Understanding IT in Healthcare: Relevance and Training Needs of IT in Private Medical Practice.

BACKGROUND: The integration of Information Technology (IT) into private medical practice is crucial in modern healthcare. Physicians managing office-related IT without proper knowledge risk operational inefficiencies and security. OBJECTIVES: This study determines the relevance of specific IT topics in medical practice and identifies the training needs of physicians for enhancing IT competencies in healthcare. METHODS: In March 2023 a cross-sectional online survey was conducted with physicians comprising nine IT-related topics in Tyrol, Austria. RESULTS: The survey results highlighted a strong perceived relevance and high demand for IT education among physicians working in their medical practice, especially in areas of core medical IT and security. The majority of responses indicated high relevance (76.7%) and high demand (69.7%) for IT topics in medical practice. CONCLUSION: The findings underscore a significant need for targeted IT training and support in medical practices, particularly in areas related to the medical practice and security. Addressing these needs could lead to improved healthcare delivery and better management of technological resources in the healthcare sector.

Transforming Tele-Ophthalmology: Utilizing Cloud Computing for Remote Eye Care.

BACKGROUND: Tele-ophthalmology is gaining recognition for its role in improving eye care accessibility via cloud-based solutions. The Google Cloud Platform (GCP) Healthcare API enables secure and efficient management of medical image data such as high-resolution ophthalmic images. OBJECTIVES: This study investigates cloud-based solutions' effectiveness in tele-ophthalmology, with a focus on GCP's role in data management, annotation, and integration for a novel imaging device. METHODS: Leveraging the Integrating the Healthcare Enterprise (IHE) Eye Care profile, the cloud platform was utilized as a PACS and integrated with the Open Health Imaging Foundation (OHIF) Viewer for image display and annotation capabilities for ophthalmic images. RESULTS: The setup of a GCP DICOM storage and the OHIF Viewer facilitated remote image data analytics. Prolonged loading times and relatively large individual image file sizes indicated system challenges. CONCLUSION: Cloud platforms have the potential to ease distributed data analytics, as needed for efficient tele-ophthalmology scenarios in research and clinical practice, by providing scalable and secure image management solutions.

Technology-Supported Behavior Change-Applying Design Thinking to mHealth Application Development.

Non-communicable diseases are the leading cause of global deaths. The risk of their development and progression is increased by modifiable behavioral risk factors. Yet, despite the known benefits of primary and secondary prevention, people often do not follow recommendations for a healthier lifestyle. To this end, mobile health (mHealth) applications offer features for behavioral interventions. Yet, reported user engagement is often low. The objective of the work presented in this article is thus to evaluate the suitability of Design Thinking (DT) as a means to inform the development of an mHealth application that helps increase long-term engagement, and consequently supports individuals in sustainably changing their lifestyle. Applying the DT approach, key user needs and challenges were investigated and used to design a first low-fidelity mHealth application prototype. Think-Aloud analysis, task completion, and post-test interviews were then used to evaluate the prototype and generate early-stage insights. Subsequently, a structured, retrospective analysis of this process, evaluating the insight-generation potential of each step in the DT process cycle, was used to reflect on its suitability to inform mHealth application development. The respective results highlight (1) the distinct value of the DT method, particularly in the early stages of a development project; (2) the strong need for interdisciplinary collaboration in such projects, so as to capture realistic end-user requirements and improve the overall effectiveness of the application design; and (3) the significance of integrating behavioral change theories into the design of mHealth applications, in order to promote long-term engagement.

The Surviral Epidemiological Early Warning System Tyrol Dashboard - System, Functionality and Findings.

BACKGROUND: Dashboards provide a good retrospective view of the development of the disease. Yet, current COVID-related dashboards typically lack the capability to predict future trends. However, this is important for health policy makers and health care providers in order to adopt meaningful containment strategies. OBJECTIVES: The aim of this paper is to present the Surviral dashboard, which allows the effective monitoring of infectious disease dynamics. METHODS: The presented dashboard comprises a wide range of information, including retrospective and prognostic data based on an agent-based simulation framework. It served as the basis for informed decision-making and planning of disease control strategies within the federal state of Tyrol. RESULTS: By visualizing the information in an understandable format, the dashboard provided a comprehensive overview of the COVID-19 situation in Tyrol and allowed for the identification of trends and patterns. CONCLUSION: The presented dashboard is a valuable tool for managing pandemics such as COVID-19. It provides a convenient and efficient way to monitor the spread of a disease and identify potential areas for intervention.

Making a Virtue of Necessity - A Highly Structured Clinical Data Warehouse as the Source of Assured Truth in a Hospital.

Data-driven decision-making in health care is becoming increasingly important in daily clinical use. A data warehouse, storing all the clinically relevant information in a highly structured way, is a primary basis for achieving this goal. We are developing a clinical data warehouse where more than 20 years of clinical data can be persisted, and newly generated data from different sources can be integrated. A back room was created to store all hospital information system data in a PostgreSQL database. Due to the enormous number of diverse forms in the hospital information system, a broker service was developed that integrates the individual data sources into the data warehouse as soon as they are released for storage. The front room represents the interface from the infrastructure to the targeted analysis. Database query and visualization tools or business intelligence tools can display and analyze processed and interleaved data. In all areas of business and medicine, structured and quality-adjusted data is of major importance. With the help of a clinical data warehouse system, it is possible to perform patient-centered analyses and thus realize optimal therapy. Furthermore, it is possible to provide staff and management with dashboards for control purposes.

Integrating a Novel Eye Imaging System into Clinical Practice: An Open-Source DICOM Simulation Platform.

BACKGROUND: The integration of innovative imaging technologies into clinical workflows requires the utilization of a standardized data exchange format. The "Digital Imaging and Communications in Medicine" (DICOM) standard is widely used in healthcare to process and transfer medical images. However, no simulation environment is ready to use for development. The objective of this paper is to provide an open-source DICOM platform for integrating a novel ocular photography system into a clinical setting. METHODS: After a thorough analysis of the available open-source tools, a subset was selected and aligned with the U-Eyecare Profile of Integrating the Healthcare Enterprise (IHE). RESULTS: Orthanc served as a PACS with a modality worklist and the OHIF-Viewer for image retrieval. Minimal interfaces for the electronic health record and image modality were created. Docker-compose further integrates all components and simulates the network protocols DICOM Message Service Element and DICOMWeb. DISCUSSION: The platform was used to develop and integrate the developed image modality and will be further utilized for teleophthalmology and processing eye images. The platform could be useful for other researchers to integrate an image modality into a clinical environment along IHE.

Data Exchange Standards in Teleophthalmology: Current and Future Developments.

BACKGROUND: Teleophthalmology services are considered capable of supporting screening, early diagnosis, and monitoring of leading causes of blindness on a global scale. Therefore, standards and best practices are needed to seamlessly exchange medical ocular images and related data among relevant stakeholders with maximum interoperability. OBJECTIVES: This paper provides an overview of current standards in the field of store-and-forward teleophthalmology data exchange and further developments in this area. METHODS: A literature review was conducted for healthcare standards with a focus on data exchange in ophthalmology. RESULTS: IHE, HL7 FHIR, DICOM, and clinical terminologies are considered the most important standards, providing distinct concepts, solutions, and guidelines for ophthalmology. CONCLUSION: Available standards provide the necessary base for teleophthalmology on technical and semantic interoperability, but practical use is limited due to missing process interoperability resulting in proprietary interfaces of vendors and rejection by ophthalmologists. Further investigations should analyze processual needs on ophthalmology data exchange standards.

Experiences With Developing and Using Vital Sign Telemonitoring to Support Mobile Nursing in Rural Regions: Feasibility and Usability Study.

BACKGROUND: Modern information and communication technology has the potential to support mobile care in rural regions such as the Alpine region, which is characterized by long distances or even physically unreachable areas. OBJECTIVE: This study investigated the potential of supporting mobile nursing organizations in rural regions with the use of mobile telemonitoring systems in a case study setting. METHODS: As a subproject of the European Union-funded project INTESI, the VITAl parameter MOnitoring (VITAMO) project gathered stakeholders' requirements for telemonitoring support of mobile care in rural regions and then developed and implemented a prototype system that was used for a 3-month test period with a local nursing organization in Austria. Log analysis, surveys, and interviews were used to evaluate the system according to the Technology Acceptance Model. The focus was technology assessment and user satisfaction of both patients and nurses. RESULTS: Participants were provided Bluetooth devices to measure blood pressure, body weight, and blood glucose and to track activity. They also received a tablet with a mobile internet connection to see the results. The nurses were able to access the results remotely. Regularly executed speed tests and log analysis demonstrated the availability of high-speed mobile internet in the rural test region. Log analysis, surveys, and interviews revealed the suitability of the technology environment and showed that the system was easy to use and potentially useful. The perceived usefulness for supporting mobile care was rated meaningfully low, and the frequency of nurses using the tool declined continuously over the field test period. Further group discussions investigated this issue. CONCLUSIONS: While the technology environment with mobile internet, Bluetooth devices, and smart vital sign monitoring devices was adequate and suitable to support mobile nursing in rural regions, the potential benefit for the nursing organization could not be confirmed. Further analysis revealed that operational care processes did not follow a well-defined care strategy. Technology has the potential to leverage the available environment for developing meaningful solutions. These experiences could contribute to further investigations that need to identify and analyze existing mobile care processes at an organizational level.

Real-Time & Autonomous Data Transmission for Vital-Sign Telemonitoring: Requirements & Conceptualization.

The alpine space is challenging for mobile care organizations as rural homes of patients are often characterized through long way distances or might be sometimes even isolated due to weather conditions. Real-time monitoring features for supporting mobile care require the easy conduction of self-measurements on vital signs for patients. Therefore, a vital sign telemonitoring system got conceptualized, utilizing the potential of Information and Communication Technology (ICT). The aim of this work was to gather technical and user-related requirements for a patient-centered telemonitoring system. Therefore, a mixed approach was followed comprising a comprehensive technical review, a literature review and interviews with stakeholders. Suitable use cases were derived from the gathered technical and user-related requirements. The results yielded to a concept for a seamless integrated, unobtrusive home monitoring system for elderly people with real-time data synchronization and communication features to support the mobile nurse organization, which got implemented and evaluated in the field. The concept overcomes known barriers of usability on telemonitoring systems like complex interaction which might lead to more efficiency and effectiveness in mobile nursing. The developed concept got further implemented as a prototype and validated within a 3-month test period.

An Approach for Dynamic Vital Parameter Monitoring - Prototype Development.

The alpine space is characterized with rural regions, often hard to reach for mobile care. As part of the EU-funded INTESI project, a mobile platform for vital sign self-monitoring for patients who receive mobile care was developed. Based on a thorough analysis of user requirements and available technology a platform was established, that integrates several Bluetooth low energy devices for measuring vital signs. The developed VITAMO app further enables clients and nurses to easily govern measurements and jointly take control of a client's health during the care process. In addition, the system supports the communication of clients and nurses electronically. The internal data structure adheres to current healthcare standards e.g. FHIR and offers easy interfaces for future applications. The complete system was applied in a pilot study and got formally evaluated.

An Approach for the Support of Semantic Workflows in Electronic Health Records.

With the unprecedented increase of healthcare data, technologies need to be both, highly efficient for the meaningful utilization of accessible data and flexible to adapt to future challenges and individual preferences. The OntoHealth system makes use of semantic technologies to enable flexible and individual interaction with Electronic Health Records (EHR) for physicians. This is achieved by the execution of formally modelled clinical workflows and the composition of Semantic Web Services (SWS). Several seamless components provide a service-oriented structure defined by individual designed EHR-workflows. This work gives an overview of the planned architecture and its main components. The architecture constitutes the basis for the prototype implementation of all components. With its highly dynamic structure based on SWS, the architecture will be able to cope with both, the individual users' needs as well as the quick evolving healthcare domain.

Semantic Web Service Delivery in Healthcare Based on Functional and Non-Functional Properties.

In the past decades, a lot of endeavor has been made on the trans-institutional exchange of healthcare data through electronic health records (EHR) in order to obtain a lifelong, shared accessible health record of a patient. Besides basic information exchange, there is a growing need for Information and Communication Technology (ICT) to support the use of the collected health data in an individual, case-specific workflow-based manner. This paper presents the results on how workflows can be used to process data from electronic health records, following a semantic web service approach that enables automatic discovery, composition and invocation of suitable web services. Based on this solution, the user (physician) can define its needs from a domain-specific perspective, whereas the ICT-system fulfills those needs with modular web services. By involving also non-functional properties for the service selection, this approach is even more suitable for the dynamic medical domain.

Building a Semantic Model to Enhance the User's Perceived Functionality of the EHR.

In order to facilitate and increase the usability of Electronic Health Records (EHRs) for healthcare professional's daily work, we have designed a system that enables functional and flexible EHR access, based on the execution of clinical workflows and the composition of Semantic Web Services (SWS). The backbone of this system is based on an ontology. In this paper we present the strategy that we have followed for its design, and an overview of the resulting model. The designed ontology enables to model patient-centred clinical EHR workflows, the involved sequence of tasks and its associated functionality and managed clinical data. This semantic model constitutes also the main pillar for enabling dynamic service selection in our system.

Dynamic User Interfaces for Service Oriented Architectures in Healthcare.

Electronic Health Records (EHRs) play a crucial role in healthcare today. Considering a data-centric view, EHRs are very advanced as they provide and share healthcare data in a cross-institutional and patient-centered way adhering to high syntactic and semantic interoperability. However, the EHR functionalities available for the end users are rare and hence often limited to basic document query functions. Future EHR use necessitates the ability to let the users define their needed data according to a certain situation and how this data should be processed. Workflow and semantic modelling approaches as well as Web services provide means to fulfil such a goal. This thesis develops concepts for dynamic interfaces between EHR end users and a service oriented eHealth infrastructure, which allow the users to design their flexible EHR needs, modeled in a dynamic and formal way. These are used to discover, compose and execute the right Semantic Web services.

Robotic Assistance in Medication Management: Development and Evaluation of a Prototype.

An increasing number of elderly people and the prevalence of multimorbid conditions often lead to age-related problems for patients in handling their common polypharmaceutical, domestic everyday medication. Ambient Assisted Living therefore provides means to support an elderly's everyday life. In the present paper we investigated the viability of using a commercial mass-produced humanoid robot system to support the domestic medication of an elderly person. A prototypical software application based on the NAO-robot platform was implemented to remind the patient for drug intakes, check for drug-drug-interactions, document the compliance and assist through the complete process of individual medication. A technical and functional evaluation of the system in a laboratory setting revealed versatile and viable results, though further investigations are needed to examine the practical use in an applied field.

Requirements for Workflow-Based EHR Systems - Results of a Qualitative Study.

BACKGROUND: Today's high quality healthcare delivery strongly relies on efficient electronic health records (EHR). These EHR systems or in general healthcare IT-systems are usually developed in a static manner according to a given workflow. Hence, they are not flexible enough to enable access to EHR data and to execute individual actions within a consultation. OBJECTIVES: This paper reports on requirements pointed by experts in the domain of diabetes mellitus to design a system for supporting dynamic workflows to serve personalization within a medical activity. METHODS: Requirements were collected by means of expert interviews. These interviews completed a conducted triangulation approach, aimed to gather requirements for workflow-based EHR interactions. The data from the interviews was analyzed through a qualitative approach resulting in a set of requirements enhancing EHR functionality from the user's perspective. RESULTS: Requirements were classified according to four different categorizations: (1) process-related requirements, (2) information needs, (3) required functions, (4) non-functional requirements. CONCLUSION: Workflow related requirements were identified which should be considered when developing and deploying EHR systems.

Requirements for Evidence-Based Templates in Electronic Case Report Forms.

BACKGROUND: Electronic case report forms (eCRF) play a key role in medical studies and medical data registries (MDR) for clinical research. The creation of suitable eCRFs is a challenging and yet a very individual task. OBJECTIVES: We plan to create evidence-based templates for eCRFs which are aligned with existing studies or MDRs. METHODS: In this paper we investigated existing standards for eCRFs, defined uses cases and derived requirements needed to identify and annotate data items and pertinent information within study protocols, literature or patient cases. RESULTS: In order to establish evidence-based eCRF templates based on annotated text documents, a standard-based, hierarchical structure with linkage to existing data repositories needs to be modeled. Standards like ISO/IEC 11179 provide a necessary base, which needs to be extended with proper linking functions. CONCLUSION: Linking evidence-based sources with eCRFs allows creating templates, which could be used to define eCRFs for new clinical studies or even compare studies among them. As a next step, the derived requirements from this paper will be used to establish an ontology-based structure for annotating existing text-documents with eCRF data elements.

A software tool to analyze clinical workflows from direct observations.

Observational data of clinical processes need to be managed in a convenient way, so that process information is reliable, valid and viable for further analysis. However, existing tools for allocating observations fail in systematic data collection of specific workflow recordings. We present a software tool which was developed to facilitate the analysis of clinical process observations. The tool was successfully used in the project OntoHealth, to build, store and analyze observations of diabetes routine consultations.