© diz.ikim.nrw | Universitätsmedizin Essen
© diz.ikim.nrw | Universitätsmedizin Essen

Synergy of Medicine and IT: Advances in Infection Medicine | 5 Questions for Roland Ihle and Anja Stempel on the conclusion of the HELP project

The increase in multi-resistant germs is confronting doctors in hospitals with growing challenges. An infection with the bacterium Staphylococcus aureus, for example, is frequently lethal. The right antibiotic therapy can significantly reduce mortality. However, if antibiotics are used too frequently or incorrectly, pathogens can develop resistance. This is where the clinical project HELP came in: With the help of an app, infectiological and microbiological consultation on the wards was to be supported and the use of antibiotics optimized. As a web app or PDF download, the HELP manual guided doctors in charge gradually through the diagnosis and therapy of staphylococcal bloodstream infections. The study on the use of the HELP manual  ran from 2020 to 2022 at the university hospitals in Aachen, Essen, Halle, Jena and Leipzig. At the end of June 2023, the project was completed. HELP is a clinical use case of the SMITH Consortium within the Medical Informatics Initiative (MII).

In our latest “5 Questions for” interview, Roland Ihle, software engineer at the Data Integration Center of the University Medical Center Essen, and Anja Stempel, study coordinator at the Clinic for Infectious Diseases at the University Medical Center Essen, share their findings from the HELP study. They also explain which aspects need to be taken into account for seamless integration of IT solutions into everyday clinical practice.

Mr. Ihle, you were involved in the technical provision of the HELP manual. The manual supports physicians in responsible antibiotic therapy for staphylococcal bloodstream infections. What technical challenges did you overcome in the process?

Roland Ihle: The technical implementation involved three tasks: First, in collaboration with the microbiology team, we informed the physicians that a HELP manual exists at all. For the technical implementation, we integrated a link on the microbiology report that the physicians could click to follow the HELP manual. Second, we emailed the Study Nurses daily to inform them of the specific patients who were suspected of having a staphylococcal infection. These patients were potentially eligible for the study. The third and final part was the most exciting part of the whole project: the analysis of the data. Using an electronic recording system called RedCap, the study nurses entered the data of the patients involved. The data from the questionnaires, such as information on infection type or medication, had to be merged with the patient data that already existed in our primary source systems. To ensure that the evaluation scripts functioned consistently at all sites, it was necessary to convert the data to a uniform format at each site. In MII, this process is referred to as “interoperability.” Achieving this was the goal: to show that we can standardize and structure the data in such a way that it is uniformly available at every university hospital. The fact that this is not already the case in the healthcare system is currently a significant challenge.

The HELP manual was tested at five university medical sites from 2020 to 2022 as part of a study. What should the clinical side pay attention to when implementing the app?

Anja Stempel: The HELP manual has been well received at Essen University Hospital because we have, of course, also provided good training. Shortly before it was activated, we went to every ward and explained to the doctors what this link on the microbiology report means. We also communicated through many different channels that the HELP manual was available, for example, through the internal clinic newsletter, with flyers, and a presentation. We repeatedly called the wards to clarify possible difficulties. When many doctors go into a rotation and change, as it is common especially in such a large hospital like the University Hospital Essen, it is sometimes difficult to train every doctor. I think the biggest challenge was to get all the doctors on board. Ultimately, the use of the manual was voluntary. We never had any influence on whether doctors actually clicked on the link.

What was the feedback from clinicians on the use of the HELP manual?

Anja Stempel: We have received some good feedback. At Essen University Hospital, however, we are not dependent on the manual, since advice is provided via the antibiotics consultation service and the infectious diseases consults. But we clearly find that the HELP manual can be a great help, especially for smaller hospitals without microbiology or infectiology. It can prevent incorrect therapy or waste of antibiotics. But it would also make life easier at larger hospitals, as it would then not always be necessary to immediately initiate a consultation with colleagues in infectious diseases or microbiology.

What did you both learn from the project?

Anja Stempel: That it is difficult to get a project like this through the ethics committee anywhere in Germany. Each site was at a completely different stage and it was limping along in some places. Fortunately, that has now been resolved in 2023. I also learned that every university hospital works differently and uses different software, for example. That wasn’t always easy for us. Even though we had hurdles, on the whole, it was a great pleasure to be involved. I hope for the future that we can reduce antibiotic therapies and prevent the excessive use of antibiotics.

Roland Ihle: I have nothing to do with the day-to-day running of a clinic and have no idea about medicine, but technically it was of course very interesting. For me, it was the first project in which I was allowed to accompany a study. I learned a lot about FHIR, the data structures, and the RedCap system, which I had never worked with before. What was done in the project was all new and therefore very interesting for me.

Finish the following sentence: What I particularly appreciated about my involvement in the SMITH project was…

Anja Stempel: …the collaboration with the IT department. I have never experienced this before, it was really a great interaction and I personally benefited a lot from it. In general, I really appreciated the team of the SMITH-HELP project, the cohesion, the positivity, and how we overcame the hurdles together.

Roland Ihle: …the interdisciplinary cooperation. As employees in the Data Integration Center, we rarely get out of our own department. It was therefore nice to have worked a lot with colleagues from infectious diseases. In this way, we also saw something of everyday clinical life. However, we noticed where something was not working so well and where we could provide technical solutions. At the same time, the collaboration with colleagues from the other sites went very well. It was nice to see how the other sites work and what IT is like there. That’s actually what counts in the end, that we interconnect with the other sites.