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Background: Due to the increasing functionality of medical information systems, it is hard to imagine day to day work in hospitals without IT support. Therefore, the design of dialogues between humans and information systems is one of the most important issues to be addressed in health care. This survey presents an analysis of the current quality level of human-computer interaction of healthcare-IT in German hospitals, focused on the users' point of view., Methods: To evaluate the usability of clinical-IT according to the design principles of EN ISO 9241-10 the IsoMetrics Inventory, an assessment tool, was used. The focus of this paper has been put on suitability for task, training effort and conformity with user expectations, differentiated by information systems. Effectiveness has been evaluated with the focus on interoperability and functionality of different IT systems., Results: 4521 persons from 371 hospitals visited the start page of the study, while 1003 persons from 158 hospitals completed the questionnaire. The results show relevant variations between different information systems., Conclusions: Specialised information systems with defined functionality received better assessments than clinical information systems in general. This could be attributed to the improved customisation of these specialised systems for specific working environments. The results can be used as reference data for evaluation and benchmarking of human computer engineering in clinical health IT context for future studies.

The journal impact factor (IF), which is published annually by the Institute for Scientific Information, (Philadelphia, USA), is meanwhile in widespread use as a scientometric parameter for the evaluation of research and researchers in Germany and other European countries. The present article subjects the IF to critical analysis. It first deals with processes of production, transfer, and use of medical knowledge, because the IF intervenes in these processes on account of its reflexivity. Secondary effects of the IF resulting from its reflexivity are discussed with the focus on the level of the author, the journal and the medical discipline as well as on social knowledge processes in society. In addition, the extent to which the IF is appropriate for evaluating the quality of a specific article, of a journal or of individual and collective research achievements is discussed. The present article calls for (1) research evaluation in accordance with the recommendations of the Deutsche Forschungsgemeinschaft (German Research Council) and of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (Association of the Scientific Medical Societies) and (2) more intensive occupation with and organization of medical knowledge processes.

Until now, in comparison to psychiatric day clinics, there is only a limited amount of psychotherapeutic day clinics which offer an intense, multimodal treatment on a psychodynamic basis comparable to that of inpatient settings. We present the example of the day clinic in Freiburg to discuss characteristic aspects of the setting and criteria for indication. Preliminary empirical results indicate, that even severely disturbed patients can be adequately treated. The combination of an intense therapy program with the daily involvement in the outside reality has substantial advantages for some groups of patients and eases the transition at discharge.

Due to typical problems (heterogeneity, lack of clinical functionality, Y2K problems) the board of directors of the university hospital of Marburg decided in 1997 to replace major components of the existing system by commercially available software. The products available on the market were analyzed, and, under participation of different user groups, a comprehensive functional specification was generated. This was the basis for a Europe-wide vendor selection process. In this context, several key aspects were identified, which are critically important for realizing a HIS that fulfills the specified functional requirements. Among these key aspects are the integration of heterogeneous system components, the support of cross-departmental workflow, and flexibility as well as adaptability to specific clinical requirements. As a result, we found that with today's commercially available products and standards there is no single solution that fully meets all requirements. However, some "generalist" vendors are offering integrated systems with acceptable clinical functionality. Tools are emerging which enable the clinical user to generate forms for data input and data flow. Still, a hospital information system will consist of separate components that have to be integrated, but the role of integrated, component-based approaches is becoming more important.