Händel A, Jünemann A G M, Prokosch H-U, Beyer A, Ganslandt T, Grolik R, Klein A, Mrosek A, Michelson G, Kruse F E
Augenklinik, Universitätsklinikum Erlangen, Erlangen.
Klin Monbl Augenheilkd. 2009 Mar;226(3):161-7. doi: 10.1055/s-0028-1109193. Epub 2009 Mar 17.
A prerequisite for integrated care programmes is the implementation of a communication network meeting quality assurance standards. Against this background the main objective of the integrated care project between the University Eye Hospital Erlangen and the health insurance company AOK Bayern was to evaluate the potential and the acceptance of a web-based electronic patient record in the context of cataract and retinal surgery.
Standardised modules for capturing pre-, intra- and post-operative data on the basis of clinical pathway guidelines for cataract- and retinal surgery have been developed. There are 6 data sets recorded per patient (1 pre-operative, 1 operative, 4-6 post-operative). For data collection, a web-based communication system (Soarian Integrated Care) has been chosen which meets the high requirements in data security, as well as being easy to handle. This teleconsultation system and the embedded electronic patient record are independent of the software used by respective offices and hospitals. Data transmission and storage were carried out in real-time.
At present, 101 private ophthalmologists are taking part in the IGV contract with the University Eye Hospital Erlangen. This corresponds to 52% of all private ophthalmologists in the region. During the period from January 1st 2006 to December 31st 2006, 1844 patients were entered. Complete documentation was achieved in 1390 (75%) of all surgical procedures. For evaluation of this data, a multidimensional report and analysis tool (Cognos) was used. The deviation from target refraction as one quality indicator was in the mean 0.09 diopter.
The web-based patient record used in this project was highly accepted by the private ophthalmologists. However there are still general concerns against the exchange of medical data via the internet. Nevertheless, the web-based patient record is an essential tool for a functional integration between the ambulatory and stationary health-care units. In addition to the telemedicine functions of the system, we achieved the export of the data to a data warehouse system in order to provide a flexible and powerful tool for quality assurance analysis and reporting.
综合护理项目的一个前提条件是实施符合质量保证标准的通信网络。在此背景下，埃尔朗根大学眼科医院与巴伐利亚AOK健康保险公司之间的综合护理项目的主要目标是评估在白内障和视网膜手术背景下基于网络的电子病历的潜力和接受度。
已根据白内障和视网膜手术的临床路径指南开发了用于记录术前、术中和术后数据的标准化模块。每位患者记录6组数据（1组术前、1组术中、4 - 6组术后）。为了进行数据收集，选择了一个基于网络的通信系统（Soarian综合护理系统），该系统满足数据安全方面的高要求，并且易于操作。这个远程会诊系统和嵌入式电子病历独立于各个诊所和医院所使用的软件。数据传输和存储实时进行。
目前，101名私人眼科医生参与了与埃尔朗根大学眼科医院的IGV合同。这相当于该地区所有私人眼科医生的52%。在2006年1月1日至2006年12月31日期间，录入了1844例患者。在所有手术中，1390例（75%）实现了完整记录。为了评估这些数据，使用了一个多维报告和分析工具（Cognos）。作为一项质量指标的目标屈光度偏差平均为0.09屈光度。
本项目中使用的基于网络的病历受到了私人眼科医生的高度认可。然而，对于通过互联网交换医疗数据仍存在普遍担忧。尽管如此，基于网络的病历是门诊和住院医疗单位之间功能整合的重要工具。除了该系统的远程医疗功能外，我们还实现了将数据导出到数据仓库系统，以便为质量保证分析和报告提供一个灵活且强大的工具。
