MEDinsight

MEDinsight was developed in response to clinicians’ requirements to carry out quality assurance of patient examinations and treatment, as well as to cover researchers’ needs for storage and collation of research results.

“By making systematic use of good research and quality registers, researchers and clinicians can evaluate the process and results of patient treatment, which furthermore can help with the understanding and patient-focused management of patient treatment and research.”

Overview

National strategies for improving the quality of the health service have led to an increased need for documentation of the results and quality of diagnostics and treatment. Hospital owners and the central authorities see this as an important focus area with regard to quality development and management information for the individual hospital and within the various professional environments. Medinsight have produced more than 150 different registers and databases and is the standard tool for developing and hosting quality registers and research databases at Oslo University Hospital.

A number of systems are used within the health enterprise to follow up with patients during their day-to-day treatment, such as the electronic patient journal (EPJ), patient administrative system (PAS) and systems for recording test results and treatments. These systems constitute an important part of the documentation for the individual patient, however, they do not necessarily cover the requirement to be able to record and extract the kind of structured information required to implement an improvement in quality over time. The reality is that enthusiasts in the professional environments create their own databases to the best of their abilities. These vary in quality with regard to content, reporting, security and operation. We see a major and fairly urgent need for a standardized tool that guarantees these principles.

Furthermore the hospital’s goal is to continue to develop its role as the country’s strongest medical research environment and focus on strategic research. To this end, quality assured data and good tools are required in order to extract and analyze the material.

The MEDinsight Concept

The MEDinsight concept

Since 2004 we have developed and continually improved a tool to support the improvement in quality and research work. MEDinsight is now a concept that covers the following areas:

• The MEDinsight framework
• MEDinsight databases
• MEDinsight quality indicators
• The MEDinsight portal
• MEDinsight data protection and data security
• MEDinsight competence

The MEDinsight framework

MEDinsight reporting and statistics

The toolbox

The MEDinsight framework can be regarded as a toolbox consisting of a set of functions that all the databases can use. The framework is developed in parallel with the creation of new quality registers and is subject to constant change based on the wishes and requirements of users. The purpose of the framework is to implement new databases within a short period of time that contain functionality that supports the principles of data quality, data accessibility, security and simple reporting. These are principles we believe to be necessary in order to carry out successful quality improvement and research.

By means of the patient explorer, which is the basic structure in MEDinsight, users will be able to gain an overview of the logical connection between patient data from the various databases. A timeline shows a visual representation of the patient’s progress in chronological order. These functions can be used to form the basis for defined treatment lines for patients.

Reports and statistics

”Good reporting routines are crucial in determining whether or not a register will succeed. Out of respect for the people who spend time and resources on registration, the reports must be perceived as useful and be easily accessible, and it must be possible to use them as an effective instrument for their own quality development.” (Handbook for medical quality registers, SKDE 2008).

MEDinsight Timeline

This is one of the main principles in MEDinsight. Functionality has been included to allow health staff and researchers to create their own reports without requiring help from database specialists. Key elements in the report module are functions for counting, filtering and analysis, survival curves and age distribution. Data can be transferred from the report module to statistics tools such as SPSS if more advanced analyses are required.

The report function in MEDinsight can also be used to generate quality indicators, which help to define the quality of the aspect to be measured.

MEDinsight databases

Databases to support quality improvement and research

MEDinsight databases are custom built databases based on the individual user’s requirements, and are connected to any accessible data sources via the MEDinsight portal. Existing data from other types of databases such as DataEase, Access, Excel and SPPS can be converted into a MEDinsight database.

MEDinsight is created as a Windows program, which is installed centrally and
upgraded to the latest version by automated procedures. The individual user can access to the system via the hospital’s internal network. The standardized framework makes it easy to create new databases in MEDinsight with related common functionality which supports the principles of data quality, data accessibility, security and simple reporting.

Data quality

To ensure that the data is of good quality, MEDinsight contains a number of control functions to clean the registered data. The report module is a useful tool for finding faults and omissions in the data set. There is an emphasis on structured information in the forms, and the register must not contain free text — with the exception of where the purpose is to record supplementary information that is only useful for a single patient. All fields are validated according to a set of rules when registering and the forms are allocated a status to indicate their level of completion. Field definitions and help functions help users gain a common understanding of the significance of the different fields in the database.

MEDinsight Quality Indicators

MEDinsight quality indicators were developed as a part of the systematic process to ensure and develop the quality of treatment offered. Quality indicators can provide some information about the quality of the treatment administered, and can give an indication or warn of any discrepancies. In order to say anything about this, it is important to first define goals that describe what good quality entails. The professional environments are making progress in identifying and defining specific quality indicators that form a natural part of the patients’ treatment and that are to be registered in our own operating systems. Over time, we hope many of the indicators should be introduced as national quality indicators for all hospitals that carry out similar diagnostics and treatment. This will enable us to gain an overview of the different types of treatment with the corresponding results. The indicators can be generated via the report functionality from the individual database in MEDinsight and transferred to a separate tool for further publication.

The MEDinsight portal

The portal in MEDinsight makes it possible to connect databases, and thus collate information from several systems, based on access control. This supports the principle of data accessibility. The portal provides an overview of the logical connection between patient data from different databases and treatment systems. The reporting functionality in the framework provides a simple way to obtain and collate data. Over time, we hope to be able to obtain data from all necessary systems that can provide the user with information about the patient’s administrative data, lab data, test results and treatment results. Part of the purpose of the portal is to avoid duplicate registration, which can lead to inconsistencies in the data. It is important that the information that is already registered in other systems can be extracted as part of the collection of data for the registers. It is important for the fields in the reference database to be well defined in order to ensure that there is a shared understanding of what the different parameters measure/mean.

Collecting the basis data is a time-consuming process in the majority of research projects. MEDinsight provides people working on a research project with access to collated clinical data, thus ensuring the effective use of research resources. This gives researchers the freedom to focus their attention on the research itself and spend less time on logistics.

MEDinsight data protection and data security

All medical registers in MEDinsight are stored in a standardized format (SQL server) with the same routines for backing up data as the other patient-related systems in the hospital network. This enables us to ensure that sensitive patient information is stored safely. It is important to comply with both internal guidelines for information security and government regulations regulating the processing of personal data. IMI has achieved this by established a routine to ensure that the quality registers and research registers have the required permits before commencing operation.

Access to the databases in MEDinsight is controlled through a role-based user filter in the framework, based on users’ existing accounts on the hospital network. As a user, you can only access relevant data that you have the right to view in accordance with your role. This means that there are strict rules governing who can access which kinds of patient-identifiable data.

Specific rules apply to research databases for de-identification and time-limited storage of data. Applications and concessions from the Data lnspectorate are quality checked for each individual research project. This ensures that any conditions in the permits are implemented in the system so that the correct storage of and access to sensitive information is established in the register.

MEDinsight competence

In order for the aforementioned elements to function, it is important that cross-discipline collaboration and competence exists both within medicine and IT. In MEDinsight, developers and healthcare providers work closely together. This collaboration is important to establish user-friendly registers that are adapted to each user’s requirements, be in terms of quality assurance or research.

Competence areas:

• Legal: Provide assistance in applying for necessary concessions and licenses
• Professional: Supervise health staff and researchers with the structuring of data with regard to the intended purpose of the register
• Technical: Develop specially adapted databases and connect these to any existing data
• Training: Provide training in using the report module and the other functions in MEDinsight to achieve the most efficient use of the register.
• Operations: Ensure the secure storage of data with backup routines and version management

Communication with the users is extremely important. Terminology and working processes must be learned and understood before new projects can be implemented. The total data flow in the hospital is complex and subject to continuous change. MEDinsight is developed continuously to reveal inconsistencies and enable better data flow. Clinicians, researchers and programmers have learned to collaborate in a goal-oriented and systematic manner through the development of different types of registers. We have had the benefit of being located in the same place and many years of close collaboration. The programmers have been available and have reaped the benefits in the form of trust and many good ideas. Everyone rightly feels ownership of what we have created.

Our work is long-term. Requirements, organization and technology will continue to change and MEDinsight must incorporate changes without losing continuity.

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