Structured, Harmonized, and Interoperable Integration of Clinical Routine Data to Compute Heart Failure Risk Scores.

Risk prediction in patients with heart failure (HF) is essential to improve the tailoring of preventive, diagnostic, and therapeutic strategies for the individual patient, and effectively use health care resources. Risk scores derived from controlled clinical studies can be used to calculate the risk of mortality and HF hospitalizations. However, these scores are poorly implemented into routine care, predominantly because their calculation requires considerable efforts in practice and necessary data often are not available in an interoperable format. In this work, we demonstrate the feasibility of a multi-site solution to derive and calculate two exemplary HF scores from clinical routine data (MAGGIC score with six continuous and eight categorical variables; Barcelona Bio-HF score with five continuous and six categorical variables). Within HiGHmed, a German Medical Informatics Initiative consortium, we implemented an interoperable solution, collecting a harmonized HF-phenotypic core data set (CDS) within the openEHR framework. Our approach minimizes the need for manual data entry by automatically retrieving data from primary systems. We show, across five participating medical centers, that the implemented structures to execute dedicated data queries, followed by harmonized data processing and score calculation, work well in practice. In summary, we demonstrated the feasibility of clinical routine data usage across multiple partner sites to compute HF risk scores. This solution can be extended to a large spectrum of applications in clinical care.

An Apple Watch Dashboard for HiGHmed Heart Insufficency Patients.

Wearables are commercially available devices allowing continuous monitoring of users' health parameters. Their easy availability, increasing accuracy and functionality render them relevant for medical practice, specifically for longitudinal monitoring. There are clear benefits for the health care system, such as the opportunity of timely interventions by monitoring a patient during his daily life, resulting in a cost reduction in medical care and improved patient well-being. However, some tools are essential to enable the application of wearables in medical daily practice. For example, there is a need for software solutions that allow clinicians to quickly and easily analyze data from devices of their patients. The goal of this study was to develop a dashboard for physicians, which allows rapid data interpretation of longitudinal data from the Apple Watch. The prototype dashboard is an interactive web-based visualization platform utilizing Plotly. The dashboard displays the most important parameters like heart rate, steps per day, activity, exercise collected by the Apple Watch in a user-friendly and accessible way. Clear visualization makes it easy to identify trends or deviations in the data and see how these changes in daily behaviour affect patients' health. Our software is a key component to monitor patients with heart failure who participate in the HiGHmed use case cardiology project.

Preliminary Analysis of Structured Reporting in the HiGHmed Use Case Cardiology: Challenges and Measures.

The HiGHmed consortium aims to create a shared information governance framework to integrate clinical routine data. One challenge is the replacement of unstructured reporting (e.g. doctoral letters) with structured reporting in clinical routine. The Heidelberg cardiology department evaluates dynamic PDF forms for structured data reporting of heart failure (HF) patients. In this use case, we aim to identify potential caveats or shortcomings in data processing at an early stage. We employed data mining strategies to detect patterns related to incomplete or false data, which we found to be present among all data types. We then discuss the characteristics of the baseline patient cohort in Heidelberg to find out about specific peculiarities and potential biases, which may be site-specific. Briefly, our patient population is predominantly male (67%), NYHA I & II are the most common severity classes, NYHA IV is missing entirely. Most patients have a dilated cardiomyopathy (DCM) or coronary heart disease (CHD) diagnosed as their cause of HF. Finally, we also analyzed how comorbidities and risk factors relate to specific disease entities of heart failure patients. Family anamnesis was more frequent among cardiomyopathy patients than among CHD patients, who show a more dominating presence of dyslipidemia instead. Generally, the most dominant risk factor was arterial hypertension, while at the other end of the scale alcoholism appears to be underreported.

MedEx - Data Analytics for Medical Domain Experts in Real-Time.

Translational research in the medical sector is dependent on clear communication between all participants. Visualization helps to represent data from different sources in a comprehensible way across disciplines. Existing tools for clinical data management are usually monolithic and technically challenging to set up, others require a transformation into specific data models while providing mostly non-interactive visualizations or being specialized to very particular use cases. Statistical programming languages (R, Julia) on the other hand offer great flexibility in data analytics, but are harder to access for clinicians with little to no programming expertise. Our software, the Medical Data Explorer (MedEx), aims to fill this gap as light-weight, intuitive, web-based solution with simple data import routes. We couple a modern dynamic web interface with an in-memory database solution for near real-time responsiveness. MedEx provides multiple visualization options (Scatterplot, correlation heatmap, bar chart, grouped boxplot, grouped histogram, coplot) to get an easy overview on the loaded data as well as to perform pattern discovery and elementary statistics. We demonstrate the utility of MedEx, by example, on data from the cardiology research warehouse of Heidelberg University Hospital. In summary, our tool empowers clinicians to conduct their own interactive exploratory data analysis.

The role of 11-cis-retinyl esters in vertebrate cone vision.

A cycle of cis-to-trans isomerization of the chromophore is intrinsic to vertebrate vision where rod and cone photoreceptors mediate dim- and bright-light vision, respectively. Daylight illumination can greatly exceed the rate at which the photoproduct can be recycled back to the chromophore by the canonical visual cycle. Thus, an additional supply pathway(s) must exist to sustain cone-dependent vision. Two-photon microscopy revealed that the eyes of the zebrafish (Danio rerio) contain high levels of 11-cis-retinyl esters (11-REs) within the retinal pigment epithelium. HPLC analyses demonstrate that 11-REs are bleached by bright light and regenerated in the dark. Pharmacologic treatment with all-trans-retinylamine (Ret-NH2), a potent and specific inhibitor of the trans-to-cis reisomerization reaction of the canonical visual cycle, impeded the regeneration of 11-REs. Intervention with 11-cis-retinol restored the regeneration of 11-REs in the presence of all-trans-Ret-NH2. We used the XOPS:mCFP transgenic zebrafish line with a functional cone-only retina to directly demonstrate that this 11-RE cycle is critical to maintain vision under bright-light conditions. Thus, our analyses reveal that a dark-generated pool of 11-REs helps to supply photoreceptors with the chromophore under the varying light conditions present in natural environments.