Patient Portal Integration - A Native IHE Connector Implementation for PEHR.

Providing patients with access to their medical data has recently evolved as a topic in several countries. Different approaches are possible. For example patient portals are used for patient access towards medical data. The University Hospital Heidelberg is engaged in a research project to develop a personal cross-enterprise electronic health record (PEHR). The objective of this work is to describe the architecture and implementation of a component called IHE Connector which represents the native IHE-based integration between the patient portal and the PEHR core components. The architecture of the PEHR is accepted based on international standards. The core components consist out of ready to use software products like a master patient index. The patient portal has been developed using Liferay framework. The IHE Connector is mainly based on the Open eHealth Integration Platform (IPF) Framework, which has been deeply integrated into the patient portal to support the needed IHE transactions. Several IHE profiles for sharing documents and patient information are supported by the IHE Connector. As IPF already provides interfaces for some IHE profiles others had to be developed from scratch. The IHE Connector can not only be used for connectivity between patient portal and PEHR core, but also provide connectivity for third party apps and healthcare providers' information systems.

Working with a domestic assessment system to estimate the need of support and care of elderly and disabled persons: results from field studies.

This article describes the results of field studies performed over a period between five months and 24 months. The objectives of these studies were to collect long-term real-life data to evaluate how these data can be mapped to items on standardized assessment tests and which presentation method is most suitable to inform caregivers about critical situations and changes in health or care needs. A Home-monitoring system which uses modern sensor technologies was developed for and used in these field studies. It was installed in living environments of seven people (three who were not in need of care, two in need of care, and two with mental disabilities). The data were generated by sensor data acquisition and questionnaire reporting. Four types of data analysis and representation were evaluated to support caregivers. Results show that sensor data can be used to determine information directly or indirectly, which can be mapped to relevant assessment items and presented with different degrees of granularity. It is also feasible to determine and present additional information of potential interest which cannot be directly mapped to any assessment item. Sensor data can also be displayed in a live view. This live data representation led to a decrease in the caregivers' workload when assessed according to the German version of the Perceived Stress Questionnaire.

Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies--outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL).

Many societies across the world are confronted with demographic changes, usually related to increased life expectancy and, often, relatively low birth rates. Information and communication technologies (ICT) may contribute to adequately support senior citizens in aging societies with respect to quality of life and quality and efficiency of health care processes. For investigating and for providing answers on whether new information and communication technologies can contribute to keeping, or even improving quality of life, health and self-sufficiency in ageing societies through new ways of living and new forms of care, the Lower Saxony Research Network Design of Environments for Ageing (GAL) had been established as a five years research project, running from 2008 to 2013. Ambient-assisted living (AAL) technologies in personal and home environments were especially important. In this article we report on the GAL project, and present some of its major outcomes after five years of research. We report on major challenges and lessons learned in running and organizing such a large, inter- and multidisciplinary project and discuss GAL in the context of related research projects. With respect to research outcomes, we have, for example, learned new knowledge about multimodal and speech-based human-machine-interaction mechanisms for persons with functional restrictions, and identified new methods and developed new algorithms for identifying activities of daily life and detecting acute events, particularly falls. A total of 79 apartments of senior citizens had been equipped with specific "GAL technology", providing new insights into the use of sensor data for smart homes. Major challenges we had to face were to deal constructively with GAL's highly inter- and multidisciplinary aspects, with respect to research into GAL's application scenarios, shifting from theory and lab experimentation to field tests, and the complexity of organizing and, in our view, successfully managing such a large project. Overall it can be stated that, from our point of view, the GAL research network has been run successfully and has achieved its major research objectives. Since we now know much more on how and where to use AAL technologies for new environments of living and new forms of care, a future focus for research can now be outlined for systematically planned studies, scientifically exploring the benefits of AAL technologies for senior citizens, in particular with respect to quality of life and the quality and efficiency of health care.

A technical platform for environments for ageing--lessons learned from three field studies.

The Lower Saxony Research Network "Design of Environments for Ageing" (GAL) studied possible applications of assistive technology for enabling older adults to live longer and independent in their own home. As part of this work, a technical platform was developed as a common technical basis for all assistive systems in the project. This article presents an overview of the architecture and core functionality of the technical platform, which in the first generation was developed for use in a laboratory setting, and in a second generation was extended for use in the project's field studies, i.e. prototype installations in end-users homes. The field studies' primary objective was the evaluation of the assistive technologies, that were developed within the overall project. However, these studies also confirmed that the fundamental concept of the technical platform is valid, and the prototypes continuously worked 24 h a day for several months. However, there were some problems related to lack of infrastructure in the older adults' homes and human factors such as inadvertent placement of objects across sensors' field of view, acceptance problems due to aesthetical reasons or simply communication problems, which show that making complex technologies work for users with little technical experience is well possible, but requires a careful consideration of the complete service chain and related "soft factors".

A system for the model based emergency detection and communication for the telerehabilitation training of cardiopulmonary patients.

Cardiopulmonary diseases affect millions of people and cause high costs in health care systems worldwide. Patients should perform regular endurance exercises to stabilize their health state and prevent further impairment. However, patients are often uncertain about the level of intensity they should exercise in their current condition. The cost of continuous monitoring for these training sessions in clinics is high and additionally requires the patient to travel to a clinic for each single session. Performing the rehabilitation training at home can raise compliance and reduce costs. To ensure safe telerehabilitation training and to enable patients to control their performance and health state, detection of abnormal events during training is a critical prerequisite. Therefore, we created a model that predicts the heart rate of cardiopulmonary patients and that can be used to detect and avoid abnormal health states. To enable external feedback and an immediate reaction in case of a critical situation, the patient should have the possibility to configure the system to communicate warnings and emergency events to clinical and non-clinical actors. To fulfill this task, we coupled a personal health record (PHR) with a new component that extends the classic home emergency systems. The PHR is also used for a training schedule definition that makes use of the predictive HR model. We used statistical methods to evaluate the prediction model and found that our prediction error of 3.2 heart beats per minute is precise enough to enable a detection of critical states. The concept for the communication of alerts was evaluated through focus group interviews with domain experts who judged that it fulfills the needs of potential users.

The Lower Saxony research network design of environments for ageing: towards interdisciplinary research on information and communication technologies in ageing societies.

Worldwide, ageing societies are bringing challenges for independent living and healthcare. Health-enabling technologies for pervasive healthcare and sensor-enhanced health information systems offer new opportunities for care. In order to identify, implement and assess such new information and communication technologies (ICT) the 'Lower Saxony Research Network Design of Environments for Ageing' (GAL) has been launched in 2008 as interdisciplinary research project. In this publication, we inform about the goals and structure of GAL, including first outcomes, as well as to discuss the potentials and possible barriers of such highly interdisciplinary research projects in the field of health-enabling technologies for pervasive healthcare. Although GAL's high interdisciplinarity at the beginning slowed down the speed of research progress, we can now work on problems, which can hardly be solved by one or few disciplines alone. Interdisciplinary research projects on ICT in ageing societies are needed and recommended.