Einfluss einer elektronischen Patientenakte (EPA) auf das Arzt-Patienten-Verhältnis: eine systematische Übersicht der medizinethischen Implikationen

Background

In a model project, the implementation of a comprehensive, personal electronic patient record (PEPA) shall not only improve consistency of care, but also realize the right to informational self-determination to the effect that every patient is made administrator of a data-cloud containing all his medical data. A systematic literature review on the topic “electronic health records (EHR)” anticipates possible ethical challenges in connection with the mentioned PEPA. Of the initial 2487 publications, 51 articles were analyzed: 30 empirical studies, 10 medical ethics analyses, and 11 comments.

Results

In the empirical studies, a more comprehensive medical record was described as an initial effect. The option for access to the EMR by the patient resulted in a better understanding of the needed medical care and thereby higher compliance by the patient. An improvement of the quality of medical care was attributed to prevention of medical errors through the access to records by the patient, a more effective utilization of physician–patient visitations and an improved understanding of the therapeutic concept. Studies also showed a strengthening of the bond of trust in the physician–patient relationship. Concerns were related to data security, possible decline in the personal physician–patient relationship and potential excessive demands on the patient.

Discussion

In an assessment of the EMR, weighing beneficence against patient autonomy plays a major role. Concerns by medical ethics pertaining to a loss of trust or a disturbance of the physician–patient relationship could not be proven empirically. The feared risks to data security were weighed by those affected in favor of the potential benefits of the EMR. Provided that data are protected, the PEPA has the potential to influence the physician–patient relationship positively through participation of the patient. The specific ethical challenges associated with the co-administration of PEPA will be examined in the pilot project.

     

Towards Systematic Business Model Innovation: Lessons from Product Innovation Management

Although business model innovations are decisive for a company's long‐term success or failure, they are still poorly understood compared to product innovations. Thus, their execution is imperfectly supported, and their organizational accountability is insufficiently regulated. In this paper, we systematically investigate similarities and differences between product and business model innovation to assess the potential of transferring insights and best practices. Therefore, we condense key findings of product innovation management into a framework as a basis for the analysis of 11 current cases of business model innovation. This paper intends to contribute to a better understanding of the options that exist for business model innovation. We derive implications for an improved management of business model innovation based on the cases analysed. For the innovation process and its organizational anchoring, we disclose potential benefits of a more structured and holistic approach.     

Design and Evaluation of a Conversational Agent for Facilitating Idea Generation in Organizational Innovation Processes

Information Systems Frontiers - Large numbers of incomplete, unclear, and unspecific submissions on idea platforms hinder organizations to exploit the full potential of open innovation initiatives...     

Factorial and reduced K-means reconsidered

Factorial K-means analysis (FKM) and Reduced K-means analysis (RKM) are clustering methods that aim at simultaneously achieving a clustering of the objects and a dimension reduction of the variables. Because a comprehensive comparison between FKM and RKM is lacking in the literature so far, a theoretical and simulation-based comparison between FKM and RKM is provided. It is shown theoretically how FKM’s versus RKM’s performances are affected by the presence of residuals within the clustering subspace and/or within its orthocomplement in the observed data. The simulation study confirmed that for both FKM and RKM, the cluster membership recovery generally deteriorates with increasing amount of overlap between clusters. Furthermore, the conjectures were confirmed that for FKM the subspace recovery deteriorates with increasing relative sizes of subspace residuals compared to the complement residuals, and that the reverse holds for RKM. As such, FKM and RKM complement each other. When the majority of the variables reflect the clustering structure, and/or standardized variables are being analyzed, RKM can be expected to perform reasonably well. However, because both RKM and FKM may suffer from subspace and membership recovery problems, it is essential to critically evaluate their solutions on the basis of the content of the clustering problem at hand.     

VXQR: derivative-free unconstrained optimization based on QR factorizations

This paper presents basic features of a new family of algorithms for unconstrained derivative-free optimization, based on line searches along directions generated from QR factorizations of past direction matrices. Emphasis is on fast descent with a low number of function values, so that the algorithm can be used for fairly expensive functions. The theoretical total time overhead needed per function evaluation is of order O(n ²), where n is the problem dimension, but the observed overhead is much smaller. Numerical results are given for a particular algorithm VXQR1 from this family, implemented in Matlab, and evaluated on the scalability test set of Herrera et al. (, 2010) for problems in dimensions n ∈ {50, 100, 200, 500, 1,000}. Performance depends a lot on the graph {(t,f(x+th)) | t ? [0,1]}\{(t,f(x+th))\mid t\in[0,1]\} of the function along line segments. The algorithm is typically very fast on smooth problems with not too rugged graphs, and on problems with a roughly separable structure. It typically performs poorly on problems where the graph along many directions is highly multimodal without pronounced overall slope (e.g., for smooth functions with superimposed oscillations of significant size), where the graphs along many directions are piecewise constant (e.g., for problems minimizing a maximum norm), or where the function overflows on the major part of the search region and no starting point with finite function value is known.     

A satellite data set for tropical forest area change assessment

A database of largely cloud-free (less than 2.5% of all sites have more than 5% cloud cover), geo-referenced 20 km?×?20 km sample sites of 30 m resolution optical satellite imagery have been prepared for the 1990 and 2000 epochs. This spans the tropics with a systematic sample located at the degree confluence points of the geographic grid. The resulting 4016 sample pairs are to be used to measure changes in the area of forest cover between the two epochs. The primary data source was the National Aeronautics and Space Administration's (NASA's) global land survey (GLS) data sets. Visual screening of GLS images at all 4016 confluence points from each date identified 2868 suitable pairs where no better alternatives exist (71.6% of the sample). Better alternatives could be found for 26.6% of the sample, substituting cloudy or missing GLS data sets at one or the other epoch or both (GLS-1990 or GLS-2000). Gaps were filled from the United States Geological Survey (USGS) Landsat archives (1070 samples), data from other Landsat archives (53 samples) or with alternatives to Landsat, that is, 15 samples from Satellite Pour l'Observation de la Terre (SPOT). This increased the effective number of sample pairs to 3945 representing 98% of all target samples. No suitable image pairs were found for 71 confluence points, which were not randomly distributed, but mostly concentrated in the Congo basin, where around 15% of the region remains un-sampled. Variations in date of image acquisition and geometric fidelity are documented. Results highlight the importance of combining systematic data-processing schemes with targeted image acquisition and archiving strategies for global scale applications such as deforestation monitoring and shows that by replacing cloudy or missing GLS data with alternative imagery, the overall coverage of the sample sites within the ecological zones ‘Tropical rainforest’ and ‘Tropical mountain system’ can be improved by 16%.     

Empirical models for estimating daily surface water vapour pressure,air temperature,and humidity using MODIS and spatiotemporal variables. Applications to peninsular Spain

In this article, we present empirical models for estimating daily surface water vapour pressure (e₀), air temperature (T_a), and relative humidity (RH) over cloud-free land areas in peninsular Spain using Moderate Resolution Imaging Spectroradiometer (MODIS) and spatiotemporal variables. The models were obtained and validated using daily mean, maximum, and minimum e₀, T_a, and RH data (year 2010) from 331 ground-level meteorological stations and the diurnal Terra-MODIS data in peninsular Spain, but the methodology can easily be extrapolated and used to obtain algorithms for other regions around the world. The best e₀ models are based on total precipitable water (W) estimations obtained by MOD05 or IMAPP WVNIR products and the spatiotemporal variables of longitude (λ), distance to the coast (d_coast), and Julian day (JD). Other models based on Sobrino’s W algorithm or on Recondo’s e₀ algorithm for Asturias (in northern Spain) were also tested. The best T_a models are based on land surface temperature (LST) obtained by the MOD11 LST or IMAPP LST products and on other remote-sensing variables, such as W and the normalized difference vegetation index (NDVI), and the spatiotemporal variables λ, JD, and height (h). Models based on Sobrino’s LST algorithms were also tested. RH can be derived directly from e₀ and T_a or from models similar to those used to obtain e₀ and T_a. Models based on the NASA standard products MOD05 and MOD11 LST are slightly better than those based on IMAPP products, but the advantage of IMAPP products for our purposes is that they can be generated in almost real time from the data obtained by the MODIS antenna at the University of Oviedo. IMAPP models obtain the following: R² = 0.83-0.79-0.70 and RSE = 1.62-1.59-1.76 hPa for e_0mean, e_0max, and e_0min; and R² = 0.91-0.91-0.80 and RSE = 1.96-2.25-3.00 K for T_mean, T_max, and T_min. Worse results are obtained for RH: R² = 0.49-0.39 and RSE = 7.21-9.75% for RH_min and RH_mean, with no correlation found for RH_max. Model validations yield R² and RSE values similar to those obtained in the models, with an RMSD = 1.86-1.99-2.21 hPa for e_0mean, e_0max, and e_0min; an RMSD = 2.05-2.40-2.95 K for T_mean, T_max, and T_min; and RMSD = 8-11% for RH_min and RH_mean. The bias is small in all cases: <0.2 hPa for e₀, ≤0.1 K for T_a, and ≤ |1|% for RH. From the results of this article, we propose substituting the traditionally used RH variable with the e₀ variable to be used as meteorological variable in environmental risk models such as, for example, fire risk models.     

Head movements during two computer work tasks assessed by accelerometry

We investigated whether potential differences in head inclinations and accelerations for two highly similar computer work tasks could be detected using (1) a triaxial accelerometer and (2) a simulated uniaxial accelerometer.Ten subjects’ head movements were registered with a triaxial accelerometer system for two similar document-management tasks at their work place: a fully electronic document-management task and one also involving paper documents.In situations where head movements were small, a triaxial accelerometer was able to discriminate between the different degrees of static work of the neck in terms of range of head inclinations and accelerations. A difference in head acceleration was also found by using a simulated uniaxial accelerometer. Thus, in terms of head movement and for work similar to this office work, potential dynamic differences in observationally similar work tasks can be investigated by using a triaxial accelerometer. For acceleration alone, a uniaxial accelerometer can also be used.