TBase - an Integrated Electronic Health Record and Research Database for Kidney Transplant Recipients

We demonstrate the visibility and benefits of a database that is used as an electronic health record for post-transplant care and clinical routine. And also has a highly sophisticated modular research design for the specific requirements of transplant research. Our electronic health record enables easy everyday clinical use, and quick access for research questions while ensuring highest data quality through data validation in a clinical routine setting.

Clinical users and patients rely on correct laboratory data, and medication plans for treatment thereby validating, and correcting the clinical data in daily practice. The electronic health record TBase has a modular database design based, and commonly used standards such as HL7, which allows for easy scalability into other transplant centers. This design also allows for implementation of other features that may be required for different outpatient clinics or other research areas.

To begin, enter the web link for TBase into a Chrome engine-based web browser in Charite intranet. Enter the username and password assign by the TBase administrator and click log on. Next, click on the add new patient button at a bottom of the patient overview frame on the left.

In the input screen that appears, enter the patient's name, date of birth, Charite hospital patient number or case number, and the information regarding patient consent for data processing. Once data entry is complete, click on the save button on the bottom right. Search for desired patient by entering the patient's name or date of birth in the search field on the top left, then click on the search button on the right of the search field or hit enter.

From the results that appear, click on the correct patient's name to open the master data viewing page. To navigate back from another page, click on the master data tab on the top left. To change the master data, click on the change button on the bottom right.

In the new input screen, change data such as the patient's phone number, address or identification code by typing the new information into the designated input fields. Once the changes are made, click on the save button on the bottom right. This will redirect to the master data viewing page where the changes can be seen and verified.

To add a new medication, in the medication tab, click on the new button at the bottom right. Enter the name of the substance dosing scheme, and starting date, which is automatically set at the current date but can be changed if required. Additionally, add an indication or a remark into the designated input fields if required.

Add the medication to the list by clicking on the save button on the bottom right. To change an existing medication, click on the appropriate item in the medication list, then click on the change button on the bottom right. Make the changes regarding dosage or application method in the designated input fields, and apply them by clicking on the save button on the bottom right.

To discontinue a drug, click on designated drug, then click on the discontinue button on the top. To search for previous medication, click on the search field on the top left, then select the correct option from the historic medication list to open a chart with all previous medications. To create a standardized medication list for the patient, according to German Regulations, click on the German Standard Medication Plan button on the top right to create a PDF file, and download it automatically for printout.

To view the medical course, click on the course tab on the top. To add a new entry to the medical course, click on the new button on the bottom right, and enter the information assessed into the desired input fields. Add the date and time of the next appointment into the designated input fields on the top right, and submit the data by clicking the save button on the bottom right.

To change an existing entry, click on it, then click the change button on the bottom right. Enter additional data into the designated input fields or change existing data. Change or update information in the notification field, and submit the changes by clicking the save button on the bottom right.

To create an automated medical report with a few clicks, click on the medical report button on the bottom right, then click on outpatient medical report. The patient's name, treating physician, last date of the laboratory values, and last date of medical course will be automatically filled out but can be changed if needed. After confirmation, click on okay to generate a properly formatted Word document containing the selected information.

To actively log out of TBase, click the log button at the bottom right. To query the collected data, use the replication server, and any data processing programs that can connect to a database via ODBC or JDBC. For example, to set up an ODBC database connection, open the ODBC tool, Add a new user data source name under control panel and security management.

Then enter the available connection data to the replication database. To generate a query in the open-source software RStudio, open file, click new file in the application RStudio at the top left, then click on our script. Enter the script code in the empty script window that appears.

Click on the run button on the top of the script window to run the script. Data from the connected database is used to generate the bar chart defined in the script. For more than 20 years, TBase has been prospectively collecting data from all kidney transplant recipients.

Over the years, a total of 6, 317 patients with 7, 595 kidney transplantation have been documented. The electronic health record TBase is based on four different databases with the live system at the core, enabling different groups of agents to work in parallel. Clinical users enter data via the graphical user interface, maintaining its high-quality.

Most information is automatically imported via interfaces from hospital information systems, laboratory partners, and drug-to-drug interaction checkers. Developers can implement new functionalities which are tested on the quality database before integration into the live system. For research purposes, the live database is replicated regularly so that no interference with live system is necessary when the database queries are performed by clinical researchers.

For the representation of patient data, a simple table structure was implemented. The patient table with the patient ID as the primary key is at the center of the table structure. Almost all tables except individual sub tables are connected to the central table through patient ID.Graphical results, such as the one shown here can be easily obtained by connecting to the database via a database interface in using data processing software like RStudio to send queries.

For a clinician using the graphic user interface of the electronic health record, it's very easy, intuitive, and self explanatory. For the researcher, it is important to set up the ODBC database connection to enable use of the standard statistical software packages like SPSF or RStudio. Over the last 20 years, TBase has been used to address numerous research questions related to kidney transplantation.

TBase can be easily used in other transplant centers due to its modularity and platform independence. Its design also allows for integration of home monitoring data, and AI-driven data analysis.