Abstract:
A relational database was developed tracking demographic and examination information for patients undergoing PET/CT studies. Methods: A worksheet was first developed to capture patient and study information which was then entered into a relational database. Reports were designed to provide administrative and clinical information. Results:
Approximately 2000 patients and three years of data have been recorded in the database. Reports have been used for administrative and research purposes. Conclusion: The database provided reports used to justify staffing, expenditures, and growth. It has also provided research data as well as clinical feedback used to improve the care and management of our patients.
Introduction:
In July 2003, the Medical College of Georgia installed a PET/CT scanner in its Radiation Therapy Outpatient Center. The scanner is used to perform a variety of diagnostic and oncology-related procedures. In order to be able to retroactively derive research data, a means of tracking patients as well as their individual studies was needed. Although a previously existing diagnostic PET scanner was in use, only radiopharmaceutical records were kept. In the radiation therapy PET/CT environment we felt it important to record additional information obtained from the in-depth patient history and physical.
Materials and Methods:
A worksheet was developed which allows the technologist to record a current medical history. It was designed by the nuclear medicine physician, the on-site radio pharmacist, and the lead PET technologist. Worksheet entries directly correspond to the database fields to simplify data input for the technologist. If funding becomes available for a computer in the incubation area, the technologist will be able to enter the history directly into the database. Worksheets are filled out by the nuclear medicine technical staff but in order to reduce errors, only the certified PET technologists perform data entry. Data has been collected since the inception of the PET/CT unit in August, 2003. The database currently holds approximately 2000 patients each of whom has had from 1 to 6 PET/CT examinations.
Because of the complexity of the information to be recorded, it was determined that a relational database rather than a spreadsheet would be the most effective tool. A relational database promotes accuracy and flexibility and also simplifies data input. Rather than the free text fields used in spreadsheets, extensive use was made of drop boxes and radio buttons as shown in figure 1 which provide selection from fixed, pre-established choices.
Because a patient can and often does have multiple examinations, one table was established for the patient and a related table for procedures. There is also a table of examination types. Using the relational capability of the database, every procedure is linked to a specific patient and exam type, both of which are selected from drop boxes. Tables were also developed for referring physicians and exam indications. Because information is linked rather than entered as free text, accuracy is improved and consistency is ensured.
Current departmental research interests focus on several patient populations including pediatric lymphoma, cervical and gynecological cancer, and patients requiring treatment planning. Specific database fields were selected to allow future correlations of disease and risk factors. In addition, fields were provided related to patient demographics in order to provide regional coverage documentation for the Certificate of Need.
As shown in figure 2, pre-designed reports are available to users at the touch of a button by clicking on icons on the front page of the database. These reports have been designed to address both administrative and clinical research needs. Example administrative reports include monthly procedure counts (figure 3), Veteran’s Administration patient volume, patient demographics for the Certificate of Need, and patient referral volume by physician (figure 4). For research purposes, study data in reports can be filtered by examination indications, type of exam, or patient sex, race, age, or risk factors.
Results:
The database is useful in providing financial reports. These reports are used to correlate contract billing and to monitor coding accuracy. Reports are also useful in looking at volumes in order to monitor productivity and develop future budgets.
Database reports organize research data on patients and their studies including demographics, history, and risk factors. The tools associated with a relational database provide statistics useful in the publication of case studies, preparation of lectures, and tracking of research data.
Discussion:
The database was designed and structured to provide flexibility in the use and presentation of information. One of the advantages of a properly designed database is that the presentation of information can be readily customized. Those entering information into the database as well as the individuals who will be using the results and reports should be involved in the design process. After obtaining all potentially useful information in the proper format, reports can be customized to fit the needs of administrators and researchers.
The approach used in the development and use of this database is adaptable to other types of institutions. The focus should be predicting the information required by the specific users as well as simplifying data entry. Well-designed database structure and screens can save time and reduce or eliminate many input errors, thus enhancing productivity and accuracy. Once accurate information is collected in a well-designed format, it is relatively simple for someone proficient with databases to produce customized reports. This is especially important because users often have changing needs and interests over time.
Below are examples of reports which administrators and clinicians at our institution have found useful:
• Veteran Patient Volume
The reimbursement department uses this data to track billing cycles.
• Physician Referral Base
This information is useful in focusing marketing efforts by identifying areas for development.
• Pediatric Lymphomas
Following pediatric patients over a period of years will help determine improved clinical pathways for disease management.
• Gynecological Cancers
The gynecological clinic is one of our largest referral bases. This information will be used to differentiate needs for customized scanning such as “dual point” scanning post surgery.
• Patient Logs and Volumes
Reports provide monthly and yearly patient volume data in both textual and graphical format. Accurate volume information allows us to project staffing needs and schedule system maintenance. The printout also provides a hardcopy back-up of invaluable data.
• Radiation Treatment Planning
By tracking the protocol used for each patient, outcomes are improved by retrospectively analyzing clinical patient management.
Conclusion:
This database has provided hospital administration with accurate and timely reports to justify staffing, expenditures, and growth. It has provided our physicians with a plethora of research data and has provided our technologists with a method of correlative thinking in the care and management of our patients.
As volume increases, the need for accurate, easily accessible information becomes more important. The database is being continually modified and new reports are being developed to enhance management and research functions. Use of a PET/CT tracking database should prove helpful to other facilities to exploit the potential of this technology.
References:
1. Gardner WD. Breast Cancer Database Provides Faster Access To Patient Records. InformationWeek Web site. 2005. Available at: http://www.informationweek.com/story/showArticle.jhtml;jsessionid=NBXENMVY3EP5AQSNDBGCKHSCJUMEKJVN?articleID=174400322. Accessed April 28, 2007.
2. Johnson S, Paul T, Khenia A. Generic Database Design for Patient Management Information. American Medical Informatics Association Web site. Available at: http://www.amia.org/pubs/symposia/D004062.PDF. Accessed April 28, 2007.
3. Friedman C, Hripcsak G, Johnson SB, Cimino JJ, Clayton PD. A Generalized Relational Scheme for an Integrated Clinical Patient Database. Proceedings of the Fourteenth Annual Symposium on Computer Applications in Medical Care. Washington, D.C. 1990.
4. Essin DJ, Lincoln TL. Implementing a Low-cost Computer-based Patient Record: A controlled vocabulary reduces database design complexity. In: Gardner R, ed. Nineteenth Symposium on Computer Applications in Medical Care. Philadelphia: Hanley and Belfus, 1995:431-5.