Technical Realisation of the Computer Based Decision Support System (MEDAN CBDSS)

I. Implementation

    The computer based decision support system (CBDSS) is implemented on the MEDAN server and accessed via internet using a standard browser (MS Internet Explorer, Netscape Communicator, Opera, etc.). The main components of the implementation can be seen in Figure 1.

Main components of the MEDAN CBDSS
Figure 1: The main components of the MEDAN CBDSS.

Participants connect to the system by calling a HTML login page. The APACHE web server authenticates the participant and grants access to the CBDSS. In subsequent dynamic HTML pages (generated by an integrated PHP module) the participant can register a new patient record, add new data for own patients, and request warnings or diagnostic/therapeutic options. Therefore, the system uses an internal MySQL database to store the patient data while a decision module provides the neural network information.

II. Functionality

    In the following, a brief description of the possible user actions and their corresponding functional implementation is given. Access is always restricted to the participant's own patients. All submitted data is stored in the internal study database. Furthermore, all data is copied to both the monitoring and the statistical committee to guarantee transparent trial results.
  • Registering a New Patient Record
    Participants are allowed to register new abdominal septic shock patients to the MEDAN CBDSS. After registration the system allocates the next unused patient identification key (PID) and assigns the patient to the "information" or "no information" group according to a random list. This list is generated and delivered to both the monitoring and the statistical committee at the beginning of the study to prevent manipulations of the trial results.

  • Adding Patient Data
    Adding new data (blood pressure, thrombocytes, etc.) is only allowed for patients assigned to the "information" group. According to the submitted data the system decides whether a warning message ("critical" resp. "very critical state") and/or diagnostic/therapeutic options are presented to the participant.

  • Patient Information Request
    Participants can always request warning messages and/or diagnostic/therapeutic options for patients assigned to the "information" group (as long as the patient record is not closed).

  • Closing a Patient Record
    Discharge or lethality of a patient leads to the closure of a patient record. In both cases the participant submits the outcome result to the system. After closure, any data transaction for this patient record is prohibited.

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