The vast amounts of data in our clinical information systems have enormous potential for tomorrow's healthcare. Medical research based on the reuse, aggregation and analysis of medical data increasingly enables the development of new and improved treatments, pharmaceuticals and technologies. This is where SMITH - Smart Medical Technology for Healthcare starts, using innovative IT solutions to set the basis for bringing research and clinical care closer together.
For this purpose, seven of the ten university hospitals participating in the consortium are establishing data integration centres (DIC). The aim of the generic infrastructure is to make data from routine care usable for medical research. This is being done in close cooperation with the universities of Aachen, Jena and Leipzig, as well as two non-university research institutions and four industrial partners.
By bundling medical informatics, clinical, systems medicine, computational linguistics and epidemiological expertise, this architecture enables interoperable use of data from patient care and patient-oriented research across the borders of multiple locations. The consortium demonstrates the functionality and added value of intelligent and responsible data use through one methodological use case and two clinical use cases in the areas of intensive care and infectious medicine. Via the SMITH service platform, the results can be used by further networking partners. Diagnosis, prevention and therapy on patients can thus be improved decisively and in the long term.
SMITH is one of four consortia of the Medical Informatics Initiative (MII) funded by the Federal Ministry of Education and Research (BMBF) and is supported by the BMBF in the development and networking phase from 2018 to 2021.
SMITH in a nutshell:
- 1 methodical use case to support clinical evaluation projects
- 2 clinical use cases for targeted care in intensive and infectious medicine
- 19 partners from science and industry
- Partners include 10 German university hospitals
- Over 200 project members
- Approx. EUR 45 million total funding volume (2018 - 2021)
Data integration centres
At seven of the ten participating university hospitals, cooperating generic data integration centres (DIC) are being established. The centres enable electronic health data from medical care and patient-oriented research to be used across institutions and locations. Their tasks as data brokers and independent trustees include preparing and organizing the release of information. To this end, the DIC maintains integrative databases with metadata directories.
The setup of the seven data integration centres is carried out with identical functionality. All centres are embedded in the university hospitals with access to local electronic medical patient information. This allows data analyses to be directly linked to statutory patient care.
The added value of this data use is demonstrated by the consortium in one methodological and two clinical use cases.
Methodological use case: PheP – Phenotyping pipeline supporting clinical evaluation projects
In the methodological use case Phenotyping Pipeline, PheP for short, SMITH develops innovative data analytical methods that automatically extract medical information from electronic patient records. Evaluation projects and calculations on existing data lead to ever new patient-related information and to a differentiated characterization of human attributes, so-called phenotypes. The rich data pool enables long-term optimization of clinical research and patient care.
SMITH demonstrates the procedure in two clinical use cases.
Clinical use case 1: ASIC - Algorithmic Surveillance in Intensive Care
With the ASIC use case, the consortium promotes the improvement of patient care by using already existing clinical routine data. This will be shown using the example of the therapy of patients with acute lung failure (ARDS), a disease from which about 40 percent of all affected patients still die today. The ASIC app developed for this purpose functions as an early warning system by alerting doctors to potential ARDS before the patient's condition threatens to become critical.
Clinical use case 2: HELP - Target-oriented antibiotic therapy in infection medicine
The HELP use case focuses on the guideline-based and recommended use of antibiotics for early and targeted control of certain bacterial infections. The main focus lies on the support of infectiology in normal and intensive care units using the HELP app developed for this purpose. This provides medical staff with rapid information and recommendations for responsible antibiotic therapy in staphylococcal bloodstream infections.
Data usage concept
Data is used locally via the data integration centres, which have access to the hospital information systems (HIS) and thus to the use of patient data. The patient data is individually analyzed and commented on in the hospital. This data can only be accessed by authorized employees of the data integration centres via the locally operating HIS system. Research into patient data is only possible with the patient's consent. In this respect, the data integration centres set up an independent trustee office.
Measures to strengthen medical informatics
- Conception of coordinated, joint training, advanced training and continuing education modules
- Offers for curricula in the area of "Master of Science" (M.Sc.) medical informatics and in the postgraduate area
- Establishment of a professorship for Medical Informatics at the University RWTH Aachen
- Establishment of a professorship for Medical informatics at the University Hospital Jena
- Establishment of a professorship for Medical Data Science at the University of Leipzig
- Further professorships will be established at the Bonn, Essen, Halle and Hamburg locations
- Establishment of junior research groups in connection with the establishment of professorships
The aim of the SMITH consortium is to develop an innovative structure for cross-institutional networking and the exchange of research and care data between the funded sites and beyond the consortium.
The project proposal envisages that cooperating generic data integration centres (DIC) will be established at the locations. The DIC will ensure the transfer of data from primary systems and the consolidation and preparation of data. A further task is to ensure data protection and data quality.
For the practical demonstration of the data exchange, methodological and clinical use cases have been conceptually developed to prove the effectiveness of the data integration centers. Thus, a concept for a methodical phenotyping platform was developed, whose task is to build a new data set for specific human attributes, so-called phenotypes, from patient-related information. This rich data set will enable the support of clinical evaluation projects and in the long run a patient-centered care. In addition, the concept development for clinical use cases in the fields of intensive care and infectious medicine was performed.
In addition, a joint training, further education and continuing education module was designed for the locations, which offers similar and modular curricula in the "Master of Science" medical informatics area and in the postgraduate area. The project proposal was approved by the Federal Ministry of Education and Research (BMBF) in July 2017. Since 2018, the SMITH consortium is in the development and networking phase.