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Modeling in biomedical informatics—An exploratory analysis
i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 6 ( 2 0 0 7 ) 96–102
journal homepage: www.intl.elsevierhealth.com/journals/ijmi
Modeling in biomedical informatics— An exploratory analysis Part 2 A. Hasman a,∗ , R. Haux b a
University of Amsterdam, Academic Medical Center, Department of Medical Informatics, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands b Technical University of Braunschweig, Institute for Medical Informatics, Muehlenpfordtstr. 23, 38106 Braunschweig, Germany
a r t i c l e
i n f o
a b s t r a c t
Article history:
Objective: Modeling is a significant part of research, education and practice in biomedical
Received 7 February 2006
and health informatics. Our objective was to explore which types of models of processes
Received in revised form
are used in current biomedical/health informatics research, as reflected in publications of
13 June 2006
scientific journals in this field. Also, the implications for medical informatics curricula were
Accepted 29 August 2006
investigated. Methods: Retrospective, prolective observational study on recent publications of the two official journals of the International Medical Informatics Association (IMIA), the International
Keywords:
Journal of Medical Informatics (IJMI) and Methods of Information in Medicine (MIM). All
Modeling
publications of the years 2004 and 2005 from these journals were indexed according to a
Biomedical informatics
given list of model types. Random samples out of these publications were analysed in more
Medical informatics
depth.
Health informatics
Results: Three hundred and eighty-four publications have been analysed, 190 of IJMI and 194 of MIM. For publications in special issues (121 in IJMI) and special topics (132 in MIM) we found differences between theme-centered and conference-centered special issues/special topics (SIT) publications. In particular, we could observe a high variation between modeling in publications of theme-centered SITs. It became obvious that often sound formal knowledge as well as a strong engineering background is needed for carrying out this type of research. Usually, this knowledge and the related skills can be best provided in consecutive B.Sc. and M.Sc. programs in medical informatics (respectively, health informatics, biomedical informatics). If the focus should be primarily on health information systems and evaluation this can be offered in a M.Sc. program in medical informatics. Conclusions: In analysing the 384 publications it became obvious that modeling continues to be a major task in research, education and practice in biomedical and health informatics. Knowledge and skills on a broad range of model types are needed in biomedical/health informatics. © 2006 Elsevier Ireland Ltd. All rights reserved.
∗
Corresponding author. E-mail addresses: [email protected] (A. Hasman), [email protected] (R. Haux). 1386-5056/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2006.08.004
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1.
Introduction
Modeling is a significant part of research, education and practice not only in biomedical informatics and health informatics, but also for medicine and health care in general. Ten years after their paper on modeling of processes in medical informatics [1] the authors were interested in the frequency of the introduced model types in current biomedical/health informatics research as reflected in publications in scientific journals and whether these types appropriately reflect our field’s research or whether other types are more adequate. In a retrospective, but prolective observational study on recent publications we intensively looked at publications of the two official journals of the International Medical Informatics Association (IMIA [2]), the International Journal of Medical Informatics (IJMI [3]) and Methods of Information in Medicine (MIM [4]). All publications of the years 2004 and 2005 from these journals were indexed according to a given list of model types. Random samples out of these publications were analysed in more depth. As described in detail in part 1, regular publications are defined as journal publications, not being part of a special issue/special topic (SIT). According to [1] we distinguished (non-disjoint) types of ‘core’ models for -
modeling biological processes (B), modeling communication processes (CM), modeling decision processes (D), modeling engineering processes (EN), modeling educational processes (ED), modeling organizational processes (O), and modeling computational processes (CP).
In part 2 of our paper we will report on our results for publications in special issues (as denoted in IJMI) and special topics (as denoted in MIM). The introductory sections and results for our investigations on regular publications of these journals can be found in part 1 of this paper [5].
2.
Material and methods
In this section, we add those parts of the study design relevant for SITs. The first part of the study design was presented in part 1 of our paper [5]. Here also the research questions Q1–Q4 are presented. Questions Q2–Q4 will be repeated here. For question Q2 “What are the current types of models of processes, investigated in special issue/special topic publications in biomedical/health informatics?” we were looking into publications of special issues/special topics. In the regarded time period, IJMI published:
97
I4 ‘Realizing Security into the Electronic Health Record’ (Sec, volume 73, 2004, Issue 3), I5 ‘Improving Patient Safety with Technology’ (PSave, volume 73, 2004, issues 7–8) [10], I6 ‘Supporting Communication in Health Care’ (ComHC, volume 74, 2005, issue 10) [11], and I7 ‘Nursing Informatics’ (NI, volume 74, 2005, issues 11–12) as theme-centered SITs. MIM published: M1 ‘Selected Papers from the 50th Colloquium of the German Region of the Int. Biometric Society’ (BC04, volume 43, 2004, parts of issue 5) and M2 ‘Selected Papers from gmds2004’ (gmds04, volume 44, 2005, issue 4, gmds2004 comprised the 2004 joint annual national medical informatics conferences of Austria, Germany, and Switzerland) as conference-centered SITs, as well as: M3 ‘4th BioSignal Interpretation Workshop’ (BSI, volume 43, 2004, issue 1), M4 ‘Advances in Biomedical Image Analysis’ (BMI, volume 43, 2004, parts of issue 4), M5 ‘Electronic Patient Information—Pioneers and MuchMore’ (EPInf, volume 43, 2004, parts of issue 5) [17], M6 ‘The Future of HealthGrids’ (HGrid, volume 44, 2005, parts of issue 2), M7 ‘Methods of Information in the Age of Prospective Medicine’ (PMed, volume 44, 2005, parts of issue 2) [19], and M8 ‘Microarray Gene Expression Experiments’ (MArray, volume 44, 2005, parts of issue 3) [20] as theme-centered SITs. As for regular publications (see Q1.1 in part 1 of our paper) we were looking into all publications of these SITs in order to give an answer to question. Q2.1 How are the types of models of processes distributed in SIT publications? Both authors independently indexed the publications with respect to the types of models used, i.e. B, CM, D, EN, ED, O, and CP. If an abstract was regarded as sufficiently informative, indexing was based on a publication’s abstract. For providing answers to the questions:
as conference-centered SITs, as well as:
Q2.2 Are there specific models in theme-centered special issues/special topics? Q2.3 Are there specific models in special issues/special topics of (inter)national medical informatics conferences? Q2.4 Are there special observations in the context of modeling, we want to report about? Q2.5 What are the current research aims, intended to be achieved, compared to the aims of medical informatics, as defined 10 years ago?
I3 ‘IMIA Working Group on Education’ (Edu, volume 73, 2004, issue 2),
A sample of 20 SIT publications of IJMI as well as of MIM were obtained in the following way:
I1 ‘Medical Informatics Europe 2003’ (MIE03, volume 74, 2005, issues 2–4) and I2 ‘MedInfo 2004’ (MI04, volume 74, 2005, issues 7–8)
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- For the two conference-centered SIT publications in each journal (Q2.2) a random sample of four papers of each SIT was taken. - For the remaining theme-centered SIT publications (Q2.3), first three SITs for each journal were randomly selected. Then, for each of these SITs, four publications were randomly selected. As the special topic ‘Electronic Patient Information—Pioneers and MuchMore’ (in issue 5, volume 43 of MIM), consisted of only two publications, we decided to exclude this SIT for selection. As for Q1.2 and Q1.3 comments with respect to these questions also were independently made by both authors and were based on the publications’ full papers. Comments with respect to these questions were independently made by both authors and were based on the publications’ full papers.
Introduction
Table 1 provides an overview of the publications in SITs in the time period, considered for this analysis.
3.2.
‘IMIA Working Group on Education’ [8] with publications [21–24], I4 ‘Realizing Security into the Electronic Health Record’ [9] with publications [25–28], I7 ‘Nursing Informatics’ [12] with publications [29–32], M3 ‘4th BioSignal Interpretation Workshop’ [15] with publications [33–36], M4 ‘Advances in Biomedical Image Analysis’ [16] with publications [37–40], and M6 ‘The Future of HealthGrids’ [18] with publications [41–44]. The randomly selected publications of the conferencecentered SITs were [45–48] for MIE03 [6,49–52], for MI04 [7,53–56] for BC04 [13], and [57–60] for gmds04 [14]. We will refer to publications of this list in this part 2.
3.3.
Distribution of model types (Q2.1)
In Table 2 the model types, assigned independently by the authors, can be found for SIT publications. As our assignments partially differed, we decided to present the results of both authors and not to present an average assignment. Obviously, there are differences between theme-centered and conference-centered SIT publications.
3. Results: types of models presented in special issue/special publications 3.1.
I3
3.4. Models in theme-centered special issues/special topics (Q2.2)
Selected SITs and selected SIT publications
The following theme-centered SITs and, within these SITs, the following publications have been randomly selected:
In the publications, drawn in the sample, we could observe a high variation between the various SITs. This observation corresponded to our indexing results. The model classes
Table 1 – Overview of special issue/special topic (SIT) publications of IJMI and MIM in the years 2004 and 2005 Number of SIT publications . . . (number of SITs)
International Journal of Medical Informatics
2004 . . . in conference-centered SITs
. . . in theme-centered SITs
Total 2005 . . . in conference-centered SITs
. . . in theme-centered SITs
Total
SIT abbreviations are explained in the text.
(0)
0
Methods of Information in Medicine BiomC
18
(1)
18
Edu Sec PSave
15 17 15
BSI BMI EPInf
26 16 2
(1)
18
(3)
47
(3)
44
(6)
91
(3)
47
(4)
62
(7)
109
MIE03 MI04
29 21
gmds04
16
(2)
50
(1)
16
(3)
66
ComHC NI
7 17
Grid PMed MArray
27 14 13
(2)
24
(3)
54
(5)
78
(4)
74
(4)
70
(8)
144
(7)
121
(8)
132
(15)
253
Table 2 – Assigned model types in all special issue/special topic (SIT) publications of IJMI and MIM in the years 2004 and 2005 Model types for modeling . . . by A.H./R.H.
. . . theme-centered SIT publications Edu (n. pub. = 15) Sec (n. pub. = 17) PSave (n. pub. = 15) ComHC (n. pub. = 7) NI (n. pub. = 17) (n. pub. = 81) IJMI (n. pub. = 121) . . . in MIM . . . . . . conference-centered SIT publications: BiomC (n. pub. = 18) gmds04 (n. pub. = 16) (n. pub. = 34) . . . theme-centered SIT publications: BSI (n. pub. = 26) BMI (n. pub. = 16) EPInf (n. pub. = 2) Grid (n. pub. = 27) PMed (n. pub. = 14) MArray (n. pub. = 13) (n. pub. = 98) MIM (n. pub. = 132)
Communication processes
Decision processes
Engineering processes
Educational processes
Organizational processes
Computational processes
-/-/3 0/3
4/25 2/12 6/37
7/9 6/2 13/11
21/11 8/7 29/18
3/3 1/2 4/5
2/20 -/14 2/34
3/7 4/7/7
-/-/-/-/-/0/0 0/3
-/17/4 5/3 5/7 5/6 32/20 38/57
-/-/2/1 -/1/3/1 16/12
-/1 12/1 4/2 -/1 8/1 24/6 53/24
15/15 -/3/2 -/4/2 22/19 26/24
3/7 17/17 3/10 2/6 2/14 27/54 29/88
-/1/1/2 -/-/2/2 9/9
1/12 2/4 3/16
-/2/5 2/5
1/18 1/11 2/29
1/3/4 4/4
-/-/0/0
1/1/5 2/5
14/17 4/6 18/23
25/25 -/15 -/1/3/-/6 29/46 32/62
1/-/1 2/2 2/27 1/-/6/30 8/35
3/15 1/10 -/2 2/-/7 -/13 6/47 8/76
-/2/9 -/21/9 -/5/28/18 32/22
-/1/-/-/4/-/5/0 5/0
-/-/-/2 -/25 5/14 2/7/41 9/46
20/20 14/14 -/2/4 1/6/5 43/43 61/66
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. . . in IJMI . . . . . . conference-centered SIT publications MIE03 (n. pub. = 29) MI04 (n. pub. = 21) (n. pub. = 40)
Biological processes
SIT abbreviations are explained in the text.
99
100
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used in different SITs differ significantly, e.g. compare Edu in IJMI [21–24] with BSI in MIM [33–36]. Some SITs have mainly research-oriented scientific publications (e.g. [35,40]). They only differ from regular publications in the use of more focussed model classes. Other SITs contain mainly visionary and opinion papers as well as publications, reporting on early progress. Examples are the HGrid SIT in MIM [41–44] and the Sec SIT in IJMI [25–28]. For such SITs we can see that, in contrast to most regular publications, they consist not necessarily of typical ‘scientific’ papers according to the criteria used, e.g. to select best papers for the IMIA Yearbook of Medical Informatics [2]. Obviously, such papers are also necessary, but need different selection and reviewing processes. Publications on education differ in so far, as they present more frequent examples on courses (e.g. [21–24]).
3.5. Models in special issues/special topics of conferences (Q2.3) The drawn sample confirmed the indexing results, that conference-centered SIT publications have model classes rather similar to the ones in regular publications. As for regular publications we can observe a broad mixture of models, including rather in-depth formal approaches (e.g. [45,53]), simulation (e.g. [55]), and statistical modeling (e.g. [54,56]). In particular, for conferences in non-English speaking countries such special issues/special topics enable international (English) communication of the research topics described in the selected (best) papers. The selection and reviewing procedures are similar to regular papers. For IMIA official journals, such SITs are regarded as important contributions for sharing research results. In MIM, we can observe a broader range of models used, including statistical models. A reason, why this is the case, has been mentioned in the discussion section of part 1.
3.6.
Special observations (Q2.4)
Our main observations have been presented in the sections before. There were in our point of view no further significant differences to the observations, mentioned in part 1, Section 4.3 for regular papers.
3.7.
Research aims (Q2.5)
As already mentioned in part 1, in all publications of the drawn samples, in regular as well as in special topics and special issues, the aim “to provide solutions for problems related to data, information and knowledge processing” and “to study the general principles of processing data, information and knowledge in medicine and health care” in order to contribute to “improve the quality of health care, and of research and education in medicine and the health sciences” ([1], p. 132) was given, at least implicitly.
3.8.
On model classes (Q3)
Were there other types of models used than the ones specified 10 years ago? We could observe variations and/or extensions in model classes, e.g. when analysing biological processes
(e.g. SIT MArray). However, we mainly observed a continuous progress, but no ‘scientific revolution’.
3.9.
On education (Q4)
What can be concluded, in particular with respect to core competencies of biomedical/health informaticians and to education in biomedical/health informatics? As mentioned and argued in part 1, Section 4.3, besides knowledge and skills for ‘core’ models for, e.g. biological or communication processes, and of course besides knowledge and skills in software engineering and project management, models for simulation and evaluation seem to be highly relevant. Educational programs in health informatics, medical informatics, and biomedical informatics should consider this. It became obvious that for some of the published research, sound formal (mathematical) knowledge and skills are needed as well as a strong engineering background. This is often related to methodological contributions to our field. Usually, this knowledge and the related skills can best be provided in consecutive B.Sc. and M.Sc. programs in medical informatics (respectively, health informatics, . . .), maybe followed by Ph.D. studies. In the IMIA recommendations on education [61] this educational approach has been described as the informaticsoriented approach to medical informatics. Some research primarily needs profound knowledge of the health care field or on diagnosis and therapy. If educational programs focus on these questions, and restrict themselves to primarily courses on health information systems and evaluation, then in particular organizational knowledge and skills as well as on evaluation is needed in addition to managing projects and some software engineering. This can, in our opinion, be offered in M.Sc. programs in medical informatics, maybe also followed by Ph.D. studies. In the IMIA recommendations on education [61] this educational approach has been described as the healthcare-oriented approach to medical informatics.
4.
Discussion
As mentioned in part 1, we were surprised by our rather high inter-rater variability. In 230 of the 384 publications we indexed similarly (at least 1 identical index). However, in 154 publications there was no agreement, either due to only different indices or because one of us did not set an index, but the other one did. We decided to have an additional analysis of a random sample of about 5% (n = 8) of those publications, about which we had no agreement, in order to understand this for us unexpected rather high inter-rater variability. We randomly selected publications [62–69]. When analysing the papers we again identified that all these papers focus on more than one of the processes, described at the beginning. The major differences were due to differences in the interpretation of which processes were important and worth to be indexed for the particular paper. In one case we identified an indexing error. In addition, many papers on the one hand focussed on certain ‘core models’, and on the other hand described the research process. Both levels, however could be regarded. This was also a cause of variation. One publication [62], for example, described several methods for
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analysing gene function. This publication could be indexed as a communication process, but in fact it is an analysis process. Research processes however were not included in our ‘core’ models. The various processes described in our earlier publication [1] were very broadly defined. Problems may arise when, for example, planning and coordination are described in the article. Is this an example of a communication process, an organizational process or both? We think that the processes are sufficiently different for a broad categorization of the field of medical informatics. For a detailed view the processes should become more specific and ‘meta’-processes (concerning, e.g. the research process) should be added. In analysing the 384 publications it became obvious that modeling of processes continues to be a major task in research, education and practice of biomedical and health informatics. Knowledge and skills on a broad range of model types is needed in biomedical/health informatics. This field itself is dealing with topics of increasing importance for medicine and health care. In other words “medical informatics as a discipline has taken a leading role in the further development of health care” ([70], p. 5).
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Acknowledgement [24]
The authors would like to thank Natalie Gusew, Braunschweig, for her support in recording and analysing the data.
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journal homepage: www.intl.elsevierhealth.com/journals/ijmi
Modeling in biomedical informatics— An exploratory analysis Part 2 A. Hasman a,∗ , R. Haux b a
University of Amsterdam, Academic Medical Center, Department of Medical Informatics, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands b Technical University of Braunschweig, Institute for Medical Informatics, Muehlenpfordtstr. 23, 38106 Braunschweig, Germany
a r t i c l e
i n f o
a b s t r a c t
Article history:
Objective: Modeling is a significant part of research, education and practice in biomedical
Received 7 February 2006
and health informatics. Our objective was to explore which types of models of processes
Received in revised form
are used in current biomedical/health informatics research, as reflected in publications of
13 June 2006
scientific journals in this field. Also, the implications for medical informatics curricula were
Accepted 29 August 2006
investigated. Methods: Retrospective, prolective observational study on recent publications of the two official journals of the International Medical Informatics Association (IMIA), the International
Keywords:
Journal of Medical Informatics (IJMI) and Methods of Information in Medicine (MIM). All
Modeling
publications of the years 2004 and 2005 from these journals were indexed according to a
Biomedical informatics
given list of model types. Random samples out of these publications were analysed in more
Medical informatics
depth.
Health informatics
Results: Three hundred and eighty-four publications have been analysed, 190 of IJMI and 194 of MIM. For publications in special issues (121 in IJMI) and special topics (132 in MIM) we found differences between theme-centered and conference-centered special issues/special topics (SIT) publications. In particular, we could observe a high variation between modeling in publications of theme-centered SITs. It became obvious that often sound formal knowledge as well as a strong engineering background is needed for carrying out this type of research. Usually, this knowledge and the related skills can be best provided in consecutive B.Sc. and M.Sc. programs in medical informatics (respectively, health informatics, biomedical informatics). If the focus should be primarily on health information systems and evaluation this can be offered in a M.Sc. program in medical informatics. Conclusions: In analysing the 384 publications it became obvious that modeling continues to be a major task in research, education and practice in biomedical and health informatics. Knowledge and skills on a broad range of model types are needed in biomedical/health informatics. © 2006 Elsevier Ireland Ltd. All rights reserved.
∗
Corresponding author. E-mail addresses: [email protected] (A. Hasman), [email protected] (R. Haux). 1386-5056/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2006.08.004
i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 6 ( 2 0 0 7 ) 96–102
1.
Introduction
Modeling is a significant part of research, education and practice not only in biomedical informatics and health informatics, but also for medicine and health care in general. Ten years after their paper on modeling of processes in medical informatics [1] the authors were interested in the frequency of the introduced model types in current biomedical/health informatics research as reflected in publications in scientific journals and whether these types appropriately reflect our field’s research or whether other types are more adequate. In a retrospective, but prolective observational study on recent publications we intensively looked at publications of the two official journals of the International Medical Informatics Association (IMIA [2]), the International Journal of Medical Informatics (IJMI [3]) and Methods of Information in Medicine (MIM [4]). All publications of the years 2004 and 2005 from these journals were indexed according to a given list of model types. Random samples out of these publications were analysed in more depth. As described in detail in part 1, regular publications are defined as journal publications, not being part of a special issue/special topic (SIT). According to [1] we distinguished (non-disjoint) types of ‘core’ models for -
modeling biological processes (B), modeling communication processes (CM), modeling decision processes (D), modeling engineering processes (EN), modeling educational processes (ED), modeling organizational processes (O), and modeling computational processes (CP).
In part 2 of our paper we will report on our results for publications in special issues (as denoted in IJMI) and special topics (as denoted in MIM). The introductory sections and results for our investigations on regular publications of these journals can be found in part 1 of this paper [5].
2.
Material and methods
In this section, we add those parts of the study design relevant for SITs. The first part of the study design was presented in part 1 of our paper [5]. Here also the research questions Q1–Q4 are presented. Questions Q2–Q4 will be repeated here. For question Q2 “What are the current types of models of processes, investigated in special issue/special topic publications in biomedical/health informatics?” we were looking into publications of special issues/special topics. In the regarded time period, IJMI published:
97
I4 ‘Realizing Security into the Electronic Health Record’ (Sec, volume 73, 2004, Issue 3), I5 ‘Improving Patient Safety with Technology’ (PSave, volume 73, 2004, issues 7–8) [10], I6 ‘Supporting Communication in Health Care’ (ComHC, volume 74, 2005, issue 10) [11], and I7 ‘Nursing Informatics’ (NI, volume 74, 2005, issues 11–12) as theme-centered SITs. MIM published: M1 ‘Selected Papers from the 50th Colloquium of the German Region of the Int. Biometric Society’ (BC04, volume 43, 2004, parts of issue 5) and M2 ‘Selected Papers from gmds2004’ (gmds04, volume 44, 2005, issue 4, gmds2004 comprised the 2004 joint annual national medical informatics conferences of Austria, Germany, and Switzerland) as conference-centered SITs, as well as: M3 ‘4th BioSignal Interpretation Workshop’ (BSI, volume 43, 2004, issue 1), M4 ‘Advances in Biomedical Image Analysis’ (BMI, volume 43, 2004, parts of issue 4), M5 ‘Electronic Patient Information—Pioneers and MuchMore’ (EPInf, volume 43, 2004, parts of issue 5) [17], M6 ‘The Future of HealthGrids’ (HGrid, volume 44, 2005, parts of issue 2), M7 ‘Methods of Information in the Age of Prospective Medicine’ (PMed, volume 44, 2005, parts of issue 2) [19], and M8 ‘Microarray Gene Expression Experiments’ (MArray, volume 44, 2005, parts of issue 3) [20] as theme-centered SITs. As for regular publications (see Q1.1 in part 1 of our paper) we were looking into all publications of these SITs in order to give an answer to question. Q2.1 How are the types of models of processes distributed in SIT publications? Both authors independently indexed the publications with respect to the types of models used, i.e. B, CM, D, EN, ED, O, and CP. If an abstract was regarded as sufficiently informative, indexing was based on a publication’s abstract. For providing answers to the questions:
as conference-centered SITs, as well as:
Q2.2 Are there specific models in theme-centered special issues/special topics? Q2.3 Are there specific models in special issues/special topics of (inter)national medical informatics conferences? Q2.4 Are there special observations in the context of modeling, we want to report about? Q2.5 What are the current research aims, intended to be achieved, compared to the aims of medical informatics, as defined 10 years ago?
I3 ‘IMIA Working Group on Education’ (Edu, volume 73, 2004, issue 2),
A sample of 20 SIT publications of IJMI as well as of MIM were obtained in the following way:
I1 ‘Medical Informatics Europe 2003’ (MIE03, volume 74, 2005, issues 2–4) and I2 ‘MedInfo 2004’ (MI04, volume 74, 2005, issues 7–8)
98
i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 6 ( 2 0 0 7 ) 96–102
- For the two conference-centered SIT publications in each journal (Q2.2) a random sample of four papers of each SIT was taken. - For the remaining theme-centered SIT publications (Q2.3), first three SITs for each journal were randomly selected. Then, for each of these SITs, four publications were randomly selected. As the special topic ‘Electronic Patient Information—Pioneers and MuchMore’ (in issue 5, volume 43 of MIM), consisted of only two publications, we decided to exclude this SIT for selection. As for Q1.2 and Q1.3 comments with respect to these questions also were independently made by both authors and were based on the publications’ full papers. Comments with respect to these questions were independently made by both authors and were based on the publications’ full papers.
Introduction
Table 1 provides an overview of the publications in SITs in the time period, considered for this analysis.
3.2.
‘IMIA Working Group on Education’ [8] with publications [21–24], I4 ‘Realizing Security into the Electronic Health Record’ [9] with publications [25–28], I7 ‘Nursing Informatics’ [12] with publications [29–32], M3 ‘4th BioSignal Interpretation Workshop’ [15] with publications [33–36], M4 ‘Advances in Biomedical Image Analysis’ [16] with publications [37–40], and M6 ‘The Future of HealthGrids’ [18] with publications [41–44]. The randomly selected publications of the conferencecentered SITs were [45–48] for MIE03 [6,49–52], for MI04 [7,53–56] for BC04 [13], and [57–60] for gmds04 [14]. We will refer to publications of this list in this part 2.
3.3.
Distribution of model types (Q2.1)
In Table 2 the model types, assigned independently by the authors, can be found for SIT publications. As our assignments partially differed, we decided to present the results of both authors and not to present an average assignment. Obviously, there are differences between theme-centered and conference-centered SIT publications.
3. Results: types of models presented in special issue/special publications 3.1.
I3
3.4. Models in theme-centered special issues/special topics (Q2.2)
Selected SITs and selected SIT publications
The following theme-centered SITs and, within these SITs, the following publications have been randomly selected:
In the publications, drawn in the sample, we could observe a high variation between the various SITs. This observation corresponded to our indexing results. The model classes
Table 1 – Overview of special issue/special topic (SIT) publications of IJMI and MIM in the years 2004 and 2005 Number of SIT publications . . . (number of SITs)
International Journal of Medical Informatics
2004 . . . in conference-centered SITs
. . . in theme-centered SITs
Total 2005 . . . in conference-centered SITs
. . . in theme-centered SITs
Total
SIT abbreviations are explained in the text.
(0)
0
Methods of Information in Medicine BiomC
18
(1)
18
Edu Sec PSave
15 17 15
BSI BMI EPInf
26 16 2
(1)
18
(3)
47
(3)
44
(6)
91
(3)
47
(4)
62
(7)
109
MIE03 MI04
29 21
gmds04
16
(2)
50
(1)
16
(3)
66
ComHC NI
7 17
Grid PMed MArray
27 14 13
(2)
24
(3)
54
(5)
78
(4)
74
(4)
70
(8)
144
(7)
121
(8)
132
(15)
253
Table 2 – Assigned model types in all special issue/special topic (SIT) publications of IJMI and MIM in the years 2004 and 2005 Model types for modeling . . . by A.H./R.H.
. . . theme-centered SIT publications Edu (n. pub. = 15) Sec (n. pub. = 17) PSave (n. pub. = 15) ComHC (n. pub. = 7) NI (n. pub. = 17) (n. pub. = 81) IJMI (n. pub. = 121) . . . in MIM . . . . . . conference-centered SIT publications: BiomC (n. pub. = 18) gmds04 (n. pub. = 16) (n. pub. = 34) . . . theme-centered SIT publications: BSI (n. pub. = 26) BMI (n. pub. = 16) EPInf (n. pub. = 2) Grid (n. pub. = 27) PMed (n. pub. = 14) MArray (n. pub. = 13) (n. pub. = 98) MIM (n. pub. = 132)
Communication processes
Decision processes
Engineering processes
Educational processes
Organizational processes
Computational processes
-/-/3 0/3
4/25 2/12 6/37
7/9 6/2 13/11
21/11 8/7 29/18
3/3 1/2 4/5
2/20 -/14 2/34
3/7 4/7/7
-/-/-/-/-/0/0 0/3
-/17/4 5/3 5/7 5/6 32/20 38/57
-/-/2/1 -/1/3/1 16/12
-/1 12/1 4/2 -/1 8/1 24/6 53/24
15/15 -/3/2 -/4/2 22/19 26/24
3/7 17/17 3/10 2/6 2/14 27/54 29/88
-/1/1/2 -/-/2/2 9/9
1/12 2/4 3/16
-/2/5 2/5
1/18 1/11 2/29
1/3/4 4/4
-/-/0/0
1/1/5 2/5
14/17 4/6 18/23
25/25 -/15 -/1/3/-/6 29/46 32/62
1/-/1 2/2 2/27 1/-/6/30 8/35
3/15 1/10 -/2 2/-/7 -/13 6/47 8/76
-/2/9 -/21/9 -/5/28/18 32/22
-/1/-/-/4/-/5/0 5/0
-/-/-/2 -/25 5/14 2/7/41 9/46
20/20 14/14 -/2/4 1/6/5 43/43 61/66
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. . . in IJMI . . . . . . conference-centered SIT publications MIE03 (n. pub. = 29) MI04 (n. pub. = 21) (n. pub. = 40)
Biological processes
SIT abbreviations are explained in the text.
99
100
i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 6 ( 2 0 0 7 ) 96–102
used in different SITs differ significantly, e.g. compare Edu in IJMI [21–24] with BSI in MIM [33–36]. Some SITs have mainly research-oriented scientific publications (e.g. [35,40]). They only differ from regular publications in the use of more focussed model classes. Other SITs contain mainly visionary and opinion papers as well as publications, reporting on early progress. Examples are the HGrid SIT in MIM [41–44] and the Sec SIT in IJMI [25–28]. For such SITs we can see that, in contrast to most regular publications, they consist not necessarily of typical ‘scientific’ papers according to the criteria used, e.g. to select best papers for the IMIA Yearbook of Medical Informatics [2]. Obviously, such papers are also necessary, but need different selection and reviewing processes. Publications on education differ in so far, as they present more frequent examples on courses (e.g. [21–24]).
3.5. Models in special issues/special topics of conferences (Q2.3) The drawn sample confirmed the indexing results, that conference-centered SIT publications have model classes rather similar to the ones in regular publications. As for regular publications we can observe a broad mixture of models, including rather in-depth formal approaches (e.g. [45,53]), simulation (e.g. [55]), and statistical modeling (e.g. [54,56]). In particular, for conferences in non-English speaking countries such special issues/special topics enable international (English) communication of the research topics described in the selected (best) papers. The selection and reviewing procedures are similar to regular papers. For IMIA official journals, such SITs are regarded as important contributions for sharing research results. In MIM, we can observe a broader range of models used, including statistical models. A reason, why this is the case, has been mentioned in the discussion section of part 1.
3.6.
Special observations (Q2.4)
Our main observations have been presented in the sections before. There were in our point of view no further significant differences to the observations, mentioned in part 1, Section 4.3 for regular papers.
3.7.
Research aims (Q2.5)
As already mentioned in part 1, in all publications of the drawn samples, in regular as well as in special topics and special issues, the aim “to provide solutions for problems related to data, information and knowledge processing” and “to study the general principles of processing data, information and knowledge in medicine and health care” in order to contribute to “improve the quality of health care, and of research and education in medicine and the health sciences” ([1], p. 132) was given, at least implicitly.
3.8.
On model classes (Q3)
Were there other types of models used than the ones specified 10 years ago? We could observe variations and/or extensions in model classes, e.g. when analysing biological processes
(e.g. SIT MArray). However, we mainly observed a continuous progress, but no ‘scientific revolution’.
3.9.
On education (Q4)
What can be concluded, in particular with respect to core competencies of biomedical/health informaticians and to education in biomedical/health informatics? As mentioned and argued in part 1, Section 4.3, besides knowledge and skills for ‘core’ models for, e.g. biological or communication processes, and of course besides knowledge and skills in software engineering and project management, models for simulation and evaluation seem to be highly relevant. Educational programs in health informatics, medical informatics, and biomedical informatics should consider this. It became obvious that for some of the published research, sound formal (mathematical) knowledge and skills are needed as well as a strong engineering background. This is often related to methodological contributions to our field. Usually, this knowledge and the related skills can best be provided in consecutive B.Sc. and M.Sc. programs in medical informatics (respectively, health informatics, . . .), maybe followed by Ph.D. studies. In the IMIA recommendations on education [61] this educational approach has been described as the informaticsoriented approach to medical informatics. Some research primarily needs profound knowledge of the health care field or on diagnosis and therapy. If educational programs focus on these questions, and restrict themselves to primarily courses on health information systems and evaluation, then in particular organizational knowledge and skills as well as on evaluation is needed in addition to managing projects and some software engineering. This can, in our opinion, be offered in M.Sc. programs in medical informatics, maybe also followed by Ph.D. studies. In the IMIA recommendations on education [61] this educational approach has been described as the healthcare-oriented approach to medical informatics.
4.
Discussion
As mentioned in part 1, we were surprised by our rather high inter-rater variability. In 230 of the 384 publications we indexed similarly (at least 1 identical index). However, in 154 publications there was no agreement, either due to only different indices or because one of us did not set an index, but the other one did. We decided to have an additional analysis of a random sample of about 5% (n = 8) of those publications, about which we had no agreement, in order to understand this for us unexpected rather high inter-rater variability. We randomly selected publications [62–69]. When analysing the papers we again identified that all these papers focus on more than one of the processes, described at the beginning. The major differences were due to differences in the interpretation of which processes were important and worth to be indexed for the particular paper. In one case we identified an indexing error. In addition, many papers on the one hand focussed on certain ‘core models’, and on the other hand described the research process. Both levels, however could be regarded. This was also a cause of variation. One publication [62], for example, described several methods for
i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 7 6 ( 2 0 0 7 ) 96–102
analysing gene function. This publication could be indexed as a communication process, but in fact it is an analysis process. Research processes however were not included in our ‘core’ models. The various processes described in our earlier publication [1] were very broadly defined. Problems may arise when, for example, planning and coordination are described in the article. Is this an example of a communication process, an organizational process or both? We think that the processes are sufficiently different for a broad categorization of the field of medical informatics. For a detailed view the processes should become more specific and ‘meta’-processes (concerning, e.g. the research process) should be added. In analysing the 384 publications it became obvious that modeling of processes continues to be a major task in research, education and practice of biomedical and health informatics. Knowledge and skills on a broad range of model types is needed in biomedical/health informatics. This field itself is dealing with topics of increasing importance for medicine and health care. In other words “medical informatics as a discipline has taken a leading role in the further development of health care” ([70], p. 5).
[15]
[16]
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[20]
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[23]
Acknowledgement [24]
The authors would like to thank Natalie Gusew, Braunschweig, for her support in recording and analysing the data.
[25]
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