Design, Development, and Evaluation of an Automated Solution for Electronic Information Exchange Between Acute and Long-term Postacute Care Facilities: Design Science Research

BACKGROUND

Information exchange is essential for transitioning high-quality care between care settings. Inadequate or delayed information exchange can result in medication errors, missed test results, considerable delays in care, and even readmissions. Unfortunately, long-term and postacute care facilities often lag behind other health care facilities in adopting health information technologies, increasing difficulty in facilitating care transitions through electronic information exchange. The research gap is most evident when considering the implications of the inability to electronically transfer patients' health records between these facilities.

OBJECTIVE

This study aimed to design and evaluate an open standards-based interoperability solution that facilitates seamless bidirectional information exchange between acute care and long-term and postacute care facilities using 2 vendor electronic health record (EHR) systems.

METHODS

Using the design science research methodology, we designed an interoperability solution that improves the bidirectional information exchange between acute care and long-term care (LTC) facilities using different EHR systems. Different approaches were applied in the study with a focus on the relevance cycle, including eliciting detailed requirements from stakeholders in the health system who understand the complex data formats, constraints, and workflows associated with transferring patient records between 2 different EHR systems. We performed literature reviews and sought experts in the health care industry from different organizations with a focus on the rigor cycle to identify the components relevant to the interoperability solution. The design cycle focused on iterating between the core activities of implementing and evaluating the proposed artifact. The artifact was evaluated at a health care organization with a combined footprint of acute and postacute care operations using 2 different EHR systems.

RESULTS

The resulting interoperability solution offered integrations with source systems and was proven to facilitate bidirectional information exchange for patients transferring between an acute care facility using an Epic EHR system and an LTC facility using a PointClickCare EHR system. This solution serves as a proof of concept for bidirectional data exchange between Epic and PointClickCare for medications, yet the solution is designed to expand to additional data elements such as allergies, problem lists, and diagnoses.

CONCLUSIONS

Historically, the interoperability topic has centered on hospital-to-hospital data exchange, making it more challenging to evaluate the efficacy of data exchange between other care settings. In acute and LTC settings, there are differences in patients' needs and delivery of care workflows that are distinctly unique. In addition, the health care system's components that offer long-term and acute care in the United States have evolved independently and separately. This study demonstrates that the interoperability solution improves the information exchange between acute and LTC facilities by simplifying data transfer, eliminating manual processes, and reducing data discrepancies using a design science research methodology.

The SSTeP-KiZ System-Secure Real-Time Communication Based on Open Web Standards for Multimodal Sensor-Assisted Tele-Psychotherapy

In this manuscript, we describe the soft- and hardware architecture as well as the implementation of a modern Internet of Medical Things (IoMT) system for sensor-assisted telepsychotherapy. It enables telepsychotherapy sessions in which the patient exercises therapy-relevant behaviors in their home environment under the remote supervision of the therapist. Wearable sensor information (electrocardiogram (ECG), movement sensors, and eye tracking) is streamed in real time to the therapist to deliver objective information about specific behavior-triggering situations and the stress level of the patients. We describe the IT infrastructure of the system which uses open standards such as WebRTC and OpenID Connect (OIDC). We also describe the system's security concept, its container-based deployment, and demonstrate performance analyses. The system is used in the ongoing study SSTeP-KiZ (smart sensor technology in telepsychotherapy for children and adolescents with obsessive-compulsive disorder) and shows sufficient technical performance.

Design for a Modular Clinical Trial Recruitment Support System Based on FHIR and OMOP

The MIRACUM consortium is developing a Clinical Trials Recruitment Support System to support the data-driven recruitment of patients for clinical trials. The design of the prototype includes both open source solutions (OMOP CDM, Atlas) and open standards for interoperability (FHIR). The aim of the prototype is to create a patient screening list of potential participants for a clinical study. The paper shows the modular structure and functionality of the prototype building the foundation for the practical implementation of the CTRSS and, at the same time, demonstrating the use of open source solutions and standards for the development of clinical support systems.

Interoperable Open Specifications Framework for the Implementation of Standardized Urban Platforms

The current cities’ urban challenges go through digitalization and integration of new technologies under the perspective of actual and future ecological, as well as socio-economic commitments. This process is translated into the Open Standardized Urban Data Platform, which plays a pivotal role. Within its main functionalities, data ingestion, analytics and services as vertical domains become necessary to create more environmentally friendly cities. However, there still exist some deficits. Among them, openness and interoperability are outlined. On the one hand, there is a lack of open data initiatives for increasing the smart services stock. On the other hand, interoperability depends upon vendors and integrators, reducing the possibilities of Smart City growth. In this context, under the mySMARTLife project (GA #731297) umbrella, an Open Specifications Framework has been developed in order to address four main issues: (1) data interoperability; (2) services or verticals interoperability; (3) openness; and (4) replicability. It enlightens the implementation and integration of multiple city domains (like infrastructures, mobility, energy, buildings) for smart management and big-data analytics. Its applicability is demonstrated in the three lighthouse cities of the project, Nantes (France), Hamburg (Germany) and Helsinki (Finland).

Developing a theory of change for a community-based response to illegal wildlife trade

The escalating illegal wildlife trade (IWT) is one of the most high-profile conservation challenges today. The crisis has attracted over US$350 million in donor and government funding in recent years, primarily directed at increased enforcement. There is growing recognition among practitioners and policy makers of the need to engage rural communities that neighbor or live with wildlife as key partners in tackling IWT. However, a framework to guide such community engagement is lacking. We developed a theory of change (ToC) to guide policy makers, donors, and practitioners in partnering with communities to combat IWT. We identified 4 pathways for community-level actions: strengthen disincentives for illegal behavior, increase incentives for wildlife stewardship, decrease costs of living with wildlife, and support livelihoods that are not related to wildlife. To succeed the pathways, all require strengthening of enabling conditions, including capacity building, and of governance. Our ToC serves to guide actions to tackle IWT and to inform the evaluation of policies. Moreover, it can be used to foster dialogue among IWT stakeholders, from local communities to governments and international donors, to develop a more effective, holistic, and sustainable community-based response to the IWT crisis.

From Sensor to Observation Web with environmental enablers in the Future Internet

This paper outlines the grand challenges in global sustainability research and the objectives of the FP7 Future Internet PPP program within the Digital Agenda for Europe. Large user communities are generating significant amounts of valuable environmental observations at local and regional scales using the devices and services of the Future Internet. These communities’ environmental observations represent a wealth of information which is currently hardly used or used only in isolation and therefore in need of integration with other information sources. Indeed, this very integration will lead to a paradigm shift from a mere Sensor Web to an Observation Web with semantically enriched content emanating from sensors, environmental simulations and citizens. The paper also describes the research challenges to realize the Observation Web and the associated environmental enablers for the Future Internet. Such an environmental enabler could for instance be an electronic sensing device, a web-service application, or even a social networking group affording or facilitating the capability of the Future Internet applications to consume, produce, and use environmental observations in cross-domain applications. The term “envirofied” Future Internet is coined to describe this overall target that forms a cornerstone of work in the Environmental Usage Area within the Future Internet PPP program. Relevant trends described in the paper are the usage of ubiquitous sensors (anywhere), the provision and generation of information by citizens, and the convergence of real and virtual realities to convey understanding of environmental observations. The paper addresses the technical challenges in the Environmental Usage Area and the need for designing multi-style service oriented architecture. Key topics are the mapping of requirements to capabilities, providing scalability and robustness with implementing context aware information retrieval. Another essential research topic is handling data fusion and model based computation, and the related propagation of information uncertainty. Approaches to security, standardization and harmonization, all essential for sustainable solutions, are summarized from the perspective of the Environmental Usage Area. The paper concludes with an overview of emerging, high impact applications in the environmental areas concerning land ecosystems (biodiversity), air quality (atmospheric conditions) and water ecosystems (marine asset management).