Integrated Hospital Information System Research Articles

Visit Improvement Effort of Inpatient Obstetrics and Gynecology in RSIA Kirana Sidoarjo Using Blue Ocean Strategy

Purpose: The purpose of this study is to identify and analyze innovation efforts to increase inpatient obstetrics and gynecology at the Kirana Sidoarjo Mother and Children Hospital (RSIA) using the Blue Ocean Strategy.
 Design/methodology/approach: The design/methodology/approach used in this research is descriptive qualitative research with a case study. This research is directed to reach a strategic decision through the blue ocean strategy at RSIA Kirana Sidoarjo which is supported by analysis and clear arguments. The search for untapped market space makes it necessary to first configure the logic of the Blue Ocean Strategy.
 Findings: The results showed that innovation efforts to increase inpatient visits to obstetrics and gynecology at the Kirana Sidoarjo Mother and Child Hospital (RSIA) using the Blue Ocean Strategy were by increasing digital marketing factors, quality of human resources and services, integrated hospital information systems, Hospital service innovation, Quality control/assurance. brand and the creation of Complimentary Service factors, After sales service.
 Paper type: Research paper

Root Cause Analysis and Strategies to Improve Outpatient Pharmacy Services

XYZ is a hospital that provides health services and also provides pharmaceutical services. According to Permenkes No.129 of 2008 concerning Minimum Service Standards for Hospitals, the waiting time for ready-made medicine is ≤ 30 minutes and the waiting time for concoction medicine is ≤ 60 minutes. However, in 2019 and 2020 XYZ Hospital has not been able to achieve it, so a preliminary study was carried out by evaluating the outpatient pharmaceutical service business processes using the Quality Evaluation Framework (QEF) approach with the results showing a mismatch in target achievement in the prescription review process which included prescription review failures. (Q5), the process of checking drug availability which includes failure to check drug availability (Q7), the drug billing process which includes drug billing time efficiency (Q14), the administrative process which includes administrative time efficiency (Q18) and the process of providing information/counseling which includes authority provision of information/counseling (Q24). After knowing the quality factors that are not achieved, it is necessary to analyze the root causes and strategies for improving outpatient pharmacy services. This study aims to analyze the gaps in the business process of outpatient pharmacy services and determine the improvement strategy at XYZ Hospital. Collecting data in this study by conducting Focus Group Discussion (FGD) and documentation studies. Analysis of the data used using qualitative methods by doing data reduction, data display and conclusion/verification. From the results of the study, it was found that the gap in outpatient pharmacy services using Root Cause Analysis (RCA) was in the categories of procedures, people, policies, and plant/technology so the strategy for improving outpatient pharmacy services was by implementing e-prescriptions, eliminating hanging billing procedures, adding human resources and infrastructure, strengthening the integrated hospital information system. Thus it can be concluded that an analysis of the root causes of the business processes of outpatient pharmacy services needs to be carried out so that service improvement strategies can be determined.

The Use of Information Technology in the Construction of a Nursing Communication Platform System.

In order to effectively connect patient care information and reduce the amount of administrative work, a nursing care communication platform can effectively achieve 1. Real-time display of patient information while protecting patient privacy; 2. Integration of hospital information system, with individualized medical care team information; 3. Accurate and timely delivery of need for patient report; 4. Increase of interaction between the patient's family and staff and breakthrough from the limit of paper-based health education information.

Challenges of Home Health Care During COVID-19 Outbreak in Iran.

The pandemic of COVID-19 is the second one in the 21st century after H1N1 Swine Flu in 2009-2010, which infected more than 4.9 million and caused more than 327000 death as of 23 May 2020 worldwide.1 This pandemic has overwhelmed the health systems, specially hospitals, and the need for ICU beds and ventilators increased while many of patients with mild symptom of COVID-19 could be recovered at home.2 In addition, early discharge of hospitalized patient and referring for Home Health Care (HHC) would be a suitable strategy for decreasing the overload of patient in hospitals and its consequences such as nosocomial infections. On the other side, many patients who receive HHC for other conditions (usually old people with chronic disease) need special attention during the pandemic for ensuring continuation of care and prevention of COVID-19 threat. The first patient in Iran was officially reported on February 19, 2020 in Qom city. According to World Health Organization about 129 341 Iranians were infected by Novel Corona Virus and 7249 died till 23 May 2020.1 As the nurses are frontline health worker who provide services in hospitals as well as in home settings, Deputy for Nursing of MOHME published the guideline for Home care for COVID-19 patient and about 405 institute for Home Care services were active to care of patient in their homes.3 Regardless of the availability of detailed information about hospitalized COVID-19 patients by means of integrated Hospital Information Systems (HIS), there is no information about the number, characteristics and health outcomes of people who receive professional HHC in Iran during this pandemic. It is not only the problem of Iran’s Health system, but European countries have also encounter with lack of home care data.4 The history of HHC, as an industry in Iran, dates back to 1999 when the first bylaw for HHC was ratified by Health Minister. In recent years, Act on the Sixth Five-Year Economic, Cultural and Social Development Plan of Iran for 2017-2022 enforced the MOHME to expand the HHC in community and insurance coverage for HHC is on the High Council of Health Insurance’s agenda. Thus, nowadays home health care is becoming integrated in the health system of Iran more than ever. One of the problems of HHC during the COVID-19 in Iran (at least in the beginning of epidemic) was lack of appropriate and adequate Personal Protective Equipment (PPE) for the staff who worked in HHC settings directly with patients and families and raised fear of the risk of cross-infections by the staff and patients. The lack of information and data about home care in Iran’s healthcare system, lack of adequate and accurate monitoring, and inability of supervising have been among the challenges of HHC in Iran,5 which during COVID-19 epidemic became more challenging. The lack of data has weakened the ability of policymakers for evidence-based and timely decisions to combat the disease. Using Information Technology (IT) in HHC has many advantages such as gathering and sharing information, supervising and providing telenursing. The HHC teams and patients as well as policymakers can benefit from IT implementation in HHC. This issue is especially a priority in the disasters like COVID-19 pandemic when the health system needs integrated and real-time data. On the other hand, to minimize the contacts between nurses and patients aiming to decrease the cross-contamination, Telenursing can be used for frequent contact between the nurses and patients to manage the condition by telephone or video call without direct contact. According to lessons learned from COVID-19 pandemic, using IT in Home Health Care, especially implementation of Home Health Care Information System and its integration into national Electronic Health Record (EHR) and using Telenursing are among the important factors for developing the role of HHC in the health system of Iran; this could help to better manage the outbreaks. It is not a simple policy to implement and needs a national determination and plan with multi-sectoral cooperation.

Usage of Standards to Integration of Hospital Information Systems

Introduction: Data exchange across healthcare facilities is a major issue in healthcare information systems. Standards play an important role in the context of communication. In this paper, we surveyed the usage of standards in the hospital information systems (HISs) in the affiliated hospitals of Tehran University of Medical Sciences.Material and Methods: This survey was performed in 2014-2015. A total of 17 hospitals with HISs were surveyed. The data were collected using a structured questionnaire. The design of the questionnaire was based on a literature review and consisted of three parts. Descriptive statistics were used to analyze the data.Results: XML, HL7 and DICOM are commonly used international interchange standards. In the case of security standards, 76.5% of HISs do not support the HIPPA and CEN TC 251 security standards. ICD was the most commonly used terminology standard in the HISs. Several studies have indicated that HISs should cover data exchange, security and terminology standards to provide integration of heterogeneous systems.Conclusion: In the current study, the role of standards in the architecture of the HISs was inconspicuous. To make the HIS effective, it is necessary to consider the standards when developing the system. In this matter, legislation could help.

Health Professionals’ Attitudes towards Digital Transformation through the Use of Hospital Information Systems: The Case of a General Oncology Hospital of Attica

Purpose: The study of the attitude of Health Professionals of the General Oncology Hospital of Attica towards the integrated Hospital Information Systems (HISs) as well as of the socio-demographic factors that shape it. Material-Method: A stratified sampling quantitative survey was conducted using the occupational category of the employees as the stratification variable. Data were collected by employing the standard Nurses Attitudes towards Computerization (NATC) self-report questionnaire. Statistical analysis was conducted with the use of the statistical data processing SPSS-v25 software. Results: The staff of the General Oncology Hospital under study have a positive attitude towards the use of Hospital Information Systems (Mean = 3.73, SD. = 0.54). Statistically significant differences between occupational categories were found only for the dimension of “Providing quality care to the patient” (p = 0.007) and more specifically among nurses and doctors. Regarding the effect of demographic factors on the five dimensions that form the attitude of health professionals towards the HIS, only “gender” (p = 0.009) and “occupation categories” (p = 0.007) seem to influence this attitude and specifically the dimension “Providing quality care to the patient”, whereas “previous experience in use of computers at work” affects the dimension “Reduction in jobs” (p = 0.009). Conclusions: The statistical analysis of the data showed that the employees of the General Oncology Hospital under study have a positive attitude towards the use of the integrated Hospital Informatics Systems (HISs). Males tend to have the most positive attitude while employees who already make use of personal computers in their work, tend to disagree with the view that HIS will lead to a job reduction.

The degree of cost accounting development in the context of hospital information system

The article describes the results of research on the model of hospital cost accounting maturity obtained in the second stage of own research. The aim of the conducted research was to identify the premises of cost accounting maturity in the context of the hospital information system. In order to achieve thus defined goal, a research hypothesis was formulated that the level of the maturity of hospital cost accounting depends on the degree of achievement of goals resulting from external and internal information needs of data recip-ients. It has been accepted that external needs determining the maturity of cost accounting arise from formal regulations. In the case of hospitals functioning as independent public health care centers, they have been recommended for use for 27 years. As regards the internal needs, the so called substantive integration of cost and medical data has been defined, among other things. The research shows that both formal regula-tions and managerial needs determine the level of cost accounting maturity. It also indicates that the sub-stantive integration of the collected data serving the needs of the management is more important than the technical integration of hospital information system.

Utjecaj novog Zakona o zaštiti osoba s duševnim smetnjama na učestalost prisilne hospitalizacije na Klinici za psihijatriju KBC Rijeka

The research was conducted at the Clinic for Psychiatry of the Rijeka Clinical Hospital Center with the purpose of determining the impact of the new Law on the Protection of Persons with Mental Disorders (LPPMD) on the frequency of involuntary hospitalization. It has covered two investigated periods: The first investigated period is the period of application of the old LPPMD from 01.01.2012. until 31.12.2014. and the Second Investigated Period is the period of application of the New LPPMD from 01.01.2015. until 31.12.2017. In addition to comparing the frequency of involuntary hospitalizations, the study includes diagnostic criteria, socio-demographic data as well as ways of approach to the Clinic (Police, Emergency Medical Assistance, Family) and the means of separation and restrictions. For the purposes of research, data from the Protocol on Involuntary Hospitalization, the History of Disease and the Integrated Hospital Information System were used. Analysis of the obtained results showed that there is no statistically significant difference in the frequency of involuntary hospitalization according to the old and new LPPMD, although when observing the examined periods we can notice the tendency of increasing the frequency of involuntary hospitalization according to the new LPPMD. According to the results of the research, the majority of involuntary hospitalized patients are male, 46.6 (SD 13.9) years old, unmarried, with finished high school education, unemployed, diagnosed with F20-F29 - schizophrenia, schizophrenia-like disorder and insanely state and F10-F19 - Mental disorders and behavioral disorders caused by the use of psychoactive substances, forcibly hospitalized in police escort, and some of the means of separation and restriction were applied to them.

Hospital Information Integration Based on Integration Platform

This paper analyzes the current situation of hospital informatization, and puts forward a new solution to realize the integration of hospital information system to make up the defects of the traditional integration scheme in the current hospital informatization construction. Medical information integration and data sharing are realized by building a unified hospital information integration platform based on HL7 standards, SOA architecture and ESB technology. Each independent medical information subsystem is closely linked through the hospital information integration platform. On the base of the open architecture, the integration platform has strong scalability and supportsthe connection of customized adapters and the application of complex heterogeneous systems, so as to realize the data sharing and information collaboration among various hospital systems.

Hospital Information Systems: The status and approaches in selected countries of the Middle East.

Background and aimSince hospital information systems (HISs) are among the most important information systems in the health sector, the present study aimed to shed light upon the situation of HISs in selected countries of the Persian Gulf region to reflect national strategies and activities in the case of HISs.MethodsIn this descriptive cross-sectional study, the information about HISs status of the selected countries of the Persian Gulf region were obtained through approaches including review of national and international resources. Then, according to aspects included in HIS status, content analysis was performed. Information obtained from content analysis after several stages of reading, was categorized and then findings, presented.ResultsThe findings revealed that the surveyed countries have widely used HISs since the 1980s. HIS use and development vary to a certain extent. Since the middle of the first decade of the 21st century, Ministry of Health officials of the studied countries have considered the importance of HIS’s integration and creating Electronic Health Record where, Oman, Bahrain and UAE are among the leading countries.ConclusionSince the emergence of HISs in healthcare centers, these countries have employed various approaches. In any case, in order to avoid wasting important resources, including financial and human ones, the use of successful experiences of other countries along with the formulation of a comprehensive plan is highly recommended while considering all HIS aspects, including national and international standards.

Middleware for the Integration of Hospital Information Systems

Background: The integration of healthcare information systems is one of the most urgent priorities of healthcare organizations. Middleware has a major role in the integration of hospital information system (HIS). The purpose of this study is to determine the type of middleware used, their configuration and integration approaches in the hospitals of the research community.Methods: This study was descriptive in nature and was conducted in the form of a survey, with data being gathered via a self-structured questionnaire, in 2014. Seventeen hospitals affiliated to TUMS that have the HIS were recruited for this study. The questionnaire consisted of three parts. Simple statistical analysis was used to determine the integration status of HISs.Results: The most striking result to emerge from the data is that 64.7% of HISs had database-oriented middleware. Approximately half of surveyed HISs (41.2%) used synchronous mechanism and almost two-thirds of them (70.2%) used web service. Although, 17.2% of HISs use service-oriented integration approach, but the overall response to this question was poor.Conclusion: The result of the study indicates that the database-oriented middleware facilitate accessibility of the databases, on a variety of platforms. It might be related to the variety of company those developed the HISs. The result showed that the using web services could be helpful to application integration. The results of this investigation show that the HIS companies and healthcare facilities must be considered to the standards of interoperability for development and selection of the systems. Further research should be done to investigate the integration status of HISs in cross-national level and with other information systems in the field of healthcare.

Sinkronisasi Pangkalan Data Rumah Sakit dengan Aplikasi Open Source SymmetricDS

Health is an important supporting factor in the society. One of the curative implementation of the healthcare is hospital. Supporting system based on Information Technology of hospital is called Hospital Information System (SIRS) in which this system is mandatory in every hospital. Unfortunately, this system is developed individually by the hospital so that the integration of the system in higher levels is difficult. This research demonstrates integration of Hospital Information System in small scale using SymmetricDS Open Source database replication software. It can be shown that the integration of Hospital Information System is highly possible to enable higher scale healthcare support system in the future.

An example of usability measurement in clinical software procedures.

As a consequence of the dramatic improvements achieved in information technology standards in terms of single hardware and software components, efforts in the evaluation processes have been focused on the assessment of critical human factors, such as work-flow organisation, man-machine interaction and, in general, quality of use, or usability. This trend is particularly valid when applied to medical informatics, since the human component is the basis of the information processing system in health care context. With the aim to establish an action-research project on the evaluation and assessment of clinical software procedures which constitute an integrated Hospital Information System, the authors adopted this strategy and considered the measurement of perceived usability as one of the main goals of the project itself: the paper reports the results of this experience.

The Relationship between User Satisfaction, System Attributes and the Motivating Potential of System Use

User satisfaction (US) is an important information systems success measure. This paper contributes to our understanding of US in workplace settings by conceptualizing US as resulting from user evaluations of both the attribute level performance of the system and its impacts on the motivating potential of their work. Data was collected from a sample of 154 nurses in a regional public hospital in South Africa who are users of an integrated hospital information system. The authors considered that use of the system has implications for the motivating potential of work through its impacts on skill variety, task identity, significance, autonomy, and work performance. Their results show that a system's impact on motivating potential is significant for US. Moreover, system quality, information quality, and user support attributes of the IS have significant direct effects on US as well as indirect effects through motivating potential. A high performing system is thus important for US as it provides a platform to increase the motivating potential of work.

Innovation Diffusion among Healthcare Workforce: Analysis of Adoption and Use of Medical ICT in Ghanaian Tertiary Hospitals

One of the many notable interventions in the healthcare delivery service in Ghana is the adoption and use of medical technology to different aspects of hospital management especially the integrated Hospital Information Systems. These are comprehensive information support systems (medical sensors, scanners, expert systems, patent record management) implemented in most hospitals to integrate and provide rapid information in respect of patients, clinical, ancillary, legal, financial, service processing and other administrative issues. This research integrates each of the major elements from existing models to predict user acceptance, adoption and use of medical ICT in government hospitals in China and Ghana. Data is collected from a tertiary hospital in Ghana and analysed to evaluate a hierarchy of constraints and stimulants to the adoption and use of Medical ICT in government hospitals in Ghana, determines the extent to which cultural values or others can explain differences in the rate of adoption and use of Medical ICT in government hospitals in developing countries and make policy proposals towards amelioration of the problem of medical ICT adoption and use in government hospitals based on research outcome.

Pharmaceutical care for patients with acute myocardial infarction in Hungary

To obtain informationon the main causatives of acute myocardialinfarction (AMI), the background needs to be analyzed. Our aim was to identify those pharmaceutical aspects of this polymorbidity where the pharmacist can contribute. Earlier and recent European and Hungarian studies show similar results: cardiovascular (CV) death is still the leading cause of mortality. The quality of life is much lower and life expectancy is shorter in the investigated Borsod-Abaúj Zemplén county population compared to the whole of the country. After pharmaceutical care has been defined, its role should be established. A retrospective hospital-based survey was carried out. Medical records of 659 patients treated for myocardial infarction at the 1st Department of Internal Medicine-Cardiology of Borsod-Abaúj-Zemplén County Hospital and University Hospital were analyzed. Data were obtained using the MedWorkS integrated hospital information system and were selected based on Social Security Number (TAJ) and The International Statistical Classification of Diseases and Related Health Problems (ICD). We focused on the therapy and medication of patients. The obtained results are consistent with those of previous Hungarian studies (OLEF 2000) and statistical analyses. Based on the present study we suggest that pharmacists should work more closely with the medical staff. In studying the medication, we concentrated on antiplatelet therapy and studied the use of aspirin alone compared to aspirin plus clopidogrel. Of the 659 patients only 172 received aspirin as a preventive agent. We noticed that during this study only a low number of patients received ASA treatment and it could be seen in the outcome of the illness. We also found that dual antiplatelet therapy did not decrease the incidence of reinfarction in patients with AMI. In this study the theory (guidelines, other studies) and the clinical practice of the therapy and medication of AMI were compared. ASA therapy did not produce any significant effect. Our results are similar to those studies which concluded that ASA did not decrease the risk of cardiovascular events. Most patients with AMI suffer from polymorbidity. Since the occurrence of underlying chronic diseases is high, not only AMI must be treated, but therapy and medication must be complex. Complex therapeutic management is the key to the success of pharmaceutical care in the community pharmacy following hospital treatment.

Integrated Hospital Information System (HIS) Special focus on BIRDEM Hospital (600 Beds)

Introduction: Integrated Hospital Information System (HIS) is vital to decision making and plays a crucial role in the success of the organization. Computerization of the medical records and documentation has resulted in efficient data management and information dissemination for the users. Hospital Information System addresses the entire major functional areas of modern multi-specialty hospitals. The package enables improved patient care, patient safety, efficiency and reduced costs. It provides easy access to critical information, thereby enabling management to make better decisions on time. Aims: The short-term objectives of the on-line computerized system are to reduce costs and improve the accuracy and timeliness of patient care, accounting and administration, record keeping, and management reporting. The long-term goal is to build and maintain patient database for analysis of data to facilitate decision-making process. Methods: To run the system it requires some Hardware & Database for IT Department. The technique involves Patient Registration System, Finance & Accounts, Human Resource Management System, Laboratory, Out Patient Management System, and Inpatient Management System. Results: In the mid seventies, a complex was established at Shahbag area in the name of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM). From 1982 BIRDEM was designated as the WHO collaborating centre for research on prevention and control of diabetes. It is first of its kind outside Europe. Now from 2000 BIRDEM has successfull developed & implemented some crucial part of HIS System like Patient Admission & Billing System, Finanace & Account System, Human Resourse Management & Payroll System, Store Inventory & Procurement Management System, Labrotary Management System, Assets Management System, Radiology & Imaging Management System. Conclusions: It can thus be seen that deploying IT can help the medical profession in improving its quality of service and thus automatically increasing the preparedness and defensiveness. Of course, it is of vital importance that the software must have the right type of modularity and openness so that it is manageable, maintainable and upgradeable. They can perform the complex task of matching, tabulating, calculating, retrieving, printing and securing the data as required. Well designed, integrated computer system can be a great tool in the hands of the hospital management in improving services, controlling cost, and ensuring optimal utilization of facilities.

Integrating Hospital Information Systems in Healthcare Institutions: A Mediation Architecture

Many studies have examined the integration of information systems into healthcare institutions, leading to several standards in the healthcare domain (CORBAmed: Common Object Request Broker Architecture in Medicine; HL7: Health Level Seven International; DICOM: Digital Imaging and Communications in Medicine; and IHE: Integrating the Healthcare Enterprise). Due to the existence of a wide diversity of heterogeneous systems, three essential factors are necessary to fully integrate a system: data, functions and workflow. However, most of the previous studies have dealt with only one or two of these factors and this makes the system integration unsatisfactory. In this paper, we propose a flexible, scalable architecture for Hospital Information Systems (HIS). Our main purpose is to provide a practical solution to insure HIS interoperability so that healthcare institutions can communicate without being obliged to change their local information systems and without altering the tasks of the healthcare professionals. Our architecture is a mediation architecture with 3 levels: 1) a database level, 2) a middleware level and 3) a user interface level. The mediation is based on two central components: the Mediator and the Adapter. Using the XML format allows us to establish a structured, secured exchange of healthcare data. The notion of medical ontology is introduced to solve semantic conflicts and to unify the language used for the exchange. Our mediation architecture provides an effective, promising model that promotes the integration of hospital information systems that are autonomous, heterogeneous, semantically interoperable and platform-independent.

Evaluation of a Computerized Anesthesia Report

In Brazil, the use of information systems that allows filling out anesthesia reports automatically is still in its initial stages. The objective of this study was to validate an automated anesthesia record. This study was approved by the Ethics Commission of the institution; an industry-university partnership (Dixtal, São Paulo, Brazil and Universidade de São Paulo) was developed, and the study received a grant from FINEP (Financiadora de Estudos e Projetos do Ministério de Ciência e Tecnologia). The integration of hospital information systems for recovery of data regarding identification, preoperative evaluation, and laboratorial exams was the premise of this study. The applicability of the final version of the prototype of the automated system was evaluated by applying a semi-structured tool to 33 physicians, residents, and/or anesthesiologists during surgery procedures in 66 patients. Descriptive evaluation of the data was undertaken. The computerized system was considered reliable even for large surgeries by 81% of the participants. The majority of the anesthesiologists considered the prototype of great value for future studies and capable of meeting the requirements of anesthesia reports, bringing benefits for anesthesiologists, patients, and hospitals. The full use of the system requires training and some of its aspects can be improved. Validation of this prototype of a computerized system for elaboration of anesthesia reports showed the viability of this type of solution to help anesthesiologists in their daily tasks, increasing the reliability of the data. Besides, when evaluating the applicability, anesthesiologists considered that the prototype could be useful for patients, physicians, and hospitals.

Categorizing Communication Errors in Integrated Hospital Information Systems

Hospital information systems (HIS) are the hospital's nervous system. The HIS are mostly grown over several years, dedicated to specific needs and comprise individual workarounds. Changes to such complex systems may cause a variety of differ-ent negative side-effects. In order to understand the nature of incorrect communication in integrated HIS, a concise structured categorization of common communication problems and their reasons is essential. The objective of this paper is to present such a categorization, its development and verification. We used a combined approach for the development of the error categorization: We started with a qualitative content analysis on available literature in PubMed. In order to ensure the validity and completeness of the results, we chose the method of problem-centered expert interviews. The resulting categorization of communication problems is represented as a five-level hierarchy. It comprises 81 problems that are related to the electronic communication. Further, it contains in total 229 entries that are either the reasons of these problems or recommendation for avoiding the problems. To our knowledge there is no similar summary that concisely summarizes common communication problems and also refers to their underlying reasons. Equivalent content is mostly published in experience reports that just concentrate on single aspects. We used the details of such references in order to compile our categorization - it thus can be regarded as an intersection of relevant experiences. The categorization can raise a basic awareness on potential problems and supports the understanding of the underlying reasons. An evaluation in a real environment must prove whether the content of the categorization is correct.