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Braun U, Hennig O, Forstner J, Gerhardt S, Deffaa M, Hirjak D, Deuschle M, Koopmann A, Wisch C, Fritz M, Ende G, Tost H, Schöfer P, Bischoff S, Janta M, Kiefer F, Schmahl C, Banaschewski T, Meyer-Lindenberg A. [Diagnosis and admission center : Establishment and evaluation of an integrated translational infrastructure for clinical psychiatric research]. DER NERVENARZT 2024; 95:254-261. [PMID: 38381168 PMCID: PMC10914871 DOI: 10.1007/s00115-024-01609-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 02/22/2024]
Abstract
The routine in-depth characterization of patients with methods of clinical and scale-based examination, neuropsychology, based on biomaterials, and sensor-based information opens up transformative possibilities on the way to personalized diagnostics, treatment and prevention in psychiatry, psychotherapy, and psychosomatics. Effective integration of the additional temporal and logistical effort into everyday care as well as the acceptance by patients are critical to the success of such an approach but there is little evidence on this to date. We report here on the establishment of the Diagnosis and Admission Center (DAZ) at the Central Institute of Mental Health (ZI) in Mannheim. The DAZ is an outpatient unit upstream of other care structures for clinical and scientific phenotyping across diagnoses as a starting point for data-driven, individualized pathways to further treatment, diagnostics or research. We describe the functions, goals, and implementation of the newly created clinical scientific translational structure, provide an overview of the patient populations it has reached, and provide data on its acceptance. In this context, the close integration with downstream clinical processes enables a better coordinated and demand-oriented allocation. In addition, DAZ enables a faster start of disorder-specific diagnostics and treatment. Since its launch in April 2021 up to the end of 2022, 1021 patients underwent psychiatric evaluation at DAZ during a pilot phase. The patient sample corresponded to a representative sample from standard care and the newly established processes were regarded as helpful by patients. In summary, the DAZ uniquely combines the interests and needs of patient with the collection of scientifically relevant data.
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Affiliation(s)
- Urs Braun
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Mannheim-Heidelberg-Ulm, Deutschland.
| | - Oliver Hennig
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Johanna Forstner
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Sarah Gerhardt
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Mirjam Deffaa
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Dusan Hirjak
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Michael Deuschle
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Anne Koopmann
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Christian Wisch
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Melanie Fritz
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Gabriele Ende
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Mannheim-Heidelberg-Ulm, Deutschland
| | - Heike Tost
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Mannheim-Heidelberg-Ulm, Deutschland
| | - Peter Schöfer
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Stefan Bischoff
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Matthias Janta
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Falk Kiefer
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Mannheim-Heidelberg-Ulm, Deutschland
| | - Christian Schmahl
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Mannheim-Heidelberg-Ulm, Deutschland
| | - Tobias Banaschewski
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Mannheim-Heidelberg-Ulm, Deutschland
| | - Andreas Meyer-Lindenberg
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Mannheim-Heidelberg-Ulm, Deutschland
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Dugas M, Blumenstock M, Dittrich T, Eisenmann U, Feder SC, Fritz-Kebede F, Kessler LJ, Klass M, Knaup P, Lehmann CU, Merzweiler A, Niklas C, Pausch TM, Zental N, Ganzinger M. Next-generation study databases require FAIR, EHR-integrated, and scalable Electronic Data Capture for medical documentation and decision support. NPJ Digit Med 2024; 7:10. [PMID: 38216645 PMCID: PMC10786912 DOI: 10.1038/s41746-023-00994-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024] Open
Abstract
Structured patient data play a key role in all types of clinical research. They are often collected in study databases for research purposes. In order to describe characteristics of a next-generation study database and assess the feasibility of its implementation a proof-of-concept study in a German university hospital was performed. Key characteristics identified include FAIR access to electronic case report forms (eCRF), regulatory compliant Electronic Data Capture (EDC), an EDC with electronic health record (EHR) integration, scalable EDC for medical documentation, patient generated data, and clinical decision support. In a local case study, we then successfully implemented a next-generation study database for 19 EDC systems (n = 2217 patients) that linked to i.s.h.med (Oracle Cerner) with the local EDC system called OpenEDC. Desiderata of next-generation study databases for patient data were identified from ongoing local clinical study projects in 11 clinical departments at Heidelberg University Hospital, Germany, a major tertiary referral hospital. We compiled and analyzed feature and functionality requests submitted to the OpenEDC team between May 2021 and July 2023. Next-generation study databases are technically and clinically feasible. Further research is needed to evaluate if our approach is feasible in a multi-center setting as well.
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Affiliation(s)
- Martin Dugas
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Max Blumenstock
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Dittrich
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Urs Eisenmann
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Stephan Christoph Feder
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Fleur Fritz-Kebede
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Lucy J Kessler
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
- Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Klass
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Petra Knaup
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Angela Merzweiler
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Niklas
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas M Pausch
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Nelly Zental
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Ganzinger
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany.
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Federated electronic data capture (fEDC): Architecture and prototype. J Biomed Inform 2023; 138:104280. [PMID: 36623781 DOI: 10.1016/j.jbi.2023.104280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
In clinical research as well as patient care, structured documentation of findings is an important task. In many cases, this is achieved by means of electronic case report forms (eCRF) using corresponding information technology systems. To avoid double data entry, eCRF systems can be integrated with electronic health records (EHR). However, when researchers from different institutions collaborate in collecting data, they often use a single joint eCRF system on the Internet. In this case, integration with EHR systems is not possible in most cases due to information security and data protection restrictions. To overcome this shortcoming, we propose a novel architecture for a federated electronic data capture system (fEDC). Four key requirements were identified for fEDC: Definitions of forms have to be available in a reliable and controlled fashion, integration with electronic health record systems must be possible, patient data should be under full local control until they are explicitly transferred for joint analysis, and the system must support data sharing principles accepted by the scientific community for both data model and data captured. With our approach, sites participating in a joint study can run their own instance of an fEDC system that complies with local standards (such as being behind a network firewall) while also being able to benefit from using identical form definitions by sharing metadata in the Operational Data Model (ODM) format published by the Clinical Data Interchange Standards Consortium (CDISC) throughout the collaboration. The fEDC architecture was validated with a working open-source prototype at five German university hospitals. The fEDC architecture provides a novel approach with the potential to significantly improve collaborative data capture: Efforts for data entry are reduced and at the same time, data quality is increased since barriers for integrating with local electronic health record systems are lowered. Further, metadata are shared and patient privacy is ensured at a high level.
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