Rolling Medical Practice: Ambulant Mobile Medical Care for Rural Areas.

We designed, constructed, and evaluated a mobile medical care vehicle called "Rollende Arztpraxis" (rolling medical practice, RMP) that delivers the full medical care of a general practitioner to increase medical care supply in rural areas. Six communities have been identified, where the RMP has been visited 501 times in 14 months. Two different schedules of stops and treatment times have been tested. We show that the RMP treated mainly elderly and multimorbid patients. An accompanying study showed high acceptance and satisfaction of treated patients and treating doctors. An economic evaluation of three different utilization models with three treatment modes each showed no financial sustainability. We show that ambulatory care in rural areas can be complemented by a mobile care unit, if legal and financial barriers can be overcome.

Rollende arztpraxis - first results of an ambulant mobile care model for rural areas.

German medical care is going to suffer from a decreasing number of general practitioners due to demographic change. We study if ambulatory care in rural areas can be complementary ensured by a mobile care unit. A medical care van - the "rolling medical practice" (RMP) - has been constructed based on care scenarios created for rural communities in northern Germany. Performance and acceptance of the RMP is evaluated by constant monitoring of anonymized medical documentation and questionnaires. The RMP is visiting six villages on two days a week in a three-week interval. It is constructed from a standard van with a custom box body fully equipped for general care needs. Actually treated care cases meet expectations and are acute as well as chronicle symptoms. Case numbers range from 6 to 50 visits in 5 month. We showed that almost full ranged mobile medical care, as supplement to general medical supply is possible.

Assessing the prognoses on Health care in the information society 2013--thirteen years after.

Health care and information technology in health care is advancing at tremendous speed. We analysed whether the prognoses by Haux et al. - first presented in 2000 and published in 2002 - have been fulfilled in 2013 and which might be the reasons for match or mismatch. Twenty international experts in biomedical and health informatics met in May 2013 in a workshop to discuss match or mismatch of each of the 71 prognoses. After this meeting a web-based survey among workshop participants took place. Thirty-three prognoses were assessed matching; they reflect e.g. that there is good progress in storing patient data electronically in health care institutions. Twenty-three prognoses were assessed mismatching; they reflect e.g. that telemedicine and home monitoring as well as electronic exchange of patient data between institutions is not established as widespread as expected. Fifteen prognoses were assessed neither matching nor mismatching. ICT tools have considerably influenced health care in the last decade, but in many cases not as far as it was expected by Haux et al. in 2002. In most cases this is not a matter of the availability of technical solutions but of organizational and ethical issues. We need innovative and modern information system architectures which support multiple use of data for patient care as well as for research and reporting and which are able to integrate data from home monitoring into a patient centered health record. Since innovative technology is available the efficient and wide-spread use in health care has to be enabled by systematic information management.

Past and next 10 years of medical informatics.

More than 10 years ago Haux et al. tried to answer the question how health care provision will look like in the year 2013. A follow-up workshop was held in Braunschweig, Germany, for 2 days in May, 2013, with 20 invited international experts in biomedical and health informatics. Among other things it had the objectives to discuss the suggested goals and measures of 2002 and how priorities on MI research in this context should be set from the viewpoint of today. The goals from 2002 are now as up-to-date as they were then. The experts stated that the three goals: "patient-centred recording and use of medical data for cooperative care"; "process-integrated decision support through current medical knowledge" and "comprehensive use of patient data for research and health care reporting" have not been reached yet and are still relevant. A new goal for ICT in health care should be the support of patient centred personalized (individual) medicine. MI as an academic discipline carries out research concerning tools that support health care professionals in their work. This research should be carried out without the pressure that it should lead to systems that are immediately and directly accepted in practice.

Design and implementation of an informed consent process for a standardized health information exchange solution on the example of the lower saxony bank of health.

OBJECTIVE: Multicenter medical treatment requires health related data to be available across institutions. Since health information exchange solutions are emergent, fulfillment of privacy needs, including patients' informed consent, is vital for successful data exchange. METHODS: We designed a software supported consent process for the recently founded Lower Saxony Bank of Health (LSBH) with regard to particularities of German law. To implement the application, web technologies and well-described interfaces to IHE XDS profile components have been used. RESULTS: A two staged process has been developed. A special consent application creates a customized form containing all orally given constraints defined by the patient. The form is printed out and signed by the patient while an electronic policy is created and registered at the LSBH. CONCLUSION: The process completely reflects a conventional informed consent procedure but increases simplicity, clarity and understandability of the consent form. Technical and legal restrictions in Germany create a media split becoming a media crack in some environments. Availability of signature cards could improve the process by making it completely electronic.

eHealth vision towards cooperative patient care--domain fields and architectural challenges of regional health care networks.

Numerous eHealth projects and efforts to establish inter-organizational communication and to build up regional health care networks could be observed in the last ten years. Nevertheless the success of such efforts is profoundly different. The aim of this paper is to introduce the lately started regional initiative eHealth.Braunschweig compounding of the major health care players (hospitals, physician offices, nursing services and nursing homes) in the region of Braunschweig, participants from research institutions and industry. We propose in this paper the main goals of the regional initiative eHealth.Braunschweig, its constitution and major approaches. Based on respective literature and our former projects as well as experiences in this field we discuss our vision of a patient-oriented cooperative health care by depicting regional distinctions, identifying the major domain fields in this context and discussing the architectural challenges for the regional health care network eHealth.Braunschweig. In our view this work can be considered as a systematical approach to the establishment of regional health care networks with lasting and sustainable effects on patient-centered health care in a region.

People's perceptions and expectations of assistive health-enabling technologies: an empirical study in Germany.

Demographic shifts and their consequences will lead to changes in the way health care is provided. Although assistive health-enabling technologies are regarded as one means to support these changes, they are minimally used, despite the maturity of the underlying technologies. This may partly be attributable to a disregard of users' needs and preferences. The aim of this article is to assess acceptance of health-enabling technologies with regard to their perceived usefulness, risks, and people's readiness to actually use them. Furthermore, we attempted to find out to whom individuals would entrust their health information, and what their basic fears are. We used a questionnaire presenting four exemplary technologies: emergency call systems, videophones, activity and health status monitoring. We conducted 147 face-to-face interviews and analyzed the results using descriptive statistics. Emergency call systems, health status and activity monitoring were rated as useful or very useful, videophones as hardly useful. Intrusion into one's privacy was the most prominent concern. Regarding fears in old age, people were mostly afraid of diseases and loss of independence. They would entrust their medical data to their physicians rather than relatives or caregivers. This study may contribute to systematic analyses of users' perceptions and preferences concerning assistive health-enabling technologies.

Home care decision support using an Arden engine--merging smart home and vital signs data.

UNLABELLED: The demographic change with a rising proportion of very old people and diminishing resources leads to an intensification of the use of telemedicine and home care concepts. To provide individualized decision support, data from different sources, e.g. vital signs sensors and home environmental sensors, need to be combined and analyzed together. Furthermore, a standardized decision support approach is necessary. OBJECTIVE: The aim of our research work is to present a laboratory prototype home care architecture that integrates data from different sources and uses a decision support system based on the HL7 standard Arden Syntax for Medical Logical Modules. METHODS: Data from environmental sensors connected to a home bus system are stored in a data base along with data from wireless medical sensors. All data are analyzed using an Arden engine with the medical knowledge represented in Medical Logic Modules. RESULTS: Multi-modal data from four different sensors in the home environment are stored in a single data base and are analyzed using an HL7 standard conformant decision support system. CONCLUSION: Individualized home care decision support must be based on all data available, including context data from smart home systems and medical data from electronic health records. Our prototype implementation shows the feasibility of using an Arden engine for decision support in a home setting. Our future work will include the utilization of medical background knowledge for individualized decision support, as there is no one-size-fits-all knowledge base in medicine.

Health-enabling technologies for pervasive health care: on services and ICT architecture paradigms.

BACKGROUND: Progress in information and communication technologies (ICT) is providing new opportunities for pervasive health care services in aging societies. OBJECTIVES: To identify starting points of health-enabling technologies for pervasive health care. To describe typical services of and contemporary ICT architecture paradigms for pervasive health care. METHODS: Summarizing outcomes of literature analyses and results from own research projects in this field. RESULTS: Basic functions for pervasive health care with respect to home care comprise emergency detection and alarm, disease management, as well as health status feedback and advice. These functions are complemented by optional (non-health care) functions. Four major paradigms for contemporary ICT architectures are person-centered ICT architectures, home-centered ICT architectures, telehealth service-centered ICT architectures and health care institution-centered ICT architectures. CONCLUSIONS: Health-enabling technologies may lead to both new ways of living and new ways of health care. Both ways are interwoven. This has to be considered for appropriate ICT architectures of sensor-enhanced health information systems. IMIA, the International Medical Informatics Association, may be an appropriate forum for interdisciplinary research exchange on health-enabling technologies for pervasive health care.

CyberMarathon - increasing physical activity using health-enabling technologies.

The prevalence of overweight and obesity has increased worldwide in the last years as well as in Germany. The goal of cyberMarathon is to increase daily activities and participation of children and adolescents on sport courses using health-enabling technologies. Our objective is to propose an approach of an interdisciplinary intervention program containing a concept for architecture for a sensor-enhanced health information system which will be evaluate in two studies. Using sensors and health-enabling technologies in the preparatory study daily physical activities increased by 7,7%. Measuring of daily physical activities, the feedback of the analyzed data and the deal with the own body and activity seems to be an effective prevention for adolescents.

Sustainable ubiquitous home health care--architectural considerations and first practical experiences.

Despite the abundance of past home care projects and the maturity of the technologies used, there is no widespread dissemination as yet. The absence of accepted standards and thus interoperability and the inadequate integration into transinstitutional health information systems (tHIS) are perceived as key factors. Based on the respective literature and previous experiences in home care projects we propose an architectural model for home care as part of a transinstitutional health information system using the HL7 clinical document architecture (CDA) as well as the HL7 Arden Syntax for Medical Logic Systems. In two short case studies we describe the practical realization of the architecture as well as first experiences. Our work can be regarded as a first step towards an interoperable - and in our view sustainable - home care architecture based on a prominent document standard from the health information system domain.