Managing Clinical Data for Research - Epic & i2b2

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Managing Clinical Data for Research - Epic i2b2

• Keith Marsolo, PhD
• Division of Biomedical Informatics
• Cincinnati Childrens Hospital Medial Center
• October 28, 2009

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Background

• Cincinnati Childrens in midst of 3 year Epic
  rollout
• Go live dates
• First outpatient clinic September 2007
• Registration scheduling July 2008
• ED November 2009
• Inpatient January 2010

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Background (2)

• Dashboards for Outpatient Quality/Outcomes
  Measures Division of Clinical Effectiveness
  (HPCE)
• Each clinic/specialty focuses on 2-3 diseases and
  for each disease, defines 3-5 outcome measures
• Each measure would be displayed in an online
  chart/dashboard
• Charts would be refreshed on weekly/monthly/quarte
  rly basis
• Several hundred measures total
• Goal automation, ease of maintenance

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Background (3)

• Pre-Epic, HPCE manually computed many charts,
  pulling together multiple spreadsheets
• Original plan was to calculate the measures in
  Business Objects
• Brittle solution with many hardcoded literals
• Data tied up in application, difficult to use for
  other purposes
• Meta-data design, maintenance, performance an
  issue

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Solution

• Construct a parameter-based template datamart
  containing major content types
• Demographics
• Diagnoses Problem List
• Medications
• Orders
• Flowsheets
• Create a divisional mart for each clinic
• Additional logic to create disease-based
  registries
• Push data to Oracle, SQL Server depending on need

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Lessons Learned

• Data needs to look like a spreadsheet (but beware
  column limits)
• Make base tables as broad as possible
• End-user documentation is very important
• Partner with IS, HPCE to create a data wiki
• Contains operational definitions, business rules,
  screenshots of application, location in data mart

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i2b2 _at_ CCHMC

• Development
• Flat-file export
• Visit-based view
• Direct data entry
• Reporting
• Data model/ontology changes
• Age _at_ fact
• Context?

• Migration strategy (until features ready)
• Create Epic mart for reporting
• Map legacy data to Epic-like format
• Move into i2b2

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i2b2 Projects

• New grants
• Rheumatology
• Eosinophilic Esophagitis
• Liver Transplant redevelopment of existing
  database
• IBD

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Questions?

• For further information
• E-mail keith.marsolo_at_cchmc.org
• Web http//i2b2.cchmc.org