On Teaching International Courses on Health

Original Articles OPEN ACCESS e39 On Teaching International Courses on Health Information Systems Lessons Learned during 16 Years of Frank – van Swieten Lectures on Strategic Information Management in Health Information Systems

Elske Ammenwerth1; Petra Knaup2; Alfred Winter3; Axel W. Bauer4; Oliver J. Bott5,6; Matthias Gietzelt2; Birger Haarbrandt5; Werner O. Hackl1; Nils Hellrung5,7; Gudrun Hübner-Bloder1; Franziska Jahn3; Monique W. Jaspers8; Ulrike Kutscha9; Christoph Machan1; Bianca Oppermann5; Jochen Pilz9; Jonas Schwartze5; Christoph Seidel10; Jan-Eric Slot11,12; Stefan Smers13; Katharina Spitalewsky2,14; Nathalie Steckel5,15; Alexander Strübing3; Minne van der Haak2,16; Reinhold Haux5; Willem J. ter Burg8 1 Institute of Medical Informatics, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; 2 Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany; 3Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany; 4 History, Philosophy, and Ethics in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 5 University of Braunschweig – Institute of Technology and Hannover Medical School, Peter L. Reichertz Institute for Medical Informatics, Braunschweig, Germany; 6 Department of Information and Communication, Hannover University of Applied Sciences and Arts, Hannover, Germany; 7 Symeda GmbH, Braunschweig, Germany; 8 Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; 9 Center of Information Technology and Medical Engineering, University Hospital of Heidelberg, Heidelberg, Germany; 10 Department for Information Technology and Business Development, Braunschweig Medical Center, Braunschweig, Germany; 11 IT Academic Center, University of Amsterdam, Amsterdam, The Netherlands; 12 ICT Department, Bernhoven Hospital, Uden, The Netherlands; 13 Department for Information Technology, University Hospital of Leipzig, Leipzig, Germany; 14 Clinical Trial Center (CTCW), University Hospital of Wuerzburg, Wuerzburg, Germany; 15 Department UK-IT, University Hospital of Bonn, Bonn, Germany; 16Siemens AG, Erlangen, Germany

Keywords informaticians are needed. Because of these Methods: The basic concept of the Frank – Education, strategic information manage- reasons, in 2001 an international course has van Swieten lectures is to teach the theoreti- ment, health information systems, medical been established: The Frank – van Swieten cal background in local lectures, to organize informatics, biomedical informatics, health Lectures on Strategic Information Manage- practical exercises on modelling sub-infor- informatics ment of Health Information Systems. mation systems of the respective local HIS Objectives: Reporting about the Frank – van and finally to conduct Joint Three Days as an Summary Swieten Lectures and about our students‘ international meeting were the resulting Background: Health information systems feedback on this course during the last 16 models are introduced and compared. (HIS) are one of the most important areas for years. Summarizing our lessons learned and Results: During the last 16 years, the Univer- biomedical and health informatics. In order making recommendations for such inter- sities of Amsterdam, Braunschweig, Heidel- to professionally deal with HIS well-educated national courses on HIS. berg/Heilbronn, Leipzig as well as UMIT were involved in running this course. Overall, 517 students from these universities participated. Correspondence to: Methods Inf Med 2017; 56(Open): e39 – e48 Our students‘ feedback was clearly positive. Prof. Dr. Reinhold Haux https://doi.org/10.3414/ME16-01-0124 Peter L. Reichertz Institute for Medical Informatics received: October 21, 2016 The Joint Three Days of the Frank – van University of Braunschweig – Institute of Technology accepted: February 18, 2017 Swieten Lectures, where at the end of the and Hannover Medical School published: March 8, 2017 course all students can meet, turned out to Muehlenpfordtstr. 23 be an important component of this course. 38106 Braunschweig Germany Based on the last 16 years, we recommend E-Mail: [email protected] common teaching materials, agreement on

equivalent clinical areas for the exercises, Because of these reasons courses on • How can we assess the quality of health support of group building of international health information systems and their man- information systems? student groups, motivation of using a col - agement always played an important role • How can we strategically manage health laboration platform, ensuring quality man- in our universities’ educational programs. information systems? agement of the course, addressing different As our graduates’ work became more and levels of knowledge of the students, and en- more global, we decided in 2000 to estab- Content suring sufficient funding for joint activities. lish an international course on this subject, The course content, based on the book Conclusions: Although associated with at first under the umbrella of IΦE, the In- presented in ([26]), is organized into the considerable additional efforts, we can ternational Partnership for Health Infor- following topics, each forming one book clearly recommend establishing such inter- matics Education [21, 22]. Since its start in chapter: national courses on HIS, such as the Frank – 2001, this course is focussing on the stra- 1. Introduction van Swieten Lectures. tegic information management of health 2. Health Institution and Information Pro- information systems as well as on HIS cessing: architectures [23, 24]. For this course a Significance of information processing textbook was written [25] and recently re- in hospitals, progress in information 1. Introduction vised [26]. Since 2005 our course has been and communication technology, im- called Frank – van Swieten Lectures on Stra- portance of systematic information Health information systems (HIS) were, tegic Information Management of Health In- management. are currently, and, as far as we can see, will formation Systems, or, briefly, Frank – van 3. Information System Basics: also be in future one of the most important Swieten Lectures. Data, information and knowledge, in- areas for biomedical and health informat- After having organized and taught the formation systems and their compo- ics. There is a global consensus about their Frank – van Swieten Lectures during 16 nents, information management. relevance for health care, which, e. g., led in years, we decided to review, summarize, 4. Health Information Systems: 2005 to the World Health Assembly’s and communicate our activities. Our ob- Hospital information systems, trans- eHealth Resolution [1, 2, 3] and to the im- jectives, which lead to this manuscript, are institutional HIS, electronic health rec- plementation of the World Health Organi- to report and share our knowledge ords, and challenges for HIS. zation’s Global Observatory for eHealth [4, (O1) about the Frank – van Swieten Lec- 5. Modeling Health Information Systems: 5]. Its importance has been emphasized in tures (section 2.1 – 2.4) and On models and metamodels, a meta- many publications of our scientific com- (O2) about our students’ feedback on this model for modeling health information munity (e. g. [6, 7, 8, 9, 10]). course (section 2.5). systems: 3LGM2, on reference models, a In order to professionally deal with HIS, We will then reference model for the domain layer of we need to understand their respective (O3) summarize our lessons learned (sec- hospital information systems. architectures and infrastructures (e. g. the tion 3.1) and 6. Architectures of Hospital Information architecture of the information system of a (O4) make recommendations for such in- Systems: certain hospital, e. g. [11], or of a nation’s ternational courses on HIS (section Domain layer – data to be processed ‘eHealth infrastructure’, e. g. [12]), and we 3.2). and hospital functions, logical tool layer need to know how such information sys- – application components and their in- tems are adequately managed. In particu- tegration, physical tool layer – data-pro- lar, its strategic information management is 2. The Frank – van Swieten cessing systems and their integration. crucial, both for the quality of care and for Lectures 7. Specific Aspects for Architectures of the costs of information processing and Transinstitutional Health Information 2.1 Objectives, Content, Structure, storage (e. g. [13]). Systems: For being able to do this, well-educated and Characteristics Domain layer, logical tool layer, physical informaticians are needed. The Interna- Objectives tool layer. tional Medical Informatics Associations The lecture in general aims to give students 8. Quality of Health Information Systems: (IMIA) has raised this importance, when the competence to answer the following Quality of structures, quality of pro- IMIA’s General Assembly adopted recom- questions ([26], p. 2): cesses, quality of outcome, balance as a mendations on health and medical edu- • Why is systematic information process- challenge for information management, cation in 1999 [14], and confirmed the ing in healthcare institutions important? evaluation of health information sys- rele vance for educating informatics stu- • What are appropriate models for health tems quality. dents about HIS in its first revision in 2009 information systems? 9. Strategic Information Management in [15]. Furthermore, graduates of education- • How do health information systems Hospitals: al programs in medical informatics fre- look like and what architectures are ap- Strategic, tactical and operational in- quently work in the area of health informa- propriate? formation management, organizational tion systems [16, 17, 18, 19, 20]. structures for information management,

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University of University of University of UMIT: University of Leipzig: Amsterdam: Heidelberg: Braunschweig: Lecture Lecture Lecture Lecture Lecture

Figure 1 Organization of the Frank – van Swieten Student groups Student groups Student groups Student groups Student groups Lectures. Please note Block 2 exercise exercise exercise exercise exercise that not all universities participated in all 16 years (for details, see ▶ Table 1). 3 days: UMIT = University for Joint Three Days of the Frank - van Swieten Lectures Health Sciences, Block 3 Joint completion of exercises within international student groups Medical Informatics Oral presentation by international student groups and Technology, Hall in Tirol.

strategic planning, monitoring and di- and infrastructures of the hospital infor- and-use-case-diagrams of the Unified recting of hospital information systems. mation system. Modelling Language (UML) as model- 10.Strategic Information Management in • Block 3: Students and teachers meet for ling techniques. Health Care Networks: approximately three days at one of the • Assess the quality of information pro- Description of health care networks, or- participating universities, the so-called cessing and the quality of the architec- ganizational structures of information Joint Three Days of the Frank – van ture and infrastructure of the area’s in- management, types of health care net- Swieten Lectures. There, they get addi- formation subsystem ([26], section 8). works. tional lectures on hospital information What are strengths and weaknesses? 11.Final Remarks systems, and they get an introduction to What are opportunities and threats? the local hospital information systems Analyse two of the main problems in Structure and their strategic information manage- detail and discuss possible solutions. The course is yearly organized in three ment of all participating sites. Students • Describe how the future sub-informa- blocks (▶ Figure 1): jointly finalize the international part of tion system could look like, to solve the • Block 1: The contents of the book are their exercises by comparing their re- problems detected before. taught separately by the teachers of the spective results of Block 2 with match- • Describe the differences in the sub-in- respective programs at the participating ing groups at the other universities, and formation system (with focus on archi- universities – either in Dutch or in Ger- prepare their joint international presen- tectures, infrastructures and processes) man. Students are then introduced to tations. Finally, each international stu- between the different medical centers. their exercises. They are assigned to dent group jointly presents the results of groups, each group looking at a given their exercises. The structure of the lecture remained clinical/hospital area (e. g. cardiology, mostly unchanged during the 16 years. ophthalmology, emergency unit, patient Within the exercises, the students have to There were minor adaptations, though, administration). The choice of the areas fulfil the following tasks: based on the lessons learned and the stu- is coordinated between all participating • Describe the current state of the sub-in- dent evaluation, including a more detailed universities, so that international stu- formation system in one typical area of guideline for the students on how to struc- dent groups covering the same clinical your local medical center! Which enter- ture both the oral and the written presenta- area can be formed. prise functions are important? Which tions. • Block 2: Students start to work on their (computer-based and non-computer- exercises. These exercises comprise the based) application components are Characteristics analysis and assessment of a part of used? Which physical data processing This course is, to our knowledge, unique. their local hospital information system systems are used? There are eight characteristics being essen- during short internships. Details of the • Develop a model of the information tial for the Frank – van Swieten Lectures: exercises are presented further down. subsystem of the respective area and use c1 Universities from different countries This block includes local site visits for the three-layer graph-based metamodel perform jointly a master/bachelor each group in the respective clinical 3LGM² as metamodel ([26], section 5.3, course. areas of the local medical centers, and a [27, 28, 29]). Describe one typical pro- c2 The collaboration is multilateral and presentation of the overall architectures cess in detail, using activity-diagrams open for new partners.

Table 1 Year, participating universities, and location of the Joint Three Days of the Frank – van Swieten Lectures.

Year Participating universities Location of the Joint Three Year Participating universities Location of the Joint Three Days Days 2001 Amsterdam Heidelberg 2010 Amsterdam Braunschweig Heidelberg/Heilbronn Braunschweig 2002 Amsterdam Amsterdam Hall i.T. Hall i.T.* Leipzig Heidelberg/Heilbronn 2011 Amsterdam Amsterdam 2003 Amsterdam Innsbruck Braunschweig Hall i.T.* Hall i.T. Heidelberg/Heilbronn Heidelberg/Heilbronn Leipzig 2004 Amsterdam Heidelberg Hall i.T.* 2012 Amsterdam Leipzig Heidelberg/Heilbronn Braunschweig Hall i.T. 2005 Amsterdam Amsterdam Leipzig Braunschweig Hall i.T. 2013 Amsterdam Amsterdam Heidelberg/Heilbronn Braunschweig Hall i.T. 2006 Amsterdam Braunschweig Heidelberg/Heilbronn Braunschweig Leipzig Hall i.T. Heidelberg/Heilbronn 2014 Amsterdam Braunschweig Braunschweig 2007 Amsterdam Amsterdam Heidelberg/Heilbronn Braunschweig Leipzig Hall i.T. 2015 Amsterdam Leipzig 2008 Amsterdam Braunschweig Braunschweig Braunschweig Leipzig Heidelberg/Heilbronn 2016 Amsterdam Heidelberg 2009 Amsterdam Amsterdam Braunschweig Braunschweig Heidelberg/Heilbronn Hall i.T. Leipzig Heidelberg/Heilbronn Leipzig * before 2005: Innsbruck

c3 The course has been held every year information systems in health care and 2.2 Universities and Educational since 16 years. to train skills related to systems analysis. Programs Involved c4 At each university the course is integral c7 Each year’s course starts with local on- part of a ‘usual’ master or bachelor pro- site lectures and exercises but culmi- The participating students come (with gram (or specialization within a pro- nates finally in an international gather- some variations over the last 16 years, for gram) and thus addresses not only a ing of all participating universities’ details see ▶ Table 1) from the Medical In- small subgroup of students (elite) but all students and lecturers at one place: the formatics bachelor program of the Uni- students enrolled for the respective pro- Joint Three Days of the Frank – van versity of Amsterdam, from the Medical gram. Swieten Lectures. Exercises are then Informatics master program of the Univer- c5 Each year the course is held during the finalized in project groups as an inter- sity of Heidelberg / University of Applied same period of time. It is based on the national teamwork. Sciences Heilbronn, from the Medical In- same curriculum and, since 2003, on the c8 Students train their English capabilities, formatics master program of the University same textbook (now, since 2010, [26]). learn about different countries’ styles of for Health Sciences, Medical Informatics c6 The course combines theoretical parts HIS and experience different cultural and Technology (UMIT) in Hall in Tirol, (lectures) to teach knowledge about HIS backgrounds. from the Computer Science (in Econom- and practical systems analysis parts (ex- ics) master program of the University of ercises) to give insight into real world Braunschweig, and from the Computer Science master program of the University

MethodsLicense terms: Inf Med CC-BY-NC-ND Open/2017 (https://creativecommons.org/licenses/by-nc-nd/4.0) © Schattauer 2017 E. Ammenwerth et al.: On Teaching International Courses e43 of Leipzig. Overall, 517 students from these Table 2 Year and analysed sub-information systems of the Frank – van Swieten Lectures. For 2008, no programmes participated. information is available. Year Analysed sub-information systems 2.3 On the Name ‘Frank – van 2002 cardiology, laboratory, obstetrics/gynaecology, paediatrics, radiology Swieten Lectures’ 2003 administration, intensive care, internal medicine, laboratory, nuclear medicine, paedia- In June 2004, R.H. asked A.W.B. to give trics, pharmacy, radiology him the name of a famous physician who 2004 administration, throat/nose/ear, intensive care, internal medicine, laboratory, nuclear would be suitable as a patron for an Inter- medicine, pathology, radiology national Course on Strategic Information 2005 administration, cardiology, ear, nose & throat, intensive care unit, internal medicine, Management in Health Information Sys- laboratory, nuclear medicine, paediatrics, pharmacy, radiology tems with students from Amsterdam, Hei- 2006 accident surgery, , endocrinology, internal medicine, laboratory, nuclear medicine, pa- delberg/Heilbronn, and Hall in Tyrol (be- thology, radiation therapy, radiology, revalidation, vascular medicine fore 2005: Innsbruck), i.e. from the three 2007 accident surgery, accounting, admission, internal medicine, nuclear medicine, paedia- educational programs, participating at that trics, pathology, radiation therapy time in this course. A.W.B. suggested two historical figures who represented the tri- 2009 cardiology, emergency care, intensive care, laboratory, nuclear medicine, pathology, radiology, radiotherapy national profile which was requested: Ger- ard van Swieten and Johann Peter Frank, 2010 cardiology, emergency care, gynaecology, intensive care, laboratory, nuclear medicine, two of the most outstanding medical repre- radiology, radiotherapy sentatives of Austria’s Enlightened Despot- 2011 archive, cardiology, emergency care, gynaecology, haematology, internal medicine, lab- ism between 1750 and 1800 [30, 31, 32, 33, oratory, microbiology, neurology, nuclear medicine, oncology, psychiatry, radiology, 34, 35]. radiotherapy, surgery Gerard van Swieten (1700–1772) was 2012 dental clinic, emergency care, endoscopy, internal medicine, laboratory, nuclear medi- born in Leiden/South Holland. He studied cine, radiology, radiotherapy, surgery medicine and stayed in Leiden until 1745, 2013 gynaecology, internal medicine, laboratory, nuclear medicine, radiology, radiotherapy when he became the personal physician of 2014 anaesthesiology, dental medicine, ear, nose & throat, gynaecology, microbiology & im- the Austrian Empress Maria Theresa munology, nuclear medicine, pathology, oncology, orthopaedics, radiology, radiother- (1717–1780) in Vienna. Van Swieten is apy well-known as a founder of the first Vienna 2015 anaesthesiology, ear, nose & throat, gynaecology, transfusion medicine, heart center, Medical School and as a reformer of the human genetics, immunology & hygiene, intensive care unit, IT department, microbiol- Medical Faculty in Vienna. In this position ogy, paediatrics, radiotherapy, radio oncology he implemented a transformation of the 2016 ambulatory center, cardiac surgery, clinical chemistry, gynaecology, IT departments, Austrian health service and of medical nuclear medicine, radiology, radiotherapy, radio-oncology education. Van Swieten played a pivotal role in the implementation of health re- forms throughout the entire Habsburg Monarchy. He advocated more govern- Johann Peter Frank (1745–1821) was a Frank in the hospital wards. He established mental involvement in health matters. The famous physician and hygienist born near a surgical clinic and required that medical main sanitation reform, which had been Pirmasens in Germany. He first studied students had to attend surgical courses and put forward by van Swieten and was issued theology, later medicine at the Universities students of surgery medical courses. In by Maria Theresa in 1770, reorganized ad- of Strasbourg and Heidelberg, where he 1795, Emperor Francis II (1768–1835) em- ministrative health structures in the entire earned his medical doctorate in 1766. In ployed Frank for the regulation of the sani- monarchy. It comprised three parts: 1st the 1772 he became physician-in-ordinary to tary service of the army and as Director structure and function of the sanitary net- the Prince-Bishop of Speyer in Bruchsal. General of the Principal Hospital of Vien- work and administration, 2nd the structure He was appointed professor of Physiology na. In 1804 he went to Vilnius in Lithuania and the duties of medical practitioners, and and Medical Police at the University of as professor of Clinical Medicine. From 3rd the prevention of epidemics. Due to his Goettingen in 1784, but only one year later 1805 to 1808 Frank served as the personal organizational work van Swieten can be he went to Italy and joined the Medical physician to the Russian Czar Alexander I characterized as a medical manager – long Faculty of the University of Pavia as the (1777–1825) in St. Petersburg. In 1808, he before this term was coined. His son teacher of Clinical Medicine until 1795. retired in disappointment and went back to Gottfried van Swieten (1733–1803) had his Backed by the authority of the Austrian Vienna. Johann Peter Frank was an impor- own career in government service and is Emperor Joseph II (1741–1790), Frank re- tant protagonist in social medicine; be- remembered as a friend and creditor of organized the Medical School from the tween 1779 and 1819 he published 6 vol- Wolfgang Amadé Mozart (1756–1791). bottom. Clinical instruction was given by umes of a System of Complete Medical

Table 3 Participating students, returned evaluation questionnaires and results to the question “C1. to the overall structure, organization, con- Overall, I think that I really benefited from the 3 days of international exchange (compared to only pure tent and outcome of the international national lectures/exercises).” and “C2. Overall, I would recommend other students to participate next course. The students indicted that they year in the international part of the HIS module.” of the Frank – van Swieten Lectures. No evaluation was done in 2003, 2013 and 2014. Scale: (1) totally disagree, (2) partly disagree, (3) agree/disagree, (4) were sufficiently informed about the struc- partly agree, (5) totally agree. ture (M = 3.80) and organization (M = 3.62). The students felt that they were suf- Year Number of Number of returned C1 “I benefited” C2 “I would recom- ficiently prepared by the initial lectures students questionnaires (mean) mend it” (mean) offered at their home university for the ex- 2002 30 28 (93 %) 4.67 4.79 ercises and the international part of the 2004 46 40 (87 %) 4.54 4.63 course (M = 3,83). Part B of the questionnaire was con- 2005 77 66 (86 %) 4.59 4.72 cerned with the personal assessment of the 2006 33 31 (94 %) 4.24 4.26 international course with respect to study 2007 44 37 (84 %) 4.68 4.79 effort of the international course, the ben- 2008 26 26 (100 %) 3.96 4.12 eficial effect of the international course. The students indicated that they found the 2009 62 48 (77 %) 4.45 4.58 exercises interesting and useful (M = 3,93), 2010 61 44 (72 %) 4.21 4.32 the students learned from the joint HIS lec- 2011 64 50 (78 %) 4.36 4.56 tures (M = 3,85), and benefited from ex- 2012 40 31 (78 %) 3.65 3.76 changing ideas with students from other nationalities and the international dis- 2015 34 27 (79 %) 4.38 4.48 cussions and presentations (M = 4,18 and Weighted mean: 4.37 4.27 M = 4,00 respectively). Students stated that they made use of their time in the joint discussion groups to learn from each other and enjoyed the exchange of ideas on hos- Police, a comprehensive treatise on all as- 2.5 Student‘s Feedback pital information systems with other inter- pects of hygiene and public health. Frank national students (M = 3,76 and M = 4,21 stressed the importance of keeping accu- To evaluate the Frank – van Swieten Lec- respectively). The students indicated that rate statistical records for hospitals. His tures we conducted during its Joint Three they learned about other hospital informa- system of record compilation was used by Days a systematic evaluation with a struc- tion systems besides their own hospitals obstetrician Ignaz Philipp Semmelweis tured questionnaire based on closed ques- and had a better insight into healthcare sys- (1818–1865) when in 1848 this one dem- tions. The survey instrument was devel- tems (M = 4,00 and M = 3,97 respectively). onstrated the correlation between puer- oped by the teachers of the Frank – van Students indicated also that they improved peral sepsis and unsanitary obstetrical Swieten Lectures in 2001 and was used their presentation skills and that they ben- practices. since then. As the instrument was not de- efited with regard to professional knowl- signed as psychometric questionnaire, no edge and skills (M = 3,84 and M = 4.08 re- 2.4 Analysed Sub-information formal validation was conducted. Data spectively). Finally the students enjoyed Systems analysis comprised the descriptive results getting to know students from other na- for each question. tionalities (M = 4,49). Each year, the exercises within the Frank – The evaluation took place from 2001 Part C of the questionnaire was con- van Swieten Lectures focussed on pre-de- until 2016, except 2003, 2013 and 2014. A cerned with the overall assessment of the fined sub-information systems. These sub- total of 553 students participated over the international course. Students indicated information systems were selected based years in the Frank – van Swieten Lectures that they benefited from the international on the availability of sufficient support in and 452 students returned the question- course and would recommend other stu- the respective departments, but also trying naire. The questionnaire has a rating scale dents to participate (M = 4,37 and M = 4,27 to have comparable sub-information sys- of one to five with the following meaning: respectively). ▶ Table 3 shows details of tems in the participating universities, to (1) totally disagree, (2) partly disagree, (3) this overall evaluation. allow forming of international student agree/disagree, (4) partly agree, (5) totally We also asked each student the ques- groups. ▶ Table 2 shows the analysed sub- agree. We combined the results (2001– tions (1) “What did you like best?”, (2) information system in the last 16 years. 2015) in a weighted average, taking into ac- “What did you like least? Changes next count the different number of students that time?” and (3) “Most important thing participated each year. learned?”. Part A of the questionnaire was con- Here many responses of both (1) and (3) cerned with students opinions with regard again positively highlighted the opportun-

MethodsLicense terms: Inf Med CC-BY-NC-ND Open/2017 (https://creativecommons.org/licenses/by-nc-nd/4.0) © Schattauer 2017 E. Ammenwerth et al.: On Teaching International Courses e45 ity to meet and to collaborate with students transinstitutional aspect may come into the time schedule is very tight and could easily from other countries and to communicate focus of the analyses. be extended to four of five days to intensify and to present in English. Also a better During all of the time when teaching the exchange and experiences. Neverthe- understanding of HIS architectures was the Frank – van Swieten Lectures we used less, we assume that this would exceed the often positively mentioned. Concerning (2) 3LGM² and UML for modelling hospital reasonable effort given the universities’ we received mainly comments on the in- information systems. Since – to our knowl- processes. tensive workload during the Joint Three edge – no better alternatives have shown Days and sometimes with respect to ac- up they proved its value and we will con- 3.2 Recommendations commodation. tinue working with them. In the joint evaluations we could neither During the course we continuously According to our experiences over the last observe noticeable changes during the evaluated the students’ feedback and our 16 years we provide the following recom- years nor in between the students of differ- own experiences in order to regularly dis- mendations for establishing joint inter- ent universities. Although the questions of cuss potential improvements. Since it was national courses, independent of a particu- the joint evaluation were on the Frank – always a challenge to identify similar clini- lar subject: van Swieten Lectures as a whole, responses cal/hospital areas in the different partici- • Starting point should be a consensus focussed to some extent on the Joint Three pating medical centers we had the idea to about teaching material, which is ideally Days, as the evaluation took place there. analyse and compare enterprise functions published with easy access for all par- of the hospitals instead. This, however, did ticipants, e. g. published as text book or not prove successful, as it was much more provided by an e-learning course. 3. Lessons Learned and difficult or even impossible to identify one • The contents of this teaching material Recommendations contact person per enterprise function. So should be taught at each participating we finally continued with the clinical/hos- university before a joint meeting takes 3.1 Lessons Learned pital areas. place (in our case the Joint Three Days). As our students’ feedback was clearly posi- Anyway, for participating in the Frank – • At the beginning of the joint meeting an tive (cf. chapter 2.4), we were encouraged van Swieten Lectures it is necessary to have initial lecture is helpful to start com- to continue with the course for now 16 good connections to a local teaching hospi- munication with a joint terminology. years. The mostly highlighted aspects were tal where students are granted access to • Offer team building activities at the first the exchange, the communication and the clinical departments and can interview evening with mixed groups, so that stu- joint activities with students from other hospital staff. dents from different universities start to universities, even of different nations. This Very effective was the idea to integrate interact on a relaxed basis. shows us the relevance of such an inter- site visits into the Joint Three Days of the • It is crucial to identify similar areas for national teaching effort. Frank – van Swieten Lectures. During the analyses at each of the participating As teachers in the field of HIS we ob- last years we have established that the host- hospitals and to have good contacts to serve an ongoing importance of strategic ing university offers our students visits to people working there to organize the information management for medical in- certain clinical/hospital areas, which are in- field work. If possible each group of stu- formatics students and graduates. The Joint troduced by local staff. dents should have a counterpart from Three Days of the Frank – van Swieten Most interestingly, there is currently another university with the same scope Lectures show us each year that there are hardly any interaction among students in order to improve comparability and significant differences in the information from different universities outside the Joint to stimulate discussions. systems of the hospitals of the different Three Days. Although a collaboration plat- • During the field work close mentoring sites. Most interestingly these differences form had been offered over many years, the by an experienced teacher should be were bigger in the past. We now have real- students did not use it. However, especially provided. ised that the information architectures of for a course with participants from differ- • Motivate students to use a collaboration the local hospital information systems ent universities an e-learning platform like platform and initiate students’ interac- started to converge. For example, in all hos- Moodle or Ilias could provide joint teach- tion before the joint meeting. pitals, a communication server is used as a ing materials, video-recorded lectures, a • Establish a quality management of the central component, and ‘patient manage- discussion forum for the student groups, lectures, e. g. by annual staff meetings to ment system’, ‘digital archiving system’ and knowledge tests and evaluation forms. This discuss experiences and limitation and ‘picture archiving and documentation sys- could strengthen the students’ perception to continuously improve the structure tem’ are major hospital-wide application of the Frank – van Swieten Lectures as an and processes of the international components. This used to be far more het- international course beyond the three joint course. erogeneous a decade ago. This shows the days. • Make sure that the participation in the evolution of the field. In the next future The Joint Three Days are most helpful joint meeting is voluntary, but provide more detailed implementation aspects and for the international exchange and are credit points for it. often filled with an intensive program. The

• Students in a master program might • A lot of institutions perform inter- courses on HIS, such as the Frank – van have more skills for systems analysis, for national collaborations in biomedical Swieten Lectures. team work, and for English presentation and health informatics (c.f. c1). In order than students in a bachelor program to support knowledge transfer from US Acknowledgment and might therefore have a greater ben- universities to Peru a bilateral (c2) col- efit. laborative training program between Our universities and their sponsoring as- • An important prerequisite for inter- the Universidad Peruana Cayetano sociations generously and continuously national collaborations in teaching are Heredia and the University of Washing- supported our Frank – van Swieten Lec- national funds supporting academic ton is working since 1999. Undergrad- tures, despite of all challenges, such an un- teaching purposes. Every year, the par- uates are educated in Peru whereas key usual joint international course is causing. ticipating groups are confronted with Peruvian faculty members undergo in- The hospitals at Amsterdam (AMC), the problem of financing the students’ tensive trainings in the US [36]. Braunschweig (Braunschweig Medical trips to another city or country for the • c 6, i.e. adding visits and systems analysis Center), Heidelberg (Heidelberg University joint lectures. Unfortunately, from a of real-life HIS to lectures on HIS, is Hospital), Innsbruck (TILAK) and Leipzig German perspective we could not find used in other programs as well [37]. (Leipzig University Hospital) always made appropriate dedicated funding pro- • Training computer science students for it possible that our students could visit and grams for such recurring short-term ex- careers in global software projects (c7) analyze their clinical, administrative and IT cursions. E.g., the PROMOS funds, of- dealing with different cultural back- departments. Last, but not least, our stu- fered by the German Academic Ex- grounds (c8) is a mayor driver for a dents continuously helped us during the change Service for German Students, Swedish-US collaboration. Rose-Hul- last 16 years to improve this course by are not available in certain universities, man Institute of Technology (US) and evaluating our lectures and by providing us for study trips within Germany, and for Uppsala University (Sweden) define with many constructive ideas and helpful foreign students studying at German joint software projects in a real world comments*. We cordially want to thank all universities. environment (c.f. c6) and elected stu- of them. dents (c4) from US will come to Sweden to finalize the project with their Swedish On the Authors‘ Roles at the Frank – fellow students [38]. 4. Discussion van Swieten Lectures • Since financial issues are considerable The recommendations made in section 3.2 barriers for physical exchange of stu- Within the Frank – van Swieten Lectures actually intend to encourage readers to dents in an international setting (c7) the authors had the following roles: E.A. copy this program. Nevertheless we are some educational collaboration projects has been lecturer at UMIT from 2005 to aware of the fact that these recommen- use digital communication media for 2013, assistant lecturer at the University of dations are based on subjective experiences virtual collaboration as for example in a Heidelberg in 2001 and at UMIT in 2002. and by no means evidence based – al- joint Swedish-US nursing education P.K. has been lecturer at the University of though they are backed up by repeated and program [39]. Heidelberg since 2008. A.W. has been lec- ongoing evaluations. • Adopting the long tradition of so called turer at the University of Leipzig since Of course, we are aware that having a master classes in the performing arts a 2009. A.W.B. has been asked to search for partnership between three German, one particular master class in health in- appropriate names for the course and sug- Austrian and one Dutch University is not a formatics had been established [40]. gested the names Johann Peter Frank and very broad international collaboration. For This educational program was also ad- Gerard van Swieten. O.J.B. has been assist- students as well as teachers it would be dressing international collaboration (c1) ant lecturer at the University of Braun- even more exciting to have partners from and physical gathering of students and schweig from 2005 to 2007. M.G. has been countries with more different languages lecturers at one site (c7). But – as usual assistant lecturer at the University of Hei- and cultural backgrounds. In this case the with such master classes – there is no delberg since 2014. B.H. has been assistant financial and organisation hurdles might preceding joint course (c3 – c6) and no lecturer at the University of Braunschweig turn out to become even bigger. So, in our practical part (c6). in 2014. W.O.H. has been assistant lecturer opinion, a good compromise should be es- at UMIT from 2009 to 2013. N.H. has been tablished. However, to our knowledge, the combi- assistant lecturer at the University of The idea of supporting education, es- nation of the characteristics c1 to c8, de- Braunschweig from 2005 to 2008. G.H.B. pecially in biomedical and health infor- scribed in section 2.1, in one program, matics, by international collaboration is makes the Frank – van Swieten Lectures not unique. Also, the characteristics c1 to unique. c , mentioned in section 2.1 may be found Although associated with considerable * Some of them – B.H., W.O.H., N.H., G.H.B., C.M., 8 B.O., J.S., N.S., A.S. and M.v.d.H. – became them- in other programs and courses as well as additional efforts, we can clearly recom- selves lecturers after having been participating in can be seen by the following examples: mend establishing such international this course as student!

MethodsLicense terms: Inf Med CC-BY-NC-ND Open/2017 (https://creativecommons.org/licenses/by-nc-nd/4.0) © Schattauer 2017 E. Ammenwerth et al.: On Teaching International Courses e47 has been assistant lecturer at UMIT from 6. Reichertz PL. Hospital information systems – past, 22. Jaspers MW, Gardner RM, Gatewood LC, Haux R, present, future. Key-note address during ‘Medical Schmidt D, Wetter T. The International Partner- 2003 to 2006. F.J. has been assistant lecturer Informatics Europe 84’, 5th Congress of the Euro- ship for Health Informatics Education: lessons at the University of Leipzig since 2009. pean Federation for Medical Informatics, Brussels, learned from six years of experience. Methods Inf M.W.J. has been among the initiators of September 10–13, 1984. Reprinted and first pub- Med. 2005; 44: 25–31. this course in the context of IΦE. U.K. has lished in [7]. 23. Haux R, Ammenwerth E, ter Burg WJ, Pilz J, 7. Kuhn KA, Giuse DA. From hospital information Jaspers MW. An international course on strategic been lecturing parts of the course at the systems to health information systems. Problems, information management for medical informatics University of Heidelberg since 2010. challenges, perspectives. Methods Inf Med. 2001; students: aim, content, structure, and experiences. C.M.(†) has been assistant lecturer at 40: 275–287. Int J Med Inform. 2004; 73: 97–100. UMIT in 2007. B.O. has been assistant lec- 8. Haux R. Health information systems – past, pres- 24. Jaspers MW, Ammenwerth E, Ter Burg WJ, Kaiser ent, future. Int J Med Inform. 2006; 75: 268–281. F, Haux R. An international course on strategic in- turer at the University of Braunschweig 9. Reichertz PL. Hospital information systems – past, formation management for medical informatics since 2016. J.P. has been assistant lecturer at present, future. Int J Med Inform. 2006; 75(3–4): students: international perspectives and evalu- the University of Heidelberg in 2008 and 282–299. ation. Int J Med Inform. 2004; 73: 807–815. 2009. J.S. has been assistant lecturer at the 10. Haux R. Medical informatics: past, present, future. 25. Haux R, Winter A, Ammenwerth E, Brigl B. Stra- Int J Med Inform. 2010; 79: 599–610. tegic information management in hospitals. An in- University of Braunschweig since 2012. As 11. Jahn F, Issler L, Winter A, Takabayashi K. Compar- troduction to hospital information systems. New CIO, C.S. has been and is involved in pres- ing a Japanese and a German hospital information York: Springer; 2004. enting Braunschweig Medical Center’s in- system. Methods Inf Med. 2009; 48: 531–539. 26. Winter A, Haux R, Ammenwerth E, Brigl B, Hell- formation system. As CIO, J.E.S. has been 12. Stroetmann KA, Artmann J, Stroetmann V. Devel- rung N, Jahn F. Health information systems – oping national eHealth infrastructures – results architectures and strategies. London: Springer; involved in presenting the information sys- and lessons from Europe. Proc AMIA Ann Symp. 2011. tem of the University of Amsterdam’s Aca- 2011: 1347–1354. 27. Winter A, Haux R. A three-level graph-based demic Medical Center. As CIO, S.S. has 13. Winter A, Ammenwerth E, Bott OJ, Brigl B, Bu- model for the management of hospital informa- chauer A, et al. Strategic information management tion systems. Methods Inf Med. 1995; 34: 378–396. been and is involved in presenting the in- plans: the basis for systematic information man- 28. Winter A, Brigl B, Funkat G, Häber A, Heller O, formation system of the University Hospi- agement in hospitals. Int J Med Inform. 2001; 64: Wendt T. 3LGM2-modeling to support manage- tal of Leipzig. K.S. has been assistant lec- 99–109. ment of health information systems. Int J Med In- turer at the University of Heidelberg from 14. International Medical Informatics Association, form. 2007; 76: 145–150. Working Group 1: Health and Medical Informatics 29. Stäubert S, Schaaf M, Jahn F, Brandner R, Winter 2008 to 2013. N.S. has been assistant lec- Education. Recommendations of the International A. Modeling Interoperable Information Systems turer at the University of Braunschweig in Medical Informatics Association (IMIA) on edu- with 3LGM2 and IHE. Methods Inf Med. 2015; 54: 2008 and 2009. A.S. has been assistant lec- cation in health and medical informatics. Methods 398–405. turer at the University of Leipzig in 2012. Inf Med. 2000; 39: 267–277. 30. Brechka FT. Gerard van Swieten and his world 15. Mantas J, Ammenwerth E, Demiris G, Hasman A 1700–1772. The Hague: Martinus Nijhoff; 1970. M.v.d.H. has been assistant lecturer at the et al; IMIA Recommendations on Education Task 31. Fernández-Guerrero IM, Fernández-Guerrero C, University of Heidelberg from 2003 to Force. Recommendations of the International Fernández-Cano A: A pioneering on medical edu- 2006. R.H. was among the initiators of this Medical Informatics Association (IMIA) on Edu- cation: The seminal text of J. P. Frank’s De medicis course in the context of IΦE and has been cation in Biomedical and Health Informatics. First peregrinationibus – Medical travels (1792). Educa- Revision. Methods Inf Med. 2010; 49: 105–120. ción Médica. 2016; 17: 29–34. lecturer since 2001, from 2001 to 2005 at 16. Knaup P, Frey W, Haux R, Leven FJ. Medical in- 32. Frank JP. A system of complete medical police. the University of Heidelberg, from 2001 to formatics specialists: what are their job profiles? Baltimore: Johns Hopkins University Press; 1976. 2004 at UMIT, and since 2005 at the Uni- Results of a study on the first 1024 medical in- 33. Gerster AG. The life and times of Gerhardt van versity of Braunschweig. W.J.t.B. has been formatics graduates of the Universities of Heidel- Swieten. Johns Hopkins Hosp Bull. 1909; 20(219): berg and Heilbronn. Methods Inf Med. 2003; 42: 161–168. course coordinator and lecturer at the Uni- 578–587. 34. Sechel TD. The emergence of the medical profes- versity of Amsterdam since 2001. 17. Mantas J, Diomidous M. Implementation and sion in Transylvania (1770–1848). In: Karady V, evaluation of the MSc course in health informatics Török BZ, editors. Cultural dimensions of elite in Greece. Methods Inf Med. 2007; 46(1): 90–92. formation in Transylvania (1770–1950). Cluj-Na- 18. Nøhr C, Sørensen M. The Career Paths for Masters poca: EDRC Foundation; 2008. p. 95–114. References in Health Informatics in Denmark. Paper pres- 35. Sigerist H. The people’s misery: mother of dis- ented at IMIA Working Group on Health and eases. An address, delivered in 1790 by Johann 1. World Health Assembly. Fifty-eighth Assembly Medical Informatics Education Meeting. Building Peter Frank in Pavia. Translated from the Latin, (May 16–25, 2005), Resolution WHA58.28 [cited Worldwide Capacity for the Health Informatics with an introduction. Bull Hist Med. 1941; 9: 2016 May 15]. Available from: http://www.who. Workforce, Buenos Aires, Argentina; 2008 [cited 81–100. int/healthacademy/media/WHA58–28-en.pdf. 2016 June 19]. Available from: http://vbn.aau.dk/ 36. Curioso WH, Fuller S, Garcia PJ, Holmes KK, 2. Healy JC. The WHO eHealth Resolution – eHealth files/16597939/The_ Career_Paths.pdf. Kimball AM. Ten years of international collabor- for all by 2015? Methods Inf Med. 2007; 46: 2–4. 19. Ammenwerth E, Hackl WO. Job Profiles of Bio- ation in biomedical informatics and beyond: the 3. Al-Shorbaji N. The World Health Assembly reso - medical Informatics Graduates. Results of a Grad- AMAUTA program in Peru. J Am Med Inform lutions on eHealth: eHealth in support of universal uate Survey. Methods Inf Med. 2015; 54: 372–375. Assoc. 2010; 17: 477–480. health coverage. Methods Inf Med. 2013; 52: 20. Macedo AA, Ruiz ES, Baranauskas JA. Survey of 37. Haux R, Ammenwerth E, Häber A, Hübner-Bloder 463–466. the Job Profiles of Biomedical Informatics Grad- G, Knaup-Gregori P, Lechleitner G, Leiner F, 4. World Health Organization. Global Observatory uates. Methods Inf Med. 2016; 55: 473–477. Weber R, Winter A, Wolff AC. Medical infor eHealth [cited 2016 May 14]. Available from: 21. Jaspers MW, Gardner RM, Gatewood LC, Haux R, formatics education needs information system http://www.who.int/goe/en/. Leven FJ, et al. IPHIE: an International Partner- practicums in health care settings – experiences 5. Kay M, Santos J. Report on the World Health Or- ship in Health Informatics Education. Stud Health and lessons learned from 32 practicums at four ganization Global Observatory for eHealth stra- Technol Inform. 2000; 77: 549–553. universities in two countries. Methods Inf Med. tegic planning workshop, April 2008. Methods Inf 2006; 45: 294–299. Med. 2008; 47: 381–387.

38. Laxer C, Daniels M, Cajander A, Wollowski M. Prof. Dr. Petra Knaup Prof. Dr. Reinhold Haux Evolution of an International Collaborative Stu- dent Project. ACE ’09 Proceedings of the Eleventh Institute of Medical Biometry and Peter L. Reichertz Institute for Medical Australasian Conference on Computing Edu- Informatics Informatics cation. 2009; 95: 111–118. University of Heidelberg University of Braunschweig – Institute of 39. Wihlborg M, Friberg E. Framework for a virtual Im Neuenheimer Feld 130.3 Technology and Hannover Medical School nursing faculty and student learning collaboration between universities in Sweden and the United 69120 Heidelberg Mühlenpfordtstr. 23 States: A theoretical paper. Nurse Educ Today. Germany 38106 Braunschweig 2016; 41: 50–53. E-mail: Germany 40. Gatewood L, Limburg M, Gardner R, Haux R, [email protected] E-mail: [email protected] Jaspers M, Schmidt D, et al. International Master Classes in health informatics. Int J Med Inform. 2004; 73: 111–116. Prof. Dr. Alfred Winter Willem Jan ter Burg, MSc Institute for Medical Informatics, Statistics Department of Medical Informatics and Epidemiology Academic Medical Center Addresses of First and Senior Authors University of Leipzig University of Amsterdam Prof. Dr. Elske Ammenwerth Härtelstr. 16–18 P.O.Box 2 22700 Institute of Medical Informatics 04107 Leipzig 1100 DE Amsterdam UMIT – University for Health Sciences, Germany The Netherlands Medical Informatics and Technology E-mail: [email protected] E-mail: [email protected] Eduard-Wallnöfer-Zentrum 1 6060 Hall in Tirol Austria E-mail: [email protected]

MethodsLicense terms: Inf Med CC-BY-NC-ND Open/2017 (https://creativecommons.org/licenses/by-nc-nd/4.0) © Schattauer 2017