Implementation of a Web-based dynamic database for differential diagnosis of hematopoietic neoplasms using immunophenotyping by flow cytometry. This application included the following modules: differential diagnosis with user's input data; immunophenotyping pattern of hematopoietic neoplasms; marker information; and data warehouse of archived cases. The data warehouse of clinical cases was an important part of this application. This would play a critical role in fine-tuning the inference process used in differential diagnosis as well as in discovering marker patterns of interests.
A major challenge in designing dynamic database on the Web has been to accommodate various types of Web browsers that use different client-side technology (Client-side Active X, different Java versions, etc.). Active Server Pages (ASP) technology (Microsoft, Seatlle, Washington) helps facilitate development of CD-MARKER DX, a platform-independent database implemented on the World Wide Web. All the processing work is done on the Web server, allowing for the use of a "thin" client (a Web browser without any plug-ins and extensions).
The current version of this application included the knowledge-base for 33 hematopoietic neoplasms, 43 diagnostic immunophenotyping markers, and approximately 100 archived cases. The core materials in CD-MARKER DX were derived from those developed for CD-Marker, a Microsoft Access database for personal computer designed previously by the authors. The search engine in this program, written in Microsoft Visual Basic for Access, was based on backward-chaining inference. Further details of the components, inference algorithm, and validation results for CD-Marker had previously been described. Conversion of the materials from the Access-based version to the ASP-based version required a complete rewriting of all the software codes to accommodate the web medium.
As the Web rapidly becomes more accessible to users around the world, Web-based software may eventually form the core of decision-support systems in clinical setting. ASP-based applications, such as the one described in this paper, are expected to contribute significantly in this area.
CD-MARKER DX was designed as a three-tiered application (presentation, logics, data layers) implemented in Microsoft ASP 2.0. The ASP technology works on the Active Server platform which utilizes Component Object Model (COM). The analytical portion of the logics tier is encapsulated in a set of in-process COM objects which were built in this project with Visual Basic (in the form of ActiveX DLL). ASP was used as a skeletal structure to connect the COM objects together. Manipulation of data can be achieved with Active Data Object (ADO) in conjunction with structured query language (SQL). Stored SQL procedures in database server eased the design of complex queries performed on the repository. VBScript and JavaScript were used for scripting on the server side and the client side, respectively. CD-MARKER DX was installed in a Microsoft Windows NT 4.0 server running Microsoft Internet Information Server 4.0. The data reside in a Microsoft SQL Server 7.0. Active Server Components (COM objects) are managed by Microsoft Transaction Server 2.0.
Nguyen, A., Wu, S., Jalali, M., Uthman, M., Johnson, K., Banez, E.: A Web-based Database for Diagnosis of Haematologic Neoplasms Using Immunophenotyping by Flow Cytometry. Medical Informatics & The Internet in Medicine. Volume: 26 Number: 4 Page: 309 - 323.