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Bronchiectasis (BE) might be frequently present in COPD but masked by COPD symptoms. We studied the relationship of clinical signs of bronchiectasis to the presence and extent of its radiological signs in patients of different COPD severity. Visit 4 data (GOLD grades 1-4) of the COSYCONET cohort was used. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0: absence, 1: ≤50%, 2: >50% BE-involvement for each lobe). 1176 patients were included (61%male, age 67.3y), among them 38 (3.2%) with reported physicians' diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). CT scans were obtained in 429 patients. Within this group, any signs of bronchiectasis were found in 46.6% of patients, whereby ≤50% BE occurred in 18.6% in ≤2 lobes, in 10.0% in 3-4 lobes, in 15.9% in 5-6 lobes; >50% bronchiectasis in at least 1 lobe was observed in 2.1%. Scores ≥4 correlated with an elevated ratio FRC/RV. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally ≥5. In COPD patients, clinical diagnosis and radiological signs of BE showed only weak correlations. Correlations became significant with increasing BE-severity implying radiological alterations in several lobes. This indicates the importance of reporting both presence and extent of bronchiectasis on CT. Further research is warranted to refine the criteria for CT scoring of bronchiectasis and to determine the relevance of radiologically but not clinically detectible bronchiectasis and their possible implications for therapy in COPD patients.

The COPD Assessment Test (CAT) is in widespread use for the evaluation of patients with chronic obstructive pulmonary disease (COPD). We assessed whether the CAT items carry additional information beyond the sum score regarding COPD characteristics including emphysema. Patients of GOLD grades 1 to 4 from the COPD cohort COSYCONET (German COPD and Systemic Consequences - Comorbidities Network) with complete CAT data were included (n = 2270), of whom 493 had chest CT evaluated for the presence of emphysema. Comorbidities and lung function were assessed following standardised procedures. Cross-sectional data analysis was based on multiple regression analysis of the single CAT items against a panel of comorbidities, lung function, or CT characteristics (qualitative score, 15th percentile of mean lung density), with age, BMI and gender as covariates. This was supported by exploratory factor analysis. Regarding the relationship to comorbidities and emphysema, there were marked differences between CAT items, especially items 1 and 2 versus 3 to 8. This grouping was basically confirmed by factor analysis. Items 4 and 5, and to a lower degree 1, 2 and 6, appeared to be informative regarding the presence of emphysema, whereas the total score was not or less informative. Regarding comorbidities, similar findings as for the total CAT score were obtained for the modified Medical Research Council scale (mMRC) which was also informative regarding emphysema. Our findings suggest that the usefulness of the CAT can be increased if evaluated on the basis of single items which may be indicating the presence of comorbidities and emphysema.

Summary Objectives: To identify the key performance indicators for hospital information systems (HIS) that can be used for HIS benchmarking. Methods: A Delphi survey with one qualitative and two quantitative rounds. Forty-four HIS experts from health care IT practice and academia participated in all three rounds. Results: Seventy-seven performance indicators were identified and organized into eight categories: technical quality, software quality, architecture and interface quality, IT vendor quality, IT support and IT department quality, workflow support quality, IT outcome quality, and IT costs. The highest ranked indicators are related to clinical workflow support and user satisfaction. Isolated technical indicators or cost indicators were not seen as useful. The experts favored an interdisciplinary group of all the stakeholders, led by hospital management, to conduct the HIS benchmarking. They proposed benchmarking activities both in regular (annual) intervals as well as at defined events (for example after IT introduction). Most of the experts stated that in their institutions no HIS benchmarking activities are being performed at the moment. Conclusion: In the context of IT governance, IT benchmarking is gaining importance in the healthcare area. The found indicators reflect the view of health care IT professionals and researchers. Research is needed to further validate and operationalize key performance indicators, to provide an IT benchmarking framework, and to provide open repositories for a comparison of the HIS benchmarks of different hospitals.

To prevent information overload of physicians when accessing EHRs we introduce a method to extend the IHE XDS profile metadata-based search towards a content-based search. Detailed queries are created based on predefined information needs mapped to ISO/EN 13606 Archetypes. They are aggregated to a metadata-based query to retrieve all relevant documents, which are then analyzed for the desired contents. The results are presented in a tabular form. The content-based search in IHE-XDS could be implemented efficiently and was found helpful by the evaluating physicians.

The EHR system ZK-ARCHE automatically generates forms from ISO/EN 13606 archetypes. For this purpose the archetypes are augmented with components of the reference model to achieve so-called "comprehensive archetypes". Data collected via the forms are stored in a list which associates each value with the path of the corresponding comprehensive archetype node coded as W3C XPath. From this list archetype-conformant EHR extracts can be created. The system is embedded with the IHE XDS profile to allow direct data exchange in an environment of distributed data storage.

Archetypes model individual EHR contents and build the basis of the dual-model approach used in the ISO/EN 13606 EHR architecture. We present an approach to create archetypes using an iterative development process. It includes automated generation of electronic case report forms from archetypes. We evaluated our approach by developing 128 archetypes which represent 446 clinical information items from the diabetes domain.

An important part of hospital information systems (HIS) evaluation is the quality assessment of its architecture, i.e. the structure of its IT infrastructure. Therefore, quantitative architectural quality criteria are needed. On the basis of relevant architectural components of a HIS, as defined by 3LGM2, the following quality criteria were defined: functional redundancy, functional under-saturation, functional correspondence, informational redundancy, degree of heterogeneity and degree of computer-support. These quality criteria were implemented as part of the 3LGM2 tool: a modelling tool to create 3LGM2 conformant HIS models. For every 3LGM2 model and its corresponding components, the relevant quality criteria are automatically calculated and presented. The defined quality criteria can be used for several information management purposes. Nevertheless they are not intended to make absolute statements about the HIS quality. To ensure their expressiveness, complete and consistent underlying 3LGM2 models are needed.

One of the tasks of information management is systematic planning of a Hospital Information System (HIS). However, the description and the analysis of the current state of a HIS typically create high costs and are not well supported. The aim of this paper is therefore to report about the specification of a reference model for the domain layer of a Hospital Information System.We developed a reference model for the domain layer of a Hospital Information System based on the requirements index for information processing in hospitals for describing the enterprise functions, and based on the object types from the Health Level 7 Reference Information Model (HL7-RIM) for describing the entity types.The developed reference model is a comprehensive hierarchic model of the enterprise functions of hospital information systems. The central enterprise function "patient treatment" for example is described with 35 enterprise functions and 38 entity types on a three-level hierarchy.Reference models provide a kind of modelling patterns that can easily be used and adapted to a respective Information System. The availability of reference models should therefore provide a highly valuable contribution to keep the costs for modelling Hospital Information Systems low. We will start to evaluate the reference model by using it in the description of the information systems of a University Clinic of the Tiroler Landeskrankenanstalten GmbH (TILAK), Austria. If this pre-test is positive, it is planned to extend the use of the reference model to the overall Hospital Information System of the TILAK.

Summary Objectives: To report about the themes and about experiences with practicums in the management of information systems in health care settings (health information management) for medical informatics students. Methods: We first summarize the topics of the health information management practicums/projects that the authors organized between 1990 and 2003 for the medical informatics programs at Heidelberg/ Heilbronn, Germany, UMIT, Austria, as well as for the informatics program at the University of Leipzig, Germany. Experiences and lessons learned, obtained from the faculty that organized the practicums in the past 14 years, are reported. Results: Thirty (of 32) health information management practicums focused on the analysis of health information systems. These took place inside university medical centers. Although the practicums were time-intensive and required intensively tutoring students with regard to health information management and project management, feedback from the students and graduates was mainly positive. Discussion: It is clearly recommended that students specializing in medical informatics need to be confronted with real-world problems of health information systems during their studies.