Interoperability Maturity Model: Orchestrator Tool for Platform Ecosystems

The orchestration of platform ecosystems is becoming increasingly complex due to the growing number of players, complementary services and technological innovations. Interoperability is an important prerequisite for convincing customer journeys as well as functional and quality-assured data exchange and offers increasing potential for automation, especially with the help of machine learning or artificial intelligence. The interoperability maturity model developed in this study can be used as a conceptual framework to measure the interoperability of current and future platform ecosystem components and complements. The model, developed as an artifact of design science research, was evaluated using an iterative approach with orchestrators of health data platforms and their ecosystem. The results suggest that it can contribute to achieving and sustaining integrated value chains with multiple actors and diverse technologies, and can be used to assess the interoperability of care chains (e.g., care scenarios such as diabetes or cardiac insufficiency) and guide future interoperability considerations

The Emergence and Dynamics of Electronic Health Records – A Longitudinal Case Analysis of Multi-Sided Platforms from an Interoperability Perspective

Emerging health record platforms are interesting examples of the ongoing process of digitalization and the great opportunities they provide for innovation and additional services. Incumbent players are under increasing pressure from new entrants to offer their customers a user experience they have become familiar with through platforms such as Apple and Google. The emergence of the digital German health record is shown as a case-study, harnessing a longitudinal database and adopting a process-sensitive perspective. Important events are structured into individual episodes and phases and discussed in-depth. The study shows how platform owners of health records respond to changes in the highly regulated healthcare system and its digitalization in Germany. Contrasting with extant knowledge about interoperability as a relevant precondition for platforms, our study shows the important role played by interoperability as a design parameter for emerging platforms, which results in seven interoperability challenges for respective stakeholders

Enabling Data-Driven Mobility Research: Design Principles and Design Features for an Open Platform Approach

In the field of mobility research, up-to-date data are needed in order to explore current problems and challenges. Proponents of Open Science argue that research data should be Findable, Accessible, Interoperable, and Reusable (FAIR). Adopting the Design Science Research methodology, we derive design requirements, design principles and design features for a suitable platform to realize the FAIR principles, based on a literature review, existing solutions, and interviews with mobility researchers (with qualitative and quantitative research backgrounds). In a practical way, and after an evaluation of our prototype, we show how a platform should be designed to allow users, regardless of their level of experience, to participate. We contribute to the discussion in the field of Open Science on how artifacts should be designed according to an open design, which also takes into account the different needs of researchers

FUTURE-ORIENTED AND PATIENT-CENTRIC? A QUALITATIVE ANALYSIS OF DIGITAL THERAPEUTICS AND THEIR INTEROPERABILITY

This paper focuses on the integration of digital therapeutics (DTx) into future-oriented and patient-centric care pathways. Based on a workshop series and problem-centered interviews in Germany, the current state-of-the-art of regulatory and technical integration of DTx was mapped as a landscape of DTx interoperability. The results focus on key interfaces of DTx, namely with Electronic Health Records (EHRs), devices, and other digital health innovations such as telemedicine, and highlight current challenges and potentials for future development. On a broader level, the results point to unresolved issues of care coordination, the optional role of the EHRs as regulated platforms for care, and the importance of integrating DTx data into public data spaces for research

How to turn the Fast-Track into a Fast-Track: Process integration for evaluation of the quality of Digital Health Applications (DiGAs) on the example of the German Fast-Track Process

In this paper, we address the research question of which integration points in the \textit{German Fast-Track process} are particularly well suited for the integration of evaluation platforms for digital health applications. For this purpose, possible integration points are first identified and then analyzed with the help of a utility analysis with regard to the posed research question. Finally, a recommendation for action is made based on the results of the conducted utility analysis

Preparing for patients with high-consequence infectious diseases: Example of a high-level isolation unit

Introduction: Patients with high-consequence infectious diseases (HCID) are rare in Western Europe. However, high-level isolation units (HLIU) must always be prepared for patient admission. Case fatality rates of HCID can be reduced by providing optimal intensive care management. We here describe a single centre’s preparation, its embedding in the national context and the challenges we faced during the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic. Methods: Ten team leaders organize monthly whole day trainings for a team of doctors and nurses from the HLIU focusing on intensive care medicine. Impact and relevance of training are assessed by a questionnaire and a perception survey, respectively. Furthermore, yearly exercises with several partner institutions are performed to cover different real-life scenarios. Exercises are evaluated by internal and external observers. Both training sessions and exercises are accompanied by intense feedback. Results: From May 2017 monthly training sessions were held with a two-month and a seven-month break due to the first and second wave of the SARS-CoV-2 pandemic, respectively. Agreement with the statements of the questionnaire was higher after training compared to before training indicating a positive effect of training sessions on competence. Participants rated joint trainings for nurses and doctors at regular intervals as important. Numerous issues with potential for improvement were identified during post processing of exercises. Action plans for their improvement were drafted and as of now mostly implemented. The network of the permanent working group of competence and treatment centres for HCID (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger (STAKOB)) at the Robert Koch-Institute (RKI) was strengthened throughout the SARS-CoV-2 pandemic. Discussion: Adequate preparation for the admission of patients with HCID is challenging. We show that joint regular trainings of doctors and nurses are appreciated and that training sessions may improve perceived skills. We also show that real-life scenario exercises may reveal additional deficits, which cannot be easily disclosed in training sessions. Although the SARS-CoV-2 pandemic interfered with our activities the enhanced cooperation among German HLIU during the pandemic ensured constant readiness for the admission of HCID patients to our or to collaborating HLIU. This is a single centre’s experience, which may not be generalized to other centres. However, we believe that our work may address aspects that should be considered when preparing a unit for the admission of patients with HCID. These may then be adapted to the local situations.Peer Reviewe

Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. METHODS: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. RESULTS: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. CONCLUSION: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches

Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study

Abstract Background General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. Methods We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. Results The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36–40 mmHg (4.8–5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO2 target of 30–35 mmHg (4–4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). Conclusions Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome