Concepts of GTDS - An Oncology Workstation

U. Altmann, F. R. Katz, V. Haeberlin, C. Willems and J. Dudeck (Beitrag für Medinfo 95)

Arbeitsgruppe zur Koordination Klinischer Krebsregister, Institut für Medizinische Informatik,
Heinrich-Buff-Ring 44, 35392 Gießen, Germany





Choice of Development Tools

Realization and Applications

Future Perspectives




In Germany computer systems are in use in hospital cancer registries for more than 10 years. Primarily they have been used for retrospective documentation of malignant tumors with only few functions for the support of follow up care and statistical evaluation. With the general availability of PC-systems and computer networks interest increased to use the data for the support of the treatment process itself. Therefore we have decided to design and develop a new oncology information system which covers both aspects, (1) the documentation of all relevant data items for the cancer registries and (2) the routine support of the physician in the clinical treatment process. In this contribution the design and concept of this oncology information system as well as experiences gained during the development process are discussed. Future plans to further extend the system to a comprehensive oncology workstation are presented.

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1. Introduction

The treatment of malignant tumors is a task of increasing complexity which requires the cooperation of different medical disciplines. Computers can support this process by providing patient data, comprehensive information and medical knowledge at the physicians desk. Several systems like OCIS [1] and ONCOCIN [2] have been successfully developed to support the management of patient care and the requirements for the development of an "Integrated Oncology Workstation" have been described[3].

Since the beginning of the eighties a network of hospital cancer registries (HCR) has been established in Germany supported by the Federal Government and the "Deutsche Krebshilfe", a private nonprofit organization. Primarily the HCR collected and stored data of nearly all patients treated in comprehensive cancer centers and related hospitals according to a uniform basic data set (UBDS) defined by the Association of German Tumor Centers (ADT). The scope of the data set and the encoding rules are described in the "Basisdokumentation für Tumorkranke" [4]. The availability of computer networks within hospitals has increased the interest to use these data not only for retrospective documentation but also for supporting the treatment process itself. The content of UBDS has therefore been redefined [5, 6]. In particular the description of treatment data was extended. To introduce this new UBDS it was necessary to develop a comprehensive oncology workstation which is able to handle this data set and to provide it for treatment purposes. Therefore in 1991 a nationwide working group ("Arbeitsgruppe Tumordokumentationssystem", AGTDS) has been established to define the requirements and the design of a new oncology information system. The working group has been composed of medical and computer science specialists working in comprehensive cancer care centers. Coordination of this work and programming of the system ("Gießener Tumordokumentationssystem", GTDS) was done by the working group ("Arbeitsgruppe zur Koordination Klinischer Krebsregister", AKKK). The whole development has been sponsored by the Federal Ministry of Health.

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2. Concepts

The fundamental concepts, which have been considered during the GTDS development are the following [7]:

As mentioned above the AGTDS has been composed of medical and computer science specialists coming from different centers and using different documentation systems. Thus a wide range of experiences could be integrated in the design and development. The intention for the sponsoring of the development by the Federal Ministry of Health was to create a documentation tool, which should be centrally programmed and supported to avoid ineffective dispersion of financial efforts. Therefore the system should be suitable to different centers with different organization and contents of documentation (apart from the minimum basic data set). The design of the system had to be functionally but not organizationally oriented. The structure had to be modular with the ability to make individual adjustments. As many function as possible should be dependent from parameters stored in the database itself. For the reason that the system should be integrated in different environments and as independent as possible from certain hardware requirements, the development tools should allow an easy portability to different platforms.

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3. Choice of the Development Tools

Data should be stored in a relational database management system (RDBMS), because this is the easiest way to access data in different ways. Data design should be made using an entity relationship diagram as the adequate method for the design of a relational database system. First we decided to use a CASE tool (IEF from Texas Instruments) which is not only independent from hardware but also from RDBMSs concerning the target environment [8]. Although it is possible to generate an almost complete system using IEF, we finally decided to use ORACLE and its tools for the programming when the phase of data design had finished. The reason was that the development of two small prototypes with ORACLE and IEF had shown, that the functional capabilities and the speed of development of ORACLE tools are much higher than those of IEF, which only allowed a block mode oriented processing. We used ORACLE's SQL*Forms and SQL*Menu for programming the entry forms and SQL*ReportWriter for medical reports and simple statistics.

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4. Realization and Applications

In 1992 an alpha version has been implemented at three centers to test and adapt the functionality. The system was chosen for the application in particular in centers in the new states by the Federal Ministry of Health. In 1993 the beta phase began with the installation at ten more centers. From the beginning approximately 2,5 persons are engaged in programming and support of the system. Up to now GTDS has been introduced in over 17 centers with different demands concerning the hospital cancer registry. Some centers use it only for the documentation of tumor diseases. Others use it for managing or supporting the follow up care by sending reminders to outstanding examinations to doctors or patients and collecting the results of these examinations. They send medical reports or overviews generated by GTDS to the participant physicians to improve communication among them. An other way of using GTDS is as on line information system for a oncology ward or outpatient department. Chemotherapy can be planned on line and the physicians rely on the information in a high grade. This is the step which is most close to the realization of an oncology workstation.

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5. Future Perspectives

Although many functions of an oncology workstation could be realized in GTDS there are further steps which have to be done to realize a fully integrated workstation.

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6. Conclusion

Developing a system with a CASE-tool enforces systematic proceeding. In this way severe errors during development are reduced. It is not possible to do the development quick and dirty. In this regard there was a benefit by using a CASE-tool not only in view of the generation of DDL-statements. The 4GL we used enabled us to develop a complex and comfortable application with limited human resources. A small developing team reduces communication overhead. Combined with the tool's capabilities a flexible response to user wishes is possible. The present version of GTDS is a useful tool for hospital cancer registries. There are extensive possibilities for the documentation of tumor dieseases. Many functions are realized which help to support the patients' treatment and thus increase the cancer registries' acceptance. This is the result of the cooperative work of many specialists and the use of modern tools for design and programming (CASE tools and 4GL). The further development towards an integrated oncology workstation and its integration into HIS requires extensions which are partially about to be realized.

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7. References

1. J.P. Enterline, R. Lenhard, B.I. Blum, A clinical information system for oncology, Springer Verlag New York Berlin Heidelberg 1989

2. D.L. Kent, E.H. Shortliffe, R.W. Carlson, M.B. Bischoff, C.D. Jacobs, Improvement in Data Collection Through Physician Use of a Computer-Based Chemotherapy Treatment Consultant, Journal of Clinical Oncology, Vol 3, No 10 (October) 1985, 1409-1417

3. E.H. Shortliffe, An Integrated Oncology Workstation, National Cancer Institute, Maryland, Bethesda (1990)

4. G. Wagner, E. Grundmann, Basisdokumentation für Tumorkranke 3. Aufl., Springer Verlag Berlin Heidelberg New York etc. 1983

5. J. Dudeck, G. Wagner, E. Grundmann, P. Hermanek, Basisdokumentation für Tumorkranke 4. Aufl., Springer Verlag Berlin Heidelberg New York etc. (1994)

6. J. Dudeck, W. Wächter, U. Altmann, F. Katz, The definition of a new uniform basic data set for hospital cancer registries in Germany, in: MIE-Proceedings 1993, Freund Publishing House Ltd. 489-492

7. F. Katz, U. Altmann, J. Müller, J. Dudeck, Funktionsumfang des Gießener Tumordokumentationssystems (GTDS), in Entwicklungstendenzen der Tumordokumentation in Klinik und Nachsorge - 6. Informationstagung Tumordokumentation Dortmund 1992, Ferber Gießen (1994) 101-131

8. U. Altmann, F. Katz, J. Müller, W. Wächter, J. Dudeck, Die Entwicklung eines Tumordokumentationssystems für Klinische Krebsregister, Europäische Perspektiven der Medizinischen Informatik, Biometrie und Epidemiologie, 37. Jahrestagung der GMDS 1992, MMV Medzin Verlag München (1993) 41-44

9. H.U. Prokosch, B. Puhle, J. Dudeck, One-Stop-Information-Shopping: Do we meet the information needs of the hospital staff? MIE-Proceedings 94, 362-365

10. G. L. Kreps, M. D. Naughton, The role of PDQ in Disseminating Cancer Information, MEDINFO 86, Elsevier Science Publishers (1986)

11. C. J. McDonald, S. L. Hui, D. M. Smith, W. M. Tierney, S. J. Cohen, M. Weinberger, G. P. McCabe, Reminders to Physicians from an Introspective Computer Medical Record, Annals of Internal Medicine, 1984;100:130-138

12. G. Hripcsak, P.D. Clayton, T.A. Pryor, P. Haug, O.B. Wigertz, J. Van der lei., The Arden Syntax for Medical Logic Modules, SCAMC 1990, 200-204

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