ZUSAMMENFASSUNGDas Krankheitsbild des Diabetes mellitus besitzt eine immense gesundheitspolitische und gesellschaftliche Relevanz. Im Jahr 2008 sind nach Angaben des statistischen Bundesamts für die Versorgung von Menschen mit Diabetes direkte Kosten von insgesamt 6,34 Milliarden Euro durch Medikamente, ambulante und stationäre Behandlung, Pflege- und Rehabilitationsleistungen aufgelaufen. Dies entspricht einem Anteil von 2,5 % der Gesundheitsausgaben aller Krankheiten. Lässt sich jedoch der HbA1c-Wert nachhaltig senken – beispielsweise über einen telemedizinischen Ansatz von 9,0 auf 7,0 % – ergibt sich, gemessen zwischen dem 41. und dem 95. Lebensjahr, anhand einer Markov-Modellierung pro Person und Zyklus ein maximales mittleres Einsparpotenzial von 579,14 Euro pro Patient. Seine maximale Ausprägung erreicht das Einsparpotenzial jedoch bei an Diabetes erkrankten Menschen zwischen dem 41. und dem 61. Lebensjahr: In dieser Zeitspanne lassen sich im Mittel 921,13 Euro pro Person und vorab definiertem Zyklus einsparen, wenn es gelingt, den HbA1c-Wert dauerhaft von 8,0 auf 6,0 % zu senken. In späteren Lebensaltern gleichen sich die Kostenverläufe zwischen niedrigen und hohen HbA1c-Werten allerdings zunehmend an. Da jedoch diverse diabetische Folgeerkrankungen sowie relevante Kostenbestandteile aufgrund einer eingeschränkten Datenlage außerhalb der durchgeführten Analysen verbleiben, liegen die errechneten Einsparpotenziale voraussichtlich unterhalb der real erzielbaren.
Introduc on: In Germany, there is currently no consistent analy c structure within genomic diagnos cs in oncological diseases. Within the framework of the project GENeALYSE, a standardized and interoperable specifi ca on for associated uses cases shall be developed. Intended Methods: Through process analysis and interface modeling, problems of the actual processes will be depicted between the involved actors. In the next step, the workfl ows and relevant fi ndings will be displayed and adapted. In par cular, the heterogeneous workfl ows in genome diagnos cs will be represented by seman c annota on in an interna onal terminology. The results of the seman c annota on build the basement for the crea on of an implementa on guide for standardized genome analy cs, referring to HL7 Clinical Document Architecture (HL7 CDA). Discussion: The problems of heterogeneous genomic diagnos cs as well as unstructured fi ndings in oncology leave the actors face comparable challenges on a regional and suprana onal level. Interfaces, ambiguous seman cs and manual ac vi es inhibit interoperability, promote errors and lead to risks for pa ents and their suffi cient medical treatment. A major challenge will be consistency between the heterogeneous terms to be found in genome analysis. The problem shall be addressed via using interna onal terminologies as well as appropriate mapping techniques. Conclusions: The aim of the project is to create an implementa on guide for standardized digital documenta on and communica on solu ons between diagnos cs, medical therapy and research in the fi eld of genome analysis. GENeALYSE is intended to op mize the coordina on between the diagnos c genome laboratory and the clinical therapy decision in order to increase the safety and success of medical treatment, as well as to improve the health-related quality of life of the aff ected pa ents.
The use of eCommerce solutions in the German health care market is hindered by fragmented solutions and lack of guidance to the use of standards. Especially the area of procurement is mainly dominated by proprietary solutions. Also, the splits in the area of information transfer -which are attributable to the non-coverage usage of standards -result in delays, transcription errors, wrong orders and patient confusion. The project "Standards zur Unterstützung von eCommerce im Gesundheitswesen" (eCG) w a s launched in August 2012 and i s funded by the German Federal Ministry for Economic Affairs and Energy -"Bundesministerium für Wirtschaft und Energie" (BMWi) -within the programme "Mittelstand Digital". The eCG project consortium consists Medical Technology Association "Bundesverband der Medizintechnologie" (BVMed e.V.) and "Integrating the Healthcare Enterprise" in Germany (IHE Deutschland e.V.).One of the main goals of this project is to design a sustainable supply system for healthcare and subsequently produce a significant increase of potentials for efficiency within the health sector by developing interoperability between different, already used standards in the healthcare and the logistics domain. After a literature research and analyses of business processes in hospital new IHE Integration Profiles were modeled in order to describe the interaction between different (software) actors in a hospital starting with ordering products in a point of care until buying it by an external vendor. These profiles are described in an implementation guide "eSupply in Healthcare". For transactions between the actors HL7 v2 messages and GS1 standard were used.
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