Onkopedia casestudy

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A case study on the use of Plone and XML Director as a content management system for the Onkopedia guidelines portal from the German Society of Hematology and Medical Oncology.

The customer

The Deutsche Gesellschaft für Hämatologie und medizinische Onkologie (DGHO) e.V. (English: German Society for Hematology and Medical Oncology) is a medical society dedicated to, inter alia, the education and training of physicians and medical staff and the drafting and publication of medical guidelines. Its members comprise scientists and doctors who specialise in the research, diagnosis and treatment of blood diseases and malignant tumours.
 
Together with other medical societies from Germany, Austria and Switzerland, the DGHO operates the online guidelines portal Onkopedia. In addition to medical guidelines, the portal provides important medical information for patients and care-givers. Andreas Jung and ZOPYX were commissioned by the DGHO to develop the portal in 2010. It is based on the Produce & Publish authoring environment by ZOPYX and the open source content management system Plone.
 
The guidelines portal revolutionised the work of the DGHO. It structured and accelerated the editorial workflow and ensured that doctors and care-givers had quick, easy access to the latest guidelines and information. The portal facilitates the intensified exchange of specialist information and serves as an important tool for quality assurance in clinical practice.
 
For the doctors and scientists developing the guidelines, the workflow has remained unchanged. They continue to author documents in Microsoft Word. Once complete, the Word documents are reviewed for technical suitability by a DGHO staff member and fed into the CMS, where they are converted into HTML and – for printing – into PDF.

The challenge

The DGHO commissioned Andreas Jung and ZOPYX to extend the guidelines portal in 2014. The aim was for the publication workflow to be automated to the greatest possible extent, since the large volume of documents could no longer be managed by the available manpower. In addition, ZOPYX was to lay the technical groundwork to allow Onkopedia content to be fed directly into external third-party systems (such as hospital information systems) via standardised interfaces. Going forward, this would enable the DGHO to make use of new distribution channels.

The solution

To ensure semantically targeted, finely grained access to the guidelines via an API, ZOPYX decided to begin storing data in a special XML format defined for Onkopedia. It also decided to implement an end-to-end XML-based publication workflow.
 
XML offers a number of advantages. It has been the undisputed industry standard for the publishing sector for many years. In addition, there are a number of proven, powerful tools available for XML processing.
 
Little changed for the authors in the new XML-based publication workflow: they simply switched to a new Word template for creating content. Among other things, the new template enabled automatic validation of document structure and automatic generation of references and links. The conversion of DOCX files to XML is performed by the web service C-REX.net (Practice Innovation). The system is round-trip capable, which means that content can be converted from DOCX to XML and back again as often as required.
 
Thanks to this functionality, authors can check out previously uploaded content as a Word document and revise it at any time. Once the revision is complete, the C-REX.net converter also generates the HTML version for display on the web. PDF files are generated directly from the XML files using CSS Paged Media and the PDF engine PDFreactor. This new PDF converter meets every standard expected of a modern, high-quality PDF: tables, multi-column layouts, hyphenation, complex graphical layouts and more.
 
The new Onkopedia can supply information in a semantically correct, structured form, making it possible for all content to be embedded easily in external systems. Since all the information is stored in an XML database, external systems can send targeted, highly specific queries to the system and meaningfully process the structured content that is returned. This means that the new Onkopedia is a flexible and open system.
 
To enable users to obtain quick, efficient access to the most up-to-date medical knowledge, guidelines are linked with other information using a practical system of metadata. Other information can include study results, certifications, protocols and more. In this way, all available information is compiled and organised into clear topic categories.

Architecture & technology

The XML Director extension, which works with Plone 5, was developed by ZOPYX for storing XML content and assets in user-defined storage systems such as file systems, cloud storage or XML databases. Content can be entered through-the-web – via the browser – or imported from DOCX files via open interfaces. XML Director supports external editors like MS Word as well as embedded online editors that run in the browser. All content can be displayed in HTML and made available for download as a PDF or EPUB file. XML Director is an open system and offers powerful CMS functions including role-based access management, adaptable workflows and a simple, intuitive user interface. In addition, as an XML-based system, it is open in all directions and can be networked with standard office software on one side and external systems (via XQuery or WebDAV) on the other. As such, XML Director functions as a central control component in high-grade automated publishing environments.

Onkopedia highlights

DOCX-based processing workflow

Onkopedia uses a DOCX (Word)-based editorial process. DOCX was chosen as the standard format due to authors‘ familiarity with the standard application Microsoft Word. The use of other authoring tools was reviewed as part of the process; however, the reality is that authors still often write and review the guidelines in their spare time or while travelling. The standard workflow for the drafting of joint publications in the medical field was and remains Word. As such, it would have made little sense to forcibly implement a different solution.
 
Onkopedia uses XML as its internal data format. The conversion process enables lossless conversion of DOCX to XML. Where necessary, it also enables lossless conversion from XML back to DOCX to provide authors with the latest version of a guideline for revision. Only one official version of each document exists at any given time – as an XML in the editorial system.

XML processing and cross-media storage

The entire editorial workflow and subsequent conversion to different formats is based on XML, the industry standard for the publishing sector. Vendor independence is guaranteed thanks to to a comprehensive set of XML tools and converters. As a cross-media format, XML enables the provision of content in all possible formats and for all possible output channels.
  • Web/browser: HTML
  • Print: PDF
  • Apps for smartphones and tablets
  • Exports in vendor-specific formats (e.g. for use of content by third parties)

Self-publishing and autonomy over content

The Onkopedia editorial system was designed as a self-publishing portal that enables the customer to maintain full control over the creation and publishing of new content, eliminating the need for service provider involvement. Thanks to this autonomy, the DGHO retains sovereignty over its data and content. Content belonging to the DGHO never leaves its own portal. This guarantees the integrity of data and content as well as the DGHO’s independence from external vendors or service providers.

Comprehensive, individual master data management

All documents in Onkopedia have a comprehensive set of master data. Some master data is specific to the use case. Alongside this, Onkopedia uses a number of official codifications including:
  • Document type (guideline, protocol, drug assessments, drug interactions, etc.)
  • Storage location (guidelines, drugs, knowledge database, AYApedia, care)
  • ICD10 (ICD11 pending)
  • ATC codes (for documents related to medicines)
  • Participating medical associations
  • Date and status
  • Authors
  • Language
Thanks to this comprehensive set of metadata, Onkopedia can automatically generate cross-references between related documents (e.g. all documents on the topic of „Breast cancer in women“) or perform the automatic linking of drug-related documents with corresponding guidelines.

Treatment pathways

Over time, treatment pathways have emerged as a key source of information for medical personnel. These pathways provide an overview of treatment options in light of relevant patient data. To record and maintain record patient pathways, Onkopedia uses the web-based 360° Patient Pathways Editor by 360° Medical, where pathways are recorded by authors in parallel to the regular DOCX workflow and imported into the Onkopedia editorial system semi-automatically during the conversion from DOCX to XML. Pathways are also available internally as XML or JSON files in the standardised BPMN format.

Onkopedia app

Smartphone and tablet users can also access all Onkopedia content via the Onkopedia app (platforms: iOS and Android). The provision of the app recognises the value of the offline capability of content: a key requirement in environments where attending physicians have no radio connection or WLAN access. Medics can download relevant content and read it offline. Updates and changes to content are automatically indicated.

Four-step publication workflow

The environment for internal editing was designed for particular ease of use. By definition, a self-service publishing portal should enable users to respond promptly and independently to changing situations. In the Onkopedia project, this approach was realised predominantly by means of a four-step workflow:
  • Upload of source data (DOCX documents and treatment pathways)
  • Conversion of DOCX to XML
  • Conversion to PDF
  • Approval and publication

Conflict of interest management

The Onkopedia portal has its own tool for managing conflict of interest declarations by guideline authors. It requires authors to submit corresponding declarations for each set of guidelines at the time of publication or revision. The custom, web-based conflict of interest tool provides authors with forms for entering and submitting declarations. In the approval workflow, declarations are either accepted or sent back to authors for revision. Acceptable declarations are integrated automatically into guideline documents through the press of a button by the editorial team. This central approach to conflict of interest management replaces a complex, chaotic workflow involving emails, telephone and fax.

A unified approach for different document types and storage locations

Uniformity and ease of use are the keys to Onkopedia’s success. The integrated, standardised approach for document structures and master data enables the DGHO to respond to new situations with ease. It is similarly straightforward for service providers to implement new requirements and change requests – making it possible, for example, to realise the necessary extensions at speed during the COVID-19 pandemic. As a result, specialists have been able to provide COVID-19-relevant information for particular conditions as soon as it becomes available.

Third-party use of content outside Onkopedia

Thanks to the cross-media storage of content as XML, it is theoretically possible to generate any user-requested or manufacturer-specific format. This means that content from Onkopedia can be integrated into other systems as a key source of information. Such systems could include hospital systems, physician databases or patient information systems.

Automated functions to assist the smooth running of the editorial process

The Onkopedia editorial workflow supports authors and internal editors in a number of ways. A comprehensive range of automated functions take over the management of routine processes, including the automatic linking of internal references and digital object identifiers (DOI). The internal editing environment provides tools for automatically reviewing the consistency of documents or the functioning of hyperlinks. Links to related topics or documents are integrated automatically using metadata.

History and facts

  • Online since 2010
  • Switched to XML in 2014
  • Total documents published: 553
    • Guidelines, protocols and study results:  325
    • Drugs (assessments, factsheets, interactions): 227
  • Total documents (incl. archive): ~1800
  • Continuous further development and adaptation to technical requirements
  • Highly regarded by expert communities in the German-speaking world

Advantages at-a-glance

Reduced workload

The simplified publication workflow with automated quality control significantly reduced the workload of authors and editors. It is only thanks to the combination of simplified operation and extensive automation that such a large number of publications have been able to be handled by a relatively compact team.

Timely publication of changes

Authors and internal editors are able to publish changes to documents promptly and without the involvement of external parties. At the beginning of the COVID-19 pandemic, this emerged as a ket advantage, since a large amount of COVID-19-related specialist information was required to be published rapidly and updated frequently. The DGHO was able to make the information available quickly and in a targeted manner in a dedicated COVID-19 section.

New distribution options

Third-party systems such as hospital information systems or medical applications can access information directly via open, standardised interfaces. 

Effective image-building

Thanks to Onkopedia’s efficient provision of information across multiple channels, the DGHO can confidently position itself as a modern, knowledgeable and highly accomplished medical association.

Greater cost efficiency

The new Onkopedia enabled the DGHO to achieve the highly efficient production of mandatory guidelines and their implementation in clinical practice. The openness of the system renders it excellently placed to adapt to future requirements. Extensions to the scope of services can be realised with minimal time and effort.

Individual solutions are more cost-effective than those off the shelf

All professional associations have different expectations and requirements regarding the publication of guidelines. A standard solution or ‚off-the-shelf‘ software product almost never satisfies all requirements and must often be adapted at great cost. In addition, the purchasing organisation often loses control over its content and is no longer independent (so-called „vendor lock-in“).

The Onkopedia Case Study (old version from 2014) for download: