A sharable cloud-based pancreaticoduodenectomy collaborative database for physicians: Emphasis on security and clinical rule supporting

ArticleinComputer methods and programs in biomedicine 111(2) · May 2013with36 Reads
DOI: 10.1016/j.cmpb.2013.04.019 · Source: PubMed
Abstract
BACKGROUND: Pancreaticoduodenectomy (PD) is a major operation with high complication rate. Thereafter, patients may develop morbidity because of the complex reconstruction and loss of pancreatic parenchyma. A well-designed database is very important to address both the short-term and long-term outcomes after PD. OBJECTIVE: The objective of this research was to build an international PD database implemented with security and clinical rule supporting functions, which made the data-sharing easier and improve the accuracy of data. METHODS: The proposed system is a cloud-based application. To fulfill its requirements, the system comprises four subsystems: a data management subsystem, a clinical rule supporting subsystem, a short message notification subsystem, and an information security subsystem. After completing the surgery, the physicians input the data retrospectively, which are analyzed to study factors associated with post-PD common complications (delayed gastric emptying and pancreatic fistula) to validate the clinical value of this system. RESULTS: Currently, this database contains data from nearly 500 subjects. Five medical centers in Taiwan and two cancer centers in Mongolia are participating in this study. A data mining model of the decision tree analysis showed that elderly patients (>76 years) with pylorus-preserving PD (PPPD) have higher proportion of delayed gastric emptying. About the pancreatic fistula, the data mining model of the decision tree analysis revealed that cases with non-pancreaticogastrostomy (PG) reconstruction - body mass index (BMI)>29.65 or PG reconstruction - BMI>23.7 - non-classic PD have higher proportion of pancreatic fistula after PD. CONCLUSIONS: The proposed system allows medical staff to collect and store clinical data in a cloud, sharing the data with other physicians in a secure manner to achieve collaboration in research.
    • "However, their approach does not specify about the level of trust made on the CA, hence data tempering is possible. Health Personal Cards – HPC are used for the authentication of new physicians by Yu et al. [22], and for the existing physicians the healthcare data access is provided through a secure protocol like Secure Socket Layer—SSL. Eavesdropping is reduced; however this approach has interoperability issues. "
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    • "Accordingly, we classified the literature into two categories: theoretical and empirical. The theoretical category covered articles delivering general statements about CCS in hospitals (e.g., [31]) or proposing CCS that are not yet deployed in practice (e.g., [2]), while the empirical category contained articles describing concrete CCS for hospitals (e.g., [32]). We observed that some articles deliver general statements or features about CC and then apply them to concrete CCS for hospitals (e.g., [33]). "
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    • "Nevertheless, the DIRECT messaging to access request does not specify whether a certificate authority is trusted or not and, therefore, can potentially lead to tampering. Yu et al. [59] presented a methodology that permits the physicians to collect the patients' evidence-based data and share it with other physicians. The privacy of the data is preserved through a secure authentication mechanism. "
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