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Use and Re-Use of Clinical Data

Managing Data for Clinical Care Delivery and Research Getting More Bang For Your Buck Standards & Terminologies James J. Cimino, M.D. Columbia University Departments of Medical Informatics in Medicine. Use and Re-Use of Clinical Data. Primary use: report back to clinicians Secondary uses:

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Use and Re-Use of Clinical Data

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  1. Managing Data for Clinical Care Delivery and ResearchGetting More Bang For Your BuckStandards & TerminologiesJames J. Cimino, M.D.Columbia UniversityDepartments of Medical Informatics in Medicine

  2. Use and Re-Use of Clinical Data • Primary use: report back to clinicians • Secondary uses: • Patient care • Administrative • Research!

  3. $ Collecting Clinical Data for Research

  4. Messaging Standards Standards for Collecting Clinical Data Terminology Standards Data Model Standards $

  5. Study 2: Study 1: Nonstandard Terminologies Glucose Low White Count Tumor Class A Tumor Grade I Leukopenia Serum Glucose

  6. Hematology Findings Chemistry Test Results Tumor Grade Leukopenia Synonym: Low White Count Tumor Grade I Synonym: Tumor Class A Glucose Test Results Serum Glucose Plasma Glucose Standard Terminology Findings

  7. Terminology Standards • Coding vs. abstraction • Intended use vs. ability to re-use • Granularity of care vs. research concepts • Classifications • Pre-coordinated vs. postcoordinated (e.g., “Right Kidney” vs. “Right” + “Kidney”)

  8. High-Quality Terminology • Concept-oriented • Breadth and depth • Multi-grained • Multiple classifications • Maintenance process

  9. Case Studies • Data summarization

  10. Data Summarization • Data collected for patient care • Summaries over time • Multiple labs/institutions • Multiple user interfaces

  11. Outpatient Summary

  12. Inpatient Summary

  13. Case Studies • Data summarization • Research recruitment

  14. Research Recruitment • Data collected for patient care • Monitoring system detects patterns • Enrollment criteria can be logically defined

  15. Case Study: Patient Recruitment • Study of bisphosphonates in hypercalcemia • Patients treated before enrollment ineligible • Monitor checked for elevated calcium • Monitor sent message to research fellow • Enrollment was complete in two months

  16. Case Studies • Data summarization • Research recruitment

  17. Available Standards • Terminologies • ICD9-CM/ICD10/CM • SNOMED-RT/CT • LOINC (Baorto DM, Cimino JJ, Parvin CA, Kahn MG. Combining laboratory data sets from multiple institutions using the logical observation identifier names and codes (LOINC). International Journal of Medical Informatics. 1998;51(1):29-37. • Messaging • Health Level 7 (HL7) • Data Models • HL7 Reference Information Model (RIM)

  18. Implications for Clinical Research • Data collected for care can be reused for: • Research • Recruitment • Collaboration • Retrospective studies • Reduce duplication of effort • Longitudinal consistency • Sharable and pool-able data

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