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Internal fracture fixation represents a widespread concept for the treatment of fractures. As the number of implants increases, person tracking may be possible. In spring 2010 near Rostock (Germany), human remains including a stainless steel nail were found. Forensic analysis considered the parts of skeleton to belong to a man of medium height, exposed to outdoor conditions for several years to a few decades. The tibial nail was analysed and according to the product identification number possible hospitals of implant placement and transportation paths were determined and screened. Furthermore a match analysis of the database of missing individuals of the last 15 years was undertaken and a DNA match analysis identified a local individual who had been missing since winter 2003. Equipped with the actual patient's identity, out of academic interest a survey of clinical documents such as discharge letters and operative reports was performed, but was inconclusive. Although technically feasible, tracking the patient in this case based on the implant product number itself was unsuccessful. In this case report, the feasibility, validity and efficiency of this option are presented and discussed.

Background: Hospitals are implementing a risk management system to avoid patient or surgery mix-ups. The trend is to use preoperative checklists. This work deals specifically with a type of patient identification, which is realized by storing patient data on a patient-fixed medium., Material and Methods: In 127 ENT surgeries data relevant for patient identification were encrypted in a 2D-QR-Code. The code, as a separate document coming with the patient chart or as a patient wristband, has been decrypted in the OR and the patient data were presented visible for all persons. The decoding time, the compliance of the patient data, as well as the duration of the patient identification was compared with the traditional patient identification by inspection of the patient chart., Results: A total of 125 QR codes were read. The time for the decrypting of QR-Code was 5.6 s, the time for the screen view for patient identification was 7.9 s, and for a comparison group of 75 operations traditional patient identification was 27.3 s. Overall, there were 6 relevant information errors in the two parts of the experiment. This represents a ratio of 0.6% for 8 relevant classes per each encrypted QR code., Conclusion: This work allows a cost effective way to technically support patient identification based on electronic patient data. It was shown that the use in the clinical routine is possible. The disadvantage is a potential misinformation from incorrect or missing information in the HIS, or due to changes of the data after the code was created. The QR-code-based patient tracking is seen as a useful complement to the already widely used identification wristband., (© Georg Thieme Verlag KG Stuttgart · New York.)

Electronic health records (EGA), as overall medical applications for the documentation of medical information under the guidance and sovereignty of the patient, change the traditional doctor-patient relationship. Unlike the electronic patient record (EPA), which the treating physician is in charge of, the patient has the sole right to decide who may insert which data into it and who may see his electronic health record (EGA). Thus, the patient's right of informational self-determination and his possibilities to get involved in the treatment process are substantially strengthened. The current situation of the EGA in Germany is described and the parallel development of EGA and EPA is discussed. The electronic health record acquires extensive significance, especially in line with the imminent introduction of the electronic health card on the basis of a standardised telematics infrastructure in Germany.

From 2006 onwards all members of the health insurance system in Germany will be issued an electronic health card which will replace the current health insurance card. The new health card will be technically upgraded to also include patient-related health data or provide access to such data in addition to its administrative functions. Therefore, it is evident that the health card be fitted with a microprocessor that permits authentication (electronic identity check), encryption and the electronic digital signature, thus ensuring maximum data safety and security. For easy identification of the insured person, the electronic health card will bear a photograph of the card holder.

Electronic prescribing shall contribute essentially to improved healthcare services from 2006 onwards in Germany. The desired improvements, however, can only be achieved with "real" telematic solutions. The alternative of pharmaceutical prescription transmission via secure network connections or via electronic health card provides a considerable empowerment to the patients. Electronic prescribing, however, does not provide direct advantages to patients. Benefits for them can be realised by a drug documentation system, ready to identify contraindications or multiple prescriptions. The patients' acceptance of the system to be established therefore largely depends on the concurrent introduction of both elements.

Telematics applications in health care improve patient care in many ways. Especially the improvements through electronic communication, documentation and cooperation between the different providers have high potential for a qualitative and effective health care. Immaterialization of patient records enables their availability as health records across all health care institutions that are involved in the treatment of a patient. However, the realization of a telematic platform in health care raises new questions concerning ethical and technical issues. These questions must be answered in consideration of the interests of citizens, patients, health care providers and insurance companies. Against this background ten critical theses regarding patient-oriented applications in health telematics are presented and discussed. Special attention is paid to the changes in the relationship between patients and physicians and the necessity to establish a new cooperative medical documentation culture, based on controlled vocabularies and where patients and physicians together decide, which information should be added to the central health record, as well as the creation of the necessary trustworthiness and the balance of effective benefit of health telematics and the informational self determination of the patient.

Medication histories as the most common way to document individual drug use provide a valuable database. Their main purpose is to check the patient's medication for so-called drug-related problems such as interactions, compliance problems, adverse drug reactions, and others. A second concern is to gain epidemiological evidence which increases the knowledge about benefits and risks of drugs including economic consequences. By referring to well-accepted principles of data protection, the documentation of drug use data has to be an essential part of complex care programmes which allows improvement of the individual drug therapy by reducing possible risks and increasing the therapeutic outcome of drug use more effectively. In addition, systematic drug documentation can be used to build structured databases which usually make use of prescription data. Given that principles of data protection, especially with regard to anonymity, are considered such databases provide an opportunity of data linkage with other health-related information such as health care services or number of sick leave days. Regardless of certain methodological limitations, these databases can also be used for health economics research and evaluation.

The German law for the modernization of statutory health care defines a functional framework for the upcoming telematics infrastructure in health care based on electronic health professional cards, electronic patient data cards and the necessary information, communication and security infrastructure. The currently ongoing discussion for the implementation is strongly influenced by diverse particulate interests often hindering systematic development. This article presents the fundamental technical mechanisms usable for a stepwise and expandable solution. The interdependence of the components is illustrated using the example of the ATG concept for an electronic patient record. These facts call for a stepwise implementation of telematic infrastructure based on the presented mechanisms.

The user acceptance of health telematics in medical care plays a critical role in mediating the success of its implementation. Model assumptions evolving from different fields such as industry, health care and medical psychology are presented, and various perspectives for patients and providers involved in these models are highlighted. The impact of health telematics on health care results from four components: (a) the improvement of work characteristics and communication processes, (b) the enhancement of diagnostic and treatment quality via telematics, (c) technical and economic advantages and (d) communication tools for patient. The evidence concerning clinical, economic and psychosocial criteria within these domains is reviewed according to the published literature. Despite the fact that a considerable benefit of health telematics has been shown in individual studies, the evidence concerning the improvement of health care, the improvement of work and communication processes as well as concerning its clinical and cost effectiveness is still scarce. It is recommended to further integrate health telematics and health service research.