gms | German Medical Science

Introduction: Improvement of health services is one of the main aims of hospitals. With clinical follow-up studies, groups of patients are assembled and assesses after hospitalization. Determined by a factor of interest the subjects are contacted by phone with compiled questionnaires and the answers are collected and evaluated with pen and paper. This outcome management of clinical and medical data faced numerous problems, such as time-consuming data collection or multiple patient calls based on a lack of event messaging, data sharing options and reuse of data. We developed a software solution that facilitated more powerful studies with digitized questionnaires, electronic data capture forms and data collection, and support for data exchange between hospital workgroups based on an event driven and reactive HL7 and FHIR aligned software architecture for collaborative work, data interoperability and reuse of data.

Concept: For requirement gathering, we conducted study-nurses surveys, data analysis with rating tables and market research. We created different prototypes and GUI designs that described how the software would look, work, and function. We created class- and workflow diagrams to assist with the development process. The code was data interoperable with a RESTful resource API and HL7 FHIR standard, used frameworks and security libraries, and included testing procedures that made the software efficient, scalable, and robust. We conducted various tests during the build process to eliminate vulnerabilities that the software performed as intended, and was free of bugs and errors. Finally, the software was installed on our own-cloud based servers and the usability was evaluated. We updated the software based on the usability evaluation results and the University Hospital requirements.

Implementation: The basis for our flexible and maintainable system was the alignment between our software design and the clinical hospital domain with a Domain-Driven Design. Our strategic domain design divided the system into smaller, bounded components. Complementary, the tactical domain design identified the entities, relationships, and behavior and developed a four-layer model with GUIs, application services, resources, and adapter with databases. We developed an event-sourced domain model and implemented in the backend and frontend an asynchronous processing of events with a decoupling of the single components. This event-driven architecture supported our strategic domain design and enabled communication between the components with a loose coupling. The reactive and responsive graphical user interface included different listings, electronic data capture forms, and an easy to use questionnaire editor for questions and questionnaire creation. An hospital connector allowed search, transfer, and update of patient data. Additionally, we prioritized data security and privacy in our software architecture and development process.

Lessons learned: Our reactive, collaborative and event-driven software architecture was the suitable solution for our requirements. Reactiveness and real-time events could be used to trigger processes and actions. Additional, our hybrid software development process was agile and could accommodate modifications iteratively in response to evaluation and usability feedback from users. Unfortunately, the existing hospital information system (HIS) will be replaced during the upcoming years. The new HIS integrated with follow-up modules prioritized the new software over the presented one.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.