|Home | About | Journals | Submit | Contact Us | Français|
CONFLICT OF INTEREST: NONE DECLARED
Last two years, the health informatics profession celebrated five jubilees in Bosnia and Herzegovina: thirty years from the introduction of the first automatic manipulation of data, twenty years from the establishment of Society for Medical Informatics BiH, fifteen years from the establishment of the Scientific and Professional Journal of the Society for Medical Informatics of Bosnia and Herzegovina „Acta Informatica Medica“, fifteen years on from the establishment of the first Cathedra for Medical Informatics on Biomedical Faculties in Bosnia and Herzegovina and five years on from the introduction of the method of “Distance learning” in medical curriculum. The author of this article are eager to mark the importance of the above mentioned Anniversaries in the development of Health informatics in Bosnia and Herzegovina and have attempted, very briefly, to present the most significant events and persons with essential roles throughout this period.
All five of the mentioned activities in the area of health informatics had special importance and gave appropriate contributions to the development of health informatics in Bosnia And Herzegovina. The Society for Medical Informatics of Bosnia and Herzegovina gathered the most eminent experts, mostly medical doctors with various specialties (we belong among countries who are members of the European Federation of Medical Informatics – EFMI, which involve the largest number of health professionals). BiH Society became a member of European Federation of Medical Informatics – EFMI during the war in 1994, and in the same year, a member of the International Medical Informatics Association – IMIA. In 2005 the Society for Medical Informatics of Bosnia and Herzegovina were given the opportunity to organize the 22nd European Congress of Medical Informatics in Sarajevo and in 2009 a prestige event and merit to BiH experts in medical informatics. This international rating has reached just a few similar societies in Europe and around the World.
It should especially be pointed out that the professionals and experts of health informatics in Bosnia and Herzegovina have given important contributions to the promotion of this medical discipline through several studies and projects, from the building and realization of information systems at certain levels of healthcare to introducing modern education models in biomedicine using contemporary information technologies (8,9,10).
The authors of this article are eager to mark the importance of the above mentioned Anniversaries in the development of Health informatics in Bosnia and Herzegovina and have attempted, very briefly, to present the most significant events and persons with essential roles throughout this period (1,2).
Health (medical) informatics as a separate scientific discipline began to be effective in academic institutions at the end of the 70’s by the presentation of actual accomplishments in this area in under and postgraduate education at biomedical faculties. As a specialized discipline, health informatics has its rudiments in Bosnia and Herzegovina (BiH) in the beginning of the past century (20th), when experts, mostly graduates from the Vienna Medical Faculty, began their professional Careers in our country. Those who were more involved in the area of health statistics started to be intensely interested in the application of health technologies in health science.
Officially, health informatics has been used in BiH after the Second World War in Public health institutes on a regional level, special emphasis should go to the contribution of Fuad Secerbegovic, being manager of the department for health statistics of Public health institute of Bosnia and Herzegovina from 1972 to 1995, after Evgenije Serstnev, the first chef of that Department (1946-1971). From 1977 the automatic analysis of health data in the above institutions was introduced gradually thanks to the engagement of Fuad Secerbegovic, who has published annual reviews and summary health statistics reports in BiH and utilization of health capacities under the title “Network, capacities and services of health institutions in BiH”. The first health data was collected and processed by computers by the Company „Energovinvest“ Ltd in Sarajevo during that year.
By the end of the 70’s of the previous century, at the University of Sarajevo Health informatics under the subject Social medicine and organization of health care as well as on postgraduate studies of the same faculty was being taught. During 1992, the first year of the War, the Cathedra for Medical Informatics was established at the Medical Faculty, University of Sarajevo, and later on at other medical faculties in Bosnia and Herzegovina with a certain number of hours of theoretical and practical education. Currently, curricula are being adapted using the principles of Bologna process and declaration.
Initiation, development and implementation of some informatics activities, the automatic manipulation of health data and the intensive use of information technologies for the need of diagnostics, therapy and patient rehabilitation on all levels of care in BiH health system started to be solved systematically by the end of 70’s and beginning of the 80’s. A crucial decision with a state charter was made in 1981, when the BiH government made a decision to start with work on the project “Development of BiH health information system”. Before the project, it was the completed study/analysis “Social-economical position of the health system in BiH”; based on that the BiH parliament approved the preparation of the appropriate project, this should have made modernization of the information system of health care. Basically, this project was to modernize and make automatic, the well developed and functional health statistics system in Bosnia and Herzegovina, which was part of an also well organized (centralized) Yugoslav health statistics system lead by the State Public Health Institute Belgrade. Project “Development of information system of health care BiH in circumstances of electronic data manipulation” was approved by the Executive Board of Association of healthcare communities BiH. On the 8th December 1983, eight companies applied for the tender, a contract was signed with the Intertrade Company from Ljubljana, Slovenia. In 1985 after positively assessed revisions the project was adopted and in the same year began its implementation after financial funds were assured.
In 1985 the Electronic calculation centre of health and retirement insurance Sarajevo (ERC ZIPO) was established . The act itself, culminated in the establishment of a centre, was “Elaborate about social-economic finding of establishing working unit for manipulation of electronic data for health and retirement insurance fund”. For a number of years the centre was lead by engineer Mirza Ceric. Unfortunately, this very well designed project, content of activities, as well as part of completed tasks in regard to the procurement of hardware and production of software applications, has never been completed and realized in practice. The concept of centralization of data manipulation in the architecture proposed in the ZIS BiH project (central host and analysis in Sarajevo, regional analysis in eight centres in BiH and local in 109 municipalities) has never been finalized and fell down. It was utopia which has no chance to be realized in practice. It is true that some of the designed activities were started at an institutional level, but never reached their end as Clinical information system of the University clinical centre in Sarajevo, which was one of the biggest projects in area of development and construction of medical information systems. From 23 companies bidding on the tender, IRIS (eminent Company for hardware and software and part of Energoinvest Company, fourth biggest company in formal Yugoslavia) was chosen and has spent almost ten years working on the Study, Initiative design and Main project of Clinical information system of the University clinical centre in Sarajevo.
This project was also unfinished due to the War. Already procured hardware and designed software for some applications from the project (Medical subsystem, Diagnostics-polyclinic subsystem, Administrative-technical subsystem and Financial-economical subsystem) were destroyed or in the meantime lost their usefulness. The biggest progress was made in the development of information system for the pharmaceutical sector (only in Sarajevo the system connected 43 pharmacies in a centralized system of receipt collection and analysis). Besides the University clinical centre in Sarajevo, certain health institutions in Bosnia and Herzegovina started with the development of local and unique health information systems. The first Local Health Information System was created and used in Sarajevo in the year 1982 when Izet Masic and Arif Agovic tested special designed Health data bases for the supervision of approximately 6.000 citizens – users of health care services at the Community health centre „Visnjik“ in Sarajevo. Health data was processed by a specially designed software package ARCHIVE on a Personal Sinclair QL computer, later redesigned in Clipper and DBASE III and FoxBASE. After 3 years of testing those data bases Izet Masic graduated first master thesis within Health informatics – it was the first defended master thesis in that field in any of the Balkan countries. During the war (1992-1995), and after the war, a lack of appropriate financial funds, and many other factors influenced the interruption of the planned activities, especially, having in mind how those activities were recommended in project plans regarding system development and perception.
The Ministry of Health and Social Welfare of Socialistic Republic BiH set up a Commission for a health information system. The Commission was put in charge to assess the above projects, concept, content of data necessary to collect, methods and methodology, information flow, functionality, rationality and efficiency. The Chair person for the Commission was Izet Masic and members were: Irfan Zulic, Zoran Ridjanovic, Gojko Babic, Nedzad Mehic, Stevica Krsmanovic, Mirza Ceric, Mustafa Hasovic and Naim Grebo. In spite of the fact that this Commission was very successful, in the last three structures of the Ministry of Health there is no such body.
The need for additional education of health professionals was realised after the first application of electronic data manipulation. For physicians in primary health care and in clinics, in order to perform their duties in a high quality manner, must have been up to date with the latest accomplishments in medicine and health. Since the 60’s the development of information technologies has had a quantitative and qualitative growth especially in diagnostics and therapy, and health workers had to follow that. The International Federation for Information Processing (IFIP) in the early 60’s organized expert teams whose task was to develop strategy, concepts and content of under and postgraduate medical education. At a later date the IFIP separated and formed the IMIA – International Medical Informatics Association and EFMI – European Federation for Medical Informatics. Working groups in those scientific and expert associations, with their recommendations, defined education for medical informatics on three levels:
First, informatics education which should provide general knowledge to users and data analysis on the place of their generation, and on all places of collecting data in health system (physicians of all specializations, nurses and paramedical staff).
Second level, informatics education of this level is in regard to medical staff which was directly involved in collection, manipulation, analysis and interpretation of health data. This kind of education was expanded with skills, knowledge and practical applications which are necessary for personnel on this level.
The Third level is basically a very wide and highly specialized education for experts in the health sector who would like to be professionally involved in this kind of work. In BiH there has never been an accepted proposal for introducing sub-specialization from medical informatics in spite of the fact that authors of this paper put a lot of effort and energy into making it official. It is a fact that at some universities in European countries there are separate faculties or universities for graduates with the title of engineers of health informatics.
There are five medical faculties in Bosnia and Herzegovina (Sarajevo, established in 1946; Tuzla, established in 1976; Banja Luka, established in 1986; Foca, established in 1994; and Mostar, established in 1997). At all the faculties, since 1992 and later, cathedras for medical informatics were established and/or introduced as independent subjects: medical informatics or health informatics, bioinformatics, etc. In principle, 60-70% of the curriculum are the same, or very similar; the only difference is that the chiefs of some cathedras are medical doctors and of others are professors, engineers, mathematicians or economists with the title of MSc or PhD in this area. Most of those cathedras have web sites where students can check the number of hours and content to be taught.
Openly speaking in undergraduate education until 1992 when medical informatics was introduced as an independent subject at the Medical Faculty, University of Sarajevo just some lectures were taught; those were methodological units in that time very important for health practice (medical documentary with two teaching hours and health information systems also two teaching hours) under the subject of Social medicine and organization of health care and Professor Izet Masic. from 1979 on Postgraduate education at the Medical Faculty, University of Sarajevo there were subject Health informatics led by the pioneer of health informatics in ex-Yugoslavia Prof Gjuro Dezelic, PhD using concept, content and methodology at the Medical Faculty, University of Zagreb. In the school year 1970-1971 at the Medical Faculty, University of Zagreb was introduced “Basic Informatics” (named Use of electronic computers in health care) as obligatory subject for 6th semester students with a duration of 15 school hours. A similar programme was at postgraduate studies at the same faculty under the subject “Introduction in scientific work”. In 1973 a separate cathedra for “Basics of Informatics” was established since it was obvious to make a distinction between those two areas. Both, under and postgraduate students had the chance to attend “Techniques of programming electronic computers” for a duration of 20 school hours. In 1973 the subject at postgraduate studies “Analysis of health data by methods of informatics and statistics” for a duration of 20 hours it was introduced.
Since 1985, Professor Izet Masic took over the leader position and with the help of Professor Gjuro Dezelic and Professor Arif Smajkic launched a separate course “Informatics and Economics in Health” for a total duration of 30 hours. Numbers of postgraduate students became MSc and PhD in this subject, and some of them became professors and assistants in BiH universities and abroad. Since 1992 at the Medical Faculty, University of Sarajevo there have been Cathedra for Medical Informatics. The content of education is 30 hours of theoretical and 45 hours of practical education for students of the Medical Faculty, 15+15 hours for students of Faculty of Dental medicine and 30+30 hours for students of College of Noursing. From 2002 the subject is split into two parts: Basics of medical informatics with funding of 15+15 hours in the second semester of studies and Applicative medical informatics with funding of 15+45 hours in the eleventh semester. The final exam is due after the 11th semester. Curriculum, teaching materials, application for the exam, the exam itself and checking of results are possible at the web site (www.imasic.org/mi). Also, since 2002 at Cathedra for Medical informatics the project “Distance learning in biomedicine” is in progress which allows students to use an electronic way of learning and to pass their exams in this subject. This method of education is in a pilot phase and waiting for official approval from the appropriate institutions in charge for high education. In total, education from Medical informatics gained 2500 students. At postgraduate students of The Medical Faculty, University of Sarajevo there are subject Medical Informatics with funding of 15+15 hours and this type of education enabled over 800 medical doctors all medical specializations. In progress is the adaptation of curriculum of neighbouring countries in Medical informatics and content of methodological units with the Bologna process.
All the above mentioned activities could not have been realized in practice without strategies and concepts developed by professionals and experts in the area of medical informatics. In the early 80’s, first in Sarajevo, then in other towns within Bosnia and Herzegovina, mostly engineers of electro-technique start to be intensely interested for some segments of health informatics; some of them managed certain projects, besides others they were involved in preparation of design of software applications for the mentioned project ZIS BiH. They have been followed by ambitious physicians who could see in the new information technologies a future and practical help in performing their everyday jobs. Pioneers in this area were: Izet Masic, Zoran Ridjanovic, Benjamin Djulbegovic, Sead Beganovic and others who attended professional meetings and workshops with appropriate topics from medical informatics. They were supported by Professor Abdulah Konjicija who in 1984 started to introduce mathematical models in diagnostics and therapy of certain diseases, and altered with mentioned experts algorithms for curing the phases of a disease.
Later, those experts began to work more closely on some parts of the medical informatics for which they had an affinity. Some of them have prepared papers and presentations for specially organized symposiums “BiH days of informatics” held annually on the mountain of Jahorina near Sarajevo from the year 1976. In October 1987 a group of experts within the field of Medical informatics decided at General Assembly to set up an independent Society for medical informatics of Bosnia and Herzegovina which was joined with similar independent societies from Croatia, Slovenia and Serbia (established at General assembly on February 16th 1989 at Andrija Stampar School in Zagreb, Croatia) as the Association of societies for medical informatics of Yugoslavia.
The President of the Association board was Gjuro Dezelic, and members were Stefan Adamic, Rajko Vukasinovic and Izet Masic. In 1990 this association became a member of the European Federation for Medical Informatics and was officially accepted on the EFMI Council in Glasgow. The EFMI Council in Glasgow was attended by Gjuro Dezelic and Izet Masic who, in the same year, organized the First Congress of Medical Informatics in the Sava centre in Belgrade on December 6th- 8th which was opened by the EFMI president (at the time) Stellan Bengtsson. Over 500 delegates attended the First Congress of Medical Informatics.
In 1991 this association fell apart and each member established society at the level of new recognized states. The BiH society during the war year of 1992 became an independent professional organization and first of its kind in the independent state of Bosnia and Herzegovina. In the same year a group of society members (Izet Masic, Zoran Ridjanovic, Irfan Zulic, Aziz Hodzic, Zelimir Nastic, Ljubomir Kravec, Marijan Dover, etc.) kicked off the initiative for acceptance of the Society for Medical Informatics BiH in the European Federation for Medical Informatics. In 1994 the Society for Medical Informatics BiH became a member of the EFMI (EFMI Council decision in Lisbon) and IMIA (the Decision of the General Assembly in Dresden). It should be pointed out that much gratitude for those acceptances must go to President Stellan Bengtsson and Gjuro Dezelic, who, during unbelievable war conditions, carried out pre-activities over radio links with the establisher and first president of SMI BiH, Izet Masic. This was the only possible link from Sarajevo in that time. During incredible war conditions an official delegation (Izet Masic and Zoran Ridjanovic) attended the EFMI Council and were present at the official ceremony of this distinguished scientific association (Figure 1).
The War period (1992-1995) in Bosnia and Herzegovina Society for Medical Informatics was spent working very hard and in almost impossible conditions eight scientific and professional events were organized. At those events over 500 papers were presented which were published from the proceedings, which at that time was a real miracle and fantastic achievement having in mind that Sarajevo was under what was to be the longest siege any City has endured in history, added to this a severe lacking in electricity, water supply, gas and food. The siege of Sarajevo was to last for Approx: 1245 days without a break. Those materials found their way across Europe and they were recognized as a Sarajevo miracle at the time.
Serious activities of the Society follow on local and international level. The Society has organized a number of professional symposiums (eight in total so far) on the actual themes of:
The Society also organized the First congress of Medical Informatics of Bosnia and Herzegovina with international participation, held in Sarajevo in November 1999 and attended by 70 participants (from BiH, Croatia, Slovenia, Serbia and Montenegro, Macedonia, Norway, etc.) and officially opened by Professor Attila Naszlady.
The Second congress of Medical Informatics with international participation, organized in Sarajevo in May 2004 was officially opened by Professor Assa Reichert, president of the EFMI where 90 delegates from BiH, Croatia, Slovenia, Canada, Israel, Switzerland, Holland, United Kingdom, Germany, Norway, etc. Attended. During the congress the EFMI held a meeting of the EFMI Board, which consisted of: Assa Reichert, president; Robert Boaud, vice president; Jacob Hofdijk, secretary; Rolf Engelbrecht, vice president IMIA; Johan Bryden, executive officer; Patrick Weber, treasurer. Members of the Board carried out an official visit to Bosnia and Herzegovina with regard to SMI BiH and the City of Sarajevo for the organization of MIE2009. At the next meeting of the EFMI Council held in Munich in June 2004, the Board made a positive decision on the application and recommended to SMI BiH the preparation of the BID book for the following EFMI Council. Finally, on the EFMI Council meeting in Athens held on 18 March 2005, an official decision was made that Sarajevo will be the host of the 22nd European Congress of Medical Informatics – MIE2009 to be held in Sarajevo by end of August 2009.
The President and SMI BiH members were obliged to report to the next EFMI Council meeting about progress made in regard to preparations and activities for MIE2009. In Geneva, Switzerland on the 27th August 2005 Izet Masic, Ahmed Novo and Selim Toromanovic were present; in Timisoara, Romania on 7 April 2006 (Izet Masic) and Maastricht, the Netherlands (Izet Masic, Almir Dzananovic and Selim Toromanovic were present). Information on the above activities are described and published at www.mie2009.org. The SMI BiH also organized a Special Topic Conference named “eHealth and eEducation” in the premises of the rector of Sarajevo University on 20th December 2005. During the conference Professor Rolf Engelbrecht, as key speaker, held a tele-conference from Munich, Germany on “Tele-medicine in Germany”. It was the very first tele-lecture from biomedicine organized by our society. The event was organized with the support of ERICSSON and the International Society for tele-medicine and eHealth having in mind that the SMI BiH becomes an official member of the ISfTeH and Izet Masic a member of the ISfTeH Governing Council.
SMI BiH after establishing in 1993 launched the professional and scientific journal Acta Informatica Medica (AIM) and it has been published continuously for the past 14 years. At first AIM was published twice a year, then three times a year and since 2005 has been published quarterly. The Journal is published in the English language and it is currently in the process of indexation in global biomedical data bases. So far, it has published over 700 scientific papers, articles, editorials, case studies, and various actualities. The first Editorial Board in 1993 were: Izet Masic (editor-in-chief), Zoran Ridjanovic (assistant of editor-in-chief), Amra Redzepovic (secretary), Ljubomir Kravec (technical editor), Georgina Janjic (lector), Tatjana Prastalo (English translation). Editorial board members were: Kenan Ar-nautovic, Meho Basic, Mahmut Djapo, Zoran Hadziahmetovic, Dragan Huml, Mehmed Kantardzic, Mustafa Kulenovic, Nedzad Mehic, Miroslav Polomik, Nikola Rukavina, Borisa Telebak, Irfan Zulic. Teachers and associates involved in the education of students on post and undergraduate studies on biomedical faculties in Bosnia and Herzegovina during the past 15 years published a number of books, monographies, and other publications, some of which, have been translated into the English language. Also, BiH experts for medical informatics participate enthusiastically at European and world congresses of medical informatics with oral presentations or poster presentations. This is an opportunity to mention just some of the more important publications: Medical informatics I, by Izet Masic, Zoran Ridjanovic, 1994; Practicum for medical informatics by Izet Masic, Haris Pandza, 2000; Health ethics and data protection by Izet Masic, Zoran Ridjanovic, 2001; Medical informatics II by Izet Masic, Zoran Ridjanovic, 2001. Izet Masic and Ahmed Novo are also co-authors in a book “Advances in International Tele-medicine and eHealth around the world” edited by Wojciech Glinkowski (2006). An important part of medical informatics in Bosnia and Hercegovina has to be underlined-this is the System of biomedical scientific and professional information (Library system in BiH-SBMNI), developed by the group of medical librarians and informatics professionals in BiH (Ana Gerc, coordinator, librarians: Amila Čolaković, Tanja Benić, Jelena Koprivica, Miljenko Krsmanović etc..) during the period 1984-1990. That SBMNI was a part of the Yugoslavian system of biomedical informing, established 1980 in Belgrade, known as Biomedicina Iugoslavica, in other words Index Medicus Iugoslavicus as a secondary periodic publication. This was like a continuing work of Index Medicus Iugoslavicus (1966-1983) published by the General hospital »Dr. J. Kajfes», Zagreb and Biomedicina Slovenica published by the Institute for biomedical informatics Ljubljana since 1976. Scientific and professional articles published in indexed journals in former Yugoslavia were stored in computer host “System of biomedical, scientific and research information”, called Index Medicus Iugoslavicus/Biomedicina Iugoslavica. It included professional papers, monographies, master and PhD thesis, scientific reports and other similar documents published in the country and aboard. Gathering and editing documents was performed using the well known rules in SBMNI, based on MEDLARS standards in English. Biomedicina Iugoslavica had the three parts: lists of documents, content’s index, and author’s index that provided finding of a document by the content and by the author. Datas were interconnected by a current number of documents. It ceased to be published in 1991.
Society of Medical Informatics of Bosnia and Herzegovina (BHSMI) became a member of European Federation of Medical Informatics (EFMI) and International Medical Informatics Association (IMIA) in 1994, during terrible wartime in Bosnia and Herzegovina and Balkan region. During MIE ‘94 Conference in Lisbon, at my first participation at EFMI Council meeting, idea was born in my mind - to organize one of MIE Conferences in Bosnia and Herzegovina. I had many reasons for that. Candidature of BHSMI for one of MIE conferences to be organized in Sarajevo or any other part of Bosnia and Herzegovina became official in Sent Malo in 2003 at EFMI Council meeting. EFMI Board officially accepted nomination of Croatia and Bosnia and Herzegovina as co-organisers of MIE 2011. Just year after, in 2004, EFMI Board visited Sarajevo, spoke with most respectable political, scientific, cultural and other leaders and were assured that Sarajevo can be host one of MIE conferences. In 2005, in Athens, EFMI Council decided that MIE conference will be held in Sarajevo in 2009 (MIE 2009). After that decision, five long years of preparations started in order to organise the conference where participants from almost all medical-informatics community of Europe and the world will gather. From 30th August to 2nd September 2009 MIE 2009 Conference - highly rated scientific event of MIE was succesfully realized in Sarajevo. Most of paricipants noticed that Sarajevo Conference was THE BEST EVER MIE (Figure 3). We are proud for that and we will try to continue development of Medical informatics in our country. Key activity of the BiH SMI will be to enhance efforts on reconstructing a high education system in the country in accordance with the Bologna process. There are two areas which the focus of activities needs to be directed: under and postgraduate education and continuous medical education (CME) for health workers, medical doctors as well as nurses.