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Model-guided Therapy and Surgical Workflow Systems are two interrelated research fields, which have been developed separately in the last years. To make full use of both technologies, it is necessary to integrate them and connect them to Hospital Information Systems. We propose a framework for integration of Model-guided Therapy in Hospital Information Systems based on the Electronic Medical Record, and a taskbased Workflow Management System, which is suitable for clinical end users. Two prototypes - one based on Business Process Modeling Language, one based on the serum-board - are presented. From the experience with these prototypes, we developed a novel personalized visualization system for Surgical Workflows and Model-guided Therapy. Key challenges for further development are automated situation detection and a common communication infrastructure.
The implementation of a web based portal QA solution will lead to a high acceptance of the staff as the usage of commonly known standard software (e.g. web browser) allows intuitive handling. In the daily use a significant simplification of the workflow and Performance enhancement can be achieved by easy access to the check documents. As the data is now saved in a database it can easily be processed and long-term trends can be displayed. Therefore possible errors can be detected much easier and earlier. By the usage of time stamps and user authentication procedures and user responsibilities are comprehensibly documented. As the software is browser based, integration into an existing software Environment is not critical. As only technical QA data is processed, no further data security measures are necessary. A certification as a medical product is not required.
The amount of image data has been rising exponentially over the last decades due to numerous trends like social networks, smartphones, automotive, biology, medicine and robotics. Traditionally, file systems are used as storage. Although they are easy to use and can handle large data volumes, they are suboptimal for efficient sequential image processing due to the limitation of data organisation on single images. Database systems and especially column-stores support more stuctured storage and access methods on the raw data level for entiere series.
In this paper we propose definitions of various layouts for an efficient storage of raw image data and metadata in a column store. These schemes are designed to improve the runtime behaviour of image processing operations. We present a tool called column-store Image Processing Toolbox (cIPT) allowing to easily combine the data layouts and operations for different image processing scenarios.
The experimental evaluation of a classification task on a real world image dataset indicates a performance increase of up to 15x on a column store compared to a traditional row-store (PostgreSQL) while the space consumption is reduced 7x. With these results cIPT provides the basis for a future mature database feature.
Analysis of multicellular patterns is required to understand tissue organizational processes. By using a multi-scale object oriented image processing method, the spatial information of cells can be extracted automatically. Instead of manual segmentation or indirect measurements, such as general distribution of contrast or flow, the orientation and distribution of individual cells is extracted for quantitative analysis. Relevant objects are identified by feature queries and no low-level knowledge of image processing is required.
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.
Being able to monitor the heart activity of patients during their daily life in a reliable, comfortable and affordable way is one main goal of the personalized medicine. Current wearable solutions lack either on the wearing comfort, the quality and type of the data provided or the price of the device. This paper shows the development of a Textile Sensor Platform (TSP) in the form of an electrocardiogram (ECG)-measuring T-shirt that is able to transmit the ECG signal to a smartphone. The development process includes the selection of the materials, the design of the textile electrodes taking into consideration their electrical characteristics and ergonomy, the integration of the electrodes on the garment and their connection with the embedded electronic part. The TSP is able to transmit a real-time streaming of the ECG-signal to an Android smartphone through Bluetooth Low Energy (BLE). Initial results show a good electrical quality in the textile electrodes and promising results in the capture and transmission of the ECG signal. This is still a working- progress and it is the result of an interdisciplinary master project between the School of Informatics and the School of Textiles & Design of the Reutlingen University.
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.
We present an approach for segmenting individual cells and lamellipodia in epithelial cell clusters using fully convolutional neural networks. The method will set the basis for measuring cell cluster dynamics and expansion to improve the investigation of collective cell migration phenomena. The fully learning-based front-end avoids classical feature engineering, yet the network architecture needs to be designed carefully. Our network predicts how likely each pixel belongs to one of the classes and, thus, is able to segment the image. Besides characterizing segmentation performance, we discuss how the network will be further employed.
Background: Internationally, teledermatology has proven to be a viable alternative to conventional physical referrals. Travel cost and referral times are reduced while patient safety is preserved. Especially patients from rural areas benefit from this healthcare innovation. Despite these established facts and positive experiences from EU neighboring countries like the Netherlands or the United Kingdom, Germany has not yet implemented store-and-forward teledermatology in routine care.
Methods: The TeleDerm study will implement and evaluate store-and-forward teledermatology in 50 general practitioner (GP) practices as an alternative to conventional referrals. TeleDerm aims to confirm that the possibility of store-and-forward teledermatology in GP practices is going to lead to a 15% (n = 260) reduction in referrals in the intervention arm. The study uses a cluster-randomized controlled trial design. Randomization is planned for the cluster “county”. The main observational unit is the GP practice. Poisson distribution of referrals is assumed. The evaluation of secondary outcomes like acceptance, enablers and barriers uses a mixed methods design with questionnaires and interviews.
Discussion: Due to the heterogeneity of GP practice organization, patient management software, information technology service providers, GP personal technical affinity and training, we expect several challenges in implementing teledermatology in German GP routine care. Therefore, we plan to recruit 30% more GPs than required by the power calculation. The implementation design and accompanying evaluation is expected to deliver vital insights into the specifics of implementing telemedicine in German routine care.