Implementation of cloud computing in the German healthcare system.

With the advent of artificial intelligence and Big Data - projects, the necessity for a transition from analog medicine to modern-day solutions such as cloud computing becomes unavoidable. Even though this need is now common knowledge, the process is not always easy to start. Legislative changes, for example at the level of the European Union, are helping the respective healthcare systems to take the necessary steps. This article provides an overview of how a German university hospital is dealing with European data protection laws on the integration of cloud computing into everyday clinical practice. By describing our model approach, we aim to identify opportunities and possible pitfalls to sustainably influence digitization in Germany.

Dentistry and Interoperability.

Information has become the vital commodity of exchange in recent decades. Medicine is no exception; the importance of patient information in the digital form has been recognized by organizations and health care facilities. Almost all patient information, including medical history, radiographs, and feedback, can be digitally recorded synchronously and asynchronously. Nevertheless, patient information that could be shared and reused to enhance care delivery is not readily available in a format that could be understood by the systems in recipient health care facilities. The systems used in medical and dental clinics today lack the ability to communicate with each other. The critical information is stagnant in isolated silos, unable to be shared, analyzed, and reused. In this article, we propose enabling interoperability in health care systems that could facilitate communication across systems for the benefit of patients and caregivers. We explain in this article the importance of interoperable data, the international interoperability standards available, and the range of benefits and opportunities that interoperability can create in dentistry for providers and patients alike.

[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.

Pelagic Sargassum community change over a 40-year period: temporal and spatial variability.

Pelagic forms of the brown algae (Phaeophyceae) Sargassum spp. and their conspicuous rafts are defining characteristics of the Sargasso Sea in the western North Atlantic. Given rising temperatures and acidity in the surface ocean, we hypothesized that macrofauna associated with Sargassum in the Sargasso Sea have changed with respect to species composition, diversity, evenness, and sessile epibiota coverage since studies were conducted 40 years ago. Sargassum communities were sampled along a transect through the Sargasso Sea in 2011 and 2012 and compared to samples collected in the Sargasso Sea, Gulf Stream, and south of the subtropical convergence zone from 1966 to 1975. Mobile macrofauna communities exhibited changes in community structure and declines in diversity and evenness within a 6-month time period (August 2011-February 2012). Equivalent declines in diversity and evenness were recorded in the same region (Sargasso Sea, 25°-29°N) in 1972-1973. Recent community structures were unlike any documented historically, whether compared to sites of the same latitude range within the Sargasso Sea, or the broader historical dataset of sites ranging across the Sargasso Sea, Gulf Stream, and south of the subtropical convergence zone. Recent samples also recorded low coverage by sessile epibionts, both calcifying forms and hydroids. The diversity and species composition of macrofauna communities associated with Sargassum might be inherently unstable. While several biological and oceanographic factors might have contributed to these observations, including a decline in pH, increase in summer temperatures, and changes in the abundance and distribution of Sargassum seaweed in the area, it is not currently possible to attribute direct causal links.

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.