Duke Tissue Bank Informatics Review

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Duke Tissue BankInformatics Review

• Raj C. Dash, MD
• Assistant Professor of Pathology
• Chris Hubbard
• Director of Pathology Informatics
• Duke University Medical Center

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The Process
INFORMED CONSENT
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MAW3 - - - BIGR

• Do you need both?
• Duke-Ardais Informatics
• Central Hub BIGR
• Donor Site MAW3
• Some functionality redundant
• Double checks?
• Validation?
• Most functionality complementary
• Whats not in BIGR!!! (thats needed at a donor
  institution)

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MAW3 - - - BIGR

• MAW3
• Data entry at point of data collection
• Front-end SNOMED CT coding via templates
• Data storage in native format of institution
• Data queries
• Daily tracking
• QA
• Research
• Back-end coding in SNOMED CT for data retrieval
  based on flexible (not predetermined) criteria
• Link to patient (secure PHI)

• BIGR / ILTDS
• Data entry at point of data collection
• Data storage in predefined structure defined by
  Ardais
• Data queries
• Daily tracking
• QA
• Research
• Selection of tissues based on specific criteria
  e.g. institution, tumor, path verification,
  stage, grade, tumor type
• No link to patient (no PHI)

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MAW3 Data Storage
Tissue Banking Report (Hemi-hepatectomy July 2002)
Lab Data Report (CEA Mar 2002)
Lab Data Report (CEA June 2002)
Tissue Banking Report (Colectomy, Jan 2002)
Lab Data Report (CEA Oct 2002)
Outside Slide Review (Jan 2002)
Autopsy (Jan 2003)
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Medical Assistant on the World Wide Web (MAW3)

• A prototype for a centralized, multi-institutional
  medical database
• To fulfill the need for a centralized electronic
  medical record (EMR)
• Currently serves as Autopsy IS at Duke
• Security is critical
• SNOMED CT encodes data elements
• Within templates at point of data-entry
• On back-end using auto-encoder for free-text

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MAW3 Key Components

• Data entry
• Data storage
• Data reporting
• Very flexible multiple data paradigms
• Underlying Unifying factor SNOMED CT
• Common index or dictionary against which all data
  is encoded, stored, and referenced

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1st Step Security
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MAW3 Fields Captured in a Tissue Banking Report
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MAW3 Tissue Banking Details
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Pathology Data Privacy
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MAW3 Getting to the data that the donor
researchers need
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What about all that unstructured data in the EMR?
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Template-driven data entry
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Encoding Free TextusingSNOMED CT

• Link from source text to encoded representation
• Natural language processor
• Related term browser

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Encoding Free TextusingSNOMED CT

• Identify SNOMED CT code meaning
• Browse Hierarchy
• View canonical forms

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Current Status

• Over 17,000 tissue samples are available
• Spanning nearly 2500 consented patients
• MAW3 stores information related to
• patient consent,
• tissue sample banking (i.e. sample descriptions),
  
• inventory management (i.e. freezer locations,
  shipping, etc.), and
• clinical data annotations associated with the
  tissue banking event (i.e. clinic note and/or
  discharge summary, operative note, anatomic
  pathology report, and any relevant clinical lab
  data and radiographic reports).

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Current Development Platform

• The MAW3 application was initially developed
  using JavaScript running Active Server Pages on
  a Microsoft Windows Internet Information
  Server platform. Internet Explorer was
  selected as the required client browser.
• .NET transition utilizing web services is underway

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Future Development caTissue aware

• The current caTissue project is based on a
  web-based Java-coded platform. Although this
  platform differs from what MAW3 is based upon,
  the web services based architecture can be used
  for interprocess communication and provide a
  universal programming interface for seamless
  co-development.
• .NET web services will be made caBIG compliant

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Brief Project Plan

• The following tasks need to be accomplished
• 1. Utilize a caBIG compliant web-service model
  rather than Active Server Pages for
  implementation for all external interfaces (this
  is already a work-in-progress).
• 2. Transform currently tightly integrated
  processing into stand-alone components, modeled
  after the caTissue specification.
• 3. Demonstration / reference implementation
  utilizing cross queries between MAW3 and other
  caTissue adopter sites.
• 4. Documentation.

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Deliverables

• 1. A caTissue compliant informatics system
  (MAW3) interfaced to the grid and queryable
  across other caTissue adopter sites.
• 2. Open source web service disclosing how to
  use the caTissue API to map data objects and
  incorporate caTissue processes into an existing
  information system.
• 3. End-user documentation for users and
  administrators.
• 4. Technical documentation for developers.