Demonstration of SLUMIS: A Clinical Database and Management Information System for a Multi Organ Transplant Program Michael Kurtz, M.S., Tom Bennett, M.B.A., Paul Garvin, M.D., Felipe Manuel, B.S., Maria Williams, B.A., Scott Langreder, A.S.
Department of Surgery, St. Louis University Medical Center, 3635 Vista Avenue at Grand Boulevard, PO Box 15250, St. Louis, MO 63110-0250, (314) 577-8561 FAX (314) 771-1945 k-
Abstract
..
Donar
Introduction
SLUMIS is divided into several major areas: 1) patient demographical information, 2) transplant candidate and registration information, 3) txp surgery information, 4) pre/post transplant followup and laboratory information, and 5) organ donor information. In addition, SLUMIS contains an HLA module that supports all functions of the histocompatibility laboratory including on line test requisitioning/reporting , generation of hard copy lab test results, billing for laboratory tests, sera/cell quality control testing, and tissue registry, typing/antibody screening tray statistics and maintenance. All major areas of the database are linked by a common key field and are accessed through the patients file (Figure 1). Reporting features of SLUMIS include automation of all required internal and external reports, complete operative histories including online access to actuarial graft and patient survival analysis, patient descriptive statistics, online graphical representation of creatinine and cyclosporine levels, patient sensitization 0195-4210/91/$5.00 © 1992 AMIA, Inc.
I
Inkomason
Because of the rapid evolution of the heart, heart/lung, liver, kidney and kidney/pancreas transplant programs at our institution, and because of a lack of an existing comprehensive database, we were required to develop a computerized management information system capable of supporting both clinical and research requirements of a multifaceted transplant program. SLUMIS ( ST. LOUIS UNIVERSITY MULTI-ORGAN INFORMATION SYSTEM) was developed for the following reasons: 1) to comply with the reporting requirements of various transplant registries, 2) for reporting to an increasing number of government agencies and insurance carriers, 3) to obtain updates of our operative experience at regular intervals, 4) to integrate the Histocompatibility and Immunogenetics Laboratory (HLA) for online test result reporting, and 5) to facilitate clinical investigation.
aet
ProPost TUp
Ciinlic
Twt
Iminopnedc.,iskmafSbhI
Infonmw on
I_
HLA
PaietsRo~ma
Laboratory --
Figure 1. Database Structure histories, and survival curves. SLUMIS also contains separate address files for tracking referring physicians and dialysis centers for appropriate renal patients. The transplant physician is aided by automated generation of form letters to referring medical personnel using current clinical information imported from multiple database files. Management of data flow is handled by completion of various data cards by clinical staff personnel, depending on the type of information being retrieved (eg. candidate registration by transplant coordinators, surgery information by the surgeon, HLA test results by HLA technicians, etc.). Because of the large amount of data being recorded, and its wide variability in type and location, the information retrieval system as a whole became crucial to the success of the database, as one individual could not possibly retrieve all required information for entry (Figure 2). In addition, data collection cards were designed to resemble as closely as possible the data entry screens, and hand written information was kept to a minimum to eliminate data collection/entry errors. Actual data entry from the data cards as well as all network management responsibilities,
889
internal and external report generation, search/query functions, and quality assurance, are managed by one individual with the support of an in-house data processing division.
addition, all of the graphical capabilities as well as numerous report capabilities will be demonstrated. Conclusion SLUMIS is a flexible, powerful, yet user friendly management information system allowing transplant physicians and other clinical personnel to retrieve, analyze, integrate and interpret numerous pieces of clinical information conveniently and quickly. Since all network management responsibilities as well as data entry, report generation and search and query functions are handled by one person, key clinical personnel are freed from burdensome clerical tasks. SLUMIS is a useful resource in the management and development of our transplant program and facilitates both clinical and investigative aspects of our program as well.
Figure 2. Flow of Information.
System Hardware and Software
W
The SLUMIS system was designed using Acius 4th Dimension"" Database software for Apple Macintoshtm because of its power and flexibility as well as its user friendly interface. Because of the large amount of data being retrieved and tracked, it was felt that a user friendly interface was a key feature needed in order to accurately enter and retrieve information from the database. (Figure 3).
F.rE Edlt PutbutsStwin -
....
---
.owds kuPbi
---
ELI
-..
MGItOM_
0 Cusom
_-_ a 0
Ov
D30 bram_ra hoUw
OAS
Da_d 03OD Damw Da m
L
DO__ _______
l
D A"s
o
Damewsb _
a-
25A.9
_ovw
Novell Netware® was selected as network software in order to remain compatible with the University's Wide Area Network, which is mainly of the Arcnet/Ethernet topology using Novell, as well as to take advantage of it's ability to support both IBM® and Apple Macintosh workstations. Use of this network topology also provides a major increase in speed over Apple's built in networking protocol. The file server is an Everex Step Server 386® (IBM Clone) 33mhz machine configured with 5 megabytes RAM and a 640 megabyte hard drive. Each Macintosh workstation has 2-3 megabytes of RAM and is configured with a Thomas-Conrad Arcnet card allowing access to the Novell Network.
1=
I-,
0
Figure 3. Sample Database Entry Screen
Description of Demonstration
The demonstration will consist of the creation and tracking of a transplant patient through the entire transplantation process. Beginning with initial patient contact with either the transplant physician or coordinator, acceptance as a viable transplant candidate, pretransplant workup, transplant surgery and post-transplant followup(s). HLA tests will be requested on-line and results reported throughout this entire process. In
890
Department of Surgery, St. Louis University Medical Center, 3635 Vista Avenue at Grand Boulevard, PO Box 15250, St. Louis, MO 63110-0250, (314) 577-8561 FAX (314) 771-1945 k-
Abstract
..
Donar
Introduction
SLUMIS is divided into several major areas: 1) patient demographical information, 2) transplant candidate and registration information, 3) txp surgery information, 4) pre/post transplant followup and laboratory information, and 5) organ donor information. In addition, SLUMIS contains an HLA module that supports all functions of the histocompatibility laboratory including on line test requisitioning/reporting , generation of hard copy lab test results, billing for laboratory tests, sera/cell quality control testing, and tissue registry, typing/antibody screening tray statistics and maintenance. All major areas of the database are linked by a common key field and are accessed through the patients file (Figure 1). Reporting features of SLUMIS include automation of all required internal and external reports, complete operative histories including online access to actuarial graft and patient survival analysis, patient descriptive statistics, online graphical representation of creatinine and cyclosporine levels, patient sensitization 0195-4210/91/$5.00 © 1992 AMIA, Inc.
I
Inkomason
Because of the rapid evolution of the heart, heart/lung, liver, kidney and kidney/pancreas transplant programs at our institution, and because of a lack of an existing comprehensive database, we were required to develop a computerized management information system capable of supporting both clinical and research requirements of a multifaceted transplant program. SLUMIS ( ST. LOUIS UNIVERSITY MULTI-ORGAN INFORMATION SYSTEM) was developed for the following reasons: 1) to comply with the reporting requirements of various transplant registries, 2) for reporting to an increasing number of government agencies and insurance carriers, 3) to obtain updates of our operative experience at regular intervals, 4) to integrate the Histocompatibility and Immunogenetics Laboratory (HLA) for online test result reporting, and 5) to facilitate clinical investigation.
aet
ProPost TUp
Ciinlic
Twt
Iminopnedc.,iskmafSbhI
Infonmw on
I_
HLA
PaietsRo~ma
Laboratory --
Figure 1. Database Structure histories, and survival curves. SLUMIS also contains separate address files for tracking referring physicians and dialysis centers for appropriate renal patients. The transplant physician is aided by automated generation of form letters to referring medical personnel using current clinical information imported from multiple database files. Management of data flow is handled by completion of various data cards by clinical staff personnel, depending on the type of information being retrieved (eg. candidate registration by transplant coordinators, surgery information by the surgeon, HLA test results by HLA technicians, etc.). Because of the large amount of data being recorded, and its wide variability in type and location, the information retrieval system as a whole became crucial to the success of the database, as one individual could not possibly retrieve all required information for entry (Figure 2). In addition, data collection cards were designed to resemble as closely as possible the data entry screens, and hand written information was kept to a minimum to eliminate data collection/entry errors. Actual data entry from the data cards as well as all network management responsibilities,
889
internal and external report generation, search/query functions, and quality assurance, are managed by one individual with the support of an in-house data processing division.
addition, all of the graphical capabilities as well as numerous report capabilities will be demonstrated. Conclusion SLUMIS is a flexible, powerful, yet user friendly management information system allowing transplant physicians and other clinical personnel to retrieve, analyze, integrate and interpret numerous pieces of clinical information conveniently and quickly. Since all network management responsibilities as well as data entry, report generation and search and query functions are handled by one person, key clinical personnel are freed from burdensome clerical tasks. SLUMIS is a useful resource in the management and development of our transplant program and facilitates both clinical and investigative aspects of our program as well.
Figure 2. Flow of Information.
System Hardware and Software
W
The SLUMIS system was designed using Acius 4th Dimension"" Database software for Apple Macintoshtm because of its power and flexibility as well as its user friendly interface. Because of the large amount of data being retrieved and tracked, it was felt that a user friendly interface was a key feature needed in order to accurately enter and retrieve information from the database. (Figure 3).
F.rE Edlt PutbutsStwin -
....
---
.owds kuPbi
---
ELI
-..
MGItOM_
0 Cusom
_-_ a 0
Ov
D30 bram_ra hoUw
OAS
Da_d 03OD Damw Da m
L
DO__ _______
l
D A"s
o
Damewsb _
a-
25A.9
_ovw
Novell Netware® was selected as network software in order to remain compatible with the University's Wide Area Network, which is mainly of the Arcnet/Ethernet topology using Novell, as well as to take advantage of it's ability to support both IBM® and Apple Macintosh workstations. Use of this network topology also provides a major increase in speed over Apple's built in networking protocol. The file server is an Everex Step Server 386® (IBM Clone) 33mhz machine configured with 5 megabytes RAM and a 640 megabyte hard drive. Each Macintosh workstation has 2-3 megabytes of RAM and is configured with a Thomas-Conrad Arcnet card allowing access to the Novell Network.
1=
I-,
0
Figure 3. Sample Database Entry Screen
Description of Demonstration
The demonstration will consist of the creation and tracking of a transplant patient through the entire transplantation process. Beginning with initial patient contact with either the transplant physician or coordinator, acceptance as a viable transplant candidate, pretransplant workup, transplant surgery and post-transplant followup(s). HLA tests will be requested on-line and results reported throughout this entire process. In
890
