[AKTIN - The German Emergency Department Data Registry - real-time data from emergency medicine : Implementation and first results from 15 emergency departments with focus on Federal Joint Committee's guidelines on acuity assessment]. / Das AKTIN-Notaufnahmeregister ­ kontinuierlich aktuelle Daten aus der Akutmedizin : Ergebnisse des Registeraufbaus und erste Datenauswertungen aus 15 Notaufnahmen unter besonderer Berücksichtigung der Vorgaben des Gemeinsamen Bundesausschusses zur Ersteinschätzung.

BACKGROUND: Emergency care in Germany is in transition. Emergency departments (EDs) treat their patients based on symptoms and acuity. However, this perspective is not reflected in claims data. The aim of the AKTIN project was to establish an Emergency Department Data Registry as a data privacy-compliant infrastructure for the use of routine medical data. METHODS: Data from the respective documentation systems are continuously transmitted to local data warehouses using a standardized interface. They are available for several applications such as internal reports but also multicentre studies, in compliance with data privacy regulations. Based on a 12-months period we evaluate the population with focus on acuity assessment (triage) and vital parameters in combination with presenting complaints. RESULTS: For the period April 2018 to March 2019, 436,149 cases from 15 EDs were available. A triage level is documented in 86.0% of cases, and 70.5% were triaged within 10 min of arrival. Ten EDs collected a presenting complaint regularly (82.3%). The respective documentation of vital signs shows plausible patterns. CONCLUSIONS: The AKTIN registry provides an almost real-time insight into German EDs, regardless of the primary documentation system and health insurance claims data. The Federal Joint Committee's requirements are largely met. Standardized presenting complaints allow for symptom-based analyses as well as health surveillance.

Secure Electronical Communications and Data Transfers in a Clinical Environment.

As part of the German Project AKTIN, data security arises as an important issue. The context of this issue was detailed and the requirements were determined, with special focus on the hospital's point of view. The solution is illustrated in this poster. Further use cases in other medical or study context are also discussed.

Design and multicentric implementation of a generic software architecture for patient recruitment systems re-using existing HIS tools and routine patient data.

OBJECTIVE: (1) To define features and data items of a Patient Recruitment System (PRS); (2) to design a generic software architecture of such a system covering the requirements; (3) to identify implementation options available within different Hospital Information System (HIS) environments; (4) to implement five PRS following the architecture and utilizing the implementation options as proof of concept. METHODS: Existing PRS were reviewed and interviews with users and developers conducted. All reported PRS features were collected and prioritized according to their published success and user's request. Common feature sets were combined into software modules of a generic software architecture. Data items to process and transfer were identified for each of the modules. Each site collected implementation options available within their respective HIS environment for each module, provided a prototypical implementation based on available implementation possibilities and supported the patient recruitment of a clinical trial as a proof of concept. RESULTS: 24 commonly reported and requested features of a PRS were identified, 13 of them prioritized as being mandatory. A UML version 2 based software architecture containing 5 software modules covering these features was developed. 13 data item groups processed by the modules, thus required to be available electronically, have been identified. Several implementation options could be identified for each module, most of them being available at multiple sites. Utilizing available tools, a PRS could be implemented in each of the five participating German university hospitals. CONCLUSION: A set of required features and data items of a PRS has been described for the first time. The software architecture covers all features in a clear, well-defined way. The variety of implementation options and the prototypes show that it is possible to implement the given architecture in different HIS environments, thus enabling more sites to successfully support patient recruitment in clinical trials.

LOINC in prehospital emergency medicine in Germany - experience of the `DIRK´-project.

BACKGROUND: Treatment of patients picked up by emergency services can be improved by data transfer ahead of arrival. Care given to emergency patients can be assessed and improved through data analysis. Both goals require electronic data transfer from the emergency medical services (EMS) to the hospital information system. Therefore a generic semantic standard is needed. OBJECTIVES: Objective of this paper is to test the suitability of the international nomenclature Logical Observation Identifiers Names and Codes (LOINC) to encode the core data-sets for rescue service protocols (MIND 2 and MIND 3). Encoding diagnosis and medication categories using ICD-10 and ATC were also assessed. METHODS: Protocols were broken down into concepts, assigned to categories, translated and manually mapped to LOINC codes. Each protocol was independently encoded by two healthcare professionals and in case of discrepancies a third expert was consulted to reach a consensus. RESULTS: Currently 39% of parameters could be mapped to LOINC. Additional use of other coding systems such as International Statistical Classification of Diseases and Related Health Problems (ICD-10) for diagnoses and Anatomical Therapeutic Chemical Classification System (ATC) for medications increases the rate of 'mappable' parameters to 56%. CONCLUSIONS: Although the coverage is low, mapping has shown that LOINC is suitable to encode concepts of the rescue services. In order to create a generic semantic model to be applied in the field our next step is to request new LOINC codes for the missing concepts.

Cardiac effects of echinocandin preparations - three case reports.

WHAT IS KNOWN AND OBJECTIVE: Echinocandins are antifungal agents, routinely used in invasive candida infections in critically ill patients. Their excellent anticandidal activity and their low frequency of reported adverse events and drug interactions make them first-line guideline treatments of candidiasis especially in intensive care units (ICU). We report on three ICU patients who developed cardiac insufficiency and hemodynamic instability during administration of loading doses of an echinocandin. CASE SUMMARY: Three ICU patients showed a substantial drop in their cardiac index or a deterioration of the mean arterial pressure following start of echinocandin administration. The patients were 75 years (female), 71 years (male) and 66 years (male) old. One patient received caspofungin, and two patients received anidulafungin as empirical antifungal treatment for severe sepsis. WHAT IS NEW AND CONCLUSION: Our cases suggest that the observed cardiac impairment could be associated with echinocandin administration. Therefore, we recommend close hemodynamic monitoring of critically ill patients receiving echinocandins.