Quality Requirements for Electronic Health Record Systems*. A Japanese-German Information Management Perspective.

BACKGROUND: For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities. OBJECTIVES: To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS. METHODS: Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions. RESULTS: The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management). CONCLUSIONS: Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.

Teaching medical informatics at SSMU Tomsk for modernization health care.

Education is the basis for running a health care system effectively and efficiently. It is integrated into the curriculum for medical students and supported by training. International participation in concept and practice will be necessary for success and further development. Institutional cooperation will transfer experience and recommendations. It may lead to a partnership for modernization on European level.

Improvement of cross-sector communication in the integrated health environment.

Patient care is a complex process with different providers located in various institutions co-operating within an integrated health environment. In spite of technical improvements in medical care, patient information is usually exchanged by paper. Digital and timely communication between regional care providers can improve the exchange of information. Different systems and missing data standards are challenges that have to be met. ByMedConnect, a project sponsored by the Bavarian State Ministry of the Environment and Public Health, develops and demonstrates a communication solution based on the EN 13606 standard. In a first step the dataset, which will be exchanged by the care providers, is defined. ByMedConnect develops the dataset in cooperation with practicing clinicians and converts it via modeling tools into archetypes that provide the base for reliable cross-sector communication. Existing heterogeneous systems are integrated via a dedicated module that transforms legacy data into a normalized representation. Information provided in a standardized form thereby enables semantic interoperability between different systems and allows medical add-on applications to connect. A secure digital communication network guarantees easy and direct data sharing. ByMedConnect aims to evaluate the achieved theoretical preliminary work in practice and to draft approaches, which can be applied beyond the pilot application.

BioHealth--the need for security and identity management standards in eHealth.

The experience gained in these last years and the several lesson learned have clearly shown that eHealth is more than just a simple change from paper records to electronic records. It necessitates a change of paradigms, on the one hand and the use of new technologies and introduction of new procedures on the other. Interoperability becomes a crucial issue. Security and confidentiality are vital for the acceptance of the new approaches and for the support of eHealth. Shared care and across-border interactions require a reliable and stable normative framework based on the application of standardized solutions, which are often not yet sufficiently known, diffused and implemented. Feeling this gap, a group of international experts in the medical area proposed to the EC the BioHealth project whose main aim is to create awareness about standardization in eHealth and to facilitate its practical implementation. The project will address all the stakeholders concerning their respective domain. It will evaluate the socio-economic and cultural aspects concerning eHealth with particular reference to the growing introduction of emerging technologies such as health cards, biometrics, RFID (radio-frequency identification) and NFC (Near field communication) tags. By providing information and expert advice on standardization and best practices it will raise the acceptance on standardization. Furthermore, the project will deeply approach the ethical and accessibility issues connected to identity management in eHealth, which -together with privacy- represent probably the most significant obstacles for the wide diffusion of eHealth procedures.

Educational standards -- terminologies used.

Efficient and effective delivery of health care requires accurate and relevant knowledge, patient-centred clinical data and medical information which is available to different actors and institutions in health care. Sharing data and knowledge means understanding the underlying concepts, terms, etc. Therefore a basic requirement in medical education is terminology, coding and classification. Vocabularies, data sets, schemes are to be used for medical documentation, medical statistics, analysis and system operation. Communication between heterogeneous environments will be possible when common terminologies etc. are available and used during system development. The following chapters give an overview on this important field of health telematics.

DIABCARD CCMIS--a portable and scalable CPR for diabetes care.

The aim of this paper is to introduce the main software module of the DIABCARD Chip Card Medical Information System (DIABCARD CCMIS) that provides an online, portable diabetes medical record information system based on a high performance object-oriented rapid application development language such as Borland Delphi. A chip card based medical information system was developed as a good possibility to create a portable electronic patient record. In particular the patient data card makes the up-to-date patient's record available whenever needed. The developed DIABCARD Core System, described in this paper, includes a patient record management system that has the ability to handle topics such as administrative and medical data, medical anamnesis, and physical examination data. Issues tackled were simplicity, data security and reporting, customization, and internationalization. Especially for the two last issues (customization and internationalization) a novel approach based on using native initialization table files is presented. Proper care has been addressed during the development of the software modules for matters of security, data integrity and confidentiality.