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A Web-based Platform for Implementing Clinical Notes A production of clinical medical records of web-basedplatform

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A production of clinical medical records of web-based platform

A Web-based Platform for Implementing Clinical Notes

Chin-Jung Chen a, * Chia-Hsien Wen a, b, Yeda Cheng c, Chen Qiwen d

a Taichung Veterans General Hospital Information Department, b University of Information Science and Engineering, East China Sea

c Taichung Veterans General Hospital, General Surgery, d Ju Ren Technology Co., Ltd.

* E-mail: chwen@vghtc.gov.tw

Summary

For the implementation of electronic medical records, Taichung

Veterans General Hospital developed a clinical medical records produced web-based platform. This platform will be the clinical records of each style and content into two parts, and provide the style designer, content editor and record generator functions. The design of clinical units available style home design style necessary clinical records; physicians by content editor input medical records; record generator Ke Yi style to the content of the information input into the clinical record of the article type for online viewing or printing . Entered clinical information to XML format, stored in a database, clinical staff can provide in the future of medical research. Ben Wang-based platform for the development of the clinical use of medical records, not to be involved in software development personnel, can save a lot of the development of human, but also greatly simplifies and reduces clinical medical records

computerized process. The clinical records has been completed a total of 144 kinds of styles, including all hospital medical records of each clinical section of the summary of operation records, medical records and discharge summaries.

Keywords: Clinical medical records, electronic medical records, web-based platform

Abstract

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Taichung Veterans General Hospital has developed a web-based platform for implementing clinical notes as a pilot system to promote electronic patient records. Each clinical note is partitioned into a template and a set of data contents. The platform provides three functions, named template designer, content editor, and note generator, for physicians to implement patients' clinical notes. The template designer is used to set up the format, called template, of a clinical note. A physician may enter and edit contents of a clinical note by the content editor under its template. According to the template and entered contents, the note generator generates a textual note for review and print. Using this web- based platform, a hospital may simplify the process in implementing her tremendous clinical notes without devoting any application designer. There are 144 templates of admission notes, operation notes, and discharge notes in TCVGH now.

Keywords: Clinical note, Electronic patient record, web-based platform I. Introduction

With the widespread use of the Internet, electronic medical records has become the world development trend of medical information. Department of Health has strongly promoted in recent years, electronic medical records between medical institutions to exchange [8], led to major hospitals in China actively involved in the development of electronic medical records. HIS has been developed in addition to various doctor's advice, the clinical medical records (Clinical Notes, hereinafter referred to as clinical records) to become the focus of current development of electronic medical records.

Taichung Veterans General Hospital since 1982, using the IBM mainframe, the development of their overall hospital information system (HIS). Because the use of IMS hierarchical database will not support multimedia, PCS / ADS Application of Activity development tools has failed to provide graphical user interface, word editing ability is very limited; Although the application of operations are quite complete and efficient, but and nowadays Home mainstream web-based

application operating in the operational use on a considerable gap. In particular, medical records or physician diagnosis in the production of a certificate, even more inconvenience. After careful assessment, therefore, in the year 2000, hospital-wide decision information system reengineering [2], and selected to J2EE (Java 2 Enterprise Edition) for the application development and execution

environment, Web-based clinical records to the new system pilot project [5].

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Figure 1: A physician hand-drawn sketches of prostate nodules, data sources [9]

Clinical records produced daily routine of clinicians, Web-based clinical records must be fully compatible with the needs of physicians and their acceptance of and are happy to use before being implemented successfully. However, the

development of Web-based clinical records a number of issues to be resolved: first clinical records of many types and formats, in addition to a summary of patient medical records, progress notes, surgical records, discharge summary records, ...

and so the classification; different clinical subjects or to different parts of different diseases they may have different formats of clinical records; such as general surgery by the hospital medical records summary on Breast, Stomach, Intestine, Appendix, Hernia, Liver, Biliary, Pancreas, Thyroid, Jaundice, Abdomen Pain and other parts of the different forms . Itemized by the IT staff development, not only when the charges on mine also does not necessarily meet the needs of clinicians, the best designed by the clinical need of general practitioners clinical records.

Furthermore the clinical records of a web page content and information complexity than most web pages, such as breast cancer, medical records

summary, including chief complaint, present illness, past medical history, family history, systematic review, physical examination, surgery status, checking

(inspection) report (including images), image, treatment planning, and other parts of the complexity of each part of the web pages are larger than the average commercial [6]. And these pages often changes as required, whenever the page changes, the back-end database must change in order to maintain data

synchronization between the new and old versions. In addition, the Web-based clinical records need to provide more sophisticated graphics features, such as the expression of a prostate nodule map the location and size of the non-in JSP, ASP, or PHPand other web-based program can be easily accomplished. Moreover, the current hospital accreditation requirements are clinicians making clinical records of all the content should be a complete and elegantly written article, to integrate many different sources of medical information and converting it into a readable article type clinical records, is no easy task.

To solve the above problem, Taichung Veterans General Hospital, Ren-

technological cooperation with the giant companies developed a production of clinical records of web-based platform. This platform compliance framework (frame) concept [11], a copy of clinical records are divided into style (template)and content (content) of two parts; different clinical records of patients share the same style, but the information in clinical records library content stored in each. This

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platform also provides a style designer (template designer),the content editor (content editor) and the record generator (note generator) three functions. Style

designer for the Department of the Clinical records of subjects required for the design of clinical style, and style to XML format, stored in the server [7], while producing the corresponding clinical records database. Content Editor is required for clinicians to access clinical records style, the effective input and edit the contents of clinical records, the content automatically to XML format is stored in the corresponding medical records database for all subjects for medical clinicians research. To facilitate the importation of doctors in the future at any time to read and provide access to information and records of generator can be stored in the database information into an article-style illustrations of clinical records. The

platform also provides the functions of the clinical records of printing, printing paper type of clinical records, to comply with the provisions of the existing paper medical records.

The clinical records of web-based platform in 2003at Taichung Rong Zongqi use.

1 to 3 months of the completion of all hospital medical records of each clinical section of the summary, 9 to 10months to complete operation record, the following year1 to 2 months to complete medical records discharge summaries;

There are currently 144 clinical records of the style.

II, Materials and Methods

Clinical record data if the traditional approach to design, software developers have to design the input screen format recording, storage, input data and derived information, database and data processing procedures according to written program. Once the user's needs change, even if only to add a data field, software developers have to modify the input screen, database fields, as well as information related to this program and test all. If the clinical records of the format change frequently, software developers will be rapid increase in labor costs, while the response to aging will be stretched.

Taichung Veterans General Hospital beginning in the development of the HIS, which set up operations using the unit coordinator system, coordinated by the unit is responsible for design changes to all screen formats and forms, and user training, to accelerate the application development work. Therefore, the development of Web-based clinical records, also would like to quote the same concept, only to provide an information unit of the clinical records of web-based

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production platform, each clinical section you can customize the style of various clinical records, clinicians will be elected as needed style and enter the patient clinical data related to the last automatically generated by the platform of clinical records.

Figure 2 shows the web-based platform, the design concept and function.

Clinical records of each style has its corresponding data files and content. Style

designed home to add or edit the style of the clinical records, from style to style XML file type stored in the database [10]. Content editor access database style style and content of the database to add or edit the content of clinical records, and the results back to the content stored in database. Records generator depends on the type and style of the clinical records of the database content into the article-style clinical records.

Figure 2: Clinical records of web-based platform, the design concept and function

1, style designer

Style designers to design each clinical section provides the necessary functions of the various styles of clinical records, its practice as follows:

1. Graphical visual interface for pattern design clinical records were dragging the mouse to set each element appears on the screen in the location and includes relations.

2. Way to fill in or choose to set various properties of components, such as the components of the title, it is required, the default value, select the components of the options.

3. Way to set the device to select sources of information to clinical records in the new automated access to external sources of information, reduce the work of physician input.

4. After editing, each component will be converted into XML format attribute value, and then integrated into a XML file (called the style file) save to the style in the database [12].

5. Clinical records of each style are modified versions of Automatic Updates, and create a new content database. The platform will keep the old style version of the content information corresponding to the old and the new

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style reference to the new version will automatically enter the information on.

Figure 3: style designers showing in the browser's appearance

Style designer to introduce a Web-based application interface concept of crash tool OpenPath PageBuilder [1] [3] [4],provision of text descriptions, graphics surgery, family history and other components, allows designers to drag way, in the

shortest possible time a complete clinical record editing style. Figure 3 designers for the style show in the browser's appearance: the right of the screen design for theUI part of; the upper left corner of the toolbox for designers to select various components to the UIscreen drag; the lower left corner shows the effect of the components of its properties names and attribute values, designers can directly modify the attribute value in that.

Second, the content editor

Content editor for the physician input / edit medical records of patients.

Patients when used according to specialty, physician, or disease select the clinical records of other styles displayed in the browser; input is completed will be content to pass XML file server processing and storage. Figure 4 describes a new clinical record, the user, Web images, servers, and database interaction order.

Figure 4: Add the clinical record, the user, Webimages, servers, and database sequence diagram of interaction between

As more clinical research data collection to the main hospital medical records, so doctors should be patient during hospitalization, making it strictly medical records summary, course records, inspection (inspection) reports, surgical records,

treatment records, medication records, ... etc. Finally, in the medical records of patients discharged from hospital discharge summaries when making order out of a complete patient medical records. The current format of the clinical records of many articles for free-style record, and the use of medical terminology is no set legal rules, it is hard to study for statistical analysis. To meet the clinical subjects to establish their research database, this platform provides a variety of input in

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selecting a way to improve the quality of recorded data, such as radio, multiple choice, drop-down menu; automatically show a small calendar for date input; auto show to calculate the number for input. In addition, an automatic review and input functions, such as whether the input data required, enter the options meet the requirements and conditions will automatically need to enter the data fields, text field to provide input and phrases such as spell check function.

Set in the design styles as long as the specifications required, the content editor in the data input will automatically check its accuracy.

In addition to doctors to input information, content editor, Ke Yi style of set automatically by the medical records of different data sources, edited for physicians to join the clinical records, clinical records to simplify the production process data. Automatic access of medical records, including access to various types of self-HIS inspection (inspection) report, drawn from the PACS medical imaging, physicians can also be prepared to read the digital imaging.

Clinical records in response to the characteristics and requirements of

multimedia data, content editor provides a family history of maps, record maps Rendering operations and filling functions. Family history of mapping in Figure 5, each node tailor family sex selection, keep dead, health patterns and other characteristics and relationship with the existing nodes, the automatically added to the figure. To facilitate the operation of drawing record plans, content editor with similar features Paint Figure 6, select the stock map for physicians or patients that the medical image base map, and described its operation on the location, length, to be writing notes, etc. .

Figure 5: The way of drawing a family history of Map Options

Figure 6: The clinical records of the platform graphics Third, record generator

Records generator to enter the records of the physicians, medical records into paper-based, for physicians to view directly on your computer, or print out from the printer unit in the paper medical records within the folder. The processes

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shown in Figure 7. Obtain records of generator-style XML file of all components required to establish, after reading, fill in the corresponding content of XML data, then call component of the print () to output theHTML data. The properties of each component according to its own output corresponding to the HTML, then the container element integrated into a complete HTML file. Graphic element

graphic output to a temporary directory will be, then in the <img..> HTML tags to link to the map. Finally theHTML back to the browser for viewing, or sent to the printer server to print.

Parameters, results

1491 Taichung Veterans General Hospital beds available, including 1,235 acute beds, bed rate of 90.4%, the average hospital stay was 9.11 days, daily living (a) hospital size of about 130 people. Since the January 2003 opening of Ben Wang- based platform, currently there are 144 clinical records of styles, including summary of 72 patient medical records, discharge summaries of 33 medical records, surgical records of 39.

Figure 7: Record Generator handler

Clinical records of Web-based platform in the overall implementation framework of Taichung Veterans General Hospital, shown in Figure 8. In addition to the hospital clinicians to the use of the platform, also through the use of the Internet in the lobby. The core of this platform for the IBM WebSphere V5.0.2Application Server, IBM SecureWay LDAP and Oracle 9i database management system.

Application server and database management system hardware for the IBM RS/6000 SP2 9076-550, operating system AIX 4.3.3. The database of patients to IBM Message Queue (MQ) HIS from the host to download, its inspection (inspection) report or past medical records Zeyi Java CICX instant online access to patient images can be read immediately posted to the clinical record. Enter the content of the article-type form after the completion of clinical records for viewing and printing in the printer unit.

Figure 8: Clinical records of web-based platform for the overall implementation framework

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The complex pattern of clinical records vary, depending on various clinical subjects demand. Surgical breast cancer patients, such as general medical records summary that includes chief complaint, present illness, past history, family history, personal history, review of system, physical examination, laboratory data or image studies, GS conditions, impression and plan to doetc. part; the medical department of the newborn child medical records summaries are only included chief complaint, present illness, maternal history, impression andplan to do so in five parts.

The following summary will be neonatal medical records as an example to show clinicians to use Ben Wang actual situation based platform. Figure 9 shows the design style to style designers part of the present illness, the rest mostly text will not go into details. Figure 10 using the content editor by typing the contents of present illness. Figure 11 was recorded article produced by generator-style hospital medical record review.

Figure 9: The design style designers neonatal medical records summary of some of the style ofpresent illness

Wantonly, discussion and conclusions

Ben Wang-based platform to use the clinical records of the design style, change and test, only a graphical interface to configure the various components on the screen location and property, almost entirely without the participation of software developers, do not modify the program significantly reduce the burden on IT personnel, but also accelerated the development of computerized clinical records.

However, the actual operation of the platform and found that the following issues need attention and improvement:

Figure 10: The content editor input neonatal medical records in the summary part of present illness

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1. To meet the complex needs of the user interface using Java Swing to implement Applet, front-end must be installed Java Plug-in, so that the platform of the hardware specifications page is higher than pure HTML.

2. Java Plug-in Although the first use will be automatically downloaded and installed, but the Court is concerned ministries have been installed in the computer department or nursing station, only the general user rights, but install the Java Plug-in requires administrator privileges, so IT staff still need to be installed in each computer.

3. Content stored in the medical record, the result of abandoning the

traditional database fields and data table storage, use of XML format, can not be used like a traditional relational database query language SQL or statistical analysis.

4. Drawing too much when the clinical record or in use outside the hospital, probably because of bandwidth issues, implementation of the storage function of the scenarios that have failed.

5. The platform test, the application server is a Windows 2000 machine, and formally launched when the application server is a UNIXmachine. In

viewing and printing, sometimes hand-drawing in the UNIX machine can not be fully rendered out.

6. IE and printer settings foreach user can change, and more often failed to recover after the move, which under the influence of a user.

Figure 11: Record generator produces neonatal medical records summary

References

1. 3 Hui Science and Technology (2001), "Web-based application interface Quick Tools - OpenPath PageBuilder", http://www.openpath.com.tw/pagebuilder.asp .

2. Taichung Veterans General Hospital (2000), Taichung Veterans General Hospital information system reengineering plan.

3. Chen Kung (2001), Web Application Design Style One-Page Web Application, RUNPC magazine, eighth 17.

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4. Jane Jin Hong (2001), a high performance Web application development framework, National Taiwan University of Technology Department of Information Management, Vol.

5. Xie Meng saying (2001), in the framework of J2EE WEB application development, Institute of Information Engineering, National Central University, Master Thesis .

6. Purkinje | Dossier, Clinical Note Writer, http://www.purkinje.com/

7. ASTM E2182-02, Standard Specification for Clinical XML DTDs in Healthcare.

8. DOH (2002), "Challenge 2008: National Development Focus Plan (6.4.2.7.1 Online Health Services Promotion Plan)", http://www.doh.gov.tw/dohenglish/Search/Search_Content.asp?

No=58&Table = Media #

9. E. Shortliffe, L. Perreault (2001), Medical Informatics, Computer Applications in Health Care and Biomedicine, 2nd ed., New York: Springer-Verlag, pp46.

10. G. Patersona, M. Shepherdb, X. Wangb, C. Wattersb, D. Zitnera (2002), "Using the XML- based Clinical Document Architecture for Exchange of Structured Discharge Summaries", Proceedings of the 35th Hawaii International Conference on System Sciences .

11. N. Nilsson (1998), Artificial Intelligence: A New Synthesis, San Francisco: Morgan Kaufmann, pp312-313.

12. OOP-Research, "Java Swing GUI Builder by XML", http://www.oop- reserch.com/index.html

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