Procedural Creation of Medical Reports with Hierarchical Information Processing in Radiation Oncology

Background: For many years, the oncological doctor's letter has been the pivotal means of information transfer to general practitioners, medical specialists or medical consultants. Yet, both creator and recipient require a high level of abstraction, retentiveness and analysis due to the large number of diagnoses and therapies. In contrast to the commonly used structure of doctor's letters, where all diagnoses and therapies are listed in sequential order with all diagnoses first, it is by no means trivial to establish the important chronological and hierarchical context in the description of oncological cases. Additional aspects of importance are the integration of these letters into existing clinical and departmental information systems (for example via HL7 interface), various export formats (for example PDF, HTML), fax and encrypted email. Moreover these letters need a modern layout that, among others, meets the requirements of corporate design. Methods: The requirements for a doctor's letter system are manifold and can only be represented rudimentarily via a normal word processing system. Due to this deficiency we developed a system that covers all special features and requirements for clinical use. The system is based on a scalable and extensible client-server architecture. We use the programming languages Harbour, C++, PHP and JavaScript, Microsoft SQL database for data storage and the HL7 standard as the interface to other information systems such as hospital information system (HIS). Export formats are PDF, HTML/XML. Layouts are generated with TeX, LaTeX and MikTeX. Results: The aforementioned requirements were resolved with the doctor's letter and finding system IntDok. The hierarchical presentation of diagnoses, histologies and therapies provides the recipient with a first outline of the course of the disease. A strict procedure controls the whole process of document compilation and assists the user with many highly regarded tools such as text blocks, import and export (PDF and HTML/XML including barcodes) functions or HL7 interface to other information systems. The software also provides a sophisticated mail merging. All content from previous letters can easily be inserted into the current document. A TeX-server automatically provides document layout including supreme hyphenation so that uniform and perfect appearance (corporate design) is guaranteed. The documents are saved in a MS-SQL database (almost 230,000 documents since 1991), independent of any proprietary formats such as MS-Word. Conclusion: Creation of documents is fast, simple and well-structured. Sophisticated tools guarantee the optimal use of human resources and time. The system is an important module in our overall digital work environment.