[Status and perspectives of registry-based studies in German ophthalmology]

[Current situation of electronic medical records in ophthalmological departments in Germany]

BACKGROUND

Electronic medical records are required in ophthalmology clinics to be integrated into digital care networks and efficient clinical registry databases.

AIM OF THE WORK

To assess the prevalence and methods of electronic medical recordkeeping in inpatient ophthalmological care in Germany.

MATERIAL AND METHODS

An online questionnaire was sent to all German university eye hospitals and ophthalmology departments in June 2021. It included 13 open and closed option questions concerning current practices of digital recordkeeping, including the structure of data storage and the recording of billing-relevant codes in the departments.

RESULTS

A total of 44 (44%) out of 100 clinics responded. Patient documentation was completely digital in 15 (34%) clinics and partly digital and paper-based in the remaining 29 (66%). A total of 16 different constellations of documentation programs were specified. The most frequently used programs were Orbis (27%) (Dedalus HealthCare, Bonn, Germany), FIDUS (18%) (Arztservice Wente, Darmstadt, Germany), and SAP/i.s.h.med (16%) (SAP Deutschland, Walldorf, Germany; Cerner Deutschland, Berlin, Germany) and 3 clinics indicated primary use of paper records. Structured documentation of findings was performed in 61% of the departments, while 23% used a semistructured manner and 15% used a nonstructured format. Electronic documents are stored as DICOM (Digital Imaging and Communications in Medicine) documents 20% of the clinics and as PDF (Portable Document Format) files in 34% of the clinics while 23% store scanned printouts.

DISCUSSION

Methods of medical record keeping in German eye clinics are heterogeneous, with paper-based documentation continuing to play an important role. This, as well as the high number of different electronic medical record software pose important challenges in terms of interoperability and secondary use of clinical data.

[The Hamburg register for intravitreal injection therapies (QIVOM)]

BACKGROUND

Intravitreal drug delivery belongs to the most common medical procedures, with approximately 1.5 million treatments per year in Germany. However, for this enormous challenge to provision of proper care, there is a lack of empirical data regarding the treatment process and its clinical and subjective effect.

MATERIALS AND METHODS

This publication presents the development and structure of the Hamburg register for intravitreal therapies (QIVOM). Patients undergoing intravitreal injection therapy were invited to join the register study. Patients were recruited from the Hamburg eye clinics in Heidberg-Nord and Barmbek as well as from the University Medical Center Hamburg-Eppendorf (UKE). Both subjective patient-reported information about the perception of their eye disease and its treatment as well as medical parameters were stored in a central electronic database.

RESULTS

Of the first 162 study patients (aged 41-95 years), 64% suffered from wet age-related macular degeneration (AMD), 22% had a retinal vein occlusion, and 11% a diabetic macula edema. Disease severity and subjective impairment were heterogenous. Among these patients, 31.8% had a visual acuity above 10/20 on the treated eye compared to 79.1% on the other eye. The reduced ability to read was the most relevant limitation for more than one third of patients. However, 62% were able to drive a vehicle. An improvement of vision through intravitreal therapy was experienced by 45%.

CONCLUSION

Collection of patient-reported as well as treatment-related data comprises the advantage of the newly created register. This extension of the data basis should deliver new findings in the future and contribute to quality assurance in intravitreal care.

Childhood glaucoma registry in Germany: initial database, clinical care and research (pilot study)

Objective

The aim of this prospective pilot study is to establish an initial database to register patients diagnosed with different types of childhood glaucoma and the set-up of a national registry for childhood glaucoma (ReCG) in Germany. 28 children with different types of diagnosed childhood glaucoma, who were admitted and treated at the Childhood Glaucoma Center of the University Medical Center Mainz, Germany were included. Main outcome measures were the type of childhood glaucoma, mean intraocular pressure (IOP) and genetic data of the patients.

Results

The documents and questionnaires for each individual included: informed consent form of the parents, medical history form of the child, patient’s gestational history questionnaire and general anesthesia examination form. Primary congenital and secondary childhood glaucoma were revealed in 11 (39%) and 17 (61%) patients, respectively. The mean IOP measured with Perkins tonometer in all patients under general anesthesia at the time of inclusion was 17.5 ± 11.8 mmHg in the right and 17 ± 8.9 mmHg in the left eyes. In 33% of children with glaucoma mutations in the CYP1B1, FOXC1, LTBP2 and TEK genes were found. The development of specific questionnaires for childhood glaucoma provides detailed baseline data to establish a ReCG in Germany for the first time.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-05921-8.

[Automated data extraction into a cataract surgery registry : Automatic investigation of results in the registry on ophthalmological analysis (ROPHA)]

BACKGROUND

Medical data should be evaluated with respect to quality management, for scientific and research purposes on the basis of registries. These data are stored in the EMR in an unstructured way and are not suitable for automatic evaluation.

METHOD

The EMR tomedo (Zollsoft/Jena) and the PACS of FORUM (Zeiss/Oberkochen) manage personal, medical and image data for cataract surgery. New developed input masks gather data from diagnostic tools direct in a structured way. These data are automatically extracted by an ETL process and are stored in our data warehouse. Via Excel specific data can be selected and displayed in the dashboard. All medical data are structured and stored electronically. Few data are entered manually and most of the data are entered by pull-down menus or taken over directly from diagnostic equipment.

RESULTS

A total of 2816 cataract surgeries of 1844 patients were selected for a first analysis. Results of IOL type distribution in relation to the patients and to the surgeons are displayed as well as prediction error of refraction for the 4 different groups of IOLs.

DISCUSSION

Structured data input into the EMR (electronic medical record) makes data for automatic extraction available thus reducing input errors or confounding data. The result is a high quality of data sets. Input of epidemiological and general medical data also helps to perform health services research. These registry data represent better information for real live data than data from clinical trials. Bureaucratic hurdles in Germany prevent the use of registry data.