but further high quality research is needed to better understand what technological solutions can offer clinicians and patients. OBJECTIVES This paper provides a description of a substantive review of published international literature evaluating the impact of computerised clinical decision support systems (CCDSS) on the care of emergency department (ED) patients. The principal aims of this review are: to identify the body of CCDSS research undertaken in EDs, the research methods used, their quality and the impact of CCDSSs on clinical care in EDs. The discussion synthesises what is known and not known about the effectiveness of CCDSSs in Emergency Care and the quality of the current evidence base

Online Guide for Electronic Health Evaluation Approaches: Systematic Scoping Review and Concept Mapping Study

BACKGROUND: Despite the increase in use and high expectations of digital health solutions, scientific evidence about the effectiveness of electronic health (eHealth) and other aspects such as usability and accuracy is lagging behind. eHealth solutions are complex interventions, which require a wide array of evaluation approaches that are capable of answering the many different questions that arise during the consecutive study phases of eHealth development and implementation. However, evaluators seem to struggle in choosing suitable evaluation approaches in relation to a specific study phase. OBJECTIVE: The objective of this project was to provide a structured overview of the existing eHealth evaluation approaches, with the aim of assisting eHealth evaluators in selecting a suitable approach for evaluating their eHealth solution at a specific evaluation study phase. METHODS: Three consecutive steps were followed. Step 1 was a systematic scoping review, summarizing existing eHealth evaluation approaches. Step 2 was a concept mapping study asking eHealth researchers about approaches for evaluating eHealth. In step 3, the results of step 1 and 2 were used to develop an "eHealth evaluation cycle" and subsequently compose the online "eHealth methodology guide." RESULTS: The scoping review yielded 57 articles describing 50 unique evaluation approaches. The concept mapping study questioned 43 eHealth researchers, resulting in 48 unique approaches. After removing duplicates, 75 unique evaluation approaches remained. Thereafter, an "eHealth evaluation cycle" was developed, consisting of six evaluation study phases: conceptual and planning, design, development and usability, pilot (feasibility), effectiveness (impact), uptake (implementation), and all phases. Finally, the "eHealth methodology guide" was composed by assigning the 75 evaluation approaches to the specific study phases of the "eHealth evaluation cycle." CONCLUSIONS: Seventy-five unique evaluation approaches were found in the literature and suggested by eHealth researchers, which served as content for the online "eHealth methodology guide." By assisting evaluators in selecting a suitable evaluation approach in relation to a specific study phase of the "eHealth evaluation cycle," the guide aims to enhance the quality, safety, and successful long-term implementation of novel eHealth solutions

App-based treatment for female urinary incontinence:evidence-based eHealth as an alternative to care-as-usual

App-based treatment for female urinary incontinence. Urinary incontinence affects 1 in 3 women, and only few of them ask for help. Pelvic floor muscle training and bladdertraining are effective, however they are also costly and adherence varies. An app-based treatment could offer a solution. There are already over 100 incontinence-apps available, but research into their effectiveness is scarce. It is important to know if an app is as effective as care-as-usual, before women start downloading and using it. We developed an app-based treatment for stress-, urgency- and mixed type female urinary incontinence. We compared the app with care-as-usual in a randomized controlled trial and we performed interviews. This thesis shows that an app-based treatment is at least as effective as care-as-usual and cheaper. We personalized treatment-decision as we predicted per patient, based on her characteristics, which of both treatment options would lead to the most improvement of incontinence. Interviews with women with high- and low treatment effect showed that factors that act as facilitators and barriers are very personal. In general, adherence is the most important factor for success. Furthermore, factors that were expected to facilitate (for example graphs and reminders) for some women actually had an opposite effect. App-based treatment for urinary incontinence offers a viable alternative to care-as-usual. Based on these results, the URinControl-app is now freely available for all women in the Netherlands (urincontrol.online). This was subsidized by ZonMw and part of further research into implementation. Scientific results are translated into illustrations, they are available in the thesis and on the website www.urincontrol.nl