MS

thesisTo conduct clinical research, data are needed from the clinical routine. Due to the complexity of today's Healthcare Information Systems (HIS), clinical researchers oftentimes struggle finding relevant information. As part of the reengineering efforts of the clinical data warehouse towards a translational enterprise data warehouse, a general methodology is developed to describe the complexity of current HIS in all domains, to guide researchers with a clinical questions to the dta they need, and thus to increase accessibility of clinical data for research. An information-requirements analysis was conducted with clinical researchers and data warehouse experts in the domain of pharmacy as groundwork for a new translational meta-model. The results of this analysis were used adapt the strategic HIS management meta-model 3LGM2 and to implement it into the domain of pharmacy. The new translational meta-model consists of a domain-, a logical tool-, and a data description-layer with interlayer relationships. Two further layers, added in a perpendicular way give information about access and quality. This meta-model is implemented as a Web-based solution, providing modeling and browsing functionality. The presented translation meta-data solution shows a promising approach to the problem of clinical data access in research. Further research in needed to prove its applicability and usefulness in the daily routine

Referenzmodell für die Kommunikation eines Universitätsklinikums mit dem niedergelassenen Bereich

Das traditionell gewachsene System der deutschen Gesundheitsversorgung gliedert sich in den stationären und niedergelassenen Bereich. Stand der Technik ist es in beiden Bereichen die Vorteile der elektronischen Verarbeitung der Patientendaten zu nutzen. Defizite gibt es jedoch bei der elektronischen Kommunikation zwischen den beiden Teilbereichen. Dies liegt zum einen an der komplexen Gesetzeslage, zum anderen an den vielfältigen Anforderungen einer technischen Umsetzung der sektorübergreifenden Kommunikation. Hier setzt die vorliegende Arbeit an, indem ein Katalog für die gesetzlichen, technischen und ökonomischen Anforderungen erstellt wird. Für den elektronischen Datenaustausch gibt es zahlreiche etablierte Verfahren, wie z.B. die E-Mail-Kommunikation. Es werden einige weit verbreitete aber auch speziell auf die Gegebenheiten des deutschen Gesundheitswesens zugeschnittene Verfahren vorgestellt und den Anforderungen gegenübergestellt. Ziel der Untersuchung ist die Ermittlung eines anforderungskonformen Verfahrens. Die auf diese Weise gewonnenen Erkenntnisse werden bei der Erstellung eines Referenzmodells für die Kommunikation zwischen stationären und ambulanten Bereich genutzt. Dabei wird ein schrittweises Vorgehen verfolgt. Zunächst werden mit UML Use Case Diagrammen Anwendungsfälle analysiert. Anschließend werden mit Hilfe von Sequenzdiagrammen die Kommunikationsprozessabläufe modelliert. Alle Erkenntnisse münden in der Erstellung eines Drei-Ebenen-Modells. Das 3LGM2-Referenzmodell soll dem Informationsmanager in einem Krankenhauses bei der Modellierung des Informationsflusses zwischen den Einrichtungen des Gesundheitswesens unterstützen

Transinstitutional information management in health care networks: requirements and methods

Die koordinierte Zusammenarbeit zwischen medizinischen Leistungserbringern, Organisationen des Gesundheitswesens und Systemsektoren ist ein wichtiger Faktor für die Qualität und Effizienz der Versorgung insgesamt. In Deutschland, wie auch in anderen Ländern nehmen daher die Bestrebungen zu, die organisatorischen Grundlagen für die die einrichtungsübergreifende Zusammenarbeit durch die Bildung von Gesundheitsnetzwerken zu verbessern. Transinstitutionelle Informationssystemarchitekturen werden als eine zentrale Voraussetzung für die Realisierung eines patientenzentrierten Versorgungsparadigmas betrachtet. Es ist unklar, wie transinstitutionelle Systeme angesichts der teilweise divergierenden Interessen von Gesundheitsnetzwerkmitgliedern systematisch geplant, gesteuert und überwacht werden können. Eine Ursache hierfür liegt in fehlenden Ansätzen der systematischen Ermittlung von Faktoren, die das Informationsmanagement in Gesundheitsnetzwerken beeinflussen sowie in der Schwierigkeit, diese Einflüsse strukturiert zu beschreiben. In dieser Arbeit werden daher zunächst die relevanten Forschungsergebnisse der Netzwerkforschung aufgearbeitet. Hierbei wird der Fokus auf die Probleme gelegt, die sich aus der Koexistenz von Eigenständigkeit und Kooperation ergeben, gelegt. Darauf aufbauend wird eine Studie konzipiert, durchgeführt und ausgewertet, deren Ziel in der Ermittlung von Umsetzungsbarrieren des einrichtungsübergreifenden Informationsmanagements liegt. Es wird das integrierte Ordnungssystem für Gesundheitsnetzwerke (DIOGEN) vorgestellt. Dies ist ein Ordnungssystem, welches ermöglicht, Gesundheitsnetzwerke anhand der Hauptmerkmale Netzwerkstruktur, Netzwerkmanagementsystem, Versorgungssystem, transinstitutionelles Informationssystem sowie Netzwerkphase, zu charakterisieren. Die Bedeutung der Zentralität des transinstitutionellen Informationsmanagements sowie daraus resultierender einrichtungsübergreifender Abhängigkeiten ist ein weiterer Schwerpunkt dieser Arbeit.The rapid advancement of medical knowledge and technologies for preventive, diagnostic and therapeutic interventions are leading to increasing functional und organizational differentiation in modern health care systems. Appropriate coordination of health care activities between professionals, health organizations and system sectors is conceived as a key requirement for efficient and effective health care. In Germany, as well as in other countries, efforts have emerged to improve transinstitutional cooperation by the means of health care networks. Transinstitutional information system architectures are playing a vital role in implementing the patient-centered care paradigm. It is not clear how can transinstitutional information systems be planned, steered and controlled systematically against the background of the legal autonomy and potentially conflicting interests of participating actors. In order to develop adequate methods of transinstitutional information management, factors that influence information management in health care networks have to be identified and described systematically. Hence, the first goal of this thesis is to review relevant literature from the field of network research, in particular with respect to the complexity that arises from the coexistence of autonomy and cooperation in health care networks. A study is presented that aims at identifying barriers of transinstitutional information management in health care networks. An integrated description framework for health care networks (DIOGEN) is presented. It characterizes health care networks by the dimensions network structure, network management system, care system, transinstitutional information system and network phase. One important focus of this thesis lies on interorganizational dependencies that arise from centralized transinstitutional information management. An approach for modeling and quantifying centrality is developed

Designing a reference architecture for health information systems

Background: Healthcare relies on health information systems (HISs) to support the care and receive reimbursement for the care provided. Healthcare providers experience many problems with their HISs due to improper architecture design. To support the design of a proper HIS architecture, a reference architecture (RA) can be used that meets the various stakeholder concerns of HISs. Therefore, the objective of this study is to develop and analyze an RA following well-established architecture design methods. Methods: Domain analysis was performed to scope and model the domain of HISs. For the architecture design, we applied the views and beyond approach and designed the RA's views based on the stakeholders and features from the domain analysis. We evaluated the RA with a case study. Results: We derived the following four architecture views for HISs: The context diagram, decomposition view, layered view, and deployment view. Each view shows the architecture of the HIS from a different angle, suitable for various stakeholders. Based on a Japanese hospital information system study, we applied the RA and derived the application architecture. Conclusion: We demonstrated that the methods of the software architecture design community could be used in the healthcare domain effectively and showed the applicability of the RA. 2021, The Author(s).Scopus2-s2.0-8510966531

An architectural concept for implementing the socio-technical workflow of Digital Pathology in Chile

Virtual Microscopy opens up the possibility to remotely access high quality images at large scales for scientific research, education, and clinical application. For clinical diagnostics, Digital Pathology (DP) presents a novel opportunity to reduce variability [Bauer et al., 2013] due to the reproducible access to Whole Slide Imaging, quantitative parameters (e.g. HER2 stained membrane) [Al-Janabi et al., 2012], second opinion and Quality Assurance [Ho et al., 2013]. Despite of the mentioned advantages, the challenge remains to incorporate DP into the pathologists workflow within a heterogeneous environment of systems and infrastructures [Stathonikos et al., 2013]. Different issues must be solved in order to optimize the impact of DP in the daily clinical practice [Daniel et al., 2012] [Ho et al., 2006]. The integration needs precise planning and comprehensive evaluation for adopting this technology [Stathonikos et al., 2013]. This thesis will focus on an organizational development approach based on a Socio-Technical System (STS). The socio-technical approach covers: (i) the technical issue: tissue-scanner, NDP.view, NDP.serve, analysis software, and (ii) the social issue: pathologists, technicians. In order to improve the integration, a joint optimization (of i and ii) is necessary. The developed STS approach will optimize the integration of DP towards improved workflows in clinical environments. The improved workflows will reduce the pathologists turnaround time, improve the certainty of the diagnostics, and provide a more effective patient care within the covered institutions. An overt multi-site Participatory Observation, Questionnaires, and Business Process Modelling Notation will be used to analyse the existing pathological workflows. Based on this, the system will be modelled with the 3lgm2 Toolkit [Winter et al., 2007] under consideration of various technical subsystems that are present in the clinical environment. Afterwards, the interfaces between subsystems and its possible interoperabilities will be evaluated, taking into account the different existing standards and guidelines for image processing and management, as well as business processes in DP. In order to analyse the existing preconditions a questionnaire will be evaluated to establish a robust and valid view. In addition, the overt participatory observation will support this elevation, giving a deeper insight on the social part. This observation also covers the technical side including the whole pathological process. The socio technical model will then reveal measurable potential for optimization with incorporated DP (e.g. higher throughput for slides). The organizational development approach consists of a Socio-Technical System based on overt multi-site participatory observations, questionnaires, business process modelling and 3LGM2, will optimize the use of Digital Pathology in the daily clinical practice and raise the acceptance to incorporate integrate the new technology within the dayly workflow through the user centred process of incorporation. • Perform and evaluate a questionnaire and a participant observation of pathologists work days in private & public institutions • Create and evaluate a 3lgm2 model • Model the current pathological process (viewpoint of pathologist & technical assistant) & perform and evaluate a contextual inquiry to elevate the pathologists requirements & expectations towards the system • Test the future WF according the model parameters. This project will detect unsuspected interrelations and interdependencies within the socio- technical workflow with a pathology laboratory. The observation will reveal the action conformity as well as the environment in which the process has to be embedded. Furthermore it will establish an optimized workflow for a specific clinical environment to prepare the implementation of DP. Additionally it will be possible to quantify digitized images in order to improve decision making and lastly to improve patient care. In the future it will be possible to extend automated image analysis in order to support clinical decision support. Depending on acceptance, this can lead towards an automated clinical decision support for cases with low complexity

Informationsverarbeitung im Informationsmanagement : Modellierung von Aufgaben und verarbeiteten Informationen am Beispiel der Information Technology Infrastructure Library (ITIL)

Das Informationsmanagement im Gesundheitswesen entwickelt Informationssysteme von Krankenhäusern und medizinischen Organisationen weiter. Dazu benötigt es Informationen, die ihm von Informationsmanagement-Informationssystem (IMIS) bereitgestellt werden. Das IMIS muss ebenfalls zielgerichtet weiterentwickelt werden. Die Grundlage für die Bewertung und Konstruktion eines IMIS ist ein Modell der Aufgaben und verarbeiteten Informationen im Informationsmanagement. Der Autor entwickelt eine Formalisierung der Informationsverarbeitung und darauf aufbauend Kriterien für Modelle der Informationsverarbeitung im Informationsmanagement im Gesundheitswesen sowie Modellierungsregeln und ein Vorgehen zur Modellierung. Die Angemessenheit der entwickelten Formalisierung und der Kriterien, der Regeln und des Vorgehens zeigt der Autor mit der Modellierung der Informationsverarbeitung in den neun Kernprozessen der Information Technology Infrastructure Library (ITIL), einer Sammlung von Empfehlungen für das Management von IT-Dienstleistungen. Aufbauend auf einer erweiterten Version dieses Modells kann ein IMIS für das Gesundheitswesen konstruiert werden

Reclaimed asphalt pavement with waste frying oil and crumb rubber

The application of Reclaimed Asphalt Pavement (RAP) has become a relatively standard material in the road industry in most countries. However, some of the problems associated with the addition of RAP to asphalt mixtures are the increase in moisture and cracking damage. The addition of rejuvenators into the recycled mixture containing RAP is also needed to enhance its performance although the rutting resistance remains a major issue. Therefore, there is a need to investigate the incorporation of other materials in the design of the asphalt mixture to achieve improved properties and better performance. This study was carried out to investigate the performance of the recycled asphalt mixture that consists of the conventional asphalt binder with 60/70 penetration grade, 25% and 40% RAP, and the incorporation of waste materials comprising 2.6% and 4.7% Waste Frying Oil (WFO) as the rejuvenator and 1.5% Crumb Rubber (CR) with sieve size of 0.15 mm as the modifier. The study was divided into three stages, namely evaluation of material properties, analysis of the asphalt binder properties, and determination and analysis of the asphalt mixture performance. Based on the results, the addition of 25% and 40% RAP in the asphalt mixture along with WFO and CR lowered the Indirect Tensile Strength (ITS) by 31.1% and 47.3%, respectively, which fulfilled the requirement of the ITS ratio test. The resilient modulus pattern for the recycled asphalt mixture containing WFO and CR was identical at 25 and 40 °C. When tested at 40 °C, the 25% and 40% RAP with incorporated WFO and CR generated a significant resilient modulus of 848 and 901 MPa, respectively. The recycled asphalt mixture with WFO and CR also exhibited a lower permanent strain than that of the virgin asphalt binder. The rutting values of all asphalt mixtures in the wheel tracking test demonstrated a similar pattern at 45 and 60 °C test temperatures. The rutting resistance of the recycled asphalt mixture with WFO and CR slightly improved compared to the virgin asphalt binder at 60 °C. Therefore, the incorporation of WFO and CR has a considerable influence on the RAP performance while preserving the environment and reducing pollution through the recycling of waste materials