Initial Implementation of an Intelligent Patient Data Review Assistant (IPDRA) LTC Trinka Coster, MD Matthew Medlock, MD LTC Joseph Parker, MD Jim Ong, MS Jane Dowling, MS Stephen Porter, MD Seth Powsner, MD Ida Sim, MD PhD Walter Reed Army Institute of Research Uniformed Services Univ. of the Health Sciences Walter Reed Army Medical Center Stottler Henke NYU Medical Center Harvard Medical School Yale University School of Medicine UC San Francisco School of Medicine ATA 2004 TATRC

PROBLEM Automated clinical results require users to shift through voluminous, un- summarized electronic data which are not formatted in a way to help the physician discover and/or see relationships No method to communicate to and from a medical consultant integrated medical data to facilitate diagnosis or management of a medical problem TATRC

Small Business Innovative Research Project – Cognitive Patient-Clinician Encounter Model. Mission Project Goals Testbed Integrate patient data to facilitate rapid identification of trends, interactions, and/or medically relevant relationships Develop and evaluate an operational prototype that demonstrates feasibility and utility Dept. of Defense clinical databases

Intelligent Patient Data Review Assistant Strategy (IPDRA) Patient data views Information- dense displays Web access Visual view authoring Integrate data across disparate sources to present clinically- meaningful subsets of medical data by problem, guideline or concept MultiTimeGraphs displays coordinated timelines and time-series graphs Web browser displays views generated by the IPDRA web application server Users specify view logic by using authoring tool to draw flow charts

Research Questions Utility of views View design principles Feasibility Do views decrease the time for patient data review by clinicians? Do views make it easier to detect trends and/or relationships? Do views decrease medical errors? What design guidelines and principles can help ensure effective views? Does the authoring tool enable practical and economical creation of potentially large libraries of views?

Cardiac View (ICDB)

Hypertension View (ICDB)

Diabetes View / summary (ICDB)

MultiTimeGraphs mockup

IPDRA Architecture View Generation View Authoring Authoring Tool (SimBionic) View logic specifications IPDRA Web Application Server or IPDRA View Test/Debug Application SimBionic Run-time System predicates: db utils actions: HTML, XML generation clinical database (ICDB, M2, CHCS II) IPDRA database (graph, SQL, HTML templates)

IPDRA View Authoring Tool

Preliminary View Design Findings Data review steps can be inferred from clinical practice guidelines to guide view design For complex problem views, physician can use authoring tool to visualize integrated data Views can show physical exam results, risk factors, related problems (ICD9), labs, pharmacy, procedures and radiology TATRC

IPDRA Status Designed and implemented prototype of IPDRA authoring and view generation software Prototyped 3 views (hypertension, cardiac overview, diabetes mellitus) using DoD’s Integrated Clinical Data Base (ICDB) as the test database Evaluation (and refinement) of views planned for fall 2004 IF WE GET ACCESS TO SANITIZED CLINICAL DATA TATRC

ISSUES Access To Sanitized Clinical Data Electronic Drug Label – Knowledge Source Electronic Guidelines – Knowledge Source Redefine “Drug Allergy Section” to “Allergy & Drug Intolerance and Ineffectiveness” Medical Confounders: “Yes/No” “Start Date/Stop Date” Edit and Annotation Features TATRC