Introduction: It is estimated that more than 382 million people suffer from diabetes across the globe, most of which are between the age of 40 and 59 years. ICT can play a key role in better management of diabetes and in patient empowerment. Patient empowerment involves patients to a greater extent in their own healthcare process and disease management becomes an integrated part of their daily life. Self-management opens the possibility for patients to contribute to their own healthcare as well as to be more in control of their disease. Objectives: The objective of our study was to explore the impact of an ICT-based patient empowerment framework in diabetes self-management.Methods: A modular patient empowerment framework that fosters diabetes self-management was designed and implemented. The framework incorporates expert knowledge in the form of clinical guidelines, and it supports patients in the specification of personalized activities that are based on medical recommendations and personal goals, and in the collection of observations of daily living. The usability and usefulness of the proposed framework were assessed in a pilot study with the participation of 60 patients and 12 health professionals.Results: The study revealed that a patient empowerment approach based on self-management ICT tools is useful and accepted by both the patients and the physicians. For those patients who were already disciplined in their disease management the piloted solution served as a facilitator for data logging. For the rest, it served as an incentive for better adherence to disease management principles. The ICT tools prompted many patients into becoming more physically active and into making dietary habits' adjustments. However, this impact proved to be tightly correlated with the sociocultural background of the subjects. The study also demonstrated that even in patient-centric self-management interventions the physicians still have a key role to play. However, the acceptance of such interventions by the healthcare professionals depends not only on the level of impact in their patients' disease management but also on the level of impact in their workflow.Conclusions: It is evident that a patient empowerment approach based on self-management ICT tools is useful and accepted by patients and physicians. Further, there are clear indications that ICT frameworks such as the one presented in this paper support patients in behavioral changes and in better disease management. Finally, it was realized that self-management solutions should be built around the objective not only to educate and guide patients in disease self-management, but also to assist them in exploring the decision space and to provide insight and explanations about the impact of their own values on the decision. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

BACKGROUND:Smart Health is known as a concept that enhances networking, intelligent data processing and combining patient data with other parameters. Open data models can play an important role in creating a framework for providing interoperable data services that support the development of innovative Smart Health applications profiting from data fusion and sharing.METHODS:This article describes a model-driven engineering approach based on standardized clinical information models and explores its application for the development of interoperable electronic health record systems. The following possible model-driven procedures were considered: provision of data schemes for data exchange, automated generation of artefacts for application development and native platforms that directly execute the models. The applicability of the approach in practice was examined using the openEHR framework as an example.RESULTS:A comprehensive infrastructure for model-driven engineering of electronic health records is presented using the example of the openEHR framework. It is shown that data schema definitions to be used in common practice software development processes can be derived from domain models. The capabilities for automatic creation of implementation artefacts (e.g., data entry forms) are demonstrated. Complementary programming libraries and frameworks that foster the use of open data models are introduced. Several compatible health data platforms are listed. They provide standard based interfaces for interconnecting with further applications.CONCLUSION:Open data models help build a framework for interoperable data services that support the development of innovative Smart Health applications. Related tools for model-driven application development foster semantic interoperability and interconnected innovative applications.

Diabetes is a serious world-wide medical challenge and there is a recognised need for improved diabetes care outcomes. This paper describes results of the EMPOWER project, to foster the self-management of diabetes patients by integration of existing and new services offered to patients after having been diagnosed with diabetes. The Self-Management Pathway described in this paper helps patients in the specification of personalized activities based on medical recommendations and personal goals, as well as self-monitoring of the results. The whole process is supported by innovative ICT services that motivate patients to change their lifestyle and adhere to defined medication and activity plans. We describe the approach and present the findings of the validation phase in Germany and Turkey.

Introduction: Diabetes requires a high level of disease management to be executed by the patient himself in order to succeed in treatment and for improving or at least preserving his health status. Aim: The main objective of the presented project is to design and implement a web technology based application framework. It shall provide sufficient means for selfmanagement and enable patient empowerment within the treatment process. Its underlying concept will be outlined in this work. Methods: Common techniques on requirements’ engineering have been applied to derive an initial concept. It is based on a comprehensive state of the art analysis drawn from literature and web search. Results: A service-oriented architecture could be drafted that enables interoperability with existing eHealth systems on a technical and semantic level. Pilots will be deployed in Germany and Turkey. Pilot specific requirements can be address as well due to its modular architecture. Conclusion: The given concept gives a high level description of the envisaged approach. An initial prototype has been implemented. A second prototype is well on the way offering all major functionality and will be deployed within the pilot regions.

In this paper we present the functional features of a mobile Personal Health Application that aims to empower Type 1 and Type 2 diabetic patients by facilitating self-management of their disease. The application supports the collection of observations of daily living i.e. vital signs, diet, quality and quantity of sleep, physical parameters such as weight, mental parameters such as self-assessment of quality of life, level of mood and stress, and physical activity related information. The application can operate in stand-alone mode as a consumer health app running in smartphones and tablets. However, the full range of its functionality is available when integrated with a server-based patient empowerment framework that further facilitates diabetes management with the active involvement of healthcare professionals, the exploitation of inclusive knowledge from clinical guidelines, and the incorporation of comprehensive information material.

An efficient interaction between a doctor and an electronic health record (EHR) also depends on the visual layer of an EHR. As users with various backgrounds and needs have different perspectives on the same data visualization, methods must be flexible in order to provide the optimal interface. The ISO 13606 community is interested in developing requirements on a generic visualization method that can supplement the archetype model. Our research aims at specifying the requirements on a medical data visualization method based on the ISO13606 data model. XML provides an efficient format to store and process visualization data. It allows a clear structuring and validation of the data due to the built-in standard features. The proposed visual medical concept allows separating the medical knowledge from the visualization knowledge. Our current research is focused on defining the optimal XML schema for a visual medical concept that will allow multi-client generic data presentation. One important part of the study is the analysis/representation of the patients' perception of the medical data.

SummaryBackground: To organize an efficient interaction between a doctor and an EHR the data has to be presented in the most convenient way. Medical data presentation methods and models must be flexible in order to cover the needs of the users with different backgrounds and requirements. Most visualization methods are doctor oriented, however, there are indications that the involvement of patients can optimize healthcare.Objectives: The research aims at specifying the state of the art of medical data visualization. The paper analyzes a number of projects and defines requirements for a generic ISO 13606 based data visualization method. In order to do so it starts with a systematic search for studies on EHR user interfaces.Methods: In order to identify best practices visualization methods were evaluated according to the following criteria: limits of application, customizability, re-usability. The visualization methods were compared by using specified criteria.Results: The review showed that the analyzed projects can contribute knowledge to the development of a generic visualization method. However, none of them proposed a model that meets all the necessary criteria for a re-usable standard based visualization method. The shortcomings were mostly related to the structure of current medical concept specifications.Conclusion: The analysis showed that medical data visualization methods use hard-coded GUI, which gives little flexibility. So medical data visualization has to turn from a hardcoded user interface to generic methods. This requires a great effort because current standards are not suitable for organizing the management of visualization data. This contradiction between a generic method and a flexible and user-friendly data layout has to be overcome.

Semantic interoperability of EHR (electronic health records) is a major challenge in medical informatics. In the presented solution the electronic communication barriers caused by heterogeneous EHR systems are exemplified in a regional doctors' network in Germany. EHR interoperability is enabled by a canonical model of clinical data using the EHR standards ISO 13606 and ASTM CCR. In addition a communication server is developed which provides state of the art communication interfaces and offers solutions for those EHR systems which cannot fulfill modern interoperability requirements. This ensures high participation within the network. The server also offers rich visualization capabilities (that are applied on the exchanged data); this adds value to the data exchange solution.

Feeling an integrative part of a social community adds to the quality of life. Elderly people who find it more difficult to actively join activities are often threatened by isolation. Social networking can enable communication and sharing activities makes it easier to set up and maintain contacts. This paper describes the development of a social networking platform and activities like gaming and exergaming all of which aim to facilitate social interaction. It reports on the particular challenges that need to be addressed when creating a social networking platform specially designed to meet the needs of the elderly.

Patient care is a complex process with different providers located in various institutions co-operating within an integrated health environment. In spite of technical improvements in medical care, patient information is usually exchanged by paper. Digital and timely communication between regional care providers can improve the exchange of information. Different systems and missing data standards are challenges that have to be met. ByMedConnect, a project sponsored by the Bavarian State Ministry of the Environment and Public Health, develops and demonstrates a communication solution based on the EN 13606 standard. In a first step the dataset, which will be exchanged by the care providers, is defined. ByMedConnect develops the dataset in cooperation with practicing clinicians and converts it via modeling tools into archetypes that provide the base for reliable cross-sector communication. Existing heterogeneous systems are integrated via a dedicated module that transforms legacy data into a normalized representation. Information provided in a standardized form thereby enables semantic interoperability between different systems and allows medical add-on applications to connect. A secure digital communication network guarantees easy and direct data sharing. ByMedConnect aims to evaluate the achieved theoretical preliminary work in practice and to draft approaches, which can be applied beyond the pilot application.

To build a semantically interoperable Electronic Health Record is one of the most challenging research fields in health informatics. In order to reach this objective, EHR standards that formally describe health data structures have to be used. CEN EN13606 is one of the most promising approaches. It covers the technical needs for semantic interoperability and, at the same time, it incorporates a mechanism (archetype model) that enables clinical domain experts to participate in building an EHR system. In this paper we present EHRflex, a generic system based on archetypes. It empowers the clinician and allows him to manage his own EHR system in a simple and generic way, assuring that the user works with underlying standardized data structures. These can be exchanged with other people and systems when needed. EHRflex introduces EHR standards into the clinical routine delivering a technical platform which works directly on archetype based data.

All types of advanced communication, collaboration, and cooperation in healthcare require a strong involvement of all addressed parties including health professionals and patients. Modern healthcare aims at involving patients having them take over responsibility for their own health status. Allowing them to take on their changed roles as emancipated partners in advanced care management, health professionals need to be educated and patients need to be empowered. From a security viewpoint, health issues have to be communicated via trusted health networks. To provide communication and cooperation between professionals and patients as well as to guarantee the required level of involvement of patients in shared care management environments, cards are widely used as person identifiers, on the one hand, and as security tokens, on the other. Being introduced as storage media and portable personalized application system, cards enable a patient controlled access to personalized health services as well as proper use and exchange of personal health data for specific purposes such as emergency. Furthermore, cards allow access to the wider electronic patient record via pointers or tickets. Cards can empower patients. The German Electronic Health Card (eGK) shall thus support care management and specific workflow processes e.g. for prescription and disease management. Regardless whether designed as data or pointer card - international standardization is a prerequisite also for national solutions. The more information patients have regarding different procedures and processes in healthcare, the more are they able to play their dedicated role within care management. Cards can and will contribute by allowing patients to get controlled access to administrative and medical data stored either on cards or in networks. Card holders determine who has access to their health information.

Shared care and cross-border interactions require a reliable and stable framework based on the application of standardised solutions. These are often not sufficiently known, diffused and not implemented. The EC funded project BioHealth aims to raise awareness on eHealth standardisation, to inform on security standards and to facilitate their practical implementation. It also evaluates socio-economic and cultural aspects concerning eHealth with particular reference to the introduction of emerging technologies such as biometrics and RFID.