A Regional Health Care Network: eHealth.Braunschweig

N. Gusew; T. Bartkiewicz; W. Bautsch; A. Gerlach; M. Goldapp; R. Haux; U. Heller; H. P. Kierdorf; T. Kleinschmidt; W. Ludwig; U. Markurth; S. Pfingsten-Würzburg; M. Plischke; H. Reilmann; R. Schubert; C. Seidel; R. Warnke

doi:10.3414/ME11-02-0010

Methods of Information in Medicine, Table of Contents

Methods Inf Med 2012; 51(03): 199-209
DOI: 10.3414/ME11-02-0010

Original Articles

Schattauer GmbH

A Regional Health Care Network: eHealth.Braunschweig

Domain Fields and Architectural Challenges

N. Gusew

¹Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig – Institute of Technology and Hanover Medical School, Braunschweig, Germany

,

T. Bartkiewicz

²Medical Center Braunschweig, Braunschweig, Germany

,

W. Bautsch

²Medical Center Braunschweig, Braunschweig, Germany

,

A. Gerlach

³BITZ, Center of Informatics and Technology, Braunschweig, Germany

,

M. Goldapp

⁴LINEAS Healthcare GmbH, Braunschweig, Germany

,

R. Haux

¹Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig – Institute of Technology and Hanover Medical School, Braunschweig, Germany

,

U. Heller

²Medical Center Braunschweig, Braunschweig, Germany

,

H. P. Kierdorf

²Medical Center Braunschweig, Braunschweig, Germany

,

T. Kleinschmidt

⁵Association of Statutory Health Insurance Physicians Lower Saxony, Germany

,

W. Ludwig

¹Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig – Institute of Technology and Hanover Medical School, Braunschweig, Germany

,

U. Markurth

⁶City Council of Braunschweig, Braunschweig, Germany

,

S. Pfingsten-Würzburg

⁷Public Health Department of Braunschweig, Braunschweig, Germany

,

M. Plischke

³BITZ, Center of Informatics and Technology, Braunschweig, Germany

,

H. Reilmann

²Medical Center Braunschweig, Braunschweig, Germany

,

R. Schubert

⁶City Council of Braunschweig, Braunschweig, Germany

,

C. Seidel

²Medical Center Braunschweig, Braunschweig, Germany

,

R. Warnke

⁸Nibelungen Housing Association, Braunschweig, Germany

› Author Affiliations

Abstract

Summary

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.

Keywords

Regional health care networks - patient-centered care - integrated health care systems - intersectoral communication.

Full Text

References

References
1 Mäenpää T, Suominen T, Asikainen P, Maass M, Rostila I. The outcomes of regional health care information systems in health care: A review of the research literature. Int J Med Inform 2009; 78 (11) 757-771.
2 Toth-Pal E, Nilsson GH, Furhoff AK. Clinical effect of computer generated physician reminders in health screening in primary health care - a controlled clinical trial of preventive services among the elderly. Int J Med Inform 2004; 73: 695-703.
3 Maglaveras N, Iakovidis I, de Groen PC. Regional health information networks and telematics applications in a user friendly information society. Meth Inf Med 2002; 41 (05) 357-450.
4 Bergmann J, Bott OJ, Pretschner DP, Haux R. An e-consent-based shared EHR system architecture for integrated healthcare networks. Int J Med Inform 2006; 76 (2-3) 130-136.
5 Schabetsberger T, Ammenwerth E, Andreatta S, Gratl G, Haux R, Lechleitner G, Schindelwig K, Stark C, Vogl R, Wilhelmy I, Wozak F. From a paper-based transmission of discharge summaries to electronic communication in health care regions. Int J Med Inform 2006; 75 (3-4) 209-215.
6 Adler G, vdKnesebeck JH. Shortage and need of physicians in Germany? Questions addressed to health services research. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54 (02) 228-237. In German
7 Korczak D, Huber B, Steinhauser G, Dietl M. Outpatient pulmonary rehabilitation - rehabilitation models and shortcomings in outpatient aftercare. GMS Health Technol Assess 2010
8 Stiel S, Joppich R, Korb K, Hahnen M, Elsner F, Rossaint R, Radbruch L. Problems and deficits in the transition from inpatient and outpatient care of cancer patients. A qualitative analysis. Schmerz 2009; 23 (05) 510-517. In German
9 Bergmann J, Bautsch W, Donhuijsen K, Haux R, Plail M, Seidel C. et al. Architecture, operation and evaluation of a clinical finding platform (in German). In: Löffler M, Winter A. (eds) Conference Proceedings of the 51st Congress of the GMDS 2006 Leipzig: University of Leipzig; 2006: 285-286.
10 Bott OJ, Marschollek M, Wolf KH, Haux R. Towards New Scopes: Sensor-enhanced Regional Health Information Systems - Part 1: Architectural Challenges. Methods Inf Med 2007; 46: 476-483.
11 Haux R, Howe J, Marschollek M, Plischke M, Wolf KH. Health-enabling technologies for pervasive health care: on services and ICT architecture paradigms. Informatics for Health and Social Care 2008; 33: 77-89.
12 Gusew N, Hellrung N, Willkomm M, Haux R. Requirements of the transisntitutional management information systems in networked cooperative care systems (in German). In: Conference Proceedings of the 53rd Congress of the GMDS. Stuttgart: 2008
13 Hellrung N. Strategic information management in integrated care - a systematic approach. In: Kuhn KA, Warren JR, Leong TY. (eds) Medinfo 2007; Proceedings of the 12th World Congress on Health (Medical) Informatics; Building Sustainable Health Systems Amsterdam: IOS Press; 2007: 2099-2104.
14 Hellrung N. Transinstitutional information management in health care networks: Requirements and methods (in German). PHD-Thesis, University of Braunschweig, 12/2008 Available at http://www.digibib.tu-bs.de/?docid=00024464 Last access: October 13 2009
15 Ludwig W, Wolf K-H. Duwenkamp C, Gusew N, Hellrung N, Marschollek M, von Bargen T, Wagner M, Haux R. Health Information Systems for Home Telehealth Services - A Nomenclature for Sensor-enhanced Transinstitutional Information System Architectures. Informatics for Health and Social Care 2010; 35 (3-4) 211-225.
16 Hellrung N, Gusew N, Willkomm M, Haux R. IT-based information management in health care networks: the MedoCom approach. In: Andersen SK. et al. (eds). eHealth Beyond the Horizon - Get IT There. Goteborg MIE 2008. IOS Press 2008: 623-628.
17 Hellrung N, Awe B, Bogenstahl C, Gründler M, Gusew N, Schultz C, Spekker H, Gemünden HG, Haux R, Thoben W. Transinstitutional information systems in integrated care - ten case analyses. (German). In: Wichmann HE, Nowak D, Zapf A. (eds) Conference Proceedings of the Congress of the GMDS, Augsburg. 2007
18 Gusew N, Haux R. A taxonomy for describing transinstitutional information systems in health care. Submitted and accepted as poster at MIE 2011 in Oslo Norway.:
19 Schabetsberger T, Wozak F, Katt B, Mair R, Hirsch B, Hörbst A. Implementation of a Secure and Interoperable Generic e-Health Infrastructure for Shared Electronic Health Records Based on IHE Integration Profiles. In: Medinfo. 2010; Proceedings of the 13th World Congress on Medical Informatics 889-893.
20 Allard T, Anciaux N, Bouganim L, Pucheral P, Thion R. Seamless access to healthcare folders with strong privacy guarantees. International Journal of Healthcare Delivery Reform Initiatives 2009; 1 (04) 82-107.
21 Bernstein K, Bruun-Rasmussen M, Vingtoft S, Andersen SK, Nohr C. Modelling and implementing electronic health records in Denmark. Int J Med Inform 2005; 74 (2-4) 213-220.
22 Bray B. The PICNIC approach to regional care networks. Stud Health Technol Inform 2003; 96: 80-87.
23 Chronaki CE, Chiarugi F, Mavrogiannaki E, Demou C, Lelis P, Trypakis D, Spanakis M, Tsiknakis M, Orphanoudakis SC. An eHealth platform for instant interaction among health professionals. Computers in Radiology 2003
24 Frisse ME, King JK, Rice WB, Tang L, Porter JP, Coffman TA, Assink M, Yang K, Wesley M, Holmes RL, Gadd C, Johnson KB, Estrin VY. A regional health information exchange: architecture and implementation. AMIA Annu Symp Proc 2008; 6: 212-216.
25 Ganguly S, Kataria P, Juric R, Ertas A, Tanik MM. Sharing information and data across heterogeneous e-health systems. Telemed J E Health 2009; 5: 454-464.
26 Marschollek M, Wolf KH, Bott OJ, Geisler M, Plischke M, Ludwig W, Hornberger A, Haux R. Sustainable ubiquitous home health care - architectural considerations and first practical experiences. In: Medinfo 2007; Proceedings of the 12th World Congress on Health (Medical) Informatics; Building Sustainable Health Systems 8-12.
27 European Antimicrobial Resistance Surveil-lance System. EARSS Annual Report 2008 Available at: http://www.ecdc.europa.eu/en/activities/surveillance/EARS-Net/Documents/2008_EARSS_Annual_Report.pdf Last access: January 7 2011
28 Friedrich AW, Daniels-Haardt I, Köck R, Verhoeven F, Mellmann A, Harmsen D, van Gemert-Pijnen JE, Becker K, Hendrix MG. EUREGIO MRSA-net Twente/Münsterland - a Dutch-German cross-border network for the prevention and controlof infections caused by methicillin-resistantStaphylococcus aureus. Euro Surveill. 2008; 13 (35) Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18965 Last access: January 7 2011
29 German Federal Ministry of Health, German Antibiotic Resistance Strategy (in German) Berlin, 2008. Last access: 12th of January 2011 Available at: http://www.bmg.bund.de/fileadmin/redaktion/pdf_broschueren/Antibiotika-Resistenzstrategie.pdf
30 Siebert HR, Ruchholtz S. Projekt TraumaNetzwerkD of the DGU (in German). Trauma Berufskrankh 2007; 9: 265-270.
31 MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO. A National Evaluation of the Effect of Trauma Centre Care on Mortality. N Engl J Med 2006; 354 (04) 366-378.
32 Ruchholtz S, Waydhas C, Lewan U, Piepenbrink K, Stolke D, Debatin J, Schweiberer L, Nast-Kolb D. A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers. Intensive Care Med 2002; 28 (10) 1395-1404.
33 Lukowicz P, Kirstein T, Tröster G. Wearable systems for health care applications. Methods Inf Med 2004; 43 (03) 232-238.
34 Ermes M, Pärkka J, Mantyjarvi J, Korhonen I. Detection of daily activities and sports with wearable sensors in controlled and uncontrolled conditions. IEEE Trans Inf Technol Biomed 2008; 12 (01) 20-26.
35 Intille S, Larson K, Tapia E, Beaudin J, Kaushik P, Nawyn J, Rockinson R. Using a Live-In Laboratory for Ubiquitous Computing Research. In: Pervasive Computing 2006; 3968: 349-365.
36 Logan B, Healey J, Philipose M, Tapia E, Intille S. A Long-Term Evaluation of Sensing Modalities for Activity Recognition. Ubiquitous Computing 2007; 4717: 483-500.
37 Eichelberg M, Aden T, Riesmeier J, Dogac A, Laleci GB. A survey and analysis of Electronic Healthcare Record standards. ACM Computing Surveys 2005; 37 (04) 277-315.
38 López DM, Blobel B. Architectural approaches for HL7-based health information systems implementation. Methods Inf Med 2010; 49 (02) 196-204.
39 Martínez-Costa C, Menárguez-Tortosa M, Fernández-Breis JT. An approach for the semantic interoperability of ISO EN 13606 and OpenEHR archetypes. J Biomed Inform 2010; 43 (05) 736-746.
40 Ohmann C, Kuchinke W. Future developments of medical informatics from the viewpoint of networked clinical research. Interoperability and integration. Methods Inf Med 2009; 48 (01) 45-54.
41 Fernandez-Bayó J. IHE profiles applied to regional PACS. Eur J Radiol 2010
42 Zhang J, Zhang K, Yang Y, Sun J, Ling T, Wang G, Ling Y, Peng D. Grid based implementation of XDS-I as part of image-enabled EHR for regional healthcare in Shanghai. Int J Comput Assist Radiol Surg 2011; 6 (02) 273-284.
43 Blobel B. Architectural Approach to eHealth for Enabling Paradigm Changes in Health. Methods Inf Med 2010; 49 (02) 123-134.
44 Namli T, Dogac A. Testing Conformance and Interoperability of eHealth Applications. Methods Inf Med 2010; 49 (03) 281-289.
45 Winter A. The Future of Medical Informatics - Some Perspectives of Intra- and Inter-institutional Information Systems. Methods Inf Med 2009; 48 (01) 62-65.
46 Pirnejad H, Niazkhani Z, Berg M, Bal R. Intra-organizational Communication in Healthcare - Considerations for Standardization and ICT Application. Methods Inf Med 2008; 47 (04) 336-345.
47 Heimly V, Berntsen KE. Consent-based Access to Core EHR Information - Collaborative Approaches in Norway. Methods Inf Med 2009; 48 (02) 144-148.
48 Dorda GW, Duftschmid L, Gerhold W, Gall J. Gambal Austria’s Path Toward Nationwide Electronic Health Records. Methods Inf Med 2008; 47 (02) 117-123.
49 eGesundheit NRW. Available at: http://www.egesundheit.nrw.de Last access: January 25 2011
50 ELGA Available at: http://www.initiative-elga.at/enter.htm Last access: 25th of January 25 2011
51 MedCom Available at: http://www.medcom.dk/wm109991 Last access: January 2011
52 Electronic Case Record (German: Fallakte) Available at: http://www.fallakte.de Last access: April 19 2011
53 MedCom 15 years. Status report. Susanne Noesgaard (ed). December 2009 Available at: http://www.medcom.dk/dwn3595 Last access: January 25 2011
54 eBusiness W@tch. Case Study: MedCom - the Danish Healthcare Data and Information Network. 2004 Avalable at: http://www.ebusiness-watch.org Last access: January 25 2011