Paper presented at the 2012 MLA Quad Chapter meeting in Baltimore, MD, Oct. 13-16. Discusses i2b2 and how it could be used in medical education. And suggests other data if i2b2 not available in your hospital.
Practicum Project"To improve patient outcomes, proactively identifychronic and high-risk patients in this newenvironment, and effectively manage their financialperformance, healthcare organizations must be ableto provide analytics at the point of service and relyon historical and longitudinal data to managepatient populations.”Health Research Institute (2012). Needles in a haystack: Seeking knowledge with clinicalinformatics. http://www.pwc.com/us/en/health-industries/publications/needles-in-a-haystack.jhtml.
The Biomedical Informatics Core(BIC) of the Center for Clinical andTranslational Research (CCTR)supports research with variousdata services including: • REDCap for surveys • i2b2 has de-identified hospital EHR data • Clinical Data Warehouse (CDW) has full data from Hospital EHR • Health Facts, from Cerner, which contains de- identified data from 160 hospital using Cerner.
REDCap used for ResearchNeed to getpatient IDsfrom i2b2. Needs IRBapproval to use this data.
i2b2Informatics for Integrating Biology & the Bedside• Name of the software and an NIH-funded National Center for Biomedical Computing based at Partners HealthCare System in Boston, MA.• Software is open source and modular.• Developed for translational research.• Doesn’t require IRB approval to use at VCU• www.i2b2.org
Ontologies used in i2b2Librarians know ontologies!• International Classification of Diseases, Ninth Revision, Clinical Modification - ICD9-CM• Logical Observation Identifiers Names and Codes - LOINC• National Drug Code - NDC• Systematized Nomenclature of Medicine – Clinical Terms - SNOMED-CTVarious places to find these on the Internet for further study.Could be used to reinforce use of MeSH.
Why Teach EHR Database Use?Physicians must be dutiful.The ability to retrieve (from electronic databases and otherresources), manage, and utilize biomedical information forsolving problems and making decisions that are relevant tothe care of individuals and populations.Medical School Objectives Project. Report I. Learning Objectives for Medical StudentEducation: Guidelines for Medical Schools. AAMC. January 1998.
Role of Researcher1. Determine what data exist relative to a clinical question orformal hypothesis, demonstrating the following:a. The ability to use information technology to locate existing data sources.b. Knowledge of data sources …at one’s own institution…c. The ability to locate existing data sets not maintained at one’s own institution…Medical School Objectives Project. Report II. Contemporary Issues in Medicine: MedicalInformatics and Population Health. AAMC. June 1998.
Teaching Use of i2b2Give students scenarios to find:• Conditions of patients who are seen in clinic.• Demographics of patients with specific condition at this institution.• Which antibiotic resistant organisms that have been tested for in the hospital?Hopefully, seeing how hard it is to find what theyneed will encourage better input.
Future use of Data Warehouse• i2b2 provider field only lists doctor who admitted patient.• Work with BIC to develop at query that can have a name added and a profile of patients seen can be returned so Residents can conduct self-assessments.
Be Aware of EHR Data Problems• Clinicians dont always document everything.• Billing codes arent always the best description of problem.• Too many variations of disease names.• Coding errors.• Narrative versus structured data.
Open DataLibrary and information professionals:• need to become more involved with semantic web or users will reinvent wheel (i.e. ontologies)• have the interpersonal and subject specialization for reference/consultation that IT doesnt haveStuart, David.(2011) Facilitating Access to the Web of Data: a Guide forLibrarians. Facet Publishing.