Workshop within the gmds 2008 session in Stuttgart

The 53rd annual session of the German Medical Documentation Society  (gmds) is being held in cooperation with the State Health Office of the German federal state of Baden-Württemberg.

The Society's proclaimed goal is to build a bridge from medical information science, biometrics and epidemiology to medical technology.
More information at: www.gmds2008.de

Lecture presented to the gmds 2008 session

The 53rd annual session of the German Medical Documentation Society  (gmds) is being held in cooperation with the State Health Office of the German federal state of Baden-Württemberg.

The Society's proclaimed goal is to build a bridge from medical information science, biometrics and epidemiology to medical technology.
More information at: www.gmds2008.de

A key feature of the solution is the ability to leverage an organization’s existing infrastructure. Darryl Low, president of MZIHC comments, “Our partnership with ICW allows us to offer a viable solution to the problem of connectivity for system-wide network communications that allows the creation of consolidated electronic patient records, simplifying administrative and medical processes for physicians.”

A defining characteristic of ICW’s solution is its flexibility in aggregating data from EZ‑CAP along with other data sources such as pharmacies, laboratories, hospitals, and physicians offices, and providing core information in the form of an electronic patient record.

Jeremy Coote, CEO of ICW Inc., notes, “Connectivity and the ability to deliver true interoperability are critical factors in the success of this partnership. By combining the EZ‑CAP platform and ICW solutions, we can deliver relevant data to all stakeholders in the care continuum, when and where it is needed. Moreover, our customers will have an extendable platform, ready for the integration of value-added applications.”

ICW has recently implemented its interoperable solution at an existing EZ‑CAP customer in southern California.

Download press release about EZ-CAP and ICW

How does the new Diabetes Risk Management System work?

The Diabetes Risk Management System consists of various software solutions offered by ICW and Accu-Chek blood glucose measurement devices provided by Roche Diagnostics. The components of the risk management system automate data flow and documentation and thus facilitate diabetes management that conforms to current treatment guidelines.

During the course of the study, ICW will provide patients with the personal health record LifeSensor®. Roche Diagnostics will supply patients with blood glucose meters (Accu-Chek® Aviva and the information management system Accu-Chek® SmartPix) free of charge. On a regular basis, patients will measure their blood glucose values at home. Via Accu-Chek SmartPix they will be able to analyze easy-to-understand blood glucose graphs and statistics on their personal computers.

The Roche Diagnostics glucose meters can save up to 400 values. At the patient’s next consultation, these data will be transferred to a physician’s computer and uploaded to the CDM Diabetes Monitor, a software solution based on ICW’s Care and Disease Manager application. The CDM Diabetes Monitor improves management of diabetes patients in the primary care study setting.

In addition to blood glucose data, the CDM Diabetes Monitor collects further information relevant for diabetes patients including basic parameters such as blood pressure, weight, waist and hip size. Moreover, laboratory blood test results are also collected. These data are then transferred via an integrated interface to Roche Diagnostics where it is processed into an Accu-Chek® Mellibase risk report. Based on the patient’s individual health status, the risk report provides him or her with a 10-year risk prognosis of developing complications related to diabetes. The report also explains how this risk can be reduced by optimizing the patient’s diabetes care. This information constitutes the basis for a decision-making process that focuses on the patient’s unique health situation.

The Accu-Chek Mellibase report is made available to physicians via the CDM Diabetes Monitor. Likewise, the report will also be stored in patient’s personal LifeSensor record.

Study design

The study is a prospective, randomized and controlled intervention study. In total 1,200 patients with type 2 diabetes will be recruited. These patients range in age between 38 and 68 years. Twenty-four primary care physicians and one specialist will also participate in the study. The research project is scheduled to be completed within 2 years. During the study period, patients will have at least four health check visits at six months intervals.

The concept for the CDRM research project was designed by the Department of Epidemiology at the University of Groningen, the Netherlands in cooperation with the Institute of Medical Sociology and Social Medicine at the Philipps University Marburg, Germany. For further information on the scientific evaluation, please visit the study's homepage.

Diabetes type 2 and secondary prevention

About 90 percent of diabetes patients suffer from type 2 diabetes. Older individuals are particularly affected by type 2 diabetes. However, in recent years, an increasing number of young people and children are afflicted by the disease. When suffering from type 2 diabetes, the body’s cells become more resistant to the effects of insulin. Blood glucose can no longer be transported to the somatic cells in sufficient amounts. Risk factors for type 2 diabetes include obesity and sedentary lifestyles.

Diabetes patients have an increased risk for heart attacks, strokes, diabetes related kidney or eye disease and limb amputations. This is why an integrated treatment approach that considers all relevant risk factors is vital when providing good diabetes care. 

Download press release about diabetes risk management

At the start of the program, participants had the opportunity to undergo a variety of health and fitness tests and enter the results into their own Web-based, LifeSensor personal health record provided by InterComponentWare AG (ICW), the Walldorf-based eHealth specialist. At the conclusion of the program the tests were repeated. This meant that any changes could be graphically displayed in the LifeSensor personal health record, and participants were able to get a quick overview of their training progress.

In a survey conducted afterward, most of the city's employees found the personal health record to be useful. The opinions of participants about the comprehensive and detailed documentation of their own health and fitness data were especially positive. The digital exchange of data between physicians and other health and fitness experts was made possible thanks to LifeSensor - another big plus for many of the city's workers. Particular praise was also given for the ability to provide emergency data in the personal health record, just in case.

The success of this preventative health program is having an encouraging effect: Two thirds of the city's employees want to continue with the program and will be keeping themselves fit at the Pfitzenmeier Wellness & Fitness Park. In order to continue to get the best possible support from physicians and fitness experts, they will be continuing to document their health data in their LifeSensor. "I am glad that so many of our employees participated in this preventative program and want to continue with it. Comprehensive coaching and individual encouragement enabled each participant to influence his or her health and wellbeing more actively”, says Dr. René Pöltl, the city of Schwetzingen's deputy mayor.

The initiators of this preventative health program were the Schwetzingen city government, the Rhine-Neckar Health Initiative, the Schwetzingen Medical Network and the Pfitzenmeier Wellness & Fitness Park.

Download press release about the city that moves

Contact City of Schwetzingen

Press Office
Wolfgang Leberecht
Tel.: +49 (0) 6202 87 105
wolfgang.leberecht@schwetzingen.de

The program’s purpose is to produce improved patient outcomes by centralizing specialized, intense case management for chronically ill patients. Studies have shown that telemonitoring of CHF patients increases the patient’s quality of life and can reduce care delivery costs by avoiding unnecessary emergency room visits and hospitalizations.

ICW’s DCS will manage and securely distribute information to and from the medical devices in the patient’s home. ICW’s PXS serves as the interoperability platform for Coventry’s internal and external networks.  The PXS facilitates the seamless and secure exchange of information between disparate systems both inside and outside of the Coventry umbrella of healthcare services.

Dr. Vishu Jhaveri, Executive Vice President and Chief Medical Officer for
Coventry Health Care, and Executive Sponsor for the program, notes: “We hope to develop specialized intense care management methodologies that bring proven results to patients, providers and health plans. We can’t accomplish these goals without exceptional technology. ICW’s ten-year experience with providing proven eHealth solutions, along with their experience with other cardiac care projects, makes them the obvious partner for Coventry’s new program.”

ICW is involved with two large-scale cardiac care projects in Europe: The Partnership for the Heart, a telemedicine collaborative with Charité university hospital, and AOK Plus, a health plan-driven telemedicine project for serious CHF patients in the German state of Saxony.

Jeremy Coote, CEO of InterComponentWare Inc., adds: “The alignment of patient, provider and case manager is greatly improved by a truly interoperable technology platform capable of sharing data from a multitude of source systems.  ICW has provided these solutions both within the U.S. and Europe with notable success and looks forward to working closely with Coventry as they launch this revolutionary program.”

Download press release about Coventry Health Care and ICW

The performance test scenario did not just simulate access by 10,000 virtual users to a database consisting of 10 million personal health records, but also by 20,000 doctors and pharmacists. While patients, for example, enter health information relating to their most recent medical appointments or create new appointments, doctors process larger amounts of data when synchronizing their patients' personal health records with their own local patient documentation systems. Peak loads during the performance benchmark showed that up to 700 simultaneous record accesses were possible, system performance remaining stable. That means that even over a prolonged period of time up to 8,500 users could process personal health records at any given time. At times of peak use, more than 10,000 simultaneous users were online. The results confirmed that the LifeSensor personal health record is not only highly capable and scalable but also especially secure.

"ICW has done exemplary work in designing and developing the LifeSensor personal health record platform. Running on HP's hardware, LifeSensor
delivers outstanding results and fulfills the requirements of markets worldwide", says Hans-Jürgen Preuss, sales manager for the health sector of Hewlett Packard Germany.

"Personal health record platforms need to be scalable, highly accessible,
stable, and above all secure, so that users and health care providers can use the records anytime, world-wide. The test results prove once again that
LifeSensor is ready for widespread use", adds Peter Reuschel, CEO of ICW. 

Test parameters

The benchmark test was conducted using industrial standard hardware and operating system software from leading technology providers. Among the equipment used were ProLiant DL 380 G5 servers with quad-core Intel-Xeon processors and AMD Opteron quad-core processors. Also used was an HP EVA 4000 SAN storage system equipped with 5 TB hard disk storage. The system was run using the Novell Suse SLES 10 64-bit operating system, and with Oracle 10g R2 and Real Application Cluster Option as the database. The desired high level of user load was simulated using Apache JMeter freeware.
 
Along with ICW's Master Patient Index (MPI), one of the components of ICW's Professional Exchange Server, LifeSensor is the second solution out of the ICW portfolio to be subjected to performance testing at the Hewlett Packard European Performance and Benchmark Center. Together with its partners, ICW conducts periodic performance benchmarks for the continuous improvement of its product line.

Download press release about LifeSensor performance benchmark
Read more about the LifeSensor personal health record, here...

gematik and value added

Dirk Drees will now be helping to expand this privately financed kernel into a national, open and at the same time highly variable healthcare IT infrastructure. "For me, GeTeG is on the one hand an opportunity to put the technical specifications for the healthcare IT infrastructure that I designed along with my team, quickly and flexibly into practice", is how Drees describes his new challenge. "On the other hand, now I can put the power of private business into all of the ideas and opportunities that go beyond the gematik's charter, together with interested business partners and investors."

Reverse PPP

Because GeTeG is open to new partners from the public and private sectors, its concept might be described as "reverse PPP": With support from ICW, GeTeG is providing service in advance by investing know-how and capital in building up a neutral, Germany-wide infrastructure, and opening it up to additional partners. In doing this, it reduces the financial risk to the public sector and the overall costs, which are sustained by a number of mutually supporting business models.

In parallel with the creation of a healthcare IT infrastructure in Germany by GeTeG, ICW continues to offer its eHealth infrastructure solutions on the international market.

Dirk Drees

Dirk Drees, born in 1962, has many years of experience in the healthcare and insurance sectors. His career began in 1981 with Zürich Insurance, where he led a number of IT projects. After moving to Victoria Insurance, he was as department head responsible for company organization and the central systems of the insurance group.

Later, Drees concentrated on healthcare. As healthcare IT consultant and project manager, he designed and implemented data warehouse systems, data transfer solutions and quality assurance systems.

In 2005, Drees was first consultant to the top-level architecture working group of gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbH. In November of that year he was called upon to take over as Technical Director, responsible for the implementation, maintenance and improvement of the Electronic Health Card and its healthcare IT infrastructure in Germany.

Download press release about Dirk Drees

Download photo of Dirk Drees (zip archive, 267 KB)