vojtech huser, md phd laboratory for informatics development nih clinical center
DESCRIPTION
IDR Snapshot: Quantitative Assessment Methodology Evaluating Size and Comprehensiveness of an Integrated Data Repository. Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center. Research question. How can you evaluate an IDR? - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/1.jpg)
IDR Snapshot:Quantitative Assessment Methodology Evaluating Size and Comprehensiveness of an Integrated Data Repository
Vojtech Huser, MD PhDLaboratory for Informatics Development
NIH Clinical Center
![Page 2: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/2.jpg)
http://code.google.com/p/idrsnapshot/ 2
Research question
• How can you evaluate an IDR?• What makes a good IDR ? (for research)?
• IDR A(in 2007) vs. IDR A (in 2012)• IDR A vs. IDR B
• Other domains:• Compare countries based on GDP
– per person and (PPP) adjusted (purchasing power parity)
Vojtech Huser
![Page 3: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/3.jpg)
http://code.google.com/p/idrsnapshot/ 3Vojtech Huser
![Page 4: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/4.jpg)
http://code.google.com/p/idrsnapshot/ 4
Motivation/Assumptions
• Improving IDR– while acknowledging the a-priori limitations
• Ideal IDR for a researcher – versus existing data
• General measure on whole-IDR level– Not research project specific
• Build on IDR surveys from 2007, 2008 and 2010
Vojtech Huser
![Page 5: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/5.jpg)
http://code.google.com/p/idrsnapshot/ 5
Examples
• Academic medical center • with limited number of outpatient clinics
– University of Utah
• Integrated delivery network• Outpatient and inpatient records
– Partners Healthcare
• HMO• Health Plan component
– Kaiser Permanente South California
Vojtech Huser
![Page 6: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/6.jpg)
http://code.google.com/p/idrsnapshot/ 6
Target level (researcher-facing schema)
• Level 1: Epic Clarity (6000+ tables)
• Level 2: Clinical Data Repository (add data from GE Centricity (outpatient) (plus other sources)
• Level 3: subset of CDR for health plan members only
• Level 4: i2b2, or VDW, or OMOP, or XYZ (Deduce, Futher, BTRIS)
Vojtech Huser
![Page 7: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/7.jpg)
http://code.google.com/p/idrsnapshot/ 7
Beyond core data sources
• Diagnoses, Procedures, Labs• Cost data• ADT data (admission, ICU)• Visit data
• specialty of the encounter clinician
• Clinical document types• Biopsy, Well-child visit note, Bone mineral density report• Actual text on top of the document type
• PHR usage data
Vojtech Huser
![Page 8: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/8.jpg)
http://code.google.com/p/idrsnapshot/ 8
Less-common data sources
• Insurance history data• Over the counter drug data• Death certificate data
• Link to other sources
• Pharmacy dispensing data• Out of network claims data– Health Plan data
» Heath Assessment questionnaire data» Out of network pharmacy refills data
Vojtech Huser
![Page 9: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/9.jpg)
http://code.google.com/p/idrsnapshot/ 9
How can we measure all this?
Vojtech Huser
![Page 10: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/10.jpg)
http://code.google.com/p/idrsnapshot/ 10
What is a good measure?
• Amount of common type of data• Many IDRs contain such data
• diagnoses vs. tumor registry data• Count of unique patients
• Desired feature by researchers• Complete record (e.g., claims data, pharmacy refills)• comparative effectiveness research (CER)
• Expert consensus • Mixed approach
Vojtech Huser
![Page 11: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/11.jpg)
http://code.google.com/p/idrsnapshot/ 11
Measures
• Glasgow comma scale of 10 vs. 5• Apgar score of 7 vs. 5•
• Good measure:– Intuitive to interpret (count of patients)– facilitates monitoring and improvement– does not place any arbitrary value on individual measure
components – (e.g., value of 10 years of medication history vs. 10 years of weight/height
history).
Vojtech Huser
![Page 12: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/12.jpg)
http://code.google.com/p/idrsnapshot/ 12
IDR v1: Marshfield Clinic (case study)
(Event-DOB) + ‘3000-01-01’ Vojtech Huser
![Page 13: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/13.jpg)
http://code.google.com/p/idrsnapshot/ 13
IDR case study 1 (Marshfield Clinic)
• Table generation: took 2.5 hours• Size: 43 GB (includes some additional info)• Initial set of measures (G1-2, D1-4, L1-2)
Vojtech Huser
![Page 14: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/14.jpg)
http://code.google.com/p/idrsnapshot/ 14
“Consortia made easy(ier)”
Vojtech Huser
![Page 15: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/15.jpg)
http://code.google.com/p/idrsnapshot/ 15
Case study 2 (NIH IDR)
Vojtech Huser
![Page 16: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/16.jpg)
http://code.google.com/p/idrsnapshot/ 16
IDR snapshot (past and future)
• Initial set of measures defined (version 1)• Applied at single institution (MC)• Use at second institution (NIH, BTRIS)• Scripts running against i2b2 schema (version 2)• Third institution potentially using it (in IRB stage)• ------- “you are here” -------• Broader panel of experts developing (version 3)• Potentially a direct i2b2 plugin• Addition of other aspects
– Direct qualitative component– Institutional component
Vojtech Huser
![Page 17: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/17.jpg)
http://code.google.com/p/idrsnapshot/ 17Vojtech Huser
![Page 18: Vojtech Huser, MD PhD Laboratory for Informatics Development NIH Clinical Center](https://reader035.vdocument.in/reader035/viewer/2022062323/56815ab3550346895dc863db/html5/thumbnails/18.jpg)
http://code.google.com/p/idrsnapshot/ 18
Next steps
• Recruit IDR experts who would like to participate on the expert panel defining the measures (ver. 3)
• Recruit sites willing to use it and potentially participate on joint publication presenting the data
– as institution A, B, C, D…– IRB template available
• (a) data only IRB option or even (b) under IDR’s master IRB: fast-track mechanism
• If interested:• email: [email protected]• Stop by AMIA joint summit poster (March 2012)
IDR Snapshot: Quantitative Assessment Methodology Evaluating Size and Comprehensiveness of an Integrated Data Repository (Huser V)
• Thank you for your attention
Vojtech Huser