Cardiovascular Implantable Electronic Devices (CIED) are gaining popularity in treating patients with heart disease. Remote monitoring through care management systems enables continuous surveillance of such patients by checking device functions and clinical events. These care management systems include decision support capabilities based on clinical guidelines. Data input to such systems are from different information sources including medical devices and Electronic Health Records (EHRs). Although evidence-based clinical guidelines provides numerous benefits such as standardized care, reduced costs, efficient and effective care management, they are currently underutilized in clinical practice due to interoperability problems among different healthcare data sources. In this paper, we introduce the iCARDEA care management system for atrial fibrillation patients with implant devices and describe how the iCARDEA care plan engine executes the clinical guidelines by seamlessly accessing the EHR systems and the CIED data through standard interfaces.

Introduction: The crowding of emergency departments (ED) has been a growing problem for years, putting the care of critically ill patients increasingly at risk. The INDEED project's overall aim is to get a better understanding of ED utilization and to evaluate corresponding primary health care use patterns before and after an ED visit while driving forward processes and methods of cross-sectoral data merging. We aim to identify adequate utilization of EDs and potentially avoidable patient contacts as well as subgroups and clusters of patients with similar care profiles.Methods: INDEED is a joint endeavor bringing together research institutions and hospitals with EDs in Germany. It is headed by the Charité–Universitätsmedizin Berlin, collaborating with Otto von Guericke University Magdeburg, Technische Universität Berlin, the Central Research Institute of Ambulatory/Outpatient Health Care in Germany (Zi), and the AOK Research Institute as part of the Federal Association of AOK, as well as experts in the technological, legal, and regulatory aspects of medical research (TMF). The Institute for Information Technology (OFFIS) was involved as the trusted third party of the project. INDEED is a retrospective study of approximately 400,000 adult patients with statutory health insurance who visited the ED of one of 16 participating hospitals in 2016. The routine hospital data contain information about treatment in the ED and, if applicable, about the subsequent hospital stay. After merging the patients' hospital data from 2016 with their outpatient billing data from 2 years before to 1 year after the ED visit (years 2014–2017), a harmonized dataset will be generated for data analyses. Due to the complex data protection challenges involved, first results will be available in 2021.Discussion: INDEED will provide knowledge on extracting and harmonizing large scale data from varying routine ED and hospital information systems in Germany. Merging these data with the corresponding outpatient care data of patients offers the opportunity to characterize the patient's treatment in outpatient care before and after ED use. With this knowledge, appropriate interventions may be developed to ensure adequate patient care and to avoid adverse events such as ED crowding.

Background It has been shown previously that a relevant proportion of childhood cancer survivors suffers from late effects, which are often directly related to the cancer itself or its therapy, resulting in particular follow-up needs, additionally burdening healthcare systems. Being diagnosed with cancer at a vulnerable stage of development, this group of cancer survivors is at comparatively higher risk of relapse or subsequent cancer. Although national and international follow-up guidelines based on treatment modalities have been developed, their implementation seems to leave room for improvement. Additionally, they lack a sufficient consideration of the survivors’ psychosocial needs, affecting their adherence to them. The aim of the VersKiK study is to provide representative information on late effects in childhood and adolescence cancer survivors in Germany. The main research objectives are: (1) to describe the state of follow-up care among survivors after a cancer diagnosis in childhood or adolescence; (2) to quantify the occurrence of late effects among this group of survivors; (3) to examine the adherence to selected audiological and cardiological follow-up guidelines and to identify factors affecting it; (4) to explore actual follow-up needs of paediatric cancer survivors; (5) to review selected follow-up guidelines with the aim to improve and expand them. Methods VersKiK is designed as a mixed-methods non-interventional study. We will use claims data from statutory health insurance companies in combination with individually linked population-based registry data from the German Childhood Cancer Registry (GCCR). This data base will permit us to quantify diagnoses and procedures in comparison to the general population as well as the adherence to existing follow-up guidelines. Additional information will be obtained through interviews with childhood and adolescence cancer survivors and their informal caregivers, as well as in focus groups with healthcare professionals. Discussion The present study aims to research the actual needs of individuals after cancer diagnosis and treatment in childhood or adolescence – physical, psychological and organisational – in order to improve existing follow-up guidelines. These improvements might further positively affect not only actual care provided to paediatric cancer survivors, but also benefit healthcare systems in general while decreasing consequent medical visits in this group of patients. Trial registration Registered at German Clinical Trial Register (ID: DRKS00025960 and DRKS00026092).

For patients with Cardiovascular Implantable Electronic Devices (CIEDs), telemonitoring promises improved quality of life and safety, since events recorded by the device or observed by the patient can alert a health professional. Taking into account the latest clinical guidelines when responding to such alerts, is a topic of active research addressed by the iCARDEA project. A key technical challenge is correlating telemonitoring CIED report data in a vendor-independent format with Electronic Health Record (EHR) data collected in the hospital and Personal Health Record (PHR) data entered by the patient, in guideline-driven care processes. The iCARDEA CIED exposure service component presented in this paper employs standards specifications from ISO/IEEE 11073 (Health Informatics, Point-of-care Medical Device Communication) and HL7v2.x in the context of Integrating the Healthcare Enterprise (IHE) profiles to deliver telemonitoring CIED report data from two different CIED vendors to the adaptive care planner that implements guideline-driven care plans. Experience gained with implementation and initial component testing is discussed, while challenges and expectations for future health information standards to effectively support EHR-integrated guide-line-driven telemonitoring services are highlighted.