MEDINFO 2010 Studies in Health Technology and Informatics This book series was started in 1990 to promote research conducted under the auspices of the EC programmes’ Advanced Informatics in Medicine (AIM) and Biomedical and Health Research (BHR) bioengineering branch. A driving aspect of international health informatics is that telecommunication technology, rehabilitative technology, intelligent home technology and many other components are moving together and form one integrated world of information and communication media. The complete series has been accepted in Medline. Volumes from 2005 onwards are available online. Series Editors: Dr. O. Bodenreider, Dr. J.P. Christensen, Prof. G. de Moor, Prof. A. Famili, Dr. U. Fors, Prof. A. Hasman, Prof. E.J.S. Hovenga, Prof. L. Hunter, Dr. I. Iakovidis, Dr. Z. Kolitsi, Mr. O. Le Dour, Dr. A. Lymberis, Prof. J. Mantas, Prof. M.A. Musen, Prof. P.F. Niederer, Prof. A. Pedotti, Prof. O. Rienhoff, Prof. F.H. Roger France, Dr. N. Rossing, Prof. N. Saranummi, Dr. E.R. Siegel, Prof. T. Solomonides and Dr. P. Wilson Volume 160 Recently published in this series Vol. 159. T. Solomonides, I. Blanquer, V. Breton, T. Glatard and Y. Legré (Eds.), Healthgrid Applications and Core Technologies – Proceedings of HealthGrid 2010 Vol. 158. C.-E. Aubin, I.A.F. Stokes, H. Labelle and A. Moreau (Eds.), Research into Spinal Deformities 7 Vol. 157. C. Nøhr and J. Aarts (Eds.), Information Technology in Health Care: Socio-Technical Approaches 2010 – From Safe Systems to Patient Safety Vol. 156. L. Bos, B. Blobel, S. Benton and D. Carroll (Eds.), Medical and Care Compunetics 6 Vol. 155. B. Blobel, E.Þ. Hvannberg and V. Gunnarsdóttir (Eds.), Seamless Care – Safe Care – The Challenges of Interoperability and Patient Safety in Health Care – Proceedings of the EFMI Special Topic Conference, June 2–4, 2010, Reykjavik, Iceland Vol. 154. B.K. Wiederhold, G. Riva and S.I. Kim (Eds.), Annual Review of Cybertherapy and Telemedicine 2010 – Advanced Technologies in Behavioral, Social and Neurosciences Vol. 153. W.B. Rouse and D.A. Cortese (Eds.), Engineering the System of Healthcare Delivery Vol. 152. T.C. Lee and P.F. Niederer (Eds.), Basic Engineering for Medics and Biologists – An ESEM Primer Vol. 151. E.J.S. Hovenga, M.R. Kidd, S. Garde and C. Hullin Lucay Cossio (Eds.), Health Informatics – An Overview Vol. 150. K.-P. Adlassnig, B. Blobel, J. Mantas and I. Masic (Eds.), Medical Informatics in a United and Healthy Europe – Proceedings of MIE 2009 – The XXIInd International Congress of the European Federation for Medical Informatics Vol. 149. R.G. Bushko (Ed.), Strategy for the Future of Health Vol. 148. R. Beuscart, W. Hackl and C. Nøhr (Eds.), Detection and Prevention of Adverse Drug Events – Information Technologies and Human Factors Vol. 147. T. Solomonides, M. Hofmann-Apitius, M. Freudigmann, S.C. Semler, Y. Legré and M. Kratz (Eds.), Healthgrid Research, Innovation and Business Case – Proceedings of HealthGrid 2009 Vol. 146. K. Saranto et al. (Eds.), Connecting Health and Humans – Proceedings of NI2009 – The 10th International Congress on Nursing Informatics ISSN 0926-9630 (print) ISSN 1879-8365 (online) MEDINFO 2010 Proceedings of the 13th World Congress on Medical Informatics Part I Edited by C. Safran Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA S. Reti Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA and H.F. Marin Nursing School and Health Informatics Department, Universidade Federal de Sao Paulo, Brazil Amsterdam • Berlin • Tokyo • Washington, DC © 2010 IMIA and SAHIA. All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without prior written permission from the publisher. ISBN 978-1-60750-587-7 (print) ISBN 978-1-60750-588-4 (online) Library of Congress Control Number: 2010930892 Publisher IOS Press BV Nieuwe Hemweg 6B 1013 BG Amsterdam Netherlands fax: +31 20 687 0019 e-mail: [email protected] Distributor in the USA and Canada IOS Press, Inc. 4502 Rachael Manor Drive Fairfax, VA 22032 USA fax: +1 703 323 3668 e-mail: [email protected] LEGAL NOTICE The publisher is not responsible for the use which might be made of the following information. PRINTED IN THE NETHERLANDS Dedicated to Steven A. Huesing IMIA Executive Director, 1997–2009 An outstanding person and professional This page intentionally left blank MEDINFO 2010 vii C. Safran et al. (Eds.) IOS Press, 2010 © 2010 IMIA and SAHIA. All rights reserved. Editorial The 13th World Congress on Medical and Health Informatics, Medinfo 2010, held in Cape Town, South Africa has many forms of participation from preconference tutorials, workshops, keynotes, in- vited presentations, scientific presentations, panels, demonstrations, and posters. The Organizing Committee, led by Dr. Lyn Hanmer from South Africa, collaborated with the Scientific Program Committee, led by Drs. Riccardo Bellazzi from Italy and Johanna Westbrook from Australia, to sculpt an outstanding program. The Editorial Committee has tried to organize a subset of this rich content, the scientific papers and abstracts of posters, into the Proceedings. Our greatest challenge has been to make each paper have identical formatting. Only 10% of all submit- ted papers exactly complied with the organizers instructions. Further work break down analysis shows total editorial time (excluding meetings) of approximately 200 hours, evenly spread between posters and papers. Of that 200 hours, two-thirds are corrections in to conference requirements, and one-third is formatting in to publisher’s requirements. We thank Christine Archuleta for her diligent copy edit- ing. We have organized the paper Proceedings into 20 chapters, where the last chapter is comprised of the abstract of posters organized by the authors self-selected theme. We have attempted to organize the scientific papers in 19 chapters starting with the individual and moving through an ever expanding view of organization and systems. Of course, most papers could easily have fit into multiple sections, so we not only provide a keyword index, but also a searchable CD-ROM version. Charles Safran, MD, MS Shane Reti, MCHCB Heimar Marin, RN, PhD This page intentionally left blank ix Preface from the Scientific Program Co-Chairs The theme for the International Medical Informatics Association’s (IMIA) 13th World Congress on Medical and Health Informatics, Medinfo 2010 is Partnerships for effective e-Health solutions. It is well recognised that information and communication technologies have enormous potential for im- proving the health and lives of individuals. Innovative and effective change using such technologies is reliant upon people working together in partnerships to create innovative and effective solutions to problems with particular regard to contextual and environmental factors. Medinfo 2010 brings together the health informatics community from across the globe with a focus on how we can work together and share our experiences and knowledge to promote sustainable solutions to the challenges presenting to us all. This will be an historical event as Medinfo 2010 is hosted in Af- rica for the first time. The Scientific Program Committee (SPC) was presented with a strong field of 905 submissions meet- ing the call of the congress challenge. This included 603 papers, 203 posters, 41 workshops/tutorials, 37 panels and 21 scientific demonstration applications. The final paper acceptance rate was 43%. All papers were assigned to two or three reviewers who scored each of the papers and provided feedback to authors. All submissions were categorised into one of four major themes (Hospital information sys- tems, Consumer-health informatics, Knowledge management, National and International Health IT) and submissions within each of these theme areas were re-reviewed by assigned members of the SPC. The final program covers all aspects of modern health informatics, ranging from traditional topics, such as hospital information systems, patient registries, nursing informatics, data integration, stan- dards, interoperability issues and decision support, to new topics such as translational bioinformatics, text mining, intelligent data analysis, emerging technologies, quality, social networking, workflow and organizational issues. The papers have been selected with the guiding principle of including in the pro- gram both high quality methodological research and high impact applications of health informatics. In some cases, the authors achieved both goals. A distinguishing feature of Medinfo 2010 program is the presence of several sessions on public health and national and international initiatives to promote health IT. The scientific challenges to implement large-scale initiatives are strongly related to the conference theme, as they rely on effective partner- ships between all actors involved in health care informatics. The scientific rigor of the congress papers can be seen both as a consequence and reflection of IMIA’s strategic decision to see its role as a pro- moter of science and health IT throughout the world. Health Informatics researchers internationally are rising to the challenge of providing robust evidence of the transformational effects of effective health information exchange. The Scientific Program Committee thanks all those who made submissions to Medinfo. Special thanks also go to the worldwide team who reviewed these submissions and provided feedback. For the first time the SPC organised a mentor scheme which provided the opportunity for researchers seeking to x submit papers to Medinfo to have their work reviewed by an international expert prior to the Congress submission closing date. 42 papers were reviewed as part of this process. We thank the team of men- tors who generously gave their time to support their colleagues as part of this scheme. Riccardo Bellazzi, PhD Johanna Westbrook, PhD University of Pavia The University of Sydney Pavia, Italy Lidcombe, New South Wales, Australia