Processing of medical data: experience with a finished project

1. Processing of medical data:experience with a finished project Ladislav Jirsa Academy of Sciences of the Czech Republic Institute of Information Theory and Automation Adaptive Systems jirsa@utia.cas.cz ČSKI, ÚTIA AV ČR, 19.2.2008

2. Information Society Project 2004–2007 Partners: • ÚTIA AV ČR (dept. AS) • UK 2.LF (Inst. of Biophysics, Informatics…) • Motol Hospital (Clinic of Nuclear Medicine and Endocrinology (KNME)) Goals: • collect all clinical data and unify heterogenous data sources, • improve tools for data processing, • process the data with the tools and design an advisory system for individual dosage, • the results are to be applied at the KNME. ČSKI, ÚTIA AV ČR, 19.2.2008 2

3. Clinic of Nuclear Medicine and Endocrinology • dealing with nuclear medicine • successful in treatment of thyroid diseases by 131I • employing doctors, physicists, supervising engineers, medical staff etc. • computers and information technologies available • forced by law to monitor radiation load on patients and staff • monitoring needs measurement, computations, data processing • computation attracts engineers we know, that ČSKI, ÚTIA AV ČR, 19.2.2008 3

4. Historical remarks the first contact of medicine and computation: An engineer wanted to remove the burden of using calculator for the same computations from the colleagues and to utilize the modern machines (ancient today). …and it triggered many future activities ČSKI, ÚTIA AV ČR, 19.2.2008 4

5. Development of the data processing etc. engineers 4 1. manual processing of dosimetric data (calculator, semi-logarithmic paper, ruler) 3 2 programmers staff 7 2. very primitive HW/SW, basic computational automation, linear regression, deterministic 1 “scientists” 5 6 doctors 3. less primitive HW/SW, simple database support (51/4’’ diskette), computation methods still deterministic; data archiving   4. better HW/SW, database system Iodine III with external numerical routines; stochastic models identified by Bayesian methodology, meaningless results eliminated by the method; capability of full patient data management; more data archived 5. scientists permanently try to attract doctors’ attention to the potential of the software 6. scientists developed first version of the cause-consequence model, doctors are mildly and conditionally impressed 7. doctors came with new ideas what new achievements and useful tools should be developed and implemented in the Clinic (actually, see the points 4 and 6) 8. doctors are (finally) motivated for unified management of various data and their use in cooperation in the research, better access to information etc. ČSKI, ÚTIA AV ČR, 19.2.2008 5

6. A few notes and remarks • no activity covered all the groups together • doctors are superior overengineers and physicists • doctors were motivated to consider seriously non-medical activities after they felt lost in their ways of data management, needed an easy access to their data and saw a practical effect of the software developed “by the way” engineers 4 3 2 programmers staff 7 1 “scientists” 5 6 doctors ?   And how the situation about the data looked like? ČSKI, ÚTIA AV ČR, 19.2.2008 6

7. Data sources and flows in the past information system of the hospital database by Doctor1    information system of the clinic database by Doctor2 patient’s examination Iodine III     automatic data archiving paper cards paper archives Many data items are missing, some records are incomplete. ČSKI, ÚTIA AV ČR, 19.2.2008 7

8. A few notes on the data • heterogenous non-systematic collection of world-unique data as for their amount and set of quantities • necessary to be unified and simplified: • motivation — the doctors must decide • effort — a lot of analysis, programming, typing… • money — projects • compatibility with major existing systems should be considered • manual typing is the only way to transfer majority of the data • typing is an exhausting work, potential source of errors (correction necessary) and very expensive. ČSKI, ÚTIA AV ČR, 19.2.2008 8

9. Data sources and flows now (I) information system of the hospital database by Doctor1    information system of the clinic database by Doctor2 patient’s examination Iodine III     automatic data archiving paper cards paper archives ČSKI, ÚTIA AV ČR, 19.2.2008 9

10. Data sources and flows now (II) information system of the hospital  patient database of the clinic patient’s examination    JodWeb  automatic data archiving paper cards and archives Data are input only once, all the flow is automatic. ČSKI, ÚTIA AV ČR, 19.2.2008 10

11. Problems with the data transfer • intention: involve a person who cares about the network in the hospital and who is interested in data processing, too (exists!) • but: most energy of the person is dedicated to the routine network management, tasks delayed • furthermore: the hospital information system was being developed, the SW company is overwhelmed by specific requests of clinics • the GUI of the patient database unstable, programmers responded slowly, delays in manual typing • slow responses in programming of inter-database interface • structure of the patient database copied paper cards too much, types of some fields were not suitable for machine processing (I told them…), transformation was necessary • doctors did not care, i.e. they did not push the work forward ČSKI, ÚTIA AV ČR, 19.2.2008 11

12. Summary of the achievements so far • doctors see advantage of electronic database • paper cards are printed (for the tradition’s sake), no more manual data transfer • development of user-friendly web applications for accessing the clinical database (CaThy) and a dosimetric database with measurement support and processing (JodWeb, formerly Iodine III) • Bayesian estimates of biophysical and radio-hygienic quantities were implemented in JodWeb • several original results achieved concerning kinetics of 131I • management of patients’ data, archiving for research • initial version of cause-consequence model (advisory system) developed ČSKI, ÚTIA AV ČR, 19.2.2008 12

13. What has not been done • all the data has not been collected in time • therefore they have not been processed yet • the software is not fully debugged and finished • Improved version of the advisory system is not finished but • the tasks are near-finished, doctors see their potential for research and treatment • finishing the tasks does not require much energy • world-unique database is going to be available ČSKI, ÚTIA AV ČR, 19.2.2008 13

14. Plans and ideas • finishing the SW tools asap (but no more money) • huge and extensive retrospective data studies • medical feedback to mathematical modelling, discovering dependences in multidimensional data spaces • improvement and extension of the advisory system, analysis of its results • involvement of Ph.D. students ČSKI, ÚTIA AV ČR, 19.2.2008 14

15. Experience • without a motivation, no one will take effort • doctors cure (which is OK) but they leave a lot of things up to you (organization, budget structure…) • things must be arranged at the top (= doctor) level, building conceptions from bottom (= non-doctor) is not effective • don’t believe that anyone will help you to manage the project • don’t involve people who are too busy by themselves • think twice to start a similar project next time as the manager • cooperation with doctors is a hard job ČSKI, ÚTIA AV ČR, 19.2.2008 15

16. Thank you