Towards Implementation of OMOP in a German University Hospital Consortium.

BACKGROUND: In 2015, the German Federal Ministry of Education and Research initiated a large data integration and data sharing research initiative to improve the reuse of data from patient care and translational research. The Observational Medical Outcomes Partnership (OMOP) common data model and the Observational Health Data Sciences and Informatics (OHDSI) tools could be used as a core element in this initiative for harmonizing the terminologies used as well as facilitating the federation of research analyses across institutions. OBJECTIVE: To realize an OMOP/OHDSI-based pilot implementation within a consortium of eight German university hospitals, evaluate the applicability to support data harmonization and sharing among them, and identify potential enhancement requirements. METHODS: The vocabularies and terminological mapping required for importing the fact data were prepared, and the process for importing the data from the source files was designed. For eight German university hospitals, a virtual machine preconfigured with the OMOP database and the OHDSI tools as well as the jobs to import the data and conduct the analysis was provided. Last, a federated/distributed query to test the approach was executed. RESULTS: While the mapping of ICD-10 German Modification succeeded with a rate of 98.8% of all terms for diagnoses, the procedures could not be mapped and hence an extension to the OMOP standard terminologies had to be made.Overall, the data of 3 million inpatients with approximately 26 million conditions, 21 million procedures, and 23 million observations have been imported.A federated query to identify a cohort of colorectal cancer patients was successfully executed and yielded 16,701 patient cases visualized in a Sunburst plot. CONCLUSION: OMOP/OHDSI is a viable open source solution for data integration in a German research consortium. Once the terminology problems can be solved, researchers can build on an active community for further development.

Audit on the usage of plasma derived/recombinant coagulation factor concentrates at a German university hospital.

BACKGROUND: There is a lack of data on the usage of plasma derived/recombinant coagulation factor concentrates (PD/RCFC) regarding diagnostic categories. An audit of PD/RCFC and blood component usage at a tertiary care teaching hospital in northern Bavaria was conducted. STUDY DESIGN AND METHODS: All blood components and PD/RCFC transfused at a university hospital (Erlangen, Germany) during the year 2006 were analysed. Transfused blood products were listed by major diagnostic categories (MDC) formed from principal diagnoses of recipients according to the International Classification of Diseases, tenth revision and German modification. RESULTS: Blood component usage has markedly increased since last surveyed in 1994 through 1996. The diagnostic categories responsible for most transfusions have not changed since. Antithrombin is the PD/RCFC used most, whereas most money for PD/RCFC was spent on FVIII concentrates. Polytrauma patients need most fibrinogen, whereas most of FXIII is needed in patients with malignancies. Patients with prolonged artificial ventilation receive PCC most often. Altogether, three MDCs (Pre, 17, 05) accounted for 80·5% of costs created by PD/RCFC transfusion. CONCLUSION: This study provides for the first time combined data on blood component and PD/RCFC usage in a German university hospital. It shows that the MDCs responsible for most of the costs in transfusion therapy with blood components and with PD/RCFC are few, and are the same. At the same time, blood bank information software should be further improved in order to be able to identify new trends in hemotherapy in more detail.

Applicability of Lewin s change management model in a hospital setting.

OBJECTIVES: Today's socio-economic developments in the healthcare area require continued optimization of processes and cost structures at hospitals, often associated with process changes for different occupational groups in the hospital. Formal methods for managing change have been established in other industries. The goal of this study was to assess the applicability of Kurt Lewin's change management method to a health informatics-related project at a German university hospital. METHODS: A project at the University Hospital Erlangen introducing changed requirements in the documentation of costly material in the surgical area was conducted following the concept of Lewin's approach based on field theory, group dynamics, action research and the three steps of change. A data warehouse contributed information to several steps in the change process. RESULTS: The model was successfully applied to the change project. Socio-dynamic forces relevant to the project goals were identified and considered in the design of the new documentation concept. The achieved documentation level met the new requirements and in some areas even exceeded them. CONCLUSIONS: Based on the project experiences, we consider Kurt Lewin's approach applicable to change management projects in the hospital sector without a requirement for substantial additional resources, however, specific hospital characteristics need to be taken into account. The data warehouse played an important role by providing essential contributions throughout the entire change process.

[Web-based electronic patient record as an instrument for quality assurance within an integrated care concept]. / Webbasierte elektronische Krankenakte im Rahmen eines integrierten Versorgungskonzepts als Instrument der Qualitätssicherung.

OBJECTIVE: A prerequisite for integrated care programmes is the implementation of a communication network meeting quality assurance standards. Against this background the main objective of the integrated care project between the University Eye Hospital Erlangen and the health insurance company AOK Bayern was to evaluate the potential and the acceptance of a web-based electronic patient record in the context of cataract and retinal surgery. METHODS: Standardised modules for capturing pre-, intra- and post-operative data on the basis of clinical pathway guidelines for cataract- and retinal surgery have been developed. There are 6 data sets recorded per patient (1 pre-operative, 1 operative, 4-6 post-operative). For data collection, a web-based communication system (Soarian Integrated Care) has been chosen which meets the high requirements in data security, as well as being easy to handle. This teleconsultation system and the embedded electronic patient record are independent of the software used by respective offices and hospitals. Data transmission and storage were carried out in real-time. RESULTS: At present, 101 private ophthalmologists are taking part in the IGV contract with the University Eye Hospital Erlangen. This corresponds to 52% of all private ophthalmologists in the region. During the period from January 1st 2006 to December 31st 2006, 1844 patients were entered. Complete documentation was achieved in 1390 (75%) of all surgical procedures. For evaluation of this data, a multidimensional report and analysis tool (Cognos) was used. The deviation from target refraction as one quality indicator was in the mean 0.09 diopter. CONCLUSIONS: The web-based patient record used in this project was highly accepted by the private ophthalmologists. However there are still general concerns against the exchange of medical data via the internet. Nevertheless, the web-based patient record is an essential tool for a functional integration between the ambulatory and stationary health-care units. In addition to the telemedicine functions of the system, we achieved the export of the data to a data warehouse system in order to provide a flexible and powerful tool for quality assurance analysis and reporting.

[A multidisciplinary mModule for oncological documentation within a hospital information system]. / Ein interdisziplinäres Modul zur onkologischen Dokumentation in einem Klinikinformationssystem.

The follow-up documentation of oncological patients in Germany is inadequate in many cases: it is usually limited to a minimal dataset mandated by the epidemiological tumor registers; it is carried out in a paper-based fashion and rarely in a multi-disciplinary context. Parallel documentation efforts can result in redundant or erroneous data and excess work. The introduction of hospital information systems (HIS) allows the implementation of digital oncological documentation systems integrated in surrounding clinical workflows that can provide access to existing data sources as well as data entry and presentation across departmental boundaries. This concept enables the integration of tumor documentation, quality assurance and process optimization within HIS. Feasibility requirements include a high flexibility and adaptability of the underlying HIS to reach a seamless integration of oncological documentation forms within routine clinical workflows. This paper presents the conceptual design and implementation of a modular oncological documentation system at the Muenster University Hospital that is capable of integrating the documentation requirements of multiple departments within the hospital.

[Telemedicine in pediatric oncology]. / Telemedizin in der Pädiatrischen Onkologie - Ergebnisse einer Fragebogenaktion des Kompetenznetzes Pädiatrische Onkologie -

UNLABELLED: The telemedicine project of the Competence Net Pediatric Oncology of the German/Austrian Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) has as an initial step of its work-programme sent out a questionnaire to the 54 largest pediatric hematology/oncology units in Germany. Institutions were asked for their experience, motivation, existing infrastructure, and anticipated benefits and obstacles regarding the implementation of telemedicine in patient care and research. Of the 54 largest German Pediatric Oncology institutions asked, 46 completed the questionnaire (85 %). RESULTS: 1. The need for further detailed information on implementation and for help in technical realization of telemedicine applications was expressed by all participants. 2. The majority expected practical advantages from telemedicine communication and anticipated that telemedicine will increase quality in treating children with cancer. 3. Expert consultation (study chairman, reference radiologists) is stated as to be most important. 4. Thirty-three of 46 physicians (72 %) believe that telemedicine will reduce costs in medical care within the next years. 5. It is anticipated that the introduction of telemedicine is time consuming. 6. The lack of available medical informatics competence and manpower was regarded as the most important obstacle. 7. Data security and standardization, transfer speed and transmission quality are considered most important. 8. Most of the institutions (91 %) use computers in the management of patients. Fourty-four (96 %) are connected to the Internet. 9. Thirty-seven of 46 institutions were prepared to invest in the implementation of telemedicine. This analysis demonstrates that the use of telemedicine is expected to become standard in pediatric oncology, while the existing infrastructure and status of information regarding this subject at present are insufficient. The most pressing practical need for telemedicine applications is seen in the field of electronic expert consultation. Hence, the Telemedicine-Project of the GPOH Competence Net will focus on this aspect first.

[Formal decision aids in surgery--results of a survey]. / Formale Entscheidungshilfen in der Chirurgie--Ergebnisse einer Umfrage.

Even though many decision-aids have been developed in the past, the application of these systems in clinical practice is still rare. There are many reasons for this, including the reservations of potential users. A survey in three university surgery clinics was conducted to assess the experience and attitudes towards decision-aids among physicians. Seventy-two of the 102 physicians approached (71%) filled out and returned the short questionnaire that was sent to them. More than half of the 72 survey participants already use decision-aids. Among them, guidelines are used most often (46%), whereas other instruments (algorithms, scores, decision trees) are used less frequently (10-17%). Computer-based decision-aids are hardly used at all (7%). These results are in contrast to the strong request for more decision-aids, especially for computer-based systems (40%). Physicians who already use decision-aids are more interested in additional systems. More than 70% of all participants are interested in more information about the topic. The standardized question about attitudes towards computer-based decision-aids reveals more positive than negative appraisal, whereas the answers to open questions focus more on objections. The substantial differences between the three survey locations in parts of the survey results show that attitudes towards decision-aids are influenced by the way the instruments are introduced and the way the users are informed and involved in the process of implementation. A successful implementation of decision-aids in clinical practice should therefore try to integrate the future users as much as possible.