[Institutes of medical informatics, biometry and epidemiology at medical faculties in Germany: A historical review and outlook using the example of Essen]

 Andreas Stang <sup>1,2

1</sup> Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Essen, Germany
² School of Public Health, Department of Epidemiology, Boston University, Boston, United States

Abstract

The present work attempts to outline the founding history of the Institute for Medical Informatics, Biometry and Epidemiology (IMIBE) of the Medical Faculty of the University of Duisburg-Essen using all available archive documents of the Institute, the Dean’s Office and the University of Duisburg-Essen. The IMIBE was founded in 1974. Similar to the founding of the sister institutes in Kiel (1964) and Freiburg (1963), medical doctors from the medical faculties were the driving force behind the founding of the institutes. At the Essen Medical Faculty, these were Prof. Scherer and Doz. Dr. med. Dr. phil. Jansen. As late as 1991, the Essen chair holder, Prof. Schmitt, declared that epidemiology was to be regarded as a “subset of biomathematics or biometrics” and was not mentioned as an independent subject either in the licensing regulations or in the further training regulations for medical doctors. It remains important for the subjects of medical informatics, biometry and epidemiology at the faculty of medicine that the medical profession recognizes that these disciplines provide a basis for scientific work in medicine.

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Introduction

The majority of professorships and institutes in the three subjects “Medical Informatics, Biometry and Epidemiology” are an integral part of the 38 state medical faculties and the six private universities with medical faculties or private medical schools in Germany [1].

The Institute for Medical Informatics, Biometry and Epidemiology (IMIBE) of the Medical Faculty of the University of Duisburg-Essen was founded in 1974 [2] and celebrated its 50^th anniversary in 2024. The aim of this paper is to present the founding history of the institute and to work out the retrospectively recognizable arguments for the founding of the Essen Institute in order to open up a medical-historical discussion. Furthermore, the aim of this work is to use the historical development of the IMIBE to provide an outlook for the future prospects of these institutes in Germany.

All available archive documents of the IMIBE, the Dean’s Office of the Faculty of Medicine and the University Archive of the University of Duisburg-Essen regarding the history of the Institute were examined. Furthermore, information was taken from the 100-year anniversary publication of the University Hospital [3]. For a historical understanding of the founding of the IMIBE, it is necessary to consider various developments, some of which took place in parallel. The existence of the Medical Faculty of the University of Duisburg-Essen was a mandatory prerequisite for the establishment of the IMIBE. Table 1 [Tab. 1] therefore presents a brief overview of the historical milestones in the founding of this faculty and the University Hospital Essen for the interested reader.

Please note that I have translated quotations, indicated by quotation marks, from German into English. If you are interested in the original German quotes, please refer to the German version of the work.

Suggestions from the medical profession at the Faculty of Medicine in Essen

The Faculty of Medicine in Essen, which was initially a faculty of the “Westfälische Wilhelms-Universität Münster” (1963–1967) and later of the “Ruhr-Universität Bochum” (1967–1972), consisted of two faculties at the time of its foundation: Faculty 7, “Theoretical Medicine” (often referred to as faculty VII) and Faculty 8, “Practical Medicine” (often referred to as faculty VIII). On May 10, 1968, Prof. Dr. med. Eberhard Scherer, „Röntgeninstitut und Strahlenklinik, Städtische Krankenanstalten, Klinikum Essen der Ruhr-Universität Bochum“, wrote a letter to the Dean of Department VIII at the “Klinikum Essen der Ruhr-Universität Bochum”:

Apparently, in two faculty meetings in the winter semester of 1967/1968 Scherer had suggested a department for statistics and documentation to be set up. One of the reasons he gave for this was the large volume of data being generated. He was given the task of estimating the expected volume of data that would be generated each year in the Faculty of Medicine and the University Hospital Essen.

On September 13, 1968, Doz. Dr. med. Dr. phil. Gerd Jansen, Occupational Medicine, Institute for Hygiene and Occupational Medicine at the Ruhr University Bochum, Medical Faculty Essen, wrote a letter to the Dean, Prof. Dr. med. H. J. Schümann, Dean of Department VII, Essen:

In this letter, Jansen describes that the help of mathematicians is useful for dealing with medical problems and that young doctors are not sufficiently trained methodologically. Like Scherer, he therefore suggests the establishment of a chair. This suggestion by doctors at the Essen Medical Faculty cannot be traced back to the licensing regulations for doctors in force at the time (“Bestallungsordnung für Ärzte” [6], Table 2 [Tab. 2]) because these regulations did not yet include the three subjects biometry, epidemiology, and medical informatics.

Development of the licensing regulations for medical doctors in West Germany

The licensing regulations for doctors (abbreviated to ÄApprO) regulate medical studies. The revision of the ÄApprO is the responsibility of the federal and state governments and must be approved by the Federal Council. The revision is therefore a political task. The Federal Ministry of Health is centrally involved in this.

In 1970, the subject biomathematics was integrated into the ÄApprO (Table 2 [Tab. 2]) and from then on medical students had to take “Exercises in Biomathematics for Physicians”, which required curricular teaching and qualified personnel. Obviously, the political view had also been reached that medical students should acquire a minimum knowledge of biomathematics. According to the ÄApprO, curricular teaching is mandatory in medical studies. The subjects of medical informatics and epidemiology were not mentioned in the ÄApprO of 1970. In a letter dated February 28, 1991, Prof. Schmitt, Director of the Institute for Medical Informatics and Biomathematics at Essen University Hospital, informed the Dean of Faculty 14, Prof. Dr. W. M. Fischer, among others:

With the ÄApprO of 2002, the subjects “Epidemiology, medical biometry and medical informatics” were introduced, so that from then on all three subjects were firmly anchored in the ÄApprO.

Most recently, on March 31, 2017, the “Master Plan for Medical Studies 2020” was adopted by the Federal Ministry of Education and Research (BMBF), the Federal Ministry of Health (BMG), the Standing Conference of the Ministers of Education and Cultural Affairs (KMK), the Conference of Health Ministers (GMK) and parliamentary group representatives. This publication makes a revision of the ÄApprO necessary. To this end, the Federal Ministry of Health presented a draft bill in November 2020, which will probably lead to a revision of the ÄApprO in the medium term [8].

Founding of today’s Institute for Medical Informatics, Biometry and Epidemiology (IMIBE) at Essen University Hospital

The excerpt from the minutes of the joint faculty meeting of Departments VII and VIII (RUB) from May 24, 1973 contains the adoption of an appointment list to fill the chair of “Biostatistics and Documentation”, in which Prof. H. G. Schmitt, Würzburg, was in first place [9]. Schmitt took up the professorship in 1974 and the “Institute for Biostatistics and Documentation” was founded in the same year [2]. In addition to his professorship, the institute consisted of two assistants, a secretary and a programmer.

After taking up the professorship, Schmitt wrote to both Deans of Departments VII (Theoretical Medicine) and VIII (Practical Medicine) on October 24, 1974, requesting the procurement of a “data transfer station” for connection to a large computer system for Departments VII and VIII, including the clinic administration, from both Deans of these departments [2]. Schmitt apparently immediately took care of setting up an institution-wide IT system.

In a letter dated January 21, 1975, Schmitt requested that the “Institute for Biostatistics and Documentation” be renamed the “Institute for Medical Informatics and Biomathematics” on the grounds that it was not apparent “that the aforementioned institute was located in the field of medicine” [10]. The Medical Faculty of both departments agreed to this change at its meeting on February 13, 1975 [11].

In a letter dated May 15, 1979 [12], Schmitt informed the dean that he had succeeded,

The IMIBE was in charge of the hospital information system of the Operative Center II from 1989 to 1997. Since 1997, the “Central Information Processing Facility” (ZEI) of the University Hospital has been responsible for setting up and expanding the hospital-wide communication and information system in patient care. It was not until February 2016 that ZEI was renamed the “Central IT” (ZIT) and its management was separated from IMIBE [13].

With the impending retirement of Prof. Dr. H. G. Schmitt, the Rectorate of the University of Essen decided on 17.7.1991 to advertise a professorship for the subjects “Medical Informatics and Biomathematics” at grade C4. It was noted in the letter:

With the unexpected death of Prof. Schmitt before his retirement, PD Dr. R.-J. Fischer temporarily headed the Institute. In a letter dated 17.12.1993 from the Dean Prof. Dr. W. M. Fischer to the Ministry of Science and Research NRW, the renaming of the Institute to “Institute for Medical Informatics, Biometry and Epidemiology” was requested with the following reasons:

In January 1994, the Senate of Essen University Gesamthochschule approved the renaming of the Institute as the “Institute of Medical Informatics, Biometry and Epidemiology” [16]. The appointed Prof. Dr. rer. nat. Karl-Heinz Jöckel was Director of the Institute from 1994 to 2019. He was succeeded by Prof. Dr. med. Andreas Stang, MPH, in January 2020.

Outlook

The increasing importance of biomathematics for scientific work in medicine from the perspective of the Essen medical profession and the realization that special expertise is required in handling electronic data at Essen University Hospital are understandable explanations for the founding of the Institute for Medical Informatics, Biometry and Epidemiology at the Faculty of Medicine in 1974. The establishment of these subjects in Germany was and is strongly linked to developments in the medical faculties and the ÄApprO.

Founded in 1957, the Science Council, a joint institution of the federal and state governments, developed a recommendation on the expansion of scientific institutions, which was published in 1960 [17]. Among others, the well-known internist Prof. Paul Martini, University Hospital Bonn, after whom the GMDS prize of the same name is named in recognition of the development of the methodology of clinical-evaluative research for the assessment of therapeutic measures [18], was involved [19]. Among other things, the Science Council recommended:

The “Structure of university hospitals” chapter of the recommendations contains the following:

Interestingly, these recommendations played no recognizable role in the founding of the institutes in Kiel (IMIS, founded in 1964) [20], Freiburg (IMBI, founded in 1963) [21] and Essen, for which we have the founding histories. In fact, “the recommendations initially caused great indignation in the Freiburg Medical Faculty; the autonomy and unity of the faculty was seen as extremely endangered by the demand for an increase in chairs in accordance with a ‘minimum endowment’ specified by the Science Council.” [21]. In these three medical faculties, however, medical doctors played a decisive role in setting up the institutes (Kiel: Prof. Albin Proppe; Freiburg: Prof. Richard Haas and Prof. Walter Keller; Essen: Prof. Eberhard Scherer). The hygienist Prof. Haas and the pediatrician Prof. Walter, both from Freiburg, wrote a memorandum on the establishment of a chair for medical statistics and documentation at the Medical Faculty of the University of Freiburg even before the recommendations of the Science Council in 1960 [22]. We were only able to find explicit information at the Mainz Institute (founded as the Institute for Medical Statistics and Documentation, IMSD, in 1963, later renamed the Institute for Medical Biometry, Epidemiology and Informatics, IMBEI) that the founding of the institute there was based on the recommendation of the Science Council in 1960.

It is essentially the appreciation of these subjects by the medical profession (at least in Kiel, Freiburg and Essen) and the formation of political will in Germany (revision of the ÄApprO) that made it possible for institutes or professorships for these subjects to be established not only at the Essen Medical Faculty, but also at various other medical faculties in Germany. Due to this “German way” of the academic development of these subjects, it is obvious to analyze the German historical peculiarities and to derive an outlook for the future of these subjects at medical faculties, as long as the majority of professorships and institutes of these subjects remain integrated in the medical faculties and separate faculties are not created for these subjects.

There is some evidence that a) the continued appreciation of the three subjects among the medical profession and b) the active political consultation of the decision-making bodies with regard to the ÄApprO and the committees of the German Council of Science are important. For the medical profession, it is increasingly difficult to understand the significance of the curricular subjects of medical informatics, biometrics and epidemiology in the context of these terms and in the context of medical studies due to the various subspecializations and new developments with sometimes blurred subject or field designations (machine learning, artificial intelligence, big data, (medical) data science, bioinformatics, statistical computing, computer science). For this reason, especially in times of modern methods of machine learning and statistical modeling, it is important that institutes and professorships of these curricular subjects at medical faculties maintain close research and teaching collaborations with the other institutes and clinics of medical faculties, without falling into an exclusive service or service provider function. It must remain clear to the medical profession that specialist expertise in medical informatics, biometrics and epidemiology is an essential basis for scientific work in medicine.

The professional representatives and their professional societies “Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie, gmds” (founded in 1955 under the name “Gesellschaft für Dokumentation”, DGD, renamed in 1966 as “Deutsche Gesellschaft für Medizinische Dokumentation und Statistik”, GMDS, current name since 1992) (https://www.gmds.de/), “German Region of the International Biometric Society, IBS-DR” (founded in 1954) (https://www.biometrische-gesellschaft.de/) and “German Society for Epidemiology, DGEpi” (founded in 2005) (https://www.dgepi.de/) retain the important task of influencing political consultation in the context of revisions to the ÄApprO and statements by the Science Council. For the upcoming revision to the ÄApprO, which has not yet been adopted, it was not guaranteed in initial drafts that all three curricular subjects would continue to be present [23]. Only after intervention by the specialist societies was it possible to ensure that all three curricular subjects remained in the current draft of the ÄApprO.

It is unclear how significant the revision of the ÄApprO in 1970 with the introduction of the subject of biomathematics was for the founding of sister institutes at other medical faculties. It is also unclear at how many medical faculties the Science Council’s report from 1960 had an influence on the founding of the institutes. A systematic review of the medical faculties’ archives on the founding histories of the institutes and professorships could provide important information in this regard. It can be assumed that the Science Council’s 1960 report made it easier to convince the responsible state ministries to approve positions and funding for the chairs.

Studying the history of the founding of the institutes and professorships of medical informatics, biometry and epidemiology at the medical faculties in Germany provides information about the origins, changeability and developments of the three disciplines and thus leads to a better understanding of the present; it can also sensitize us to future developments.

Notes

Author’s ORCID

Andreas Stang: 0000-0001-6363-9061

Acknowledgement

I would like to thank the Dean’s Office of the Medical Faculty of the University of Duisburg-Essen and Mr. Nils Ingenfeld, University Archive, University of Duisburg-Essen, for providing archive documents relating to the founding of the Institute. I would also like to thank Dr. Fabian Standl, Munich, Prof. Dr. Jürgen Stausberg, Essen, and Prof. Martin Schumacher, Freiburg, for their valuable comments on the manuscript. Finally, I would like to thank an anonymous reviewer who made many valuable suggestions for improvement.

Competing interests

The author declares that he has no competing interests.

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