Project Description (Subproject C.5)

Starting Point

For an effective and efficient treatment of glaucoma patients a continuous control of several medical factors (e.g. inner ocular pressure, medication, allergies, form and degree of the glaucoma) is necessary. Thereby, the specific patient's context has to be taken into consideration (e.g. the course of disease, the history of medical treatment). Many of these information are meanwhile managed electronically. An effective research in the area of glaucoma is only possible, if the medical data, stemming from these various sources are consistent and are harmonized with each other. Many of the data are derived from patient data. The electronic management of these many data is good for increasing the quality of patients' treatments, supports research work since multiple examinations analyses of the data are made possible (e.g. benchmarking, statistical analysis).

Scenarios

Data Logistics as a concept to improve the quality of input data for statistical analysis (Subproject C.1) )

The goal of this project is to analyze, what the results of a loss of nerve fibers are to the visual field of a patient. To do so, data from different sources has to be accounted for. Relevant information are the patients anamnesis from the Glaukom Registry, test results of the visual field created by the Octopus system and raw data created by testing for multifocal ERG and multifocal VEP. All this data has to be transferred into the statistical database, including a great amount of image data. To achieve statistical conclusion of high quality, it is important that the data remains unchanged and uninterpreted. Any modification to the input data would result in a falsification of the statistic. Thus, the data should preferably be transferred to the statistical database right after they have been generated (Teilprojekt Z). Aspects of data protection also have to be considered. Therefore, the data has to be made anonymous before transmission using a global patient identification number. Identity information, that enables a reunification of the data, has to be transferred separately.

Utilization of DataLogistics for improvement of the medical treatment of glaucoma-patients, involving self tonometry data

Self tonometry is the process of collecting the inner ocular pressure values of both eyes from the patents themselves, and sending them to the ophthalmic university clinic of Erlangen together with the blood pressure and the heart rate. In this context, the data from the interactive dialog system must be transferred in the Glaucoma-register as shown in the figure on the left. The Glaucoma-register is eventually set in a patient-specific context - in other words it is merged, on the basis of a globally unique patient identifier, with the existing data and the anamnesis of the respective patient. The measurements report, which is set in the patient-specific context, must be validated against a set of clinical and medical rules. If needed, it might be presented for inspection to the appointed doctor, performing the treatment. For this reason diverse information, of relevance to the responsible doctor, can be added, e.g. background information as in the case of ophthalmology at www.onjoph.com.

Method of Resolution

Parts of the IntDaLog system

The following picture provides an overview of the architecture. "Data entry" represents the different kind of data input, e.g. a telephon based entry of medical data of the so called "Self tonometry", where the patient is entering his data with the touch tone system. Or a surgery report, which is entered through a web form. The arrow "Data presentation" stands for the different kinds of outputs, where information is exchanged with e.g. the patient or the physician. PDL in the centre allows to control the data flow according to medical or clinical rules (process models). The data is than provided as required (e.g. all required patient data for a finding) without additional effort from the physician. The lower part depicts the integration of PDL with existing clinical IT infrastructure.

Method

1. Record Clinical Processes

   First the relevant medical and clinical processes, especially of the research area "diagnosis and conservative therapy of glaucoma patients" are examined. The result is a process oriented model that describes when data and what kind of data is produced (i.e. "generated", e.g. by user input) and consumed (i.e. "used", e.g. for reports) by which IT system. This model describes the preferred processing order of the medical application. By using a process based approach it is possible to ensure that the discovered work sequences have been designed close to optimal.

2. Derive the necessary data logistics information of the involved IT systems

   The process oriented modeling of the glaucoma patient treatment processes is not intended to develop a classical medical workflow, but to serve as basis for the intelligent data logistics. Starting with an optimized process model, we check which IT systems have to be supplied with what data (originating from other IT systems), in order to enable high quality treatment of glaucoma patients. Together these requirements define the tasks for the intelligent data logistics system IntDaLog. These tasks themselves have to be defined as data logistic processes. All necessary information regarding data consumption and supply, especially interface definitions and data flow, is stored in a central repository.

Advantages of Secondary Process Support

• It enables the medical users' freedom and flexibility for their daily work. The core medical processes are not controlled directly by the data logistics system. This flexibility cannot be achieved by workflow concepts in medical environments.
• By the data logistics (data supply and propagation for IT systems) running in the background, this approach enables for more quality in medical processes.
• The medical staff can use its IT systems as usual and does not have to learn how to use an additional system.