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Koch M, Richter J, Hauswaldt J, Krefting D. How to Make Outpatient Healthcare Data in Germany Available for Research in the Dynamic Course of Digital Transformation. Stud Health Technol Inform 2023; 307:12-21. [PMID: 37697833 DOI: 10.3233/shti230688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
INTRODUCTION There is increasing interest on re-use of outpatient healthcare data for research, as most medical diagnosis and treatment is provided in the ambulatory sector. One of the early projects to bring primary data from German ambulatory care into clinical research technically, organizationally and in compliance with legal demands has been the RADAR project, that is based on a broad consent and has used the then available practice information system's interfaces to extract and transfer data to a research repository. In course of the digital transformation of the German healthcare system, former standards are abandoned and new interoperability standards, interfaces and regulations on secondary use of patient data are defined, however with slow adoption by Health-IT systems. Therefore, it is of importance for all initiatives that aim at using ambulatory healthcare data for research, how to access this data in an efficient and effective way. METHODS Currently defined healthcare standards are compared regarding coverage of data relevant for research as defined by the RADAR project. We compare four architectural options to access ambulatory health data through different components of healthcare and health research data infrastructures along the technical, organizational and regulatory conditions, the timetable of dissemination and the researcher's perspective. RESULTS A high-level comparison showed a high degree of semantic overlap in the information models used. Electronic patient records and practice information systems are alternative data sources for ambulatory health data - but differ strongly in data richness and accessibility. CONCLUSION Considering the compared dimensions of architectural routes to access health data for secondary research use we conclude that data extraction from practice information systems is currently the most promising way due to data availability on a mid-term perspective. Integration of routine data into the national research data infrastructures might be enforced by convergence of to date different information models.
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Affiliation(s)
- Marius Koch
- Department of Medical Informatics, University Medical Center Göttingen, Germany
| | - Jendrik Richter
- Department of Medical Informatics, University Medical Center Göttingen, Germany
| | - Johannes Hauswaldt
- Department of General Practice, University Medical Center Göttingen, Germany
| | - Dagmar Krefting
- Department of Medical Informatics, University Medical Center Göttingen, Germany
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Hauswaldt J, Bahls T, Blumentritt A, Demmer I, Drepper J, Groh R, Heinemann S, Hoffmann W, Kempter V, Pung J, Rienhoff O, Schlegelmilch F, Wieder P, Yahyapour R, Hummers E. [Secondary Use of Electronic Medical Record Data from Primary Health Care is Feasible: Report from RADAR Project]. Gesundheitswesen 2021; 83:S130-S138. [PMID: 34852383 DOI: 10.1055/a-1676-4020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objectives It is difficult to obtain longitudinal 'real world' data from ambulatory medical care in Germany in a systematic way. Our vision is a large German research data repository featuring representative, anonymized patient and outpatient health care data, longitudinal, continuously updated and across different providers, offering a perspective of linking secondary care data or additional data obtained from research cohorts, for example patient reported data or biodata, and will be accessible for other researchers. Here we report specific methods and results from the RADAR project.Methods Survey of legislation, design of technical processes and organisational solutions, with a feasibility study to evaluate technical and content functionality, acceptability and performance fitness for health services research questions.Results In 2016, a multi-disciplinary scientific team initiated the development of a privacy protection and IT security concept for data exported from the electronic medical records (EMR) of physicians' practices in line with the European General Data Protection Regulation. Technical and organisational requirements for lawful research infrastructure were developed and executed for use in a specific case, namely ̒oral anticoagulation'. In 7 Lower Saxonian general practices, 100 patients were selected by their physician and their data - reduced to 40 essential data fields - extracted from EMR via a mandatory software interface after informed consent. Still in the practice, the data were split into identifying or medical data. These were encrypted and transferred either to a trusted third party (TTP) or to a data repository, respectively. 75 patients who met our inclusion criteria (minimum of one year of oral anticoagulation treatment) received a quality-of-life questionnaire via the TTP. Of the 66 returns, 63 responses were then linked to the EMR data in the repository.Conclusion Results from RADAR project proved the technical and organisational feasibility of lawful, pseudonymised data acquisition and the linkage of questionnaires to EMR data. The protecting concepts privacy by design and data minimization (Art. 25 GDPR with Recital 78) were implemented. Without informed consent, secondary use of routine data from ambulatory care which are sufficiently anonymized but still meaningful is all but impossible under current German law.
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Affiliation(s)
- Johannes Hauswaldt
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Thomas Bahls
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Arne Blumentritt
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Iris Demmer
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Johannes Drepper
- Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., TMF, Berlin, Deutschland
| | - Roland Groh
- Gesellschaft für wissenschaftliche Datenverarbeitung mbH Göttingen, Göttingen, Deutschland
| | - Stephanie Heinemann
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Valérie Kempter
- Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., TMF, Berlin, Deutschland
| | - Johannes Pung
- Medizinische Informatik, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Otto Rienhoff
- Medizinische Informatik, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Falk Schlegelmilch
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Philipp Wieder
- Gesellschaft für wissenschaftliche Datenverarbeitung mbH Göttingen, Göttingen, Deutschland
| | - Ramin Yahyapour
- Gesellschaft für wissenschaftliche Datenverarbeitung mbH Göttingen, Göttingen, Deutschland
| | - Eva Hummers
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Bahls T, Pung J, Heinemann S, Hauswaldt J, Demmer I, Blumentritt A, Rau H, Drepper J, Wieder P, Groh R, Hummers E, Schlegelmilch F. Designing and piloting a generic research architecture and workflows to unlock German primary care data for secondary use. J Transl Med 2020; 18:394. [PMID: 33076938 PMCID: PMC7574413 DOI: 10.1186/s12967-020-02547-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background Medical data from family doctors are of great importance to health care researchers but seem to be locked in German practices and, thus, are underused in research. The RADAR project (Routine Anonymized Data for Advanced Health Services Research) aims at designing, implementing and piloting a generic research architecture, technical software solutions as well as procedures and workflows to unlock data from family doctor’s practices. A long-term medical data repository for research taking legal requirements into account is established. Thereby, RADAR helps closing the gap between the European countries and to contribute data from primary care in Germany. Methods The RADAR project comprises three phases: (1) analysis phase, (2) design phase, and (3) pilot. First, interdisciplinary workshops were held to list prerequisites and requirements. Second, an architecture diagram with building blocks and functions, and an ordered list of process steps (workflow) for data capture and storage were designed. Third, technical components and workflows were piloted. The pilot was extended by a data integration workflow using patient-reported outcomes (paper-based questionnaires). Results The analysis phase resulted in listing 17 essential prerequisites and guiding requirements for data management compliant with the General Data Protection Regulation (GDPR). Based on this list existing approaches to fulfil the RADAR tasks were evaluated—for example, re-using BDT interface for data exchange and Trusted Third Party-approach for consent management and record linkage. Consented data sets of 100 patients were successfully exported, separated into person-identifying and medical data, pseudonymised and saved. Record linkage and data integration workflows for patient-reported outcomes in the RADAR research database were successfully piloted for 63 responders. Conclusion The RADAR project successfully developed a generic architecture together with a technical framework of tools, interfaces, and workflows for a complete infrastructure for practicable and secure processing of patient data from family doctors. All technical components and workflows can be reused for further research projects. Additionally, a Trusted Third Party-approach can be used as core element to implement data privacy protection in such heterogeneous family doctor’s settings. Optimisations identified comprise a fully-electronic consent recording using tablet computers, which is part of the project’s extension phase.
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Affiliation(s)
- Thomas Bahls
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, Greifswald, 17475, Germany.
| | - Johannes Pung
- Department of Medical Informatics, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, 37075, Germany
| | - Stephanie Heinemann
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany
| | - Johannes Hauswaldt
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany
| | - Iris Demmer
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany
| | - Arne Blumentritt
- Trusted Third Party of the University Medicine Greifswald, Ellernholzstr. 1-2, Greifswald, 17475, Germany
| | - Henriette Rau
- Trusted Third Party of the University Medicine Greifswald, Ellernholzstr. 1-2, Greifswald, 17475, Germany
| | - Johannes Drepper
- TMF - Technology, Methods, and Infrastructure for Networked Medical Research (TMF e.V.), Charlottenstraße 42, Berlin, 10117, Germany
| | - Philipp Wieder
- Gesellschaft für wissenschaftliche Datenverarbeitung mbH, Am Faßberg 11, Göttingen, 37077, Germany
| | - Roland Groh
- Gesellschaft für wissenschaftliche Datenverarbeitung mbH, Am Faßberg 11, Göttingen, 37077, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany
| | - Falk Schlegelmilch
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, Göttingen, 37073, Germany
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Abstract
BACKGROUND Routinely recorded data from everyday ambulatory medical care are urgently needed for health services and systems research, but this faces major limitations in Germany. In 2018, European General Data Protection Regulation (GDPR) and new German Federal Data Protection Act (FDPA) become effective. Via simulated real-life scenarios it may be possible to find out if access to and utilization of routine data for research becomes easier or faces additional obstacles. METHODS General practitioners, information scientists, data trustees and privacy protection experts create concepts, processes and standards for lawful handling of routinely recorded data for secondary research and study their feasibility in 2 scenarios (anonymous and pseudonymous data utilization). From the point of view of technical assessment and privacy protection, technical and organizational obstacles are presented as well as the legal framework. RESULTS Outdated software interface, insufficient maintenance by software vendors, burdens associated with organization and cost as well as poor IT standards place obstacles to systematic and longitudinal use of healthcare routine data. Future pan-European law for privacy protection will allow research utilization of ambulatory data in principle. However, there are persisting conflicts between individual (fundamental right of privacy protection) and public interests (research for quality and efficiency of public spending; European market's free exchange of goods and services). This becomes evident especially when using routine data via pseudonymization. DISCUSSION Neither insurmountable hurdles by privacy protecting law nor a threat from Big Data are currently the major obstacles to secondary utilization of routine data but real-life problems at the technology and operational level. GDPR and FDPA that have become into effect in May 2018 have improved European legal unity and transparency of patients' interests. Tension between privacy protection of data on an identified or identifiable person and scientific utilization and exchange of such data in public interest necessitates additional legal clarification. One possible solution, an advanced and ready-to-use software interface, awaits implementation.
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Affiliation(s)
| | - Valérie Kempter
- Technologie- und Methodenplattform für die vernetzte medizinische Forschung e.V.,Technologie- und Methodenplattform für die vernetzte medizinische Forschung e.V., Berlin
| | - Wolfgang Himmel
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen
| | - Eva Hummers
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen
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Kalda R, Silina V, Bayen-Krohn S, Deruytter N, Streit S, Verschoor M, Rodondi Bonfim Daiana N, Burman RA, Canan T, Collins C, Gerasimovska Biljana K, Gintere S, Bravo Gómez R, Hoffmann K, Biyiklioglu T, Kolesnyk P, Mechili EA, Harris M, Schonmann Y, Bleich O, Matalon A, Yeshua H, Vinker S, Prus J, Comaneshter DS, Cohen AD, Lahad A, Terjajeva L, Silina V, Skurule I, Le Reste JY, Le Mer R, Derriennic J, odorico M, le Goff D, Lalande S, Nabbe P, Le Floch B, Billot Grasset A, Baptiste Nousbaum J, Collins C, O’Shea M, Wrigley M, Ryan J, Osborne B, Thakore J, Hanlon DO, Finegan P, Skuja E, Kristina Zackrisson E, Skuja I, Biyiklioglu T, Kolesnyk P, Mechili EA, Harris M, Bösner S, Abushi J, Donner-Banzhoff N, Stolper E, Van Royen P, van de Wiel M, van Bokhoven L, Jan Dinant G, Schmalstieg K, Himmel W, Hummers E, Pautrat M, Laporte C, Pierre Lebeau J, Ivanova J, Silina V, Muñoz MA, Vaillant-Roussel H, Lingner H, Demurtas J, Neves AL, Torsza P, Asenova R, Klemenc-Ketis Z, Glynn L, Kulbay H, Verdú JM, Tabenkin H, Nothnagle M, Borkan J, Schlöszler K, Splittgerber R, Kühlwind A, Donner-Banzhoff N, Saxvik A, Franz A, Hagqvist I, Rödjer S, Bondjers G, Saxvik A, Petek Šter M, Selič P, Hauswaldt J, Heinemann S, Verhoeven A, Leuridan E, Peremans L, Remmen R, Mada L, Tilea R. European General Practice Research Network (EGPRN) Abstracts from the EGPRN conference in Riga, Latvia, 11?14 May 2017. Theme: 'Reducing the risk of chronic diseases in general practice/family medicine'. Eur J Gen Pract 2017; 23:227-240. [PMID: 29022405 PMCID: PMC5965853 DOI: 10.1080/13814788.2017.1357694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ruth Kalda
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Vija Silina
- Department of Family Medicine, Riga Stradins University, Riga, Latvia
| | | | | | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Schweiz
| | | | | | - Robert A. Burman
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Schweiz
| | - Tuz Canan
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Schweiz
| | - Claire Collins
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Schweiz
| | | | - Sandra Gintere
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Schweiz
| | - Raquel Bravo Gómez
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Schweiz
| | - Kath Hoffmann
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Schweiz
| | | | | | | | | | - Yochai Schonmann
- Clalit Health Services and Department of Family Medicine, Rabin Medical Center, Tel Aviv, Israel
| | - O. Bleich
- Clalit Health Services and Department of Family Medicine, Rabin Medical Center, Tel Aviv, Israel
| | - Andre Matalon
- Clalit Health Services and Department of Family Medicine, Rabin Medical Center, Tel Aviv, Israel
| | - Hanny Yeshua
- Clalit Health Services and Department of Family Medicine, Rabin Medical Center, Tel Aviv, Israel
| | - Shlomo Vinker
- Family Medicine, Tel Aviv University, Ashdod, Israel
| | - Judit Prus
- Family Medicine, Tel Aviv University, Ashdod, Israel
| | | | | | - Amnon Lahad
- Family Medicine, Tel Aviv University, Ashdod, Israel
| | | | - Vija Silina
- Family Medicine, Riga Stradins University, Salaspils, Latvia
| | - Iveta Skurule
- Family Medicine, Riga Stradins University, Salaspils, Latvia
| | | | - Ronan Le Mer
- General Practice, Université de Bretagne Occidentale, Brest, France
| | | | - Michele odorico
- General Practice, Université de Bretagne Occidentale, Brest, France
| | - Delphine le Goff
- General Practice, Université de Bretagne Occidentale, Brest, France
| | - Sophie Lalande
- General Practice, Université de Bretagne Occidentale, Brest, France
| | - Patrice Nabbe
- General Practice, Université de Bretagne Occidentale, Brest, France
| | - Bernard Le Floch
- General Practice, Université de Bretagne Occidentale, Brest, France
| | | | | | | | | | | | | | | | | | | | | | - Elina Skuja
- Family Medicine, Riga Stradins University, Riga, Latvija
| | | | - Ilze Skuja
- Family Medicine, Riga Stradins University, Riga, Latvija
| | | | | | | | | | | | | | | | - Erik Stolper
- General Practice, CAPHRI, Maastricht, The Netherlands
| | | | | | | | | | - Katharina Schmalstieg
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfgang Himmel
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Maxime Pautrat
- Département universitaire de médecine générale, Faculté de médecine, Tours, France
| | - Catherine Laporte
- Département universitaire de médecine générale, Faculté de médecine, Tours, France
| | - Jean Pierre Lebeau
- Département universitaire de médecine générale, Faculté de médecine, Tours, France
| | | | - Vija Silina
- Continuing education faculty, Riga Stradins University, Riga, Latvia
| | - Miguel-Angel Muñoz
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - Helene Vaillant-Roussel
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - Heidrun Lingner
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - Jacopo Demurtas
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - Ana-Luisa Neves
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - Peter Torsza
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - Radost Asenova
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - Zalika Klemenc-Ketis
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - Liam Glynn
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - Hayriye Kulbay
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - José-Maria Verdú
- Unitat de Suport a la Recerca, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | - Hava Tabenkin
- Family Medicine, Ben Gurion University, Ein Harod M, Israel
| | | | - Jeffrey Borkan
- Family Medicine, Ben Gurion University, Ein Harod M, Israel
| | | | | | - Anne Kühlwind
- Family Medicine, Philipps-University Marburg, Marburg, Germany
| | | | - Ausra Saxvik
- Family Physician Center Närhälsan Öckerö, PLUS program, Hönö, Sweden
| | - Anna Franz
- Family Physician Center Närhälsan Öckerö, PLUS program, Hönö, Sweden
| | - Inger Hagqvist
- Family Physician Center Närhälsan Öckerö, PLUS program, Hönö, Sweden
| | - Stig Rödjer
- Family Physician Center Närhälsan Öckerö, PLUS program, Hönö, Sweden
| | - Göran Bondjers
- Family Physician Center Närhälsan Öckerö, PLUS program, Hönö, Sweden
| | - Ausra Saxvik
- Family Physician Center Närhälsan Öckerö, PLUS program, Hönö, Sweden
| | - Marija Petek Šter
- Department for Family medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Polona Selič
- Department for Family medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Johannes Hauswaldt
- University Medicine Göttingen, Institute of General Practice and Family Medicine, Göttingen, Germany
| | - Stephanie Heinemann
- University Medicine Göttingen, Institute of General Practice and Family Medicine, Göttingen, Germany
| | - Ann Verhoeven
- Centre for general practice-department Eliza, University of Antwerp, Antwerpen, Belgium
| | - Elke Leuridan
- Centre for general practice-department Eliza, University of Antwerp, Antwerpen, Belgium
| | - Lieve Peremans
- Centre for general practice-department Eliza, University of Antwerp, Antwerpen, Belgium
| | - Roy Remmen
- Centre for general practice-department Eliza, University of Antwerp, Antwerpen, Belgium
| | - Leonard Mada
- Department of Research, Syonic SRL, Timisoara, Romania
| | - Roxana Tilea
- Department of Research, Syonic SRL, Timisoara, Romania
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Abstract
Dyspnea represents one of the most frequent cardinal symptoms in general practice and interdisciplinary emergency care across all sectors. Due to its subjective character, dyspnea is described by patients in many different ways, including "shortness of breath, difficulty of breathing, feeling of chest tightness, etc". The spectrum of differential diagnoses is broad, including in particular pulmonary and cardiovascular diseases. In addition to an evaluation of severity and an assessment of temporal, situation-related, and causal classification criteria, a structured process of multiple diagnostic steps in both primary and emergency care is a prerequisite for fast and correct diagnosis. In this context, it is of crucial importance to identify life-threatening diseases according to defined criteria and thus initiate adequate emergency measures. Further treatment options at the interface between primary and clinical care can be based on the German Appropriate Evaluation Protocol (G-AEP) criteria.
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Affiliation(s)
- J Hauswaldt
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - S Blaschke
- Interdisziplinäre Notaufnahme, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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Barais M, Hauswaldt J, Hausmann D, Czachowski S, Sowinska A, Van Royen P, Stolper E. The linguistic validation of the gut feelings questionnaire in three European languages. BMC Fam Pract 2017; 18:54. [PMID: 28521742 PMCID: PMC5437565 DOI: 10.1186/s12875-017-0626-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/30/2017] [Indexed: 01/14/2023]
Abstract
Background Physicians’ clinical decision-making may be influenced by non‐analytical thinking, especially when perceiving uncertainty. Incidental gut feelings in general practice have been described, namely, as “a sense of alarm” and “a sense of reassurance”. A Dutch Gut Feelings Questionnaire (GFQ) was developed, validated and afterwards translated into English following a linguistic validation procedure. The aims were to translate the GFQ from English into French, German and Polish; to describe uniform elements as well as differences and difficulties in the linguistic validation processes; to propose a procedural scheme for future GFQ translations into other languages. Methods We followed a structured, similar and equivalent procedure. Forward and backward-translations, repeated consensus procedures and cultural validations performed in six steps. Exchanges between the several research teams, the authors of the Dutch GFQ, and the translators involved continued throughout the procedure. Results 12 translators, 52 GPs and 8 researchers in the field participated to the study in France, Germany, Switzerland and Poland. The collaborating research teams created three versions of the 10-item GFQ. Each research team found and agreed on compromises between comparability and similarity on one hand, and linguistic and cultural specificities on the other. Conclusions The gut feeling questionnaire is now available in five European languages: Dutch, English, French, German and Polish. The uniform procedural validation scheme presented, and agreed upon by the teams, can be used for the translation of the GFQ into other languages. Comparing results of research into the predictive value of gut feelings and into the significance of the main determinants in five European countries is now possible. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0626-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Barais
- ERCR SPURBO, Department of General Practice, Université de Bretagne Occidentale, Brest, France.
| | - Johannes Hauswaldt
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Daniel Hausmann
- Department of Psychology - Applied Social and Health Psychology, University of Zurich, Zurich, Switzerland
| | | | - Agnieszka Sowinska
- Department of English Studies, Nicolaus Copernicus University, Toruń, Poland
| | - Paul Van Royen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Erik Stolper
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Health, Medicine and Life Sciences, Caphri School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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8
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Abstract
The role of gut feelings in diagnostic reasoning is recognized by most GPs throughout Europe, and probably throughout the world. Studies on this topic have emerged from different countries but there is the risk that authors will use different terms for similar concepts. The European Expert Group on Cognitive and Interactive Processes in Diagnosis and Management in General Practice, COGITA for short, was founded in 2008 to conduct cross-border research in the area of non-analytical diagnostic reasoning. Academic GPs, PhD students, psychologists, linguists and students meet once a year to share their experiences, exchange results and initiate new studies on the topic. A milestone in their research is this publication of a short glossary of diagnostic reasoning terms relating to the gut feelings research topic. It was constructed by the COGITA group members following a literature review, which aimed to define salient terms used in their publications. They described the terms, cross-reviewed the wording and reached consensus within the group. Two sections were created: (1) a diagnostic reasoning section that describes concepts such as analytical and non-analytical reasoning, clinical mind lines, and intuition, and (2) a research methods section describing concepts such as linguistic validity and saturation. The glossary, including relevant literature, has been published on the website http://www.gutfeelingsingeneralpractice.eu. In the future, the glossary will be modified if necessary and completed by members of the COGITA group. A glossary of diagnostic reasoning terms relating to gut feelings research was constructed by the COGITA group to define salient terms, used in their publications. It is a prerequisite to conduct further cross-border research into gut feelings in family medicine. The development of the glossary is ongoing.
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Affiliation(s)
- Marie Barais
- a ERCR SPURBO, Department of General Practice , Université de Bretagne Occidentale , Brest , France
| | - Johannes Hauswaldt
- b Department of General Practice , University Medical Center , Göttingen , Germany
| | - Geert-Jan Dinant
- c Faculty of Health, Medicine and Life Sciences, Caphri School for Public Health and Primary Care, Department of Family Medicine , Maastricht University , Maastricht , The Netherlands
| | - Margje van de Wiel
- d Faculty of Psychology and Neuroscience, Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands
| | - C F Erik Stolper
- c Faculty of Health, Medicine and Life Sciences, Caphri School for Public Health and Primary Care, Department of Family Medicine , Maastricht University , Maastricht , The Netherlands.,e Department of Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium
| | - Paul Van Royen
- f Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium
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9
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Hauswaldt J, Hummers-Pradier E, Himmel W. Does an increase in visits to general practice indicate a malignancy? BMC Fam Pract 2016; 17:94. [PMID: 27456975 PMCID: PMC4960682 DOI: 10.1186/s12875-016-0477-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 07/06/2016] [Indexed: 11/10/2022]
Abstract
Background An increase in a patient’s visits to doctors usually raises concerns and may be a ‘red flag’ for a patient’s deterioration of health. The aim of this study was to analyze whether an increase of patient-physician contacts is a first sign of a malignancy in a patient’s near future. Methods This is a retrospective case-control study. From 153 German general practices’ electronic patient records (EPR), cases with at least one new malignancy diagnosis and no-malignancy controls were matched for gender and age. We calculated (1) the number of contacts in the first quarter up to the sixth quarter before a malignancy diagnosis was made and (2) the inter-contact interval (ICI), i.e. the time lag between two consecutive patient-physician contacts measured in days. Differences between cases and controls were investigated in several analyses of variance, with group and time as main factors. Results A total of 3,310 cases and 3,310 controls could be included. The number of contacts for cases in the six quarters before a malignancy diagnosis increased from 4.8 contacts (SD 4.3) to 5.5 contacts (SD 4.8). The number of contacts for controls increased only marginally from 4.3 contacts (SD 3.6) to 4.5 (SD 4.2). The factor ‘group’ (cases vs. controls) was highly significant in the analyses of variance, also ‘time’ and the interaction ‘group * time’. The effect size, however, was very small (R2 being less than 0.02), which is the equivalent for about one additional contact per quarter in cases directly before a newly made malignancy diagnosis. Conclusion An increase in contact frequency is a call for GPs to become more attentive towards these patients. It may raise the suspicion of an impending serious disease but the increase is not so dramatic and unique that it can be interpreted a reliable sign of a malignant diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0477-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes Hauswaldt
- Department of General Practice, University Medical Center, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Eva Hummers-Pradier
- Department of General Practice, University Medical Center, Humboldtallee 38, 37073, Göttingen, Germany
| | - Wolfgang Himmel
- Department of General Practice, University Medical Center, Humboldtallee 38, 37073, Göttingen, Germany
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Hauswaldt J, Himmel W, Hummers-Pradier E. The inter-contact interval: a new measure to define frequent attenders in primary care. BMC Fam Pract 2013; 14:162. [PMID: 24152427 PMCID: PMC3834877 DOI: 10.1186/1471-2296-14-162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/10/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Frequent attenders receive much attention in primary care research. Defining frequent attendance is crucial for an adequate view on this group of demanding patients. We aimed to develop a purely contact-based definition of "frequent attendance" and to apply it to real patients. METHODS From electronic records of 123 general practices in Germany, patients' inter-contact intervals (ICI) between two consecutive doctor-patient-contacts were calculated in this retrospective observational study. ICI less than 7 days were labelled "frequent attendance", patients with 60% or more of such intervals "frequent attenders (new view)". In contrast, patients having at least 24 contacts per calendar year were considered "frequent attenders (traditional view)". Both groups were analysed in their diseases and demands, using multiple logistic regression. RESULTS A total of 177,057 patients with at least 3 ICI in 1996 until 2006 yielded 4,408,033 ICI. One third were "short" ICI (less than 7 days), resulting in 19,759 (11.2%) frequent attenders (new). In contrast, 22,921 (12.9%) patients were frequent attenders (traditional). Compared to non-frequent attenders, frequent attenders (new) were more likely to have pneumonia (OR 1.66), stroke (OR 1.49), dementia (OR 1.46), or severe substance abuse (OR 1.44), also to need home visits or emergency attention. Frequent attenders (traditional) were more likely to have dementia (OR 2.76) or stroke (OR 2.06), and by far to need home visits (OR 5.43; all p < 0.001). CONCLUSIONS A new measure, the interval in days of two consecutive face-to-face contacts (ICI), widens our perspective on frequent attenders in general practice. In many cases, their consultation behaviour and need for medical services seem to follow "disease logic".
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Affiliation(s)
- Johannes Hauswaldt
- Department of General Practice/Family Medicine, University Medical Centre, Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany.
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11
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Hauswaldt J, Hummers-Pradier E, Junius-Walker U. In reply. Dtsch Arztebl Int 2013; 110:254. [PMID: 23616821 PMCID: PMC3632815 DOI: 10.3238/arztebl.2013.0254b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Hauswaldt J, Hummers-Pradier E, Junius-Walker U. Health service use among patients with chronic or multiple illnesses, and frequent attenders: secondary analysis of routine primary care data from 1996 to 2006. Dtsch Arztebl Int 2012; 109:814-20. [PMID: 23248711 PMCID: PMC3521193 DOI: 10.3238/arztebl.2012.0814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 07/20/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little or no longitudinal data have been available to date on the utilization of primary care physicians' services, particularly by chronically ill and multimorbid patients and by those who see their primary care physician often ("frequent attenders"). METHODS We collected anonymous data on 305 896 patients from 155 primary care practices over the period 1996-2006 and analyzed them with descriptive statistics, correlations, and multiple logistic regression. RESULTS Over the period of the study, patients visited their primary care physicians about 7 times per year on average. Frequent attendance, defined as 24 or more contacts per year, was not strongly associated with chronic illness or multimorbidity (r=0.19 and r=0.24, respectively) but was found to be linked to time-consuming medical services, such as detailed counseling (adjusted odds ratio [OR], 5.8) and house calls (OR, 3.5). Chronically ill patients utilized their primary care physicians' services less than we had expected. Chronic illness and multimorbidity were more common with increasing age; also correlated with age were the utilization of medical services, the number of visits to the primary care physician, and the number of visits to the primary care physician among frequent attenders. DISCUSSION Although in Germany visits to physicians of all types (both primary care physicians and specialists) in private practice became more frequent in total over the period of this study, visits to primary care physicians alone did not. Frequent attenders do not necessarily have chronic illness or multimorbidity but seem to constitute a particularly problematic group. Chronic illness is not a predictor for greater utilization of primary care physicians' services.
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Affiliation(s)
- Johannes Hauswaldt
- Department of General Practice at the University Medical Centre Göttingen, Humboldtallee 38, Göttingen, Germany.
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Kersting M, Hauswaldt J, Lingner H. [Modeling the requirements on routine data of general practitioners from the health-care researcher's point of view with the help of unified modeling langauge (UML)]. Gesundheitswesen 2012; 74:e68-75. [PMID: 22836932 DOI: 10.1055/s-0032-1314824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Health-care research is, besides primary acquired study data, based on data from widely differing secondary sources. In order to link, compare and analyze data sources uniform models and methods are needed. This could be facilitated by a more structured description of requirements, models and methods of health-care research than those currently used. Suitable methods of presentation were sought in an approach to this target and the unified modeling language (UML) identified as a possible alternative. METHODS Using different tools 3 UML diagrams were created to represent some individual aspects of a scientific use file (SUF): A use case diagram as well as an activity and a class diagram. In the use case diagram we attempted to represent the general use cases of an SUF based on general practitioners routine data. Secondly a class diagram was constructed to visualize the contents and structure of a SUF. Thirdly an activity diagram was developed to graphically represent the concept of a general practitioner's episode of care. RESULTS The creation of the UML diagrams was possible without any technical difficulties. Regarding the content the 3 diagrams must still be considered as prototypes. The use case diagram shows possible uses and users of an SUF, e. g. a research worker, industry but also the general practitioner who supplies the data. The class diagram reveals a general data structure that can serve information processes in practice and research. Besides aggregation, possibilities for specialization and generalization are essential elements of the class diagram that can be used meaningfully. The activity diagram for the schematic representation of a general practitioner's episode of care reveals the existence of multiple endpoints of an episode and the possibility to form relationships by means of episodes (diagnosis>therapy). CONCLUSION The constructed diagrams are preliminary results and should be refined in future steps. Use case diagrams enable a rapid overview of the meaning and purpose of a system, in this case an SUF. Class diagrams can help at a professional level to describe relationships between entities (classes/objects) more clearly than with the existing methods of representation. Activity diagrams are successors to classic flow charts. They are complemented appropriately by status diagrams. UML is suitable to uniformly and graphically describe a system (here an SUF) from various points of view. In future, validated UML models will help us to present scientific concepts and results in a more structured form than before and to promote the technological use of these concepts in practice.
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Affiliation(s)
- M Kersting
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover.
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Hauswaldt J. [What else is Evidence-based Medicine?]. Z Evid Fortbild Qual Gesundhwes 2010; 104:625-629. [PMID: 21129698 DOI: 10.1016/j.zefq.2010.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence. Strange enough, scientific discussion focuses on external evidence from systematic research, but neglects its counterpart, i.e., individual clinical expertise. Apart from a lack of appropriate intellectual tools for approaching the latter, this might be due to the mutual concealment of thought and action, of sensor and motor activity (Viktor von Weizsaecker's principle of the revolving door). Behind this, and incommensurably different from each other, lie the world of physics and the world of biology with an ego animal, that is, the dilemma of the self-conscious subject in a world of objects. When practicing medicine, this dilemma of self-reference is being resolved but only through a holistic approach combining rational and external evidence with biographical, spiritual, emotional and pre-rational elements represented in the physician's individual clinical expertise.
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Affiliation(s)
- Johannes Hauswaldt
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover.
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Kersting M, Gierschmann A, Hauswaldt J, H.-Pradier E. Routinedaten aus hausärztlichen Arztinformationssystemen – Export, Analyse und Aufbereitung für die Versorgungsforschung. Gesundheitswesen 2010; 72:323-31. [DOI: 10.1055/s-0030-1249689] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hauswaldt J, Kersting M, Hummers-Pradier E. [Influenza vaccination by Lower Saxonian general practitioners - a secondary analysis of physicians' data from 1995/1996, 2002/2003, and 2005/2006]. Gesundheitswesen 2010; 72:332-9. [PMID: 20440676 DOI: 10.1055/s-0030-1249690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vaccination against infection with human influenza virus is considered to be one of the most effective preventive measures available, especially when complications such as hospitalisation or death and indirect costs from off-work are considered. General practice is the preferable place for annual influenza vaccination because here the elderly and those endangered from bad health conditions are cared for frequently and regularly. The aim of this study was to find out the frequencies of influenza vaccination by Lower Saxonian contract physicians during three time periods with special respect to patients of older age or at risk. Data from two sources of health-care service have been analysed, namely from the contract physicians' union of Lower Saxony with all physicians vaccinating against influenza in the winter seasons of 1995/1996, 2002/2003, and 2005/2006, and from direct access to the electronic practice record system of 79 general practices via the BDT software data interface. Contract physicians, of whom more than 90 % are general practitioners, from Lower Saxony, vaccinate patients of the statutory health insurance against influenza in markedly increasing numbers, since 1995/1996 and 2002/2003 up to 2005/2006. Those over sixty years old or at high risk from bad health conditions are vaccinated up to seven-fold more frequently, compared to other patients. Influenza vaccination coverage rates (VCRs) are significantly higher in small and in medium-sized practices, compared to those with many patients. Nevertheless, influenza VCRs in Lower Saxony are not yet as high as would be necessary or desirable when compared internationally. Secondary analysis of aggregated health service data revealed inconsistencies in the primary material on cross-checking and validating, probably being caused during the external process of data aggregation and anonymisation. Also major systematic obstacles were found in the subsequent process of analysis. Nevertheless, fundamental results have been produced and are valid for all statutory health insured Lower Saxonians. Data from direct access to electronic practice records allowed for a deeper and multi-faceted insight into 101 928 patients of the same population, limited by the possibility of selection bias ('convenience sample'). Secondary analysis of health service data from different sources and their cross-check comparison is possible and successful. It is important to inform and involve the holder of the primary data extensively, following the guide lines of "good practice secondary data analysis".
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Affiliation(s)
- J Hauswaldt
- Institut für Allgemeinmedizin der Medizinischen Hochschule Hannover.
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Hauswaldt E, Hauswaldt J. German remuneration system for out-patient medical services. Eur J Gen Pract 2005; 11:37-8. [PMID: 15841067 DOI: 10.3109/13814780509178019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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