Elektronische Heilberufsausweise als unverzichtbare Elemente der kommenden Telematikinfrastruktur im Gesundheitswesen

The German law for the modernization of statutory health care defines a functional framework for the upcoming telematics infrastructure in health care based on electronic health professional cards, electronic patient data cards and the necessary information, communication and security infrastructure. The currently ongoing discussion for the implementation is strongly influenced by diverse particulate interests often hindering systematic development. This article presents the fundamental technical mechanisms usable for a stepwise and expandable solution. The interdependence of the components is illustrated using the example of the ATG concept for an electronic patient record. These facts call for a stepwise implementation of telematic infrastructure based on the presented mechanisms.

Die elektronische Gesundheitsakte in Deutschland

Electronic health records (EGA), as overall medical applications for the documentation of medical information under the guidance and sovereignty of the patient, change the traditional doctor-patient relationship. Unlike the electronic patient record (EPA), which the treating physician is in charge of, the patient has the sole right to decide who may insert which data into it and who may see his electronic health record (EGA). Thus, the patient's right of informational self-determination and his possibilities to get involved in the treatment process are substantially strengthened. The current situation of the EGA in Germany is described and the parallel development of EGA and EPA is discussed. The electronic health record acquires extensive significance, especially in line with the imminent introduction of the electronic health card on the basis of a standardised telematics infrastructure in Germany.

Akzeptanz der Gesundheitstelematik bei ihren Anwendern

The user acceptance of health telematics in medical care plays a critical role in mediating the success of its implementation. Model assumptions evolving from different fields such as industry, health care and medical psychology are presented, and various perspectives for patients and providers involved in these models are highlighted. The impact of health telematics on health care results from four components: (a) the improvement of work characteristics and communication processes, (b) the enhancement of diagnostic and treatment quality via telematics, (c) technical and economic advantages and (d) communication tools for patient. The evidence concerning clinical, economic and psychosocial criteria within these domains is reviewed according to the published literature. Despite the fact that a considerable benefit of health telematics has been shown in individual studies, the evidence concerning the improvement of health care, the improvement of work and communication processes as well as concerning its clinical and cost effectiveness is still scarce. It is recommended to further integrate health telematics and health service research.

Patientenfach und elektronisches Rezept

Electronic prescribing shall contribute essentially to improved healthcare services from 2006 onwards in Germany. The desired improvements, however, can only be achieved with "real" telematic solutions. The alternative of pharmaceutical prescription transmission via secure network connections or via electronic health card provides a considerable empowerment to the patients. Electronic prescribing, however, does not provide direct advantages to patients. Benefits for them can be realised by a drug documentation system, ready to identify contraindications or multiple prescriptions. The patients' acceptance of the system to be established therefore largely depends on the concurrent introduction of both elements.

Kritische Thesen zu patientenbezogenen Anwendungen der Gesundheitstelematik

Telematics applications in health care improve patient care in many ways. Especially the improvements through electronic communication, documentation and cooperation between the different providers have high potential for a qualitative and effective health care. Immaterialization of patient records enables their availability as health records across all health care institutions that are involved in the treatment of a patient. However, the realization of a telematic platform in health care raises new questions concerning ethical and technical issues. These questions must be answered in consideration of the interests of citizens, patients, health care providers and insurance companies. Against this background ten critical theses regarding patient-oriented applications in health telematics are presented and discussed. Special attention is paid to the changes in the relationship between patients and physicians and the necessity to establish a new cooperative medical documentation culture, based on controlled vocabularies and where patients and physicians together decide, which information should be added to the central health record, as well as the creation of the necessary trustworthiness and the balance of effective benefit of health telematics and the informational self determination of the patient.

Arzneimitteldokumentation

Medication histories as the most common way to document individual drug use provide a valuable database. Their main purpose is to check the patient's medication for so-called drug-related problems such as interactions, compliance problems, adverse drug reactions, and others. A second concern is to gain epidemiological evidence which increases the knowledge about benefits and risks of drugs including economic consequences. By referring to well-accepted principles of data protection, the documentation of drug use data has to be an essential part of complex care programmes which allows improvement of the individual drug therapy by reducing possible risks and increasing the therapeutic outcome of drug use more effectively. In addition, systematic drug documentation can be used to build structured databases which usually make use of prescription data. Given that principles of data protection, especially with regard to anonymity, are considered such databases provide an opportunity of data linkage with other health-related information such as health care services or number of sick leave days. Regardless of certain methodological limitations, these databases can also be used for health economics research and evaluation.

Die Einführung der elektronischen Gesundheitskarte in Deutschland

From 2006 onwards all members of the health insurance system in Germany will be issued an electronic health card which will replace the current health insurance card. The new health card will be technically upgraded to also include patient-related health data or provide access to such data in addition to its administrative functions. Therefore, it is evident that the health card be fitted with a microprocessor that permits authentication (electronic identity check), encryption and the electronic digital signature, thus ensuring maximum data safety and security. For easy identification of the insured person, the electronic health card will bear a photograph of the card holder.

Radio-frequency identification: its potential in healthcare

Radio-frequency identification (RFID) technology is just starting to make inroads into healthcare. RFID uses radio-frequency tags attached to people or objects to provide identification, tracking, security, and other functions that fall under the general heading of automatic identification and data capture (AIDC). In the retail supply chain, RFID is already well established as a way to reduce theft and track objects from manufacture through shipment to delivery. In healthcare, basic RFID is already being used to track patients for anti-elopement and anti-abduction programs. As more sophisticated systems move into hospitals, RFID is also beginning to see use to provide more extensive patient identification than traditional bar coding can, and to track and locate capital equipment within the hospital. In years to come, RFID could be used for a variety of applications, including tracking and matching blood for transfusions, tracking pharmaceuticals, and combating the counterfeiting of medical products. RFID may ultimately be used for many of the functions currently carried out using bar coding--but not until the cost of RFID comes down. For the foreseeable future, the two technologies are likely to be used in tandem in many hospitals. In this article, we describe the components and operation of RFID systems and detail the different ways in which these systems are being used, and could be used, in hospitals.

The NPSA recommendations to promote correct-site surgery

NPSA recommendations to promote correct-site surgery have been published. This article considers the need for such guidance and highlights its implications for nurses.

Face localization and authentication using color and depth images

This paper presents a complete face authentication system integrating both two-dimensional (color or intensity) and three-dimensional (3-D) range data, based on a low-cost 3-D sensor, capable of real-time acquisition of 3-D and color images. Novel algorithms are proposed that exploit depth information to achieve robust face detection and localization under conditions of background clutter, occlusion, face pose alteration, and harsh illumination. The well-known embedded hidden Markov model technique for face authentication is applied to depth maps and color images. To cope with pose and illumination variations, the enrichment of face databases with synthetically generated views is proposed. The performance of the proposed authentication scheme is tested thoroughly on two distinct face databases of significant size. Experimental results demonstrate significant gains resulting from the combined use of depth and color or intensity information.

An Intelligent 802.11 Triage Tag for medical response to disasters

When medical care is initiated at a mass casualty event, the first activity is the triage of victims, which is the grouping by victims severity of injury. Paper triage tags are often used to mark victims' triage status and to record information on injuries and treatments administered in the field. In this paper we describe the design and development of an"Intelligent Triage Tag" (ITT), an electronic device to coordinate patient field care. ITTs combine the basic functionality of a paper triage tag with sensors, nonvolatile memory, a microprocessor and 802.11 wireless transmission capabilities. ITTs not only display victims' triage status but also signal alerts, and mark patients for transport or immediate medical attention. ITTs record medical data for later access offsite and help organize care by relaying information on the location of the victims during field treatment. ITTs are a part of the Wireless Information System for Medical Response in Disasters (WIISARD) architecture.

Patient misidentification in a pediatric emergency department: patient safety and legal perspectives

Emergency departments across the nation are faced with ever-increasing high volumes, overcrowding, and patient acuity. Along with these growing trends, the Joint Commission on the Accreditation of Healthcare Organizations is instituting new patient safety initiatives to reduce patient medical errors in the hospital setting. The emergency department is one area under great scrutiny with patient identification as primary concern. This article discusses a case study involving patient misidentification in the pediatric emergency department and reviews the legal and safety programs implemented at a children's hospital to improve patient safety outcomes.

Use of an electronic barcode system for patient identification during blood transfusion: 3-year experience in a regional hospital

OBJECTIVE

To evaluate the use of an electronic barcode system for patient identification during blood transfusion.

DESIGN

Retrospective study.

SETTING

Regional hospital, Hong Kong.

PATIENTS

For all patients requiring blood transfusion between May 1999 and April 2002, with the exception of patients in the psychiatric wards and the accident and emergency department, a portable, hand-held scan-and-print electronic device was used to verify and document patients' identity at two critical points of transfusion: blood sampling for the compatibility test and blood administration.

MAIN OUTCOME MEASURES

Scope of use of the electronic device, cost, effectiveness, staff compliance, problems and solution for improvement.

RESULTS

In the first 3 years of hospital-wide use of the new device, no incidents of blood transfusion to wrong patients, or wrong labelling of blood samples, occurred with 41,00 blood sampling procedures and administration of 27 000 units of blood. Blood sampling took 6 minutes to complete with the use of the electronic device-similar to that taken by the conventional second-checker system. Among hospital staff, the compliance rate of using the new device approached 90%. Battery problems occurred in 12% of episodes of use of the device.

CONCLUSIONS

The electronic barcode system was effective in reducing human error related to bedside transfusion procedures. The future goal is to tailor-make a more efficient device with additional functions.

Characterization of Palmprints by Wavelet Signatures via Directional Context Modeling

The palmprint is one of the most reliable physiological characteristics that can be used to distinguish between individuals. Current palmprint-based systems are more user friendly, more cost effective, and require fewer data signatures than traditional fingerprint-based identification systems. The principal lines and wrinkles captured in a low-resolution palmprint image provide more than enough information to uniquely identify an individual. This paper presents a palmprint identification scheme that characterizes a palmprint using a set of statistical signatures. The palmprint is first transformed into the wavelet domain, and the directional context of each wavelet subband is defined and computed in order to collect the predominant coefficients of its principal lines and wrinkles. A set of statistical signatures, which includes gravity center, density, spatial dispersivity and energy, is then defined to characterize the palmprint with the selected directional context values. A classification and identification scheme based on these signatures is subsequently developed. This scheme exploits the features of principal lines and prominent wrinkles sufficiently and achieves satisfactory results. Compared with the line-segments-matching or interesting-points-matching based palmprint verification schemes, the proposed scheme uses a much smaller amount of data signatures. It also provides a convenient classification strategy and more accurate identification.

A smart-card-enabled privacy preserving E-prescription system

Within the overall context of protection of health care information, privacy of prescription data needs special treatment. First, the involvement of diverse parties, especially nonmedical parties in the process of drug prescription complicates the protection of prescription data. Second, both patients and doctors have privacy stakes in prescription, and their privacy should be equally protected. Third, the following facts determine that prescription should not be processed in a truly anonymous manner: certain involved parties conduct useful research on the basis of aggregation of prescription data that are linkable with respect to either the patients or the doctors; prescription data has to be identifiable in some extreme circumstances, e.g., under the court order for inspection and assign liability. In this paper, we propose an e-prescription system to address issues pertaining to the privacy protection in the process of drug prescription. In our system, patients' smart cards play an important role. For one thing, the smart cards are implemented to be portable repositories carrying up-to-date personal medical records and insurance information, providing doctors instant data access crucial to the process of diagnosis and prescription. For the other, with the secret signing key being stored inside, the smart card enables the patient to sign electronically the prescription pad, declaring his acceptance of the prescription. To make the system more realistic, we identify the needs for a patient to delegate his signing capability to other people so as to protect the privacy of information housed on his card. A strong proxy signature scheme achieving technologically mutual agreements on the delegation is proposed to implement the delegation functionality.

Linking primary and secondary healthcare databases in New Zealand

AIM

To investigate the effectiveness of linking primary and secondary care data using an encrypted national health index (ENHI).

METHODS

Primary care patient registers from 106 practices collected by the Dunedin Research Unit of the Royal New Zealand College of General Practitioners (RNZCGP) for the year 2001 were linked to the entire National Minimum Data Set (NMDS) for 2001 using an ENHI. The success of matching using the ENHI was measured, and primary and secondary care populations were compared in terms of hospital utilisation (number of discharges, length of stay, major diagnostic category [MDC]).

RESULTS

86,608 unique general practice ENHIs were successfully linked to the NMDS for the study period. Date of birth was matched on ENHIs (96.6%), sex (99.1%), and ethnicity (84.0%). Hospital morbidity and hospital utilisation (in terms of number of discharges and length of stay) were similar for general practice patient admissions and the entire NMDS admission data set.

CONCLUSIONS

Data collected in general practice linked well to secondary care data using the ENHI. Linked primary and secondary care data sets will provide a sound basis for research into publicly funded healthcare.