Transcript 2003-Clinical Computing and the Repository

Clinical computing and
the repository
George Hripcsak
Jim Cimino
Pete Stetson
WebCIS
Data
sources
MED
Info
resources
Repository
CDW
Data mart
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
Theoretical
Practical
(Use of natural language
processing)
• Carol Friedman, Steve Johnson
Temporal representation and
reasoning
2003-09-06-08:11:34.243563
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
Substance
Chemical
Laboratory
Specimen
Anatomic
Substance
Plasma
Carbohydrate
Bioactive
Substance
Glucose
Plasma
Specimen
Event
Diagnostic
Procedure
Laboratory
Test
Plasma
Glucose
Test
Laboratory
Procedure
CHEM-7
Part of
Translations with the MED
Intravascular
Gentamicin
Tests
Summary
Reports
Injectable
Gentamicin
Serum
Gentamicin
Level
Gentamicin
Gentamicn
Sensitivity
Test
Decision
Rule
Gentamicin
Toxicity
Drug
Information
Expert
System
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
WebCIS User
MD Input
CDR
CDW
Billing
Office
MD
Review
Billing Compliance
Officer
To IDX