The nephrology eHealth-system of the metropolitan region of Hannover for digitalization of care, establishment of decision support systems and analysis of health care quality

Background Even though a high demand for sector spanning communication exists, so far no eHealth platform for nephrology is established within Germany. This leads to insufficient communication between medical providers and therefore suboptimal nephrologic care. In addition, Clinical Decision Support Systems have not been used in Nephrology until now. Methods The aim of NEPHRO-DIGITAL is to create a eHealth platform in the Hannover region that facilitates integrated, cross-sectoral data exchange and includes teleconsultation between outpatient nephrology, primary care, pediatricians and nephrology clinics to reduce communication deficits and prevent data loss, and to enable the creation and implementation of an interoperable clinical decision support system. This system will be based on input data from multiple sources for early identification of patients with cardiovascular comorbidity and progression of renal insufficiency. Especially patients will be able to enter and access their own data. A transfer to a second nephrology center (metropolitan region of Erlangen-Nuremburg) is included in the study to prove feasibility and scalability of the approach. Discussion A decision support system should lead to earlier therapeutic interventions and thereby improve the prognosis of patients as well as their treatment satisfaction and quality of life. The system will be integrated in the data integration centres of two large German university medicine consortia (HiGHmed (highmed.org) and MIRACUM (miracum.org)). Trial registration ISRCTN16755335 (09.07.2019)

A privacy-preserving design for sharing demand-driven patient datasets over permissioned blockchains and P2P secure transfer

Sharing patient datasets curated by health institutions is critical for the advance of monitoring, surveillance and research. However, patient data is sensitive data and it can only be released under certain conditions and with previous explicit consent. Privacy preserving data sharing provides techniques to distribute datasets minimizing the risk of identification of patients. However, the sharing of datasets is typically done without considering the needs or requests of data consumers. Blockchain technologies provide an opportunity to gather those requests and share and assemble datasets using privacy-preserving methods as data and requirements on anonymity match. The architecture and design of such a solution is described, assuming an underlying permissioned blockchain network where providers such as healthcare institutions deal with consent, patient preferences and anonymity guarantees, playing a mediator role to a network of organizations