1st Annual EUBIROD meeting

Dasman Center for Research and Treatment of Diabetes, Kuwait City

Kuwait City, Kuwait, 2nd-4th May 2009

The BIRO Project

Fabrizio Carinci, University of Perugia, Italy

First BIRO Academy Residential Course, Kuwait City, Kuwait, 2nd May 2009


The project "Best Information through Regional Outcomes" (BIRO) bears upon a systematic, evidence-based approach to improve management and prevention of diabetes complications in Europe through better information at all levels. The EU proposal envisaged a new model for international benchmarking of quality and outcomes through a shared system capable of delivering diabetes indicators in a sustainable and automated fashion.

In this presentation Dr.Fabrizio Carinci, a senior biostatistician and Technical Coordinator of the project for the University of Perugia, presents the main features in the design and development of the BIRO project. Fabrizio introduces its general objectives and explains how the plan for BIRO aimed at overcoming a number of unresolved issues that are practically relevant, for which the availability of better information is key to act. The BIRO proposal came at a time when both the IDF and the EU Council recommended continuous monitoring and benchmarking as top priority for diabetes in Europe.

Bearing upon his background and diverse expertise on field at international level, Fabrizio provides an overview of the many technological advancements at the basis of an integrated solution. He explains how the BIRO design was inspired by strategies that were perceived to be crucial, including: using different sources of information; involving databases already in place at the regional level; defining an architecture that could ensure privacy and confidentiality according to international standards; using open source software to allow the widest dissemination of the software and modern technology for online reporting.

Dr.Carinci highlights the importance of a particular notion: the "region" intended not as an administrative entity, but as a network of centres sharing a homogeneous set of organizational aspects, including the definition of individual data items and the way parameters are measured and routinely collected. This way the concept of region (and the annexed information system infrastructure) can be flexibly applicable to any relevant level, from a diabetes clinic to a collaborating network, or even an entire country. To allow compatibility with the BIRO approach, a data dictionary would allow collaborating “regions” to map their own definitions to those adopted by the BIRO network.

Dr.Carinci presents the BIRO workplan, its 15 workpackages, and the main results obtained in 40 months between 2005-2009. He describes the clinical review, leading to the specification of parameters and indicators, the common dataset and data dictionary, fully developed in XML, the template adopted for BIRO reports. The agreed architecture was identified through a privacy impact assessment allowing specification of details for data transmission, and driving all software development, including: database tools written in Java and Postgres, the statistical engine based on R and Latex, communication software using web services, and the web portal realized in Drupal. The system was completed by developing an integrated GUI interface automating the usage of all functions. The BIRO system runs on both Linux and Microsoft systems, and is released as open source under the GPL.

Dr.Carinci concludes his presentation explaining how the BIRO system is now being rolled out to a network of clinical units, regions, and Member States, as a basis for the creation of a European Diabetes Register, towards which the EUBIROD project will continue to disseminate, apply and refine the BIRO approach.