gms | German Medical Science

Introduction: The German Medical Informatics Initiative strives to improve semantic interoperability for data exchange to foster joint research, but also to support patient care. Within the HiGHmed consortium, the Use Case Cardiology establishes a registry of heart failure patients to identify patients with a high mortality rate or at high risk for future hospitalizations [1]. For this purpose, a harmonized data set, based on the data models of the German Center for Cardiovascular Research e.V. (DZHK), is collected from routine clinical practice data. However, especially for medical history, data are often recorded in an unstructured format, making them hardly usable for research.

In order to improve the usability of clinical data, we developed a web application that implements structured forms using the openEHR standard. We further evaluated additional steps necessary in order to integrate the application into clinical routine for various use cases.

State of the art: Many manufacturers of clinical systems offer their own user interfaces for recording data. However, the data is often either only partially structured or stored in a proprietary format and must be mapped in order to be merged with data from other clinical systems, resulting in a loss of information.

Concept & implementation: Using Angular, we built a web application to render forms that can be stored as openEHR compositions in our clinical data repository, the Better platform [2]. We used the tools provided by Better as basis for creating forms from openEHR templates and rendering the forms. The medical history form was developed on the basis of the medical history template [3] in collaboration with the study nurses who use the form to achieve a tailored user experience. Designed to render any openEHR template, however, the application is easily extensible for different use cases.

In the application, patient selection is done by entering the patient identifier, which is validated via an interface with the clinical information system. The application is accessible through the MHH network, and user authentication is managed via OAuth2.0. We use Keycloak as our Authorization Server, which is connected to the Active Directory.

The application is currently in use at three cardiology wards for entering medical history on a tablet at the patient's bedside.

Lessons learned: At the time of writing, we have recorded medical history datasets from 1050 patients, all of them entered by the study nurses via the web application.

In order to integrate the application into clinical routine, further close cooperation with the physicians is essential. We have found that in addition to providing access to the data for research, making the data available for doctors' letters, e.g. in the form of text modules, would be a great benefit. Arrangements have already been made with the MHH IT department, and the implementation is planned.

We already proved the flexible use of the application for different use cases: The application has already been rolled out in study settings at other HiGHmed partners, and is used at MHH to collect data on COVID-19 patients with different openEHR templates.

The authors declare that they have no competing interests.

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