DBMS for Diabetes Evidence

DATABASE MANAGEMENTDATABASE MANAGEMENT
SYSTEM FORSYSTEM FOR
EPIDEMIOLOGICAL EVIDENCEEPIDEMIOLOGICAL EVIDENCE
ON RISK FACTORS:ON RISK FACTORS: DIABETESDIABETES
FOOT PROBLEMSFOOT PROBLEMS
S. Pruna1
, Andreea Pruna1
, Mihaela Ionescu2
, and M. Grigorescu2
.
1. Romanian Society for Clinical Engineering and Medical Computing,
Telemedicine Centre,
2. Diabetes Ambulatory Centre, Bucharest. I.L. Caragiale Str. 12, Sect. 2,
70208, Bucharest, ROMANIA, e-mail: simion.pruna@telemed.ro

Jun 2, 2013 Simion Pruna, et al http:// www.telemed.ro2
BS TeleDiab
Romanian Society for
Clinical Engineering and
Medical Telemedicine
Centre, Bucharest
A WHO
Collaborating Centre
Simion Pruna, PhD
President of RSCEMC
Director Telemedicine Centre

BS TeleDiab
BSTD HistoryBSTD History
BSTD began in 1996 :
EPI_INFO 1996 (Diabcare)
BSTD 1998 (Diabcare - GEHR)
SincroDiab 2000 (EHCR-GEHR)
It is not, and should not be presented as hard
factual evidence about the performance of
individual services; it is not a set of league
tables that should be used to identify good and
bad practice.

BS TeleDiab
EHCREHCR 1990-20021990-2002
 No standard format or methods of data interchange
has emerged
 Very few doctors are using the electronic medical
record despite its technically feasibility
 Abstinence of doctors, lack of keyboarding skills,
unfriendly software, lack of familiarity and
training, and lack of financial and other incentives
to produce superior medical record

BS TeleDiab
““Managing the Epidemic!”Managing the Epidemic!”
 Managing the Epidemic from countries and
regions is a simple goal, but difficult to fulfill
– Collection and aggregation of country (or region)
wide diabetes data into a single repository,
– Unified epidemic data collection and aggregation
to examine performance in unique and innovative
ways,
How can this be achieved?
– Integration and aggregation tools are available to assist
in the automation of this process

BS TeleDiab
New TechnologyNew Technology
 To increase the efficiency, speed and accuracy of
diabetes care results
– Billing reports that once took weeks to turnaround are
now taking days, laboratory results that once took days
to turnaround are taking hours, and pharmacy orders
that once took hours to turnaround are now taking
minutes
– Real-time data collection for diabetes monitoring
and disease management

BS TeleDiab
New IT - new concernsNew IT - new concerns
One of the major concerns when using new
technology is the issue of data security and
confidentiality, especially when data
contains a person’s medical history
New IT do not come without costs!

BS TeleDiab
What Options are Available toWhat Options are Available to
Medical Units?Medical Units?
 Upgrade the legacy systems in order to comply
with each of the European Directive of Data
Protection and regulations
 Implement a new hospital system that provides
compliance and advanced data visualization
As managers, what will you say?

BS TeleDiab
Questions?Questions?
What are the pros and cons of converting
your legacy system?
What about pros and cons of simply
replacing your system?

BS TeleDiab
Open Source software for diabetesOpen Source software for diabetes

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BSTD AIMSBSTD AIMS
 Promote medical informatics in Eastern Europe
and New Independent States
 Software package to store information relating to
patients with diabetes
 Provide framework for monitoring the outcome of
diabetes care

BS TeleDiab
Issues with Implementing aIssues with Implementing a
New System Include:New System Include:
 What solutions are available?
– There are many healthcare systems commercial
solutions available.
 For NAS and NIS A possible solution include:
– BSTD, free of charge at:
http://www.telemed.ro/news.htm
 For the PCD Europe I am suggesting an Open
Source development (which may start from BSTD
sources code which is free available)

BS TeleDiab
Countrie s re prese nte d in the Good Europe an HealthCountrie s re prese nte d in the Good Europe an Health
Re c ord Pro je ctRe c ord Pro je ct
Croix Rouge Francais e
S mithKline Beecham
United Kingdom
St Bartholomew’s Hospital
Me dica l Colle ge
The Royal Hos pitals NHS Trust
City & East London FHS A
The Royal Marsden Hospital
University of Hull
Instituto Clinica
Gera l Zona Norte
Portugal
Clinica P uerta de Hie rro
Spain
Association des Medecins et
Me decins Dentistes
Luxembourg
Microdata SARL
Ce ntre de Recherche Public
Henri Tudor
Ze ntralinstitut fur die
Kasse narztliche Ve rsorgung
Germany
University of Athens
Gree ce
Fra nce Telecom
France
C2V
Kalamazoo S.A.
Belgium
He alth Data Ma nagement Partners
ERIM
Federation des Association Medecins
Generalistes de Bruxelles
Insitut D’Hygiene et d’Epidemiologie
GEHR

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Good European HealthGood European Health
RecordRecord
First complete data structure for EHCRs
Ability to incorporate a wide range of data types
Facility to transmit medical records safely across
telecommunications networks
Incorporation of mechanisms for translation of
the information into different languages
Support for the process of clinical care and
medical education

BS TeleDiab
Electronic Health CareElectronic Health Care
RecordsRecords
Single subject of care
Owned by particular organisation
Medico-legal record
Appropriate access rights
Provision for exchange of information
Global distributed record
Mirror paper records

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Collection and aggregation ofCollection and aggregation of
data hospital widedata hospital wide
Data into a single repository, allowing you
to monitor the performance of your entire
diabetes care using a network infrastructure
Powerful and Flexible Reporting

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Question – Cost EstimationQuestion – Cost Estimation
 As managers, we’re
often asked to estimate
costs
 What will you say?

BS TeleDiab
Make smarter decisionsMake smarter decisions
based on accurate informationbased on accurate information
Blood Glucose (mg/dl)
Missing Data> 150135-150110-13570-110< 70
FastingPlasmaGlucose
80%
60%
40%
20%
0%
6
71
1011183998169158269 203898157147389 202550735963N =
Duration of Diabetes
25-29 years
20-24 years
15-19 years
10-14 years
05-9 years
0-4 years
%ofType2onInsulin
100
80
60
40
20
0
COUNTRY
1
2
3

BS TeleDiab
BSTD has an extensible andBSTD has an extensible and
open architectureopen architecture
Highly extensible and open architecture
allows to easily integrate new EHCR
functions:
• To create, review, annotate or maintain a
patient’s EHCR of any aspect of the patient
health condition, medication, visit history
• Accounting uniform monitoring across both
networks or workstation infrastructure

BS TeleDiab

BS TeleDiab
Pharmaceutical reportsPharmaceutical reports

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Introducing BSTDIntroducing BSTD
 The BSTD is a yearly screening tool for early
complications and appropriate treatment if
complications are detected
 Managing diabetes in the 21st
Century the quality
is everything
– Poor health care delivery result in lost patients and lost
revenue
– Ensuring high quality care is expensive
– ITC leads to decrease costs and increase quality

BS TeleDiab
BSTD comply rules for accessBSTD comply rules for access
to patient recordsto patient records
 BSTD has resources to
effectively log and monitor
every instance of access to a
patient’s records which are
required for the audit trail
 Solution:
– Control access (limit access)
– Use administrative privileges
(read vs. write)
– Disable high-risk commands
(Delete, Modify, etc.)

BS TeleDiab
BSTD - SummaryBSTD - Summary
 Good distribution (RO, UKR)
 High satisfaction rate
 Interest from additional countries
 Data fed back to WHO
 Unified Performance Data Collection
 Network Technology Support

BS TeleDiab
IT in medicine = hardware,IT in medicine = hardware,
software and managementsoftware and management

BS TeleDiab
Black Sea TeleDiab SystemBlack Sea TeleDiab System
 MEDIFON 2001 boot in
London was a great success
with substantial audience for
our software demo
 RSCEMC’s success in
delivering and implementing
BSTD was due two decades of
experience in the software
development combined with
the comprehensive knowledge
of the users requirements

BS TeleDiab
Thank youThank you

DBMS for Diabetes Evidence

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