TBase - an Integrated Electronic Health Record and Research Database for Kidney Transplant Recipients

Summary

TBase combines an electronic health record with an innovative research database for kidney transplant recipients. TBase is built upon an in-memory database platform, connected to different hospital systems, and used for regular outpatient care. It automatically integrates all relevant clinical data including transplantation-specific data creating a unique research database.

Abstract

TBase is an electronic health record (EHR) for kidney transplant recipients (KTR) combining automated data entry of key clinical data (e.g., laboratory values, medical reports, radiology and pathology data) via standardized interfaces with manual data entry during routine treatment (e.g., clinical notes, medication list, and transplantation data). By this means, a comprehensive database for KTR is created with benefits for routine clinical care and research. It enables both easy everyday clinical use and quick access for research questions with highest data quality. This is achieved by the concept of data validation in clinical routine in which clinical users and patients have to rely on correct data for treatment and medication plans and thereby validate and correct the clinical data in their daily practice. This EHR is tailored for the needs of transplant outpatient care and proved its clinical utility for more than 20 years at Charité - Universitätsmedizin Berlin. It facilitates efficient routine work with well-structured, comprehensive long-term data and allows their easy use for clinical research. To this point, its functionality covers automated transmission of routine data via standardized interfaces from different hospital information systems, availability of transplant-specific data, a medication list with an integrated check for drug-drug interactions, and semi-automated generation of medical reports among others. Key elements of the latest reengineering are a robust privacy-by-design concept, modularity, and hence portability into other clinical contexts as well as usability and platform independence enabled by HTML5 (Hypertext Markup Language) based responsive web design. This allows fast and easy scalability into other disease areas and other university hospitals. The comprehensive long-term datasets are the basis for the investigation of Machine Learning algorithms, and the modular structure allows to rapidly implement these into clinical care. Patient reported data and telemedicine services are integrated into TBase in order to meet future needs of the patients. These novel features aim to improve clinical care as well as to create new research options and therapeutic interventions.

Introduction

Motivation for an integrated electronic health record and research database
Clinical research is based on the availability of high-quality data, regardless of whether classical statistical methods or Machine Learning (ML) techniques are used for analysis^1,2. In addition to routine data (e.g., demographic, laboratory, and medication data), domain-specific data (e.g., transplantation-relevant data) are required with high granularity^3,4. However, routine care at many university hospitals is performed with hospital information system....

Protocol

The protocol demonstrates the use of the electronic health record TBase, how to add data into the database, and how to extract them for research purposes. All steps are in accordance with the guidelines of the human research ethics committee of Charité - Universitätsmedizin Berlin.

1. Register a new patient and add basic patient data into TBase

1. Upon registration, transfer the patient's basic data (name, birth date, and health insurance data) from the patient's hea.......

Discussion

TBase combines a web-based EHR for specialized outpatient care of KTR with a research database, creating a comprehensive long-term database for patients with kidney disease^6,11,15,37. Regarding organizational structure, this is enabled by implementing a modern software design process as an institutional agent and including over 20 years of experience as developers, clinical users and researcher.......

Materials

Name	Company	Catalog Number	Comments
Developer platform SAP Web IDE	SAP SE
GUI Toolbox SAPUI5	SAP SE
In-memory database SAP-HANA	SAP SE
Interface Standard HL7	Health Level Seven International
Interface Standard HL7 FHIR	Health Level Seven International
RStudio	RStudio Inc.
TBase - Electronic Health Record	Charité - Universitätsmedizin Berlin
Webserver SAP-HANA XSA	SAP SE