@Article{CitationKey,
author = {Ziegler, Volker and Rashid, Asarnusch and M\"{u}ller-Gorchs, Mercè
and Kippnich, Uwe and Hiermann, Erich and K\"{o}gerl, Charlotte and Holtmann,
Carsten and Siebler, Mario and  Griewing, Bernd},
title = {{Einsatz mobiler Computing-Systeme in der pr\"{a}klinischen
Schlaganfallversorgung}},
journal = {Der Anaesthesist},
year = {2008},
volume = {57},
pages = {677-685},
number = {7},
month = {Juli 2008},
note = {ISSN: 0003-2417 (Print) 1432-055X (Online)},
url = {http://www.springerlink.com/content/7lr2332n1r030574/},
key = {Acute stroke - Emergency management - Preclinical management - Mobile
computing technology - Rescue services - Intersectional processes},
abstract = {Background  Telemedical networks that apply innovative mobile
information technologies (IT) are an innovative approach to improve stroke care
in community settings. Within the German Stroke Angel initiative and the research
project PerCoMed (Pervasive Computing in Medical Care, funded by the Federal
Ministry of Education and Research, http://www.percomed.de) the effects of such
a solution were assessed by an interdisciplinary research approach. The main
goal of the team of researchers and practitioners was to provide clear evidence
of improvements in intersectional processes of the stroke chain survival, namely
in the acute stroke processes between prehospital rescue services and hospital
stroke units.

Material and methods  Between October 2005 and October 2007 the paramedical
staff of five rescue service transporters in a rural area of northern Bavaria
was included in a network with the stroke unit of the Neurological Clinic Bad
Neustadt. Telemedical support by the Stroke Angel computing system – a software
running on a personal digital assistant (PDA) to transmit patient data from
the rescue team to the hospital during patient transporting time – was
established. As procedural guidance, the Stroke Angel system suggests a predefined
path through the necessary emergency procedures according to the structure of
the mandatory protocol and the implemented Los Angeles Prehospital Stroke Screen
(LAPSS).

Results  In the empirical study the authors obtained a complete data set of
226 consecutively admitted patients for analysis in Bad Neustadt and LAPSS data
of 217 patients from a second scenario in D\"{u}sseldorf. Medical, economic
and technical analyses were applied. The technological robustness of the Stroke
Angel system could be proven and information entered was transmitted fully and
correctly. Concerning medical research questions, for both scenario locations
LAPSS with a sensitivity of 68.3% and a specificity of 85.1% has to be deemed
insufficient. Hence, alternative algorithms will have to be used in the next
steps of evaluation. The system significantly influenced the clinical process
of acute stroke management more than the preclinical ones (door-to-CT: 32 min.
before and 16 min. at the end of the project). Lysis treatment rose from 6.12%
(2005) to 11.17% (2007) of patients with acute stroke.

Conclusions  From the set of perspectives taken, the study illustrates that
mobile computing technologies offer new and innovative approaches to improve
intersectional acute stroke care. It also teaches the participants that
interdisciplinary research can significantly deepen the understanding of such
technologies and projects, which can lead to better decision making concerning
solution implementation, management and improvements. The approach will be brought
into daily practice in Bad Neustadt/Saale within the next months.}}

					

@Article{CitationKey,
author = {Holtmann, Carsten and Rashid, Asarnusch and M\"{u}ller-Gorchs, Mercè
and Griewing, Bernd and K\"{o}gerl,Charlotte and Ziegler, Volker},
title = {{Sektoren\"{u}bergreifendes Informationsmanagement im Gesundheitswesen.
Neue Wege durch Pervasive Computing}},
journal = {Technikfolgenabsch\"{a}tzung - Theorie und Praxis},
year = {2008},
volume = {1},
pages = {19-26},
number = {17},
month = {May},
url = {http://www.itas.fzk.de/tatup/081/houa08a.pdf},
abstract = {„Stroke Angel“ ist die erste der Fallstudien

im Forschungsprojekt PerCoMed, bei der der

Einsatz von Pervasive-Computing-Technologien

zur Verbesserung des Informationsmanagements

an der pr\"{a}klinisch-klinischen

Schnittstelle in der Schlaganfallversorgung

evaluiert wird. Im Rahmen dieses Teilprojektes

erfassten Rettungsassistenten bei Verdacht

auf Schlaganfall die Patientendaten

leitfadengest\"{u}tzt mit mobilen Ger\"{a}ten am

Notfallort und versandten diese bereits vor

dem Transport des Patienten an das Zielkrankenhaus.

Die \"{A}rzte im Krankenhaus

konnten sich durch diese Vorinformation auf

den Notfall vorbereiten und eine reibungslose

\"{U}bernahme des Patienten sicherstellen.

Die PerCoMed-Forschungspartner flankierten

zwei Jahre lang das Stroke-Angel-Projekt

mit wissenschaftlichen Untersuchungen

und f\"{u}hrten sowohl technische als auch

sozio\"{o}konomische und soziotechnische

Analysen durch. In dieser Arbeit werden die

Ergebnisse des Projektes vorgestellt und die

Bedeutung von Pervasive Computing f\"{u}r ein

sektoren\"{u}bergreifendes Informationsmanagement

diskutiert.}}

					

@Inproceedings{CitationKey,
author = {Hottum, Peter and Schaff, Martina and M\"{u}ller-Gorchs, Mercè and
Howahl, Fabian and G\"{o}rlitz, Roland},
title = {{Capturing and Measuring quality and productivity in healthcare service
systems}},
booktitle = {XXI. International RESER Conference “Productivity of Services NextGen
– Beyond Output / Input”},
year = {2011},
address = {Hamburg},
url = {http://www.reser2011.de/},
abstract = {Due to medical and technical progress as well as the on-going
demo-graphic shift, the healthcare sector has become an increasingly important
part of our economy. As a consequence, the healthcare services’ quality and
efficiency receive broader attention. However, interfering objectives such as
the patient’s well-being and economic targets pose major chal-lenges to a clear
definition of as well as measuring service quality and productivity. This paper
provides an insight in current research activities on productivity in healthcare
service systems. Additionally, the authors present an approach for systematic
measurement of service quality and productivity in the healthcare.}}

					

@Inproceedings{CitationKey,
author = {Kwan, Stephen and M\"{u}ller-Gorchs, Mercè},
title = {{Constructing Effective Value Propositions for Stakeholders in Service
System Networks}},
booktitle = {Academic Conference - Understanding Complex Services Through
Different Lenses},
year = {2011},
address = {Cambridge, UK},
url =
{http://www.cambridgeservicealliance.org/calendar/60/4-Academic-Conference---Understanding-Complex-Services-Through-Different-Lenses.html},
abstract = {The concept of value co-creation is a fundamental premise of Service
Dominant Logic, which has been an important theme of current research thinking
in service science (Vargo & Lusch 2004, 2008, 2011). This concept has become
more complex since more and more service systems are configured as service
networks with a concomitant increase in the number and interaction of
stakeholders. Single provider service systems are becoming more rare as
globalization and technological advances are changing revenue sources and business
models. The purpose of this research is to develop a conceptual framework for
constructing effective value propositions for stakeholders in the design of
service system networks. The model will take an approach that considers both
the stakeholders (esp. the customer) and the provider’s perspectives in value
determination. The framework will be useful in the development of the business
model for the design of a service system in ensuring that the value systems
of the stakeholders are taken into consideration. The success of the service
system will depend on how this stakeholder perspective is taken from the
customer-facing aspect of the front stage to the technical implementation in
the back stage. In the research we will develop the framework using the customer
as the prime stakeholder. The applicability of the framework to value propositions
for other stakeholders will also be demonstrated. We employ mathematical modeling
as the methodology to develop the conceptual framework to illustrate the
relationship among the components. We will also illustrate the applicability
of the framework with examples from the current business environment.}}

					

@Inproceedings{CitationKey,
author = {M\"{u}ller-Gorchs, Mercè and Filipova-Neumann, Lilia and Holtmann,
Carsten and Weinhardt, Christof},
title = {{Quo Vadis Healthcare? Measuring service quality in the stroke chain
of survival}},
booktitle = {17th International Annual EurOMA Conference Managing Operations
in Service Economies},
year = {2010},
address = {Porto, Portugal},
url = {http://www.euroma2010.org/proceedings/papers/proceedings.html},
abstract = {Research on services and their appropriate design is still scarce
in healthcare and needs to be advanced. The contribution of this work is twofold:
First, we derive appropriate metrics for measuring service quality from our
interdisciplinary work on the stroke chain of survival. Second, we illustrate
how measurements of quality of service should be performed by using IT to collect
the required data. This paper provides service quality measures in the context
of the stroke chain of survival and performs a proof of concept in a case study.}}

					

@Inproceedings{CitationKey,
author = {Rosales Saurer, Bruno and M\"{u}ller-Gorchs, Mercè and Kunze,
Christophe},
title = {{Scenario-based design of an ICT platform for mobile information services
in ambulatory care nursing}},
booktitle = {Connecting Health and Humans   - Proceedings of NI2009 – The 10th
International Congress on Nursing Informatics},
year = {2009},
url = {http://booksonline.iospress.nl/Content/View.aspx?piid=12620},
abstract = {The field of ambulatory care nursing is rapidly growing due to rising
health care costs and the demographic development. Against this background,
the VitaBIT project started in 2007 with the objective of designing an ICT
platform for the safe application of mobile information services in ambulatory
care nursing. Communication and secure information exchange between all parties
involved in the care process are also guaranteed. The article explains the
project’s current approach to develop a user-oriented solution using the design
steps implied by ISO 13407 [1]. Even if a technology is developed and formally
tested to be highly usable there exists no guarantee that this will lead to
acceptance. That is the reason why end users are involved in all the project
stages and serve as testers of prototypes in VitaBIT.}}

					

@Inproceedings{CitationKey,
author = {Holtmann, Carsten and M\"{u}ller-Gorchs, Mercè and Rashid, Asarnusch
and Weidenhaupt, Klaus and Ziegler, Volker and Griewing, Bernd and Weinhardt,
Christof},
title = {{Medical Opportunities by Mobile IT Usage – A Case Study in the Stroke
Chain of Survival}},
booktitle = {Tagungsband des zweiten European Conference on eHealth 2007, 11.
– 12. Oktober 2007, OFFIS Oldenburg},
year = {2007},
url = {http://eceh07.offis.de/},
abstract = {Mobile technologies are likely to reveal a high potential to improve
the information exchange in medical treatment. Especially in emergency services,
the use of these technologies can support the work of the regionally distributed
actors. During the last years many projects dealing with innovative mobile systems
were started as pilots but in most cases the concrete effects of their application
were neither analysed in detail nor were the solutions able to reach the status
of operative systems. This paper presents a concrete application scenario of
mobile IT in medical treatment, presents the results from especially a process
analysis and discusses chances and risks that can be deduced from the case
study.}}

					

@Conference{CitationKey,
author = {Ziegler, Volker and G\"{o}rlitz, Roland A. and Schaff, Martina and
Rashid, Asarnusch and M\"{u}ller-Gorchs, Mercè and Kippnich, Uwe and Cavael,
Dominik and Griewing, Bernd},
title = {{INSPIRE – Improving Service Productivity in Healthcare. Verbesserung
der Schlaganfallversorgung durch sektoren\"{u}bergreifende und
technikunterst\"{u}tzte Betrachtung}},
booktitle = {DGN Deutsche Gesellschaft f\"{u}r Neurologie}}

					

@Conference{CitationKey,
author = {M\"{u}ller-Gorchs, Mercè and Holtmann, Carsten and Filipova-Neumann,
Lilia and Rashid, Asarnusch and Weinhardt, Christof},
title = {{Decision Making in the Stroke Chain – The Design of an Appropriate
Feedback Mechanism}},
booktitle = {Group Decision & Negotiation 2010},
year = {2010},
address = {Delft, Netherlands},
url = {http://www.gdn2010.tbm.tudelft.nl/},
abstract = {Driven through demographic shift, German hospitals and healthcare
institutions have to position themselves as efficient service providers. In
doing so, beside medical objectives also economic as well as technical goals
have to be pursued. Especially the introduction of IT-based services is deemed
promising for healthcare institutions, since there is heterogeneous and wide
scattered information which is needed for successful care. The introduction
of an IT-based service enables to digitize and provide information in time.
But introducing IT-based services also rise to a challenge as healthcare services
are mainly produced by human service personnel with heterogeneous education
levels (physicians, paramedics, nurses, etc). Innovative IT-based services within
healthcare not only affect the business philosophy, but also aspects of
information transfer and feedback, acceptance of the IT-services and motivation
of the decision maker which uses the new services. Against this backdrop, our
goal is to develop a feedback mechanism in a case study, which supports the
decision making of the personnel within the stroke chain of survival in order
to improve motivation and provide learning affects. Our focus is the measurement
of current feedback provision concerning the different decision makers. The
measurement is based on interviews and concrete consulting activities. Evaluating
current feedback provision enables us to design an appropriate feedback mechanism
in order to improve motivation and support learning.}}

					

@Conference{CitationKey,
author = {Rashid, Asarnusch and M\"{u}ller-Gorchs, Mercè and Zentek, Tom},
title = {{Cardio Angel: IT in der Rettungskette der Herzinfarktversorgung}},
booktitle = {39. Jahrestagung der Gesellschaft f\"{u}r Informatik 2009, L\"{u}beck
2009},
year = {2009},
url =
{https://www.itm.uni-luebeck.de/conftool-gi09/index.php?page=browseSessions&form_room=8&presentations=show}}

					

@Conference{CitationKey,
author = {Rosales Saurer, Bruno and M\"{u}ller-Gorchs, Mercè and Lindner, Thomas
and Becker, Becker},
title = {{Analyse und Spezifikation einer offenen Plattform f\"{u}r die ambulante
Pflege unter Ber\"{u}cksichtigung aktueller Standardl\"{o}sungen}},
booktitle = {8. Workshop der GMDS-Projektgruppe Mobiles Computing in der Medizin
(MoCoMed 2008), 53. Jahrestagung der Deutschen Gesellschaft f\"{u}r Medizinische
Informatik, Biometrie und Epidemiologie (GMDS)},
year = {2008},
url = {http://www.egms.de/static/en/journals/mibe/2008-4/mibe000077.shtml},
abstract = {Was wissenschaftliche Studien seit Jahren belegen, wird aktuell
in den Medien hei\ss diskutiert: Immer mehr Menschen in Deutschland sind auf
ambulante Hilfe angewiesen. So leben heute rund zwei Millionen
Pflegebed\"{u}rftige in der Bundesrepublik. Experten prognostizieren, dass sich
deren Zahl bis 2050 weit mehr als verdoppeln wird. Vor diesem Hintergrund startete
2007 das Projekt VitaBIT mit der zentralen Frage, wie ambulante Pflege bereits
heute effizienter, qualitativ hochwertiger und damit kostensparender gestaltet
werden kann. Die Partner mit technologischer, wissenschaftlicher und sozialer
Ausrichtung haben es sich zum Ziel gesetzt, eine offene IT-Pflege-Plattform
f\"{u}r die ambulante Pflege zu erstellen. Die Plattform soll die Kommunikation
und den sicheren Informationsaustausch zwischen allen Beteiligten im Pflegeprozess
erstmals rundum gew\"{a}hrleisten. Der Beitrag erl\"{a}utert die bisherige
Vorgehensweise im Projekt mit dem Ziel eine anwenderorientierte L\"{o}sung aus
bereits bestehenden Komponenten zu entwickeln.}}

					

@Conference{CitationKey,
author = {Ziegler, Volker and M\"{u}ller-Gorchs, Mercè and Rashid, Asarnusch
and Kippnich, Uwe and K\"{o}gerl, Charlotte and Holtmann, Carsten and Griewing,
Bernd},
title = {{Einsatz der 3-Item Stroke Scale (3I-SS) in der pr\"{a}klinischen
Schlaganfallversorgung }},
booktitle = {DGN Deutsche Gesellschaft f\"{u}r Neurologie 2008},
year = {2008},
url = {http://www.dgn2008.de/},
abstract = {Fragestellung: Die National Institute of Stroke Scale (NIHSS) ist
eine klinisch anerkannte Skala zur Bestimmung der Auspr\"{a}gung eines
Schlaganfalls. F\"{u}r die korrekte Messung mittels dieser Skala wird eine gewisse
Zeit ben\"{o}tigt, so dass diese f\"{u}r die pr\"{a}hospitale Anwendung im
Rettungsdienst weniger geeignet ist. Mit der 3-Item Stroke Scale (3I-SS) steht
eine kurze Rating-Scale zur Verf\"{u}gung, die schnell erlernt und angewendet
werden kann. Im Rahmen des Stroke Angel Projektes wurden beide Skalen in der
Klinik mehrfach erhoben, mit dem Ziel, die Vorhersagekraft der 3I-SS auf die
NIHSS zu untersuchen. Methode: Die 3I-SS erhebt 3 Parameter: 1. Vigilanz, 2.
Kopf- und Blickwendung und 3. L\"{a}hmung. Jedes Item wird mit 0 - 2 Punkten
bewertet, so dass maximal 6 Punkte erreichbar sind. Hierbei entsprechen 0 Punkte
einem Normalbefund und 2 einer schweren Auspr\"{a}gung. Im Rahmen des Stroke
Angel Projekts wurden bei 126 Patienten w\"{a}hrend der Aufnahme und im zeitlichen
Verlauf sofern die Patienten noch in der Klinik waren nach 7, 30 und 90 Tagen
mehrfach die 3I-SS und der NIHSS erhoben. Es wurden die Mittelwerte bestimmt
sowie die Kovarianz und die Korrelation berechnet. Ergebnisse: Insgesamt standen
265 Datenpaare f\"{u}r die Auswertung zur Verf\"{u}gung, wobei der 3I-SS-Wert
5 gar nicht und der Wert 6 einmal erhoben wurden. Damit sind die folgenden
Aussagen auf die 3I-SS-Werte 0-4 zu beziehen. Die statistische Auswertung ergab,
dass basierend auf den 3I-SS-Werten die Intervalle f\"{u}r die NIHSS gebildet
werden k\"{o}nnen. Diese sind inklusive der Mittelwerte des NIHSS f\"{u}r den
jeweiligen 3I-SS-Wert in der Tab. 1 abgebildet. Aufgrund der erhobenen Werte,
sprechen die 3I-SS-Werte 0 und 1 f\"{u}r eine leichte (NIHSS 0 - 6 Punkte),
2 und 3 Punkte f\"{u}r eine mittelschwere Sch\"{a}digung (NIHSS 6 -11 Punkte),
bzw. 4 und mehr Punkte f\"{u}r einen starken Funktionsausfall. Schlussfolgerungen:
Unsere bisherige Untersuchung zeigt bereits eine Tendenz zu einem linearen
Zusammenhang zwischen der 3I-SS (Bereich 0-4 Punkte) und der NIHSS. Wie von
Singer erstmals gezeigt, korrelieren auch unsere Ergebnisse sehr stark mit der
NIHSS. Gerade im Hinblick auf den zeitlichen Druck w\"{a}hrend der
pr\"{a}hospitalen Patientenversorgung erscheint ein Einsatz in der
pr\"{a}hospitalen Schlaganfallversorgung damit sinnvoll. Allerdings fehlen Daten
f\"{u}r den oberen Bereich der 3I-SS, so dass weitere Untersuchungen im
rettungsdienstlichen Bereich der pr\"{a}klinischen Schlaganfallversorgung f\"{u}r
eine signifikante Vorhersagekraft notwendig sind.}}

					

@Conference{CitationKey,
author = {M\"{u}ller-Gorchs, Mercè and Rashid, Asarnusch and Ziegler, Volker},
title = {{Stroke Angel: Technologieeinsatz und -bewertung in der Rettungskette}},
booktitle = {41. Jahrestagung der DGBMT - Deutschen Gesellschaft f\"{u}r
Biomedizinische Technik im VDE Aachen, 26.-29. September 2007},
year = {2007},
abstract = {Stroke Angel ist eine interdisziplin\"{a}re Studie, die sich der
Verbesserung der pr\"{a}klinisch-klinischen Schlaganfallversorgung widmet und
mobile Technologien zur Unterst\"{u}tzung von Entscheidungs-, Dokumentations-
und Kommunikationsprozessen zwischen Rettungswagen und Klinik in der Region
Rh\"{o}n-Grabfeld erprobt. Im Rahmen der Studie wurden im Laufe einer
zweij\"{a}hrigen Projektlaufzeit in einem ganzheitlichen Ansatz medizinische,
sozio-technische sowie sozio-\"{o}konomische Potentiale untersucht. Dieser Beitrag
stellt die Resultate der Analyse vor und zeigt auf, wie mobile Technologien
im Rettungsdienst eingesetzt und evaluiert werden k\"{o}nnen.}}