International Journal of Medical Informatics (2004) 73, 503513

Information literacywhat it is about?

Literature review of the concept and the context
Kaija Saranto a,*, Evelyn J.S. Hovenga b,1

a
Department of Health Policy and Management, University of Kuopio, P.O. Box 1627, FIN-70211 Kuopio,
Finland
b
Faculty of Informatics and Communication, Central Queensland University, Rockhampton, Australia
Received 31 March 2003 ; received in revised form 21 October 2003; accepted 1 March 2004

KEYWORDS
Health informatics;
Medical informatics;
Nursing informatics;
Education;
Recommendations;
Computer literacy;
Information literacy;
Computer skills;
Information technology
literacy
Summary Objectives: The use of IT in health care has merged advanced knowledge
and skills for health care professionals. Former studies indicate that basic skills in
computer use are no more than comprehensive competencies to manage electroni-
cally stored information in health care. The purpose of this paper is to review the
literature focusing on the concept information literacy in the eld of health, nursing
and medical informatics. The target is to nd out how information literacy is dened,
in what kind of context it is presented and who are the focus of interest. Methods:
An automated literature search was performed on-line to Medline and by using the
EndNote Bibliographic Software. All together the number of papers analyzed was 97
or 78% of the total literature search result. Results: The survey indicates that the con-
cept information literacy does not exist as such in the literature, but it can be found
as a synonym to computer literacy or even more obscure concepts such as infor-
matics awareness or computer experience. The denitions of these concepts varied
considerably. A variety of descriptions of educational programs were also found, none
were based on the IMIA recommendations. Conclusions: In international cooperation
such as that of IMIA WG1, a wide range of efforts still needs to be carried out to com-
pile educational programmes in health informatics to enhance knowledge and skills
in computer use among health care professionals.
2004 Elsevier Ireland Ltd. All rights reserved.

1. Introduction informatics education for health care professionals

Health informatics education has been a topic of
interest for the International Medical Informatics
Association (IMIA) for many years. The Recom-
mendations on Education in Health and Medical
Informatics by IMIA working group one (WG1) are
compiled to be used internationally as a basis for
Corresponding
author.
E-mail addresses: kaija.saranto@uku. (K. Saranto),
e.hovenga@cqu.edu.au (E.J.S. Hovenga).
1 Past chair, IMIA Health and Medical Informatics Education Work-
ing Group.
1386-5056/$ see front matter 2004 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijmedinf.2004.03.002
(http://www.imia.org/wg1). In their recommen-
dations IMIA WG1 has used a three dimensional
framework for educational needs that includes (1)
professional in health care (IT user), (2) a type of
specialization in health and medical informatics
(Health and Medical Informatics (HMI) Specialist
and (3) the stage of career progression for each.
The recommendations are classied into three
knowledge/skill domain areas:
1. methodology and technology for the processing
of data, information and knowledge in medicine
and health care;
504
2. medicine, health and biosciences, health system
organization;
3. informatics/computer science, mathematics,
biometry.
Each domain has several learning and skill topics.
Learning outcomes for each domain for all health
care professionals in their role as IT users or HMI
Specialists, distinguish between introductory, inter-
mediate and advanced knowledge and skill. Infor-
mation literacy is one of the knowledge/skill topics
in the domain of Methodology and Technology for
the Processing of Data, Information and Knowledge
in Medicine and Health Care. It focuses on library
classication and systematic health related termi-
nologies and their coding, as well as literature re-
trieval methods. For health professionals as IT users
the recommended level of knowledge and skills is
intermediate [1].
Many universities have also focused on informa-
tion literacy demands from the librarys perspec-
tive [2]. In addition the relationship between the
concepts information literacy and computer or in-
formation technology literacy in health care facili-
ties has emerged [3,4]. Information literacy can be
dened as an understanding and set of abilities
enabling individuals to recognize when information
is needed and have the capacity to locate, eval-
uate and use effectively the needed information
[5]. Information technology literacy refers to a set
of capabilities, knowledge and skills needed to use
information technology at a level appropriate to a
persons position, work environment and discipline
and the ability to continue to develop them into the
future [6]. Computer literacy has already existed
for many years in the literature [79] and the con-
tent of the concept has focused on basic knowledge
and skills in computer use [10].
Information retrieval from electronic resources
such as clinical and research databases is evident
for health care professionals. This requires both
abilities and possibilities to access information as
well as knowledge to recognize information needs
and to assess the quality of the information. There
is a demand to easily combine evidence-based re-
search and clinical data in practice [11]. Thus not
only the competencies of health care profession-
als, but also the availability of electronic databases
have to be taken in account. This paper reviews the
literature that focuses on the concept of informa-
tion literacy. The purpose of the review was to an-
swer the following questions:
In what kind of publications have studies about
information literacy been published?
Within what context is information literacy pre-
sented?
K. Saranto, E.J.S. Hovenga
How is information literacy dened in recent pub-
lications?
Who are the focus of interest?
In addition, attention was paid to the concept
of evidence based practice (EBP) as well as to the
nationality of the authors.
2. Material and methods
2.1. Sampling
An electronic literature search was performed us-
ing Medline (PubMed), Cumulative Index of Nurs-
ing and Allied Health Literature (CINAHL) and Eric
databases. The search terms used were informa-
tion literacy, literacy and health, medical as well as
nursing informatics based on the review questions.
The search from Medline was made on-line us-
ing EndNote Bibliographic Software. The keywords
matched with 286 records and the search result
was easy to explore further with the software
options. The number of records in the PubMed
search diminished once these were examined more
closely as all records with the terms nursing and
health informatics and information literacy were
matched with and were duplicates of those found
using medical informatics and information literacy
as the search terms. As well some of them were
duplicates to nursing and health informatics and
medical informatics and literacy. The elimination
of duplicates and records published before 1995
was made automatically with the duplication op-
tion of the software. It was not possible to use the
on-line connection search of the Cinahl and Eric
databases, thus the electronic databases of the lo-
cal library were used for searching. Records found
in the Cinahl database (n = 18) also had duplicates
(n = 8) in PubMed searches. Due to the scarce num-
ber of records in the Cinahl database an additional
search was made using the keywords information
literacy and nursing. Of those records (n = 7) two
had duplicates in former searches. There were only
two records identied in the Eric database. How-
ever, those papers were totally irrelevant to the
subject. Obviously the scarcity of the number of
the records in the educational database was due to
the Boolean operation search terms and nursing,
health or medical. The resultant nal number of
the papers to be examined was 125 (Table 1).
2.2. Content analysis
The inclusion criteria for the content analysis were
that papers had to
Information literacywhat it is about? Literature review of the concept and the context 505

Table 1 No. of references found and total found to be useful

Search terms Medline via Published before 1995 19952001 Total
PubMed and number of
eliminated duplicates
Medical informatics and literacy 100 100
Medical informatics and information literacy 62 21 Hi-lit
13 Ni-lit
28 Mi-lit
Health informatics and literacy 48 11 Ni-lit 5
32 Mi-lit
Health informatics and information literacy 29 All included in Hi literacy
Nursing informatics and literacy 30 25 Mi-lit 5
Nursing informatics and Information literacy 19 All included in Ni literacy
Total 286 110
Search terms Cinahl via Published before 1995 and 19952001
ProQuest number of eliminated Total
duplicates
Medical informatics and literacy 1 1 Mi-lit
Medical informatics and information literacy 4 2 Mi-lit 2
Health informatics and literacy 2 1 Ni-lit 1
Health informatics and information literacy
Nursing informatics and literacy 11 4 Mi-lit 7
Nursing informatics and information literacy
Information literacy and nursing 7 2 Mi-lit 5
Total 25 15

(a) be written in English;
(b) be able to be retrieved electronically as full
text or to be reached locally without an inter-
national ordering procedure.
The authors language abilities restricted the se-
lection of non-English papers, however only seven
papers published in languages other than English
were excluded from the sample. For a better cov-
erage available abstracts from readily available full
text publications were also included in the content
analysis. All in all 65 papers and 32 abstracts (78%
out of 125 unique records identied) were included
for the analysis. As a rst step the papers and ab-
stracts were identied on the basis of the review
questions. Then, an internal classication based on
each question was made.
and medical informatics. Beyond the content analy-
sis the concept was rst discovered in a publication
in 1986.
The papers had been published mainly in jour-
nals (n = 55) and conference proceedings (n = 39).
All in all papers were published in a variety of 28
journals and seven different proceedings of which
eight articles had been published in Medinfo95
proceedings. The journals represented both health
informatics and health education elds. Only a few
papers (n = 3) had been published as chapters in
an edited book. The rst authors of the papers
represented 19 countries. The two most common
countries were USA (n = 34) and Australia (n = 11)
(Table 2). A total of 40 papers came from Europe.
The countries represented the continent well.
However, contributions from Asian countries were
missing.

3. Results 3.2. The context of information literacy

3.1. Type of publications where the papers
have been published
The search strategy revealed that information lit-
eracy is a relatively new concept in health, nursing
The search identied papers describing:
(a) the content of health informatics education
programmes or curriculum development in dif-
ferent education levels and countries;
506
Table 2 Context of information literacy among countries
Context of information Countries (N = 19)
literacy (papers n = 97a )
Australia
Literacy assessment Australia (4), 12%
(n = 33)
Curriculum development
(n = 11)
Programme description Australia (7), 27%
(n = 26)
Information system
implementation
(n = 24)
a
Three papers could not be categorized.
(b) assessment of computer skills and competen-
cies among health care professionals;
(c) evaluation of information system implementa-
tion in health care;
(d) overviews of Electronic Patient Record (EPR)
development from technical as well as users
perspectives or IT (e.g. multimedia) education
integration.
The papers were classied on the basis of the
following topics: (1) literacy assessment, (2) cur-
riculum development, (3) educational program
description, and (4) information system implemen-
tation issues (Table 3). The difference between
curriculum development and educational program
description seemed to be very slight. However
papers describing educational programs also had
information about the implementation of the pro-
gram. A frequent theme focused on the assessment
of information or computer literacy (n = 33). The
papers described many types of methods to assess
computer skills both in education and in clinical
context [4,1243]. Education in health informat-
ics, i.e. papers describing informatics educational
programs (n = 26) [4469] and descriptions of cur-
riculum development processes (n = 11) were also
popular themes [7080]. There were also special
courses focusing on information retrieval skills
[22,36,44,68,69]. The papers focused both on fac-
ulty issues and broadly on clinical aspects. The
category named Information system implementa-
tion was also quite large (n = 23) [81103]. The
most common topic of these papers was electronic
patient records (EPR). Finally four papers proved
to be irrelevant for the content analysis.
The papers focusing on curriculum development
and educational programs were also analyzed on the
K. Saranto, E.J.S. Hovenga
Europe North America Others
Check Rebuplik, Croatia, Canada (2),
Denmark, Germany (2), USA (15), 52%
Ireland (2), Italy, Portugal,
Sweden, UK (2), 36%
Finland (2), Netherlands Canada (3),
(2), UK, 45% USA (3), 55%
Finland, France, Ireland Canada, USA Lebanon, 4%
(2), Italy, Netherlands, (7), 31%
Romania (2), UK (2), 38%
Germany, Italy, Canada, USA South Africa
Netherlands, Romania, (9), 42% (2), 8%
Spain, Sweden (5), UK
(2), 50%
basis of their references to be able to nd out if the
IMIA recommendations for education (published in
1998) had been considered. The recommendations
were not used as references in any of the papers.
This is primarily due to the large number of ab-
stracts used for this review [32] where such a refer-
ence is unlikely. Many of the remaining papers were
published prior to the publication of these guide-
lines.
The context of information literacy was also an-
alyzed with respect to countries of the authors
(Table 2). Literacy assessment was of interest both
in Europe and USA. Curriculum development, pro-
gram description and information system imple-
mentation were of most interest in Europe.
3.3. The denition of the concept
information literacy
The literature indicates a huge variety of deni-
tions of the concept information literacy. There
were papers (n = 9) that totally lacked the concept
information literacy as well as papers (n = 31) that
lacked the denition of the concept. Based on the
content analysis the concepts describing informa-
tion literacy in the papers could be classied into
three categories: (1) computer literacy or skills
(n = 33), (2) information literacy (n = 23), and
(3) informatics awareness or computer experience
(n = 32). In some papers the denition could be
derived from the context such as from objectives
of an educational program. Based on the denitions
they were classied into the categories.
The denition of computer literacy described
the basic or lowest level of computer use. The most
frequent denition was connected to abilities to
Information literacywhat it is about? Literature review of the concept and the context 507

Table 3 Issues identied by number of references

Issues Comments and references n = 97a
1. Assessment of information Many types of assessment methods in n = 33
or computer literacy education or clinical context (refs.
[4,1243])
2. Description of educational Describing informatics educational n = 26
programs programs that included information
about program implementation (refs.
[4469])
3. Curriculum development Descriptions of curriculum n = 11
development processes (refs. [7080])
4. Information system Most common EPRs (refs. [81103]) n = 23
implementation
a
Four irrelevant references for the content analysis.

use computers that is basic computer skills such as
knowledge of the on-and-off switch and how to use
an application [38,58,74]. Furthermore these types
of denitions contained different software skills
such as word processing, spread sheet, or statistics
[24,53,56,76]. The computer device and the lim-
itations of computer use were also mentioned in
the denitions [24,38,40].
The denition of information literacy consisting
of basic computer skills as well as information re-
trieval abilities and communication skills was found
in several papers [32,33,36,37,46,79]. Information
literacy was regarded as awareness of literature,
the skills to locate, retrieve and evaluate, and
apply information in critical thinking and problem
solving [67]. The concept information literacy
was also seen as an abstract concept. Symbolically,
it appears to represent the ability to use informa-
tion, or possibly the possession of knowledge of
information [41].
The denitions of informatics awareness or
computer experience were connected to the pro-
fessional use of computers for example clinical
informatics [15,28,54,55,63,74]. It contains items
of computer and information literacy including soft-
ware packages, e-mail, Internet as well as search
engines and database searches. The denitions
also highlight the management of clinical infor-
mation within the health care applications [35,43,
46,78].
The importance of positive attitudes towards
computer use was also mentioned as a part of some
denitions [4,24,31,32,39,42,53,5759,77]. Com-
puter literacy (n = 8), information literacy (n = 5),
and informatics awareness (n = 3) were all con-
nected to attitudes towards computer use. The
concept evidence-based practice was also of inter-
est, it was connected to all these three information
literacy categories [32,36,67,103].
The relationships between the denitions and
the denition categories in the analyzed papers
are shown in the Table 4. Literacy assessment has a
strong relationship with both computer and infor-
mation literacy and program description strongly
relates to informatics awareness.
3.4. The focus group of interest
The papers were also analyzed on the basis of ac-
tors. The main interest group consisted of health
care professionals with different backgrounds
(n = 22). In several publications both medical

Table 4 The relationship between denitions and the context of information literacy
Context of information Denition categories
literacy
Computer literacy (%) Information literacy (%) Informatics awareness (%)
Literacy assessment 49 48 25
Curriculum development 3 13 19
Programme description 15 30 40
Information system 33 9 16
implementation
N = 88a 100 100 100
a
Nine papers could not be categorized.
508
(n = 16) and nursing (n = 12) students were of in-
terest. The papers focused also on nurses (n = 9) or
physicians (n = 14) as well as on nurses and physi-
cians (n = 1). Both students and educators were
also of interest: medical students and physicians
(n = 18) and nurse students and their educators
(n = 9). In six papers consumers and patients were
of interest [30,76,91,92,96,102]. In four papers the
expressions were so diffuse that the focus group
could not been stated. A number of papers (n = 14)
covered more than one type of actor.
4. Discussion
4.1. The reliability and validity of the study
The literature review can be criticized for several
reasons. The keywords used for sampling in this
study operated well although information literacy
is not a term in either the Medline or the Cinahl the-
saurus. Despite this decit, the term is used when
indexing papers and could also be found in some ab-
stracts. The term illiteracy could also have been a
search term. However, it was not used as our target
was to dene the concept information literacy. Both
authors determined the procedure of the content
analysis. The rst author then made the analysis.
However the authors had several discussions during
the analysis process and the categories adopted for
the analysis were a joint decision based on a con-
sensus agreement reached.
The main decit of the study is the criteria used
for the selection of papers for content analysis. Only
papers that could be reached on-line as full text
or internally by the local library where included in
the study. Therefore on-line abstracts were also de-
cided to be included in the analysis. However, the
quality of the abstracts varied, which made it im-
possible to classify the content of some abstracts.
All in all the variety of 97 papers (78%) from 19
countries indicates an international sampling. The
papers were published mainly in two types of publi-
cations: journals and proceedings. The proceedings
proved to be easily reached compared with the va-
riety of international journals that made it impossi-
ble to reach many of them electronically or manu-
ally from the local library. Moreover, multiplicity of
the journals highlights the importance of the topic.
It was also rewarding to nd that the number of full
texts available from electronic databases is increas-
ing. Medline was used as the main database, at the
same time it was the only one reached on-line. The
bibliographic software proved to be very exible for
this on-line literature search although it did result in
many incomplete references that needed to be cor-
K. Saranto, E.J.S. Hovenga
rected manually later. The possibility to use differ-
ent keywords and eliminate duplicate records was
useful. During the search process the options of the
software, including the ability to create your own
libraries (databases) for different purposes, proved
to be helpful for the content analysis. The created
libraries were also rewarding during the writing pro-
cess.
The selected time period 19952001 can be criti-
cized for several reasons. However before 1995 the
information literacy concept was most frequently
used by librarians. Advances in hospital information
systems and the use of electronic patient records
have made the concept important for health care
professionals.
4.2. Implications for the future
This study focused on the denitions of the con-
cept information literacy. The results show that
the concept is understood in a variety of ways.
On the basis of the content analysis the concept
had three categories which proved to be hierar-
chical: computer literacy, information literacy and
informatics awareness or experience. All these
categories or levels have overlapping competen-
cies, but also specic knowledge and skill areas.
The concept computer literacy as dened in this
study had no connections to professional use of
computers. The denitions mainly describe basic
computer skills. The denitions of the concept
were very broad and could be applied to any eld
or profession. However, the existence of this basic
skills level can be justied by the fact that there
are still a large number of nurses and physicians
who lack skills in computer use [27,58,74]. This
makes it obvious that the teaching of basic com-
puter skills still needs to be included in educational
programs. The content analysis also indicates that
a huge variety of efforts are focused on informat-
ics education of health care professionals. The
content of the computer literacy concept relates
to the knowledge and skill domain, referred to
as informatics/computer science by the IMIA WG1
recommendations.
The concept information literacy further de-
scribes abilities in computer use and computer
literacy. Thus computer literacy appears to refer to
the basic ability to read and write using a computer.
The use of networks and computer communication
links to libraries were essential skill requirements.
The concept was also connected to professional
use of computers regarding searches of electronic
databases. The concept evidence based practice
was connected to information literacy in some pa-
pers [36,67,103]. This category relates to the IMIA
Information literacywhat it is about? Literature review of the concept and the context
WG1 recommendations perspective of the concept
itself.
The concept informatics awareness or experience
was connected to professional use of computers,
information systems or EPR. As a conclusion of the
content analysis the term informatics awareness
was chosen for the name of the category as the
most advanced competency level. However in many
denitions the concept knowledge management
was also mentioned. Knowledge management was
not used as a search term as this is seen as a higher
level concept requiring information literacy as a
pre-requisite. As stated in the literature the trans-
formation from data to information and to knowl-
edge is an essential part of the information manage-
ment process [11,104,105]. This category relates
to IMIA WG1 recommendations learning outcomes
as a whole. The category had methodological,
technological, organizational, as well as scientic
aspects.
None of the papers analyzed mentioned the IMIA
WG1 recommendations for teaching health infor-
matics as a reference although they could be rec-
ognized from some of the papers. Due to the use
of abstract and time period limitations previously
mentioned it is not possible to reach any meaningful
conclusion regarding this. In accordance with the
principles adopted for the recommendations, many
of the educational programs focused on health
care professionals to be taught in homogenous or
heterogeneous profession groups [48,50,51,74].
The need for alternative types of specialization
in health and medical informatics was also recog-
nized, but only one paper described the health in-
formatics specialists level [80]. Although education
was seen as a continuum at different competency
levels the respective stage of career progression
could be seen only in some of the program de-
scriptions [31,63,65,66]. Eight papers focused on
educators. According to these papers there is still
the need for qualied teachers of health infor-
matics and their education should be strengthened
[32,63].
The IMIA recommendations distinguish knowl-
edge and skill levels within educational domains.
Most of the papers describe knowledge and skills as
integrated levels. However the difference between
knowledge and skills could be seen in the edu-
cational program objectives. Also literacy assess-
ments focused mainly on personal assessment of
ones abilities regarding knowledge and skills. The
assessments were mainly surveys using question-
naires. Attitudes towards computer use in health
care were also mentioned as a part of denitions.
In the IMIA recommendations positive attitudes are
not mentioned relative to learning outcomes. How-
509
ever terms like necessity, benets, values, need
and others can be interpreted as descriptions of
positive attitudes.
5. Conclusion
Information literacy proved to be an ambiguous
concept. This concept was given a variety of de-
nitions, which could be categorized into different
educational levels. In the analyzed papers edu-
cation of health informatics appears to have an
active role among health care professionals and
students. The concept was described in connec-
tion with literacy assessment, curriculum devel-
opment and educational program description as
well as information system implementation. Both
journals and conference proceedings seem to have
an active role of disseminating research results of
health informatics education. Although IMIA WG1
has described the knowledge and skill learning
outcomes of education in its recommendations,
these are not mentioned in terms of a framework
for curriculum development or reference for the
described educational programs. Above all, the
number of the papers focusing on health infor-
matics programme descriptions reect that a lot
of educational activities exist internationally. De-
spite the variable denitions, there appears to be
a general consensus that information literacy and
information technology literacy is a foundational
educational outcome to be achieved by all health
professionals.
Acknowledgements
The authors want to express their gratitude to Cen-
tral Queensland University, Faculty of Informatics
and Communication. The study has been conducted
during the rst authors Visiting Scholarship. With
the kind help of the CQU Library staff the data
collection for the study, using an on-line literature
search was exible and fast to conduct.
References
[1] R. Haux, A. Hasman, E.J.S. Hovenga, P. Knaup (Eds.), IMIA
WG1 2000 recommendations of the International Medical
Informatics Association (IMIA) on education in health and
medical informatics, Methods Inform. Med. 39 (3) (2000)
267277.
[2] M. Appleton, D. Orr, Meeting the needs of distance edu-
cation students, in: C. Bruce, P. Candy (Eds.), Information
Literacy Around the World, Advances in Programs and re-
search, Occassional Paper No. 1, Center for Information
510
Studies, Charles Sturt University, Wagga, NSW, Autsralia,
2000, pp. 1224.
[3] B. Carty, P. Roseneld, From computer technology to in-
formation technology: ndings from a national study of
nursing education, Computers Nurs. 16 (5) (1998) 259
265.
[4] N. Staggers, C.A. Gassert, C. Curran, Informatics com-
petencies for nurses at four levels of practice, J. Nurs.
Educ. 40 (7) (2001) 303316.
[5] Presidential Committee on Information Literacy, American
Library Association, Chicago, 1989.
[6] J. Winship, IT Literacy Project The First Step Forward,
Council of Australian University Directors of IT (CAU-
DIT), 2001, p. 13 (also available at http://www.caudit.
edu.au/caudit/information/project/itlit 2001.html ac-
cessed 22 August 2003).
[7] M.L. Amstrong, Computer competence for nurse educa-
tors, IMAGE: J. Nurs. Scholarship 18 (1986) 155160.
[8] H. Peterson, U. Gerdin-Jelger, Preparing nurses for using
information systems: recommended informatics compe-
tencies, NLN Publications, New York, 1988.
[9] A. Hasman, et al. (Eds.), Education and Training in Health
Informatics in Europe, IOS Press, Amsterdam, 1995.
[10] D.B. Bryson, The computer literate nurse, Computers
Nurs. 9 (3) (1991) 100107.
[11] S. Bakken, An informatics infrastructure is essential for
evidence-based practice, J. Am. Med. Informatics Assoc.
8 (2001) 199201.
[12] D.J. Bigsby, J.R. Moehr, Internet for teaching and learning
introductory health informatics, in: R.M. Gardner (Ed.),
Symposium on Computer Applications in Medical Care,
Journal of the American Medical Informatics Association,
Symposium Supplement New Orleans, 1995, pp. 532536.
[13] K. Brandt, H. Lehmann, Teaching literature searching in
the context of the world wide web, Journal of American
Medical Informatics Association, Symposium Supplement
New Orleans, 1995, pp. 888892.
[14] D.B. Ferguson, S.C. Rutishauser, A problem-based pre-
clinical course for dental students, Br. Dent. J. 182 (10)
(1997) 387392.
[15] W. Hersh, et al., Implementation and evaluation of a dis-
tance learning introductory course in medical informat-
ics, in: V.L Patel, R. Rogers, R. Haux (Eds.), Proceedings
Medinfo 2001, IOS Press, London, Amsterdam, pp. 1023
1027.
[16] A.F. Jerant, A.J. Lloyd, Applied medical informatics and
computing skills of students, residents, and faculty, Fam.
Med. 32 (4) (2000) 267272.
[17] M. Kristensen, C. Nohr, Technological changes in the
healthcare sector, A method to assess change readi-
ness, in: A. Hasman, B. Blobel, J. Dudeck, R. Engel-
brecht, G. Gell, H. Prokosh (Eds.), Proceedings of MIE
2000 and GMDS 2000, IOS Press Studies in Health Technol-
ogy and Informatics, Amsterdam, vol. 77, 2000, pp. 259
263.
[18] B. Langer, T. Wetter, Physicians attitudes towards health
telematicsan empirical survey, in: A. Hasman, B. Blobel,
J. Dudeck, R. Engelbrecht, G. Gell, H. Prokosh (Eds.),
Proceedings of MIE 2000 and GMDS2000, IOS Press Studies
in Health Technology and Informatics, Amsterdam, vol.
77, 2000, pp. 11061111.
[19] N.J. Ray, A. Hannigan, A survey of the computer literacy
of undergraduate dental students at a University Dental
School in Ireland during the academic year 199798, Eur.
J. Dent. Educ. 3 (2) (1999) 5663.
[20] K.L. Titus, T.K. Schleyer, H. Torres-Urquidy, S. Straja, Val-
idation of an instrument to measure dental students use
K. Saranto, E.J.S. Hovenga
of, knowledge about, and attitudes towards computers,
J. Dent. Educ. 65 (9) (2001) 883891.
[21] C.S. Scott, D.C. Schaad, L.S. Mandel, D.M. Brock, S. Kim,
Information and informatics literacy: skills, timing, and
estimates of competence, Teaching Learning Med. 12 (2)
(2000) 8590.
[22] M.R. Spala, F. Choc, A new task for the information liter-
acy training by the university libraries: electronic media
and computer networking, Sbornik Lekarsky 97 (4) (1996)
445448.
[23] J. Aroian, O. Breton, Nursing informatics in a registered
nurse graduate program, in: U. Gerdin, M. Tallberg, P.
Wainwright (Eds.), Proceedings Nursing Informatics97,
Stockholm, IOS Press Studies in Health Technology
and Informatics, No. 46, Amsterdam, 1997, pp. 191
194.
[24] S.I. Austin, Baccalaureate nursing faculty performance of
nursing computer literacy skills and curriculum integra-
tion of these skills through teaching practice, J. Nurs.
Educ. 38 (6) (1999) 260266.
[25] G. Eysenbach, et al., An international dermatological im-
age atlas on the WWW: practical use for undergraduate
and continuing medical education, patient education and
epidemiological research, in: B. Cesnik, A.T. McCray, J.-R.
Scherrer (Eds.), Proceedings Medinfo, IOS Press Studies in
Health Technology and Informatics, Amsterdam, vol. 52
(Pt. 2), 1998, pp. 788792.
[26] J.L. Hardy, Assessment of the level of the actual and
desirable levels of computer literacy, usage and ex-
pected knowledge of undergraduate students of nursing,
in: R.A Greenes, H.E Peterson, D. Protti (Eds.), Proceed-
ings Medinfo, Vancouver, HC&CI, Canada, Pt. 2, 1995,
pp. 13261330.
[27] R. Jayasuriya, Determinants of microcomputer technology
use: implications for education and training of health
staff, Int. J. Med. Informatics 50 (13) (1998) 187194.
[28] J. Kern, Medical informatics in the medical curriculum
when, in: P. Kokol, B. Zupan, J. Stare, M. Premik, R.
Engelbrecht (Eds.), Medical Informatics Europe99, IOS
Press Studies in Health Technology and Informatics, vol.
68, 1999, pp. 484488.
[29] M.C. Mazzoleni, P. Baiardi, I. Giorgi, G. Franchi, R. Mar-
coni, M. Cortesi, Assessing users satisfaction through per-
ception of usefulness and ease of use in the daily inter-
action with a hospital information system, in: J. Cimino
(Ed.), Proceedings/AMIA Annual Fall Symposium, Philadel-
phia, Hanley & Belfus, 1996, pp. 752756.
[30] S. Munir, R. Boaden, Patient empowerment and the elec-
tronic health record, in: V.L Patel, R. Rogers, R. Haux
(Eds.), Proceedings Medinfo, IOS Press, London, Amster-
dam, Pt. 1, 2001, pp. 663665.
[31] M.S. Nesler, et al., Nursing informatics needs assessment.
Are distance programs needed? Nurse Educator 23 (5)
(1998) 2529.
[32] M. Sinclair, J. Gardner, Planning for information technol-
ogy key skills in nurse education, J. Adv. Nurs. 30 (6)
(1999) 14411450.
[33] L.L. Stamler, B. Thomas, S. McMahon, Nursing students
respond to a computer assignment, J. Professional Nurs.:
Off. J. Am. Assoc. Colleges Nurs. 15 (1) (1999) 52
58.
[34] J. Stephenson, As discoveries unfold, a new urgency to
bring genetic literacy to physicians, JAMA: J. Am. Med.
Assoc. 278 (15) (1997) 12251226.
[35] Teixeira, L.M. Anjos, Telematics in nursingction or re-
ality changing mentalities, in: Mantas (Ed.), Advances in
Health Telematics Education, IOS Press, Studies in Health
Information literacywhat it is about? Literature review of the concept and the context
Technology and Informatics, Amsterdam, vol. 51, 1998,
pp. 156165.
[36] M.P. Verhey, Information literacy in an undergraduate
nursing curriculum: development, implementation, and
evaluation, J. Nurs. Educ. 38 (6) (1999) 252259.
[37] V. Vimarlund, T. Timpka, N. Hallberg, The economic im-
plications of users willingness to increase knowledge cap-
ital in health informatics, in: B. Cesnik, A.T. McCray, J.-R.
Scherrer (Eds.), Proceedings Medinfo98, IOS Press Stud-
ies in Health Technology and Informatics, Amsterdam, Pt.
2, 1998, pp. 711715.
[38] C.A. Gassert, D. McDowell, Evaluating graduate and un-
dergraduate nursing students computer skills to deter-
mine the need to continue teaching computer literacy,
in: R.A. Greenes, H.E. Peterson, D. Protti (Eds.), Proceed-
ings Medinfo, Vancouver, HC&CI, Canada, Pt. 2, 1995,
p. 1370.
[39] R.M. Ribbons, The use of computers as cognitive tools to
facilitate higher order thinking skills in nurse education,
Computers Nurs. 16 (4) (1998) 223228.
[40] D. Billings, Preparing nursing faculty for information-age
teaching and learning, Computers Nurs. 13 (6) (1995) 264,
268270.
[41] J. Cheek, I. Doskatsch, Information literacy: a resource
for nurses as lifelong learners, Nurse Educ. Today 18
(1998) 243250.
[42] E. Miller, E. Arquiza, Improving computer skills to support
hospital restructing, J. Nursing Care Quality 13 (5) (1999)
4456.
[43] S. Hoffman, J. Ash, A survey of academic and industry
professionals regarding the preferred skillset of graduates
of medical informatics programs, in: V.L. Patel, R. Rogers,
R. Haux (Eds.), Proceedings Medinfo, IOS Press, London,
Amsterdam, 2001, pp. 10281032.
[44] W.R. Hersh, et al., Factors associated with successful an-
swering of clinical questions using an information retrieval
system, Bull. Med. Library Assoc. 88 (4) (2000) 323
331.
[45] L.M. Fox, J.M. Richter, N.E. White, A multidimensional
evaluation of a nursing information-literacy program,
Bull. Med. Library Assoc. 84 (2) (1996) 182190.
[46] D.M. Kaufman, P.A. Jennett, Preparing our future physi-
cians: integrating medical informatics into the undergrad-
uate medical education curriculum, in: S.J. Weghorst,
K.S. Morgan, H. Hoffman, Stredney (Eds.), Studies in
Health Technology and Informatics, IOS Press, Amster-
dam, vol. 39, 1997, pp. 543546.
[47] T. Schleyer, Assessing outcomes of an academic computing
initiative, J. Dent. Educ. 62 (6) (1998) 432440.
[48] M. Bazavan, R. Dimitriu, Medical informatics training pro-
gramme to support the Romanian Health Care Manage-
ment Information System, in: C. Pappas, N. Maglaveras,
J.-R. Scherrer (Eds.), Medical Informatics Europe97, IOS
Press Studies in Health Technology and Informatics, Am-
sterdam, vol. 43 (Pt. B), 1997, pp. 717721.
[49] M. Crudele, A. Serio, A distributed support system
for medical and nursing students, in: C. Pappas, N.
Maglaveras, J.-R. Scherrer (Eds.), Medical Informatics
Europe97, IOS Press Studies in Health Technology and In-
formatics, Amsterdam, vol. 43 (Pt. B), 1997, pp. 699
701.
[50] J. Grimson, An IT awareness programme for the health
sector in Ireland, in: P.A. Kokol (Ed.), Medical Informat-
ics Europe99, IOS Press, Amsterdam, 1999, pp. 151
155.
[51] J. Grimson, et al., A multimedia approach to raising
awareness of information and communications technol-
511
ogy amongst healthcare professionals, Int. J. Med. Infor-
matics 5859 (2000) 297305.
[52] E.J. Hovenga, D. Goldsworthy, Health informatics educa-
tion for undergraduates: teaching experiences with multi
media, in: J. Mantas (Ed.), Advances in Health Telematics
Education, IOS Press, Amsterdam, 1998, pp. 313.
[53] M.R. Kidd, W. McPhee, The lost generation: IT educa-
tion for healthcare professionals, Med. J. Aust. 171 (10)
(1999) 510511.
[54] S. Kinn, R. Jones, Continuing education in health infor-
matics in the UK: the need for learning materials, in:
R.A. Greenes, H.E. Peterson, D. Protti (Eds.), Proceed-
ings Medinfo, Vancouver, HC&CI, Canada, Pt. 2, 1995,
pp. 12601264.
[55] V.P. Lane, P. Curran, Computing education of medical
students through a study of hospital and clinical activities:
seven years experience, in: R.A. Greenes, H.E. Peterson,
D. Protti (Eds.), Proceedings Medinfo, Vancouver, HC&CI,
Canada, Pt. 2, 1995, pp. 11441148
[56] D. Lewis, J.E. Watson, S. Neweld, Implementing instruc-
tional technology. Strategies for success, Computer Nurs.
15 (4) (1997) 187190.
[57] S.T. Liaw, J.J. Marty, Learning to consult with computers,
Med. Educ. 35 (7) (2001) 645651.
[58] S.D. Marini, Introduction of nursing informatics in the
nursing baccalaureate program at the American University
of Beirut, Computer Nurs. 18 (5) (2000) 240247.
[59] J. McGowan, et al., A vertical curriculum to teach the
knowledge, skills, and attitudes of medical informatics,
in: C. Chute (Ed.), Proceedings/AMIA Symposium, 1998,
pp. 457461.
[60] W. McPhee, B. Cesnik, The evaluation of computer knowl-
edge and skills of medical students: a three-year com-
parison, in: R.A. Greenes, H.E Peterson, D. Protti (Eds.),
Proceedings Medinfo, Vancouver, HC&CI, Canada, Pt. 2,
1995, p. 1166.
[61] G.I. Mihalas, Health informatics education for pharmacy
students in Romania, in: C. Pappas, N. Maglaveras, J.-R.
Scherrer (Eds.), Medical Informatics Europe97, IOS Press
Studies in Health Technology and Informatics, Amsterdam,
vol. 43 (Pt. B), 1997, pp. 702706.
[62] K. Moidu, M.A. Leehy, I. Steinberg, S. Einreinhofer, J.J.
Falsone, J. Cleary, S. Nair, E. Mazur, Informatics integra-
tion in a medical residency program: early experiences,
in: J. Cimino (Ed.), Proceedings/AMIA Annual Fall Sympo-
sium, Philadelphia, Hanley & Belfus, 1996, pp. 5559.
[63] V.K. Saba, J.B. Riley, Nursing informatics in nursing edu-
cation, in: U. Gerdin, M. Tallberg, P. Wainwright (Eds.),
Proceedings Nursing Informatics97, IOS Press Studies in
Health Technology and Informatics, Stockholm, Amster-
dam, 1997, No. 46, pp. 185190.
[64] G. Soula, Designing medical hypermedia: the FORUM
project, in: C. Pappas, N. Maglaveras, J.-R. Scherrer
(Eds.), Medical Informatics Europe97, IOS Press Studies
in Health Technology and Informatics, Amsterdam, vol.
43 (Pt. B), 1997, pp. 712716.
[65] M. Tallberg, The Finnish informatics nurse, her job and
education against a background of international develop-
ment, in: J. Mantas (Ed.), Advances in Health Telematics
Education. IOS Press, Studies in Health Technology and
Informatics, Amsterdam, vol. 51, 1998, pp. 3540.
[66] E.H. van Aalst, H. Springer, The training of the infor-
matics nurse: an intermediary between the discipline of
nursing and the developers of information systems, in:
R.A Greenes, H.E Peterson, D. Protti (Eds.), Proceed-
ings Medinfo, Vancouver, HC&CI, Canada, Pt. 2, 1995,
pp. 13441348.
512
[67] A. Shorten, M.C. Wallace, P.A. Crookes, Developing in-
formation literacy: a key to evidence-based nursing, Int.
Nurs. Rev. 48 (2) (2001) 8692.
[68] M.C. Wallace, et al., Integrating information literacies
into an undergraduate nursing programme, Nurse Educ.
Today 18 (3) (1999) 243250.
[69] M.C. Wallace, A. Shorten, P.A. Crookes, Teaching infor-
mation literacy skills: an evaluation, Nurse Educ. Today
20 (6) (2000) 485489.
[70] A. Hasman, Challenges for medical informatics in the 21st
century, Int. J. Med. Informatics 44 (1) (1997) 17.
[71] A.F. Jerant, Training residents in medical informatics,
Fam. Med. 31 (7) (1999) 465472.
[72] E.C. Schneider, J.M. Eisenberg, Strategies and methods
for aligning current and best medical practices. The role
of information technologies, Western J. Med. 168 (5)
(1998) 311318.
[73] D.M. Kaufman, Integrating medical informatics into an un-
dergraduate medical curriculum, in: R.A. Greenes, H.E.
Peterson, D. Protti (Eds.), Proceedings Medinfo, Vancou-
ver, HC&CI, Canada, Pt. 2, 1995, pp. 11391143.
[74] J. Murphy, et al., Preparing the next generation of
clinicians to manage information, in: C. Pappas, N.
Maglaveras, J.-R. Scherrer (Eds.), Medical Informat-
ics Europe97, IOS Press, Amsterdam, 1997, pp. 676
680.
[75] G.I. Paterson, D.M. Kaufman, Medical informatics and
problem-based learning in conjunction, in: R.A Greenes,
H.E. Peterson, D. Protti (Eds.), Proceedings Medinfo,
Vancouver, HC&CI, Canada, Pt. 2, 1995, pp. 1149
1153.
[76] K. Saranto, H. Leino-Kilpi, Computer literacy in nursing:
developing the information technology syllabus in nursing
education, J. Adv. Nurs. 25 (2) (1997) 377385.
[77] K. Saranto, M. Tallberg, Nursing informatics in nursing
educationa challenge to nurse teachers, Nurse Educ.
Today 18 (1) (1998) 7987.
[78] J.H. van Bemmel, New ways of teaching health informat-
ics, M.D. Computing: Computers Med. Pract. 16 (3) (1999)
1415.
[79] K. Hodson-Carlton, J.L. Dorner, An electronic approach
to evaluating healthcare Web resources, Nurse Educator
24 (5) (1999) 2126.
[80] H.D. Covvey, et al., The development of model curricula
for health informatics, in: V.L. Patel, R. Rogers, R. Haux
(Eds.), Proceedings Medinfo, London, IOS Press, Amster-
dam, 2001, pp. 10081013.
[81] P.L. Emiliani, Toward an information society for all: chal-
lenges in health telematics, in: A. Trakatellis, S. Maglav-
era, I. Iakovidis (Eds.), Education and Training in Health
Telematics, Studies in Health Technology Informatics, IOS
Press, Amsterdam, vol. 72, 2000, pp. 108115.
[82] M.E. Frisse, et al., Informatics and medical libraries:
changing needs and changing roles, Acad. Med.: J. Assoc.
Am. Med. Colleges 70 (1) (1995) 3035.
[83] C.U. Lehmann, D.J. Wang, G.R. Kim, K. Johnson, Utiliza-
tion of a paediatric link collection by health professionals
and laypersons, Med. Inform. (Lond.) 23 (1) (1998) 5362.
[84] T. McDonald, P.J. Blignaut, A comparison of a manual
and a computer system in a primary health care clinic,
Curationis 21 (3) (1998) 813.
[85] A. Mordue, M.E. Seeley, The development of an approach
to evaluate NHS managers competence in medical infor-
matics, Computer Methods Programs Biomed. 54 (12)
(1997) 3947.
[86] R.E. Nikula, Organizational and technological insight as
important factors for successful implementation of IT,
K. Saranto, E.J.S. Hovenga
in: N. Lorenzi (Ed.), Proceedings/AMIA Symposium, 1999,
Philadelphia, pp. 585588.
[87] V.L. Patel, A.W. Kushniruk, Understanding, navigating,
and communicating knowledge: issues and challenges,
Methods Inform. Med. 37 (45) (1998) 460470.
[88] J. Rashbass, The impact of information technology on
histopathology, Histopathology 36 (1) (2000) 17.
[89] A.K. Singh, et al., Bhorugram (India): revisited, A 4 year
follow-up of a computer-based information system for
distributed MCH services, Int. J. Med. Informatics 44 (2)
(1997) 117125.
[90] J.J. van Overbeeke, H.P. Westerhof, The Dutch Benet-II
project: do physicians benet from using an electronic
medical dossier? Int. J. Biomed. Comput. 42 (12) (1996)
9196.
[91] D. Vordermark, O. Kolbl, M. Flentje, The Internet as
a source of medical information Investigation in a
mixed cohort of radiotherapy patients, Strahlentherapie
und Onkologie: Organ der Deutschen Rontgengesellschaft
176 (11) (2000) 532535.
[92] P.F. Brennan, Health informatics and community health:
support for patients as collaborators in care, Methods
Inform. Med. 38 (45) (1999) 274278.
[93] J.G. Anderson, L.L. Casebeer, R.E. Kristofco, Medcast:
evaluation of an intelligent pull technology to support
the information needs of physicians, in: N. Lorenzi (Ed.),
Proceedings/AMIA Symposium, Philadelphia, 1999, pp.
466470.
[94] V. Arias-Vimarlund, M. Ljunggren, T. Timpka, Implementa-
tion of computer-based patient records in primary care:
the societal health economic effects, in: J. Cimino (Ed.),
Proceedings/AMIA Annual Fall Symposium, Philadelphia,
1996, pp. 503507.
[95] P.J. Blignaut, Software for primary healthcare in a devel-
oping country. Background and problem statement, Com-
puters Nurs. 17 (6) (1999) 291296.
[96] T.R. Eng, et al., Access to health information and support:
a public highway or a private road? JAMA: J. Am. Med.
Assoc. 280 (15) (1998) 13711375.
[97] M.G. Kahn, The computer-based patient record and
Robert Fulghums 16 principles, M.D. Comput.: Comput-
ers Med. Pract. 12 (4) (1995) 253258.
[98] M. Martin-Baranera, et al., Assessing physicians expecta-
tions and attitudes toward hospital information systems.
The IMASIS experience, M.D. Comput.: Computers Med.
Pract. 16 (1) (1999) 7376.
[99] I. Moisil, et al., Strategic plan for promoting ICNP in
Romania, in: C. Pappas, N. Maglaveras, J.-R. Scherrer
(Eds.), Medical Informatics Europe97 IOS Press Studies in
Health Technology and Informatics, Amsterdam, vol. 43
(Pt. B), 1997, pp. 691693.
[100] R.E. Nikula, P.B. Elberg, H.B. Svedberg, Clinicians must
invest resources when implementing electronic patient
records, in: M. Prernik, P. Kokol, R. Engelbrecht, B. Zu-
pan, J. Stare (Eds.), Proceeding Medical Informatics Eu-
rope (MIE99), IOS Press, Studies in Health Technology
and Informatics, Amsterdam, vol. 68, 1999, pp. 824
827.
[101] R.E. Nikula, P.B. Elberg, H.B. Svedberg, Informed de-
cisions by clinicians are fundamental for EPR imple-
mentation, Int. J. Med. Informatics 5859 (2000) 141
146.
[102] S.C. Porter, I.S. Kohane, Optimal data entry by patients:
effects of interface structure and design, in: V.L Pa-
tel, R. Rogers, R. Haux (Eds.), Proceedings Medinfo,
London, IOS Press, Amsterdam, Pt. 1, 2001, pp. 141
145.
Information literacywhat it is about? Literature review of the concept and the context 513

[103] E.H. Shortliffe, The evolution of health-care records in
the era of the Internet, in: B. Cesnik, A.T. McCray, J.-R.
Scherrer (Eds.), Proceedings Medinfo, IOS Press Studies in
Health Technology and Informatics, Amsterdam, vol. 52
(Pt. 1), 1998, pp. 814.
[104] W.T. Goossen, Nursing information management and pro-
cessing: a framework and denition for systems analysis,
Int. J. Biomed. Comput. 40 (1996) 187195.
[105] S.B. Henry, Nursing Informatics: state of the science, J.
Adv. Nurs. 22 (1995) 11821192.