Clinical computing and the repository George Hripcsak Jim Cimino Pete Stetson

WebCIS Data sources CDWData mart Repository Info resources MED

George Hripcsak MD – internal medicine MS – biostatistics Professor and Vice Chair

Repository 13 years > 2,000,000 patients > 5,000,000 narrative reports Data are useful only for the purpose for which they were collected Data collected without a purpose are useless

We are overflowing with information We just need to know how to tap it

Data mining We can use the information in the repository to discover knowledge about medicine and biology So close and yet so far

Range of projects TheoreticalPractical

(Use of natural language processing) Carol Friedman, Steve Johnson

Temporal representation and reasoning :11: My pneumonia was a while before the stroke

Case-based reasoning Match on a case level (gestalt) to overcome inaccuracies and missing data

Evaluation Use computer intensive techniques to figure out whether you have a significant data mining result

Summarization Give providers a quick summary of the important facts about a patient

Patient safety Detect (and someday prevent) medical errors using the repository

Jim Cimino MD – internal medicine Postdoctoral fellowship (MGH) Professor

Data Re-View and Re-Use View: look at data in their original form Re-View: alternate views of clinical info Use: original intent for collecting data Re-Use: any other use

Data Re-View For other users: PatCIS

Data Re-View For other users: PatCIS For other platforms: PalmCIS

Data Re-View For other users: PatCIS For other platforms: PalmCIS Problem-oriented views: QingCIS

Data Re-View For other users: PatCIS For other platforms: PalmCIS Problem-oriented views: QingCIS Using patient data to improve information retrieval: MendonCIS

Data Re-View For other users: PatCIS For other platforms: PalmCIS Problem-oriented views: QingCIS Using patient data to improve information retrieval: MendonCIS

Data Re-Use Examples of reuse: –Summary reports –Automated decision support –Context-specific information retrieval (infobuttons) Challenge: –Mapping concepts of raw data to concepts of reuse Solution: –Medical Entities Dictionary

MED Structure Medical Entity Plasma Glucose Test Laboratory Specimen Plasma Specimen Anatomic Substance Plasma Substance Sampled Part of Has Specimen Substance Measured Laboratory Procedure CHEM-7 Laboratory Test Event Diagnostic Procedure Substance Bioactive Substance Glucose Chemical Carbo- hydrate

Translations with the MED Gentamicin Injectable Gentamicin Gentamicn Sensitivity Test Serum Gentamicin Level Gentamicin Toxicity Etiology Measures Sensitivity Substance Measured Has ingredient is-a Intravascular Gentamicin Tests Summary Reports Decision Rule Expert System Drug Information

Research Issues Identifying information needs Developing automated solutions Conceptual mapping Terminology management

Pete Stetson Training: –MD – Internal Medicine –MA – Informatics (Columbia’s RMA) Positions: –Assistant Professor –Associate Program Director, IM Residency –Chair, Institutional Decision Support and Clinical Alerts Committee

Projects “Real solutions for real users.” Patient Safety: –Detection: Computerized algorithms to screen the electronic medical record for adverse events (CLIPS) –Prevention: Clinical Alerts Information Access – PalmCIS Clinical Communication –Understanding how physicians talk to eachother (Sign-outs) –Increasing the portability of patient information (PalmCIS) –Matching patients to providers (Patient-Provider Index) –Improving capture of narrative data (Hospitalist eNote)

Potential Student Projects Detection: –Using NLP to screen narrative data for evidence of adverse events Prevention: –Development and ownership of alerts (eg: K+ > 6.0) –User interface design for new PalmCIS platforms –Development of an algorithm to match patients to their primary providers (PPI) –User interface design, evaluation, real-time NLP, summarization views of clinical notes (Hospitalist eNote)

Hospitalist eNote Architecture CDR CDW MD Input WebCIS User Billing Compliance Officer MD Review Billing Office To IDX