Background Multimorbidity raises the number of essential information needed for delivery of high-quality care in patients with chronic diseases like rheumatoid arthritis (RA). We evaluated an innovative ICT platform for integrated care which orchestrates data from various health care providers to optimize care management processes. Methods The Horizon2020-funded research project PICASO (picaso-project.eu) established an ICT platform that offers integration of care services across providers and supports patients’ management along the continuum of care, leaving the data with the owner. Strict conformity with ethical and legal legislations was augmented with a usability-driven engineering process, user requirements gathering from relevant stakeholders, and expert walkthroughs guided developments. Developments based on the HL7/FHIR standard granting interoperability. Platform’s applicability in clinical routine was an essential aim. Thus, we evaluated the platform according to an evaluation framework in an observational 6-month proof-of-concept study with RA patients affected by cardiovascular comorbidities using questionnaires, interviews, and platform data. Results Thirty RA patients (80% female) participated, mean age 59 years, disease duration 13 years, average number of comorbidities 2.9. Home monitoring data demonstrated high platform adherence. Evaluations yielded predominantly positive feedback: The innovative dashboard-like design offering time-efficient data visualization, comprehension, and personalization was well accepted, i.e., patients rated the platform “overall” as 2.3 (1.1) (mean (SD), Likert scales 1–6) and clinicians recommended further platform use for 93% of their patients. They managed 86% of patients’ visits using the clinician dashboard. Dashboards were valued for a broader view of health status and patient-physician interactions. Platform use contributed to improved disease and comorbidity management (i.e., in 70% physicians reported usefulness to assess patients’ diseases and in 33% potential influence on treatment decisions; risk manager was used in 59%) and empowered patients (i.e., 48% set themselves new health-related goals, 92% stated easier patient-physician communications). Conclusion Comprehensive aggregation of clinical data from distributed sources in a modern, GDPR-compliant cloud platform can improve physicians’ and patients’ knowledge of the disease status and comorbidities as well as patients’ management. It empowers patients to monitor and positively contribute to their disease management. Effects on patients’ outcome, behavior, and changes in the health care systems should be explored by implementing ICT-based platforms enriched by upcoming Artificial Intelligence features where possible. Trial registration DRKS—German Clinical Trials Register, DRKS00013637, prospectively registered. 17 January 2018.

Online process mining techniques are increasingly used to provide operational support. In this work we describe tools to support distributed business processes which handle sensitive data and require a high level of security together with real-time validation. The techniques presented here have been specifically developed for real-time compliance checking of distributed processes in choreographies of heterogeneous entities. Challenges include the fast aggregation, analysis and validation of process logs that are collected from the distributed participants. The autonomy of the participating entities has to be respected and no sensitive data pertaining to the content of the individual transactions must be accessed for process support and validation purposes. A validation authority for process monitoring and validation is set up. Together with software agents dispatched to the participating entities the validation authority collects events in a central log and then analyzes these events using a particular representation of the process in form of a validation tree to detect and resolve anomalies. We describe the application of these technologies in a distributed business process with more than 400,000 daily process executions. The business process is supported by a help desk managing and responding to incidents and anomalies. We observe a reduction of 90% of the calls to the help desk and an average reduction of 15% in call length. Further the help desk was enabled to act pro-actively, calling participants to the process even before they became aware of anomalies that affected their organization

The PICASO ("A Personalised Integrated Care Approach for Service Organisations and Care Models for Patients with Multi-Morbidity and Chronic Conditions") project provides an integration platform for the cross-organizational exchange of electronic health records and care plans to facilitate the closer integration of formal and informal carers and a personalized orchestration of care services. PICASO enables the collaboration of carers across sectors encompassing the entire care continuum from the clinical setting to a patients private home. In this work we discuss how PICASO addresses the security, privacy and trust challenges of the associated cloud based health system.

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