CC BY-NC-ND 4.0 · Appl Clin Inform 2021; 12(03): 551-563
DOI: 10.1055/s-0041-1731286
State of the Art/Best Practice Paper

Designing and Implementing an IT Architecture for a Digital Multicenter Dementia Registry: digiDEM Bayern

Michael Reichold
1   Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
,
Nikolas Dietzel
2   Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
,
Christina Chmelirsch
2   Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
,
Peter L. Kolominsky-Rabas
2   Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
,
Elmar Graessel
3   Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
,
Hans-Ulrich Prokosch
1   Department of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
› Author Affiliations
Funding The project is funded by the Bavarian State Ministry of Health and Care as part of the funding initiative BAYERN DIGITAL II ' (funding code: G42d-G8300–2017/1606–83).

Abstract

Background Registries are an essential research tool to investigate the long-term course of diseases and their impact on the affected. The project digiDEM Bayern will set up a prospective dementia registry to collect long-term data of people with dementia and their caregivers in Bavaria (Germany) supported by more than 300 research partners.

Objective The objective of this article is to outline an information technology (IT) architecture for the integration of a registry and comprehensive participant management in a dementia study. Measures to ensure high data quality, study governance, along with data privacy, and security are to be included in the architecture.

Methods The architecture was developed based on an iterative, stakeholder-oriented process. The development was inspired by the Twin Peaks Model that focuses on the codevelopment of requirements and architecture. We gradually moved from a general to a detailed understanding of both the requirements and design through a series of iterations. The experience learned from the pilot phase was integrated into a further iterative process of continuous improvement of the architecture.

Results The infrastructure provides a standardized workflow to support the electronic data collection and trace each participant's study process. Therefore, the implementation consists of three systems: (1) electronic data capture system for Web-based or offline app-based data collection; (2) participant management system for the administration of the identity data of participants and research partners as well as of the overall study governance process; and (3) videoconferencing software for conducting interviews online. First experiences in the pilot phase have proven the feasibility of the framework.

Conclusion This article outlines an IT architecture to integrate a registry and participant management in a dementia research project. The framework was discussed and developed with the involvement of numerous stakeholders. Due to its adaptability of used software systems, a transfer to other projects should be easily possible.

Protection of Human and Animal Subjects

The study obtained ethical approval by the Ethics Committee of Medical Faculty of Friedrich-Alexander-University Erlangen-Nürnberg (FAU) (application number: 253_20 B).




Publication History

Received: 04 March 2021

Accepted: 05 May 2021

Article published online:
16 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Pop B, Fetica B, Blaga ML. et al. The role of medical registries, potential applications and limitations. Med Pharm Rep 2019; 92 (01) 7-14
  • 2 Nelson EC, Dixon-Woods M, Batalden PB. et al. Patient focused registries can improve health, care, and science. BMJ 2006; 354: i3319
  • 3 Schüler P, Kolominsky-Rabas P. Patient registries for neurodegenerative diseases: approaches for the 21 century. Curr Res Neurol Neurosurg 2019; 2 (01) 006-010
  • 4 Richesson RL, Vehik K. Patient Registries*. In: Richesson RL, Andrews JE. eds. Clinical Research Informatics. Health Informatics. London: Springer London; 2012: 233-252
  • 5 Dreyer NA, Garner S. Registries for robust evidence. JAMA 2009; 302 (07) 790-791
  • 6 Alzheimer's Association. 2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016; 12 (04) 459-509
  • 7 Deutsche Alzheimer Gesellschaft V. Die Häufigkeit von Demenzerkrankungen. Published online 2018. Accessed January 10, 2021 at: https://www.deutsche-alzheimer.de/fileadmin/alz/pdf/factsheets/infoblatt1_haeufigkeit_demenzerkrankungen_dalzg.pdf
  • 8 Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit. Gesundheitsreport Bayern: 2/2019–Update Demenzerkrankungen. Published online 2019. Accessed January 8, 2021 at: https://www.lgl.bayern.de/publikationen/doc/gesundheitsreport_2_2019.pdf
  • 9 Krysinska K, Sachdev PS, Breitner J, Kivipelto M, Kukull W, Brodaty H. Dementia registries around the globe and their applications: a systematic review. Alzheimers Dement 2017; 13 (09) 1031-1047
  • 10 Dietzel N, Kürten L, Karrer L. et al. Digital Dementia Registry Bavaria-digiDEM Bayern: study protocol for a multicentre, prospective, longitudinal register study. BMJ Open 2021; 11 (02) e043473
  • 11 Lacey Jr JV, Savage KE. 50 % Response rates: half-empty, or half-full?. Cancer Causes Control 2016; 27 (06) 805-808
  • 12 Fogel DB. Factors associated with clinical trials that fail and opportunities for improving the likelihood of success: a review. Contemp Clin Trials Commun 2018; 11: 156-164
  • 13 Connell CM, Shaw BA, Holmes SB, Foster NL. Caregivers' attitudes toward their family members' participation in Alzheimer disease research: implications for recruitment and retention. Alzheimer Dis Assoc Disord 2001; 15 (03) 137-145
  • 14 Shatenstein B, Kergoat M-J, Reid I. Issues in recruitment, retention, and data collection in a longitudinal nutrition study of community-dwelling older adults with early-stage Alzheimer's dementia. J Appl Gerontol 2008; 27 (03) 267-285
  • 15 Mundy J, Stansfeld J, Orrell M, Cartwright M, Wenborn J. Reasons for nonparticipation in the Valuing Active Life in Dementia randomised controlled trial of a dyadic occupational therapy intervention: an interview study. SAGE Open Med 2020; 8: 2050312120958926
  • 16 Nuseibeh B. Weaving together requirements and architectures. Computer 2001; 34 (03) 115-119
  • 17 Reichold M, Dietzel N, Karrer L, Graessel E, Kolominsky-Rabas PL, Prokosch H-U. Stakeholder perspectives on the key components of a digital service platform supporting dementia - digiDEM Bayern. Stud Health Technol Inform 2020; 271: 224-231
  • 18 Dietzel N, Karrer L, Wolff F. et al. Predictors of caregiver burden in dementia: results of the Bavarian Dementia Survey (BayDem) [in German]. Gesundheitswesen 2020; 82 (01) 30-39
  • 19 Karrer L, Dietzel N, Wolff F. et al. Use of outpatient care services by people with dementia: results of the Bavarian Dementia Survey (BayDem) [in German]. Gesundheitswesen 2020; 82 (01) 40-49
  • 20 Kratzer A, Karrer L, Dietzel N. et al. symptom burden, health services utilization and places and causes of death in people with dementia at the end of life: the Bavarian Dementia Survey (BayDem) [in German]. Gesundheitswesen 2020; 82 (01) 50-58
  • 21 About the Business Process Model And Notation Specification Version 2.0. Accessed February 22, 2021 at: https://www.omg.org/spec/BPMN/2.0/About-BPMN
  • 22 KRITIS - Introduction. Accessed February 18, 2021 at: https://www.kritis.bund.de/SubSites/Kritis/EN/introduction/introduction_node.html;jsessionid=F41083AEA692B310FB3B575A74989458.2_cid345
  • 23 Orientierungshilfe zu Nachweisen gemäß § 8a Absatz 3 BSIG. Accessed February 18, 2021 at: https://www.bsi.bund.de/DE/Themen/KRITIS-und-regulierte-Unternehmen/Kritische-Infrastrukturen/Allgemeine-Infos-zu-KRITIS/Nachweise-erbringen/OH_Nachweise/orientierungshilfe_node.html
  • 24 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
  • 25 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
  • 26 Pung J, Rienhoff O. Key components and IT assistance of participant management in clinical research: a scoping review. JAMIA Open 2020; 3 (03) 449-458
  • 27 Loh PK, Ramesh P, Maher S, Saligari J, Flicker L, Goldswain P. Can patients with dementia be assessed at a distance? The use of Telehealth and standardised assessments. Intern Med J 2004; 34 (05) 239-242
  • 28 Wadsworth HE, Dhima K, Womack KB. et al. Validity of teleneuropsychological assessment in older patients with cognitive disorders. Arch Clin Neuropsychol 2018; 33 (08) 1040-1045
  • 29 Carotenuto A, Rea R, Traini E, Ricci G, Fasanaro AM, Amenta F. Cognitive assessment of patients with Alzheimer's disease by telemedicine: pilot study. JMIR Ment Health 2018; 5 (02) e31
  • 30 Smoltczyk M. Hinweise für Berliner Verantwortliche zu Anbietern von Videokonferenz-Diensten. Published online July 3, 2020. Accessed February 26, 2021 at: https://www.datenschutz-berlin.de/fileadmin/user_upload/pdf/orientierungshilfen/2020-BlnBDI-Hinweise_Berliner_Verantwortliche_zu_Anbietern_Videokonferenz-Dienste.pdf
  • 31 Jitsi.org - develop and deploy full-featured video conferencing. Jitsi. Accessed January 24, 2021 at: https://jitsi.org/
  • 32 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12 (03) 189-198
  • 33 Nasreddine ZS, Phillips NA, Bédirian V. et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53 (04) 695-699
  • 34 Nurmi S-M, Kangasniemi M, Halkoaho A, Pietilä A-M. Privacy of clinical research subjects: an integrative literature review. J Empir Res Hum Res Ethics 2019; 14 (01) 33-48
  • 35 Wichmann H-E, Kaaks R, Hoffmann W, Jöckel K-H, Greiser KH, Linseisen J. Die Nationale Kohorte. Bundesgesundheitsbl. 2012; 55 (6–7): 781-789
  • 36 Schilpzand EJ, Sciberras E, Efron D, Anderson V, Nicholson JM. Improving survey response rates from parents in school-based research using a multi-level approach. PLoS ONE 2015; 10 (05) e0126950
  • 37 Szabo SM, Whitlatch CJ, Orsulic-Jeras S, Johnson JD. Recruitment challenges and strategies: lessons learned from an early-stage dyadic intervention (innovative practice). Dementia 2018; 17 (05) 621-626
  • 38 Der Vorstand des NAKO e. V. Datenschutz in der NAKO. NAKO Gesundheitsstudie. Accessed February 20, 2021 at: https://nako.de/allgemeines/was-ist-die-nako-gesundheitsstudie/datenschutz-in-der-nako/
  • 39 Gliklich RE, Dreyer NA, Leavy MB. eds. Registries for Evaluating Patient Outcomes: A User's Guide. 3rd ed.. Agency for Healthcare Research and Quality (US); 2014. Accessed February 20, 2021 at: http://www.ncbi.nlm.nih.gov/books/NBK208616/
  • 40 Gliklich RE, Dreyer NA, Leavy MB, Christian JB. eds. 21st Century Patient Registries: Registries for Evaluating Patient Outcomes: A User's Guide: 3rd ed., Addendum. Agency for Healthcare Research and Quality (US); 2018 . Accessed February 20, 2020 at: http://www.ncbi.nlm.nih.gov/books/NBK493818/
  • 41 ACSQHC. Australian Commission on Safety and Quality in Health Care. Operating Principles and Technical Standards for Australian Clinical Quality Registries.. Accessed February 20, 2021 at: http://www.med.monash.edu.au/assets/docs/sphpm/operating-principles.pdf
  • 42 Technologie- und Methodenplattform für die Vernetzte Medizinische Forschung e. V, IT-Reviewing Board, Akademische Verlagsgesellschaft AKA GmbH. IT-Infrastrukturen in der patientenorientierten Forschung Aktueller Stand und Handlungsbedarf - 2016.
  • 43 Saiepour N, Ware R, Najman J, Baker P, Clavarino A, Williams G. Do Participants with different patterns of loss to follow-up have different characteristics? A multi-wave longitudinal study. J Epidemiol 2016; 26 (01) 45-49
  • 44 Schröder ML, de Wispelaere MP, Staartjes VE. Predictors of loss of follow-up in a prospective registry: which patients drop out 12 months after lumbar spine surgery?. Spine J 2019; 19 (10) 1672-1679
  • 45 Chevrier R, Foufi V, Gaudet-Blavignac C, Robert A, Lovis C. Use and understanding of anonymization and de-identification in the biomedical literature: scoping review. J Med Internet Res 2019; 21 (05) e13484
  • 46 Art. 35 GDPR - Data protection impact assessment. GDPR.eu. Published November 14, 2018. Accessed April 8, 2021 at: https://gdpr.eu/article-35-impact-assessment/
  • 47 Federal Office for Information Security. Guidelines on content and requirements for industry-specific security standards (B3S) according to § 8a (2) BSIG. Accessed April 8, 2021 at: https://www.bsi.bund.de/SharedDocs/Downloads/EN/BSI/IT-SiG/b3s_Orientierungshilfe_1_0_en.pdf?__blob=publicationFile&v=1
  • 48 Almeida JR, Gini R, Roberto G, Rijnbeek P, Oliveira JL. TASKA: a modular task management system to support health research studies. BMC Med Inform Decis Mak 2019; 19 (01) 121
  • 49 Royce W. Managing the Development of Large Software Systems. Published online 1970. Accessed February 20, 2021 online: http://www-scf.usc.edu/~csci201/lectures/Lecture11/royce1970.pdf
  • 50 Petersen K, Wohlin C, Baca D. The Waterfall model in large-scale development. In: Bomarius F, Oivo M, Jaring P, Abrahamsson P. eds. Product-Focused Software Process Improvement. Vol. 32. Lecture Notes in Business Information Processing.. Heidelberg, Germany: Springer Berlin Heidelberg; 2009: 386-400
  • 51 Avgeriou P, Grundy J, Hall JG, Lago P, Mistrík I. eds. Relating Software Requirements and Architectures. Heidelberg, Germany: Springer Berlin Heidelberg; 2011
  • 52 Osorio JA, Chaudron MRV, Heijstek W. Moving from Waterfall to Iterative Development: An Empirical Evaluation of Advantages, Disadvantages and Risks of RUP. In: 2011 37th EUROMICRO Conference on Software Engineering and Advanced Applications. IEEE; 2011: 453-460
  • 53 Bjarnason E. Distances between requirements engineering and later software development activities: a systematic map. In: Doerr J, Opdahl AL. eds. Requirements Engineering: Foundation for Software Quality. Vol. 7830. Lecture Notes in Computer Science. Heidelberg, Germany: Springer Berlin Heidelberg; 2013: 292-307
  • 54 Bygstad B. Controlling iterative software development projects: the challenge of stakeholder and technical integration. IEEE. 2004. HICSS; 2004: 10
  • 55 Chung L, do Prado Leite JCS. On non-functional requirements in software engineering. In: Borgida AT, Chaudhri VK, Giorgini P, Yu ES. eds. Conceptual Modeling: Foundations and Applications. Vol. 5600. Lecture Notes in Computer Science. Heidelberg, Germany: Springer Berlin Heidelberg; 2009: 363-379
  • 56 Weber BA, Yarandi H, Rowe MA, Weber JP. A comparison study: paper-based versus web-based data collection and management. Appl Nurs Res 2005; 18 (03) 182-185
  • 57 Sahoo U, Bhatt A. Electronic data capture (EDC)--a new mantra for clinical trials. Qual Assur 2003; 10 (3-4): 117-121
  • 58 Walther B, Hossin S, Townend J, Abernethy N, Parker D, Jeffries D. Comparison of electronic data capture (EDC) with the standard data capture method for clinical trial data. PLoS ONE 2011; 6 (09) e25348
  • 59 Staziaki PV, Kim P, Vadvala HV, Ghoshhajra BB. Medical registry data collection efficiency: a crossover study comparing web-based electronic data capture and a standard spreadsheet. J Med Internet Res 2016; 18 (06) e141
  • 60 Mosa ASM, Yoo I, Parker JC. Online electronic data capture and research data repository system for clinical and translational research. Mo Med 2015; 112 (01) 46-52
  • 61 Lundström M, Albrecht S, Svensson K, Wendel E. Handbook for Establishing Quality Registries. Karlskrona, Sweden: EyeNet; 2005
  • 62 Faulds MC, Bauchmuller K, Miller D. et al; South Yorkshire Hospitals Audit and Research Collaboration (SHARC). The feasibility of using 'bring your own device' (BYOD) technology for electronic data capture in multicentre medical audit and research. Anaesthesia 2016; 71 (01) 58-66
  • 63 McGirt MJ, Parker SL, Asher AL, Norvell D, Sherry N, Devin CJ. Role of prospective registries in defining the value and effectiveness of spine care. Spine 2014; 39 (22, Suppl 1): S117-S128
  • 64 Richesson RL, Andrews JE. eds. Clinical Research Informatics. Basel: Springer; 2012
  • 65 Deakyne Davies SJ, Grundmeier RW, Campos DA. et al; Pediatric Emergency Care Applied Research Network. The pediatric emergency care applied research network registry: a multicenter electronic health record registry of pediatric emergency care. Appl Clin Inform 2018; 9 (02) 366-376
  • 66 Joseph A, Mullett C, Lilly C. et al. Coronary artery disease phenotype detection in an academic hospital system setting. Appl Clin Inform 2021; 12 (01) 10-16
  • 67 Wolff F, Dietzel N, Karrer L. et al. Timely diagnosis of dementia: results of the Bavarian Dementia Survey (BayDem) [in German]. Gesundheitswesen 2020; 82 (01) 23-29
  • 68 Rakesh G, Szabo ST, Alexopoulos GS, Zannas AS. Strategies for dementia prevention: latest evidence and implications. Ther Adv Chronic Dis 2017; 8 (8-9): 121-136
  • 69 Mandavia R, Knight A, Phillips J, Mossialos E, Littlejohns P, Schilder A. What are the essential features of a successful surgical registry? A systematic review. BMJ Open 2017; 7 (09) e017373
  • 70 Stausberg J, Harkener S, Siddiqui R, Semler SC. IT infrastructure for registries in health services research: a market study in Germany. Stud Health Technol Inform 2018; 251: 183-186
  • 71 Dowling NM, Olson N, Mish T, Kaprakattu P, Gleason C. A model for the design and implementation of a participant recruitment registry for clinical studies of older adults. Clin Trials 2012; 9 (02) 204-214
  • 72 Gombosev A, Salazar CR, Hoang D, Cox CG, Gillen DL, Grill JJ. Direct mail recruitment to a potential participant registry. Alzheimer Dis Assoc Disord 2021; 35 (01) 80-83
  • 73 Zwan MD, Flier WM, Cleutjens S. et al. Dutch Brain Research Registry for study participant recruitment: design and first results. Alzheimers Dement (N Y) 2021; 7 (01) e12132
  • 74 Grill JD, Hoang D, Gillen DL. et al. Constructing a local potential participant registry to improve Alzheimer's disease clinical research recruitment. J Alzheimers Dis 2018; 63 (03) 1055-1063
  • 75 Langbaum JB, High N, Nichols J, Kettenhoven C, Reiman EM, Tariot PN. The Alzheimer's Prevention Registry: a large Internet-based participant recruitment registry to accelerate referrals to Alzheimer's-focused studies. J Prev Alzheimers Dis 2020; 7 (04) 242-250
  • 76 Grimes DA, Schulz KF. Cohort studies: marching towards outcomes. Lancet 2002; 359 (9303): 341-345
  • 77 Abshire M, Dinglas VD, Cajita MIA, Eakin MN, Needham DM, Himmelfarb CD. Participant retention practices in longitudinal clinical research studies with high retention rates. BMC Med Res Methodol 2017; 17 (01) 30
  • 78 Jelicić H, Phelps E, Lerner RM. Use of missing data methods in longitudinal studies: the persistence of bad practices in developmental psychology. Dev Psychol 2009; 45 (04) 1195-1199
  • 79 Menard SW. ed. Handbook of Longitudinal Research: Design, Measurement, and Analysis. 1st ed.. Amsterdam: Elsevier; 2008
  • 80 Adams JL, Myers TL, Waddell EM, Spear KL, Schneider RB. Telemedicine: a valuable tool in neurodegenerative diseases. Curr Geriatr Rep 2020; 9 (02) 72-81
  • 81 Orlando JF, Beard M, Kumar S. Systematic review of patient and caregivers' satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients' health. PLoS One 2019; 14 (08) e0221848
  • 82 Cuffaro L, Di Lorenzo F, Bonavita S, Tedeschi G, Leocani L, Lavorgna L. Dementia care and COVID-19 pandemic: a necessary digital revolution. Neurol Sci 2020; 41 (08) 1977-1979