The Heidelberg-Heilbronn medical informatics program, whose foundation and development during its first 50 years are reported here, was initially established in 1972 as a diploma program, then converted into a consecutive bachelor’s and master’s program starting in 2007. With approximately 2,000 graduates, it is probably not only the world’s oldest dedicated medical informatics program, but also the one with the most graduates. Important impulses have been set nationally and internationally by teachers as well as by graduates of the Heidelberg-Heilbronn medical informatics program. An important piece of history was written at Heidelberg University and Heilbronn University of Applied Sciences with this medical informatics program. In terms of its objectives, the field of medical informatics belongs to medicine. In terms of methods and tools, it can be largely assigned to computer science. To adequately map the synergies that can arise from this duality of medicine and informatics in a dedicated medical informatics curriculum was and remains an important as well as challenging task.

This is a commentary on Professor Giere’s essay ‘Verpasste Chancen. Nachdenken über Fehlentwicklungen der Medizinischen Informatik [Missed opportunities. Reflections on misdevelopments in medical informatics]’. The author addresses some of the issues discussed in the ‘missed opportunities’ and comments on them in six commentaries. In addition, he seeks to describe the period of the 1970s, a time when medical informatics was established as a new field, with Wolfgang Giere as one of its pioneers. After reading the ‘missed opportunities’, one may ask: Were there mainly misdevelopments during the time described, were there only ‘missed opportunities’? This impression would by no means be correct from the author’s point of view. It would have been desirable that further progress could have been made in the projects described by Wolfgang Giere – if this was realistically possible given the state of knowledge and the organizational and technical possibilities at that time. Though there was also important, successful work and considerable progress during that period.

Summary Objective : To provide guidance on the future development and role of medical informatics, or biomedical and health informatics, in form of reflections. Method : To report on the author’s previous activities as a medical informatician, which spans almost half a century. It began in 1973 when he started to study medical informatics. In 1978, more than four decades ago, his professional work started. He retired at the end of summer semester 2021. This was the occasion to prepare this farewell lecture. Results : In twenty reflections, thoughts are presented on professional careers (R1 – ‘places’), on medical informatics as discipline (R2 – ‘interdisciplinarity’, R3 – ‘focuses’, R4 – ‘affiliations’), on research (R5 – ‘duality’, R6 – ‘confluences’, R7 – ‘correlations’, R8 – ‘collaboration’), on education (R9 – ‘community’, R10 – ‘competencies’, R11 – ‘approaches’), on academic self-governance (R12 – ‘autonomy’), on engagement (R13 – ‘Sisyphos’, R14 – ‘professional societies’, R15 – ‘respect’, R16 – ‘tightrope walk’), and on good scientific practice (R17 – ‘time invariants’, R18 – ‘Zeitgeist’, R19 – ‘knowledge gain’, R20 – ‘exercising’). Conclusions : It has been a pleasure for me to participate in medical informatics activities for almost fifty years. During that time, there have been significant advances, including in medicine and in informatics, and also in medical informatics itself. And now it is the turn of others. While keeping in mind that tradition is not preserving the ashes, but passing on the fire, this report with its reflections may be of some help.

AbstractHealth information systems can be described at three layers: The domain layer describing entity types and functions, the logical tool layer describing application components, and the physical tool layer. Data can be classified into personal and non-personal data and into standardized and non-standardized data.The architectures of an information system can be characterized by the number of databases, the number of application systems, the number of application software products and vendors, and the communication pattern.Technical interoperability describes the ability of application systems to send or receive data. Syntactic interoperability comprises the ability to use predefined message structures. Semantic interoperability means the ability to exchange and process meaningful messages. Process interoperability addresses whether application systems can cooperate. Interoperability standards support one or more aspects of interoperability.Integrating application systems leads to integrated health information systems. Data integration is achieved when data that have been recorded once in one application system are made available in other application systems. Semantic integration is achieved when application systems actually use the same system of concepts. User interface integration is guaranteed when different application systems organize their user interfaces in a unified way. Context integration is achieved when context is preserved when switching application systems. Feature integration is achieved when software features are implemented only once. Process integration is guaranteed when business processes are supported by cooperating application systems.Several integration technologies such as transaction management, communication servers, and open platforms support integrity and integration in heterogeneous health information systems.

AbstractA common terminology is needed when dealing with information systems. Health information systems, as socio-technical subsystems of a healthcare setting, compriss data, information, and knowledge processes as well as the associated actors. They support information and knowledge logistics.When dealing with health information systems and their architecture, we distinguish between concepts such as entities and entity types, computer-based and non-computer-based application components supporting functions, and physical data processing systems. Electronic health records (EHR) are parts of health information systems that collect patient health data from different health care settings. A patient record is the collection of a patient’s health data from a certain facility.Management of health information systems includes planning, directing, and monitoring tasks. The three-layer graph-based metamodel (3LGM2) is a metamodel that supports the management of health information systems. It describes the components of health information system architectures and their relationships among each other at three layers. It consists of the domain layer to describe functions and entity types, the logical tool layer to describe application components, and the physical tool layer to describe physical tools, as well as the inter-layer relationships between the three layers.

AbstractThe quality of the management of information systems comprises the quality of IT governance, the quality of strategic, tactical, and operational management, and the quality of architectures and infrastructures of health information systems.Quality of IT governance comprises, among other things, clear responsibilities for strategic, tactical, and operational management. Quality of strategic management comprises, among other things, the availability of a strategic information management plan aligned with business goals together with a strategic project portfolio and strategic monitoring based on key performance indicators. Quality of tactical management comprises state-of-the-art project management. Quality of operational management comprises, among other things, a business continuity plan, information technology service management and service-level agreements, and competent IT staff.The quality of architectures and infrastructures comprises, among other things, sufficient support for information and knowledge, reliable and user-friendly application systems, a flexible information system architecture, integrated application systems allowing high levels of data integration, semantic integration, context integration, user interface integration, feature integration, and process integration, and stable and available physical data processing systems.Evaluating the quality of information systems comprises several steps: identification of an evaluation question which depends on the phase of adoption of an application system and the decision that is to be made; deciding on a study design; the collection of quantitative or qualitative data; and, finally, answering the evaluation question to support a decision.

AbstractHealth care in different life situations is provided in various health care settings. Consequently, the information systems of different health care settings show specific characteristics both from a technological and a management perspective.Information systems in hospitals have to address the information needs of many clinical and administrative areas and groups of persons. Hospital information systems must therefore support a large number of functions and integrate a comparably large number of application components. Integrity and integration are thus especially crucial topics. Overall, systematic information management is essential in hospitals, being the most complex institutional health care setting.Information systems in nursing homes are typically less complex, as the number of areas and persons is smaller. Consequently, the number of application components is lower than in hospitals. Information systems in ambulatory nursing organizations and medical offices are even less complex and may comprise an even smaller number of application systems. Nevertheless, systematic management of the specific information systems is still needed at least to some extent in order to respond to specific requirements in these health care settings.Information systems in medical research facilities support dedicated functions such as research management or the planning and executing of studies. They typically comprise numerous application components and also have to respond to the requirement of cross-institutional or interprofessional research collaboration.Information systems in personal environments may typically support wellness, prevention, treatment, or rehabilitation and may be either part of institutional health information systems or be realized as a separate information system in a personal environment.

It is considered important or even necessary for a continuous exchange of scientific information that all relevant stakeholders can access the inner-scientific communication. The traditional publication model, however, does not provide an inclusive flow of communication but rather favours researchers affiliated with resource-strong institutions, oftentimes located in the Global North. Hence, there are increased efforts to establish an alternative, open access (OA) publication model. Since such a model can only be successful if scientists themselves support and use it, this paper presents a two-tier study examining the factors that might shape scientists’ decision (not) to choose an OA option for disseminating their own work. Based on (semi-)standardized surveys of scientific organizations and individual researchers in the field of biomedical and health informatics, it provides an overview of individual and institutional frame conditions that influence the dissemination and reception of scientific knowledge. In order to account for regional differences, it draws on a global sample, comprising respondents from Africa, Asia and the Pacific, Europe, Latin America, Middle East and North America. Overall, the findings provide a heterogeneous picture of how OA is perceived and practiced. Respondents appreciate the convenient way to access OA articles as readers and the opportunity to reach broader (non-academic) audiences as authors. However, due to high publication fees and concerns regarding quality and reputation, a positive attitude towards OA does not necessarily translate into willingness to choose this publication model. Especially researchers from low-income countries benefit from a barrier-free communication mainly in their role as readers and much less in their role as authors of scientific information. This is also evident at the institutional level, as OA policies or financial support through funding bodies are most prevalent in Europe and North America. These findings call for more attention to inner-scientific communication as part of (science) communication research.

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The aim of this essay is to provide guidance on the future development and role of medical informatics, or biomedical and health informatics, in the form of reflections.In order to make these reflections on the future of medical informatics more understandable, it seemed necessary for the author to report on his previous work as a medical informaticist, which spans almost half a century. It began in 1973 when he started to study medical informatics. In 1978, more than four decades ago, his professional work started. He retired at the end of the 2021 summer semester. This was the occasion to prepare this farewell lecture. In 20 reflections, thoughts are presented on professional careers (R – ‘places’), on medical informatics as discipline (R – ‘interdisciplinarity’, R – ‘focuses’, R – ‘affiliations’), on research (R – ‘duality’, R – ‘confluences’, R – ‘correlations’, R – ‘collaboration’), on education (R – ‘community’, R – ‘competencies’, R – ‘approaches’), on academic self-governance (R – ‘autonomy’), on participation (R – ‘Sisyphos’, R – ‘professional societies’, R – ‘respect’, R – ‘tightrope walk’), and on good scientific practice (R – ‘time invariants’, R – ‘Zeitgeist’, R – ‘knowledge gain’, R – ‘exercising’).

ZusammenfassungIn praktisch allen Bereichen unserer Gesellschaften verändert die Digitalisierung unsere Lebenswelten. Dieses Buch befasst sich mit aktuellen Entwicklungen des Zusammenwirkens von natürlicher und künstlicher Intelligenz. Der Beitrag möchte in diese Thematik einführen und auf technische, ethische und rechtliche Herausforderungen des Zusammenwirkens lebender und nicht lebender Entitäten im Zeitalter der Digitalisierung hinweisen.

ZusammenfassungIm Querschnittsfeld Technik und Medizin wird aus Informatik und Philosophie die Frage bearbeitet, welche Werte und Evaluationskriterien beim erweiterten Zusammenwirken von Menschen und Maschinen zu berücksichtigen sind. Das in der VDI-Richtlinie 3780 zur Technikbewertung enthaltene Werteoktogon, das acht grundlegende Werte technischen Handelns zueinander in Beziehung setzt und das Abwägungsentscheidungen für Politik und Gesellschaft ermöglichen soll, wird besprochen. Nach Einführung der aktuell verwendeten Evaluationsmethodik in der klinischen Medizin, dort insbesondere in der Therapieforschung, wird diskutiert, inwieweit diese Evaluationsansätze sich auch auf Fragen bestmöglicher Diagnostik und Therapie, Prävention und Nachsorge im erweiterten Zusammenwirken von Menschen und Maschinen angewandt werden können. Es wird ausgeführt, dass zu der Evaluation dieses Zusammenwirkens ein hoher interdisziplinärer Forschungsbedarf besteht und dass adäquate Ausbildungsangebote vorhanden sein sollten.

BACKGROUND:Many countries adopt eHealth applications to support patient-centered care. Through information exchange, these eHealth applications may overcome institutional data silos and support holistic and ubiquitous (regional or national) information logistics. Available eHealth indicators mostly describe usage and acceptance of eHealth in a country. The eHealth indicators focusing on the cross-institutional availability of patient-related information for health care professionals, patients, and care givers are rare.OBJECTIVES:This study aims to present eHealth indicators on cross-institutional availability of relevant patient data for health care professionals, as well as for patients and their caregivers across 14 countries (Argentina, Australia, Austria, Finland, Germany, Hong Kong as a special administrative region of China, Israel, Japan, Jordan, Kenya, South Korea, Sweden, Turkey, and the United States) to compare our indicators and the resulting data for the examined countries with other eHealth benchmarks and to extend and explore changes to a comparable survey in 2017. We defined "availability of patient data" as the ability to access data in and to add data to the patient record in the respective country.METHODS:The invited experts from each of the 14 countries provided the indicator data for their country to reflect the situation on August 1, 2019, as date of reference. Overall, 60 items were aggregated to six eHealth indicators.RESULTS:Availability of patient-related information varies strongly by country. Health care professionals can access patients' most relevant cross-institutional health record data fully in only four countries. Patients and their caregivers can access their health record data fully in only two countries. Patients are able to fully add relevant data only in one country. Finland showed the best outcome of all eHealth indicators, followed by South Korea, Japan, and Sweden.CONCLUSION:Advancement in eHealth depends on contextual factors such as health care organization, national health politics, privacy laws, and health care financing. Improvements in eHealth indicators are thus often slow. However, our survey shows that some countries were able to improve on at least some indicators between 2017 and 2019. We anticipate further improvements in the future.

Open Access (OA) is an evolving publication model that is heavily supported by politics and science organizations aiming to make scientific knowledge more accessible to a wider audience. Whether it will indeed alter scholarly communication, however, depends on researchers' underlying attitudes, motivations, and needs. Drawing on group discussions and interviews (n = 42), this study explores the perceptions, attitudes and behaviours of researchers towards OA publishing. We focus on researchers in the field of biomedical and health informatics located in different global regions and from different seniority levels. Overall, the results show that whilst most researchers support the idea of making scientific knowledge freely accessible to everyone, they are hesitant about actually living this practice by choosing OA journals to publish their own work. Article processing charges and quality issues are perceived as the main obstacles in this respect, revealing a two-sided evaluation of OA models, reflecting the different viewpoints of researchers as authors or readers. The results further highlight hitherto underexplored influencing factors regarding institutional frame conditions, located on the level of the scientific system, the publication service providers or the national/international OA policies.

INTRODUCTION:Shoulder lesions rank among the top 15 diagnoses accounting for days of incapacity to work. Inpatient or full-day outpatient rehabilitation are some of the standard therapies. For sustainable rehabilitation, continuation of rehabilitation after discharge from a rehabilitation centre is vital. Besides medical exercise therapy (MET), home-based physical exercise programmes are used. To monitor exercise quantity and quality, AGT-Reha, a health-enabling technology for home rehabilitation, has been developed and evaluated in a pilot study for technical feasibility and acceptance. To integrate the digital therapeutic AGT-Reha into regular healthcare processes, an efficacy evaluation is required. METHODS AND ANALYSIS:AGT-Reha-WK is a prospective, monocentric, non-randomised, unblinded non-inferiority trial. Primary objective is to investigate whether AGT-Reha enhanced home-based exercise training is non-inferior to MET as standard aftercare. Secondary objective is to compare the costs of both therapies. Efficacy as medical success (primary outcome) is examined with regard to ability to work, return to work and sustainability of training (secondary outcomes). The outcome measure for non-inferiority is shoulder function (pain and disability) assessed by the standardised Shoulder Pain and Disability Index (SPADI). The non-inferiority margin is set to 10 points on SPADI score using a 95% CI. Subjects will be recruited at the Rehabilitation Center Bad Pyrmont, Germany. The total number of subjects should be 84 (42 per group). Treatment takes 6 months per patient. Subjects will be assessed at four time points: pre-baseline (admission to rehabilitation centre), baseline (discharge from rehabilitation centre), post-therapy and follow-up (3 months post-therapy). ETHICS AND DISSEMINATION:Ethics approval was granted by the Ethics Committee of Hannover Medical School (ethics approval no: 7313). Results of the trial are planned to be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER:German Clinical Trials Register DRKS00011596. Registered 2 June 2017. Recruitment started on 3 March 2017, and it is expected to continue until December 2020. PROTOCOL VERSION:V2.0, 23 May 2018, Amendment 01: improved risk analysis, clarification of exclusion criteria to increase reproducibility, additional documentation with OpenClinica; these changes have no effect on structural equality.

Medical informatics (MI), or more generally Biomedical and Health Informatics, has been most variously and often inconsistently defined.1According to onedefinition, it is “concerned with the optimal use of information, often aided by the use of technology, to improve individual health, health care, public health, and biomedical research.”2According to another it is “a discipline, concernedwith the systematic organization, representation, and analysis of data, information, and knowledge in biomedicine and health care.”3 Recommendations for MI education, which were revised by the International Medical Informatics Association (IMIA), can also be a clue for defining the field of MI.4 On the other hand, MI is frequently referred to by other names, with different yet closely related meanings. “Biomedical and Health Informatics,” “Biomedical Informatics,” Healthcare Informatics,” and “Clinical Informatics” are someof them.5 As the name MI is more frequently used in journal classifications (such as Institute for Scientific Information [ISI] and Science-Metrix), terminologies (PubMed), or in the names of non-governmental organizations (such as IMIA and American

Business informatics and medical informatics adopt and adapt methods and knowledge from computer science and further develop appropriate methods for the particular needs in their application domains. A panel discussion at the 2018 conference of the German Society for Medical Informatics, Biometry and Epidemiology (GMDS) analyzed the relationship between business informatics, medical informatics and computer science. Five questions guided the discussion:The analysis made clear that business informatics, medical informatics and computer science would gain profit from a more systematic mutual exchange. The “Learning Healthcare System” could provide a useful framework.