E-Health and telemedicine concept of the children's health network of Eastern Bavaria
The ProKimedO project was dedicated to ensuring regional nationwide health care for children and young people in the Lower Bavarian part of Eastern Bavaria. As paediatric care in rural areas is facing increasing challenges, such as a lack of specialists, fluctuation of assistant doctors and increasing specialisation within the specialist area, special attention must be paid to the creation and guarantee of a continuity of content care by means of a coordinated trans-sectoral and inter-professional treatment path within a regional children's health network.
Against this background, the University of Passau, in direct cooperation with the Children's Hospital Dritter Orden Passau and its cooperation partners in telemedicine, has made an important contribution to guaranteeing care for children and young people close to home in the medium and long term. By combining modern information and communication technology, the following goals were achieved in the ProKimedO e-health project:
- Creating trans-sectoral treatment pathways and standards with focus on usability in a distributed system
- Development of a trans-sectoral knowledge database and communication platform including user interface for medical personnel (ProKimedO SPP)
- Teleconsulting system
Development of guidelines and patient (care) pathway
Guidelines and patient (care) pathway for paediatrics, the so-called medical standards, serve as orientation for doctors and make an important contribution to the continuous improvement of treatment processes and clinical procedures. The quality of the standards is of decisive importance. On the one hand, they must be kept concise and thus clearly and quickly comprehensible, on the other hand, they must be sufficiently detailed and correspond to the current state of the art in science. It is therefore crucial that the guidelines and patient pathways have a uniform structure and thus always have the same, easily recognizable structure. This makes it possible to implement the standards quickly and easily at a later date.
The ProKimedO Standard Procedure Platform (ProKimedO SPP) provides medical standards and procedures distributed over computer networks. Knowledge can thus be shared within the institution or, accessible via the Internet, across institutions. This enables doctors in rural areas in particular to benefit from the current and specialised knowledge of a large institution such as a clinic or medical faculty. ProKimedO SPP offers not only efficient knowledge dissemination but also a management system that improves the quality, timeliness and accuracy of standards and procedures through an integrated communication platform for physicians managing the standards and procedures.
ProKimedO is currently available to the staff of the Passau Children's Hospital and will soon also be available to the partners of the Eastern Bavaria Children's and Family Health Network (KiGo).
ProKimedO Teleconsoluting System
A teleconsulting system will also be integrated to support the discussion of treatment pathways, guidelines and knowledge base. For this purpose, a ticket-based communication solution will be implemented, through which specific questions on individual points can be processed.
Each communication thread can be assigned a category and a status. Participants in a discussion are given the opportunity to be informed by e-mail about new posts and changes in status. Furthermore, a discussed topic can be marked as closed.
The integrated search function helps the user to find questions that have already been solved and to avoid multiple discussions, thereby increasing the efficiency of problem solving.
Figure 1: Knowledge of a maximum care hospital is shared by ProKimedO-SSP with general practitioners or medical care centres. Inside the hospital, the quality assurance process or life cycle of a proposal to change a medical standard or procedure is presented.
The ProKimedO Standard Procedure Platform (ProKimedO SPP, P-SPP) provides medical standards and procedures distributed over computer networks. In addition to the efficient dissemination of knowledge, P-SPP also offers a management system that improves the quality, timeliness and accuracy of standards and procedures through an integrated communication platform for physicians managing the standards and procedures.
State of the Art
Large medical institutions (hospitals, medical faculties, etc.) manage medical standards and procedures, which are stored as files (usually in proprietary Word format) on a file server. Medical personnel can access them within the facility. This unifies diagnosis and treatment and shares knowledge. If an error is detected by an employee in a standard or procedure, the employee contacts the physicians responsible for this standard or procedure, for example in a personal conversation or by e-mail. The physicians responsible then decide on a possible change to the standard or procedure. If the time of validation of a standard or procedure is imminent, the administrative staff (secretariat) will inform the physicians responsible.
The following problems occur:
- Problem 1: Availability of standards and procedures requires computer system with special software
- Problem 2: Knowledge distribution is limited to institution
- Problem 3: Standards or procedures can be changed by anyone
- Problem 4: Time of validation is overlooked
- Problem 5: Employee turnover means that employees responsible for standards or procedures are no longer available, but are still managed as such
- Problem 6: Personal communication behaviour of individual employees determines the dissemination of knowledge
- Problem 7: Doctors are not notified of changes, only the default is changed
Distribution of Knowledge
Within an Institution
ProKimedO SPP is a distributed server-client application that is used via a browser. As a result, ProKimedO SPP can be used on a variety of devices (PC, mobile phone, tablet, etc.) and requires only a network connection and a browser as infrastructure. Thus the standards and procedures are easily available almost always and almost everywhere (problem 1).
If the ProKimedO SPP server is connected to the Internet, medical standards and procedures of a large medical institution (clinic, medical faculty, etc.) can be made available to other smaller institutions (practice for children, medical care centre, etc.) or individuals (pediatrician, parents, etc.). Thus the dissemination of knowledge is no longer limited to the institution (problem 2). This enables the smaller units to implement current changes in medical standards immediately in diagnostics and treatment.
Connecting the ProKimedO SPP server to the Internet also benefits the staff of the facility itself, as they can also access the standards and procedures outside the facility and outside working hours.
Users and Rights
ProKimedO SPP enables users with different access rights to be managed and special physicians to be given responsibility for standards and procedures. This ensures that only certain physicians can change certain standards and procedures. This excludes accidental or deliberate modification by persons not responsible for this standard or this procedure (problem 3).
ProKimedO SPP supports the administration in keeping track of which physicians are responsible for which standard or which procedure and when. ProKimedO SPP also automatically reminds the physician responsible of a time of validation that can be determined individually for each standard or procedure (problem 4). ProKimedO SPP has a user administration, so that standards or procedures are always assigned to an available employee and do not orphan (problem 5).
Platform of Communication
Medical standards and procedures are constantly changing. A single physician is hardly in a position to always be up to date in his field. In a large medical facility, several physicians under the guidance of experts (senior and chief physicians) monitor the quality, timeliness and accuracy of the standards and procedures available there. ProKimedO SPP combines the management system for standards and procedures with a standardized communication platform. Communication has been standardized so that suggestions for changes to standards and procedures on the platform can be viewed and commented on by specific user groups. This makes the communication and thought processes that lead to a change transparent and comprehensible for other physicians. Thus the dissemination of knowledge no longer depends on the communication behaviour of a single physician (problem 6). In addition, ProKimedO SPP allows physicians to specify the subject areas in which they want to be informed about changes in standards and procedures. These physicians are then informed immediately (problem 7). Changes in standards and procedures are also documented and archived at any time. This improves the quality, timeliness and accuracy of the standards.
Figure 1 shows schematically the standardized communication in ProKimedO SPP. Users with certain rights can create a change proposal (ticket). Until publication, the proposed amendment belongs exclusively and not publicly to this user. If the latter decides to publish the proposed amendment, it shall be forwarded to the physician responsible for the disease at the lowest level and published. Each user can now comment on the change proposal, but cannot change it himself. This can only be done by the responsible physician. This guarantees that only certain suitably qualified persons designated by the management of the institution make changes to the standard or procedure during the review phase. The physician primarily responsible for a standard or procedure can discard, save or validate the change proposal in the archive. In contrast to vidieren, the date of the last vidierung of a standard or procedure is not changed when saving.
Example: Nurse Mr. Niedermeier discovers an alleged error in a standard. He creates a change proposal. At first, this can only be viewed by the user himself. Mr. Niedermeier studies the relevant literature over the next few days and gradually improves his proposed amendment. He justifies his amendment proposal in detail with the help of the comment function. Finally, he is satisfied with his proposed change and assigns it to Dr. Untermeier, who is responsible for this standard at the lowest level. Dr. Untermeier studies the proposed change and can now discard it in the archive or forward it to Prof. Dr. Obermeier, the chief physician mainly responsible for this standard. Dr. Untermeier makes a correction, comments on it and assigns the proposed amendment to Prof. Dr. Obermeier. While he is working on the change proposal, other employees comment on the change proposal. Prof. Dr. Obermeier now has the possibility to discard the proposed change in the archive, to reject it back to Dr. Untermeier, to save it or to validate it. When you save or validate, the proposed change becomes the new standard and the old standard is discarded to the archive. Mr. Niedermeier, Dr. Untermeier and all interested parties can understand through the comments why a standard was changed or an amendment proposal was rejected.
ProKimedO Teleconsoluting System
The ProKimedO Teleconsoluting System is a teleconsoluting system for medical personnel.