Project:  Mayo Clinic - Clinical Document Management

CDM Reports

CDM (Clinical Document Management) Reports is an application developed to allow electronic data entry and access to some of the complex clinical reports which were available previously only through existing paper forms. These reports were selected from a catalog of hundreds of departmental reports, and specifically fell into this development strategy because of their complexity, including tables, graphs, diagrams, lists of checkboxes, diagonal text, complex layouts, etc.

The CDM Reports project team has recognized the advantage of storing documents in XML, as database design is greatly simplified and streamlined. In CDM Reports, the XML is stored as text in a single database field. Because of document management requirements, the document header (which contains indexable information about the document) is stored relationally. Only the body of the document is stored in XML format, but this is exactly the part of each new report that has a varying schema. So this solution works well because no new database tables or fields need to be created when designing a new report.

CDM Reports implements XML-aware widgets. In other words, each widget (visual component) knows how to parse and generate its own markup. The container widgets divide up the markup and pass these markup segments to the contained widgets, some of which could recursively be container widgets themselves. In designing a persistent form by dropping on these XML-aware widgets, the XML for a large, complex form is generated and parsed automatically from the form design, with no further coding required. This streamlines the process of creating new report forms.

Widgets are linked at design time to encode the relationships between specific elements on the form, so that these relationships are expressed in the XML that is produced when the form is filled out. Widgets can communicate with each other and initiate state changes that are based on generated initialization XML stored with the form. This is an additional application of XML within the project.

The application was designed in 1997, and has been in production use since July 1998.

MICS Clinical Notes-II

For 5 years Mayo has been using an internally developed Clinical Notes-I system for entry, management, display and print of various clinical encounter documents, including general examinations, consultations, office visits, hospital summaries, and patient-related correspondence. The production system generates over 33,000 notes per week and currently has over 3 million on-line documents available to clinicians on over 8000 workstations.

In planning for future evolution and supplanting of this system, the MICS Clinical Notes-II project group has finished scope planning and is currently in component design and development phases. This is a joint effort between Mayo and IDX Systems Corporation (http://www.idx.com/). MICS Clinical Notes-II will manage the medical documents stored within the IDX LastWordÔ System. It is a set of XML-aware applications directly integrated into the IDX LastWordÔ system. These applications will support the entry, revision, review, and printing of clinical notes, clinical summaries, patient longitudinal histories (family history, social history, med-surg history, etc.) and correspondence. At this time, the design of Notes II will support the future inclusion of clinical reports in later development.

The utilization of XML as the encoding strategy for Clinical Notes-II will assist Mayo and IDX in the construction, management, and display of complex documents in a standardized fashion, minimizing development risk and decreasing database design overhead. XML was selected for this strategy because it is an open standard. XML has become an important standard to encode documents by content, not format. Utilization of XSL provides breadth in display formats for common document elements.