Biomedical subjects
Publications and source records attributed to J Dudeck.
This paper discusses some experiences with the integration of a tumor documentation system into a distributed healthcare environment using a new European middleware technology. Although the middleware already offers a considerable support to the software engineer, further facilities have been suggested and partially implemented in order to accelerate integration scenarios.
The concept of maintaining a medical data dictionary as a HIS core component was fundamental for all HIS development phases since the mid eighties at Giessen University Hospital. Being influenced by an early experimental installation of the HELP hospital information system and its PTXT data dictionary, we kept this approach through a number of development cycles of our own hospital information system. While our first data dictionary implementation (GMDD) was still very close to the PTXT structure (polyhierarchical design with an eight level hierarchy), the second generation dictionary (MDD-GIPHARM) has already been designed using a more flexible semantic network model. GMDD was a mainframe development (realized on Tandem Computers) based on the Tandem Nonstop SQL RDBMS. The major clinical applications established on top of the GMDD were laboratory results review, diagnosis documentation and physician discharge summaries. The MDD-GIPHARM development was initiated on PC-basis as the core of a rheumatology departmental system using MS-Access and then further enhanced within a research project to build knowledge-based functions for drug therapy. A first set of such functions based on MDD-GIPHARM is in routine use since 1996. Our current focus is to enhance MDD-GIPHARM towards an application independent vocabulary server (GDDS), which may be used for a variety of applications with the intranet of Giessen University Hospital. In this paper the evolutionary development of those data dictionary concepts at Giessen University Hospital is illustrated and compared with international activities in the last decade.
Since 1985 a special work group involved in the coordination of hospital cancer registries in Germany (AKKK) has been collecting, storing and analysing data on tumour patients, received from cancer centres, oncological departments and specialised practices. The documentation of tumour patients is based, among other things, on information concerning localisation, histological findings and tumour spread. The data are stored in a central database administered by the work group. At present it contains data on approximately 500,000 oncological patients. In the period from 1987 to 1992, 56,013 initial entries were made concerning patients with urological tumours. Of these cases, tumours of the kidney (n = 11,424) constituted 20.4%. In 94.6% of the cases, histological investigation revealed a renal cell carcinoma-pT1: 5.8%; pT2: 53.6%, pT3: 37.2% and pT4: 3.4%. Tumours of the urinary bladder (n = 16,246) constituted 29.0% of all urological tumours. In 93.8% of the cases a transitional cell carcinoma was detected-pTis: 1.0%; pTa: 36.9%; pT1: 29.6%; pT2: 16.9%; pT3: 11.4%; pT4: 4.4%. Transitional cell carcinomas of the ureter or of the collecting system (n = 1,846) constituted 3.3% of the cases. The proportion of testicular tumours (n = 6,594) amounted to 11.8%; 53.6% of these germ-cell tumours (n = 6,281) were seminomas and 46.6% were non-seminomas. In all, 66.3% of the cases were lymph-node negative. Tumours of the prostate (n = 19,903) constituted 35.5% of the cases. In the period from 1987 to 1992, the proportion of lymph-node-positive prostate carcinomas decreased from 39.8% to 16.2%. The detailed analysis of these data shows how the hospital cancer registries can support the discussion regarding diagnosis and therapy of urological tumours.
Communication standards are to facilitate the exchange of structured data and information between healthcare systems with different architectural concepts. Several national and international standard development organizations (SDO) are developing and maintaining standards, sometimes even for the same application. There is an increasing demand for a closer cooperation between SDO's and for a better harmonization of different standards going on. The current status of the most important standard application in healthcare is discussed and some further considerations for improving the harmonization process will be given.
The following paper analyses the transition from a host centered to a client-server based Hospital Information System (HIS) which takes place at the University Hospital of Giessen, Germany, since 1995. It focuses on the overall concept and practical realisation of the cornerstone within this transition, the Macintosh Mosaic Software Architecture (MMSA) which delivers now more than 90% of the clinical data which is entered on the wards and within the operating rooms. Besides the technical problems of the project, the paper also describes some aspects of the organisational challenges which took place within a typical German University Hospital during the last 4 Years and which mainly affect the daily management of a large HIS.
Explore the source record for details and available documents.
This paper discusses some experiences with the integration of a tumor documentation system into a distributed healthcare environment using a new European middleware technology. Although the middleware already offers a considerable support to the software engineer further facilities have been developed in order to accelerate integrations. Such facilities arised from the software engineering principle of separating reusable parts and non-reusable parts.
New functions have been integrated in the Giessen Hospital Information System WING to support the classification of all intensive care patients into the Therapeutic Intervention Scoring System TISS. The use of those functions has been pushed by legal requirements which made it essential to assess the staffing of intensive care wards in comparison with the accumulated TISS scores. This paper describes the experiences made within two years of TISS scoring. We think that TISS gave a major impact to the construction and implementation of nursing documentation into our HIS.
Integrating autonomous applications is a difficult task since they usually represent similar informations in different data schemes. Any communication requires an agreement of sender and receiver on a common data representation. The number of interfaces to convert one data representation into another is minimized if all participants of an information system agree on one data representation such as Health Level Seven (HL7) or Edifact. Even more convenient is the use of a middleware solution like the Distributed Healthcare Environment (DHE) that keeps message transfer completely transparent to the integration process. This paper discusses a project that aims at the integration of a cancer registry system into a DHE based Hospital Information System (HIS). The project is a cooperation between the universities of Giessen and Magdeburg within the framework of the European Communities Telematics Research Project HC 1019 HANSA (Healthcare Advanced Networked System Architecture). The concept of a so called 'DHE-Adapter' to integrate existing legacy systems is explained. This adapter converts a data or message format of a legacy system into calls of the DHE programming interface. To develop a DHE-Adapter for our cancer registry system we intend to design a DHE-Adapter-Generator which would be able to produce DHE-Adapters for different systems and export formats, e.g. HL7 or Edifact. That would allow a variety of software vendors to integrate their products into the DHE without entering deeply into the DHE's programming interface.
Current database management systems, client-server architecture and the internet infrastructure are simplifying the exchange of information. Large and widespread electronic medical record systems are accessible via platform-independent browsing applications. The following brief summary shows one of the manifold conceivable applications of these technologies in medicine. It describes a survey among physicians with the scope of quality assurance in medicine. The dynamic, platform-independent, world-wide access to databases offers interesting aspects in medical informatics.
The "Methodology for the Development of Health Care Messages" was published in 1995 by CEN TC251. This contribution describes the application of the methodology in a project of developing messages for the exchange of tumour patient data. A standard data set, the "Basisdokumentation für Tumorkranke" was already available for the data of tumour documentation. The development of the messages as well as the design and implementation of a communication interface in a documentation system could therefore be carried out straight forward. Problems arise due to the import of data from different sources. Up to now, there is no standardized method for identifying patients and numbering of different tumours. An automated matching of new data to a specific patient or tumour is therefore not always possible. Methods are presented which try to make a compromise between fully automatic data import and complete user control.
Patient Care Evaluation Studies are valid tools of quality management in oncology. With the use of modern methods of medical informatics, epidemiology and biometrics, the acceptance of tumor documentation in the clinical routine will be improved. We will describe the ideas behind the concept of the PCE studies.
In this paper we present the introduction of knowledge based functions into clinical routine at Giessen University Hospital. For this purpose a therapy planning module at the medical intensive care unit has been extensively redesigned in order to support the structured documentation of drug prescriptions. After introduction of this new HIS component in January 1996 research has been initiated to establish a basic drug therapy knowledge base. The main components of a knowledge based system have been fully incorporated into the hospital information system WING and are in routine use since December 1996. During a pre-production phase warnings of reminder functions were logged and reviewed by an interdisciplinary team in order to adapt the system to the actual clinical environment. The paper describes experiences during this fine tuning and adaptation process which was necessary to bring a small set of knowledge modules into clinical routine.
German hospital tumor registries play an active role in the treatment of cancer patients. Besides the documentation of the course of a disease, they directly support medical treatment and follow-up care over a long period. As the treatment of oncologic patients is a shared multidisciplinary task, the availability of information is one of the most valuable outputs. Therefore, the documentation has to be integrated into the medical treatment, which only can be achieved when useful services are based on it. Since 1983 the basis of the documentation has been a uniform basic data set which was revised in 1990 and, according to be requirements mentioned above, allows detailed documentation, especially of therapy. During the last four years a new documentation system for tumor diseases has been developed and was implemented in 30 hospital tumor registries by the "Arbeitsgruppe zur Koordination Klinischer Krebsregister". The so-called "Giessener Tumordokumentationssystem" (GTDS) is the basis of the work in those registries. In this paper the functions and services which were implemented in order to support the individual treatment of oncologic patients and the methods of collecting and delivering that information to the physician are presented.
The paper describes the design and implementation of a software architecture for a low cost bedside workstation for intensive care units. The development is fully integrated into the information infrastructure of the existing hospital information system (HIS) at the University Hospital of Giessen. It provides cost efficient and reliable access for data entry and review from the HIS database from within patient rooms, even in very space limited environments. The architecture further supports automatical data input from medical devices. First results from three different intensive care units are reported.
For the development of a rheumatology information system, a medical data dictionary was developed that supports all phases of software development. In the design phase, the medical expert described his clinical environment and the rheumatology medical record in a semantic network structure. Causal relationships between different items of the medical record (e.g., a problem may be related to an adverse drug event caused by a particular drug) are also represented in the semantic network and transferred into referential integrity constraints of the patient database. Furthermore, by also integrating the domain management as a feature of the medical data dictionary, the elementary attributes of the medical record and the associated lists of valid attribute entries have also been defined within the semantic network. This structure allowed the automatic generation of data entry screens, thus making the clinical applications as independent from any hardcoded program module as possible.
This paper is intended to give you an overview about the migration process of the Hospital Information System (HIS) at the University Hospital of Giessen towards an open client server based architecture. It describes the software architecture of the existing mainframe applications and the network interfaces involved in opening the centralized software architecture to a wide variety of remote applications.
In Germany, computer systems have been used in hospital cancer registries for more than 10 years. Primarily, they have been used for retrospective documentation of malignant tumors, and these resources have rarely been tapped for the support of follow up care and statistical evaluation. In response to the increasing availability of PC-systems and growing interest in computer networks, we have decided to design and develop a new oncology information system which covers two important aspects of oncology care: (1) the documentation of all relevant data items for the cancer registries, and (2) the routine support of the physician in the clinical treatment process. In this paper we discuss the design and concept of this oncology information system as well as experiences gained during the development process are discussed. Future plans to further extend the system to a comprehensive oncology workstation are presented.