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Access to electronic medical record systems is limited in many medical informatics education programs. The objective of this study was to inventory open-source patient record systems with decision support capabilities, implement a system for educational use, and test the effect of the system on students' learning. We sought systems that were under active development, with source code available, having an SQL-queryable database, and having decision support capabilities. We identified 20 candidate electronic health record systems, of which 6 mentioned decision support capabilities in their documentation. Of these, the OpenMRS system appeared to meet all of the requirements for use in our course; however, decision support capabilities needed to be added by use of a custom module implementing Arden2Bytecode, an Arden Syntax interpreter. Students who used this system showed an improvement in their knowledge of decision support systems and their capabilities. We conclude that there are a number of promising open-source electronic patient record systems currently under active development, but decision support capabilities are still immature. We anticipate further developments in this area in the coming years.

The rising use of the Internet and information technology has made computerized interventions an attractive channel for providing advice and support for behaviour change. Health behaviour and behaviour change theories are a family of theories which aim to explain the mechanisms by which human behaviours change and use that knowledge to promote change. Among the best-known of these theories are the Social Learning and Social Cognitive theories, the Health Belief Model, the Theory of Reasoned Action and its successors the Theory of Planned Behaviour and the Reasoned Action Approach, and the Transtheoretical model. We discuss three examples of how behaviour change theories have been applied in computer-based interventions: a system to aid users to quit smoking, a decision aid for choice of breast cancer therapy, and an internet-based exercise program for reducing cardiovascular risk. We also discuss misapplication of theory, and reflect on how these theories can best be used. Behaviour change theory can be applied in health informatics interventions in several ways; for example, to select participants for a particular intervention, to shape the content of the intervention to effectively influence behaviour, or to tailor content to individual needs. Application of these theories to provide personalized advice ("decision support") is a young but promising area of research, and could inform other decision support interventions, including those that provide support for clinicians.

Falls form a major health problem for older persons, and increasingly strain the healthcare system. The Internet is a potentially useful platform for empowering seniors. The aim of this study was therefore to investigate the information-seeking behavior about falls among elderly Internet users. A web-based survey was distributed among all members of an association of elderly people (> 60 years old). Fallers and non-fallers, seniors with and without experience with information seeking and the willingness of elderly for undertaking self-assessment tests on the Internet versus solely receiving information about falls were compared. In general, there was much stated interest in receiving information about conditions and medications that increase the risk of falls and information on safety in the house. Around half of the 62 respondents did not feel that they are well-informed about falls. Searching for fall-related information was not significantly associated with having falls in the previous 12 months (OR 2.11, CI: 0.55-8.16). The majority expressed higher interest in receiving fall-related information than undertaking a self-assessment test. However, only a small proportion had searched for this information already.

The internet is viewed as an important channel for patient empowerment, enabling patients to feel more knowledgeable and take action to improve their own health. Internet use among seniors in the Netherlands is increasing, but it is not known if they also use it for health information, nor if seeking information on the internet has different consequences for empowerment than seeking information from other sources. We sought to investigate seniors' use of the internet compared to other resources for health information, and the consequences in terms of both subjective responses and actions taken. Using an email invitation and a web survey, we surveyed 100 elderly internet users, of which 85% had used the internet for health information. The consequences were similar for information found via internet and other sources, and generally positive. Over half reported feeling more knowledgeable and 51% reported making lifestyle changes, but fewer reported having taken other actions (e.g. discussing the information with their doctor). Encouraging the translation of knowledge into action represents an opportunity for empowerment in this population.

Unlabelled: Dutch general practices have a high adoption rate for computerized patient records and clinical decision support. We sought to measure the attitudes and experience of Dutch general practitioners towards clinical decision support., Methods: A preliminary survey was created based on questions from published surveys, modified with the results of interviews. The final web-based survey was administered to 43 general practitioners in a practice area where a decision support implementation is planned., Results: Thirty general practitioners (70%) completed the survey. Most felt that decision support is a good idea (23/30), although fewer reported positive experience with decision support (10/30). Participants were supportive of rules and guidelines, but commonly had the sense that there were too many alerts., Conclusion: Dutch clinicians are positive about decision support, but future efforts should try to reduce the perception of overload, for example by ensuring that alerts are relevant and choosing less interruptive forms of notification for less severe alerts.

The Logical Elements Rule Method (LERM) is a step-wise method for formalizing if-then clinical rules. We applied LERM to a set of 40 clinical rules used in pharmacological quality assessment initiatives to assess (1) the amenability of the rules to formalization for decision support application (2) comparing adherence to rules that can and cannot be formalized, and (3) the usefulness of LERM as a tool for this task. Five rules could not be formalized, all due to unclear decision criteria. The adherence to ambiguous, non-formalizable rules was significantly lower than for formalizable ones (<0.001). We modified LERM with three additions for this task: (a) adding the sub-step of restating the rules in a consistent natural-language grammar before decomposing them into normal form, (b) creating rules to use in lieu of a controlled vocabulary, and (c) adding the requirement that a time frame must be defined for all medications (before hospitalization, current medication, new medication, or discharge medication). Although the clinical rules in this sample are all stated as semi-structured if-then recommendations and are used in quality assessment initiatives, many ambiguities and inconsistencies in the clinical rules were identified by using LERM.