Experiences with a generator tool for building clinical application modules.

OBJECTIVES: To elaborate main system characteristics and relevant deployment experiences for the health information system (HIS) Orbis/OpenMed, which is in widespread use in Germany, Austria, and Switzerland. METHODS: In a deployment phase of 3 years in a 1.200 bed university hospital, where the system underwent significant improvements, the system's functionality and its software design have been analyzed in detail. We focus on an integrated CASE tool for generating embedded clinical applications and for incremental system evolution. We present a participatory and iterative software engineering process developed for efficient utilization of such a tool. RESULTS: The system's functionality is comparable to other commercial products' functionality; its components are embedded in a vendor-specific application framework, and standard interfaces are being used for connecting subsystems. The integrated generator tool is a remarkable feature; it became a key factor of our project. Tool generated applications are workflow enabled and embedded into the overall data base schema. Rapid prototyping and iterative refinement are supported, so application modules can be adapted to the users' work practice. CONCLUSIONS: We consider tools supporting an iterative and participatory software engineering process highly relevant for health information system architects. The potential of a system to continuously evolve and to be effectively adapted to changing needs may be more important than sophisticated but hard-coded HIS functionality. More work will focus on HIS software design and on software engineering. Methods and tools are needed for quick and robust adaptation of systems to health care processes and changing requirements.

[Use of corticosteroids and immunoglobulins in acute and chronic immune thrombocytopenia in childhood. A clinically oriented treatment concept]. / Die Anwendung von Corticosteroiden und Immunglobulinen bei der akuten und der chronischen Immunthrombozytopenie im Kindesalter. Ein klinisch orientiertes Behandlungskonzept.

In 80% of children suffering from immune thrombocytopenic purpura, the disease is a self-limited process. Established therapeutic measures are commonly used to effect symptomatic relief. The foremost of these is the administration of immunoglobulins and corticosteroids. A total of 113 children and adolescents with immune thrombocytopenic purpura were examined retrospectively in this study. Of these, 48%, did not require any therapy, 37% were treated with high-dose immunoglobulin, and 15% with prednisolone as first-line treatment of extensive purpura of the skin and the mucous membrane. The time until the thrombocyte count reached 100 G/l was shorter in the treated group than in the one that was not treated (4.5 and 6.0 versus 21 days). 71% of all patients achieved remission in six month. In 29% the disease took a chronic course. Of 33 children with chronic therapy-dependent disease, 7 were splenectomised successfully. Seven further patients continue to live with thrombocyte counts below 20 G/l, of which 4 suffer from recurrent bleeding episodes. In patients with acute and chronic immune thrombocytopenic purpura, the aim of treatment is to prevent potentially fatal bleeding. Patients with thrombocyte counts below 20 G/l are high-risk patients. Nevertheless, even in this group, the therapy should be decided clinically according to bleeding tendency. Ideally, the therapy should result in a quick increase of thrombocyte counts whilst causing minimum side effects. Of the various established treatment modalities, high-dose immunoglobulin and high-dose prednisolone best fulfil these requirements.