International Journal of Medical Informatics 50 (1998) 7 19

Conference Overview

Health and medical informatics education: perspectives for the next decade
Reinhold Haux
Department of Medical Informatics, Uni6ersity of Heidelberg, Institute for Medical Biometry and Informatics, Im Neuenheimer Feld 400, D -69120 Heidelberg, Germany

Abstract It is argued that the progress of information processing and information technology changes our societies. Examples are given that there is a signicant economic relevance of information technology for medicine and healthcare and for the quality of healthcare as well. In order to adequately pursue the goal of Transforming healthcare through innovative use of information technology for the 21st century (the topic of the 6th International Conference on Health and Medical Informatics Education and of this special issue of the International Journal of Medical Informatics), health professionals are needed who are well-educated in health informatics or medical informatics, respectively. Raising the scope and the quality of education in the eld of health and medical informatics would help to raise the quality and efciency of healthcare. In this context the International Medical Informatics Association (IMIA) and its working group 1 (WG1) on Health and Medical Informatics Education can make a contribution by disseminating information and by elaborating recommendations on courses and programs in health and medical informatics. For this purpose IMIA WG1 has established a WWW site (http://www.imia.org/wg1) with information on health and medical informatics programs and courses. All teachers and institutions are encouraged to submit information about courses and programs offered and to set pointers to their own WWW sites. In addition, a mailing list was installed to facilitate communication between all persons involved in health and medical informatics education. For subscription, a message has to be sent to listserv@relay.urz.uni-heidelberg.de. The body of the message should read SUBSCRIBE IMIA-WG1. 1998 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Medical Informatics; Health Informatics; Education; IMIA

1. Introduction The 6th international conference on health and medical informatics education is spon-

sored by the International Medical Informatics Association (IMIA), the Asia Pacic Association for Medical Informatics (APAMI), the Health Informatics Society of

1386-5056/98/$19.00 1998 Elsevier Science Ireland Ltd. All rights reserved. PII S1386-5056(98)00046-X

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Australia (HISA) and is hosted by the Faculty of Medicine and Health Sciences of the University of Newcastle, Australia. It has chosen as the key topic The transformation of healthcare through innovative use of information technology for the 21st century and, especially, its consequences for education in this eld. I will now introduce this key topic by discussing the following questions: What changes in healthcare through information processing and information technology do we have to expect? What should be the consequences for educating health and medical informatics? What can be the role of IMIA and its working group 1 (WG1) on health and medical informatics education? What are the perspectives for the next decade for health and medical informatics education? The meaning of the terms health informatics and medical informatics is varying within and between different nations. I will use both terms as interchangeably synonyms in a broad and comprehensive manner, in terms of the discipline dealing with the systematic processing of data, information and knowledge in medicine and healthcare. For the sake of simplicity, however, I shall usually employ the term information processing instead of processing data, information and knowledge.

nology do we have to expect? For the purpose of providing an answer to this question we rst should have a look at the past. I would like to quote Karl Jaspers, a philosopher and physician, who was for most of his professional life member of the Ruprecht-Karls-University of Heidelberg (Figs. 1 and 2). It is taken from a speech he gave in 1958 at the 100th Conference of the Association of German Scientists and Physicians. About the miracle of modern medicine hardly a word needs mentioning. Who, since the turn of the century has taken part in it, is a contemporary witnessing a process that is without comparison in the history of medicine. This process of progress in medical knowledge, slowly beginning

2. What changes in healthcare through information processing and information technology do we have to expect?

2.1. Information processing and information technology changes our societies

Now, what changes in healthcare through information processing and information tech-

Fig. 1. Karl Jaspers (1883 1969). Picture from [2].

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Fig. 2. The house in the old town of Heidelberg, where Karl Jaspers lived.

since the 17th century, accelerating by the middle of the 19th century, has speeded up since 50 years in a breath taking manner. The reason for this progress is research in the natural sciences, ranging from the exact sciences to biology ([1], p. 391).
1 8 ber das Wunder der modernen German original text: U Medizin bedarf es kaum eines Wortes. Wer seit der Jahrhundertwende dabei war, wei sich als Zeitgenosse eines Vorgangs, der ohne Vergleich in der Geschichte der Medizin ist. Dieser Fortschrittsproze a rztlichen Ko nnens, langsam begonnen seit dem 17. Jahrhundert, seit der Mitte des 19. Jahrhunderts schneller, hat seit 50 Jahren einen atemberaubenden Gang genommen. Der Grund dieses Fortschritts ist die

These sentences are remarkable in so far as his work, although methodically sound, never has been technical or even formal. From my point of view his philosophical statements, inuenced by Kant and Kierkegaard, often seem more related to the great Asian philosophies than to the western-oriented philosophy of science. And in the sense of this statement we can recognise that in the 19th century many of our societies were marked by power-producing industry and industrial production. From the second half of the 20th century onwards, at the latest, the idea of communicating and processing data by means of computers and computer networks was already emerging. Nowadays, we already speak of the 21st century as being the century of information technology, the century of an information society. It is supposed to become a century in which informatics will play a key role. Information, tied to a medium of matter and energy but largely independent of place and time, shall be made available to man at any time and in any place imaginable. Information shall nd its way to man and not vice versa. Progress in information processing and information technology changes our societies. Globalisation of labour, as one of the consequences, is already signicantly changing our world.

2.2. Information technology has become economically rele6ant

For many countries this vision of an information society is already becoming reality. Nowadays, more personal computers are sold world-wide than cars [4]. Nearly every mod-

naturwissenschaftliche Forschung, von den exakten Wissenschaften bis zur Biologie.

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ern economic branch is shaped by information processing and information technology. In 1995 the German Ministry of Economy estimated the annual turnover of the world market on information technology at approximately 3 trillion US-dollars [3], with an increasing growth rate between 7 and 15 percent per year [3]. In 1994 in Germany the expected total annual turnover in information technology (approximately 382 billion German Deutschmarks due to [3]) had nearly reached the same volume as the total annual budget of the federal government. This development can also be observed in healthcare. In 1993 Jan van Bemmel reported on studies on the amount of investments in both hardware and software in the healthcare market. I quote ([5], p.2): It is estimated that the USA spends over 5 billion US$ annually on information systemsand that the European market in this area in 1993 is about 3.5 billion ECU, expected to grow to 15 billion ECU in the year 2000The world-wide market for hospital information systems is estimated to be around the turn of the century 100 billion US$. In 1996 the German Research Association funded hardware and software investments for 36 German university hospitals with 55 million German Deutschmarks (approx. 40 million US-dollars, [6]). The real annual investments are expected much higher. In my opinion they are at least three times higher. Additional costs for operating expenses have to be added, not to speak of the costs for conventional information processing, done without computers. One might have doubts about the validity of these, rather rough numbers. However, they all exemplify the following: there is a signicant economic relevance of information technology in general and for medicine and healthcare.

2.3. Information processing and information technology has become rele6ant for the quality of healthcare
Besides the economic relevance it is of importance to recognise the relevance of information processing and information technology for the quality of healthcare [710]. There have been tremendous improvements in diagnostics, e.g. taking into regard the progress of medical signal and image processing. Magnetic resonance tomography, e.g. would not have been possible without methodical improvements in information processing and without modern information technology. As a consequence, better diagnostics result in an apparent improvement of therapy. Some therapies, e.g. in neurosurgery or clinical radiology, are even hardly possible without the progress mentioned. Important progress caused by methodical improvements in information processing and by modern information technology can also be observed by information systems in healthcare. The role of information systems, together with medical documentation and knowledge-based decision support can hardly be overestimated with respect to the quality of healthcare. The volume of data available today is much higher than it has been some decades ago. Nowadays, diagnostics is highly sophisticated compared with diagnostics of the past. Many diagnostic procedures supply an almost indeterminable number of mainly quantitative single ndings which must be evaluated as a whole. Moreover, there is an increased readiness of patients to change their doctor, as well as a higher regional mobility. Owing to the achievements of modern medicineparticularly in the eld of acute diseaseschronic diseases and multimorbidity, caused by age, rank higher and higher. The high degree of division of labour which in many countries is common practice

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in patient care today creates a great demand for information processing among health professionals, among the staff of wards, outpatient departments and laboratories etc. and, as a consequence, calls for more comprehensive documentation and efcient, functional comprehensive information systems. Especially in hospitals the volume of information processing as well as the organisational, methodical and also technical work load for managing information processing should not be underestimated.

2.3.1. Example 1 The Heidelberg University Hospital, for example, is an enterprise with about 7000 employees and an annual budget amounting to about 800 million German Deutschmarks. It is entrusted with a variety of tasks related to research, education and patient care. Currently, it comprises 60 medical departments with 103 wards and a total of 1732 beds, 91 outpatient units, 31 operating theatres for in-patients and additional ones for outpatients. For the roughly 50000 inpatients and about 250000 outpatients treated every year, about 20000 operation reports are written, about 250000 physicians reports drawn up and more than 1 million ndings established (laboratory, radiology ndings etc.). All this must be made available at the right time, in the right place, to authorised persons and in an appropriate form. About 300000 new medical records are opened every year containing about 6 million documents. When archived in the conventional way this corresponds to a le volume of about 1500 metres per year and in Germany les must normally be kept for 30 years. In the case of digital storage, the estimated data volume will come to about 2 terabytes a year. These data, too, must be kept available and stored.

2.3.2. Example 2 I want to demonstrate to you another example from my hospital, for which I am indebted to the head of the Department of Neonatologie of the Heidelberg University Hospital, Professor Otwin Linderkamp, in order to exemplify the relevance of information processing for patient care from a different viewpoint. Imagine the following situation, which occurred recently. A prematurely born child (born in the 28th week, 4 weeks old) is developing an emphysema (a strong swelling) of the right lung. From the viewpoint of thoracic surgery, as possible therapy for this highly dangerous disease, the extraction of the right lung was mentioned. The paediatric physician, treating the infant has the following question. Which therapeutic opportunities exist? The physician, who at this point of time does not know about other opportunities to treat this rarely occurring disease, consults a computer, located on his ward, respectively, his ofce, his health professional workstation. This workstation, which can be used for a variety of tasks, is connected to the knowledge server of the hospital [11]. The physician calls up this medical knowledge server and, as part of it, a literature database (MEDLINE), containing the present knowledge of medical literature world-wide. This medical knowledge server can be accessed from every health professional workstation of the hospital at any time of the day. The result of this consultation was, several references state, that in the case of extracting the right lung the mortality rate for infants lies between 60 and 100%. For prematurely born children it must be expected, that this disadvantageous prognosis will be even worse than for normally born children. One case report was found, reporting about a conservative treatment, after which a prematurely born child survived. The

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therapeutic measure chosen was intubation with oscillating respiration of the left lung. The subsequent conservative treatment was successful. The child survived in good health. By the way, the cost for establishing such a knowledge server for a complete hospital is usually far below the cost of one ultrasonic device, provided that the information system of the hospital provides a certain (minimal) infrastructure. In many parts of the world every hospital could afford such a tool nowadays. At the Heidelberg University Hospital there were about 70000 of such consultations in the year 1996. Other hospitals reported about similar numbers. To summarise, in addition to the economic relevance there is also a signicant relevance of information processing and information technology for the quality of healthcare. High level information processing and information technology forms one basis for a high level healthcare.

In Table 1 a statistic is shown with patients having diagnosis D, e.g. rheumatism and treated in the years r, e.g. 19861996, at the Medical School Plo tzberg. The patients have either been treated with standard therapy, denoted as Verum, or with a new therapy, denoted as Novum. Comparing the success rates of Novum and Verum, one might conclude that the new therapy is better than the standard therapy. Computing an appropriate statistical test would lead to a low P -value and a signicant result. Unfortunately the success rate also had been computed stratied by sex. And here for the female patients as well as for male patients Verum was superior. Is one of our conclusions a fallacy? Or maybe both? What would be a systematic design and analysis of such a register? After

2.4. Appropriately applying of information technology needs a systematic processing of information

This, however, not only requires applying powerful information technology, but especially requires a systematic processing of information. Considering the above example a systematic management of the information processing in hospitals was necessary.

Table 1 Example (ctive) for Simpsons paradox. Success rates of treatments Novum and Verum for patients with diagnosis D, treated in the years r at the Medical School Plo tzberg

2.4.1. Example 3 Taking another example (oriented at a similar one in [12]) I want to show from yet another viewpoint, what can happen when information processing is done in a non-systematic (or, better, chaotic?) manner. Let us analyse a (ctive) clinical register from the (also ctional) Medical School Plo tzberg.

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having a look at the data one can identify the quite simple reason for this so-called Simpsons paradox. The methodology for a systematic processing of information, needed to prevent such fallacies, however, is far more complex. To summarise again, adequately processing information and applying information technology also needs knowledge of the system atic processing of information.

2.5. Information processing and information technology will continue to change our society
Now once more, what changes in healthcare through information processing and information technology do we have to expect? The developments mentioned will probably continue into the next decade at least at the same rate given today. The development of our societies with respect to information processing and information technology will continue to have a considerable effect on our societies in general and on our healthcare systems in particular. The globalisation of providing healthcare and the co-operation of health professionals will, in my opinion, even increase. Providing high quality and efcient healthcare will continue to be strongly correlated with high quality information technology and a sound methodology for systematically processing information. Both, technology and methodology of information processing, of course must adequately and responsibly be applied. 3. What should be the consequences for educating health and medical informatics? Considering these developments, what are the consequences for educating health and medical informatics?

First of all, for a systematic processing of information in medicine and in healthcare, for an appropriate application of information technology, health professionals are needed who are well-trained in health and medical informatics. Physicians, nurses, healthcare administrators and other health professionals need knowledge about methods and tools of information processing. In addition we need specialists, intensively and explicitly educated in health and medical informatics. And we need computer scientists, being aware of the information processing problems in medicine and healthcare. Obviously, education in health and medical informatics has to be done at various levels of education and can range either from educational components in certain curricula or from dedicated programs in health and medical informatics to continuous education in this eld. This need for education has always been there. However, it has become more important as information processing and information technology became more important. Table 2 presents a survey on the reasons, levels and types of education in health and medical informatics. Although there is such a need for education, we must observe, that quite different opportunities for getting educated in this eld have been established world-wide. Whereas in some countries there is an intensive education in health and medical informatics on different levels of education and for the different healthcare professions, many other countries do not, or at least not sufciently, have established such opportunities until now, with all the consequences concerning the quality and effectiveness of healthcare. Raising the scope and the quality of education in the eld of health and medical informatics would help to raise the quality and efciency of healthcare.

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Table 2 Education in health and medical informatics (according to [13]) Why Teaching Health/Medical Informatics? Well-trained healthcare professionals raise the quality of information processing. The quality of information processing inuences the quality of medicine and healthcare itself. Therefore, for a systematic processing of information in medicine and in healthcare, healthcare professionals are needed that are well-trained in health and medical informatics. Where and to Whom is Health/Medical Informatics Education Offered? Health and medical informatics education has become an integral part of education and training, e.g. for physicians, nurses and for administrators in the eld of healthcare in a variety of countries all over the world. In addition there exist health and medical informatics courses for informatics students and even dedicated programs for specialists in health and medical informatics. Which Types of Programs and Courses Exist? Training and education in health and medical informatics is done at various levels of education and ranges from either educational components in certain curricula or from dedicated programs in health and medical informatics to continuous education in this eld. There exist, e.g. Courses in health and medical informatics as part of educational programs Health and medical informatics courses for medical students Health and medical informatics courses for informatics/computer science students Health and medical informatics courses as part of other programs, e.g. on epidemiology, nursing Dedicated programs in health and medical informatics Ph.D. programs in health and medical informatics Bachelors and masters programs in health and medical informatics Programs for medical data administrators and for medical data technicians Courses for continuing education and for fellowship training in health and medical informatics

4. What can be the role of IMIA and its WG1 on health and medical informatics education?

4.1. About IMIA WG1

What can be the role of IMIA and its WG1 on health and medical informatics education? The IMIA WG1 is concerned with the promotion of health medical informatics programs and courses at a high professional and/or scientic level. In accordance with the aims of IMIA, WG1 seeks to advance the knowledge of How informatics is taught in the education of healthcare professionals around the world. How, in particular, health and medical informatics is taught to students of computer science/informatics. How it is taught within dedicated curricula for health and medical informatics ([14] and WG1 reports in [10]). At an early stage IMIA WG1 and its predecessor IFIP WG4 (IFIP: International Federation of Information Processing), were perceptive to the need of education in the then new eld of health and medical informatics. Basic responses to this need were published in 1974 on the basis of the rst IMIA working conference on education held in Lyon in 1970.Meanwhile six working conferences have been organised by WG1: Lyon, France 1970 [15]. Chamonix, France 1983 [16]. Victoria, Canada 1989 [17]. Prague, Czech Republic 1990 [18]. Heidelberg/Heilbronn, Germany 1992 [19]. Newcastle, Australia 1997 [20,21]. Many other meetings, sessions and workshops have also been organised by members of the working group, e.g. during MEDINFO conferences.

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4.2. The role of IMIA WG1

At its meetings in Vancouver during MEDINFO 95 and in Copenhagen during MIE 96, IMIA WG1 members discussed future plans for WG1. Four aims were presented: To disseminate and exchange information on health and medical informatics programs and courses. To promote the IMIA WG1 database on programs and courses in health and medical informatics. To produce international recommendations on health and medical informatics programs and courses. To support health and medical informatics courses and exchange of students and teachers. Achieving these aims should in my opinion be the role of IMIA WG1, in order to raise the scope and the quality in health and medical informatics education. And we should of course take advantage of the progress in our own eld by investigating new ways of education by applying modern information technology. Consequences for disseminating and exchanging information are to organise conferences like the ones mentioned and to contribute to other conferences. Important additional opportunities are to make use of the established WWW server and the list server of IMIA WG1. In collaboration with corresponding national institutions and working groups we should in addition inform national and international decision makers about the necessity of education in the eld of health and medical informatics. We should point out ways, how and for whom courses and programs in health and medical informatics can be established. We should also give recommendations on the quality and contents of such courses and programs.

4.3. Recommendations for educating health and medical informatics

In order to raise the extent and the level of education in health and medical informatics and with it the level of healthcare, IMIA WG1 can play an important role in preparing an international framework for recommendations for education in health and medical informatics. One of the main topics of the Newcastle conference was to discuss such an international framework of recommendations for health and medical informatics education. These discussions are intended to be continued together with the national societies in our eld, considering the experiences and/or the expectations and needs these countries have. The recommendations should build upon existing, e.g. national, recommendations [22 25] and have to consider the variety of existing levels of education in different nations. A framework for such recommendations, suggested in Jan van Bemmels Handbook of Medical Informatics, is presented in Table 3.

4.4. The IMIA WG1 database for programs and courses in health and medical informatics
IMIA WG1 has established a WWW site (http://www.imia.org/wg1) to provide up-todate information about its work [26]. The core of the site is an underlying database providing information on health and medical informatics programs and courses worldwide. To be able to have a database of high quality and value all teachers and institutions are encouraged to submit information about courses and programs on HMI education offered and to set pointers to their own WWW sites. Acknowledging the diversity of programs and courses in existence a simple database

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Table 3 A framework for recommendations for education in health and medical informatics (according to [13]) Because a variety of educational systems and of healthcare systems exist all over the world, programs and courses in health and medical informatics (HMI) may be distinct in different countries. There are different existing qualities of HMI education, that have been reached up to now. In spite of this variability, basic similarities as a framework for recommendations on HMI education can be identied Need for HMI Education Systematic processing of information is needed for a good quality of healthcare. In order to provide good quality of healthcare, training and education in HMI is needed on various le6els of education, in different modes of education, for various professions in the eld of healthcare, with different types of specialisation in HMI. There must be recognised qualications for HMI positions and qualied teachers for HMI courses Levels of HMI Education Health and medical informatics courses should be offered within educational programs (e.g. medicine, nursing, computer science), where information processing in medicine and healthcare is of importance and as educational programs of its own (e.g. bachelor, master, Ph.D. programs in HMI). They should be offered at universities, but also e.g. at professional schools (e.g. medical records administration). For healthcare professionals, in addition, courses for continuing education in HMI should be offered. In those countries, where courses in HMI have not yet been sufciently established, summer schools etc. on HMI for healthcare professionals should be offered for a certain period of time Modes of HMI Education Besides lectures it is of importance that practical exercises and practicals within healthcare institutions (e.g. in hospitals) are offered. Besides, traditional lectures and exercises within universities and given the explosive growth of the Internet, distance learning should be actively pursued Professions Needing HMI Education Practically all healthcare professions are to be considered with respect to HMI education: e.g.

Table 3 (continued) physicians, nurses, healthcare administrators, medical records librarians and also health and medical informaticians as graduates from specialised programs in HMI. Computer Scientists and engineers, who intend to work in the elds of medicine and healthcare also need HMI education Types of Specialisation in HMI The types of specialisation range from few courses as educational components in certain curricula to dedicated programs in health and medical informatics Many healthcare professionals just need to know about the potentials and the risks of information processing in healthcare. Students for these professions, e.g. medical students, nursing students should have the opportunity to learn the basics of HMI. These basics should include an introduction into the methodology of information processing, the potentials for medicine and healthcare and the use of computers as information processing tools In addition there should also be the possibility the specialise in the eld of health and medical informatics. Such a specialisation can e.g. be offered within specic programs, leading to a dedicated bachelor, master, or Ph.D./M.D. degree in HMI Recognised Qualications for HMI Positions There must be recognised qualications in HMI, e.g. for positions in HMI Qualied Teachers for HMI Education HMI courses and programs must be of good quality. Teachers of HMI courses must have adequate and specic qualications in this eld. It must be able to obtain such qualications for lecturing in HMI, usually from universities

scheme was developed (see Fig. 3) which hopefully is sufcient to accommodate the programs and courses encountered in practice. The attributes of the three components of the database are listed in Tables 36. The attributes of the database were selected to form a minimum data set, especially providing key information relevant for searching for a course or program. More detailed information may be provided in the database links to

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WWW pages of the respective course or program. Please enter current information about your programs and courses. Add pointers to your own WWW sites! Keep the database alive!

4.5. The IMIA WG1 mailing list

In addition, a mailing list was installed to facilitate communication between all persons interested in health and medical informatics education world-wide. For subscription, a message has to be sent to listserv@relay. urz.uni-heidelberg.de. The body of the message should read SUBSCRIBE IMIA-WG1. Messages to the IMIA WG1 list have to be sent to imia-wg1@urzinfo.urz.uni-heidelberg.de.

Fig. 3. Structure of the IMIA WG1 database on health and medical informatics programs and courses.

5. What are the perspectives for the next decade for health and medical informatics education? Finally, what are the perspectives for the next decade for health and medical informatics education? In my opinion the answer can be found by summarising the conclusions of the preceding sections: Progress in information processing and information technology is changing our societies. There is a signicant economic relevance of information technology for medicine and healthcare. There is also a signicant relevance of information processing and information technology and for its systematic application, for the quality of healthcare. These developments will continue in the next decade, probably at least at the same pace as can be observed today. For a systematic processing of information

in medicine and in healthcare and for an appropriate and responsible application of information technology, health professionals are needed who are well-educated in health informatics or medical informatics, respectively. Raising the scope and providing high quality of education in the eld of health and medical informatics and having welleducated health professionals world-wide, would considerably help to raise the quality and efciency of healthcare. Once more it can be observed that also for our eld, although a technical and formal
Table 4 Database attributes for an institution Institution Name of Institution Faculty/School Department Contact Person Street City State Postal code Country Phone number Fax number E-mail address WWW address Date of last update

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Table 5 Database attributes for a program Program Name of Program Institution(s) Type of Program Duration of Program (years) Degree/Qualication awarded Year created Language of Instruction No. of Full-time Faculty No. of Part-time Faculty Application Requirements Application deadline(s) Enrolment/year No. of Students currently enrolled No. of Graduates Program Description/Remarks WWW address Date of last update

prohibited lectureship. Medicine is dealing with the health of man, its preservation, promotion and recovery, on the basis of knowledge, nature of man is understanding[Foundation] for the whole doing isa non scientic groundIn medicine the ground is the will to promote life and health of every person as person in her or his nature. There is no restriction. ([27], pp. 79802). Acknowledgements The author is indebted to Petra Knaup, Perry Williams and a referee for their comments on an earlier version of this paper. References
[1] K. Jaspers, Der Arzt im technischen Zeitalter (The physician in the technical age). Klinische Wochenschrift, November 1958. Cited from: Jaspers K: Der Arzt im technischen Zeitalter. Piper, Mu nich, 1986. [2] K. Jaspers (1957). Die groen Philosophen (The great philosophers). Piper, Mu nich, 1957. Picture from the cover of the new edition, 1988. [3] Ministry of Economy, Federal Republic of Germany (BMWi): Die Informationsgesellschaft (The Information Society) BMWi Report. BMWi, Bonn, 1995. [4] Ministry of Economy, Federal Republic of Germany (BMWi): Info 2000: Deutschlands Weg in die Informationsgesellschaft (Germanys way to the Information Society). BMWi, Bonn, 1996.
2 German original text: In der Medizin handelt es sich um die Gesundheit des Menschen, ihre Erhaltung, Fo rderung und Wiederherstellung auf Grund eines Wissens, das die Natur des Menschen begreift[Grundlage] ist fu r das gesamte Tunein nicht wissenschaftlicher BodenIn der Medizin ist der Boden der Wille zur Fo rderung des Lebens und der Gesundheit jedes Menschen als Menschen in seiner Artung. Es gibt keine Einschra nkung.

one, what ranks rst is the individual and her or his health. This should be understood in the sense, in which Karl Jaspers described the role of faculties in medicine (and health sciences, as he would probably say today). It is part of his book on the idea of the university, he was able to publish in 1946 after overcoming hard times including 8 years of
Table 6 \Database attributes for a course Course Name of Course Course Number Institution Program Credit Hours Level Instructor E-mail address of Instructor WWW address Course Description/Syllabus Date of last update

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