Primary care provider's acceptance of health information exchange utilizing IHE XDS.

OBJECTIVE: We assessed primary care providers' perception of a health information exchange system (HIE) based on IHE XDS in the metropolitan area of Braunschweig, Lower Saxony, Germany. DESIGN: An application enabling access to medical documents in an XDS Affinity Domain was developed. We examined usability and factors related to user acceptance. MEASUREMENTS: User perception was probed using system usability scale (SUS) and semi-structured interviews. The framework analysis was used in the review and interpretation of the interview data. RESULTS: The evaluation was performed on 7 participants. The SUS showed an above average usability with a median score of 77.5. Participants submitted suggestions for additional features and improvement of usability. Poor integration of functionality into existing workflows was most frequently criticized. CONCLUSION: We found, that, while usability was well perceived by primary care providers, challenges remain in adoption of XDS based IHE.

Primary care providers' acceptance of health information exchange utilizing IHE XDS.

We assessed primary care providers' perception of a health information exchange system (HIE) based on IHE XDS. The HIE will be part of a regional health network in the metropolitan area of Braunschweig, Lower Saxony, Germany. An application enabling access to medical documents in an XDS Affinity Domain was developed. We examined usability and factors related to user acceptance. User perception was probed using system usability scale (SUS) and semi-structured interviews. The evaluation was performed on 7 participants. The SUS showed an above average usability with a median score of 77.5. During interviews, participants submitted suggestions for additional features and improvement of usability. Poor integration of functionality into existing workflows was most frequently criticized. While usability was well perceived by primary care providers, challenges remain in adoption of XDS based IHE. To speed up document access in time-critical domains, we suggest use of complementary methods, enabling directed communication flows.

Health-enabling technologies for the elderly--an overview of services based on a literature review.

BACKGROUND: Services for the elderly based on health-enabling technologies promise to contribute significantly to the efficiency and effectiveness of future health care. Due to this promise, over the last years the scientific community has designed a complex variety of these valuable innovations. A systematic overview of the developed services would help to better understand their opportunities and limitations. OBJECTIVE: To obtain a systematic overview of services for the elderly based on health-enabling technologies and to identify archetypical service categories. METHODS: We conducted a literature review using PubMed and retrieved 1447 publications. We stepwise reduced this list to 27 key publications that describe typical service archetypes. RESULTS: We present six archetypical service categories, namely handling adverse conditions, assessing state of health, consultation and education, motivation and feedback, service ordering and social inclusion and describe their implementation in current research projects.

Health information systems for home telehealth services--a nomenclature for sensor-enhanced transinstitutional information system architectures.

Home telehealth services for elderly people promise to contribute to a more efficient health care in the future. Though isolated services at a patient's home might make sense for some applications, the full potential of home telehealth only arises through its integration into existing health information systems (HIS) and care processes. We know about traditional HIS architectures. However, so far no models exist, helping us to understand and describe the upcoming sensor-enhanced transinstitutional information system architectures for home telehealth services. To develop a nomenclature for sensor-enhanced transinstitutional health information system architectures. We conducted two systematic literature reviews, assessing typical services and users of home telehealth and key characteristics of transinstitutional health information system architectures. The information retrieved from both reviews was integrated to build the nomenclature sought after. We present a nomenclature of information and communication technology (ICT) architectures for home telehealth services. The developed dimensions provide an overview on typical users, services, operating organisations, information flow, geographical reach and architectural paradigms of sensor-enhanced transinstitutional health information systems. The developed nomenclature helps us to better understand the upcoming ICT architectures. However, we are still in need of further experiences with their application.

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.

IT-based information management in health care networks: the MedoCom approach.

Transinstitutional information systems support collaboration beyond the borders of single health care institutions. Information management in health care networks aims at establishing systematic information processing in order to contribute to the network's strategic goals. Health care networks can be characterized by complex and even conflicting goal systems. Our objective is to propose a framework, which describes organizational characteristics of health care networks. The framework is used to deduce effects of network characteristics on information management. Concluding, we present an architectural approach of a management platform for health care networks. The framework as well as the management platform are parts of our MedoCom approach.

HIS modelling and simulation based cost-benefit analysis of a telemedical system for closed-loop diabetes therapy.

OBJECTIVES: INCA (Intelligent Control Assistant for Diabetes) is an EU funded project aimed at improving diabetes therapy by creating a personal closed-loop system interacting with telemedical remote control. This study aims at identifying and applying suitable methods for a cost-benefit analysis from the perspective of the payor for health services. METHODS: For cost analysis MOSAIK-M was used, a method and tool for health information systems analysis and design. Two MOSAIK-M models were created describing conventional insulin pump based diabetes care (CSII), and INCA based diabetes care. Both models were parameterized with costs and simulated to determine yearly costs of diabetes management and treatment for a patient with no diabetes related complications. Probability of developing complications and their duration were determined based on the Archimedes model. It was parameterized with results of a clinical study concerning HbA1c-value changes using the INCA system compared with conventional CSII. The simulation results in form of years of disease within a 30-year time frame were multiplied with corresponding treatment costs. RESULTS: Yearly costs of conventional insulin CSII for a diabetes type 1 patient are euro 5908 (German health care system). Using INCA based on the clinical study setting would raise yearly costs by euro 2233. 24% of the INCA costs are generated by the continuous blood glucose measurement device, 5% by IT devices and services. Considering also diabetes related complications in a 30-year time frame and HbA1c value reductions from 7.9 and 7.6% (conventional CSII) to 7.5 and 7.3% (INCA) reduces the additional costs of INCA to euro 2102 and euro 2162. CONCLUSIONS: The approach produces an estimation of a lower bound for cost savings concerning the treatment of diabetes related complications in a 30-year time frame. These savings alone do not prove cost efficiency of the INCA approach. Further work is needed to improve the approximation and to include indirect and intangible costs.