Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology The SUNY – wide CIDR project. Where.

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Presentation transcript:

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology The SUNY – wide CIDR project. Where are we? Werner Ceusters, MD Prof., Department of Biomedical Informatics Dir. of Research, UB Institute for Healthcare Informatics Dir., National Center for Ontological Research

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Long-Term Goals Develop and Maintain a centralized clinical integrated data repository (CIDR) of SUNY EHR Data Use this CIDR as a research asset for SUNY investigators

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Semantic Interoperability: the goal Everything collected wherever, whenever and about whomever which is relevant to a medical problem in whomever, whenever and wherever, should be accessible without loss of relevant detail.

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Initial EHR Database Assessment Representing and Failing to Represent in EHR Data (Bona, Ceusters) Based on ontological realism and referent tracking Goal: Understand questions easily answered by EHR interface but difficult to answer with database

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Initial EHR Database Assessment (con’t) Issues – Multiple entries stand for same entity – Single entry that stands for more tan one entity – Entries unclear about temporal distinctions – Entries incorrectly marked as Entered in error or Resolved – Entries that are wrong or outdated but still marked as Active

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Ontology based data warehousing

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Five Core Report Goals 1.Catalog EHR assets across all SUNY entities that provide clinical care 2.Review the regulatory environment for clinical data research 3.Organize stakeholder meetings 4.Review collected information to create a roadmap for CIDR creation 5.Host a CIDR summit to review and discuss the findings

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Questionnaire 79 questions Distributed to SUNY and SUNY-related clinical organizations Components: – Demographic data – Organizational environment – EHR system characteristics

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Groups contacted SUNY BuffaloSUNY Upstate ECMCUB OrthopedicsCrouse HospitalPrivacy Office UB AnesthesiologyUB OtolaryngologyEpic SystemsSt. Joseph’s hospital UB Emergency MedicineUB PathologyIMT AdministrationUHS Binghamton University RadiologyUB Vascular Surgery LabLourdes HospitalUHS Wilson Medical UB NeurosurgeryHealthcare InformaticsPediatrics UB Nuclear MedicineUBMD UB OphthalmologyKaleida Health SUNY DownstateSUNY Albany SUNY Downstate Medical CenterInformation Studies Medical Compliance OfficeSUNY Albany School of Public health

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Questionnaire Completion Rate Institutions which responded UB Associates UB Emergency Medicine UB Ophthalmology UB Radiology Kaleida Health SUNY Downstate Crouse Hospital UB Orthopedics UB Otolaryngology ECMC Institutions which did not UB Anesthesiology UB Neurosurgery UB Nuclear Medicine UB Pathology UB Vascular Surgery Lab St. Joseph’s Hospital Binghamton General Hospital UHS Wilson

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Core Task One – Catalog SUNY EHR Assets Reported Electronic Health Records in use 1.Allscripts Touchworks 2.Allscripts Sunrise Clinical Manager 3.Epic 4.Medflow 5.Cerner 6.Siemens Invision 7.Medent 8.CPRS 9.Meditech 10.Vista

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology EHR Statistics on submitted reports Clinical GroupProvidersInpatientOutpatientTotal UBMD475-90,000 Upstate Medical University ,000 discharges / year 500,000 visits/ year 1,509,247 UB Ophthalmology21-60,000 UB Orthopedics99-272,673 UB Otolaryngology4-19,800 Kaleida Health2,4001,500,000- Downstate Medical Center ,000 ECMC940843,12353,928897,051

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Reported RHIO Connections Clinical GroupRHIO Connection UBMDHEALTHeLINK Upstate Medical CenterHealtheConnections UB Emergency MedicineHEALTHeLINK UB OrthopedicsHEALTHeLINK, Greater Rochester RHIO, HealtheConnections, HIXNY UB OtolaryngologyHEALTHeLINK Kaleida HealthHEALTHeLINK

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Special Population Identification Special PopulationIdentification Rate Children73% Elderly64% Impoverished18% Underrepresented Minorities 45% African-Americans73% Hispanics73% Native Americans73% Pacific Islanders55% Childhood Illness Survivor36%

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Data Extraction for Research Several analytic databases currently in use among SUNY clinical groups Data taken and separate from production databases Production  Analytic ‘translation’ issues – Information in different fields – Missing data – Fields merged

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Core Task Two – Regulatory Environment No reported contractual data sharing agreements that would provide restrictions other than legal – Many ‘unknown’ answers Interpretation of – HIPAA Compliance – IRB Compliance – Patient Consent

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Core Task Three – Stakeholder Meetings Bi-Weekly Status Meetings Quarter one meeting held in Albany (SUNY Albany) – RHIO connectivity, SUNY Buffalo EHR activity, conversion and interoperability of EHR data Quarter two meeting held in Syracuse (SUNY Upstate) – Regulatory roadblocks, coordinating different data sources Quarter three meeting held in New York City (SUNY Downstate) – Compliance concerns, possible technical architecture

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Core Task Four – CIDR Roadmap Goals outlined for task four have proven extremely challenging to complete Needs: – More technical details (data dictionaries) – More clarity about legal and regulatory concerns – Institutional commitment

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Core Task Five – CIDR Stakeholder Summit This meeting Goals: – Review results of collection efforts – Come to a consensus on conclusions drawn – Make recommendations on how best to proceed

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Barriers and Obstacles Interfaces between EHRS – Concerns that EHRs are not interoperable Data dictionaries – Only one currently available Institutional resistance – Fears over HIPAA and IRB compliance – Legal concerns regarding sharing, possession, and security of data

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Barriers and Obstacles (con’t) Institutional resistance – Participation in RHIOs and SHIN-NY reduces perceived importance of CIDR – Some consider CIDR not worth time/effort/money Lack of technical data – Questionnaires answered by directors, not individuals with intimate technical knowledge

Department of Biomedical Informatics UB Institute for Healthcare Informatics National Center for Biomedical Ontology Conclusions