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In this work, a web-based software architecture and framework for management and diagnosis of large amounts of medical data in an ophthalmologic reading center is proposed. Data management for multi-center studies requires merging of standing data and repeatedly gathered clinical evidence such as vital signs and raw data. If ophthalmologic questions are involved the data acquisition is often provided by non-medical staff at the point of care or a study center, whereas the medical finding is mostly provided by an ophthalmologist in a specialized reading center. The study data such as participants, cohorts and measured values are administrated at a single data center for the entire study. Since a specialized reading center maintains several studies, the medical staff must learn the different data administration for the different data center. With respect to the increasing number and sizes of clinical studies, two aspects must be considered. At first, an efficient software framework is required to support the data management, processing and diagnosis by medical experts at the reading center. In the second place, this software needs a standardized user-interface that has not to be trained/taylore /adapted for each new study. Furthermore different aspects of quality and security controls have to be included. Therefore, the objective of this work is to establish a multi purpose ophthalmologic reading center, which can be connected to different data centers via configurable data interfaces in order to treat various topics simultaneously.
Clinical reading centers provide expertise for consistent, centralized analysis of medical data gathered in a distributed context. Accordingly, appropriate software solutions are required for the involved communication and data management processes. In this work, an analysis of general requirements and essential architectural and software design considerations for reading center information systems is provided. The identified patterns have been applied to the implementation of the reading center platform which is currently operated at the Center of Ophthalmology of the University Hospital of Tübingen.
This work is a report on practical experiences with the issue of interoperability in German practice management systems (PMSs) from an ongoing clinical trial on teledermatology, the TeleDerm project. A proprietary and established web-platform for store-and-forward telemedicine is integrated with the IT in the GPs’ offices for automatic exchange of basic patient data. Most of the 19 different PMSs included in the study sample lack support of modern health data exchange standards, therefore the relatively old but widely available German health data exchange interface “Gerätedatentransfer” (GDT) is used. Due to the lack of enforcement and regulation of the GDT standard, several obstacles to interoperability are encountered. As a partial, but reusable working solution to cope with these issues, we present a custom middleware which is used in conjunction with GDT. We describe the design, technical implementation and observed hindrances with the existing infrastructure. A discussion on health care interfacing standards and the current state of interoperability in German PMS software is given.