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Processing of medical data:experience with a finished project
Ladislav Jirsa
Academy of Sciences of the Czech Republic
Institute of Information Theory and Automation
Adaptive Systems
ČSKI, ÚTIA AV ČR, 19.2.2008
Information Society Project 2004–2007
• ÚTIA AV ČR (dept. AS)
• UK 2.LF (Inst. of Biophysics, Informatics…)
• Motol Hospital (Clinic of Nuclear Medicine and Endocrinology (KNME))
ČSKI, ÚTIA AV ČR, 19.2.2008 2
Goals:• collect all clinical data and unify heterogenous data sources,
• improve tools for data processing,
• process the data with the tools and design an advisory system for individual dosage,
• the results are to be applied at the KNME.
Partners:
Clinic of Nuclear Medicine and Endocrinology
• dealing with nuclear medicine
• successful in treatment of thyroid diseases by 131I
• employing doctors, physicists, supervising engineers, medical staff etc.
• computers and information technologies available
• forced by law to monitor radiation load on patients and staff
ČSKI, ÚTIA AV ČR, 19.2.2008 3
we know, that• monitoring needs measurement,
computations, data processing
• computation attracts engineers
Historical remarks
ČSKI, ÚTIA AV ČR, 19.2.2008 4
An engineer wanted to remove the burden of using calculator for the same computations from the colleagues and to utilize the modern machines (ancient today).
the first contact of medicine and computation:
…and it triggered many future activities
Development of the data processing etc.
ČSKI, ÚTIA AV ČR, 19.2.2008 5
staff
engineers
“scientists”
programmers
doctors
1
1. manual processing of dosimetric data (calculator, semi-logarithmic paper, ruler)
2
2. very primitive HW/SW, basic computational automation, linear regression, deterministic
3
3. less primitive HW/SW, simple database support (51/4’’ diskette), computation methods still deterministic; data archiving
4
4. better HW/SW, database system Iodine III with external numerical routines; stochastic models identified by Bayesian methodology, meaningless results eliminated by the method; capability of full patient data management; more data archived
5
5. scientists permanently try to attract doctors’ attention to the potential of the software
6
6. scientists developed first version of the cause-consequence model, doctors are mildly and conditionally impressed
7
7. doctors came with new ideas what new achievements and useful tools should be developed and implemented in the Clinic (actually, see the points 4 and 6)
8. doctors are (finally) motivated for unified management of various data and their use in cooperation in the research, better access to information etc.
A few notes and remarks
ČSKI, ÚTIA AV ČR, 19.2.2008 6
And how the situation about the data looked like?
• no activity covered all the groups together
• doctors are superior over engineers and physicists
• doctors were motivated to consider seriously non-medical activities after they felt lost in their ways of data management, needed an easy access to their data and saw a practical effect of the software developed “by the way”
staff
engineers
“scientists”
programmers
doctors
1
2
3
4
5 6
7
?
Data sources and flows in the past
ČSKI, ÚTIA AV ČR, 19.2.2008 7
patient’s examination
information system of the clinic
database by Doctor1
database by Doctor2
paper cards paper archives
information system of the hospital
Iodine III
automatic data archiving
Many data items are missing, some records are incomplete.
A few notes on the data
ČSKI, ÚTIA AV ČR, 19.2.2008 8
• heterogenous non-systematic collection of world-unique data as for their amount and set of quantities
• necessary to be unified and simplified: motivation — the doctors must decide effort — a lot of analysis, programming, typing… money — projects
• compatibility with major existing systems should be considered
• manual typing is the only way to transfer majority of the data
• typing is an exhausting work, potential source of errors (correction necessary) and very expensive.
Data sources and flows now (I)
ČSKI, ÚTIA AV ČR, 19.2.2008 9
patient’s examination
information system of the clinic
database by Doctor1
database by Doctor2
paper cards paper archives
information system of the hospital
Iodine III
automatic data archiving
Data sources and flows now (II)
ČSKI, ÚTIA AV ČR, 19.2.2008 10
patient’s examination
patient database of the clinic
paper cards and archives
information system of the hospital
JodWeb
automatic data archiving
Data are input only once, all the flow is automatic.
Problems with the data transfer
ČSKI, ÚTIA AV ČR, 19.2.2008 11
• intention: involve a person who cares about the network in the hospital and who is interested in data processing, too (exists!)
• but: most energy of the person is dedicated to the routine network management, tasks delayed
• furthermore: the hospital information system was being developed, the SW company is overwhelmed by specific requests of clinics
• the GUI of the patient database unstable, programmers responded slowly, delays in manual typing
• slow responses in programming of inter-database interface
• structure of the patient database copied paper cards too much, types of some fields were not suitable for machine processing (I told them…), transformation was necessary
• doctors did not care, i.e. they did not push the work forward
Summary of the achievements so far
ČSKI, ÚTIA AV ČR, 19.2.2008 12
• doctors see advantage of electronic database
• paper cards are printed (for the tradition’s sake), no more manual data transfer
• development of user-friendly web applications for accessing the clinical database (CaThy) and a dosimetric database with measurement support and processing (JodWeb, formerly Iodine III)
• Bayesian estimates of biophysical and radio-hygienic quantities were implemented in JodWeb
• several original results achieved concerning kinetics of 131I
• management of patients’ data, archiving for research
• initial version of cause-consequence model (advisory system) developed
What has not been done
ČSKI, ÚTIA AV ČR, 19.2.2008 13
• all the data has not been collected in time
• therefore they have not been processed yet
• the software is not fully debugged and finished
• Improved version of the advisory system is not finished
but• the tasks are near-finished, doctors see their potential for research and
treatment
• finishing the tasks does not require much energy
• world-unique database is going to be available
Plans and ideas
ČSKI, ÚTIA AV ČR, 19.2.2008 14
• finishing the SW tools asap (but no more money)
• huge and extensive retrospective data studies
• medical feedback to mathematical modelling, discovering dependences in multidimensional data spaces
• improvement and extension of the advisory system, analysis of its results
• involvement of Ph.D. students
Experience
ČSKI, ÚTIA AV ČR, 19.2.2008 15
• without a motivation, no one will take effort
• doctors cure (which is OK) but they leave a lot of things up to you (organization, budget structure…)
• things must be arranged at the top (= doctor) level, building conceptions from bottom (= non-doctor) is not effective
• don’t believe that anyone will help you to manage the project
• don’t involve people who are too busy by themselves
• think twice to start a similar project next time as the manager
• cooperation with doctors is a hard job
Thank you