The lower saxony bank of health. rationale, principles, services, organization and architectural framework.

INTRODUCTION: This article is part of a Focus Theme of METHODS of Information in Medicine on Health Record Banking. BACKGROUND: Poor communication of health care information between health care providers (HCP) is still a major problem. One recent approach is the concept of Health Record Banking. OBJECTIVES: With this report we want to introduce the Lower Saxony Bank of Health (LSBH) to the international community. The main objective of this paper is to report and explain: 1) why this organization has been founded, 2) which basic principles have been set, 3) which services will be provided, 4) which type of organization has been chosen, and 5) which architectural framework has been selected. METHODS: To report and discuss how we plan to achieve the intended objectives. RESULTS: The LSBH was founded as an entrepreneurial company, regarding itself as a neutral third-party information broker. The bank does not store medical documents on its central servers but offers a document registry with links to documents stored at participating health care providers. Subject to valid patient consent, the LSBH grants access to these documents to authorized health care providers. To implement our services, we chose the established technical frameworks of the Integrating the Healthcare Enterprise (IHE) initiative using cross-enterprise document sharing (XDS). CONCLUSIONS: Different approaches to establish health information exchange (HIE) are in early stages and some have failed in the past. Health Record Banking can address major challenges described in the literature about HIE. The future will show if our provider-sponsored business model is sustainable. After reaching a stable network, we intend to add additional HCPs, e.g., care homes or ambulance services, to the network.

A Regional health care network: eHealth.Braunschweig. Domain fields and architectural challenges.

BACKGROUND: Health care network eHealth.Braunschweig has been started in the South-East region of Lower Saxony in Germany in 2009. It composes major health care players, participants from research institutions and important local industry partners. OBJECTIVES: The objective of this paper is firstly to describe the relevant regional characteristics and distinctions of the eHealth.Braunschweig health care network and to inform about the goals and structure of eHealth.Braunschweig; secondly to picture and discuss the main concepts and domain fields which are addressed in the health care network; and finally to discuss the architectural challenges of eHealth.Braunschweig regarding the addressed domain fields and defined requirements. METHODS: Based on respective literature and former conducted projects we discuss the project structure and goals of eHealth.Braunschweig, depict major domain fields and requirements gained in workshops with participants and discuss the architectural challenges as well as the architectural approach of eHealth.Braunschweig network. RESULTS: The regional healthcare network eHealth.Braunschweig has been established in April 2009. Since then the network has grown constantly and a sufficient progress in network activities has been achieved. The main domain fields have been specified in different workshops with network participants and an architectural realization approach for the transinstitutional information system architecture in the healthcare network has been developed. However, the effects on quality of information processing and quality of patient care have not been proved yet. Systematic evaluation studies have to be done in future in order to investigate the impact of information and communication technology on the quality of information processing and the quality of patient care. CONCLUSIONS: In general, the aspects described in this paper are expected to contribute to a systematic approach for the establishment of regional health care networks with lasting and sustainable effects on patient-centered health care in a regional context.

On health-enabling and ambient-assistive technologies. What has been achieved and where do we have to go?

OBJECTIVES: To provide an introductory overview on selected areas of health-enabling and ambient-assistive technologies and to suggest relevant fields for future research. METHODS: Summarizing the state of the art for 1) ambient environments and 2) health-related sensor technologies, 3) presenting relevant medical conditions and their relation to health-enabling technologies, and 4) illustrating the application of those technologies for lifestyle management with examples for activity monitoring and prevention of overweight. The suggestions for future research are based on own research projects in this field. RESULTS: Health-enabling and ambient-assistive technologies are regarded to have the potential to significantly improve quality of life and efficiency of health care in aging societies. Research on health-enabling and ambient-assistive technologies is highly multidisciplinary. CONCLUSIONS: It still has, to a large extent, to be exploratory. An increasing amount of outcomes research through well-designed evaluation studies that explore technical solutions in a social context and in relation to individual needs will be crucial.

virtX - evaluation of a computer-based training system for mobile C-arm systems in trauma and orthopedic surgery.

OBJECTIVES: Operating room personnel (ORP) operating mobile image intensifier systems (C-arms) need training to produce high quality radiographs with a minimum of time and X-ray exposure. Our study aims at evaluating acceptance, usability and learning effect of the CBT system virtX that simulates C-arm based X-ray imaging in the context of surgical case scenarios. METHODS: Prospective, interventional study conducted during an ORP course with three groups: intervention group 1 (training on a PC using virtX), and 2 (virtX with a C-arm as input device), and a control group (training without virtX) - IV1, IV2 and CG. All participants finished training with the same exercise. Time needed to produce an image of sufficient quality was recorded and analyzed using One-Way-ANOVA and Dunnett post hoc test (alpha = .05). Acceptance and usability of virtX have been evaluated using a questionnaire. RESULTS: CG members (n = 21) needed more time for the exercise than those of IV2 (n = 20): 133 +/- 55 vs. 101 +/- 37 sec. (p = .03). IV1 (n = 12) also performed better than CG (128 +/- 48 sec.), but this was not statistically significant. Seventy-nine participants returned a questionnaire (81% female, age 34 +/- 9 years, professional experience 8.3 +/- 7.6 years; 77% regularly used a C-arm). 83% considered virtX a useful addition to conventional C-arm training. 91% assessed virtual radiography as helpful for understanding C-arm operation. CONCLUSIONS: Trainees experienced virtX as substantial enhancement of C-arm training. Training with virtX can reduce the time needed to perform an imaging task.

Viscoelasticity near the gel point: a molecular dynamics study.

We report on extensive molecular dynamics simulations on systems of soft spheres of functionality f, i.e., particles that are capable of bonding irreversibly with a maximum of f other particles. These bonds are randomly distributed throughout the system and imposed with probability p. At a critical concentration of bonds, p(c) approximately 0.2488 for f=6, a gel is formed and the shear viscosity eta diverges according to eta approximately (p(c)-p)(-s). We find s approximately 0.7 in agreement with some experiments and with a recent theoretical prediction based on Rouse dynamics of phantom chains. The diffusion constant decreases as the gel point is approached but does not display a well-defined power law.

Telemedical support of prehospital emergency care in mass casualty incidents.

In the German emergency medical service system (EMSS) medical treatment can be improved in most of mass casualty incidents (MCI). Currently, the incident commander who is responsible for classification of the victims (depending on their urgency and condition, the so called triage) and ordered transportation uses paper-based documentation. Triage tags are used to identify and classify patients and gather treatment information. This can cause problems in medical treatment and in transportation of injured victims. Object-oriented modelling, simulation, and visualisation of processes can show deficits in treatment and data processing and thereby help to optimise medical workflow and logistics. If documentation by paramedics and emergency physicians is done electronically, all patient records could be send to a telemedical centre for central data administration. A telemedical supported triage tag helps identifying victims and managing detailed identification protocols. The paper-based documentation in emergency would become obsolete, if hospitals can query all protocols, diagnoses, and findings from the telemedical centre. Safety and security aspects can be guaranteed. The complete medical treatment workflow can be supported by telemedicine. Therefore, in case of MCI, telemedicine can optimise medical treatment and exonerate the paramedics from unnecessary documentation.

Entropic rigidity of randomly diluted two- and three-dimensional networks.

In recent work, we presented evidence that site-diluted triangular central-force networks, at finite temperatures, have a nonzero shear modulus for all concentrations of particles above the geometric percolation concentration p(c). This is in contrast to the zero-temperature case where the (energetic) shear modulus vanishes at a concentration of particles p(r)>p(c). In the present paper we report on analogous simulations of bond-diluted triangular lattices, site-diluted square lattices, and site-diluted simple-cubic lattices. We again find that these systems are rigid for all p>p(c) and that near p(c) the shear modulus mu approximately (p-p(c))(f), where the exponent f approximately 1.3 for two-dimensional lattices and f approximately 2 for the simple-cubic case. These results support the conjecture of de Gennes that the diluted central-force network is in the same universality class as the random resistor network. We present approximate renormalization group calculations that also lead to this conclusion.

Molecular dynamics study of replica symmetry in the vulcanization transition.

We report on computer simulations of the vulcanization transition of randomly crosslinked polymer melts. We focus on the order parameter between different realizations of the same distribution of random crosslinks, as well as the overlap distribution of these systems.