Building a Comprehensive Clinical Data Repository Using FHIR, LOINC and SNOMED.

In 2018 the University Hospital of Giessen (UHG) moved its hospital information system from an in-house solution to commercial software. The introduction of MEONA and Synedra-AIM allowed for the successful migration of clinical documents. The large pool of structured clinical data has been addressed in a second step and is now consolidated in a HAPI-FHIR server and mapped to LOINC and SNOMED for semantic interoperability in multicenter research projects, especially the German Medical Informatics Initiative (MII) and the Medical Informatics in Research and Care in University Medicine (MIRACUM) consortium.

SangeR: the high-throughput Sanger sequencing analysis pipeline.

Summary: In the era of next generation sequencing and beyond, the Sanger technique is still widely used for variant verification of inconclusive or ambiguous high-throughput sequencing results or as a low-cost molecular genetical analysis tool for single targets in many fields of study. Many analysis steps need time-consuming manual intervention. Therefore, we present here a pipeline-capable high-throughput solution with an optional Shiny web interface, that provides a binary mutation decision of hotspots together with plotted chromatograms including annotations via flat files. Availability and implementation: SangeR is freely available at https://github.com/Neuropathology-Giessen/SangeR and https://hub.docker.com/repository/docker/kaischmid/sange_r. Contact: Kai.Schmid@patho.med.uni-giessen.de or Daniel.Amsel@patho.med.uni-giessen.de. Supplementary information: Supplementary data are available at Bioinformatics online.

Reduced Rate of Inpatient Hospital Admissions in 18 German University Hospitals During the COVID-19 Lockdown.

The COVID-19 pandemic has caused strains on health systems worldwide disrupting routine hospital services for all non-COVID patients. Within this retrospective study, we analyzed inpatient hospital admissions across 18 German university hospitals during the 2020 lockdown period compared to 2018. Patients admitted to hospital between January 1 and May 31, 2020 and the corresponding periods in 2018 and 2019 were included in this study. Data derived from electronic health records were collected and analyzed using the data integration center infrastructure implemented in the university hospitals that are part of the four consortia funded by the German Medical Informatics Initiative. Admissions were grouped and counted by ICD 10 chapters and specific reasons for treatment at each site. Pooled aggregated data were centrally analyzed with descriptive statistics to compare absolute and relative differences between time periods of different years. The results illustrate how care process adoptions depended on the COVID-19 epidemiological situation and the criticality of the disease. Overall inpatient hospital admissions decreased by 35% in weeks 1 to 4 and by 30.3% in weeks 5 to 8 after the lockdown announcement compared to 2018. Even hospital admissions for critical care conditions such as malignant cancer treatments were reduced. We also noted a high reduction of emergency admissions such as myocardial infarction (38.7%), whereas the reduction in stroke admissions was smaller (19.6%). In contrast, we observed a considerable reduction in admissions for non-critical clinical situations, such as hysterectomies for benign tumors (78.8%) and hip replacements due to arthrosis (82.4%). In summary, our study shows that the university hospital admission rates in Germany were substantially reduced following the national COVID-19 lockdown. These included critical care or emergency conditions in which deferral is expected to impair clinical outcomes. Future studies are needed to delineate how appropriate medical care of critically ill patients can be maintained during a pandemic.

Challenges and Opportunities in Changing Data Structures of Clinical Document Archives from HL7-V2 to FHIR-Based Archive Solutions.

In 2018, a major replacement of clinical applications took place at the University Hospital of Giessen. One key part was the clinical document archive containing a vast collection of clinical data from the last 30 years. The aim of this sub-project was to move all data to a new system without any loss, while maintaining all functionality and all communication interfaces. This project successively resulted in a complete paradigm change in document storage. While the legacy clinical data repository (LCDR) was designed according to HL7-V2 principles, the replacement resulted in an HL7-FHIR implementation. The aim of this work is to discuss the differences between both approaches, the obstacles that appeared during migration, but also the opportunities resulting from the new philosophy, especially as far as the impact on the use of scientific data is concerned.