Searching Patient Data: A Role for Librarians in the Improvement of Healthcare Margaret Henderson, MLIS, AHIP Tompkins-McCaw Library

How it all started:

Practicum Project "To improve patient outcomes, proactively identify chronic and high-risk patients in this new environment, and effectively manage their financial performance, healthcare organizations must be able to provide analytics at the point of service and rely on historical and longitudinal data to manage patient populations.” Health Research Institute (2012). Needles in a haystack: Seeking knowledge with clinical informatics. haystack.jhtml.

The Biomedical Informatics Core (BIC) of the Center for Clinical and Translational Research (CCTR) supports research with various data services.

i2b2 Informatics for Integrating Biology & the Bedside Name of the software and an NIH-funded National Center for Biomedical Computing based at Partners HealthCare System in Boston, MA. Software is open source and modular. Developed for translational research. Doesn’t require IRB approval to use at VCU

Ontologies used in i2b2 Librarians know ontologies! International Classification of Diseases, Ninth Revision, Clinical Modification - ICD9-CM Logical Observation Identifiers Names and Codes - LOINC National Drug Code - NDC Systematized Nomenclature of Medicine – Clinical Terms - SNOMED-CT Various places to find these on the Internet for further study. Could be used to reinforce use of MeSH.

I2b2 Interface

Clinical Data Warehouse CALL BOB!!!!

Health Facts Cerner product HIPAA-compliant database collected from participating clinical facilities De-identified, real-world data Especially helpful for comparative effectiveness research on drugs

How can we help? Physicians must be dutiful. The ability to retrieve (from electronic databases and other resources), manage, and utilize biomedical information for solving problems and making decisions that are relevant to the care of individuals and populations. Medical School Objectives Project. Report I. Learning Objectives for Medical Student Education: Guidelines for Medical Schools. AAMC. January 1998.

Role of Researcher 1. Determine what data exist relative to a clinical question or formal hypothesis, demonstrating the following: a.The ability to use information technology to locate existing data sources. b.Knowledge of data sources …at one’s own institution… c.The ability to locate existing data sets not maintained at one’s own institution… Medical School Objectives Project. Report II. Contemporary Issues in Medicine: Medical Informatics and Population Health. AAMC. June 1998.

Be Aware of EHR Data Problems Clinicians don't always document everything. Billing codes aren't always the best description of problem. Too many variations of disease names. Coding errors. Narrative versus structured data.

Published Uses of EHR Data

Open Data Library and information professionals: need to become more involved with semantic web or users will reinvent wheel (i.e. ontologies) have the interpersonal and subject specialization for reference/consultation that IT doesn't have Stuart, David.(2011) Facilitating Access to the Web of Data: a Guide for Librarians. Facet Publishing.

Look for Health Data Everywhere

Questions?