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

L Pape,N Hellrung,H U Prokosch,M Marschollek,U Junius-Walker,N Schneider,B Haarbrandt,T Schleef,H Haller,M Schiffer,R Brunkhorst

doi:10.1186/s12911-019-0902-0

Abstract

BackgroundEven 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.MethodsThe 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.DiscussionA 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 registrationISRCTN16755335 (09.07.2019).

Highlights

Even though a high demand for sector spanning communication exists, so far no eHealth platform for nephrology is established within Germany
Nephrology patients often require inpatient care. This is usually provided in nephrology departments at Hannover Medical School (MHH) (Hannover Metropolitan Region) and Klinikum Siloah (Klinikum Region Hannover)
We aim to develop and evaluate an open standards-based approach for establishing a Clinical Decision Support System (CDSS) upon this platform with an exemplary system for automated prognosis of kidney function and the development of cardiovascular disease in nephrology patients (Fig. 1)

Summary

Introduction

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 suboptimal nephrologic care. Nephrology patients often require inpatient care (e.g. due to dialysis [access] problems, infections, transplants, transplant complications, other comorbidities). This is usually provided in nephrology departments at Hannover Medical School (MHH) (Hannover Metropolitan Region) and Klinikum Siloah (Klinikum Region Hannover). Patient information between the different sectors of the health system are only exchanged through paper reports or phone calls This leads to information and data losses and to a quality deterioration in the medical treatment of (pediatric) nephrological patients. The intelligent support of patient care within a multi-stakeholder environment through decision support systems, as well as quality management and comparison between different regions, is currently not feasible

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