1. Clinical computing and the repository George Hripcsak Jim Cimino Pete Stetson

2. WebCIS Data sources CDWData mart Repository Info resources MED

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

4. 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

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

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

7. Range of projects TheoreticalPractical

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

9. Temporal representation and reasoning 2003-09-06-08:11:34.243563 My pneumonia was a while before the stroke

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

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

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

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

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

16. 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

17. Data Re-View For other users: PatCIS

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

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

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

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

24. 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

25. 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

26. 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

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

31. 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

32. 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)

33. 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)

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