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Health information systems (HIS) are one of the most important areas for biomedical and health informatics. In order to professionally deal with HIS well-educated informaticians are needed. Because of these reasons, in 2001 an international course has been established: The Frank – van Swieten Lectures on Strategic Information Management of Health Information Systems.
Reporting about the Frank – van Swieten Lectures and about our students‘ feedback on this course during the last 16 years. Summarizing our lessons learned and making recommendations for such international courses on HIS.
The basic concept of the Frank – van Swieten lectures is to teach the theoretical background in local lectures, to organize practical exercises on modelling sub-information systems of the respective local HIS and finally to conduct Joint Three Days as an international meeting were the resulting models are introduced and compared.
During the last 16 years, the Universities of Amsterdam, Braunschweig, Heidelberg/Heilbronn, Leipzig as well as UMIT were involved in running this course. Overall, 517 students from these universities participated. Our students‘ feedback was clearly positive. The Joint Three Days of the Frank – van Swieten Lectures, where at the end of the course all students can meet, turned out to be an important component of this course. Based on the last 16 years, we recommend common teaching materials, agreement on equivalent clinical areas for the exercises, support of group building of international student groups, motivation of using a collaboration platform, ensuring quality management of the course, addressing different levels of knowledge of the students, and ensuring sufficient funding for joint activities.
Although associated with considerable additional efforts, we can clearly recommend establishing such international courses on HIS, such as the Frank – van Swieten Lectures.
Health information systems (HIS) were, are currently, and, as far as we can see, will also be in future one of the most important areas for biomedical and health informatics. There is a global consensus about their relevance for health care, which, e. g., led in 2005 to the World Health Assembly’s eHealth Resolution [1, 2, 3] and to the implementation of the World Health Organization’s Global Observatory for eHealth [4, 5]. Its importance has been emphasized in many publications of our scientific community (e. g. [6, 7, 8, 9, 10]).
In order to professionally deal with HIS, we need to understand their respective architectures and infrastructures (e. g. the architecture of the information system of a certain hospital, e. g. , or of a nation’s ‘eHealth infrastructure’, e. g. ), and we need to know how such information systems are adequately managed. In particular, its strategic information management is crucial, both for the quality of care and for the costs of information processing and storage (e. g. ).
For being able to do this, well-educated informaticians are needed. The International Medical Informatics Associations (IMIA) has raised this importance, when IMIA’s General Assembly adopted recommendations on health and medical education in 1999 , and confirmed the relevance for educating informatics students about HIS in its first revision in 2009 . Furthermore, graduates of educational programs in medical informatics frequently work in the area of health information systems [16, 17, 18, 19, 20].
Because of these reasons courses on health information systems and their management always played an important role in our universities’ educational programs. As our graduates’ work became more and more global, we decided in 2000 to establish an international course on this subject, at first under the umbrella of IΦE, the International Partnership for Health Informatics Education [21, 22]. Since its start in 2001, this course is focussing on the strategic information management of health information systems as well as on HIS architectures [23, 24]. For this course a textbook was written  and recently revised . Since 2005 our course has been called Frank – van Swieten Lectures on Strategic Information Management of Health Information Systems, or, briefly, Frank – van Swieten Lectures.
After having organized and taught the Frank – van Swieten Lectures during 16 years, we decided to review, summarize, and communicate our activities. Our objectives, which lead to this manuscript, are to report and share our knowledge
The lecture in general aims to give students the competence to answer the following questions (, p. 2):
The course content, based on the book presented in (), is organized into the following topics, each forming one book chapter:
The course is yearly organized in three blocks (► Figure 1):
Within the exercises, the students have to fulfil the following tasks:
The structure of the lecture remained mostly unchanged during the 16 years. There were minor adaptations, though, based on the lessons learned and the student evaluation, including a more detailed guideline for the students on how to structure both the oral and the written presentations.
This course is, to our knowledge, unique. There are eight characteristics being essential for the Frank – van Swieten Lectures:
The participating students come (with some variations over the last 16 years, for details see ► Table 1) from the Medical Informatics bachelor program of the University of Amsterdam, from the Medical Informatics master program of the University of Heidelberg / University of Applied Sciences Heilbronn, from the Medical Informatics master program of the University for Health Sciences, Medical Informatics and Technology (UMIT) in Hall in Tirol, from the Computer Science (in Economics) master program of the University of Braunschweig, and from the Computer Science master program of the University of Leipzig. Overall, 517 students from these programmes participated.
In June 2004, R.H. asked A.W.B. to give him the name of a famous physician who would be suitable as a patron for an International Course on Strategic Information Management in Health Information Systems with students from Amsterdam, Heidelberg/Heilbronn, and Hall in Tyrol (before 2005: Innsbruck), i.e. from the three educational programs, participating at that time in this course. A.W.B. suggested two historical figures who represented the trinational profile which was requested: Gerard van Swieten and Johann Peter Frank, two of the most outstanding medical representatives of Austria’s Enlightened Despotism between 1750 and 1800 [30, 31, 32, 33, 34, 35].
Gerard van Swieten (1700–1772) was born in Leiden/South Holland. He studied medicine and stayed in Leiden until 1745, when he became the personal physician of the Austrian Empress Maria Theresa (1717–1780) in Vienna. Van Swieten is well-known as a founder of the first Vienna Medical School and as a reformer of the Medical Faculty in Vienna. In this position he implemented a transformation of the Austrian health service and of medical education. Van Swieten played a pivotal role in the implementation of health reforms throughout the entire Habsburg Monarchy. He advocated more governmental involvement in health matters. The main sanitation reform, which had been put forward by van Swieten and was issued by Maria Theresa in 1770, reorganized administrative health structures in the entire monarchy. It comprised three parts: 1st the structure and function of the sanitary network and administration, 2nd the structure and the duties of medical practitioners, and 3rd the prevention of epidemics. Due to his organizational work van Swieten can be characterized as a medical manager – long before this term was coined. His son Gottfried van Swieten (1733–1803) had his own career in government service and is remembered as a friend and creditor of Wolfgang Amadé Mozart (1756–1791).
Johann Peter Frank (1745–1821) was a famous physician and hygienist born near Pirmasens in Germany. He first studied theology, later medicine at the Universities of Strasbourg and Heidelberg, where he earned his medical doctorate in 1766. In 1772 he became physician-in-ordinary to the Prince-Bishop of Speyer in Bruchsal. He was appointed professor of Physiology and Medical Police at the University of Goettingen in 1784, but only one year later he went to Italy and joined the Medical Faculty of the University of Pavia as the teacher of Clinical Medicine until 1795. Backed by the authority of the Austrian Emperor Joseph II (1741–1790), Frank reorganized the Medical School from the bottom. Clinical instruction was given by Frank in the hospital wards. He established a surgical clinic and required that medical students had to attend surgical courses and students of surgery medical courses. In 1795, Emperor Francis II (1768–1835) employed Frank for the regulation of the sanitary service of the army and as Director General of the Principal Hospital of Vienna. In 1804 he went to Vilnius in Lithuania as professor of Clinical Medicine. From 1805 to 1808 Frank served as the personal physician to the Russian Czar Alexander I (1777–1825) in St. Petersburg. In 1808, he retired in disappointment and went back to Vienna. Johann Peter Frank was an important protagonist in social medicine; between 1779 and 1819 he published 6 volumes of a System of Complete Medical Police, a comprehensive treatise on all aspects of hygiene and public health. Frank stressed the importance of keeping accurate statistical records for hospitals. His system of record compilation was used by obstetrician Ignaz Philipp Semmelweis (1818–1865) when in 1848 this one demonstrated the correlation between puerperal sepsis and unsanitary obstetrical practices.
Each year, the exercises within the Frank – van Swieten Lectures focussed on pre-defined sub-information systems. These sub-information systems were selected based on the availability of sufficient support in the respective departments, but also trying to have comparable sub-information systems in the participating universities, to allow forming of international student groups. ► Table 2 shows the analysed sub-information system in the last 16 years.
To evaluate the Frank – van Swieten Lectures we conducted during its Joint Three Days a systematic evaluation with a structured questionnaire based on closed questions. The survey instrument was developed by the teachers of the Frank – van Swieten Lectures in 2001 and was used since then. As the instrument was not designed as psychometric questionnaire, no formal validation was conducted. Data analysis comprised the descriptive results for each question.
The evaluation took place from 2001 until 2016, except 2003, 2013 and 2014. A total of 553 students participated over the years in the Frank – van Swieten Lectures and 452 students returned the questionnaire. The questionnaire has a rating scale of one to five with the following meaning: (1) totally disagree, (2) partly disagree, (3) agree/disagree, (4) partly agree, (5) totally agree. We combined the results (2001–2015) in a weighted average, taking into account the different number of students that participated each year.
Part A of the questionnaire was concerned with students opinions with regard to the overall structure, organization, content and outcome of the international course. The students indicted that they were sufficiently informed about the structure (M = 3.80) and organization (M = 3.62). The students felt that they were sufficiently prepared by the initial lectures offered at their home university for the exercises and the international part of the course (M = 3,83).
Part B of the questionnaire was concerned with the personal assessment of the international course with respect to study effort of the international course, the beneficial effect of the international course. The students indicated that they found the exercises interesting and useful (M = 3,93), the students learned from the joint HIS lectures (M = 3,85), and benefited from exchanging ideas with students from other nationalities and the international discussions and presentations (M = 4,18 and 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 hospital information systems with other international students (M = 3,76 and M = 4,21 respectively). The students indicated that they learned about other hospital information systems besides their own hospitals and had a better insight into healthcare systems (M = 4,00 and M = 3,97 respectively). Students indicated also that they improved their presentation skills and that they benefited with regard to professional knowledge and skills (M = 3,84 and M = 4.08 respectively). Finally the students enjoyed getting to know students from other nationalities (M = 4,49).
Part C of the questionnaire was concerned with the overall assessment of the international course. Students indicated that they benefited from the international course and would recommend other students to participate (M = 4,37 and M = 4,27 respectively). ► Table 3 shows details of this overall evaluation.
We also asked each student the questions (1) “What did you like best?”, (2) “What did you like least? Changes next time?” and (3) “Most important thing learned?”.
Here many responses of both (1) and (3) again positively highlighted the opportunity to meet and to collaborate with students from other countries and to communicate and to present in English. Also a better understanding of HIS architectures was often positively mentioned. Concerning (2) we received mainly comments on the intensive workload during the Joint Three Days and sometimes with respect to accommodation.
In the joint evaluations we could neither observe noticeable changes during the years nor in between the students of different universities. Although the questions of the joint evaluation were on the Frank – van Swieten Lectures as a whole, responses focussed to some extent on the Joint Three Days, as the evaluation took place there.
As our students’ feedback was clearly positive (cf. chapter 2.4), we were encouraged to continue with the course for now 16 years. The mostly highlighted aspects were the exchange, the communication and the joint activities with students from other universities, even of different nations. This shows us the relevance of such an international teaching effort.
As teachers in the field of HIS we observe an ongoing importance of strategic information management for medical informatics students and graduates. The Joint Three Days of the Frank – van Swieten Lectures show us each year that there are significant differences in the information systems of the hospitals of the different sites. Most interestingly these differences were bigger in the past. We now have realised that the information architectures of the local hospital information systems started to converge. For example, in all hospitals, a communication server is used as a central component, and ‘patient management system’, ‘digital archiving system’ and ‘picture archiving and documentation system’ are major hospital-wide application components. This used to be far more heterogeneous a decade ago. This shows the evolution of the field. In the next future more detailed implementation aspects and transinstitutional aspect may come into the focus of the analyses.
During all of the time when teaching the Frank – van Swieten Lectures we used 3LGM2 and UML for modelling hospital information systems. Since – to our knowledge – no better alternatives have shown up they proved its value and we will continue working with them.
During the course we continuously evaluated the students’ feedback and our own experiences in order to regularly discuss potential improvements. Since it was always a challenge to identify similar clinical/hospital areas in the different participating medical centers we had the idea to analyse and compare enterprise functions of the hospitals instead. This, however, did not prove successful, as it was much more difficult or even impossible to identify one contact person per enterprise function. So we finally continued with the clinical/hospital areas.
Anyway, for participating in the Frank – van Swieten Lectures it is necessary to have good connections to a local teaching hospital where students are granted access to clinical departments and can interview hospital staff.
Very effective was the idea to integrate site visits into the Joint Three Days of the Frank – van Swieten Lectures. During the last years we have established that the hosting university offers our students visits to certain clinical/hospital areas, which are introduced by local staff.
Most interestingly, there is currently hardly any interaction among students from different universities outside the Joint Three Days. Although a collaboration platform had been offered over many years, the students did not use it. However, especially for a course with participants from different universities an e-learning platform like Moodle or Ilias could provide joint teaching materials, video-recorded lectures, a discussion forum for the student groups, knowledge tests and evaluation forms. This could strengthen the students’ perception of the Frank – van Swieten Lectures as an international course beyond the three joint days.
The Joint Three Days are most helpful for the international exchange and are often filled with an intensive program. The time schedule is very tight and could easily be extended to four of five days to intensify the exchange and experiences. Nevertheless, we assume that this would exceed the reasonable effort given the universities’ processes.
According to our experiences over the last 16 years we provide the following recommendations for establishing joint international courses, independent of a particular subject:
The recommendations made in section 3.2 actually intend to encourage readers to copy this program. Nevertheless we are aware of the fact that these recommendations are based on subjective experiences and by no means evidence based – although they are backed up by repeated and ongoing evaluations.
Of course, we are aware that having a partnership between three German, one Austrian and one Dutch University is not a very broad international collaboration. For students as well as teachers it would be even more exciting to have partners from countries with more different languages and cultural backgrounds. In this case the financial and organisation hurdles might turn out to become even bigger. So, in our opinion, a good compromise should be established.
The idea of supporting education, especially in biomedical and health informatics, by international collaboration is not unique. Also, the characteristics χ1 to χ8, mentioned in section 2.1 may be found in other programs and courses as well as can be seen by the following examples:
However, to our knowledge, the combination of the characteristics χ1 to χ8, described in section 2.1, in one program, makes the Frank – van Swieten Lectures unique.
Although associated with considerable additional efforts, we can clearly recommend establishing such international courses on HIS, such as the Frank – van Swieten Lectures.
Our universities and their sponsoring associations generously and continuously supported our Frank – van Swieten Lectures, despite of all challenges, such an unusual joint international course is causing. The hospitals at Amsterdam (AMC), Braunschweig (Braunschweig Medical Center), Heidelberg (Heidelberg University Hospital), Innsbruck (TILAK) and Leipzig (Leipzig University Hospital) always made it possible that our students could visit and analyze their clinical, administrative and IT departments. Last, but not least, our students continuously helped us during the last 16 years to improve this course by evaluating our lectures and by providing us with many constructive ideas and helpful comments*. We cordially want to thank all of them.
On the Authors‘ Roles at the Frank – van Swieten Lectures
Within the Frank – van Swieten Lectures the authors had the following roles: E.A. has been lecturer at UMIT from 2005 to 2013, assistant lecturer at the University of Heidelberg in 2001 and at UMIT in 2002. P.K. has been lecturer at the University of Heidelberg since 2008. A.W. has been lecturer at the University of Leipzig since 2009. A.W.B. has been asked to search for appropriate names for the course and suggested the names Johann Peter Frank and Gerard van Swieten. O.J.B. has been assistant lecturer at the University of Braunschweig from 2005 to 2007. M.G. has been assistant lecturer at the University of Heidelberg since 2014. B.H. has been assistant lecturer at the University of Braunschweig in 2014. W.O.H. has been assistant lecturer at UMIT from 2009 to 2013. N.H. has been assistant lecturer at the University of Braunschweig from 2005 to 2008. G.H.B. has been assistant lecturer at UMIT from 2003 to 2006. F.J. has been assistant lecturer at the University of Leipzig since 2009. M.W.J. has been among the initiators of this course in the context of IΦE. U.K. has been lecturing parts of the course at the University of Heidelberg since 2010. C.M.(†) has been assistant lecturer at UMIT in 2007. B.O. has been assistant lecturer at the University of Braunschweig since 2016. J.P. has been assistant lecturer at the University of Heidelberg in 2008 and 2009. J.S. has been assistant lecturer at the University of Braunschweig since 2012. As CIO, C.S. has been and is involved in presenting Braunschweig Medical Center’s information system. As CIO, J.E.S. has been involved in presenting the information system of the University of Amsterdam’s Academic Medical Center. As CIO, S.S. has been and is involved in presenting the information system of the University Hospital of Leipzig. K.S. has been assistant lecturer at the University of Heidelberg from 2008 to 2013. N.S. has been assistant lecturer at the University of Braunschweig in 2008 and 2009. A.S. has been assistant lecturer at the University of Leipzig in 2012. M.v.d.H. has been assistant lecturer at the University of Heidelberg from 2003 to 2006. R.H. was among the initiators of this course in the context of IΦE and has been lecturer since 2001, from 2001 to 2005 at the University of Heidelberg, from 2001 to 2004 at UMIT, and since 2005 at the University of Braunschweig. W.J.t.B. has been course coordinator and lecturer at the University of Amsterdam since 2001.
* Some of them – B.H., W.O.H., N.H., G.H.B., C.M., B.O., J.S., N.S., A.S. and M.v.d.H. – became themselves lecturers after having been participating in this course as student!