Mapping the Domain of Medical Informatics

Objectives: The domain of medical informatics (MI) is not well defined. It covers a wide range of research topics. Our objective is to characterize the field of MI by means of the scientific literature in this domain. Methods: We used titles and abstracts from MEDLINE records of papers published between July 1993 and July 2008, and extracted uni-, bi- and trigrams as features. Starting with the ISI category of medical informatics, we applied a semi-automated procedure to identify the set of journals and proceedings pertaining to MI. A clustering algorithm was subsequently applied to the articles from this set of publications. Results: MI literature can be divided into three subdomains: 1) the organization, application, and evaluation of health information systems, 2) medical knowledge representation, and 3) signal and data analysis. Over the last fifteen years, the field has remained relatively stable, although most journals have shifted their focus somewhat. Conclusions: We identified the scientific literature pertaining to the field of MI, and the main areas of research. We were able to show trends in the field, and the positioning of different journals within this field

With good intentions

OBJECTIVE: To develop a framework for clinical practice guidelines that not only allows the representation of best practices, but also facilitates reasoning about acceptable alternatives for those best practices. METHOD: Design of an explicit representation formalism of intentions of guidelines and guideline steps. Implementation of this representation and reasoning mechanisms in GASTON, a tool for representing and executing computerized clinical guidelines. RESULTS: The developed formalism is used to represent a heart failure clinical guideline. It is demonstrated that the representation of intentions provides the needed flexibility to avoid unnecessary errors and warnings. CONCLUSION: By using an explicit representation of the intentions of guidelines and guideline steps, a flexible decision support system can be built that does not check only the adherence to the formal guideline but evaluates clinical activities in light of the intention of the guideline

Inter-organizational future proof EHR systems A review of the security and privacy related issues

OBJECTIVES: Identification and analysis of privacy and security related issues that occur when health information is exchanged between health care organizations. METHODS: Based on a generic scenario questions were formulated to reveal the occurring issues. Possible answers were verified in literature. RESULTS: Ensuring secure health information exchange across organizations requires a standardization of security measures that goes beyond organizational boundaries, such as global definitions of professional roles, global standards for patient consent and semantic interoperable audit logs. CONCLUSION: As to be able to fully address the privacy and security issues in interoperable EHRs and the long-life virtual EHR it is necessary to realize a paradigm shift from storing all incoming information in a local system to retrieving information from external systems whenever that information is deemed necessary for the care of the patien