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Librarians Connecting EHR Data

Margaret HendersonTompkins-McCaw Library

How it all started:

Practicum Project"To improve patient outcomes, proactively identify chronic and high-risk patients in this new environment, and effectively manage their financial performance, healthcare organizations must be able to provide analytics at the point of service and rely on historical and longitudinal data to manage patient populations.”

Health Research Institute (2012). Needles in a haystack: Seeking knowledge with clinical informatics. http://www.pwc.com/us/en/health-industries/publications/needles-in-a-haystack.jhtml.

The Biomedical Informatics Core (BIC) of the Center for Clinical and Translational Research (CCTR) supports research with various data 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 Research

Need to get patient IDs from i2b2. Needs IRB

approval to use this

data.

i2b2 Informatics 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-CT Various places to find these on the Internet for further study.Could be used to reinforce use of MeSH.

I2b2 Interface

Why Teach EHR Database Use?

Physicians must be dutiful.The ability to retrieve (from electronic databases and other resources), manage, and utilize biomedical information for solving problems and making decisions that are relevant to the care of individuals and populations.

Medical School Objectives Project. Report I. Learning Objectives for Medical Student Education: Guidelines for Medical Schools. AAMC. January 1998.

Role of Researcher1. Determine what data exist relative to a clinical question or formal 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: Medical Informatics and Population Health. AAMC. June 1998.

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative

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 they need 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 don't always document everything.• Billing codes aren't always the best

description of problem.• Too many variations of disease names.• Coding errors.• Narrative versus structured data.

Published Uses of EHR 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 doesn't have

Stuart, David.(2011) Facilitating Access to the Web of Data: a Guide for Librarians. Facet Publishing.

Look for Health Data Everywhere

Questions?