Skip to main content
Log in

Design and evaluation of a multimedia electronic patient record “oncoflow” with clinical workflow assistance for head and neck tumor therapy

  • Original Article
  • Published:
International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Objectives

The management of patient-specific information is a challenging task for surgeons and physicians because existing clinical information systems are insufficiently integrated into daily clinical routine and contained information entities are distributed across different proprietary databases. Thus, existing information is hardly usable for further electronic processing, workflow support or clinical studies.

Methods

A Web-based clinical information system has been developed that automatically imports patient-specific information from different information systems. The system is tailored to the existing workflow for the treatment of patients with head and neck cancer. In this paper, the clinical assistance functions and a quantitative as well as a qualitative system evaluation are presented.

Results

The information system has been deployed at a clinical site and is in use in daily clinical routine. Two evaluation studies show that the information integration, the structured information presentation in the Web browser and the assistance functions improve the physician’s workflow. The studies also show that the usage of the new information system does not impair the time physicians need for a process step compared with the usage of the existing information system.

Conclusions

Information integration is crucial for efficient workflow support in the clinic. The central access to information within a modern and structured user interface saves valuable time for the physician. The comprehensive database allows an instant usage of the existing information clinical workflow support or the conduction of trial studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Neame R (2000) Creating an infrastructure for the productive sharing of clinical information. Top Health Inf Manag 20(3):85–91

    CAS  Google Scholar 

  2. Boehm A, Müller S, Pankau T, Strauß G, Bohn S, Fuchs M, Dietz A (2011) Computergestützte Assistenz zur Verbesserung der Therapie-Planung in der Kopf-Hals-Onkologie. Laryngo-Rhino-Otol 90(12):732–738

    CAS  Google Scholar 

  3. Boehm A, Wichmann G, Mozet C, Dietz A (2010) Aktuelle Therapieoptionen bei rezidivierenden Kopf-Hals-Tumoren. HNO 58(8):762–769

    Article  PubMed  CAS  Google Scholar 

  4. Knaup P, Harkener S, Ellsässer KH, Haux R, Wiedemann T (2001) On the necessity of systematically planning clinical tumor documentation. Methods Inf. Med. 40(2):90–98

    PubMed  CAS  Google Scholar 

  5. Gell G, Schmücker P, Pedevilla M, Leitner H, Naumann J, Fuchs H, Pitz H, Köle W (2003) SAP and partners: IS-H and IS-H* MED. Methods Inf. Med. 42(1):16–24

    PubMed  CAS  Google Scholar 

  6. McDonald CJ (1997) The barriers to electronic medical record systems and how to overcome them. J. Am. Med. Inform. Assoc. 4(3):213–221

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  7. McDonald CJ, Overhage JM, Tierney WM, Dexter PR, Martin DK, Suico JG, Zafar A, Schadow G, Blevins L, Glazener T, Meeks-Johnson J, Lemmon L, Warvel J, Porterfield B, Warvel J, Cassidy P, Lindbergh D, Belsito A, Tucker M, Williams B, Wodniak C (1999) The Regenstrief medical record system: a quarter century experience. Int J Med Inform 54(3):225–253

    Article  PubMed  CAS  Google Scholar 

  8. Krishnankutty B, Bellary S, Kumar NBR, Moodahadu LS (2012) Data management in clinical research: an overview. Indian J. Pharmacol. 44(2):168–172

    Article  PubMed  PubMed Central  Google Scholar 

  9. Patkar V, Acosta D, Davidson T, Jones A, Fox J, Keshtgar M (2011) Cancer multidisciplinary team meetings: evidence, challenges, and the role of clinical decision support technology. Int J Breast Cancer 1–7:2011

    Google Scholar 

  10. Meier J, Boehm A, Schreiber E, Lippert S, Neumuth T, Bohn S (2012) Development of a modular IT-Framework supporting the oncological patient treatment in ENT surgery. Biomed. Tech. (Berl)

  11. Barrows RC, Clayton PD (1996) Privacy, confidentiality, and electronic medical records. J Am Med Inform Assoc 3(2):139–148

    Article  PubMed  PubMed Central  Google Scholar 

  12. Born S, Wellein D, Bohn S, Strauß G, Bartz D (2010) 3D Visualization for tumor intervention planning. Eurographics workshop on visual computing for biology and medicine

  13. Eisner M (2011) IT-Unterstützung für Tumorkonferenzen. Österr. Gesundheitswesen - ÖKZ, vol 52. Jg., no 07

  14. CREDOS Tumordokumentation. Tumordokumentation mit SAP/ISH*Med-Comprehensive Cancer Center Ulm, Universitätsklinikum Ulm

  15. Altmann U, Katz FR, Tafazzoli AG, Haeberlin V, Dudeck J (1996) GTDS: a tool for tumor registries to support shared patient care. Proceedings of the AMIA Annual fall symposium, pp 512–516

  16. Li H, Lober W, Trigg L, Dockrey M, Chou D, Stewart B (2002) Iterative Development of a Web application to support teleconferencing of a distributed tumor board. In: Proceedings of the AMIA symposium, pp 1081–1081

  17. Bumm R, Siess M, Lange M, Siewert JR (2002) Notwendige Voraussetzungen für die Funktion eines onkologischen Kompetenzzentrums. DMW-Dtsch Med Wochenschr 127(17):907–912

    Article  CAS  Google Scholar 

  18. Siess M, Bumm R, Molls M, Peschel C, Siewert JR (2002) Qualitätsmanagement und Erfahrungen mit dem, Cancer Center. DMW-Dtsch Med Wochenschr 127(17):896–900

    Article  CAS  Google Scholar 

  19. van der Haak M, Mludek V, Wolff AC, Bülzebruck H, Oetzel D, Zierhut D, Drings P, Wannenmacher M, Haux R (2002) Networking in shared care-first steps towards a shared electronic patient record for cancer patients. Methods Inf Med 41(5):419–425

    PubMed  Google Scholar 

  20. Zhang Z, Ahmed F, Mittal A, Ramakrishnan I, Zhao R, Viccellio A, Mueller K (2011) AnamneVis: a framework for the visualization of patient history and medical diagnostics chains. In: Proceedings of the IEEE visual analytics in health care (VAHC) workshop

  21. Documet J, Le A, Liu B, Chiu J, Huang HK (2010) A multimedia electronic patient record (ePR) system for image-assisted minimally invasive spinal surgery. Int J Comput Assist Radiol Surg 5(3):195–209

    Article  PubMed  PubMed Central  Google Scholar 

  22. Le AH, Liu B, Schulte R, Huang HK (2011) Intelligent ePR system for evidence-based research in radiotherapy: proton therapy for prostate cancer. Int J Comput Assist Radiol Surg 6(6):769–784

    Article  PubMed  Google Scholar 

  23. Deshpande R, Zhou A, Zhang J, DeMarco J, Liu BJ (2013) Role of an imaging informatics-based DICOM-RT cancer registry in evaluating treatment parameters of IMRT for prostate cancer. p 86740O–86740O-8

  24. Rockstroh M, Franke S, Neumuth T (2013) Requirements for the structured recording of surgical device data in the digital operating room. Int J Comput Assist Radiol Surg

  25. Weiner DL, Butte AJ, Hibberd PL, Fleisher GR (2003) Computerized recruiting for clinical trials in real time. Ann Emerg Med 41(2):242–246

    Article  PubMed  Google Scholar 

  26. Segagni D, Tibollo V, Dagliati A, Zambelli A, Priori SG, Bellazzi R (2012) An ICT infrastructure to integrate clinical and molecular data in oncology research. BMC Bioinform 13(Suppl 4):S5

    Article  Google Scholar 

  27. Safran C, Bloomrosen M, Hammond WE, Labkoff S, Markel-Fox S, Tang PC, Detmer DE (2007) Toward a national framework for the secondary use of health data: an American medical informatics association white paper. J Am Med Inform Assoc JAMIA 14(1): 1–9

    Article  Google Scholar 

  28. Safran C, Sands DZ, Rind DM (1999) Online medical records: a decade of experience. Methods Inf Med 38(4–5):308–312

    PubMed  CAS  Google Scholar 

  29. Boehm A, Dornheim J, Müller S, Strauß G, Wichmann G, Dietz A, Preim B (2010) TTM Tumor therapy manager. In: O Burgert, LA Kahrs, B Preim, J Schipper, (eds) curac2010MEDICA. Chirurgische Interventionen: vom Neanderthaler zur Roboterassistenz. Tagungsband zur 9. Jahrestagung der Deutschen Gesellschaft für Computer- und Roboterassistierte Chirurgie e.V. Der Andere Verlag, Tönning, pp 17–19

  30. Sobin LH (2009) TNM classification of malignant tumours. Wiley, Oxford

    Google Scholar 

  31. Sinn HP, Hermanek P, Wagner G, Wittekind C (2002) Organspezifische Tumordokumentation. Deutsche Krebsgesellschaft

  32. OnkoZert-Deutsche Krebsgesellschaft. Informationen Zertifizierung Kopf-Hals-Tumor-Zentren

  33. Blayney DW (2012) Tumor Boards (Team Huddles) Aren’t enough to reach the goal. JNCI J Natl Cancer Inst. doi:10.1093/jnci/djs523

  34. Keating NL, Landrum MB, Lamont EB, Bozeman SR, Shulman LN, McNeil BJ (2012) Tumor boards and the quality of cancer care. JNCI J Natl Cancer Inst. doi:10.1093/jnci/djs502

  35. Bumm R, Feith M, Lordick F, Herschbach P, Siewert JR (2007) Impact of multidisciplinary tumor boards on diagnosis and treatment of esophageal cancer. Eur Surg 39(3):136–140

    Article  Google Scholar 

  36. Bühner M (2006) Einführung in die Test- und Fragebogenkonstruktion, 2, aktualisierte und erw. Aufl. München [u.a.]: Pearson Studium

  37. Neumuth T, Durstewitz N, Fischer M, Strauss G, Dietz A, Meixensberger J, Jannin P, Cleary K, Lemke HU, Burgert O (2006) Structured recording of intraoperative surgical workflows, p 61450A–61450A

  38. Neumuth T, Jannin P, Strauss G, Meixensberger J, Burgert O (2009) Validation of knowledge acquisition for surgical process models. J Am Med Inform Assoc JAMIA 16(1):72–80

    Article  Google Scholar 

  39. Team RC (2013) R: a language and environment for statistical computing. Austria, Vienna

    Google Scholar 

  40. Shapiro SS, Wilk MB (1965) An analysis of variance test for normality (complete samples). Biometrika 52(3/4):591–611

    Article  Google Scholar 

  41. Johnson NL (1994) Continuous univariate distributions, 2nd edn. Wiley, New York

    Google Scholar 

  42. Box JF (1987) Guinness, Gosset, Fisher, and small samples. Stat Sci 2(1):45–52

    Article  Google Scholar 

  43. Bronstein IN, Semendjajew KA (2001) Taschenbuch der Mathematik, 5th edn. Thun [u.a.]: Deutsch

  44. Faber MG (2003) Design and introduction of an electronic patient record: How to involve users? Methods Inf Med 42(4):371–375

    PubMed  CAS  Google Scholar 

  45. Lemke HU, Berliner L (2013) The digital operating room: towards intelligent infrastructures and processes. In: SPIE Proceedings, vol 8674, p 86740R–86740R-11

Download references

Acknowledgments

ICCAS is funded by the German Federal Ministry of Education and Research (BMBF) and the Saxon Ministry of Science and Fine Arts (SMWK) in the scope of the Unternehmen Region with Grant Number 03Z1LN12 and by the European Regional Development Fund (ERDF) and the state of Saxony within the frame of measures to support the technology sector.

Conflict of interest

The authors have no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Neumuth.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Meier, J., Boehm, A., Kielhorn, A. et al. Design and evaluation of a multimedia electronic patient record “oncoflow” with clinical workflow assistance for head and neck tumor therapy. Int J CARS 9, 949–965 (2014). https://doi.org/10.1007/s11548-014-0988-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11548-014-0988-x

Keywords

Navigation